WorldWideScience

Sample records for arthrodesis

  1. First metatarsophalangeal joint arthrodesis: current fixation options.

    Science.gov (United States)

    Moon, Jared L; McGlamry, Michael C

    2011-04-01

    This article reviews the current literature on first metatarsophalangeal joint arthrodesis rates using various forms of fixation, as well as reviewing biomechanical studies comparing the strengths of the different fixation options that are available.

  2. Arthroscopic tibiotalar and subtalar joint arthrodesis.

    Science.gov (United States)

    Roussignol, X

    2016-02-01

    Arthroscopy has become indispensable for performing tibiotalar and subtalar arthrodesis. Now in 2015, it is the gold-standard surgical technique, and open surgery is reserved only for cases in which arthroscopy is contraindicated: material ablation after consolidation failure, osteophytes precluding a work chamber, excentric talus, severe malunion, bone defect requiring grafting, associated midfoot deformity, etc. The first reports of arthroscopic tibiotalar and subtalar arthrodesis date from the early 1990s. Consolidation rates were comparable to open surgery, but with significantly fewer postoperative complications: infection, skin necrosis, etc. Arthroscopy was for many years reserved to moderate deformity, with frontal or sagittal deviation less than 10°. The recent literature, however, seems to extend indications, the only restriction being the surgeon's experience. Tibiotalar arthrodesis on a posterior arthroscopic approach remains little used. And yet the posterior work chamber is much larger, and initial series showed consolidation rates similar to those of an anterior approach. The surgical technique for posterior tibiotalar arthrodesis was described by Van Dijk et al., initially using a posterior para-Achilles approach. This may be hampered by posterior osteophytes or ankylosis of the subtalar joint line (revision of non-consolidated arthrodesis, sequelae of calcaneal thalamus fracture) and is now used only by foot and ankle specialists. Posterior double tibiotalar-subtalar arthrodesis, described by Devos Bevernage et al., is facilitated by transplantar calcaneo-talo-tibial intramedullary nailing.

  3. Dynesys dynamic stabilization-related facet arthrodesis.

    Science.gov (United States)

    Fay, Li-Yu; Chang, Peng-Yuan; Wu, Jau-Ching; Huang, Wen-Cheng; Wang, Chun-Hao; Tsai, Tzu-Yun; Tu, Tsung-Hsi; Chang, Hsuan-Kan; Wu, Ching-Lan; Cheng, Henrich

    2016-01-01

    OBJECTIVE Dynamic stabilization devices are designed to stabilize the spine while preserving some motion. However, there have been reports demonstrating limited motion at the instrumented level of the lumbar spine after Dynesys dynamic stabilization (DDS). The causes of this limited motion and its actual effects on outcomes after DDS remain elusive. In this study, the authors investigate the incidence of unintended facet arthrodesis after DDS and clinical outcomes. METHODS This retrospective study included 80 consecutive patients with 1- or 2-level lumbar spinal stenosis who underwent laminectomy and DDS. All medical records, radiological data, and clinical evaluations were analyzed. Imaging studies included pre- and postoperative radiographs, MR images, and CT scans. Clinical outcomes were measured by a visual analog scale (VAS) for back and leg pain, the Oswestry Disability Index (ODI), and Japanese Orthopaedic Association (JOA) scores. Furthermore, all patients had undergone postoperative CT for the detection of unintended arthrodesis of the facets at the indexed level, and range of motion was measured on standing dynamic radiographs. RESULTS A total of 70 patients (87.5%) with a mean age of 64.0 years completed the minimum 24-month postoperative follow-up (mean duration 29.9 months). Unintended facet arthrodesis at the DDS instrumented level was demonstrated by CT in 38 (54.3%) of the 70 patients. The mean age of patients who had facet arthrodesis was 9.8 years greater than that of the patients who did not (68.3 vs 58.5 years, p = 0.009). There were no significant differences in clinical outcomes, including VAS back and leg pain, ODI, and JOA scores between patients with and without the unintended facet arthrodesis. Furthermore, those patients older than 60 years were more likely to have unintended facet arthrodesis (OR 12.42) and immobile spinal segments (OR 2.96) after DDS. Regardless of whether unintended facet arthrodesis was present or not, clinical

  4. Relationship between New Osteoporotic Vertebral Fracture and Instrumented Lumbar Arthrodesis

    OpenAIRE

    Kim, Bung-Hak; Choi, Dong-Hyuk; Jeon, Seong-Hun; Choi, Yong-Soo

    2010-01-01

    Study Design Retrospective study. Purpose To evaluate the relationship between a new osteoporotic vertebral fracture and instrumented lumbar arthrodesis. Overview of Literature In contrast to the growing recognition of the importance of adjacent segment disease after lumbar arthrodesis, relatively little attention has been paid to the relationship between osteoporotic vertebral fractures and instrumented lumbar arthrodesis. Methods Twenty five patients with a thoracolumbar vertebral fracture ...

  5. Knee Arthrodesis after failure of Knee Arthroplasty

    DEFF Research Database (Denmark)

    Gottfriedsen, Tinne B; Morville Schrøder, Henrik; Odgaard, Anders

    2016-01-01

    BACKGROUND: Arthrodesis is considered a salvage procedure after failure of a knee arthroplasty. Data on the use of this procedure are limited. The purpose of this study was to identify the incidence, causes, surgical techniques, and outcomes of arthrodesis after failed knee arthroplasty...... in a nationwide population. METHODS: Data were extracted from the Danish Civil Registration System, the Danish National Patient Register, and the Danish Knee Arthroplasty Register. A total of 92,785 primary knee arthroplasties performed in Denmark from 1997 to 2013 were identified by linking the data using....... Differences in cumulative incidence were compared with the Gray test. RESULTS: A total of 164 of the 165 arthrodeses were performed for causes related to failed knee arthroplasty. The 15-year cumulative incidence of arthrodesis was 0.26% (95% confidence interval, 0.21% to 0.31%). The 5-year cumulative...

  6. Triple arthrodesis for adult acquired flatfoot.

    Science.gov (United States)

    Catanzariti, Alan R; Dix, Brian T; Richardson, Phillip E; Mendicino, Robert W

    2014-07-01

    The primary goal of triple arthrodesis for stage III and IV adult acquired flatfoot is to obtain a well-aligned plantigrade foot that will support the ankle in optimal alignment. Ancillary procedures including posterior muscle group lengthening, medial displacement calcaneal osteotomy, medial column stabilization, peroneus brevis tenotomy, or transfer and harvest of regional bone graft are often necessary to achieve adequate realignment. Image intensification is helpful in confirming optimal realignment before fixation. Results of triple arthrodesis are enhanced with adequate preparation of joint surfaces, bone graft/orthobiologics, 2-point fixation of all 3 tritarsal joints, and a vertical heel position.

  7. Arthroscopic Posterior Subtalar Arthrodesis: Surgical Technique

    Science.gov (United States)

    Vilá y Rico, Jesús; Ojeda Thies, Cristina; Parra Sanchez, Guillermo

    2016-01-01

    Surgical fusion of the subtalar joint is a procedure indicated to alleviate pain of subtalar origin, such as in post-traumatic osteoarthritis, adult-acquired flatfoot deformity, and other disorders. Open subtalar arthrodesis has been performed with predictable results, but concerns exist regarding injury to proprioception and local vascularity due to wide surgical dissection. Minimally invasive techniques try to improve results by avoiding these issues but have a reputation for being technically demanding. We describe the surgical technique for arthroscopic subtalar arthrodesis, which has proved to be a safe and reliable technique in our experience, with consistent improvements in American Orthopaedic Foot & Ankle Society scores. PMID:27073783

  8. Reproducibility of tomographic evaluation of posterolateral lumbar arthrodesis consolidation

    Directory of Open Access Journals (Sweden)

    Marcelo Italo Risso Neto

    2015-06-01

    Full Text Available OBJECTIVE: To evaluate interobserver agreement of Glassman classification for posterolateral lumbar spine arthrodesis.METHODS: One hundred and thirty-four CT scans from patients who underwent posterolateral arthrodesis of the lumbar and lumbosacral spine were evaluated by four observers, namely two orthopedic surgeons experienced in spine surgery and two in training in this area. Using the reconstructed tomographic images at oblique coronal plane, 299 operated levels were systematically analyzed looking for arthrodesis signals. The appearance of bone healing in each operated level was classified in five categories as proposed by Glassman to the posterolateral arthrodesis: 1 bilateral solid arthrodesis; 2 unilateral solid arthrodesis; 3 bilateral partial arthrodesis; 4 unilateral partial arthrodesis; 5 absence of arthrodesis. In a second step, the evaluation of each operated level was divided into two categories: fusion (including type 1, 2, 3, and 4 and non fusion (type 5. Statistical analysis was performed by calculating the Kappa coefficient considering the paired analysis between the two experienced observers and between the two observers in training.RESULTS: The interobserver reproducibility by the kappa coefficient for arthrodesis consolidation analysis for the classification proposed, divided into 5 types, was 0.729 for both experienced surgeons and training surgeons. Considering only two categories kappa coefficient was 0.745 between experienced surgeons and 0.795 between training surgeons. In all analyzes, we obtained high concordance power.CONCLUSION: Interobserver reproducibility was observed with high concordance in the classification proposed by Glassman for posterolateral arthrodesis of the lumbar and lumbosacral spine.

  9. THE METHOD OF KNEE JOINT ARTHRODESIS

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    V. G. Fedorov

    2011-01-01

    Full Text Available The usage of bone plastics by cylindrical autotransplant in cases of posttraumatic changes of knee joint is described. Knee joint arthrodesis is supposed to be used as alternate in term of replacement impossibility (for example, high-grade deformity, the age (osteoporosis, concomitant diseases that can lead to complicate operation.

  10. Salvage arthrodesis for failed total ankle arthroplasty

    Science.gov (United States)

    Zürcher, Arthur W

    2010-01-01

    Background and purpose Total ankle arthroplasty (TAA) has gained popularity in recent years. If it fails, however, salvage arthrodesis must be reliable as a rescue procedure. We therefore investigated the clinical, radiographic, and subjective outcome after salvage arthrodesis in a consecutive group of patients, and concentrated on the influence of the method of fixation on union rate and on salvage in inflammatory joint disease. Patients and methods Between 1994 and 2005, salvage arthrodesis was performed on 18 ankles (18 patients). Diagnosis was inflammatory joint disease (IJD) in 15 cases and osteoarthritis (OA) in 3. Tibio-talar fusion was performed in 7 ankles, and tibio-talocalcaneal fusion in 11. Serial radiographs were studied for time to union. Clinical outcome at latest follow-up was measured by the AOFAS score, the foot function index (FFI) and by VAS scores for pain, function, and satisfaction. Results Blade plates were used in 7 ankles (4 IJD, 3 OA); all united. Nonunion developed in 7 of the 11 rheumatic ankles stabilized by other methods. 11 patients (8 fused ankles, 3 nonunions) were available for clinical evaluation. Their mean AOFAS score was 62 and mean overall FFI was 70. VAS score for pain was 20, for function 64, and for satisfaction 74. The scores were similar in united and non-united ankles. Interpretation Blade plate fixation is successful in salvage arthrodesis for failed TAA. A high nonunion rate was found after salvage ankle arthrodesis in IJD with other methods of fixation. Clinical results were fair to good. PMID:20175648

  11. Arthrodesis for osteoarthritis of the manubriosternal joint.

    Science.gov (United States)

    Al-Dahiri, Ahmed; Pallister, Ian

    2006-01-01

    Osteoarthritis of the manubriosternal joint is rare. The diagnosis is not easy to make, and more serious causes of chest pain have to be ruled out first. We report one case that was treated with arthrodesis of the manubriosternal joint using double locking screw compression plating (LCP) with excellent results. Pre-operative CT-scan images with 3D reconstruction were used to measure the screw length and the drill stop depth. In this case report, we have shown that arthrodesis can be an effective way of treating osteoarthritis of the manubriosternal joint, when other measures fail. Furthermore, the use of a locking compression plate with appropriate and careful pre-operative planning affords a safe surgical technique, rapid pain relief and ultimately sound and asymptomatic union of the joint.

  12. Symptomatic Hardware Removal After First Tarsometatarsal Arthrodesis.

    Science.gov (United States)

    Peterson, Kyle S; McAlister, Jeffrey E; Hyer, Christopher F; Thompson, John

    2016-01-01

    Severe hallux valgus deformity with proximal instability creates pain and deformity in the forefoot. First tarsometatarsal joint arthrodesis is performed to reduce the intermetatarsal angle and stabilize the joint. Dorsomedial locking plate fixation with adjunctive lag screw fixation is used because of its superior construct strength and healing rate. Despite this, questions remain regarding whether this hardware is more prominent and more likely to need removal. The purpose of the present study was to determine the incidence of symptomatic hardware at the first tarsometatarsal joint and to determine the incidence of hardware removal resulting from prominence and/or discomfort. A review of 165 medical records of consecutive patients who had undergone first tarsometatarsal joint arthrodesis with plate fixation was conducted. The outcome of interest was the incidence of symptomatic hardware removal in patients with clinical union. The mean age was 55 (range 18.4 to 78.8) years. The mean follow-up duration was 65.9 ± 34.0 (range 7.0 to 369.0) weeks. In our cohort, 25 patients (15.2%) had undergone hardware removed because of pain and irritation. Of these patients, 18 (72.0%) had a locking plate and lag screw removed, and 7 (28.0%) had crossing lag screws removed. The fixation of a first tarsometatarsal joint fusion poses a difficult situation owing to minimal soft tissue coverage and the inherent need for robust fixation to promote fusion. Hardware can become prominent postoperatively and can become painful and/or induce cutaneous compromise. The results of the present observational investigation imply that surgeons can reasonably inform patients that the incidence of symptomatic hardware removal after first tarsometatarsal arthrodesis is approximately 15% within a median duration of 9.0 months after surgery.

  13. [Shortening arthrodesis of three wrist bones].

    Science.gov (United States)

    Delattre, O; Dupont, P; Reau, A F; Rouvillain, J L; Mousselard, H; Catonné, Y

    1997-01-01

    In advanced cases of wrist osteoarthritis with lesions of the radio-scaphoid and mediocarpal joints, and when a proximal row carpectomy is not possible because of lesions of the head of the capitate, we suggest a new technique: The hamate-capitate-lunate shortening arthrodesis with a scaphoid-triquetral resection. The good results observed with proximal row carpectomies, and particularly their long-term reliability, have encouraged us on this new path. Effectively, this operation takes the concept of proximal row carpectomy one step further by reconstructing the head of the capitate with the lunate whose proximal articular surface is often not deteriorated even in very advanced cases of radio and mediocarpal osteoarthritis. The two theoretical concepts of this operation are the shortening of the carpus and respect of the physiological congruence of the radio-lunate joint, the goal being obtain similar results those with proximal row carpectomy, particularly concerning mobility. We present our first two cases with this technique. This new procedure is an alternative to the four bone arthrodesis, particularly in SLAC wrist sequellae when they have evolved to the stage of radio and mediocarpal osteoarthritis.

  14. Reproducibility of tomographic evaluation of posterolateral lumbar arthrodesis consolidation

    OpenAIRE

    Marcelo Italo Risso Neto; Guilherme Rebechi Zuiani; Roberto Rossanez; Sylvio Mistro Neto; Augusto Celso Scarparo Amato Filho; Paulo Tadeu Maia Cavali; Ivan Guidolin Veiga; Wagner Pasqualini; Marcos Antônio Tebet; Elcio Landim

    2015-01-01

    OBJECTIVE: To evaluate interobserver agreement of Glassman classification for posterolateral lumbar spine arthrodesis.METHODS: One hundred and thirty-four CT scans from patients who underwent posterolateral arthrodesis of the lumbar and lumbosacral spine were evaluated by four observers, namely two orthopedic surgeons experienced in spine surgery and two in training in this area. Using the reconstructed tomographic images at oblique coronal plane, 299 operated levels were systematically analy...

  15. A 3-portal approach for arthroscopic subtalar arthrodesis

    NARCIS (Netherlands)

    Beimers, L.; de Leeuw, P.A.J.; van Dijk, C.N.

    2009-01-01

    We present a 3-portal approach for arthroscopic subtalar arthrodesis with the patient in the prone position. The prone position allows the use of the two standard posterior portals and it allows for accurate control of hindfoot alignment during surgery. Furthermore, the introduction of talocalcaneal

  16. Patellofemoral arthrodesis as pain relief in extreme patella alta

    NARCIS (Netherlands)

    Venkatesan, S.; Kampen, A. van

    2014-01-01

    PURPOSE: There is no golden standard management for neglected, chronic patellar tendon rupture as they are fairly rare. Nevertheless, accompanying pain can be highly debilitating. By presenting a case of patellar tendon repair, the exceptional results of a patellofemoral arthrodesis are described. M

  17. OVERLOAD STUDY ON ADJACENT DISC AFTER ARTHRODESIS IN THORACOLUMBAR FRACTURES

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    GUSTAVO SERRA REINAS

    Full Text Available ABSTRACT Objective: To analyze the degeneration of the adjacent disc after arthrodesis due to thoracolumbar fractures. Methods: Eighty-three patients who underwent posterolateral arthrodesis in thoracolumbar levels had their x-rays analyzed for degeneration of adjacent discs to the arthrodesis. The disc spaces were classified by the UCLA scale. Results: Of the 83 patients evaluated, 66 were males (79% and 18 females (21%, with a mean age of 35.5 years. The mean follow-up period was 40 months. As the fractures 75% were between T12 and L2 (p<0.001, being of the A3 type in 65% of the cases (p<0.001. The most common mechanism of injury, accounting for 50% of the cases (p<0.001, was fall from height. Only 6% of the superior discs and 12% of the inferior ones showed some degree of degeneration. No patient underwent a new surgical approach. Conclusion: The incidence of degeneration on adjacent disc in patients after arthrodesis resulting from fractures ranged from 6% to 12% with an average follow-up of 40 months.

  18. Conversion of failed ankle arthroplasty to an arthrodesis. Technique using an arthrodesis nail and a cage filled with morsellized bone graft.

    NARCIS (Netherlands)

    Bullens, P.H.J.; Waal Malefijt, M.C. de; Louwerens, J.W.

    2010-01-01

    Arthrodesis of the ankle joint after a failed ankle prosthesis is most often demanding because of bone loss. The bone loss is also responsible for limb length discrepancy. Intramedullary nail fixation has been described to be successful for arthrodesis of the arthritic ankle joint. We report the use

  19. Hip arthrodesis in children: A review of 28 patients

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    Banskota Ashok

    2009-01-01

    Full Text Available Background: The best method of treating intractable hip pain in an unsalvageable hip joint in a child is still a subject open to debate. We believe that hip arthrodesis in such patients provides a painless and stable hip for most activities of daily living in our challenging rural terrain. Therefore, we conducted this study to assess the functional ability of children with painful hip arthrosis treated by arthrodesis of the hip. Materials and Methods: A retrospective evaluation of 28 children (out of 35 who had an arthrodesis of the hip performed between 1994 and 2008 was carried out. The average age was 14 years, with 12 males and 16 females. There was involvement of the right hip in 13 and left in 15 cases. The average duration of follow-up was 4.87 years. The preferred position of the hip for arthrodesis was 20-30° of flexion, neutral abduction-adduction, and neutral rotation, irrespective of the method of fixation. Results: The average duration of clinical and radiological arthrodesis was found to be 4 months (2-6 months. At the last follow-up, all patients were painfree and had good ambulatory capacity. The average Modified Harris Hip Score increased from 53 to 84 and the average post-surgical limb length discrepancy was 1.3 cm, which was well tolerated in all cases. Patients, however, had difficulty in squatting and had to modify their posture for foot care, putting on shoes, etc. Also, some patients complained of ipsilateral knee, contralateral hip, or low back pain with prolonged activity, but this was not severe enough to restrict activity except in one case that was known to have juvenile rheumatoid arthritis and needed ambulatory aid. Conclusion: In an environment where pathology generally presents very late and often in a dramatic manner, where the patient′s socioeconomic status, understanding, compliance, and the logistics of follow-up are consistently a challenge in management, hip arthrodesis has been an important procedure for

  20. Conversion of hip arthrodesis to total hip arthroplasty.

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    Panagiotopoulos, K P; Robbins, G M; Masri, B A; Duncan, C P

    2001-01-01

    With the predictably good outcome now found with THA, hip arthrodesis has limited indications today. The procedure still has a role in the case of the young, heavy demand male with an isolated arthritic hip condition, and developments such as the Cobra head plate have considerably improved success rates. However, a long-term hip arthrodesis can have profound effects on a patient's daily function and activities of daily living. In addition, gait pattern is considerably affected as well as other joints such as the lower back, ipsilateral knee, and contralateral hip. Many patients with a hip arthrodesis will eventually require a takedown of the fused hip and conversion to a THA. The primary indications include fusion in malposition, pseudarthrosis, or severe pain in other joints. The surgeon undertaking such a task must be familiar with the arthrodesis techniques that have been used in the past as well as the equipment that may be required to extract the fixation hardware. Clinical assessment with particular attention to leg-length discrepancy, position of the arthrodesis, and function of the abductors is of paramount importance. The surgeon must carefully review preoperative radiographs to plan the procedure. The surgeon must also be aware of the presence of pathology in other joints. After takedown of a hip arthrodesis and conversion to a THA, patients cannot expect the result to equal the success rates of primary THA. Patients generally can expect an improvement in function and mobility. Back pain and ipsilateral knee pain are usually improved postoperatively, but the effect on contralateral hip pain is less predictable. Many patients will continue to show a positive Trendelenburg sign, but further improvement in strength of the hip abductors can be expected with time. Leg-length discrepancy is generally improved substantially after THA. However, a substantial number of patients will require a walking aid postoperatively. Overall, the risk of complications and the

  1. Immediate postoperative pain level from lumbar arthrodesis following epidural infiltration of morphine sulfate☆

    OpenAIRE

    Carlos Alexandre Botelho do Amaral; Tertuliano Vieira; Edgar Taira Nakagawa; Eduardo Aires Losch; Pedro José Labronici

    2015-01-01

    OBJECTIVE: To evaluate the pain level in patients treated with epidural infusion of morphine sulfate in a single dose, after a surgical procedure to perform lumber arthrodesis.METHODS: Forty patients underwent posterolateral lumbar arthrodesis or intersomatic lumbar arthrodesis via a posterior route at one, two or three levels. They were prospectively randomized into two groups of 20. In the first group (study group), 2 mg of morphine sulfate diluted in 10 mL of physiological serum was infilt...

  2. Double arthrodesis through a medial approach for end-stage adult-acquired flatfoot.

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    Catanzariti, Alan R; Adeleke, Adebola T

    2014-07-01

    Triple arthrodesis has traditionally been the procedure of choice for end-stage adult-acquired flatfoot. The results have been universally good, and it has proven to be dependable and predictable. Nonetheless, complications have been reported following triple arthrodesis in certain patients. Selective arthrodesis of the talonavicular joint and subtalar joint through a single medial approach has been developed as an alternative. The authors especially prefer this procedure with severe transverse plane deformity and often choose this approach as an alternative to triple arthrodesis in high-risk patients, including those patients with diabetes mellitus, rheumatoid arthritis, long-term steroid use, and the elderly.

  3. Scaphocapitolunate arthrodesis and radial styloidectomy for posttraumatic degenerative wrist disease.

    Science.gov (United States)

    Klausmeyer, Melissa A; Fernandez, Diego L; Caloia, Martin

    2012-08-01

    Long-standing scaphoid nonunion, scaphoid malunion, and chronic scapholunate dissociation result in malalignment of the carpal bones, progressive carpal collapse, instability, and osteoarthritis of the wrist. The most commonly used procedures to treat scaphoid nonunion advanced collapse (SNAC) and scapholunate advanced collapse (SLAC) wrists are the four-corner fusion (4CF) and the proximal row carpectomy (PRC). The purpose of this study was to evaluate the clinical outcome of a different treatment modality: radial styloidectomy and scaphocapitolunate (SCL) arthrodesis. This treatment option is chosen in an effort to maintain the joint contact surface and load transmission across the radiocarpal joint. We conducted a retrospective review of 20 patients (average age 62 years, range: 27 to 75 years) treated from 1994 to 2010. Seven patients were treated for SNAC, 12 patients for SLAC wrists, and 1 for degenerative joint disease following a transscapho-transcapitate perilunar dislocation. Sixteen patients had Herbert screw fixation, and four had Spider plate fixation. All patients had autologous bone graft used for the arthrodesis. The mean follow-up was 4.6 years (range: 2 to 9.6 years). Patients were evaluated clinically and radiographically. Nineteen of 20 arthrodeses healed on an average of 9.6 weeks. One patient was reoperated 8 months after the initial operation with salvage of the SCL arthrodesis with a spider plate with an adequate result. The mean active flexion-extension arc was 70 degrees and the radioulnar deviation arc was 23 degrees. Pain decreased in all patients, 13 of whom were pain free postoperatively. The average postoperative disabilities of arm, shoulder, and hand score was 24. Radiographically, neither radiolunate nor radioscaphoid arthritis was noted on follow-up. SCL arthrodesis with radial styloidectomy resulted in an adequate residual range of motion and pain relief. This method preserves the normal ulnar sided joints of the carpus and

  4. CORRELATION: IMPEDANCE AND TOMOGRAPHY IN IMPLANTS INSERTION IN LUMBAR ARTHRODESIS

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    ÉRIKO GONÇALVES FILGUEIRA

    Full Text Available ABSTRACT Objective: To define whether the electroneurophysiological stimulation would be a safe method for reducing injuries in nerve roots during surgery of lumbar spine arthrodesis, as well as verify whether there is a direct correlation between the intraoperative impedance values and the distance from the medial cortical pedicle screw. Methods: Randomized retrospective multicenter study of 10 patients who underwent arthrodesis of lumbar spine after conservative treatment failure, with a total of 50 pedicle screws instrumented. Reliable and safe impedance values were measured in order to reduce the risk of injury to nerve roots in the perioperative period, and these values were compared with the distance between the screw and the medial cortical of the pedicle by CT scan, measured in the immediate post-operative period. Results: There is no direct correlation between the intraoperative impedance values and the distance from the screw to the medial cortical of the pedicle. Conclusion: The electroneurostimulation proved to be a reliable quantitative method to reduce the risk of injury to nerve roots during surgery of lumbar spine arthrodesis when the measured values are greater than 10mA.

  5. Radioscapholunate arthrodesis using low-profile dorsal pi plate.

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    Galvis, Elkin J; Kumar, Kannan K; Özyurekoglu, Tuna

    2013-06-01

    Radioscapholunate arthrodesis is a desirable method to treat isolated radiolunate arthritis or ulnar translocation of the carpal bones. An intact midcarpal joint is a prerequisite for functional range of motion. Previously, high rates of nonunion were observed with these procedures, as rigid fixation was difficult to obtain with simple Kirschner wires and screws. A successful outcome depends on bringing the scaphoid, lunate, and the radius to an anatomic alignment, and rigid fixation of the arthrodesis. We describe a technique for the arthrodesis of the radioscapholunate joint from the dorsal side using a low-profile locking Pi plate. We observed the advantages of an easy approach, better visualization of the joint, and easier manipulation of the carpal bones. The Pi plate fits on the scaphoid, lunate, and the radius with minimal adjustment. It is not necessary to remove the Lister's tubercle. Pi plate allows for rigid fixation and compression between the scaphoid, lunate, and the radius by 1 compression and 1 locking screw in scaphoid and lunate, and by 2 eccentric compression screws in the radius. Rectangular retinacular flaps were used under and over the extensor tendons. We performed these arthrodeses in patients with lunate fossa arthritis after a distal radius fracture, and with ulnar translocation of the carpus. We have observed excellent clinical results with about 50% of wrist motion preserved and no cases of nonunion or delayed union.

  6. First metatarsophalangeal arthrodesis: a clinical, pedobarographic and gait analysis study.

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    DeFrino, Paul Francis; Brodsky, James White; Pollo, Fabian E; Crenshaw, Stephanie J; Beischer, Andrew D

    2002-06-01

    This study investigated the results of first metatarsophalangeal (MTP) arthrodesis in terms of clinical outcome measures, plantar pressure distribution, and gait patterns. Ten feet in nine patients with severe hallux rigidus (HR) who underwent first MTP arthrodesis were studied. The preoperative evaluation included a subjective questionnaire, physical exam, AOFAS hallux score, radiographs and dynamic pedobarography (EMED). At follow-up (average 34 months) these were repeated, and gait analysis studies were obtained. Patients showed significant clinical improvement based on the subjective criteria. The mean AOFAS score improved from 38 preoperatively to 90 postoperatively. Postoperative EMED analysis showed restoration of the weightbearing function of the first ray, with greater maximum force carried by the distal hallux at toe-off. Kinematic and kinetic gait analysis from each patient's operative limb were compared to the unaffected contralateral limb and to age- and sex-matched healthy subjects. The kinematic data indicated a significantly shorter step length with some loss in ankle plantar flexion at toe-off on the fused side. The kinetic data indicated a reduction in both ankle torque and ankle power at push-off. Clinical results indicated effective pain relief and a high level of patient satisfaction, consistent with previous reports in patients with symptomatic Hallux Rigidus.

  7. [Arthrodesis versus total joint replacement of the ankle].

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    Mittlmeier, T

    2013-06-01

    In general, for the treatment of end-stage osteoarthritis of the ankle joint arthrodesis is considered to be the gold standard based on its versatility and eligibility for numerous indications. Nowadays, total ankle arthroplasty represents a viable alternative to ankle arthrodesis taking into account distinct premises as both procedures provide a calculable reduction of the preoperative pain level and a comparable functional gain. Furthermore, current 10-year-survival rates of total ankle replacement are reported to range between 76 % and 89 %. Revision rates of up to 10 % for both techniques have been reported with manifest differences within the respective spectrum of complications. Due to the fact that more than two thirds of patients suffer from post-traumatic osteoarthritis with a relatively low average of age concomitant malalignment, soft tissue damage or instability may frequently occur. A restoration of anatomic axes and an adequate centering of the talus under the tibia appear to be crucial for the outcome as well as an adequate soft tissue balancing, in particular in total ankle replacement. Thus, the selection of the correct indication and the right choice of treatment on the basis of complete preoperative diagnostics considering necessary additive surgical measures are of paramount importance for the final outcome.

  8. Evaluation of idiopathic scoliosis by anterior and posterior arthrodesis

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    Jean Carlo Frigotto Queruz

    2015-06-01

    Full Text Available OBJECTIVE: To evaluate comparatively surgical treatment of adolescent idiopathic scoliosis type 5CN by anterior and posterior approach.METHODS: The study consists of a comparative retrospective study of two groups of patients with the thoracolumbar spine arthrodesis technique by anterior and posterior approach. Twenty and two patients were sequentially selected, 11 operated by anterior approach - called Group I - and 11 by posterior approach - Group II. Anamnesis and physical examination were performed, as well as length of hospital stay and ICU stay, degree of correction, comorbidities and pre and postoperative radiographic images data were gathered.RESULTS: The mean age was 13.7 years in Group I and 14 years in Group II. The average hospital stay was 5.81 days for Group I and 5 for Group II. The average ICU stay was 2.81 and 2 days, respectively. Considering the operated levels, Group I presented an average of 4.81 vertebrae (4-6 levels, and Group II presented an average of 6.36 vertebrae (5-11 levels. Complications did not show statistically significant difference.CONCLUSION: Despite the limited number of patients in groups, it was demonstrated that the posterior approach reduces the number of days of hospitalization and ICU stay. However, it was found increased levels included in the arthrodesis.

  9. Metatarsocuneiform joint resection arthroplasty for atraumatic osteoarthrosis: an alternative to arthrodesis.

    Science.gov (United States)

    Gilheany, Mark F; Amir, Ozan T

    2013-01-01

    The reported operative treatment of primary osteoarthrosis of the metatarsocuneiform joint has focused primarily on methods of arthrodesis. Arthrodesis of the metatarsocuneiform joint can result in complications in the older or obese patient who is unable to tolerate non-weightbearing. Age and health status can also increase the rate of nonunion and venous thromboembolism, especially in the immobile patient. We present a technique not previously described. The procedure is presented as an alternative to arthrodesis and involves resection arthroplasty of the metatarsocuneiform joint.

  10. An unusual cause of pain post ankle arthrodesis in patients with rheumatoid arthritis.

    LENUS (Irish Health Repository)

    Burke, Neil G

    2012-02-01

    Rheumatoid arthritis is an autoimmune disease which frequently affects the ankle and foot. End stage ankle arthritis from rheumatic disease is commonly managed by the established practice of ankle arthrodesis. Among the adverse sequelae causing pain following this surgery is infection, pseudo-arthrosis and non-union. Stress fracture of the distal third is a recognised but unusual cause of pain of tibia following ankle arthrodesis. The authors\\' present three patients with rheumatoid arthritis who sustained a stress fracture of the distal tibia following arthrodesis, and discuss the contributing factors and highlight the need for orthopaedic surgeons to be suspicious of this complication post surgery.

  11. Primary ankle arthrodesis for neglected open weber B ankle fracture dislocation.

    LENUS (Irish Health Repository)

    Thomason, Katherine

    2014-07-01

    Primary ankle arthrodesis used to treat a neglected open ankle fracture dislocation is a unique decision. A 63-year-old man presented to the emergency department with a 5-day-old open fracture dislocation of his right ankle. After thorough soft tissue debridement, primary arthrodesis of the tibiotalar joint was performed using initial Kirschner wire fixation and an external fixator. Definitive soft tissue coverage was later achieved using a latissimus dorsi free flap. The fusion was consolidated to salvage the limb from amputation. The use of primary arthrodesis to treat a compound ankle fracture dislocation has not been previously described.

  12. Special aspects of wrist arthritis management for SLAC and SNAC wrists using midcarpal arthrodesis: results of bilateral operations and conversion to total arthrodesis.

    Science.gov (United States)

    Gohritz, Andreas; Gohla, Thomas; Stutz, Nicolas; Moser, Veith; Koch, Hilmar; Krimmer, Hermann; Lanz, Ulrich

    2005-01-01

    Although midcarpal wrist arthrodesis is recognized as a standard procedure to treat scapholuate advanced collapse (SLAC) and scaphoid nonunion advanced collapse (SNAC) of the wrist, little has been reported about patients with bilateral involvement and the number, cause, and results of failed cases requiring conversion to total wrist arthrodesis. This study investigated the results of 20 patients with bilateral procedures and of 22 patients who underwent total wrist fusion after failed midcarpal arthrodesis out of an overall group of 907 patients treated by this method during a 12-year period. Of these, 16 bilateral and 20 converted cases were reexamined after an average of 48 months and 42 months, respectively. Patients after bilateral midcarpal arthrodesis experienced a pain reduction by an average of 54% of the preoperative pain values at rest and by 56% at stress on the visual analog scale (scale range: 0 to 100) and from intolerable (3.7) to pain only during stress (1.9) on the verbal scale (scale range: I to 4). A mean arc of wrist extension and flexion of 53 degrees on the right and 49 of the left wrist was preserved. The mean DASH score was 45 points and 70% of the patients felt impaired only during certain activities. Total arthrodesis reduced pain in 18 of 20 reexamined wrists by 67% of the previous values after the failed partial arthrodesis at rest and by 46% at stress on the visual analog scale andfrom intolerable pain (3.7) to pain only during stress (2.1) on the verbal scale. Seven of the 20 reexamined patients noted complete pain relief at rest and two also under stress conditions. The DASH score averaged 39 points. A mean Krimmer score of 46 points and a mean Buck-Gramcko and Lohman evaluation of 6 points represented a satisfactory result. Grip strength of the operated hand averaged 53% of the opposite side. Subjectively, 30% felt impaired only during certain activities, 55%felt considerably and 15% strongly limited in daily life. However, all but

  13. Outcome of distraction interference arthrodesis of the sacroiliac joint for sacroiliac arthritis

    Directory of Open Access Journals (Sweden)

    Stefan Endres

    2013-01-01

    Conclusions: Refractory sacroiliac pain as a result of multi-level fusion surgery can be successfully treated with minimally invasive arthrodesis. It offers a safe and effective treatment for severe SIJ pain. Careful patient selection is important.

  14. Radiographic evaluation of the use of transverse traction device in vertebral arthrodesis for degenerative diseases

    OpenAIRE

    Edgar Takao Utino; João Paulo Machado Bergamaschi; Luciano Antonio Nassar Pellegrino; Ricardo Shigueaki Galhego Umeta; Maria Fernanda Silber Caffaro; Robert Meves; Osmar Avanzi

    2014-01-01

    OBJECTIVE: Perform radiographic analysis of the use of Transverse Traction Device (DTT) with respect to fusion rate in patients submitted to vertebral arthrodesis for degenerative lumbar diseases. METHODS: We selected x-ray images on anteroposterior, lateral and oblique views and with maximum flexion and extension dynamics of 23 patients submitted to posterolateral arthrodesis of the lumbar spine with a minimum follow-up period of six months. The images were evaluated and classified by the ...

  15. Transfixation cast technique for arthrodesis of the distal interphalangeal joint of horses.

    Science.gov (United States)

    Easter, J L; Schumacher, J; Watkins, J P

    2011-01-01

    Surgical arthrodesis of the distal interphalangeal (DIP) joint by transfixation casting was used to salvage a three-year-old filly and a yearling filly that were chronically lame because of infection of the DIP joint for breeding. Unlike previously described techniques for arthrodesis of the DIP joint, the technique used did not require insertion of implants across the joint, which may have contributed to the successful outcome.

  16. One year successful outcomes for novel sacroiliac joint arthrodesis system

    Directory of Open Access Journals (Sweden)

    Sachs Donald

    2012-12-01

    Full Text Available Abstract Background SI joint pain can mimic discogenic low back pain or even radicular pain. Patient presentations vary considerably and conditions may include low back, groin, and/or radicular pain, leading to the potential for inaccurate diagnosis and treatment. Despite the large number of patients with SI joint pain, treatment options have been limited to conservative care involving physical therapy and joint injections, radiofrequency rhizotomy, or traditional open SI joint arthrodesis surgery. The purpose of this retrospective study is to evaluate the safety and effectiveness of MIS SI joint arthrodesis via an ileosacral approach in patients refractory to conservative care. Methods We report on the first 11 consecutive patients treated with a novel MIS SI joint fusion system by a single surgeon. Medical charts were reviewed for perioperative metrics and baseline pain scores recorded using a 0-10 numerical rating scale. Results Ninety one percent (91% of patients were female and the average patient age was 65 years (range 45-82. Mean baseline pain score (SD was 7.9 (± 2.2. Mean pain score at the 12 month follow up interval was 2.3 (±3.1, resulting in an average improvement of 6.2 points from baseline, representing a clinically and statistically significant (p=0.000 improvement. Patient satisfaction was very high with 100% indicating that they would have the same surgery again for the same result. Conclusions The results of this small case series illustrate the safety and effectiveness of minimally invasive SI joint fusion using a series of triangular porous plasma coated titanium implants in carefully selected patients. Larger multi centered studies are warranted.

  17. 3D musculo-skeletal finite element analysis of the foot kinematics under muscle activation with and without ankle arthrodesis

    OpenAIRE

    Perrier, Antoine; Bucki, Marek; Luboz, Vincent; Vuillerme, Nicolas; Payan, Yohan

    2015-01-01

    International audience; The choice between arthrodesis and arthroplasty in the context of advanced ankle arthrosis remains a highly disputed topic in the field of foot and ankle surgery. Arthrodesis, however, represents the most popular option. Biomechanical modeling has been widely used to investigate static loading of cadaveric feet as well as consequences of arthrodesis on bony structures. Although foot kinematics has been studied using motion analysis, this approach lacks accuracy in capt...

  18. ARTHRODESIS OF THE FIRST METATARSOPHALANGEAL JOINT IN PATIENTS WITH RHEUMATOID ARTHRITIS AND HALLUX VALGUS: CHOICE OF TECHNIQUE OF ARTHRODESIS FIXATION, COMPLICATIONS AND LONG-TERM RESULTS

    Directory of Open Access Journals (Sweden)

    V. P. Pavlov

    2014-01-01

    Full Text Available Objective: to study results of arthrodesis of the first metatarsophalangeal joint (I MPT joint in patients with rheumatoidarthritis (RA and hallux valgus, assess methods of arthrodesis fixation, reveal complications and analyze longterm results.Subjects and methods. Authors observed 86 patients with RA, female : male ratio 3.2:1, mean age was 53.8±9.5 years (from 18 to 75 years; 80 from them had seropositive and 6 – seronegative RA. 72 patients had low, and 14 –moderate activity of the disease. II stage of RA was revealed in 31.4%, III – in 62.8%, IV – in 5.8%; 52.3% of  patients had I and 47.7% – II functional class. All patients  ad hallux valgus as a component of typical deformation of the forefoot – digitis V rheumaticus (DVR. Standard global reconstructive operation (SGRO and its modification (MGRO were used. Both techniques included arthrodesis of the I MTP joint where fusion of bones was fixed with Kirschner wire and compression clamps in groups A and B respectively. Results of surgical treatmentwere assessed separately for I and II–V toes. The present work provides solely the results of the I MTP joint arthrodesis.Results. Assessment of the I MTP joint with hallux valgus before and 2.3±1.5 years after operation based on AOFAS comprised 35.51±8.16/82.32±6.09 in the group A and 39.93±6.65/82.26±5,59 in the group B. Inefficiency of arthrodesis of the I MTP joint was observed in 3 patients from the group B (2.15%. Before operation, 3 from 141 feet had hallux valgus of the II stage (21–40°; III (41–60° and IV (>60° stages of hallux valgus were recorded in 90 and48 feet respectively. Following 2.3 years after arthrodesis normal I MTP joints (10–11° were observed in 131 feet whereas, that of the II stage of hallux valgus (12–20° – in 10 feet.Conclusion. High efficacy of arthrodesis of the I MTP joint in patients with RA and hallux valgus and, subsequently, low failure rate (2.15% were achieved as

  19. Transfibular ankle arthrodesis: A novel method for ankle fusion - A short term retrospective study

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    S Muthukumar Balaji

    2017-01-01

    Full Text Available Background: Ankle arthrodesis has long been the traditional operative treatment for posttraumatic arthritis, rheumatoid arthritis, infection, neuromuscular conditions, and salvage of failed ankle arthroplasty. It remains the treatment of choice for patients in whom heavy and prolonged activity is anticipated. We present our short term followup study of functional outcome of patients who underwent transfibular ankle arthrodesis for arthritis of ankle due to various indications. Materials and Methods: 29 transfibular ankle arthrodesis in 29 patients performed between April 2009 and April 2014 were included in this study. The mean age was 50 years (range 22-75 years. The outcome analysis with a minimum of 1-year postoperative followup were included. All the patients were assessed with the American Orthopaedic Foot and Ankle Society (AOFAS Hindfoot scale. Results: All cases of ankle fusions (100% progressed to solid union in a mean postoperative duration of 3.8 months (range 3-6 months. All patients had sound arthrodesis. The mean followup period was 32.52 months (standard deviation ± 10.34. The mean AOFAS score was 74 (pain score = 32, functional score = 42. We found that twenty patients (68.96% out of 29, had excellent results, 7 (24.13% had good, and 2 (6.89% showed fair results. Conclusion: Transfibular ankle arthrodesis is a simple and effective procedure for ankle arthritis. It achieves a high rate of union and good functional outcome on midterm followup.

  20. Transfibular ankle arthrodesis: A novel method for ankle fusion – A short term retrospective study

    Science.gov (United States)

    Balaji, S Muthukumar; Selvaraj, V; Devadoss, Sathish; Devadoss, Annamalai

    2017-01-01

    Background: Ankle arthrodesis has long been the traditional operative treatment for posttraumatic arthritis, rheumatoid arthritis, infection, neuromuscular conditions, and salvage of failed ankle arthroplasty. It remains the treatment of choice for patients in whom heavy and prolonged activity is anticipated. We present our short term followup study of functional outcome of patients who underwent transfibular ankle arthrodesis for arthritis of ankle due to various indications. Materials and Methods: 29 transfibular ankle arthrodesis in 29 patients performed between April 2009 and April 2014 were included in this study. The mean age was 50 years (range 22-75 years). The outcome analysis with a minimum of 1-year postoperative followup were included. All the patients were assessed with the American Orthopaedic Foot and Ankle Society (AOFAS) Hindfoot scale. Results: All cases of ankle fusions (100%) progressed to solid union in a mean postoperative duration of 3.8 months (range 3–6 months). All patients had sound arthrodesis. The mean followup period was 32.52 months (standard deviation ± 10.34). The mean AOFAS score was 74 (pain score = 32, functional score = 42). We found that twenty patients (68.96%) out of 29, had excellent results, 7 (24.13%) had good, and 2 (6.89%) showed fair results. Conclusion: Transfibular ankle arthrodesis is a simple and effective procedure for ankle arthritis. It achieves a high rate of union and good functional outcome on midterm followup. PMID:28216754

  1. Arthroscopic arthrodesis of the shoulder: Fourteen-year follow-up

    Directory of Open Access Journals (Sweden)

    Antonio Jiménez-Martín

    2011-01-01

    Full Text Available Shoulder arthrodesis is indicated in infections, brachial paralysis, irreparable rotator cuff tears, osteoarthritis without indication of prosthesis, rescue after arthroplasty, or after surgery for cancer. Arthroscopic arthrodesis is exceptional. Our aim is presenting our result after 14 years of follow-up of one patient. We present a case report of a 17-year-old male patient. He suffered fracture of left scapula (type V, Ideberg, fracture of left clavicle (type I, Craig, and fracture of left distal ulna. We realized osteosynthesis of clavicle (plate and screws with the aim of treating this floating shoulder. Electromyography showed partial axonotmesis of axilar nerve. After 7 months of follow-up, axonotmesis was still present. We realized arthroscopic shoulder arthrodesis (three cannulated screws. Fourteen years later, shoulder movement was as follows: Flexion, 0-90°; maximum abduction, 40° with shoulder atrophy; Constant, 47 points; and UCLA, 17 points, without pain. Arthrodesis with screws reaches a subjective benefit in 82% of patients. Percentage of pseudarthrosis is less than in patients treated with plates, although the risks of infections, fractures, and material removal are greater than in patients treated with plates. Shoulder arthroscopic arthrodesis is exceptional, but it allows minimal surgical aggression.

  2. Ogilvie′s syndrome following posterior spinal arthrodesis for scoliosis

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    Athanasios I Tsirikos

    2013-01-01

    Full Text Available We report Ogilvie′s syndrome following posterior spinal arthrodesis on a patient with thoracic and lumbar scoliosis associated with intraspinal anomalies. Postoperative paralytic ileus can commonly complicate scoliosis surgery. Ogilvie′s syndrome as a cause of abdominal distension and pain has not been reported following spinal deformity correction and can mimic post-surgical ileus. 12 year old female patient with double thoracic and lumbar scoliosis associated with Arnold-Chiari 1 malformation and syringomyelia. The patient underwent posterior spinal fusion from T 4 to L 3 with segmental pedicle screw instrumentation and autogenous iliac crest grafting. She developed abdominal distension and pain postoperatively and this deteriorated despite conservative management. Repeat ultrasounds and abdominal computer tomography scans ruled out mechanical obstruction. The clinical presentation and blood parameters excluded toxic megacolon and cecal volvulus. As the symptoms persisted, a laparotomy was performed on postoperative day 16, which demonstrated ragged tears of the colon and cecum. A right hemi-colectomy followed by ileocecal anastomosis was required. The pathological examination of surgical specimens excluded inflammatory bowel disease and vascular abnormalities. The patient made a good recovery following bowel surgery and at latest followup 3.2 years later she had no abdominal complaints and an excellent scoliosis correction. Ogilvie′s syndrome should be included in the differential diagnosis of postoperative ileus in patients developing prolonged unexplained abdominal distension and pain after scoliosis correction. Early diagnosis and instigation of conservative management can prevent major morbidity and mortality due to bowel ischemia and perforation.

  3. Quantitative analysis in outcome assessment of instrumented lumbosacral arthrodesis.

    Science.gov (United States)

    Champain, Sabina; Mazel, Christian; Mitulescu, Anca; Skalli, Wafa

    2007-08-01

    The outcome assessment in instrumented lumbosacral fusion mostly focuses on clinical criteria, complications and scores, with a high variability of imaging means, methods of fusion grading and parameters describing degenerative changes, making comparisons between studies difficult. The aim of this retrospective evaluation was to evaluate the interest of quantified radiographic analysis of lumbar spine in global outcome assessment and to highlight the key biomechanical factors involved. Clinical data and Beaujon-Lassale scores were collected for 49 patients who underwent lumbosacral arthrodesis after prior lumbar discectomy (mean follow-up: 5 years). Sagittal standing and lumbar flexion-extension X-ray films allowed quantifying vertebral, lumbar, pelvic and kinematic parameters of the lumbar spine, which were compared to reference values. Statistics were performed to assess evolution for all variables. At long-term follow-up, 90% of patients presented satisfactory clinical outcomes, associated to normal sagittal alignment; vertebral parameters objectified adjacent level degeneration in four cases (8%). Clinical outcome was correlated (r = 0.8) with fusion that was confirmed in 80% of cases, doubtful in 16% and pseudarthrosis seemed to occur in 4% (2) of cases. In addition to clinical data (outcomes comparable to the literature), quantitative analysis accurately described lumbar spine geometry and kinematics, highlighting parameters related to adjacent level's degeneration and a significant correlation between clinical outcome and fusion. Furthermore, criteria proposed to quantitatively evaluate fusion from lumbar dynamic radiographs seem to be appropriate and in agreement with surgeon's qualitative grading in 87% of cases.

  4. The results of ankle arthrodesis with screws for end stage ankle arthrosis.

    Science.gov (United States)

    Torudom, Yingyong

    2010-02-01

    Aim of this study was to evaluate the results of ankle arthrodesis with screws in patients with ankle arthrosis. The author studied 19 patients (20 feet) who had been treated by ankle arthrodesis with screws from 2003 to 2008. Ten patients were men (11 feet) and nine (9 feet) were women. Their mean age was 56 years (30 to 65), and the average duration of follow-up was four years (2 to 6). Two compression screws were used in all feet. Union was achieved in 19 of the 20 feet (95%). Average scores for pain and clinical condition are increase after operation. One re-operation was performed for nonunion. Author conclude that ankle arthrodesis with screws was effective treatment for ankle arthrosis.

  5. A new plate for partial wrist fusions: results in midcarpal arthrodesis.

    Science.gov (United States)

    Allison, D M

    2011-05-01

    Partial wrist fusions are commonly performed for various degenerative conditions. In this series 30 wrists had a scaphoidectomy and midcarpal arthrodesis performed with a new plate. The most common indications were SLAC and SNAC wrists. In 24 cases a four-corner arthrodesis was done and in the other six the triquetrum was not included. Mean follow-up was 3 years. Mean flexion was 31° and extension 35°. Union was achieved in all wrists despite movement being commenced early. The plates proved straightforward to use, allowing some latitude in placement. This series confirms that scaphoidectomy and midcarpal arthrodesis is a useful salvage procedure and that these plates are suitable for that purpose.

  6. Knee arthrodesis – ultima ratio for the treatment of the infected knee

    Directory of Open Access Journals (Sweden)

    Tiemann, Andreas H. H.

    2013-04-01

    Full Text Available The irretrievable destruction of the knee due to trauma, tumor or infection is the indication for knee arthrodesis. The main reason for knee arthrodesis in terms of infection ist the infected total knee arthroplasty. Central problem is the definition of the term “irretrievable”. It is based on the subjective opinion of the attending physician and depends on his expert knowledge of this specific entity. The preservation of a functioning extremity is the main goal.This article shows the typical indications and contraindications for knee arthrodesis following septic knee diseases. In addition it gives insight into the biomechanical and technical considerations to be kept in mind. Finally the postoperative care and outcome of different techniques are analysed.

  7. ANALYSIS OF THE SECONDARY CURVES IN PATIENTS UNDERGOING SELECTIVE ARTHRODESIS LENKE I

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    TADEU GERVAZONI DEBOM

    2015-12-01

    Full Text Available Objective : To radiographically evaluate the behavior of the secondary curves in the coronal and sagittal planes in patients with AIS classified as Lenke I, who underwent surgical treatment of selective arthrodesis by posterior approach. Methods : Retrospective study which analyzed 40 patients with AIS, being 33 female. The measurement of the radiographic parameters used followed the recommendations by Cobb. Results : The average correction of the thoracic proximal, primary and lumbar curves was 34.73%, 75.06% and 64.64%, respectively. Conclusion : Surgical treatment by selective arthrodesis in cases of AIS Lenke type I provide correction of compensatory curves in the coronal and maintenance in the sagittal plane.

  8. Management of wound infection after lumbar arthrodesis maintaining the instrumentation

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    Asdrubal Falavigna

    2015-06-01

    Full Text Available OBJECTIVE: To determinate whether a surgical protocol with immediate extensive debridement, closed irrigation system and antibiotic therapy would be effective to achieve healing of deep wound infection without removing the instrumentation.METHODS: Prospective cohort study with 19 patients presenting degenerative spinal stenosis or degenerative spondylolisthesis, who developed infection after posterior lumbar arthrodesis. The diagnosis was confirmed by a microbial culture from subfascial lumbar fluid and/or blood. Patients were treated with a protocol of wound exploration, extensive flushing and debridement, placement of a closed irrigation system that was maintained for five days and intravenous antibiotics. The instrumentation system was not removed.RESULTS: Mean age was 59.31 (±13.17 years old and most patients were female (94.7%; 18/19. The mean period for the identification of the infection was 2 weeks and 57.9% underwent a single wound exploration. White blood count, erythrocyte sedimentation rate and C-reactive protein showed a significant decrease post-treatment when compared to pre-treatment values. A significant reduction of erythrocyte sedimentation rate and C-reactive protein was also observed at the final evaluation. No laboratory test was useful to predict the need for more than one debridement.CONCLUSION: Patients with wound infection after instrumentation can be treated without removal of the instrumentation through wound exploration, extensive flushing, debridement of necrotic tissue, closed irrigation system during 5 days and proper antibiotic therapy. The blood tests were not useful to predict surgical re-interventions.

  9. Application of the First Expert Arthrodesis Nail to a Patient with Previous Performed Arthrodesis According to Ulrich Holz – Case Report

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    Slavcho Stojmenski

    2014-09-01

    CONCLUSION: So we received fixed position on of the food on 110 degrees which was steel unacceptable for normal walking. At last we remove the screws, make once again osteotomy with positioning of the food in maximal dorsiflexion and perform the Experf Hindfood arthrodesis nail so with this method we achieve correction of dorsiflexion on 95 degrees, and the patient become satisfied because he can walk without support.

  10. The effects of gastrocnemius-soleus muscle forces on ankle biomechanics during triple arthrodesis

    DEFF Research Database (Denmark)

    Hejazi, Shima; Rouhi, Gholamreza; Rasmussen, John

    2016-01-01

    This paper presents a finite element model of the ankle, taking into account the effects of muscle forces, determined by a musculoskeletal analysis, to investigate the contact stress distribution in the tibio-talar joint in patients with triple arthrodesis and in normal subjects. Forces of major a...

  11. Effectiveness of Hindfoot Arthrodesis by Stable Internal Fixation in Various Eichenholtz Stages of Neuropathic Ankle Arthropathy.

    Science.gov (United States)

    Sundararajan, Silvampatty R; Srikanth, Kanchana P; Nagaraja, Handenahally S; Rajasekaran, Shanmuganathan

    The optimal time to treat neuropathic (Charcot) arthropathy of the ankle and peritalar joint is controversial because of the various treatment options available and the variable results reported in published studies. We sought to determine the outcome of hind foot arthrodesis with stable internal fixation in patients with different Eichenholtz stages of arthropathy. We prospectively studied patients with substantial disabilities caused by neuropathic arthropathy in deformed, unstable ankle and peritalar joints, with or without ulcerations, who had undergone treatment from July 2007 to December 2012. All patients underwent ankle arthrodesis, autologous iliac crest bone grafting, and subtalar joint arthrodesis, with or without talonavicular joint arthrodesis, fixed internally with an intramedullary hindfoot nail, with or without an additional plate or cancellous screws. Of the 33 enrolled patients, 9 (27.3%) had stage I, 13 (39.4%) had stage II, and 11 (33.3%) had stage III Charcot arthropathy. The cause of arthropathy was diabetes mellitus in 25 (75.8%) patients. The duration of symptoms ranged from 1 to 120 (median 7) months. The mean follow-up period was 40 (range 12 to 76) months and did not differ markedly among the groups. The hindfoot scores, rate of salvage or amputation, or complication rates did not differ significantly across Eichenholtz stage. For the patients with stage I, II, and III, the preoperative hindfoot score was 50, 49, and 48, respectively (p = .9). The corresponding postoperative scores were 68, 68, and 70 (p = .5). We found no evidence that the effectiveness of hindfoot arthrodesis by stable fixation varied across the Eichenholtz stage of Charcot arthropathy involving ankle and peritalar joint. Furthermore, we found that stable internal fixation and bone grafting using a hindfoot nail results in an 84.84% union rate and salvages the unstable and disabled foot in 90.9% of patients with ankle and peritalar Charcot arthropathy.

  12. Trephine arthrodesis of subtalar joints: operative tech-nique and clinical effect

    Institute of Scientific and Technical Information of China (English)

    LIU Hua-shui; DUAN Sheng-jun; LIU Shi-dong; XIE Xin-min; LUAN Tao; LI Lai-feng; BU Jin-peng; ZHAO Xue-chun

    2009-01-01

    Objective: To review the operative technique of tre-phine arthrodesis of subtalar joints and evaluate its clinical effect.Methods: From June 1998 to October 2006, we per-formed subtalar arthrodesis on 38 feet of 34 patients for a variety of painful disorders of hindfoot with trephine technique. Clinical and radiologic follow-up evaluations were performed for 45 months on average (range, 21 to 110 months) after arthrodesis.Results: No severe complications were found in this study except one patient with dropfoot and two with skin necrosis. The average anlde-hindfoot scores of the American Orthopaedic Foot and Ankle Society (AOFAS) was improved from 48.3 preoperatively to 79.2 postoperatively (P<0.05). The pain scores of visual analogue scales (VAS) decreased from 7.2 (range, 3 to 10) preoperatively to 2.6 (range,1 to 6) post-operatively (P<0.05). Subjectively, the patients experienced improvements in pain, function, cosmesis, and shoewearing.Overall, 30 patients were satisfied and all patients would have this procedure again under similar circumstances. Post-operative radiology showed that complete union was found in 35 feet 6 months after operation, with the successful union rate of 92.1%. There was an increase in arthritic scores for 5 ankles, 4 talonavieular joints, 4 calcaneocuboid joints, and 4 midfoot joints. Nonunion occurred in 3 subtalar joints with anterolaterai approach, which required revision arthrodesis.Conclusion: Isolated subtalar arthrodesis with tre-phine method is an effective procedure for painful malalignment of hindfoot.

  13. Tendon interposition arthroplasty versus arthrodesis for the treatment of trapeziometacarpal arthritis: a retrospective comparative follow-up study.

    Science.gov (United States)

    Mureau, M A; Rademaker, R P; Verhaar, J A; Hovius, S E

    2001-09-01

    Long-term subjective and objective outcomes of 24 tendon interposition arthroplasties in 17 patients and 32 trapeziometacarpal (TMC) arthrodeses in 26 patients were compared retrospectively in a standardized manner. Tendon interposition arthroplasty led to complications less often (27%) than TMC arthrodesis (39%). Patients in the tendon interposition arthroplasty group reported significantly less pain, less temperature intolerance, and better thumb mobility and were more satisfied with pain symptoms than patients in the arthrodesis group. Patients undergoing tendon interposition arthroplasty had better thumb opposition, interphalangeal joint mobility, and radial and palmar TMC joint range of motion. No statistically significant differences were found in tip pinch, key pinch, and grip strength between the 2 groups. Proximal first metacarpal collapse occurred in the tendon interposition patients without affecting subjective or objective outcome. Seven of 25 patients with TMC arthrodesis had pseudarthrosis. Tendon interposition arthroplasty seems to be preferable to TMC joint arthrodesis for the treatment of TMC arthritis.

  14. Minimally invasive proximal interphalangeal joint arthrodesis using a locking compression plate and tissue engineering in horses: a pilot study.

    Science.gov (United States)

    Seo, Jong-pil; Yamaga, Takashi; Tsuzuki, Nao; Yamada, Kazutaka; Haneda, Shingo; Furuoka, Hidefumi; Tabata, Yasuhiko; Sasaki, Naoki

    2014-11-01

    This pilot study assessed the efficacy of 2 minimally invasive techniques for proximal interphalangeal (PIP) joint arthrodesis in horses. The PIP joints of both forelimbs (n = 6) were stabilized with locking compression plates (LCP) using a minimally invasive technique (LCP technique). Subsequently, for 1 randomly selected PIP joint of each horse, surgical drilling (SurD) was performed and tissue engineering (TE) was applied (LCP/SurD/TE technique). Minimally invasive PIP joint arthrodesis with LCP demonstrated low postoperative infection rates. Gross and histological evaluations revealed considerable destruction of the articular cartilage in the LCP/SurD/TE-treated joints. In contrast, almost no destruction of the cartilage was observed in the LCP-treated joints. Our results suggest that the LCP technique alone is not sufficient for PIP joint arthrodesis and that the LCP/SurD/TE technique may be useful for PIP joint arthrodesis in horses.

  15. Minimally invasive proximal interphalangeal joint arthrodesis using a locking compression plate and tissue engineering in horses: A pilot study

    OpenAIRE

    SEO, Jong-Pil; Yamaga, Takashi; TSUZUKI, Nao; YAMADA, Kazutaka; HANEDA, Shingo; Furuoka, Hidefumi; Tabata, Yasuhiko; SASAKI, Naoki

    2014-01-01

    This pilot study assessed the efficacy of 2 minimally invasive techniques for proximal interphalangeal (PIP) joint arthrodesis in horses. The PIP joints of both forelimbs (n = 6) were stabilized with locking compression plates (LCP) using a minimally invasive technique (LCP technique). Subsequently, for 1 randomly selected PIP joint of each horse, surgical drilling (SurD) was performed and tissue engineering (TE) was applied (LCP/SurD/TE technique). Minimally invasive PIP joint arthrodesis wi...

  16. Narrative review of the in vivo mechanics of the cervical spine after anterior arthrodesis as revealed by dynamic biplane radiography.

    Science.gov (United States)

    Anderst, William

    2016-01-01

    Arthrodesis is the standard of care for numerous pathologic conditions of the cervical spine and is performed over 150,000 times annually in the United States. The primary long-term concern after this surgery is adjacent segment disease (ASD), defined as new clinical symptoms adjacent to a previous fusion. The incidence of adjacent segment disease is approximately 3% per year, meaning that within 10 years of the initial surgery, approximately 25% of cervical arthrodesis patients require a second procedure to address symptomatic adjacent segment degeneration. Despite the high incidence of ASD, until recently, there was little data available to characterize in vivo adjacent segment mechanics during dynamic motion. This manuscript reviews recent advances in our knowledge of adjacent segment mechanics after cervical arthrodesis that have been facilitated by the use of dynamic biplane radiography. The primary observations from these studies are that current in vitro test paradigms often fail to replicate in vivo spine mechanics before and after arthrodesis, that intervertebral mechanics vary among cervical motion segments, and that joint arthrokinematics (i.e., the interactions between adjacent vertebrae) are superior to traditional kinematics measurements for identifying altered adjacent segment mechanics after arthrodesis. Future research challenges are identified, including improving the biofidelity of in vitro tests, determining the natural history of in vivo spine mechanics, conducting prospective longitudinal studies on adjacent segment kinematics and arthrokinematics after single and multiple-level arthrodesis, and creating subject-specific computational models to accurately estimate muscle forces and tissue loading in the spine during dynamic activities.

