Study to Determine the Efficacy of Illizarov Fixator for the Treatment of Complex Tibial Plateau Fractures

Aim: To evaluate the results of illizarov external fixation using ligamentotaxis technique in high-energy plateau fractures of the tibia. Methodology: The external fixation of illizarov external fixation using ligamentotaxis was performed in 32 patients aged 18-50 years due to high-energy plateau fractures of the tibia. 18 on the right knee and 14 on the left knee. 28had closed wound and four had open wound fractures. According to the classification of Schatzker’s; classification was carried out for fractures. After two years (range 12 to 24 months) of follow-up, each affected knee was assessed using the Knee Society Score (KSS). Results: There were 24Schatzker type VI and eight type V fractures of the tibia. Complications included deep infection in two cases, one patient had pin tract infection, deep vein thrombosis in two patients and one had fusional defect. The knee motionmean range was 120 degrees of flexion and six degrees of deficiency in extension. According to the KSS criteria, the outcomes were excellent in 22 patients (68.75%), 4 patients (12.5%)have good results, moderate in 5 patients (15.65%) and weak in 1 patient (3.12%). Conclusion: Ilizarov External fixation gives good anatomicalreduction of joint surface, earlypainfreewt bear, stable fixation and maintain soft tissue envelope without major complications.

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Results of Staged Treatment with External Fixation for High Energy Calcaneus Fractures

Foot & Ankle Orthopaedics ◽

10.1177/2473011420s00304 ◽

2020 ◽

Vol 5 (4) ◽

pp. 2473011420S0030

Author(s):

Jessica M. Kohring ◽

Mackenzie A. Neumaier ◽

John P. Ketz

Keyword(s):

Soft Tissue ◽

Physical Function ◽

External Fixation ◽

High Energy ◽

Inclusion Criteria ◽

Soft Tissue Envelope ◽

Calcaneus Fracture ◽

Initial Injury ◽

Staged Treatment ◽

Calcaneus Fractures

Category: Trauma; Hindfoot Introduction/Purpose: High energy calcaneus fractures have significant soft tissue compromise and typically poor outcomes. The purpose of this study was to describe patient complications and outcomes, after undergoing staged treatment for high energy calcaneus fractures, including initial treatment with medial calcaneal external fixation followed by definitive reconstruction. Methods: A retrospective chart review with prospective data was performed from April 2013 to February 2019. Inclusion criteria for the study included: patients >18 years of age, closed Sanders III and IV fractures or open fractures of the calcaneus. Patients were initially treated with placement of a medial based external fixator with closed reduction. Once the soft tissue envelope had improved, definitive fixation was performed, either ORIF or ORIF with primary subtalar fusion. Results: There were a total of 15 patients that met inclusion criteria for the study. 9 of the fractures were open and 6 were closed. The medial calcaneal external fixation (ex-fix) was placed at a mean of 2.0 (0-12) days after initial injury. The definitive procedure occurred at a mean of 23.6 (12-42) days after ex-fix placement. 11 of the patients underwent calcaneus fracture ORIF with primary subtalar (ST) fusion and 4 patients were treated with calcaneus fracture ORIF alone. 14 (93%) of the patients showed radiographic union at an average of 6.7 months. Mean PROMIS scores showed improvement in physical function, mood, and a decrease in pain at an average of 19 (5-72) months after initial injury. The average VAS pain score was 3.5 (0-7). Conclusion: A staged protocol for high-energy and open calcaneal fractures is an effective tool in treating these difficult injuries. It allows the soft tissues to improve while maintaining length and alignment of the fracture for definitive fixation and minimizing complications. There were improvements in physical function, mood, and a decrease in pain at final follow-up of almost 2 years. [Table: see text]

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Tibial plateau fractures

10.1093/med/9780199550647.003.012056 ◽

2011 ◽

Author(s):

Phil Walmsley ◽

John Keating

Keyword(s):

Internal Fixation ◽

External Fixation ◽

Tibial Plateau ◽

Soft Tissues ◽

Plate Fixation ◽

High Energy ◽

Soft Tissue Envelope ◽

Fine Wire ◽

Peroneal Palsy ◽

Lateral Plateau

♦ Split depression pattern lateral plateau most common type♦ Bicondylar and medial plateau fractures high energy injuries♦ Compartment syndrome, vascular injury, and common peroneal palsy may occur with high energy patterns♦ Internal fixation preferred treatment with good soft tissue envelope♦ Limited internal fixation suitable for many simple patterns♦ Plate fixation preferred for medial and bicondylar fractures♦ External fixation used with poor soft tissues♦ Fine wire external fixation should be considered for most complex patterns.

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May-Thurner syndrome – Are we aware enough?

