scholarly journals Surgery in multisegmental cervical spondylotic myelopathy: Outcome analysis in a series of 65 patients

2013 ◽  
Vol 02 (02) ◽  
pp. 170-174
Author(s):  
K.B. Shankar ◽  
Shashank Kale ◽  
Bhawani Sharma ◽  
Sumit Sinha
Keyword(s):  
Clinical Outcome ◽  
Surgical Approach ◽  
Cervical Spondylotic Myelopathy ◽  
Outcome Analysis ◽  
Cervical Laminoplasty ◽  
Japanese Orthopedic Association ◽  
Excellent Outcome ◽  
The Mean ◽  
Cervical Plating

Abstract Multi-segmental cervical spondylotic myelopathy (MS-CSM) can be dealt with by either anterior or posterior approaches. The aim of study was to analyze the surgical outcomes of MS-CSM treated by either anterior cervical discectomy with fusion and cervical plating (ACDF) or cervical laminoplasty (LP). Sixty-five patients with MS-CSM (two or more levels) underwent either ACDF (n=13) or LP (n=52). ACDF was performed in patients having these criteria: (i) three or less levels involved, (ii) myeloradiculopathy, (iii) pre-dominant anterior compression radiologically, (iv) <50 years age. LP was chosen in: (i) more than three levels involved (ii) posterior compression radiologically, (iii) >50 years age. Patients were evaluated pre- and post-operatively on the basis of modified Japanese Orthopedic Association (mJOA) scoring and Hirabayashi formula. Thirty-five patients were followed up (8 in ACDF group and 27 in LP group). The mean follow-up period was 37.5 months (12.5-54 months). The mean pre-operative mJOA score in the ACDF group and the LP group was 11±2.62 and 10.6±2.04, respectively. The mean final post-operative mJOA score in the ACDF group (n=8) in follow-up was 14.12±2.36 (P<0.05) and in the LP group (n=27) was 14.63±1.64 (P<0.05). 86% had good-to-excellent outcome while 8.5% had poor outcome. Overall, the mean recovery was 64.73±18.9%. On analyzing two groups separately, the mean recovery in the ACDF group was 59.62±24.2, while in the LP group was 66.25±17.3 (P<0.05). The choice of ACDF and LP in MS-CSM depends on pre-operative clinical and radiological parameters. If the surgical approach is chosen correctly, the surgery in MS-CSM can result in significant improvement in the clinical outcome of these patients.

scholarly journals Laminectomy versus open-door laminoplasty for cervical spondylotic myelopathy: A clinical outcome analysis

2020 ◽  
Vol 11 ◽  
pp. 73 ◽  
Author(s):  
Mauro Dobran ◽  
Fabrizio Mancini ◽  
Riccardo Paracino ◽  
Simona Lattanzi ◽  
Lucia di Somma ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Clinical Outcome ◽  
Cervical Spondylotic Myelopathy ◽  
Outcome Analysis ◽  
Complication Rates ◽  
Open Door ◽  
Analog Scale ◽  
Geriatric Population ◽  
Decompressive Laminectomy ◽  
Japanese Orthopedic Association

Background: Cervical spondylotic myelopathy (CSM) is one of the most common diseases in the geriatric population. Decompressive laminectomy or laminoplasty is the predominant surgical procedure of choice, but there remains debate as to which procedure is optimal for managing CSM. Methods: Here, we retrospectively analyzed 64 patients with CSM undergoing laminectomy (39 patients) versus laminoplasty (25 patients). The data were collected included respective Japanese orthopedic association (JOA) scores, Nurick grades, and Visual analog scale (VAS) values preoperatively versus 12 months postoperatively. Results: The JOA score after 1 month improved in both groups utilizing laminectomy or laminoplasty. However, at 12 postoperative months, the JOA scores and Nurick grades showed greater improvement following laminoplasty, despite no differences in postoperative pain and complication rates. Conclusion: Patients with cervical spondylotic myelopathy undergoing laminoplasty (25 patients) showed better 12-month postoperative outcomes (JOA scores and Nurick grades) versus those having laminectomies (39 patients).

