Prevalence of Anterior Inferior Iliac Spine Dysmorphism and Development of a Novel Classification System: An Anatomic Study of 1,797 Cadaveric Specimens

Purpose: Subspine impingement occurs due to a morphologically abnormal anterior inferior iliac spine (AIIS), capable of causing impingement against the distal femoral neck. The purpose of this investigation was to determine the prevalence of AIIS dysmorphism based on specimen sex, race, and age, while introducing a novel anatomic-based classification system.Methods: A total of 1,797 adult cadaveric specimens (n = 3,594 hemipelvises) were analyzed. AIIS with the potential for subspine impingement (SSI) was recorded in each specimen by two independent authors. Specimens with AIIS dysmorphism were then reexamined to determine SSI subtype using a novel descriptive anatomic classification system.Results: AIIS dysmorphism was present in 6.4% (n = 115 of 1,797 specimens) of specimens and 5.2% (n = 186 of 3,594) of hemipelvises. Dysmorphism was significantly more common in male specimens (p = 0.04) and African–American specimens (p = 0.04). No significant overall difference in prevalence was appreciated based on specimen age (p = 0.89). Subtype classification found that 67% of hemipelvises possessed a columnar type AIIS, 30% were bulbous and 3% hook type. Males possessed a significantly higher prevalence of columnar type AIIS dysmorphism (p < 0.001). No significant overall differences in anatomic classification were appreciated based on race (p = 0.12) or when analyzed based on age (p = 0.34).Conclusion: AIIS dysmorphism was present in 6.4% of the 1,797 cadaveric specimens evaluated. African-American and male specimens possessed significantly higher prevalence of AIIS dysmorphism, with no significant difference based on specimen age. Columnar type AIIS dysmorphism was most common. Anatomic classification was not significantly different based on specimen race or age.Level of Evidence: Case Series, Level IV.

Download Full-text

Combining Microfractures, Autologous Bone Graft, and Autologous Matrix-Induced Chondrogenesis for the Treatment of Juvenile Osteochondral Talar Lesions

Foot & Ankle International ◽

10.1177/1071100716687367 ◽

2017 ◽

Vol 38 (5) ◽

pp. 485-495 ◽

Cited By ~ 17

Author(s):

Riccardo D’Ambrosi ◽

Camilla Maccario ◽

Chiara Ursino ◽

Nicola Serra ◽

Federico Giuseppe Usuelli

Keyword(s):

Bone Graft ◽

Repeated Measures ◽

Osteochondral Lesion ◽

Young Patients ◽

Case Series ◽

Autologous Bone Graft ◽

Lesion Size ◽

Level Of Evidence ◽

Significant Difference ◽

Autologous Bone

Background: The purpose of this study was to evaluate the clinical and radiologic outcomes of patients younger than 20 years, treated with the arthroscopic-talus autologous matrix-induced chondrogenesis (AT-AMIC) technique and autologous bone graft for osteochondral lesion of the talus (OLT). Methods: Eleven patients under 20 years (range 13.3-20.0) underwent the AT-AMIC procedure and autologous bone graft for OLTs. Patients were evaluated preoperatively (T0) and at 6 (T1), 12 (T2), and 24 (T3) months postoperatively, using the American Orthopaedic Foot & Ankle Society Ankle and Hindfoot (AOFAS) score, the visual analog scale and the SF-12 respectively in its Mental and Physical Component Scores. Radiologic assessment included computed tomographic (CT) scan, magnetic resonance imaging (MRI) and intraoperative measurement of the lesion. A multivariate statistical analysis was performed. Results: Mean lesion size measured during surgery was 1.1 cm3 ± 0.5 cm3. We found a significant difference in clinical and radiologic parameters with analysis of variance for repeated measures ( P < .001). All clinical scores significantly improved ( P < .05) from T0 to T3. Lesion area significantly reduced from 119.1 ± 29.1 mm2 preoperatively to 77.9 ± 15.8 mm2 ( P < .05) at final follow-up as assessed by CT, and from 132.2 ± 31.3 mm2 to 85.3 ± 14.5 mm2 ( P < .05) as assessed by MRI. Moreover, we noted an important correlation between intraoperative size of the lesion and body mass index (BMI) ( P = .011). Conclusions: The technique can be considered safe and effective with early good results in young patients. Moreover, we demonstrated a significant correlation between BMI and lesion size and a significant impact of OLTs on quality of life. Level of Evidence: Level IV, retrospective case series.

