scholarly journals Completely extruded talus without soft tissue attachments

2011 ◽  
Vol 1 (1) ◽  
pp. 12 ◽  
Author(s):  
Young Rak Choi ◽  
Jae Jung Jeong ◽  
Ho Seong Lee ◽  
Sang Woo Kim ◽  
Jin-Soo Suh
Keyword(s):  
Physical Activity ◽  
Soft Tissue ◽  
Femoral Head ◽  
Aseptic Loosening ◽  
Ankle Joint ◽  
Present Report ◽  
Bone Bank ◽  
Wound Debridement ◽  
Ankle Fusion

A completely extruded talus without any remaining soft tissue attachments is extremely rare. The present report describes treatment of a 45-year-old man who sustained a completely extruded talus injury following a rockclimbing fall. Upon admission, the extruded talus was deep-frozen in our bone bank. The open ankle joint underwent massive wound debridement and irrigation for 3 days. Four days later we performed a primary subtalar fusion between the extruded talus and the calcaneus, anticipating revascularization from the calcaneus. However, aseptic loosening and osteolysis developed around the screw and talus. At 12 months post-trauma we performed a tibiocalcaneal ankle fusion with a femoral head allograft to fill the talar defect. Follow-up at 24 months post-trauma showed the patient had midfoot motion, tibio-talar-calcaneal fusion, and was able partake in 4-hour physical activity twice per week.

Mid-term results of short stem total hip arthroplasty in patients with osteonecrosis of the femoral head

2018 ◽  
Vol 29 (6) ◽  
pp. 603-608 ◽  
Author(s):  
Yingyong Suksathien ◽  
Jithayut Sueajui
Keyword(s):  
Femoral Head ◽  
Total Hip Arthroplasty ◽  
Aseptic Loosening ◽  
Hip Arthroplasty ◽  
Short Stem ◽  
Stem Revision ◽  
The Mean ◽  
Bone Trabeculae ◽  
Mid Term Results

Purpose: To evaluate the clinical and radiographic mid-term results of short-stem total hip arthroplasty (THA) in patients with osteonecrosis of the femoral head (ONFH). Methods: We reviewed 83 cases that underwent Metha stem between November 2010 and November 2012. The appearance of bone trabeculae development and radiolucent line were reviewed and HHS was recorded at 6 months postoperatively then yearly to evaluate the clinical results. Results: The mean age of patients was 43.8 years with the mean follow-up 69.3 (60–84) months. Harris Hip Score improved significantly from 44.7 preoperatively to 99.6 at the last follow-up ( p < 0.0001). There were 4 cases (4.8%) of intraoperative femoral fractures. There was 1 case (1.2%) of distal stem perforation that had stable bone ingrowth and there was 1 case (1.2%) of 5-mm subsidence, which was then stable at 3 months postoperatively. Bone trabecular development was detected at zone 1 (65.1%), 2 (69.9%), 3 (14.4%), 4 (1.2%), 6 (97.6%) and 7 (81.9%). There was 1 case (1.2%) where radiolucent lines were observed in zones 1 and 7. There was 1 femoral stem revision from periprosthetic fracture 4 years after index surgery and 1 cup revision from aseptic loosening. Kaplan-Meier survivorship with the end point of stem revision for any reason was 98.8% and for aseptic loosening it was 100% at 7 years. Conclusions: The mid-term clinical and radiographic results of the Metha stem in patients with ONFH were promising. Its design enables preservation of the bone stock and the bone trabeculae appear to confirm the assumption of proximal force transmission.

scholarly journals Staged Joint Arthrodesis in the Treatment of Severe Septic Ankle Arthritis Sequelae: A Case Report

2021 ◽  
Vol 18 (23) ◽  
pp. 12473
Author(s):  
Yong-Cheol Hong ◽  
Ki-Jin Jung ◽  
Hee-Jun Chang ◽  
Eui-Dong Yeo ◽  
Hong-Seop Lee ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Soft Tissue ◽  
Limb Salvage ◽  
Ankle Joint ◽  
Daily Life ◽  
Emission Computed Tomography ◽  
Ankle Arthritis ◽  
Joint Deformity ◽  
The Right