Arthroplasty for cervical spondylotic myelopathy: similar results to patients with only radiculopathy at 3 years' follow-up

2014 ◽  
Vol 21 (3) ◽  
pp. 400-410 ◽  
Author(s):  
Li-Yu Fay ◽  
Wen-Cheng Huang ◽  
Jau-Ching Wu ◽  
Hsuan-Kan Chang ◽  
Tzu-Yun Tsai ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Heterotopic Ossification ◽  
Cervical Myelopathy ◽  
Cervical Spondylotic Myelopathy ◽  
Viable Option ◽  
Cervical Arthroplasty ◽  
Arm Pain ◽  
Significant Difference ◽  
The Mean

Object Cervical arthroplasty has been accepted as a viable option for surgical management of cervical spondylosis or degenerative disc disease (DDD). The best candidates for cervical arthroplasty are young patients who have radiculopathy caused by herniated disc with competent facet joints. However, it remains uncertain whether arthroplasty is equally effective for patients who have cervical myelopathy caused by DDD. The aim of this study was to compare the outcomes of arthroplasty for patients with cervical spondylotic myelopathy (CSM) and patients with radiculopathy without CSM. Methods A total of 151 consecutive cases involving patients with CSM or radiculopathy caused by DDD and who underwent one- or two-level cervical arthroplasty were included in this study. Clinical outcome evaluations and radiographic studies were reviewed. Clinical outcome measurements included the Visual Analog Scale (VAS) of neck and arm pain, Japanese Orthopaedic Association (JOA) scores, and the Neck Disability Index (NDI) in every patient. For patients with CSM, Nurick scores were recorded for evaluation of cervical myelopathy. Radiographic studies included lateral dynamic radiographs and CT for detection of the formation of heterotopic ossification . Results Of the 151 consecutive patients with cervical DDD, 125 (82.8%; 72 patients in the myelopathy group and 53 in the radiculopathy group) had at least 24 months of clinical and radiographic follow-up. The mean duration of follow-up in these patients was 36.4 months (range 24–56 months). There was no difference in sex distribution between the 2 groups. However, the mean age of the patients in the myelopathy group was approximately 6 years greater than that of the radiculopathy group (53.1 vs 47.2 years, p < 0.001). The mean operation time, mean estimated blood loss, and the percentage of patients prescribed perioperative analgesic agents were similar in both groups (p = 0.754, 0.652, and 0.113, respectively). There were significant improvements in VAS neck and arm pain, JOA scores, and NDI in both groups. Nurick scores in the myelopathy group also improved significantly after surgery. In radiographic evaluations, 92.5% of patients in the radiculopathy group and 95.8% of those in the radiculopathy group retained spinal motion (no significant difference). Evaluation of CT scans showed heterotopic ossification in 34 patients (47.2%) in the myelopathy group and 25 patients (47.1%) in the radiculopathy group (p = 0.995). At a mean of over 3 years postoperatively, no secondary surgery was reported in either group. Conclusions The severity of myelopathy improves after cervical arthroplasty in patients with CSM caused by DDD. At 3-year follow-up, the clinical and radiographic outcomes of cervical arthroplasty in DDD patients with CSM are similar to those patients who have only cervical radiculopathy. Therefore, cervical arthroplasty is a viable option for patients with CSM caused by DDD who require anterior surgery. However, comparison with the standard surgical treatment of anterior cervical discectomy and fusion is necessary to corroborate the outcomes of arthroplasty for CSM.

FUNCTIONAL OUTCOME OF MODIFIED PUTTI PLATT PROCEDURE IN RECURRENT DISLOCATION OF SHOULDER – A RETROSPECTIVE ANALYSIS

2021 ◽  
pp. 42-47
Author(s):  
Rijesh P
Keyword(s):  
Clinical Outcome ◽  
Retrospective Analysis ◽  
External Rotation ◽  
Donor Site ◽  
Good Clinical Outcome ◽  
Musculotendinous Junction ◽  
Excellent Outcome ◽  
Donor Site Pain ◽  
The Mean