Download Full-text

Total hip arthroplasty for high-riding hips: A retrospective analysis of 79 cases and proposal of a new classification

Journal of Orthopaedic Surgery ◽

10.1177/2309499020924164 ◽

2020 ◽

Vol 28 (2) ◽

pp. 230949902092416

Author(s):

İsmail Demirkale ◽

Yüksel Uğur Yaradılmış ◽

Ahmet Ateş ◽

Murat Altay

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Classification System ◽

Operating Time ◽

Limb Length Discrepancy ◽

Harris Hip Score ◽

Level Of Evidence ◽

Total Hip ◽

Significant Difference ◽

Functional Scores

Purpose: Total hip arthroplasty (THA) for high-riding hips is a complex procedure and the requirement for subtrochanteric osteotomy (STO) is an important decision that needs to be taken preoperatively. STO renders this complex surgery even more complicated and there are no guidelines to determine the STO requirement. In this study, the outcomes of THA for patients with high-riding hips were evaluated and a practical classification system is proposed to predict any osteotomy requirement. Methods: A retrospective evaluation was made of 79 hips of 76 patients who underwent THA for high-riding hip dysplasia. The amount of shortening in patients with STO and in patients without STO was compared. All patients were evaluated in respect of Harris hip score, operating time, erythrocyte suspension need, and actual limb length discrepancy. Preoperative radiographs were classified into four types according to the ratio of the distance between the lesser trochanter and the ischial tuberosity with pelvic height (LT-IT/P) to grade the degree of dislocation. Results: The mean follow-up was 30 ± 6.54 months. STO was applied to 47 (60%) hips and not to 32 (40%). There was no statistically significant difference between the groups in respect of the functional scores. STO prolonged the operating time and increased the need for blood transfusion ( p = 0.026, p < 0.001, respectively). When the LT-IT/P index was <0.19 (type 1), no additional surgical approach was required for reduction, at 0.19–0.29 (type 2), the head can be safely reduced with additional reduction methods, and when >0.3 (type 3), a shortening osteotomy will most likely be required. The rate of complications is increased if LT-IT/P is >0.4 (type 4). Conclusion: STO adjunct to THA increases the rate of complications. This practical classification system may guide the surgeon in the decision of whether an STO should be added to the procedure or not. Level of evidence: Level III, clinical trial

Download Full-text

Effect of Postoperative Ketorolac Administration on Bone Healing in Ankle Fracture Surgery

Foot & Ankle International ◽

10.1177/1071100718782489 ◽

2018 ◽

Vol 39 (10) ◽

pp. 1135-1140 ◽

Cited By ~ 9

Author(s):

Elizabeth McDonald ◽

Brian Winters ◽

Kristen Nicholson ◽

Rachel Shakked ◽

Steven Raikin ◽

...

Keyword(s):

Bone Healing ◽

Case Series ◽

Ankle Fractures ◽

High Rate ◽

Foot And Ankle ◽

Level Of Evidence ◽

Radiographic Outcomes ◽

Significant Difference ◽

Clinical Healing ◽

Mean Time

Background: In an effort to minimize narcotic analgesia and its potential side effects, anti-inflammatory agents offer great potential provided they do not interfere with bone healing. The safety of ketorolac administration after foot and ankle surgery has not been well defined in the current literature. The purpose of this study was to report clinical healing and radiographic outcomes for patients treated with a perioperative ketorolac regimen after open reduction and internal fixation (ORIF) of ankle fractures. Methods: A retrospective review was performed on all patients that received perioperative ketorolac at the time of lateral malleolar, bimalleolar, and trimalleolar ankle ORIF by a single surgeon between 2010 and 2016 with minimum 4 months follow-up. Patients received 20 tablets of 10 mg ketorolac Q6 hours. Radiographs were evaluated independently by 2 blinded fellowship-trained orthopedic foot and ankle surgeons to assess for radiographic healing. A total of 281 patients were included, with a median age of 51 years and 138 males (47%). Statistical analysis consisted of a linear mixed-effects regression. Results: In all, 265/281 (94%) were clinically healed within 12 weeks and 261/281 (92%) were radiographically healed within 12 weeks. Within the group of patients that did not heal within 12 weeks, mean time to clinical healing was 16.9 weeks (range = 14-25 weeks), and mean time to radiographic healing was 17.1 weeks (range = 14-25 weeks). In patients taking ketorolac, there were no cases of nonunion in our series (n = 281) and no significant difference found between fracture patterns and healing or complications ( P = .500). Conclusions: Perioperative ketorolac use was associated with a high rate of fracture union by 12 weeks. This is the first study to examine the effect of ketorolac on radiographic time to union of ankle fractures. Additional studies are necessary to determine whether ketorolac helps reduce opioid consumption and improve pain following ORIF of ankle fractures. Level of Evidence: Level IV, case series.

