Ankle Arthrodesis with Bone Graft after Distal Tibia Resection for Bone Tumors

2008 ◽  
Vol 29 (10) ◽  
pp. 1031-1037 ◽  
Author(s):  
Domenico Andrea Campanacci ◽  
Guido Scoccianti ◽  
Giovanni Beltrami ◽  
Marco Mugnaini ◽  
Rodolfo Capanna
Keyword(s):  
Distal Tibia ◽  
Functional Results ◽  
Bone Grafts ◽  
Ankle Arthrodesis ◽  
Long Bone ◽  
Soft Tissue Coverage ◽  
Tumor Surgery ◽  
Retrospective Case ◽  
Level Of Evidence ◽  
Autologous Bone

Background: Treatment of distal tibial tumors is challenging due to the scarce soft tissue coverage of this area. Ankle arthrodesis has proven to be an effective treatment in primary and post-traumatic joint arthritis, but few papers have addressed the feasibility and techniques of ankle arthrodesis in tumor surgery after long bone resections. Materials and Methods: Resection of the distal tibia and reconstruction by ankle fusion using non-vascularized structural bone grafts was performed in 8 patients affected by malignant (5 patients) or aggressive benign (3 patients) tumors. Resection length of the tibia ranged from 5 to 21 cm. Bone defects were reconstructed with cortical structural autografts (from contralateral tibia) or allografts or both, plus autologous bone chips. Fixation was accomplished by antegrade nailing (6 cases) or plating (2 cases). Results: All the arthrodesis successfully healed. At followup ranging from 23 to 113 months (average 53.5), all patients were alive. One local recurrence was observed with concomitant deep infection (a below-knee amputation was performed). Mean functional MSTS score of the seven available patients was 80.4% (range, 53 to 93). Conclusion: Resection of the distal tibia and arthrodesis of the ankle with non-vascularized structural bone grafts, combined with autologous bone chips, can be an effective procedure in bone tumor surgery with durable and satisfactory functional results. In shorter resections, autologous cortical structural grafts can be used; in longer resections, allograft structural bone grafts are needed. Level of Evidence: IV, Retrospective Case Study

Management of Long-Term Sequelae of Compartment Syndrome Involving the Foot and Ankle

2009 ◽  
Vol 30 (9) ◽  
pp. 847-853 ◽  
Author(s):  
Francois Lintz ◽  
Jean A. Colombier ◽  
Joseph Letenneur ◽  
Francois Gouin
Keyword(s):  
Compartment Syndrome ◽  
Case Series ◽  
Personal Data ◽  
Functional Results ◽  
Ankle Arthrodesis ◽  
Foot And Ankle ◽  
Retrospective Case ◽  
Level Of Evidence ◽  
Muscle Fibrosis

Background: Lower leg compartment syndrome can lead to severe sequelae affecting patient autonomy. Ischemic muscle fibrosis and retraction result in foot and ankle deformities ranging from claw toes to complex multiplanar dislocations with soft tissue impairment requiring amputation. Although these deformities have been reported in relation to compartment syndrome, they have rarely been discussed specifically in the light of a long term follow up. Materials and Methods: Between 1981 and 2006, 151 patients were treated in our hospital for compartment syndrome of the lower limb. Ten of them later required further surgery to treat sequelae on the foot and ankle and were followed up prospectively. Personal data and surgical events were recorded, as well as potential risk factors for sequelae and functional outcome. The data was analyzed and compared to that available in previous literature. We analyzed and describe the different surgical procedures available for the management of this condition including arthroscopic ankle arthrodesis which could be a less invasive and efficient technique in mild equinus deformities. Results: All ten patients were diagnosed late for compartment syndrome. The anterior and lateral compartments were most often involved but rarely accounted for late sequelae. The deep posterior compartment seems to be the key element in generating after effects. Functional results were good in eight patients. Two required amputation after failed secondary surgery. Conclusion: The late, post-compartment syndrome affecting the foot and ankle can be treated efficiently provided surgery is performed acurately, taking into account the multiplanar deformity. However, the best treatment for this condition remains prevention. Level of Evidence: IV, Retrospective Case Series

scholarly journals Limited Open Reduction and Internal Fixation of Calcaneal Fractures