Hand, which is considered to be an extension of brain and a tool for the execution of human intellect and will, owes much to the versatility of the movement of the shoulder for its placement on the desired spot of action. The shoulder, by virtue of its anatomy and biomechanics, is one of the most unstable and frequently dislocated joints, accounting for nearly 50% of all dislocations. Most of the recurrent dislocations of shoulder (96%) follow an initial signicant traumatic dislocation. There are two basic types of surgical approaches for shoulders with anterior instability: "anatomic" and "non-anatomic" repairs. With anatomic repairs, the goals are to restore the labrum toits normal position and to reestablish the appropriate tension in the shoulder capsule and ligaments. The goal of non-anatomic surgical procedures is to stabilize the shoulder by compensating for the capsulolabral and osseous injury with an osseous or soft-tissue checkrein that blocks excessive translation and restores stability. In Modied Putti Platt procedure, as done in our institute, after proper positioning and adequate exposure, the subscapularis muscle and capsule is incised at the musculotendinous junction. Aquadrangular unicortical graft, harvested from the iliac crest, is inserted fully into the trough made in the anterior glenoid, resulting in deepening of the glenoid articular surface. Subscapularis and the capsule are closed by double breasting, keeping the arm in external rotation. We did a retrospective analysis to assess the outcome of this procedure done in our institute. 102 patients were assessed and the required data were collected using hospital medical records, telephonic interview and direct clinicoradiological assessment. All the patients had positive apprehension test, pre- operatively. The mean Rowe score was 30.98 (standard deviation 5.846). The mean follow up duration was 44.52 months. 91 patients (89.2%) had no pain at last follow up duration and the rest had slight and occasional pain. All the patients were able to work above shoulder. The mean external rotation at 6 months follow up was 37.89° (SD 9.239), which increased to 65.88° (SD 8.967) at last follow up. The mean internal rotation at 6 months follow up was 61.18° (SD 4.623), which increased to 77.16° (SD 6.234) at last follow up. There was signicant improvement of Rowe's score post-operatively when compared to pre-operative Rowe's score. There was a signicant mean increase of 49.216 points post operatively with a correlation coefcient of +0.513. (p<0.05). All patients, at last follow up had a UCLA score of more than 27, with 96 patients (94.1%) had good clinical outcome (according to UCLA grading system). 6 patients had fair clinical outcome. 77 patients (75.5 %), according to Rowe score had good clinical outcome.12 patients (11.8%) had excellent outcome. 13 patients had fair clinical outcome. None of the patients who were operated in our institute had recurrence of dislocation. None of them were reoperated. 91 patients (89.2%) had negative apprehension with no evidence of subluxation. 10 patients (9.8%) had negative apprehension, but slight discomfort in abduction and external rotation. One person had positive apprehension test, but he was able to continue his activities of daily living and continued to engage in professional non contact sports, though at one level below; and he did not choose to undergo a reoperation. 6 patients, all aged more than 45 years, had clinicoradiological evidence of mild arthrosis of the shoulder joint. They are being treated conservatively with physical therapy and analgesics Mild donor site pain was there in 6 patients in the rst yr of surgery. This subsided with time with analgesics. None had evidence of donor site infection, and none had evidence of visceral injuries.

scholarly journals FRI0418 SELECTIVE PATELLAR RESURFACING IN TOTAL KNEE ARTHROPLASTY FOR THE OSTEOARTHRITIC KNEE: A PROSPECTIVE STUDY

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 807.3-807
Author(s):  
I. Moriyama
Keyword(s):  
Total Knee Arthroplasty ◽  
Clinical Outcome ◽  
Knee Arthroplasty ◽  
Patellofemoral Joint ◽  
Osteoarthritis Of The Knee ◽  
Patellar Resurfacing ◽  
Criterion A ◽  
Total Knee ◽  
The Mean

