Modified MCL Indentation Technique in Total Knee Arthroplasty With Severe Type II Valgus Deformity

Abstract Purpose A modified technique, medial indentation of the medial collateral ligament(MCL),was usedin total kneearthroplastywith severe type II valgus deformity. The study compared the clinical outcomes of the technique relative to conventional release group. Methods Consecutive patients with a Krackow type II valgus deformity of >20° who underwent a primary unilateral TKA between May 2008 and June 2017 were retrospectively studied. Modified MCL indentation technique was performed in 20 patients (group A), while the remaining 23 patients (group B) received routine release technique. Radiological parameters, such as the valgus angle (VA), and functional outcomes including the use of constraint implants, Knee Society Score(KSS), Knee Society function score(KSF), and height of the polyethylene insert, were compared between the two groups.Results 43 consecutive patients had a minimum 2-year follow-up. The preoperative VA was comparable between group A (23.5° ± 5.8°) and group B (21.3° ± 3.2°, P =0.134), so was the postoperative VA (1.1° ± 2.1° and 2.5° ± 3.0°, P =0.084 in groups A and B, respectively).The postoperative KSS and KSF showed marked improvement. While no statistically significant difference in preoperative or postoperative functional scores was found between two groups, group A had thinner PE insert (9.5 ± 1.1 mm vs. 12.9 ± 1.5 mm) and less use of constrained condylar inserts(15% vs. 69.6%). Conclusion Modified MCL indentation technique can achieve good outcomes in TKA with type II valgus deformity of >20°.

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Extended Distal Chevron Osteotomy

Foot & Ankle Orthopaedics ◽

10.1177/2473011417s000229 ◽

2017 ◽

Vol 2 (3) ◽

pp. 2473011417S0002 ◽

Cited By ~ 1

Author(s):

Chan Kang ◽

Jaehwang Song ◽

Donghun Kang ◽

Chang-Kyun Noh ◽

Ahn Ki Jun

Keyword(s):

Hallux Valgus ◽

Valgus Deformity ◽

Plantar Surface ◽

Chevron Osteotomy ◽

Hallux Valgus Deformity ◽

Radiographic Measurements ◽

Valgus Angle ◽

Group A ◽

Group B

Category: Bunion, Midfoot/Forefoot Introduction/Purpose: Numerous corrective osteotomies have been performed for surgical treatment of hallux valgus(HV). One of these procedures is distal chevron osteotomy, traditionally indicated for correction of mild to moderate HV. We proposed a new modification of the chevron osteotomy, extended distal chevron osteotomy, to provide even greater stability by extend the contact surface, as well as more effective and accurate correction of the angulation and rotational profile than conventional osteotomy. Methods: Between July 2013 and June 2014, the extended distal chevron osteotomy (DCO) was performed for the treatment of mild-to-moderate hallux valgus deformity in 63 feet (Group A) by the same surgeon. For the extended chevron, the first osteotomy was performed to cut 5-10 mm from the head of metatarsal to the proximal upper 1/3 of the neck. The second osteotomy was performed to cut 2.5~3.0 cm from the upper 1/3 of the neck toward horizontal plane of the plantar surface with an angle of 45~50 degree. Standard foot radiographic measurements, hallux valgus angle(HVA) and intermetatarsal angle(IMA), were recorded to compare with the values of 37 patients (Group B) who were treated by the traditional DCO technique. Results: Mean patient age was 45.3 (range 15–78) years, and 54 patients were available for follow-up at both one and two years postoperatively. Mean follow-up duration was 13.7 (range 4–26) months. In group A, mean HVA decreased from 32.3° preoperatively to 8.4° at final follow-up, while the angle of group B decreased from 32.4° to 11.4°. Mean IMA decreased from 15.1° preoperatively to 7.3° at final follow-up in group A, while the IMA decreased from 15.1° to 8.9° in group B. That way we could verify that the extended chevron osteotomy is more effective for stability and correcting of the angulation and rotational profile than traditional DCO. Conclusion: The extended chevron osteotomy achieved even greater stability and accurate correction of the deformity. Furthermore, it was more effective than traditional chevron osteotomy in terms of correction of the angulation and rotational profile.

