MIDDLE PATH REGIMEN FOR THE MANAGEMENT OF TRAUMATIC DISLOCATION OF KNEE JOINT WITH VASCULAR DEFICIT.

2021 ◽  
pp. 12-15
Author(s):  
Puneet H Chamakeri ◽  
Shailesh V Udapudi ◽  
Sameer Haveri ◽  
Anmol Rs Mittal
Keyword(s):  
Knee Joint ◽  
Extended Period ◽  
Skin Grafting ◽  
International Knee Documentation Committee ◽  
Treatment Modalities ◽  
Spontaneous Reduction ◽  
Joint Dislocations ◽  
Split Thickness Skin Grafting ◽  
The Mean ◽  
Tibial Translation

Background: Dislocation of the knee joint is one of the most under-reported orthopaedic emergencies due to its ability to undergo spontaneous reduction. It carries a high risk of involving the popliteal artery and peroneal nerve both acutely, or in the long term. Due to this catastrophic potential of the condition, it has been well established that it warrants prompt diagnosis and management. It may be secondary to ultra-low, low or high velocity trauma which makes every dislocation case unique due to involvement of different joint structures, capsule or fractures of the articulating bones. A broad spectrum of treatment modalities (both conservative and surgical) has been documented for this condition, with the latter showing better results across most studies. In developing countries like India, the nancial chasm is relatively bigger with a major chunk of the population unable to bear the cost of complete surgical management. Objective: To assess the functional outcome in patients with frank knee dislocations with multiligamentous injuries and vascular decit treated by a middle path regimen of an extended period of external xator and immobilization. Method: A prospective study was undertaken from January 2018 to July 2020 involving 10 patients with knee joint dislocations with vascular decit and multiligamentous injury, treated by an extended period of external xator application and immobilization. Fasciotomy was done wherever needed, in association with split thickness skin grafting. The assessments were made using Lysholm knee scoring scale (LKSS), International Knee Documentation Committee Scores (IKDC), range of motion (ROM), antero- posterior tibial translation (AP translation) and overall patient satisfaction on every follow-up. Results: The mean LKSS score was 78.3±6.23, mean IKDC score was 68.17±5.34, mean ROM progressively increased to 135.8⁰ with a mean extension lag of 2.2⁰, while the mean AP tibial translation was noted to be 9.16 mm. No poor result or complication was reported. Conclusion: The middle path regimen provides an affordable alternative for providing a stable knee to patients who are ill-affording and are expected to have a sedentary lifestyle, without indulging into rigorous activities

scholarly journals Locking Plate alone or in Combination with Cannulated Screws for Hoffa Fractures: A retrospective cohort study

2021 ◽  
Author(s):  
Zhen Li ◽  
Zhenyue Chen ◽  
Xiaotan Wang ◽  
Jingyin Li ◽  
Lizhong Jing ◽  
...  
Keyword(s):  
Cohort Study ◽  
Knee Joint ◽  
Locking Plate ◽  
Functional Results ◽  
International Knee Documentation Committee ◽  
Cannulated Screws ◽  
Range Of Movement ◽  
The Mean ◽  
Active Rehabilitation

Abstract Purpose Locking plate or screws have been used for Hoffa fractures; however, evidence to support the effectiveness of the procedure remains scarce. The present study aimed to determine the efficacy of distal femur condyle locking plate(DFCLP)alone or in combination with cannulated screws for Hoffa fractures. Methods In this cohort study, 13 patients with isolated Hoffa fractures were enrolled during the study period (May 2014 to February 2019) and retrospectively analyzed. Patients underwent open reduction and internal fixation by DFCLP alone or in combination with cannulated screws followed by early active rehabilitation postoperatively. The primary outcome was evaluated with Knee Society Score (KSS), the range of movement (ROM), International Knee Documentation Committee (IKDC) scoring system and the stability of the fixation site of the patients during the 24-month follow-up period. Results A total of 13 patients completed the 24-month follow-up assessment and achieve bone re-union at Hoffa fracture sites. The average follow-up period was 24.5months (ranging from 24 to 28 months), and the average time to healing was 3.5 months (ranging from 3 to 4 months). The mean ROM was determined as 119°, the mean KSS was 87.9, and the mean IKDC score was 84.2. It is worth mentioning that 2 patients suffered from knee joint stiffness and osteoarthritis during the 24 months follow-up. Eleven patients (84.6%) achieved satisfactory knee joint function through early postsurgical rehabilitation. Conclusion In patients with Hoffa fractures, treatment with DFCLP alone or in combination with cannulated screws followed by early active rehabilitation resulted in great stability and satisfactory functional results after 24 months.