VASA ◽

10.1024/0301-1526/a000775 ◽

2019 ◽

Vol 48 (5) ◽

pp. 381-388 ◽

Cited By ~ 6

Author(s):

Katalin Mako ◽

Attila Puskas

Keyword(s):

Contraceptive Use ◽

Iliac Vein ◽

Common Iliac Vein ◽

Vein Thrombosis ◽

Compression Syndrome ◽

Threatening Condition ◽

Life Threatening ◽

Iliac Vein Compression ◽

Iliac Vein Compression Syndrome ◽

The Right

Summary. Iliac vein compression syndrome (May-Thurner syndrome – MTS) is an anatomically variable clinical condition in which the left common iliac vein is compressed between the right common iliac artery and the underlying spine. This anatomic variant results in an increased incidence of left iliac or iliofemoral vein thrombosis. It predominantly affects young women in the second or third decades of life with preponderance during pregnancy or oral contraceptive use. Although MTS is rare, its true prevalence is underestimated but it can be a life-threatening condition due to development of pulmonary embolism (PE). In this case based review the authors present three cases of MTS. All patients had been previously confirmed with PE, but despite they were admitted to hospital, diagnosed and correctly treated for PE and investigated for thrombophilia, the iliac vein compression syndrome was not suspected or investigated. With this presentation the authors would like to emphasize that MTS is mostly underdiagnosed, and it needs to be ruled out in left iliofemoral vein thrombosis in young individuals.

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Shock interactions in inviscid air and $$\hbox {CO}_2$$–$$\hbox {N}_2$$ flows in thermochemical non-equilibrium

Shock Waves ◽

10.1007/s00193-021-00999-8 ◽

2021 ◽

Author(s):

C. Garbacz ◽

W. T. Maier ◽

J. B. Scoggins ◽

T. D. Economon ◽

T. Magin ◽

...

Keyword(s):

Chemical Species ◽

High Energy ◽

Ideal Gas ◽

Shock Interaction ◽

Interaction Patterns ◽

Shock Interactions ◽

Wave Interference ◽

Type V ◽

The Impact ◽

Non Equilibrium

AbstractThe present study aims at providing insights into shock wave interference patterns in gas flows when a mixture different than air is considered. High-energy non-equilibrium flows of air and $$\hbox {CO}_2$$ CO 2 –$$\hbox {N}_2$$ N 2 over a double-wedge geometry are studied numerically. The impact of freestream temperature on the non-equilibrium shock interaction patterns is investigated by simulating two different sets of freestream conditions. To this purpose, the SU2 solver has been extended to account for the conservation of chemical species as well as multiple energies and coupled to the Mutation++ library (Multicomponent Thermodynamic And Transport properties for IONized gases in C++) that provides all the necessary thermochemical properties of the mixture and chemical species. An analysis of the shock interference patterns is presented with respect to the existing taxonomy of interactions. A comparison between calorically perfect ideal gas and non-equilibrium simulations confirms that non-equilibrium effects greatly influence the shock interaction patterns. When thermochemical relaxation is considered, a type VI interaction is obtained for the $$\hbox {CO}_2$$ CO 2 -dominated flow, for both freestream temperatures of 300 K and 1000 K; for air, a type V six-shock interaction and a type VI interaction are obtained, respectively. We conclude that the increase in freestream temperature has a large impact on the shock interaction pattern of the air flow, whereas for the $$\hbox {CO}_2$$ CO 2 –$$\hbox {N}_2$$ N 2 flow the pattern does not change.

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Single center experience with ultrasound guided axillary vein port placement

The Journal of Vascular Access ◽

10.1177/11297298211008094 ◽

2021 ◽

pp. 112972982110080

Author(s):

Patrick Tivnan ◽

Micaela Nannery ◽

Yan Epelboym ◽

Rajendran Vilvendhan

Keyword(s):

Demographic Data ◽

Axillary Vein ◽

Safe Procedure ◽

Ultrasound Guided ◽

Port Placement ◽

Chi Square ◽

Vein Thrombosis ◽

Single Center Experience ◽

Procedural Complications ◽

The Right

Purpose: To retrospectively review a single institution experience of ultrasound guided axillary vein port placement. Methods: In this retrospective study, a patient list was generated after searching our internal database from 1/1/2012 to 10/1/2018. Patients who had undergone axillary vein port placement were included. Chart review was performed to confirm approach, laterality and to gather demographic data, clinical indications, technical outcomes, and complications. Descriptive statistics were used to analyze this cohort. Chi-square statistics were used to compare outcomes by laterality. Results: Three hundred seven patients (51% female) with an average age of 58 years were included. The port was placed via the right axillary vein in 85% (261/307), predominantly for the indication of chemotherapy access (296/307). Technical success was achieved in all 307 cases. Peri procedural complications occurred in 1% (4/307) of cases and included port malpositioning requiring replacement and a case of port pocket hematoma. Post procedural complications including deep vein thrombosis and port malfunction occurred in 17% (52/307) of cases and port removal as a result of complication occurred in 9% (29/307) of cases. Conclusions: Ultrasound guided placement of an axillary port is a safe procedure to perform and demonstrates good clinical outcomes.

