Titel Treatment of Hand and Wrist Fractures with the Stryker Hand Plating System

Abstract Background: 10% of all fractures occur in the fingers and metacarpal region. Early mobilization with preservation of grip function is the goal of any therapy for these injuries. Osteosyntheses with plates are used in complex fractures that do not allow any other treatment. The aim of this retrospective study was to evaluate the performance and safety of the Stryker Hand System.Patients and Methods: Between 2010 and 2019, 190 patients underwent surgical treatment with plates for fractures of the fingers and metacarpal region. Of these, 140 operations could be analyzed according to the inclusion criteria based on clinical and radiological parameters.Results: Three-quarters of the patients were male. The mean age at the time of surgery was 39.3 ± 15.97 years. Falling was the leading cause for hand fractures, and the commonest were fractures of the shaft (>52%). More than 15% were complex hand injuries with more than one fractured finger. The majority of patients were healthy non-smokers without systemic diseases and relevant medical history. Conclusion: The Stryker Finger Plates are safe implants with good results that are consistent with those reported in the literature. The trend is also toward stable-angle implants for fracture treatment of the finger, in order to enable the earliest possible functional, safe mobilization. The maxim that the extent of the soft tissue injury is responsible for the result continues to apply.Level of Evidence Level: IV; Outcome-study, retrospective

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Intra-articular Calcaneus Fractures: Current Concepts Review

Foot & Ankle Orthopaedics ◽

10.1177/2473011420927334 ◽

2020 ◽

Vol 5 (3) ◽

pp. 247301142092733

Author(s):

Paul R. Allegra ◽

Sebastian Rivera ◽

Sohil S. Desai ◽

Amiethab Aiyer ◽

Jonathan Kaplan ◽

...

Keyword(s):

Tissue Injury ◽

Soft Tissue Injury ◽

Treatment Strategies ◽

Late Complications ◽

Classification Systems ◽

Surgical Approaches ◽

Calcaneal Fractures ◽

Level Of Evidence ◽

Tarsal Bones ◽

Calcaneus Fractures

Calcaneal fractures are the most common fracture of the tarsal bones and represent 1% to 2% of all fractures. Roughly 75% of these fractures include intra-articular involvement of the posterior facet of the calcaneus. Intra-articular calcaneal fractures are challenging injuries to manage for both patients and surgeons given their association with both early and late complications. This article aims to review the management, classification systems, surgical approaches, and care regarding intra-articular calcaneal fractures. A review of the current literature yielded treatment strategies that aim to reduce complications such as soft tissue injury or loss of articular reduction while maintaining satisfactory clinical outcomes. The purpose of this article is to review these current concepts in the management of intra-articular calcaneal fractures. Level of Evidence: Level V, expert opinion.

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The Pedicled Robertson Mammaplasty: Minimization of Complications in Obese Patients With Extreme Macromastia

Aesthetic Surgery Journal ◽

10.1093/asj/sjaa073 ◽

2020 ◽

Vol 40 (12) ◽

pp. NP666-NP675

Author(s):

Richard J Restifo

Keyword(s):

High Risk ◽

Wound Care ◽

Ideal Body Weight ◽

Patient Characteristics ◽

Clinical Situation ◽

High Risk Group ◽

Obese Patients ◽

Inclusion Criteria ◽

Level Of Evidence ◽

The Mean

Abstract Background Breast reduction for extreme macromastia in obese patients is a potentially high-risk endeavor. Free nipple grafting as well as a variety of pedicled techniques have been advocated for large reductions in obese patients, but the number of different approaches suggests that no single method is ideal. This paper suggests the Robertson Mammaplasty, an inferior pedicle technique characterized by a curvilinear skin extension onto the pedicle, as a potentially favorable approach to this clinical situation. Objectives The author sought to determine the safety of the Pedicled Robertson Mammaplasty for extreme macromastia in obese patients. Methods The records of a single surgeon’s practice over a 15-year period were retrospectively reviewed. Inclusion criteria were a Robertson Mammaplasty performed with a >3000-g total resection and a patient weight at least 20% above ideal body weight. Records were reviewed for patient characteristics, operative times, and complications. Results The review yielded 34 bilateral reduction patients that met inclusion criteria. The mean resection weight was 1859.2 g per breast, the mean body mass index was 36.4 kg/m2, and the mean sternal notch-to-nipple distance was 41.4 cm. Mean operative time was 122 minutes. There were no cases of nipple necrosis and no major complications that required reoperation under general anesthesia. A total 26.4% of patients had minor complications that required either local wound care or small office procedures, and 4.4% received small revisions under local anesthesia. Conclusions The Pedicled Robertson Mammaplasty is a fast and safe operation that yields good aesthetic results and a relative minimum of complications in the high-risk group of obese patients with extreme macromastia. Level of Evidence: 4