  17. Long-term results of lunocapitate arthrodesis with scaphoid excision for SLAC and SNAC wrists.

    Science.gov (United States)

    Ferreres, A; Garcia-Elias, M; Plaza, R

    2009-10-01

    When treating the degenerative arthritis that follows scapholunate instability or scaphoid pseudarthrosis, excision of the scaphoid must be combined with a stabilisation of the midcarpal joint. Two alternatives have been proposed for that purpose: fusing the lunate, triquetrum, capitate and hamate (four corner fusion), 4CF; or limiting the arthrodesis to the lunate and capitate, preserving or excising the triquetrum. Previous reports have attributed a high level of complications to lunocapitate arthrodesis, mainly in respect of nonunion. We have reviewed 17 patients who had been treated with a lunocapitate fusion, after an 8 to 12-year follow-up period, and found similar results compared with 4CF, even with a major degree of motion in ulnar-radial deviation. Recent work on the innervation of the radiotriquetral ligaments has given relevance to the preservation of lunotriquetral motion in maintaining proprioception. Also if the triquetrum is excised to gain more motion, the proprioceptive role of the radiotriquetral ligaments is compromised.

  18. Primary subtalar arthrodesis for the treatment of comminuted intra-articular calcaneal fractures.

    Science.gov (United States)

    Potenza, V; Caterini, R; Farsetti, P; Bisicchia, S; Ippolito, E

    2010-07-01

    We report the short- and mid-term results in six patients (seven feet) affected by markedly comminuted intra-articular calcaneal fractures (Sanders type IV), treated by primary subtalar arthrodesis. The average age at surgery was 40 years. In all patients, arthrodesis of the subtalar joint was performed using a limited lateral approach to the calcaneus; it was stabilised with two or three cannulated screws. No patient had a preliminary reduction and internal fixation of the fracture. The time from injury to surgery averaged 20 days because all of the patients had associated visceral and/or other skeletal injuries. All of the patients were followed up clinically and radiographically 2 times, at an average of 12 months and 53 months after surgery. At the short-term follow-up, the mean AOFAS score was 70 points; the X-rays showed a complete fusion of the subtalar joint in all seven feet, without any sign of osteoarthritis of the calcaneo-cuboid and the talo-navicular joints. In all cases, an altered shape of the calcaneus was present. At the mid-term follow-up, the mean AOFAS score increased to 85 points; in one patient, radiographic signs of osteoarthritis of the calcaneo-cuboid and the talo-navicular joints were present and, in another patient, only talo-navicular joint was present, although both patients were free from pain. The difference between the two AOFAS scores was statistically significant. We believe that primary subtalar arthrodesis performed for markedly comminuted Sanders type IV calcaneal fractures yielded good mid-term results, and it is especially indicated when surgical treatment is delayed for whatever reason. A preliminary open reduction and internal fixation to restore the normal height of the calcaneus before performing the subtalar arthrodesis, as suggested by several authors, does not seem indispensable to obtain good clinical results.

  19. Minimally invasive arthrodesis for chronic sacroiliac joint dysfunction using the SImmetry SI Joint Fusion system

    OpenAIRE

    Miller LE; Block JE

    2014-01-01

    Larry E Miller,1,2 Jon E Block21Miller Scientific Consulting, Inc., Asheville, NC, USA; 2The Jon Block Group, San Francisco, CA, USA Abstract: Chronic sacroiliac (SI) joint-related low back pain (LBP) is a common, yet under-diagnosed and undertreated condition due to difficulties in accurate diagnosis and highly variable treatment practices. In patients with debilitating SI-related LBP for at least 6 months duration who have failed conservative management, arthrodesis is a viable option. The...

  20. First metatarsophalangeal joint arthrodesis for the treatment of tophaceous gouty arthritis.

    Science.gov (United States)

    Kim, Yong Sang; Park, Eui Hyun; Lee, Ho Jin; Koh, Yong Gon

    2014-02-01

    In tophaceous gouty arthritis, surgeons face the choice between preservation of the involved joint and arthrodesis after tophi excision. Magnetic resonance imaging (MRI) can allow evaluation of the distribution of tophaceous deposits, which can be difficult to visualize on radiography. The goal of this study was to evaluate the characteristic MRI features of tophaceous lesions and to compare the clinical outcomes of arthrodesis after tophi excision with those of simple tophi excision. The authors reviewed 16 feet in 15 consecutive patients diagnosed with tophaceous gouty arthritis of the first metatarsophalangeal (MTP) joint who underwent surgery. Nine feet (group A) were treated with simple tophi excision, whereas the other 7 (group B) underwent first MTP joint arthrodesis after tophi excision. For clinical evaluation, the visual analog scale (VAS) for pain, American Orthopaedic Foot and Ankle Society (AOFAS) score, Tegner activity scale, and patient satisfaction assessments were used. Magnetic resonance imaging was performed to evaluate the characteristics of tophaceous deposits in the first MTP joint. Mean VAS and AOFAS scores and patient satisfaction significantly differed between the 2 groups at final follow-up (P=.007, .005, and .002, respectively). In group A, progression of arthritis of the first MTP joint was observed in 6 of 9 cases at final follow-up. The tophaceous lesions of these 6 cases were found to be located intra-articularly on MRI. Arthrodesis after tophi excision should be considered for treating tophaceous gouty arthritis of the first MTP joint when tophi are located intra-articularly and loss of cartilage involved is greater than 50% of the entire joint.

  1. Arthrodesis of the proximal interphalangeal joint affected with septic arthritis in 8 horses.

    OpenAIRE

    Groom, L J; Gaughan, E M; Lillich, J D; Valentino, L W

    2000-01-01

    Arthrodesis was performed to treat septic arthritis of the proximal interphalangeal joint of 8 horses. Records of the horses were reviewed to determine outcome and possible factors that influenced success or failure. All horses were female. Seven horses had 1 joint treated and 1 horse was treated for bilateral pelvic limb involvement. The duration of sepsis before surgery ranged from 1 to 66 days. Bone lysis and production was radiographically apparent in 7 horses before surgery. Six horses h...

  2. Current concepts on spinal arthrodesis in degenerative disorders of the lumbar spine

    OpenAIRE

    Lykissas, Marios G; Aichmair, Alexander

    2013-01-01

    Back pain is a common chronic disorder that represents a large burden for the health care system. There is a broad spectrum of available treatment options for patients suffering from chronic lower back pain in the setting of degenerative disorders of the lumbar spine, including both conservative and operative approaches. Lumbar arthrodesis techniques can be divided into sub-categories based on the part of the vertebral column that is addressed (anterior vs posterior). Furthermore, one has to ...

  3. The effects of gastrocnemius-soleus muscle forces on ankle biomechanics during triple arthrodesis.

    Science.gov (United States)

    Hejazi, S; Rouhi, G; Rasmussen, J

    2017-02-01

    This paper presents a finite element model of the ankle, taking into account the effects of muscle forces, determined by a musculoskeletal analysis, to investigate the contact stress distribution in the tibio-talar joint in patients with triple arthrodesis and in normal subjects. Forces of major ankle muscles were simulated and corresponded well with the trend of their EMG signals. These forces were applied to the finite element model to obtain stress distributions for patients with triple arthrodesis and normal subjects in three stages of the gait cycle, i.e. heel strike, midstance, and heel rise. The results demonstrated that the stress distribution patterns of the tibio-talar joint in patients with triple arthrodesis differ from those of normal subjects in investigated gait cycle stages. The mean and standard deviations for maximum stresses in the tibo-talar joint in the stance phase for patients and normal subjects were 9.398e7 ± 1.75e7 and 7.372e7 ± 4.43e6 Pa, respectively. The maximum von Mises stresses of the tibio-talar joint for all subjects in the stance phase found to be on the lateral side of the inferior surface of the joint. The results also indicate that, in patients with triple arthrodesis, increasing gastrocnemius-soleus muscle force reduces the stress on the medial malleolus compared with normal subjects. Most of stresses in this area are between 45 and 109 kPa, and will decrease to almost 32 kPa in patients after increasing of 40% in gastrocnemius-soleus muscle force.

  4. Sagittal alignment of the first metatarsophalangeal joint after arthrodesis for rheumatoid forefoot deformity.

    Science.gov (United States)

    Tanabe, Akihiko; Majima, Tokifumi; Onodera, Tomohiro; Sawaguchi, Naohiro; Watanabe, Takuya; Kasahara, Yasuhiko; Takahashi, Daisuke

    2013-01-01

    The present study assessed the midterm results of reconstruction for rheumatoid forefoot deformity with arthrodesis of the first metatarsophalangeal (MTP) joint, scarf osteotomy, resection arthroplasty of the metatarsal head of the lesser toes, and surgical repair of hammertoe deformity (arthrodesis of the proximal interphalangeal joint). Special focus was placed on the sagittal alignment of the first metatarsophalangeal joint after arthrodesis. We retrospectively evaluated the postoperative clinical outcomes and radiographic findings for 16 consecutive female patients (20 feet) with symptomatic rheumatoid forefoot deformities. The mean duration of follow-up was 7.9 (range 4 to 13) years. All first MTP joints and first metatarsal bones were fused successfully. The mean value of the American Orthopaedic Foot and Ankle Society and Japanese Society for Foot Surgery clinical scores significantly improved overall, except for 2 patients (10%), who complained of first toe pain at the final follow-up visit owing to sagittal misalignment of the fused first MTP joint. Sagittal alignment of the first metatarsal varies greatly because of the rheumatoid midfoot and hindfoot deformities. Therefore, inclination of the first metatarsal should be considered when determining the first MTP joint sagittal fusion angle.

  5. Effects of the lapidus arthrodesis and chevron bunionectomy on plantar forefoot pressures.

    Science.gov (United States)

    King, Christy M; Hamilton, Graham A; Ford, Lawrence A

    2014-01-01

    Hallux valgus with or without first ray insufficiency has been strongly implicated as a contributing factor in lesser metatarsal overload. The principle goals of a bunionectomy are to relieve the pain, correct the deformity, and restore first metatarsophalangeal joint congruity. Until now, little evidence has been available to assess the effects of bunionectomy procedures on forefoot pressure. The primary aim of the present prospective study was to evaluate the preoperative and postoperative plantar pressures after 2 specific bunionectomies: the chevron bunionectomy and Lapidus arthrodesis. A total of 68 subjects, 34 in each group, were included for radiographic and pedographic evaluation. Both procedures demonstrated radiographic improvements in the mean intermetatarsal and hallux abductus angles. The mean hallux plantar pressure decreased significantly in both procedure groups (p forefoot pressure (p = .01). Furthermore, the pressure under the second metatarsal as a percentage of the total forefoot pressure decreased significantly (p = .01). This study suggests that the Lapidus arthrodesis and chevron bunionectomy both provide correction for hallux valgus deformity, but when comparing forefoot load sharing pressures, the Lapidus arthrodesis appeared to have greater influence on the load sharing distribution of forefoot pressure than did the bunionectomy employing the chevron osteotomy.

  6. Immediate postoperative pain level from lumbar arthrodesis following epidural infiltration of morphine sulfate

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    Carlos Alexandre Botelho do Amaral

    2015-02-01

    Full Text Available OBJECTIVE: To evaluate the pain level in patients treated with epidural infusion of morphine sulfate in a single dose, after a surgical procedure to perform lumber arthrodesis.METHODS: Forty patients underwent posterolateral lumbar arthrodesis or intersomatic lumbar arthrodesis via a posterior route at one, two or three levels. They were prospectively randomized into two groups of 20. In the first group (study group, 2 mg of morphine sulfate diluted in 10 mL of physiological serum was infiltrated into the epidural space, through the laminectomy area. The second group (controls did not receive analgesia. The patients were asked about their pain levels before and after the operation, using a visual analog scale (VAS.RESULTS: It was found that the patients presented a significant diminution of pain as shown by the VAS. From before to after the operation, it decreased by an average of 4.7 points (p = 0.0001, which corresponded to 53.2% (p = 0.0001.CONCLUSION: Application of 2 mg of morphine sulfate in a single epidural dose was shown to be a good technique for pain therapy following lumbar spinal surgery.

  7. Use of a trabecular metal implant in ankle arthrodesis after failed total ankle replacement

    Science.gov (United States)

    2010-01-01

    Background and purpose Arthrodesis after failed total ankle replacement is complicated and delayed union, nonunion, and shortening of the leg often occur—especially with large bone defects. We investigated the use of a trabecular metal implant and a retrograde intramedullary nail to obtain fusion. Patients and methods 13 patients with a migrated or loose total ankle implant underwent arthrodesis with the use of a retrograde intramedullary nail through a trabecular metal Tibial Cone. The mean follow-up time was 1.4 (0.6–3.4) years. Results At the last examination, 7 patients were pain-free, while 5 had some residual pain but were satisfied with the procedure. 1 patient was dissatisfied and experienced pain and swelling when walking. The implant-bone interfaces showed no radiographic zones or gaps in any patient, indicating union. Interpretation The method is a new way of simplifying and overcoming some of the problems of performing arthrodesis after failed total ankle replacement. PMID:21067435

  8. Arthrodesis of the Trapeziometacarpal Joint Using a Chevron Osteotomy and Plate Fixation

    Directory of Open Access Journals (Sweden)

    G. Shyamalan

    2014-01-01

    Full Text Available Introduction. Trapeziometacarpal (TM osteoarthritis is common. Despite the availability of numerous surgical options, none has been definitively proven to be superior. This study aims to determine the union rate and key strength following arthrodesis using a chevron osteotomy and plate fixation. Methods. 32 consecutive cases of TM joint arthrodesis performed between 2001 and 2006 were retrospectively identified. A chevron osteotomy was used to resect joint surfaces and fixation obtained using an AO mini T-plate. The patients were followed up for a mean of 65 months. Outcomes included visual analogue pain score, patient satisfaction, pinch strength, radiographic union, radiographic signs of scaphotrapezial arthritis, and complications. Results. The 32 cases included 16 females and 8 males with an average age of 56 years. Overall there was a 90% patient satisfaction rate. Average key pinch strength was 8.4 kg and pain score was 2.5. The union rate was 94%, and the two patients with nonunion underwent successful revision surgery. Only one case of radiographic progression of scaphotrapezoid arthritis was identified during followup. Conclusion. TM joint arthrodesis using a chevron osteotomy and plate fixation has high patient satisfaction and low nonunion rates. The authors endorse this technique in the management of TM joint osteoarthritis.

  9. Evaluation of Occipitocervical Arthrodesis Rates with Screw-based Fixation and Osteoinductive Fusion Adjuncts.

    Science.gov (United States)

    Stone, Jeremy G; Panczykowski, David M; Tempel, Zachary J; Tormenti, Matthew; Kanter, Adam S; Okonkwo, David O

    2015-09-01

    Occipitocervical (OC) instability may be associated with neurologic impairment and even death. There is a paucity of research on the rate of arthrodesis utilizing modern screw-based constructs coupled with adjuvant osteoinductive agents. We reviewed our experience with OC constructs and compared the fusion rate, functional outcome, and rate of adverse events between recombinant human bone morphogenetic protein (BMP)-2, autologous iliac crest bone graft (ICBG), a combination of BMP and ICBG, and local bone autograft alone. We performed a retrospective cohort analysis of all adult admissions for operative treatment of OC instability utilizing segmental screw-based constructs for OC arthrodesis between January 2003 and September 2012. Data concerning demographic characteristics, diagnostic and procedural details, radiographic pathology, and clinical course were abstracted from medical records. The primary end point was evidence of stable fixation and osseous union on either dynamic lateral radiographs or computed tomography (CT) imaging at most recent follow-up. Secondary end points included functional outcome as determined by Nurick scale and Neck disability index (NDI) at ≥ 1year postoperation, as well as perioperative morbidity and mortality at 30 days and 3 months. During the study period, 94 patients (mean age: 62 ± 18 years) underwent OC fixation with segmental screw-based constructs. The four fusion adjunct cohorts analyzed included local autograft alone (32%), ICBG (41%), BMP (14%), or a combination of ICBG and BMP (14%). Notably, demineralized bone matrix was also used in 61% of cases overall, but its use did not differ significantly among the four cohorts (p = 0.28). Median radiographic follow-up was 6 months postoperatively (range: 1.5-54 months). Clinical outcomes were assessed at a median postoperative follow-up of 45 months (range: 12-87 months). Overall, radiographic evidence of arthrodesis was present in 83% of patients assessed and was

  10. Limb Preservation in Recurrent Giant Cell Tumour of Distal End of Radius with Fibular Graft Fracture: Role of Ulnocarpal Arthrodesis.

    Science.gov (United States)

    Kumar, Narinder

    2015-01-01

    Giant cell tumors of distal radius are locally aggressive tumors with a high rate of recurrence. Though surgery remains the mainstay of treatment, reconstruction remains a challenge in cases of recurrence. Recurrences of GCT in autogenous fibular grafts have been rarely reported and pathological fractures through such grafts are even rarer. Ulnocarpal arthrodesis has never been described as a limb preservation procedure in such a recurrent lesion in distal radius with pathological fracture through a well incorporated fibular graft. A case of pathological fracture in a well incorporated autogenous non-vascularized fibular bone graft in recurrent GCT of distal radius and its successful management with ulnocarpal arthrodesis is reported. In such a scenario where other reconstructive options like allograft or prosthetic reconstructions are not likely to succeed, ulnocarpal arthrodesis may be considered as a salvage procedure.

  11. Hardware-related complications following radiocarpal arthrodesis using a dorsal plate.

    Science.gov (United States)

    Berling, Stephen E; Kiefhaber, Thomas R; Stern, Peter J

    2015-02-01

    Background Hardware-related complications more than 6 months after total wrist arthrodesis are rarely reported, and controversy remains around the inclusion of the middle finger carpometacarpal joint (CMCJ) in the fusion mass. Purpose To determine the frequency of hardware-related complications including plate fractures, screw fractures, and symptomatic plate/screw loosening, and to investigate whether failure to fuse the middle finger CMCJ contributed to these hardware complications. Patients and Methods A retrospective chart review was designed to identify long-term hardware-related complications following 122 wrist arthrodeses using plate fixation. Patients with at least 6 months of follow-up were reviewed to determine the number of complications, the involvement of the middle finger CMCJ, and the procedures required to address these complications. Results At a median of 2.5 years following arthrodesis (range, 6 months-19 years), 20 (16%) hardware-related complications occurred and included screw fracture (n = 12), plate loosening (n = 5), and plate fracture (n = 3). Thirteen (65%) of the hardware complications occurred after the CMCJ was not fused during the procedure. The CMCJ did not fuse after attempted arthrodesis in 6 additional wrists. Conclusions Persistent middle finger CMCJ micromotion was likely present in 19/20 wrists (95%) that experienced symptomatic hardware complications. Given the occurrence of hardware failures centering on this joint, it is our recommendation that, unless one plans for routine plate removal within a given timeframe, the middle finger CMCJ must be included in the fusion mass. Level 4 Therapeutic Case Series.

  12. Ankle arthrodesis fusion rates for mesenchymal stem cell bone allograft versus proximal tibia autograft.

    Science.gov (United States)

    Anderson, John J; Boone, Joshua J; Hansen, Myron; Brady, Chad; Gough, Adam; Swayzee, Zflan

    2014-01-01

    Ankle arthrodesis is commonly used in the treatment of ankle arthritis. The present study compared mesenchymal stem cell (MSC) bone allografts and proximal tibia autografts as adjuncts in performing ankle arthrodesis. A total of 109 consecutive ankle fusions performed from 2002 to 2008 were evaluated retrospectively. Of the 109 fusions, 24 were excluded from the present study, leaving 85 patients who had undergone ankle arthrodesis. Of the 85 patients, 41 had received a proximal tibia autograft and 44, an MSC bone allograft. These 2 groups were reviewed and compared retrospectively at least 2 years postoperatively for the overall fusion rate, interval to radiographic fusion, and interval to clinical fusion. A modified and adjusted American College of Foot and Ankle Surgeons ankle scale was used to measure patient satisfaction. The overall fusion rate was 84.1% in the MSC bone allograft group and 95.1% in the proximal tibia autograft group (p = .158). The corresponding mean intervals to radiographic fusion were 13.0 ± 2.5 weeks and 11.3 ± 2.8 weeks (p ≤ .001). The interval to clinical fusion was 13.1 ± 2.1 weeks and 11.0 ± 1.5 weeks (p ≤ .001) in the MSC bone allograft and proximal tibia autograft group, respectively. No statistically significant difference was found in the fusion rates between the MSC bone allograft and proximal tibia autograft groups. Also, no statistically significant difference was found between the preoperative and postoperative scores using a modified and adjusted American College of Foot and Ankle Surgeons ankle scale between the 2 groups (p = .41 and p = .44, respectively). A statistically significant delay to radiographic and clinical fusion was present in the MSC bone allograft group compared with the proximal tibia autograft group; however, no difference was found in patient satisfaction.

  13. Computer assisted knee arthrodesis in a primary case of septic arthritis: a case report.

    Science.gov (United States)

    Maniar, Rajesh N; Baviskar, Jayesh V

    2011-12-01

    We report a case of a 78 year old patient with primary septic arthritis who was treated with knee arthrodesis using computer navigation. Use of computer navigation avoided violating the medullary canal and its associated risks. Also, it offered the advantage of making precise bone cuts in all the three planes, thus minimizing the risk of malalignment. At 3 months, our patient showed good appositional contact of the bone ends, stable fusion, with no sign of infection and was mobilized with a simple brace. At 6 months review, the patient was walking painlessly without support. We achieved a mechanical axis alignment of 0° and 11° flexion as planned.

  14. An evaluation of chemical arthrodesis of the proximal interphalangeal joint in the horse by using monoiodoacetate.

    OpenAIRE

    Penraat, J H; Allen, A L; Fretz, P. B.; Bailey, J. V.

    2000-01-01

    The use of monoiodoacetate (MIA) for arthrodesis of the proximal interphalangeal joint (PIJ) and the effect of exercise on the degree of fusion were investigated. Eight horses received 3 injections (Weeks 0, 3, 6) of MIA (2 mL; 60 mg/mL) into the right or left front PIJ. Peri-operatively, the horses received phenylbutazone, butorphanol, and abaxial sesamoidean nerve blocks to relieve pain. During the study, the horses were monitored for general health, lameness, and swelling around the inject...

  15. Capitolunate arthrodesis maintaining carpal height for the treatment of SNAC wrist.

    Science.gov (United States)

    Giannikas, D; Dimitrios, G; Karageorgos, A; Athanasios, K; Karabasi, A; Ageliki, K; Syggelos, S; Spiridon, S

    2010-03-01

    The clinical and radiological results of a modified midcarpal fusion technique for scaphoid nonunion advance collapse were retrospectively studied in eight patients. All had partial resection of the proximal part of the fractured scaphoid, limited radial styloidectomy, scaphocapitate and lunocapitate arthrodesis, using a block of iliac crest graft to maintain carpal height. All united without complications and wrist motion, grip strength and carpal height were improved postoperatively. The modified Mayo wrist score at follow-up was 70%. Three patients continued to have some pain and one patient had a poor result.

  16. Measurement of Nitinol Recovery Distance Using Pseudoelastic Intramedullary Nails for Tibiotalocalcaneal Arthrodesis.

    Science.gov (United States)

    Kildow, Beau J; Gross, Christopher E; Adams, Samuel D; Parekh, Selene G

    2016-07-07

    Background Tibiotalocalcaneal arthrodesis is a salvage procedure for patients with complex disease of the ankle and subtalar joints. Despite the clinical efficacy and mechanical advantage of intramedullary nails, complications, such as nonunion, are common. It may be possible to sustain compression in the face of bone resorption and implant loosening over the course of healing using a novel pseudoelastic intramedullary nail with an internal nitinol element. Methods We identified 15 patients with average age of 54.7 years (range, 28-75 years) who had undergone a tibiotalocalcaneal arthrodesis using a pseudoelastic intramedullary nail. Serial radiographs were used to determine the amount and rate of nitinol element migration over the first 3 postoperative months. Results Postoperatively, there was at least 2.38 mm of nitinol element migration proximally with mean of 5.58 mm (± 1.38), (range, 2.38-8.11 mm). Average follow-up time was 195 days (± 106.3), (range, 89-490 days). On average, 86% of the total recovered distance took place within the first 39.7 days (±10.03). Conclusions The nitinol element recovers distance when stretched intraoperatively and maintains moderate compression in response to bone resorption. Further studies are needed to assess if this increased compression lends itself to higher fusion rates than traditional intramedullary nails.

  17. Minimally invasive arthrodesis for chronic sacroiliac joint dysfunction using the SImmetry SI Joint Fusion system

    Directory of Open Access Journals (Sweden)

    Miller LE

    2014-05-01

    Full Text Available Larry E Miller,1,2 Jon E Block21Miller Scientific Consulting, Inc., Asheville, NC, USA; 2The Jon Block Group, San Francisco, CA, USA Abstract: Chronic sacroiliac (SI joint-related low back pain (LBP is a common, yet under-diagnosed and undertreated condition due to difficulties in accurate diagnosis and highly variable treatment practices. In patients with debilitating SI-related LBP for at least 6 months duration who have failed conservative management, arthrodesis is a viable option. The SImmetry® SI Joint Fusion System is a novel therapy for SI joint fusion, not just fixation, which utilizes a minimally invasive surgical approach, instrumented fixation for immediate stability, and joint preparation with bone grafting for a secure construct in the long term. The purpose of this report is to describe the minimally invasive SI Joint Fusion System, including patient selection criteria, implant characteristics, surgical technique, postoperative recovery, and biomechanical testing results. Advantages and limitations of this system will be discussed. Keywords: arthrodesis, fusion, minimally invasive, sacroiliac, SImmetry

  18. Scaphocapitolunate arthrodesis and radial styloidectomy: a treatment option for posttraumatic degenerative wrist disease.

    Science.gov (United States)

    Klausmeyer, Melissa; Fernandez, Diego

    2012-11-01

    Longstanding scaphoid nonunion, scaphoid malunion, and chronic scapholunate dissociation result in malalignment of the carpal bones, progressive carpal collapse, instability, and osteoarthritis of the wrist. The most commonly used procedures to treat scaphoid nonunion advanced collapse (SNAC) and scapholunate advanced collapse (SLAC) wrists are the four-corner fusion (4CF) and the proximal row carpectomy (PRC). Here we describe a different treatment option: radial styloidectomy and scaphocapitolunate (SCL) arthrodesis. This treatment option is chosen in an effort to maintain the joint contact surface and load transmission across the radiocarpal joint. Twenty patients were treated by the senior author (DLF) with this method with a mean follow-up of 4.6 years. Pain decreased in all patients, and 13 patients were pain-free postoperatively. The average Disabilities of the Arm, Shoulder, and Hand (DASH) scores decreased from 44 preoperatively to 23 postoperatively. One patient's course was complicated by nonunion, which was successfully treated with revision of the SCL arthrodesis. On follow-up radiographs, no patient had progressive osteoarthritis. This method preserves the normal ulnar-sided joints of the carpus, which are sacrificed during 4CF, and maintains a more physiologic joint surface for radiocarpal load sharing.

  19. TALONAVICULAR JOINT ARTHRODESIS AND MEDIAL DISPLACEMENT CALCANEAL OSTEOTOMY FOR TREATMENT OF PATIENTS WITH PLANOVALGUS DEFORMITY

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    G. O. Dubovik

    2012-01-01

    Full Text Available The aim of this study was to assess the results of talonavicular joint arthrodesis and medial displacement calcaneal osteotomy for surgical correction of pes planovalgus. Fourteenth patients with a pes planovalgus deformity were underwent surgery from February 2008 to December 2011. The mean age was 45,5. In 90% of cases, operations were performed on one foot, and 10% of cases at two feet. All patients were assessed before the operation with the scale of the American Orthopaedic Foot and Ankle Society (AOFAS. According to the AOFAS scale, the average improvement was 41 before the operation had reached values of 84.2 after the operation. Radiography showed an average decrease in the angle of the longitudinal arch from 12 and an average decrease in the angle of deviation between the vehicle collision and the calcaneus to 38°, increasing the height of a set of 5 mm. This combination of procedures allows greater correction and stability than either procedure performed alone, and provides a viable alternative to triple arthrodesis.

  20. Radiographic evaluation of the use of transverse traction device in vertebral arthrodesis for degenerative diseases

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    Edgar Takao Utino

    2014-03-01

    Full Text Available OBJECTIVE: Perform radiographic analysis of the use of Transverse Traction Device (DTT with respect to fusion rate in patients submitted to vertebral arthrodesis for degenerative lumbar diseases. METHODS: We selected x-ray images on anteroposterior, lateral and oblique views and with maximum flexion and extension dynamics of 23 patients submitted to posterolateral arthrodesis of the lumbar spine with a minimum follow-up period of six months. The images were evaluated and classified by the Linovitz's system by two spine surgeons. RESULTS: We evaluated the radiographs of 23 patients after the minimum postoperative period of 6 months and of these, 11 have used DTT. With regard to the consolidation rate, seven patients (63.6% in the group of DTT were classified as fusion as well as six patients (50% who were not submitted to the treatment. There was no statistical difference between the groups regarding the consolidation rate. CONCLUSION: The use of transverse traction device in this study showed no significant difference in the rate of consolidation in radiographic evaluation. Studies on the effective participation of this device in the stability of pedicle fixation systems are still lacking in the literature.

  1. The results of Grice Green subtalar arthrodesis of valgus foot in spina bifida

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    Fatih Küçükdurmaz

    2012-01-01

    Full Text Available Background: Valgus foot is a common foot deformity in spina bifida. The most popular operation for the valgus deformity has been the Grice talocalcaneal blocking. It has not been studied primarily in children with spina bifida. We report a prospective series, we present the results of hind foot valgus deformity of children with spina bifida, using Grice talocalcaneal arthrodesis with a tricortical iliac bone graft. Materials and Methods: Between May 2000 and December 2003, 21 patients with bilateral (42 feet valgus deformity of feet underwent surgery. There were 7 males and 14 females. The mean age of patients was 67.7 months (range 50-108 months. Results: The total number of feet that had nonunion was 11, in 7 of them the grafts were completely reabsorbed and the outcome of all these feet was unsatisfactory. Four feet had partial union of which three had unsatisfactory and one had satisfactory outcome. Sixteen feet had residual valgus deformity at the last followup visit, 10 patients had nonunion, and 6 had inadequate correction. Mean preoperative talocalcaneal and calcaneal pitch angles were 48.5΀ and 31.9΀, respectively, which decreased to 38.5΀ and 29.1΀, respectively, postoperatively. The decrease in talocalcaneal angle and calcaneal pitch was significant between preoperative and postoperative measurements (P<0.05. Conclusion: Grice subtalar arthrodesis technique is still a valuable option for valgus foot in patients with spina bifida. In this study, we found more encouraging results in older patients.

  2. Long-term results after a triple arthrodesis of the hindfoot: function and satisfaction in 36 patients

    NARCIS (Netherlands)

    I.B. de Groot (Ingrid); M. Reijman (Max); H.A.F. Luning (Hilco); J.A.N. Verhaar (Jan)

    2008-01-01

    textabstractThe long-term functional results of a triple arthrodesis of the hindfoot are not well known. In this retrospective cohort study we therefore investigated pain, function and alignment of the tibiotalar joint, patient satisfaction with the procedure and the prevalence of osteoarthritis (OA

  3. Ilizarov External Fixator Versus Retrograde Intramedullary Nailing for Ankle Joint Arthrodesis in Diabetic Charcot Neuroarthropathy.

    Science.gov (United States)

    ElAlfy, Barakat; Ali, Ayman M; Fawzy, Sallam I

    Charcot neuroarthropathy of the ankle joint is a destructive process that leads to instability and significant morbidity that can end with amputation. Surgical arthrodesis in Charcot neuroarthropathy has a high failure rate. The aim of the present prospective study was to compare the outcomes of an Ilizarov external fixator and retrograde intramedullary nailing (IMN) for tibiotalar arthrodesis in Charcot neuroarthropathy. From February 2010 to October 2013, 27 patients (16 males and 11 females) with Charcot neuropathy of the ankle joint were treated in our department. Their ages ranged from 32 to 75 (average 54) years. Of the 27 patients, 14 received an Ilizarov external fixator and 13 underwent IMN. A preoperative clinical and radiologic assessment of all patients was performed. The outcomes were measured for bone union, development of complications, and clinical follow-up. The mean score of modified American Orthopaedic Foot and Ankle Society ankle hindfoot scale was 80 ± 2.7 points in the Ilizarov group and 75 ± 1.9 points in the IMN group. In the Ilizarov group, 12 of 14 patients achieved union, and in the IMN group, 10 of 13 patients achieved union. The complication rate was significantly greater in the external fixator group than in the IMN group. The complications in the Ilizarov group included nonunion in 2 patients (14%), pin tract infection in 8 (57%), pin tract loosening in 3 (21%), surgical wound infection in 3 (21%), and wound breakdown in 1 patient (7%). In the IMN group, nonunion occurred in 3 patients (23.1%), back-out of a distal locking bolt in 2 (15.4 %), and a superficial wound infection that resolved with antibiotics in 1 patient (7.7%). In conclusion, retrograde IMN and the Ilizarov external fixator both yielded better union for tibiotalar arthrodesis in Charcot neuroarthropathy. The Ilizarov external fixator resulted in a greater union rate than IMN but the complications with external fixation were significantly greater than those

  4. Modified Girdlestone arthroplasty and hip arthrodesis using the Ilizarov external fixator as a salvage method in the management of severely infected total hip replacement

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    Nikolai M Kliushin

    2016-01-01

    Conclusion: The modified Girdlestone arthroplasty and hip arthrodesis using the Ilizarov apparatus results in sufficient ability for ambulation and good infection control in cases of failed THR associated with severe infection.

  5. Tibio-calcaneo-naviculo-cuboidale arthrodesis: 6 patients followed for 1-8 years.

    Science.gov (United States)

    Weber, Michael; Schwer, Helmut; Zilkens, Karl W; Siebert, Christian H

    2002-01-01

    As a salvage procedure for patients with irreparable damage to the peritalar anatomy, we used a new method, the Ilizarov ring fixator, to stabilize a tibio-calcaneo-naviculo-cuboideal (TCNC) arthrodesis after resecting the talus in 6 patients with an average follow-up of 3 years. The tibia was lengthened by callus distraction, mean 6 (3.5-10) cm. Patients with exacerbation of a chronic talar osteomyelitis, symptomatic posttraumatic changes, and those with extremely unstable club feet and talar deformity preventing an adequate reduction of the joint, were successfully treated with the TCNC-fusion. The method permits early weight bearing, while providing stability and compression of the fusion, thereby avoiding further loss of bone stock.

  6. Minimally invasive arthrodesis for chronic sacroiliac joint dysfunction using the SImmetry SI Joint Fusion system.

    Science.gov (United States)

    Miller, Larry E; Block, Jon E

    2014-01-01

    Chronic sacroiliac (SI) joint-related low back pain (LBP) is a common, yet under-diagnosed and undertreated condition due to difficulties in accurate diagnosis and highly variable treatment practices. In patients with debilitating SI-related LBP for at least 6 months duration who have failed conservative management, arthrodesis is a viable option. The SImmetry(®) SI Joint Fusion System is a novel therapy for SI joint fusion, not just fixation, which utilizes a minimally invasive surgical approach, instrumented fixation for immediate stability, and joint preparation with bone grafting for a secure construct in the long term. The purpose of this report is to describe the minimally invasive SI Joint Fusion System, including patient selection criteria, implant characteristics, surgical technique, postoperative recovery, and biomechanical testing results. Advantages and limitations of this system will be discussed.

  7. Evaluation of Nitinol staples for the Lapidus arthrodesis in a reproducible biomechanical model

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    Nicholas Alexander Russell

    2015-12-01

    Full Text Available While the Lapidus procedure is a widely accepted technique for treatment of hallux valgus, the optimal fixation method to maintain joint stability remains controversial. The purpose of this study was to evaluate the biomechanical properties of new Shape Memory Alloy staples arranged in different configurations in a repeatable 1st Tarsometatarsal arthrodesis model. Ten sawbones models of the whole foot (n=5 per group were reconstructed using a single dorsal staple or two staples in a delta configuration. Each construct was mechanically tested in dorsal four-point bending, medial four-point bending, dorsal three-point bending and plantar cantilever bending with the staples activated at 37°C. The peak load, stiffness and plantar gapping were determined for each test. Pressure sensors were used to measure the contact force and area of the joint footprint in each group. There was a significant (p < 0.05 increase in peak load in the two staple constructs compared to the single staple constructs for all testing modalities. Stiffness also increased significantly in all tests except dorsal four-point bending. Pressure sensor readings showed a significantly higher contact force at time zero and contact area following loading in the two staple constructs (p < 0.05. Both groups completely recovered any plantar gapping following unloading and restored their initial contact footprint. The biomechanical integrity and repeatability of the models was demonstrated with no construct failures due to hardware or model breakdown. Shape memory alloy staples provide fixation with the ability to dynamically apply and maintain compression across a simulated arthrodesis following a range of loading conditions.

  8. Isolated talonavicular arthrodesis in patients with rheumatoid arthritis of the foot and tibialis posterior tendon dysfunction

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    Pokorný David

    2010-02-01

    Full Text Available Abstract Background The foot is often affected in patients with rheumatoid arthritis. Subtalar joints are involved more frequently than ankle joints. Deformities of subtalar joints often lead to painful flatfoot and valgus deformity of the heel. Major contributors to the early development of foot deformities include talonavicular joint destruction and tibialis posterior tendon dysfunction, mainly due to its rupture. Methods Between 2002 and 2005 we performed isolated talonavicular arthrodesis in 26 patients; twenty women and six men. Tibialis posterior tendon dysfunction was diagnosed preoperatively by physical examination and by MRI. Talonavicular fusion was achieved via screws in eight patients, memory staples in twelve patients and a combination of screws and memory staples in six cases. The average duration of immobilization after the surgery was four weeks, followed by rehabilitation. Full weight bearing was allowed two to three months after surgery. Results The mean age of the group at the time of the surgery was 43.6 years. MRI examination revealed a torn tendon in nine cases with no significant destruction of the talonavicular joint seen on X-rays. Mean of postoperative followup was 4.5 years (3 to 7 years. The mean of AOFAS Hindfoot score improved from 48.2 preoperatively to 88.6 points at the last postoperative followup. Eighteen patients had excellent results (none, mild occasional pain, six patients had moderate pain of the foot and two patients had severe pain in evaluation with the score. Complications included superficial wound infections in two patients and a nonunion developed in one case. Conclusions Early isolated talonavicular arthrodesis provides excellent pain relief and prevents further progression of the foot deformities in patients with rheumatoid arthritis and tibialis posterior tendon dysfunction.

  9. Comparison of total ankle replacement and ankle arthrodesis in patients with haemophilia using gait analysis: two case reports

    OpenAIRE

    Dauty, Marc; Gross, Raphael; Leboeuf, Fabien; Trossaert, Marc

    2015-01-01

    Background Severe hemophilia is an inherited, lifelong bleeding disorder characterized by spontaneous bleeding, which results in painful joint deformities. Currently two surgical treatments are available to treat haemophilia-related ankle joint destruction: ankle arthrodesis and total ankle replacement. The aim of the present study was to compare these two surgical procedures in haemophiliac subjects. Case presentation Kinematic and dynamic parameters were quantified using a three-dimensional...

  10. Is End-Stage Ankle Arthrosis Best Managed with Total Ankle Replacement or Arthrodesis? A Systematic Review

    OpenAIRE

    Jordan, Robert W.; Chahal, Gurdip S.; Anna Chapman

    2014-01-01

    Introduction. End-stage ankle osteoarthritis is a debilitating condition. Traditionally, ankle arthrodesis (AA) has been the surgical intervention of choice but the emergence of total ankle replacement (TAR) has challenged this concept. This systematic review aims to address whether TAR or AA is optimal in terms of functional outcomes. Methods. We conducted a systematic review according to PRISMA checklist using the online databases Medline and EMBASE after January 1, 2005. Participants must ...

  11. Comparative analysis of uniplanar external fixator and retrograde intramedullary nailing for ankle arthrodesis in diabetic Charcot′s neuroarthropathy

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    Nakul S Shah

    2011-01-01

    Results: All five (100% patients treated by intramedullary nailing achieved radiological union on an average follow-up of 16 weeks. The external fixation group had significantly higher rate of complications with one amputation, four non unions (66.7% and a delayed union which went on to full osseous union. Conclusion: The retrograde intramedullary nailing for tibio-talar arthrodesis in Charcot′s neuroarthropathy yielded significantly better outcomes as compared to the use of uniplanar external fixator.

  12. Posttraumatic severe infection of the ankle joint - long term results of the treatment with resection arthrodesis in 133 cases

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    Kienast B

    2010-02-01

    Full Text Available Abstract Although there is a clear trend toward internal fixation for ankle arthrodesis, there is general consensus that external fixation is required for cases of posttraumatic infection. We retrospectively evaluated the technique and clinical long term results of external fixation in a triangular frame for cases of posttraumatic infection of the ankle. From 1993 to 2006 a consecutive series of 155 patients with an infection of the ankle was included in our study. 133 cases of the advanced "Gächter" stage III and IV were treated with arthrodesis. We treated the patients with a two step treatment plan. After radical debridement and sequestrectomy the malleoli and the joint surfaces were resected. An AO fixator was applied with two Steinmann-nails inserted in the tibia and in the calcaneus and the gap was temporary filled with gentamicin beads as the first step. In the second step we performed an autologous bone graft after a period of four weeks. The case notes were evaluated regarding trauma history, medical complaints, further injuries and illnesses, walking and pain status and occupational issues. Mean age at the index procedure was 49.7 years (18-82, 104 patients were male (67,1%. Follow up examination after mean 4.5 years included a standardised questionnaire and a clinical examination including the criteria of the AO-FAS-Score and radiographs. 92,7% of the cases lead to a stable arthrodesis. In 5 patients the arthrodesis was found partly-stable. In six patients (4,5% the infection was not controllable during the treatment process. These patients had to be treated with a below knee amputation. The mean AOFAS score at follow up was 63,7 (53-92. Overall there is a high degree of remaining disability. The complication rate and the reduced patient comfort reserve this method mainly for infection. Joint salvage is possible in the majority of cases with an earlier stage I and II infection.

  13. Proximal row carpectomy versus four-corner arthrodesis as a treatment for SLAC (scapholunate advanced collapse) wrist.

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    Vanhove, W; De Vil, J; Van Seymortier, P; Boone, B; Verdonk, R

    2008-04-01

    Four-corner arthrodesis and proximal row carpectomy are motion-preserving salvage solutions for the scapholunate advanced collapse wrist. We compared both procedures in a non-randomised, retrospective study of 30 cases with a mean follow-up of 3(1/2) years. Pain relief and functional gain were equal in both treatment groups. However, the complication rate was higher in the four-corner arthrodesis group, partly because of the need for internal fixation. The higher incidence of carpal tunnel syndrome following four-corner arthrodesis is intriguing. We also found significant differences in the duration of hospital stay and of postoperative sick leave in favour of proximal row carpectomy. If the cartilage on the capitate head is well preserved (Stages I-II), we prefer proximal row carpectomy because of the socio-economic benefits, the lower complication rate and the ease of the procedure. Degenerative changes following proximal row carpectomy may be a concern in young manual labourers, but have not been observed.

  14. Late Corrective Arthrodesis in Nonplantigrade Diabetic Charcot Midfoot Disease Is Associated with High Complication and Reoperation Rates

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    Anica Eschler

    2015-01-01

    Full Text Available Introduction. Charcot arthropathy may lead to a loss of osteoligamentous foot architecture and consequently loss of the plantigrade alignment. In this series of patients a technique of internal corrective arthrodesis with maximum fixation strength was provided in order to lower complication rates. Materials/Methods. 21 feet with severe nonplantigrade diabetic Charcot deformity Eichenholtz stages II/III (Sanders/Frykberg II/III/IV and reconstructive arthrodesis with medial and additional lateral column support were retrospectively enrolled. Follow-up averaged 4.0 years and included a clinical (AOFAS score/PSS, radiological, and complication analysis. Results. A mean of 2.4 complications/foot occurred, of which 1.5/foot had to be solved surgically. 76% of feet suffered from soft tissue complications; 43% suffered hardware-associated complications. Feet with only 2 out of 5 high risk criteria according to Pinzur showed significantly lower complication counts. Radiographs revealed a correct restoration of all foot axes postoperatively with superior fixation strength medially. Conclusion. Late corrective arthrodesis with medial and lateral column stabilization in the nonplantigrade stages of neuroosteoarthropathy can provide reasonable reconstruction of the foot alignment. Nonetheless, overall complication/reoperation rates were high. With separation into low/high risk criteria a helpful guide in treatment choice is provided. This trial is registered with German Clinical Trials Register (DRKS under number DRKS00007537.

  15. Postoperative comparison of the results from use of antibiotic prophylaxis for one and five days among patients undergoing lumbar arthrodesis

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    Charbel Jacob Júnior

    2016-06-01

    Full Text Available ABSTRACT OBJECTIVE: To compare the postoperative results from use of antibiotic prophylaxis for one and five days among patients undergoing lumbar arthrodesis at up to three levels. METHODS: Forty-three patients who all underwent lumbar arthrodesis due to degenerative disc disease at one, two or three levels were evaluated. They were divided randomly into two groups: one received antibiotic prophylaxis with cefalotin (1 g and the other received the same antibiotic for five days. After the surgical intervention, the patients were evaluated at the time of hospital discharge, at the first return to the clinic (two weeks later and 90 days after the date of the surgery with the surgical wound, with clinical examination of the surgical wound and laboratory tests on both groups. RESULTS: It was observed that among the patients in the group with one day of antibiotic prophylaxis, 28.6% presented complications in the surgical wound, while in the group with five days, 27.9% presented complications. CONCLUSION: This study demonstrates that a single dose of antibiotic prophylaxis is as effective as a regimen of multiple doses in lumbar arthrodesis surgery at up to three levels. Thus, the costs and risks of subjecting patients to hospitalization under a prolonged drug regimen are unjustifiable.

  16. Tríplice artrodese na paralisia cerebral Triple arthrodesis in cerebral palsy

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    Kotoe Umeda

    2010-01-01

    Full Text Available OBJETIVOS: Avaliar o resultados clínicos díplice artrodese em portadores de paralisia cerebral espástica, verificar a correspondência entre os resultados e a escala AOFAS e os ângulos nos períodos pré e pós-operatórios. MÉTODOS: Entre 1985 e 2005, foram avaliados 34 pacientes (40 pés submetidos a tríplice artrodese do pé, com acompanhamento médio de 91 meses, quanto a satisfação e dor, apoio plantígrado, deformidade residual e o arco de movimento do tornozelo e escala AOFAS. Foram avaliadas artrose de tornozelo, pseudoartrose das articulações e medidos os ângulos: talocalcâneo, talo-primeiro metatarsiano (APM e tíbio-talar, e talocalcâneos (ATC e o calcâneo-solo (ACS. RESULTADOS: Obtivemos bons resultados em 32,4% dos casos e regulares em 44,1%. 85,3% dos pacientes estavam satisfeitos; 88,2% tinham apoio plantígrado. Houve 33,3% de resultados bons pela escala AOFAS e 24,2% regulares. Na radiografia com incidência ântero-posterior, o APM apresentou melhora em média de 15º; no ACS, na incidência em perfil, melhora de 7º. No ATC, nas duas incidências, houve melhora de 1º. CONCLUSÕES: A triplice artrodese corrige ou melhora as deformidades, com grau de satisfação elevada, dando ao paciente pés plantígrados. A escala AOFAS teve fraca concordância com o resultado. Os APM e ACS foram os mais sensíveis na avaliação do procedimento cirúrgico.OBJECTIVE: To demonstrate the clinical results of triple arthrodesis in Cerebral Palsy patients and determine whether there is any correspondence between the results and the AOFAS scale, and changes in radiographic angles between the pre- and postoperative periods. METHODS: Between 1985 and 2005, thirty-four patients (40 feet were submitted to triple arthrodesis of the foot, with an average follow-up time of ninety-one months. The evaluation consisted of the patient's satisfaction and the presence of pain, plantigrade support, residual deformity, range of movement of the

  17. Reliability of the Radiographic Sagittal and Frontal Tibiotalar Alignment after Ankle Arthrodesis.

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    Madeleine Willegger

    Full Text Available Accurate measurement of the tibiotalar alignment is important in radiographic outcome assessment of ankle arthrodesis (AA. In studies, various radiological methods have been used to measure the tibiotalar alignment leading to facultative misinterpretation of results. However, to our knowledge, no previous study has investigated the reliability of tibiotalar alignment measurement in AA. We aimed to investigate the reliability of four different methods of measurement of the frontal and sagittal tibiotalar alignment after AA, and to further clarify the most reliable method for determining the longitudinal axis of the tibia.Thirty-eight weight bearing anterior to posterior and lateral ankle radiographs of thirty-seven patients who had undergone AA with a two screw fixation technique were selected. Three observers measured the frontal tibiotalar angle (FTTA and the sagittal tibiotalar angle (STTA using four different methods. The methods differed by the definition of the longitudinal tibial axis. Method A was defined by a line drawn along the lateral tibial border in anterior to posterior radiographs and along the posterior tibial border in lateral radiographs. Method B was defined by a line connecting two points in the middle of the proximal and the distal tibial shaft. Method C was drawn "freestyle"along the longitudinal axis of the tibia, and method D was defined by a line connecting the center of the tibial articular surface and a point in the middle of the proximal tibial shaft. Intra- and interobserver correlation coefficients (ICC and repeated measurement ANOVA were calculated to assess measurement reliability and accuracy.All four methods showed excellent inter- and intraobserver reliability for the FTTA and the STTA. When the longitudinal tibial axis is defined by connecting two points in the middle of the proximal and the distal tibial shaft, the highest interobserver reliability for the FTTA (ICC: 0.980; CI 95%: 0.966-0.989 and for the

  18. Outcome of unilateral ankle arthrodesis and total ankle replacement in terms of bilateral gait mechanics.

    Science.gov (United States)

    Chopra, Swati; Rouhani, Hossein; Assal, Mathieu; Aminian, Kamiar; Crevoisier, Xavier

    2014-03-01

    Previous studies assessed the outcome of ankle arthrodesis (AA) and total ankle replacement (TAR) surgeries; however, the extent of postoperative recovery towards bilateral gait mechanics (BGM) is unknown. We evaluated the outcome of the two surgeries at least 2 years post rehabilitation, focusing on BGM. 36 participants, including 12 AA patients, 12 TAR patients, and 12 controls were included. Gait assessment over 50 m distance was performed utilizing pressure insoles and 3D inertial sensors, following which an intraindividual comparison was performed. Most spatiotemporal and kinematic parameters in the TAR group were indicative of good gait symmetry, while the AA group presented significant differences. Plantar pressure symmetry among the AA group was also significantly distorted. Abnormality in biomechanical behavior of the AA unoperated, contralateral foot was observed. In summary, our results indicate an altered BGM in AA patients, whereas a relatively fully recovered BGM is observed in TAR patients, despite the quantitative differences in several parameters when compared to a healthy population. Our study supports a biomechanical assessment and rehabilitation of both operated and unoperated sides after major surgeries for ankle osteoarthrosis.

  19. Lumbar extracavitary corpectomy with a single stage circumferential arthrodesis: surgical technique and clinical series.

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    Singh, Kern; Park, Daniel K

    2012-07-01

    Circumferential arthrodesis and reconstruction is necessary after a lumbar corpectomy in the setting of malignancy and infection. The advent of expandable cage technology now allows for safe anterior column reconstruction via a posterior approach with no transection and minimal retraction of the lumbar spinal nerve roots. Fifteen patients underwent a single-stage, circumferential corpectomy and anterior spinal reconstruction with an expandable cage via a midline, posterior, lateral lumbar extracavitary approach. Posterior segmental pedicle screw fixation and iliac crest bone graft was used in all cases. Fifteen lumbar extracavitary corpectomy nerve root-sparing procedures have been performed to date, with at least 1-year follow-up (12 tumors/3 infections). No patient suffered any neurological complications. One patient suffered from a postoperative myocardial infarction 10 days after the procedure. Two patients had medical complications that were treated without sequelae. We present a technical description and case series of patients undergoing a single-stage, circumferential corpectomy and anterior spinal reconstruction with an expandable cage via a midline, posterior, lateral lumbar extracavitary approach with at least 1-year follow-up. The technique is safe, technically feasible, and obviates an anterior approach in this oftentimes critically ill patient population.

  20. Mesenchymal Stem Cells for the Treatment of Spinal Arthrodesis: From Preclinical Research to Clinical Scenario

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    F. Salamanna

    2017-01-01

    Full Text Available The use of spinal fusion procedures has rapidly augmented over the last decades and although autogenous bone graft is the “gold standard” for these procedures, alternatives to its use have been investigated over many years. A number of emerging strategies as well as tissue engineering with mesenchymal stem cells (MSCs have been planned to enhance spinal fusion rate. This descriptive systematic literature review summarizes the in vivo studies, dealing with the use of MSCs in spinal arthrodesis surgery and the state of the art in clinical applications. The review has yielded promising evidence supporting the use of MSCs as a cell-based therapy in spinal fusion procedures, thus representing a suitable biological approach able to reduce the high cost of osteoinductive factors as well as the high dose needed to induce bone formation. Nevertheless, despite the fact that MSCs therapy is an interesting and important opportunity of research, in this review it was detected that there are still doubts about the optimal cell concentration and delivery method as well as the ideal implantation techniques and the type of scaffolds for cell delivery. Thus, further inquiry is necessary to carefully evaluate the clinical safety and efficacy of MSCs use in spine fusion.

  1. Retrograde nail for tibiotalocalcaneal arthrodesis as a limb salvage procedure for open distal tibia and talus fractures with severe bone loss.

    Science.gov (United States)

    Ochman, Sabine; Evers, Julia; Raschke, Michael J; Vordemvenne, Thomas

    2012-01-01

    The treatment of complex fractures of the distal tibia, ankle, and talus with soft tissue damage, bone loss, and nonreconstructable joints for which the optimal timing for reduction and fixation has been missed is challenging. In such cases primary arthrodesis might be a treatment option. We report a series of multi-injured patients with severe soft tissue damage and bone loss, who were treated with a retrograde tibiotalocalcaneal arthrodesis nail as a minimally invasive treatment option for limb salvage. After a median follow-up of 5.4 years, all patients returned to their former profession. The ankle and bone fusion was complete, with moderate functional results and quality of life. Calcaneotibial arthrodesis using a retrograde nail is a good treatment option for nonreconstructable fractures of the ankle joint with severe bone loss and poor soft tissue quality in selected patients with multiple injuries, in particular, those involving both lower extremities, as a salvage procedure.

  2. Load transfer through the radiocarpal joint and the effects of partial wrist arthrodesis on carpal bone behaviour: a finite element study.

    Science.gov (United States)

    Gíslason, M K; Stansfield, B; Bransby-Zachary, M; Hems, T; Nash, D H

    2012-11-01

    A finite element model of the wrist was developed to simulate mechanical changes that occur after surgery of the wrist. After partial arthrodesis, the wrist will experience altered force transmission during loading. Three different types of partial arthrodesis were investigated - radiolunate, radioscaphoid, and radioscapholunate - and compared with the healthy untreated wrist. The results showed that the compressive forces on the radiocarpal joint decreased compared with the untreated wrist with both radiolunate and radioscaphoid fusions. The load transmission through the midcarpal joints varied depending on arthrodesis type. The forces in the extrinsic ligaments decreased with the fusion, most noticeably in the dorsal radiotriquetral ligament, but increased in the dorsal scaphotriquetral ligament. From the results of the study it can be concluded that the radioscapholunate fusion shows the most biomechanically similar behaviour out of the three fusion types compared with the healthy wrist. The modelling described in this paper may be a useful approach to pre-operative planning in wrist surgery.

  3. Posterior arthrodesis of C1-C3 for the stabilization of multiple unstable upper cervical fractures with spinal cord compromise

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    Xue, Deting; Chen, Qixin; Chen, Gang; Zhuo, Wenhai; Li, Fangcai

    2017-01-01

    Abstract Background: Multiple fractures of the atlas and axis are rare. The management of multiple fragment axis fractures and unstable atlas fractures is still challenging for the spinal surgeon. There are no published reports of similar fractures with 3-part fracture of axis associated with an unstable atlas fracture. Case summary: We present a patient with concurrent axis and atlas fractures, which have not been reported. The patient suffered hyperextension injury with neck pain and numbness of the bilateral upper extremity associated with weakness after a 2-m fall. The axis fractures included an odontoid type IIA fracture and traumatic spondylolisthesis of C2-C3. The atlas fracture was unstable. The neurological examination manifested as central canal syndrome, which was due to the hyperextension injury of cervical spine and spondylolisthesis of C2-C3. The patient was diagnosed as multiple unstable upper cervical fractures with spinal cord compromise. We performed posterior arthrodesis of C1-C3. Postoperatively, the patient showed neurological improvement, and C1-C3 had fused at the 3-month follow-up. Conclusion: Posterior arthrodesis of C1-C3 could provide a stable fixation for the 3 parts of axis (an odontoid type IIA fracture and traumatic spondylolisthesis of C2-C3) combined an unstable atlas fracture. Both the patient and the doctor were satisfied with the results of the treatment. So posterior arthrodesis of C1-C3 is a suitable treatment option for the treatment of a concurrent unstable atlas fracture and multiple fractures of the axis. PMID:28072744

  4. Posterior spinal decompression, stabilization and arthrodesis in Nigerian adults: Profile and outcome

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    O E Idowu

    2012-01-01

    Full Text Available Background: The availability of intraoperative fluoroscopy and improved access to varieties of spinal titanium implants has revived posterior spinal stabilization techniques with their distinct advantages. Our aim is to describe the profile of various spine pathologies requiring subaxial posterior spinal decompression, stabilization (using titanium implants, and arthrodesis, and to determine the rate of postoperative complications and factors affecting outcome. Materials and Methods: This is a prospective single institution study of consecutive adult patients seen during the study period. Data collected included the patients′ demographics, radiological findings, indication for surgery, surgical procedure, operation time, intraoperative blood loss, and postoperative complications. Results: There were 26 patients (15 males and 11 females. Their ages ranged between 24 and 78 years (median = 42 years. The most common indications for surgery were spinal trauma and degenerative spine disease (24 patients. The region that was most commonly stabilized was the lumbar- 12 cases (46.2%. No patients experienced neural or vascular injury as a result of screw position; likewise no patient had screw loosening. There was a case each of superficial surgical site infection and transient cerebrospinal fluid leak but no case of implant failure was encountered. The outcome was significantly associated with the etiology (0.030 of the indication for surgery and preoperative power grade (0.000. Conclusion: Spinal trauma and degenerative spine disease are the two most common indications for posterior spinal decompression, stabilization and fusion in our center. It is associated with acceptable postoperative complication rate when done under fluoroscopic guidance. Outcome is related more to the preoperative neurological deficit and etiology of the indication for surgical stabilization.

  5. Arthrodesis with external fixation in the unstable or misaligned Charcot ankle in patients with diabetes mellitus.

    Science.gov (United States)

    Fabrin, Jesper; Larsen, Kirsten; Holstein, Per E

    2007-06-01

    The unstable or misaligned Charcot ankle with or without chronic foot ulceration is a major clinical challenge. When it cannot be accommodated with an ankle foot orthosis, surgical treatment is indicated in order to avoid leg amputation. This requires extensive soft tissue release and bony resection to realign the foot and arthrodesis with internal or external fixation. The guidance in the literature favors internal fixation. This article reports results with external fixation in 11 patients (12 feet) over a period of 12 years. External fixation was chosen as the surgical option because of the presence of foot ulcers with the attendent risk of infection. There were 7 tibio-talar and 5 tibio-calcaneal fusions. Compression was applied for 6 weeks with an external frame according to Charnley, followed by 6 weeks with total-contact cast. Weight bearing with a rigid leather brace was allowed after 12 weeks. In one case, transtibial amputation was required due to loosening of the distal pins from osteopenic disintegrating bone. In 11 cases (92%), the foot was successfully realigned and independent walking with a brace retained during the follow-up of median 48 months (10-102 months). Bony union took place in 5 out of 7 cases with tibio-talar fusion and in 1 out of 5 with tibio-calcaneal fusion. The functional result in cases with fibrous union was, however, satisfactory. Although meaningful comparisons of series are difficult to conduct and interpret from, the limb salvage rate was similar to results with internal fixation. The authors consider the results to be encouraging and to be used to develop a higher level of evidence.

  6. Is End-Stage Ankle Arthrosis Best Managed with Total Ankle Replacement or Arthrodesis? A Systematic Review

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    Robert W. Jordan

    2014-01-01

    Full Text Available Introduction. End-stage ankle osteoarthritis is a debilitating condition. Traditionally, ankle arthrodesis (AA has been the surgical intervention of choice but the emergence of total ankle replacement (TAR has challenged this concept. This systematic review aims to address whether TAR or AA is optimal in terms of functional outcomes. Methods. We conducted a systematic review according to PRISMA checklist using the online databases Medline and EMBASE after January 1, 2005. Participants must be skeletally mature and suffering from ankle arthrosis of any cause. The intervention had to be an uncemented TAR comprising two or three modular components. The comparative group could include any type of ankle arthrodesis, either open or arthroscopic, using any implant for fixation. The study must have reported at least one functional outcome measure. Results. Of the four studies included, two reported some significant improvement in functional outcome in favour of TAR. The complication rate was higher in the TAR group. However, the quality of studies reviewed was poor and the methodological weaknesses limited any definitive conclusions being drawn. Conclusion. The available literature is insufficient to conclude which treatment is superior. Further research is indicated and should be in the form of an adequately powered randomised controlled trial.

  7. The management of Charcot joint disease affecting the ankle and foot by arthrodesis controlled by an Ilizarov frame: early results.

    Science.gov (United States)

    El-Gafary, K A M; Mostafa, K M; Al-Adly, W Y

    2009-10-01

    Charcot osteoarthropathy of the foot is a chronic and progressive disease of bone and joint associated with a risk of amputation. The main problems encountered in this process are osteopenia, fragmentation of the bones of the foot and ankle, joint subluxation or even dislocation, ulceration of the skin and the development of deep sepsis. We report our experience of a series of 20 patients with Charcot osteoarthropathy of the foot and ankle treated with an Ilizarov external fixator. The mean age of the group was 30 years (21 to 50). Diabetes mellitus was the underlying cause in 18 patients. Five had chronic ulcers involving the foot and ankle. Each patient had an open lengthening of the tendo Achillis with excision of all necrotic and loose bone from the ankle, subtalar and midtarsal joints when needed. The resulting defect was packed with corticocancellous bone graft harvested from the iliac crest and an Ilizarov external fixator was applied. Arthrodesis was achieved after a mean of 18 weeks (15 to 20), with healing of the skin ulcers. Pin track infection was not uncommon, but no frame had to be removed before the arthrodesis was sound. Every patient was able to resume wearing regular shoes after a mean of 26.5 weeks (20 to 45).

