scholarly journals Syndesmosis assessment in postoperative patients subjected to surgical treatment of supra-syndesmotic fracture

2018 ◽  
Vol 12 (4) ◽  
pp. 276-83
Author(s):  
Marcelo De Brito Teixeira ◽  
Gabriel Souza Albuquerque ◽  
Clauser Roberto Souza Lima Segundo ◽  
Felipe Rodrigues Santos Carneiro ◽  
Janice Souza Guimarães ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Postoperative Period ◽  
Articular Surface ◽  
Contralateral Side ◽  
Normal Range ◽  
Level Of Evidence ◽  
Radiographic Images ◽  
Reproducible Method ◽  
The Mean ◽  
Additional Value

Objective: To demonstrate the patterns of syndesmosis reconstruction in ankle fractures via the measurement of pre-established and universally accepted parameters. Methods: In a retrospective study, fractures with radiographic images obtained during the postoperative period showing fixation of the distal tibiofibular syndesmosis were selected. After this selection, fracture reduction and syndesmosis fixation were evaluated by measuring radiographic parameters in the selected cases. Results: Twenty-three patients (63.8%) were male. Fourteen fractures (38.8%) were operated on by a senior surgeon (foot and ankle specialist). All syndesmoses were fixed with only 1 screw, and 35 patients (97.2%) had syndesmosis fixation involving 3 cortices. The mean syndesmosis fixation height from the articular surface was 2.20cm. Four fractures (11.1%) presented radiographic signs of medial ligament reconstruction. Regarding measurement of the tibiofibular space, in the anteroposterior (AP) view, 33 patients (91.6%) had values within the normal range. Regarding the tibiofibular overlap, in the AP view, 19 patients (52.7%) had measurements with values greater than 10mm (normal). In the evaluation of tibiofibular overlap, in the true AP view, all patients (100%) presented measurements greater than 1mm (normal). Regarding the measurement of the talocrural angle, only 1 patient did not have normal parameters. Regarding the medial clear space, only 2 patients (5.5%) had values above normal during the postoperative period. Conclusion: The adoption of objective parameters, in a standardized manner and relative to the contralateral side, adds additional value to the evaluation and ensures an accessible and reproducible method for the evaluation of these injuries. Level of Evidence II; Prognostics Studies; Retrospective Study.

scholarly journals PO 18123 - Syndesmosis assessment in postoperative patients subjected to surgical treatment of supra-syndesmotic fracture

2019 ◽  
Vol 13 (Supl 1) ◽  
pp. 22S
Author(s):  
Marcelo De Brito Teixeira ◽  
Gabriel Souza de Albuquerque ◽  
Clauser Roberto Souza Lima Segundo ◽  
Felipe Rodrigues Santos Carneiro ◽  
Janice De Souza Guimarães ◽  
...  
Keyword(s):  
Postoperative Period ◽  
Articular Surface ◽  
Contralateral Side ◽  
Ankle Fractures ◽  
Foot And Ankle ◽  
Normal Range ◽  
Radiographic Images ◽  
Reproducible Method ◽  
The Mean ◽  
Standardized Parameters

Objective: To demonstrate the patterns of syndesmosis reconstruction in ankle fractures via the measurement of pre-established and universally accepted parameters. Methods: In a retrospective study, fractures with radiographic images obtained during the postoperative period and showing fixation of the distal tibiofibular syndesmosis were selected. Fracture reduction and syndesmosis fixation were evaluated by measuring radiographic parameters in the selected cases. Results: Twenty-three patients (63.8%) were male. Fourteen fractures (38.8%) were operated on by a senior surgeon (foot and ankle specialist). All syndesmoses were fixed with only one screw, and 35 patients (97.2%) had syndesmosis fixation involving 3 cortices. The mean syndesmosis fixation height from the articular surface was 2.20 cm. Four fractures (11.1%) presented radiographic signs of medial ligament reconstruction. Regarding the measurement of the tibiofibular space, in the anteroposterior (AP) view, 33 patients (91.6%) had values within the normal range. Regarding the tibiofibular overlap, in the AP view, 19 patients (52.7%) had measurements with values greater than 10 mm (normal). In the evaluation of tibiofibular overlap, in the true anteroposterior (AP) view, all patients (100%) presented measurements greater than 1 mm (normal). Regarding the measurement of the talocrural angle, only 1 patient did not have normal parameters. Regarding the medial clear space, only 2 patients (5.5%) had values above normal during the postoperative period. Conclusion: The adoption of objective, standardized parameters relative to the contralateral side adds value to the evaluation and ensures an accessible and reproducible method for evaluating syndesmotic ankle fractures.