scholarly journals One-Step Autologous Minced Cartilage Procedure for the Treatment of Knee Joint Chondral and Osteochondral Lesions: A Series of 27 Patients With 2-Year Follow-up

2019 ◽  
Vol 7 (6) ◽  
pp. 232596711985377 ◽  
Author(s):  
Felix Kurt Massen ◽  
Cyril Raphael Inauen ◽  
Laurent Pascale Harder ◽  
Armin Runer ◽  
Stefan Preiss ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
Knee Joint ◽  
Large Diameter ◽  
Single Step ◽  
Knee Function ◽  
Area Measurement ◽  
Treatment Modalities ◽  
Osteochondral Lesions ◽  
The Mean

Background:Chondral and osteochondral lesions are being detected with increasing frequency. For large-diameter lesions, cell-based treatment modalities are speculated to result in the best possible outcome.Purpose:To prospectively evaluate the 2-year clinical and radiological results after the treatment of chondral and osteochondral knee joint lesions by a single-step autologous minced cartilage procedure.Study Design:Case series; Level of evidence, 4.Methods:From February 2015 to June 2016, a total of 27 consecutive patients suffering from chondral or osteochondral lesions of the knee joint were treated using a single-step autologous minced cartilage procedure. All patients underwent preoperative and postoperative magnetic resonance imaging for the collection of AMADEUS (Area Measurement and Depth and Underlying Structures) and MOCART (magnetic resonance observation of cartilage repair tissue) scores. Clinical analysis was conducted by a numeric analog scale (NAS) for pain and knee function before the intervention and at 12 and 24 months postoperatively.Results:A total of 12 female and 15 male patients (mean age, 28.7 years) were evaluated for a mean of 28.2 ± 3.8 months. The mean cartilage defect size encountered intraoperatively was 3.1 ± 1.6 cm2. There was a significant decrease in pain from 7.2 ± 1.9 preoperatively to 1.8 ± 1.6 ( P < .001) at 2-year follow-up. Knee function improved from a mean of 7.2 ± 2.0 preoperatively to 2.1 ± 2.3 ( P < .001) at 2 years after surgery. The mean preoperative AMADEUS score was 57.4 ± 21.4. Postoperatively, the mean MOCART score was 40.6 ± 21.1 at 6-month follow-up. No correlation was observed between the clinical data and the MOCART or AMADEUS scores.Conclusion:Overall, the findings of this study demonstrated that patients undergoing a single-step autologous minced cartilage procedure had a satisfactory outcome at 2-year follow-up. As a result, the single-step autologous minced cartilage procedure does represent a possible alternative to standard autologous chondrocyte implantation. Longer follow-up and larger cohorts are required to define the benefits of this procedure.

A Feasibility Pilot Study on the Use of Telemedicine for the Examination of the Knee Joint

2020 ◽  
Author(s):  
Sebastian Scheidt ◽  
Michael Kehrer ◽  
Max Jaenisch ◽  
Hans Goost ◽  
Dieter Christian Wirtz ◽  
...  
Keyword(s):  
Knee Joint ◽  
Physical Examination ◽  
National Level ◽  
Treatment Modalities ◽  
Medical Background ◽  
Leg Axis ◽  
Number Of Patients ◽  
Video Consultation ◽  
The Mean ◽  
Self Examination

