scholarly journals Minimally invasive intramedullary fixation with flexible nails in the treatment of metatarsal neck fractures

2019 ◽  
Vol 13 (2) ◽  
pp. 97-103 ◽  
Author(s):  
Victor Chammas ◽  
Inácio Diogo Asaumi ◽  
Alfonso Apostólico Netto ◽  
Rafael Da Rocha Macedo ◽  
Donato Lo Turco ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Statistical Tests ◽  
Case Series ◽  
Metatarsophalangeal Joint ◽  
Intramedullary Fixation ◽  
Level Of Evidence ◽  
Significant Difference ◽  
Fracture Consolidation ◽  
Flexible Intramedullary Nails

Objective: This study was designed to retrospectively assess patients with deviated central metatarsal neck fractures subjected to reduction and fixation with flexible intramedullary nails. Methods: Thirty-six patients (36 feet) diagnosed with acute fractures of one or more metatarsals and whose therapeutic indication was exclusively surgical were evaluated between June 2010 and August 2011. Considering the metatarsophalangeal joint, such injuries should be located up to two centimeters in the proximal direction of this segment, with plantar deviation greater than 10 degrees and translation greater than three millimeters in any plane. Minimally invasive intramedullary fixation with two flexible titanium nails was used when adequate stability was not obtained with the use of one nail. The visual analog scale (VAS), American Orthopedic Foot & Ankle Society (AOFAS) forefoot score and specific statistical tests were used. Results: There was a significant (p<0.001) improvement in the results until 6 months of follow-up. There was no significant difference (p>0.05) in the results between 6 and 12 months of follow-up. The average time of consolidation was 8 weeks, and there were no complications during the period evaluated. Conclusion: This technique provided a significant (p<0.001) improvement in the VAS and AOFAS forefoot scores at 6 months of follow-up. Between 6 and 12 months of postoperative follow-up, we did not observe a significant (p<0.05) difference in the results of the analysis due to stabilization of the condition and fracture consolidation. Although the results were considered excellent, the level of evidence of studies should be increased to effectively demonstrate the efficacy of this technique. Level of Evidence IV; Therapeutic Studies; Case Series.

Interdigital Commissural Approach for Morton’s Neuroma

2020 ◽  
Vol 41 (10) ◽  
pp. 1226-1233
Author(s):  
Juan Manuel Yañez Arauz
Keyword(s):  
Minimally Invasive ◽  
Case Series ◽  
Complication Rates ◽  
Morton’S Neuroma ◽  
Retrospective Case ◽  
Level Of Evidence ◽  
Long Term Outcome ◽  
Significant Difference ◽  
Morton's Neuroma

Background: Morton’s neuroma is a frequent cause of metatarsalgia. Operative treatment is indicated if nonoperative management has failed. The objective of the present study was to describe a technique of Morton’s neuroma excision by a minimally invasive commissural approach and evaluate the long-term outcome and complications. Methods: A retrospective study of 108 patients with Morton’s neuroma treated surgically with a commissural approach between September 1990 and December 2010 was performed. The surgical technique is described. Clinical outcomes and complications were evaluated. The average follow-up was 121 months. Eleven patients were men and 97 women. The average age was 49.4 years; 56.8% neuromas were at the third space and 43.2% at the second space. Six patients presented 2 neuromas in the same foot, and 9 patients had bilateral neuroma. Results: The visual analog scale (VAS) average pain score was 5.4 points preoperatively and 0.2 points at the final follow-up. The author found a significant difference between the VAS scores preoperatively and postoperatively ( P < .01). Excellent and good satisfaction outcomes were achieved in 93.6%. The postoperative complication incidence was 3%. Conclusion: The author believes a minimally invasive commissural approach has advantages over a dorsal or plantar incision. It is a simple and reproducible technique, with satisfactory outcomes, low complication rates, and a quick return to usual activities. Level of Evidence: Level IV, retrospective case series.

