Surgical Repair of Open Achilles Tendon Injuries Using No.1 Prolene to Pull Down the Proximal Tendon: A Safe Technique

From July 1998 to October 2004 forty-seven patients with open tendo-Achilles injuries were treated pull down the proximal tendon with no.1 prolene. In this surgical method no.1 prolene was threaded through the proximal tendon and the same suture material passed through the distal tendon and its bilateral ends were tightened over the rubber button either under the heel or by the sides of the heel. Box sutures apposed cut ends of the tendon. The ankle was placed in the cast in near neutral position. At six weeks the cast was removed and active flexion program was started. Partial weight bearing was allowed at seven weeks and full bearing was allowed at ten weeks after surgery. The average follow up period is 1.8 years. All the patients exhibited full range of motion at the final follow-up. doi: 10.3329/taj.v21i2.3792 TAJ 2008; 21(2): 132-134

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Differences in femoral component subsidence rate after THA using an uncemented collarless femoral stem: full weight-bearing with an enhanced recovery rehabilitation versus partial weight-bearing

Archives of Orthopaedic and Trauma Surgery ◽

10.1007/s00402-021-03913-0 ◽

2021 ◽

Author(s):

Franziska Leiss ◽

Julia Sabrina Götz ◽

Matthias Meyer ◽

Günther Maderbacher ◽

Jan Reinhard ◽

...

Keyword(s):

Risk Factors ◽

Enhanced Recovery ◽

Weight Bearing ◽

Femoral Stem ◽

Full Weight Bearing ◽

Partial Weight Bearing ◽

Fill Ratio ◽

Stem Subsidence ◽

Partial Weight

Abstract Background Femoral component subsidence is a known risk factor for early failure of total hip arthroplasty (THA) using cementless stems. The aim of the study was to compare an enhanced recovery concept with early full weight-bearing rehabilitation and partial weight-bearing on stem subsidence. In addition, the influence of patient-related and anatomical risk factors on subsidence shall be assessed. Methods One hundred and fourteen patients underwent primary cementless THA and were retrospectively analyzed. Sixty-three patients had an enhanced recovery rehabilitation with early full weight-bearing and 51 patients had rehabilitation with partial weight-bearing (20 kg) for 6 weeks. Postoperative subsidence was analyzed on standing pelvic anterior–posterior radiographs after 4 weeks and 1 year. Subsidence was measured in mm. Anatomical and prosthetic risk factors (stem size, canal flare index, canal fill ratio as well as BMI and demographic data) were correlated. Results Femoral stem subsidence rate was significantly higher for the group with an enhanced recovery concept compared to the group with partial weight-bearing at the first radiological follow up after 4 weeks [2.54 mm (SD ± 1.86) vs. 1.55 mm (SD ± 1.80)] and the second radiological follow up after 1 year [3.43 mm (SD ± 2.24) vs. 1.94 (SD ± 2.16)] (p < 0.001, respectively). Stem angulation > 3° had a significant influence on subsidence. Canal flare index and canal fill ratio showed no significant correlation with subsidence as well as BMI and age. Conclusion In the present study, cementless stem subsidence was significantly higher in the group with enhanced recovery rehabilitation compared to partial weight-bearing. Small absolute values and differences were demonstrated and therefore possibly below clinical relevance. Anatomical radiological parameters and anthropometric data did not appear to be risk factors for stem subsidence.

