scholarly journals Incomplete reossification after craniosynostosis surgery—incidence and analysis of risk factors: a clinical-radiological assessment study

2018 ◽  
Vol 22 (2) ◽  
pp. 120-127 ◽  
Author(s):  
José Luis Thenier-Villa ◽  
Pablo Sanromán-Álvarez ◽  
Pablo Miranda-Lloret ◽  
María Estela Plaza Ramírez
Keyword(s):  
Multivariate Analysis ◽  
Ct Scan ◽  
Open Surgery ◽  
Surgical Techniques ◽  
Positive Association ◽  
Bone Defects ◽  
Quantitative Measurements ◽  
Cranial Defect ◽  
Surgery Group

OBJECTIVEOne of the principles of the surgical treatment of craniosynostosis includes the release of fused bone plates to prevent recurrence. Such bone defects require a reossification process after surgery to prevent a cosmetic problem or brain vulnerability to damage. The objective of this study is to describe and analyze the radiological and clinical evolution of bone defects after craniosynostosis.METHODSFrom January 2005 to May 2016, 248 infants underwent surgical correction of craniosynostosis at HUiP La Fe Valencia; the authors analyzed data from 216 of these cases that met the inclusion criteria for this study. Various surgical techniques were used according to the age of the patient and severity of the case, including endoscopic-assisted suturectomy, open suturectomy, fronto-orbital advancement, and cranial vault remodeling. Clinical follow-up and radiological quantitative measurements in 2 periods—12–24 months and 2 years after surgery—were analyzed; 94 patients had a postoperative CT scan and were included in the radiological analysis.RESULTSAt the end of the follow-up period, 92 of 216 patients (42.59%) showed complete closure of the bone defect, 112 patients (51.85%) had minor bone defects, and 12 patients (5.56%) had significant bone defects that required surgical intervention. In the multivariate analysis, age at first surgery was not significantly associated with incomplete reossification (p = 0.15), nor was surgical site infection (p = 0.75). Multivariate analysis identified area of cranial defect greater than 5 cm2 in the first CT scan as predictive of incomplete reossification (p = 0.04). The mean area of cranial defect in the first CT scan (12–24 months after surgery) was 3.69 cm2 in patients treated with open surgery and 7.13 cm2 in those treated with endoscopic-assisted procedures; in the multivariate analysis, type of procedure was not related to incomplete reossification (p = 0.46). The positive predictive value of palpation as evaluation of bone cranial defects was 50% for significant defects and 71% for minor defects.CONCLUSIONSThe incidence of cranial defects due to incomplete reossification requiring cranioplasty was 5.56% in our series. Defects greater than 5 cm2 in the first postoperative CT scan showed a positive association with incomplete reossification. Patients treated with endoscope-assisted procedures had larger defects in the initial follow-up, but the final incidence of cranial defects was not significantly different in the endoscope-assisted surgery group from that in the open surgery group.

scholarly journals All-On-Four Protocol With Immediate Load on Short Implants in an Atrophic Mandible: A Case Report with a 4-Year Follow-Up

2018 ◽  
Vol 12 (1) ◽  
pp. 1004-1011
Author(s):  
Enéias Carpejani Rosa ◽  
Tuanny Carvalho de Lima Do Nascimento ◽  
Aline Monise Sebastiani ◽  
Rafaela Scariot ◽  
Tatiana Miranda Deliberador ◽  
...  
Keyword(s):  
Case Report ◽  
Ct Scan ◽  
Treatment Planning ◽  
Treatment Plan ◽  
Surgical Techniques ◽  
Masticatory Function ◽  
Facial Esthetics ◽  
Short Implants ◽  
Computer Tomography Scan