2019 ◽  
Vol 41 (1) ◽  
pp. 57-62 ◽  
Author(s):  
Anne K. Bremer ◽  
Lukas Kraler ◽  
Lars Frauchiger ◽  
Fabian G. Krause ◽  
Martin Weber
Keyword(s):  
Wound Healing ◽  
Internal Fixation ◽  
Open Reduction ◽  
Case Series ◽  
Functional Results ◽  
High Rate ◽  
Calcaneal Fractures ◽  
Retrospective Case ◽  
Level Of Evidence

Background: The treatment of displaced intra-articular calcaneal fractures remains a challenge and the optimal approach is still controversial. The main reason to avoid the extended lateral approach is the high complication rate due to wound healing problems. We report on 16 years of experience with a standardized limited open reduction and internal fixation technique. Methods: Between 2001 and 2017, we prospectively followed 240 consecutive patients operatively treated for a displaced intra-articular calcaneal fracture. Patients with open, multiple, bilateral, extra-articular, and Sanders IV fractures and those lost to follow-up were excluded. A lateral subtalar approach was used, with a cast for 8 weeks and full weightbearing allowed after 12 weeks. Follow-up examinations were scheduled until 24 months. Subjective and clinical assessment included gait abnormality, subtalar and ankle range of motion, and stability and alignment. The American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot score was calculated. Alignment was analyzed on standard radiographs. In total, 131 patients were excluded. The remaining 109 patients were followed for a minimum of 24 months (34.4 ± 14.2 [range, 24-102] months). Results: The mean AOFAS score was 87 ± 13 (range, 32-100). “Excellent” and “good” results, as well as hindfoot motion with “normal/mild” and “moderate” restrictions, were seen in 80% of patients. Early reoperations were performed for insufficient reduction (2 patients), delayed wound healing (debridement, 3 patients), and hematoma (1 patient). Late revisions were arthrodesis (3 patients), medializing calcaneal osteotomy (1 patient), and implant removal (53 patients; 49%). Conclusion: The presented approach has remained unmodified for 16 years and resulted in consistently good functional results. The main disadvantage was the high rate of heel screw removal. Level of Evidence: Level IV, retrospective case series.

Ethylene oxide gas sterilization: a simple technique for storing explanted skull bone

2007 ◽  
Vol 107 (2) ◽  
pp. 440-445 ◽  
Author(s):  
David H. Jho ◽  
Sergey Neckrysh ◽  
Julian Hardman ◽  
Fady T. Charbel ◽  
Sepideh Amin-Hanjani
Keyword(s):  
Ethylene Oxide ◽  
Decompressive Craniectomy ◽  
Room Temperature ◽  
Simple Technique ◽  
Functional Results ◽  
Bone Grafts ◽  
Increased Risk ◽  
Autologous Bone ◽  
Autologous Bone Grafts

✓ The authors evaluated the effectiveness of a simple technique using ethylene oxide (EtO) gas sterilization and room temperature storage of autologous bone grafts for reconstructive cranioplasty following decompressive craniectomy. The authors retrospectively analyzed data in 103 consecutive patients who underwent cranioplasty following decompressive craniectomy for any cause at the University of Illinois at Chicago between 1999 and 2005. Patients with a pre-existing intracranial infection prior to craniectomy or lost to follow-up before reconstruction were excluded. Autologous bone grafts were cleansed of soft tissue, hermetically sealed in sterilization pouches for EtO gas sterilization, and stored at room temperature until reconstructive cranioplasty was performed. Cranioplasties were performed an average of 4 months after decompressive craniectomy, and the follow-up after reconstruction averaged 14 months. Excellent aesthetic and functional results after single-stage reconstruction were achieved in 95 patients (92.2%) as confirmed on computed tomography. An infection of the bone flap occurred in eight patients (7.8%), and the skull defects were eventually reconstructed using polymethylmethacrylate with satisfactory results. The mean preservation interval was 3.8 months in patients with uninfected flaps and 6.4 months in those with infected flaps (p = 0.02). A preservation time beyond 10 months was associated with a significantly increased risk of flap infection postcranioplasty (odds ratio [OR] 10.8, p = 0.02). Additionally, patients who had undergone multiple craniotomies demonstrated a trend toward increased infection rates (OR 3.0, p = 0.13). Data in this analysis support the effectiveness of this method, which can be performed at any institution that provides EtO gas sterilization services. The findings also suggest that bone flaps preserved beyond 10 months using this technique should be discarded or resterilized prior to reconstruction.