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Middle-term Clinical Evaluations of Lisfranc Ligament Anatomical Reconstruction Surgery

Foot & Ankle Orthopaedics ◽

10.1177/2473011417s000193 ◽

2017 ◽

Vol 2 (3) ◽

pp. 2473011417S0001

Author(s):

Takaaki Hirano ◽

Akiyama Yui ◽

Hiroyuki Mitsui ◽

Shingo Maeda ◽

Hisateru Niki

Keyword(s):

Weight Bearing ◽

Anatomical Reconstruction ◽

X Rays ◽

Partial Weight Bearing ◽

Acute Case ◽

Middle Term ◽

Reconstruction Surgery ◽

Lisfranc Ligament ◽

Partial Weight

Category: Midfoot/Forefoot Introduction/Purpose: We report the middle-term outcomes after performing Lisfranc ligament anatomical reconstruction surgery (LARS), using an optimal route of reconstruction based on anatomical measurements of and biomechanical experiments with cadavers. Methods: Subjects included 20 patients (8 female and 12 male, mean age: 35.5 years, mean follow-up period: 35 months) who were diagnosed with Lisfranc joint injury and underwent surgical treatment from 2012 to 2015. Acute case were fourteen cases, chronic cases were 6 cases. The optimal anatomical route of reconstruction was calculated from anatomical measurements obtained from 78 legs of cadavers. The Myerson’s classification and the Kaar’s classification based on stress X-rays were used to classify the injuries at the time of their occurrence. Furthermore, the Japanese Society for Surgery of the Foot (JSSF) Midfoot scale and Stein’s radiographic assessment were used for clinical evaluation postoperatively. Results: According to the Myerson’s classification, Type B1 was one case, Type B2 was 15 cases, Type C1 and Type C2 were each 2 cases. According to the Kaar’s classification, 17 patients had transverse-type injuries and 3 patients had longitudinal-type injury. Partial weight bearing was encouraged within 6 week and return to exercise within 12 weeks. Average JSSF scores at final follow-up were 93.8 points in both examples (85-100) respectively. Joint congruities on X ray were appropriate in most cases but admitted a little diastasis by one case of chronic and one acute case. Conclusion: LARS achieves both static and dynamic stability, does not require removal of the internal fixation material, and enables all patients to support a full load 8 weeks postoperatively. LARS is beneficial for maintaining anatomical reduction, preserving the joint, and shortening the post-therapy period. Our newly developed ligament reconstruction is not only able to acute injuries but also to the chronic injuries.

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Multi-Ligament Knee Injury with Concomitant Tibial Tubercle Fracture: A Challenging Case Report and Review of the Pertinent Literature

Journal of Orthopedic and Spine Trauma ◽

10.18502/jost.v6i4.5567 ◽

2021 ◽

Author(s):

Mohammad Tahami ◽

Arash Sharafat Vaziri ◽

Mohammad Naghi Tahmasebi ◽

Fardis Vosoughi ◽

Majid Khalilizad ◽

...

Keyword(s):

Case Report ◽

Knee Injury ◽

Cruciate Ligament ◽

Weight Bearing ◽

Full Range ◽

The Body ◽

Tibial Tubercle ◽

Partial Weight Bearing ◽

Rehabilitation Protocol ◽

Partial Weight

Background: Multi-ligament knee injury (MLKI) combined with a comminuted tibial tubercle avulsion fracture in the literature has been reported as a very rare condition. To the best of our knowledge, there was no case report of this condition associated with open proximal tibia fractures. Case Report: A 32-year-old man was referred to our center, with a comminuted tibial tubercle fracture, patella alta, fracture of the tibia at the proximal meta-diaphyseal junction, a Segond fracture, and proximal tibiofibular dislocation on X-ray images. Further assessment of intra-articular pathologies was performed during the operation and complete tear of anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) tear were identified. Radial tear of the body and anterior root avulsion of medial meniscus were also noted. All of the extra-articular and intra-articular injuries were addressed surgically, except ACL and PCL tear, which were postponed to a second stage. Proximal tibiofibular dislocation was not approached surgically. The rehabilitation protocol included 6 weeks of non-weight-bearing followed by 6 weeks of crutch-assisted partial weight-bearing ambulation, and forbidden active knee extension during the first 6 weeks and allowing the patient to perform passive flexion of the knee to 90 degrees starting from the second week. Following the rehabilitation program, the patient achieved near-full range of motion (ROM) by the end of 6 months of clinical follow-up. Conclusion: By means of our specific surgical technique and post-operative rehabilitation protocol, we led the patient with this specific condition to have fracture union and near-normal ROM by the end of 6 months.

