Comparing Functional Outcome of Triangle Tilt Surgery Performed Before Versus After Two Years of Age

Background: Many patients each year who are born with obstetric brachial plexus injuries eventually do not achieve complete recovery. As a result of the primary nerve injuries, these patients will often develop bony deformities involving the shoulder joint as a secondary consequence. The triangle tilt surgery has been shown to be an effective procedure to correct these deformities and has been performed on patients ranging in age from less than a year old to adolescence. The purpose of this retrospective study is to compare outcomes of triangle tilt surgery performed on patients before the age of 2 years versus after 2 years of age to determine an optimal age to operate on these children. Methods: 36 patients with deformities developed secondarily from the initial obstetric brachial plexus injury in this study were divided into 2 groups. Group 1, those who had undergone triangle tilt surgery at < 2 yrs of age (16 patients). Group 2, those who were operated at > 2 yrs of age (20 patients). Group 1 age range: 9 months to 23 months, average: 18 months. Group 2 age range: 26 months to 9 years, average: 6 years. Results: Significant differences were found between the 2 groups (0-2 yrs vs > 2yrs) in regards to overall changes (pre- to post-op) in Mallet score, external rotation score, hand-to-mouth score, and supination angle. Discussion: This study demonstrates that triangle tilt surgery had better outcomes on clinical functioning if performed before the age of 2 years, however, improvement in clinical functioning can still be achieved if the triangle tilt surgery is performed after the age of 2 years as well. A possible mechanism to explain this phenomenon is the increased potential for anatomical remodeling if the triangle tilt surgery is performed at a younger age, thereby leading to significant functional improvement.

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Short-term follow-up results of children with familial Mediterranean fever after cessation of colchicine: is it possible to quit?

Rheumatology ◽

10.1093/rheumatology/kez156 ◽

2019 ◽

Vol 58 (10) ◽

pp. 1818-1821 ◽

Cited By ~ 1

Author(s):

Ayşe Tanatar ◽

Şerife Gül Karadağ ◽

Hafize Emine Sönmez ◽

Mustafa Çakan ◽

Nuray Aktay Ayaz

Keyword(s):

Acute Phase ◽

Colchicine Treatment ◽

Acute Phase Reactants ◽

Younger Age ◽

Mediterranean Fever ◽

Group 2 ◽

Age Range ◽

Current Guidelines ◽

Group 1

Abstract Objective To define the characteristics of children expressing the FMF phenotype under colchicine until it was ceased and to compare the clinical features of patients requiring colchicine again with the patients who did not need colchicine. Methods Sixty-four of 1786 children with FMF in whom colchicine was stopped by the physician or patients/parents were enrolled. These patients were grouped as children who were in need of colchicine due to attacks and/or elevated acute phase reactants after cessation of colchicine (group 1) and children in whom colchicine was not necessary and not restarted (group 2). Results Colchicine was stopped in 59.4% by the physician and in 40.6% by the patient/parents. It was ceased at a median of 10.6 years of age (range 2.1–20.5) and attack- and inflammation-free periods of 18.2 months (range 6–148). The median follow-up of 64 patients after colchicine cessation was 37.4 months (range 6.4–154.7). It was restarted in 17 patients due to attacks (n = 11) or elevated acute phase reactants (n = 6). The age at cessation of the colchicine was lower (P = 0.04) and the duration of colchicine treatment until its cessation was shorter (P = 0.007) in group 1 compared with group 2. Conclusion Life-long colchicine treatment may not be required in all FMF patients. There are no current guidelines to determine in which patients it is safe to stop colchicine. We found that younger age during cessation and shorter duration of colchicine treatment lead to a higher risk of needing to restart colchicine.

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Results of Sever- L’ Episcopo procedure for obstetric brachial plexus palsy

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20164628 ◽

2016 ◽

Vol 3 (1) ◽

pp. 50

Author(s):

Karthi Sundar V. ◽

Anil Kumar S.V.