Revisiting the Natural History of Chronic Scaphoid Nonunions: A Retrospective Study of 20 Cases

2021 ◽  
Author(s):  
J. Terrence Jose Jerome
Keyword(s):  
Retrospective Study ◽  
Natural History ◽  
Functional Outcome ◽  
Grip Strength ◽  
Scaphoid Nonunion ◽  
Proximal Pole ◽  
Degenerative Arthritis ◽  
Level Of Evidence ◽  
History Of ◽  
The Mean

Abstract Background The natural history of scaphoid nonunion is the development of degenerative arthritis. A lot of information is still unclear about this progression. The purpose of this study is to analyze patients with scaphoid nonunions who had not received any kind of treatment and to assess the functional outcome. Materials and Methods This is a retrospective study that analyzed the patients with chronic scaphoid nonunions between 2009 and 2019. None of the patients received any treatment. The age at the time of injury, examination, pattern of fracture, types of scaphoid nonunion, symptoms, and duration of nonunion were noted. Diagnosis was confirmed by radiographs, computed tomography (CT) scan, and magnetic resonance imaging (MRI). Scapholunate and radiolunate angles were recorded. Pain score, modified mayo wrist score, grip strength, range of movement, and the functional outcome of these scaphoid nonunions were analyzed. A statistical correlation between the scaphoid nonunion presentations and the functional outcome was assessed. Results The mean age of the patients was 62 years (range: 35–82 years.). There were 17 male and 3 female patients. There were 9 waist and 11 proximal pole scaphoid nonunions. The mean duration of scaphoid nonunion was 34 years (range: 10–62 years). None of the patients had avascular necrosis (AVN) of the proximal scaphoid. The age at examination, gender, side of injury, fracture pattern (waist/proximal pole), fracture displacement ≤ 1 mm or > 1 mm, nonunion duration, and radiographic arthritic parameters had no significant impact on the functional outcome. Conclusions Untreated chronic scaphoid nonunion leads to the development of degenerative arthritis over a period of years, which is still unpredictable. Most of the patients become aware of the nonunion following a precedent injury or other reasons. Most of the patients have fair/good functional outcome despite reduced range of movements and grip strength. Many do not favor surgical intervention in the course of nonunion. Chronic nonunions open a lot of unanswered questions. Clinical relevance There have been numerous studies on the treatment aspects of scaphoid nonunion, with little knowledge about certain people with nonunion who did not have any kind of treatment. The demographics, clinical findings, and radiological parameters do confirm the progression of these nonunion to arthritis, but most of them had fair-to-good outcome throughout their life. It opens our thinking about the real need of treatment in such nonunions and raises numerous questions about the disease. Level of evidence This is a Level IV study.

scholarly journals ALTERNATIVE TO THE INVERTED “Y” INCISION IN SCOLIOSIS SECONDARY TO MYELOMENINGOCELE

2019 ◽  
Vol 18 (1) ◽  
pp. 14-16
Author(s):  
Diego Veiga Bezerra ◽  
Luis Eduardo Munhoz da Rocha ◽  
Dulce Helena Grimm ◽  
Carlos Abreu de Aguiar ◽  
Luiz Müller Ávila ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Spina Bifida ◽  
Postoperative Period ◽  
Medical Records ◽  
Surgical Intervention ◽  
Case Series ◽  
Material Failure ◽  
Spinal Deformities ◽  
Level Of Evidence ◽  
Skin Conditions

ABSTRACT Objective: To evaluate the healing of the modified inverted “Y” incision in patients with scoliosis due to myelomeningocele. Methods: Retrospective study through medical records review of patients with myelomeningocele surgically treated with a modified inverted “Y” approach between January 2013 and December 2015. Results: We analyzed the medical records of six patients. Two patients progressed with skin complications in the immediate postoperative period and only one of them required surgical intervention for debridement and suturing. In another patient, it was necessary to perform two surgical reviews due to material failure without skin complications in these interventions. Conclusions: The modified inverted “Y” technique is a great alternative to traditional incision and inverted “Y” because it has good results in patients with spina bifida associated with poor skin conditions treated surgically for correction of spinal deformities. Level of Evidence IV; Case series.