scholarly journals Our experience with percutaneous autologous bone marrow injection in the management of delayed and nonunion of long bone fractures

2018 ◽  
Vol 4 (2) ◽  
pp. 291
Author(s):  
Yeshwanth Subash
Keyword(s):  
Bone Marrow ◽  
Bone Fractures ◽  
Autologous Bone Marrow ◽  
Functional Results ◽  
Long Bone ◽  
Female Ratio ◽  
Long Bone Fractures ◽  
The Mean ◽  
Autologous Bone ◽  
Mean Time

<p class="abstract"><strong>Background:</strong> Various modalities of treatment are available for the management of delayed and nonunion of long bone fractures. The aim of this study was to evaluate the role of percutaneous autologous bone marrow injection in the management of these fractures and to compare the results with studies of other authors as available in literature<span lang="EN-IN">.</span></p><p class="abstract"><strong>Methods:</strong> 15 patients with delayed and nonunion of long bone fractures were studied between January 2013 to January 2015 and were followed up for a period of 1 year. The patients were clinically and radiologically evaluated at regular time intervals at follow up.<strong></strong></p><p class="abstract"><strong>Results:</strong> The age of the patients ranged from 28 to 60 years with the mean age being 44.2 years. There was a male preponderance in our study with the male to female ratio being 2:1. The left side was more commonly affected as compared to the right. The mean time to radiological appearance of callus was 6.4 weeks. The mean time to clinical union was 7.33 weeks while the mean time to radiologic union was 13.4 weeks. We had a union rate of 93.3% in our series with one fracture going in for failure of union<span lang="EN-IN">. </span></p><p class="abstract"><strong>Conclusions:</strong> Percutaneous autologous bone marrow injection is a minimally invasive, safe and cost effective option in the management of delayed and nonunion of long bone fractures and gives good functional results<span lang="EN-IN">.</span></p>

Preliminary Outcomes of Calcaneal Lengthening in Adolescent Flatfoot in Müller-Weiss Disease

2019 ◽  
Vol 40 (7) ◽  
pp. 803-807 ◽  
Author(s):  
Abdel-Salam Abdel-Aleem Ahmed ◽  
Mahmoud Ibrahim Kandil ◽  
Eslam Abdelshafi Tabl
Keyword(s):  
Treatment Options ◽  
Case Series ◽  
Deformity Correction ◽  
Functional Results ◽  
The Body ◽  
Retrospective Case ◽  
Level Of Evidence ◽  
Duration Of Symptoms ◽  
The Mean ◽  
Calcaneal Lengthening

Background: Müller-Weiss disease (MWD) remains a controversial painful foot condition without consensus on its pathogenesis or a gold standard treatment modality. The aim of the study was to evaluate the outcomes of calcaneal lengthening in adolescent patients with symptomatic MWD with flatfoot. Methods: The study included 13 feet of 7 patients including 5 females and 2 males who were treated from March 2012 until June 2015 by calcaneal lengthening. The mean age was 15.6 years. The mean duration of symptoms was 13.5 months. The body mass index (BMI) averaged 28.9 kg/m2 at presentation. The patients were followed up for a mean of 37.8 months. Results: The osteotomy healed in all cases after a mean of 7.2 weeks. The second foot was operated on after an average of 11.5 months. The mean talometatarsal-1 angle improved from 39.8 degrees preoperatively to 5.9 degrees. The mean preoperative calcaneal pitch angle of 7.5 degrees increased to an average of 17.8 degrees postoperatively. The mean American Orthopaedic Foot & Ankle Society (AOFAS) Ankle-Hindfoot Score was improved from 61.9 preoperatively to 94.2 postoperatively. Four patients had occasional exertional pain. Four feet had mild residual forefoot abduction. Arthrodesis was not needed in any case by the last follow-up. Conclusion: Early diagnosis of MWD with flatfoot was important and allowed for nonfusion treatment options. Calcaneal lengthening osteotomy in selected MWD cases achieved satisfactory outcomes with pain control, deformity correction, and improvement of the functional results. Level of Evidence: Level IV, retrospective case series.

