scholarly journals Complex Foot Deformities Associated With Lower Limb Deformities: a New Therapeutic Strategy for Simultaneous Correction Using Ilizarov Procedure Together With Osteotomy and Soft Tissue Release

2020 ◽  
Author(s):  
Qin Boquan ◽  
Ren Yi ◽  
Gan Tingjiang ◽  
Liu Xi ◽  
Zhang Hui
Keyword(s):  
Soft Tissue ◽  
Lower Limb ◽  
Therapeutic Strategy ◽  
Case Series ◽  
Soft Tissue Balance ◽  
Soft Tissue Release ◽  
Osteotomy Site ◽  
Foot Deformities ◽  
Limb Deformities ◽  
The Mean

Abstract Aim The aim of the current study is to introduce a new therapeutic strategy for simultaneous correction of complex foot deformities (CFD) and the associated lower limb deformities (LLD) by using Ilizarov technique with osteotomy and soft tissue procedure and to report its early clinical results.Methods A retrospective review of CFD associated with LLD simultaneous correction utilizing Ilizarov procedure together with osteotomy and soft tissue balance from 2015 to 2019 was conducted.Results Thirty-two patients were followed for an average of 42.8 months. The mean external fixation time (EFT) was 6.5 months. The mean healing index (HI) was 1.7 months/cm. At the time of fixator removal, plantigrade feet were achieved in all patient, lower limb deformities were corrected. No recurrence of the deformities occurred. The mean LLRS AIM score was improved from 7.5 to 0.3. At the final follow-up, ASAMI-Paley score was graded as excellent in all limbs in the aspect of bone results, and functional results were defined as excellent in 29 (90.6%) limbs and good in 3 (9.4%) limbs. The mean Modified Dimeglio score was significantly improved from 7.2 to 1.3. No deep infection of the osteotomy site or nonunion was noted in the current study.Conclusion The therapeutic strategy by using Ilizarov procedure together with osteotomy and soft tissue balance is a safe and effective way to simultaneously correct CFD and LLD.Level of Evidence Level IV, retrospective case series

scholarly journals Complex foot deformities associated with lower limb deformities: a new therapeutic strategy for simultaneous correction using Ilizarov procedure together with osteotomy and soft tissue release

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Qin Boquan ◽  
Ren Yi ◽  
Gan Tingjiang ◽  
Liu Xi ◽  
Zhang Hui
Keyword(s):  
Soft Tissue ◽  
Lower Limb ◽  
Therapeutic Strategy ◽  
Case Series ◽  
Soft Tissue Balance ◽  
Soft Tissue Release ◽  
Osteotomy Site ◽  
Foot Deformities ◽  
Limb Deformities ◽  
The Mean

Abstract Aim The aim of the current study is to introduce a new therapeutic strategy for simultaneous correction of complex foot deformities (CFD) and the associated lower limb deformities (LLD) by using Ilizarov technique with osteotomy and soft tissue procedure and to report its early clinical results. Methods A retrospective review of CFD associated with LLD simultaneous correction utilizing the Ilizarov procedure together with osteotomy and soft tissue balance from 2015 to 2019 was conducted. Results Thirty-two patients were followed for an average of 42.8 months. The mean external fixation time (EFT) was 6.5 months. The mean healing index (HI) was 1.7 months/cm. At the time of fixator removal, plantigrade feet were achieved in all patient and lower limb deformities were corrected. No recurrence of the deformities occurred. The mean LLRS AIM score was improved from 7.5 to 0.3. At the final follow-up, the ASAMI-Paley score was graded as excellent in all limbs in the aspect of bone results, and functional results were defined as excellent in 29 (90.6%) limbs and good in 3 (9.4%) limbs. The mean modified Dimeglio score was significantly improved from 7.2 to 1.3. No deep infection of the osteotomy site or nonunion was noted in the current study. Conclusion The therapeutic strategy by using the Ilizarov procedure together with osteotomy and soft tissue balance is a safe and effective way to simultaneously correct CFD and LLD. Level of evidence Level IV, retrospective case series

scholarly journals Complex foot deformities associated with lower limb deformities: a new therapeutic strategy for simultaneous correction using Ilizarov procedure together with osteotomy and soft tissue release