  8. Percutaneous consolidation of loosened spine arthrodesis under CT and fluoroscopy guidance by radiologists: a new useful technique

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    Amoretti, Nicolas; Bertrand, Anne-Sophie; Gallo, Giacomo; Caudal, Amandine; Boileau, Pascal [Centre Hospitalier Universitaire de Nice, Nice (France); Cornelis, Francois; Hauger, Olivier [Centre Hospitalier Universitaire de Bordeaux, Bordeaux (France)

    2015-04-01

    The objective was to evaluate percutaneous computed tomography (CT) and fluoroscopy-guided injection of bone cement for consolidation of loosened posterior arthrodesis performed by radiologists. A single-centre prospective study involving four consecutive patients (three women, one man) suffering from screw loosening (three at the vertebral level, one at the iliac wing level) after Posterior Lumbar Interbody Fusion (PLIF) treatment was done. The average age was 80 years. Surgical treatment was not indicated or not wished for by the patients. Institutional review board approval and informed consent were obtained. Percutaneous consolidation was performed by an interventional radiologist under CT and fluoroscopy guidance. The path of the trocars was made outside loosened screws bilaterally. Follow-up was assessed using the Visual Analog Scale (VAS). In all cases, bone cement was successfully placed around the loosened screw. The mean volume of cement that was injected was 3 ml. No cement leakage was observed. No neurological complication occurred. Using VAS, pain decreased from more than 9/10 preoperatively to less than 2/10 the day after the procedure for all patients (p < 0.05). This study suggests that loosening of spine arthrodesis could be successfully treated by percutaneous injection of bone cement under CT and fluoroscopy guidance. (orig.)

  9. Is End-Stage Ankle Arthrosis Best Managed with Total Ankle Replacement or Arthrodesis? A Systematic Review

    Science.gov (United States)

    Jordan, Robert W.; Chahal, Gurdip S.; Chapman, Anna

    2014-01-01

    Introduction. End-stage ankle osteoarthritis is a debilitating condition. Traditionally, ankle arthrodesis (AA) has been the surgical intervention of choice but the emergence of total ankle replacement (TAR) has challenged this concept. This systematic review aims to address whether TAR or AA is optimal in terms of functional outcomes. Methods. We conducted a systematic review according to PRISMA checklist using the online databases Medline and EMBASE after January 1, 2005. Participants must be skeletally mature and suffering from ankle arthrosis of any cause. The intervention had to be an uncemented TAR comprising two or three modular components. The comparative group could include any type of ankle arthrodesis, either open or arthroscopic, using any implant for fixation. The study must have reported at least one functional outcome measure. Results. Of the four studies included, two reported some significant improvement in functional outcome in favour of TAR. The complication rate was higher in the TAR group. However, the quality of studies reviewed was poor and the methodological weaknesses limited any definitive conclusions being drawn. Conclusion. The available literature is insufficient to conclude which treatment is superior. Further research is indicated and should be in the form of an adequately powered randomised controlled trial. PMID:25215242

  10. An aggressive chondroblastoma of the knee treated with resection arthrodesis and limb lengthening using the Ilizarov technique.

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    Tomić, Slavko; Lesić, Aleksandar; Bumbasirević, Marko; Sopta, Jelena; Rakocević, Zoran; Atkinson, Henry D

    2010-07-28

    This case report describes the management of a 15 year old male with a biologically aggressive chondroblastoma of the knee. Following CT, bone scan, angiography and an open biopsy, the diagnosis was confirmed histologically and immunohistochemically. The patient underwent a 13 cm en-bloc excision of the knee, and knee arthrodesis with simultaneous bone transport using an Ilizarov ring fixator. Following 136 days of bone transport, the patient achieved radiological and clinical bony union after a total frame time of 372 days. He then commenced 50% partial weight-bear in a protective knee brace and gradually worked up to full weight-bearing by 4 months. The patient developed superficial pin tract infections around the k-wires on 2 occasions; these settled with a cephalosporin antibiotic spray and local dressings. At 13 years follow-up there are no signs of disease recurrence or failure at the fusion site. The patient is able to fully weight bear and stand independently on the operated leg. Knee arthrodesis with simultaneous limb-lengthening is an effective treatment modality following en-bloc resection of an aggressive chondroblastoma. The case is discussed with reference to the literature.

  11. An aggressive chondroblastoma of the knee treated with resection arthrodesis and limb lengthening using the Ilizarov technique

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    Rakočević Zoran

    2010-07-01

    Full Text Available Abstract This case report describes the management of a 15 year old male with a biologically aggressive chondroblastoma of the knee. Following CT, bone scan, angiography and an open biopsy, the diagnosis was confirmed histologically and immunohistochemically. The patient underwent a 13 cm en-bloc excision of the knee, and knee arthrodesis with simultaneous bone transport using an Ilizarov ring fixator. Following 136 days of bone transport, the patient achieved radiological and clinical bony union after a total frame time of 372 days. He then commenced 50% partial weight-bear in a protective knee brace and gradually worked up to full weight-bearing by 4 months. The patient developed superficial pin tract infections around the k-wires on 2 occasions; these settled with a cephalosporin antibiotic spray and local dressings. At 13 years follow-up there are no signs of disease recurrence or failure at the fusion site. The patient is able to fully weight bear and stand independently on the operated leg. Knee arthrodesis with simultaneous limb-lengthening is an effective treatment modality following en-bloc resection of an aggressive chondroblastoma. The case is discussed with reference to the literature.

  12. History and prospects of the application of porous tantalum in arthrodesis%多孔钽在关节融合中的历史与前景

    Institute of Scientific and Technical Information of China (English)

    赵阳; 李亮; 王志强

    2014-01-01

    Objective To review the characteristics of metal porous tantalum and its application in arthrodesis. Methods Recent literatures concerning the characteristics of porous tantalum and its application in arthrodesis were retrieved from China National Knowledge Internet ( CNKI ) and PubMed databases. Results Porous tantalum was a kind of metal with low elastic modulus, whose appearance was similar to that of cancellous bone. Recently, it had been widely applied in the orthopaedic ifeld, inluding hip replacement and knee replacement, spine surgery, bone graft substitutes and arthrodesis. Porous tantalum could be attached by a great quantity of bones and soft tissues quickly, with a high volumetric porosity of 70%-80%, good mechanical characteristics, biocompatibility and biological activity and excellent growth characteristics of bone and soft tissues. At present, satisfactory outcomes could be achieved in the clinical application of porous tantalum for hip and knee injuries. Furthermore, with the development of medicine, porous tantalum could be applied in the treatment of other joint injuries. Conclusions Good mechanical stability and early surgical outcomes can be obtained by porous tantalum material in arthrodesis.

  13. Finite element analysis of a pseudoelastic compression-generating intramedullary ankle arthrodesis nail.

    Science.gov (United States)

    Anderson, Ryan T; Pacaccio, Douglas J; Yakacki, Christopher M; Carpenter, R Dana

    2016-09-01

    Tibio-talo-calcaneal (TTC) arthrodesis is an end-stage treatment for patients with severe degeneration of the ankle joint. This treatment consists of using an intramedullary nail (IM) to fuse the calcaneus, talus, and tibia bones together into one construct. Poor bone quality within the joint prior to surgery is common and thus the procedure has shown complications due to non-union. However, a new FDA-approved IM nail has been released that houses a nickel titanium (NiTi) rod that uses its inherent pseudoelastic material properties to apply active compression across the fusion site. Finite element analysis was performed to model the mechanical response of the NiTi within the device. A bone model was then developed based on a quantitative computed tomography (QCT) image for anatomical geometry and bone material properties. A total bone and device system was modeled to investigate the effect of bone quality change and gather load-sharing properties during gait loading. It was found that during the highest magnitude loading of gait, the load taken by the bone was more than 50% higher than the load taken by the nail. When comparing the load distribution during gait, results from this study would suggest that the device helps to prevent stress shielding by allowing a more even distribution of load between bone and nail. In conditions where bone quality may vary patient-to-patient, the model indicates that a 10% decrease in overall bone modulus (i.e. material stiffness) due to reduced bone mineral density would result in higher stresses in the nail (3.4%) and a marginal decrease in stress for the bone (0.5%). The finite element model presented in this study can be used as a quantitative tool to further understand the stress environment of both bone and device for a TTC fusion. Furthermore, the methodology presented gives insight on how to computationally program and use the unique material properties of NiTi in an active compression state useful for bone fracture healing

  14. National Trends in Foot and Ankle Arthrodesis: 17-Year Analysis of the National Survey of Ambulatory Surgery and National Hospital Discharge Survey.

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    Best, Matthew J; Buller, Leonard T; Miranda, Alejandro

    2015-01-01

    Foot and ankle arthrodesis reliably reduces pain and functional disability among patients with arthritis and deformity. Since its introduction in 1953, improvements in surgical technique have enhanced the outcomes and reduced complications. However, little is known regarding US national trends of foot and ankle arthrodesis. The present study sought to use the most recently available Centers for Disease Control and Prevention data to investigate changes in the usage of inpatient and ambulatory foot and ankle arthrodesis. Cases of foot and ankle arthrodesis were identified using the National Hospital Discharge Survey and National Survey of Ambulatory Surgery, and the data were analyzed for trends in demographics, treatment, and usage. From 1994 to 2006, the population-adjusted rates of foot and ankle arthrodeses increased by 146% (8.2/100,000 capita to 20.2/100,000 capita). The number of outpatient arthrodeses performed with arthroscopic assistance increased by 858%. The population-adjusted rate of outpatient and inpatient procedures increased by 415% and 17%, respectively. The gender-adjusted rates increased by 59% for males and 209% for females. The age-adjusted rates increased among patients >35 years old in both settings. The use of peripheral nerve blocks during ambulatory procedures increased from 3.3% to 10.1%. Private insurance was the largest compensator. In conclusion, the rate of foot and ankle arthrodesis increased dramatically from 1990 to 2007 using the most up-to-date publicly available data. Knowledge of these national practice patterns could aid policy-makers and surgeons in appropriately allocating healthcare resources to ensure quality patient care.

  15. Posterior lumbar dynamic stabilization instead of arthrodesis for symptomatic adjacent-segment degenerative stenosis: description of a novel technique.

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    Mashaly, Hazem; Paschel, Erin E; Khattar, Nicolas K; Goldschmidt, Ezequiel; Gerszten, Peter C

    2016-01-01

    OBJECTIVE The development of symptomatic adjacent-segment disease (ASD) is a well-recognized consequence of lumbar fusion surgery. Extension of a fusion to a diseased segment may only lead to subsequent adjacent-segment degeneration. The authors report the use of a novel technique that uses dynamic stabilization instead of arthrodesis for the surgical treatment of symptomatic ASD following a prior lumbar instrumented fusion. METHODS A cohort of 28 consecutive patients was evaluated who developed symptomatic stenosis immediately adjacent to a previous lumbar instrumented fusion. All patients had symptoms of neurogenic claudication refractory to nonsurgical treatment and were surgically treated with decompression and dynamic stabilization instead of extending the fusion construct using a posterior lumbar dynamic stabilization system. Preoperative symptoms, visual analog scale (VAS) pain scores, and perioperative complications were recorded. Clinical outcome was gauged by comparing VAS scores prior to surgery and at the time of last follow-up. RESULTS The mean follow-up duration was 52 months (range 17-94 months). The mean interval from the time of primary fusion surgery to the dynamic stabilization surgery was 40 months (range 10-96 months). The mean patient age was 51 years (range 29-76 years). There were 19 (68%) men and 9 (32%) women. Twenty-three patients (82%) presented with low-back pain at time of surgery, whereas 24 patients (86%) presented with lower-extremity symptoms only. Twenty-four patients (86%) underwent operations that were performed using single-level dynamic stabilization, 3 patients (11%) were treated at 2 levels, and 1 patient underwent 3-level decompression and dynamic stabilization. The most commonly affected and treated level (46%) was L3-4. The mean preoperative VAS pain score was 8, whereas the mean postoperative score was 3. No patient required surgery for symptomatic degeneration rostral to the level of dynamic stabilization during the

  16. Radiologic and histological observations in experimental T1–T12 dorsal arthrodesis: A qualitative description of T1-T12 segment and other body parts involved, between prepubertal age and skeletal maturityxs

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    Federico Canavese

    2016-01-01

    Conclusions: The process of fusion mass and bone formation, associated with the arthrodesis, involves at different degrees of the vertebral bodies, discs and intervertebral foramens, ganglia and spinal nerve roots.

  17. Totally absorbable screws in fixation of subtalar extra articular arthrodesis in children with spastic neuromuscular disease: preliminary report of a randomized prospective study of fourteen arthrodeses fixed with absorbable or metallic screws.

    Science.gov (United States)

    Partio, E K; Merikanto, J; Heikkilä, J T; Ylinen, P; Mäkelä, E A; Vainio, J; Törmälä, P; Rokkanen, P

    1992-01-01

    Seven patients with spastic neuromuscular disease and severe hindfoot valgus deformity were treated by subtalar arthrodesis. Arthrodesis was performed in both feet at the same operation and fixed on one side with a self-reinforced poly-L-lactide (SR-PLLA) screw, and with a standard AO screw on the other side. The functional status state was improved, and radiographic union of the arthrodesis occurred in all feet. The radiograph showed better solid fusion in five feet treated with PLLA screws, similar fusion in both sides in one patient, and one slower fusion in the side treated initially with a PLLA screw. Totally absorbable SR-PLLA screws appear to be firm enough for fixation of subtalar extraarticular arthrodesis in children.

  18. Chance fracture in an older patient with positive sagittal imbalance and previous lumbar arthrodesis: what can be done?

    Science.gov (United States)

    Zwolak, Pawel; Kröber, Markus

    2016-04-01

    The Chance fracture occurs frequently in school-aged patients' population and is related to flexion-distraction injury in motor vehicle accidents. It is so called seat-belt syndrome because the seatbelt lies over the abdomen. After sudden deceleration bends the child around the lap belt causing injuries to the abdomen, and the spine (e.g., Chance fracture). The Chance fracture after a low energy fall in elderly patient's population has rarely been reported. We present an 82 years old patient who suffered unrecognized Chance fracture after a low energy fall. The management of this patient with positive sagittal imbalance and previous arthrodesis consisted of decompression, Smith-Petersen osteotomy and posterior pedicle screw instrumentation.

  19. Prospective validation of a blood ordering protocol for elective spine arthrodesis and its impact on cost reduction

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    Muhammad Waqas

    2014-01-01

    Full Text Available Background: On the basis of an institutional audit, the authors published an individual patient-based protocol for preoperative arrangement of blood products in patients undergoing elective spine arthrodesis. The present study was conducted for the prospective validation of the proposed protocol in reducing cross match to transfusion ratio, and its implications on overall cost. Methods: This cross-sectional study was conducted over 1 year (2012. All adult patients who underwent elective spinal arthrodesis were included and prospectively observed. The actual transfusion index was calculated for individual patients with the formula C1/T, where C1 is the number of units of packed RBCs cross matched and T is the number of actual transfusions. C1/T was then compared with a theoretical transfusion index C2/T for the same group of patients, C2 being the number derived from calculating the number of units of packed RBCs that would have been ordered for individual patient according to the protocol. The cost difference between C1/T and C2/T was analyzed. Results: A total of 125 patients were included. A total of 435 units of packed RBCs were ordered (C1, out of which only 108 units were transfused (T, yielding a C1/T of 4.02. The C2 for the same group of patients was 188 units of packed RBCs and the C2/T was thus calculated to be 1.74. Implementation of the protocol would reduce per patient cost from Pakistani Rupees (PKR 6676.8 ± 4125.8 to 4700.8 ± 1712.86, with a P < 0.001 and an overall reduction of 30%. Conclusion: Cross match to transfusion ratio and blood ordering related cost are both significantly reduced with the application of institutional cross-match protocol.

  20. Mistakes and complications in the surgical treatment of ambulatory equino planovalgus foot deformities in patients with cerebral palsy using extra-articular subtalar arthrodesis

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    Валерий Владимирович Умнов

    2016-06-01

    Full Text Available Aim.To evaluate the results of a modified technique for extra-articular arthrodesis of the subtalar joint for patients with cerebral palsy with an ambulatory form of equine-planovalgus deformity of the foot. The mistakes and complications that occurred during treatment with this technique are discussed.Materials and methods.Between 2005 and 2015, this surgical method for performing arthrodesis of the subtalar joint, was performed on 544 patients (989 feet between 4 and 15 years old. Correction of equinus contracture was performed using Achilles tendon plasty or dissection of the tendon of the gastrocnemius muscle. Abnormal muscle tone was reduced either by administering Dysport® in the calf muscle or by selective neurotomy of the tibial nerve.Results. Good results were achieved for 72% of cases, satisfactory for 23% of cases, and unsatisfactory for 5% of cases. Unsatisfactory results of treatment were associated with overvaluation of the degree of mobility of the deformity and with a number of technical and tactical mistakes.Conclusion.This analysis of mistakes and complications of extra-articular arthrodesis of the subtalar joint will allow surgeons to avoid these issues in the future and improve the quality of treatment for similar patients.

  1. Posterolateral arthrodesis in lumbar spine surgery using autologous platelet-rich plasma and cancellous bone substitute: an osteoinductive and osteoconductive effect.

    Science.gov (United States)

    Tarantino, Roberto; Donnarumma, Pasquale; Mancarella, Cristina; Rullo, Marika; Ferrazza, Giancarlo; Barrella, Gianna; Martini, Sergio; Delfini, Roberto

    2014-08-01

    Study Design Prospective cohort study. Objectives To analyze the effectiveness and practicality of using cancellous bone substitute with platelet-rich plasma (PRP) in posterolateral arthrodesis. Methods Twenty consecutive patients underwent posterolateral arthrodesis with implantation of cancellous bone substitute soaked with PRP obtained directly in the operating theater on the right hemifield and cancellous bone substitute soaked with saline solution on the right. Results Computed tomography scans at 6 and 12 months after surgery were performed in all patients. Bone density was investigated by comparative analysis of region of interest. The data were analyzed with repeated-measures variance analyses with value of density after 6 months and value of density after 12 months, using age, levels of arthrodesis, and platelet count as covariates. The data demonstrated increased bone density using PRP and heterologous cancellous block resulting in an enhanced fusion rate during the first 6 months after surgery. Conclusions PRP used with cancellous bone substitute increases the rate of fusion and bone density joining osteoinductive and osteoconductive effect.

  2. [Arthrodesis of the sub-occipital spine by screwed occipito-cervical plate. Clinical case and technical notes].

    Science.gov (United States)

    Gros, C; Privat, J M; Frerebeau, P; Bonnel, F; Bazin, M; Benezech, J

    1975-01-01

    The authors report a new technique in arthrodesis of the sub-occipital spine which has been experienced since 1973 in case of metastases at CI-C2 level. An occipitovertebral metal plate, inverted Y shaped has been realised after anatomical and biomecanical studies. It is adapted to the occipito-vertebral curvature and screwed in the articular processes of C3 and C4 (14 mm screw), and in the pedicles of C2 (32 mm screw). At the upper part, the occiptal ridge offers fixation by 12 and 14 mm Muller's screw. In addition CI is attached to the plate, by a nylon thread. After the report of the first clinical case with a nine month period of follow up technical features of the material as well as practical problems are exposed. Tomograms of the cervical spine as well as bilateral brachial angiography are of paramount value. The latter investigation may reveal anomalies of the vertebral artery that can hinder of forbid the pedicular fixation. Finally the authors discuss the extension of this technique to complexe trauma of the suboccipital column.

  3. Multi-segment foot kinematics after total ankle replacement and ankle arthrodesis during relatively long-distance gait.

    Science.gov (United States)

    Rouhani, H; Favre, J; Aminian, K; Crevoisier, X

    2012-07-01

    This study aimed to investigate the influence of ankle osteoarthritis (AOA) treatments, i.e., ankle arthrodesis (AA) and total ankle replacement (TAR), on the kinematics of multi-segment foot and ankle complex during relatively long-distance gait. Forty-five subjects in four groups (AOA, AA, TAR, and control) were equipped with a wearable system consisting of inertial sensors installed on the tibia, calcaneus, and medial metatarsals. The subjects walked 50-m twice while the system measured the kinematic parameters of their multi-segment foot: the range of motion of joints between tibia, calcaneus, and medial metatarsals in three anatomical planes, and the peaks of angular velocity of these segments in the sagittal plane. These parameters were then compared among the four groups. It was observed that the range of motion and peak of angular velocities generally improved after TAR and were similar to the control subjects. However, unlike AOA and TAR, AA imposed impairments in the range of motion in the coronal plane for both the tibia-calcaneus and tibia-metatarsals joints. In general, the kinematic parameters showed significant correlation with established clinical scales (FFI and AOFAS), which shows their convergent validity. Based on the kinematic parameters of multi-segment foot during 50-m gait, this study showed significant improvements in foot mobility after TAR, but several significant impairments remained after AA.

  4. Lateral column lengthening for acquired adult flatfoot deformity caused by posterior tibial tendon dysfunction stage II: a retrospective comparison of calcaneus osteotomy with calcaneocuboid distraction arthrodesis.

    Science.gov (United States)

    Haeseker, Guus A; Mureau, Marc A; Faber, Frank W M

    2010-01-01

    In this study, clinical and radiological results after lateral column lengthening by calcaneocuboid distraction arthrodesis and calcaneus osteotomy were compared. Thirty-three patients (35 feet) treated with lateral column lengthening by distraction arthrodesis (14 patients, 16 feet; group I) or by calcaneus osteotomy (19 patients, 19 feet; group II) for adult-acquired flatfoot deformity caused by stage II posterior tibial tendon dysfunction were compared retrospectively. Mean follow-up was 42.4 months (range, 6-78 months) for group I and 15.8 months (range, 6-32 months) for group II (P < .001). The American Orthopaedic Foot & Ankle Society ankle-hindfoot score was determined, 4 variables were measured on preoperative and postoperative weight-bearing radiographs, and a number of independent and outcome variables, including patient satisfaction, were recorded. Group 2 had a significantly higher American Orthopaedic Foot & Ankle Society score compared with group I (mean, 85 vs. 72, respectively; P < .02) at time of last follow-up, and there were no dissatisfied patients in group I, whereas 2 patients in group II were dissatisfied with the result of the operation. All radiological results were significantly better at time of follow-up in both groups (except for talocalcaneal angle in group I), although no significant differences were noted in the amount of change in radiographic measurements between the groups. No significant correlation was found between follow-up time and radiographic improvement, indicating stable radiographic measurements over time. In group II, 13 mild calcaneocuboid subluxations were observed. In both groups, 1 nonunion and 1 wound complication occurred. Based on our experience with the patients described in this report, we recommend lateral column lengthening by means of calcaneus osteotomy rather than distraction arthrodesis of the calcaneocuboid joint, for correction of stage II posterior tibial tendon dysfunction.

  5. Treatment of Isolated Ankle Osteoarthritis with Arthrodesis or the Total Ankle Replacement: A Comparison of Early Outcomes

    Science.gov (United States)

    Saltzman, Charles L.; Kadoko, Robert G.

    2010-01-01

    Background Ankle arthrodesis and replacement are two common surgical treatment options for end-stage ankle osteoarthritis. However, the relative value of these alternative procedures is not well defined. This study compared the clinical and radiographic outcomes as well as the early perioperative complications of the two procedures. Methods Between January 2, 1998 and May 31, 2002, 138 patients were treated with ankle fusion or replacements. Seventy one patients had isolated posttraumatic or primary ankle arthritis. However, patients with inflammatory arthritis, neuropathic arthritis, concomitant hind foot fusion, revision procedures and two component system ankle replacement were excluded. Among them, one group of 42 patients had a total ankle replacement (TAR), whereas the other group of 29 patients underwent ankle fusion. A complete follow-up could be performed on 89% (37/42) and 73% (23/29) of the TAR and ankle fusion group, respectively. The mean follow-up period was 4.2 years (range, 2.2 to 5.9 years). Results The outcomes of both groups were compared using a student's t-test. Only the short form heath survery mental component summary score and Ankle Osteoarthritis Scale pain scale showed significantly better outcomes in the TAR group (p < 0.05). In the radiographic evaluation, there was no significant difference in preoperative and postoperative osteoarthritis between the TAR and fusion groups. Conclusions The clinical results of TAR are similar to those of fusion at an average follow-up of 4 years. However, the arthroplasty group showed better pain relief and more postoperative complications that required surgery. PMID:20190994

  6. Management of a distal femoral non-union with coexisting failure of the knee extensor mechanism using osteobridge knee-arthrodesis system: A case report

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    Begkas Dimitrios

    2015-01-01

    Full Text Available Introduction. Reconstruction of bone defects is a long, challenging process both for the patient and for the treating surgeon. Bone defects frequently occur as a result of aggressive surgical debridement and bone resection in case of acute trauma, open fractures, chronic bone infections, tumors and non-unions. Early amputation is often superior to prolonged attempts at salvage because they can create serious problems in the patients’ lives. There are numerous alternative methods of limb-salvage nowadays. Case Report. We report a case of a fifty-year-old man with a distal femoral non-union and a co-existing failure of the knee extensor mechanism, who was treated using an intramedullary segmental defect bridging knee arthrodesis system (Osteobridge. At the final check-up twenty four months later, he had excellent clinical, functional and radiological results. Conclusion. Osteobridge is an excellent knee arthrodesis system, which is preferable to other methods in case of resection of the distal femur along with the failure of the knee extensor mechanism.

  7. Artrodese do quadril: estudo retrospectivo com mais de 20 anos de seguimento Hip arthrodesis: a minimum 20 year follow-up retrospective study

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    José Ricardo Negreiros Vicente

    2011-01-01

    Full Text Available OBJETIVO: Avaliar os resultados a longo prazo de setenta pacientes submetidos à artrodese do quadril pela técnica original descrita por Davis. MÉTODOS: Realizamos um estudo clínico retrospectivo com 70 pacientes, operados entre 1982 e 1995. A presença de sintomas sobre a coluna lombar, joelho ipsilateral e quadril contralateral foi aferida assim como o sucesso da consolidação da artrodese, o posicionamento da mesma e a eventual indicação para conversão à artroplastia total do quadril. RESULTADOS: O tempo médio de seguimento foi 21,6 anos. Uma consolidação satisfatória foi constatada em 48 pacientes (85,7%. A dor lombar foi presente em 11 pacientes (19,6% e osteoartrite dolorosa do joelho em quatro pacientes (7,1%. Discussão: Dois trabalhos com seguimento superior ao nosso estudo ( 35 e 38 anos apresentaram repercussões sobre a coluna lombar mais prevalentes (57% e 62%, assim como dor no joelho homolateral (45% e 57% e indicação para conversão em artroplastia total do quadril (17% e 28%. CONCLUSÃO: Concluímos que a artrodese do quadril pela técnica de Davis apresenta resultados satisfatórios até o vigésimo ano, porém a presença de dor lombar é mais frequente com o passar dos anos e a dor no joelho homolateral sugere associação com a posição inicial em abdução do quadril artrodesado. Nivel de Evidência III, estudo clinico.OBJECTIVE: To evaluate the long-term results of seventy patients who underwent hip arthrodesis using the original technique described by Davis. METHODS: We carried out a retrospective study involving seventy patients submitted to hip arthrodesis between 1982 and 1995. The presence of symptoms involving the lumbar spine, ipsilateral knee, and contralateral hip was noted, as well as the success of the arthrodesis fusion, its positioning, and the need for conversion surgery to total hip replacement. RESULTS: The mean follow-up time was 21.6 years. A satisfactory hip fusion was found in 48 patients

  8. Lumbar disc degeneration below a long arthrodesis (performed for scoliosis in adults) to L4 or L5.

    Science.gov (United States)

    Harding, Ian J; Charosky, Sebastian; Vialle, Raphael; Chopin, Daniel H

    2008-02-01

    A retrospective analysis of adults treated with long instrumented fusion for scoliosis from the thoracic spine proximally to L4 or L5. To evaluate the long-term clinical outcomes as well as radiological changes in distal unfused mobile segments and to evaluate factors that may predispose to distal disc degeneration and/or poor outcome. A total of 151 mobile segments in 85 patients (65 female), mean age 43.2 (range 21-68), were studied. Curve type, number of fused levels and pelvic incidence were recorded. Clinical outcome was measured using the Whitecloud function scale and disc degeneration using the UCLA disc degeneration score. Spinal balance, local segmental angulations and lumbar lordosis were measured pre- and post-operatively as well as at the most recent follow up--mean 9.3 years (range 7-19). A total of 62% of patients had a good or excellent outcome. Eleven had a poor outcome of which ten underwent extension of fusion--five for pain alone, three for pain with stenosis and two for pseudarthroses. Pre-operative disc degeneration was often asymmetric and was slightly greater in older patients. Overall, there was a significant deterioration in disc degeneration (P < 0.0001) that did not correlate with clinical outcome. Disc degeneration correlated with the recent sagittal balance (Anova F = 14.285, P < 0.001) and the most recent lordosis (Anova F = 4.057, P = 0.048). The post-operative sagittal balance and local L5-S1 sagittal angulation correlated to L4 and L5 degeneration, respectively. There was no correlation between degeneration and age, pre-operative degenerative score, pelvic incidence, sacral slope, number of fused levels or distal level of fusion. Disc degeneration does occur below an arthrodesis for scoliosis in adults which does not correlate with clinical outcome. The correlation of loss of sagittal balance with disc degeneration may be as a result of degeneration causing the loss of balance or vice versa, i.e. sagittal imbalance causing

  9. Midcarpal arthrodesis with complete scaphoid excision and interposition bone graft in the treatment of advanced carpal collapse (SNAC/SLAC wrist): operative technique and outcome assessment.

    Science.gov (United States)

    Sauerbier, M; Tränkle, M; Linsner, G; Bickert, B; Germann, G

    2000-08-01

    Thirty-six patients with stage II or III SNAC and SLAC wrists were treated by midcarpal arthrodesis and complete scaphoid excision. When assessed at a mean follow-up of 25 months, pain was significantly reduced both under resting and stress conditions. The active range of motion was 54% of the contralateral wrist and grip strength was 65% of the non-operated hand. The mean DASH score was 28 points, the Mayo wrist score was 63 points, and the Krimmer wrist score was 68. Correlation of the wrist scores with the DASH values demonstrated a significant correlation. Our data demonstrate that midcarpal fusion with complete excision of the scaphoid is a reliable procedure for treating advanced carpal collapse.

  10. 舟骨-大-小多角骨新型融合器的稳定性%Stability of scaphotrapeziotrapezoid novel arthrodesis apparatus

    Institute of Scientific and Technical Information of China (English)

    唐亮; 卢弘栩; 丁健; 房宏生; 戴永平; 洪克建

    2009-01-01

    BACKGROUND: Traditional scaphotrapeziotrapezoid limited intercarpal arthrodesis contains Kirschner wire, U-shaped nail, AO/ASIF steel plate and so on. Long-term plaster external fixation was needed following surgery. USA-designed arthrodesis apparatus is mainly suitable for European and people from USA, but not fit for Asian.OBJECTIVE: To simulate scaphotrapeziotrapezoid limited intercarpal arthrodesis, and to test the stability of the novel arthrodesis apparatus developed by the group according to anatomic form of dorsal joint fovea of Chinese scaphotrapeziotrapezoid.DESIGN, TIME AND SETTING: The observational study was performed at the Laboratory of Biomechanics of the Department of Orthopaedics, Nantong University from April 2006 to March 2007.MATERIALS: A total of 40 fresh forearm samples of corpses that were not subjected to antiseptic treatment were used for this study. Radiograph verified that these samples did not develop wrist joint affection or abnormal alinement.METHODS: The cadaver models were imitated limited intercarpal instability before scaphotrapeziotrapezoid arthrodesis used circular plate. Then, simulated flexion 50°, extenion 35°, ulnar deviation 30°, radial deviation 10° ultimate activities (50000).CT scan and 3-D reconstruction should be taken before and after motion.MAIN OUTCOME MEASURES: The index of the radial-scapho angle (RSA), radial-scapho distance (RSD), scapho length(SL), trapezium-trapezoid inclination (TTI), trapezium-trapezoid width (TTW) were measured.RESULTS: Prior to motion RSA, RSD, SL, TTW and TTI were (38.725±2.230) °, (18.988±1.216) mm, (1.686±0.191) cm,(27.360±1.571) mm and (114.975±2.293) °. Following motion RSA, RSD, SL, TTW and TTI were (38.800±2.388) °,(19.215±1.443) mm, (1.683±0.209) cm, (27.718±1.910) mm, (115.300±3.023) °. No significant difference in above-described indexes was determined before and after motion (P > 0.05).CONCLUSION: The novel STT limited intercarpal arthrodesis apparatus shows

  11. A novel computer algorithm allows for volumetric and cross-sectional area analysis of indirect decompression following transpsoas lumbar arthrodesis despite variations in MRI technique.

    Science.gov (United States)

    Gates, Timothy A; Vasudevan, Ram R; Miller, Kai J; Stamatopoulou, Vasiliki; Mindea, Stefan A

    2014-03-01

    Many patients present for neurosurgical spine evaluation with MRI studies conducted at facilities outside of the treating medical center. These images often vary widely in technique, for example, variation in slice thickness, number of slices, and gantry angle. While these images may be sufficient in conjunction with a physical exam to make surgical evaluations, we have found they are often incapable of being used for objective post-operative volumetric comparisons. In order to overcome this, we created a computer program that compensates for these variations in MRI technique. For this study, we examined patients who had undergone outside MRI pre-operatively and were deemed appropriate for a lateral retroperitoneal transpsoas lumbar interbody arthrodesis procedure. Volumetric analysis was performed on sagittal and axial T2-weighted pre- and post-operative MRI. The percentage change of central canal volume and foraminal area was calculated for each level. The authors identified five levels with MRI sufficient for volumetric analysis and eight levels (16 foramina) sufficient for foraminal cross-sectional analysis. Through use of our computer algorithm, average central canal volume and foraminal cross-sectional area was calculated to increase by 32.8% and 67.6% respectively following the procedure. These results are consistent with previous study findings and support the idea that restoration of the anterior column via a lateral approach can result in significant indirect decompression of the neural elements. Additionally, the novel algorithm created and used for this study suggests that it can achieve quick measurement and comparison of MRI studies despite variations in pre- and post-operative technique.

  12. Use of recombinant human bone morphogenetic protein-2 as an adjunct for instrumented posterior arthrodesis in the occipital cervical region: An analysis of safety, efficacy, and dosing

    Directory of Open Access Journals (Sweden)

    D Kojo Hamilton

    2010-01-01

    Full Text Available Background: There have been few reports on the use of recombinant human bone morphogenetic protein (rhBMP-2 in posterior spine. However, no study has investigated the dosing, safety, and efficacy of its use in the posterior atlantoaxial, and/or craniovertebral junction. Recent case report of the cytokine-mediated inflammatory reaction, following off label use of rhBMP-2 as an adjunct for cervical fusion, particularly in complex cases, has increased concern about complications associated with the product. Objective: To assess the safety, efficacy, and dosing of rhBMP-2 as an adjunct for instrumented posterior atlantoaxial and/or craniovertebral junction arthrodesis. Materials and Methods: We included all patients treated by the senior author that included posterior atlantoaxial and/or craniovertebral junction instrumented fusion using rhBMP-2 from 2003 to 2008 with a minimum two year follow-up. Diagnosis, levels fused, rhBMP-2 dose, complications, and fusion were assessed. Results: Twenty three patients with a mean age of 60.9 years (range 4 - 89 years and an average follow-up of 45 months (range 27 to 84 months met inclusion criteria. The indications for surgery included, atlantoaxial instability (n = 16, basilar invagination (n = 6, and kyphoscoliosis (n = 1. The specific pathologic diagnosis included type 2 dens fracture (n = 7, complex C1 and C2 ring fracture (n = 2, chordoma (n = 2, degenerative/osteoporosis (n = 3, rheumatoid disease (n = 8, and pseudogout (n = 1. The average rhBMP-2 dose was 2.38 mg/level, with a total of 76 levels treated (average 3.3 levels, SD= 1.4 levels. There were no complications. During the most recent follow-up, all patients had achieved fusion. Conclusions: In a series of patients with complex pathology and/or rheumatoid arthritis, 100% fusion rate was achieved with adjunct use of rhBMP-2, with a safe and effective average rhBMP-2 dose of 2.38 mg per level.

  13. 后路内固定融合术治疗脊柱胸腰段骨折的疗效观察%The curative effect observation on arthrodesis posterior internal fixation used in thoracic lumbar spine fractures

    Institute of Scientific and Technical Information of China (English)

    林建新; 林建民; 肖胜捷

    2014-01-01

    目的:探讨胸腰椎段骨折采用后路内固定融合术治疗的效果。方法选取胸腰椎段骨折患者90例,研究组(50例)采用后路内固定融合术治疗,对照组(40例)采用前路内固定术治疗,对比两组术前术后神经功能与伤椎情况,手术效果以及不良情况。结果研究组的神经功能与伤椎情况改善均更显著;研究组总有效率为94.0%;对照组为82.5%;研究组不良情况率为2.0%,对照组为10.0%;研究组手术效果明显更优( P<0.05)。结论胸腰椎段骨折采用后路内固定融合术治疗,效果显著,安全性高,值得临床推广应用。%Objective To discuss the curative effect of arthrodesis posterior internal fixation used in thoracic lumbar spine fractures. Methods 90 cases of patients with thoracic lumbar spine fractures were selected,the research group(50cases) were cured by arthrodesis posterior internal fixation,the control group(40cases)were cured by anterior fixation,then compared the situation of nerve function and injured vertebral before and after operation,surgical effect and adverse conditions. Results After the operation,the situation of nerve function and injured vertebral of the research group all improved more apparently;the total effective rate of the research group was 94.0%,and the rate of the control group was 82.5%;the rate of adverse situation of the research group was 2.0%.and the rate of the control group was 10.0%;the surgical effect of the research group was significantly better(P < 0.05). Conclusion The curative effect on arthrodesis posterior internal fixation used in thoracic lumbar spine fractures is significant,and there has high safety,it is worth promoting.

  14. Estudo comparativo do trofismo do multífido na artrodese lombar aberta versus minimamente invasiva Estudio comparativo de trofismo del multífido en la artrodesis lumbar abierta versus la mínimamente invasiva Comparative study of tropism of the multifidus muscle in open lumbar arthrodesis versus minimally invasive arthrodesis

    Directory of Open Access Journals (Sweden)

    Cristiano Magalhaes Menezes

    2012-01-01

    January 2010 27 patients undergoing surgical procedure and arthrodesis MIS were evaluated. Open MRI was performed in the postoperative period, between 12 and 36 months after surgery, with visualization of the multifidus muscle for its study. RESULTS: All patients were operated on a level of arthrodesis using the open technique and MIS. CONCLUSION: No significant differences were found regarding the age and sex with the area and tropism of multifidus muscle on both sides.

  15. Interest of the SPECT-CT merging to detect pseudo-arthrosis after lumbar arthrodesis: preliminary results; Interet de la fusion TEMP-TDM pour la detection des pseudarthroses apres arthrodese lombaire: resultats preliminaires

    Energy Technology Data Exchange (ETDEWEB)

    Rager, O.; Ratib, O.; Tessitore, E. [Hopitaux universitaire de Geneve (Switzerland)

    2010-07-01

    Pseudo arthrosis is a potential complication after a lumbar arthrodesis. The symptoms are nonspecific and revision surgery is not always an effective treatment. Scintigraphy SPECT / CT with {sup 99m}Tc and CT were studied separately for the diagnosis of pseudo arthrosis before the widespread use of software fusion. It is well established that the diagnosis based on CT led to a number of false positive (10%). The purpose of this study is to evaluate the usefulness of SPECT-CT fusion imaging in the diagnosis of pseudo arthrosis. Conclusions: SPECT / CT fusion imaging may increase the specificity for the diagnosis of pseudo arthrosis at the level of inter body cages and increase sensitivity for the detection of degenerative diseases on the back joints. (N.C.)

  16. Functional outcome of en bloc resection of a giant cell tumour of the distal radius and arthrodesis of the wrist and distal ulna using an ipsilateral double barrel segmental ulna bone graft combined with a modified Sauve-Kapandji procedure.

    Science.gov (United States)

    Zhang, W; Zhong, J; Li, D; Sun, C; Zhao, H; Gao, Y

    2016-08-25

    Giant cell tumour of the distal radius is a locally aggressive lesion. In this study, we performed a wrist arthrodesis reconstruction with an ipsilateral double barrel segmental ulnar bone graft combined with a modified Sauve-Kapandji procedure for a giant cell tumour of the distal radius. From January 2007 to September 2013, we followed eight patients for a mean duration of 36 months. One patient developed a recurrence and was treated by amputation; the other seven patients achieved radiological union in about 8 months. There was no wrist instability, deformation or dislocation; the mean range of motion of the forearm achieved 75° of supination and 70° of pronation. The patients could recover reasonable grip strength. This new operative procedure can excise the tumour with a low rate of recurrence, fewer functional deficits and fewer complications than reported for other procedures.

  17. Evaluation of arthrodesis and cervical alignment in the surgical results of cervical discectomy using polymethylmetacrylate Avaliação da artrodese e do alinhamento cervical após discectomia cervical com interposição de polimetilmetacrilato

    Directory of Open Access Journals (Sweden)

    Marcelo Luis Mudo

    2009-09-01

    Full Text Available BACKGROUND AND OBJECTIVES: Surgical treatment of cervical radiculopathy with or without myelopathy is a controversy issue, although anterior discectomy is the most common form of treatment. METHOD: We present the evaluation of the arthrodesis' rate and cervical alignment in 48 patients with cervical degenerative disease (CDD submitted to anterior cervical discectomy with interposition of polymethylmetacrylate (PMMA. Odom and Nürick scales were used to evaluation of functional status before and after surgery. Cervical spine X-rays were used to access arthrodesis and alignment, at least 2 years after the procedure. RESULTS: Excellent and good results (Odom I and II were obtained in 91% of the patients with radiculopathy and in 69% of those with myelopathy. Using the chi square test of independence (1% of significance, there was no association between excellent and good clinical results with the presence of arthrodesis verified in cervical X-rays. The presence of cervical alignment had association with good results, whereas the misalignment was associated with unfavorable outcomes. Two patients died: one cervical hematoma and other from graft migration with cord compression. CONCLUSIONS: Cervical alignment was more important than fusion to achieve good surgical results in CDD.TEMA E OBJETIVO: O tratamento cirúrgico da radiculopatia cervical com ou sem mielopatia é um tema controverso, embora a discectomia por via anterior seja uma das formas mais comuns de tratamento. MÉTODO: Apresentamos a avaliação da artrodese cervical e do alinhamento pós operatório em 48 pacientes com doença degenerativa cervical (DDC submetidos a discectomia por via anterior seguida da interposição de polimetilmetacrilato (PMMA. As escalas de Odom e de Nurick foram utilizadas para avaliar o status funcional dos pacientes antes e após a cirurgia. Radiografias da coluna cervical foram utilizadas para avaliar a artrodese e o alinhamento cervical, pelo menos 2 anos ap

  18. Evidence Based Research on Dynamical System Adaped to Arthrodesis of the Spine%适应于脊柱融合的动态系统的循证研究

    Institute of Scientific and Technical Information of China (English)

    曹文; 薛桂松

    2011-01-01

    Arthrodesis of the spine is an important and useful technique for the management of spinal disorders including deformity, trauma, segmental instability, and symptomatic disc degeneration. Rigid stabilization of the spine with segmental fixation, fixed axis screws, and large diameter rods creates a mechanical environment that is associated with higher fusion rates than non-instrumented or semi-rigid constructs. However,rigid segmental fixation may have significant adverse effects including an increase in the stress on adjacent mobile segments, and stress shielding the bone graft material within the regenerate. Dynamic stabilization of a painful motion segment is an alternative to rigid internal fixation that may be useful in improving rates of fusion, or in providing an alternative approach to the surgical management of a painful motion segment without arthrodesis. Techniques of dynamic stabilization have been developed and evaluated for the treatment of degenerative conditions of the cervical and lumbar spine, and for thoracolumbar trauma and deformity.%对于脊柱疾病而言,脊柱融合术是一项重要、非常有用的技术,无论是畸形、外伤、节段性失稳,还是有症状的椎间盘退变.与无器械固定或者半坚强固定而言,借助节段间固定、牢固的轴向螺钉以及大直径的纵向连接杆构建的力学环境形成的坚强脊柱固定,其脊柱融合率明显提高.但是,坚强的节段间固定可能有显著的负面效应,包括增加邻近节段的应力,应力遮挡效应影响移植骨的再生.对于疼痛节段而言,动态固定可能是脊柱坚强固定的一种替代方法内固定,可能有助于提高融合率,或者提供一种非融合技术.动态固定技术得到了发展,其治疗颈椎和腰椎退行性疾病、胸腰椎损伤和畸形的作用也得到评价.

  19. Artrodese do punho com fixação mínima preservando as articulações carpometacarpianas Wrist arthrodesis with minimal internal fixation preserving the carpometacarpal joints

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    Arlindo Gomes Pardini Júnior

    2010-01-01

    Full Text Available OBJETIVO: Artrodese do punho é uma cirurgia que deve ser sempre considerada em casos de patologias que alteram sua estrutura anatômica e funcional. Em geral os resultados são muito satisfatórios, principalmente no alívio da dor e na maioria das vezes a melhora funcional é considerável. Existem várias técnicas descritas, com variações no método de fixação interna e a maioria delas incluindo as articulações carpometacarpianas na fusão. O objetivo deste estudo é avaliar os resultados da artrodese do punho com uma técnica mais simples, mais biológica, menos dispendiosa e que não inclui as articulações carpometacarpianas. MÉTODOS: foram avaliados 15 pacientes (seis sequelas de traumatismo, quatro de artrite reumatoide, três de Kienbock grau IV, um de Preiser e um de pan-artrose. A técnica consistiu no uso de placa óssea do ilíaco e fixação com fios de Kirschner, sem incluir as articulações carpometacarpianas. RESULTADOS: A avaliação foi feita conforme o tempo de consolidação (93% em sete semanas; movimentos dos dedos e de pronossupinação; da força de pinça e preensão; avaliação funcional pelo questionário DASH, da dor e satisfação dos pacientes. Em geral, os resultados foram semelhantes aos das outras técnicas mais agressivas e a não inclusão das articulações carpometacarpianas na artrodese não afetou o resultado final. CONCLUSÃO: A artrodese do punho com fixação através de fios de Kirschner e uso de placa óssea do ilíaco preservando as articulações carpometacarpianas dá resultado bom ou excelente, não inferior ao de outras técnicas descritas. Apresenta, porém uma grande vantagem sobre as demais: é menos agressiva, mais barata e não apresenta os inconvenientes do uso de placas e parafusos sujeitos a maiores complicaçõesOBJECTIVE: Wrist arthrodesis is a surgical procedure that should always be considered in pathologies where there is alteration of the anatomical and functional

  20. Avaliação retrospectiva de artrodese cervical com enxerto autólogo versus hidroxiapatita Estudio retrospectivo de la artrodesis cervical con autoinjerto versus hidroxiapatita Retrospective study of cervical arthrodesis with autograft versus hydroxyapatite graft

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    Yoshinobu Nagasse

    2010-12-01

    ña serie de casos no hubo diferencias significativas entre los resultados de la fusión cervical anterior con injerto de hidroxiapatita en comparación con injerto autólogo ilíaca.OBJECTIVE: the authors carried out a study to compare the radiografic result in the use of hydroxyapatite graft and iliac crest bone graft (autologous in the surgical treatment of cervical discal herniation in one level, and a cervical arthrodesis was carried out previously with plate. METHODS: a retrospective study with patients who were submitted to cervical artrodesis, comparing two groups of ten patients: one in which the hydroxyapatite graft was used and the other in which the autologous iliac crestwas used. Postoperative x-rays were measured and compared, in search for losses of angular alignment. RESULTS: the two types of grafts demonstrated an alignment in similar rates, with consolidation in all patients. The study did not show fragmentation of the hydroxyapatite graft or acquittal of the synthesis material. CONCLUSION: in this small series of cases, no significant difference was observed between the results of the anterior cervical arthrodesis with hydroxyapatite graft in relation to the iliac crest bone graft.

  1. Spinal Arthrodesis Posterior Internal Fixation in Thoracic Lumbar Fracture Analysis of the Application Effect%脊柱胸腰段骨折中后路内固定融合术的应用效果分析

    Institute of Scientific and Technical Information of China (English)

    余建

    2015-01-01

    目的:探讨脊柱胸腰段骨折中后路内固定融合术的应用效果.方法:采用回顾性方法分析,选取我院自2011年2月~2013年2月以来收治的63例脊柱胸腰段骨折患者的临床资料,随机将其分为对照组(31例)和观察组(32例) ,对照组给予前路内固定融合术治疗,观察组给予后路内固定融合术治疗,比较2组患者治疗效果.结果:2组患者手术成功率、并发症、术中出血量、上、下床活动时间等均有显著差异(P<0.05);术后随访1年,2组椎体前缘、后缘高度、后凸Cobb角及椎管占位率均无明显差异(P>0.05).结论:后路内固定融合术治疗脊柱胸腰段骨折具有显著疗效,可有效减少并发症,提高患者生活质量,值得临床推广应用.%Objective:To investigate the thoracic lumbar spine fractures in the application effect of internal fixation posterior arthrode-sis.Methods:A retrospective method to analyze and select our hospital from February 2011 to February 2013 has been treated, 63 cases of thoracic lumbar spine fractures in patients with clinical data, its randomly divided into control group (31 cases) and observation group (32 cases) and control group given anterior internal fixation fusion treatment, observation group was given arthrodesis posterior internal fixation treatment, compared two groups of patients with therapeutic effect.Results: Two groups of patients with surgical success rate, complications, intraoperative blood loss, ambulation time had significant difference (P <0.05);Postoperative follow-up of 1 year, fan-terior edge, trailing edge height, the two groups of the protruding after Cobb Angle and vertebral canal placeholder rate had no obvious difference (P >0.05).Conclusion:Lumbar arthrodesis posterior internal fixation treatment of thoracic spine fractures with significant curative effect, can effectively reduce the complications and improve patient quality of life, worthy of clinical popularization and

  2. 骨外固定支架技术在踝关节融合与矫形中的应用%Application of external fixation in ankle joint arthrodesis

    Institute of Scientific and Technical Information of China (English)

    谢鸣; 黄若昆; 方真华; 赵晶晶; 李静; 肖凯; 勘武生

    2011-01-01

    目的 探讨骨外固定支架技术在踝关节融合与矫形中的疗效.方法 2001年1月至2009年6月采用外固定支架技术治疗27例踝关节创伤性患者,男18例,女9例;年龄32~68岁,平均41岁.其中创伤性关节炎13例,地方性大骨节病3例,骨关节炎5例,结核性踝关节炎2例,踝关节置换术后失败3例,骨髓炎1例.为保证骨对骨加压接触行外固定支架固定.结果 所有患者术后获6~38个月(平均10个月)随访.随访发现关节无肿胀和疼痛,行走步态和功能明显改善,X线片示关节均获骨性融合.结论 外固定支架技术用于踝关节融合率高,对踝关节感染及复合足踝关节畸形有一定优势性.%Objective To study the curative effect of external fixation in ankle joint arthrodesis.Methods From January 2001 to June 2009, we used external fixation in arthrodesis for 27 cases of traumatic ankle joint They were 18 males and 9 females, with an average age of 41 years (range, 32 to 68 years) . There were 13 cases of traumatic osteoarthritis of the ankle joint, 3 cases of local kaschin beck disease, 5 cases of ankle osteoarthritis, 2 cases of tuberculous ankle arthritis, 3 cases of ankle replacement failure, one case of osteomyelitis. Fibular flap grafts were used in 8 cases, bone autografts in 11 cases, bone allografts in 2 cases,and combined bone grafts in 11 cases. External fixation was applied for all cases to ensure compressive contact between bone ends. Results The patients were followed up for 6 to 38 months (average, 10 months). No pain or swelling was found at the ankle joint. Significant improvements were made in walking gait and function of the ankle. X-ray films verified bony fusion in all cases. Conclusion External fixation can lead to a high rate of bony fusion of the ankle joint, and is advantageous for treatment of ankle infection and combined deformity of the ankle and foot.

  3. Finite element modeling of ankle arthrodesis with two fixation techniques%踝关节融合术两种固定方式的三维有限元分析

    Institute of Scientific and Technical Information of China (English)

    欧阳汉斌; 熊军; 项鹏; 崔壮; 陈丽光; 余斌

    2012-01-01

    [Objective] To qualitatively compare stability provided by two fixation techniques in ankle arthrodesis and study the biomechanical characteristics,using the finite element method. [ Method] A three-dimensional model of a healthy ankle was developed from computed tomography images. Ankle arthrodesis fixed either by 3 screws or 4 screws with fibular strut graft was simulated by Abaqus 6. 9 software. Then the model was submitted to mechanical analysis under four load patterns simulating postoperative activity of the ankle joint. [Result] Three screws fixation had a comparable anti-rotation effect on fusion site to fibular strut fixation. Under the dorsiflexion load,a better stability was provided by 3 screws fixation rather than fibular strut fixation. Three screws fixation also yielded greater compression at fusion site than fibular strut fixation. Once the fibular strut was removed, compression effect was lower than before. In the safety evaluation, higher stress peak and stress concentration on distal tibia were found in 3 screws fixation rather than fibular strut fixation. [ Conclusion ] In the condition of bone quality ,3 screws fixation showed better biomechanical stability and compression at fusion site when compared to fibular strut fixation. However, fibular strut fixation tended to lower the risk of stress fracture of distal tibia,especially in patients with low bone quality.%[目的]通过三维有限元方法对踝关节融合的两种固定方式进行对比评价,并对其固定生物力学机制进行初步分析,为其临床应用提供理论依据.[方法]以正常人体踝关节CT扫描断层数据为基础,建立踝关节三维模型,模拟进行3螺钉固定和腓骨支撑固定手术,对模型中立、背屈、内旋和外旋4种载荷进行加载,分别进行有限元求解.[结果]3螺钉固定与腓骨支撑固定在抗旋转载荷上无明显差别,而在对抗背屈载荷作用优于腓骨支撑固定;在融合加压效果方面,3螺钉

  4. 关节融合术治疗中足骨折脱位致平足症的疗效%Arthrodesis for traumatic fiat foot caused by midtarsal fracture dislocation

    Institute of Scientific and Technical Information of China (English)

    梁晓军; 李毅; 赵宏谋; 宋涛; 鹿军; 马强; 潘文杰; 杨杰

    2013-01-01

    目的 探讨中足关节融合术治疗陈旧性中足骨折脱位致创伤性平足症的临床疗效. 方法 2009年1月至201 1年10月采用关节融合术治疗陈旧性中足损伤后成人创伤性平足症15例,其中男10例,女5例;年龄22~57岁,平均38.4岁;左足8例,右足7例.比较术前和末次随访时足部力线改变情况,并采用美国足踝外科协会(AOFAS)中足评分和视觉模拟评分(VAS)评估功能预后. 结果 12例患者术后获平均23个月(12 ~37个月)随访.末次随访时距骨-第1跖骨角(14.7°±3.7°)、距骨-第2跖骨角(18.9°±2.9°)、距骨-跖骨角(3.4°±1.2°)较术前(26.1°±8.9°、28.6°±12.7°、10.7°±6.7°)减小,差异均有统计学意义(P<0.05).末次随访时距骨-跟骨角(24.6°±4.3°)较术前(21.3°±4.7°)增加,差异无统计学意义(P> 0.05).末次随访时AOFAS中足评分[(81.5±6.3)分]、VAS评分[(2.6±0.9)分]较术前[(30.5±14.9)分、(5.7±0.9)]明显改善,差异均有统计学意义(P<0.05). 结论 中足融合术可以明显改善创伤性平足症患者的足部力线和外形,稳定足弓,且可较好地缓解临床症状.但多数患者仍无法完全恢复伤前活动能力,早期诊断和合理治疗对中足骨折脱位仍非常关键.%Objective To evaluate the short to mid-term outcomes of arthrodesis for traumatic fiat foot caused by midtarsal fracture dislocation.Methods From January 2009 to October 2011,15 patients with traumatic flat foot caused by midtarsal fracture dislocation were treated by arthrodesis in our department.They were 10 males and 5 females,with a mean age of 38.4 years (range,22 to 57 years).Eight fiat feet were left and 7 were right.A retrospective analysis was performed to evaluate alignment of the treated foot between pre-and post-operation and functional recovery at the final follow-up using the American Orthopaedic Foot and Ankle Society (AOFAS) mid-foot score and visual analogue scale (VAS).Results A total of 12 cases

  5. 腓骨支撑踝关节融合的三维有限元分析%Three-dimensional finite element analysis of ankle arthrodesis with fibular strut graft

    Institute of Scientific and Technical Information of China (English)

    欧阳汉斌; 熊军; 项鹏; 崔壮; 陈丽光; 余斌

    2012-01-01

    背景 利用有限元法进行模拟实验具有实验时间短、费用低、可模拟复杂边界条件、力学性能测试全面和可重复性好等优点.目的 通过建立腓骨支撑固定融合踝关节三维有限元模型,分析其生物力学稳定性及安全性,并进一步探讨其生物力学特性.方法 基于正常人体足踝部的三维CT 断层数据集,重建踝关节几何形态,应用Abaqus6.9 软件模拟踝关节4 种活动模式(中立位、背屈位、内旋位和外旋位)时的受力状况,进行静力学有限元分析.结果与结论 成功建立了腓骨支撑固定踝关节融合三维有限元模型,具有良好的几何相似性;在4 种载荷下,背屈位引起的螺钉应力峰值最大,应力分布主要集中在螺钉的融合面水平,同时融合面发生的位移最大;而4 枚螺钉中,胫骨后外侧螺钉应力最大;外侧支撑腓骨的应力主要集中在钉孔周围及上下钉孔之间的腓骨体部.说明踝关节行腓骨支撑固定融合时,应注意合理放置2 枚交叉螺钉,避免应力过分集中,而内固定后应加强抗背屈方向的制动;在处理外侧支撑腓骨时,螺钉钉孔应避免靠近腓骨边缘且上下钉距不宜过大,可有效降低内固定失效的风险.%BACKGROUND: Finite element modeling in biomechanical experiment has advantages in shorter experiment time, lower expense,simulation of complex boundary condition, full analysis of biomechanical characteristics and repeatability.OBJECTIVE: To establish a finite element model of ankle arthrodesis with fibular strut graft, to evaluate the biomechanical stability and safety, and to study the biomechanical characteristics of ankle arthrodesis with fibular strut graft.METHODS: A three-dimensional model of a healthy ankle was developed from computed tomography images. Ankle arthrodesis was simulated by Abaqus 6.9 software, and the model was submitted to mechanical analysis under four load procedures according to the postoperative

  6. 晚期创伤性踝关节炎应用关节镜辅助踝关节融合术治疗的临床观察%The Observasion of the Clinical Effect to Arthroscopy With Ankle Arthrodesis of Advanced Stage of Traumatic Anklebone Arthritis

    Institute of Scientific and Technical Information of China (English)

    吕国福

    2015-01-01

    Objective To observe the effect of arthroscopic with ankle arthrodesis treating by advanced stage of traumatic anklebone arthritis. Methods 32 cases of patients with advanced stage of traumatic ankle arthritis were selected into the study, and treated by arthroscopic ankle fusion, the treatment effect was analyzed. Results The time of operation was(122±24)min,the amount of bleeding was(50±15)ml. After 1 year,VAS score was(2.6±1). Conclusion The clinical effect of arthroscopy with ankle arthrodesis for the treatment of advanced stage of traumatic anklebone arthritis is significant.%目的:观察关节镜辅助踝关节融合术治疗晚期创伤性踝关节炎的效果。方法选取32例晚期创伤性踝关节炎患者做研究对象,均采用关节镜辅助踝关节融合术治疗,分析治疗效果。结果手术时间(122±24)min,出血量(50±15)ml;术后1年疼痛VAS评分为(2.6±1.0)分。结论关节镜辅助踝关节融合术治疗晚期创伤性踝关节炎效果显著。

  7. Evaluation of Trinity Evolution in Patients Undergoing Foot and Ankle Fusion

    Science.gov (United States)

    2014-04-07

    Tibiotalar Arthrodesis; Subtalar Arthrodesis; Calcaneocuboid Arthrodesis; Talonavicular Arthrodesis; Double Arthrodesis (i.e. Calcaneocuboid and Talonavicular); Triple Arthrodesis (i.e. Subtalar, Calcaneocuboid, and Talonavicular)

  8. Avaliação dos resultados da artrodese da articulação escapulotorácica no tratamento da escápula alada na distrofia fascioescapulumeral Evaluation of scapulothoracic arthrodesis results in the treatment of winged scapula in facioscapulohumeral dystrophy

    Directory of Open Access Journals (Sweden)

    Luciano Antonio Nassar Pellegrino

    2008-02-01

    Full Text Available OBJETIVO: Avaliar a técnica cirúrgica da artrodese escapulotorácica na distrofia fascioescapulumeral (DFEU, analisando os resultados e as complicações pós-operatórias. MÉTODOS: No período de fevereiro de 1992 a fevereiro de 2006 foram realizadas oito artrodeses escapulotorácicas em cinco pacientes no Departamento de Ortopedia e Traumatologia da Faculdade de Ciências Médicas da Santa Casa de São Paulo (DOT-FCM-SCSP. Os critérios para indicação cirúrgica foram: dor, déficit funcional do membro acometido, fadiga muscular e deformidade estética. Na técnica cirúrgica empregada para a artrodese foi realizada a fixação da escápula à parede torácica por meio de amarrilho com fios de poliéster nº 5, uma placa metálica estreita e fina, além de colocação de enxerto esponjoso autólogo. RESULTADOS: O seguimento médio dos pacientes foi de 124 meses. Na comparação da amplitude de movimentos pré e pós-operatórios, notou-se melhora na elevação, mantida a rotação lateral, com o UCLA no período pré-operatório variando de 7 a 11 e pós-operatório de 29 a 33. Dentre as complicações, encontraram-se dois casos de pneumotórax, um caso de soltura do material de síntese e um caso de ausência de consolidação óssea. COMENTÁRIO: Obtida consolidação da artrodese em seis casos, além da melhora da dor e elevação. Dois casos foram reoperados, sendo um devido à quebra do material e o outro, à não consolidação. Todos evoluíram para consolidação.OBJECTIVE: To evaluate the surgical scapulothoracic arthrodesis technique in facioscapulohumeral dystrophy (FSHD by analyzing post-op results and complications. METHODS: from February 1992 to February 2006, eight scapulothoracic arthrodesis procedures were performed in five patients at the Orthopedics and Traumatology Department of the Medical Sciences School at the Santa Casa Hospital of São Paulo (DOT-FCM-SCSP. The criteria for surgical indication were pain, functional

  9. Clinical effect of the 360°annular arthrodesis via the posterior lumbar in the treatment of lumbar spondylolisthesis%腰椎后路360°环形融合术治疗腰椎滑脱50例疗效观察

    Institute of Scientific and Technical Information of China (English)

    王建新; 薛滨勇; 苏艳

    2011-01-01

    Objective To discuss the clinical effect of the 360°annular aithrodesis via the posterior lumbar to cure lumbar spondylolisthesis. Methods 100 patients suffered the lumbar spondylolisthesis were selected from 2005 to 2010 , and evenly were divided into the PLF group and the 360°annular aithrodesis group at random. Conduct the traditional posterolateral fusion for PLF group and the posterior lumbar interbody fusion and posterolateral fusion for the 360°annular arthrodesis group, and compare the changes of the image index, JOA lumbar mark and the Oswestry marks before and after the treatment and compare the conditions between the two groups. Results The Cobb angle in two groups have reduced to be lower than 100 after the operation, and the difference is significant between the two groups(P<0.05). Compared with PLF group and 360°annular arthrodesis group, the locomotivity, perceptibility, bladder function, JOA marks and Oswestry marks have been improved after the operation. The above indexes in annular arthrodesis group is better than those in the PLF group. Conclusion The 360°annular arthrodesis via the posterior lumbar can improve the image index and promote the JOA marks and Oswestry marks, and hence has good efficacy in the treatment of lumbar spondylolisthesis.%目的 探讨腰椎后路360°环形融合术治疗腰椎滑脱的临床疗效。方法 将2005-2010年在我院住院的腰椎滑脱患者100例平均随机分为PLF组和360°环形融合组各50例,PLF组行传统后外侧植骨融合术,360°环形融合组行后路椎体间融合术加后外侧植骨融合术,比较两组患者术前术后影像学指标、JOA腰椎评分、Oswestry评分的变化情况,并行组间对比。结果 PLF组和环形融合组手术后Cobb's角均明显下降至小于10°,组间角度差异有统计学意义(P<.05)。PLF组、环形融合组治疗后运动能力、感觉能力、膀胱功能及JOA总分、Oswestry评分均较治疗前提高,以上

  10. EFFECTIVENESS OF IN SITU SUBTALAR ARTHRODESIS WITH BONE GRAFT FOR SUBTALAR TRAUMATIC ARTHRITIS AND GAIT ANALYSIS%距下关节创伤性关节炎原位植骨融合术后疗效与步态分析的临床研究

    Institute of Scientific and Technical Information of China (English)

    吴战坡; 陈伟; 张奇; 殷兵; 李明; 王海立; 张英泽

    2011-01-01

    Objective To evaluate the effects of in situ subtalar arthrodesis with bone graft for subtalar traumatic arthritis, and to analyse the plantar pressure distribution so as to provide the evidence for effectiveness evaluation. Methods Between March 2004 and December 2008, 26 patients with unilateral subtalar arthrodesis undergoing bone graft fusion were enrolled (test group). After operation, the imageology diversity and the effect of subtalar arthrodesis on adjacent joint were observed. American Orthopaedic Foot and Ankel Society (AOFAS) ankle and hindfoot score and radiographs were used to assess the foot function before and after operation. Twenty-six normal subjects served as controls. Footscan system was used to test the distribution of maximum plantar pressure and the change of gravity center curve. No significant difference was found in gender, age, height, and weight between 2 groups (P > 0.05). Results All patients were followed up 18.2 months on average (range, 14-71 months). The mean subtalar arthrodesis time was 5.6 months (range, 4 months and 15 days to 11 months). The mean AOFAS ankle and hindfoot score improved from 35.18 ± 8.16 preoperatively to 76.36 ± 6.90 postoperatively (t=13.910, P=0.000). Nine (34.6%) patients had satisfactory functional effects, and 13 (50.0%) patients basically satisfactory. The talocalcaneal height, talocalcaneal angle, talar declination angle, and calcaneus patch angle were 87.04% ± 6.17%, 76.73% ± 5.13%, 65.86% ± 7.01%, and 70.19% ± 8.33% of the contralateral side, respectively. Osteoarthritis of the adjacent joints occurred in 7 cases. The maximum plantar pressure increased in the third to fifth metatarsal bones and decreased in the first to second metatarsal bones, showing significant differences when compared with normal controls (P < 0.05). No significant difference was found in the plantar pressure between arthrodesis foot and contralateral foot of the test group (P > 0.05). The plantar pressure was well

  11. Conduta na lesão dural intraoperatória em artrodese da coluna lombar Conducta en lesión de duramadre intraoperatoria en artrodesis de la columna lumbar Management of intraoperatory dural tear in lumbar spine arthrodesis

    Directory of Open Access Journals (Sweden)

    Fabiano de Mendonça Grandese

    2010-12-01

    tendieren sido tratados por un protocolo basado en la reparación primaria de la lesión, subaracnoidea drenaje cerrado, aspiración subfascial y subcutánea realizada por cirujanos con experiencia, combinada con el reposo relativo, con la movilización precoz y el tratamiento farmacológico. Sus notas y las imágenes fueron verificadas con el seguimiento postoperatorio y direccionadas para la identificación de síntomas sugestivos de complicaciones. RESULTADOS: todos los pacientes tuvieron buena evolución, sin registro de pérdidas de líquido cefalorraquídeo o infección postoperatoria, tres tuvieron cefalea en el postoperatorio de intensidad leve. No hubo necesidad de reintervención en esos pacientes. CONCLUSIÓN: la conducta adoptada es segura y con buen resultado para pacientes en los que este tipo de lesión se produce, independiente de la extensión de la misma.OBJECTIVE: a retrospective study of patients with spinal dural intraoperative lumbar spine surgery, conducted by means of a protocol regardless of the extent of the injury, associated complications and follow-up results after a minimum of one year. METHODS: a total of 10 patients with accidental durotomy in surgical decompression and arthrodesis of the lumbar spine during the period from January 2007 to January 2009 for treatment of degenerative disease had their records reviewed after being treated by a protocol based in primary repair of the lesion, closed subarachnoid drainage, subfascial and subcutaneous aspiration drainage performed by experienced surgeons, combined with relative rest with early mobilization and drug therapy. Their notes and imaging were verified with follow-up aimed to identify symptoms that could suggest complications. RESULTS: all patients had a good outcome, without occurrence of cerebrospinal fluid leaks or postoperative infection; three had postoperative headache of mild intensity. There was no need for reoperation in these patients. CONCLUSION: we concluded that the conduct

  12. [Comparative outcome assessment of the wrist joint--mediocarpal partial arthrodesis and total arthrodesis].