Purpose: Edentulism has been demonstrated to have negative social and psychological effects on individuals that include adverse impacts on facial and oral esthetics, masticatory function and speech abilities, that when combined, are translated into significant reductions in patients’ quality of lives. It is well-known that immediate placement of implants is a challenging surgical procedure that requires proper treatment planning and surgical techniques. Therefore, the present study describes a 4-year follow-up case report where short implants were placed in an atrophic mandibule and were loaded with the utilization of an all-on-four prosthetic protocol. Case report: A 54 year-old woman dissatisfied with her oral and facial esthetics, masticatory function and speech ability came to the implantology clinic of the Positivo University seeking for oral rehabilitation treatment. After detailed physical and clinical examination, a Computer Tomography scan (CT-scan) was performed to determine the patient’s bone ridge density, dimensions and eligibility for the placement of dental implants. The CT-scan results have indicated the presence of an extremely atrophic mandibular bone ridge. The CT-scan was also used as an aid during the final restoration treatment planning in terms of vertical dimension of occlusion, masticatory function, and stabilization of the lower denture. An all-on-four protocol supported by short implants was then treatment-planned to reduce time, costs and morbidity, and also to achieve superior immediate esthetic results and masticatory function. To reconstruct the patient’s atrophic edentulous mandibule, 4 short implants, including 2 distally tilted, were placed with a final torque of 45 Ncm. Results: Following the development and implementation of a complex treatment plan, the patient displayed stable soft and hard tissues at 4-year postoperative follow-up assessment, demonstrating the effectiveness of the all-on-four technique supported by short implants. Conclusion: Within the limits of this study, the present case report demonstrated that the all-on-four prosthetic protocol with immediate loading on short implant was effective in an atrophic mandible over a 4-year follow-up.

Prospective randomized comparison of quality of regenerate in distraction osteogenesis of ring versus monolateral fixator in patients with infected nonunion of the tibia using digital radiographs and CT

2019 ◽  
Vol 101-B (11) ◽  
pp. 1416-1422 ◽  
Author(s):  
Rajesh Rohilla ◽  
Pankaj K. Sharma ◽  
Jitendra Wadhwani ◽  
Seema Rohilla ◽  
Rajeev Beniwal ◽  
...  
Keyword(s):  
Ct Scan ◽  
Tibial Fracture ◽  
Randomized Study ◽  
Bone Defects ◽  
Infected Nonunion ◽  
Digital Radiographs ◽  
Circular Frame ◽  
Group A

Aims In this randomized study, we aimed to compare quality of regenerate in monolateral versus circular frame fixation in 30 patients with infected nonunion of tibia. Patients and Methods Both groups were comparable in demographic and injury characteristics. A phantom (aluminium step wedge of increasing thickness) was designed to compare the density of regenerate on radiographs. A CT scan was performed at three and six months postoperatively to assess regenerate density. A total of 30 patients (29 male, one female; mean age 32.54 years (18 to 60)) with an infected nonunion of a tibial fracture presenting to our tertiary institute between June 2011 and April 2016 were included in the study. Results The regenerate mineralization on radiographs was comparable in both groups at two, four, six, and ten months’ follow-up but the rail fixator group had statistically significant higher grades of mineralization when compared with the circular frame group at eight and 12 months’ follow-up. The regenerate mineralization was also higher in the rail fixator group than in the circular frame group on CT at three and six months, although this difference was not statistically significant. Conclusion Overall, the regenerate mineralization was higher in the monolateral than the circular frame group. A monolateral fixator may be preferred in patients with infected nonunion of the tibia with bone defects up to 7 cm. Cite this article: Bone Joint J 2019;101-B:1416–1422.

scholarly journals Partial Plantar Fasciotomy Using Endoscope with Inner Two-Channel Portals Produced Better Functional Outcomes Than Mini-Open Procedures for The Treatment of Refractory Plantar Fasciitis

2019 ◽  
Author(s):  
Shi-Ming Feng ◽  
Ai-Guo Wang ◽  
Zai-Yi Zhang
Keyword(s):  
Minimally Invasive Surgery ◽  
Minimally Invasive ◽  
Invasive Surgery ◽  
Plantar Fasciitis ◽  
Open Surgery ◽  
Clinical Effects ◽  
Surgery Group ◽  
Sf 36 ◽  
Medial Access