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MesoTIPS: Combined Approach for the Treatment of Portal Hypertension Secondary to Portal Vein Thrombosis – A Brief Report

The Arab Journal of Interventional Radiology ◽

10.1055/s-0041-1728964 ◽

2017 ◽

Vol 01 (01) ◽

pp. 20-26

Author(s):

Abbas Chamsuddin ◽

Lama Nazzal ◽

Thomas Heffron ◽

Osama Gaber ◽

Raja Achou ◽

...

Keyword(s):

Portal Hypertension ◽

Portal Vein ◽

Portal Vein Thrombosis ◽

Transjugular Intrahepatic Portosystemic Shunt ◽

Portosystemic Shunt ◽

Vein Thrombosis ◽

Intrahepatic Portosystemic Shunt ◽

The Right ◽

Minilaparotomy Approach ◽

Mean Time

AbstractIntroduction: We describe a technique we call “Meso-transjugular intrahepatic portosystemic shunt (MTIPS)” for relief of portal hypertension secondary to portal vein thrombosis (PVT) using combined surgical and endovascular technique. Materials and Methods: Nine adult patients with PVT underwent transjugular intrahepatic portosystemic shunt through a combined transjugular and mesenteric approach (MTIPS), in which a peripheral mesenteric vein was exposed through a minilaparotomy approach. The right hepatic vein was accessed through a transjugular approach. Mechanical thrombectomy, thrombolysis, and angioplasty were performed when feasible to clear PVT. Results: All patients had technically successful procedures. Patients were followed up for a mean time of 13.3 months (range: 8 days to 3 years). All patients are still alive and asymptomatic. Conclusion: We conclude that MTIPS is effective for the relief of portal hypertension secondary to PVT.

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An Unusual Presentation of Pyelonephritis: Is It COVID-19 Related?

SN Comprehensive Clinical Medicine ◽

10.1007/s42399-021-00909-0 ◽

2021 ◽

Author(s):

L. J. van ‘t Hof ◽

L. Pellikaan ◽

D. Soonawala ◽

H. Roshani

Keyword(s):

Late Onset ◽

Blood Clot ◽

Time Frame ◽

Venous Occlusion ◽

Late Complications ◽

Organ Injury ◽

Vein Thrombosis ◽

Lower Back ◽

The Right ◽

Renal Infection

AbstractIn severe cases of COVID-19, late complications such as coagulopathy and organ injury are increasingly described. In milder cases of the disease, the exact time frame and causal path of late-onset complications have not yet been determined. Although direct and indirect renal injury by SARS-CoV-2 has been confirmed, hemorrhagic renal infection or coagulative problems in the urinary tract have not yet been described. This case report describes a 35-year-old female without relevant medical history who, five days after having recovered from infection with SARS-CoV-2, had an unusual course of acute pyelonephritis of the right kidney and persistent fever under targeted antibiotic treatment. A hemorrhagic ureteral obstruction and severe swollen renal parenchyma preceded the onset of fever and was related to the developing pyelonephritis. Sudden thrombotic venous occlusion in the right eye appeared during admission. Symmetrical paresthesia in the limbs in combination with severe lower back pain and gastro-intestinal complaints also occurred and remained unexplained despite thorough investigation. We present the unusual combination of culture-confirmed bacterial hemorrhagic pyelonephritis with a blood clot in the proximal right ureter, complicated by retinal vein thrombosis, in a patient who had recovered from SARS-CoV-2-infection five days before presentation. The case is suspect of a COVID-19-related etiology.

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Spontaneous Thrombosis of an Orbital Arteriovenous Malformation Revealing Hereditary Haemorrhagic Telangiectasia (Rendu-Osler-Weber Disease)

Interventional Neuroradiology ◽

10.1177/159101991101700411 ◽

2011 ◽

Vol 17 (4) ◽

pp. 466-471 ◽

Cited By ~ 5

Author(s):

C. Van Went ◽

A. Ozanne ◽

G. Saliou ◽

G. Dethorey ◽

I. De Monchy ◽

...

