scholarly journals Systematic treatment of charcot arthropathy of the midfoot

2018 ◽  
Vol 12 (4) ◽  
pp. 324-31
Author(s):  
Milena Peloggia Cursino Fernandes ◽  
Marco Túlio Costa ◽  
Ricardo Cardenuto Ferreira
Keyword(s):  
Conservative Treatment ◽  
Treatment Protocol ◽  
Type Ii ◽  
Charcot Arthropathy ◽  
Systematic Treatment ◽  
Level Of Evidence ◽  
Satisfactory Outcome ◽  
The Mean ◽  
Lost To Follow Up

Objective: The objective of this study was to evaluate the efficacy of the systematic protocol developed in our institution for the treatment of Charcot arthropathy (CA) of the midfoot, specifically for cases anatomically classified as Brodsky type II. Methods: Sixty patients with type II CA were treated in the period between 1997 and 2017 following a systematic protocol adopted at our institution. Two patients (3%) were lost to follow-up, leaving a total of 58 patients with 64 feet (six had bilateral involvement). The mean follow-up time was 31 months (range 12 to 150), and the mean age was 55 years (range 27 to 73). Conservative treatment was indicated in 41/64 of the extremities (64%), and surgical treatment was indicated in 23/64 of the extremities (36%). We considered the result as satisfactory when the patient was able to walk independently, placing full body weight on the foot. The result was considered unsatisfactory when the affected extremity presented clear instability and was deformed to the point that it was not possible to fit it in a stabilizing orthosis or for the patient to place their weight on the foot during walking as well as when it was necessary to perform an amputation. Results: We obtained a satisfactory outcome in 54/60 patients (90%) and in 58/64 feet (91%). In 19/23 of the operated feet (83%) and 39/41 of the conservatively treated feet (95%), the result was  atisfactory. Conclusion: The systematic treatment protocol developed at our institution allows achievement of a favorable prognosis regarding the clinicalfunctional outcome of type II CA, with conservative treatment being sufficient in most cases. Level of Evidence IV; Prognostic Study; Retrospective study.

scholarly journals Evaluation of the prognosis of type IV Charcot arthropathy treatment

2018 ◽  
Vol 12 (4) ◽  
pp. 316-23
Author(s):  
Marcelo Marcucci Chakkour ◽  
Noé De Marchi Neto ◽  
Ricardo Cardenuto Ferreira
Keyword(s):  
Treatment Protocol ◽  
Case Series ◽  
Diabetic Patients ◽  
Charcot Arthropathy ◽  
Level Of Evidence ◽  
Unsatisfactory Result ◽  
Type Iv ◽  
The Mean ◽  
Lost To Follow Up

Objective: To evaluate the prognosis of specialized orthopedic treatment to obtain a functional foot and ankle in diabetic patients with neglected Charcot arthropathy (NCA). Methods: Sixty-five patients with NCA were treated in the period between 2000 and 2017, according to a systematized protocol adopted atour institution. Six patients (9%) were lost to follow-up, and the remaining 59 patients had a total of 63 affected extremities (four patients were bilaterally affected). The mean follow-up time was 72 months (range 12 to 132 months), and the mean age was 54 years (range 30 to 80 years). We considered the results satisfactory when the patient was able to walk independently, fully supporting the foot on the ground. We considered the results unsatisfactory when the affected extremity presented a frank instability and was deformed to the point that it was not possible to accommodate it in a stabilizing orthesis or support it during gait or when amputation was necessary. Results: We obtained an unsatisfactory result in 31 of the 59 patients (53%). Only 31 of the 63 extremities (49%) were considered functional after treatment. Conclusion: The prognosis of NCA treatment using the systematized treatment protocol is poor. Only half of the treated extremities were capable of plantar support and independent gait. Level of Evidence IV; Prognostic Studies; Case Series.