Abstract Objective: To evaluate the clinical efficacy of partial fasciotomy using two-channel arthroscope in the treatment of refractory plantar fasciitis, and to compare it with the clinical effects of partial fasciotomy using minimally invasive open. Methods: Sixty-two patients with refractory fasciitis admitted from January 2015 to July 2017 were randomly assigned to the arthroscopic group and the open surgery group. Arthroscopic partial section was performed using endoscope with inner two-channel portals. The open surgery group underwent partial sacral fascia resection with minimally invasive medial incision. Then compare the pain visual analogue scale (VAS), the American foot and ankle surgery association score (AOFAS), the calcaneodynia score (CS), and the medical outcomes short form 36-item (SF-36) health survey between the two groups. Results: All patients were followed up for at least 24 months, and there was no difference in follow-up between two groups. At the last follow-up, the patient's plantar pain symptoms completely disappeared. There was no recurrence of the bone spurs, and the ankle and foot movements were normal. There was no statistically significant difference in VAS, AOFAS, and CS scores between the two groups. The SF-36 score of the arthroscopy group is significantly higher than the open surgery group. Conclusions: Arthroscopic partial fascia resection with medial access provides better clinical outcomes than the open minimally-invasive surgery. Arthroscopic partial fasciotomy with the medial access provides a new option better than the open minimally-invasive surgery for postoperative daily life.

scholarly journals Complications in adult spinal deformity surgery: an analysis of minimally invasive, hybrid, and open surgical techniques

2014 ◽  
Vol 36 (5) ◽  
pp. E15 ◽  
Author(s):  
Juan S. Uribe ◽  
Armen R. Deukmedjian ◽  
Praveen V. Mummaneni ◽  
Kai-Ming G. Fu ◽  
Gregory M. Mundis ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Spinal Deformity ◽  
Open Surgery ◽  
Adult Spinal Deformity ◽  
Intraoperative Complications ◽  
Surgical Techniques ◽  
Open Group ◽  
Inclusion Criteria ◽  
Significant Difference

Object It is hypothesized that minimally invasive surgical techniques lead to fewer complications than open surgery for adult spinal deformity (ASD). The goal of this study was to analyze matched patient cohorts in an attempt to isolate the impact of approach on adverse events. Methods Two multicenter databases queried for patients with ASD treated via surgery and at least 1 year of follow-up revealed 280 patients who had undergone minimally invasive surgery (MIS) or a hybrid procedure (HYB; n = 85) or open surgery (OPEN; n = 195). These patients were divided into 3 separate groups based on the approach performed and were propensity matched for age, preoperative sagittal vertebral axis (SVA), number of levels fused posteriorly, and lumbar coronal Cobb angle (CCA) in an attempt to neutralize these patient variables and to make conclusions based on approach only. Inclusion criteria for both databases were similar, and inclusion criteria specific to this study consisted of an age > 45 years, CCA > 20°, 3 or more levels of fusion, and minimum of 1 year of follow-up. Patients in the OPEN group with a thoracic CCA > 75° were excluded to further ensure a more homogeneous patient population. Results In all, 60 matched patients were available for analysis (MIS = 20, HYB = 20, OPEN = 20). Blood loss was less in the MIS group than in the HYB and OPEN groups, but a significant difference was only found between the MIS and the OPEN group (669 vs 2322 ml, p = 0.001). The MIS and HYB groups had more fused interbody levels (4.5 and 4.1, respectively) than the OPEN group (1.6, p < 0.001). The OPEN group had less operative time than either the MIS or HYB group, but it was only statistically different from the HYB group (367 vs 665 minutes, p < 0.001). There was no significant difference in the duration of hospital stay among the groups. In patients with complete data, the overall complication rate was 45.5% (25 of 55). There was no significant difference in the total complication rate among the MIS, HYB, and OPEN groups (30%, 47%, and 63%, respectively; p = 0.147). No intraoperative complications were reported for the MIS group, 5.3% for the HYB group, and 25% for the OPEN group (p < 0.03). At least one postoperative complication occurred in 30%, 47%, and 50% (p = 0.40) of the MIS, HYB, and OPEN groups, respectively. One major complication occurred in 30%, 47%, and 63% (p = 0.147) of the MIS, HYB, and OPEN groups, respectively. All patients had significant improvement in both the Oswestry Disability Index (ODI) and visual analog scale scores after surgery (p < 0.001), although the MIS group did not have significant improvement in leg pain. The occurrence of complications had no impact on the ODI. Conclusions Results in this study suggest that the surgical approach may impact complications. The MIS group had significantly fewer intraoperative complications than did either the HYB or OPEN groups. If the goals of ASD surgery can be achieved, consideration should be given to less invasive techniques.