Abstract Background In times of a pandemic threat, such as COVID-19, and the need for reduced direct doctor-patient contact, internet-based telemedicine has attracted more and more attention as a surrogate service. Suspending the diagnosis and treatment of non-virus related diseases for longer periods of time is not a viable option since this would only exacerbate problems on the patient and national level. The need for alternative treatment modalities increased rather quickly. So far, telemedical applications have mainly focused on teleradiological diagnosis, follow-up and monitoring of psychiatric and internal diseases, as well as geriatric patient care. As far as these authors are aware, orthopaedic physical examination of the knee joint, including trauma work-up, has not been the subject of any studies to date. This feasibility study explores how video consultation can be designed and implemented in the context of history taking and physical examination in knee joint complaints. Material and Method 21 patient actors (PA) with simulated complaints of the knee joint were examined individually for each diagnosis, first via video consultation and then directly by a specialist (SP). One PA group has a medical background, the other was made up of laypersons. The time was measured for both types of consultation. The physician documented the detected symptoms, the quality of implementation of the self-examination steps, and the derived diagnosis on an assessment form. After completion of both consultation sessions, the PAs were handed a questionnaire on the respective examination modality. Results With the video consultation the examination lasted 8.63 (± 2.5) minutes on average and with the regular consultation in person 5.63 (± 1.7) minutes (p < 0.001). For the group with medical background the examination lasted 7.67 (± 1.4) minutes on average, while for the lay group the video consultation took 9.7 (± 3.1) minutes (p = 0.049). With increased age, the video consultation was prolonged (p = 0.032; r = 0.47). The mean value for self-examination of leg axis, gait pattern and degrees of freedom was 9.32 (± 0.4) of 10 points. The following functional tests resulted in lower mean values (points): Payr 7.2 (± 2.3), Merke 5.9 (± 2.8), no-touch Lachmann 6.4 (± 2.7), gravity sign-recurvatum 6.7 (± 2.4). The mean grade by the PAs for the feasibility of self-examination was 2.43 (± 0.98) out of 5 points. Conclusion The video consultation for musculoskeletal complaints of the knee joint allows exploratory remote examination and helps to minimise the number of patients in hospitals and practices. It takes longer for the physician to perform and does not permit functional testing for ligament injuries of the knee joint. In its present form, telemedical examination is not able to fully replace personal consultation.

scholarly journals Comparison of the effectiveness of Ropivacaine soaked vs bupivacaine soaked dressing for pain relief at split thickness skin graft donor site.

2020 ◽  
Vol 27 (09) ◽  
pp. 1952-1957
Author(s):  
Abdul Malik Mujahid ◽  
Farrukh Aslam Khalid ◽  
Kashif Mehmood Sheikh ◽  
Muhammad Sheraz Raza ◽  
Husnain Khan ◽  
...  
Keyword(s):  
Pain Relief ◽  
Rating Scale ◽  
Donor Site ◽  
Skin Grafting ◽  
Tissue Loss ◽  
Thickness Skin ◽  
Split Thickness Skin Grafting ◽  
Group A ◽  
The Mean ◽  
Group B

Objectives: To compare the mean pain score of ropivacaine soaked dressing versus bupivacaine-soaked dressing for pain relief at the donor site among patients requiring split thickness skin grafting after burns and tissue loss. Study Design: (RCT) Randomized control trial. Setting: Department of Plastic Surgery Jinnah Burn and Reconstructive Surgery Center Lahore. Period: January 1, 2019 to June 31, 2019. Material & Methods: Total 120 patients meeting the inclusion criteria were enrolled and divided randomly into Group-A and Group-B based on lottery method. Group A was dressed with ropivacaine soaked dressing while group-B with bupivacaine-soaked dressing. Patients were asked about pain four hours after the dressing using the verbal rating scale of 0-10. Result: Total 120 patients were included and randomly divided in to two groups. The mean age of ropivacaine group (Group A) patients was 40.82±13.20 years and bupivacaine group (Group-B) patients was 39.70±12.20 years. 56(46.67%) patients were males and 64(53.33%) patients were females.  Male to female ratio was 0.8:1. The mean size of the defect for Group-A patients was 10.43±2.92 and Group B patients was 10.13±2.91. The Mean Visual Rating Scale (VRS) at the baseline for ropivacaine was 7.95 ± 1.04 and for bupivacaine was 8.0167 ±.791 (p =0.695) and VRS (verbal rating scale) at 4 hours of ropivacaine group patients was 1.27±1.13 and in bupivacaine group patients was 2.58±1.61. The statistically significant difference is found between the two study groups for VRS at 4 hours (p-value=0.001). Conclusion: Ropivacaine soaked dressing showed significantly better outcome than bupivacaine-soaked dressing at the donor site among patients requiring split thickness skin grafting after burns and tissue loss.