Keyword(s):

Brachial Plexus ◽

External Rotation ◽

Social Stigma ◽

Functional Results ◽

Functional Improvement ◽

Brachial Plexus Palsy ◽

Obstetric Brachial Plexus Palsy ◽

Obstetric Brachial Plexus ◽

Teres Major

Background: The reported incidence of obstetric brachial plexus palsy (OBPP) varies from 0.3 to 2.5 per 1000 live birthsresulting in internal rotation deformity and weak abduction of the involved side shoulder.Methods: To retrospectively analyse the functional results of the Sever- L‘ Episcopo procedure for OBPP with a minimum follow-up of 2 years to a maximum of 13 years using modified Mallet scoring system for shoulder.Results: A significant improvement in the range of abduction and the restoration of external rotation of shoulder was achieved with Sever- L’Episcopo procedure. Conclusions: The results of secondary reconstruction of a dysfunctional shoulder by means of a Lattismus dorsi & Teres major transfer as described by Sever- L’Episcopo is definitely beneficial. However this procedure will improve, but will not normalize, function. Apart from functional improvement this procedure corrects a deformity thereby easing the psycho-social stigma associated with it.

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Association of Visual Appearance on Outcomes After Hallux Valgus Surgery

Foot & Ankle International ◽

10.1177/10711007211019940 ◽

2021 ◽

pp. 107110072110199

Author(s):

Hakan Bahar ◽

Kadir Ilker Yildiz

Keyword(s):

Hallux Valgus ◽

Short Form ◽

Functional Improvement ◽

Level Of Evidence ◽

Visual Appearance ◽

Chevron Osteotomy ◽

Sf 36 ◽

Functional Scores ◽

Group 2 ◽

Group 1

Background: In this study, our aim was to determine the effect of cosmetic improvement on patient satisfaction and functional scores in hallux valgus (HV) surgery. Methods: Preoperative foot photographs of 105 patients who had undergone chevron osteotomy for HV between 2016 and 2018 were taken. The patients were divided into 2 groups. Twenty-four months after surgery, the preoperative foot photographs were shown to patients in group 1 (n = 52) but not to patients in group 2 (n = 53). The groups were then compared using the visual analog scale (VAS), the American Orthopaedic Foot & Ankle Society Hallux Metatarsophalangeal-Interphalangeal (AOFAS Hallux MTP-IP), and the 36-Item Short Form Health Survey (SF-36) scores. Both groups were evaluated radiologically with preoperative and postoperative hallux valgus angles and intermetatarsal angles. Results: There was no difference between the 2 groups in terms of radiologic parameters either pre- or postoperatively, or AOFAS Hallux MTP-IP scores postoperatively. However, for group 1, the VAS was lower (0.4±0.8 vs 1.8±1.6, P = .003) and both the SF-36 physical functioning (88.3±18.1 vs 79.1±23.2, P = .017) and SF-36 mental health scores were higher (78.8±19 vs 69.2±16.3, P = .022). Conclusion: Visualizing improvement in the cosmetic appearance of the foot appears associated with patients’ perception of subjective pain and functional improvement. We recommend that preoperative foot photographs be taken and recorded. Level of Evidence: Level III, case-control study.

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Arthroscopic Bankart repair with knotless suture anchors: A comparison of the permanent and absorbable types

Journal of Orthopaedics Trauma and Rehabilitation ◽

10.1177/2210491720953595 ◽

2020 ◽

Vol 27 (2) ◽

pp. 202-207

Author(s):

Abdulrahman D Algarni

Keyword(s):

