scholarly journals Madelung Deformity: Surgical Correction with Radial Dome Osteotomy

2021 ◽  
pp. 7-13
Author(s):  
Corain M. ◽  
Giardini M. ◽  
Bissoli A. ◽  
Palazzolo G. ◽  
Bevilacqua G. ◽  
...  
Keyword(s):  
Functional Outcomes ◽  
Articular Surface ◽  
Outcome Questionnaire ◽  
Growth Disturbance ◽  
Madelung Deformity ◽  
Post Operative Pain ◽  
Dome Osteotomy ◽  
The Aesthetic ◽  
Jamar Dynamometer ◽  
Dash Questionnaire

Madelung deformity is a rare wrist malformation caused by a growth disturbance of the palmar and ulnar part of the distal radial physis. The aim of this study is to evaluate the outcome of radial dome osteotomy in patients affected by Madelung deformity. The endpoint of this operation is to improve the orientation of the articular surface of the radius, so as to support to the carpal bones. Between 2017 and 2019, in our clinic, 4patients were treated using this technique. Post-operative pain was evaluated using the NRS. Functional outcomes were assessed through evaluation of ROM, grip strength via Jamar dynamometer and using DASH questionnaire. The aesthetic defects were estimated using a section of the Michigan Hand Outcome Questionnaire. Correction of deformities was evaluated on post-operative RX using McCarrol Criteria. Were also analyzed the accuracy and tolerance of the plates used.

Effect of Proximal Dome and Distal Chevron Osteotomies on Plantar Pressures and Radiographic and Functional Outcomes in Hallux Valgus Surgery: A Retrospective Analysis

2021 ◽  
Vol 111 (3) ◽  
Author(s):  
Kadir Ilker Yildiz ◽  
Abdulhamit Misir ◽  
Turan Bilge Kizkapan ◽  
Mustafa Cukurlu ◽  
Canan Gonen Aydin
Keyword(s):  
Hallux Valgus ◽  
Inclination Angle ◽  
Plantar Pressure ◽  
Functional Outcomes ◽  
First Metatarsal ◽  
Pressure Point ◽  
Radiographic Outcomes ◽  
Metatarsal Angle ◽  
Dome Osteotomy ◽  
Pressure Changes

Background No detailed comparative studies have been performed regarding plantar pressure changes between proximal dome and distal chevron osteotomies. This study aimed to compare radiographic and plantar pressure changes after distal chevron and proximal dome osteotomies and to investigate the effect of radiographic and plantar pressure changes on clinical outcomes. Methods This study included 26 and 22 patients who underwent distal chevron and proximal dome osteotomies, respectively. Visual analog scale (VAS) and American Orthopaedic Foot & Ankle Society (AOFAS) forefoot scores were used to evaluate pain and functional outcomes. Hallux valgus angle, intermetatarsal angle, talar–first metatarsal angle, and calcaneal inclination angle were measured in the evaluation of radiographic outcomes. Preoperative and postoperative plantar pressure changes were evaluated. Results There were no statistically significant differences between the two groups in age, body mass index, or AOFAS forefoot and VAS scores. In the proximal dome group, the pressure measurement showed significant lateralization of the maximal anterior pressure point in the forefoot (P < .001). In addition, the postoperative calcaneal inclination angle was significantly lower (P = .004) and the talar–first metatarsal angle was significantly higher (P < .001) in the proximal dome group. Postoperative transfer metatarsalgia was observed in one patient (3.8%) in the distal chevron group and five (22.7%) in the proximal dome group (P < .05). Conclusions Proximal dome osteotomy led to more lateralization of the maximum anterior pressure point, decreased calcaneal inclination angle and first metatarsal elevation, and related higher transfer metatarsalgia.

Perforator-Based Flap Reconstruction after Melanoma Resection: Evaluation of Oncological, Aesthetic, and Functional Outcomes

2021 ◽  
Author(s):  
Beniamino Brunetti ◽  
Rosa Salzillo ◽  
Stefania Tenna ◽  
Bruno Brunetti ◽  
Mario Alessandri Bonetti ◽  
...  
Keyword(s):  
Functional Outcomes ◽  
Locoregional Recurrence ◽  
Demographic Data ◽  
Exact Test ◽  
Significant Difference ◽  
Chi Squared ◽  
Group A ◽  
The Aesthetic ◽  
One Year ◽  
Group B

