scholarly journals A Modified Posterolateral Approach for the Treatment of Posterior Malleolar Fracture

2020 ◽  
Author(s):  
Fang Wenlai ◽  
Kong jianzhong ◽  
Chen mochuan
Keyword(s):  
Short Form ◽  
Operation Time ◽  
Healing Time ◽  
Posterolateral Approach ◽  
Flexor Hallucis Longus ◽  
Malleolar Fracture ◽  
Posterior Malleolar Fracture ◽  
Sf 36 ◽  
The Mean

Abstract Background: To observe the clinical effect of a modified posterolateral approach internal fixation in the treatment of posterior malleolar fracture. Method: From January 2015 to October 2018, 30 cases involving lateral and posterior malleolar fracture patient data were treated in our department. we observed operation time, fracture healing time and postoperative complications. At the time of the last follow-up, we evaluated ankle joint function by the American Orthopedic Foot Ankle Society (AOFAS) ankle- hindfoot scale, the Short Form-36 (SF-36) outcome Tools and the American Academy of Orthopaedic Surgeons (AAOS) Foot and Ankle Questionnaire. Result: In this group of 30 patients, the operation time of the patients was 80-120min (median 90min). The 25 patients were followed up for more than 1 year. 3 ~ 5 months after the operation, all the patients had bony healing. 3 cases with superficial wound infection. No other complication was found. The mean AOFAS scores at the postoperative 6-month, 12-month, and final follow-up were 78.4 (range, 72–90), 89.4 (range, 80–96), and 90.8 (range, 84–96), respectively. The mean SF-36 scores at the postoperative 12-month and final follow-up were 82.4 (range, 77.6–90.6) and 84.6 (range, 77.8–92.6), the mean AAOS scores at the postoperative 12-month and final follow-up were87.8 (range, 79–95), 90.6 (range, 82–96). Conclusion: Modified posterolateral approach avoided stripping the muscular origins of flexor hallucis longus, reduced the adhesion, and can fix the lateral and posterior malleolar fracture in the same incision, is worth popularizing in clinical.

Arthroscopic Microfracture for Osteochondral Lesions of the Talus: Functional Outcomes at a Mean of 6.7 Years in 165 Consecutive Ankles

2019 ◽  
Vol 48 (1) ◽  
pp. 153-158 ◽  
Author(s):  
Seung-Won Choi ◽  
Gun-Woo Lee ◽  
Keun-Bae Lee
Keyword(s):  
Functional Outcomes ◽  
Short Form ◽  
Arthroscopic Surgery ◽  
Case Series ◽  
Osteochondral Lesions ◽  
Study Cohort ◽  
Arthroscopic Microfracture ◽  
Sf 36 ◽  
The Mean

Background: Arthroscopic microfracture for osteochondral lesions of the talus (OLT) has shown good functional outcomes. However, some studies have reported that functional outcomes deteriorate over time after surgery. Purpose: To use various functional scoring systems to evaluate functional outcomes in a large sample of patients with OLT treated by arthroscopic microfracture. Study Design: Case series; Level of evidence, 4. Methods: The study cohort consisted of 165 ankles (156 patients) that underwent arthroscopic microfracture for small to mid-sized OLT. The mean lesion size was 73 mm2 (range, 17-146 mm2), and the mean follow-up period was 6.7 years (range, 2.0-13.6 years). The Foot and Ankle Outcome Score (FAOS), American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot scale, visual analog scale (VAS) for pain, and 36-Item Short Form Health Survey (SF-36) were used to compare the functional outcomes between the preoperative and final follow-up assessments. Results: The mean FAOS significantly improved in regard to all subscores ( P < .001). The AOFAS ankle-hindfoot scale showed an improvement from 71.0 points (range, 47.0-84.0) preoperatively to 89.5 points (range, 63.0-100) at the final follow-up ( P < .001). The VAS score showed an improvement from 6.2 points (range, 4.0-9.0) preoperatively to 1.7 points (range, 0-6.0) at the final follow-up ( P < .001). The mean SF-36 score improved from 62.4 points (range, 27.4-76.6) preoperatively to 76.2 points (range, 42.1-98.0) at the final follow-up ( P < .001). Among 165 ankles, 22 ankles (13.3%) underwent repeat arthroscopic surgery for evaluation of repaired cartilage status. Conclusion: Arthroscopic microfracture showed good functional outcomes and improved quality of life with maintenance of satisfactory outcomes at a mean follow-up of 6.7 years. Therefore, arthroscopic microfracture seems to be reliable as a first-line treatment for OLT at an intermediate-term follow-up.