An ulnar parametacarpal perforator flap for volar digital soft tissue reconstruction

2020 ◽  
Vol 45 (8) ◽  
pp. 842-848
Author(s):  
Satoshi Usami ◽  
Kohei Inami ◽  
Yuichi Hirase ◽  
Hiroki Mori
Keyword(s):  
Donor Site ◽  
Perforator Flap ◽  
Soft Tissue Reconstruction ◽  
Level Of Evidence ◽  
Tissue Reconstruction ◽  
The Mean ◽  
Lost To Follow Up ◽  
Pulp Repair ◽  
Sensory Reinnervation

We present outcomes of using a perforator-based ulnar parametacarpal flap in 25 patients for digital pulp defects. These included 17 free transfers to the thumb, index, middle and ring fingers and eight reverse pedicled transfers to the little fingers. This flap includes a dorsal sensory branch of the ulnar nerve, which was sutured to the digital nerve in all transfers. Each flap had one to three reliable perforators (mean 0.44 mm diameter) to the ulnar parametacarpal region and contained at least one perforator within 2 cm proximal to the palmar digital crease. All the 25 flaps survived completely. Twenty-two patients were followed for 15 months (range 12 to 24), and three were lost to follow-up. The mean static and moving two-point discrimination of the flap was 7 mm and 5 mm, respectively. At the donor site, sensory reinnervation was acceptable. We conclude that ulnar parametacarpal perforator flaps offer sensate, thick and glabrous skin for finger pulp repair, all in a single operative field. Level of evidence: IV

The Value of Power Doppler Ultrasonography in Achilles Tendinopathy

2007 ◽  
Vol 35 (10) ◽  
pp. 1696-1701 ◽  
Author(s):  
Robert-Jan de Vos ◽  
Adam Weir ◽  
Lodewijk P. J. Cobben ◽  
Johannes L. Tol
Keyword(s):  
Conservative Treatment ◽  
Doppler Ultrasonography ◽  
Power Doppler ◽  
Achilles Tendinopathy ◽  
Clinical Severity ◽  
Power Doppler Ultrasonography ◽  
Level Of Evidence ◽  
Vas Score ◽  
The Mean

Background Neovascularization, detected with power Doppler ultrasonography (PDU), is thought by some to play a central role in pathogenesis of Achilles tendinopathy. Hypothesis Power Doppler ultrasonography neovascularization score is correlated with clinical severity at baseline and after conservative treatment. Study Design Cohort study (prognosis); Level of evidence, 2. Methods Seventy tendons from 58 patients with chronic midportion Achilles tendinopathy were included, and 63 symptomatic tendons were analyzed. All patients were prescribed a 12-week heavy-load eccentric training program and evaluated with PDU at baseline and 12 weeks. Patient satisfaction, Victorian Institute of Sports Assessment—Achilles (VISA-A) score, and mean visual analog scale (VAS) score were correlated with degree of neovascularization (5-grade scale). Results Of the 63 symptomatic tendons, baseline neovascularization scores were 23 grade 0 (37% no neovessels), 18 grade 1, 8 grade 2, 8 grade 3, and 6 grade 4 (63% neovascularization grades 1-4). At baseline, neovascularization was not significantly correlated with the mean VAS score (r = .19, P = .131) and VISA-A score (r = —.23, P = .074). At 12-week follow-up, the neovascularization score significantly correlated with the mean VAS score (r = .43, P < .001) and VISA-A score (r = —.46, P < .001). No significant differences were found in improvement of VISA-A score after treatment between patients with neovessels (grades 1-4) or without neovessels (grade 0) at baseline. Conclusion Sixty-three percent of the symptomatic tendons were found to have neovessels at baseline. There was no significant correlation between neovascularization score and clinical severity at baseline, but at follow-up, there was a significant correlation. Neovascularization at baseline did not predict clinical outcome after conservative treatment.

Hybrid Fixation for Ankle Fusion in Diabetic Charcot Arthropathy

2017 ◽  
Vol 39 (1) ◽  
pp. 93-98 ◽  
Author(s):  
Hani El-Mowafi ◽  
Mazen Abulsaad ◽  
Yasser Kandil ◽  
Ahmed El-Hawary ◽  
Samer Ali
Keyword(s):  
External Fixator ◽  
Intramedullary Nail ◽  
Case Series ◽  
Poor Quality ◽  
Charcot Arthropathy ◽  
Hybrid Fixation ◽  
Level Of Evidence ◽  
Ankle Fusion ◽  
The Mean