Abstract Background Evidence in literature about the best reconstructive approach after melanoma resection is controversial, with some authors advocating that tissue rearrangement flap techniques might hinder the early detection of local relapses. The aim of the present study is to evaluate oncological, aesthetic, and functional outcomes following melanoma reconstruction using pedicled perforator-based flaps. Methods The authors reviewed all patients affected by melanoma treated during a 6-year period. Demographic data, tumor characteristics, and operative variables were evaluated. Locoregional recurrence was assessed with clinical and radiological follow-up. One-year postoperatively patients rated on a 5-point Likert scale the aesthetic and functional outcomes of the procedure. Three blind observers examined preoperative and 1-year postoperative photographs and rated the aesthetic outcome of the reconstructive procedure. Results One-hundred sixty-five patients were treated with wide excision and delayed reconstruction, including pedicled perforator-based flaps in 70 patients (group A) and primary closure in 95 patients (group B). Mean Breslow thickness was 2.972 and 2.189 mm in group A and B, respectively. There was no statistically significant difference in locoregional recurrence (chi-squared test, p = 0.8333; Fisher's exact test, p > 0.9999) between the two groups. Group A reported a higher satisfaction with both the aesthetic (mean rating 4.390 in group A and 4.094 in group B) and functional (mean rating 4.732 in group A and 4.170 in group B) outcomes of the procedure, the latter being statistically significant (p = 0.0006). Conclusion This series suggests that pedicled perforator-based flaps provide optimal aesthetic and functional outcomes in melanoma reconstruction without impairing the locoregional control of the disease.

The Quality Test for Postoperative Pain Management using the American Pain Society Patient Outcome Questionnaire Revisied (APS-POQ-R) version Indonesia at Mohammad Hoesin Hospital in Palembang (A study of the quality level of postoperative pain management

2020 ◽  
Vol 1 (2) ◽  
pp. 41-45
Author(s):  
Malina Resta Maria Panjaitan ◽  
Dewi Arsinta ◽  
Rose Mafiana
Keyword(s):  
Patient Outcome ◽  
Pain Management ◽  
Postoperative Pain ◽  
Emotional Experience ◽  
Postoperative Pain Management ◽  
Education Level ◽  
Quality Level ◽  
Outcome Questionnaire ◽  
Post Operative Pain

A B S T R A C TPain is an unpleasant sensory and emotional experience associated with actual orpotential tissue damage, or described in terms of such damage. APS-POQ-R (RevisedAmerican Pain Society Patient Outcome Questionnaire) is a measuring tool for assessingthe quality of postoperative pain management by exploring patient experiences andoutcomes. This research aims to assess the quality of postoperative pain managementat Mohammad Hoesin Hospital Palembang and to determine the factors that influenceit. The Cross-sectional observational analytic study was conducted toward 51respondents. Data was collected primarily by using questionnares and interview. Datawas analyzed by using chi-square. The study showed that the quality of postoperativepain management at RSUP Mohammad Hoesin General Hospital Palembang has goodquality with a total of 27 patients (52.9%). From statistical analysis there wassignificant relationship between the quality of post-operative pain management withage (p=0,037), gender (p=0,027), ethnicity (p=0,039), education level (p=0,039), andeconomic level (p=0,005). So it can be concluded that was a significant relationshipbetween the quality of post-operative pain management with age, gender, ethnicity,education level, and economic level.

scholarly journals Open Reduction Internal Fixation versus External Fixation with Limited Internal Fixation for Displaced Comminuted Closed Pilon Fractures: A Randomised Prospective Study

2018 ◽  
Vol 24 (1) ◽  
pp. 84-89
Author(s):  
Rayan Ahmed ◽  
Kotb Ahmed ◽  
M. Elmoatasem Elhussein ◽  
Samir Shady ◽  
Tamer A. El-Sobky ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Prospective Study ◽  
Internal Fixation ◽  
External Fixation ◽  
Functional Outcomes ◽  
Open Reduction ◽  
Articular Surface ◽  
High Energy ◽  
Complication Rates ◽  
Pilon Fractures