Prospective study of disc repair with allogeneic chondrocytes Presented at the 2012 Joint Spine Section Meeting

2013 ◽  
Vol 18 (1) ◽  
pp. 85-95 ◽  
Author(s):  
Domagoj Coric ◽  
Kenneth Pettine ◽  
Andrew Sumich ◽  
Margaret O. Boltes
Keyword(s):  
Rating Scale ◽  
Short Form ◽  
Total Disc Replacement ◽  
Controlled Study ◽  
Lumbar Spondylosis ◽  
Cell Based Therapy ◽  
Sf 36 ◽  
Disc Repair ◽  
The Mean

Object The purpose of the study was to evaluate the safety and initial efficacy of NuQu allogeneic juvenile chondrocytes delivered percutaneously for the treatment of lumbar spondylosis with mechanical low-back pain (LBP). NuQu is a cell-based biological therapy for disc repair. The authors report the results at 12 months of the NuQu Phase I investigational new drug (IND) single-arm, prospective feasibility study for the treatment of LBP for single-level degenerative disc disease (Pfirrman Grades III–IV) at L3–S1. Methods Fifteen patients (6 women and 9 men) were enrolled at 2 sites. Institutional review board approval was obtained, and all patients signed a study-specific informed consent. All patients have completed a minimum of 1 year of follow-up. Patients were evaluated pretreatment and at 1, 3, 6, and 12 months posttreatment. Evaluations included routine neurological examinations, serum liver and renal function studies, MRI, the Oswestry Disability Index (ODI), the Numerical Rating Scale (NRS), and the 36-Item Short Form Health Survey (SF-36). Results Fifteen patients were treated with a single percutaneous delivery of NuQu juvenile chondrocytes. The mean patient age was 40 years (19–47 years). Each treatment consisted of 1–2 ml (mean injection 1.3 ml) of juvenile chondrocytes (approximately 107 chondrocyte cells/ml) with fibrin carrier. The mean peak pressure during treatment was 87.6 psi. The treatment time ranged from 5 to 33 seconds. The mean ODI (baseline 53.3, 12-month 20.3; p < 0.0001), NRS (baseline 5.7, 12-month 3.1; p = 0.0025), and SF-36 physical component summary (baseline 35.3, 12-month 46.9; p = 0.0002) scores all improved significantly from baseline. At the 6-month follow-up, 13 patients underwent MRI (one patient underwent CT imaging and another refused imaging). Ten (77%) of these 13 patients exhibited improvements on MRI. Three of these patients showed improvement in disc contour or height. High-intensity zones (HIZs), consistent with posterior anular tears, were present at baseline in 9 patients. Of these, the HIZ was either absent or improved in 8 patients (89%) by 6 months. The HIZ was improved in the ninth patient at 3 months, with no further MRI follow-up. Of the 10 patients who exhibited radiological improvement at 6 months, findings continued to improve or were sustained in 8 patients at the 12-month follow-up. No patient experienced neurological deterioration. There were no disc infections, and there were no serious or unexpected adverse events. Three patients (20%) underwent total disc replacement by the 12-month follow-up due to persistent, but not worse than baseline, LBP. Conclusions This is a 12-month report of the clinical and radiographic results from a US IND study of cell-based therapy (juvenile chondrocytes) in the treatment of lumbar spondylosis with mechanical LBP. The results of this prospective cohort are promising and warrant further investigation with a prospective, randomized, double-blinded, placebo-controlled study design. Clinical trial registration no.: BB-IND 13985.