Background: Ankle fusion is difficult to achieve in the diabetic Charcot ankle Brodsky type 3a because of the poor quality of the bone and the inability to achieve a stable biomechanical construct. The aim of this study was to report the outcome of ankle fusion using a combination of an intramedullary nail and a circular external fixator in patients with diabetic Charcot arthropathy. Methods: We prospectively studied 24 patients with diabetic Charcot arthropathy of the ankle who were treated by fusion of the tibiotalar joint using a combined retrograde intramedullary nail and Ilizarov external fixator. Their mean age was 50.7 ± 6.9 (range, 43-62) years. The mean follow-up after surgery was 36.4 ± 5.8 (range, 24-98) months. Results: Twenty-two patients (92%) achieved clinical and radiographic solid bony fusion. No patients in this series needed amputation. All the patients were pain free, and the mean American Orthopaedic Foot & Ankle Society Score (AOFAS) improved significantly from 34.6 ± 6.8 to 66.4 ± 4.5 at the last follow-up. Two patients developed an ulcer over the heel due to a prominent nail. The ulcer healed after nail removal. Eight patients developed pin tract infection. Conclusion: We report a successful outcomes of ankle fusions using combined intramedullary nail locked only proximally and ring external fixator (hybrid fixation) in patients with diabetic Charcot arthropathy. Level of Evidence: Level IV, case series.

scholarly journals Acute retrograde tibiotalocalcaneal nailing in osteoporotic periarticular ankle fractures

2020 ◽  
Vol 14 (2) ◽  
pp. 117-122
Author(s):  
Mario Herrera-Perez ◽  
Pablo Martín-Vélez ◽  
Diego Rendón-Díaz ◽  
José Luis Pais-Brito
Keyword(s):  
Case Series ◽  
Deep Infection ◽  
Ankle Fractures ◽  
Assistive Device ◽  
Short Term ◽  
Level Of Evidence ◽  
The Mean ◽  
Fracture Level ◽  
Lost To Follow Up

Objective: This study aimed to report the short-term results of retrograde tibiotalocalcaneal (TTC) nailing in a selected series of patients with fragility ankle fractures. Methods: This study included 17 patients who underwent primary retrograde TTC nailing from January 2016 to April 2019. The Olerud-Molander ankle score (OMAS) was recorded preoperatively and at the final follow-up. Results: Mean patient age was 81.5 years (range, 67-91 years), and mean follow-up duration was 20.9 months (range, 8-50 months). No patient was lost to follow-up. Eleven patients had diabetes. Thirteen patients were able to walk with an assistive device, and 4 with help from another person. Two patients died at 8 and 9 months after treatment. Radiographic healing was observed in 100% of the fractures. No deep infection or scarring problems were recorded. Two patients were wheelchair bound after treatment, whereas 15 recovered their previous autonomy. The mean OMAS score changed from 64.1 (range, 55-75) preoperatively to 55.3 (range, 45-65) postoperatively. Conclusion: Our results suggest that primary retrograde TTC nailing is a valid option in selected patients with fragility ankle fractures, multiple comorbidities, poor soft tissue condition, and difficulty in walking before the fracture. Level of Evidence IV; Therapeutic Studies, Case Series.

Scaphometacarpal arthroplasty: a report of ten cases of trapeziometacarpal prosthesis and trapeziectomy revision

2020 ◽  
Vol 45 (5) ◽  
pp. 483-487 ◽  
Author(s):  
Leo Chiche ◽  
Herve Lamarre ◽  
Stephane Barbary ◽  
Jacques Teissier
Keyword(s):  
Multicentre Study ◽  
Medium Term ◽  
Level Of Evidence ◽  
Power Grip ◽  
Early Loosening ◽  
Cause Of Failure ◽  
The Mean ◽  
Quick Dash ◽  
Lost To Follow Up

Loosening of the trapezial component is a main cause of failure of trapeziometacarpal prostheses. This report presents the preliminary results of scaphometacarpal prostheses used for revision of trapeziometacarpal prostheses and failed trapeziectomies. A retrospective multicentre study was conducted on ten patients. Four had revision surgery after failure of trapeziometacarpal prostheses, five after trapeziectomy and one after a trapezial silicone implant. Pain, mobility, strength, QuickDASH, satisfaction score and radiographs were assessed. Nine patients were assessed (one was lost to follow-up), with a mean follow-up of 34 months. The mean pain score was 1.2/10, Quick-DASH was 39 and opposition according to the Kapandji score was 8.6. Strength was 3 kg for key pinch and 13.6 kg for power grip. One failure was observed, with early loosening of the scaphoid cup. Scaphometacarpal arthroplasty is a reliable medium-term solution for revision of the loosening of a trapeziometacarpal prosthesis with trapezial damage and for failed trapeziectomy. Level of evidence: IV

scholarly journals 63 Chronic Femoral Osteomyelitis Case Series: Outcomes and Economic Impact at A United Kingdom Based Tertiary Centre