Background:No widely accepted view or criteria currently exist concerning whether or not patellar replacement (resurfacing) should accompany total knee arthroplasty for osteoarthritis of the knee.1)2)3)Objectives:We recently devised our own criteria for application of patellar replacement and performed selective patellar replacement in accordance with this set of criteria. The clinical outcome was analyzed.Methods:The study involved 1150 knees on which total knee arthroplasty was performed between 2005 and 2019 because of osteoarthritis of the knee. The mean age at operation was 73, and the mean postoperative follow-up period was 91 months. Our criteria for application of patellar replacement are given below. Criterion A pertains to evaluation of preoperative clinical symptoms related to the patellofemoral joint: (a) interview regarding presence/absence of pain around the patella, (b) cracking or pain heard or felt when standing up from a low chair, (c) pain when going upstairs/downstairs. Because it is difficult for individual patients to identify the origin of pain (patellofemoral joint or femorotibial joint), the examiner advised each patient about the location of the patellofemoral joint when checking for these symptoms. Criterion B pertains to intense narrowing or disappearance of the patellofemoral joint space on preoperative X-ray of the knee. Criterion C pertains to the intraoperatively assessed extent of patellar cartilage degeneration corresponding to class 4 of the Outerbridge classification. Patellar replacement was applied to cases satisfying at least one of these sets of criteria (A-a,-b,-c, B and C). Postoperatively, pain of the patellofemoral joint was evaluated again at the time of the last observation, using Criterion A-a,-b,-c.Results:Patellar replacement was applied to 110 knees in accordance with the criteria mentioned above. There were 82 knees satisfying at least one of the Criterion sets A-a,-b,-c, 39 knees satisfying Criterion B and 70 knees satisfying Criterion C. (Some knees satisfied 2 or 3 of Criteria A, B and C).When the pain originating from patellofemoral joint (Criterion A) was clinically assessed at the time of last observation, pain was not seen in any knee of the replacement group and the non-replacement group.Conclusion:Whether or not patellar replacement is needed should be determined on the basis of the symptoms or findings related to the patellofemoral joint, and we see no necessity of patellar replacement in cases free of such symptoms/findings. When surgery was performed in accordance with the criteria on patellar replacement as devised by us, the clinical outcome of the operated patellofemoral joint was favorable, although the follow-up period was not long. Although further follow-up is needed, the results obtained indicate that selective patellar replacement yields favorable outcome if applied to cases judged indicated with appropriate criteria.References:[1]The Effect of Surgeon Preference for Selective Patellar Resurfacing on Revision Risk in Total Knee Replacement: An Instrumental Variable Analysis of 136,116 Procedures from the Australian Orthopaedic Association National Joint Replacement Registry.Vertullo CJ, Graves SE, Cuthbert AR, Lewis PL J Bone Joint Surg Am. 2019 Jul 17;101(14):1261-1270[2]Resurfaced versus Non-Resurfaced Patella in Total Knee Arthroplasty.Allen W1, Eichinger J, Friedman R. Indian J Orthop. 2018 Jul-Aug;52(4):393-398.[3]Is Selectively Not Resurfacing the Patella an Acceptable Practice in Primary Total Knee Arthroplasty?Maradit-Kremers H, Haque OJ, Kremers WK, Berry DJ, Lewallen DG, Trousdale RT, Sierra RJ. J Arthroplasty. 2017 Apr;32(4):1143-1147.Disclosure of Interests:None declared

scholarly journals Autologous Matrix-Induced Chondrogenesis for Treatment of Focal Cartilage Defects in the Knee: A Follow-up Study

2021 ◽  
Vol 9 (2) ◽  
pp. 232596712098187
Author(s):  
Justus Gille ◽  
Ellen Reiss ◽  
Moritz Freitag ◽  
Jan Schagemann ◽  
Matthias Steinwachs ◽  
...  
Keyword(s):  
Repeated Measures ◽  
Demographic Data ◽  
Case Series ◽  
Defect Size ◽  
Lysholm Score ◽  
Outcome Analysis ◽  
Cartilage Defects ◽  
Chondral Defects ◽  
The Mean

Background: Autologous matrix-induced chondrogenesis (AMIC) is a well-established treatment for full-thickness cartilage defects. Purpose: To evaluate the long-term clinical outcomes of AMIC for the treatment of chondral lesions of the knee. Study Design: Case series; Level of evidence, 4. Methods: A multisite prospective registry recorded demographic data and outcomes for patients who underwent repair of chondral defects. In total, 131 patients were included in the study. Lysholm, Knee injury and Osteoarthritis Outcome Score (KOOS), and visual analog scale (VAS) score for pain were used for outcome analysis. Across all patients, the mean ± SD age of patients was 36.6 ± 11.7 years. The mean body weight was 80.0 ± 16.8 kg, mean height was 176.3 ± 7.9 cm, and mean defect size was 3.3 ± 1.8 cm2. Defects were classified as Outerbridge grade III or IV. A repeated-measures analysis of variance was used to compare outcomes across all time points. Results: The median follow-up time for the patients in this cohort was 4.56 ± 2.92 years. Significant improvement ( P < .001) in all scores was observed at 1 to 2 years after AMIC, and improved values were noted up to 7 years postoperatively. Among all patients, the mean preoperative Lysholm score was 46.9 ± 19.6. At the 1-year follow-up, a significantly higher mean Lysholm score was noted, with maintenance of the favorable outcomes at 7-year follow-up. The KOOS also showed a significant improvement of postoperative values compared with preoperative data. The mean VAS had significantly decreased during the 7-year follow-up. Age, sex, and defect size did not have a significant effect on the outcomes. Conclusion: AMIC is an effective method of treating chondral defects of the knee and leads to reliably favorable results up to 7 years postoperatively.