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Endoscopic treatment of complex multiloculated hydrocephalus in children, steps that may help to decrease revision rate

Surgical Neurology International ◽

10.25259/sni_608_2021 ◽

2021 ◽

Vol 12 ◽

pp. 434

Author(s):

Sherif Elsayed Elkheshin ◽

Mohamed Bebars

Keyword(s):

Randomized Clinical Trials ◽

Standard Technique ◽

Ventricular System ◽

Redo Surgery ◽

Modified Technique ◽

Shunt Insertion ◽

Multiloculated Hydrocephalus ◽

Significant Difference ◽

Group A ◽

Group B

Background: Multiloculated hydrocephalus (MLH) is associated with increased intracranial pressure, with intraventricular septations, loculations, and isolation of parts of the ventricular system. Search continues for ideal surgical remedy capable of addressing the dimensions of the problem. We aimed to evaluate endoscopic septal fenestration and pellucidotomy combined with proximal shunt tube refashioning and further advancement into isolated loculations of the ventricular system containing choroid plexus. Methods: This retrospective study was conducted on 55 patients with symptomatic complex MLH who underwent endoscopic surgery. The collected data included patients’ age, gender, presenting manifestations, operative details, rate of remission of preoperative clinical and imaging signs, postoperative complications, redo surgery, or extra shunt hardware insertion. Patients were divided into Group A (underwent the standard technique of endoscopic multiseptal wide fenestration and final ventriculoperitoneal shunt insertion) and Group B (modified technique by adding extra side ports along the proximal shunt hardware). Results: Groups A and B included 25 and 30 patients, respectively. The percentage of patients showing improvement of almost all manifestations was higher in Group B compared to Group A, with no significant difference (P > 0.05). Group B had lower rate of complications (20% vs. 36%, P = 0.231), insertion of two shunts (16.7% vs. 20%, P = 1.000), and redo surgery (20% vs. 44%, P = 0.097). Conclusion: The modified technique was associated with better outcomes in terms of the use of single shunt and redo surgery. Launching randomized clinical trials to compare the two techniques are recommended to ascertain the efficacy of the modified technique.

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Surgical management of consecutive multisegment thoracic and lumbar tuberculosis: anterior-only approach vs. posterior-only approach.

10.21203/rs.3.rs-30950/v1 ◽

2020 ◽

Author(s):

Chen Zhao ◽

Lei Luo ◽

Liehua Liu ◽

Pei Li ◽

Lichuan Liang ◽

...

Keyword(s):

Loss Rate ◽

Deformity Correction ◽

Operation Time ◽

Clinical Results ◽

Surgery Group ◽

Significant Difference ◽

Functional Scores ◽

Group A ◽

Group B

Abstract Purpose: To compare the efficacy, safety, and technical characteristics of anterior-only and posterior-only approach surgeries for the treatment of consecutive multisegment thoracic and lumbar tuberculosis.Methods: Thirty-five patients who developed consecutive multisegment thoracic and lumbar tuberculosis from September 2012 to May 2016 were retrospectively analyzed. Group A was the posterior-only surgery group, and group B was the anterior-only surgery group. The data on the surgery, deformity correction, functional scores and complications were compared between the two groups.Results: There was no significant difference in the operation time or blood loss between groups A and B (P>0.05). The preoperative average Cobb angle of kyphosis in groups A and B were 36.2±15.2° and 27.9±7.7°, respectively, which significantly decreased to 4.9±11.8° and 10.4±5.6° after the operation, respectively (P<0.05). At the final follow-up, the angles were 7.1±10.5° and 14.6±8.0°, respectively. The correction angle and correction rate in group A (31.3±16.6°, 88.6±43.6%) were greater than those in group B (17.5±4.4°, 64.9±14.0%) (P<0.05). There was no significant difference in the loss angle between groups A and B (P>0.05), but the loss rate in group B (24.0±27.8%) was higher than that in group A (9.6±10.2%) (P<0.05). There was no significant difference in the incidence of complications between the two groups (P>0.05). Conclusion: The posterior-only and anterior-only approaches can lead to satisfactory clinical results in the treatment of patients with consecutive multisegment thoracic and lumbar tuberculosis. With posterior-only surgery, kyphosis can be better corrected, and the correction can be better maintained than with anterior-only surgery.

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Modified technique of end to side distal radio-cephalic shunt to overcome juxta-anastomotic stenosis

International Surgery Journal ◽

10.18203/2349-2902.isj20191060 ◽

2019 ◽

Vol 6 (4) ◽

pp. 1029

Author(s):

Haitham Atif ◽

Nehad Abdou Zaid ◽

Abd El-Mieniem Fareed Mohamed ◽

Yehia Mohamed Alkhateep

Keyword(s):