CLINICAL OUTCOMES OF PATIENTS UNDERGOING CORRECTION OF NEUROMUSCULAR SCOLIOSIS WITH A CONTROLLED HOSPITAL PROTOCOL – PRELIMINAR OUTCOMES

2021 ◽  
Vol 20 (4) ◽  
pp. 249-253
Author(s):  
Gabriela Alcalde Pereira ◽  
Caroline de Carvalho Garcia ◽  
Marcia Almeida Lima ◽  
José Carlos Baldocchi Pontin ◽  
Andrea Dias Lamas Mafra
Keyword(s):  
Retrospective Study ◽  
Surgical Correction ◽  
Neuromuscular Scoliosis ◽  
Complication Rates ◽  
Level Of Evidence ◽  
The Mean ◽  
Underlying Diseases ◽  
Level Hospital ◽  
Epidemiological Characterization

ABSTRACT Objectives: To identify the main hospital outcomes of patients undergoing surgical correction of neuromuscular scoliosis and to assess complication rates and achievement of mobility goals after the use of a managed protocol. Methods: This is a longitudinal, retrospective study, with data obtained six months after the application of a protocol in 103 patients of both sexes submitted to surgical correction of neuromuscular scoliosis, at a tertiary level hospital in São Paulo, between June and December 2018 (pre-protocol) and between May and September 2019 (post-protocol). Data from patients who had previously undergone other orthopedic spine surgeries were excluded. In addition to the data for epidemiological characterization of the underlying diseases, the clinical characteristics and complications were analyzed. Results: Of the 103 patients evaluated, there was a predominance of females (53.4%) and a mean age of 14.9 years. The most frequent diagnosis was cerebral palsy, the mean angle of curvature was 75°, and the most frequently observed comorbidities were lung diseases (25%). The protocol was partially adhered to by professionals and after its implementation, there was a significant decrease in pain and the systemic inflammatory response syndrome (SIRS), prevention of immobility and a low rate of infection. Conclusions: The use of a protocol focused on patients undergoing correction of neuromuscular scoliosis led to reduced complications of SIRS and reduced pain; kept the surgical site infection rate low, and prevented short-term immobility. Level of evidence III; Retrospective study.

Syndactyly release: a comparison of skin graft versus graftless techniques in the same patient

2019 ◽  
Vol 44 (8) ◽  
pp. 845-849 ◽  
Author(s):  
Angela A. Wang ◽  
Douglas T. Hutchinson
Keyword(s):  
Visual Analogue Scale ◽  
Skin Graft ◽  
Analogue Scale ◽  
Contralateral Side ◽  
Level Of Evidence ◽  
Tourniquet Time ◽  
The Mean ◽  
Scar Score

Syndactyly release may be done by skin graft or graftless techniques. We prospectively examined bilateral syndactyly releases in the same patient at one operation. The grafted side was randomized and the contralateral side was done graftless. Fourteen patients had surgery at a mean age of 27 months (range 7–166). The mean follow-up was 52 months (range 6–111). The mean tourniquet time was 97 minutes (range 66–135) for graft and 84 minutes (55–120) for graftless. The mean finger abduction was 57° (32°–80°) for graft and 54° (38°–80°) for graftless. The mean web creep score was 1.2 (0–3) for graft and 2.1 (0–3) for graftless. The mean scar score was 1.9 (1–3) bilaterally. The mean parents’ visual analogue scale for graft cosmesis was 7.1 (5–9) and 6.2 (4.3–8) for graftless. The surgeon’s visual analogue scale for graft was 7.9 (6.4–9.5) and 6.2 (4–8.7) for graftless. The therapist’s visual analogue scale was 7.9 (6.5–10) and 6.4 (4.7–8) for graftless. Although there is a longer tourniquet time with grafting, there may be advantages in appearance and web creep. Level of evidence: II