scholarly journals Minimally invasive bunionette treatment

2020 ◽  
Vol 14 (2) ◽  
pp. 148-152
Author(s):  
Alexander Felipe de Vete Lima ◽  
Tiago Soares Baumfeld ◽  
Bruno Maciel Maciel ◽  
Daniel Soares Baumfeld ◽  
Guillaume Cordier ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Minimally Invasive ◽  
Callus Formation ◽  
Case Series ◽  
Invasive Technique ◽  
Aofas Score ◽  
Level Of Evidence ◽  
Radiographic Measurements ◽  
Significant Difference

Objective: To report the clinical and radiographic results of surgical treatment of bunionette deformity with a minimally invasive technique without the use of hardware. Methods: This is a case series of 13 patients (14 feet) with a diagnosis of bunionette surgically treated with a minimally invasive osteotomy of the fifth metatarsal. All patients completed the American Orthopedic Foot and Ankle Society (AOFAS) score and a visual analog scale (VAS) for pain preoperatively and in the last follow-up visit. Radiographic measurements included the fourth-fifth intermetatarsal angle (4-5 IMA) and the fifth metatarsophalangeal (MTP-5) angle. Complications and level of patient satisfaction were also documented. Results: Mean follow-up was 12.3 months. The mean AOFAS score increased from 51.3 to 94.0, and the VAS score decrease from 7.5 to 1.1. The MTP-5 angle decreased from 11.5º to 2.3º, and the 4-5 IMA decreased from 9.8º to 3.6º. These outcomes showed a statistically significant difference (p<0.001). The only complication was hypertrophic callus formation observed in 3 feet (21.4%). There were no cases of infection, neurapraxia, wound dehiscence, nonunion, or deformity recurrence. Ten patients rated their outcome as excellent and 3 as good. Conclusion: Treatment of bunionette with percutaneous osteotomy of the fifth metatarsal without the use of hardware showed good clinical and radiographic results, with a low complication rate and a high level of patient satisfaction. Level of Evidence IV; Therapeutic Studies; Case Series.

Outcomes After Interpositional Arthroplasty of the First Metatarsophalangeal Joint

2017 ◽  
Vol 38 (5) ◽  
pp. 514-518 ◽  
Author(s):  
Michael C. Aynardi ◽  
Lara Atwater ◽  
Eric J. Dein ◽  
Talal Zahoor ◽  
Lew C. Schon ◽  
...  
Keyword(s):  
Case Series ◽  
Metatarsophalangeal Joint ◽  
Hallux Rigidus ◽  
Level Of Evidence ◽  
First Metatarsophalangeal Joint ◽  
Interpositional Arthroplasty ◽  
Significant Difference ◽  
Patient Reported ◽  
Functional Scores

Background: For patients with hallux rigidus seeking a motion-sparing procedure, interposition arthroplasty is an alternative to fusion. The purpose of this study was to report patient outcomes after interpositional arthroplasty for hallux rigidus. Methods: All patients undergoing interpositional arthroplasty at our institution from 2001 to 2014 were identified and a retrospective chart review was performed. Follow-up was conducted through a telephone survey to obtain survivorship, satisfaction, and functional scores. Survivorship of the interpositional arthroplasty procedure was defined as no subsequent surgery on the hallux after the index procedure. Patients were excluded for incomplete records. Complications were recorded. From 2001 to 2014, 183 patients were identified. Of these, 14 were excluded for incomplete data, leaving 169 patients. Of these, 133 had an average follow-up of 62.2 months (range, 24.3 months to 151.2 months). Results: The overall failure rate was 3.8% (5/133). Patient-reported outcome was rated as excellent in 65.4% (87/133) or good in 24.1% (32/133) of patients and fair or poor in 10.5% (14/133) of patients. Of 133 patients, 101 (76%) were able to return to fashionable or regular footwear. The infection rate was 1.5% (2/133). Patient-reported cock-up deformity of the first metatarsophalangeal joint (MTPJ) occurred in 4.5% (6/133) of patients. In addition, 17.3% (23/133) of patients reported metatarsalgia of the second or third MTPJ at the time of final follow-up, and there was no significant difference between interposition types ( P = .441). Conclusion: Interpositional arthroplasty for hallux rigidus was found to have excellent or good results in most patients at a mean follow-up of 62.2 months. Level of Evidence: Level IV, retrospective case series.