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Percutaneous Posterior to Anterior Screw Fixation of the Talar Neck

Foot & Ankle Orthopaedics ◽

10.1177/2473011418s00204 ◽

2018 ◽

Vol 3 (3) ◽

pp. 2473011418S0020

Author(s):

Cesar de Cesar Netto ◽

Lauren Roberts ◽

Alexandre Godoy Dos Santos ◽

Jackson Staggers ◽

Sung Lee ◽

...

Keyword(s):

Soft Tissue ◽

Achilles Tendon ◽

Tissue Injury ◽

Soft Tissue Injury ◽

Injury Rate ◽

Posterolateral Approach ◽

Flexor Hallucis Longus ◽

Peroneal Tendons ◽

The Mean ◽

Tissue Structures

Category: Trauma Introduction/Purpose: Fractures of the talar neck and body can be fixed with percutaneously placed screws directed from anterior to posterior or posterior to anterior. The latter has been found to be biomechanically and anatomically superior. Percutaneous pin and screw placement poses anatomic risks for posterolateral and posteromedial neurovascular and tendinous structures. The objective of this study was to enumerate the number of trials for proper placement of two parallel screws and to determine the injury rate to neurovascular and tendinous structures. Methods: Eleven fresh frozen cadaver limbs were used. 2.0 mm guide wires from the Stryker (Selzach, Switzerland) 5.0-mm headless cannulated set were percutaneously placed (under fluoroscopic guidance) into the distal posterolateral aspect of the ankle. All surgical procedures were performed by a fellowship-trained foot and ankle surgeon. Malpositioned pins were left intact to allow later assessment of soft tissue injury. The number of guide wires needed to achieve an acceptable positioning of the implant was noted. Acceptable positioning was defined as in line with the talar neck axis in both AP and lateral fluoroscopic views. After a layered dissection from the skin to the tibia, we evaluated neurovascular and tendinous injuries, and measured the shortest distance between the closest guide pin and the soft tissue structures, using a precision digital caliper. Results: The mean number of guide wires needed to achieve acceptable positioning for 2 parallel screws was 2.91 ± 0.70 (range, 2 - 5). The mean distances between the closest guide pin and the soft tissue structures of interest were: Achilles tendon, 0.53 ± 0.94 mm; flexor hallucis longus tendon, 6.62 ± 3.24 mm; peroneal tendons, 7.51 ± 2.92 mm; and posteromedial neurovascular bundle, 11.73 ± 3.48 mm. The sural bundle was injured in all the specimens, with 8/11 (72.7%) in direct contact with the guide pin and 3/11 (17.3%) having been transected. The peroneal tendons were transected in 1/11 (9%) of the specimens. The Achilles tendon was in contact with the guide pin in 6/11 (54.5%) specimens and transected in 2/11 (18.2%) specimens. Conclusion: The placement of posterior to anterior percutaneous screws for talar neck fixation is technically demanding and multiple guide pins are needed. Our cadaveric study showed that important tendinous and neurovascular structures are in close proximity with the guide pins and that the sural bundle was injured in 100% of the cases. We advise performing a formal small posterolateral approach for proper visualization and retraction of structures at risk. Regardless, adequate patient education about the high risk of injury from this procedure is crucial.