scholarly journals Paradigm Shift in Treatment Strategies for Second-Degree Burns Using a Caprolactone Dressing (Suprathel®)? A 15-Year Pediatric Burn Center Experience in 2084 Patients

2021 ◽  
Vol 3 (1) ◽  
pp. 1-9
Author(s):  
Katharina Schriek ◽  
Hagen Ott ◽  
Mechthild Sinnig
Keyword(s):  
Retrospective Study ◽  
General Anesthesia ◽  
Skin Grafting ◽  
Treatment Modalities ◽  
Control Group ◽  
Study Group ◽  
Pediatric Hospital ◽  
Thickness Skin ◽  
Split Thickness Skin Grafting ◽  
Second Degree

Background: Thermal injuries represent a highly relevant epidemiologic problem with 11 million individuals affected globally each year, of which around 2.75 million are children. Different approaches to the conservative treatment of second-degree burns have been widely discussed in the existing literature. One method that has attracted increasing attention is the use of caprolactone dressings. This paper describes a study involving the therapeutic management of 2084 pediatric patients suffering from mixed superficial and deep dermal second-degree burns who received comprehensive expert treatment using caprolactone membranes at the pediatric hospital AUF DER BULT. Methods: A retrospective study was conducted to evaluate the frequency and effect of caprolactone membrane usage on children who were admitted to the pediatric hospital between 2002 and 2016 with mixed second-degree burns. The number of dressing changes under general anesthesia and the requirement for split thickness skin grafting were monitored and recorded. In addition, a cost comparison analysis of different treatment modalities was performed. Results: This retrospective study involved 2084 children who had been treated for mixed superficial and deep dermal burns between 2002 and 2016 using either caprolactone dressing (Suprathel®) (study group; n = 1154) or an alternative dressing material (control group; n = 930). Of the patients in the study group, 91.74% (n = 1053) were treated conservatively compared to 76.05% of the control group patients, meaning that 8.26% (n = 101) of the study group patients required skin grafting, compared to 23.95% (n = 223) in the control group. Additionally, the number of procedures under general anesthesia per patient was found to be 54.3% lower among all patients treated with caprolactone dressing (1.75 procedures per patient) compared to the entire control group (3.22 procedures per patient). In the subgroups, patients treated conservatively with caprolactone dressing required 1.42 procedures per patient compared to 2.25 procedures per patient in patients with alternative wound treatment. When split thickness skin grafting was necessary, 1.2 times as many procedures were performed on patients with alternative dressing compared to those treated with caprolactone dressing. Finally, the cost per patient was considerably lower in the conservative therapy group in comparison to the group that consisted of patients undergoing operative therapy with split thickness skin grafting. Conclusions: Caprolactone dressings were found to be beneficial for children who reported with mixed superficial and deep dermal burns. Specifically, they reduced the need for skin transplantation, the number of dressing changes under general anesthesia, and the treatment costs.

scholarly journals Locking Plate Alone or in Combination With Cannulated Screws for Hoffa Fractures: a Retrospective Cohort Study

2021 ◽  
Author(s):  
Zhen Li ◽  
Zhenyue Chen ◽  
Xiaotan Wang ◽  
Jingyin Li ◽  
Lizhong Jing ◽  
...  
Keyword(s):  
Cohort Study ◽  
Knee Joint ◽  
Locking Plate ◽  
Functional Results ◽  
International Knee Documentation Committee ◽  
Cannulated Screws ◽  
Range Of Movement ◽  
The Mean ◽  
Active Rehabilitation