    Science.gov (United States)

    Krimmer, H; Wiemer, P; Kalb, K

    2000-11-01

    Total wrist fusion still represents the main treatment for severe posttraumatic disorders of the wrist due to longstanding scaphoid nonunion (SNAC-wrist) or scapholunate dissociation (SLAC-wrist). During the last decade, midcarpal fusion has become more and more popular as it preserves motion. The question, however, remained if the preserved motion is of real benefit from a patient point of view, as complete pain relief is rare following this type of limited wrist fusion. The purpose of this study was to compare the outcome of both treatments with the modified Cooney wrist score and the DASH questionnaire. Between 1993 and 1997, 138 patients with progressive carpal collapse were treated either by midcarpal fusion (97) or total wrist fusion (41). Overall satisfaction was high in both groups with 86% (midcarpal fusion) and 84% (total wrist fusion). The traditional wrist score (70 versus 52 points) and the DASH questionnaire (33 versus 45 points) revealed the superiority of midcarpal fusion. The correlation between the wrist score and the DASH was statistically high (p wrist fusion for treatment of progressive carpal collapse (SLAC- and SNAC-wrist). The DASH represents a sensitive tool to evaluate the outcome of salvage procedures for treatment of disorders of the wrist.

  13. 镍钛记忆合金腕骨四角融合器应用于腕塌陷的疗效观察%The outcomes of NiTi shape memory alloy four-corner arthrodesis concentrator for carpal collapse

    Institute of Scientific and Technical Information of China (English)

    徐永清; 齐保闯; 朱跃良; 徐小山; 陆声; 李军; 丁晶; 覃励明

    2011-01-01

    Objective To evaluate the results of NiTi shape memory alloy four-corner arthrodesis concentrator (NTMA-FCAC) for carpal collapse. Methods We reviewed retrospectively 13 patients who underwent scaphoid excision with four-corner arthrodesis using NTMA-FCAC for carpal collapse from August 2006 to June 2009. There were eight males and five females, with an average age of 38 years (range, 23-61years). The cause of carpal collapse was SNAC in 7 cases, perilunate dislocations in five and SLAC in one.The injury mechanisms included traffic accidents (5 cases), falling from a height (4 cases), crashes (3 cases)and sprain (1 case). Objective measurements included grip strength and range of the wrist. Radiographs were performed in all patients. A visual analogue scale (VAS) was used to assess wrist pain. The results were evaluated according to the Krimmer wrist scores. Results The mean follow-up time was 26.5 months (range,6-36 months). Clinical evaluation yielded the mean grip strength of (32.49±6.21) kg (80.8% of opposite side).The mean range of the wrist reached over 53% of the healthy side. Non-union and wound infection were not seen. The mean VAS scores had improved from 4.46±1.27 preoperatively to 1.31 ±0.95 postoperatively. The mean pain scores under stress had improved from 7.00±1.41 preoperatively to 2.62±1.26 postoperatively.There were remarkable differences between them. The mean Krimmer wrist score was 79. Conclusion Four-corner arthrodesis using NTMA-FCAC is an effective method for carpal collapse, preserving a majority of wrist function.%目的 评价应用镍钛记忆合金腕骨四角融合器(NiTi shape memory alloy four-corner arthrodesis concentrator,NTMA-FCAC)治疗腕塌陷(carpal collapse)的效果.方法 2006年8月至2009年6月,应用NTMA-FCAC行头骨、月骨、三角骨及钩骨四角融合并舟骨切除术治疗13例腕塌陷患者,男8例,女5例;年龄23~61岁,平均38岁;右手9例,左手4例.其中陈旧性舟

  14. Evaluación clínico-radiológica de pacientes tratados con artrodesis posterolateral vs artrodesis circunferencial (360º en columna lumbosacra: 10 años de experiencia Avaliação clínico-radiológica de pacientes tratados com artrodese póstero-lateral vs circunferencial (360° na coluna lombossacral: 10 anos da experiência Clinical and radiological evaluation of patients treated with posterolateral vs circumferential arthrodesis in the lumbosacral spine: 10 years of experience

    Directory of Open Access Journals (Sweden)

    Albaro Barrera

    2012-06-01

    da fadiga dos implantes na artrodese póstero-lateral e em 2 casos de artrodese 360º; 2 casos do pseudoartrose com artrodese póstero-lateral e circunferencial; 1 caso de infecção em cada grupo do estudo. CONCLUSÃO: Nossos resultados não refletem discrepâncias funcionais; contudo, evidenciamos menos complicações na síndrome de transição (11 vs 2 e migração dos implantes (5 vs 2 com artrodese póstero-lateral com relação à artrodese 360º, embora sem significância do ponto de vista estatístico.OBJECTIVE: To present our experience in posterolateral vs circumferential (360º arthrodesis in the lumbosacral spine during the period 2000-2010. METHODS: 132 patients (61 patients with arthrodesis 360º and 71 patients with posterolateral arthrodesis. RESULTS: Female predominance (51.5%; mean age 45.5 years, follow-up of 60 months; instrumented level with arthrodesis 360º, L4-L5 (54.5% and posterolateral, L5-S1 (38.5%; there was similarity between the Oswestry Quesionnaire and Visual Analog Pain Scale in the pre- and postoperative period. Radiologically it was demonstrated transition syndrome in 15.5% posterolateral and arthrodesis 360º in 3.2%; 5 cases of fatigue of the implants in the posterolateral arthrodesis and 2 cases of arthrodesis 360º; 2 cases of pseudoartrose with posterolateral and circumferential fusion; 1 case of infection in each study group. CONCLUSION: Our results do not reflect functional differences; however we found fewer complications in the transitional syndrome (11 vs 2 and migration of the implants (5 vs 2 fusion with posterolateral arthrodesis vs 360º arthrodesis, although without statistical significance.

  15. Tomografia computadorizada da coluna lombar após artrodese com emprego de material metálico: avaliação da qualidade da imagem para diferentes algoritmos matemáticos Lumbar spine computed tomography after arthrodesis with metal implant: a qualitative evaluation of images reconstructed with different mathematical algorithms

    Directory of Open Access Journals (Sweden)

    José Augusto Marconato

    2007-02-01

    Full Text Available OBJETIVO: Selecionar os melhores algoritmos para o exame de coluna lombar na avaliação de artrodese com material metálico. MATERIAIS E MÉTODOS: Utilizou-se um equipamento de tomografia computadorizada de 16 fileiras de detectores. Imagens de dez pacientes foram reconstruídas com filtros 20, 40, 60 e 80 e realizadas reformatações em três dimensões e multiplanares com espessuras de 2 mm e 4 mm. Um total de 320 imagens foi avaliado por três experientes radiologistas, que deram notas de 1 a 5 (1 = não-aceitável; 2 = abaixo dos padrões; 3 = aceitável; 4 = acima da média; 5 = excelente. Além disso, foram realizadas medidas de ruído para correlação com o tipo de filtro utilizado. RESULTADOS: As médias do valor de ruído para reconstrução com 2 mm e filtros 20, 40, 60 e 80 foram de 24,7 ± 4,3; 35,5 ± 4,2; 106,0 ± 18,5 e 145,9 ± 26,9, respectivamente, e para 4 mm foram de 18,1 ± 2,4; 25,1 ± 4,6; 76,7 ± 17,2 e 106,6 ± 23,4. CONCLUSÃO: As imagens coloridas em três dimensões são mais bem visualizadas com filtro 20, entretanto, nas imagens em tons de cinza um filtro intermediário de 40 ou 60 pode ser útil para demonstrar os parafusos com maior detalhe. Para reconstruções multiplanares com espessura de 2 mm o filtro 40 é mais bem aceito, e para uma espessura de 4 mm um filtro 60 apresentou melhor qualidade.OBJECTIVE: To select the best mathematical algorithms for lumbar spine imaging studies to assess arthrodesis with metal implant. MATERIALS E METHODS: The images acquisition was performed with a multidetector (16 rows CT scanner, and 2 mm and 4 mm slice thickness. Images of ten patients were reconstructed with filters 20, 40, 60 and 80, employing multiplanar three-dimensional volume-rendering techniques. A total of 320 images were evaluated by three experienced radiologists who rated the images from 1 to 5 (1 = unacceptable; 2 = substandard; 3 = acceptable; 4 = above the average; 5 = excellent. Additionally, noise

  16. En-block切除术联合结构性植骨治疗第1跖趾关节痛风性关节炎%Treatment of first metatarsophalangeal joint gouty arthritis by arthrodesis with En-block resection and structural bone graft

    Institute of Scientific and Technical Information of China (English)

    宋国勋; 高鹏; 余伟林; 顾文奇; 施忠民

    2014-01-01

    背景:痛风性关节炎最常累及第1跖趾关节关节,伴有肿痛、畸形及关节僵硬,严重影响患者的生活质量。目的:探讨采用En-block切除术结合结构性植骨关节融合治疗第1跖趾关节痛风性关节炎的手术技术及疗效。方法:2012年6月至2013年6月,我院共收治8例第1跖趾关节痛风性关节炎患者。男7例,女1例,年龄25~68岁,平均47.6岁。所有患者均采用En-block病灶切除结合结构性植骨第1跖趾关节融合术。术后定期复查,摄片明确愈合情况,并采用美国骨科足踝外科协会(AOFAS)前足评分及疼痛直观模拟量表(VAS)评价治疗效果,记录相关并发症。结果:所有患者伤口均一期愈合,未见伤口感染、皮肤坏死等软组织并发症。术后7例患者获得12~24个月随访,平均18个月。影像学检查明确术后平均10周融合端骨性愈合。AOFAS评分从术前平均(44.4±10.5)分提高至术后(80.0±10.8)分,而VAS评分从术前平均(7.0±2.0)分降至术后(1.1±0.9)分,其差异均有统计学意义(P<0.0001)。随访期间未见骨不连、畸形愈合及固定失效等并发症。结论:En-block切除结合结构性植骨融合治疗第1跖趾关节痛风性关节炎具有症状缓解明显、融合率高、并发症少等优势,可有效改善患者生活质量,是一种安全有效的治疗方式。%Background:Gouty arthritis most commonly involves the first metatarsophalangeal joint (MTPJ), causing pain, deformity and anchylosis and reducing patients' quality of life. Objective:To investigate the technique and clinical outcome of arthrodesis with En-block resection and structural bone graft to treat the 1st MTPJ gouty arthritis. Methods: From June 2012 to June 2013, 8 patients suffering from 1st MTPJ gouty arthritis were treated in our hospital. There were 7 men and 1 woman with an average age of 47.6 years (range 25-68 years). The first MTPJ

  17. Influência da extensão da artrodese lombossacra nos resultados clínicos e funcionais Influencia de la extensión de la artrodesis lumbosacra en los resultados clínicos y funcionales Influence of the extent of lumbosacral arthrodesis in clinical and functional outcomes

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    Alberto Ofenhejm Gotfryd

    2012-01-01

    de medicamentos analgésicos y satisfacción con el tratamiento y la escala analógica visual para el dolor lumbar y la ciática. Por otra parte, se aplicaran los cuestionarios Oswestry y SF-36 para evaluar la calidad de vida. RESULTADOS: El SF-36 mostró resultados de buenos niveles de calidad de vida en ambos grupos, excepto en el campo "Aspectos Físicos". No hubo correlación significativa entre la magnitud de la artrodesis y los resultados clínicos. CONCLUSIONES: Los pacientes que fueron sometidos a artrodesis posterolateral mostraron calidad de vida satisfactoria, con excepción de disminución de la aptitud física. Sin embargo, el mayor número de niveles fusionados no tuvo un impacto negativo en los aspectos clínicos y funcionales.OBJECTIVE: Investigate the influence of the extent of posterolateral lumbosacral fusion and its impact on clinical and functional results. METHODS: We evaluated 22 patients with central or foraminal stenosis or lumbar disc herniation associated with segmental instability that underwent to surgery for nerve decompression and posterolateral arthrodesis. Patients were divided into two groups according to the number of levels fused: Group 1: fusion at one level and Group 2: fusion of two or more levels. Patients completed questionnaires regarding postoperative follow-up (use of analgesic medications and treatment satisfaction and visual analog scale for lumbar pain and sciatica. Moreover, the questionnaires Oswestry and SF-36 were administered to assess quality of life. RESULTS: SF-36 showed good levels of quality of life in both groups, except the field "Physical Aspects". There was no significant correlation between the extent of the arthrodesis and clinical outcomes. CONCLUSIONS: Patients who underwent posterolateral arthrodesis showed satisfactory quality of life, except for a decrease of physical fitness. However, the higher number of levels fused did not have negative impact on clinical and functional aspects.

  18. Artrodese lombar minimamente invasiva com acesso intermuscular sem material cirúrgico especial: estudo de série de casos Artrodesis lumbar mínimamente invasiva con acceso intermuscular sin material quirúrgico especial: estudio de serie de casos Minimally invasive lumbar arthrodesis with intermuscular approach without special surgical material: a case series

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    Bruno de Azevedo Oliveira

    2011-01-01

    por enfermedad degenerativa. El Índice de Discapacidad de Oswestry (ODI versión 2.0 y la escala visual analógica de dolor (VAS fueron analizados antes de la cirugía y 6 meses después. La artrodesis se realizó con el acceso paramediano bilateral entre los músculos multifidus y longisimus utilizando sistemas simples de retractores cervicales, con láminas sustituibles, e implantes convencionales. RESULTADOS: Se observó una mejoría media de 3,6 puntos en la VAS y 27,5 puntos porcentuales en el ODI comparado con las evaluaciones realizadas antes y 6 meses después de la cirugía. La mejora fue mayor en los pacientes con ciática por hernia discal asociada con discopatía. Las preguntas del Índice de Oswestry, que presentaron mejores resultados, fueron la intensidad del dolor y la calidad del sueño. Las que tuvieron peores resultados fueron la capacidad de levantamiento de pesos y el dolor al sentarse. No hubo mayores dificultades relacionadas con la técnica y el material utilizado. CONCLUSIONES: La artrodesis de la columna lumbosacra, con abordaje intermuscular mínimamente invasivo, es posible de ser realizada con retractores quirúrgicos normales e implantes semejantes a los de la técnica tradicional, sin perjuicio técnico y sin comprometer el resultado clínico.OBJECTIVES: To analyze the clinical results of a series of patients with degenerative disease of the lumbar spine treated with circumferential arthrodesis with minimally invasive intermuscular approach without special surgical material. METHODS: Analysis of a prospective series of 12 consecutive non-randomized patients undergoing single level lumbosacral fusion for degenerative disease. Oswestry Disability Index (ODI version 2.0 and visual analogue pain scale (VAS were performed preoperatively and six months after surgery. Arthrodesis was performed with bilateral paramedian approach between the multifidus and longissimus muscles using simple cervical retractor systems and conventional implants

  19. Utilização da densitometria óssea como método de avaliação dos resultados da utilização de BMP bovina em artrodese de coluna em coelhos Bone densitometry in the evaluation of the results obtained with the use of bovine BMP in spine arthrodesis in rabbits

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    Paulo Roberto Moura Machado

    2005-01-01

    do osso normal nos dois grupos.The object of this study is to evaluate the use of the bone densitometry as an evaluation method of the bone increment observed when we used bovine BMP in intertransverse arthrodesis of the rabbits' lumbar spine. Since the discovery of the BMP bone inductive properties, countless experimental models have been proposed. This caused the need of setting up evaluation methods to make possible a better understanding of the found results. Twenty female rabbits from New Zealand, divided in two groups, were submitted to the intertransverse arthrodesis of the lumbar column, segment L5/L6, posterior side. In the first group it was used autologous graft and in the second an association of autologous graft with biocompound (bovine BMP, 1.0 mg and hydroxyapatite, 9.0 mg. The animals were maintained in captivity, isolated and after 15 weeks submitted to the execution of bone densitometry by computerized tomography. 268 bone density measures of the normal bone, 134 measures of the newly formed bone by the association of the isolated autologous graft and 134 measures of the newly formed bone by the association autologous graft and BMP were obtained, what demonstrated a significant bone increment after statistical analysis (p=0.034 of the BMP/HAP group, when compared to the control group. We found this same variation of bone density analyzing the normal bone. The bone densitometry accomplished by the computerized tomography is an alternative method to assess the results when the BMP is used in experimental studies. Further studies should be accomplished for better understanding of the bone density variation found when the measures of the normal bone in the two groups are compared.

  20. Remoção da cartilagem articular associada ou não a implante homógeno ou enxerto autógeno de osso esponjoso em cães submetidos à artrodese atlantoaxial Joint cartilage removal associated or not to homologous implant or autologous cancellous bone graft in dogs submitted to atlantoaxial arthrodesis

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    Rafael Festugatto

    2013-03-01

    Full Text Available O objetivo deste estudo foi avaliar o grau de fusão articular e formação óssea na articulação atlantoaxial de cães submetidos à artrodese após a remoção da cartilagem articular associada ou não ao implante homógeno ou enxerto autógeno de osso esponjoso. Foram utilizados 12 cães, adultos, distribuídos aleatoriamente em três grupos iguais. Grupo I (GI: realizada apenas a remoção da cartilagem articular e imobilização articular com pinos e resina acrílica. Grupo II (GII: feita a remoção da cartilagem articular e imobilização da articulação, seguida da colocação e modelagem do implante ósseo esponjoso homógeno entre as superfícies articulares. Grupo III (GIII: foi realizado o mesmo procedimento do GII, mais o enxerto ósseo esponjoso autógeno no local determinado. Realizaram-se exames radiográficos em todos os animais aos 30, 60 e 90 dias de pós-operatório (PO. Aos 90 dias de PO foi feita a eutanásia para o emprego do teste de palpação manual, avaliação tomográfica e histopatológica. Para análise estatística da associação entre o grau de fusão articular, aplicou-se o Teste Qui-quadrado de independência. Os resultados dos testes foram avaliados pela significância exata e considerados significantes a 5% (PThe aim of this study was to evaluate the degree of joint fusion and bone formation in dogs undergoing atlantoaxial arthrodesis after removal of articular cartilage associated or not to implant homogenous or autogenous cancellous bone. Twelve dogs, weighing between 8 and 12kg were randomly divided into three groups. Group I (GI performed only the removal of joint cartilage and joint immobilization with acrylic resin and pins. Group II (GII: after removel of joint cartilage and articular immobilization was performed modeling and placement of homogenous cancellous bone at the given location. The volume of homograft placed in the joint was measured using a precision balance and all animals received the

  1. Artrodesis C1C2 con tornillos transarticulares en artritis reumatoidea: experiencia y revisión de la literatura Artrodese C1 C2 com parafusos transarticulares em artrite reumatoide: experiência e revisão de literatura C1 C2 arthrodesis with transarticular screws in rheumatoid arthritis: experience and literature review

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    Lyonel Beaulieu Lalanne

    2011-01-01

    tratamento cirúrgico. Foi realizada a fixação C1-C2 com parafusos transarticulares por via posterior e cerclagem com fio metálico e enxerto autólogo. O Índice de Ranawat pré e pós-operatorio foi registrado, assim como a distância anterior atlas-dontoide (DAAO, o tempo operatório, os dias de hospitalização, as complicações trans e pós-operatórias e o tempo de consolidação. O seguimento médio foi de 34 meses. RESULTADOS: Todos os pacientes apresentaram melhora do Índice de Ranawat no pós-operatório, a DAAO pré-operatória média foi de 11,9 cm (DP ± 2,57, variação de 7 a 16, e a DAAO pós-operatória média foi de 3 cm (DP ± 1,20, com a variação de 2 a 6. O tempo cirúrgico médio foi de 94 minutos e o período médio de de hospitalização foi 7 dias. Não foram observadas complicações intraoperatórias. Um paciente apresentou seroma de ferida operatória que necessitou de tratamento cirúrgico. O tempo de consolidação foi em média 14 semanas. CONCLUSÃO: A artrodese atlanto-axial com parafusos e cerclagem com fio metálico é uma boa alternativa no tratamento da instabilidade C1-C2 nos pacientes portadores de AR, proporcionando bons resultados clínicos e radiológicos.OBJECTIVE: Present the long term clinical and radiological results in C1-C2 transarticular screws technique with posterior wiring in RA patients and presenting the current literature review. METHODS: From 2002 to 2006, eleven patients (9 women and 2 men with RA and C1-C2 instability underwent C1-C2 arthrodesis with transarticular screws plus posterior wiring and autologous iliac crest bone graft. A retrospective chart and radiographic review was performed. Ranawat Index was recorded in pre- and post-operative, as well as anterior atlantodental interval (AADI, operating time, days of hospitalization and complications. The mean follow up (FU was 34 months. RESULTS: All patients presented improved Ranawat Index at follow up. Average pre-operative AADI was 11,9mm (SD ± 2

  2. Medium- to long-term outcome of ankle arthrodesis

    NARCIS (Netherlands)

    R.P.M. Hendrickx; S.A.S. Stufkens; E.E. de Bruijn; I.N. Sierevelt; C.N. van Dijk; G.M.M.J. Kerkhoffs

    2011-01-01

    Despite improvement in outcome after ankle arthroplasty, fusion of the ankle joint is still considered the gold standard. A matter of concern is deterioration of clinical outcome as a result of loss of motion and advancing degeneration of adjacent joints. We performed a long-term study to address th

  3. TIBIOTARSAL COMPRESSION ARTHRODESIS USING A LATERAL LOCKING PLATE.

    Science.gov (United States)

    Coughlin, Michael J; Nery, Caio; Baumfeld, Daniel; Jastifer, James

    2012-01-01

    Objetivos: A artrodese tibiotársica (TT) continua sendo uma importante opção no tratamento da artrose primária ou pós-traumática do tornozelo mas persiste ainda a controvérsia sobre o melhor método de fixação do foco de artrodese. Independentemente do tipo de material utilizado, o objetivo maior é a obtenção da fusão articular sólida, saudável e indolor. O propósito do presente estudo é apresentar os resultados preliminares de um novo sistema de placa bloqueada lateral compressiva para a artrodese do tornozelo. Método: Treze pacientes consecutivos portadores de artrose tibiotársica foram submetidos à artrodese do tornozelo nove pacientes eram homens e quatro mulheres. Com o auxílio de um guia, as superfícies articulares do talo e da tíbia foram decorticadas. Um sistema de compressão foi aplicado para evitar o alinhamento indesejável dos segmentos e uma placa bloqueada pré-moldada lateral foi utilizada para obter a fusão articular. Resultados: Tanto o escore AOFAS quanto o VAS melhoraram com a cirurgia. Todos os tornozelos operados consolidaram dentro do prazo de seis meses. Em todos os pacientes, foi obtido um ótimo alinhamento nos planos sagital, coronal e transverso. Conclusão: Acreditamos que a combinação de compressão bilateral, cortes ósseos com contornos pré-demarcados e placa lateral bloqueada, constitui uma técnica moderna, segura e útil para a artrodese do tornozelo.

  4. Stabilisation of atlantoaxial subluxation in the dog through ventral arthrodesis.

    Science.gov (United States)

    Jeserevics, J; Srenk, P; Beranekl, J; Jaggy, A; Touru, S; Cizinauskas, S

    2008-02-01

    Ten miniature breed dogs with atlantoaxial subluxation underwent ventral lag screw stabilisation. The procedure did not include bone graft packing into the atlantoaxial articulation. Four dogs showed continuous improvement after surgery. Three dogs developed complications due to external trauma and postoperative implant failure but improved with conservative therapy. Three patients died or were euthanized in early perioperative or postoperative period. The long-term outcome was good or favourable in all surviving patients. Suspected fibrous tissue proliferation and stabilisation without permanent bone fusion was found to be clinically satisfactory when the atlantoaxial joint has been subjected to limited stress during a long-term monitoring period.

  5. Artrodese cervical anterior em três e quatro níveis com dispositivo intersomático não associado à placa cervical Artrodesis cervical anterior en tres y cuatro niveles con dispositivo intersomático no asociado a placa cervical Anterior cervical arthrodesis for three and four levels using stand-alone interbody cages without cervical plates

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    Marcel Luiz Benato

    2009-06-01

    en tercer y cuarto niveles; dolor axial y/o irradiada; con mínimo seis meses de postoperatorio. El criterio de exclusión fue la presencia de inestabilidad cervical traumática. Fueron evaluadas las tasas de consolidación, la presencia de síntomas, la tasa de complicaciones y la posición de los dispositivos intersomáticos (subsidente después de seis meses. RESULTADOS: todos los pacientes obtuvieron consolidación en tres meses, sin embargo, dos pacientes presentaron el fenómeno de subsidente, o sea, migración con consolidación en cifosis, sin alterar los resultados clínicos y la consolidación de la artrodesis a los seis meses de postoperatorio. Los pacientes presentaron mejoría del dolor preoperatorio y solo tres (15% presentaron dolor residual. No hubo complicaciones mayores. El tiempo de hospitalización fue de dos días. No fue utilizada inmovilización rígida en el postoperatorio. CONCLUSIÓN: fue obtenida consolidación con esta técnica en todos los casos. La técnica se mostró segura y promovió buenos resultados radiológicos y clínicos.evaluate the rates of fusion of the anterior cervical discectomy and arthrodesis for three and four levels using interbody cages (stand-alone without cervical plates six months after post-operative. METHODS: from November 2005 to July 2008, 20 patients were treated as proposed. The inclusion criteria were: cervical degenerative disease of three and four levels; axial and/or irradiated pain at least six months of follow-up. The exclusion criteria were: cervical traumatic instability. The fusion rate, clinical symptoms, rate of complications and the implant position were evaluated six months after post-operative. RESULTS: results were favorable in 100% of the patients, with residual pain in two cases. Fusion was found in 100% of the patients, except for two cases with minimum subsidence and fusion in a slight kyphotic position. There were not significant complications. The discharge of the hospital was performed

  6. Avaliação de série de pacientes com artrodese C1-C2 Evaluación de diferentes casos con artrodesis C1-C2 Evaluation of different cases with C1-C2 arthrodesis

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    Cesar Salge Ghilardi

    2012-01-01

    vasculares. Complicaciones infecciosas se registraron en dos pacientes. Hemos logrado una tasa de 85% de consolidación de la artrodesis y no se requirieron cirugías de revisión. CONCLUSIONES: Todas las técnicas usadas produjeron la consolidación ósea satisfactoria y fueron excelentes para controlar la inestabilidad atlantoaxial.OBJECTIVE: Retrospective record analysis of patients with C1-C2 instability of traumatic and nontraumatic causes who underwent C1-C2 arthrodesis. METHODS: We performed retrospective analysis of medical records of 20 outpatients from the column of IOT-FMUSP aged between 7 and 83 years (mean 43 years of both sexes. The radiographic parameters for instability were based on measurement of atlanto-axial interval greater than 3 mm in adults and 5 mm in children, using measures obtained from lateral plain X-rays. RESULTS: We operated 20 patients with high cervical instability, mostly due to trauma. The surgical technique used was that described by Magerl. There were no vascular injuries. Infectious complications were reported in two patients. We achieved a solid fusion rate of 85% and no revision surgeries were required. CONCLUSIONS: All techniques produced satisfactory bone healing and were excellent for the control of atlanto-axial instability.

  7. Avaliação do tratamento da discopatia degenerativa cervical pela artrodese via anterior utilizando placas associadas a cages ou cages em peek isoladamente Evaluación del tratamiento de la enfermedad degenerativa del disco cervical por la artrodesis anterior utilizando placas asociadas con jaulas o jaulas en peec, aisladamente Evaluation of cervical degenerative disc disease treatment by anterior arthrodesis using plates associated with cages or cages in peek alone

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    André Rafael Hübner

    2011-01-01

    por el método de fijación con placas asociadas a jaulas - Grupo I - y 35 con las jaulas en PEEK, aisladamente - Grupo II. Se recolectarondatos de historial clínico, examen físico, puntuaciones de dolor (escala visual y analógica del dolor-EVA y función (criterios de Odom, SF-36, Índice de Discapacidad Cervical del pre y posoperatorio y exámenes de imagen. RESULTADOS: Se encontró un predominio de pacientes de sexo femenino en ambos grupos, con una edad promediode 55 años en el Grupo I y de 47 en el Grupo II. Ambos grupos mostraron una distribución similar en el número de niveles operados, así como de las complicaciones encontradas y de las puntuaciones de dolor, índice de discapacidad cervical y SF36 para el pre y posoperatorio. Hubo 97,1% para la fusión y 94,3% de buenos resultados en el Grupo I y el 100% de fusión, con 97% de buenos resultados en el Grupo II. CONCLUSIONES: El estudio comparativo de la utilización de placas con jaulas y estas en PEEK, aisladamente, presentó resultados similares y satisfactorios para los grupos estudiados, sin mostrar superioridad o inferioridad de un método sobre otro.OBJECTIVES: To comparatively evaluate the treatment of cervical degenerative disc disease by anterior approach using plates associated or cages and PEEK device alone. METHODS: A retrospective study comparing two groups of patients treated by anterior arthrodesis was performed. Seventy patients were randomly selected, 35 operated using plates associated with cages - Group I - and 35 with cages in PEEK alone - Group II. Medical history was obtained as well as physical examination, pain scores (pain visual analogue score and function scores (Odom's criteria, SF-36, Neck Disability Index and the pre and postoperative imaging studies. RESULTS: There was a predominance of female patients in both groups, with a mean age of 55 years in Group I and 47 in Group II. Both groups showed a similar distribution of the number of levels operated, as well as the

  8. Avaliação dos pacientes submetidos à descompressão e artrodese póstero-lateral devido à espondilolistese degenerativa com dois anos de acompanhamento Evaluación de los pacientes sometidos a descompresión y artrodesis posterolateral debido a la espondilolistesis degenerativa con dos años de seguimiento Evaluation of patients undergoing decompression and posterolateral arthrodesis because of degenerative spondylolisthesis with two years of follow up

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    Fernando William Figueiredo da Rosa

    2012-09-01

    evaluados VAS, Índice de Oswestry y Roland-Morris en el preoperatorio, con seguimiento de un mes, seis meses, un año y dos años. Los datos fueron analizados, estadísticamente, con nivel de significación de 5%. RESULTADOS: El nivel operado más frecuentemente fue L4-L5, con 52,38%. El VAS tuvo mejoría significativa de 53,48% en los 6 meses posteriores al procedimiento. El Índice de Incapacidad de Oswestry presentó empeoramiento en el primer mes, evolución para mejoría de la capacidad hasta el sexto mes, y permaneció constante hasta el fin del acompañamiento. Según el cuestionario de Incapacidad de Roland-Morris, hubo mejoría progresiva significativa hasta el sexto mes y, por último, un leve empeoramiento. CONCLUSIÓN: Los pacientes con espondilolistesis degenerativa, sometidos a la artrodesis posterolateral instrumentada y a la descompresión, presentaron mejoría significativa de la calidad de vida y del dolor, aún después de dos años de acompañamiento.OBJECTIVE: To evaluate the decompression and posterolateral arthrodesis in degenerative spondylolisthesis in patients whose main symptom is neurogenic claudication. METHODS: We selected 21 patients with degenerative spondylolisthesis who were referred for surgical treatment. 8 men and 13 women between aged 36 and 77 years were evaluated. The standardized surgical procedure was posterolateral arthrodesis with instrumentation and decompression associated. Patients were evaluated by VAS, Oswestry Disability Index and Roland-Morris questionnaire preoperatively, with one month, six months, one year, and two years of follow up. Data were analyzed statistically with a significance level of 5%. RESULTS: The most frequently operated level was L4-L5 with 52.38%. VAS had significant improvement of 53.48% 6 months after the procedure. The Oswestry Disability Index showed a worsening in the first month, with improved capacity until the sixth month, remaining constant until the end of follow up. According to the Roland

  9. Avaliação prospectiva da evolução funcional de pacientes tratados de estenose de canal lombar com descompressão sem artrodese Evaluación prospectiva de la evolución funcional de los pacientes tratados de estenosis del canal lumbar con descompresión sin artrodesis Prospective evaluation of functional evolution of patients treated of lumbar canal stenosis with decompression without arthrodesis

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    Frederico Araújo Leite

    2013-01-01

    preoperatively and during the postoperative follow-up at one month, six months, and one year, carrying out surgical decompression surgery without pedicle instrumentation or arthrodesis. RESULTS: There were improvements in measurements of pain and disability during follow-up one year after surgery compared to baseline. CONCLUSION: The decompression without fusion in patients with lumbar canal stenosis proved to be effective in improving pain and disability in selected patients one year postoperatively.

  10. Avaliação radiográfica da descompensação do tronco após artrodese seletiva torácica em portadores de escoliose idiopática do adolescente King II (Lenke B e C Evaluación radiográfica de la descompensación del tronco después de una artrodesis selectiva torácica en portadores de escoliosis idiopática del adolescente King II (Lenke B y C Radiographic evaluation of trunk decompensation with selective thoracic arthrodesis in patients with adolescent idiopathic scoliosis type King II (Lenke B e C

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    Osmar Avanzi

    2009-12-01

    lumbar de 49±13%, se verificó descompensación coronal inmediata en seis pacientes (27,20%. Después de acompañamiento promedio de 65 meses, cuatro pacientes (18,18% estaban con el tronco descompensado. En sólo un paciente fue necesaria una extensión de la artrodesis, incluyendo la curva lumbar. CONCLUSIONES: la descompensación grave del tronco con necesidad de un segundo procedimiento para artrodesis lumbar fue una complicación no frecuente en esta serie de casos.OBJECTIVE: to evaluate radiographic results regarding trunk decompensation of AIS treated with selective thoracic arthrodesis and 3ª generation instrumentation. METHODS: pre-operatory, immediately post-operatory and last radiography evaluations were carried out in 22 patients with adolescent idiopathic scoliosis AIS type King II treated with selective thoracic arthrodesis from 1993 to 2007. The percentage of correction of the thoracic and lumbar curve was observed by means of Cobb method, as well as the trunk coronal balance by using SRS criteria. RESULTS: after mean percentage of correction in thoracic curve of 56 ± 11% and 49 ± 13% in lumbar curve, we observed an immediate coronal decompensation in six patients (27.20%. After a mean 65-month follow-up, four patients (18.18% showed trunk coronal decompensation. Only one patient needed a new surgery with arthrodesis extension, including the lumbar curve, due to lumbar curve decompensation. CONCLUSIONS: severe trunk decompensation in need of a second procedure for lumbar fusion was not a frequent complication in this series.

  11. Avaliação da dor e morbidade local da retirada do enxerto ósseo da crista ilíaca para artrodese cervical anterior Evaluación del dolor y morbilidad local del injerto extraído de la cresta ilíaca para artrodesis cervical anterior Evaluation of the pain and local morbidity of the insertion taken out from the iliac crest to the anterior cervical arthrodesis

    Directory of Open Access Journals (Sweden)

    Rafael Barreto Silva

    2010-12-01

    . Todos los pacientes fueron sometidos al mismo procedimiento cirúrgico para la retirada del injerto, siendo que fueron operados por el mismo equipo en el Hospital de Clínicas de la Unicamp (HC Unicamp. Las variantes analizadas fueron: dolor residual, tasa de infección, lesión neurológica o vascular y aparición de fractura en el ala ilíaca. Los datos fueron colocados en una tabla, y las mediciones y porcentajes fueron calculados. RESULTADOS: de los 20 pacientes, 12 hombres y 8 mujeres, con edad media de 51,75 años (29-74, acompañamiento medio de 11,83 meses (2-29. No tuvo ninguna lesión grave como fractura, lesión arterial o neurológica. Hubo un caso de infección superficial (5%, y 25% de los pacientes se quejaron de malestar leve y dificultades para andar no incapacidad. CONCLUSIÓN: la retirada del injerto de la cresta ilíaca anterior esta relacionada a muchas complicaciones, siendo importante el conocimiento de otras opciones de injerto y exposición al paciente de las posibles complicaciones. A través del levantamiento, no se verificó ninguna complicación grave y el porcentual de pacientes con dolor residual pude se comparar con los encontrados en literatura, pudiendo ser reducidos a través de una disección cuidadosa de la cresta ilíaca.OBJECTIVE: to evaluate the possible complications associated to the removal of the insertion of the anterior iliac crest in surgery to the anterior cervical arthrodesis, especially to the residual pain. METHODS: the retrospective study with the medical records analysis and the application of a form by telephone with 20 patients in a period from August 2008 to November 2009 were performed. All patients were submitted to the same surgical technique for the crest extraction, and were operated by the same team at Hospital das Clínidas da Unicamp (HC Unicamp. The variants analyzed were: residual, pain infection rate, neurologic or vascular lesion and occurrence of the fracture of the iliac wing. The data was placed in a

  12. [Mixed knee arthrodesis a rescue alternative in knee periprosthetic joint infection].

    Science.gov (United States)

    López-Cervantes, Roberto Enrique; Rivera-Villa, Adrián Huematzin; Miguel-Pérez, Adrián; Morales-de Los Santos, René; Torres-González, Rubén; Pérez-Atanasio, José Manuel

    2016-01-01

    Introducción: la artrodesis es una cirugía de salvamento para la infección periprotésica de rodilla; este procedimiento reporta moderada efectividad, alto índice de complicaciones y es la última alternativa antes de la amputación. El objetivo de este estudio fue identificar si la artrodesis de rodilla con clavo expandible y fijador externo es un tratamiento seguro y efectivo. Métodos: estudio observacional, retrospectivo, en 17 pacientes con infección periprotésica y pérdida ósea importante, tratados mediante artrodesis con clavo centro-medular expandible autobloqueante y fijador externo monoplanar con evolución mínima de 1 año; la información se obtuvo del expediente clínico e imágenes de rayos X, siendo estas evaluadas por 2 ortopedistas especializados en rescate osteoarticular. Resultados: de 17 pacientes, con una pérdida ósea grado III en un 88.2% de los casos, se obtuvo una fusión en el 82.5%. Logrando la deambulación independiente en el 88.2%. Con un promedio de 2.4 intervenciones quirúrgicas por paciente. Sin complicaciones transquirúrgicas reportadas. Con un índice de complicaciones global del 47.1% incluyendo una amputación por sepsis. La evaluación inter-observador tuvo un valor de Kappa del 0.90 y la muestra alcanzó un poder estadístico del 60%. Conclusiones: se obtuvo una consolidación similar a otros métodos, en un tiempo promedio de 6.3 meses, con un menor índice de complicaciones al reportado con otras técnicas. Siendo esta una alternativa de salvamento para la realización de artrodesis de rodilla, antes de considerar la amputación de la extremidad.

  13. Risk Factors for the Development of Adjacent Segment Disease Following Anterior Cervical Arthrodesis

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    Ezgi Akar

    2015-06-01

    Full Text Available Aim: The aim of this study was to clinically and radiologically evaluate the efficacy of anterior cervical discectomy and fusion (ACDF in the treatment of adjacent level degeneration. Methods: We retrospectively evaluated 89 patients (55 females, 34 males who underwent ACDF. Adjacent segment degeneration findings were evaluated by investigating new osteophyte formation, growth of existing osteophytes, ossification of the anterior longitudinal ligament, presence of intervertebral disc space narrowing, sagittal alignment and range of motion (ROM using serial radiographs and magnetic resonance imaging. Results: The mean age of the 89 patients was 41.3 (24-76 years. The mean follow-up duration was 34.3 (12-64 months. Radiographic evidence of adjacent segment degeneration was observed in 12 patients (13.4%. Nine (75% patients had new complaints. Of the patients who had degenerative changes, 7 were (58% were male, 5 (42% were female; the mean age was 46 (30- 62 years. It was observed that the level of fusion and the number of fusion did not increase the adjacent segment degeneration. All of 12 patients were observed to have a non lordotic cervical spine and increased ROM. Conclusion: Development of degeneration at the level adjacent to region anterior cervical discectomy and fusion performed is higher compared to non-adjacent levels. The level of fusion and the number of fusion levels have no effect on the development of degeneration. (The Medical Bulletin of Haseki 2015; 53:120-3

  14. Risk Factors for the Development of Adjacent Segment Disease Following Anterior Cervical Arthrodesis

    OpenAIRE

    Ezgi Akar; Mehmet Ufuk Akmil; Merih İş

    2015-01-01

    Aim: The aim of this study was to clinically and radiologically evaluate the efficacy of anterior cervical discectomy and fusion (ACDF) in the treatment of adjacent level degeneration. Methods: We retrospectively evaluated 89 patients (55 females, 34 males) who underwent ACDF. Adjacent segment degeneration findings were evaluated by investigating new osteophyte formation, growth of existing osteophytes, ossification of the anterior longitudinal ligament, presence of inter...

  15. The prevalence of distal junctional kyphosis following posterior instrumentation and arthrodesis for adolescent idiopathic scoliosis.

    Science.gov (United States)

    Ameri, Ebrahim; Behtash, Hamid; Mobini, Bahram; Ghandhari, Hassan; Vahid Tari, Hossein; Khakinahad, Mohammad

    2011-01-01

    Distal junctional kyphosis (DJK) is a radiographic finding in patients that undergo spinal instrumentation and fusion, since there is an abrupt transition between fixed and mobile spinal segments.The true incidence of DJK is variable in literature and seems that has a multifactorial etiology. A consecutive series of 130 patients (mean age 15.6 years) with adolescent idiopathic scoliosis who underwent posterior spinal fusion and instrumentation were evaluated by analyzing coronal and sagittal angulation and balance measurements from standing radiographs obtained pre-operatively, within 6 weeks post-operation, at two years postoperative and at the latest follow-up. There was 35 male and 95 female. The mean time of follow-up was 36 months. The incidence of DJK at latest follow-up was 6.9% (9 patients). In DJK group, distal junctional angle from pre-operative of -12.5° lordosis (-30 to 0) reached to -5.5° (P=0.015) at 6 weeks postoperation and to -1.4° (-20 to 12°) (P=0.000) at 2 years follow-up,with mean of 12.1° kyphotic change (10-20°). In non DJK group, distal junctional angle from pre-operative angle of -7.5° reached -8.1° at 2 years follow-up (P=0.43). The mean age of DJK group at surgery was 17 years and for non-DJK group was 15.4 years (P=0.022). Distal junctional kyphosis was less common in this study than previous reports and stabilized after two years. The magnitude of coronal cobb angles or multiplicity of coronal curves had no effect in developing DJK that may be prevented by incorporation of the first lordotic disc into the fusion construct.

  16. The Prevalence of Distal Junctional Kyphosis Following Posterior Instrumentation and Arthrodesis for Adolescent Idiopathic Scoliosis

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    Ebrahim Ameri

    2011-06-01

    Full Text Available Distal junctional kyphosis (DJK is a radiographic finding in patients that undergo spinal instrumentation and fusion, since there is an abrupt transition between fixed and mobile spinal segments.The true incidence of DJK is variable in literature and seems that has a multifactorial etiology. A consecutive series of 130 patients (mean age 15.6 years with Adolescent Idiopathic Scoliosis who underwent posterior spinal fusion and instrumentation were evaluated by analyzing coronal and sagittal angulation and balance measurements from standing radiographs obtained pre-operatively, within 6 weeks post-operation, at two years postoperative and at the latest follow-up. There was 35 male and 95 female. The mean time of follow-up was 36 months. The incidence of DJK at latest follow-up was 6.9% (9 patients. In DJK group ,distal junctional angle from pre-operative of -12.5 ̊ lordosis (-30 to 0 reached to -5.5 ̊ (P=0.015 at 6 weeks postoperation and to -1.4 ̊ (-20 to 12 ̊ (P=0.000 at 2 years follow-up,with mean of 12.1 ̊ kyphotic change (10-20 ̊. In non DJK group, distal junctional angle from pre-operative angle of -7.5 ̊ reached -8.1 ̊ at 2 years follow-up (P=0.43. The mean age of DJK group at surgery was 17 years and for non-DJK group was 15.4 years (P=0.022. Distal junctional kyphosis was less common in this study than previous reports and stabilized after two years. The magnitude of coronal cobb angles or multiplicity of coronal curves had no effect in developing DJK that may be prevented by incorporation of the first lordotic disc into the fusion construct.

  17. [Arthrodesis and endoprostheses of the ankle joint: indications, techniques and pitfalls].

    Science.gov (United States)

    Wirth, S H; Klammer, G; Espinosa, N

    2013-09-01

    If adequate conservative measures for the treatment of end-stage ankle osteoarthritis have failed, surgery may be taken into consideration. After exorbitant failure rates in the beginning of total ankle replacement, nowadays this kind of treatment has regained lot of interest and has become a viable alternative to ankle fusion. The correct indication and a precise explanation of the surgical procedure, outcomes and potential complications provide a solid base for future success.Currently, there is no doubt that total ankle replacement has become an important player in the treatment of symptomatic and debilitating end-stage ankle arthritis. With increasing number of patients who undergo total ankle replacement the experience with this kind of procedure increases too. As a consequence several surgeons have started to stretch indications favoring total ankle replacement. However, it must be mentioned here, despite progress in terms of improved anatomical and biomechanical understanding of the hindfoot and improved surgical techniques and instruments, total ankle replacement and ankle fusion remain challenging and difficult procedures. We provide a review article including an overview of the relevant techniques. This article should serve as rough guide for surgeons and help in decision-making regarding total ankle replacement and ankle fusion.

  18. Posterior cervical spine arthrodesis with laminar screws: a report of two cases

    Directory of Open Access Journals (Sweden)

    Sugimoto,Yoshihisa

    2007-04-01

    Full Text Available We performed fixation using laminar screws in 2 patients in whom lateral mass screws, pedicle screws or transarticular screws could not be inserted. One was a 56-year-old woman who had anterior atlantoaxial subluxation (AAS. When a guide wire was inserted using an imaging guide, the hole bled massively. We thought the re-insertion of a guide wire or screw would thus increase the risk of vascular injury, so we used laminar screws. The other case was an 18-year-old man who had a hangman fracture. Preoperative magnetic resonance angiography showed occlusion of the left vertebral artery. A laminar screw was inserted into the patent side (i.e., the right side of C2. Cervical pedicle screws are the most biomechanically stable screws. However, their use carries a high risk of neurovascular complications during screw insertion, because the cervical pedicle is small and is adjacent laterally to the vertebral artery, medially to the spinal cord, and vertically to the nerve roots. Lateral mass screws are also reported to involve a risk of neurovascular injuries. The laminar screw method was thus thought to be useful, since arterial injuries could thus be avoided and it could also be used as a salvage modality for the previous misinsertion.

  19. Knee arthrodesis as limb salvage for complex failures of total knee arthroplasty.

    Science.gov (United States)

    Kuchinad, Raul; Fourman, Mitchell S; Fragomen, Austin T; Rozbruch, S Robert

    2014-11-01

    Patients with multiple failures of total knee arthroplasty (TKA) are challenging limb salvage cases. Twenty one patients over the last 10 years were referred to our service for knee fusion by arthroplasty surgeons who felt they were not candidates for revision TKA. Active infection was present in 76.2% and total bone loss averaged 6.6 cm. Lengthening was performed in 7/22 patients. Total time in Ilizarov frames was 9 months, with 93.3% union. Patients treated with IM fusion nails had 100% union. Average LLD increased from 3.6 to 4.5 cm following intervention, while those with concurrent lengthening improved to 1.6 cm. Findings suggest that bone loss and the soft-tissue envelope dictate knee fusion method, and multiple techniques may be needed. A treatment algorithm is presented.

  20. Arthrodesis to L5 versus S1 in long instrumentation and fusion for degenerative lumbar scoliosis.

    Science.gov (United States)

    Cho, Kyu-Jung; Suk, Se-Il; Park, Seung-Rim; Kim, Jin-Hyok; Choi, Sung-Wook; Yoon, Young-Hyun; Won, Man-Hee

    2009-04-01

    There is a debate regarding the distal fusion level for degenerative lumbar scoliosis. Whether a healthy L5-S1 motion segment should be included or not in the fusion remains controversial. The purpose of this study was to determine the optimal indication for the fusion to the sacrum, and to compare the results of distal fusion to L5 versus the sacrum in the long instrumented fusion for degenerative lumbar scoliosis. A total of 45 patients who had undergone long instrumentation and fusion for degenerative lumbar scoliosis were evaluated with a minimum 2 year follow-up. Twenty-four patients (mean age 63.6) underwent fusion to L5 and 21 patients (mean age 65.6) underwent fusion to the sacrum. Supplemental interbody fusion was performed in 12 patients in the L5 group and eleven patients in the sacrum group. The number of levels fused was 6.08 segments (range 4-8) in the L5 group and 6.09 (range 4-9) in the sacrum group. Intraoperative blood loss (2,754 ml versus 2,938 ml) and operative time (220 min versus 229 min) were similar in both groups. The Cobb angle changed from 24.7 degrees before surgery to 6.8 degrees after surgery in the L5 group, and from 22.8 degrees to 7.7 degrees in the sacrum group without statistical difference. Correction of lumbar lordosis was statistically better in the sacrum group (P = 0.03). Less correction of lumbar lordosis in the L5 group seemed to be associated with subsequent advanced L5-S1 disc degeneration. The change of coronal and sagittal imbalance was not different in both groups. Subsequent advanced L5-S1 disc degeneration occurred in 58% of the patients in the L5 group. Symptomatic adjacent segment disease at L5-S1 developed in five patients. Interestingly, the development of adjacent segment disease was not related to the preoperative grade of disc degeneration, which proved minimal degeneration in the five patients. In the L5 group, there were nine patients of complications at L5-S1 segment, including adjacent segment disease at L5-S1 and loosening of L5 screws. Seven of the nine patients showed preoperative sagittal imbalance and/or lumbar hypolordosis, which might be risk factors of complications at L5-S1. For the patients with sagittal imbalance and lumbar hypolordosis, L5-S1 should be included in the fusion even if L5-S1 disc was minimal degeneration.

  1. Resultados funcionais da artrodese do punho Functional results of wrist arthrodesis

    OpenAIRE

    Cláudio Henrique Barbieri; Nílton Mazzer; Valéria M. C. Elui; Fonseca,Marisa C. R.

    2002-01-01

    São analisados os resultados funcionais 51 artrodeses do punho em 49 pacientes, portadores de variadas patologias dessa região. Em todos os casos, a artrodese foi realizada com fixação interna rígida, usando placa e parafusos e o seguimento pós-operatório variou de 6 a 201 meses (média: 73 meses). Para a avaliação funcional foi empregado um método de subjetivo, baseado nas impressões dos próprios pacientes, e outro objetivo, através da análise das radiografias e de testes funcionais que simul...

  2. Low-profile plate fixation in arthrodesis of the first metacarpophalangeal joint

    DEFF Research Database (Denmark)

    Rasmussen, Claudia; Roos, S; Boeckstyns, M

    2011-01-01

    case a tenolysis. Follow-up time was 13-92 months (mean 52). There was no correlation between patient satisfaction and position of fusion. We conclude that this technique gives a high rate of union, a short period of immobilization and rehabilitation, and a reliable position at the site of fusion....

  3. Ipsilateral pedicle screw placement with contralateral percutaneous facet screws: Early results with an alternative in lumbar arthrodesis

    Directory of Open Access Journals (Sweden)

    Richard B Rhiew

    2009-03-01

    Full Text Available Richard B Rhiew, Sunil Manjila, Andrew M Lozen, David Hong, Murali Guthikonda, S S RengacharyDepartment of Neurosurgery, Wayne State University, Detroit, MI, USAAbstract: Transforaminal lumbar interbody fusion (TLIF is a widely used method of surgical treatment for a variety of lumbar spinal disorders. Bilateral transpedicular instrumentation is routinely used in conjunction with an interbody graft to provide additional stability. In this technical note, we describe our fusion construct using ipsilateral pedicle screw placement on the side of TLIF and contralateral facet screw placement. We performed this construct at six levels in four patients. Suggested advantages include: low morbidity, small incision and lower cost. Outcomes parameters included radiographic evidence of solid union at four months and improvement in Oswestry Disability Index. A mean improvement from a preoperative score of 73 to 26 after surgery was observed at one-year follow-up. There were no instrument-related complications. In conclusion, this hybrid screw system minimizes contralateral dissection and is an attractive alternative to standard bilateral pedicle screw fixation.Keywords: TLIF, facet screw, pedicle screw, lumbar spine fusion

  4. Adolescent idiopathic scoliosis (AIS treated with arthrodesis and posterior titanium instrumentation: 8 to 12 years follow up without late infection

    Directory of Open Access Journals (Sweden)

    Gluch Herbert

    2009-08-01

    Full Text Available Abstract Background There are no data in the peer-reviewed literature regarding long term results in patients treated for AIS with a posterior titanium instrumentation. Therefore we assessed the outcome in 50 patients treated by titanium implant. Methods A total of 50 patients with a mean age of 16.6 years were treated. In all patients, titanium hooks and pedicle screws were used in combination. The demographic data and the pre- and post-operative radiographs of all 50 patients were re-examined, and 49 of the 50 patients (98% attended a radiological and clinical follow up-examination on average 10.1 years post-operatively. The clinical results were recorded by means of the SRS 24 questionnaire. Results In the frontal plane, the mean pre-operative thoracic and lumbar curve had been 62.4° and 43.5° respectively, post-operatively the curves were reduced to 26.9° and 16.3°, resulting in a correction rate of 56.9% for thoracic and 62.5% for lumbar curve. At the follow up-evaluation, the Cobb angle of the thoracic and lumbar curve was 31.0° and 21.3° respectively, giving a final correction rate of 50.3% for thoracic, and 51.0% for lumbar curve. 7 of the 50 patients (14.3% had undergo revision surgery for complications, but complete implant removal was necessary in only one case. Analysis of the SRS 24 questionnaire showed an average score of 95.8 points. Conclusion Posterior titanium instrumentation is a safe and effective procedure in the surgical correction of AIS. In this retrospective study with small patient number, it shows favourable long-term results; in particular, the loss of correction is low, no late infection occurred and there was a very high survival rate of the implant itself.

  5. Anterior cervical discectomy with arthroplasty versus arthrodesis for single-level cervical spondylosis: a systematic review and meta-analysis.

    Directory of Open Access Journals (Sweden)

    Aria Fallah

    Full Text Available OBJECTIVE: To estimate the effectiveness of anterior cervical discectomy with arthroplasty (ACDA compared to anterior cervical discectomy with fusion (ACDF for patient-important outcomes for single-level cervical spondylosis. DATA SOURCES: Electronic databases (MEDLINE, EMBASE, Cochrane Register for Randomized Controlled Trials, BIOSIS and LILACS, archives of spine meetings and bibliographies of relevant articles. STUDY SELECTION: We included RCTs of ACDF versus ACDA in adult patients with single-level cervical spondylosis reporting at least one of the following outcomes: functionality, neurological success, neck pain, arm pain, quality of life, surgery for adjacent level degeneration (ALD, reoperation and dysphonia/dysphagia. We used no language restrictions. We performed title and abstract screening and full text screening independently and in duplicate. DATA SYNTHESIS: We used random-effects model to pool data using mean difference (MD for continuous outcomes and relative risk (RR for dichotomous outcomes. We used GRADE to evaluate the quality of evidence for each outcome. RESULTS: Of 2804 citations, 9 articles reporting on 9 trials (1778 participants were eligible. ACDA is associated with a clinically significant lower incidence of neurologic failure (RR = 0.53, 95% CI = 0.37-0.75, p = 0.0004 and improvement in the Neck pain visual analogue scale (VAS (MD = 6.56, 95% CI = 3.22-9.90, p = 0.0001; Minimal clinically important difference (MCID = 2.5. ACDA is associated with a statistically but not clinically significant improvement in Arm pain VAS and SF-36 physical component summary. ACDA is associated with non-statistically significant higher improvement in the Neck Disability Index Score and lower incidence of ALD requiring surgery, reoperation, and dysphagia/dysphonia. CONCLUSIONS: There is no strong evidence to support the routine use of ACDA over ACDF in single-level cervical spondylosis. Current trials lack long-term data required to assess safety as well as surgery for ALD. We suggest that ACDA in patients with single level cervical spondylosis is an option although its benefits and indication over ACDF remain in question.

  6. Application of a 3D custom printed patient specific spinal implant for C1/2 arthrodesis

    Science.gov (United States)

    Phan, Kevin; Sgro, Alessandro; Maharaj, Monish M.; D’Urso, Paul

    2016-01-01

    The study aims to describe a three-dimensional printed (3DP) posterior fixation implant used for C1/C2 fusion in a 65-year-old female. Spinal fusion remains a common intervention for a range of spinal pathologies including degenerative disc and facet disease when conservative methods are unsuccessful. However, fusion devices are not always entirely efficacious in providing the desired fixation, and surgeons rely on ‘off the shelf’ implants which may not provide an anatomical fit to address the particular pathology. 3DP refers to a process where three-dimensional objects are created through successive layering of material, so called ‘additive manufacturing’. Although this technology enables accurate fabrication of patient-specific orthopaedic and spinal implants, literature on its utilization in this regard is rare. A 65-year-old female, with severe facet arthropathy at the C1/C2 level, osteophyte formation and impingement of the exiting C2 nerve root underwent a C1/C2 posterior fusion and rhizolysis of the C2 nerve roots. A custom posterior fixation implant was designed and on-laid over the C2 spinous process and lamina, with screw holes made to a depth and angulation that was pre-calculated based on the preoperative CT based 3D modelling. The patient had an uneventful recovery and reported a significant reduction in occipital neuralgia and sub-occipital pain and 2-month follow-up. We report the first case of a customized 3DP spinal prosthesis for posterior C1/C2 fusion. The implant added significant value reducing the overall time of the procedure, and safety with a reduced risk of neurovascular compromise. PMID:28097249

  7. The application of philos plate in ankle arthrodesis%Philos钢板在踝关节融合术中的应用

    Institute of Scientific and Technical Information of China (English)

    王枰稀; 黄焱星; 张廷玖; 庾明; 王进

    2013-01-01

    目的 评价经外踝截骨philos钢板固定行踝关节融合术的手术方法和临床疗效.方法 对2010年1月~2011年6月收治的13例踝关节炎手术患者资料进行分析.结果 术后有2例患者出现伤口延迟愈合,经换药后愈合.所有患者获平均15个月随访.所有随访患者X片证实踝关节术后平均16周骨性愈合.末次随访时患者关节疼痛完全缓解,无内固定失败、融合失败等并发症发生.末次随访踝-后足评分为(82.4±7.8)分.与术前比较差异有统计学意义(t=25.021,P<0.01).结论 采用经外踝截骨philos钢板固定行踝关节融台术显露充分,融合率高,踝关节疼痛明显减轻,融合效果可靠.