External Rotation ◽

Shoulder Function ◽

Bankart Repair ◽

Suture Anchors ◽

Glenohumeral Instability ◽

Arthroscopic Bankart Repair ◽

Significant Difference ◽

Functional Scores ◽

Group 2 ◽

Group 1

Aim: The aim of this study was to compare the clinical outcomes of arthroscopic Bankart repair (ABR) using two types of knotless suture anchors (KSAs) in patients with post-traumatic recurrent anterior glenohumeral instability (AGHI). Methods: Thirty-two patients underwent an ABR using KSAs: a permanent KSA (PushLock) and an absorbable counterpart (BioKnotless). There were 16 patients in each group. Pre-and post-operative assessment for shoulder function using the American Shoulder and Elbow Surgeons and Constant–Murley scores, recurrence of instability, post-operative limitation of external rotation (ER) and ability to return to pre-injury level were recorded in both groups. Results: Both groups displayed significant improvements in functional scores ( p < 0.0001) without a significant difference between the groups. Of the 32 patients, 9.4% had recurrence of instability (one re-dislocation in group 1 and two symptomatic subluxations in group 2). Return to pre-injury level occurred in 87.5% and 81.3% of group 1 and group 2, respectively. There was 2° to 3° loss of ER after ABR in both groups; the difference between the groups was not significant ( p = 0.45). Conclusion: ABR for recurrent AGHI using a permanent or absorbable KSA offers comparable successful outcomes; no significant statistical difference was found.

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Latissimus Dorsi Transfer for External Rotation Weakness of the Shoulder in Obstetric Brachial Plexus Palsy

Journal of Hand Surgery (European Volume) ◽

10.1016/s0266-7681(02)00393-5 ◽

2003 ◽

Vol 28 (5) ◽

pp. 405-408 ◽

Cited By ~ 14

Author(s):

M. M. Al-QATTAN

Keyword(s):

Brachial Plexus ◽

Latissimus Dorsi ◽

External Rotation ◽

Skeletal Development ◽

Shoulder Abduction ◽

Brachial Plexus Palsy ◽

Obstetric Brachial Plexus Palsy ◽

Latissimus Dorsi Transfer ◽

Obstetric Brachial Plexus ◽

Shoulder External Rotation

This report describes the results of latissimus dorsi transfer for weakness of shoulder external rotation in 12 children with obstetric brachial plexus palsy. Selection criteria for the muscle transfer procedure included good passive external rotation of the shoulder, normal skeletal development of the shoulder joint, and adequate power of the deltoid. In addition to measuring the ranges of motion of joints before and after surgery, a modified Mallet grading system was utilized for the functional assessment of shoulder external rotation. At a mean follow-up of 4 years, two of the 12 children had recurrence of the shoulder deformity. In the remaining 10 children, the mean active external rotation was 30° (range, 20–60°), mean shoulder abduction was 140° (range, 90–170°), and all children had achieved a modified Mallet score of 4.

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Management strategies for shoulder reconstruction in obstetric brachial plexus injury with special reference to loss of internal rotation after surgery

Journal of Hand Surgery (European Volume) ◽

10.1177/1753193412440221 ◽

2012 ◽

Vol 37 (8) ◽

pp. 772-779 ◽

Cited By ~ 11

Author(s):

M. Sibinski ◽

T. E. J. Hems ◽

D. A. Sherlock

Keyword(s):

Soft Tissue ◽

Brachial Plexus ◽

Internal Rotation ◽

External Rotation ◽

Management Strategies ◽

Shoulder Function ◽

Obstetric Brachial Plexus ◽

Teres Major ◽

Shoulder Reconstruction

We assessed the outcomes in 24 of 25 children (mean age 3 years) who had soft-tissue shoulder reconstruction procedures for obstetric brachial plexus injuries. All had latissimus dorsi and teres major transfers to strengthen external rotation combined with subscapularis lengthening, reduction of posterior dislocation or subluxation, and humeral osteotomy, if necessary. At a mean follow-up of 3.8 years, the mean Mallet score improved from 12.3 preoperatively to 17.4 postoperatively, active external rotation improved from 21° to 32°, and passive external rotation improved from 26° to 67°. The shoulder remained in joint in all patients. Active internal rotation deteriorated in nine shoulders, two requiring secondary internal rotation osteotomy. Combined soft tissue rebalancing and bony procedures gives reliable shoulder function improvement. Care is required regarding the effect on internal rotation.