Clinical and Ultrasonographic Results of Ultrasonographically Guided Percutaneous Radiofrequency Lesioning in the Treatment of Recalcitrant Lateral Epicondylitis

2011 ◽  
Vol 39 (11) ◽  
pp. 2429-2435 ◽  
Author(s):  
Cheng-Li Lin ◽  
Jung-Shun Lee ◽  
Wei-Ren Su ◽  
Li-Chieh Kuo ◽  
Ta-Wei Tai ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Grip Strength ◽  
Surgical Intervention ◽  
Current Trend ◽  
Case Series ◽  
Lateral Epicondylitis ◽  
Extensor Tendon ◽  
Level Of Evidence ◽  
Vas Score

Background: In patients with lateral epicondylitis recalcitrant to nonsurgical treatments, surgical intervention is considered. Despite the numerous therapies reported, the current trend of treatment places particular emphasis on minimally invasive techniques. Purpose: The authors present a newly developed minimally invasive procedure, ultrasonographically guided percutaneous radiofrequency thermal lesioning (RTL), and its clinical efficacy in treating recalcitrant lateral epicondylitis. Study Design: Case series: Level of evidence, 4. Methods: Thirty-four patients (35 elbows), with a mean age of 52.1 years (range, 35-65 years), suffered from symptomatic lateral epicondylitis for more than 6 months and had exhausted nonoperative therapies. They were treated with ultrasonographically guided RTL. Patients were followed up at least 6 months by physical examination and 12 months by interview. The intensity of pain was recorded with a visual analog scale (VAS) score. The functional outcome was evaluated using grip strength, the upper limb Disability of Arm, Shoulder and Hand (QuickDASH) outcome measure, and the Modified Mayo Clinic Performance Index (MMCPI) for the elbow. The ultrasonographic findings regarding the extensor tendon origin were recorded, as were the complications. Results: At the time of the 6-month follow-up, the average VAS score in resting (from 4.9 to 0.9), palpation (from 7.6 to 2.5), and grip (from 8.2 to 2.9) had improved significantly compared with the preoperative condition ( P < .01). The grip strength (from 20.6 to 27.0 kg) and QuickDASH score (from 54.3 to 21.0) had also improved significantly ( P < .01). The MMCPI score improved from “poor” to “excellent.” The ultrasonographic finding revealed that the thickness of the common extensor tendon origin did not change significantly. At the final follow-up (mean, 14.3 months; range, 12-21 months), the patients reported a 78% reduction in pain compared with the preoperative status. No major complications were noted in any patient. Conclusion: Ultrasonographically guided RTL for recalcitrant lateral epicondylitis was found to be a minimally invasive treatment with satisfactory results in this pilot investigation. This innovative method can be considered as an alternative treatment of recalcitrant lateral epicondylitis before further surgical intervention.

scholarly journals Arthroscopic-Guided Balloon Tibioplasty in Schatzker III Tibial Plateau Fracture

Joints ◽  
2018 ◽  
Vol 06 (04) ◽  
pp. 220-227 ◽  
Author(s):  
Fabrizio Cuzzocrea ◽  
Eugenio Jannelli ◽  
Alessandro Ivone ◽  
Simone Perelli ◽  
Alberto Fioruzzi ◽  
...  
Keyword(s):  
Ct Scan ◽  
Tibial Plateau ◽  
Case Series ◽  
Clinical Score ◽  
Joint Surface ◽  
X Rays ◽  
Level Of Evidence ◽  
Significant Difference ◽  
The Mean