Combined use of platelet-rich plasma and autologous bone grafts in the treatment of long bone defects in mini-pigs

Injury ◽  
2010 ◽  
Vol 41 (7) ◽  
pp. 717-723 ◽  
Author(s):  
M. Hakimi ◽  
P. Jungbluth ◽  
M. Sager ◽  
M. Betsch ◽  
M. Herten ◽  
...  
Keyword(s):  
Platelet Rich Plasma ◽  
Bone Grafts ◽  
Bone Defects ◽  
Long Bone ◽  
Combined Use ◽  
Autologous Bone ◽  
Autologous Bone Grafts ◽  
Mini Pigs

scholarly journals Large Osteochondral Lesions of the Talus Treated With Autologous Bone Graft and Periosteum Transfer

2019 ◽  
Vol 4 (3) ◽  
pp. 247301141987403
Author(s):  
Dimitrios Nikolopoulos ◽  
Neoptolemos Sergides ◽  
George Safos ◽  
Konstantinos Moustakas ◽  
Petros Safos ◽  
...  
Keyword(s):  
Bone Graft ◽  
Donor Site ◽  
Autologous Transplantation ◽  
Case Series ◽  
Autologous Bone Graft ◽  
Osteochondral Lesions ◽  
Retrospective Case ◽  
Level Of Evidence ◽  
Functional Scores ◽  
Autologous Bone

Background: The treatment of large osteochondral lesions of the talus (OLTs) is challenging due to the poor intrinsic reparative capability of the damaged articular cartilage. Autologous transfer of bone and periosteum has been used successfully in the treatment of large defects in animals, and therefore it was believed that this technique might show similar results in humans. The purpose of this study was to assess the outcome of an innovative technique for autologous transplantation of cancellous tibial graft with periosteal transfer in large OLTs. Methods: Forty-one patients (22 females, 19 males), with a mean age of 34.9 years (range, 18-72 years), with a large OLT (>200 mm2) were treated with autologous bone graft and periosteum transfer. OLTs averaging 310 mm2 were identified on a preoperative computed tomography scan. The procedure consisted of malleolar osteotomy, curettage of sclerotic bone, autologous bone graft from the proximal tibia, and transfixion of periosteum over the graft. Outcome measures, including the pain visual analog scale (VAS), ankle range of motion (ROM), American Orthopaedic Foot & Ankle Society (AOFAS) score, and Foot & Ankle Disability Index (FADI), were compared between preoperative and 1 and 2 years following surgery. Results: There were significant improvements in VAS pain score from 7.7 before surgery to 1.1 at 1 year after surgery and 0.4 at 2 years or more after surgery. The AOFAS and FADI scores were also significantly improved from 40.3 and 53.3 preoperatively to 95 and 93.2 postoperatively at 1 year and 95 and 93.2 at 2 or more years postoperatively, respectively. Postoperative complications included 2 patients who required removal of medial malleolar osteotomy tension bands due to symptomatic hardware. There were no nonunions or malunions of the osteotomies and no donor site complications. Conclusion: Autologous bone graft and periosteum transfer was an effective treatment for large OLTs leading to significant decreases in pain and improvement in functional scores at more than 2 years after surgery. Level of Evidence: Level IV, retrospective case series.

scholarly journals Poly-4-Hydroxybutyrate (P4HB) Scaffold Internal Support: Preliminary Experience with Direct Implant Opposition During Complex Breast Revisions

2018 ◽  
Vol 39 (11) ◽  
pp. 1203-1213 ◽  
Author(s):  
Narayanan M Nair ◽  
Daniel C Mills
Keyword(s):  
Soft Tissue ◽  
Capsular Contracture ◽  
Case Series ◽  
Soft Tissue Coverage ◽  
Retrospective Case ◽  
Level Of Evidence ◽  
Internal Support ◽  
Invaluable Tool ◽  
Preliminary Study ◽  
Exhaustive Study

Abstract Background The GalaFLEX scaffold is a mesh composed of resorbable poly-4-hydroxybutyrate (P4HB) monofilament fibers that aids in providing immediate internal soft tissue support, similar to that offered by an underwire bra, after breast reduction, lift, or augmentation. Objectives Our goal was to explore the possibility of using GalaFLEX as an internal support to prevent future sagging, predominantly in the lower pole of the breast. This preliminary study investigated GalaFLEX as a direct alternative to implants in a variety of complex revisional breast cases. Our intention was to establish a safety and efficacy profile in an effort to promote further investigation. Methods A retrospective case series of 5 patients over 2 years were evaluated. Inclusion criteria were capsular contracture with concerns over soft tissue coverage and future ptosis, along with complicated muscle coverage deficits secondary to plane switching. Results A retrospective review of photographs taken at the most recent follow-up consistently showed retention of implant position and soft implants. Additionally, patients presented with a mean ± SD Baker Grade Contraction score of 2.8 ± 0.9189 preoperatively compared with a score of 1 ± 0 postoperatively. Conclusions This preliminary study shows the initial safety of GalaFLEX but indicates the need for a multicenter, exhaustive study. Its versatility for complex revisional cases combined with acceptable aesthetic outcomes makes GalaFLEX an invaluable tool for plastic surgeons to consider. Level of Evidence: 4

scholarly journals POSTOPERATIVE RETROSPECTIVE ANALYSIS OF THE TREATMENT OF DUPLICATED THUMB