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Early Detection of Occult Fractures around the Hip with Magnetic Resonance Imaging

Hip International ◽

10.1177/112070000301300204 ◽

2003 ◽

Vol 13 (2) ◽

pp. 80-85

Author(s):

A. González Della Valle ◽

U. Macea Ibáñez ◽

M. Buttaro ◽

A. Rolón ◽

F. Piccaluga

Keyword(s):

Medical Records ◽

Weight Bearing ◽

Resonance Imaging ◽

Imaging Studies ◽

Partial Weight Bearing ◽

Neck Fracture ◽

Occult Fractures ◽

Displaced Fracture ◽

Partial Weight

Hip fractures may not be evident on initial radiographs but can be demonstrated with special imaging studies. These “occult fractures” can displace if not promptly treated. In a four-year period, 34 occult fractures around the hip in 33 patients were diagnosed in one general hospital. There were 6 men and 27 women, with a mean age of 74 years (22/92). The medical records and imaging studies were retrospectively reviewed. Two patients presented with a displaced femoral neck fracture one month and 10 days respectively after a fall and initial radiographs resulting normal. In the remaining 31 patients with normal radiographs, 30 fractures were detected with MRI obtained at an average of 6.8 days (0/35) from the onset of symptoms, and one with bone scan. Treatment consisted in partial weight-bearing or surgery, depending on the location and displacement of the fracture. Fractures united in all patients treated non-operatively and in those treated with internal fixation. One patient with a displaced fracture underwent a hip arthroplasty. At an average follow-up of 16.7 months (6/46) all patients remained ambulatory. In a selected group of patients with high suspicion of hip fracture, full-sequence MRI proved to be useful for early diagnosis and localization of an occult fracture around the hip.

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Evaluation of osteoporotic trochanteric fractures treated with cement-augmented dynamic hip screw

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20163121 ◽

2016 ◽

Vol 2 (3) ◽

pp. 147

Author(s):

Rahul Kumar Chandan ◽

Dharampal Verma ◽

R. C. Meena ◽

Jakir Husain

Keyword(s):

Weight Bearing ◽

Trochanteric Fracture ◽

Fracture Site ◽

Dynamic Hip Screw ◽

Intertrochanteric Fractures ◽

Partial Weight Bearing ◽

Hip Screw ◽

Lost To Follow Up ◽

Partial Weight

Background: Dynamic hip screw (DHS) has been the standard treatment for stable trochanteric fracture patterns. However, primary stabilization with dynamic/sliding hip screw is not always successful, especially in osteoporotic fractures. Internal fixation in such a situation may achieve a satisfactory initial fracture site reduction, but late fracture collapse into varus during weight bearing, can lead to a high failure rate. Since 1975, polymethylmethacrylate (PMMA) cement-augmented DHS have been used as a solution in unstable ITFs by adding an anchoring ability to the lag screw.Methods: A series of 33 osteoporotic intertrochanteric fractures were operated with cement augmented dynamic hip screw. One patient lost to follow up. All patients were then allowed partial weight bearing walker aided ambulation under the guidance of physiotherapist on the second or third postoperative day. The patients were followed radio logically and clinically at regular intervals (1st month, than at 3rd month and then at 6th month interval after surgery). Results were graded as excellent (score >31), good (score 24-31), fair (score 16-23), and poor (score <16). Clinical result was given according to Salvati and Wilson scoring.Results: Total 33 patients were taken for the study they were followed for minimum 6 months and at 6 months the clinical outcome was rated as per the Salvati and Wilson scoring system. One patient lost to follow-up. Final clinical results as evaluated by Salvati and Wilson scoring were; excellent in 24 cases (75%), good in 7 cases (21.88%), fair in 1 case (3.12%) and poor in 0 cases (0%). There were no non-union, AVN, implant failure and screw cut-out in our study.Conclusions: The surgical management of intertrochanteric fractures with PMMA augmented DHS provide a stable fixation with moderate pain free early mobilisation and better outcome in osteoporotic patients without the complications of superior screw cut-out, sliding collapse, and with the appropriate placement of bone cement along with proper amount (4-5 ml) of cement we can also reduce the cement related complications such as delayed healing, nonunion, heat necrosis and avascular necrosis.