Treatment of unstable proximal interphalangeal joint fractures with hemi-hamate osteochondral autografts

2016 ◽  
Vol 42 (2) ◽  
pp. 188-193 ◽  
Author(s):  
M. Burnier ◽  
T. Awada ◽  
F. Marin Braun ◽  
P. Rostoucher ◽  
M. Ninou ◽  
...  
Keyword(s):  
Range Of Motion ◽  
Articular Surface ◽  
Proximal Interphalangeal Joint ◽  
Interphalangeal Joint ◽  
Pinch Strength ◽  
Middle Phalanx ◽  
Level Of Evidence ◽  
Active Flexion ◽  
The Mean

The primary aim of this study was to assess the clinical and radiological results after hemi-hamate resurfacing arthroplasty in patients with acute or chronic unstable fractures of the base of the middle phalanx and to describe technical features that can facilitate the surgical procedure. Hemi-hamate arthroplasties were done in 19 patients (mean age 39 years) with an isolated fracture at the base of the middle phalanx that involved more than 40% of the articular surface. We assessed ten chronic cases (treated >6 weeks after fracture) and nine acute ones (<6 weeks) at a mean of 24 months. Pain scores, QuickDASH scores, grip strengths, range of motion and radiological findings were recorded at follow-up. At follow-up, the mean active flexion at the proximal interphalangeal joint was to 83° with a mean fixed flexion of 17° (active range of motion 66°). The mean active distal interphalangeal motion was 41°. The mean visual analogue scale score was 1.1. The mean QuickDASH score was 11. The mean pinch strength was 82% of the opposite side. Radiographs revealed one partial graft lysis. Level of evidence: IV

scholarly journals Ultrasound Versus Arthrography in Diagnosing the Stability of Minimally Displaced Lateral Humeral Condyle Fractures in Children

2020 ◽  
Author(s):  
Xing Wu ◽  
Xiongtao Li ◽  
Shaowei Yang ◽  
Si Wang ◽  
Jingdong Xia ◽  
...  
Keyword(s):  
Articular Cartilage ◽  
Articular Surface ◽  
Level Of Evidence ◽  
Fractures In Children ◽  
Pearson Coefficient ◽  
The Mean ◽  
Pre Treatment ◽  
The Stability ◽  
Humeral Condyle ◽  
Humeral Epiphysis

Abstract Background: The evaluation of the articular cartilage status of the distal humeral epiphysis is difficult. Ultrasound of the elbow is increasingly used to confirm the integrity of the articular cartilage of minimally displaced lateral humeral condyle fractures in children in minimally displaced fractures. The aim of this study was to assess the correlation between ultrasound with arthrography for predicting the integrity of the cartilage hinge and describe the utility of ultrasound in directing the need for pre-treatment. Methods: 39 patients with minimally displaced lateral humeral condyle fractures and underwent ultrasound and arthrography examinations before operation from May 2018 to December 2019 were included in this study. The ultrasound and arthrography predictors of the cartilage hinge status were independently measured. Result of ultrasound and arthrography were compared.Results: The mean displacement of fractures was 3.1 mm (range, 2.0～5.0 cm). The arthrography showed an incomplete fracture in 24 patients (61.5%) and complete in 15 patients (38.5%). The ultrasound showed an incomplete fracture in 25 patients (64.1%) and complete in 14 patients (35.9%). The ultrasound and arthrography evaluations of the integrity of the articular surface were consistent in 92.3% of the cases, including 23 were predicted to have an intact articular surface, and 13 were predicted to have incongruity articular surface. There was no correlation between displacement and the fracture being complete on ultrasound. The Pearson coefficient value of ultrasound and arthrography for assessing the integrity of the articular surface was 0.837. Conclusions: Ultrasound and arthrography assessments of the integrity of the cartilage hinge status appear to be highly consistent. Ultrasound can be used as a complementary tool with arthrography to predict the integrity of the cartilage hinge status of patients with minimally displaced lateral humeral condyle fractures in children.Level of evidence: Retrospective study; level Ⅳ.