Background Pilon fractures involve the dome of the distal tibial articular surface. The optimal treatment for high-energy pilon fractures remains controversial. Some authors advocate the use of open reduction and internal fixation (ORIF) to avoid articular incongruence. Others advocate the use of bridging external fixation with limited internal fixation (EFLIF) to reduce soft tissue complications. Literature reports of prospective studies comparing the radioclinical outcomes of ORIF and EFLIF in high-energy fractures are scarce. Retrospective studies have their limitations because of insufficient randomisation. The objective of this randomised prospective study is to compare the clinical, radiologic and functional outcomes of displaced and comminuted closed pilon fractures, Rüedi and Allgöwer type II and III, treated by either ORIF or EFLIF. Materials and Methods Forty-two patients were selected for the study. Twenty-two patients were subjected to ORIF and 20 patients were subjected to EFLIF. We used the American Orthopaedic Foot and Ankle Society score as a standard method of reporting clinical status of the ankle. Patients were followed-up clinically and radiologically for over 2 years after the surgical treatment. Results The results of ORIF and EFLIF in treatment of high-energy pilon fractures are equally effective in terms of functional outcomes and complication rates on the short term. Conclusion Soft tissue integrity and fracture comminution seem to have a significant influence on outcomes of intervention. A prospective multicentre study with a larger sample size that controls for other associated variables and comorbidities is warranted. Level of evidence Level II.

scholarly journals Clinico-radiological and functional outcomes of bicolumnar plating in schatzker type 5 and type 6 fractures of proximal tibia in tertiary care hospital in North India: a series of 26 patients

2021 ◽  
Author(s):  
Pankaj Vir Singh ◽  
Gagandeep Singh ◽  
Manmeet Singh ◽  
Abdul Ghani ◽  
Amarjeet Singh ◽  
...  
Keyword(s):  
Scoring System ◽  
Functional Outcomes ◽  
Proximal Tibia ◽  
Articular Surface ◽  
Tertiary Care ◽  
North India ◽  
Care Hospital ◽  
Schatzker Type ◽  
Anatomic Reduction ◽  
Radiological Union

<p class="abstract"><strong>Background:</strong> Ideal mode of treatment is always debatable for Schatzker type 5 and type 6 fractures in proximal tibia. The aim of the study was management in tibial plateau fracture are to obtain anatomic reduction of the articular surface, restoration of axial alignment, and achieve stable fixation which can be done by open reduction and internal fixation (ORIF) using bicolumnar plating.</p><p class="abstract"><strong>Methods:</strong> 26 patients with Schatzker type 5 and type 6 fractures were managed by bicolumnar plating. They were followed up to six months in terms of radiological union, functional outcomes and complications. Functional outcome at the end of follow up was assessed using knee society scoring system.<strong></strong></p><p class="abstract"><strong>Results:</strong> Good to excellent results were obtained in almost all the patients using knee society scoring system, mean knee ROM achieved was 114.5 degree. Average time to achieve radiological union was 14.4 weeks. These results were in comparison with the studies done earlier.</p><p class="abstract"><strong>Conclusions:</strong> Bicolumnar plating is an effective method of treatment of Schatzker type 5 and type 6 fractures and provide excellent result in expert hands. Rehabilitation using early CPM (continuous passive movement) is very effective in reducing the post-operative complications like knee stiffness.</p><p> </p>

scholarly journals Reverse wedge osteotomy for Madelung’s deformity in a high school student: A case report

2021 ◽  
Vol 9 ◽  
pp. 2050313X2110498
Author(s):  
Tsuyoshi Tajika ◽  
Takuro Kuboi ◽  
Fumitaka Endo ◽  
Yuhei Hatori ◽  
Hirotaka Chikuda
Keyword(s):  
Case Report ◽  
Distal Radius ◽  
Joint Surface ◽  
Wedge Osteotomy ◽  
Growth Disturbance ◽  
Left Wrist ◽  
Ulnar Head ◽  
Madelung Deformity ◽  
Volar Aspect ◽  
Madelung’S Deformity

Madelung deformity is a congenital disorder with the malformation of anterior ulnar bowing of radius and a dorsally protruding ulnar head caused by premature growth disturbance at the medial volar aspect of the distal radius. This report describes a bilateral idiopathic Madelung deformity in a 17-year-old woman treated successfully using reverse wedge osteotomy of the distal radius in a symptomatic left wrist. Reverse wedge osteotomy can orient the radial joint surface while correcting the whole radius length by reversely putting the wedge bone removed from the distal metaphysis of radius, the base of which is cut from the surplus of the radial and dorsal cortical bone in the hypotrophic portion. We corrected the palmar subluxation of the carpus, restored her good function, and relieved her wrist pain.