Keyword(s):

Visual Acuity ◽

Intraocular Pressure ◽

Arteriovenous Malformation ◽

Genetic Disorder ◽

Hereditary Haemorrhagic Telangiectasia ◽

Spontaneous Thrombosis ◽

Vein Thrombosis ◽

Recurrent Epistaxis ◽

The Right ◽

Central Retinal Vein

Hereditary Haemorrhagic Telangiectasia (HHT) is a genetic disorder responsible for cutaneous or mucosal telangiectasia and arteriovenous malformations (AVMs). The most frequent locations are lung and brain. In contrast, orbital AVMs are very rare. We describe a case of symptomatic orbital arteriovenous malformation due to spontaneous thrombosis. A 65-year-old woman was referred for chronic right eye proptosis associated with dilation of conjunctival vessels with a jellyfish pattern. Right visual acuity was 20/40 and intraocular pressure was 40 mmHg. Personal and familial history of recurrent epistaxis, associated with multiple telangiectasia within lips and palate, led to the diagnosis of HHT. Magnetic resonance imaging (MRI) completed with cerebral angiography found a giant and occluded AVM within the right orbit. Other AVMs were also found in brain and chest, confirming the diagnosis. Antiglaucomatous eyedrops were added to reduce intraocular pressure and a steroid therapy was begun. Two months later, visual acuity decreased in the right eye, due to a central retinal vein thrombosis. In conclusion, Most brain or pulmonary AVM can be treated by embolization. By contrast, this treatment in case of orbital location can lead to central retinal artery and/or central retinal vein occlusion, which may also appear as a spontaneous complication of the orbital AVM. Therapeutic management of orbital AVM is thus not standardized, and the balance between spontaneous and iatrogenic risk of visual loss has to be taken into account.

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May-Thurner Syndrome Is Aggravated by Pregnancy

Medicina ◽

10.3390/medicina57030222 ◽

2021 ◽

Vol 57 (3) ◽

pp. 222

Author(s):

Kuntharee Traisrisilp ◽

Manatsawee Manopunya ◽

Tanop Srisuwan ◽

Wisit Chankhunaphas ◽

Theera Tongsong

Keyword(s):

Conservative Treatment ◽

Renal Agenesis ◽

Iliac Vein ◽

Vein Thrombosis ◽

Left Lower Extremity ◽

Asymptomatic Patients ◽

Pregnancy And Postpartum ◽

Anticoagulant Prophylaxis ◽

The Right ◽

Deep Vein

This study aims to emphasize that asymptomatic patients with undiagnosed and asymptomatic May-Thurner syndrome (MTS) may firstly develop severe compression during pregnancy. A 40-year-old woman, G1P0, at 22 weeks of twin gestation presented with left lower extremity edema and pain. One twin was structurally normal while the other had bilateral renal agenesis with oligohydramnios. Magnetic resonance venography (MRV) revealed severe compression of the left iliac vein by the right iliac artery without evidence of deep vein thrombosis (DVT). Conservative treatment with anticoagulant prophylaxis was instituted throughout the rest of pregnancy and postpartum period. She was also complicated with severe pre-eclampsia, a cesarean section was performed due to a prolapsed cord at 27 weeks of gestation, and she gave birth to a surviving baby weighing 1100 g. In conclusion, this case report provides evidence that pregnancy can disclose a subtle May-Thurner anatomy to be symptomatic without DVT. Successful pregnancy outcomes could be achieved with conservative treatment and anticoagulant prophylaxis.

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Surgical Treatment for Malunion of the Lateral Humeral Epicondyle with Posterior Subluxation of the Radial Head: A Case Report and Literature Review

Case Reports in Orthopedics ◽

10.1155/2018/1901235 ◽

2018 ◽

Vol 2018 ◽

pp. 1-4

Author(s):

Koichi Yano ◽

Yasunori Kaneshiro ◽

Hideki Sakanaka

Keyword(s):

Lateral Collateral Ligament ◽

High Energy ◽

Limited Range ◽

Forearm Rotation ◽

Collateral Ligament ◽

Lateral Epicondyle ◽

Limited Range Of Motion ◽

Contracture Release ◽

Normal Congruence ◽

The Right

A 24-year-old right-handed man suffered right olecranon and lateral epicondylar fracture from high energy trauma. Fixation of olecranon was performed by a previous doctor. Three months after operation, he presented with limited range of motion (ROM) of the right elbow caused by malunion of the lateral epicondylar fracture and subluxation of the radiohumeral joint. Preoperative ROM of the right elbow was flexion 110° and extension −75°. Forearm rotation was pronation 85° and supination 65°. Fragment excision of the lateral epicondyle, which was 27 mm in length, and lateral collateral ligament repair using anchors were performed. Fourteen months postoperatively, contracture release of the elbow was performed. Twenty-four months postoperatively, radiograph of the elbow showed normal congruence without osteoarthritic changes and the ROM of the right elbow was flexion 120° and extension −35°. Forearm rotation was pronation 90° and supination 70°. In the surgical setting, in case of the size of the lateral epicondylar fragment is relatively large, the fragment should be fixed or lateral collateral ligament should be repaired when the instability of the elbow is found.

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