Abstract Purpose The study aims to present the results at a mean 28-months follow-up of arthroscopic-guided balloon tibioplasty and to spot some technical tricks and some practice using tools and materials. Methods The study relates to six patients with tibial plateau fractures type Schatzker III with tibial plateau depression more than 4 mm at preoperative computed tomography scan (CT-scan). The follow-up period ranged from 22 to 33 months, with a mean of 28 months. No patients were lost to follow-up. The patients were evaluated clinically using the Rasmussen score system and Lysholm score systems at 6 to 12 and 24 months, postoperatively. Radiographic evaluations (standard X-rays) were done preoperatively at 1, 3, and 12 months postoperatively while a CT-scan with 3D reconstruction was performed preoperatively, at the first day and 6 months, postoperatively. Results The mean Rasmussen clinical score at 6 months postoperatively was 26.3 while at 1-year postoperatively the mean Rasmussen clinical score was 28.33. At 2-year postoperatively the mean Rasmussen clinical score was 28.83. Statistically significant difference was found in 6-months and 2-years results (p < 0.05). CT-scan achieved the first postoperative day showed the recovery of approximately 70% of the area of the interested tibial plateau, restoring of the joint surface without articular bone free fragments. Conclusion The described surgical procedure, if correctly performed with proper indications (Schatzker III), respect the principles mentioned above and the clinical and radiological results confirm our purpose. Level of Evidence This is a therapeutic case series, level IV study.

scholarly journals Stress shielding following stemless anatomic total shoulder arthroplasty

2021 ◽  
pp. 175857322110588
Author(s):  
William R Aibinder ◽  
Fares Uddin ◽  
Ryan T Bicknell ◽  
Ryan Krupp ◽  
Markus Scheibel ◽  
...  
Keyword(s):  
Shoulder Arthroplasty ◽  
Functional Outcomes ◽  
Total Shoulder Arthroplasty ◽  
Case Series ◽  
Stress Shielding ◽  
Implant Design ◽  
Level Of Evidence ◽  
Lesser Tuberosity ◽  
Significant Difference

Background Finite element analysis has suggested that stemless implants may theoretically decrease stress shielding. The purpose of this study was to assess the radiographic proximal humeral bone adaptations seen following stemless anatomic total shoulder arthroplasty. Methods A retrospective review of 152 prospectively followed stemless total shoulder arthroplasty utilizing a single implant design was performed. Anteroposterior and lateral radiographs were reviewed at standard time points. Stress shielding was graded as mild, moderate, and severe. The effect of stress shielding on clinical and functional outcomes was assessed. Also, the influence of subscapularis management on the occurrence of stress shielding was determined. Results At 2 years postoperatively, stress shielding was noted in 61 (41%) shoulders. A total of 11 (7%) shoulders demonstrated severe stress shielding with 6 occurring along the medial calcar. There was one instance of greater tuberosity resorption. At the final follow-up, no humeral implants were radiographically loose or migrated. There was no statistically significant difference in clinical and functional outcomes between shoulders with and without stress shielding. Patients undergoing a lesser tuberosity osteotomy had lower rates of stress shielding, which was statistically significant ( p = 0.021) Discussion Stress shielding does occur at higher rates than anticipated following stemless total shoulder arthroplasty, but was not associated with implant migration or failure at 2 years follow-up. Level of evidence IV, Case series.

scholarly journals Minimally invasive Chevron-Akin osteotomy

2020 ◽  
Vol 14 (3) ◽  
pp. 264-268
Author(s):  
Gustavo Nunes ◽  
João Magalhães ◽  
Tiago Baumfeld ◽  
Roberto Pinto
Keyword(s):  
Minimally Invasive ◽  
Hallux Valgus ◽  
Case Series ◽  
Preoperative Assessment ◽  
Foot And Ankle ◽  
Level Of Evidence ◽  
Intermetatarsal Angle ◽  
Akin Osteotomy ◽  
Severe Hallux Valgus