Download Full-text

NAVIGATED TOTAL KNEE ARTHROPLASTY FOR OSTEOARTHRITIS WITH EXTRA-ARTICULAR DEFORMITY

Acta Ortopédica Brasileira ◽

10.1590/1413-785220182603178367 ◽

2018 ◽

Vol 26 (3) ◽

pp. 170-174 ◽

Cited By ~ 1

Author(s):

IZUMI TANI ◽

NAOKI NAKANO ◽

KOJI TAKAYAMA ◽

KAZUNARI ISHIDA ◽

RYOSUKE KURODA ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Case Series ◽

Computer Assisted ◽

Level Of Evidence ◽

Assisted Navigation ◽

Radiographic Outcomes ◽

Navigation Group ◽

Significant Difference ◽

Total Knee

ABSTRACT Objective It is difficult to achieve proper alignment after total knee arthroplasty (TKA) in patients with extra-articular deformity (EAD) because of altered anatomical axis and distorted landmarks. As of this writing, only case series have been reported with regard to the usefulness of computer-assisted navigation systems for TKA with EAD. This study therefore compared outcomes in TKA with EAD, with and without navigation. Methods Fourteen osteoarthritis patients with EAD due to previous fracture malunion or operations were assessed. Seven TKAs were performed with navigation (navigation group) and another 7 were performed without navigation (manual group). Clinical and radiographic outcomes were compared before and two years after surgery. Results The mean postoperative Knee Society function score was significantly higher in the navigation group. No significant difference was found in postoperative range of motion and Knee Society knee score. The rate of outliers in radiographic outcomes tended to be lower in the navigation group. Conclusion Better clinical outcomes were achieved in cases in which navigation was used. Computer-assisted navigation is useful in TKA for patients with EAD. Level of Evidence III; Case control study.

Download Full-text

Intra operative assessment of the coronal balance in spinal deformity surgery : a technical note and retrospective study

Acta Orthopaedica Belgica ◽

10.52628/87.1.22 ◽

2021 ◽

Vol 87 (1) ◽

pp. 175-179

Author(s):

Thibault Dewilde ◽

Sebastiaan Schelfaut ◽

Sven Bamps ◽

Matthias Papen ◽

Pierre Moens

Keyword(s):

Retrospective Study ◽

Case Series ◽

Technical Note ◽

Coronal Alignment ◽

Level Of Evidence ◽

Coronal Balance ◽

Scoliotic Deformity ◽

Significant Difference ◽

The Mean ◽

The Right

Obtaining a spine that is well balanced after fusion for scoliotic deformity is primordial for the patients’ quality of life. A simple T-shaped instrument combined with standard intraoperative fluoroscopy can be of great help to evaluate the coronal alignment quickly. The aim of this study was to evaluate if a T-shaped device could predict the postoperative coronal balance. Before finalization of the rod fixation, the balance was checked by verifying the relationship between the T-shaped instrument and the upper instrumented vertebra (UIV), and final adjustments were made to correct the coronal balance. A retrospective study was conducted on 48 patients who underwent surgery to correct scoliotic deformity. Intraoperative and postoperative coronal alignment was measured independently by two observers. The mean intraoperative horizontal offset measured between T-shaped instrument and the center of the UIV was 1,69mm to the right with a standard deviation (SD) of 12,43 mm. On postoperative full spine radiographs, the mean offset between the centra sacral vertical line and the center of the UIV was 2,44mm to the left with a SD of 13,10mm. There is no significant difference in coronal balance between both measurements (p=0,12). With this technique we were able to predict the postoperative coronal balance in all but one patient (97,92%). We conclude that the use of a simple T-shaped instrument can provide adequate intraoperative assessment of coronal balance in correcting scoliotic deformity. Level of evidence : IV – case series

Download Full-text

Surgical treatments of patients with periprosthetic humeral fracture and comorbidities

MOJ Orthopedics & Rheumatology ◽

10.15406/mojor.2021.13.00537 ◽

2021 ◽

Vol 13 (1) ◽

pp. 1-4

Author(s):

Jiayong Liu ◽

Logan J Roebke ◽

Josh W Vander Maten ◽

Meaghan Tranovich ◽

Nabil A Ebraheim

Keyword(s):