  8. Juvenile idiopathic scoliosis treated with posterior arthrodesis and segmental pedicle screw instrumentation before the age of 9 years: a 5-year follow-up

    Directory of Open Access Journals (Sweden)

    Musaoğlu Resul

    2009-01-01

    Full Text Available Abstract Study design Retrospective study. Objective To evaluate the radiological results of fusion with segmental pedicle screw fixation in juvenile idiopathic scoliosis with a minimum 5-year follow-up. Summary of background data Progression of spinal deformity after posterior instrumentation and fusion in immature patients has been reported by several authors. Segmental pedicle screw fixation has been shown to be effective in controlling both coronal and sagittal plane deformities. However, there is no long term study of fusion with segmental pedicle screw fixation in these group of patients. Methods Seven patients with juvenile idiopathic scoliosis treated by segmental pedicle screw fixation and fusion were analyzed. The average age of the patients was 7.4 years (range 5–9 years at the time of the operation. All the patients were followed up 5 years or more (range 5–8 years and were all Risser V at the most recent follow up. Three dimensional reconstruction of the radiographs was obtained and 3DStudio Max software was used for combining, evaluating and modifying the technical data derived from both 2d and 3d scan data. Results The preoperative thoracic curve of 56 ± 15° was corrected to 24 ± 17° (57% correction at the latest follow-up. The lumbar curve of 43 ± 14° was corrected to 23 ± 6° (46% correction at the latest follow-up. The preoperative thoracic kyphosis of 37 ± 13° and the lumbar lordosis of 33 ± 13° were changed to 27 ± 13° and 42 ± 21°, respectively at the latest follow-up. None of the patients showed coronal decompensation at the latest follow-up. Four patients had no evidence of crankshaft phenomenon. In two patients slight increase in Cobb angle at the instrumented segments with a significant increase in AVR suggesting crankshaft phenomenon was seen. One patient had a curve increase in both instrumented and non instrumented segments due to incorrect strategy. Conclusion In juvenile idiopathic curves of Risser 0 patients with open triradiate cartilages, routine combined anterior fusion to prevent crankshaft may not be warranted by posterior segmental pedicle screw instrumentation.

  9. Comparison of limited-contact dynamic compression plate and locking compression plate constructs for proximal interphalangeal joint arthrodesis in the horse

    OpenAIRE

    Rocconi, Richard A.; Carmalt, James L.; Sampson, Sarah N.; Elder, Steve H.; Gilbert, Eric E.

    2015-01-01

    This study compared in vitro monotonic and cyclic mechanical properties of equine proximal interphalangeal joint arthrodeses stabilized using an open or closed technique combined with axial 4.5 mm narrow limited-contact dynamic compression plate (LC-DCP) or 4.5 mm narrow locking compression plate (LCP). Ten forelimb pairs were randomly assigned to LCP or LC-DCP groups. One limb in each pair was assigned to either open or closed technique. Limbs were tested for cyclic fatigue at 20 000 cycles ...

  10. Comparison of limited-contact dynamic compression plate and locking compression plate constructs for proximal interphalangeal joint arthrodesis in the horse.

    Science.gov (United States)

    Rocconi, Richard A; Carmalt, James L; Sampson, Sarah N; Elder, Steve H; Gilbert, Eric E

    2015-06-01

    This study compared in vitro monotonic and cyclic mechanical properties of equine proximal interphalangeal joint arthrodeses stabilized using an open or closed technique combined with axial 4.5 mm narrow limited-contact dynamic compression plate (LC-DCP) or 4.5 mm narrow locking compression plate (LCP). Ten forelimb pairs were randomly assigned to LCP or LC-DCP groups. One limb in each pair was assigned to either open or closed technique. Limbs were tested for cyclic fatigue at 20 000 cycles and then single-cycle to failure under 3-point dorsopalmar bending. There was no significant difference in stiffness of constructs during cyclic fatigue testing or on force or stiffness at failure in single cycle to failure testing between open and closed techniques or between plate types. Both implants, surgical technique, or combinations thereof are suitable for clinical use. More work is necessary to define the interaction between implant type and surgical technique.

  11. A System Approach to Navy Medical Education and Training. Appendix 21. Orthopedic Technician.

    Science.gov (United States)

    1974-08-31

    PHYSIOLOGICAL BASIS FOR THERAPY/TREATMENT TO PATIENT/ FAMILY 22 (EXPLAIN LUMBAR PUNCTURE PROCEDURES TO PATIENT 23 (1EXPLAIN MAJOR SURGICAL PROCEOURE...33 1AMPUTATION SCRUB 34 IDISARTICULATION SCRUB 35 IARTHRODESIS SCRUB 36 ITRIPLE ARTHRODESIS SCRUB 37 IMENISECTOMY SCRUP 38 IOPEN REDUCTION OF...ITENORRHAPHY CIRCULATE 15 IAMPUTATION CIRCULATE 16 IDISARTICULATION CIRCULATE 17 ARTHRODESIS CIRCULATE 18 ITRIPLE ARTHRODESIS CIRCULATE 19 IMENISECTOMY

  12. 后路内固定融合术治疗脊柱胸腰段骨折的效果分析%The Analysis in Arthrodesis Posterior Internal Fixation for the Treatment of Thoracic Lumbar Spine Fracture

    Institute of Scientific and Technical Information of China (English)

    丁鑫

    2015-01-01

    目的:分析脊柱胸腰段骨折的后路内固定融合术临床效果。方法选取80例脊柱胸腰段骨折患者,其中对照组采取前路手术内固定,观察组采取后路内固定融合术,对比两组临床疗效。结果观察组有效率、手术时间、失血量以及住院时间等明显优于对照组(P<0.05)。结论后路内固定融合术手术时间短、出血量少,疗效显著,具有临床应用价值。%Objective To analyze the clinical result of thoracolumbar spine fractures within posterior fixation and fusion.MethodsChoose 80 cases of thoracolumbar spine fractures patients,which control group take anterior fixation,the observation group taking posterior fixation and fusion, compared to clinical efficacy.Results The effective rate,operative time,blood loss and hospital stay in observation group was significantly better than the control group(P<0.05).Conclusion Posterior fixation and fusion surgery a short time,less blood loss,a significant effect,with clinical applications.

  13. Tratamiento mediante terapia de presión negativa VAC® de herida infectada tras artrodesis raquídea Treatment of infected wound secondary to spinal arthrodesis with negative pressure therapy VAC®

    Directory of Open Access Journals (Sweden)

    V. Yuste Benavente

    2011-12-01

    Full Text Available Las complicaciones cutáneas secundarias a artrodesis raquídea son un problema frecuente que requiere la colaboración de los Servicios de Cirugía Plástica y en cuyo tratamiento la terapia de presión negativa puede resultar útil. En este artículo presentamos el caso de un paciente afectado por metástasis vertebrales de adenocarcinoma gástrico que requirió artrodesis raquídea y desarrolló posteriormente una úlcera por presión dorsal debido al material implantado. El sistema VAC® permitió la limpieza y disminución de tamaño de la lesión, siendo posible la cobertura posterior de la misma con un colgajo miocutáneo de dorsal ancho. En este artículo discutimos la utilidad de la terapia de presión negativa en este tipo de lesiones.Cutaneous complications secondary to spinal fusion are a common problem that requires the collaboration of the Department of Plastic Surgery and in which negative pressure therapy treatment may be useful. In this paper we present the case of a patient with spinal metastases secondary to gastric adenocarcinoma that required spinal fusion and developed a dorsal pressure ulcer secondary to the implanted material. VAC® therapy system allowed cleaning the wound and decreasing the size of the injury, thus making it possible subsequently to cover it with a latissimus dorsi myocutaneous flap. In this paper we discuss the usefulness of negative pressure therapy in this type of injury.

  14. 四角融合术在治疗腕部疾患中的应用进展%Progress in application of four-corner arthrodesis for wrist disorders

    Institute of Scientific and Technical Information of China (English)

    覃励明; 徐永清; 申小青

    2007-01-01

    1984年Watson和Ballet在系统回顾4000多张腕部X线片后,提出了舟月进行性腕塌陷(scapholunate advanced collapse,SLAC)的概念,并系统描述了SLAC的临床表现、诊断和治疗方法,首次进行四角融合术(four—corner arthrodesis),即头状骨、月骨、三角骨和钩骨融合,是一种重建腕关节功能的部分腕骨融合手术方式,目前常常联合舟骨切除用于治疗各种原因引起的SLAC。

  15. 头、月、三角、钩骨局限性融合术治疗舟月骨进行性塌陷%Four-corner arthrodesis for the treatment of scapholunate advanced collapse (SLAC) wrist

    Institute of Scientific and Technical Information of China (English)

    刘璠; 卢魁; 朱鸣镝; 侍德

    2003-01-01

    目的介绍治疗伴严重腕痛舟月骨进行性塌陷(scapholunate advanced collapse, SLAC))的新术式.方法 11例均为伴有严重腕痛、握力显著下降、腕关节功能受限的Ⅲ期舟月骨进行性塌陷的患者.入院后均行SLAC腕重建术(头、月、三角、钩骨局限性融合).结果术后随访7个月~ 3年半,以最后1次随访结果为准,优7例,良2例,可1例,差1例.除差的1例外,10例的腕痛完全消失或基本消失,平均握力恢复至健侧的80%,腕关节活动范围为健侧的51%. 结论 SLAC腕重建术是治疗Ⅲ期疼痛性舟月骨进行性塌陷的一种可靠的挽救性手术,术后能恢复握力、保留腕关节功能.

  16. 外固定架在先天马蹄内翻足截骨融合术中的应用%Usage of extrafixator in triple arthrodesis for treatment of talips equino varus

    Institute of Scientific and Technical Information of China (English)

    陈秋生; 朱立新; 钟菁; 陈霞; 童斌辉; 谢炳贤

    1999-01-01

    对于12岁以上先天马蹄内翻足患者的治疗,国内外传统的方法是足跗三关节截骨结合石膏固定融合术.但此法容易造成截骨面移动或不融合,不易观察足的血液循环,同时容易残留或复发畸形.自1978年以来,我科应用自行设计的外固定架,固定足跗三关节截骨融合术,克服了上述弊端,使病人的患足外观基本正常,恢复三点负重,达到足的稳定步态.共治疗18例(23足),随访14例(17足),平均随访3年8个月,优良率94%.本方法操作简单、观察方便、效果好,值得推广.为此,本文就外固定架应用原理进行讨论.

  17. 65岁以上老年患者腰椎融合术后的结果%Outcome of Lumbar Arthrodesis in Patients Sixty-five Years of Age or Older

    Institute of Scientific and Technical Information of China (English)

    Steven D.Glassman; Leah Carreon; John R.Dimar; 夏志敏; 周辉

    2011-01-01

    背景:有关老年患者腰椎融合术的价值在以往的文献中报道不多.大多数文献都集中于关注老年患者腰椎融合术并发症的发生率,本研究试图通过与年轻患者的比较,明确老年患者腰椎融合术的临床结果.方法:我们对224例患者进行了单节段腰椎后外侧融合,术中均采用髂骨植骨.结果的评价指标包括Oswestry功能障碍指数(ODI)、整体健康状况36项简明调查问卷(MOS SF-36),腰背痛和腿痛的数字量表,以及融合情况的X线评价.根据患者的平均值变化以及达到临床重要差异最小阈值患者的百分比来对临床结果进行评价.作为比较,将这些患者分为两组:年龄小于65岁者174例和年龄65岁或65岁以上者50例.结果:在6个月、1年以及2年时,和基线水平相比,所有患者临床和健康相关的生活质量评价均有明显的改善.术后2年时老年患者ODI评分平均改善28.5分,年轻患者为24.5分.SF-36身体状态部分的总分,术后2年时老年组相对基线水平平均改善14.2分,年轻组为11.7分.同样,腰背痛和腿痛的数字量表在各个时期的改善程度,老年组均与年轻组类似或更好,术后2年时腿痛评分的差异有统计学意义(老年患者为10.4,年轻患者为6.4;p=0.002).围手术期的并发症虽然人们对此很有顾虑,但是从术后2年时的情况来看,其并未对临床和健康相关生活质量的结果产生明显的不良影响.结论:本研究显示对椎间盘退变性疾病行腰椎单节段减压内固定融合可使年龄65岁以上的患者明显受益,我们认为对这些患者只要进行适当的筛选,腰椎融合术仍可以作为一个有效且可行的治疗选择.

  18. Comparison of complications between morbid obesity and normal weight patients with lumbar arthrodesis%肥胖和正常体质量腰椎融合患者并发症的比较*★

    Institute of Scientific and Technical Information of China (English)

    姜宇; 朱国兴; 杨玉生

    2013-01-01

      背景:肥胖可使脊柱尤其是腰椎退化,随着肥胖发病率的增加,肥胖患者发生腰椎外科的手术日益增多,有关的研究表明,肥胖可能增加腰椎融合的并发症,尤其是伤口感染。目的:分析肥胖是否改变接受腰椎融合患者并发症的概率。方法:纳入行腰椎单节段融合的患者(包括正常体质量和肥胖患者)268例为样本,将腰椎融合了分为两种类型:前路腰椎融合和后路腰椎融合,用切除自体的髂前上棘的松质骨行椎间植骨,美敦力枢法模的钛棒固定,探查硬膜前方无碎骨屑后移,切口放置引流,逐层关闭。腰椎融合后预防感染对症治疗,分别就患者的不同并发症方面的数据进行统计学分析。结果与结论:268例中104名为肥胖患者。肥胖患者的并发症包括有心脏、肾、肺、伤口并发症等,以伤口并发症和肺部并发症为主,与正常体质量患者比较,差异均有显著性意义(P 0.05)。说明肥胖增加了腰椎融合手术并发症的风险,但在前后路腰椎不同融合方法中对患者的影响差别不大。%BACKGROUND: Morbid obesity can result in lumbar and spinal degeneration, especial y the lumbar spine degeneration. Related studies have shown that morbid obesity may increase complications of the lumbar fusion, especial y wound infection. OBJECTIVE: To analyze whether morbid obesity can alter the rates of complications in patients undergoing lumbar fusion. METHODS: 268 patients (including normal weight patients and morbid obese patients) undergoing lumbar single segment fusion were selected as samples. The lumbar and spinal fusion was divided into two types: anterior lumbar fusion and posterior lumbar fusion. The cancel ous bone with autologous anterior superior iliac spine was treated with intervertebral bone grafting, and fixed with Medtronic Sofamor titanium rod. The detection found that there was no bone fragments crumbs backward in the anterior dura mater, then the drainage was placed in the incision and closed layer by layer. Symptomatic treatment was performed to prevent infection after lumbar fusion, and the data of the different complications were statistical y analyzed. RESULTS AND CONCLUSION: Among total 268 patients, 104 patients were morbidly obese. The complications of morbidly obese patients included cardiac, renal, pulmonary and wound complications, among them, wound and pulmonary complications were the main complications. There were significant differences in the complications between normal weight patients and morbidly obese patients (P 0.05). Morbid obesity increases the risk of complications in lumbar and spinal fusion surgery, but has no different effects between the patients with anterior lumbar fusion and posterior lumbar fusion.

  19. Anterior debridement and interbody arthrodesis with posterior pedicle screw instrumentation for the treatment of tuberculosis of the lower lumbar spine%一期前后路联合手术治疗下腰椎结核

    Institute of Scientific and Technical Information of China (English)

    马君; 宋滇文; 邵将; 刘伟; 宋佳; 贾连顺

    2010-01-01

    [目的]评价一期前路经腹直肌旁腹膜后人路行病灶清除、自体髂骨植骨融合、后路椎弓根螺钉短节段固定融合治疗下腰椎单节段结核的手术疗效.[方法]2002年6月~2007年1月,本组采用该术式治疗下腰椎单节段结核27例.[结果]手术时间平均4.3 h,手术平均出血量438 ml.前路手术切口长度5~7 cm,前路显露时间平均21min,显露过程平均出血量48 ml.术后随访12~37个月,术前病变节段前凸角-2.1°±4.0°,术后4.9°±1.4°,最后随访时3.7°±3.0°.所有病例全部治愈,未发生结核复发,植骨融合率100%.[结论]前路经腹直肌旁腹膜后入路可满意显露病灶、操作简便、创伤小.后路椎弓根螺钉短节段固定融合使脊柱达到即刻稳定的同时减少正常运动节段的牺牲.该术式是治疗下腰椎结核安全、有效的方法.

  20. Evidence for Use of Bone Morphogenetic Protein in Lumbar Spine Arthrodesis%骨形态发生蛋白在腰椎融合中作用的临床证据

    Institute of Scientific and Technical Information of China (English)

    刘熹; 舒德芬; 李涛; 刘浩

    2008-01-01

    目的 探讨骨形态发生蛋白应用于腰椎融合术的效果、成本及最佳应用方案.方法 按照PICO原则,针对患者的临床问题,计算机检索ACP Journal Club(1991~2008.2)、Cochrane图书馆(2007年第4期)、PubMed(1990~2008.2)及其他相关数据库,收集关于骨形态发生蛋白临床应用的系统评价、临床随机对照试验及卫生经济学评价等,并对所获证据质量进行评价.结果 现有证据显示骨形态发生蛋白用于腰椎前路椎体间融合和后外侧融合具有良好的诱导融合效果,其安全性等于或高于自体髂骨,产生的直接成本与自体髂骨相当.目前用于临床的骨形态发生蛋白种类为BM-P2和BMP-7,推荐用法为前路椎体问融合使用固定搭配的成品,后外侧融合BMP-2每侧20 mg,BMP-7每侧3.5 mg,载体类型根据融合方式有所不同.结论 国内可尝试引进骨形态发生蛋白用于腰椎融合手术.但要广泛应用于临床还需要专门针对国人的大规模高质量临床随机对照研究作为依据,同时也需要进一步的研究来确定用于国人的最佳剂量和剂型.

  1. The clinical study of the 360° annular arthrodesis (PLIF+PLF) in curing adult lumbar spondylolisthesis%360°环形融合术(PLIF+PLF)在成人腰椎滑脱中的临床研究

    Institute of Scientific and Technical Information of China (English)

    曾水平; 黄冬莲; 郭建中; 宋卫平; 傅萍; 王勇; 朱令孝

    2013-01-01

    目的 探讨360°环形融合术(PLIF+PLF)治疗成人腰椎滑脱的临床疗效.方法 选择2004~2012年于我院接受手术治疗的96例腰椎滑脱患者,随机分为360°环形融合术(PLIF+PLF)组和后外侧融合术(PLF)组,每组48例,回顾性分析并比较两组患者在腰椎融合率、腰椎前凸角、JOA评分改善率的差异.结果 360°环形融合术组患者的腰椎融合率、腰椎前凸角、JOA评分改善率优于后外侧融合术组,两组相比差异显著(P<0.05).结论 360°环形融合术治疗成人腰椎滑脱能更好地保持腰椎生理前凸,获得更高的腰椎融合率,提高JOA评分,值得进一步探讨和推广.

  2. 65岁及以上年龄患者腰椎融合术后的结果%Outcome of Lumbar Arthrodesis in Patients Sixty-five Years of Age or Older

    Institute of Scientific and Technical Information of China (English)

    Steven D.Glassman; David W.Polly; Christopher M.Bono; Kenneth Burkus; John R.Dimar; 李锋; 杨彩虹

    2009-01-01

    背景:腰椎融合术在老年患者中的治疗价值尚无定论.大多数文献是关于老年患者腰椎融合术后并发症发生率的报道,而本文的目的是比较年轻患者与老年患者腰椎融合术后的临床结果. 方法:我们研究224例用髂骨植骨行后外侧单节段腰椎融合术的患者.结果的评定方法包括Oswestrt功能障碍指数(Oswestry disability index,ODI)、医学健康测量简表-36、腰腿痛数字等级记量表,同时以X线片评估融合情况.结果评定基于平均改变值和达到最小重要临床差别的患者百分比.作为比较,患者被分为两组:174例年龄低于65岁和50例年龄65岁及以上. 结果:记录所有临床上的实质性改善,以6个月、1年、2年为间隔进行健康相关生活质量检测.术后2年ODI评分的平均改善分数:老年患者为28.5分,较年轻患者为24.5分.简表-36生理部分简要评分平均改善分数:老年组为14.2分,较年轻组为11.7分.在全部时间间隔中数字等级评定记量表和腰腿痛分数的评定结果也显示老年具有相似或者更大的改善,术后2年的腿痛评分则有显著性差异(老年患者为10.4分,较年轻患者为6.4分,p=0.002).虽然围手术期并发症明显令人担心,但术后2年临床和健康相关的生活质量结果并未显示出不良影响. 结论:本研究显示对65岁及以上的退行性腰椎间盘疾病的患者采用单节段腰椎减压及内固定融合术具有确切的治疗效果.我们认为,只要正确选择适应证,对65岁及以上者采用这种治疗合理且有意义.

  3. The application of posterior oblique lumbar arthrodesis for degenerative spondylolisthesis%后路椎弓根钉棒复位椎间融合器固定术治疗腰椎退行性滑脱

    Institute of Scientific and Technical Information of China (English)

    张强; 邹德威; 海涌; 马华松; 白克文

    2006-01-01

    目的:探讨应用后路椎弓根钉棒复位椎间融合器固定术(简称为后路斜方向腰椎椎间关节固定术,POLAr)治疗退行性腰椎滑脱的临床效果.方法:应用POLAr治疗46例腰背痛及下肢根性疼痛的腰椎退行性滑脱患者,术前和术后对患者进行视觉疼痛评分(visual analogue pain score,VAS)、腰功能评分(low back outcome score,LBOS)和手术满意度问卷调查,评价治疗效果.结果:随访12~60个月,平均28.5个月.术前VAS和LBOS评分分别是6.2±2.5分和23.6±16.5分,随访时为2.3±1.8分(P<0.01)和48.4±20.2分(P<0.01).46例患者中43例(93%)认为手术效果优良.滑脱由术前28.6%减少到术后的3.7%(P<0.01).腰椎前凸由术前平均12.1°改善到术后的18.2°(P<0.01),没有与器械相关的并发症发生.结论:后路斜方向腰椎椎间关节固定术是一种安全有效的治疗退行性腰椎滑脱的手术方法.

  4. Nursing intervention affect orthopaedic spinal arthrodesis in patients with lumbar spine disease%护理干预对骨科腰椎疾病脊柱融合术患者的影响

    Institute of Scientific and Technical Information of China (English)

    蒲玉梅

    2013-01-01

    Objective To explore the nursing intervention in patients with lumbar disease clinical effect of spinal fusion surgery and rehabilitation. Methods Spinal fusion for lumbar diseases patients 140 cases, odd-even order divided into experimental group and the control group (n=70),control group routine treatment and nursing, the experimental group on the basis of the control group to give psychological guidance, pain nursing, exercise training intervention, etc. Results Postoperative pain intensity significantly reduced than the control group, experimental group patients physical rehabilitation effect is obviously better than control group, two groups compared significant difference (P<0.01). Conclusion Nursing intervention can significantly reduce postoperative pain in patients, promote patient's rehabilitation, so as to improve patients quality of life.%  目的探讨护理干预在腰椎疾病患者脊柱融合术术后康复中的临床作用。方法将140例有腰椎疾病行脊柱融合术的患者按奇偶顺序分成试验组及对照组各70例,对照组采取常规治疗和护理,试验组在对照组基础上给予心理指导、疼痛护理、运动训练等干预。观察2组患者术后疼痛强度及康复效果。结果试验组患者术后疼痛强度明显比对照组降低,身体康复效果明显优于对照组,2组比较差异显著(P<0.01)。结论护理干预可以明显降低腰椎疾病患者的术后疼痛,促进康复,提高患者的生活质量。

  5. 经椎板关节突螺钉固定治疗下腰椎不稳%Facet joint arthrodesis with translaminar screw fixation for low lumbar instability

    Institute of Scientific and Technical Information of China (English)

    白成宝; 郭文娟; 刘铁军; 阿扎提

    2008-01-01

    目的 探讨关节突螺钉固定在下腰椎退行性不稳定患者手术中应用的临床效果.方法 对19例退行性腰椎不稳患者采用后路椎板开窗减压,椎间植骨融合,经椎板关节突螺钉固定.结果 19例随访6~36个月(平均21个月),椎间植骨融合率6个月时为86%,1年时为93%,临床症状消失,满意率92%.未出现断钉.结论 采用后路椎板减压,经椎板关节突螺钉固定加椎间植骨能提高椎间融合率,使小关节稳定,解除临床症状.

  6. 后路斜向腰椎关节固定术治疗腰椎退行性不稳%Application of posterior oblique lumbar arthrodesis (POLAr) methods in degenerated lumbar spine instability with foraminal stenosis

    Institute of Scientific and Technical Information of China (English)

    张强; 邹德威; 马华松; 海涌

    2006-01-01

    [目的]探讨应用后路斜向腰椎关节固定术(POLAr)治疗腰椎退行性不稳并神经根管狭窄的治疗效果.[方法]采用后路腰椎侧后方对神经根管彻底减压,后路斜向腰椎关节固定术,治疗腰椎退行性不稳并神经根管狭窄患者80例,男28例,女52例;平均年龄58.5岁;其中融合2个节段者56例,3个节段者20例,4个节段者4例.[结果]全部患者均安全完成手术,未出现神经系统并发症,术前症状完全缓解.经6个月~6 a(平均2 a)随访,除5例患者外都获得了牢固的椎间骨性融合;临床疗效:优62例,良15例,可3例,优良率95%.[结论]采用后路斜向腰椎关节固定术(POLAr)治疗腰椎退行性不稳,能够恢复椎间高度,重建腰椎轴向排列和载荷,能尽可能地保留脊柱后部结构,保持了脊柱的稳定性,植骨融合牢固,POLAr术式是一种有效治疗退变性腰椎不稳神经根管狭窄的手术方法.

  7. Scapholunate advanced collapse and scaphoid nonunion advanced collapse arthritis--update on evaluation and treatment.

    Science.gov (United States)

    Strauch, Robert J

    2011-04-01

    Scapholunate advanced collapse (SLAC) and scaphoid nonunion advanced collapse are common patterns of wrist arthritis. Scaphoid nonunion advanced collapse is caused by trauma, whereas SLAC wrist may also result from chronic pseudogout and can appear bilaterally without a clear history of injury. Surgical treatment for SLAC wrist includes 4-corner arthrodesis, capitolunate arthrodesis, complete wrist arthrodesis, proximal row carpectomy (PRC), denervation, and radial styloidectomy. Scaphoid nonunion advanced collapse wrist has the additional surgical option of excision of the distal ununited scaphoid fragment. Controversy persists over the relative merits of PRC versus 4-corner arthrodesis and whether PRC may be performed in the setting of capitate arthritis.

  8. Limb salvage after infected knee arthroplasty with bone loss and extensor mechanism deficiency using a modular segmental replacement system.

    Science.gov (United States)

    Namdari, Surena; Milby, Andrew H; Garino, Jonathan P

    2011-09-01

    Multiple total knee arthroplasty revisions pose significant surgical challenges, such as bone loss and soft tissue compromise. For patients with bone loss and extensor mechanism insufficiency after total knee arthroplasty, arthrodesis is a treatment option for the avoidance of amputation. However, arthrodesis is both difficult to achieve in situations with massive bone loss and potentially undesirable due to the dramatic shortening that follows. Although intramedullary nailing for knee arthrodesis has been widely reported, this technique has traditionally relied on the achievement of bony union. We report a case of a patient with massive segmental bone loss in which a modular intercalary prosthesis was used for arthrodesis to preserve limb length without bony union.

  9. The Sauvé-Kapandji procedure: indications and tips for surgical success.

    Science.gov (United States)

    Lluch, Alberto

    2010-11-01

    Arthrodesis is the most reliable and durable surgical procedure for the treatment of a joint disorder, with the main disadvantage of loss of motion of the fused joint. The distal radioulnar joint can be arthrodesed, while forearm pronation and supination are maintained or even improved by creating a pseudoarthrosis of the ulna just proximal to the arthrodesis. This is known as the Sauvé-Kapandji procedure. This procedure is not void of possible complications, such as nonunion or delayed union of the arthrodesis, fibrous or osseous union at the pseudoarthrosis, and painful instability at the proximal ulna stump. All of these can be prevented if a careful surgical technique is used.

  10. Osteoarthritis

    Science.gov (United States)

    ... fusion of bones, often in the spine ( arthrodesis ) Total or partial replacement of the damaged joint with an artificial joint ( knee replacement , hip replacement , shoulder replacement , ankle replacement , elbow replacement )

  11. 78 FR 66942 - Orthopaedic and Rehabilitation Devices Panel of the Medical Devices Advisory Committee; Notice of...

    Science.gov (United States)

    2013-11-07

    ... promote intervertebral body fusion. During the arthrodesis procedure, they are to be used with bone graft... under the heading of ``Intervertebral Fusion Device with Bone Graft, Solid-Sphere, Lumbar'',...

  12. A Study to Determine the Best Approach for Conducting a Formal Ambulatory Surgery Program at William Beaumont Army Medical Center, El Paso, Texas

    Science.gov (United States)

    1982-05-01

    ORTHGPEDIC Amputation, Toes, Fingers- Amputation Revision, Arm% Leg Amputation Revision, Toes, Fingers Arthrodesis Arthroplasty -Arthroscopy- Diagnostic... Lumbar Sympathetic Nerve Blocks - Stellate 0 APPEINDIX B Physician Questionnaire (Býank) AMBULATORY SURGERY QUESTIONNAIRE (Please Type or Print

  13. Evolution of Oswestry 2.0 questionnaire and the physical component (PCS) of SF-36 during the first postoperative year of lumbar spine fusion in degenerative diseases

    OpenAIRE

    Alexandre Henrique Silveira Bechara; Guilherme Rebechi Zuiani; Marcelo Ítalo Risso Neto; Paulo Tadeu Maia Cavali; Ivan Guidolin Veiga; Wagner Pasqualini; Elcio Landim

    2013-01-01

    OBJECTIVE: Assess the clinical improvement of patients undergoing decompression and posterolateral lumbar arthrodesis for degenerative diseases, evaluating the evolution of the scores of Oswestry 2.0 questionnaire and the physical component (PCS) of the SF-36 scale. METHODS: Prospective study of 19 patients with degenerative disc disease (disc herniation, lumbar stenosis or degenerative spondylolisthesis) that underwent decompression and posterolateral arthrodesis. All patients included in ou...

  14. Salvage procedures for degenerative osteoarthritis of the wrist due to advanced carpal collapse.

    Science.gov (United States)

    De Smet, Luc; Degreef, Ilse; Robijns, Filip; Truyen, Jan; Deprez, Patrick

    2006-10-01

    Arthrodesis of the wrist has been considered as the gold standard for osteoarthritis of the wrist. In 1984 Watson and Ballet identified a specific pattern of carpal collapse (scapholunate advanced collapse = SLAC) with progressive osteoarthritis. In order to preserve some motion, other alternative procedures have been proposed: proximal row carpectomy (PRC) and scaphoidectomy combined with a four-corner arthrodesis (4CA). In this cohort of 63 patients, three types of surgical treatment were performed (arthrodesis in 19, PRC in 26 and scaphoidectomy with 4CA in 18). The DASH questionnaire was used to evaluate the residual disability. PRC had a significantly better outcome (DASH=16), while there were no significant differences between full arthrodesis (DASH=45) and four corner arthrodesis (DASH=39). In PRC and in four corner arthrodesis a functional range of motion could be preserved (resepectively 44 degrees and 52 degrees flexion/extension arc). Gripping force remained inferior to the non operated side. There was a significant increase in gripping force in the PRC group, but not in the others. The final gripping force was not significantly different in the three treatment regimes.

  15. The mid-term outcome of total ankle arthroplasty and ankle fusion in rheumatoid arthritis: a systematic review

    Science.gov (United States)

    2013-01-01

    Background While arthrodesis is the standard treatment of a severely arthritic ankle joint, total ankle arthroplasty has become a popular alternative. This review provides clinical outcomes and complications of both interventions in patients with rheumatoid arthritis. Methods Studies were obtained from Pubmed, Embase and Web of Science (January 1980 – June 2011) and additional manual search. Inclusion criteria: original clinical study, > 5 rheumatoid arthritis (population), internal fixation arthrodesis or three-component mobile bearing prosthesis (intervention), ankle scoring system (outcome). The clinical outcome score, complication- and failure rates were extracted and the methodological quality of the studies was analysed. Results 17 observational studies of 868 citations were included. The effect size concerning total ankle arthroplasty ranged between 1.9 and 6.0, for arthrodesis the effect sizes were 4.0 and 4.7. Reoperation due to implant failure or reoperation due to non-union, was 11% and 12% for respectively total ankle arthroplasty and arthrodesis. The methodological quality of the studies was low (mean 6.4 out of a maximum of 14 points) and was lower for arthrodesis (mean 4.8) as compared to arthroplasty (mean 7.8) (p = 0.04). Conclusions 17 observational and no (randomized) controlled clinical trials are published on the effectiveness of arthroplasty or arthrodesis of the ankle in rheumatoid arthritis. Regardless of the methodological limitations it can be concluded that both interventions show clinical improvement and in line with current literature neither procedure is superior to the other. PMID:24161014

  16. Opção minimamente invasiva lateral para artrodese intersomática tóraco-lombar Opción mínimamente invasiva lateral para artrodesis intersomática toracolumbar Minimally invasive lateral option for thoracic-lumbar intersomatic arthrodesis

    Directory of Open Access Journals (Sweden)

    Rodrigo Amaral

    2011-01-01

    Full Text Available OBJETIVO: O objetivo deste artigo é mostrar resultados clínicos e radiográficos do acesso lateral transpoas na experiência brasileira em condições degenerativas do disco intervertebral. MÉTODOS: 46 pacientes foram submetidos à fusão intersomática lombar por via lateral. Dentre os casos, 18 eram do sexo masculino e 28 do sexo feminino, com idade média de 57,3 (84-32 anos e média de IMC de 25,9 ± 3,1. Todos os pacientes completaram um ano de acompanhamento. Foram coletados exames radiológicos, como raio X e tomografia computadorizada, exame neurológico e resultados clínicos usando os questionários ODI e VAS (costas e membros inferiores. RESULTADOS: Os procedimentos foram realizados, sem ocorrência de complicações intra-operatórias importantes, em uma média de 103,9 ± 105,5 minutos e com menos de 50cc de perda sanguínea. Em oito dos 46 procedimentos (17,4% foi utilizada suplementação por parafusos pediculares percutâneos por apresentarem instabilidade segmentar. Foram tratados 80 níveis (de um a cinco níveis tóraco-lombares (de T12-L1 a L4-L5. Os resultados clínicos avaliados pelos questionários revelaram melhora significante de dor logo após uma semana da cirurgia e da função física após seis semanas. A lordose lombar foi de 36,5 ± 14,7 no pré-operatório para 43,4 ± 12,4 no seguimento de 12 meses. Todos os pacientes apresentaram formação óssea após 12 meses da cirurgia. Sete casos foram revisados (15,2%, ainda de forma minimamente invasiva devido à estenose persistente (três casos; 6,5%, afundamento do espaçador (três casos; 6,5% ou mal-alinhamento de barra da suplementação (um caso; 2,8%. CONCLUSÕES: Com melhora de parâmetros clínicos e radiológicos, a técnica se mostrou segura e eficaz no tratamento de condições degenerativas da coluna lombar.OBJETIVO: El objetivo de este artículo es mostrar resultados clínicos y radiográficos del acceso lateral transpolar, en la experiencia brasileña, en condiciones degenerativas del disco intervertebral. MÉTODOS: 46 pacientes fueron sometidos a fusión intersomática lumbar por vía lateral. Dentro de los casos, 18 eran del sexo masculino y 28 del sexo femenino, con edad promedio de 57,3 años (84-32 y promedio de IMC de 25,9 ± 3,1. Todos los pacientes completaron un año de acompañamiento. Fueron realizados exámenes radiológicos, como rayos X y tomografía computadorizada, examen neurológico y se obtuvieron resultados clínicos usando los cuestionarios ODI y VAS (espaldas y miembros inferiores. RESULTADOS: Los procedimientos fueron realizados, sin ocurrencia de importantes complicaciones intraoperatorias, en un promedio de 103,9 ± 105,5 minutos y con menos de 50 cc de pérdida sanguínea. En ocho de los 46 procedimientos (17,4% se utilizó suplementación mediante tornillos pediculares percutáneos porque se presentaba instabilidad de segmento. Se trataron 80 niveles (de uno a cinco niveles toracolumbares (de T12-L1 a L4-L5. Los resultados clínicos, a los que se tuvo acceso por los cuestionarios, revelaron mejoría significativa del dolor, luego después de una semana de la cirugía y mejor función física después de 12 meses. La lordosis lumbar fue 36,5 ± 14,7 en el preoperatorio yendo para 43,4 ± 12,4 durante el seguimiento de 12 meses. Todos los pacientes presentaron formación ósea después de 12 meses de la cirugía. Siete casos tuvieron nueva intervención (15,2%, aunque de manera mínimamente invasiva, debido a la estenosis persistente (tres casos; 6,5%, hundimiento del espaciador (tres casos; 6,5% o mala alineación de la barra de suplementación (un caso; 2,8%. CONCLUSIONES: con mejora de parámetros clínicos y radiológicos, la técnica se mostró segura y eficaz en el tratamiento de condiciones degenerativas de la columna lumbar.OBJECTIVE: The purpose of this article is to show clinical and radiological results of lateral transpsoas approach for degenerative conditions of intervertebral disc in Brazilian practice. METHODS: 46 patients have undergone lateral lumbar intersomatic fusion. Eighteen patients were male and 28 female. The mean age was 57.3 years (32 to 84 years, and mean BMI was 25.9 ± 3.1. All patients were followed up during one year. Radiology tests, such as X-ray and CT, and neurological tests were performed. The clinical results were obtained using ODI and VAS (back and leg questionnaires. RESULTS: The procedures were performed during an average time of 103.9 ± 105.5 minutes, and less than 50 mL of blood loss occurred. Also, no significant intraoperative complication occurred. Supplementation with percutaneous pedicle screws due to segmental instability was used in eight of the 46 procedures (17.4%. Eighty thoracic-lumbar (from T12-L1 to L4-L5 levels (from one to five were treated. According to the questionnaires, the clinical results showed significant pain and physical function improvement after one week and six weeks of surgery, respectively. The lumbar lordosis changed from 36.5 ± 14.7 before surgery to 43.4 ± 12.4 during one year follow-up. All patients showed bone formation 12 months after surgery. Seven cases were revised (15.2%, using minimally invasive approach due to persistent stenosis (three cases, 6.5%, depressed spacer (three cases, 6.5%, and malalignment of supplemental rod (one case, 2.8%. CONCLUSIONS: This technique showed to be a safe and efficacious treatment for degenerative diseases of lumbar spine as demonstrated by the improvement of clinical and radiological parameters.

  17. 创伤性踝关节炎:人工踝关节置换术与踝关节融合术的早期疗效对比%Treatment of post-traumatic ankle arthritis: arthrodesis versus total ankle replacement in early-stage outcome

    Institute of Scientific and Technical Information of China (English)

    赵学良; 路星辰; 陈贤明; 王子明; 王爱民

    2015-01-01

    目的 对在创伤性踝关节炎的手术治疗中,传统的踝关节融合术与踝关节置换术这两种手术方式的早期疗效进行对比研究.方法 回顾性研究收集自2009年3月-2014年10月在我院因创伤性踝关节炎行手术治疗的患者55例(56踝),平均年龄为51.2岁,平均随访35.3(3 ~68)个月.分别将采用人工全踝关节置换术、踝关节融合外支架固定术、踝关节融合内固定术的患者分为3组,其中行人工踝关节置换术的患者14例(14踝),平均随访35.4(7 ~67)个月;行踝关节融合外支架固定术的患者18例(19踝),平均随访31.2(3 ~68)个月;行踝关节融合内固定组的患者23例(23踝),平均随访38.8(10 ~58)个月;对3组患者分别在术前、术后使用美国骨科足踝协会后足评分(AOFAS)、SF-36评分、关节活动度(ROM)进行分析评价,对术后并发症进行统计分析,比较踝关节置换术与融合术的早期疗效.结果 55例患者均获得随访,踝关节置换术组术后AOFAS评分为72.92±5.42,SF-36评分为79.42±4.23,踝关节融合组(外支架固定)术后AOFAS评分为69.36±3.21,SF-36评分为67.78±4.51,踝关节融合(内固定)术后AOFAS评分为67.41±6.49,SF-36评分为72.86±6.37,3组均较术前评分有明显改善(P<0.05),且踝关节置换组在术后各评分较融合组高,踝关节置换组术后踝关节活动度为(32.1±4.7)°较术前明显改善.随访3组并发症的发生分别为2例、4例(外固定组)、3例(内固定组),早期并发症发生率差异没有统计学意义(P>0.05).结论 在创伤性关节炎的手术治疗中,人工踝关节置换术较踝关节融合术在早期内对病患的生活质量改善更明显,没有增加相应的术后并发症.

  18. Mid-term results after midcarpal arthrodesis using an iliac crest cortical chip for grade II/III SLAC/SNAC-wrists [Mittelfristige Ergebnisse nach mediokarpaler Teilarthrodese mit kortikospongiösem Beckenkammspan bei SLAC/SNAC-wrist Grad II/III

    Directory of Open Access Journals (Sweden)

    Zeplin, Philip H.

    2013-06-01

    Full Text Available [english] Purpose: The four-corner-fusion is an option for grade II/III SNAC-/SLAC-wrists. The case-control study evaluates the results of a four-corner-f with a screw-fixed iliac crest cortical chip. Methods: Ten patients with SNAC/SLAC-wrist ≥ grade II were treated. The evaluation occurred after 24 months using a standard study protocol. Results: The mean postoperative active range of motion were 46% (extension/flexion and 52% (radial/ulnar deviation of the contralateral wrist respectively. The postoperative mean grip strength was 43% of the contralateral side, and 84% compared to the preoperative values. The mean Cooney-Bussey Score was 63 and the mean DASH score was 25 (p≤0.05. Four of the patients (40% had to undergo a partial removal of the osteosynthetic material because of radiodorsal impingement. Conclusions: The four-corner fusion using an iliac crest cortical chip represents an alternative operating procedure for treatment, even though the period of immobilisation cannot be reduced. [german] Hintergrund: Die mediokarpale Teilarthrodese stellt eine anerkannte Behandlungsmethode bei karpalen Kollaps nach Skaphoidpseudarthrose (SNAC-wrist oder nach Ruptur des skapholunären Bandes (SLAC-wrist dar. Anhand der vorliegenden Fall-Kontrollstudie wurden die Ergebnisse nach mediokarpaler Teilarthrodese unter Verwendung eines kortikospongiösen Beckenkammspanes evaluiert. Material und Methoden: Zehn Patienten wurden 24 Monate nach mediokarpaler Teilarthrodese bei mit SLAC/SNAC-wrist Grad II/III mit einem kortikospongiösen Beckenkammspan nachuntersucht. Ergebnisse: Das mittlere postoperative Bewegungsausmaß des Handgelenkes betrug für Extension/Flexion 46% und für Radial-/Ulnaradduktion 52% im Vergleich zur unbehandelten Gegenseite. Die postoperative Griffstärke betrug im Mittel 43% der Gegenseite und 84% der präoperativen Werte. Der mittlere Cooney-Bussey-Score lag bei 63, der mittlere DASH-Score bei 25 (p≤0.05. Bei vier Patienten (40% erfolgte eine partielle Entfernung des Osteosynthesematerials aufgrund eines radiodorsalen Impingements. Schlussfolgerung: Die mediokarpale Teilarthrodese mit einem kortikospongiösen Beckenkammspan stellt eine mögliche Behandlungsalternative dar, obwohl die Dauer der Immobilisation nicht reduziert werden kann.

  19. 单枚cage置入结合单侧侧后方植骨融合加椎弓根螺钉固定治疗腰椎滑脱症%Treatment of lumbar spondylolisthesis with transpedicle instrument fixation system, mono-cage and semi-intertransverse process arthrodesis with bone grafting

    Institute of Scientific and Technical Information of China (English)

    梅荣成; 廉凯; 丁援建; 王明才; 莫树喜; 涂万荣

    2008-01-01

    目的 探讨单枚cage斜向置入结合对侧侧后方植骨融合加椎弓根螺钉固定治疗腰椎滑脱症的临床疗效.方法 对42例腰椎滑脱患者行后路减压和椎弓根螺钉固定,单侧斜向放置单枚cage,对侧侧后方植骨融合治疗,随访观察患者的症状、体征改善程度、融合率和手术节段椎间隙高度的变化.结果 所有患者均获得随访,时间2年~4年5个月,临床疗效综合评价:优32例,良5例,可3例,差2例.症状改善率92.9%.患者满意程度为88%,融合率为90.5%,最终随访时椎间隙高度平均减少1.5 mm.未出现螺钉折断和明显的复位丢失现象.结论 单枚cage置入结合对侧侧后方植骨融合加椎弓根螺钉固定治疗腰椎滑脱症对后柱破坏少,具有较高稳定性.

  20. 肥胖和正常体重对腰椎融合产生的并发症的影响比较%Comparison of the effect of the complications between morbid obesity and normal weight on the lumbar Arthrodesis

    Institute of Scientific and Technical Information of China (English)

    姜宇; 杨玉生; 朱国兴

    2012-01-01

      OBJECTIVE: This study analyzes whether morbid obesity alters rates of complications in patients undergoing lumbar fusion.DESIGN: A retrospective case analysis.TIME AND SETTING: This study was a retrospective case analysis and performed at the Department of Orthopedics of Wuxi No2 hospital from January 2007 to January 2010.PARTICIPANTS:In a total of 167 patients in the selection of study. The outcome of morbidly obese(52 cases) and normal weight (115 cases) were retrospectively reviewed and analyzed at a folow-up of 2years.METHODS: Our study to identify normal weight and morbidly obese patients for 2 types of spinal fusion: anterior lumbar fusion and posterior lumbar fusion. Comorbidity and complications data were colected. Multivariate logistic regression was performed.RESULTS: In total 167 admissions were identified, of which 52 were morbidly obese. Morbid obesity was associated with 87% higher in-hospital complication rates (11.6% vs. 5.3%), the complication types nearly al include cardiac, renal, pulmonary, wound complications, among others. Al effects were less pronounced in anterior lumbar fusions. On multivariate analysis, morbid obesity was the most significant predictor of complications in posterior lumbar fusion groups. CONCLUSION: Morbid obesity increase the risk of multiple complication types in lunbar fusion surgery, most particularly in posterior lumbar approaches.%  目的:本研究分析病态肥胖是否改变接受腰柱融合患者并发症的几率。方法:我们选择从2007年至2010年之间的做腰椎融合的患者(包括正常体重和病态肥胖病人)为样本,将腰柱融合了分为两种类型:前路腰椎融合和后路腰椎融合,分别就患者的并发症及死亡率等数据进行统计学分析。结果:在总共167名选择中的患者里,其中52名为病态肥胖。病态肥胖患者的并发症发生率高87%,并发症类型包括有心脏、肾、肺、伤口并发症等。统计学分析中所有的效果在前路腰椎融合组中不太明显,在后路腰椎融合组中有显著的效果。结论:病态肥胖增加了腰柱融合手术并发症的风险,尤其是提高了通过后路腰椎融合的手术的患者的风险。

  1. Artrodese de coluna: avaliação da satisfação dos cuidadores de pacientes com síndrome de Rett Artrodesis de la columna: evaluación de la satisfacción de los cuidadores de pacientes con síndrome de Rett Arthrodesis spine: satisfaction evaluation of the caregivers of patients with Rett syndrome

    Directory of Open Access Journals (Sweden)

    Cleverson Tadeu Sidoli

    2010-12-01

    Full Text Available OBJETIVO: avaliar o nível de satisfação dos cuidadores de pacientes com síndrome de Rett. MÉTODOS: foi realizado um estudo retrospectivo por meio dos prontuários de dez pacientes com Síndrome de Rett, nove femininos e um masculino. Foram obtidos os dados radiográficos e foi elaborado um questionário de 31 perguntas, respondidas pelos familiares dos pacientes. RESULTADOS: a redução média no ângulo pré-operatório e a medida no pós-imediato foi de 72,4%. Complicação pós-operatória ocorreu em apenas um caso, e 87,5% dos cuidadores afirmaram que houve melhora expressiva com relação ao efeito da cirurgia sobre os cuidados pessoais, na função e locomoção; o tempo de permanência na cadeira de rodas aumentou. Para 66,7% dos cuidadores, a frequência de internamentos por problemas médicos e a frequência de pneumonia diminuíram com a cirurgia. Também fizeram uma avaliação positiva sobre a estética da deformidade da coluna. A grande maioria dos cuidadores (85,7% submeteria novamente seus filhos à cirurgia e recomendariam para outra criança com o mesmo problema. CONCLUSÃO: houve redução significativa na média do ângulo de Cobb entre o pré e pós-operatório e melhoria em todos os aspectos do paciente. Os cuidadores manifestaram que submeteriam seus filhos ao procedimento cirúrgico novamente.OBJETIVO: evaluar el nivel de satisfacción de los cuidadores de pacientes con síndrome de Rett. MÉTODOS: fue realizado un estudio retrospectivo por medio de las historias clínicas de 10 pacientes con síndrome de Rett, nueve mujeres y un hombre. Fueron obtenidos datos radiográficos y se elaboró un cuestionario de 31 preguntas a los familiares de los pacientes. RESULTADOS: la reducción promedio en el ángulo preoperatorio y el promedio en el postoperatorio fue del 72,4%. La complicación postoperatoria ocurrió en solo un caso y el 87,5% de los cuidadores afirmaron que hubo mejoría expresiva con relación al efecto de la cirugía sobre los cuidados personales, en la función y locomoción, y además, el tiempo de permanencia en la silla de ruedas aumentó. Para el 66,7%, de los cuidadores, la frecuencia de internamientos por problemas médicos y la frecuencia de neumonía disminuyeron con la cirugía. También hicieron una evaluación positiva sobre la estética de la deformidad de la columna. La gran mayoría de los cuidadores (el 85,7% sometería nuevamente sus hijos a la cirugía y recomendaría a otro niño con el mismo problema hacer este tipo de corrección. CONCLUSIÓN: hubo una reducción significativa en el promedio del ángulo de Cobb entre el pre y postoperatorio y una mejoría en todos los aspectos del paciente. Los cuidadores manifestaron que someterían sus hijos de nuevo al procedimiento quirúrgico.OBJECTIVE: to evaluate the satisfaction of the caregivers of Rett Syndrome (RS patients. METHODS: For this retrospective study, statistical data were presented by the medical records of 10 patients with RS, nine females and only one male. With the radiological data presented in the medical records, a questionnaire was prepared with 31 questions to be answered by family. RESULTS: the average reduction of the angle that occurred between the preoperative evaluation and the postoperative evaluation was of 72.4%. Postoperative complications occurred in only one case, and 87.5% of the caregivers said that there was significant improvement with respect to the effect of surgery on personal care, function, locomotion; the time in the wheelchair increased. To 66.7% of the caregivers, with the surgery, the frequency of medical admissions and the frequency of pneumonia decreased. They also made a positive evaluation about the aesthetic deformity of the spine. The vast majority of the caregivers (87.5% said that their children could undergo surgery again and they would recommend it to another child with the same problem. CONCLUSION: there was a significant reduction in the mean Cobb angle between the preoperative and postoperative period, an improvement in all aspects of the patient, and caregivers also expressed that their children could undergo to surgery again.

  2. Long-term follow-up study of arthroscopic ankle arthrodesis and total ankle arthroplasty in treatment of ankle osteoarthritis%关节镜下踝关节融合术与人工全踝关节置换术治疗踝骨关节炎的随访研究

    Institute of Scientific and Technical Information of China (English)

    汪军; 陈路

    2016-01-01

    目的 探讨关节镜下踝关节融合术与人工全踝关节置换术治疗踝关节骨关节炎的临床效果.方法 回顾性分析2008年1月~2012年1月医院经保守治疗无效的踝关节骨关节炎患者49例49踝(含7例脱落病例)的临床资料,根据治疗方案分为A组和B组,A组29例29踝行关节镜下踝关节融合术,B组20例20踝行人工全踝关节置换术,剔除脱落病例,A组纳入24例,B组纳入18例.记录两组手术时间、术中出血量、住院时间及手术费用;出院后采用电话或门诊方式随访至2015年4月,发放踝关节评分标准(Kofoed)、美国矫形足踝协会(AOFAS)踝-后足评分、视觉模拟评分(VAS),记录并发症发生率、轻度跛行率及翻修率.结果 A组手术时间长于B组,但术中出血量、手术费用少于B组,住院时间短于B组(P<0.05);A组术后1年、2年及末次随访的Kofoed评分中的功能、活动度评分及AOFAS评分显著低于B组(P<0.05),但两组疼痛评分及VAS评分无差异(P>0.05);A组感染、切口愈合延迟、踝周疼痛及肿胀、假体松动几率分别为4.17%、0、8.33%、0显著低于B组27.77%、16.67%、33.33%、16.67% (P<0.05);A组返修率为4.17%显著低于B组27.77%,跛行几率为33.33%显著高于B组11.11%(P<0.05).结论 关节镜下踝关节融合术与人工全踝关节置换术治疗踝关节骨关节炎均可改善疼痛、踝关节活动功能,但在临床应用中均存在局限性,临床应根据患者个体特征谨慎选择.

  3. Arthroscopically assisted debridement and tibiotalar arthrodesis with half-ring sulcated external fixator for treatment of total ankle joint tuberculosis%关节镜下病灶清除并半环槽加压外固定治疗全踝关节结核

    Institute of Scientific and Technical Information of China (English)

    陈永华; 唐康来; 李起鸿; 杨柳; 陈光兴; 郭林

    2006-01-01

    目的探讨关节镜下踝关节结核病灶清除并半环槽加压外固定行踝关节融合术治疗全踝关节结核的临床经验.方法 6例全踝关节结核患者,男4例,女2例;年龄28~44岁,平均33岁.病程8~23个月,平均13个月;均为单踝关节发病.其中1例伴踝部窦道形成患者曾在外院行切开引流术.术前均行至少3周的抗结核治疗.手术采用踝关节镜前外侧及前内侧入路进行结核病灶清除和胫距关节融合,并用半环槽外固定架固定.结果术后无一例发生皮肤感染及窦道形成等并发症.患者于术后2~7 d,平均4 d即可下地活动.术后6例均获得随访,随访时间6~42个月,平均21.3个月.6例患者于术后9~17周,平均12.5周达到骨性愈合,其中3例患者术后疼痛消失,其余3例有轻度疼痛及跛行,均无结核复发.结论对没有严重骨破坏的全踝关节结核采用关节镜下病灶清除,具有损伤小、恢复快、病灶清除彻底等优点.半环槽加压外固定,可早期下床活动,有利于融合愈合.

  4. 单节段颈前路融合术后动态屈伸活动时颈椎的六个方位自由度范围%Six-Degrees-of-Freedom Cervical Spine Range of Motion During Dynamic Flexion-Extension After Single-Level Anterior Arthrodesis Comparison with Asymptomatic Control Subjects

    Institute of Scientific and Technical Information of China (English)

    William J.Anderst; Joon Y.Lee; William F.Donaldson Ⅲ; James D.Kang; 张凯; 孙伟; 赵杰

    2013-01-01

    背景:颈椎融合术后相邻节段疾病的病因仍存在争议.本研究的目的是评估单节段融合术患者与无症状对照组受试者的颈椎动态屈伸运动状态下的活动范围.方法:10例行单节段颈前路融合术(C5/C6)患者和20例无症状对照组患者,颈椎连续完全屈伸过程中以每秒30幅拍摄颈椎双平面X线片.先前验证有效的追踪系统确定每一对X线片上椎体三维位置,精确到亚毫米级.每个研究对象的多次实验中,在整个屈伸运动周期中记录邻近椎体的六个方位自由度范围.颈椎的运动学参数也通过静态的完全屈伸状态下的图像来计算.结果:与对照组相比,C5/C6融合后C4/C5节段有较大的后伸活动范围,较小的屈曲运动范围.融合组患者C4/5C后伸活动范围增大3.8°[95%可信区间(CI),0.9°~6.6°,p=0.011],屈曲运动范围减小2.9°(95%CI,-5.3°~-0.5°,p=0.019);融合组患者邻近节段向后方的水平位移较对照组大,C4/C5增大0.8 mm (95% CI,0.0 ~ 1.6 mm),C6/C7增大0.4 mm (95%CI,0.0 ~ 0.8 mm,p=0.016).根据动态功能运动中收集的影像图像测量结果发现水平位移和旋转位移均比静态完全屈伸时增大,C3/C4和C4/C5前后运动移位95%CI上限为3.45 mm,C6/C7为2.3 mm.结论:C5/C6融合术后邻近节段的整体活动范围没有受到影响,但是改变了邻近节段的运动方式分布,即功能负荷下融合节段上间隙屈曲运动减小、后伸活动增大,融合节段上下方间隙向后方移位增大.静态完全屈伸状态下的活动范围的测量结果低于动态条件下的测量结果.过度前后位移的临床评估应该考虑颈椎椎体节段水平的影响.

  5. Unstable odontoid fracture: surgical strategy in a 22-case series, and literature review.

    Science.gov (United States)

    Steltzlen, C; Lazennec, J-Y; Catonné, Y; Rousseau, M-A

    2013-09-01

    Surgical treatment of unstable odontoid fracture (type II OBAR or HTAL) has progressed, with a range of techniques, the specificities of which need to be known so as to determine their respective roles in the therapeutic arsenal now available. A retrospective study of 22 patients operated on in our center for odontoid fracture between 2005 and 2010 examined the operative techniques employed and analyzed results in the light of the literature, so as to construct an updated decision tree. Two populations could be distinguished: elderly victims of simple fall (mean age, 82.1 years), and younger victims of high-energy trauma (mean age, 42.6 years). Surgical techniques comprised: anterior odontoid screwing (n=14), transarticular C1-C2 screwing on the posterior Magerl (n=3) or anterior Vaccaro approach (n=1), Harms' posterior C1-C2 arthrodesis (n=3), and occipitocervical arthrodesis (n=3). The overall complications rate for the series was 28%, including one case of non-union, at a mean 11 months' follow-up. The risk/benefit ratio may be hard to assess in elderly patients. However, anterior screwing restores odontoid anatomy and is the technique of choice in first intention for reducible fracture. In second intention, transarticular C1-C2arthrodesis may be performed on an anterior or posterior approach, depending on local vertebral artery anatomy. Harms' posterior C1-C2 arthrodesis allows fixation of non-reduced fractures. Occipitocervical arthrodesis is a last resort, as the associated morbidity rate is higher.

  6. Guideline update for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 5: correlation between radiographic outcome and function.

    Science.gov (United States)

    Dhall, Sanjay S; Choudhri, Tanvir F; Eck, Jason C; Groff, Michael W; Ghogawala, Zoher; Watters, William C; Dailey, Andrew T; Resnick, Daniel K; Sharan, Alok; Mummaneni, Praveen V; Wang, Jeffrey C; Kaiser, Michael G

    2014-07-01

    In an effort to diminish pain or progressive instability, due to either the pathological process or as a result of surgical decompression, one of the primary goals of a fusion procedure is to achieve a solid arthrodesis. Assuming that pain and disability result from lost mechanical integrity of the spine, the objective of a fusion across an unstable segment is to eliminate pathological motion and improve clinical outcome. However, conclusive evidence of this correlation, between successful fusion and clinical outcome, remains elusive, and thus the necessity of documenting successful arthrodesis through radiographic analysis remains debatable. Although a definitive cause and effect relationship has not been demonstrated, there is moderate evidence that demonstrates a positive association between radiographic presence of fusion and improved clinical outcome. Due to this growing body of literature, it is recommended that strategies intended to enhance the potential for radiographic fusion are considered when performing a lumbar arthrodesis for degenerative spine disease.

  7. Total ankle replacement. Design evolution and results.

    Science.gov (United States)

    van den Heuvel, Alexander; Van Bouwel, Saskia; Dereymaeker, Greta

    2010-04-01

    The ankle joint has unique anatomical, biomechanical and cartilaginous structural characteristics that allow the joint to withstand the very high mechanical stresses and strains over years. Any minor changes to any of these features predispose the joint to osteoarthritis. Total ankle replacement (TAR) is evolving as an alternative to ankle arthrodesis for the treatment of end-stage ankle osteoarthritis. Initial implant designs from the early 1970s had unacceptably high failure and complication rates. As a result many orthopaedic surgeons have restricted the use of TAR in favour of ankle arthrodesis. Long term follow-up studies following ankle arthrodesis show risks of developing adjacent joint osteoarthritis. Therefore research towards a successful ankle replacement continues. Newer designs and longer-term outcome studies have renewed the interest in ankle joint replacement. We present an overview of the evolution, results and current concepts of total ankle replacement.

  8. Total Ankle Arthroplasty: An Overview of the Canadian Experience.

    Science.gov (United States)

    Latham, Warren C W; Lau, Johnny T C

    2016-06-01

    Total ankle arthroplasty use has increased across Canada over the last two decades. Multiple implant designs are readily available and implanted across Canada. Although arthrodesis is a reliable procedure for treating end-stage ankle arthritis, ankle replacement is often the preferred surgical treatment by patients. A recent prospective study evaluated intermediate-term outcomes of ankle replacement and arthrodesis at multiple centers across Canada, with variability in prosthesis type, surgeon, and surgical technique. Intermediate-term clinical outcomes of total ankle replacement and ankle arthrodesis were comparable in a diverse cohort in which treatment was tailored to patient presentation; however, rates of reoperation and major complications were higher after ankle replacement.

  9. Clinical and functional evaluation of forefoot reconstruction in patients with rheumatoid arthritis,

    Directory of Open Access Journals (Sweden)

    Marco Túlio Costa

    2014-04-01

    Full Text Available OBJECTIVE: to evaluate the long-term results from reconstruction of the forefoot in patients with rheumatoid arthritis who underwent arthrodesis of the metatarsophalangeal joint of the hallux, resection arthroplasty of the heads of the lateral metatarsals and correction of the deformities of the smaller toes through arthrodesis of the proximal interphalangeal joint or closed manipulation.METHODS: seventeen patients (27 feet who underwent forefoot reconstruction surgery by means of arthrodesis of the first metatarsophalangeal joint, resection of the heads of the lateral metatarsals and correction of the deformities of the smaller toes, were studied retrospectively. The mean follow-up was 68 months (12-148 months; the mean age was 52 years (range: 20-75 months; and four patients were male and 13 were female.RESULTS: the results were classified as excellent in 17 feet, good in two, fair in four and poor in two. The mean score on the AOFAS scale was 70 points; 21 feet (78% were found to be asymptomatic; and six feet (22% presented some type of symptom. Three feet presented pseudarthrosis, and one of these successfully underwent revision of the arthrodesis. There was no significant difference in scoring on the AOFAS scale or in the consolidation rate, between using a plate and screws and using Kirschner wires for fixation of the arthrodesis.CONCLUSION: arthrodesis of the first metatarsophalangeal joint with resection arthroplasty on the heads of the lateral metatarsals and correction of the deformities of the smaller toes, which was used in forefoot reconstruction in rheumatoid patients, showed good long-term results with a high satisfaction rate among the patients and clinical-functional improvement.