Outcomes of 2-level posterior lumbar interbody fusion for 2-level degenerative lumbar spondylolisthesis

2013 ◽  
Vol 19 (1) ◽  
pp. 90-94 ◽  
Author(s):  
Hironobu Sakaura ◽  
Tomoya Yamashita ◽  
Toshitada Miwa ◽  
Kenji Ohzono ◽  
Tetsuo Ohwada
Keyword(s):  
Lumbar Spine ◽  
Clinical Outcome ◽  
Interbody Fusion ◽  
Sagittal Alignment ◽  
Posterior Lumbar Interbody Fusion ◽  
Adjacent Segment ◽  
Lumbar Interbody Fusion ◽  
Single Level ◽  
The Mean

Object A systematic review concerning surgical management of lumbar degenerative spondylolisthesis (DS) showed that a satisfactory clinical outcome was significantly more likely with adjunctive spinal fusion than with decompression alone. However, the role of adjunctive fusion and the optimal type of fusion remain controversial. Therefore, operative management for multilevel DS raises more complicated issues. The purpose of this retrospective study was to elucidate clinical and radiological outcomes after 2-level PLIF for 2-level DS with the least bias in determination of operative procedure. Methods Since 2005, all patients surgically treated for lumbar DS at the authors' hospital have been treated using posterior lumbar interbody fusion (PLIF) with pedicle screws, irrespective of severity of slippage, patient age, or bone quality. The authors conducted a retrospective review of 20 consecutive cases involving patients who underwent 2-level PLIF for 2-level DS and had been followed up for 2 years or longer (2-level PLIF group). They also analyzed data from 92 consecutive cases involving patients who underwent single-level PLIF for single-level DS during the same time period and had been followed for at least 2 years (1-level PLIF group). This second group served as a control. Clinical status was assessed using the Japanese Orthopaedic Association (JOA) score. Fusion status and sagittal alignment of the lumbar spine were assessed by comparing serial plain radiographs. Surgery-related complications and the need for additional surgery were evaluated. Results The mean JOA score improved significantly from 12.8 points before surgery to 20.4 points at the latest follow-up in the 2-level PLIF group (mean recovery rate 51.8%), and from 14.2 points preoperatively to 22.5 points at the latest follow-up in the single-level PLIF group (mean recovery rate 55.3%). At the final follow-up, 95.0% of patients in the 2-level PLIF group and 96.7% of those in the 1-level PLIF group had achieved solid spinal fusion, and the mean sagittal alignment of the lumbar spine was more lordotic than before surgery in both groups. Early surgery-related complications, including transient neurological complications, occurred in 6 patients in the 2-level PLIF group (30.0%) and 11 patients in the 1-level PLIF group (12.0%). Symptomatic adjacent-segment disease was found in 4 patients in the 2-level PLIF group (20.0%) and 10 patients in the 1-level PLIF group (10.9%). Conclusions The clinical outcome of 2-level PLIF for 2-level lumbar DS was satisfactory, although surgery-related complications including symptomatic adjacent-segment disease were not negligible.

scholarly journals 5-Year Clinical and Radiographic Results of the Direct Anterior Approach for Total Hip Arthroplasty Using a Collared Cementless Femoral Short-Stem Prosthesis

2022 ◽  
Vol 11 (2) ◽  
pp. 346
Author(s):  
Ali Darwich ◽  
Kim Pankert ◽  
Andreas Ottersbach ◽  
Marcel Betsch ◽  
Sascha Gravius ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Clinical Outcome ◽  
Hip Arthroplasty ◽  
Anterior Approach ◽  
Hip Osteoarthritis ◽  
Direct Anterior Approach ◽  
Short Stem ◽  
Total Hip ◽  
The Mean

