Modern treatment approaches in patients with false joints and lower extremities long bones defects: analytical review

2020 ◽  
Vol 96 (2) ◽  
pp. 84-89 ◽  
Author(s):  
E.S. Prokhorova ◽  
R.Z. Urazgildeev ◽  
M.A. Eremushkin ◽  
V.A. Kolyshenkov
Keyword(s):  
Effective Treatment ◽  
Soft Tissues ◽  
Surgical Techniques ◽  
Lower Extremities ◽  
Additional Treatment ◽  
Segment Length ◽  
Long Bones ◽  
Treatment Methods ◽  
Functional Changes ◽  
Bone Segment

Research of effective treatment methods in patients with pseudoarthrosis and lower extremities long bones defects remains today very relevant. In the structure of traumatological patients general disability it takes up to 33.1% of cases. Surgical techniques are used, such as: intramedullary osteosynthesis, method of open reposition and bone fragments fixation by metal structures, method of transcutaneous osteosynthesis. They are recognized as effective treatment methods in patients with pseudoarthrosis and lower extremities long bones defects, that greatly improves treatment outcomes. Unfortunately, when they are used as single intervention, unsatisfactory therapy results occur in up to half of the cases. Concomitant structural and functional changes of the limb - such as regional blood circulation insufficiency, presence of extensive cicatrical soft tissues defects, changes in bone segment length, joints contractures, etc. - interferes bone consolidation and requires an application of additional treatment methods. Thus, the generally accepted treatment approach in patients with pseudoarthrosis and lower extremities long bones defects is a combination of surgery, pharmacotherapy, methods of physical therapy and physiotherapy in order to optimize the processes of osteoregeneration in non-union area.

Validación fisiológica de un modelo de pie humano para estudio de patología de dedo en garra

2021 ◽  
Author(s):  
◽  
L. M. González Torres
Keyword(s):  
Finite Element ◽  
Soft Tissues ◽  
Surgical Techniques ◽  
Lower Extremities ◽  
Structural Behavior ◽  
Finite Element Models ◽  
Claw Toe ◽  
Different Types ◽  
Numerical Finite Element ◽  
Future Work

The standing finite element models allow the study of their biomechanical-structural behavior. Research of this type provides podiatrists with knowledge in improving surgical techniques, thus allowing the exploration of new alternatives in the correction of biomechanical alterations in the lower extremities. Thus, reporting models in the literature with different types of contact in the joints, insertion of soft tissues such as the skin, as well as variation in the properties of the tissues. This research presents two numerical finite element models, healthy foot and claw toe pathology in the second radius. Based on the model of Mancera et al. (2020). The modifications include changes in load and contour conditions to simulate the "midstance" phase with 700 N load. The pathology model presents rotations and adjustments in the main soft tissues involved in the second radius of the foot. The two models were meshed and solved under the same conditions. The results of the simulation of the models are validated with the Costa Bartani and Kite angle. This was performed in the unloaded and loaded foot cases to verify that the model is within the parameters of the healthy foot. The Costa Bartani angle presented the greatest variation, while the Kite angle remained within the range value for a healthy foot. The models proposed during their evaluation show that pathologies that only involve the second radius of the foot affect the aforementioned angles, therefore, the biomechanical-structural behavior of the foot, allowing the study of other pathologies in future work.

Conus-level combined dorsal and ventral lumbar rhizotomy for treatment of mixed hypertonia: technical note and complications

2021 ◽  
Vol 27 (1) ◽  
pp. 102-107
Author(s):  
Ranbir Ahluwalia ◽  
Patrick Bass ◽  
Laura Flynn ◽  
Elizabeth Martin ◽  
Heather Riordan ◽  
...  
Keyword(s):  
Effective Treatment ◽  
Lower Extremities ◽  
Technical Note ◽  
Operative Approach ◽  
Less Invasive ◽  
Ventral Roots ◽  
Technical Challenges ◽  
Invasive Techniques ◽  
Csf Leaks

Combined dorsal and ventral rhizotomy is an effective treatment for patients with concurrent spasticity and dystonia, with the preponderance of complaints relating to their lower extremities. This operative approach provides definitive relief of hypertonia and should be considered after less-invasive techniques have been exhausted. Previously, the surgery has been described through an L1–S1 laminoplasty. In this series, 7 patients underwent a conus-level laminectomy for performing a lumbar dorsal and ventral rhizotomy. Technical challenges included identifying the appropriate-level ventral roots and performing the procedure in children with significant scoliosis. Techniques are described to overcome these obstacles. The technique was found to be safe, with no infections, CSF leaks, or neurogenic bladders.

How can we Preserve Sexual Function after Ablative Surgery for Benign Prostatic Hyperplasia?