Objective: To present the clinical and radiographic results of surgical treatment of patients with moderate to severe hallux valgus (HV) by minimally invasive Chevron - Akin osteotomy (MICA). Methods: The case series comprises 25 patients (30 feet) with diagnoses of moderate to severe HV treated surgically with the MICA technique. All patients answered the American Orthopedic Foot and Ankle Score (AOFAS) and rated pain on visual analogue scale (VAS) at preoperative assessment and at the last follow-up consultation. Radiological assessment included measurement of the valgus angles of the hallux (HVA) and the 1st and 2nd ray intermetatarsal angle (IMA). Complications and satisfaction ratings were also documented. Results: Mean follow-up was 14.6 months. Mean AOFAS increased from 42.8 to 90 and VAS reduced from 8.6 to 1.7. Mean HVA reduced from 31.7o to 8.4o and IMA from 14o to 5o. All these improvements were statistically significant (p<0.001). The most common complication observed was discomfort caused by hardware, affecting five feet (16.6%). Two patients (6.6%) had transitory neurapraxia and one patient (3.3%) developed reflex sympathetic dystrophy. There were no cases of infection, relapse, pseudarthrosis, or malunion of osteotomies. Subjective satisfaction ratings classified 93.3% of results as good or excellent. Conclusion: Minimally invasive Chevron-Akin osteotomy is a safe and reproducible technique that achieves good clinical and radiographic results for treatment of moderate to severe hallux valgus. Level of Evidence IV; Therapeutic Studies; Case Series.

Minimally Invasive Distal Metatarsal Metaphyseal Osteotomy (DMMO) of the Fifth Metatarsal for Bunionette Correction

2018 ◽  
Vol 39 (4) ◽  
pp. 450-457 ◽  
Author(s):  
Kar Hao Teoh ◽  
Kartik Hariharan
Keyword(s):  
Minimally Invasive ◽  
Callus Formation ◽  
Case Series ◽  
Clinical Results ◽  
Osteotomy Site ◽  
Retrospective Case ◽  
Level Of Evidence ◽  
Average Improvement ◽  
The Mean

Background: Different osteotomies have been proposed for the treatment of bunionette deformity. Minimally invasive surgery is now increasingly popular for a variety of forefoot conditions. The aim of this study was to evaluate the outcome following fifth minimally invasive distal metatarsal metaphyseal osteotomy (DMMO) for bunionette deformity. Methods: Nineteen patients (21 feet) who had symptomatic bunionette deformity and failed conservative treatment between 2014 and 2016 were included in this retrospective study. Clinical data were recorded, and pre- and postoperative Manchester-Oxford Foot Questionnaire (MOXFQ) scores and visual analog scale (VAS) pain score were collected. The mean follow-up was 28 months (range, 12-47). Results: The mean MOXFQ summary index score decreased from 71 (range, 59-81) preoperatively to 10 (range, 0-30) postoperatively. All 3 MOXFQ domains also improved. The average improvement in VAS score was 7. Forefoot swelling and some painful symptoms took an average of 3 months to settle. There were no wound or nerve complications. One patient required a dorsal cheilectomy for a symptomatic prominent dorsolateral callus formation. Conclusion: The minimally invasive fifth DMMO for bunionette deformity was a safe and effective technique. It had relatively few complications and led to good clinical results. We believe it is important to warn patients that the forefoot swelling will take months to settle compared to an osteotomy with fixation, and there is a 10% chance of a prominent callus over the osteotomy site. Level of Evidence: Level IV, retrospective case series.