The aim of this study was to investigate the radiological and clinical outcome of the direct anterior approach (DAA) in total hip arthroplasty (THA) using a collared cementless femoral short-stem. This retrospective study included 124 patients with 135 THAs operated from 2014 to 2016 using a collared cementless triple tapered hydroxyapatite-coated femoral short-stem (AMIStem H Collared®, Medacta International, Castel San Pietro, Switzerland) implanted with a DAA. Follow-up was performed at three months, 12 months, and five years. Clinical outcome was assessed using the hip osteoarthritis outcome score (HOOS) and radiological analysis was done using conventional radiographs, which included evaluation of the femur morphology based on Dorr classification, of radiolucencies based on the Gruen zone classification and of stem subsidence. The mean age was 67.7 ± 11.3 years and the mean body mass index (BMI) was 27.4 ± 4.4 kg/m2. The stem survival rate at five years was 99.1% with one revision due to recurrent dislocations. Mean HOOS score improved from 40.9 ± 18.3 preoperatively to 81.5 ± 19.7 at three months, 89.3 ± 10.9 at 12 months, and 89.0 ± 14.0 at five years (all with p < 0.001). No significant correlations were found between age, femoral bone morphology, BMI and HOOS, and the appearance of relevant radiolucencies.

scholarly journals 3D printing-based Ganz approach for treatment of femoral head fractures: a prospective analysis

2019 ◽  
Vol 14 (1) ◽  
Author(s):  
Jinwu Wang ◽  
Leyi Cai ◽  
Linzhen Xie ◽  
Hua Chen ◽  
Xiaoshan Guo ◽  
...  
Keyword(s):  
Femoral Head ◽  
3D Printing ◽  
Blood Loss ◽  
Surgical Approach ◽  
Type I ◽  
Type Ii ◽  
Femoral Head Fracture ◽  
Hip Function ◽  
The Mean

Abstract Background Femoral head fractures are uncommon injuries. Open reduction and internal fixation (ORIF) of femoral head fracture is the preferred treatment for most patients. There are several surgical approaches and treatments for this difficult fracture. However, the optimal surgical approach for the treatment of femoral head fracture remains controversial. Meanwhile, the operation is difficult and the complications are numerous. We prospectively reviewed patients with femoral head fractures managed surgically through the 3D printing-based Ganz approach to define a better approach with the least morbidity. Patients and methods Between 2012 and 2017, a total of 17 patients were included in this study. An exact 1:1 3D printing model of the injured hip side was fabricated for each patient and simulated surgery was finished preoperative. The surgical approach was performed as described by Ganz. Functional assessment was performed using the modified Merle d’Aubigne scores. The reduction of the fracture was evaluated according to Matta’s criteria. The incidence of complications, such as heterotopic ossification (HO) and avascular necrosis (AVN), and the need for additional surgery were also documented. Results Twelve of 17 patients (four females and eight males) were available for 2 years follow-up. The mean follow-up was 35 months (25–48 months). Average age for the 12 patients was 39.9 ± 12.2 years. According to the Pipkin classification, four patients were type I fracture, three patients were type II fracture, and five patients were type IV fracture. The mean operative time was 124.2 ± 22.1 min, and the estimated blood loss was 437.5 ± 113.1 ml. According to Merle d’ Aubigne scores, excellent results were achieved in six of the 12 patients; four good and two poor results occurred in the rest of the patients. On the radiograph evaluation, fracture reduction was defined as anatomical in eight patients, and imperfect in four. Most patients had good outcomes and satisfactory hip function at last follow-up. Almost all great trochanteric osteectomy healed uneventfully. One patient developed symptomatic AVN of the femoral head and underwent THA at 3 years. After THA, she regained a good hip function with the ability to return to work and almost no reduction in sports activities. Heterotopic ossification was found in four cases (type I-1, type II-2, and type III-1). Conclusions The 3D printing-based Ganz approach provides a safe and reliable approach and satisfactory results of treatment in femoral head fractures. Using 3D printed model for the fracture of the femoral head, the fracture can be viewed in every direction to provide an accurate description of fracture characteristics, which contributes to make a reasonable surgical plan for patients. In addition, the 3D printing-based Ganz approach can obtain excellent surgical exposure and protection of the femoral head blood supply, reduce the operation time and intraoperative blood loss, make the precise osteotomy, anatomically fix the intra-articular fragments, and effectively reduce postoperative complications. Trial registration We register our research at http://www.researchregistry.com. The Unique Identifying Number (UIN) from the Research Registry of the study is researchregistry4847.