  10. Tibio-talo-calcaneo fusion using a locked intramedullary compressive nail.

    Science.gov (United States)

    Krissen, Chettiar; Sumon, Halder; Nicholas, Bowman; Howard, Cottam; Andrew, Armitage; Andrew, Skyrme

    2011-12-01

    We present the clinical results and outcomes of 30 consecutive patients (31 ankles) who have undergone tibio-talo-calcaneal arthrodesis using an intramedullary nail to achieve bony union. This was a prospective study and surgery was performed by the senior author in a single hospital. We achieved high levels of satisfaction and outcome via the AOFAS and SF-36 scoring systems. We propose that this method of arthrodesis is reliable and easily reproducible for patients with severe arthritis and bone loss at the ankle and subtalar joints.

  11. Revision of the aseptic and septic total ankle replacement.

    Science.gov (United States)

    Espinosa, Norman; Wirth, Stephan Hermann

    2013-04-01

    Total ankle replacement has become a popular treatment of symptomatic end-stage ankle osteoarthritis. Contemporary total ankle replacement systems provide more anatomic and biomechanically sound function. However, longevity is still limited and long-term results of modern total ankle replacement designs are not available. In the case of failure, conversion into arthrodesis has remained the treatment of choice but at the cost of hindfoot function and potential degeneration of the adjacent joints. Thus, revision total ankle replacement by exchange of the prosthetic components represents an attractive solution. This article focuses on revision total ankle replacement and conversion to ankle arthrodesis.

  12. Total ankle joint replacement.

    Science.gov (United States)

    2016-02-01

    Ankle arthritis results in a stiff and painful ankle and can be a major cause of disability. For people with end-stage ankle arthritis, arthrodesis (ankle fusion) is effective at reducing pain in the shorter term, but results in a fixed joint, and over time the loss of mobility places stress on other joints in the foot that may lead to arthritis, pain and dysfunction. Another option is to perform a total ankle joint replacement, with the aim of giving the patient a mobile and pain-free ankle. In this article we review the efficacy of this procedure, including how it compares to ankle arthrodesis, and consider the indications and complications.

  13. Current Concepts in the Management of Ankle Osteoarthritis: A Systematic Review.

    Science.gov (United States)

    Bloch, Benjamin; Srinivasan, Suresh; Mangwani, Jitendra

    2015-01-01

    Ankle osteoarthritis is less common than hip or knee osteoarthritis; however, it is a relatively common presentation and is predominantly related to previous trauma. Treatments have traditionally consisted of temporizing measures such as analgesia, physiotherapy, and injections until operative treatment in the form of arthrodesis is required. More recently, interest has been increasing in both nonoperative and alternative operative options, including joint-sparing surgery, minimal access arthrodesis, and new arthroplasty designs. The present systematic instructional review has summarized the current evidence for the treatment options available for ankle osteoarthritis.

  14. The Effects of rhBMP-2 Used for Spinal Fusion on Spinal Cord Pathology After Traumatic Injury

    Science.gov (United States)

    2009-07-29

    et al., 2004). In 2002, the FDA approved the use of the recombinant human BMP-2 (rhBMP-2) for treatment of discogenic pain in the lower lumbar spine...concomitant SCI (Personal communication with COL(R) Kuklo, MD). 7 Spinal column arthrodesis using rhBMP-2 with concomitant SCI As surgical...first 8 hours after injury. Therefore, in a rat model of dorsal hemisection SCI, we performed spinal arthrodesis with or without rhBMP-2 30 minutes post

  15. Capitate pyrocarbon prosthesis in radiocarpal osteoarthritis.

    Science.gov (United States)

    Goubier, Jean-Noël; Vogels, Jérome; Teboul, Frédéric

    2011-03-01

    Scapholunate dissociation or scaphoid pseudarthrosis may lead to osteoarthritis of the wrist. When osteoarthritis affects the midcarpal joint, proximal row carpectomy is no longer possible and only 4 corners fusion or capitolunate arthrodesis may be indicated. However, in some cases, osteoarthritis or bone necrosis may involve the lunatum, making partial arthrodeses impossible. Total arthrodesis may be proposed in such cases, but with a loss of range-of-motion. Total prosthesis may be considered but the results of this procedure are not always encouraging. Consequently, in these situations, we perform pyrocarbon prosthesis implant, replacing the head of the capitatum. This article describes the procedure and the results of a preliminary study.

  16. Inestabilidad de la columna cervical subaxial por falla de la banda de tensión posterior: artrodesis contécnica de Magerl. informe preliminar de los resultados a corto plazo Instabilidade da coluna cervical subaxial por falha da banda de tensão posterior: artrodese com técnica de Magerl. resultados preliminares a curto prazo Subaxial cervical spine instability due to failure of posterior tension band: arthrodesis with Magerl technique. preliminary results in the short term

    Directory of Open Access Journals (Sweden)

    Javier Quiroz

    2012-06-01

    Full Text Available OBJETIVO: Analizar, retrospectivamente los resultados a corto plazo de las lesiones traumáticas inestables de la región subaxial, tratadas mediante fijación cervical por vía posterior con técnica de Magerl, utilizando sistema de barras y tornillos poliaxiales en las masas laterales. MÉTODOS: Se efectuó una revisión de pacientes con lesión traumática inestable cervical subaxial y afectación de la banda de tensión posterior (tipo B.1 de la AO, que hubieran sido operados con fijación posterior con barras y tornillos poliaxiales en las masas laterales, siguiendo la técnica de Magerl, utilizando criterios de selección anatómicos, diagnóstico-imagenológicos y éticos. Se valoraron, en el seguimiento, los resultados radiológicos, funcionales y neurológicos. RESULTADOS: Se incluyeron 9 pacientes (8 varones, 1 mujer, con edad promedio de 25 años (rango 21 - 34 y seguimiento promedio de 20 meses (rango 12 - 24. Tanto los resultados radiológicos, como los funcionales y los neurológicos, fueron excelentes en todos los casos, sin desviación en cifosis ni desplazamiento anteroposterior, y sin síntomas importantes en el seguimiento. Los dos casos tratados, con fijación de tres vértebras, presentaron cierta rigidez cervical esporádica. En ningún caso se extrajeron los implantes. CONCLUSIONES: Los beneficios obtenidos sugieren que es una técnica útil, segura, eficaz y versátil para las lesiones traumáticas inestables de la columna cervical baja, tipo B.1, inclusive aquellas multisegmentarias, especialmente en pacientes jóvenes.OBJETIVO: Analisar retrospectivamente os resultados a curto prazo de lesões traumáticas instáveis na região cervical subaxial tratadas com fixação posterior pela técnica de Magerl, usando-se um sistema de parafusos poliaxiais e hastes nas massas laterais. MÉTODOS: Foi realizada a análise de pacientes com lesão traumática cervical subaxial instável e envolvimento da banda de tensão posterior (AO tipo B.1, que haviam sido submetidos a cirurgia com fixação posterior com parafusos poliaxiais e hastes nas massas laterais, de acordo com a técnica de Magerl e segundo critérios de seleção anatômicos, de diagnóstico por imagem e éticos. No acompanhamento, foram avaliados os resultados radiológicos, funcionais e neurológicos. RESULTADOS: Foram incluídos nove pacientes (8 homens, 1 mulher com média de idade de 25 anos (faixa 21-34 e acompanhamento médio de 20 meses (faixa 12-24. Tanto os achados radiológicos quanto os neurológicos e funcionais foram excelentes em todos os casos, sem desvio ou deslocamento em cifose ântero-posterior e sem sintomas importantes ao longo do acompanhamento. Os dois casos tratados com fixação de três vértebras tinham certa rigidez cervical esporádica. Em nenhum caso os implantes foram removidos. CONCLUSÕES: Os benefícios obtidos sugerem que a técnica é útil, segura, eficiente e versátil para lesões traumáticas instáveis ​​da coluna cervical baixa tipo B.1, mesmo nas lesões multissegmentares, especialmente em pacientes mais jovens.OBJECTIVE: To analyze retrospectively the short-term results of unstable traumatic injuries in the cervical subaxial region treated with posterior fixation by Magerl technique, using polyaxial screws and rods in the lateral masses. METHODS: We performed a review of patients with unstable subaxial cervical traumatic injury and involvement of the posterior tension band (AO type B.1 who underwent surgery with posterior fixation with polyaxial screws and rods in the lateral masses according to the Magerl technique using selection criteria based on anatomy, diagnostic images, and ethics. In the follow-up period, the radiological, functional, and neurological outcomes were assessed. RESULTS: We included 9 patients (8 men, 1 woman with an average age of 25 years (range 21 - 34 and a mean follow-up of 20 months (range 12 - 24. The radiologicalas well as the neurological and functional findings were excellent in all cases, without deviation or displacement in anteroposterior kyphosis, and with no symptoms during the follow-up period. The two cases treated with fixation of three vertebrae had some sporadic cervical stiffness. In no case were the implants removed. CONCLUSIONS: The benefits obtained suggest that the technique is useful, safe, efficient and versatile for unstable traumatic injuries of the lower cervical spine type B.1, even in multisegmental lesions, especially in young patients.

  17. Inestabilidad de la columna cervical subaxial por falla de la banda de tensión posterior: artrodesis contécnica de Magerl. informe preliminar de los resultados a corto plazo Instabilidade da coluna cervical subaxial por falha da banda de tensão posterior: artrodese com técnica de Magerl. resultados preliminares a curto prazo Subaxial cervical spine instability due to failure of posterior tension band: arthrodesis with Magerl technique. preliminary results in the short term

    OpenAIRE

    Javier Quiroz; Alejandro Laluf; Tamara Sisi; Nicolas Coombes; Patricio Manzone

    2012-01-01

    OBJETIVO: Analizar, retrospectivamente los resultados a corto plazo de las lesiones traumáticas inestables de la región subaxial, tratadas mediante fijación cervical por vía posterior con técnica de Magerl, utilizando sistema de barras y tornillos poliaxiales en las masas laterales. MÉTODOS: Se efectuó una revisión de pacientes con lesión traumática inestable cervical subaxial y afectación de la banda de tensión posterior (tipo B.1 de la AO), que hubieran sido operados con fijación posterior ...

  18. Management of osteoarthrosis of the thumb joints.

    Science.gov (United States)

    Berger, Aaron J; Meals, Roy A

    2015-04-01

    We present current concepts and evidence to optimize diagnosis and management of osteoarthritis in the thumb joints. Numerous options and controversies exist for surgical treatment of carpometacarpal joint arthritis. Fewer options exist for metacarpophalangeal joint arthritis. Surgical treatment for interphalangeal arthritis is mainly arthrodesis.

  19. Successful total knee arthroplasty in the presence of sporotrichal arthritis.

    NARCIS (Netherlands)

    Koeter, S.; Jackson, R.W.

    2006-01-01

    Articular sporotrichosis, a chronic granulomatous fungal infection, is a rare entity but when present may lead to significant joint destruction. Severe knee arthrosis due to sporotrichal arthritis has traditionally been treated with arthrodesis. Total knee arthroplasty in the presence of sporotricha

  20. Total Ankle Replacement for Treatment of End-Stage Osteoarthritis in Elderly Patients

    Directory of Open Access Journals (Sweden)

    Beat Hintermann

    2012-01-01

    Full Text Available End-stage osteoarthritis of the ankle is a disabling problem, particularly in elderly patients who experience an overall loss of mobility and functional impairment and who then need compensatory adaption. Ankle arthrodesis, which has been demonstrated to provide postoperative pain relief and hindfoot stability, leaves the patient with a stiff foot and gait changes. For elderly patient, these changes may be more critical than generally believed. Additionally, the long duration of healing and rehabilitation process needed for ankle arthrodesis may be problematic in the elderly. In contrast to ankle arthrodesis, total ankle replacement has significant advantages including a less strenuous postoperative rehabilitation and preservation of ankle motion which supports physiological gait. Recently, total ankle replacement has evolved as a safe surgical treatment in patients with end-stage ankle osteoarthritis with reliable mid- to long-term results. Total ankle replacement needs less immobilization than arthrodesis and does allow for early weight-bearing and should be considered as a treatment option of first choice in many elderly patients with end-stage osteoarthritis of the ankle, especially in elderly patients with lower expectations and physical demands.

  1. [Posterior longitudinal ligament ossification: case report].

    Science.gov (United States)

    Tella, Oswaldo Inácio de; Herculano, Marco Antonio; Paiva Neto, Manoel Antonio; Faedo Neto, Atílio; Crosera, João Francisco

    2006-03-01

    Posterior longitudinal ligament ossification of cervical spine is a rare condition among caucasians. A 42 years old japanese patient with progressive walking difficulty was diagnosed with this pathology by CT scan and MRI and treated surgically by an anterior approach with arthrodesis. Pathophysiology, racial prevalence, clinical picture, radiological characteristics and surgical approaches options are revised.

  2. Biomechanical principle of arcus plantaris and its clinical application

    Institute of Scientific and Technical Information of China (English)

    2000-01-01

    Objective: To analyze the principle mechanism of the arcus plantaris and its clinical application. Methods: The states of forces sustained by the arcus plantaris were analyzed and calculated according to the mechanism of the quadratic parabolic arch. Results: The aponeurosis plantaris corresponded to the pull rod of the arcus plantaris. The medial and lateral longitudinal arches formed by the pedal bones were stable with the rod, but unstable without the rod. In the latter condition, on loading, the force sustained by the parabolic arch became a force sustained by a simple beam, and the arcus plantaris tended to disappear and to be flattened.Clinically, 240 feet with talipes equinus were treated with triple arthrodesis. In 34 out of the reexamined 156 feet, the aponeurosis plantaris was cut in addition to the triple arthrodesis and was immobilized with cast for 3 months.One or two years later, their arcus plantaris disappeared,pain developed when walking, and some of them walked with the midtarsai joint against the ground. Then, the triple arthrodesis and shortening of the aponeurosis plantaris were applied on 18 cases, and osteotomy of the calcaneus and reconstruction of the aponeurosis plantaris were made on 10 cases and satisfactory effects were obtained. Conclusions: In order to achieve satisfactory therapeutic effects of the triple arthrodesis, we should reestablish the arcus plantaris and accurately treat the aponeurosis plantaris for the balance of the surrounding muscle force.

  3. Total Ankle Replacement for Treatment of End-Stage Osteoarthritis in Elderly Patients

    Science.gov (United States)

    Hintermann, Beat; Knupp, Markus; Zwicky, Lukas; Barg, Alexej

    2012-01-01

    End-stage osteoarthritis of the ankle is a disabling problem, particularly in elderly patients who experience an overall loss of mobility and functional impairment and who then need compensatory adaption. Ankle arthrodesis, which has been demonstrated to provide postoperative pain relief and hindfoot stability, leaves the patient with a stiff foot and gait changes. For elderly patient, these changes may be more critical than generally believed. Additionally, the long duration of healing and rehabilitation process needed for ankle arthrodesis may be problematic in the elderly. In contrast to ankle arthrodesis, total ankle replacement has significant advantages including a less strenuous postoperative rehabilitation and preservation of ankle motion which supports physiological gait. Recently, total ankle replacement has evolved as a safe surgical treatment in patients with end-stage ankle osteoarthritis with reliable mid- to long-term results. Total ankle replacement needs less immobilization than arthrodesis and does allow for early weight-bearing and should be considered as a treatment option of first choice in many elderly patients with end-stage osteoarthritis of the ankle, especially in elderly patients with lower expectations and physical demands. PMID:22720158

  4. THE FEASIBILITY OF HIND FOOT AMPUTATION IN SELECTED SARCOMAS OF THE FOOT

    NARCIS (Netherlands)

    HAM, SJ; HOEKSTRA, HJ; EISMA, WH; OLDHOFF, J; KOOPS, HS

    1992-01-01

    The treatment of foot sarcomas is generally a below knee amputation. In selected sarcomas of the forefoot, however, a transtarsal amputation according to Chopart, a calcaneotibial arthrodesis according to Pirogoff, or a supramalleolar amputation according to Syme can be considered the treatment of c

  5. Reconstructive procedures for segmental resection of bone in giant cell tumors around the knee

    Directory of Open Access Journals (Sweden)

    Aggarwal Aditya

    2007-01-01

    Full Text Available Background: Segmental resection of bone in Giant Cell Tumor (GCT around the knee, in indicated cases, leaves a gap which requires a complex reconstructive procedure. The present study analyzes various reconstructive procedures in terms of morbidity and various complications encountered. Materials and Methods: Thirteen cases (M-six and F-seven; lower end femur-six and upper end tibia -seven of GCT around the knee, radiologically either Campanacci Grade II, Grade II with pathological fracture or Grade III were included. Mean age was 25.6 years (range 19-30 years. Resection arthrodesis with telescoping (shortening over intramedullary nail ( n=5, resection arthrodesis with an intercalary allograft threaded over a long intramedullary nail ( n=3 and resection arthrodesis with intercalary fibular autograft and simultaneous limb lengthening ( n=5 were the procedure performed. Results: Shortening was the major problem following resection arthrodesis with telescoping (shortening over intramedullary nail. Only two patients agreed for subsequent limb lengthening. The rest continued to walk with shortening. Infection was the major problem in all cases of resection arthrodesis with an intercalary allograft threaded over a long intramedullary nail and required multiple drainage procedures. Fusion was achieved after two years in two patients. In the third patient the allograft sequestrated. The patient underwent sequestrectomy, telescoping of fragments and ilizarov fixator application with subsequent limb lengthening. The patient was finally given an ischial weight relieving orthosis, 54 months after the index procedure. After resection arthrodesis with intercalary autograft and simultaneous lengthening the resultant gap (~15cm was partially bridged by intercalary nonvascularized dual fibular strut graft (6-7cm and additional corticocancellous bone graft from ipsilateral patella. Simultaneous limb lengthening with a distal tibial corticotomy was performed on an

  6. Distal interphalangeal joint implant arthroplasty in a musician.

    Science.gov (United States)

    Schwartz, D A; Peimer, C A

    1998-01-01

    Degenerative joint disease commonly affects the distal interphalangeal (DIP) joints, causing articular destruction and marginal bone formation. Treatment for pain relief and function is most often done through arthrodesis. The case of a 70-year-old concert violinist with left index finger DIP joint osteoarthritis is presented. Arthritis in the involved joint caused pain and deformity and interfered with the patient's ability to play music. Trial arthrodesis with K-wires proved impossible because of the patient's need for continued mobility. Swanson hinge implant arthroplasty was performed on the affected DIP joint. The patient eventually achieved an excellent result and was able to return to playing the violin professionally. Treatment and therapy guidelines are presented.

  7. Scaphoid excision with four-corner fusion.

    Science.gov (United States)

    Enna, Matthew; Hoepfner, Peter; Weiss, Arnold-Peter C

    2005-11-01

    The scaphoid plays a critical role in maintain-ing normal carpal kinematics. SLAC and SNAC wrist arthritis demonstrate the ramifications ofscaphoid pathology on wrist biomechanics. In the past, symptomatic SLAC or SNAC pathology spelled total wrist arthrodesis. Over the past 20 years there has been a movement toward limited wrist arthrodesis in the treatment of SLAC/SNAC wrists. In the long-term follow-up of four-corner fusions, patient satisfaction is high, patients are able to return to their previous vocation, and wrist function averages 60%-70% of the contralateral wrist. The Spider plate is a recent advancement in the four-corner fusion armamentarium that has thus far shown great promise in respect to fusion rates (100% in the first documented series [36]),functional range of motion, intercarpal stability[37], and patient satisfaction.

  8. Clinical outcome after treatment of infected primary total knee arthroplasty

    DEFF Research Database (Denmark)

    Husted, Henrik; Jensen, Tim Toftgaard

    2002-01-01

    Twenty-six consecutive cases of infected primary total knee arthroplasties were treated at our institution from 1989 through 2000. Eleven patients had debridement and irrigation performed within 2 months of index arthroplasty or hematogenous spread; only one infection was eradicated. Twenty......-five patients had their prostheses removed; 17 had two-stage revision arthroplasty, following which infection was eradicated in 15; one had a permanent spacer, 7 had arthrodesis (following failed revision arthroplasty in one) and 2 had a femur amputation (following failed revision arthroplasty in one) at follow......-up of mean 24 months. Infections were cured equally well with revision arthroplasty and arthrodesis. Among the 15 patients who ended up with revision arthroplasty, 11 had a better range of motion compared to the index arthroplasty, but 8 had daily pain. We present our treatment protocol, which eradicated 15...

  9. [Operative treatment of diabetic foot].

    Science.gov (United States)

    Hintermann, B

    1999-07-08

    The majority of diabetic foot ulcers are the results of repetitive pressure that exceeds the threshold of soft-tissue tolerance, leading to mechanical destruction of the tissue. Progression of plantar ulcers can rapidly lead to osteomyelitis that may result in loss of the foot through amputation. In order to prevent such a disaster, surgical treatment should be taken into consideration when conservative treatment remains without success. The goal of surgical treatment of an infected ulcer is debridement of the soft-tissue and removal of the underlying pressure by careful bone resection or correction of a deformity by arthrodesis. Various authors have recently reported successful surgical reconstruction of neuroarthropathic foot deformity and instability. Apparently arthrodesis is a viable alternative to amputation for patients with unstable deformity or recurrent ulceration. Proper preoperative evaluation is mandatory. The indications are not well defined yet.

  10. Total ankle replacement or ankle fusion in painful advanced hemophilic arthropathy of the ankle.

    Science.gov (United States)

    Rodriguez-Merchan, E Carlos

    2015-12-01

    In advanced painful hemophilic arthropathy of the ankle, the last resort is surgical treatment (ankle arthrodesis [AA] or total ankle replacement [TAR]). There is a controversy in the literature on which of the two procedures is more appropriate. A review of the literature was performed to clarify such a controversy. The first search engine was MedLine (keywords: total ankle replacement, ankle arthrodesis). Seventy articles were found in MedLine. Of these, only 16 were selected and reviewed because they were strictly focused on the topic of this article. The second search engine was the Cochrane Library, where only nine systematic reviews were found on the role of TAR and AA in non-hemophilia patients. TAR and AA provide pain relief and patient satisfaction in hemophilia patients in the short term. The available non-hemophilia literature is insufficient to conclude which treatment is superior. My current view is that AA may be preferable in most hemophilia patients.

  11. Ankle Arthritis: You Can't Always Replace It.

    Science.gov (United States)

    Hayes, Brandon J; Gonzalez, Tyler; Smith, Jeremy T; Chiodo, Christopher P; Bluman, Eric M

    2016-02-01

    End-stage arthritis of the tibiotalar joint is disabling and causes substantial functional impairment. Most often it is the residual effect of a previous traumatic injury. Nonsurgical treatment of end-stage arthritis of the ankle includes bracing, shoe-wear modifications, and selective joint injections. For patients who fail to respond to nonsurgical modalities, the two primary treatment options are arthroplasty and arthrodesis. Each has its proponents. Although no ideal treatment of ankle arthritis exists, high-quality studies can help guide treatment in patients of varying demographics. Inherent risks are linked with each treatment option, but those of greatest concern are early implant loosening that requires revision following arthroplasty and the acceleration of adjacent joint degeneration associated with arthrodesis.

  12. Total Ankle Arthroplasty: A Brief Review

    Directory of Open Access Journals (Sweden)

    Roger A. Mann

    2012-12-01

    Full Text Available Ankle fusion has long been the standard of treatment for end-stage ankle arthritis, and a successful arthroplasty has been a long sought alternative. It is a motion sparing procedure and may greatly reduce the potential for adjacent level degeneration as seen with arthrodesis. The typical candidate for arthroplasty is a healthy low demand patient, although the indications are widening as the success of the procedure has increased. Nevertheless, it is not fail-safe, technical expertise and experience are necessary to achieve a successful result. We have been treating ankle arthritis with the Scandinavian Total Ankle Replacement (STAR ankle replacement prosthesis for over ten years. We believe that arthroplasty will surpass arthrodesis as the standard of care for severe ankle arthritis.

  13. Father of the modern hip replacement: Professor Sir John Charnley (1911-82).

    Science.gov (United States)

    Jackson, John

    2011-11-01

    Professor Sir John Charnley was a British orthopaedic surgeon, inventor and skilled craftsman. He is best known for his development of the first truly successful operation for total arthroplasty of the hip, the low-friction arthroplasty. As well as publishing significant works on closed fracture management and compression arthrodesis, he can also be accredited with pioneering work in the development of clean-air operating conditions and body-exhaust suits.

  14. Predictive factors for perioperative blood transfusion in surgeries for correction of idiopathic, neuromuscular or congenital scoliosis

    Directory of Open Access Journals (Sweden)

    Alexandre Fogaça Cristante

    2014-12-01

    Full Text Available OBJECTIVE: To evaluate the association of clinical and demographic variables in patients requiring blood transfusion during elective surgery to treat scoliosis with the aim of identifying markers predictive of the need for blood transfusion. METHODS: Based on the review of medical charts at a public university hospital, this retrospective study evaluated whether the following variables were associated with the need for red blood cell transfusion (measured by the number of packs used during scoliosis surgery: scoliotic angle, extent of arthrodesis (number of fused levels, sex of the patient, surgery duration and type of scoliosis (neuromuscular, congenital or idiopathic. RESULTS: Of the 94 patients evaluated in a 55-month period, none required a massive blood transfusion (most patients needed less than two red blood cell packs. The number of packs was not significantly associated with sex or type of scoliosis. The extent of arthrodesis (r = 0.103, surgery duration (r = 0.144 and scoliotic angle (r = 0.004 were weakly correlated with the need for blood transfusion. Linear regression analysis showed an association between the number of spine levels submitted to arthrodesis and the volume of blood used in transfusions (p = 0.001. CONCLUSION: This study did not reveal any evidence of a significant association between the need for red blood cell transfusion and scoliotic angle, sex or surgery duration in scoliosis correction surgery. Submission of more spinal levels to arthrodesis was associated with the use of a greater number of blood packs.

  15. Evaluación del uso de collar cervical de inmovilización después de la descompresión y fusion cervical por acceso anterior: Revisión sistemática

    OpenAIRE

    Alberto Ofenhejm Gotfryd; Regina El Dib; Ricardo Vieira Botelho; Patrícia Rios Poletto

    2013-01-01

    This study aims to evaluate safety and effectiveness of the use of orthesis in postoperative degenerative disorders of the cervical spine. Although widely used, there are not defined criteria for the use of cervical collars, and their importance on cervical arthrodesis. A systematic literature review was undertaken and a multicentre controlled clinical trial comprising 32 specialized services, with a total of 257 patients who met the inclusion criteria of the review. Clinical and radiographic...

  16. Chronic Lyme disease arthritis: review of the literature and report of a case of wrist arthritis.

    Science.gov (United States)

    Scerpella, T A; Engber, W D

    1992-05-01

    A case of Lyme arthritis with advanced degenerative changes localized to the midcarpal joint was treated with a limited wrist arthrodesis with relief of pain and improved function. Chronic Lyme arthritis occurs as the third stage of Lyme disease. Serologic testing and a history of a characteristic rash may be helpful in the diagnosis. Radiographic and histopathologic findings are nonspecific, with both degenerative and inflammatory characteristics. Intravenous antibiotics provide an effective treatment of chronic Lyme arthritis.

  17. Total Ankle Replacement for Treatment of End-Stage Osteoarthritis in Elderly Patients

    OpenAIRE

    Beat Hintermann; Markus Knupp; Lukas Zwicky; Alexej Barg

    2012-01-01

    End-stage osteoarthritis of the ankle is a disabling problem, particularly in elderly patients who experience an overall loss of mobility and functional impairment and who then need compensatory adaption. Ankle arthrodesis, which has been demonstrated to provide postoperative pain relief and hindfoot stability, leaves the patient with a stiff foot and gait changes. For elderly patient, these changes may be more critical than generally believed. Additionally, the long duration of healing and r...

  18. Total ankle arthroplasty in end-stage ankle arthritis

    OpenAIRE

    Demetracopoulos, Constantine A.; Halloran, James P.; Maloof, Paul; Samuel B Adams; Parekh, Selene G.

    2013-01-01

    Recent advancements in ankle prosthesis design, combined with improved surgical techniques for correction of coronal plane deformity and ligamentous balancing, have led to a resurgence of interest in total ankle arthroplasty for the treatment of end-stage ankle arthritis. Although ankle arthrodesis has long been considered the gold standard treatment for ankle arthritis, recent studies have shown that patients who undergo total ankle replacement have equivalent pain relief and improved functi...

  19. Total Ankle Arthroplasty: A Brief Review

    OpenAIRE

    Mann, Roger A.; Harrison, Matthew J.

    2012-01-01

    Ankle fusion has long been the standard of treatment for end-stage ankle arthritis, and a successful arthroplasty has been a long sought alternative. It is a motion sparing procedure and may greatly reduce the potential for adjacent level degeneration as seen with arthrodesis. The typical candidate for arthroplasty is a healthy low demand patient, although the indications are widening as the success of the procedure has increased. Nevertheless, it is not fail-safe, technical expertise and exp...

  20. The Influence of Smoking on Disability Following Hospitalization for Musculoskeletal Disorders

    Science.gov (United States)

    1998-01-01

    female gender. Similar results were found in Cobb et al.’s study of smoking and non-union after ankle arthrodesis (1994): a history of cigarette...thoracic or lumbar intervertebral disc without myelopathy (includes .1, .10, .11) 722.2 Displacement of intervertebral disc, site unspecified, without...myelopathy 722.4 Degeneration of cervical intervertebral disc 722.5 Degeneration of thoracic or lumbar intervertebral disc (includes .51, .52

  1. CORRELATION BETWEEN QUALITY OF LIFE AND OSTEOLYSIS AROUND LUMBAR PEDICLE SCREWS

    Directory of Open Access Journals (Sweden)

    MARCELO ITALO RISSO NETO

    Full Text Available ABSTRACT Objective: To evaluate whether the presence of osteolysis around the pedicle screws affects the quality of life of patients who underwent posterolateral arthrodesis of the lumbosacral spine. Methods: A retrospective study of patients undergoing lumbar posterolateral or lumbosacral arthrodesis due to spinal degenerative disease. CT scans of the operated segments were performed at intervals of 45, 90, 180, and 360 postoperatively. In these tests, the presence of a peri-implant radiolucent halo was investigated, which was considered present when greater than 1mm in the coronal section. Concurrently with the completion of CT scans, the participants completed the questionnaire Oswestry Disability Index (ODI to assess the degree of disability of the patients. Results: A total of 38 patients were evaluated, and 14 (36.84% of them showed some degree of osteolysis around at least one pedicle screw at the end of follow-up. Of the 242 analyzed screws, 27 (11.15% had osteolysis in the CT coronal section, with the majority of these occurrences located at the most distal level segment of the arthrodesis. There was no correlation between the presence of the osteolysis to the quality of life of patients. The quality of life has significantly improved when comparing the preoperative results with the postoperative results at different times of application of ODI. This improvement in ODI maintains linearity over time. Conclusion: There is no correlation between the presence of peri-implant osteolysis to the quality of life of patients undergoing lumbar or posterolateral lumbosacral arthrodesis in the follow-up period up to 360 days. The quality of life in postoperative has significantly improvement when compared to the preoperative period.

  2. Neglected subtalar dislocation with unstable foot; to walk away or step our foot in?

    Science.gov (United States)

    Bajuri, Mohd Yazid; Johan, Rudy Reza; Bahari, Syah Irwan

    2013-01-01

    Chronic neglected subtalar dislocation associated with a non-union talar neck fracture is rare and never documented before. The lack of information from the literature on the optimal management prompted us to describe our experience in the management of this condition. We reported a case of a 57-year-old women presented with this injury. A satisfactory outcome was obtained using a tibio-talo-calcaneal arthrodesis through a plantar approach. PMID:23329712

  3. Procedure selection for the flexible adult acquired flatfoot deformity.

    Science.gov (United States)

    Hentges, Matthew J; Moore, Kyle R; Catanzariti, Alan R; Derner, Richard

    2014-07-01

    Adult acquired flatfoot represents a spectrum of deformities affecting the foot and the ankle. The flexible, or nonfixed, deformity must be treated appropriately to decrease the morbidity that accompanies the fixed flatfoot deformity or when deformity occurs in the ankle joint. A comprehensive approach must be taken, including addressing equinus deformity, hindfoot valgus, forefoot supinatus, and medial column instability. A combination of osteotomies, limited arthrodesis, and medial column stabilization procedures are required to completely address the deformity.

  4. SURGICAL TREATMENT OF SEVERE (2-3 DEGREE DEFORMING ARTHROSIS OF FIRST METATARSOPHALANGEAL JOINT OF FOOT: TASKS, APPROACHES, TECHNIQUE

    Directory of Open Access Journals (Sweden)

    A. V. Mazalov

    2011-01-01

    Full Text Available Based on the experience of treating 67 patients (98 feet with deforming arthrosis of first metatarsophalangeal joint is shown that the treatment of this disease the distal decompressing osteotomy in combination with maximally radical the separation of the unions and cheilectomy possesses the significant health-improvement potential, which makes it possible to be turned to arthrodesis or arthroplasty only in the limiting cases of that the heavy cases of hallux rigidus. L-osteotomy 1-st metatarsus gives more than possibilities for the correction with the heavy deformations and the degenerate changes, the basic criterion of sufficiency of which is the volume of the intra-operating straightening of 1-st fingers reached. Optimum is reaching the straightening 1-st toes to 65° even above. An indispensable stage of complex operation is maximally radical of cheilectomy. During the formation of arthrodesis 1-st metatarsophalangeal joint in the horizontal plane the axis of 1 finger should be oriented in parallel to axis second metatarsal bones. The sagittal angle of the formation of arthrodesis depends on the manifestation of valgus of rear division. Active postoperative conducting essentially improves the distant results of the surgical treatment of deforming arthrosis of first metatarsophalangeal joint.

  5. The sauvé-kapandji procedure.

    Science.gov (United States)

    Lluch, Alberto

    2013-02-01

    Arthrodesis is the most reliable and durable surgical procedure for the treatment of a joint disorder, and its only disadvantage is the loss of motion of the fused joint. The distal radioulnar joint can be arthrodesed, while forearm pronation and supination are maintained or even improved by creating a pseudoarthrosis of the ulna just proximal to the arthrodesis. This is known as the Sauvé-Kapandji (S-K) procedure. The Sauvé-Kapandji differs from the Darrach procedure in that it preserves ulnar support of the wrist, as the distal radioulnar ligaments and ulnocarpal ligaments are maintained. Aesthetic appearance is also superior after the S-K procedure, as the normal prominence of the ulnar head, most noticeable when the forearm is in pronation, is maintained. However, the S-K is not free of possible complications, such as nonunion or delayed union of the arthrodesis, fibrous or osseous union at the pseudoarthrosis, and painful instability at the proximal ulna stump. All of these complications can be prevented if a careful surgical technique is used.

  6. Role of osteogenic protein-1/bone morphogenetic protein-7 in spinal fusion

    Directory of Open Access Journals (Sweden)

    Justin Munns

    2009-10-01

    Full Text Available Justin Munns, Daniel K Park, Kern SinghDepartment of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, USAAbstract: Osteogenic protein-1 (OP-1, also known as bone morphogenetic protein-7 (BMP-7, is a protein in the TGF-β family of cellular proteins that has shown potential for application in patients undergoing spinal fusion due to its proven osteoinductive effects, particularly in patients with spondylolisthesis. OP-1 initiates numerous processes at the cellular level, acting on mesenchymal stem cells (MSCs, osteoblasts, and osteoclasts to stimulate bone growth. Animal studies of OP-1 have provided strong evidence for the ability of OP-1 to initiate ossification in posterolateral arthrodesis. Promising findings in early clinical trials with OP-1 prompted FDA approval for use in long bone nonunions in 2001 and subsequently for revision posterolateral arthrodesis in 2004 under a conditional Humanitarian Device Exemption. Larger clinical trials have recently shown no notable safety concerns or increases in adverse events associated with OP-1. However, a recent clinical trial has not conclusively demonstrated the noninferiority of OP-1 compared to autograft in revision posterolateral arthrodesis. The future of OP-1 application in patients with spondylolisthesis thus remains uncertain with the recent rejection of Premarket Approval (PMA status by the FDA (April 2009. Further investigation of its treatment success and immunological consequences appears warranted to establish FDA approval for its use in its current form.Keywords: osteogenic protein-1, bone morphogenetic protein-7, spinal fusion

  7. Tri-component, mobile bearing, total ankle replacement: mid-term functional outcome and survival.

    Science.gov (United States)

    Dhawan, Rohit; Turner, Jake; Sharma, Vikas; Nayak, Ramesh K

    2012-01-01

    Tri-component, mobile bearing, uncemented, total ankle replacements were introduced after the high failure rates of cemented, highly constrained, first-generation, total ankle replacement implants. A total of 30 primary total ankle replacements in 29 patients (20 males and 9 females) were followed up in the present retrospective study for up to 13 (mean 5.1 ± 4) years. The postoperative functional and radiographic outcomes were measured. Failure was defined as revision of either of the components for any reason or conversion of the total ankle replacement to arthrodesis because of debilitating pain that did not resolve after surgery. Of the 29 patients, 2 underwent revision and 1 underwent arthrodesis. All 3 patients had the malpositioned talar implant revised. The mean American Orthopaedic Foot and Ankle Society score was 81 at 1 year postoperatively. Revision of the tibial or talar component for any reason or conversion of the ankle replacement to arthrodesis was considered failure for the survival analysis. Kaplan-Meier analysis showed a 5-year survival rate of 87.6%. The last failure occurred 23.3 months after surgery.

  8. Extended hindfoot fusions and pantalar fusions. History, biomechanics, and clinical results.

    Science.gov (United States)

    Faillace, J J; Leopold, S S; Brage, M E

    2000-12-01

    Contemporary techniques of hindfoot and ankle arthrodesis can result in a high rate of osseous union, pain relief, and patient satisfaction. Methods range from open approaches to fully arthroscopic surgical techniques. Arthrodesis should be limited to the joints involved with the arthritic, deforming, or neuromuscular process because the rate and severity of progressive adjacent joint degeneration appear related to the number of joints fused initially. Appropriate joint position, maintained with stable internal fixation applied in compression and augmented with bone-graft material when necessary, should be considered the gold standard for most hindfoot and ankle arthrodeses. External fixation may be used in the revision or salvage setting if needed or when soft tissues or bone stock do not permit stable internal fixation. Meticulous attention must be given to the handling of soft and hard tissues as well as to correction of the underlying deformity and to appropriate positioning of the joints in question. Newer techniques, such as intramedullary fixation, arthroscopic or arthroscopically assisted ankle arthrodesis, and total ankle arthroplasty, have shown some promise and warrant more extensive study.

  9. Pelvic Fixation in Adult and Pediatric Spine Surgery: Historical Perspective, Indications, and Techniques: AAOS Exhibit Selection.

    Science.gov (United States)

    Jain, Amit; Hassanzadeh, Hamid; Strike, Sophia A; Menga, Emmanuel N; Sponseller, Paul D; Kebaish, Khaled M

    2015-09-16

    Achieving solid osseous fusion across the lumbosacral junction has historically been, and continues to be, a challenge in spine surgery. Robust pelvic fixation plays an integral role in achieving this goal. The goals of this review are to describe the history of and indications for spinopelvic fixation, examine conventional spinopelvic fixation techniques, and review the newer S2-alar-iliac technique and its outcomes in adult and pediatric patients with spinal deformity. Since the introduction of Harrington rods in the 1960s, spinal instrumentation has evolved substantially. Indications for spinopelvic fixation as a means to achieve lumbosacral arthrodesis include a long arthrodesis (five or more vertebral levels) or use of three-column osteotomies in the lower thoracic or lumbar spine, surgical treatment of high-grade spondylolisthesis, and correction of lumbar deformity and pelvic obliquity. A variety of techniques have been described over the years, including Galveston iliac rods, Jackson intrasacral rods, the Kostuik transiliac bar, iliac screws, and S2-alar-iliac screws. Modern iliac screws and S2-alar-iliac screws are associated with relatively low rates of pseudarthrosis. S2-alar-iliac screws have the advantages of less implant prominence and inline placement with proximal spinal anchors. Collectively, these techniques provide powerful methods for obtaining control of the pelvis in facilitating lumbosacral arthrodesis.

  10. CORRELATION BETWEEN OBESITY, SAGITTAL BALANCE AND CLINICAL OUTCOME IN SPINAL FUSION

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    Marcel Machado da Motta

    2015-09-01

    Full Text Available Objective:To correlate obesity with radiographic parameters of spinal and spinopelvic balance in patients undergoing spinal arthrodesis, and to correlate obesity with clinical outcome of these patients.Methods:Observational retrospective study including patients who underwent spinal arthrodesis, with minimum follow-up period of three months. We measured waist circumference, as well as height and weight to calculate body mass index (BMI and obtained radiographs of the total column. The clinical parameters studied were pain by visual analog scale (VAS and the Oswestry questionnaire (ODI. Obesity correlated with radiographic parameters of the sagittal and spinopelvic balance and postoperative clinical parameters.Results:32 patients were analyzed. The higher the BMI, the greater the value of VAS found, but without statistical significance (p=0.83. There was also no correlation between BMI and the ODI questionnaire. Analyzing the abdominal circumference, there was no correlation between the VAS and ODI. There was no correlation between BMI or waist circumference and the radiographic parameters of global spinopelvic sagittal alignment. Regarding the postoperative results, there was no correlation between the mean BMI and waist circumference and the postoperative results for ODI and VAS (p=0.75 and p=0.7, respectively.Conclusions:The clinical outcomes of patients who undergone spinal fusion were not affected by the BMI and waist circumference. Also, there was no correlation between radiographic parameters of spinal and spinopelvic sagittal balance with obesity in patients previously treated with arthrodesis of the spine.

  11. Infected primary knee arthroplasty: Risk factors for surgical treatment failure

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    Joao Gabriel Duarte Paes Pradella

    2013-09-01

    Full Text Available OBJECTIVE: To present epidemiological data and risk factors associated with surgical out-comes favorable or unfavorable for the treatment of infection in infected total knee arthroplasty. METHODS: We reviewed medical records of 48 patients who underwent treatment of primary total knee arthroplasty for infection between January 1994 and December 2008, in the Orthopedics and Traumatology Department of the Santa Casa de Misericórdia de São Paulo. The variables associated with favorable outcome of surgical treatment (debridement and retention or exchange arthroplasty in two days or unfavorable (arthrodesis or death infection. RESULTS: A total of 39 cases of infection after primary total knee arthroplasty, 22 progressed to 17 for a favorable outcome and unfavorable outcome. Early infections (OR: 14.0, 95% CI 1.5-133.2, p = 0.016 and diabetes (OR: 11.3, 95% CI 1.4-89.3, p = 0.032 were associated with arthrodesis joint and death respectively. CONCLUSION: Patients with early infection had a higher risk of developing surgical procedure with unfavorable outcome (arthrodesis and diabetics had higher odds of death after infection of primary knee arthroplasties.

  12. Salvage of Failed Total Ankle Replacement Using a Custom Titanium Truss.

    Science.gov (United States)

    Mulhern, Jennifer L; Protzman, Nicole M; White, Amari M; Brigido, Stephen A

    2016-01-01

    Subsidence of the talar component results in significant morbidity after total ankle replacement. When recognized, prompt revision could be needed to preserve the function of the implant; however, this is not always the case. In situations in which the implant cannot be revised, tibiotalocalcaneal arthrodesis might be necessary to salvage the extremity. The purpose of the present report is to describe the use of a custom titanium alloy truss to fill a bony void created by explantation of the implant components. Total ankle replacement was performed as the initial surgery to address end-stage osteoarthritis. Two years after the index procedure, the patient underwent revision of the polyethylene and talar components with subtalar arthrodesis secondary to progressive subtalar osteoarthritis and talar subsidence. The implant subsequently became infected and was removed. The patient underwent re-implantation after the infection had resolved, but significant talar subsidence required conversion to a tibiotalocalcaneal arthrodesis with a custom titanium alloy truss and retrograde intramedullary nail. At the most recent follow-up appointment, the patient was weightbearing on a stable extremity and pain free. Radiographic examination confirmed appropriate implant alignment and evidence of bone formation throughout the titanium truss. Although our results are restricted to a single case with initial, limited follow-up data, combining sound structural mechanics with an open architecture and unique texture, the custom titanium truss appears to maintain the limb length and promote healing across a large void.

  13. [Surgical treatment possibilities of advanced carpal collapse (SNAC/SLAC wrist)].

    Science.gov (United States)

    Sauerbier, M; Bickert, B; Tränkle, M; Kluge, S; Pelzer, M; Germann, G

    2000-07-01

    Longstanding and untreated scaphoid fractures and scapholunate dissociations lead to painful destruction of the wrist with carpal collapse. The severity of degenerative arthrosis is classified in three stages and can be treated adequate operatively. SNAC wrist (scaphoid nonunion advanced collapse) after failed fusion of the scaphoid and SLAC wrist (scapholunate advanced collapse) after scapholunate dissociation should be differentiated. The reconstruction of the scaphoid or scapholunate ligament in stage II and III is no reasonable option. Motion preserving procedures such as proximal row carpectomy or midcarpal arthrodesis are preferable in this situation. Thirty-one male patients (average 41 years) were treated for SNAC or SLAC wrist with midcarpal arthrodesis. All patients were reexamined, the mean follow-up was 15 months. Grip strength was measured with the Dexter-System, pain was evaluated by a visual analogue scale (VAS 0-100). Patients' daily activities and general quality of life were estimated with the DASH-questionnaire. Pain was reduced to 50% compared to the preoperative situation. Grip strength improved to 60% of the opposite side. Active range of motion reached 50% of the contralateral wrist. Total DASH-score reached 39.0. Nonunion at the fusion site necessitated additional surgery in four patients resulting in total wrist arthrodesis. 80% of the patients returned to their original occupation. Midcarpal fusion is a reliable procedure for treating the difficult condition of advanced carpal collapse if proper realignment of the carpus is performed. The DASH-score reflects the subjective impressions of the patients in daily life and justifies the choice of a salvage procedure preserving wrist mobility. Total wrist fusion represents the last line of defense.

  14. The impact of patients controlled analgesia undergoing orthopedic surgery

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    Aluane Silva Dias

    2016-06-01

    Full Text Available ABSTRACT INTRODUCTION: The currently common musculoskeletal disorders have been increasingly treated surgically, and the pain can be a limiting factor in postoperative rehabilitation. RATIONALE: Patient controlled analgesia (PCA controls pain, but its adverse effects can interfere with rehabilitation and in the patient discharge process. This study becomes important, since there are few studies evaluating this correlation. OBJECTIVES: To compare the outcomes of patients who used and did not use patient controlled analgesia in postoperative orthopedic surgery with respect to pain, unscheduled need for O2 (oxygen, and time of immobility and in-hospital length of stay. METHODS: This is an observational, prospective study conducted at Hospital Abreu Sodré from May to August 2012. The data was daily obtained through assessments and interviews of patients undergoing total hip arthroplasty (THA and total knee arthroplasty (TKA, thoracolumbar spine arthrodesis (long PVA, cervical spine arthrodesis (cervical AVA and lumbar spine arthrodesis (lumbar PVA. RESULTS: The study showed some differences between groups, namely: the painful level was higher in the group undergoing lumbar PVA without PCA compared with the group with PCA (p = 0.03 and in the group of long PVA without PCA in the early postoperative period. This latter group used O2 for a longer time (p = 0.09. CONCLUSION: In this study, PCA was useful for analgesia in patients undergoing lumbar PVA and probably would have influenced the usage time of O2 in the group of long PVA in face of a larger sample. The use of PCA did not influence the time of leaving the bed and the in-hospital length of stay for the patients studied.

  15. Transient long thoracic nerve injury during posterior spinal fusion for adolescent idiopathic scoliosis: A report of two cases

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    Athanasios I Tsirikos

    2013-01-01

    Full Text Available We present the transient long thoracic nerve (LTN injury during instrumented posterior spinal arthrodesis for idiopathic scoliosis. The suspected mechanism of injury, postoperative course and final outcome is discussed. The LTN is susceptible to injury due to its long and relatively superficial course across the thoracic wall through direct trauma or tension. Radical mastectomies with resection of axillary lymph nodes, first rib resection to treat thoracic outlet syndrome and cardiac surgery can be complicated with LTN injury. LTN injury producing scapular winging has not been reported in association with spinal deformity surgery. We reviewed the medical notes and spinal radiographs of two adolescent patients with idiopathic scoliosis who underwent posterior spinal arthrodesis and developed LTN neuropraxia. Scoliosis surgery was uneventful and intraoperative spinal cord monitoring was stable throughout the procedure. Postoperative neurological examination was otherwise normal, but both patients developed winging of the scapula at 4 and 6 days after spinal arthrodesis, which did not affect shoulder function. Both patients made a good recovery and the scapular winging resolved spontaneously 8 and 11 months following surgery with no residual morbidity. We believe that this LTN was due to positioning of our patients with their head flexed, tilted and rotated toward the contralateral side while the arm was abducted and extended. The use of heavy retractors may have also applied compression or tension to the nerve in one of our patients contributing to the development of neuropraxia. This is an important consideration during spinal deformity surgery to prevent potentially permanent injury to the nerve, which can produce severe shoulder dysfunction and persistent pain.

  16. Mid- to long-term outcome of 96 corrective hindfoot fusions in 84 patients with rigid flatfoot deformity.

    Science.gov (United States)

    Röhm, J; Zwicky, L; Horn Lang, T; Salentiny, Y; Hintermann, B; Knupp, M

    2015-05-01

    Talonavicular and subtalar joint fusion through a medial incision (modified triple arthrodesis) has become an increasingly popular technique for treating symptomatic flatfoot deformity caused by posterior tibial tendon dysfunction. The purpose of this study was to look at its clinical and radiological mid- to long-term outcomes, including the rates of recurrent flatfoot deformity, nonunion and avascular necrosis of the dome of the talus. A total of 84 patients (96 feet) with a symptomatic rigid flatfoot deformity caused by posterior tibial tendon dysfunction were treated using a modified triple arthrodesis. The mean age of the patients was 66 years (35 to 85) and the mean follow-up was 4.7 years (1 to 8.3). Both clinical and radiological outcomes were analysed retrospectively. In 86 of the 95 feet (90.5%) for which radiographs were available, there was no loss of correction at final follow-up. In all, 14 feet (14.7%) needed secondary surgery, six for nonunion, two for avascular necrosis, five for progression of the flatfoot deformity and tibiotalar arthritis and one because of symptomatic overcorrection. The mean American Orthopaedic Foot and Ankle Society Hindfoot score (AOFAS score) at final follow-up was 67 (between 16 and 100) and the mean visual analogue score for pain 2.4 points (between 0 and 10). In conclusion, modified triple arthrodesis provides reliable correction of deformity and a good clinical outcome at mid- to long-term follow-up, with nonunion as the most frequent complication. Avascular necrosis of the talus is a rare but serious complication of this technique.

  17. Supramalleolar Osteotomies for Posttraumatic Malalignment of the Distal Tibia.

    Science.gov (United States)

    Krause, Fabian; Veljkovic, Andrea; Schmid, Timo

    2016-03-01

    Supramalleolar osteotomies of the tibia (SMOT) for posttraumatic distal tibial malalignment has shown to reduce pain, improve function and radiographic signs of osteoarthritis, and delay ankle arthrodesis or total joint replacement. The procedure also protects the articular cartilage from further degenerative processes by shifting and redistributing loads in the ankle joint. It is technically demanding and requires extensive preoperative planning. The type of osteotomy (opening vs closing wedge) does not influence the final outcome. However, based on the limited evidence, a grade I treatment recommendation has been given for supramalleolar osteotomies of the tibia to treat mild to moderate ankle arthritis in the presence of distal tibial malalignment.

  18. Prosthesis of the wrist-joint

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    Feldmeier, C.

    1983-02-25

    Function of the hand-joint and the well-being of patients can be severely affected by arthrosis of the wrist-joint. Therapeutically, arthrodesis usually results in a painfree status of stiffness. A painless and well functioning joint can be achieved by alloplastic joint replacement or resurfacing. The possibilities and clinical results in cases of arthrosis of the carpo-metacarpal joint of the thumb, pseudarthrosis of the scaphoid, aseptic necrosis of the Lunate and severe arthrosis of the radio-carpal joint are demonstrated.

  19. Microtia Reconstruction and Postsurgical Grisel’s Syndrome: A Rare Cause of Torticollis in a Child

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    Jay Ching Chieh Wang, MD

    2014-06-01

    Full Text Available Summary: Grisel’s syndrome is an unusual but important cause of torticollis which may be encountered in a pediatric plastic surgery practice, where craniofacial and oropharyngeal surgeries are commonly performed. Grisel’s syndrome is characterized by painful torticollis and limited cervical rotation, and the diagnosis is confirmed via radiologic imaging. Initial management of Grisel’s syndrome is with anti-inflammatories and in some cases antibiotics. In unresolving or recurrent cases, more invasive treatments, such as cervical collar, halo, or surgical arthrodesis, may be considered.

  20. Fungal arthritis of the wrist caused by Candida parapsilosis during infliximab therapy for rheumatoid arthritis.

    Science.gov (United States)

    Miyamoto, Hideaki; Miura, Toshiki; Morita, Euan; Morizaki, Yutaka; Uehara, Kosuke; Ohe, Takashi; Tanaka, Sakae

    2012-11-01

    A 60-year-old woman with rheumatoid arthritis, who had been treated with infliximab, presented with uncontrollable wrist arthritis. Fungal arthritis caused by Candida parapsilosis was confirmed by examining her aspirated joint fluid. Her infliximab therapy was interrupted, and antifungal therapy with fluconazole was started. After the fungal infection had been ameliorated, surgical debridement and arthrodesis of the wrist joint were conducted, and her symptoms completely resolved. Although fungal arthritis is rare, it should be considered as a differential diagnosis of exacerbated monoarthritis in patients treated with biological agents.

  1. [The Taylor spatial frame fixator. Soft-tissue distraction for post-traumatic varus deformities of the hindfoot].

    Science.gov (United States)

    Gessmann, J; Seybold, D; Baecker, H; Muhr, G; Graf, M

    2009-02-01

    Despite adequate primary treatment many ankle fractures result in post-traumatic deformities and arthrosis. Revision mostly requires a multidirectional correction whereas internal fixation procedures are often not applicable due to soft tissue damage and the extent of deformity. The Taylor spatial frame enables simultaneous correction of multidirectional deformities through a virtual hinge using the same ideas of distraction osteogenesis as the Ilizarov fixator. The presented case demonstrates minimally invasive correction of a complex deformity of the ankle with the Taylor spatial frame fixator. Orthogonal alignment was achieved and a stabilizing tibiotalar arthrodesis was performed achieving a good functional and pain-free result.

  2. History and evolution of the Sauvé-Kapandji procedure.

    Science.gov (United States)

    Sebastin, Sandeep J; Larson, Bradley P; Chung, Kevin C

    2012-09-01

    Arthrodesis of the distal radioulnar joint combined with the creation of a pseudarthrosis of the distal ulna is frequently referred to as the Sauvé-Kapandji procedure. This eponym is based on the 1936 report by Sauvé and Kapandji, which is believed to be the first report of this innovative technique. There has been some controversy regarding the origin of this procedure, with similar techniques described by Berry in 1930 and Steindler in 1932. This article examines the evolution of the Sauvé-Kapandji procedure and sheds light on the lives of James Allan Berry, Arthur Steindler, Louis de Gonzague Sauvé, and Mehmed Kapandji.

  3. [Ankle joint arthritis--etiology, diagnosis and treatment].

    Science.gov (United States)

    Uri, Ofir; Haim, Amir

    2008-11-01

    Ankle joint arthritis causes functional limitation and affects the quality of life many patients. It follows traumatic injuries, inflammatory joint arthritis, primary osteoarthritis, hemochromatosis and infections. Understanding the unique anatomy and biomechanics of the ankle is important for diagnosis and treatment of ankle joint pathology. The treatment of ankle joint arthritis has advanced considerably in recent years and it is still a surgical challenge. Total ankle replacement seems to be a promising form of treatment, even though current data does not demonstrate advantages over ankle joint arthrodesis.

  4. [Revision arthroplasty of the ankle joint].

    Science.gov (United States)

    Hintermann, B; Barg, A; Knupp, M

    2011-11-01

    In the last 20 years total ankle replacement has become a viable alternative to arthrodesis for end-stage osteoarthritis of the ankle. Numerous ankle prosthesis designs have appeared on the market in the past and attracted by the encouraging intermediate results reported in the literature, many surgeons have started to perform this procedure. With increased availability on the market the indications for total ankle replacement have also increased in recent years. In particular, total ankle replacement may now be considered even in younger patients. Therefore, despite progress in total ankle arthroplasty the number of failures may increase. Up to now, arthrodesis was considered to be the gold standard for salvage of failed ankle prostheses. Because of extensive bone loss on the talar side, in most instances tibiocalcaneal fusion is the only reliable solution. An alternative to such extended hindfoot fusions would be revision arthroplasty. To date, however, there are no reported results of revision arthroplasty for salvage of a failed ankle replacement.Based on our experience prosthetic components with a flat undersurface are most likely to be able to find solid support on remaining bone stock. The first 83 cases (79 patients, 46 males, 33 females, average age 58.9 years, range 30.6-80.7 years) with a average follow-up of 5.4 years (range 2-11 years) showed excellent to good results in 69 cases (83%), a satisfactory result in 12 cases (15%) and a fair result in 2 cases (2%) and 47 patients (56%) were pain free. Primary loosening was noted in three cases and of these two cases were successfully revised by another total ankle replacement and in one case with arthrodesis. Another case with hematogenous infection was also revised by arthrodesis. At the last follow-up control two components were considered to be loose and the overall loosening rate was thus 6%.This series has proven that revision arthroplasty can be a promising option for patients with failed total

  5. Agility to INBONE: anterior and posterior approaches to the difficult revision total ankle replacement.

    Science.gov (United States)

    DeVries, J George; Scott, Ryan T; Berlet, Gregory C; Hyer, Christopher F; Lee, Thomas H; DeOrio, James K

    2013-01-01

    Total ankle replacement is now acknowledged as a viable alternative to ankle arthrodesis for end-stage ankle arthritis. The authors present a series of 14 patients who were converted from the Agility total ankle replacement to an INBONE total ankle replacement. This report is unique in that anterior and posterior approaches are discussed and detailed. Although the authors present successful conversion of the Agility total ankle replacement to an INBONE total ankle replacement, the difficulty of this procedure is demonstrated by the high complication rate and 2 early failures.

  6. Multi-detector CT imaging in the postoperative orthopedic patient with metal hardware.

    Science.gov (United States)

    Vande Berg, Bruno; Malghem, Jacques; Maldague, Baudouin; Lecouvet, Frederic

    2006-12-01

    Multi-detector CT imaging (MDCT) becomes routine imaging modality in the assessment of the postoperative orthopedic patients with metallic instrumentation that degrades image quality at MR imaging. This article reviews the physical basis and CT appearance of such metal-related artifacts. It also addresses the clinical value of MDCT in postoperative orthopedic patients with emphasis on fracture healing, spinal fusion or arthrodesis, and joint replacement. MDCT imaging shows limitations in the assessment of the bone marrow cavity and of the soft tissues for which MR imaging remains the imaging modality of choice despite metal-related anatomic distortions and signal alteration.

  7. Management of sequalae of neglected septic shoulder

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    Pawar Uday

    2009-01-01

    Full Text Available Complex deformities following septic arthritis of the shoulder in infancy are mild and therefore rarely reported. A 12 year old girl presented with shortening of upper extremity right side, with dislocation of shoulder and with entire extremity rotated to 180 degrees. The palm faced posteriorly and the olecranon anteriorly. Arthrodesis of shoulder and unifocal lengthening of humerus was achieved with three 4 mm cannulated cancellous screws and an ilizarov frame. A lengthening of 9 centimeters was achieved and regenerate healed at 12 months. At 10 years follow-up she is able to perfom her activities of daily living.

  8. Olecranon bone graft: revisited.

    Science.gov (United States)

    Mersa, Berkan; Ozcelik, Ismail Bulent; Kabakas, Fatih; Sacak, Bulent; Aydin, Atakan

    2010-09-01

    Autogenous bone grafts are frequently in use in the field of reconstructive upper extremity surgery. Cancellous bone grafts are applied to traumatic osseous defects, nonunions, defects after the resection of benign bone tumors, arthrodesis, and osteotomy procedures. Cancellous bone grafts do not only have benefits such as rapid revascularization, but they also have mechanical advantages. Despite the proximity to the primary surgical field, cancellous olecranon grafts have not gained the popularity they deserve in the field of reconstructive hand surgery. In this study, the properties, advantages, and technical details of harvesting cancellous olecranon grafts are discussed.

  9. Staphylococcal septic arthritis in three horses.

    Science.gov (United States)

    Rose, R J; Love, D N

    1979-04-01

    Three horses were diagnosed as having monarticular septic arthritis due to Staphylococcus aureus on the basis of culture of articular cartilage, synovial membrane and/or synovial fluid. The organisms were all well recognised human phage types and in two cases demonstrated beta-lactamase (penicillinase) activity. Details of case histories are presented and the bacteriological techniques and antibiotic management with cloxacillin, methicillin and penicillin discussed. Following treatment, sterile cultures of synovial fluid were achieved in all cases, but in two horses the infections resulted in degenerative articular changes. This necessitated arthrodesis of the fetlock joint in one case.

  10. Permanent antibiotic impregnated intramedullary nail in diabetic limb salvage: a case report and literature review

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    Jason B. Woods

    2012-02-01

    Full Text Available Managing complications after attempted hind foot and ankle arthrodesis with intramedullary nail fixation is a challenge. This situation becomes more problematic in the patient with diabetes mellitus and multiple comorbidities. Infection and subsequent osteomyelitis can be a devastating, limb threatening complication associated with these procedures. The surgeon must manage both the infectious process and the skeletal instability concurrently. This article provides a literature review and detailed management strategies for a modified technique of employing antibiotic impregnated polymethylmethacrylate-coated intramedullary nailing.

  11. Chondrosarcoma secondary to hereditary multiple exostosis treated by extended internal hemiplevectomy

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    Ademar Lopes

    Full Text Available The authors report on the case of a 28-year-old patient with extensive chondrosarcoma of the left ischium and pubis involving hip joint, skin, and soft tissue of the gluteal region, secondary to hereditary multiple exostosis submitted to an extended internal Enneking type II and Ill hemipelvectomy. No prosthesis or arthrodesis was used. A few years ago, patients with extensive tumors like this one were treated with interilioabdominal amputation, resulting in a loss of quality of Iife.Two years after the limb-preserving surgery, this patient was disease free, with good functional results, including bipedal ambulation with support.