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Early Outcomes of an Anterior Ankle Fusion Plating System with rhPDGF-BB Beta Tricalcium Phosphate Graft

Foot & Ankle Orthopaedics ◽

10.1177/2473011420s00178 ◽

2020 ◽

Vol 5 (4) ◽

pp. 2473011420S0017

Author(s):

Donald J. Covell ◽

Ryan McMillen

Keyword(s):

Weight Bearing ◽

Case Series ◽

Clinical Results ◽

Fusion Rate ◽

Osteoporotic Bone ◽

Ankle Arthritis ◽

Partial Weight Bearing ◽

Ankle Fusion ◽

Partial Weight

Category: Ankle; Ankle Arthritis Introduction/Purpose: Ankle fusion offers a reliable and effective treatment for end-stage ankle arthritis. Biomechanical studies have shown that plating systems may offer an advantage to ankle fusion patients with significant bone loss, bone deformity, or osteoporotic bone by providing a stiffer construct. One potential downside to plating systems is that they have been associated with soft tissue irritation due to their profile height. The objective of this case series was to assess the early patient clinical and radiographic outcomes of an anatomically designed, lower profile anterior ankle fusion plate used in combination with an autograft alternative, recombinant human protein derived growth factor (rhPDGF-BB). Methods: All ankle fusions performed between May 2018 and August 2019 at two centers were retrospectively evaluated. All patients received an anatomically designed, low profile anterior ankle fusion plate (ORTHOLOC 3Di, Wright Medical Group, Memphis, Tennessee, USA) through an anterior surgical approach. All patients also received rhPDGF-BB as part of the surgical procedure. Patients were non-weight bearing for 6 to 8 weeks in a splint or short leg cast, before transitioning to protected partial weight bearing for another 6 to 8 weeks. Patient demographics, time to radiographic fusion, length of follow-up, and adverse events were collected as part of the review. Results: There were 20 patients (12 male, 8 female) included in the analysis. The average age was 60.9 years (range, 42-90) and the average BMI was 31.6 kg/m2 (range, 21-52). There were eight diabetics, four smokers, and two patients who had preoperative ulcers. The average follow-up time was 7.8 months (range, 3-18). The fusion rate was 90%, with two nonunions. One nonunion patient was an obese, diabetic, neuropathic, smoker with a preoperative ulcer and a previous ankle fracture. She was treated with a bone stimulator and showed increased bony consolidation. The second nonunion patient was a neuropathic, diabetic who had previous hindfoot Charcot reconstruction. Her nonunion was stable and fibrous, which allowed her to ambulate pain free without bracing or assistive devices. Conclusion: This case series presents the first clinical results for this anatomically designed anterior ankle fusion plate. Outcomes were positive with a 90% fusion rate despite being used in a series of patients with a high incidence of risk factors and comorbidities. Additional complications were minor as related to wound healing. Further study is needed to confirm these promising initial results.

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A Prospective Study Comparing Two Fascial Reconstruction Techniques to Stabilise the Cranial Cruciate Deficient Stifle in the Dog

Veterinary and Comparative Orthopaedics and Traumatology ◽

10.1055/s-0038-1632434 ◽

1995 ◽

Vol 08 (02) ◽

pp. 82-90 ◽

Cited By ~ 13

Author(s):

A. M. Lubbe ◽

G. L. Coetzee

Keyword(s):