Septic ankle arthritis is a devastating clinical entity with high risks of morbidity and mortality. Prompt treatment is necessary because delayed or inadequate treatment can lead to irreversible damage that may occur on the articular surface, resulting in cartilage erosion, infective synovitis, osteomyelitis, joint deformity, and pain and joint dysfunction. An aggressive surgical approach is required when a joint infection causes severe limb-threatening arthritis. A 58-year-old woman visited our clinic with increasing pain in the right ankle, which had been present for the previous 2 months. She complained of discomfort in daily life due to deformity of the ankle; limping; and severe pain in the ankle even after walking a little. The patient reported a history of right-ankle injury while exiting a bus in her early 20s. Plain radiographs of the right ankle joint revealed that the medial malleolus was nearly absent in the right ankle joint on the anteroposterior view, and severe varus deformity was observed with osteoarthritic changes because of joint space destruction. Magnetic resonance imaging revealed diffuse synovial thickening of the destroyed tibiotalar joint with joint effusion. Hybrid 99mTc white blood cell single-photon emission computed tomography/computed tomography showed increased uptake along the soft tissue around the ankle joint; uptake was generally low in the talocrural and subtalar joints. A two-stage operation was performed to remove the infected lesions and correct the deformity, thus enabling limb salvage. The patient was nearly asymptomatic at the 6-month follow-up, with no discomfort in her daily life and nearly normal ability to carry out full functional activities. She had no complications or recurrent symptoms at the 1-year follow-up. We have described a rare case of a staged limb salvage procedure in a patient with chronic septic arthritis sequelae. For patients with severe joint deformity because of septic ankle sequelae, staged arthrodesis is a reliable method to remove infected lesions, solve soft tissue problems, correct deformities, and maintain leg length.

scholarly journals Using TSF Multi-Planar External Fixation for Overcorrection of Severe Equinus Contractures of the Ankle joint

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0015
Author(s):  
Sherif Dabash ◽  
Eric Potter ◽  
William McGarvey
Keyword(s):  
Soft Tissue ◽  
Ankle Joint ◽  
Soft Tissues ◽  
Retrospective Chart Review ◽  
Taylor Spatial Frame ◽  
Rank Test ◽  
Tertiary Referral Center ◽  
Spatial Frame ◽  
Equinus Deformity

Category: Ankle, Hindfoot, Trauma Introduction/Purpose: Equinus deformity is a debilitating condition which interferes with the activity of daily living. Correction of the deformity ranges from conservative (heel cord stretching, orthotics) to surgical treatment (Baumann, Strayer, Achilles lengthening, soft tissue releases). Severe contractures need surgical intervention with extensive dissections to release soft tissues. This study investigated the clinical outcomes of gradual equinus contracture overcorrection using a Taylor Spatial Frame with tendo-Achilles lengthening or toe flexor tenotomy as necessary. Methods: This retrospective chart review evaluated patients with significant equinus treated with a Taylor Spatial Frame at a single large tertiary referral center. Data collected included: diagnosis; patient demographics; laterality; time in frame; additional procedures; complications. Patients were assessed preoperatively and were followed at one-week, three-week, six-week, three- month, and six-month intervals, and yearly after. Results: 24 patients (26 procedures) were treated with a Taylor Spatial Frame for equinus and had complete preoperative and eighteen-month follow-up measurements. The angle of deformity increased from a preoperative -21.5 (range, -69.0 to -1.0) degrees to a postoperative 4.9 (range, -17.0 to 17.0) degrees (z = -4.4573, p = 0.0001, N = 26, Wilcoxon signed rank test). Four complications occurred during the follow up (two pin site infections, one broken pin, and one plantar abscess). Three patients had recurrence of of equinus deformity at time of last follow-up. Conclusion: Taylor Spatial Frame is a successful method for correcting severe, fixed equinus contractures of the ankle joint with minimal soft tissue related complications. Over correction should be achieved in order to compensate for the loss of some dorsiflexion after frame removal.

scholarly journals Study Protocol: Optimization of the surgical and medical management of diabetic foot infections

2019 ◽  
Author(s):  
Felix WA Waibel ◽  
Martin Berli ◽  
Sabrina Catanzaro ◽  
Kati Sairanen ◽  
Madlaina Schöni ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Antibiotic Therapy ◽  
Diabetic Foot ◽  
Primary Outcome ◽  
Randomized Clinical Trials ◽  
Antibiotic Use ◽  
Wound Debridement ◽  
Diabetic Foot Infections ◽  
Systemic Antibiotic Therapy

Abstract Background: Few studies address the appropriate duration of antibiotic therapy for diabetic foot infections (DFI); with or without amputation. We perform two randomized clinical trials (RCT) to reduce the antibiotic use and associated adverse events in DFI. Methods: We hypothesize that shorter durations of post-debridement systemic antibiotic therapy are non-inferior (10% margin, 80% power, ɑ 5%) to existing (long) durations and perform two unblinded RCTs with a total of 400 DFI episodes (randomization 1:1) from 2019 to 2022. The primary outcome for both RCT is “remission of infection” after a minimal follow-up of two months. The 1 st RCT allocates the amputations in two arms of 50 patients each: 1 vs. 3 weeks of antibiotic therapy for residual osteomyelitis (positive microbiological samples of the residual bone stump); or 1 vs. 4 days for remaining soft tissue infection. The 2 nd RCT randomizes the conservative approach in two arms with 50 patients each: 10 vs. 20 days of antibiotic therapy for soft tissue infections; and 3 vs. 6 weeks for osteomyelitis. All participants have professional wound debridement, adequate off-loading, angiology evaluation, and a concomitant surgical, re-educational, internist and infectiology care. During the surgeries, we collect tissues for BioBanking and future laboratory studies. Discussion: Both parellel RCT will enable to prescribe less antibiotics for DFI; for a conservative therapy and after amputation. Trial registration: ClinicalTrial.gov NCT04081792. Registered on 4 th September 2019. Protocol version : 2 (15 th July 2019)