Risk Factors for Complications Associated With Minimally Invasive Medial Displacement Calcaneal Osteotomy

2020 ◽  
pp. 107110072096109
Author(s):  
Michelle M. Coleman ◽  
Mostafa M. Abousayed ◽  
John M. Thompson ◽  
Bryan A. Bean ◽  
Gregory P. Guyton
Keyword(s):  
Minimally Invasive ◽  
Tobacco Use ◽  
Case Series ◽  
Complication Rates ◽  
Retrospective Case ◽  
Level Of Evidence ◽  
Asa Classification ◽  
Calcaneal Osteotomy ◽  
Current Tobacco

Background: Few studies have reported the outcomes following minimally invasive medial displacement calcaneal osteotomy (MDCO) for correction of pes planovalgus deformities. Methods: Charts were retrospectively reviewed for consecutive patients who underwent minimally invasive MDCO procedures by a single surgeon from 2013 to 2019 with more than 3 months of follow-up. A total of 160 consecutive patients who underwent 189 minimally invasive MDCO procedures were included in the study. Median follow-up was 12 months (interquartile range, 7-25 months). Results: Osteotomy healing complications were present in 7% of cases during the 6-year study period. A 12-month case cluster of osteotomy healing complications was observed. Healing complication rates were 28% during the cluster and 0.7% outside of the cluster. No definitive cause was found for the case cluster, although heat osteonecrosis from the burr was suspected to be involved. Osteotomy healing complications were significantly associated with higher American Society of Anesthesiologists (ASA) classification, female sex, current tobacco use, and higher body mass index (BMI). Healing complications were not associated with osteotomy technique or fixation type. Other complications included wound dehiscence (3%), surgical site infection (2%), transient nerve symptoms (6%), and persistent nerve symptoms (2%). Nerve symptoms were significantly associated with an increased number of concomitant procedures. Conclusion: Patients with higher ASA classification, current tobacco use, and higher BMI were at higher risk for osteotomy healing complications after minimally invasive MDCO procedures. Patients were also more likely to develop nerve complications with more extensive surgical procedures. Level of Evidence: Level IV, retrospective case series.

Long-term Follow-up of Cheilectomy for Treatment of Hallux Rigidus

2019 ◽  
Vol 40 (10) ◽  
pp. 1114-1121 ◽  
Author(s):  
Eliezer Sidon ◽  
Ryan Rogero ◽  
Timothy Bell ◽  
Elizabeth McDonald ◽  
Rachel J. Shakked ◽  
...  
Keyword(s):  
Case Series ◽  
Hallux Rigidus ◽  
Long Term Results ◽  
Retrospective Case ◽  
Level Of Evidence ◽  
First Metatarsophalangeal Joint ◽  
Significant Difference ◽  
Long Term Follow Up

Background:Hallux rigidus is the most common arthritic condition in the foot. First metatarsophalangeal joint cheilectomy produces satisfactory results in retrospective studies with reported good to excellent results in up to 97% and pain relief and function in 92%. The results of cheilectomy for higher grades of hallux rigidus are less favorable. The purpose of this study was to evaluate the long-term functional results and survivorship of cheilectomy for treatment of hallux rigidus.Methods:This was a retrospective, questionnaire-based study investigating the long-term results of cheilectomy for treatment of hallux rigidus. The preoperative arthritic grade was graded retrospectively according to the Hattrup and Johnson (H&J) grading system. A questionnaire was administered via email or telephone that included questions regarding pain recurrence following surgery, current functional status, and satisfaction with the operation. Kaplan-Meier survival analysis was performed to estimate survival time between arthritic grades. We reviewed 165 patients (169 feet) with an average follow-up of 6.6 (5.0-10.9) years.Results:The overall survival rate (painless at the time of last follow-up) was 70.4% (119 feet), with no significant difference between the 3 H&J arthritic grades. Most of the recurrences (28 feet, 75%) were at the first 2 years following the surgery. Nine feet (5.3%) had a second procedure at a mean postoperative time of 3.6 (range, 1.6-7.4) years. Of the 169 feet, 117 (69.3%) reported being satisfied or very satisfied and 127 (75.1%) indicated they would repeat the operation under the same circumstances.Conclusion:Our study supports the use of cheilectomy for treatment of hallux rigidus (grade 1-3 Coughlin and Shurnas) as a reliable procedure with favorable results. At long-term follow-up, patients who underwent cheilectomy had a low revision rate and a moderately low rate of pain recurrence.Level of Evidence:Level IV, retrospective case-series.

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