Thumb carpometacarpal osteoarthritis: trapeziectomy versus pyrocarbon interposition implant (Pi2) arthroplasty

2012 ◽  
Vol 37 (7) ◽  
pp. 617-620 ◽  
Author(s):  
M. Maru ◽  
P. Jettoo ◽  
L. Tourret ◽  
M. Jones ◽  
L. Irwin
Keyword(s):  
Short Form ◽  
Point Scale ◽  
High Complication Rate ◽  
Short Term ◽  
Early Results ◽  
Sf 36 ◽  
The Mean ◽  
Thumb Carpometacarpal ◽  
Carpometacarpal Osteoarthritis

We retrospectively compared the short-term outcomes of 18 thumbs that had a trapeziectomy and 18 that had a pyrocarbon interposition implant (Pi2) arthroplasty in 33 patients. We measured the Disability of the Arm, Shoulder, and Hand (DASH) and Short Form 36 (SF-36) scores at a mean of 20 months. Pain severity was assessed using a visual analogue scale (VAS), and level of patient satisfaction was assessed using a 5-point scale. The mean DASH scores at follow up were 27 for those that had a trapeziectomy and 35 for those that had a Pi2 arthroplasty ( p = 0.001). There was no difference in the VAS for pain, SF-36 scores, or other parameters assessed. Six out of 18 (33%) thumbs in the Pi2 group had multiple operations, usually for dislocation or subluxation of the implant. The early results of Pi2 arthroplasty show a high complication rate compared with trapeziectomy and no identifiable benefit.

Chopart amputation with tibiotalocalcaneal arthrodesis and free flap reconstruction for severe foot crush injury

2018 ◽  
Vol 100-B (10) ◽  
pp. 1359-1363 ◽  
Author(s):  
Y-C. Chiu ◽  
T-C. Chung ◽  
C-H. Wu ◽  
K-L. Tsai ◽  
I-M Jou ◽  
...  
Keyword(s):  
Short Form ◽  
Treatment Method ◽  
Crush Injury ◽  
Soft Tissue Coverage ◽  
Walking Ability ◽  
Sf 36 ◽  
Crush Injuries ◽  
The Mean ◽  
One Year

AimsThis study reports the outcomes of a technique of soft-tissue coverage and Chopart amputation for severe crush injuries of the forefoot.Patients and MethodsBetween January 2012 to December 2016, 12 patients (nine male; three female, mean age 38.58 years; 26 to 55) with severe foot crush injury underwent treatment in our institute. All patients were followed-up for at least one year. Their medical records, imaging, visual analogue scale score, walking ability, complications, and functional outcomes one year postoperatively based on the American Orthopedic Foot and Ankle Society (AOFAS) and 36-Item Short-Form Health Survey (SF-36) scores were reviewed.ResultsThe mean length of follow-up was 18.6 months (13 to 28). Two patients had a local infection, flap necrosis was seen in one patient, and one patient experienced a skin graft wound healing delay. Of the 12 patients, one had persistent infection and eventually required below-knee amputation, but pain-free walking was achieved in all the other patients. The mean one-year postoperative AOFAS and SF-36 scores were 75.6 (68 to 80) and 82 (74 to 88), respectively.ConclusionAlthough our sample size was small, we believe that this treatment method may be a valuable alternative for treating severe foot crush injuries. Cite this article: Bone Joint J 2018;100-B:1359–63.

scholarly journals The Feasibility of a Modified Exclusive Endoscopic Transcanal Transpromontorial Approach for Vestibular Schwannomas

2018 ◽  
Vol 80 (01) ◽  
pp. 082-087 ◽  
Author(s):  
In Moon ◽  
Dongchul Cha ◽  
Sung-Il Nam ◽  
Hyun-Jin Lee ◽  
Jae Choi
Keyword(s):  
Short Form ◽  
Tumor Resection ◽  
Internal Auditory Canal ◽  
Operation Time ◽  
Vestibular Schwannomas ◽  
Profound Hearing Loss ◽  
Hospitalization Period ◽  
The Mean