2020 ◽  
Author(s):  
Qin Boquan ◽  
Ren Yi ◽  
Gan Tingjiang ◽  
Liu Xi ◽  
Zhang Hui
Keyword(s):  
Soft Tissue ◽  
Lower Limb ◽  
Therapeutic Strategy ◽  
Case Series ◽  
Soft Tissue Balance ◽  
Soft Tissue Release ◽  
Osteotomy Site ◽  
Foot Deformities ◽  
Limb Deformities ◽  
The Mean

Abstract Aim The aim of the current study is to introduce a new therapeutic strategy for simultaneous correction of complex foot deformities (CFD) and the associated lower limb deformities (LLD) by using Ilizarov technique with osteotomy and soft tissue procedure and to report its early clinical results.Methods A retrospective review of CFD associated with LLD simultaneous correction utilizing Ilizarov procedure together with osteotomy and soft tissue balance from 2015 to 2019 was conducted.Results Thirty-two patients were followed for an average of 42.8 months. The mean external fixation time (EFT) was 6.5 months. The mean healing index (HI) was 1.7 months/cm. At the time of fixator removal, plantigrade feet were achieved in all patient and lower limb deformities were corrected. No recurrence of the deformities occurred. The mean LLRS AIM score was improved from 7.5 to 0.3. At the final follow-up, ASAMI-Paley score was graded as excellent in all limbs in the aspect of bone results, and functional results were defined as excellent in 29 (90.6%) limbs and good in 3 (9.4%) limbs. The mean Modified Dimeglio score was significantly improved from 7.2 to 1.3. No deep infection of the osteotomy site or nonunion was noted in the current study.Conclusion The therapeutic strategy by using Ilizarov procedure together with osteotomy and soft tissue balance is a safe and effective way to simultaneously correct CFD and LLD.Level of Evidence Level IV, retrospective case series

Outcomes of closed reduction in patients with developmental dysplasia of the hip incorporating open psoas and adductor release and using short leg cast

2021 ◽  
Vol 15 (5) ◽  
pp. 1529-1532
Author(s):  
M. S. Abdulqader ◽  
L. J. Khorsheed ◽  
Hwaizi .
Keyword(s):  
Soft Tissue ◽  
Closed Reduction ◽  
Case Series ◽  
Developmental Dysplasia ◽  
Soft Tissue Release ◽  
Plaster Of Paris ◽  
Dysplasia Of The Hip ◽  
Mid Term Results ◽  
Tönnis Grade

Background and objectives: Closed reduction and short leg spica casting are the preferred treatment options for children with developmental dysplasia of the hip. This study aimed to show the efficacy behind a standardized closed reduction for managing patients with developmental dysplasia of the hip with concomitant soft tissue releases when indicated and using a short leg plaster of Paris cast to maintain reduction and reporting mid-term results. Methods: A case series of 95 hips in 84 children aged 6-18 months who had closed reduction, with five years follow up or until next operation, involved in this study. The protocol defines acceptable concentric reduction criteria and the indications for an associated soft tissue release. All the patients were immobilized in a short leg cast for three months. Multiple follow-up radiographs were taken to assess Tönnis grade, Severin grade, acetabular index, and osteonecrosis signs. Results: A total of 48 hips were Tönnis grade 3/4 hips. At one year, 15 reductions couldn’t be maintained, and these patients needed open reduction. Of these 15 failed reductions, 7 patients were Severin 1; others were Severin 2. Of the 80 successful closed reductions, 70 hips were Severin 1. Surgical management for residual dysplasia was offered for 8 hips. Osteonecrosis was seen in 23 hips but was transient in 20. Bilateral hip dislocations and most Tönnis 4 hips were more likely to fail. Two children had severe osteonecrosis. Conclusions: Closed reduction, with subsequent adductor and psoas releases, when indicated and using a short leg plaster of Paris cast for three months, brings about good mid-term results in children with developmental dysplasia of the hip aged 6-18 months. Keywords: Developmental dysplasia of the hip, closed hip reduction, open psoas release, short leg cast.