2020 ◽  
Vol 22 (1) ◽  
pp. 4-13
Author(s):  
Ioannis Mykoniatis ◽  
Koenraad Van Renterghem ◽  
Ioannis Sokolakis
Keyword(s):  
Sexual Dysfunction ◽  
Sexual Function ◽  
Gold Standard ◽  
Erectile Function ◽  
Bladder Neck ◽  
Surgical Techniques ◽  
Sperm Retrieval ◽  
Treatment Methods ◽  
Ablative Techniques ◽  
Neurovascular Bundles

: Our aim is to provide a narrative review regarding the prevalence, the associated pathophysiologic pathways and the potential management methods of sexual dysfunction related to ablative surgical techniques for Benign Prostatic Enlargement (BPE). Men suffering from BPE are at high risk of sexual dysfunction due to the disease itself, comorbidities, and pharmacological/surgical treatments. Transurethral resection of the prostate, as the gold standard treatment option for BPE has historically been associated with relatively high rates of postoperative sexual dysfunction problems, mainly retrograde ejaculation but also erectile dysfunction. Ablative surgical techniques, including photoselective vaporization of the prostate (PVP), transurethral needle ablation (TUNA), Transurethral Microwave Therapy (TUMT), Convective Water Vapor Energy Ablation (Rezum®) and Aquablation® have been proposed as treatment methods able to reduce treatment-related complications for BPE patients, including adverse effects on erectile and ejaculatory function, without compromising the efficacy rates for BPE. The neurovascular bundles can be damaged during TURP due to posterolateral capsular perforation. Ablative techniques and especially PVP theoretically seems to skip this hazard as the distance created from the necrotic area to the capsule is generally larger compared to the distance induced after TURP . However, indirect thermal injury of erectile nerves, which could be induced also by the majority of available ablative techniques could potentially lead to ED. Two special technical characteristics (physiological saline use for tissue ablation and real time penetration depth control) of Aquablation® could be proved beneficial with regard to the effect of the method on erectile function. In general ablative techniques seems to have minor impact on sexual function. However, low methodological quality characterize the most of the studies included in this review mainly due to the impossibility, in many cases, to perform a blind randomization. Also in many studies did not have erectile and ejaculatory function as primary outcomes limiting that way their statistical power to identify significant variations. Management of sexual dysfunction problems arising from ablative surgeries for BPE treatment could be divided in two levels. Firstly, intraoperatively the avoidance of manipulation of crucial structures regarding ejaculatory (bladder neck or ejaculatory ducts) and erectile function (neurovascular bundles) could possibly decrease the negative effect of these procedures on sexual function. Thus, in this direction, modifications of classic ablative techniques have been proposed resulting in encouraging outcomes regarding postoperative sexual function. Secondly, if EjD and/or ED are established the already known treatment choices should be chosen in order sexual function rehabilitation to be achieved. Thus, regarding ED: PDE5i daily or on demand remain the gold standard first line treatment choice followed by intracaver-nosal alprostadil injections in cases of failure, while penile prosthesis implantation must be kept as final definitive solution when all the other methods have failed. Regarding ejaculation disorders (retrograde ejaculation or anejaculation): medical therapy with a-agonists (pseudoephedrine), sperm retrieval from the urine, bladder neck reconstruction, prostatic massage, electroejaculation, penile vibratory stimulation and surgical sperm retrieval are the available treatment options. Further, high quality studies are required to investigate potential side effects of BPE surgery on sexual function and efficient treatment methods to manage them.

IMMEDIATE INTERNAL FIXATION FOR OPEN FRACTURES OF THE LONG BONES OF THE UPPER AND LOWER EXTREMITIES

1994 ◽  
Vol 37 (2) ◽  
pp. 230-236 ◽  
Author(s):  
Kazuhiko Yokoyama ◽  
Masateru Shindo ◽  
Moritoshi Itoman ◽  
Makoto Yamamoto
Keyword(s):  
Internal Fixation ◽  
Lower Extremities ◽  
Open Fractures ◽  
Long Bones ◽  
Upper And Lower Extremities

Achievements of the Clinic of Traumatology and Orthopedics of Moscow State Medical and Dentistry University named after A. I. Evdokimov in treatment of complications and consequences of fractures of long bones of extremities

2021 ◽  
Vol 19 (3) ◽  
pp. 144-151
Author(s):  
P. E. ELDZAROV ◽  
Keyword(s):  
Surgical Treatment ◽  
Treatment Process ◽  
Treatment Effectiveness ◽  
Chronic Osteomyelitis ◽  
Surgical Techniques ◽  
Long Bones ◽  
Delayed Fracture ◽  
Reconstructive Operations ◽  
Fracture Consolidation ◽  
Rapid Restoration

The work is devoted to improving the effectiveness of treatment of patients with complications and consequences of fractures of the long bones of the extremities by improving and developing new surgical techniques aimed at early individual social and household rehabilitation due to the maximally complete and rapid restoration of the integrity and functions of the damaged segment. Reconstructive operations were performed in 285 patients with delayed fracture consolidation, incorrectly fused fractures, false joints, and false joints with chronic osteomyelitis. The analysis of the applied treatment methods effectiveness from the viewpoint of optimizing the treatment process allowed us to develop an algorithm for the surgical treatment of patients with complications and consequences of fractures of the long bones of the extremities. The use of the proposed algorithm in surgical treatment maximally eliminates possible errors and increases the treatment effectiveness.