Abstract Purpose: Locking plate or screws have been used for Hoffa fractures; however, evidence to support the effectiveness of the procedure remains scarce. The present study aimed to determine the efficacy of distal femur condyle locking plate（DFCLP）alone or in combination with cannulated screws for Hoffa fractures.Methods: In this cohort study, 13 patients with isolated Hoffa fractures were enrolled during the study period (May 2014 to February 2019) and retrospectively analyzed. Patients underwent open reduction and internal fixation by DFCLP alone or in combination with cannulated screws followed by early active rehabilitation postoperatively. The primary outcome was evaluated with Knee Society Score (KSS), the range of movement (ROM), International Knee Documentation Committee (IKDC) scoring system and the stability of the fixation site of the patients during the 24-month follow-up period.Results: A total of 13 patients completed the 24-month follow-up assessment and achieve bone re-union at Hoffa fracture sites. The average follow-up period was 24.5months (ranging from 24 to 28 months), and the average time to healing was 3.5 months (ranging from 3 to 4 months). The mean ROM was determined as 119°, the mean KSS was 87.9, and the mean IKDC score was 84.2. It is worth mentioning that 2 patients suffered from knee joint stiffness and osteoarthritis during the 24 months follow-up. Eleven patients (84.6%) achieved satisfactory knee joint function through early postsurgical rehabilitation.Conclusion: In patients with Hoffa fractures, treatment with DFCLP alone or in combination with cannulated screws followed by early active rehabilitation resulted in great stability and satisfactory functional results after 24 months.

Clinical Application of the Peroneal Artery Perforator Flap for Reconstruction of Lateral Malleolus Defects

2021 ◽  
pp. 153473462110158
Author(s):  
Yu-Jen Shih ◽  
Yen-Chun Wang ◽  
Chin-Ta Lin ◽  
Shun-Cheng Chang ◽  
Yuan-Sheng Tzeng ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Perforator Flap ◽  
Skin Grafting ◽  
Lateral Malleolus ◽  
Peroneal Artery ◽  
Thickness Skin ◽  
Split Thickness Skin Grafting ◽  
Ankle Joints ◽  
The Mean ◽  
Artery Perforator

The reconstruction of defects of the lateral malleolus involving the exposed fibular bone or tendon is challenging. This study aimed to evaluate the clinical application of the peroneal artery perforator flap with or without split-thickness skin grafting for soft tissue reconstruction of the bony defect of the lateral malleolus of the ankle joints. Reconstruction using a peroneal artery perforator flap with or without split-thickness skin grafting was performed for 15 patients (10 men, 5 women) between January 2007 and December 2018. The mean age was 53.7 years, and the mean size of the flaps was 40 cm2. The flaps were elevated in the form of a perforator flap, and split-thickness skin grafting was performed over the flaps and adjoining raw areas. The flaps survived in all cases; however, partial necrosis was observed in 3 cases. In cases of small-sized defects of the lateral malleolus of the ankle joints where a flap is required for the exposed bone or tendon, reconstruction using the peroneal artery perforator flap is advantageous, since the morbidity rate of the donor site is low and soft tissue is reconstructed.

A Proposed Algorithm for Managing the Open Abdomen

2005 ◽  
Vol 71 (3) ◽  
pp. 202-207 ◽  
Author(s):  
James Cipolla ◽  
Stanislaw P. Stawicki ◽  
William S. Hoff ◽  
Nathaniel Mcquay ◽  
Brian A. Hoey ◽  
...  
Keyword(s):  
Open Abdomen ◽  
Skin Grafting ◽  
Fascial Closure ◽  
Saps Ii ◽  
Absorbable Mesh ◽  
Delayed Primary Closure ◽  
Thickness Skin ◽  
Split Thickness Skin Grafting ◽  
The Mean ◽  
Surgical Conditions

Delayed abdominal closure has gained acceptance in managing a variety of surgical conditions. Multiple techniques were devised to promote safe, uncomplicated, expeditious fascial closure. We retrospectively reviewed patient records between September 22, 2001 and June 30, 2004. Of the 20 patients with open abdomen, two patients died within 24 hours and one was transferred. The remaining 17 were managed using an algorithm including a combination of delayed primary closure (DPC), vacuum-assisted fascial closure (VAFC), Wittmann Patch (WP) (Star Surgical, Inc., Burlington, WI), and planned ventral hernia via absorbable mesh with split thickness skin grafting (PVH). The mean Simplified Acute Physiology Scores (SAPS II) was 31 (predicted mortality 73%). All patients initially underwent VAFC and re-exploration 12–48 hours later. Indications for continued VAFC included 1) gross contamination, 2) massive bowel edema, 3) continued bleeding at re-exploration. If these conditions were absent, DPC was attempted or a WP was employed until fascial closure. Twenty-eight day mortality was 5.9 per cent (1/17 patients). Enterocutaneous fistulae occurred in two patients (11.7%). Fascial closure was achieved in 6 patients (35.3%). Eleven patients were managed with PVH. Using an algorithm with a combination of several techniques, open abdomen can be managed with minimal morbidity and acceptable closure rates.