Orthopedic lower limb deformities in cerebral palsy: A case series

2020 ◽  
Vol 3 (4) ◽  
pp. 112
Author(s):  
RanaivondrambolaAndo Tatiana ◽  
RasolofoLala Rakotoanadahy ◽  
RaoninahFanantenana Hanitriniony Tatamo ◽  
SolofomalalaGaëtan Duval
Keyword(s):  
Cerebral Palsy ◽  
Lower Limb ◽  
Case Series ◽  
Limb Deformities

scholarly journals Peak Contact Stress of TMT-1 Joint after Sequential Correction of Hallux Valgus Using a Proximal Opening Wedge Metatarsal Osteotomy (PMO) and Distal Soft Tissue Procedure

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0030
Author(s):  
Jonathan C. Kraus ◽  
Michael Ziegele ◽  
Mei Wang; Brian C. Law ◽  
Glenn G. Shi
Keyword(s):  
Soft Tissue ◽  
Hallux Valgus ◽  
Contact Force ◽  
Contact Stress ◽  
Soft Tissue Release ◽  
Wedge Osteotomy ◽  
Metatarsal Osteotomy ◽  
Opening Wedge ◽  
Joint Contact ◽  
The Mean

Category: Bunion; Midfoot/Forefoot Introduction/Purpose: The proximal opening wedge metatarsal osteotomy (PMO) of the first metatarsal is a common procedure for the surgical treatment of moderate to severe hallux valgus. Although with a long track record of success, limited work has been dedicated to this procedures effect on the first tarsometatarsal (TMT-1) joint. The purpose of this study is to evaluate the changes in TMT-1 joint contact stress in the diseased and corrected state following an opening wedge osteotomy of the proximal metatarsal. In addition, the effect of a distal soft tissue release (DSTR) was evaluated as it related to both radiographic correction and TMT-1 joint contact stress. Methods: Seven fresh-frozen cadaveric below knee specimens (mean age: 69yrs) with hallux valgus deformities (mean HVA: 31.7+-12.0degs) were obtained for the study. The specimen was loaded up to 400N on an MTS servo hydraulic load frame with the tibia at 90-degree to the neutrally position foot. Joint contact characteristics at TMT-1 joint were measured with a Tekscan pressure sensor (Model6900, 1100psi). A standard proximal metatarsal osteotomy was performed. Various sized metal wedges (3, 5, 7 mm) with locking plates and screws were inserted in the osteotomy for correction. Following initial tests, a complete distal soft tissue release (DSTR) was performed and the specimens were retested. Additionally, dorsoplantar weight bearing (400N) radiograph was obtained for each condition to measure intermetatarsal (IMA) and hallux valgus (HVA) angles. The contact force, area, and peak contact stress were compared among groups using ANOVA and post-hoc multiple comparisons over the untreated (Dunnett test, p<0.05). Results: The mean HVA decreased with wedge size and DSTR, reached to significant level with 7mm+DSTR (24.1 degs). The mean contact force was 39.7+-32.6 N for untreated specimens. This increased sequentially with opening wedge size and reached statistical significance 7mm opening-wedge (119.6+-53.8 N, p=0.03) and 7mm-wedge+DSTR (116.7+-58.3 N, p=0.04). The peak contact stress followed a similar trend (Figure 1). The mean peak contact stress was 2.3+-1.5 MPa for the untreated specimens and increased incrementally with wedge size to 5.3+-2.6 MPa for 7mm-wedge only (p=0.03) and 5.2+-2.1 MPa for 7mm- wedge+DSTR (p=0.04). Contact area increased with corrections, but none reached significance. Conclusion: The results from this study demonstrate that with sequentially increasing opening wedge size, loading properties through the TMT-1 joint increase. Prior work has demonstrated that joint stresses of over 4.7 MPa can be chondrotoxic, a value which was surpassed with our peak contact stress with the 7mm wedge. This has significant implications for the long-term health of the TMT-1 joint following PMO, potentially predisposing patients to arthritic joint changes. The optimal degree of correction with PMO to limit chondrotoxicity is not known at this time, and is a direction for future work.