Place of angiography, oscillography and rheography in the examination of patients with obliterating diseases of the arteries of the lower extremities

1982 ◽  
Vol 63 (3) ◽  
pp. 17-19
Author(s):  
M. N. Malinovsky ◽  
A. A. Zamaletdinov ◽  
V. E. Mamaev
Keyword(s):  
Research Methods ◽  
Lower Limb ◽  
Lower Extremities ◽  
Functional Changes ◽  
Initial Stage ◽  
Pharmacological Test ◽  
Literary Process

The data of angiographic, oscillographic and rheographic research methods were compared in 63 patients with obliterating diseases of the lower limb arteries. It has been established that arterial oscillography and rheovasography objectively reflect and document the changes occurring in the arterial bed of patients with obliterating endarteritis and atherosclerosis, only when they are used together. The pharmacological test with nitroglycerin makes it possible to differentiate organic and functional changes in the arterial bed only in the initial stage of the disease, in later periods it only helps in predicting the course of the disease. Angiographic methods of examination clarify the diagnosis, localization and length of the literary process.

scholarly journals A Case of Rhizomelic Chondrodysplasia Punctata in Newborn

2014 ◽  
Vol 2014 ◽  
pp. 1-3 ◽  
Author(s):  
Nalan Karabayır ◽  
Gonca Keskindemirci ◽  
Erdal Adal ◽  
Orhan Korkmaz
Keyword(s):  
Soft Tissues ◽  
Clinical Symptoms ◽  
Current Knowledge ◽  
Chondrodysplasia Punctata ◽  
Long Bones ◽  
Rhizomelic Chondrodysplasia Punctata ◽  
Cervical Spinal Stenosis ◽  
Brain And Spinal Cord ◽  
The Brain ◽  
Severe Growth

Rhizomelic chondrodysplasia punctate (RCDP) is a rare autosomal recessive peroxisomal disease. The main features of the disease are shortening of the proximal long bones, punctate calcifications located in the epiphyses of long bones and in soft tissues around joints and vertebral column, vertebral clefting, dysmorphic face, and severe growth retardation, whereas cervical spinal stenosis may also rarely be present. Imaging of the brain and spinal cord in patients with this disorder may aid prognosis and guide management decisions. We report the newborn diagnosed as CDP with cervical stenosis. Our aim is to discuss current knowledge on etiopathogenesis as well as radiological and clinical symptoms of diseases associated with CDP.

scholarly journals Microvasculature of the Plantar Plate Using Nano–Computed Tomography

2018 ◽  
Vol 40 (4) ◽  
pp. 457-464 ◽  
Author(s):  
Fred T. Finney ◽  
Aaron McPheters ◽  
Natalie V. Singer ◽  
Jaron C. Scott ◽  
Karl J. Jepsen ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Soft Tissues ◽  
Proximal Phalanx ◽  
Surgical Techniques ◽  
Phosphomolybdic Acid ◽  
Vascular Density ◽  
Plantar Plate ◽  
Tibial Arteries ◽  
Clinical Conditions ◽  
Mtp Joints

Background: Lesser toe plantar plate attenuation or disruption is being increasingly implicated in a variety of common clinical conditions. A multitude of surgical techniques and devices have been recently developed to facilitate surgical repair of the plantar plate. However, the microvascular anatomy, and therefore the healing potential in large part, has not been defined. We investigated the microvasculature of the plantar plate by employing a novel technique involving microvascular perfusion and nano–computed tomography (nano-CT) imaging. Methods: Twelve human adult cadaveric lower extremities were amputated distal to the knee. The anterior and posterior tibial arteries were perfused with a barium solution. The soft tissues of each foot were then counterstained with phosphomolybdic acid (PMA). The second through fourth toe metatarsophalangeal (MTP) joints of 12 feet were imaged with nano-CT at 14-micron resolution. Images were then reconstructed for analysis of the plantar plate microvasculature and calculation of the vascular density along the length of the plantar plate. Results: A microvascular network extends from the surrounding soft tissues at the attachments of the plantar plate on both the metatarsal and proximal phalanx. The midsubstance of the plantar plate appears to be relatively hypovascular. Analysis of the vascular density along the length of the plantar plate demonstrated a consistent trend with increased vascular density at approximately the proximal 29% and distal 22% of the plantar plate. Conclusion: There is a vascular network extending from the surrounding soft tissues into the proximal and distal attachments of the plantar plate. Clinical relevance: The hypovascular midportion of the plantar plate may play an important role in the underlying pathoanatomy and pathophysiology of this area. These findings may have significant clinical implications for the reparative potential of this region and the surgical procedures currently described to accomplish anatomic plantar plate repair.