Outcomes of Split Thickness Skin Grafting on Lower Extremity Wounds in Diabetics

Diabetes ◽  
2018 ◽  
Vol 67 (Supplement 1) ◽  
pp. 111-OR
Author(s):  
ELLIOT WALTERS ◽  
GREG STIMAC ◽  
NEHA RAJPAL ◽  
IRAM NAZ ◽  
TAMMER ELMARSAFI ◽  
...  
Keyword(s):  
Lower Extremity ◽  
Skin Grafting ◽  
Thickness Skin ◽  
Split Thickness Skin Grafting

Radiosurgery for dural carotid-cavernous sinus fistulas: Gamma Knife compared with XKnife radiosurgery

2010 ◽  
Vol 113 (Special_Supplement) ◽  
pp. 9-20 ◽  
Author(s):  
Hung-Chuan Pan ◽  
Ming-Hsi Sun ◽  
Jason Sheehan ◽  
Meei-Ling Sheu ◽  
Clayton Chi-Chang Chen ◽  
...  
Keyword(s):  
Clinical Improvement ◽  
Gamma Knife ◽  
Temporal Lobe ◽  
Treatment Modalities ◽  
Conformity Index ◽  
Index Number ◽  
The Mean ◽  
Instrument Accuracy ◽  
Group 1

Object In the modern era, stereotactic radiosurgery is an important part of the multidisciplinary and multimodality approach used to treat dural carotid-cavernous fistulas (DCCFs). Based on the ease of performance of techniques to fuse cerebral angiography studies with MR images or CT scans during the radiosurgical procedure, the Gamma Knife and XKnife are 2 of the most popular radiosurgical instruments for patients with DCCF. In this study, the authors compared the efficacy, neurological results, and complications associated with these 2 radiosurgical devices when used for DCCF. Methods Records for 41 patients with DCCF (15 treated using the XKnife and 26 with Gamma Knife surgery [GKS]) were retrieved from a radiosurgical database encompassing the period of September 2000 to August 2008. Among these patients, at least 2 consecutive MR imaging or MR angiography studies obtained after radiosurgery were available for determining radiological outcome of the fistula. All patients received regular follow-up to evaluate the neurological and ophthalmological function at an interval of 1–3 months. The symptomatology, obliteration rate, radiation dose, instrument accuracy, and adverse effects were determined for each group and compared between 2 groups. The data were analyzed using the Student t-test. Results The mean age of the patients was 63 ± 2.6 years, and the mean follow-up period was 63.1 ± 4.4 months (mean ± SD). Thirty-seven patients (90%) achieved an obliteration of the DCCF (93% in the XKnife cohort and 88% for the GKS cohort). In 34 of 40 patients (85%) with chemosis and proptosis of the eyes, these symptoms were resolved after treatment (4 had residual fistula and 2 had arterializations of sclera). All 5 patients with high intraocular pressure demonstrated clinical improvement. Ten (71%) of 14 patients with cranial nerve palsy demonstrated improvement following radiosurgery. Significant discrepancies of treatment modalities existed between the XKnife and GKS groups, such as radiation volume, conformity index, number of isocenters, instrument accuracy, peripheral isodose line, and maximum dosage. The XKnife delivered significantly higher radiation dosage to the lens, optic nerve, optic chiasm, bilateral temporal lobe, and brainstem. Few adverse events occurred, but included 1 patient with optic neuritis (GKS group), 1 intracranial hemorrhage (XKnife group), 1 brainstem edema (XKnife), and 3 temporal lobe radiation edemas (XKnife). Conclusions Radiosurgery affords a substantial chance of radiological and clinical improvement in patients with DCCFs. The Gamma Knife and XKnife demonstrated similar efficacy in the obliteration of DCCFs. However, a slightly higher incidence of complications occurred in the XKnife group.

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