Hip Distraction Without a Perineal Post: A Prospective Study of 1000 Hip Arthroscopy Cases

2017 ◽  
Vol 46 (3) ◽  
pp. 632-641 ◽  
Author(s):  
Omer Mei-Dan ◽  
Matthew J. Kraeutler ◽  
Tigran Garabekyan ◽  
Jesse A. Goodrich ◽  
David A. Young
Keyword(s):  
Soft Tissue ◽  
Hip Arthroscopy ◽  
Case Series ◽  
Edge Angle ◽  
Center Edge ◽  
Hip Distraction ◽  
The Mean ◽  
Distraction Force ◽  
Lateral Center Edge Angle ◽  
Center Edge Angle

Background: Hip arthroscopy has traditionally been performed with a perineal post, resulting in various groin-related complications, including pudendal nerve neurapraxias, vaginal tears, and scrotal necrosis. Purpose: To assess the safety of a technique for hip distraction without the use of a perineal post. Study Design: Case series; Level of evidence, 4. Methods: We prospectively analyzed a consecutive cohort of 1000 hips presenting to a dedicated hip preservation clinic; all patients had hip pain and were subsequently treated with hip arthroscopy. Demographic variables, hip pathology, and lateral center edge angle were recorded for each case. In the operating room, the patient’s feet were placed in traction boots in a specifically designed distraction setup, and the operative table was placed in varying degrees of Trendelenburg. With this technique, enough resistance is created by gravity and friction between the patient’s body and the bed to allow for successful hip distraction without the need for a perineal post. In a subset of 309 hips (n = 281 patients), the degrees of Trendelenburg as well as the distraction force were analyzed. Results: The mean ± SD Trendelenburg angle used among the subset of 309 hips was 11° ± 2°. The mean initial distraction force necessary was 90 ± 28 lb, which decreased to 65 ± 24 lb by 30 minutes after traction initiation ( P < .0001). The most important variables in determining initial force for this cohort of patients were, in order of magnitude, sex ( P < .0001), weight ( P < .0001), and lateral center edge angle ( P < .01). No groin-related complications occurred among the entire cohort of patients, including soft tissue or nerve-related complications. The rate of deep venous thrombosis was 2 in 1000. Conclusion: The use of the Trendelenburg position and a specially designed distraction setup during hip arthroscopy allows for safe hip distraction without a perineal post, thereby eliminating groin-related soft tissue and nerve complications. Certain patient variables can be used to estimate the required distraction force and inclination angle with this method.

scholarly journals First Tarsometatarsal Joint Loading After Sequential Correction of Hallux Valgus Using a Proximal Opening Wedge Metatarsal Osteotomy and Distal Soft Tissue Procedure

2021 ◽  
Vol 6 (3) ◽  
pp. 247301142110269
Author(s):  
Jonathan Kraus ◽  
Michael J. Ziegele ◽  
Mei Wang ◽  
Brian Law
Keyword(s):  
Soft Tissue ◽  
Hallux Valgus ◽  
Contact Force ◽  
Contact Stress ◽  
Soft Tissue Release ◽  
Wedge Osteotomy ◽  
Opening Wedge ◽  
First Metatarsal ◽  
Joint Contact ◽  
The Mean

Background: The proximal opening wedge osteotomy (POWO) of the first metatarsal (TMT-1) is commonly performed in the operative treatment of hallux valgus. Limited work has been dedicated to study POWO’s effect on the TMT-1 joint, however. The purpose of this study is to evaluate the changes in TMT-1 joint contact stress following POWO of the first metatarsal. Methods: Five fresh-frozen cadaveric below-knee specimens (mean age: 73 years) with hallux valgus deformities (mean hallux valgus angle [HVA]: 37.4 ± 8.5 degrees) were studied. The specimens were loaded to 400 N on an MTS servohydraulic load frame. Joint contact characteristics at TMT-1 joint were measured with a Tekscan pressure sensor (Model 6900, 1100 psi; Tekscan Inc, Boston, MA) with various opening wedge sizes of 3, 5, and 7 mm both without and with a distal soft tissue release (DSTR). The contact force, area, and peak contact stress were compared among groups using analysis of variance and post hoc multiple comparisons over the untreated (Dunnett test, P < .05). Results: The mean contact force was 47.7 ± 33.5 N for untreated specimens. This increased sequentially with opening wedge size and reached statistical significance for 7-mm opening wedge (129.7 ± 62.3 N, P = .01) and 7-mm wedge + DSTR (134.8 ± 60.5 N, P = .008). The mean peak contact stress was 2.8 ± 1.3 MPa for the untreated specimens and increased incrementally with wedge size to 5.7 ± 3.0 MPa for 7-mm wedge only ( P = .03) and 5.6 ± 2.5 MPa for 7-mm wedge + DSTR ( P = .05). The contact area increased with corrections, but none reached significance. Conclusion: With increasing opening wedge size, loading of the TMT-1 joint increases. Joint stresses higher than 4.7 MPa have been shown to be chondrotoxic, potentially predisposing patients to arthritic joint changes following POWO. Level of Evidence: XXXXXX