Outcome of Distal Radial Fractures in Young Adults

2000 ◽  
Vol 25 (6) ◽  
pp. 535-543 ◽  
Author(s):  
J. D. GLIATIS ◽  
S. J. PLESSAS ◽  
T. R. C. DAVIS
Keyword(s):  
Young Adults ◽  
Distal Radius ◽  
Articular Surface ◽  
Wrist Pain ◽  
Outcome Questionnaire ◽  
Fracture Union ◽  
Distal Radial Fractures ◽  
Everyday Activities

The outcome of 169 fractures of the distal radius in adults under the age of 50 were assessed at least 18 months after injury (mean follow-up, 4.9 years) using a validated, patient-based outcome questionnaire. The questionnaire responses demonstrated that neither the Frykman nor the Mayo classifications of distal radial fractures predicted outcome. Fracture union with more than 10° of dorsal tilt was associated with increased difficulty with everyday activities and work, while union with a step in the radiocarpal articular surface was associated with loss of wrist mobility and difficulty with fine dextrous tasks. No measure of either intra- or extra-articular malunion influenced the severity or frequency of persistent wrist pain.

scholarly journals Correction of Madelung deformity by monorail external fixator in young adults

2019 ◽  
Author(s):  
Li Shi ◽  
Meng-wei Wang ◽  
Dong-dong Cheng ◽  
Jia Xu ◽  
Yimin Chai ◽  
...  
Keyword(s):  
External Fixator ◽  
Articular Surface ◽  
Surgical Techniques ◽  
Surgical Trauma ◽  
Wrist Movement ◽  
Vas Score ◽  
Madelung Deformity ◽  
Limited Function ◽  
Acute Correction ◽  
Surface Angle

Abstract Aims: Many surgical techniques are proposed to address Madelung deformity, but the most suitable surgical treatment still remains unknown for symptomatic cases. We introduced a modified management by radius osteotomy and Sauvé-Kapandji’s procedure using the monorail external fixator to provide a supplement to the treatment of Madelung deformity. Methods : From January 2013 to October 2018, 12 patients (9 right and 6 left wrists) with a mean age of 18 (16 to 24) years complained of pain, deformities and limited function of effected wrists. These 12 patients received operation for subsequent acute correction by monorail external fixator. The Vas Score, ulnar tilt of the radial articular surface angle, radiopalmar tilt angle, lunate subsidence, volar translation and range of wrist movement were evaluated pre- and postoperatively. Results : Consolidation cost an average time of 87 (66 to 122) days. All patients were followed up for an average time of 24 (8 to 65) months. The Vas score for all patients decreased from 4 (2 to 7) to 0 (p<0.001). The ulnar tilt and radiopalmar tilt were decreased by a mean of 21° (mean changed from 50 to 29) and 21° (from 38 to 17), respectively (both p<0.001). The length of lunate subsidence and volar translation was reduced by a mean of 6 (from 7 to 1) mm and 8 (from 25 to 17) mm, respectively (both p<0.001). Five patients received radius lengthening for an average of 22 (18 to 29) mm. Wrist extension improved by a mean of 8° (from 50 to 58), while flexion decreased by 40° (from 100 to 40). Conclusion : Acute correction by radius osteotomy and Sauvé-Kapandji’s procedure and gradual lengthening with the extendable monorail external fixator can be used for Madelung deformity with little surgical trauma. The radiographic parameters and wrist pain are improved after surgery and postoperative therapy.

The Aesthetic and Functional Roles of Spreader Flap in Primary Rhinoplasty

2020 ◽  
Vol 37 (3) ◽  
pp. 148-153
Author(s):  
Ahmed Elnaggar ◽  
Mohammed Ashraf
Keyword(s):  
Functional Outcomes ◽  
Type I ◽  
Type Ii ◽  
Spreader Graft ◽  
Functional Roles ◽  
Primary Rhinoplasty ◽  
Valve Reconstruction ◽  
Spreader Flap ◽  
The Aesthetic ◽  
Hump Resection

Dorsal hump resection was considered as the most ordinary part of rhinoplasty. It is obviously noticed that when a humpectomy is performed in a primary rhinoplasty, some surgeons underestimate the middle third (internal valve) reconstruction resulting in an inverted-V deformity. Although spreader graft is the gold standard for middle vault reconstruction, attention is turned to returning a portion of the hump following dorsal reduction in an attempt to reconstruct the middle vault. The aim of this study is to evaluate the use of spreader flap in primary rhinoplasties. This study included 40 patients classified into 3 groups as follows: (1) type I—mild cartilaginous hump, (2) type II—moderate cartilaginous hump, and (3) type III—huge cartilaginous hump. The results are satisfactory in most cases regarding the aesthetic and functional outcomes. Using auto-spreader flaps is shown to be simple, reproducible, and effective in shaping the midvault while keeping the internal valve intact.

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