TricOsTM and Fibrin Sealant Combined for Bone Defect Filling: from Pre-Clinical Tests to Prospective Clinical Study. Preliminary Human Data

2007 ◽  
Vol 361-363 ◽  
pp. 1335-1338 ◽  
Author(s):  
Marlene Durand ◽  
Dominique Chauveaux ◽  
Maryse Moinard ◽  
Thierry Fabre ◽  
Jean Louis Rouvillain ◽  
...  
Keyword(s):  
Clinical Study ◽  
Ct Scan ◽  
Fibrin Sealant ◽  
Bone Substitute ◽  
Material Removal ◽  
Bone Defects ◽  
Tibial Osteotomy ◽  
Clinical Tests ◽  
X Ray

The association of TricOsTM (Macroporous Biphasic Ceramic Phosphate MBCP granules) and the fibrin sealant FS VH S/D 4, has been developed to answer a challenging request of orthopaedic surgeons: a biocompatible, osteogenic, mouldable, and self-hardening bone substitute able to fill randomly shaped bone defects. The aims of this study was the evaluation of the performance and safety of the bioactive bone substitute TricOs™ associated with a fibrin sealant in regeneration of functional bone. The pre-clinical tests were conducted to optimize MBCP granules size and ratio MBCP–FS VH S/D 4 (sheep maxillary sinus grafting, femoral epiphysis defect in rabbits, long bone defects in sheep). A clinical study design was set up as an exploratory prospective French multicentric phase II study sponsored by INSERM (Institut National de la Santé et de la Recherche Médicale). The application was the TOV (Tibial Osteotomy of Valgisation) using osteosynthesis and bone substitute: TricOs™ mixed with the fibrin sealant (FS VH S/D 4) for filling the space created. The follow up is 13 months with safety checks, clinical assessments, highsensitivity X-ray, and CT-scan imaging. A bone sample will be collected from the reconstructed area at 12 months, during the osteosynthesis material removal surgery. The principal criterion is CT-scan imaging performed 12 months after TOV surgery, before material removal, to assess qualitative and quantitative bone reconstruction. Animals’ studies demonstrate that the biomaterial is safe to use and shows osteoconductive properties, granules resorption and bone ingrowth at the expenses of the implants. As for clinical trial, 7 patients are today included in the study: This paper present the first results obtained from X-ray imaging during follow up.

scholarly journals A comparative evaluation of laser hemorrhoidoplasty versus open surgical hemorrhoidectomy treatment of grade III and IV hemorrhoids. A prospective observational study

2021 ◽  
Vol 6 (1) ◽  
pp. 30-36
Author(s):  
Hosni Mubarak Khan ◽  
Varahasandra Sanjeevaiah Shankare Gowda ◽  
Brahmavara Shamburao Ramesh ◽  
Dhulipudi Sandeep
Keyword(s):  
Observational Study ◽  
Open Surgery ◽  
Prospective Observational Study ◽  
Primary Outcome ◽  
P Value ◽  
Vas Score ◽  
Surgery Group ◽  
Significant Difference ◽  
Continuous Pulse

