Functional outcome among patients treated by percutaneous cannulated screw with tension band for transverse patella fracture

Introduction: Tension band wiring is the most commonly used treatment method for transverse patella fracture. Tension band construct can be achieved by various modifications. Percutaneous cannulated screw with tension band is a minimally invasive technique with stiffer fixation that follows tension band principle. This study aims to assess the clinical and radiological outcome using percutaneous cannulated screw with tension band for the management of transverse patella fracture. Methods: This was a prospective study among 30 adult patients who had closed displaced transverse patella fracture. Patients with polytrauma, comminuted fracture, neurovascular injury and prior injury to the limb were excluded from the study. Each patient was followed up at 2 weeks, 4 weeks, 3 months and 6 months postoperatively. Results: Among all surgically treated patients using this technique, Pain gradually decreased over time and was less than VAS score of 1 in all patients at 6 months follow-up with an average score of 0.3. The final range of motion at 6 months was: flexion ranging from 122 to 145 degrees and extension lag from of 0 to 8 degrees. There was significant improvement in range of motion of knee in each follow up. The mean duration for fracture union was 11.4±2.3 weeks. There were no cases of nonunion and hardware failure. The mean Lyshom score was 82.5 at final follow up. Conclusions: The percutaneous fixation of transverse patella fracture with cannulated screw and SS wire is safe and effective method which gives good functional outcome.

Download Full-text

Functional Outcome of Revision Osteosynthesis after failed surgical treatment of patellar fractures

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967119s00235 ◽

2019 ◽

Vol 7 (6_suppl4) ◽

pp. 2325967119S0023

Author(s):

Elena Müller ◽

Karl-Heinz Frosch

Keyword(s):

Range Of Motion ◽

Functional Outcome ◽

Revision Surgery ◽

Tension Band ◽

Tension Band Wiring ◽

Fracture Dislocation ◽

Secondary Fracture ◽

Patellar Fractures ◽

Tegner Score

Aims and Objectives: Patellar fractures account for approximately 1% of all skeletal fractures. They are rare, but due to the crucial function of the patella in the extensor mechanism of the knee they can lead to a serious impairment. New data are revealing functional impairment remains common even with improved surgical techniques. The aim of this study is to asses the functional outcome of patients after revision surgery in case of secondary fracture dislocation or remaining articular incongruity. Materials and Methods: The study was designed as a retrospective observatory study. We included all patients who underwent a revision surgery because of a remaining articular incongruity or a secondary fracture dislocation or re-fracture from January 2010 until december 2016. Results: Sixteen patients of mean age 51,8 years were included in the study with a mean follow-up period of 28,8 months. Fifteen patients had AO type C fractures, within ten a C3 fracture. Thirteen were initially treated with tension band wiring via k-wires or cannulated screws. The reason for a revision surgery were 5 times a remaining articular incongruity, 11 times a secondary fracture dislocation or re-fracture. We analysed pain, satisfaction, range of motion, Böstman-Score, Tegner-Score and KOOS and could extract follow-up data from 15 of the patients. All fractures healed, no articular incongruity remained. Mean pain measured with the visual analogue scale (0-10) was at rest 0,57 (range 0-3,5), on exertion 2,79 (range 0-8). The measurement of the range of motion compared with the opposite knee showed a complete extension. Mean Flexion was 120°, in the opposite knee 136° (p = 0,05). Mean postoperative Böstman-Score and Tegner-Score were 25,11 (good, max. 30) and 78,67 (moderate, max. 100). KOOS: symptoms 66,8 points, pain 77,55 points, ADL 75,67 points and qualitiy of life 56,25 points. Conclusion: Early revision surgery in case of secondary fracture dislocation, re-fracture or remaining articular incongruity leads to statisfactory functional outcomes. Furthermore in case of complexe fractures the tension band wiring technique shouldn’t be the first choice, alternatives like the plate osteosynthesis should be considered.