Early development and progression of heterotopic ossification in cervical total disc replacement

2012 ◽  
Vol 16 (1) ◽  
pp. 31-36 ◽  
Author(s):  
Soo Eon Lee ◽  
Chun Kee Chung ◽  
Tae Ahn Jahng
Keyword(s):  
Clinical Outcome ◽  
Heterotopic Ossification ◽  
Total Disc Replacement ◽  
Disc Replacement ◽  
Adjacent Segment ◽  
Segmental Motion ◽  
Cervical Total Disc Replacement ◽  
The Mean ◽  
Grade Iii

Object The purpose of cervical total disc replacement (TDR) is to decrease the incidence of adjacent segment disease through motion preservation. Heterotopic ossification (HO) is a well-known complication after hip and knee arthroplasties. There are few reports regarding HO in patients undergoing cervical TDR, however; and the occurrence of HO and its effects on cervical motion have rarely been reported. Moreover, temporal progression of HO has not been fully addressed. One goal of this study involved determining the incidence of HO following cervical TDR, as identified from plain radiographs, and demonstrating the progression of HO during the follow-up period. A second goal consisted of determining whether segmental motion could be preserved and identifying the relationship between HO and clinical outcomes. Methods The authors conducted a retrospective clinical and radiological study of 28 consecutive patients who underwent cervical TDR with Mobi-C prostheses (LDR Medical) between September 2006 and October 2008. Radiological outcomes were evaluated using lateral dynamic radiographs obtained preoperatively and at 1, 3, 6, 12, and 24 months postoperatively. The occurrence of HO was interpreted on lateral radiographs using the McAfee classification. Cervical range of motion (ROM) was also measured. The visual analog scale (VAS) and Neck Disability Index (NDI) were used to evaluate clinical outcome. Results The mean follow-up period was 21.6 ± 7.0 months, and the mean occurrence of HO was at 8.0 ± 6.6 months postoperatively. At the last follow-up, 18 (64.3%) of 28 patients had HO: Grade I, 6 patients; Grade II, 8 patients; Grade III, 3 patients; and Grade IV, 1 patient. Heterotopic ossification progression was proportional to the duration of follow-up; HO was present in 3 (10.7%) of 28 patients at 1 month; 7 (25.0%) of 28 patients at 3 months; 11 (42.3%) of 26 patients at 6 months; 15 (62.5%) of 24 patients at 12 months; and 17 (77.3%) of 22 patients at 24 months. Cervical ROM was preserved in Grades I and II HO but was restricted in Grades III and IV HO. Clinical improvement according to the VAS and NDI was not significantly correlated with the occurrence of HO. Conclusions The overall incidence of HO after cervical TDR was relatively high. Moreover, HO began unexpectedly to appear early after surgery. Heterotopic ossification progression was proportional to the time that had elapsed postoperatively. Grade III or IV HO can restrict the cervical ROM and may lead to spontaneous fusion; however, the occurrence of HO did not affect clinical outcome. The results of this study indicate that a high incidence of HO with the possibility of spontaneous fusion is to be expected during long-term follow-up and should be considered before performing cervical TDR.

scholarly journals Cannulated Cancellous Screw Fixation for Capitellum Fractures in Adolescents

2011 ◽  
Vol 19 (3) ◽  
pp. 346-349 ◽  
Author(s):  
Kee Leong Ong ◽  
Arjandas Mahadev
Keyword(s):  
Performance Index ◽  
Kirschner Wire ◽  
Excellent Outcome ◽  
Excellent Functional Outcome ◽  
Cancellous Screws ◽  
The Mean ◽  
And Function ◽  
Anterior Direction

Purpose. To review the outcome of 9 adolescents treated with 2 to 3 cannulated cancellous screws for type-1 capitellum fractures. Methods. Records of 8 boys and one girl aged 12 to 14 (mean, 14) years with type-1 capitellum fractures were reviewed. The mechanism of injury was a fall on the flexed elbow. No patient had associated injuries or neurovascular compromise. In 2 patients, the fracture was minimally displaced and treated with a cast. The remaining 7 patients with displaced fractures underwent open reduction and internal fixation using 4.0-mm cannulated partially threaded cancellous screws inserted in a posterior-to-anterior direction. In one patient, a Kirschner wire was added to fix a small comminuted fragment. Elbow pain, range of motion, stability, and function were evaluated using the Mayo Elbow Performance Index. Results. The mean follow-up period was 7 (range, 2–18) months. The mean Mayo Elbow Performance Index score was 100, indicating excellent outcome. No patient developed avascular necrosis or heterotrophic ossification. All patients achieved anatomic bone union. All implants were removed after a mean of 4.7 (range, 2–7) months. Conclusion. The fixation of type-1 capitellum fractures with 2 to 3 cannulated cancellous screws inserted posteroanteriorly achieved excellent functional outcome.

Sign in / Sign up

Export Citation Format

Share Document