Cruciate Ligament ◽

Weight Bearing ◽

Partial Weight Bearing ◽

Reconstruction Procedure ◽

Cranial Cruciate Ligament ◽

Body Weights ◽

Replacement Technique ◽

A Prospective Study ◽

Partial Weight

SummaryThe standard intra-articular “underand-over” (U & O) cranial cruciate ligament substitute technique, using autogenous fascia lata, was compared with a combined intra- and extracapsular U & O fascial reconstruction procedure. Medium, large and giant dog breeds (body weights ≥ 15 kg), presented with unilateral rupture of the cranial cruciate ligament, were included in the study. Functional usage of the operated limb was evaluated according to a clinical grading system within the first six weeks and again at 12 and 26 weeks after the operation.Dogs treated with the standard intraarticular U & O procedure were partly weight-bearing on the operated limb within three to five weeks postoperatively. Return to full use of the limb with no or only mild, occasional lameness was recorded in 20 of 24 dogs (83.3%) after 26 weeks. Those treated with the combined intra- and extracapsular U & O procedure, returned to partial weight-bearing within four to seven weeks after the operation. These dogs exhibited slightly more cranial drawer motion (± 1.0 - 2.0 mm) at the six- and 12-week follow-up examinations, when compared to the first group, but stifle stability improved between 12 and 26 weeks. The results obtained from 45 of 55 dogs (81.9%) treated with the combined intra- and extracapsular U & O technique were comparable with the standard intra-articular U & O procedure with return to full use of the limb after 26 weeks. Radiological evidence of peri-articular osteophyte formation showed no remarkable difference between the two techniques after 26 weeks. Results obtained from the standard intra-articular U & O technique indicated that it was an effective method for use in large dogs with body weights greater than 30 kg. This is in agreement with findings in other studies. The combined intra- and extracapsular U &O fascial reconstruction was a reliable alternative for use in the medium to large dog breeds with body weights ranging between 15 and 26 kg.The standard intra-articular “under-and-over” (U & O) replacement technique was effective for use in dogs with body weights (BW) >30 kg. Dogs treated with the combined intra- and extracapsular U & O method had slightly more cranial drawer motion at the six-week and 12-week examinations, but stifle stability improved between 12 and 26 weeks, especially in medium-sized to larger dogs with BW ranging between 15 and 26 kg.

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Comparing durability of water- and land-based exercise benefits among older adults in South Korea: A randomized controlled trial with 1-year follow-up

Journal of Back and Musculoskeletal Rehabilitation ◽

10.3233/bmr-200109 ◽

2021 ◽

pp. 1-11

Author(s):

Se Jun Oh ◽

Sang Heon Lee

Keyword(s):

Exercise Intervention ◽

External Rotation ◽

Short Form ◽

Controlled Trial ◽

Weight Bearing ◽

Aquatic Exercise ◽

Step Test ◽

Sf 36 ◽

Partial Weight

BACKGROUND: Aquatic exercise can improve strength, flexibility, and aerobic function while safely providing partial weight-bearing support through viscosity and buoyancy. OBJECTIVE: The aim of the present study was to compare the effects of water-based exercise with land-based exercise before and after a 10-week exercise intervention and again at one-year follow-up. METHODS: Eighty participants aged 65 years and older were randomly assigned to either a water- or a land-based 10-week exercise program. Assessment included the Senior Fitness Test (SFT), the Modified Falls-Efficacy Scale, and the 36-Item Short-Form Health Survey (SF-36). Hip and knee strength was also measured. All assessments were completed at three time points: pre- (T1), post- (T2), and at 1-year follow-up (T3). RESULTS: Significant differences were observed between the two groups on three parameters: the SFT timed up-and-go test; lower hip muscle strength in extension, adduction, and external rotation; and quality of life (QoL) measured by the SF-36 (p< 0.05). No significant differences were observed in the SFT chair stand test, dominant arm curl test, two-minute step test, chair sit-and-reach test, back scratch test, and Modified Falls-Efficacy Scale. CONCLUSION: Aquatic exercise provided greater improvement of physical health and QoL among older people than land-based exercise.

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