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The evaluation of velopharyngeal function using flexible nasendoscopy

The Journal of Laryngology & Otology ◽

10.1017/s0022215100138496 ◽

1997 ◽

Vol 111 (8) ◽

pp. 739-745 ◽

Cited By ~ 7

Author(s):

L. Ramamurthy ◽

R. A. Wyatt ◽

D. Whitby ◽

D. Martin ◽

P. Davenport

Keyword(s):

Cleft Palate ◽

Speech Therapy ◽

Treatment Options ◽

Voice Analysis ◽

Dynamic Function ◽

Post Traumatic ◽

Group 2 ◽

Velopharyngeal Function ◽

Age Range ◽

Group 1

AbstractNasendoscopy is an essential tool in assessing the dynamic function and structure of the velopharyngeal sphincter during speech and swallowing.Flexible fibre-optic nasendoscopy has been used by the cleft palate team at Withington Hospital, Manchester since 1989. Seventy-six patients were referred between 1989 and 1994 for evaluation of velopharyngeal function during speech. Flexible nasendoscopic evaluation was attempted in 50 patients, and successfully carried out in 43 patients. The age range was four years to 77 years (mean 21 years). The patients were divided into two groups: Group 1 consisting of patients with cleft palate and Group 2 comprised of patients with non-overt cleft palate-related velopharyngeal dysfunction of various aetiologies; such as, submucous cleft, post-tonsillectomy, post-adenoidectomy, neurological and post-traumatic.Based on the findings on nasendoscopy, videofluoroscopy and clinical speech/voice analysis the following treatment options were recommended: 17 (40 per cent) for pharyngoplasty, five (11 per cent) for revision pharyngoplasty, 15 (35 per cent) for speech therapy, four for an obturator and one for tonsillectomy. Two previously undetected submucous clefts were diagnosed.

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Should the Diastatic Syndesmosis be Stabilized in Advanced Pronation-External Rotation Ankle Injuries? A Retrospective Cohort Comparison

10.21203/rs.3.rs-105420/v1 ◽

2020 ◽

Author(s):

Chi-Chuan Wu ◽

Wen-Ling Yeh ◽

Po-Cheng Lee ◽

Ying-Chao Chou ◽

Yung-Heng Hsu ◽

...

Keyword(s):

External Rotation ◽

Ankle Injuries ◽

Ligament Healing ◽

Group 2 ◽

One Year ◽

The Individual ◽

Ankle Function ◽

Pronation External Rotation ◽

With Screws ◽

Group 1

Abstract Background: Ankle injuries with the advanced pronation-external rotation (PE) type are relatively uncommon and the debate about whether the diastatic syndesmosis should be stabilized concomitantly has yet achieved a consensus. Comparison of using (Group 1) or non-using (Group 2) screw stabilization for the diastatic syndesmosis was performed retrospectively. Methods: With the 10-year period, 81 consecutive adult patients with advanced PE ankle injuries (stage 3 or 4 PE type) were treated. After malleolar fractures were internally stabilized with screws and plates, the syndesmotic stability was re-checked by external rotation and hook tests. The necessity of insertion of cortical screws to stabilize diastatic syndesmosis was decided by the individual orthopedic surgeon. The outcomes of both approaches were compared. Results: Seventy-one patients were followed for at least one year (87.7%; average, 2 years; range, 1-11 years). Group 1 had 22 patients and Group 2, 49 patients. The union rate in Group 1 was 100% (22 / 22) and in Group 2, 91.8% (45 / 49; p= 0.30). Syndesmosis re-diastasis occurred in 13.6% (3 / 22) of Group 1 and 30.6% (15 / 49) of Group 2 (p= 0.13). Satisfactory ankle function was noted in 86.4% (19 / 22) of Group 1 and 65.3% (32 / 49) of Group 2 (p= 0.07). Conclusion: Although clinical comparison cannot demonstrate statistical difference, screw stabilization of the diastatic syndesmosis may guarantee safer results. The statistical insignificance may be due to insufficient sample sizes. Clinically and theoretically, insertion of syndesmotic screws to promote ligament healing may be reasonable.