Download Full-text

Robotic-Assisted Patellofemoral Replacement—Correlation of Preoperative Planning with Intraoperative Implant Position and Early Clinical Experience: A Minimum 2-Year Follow-up

The Journal of Knee Surgery ◽

10.1055/s-0040-1716848 ◽

2020 ◽

Author(s):

Veenesh Selvaratnam ◽

Andrew Cattell ◽

Keith S. Eyres ◽

Andrew D. Toms ◽

Jonathan R. P. Phillips ◽

...

Keyword(s):

Functional Outcome ◽

Preoperative Planning ◽

Trochlear Dysplasia ◽

Oxford Knee Score ◽

Implant Position ◽

Robotic Assisted ◽

Implant Positioning ◽

Flexion Extension ◽

The Mean

AbstractPatello-femoral arthroplasty (PFA) is successful in a selected group of patients and yields a good functional outcome. Robotic-assisted knee arthroplasty has been shown to provide better implant positioning and alignment. We aim to report our early outcomes and to compare Mako's (Robotic Arm Interactive Orthopaedic System [RIO]) preoperative implant planning position to our intraoperative PFA implant position. Data for this study was prospectively collected for 23 (two bilateral) patients who underwent robotic-assisted PFA between April 2017 and May 2018. All preoperative implant position planning and postoperative actual implant position were recorded. Presence of trochlear dysplasia and functional outcome scores were also collected. There were 17 (two bilateral) female and 6 male patients with a mean age of 66.5 (range: 41–89) years. The mean follow-up period was 30 (range: 24–37) months. Eighteen knees (72%) had evidence of trochlear dysplasia. The anterior trochlear line was on average, 7.71 (range: 3.3–11.3) degrees, internally rotated to the surgical transepicondylar axis and on average 2.9 (range: 0.2–6.5) degrees internally rotated to the posterior condylar line. The preoperative planning range was 4-degree internal to 4-degree external rotation, 4-degree varus to 6-degree valgus, and 7-degree flexion to 3-degree extension. The average difference between preoperative planning and intraoperative implant position was 0.43 degrees for rotation (r = 0.93), 0.99 degrees for varus/valgus (r = 0.29), 1.26 degrees for flexion/extension (r = 0.83), and 0.34 mm for proudness (r = 0.80). Six patients (24%) had a different size component from their preoperative plan (r = 0.98). The mean preoperative Oxford Knee Score (OKS) was 16 and the mean postoperative OKS was 42. No patient had implant-related revision surgery or any radiological evidence of implant loosening at final follow-up. Our early results of robotic PFA are promising. Preoperative Mako planning correlates closely with intraoperative implant positioning. Longer follow-up is needed to assess long-term patient outcomes and implant survivorship.

Download Full-text

Abstaining from symptomatic implants of modified tension band wiring by nonabsorbable suture fixation for transverse patella fractures

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-021-02494-3 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Puripun Jirangkul ◽

Arkaphat Kosiyatrakul

Keyword(s):

Steel Wire ◽

Clinical Results ◽

Tension Band ◽

Fixation Technique ◽

Nonabsorbable Suture ◽

Patella Fractures ◽

Sufficient Stability ◽

The Mean ◽

Conventional Stainless Steel

Abstract Background Modified tension band fixation has become commonly used for transverse patella fractures. The conventional stainless steel wire provides sufficient stability but may be associated with complications. Objective The study aimed to evaluate the effectiveness of a new modified tension band fixation technique for transverse patella fractures using a nonabsorbable suture. Material and methods We present the result of a prospective series using a nonabsorbable suture (FiberWire) for transverse patella fractures. The mean follow-up period totaled 12 months. A total of 16 patients were evaluated by radiographic and clinical review. The postoperative clinical evaluation employed Lysholm and Böstman scores. Result All clinical results on follow-up were good to excellent. Minimal intra-articular joint stepping and further fracture displacement were recorded. No patient needed re-operation, and functional outcomes of the knee were satisfactory. No significant differences were found between the injured and contralateral knee range of motion. No symptomatic implants and skin complications were noted, and all fractures were completed heal within 15 weeks. Conclusion FiberWire provided sufficient stability and reduced postoperative complications. The results proved appropriate, and the technique has merit, as it obviates the need for re-operation.