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Functional outcome of fixation of distal femoral fractures with DF-LCP: a prospective study

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20164000 ◽

2016 ◽

Vol 2 (4) ◽

pp. 291 ◽

Cited By ~ 1

Author(s):

Shafeed T. P. ◽

Bijo Paul

Keyword(s):

Tissue Injury ◽

Weight Bearing ◽

Soft Tissue Injury ◽

Femoral Fractures ◽

Early Mobilization ◽

Type A ◽

Full Weight Bearing ◽

Supracondylar Fractures ◽

Range Of Movement ◽

Locked Plating

Background: Management of supracondylar fractures is a real challenge to the orthopaedician due to its extensive soft tissue injury, boneloss, comminution, articular extention and instability. Open reduction and internal fixation with anatomical distal femoral locking plate permits early mobilization. Stable anatomical fixation is necessary to avoid complications and disability.Methods: 25 patients with Type A and Type C closed supracondylar femoral fractures were followed up from November 2013 to November 2015. All the patients underwent ORIF with DF-LCP. Clinical and radiological follow up were recorded for 24 months.Results: Mean time for fracture union was 4.02 months. Average duration for full weight bearing was 122 days (range 90-180days). The average range of movement for Type A fractures was 105.71 degrees, for C fractures average ROM was 93.64 degrees. Average ROM for patients <50 was 103 degree and for patients>50 ROM was 98.66 degree. Conclusions: Locked plating of DF fractures permits stable fixation and early mobilization which avoids disability and ensures good joint function.

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Effect of Syndesmotic Implant Removal on Dorsiflexion

Foot & Ankle International ◽

10.1177/1071100718818572 ◽

2019 ◽

Vol 40 (5) ◽

pp. 499-505 ◽

Cited By ~ 6

Author(s):

Jorge Briceno ◽

Timilien Wusu ◽

Philip Kaiser ◽

Patrick Cronin ◽

Alyssa Leblanc ◽

...

Keyword(s):

Final Analysis ◽

Ankle Dorsiflexion ◽

Implant Removal ◽

Inclusion Criteria ◽

Level Of Evidence ◽

Level Ii ◽

Significant Difference ◽

Before And After ◽

The Mean

Background: There is limited evidence that syndesmotic implant removal (SIR) is beneficial. However, many surgeons advocate removal based on studies suggesting improved motion. Methodologic difficulties make the validity and applicability of previous works questionable. The purpose of this study was to examine the effect of ankle dorsiflexion after SIR using radiographically measured motion before and after screw removal utilizing a standardized load. Methods: All patients undergoing isolated SIR were candidates for inclusion. Dorsiflexion was measured radiographically: (1) immediately before implant removal intraoperatively, (2) immediately after removal intraoperatively, and (3) 3 months after removal. A standardized torque force was applied to the ankle and a perfect lateral radiograph of the ankle was obtained. Four reviewers independently measured dorsiflexion on randomized, deidentified images. A total of 29 patients met inclusion criteria. All syndesmotic injuries were associated with rotational ankle fractures. There were 11 men (38%) and 18 women (62%). The mean, and standard deviation, age was 50.3 ± 16.9 years (range 19-80). Results: The mean ankle dorsiflexion pre-operatively, post-operatively, and at a 3-month follow-up was 13.7 ± 6.6 degrees, 13.3 ± 7.3 degrees and 11.8 ± 11.3 degrees, respectively ( P = .466). For subsequent analysis, 5 patients were excluded because of the potential confounding effect of retained suture button devices. Analysis of the remaining 24 patients (and final analysis of 21 patients who had complete 3-month follow-up) demonstrated similar results with no statistically significant difference in ankle dorsiflexion at all 3 time points. Conclusion: Removal of syndesmotic screws may not improve ankle dorsiflexion motion and should not be used as the sole indication for screw removal. Level of Evidence: Level II, prospective cohort study.

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The use of dynamic external fixation in the treatment of dorsal fracture subluxations and pilon fractures of finger proximal interphalangeal joints

Journal of Hand Surgery (European Volume) ◽

10.1177/1753193416674155 ◽

2016 ◽

Vol 42 (2) ◽

pp. 182-187 ◽

Cited By ~ 16

Author(s):

M. M. Abou Elatta ◽

F. Assal ◽

H. M. Basheer ◽

A. F. El Morshidy ◽

S. M. Elglaind ◽

...