Salvage of the Septic Ankle with Concomitant Tibial Osteomyelitis

1997 ◽  
Vol 18 (3) ◽  
pp. 151-156 ◽  
Author(s):  
David B. Thordarson ◽  
Michael J. Patzakis ◽  
Paul Holtom ◽  
Randy Sherman
Keyword(s):  
Soft Tissue ◽  
Distal Tibia ◽  
Treatment Protocol ◽  
Aggressive Treatment ◽  
Bone Infections ◽  
Standardized Protocol ◽  
Tissue Transfer ◽  
Ankle Fusion ◽  
Intravenous Antibiotics

Five patients with concomitant distal tibia osteomyelitis and ankle sepsis with an open, draining wound were treated. All of the patients were men with an average age of 54.8 years. All of the bone infections were polymicrobial and had open draining wounds. A standardized protocol of radical soft tissue and bone debridement, soft tissue transfer, intravenous antibiotics, and delayed ankle fusion was employed. All five fusions were successful on first attempt, with an average time to fusion of 3.5 months. All patients were free of infection at an average follow-up of 27 months. We believe our aggressive treatment protocol can salvage these extremities and preclude amputation in properly selected cases.

Replacement of the Lateral Malleolus of the Ankle Joint with a Reversed Proximal Fibular Bone Graft

1997 ◽  
Vol 18 (6) ◽  
pp. 317-323 ◽  
Author(s):  
Charles L. Herring ◽  
Reginald L. Hall ◽  
J. Leonard Goldner
Keyword(s):  
Soft Tissue ◽  
Ankle Joint ◽  
Soft Tissue Defect ◽  
Distal Fibula ◽  
Ankle Ligaments ◽  
Lateral Ankle ◽  
Proximal Fibula ◽  
Peroneus Brevis ◽  
Lateral Ankle Ligaments

Infrequently, prior reports have described the use of the ipsilateral proximal fibula to replace an absent distal fibula caused by either trauma, infection, or resection for tumor. 3 , 4 This is a 27-year follow-up of a 12-year-old patient who lost the distal 7.5 cm of her fibula secondary to trauma. The soft tissue defect was replaced early by an abdominal flap and the bone defect was eventually replaced with 7.5 cm of proximal fibula. The lateral ankle ligaments were reconstructed with the peroneus brevis, and the ankle joint has remained stable. Although traumatic arthrosis has progressed slowly, the patient at age 39 has a relatively painless, mobile ankle joint.

Inflammatory Myofibroblastic Tumour in Antimesenteric Border of Descending Colon of Children: A Case Report

2015 ◽  
Vol 3 (1) ◽  
pp. 47-50
Author(s):  
Shahnoor Islam ◽  
AKM Amirul Morshed ◽  
Afiqul Islam
Keyword(s):  
Soft Tissue ◽  
Spindle Cell ◽  
Inflammatory Myofibroblastic Tumour ◽  
Pathological Findings ◽  
Soft Tissue Lesion ◽  
Soft Tissue Tumours ◽  
Inflammatory Pseudotumour ◽  
Erythrocyte Sedimentation ◽  
Antimesenteric Border

Inflammatory myofibroblastic tumour (IMT) occurring at intraabdominal sites in children has rarely been described. Inflammatory pseudotumour is a soft tissue lesion that may be confused with a sarcoma. It is abbreviated as IMT. Inflammatory myofibroblastic tumour, also known as soft tissue tumours, atypical fibromyxoid tumours, pseudosarcomatous fibromyxoid tumour, plasma cell granuloma, pseudosarcomatous myofibrotic proliferation, post-operative spindle cell nodules. In this paper, we describe a case of inflammatory myofibroblastic tumour (IMT) with an unusual constellation of clinical, pathological findings. A 10-year-old girl had an 7-cm intraabdominal mass accompanied by severe anemia, fever, constipation, weight loss, thrombocytosis, elevated erythrocyte sedimentation rate. Laparotomy was performed. The final pathologic diagnosis was IMT. At the most recent follow up (12months) after excision of the tumour, the patient was symptom-free and there was no evidence of tumour recurrence.J. Paediatr. Surg. Bangladesh 3(1): 47-50, 2012 (January)

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