Download Full-text

Sialendoscopy With Intraductal Steroid Irrigation in Patients With Sialadenitis Without Sialoliths

Ear Nose & Throat Journal ◽

10.1177/0145561319841207 ◽

2019 ◽

Vol 98 (5) ◽

pp. 291-294 ◽

Cited By ~ 4

Author(s):

Saudamini J. Lele ◽

Mickie Hamiter ◽

Torrey Louise Fourrier ◽

Cherie-Ann Nathan

Keyword(s):

Treatment Option ◽

Case Series ◽

Complete Response ◽

Definitive Treatment ◽

Invasive Technique ◽

Effective Treatment Option ◽

Patient Reported ◽

History Of ◽

The Mean

Sialendoscopy has emerged as a safe, effective and minimally invasive technique for management of obstructive and inflammatory salivary gland disease. The aim of our study was to analyze outcomes of sialendoscopy and steroid irrigation in patients with sialadenitis without sialoliths. We performed a retrospective analysis of patients who underwent interventional sialendoscopy with steroid irrigation from 2013 to 2016, for the treatment of sialadenitis without sialolithiasis. Twenty-two patients underwent interventional sialendoscopy with ductal dilation and steroid irrigation for the treatment of sialadenitis without any evidence of sialolithiasis. Conservative measures had failed in all. Eleven patients had symptoms arising from the parotid gland, 4 patients had symptoms arising from the submandibular gland, while 6 patients had symptoms in both parotid and submandibular glands. One patient complained of only xerostomia without glandular symptoms. The mean age of the study group which included 1 male and 21 females was 44.6 years (range: 3-86 years). Four patients had autoimmune disease, while 7 patients had a history of radioactive iodine therapy. No identifiable cause for sialadenitis was found in the remaining 11 patients. The mean follow-up period was 378.9 days (range: 16-1143 days). All patients underwent sialendoscopy with ductal dilation and steroid irrigation. Twelve patients showed a complete response and 9 patients had a partial response, while 1 patient reported no response. Only 3 patients required repeat sialendoscopy. The combination of sialendoscopy with ductal dilation and steroid irrigation is a safe and effective treatment option for patients with sialadenitis without sialoliths refractory to conservative measures. Prospective studies with a larger case series are needed to establish its role as a definitive treatment option.

Download Full-text

Z-osteotomy in hallux valgus: clinical and radiological outcome after Scarf osteotomy

Orthopedic Reviews ◽

10.4081/or.2009.e4 ◽

2009 ◽

Vol 1 (1) ◽

pp. 4 ◽

Cited By ~ 1

Author(s):

Marcus Jaeger ◽

Michael Schmidt ◽

Alexander Wild ◽

Bernd Bittersohl ◽

Susanne Courtois ◽

...

Keyword(s):

Range Of Motion ◽

Hallux Valgus ◽

Metatarsophalangeal Joint ◽

Mean Value ◽

Surgical Approaches ◽

Radiological Outcome ◽

Scarf Osteotomy ◽

Post Surgery ◽

The Mean

Correction osteotomies of the first metatarsal are common surgical approaches in treating hallux valgus deformities whereas the Scarf osteotomy has gained popularity. The purpose of this study was to analyze short- and mid-term results in hallux valgus patients who underwent a Scarf osteotomy. The subjective and radiological outcome of 131 Scarf osteotomies (106 hallux valgus patients, mean age: 57.5 years, range: 22-90 years) were retrospectively analyzed. Mean follow-up was 22.4 months (range: 6 months-5 years). Surgical indications were: intermetatarsal angle (IMA) of 12-23°; increased proximal articular angle (PAA>8°), and range of motion of the metatarsophalangeal joint in flexion and extension >40°. Exclusion criteria were severe osteoporosis and/or osteoarthritis. The mean subjective range of motion (ROM) of the great toe post-surgery was 0.8±1.73 points (0: full ROM, 10: total stiffness). The mean subjective cosmetic result was 2.7±2.7 points (0: excellent, 10: poor). The overall post-operative patient satisfaction with the result was high (2.1±2.5 points (0: excellent, 10: poor). The mean hallux valgus angle improvement was 16.6° (pre-operative mean value: 37.5°) which was statistically significant (p<0.01). The IMA improved by an average of 5.96° from a pre-operative mean value of 15.4° (p<0.01). Neither osteonecrosis of the distal fragment nor peri-operative fractures were noted during the follow-up. In keeping with our follow-up results, the Scarf osteotomy approach shows potential in the therapy of hallux valgus. 筻