Patency Rate ◽

Intervention Group ◽

Anastomotic Stenosis ◽

Control Group ◽

P Value ◽

Modified Technique ◽

Significant Difference ◽

Group A ◽

Group B

Background: Juxta-anastomotic stenosis (JAS) is one of the predominant causes of arteriovenous fistula (AVF) failure, with the reported incidence of 65%, so that technical modification to alter the outflow vein configuration using the modified technique has been applied to prevent JAS and improve AVF maturation. The aim of the study to evaluate the modified technique of end-to-side distal radiocephalic A-V fistula regarding maturation, patency rate and the resultant juxta-anastomotic stenosis.Methods: This prospective study was carried out on 80 patients with end stage renal disease (ESRD) at vascular surgery unit in general surgery department, Menoufia university hospital that prepared for dialysis. 40 patients "intervention group" underwent the modified technique to establish a functioning radiocephalic fistula; the other group (40 patients, control group) had the conventional technique of end to side radiocephalic fistula. Follow up of patients was over 6 months regarding function, patency rate and development of juxta-anastomotic stenosis.Results: There was statistically significant difference between 2 groups regarding primary failure, patency and JAS. Primary failure was detected in 2 patients in group A and in 5 patients in group B (p-value is 0.04). Considering patency rate, after 3 months the ratio between group A and group B was 37:34 with significant P value of 0.02, and after 6 months the ratio was 35:33 with P value of 0.03. Regarding JAS, by the end of follow up period, 4 patients diagnosed with JAS in group A, while group B had 8 patients, with p value of 0.01.Conclusions: Modified technique of end to side anastomosis for primary radio-cephalic fistula creation has better patency rate and low incidence of JAS than conventional method.

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Early Closure of Growth Plate Due to Avascular Necrosis of the Femoral Head After Displaced Fracture of the Femoral Neck in Children

Nanoscience and Nanotechnology Letters ◽

10.1166/nnl.2020.3071 ◽

2020 ◽

Vol 12 (1) ◽

pp. 34-38

Author(s):

Fei Jiang ◽

Fei Qiao ◽

He Hu ◽

Limin Hou ◽

Dongpo Lv

Keyword(s):

Tissue Engineering ◽

Growth Plate ◽

Immunohistochemical Staining ◽

Type Ii ◽

Limb Deformity ◽

Significant Difference ◽

Group A ◽

Group B ◽

Growth Plate Injury ◽

The Right

To investigate the effect of autogenous tissue engineering of growth plates in the treatment of growth plate injury. The growth plate chondrocytes were cultured from the iliac crest of 3-week-old rabbits by mechanical shearing and type II collagenase digestion. After in vitro development, the chondrocytes were seeded on the allogeneic decalcified bone matrix. After being mixed in culture for one week, the chondrocytes were implanted into the defects of the medial growth plate at the upper end of the right tibia; the left tibia was not treated. Dynamic X-ray photography was used to measure the shortening and angular changes in the lower extremity. The H & E and collagen1 immunohistochemical staining were used to observe the in vivo outcomes of the growth plate. There was a slight deformity in the right tibia of group A and group B on the 2nd and 3rd week after the operation, however, there was no significant difference between the three groups (P > 0.05). After that, the right tibia of group B and group C had progressive severe shortening and angulation deformity, while the right tibia of group A had no significant increase in deformity. There was a significant difference between group A, B and C at each time point (P < 0.05). In group A, the normal growth plate structure from collagen-1 immunohistochemical staining was recovered, while in group B and C the damaged area was repaired by new bone tissue. Autogenous tissue engineering of the growth plate can effectively prevent limb deformity after acute growth plate injury. The implanted tissue engineered growth plate can produce a columnar structure; cells can express type II collagen.

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Elbow stability after simple elbow dislocation

Obere Extremität ◽

10.1007/s11678-020-00609-6 ◽

2020 ◽

Vol 15 (4) ◽

pp. 295-300

Author(s):

Jana Willin ◽

Jonas Schmalzl ◽

Lars Lehmann ◽

Christian Gerhardt

Keyword(s):