Objective We evaluated the feasibility of an exclusive endoscopic transcanal transpromontorial approach (EETTA) for the treatment of small vestibular schwannomas (VSs) limited to the internal auditory canal (IAC), and introduced a modification without external auditory canal closure. Methods Between June 2016 and June 2017, seven patients with VS underwent surgery using a modified EETTA. Treatment outcomes, including efficacy of tumor resection, preservation of function, operation time, and quality of life (QOL), were evaluated. Results The patients preoperatively exhibited Koos Grade I/II tumors and severe-to-profound hearing loss. Gross total resection was accomplished in all cases. There were no major complications, and all patients exhibited normal facial nerve function immediately after surgery. The mean follow-up period was 12.9 months. The operation time (average 196.3 ± 64.9 minutes) and hospitalization period (average 7.4 ± 1.0 days) were favorable. Short Form-36 scores for QOL showed unremarkable results compared with previous reports. Conclusions The modified EETTA was effective in the removal of VSs in the IAC. It can be an alternative surgical option for small VSs.

Combined Posteromedial and Posterolateral Approaches for 2-Part Posterior Malleolar Fracture Fixation

2020 ◽  
Vol 41 (10) ◽  
pp. 1234-1239 ◽  
Author(s):  
Yunfeng Yang ◽  
Wenbao He ◽  
Haichao Zhou ◽  
Jiang Xia ◽  
Bing Li ◽  
...  
Keyword(s):  
Case Series ◽  
Good Alternative ◽  
Retrospective Case ◽  
Malleolar Fracture ◽  
Level Of Evidence ◽  
Malleolar Fractures ◽  
Posterior Malleolar Fracture ◽  
The Mean ◽  
Mean Time

Background: This study investigated the clinical efficacy of combined posteromedial and posterolateral approaches for repair of 2-part posterior malleolar fractures associated with medial and lateral malleolar fractures. Methods: This case series report included 27 Weber B with Haraguchi type II patients with medial and lateral malleolar fractures combined with 2-part posterior malleolar fractures. Patients were treated with open reduction and internal fixation through a combination of posteromedial and posterolateral approaches from January 2015 to January 2018. There were 11 males and 16 females, with an average age of 61.5 years (range, 53-67 years). The procedures were performed on prone patients under spinal anesthesia. The medial, lateral, and posterior malleolar fractures were exposed through posteromedial and posterolateral approaches performed at the same time. The lateral malleolar fracture was fixed using a plate, the medial malleolar fracture was fixed using screws, and the posterior malleolar fracture was fixed using a plate or cannulated screws according to the size of the fragments. We performed follow-up on 22 patients for an average of 30 months (range, 18-48 months). Results: Primary healing of the incisions was achieved in all cases, and no infection was found. The mean time of bone union was 12.5 weeks (range, 10-15 weeks). The mean time from the operation to full weightbearing was 13 weeks (range, 11-16 weeks). We used the American Orthopaedic Foot & Ankle Society (AOFAS) Ankle-Hindfoot Scale to score patient outcomes; the mean score was 85.4 (range, 80-92) at the final follow-up. No significant pain was found at the final follow-up. Conclusion: This study showed that satisfactory outcomes were achieved with combined posteromedial and posterolateral approaches. Therefore, we believe this approach was a good alternative strategy to repair 2-part posterior malleolar fractures associated with medial and lateral malleolar fractures. Level of Evidence: Level IV, retrospective case series.

scholarly journals Arthroscopic lift, drill, fill and fix (LDFF) is an effective treatment option for primary talar osteochondral defects

2019 ◽  
Vol 28 (1) ◽  
pp. 141-147 ◽  
Author(s):  
Kaj T. A. Lambers ◽  
Jari Dahmen ◽  
Mikel L. Reilingh ◽  
Christiaan J. A. van Bergen ◽  
Sjoerd A. S. Stufkens ◽  
...  
Keyword(s):  
Rating Scale ◽  
Short Form ◽  
Case Series ◽  
Ct Scans ◽  
Osteochondral Defects ◽  
Effective Treatment Option ◽  
Level Of Evidence ◽  
Sf 36 ◽  
The Mean