Download Full-text

Reduction and Association of the Scaphoid and Lunate: A Functional and Radiographical Outcome Study

Journal of Wrist Surgery ◽

10.1055/s-0038-1668154 ◽

2018 ◽

Vol 08 (01) ◽

pp. 037-042

Author(s):

William Aibinder ◽

Ali Izadpanah ◽

Bassem Elhassan

Keyword(s):

Range Of Motion ◽

Grip Strength ◽

High Rate ◽

Salvage Procedure ◽

Level Of Evidence ◽

Long Term Follow Up ◽

The Mean ◽

Ligament Disruption

Background Management of scapholunate (SL) ligament disruption is a challenging problem. The reduction and association of the scaphoid and lunate (RASL) procedure has been described with varying results. This study assessed the outcomes of the RASL procedure. Purpose The objective of this study was to assess the outcomes of patients undergoing the RASL procedure at our institution in regard to pain relief, range of motion, radiographic and functional outcomes, complications, and reoperations. Materials and Methods Twelve patients with symptomatic chronic SL instability underwent the RASL procedure. The mean age was 35 years. The mean time from injury to surgery was 40 weeks. The mean follow-up was 89 months. Outcomes included visual analog score for pain, wrist range of motion, grip strength, and Mayo Wrist Scores. Preoperative and postoperative radiographs were reviewed. Results Pain scores improved in 10 wrists. Range of motion and grip strength worsened. The average Mayo Wrist Score was 63.3. The mean SL diastasis and angle improved, but seven wrists developed progressive degenerative changes, with two requiring a salvage procedure. Symptomatic progressive screw lucency occurred in eight wrists requiring screw removal. Conclusion The RASL procedure can improve SL widening but has a high rate of early failure and reoperation. Following reoperation, long-term follow-up demonstrates reasonable long-term durability in some cases. Level of Evidence This is a Level IV, therapeutic case study.

Download Full-text

Role of leukocyte free platelet rich plasma in planter fasciitis: a prospective study

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20175468 ◽

2017 ◽

Vol 5 (12) ◽

pp. 5432

Author(s):

Chandre Shekhar ◽

Alamgir Jhan ◽

Ganesh Singh ◽

Pankaj Singh ◽

Shailendre S. Bhandhari

Keyword(s):

Placebo Group ◽

Functional Outcome ◽

Platelet Rich Plasma ◽

Functional Results ◽

Visual Analogue Scale Pain ◽

Functional Score ◽

Outcome Scores ◽

The Mean ◽

Post Graduate Institute

Background: Planter fasciitis, is by definition, inflammation of planter fascia. Most of the cases are well treated conservatively and a few responds to surgery only. Objectives of present study were evaluating the efficacy of a single injection of leukocyte free platelet rich plasma in plantar fasciitis and to derive a correlation between the clinical and radiological outcome.Methods: The present study consisted of 120 patients of bilateral (PF), (240 feet). These patients were divided into two groups PRP group of 60 patients and Placebo group of 60 patients. The study was conducted on patients attending Orthopaedics outpatient department Post Graduate Institute of Medial Education and Research (PGIMER) from July 2011 to June 2012. A primary efficacy criterion was changes from baseline in pain using (VAS). Functional results, level of satisfaction and outcome were measured by – AOFAS Foot Scale. Correlation of clinical with radiological outcome were performed.Results: There was a significant decrease in the visual analogue scale (pain score) in the PRP. Group while in placebo group it was increased significantly at the end of 6 month. Functional outcome scores were improved significantly from their baseline values in PRP group while in placebo group the mean functional score were deteriorated at 6 months follow up. There was no improvement seen in functional status with normal saline injection. In PRP group the mean heal pad thickness was reduced significantly at 6 months follow up while in placebo group was not changed significantly at 6 months follow up. Correlation between radiological parameters and VAS was found to be positive while it was found negative with other functional outcome scores like AOFAS.Conclusions: Platelet-rich plasma (PRP), which is a natural concentrate of autologous growth factors,plays a role in the regeneration process in treatment of (PF).