Elbow Dislocation ◽

Contralateral Side ◽

Nonoperative Treatment ◽

Elbow Injury ◽

Ultrasound Evaluation ◽

Significant Difference ◽

Functional Scores ◽

Group A ◽

Group B ◽

Ligamentous Repair

Abstract Aim We aimed to compare the clinical results after ligamentous elbow dislocation between patients treated nonoperatively (group A) and patients who underwent ligamentous repair (group B). Methods Hospital records were investigated for cases of ligamentous elbow dislocation from January 2015 to December 2018. In total, 30 patients were identified: nine with nonoperative treatment and 21 with surgical ligamentous repair. The range of motion (ROM) including arc of extension/flexion and pronation/supination, valgus instability, and posterolateral rotatory instability were evaluated. The scores of several outcome measures assessing elbow injury were evaluated. Sonographic examination was performed on all patients to evaluate translation under valgus and posterolateral rotatory stress. Results Overall, 14 patients with simple elbow dislocation (group A n = 5, 46.4 ± 19.3 years, follow-up [FU] 27 ± 12.4 months; group B n = 9, 57.3 ± 21.0 years, FU 36 ± 11.1 months; 4 female patients in each group) were evaluated. No significant difference was seen in extension/flexion and ext/flex-arc although there was a tendency to limited extension (p = 0.07) in group A. A significantly reduced supination (84 ± 15° vs. 77 ± 21°, p = 0.02) was observed regarding the contralateral side in group B. There was no significant difference in the evaluated scores between the groups. A significantly increased medial angulation during ultrasound evaluation was found in group B compared with the contralateral side. Conclusion There were no significant differences concerning ROM and functional scores between the nonoperative treatment and ligamentous repair groups. On clinical evaluation, a higher rate of sufficiently healed ligaments was found following surgical repair, although this was not reflected in the ultrasound evaluation.

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Fixation of orbicularis oculi muscle and orbital septum to pretarsal fascia and correction of blepharoptosis in construction of double eyelids

Journal of International Medical Research ◽

10.1177/0300060519870417 ◽

2020 ◽

Vol 48 (4) ◽

pp. 030006051987041

Author(s):

Ziying Dong ◽

Pingping Meng ◽

Lei Zhang ◽

Zhenyu Chen

Keyword(s):

Orbicularis Oculi Muscle ◽

Modified Technique ◽

Upper Eyelid ◽

Orbicularis Oculi ◽

Orbital Septum ◽

Significant Difference ◽

Degree Of Satisfaction ◽

Group A ◽

Group B ◽

Method Group

Objective This study was performed to evaluate a novel method of constructing double eyelids by fixation of the orbicularis oculi muscle and orbital septum to the pretarsal fascia and correction of blepharoptosis. Methods In total, 285 patients requesting aesthetic construction of double eyelids were divided into three groups: those treated by the modified method (Group A, n = 108), those treated by traditional construction of the upper eyelid (Group B, n = 85), and those treated by the Park method (Group C, n = 92). The patients were followed up for 3 to 12 months (average, 6 months). The surgical effects and degree of satisfaction were compared among the three groups. Results In Group A, the mean operative time was 1.0 ± 0.2 hours. The degree of satisfaction with the surgical effect was significantly different between Group A (95.37%) and Group B (87.06%). However, no significant difference in satisfaction was noted between Group A (95.37%) and Group C (91.30%) or between Group B (87.06%) and Group C (91.30%). Conclusions The modified technique is simple and effective for construction of double eyelids and correction of blepharoptosis. All patients were satisfied with the surgical and aesthetic effects.

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Surgical management of consecutive multisegment thoracic and lumbar tuberculosis: anterior-only approach vs. posterior-only approach.

10.21203/rs.3.rs-30950/v3 ◽

2020 ◽

Author(s):

Chen Zhao ◽

Lei Luo ◽

Liehua Liu ◽

Pei Li ◽

Lichuan Liang ◽

...

Keyword(s):

Loss Rate ◽

Deformity Correction ◽

Operation Time ◽

Clinical Results ◽

Surgery Group ◽

Significant Difference ◽

Functional Scores ◽

Group A ◽

Group B

Abstract Purpose: To compare the efficacy, safety, and technical characteristics of anterior-only and posterior-only approach surgeries for the treatment of consecutive multisegment thoracic and lumbar tuberculosis . Methods: Thirty-five patients who developed consecutive multisegment thoracic and lumbar tuberculosis from September 2012 to May 2016 were retrospectively analyzed. Group A was the posterior-only surgery group, and group B was the anterior-only surgery group. The data on the surgery, deformity correction, functional scores and complications were compared between the two groups. Results: There was no significant difference in the operation time or blood loss between groups A and B (P>0.05). The preoperative average Cobb angle of kyphosis in groups A and B were 36.2±15.2° and 27.9±7.7°, respectively, which significantly decreased to 4.9±11.8° and 10.4±5.6° after the operation, respectively (P<0.05). At the final follow-up, the angles were 7.1±10.5° and 14.6±8.0°, respectively. The correction angle and correction rate in group A (31.3±16.6°, 88.6±43.6%) were greater than those in group B (17.5±4.4°, 64.9±14.0%) (P<0.05). There was no significant difference in the loss angle between groups A and B (P>0.05), but the loss rate in group B (24.0±27.8%) was higher than that in group A (9.6±10.2%) (P<0.05). There was no significant difference in the incidence of complications between the two groups (P>0.05). Conclusion: The posterior-only and anterior-only approaches can lead to satisfactory clinical results in the treatment of patients with consecutive multisegment thoracic and lumbar tuberculosis. With posterior-only surgery, kyphosis can be better corrected, and the correction can be better maintained than with anterior-only surgery.