scholarly journals Diagnostic possibilities of thermal vision study of trophic ulcers

2020 ◽  
Vol 19 (2) ◽  
pp. 38-42
Author(s):  
G. V. Yarovenko
Keyword(s):  
Conservative Treatment ◽  
Chronic Venous Insufficiency ◽  
Infrared Radiation ◽  
Venous Insufficiency ◽  
Soft Tissues ◽  
Scattered Light ◽  
Life Quality ◽  
Lower Extremities ◽  
Imaging Method ◽  
Thermal Imager

Chronic venous insufficiency is often accompanied by trophic changes in soft tissues. The treatment of such patients is long and often, ineffective. Relapse of a trophic ulcer is about 30% and leads to deterioration of life quality and dissatisfaction with conservative and even surgical treatment. Goal. Objectification of changes in the microvasculature and compensatory the possibilities of collateral circulation in the lower extremities with complicated forms of chronic venous insufficiency. Materials and methods. The studies were carried out on the Linsor installation characterizing the biological tissue by the change of scattered light intensity and on the thermal imager making possible to determine the temperature of a point with an accuracy of 0,001 degrees, followed by software image processing. The examination was performed 3-4 times in the dynamics of the treatment process and before the patient discharge, from a standard distance of 1,5 meters. The soft tissues in 23 patients with chronic venous insufficiency of the lower extremities and the presence of open trophic ulcers was studied. There were 21 women, 2 men, the average age was 45,2±3,6 years. The area of the ulcer defect varied from 5,7 cm² to 15,3 cm². Patients with extensive trophic ulcers (circular) were excluded from the examination, because of absence of ulcer defect epithelization during the period of hospitalization and its visualization by the thermographic method. Results. As a result of the study, we obtained a reduced intensity of infrared radiation of the ulcer surface in all patients. To clearly isolate ulcerative defect from the surrounding tissues, we set the temperature range 35,0–37,5 °C and recalculated the resulting area in cm² (conversion factor 22,73). We studied the microcirculatory changes occurring in the trophic ulcer and surrounding tissues, confirming the need to continue conservative treatment after complete ulcer defect epithelization for at least 7 days, and only after that period the normalized level of infrared radiation was detected and subsequently relapsed trophic ulcers did not occur for a long time. Conclusion. Based on the obtained data, we confirmed the thermal imaging method sensitivity is suitable for assess of microcirculation in the trophic ulcer area; the method provides the possibility to apply it for the dynamics of conservative treatment in patients with complicated forms of chronic venous insufficiency.

scholarly journals Organization of stage rehabilitation of servicemen with gunshot defects of soft tissues at the levels of medical care

2021 ◽  
Vol 26 (4) ◽  
pp. 188-195
Author(s):  
K.D. Babov ◽  
I.P. Khomenko ◽  
S.V. Tertyshnyi ◽  
Babova I.K. Babova I.K. ◽  
R.S. Vastianov
Keyword(s):  
Surgical Treatment ◽  
Soft Tissue ◽  
Medical Care ◽  
Soft Tissues ◽  
Lower Extremities ◽  
Gunshot Wounds ◽  
Care Quality ◽  
Rehabilitation Service ◽  
Soft Tissue Defects ◽  
Tissue Defects

Building a modern system of rehabilitation of servicemen in Ukraine is an integral part of providing medical care in armed conflict. Rehabilitation of servicemen after gunshot wounds with soft tissue defects of the lower extremities is a common but difficult problem for surgical and rehabilitation teams. The process of rehabilitation requires the implementation of certain methodological provisions. At present, medical care for servicemen is a four-levels’ one. Rehabilitation service is provided at the third and fourth levels of medical care. The aim of the study was to improve the quality of medical care for servicemen after gunshot wounds with soft tissue defects of the lower extremities by introducing a system of staged rehabilitation. Organizational and methodological bases of the system of staged rehabilitation of wounded servicemen with soft tissue defects at different levels of medical care have been developed. Two models of rehabilitation depending on the severity of the injury and the tactics of surgical treatment are proposed. The division of the stage of early sanatorium rehabilitation for the wounded with severe soft tissue injuries depending on the stage of surgical treatment and the formation of a "skin patch" is justified. The introduction of the proposed models of rehabilitation of wounded with soft tissue defects in the practice of early sanatorium rehabilitation will provide increasing of medical care quality.

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