Abstract Purpose The purpose of this study was to describe the mid-term clinical and radiological results of a novel arthroscopic fixation technique for primary osteochondral defects (OCD) of the talus, named the lift, drill, fill and fix (LDFF) technique. Methods Twenty-seven ankles (25 patients) underwent an arthroscopic LDFF procedure for primary fixable talar OCDs. The mean follow-up was 27 months (SD 5). Pre- and post-operative clinical assessments were prospectively performed by measuring the Numeric Rating Scale (NRS) of pain in/at rest, walking and when running. Additionally, the Foot and Ankle Outcome Score (FAOS) and the Short Form-36 (SF-36) were used to assess clinical outcome. The patients were radiologically assessed by means of computed tomography (CT) scans pre-operatively and 1 year post-operatively. Results The mean NRS during running significantly improved from 7.8 pre-operatively to 2.9 post-operatively (p = 0.006), the NRS during walking from 5.7 to 2.0 (p < 0.001) and the NRS in rest from 2.3 to 1.2 (p = 0.015). The median FAOS at final follow-up was 86 for pain, 63 for other symptoms, 95 for activities of daily living, 70 for sport and 53 for quality of life. A pre- and post-operative score comparison was available for 16 patients, and improved significantly in most subscores. The SF-36 physical component scale significantly improved from 42.9 to 50.1. Of the CT scans at 1 year after surgery, 81% showed a flush subchondral bone plate and 92% of OCDs showed union. Conclusion Arthroscopic LDFF of a fixable primary talar OCD results in excellent improvement of clinical outcomes. The radiological follow-up confirms that fusion of the fragment is feasible in 92%. This technique could be regarded as the new gold standard for the orthopedic surgeon comfortable with arthroscopic procedures. Level of evidence Prospective case series, therapeutic level IV.

scholarly journals Endoscopic minimally invasive transforaminal interbody fusion without general anesthesia: initial clinical experience with 1-year follow-up

2016 ◽  
Vol 40 (2) ◽  
pp. E13 ◽  
Author(s):  
Michael Y. Wang ◽  
Jay Grossman
Keyword(s):  
Minimally Invasive ◽  
General Anesthesia ◽  
Open Surgery ◽  
Interbody Fusion ◽  
Short Form ◽  
Case Series ◽  
Sf 36 ◽  
Clinical Series ◽  
The Mean

OBJECTIVE One of the principal goals of minimally invasive surgery has been to speed postoperative recovery. In this case series, the authors used an endoscopic technique for interbody fusion combined with percutaneous screw fixation to obviate the need for general anesthesia. METHODS The first 10 consecutive patients treated with a minimum of 1 year's follow-up were included in this series. The patients were all treated using endoscopic access through Kambin's triangle to allow for neural decompression, discectomy, endplate preparation, and interbody fusion. This was followed by percutaneous pedicle screw and connecting rod placement using liposomal bupivacaine for long-acting analgesia. No narcotics or regional anesthetics were used during surgery. RESULTS All patients underwent the procedure successfully without conversion to open surgery. The patients' average age was 62.2 ± 9.0 years (range 52–78 years). All patients had severe disc height collapse, and 60% had a Grade I spondylolisthesis. The mean operative time was 113.5 ± 6.3 minutes (range 105–120 minutes), and blood loss was 65 ± 38 ml (range 30–190 ml). The mean length of hospital stay was 1.4 ± 1.3 nights. There were no intraoperative or postoperative complications. Comparison of preoperative and final clinical metrics demonstrated that the Oswestry Disability Index improved from 42 ± 11.8 to 13.3 ± 15.1; the 36-Item Short Form Health Survey (SF-36) Physical Component Summary improved from 47.6 ± 3.8 to 49.7 ± 5.4; the SF-36 Mental Component Summary decreased from 47 ± 3.9 to 46.7 ± 3.4; and the EQ-5D improved from 10.7 ± 9.5 to 14.2 ± 1.6. There were no cases of nonunion identified radiographically on follow-up imaging. CONCLUSIONS Endoscopic fusion under conscious sedation may represent a feasible alternative to traditional lumbar spine fusion in select patients. Larger clinical series are necessary to validate that clinical improvements are sustained and that arthrodesis rates are successful when compared with open surgery. This initial experience demonstrates the possible utility of this procedure.