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Surgical management of consecutive multisegment thoracic and lumbar tuberculosis: anterior-only approach vs. posterior-only approach.

10.21203/rs.3.rs-30950/v2 ◽

2020 ◽

Author(s):

Chen Zhao ◽

Lei Luo ◽

Liehua Liu ◽

Pei Li ◽

Lichuan Liang ◽

...

Keyword(s):

Loss Rate ◽

Deformity Correction ◽

Operation Time ◽

Clinical Results ◽

Surgery Group ◽

Significant Difference ◽

Functional Scores ◽

Group A ◽

Group B

Abstract Purpose: To compare the efficacy, safety, and technical characteristics of anterior-only and posterior-only approach surgeries for the treatment of consecutive multisegment thoracic and lumbar tuberculosis . Methods: Thirty-five patients who developed consecutive multisegment thoracic and lumbar tuberculosis from September 2012 to May 2016 were retrospectively analyzed. Group A was the posterior-only surgery group, and group B was the anterior-only surgery group. The data on the surgery, deformity correction, functional scores and complications were compared between the two groups. Results: There was no significant difference in the operation time or blood loss between groups A and B (P>0.05). The preoperative average Cobb angle of kyphosis in groups A and B were 36.2±15.2° and 27.9±7.7°, respectively, which significantly decreased to 4.9±11.8° and 10.4±5.6° after the operation, respectively (P<0.05). At the final follow-up, the angles were 7.1±10.5° and 14.6±8.0°, respectively. The correction angle and correction rate in group A (31.3±16.6°, 88.6±43.6%) were greater than those in group B (17.5±4.4°, 64.9±14.0%) (P<0.05). There was no significant difference in the loss angle between groups A and B (P>0.05), but the loss rate in group B (24.0±27.8%) was higher than that in group A (9.6±10.2%) (P<0.05). There was no significant difference in the incidence of complications between the two groups (P>0.05). Conclusion: The posterior-only and anterior-only approaches can lead to satisfactory clinical results in the treatment of patients with consecutive multisegment thoracic and lumbar tuberculosis. With posterior-only surgery, kyphosis can be better corrected, and the correction can be better maintained than with anterior-only surgery.

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Operative Treatment of Isolated Split Greater Tuberosity Fracture (mutch type II) of Proximal Humerus with Modified PHILOS

10.21203/rs.2.24099/v1 ◽

2020 ◽

Author(s):

Gang Liu ◽

Baolu Zhang ◽

Xiaoguang Guo ◽

Shengqiang Zeng ◽

Kai Deng ◽

...

Keyword(s):

Shoulder Pain ◽

Shoulder Joint ◽

Rating Scale ◽

Proximal Humerus ◽

Type Ii ◽

Greater Tuberosity ◽

Functional Scores ◽

Group A ◽

Philos Plate ◽

Group B

Abstract Background: The greater tuberosity (GT) of the proximal humerus is the attachment point of the rotator cuff, which plays a role in the movement of the shoulder joint and is the core of the entire shoulder joint. Material and Methods: In our current study, 40 patients with isolated split GT fracture (mutch type II) from july 2017 to January 2019, which was typed by J.Mutch professor, Canada in 2014, were employed in the study. They were divided into two groups: the Modified PHILOS plate group (group A, n=20) and the Hollow Screw group (group B, n=20). The functional scores Constant‑Murley Score (CMS), American Shoulder and Elbow Surgeons (ASES), The University of California at Los Angeles shoulder rating scale (UCLA) and Visual Analogue Score (VAS) were recorded in both pre-op and post-op last follow. Results: Compared with last-follow, all shoulder scores (CMS, ASES, and UCLA) of group A was significantly better than group B (P<0.05), but VAS (P>0.05). Moreover, in post-op complications, there were one GT malunion and one shoulder pain in group A, but in group B, there were seven GT disappear (35%), three GT malunion and two patients with repeated shoulder pain. Conclusion: The Modified PHILOS plate in treating isolated split GT fracture (mutch type II) was found to be effective than hollow screw in the short term follow. However, there are still some post-op complications in both groups. Keywords : Isolated Split GT Fracture; Modified PHILOS Plate; Hollow Screw

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