Keyword(s):

Early Mobilization ◽

Proximal Interphalangeal Joint ◽

Interphalangeal Joint ◽

Joint Motion ◽

Stable Fixation ◽

Level Of Evidence ◽

The Mean ◽

Finger Motion ◽

Pilon Fractures

The aim of this study was to review the outcome of the treatment of finger proximal interphalangeal joint dorsal fracture subluxations and pilon fractures with a modified external fixator. We treated 36 patients (36 fingers). We assessed the ranges of motion and patient satisfaction. At final follow-up, 23 patients had no pain; 11 had pain in the cold; and two also had mild pain. None had moderate or severe pain. The mean range of proximal interphalangeal joint motion was 86° (60°–100°). The mean total active range of finger motion was 244° (range 200°–265°). This system is simple, cheap and relatively easily applied. It gives stable fixation that allows early mobilization. Level of evidence: IV

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Open surgery versus nonoperative treatments for paediatric trigger thumb: a systematic review

Journal of Hand Surgery (European Volume) ◽

10.1177/1753193414523245 ◽

2014 ◽

Vol 39 (7) ◽

pp. 719-726 ◽

Cited By ~ 11

Author(s):

S. Farr ◽

F. Grill ◽

R. Ganger ◽

W. Girsch

Keyword(s):

Systematic Review ◽

Open Surgery ◽

Nonoperative Treatment ◽

Joint Motion ◽

Inclusion Criteria ◽

Level Of Evidence ◽

Trigger Thumb ◽

The Mean ◽

Results Of Surgery

The purpose of this systematic review was to determine the outcome of interphalangeal (IP) joint motion in children undergoing open surgical release, splinting, and passive exercising therapy for the treatment of paediatric trigger thumb. We conducted an online literature search of seven major databases. Only studies with a mean follow-up of at least 12 months were considered for inclusion. Seventeen retrospective studies and one prospective study met all the inclusion criteria. They reported on the results of surgery (634 children, 759 thumbs), splinting (115 children, 138 thumbs), and passive exercising (89 children, 108 thumbs). The mean follow-up periods were 59 (surgery), 23 (splinting), and 76 months (exercising), respectively. Full IP joint motion without residual triggering was achieved in 95% of all children undergoing surgery, in 67% of children treated with continuous splinting, and 55% after passive exercising. Based on the low level of evidence available, it seems that open surgery resulted in more reliable and rapid outcomes compared with nonoperative treatment.

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Bilateral Gastrocnemius Flap For Harlequin Defects Around The Knee

Jurnal Plastik Rekonstruksi ◽

10.14228/jpr.v6i1.272 ◽

2020 ◽

Vol 6 (1) ◽

pp. 248-253

Author(s):

Tarun Chabra ◽

Venkatramani Hari ◽

Sabapathy SR

Keyword(s):

Soft Tissue ◽

Proximal Tibia ◽

Tissue Injury ◽

Soft Tissue Injury ◽

High Energy ◽

Tissue Loss ◽

Lateral Side ◽

Gastrocnemius Flap ◽

Schatzker Type ◽

The Mean

Background : Tibial plateau fractures (especially bicondylar Schatzker type 5 and type 6) are a result of high energy trauma. Along with bony component, soft tissue injury is a major determinant in the treatment and final outcome. Bicondylar fractures needs bicolumnar fixation and as such require separate approaches: postero-medial and lateral incisions. The soft tissue of the proximal tibia swells significantly after the injury, coupled with extensive soft tissue dissection during fixation this can lead to subsequent wound breakdown and infection along either side of the proximal tibia which resembles “harlequin eyes”. This study describes outcome of management of post operative soft tissue complications following bicolumnar fixation of proximal tibia with medial and lateral gastrocnemius flap. Method : Three patients who had bilateral soft tissue necrosis at surgical incision sites treated with debridement and bilateral gastrocnemius flaps between January 2016 and December 2017 were included in this study. The mean age was 38 years (range 18–50 years) and the mean duration of follow-up was 10 months. Outcome assessments included the condition of the flap and fracture healing time. Result : All fractures united after surgery. There were no soft tissue complications and all flaps healed well. The mean bony union time was 6 months. Conclusion: Our technique of covering soft tissue loss at surgical site on medial and lateral side of proximal tibia with bilateral gastrocnemius flap in the same setting is a reliable and safe surgical method for these conditions.