Reverse Sural Fascio-Cutaneous Flap for Management of Patients with Distal Third of Lower Limb Soft Tissue Defects Referring to the Emergency Department Following Traumatic Events; A Review of 13 Cases

2021 ◽  
Author(s):  
Hosseinali Abdorrazzaghi ◽  
Babak Hajibarati ◽  
Fateme Mohammadi
Keyword(s):  
Emergency Department ◽  
Soft Tissue ◽  
Lower Limb ◽  
Daily Life ◽  
Case Series ◽  
Lower Limbs ◽  
Soft Tissue Defects ◽  
Daily Life Activities ◽  
Cutaneous Flap ◽  
Tissue Defects

Introduction: Soft tissue defects over the distal leg and/or heel are probable injuries that need a flap. Various coverage techniques have been described in this regard. It seems that applying Reverse Sural Fascio-Cutaneous Flap (RSFCF) for reconstructing soft tissue defects of lower limbs has superiorities over other techniques. Objective: We intend to present a case series with soft tissue defect over the distal third of lower limb, covered using RSFCF technique.   Methods: This is a case series and longitudinal study in which patients with crush injuries who referred to the emergency department (Sina hospital, Tehran, Iran) from 2013 until 2020 and were treated with RSFCF technique were included. The data were collected using patients’ charts, by interviewing the patients, and from hospital records. The patients' wounds were prepared, examined, and the surgery was done. Tendon and bone defects were repaired, and wounds were closed using reverse sural Fascio-Cutaneous Flap. Results: A total of 13 patients were eligible during the 6-year study period. Men were more commonly affected with no conclusive gender trend. The posterolateral part of the foot of the right leg was the most frequently injured part (53.8%). Only 1 patient had mentioned complications after surgery including mild congestion and abnormal sensory and motor examination. Patients were followed by the surgeons until 3 months after the operation and all of them had been able to resume their daily life activities by then. Conclusion: According to our findings, almost all of the patients (except one) had received their flaps without any complications. All the patients had been able to resume their daily life activities three months after the surgery. This may show that RSFCF, which can be quickly performed and does not need microsurgical skills, could be a suitable option for the coverage of distal third of lower limb soft tissue defects caused mainly by trauma

scholarly journals Vascular parkinsonism: a case series of 17 patients

2013 ◽  
Vol 71 (10) ◽  
pp. 757-762 ◽  
Author(s):  
Thiago Cardoso Vale ◽  
Paulo Caramelli ◽  
Francisco Cardoso
Keyword(s):  
Vascular Dementia ◽  
Lower Limb ◽  
Rating Scale ◽  
Freezing Of Gait ◽  
Case Series ◽  
Executive Dysfunction ◽  
Vascular Parkinsonism ◽  
Point Reduction ◽  
Disease Rating ◽  
The Mean

Objective To report the clinical and neuroimaging findings in a case series of vascular parkinsonism (VP). Methods Seventeen patients with VP were evaluated with motor, cognitive, and neuroimaging standardized tests and scales. Results All patients had arterial hypertension. Ten patients were male and the mean age of the whole sample was 75.8±10.1 years. The mean age of parkinsonism onset was 72.2±10.0 years. Common clinical features were urinary incontinence (88.2%), lower limb parkinsonism with freezing of gait and falls (82.3%), and pyramidal signs (76.4%). The mean Unified Parkinson’s Disease Rating Scale (UPDRS) and Hoehn-Yahr scores were 72.5±21.6 points and 3.3±0.9 points, respectively. Sixteen (94.1%) patients had freezing of gait and executive dysfunction. Twelve (70.5%) patients had probable vascular dementia. The mean dose of levodopa was 530.9 mg/day. Unresponsiveness to the drug was confirmed by a 6.9 mean point reduction in the UPDRS score after the “practically defined off” test. Conclusion This series provides a profile of VP with predominant lower-limb involvement, freezing of gait and falls, pyramidal signs, executive dysfunction, concomitant vascular dementia, and poor levodopa response.

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