  12. Charcot neuroarthropathy: realignment of diabetic foot by means of osteosynthesis using intramedullary screws – case report,

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    Alexandre Leme Godoy dos Santos

    2014-10-01

    Full Text Available Diabetes mellitus is a serious disease that affects a large portion of the population. Charcot neuroarthropathy is one of its major complications and can lead to osteoarticular deformities, functional incapacity, ulcers and ankle and foot infections. Realignment of the foot by means of arthrodesis presents a high rate of implant failure due to weight-bearing on an insensitive foot. The aim of this report was to describe successful use of intramedullary osteosynthesis with compression screws to stabilize the deformed foot, in a diabetic patient with neuroarthropathy.

  13. Charcot neuroarthropathy: realignment of diabetic foot by means of osteosynthesis using intramedullary screws - case report.

    Science.gov (United States)

    Dos Santos, Alexandre Leme Godoy; Albino, Rômulo Ballarin; Ortiz, Rafael Trevisan; Sakaki, Marcos Hideyo; de Andrade Corsato, Marcos; Fernandes, Tulio Diniz

    2014-01-01

    Diabetes mellitus is a serious disease that affects a large portion of the population. Charcot neuroarthropathy is one of its major complications and can lead to osteoarticular deformities, functional incapacity, ulcers and ankle and foot infections. Realignment of the foot by means of arthrodesis presents a high rate of implant failure due to weight-bearing on an insensitive foot. The aim of this report was to describe successful use of intramedullary osteosynthesis with compression screws to stabilize the deformed foot, in a diabetic patient with neuroarthropathy.

  14. Dumb-bell-type teratoma in the lumbar spine

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    Okuyama, Koichiro; Misawa, Akiko; Tamura, Yasuki; Chiba, Mitsuho [Dept. of Orthopaedic Surgery, Akita Rosai Hospital, Odate City (Japan); Abe, Eiji [Dept. of Orthopaedic Surgery, Akita University School of Medicine (Japan); Hoshi, Naoto [2. Dept. of Pathology, Akita University School of Medicine (Japan)

    2000-02-01

    We report a case of a lumbar teratoma in a 50-year-old woman. The teratoma showed a dumb-bell-type expansion at the level of the left L3/4 foramen with massive erosion of the L3 vertebral body. MRI revealed inhomogeneous signal changes in the tumor, which were histologically compatible with a mixture of bone, muscle, fat, and cyst containing sebaceous material. Complete resection of the tumor and spinal arthrodesis with pedicle screw fixation was necessary to obtain stability of the affected spinal segment. (orig.)

  15. Mini-open anterior lumbar interbody fusion.

    Science.gov (United States)

    Gandhoke, Gurpreet S; Ricks, Christian; Tempel, Zachary; Zuckerbraun, Brian; Hamilton, D Kojo; Okonkwo, David O; Kanter, Adam S

    2016-07-01

    In deformity surgery, anterior lumbar interbody fusion provides excellent biomechanical support, creates a broad surface area for arthrodesis, and induces lordosis in the lower lumbar spine. Preoperative MRI, plain radiographs, and, when available, CT scan should be carefully assessed for sacral slope as it relates to pubic symphysis, position of the great vessels (especially at L4/5), disc space height, or contraindication to an anterior approach. This video demonstrates the steps in an anterior surgical procedure with minimal open exposure. The video can be found here: https://youtu.be/r3bC4_vu1hQ .

  16. [The diabetic foot--state of the art from the orthopedic point of view].

    Science.gov (United States)

    Schaefer, D

    1999-07-08

    A 15-30% rate of amputation of diabetic feet suggests that efforts have to be directed towards improvement of preventive measure including instruction of patients and relatives concerning foot wear. So called foot rules have been established. If surgery is indicated, an angiological and neurological assessment should be performed preoperatively. An ulcer should undergo debridement, plantar pressure release with a full contact cast and antibiotic therapy, if infected. The goal of treatment of Charcot's disease is prevention of deformity. Usually orthoses are sufficient, in irreducible deformities an arthrodesis should be considered. There is no doubt that the interdisciplinary approach improves the treatment of the diabetic foot.

  17. Incidence of Complications During the Surgeon Learning Curve Period for Primary Total Ankle Replacement: A Systematic Review.

    Science.gov (United States)

    Simonson, Devin C; Roukis, Thomas S

    2015-10-01

    Surgeons performing primary total ankle replacement have achieved outcomes comparable to ankle arthrodesis. However, while many reports exist suggesting the presence of a surgeon learning curve period during initial performance of primary total ankle replacement, no published analysis of the actual incidence of complications encountered during this period exists. Therefore, we sought to provide such an analysis through systematic review. A total of 2453 primary total ankle replacements with 1085 complications (44.2%) were identified. Our results revealed conflicting data whether an acceptably low incidence of high-grade complications leading to total ankle replacement failure exists during the surgeon learning curve period.

  18. Total Ankle Arthroplasty: An Imaging Overview.

    Science.gov (United States)

    Kim, Da-Rae; Choi, Yun Sun; Potter, Hollis G; Li, Angela E; Chun, Ka-Young; Jung, Yoon Young; Kim, Jin-Su; Young, Ki-Won

    2016-01-01

    With advances in implant technology, total ankle arthroplasty (TAA) has become an increasingly popular alternative to arthrodesis for the management of end-stage ankle arthritis. However, reports in the literature do not focus on the imaging features of TAA. Through a literature review, we demonstrate basic design features of the current ankle arthroplasty system, and the normal and abnormal postoperative imaging features associated with such devices. Pre- and postoperative evaluations of ankle arthroplasty mainly include radiography; in addition, computed tomography and magnetic resonance imaging provide further characterization of imaging abnormalities. Familiarization with multimodal imaging features of frequent procedural complications at various postoperative intervals is important in radiological practice.

  19. Total ankle arthroplasty: An imaging overview

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Da Rae; Choi, Yun Sun; Chun, Ka Young; Jung, Yoon Young; Kim, Jin Su; Young, Ki Won [Eulji Hospital, Eulji University, Seoul (Korea, Republic of); Potter, Hollis G.; Li, Angela E. [Dept. of Radiology and Imaging, Hospital for Special Surgery, New York (United States)

    2016-06-15

    With advances in implant technology, total ankle arthroplasty (TAA) has become an increasingly popular alternative to arthrodesis for the management of end-stage ankle arthritis. However, reports in the literature do not focus on the imaging features of TAA. Through a literature review, we demonstrate basic design features of the current ankle arthroplasty system, and the normal and abnormal postoperative imaging features associated with such devices. Pre- and postoperative evaluations of ankle arthroplasty mainly include radiography; in addition, computed tomography and magnetic resonance imaging provide further characterization of imaging abnormalities. Familiarization with multimodal imaging features of frequent procedural complications at various postoperative intervals is important in radiological practice.

  20. Pathological fracture dislocation of the acetabulum in a patient with neurofibromatosis-1

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    Balaji Saibaba

    2016-01-01

    Full Text Available Skeletal neurofibromatosis (NF commonly manifests as scoliosis and tibial dysplasias. NF affecting the pelvic girdle is extremely rare. Pathological fracture of the acetabulum leading to anterior hip dislocation in a patient with NF-1 has never been reported in the literature. The paper presents the clinical symptomatology, the course of management and the successful outcome of such a rare case of NF-1. Histopathological and immunohistochemistry studies showing abundant spindle cells, which are S-100 positive and of neural origin are the classical hallmarks of neurofibromatous lesions. Tumor resection and iliofemoral arthrodesis can be considered as a valid option in young patients with pathological fracture dislocation of the acetabulum.

  1. Tendon transfers in the treatment of the adult flatfoot.

    Science.gov (United States)

    Backus, Jonathon D; McCormick, Jeremy J

    2014-03-01

    Tendon transfers are critical to successful surgical correction of adult flexible flatfoot deformity and may be beneficial in correcting rigid deformities as well. Patients with refractory stage I and II deformities often require selective osteotomies in addition to tendon transfer. Patients with stage III and IV deformities typically require hindfoot arthrodesis. One of several tendons can be used for transfer based on surgeon's preference. Flexor digitorum longus (FDL) and flexor hallucis longus (FHL) transfers have been shown to have good results. A peroneus brevis transfer is typically used to supplement small FDL or FHL transfer donors or in revision cases.

  2. Dumb-bell-type teratoma in the lumbar spine.

    Science.gov (United States)

    Okuyama, K; Abe, E; Hoshi, N; Misawa, A; Tamura, Y; Chiba, M

    2000-02-01

    We report a case of a lumbar teratoma in a 50-year-old woman. The teratoma showed a dumb-bell-type expansion at the level of the left L3/4 foramen with massive erosion of the L3 vertebral body. MRI revealed inhomogeneous signal changes in the tumor, which were histologically compatible with a mixture of bone, muscle, fat, and cyst containing sebaceous material. Complete resection of the tumor and spinal arthrodesis with pedicle screw fixation was necessary to obtain stability of the affected spinal segment.

  3. The use of a pyrocarbon capitate resurfacing implant in chronic wrist disorders.

    Science.gov (United States)

    Marcuzzi, A; Ozben, H; Russomando, A

    2014-07-01

    The present study describes the technique and results of proximal row carpectomy with resection of the head of the capitate and replacement with a pyrocarbon capitate resurfacing implant. The major indication for surgical treatment was arthritic changes on the head of the capitate. Patients were assessed by range of motion, grip strength, pain and functional scoring, and radiographic studies. In most patients, wrist function was improved and pain relief was obtained. This surgical procedure may represent a good alternative to total and partial wrist arthrodesis.

  4. RESULTS OF SURGICAL TREATMENT IN THE CRANIOCERVICAL JUNCTION IN MUCOPOLYSACCHARIDOSIS

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    Luís Eduardo Carelli Teixeira da Silva

    2016-03-01

    Full Text Available ABSTRACT Objective: Evaluate the results after decompression and stabilization of craniocervical junction in patients with mucopolysaccharidosis (MPS. Method: Retrospective study of 10 patients with MPS through the analysis of medical records and additional tests. Result: All patients with mid-term and long-term follow-up achieved consolidation of the arthrodesis and 87.5% had neurological improvement of Nurick score. Conclusion: Early diagnosis and intervention in cases of stenosis and/or craniocervical instability of patients with MPS provide patients a good recovery of neurological function, despite the great technical difficulty and risk of complications.

  5. Disabling hand injuries in boxing: boxer's knuckle and traumatic carpal boss.

    Science.gov (United States)

    Melone, Charles P; Polatsch, Daniel B; Beldner, Steven

    2009-10-01

    This article describes the treatment of the two most debilitating hand-related boxing injuries: boxer's knuckle and traumatic carpal boss. Recognition of the normal anatomy as well as the predictable pathology facilitates an accurate diagnosis and precision surgery. For boxer's knuckle, direct repair of the disrupted extensor hood, without the need for tendon augmentation, has been consistently employed; for traumatic carpal boss, arthrodesis of the destabilized carpometacarpal joints has been the preferred method of treatment. Precisely executed operative treatment of both injuries has resulted in a favorable outcome, as in the vast majority of cases the boxers have experienced relief of pain, restoration of function, and an unrestricted return to competition.

  6. Complications of the anterior approach to the cervical spine

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    Marcelo Lemos Vieira da Cunha

    2014-09-01

    Full Text Available OBJECTIVE: To evaluate the complications of anterior approach to the cervical spine in patients who underwent cervical arthrodesis with instrumentation. METHODS: Prospective and descriptive study was conducted from January 2009 to April 2010. All patients who underwent arthrodesis of the cervical spine by anterior approach were included, regardless the diagnosis. Access was made by the anterior approach on the right side. We evaluated the number of operated levels (1, 2 or 3 levels and, the type of procedure performed: discectomy and placement of cage and plate (D+C+P, discectomy with placement of a cage (D+C or corpectomy with placement of cage and plate (C+C+P. All complications related to surgical approach were reported. RESULTS: We studied 34 patients, 70% male. The average age was 50 years and mean follow-up was 8 months. Eighteen percent of patients had complications, distributed as follows: dysphasia (33% and dysphonic (67%. Among patients who developed complications, most underwent to D+C+P (83% and no complications were found in patients where no cervical plate was used. Regarding levels, both complications were identified in patients operated to one or two levels. However, in patients operated on three levels, only dysphonia was identified. CONCLUSION: The most frequent complication was dysphonia. Patients who presented more complications were those undergoing discectomy and fusion with cage and anterior cervical plate. All cases of dysphonia were in this group. The number of accessible levels does not seem to have affected the incidence of complications.

  7. Modified steel basket technique for the treatment of equine cervical vertebral stenotic myelopathy - a case report

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    Frederico Fernandes Araújo

    2015-08-01

    Full Text Available Cervical vertebral stenotic myelopathy (CVSM, also known as cervical ataxia or wobbler syndrome, is caused by the narrowing of the medullary canal due to a malformation of the cervical vertebrae, resulting in compression of the spinal cord and neurological alterations such as ataxia, hypermetria, weakness, and abnormal stance. The treatment options can be conservative or surgical, with varied effectiveness. The most appropriate surgical technique in the majority of cases is arthrodesis, providing quick and efficient decompression of the spinal cord. The goal of this case report is to present an equine patient with CVSM that was surgically treated using a new modified cage model. The diagnosis was based on history, clinical signs and radiographic evidence of spinal cord compression between the C3 and C4 vertebrae, after ruling out possible infectious agents. The surgical procedure for the decompression and stabilization of the point of stenosis was performed using a modified Cloward’s technique and a new cage model fixed with two screws. Evidence of fusion was obtained by periodic radiographs over six months of postoperative care. The new cage model used in this surgery proved to be efficient for the decompression and stabilization of the vertebrae, allowing arthrodesis development and remission of the clinical signs. Fixation of the cage with screws reduces the risk of migration of the implant.

  8. [Long-term results after a modified Sauvé-Kapandji procedure. Report on 105 post-traumatic cases].

    Science.gov (United States)

    Zimmermann, R; Gabl, M; Angermann, P; Lutz, M; Pechlaner, S

    2003-07-01

    A modified Sauvé-Kapandji procedure was performed on 105 patients for a painfully limited range of motion and arthritis of the distal radioulnar joint following distal fracture of the radius ( n=81), the radius and ulna in the distal one-third ( n=18) and of the forearm shaft ( n=6). After an average of 8 years all patients were followed up clinically (motion, strength, pain) and radiographically (union of the arthrodesis, carpal translation, radioulnar distance). Rotation of the forearm had been improved by 53%. The amount of strength lay by 70% in comparison to the contralateral side. In 97% of the patients pain could be reduced. In all cases the arthrodesis had fused completely. An ulnar drift of the carpus was observed in 5% of the patients, and 74% of the patients showed radiological signs of approximation of the proximal ulnar stump to the radius. This reduction of the radioulnar distance amounted to less than 3 mm in 65% of the patients and lay between 3 and 5 mm in 29% of the patients. In none of the cases was direct contact between the ulna and the radius encountered.

  9. Clinical and radiological manifestations of the rheumatoid wrist after the Sauvé-Kapandji procedure.

    Science.gov (United States)

    Momohara, Shigeki; Mamizuka, Kyoko; Yonemoto, Kouichi; Tomatsu, Taisuke; Inoue, Kazuhiko

    2004-01-01

    A retrospective study was performed to investigate the clinical and radiological results of the Sauvé-Kapandji (S-K) procedure for the rheumatoid wrist. One hundred and eight rheumatoid wrists in 98 patients were operated on in our institute from 1992 to 2000, and in 82 wrists we used the S-K procedure. In other cases, synovectomy alone was performed on 16 wrists, and partial and total arthrodeses were performed concurrently on 5 wrists each. Carpal bones and/or radiocarpal joints in which the union could not be assessed radiologically were found in 49 wrists (59.8%) after the S-K procedure, and among them there was definite non-fusion of the carpal bone and radiocarpal joints in 29 wrists (35.4%). However, definite fusion of carpal bones and/or radiocarpal joints was found in 33 wrists (40.2%). The formation of carpal bones and partial radiocarpal fusion with some mobility was detected in some cases. Therefore, the S-K procedure may stabilize the carpus in the rheumatoid wrist to some extent while maintaining a functionally important range of motion and relieving pain. However, it does not stop the disease process and cannot reestablish or maintain carpal height. We concluded that the S-K procedure is the treatment of choice for the rheumatoid wrist, and if the wrist is unstable, as seen with arthritis mutilans, we then perform either radio-lunate partial arthrodesis or total wrist arthrodesis.

  10. Economic impact of minimally invasive lumbar surgery

    Science.gov (United States)

    Hofstetter, Christoph P; Hofer, Anna S; Wang, Michael Y

    2015-01-01

    Cost effectiveness has been demonstrated for traditional lumbar discectomy, lumbar laminectomy as well as for instrumented and noninstrumented arthrodesis. While emerging evidence suggests that minimally invasive spine surgery reduces morbidity, duration of hospitalization, and accelerates return to activites of daily living, data regarding cost effectiveness of these novel techniques is limited. The current study analyzes all available data on minimally invasive techniques for lumbar discectomy, decompression, short-segment fusion and deformity surgery. In general, minimally invasive spine procedures appear to hold promise in quicker patient recovery times and earlier return to work. Thus, minimally invasive lumbar spine surgery appears to have the potential to be a cost-effective intervention. Moreover, novel less invasive procedures are less destabilizing and may therefore be utilized in certain indications that traditionally required arthrodesis procedures. However, there is a lack of studies analyzing the economic impact of minimally invasive spine surgery. Future studies are necessary to confirm the durability and further define indications for minimally invasive lumbar spine procedures. PMID:25793159

  11. Clinical Outcomes of Surgical Treatments for Primary Malignant Bone Tumors Arising in the Acetabulum

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    Tomohiro Fujiwara

    2015-01-01

    Full Text Available The functional and oncologic results of eighteen patients with primary malignant periacetabular tumors were reviewed to determine the impact of surgical treatment. The reconstruction procedures were endoprosthesis (11, hip transposition (4, iliofemoral arthrodesis (2, and frozen bone autograft (1. After a mean follow-up of 62 months, 13 patients were alive and 5 had died of their disease; the 5-year overall survival rate was 67.2%. The corresponding mean MSTS scores of patients with endoprosthesis (11 and other reconstructions (7 were 42% and 55% (49%, 68%, and 50%, respectively. Overall, postoperative complications including deep infection or dislocation markedly worsened the functional outcome. Iliofemoral arthrodesis provided better function than the other procedures, whereas endoprosthetic reconstruction demonstrated poor functional outcome except for patients who were reconstructed with the adequate soft tissue coverage. Avoiding postoperative complications is highly important for achieving better function, suggesting that surgical procedures with adequate soft tissue coverage or without the massive use of nonbiological materials are preferable. Appropriate selection of the reconstructive procedures for individual patients, considering the amount of remaining bone and soft tissues, would lead to better clinical outcomes.

  12. Total ankle replacement--evolution of the technology and future applications.

    Science.gov (United States)

    Yu, John J; Sheskier, Steven

    2014-01-01

    Total ankle arthroplasty was developed to reduce pain and retain motion of the ankle joint in patients with osteoarthritis much like its total hip and knee counterparts. Orthopaedic surgeons are well equipped to evaluate and treat patients with end-stage hip or knee arthritis; however, the management of patients with ankle arthritis represents a challenge to both general orthopaedic surgeons and to the foot and ankle surgeons to whom these patients are often referred. Although techniques for both hip and knee arthroplasty have evolved to provide long-term pain relief and functional improvement, neither ankle arthrodesis nor arthroplasty has demonstrated comparably favorable outcomes in long-term follow-up studies. Early ankle arthroplasty designs with highly constrained cemented components were abandoned due to unacceptably high failure rates and complications. While arthrodesis is still considered the "gold standard" for treatment of end-stage ankle arthritis, progression of adjacent joint arthrosis and diminished gait efficiency has led to a resurgence of interest in ankle arthroplasty. Long-term outcome studies for total ankle replacement found excellent or good results in 82% of patients who received a newer generation ankle device compared with 72% if undergoing ankle fusion. Continued long-term follow-up studies are necessary, but total ankle arthroplasty has become a viable option for surgical treatment of ankle arthritis.

  13. A brief history of total ankle replacement and a review of the current status.

    Science.gov (United States)

    Vickerstaff, John A; Miles, Anthony W; Cunningham, James L

    2007-12-01

    Total ankle replacement (TAR) was first attempted in the early 1970s, but poor early results lead to it being abandoned in favour of arthrodesis. Arthrodesis is not totally satisfactory, often causing further hindfoot arthritis and this has lead to a resurgence of interest in joint replacement. New designs which more closely approximated the natural anatomy of the ankle and associated biomechanics have produced more encouraging results and led to renewed interest in total ankle replacement. Three prostheses dominate the market: Agility, Buechel-Pappas and STAR, and improving clinical results with these devices have led to more designs appearing on the market. Modern designs of prosthetic ankles almost exclusively consist of three part prostheses with a mobile bearing component, similar to the Buechel-Pappas and STAR. Clinical results of these newer designs are limited and short-term and have often been carried out by the designers of the implants. This paper presents a brief history of the development of total ankle replacement and a review of the current status.

  14. The SIGN nail for knee fusion: technique and clinical results

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    Anderson Duane Ray

    2016-01-01

    Full Text Available Purpose: Evaluate the efficacy of using the SIGN nail for instrumented knee fusion. Methods: Six consecutive patients (seven knees, three males with an average age of 30.5 years (range, 18–50 years underwent a knee arthrodesis with SIGN nail (mean follow-up 10.7 months; range, 8–14 months. Diagnoses included tuberculosis (two knees, congenital knee dislocation in two knees (one patient, bacterial septic arthritis (one knee, malunited spontaneous fusion (one knee, and severe gout with 90° flexion contracture (one knee. The nail was inserted through an anteromedial entry point on the femur and full weightbearing was permitted immediately. Results: All knees had clinical and radiographic evidence of fusion at final follow-up and none required further surgery. Four of six patients ambulated without assistive device, and all patients reported improved overall physical function. There were no post-operative complications. Conclusion: The technique described utilizing the SIGN nail is both safe and effective for knee arthrodesis and useful for austere environments with limited fluoroscopy and implant options.

  15. Scapholunate advanced collapse wrist salvage.

    Science.gov (United States)

    Ashmead, D; Watson, H K; Damon, C; Herber, S; Paly, W

    1994-09-01

    Patients with scapholunate advanced collapse (SLAC) wrist do not have to undergo total wrist arthrodesis; the SLAC pattern spares the radiolunate articulation, providing a basis for salvage. We report the results of 100 cases in which a technique comprised of scaphoid excision and limited wrist arthrodesis was used. The average followup period of 44 months revealed excellent functional status and a high rate of patient satisfaction. The majority of employed patients were able to return to their original jobs, and many chose to resume wrist-related recreational activities. Pain relief was good to excellent in most cases. Extension/flexion averaged 72 degrees (53% of a normal opposite wrist), radioulnar deviation 37 degrees (59%), and grip strength 80% of the opposite side. X-ray films revealed only two instances of radiolunate destruction, both in conjunction with ulnar translation of the carpus. The other 98 patients demonstrated a well-preserved radiolunate joint regardless of followup interval. Complications were few. Nonunion occurred in three cases. A dorsal impingement of the capitate and radius (12%) was felt to be technique-related and avoidable by careful capitolunate alignment.

  16. Comparison of the results of MIS-TLIF and open TLIF techniques in laborers

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    Daniel De Abreu Oliveira

    2014-01-01

    Full Text Available Objective: To compare clinical outcomes in laborers who have undergone open transforaminal interbody fusion (TLIF and minimally invasive transforaminal interbody fusion (MIS TLIF. Methods: 78 patients were submitted to lumbar arthrodesis by the same two spine surgeons partners from January 2008 to December 2012. Forty-one were submitted to traditional open arthrodesis and 37 to the minimally invasive procedure. Three patients were not included because they had already retired from work. The analyzed variables were length of hospitalization, length of follow-up, type of access (TILF or MIS TLIF, need for blood transfusion, percentage of improvement or worsening after surgery, pre- and postoperative VAS scale, time off work, pre-and postoperative Oswestry disability index, and general aspects of the laborers such as age, education, profession, working time, amount of daily weight carried at work, and use or not of personal protective equipment. Results: Time off work was longer in the TLIF group (average of 9.84 months compared with the MIS TLIF group (average of 3.20 months. Significant improvement in postoperative VAS and Oswestry was achieved in both groups. Average length of hospitalization was 5.73 days for the TLIF group and 2.76 days for the MIS TLIF group. Conclusions: Minimally invasive transforaminal lumbar interbody fusion presents similar results when compared to open TLIF, but has the benefits of less postoperative morbidity, shorter hospitalization times, and faster rehabilitation in laborer patients.

  17. A two-stage percutaneous approach to charcot diabetic foot reconstruction.

    Science.gov (United States)

    Lamm, Bradley M; Gottlieb, H David; Paley, Dror

    2010-01-01

    The goals of Charcot deformity correction are to restore osseous alignment, regain pedal stability, and prevent ulceration. Traditional reconstructive surgical approaches involve large, open incisions to remove bone and the use of internal fixation to attempt to fuse dislocated joints. Such operations can result in shortening of the foot and/or incomplete deformity correction, fixation failure, incision healing problems, infection, and the longterm use of casts or braces. We recommend a minimally invasive surgical technique for the treatment of Charcot deformity, which we performed on 11 feet in 8 patients. Osseous realignment was achieved through gradual distraction of the joints with external fixation, after which minimally invasive arthrodesis was performed with rigid internal fixation. Feet were operated on at various stages of Charcot deformity: Eichenholtz stage I (1 foot), Eichenholtz stage II (6 feet), and Eichenholtz stage III (4 feet). When comparing the average change in preoperative and postoperative radiographic angles, the transverse plane talar-first metatarsal angle (P = .02), sagittal plane talar-first metatarsal angle (P = .008), and calcaneal pitch angle (P = .001) were all found to be statistically significant. Complications included 3 operative adjustments of external or internal fixation, 4 broken wires or half-pins, 2 broken rings, and 11 pin tract infections. Most notably, no deep infection, no screw failure, and no recurrent ulcerations occurred and no amputations were necessary during an average follow-up of 22 months. Gradual Charcot foot correction with the Taylor spatial frame plus minimally invasive arthrodesis is an effective treatment.

  18. Ankle fusion stability: a biomechanical comparison of external versus internal fixation.

    Science.gov (United States)

    Hoover, Justin R; Santrock, Robert D; James, William C

    2011-04-11

    This biomechanical study compares bimalleolar external fixation to conventional crossed-screw construct in terms of stability and compression for ankle arthrodesis. The goals of the study were to determine which construct is more stable with bending and torsional forces, and to determine which construct achieves more compression.Fourth-generation bone composite tibia and talocalcaneal models were made to 50th percentile anatomic specifications. Fourteen ankle fusion constructs were created with bimalleolar external fixators and 14 with crossed-screw constructs. Ultimate bend, torque, and compression testing were completed on the external fixator and crossed-screw constructs using a multidirectional Materials Testing Machine (MTS Systems Corp, Eden Prairie, Minnesota). Ultimate bend testing revealed a statistically significant difference (P=.0022) with the mean peak load to failure for the external fixator constructs of 973.2 N compared to 612.5 N for the crossed-screw constructs. Ultimate torque testing revealed the mean peak torque to failure for the external fixator construct was 80.2 Nm and 28.1 Nm for the crossed-screw construct, also a statistically significant difference (P=.0001). The compression testing yielded no statistically significant difference (P=.9268) between the average failure force of the external fixator construct (81.6 kg) and the crossed-screw construct (81.2 kg).With increased stiffness in both bending and torsion and comparable compressive strengths, bimalleolar external fixation is an excellent option for tibiotalar ankle arthrodesis.

  19. Only fixation for cervical spondylosis: Report of early results with a preliminary experience with 6 cases

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    Atul Goel

    2013-01-01

    Full Text Available Aim: The author reports early post-operative outcome and preliminary experience with an alternative form of treatment of cervical degenerative or spondylotic disease leading to spinal canal stenosis that involves fixation-arthrodesis of the affected spinal segment using one or two (double insurance transarticular screws for each joint. Materials and Methods: During the period of months from March 2013 to July 2013, six patients having cervical spondylotic cord compression were treated with transarticular method of screw fixation of the involved segments. The operation involved section of the spinous process at its base, opening up of the facet joint, denuding of articular cartilage, placement of intraarticular cavity bone graft chips and insertion of either a single or two transarticular screws at each level. The fixation was done in four levels in four patients and at two levels in two patients. Japanese Orthopedic Association score, visual analog scale (neck pain and Odom′s criteria were used to monitor the clinical status of the patients before and after the surgery and at follow-up. Results: Immediate post-operative and a relatively short-term post-operative outcome was remarkably gratifying. During the average period of follow-up of 6 months (range: 3-8 months; there was varying degree of recovery of symptoms. The procedure resulted in firm stabilization and fixation of the spinal segment and provided a ground for arthrodesis. No patient worsened after treatment. During the period of follow-up, all patients showed remarkable and progressive recovery in symptoms. Conclusions: Vertical instability and telescoping, listhesis or overriding of the facets on physical activity seems to be the defining phenomenon in pathogenesis of cervical spondylotic disease. The clinical outcome in our patients suggest that only fixation of the spinal segment can be a rationale form of treatment. Transarticular method of treatment is a simple, safe and

  20. Analysis of postmarket complaints database for the iFuse SI Joint Fusion System®: a minimally invasive treatment for degenerative sacroiliitis and sacroiliac joint disruption

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    Miller LE

    2013-05-01

    Full Text Available Larry E Miller,1,2 W Carlton Reckling,3 Jon E Block21Miller Scientific Consulting Inc, Arden, NC, 2The Jon Block Group, San Francisco, CA, 3SI-BONE Inc, San Jose, CA, USABackground: The sacroiliac joint is a common but under-recognized source of low back and gluteal pain. Patients with degenerative sacroiliitis or sacroiliac joint disruption resistant to nonsurgical treatments may undergo open surgery with sacroiliac joint arthrodesis, although outcomes are mixed and risks are significant. Minimally invasive sacroiliac joint arthrodesis was developed to minimize the risk of iatrogenic injury and to improve patient outcomes compared with open surgery.Methods: Between April 2009 and January 2013, 5319 patients were treated with the iFuse SI Joint Fusion System® for conditions including sacroiliac joint disruption and degenerative sacroiliitis. A database was prospectively developed to record all complaints reported to the manufacturer in patients treated with the iFuse device. Complaints were collected through spontaneous reporting mechanisms in support of ongoing mandatory postmarket surveillance efforts.Results: Complaints were reported in 204 (3.8% patients treated with the iFuse system. Pain was the most commonly reported clinical complaint (n = 119, 2.2%, with nerve impingement (n = 48, 0.9% and recurrent sacroiliac joint pain (n = 43, 0.8% most frequently cited. All other clinical complaints were rare (≤0.2%. Ninety-six revision surgeries were performed in 94 (1.8% patients at a median follow-up of four (range 0–30 months. Revisions were typically performed in the early postoperative period for treatment of a symptomatic malpositioned implant (n = 46, 0.9% or to correct an improperly sized implant in an asymptomatic patient (n = 10, 0.2%. Revisions in the late postoperative period were performed to treat symptom recurrence (n = 34, 0.6% or for continued pain of undetermined etiology (n = 6, 0.1%.Conclusion: Analysis of a postmarket

  1. Transverse plane pelvic rotation increase (TPPRI following rotationally corrective instrumentation of adolescent idiopathic scoliosis double curves

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    Asher Marc A

    2010-08-01

    Full Text Available Abstract Background We have occasionally observed clinically noticeable postoperative transverse plane pelvic rotation increase (TPPRI in the direction of direct thoracolumbar/lumbar rotational corrective load applied during posterior instrumentation and arthrodesis for double (Lenke 3 and 6 adolescent idiopathic scoliosis (AIS curves. Our purposes were to document this occurrence; identify its frequency, associated variables, and natural history; and determine its effect upon patient outcome. Methods Transverse plane pelvic rotation (TPPR can be quantified using the left/right hemipelvis width ratio as measured on standing posterior-anterior scoliosis radiographs. Descriptive statistics were done to determine means and standard deviations. Non-parametric statistical tests were used due to the small sample size and non-normally distributed data. Significance was set at P Results Seventeen of 21 (81% consecutive patients with double curves (7 with Lenke 3 curves and 10 with Lenke 6 instrumented with lumbar pedicle screw anchors to achieve direct rotation had a complete sequence of measurable radiographs. While 10 of these 17 had no postoperative TPPRI, 7 did all in the direction of the rotationally corrective thoracolumbar instrumentation load. Two preoperative variables were associated with postoperative TPPRI: more tilt of the vertebra below the lower instrumented vertebra (-23° ± 3.1° vs. -29° ± 4.6°, P = 0.014 and concurrent anterior thoracolumbar discectomy and arthrodesis (5 of 10 vs. 7 of 7, P = 0.044. Patients with a larger thoracolumbar/lumbar angle of trunk inclination or larger lower instrumented vertebra plus one to sacrum fractional/hemicurve were more likely to have received additional anterior thoracolumbar discectomy and arthrodesis (c = 0.90 and c = 0.833, respectively. Postoperative TPPRI resolved in 5 of the 7 by intermediate follow-up at 12 months. Patient outcome was not adversely affected by postoperative TPPRI

  2. 后路内固定融合术治疗脊柱胸腰段骨折的临床效果观察

    Institute of Scientific and Technical Information of China (English)

    唐志辉; 周华杰; 李恪旺

    2014-01-01

    objective:to study the thoracic lumbar spine arthrodesis posterior internal fixation in the treatment of fracture, and analyze its clinical efficacy. Selection methods:60 patients with thoracic lumbar spine fracture patients as the research object, randomly divided into control group and research group, 30 cases in each group, treatment group were treated by internal fixation of the posterior arthrodesis, control group patients with anterior internal fixation fusion treatment, analysis and compare and contrast the operation situa-tion of two groups of patients and the clinical curative effect. Results:treatment group total effective rate was 93.3%, the control group was 70%, treatment group total effectiveness is significantly higher than control group (P<0.05), and the team's operation time, intra-operative blood loss, wound length, hospitalization days were significantly better than that of control group (P < 0.05). Conclusion:arthrodesis posterior internal fixation in the treatment of thoracic lumbar spine fractures has significant clinical effect, worthy of clinical application and promotion.%目的:探讨脊柱胸腰段骨折中后路内固定融合术的治疗方法,并分析其临床疗效。方法:选取我院60例脊柱胸腰段骨折患者作为研究对象,随机分成对照组与研究组,每组各30例,研究组患者采用后路内固定融合术进行治疗,对照组患者则采用前路内固定融合术进行治疗,分析和对比两组患者的手术情况和临床疗效。结果:研究组治疗总有效率为93.3%,对照组为70%,研究组治疗总有效率明显高于对照组(P<0.05),且研究组的手术时间、术中出血量、伤口长度、住院天数等均明显优于对照组(P<0.05)。结论:后路内固定融合术在脊柱胸腰段骨折的治疗中具有显著的临床疗效,值得临床的应用与推广。

  3. Accuracy of bone SPECT/CT for identifying hardware loosening in patients who underwent lumbar fusion with pedicle screws

    Energy Technology Data Exchange (ETDEWEB)

    Hudyana, Hendrah; Maes, Alex [AZ Groeninge, Department of Nuclear Medicine, Kortrijk (Belgium); University Hospital Leuven, Department of Morphology and Medical Imaging, Leuven (Belgium); Vandenberghe, Thierry; Fidlers, Luc [AZ Groeninge, Department of Neurosurgery, Kortrijk (Belgium); Sathekge, Mike [University of Pretoria, Department of Nuclear Medicine, Pretoria (South Africa); Nicolai, Daniel [AZ Groeninge, Department of Nuclear Medicine, Kortrijk (Belgium); Wiele, Christophe van de [AZ Groeninge, Department of Nuclear Medicine, Kortrijk (Belgium); University Ghent, Department of Radiology and Nuclear Medicine, Ghent (Belgium)

    2016-02-15

    The aim of this retrospective study was to evaluate the accuracy of bone SPECT (single photon emission computed tomography)/CT (computed tomography) in diagnosing loosening of fixation material in patients with recurrent or persistent back pain that underwent lumbar arthrodesis with pedicle screws using surgery and clinical follow-up as gold standard A total of 48 patients (median age 49 years, range 21-81 years; 17 men) who had undergone lumbar spinal arthrodesis were included in this retrospective analysis. SPECT/CT results were compared to the gold standard of surgical evaluation or clinical follow-up. Positive SPECT/CT results were considered true positives if findings were confirmed by surgery or if clinical and other examinations were completely consistent with the positive SPECT/CT finding. They were considered false positives if surgical evaluation did not find any loose pedicle screws or if symptoms subsided with non-surgical therapy. Negative SPECT/CT scans were considered true negatives if symptoms either improved without surgical intervention or remained stable over a minimum follow-up period of 6 months. Negative SPECT/CT scans were determined to be false negatives if surgery was still required and loosening of material was found. The median length of time from primary surgery to bone SPECT/CT referral was 29.5 months (range 12-192 months). Median follow-up was 18 months (range 6-57) for subjects who did not undergo surgery. Thirteen of the 48 patients were found to be positive for loosening on bone SPECT/CT. Surgical evaluation (8 patients) and clinical follow-up (5 patients) showed that bone SPECT/CT correctly predicted loosening in 9 of 13 patients, while it falsely diagnosed loosening in 4 patients. Of 35 negative bone SPECT/CT scans, 12 were surgically confirmed. In 18 patients, bone SPECT/CT revealed lesions that could provide an alternative explanation for the symptoms of pain (active facet degeneration in 14 patients, and disc and sacroiliac

  4. Unilateral lumbosacral dislocation: case report and a comprehensive review.

    Science.gov (United States)

    Grivas, Theodoros B; Papadakis, Stamatios A; Katsiva, Vassiliki; Koufopoulos, George; Mouzakis, Vassilios

    2012-01-01

    Lumbosacral fracture-dislocation is a rare occurrence. There are more than 73 cases reported in the English literature. We report on the imaging findings and surgical treatment in a patient suffered of unilateral traumatic L5-S1 dislocation associated with severe disruption of the posterior ligamentous complex. The patient underwent open reduction and stabilization of L4-S1 vertebrae with posterior instrumentation system. Open reduction and internal fixation was mandatory as post-traumatic ligamentous insufficiency would lead to abnormal motion. Operative treatment managed to produce a solid arthrodesis and restore stability of the lumbosacral junction. Follow-up revealed excellent results. This study reports a rare injury of the lumbosacral junction, and the literature concerning this unusual condition is extensively reviewed.

  5. Strategies for treating scoliosis in children with spinal muscular atrophy.

    Science.gov (United States)

    Tobert, Daniel G; Vitale, Michael G

    2013-11-01

    Progressive pulmonary dysfunction is a major complication of spinal muscular atrophy (SMA). Growing constructs are a well-established alternative to spinal arthrodesis to maximize pulmonary growth. We describe patients who demonstrated sustained pulmonary function and improved quality of life following hybrid growing construct implantation. The purpose of this article is to demonstrate a range of approaches for managing scoliosis in children with SMA by utilizing vertical expandable prosthetic titanium rib implantation or growing rods with lateral rib fixation to improve clinical and patient-reported outcomes. Pulmonary compromise and quality of life decline are leading concerns in the SMA population. This case series highlights important surgical strategies that can be utilized to treat scoliosis in patients with SMA.

  6. Total ankle replacement - surgical treatment and rehabilitation.

    Science.gov (United States)

    Prusinowska, Agnieszka; Krogulec, Zbigniew; Turski, Piotr; Przepiórski, Emil; Małdyk, Paweł; Księżopolska-Orłowska, Krystyna

    2015-01-01

    Functions of the ankle joint are closely connected with the gait and ability to maintain an upright position. Degenerative lesions of the joint directly contribute to postural disorders and greatly restrict propulsion of the foot, thus leading to abnormal gait. Development of total ankle replacement is connected with the use of the method as an efficient treatment of joint injuries and continuation of achievements in hip and knee surgery. The total ankle replacement technique was introduced as an alternative to arthrodesis, i.e. surgical fixation, which made it possible to preserve joint mobility and to improve gait. Total ankle replacement is indicated in post-traumatic degenerative joint disease and joint destruction secondary to rheumatoid arthritis. In this paper, total ankle replacement and various types of currently used endoprostheses are discussed. The authors also describe principles of early postoperative rehabilitation as well as rehabilitation in the outpatient setting.

  7. Hope versus hype: what can additive manufacturing realistically offer trauma and orthopedic surgery?

    Science.gov (United States)

    Gibbs, David M R; Vaezi, Mohammad; Yang, Shoufeng; Oreffo, Richard O C

    2014-01-01

    Additive manufacturing (AM) is a broad term encompassing 3D printing and several other varieties of material processing, which involve computer-directed layer-by-layer synthesis of materials. As the popularity of AM increases, so to do expectations of the medical therapies this process may offer. Clinical requirements and limitations of current treatment strategies in bone grafting, spinal arthrodesis, osteochondral injury and treatment of periprosthetic joint infection are discussed. The various approaches to AM are described, and the current state of clinical translation of AM across these orthopedic clinical scenarios is assessed. Finally, we attempt to distinguish between what AM may offer orthopedic surgery from the hype of what has been promised by AM.

  8. Reliability analysis of radiographic methods for determination of posterolateral lumbossacral fusion

    Energy Technology Data Exchange (ETDEWEB)

    Gotfryd, Alberto Ofenhejm; Moraes Pomar, Felipe de; Carneiro, Nicola Jorge Neto; Franzin, Fernando José [Santa Casa da Misericórdia de Santos, Santos, SP (Brazil); Rodrigues, Luciano Miller Reis [Faculdade de Medicina do ABC, Santo André, SP (Brazil); Poletto, Patricia Rios [Universidade Federal de São Paulo, Santos, SP (Brazil)

    2014-07-01

    To analyze intra and interobserver agreement of two radiographic methods for evaluation of posterolateral lumbar arthrodesis. Twenty patients undergoing instrumented posterolateral fusion were evaluated by anteroposterior and dynamic lateral radiographs in maximal flexion and extension. The images were evaluated initially by 6 orthopedic surgeons, and after 8 weeks, reassessed by 4 of them, totaling 400 radiographic measurements. Intra and interobserver reliability were analyzed using the Kappa coefficient and Landis and Koch criteria. Intra and interobserver agreement regarding anteroposterior radiographs were, respectively, 76 and 63%. On lateral views, these values were 78 and 84%, respectively. However, the Kappa analysis showed poor intra and interobserver agreement in most cases, regardless of the radiographic method used. There was poor intra and interobserver agreement in the evaluation of lumbosacral fusion by plain film in anteroposterior and dynamic lateral views, with no statistical superiority between the methods.

  9. OCCULT MANUBRIOSTERNAL JOINT INJURY ASSOCIATED WITH FRACTURE OF THE THORACIC SPINE.

    Science.gov (United States)

    da Silva Herrero, Carlos Fernando Pereira; Porto, Maximiliano Aguiar; Nogueira-Barbosa, Marcello Henrique; Defino, Helton Luiz Aparecido

    2011-01-01

    The authors report the occurrence of an occult manubriosternal joint injury in the initial evaluation on a patient with a thoracic spine fracture (T9). This T9 fracture was diagnosed in a 37-year-old man and was associated with a partial neurological deficit. At the initial evaluation, the radiographs produced did not show the manubriosternal joint injury. During rehabilitation, after surgical stabilization of the thoracic spine fracture, the patient suddenly felt an intense pain accompanied by deformation at the sternal level. From imaging examinations, manubriosternal luxation was diagnosed. Because of recurrence of the luxation and the incapacitating pain, open reduction and fixation of the manubriosternal joint had to be performed. At the 12-month follow-up, the patient presented complete recovery of the neurological lesion, consolidation of the arthrodesis on the T7-T11 vertebral segment and maintenance of the reduction of the manubriosternal joint, which was asymptomatic during daily activities.

  10. Osteoarthritis of the Manubriosternal Joint: An Uncommon Cause of Chest Pain.

    Science.gov (United States)

    Vaishya, Raju; Vijay, Vipul; Rai, Bibek K

    2015-11-02

    Osteoarthritis of the manubriosternal joint is a rare cause of chest pain. The diagnosis is difficult, and other serious causes of chest pain have to be ruled out first. We report one case that was treated with fusion of the manubriosternal joint using an iliac crest bone graft with a cervical locking plate and screws with excellent results. Preoperative CT scan images were used to measure the screw length and the drill stop depth. In this case report, we have shown that arthrodesis can be an effective way of treating osteoarthritis of the manubriosternal joint when other measures fail. Furthermore, the use of a cervical locking plate with appropriate and careful preoperative planning affords a safe surgical technique, rapid pain relief, and ultimately, sound and asymptomatic union of the joint.

  11. Bilateral Diabetic Knee Neuroarthropathy in a Forty-Year-Old Patient

    Directory of Open Access Journals (Sweden)

    Patrick Goetti

    2016-01-01

    Full Text Available Diabetic osteoarthropathy is a rare cause of neuropathic joint disease of the knee; bilateral involvement is even more exceptional. Diagnosis is often made late due to its unspecific symptoms and appropriate surgical management still needs to be defined, due to lack of evidence because of the disease’s low incidence. We report the case of a forty-year-old woman with history of diabetes type I who developed bilateral destructive Charcot knee arthropathy. Bilateral total knee arthroplasty was performed in order to achieve maximal functional outcome. Follow-up was marked by bilateral tibial periprosthetic fractures treated by osteosynthesis with a satisfactory outcome. The diagnosis of Charcot arthropathy should always be in mind when dealing with atraumatic joint destruction in diabetic patients. Arthroplasty should be considered as an alternative to arthrodesis in bilateral involvement in young patients.

  12. Outcome after open reduction and internal fixation of intraarticular fractures of the calcaneum without the use of bone grafts

    Directory of Open Access Journals (Sweden)

    Pendse Aniruddha

    2006-01-01

    Full Text Available Background: Intraarticular fractures of calcaneum are commenest type of calcaneal fractures. Lots of controversies exist about the ideal management for them. The focus is now shifting on operative management by open reduction and internal fixation for these fractures with or without the use of bone grafts. Method: Thirty intraarticular fractures classified by Essex Lopresti radiological classification, were treated by open reduction and fixation. The patients were followed over a mean period of 30 months (25-40 months. Results: All the fractures united at a mean duration of 14 weeks. 86% patients had excellent functional outcome with one patient having fair and one having poor functional outcome. Conclusion: Open reduction and internal fixation with plate is a good method for treatment of intraarticular fractures of calcaneum to achieve anatomical restoration of articular surface under vision, stable fixation, early mobilization and an option for primary subtalar arthrodesis if deemed necessary.

  13. Clinical evaluation of a lumbar interspinous dynamic stabilization device (the Wallis system) with a 13-year mean follow-up.

    Science.gov (United States)

    Sénégas, Jacques; Vital, Jean-Marc; Pointillart, Vincent; Mangione, Paolo

    2009-07-01

    The authors determined current health status of patients who had been included in a long-term survivorship analysis of a lumbar dynamic stabilizer. Among 133 living patients, 107 (average age at surgery, 44.2 +/- 9.9 years) completed health questionnaires. All patients had initially been scheduled for decompression and fusion for canal stenosis, herniated disc, or both. In 20 patients, the implant was removed, and fusion was performed. The other 87 still had the dynamic stabilizer. Satisfaction, Oswestry disability index, visual analog scales for back and leg pain, short-form (SF-36) quality-of-life physical composite score, physical function, and social function were significantly better (p stabilization device. SF-36 scores of the fused subgroup were no worse than those reported elsewhere in patients who had primary pedicle-screw enhanced lumbar fusion. This anatomy-sparing device provided a good 13-year clinical outcome and obviated arthrodesis in 80% of patients.

  14. [The value of the Kapandji-Sauvé procedure with considering clinical results and measurement of bone density. A clinical study].

    Science.gov (United States)

    Wüstner-Hofmann, M C; Schober, F; Hofmann, A K

    2003-05-01

    Between 1989 and 1995, 33 patients were treated with a Kapandji-Sauvé procedure for malunited fracture of the distal radius and instabilities of the distal radioulnar joint. Thirty patients were followed up with a mean follow-up time of 91 months. Fourteen patients underwent a measurement of bone density of the distal forearm. Twenty-eight patients showed good ossification of the distal radioulnar arthrodesis. Forearm rotation improved by 17.3 %. Mean grip strength was 72 % of that of the contralateral hand. Evaluation by the Cooney score resulted in 10 % very good, in 65 % good, 22 % fair and in 3 % poor results. The measurement of bone density of the distal radius showed an increase of rotation and flexure firmness. The cortical density remained constant. In the subcortical bone of the distal radius, we found a decrease of the trabecular density in the radial part.

  15. [The Sauvé-Kapandji operation. Indications and results].

    Science.gov (United States)

    Daecke, W; Streich, N A; Martini, A-K

    2004-06-01

    The Sauvé-Kapandji procedure consists of an arthrodesis of the distal radioulnar joint (DRUJ) in combination with an intentional pseudarthrosis of the distal ulna. In addition to other methods, the Sauvé-Kapandji operation is a salvage procedure of for chronic disorders of DRUJ. Different studies have confirmed that this procedure results in a pain reduction of between 73 and 100% and that patient' satisfaction lies between 68 and 100%. A reliable improvement of rotation of the forearm of between 134 and 171 degrees can be expected. On the other hand, a decrease in grip strength on the affected side is usual. The potential problem of instability of the proximal ulna stump can be avoided by performing a short distal segment and a narrow pseudarthrosis gap. The Sauvé-Kapandji procedure is a reliable salvage procedure resulting in high patient satisfaction and a reliable improvement in range of motion.

  16. An unconventional indication of the Sauve' - Kapandji procedure in a radial shaft pseudoarthrosis and chronic DRUJ dislocation: a case report.

    Science.gov (United States)

    Theodorakis, E; Fanelli, M; Ottolenghi, P; Pappalardo, S

    2013-01-01

    We present a 42-years-old male who developed a radial shaft pseudoartrosis and a chronic DRUJ dislocation/instability, following a Galeazzi fracture. He presented to our Office with a severe inability of wrist and forearm motion. A Sauve'-Kapandji procedure was adopted, performing a lateral approach to the ulna and grafting the excised ulnar block to retrieve radial length at the pseudoarthrosis level. Cancellous bone grafts from the iliac crest were also applied and mixed with autologous platelet rich plasma to promote callus formation. The goal was to create an intentional pseudoarthrosis of the distal ulna combined with a DRUJ arthrodesis, in order to resolve instability and regain forearm pronation/supination. We obtained bone healing, an excellent clinical recovery, and the patient returned to all his previous activities six months after surgery. To our knowledge, this is the first reported case of a radial shaft psudoarthrosis treated with the Sauve'-Kapandji technique.

  17. Bilateral Diabetic Knee Neuroarthropathy in a Forty-Year-Old Patient

    Science.gov (United States)

    Gallusser, Nicolas; Borens, Olivier

    2016-01-01

    Diabetic osteoarthropathy is a rare cause of neuropathic joint disease of the knee; bilateral involvement is even more exceptional. Diagnosis is often made late due to its unspecific symptoms and appropriate surgical management still needs to be defined, due to lack of evidence because of the disease's low incidence. We report the case of a forty-year-old woman with history of diabetes type I who developed bilateral destructive Charcot knee arthropathy. Bilateral total knee arthroplasty was performed in order to achieve maximal functional outcome. Follow-up was marked by bilateral tibial periprosthetic fractures treated by osteosynthesis with a satisfactory outcome. The diagnosis of Charcot arthropathy should always be in mind when dealing with atraumatic joint destruction in diabetic patients. Arthroplasty should be considered as an alternative to arthrodesis in bilateral involvement in young patients. PMID:27668112

  18. SURGICAL TREATMENT OF ADULT PATIENTS WITH CONGENITAL CLUBFOOT IN SEVERITY DEGREE

    Directory of Open Access Journals (Sweden)

    A. A. Mukhamadeev

    2012-01-01

    Full Text Available There were treated 48 patients (adolescents and adults with severe congenital clubfoot in Saratov Research Institute of Traumatology and Orthopedics. 43 patients had the age ranged from 16 to 30, 5 patients had the age over 30. 19 patients had bilateral clubfoot, 29 patients had unilateral clubfoot including 19 on right side and 10 left side. To improve treatment results and to prevent deformity recurrence we developed two-staged surgery for congenital clubfoot treatment in adults. Cartilages of talo-navicular, talo-calcanean, cuneo-talar joints are deleted and deformity is corrected with external fixator on I stage. Surgeon performs external fixator resetting, autobone grafting of these joints with compressive arthrodesis on second stage. This method results in full foot reconstruction, good functional outcome, full weight-bearing and improves patient life’s quality.

  19. Joint-preserving surgery in rheumatoid forefoot: preliminary study with more-than-two-year follow-up.

    Science.gov (United States)

    Barouk, Louis Samuel; Barouk, Pierre

    2007-09-01

    The authors propose a joint-preserving surgery for rheumatoid forefoot deformities as an alternative to the "classic" surgical approach to the rheumatoid forefoot. The main principle is joint preservation by shortening osteotomies of all the metatarsals performed at the primary location of the rheumatoid forefoot lesions, namely the metatarsophalangeal (MTP) joints and metatarsal heads. A scarf osteotomy is normally performed on the first ray. A Weil osteotomy is performed on the lesser metatarsals. Excellent correction of the hallux valgus deformity in the rheumatoid forefoot can be achieved with a scarf osteotomy in 92% of cases without the need for MTP joint arthrodesis. Similarly, 86% of the lateral metatarsal heads can be preserved using Weil osteotomies.

  20. Study on the modified Lapidus surgery for correction of subluxation of sesamoid bones%改良Lapidus手术纠正籽骨脱位的效果及重要性研究

    Institute of Scientific and Technical Information of China (English)

    张超; 王旭; 马昕; 黄加张; 顾湘杰; 姜建元

    2012-01-01

    Background: Hallux valgus is a common forefoot disease in elder people. More than 130 procedures were used to correct the deformity. But there has been much debate on the importance of correcting the position of the sesamoid bones. Objective: The aim of the study is to explore the efficiency and essentiality of modified Lapidus arthrodesis to the first metatarsal-sesamoid system in hallux valgus. Methods: Twenty-one female patients with 29 hallux valgus feet were enrolled in this study. The age of the patients ranged from 46 to 71 years (60.3±9.6 years). Hallux valgus angle (HVA), intermetatarsal angle (IMA) and tibial sesamoid position (TSP) were measured before and after the modified Lapidus arthrodesis. The results were statistically analyzed to explore the relationship between the hallux valgus and TSP and the outcome of modified Lapidus arthrodesis in the correction of TSP. Results: TSP was significantly correlated with HVA and IMA. TSP was redressed by operation. There was no significant difference in the absolute position of sesamoid bones before and after the operation. Conclusions: Modified Lapidus arthrodesis can effectively correct the first metatarsal-sesamoid system, TSP should be used for routine evaluation before surgical procedures of hallux valgus.%背景:(足母)外翻是老年人常见的前足疾病,其手术方法超过130种,但是目前对于手术矫正籽骨位置的重要性尚存争议.目的:探讨改良Lapidus手术中对第一跖骨籽骨系统恢复的必要性和有效性.方法:本组21例(29足)(足母)外翻患者,均为女性,年龄46~71岁,平均60.3±9.6岁.常规测量术前、术后(足母)外翻角(HVA),第一、二跖骨间角(IMA),胫侧籽骨位置(TSP),胫侧籽骨到第二跖骨轴线的距离与第二跖骨长度的比值,分析TSP与(足母)外翻的相关性以及手术对于恢复TSP的效果.结果:对于(足母)外翻足,TSP与HVA及IMA明显相关,术后患足TSP显著减小.手术前后籽骨的绝对位置

  1. SURGICAL TREATMENT OF SPONDYLOLISTHESIS WITH SOCON INSTRUMENTATION

    Institute of Scientific and Technical Information of China (English)

    2000-01-01

    Objective. To observe the clinical outcomes of using a new instrumentation SOCON system in the treatment of degenerative spondylolisthesis.Methods. Retrospective clinical and roentgenograph review of 21 patients who suffered from degenerative spondylolisthesis with spinal stenosis treated by decompression, posterolateral intertransverse arthrodesis, and with transpedicle instrumentation of SOCON system.Results. Nineteen of 21 patients were completely recovery from their preoperative symptoms, 17 of 18 cases with grade one slippage reduced to normal spine alignment, 2 cases of grade two slippage fully reduced, and one case of grade two spondylolisthesis got 70% reduction. Post- operative satisfactory rate was 90.5%. Pain relief was 90.5%. Neither infection nor neurologic complication occurred in this series.Conclusion. Our short time follow-up and limited cases showed satisfactory preliminary result of surgical treatment of spondylolisthesis with SOCON instrumentation.

  2. SURGICAL TREATMENT OF SPONDYLOLISTHESIS WITH SOCON INSTRUMENTATION

    Institute of Scientific and Technical Information of China (English)

    金今; 沈建雄; 邱贵兴; 赵宏; 翁习生; 王以朋

    2000-01-01

    Objective. To observe the clinical outcomes of using a new imtnunentafion SOCON system in the treatment of degenerative spondylolisthesis. Methods. Retrospective clinical and roentgenograph review of 21 patients who suffered from degenerative spondylolisthesis with spinal stenosis treated by decompression, posterolateral intertransverse arthrodesis, and with transpedicle instrumentation of SOCON system. Results. Nineteen of 21 patients were completely recovery from their preoperative symptoms, 17 of 18 cases with grade one slippage reduced to normal spine alignment, 2 cases of grade two slippage fully reduced, and one case of grade two spondylolisthesis got 70% reduction. Post-operative satisfactory rate was 90.5%. Pain relief was 90.5%.Neither infection nor neurologic complication occurred in this series. Conclusion. Our short time follow-up and limited cases showed satisfactory preliminary result of surgical treatment of spondylolisthesis with SOCON instrumentation.

  3. Supramalleolar osteotomies for degenerative joint disease of the ankle joint: indication, technique and results.

    Science.gov (United States)

    Barg, Alexej; Pagenstert, Geert I; Horisberger, Monika; Paul, Jochen; Gloyer, Marcel; Henninger, Heath B; Valderrabano, Victor

    2013-09-01

    Patients with varus or valgus hindfoot deformities usually present with asymmetric ankle osteoarthritis. In-vitro biomechanical studies have shown that varus or valgus hindfoot deformity may lead to altered load distribution in the tibiotalar joint which may result in medial (varus) or lateral (valgus) tibiotalar joint degeneration in the short or medium term. The treatment of asymmetric ankle osteoarthritis remains challenging, because more than half of the tibiotalar joint surface is usually preserved. Therefore, joint-sacrificing procedures like total ankle replacement or ankle arthrodesis may not be the most appropriate treatment options. The shortand midterm results following realignment surgery, are very promising with substantial pain relief and functional improvement observed post-operatively. In this review article we describe the indications, surgical techniques, and results from of realignment surgery of the ankle joint in the current literature.

  4. Biomechanics of the ankle joint and clinical outcomes of total ankle replacement.

    Science.gov (United States)

    Michael, Junitha M; Golshani, Ashkahn; Gargac, Shawn; Goswami, Tarun

    2008-10-01

    Until the 1970s ankle arthrodesis was considered to be the "gold-standard" to treat arthritis. But the low fusion rate of ankle arthrodeses along with the inability to achieve normal range of motion led to the growing interest in the development of total ankle replacements. Though the short-term outcomes were good, their long-term outcomes were not as promising. To date, most models do not exactly mimic the anatomical functionality of a natural ankle joint. Therefore, research is being conducted worldwide to either enhance the existing models or develop new models while understanding the intricacies of the joint more precisely. This paper reviews the anatomical and biomechanical aspects of the ankle joint. Also, the evolution and comparison of clinical outcomes of various total ankle replacements are presented.

  5. Strategies for Revision Total Ankle Replacement

    Directory of Open Access Journals (Sweden)

    Thomas S. Roukis, DPM, PhD, FACFAS

    2014-12-01

    Full Text Available As the frequency of primary total ankle replacement (TAR continues to build, revision will become more commonplace. At present there are no “standard principles” associated with revision TAR. What is clear is that the current approaches are technically complex, fraught with complications and no one approach represents the only answer. Exchange of TAR metallic components to the same system standard or dedicated revision components are viable options with limited occurrence of complications. Explantation and conversion to custom-design long stemmed components has limited availability. Explantation and conversion to another TAR system is high-risk and has strong potential for complications. The use of metal reinforced polymethylmethacrylate cement augmentation of failed TAR systems and tibio-talo-calcaneal arthrodesis should be reserved for very select situations where other options are not possible. There is a real need for long-term survivorship following revision TAR and future efforts ought to be directed in this area.

  6. Septic arthritis of the neonatal hip: acute management and late reconstruction.

    Science.gov (United States)

    Samora, Julie Balch; Klingele, Kevin

    2013-10-01

    Septic arthritis of the hip in neonates is rare but can have devastating consequences. Presenting signs and symptoms may differ from those encountered in older children, which may result in diagnostic challenge or delay. Many risk factors predispose neonates to septic arthritis, including the presence of transphyseal vessels and invasive procedures. Bacterial infection of the joint occurs via hematogenous invasion, extension from an adjacent site, or direct inoculation. A strong correlation exists between younger age at presentation and severity of residual hip deformity. Diagnosis is based on clinical examination, laboratory markers, and ultrasound evaluation. Early management includes parenteral antibiotics and surgical drainage. Late-stage management options include femoral and pelvic osteotomies, trochanteric arthroplasty, arthrodesis, pelvic support procedures, and nonsurgical measures. Early diagnosis and management continues to be the most important prognostic factor for a favorable outcome in the neonate with septic arthritis.

  7. Scaphoidectomy and Capsulodesis for SNAC or SLAC Stage II.

    Science.gov (United States)

    Trumble, Thomas E; Rafijah, Gregory; Alexander, Hayley; Waitayawinyu, Thanapong

    2012-11-01

    Two common types of wrist arthritis are scapholunate advanced collapse (SLAC) and scaphoid nonunion advanced collapse (SNAC). In stage II SLAC or SNAC, there is arthritis between the scaphoid and the radius, sparing the cartilage between the capitate and the lunate and between the lunate and the radius. When nonsurgical treatment failed, scaphoidectomy plus capsulorrhaphy was used in 8 patients to provide pain relief without requiring an arthrodesis or compromising the radiolunate articulation. After surgery the pain scores improved from 8.5 preoperatively to 2.4 postoperatively. The Disabilities of the Arm, Shoulder, and Hand (DASH) score averaged 21, and the grip strength improved from 18 to 28 kg (81% of the contralateral side).

  8. The natural progression of scaphoid instability.

    Science.gov (United States)

    Watson, H K; Weinzweig, J; Zeppieri, J

    1997-02-01

    Wrist injury or repeated wrist sprains probably result in injury to the scapholunate ligament more commonly than previously recognized, which may allow abnormal scaphoid skid under load. This results in a common clinical entity termed DWS. Scaphoid instability is a spectrum condition ranging from minor, asymptomatic findings (seen in 20% of normal adults) through symptomatic findings in patients with normal radiographs to abnormal instability on radiographs, to degenerative change, and, ultimately, to SLAC wrist (see Fig. 1). Appropriate diagnosis and management of each of these wrist disorders are highly dependent upon a keen understanding of normal periscaphoid anatomy as well as the anatomic derangements that occur within the wrist that predispose a given patient to subsequent degenerative changes. With that understanding, the appropriateness of conservative therapy, SL exploration and arthroplasty, ligament repair, triscaphe arthrodesis, or SLAC reconstruction can be readily determined in each case.