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One versus two adjacent interdigital neuroma excision: a patient outcome study

Journal of the Foot & Ankle ◽

10.30795/jfootankle.2021.v15.1582 ◽

2021 ◽

Vol 15 (3) ◽

pp. 236-240

Author(s):

Kefilwe Boineelo Benjamin ◽

Nikiforos Saragas ◽

Paulo Ferrão

Keyword(s):

Patient Outcome ◽

Patient Satisfaction ◽

Retrospective Study ◽

The Self ◽

Outcome Study ◽

Foot And Ankle ◽

Level Of Evidence ◽

Significant Difference ◽

The Mean ◽

Good For

Objective: We aimed to evaluate patient satisfaction after surgery for both single and two adjacent neuromas. Methods: We reviewed the data of patients treated operatively for interdigital neuromas between 2003 and 2016. We interviewed them and administered the Self-Reported Foot and Ankle Score questionnaire. Patient scores were then analyzed categorically, and variation between groups was assessed. Results: Sixty-two patients were available for review. Thirty-one patients had a single interdigital neuroma excised and 31 had two adjacente interdigital neuromas excised. Twenty-eight of the 31 (90%) patients with a single neuroma had good or excellent results while 23 (74.2%) of those with adjacent neuromas had similar outcomes. One patient with a single neuroma had a poor result while four patients with adjacent neuromas had poor results. The mean score was 41 (excellent) for patients with a single interdigital neuroma and 37 (good) for those with adjacent neuromas (p=0.473). The majority of patients in both groups would undergo surgery again. Conclusion: We found no statistically significant difference in outcomes of patients who undergo surgery for either single or two adjacent interdigital neuromas. General patient satisfaction is good and/or excellent post excision. Level of Evidence II; Prognostic Studies; Retrospective Study.

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Knee laxity and functional knee outcome after contralateral ACLR are comparable to those after primary ACLR

Knee Surgery Sports Traumatology Arthroscopy ◽

10.1007/s00167-020-06417-3 ◽

2021 ◽

Author(s):

Riccardo Cristiani ◽

Sofia Viheriävaara ◽

Per-Mats Janarv ◽

Gunnar Edman ◽

Magnus Forssblad ◽

...

Keyword(s):

Acl Reconstruction ◽

Cruciate Ligament ◽

Knee Laxity ◽

Anterior Tibial Translation ◽

Inclusion Criteria ◽

Level Of Evidence ◽

Anterior Tibial ◽

The Mean ◽

Tibial Translation

Abstract Purpose To evaluate and compare knee laxity and functional knee outcome between primary and contralateral anterior cruciate ligament (ACL) reconstruction. Methods Patients who underwent primary and subsequent contralateral ACL reconstruction (ACLR) at Capio Artro Clinic, Stockholm, Sweden, from 2001 to 2017, were identified in our local database. The inclusion criteria were: the same patients who underwent primary and contralateral hamstring tendon or bone-patellar tendon-bone autograft ACLR and no associated ligament injuries. The KT-1000 arthrometer, with an anterior tibial load of 134 N, was used to evaluate knee laxity preoperatively and 6 months postoperatively. The Knee injury and Osteoarthritis Outcome Score (KOOS) was collected preoperatively and at the 1-year follow-up. Results A total of 326 patients with isolated primary and contralateral ACLR met the inclusion criteria (47.9% males; mean age at primary ACLR 23.9 ± 9.4 years and contralateral ACLR 27.9 ± 10.1 years). The arthrometric laxity measurements were available for primary and contralateral ACLR for 226 patients. The mean preoperative and postoperative anterior tibial translation (ATT), as well as the mean ATT reduction from preoperatively to postoperatively, did not differ significantly between primary and contralateral ACLR. The KOOS was available for primary and contralateral ACLR for 256 patients. No significant differences were found preoperatively and at the 1-year follow-up between primary and contralateral ACLR for any of the five KOOS subscales. Conclusion The findings in this study showed that anterior knee laxity and functional knee outcome after contralateral ACLR are comparable to those after primary ACLR. It is important for clinicians to counsel patients about their expectations after contralateral ACLR. This study shows that the results after contralateral ACLR in terms of knee laxity and functional knee outcome are predictable and likely to be comparable to those after primary ACLR. Level of evidence Level III.

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