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Effects of Clonidine as an Adjuvant to Lidocaine with Epinephrine in Ultrasound Guided Axillary Brachial Plexus Block: A Randomised Controlled Trial

Journal of Clinical Medicine ◽

10.3390/jcm10184181 ◽

2021 ◽

Vol 10 (18) ◽

pp. 4181

Author(s):

Anil Ranganath ◽

Tomas Hitka ◽

Gabriella Iohom

Keyword(s):

Brachial Plexus ◽

Normal Saline ◽

Motor Block ◽

Brachial Plexus Block ◽

Onset Time ◽

Ultrasound Guided ◽

Axillary Brachial Plexus Block ◽

Group 2 ◽

Plexus Block ◽

Group 1

This study evaluated the effects of adding adjuvant clonidine to lidocaine with epinephrine on the characteristics of ultrasound-guided axillary brachial plexus block (ABPB) for upper extremity surgery. Twenty-four patients were randomised to receive an ultrasound guided ABPB with 20 mL of lidocaine 2% with 1:200,000 epinephrine plus 2 mL of either normal saline 0.9% (Group 1) or a mixture of clonidine 1 µg/kg and normal saline 0.9% (Group 2). The outcome measures that were recorded were the overall onset time and the duration of sensory and motor block. The median (IQR) overall onset time of sensory and motor block was significantly shorter in Group 2 vs. Group 1 (5 (5–7.5) min vs. 10 (8.8–12.5) min; p < 0.001) and (5 (2.5–7.5) min vs. 7.5 (6.3–7.5) min; p = 0.001), respectively. The median (IQR) overall duration of sensory and motor block was significantly longer in Group 2 vs. Group 1 (225 (200–231) min vs. 168 (148–190) min; p < 0.001) and (225 (208–231) min vs. 168(148–186) min; p < 0.001), respectively. In ultrasound-guided ABPB, the addition of clonidine to lidocaine with epinephrine resulted in shorter onset time and prolonged duration of sensory and motor block.

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Effects of local anaesthetic dilution on the characteristics of ultrasound guided axillary brachial plexus block: a randomised controlled study

Medical Ultrasonography ◽

10.11152/mu-3069 ◽

2021 ◽

Author(s):

Anil Ranganath ◽

Osman Ahmed ◽

Gabriella Iohom

Keyword(s):

Brachial Plexus ◽

Local Anaesthetic ◽

Brachial Plexus Block ◽

Onset Time ◽

Ultrasound Guided ◽

Performance Time ◽

Axillary Brachial Plexus Block ◽

Group 2 ◽

Plexus Block ◽

Group 1

Aims: Ultrasound guidance has led to marked improvement in the success rate and characteristics of peripheral nerve blocks. However, effects of varying the volume or concentration of a fixed local anaesthetic dose on nerve block remains unclear. The purpose of our study was to evaluate whether at a fixed dose of lidocaine, altering the volume and concentration will have any effect on the onset time of ultrasound-guided axillary brachial plexus block.Material and methods: Twenty patients were randomised to receive an ultrasound-guided axillary brachial plexus block with either lidocaine 2% with epinephrine (20 ml, Group 2%) or lidocaine 1% with epinephrine (40 ml, Group 1%). The primary endpoint was block onset time. Secondary outcomes included duration of the block, performance time, number of needle passes, incidence of paraesthesia and vascular puncture.Results: The median [IQR] onset time of surgical anaesthesia was shorter in Group 1% when compared to Group 2% (6.25 [5-7.5] min vs 8.75 [7.5-10] min; p=0.03). The mean (SD) overall duration of surgical anaesthesia was significantly shorter in Group 1% compared to Group 2% (150.9±17.2 min vs 165.1±5.9 min; p=0.02). Group 1% had a shorter performance time with fewer needle passes. The incidence of vascular puncture and paraesthesia was similar in the two groups.Conclusion: Ultrasound-guided axillary brachial plexus blocks performed using a higher volume of lower concentration lidocaine was associated with shorter onset time and duration of surgical anaesthesia.

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