scholarly journals Intra operative assessment of the coronal balance in spinal deformity surgery : a technical note and retrospective study

2021 ◽  
Vol 87 (1) ◽  
pp. 175-179
Author(s):  
Thibault Dewilde ◽  
Sebastiaan Schelfaut ◽  
Sven Bamps ◽  
Matthias Papen ◽  
Pierre Moens
Keyword(s):  
Retrospective Study ◽  
Case Series ◽  
Technical Note ◽  
Coronal Alignment ◽  
Level Of Evidence ◽  
Coronal Balance ◽  
Scoliotic Deformity ◽  
Significant Difference ◽  
The Mean ◽  
The Right

Obtaining a spine that is well balanced after fusion for scoliotic deformity is primordial for the patients’ quality of life. A simple T-shaped instrument combined with standard intraoperative fluoroscopy can be of great help to evaluate the coronal alignment quickly. The aim of this study was to evaluate if a T-shaped device could predict the postoperative coronal balance. Before finalization of the rod fixation, the balance was checked by verifying the relationship between the T-shaped instrument and the upper instrumented vertebra (UIV), and final adjustments were made to correct the coronal balance. A retrospective study was conducted on 48 patients who underwent surgery to correct scoliotic deformity. Intraoperative and postoperative coronal alignment was measured independently by two observers. The mean intraoperative horizontal offset measured between T-shaped instrument and the center of the UIV was 1,69mm to the right with a standard deviation (SD) of 12,43 mm. On postoperative full spine radiographs, the mean offset between the centra sacral vertical line and the center of the UIV was 2,44mm to the left with a SD of 13,10mm. There is no significant difference in coronal balance between both measurements (p=0,12). With this technique we were able to predict the postoperative coronal balance in all but one patient (97,92%). We conclude that the use of a simple T-shaped instrument can provide adequate intraoperative assessment of coronal balance in correcting scoliotic deformity. Level of evidence : IV – case series

scholarly journals Clinical and functional outcomes of Lambrinudi arthrodesis for correcting fixed equinus deformity

2018 ◽  
Vol 12 (2) ◽  
pp. 159-163
Author(s):  
José Antônio Ribeiro Muniz Filho ◽  
Cleber Jesus Pereira ◽  
Eduardo Gomes Espinosa ◽  
Flávio Malagoli Buiatti ◽  
Rafael Teixeira Fernandes ◽  
...  
Keyword(s):  
Postoperative Period ◽  
Functional Outcomes ◽  
Case Series ◽  
Functional Improvement ◽  
Level Of Evidence ◽  
Charcot Marie Tooth Disease ◽  
Significant Correction ◽  
The Mean ◽  
Equinus Deformity ◽  
The Difference

Objective: To evaluate the clinical and functional outcomes of correction of fixed equinus deformity by Lambrinudi arthrodesis. Methods: Eight patients with fixed equinus deformity were retrospectively assessed. Of these patients, three cases developed secondary to Charcot-Marie-Tooth disease, and five cases developed secondary to fibular nerve injury following trauma. All patients underwent Lambrinudi arthrodesis using the open technique, and functional improvement was analysed postoperatively. The mean age of the patients was 27 years and six months, and six patients were men. Results: The results were evaluated using the ankle and hindfoot score of the American Orthopedic Foot and Ankle Society (AOFAS) scale. The mean score in the postoperative period was 61.71 points, ranging from 41 to 74 points. The difference in the tibia-ground angle in the pre- and postoperative period was measured, and there was a significant correction of this angle. Conclusion: The outcomes of Lambrinudi arthrodesis in patients with fixed equinus deformity were satisfactory concerning the improvement of pain, gait, a high degree of correction of the deformity according to the difference in the tibia-ground angle between the pre- and postoperative period, and preservation of the ankle joint. Level of Evidence IV; Therapeutic Studies; Case Series.

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

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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