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
E Lau ◽  
Z Arshad ◽  
A Aslam ◽  
A Thahir ◽  
M Krkovic
Keyword(s):  
Economic Impact ◽  
Treatment Protocol ◽  
Case Series ◽  
Consecutive Series ◽  
Financial Loss ◽  
Patient Demographics ◽  
Tertiary Centre ◽  
The Mean ◽  
Eq Vas

Abstract Introduction Osteomyelitis refers to an inflammatory process affecting bone and bone marrow. This study reviews chronic femoral osteomyelitis treatment and outcomes, including economic impact. Method We retrospectively collected data from a consecutive series of 14 chronic femoral osteomyelitis patients treated between January 2013 and January 2020. Data collected include patient demographics, comorbidities, pathogens, complications, treatment protocol and costs. Functional outcome was assessed using EuroQOL five-dimensional interview administration questionnaire (EQ-5D-5L™) and EuroQOL Visual Analogue Scale (EQ-VAS™). Results Of these, 92.9% had one or more osteomyelitis risk factor, including smoking and diabetes. Samples from 78.6% grew at least one pathogen. Only 42.9% achieved remission after initial treatment, but 85.7% were in remission at final follow-up, with no signs of recurrence throughout the follow-up period (mean: 21.4 months). The average treatment cost was £39,249.50 with a net mean loss of £19,080.10 when funding was considered. The mean-derived EQ-5D score was 0.360 and the mean EQ-VAS score was 61.7, lower than their values for United Kingdom’s general population, p = 0.0018 and p = 0.013 respectively. Conclusions Chronic femoral osteomyelitis treatment is difficult, resulting in significant economic burden. With previous studies showing cheaper osteomyelitis treatment at specialist centres, our net financial loss incurred suggests the need for management at specialised centres.

scholarly journals Failed Surgery for Patellar Tendinopathy in Athletes: Midterm Results of Further Surgical Management

2021 ◽  
Vol 9 (3) ◽  
pp. 232596712199455
Author(s):  
Nicola Maffulli ◽  
Francesco Oliva ◽  
Gayle D. Maffulli ◽  
Filippo Migliorini
Keyword(s):  
Surgical Management ◽  
Revision Surgery ◽  
Case Series ◽  
Sports Participation ◽  
Patellar Tendinopathy ◽  
Symptom Duration ◽  
Level Of Evidence ◽  
Training Time ◽  
The Mean

Background: Tendon injuries are commonly seen in sports medicine practice. Many elite players involved in high-impact activities develop patellar tendinopathy (PT) symptoms. Of them, a small percentage will develop refractory PT and need to undergo surgery. In some of these patients, surgery does not resolve these symptoms. Purpose: To report the clinical results in a cohort of athletes who underwent further surgery after failure of primary surgery for PT. Study Design: Case series; Level of evidence, 4. Methods: A total of 22 athletes who had undergone revision surgery for failed surgical management of PT were enrolled in the present study. Symptom severity was assessed through the Victorian Institute of Sport Assessment Scale for Patellar Tendinopathy (VISA-P) upon admission and at the final follow-up. Time to return to training, time to return to competition, and complications were also recorded. Results: The mean age of the athletes was 25.4 years, and the mean symptom duration from the index intervention was 15.3 months. At a mean follow-up of 30.0 ± 4.9 months, the VISA-P score improved 27.8 points ( P < .0001). The patients returned to training within a mean of 9.2 months. Fifteen patients (68.2%) returned to competition within a mean of 11.6 months. Of these 15 patients, a further 2 had decreased their performance, and 2 more had abandoned sports participation by the final follow-up. The overall rate of complications was 18.2%. One patient (4.5%) had a further revision procedure. Conclusion: Revision surgery was feasible and effective in patients in whom PT symptoms persisted after previous surgery for PT, achieving a statistically significant and clinically relevant improvement of the VISA-P score as well as an acceptable rate of return to sport at a follow-up of 30 months.

scholarly journals A Novel Retensioning Technique for Arthroscopic Repair of PASTA Lesions: A Clinical and Radiologic Outcome Study of 24 Shoulders