Shoulder Arthroplasty ◽

Locking Plate ◽

Rare Complication ◽

Case Series ◽

Humeral Fracture ◽

Humeral Fractures ◽

Outcome Analysis ◽

Level Of Evidence ◽

Significant Difference ◽

Cerclage Wiring

Background: Periprosthetic humeral fractures represent a complex and rare complication. Currently, there is no standardized procedure for management or classification of these fractures. Questions/purposes: This unique case series purpose was to look at surgical outcomes and comorbidity profiles of 10 PHF patients. Subsequent analysis looked at whether these outcomes could add to the discussion of a proposed standard of care in a patient cohort with significant comorbidities. Patients and methods: All patients with humeral fractures from 2008-2019 were analyzed for inclusion. A total of ten patients met the inclusion criteria; humeral fracture concurrent with a shoulder arthroplasty. Each patient was managed surgically using a locking plate with or without cerclage wiring. Outcome analysis was then performed for each patient. Humoral fractures managed conservatively were removed from the dataset along with periprosthetic fractures around an elbow arthroplasty, IM nail, or supracondylar fracture after shoulder arthroplasty. Results: The average union time in all patients was 13.27±2.90 (9.86-17.29) weeks. There was no significant difference between patients treated with cerclage wiring or without. All patients had successful union except for a patient with Osteogenesis Imperfecta. There were two radial nerve palsies. The average Deyo-Charlson score and BMI was 7.1±.84 (4-13) and 29.89 respectively. Conclusion: The treatment of PHFs using the technique of ORIF with locking plate with or without cerclage wiring provides satisfactory outcomes in a patient population that usually includes significant comorbidities. Level of evidence: Therapeutic Study Level IV Retrospective Review.

Download Full-text

Comparative study of the FAOS and FAAM questionnaires as functional assessment instruments for patients with hallux valgus

Journal of the Foot & Ankle ◽

10.30795/jfootankle.2020.v14.1149 ◽

2020 ◽

Vol 14 (2) ◽

pp. 144-147

Author(s):

Alesson Filipi Bernini ◽

Silvia Iovine Kobata ◽

Alexandre Cassini de Oliveira ◽

Rubens Trabbold Aguiar ◽

Antônio César Mezêncio da Silveira

Keyword(s):

Hallux Valgus ◽

Functional Assessment ◽

Case Series ◽

Assessment Instruments ◽

Foot And Ankle ◽

Level Of Evidence ◽

Significant Difference ◽

Functional Scores ◽

The Right ◽

Relationship Of

Objective: To compare the Portuguese translations of the Foot and Ankle Activity Measure (FAAM) and the Foot and Ankle Outcome Score (FAOS) questionnaires as functional assessment instruments for patients with hallux valgus and assess correlations between scores and severity of deformity. Methods: A total of 28 patients were assessed and the functional scores provided by the FAAM and FAOS questionnaires were compared and their correlations with clinical and radiological severity were analyzed. Results: Mean age was 46.88 years (range: 18 to 64). Laterality was distributed as follows: 57.1% had the deformity on the right foot (16 cases) and 42.9% on the left (12 cases). The deformities identified were graded as follows: 26.1% of patients had mild deformity (6 cases), 45.3% had moderate deformity (14 cases), and 28.6% had severe deformity (8 cases). It was observed that the distribution of scores for the different grades of deformity was the same for both questionnaires. Conclusion: There was no significant difference between the results obtained using the FAAM or the FAOS questionnaire or in the relationship of proportionality between radiological deformity grade and the functional scores obtained using the two tests. Level of Evidence IV; Therapeutic Studies; Case Series.

Download Full-text

Arthroscopic-Guided Balloon Tibioplasty in Schatzker III Tibial Plateau Fracture

Joints ◽

10.1055/s-0039-1697607 ◽

2018 ◽

Vol 06 (04) ◽

pp. 220-227 ◽

Cited By ~ 1

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.