2018 ◽  
Vol 26 (3) ◽  
pp. 158-161
Author(s):  
HUGO ALBERTO NAKAMOTO ◽  
FREDERICO FALEIRO RAMOS ◽  
REINALDO BORGES GONÇALVES ◽  
DOV CHARLES GOLDENBERG ◽  
ROLF GEMPERLI
Keyword(s):  
Surgical Technique ◽  
Retrospective Analysis ◽  
Case Series ◽  
Functional Results ◽  
Functional Evaluation ◽  
Clinical Factors ◽  
Collateral Ligament ◽  
Retrospective Case ◽  
Level Of Evidence ◽  
Functional Factors

ABSTRACT Objective To evaluate postoperative epidemiological and functional factors in patients operated to treat duplicate thumb. Methods This retrospective case series evaluated 20 patients (23 thumbs) treated from January 2012 to December 2016 at our service. Epidemiological and clinical factors were studied, including Tada score. Results Of the 34 children who were treated surgically, only 20 appeared for the functional evaluation and were included in the study. Of the operated cases, 60% were Wassel type 4. All evaluated cases had good functional results (Tada score ≥5, mean score: 6.65). The most frequently used surgical technique was resection of the radial thumb with reconstruction of the radial collateral ligament (47.8% of cases). Conclusion Surgical correction of duplicated thumb yields good results, as long as attention is paid to abnormalities in bones, ligaments, and tendons. Level of Evidence IV; Case series.

scholarly journals Outcomes Following Treatment of the Infected Achilles Tendon

2019 ◽  
Vol 4 (2) ◽  
pp. 247301141984694
Author(s):  
Mark W. Bowers ◽  
Norman S. Turner ◽  
Daniel B. Ryssman ◽  
Steven L. Moran
Keyword(s):  
Achilles Tendon ◽  
Functional Outcomes ◽  
Case Series ◽  
Functional Results ◽  
Retrospective Case ◽  
Level Of Evidence ◽  
Therapy Program ◽  
Tendon Surgery ◽  
Secondary Closure

Background: Infection following Achilles tendon surgery is a devastating complication and can be difficult to treat and often leads to poor outcomes. A number of treatments have been described, but there is little information concerning outcomes of these treatments. Our purpose was to evaluate the clinical and functional outcomes of patients who have undergone treatment for an infected Achilles tendon after acute and chronic midsubstance repair. Methods: We retrospectively reviewed the medical records of 20 patients who had undergone surgical treatment for an infected Achilles tendon between 2000 and 2016. The mean follow-up time was 21 months (range, 2-68 months). All patients underwent extensive debridement of the tendon with removal of all infected tissue and foreign material. Soft tissue wound coverage was utilized for large wounds that were not amenable to primary or secondary closure. All patients received culture-specific intravenous (IV) antibiotics for 3 to 6 weeks. Postoperatively, the extremity was immobilized in a splint followed by a cast until the wound was healed. The cast was then replaced with a walking boot and the patients were provided a physical therapy program. Functional outcomes were measured using the Foot and Ankle Ability Measure (FAAM) Activity of Daily Living (ADL) scale. Results: All wounds had healed at the time of last follow-up. Three patients (15%) required an unplanned return to the operating room for repeat debridement. All patients were able to walk without the use of a gait aid. Five patients (25%) required continued use of a boot or brace during ambulation. Fourteen patients participated in the FAAM ADL survey. There were 6 patients lost to follow-up. The average FAAM score was 87 (range, 71.4-100). At last follow-up, most patients reported their overall function as “normal” or “nearly normal.” Eradication of infection and satisfactory functional results can be attained after radical debridement, wound closure, and administration of culture-specific IV antibiotics. Level of Evidence: Level IV, retrospective case series.

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