2021 ◽  
Vol 9 (3) ◽  
pp. 232596712098688
Author(s):  
Su Cheol Kim ◽  
Jong Ho Jung ◽  
Sang Min Lee ◽  
Jae Chul Yoo
Keyword(s):  
Constant Score ◽  
Case Series ◽  
Tendon Healing ◽  
Shoulder Abduction ◽  
Level Of Evidence ◽  
Simple Shoulder Test ◽  
Shoulder Range Of Motion ◽  
Functional Scores ◽  
The Mean

Background: There is no consensus on the ideal treatment for partial articular supraspinatus tendon avulsion (PASTA) lesions without tendon damage. Purpose: To introduce a novel “retensioning technique” for arthroscopic PASTA repair and to assess the clinical and radiologic outcomes of this technique. Study Design: Case series; Level of evidence, 4. Methods: A retrospective analysis was performed on 24 patients whose PASTA lesion was treated using the retensioning technique between January 2011 and December 2015. The mean ± SD patient age was 57.6 ± 7.0 years (range, 43-71 years), and the mean follow-up period was 57.6 ± 23.4 months (range, 24.0-93.7 months). Sutures were placed at the edge of the PASTA lesion, tensioned, and fixed to lateral-row anchors. After surgery, shoulder range of motion (ROM) and functional scores (visual analog scale [VAS] for pain, VAS for function, American Shoulder and Elbow Surgeons [ASES] score, Constant score, Simple Shoulder Test, and Korean Shoulder Score) were evaluated at regular outpatient visits; at 6 months postoperatively, repair integrity was evaluated using magnetic resonance imaging (MRI). Results: At 12 months postoperatively, all ROM variables were improved compared with preoperative values, and shoulder abduction was improved significantly (136.00° vs 107.08°; P = .009). At final follow-up (>24 months), the VAS pain, VAS function, and ASES scores improved, from 6.39, 4.26, and 40.09 to 1.00, 8.26, and 85.96, respectively (all P < .001). At 6 months postoperatively, 21 of the 24 patients (87.5%) underwent follow-up MRI; the postoperative repair integrity was Sugaya type 1 or 2 for all of these patients, and 13 patients showed complete improvement of the lesion compared with preoperatively. Conclusion: The retensioning technique showed improved ROM and pain and functional scores as well as good tendon healing on MRI scans at 6-month follow-up in the majority of patients. Thus, the retensioning technique appears to be reliable procedure for the PASTA lesion.

scholarly journals Clinical and radiological outcomes of acetabular revision surgery with trabecular titanium cups in Paprosky type II and III bone defects

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Loris Perticarini ◽  
Stefano Marco Paolo Rossi ◽  
Marta Medetti ◽  
Francesco Benazzo
Keyword(s):  
Revision Surgery ◽  
Case Series ◽  
Bone Defects ◽  
Harris Hip Score ◽  
Type Ii ◽  
Level Of Evidence ◽  
Kaplan Meier ◽  
Prospective Case Series ◽  
Acetabular Components

Abstract Background This prospective study aims to evaluate the mid-term clinical outcomes and radiographic stability of two different types of cementless trabecular titanium acetabular components in total hip revision surgery. Methods Between December 2008 and February 2017, 104 cup revisions were performed using trabecular titanium revision cups. Mean age of patients was 70 (range 29–90; SD 11) years. The majority of revisions were performed for aseptic loosening (86 cases, 82.69%), but in all the other diagnoses (18 cases), a significant bone loss (Paprosky type II or III) was registered preoperatively. Bone defects were classified according to Paprosky acetabular classification. We observed 53 type II defects and 42 type III defects. Cups were chosen according to the type of defect. Results Average follow-up was 91 (range 24–146) months. Mean Harris Hip Score (HHS) improved from 43.7 (range 25–70; SD 9) preoperatively to 84.4 (range 46–99; SD 7.56) at last follow-up. One (1.05%) cup showed radiographic radiolucent lines inferior to 2 mm and was clinically asymptomatic. One (1.05%) cup was loose and showed periacetabular allograft reabsorption. Kaplan–Meier survivorship was assessed to be 88.54% (95% CI 80.18–93.52%) at 71 months, with failure of the cup for any reason as the endpoint. Conclusion Trabecular titanium revision cups showed good clinical and radiographic results at mid-term follow-up in Paprosky type II and III bone defects. Level of evidence Level IV prospective case series

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