Download Full-text

Novel Pulmonary Function Parameter Shifts in High-Grade Upper Airway Stenoses

Ear Nose & Throat Journal ◽

10.1177/0145561319840870 ◽

2019 ◽

Vol 98 (7) ◽

pp. E104-E111

Author(s):

Paul Severin Wiggenhauser ◽

Oliver Adolph ◽

Thomas Karl Hoffmann ◽

Julia Thierauf ◽

Johannes Adrian Veit

Keyword(s):

Lung Function ◽

Case Series ◽

Upper Airway ◽

Neck Surgery ◽

Forced Expiratory Volume ◽

Function Parameter ◽

High Grade ◽

Retrospective Case ◽

Level Of Evidence ◽

Significant Difference

Upper airway stenosis (UAS) is a common problem for anesthesiologists in laryngology as well as head and neck surgery, but it may lead to life-threatening situations if it is undetected. This retrospective case series was performed on patients who had UAS and presented with severe dyspnea or encountered difficulties in airway management. To assess the severity of UAS, the degree of stenosis was calculated using computed tomography scans and direct endoscopy. Lung function test was collected, and measured values were extracted as percentage of predicted reference values. Lower and higher grade stenoses were defined by Cotton-Myer classification and median degree of stenosis. Median of detected stenoses was 73% (64%-85%), with 7 of 10 patients classified as Cotton-Myer grade 3. Lung function tests showed typical parameter shifts as known from obstructive pulmonary diseases (OPDs). Furthermore, statistical analyses showed a significant higher value of residual volume (RV)/total lung capacity (TLC) in patients with higher grade stenosis ( P < .05), whereas forced expiratory volume in 1 second /vital capacity (FEV1/VC) did not show a significant difference in same subgroups. In conclusion, the elevation of RV/TLC with concomitant normal FEV1/VC in symptomatic patients could be used to demarcate rare UAS from common OPD. Moreover, RV–TLC ratio might be used to distinguish between low- and high-grade UAS. But further epidemiological studies will be necessary to validate these findings. Level of evidence: 4.

Download Full-text

The Evidence Base of Neuropsychological Rehabilitation in Acquired Brain Impairment (ABI): How Good is the Research?

Brain Impairment ◽

10.1375/brim.7.2.119 ◽

2006 ◽

Vol 7 (2) ◽

pp. 119-132 ◽

Cited By ~ 19

Author(s):

Michael Perdices ◽

Regina Schultz ◽

Robyn Tate ◽

Skye McDonald ◽

Leanne Togher ◽

...

Keyword(s):

Research Design ◽

Methodological Quality ◽

Case Series ◽

Evidence Base ◽

Speech Disorders ◽

Single Subject ◽

Target Area ◽

Level Of Evidence ◽

Significant Difference

AbstractIn the context of evidence-based clinical practice (EBCP), the reliability of empirical data is largely determined by the methodological quality of research design. PsycBITE™ (Psychological Database of Brain Impairment Treatment Efficacy) is a web-based database listing all published, empirical reports on the effectiveness of nonpharmacological interventions for the psychological consequences of acquired brain impairment (ABI). The aim of this study was to survey the listings of PsycBITE™ and examine the methodological quality of the reports it contains. Reports listed in PsycBITE™ include systematic reviews (SRs), randomised controlled trials (RCTs), non-RCTs, case series (CSs) and single-subject designs (SSDs). They are indexed according to research design, neurological group, patient age group, target area and intervention type. The PEDro Scale is used to rate the methodological quality of RCTs, nonRCTs and CSs, with maximum obtainable methodological quality rating (MQR) of 10/10, 8/10 and 2/10 respectively. A search identified 1298 reports indexed in PsycBITE™. The largest proportion was SSDs (39%), followed by CSs (22%), RCTs (21%), non-RCTs (11%) and SRs (7%). The majority of reports was concerned with stroke (41%), traumatic brain injury (29%) and Alzheimer's and related dementias (22%). The most frequently investigated deficits were communication/language/speech disorders (24%); independent/self-care activities (19%); behaviour problems (17%); memory impairments (17%); anxiety, depression, stress, adjustment (15%). Approximately half of the RCTs, non-RCTs and CSs were rated for methodological quality. Mean MQR scores for RCTs, non-RCTs and CSs were 4.49, 2.85 and 1.15 respectively. While some PEDro criteria were met by a high proportion of RCTs and non-RCTs (≥ 70%), other criteria were only met by a small proportion of reports (as low as 1.6%). There was no significant difference in MQR scores between RCTs focusing on different neurological groups or target areas. Furthermore, there was no discernible improvement in MQR score for RCTs published over the last three decades. The methodological quality of studies investigating the efficacy of rehabilitation interventions in ABI has been consistently modest over several decades. This is largely attributable to poor adherence to fundamental tenets of research design, and requires urgent remediation. RCTs (and to a lesser extent, non-RCTs) are research methodologies which can potentially yield a high level of evidence, but only if they are adequately designed. PsycBITE™ has the facility to raise awareness of these issues and be instrumental in promoting EBCP in the field of ABI.

Download Full-text