Download Full-text

Abstract TP397: Clinical And Functional Outcome Of Adult Patients Diagnosed With Moyamoya Disease In Childhood

Stroke ◽

10.1161/str.48.suppl_1.tp397 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

David Fam ◽

Nomazulu Dlamini ◽

Cheryl Jaigobin

Keyword(s):

Ischemic Stroke ◽

North America ◽

Natural History ◽

Functional Outcome ◽

Moyamoya Disease ◽

Vascular Event ◽

Moyamoya Syndrome ◽

The Mean

Background: Moyamoya disease is a progressive occlusive arteriopathy of the terminal ICA and its branches, leading to the formation of unstable collateral vessels. The disease is found worldwide, and is associated with a number of predisposing conditions, termed moyamoya syndrome. Currently there is a paucity of data on the natural history of moyamoya disease in North America, especially the long-term outcome of pediatric moyamoya. Objective: Our objectives were to determine the rate of recurrent TIA, ischemic stroke and intracerebral hemorrhage in patients presenting with pediatric Moyamoya disease and to assess long-term functional outcome. Methods: This study was a retrospective chart review of 52 patients presenting with pediatric moyamoya disease. We included patients aged 18 or older with a diagnosis of moyamoya disease or syndrome. All patients had confirmatory baseline vascular imaging (MRA or CTA +/- cerebral angiography). Baseline demographic variables and annual vascular event recurrence risk were obtained from the records. Modified Rankin Score (MRS) at presentation and last follow-up were determined from clinical records. Results: Of the original cohort, 34 patients were included for analysis. The mean age of the patients was 23.9 years. The mean age at presentation was 9 years (SD=4) with an average follow-up of 11.3 years (SD=5.1) for a total of 383 patient years. There was slight female predominance (1.4:1). Fifty percent of patients (17) presented with ischemic stroke. A total of 26 patients (76%) underwent surgery, with 7 (21%) requiring repeat surgery. The annual vascular recurrent event rate was 5.0% (19/383), which was not significantly different between surgical and non-surgical groups or between different moyamoya syndrome subtypes. Most of the recurrent events were TIA (annual recurrence 3.7%). There was no significant difference between initial MRS, MRS at last follow-up and mean change in MRS between surgical and non-surgical groups. Conclusion: Our study is the largest North American natural history study of pediatric moyamoya. Our observations indicate that pediatric moyamoya in North America have low recurrent vascular event rates and long-term functional outcomes are good, even in conservatively managed patients.

Download Full-text

Radiographic Outcomes after Fixation of Distal Metatarsal Osteotomy for Hallux Valgus Using a Tension Band Construct

Foot & Ankle Orthopaedics ◽

10.1177/2473011419s00428 ◽

2019 ◽

Vol 4 (4) ◽

pp. 2473011419S0042

Author(s):

Alexander Volpi ◽

Robert Zbeda ◽

Christopher Katchis ◽

Lon Weiner ◽

Stuart Katchis

Keyword(s):