Pilonidal Sinus: How to Choose Between Excision and Open Granulation Versus Excision and Primary Closure?

Swiss Surgery ◽  
2002 ◽  
Vol 8 (6) ◽  
pp. 255-258 ◽  
Author(s):  
Perruchoud ◽  
Vuilleumier ◽  
Givel
Keyword(s):  
Hospital Stay ◽  
Pilonidal Sinus ◽  
Primary Closure ◽  
Average Length ◽  
Length Of Hospital Stay ◽  
Healing Time ◽  
Incision And Drainage ◽  
The Mean ◽  
Primary Healing

Aims: The purpose of this study was to evaluate excision and open granulation versus excision and primary closure as treatments for pilonidal sinus. Subjects and methods: We evaluated a group of 141 patients operated on for a pilonidal sinus between 1991 and 1995. Ninety patients were treated by excision and open granulation, 34 patients by excision and primary closure and 17 patients by incision and drainage, as a unique treatment of an infected pilonidal sinus. Results: The first group, receiving treatment of excision and open granulation, experienced the following outcomes: average length of hospital stay, four days; average healing time; 72 days; average number of post-operative ambulatory visits, 40; average off-work delay, 38 days; and average follow-up time, 43 months. There were five recurrences (6%) in this group during the follow-up period. For the second group treated by excision and primary closure, the corresponding outcome measurements were as follows: average length of hospital stay, four days; average healing time, 23 days; primary healing failure rate, 9%; average number of post-operative ambulatory visits, 6; average off-work delay, 21 days. The average follow-up time was 34 months, and two recurrences (6%) were observed during the follow-up period. In the third group, seventeen patients benefited from an incision and drainage as unique treatment. The mean follow-up was 37 months. Five recurrences (29%) were noticed, requiring a new operation in all the cases. Discussion and conclusion: This series of 141 patients is too limited to permit final conclusions to be drawn concerning significant advantages of one form of treatment compared to the other. Nevertheless, primary closure offers the advantages of quicker healing time, fewer post-operative visits and shorter time off work. When a primary closure can be carried out, it should be routinely considered for socio-economical and comfort reasons.

scholarly journals Treatment of segmental tibial defects by bone transport with circular external fixation and a locking plate

2020 ◽  
Vol 48 (4) ◽  
pp. 030006052092040
Author(s):  
Yao Lu ◽  
Teng Ma ◽  
Cheng Ren ◽  
Zhong Li ◽  
Liang Sun ◽  
...  
Keyword(s):  
External Fixation ◽  
Locking Plate ◽  
Short Form ◽  
Clinical Results ◽  
Bone Transport ◽  
Fixation Index ◽  
Fixation Time ◽  
Sf 36 ◽  
Health Related ◽  
The Mean

Objective To evaluate the effectiveness of bone transport involving circular external fixation and locking plate application for the treatment of segmental tibial defects. Methods A retrospective review of 12 patients with segmental tibial defects who underwent bone transport with circular external fixation and locking plate application. We evaluated external fixation time, external fixation index, time to achieve union, and complications. Clinical results were assessed using the Association for the Study and Application of the Methods of Ilizarov (ASAMI) score. Generic health-related outcome was assessed using the 36-Item Short-Form Health Survey questionnaire (SF-36). Results The mean follow-up was 25.8 months, and the mean defect size was 6.7 cm. All of the patients achieved union at the distraction callus and docking site. The average external fixation time was 299.5 days. The mean external fixation index was 16.5 days/cm, and the mean healing index was 44.9 days/cm. The functional outcomes were excellent in eight cases and good in four. The average SF-36 score was 92. Conclusion Bone transport with external fixation and locking plate application may be a promising method for the treatment of segmental tibial defects.

Sign in / Sign up

Export Citation Format

Share Document