The aim of the present study was to evaluate and compare the efficacy and outcomes of laser hemorrhoidoplasty with that of open surgical hemorrhoidectomy. This prospective observational study consists of 50 subjects in each group. The open surgery group underwent a standardized Milligan-Morgan technique, and the laser group underwent laser hemorrhoidoplasty with a diode laser of 1470 nm (LASOTRONIX), 8.5 watts with a continuous pulse. Postoperative pain was considered as the primary outcome and was evaluated in both groups using the visual analog scale. There was a statistically significant difference between the two groups in VAS score at different follow-up period, with a mean score of 2.3±1.05 and 5.1±1.11 (24 hours) for the laser hemorrhoidoplasty group and open surgery group, respectively (p value < 0.008). There was an improvement in VAS score in the laser hemorrhoidoplasty group compared to the conventional open surgical group in 1, 7, 14, 21, and 30 days follow up.

Suspected osseous recurrence visualized on a 68Ga- DOTATATE PET/CT scan during the follow-up of a patient with a resected pulmonary carcinoid tumour

2011 ◽  
Vol 50 (05) ◽  
pp. N57-N59
Author(s):  
S. Geiger ◽  
S. Horster ◽  
A. R. Haug ◽  
A. Hausmann ◽  
M. Schlemmer ◽  
...  
Keyword(s):  
Ct Scan ◽  
Carcinoid Tumour ◽  
Pulmonary Carcinoid ◽  
Pet Ct ◽  
Pet Ct Scan

OPEN HAEMORRHOIDS SURGERY IN SPINAL CORD INJURY PATIENTS

2020 ◽  
Vol 4 (11) ◽  
Author(s):  
Khaled Hassan
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Anal Fissure ◽  
Open Surgery ◽  
Anal Fissures ◽  
Cord Injury ◽  
Long Term Follow Up ◽  
Grade Iii

This Pilot retrospective research conducted on the results of open surgery in patients with Grade III and IV haemorrhoids With SCI. No major complications had arisen at 6 weeks post-operative and all wounds had healed, but 1 patient Anal fissure recurrence. 75% of patients reported a substantial increase in anorectal anorexia during long-term follow-up. With symptoms. Five patients reported recurrences: three haemorrhoids (18 percent) and two anal fissures (25 percent).   Keywords: Haemorrhoids, Pilot retrospective research, Anorectal Anorexia.

Intraoperative, postoperative and long-term oncosurgical safety of therapeutic mammaplasty

2013 ◽  
Vol 154 (33) ◽  
pp. 1291-1296 ◽  
Author(s):  
László Romics Jr. ◽  
Sophie Barrett ◽  
Sheila Stallard ◽  
Eva Weiler-Mithoff
Keyword(s):  
Recurrence Rate ◽  
Tumour Size ◽  
Breast Conservation ◽  
Malignant Lesion ◽  
Surgical Techniques ◽  
Incomplete Resection ◽  
Immediate Reconstruction ◽  
Oncological Safety

Introduction: (Pre)malignant lesion in the breast requiring mastectomy conventionally may be treated with breast conservation by using oncoplastic breast surgical techniques, which is called therapeutic mammaplasty. However, no reliable data has been published so far as regards the oncological safety of this method. Aim: The aim of the authors was to analyse the oncological safety of therapeutic mammaplasty in a series of patients. Method: 99 patients were treated with therapeutic mammaplasty and data were collected in a breast surgical database prospectively. Results were analysed with respect to intraoperative, postoperative and long-term oncological safety. Results: Incomplete resection rate was 14.1%, which correlated with tumour size (p = 0.023), and multifocality (p = 0.012). Time between surgery (therapeutic mammaplasty) and chemotherapy was similar to time between conventional breast surgeries (wide excision, mastectomy, mastectomy with immediate reconstruction) and chemotherapy (mean 29–31 days; p<0.05). Overall recurrence rate was 6.1%, locoregional recurrence rate was 2% during 27 month (1–88) mean follow-up. Conclusions: Since literature data are based on relatively short follow-up and low patient number, it is highly important that all data on therapeutic mammaplasty is collected in a prospectively maintained breast surgical database in order to determine true recurrence after long-follow-up. Orv. Hetil., 2013, 154, 1291–1296.

Sign in / Sign up

Export Citation Format

Share Document