Hallux Valgus ◽

Postoperative Period ◽

Weight Bearing ◽

Line Tension ◽

Tension Band ◽

Metatarsal Osteotomy ◽

First Metatarsal ◽

Distal Metatarsal Osteotomy ◽

The Mean

Category: Bunion Introduction/Purpose: Hallux valgus is a common deformity of the forefoot. There are over 130 procedures described to correct hallux valgus. Classically, the treatment of mild to moderate hallux valgus is with a distal metatarsal osteotomy. A variety of fixation techniques have been described for use with this osteotomy most of which require partial or non-weight bearing until the osteotomy is healed. Tension Band fixation is a well-known principle in orthopedic surgery. The goal of the present study is to radiographically assess the maintenance of distal first metatarsal osteotomy fixation using a novel tension band device (Re+Line tension band bunion plate system, Nextremity Solutions) with immediate post-operative weight-bearing. Methods: The patient database for one surgeon was retrospectively reviewed for patients that underwent hallux valgus correction with the Re+Line tension band device between 2014 and 2017. Postoperative protocol included a soft dressing, firm surgical shoe, and weight-bearing as tolerated with a cane. Patients were excluded if fixation was achieved with something other than a tension band construct. Radiographs were obtained and reviewed retrospectively by 3 authors. Pre and postoperative hallux valgus (HVA) and intermetatarsal angles (IMA) were measured as described previously in the literature, and the changes in correction compared. Maintenance of correction and hardware integrity were assessed at final follow-up after weight bearing as tolerated in a surgical shoe in the postoperative period. Statistical analysis was performed using a Wilcoxon signed-rank test for the changes in HVA and IMA. Results: There was a total of 72 patients and 76 toes that underwent hallux valgus correction with a tension band construct, at a mean follow-up of 4.36 months. 68 of 72 patients were female. The average age was 60.8 years old. The mean preoperative HVA was 27.1 degrees. The mean postoperative HVA was 6.14 degrees, with a mean correction of 20.22 degrees (p<0.001). The mean preoperative IMA was 14.14 degrees. The mean postoperative IMA was 6.10 degrees, with a mean correction of 7.98 degrees (p<0.001). There was loss of reduction found in 6 of 76 toes (7.89%).There were zero cases of hardware failure. All osteotomies healed at final follow-up. Conclusion: This study shows successful radiographic outcome after hallux valgus correction using a tension band construct and allowing immediate full weight-bearing in a surgical shoe in the postoperative period. Significant deformity correction was achieved and maintained and all osteotomies healed. The Re+Line tension band bunion correction system can be safely used as a successful option to fix distal first metatarsal osteotomies, while allowing patients to fully weight bear in a surgical shoe postoperatively and potentially return to activities faster than when using traditional fixation methods. Future studies are needed to assess functional outcomes and patient satisfaction with this novel technique.

Download Full-text

Clinical Outcomes of Total Ankle Arthroplasty With Total Talar Prosthesis

Foot & Ankle International ◽

10.1177/1071100719847135 ◽

2019 ◽

Vol 40 (8) ◽

pp. 948-954

Author(s):

Noriyuki Kanzaki ◽

Nobuaki Chinzei ◽

Tetsuya Yamamoto ◽

Takahiro Yamashita ◽

Kazuyuki Ibaraki ◽

...

Keyword(s):

Range Of Motion ◽

Case Series ◽

Total Ankle Arthroplasty ◽

Medial Malleolus ◽

Level Of Evidence ◽

Ankle Arthroplasty ◽

The Mean ◽

End Stage ◽

Medial Malleolus Fracture

Background: Total ankle arthroplasty (TAA) has been developed to treat patients with end-stage ankle osteoarthritis (OA). However, there is often difficulty in treating complicated pathologies such as ankle OA with subtalar joint OA and severe talar collapse. Therefore, this study aimed to explore the short-term results and complications of TAA with total talar prosthesis, known as combined TAA, as the new techniques to treat such complicated pathology. Methods: We examined postoperative results including ankle range of motion, Japanese Society for Surgery of the Foot (JSSF) scale, and complications. There were 22 patients (15 women), with mean follow-up of 34.9 (range, 24–53 months), and the mean age was 72 (range, 62–80) years. The main indications for combined TAA included osteoarthritis (18 patients), rheumatoid arthritis (3 patients), and talar osteonecrosis with osteoarthritis (one patient). Results: The mean range of motion improved from 4.0 to 14.4 degrees in dorsiflexion and from 23.8 to 32.0 degrees in plantarflexion. The JSSF scale improved from 50.5 to 91.5 points. Prolonged wound healing occurred in 3 patients, and medial malleolus fracture occurred in 4 patients. Conclusion: Combined TAA was a reliable procedure for the treatment of not only ankle OA following avascular necrosis of talus but also of degeneration of both ankle and subtalar joints. Level of Evidence: Level IV, case series.

Download Full-text