  9. Chondrocalcinosis of the wrist.

    Science.gov (United States)

    Saffar, P

    2004-10-01

    Calcium Pyrophosphate Dihydrate Deposition (CPDD) disease has characteristic radiographic features including soft tissue calcification, joint space narrowing, bone sclerosis, subchondral cyst formation without osteophyte formation, and large intraosseous geodes. Triangular fibrocartilage calcification is frequently found and isolated scapho-trapezio-trapezoid (STT) arthritis is specific for CPDD. Distal radio-ulnar (DRUJ), isolated midcarpal joint and piso-triquetral joint involvement also occur. 127 patients were reviewed. Seventy-eight had symptomatic STT joint arthritis, for which 36 underwent surgery. Twenty-two patients had a SLAC wrist deformity for which ten underwent surgery. Eight patients had isolated midcarpal arthritis for which three midcarpal arthrodeses, two four-bone arthrodeses and two carpal tunnel releases were performed. Nineteen patients had a generalized arthritis and seven of the patients underwent surgery: four-corner arthrodesis+scaphoidectomy (one case), carpal tunnel release (two cases) extensor synovectomy (two cases) and trigger finger release (two cases).

  10. External fixation of the pelvic girdle as a test for assessing instability of the sacro-iliac joint.

    Science.gov (United States)

    Slätis, P; Eskola, A

    1989-10-01

    External fixation of the pelvic girdle was used in a consecutive series of ten female patients suffering from suspected chronic instability of the sacro-iliac joint. The condition was attributed to pelvic relaxation after pregnancy in seven patients and to trauma in three. External fixation of the pelvis with a trapezoid frame reduced the average radiographic displacement of the symphysis from 5.0 to 2.4 mm in eight patients, relieved the dorsal pain in seven, and markedly improved walking ability in five. Seven of the ten patients were subsequently subjected to an anterior sacro-iliac joint arthrodesis in which square compression plates and autogenous bone grafts were used. At follow-up examination five of these patients were improved, and two unchanged. The results suggest that external fixation of the pelvis is useful in assessing painful sacro-iliac joint instability and should precede surgical intervention.

  11. Surgical reconstruction of charcot foot neuroarthropathy, a case based review.

    Science.gov (United States)

    Kučera, Tomáš; Šponer, Pavel; Šrot, Jaromír

    2014-01-01

    Our case-based review focuses on limb salvage through operative management of Charcot neuroarthropathy of the diabetic foot. We describe a case, when a below-knee amputation was considered in a patient with chronic Charcot foot with a rocker-bottom deformity and chronic plantar ulceration. Conservative treatment failed. Targeted antibiotic therapy and operative management (Tendo-Achilles lengthening, resectional arthrodesis of Lisfranc and midtarsal joints, fixation with large-diameter axial screws, and plaster cast) were performed. On the basis of this case, we discuss options and drawbacks of surgical management. Our approach led to healing of the ulcer and correction of the deformity. Two years after surgery, we observed a significant improvement in patient's quality of life. Advanced diagnostic and imaging techniques, a better understanding of the biomechanics and biology of Charcot neuroarthropathy, and suitable osteosynthetic material enables diabetic limb salvage.

  12. [Graft reconstruction of flexor tendons].

    Science.gov (United States)

    Pauchard, N; Pedeutour, B; Dautel, G

    2014-12-01

    The improvement of primary flexor tendon repair has limited the indications of secondary repairs to neglected initial wound care and deficiencies in the surgical technique or rehabilitation. The surgical and rehabilitation care is complex and prolonged, requiring full cooperation of the patient. That is why the surgeon must evaluate patient's ability to integrate instructions and to comply with a long and demanding protocol. The functional needs of the patient are important in treatment decisions and the surgeon should not hesitate to use an appropriate surgical alternative (tenodesis, arthrodesis, tendon transfer, etc.). After a brief historical review, the authors discuss the indications, technical procedures and finally the results of one-stage and two-stage flexor tendon graft, which despite mixed results keep a real place in our current armamentarium.

  13. Desmoplastic fibroma of the distal radius: an interesting case and a review of the literature and therapeutic implications.

    Science.gov (United States)

    Beebe, Kathleen S; Ippolito, Joseph A

    2016-01-13

    Desmoplastic fibromas are rare, benign, locally aggressive bone tumors, which arise primarily in patients younger than 30 years old. Historically, even with greater functional loss, en bloc or wide resection of the tumors to prevent local recurrence has been the method of choice in treatment. This article discusses the presentation of a 10-year-old male who presented with a mass in the distal forearm, after reporting difficulty in pronation and supination. The patient was ultimately treated with wide resection and allo-arthrodesis with allograft. Post-operatively, the patient has exhibited excellent recovery, including normal range of motion at the shoulder and elbow, and ability to perform all activities of daily livings despite reduced grip strength compared with the contralateral side.

  14. Traumatic Lumbosacral Dislocation Treated with Posterior Lumbar Interbody Fusion Using Intersomatic Cages

    Directory of Open Access Journals (Sweden)

    Katsuhiro Tofuku

    2009-01-01

    Full Text Available A 35-year-old man was struck by a car on his right side and presented with paraparesis of both lower extremities. Radiographic examination revealed multiple transverse process fractures and anterior displacement of L5 on S1. Computed tomography revealed a bilateral anterior facet dislocation of the fifth lumbar vertebra on the sacrum. MRI showed rupture of the posterior ligamentous complex. A posterior lumbar interbody fusion using two intersomatic cages and pedicle screw instrumentation and posterior fusion were performed. Although no major disc lesion was found at the level of L5-S1 on preoperative MRI, a severely collapsed L5-S1 disc was found intraoperatively. Two years after surgery, the patient was asymptomatic with normal neurological findings, and has resumed normal activity. We believe that lumbosacral dislocation can be considered a three-column injury with an L5-S1 disc lesion, and, therefore, requires a solid circumferential segmental arthrodesis to improve fusion rate.

  15. Post-traumatic carpal instability.

    Science.gov (United States)

    Chantelot, C

    2014-02-01

    The complexity of the carpus explains the difficulty treating carpal injuries. Lesions are dominated by perilunate dislocation, scapholunate dislocation, and scaphoid fractures. The other injuries are trivial. Symptoms include pain and loss of wrist strength, reversible for an acute and well-treated lesion. Too often, these ligament injuries are diagnosed late. For delays longer than 6 weeks, ligament repair is ineffective. These old, complex lesions are potentially highly arthritic in the radiocarpal and mediocarpal joints. Improvements in wrist surgery have mitigated these chronic lesions. Various surgical techniques can preserve a functional wrist; wrist arthrodesis is no longer the only solution for these arthritic wrists. Over the past decade, arthroscopy has contributed to better understanding the injuries of the carpus as well as to better healing them. For acute or chronic ligament injuries without degenerative osteoarthritis, arthroscopy is the treatment of the future. This technique involves a long learning curve and the various arthroscopic techniques must be validated.

  16. Ossificação do ligamento longitudional posterior: relato de caso Posterior longitudinal ligament ossification: case report

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    Oswaldo Inácio de Tella Jr

    2006-03-01

    Full Text Available Ossificação do ligamento longitudinal posterior (OLLP cervical é patologia rara em nosso meio que pode ser tratada por abordagem anterior ou posterior da coluna. Relatamos o caso de um homem japonês de 42 anos com paraparesia progressiva e TC e RM comprovando o diagnóstico de OLLLP, submetido a corpectomia anterior com artrodese. A fisiopatologia desta entesopatia, prevalência racial, quadro clínico, características radiológicas e opções do procedimento cirúrgico são revistos.Posterior longitudinal ligament ossification of cervical spine is a rare condition among caucasians. A 42 years old japanese patient with progressive walking difficulty was diagnosed with this pathology by CT scan and MRI and treated surgically by an anterior approach with arthrodesis. Pathophisiology, racial prevelence, clinical picture, radiological caractheristics and surgical approaches options are revised.

  17. Critical Limb Ischemia in Association with Charcot Neuroarthropathy: Complex Endovascular Therapy for Limb Salvage

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    Palena, Luis Mariano, E-mail: marianopalena@hotmail.com [Policlinico Abano Terme, Interventional Radiology Unit (Italy); Brocco, Enrico [Policlinico Abano Terme, Diabetic Foot Department, Foot and Ankle Clinic (Italy); Manzi, Marco [Policlinico Abano Terme, Interventional Radiology Unit (Italy)

    2013-05-09

    Charcot neuroarthropathy is a low-incidence complication of diabetic foot and is associated with ankle and hind foot deformity. Patients who have not developed deep ulcers are managed with offloading and supportive bracing or orthopedic arthrodesis. In patients who have developed ulcers and severe ankle instability and deformity, below-the-knee amputation is often indicated, especially when deformity and cutaneous involvement result in osteomyelitis. Ischemic association has not been described but can be present as a part of peripheral arterial disease in the diabetic population. In this extreme and advanced stage of combined neuroischemic diabetic foot disease, revascularization strategies can support surgical and orthopedic therapy, thus preventing osteomyelitis and leading to limb and foot salvage.

  18. [Atlas burst fracture (Jefferson fracture) requiring surgical treatment after conservative treatment--report of two cases].

    Science.gov (United States)

    Yamamoto, Hiromichi; Kurimoto, Masanori; Hayashi, Nakamasa; Ohmori, Tomoaki; Hirashima, Yutaka; Endo, Shunro

    2002-09-01

    Most cases of atlas burst fracture do not require surgical stabilization, because they can be successfully treated with external immobilization. The authors present two cases of atlas burst fracture in which surgical stabilization was required after external immobilization. The first patient was a 50-year-old male and the second patient was a 34-year-old male. Both presented with neck pain without neurological symptoms after a traffic accident. Neuroradiological examinations revealed atlas burst fracture in both patients. They were initially treated with conservative treatment; one with a rigid collar and the other with a halo vest. However, lateral offset of the atlas on the axis increased and atlanto-axial instability became evident three months later in both patients. They underwent upper cervical arthrodesis with satisfactory results. The authors review surgical indication and its timing in patients with atlas burst fracture.

  19. Prevention of avascular necrosis in displaced talar neck fractures by hyperbaric oxygenation therapy: A dual case report

    Directory of Open Access Journals (Sweden)

    Mei-Dan O

    2008-01-01

    Full Text Available Talar neck fractures are a rare injury that account for less then 2% of all foot fractures. Displaced fractures are associated with an exceedingly high rate of avascular necrosis (AVN. The incidence of AVN following Hawkins Type 3 fractures of the talar neck may approach 100%, particularly if diagnosis and reduction are delayed. Severe cases may present as pain and disability of the ankle and the subtalar joints due to a talar dome collapse, resulting in degenerative changes that usually require hind foot arthrodesis. We present two cases of traumatic displaced talar neck fractures which were treated surgically more than 2 weeks following injury due to a delay in diagnosis. Both patients underwent hyperbaric oxygen therapy (HBOT after the operation and neither resulted in AVN of the talus in a three-year follow-up. We suggest that this favorable result may be due to the beneficial effects of HBOT.

  20. Total ankle replacement – surgical treatment and rehabilitation

    Science.gov (United States)

    Krogulec, Zbigniew; Turski, Piotr; Przepiórski, Emil; Małdyk, Paweł; Księżopolska-Orłowska, Krystyna

    2015-01-01

    Functions of the ankle joint are closely connected with the gait and ability to maintain an upright position. Degenerative lesions of the joint directly contribute to postural disorders and greatly restrict propulsion of the foot, thus leading to abnormal gait. Development of total ankle replacement is connected with the use of the method as an efficient treatment of joint injuries and continuation of achievements in hip and knee surgery. The total ankle replacement technique was introduced as an alternative to arthrodesis, i.e. surgical fixation, which made it possible to preserve joint mobility and to improve gait. Total ankle replacement is indicated in post-traumatic degenerative joint disease and joint destruction secondary to rheumatoid arthritis. In this paper, total ankle replacement and various types of currently used endoprostheses are discussed. The authors also describe principles of early postoperative rehabilitation as well as rehabilitation in the outpatient setting. PMID:27407223

  1. [Three-dimensional analysis of the foot following implantation of a HINTEGRA ankle prosthesis: evaluation with the Heidelberg foot model].

    Science.gov (United States)

    Müller, S; Wolf, S; Döderlein, L

    2006-05-01

    Detailed foot kinematics after total ankle replacement has not yet been investigated. In this study 11 patients with unilateral Hintegra ankle prosthesis were analysed with the Heidelberg Foot Model. This model measures the kinematics of the fore-, mid- and hindfoot in three clinical planes. Moreover, the kinetics of the hip, knee and ankle was captured. A diminished ROM was found in all foot segments investigated. The timing of the kinematics between sound and involved side appeared similar. A limitation in the hindfoot mobility, as experienced after ankle arthrodesis, was not observed. However, a careful hindfoot alignment is essential for optimal foot function, and previous malalignments should be corrected. Concerning the kinetics, the replaced ankle showed a decreased power generation compensated by an increase in power in the ipsilateral knee. For a more detailed evaluation, further studies are required which include pre- and postoperative data and also take into account different types of prostheses.

  2. Trans-sacral screw fixation in the treatment of high dyplastic developmental spondylolisthesis.

    Science.gov (United States)

    Landi, Alessandro; Marotta, Nicola; Mancarella, Cristina; Tarantino, Roberto; Delfini, Roberto

    2013-06-16

    We describe the case of a 67-year-old woman with L5-S1 ontogenetic spondylolisthesis treated with pedicle fixation associated with interbody arthrodesis performed with S1-L5 trans-sacral screwing according to the technique of Bartolozzi. The procedure was followed by a wide decompressive laminectomy. The patient had a progressive improvement of the symptoms which gradually disappeared in 12 mo. The radiograph at 6 and 12 mo showed complete fusion system. The choice of treatment in L5-S1 ontogenetic spondylolithesis is related to a correct clinical and diagnostic planning (X-ray, computer tomography magnetic resonance imaging, Measurement). In particular, the severity index and the square of unstable zone, and the standard measurements already described in the literature, are important to understand and to plane the correct surgical strategy, that require, in most of the times, fusion and interbody artrodesis.

  3. Polymethylmethacrylate-assisted ventral discectomy: Rate of pseudarthrosis and clinical outcome with a minimum follow-up of 5 years

    Directory of Open Access Journals (Sweden)

    Maier-Hauff Klaus

    2011-06-01

    Full Text Available Abstract Background Polymethylmethacrylate (PMMA assisted ventral discectomy has been criticized for high rates of graft migration and pseudarthrosis when compared with various other fusion procedures for the treatment of cervical degenerative disc disease (DDD, therefore rendering it not the preferred choice of treatment today. Recently however spine surgery has been developing towards preservation rather than restriction of motion, indicating that fusion might not be necessary for clinical success. This study presents a long term comparison of clinical and radiological data from patients with pseudarthrosis and solid arthrodesis after PMMA assisted ventral discectomy was performed. Methods From 1986 to 2004 416 patients underwent ventral discectomy and PMMA interposition for DDD. The clinical and radiological outcome was assessed for 50 of 127 eligible patients after a mean of 8.1 years. Based on postoperative radiographs the patients were dichotomized in those with a pseudarthrosis (group A and those with solid arthrodesis (group B. Results Pseudarthrosis with movement of more than 2 of the operated segment was noted in 17 cases (group A. In 33 cases no movement of the vertebral segment could be detected (group B. The analysis of the clinical data assessed through the neck disability index (NDI, the visual analogue scale (VAS of neck and arm pain and Odom's criteria did not show any significant differences between the groups. Patients from group B showed a trend to higher adjacent segment degeneration (ASD than group A (p = 0.06. This correlated with the age of the patients. Conclusions PMMA assisted discectomy shows a high rate of pseudarthrosis. But the clinical long-term success does not seem to be negatively affected by this.

  4. Adult flatfoot.

    Science.gov (United States)

    Toullec, E

    2015-02-01

    Adult flatfoot is defined as a flattening of the medial arch of the foot in weight-bearing and lack of a propulsive gait. The 3 lesion levels are the talonavicular, tibiotarsal and midfoot joints. The subtalar joint is damaged by the consequent rotational defects. Clinical examination determines deformity and reducibility, and assesses any posterior tibialis muscle deficit, the posterior tibialis tendon and spring ligament being frequently subject to degenerative lesions. Radiographic examination in 3 incidences in weight-bearing is essential, to determine the principal level of deformity. Tendon (posterior tibialis tendon) and ligamentous lesions (spring ligament and interosseous ligament) are analyzed on MRI or ultrasound. In fixed deformities, CT explores for arthritic evolution or specific etiologies. 3D CT reconstruction can analyze bone and joint morphology and contribute to the planning of any osteotomy. Medical management associates insoles and physiotherapy. Acute painful flatfoot requires strict cast immobilization. Surgical treatment associates numerous combinations of procedures, currently under assessment for supple flatfoot: for the hindfoot: medial slide calcaneal osteotomy, calcaneal lengthening osteotomy, or arthroereisis; for the midfoot: arthrodesis on one or several rays, or first cuneiform or first metatarsal osteotomy; for the ankle: medial collateral ligament repair with tendon transfer. Fixed deformities require arthrodesis of one or several joint-lines in the hindfoot; for the ankle, total replacement after realignment of the foot, or tibiotalocalcaneal fusion or ankle and hindfoot fusion; and, for the midfoot, cuneonavicular or cuneometatarsal fusion. Tendinous procedures are often associated. Specific etiologies may need individualized procedures. In conclusion, adult flatfoot tends to be diagnosed and managed too late, with consequent impact on the ankle, the management of which is complex and poorly codified.

  5. Internal fixation and bone grafting for intraarticular nonunion of tibial plateau: a report of four cases

    Institute of Scientific and Technical Information of China (English)

    Ramesh K Sen; Ashwani Soni; Uttam Chand Saini; Daljit Singh

    2011-01-01

    Intraarticular nonunion of tibial plateau is rare.In the literature,only 9 patients were found to be treated for intraarticular tibial plateau nonunion and they got varying results.Internal fixation along with bone grafting was done as a standard treatment in all cases.We treated 4 different profile cases of intraarticular tibial plateau nonunion in our institution by 4 different methods.We treated these cases with plaster of paris cast,internal fixation along with bone graft,arthrodesis with K-nail and total knee replacement.Case 1 was treated with plaster of paris (POP)cast as the patient refused surgery.The fracture was united and the patient was fully satisfied with full range of motion despite valgus malalignment.Case 2 was managed with open reduction internal fixation along with bone grafting.The patient had a good union and got full range of motion at the knee joint.Case 3 was treated with total knee arthroplasty due to her old age and got satisfactory result.Case 4 was an infected nonunion.Arthrodesis was done and the patient could walk with full weight bearing independently.We conclude that internal fixation along with bone grafting may not be suitable in all cases of intraarticular nonunion of tibial plateau.Causes of nonunion,present condition and range of motion of the knee joint,as well as the age of patient should be all considered and the treatment should be individualised according to each patient's situation.

  6. Conservative treatment with spontaneous stabilization of Grade II isthmic spondylolisthesis L5/S1 in a forty-four-year old woman, with a six-year follow-up: a case report.

    Science.gov (United States)

    Ferrari, S; Costa, F; Fornari, M

    2012-06-01

    Spondylolisthesis is a pathological condition caused by the slipping of a vertebral body, compared to the underlying structure, following structural and/or degenerative changes to the spine. Studies have attempted evidence to the connection between the natural history of spondylolisthesis, the degree and progression of the slip factor, as well as the pain and disability. Studies have reported a high level of heterogeneity of these factors in different patients as well as difficulty in predicting behaviour. It has been suggested that vertebral instability, independent of the slip factor, could be considered the most important factor to be treated conservatively or surgically. Furthermore, it appears that some patients may manifest complete disk degeneration over time, with vertebral bodies shifting closer and spontaneous stabilisation. This case study reports a forty-four-year old woman, with isthmic spondylolisthesis, where the spine surgeon recommended physiotherapy for conservative treatment, with a prognosis of possible spontaneous stabilization. The case was followed for six years, both clinically and radiologically. Treatment was based on a specific stabilising training program (motor control), immediately aimed to improve the disability and pain factors while waiting for a possible spontaneous stabilisation, that the latest radiological exams revealed with an attempt of arthrodesis. The Oswestry Disability Index (ODI) and the Roland Morris Disability Questionnaire (RMDQ) to measure disability, and the Numeric Rating Scale (NRS) to measure pain, were carried out at the beginning, during and at the end of treatment. They were compared with the radiographic material documenting the evolution of the spondylolisthesis over time. This case study appears to confirm that the hypothesis that a specific aimed approach of rehabilitation may improve the disability and pain levels without compromising the process of spontaneous arthrodesis. The evolution was documented

  7. Reconstruction of a postraumatic radial club hand with a free fibular osteoseptocutaneous flap and Sauve-Kapandji procedure-A case report.

    Science.gov (United States)

    Horta, Ricardo; Nascimento, Ricardo; Silva, Alvaro; Pinto, Rui; Negrão, Pedro; São-Simão, Ricardo; Carvalho, Jorge; Santos Silva, Marta; Amarante, Jose

    2016-10-01

    Radial club hand may be congenital or acquired; radial deviation of the hand is usually found, associated with palmar flexion-pronation and treatment of severe forms of radial club hand is often difficult. Here we present a case of reconstruction of a severe postraumatic radial club hand with a free fibular osteoseptocutaneous flap and Sauve-Kapandji procedure in a 28-year-old man. The patient had a radial deviation of the wrist and right upper limb shortening as a result of an infected pseudarthrosis of the radius. This deformity was reconstructed with a free fibular osteoseptocutaneous flap associated to arthrodesis of the distal radioulnar joint and an ulnar resection osteotomy proximal to the arthrodesis in order to restore rotation of the forearm (Sauvé-Kapandji procedure). The flap fully survived and no complications were seen in the early postoperative period at both recipient and donor sites. Radius alignment was restored. At 5-month follow-up, the skeleton was healed. There was minimal osteopenia at the distal radial segment. Wrist extension was 48 degrees, flexion 24 degrees, and pronation-supination was 58-0-48 degrees, with full finger flexion. The patient could hold a 4 kg dumbbell with the elbow flexed without discomfort. His DASH score-Disabilities of the Arm, Shoulder, and Hand Questionnaire was 15.83. Combined free fibular osteoseptocutaneous flap and Sauve-Kapandji procedure may be considered in severe forms of postraumatic radial club hand, however, further data are necessary. © 2016 Wiley Periodicals, Inc. Microsurgery 36:593-597, 2016.

  8. Forefoot Surgery in Elderly Compared With Younger Patient Populations: Complications and Type of Procedure.

    Science.gov (United States)

    Vermersch, Thibault; Fessy, Michel Henri; Besse, Jean-Luc

    2015-01-01

    In forefoot surgery, the presenting complaints and expected benefits differ between elderly and younger patients. The present study mapped forefoot procedures recommended to elderly patients compared with those recommended to the general population and assessed the complications according to age group and comorbidity. Consecutive patients were included in a single-center, continuous, retrospective case-control study. Three age groups were defined: <65 years, 65 to 74 years, and ≥ 75 years. All patients, regardless of age, underwent the same procedure; elderly-specific techniques such as the Keller procedure were not used. A total of 321 patients were included, with a mean age of 60.6 (range 16 to 86) years. A similar procedure was used in all 3 groups, but at differing frequencies, with arthrodesis and minor procedures increasing with increasing patient age. In all 3 groups, in the population as a whole, the incidence of delayed healing, deep infection, and nonunion was 9%, 1%, and 2%, respectively. These complications were independent of age group. In the <65-year-old group, just as in the study population as a whole, arthrodesis associated with resection arthroplasty resulted in greater rates of delayed healing and deep infection. The complications rates were equivalent among the 3 age groups. Major surgical procedures should be avoided in elderly patients, if possible. However, no particular procedure is contraindicated in the elderly, although the method of fixation must be robust owing to the frequency of osteoporosis. A first step would be to achieve consensus on the age threshold for "elderliness."

  9. [Ankle joint prosthesis for bone defects].

    Science.gov (United States)

    Lampert, C

    2011-11-01

    Large defects of the talus, i.e. due to tumors, large areas of osteolysis in total ankle replacement (TAR) and posttraumatic talus body necrosis are difficult to manage. The gold standard in these circumstances is still tibiocalcaneal arthrodesis with all the negative aspects of a completely rigid hindfoot. We started 10 years ago to replace the talus by a custom-made, all cobalt-chrome implant (laser sintering). The first patient with a giant cell tumor did very well but the following patients showed all subsidence of the metal talus into the tibia due to missing bony edges. Therefore, we constructed a custom-made talus (mirrored from the healthy side) and combined it with a well functioning total ankle prosthesis (Hintegra). So far we have implanted this custom-made implant into 3 patients: the first had a chondrosarcoma of the talus (1 year follow-up), the second had massive osteolysis/necrosis of unknown origin (6 months follow-up) and the third massive osteolysis following a correct TAR (2 months follow-up). The results are very encouraging as all of the patients are practically pain free and have a good range of movement (ROM): D-P flexion 15°-0-20° but less motion in the lower ankle joint: ROM P-S 5°-0-5°. No subsidence was detected in the tibia or the calcaneus. The custom-made talus combined with the Hintegra total ankle replacement will probably be an interesting alternative to a tibiocalcaneal arthrodesis in selected cases with massive defects of the talus.

  10. To explore the treatment of 148 cases of children with tuberculosis in the treatment of children with tuberculosis%探讨我院148例小儿髓关节结核的治疗方法

    Institute of Scientific and Technical Information of China (English)

    别克博森

    2015-01-01

    Objective:to study the our hospital 148 cases of patients with infantile pulp joint tuberculosis. Methods:the method of clinical surgery. The results of The disease early diagnosis is difficult, 148 cases of 1~3 months of confirmed, through 20 cases of conservative treatment, 90 patients with synovectomy, lesions cleared, 30 underwent hip arthrodesis, 8 underwent hip replacement, no case of recurrence. Conclusion:early diagnosis and treatment is important, the earlier treatment of joint function recovery, the better, the late mainly control the condition as soon as possible and ankle arthrodesis or dormant period after total hip replacement.%目的:研究我院收治的148例患有小儿髓关节结核的病人。方法采用临床手术治疗的方法。结果本病早期诊断较困难,148例发病1~3个月确诊,通过保守治疗20例,90例进行滑膜切除术,病灶清除,30例行髋关节融合术,8例行髋关节置换术,无一例复发。结论早期诊断治疗具有重要意义,治疗越早关节功能恢复越好,晚期主要是尽快控制病情而行关节融合术或静止期后再行全髋关节置换术。

  11. [Functional results after proximal row carpectomy (PRC) in patients with SNAC-/SLAC-wrist stage II].

    Science.gov (United States)

    Baumeister, S; Germann, G; Dragu, A; Tränkle, M; Sauerbier, M

    2005-04-01

    The proximal row carpectomy (PRC) is a motion preserving procedure which creates a new joint without arthrosis. It is a frequently used procedure in stage II of a posttraumatic degenerative arthrosis of the wrist after scaphoid nonunion or scapholunate ligament instability (SNAC-/SLAC-wrist). In this retrospective analysis the functional postoperative results of this operation are compared in light of a homogenous indication (SNAC-/SLAC-wrist stage II). In 38 patients PRC was performed for a stage II SNAC- (n = 29) or SLAC-wrist (n = 9) between June 1994 and March 2002. Postoperative examination included range of motion and grip strength. Pain was assessed using a visual analogue scale (VAS 0 - 100). The DASH questionnaire (disability of the arm, shoulder and hand) was used to evaluate the disabilities in activities of daily living (ADL). Thirty patients (79 %) with a mean age of 39 years (23 - 59) were evaluated with a mean follow-up of 27 months (6 - 100). Mean extension and flexion of the wrist reached 75 degree which was 57 % of the contralateral hand. Mean radial and ulnar deviation was 33 degree corresponding with 52 % of the contralateral hand. The average grip strength was 50 % of the unaffected side. The postoperative DASH score was 27.4. Pain with strenuous activity was reduced by 40 %, resting pain by 77 %. Three patients showed radiological signs of a radiocapitate arthrosis, one patient needed conversion into a complete wrist arthrodesis. Our results are in concordance with the literature. However, our follow-up time is relatively short and we cannot make any conclusion about the long-term outcome. PRC is a technically straightforward procedure for treatment of carpal collapse. For stage II of the SNAC-/SLAC-wrist we consider the resection of the proximal carpal row an alternative procedure to the midcarpal arthrodesis particularly in patients who require less grip strength and when a shorter postoperative immobilization is reasonable.

  12. Only fixation for lumbar canal stenosis: Report of an experience with seven cases

    Directory of Open Access Journals (Sweden)

    Atul Goel

    2014-01-01

    Full Text Available Study Design and Objective: The author reports experience with treatment of degenerative lumbar canal stenosis that involved fixation-arthrodesis of the affected spinal segment using "double insurance" transarticular screws for each joint. No direct bone, ligament or disc resection is done for decompression of the spinal dural tube or root canal. Methods and Summary of Background Data: During the period March 2011-September 2011, seven patients having lumbar canal stenosis were treated with a modification of transarticular method of screw fixation that involved insertion of two or "double insurance" screws at each articular joint. The operation involved section of the spinous process at its base, opening up of the facet joint, denuding of articular cartilage, insertion of intra-articular bone graft and insertion of two transarticular screws at each facet joint. The fixation was done in four levels in two patients, at three levels in four patients and at two levels in one patient. Oswestry disability index and visual analog scale were used to clinically assess the patients before and after the surgery and at follow-up. Results: During the average period of follow-up of 26.9 months (range 24-30 months, there was varying degree of recovery of symptoms. The procedure resulted in firm stabilization and fixation of the spinal segment and provided a ground for arthrodesis. During the period of follow-up, one patient underwent re-exploration and decompressive laminectomy as she continued to have significant pain symptom. Conclusions: Vertical instability and telescoping, listhesis or overriding of the facets on physical activity seems to be the defining phenomenon in the pathogenesis of lumbar canal stenosis. The clinical outcome in our patients suggest that fixation of the spinal segment can be a rationale form of treatment. "Double insurance" transarticular method of treatment is a simple, safe, and effective method of spinal stabilization.

  13. Surgical treatment of scoliosis in Smith-Magenis syndrome: a case report

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    McClean Claire

    2010-01-01

    Full Text Available Abstract Introduction Smith-Magenis syndrome is a rare genetic condition associated with scoliosis in approximately 30% of cases. There is limited information in the literature on the treatment of scoliosis and the surgical outcome in patients with this condition. Characteristic features of the syndrome, such as the presence of congenital heart and renal disease, inherent immunodeficiency, as well as severe behavioural disorders may complicate the surgical treatment of patients. Case presentation We present the case of an 11-year-old British Caucasian girl with Smith-Magenis syndrome who developed a severe, progressive thoracic and lumbar scoliosis measuring 85° and 80°, respectively. She had no cardiac or renal anomalies. Brace treatment was unsuccessful to prevent deterioration of the scoliosis. Both curves were rigid on supine maximum side-bending and traction radiographs. Our patient underwent a posterior spinal arthrodesis with pedicle screw/hook and rod instrumentation and autologous iliac crest graft, supplemented by allograft bone. She had an uneventful postoperative course other than the development of a small wound dehiscence which required resuturing with no signs of a wound infection. A good correction of both scoliotic curvatures to 45° and 40° and a balanced spine in both the coronal and sagittal planes was achieved. Follow-up to skeletal maturity (4 years post-surgery showed no loss of deformity correction, no detected pseudarthrosis and a good clinical outcome. Conclusion Patients with Smith-Magenis syndrome can develop a severe scoliosis that may require surgical treatment. Congenital cardiac and renal disease, immunodeficiency and severe behavioural problems can affect the surgical outcome following spinal arthrodesis and need to be taken into consideration. Our case demonstrates that surgical correction of the deformity can be performed safely on this group of patients, with a good outcome and an uncomplicated

  14. Thoracolumbar kyphoscoliosis with unilateral subluxation of the spine and postoperative lumbar spondylolisthesis in Hunter syndrome.

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    Roberts, Simon B; Tsirikos, Athanasios I

    2016-03-01

    Surgical correction for kyphoscoliosis is increasingly being performed for patients with mucopolysaccharidosis (MPS). Reported case series have predominantly included patients with Type I (Hurler) and Type IV (Morquio) MPS. To their knowledge, the authors describe the first case report of surgical management of thoracolumbar kyphoscoliosis in Hunter syndrome (MPS Type II) and the rare occurrence of lumbar spondylolisthesis following surgical stabilization. A 12-year-old boy with Hunter syndrome presented with severe thoracolumbar kyphoscoliosis and no associated symptoms. Spinal radiographs demonstrated kyphosis of 48° (T11-L3) and scoliosis of 22° (T11-L3) with an anteriorly hypoplastic L-1 vertebra. The deformity progressed to kyphosis of 60° and scoliosis of 42° prior to surgical intervention. Spinal CT scans identified left T12-L1 facet subluxation, causing anterior rotatory displacement of the spine proximal to L-1 and bilateral L-5 isthmic spondylolysis with no spondylolisthesis. A combined single-stage anterior and posterior instrumented spinal arthrodesis from T-9 to L-4 was performed. Kyphosis and scoliosis were corrected to 4° and 0°, respectively. Prolonged ventilator support and nasogastric feedings were required for 3 months postoperatively. At 2.5 years following surgery, the patient was asymptomatic, mobilizing independently, and had achieved a solid spinal fusion. However, he had also developed a Grade II spondylolisthesis at L4-5; this was managed nonoperatively in the absence of symptoms or further deterioration of the spondylolisthesis to the 3.5-year postoperative follow-up visit. Satisfactory correction of thoracolumbar kyphoscoliosis in Hunter syndrome can be achieved by combined anterior/posterior instrumented arthrodesis. The risk of developing deformity or instability in motion segments adjacent to an instrumented fusion may be greater in patients with MPS related to the underlying connective tissue disorder.

  15. Use of a Proximal Humeral Locking Plate for Complex Ankle and Hindfoot Fusion.

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    Shearman, Alexander D; Eleftheriou, Kyriacos Iordanis; Patel, Akash; Pradhan, Rajib; Rosenfeld, Peter Francis

    2016-01-01

    Arthrodesis of the ankle and hindfoot in the setting of major deformity is challenging and associated with substantial risks. Patients often have significant comorbidities that lead to unforgiving soft tissues, poor vascularity, and poor bone quality. This creates the high-risk scenario of poor wound healing and poor implant fixation. Complications can be devastating, leading to loss of the limb and sepsis. The use of locking plate technology might provide biomechanical and operative technique advantages in such patients. We retrospectively assessed the results of the modified use of the PHILOS(™) (Synthes(®), Zuchwil, Switzerland) proximal humeral locking plate in 21 patients (11 males, 10 females; mean age 56.1 years, range 25 to 74 years) who had undergone complex fusions, including tibiotalar (n = 4), tibiocalcaneal (n = 7), or tibiotalocalcaneal (n =10) fusions. The average follow-up period was 14.6 (median 10, range 6 to 49) months. Of the 21 fusions, 18 achieved union (85.7%) at an average period of 4.8 (median 4.3, range 3 to 12) months. The overall deep infection rate was 14.3%. Overall, 17 of the 21 patients (81%) were satisfied with the result (good to excellent), 1 reported the result was fair (4.8%), and 3 patients developed nonunion and were dissatisfied with the procedure (14.3%). The present study is the largest series to date of patients undergoing complex ankle and hindfoot arthrodesis with the use of a proximal humeral locking plate and confirms previous findings that the technique is reliable with union, satisfaction, and complication rates comparable to those of other techniques.

  16. [Surgical treatment of the rheumatoid hand].

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    Kénési, C

    1996-10-01

    In rheumatoid arthritis, involvement of the hand is serious, frequent and occurs early. It reaches synovial sheets, articular or tendinous, and causes painful and invalidating deformities. Our experience, based on 537 operations of the hand, indicates that reconstructive surgery can be practised at all levels. For the wrist, inferior radio ulnar arthrodesis strengthens the articulation and eradicates pain when performed in the early stage. Segmentar resection of ulnar diaphysis ensures the conservation of "prono- supination". In the case of destruction or luxation of the wrist, a choice has to be made between prosthesis and arthrodesis. We tend to prefer the latter which confers a strong, painless and definitive articulation. Ulnar deviation of metacarpo-phalangeal articulations of long fingers can be corrected by ligamentar or tendinous plasties. But the results are not always durable and they cannot be used when the articulations are destroyed. In that case prostheses have to be implanted. Swanson's silastic implants enable to straighten the fingers and to suppress pain but ensure a limited mobility. Likewise, interphalangeal deviations generally call for implants or arthrodeses. Trapezo-metacarpal or phalangeo-metacarpal deformities of the thumb are stabilised by arthrodeses, ensuring a strong and painless prehension. In conclusion, reconstructive surgery allows many possibilities but its results are often incomplete. It is therefore advisable to perform synovectomy as early as possible before the occurrence of deformities. Surgical synovectomy competes with isotopic, chemical or corticoid synoviosthesis. But at tendinous level, synovectomy alone should be used, since it gives excellent results. Even though rehabilitation after synovectomies is not always easy, we hope that it will prevent the occurrence of articular or tendinous destruction for many years.

  17. Flatfoot in Müller-Weiss syndrome: a case series

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    Wang Xu

    2012-08-01

    Full Text Available Abstract Introduction Spontaneous osteonecrosis of the navicular bone in adults is a rare entity, known as Müller-Weiss syndrome. We report here on our experience with six patients with Müller-Weiss syndrome accompanied by flatfoot deformity, but on a literature search found no reports on this phenomenon. Because the natural history and treatment are controversial, an understanding of how to manage this deformity may be helpful for surgeons when choosing the most appropriate operative procedure. Case presentation Six patients (five women, one man; average age, 54 years with flatfoot caused by osteonecrosis of the navicular bone were followed up between January 2005 and December 2008 (mean follow-up period, 23.2 months. Conservative treatment, such as physical therapy, and non-steroidal anti-inflammatory drugs were used, but failed. Physical examinations revealed flattening of the medial arch of the involved foot and mild tenderness at the mid-tarsal joint. Weight-bearing X-rays (anterior-posterior and lateral views, computed tomography, and MRI scans were performed for each case. Talonavicular joint arthrodesis was performed in cases of single talonavicular joint arthritis. Triple arthrodesis was performed in cases of triple joint arthritis to reconstruct the medial arch. Clinical outcomes were assessed using the American Orthopaedic Foot and Ankle Society ankle-hindfoot scale; the scores were 63.0 pre-operatively and 89.8 post-operatively. All patients developed bony fusion. Conclusions The reason for the development of flatfoot in patients with Müller-Weiss syndrome is unknown. Surgical treatment may achieve favorable outcomes in terms of deformity correction, pain relief, and functional restoration. The choice of operative procedure may differ in patients with both flatfoot and posterior tibial tendon dysfunction.

  18. Reconstructive options in pelvic tumours

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    Mayilvahanan N

    2005-01-01

    Full Text Available Background: Pelvic tumours present a complex problem. It is difficult to choose between limb salvage and hemipelvectomy. Method: Forty three patients of tumours of pelvis underwent limb salvage resection with reconstruction in 32 patients. The majority were chondrosarcomas (20 cases followed by Ewing sarcoma. Stage II B was the most common stage in malignant lesions and all the seven benign lesions were aggressive (B3. Surgical margins achieved were wide in 31 and marginal in 12 cases. Ilium was involved in 51% of cases and periacetabular involvement was seen in 12 patients. The resections done were mostly of types I &II of Enneking′s classification of pelvic resection. Arthrodesis was attempted in 24 patients. Customized Saddle prosthesis was used in seven patients and no reconstruction in 12 patients. Adjuvant chemotherapy was given to all high-grade malignant tumours, combined with radiotherapy in 7 patients. Results: With a mean follow up of 48.5 months and one patient lost to follow up, the recurrence rate among the evaluated cases was 16.6%. Oncologically, 30 patients were continuously disease free with 7 local recurrences and 4 deaths due to disseminated disease and 2 patients died of other causes. During the initial years, satisfactory functional results were achieved with prosthetic replacement. Long-term functional result of 36 patients who were alive at the time of latest follow up was satisfactory in 75% who underwent arthrodesis and in those where no reconstruction was used. We also describe a method of new classification of pelvic resections that clarifies certain shortcomings of the previous systems of classification. Conclusion: Selection of a procedure depends largely on the patient factors, the tumour grade, the resultant defect and the tissue factors. Resection with proper margins gives better functional and oncological results

  19. Artrodese Cervical C1-C2 pelas técnicas de Harms e Magerl Artrodesis cervical C1-C2 por las técnicas de Harms y Magerl Harms and Magerl types of C1-C2 cervical artrodesis

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    Cristina Maria Varino Sousa

    2010-09-01

    ón. OBJETIVO: describir la casuística de las artrodesis atlantoaxiales realizadas en los últimos cinco años del Centro Hospitalario del Porto, particularmente, la tasa de consolidaciones, complicaciones observadas, reintervenciones y comparación con los estudios publicados. Métodos: estudio retrospectivo, con cinco años, de los pacientes sometidos a la artrodesis atlantoaxial en el Centro Hospitalario del Porto. RESULTADOS: fueron operados 11 pacientes en el periodo del estudio, la mayoría con inestabilidad de causa traumática. El método de la artrodesis más utilizado fue descrito por Magerl. No fueron observadas lesiones vasculares. Fueron registradas complicaciones infecciosas en cuatro pacientes, siendo que estas infecciones fueron más comunes en pacientes con patologías inflamatorias de base. Se obtuvo una tasa de consolidación de la artrodesis de 100%, no fueron necesarias cirugías de revisión. CONCLUSIÓN: en nuestra serie, las artrodesis posteriores por las técnicas de Harms y Magerl resultaron en un excelente control de la inestabilidad C1-C2. Pacientes con indicación de artrodesis por inestabilidad reumática presentaron una tasa alta de complicaciones infecciosas.INTRODUCTION: The atlantoaxial instability may result in neurological disorders, pain and limitation of neck mobility. It is associated with serious risks of quadriplegia or sudden death. There are several techniques of C1-C2 surgical stabilization described in literature, and the most commonly used in our department and emphasized in this article are those of Harms and Magerl. OBJECTIVE: To describe the cases of the atlantoaxial arthrodesis performed in the last five years at Centro Hospitalar do Porto, Portugal, regarding the rate of consolidation, observed complications, re-intervention and comparison with published studies. METHODS: A five years retrospective study of patients who underwent atlantoaxial arthrodesis at Centro Hospitalar do Porto. RESULTS: Eleven patients were operated

  20. Matriz óssea homóloga desmineralizada associada à medula óssea autógena fresca na artrodese vertebral dorsolateral lombar em coelhos Homologous demineralized bone matrix associated to autologous bone marrow in a rabbit dorsolateral lumbar vertebral fusion

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    D. Rizzo

    2005-04-01

    postoperative interval, 87.5% of the animals presented union (arthrodesis, which was observed by palpation, followed by 75 and 100% after seven and nine weeks, respectively. The arthrodesis indexes to X rays were of 50%, 62% and 75%, in the same evaluation period. According to histological analysis, after five weeks, there were characteristics of osteointegration of HDBM with the decorticated transverse processes, from where the blood vessels that penetrated the bone matrix originated, and the presence of cartilage tissue in the center of the graft. In the following weeks, the endocondral ossification continued and HDBM was almost totally substituted by trabecular bone tissue, forming a bridge of ripe bone among and over the adjacent transverse processes, propitiating larger mechanical resistance to the operated segment in comparison to the adjacent segments. The association of HDBM with the FABM showed as a feasible option with low cost in the vertebral dorsolateral lumbar arthrodesis in rabbits.

  1. 单节段与多节段腰椎融合术后邻近节段退变的临床观察%Clinical observation on the incidence of adjacent segment degeneration after single or multi-level lumbar fusion surgery

    Institute of Scientific and Technical Information of China (English)

    王凌挺; 徐宏光; 王弘

    2014-01-01

    目的:探讨单节段与多节段腰椎融合术后邻近节段退变的临床观察。方法:选取2007年5月~2011年8月在我科诊疗并接受腰椎融合术的61例病例,根据手术方式不同,主要分为单节段组和多节段组。通过测量椎间隙高度JOA评分、Prolo功能评分以及Pfirrmann评分系统,对患者术前、术后以及2年后随访的情况进行评分。结果:两组术后JOA评分、Prolo功能评分明显优于术前,但在末次随访评分中,多节段组明显高于单节段组(P<0.05);末次随访多节段组患者上、下邻近节段的Pfirrmann评分均明显高于单节段组,而椎间隙高度则明显小于单节段组(P<0.05)。结论:腰椎融合术治疗效果显著,多节段融合术后邻近节段较单节段融合术更易发生退变,选择合适的手术方式可提升治疗效果,改善患者生活质量。%Objective:To observe the incidence of adjacent segment degeneration after single or multi-segmental lumbar fusion surgery .Methods:Sixty-one patients undergone lumbar fusion for degenerative disease between May 2007 and August 2011 in our department were allocated to treatment group with single-level arthrodesis or multi-segment fusion on the treatment policy basis .The impacts on the incidence of adjacent segment degeneration were evaluated by comparing the total scores with the two groups concerning the height of intervertebral space measured ,Japanese Orthopaedic Association(JOA) scoring, Prolo functional scale and Pfirrmann score before and after surgery as well as conditions in two years of follow-up.Results:The postoperative scores for JOA and Prolo function were significantly better than those before surgery ,yet the scores by the final follow-up were better in group with multiple segment fusion than those treated with single-level arthrodesis(P<0.05).In addition,final follow-up of patients with multiple segment interventions showed higher scores by

  2. [Advantages of minimally-invasive reposition, retention, and Ilizarov-(hybrid)fixation for pilon-tibial-fractures fractures with particular emphasis on C2/C3 fractures].

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    Endres, T; Grass, R; Biewener, A; Barthel, S; Zwipp, H

    2004-04-01

    Between October 1993 and September 1999 a total of 62 tibial pilon fractures in 59 patients were treated at the Clinic for Trauma and Reconstructive Surgery, University Hospital Carl-Gustav-Carus, Technical University Dresden. In a retrospective study 49 patients with 50 tibial pilon fractures (81%) could be examined an average of 28 months after injury. The purpose of this study was to compare clinically and radiographically the healing results obtained after using the Ilizarov technique in combination with minimally invasive internal fixation (group I) with those after a conventional surgical procedure (internal fixation with a plate, external fixation with or without minimally invasive internal fixation, and screw fixation exclusively, group II) and to evaluate the efficacy of the Ilizarov technique. Data analysis showed a significantly higher incidence of 43 C2/C3 fractures in Ilizarov group I (73%) than in group II (33.3%). Severe soft tissue injuries and particularly open injuries had a significantly higher incidence in Ilizarov group I (100%) than in group II (38%). Despite the high incidence of C2/C3 fractures and severe soft tissue injuries in group I, there was no incidence of pseudarthrosis or osteitis in the further course and there was no need for arthrodesis during the long-term course. After therapy with a conventional surgical technique, the incidence of osteitis was 5% and of delayed union of a fracture 2.5% and arthrodesis was necessary in 8%. A disadvantage of the Ilizarov system was the relatively frequent incidence of pin infection (45%) necessitating surgical debridement in 18%. The efficacy of the treatment of 43 C2/C3 fractures with the Ilizarov technique was obvious by a statistically significantly better Maryland Foot Score in comparison with group II. More than 87% of the patients treated with the Ilizarov technique and only 38% of the patients treated with a conventional surgical procedure obtained a very good or good score. According to

  3. Two-level cervical disc replacement: perspectives and patient selection

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    Narain AS

    2017-02-01

    Full Text Available Ankur S Narain, Fady Y Hijji, Daniel D Bohl, Kelly H Yom, Krishna T Kudaravalli, Kern Singh Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA Introduction: Cervical disc replacement (CDR is an emerging treatment option for cervical degenerative disease. Postulated benefits of cervical disc replacement compared to anterior cervical discectomy and fusion include preserved motion at the operative segments and decreased motion at adjacent levels. Multiple studies have been performed investigating the outcomes of CDR in single-level pathology. The investigation of the use of CDR in two-level pathology is an emerging topic within the literature.Purpose: To critically evaluate the literature regarding two-level CDR in order to determine its utility compared to two-level cervical arthrodesis. Patient selection factors including indications and contraindications will also be explored.Methods: The PubMed database was searched for all articles published on the subject of two-level CDR up until October 2016. Studies were classified by publication year, study design, sample size, follow-up interval, and conflict of interest. Outcomes were recorded from each study, and included data on patient-reported outcomes, radiographic measurements, range of motion, peri- and postoperative complications, heterotopic ossification, adjacent segment disease, reoperation rate, and total intervention cost. Results: Fourteen studies were included in this review. All studies demonstrated at least noninferiority of two-level CDR compared to both two-level arthrodesis and single-level CDR. Patient selection in two-level CDR is driven by the inclusion and exclusion criteria presented in prospective, randomized controlled trials. The most common indication is subaxial degenerative disc disease over two contiguous levels presenting with radiculopathy or myelopathy. Furthermore, costs analyses trended toward at least noninferiority of two

  4. Combined Treatment of Wrist and Trapeziometacarpal Joint Arthritis

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    Waitzenegger, Thomas; Leclercq, Caroline; Masmejean, Emmanuel; Lenoir, Hubert; Harir, Amir; Coulet, Bertrand; Chammas, Michel

    2015-01-01

    Background Combined thumb basal and wrist joint arthritis (excluding scaphotrapeziotrapezoid arthritis) is rare considering the frequency of arthritis of either joint alone. Combined surgical treatment has never been described in the literature. Furthermore, the scaphoidectomy common to all interventions for Watson stage 2 or 3 wrist arthritis theoretically makes it impossible to perform a trapeziectomy for thumb basal joint arthritis. Question/Purpose The aim of this study was to present and analyze the results of two types of surgical treatment when both wrist and thumb arthritis was present. Materials and Methods Our retrospective series included 11 patients suffering from Eaton Stage III thumb basal joint arthritis and scapholunate advanced collapse (SLAC) II and III-type wrist arthritis. Five patients (group A) underwent trapeziectomy and palliative surgery for their wrist with conservation of the distal pole of the scaphoid (one proximal row carpectomy [PRC] and four four-corner fusions), and six (group B) patients had a trapeziometacarpal arthroplasty either with PRC (two cases) or four-corner arthrodesis (four cases) including total scaphoidectomy. Results The mean follow-up was 57 months. The overall visual analog scale (VAS) score for pain was 1.5 at rest, with no difference between the trapeziectomy and arthroplasty groups. The average Kapandji score was 9.3 (9 in group A and 9.5 in group B). The flexion/extension range of motion for the wrist was 64° following four-corner arthrodesis and 75° following PRC. Only one case of algodystrophy was observed. The radiological analysis revealed no complications. Discussion This study shows that thumb basal joint arthritis and SLAC type wrist arthritis may be treated by combined treatment during the same intervention without any complications. The results of palliative surgery for the wrist, either with trapeziectomy or with a trapeziometacarpal arthroplasty, are comparable. With a trapeziectomy, the

  5. Combined Treatment of Wrist and Trapeziometacarpal Joint Arthritis.

    Science.gov (United States)

    Waitzenegger, Thomas; Leclercq, Caroline; Masmejean, Emmanuel; Lenoir, Hubert; Harir, Amir; Coulet, Bertrand; Chammas, Michel

    2015-11-01

    Background Combined thumb basal and wrist joint arthritis (excluding scaphotrapeziotrapezoid arthritis) is rare considering the frequency of arthritis of either joint alone. Combined surgical treatment has never been described in the literature. Furthermore, the scaphoidectomy common to all interventions for Watson stage 2 or 3 wrist arthritis theoretically makes it impossible to perform a trapeziectomy for thumb basal joint arthritis. Question/Purpose The aim of this study was to present and analyze the results of two types of surgical treatment when both wrist and thumb arthritis was present. Materials and Methods Our retrospective series included 11 patients suffering from Eaton Stage III thumb basal joint arthritis and scapholunate advanced collapse (SLAC) II and III-type wrist arthritis. Five patients (group A) underwent trapeziectomy and palliative surgery for their wrist with conservation of the distal pole of the scaphoid (one proximal row carpectomy [PRC] and four four-corner fusions), and six (group B) patients had a trapeziometacarpal arthroplasty either with PRC (two cases) or four-corner arthrodesis (four cases) including total scaphoidectomy. Results The mean follow-up was 57 months. The overall visual analog scale (VAS) score for pain was 1.5 at rest, with no difference between the trapeziectomy and arthroplasty groups. The average Kapandji score was 9.3 (9 in group A and 9.5 in group B). The flexion/extension range of motion for the wrist was 64° following four-corner arthrodesis and 75° following PRC. Only one case of algodystrophy was observed. The radiological analysis revealed no complications. Discussion This study shows that thumb basal joint arthritis and SLAC type wrist arthritis may be treated by combined treatment during the same intervention without any complications. The results of palliative surgery for the wrist, either with trapeziectomy or with a trapeziometacarpal arthroplasty, are comparable. With a trapeziectomy, the

  6. The European multicenter trial on the safety and efficacy of guided oblique lumbar interbody fusion (GO-LIF

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    Birkenmaier Christof

    2010-09-01

    Full Text Available Abstract Background Because of the implant-related problems with pedicle screw-based spinal instrumentations, other types of fixation have been tried in spinal arthrodesis. One such technique is the direct trans-pedicular, trans-discal screw fixation, pioneered by Grob for spondylolisthesis. The newly developed GO-LIF procedure expands the scope of the Grob technique in several important ways and adds security by means of robotic-assisted navigation. This is the first clinical trial on the GO-LIF procedure and it will assess safety and efficacy. Methods/Design Multicentric prospective study with n = 40 patients to undergo single level instrumented spinal arthrodesis of the lumbar or the lumbosacral spine, based on a diagnosis of: painful disc degeneration, painful erosive osteochondrosis, segmental instability, recurrent disc herniation, spinal canal stenosis or foraminal stenosis. The primary target criteria with regards to safety are: The number, severity and cause of intra- and perioperative complications. The number of significant penetrations of the cortical layer of the vertebral body by the implant as recognized on postoperative CT. The primary target parameters with regards to feasibility are: Performance of the procedure according to the preoperative plan. The planned follow-up is 12 months and the following scores will be evaluated as secondary target parameters with regards to clinical improvement: VAS back pain, VAS leg pain, Oswestry Disability Index, short form - 12 health questionnaire and the Swiss spinal stenosis questionnaire for patients with spinal claudication. The secondary parameters with regards to construct stability are visible fusion or lack thereof and signs of implant loosening, implant migration or pseudarthrosis on plain and functional radiographs. Discussion This trial will for the first time assess the safety and efficacy of guided oblique lumbar interbody fusion. There is no control group, but the results, the

  7. Revision of Minimally Invasive Sacroiliac Joint Fixation: Technical Considerations and Case Studies Using Decortication and Threaded Implant Fixation

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    Fielding, Louis C

    2017-01-01

    Background Sacroiliac joint (SIJ) disease is increasingly recognized as a common source of low back pain. Arthrodesis of the SIJ has been shown to be clinically effective for this condition. In the last decade, minimally invasive (MI) SIJ fusion procedures have been developed to achieve the clinical effectiveness of open fusion procedures, with lower operative morbidity and faster recovery. However, SIJ fusion patients occasionally present with symptomatic nonunions necessitating revision. Methods Four patients who previously underwent MI SIJ arthrodesis returned with complaints of SIJ related pain confirmed by examination. Radiographic assessment showed lucency after fixation with triangular titanium interference implants. Loose implants were removed, and the patients were revised with a different MI SIJ fusion system that utilizes decortication, placement of autograft and graft extender, and fixation with cannulated threaded implants. The trajectory of the revision implants was in a more ventral-to-dorsal and caudal-to-cranial trajectory to place the implants perpendicularly through the articular portion of the SIJ. Results The triangular implants typically exhibited haloing lucency on radiographs and CT scans, and most were easily removed using the manufacturer’s instrumentation; only one implant was left in place as it was well-fixed. The removed implants exhibited little or no bony ongrowth. Decortication of the SIJ was performed, followed by placement of local autograft and fixation with 12.5 mm or 14.5mm diameter implants, as required. A more ventral-todorsal and caudal-to-cranial trajectory was established for the revision implants through the center of the articular region of the joint in order to maximize implant purchase in residual bone stock and achieve bony fusion through the articular portion of the SIJ. By six to twelve months post-revision, the presenting symptoms were successfully resolved in all patients. Conclusions Patients demonstrating

  8. C1-C2 rotary subluxation following posterior stabilization for congenital atlantoaxial dislocation.

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    Behari S

    2000-04-01

    Full Text Available The authors report a rare complication of C1-C2 rotary subluxation in two children following posterior stabilization for congenital atlantoaxial dislocation (AAD. A patient, with mobile AAD, underwent Brook′s C1-C2 fusion while the other, with fixed AAD, underwent transoral decompression followed by Jain′s occipitocervical fusion. A pre-existing ligamentous laxity associated with an asymmetrical wire tightening or slippage of the wires due to rotation of the neck in the former, and the drilling of the C1-C2 lateral joints during the transoral procedure in the latter, could have contributed to the rotary subluxation. Both patients presented with persistent torticollis due to fusion in an asymmetrical position with dislocated facet joints. Rotary C1-C2 subluxation, when coexisting with anterior dislocation, has the potential to cause severe and occasionally fatal cord compression. Well defined criteria to diagnose this entity by conventional radiology exist, however, due to the overlap of anatomy, the condition is often overlooked. In the present study, three dimensional reconstruction images using helical computerized tomography were very useful in delineating the subluxation and in planning its surgical reduction and arthrodesis.

  9. Tribology of flexible and sliding spinal implants: development of experimental and numerical models.

    Science.gov (United States)

    Le Cann, Sophie; Chaves-Jacob, Julien; Rossi, Jean-Marie; Linares, Jean-Marc; Chabrand, Patrick

    2016-11-22

    New fusionless devices are being developed to get over the limits of actual spinal surgical treatment, based on arthrodesis. However, due to their recentness, no standards exist to test and validate those devices, especially concerning the wear. A new tribological first approach to the definition of an in vitro wear protocol to study wear of flexible and sliding spinal devices is presented in this article, and was applied to a new concept. A simplified synthetic spine portion (polyethylene) was developed to reproduce a simple supra-physiological spinal flexion (10° between two vertebrae). The device studied with this protocol was tested in wet environment until 1 million cycles (Mc). We obtained an encouraging estimated wear volume of same order of magnitude compared to similar devices. An associated finite element (FE) numerical model has permitted to access contact information and study the effect of misalignment of one screw. First results could point out how to improve the design and suggest that a vertical misalignment of a screw (under or over-screwing) has more impact than a horizontal one. © 2016 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 2016.

  10. Sequelae of pediatric osteoarticular infection.

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    Ilharreborde, B

    2015-02-01

    The epidemiology and diagnosis of osteoarticular infections (OAI) have changed considerably in recent years, partly due to the development of molecular biology. Kingella kingae is now recognized as the most frequent pathogen in children under 4 years of age, while methicillin-resistant Staphylococcus aureus (SA) has been increasingly reported. Although the clinical course of OAI is mostly benign, with shorter antibiotic regimens and simplified treatments, serious functional impairments and life-threatening complications can still occur, especially in case of delayed diagnosis or infection caused by Panton-Valentine leukocidin-producing strains of SA. Newborns and patients with sickle cell disease have greater risk of orthopaedic sequelae, which need to be detected and managed early. The main sequelae of osteomyelitis are angular limb deformity, due to partial growth arrest, and lower limb discrepancy. Therapeutic options are guided by the patient's age and predictions at maturity. The main complications of septic arthritis are joint stiffness and osteonecrosis. The procedures to consider are arthrodesis, joint reconstruction in immature children, and arthroplasty at the end of growth.

  11. Use of tranexamic acid for controlling bleeding in thoracolumbar scoliosis surgery with posterior instrumentation

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    Vinícius Magno da Rocha

    2015-04-01

    Full Text Available OBJECTIVE: Scoliosis surgery involves major blood loss and frequently requires blood transfusion. The cost and risks involved in using allogeneic blood have motivated investigation of methods capable of reducing patients' bleeding during operations. One of these methods is to use antifibrinolytic drugs, and tranexamic acid is among these. The aim of this study was to assess the use of this drug for controlling bleeding in surgery to treat idiopathic scoliosis.METHODS: This was a retrospective study in which the medical files of 40 patients who underwent thoracolumbar arthrodesis by means of a posterior route were analyzed. Of these cases, 21 used tranexamic acid and were placed in the test group. The others were placed in the control group. The mean volumes of bleeding during and after the operation and the need for blood transfusion were compared between the two groups.RESULTS: The group that used tranexamic acid had significantly less bleeding during the operation than the control group. There was no significant difference between the groups regarding postoperative bleeding and the need for blood transfusion.CONCLUSIONS: Tranexamic acid was effective in reducing bleeding during the operation, as demonstrated in other studies. The correlation between its use and the reduction in the need for blood transfusion is multifactorial and could not be established in this study. We believe that tranexamic acid may be a useful resource and that it deserves greater attention in randomized double-blind prospective series, with proper control over variables that directly influence blood loss.

  12. Stem cell-mediated osteogenesis: therapeutic potential for bone tissue engineering

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    Neman J

    2012-03-01

    Full Text Available Josh Neman1, Amanda Hambrecht2, Cherie Cadry3, Rahul Jandial11Department of Neurosurgery, Beckman Research Institute, City of Hope National Cancer Center, Duarte, 2Department of Biological Sciences, University of Southern California, Los Angeles, 3Department of Public Health Sciences, University of California, Irvine, California, USAAbstract: Intervertebral disc degeneration often requires bony spinal fusion for long-term relief. Current arthrodesis procedures use bone grafts from autogenous bone, allogenic backed bone, or synthetic materials. Autogenous bone grafts can result in donor site morbidity and pain at the donor site, while allogenic backed bone and synthetic materials have variable effectiveness. Given these limitations, researchers have focused on new treatments that will allow for safe and successful bone repair and regeneration. Mesenchymal stem cells have received attention for their ability to differentiate into osteoblasts, cells that synthesize new bone. With the recent advances in scaffold and biomaterial technology as well as stem cell manipulation and transplantation, stem cells and their scaffolds are uniquely positioned to bring about significant improvements in the treatment and outcomes of spinal fusion and other injuries.Keywords: mesenchymal stem cell, osteogenesis, scaffolds, bone morphogenetic protein, Wnt, autograft, osteoblast

  13. ANALYSIS OF INTERBODY VERSUS POSTEROLATERAL FUSION FOR LUMBAR SPONDYLOSIS

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    Rodrigo Góes Medéa de Mendonça

    2015-12-01

    Full Text Available Objective : To evaluate and compare radiographic and clinical evaluation of patients undergoing interbody fusion versus posterolateral fusion of the lumbar spine. Methods : Retrospective study of patients diagnosed with lumbar spondylosis that were surgically treated in the period from 2012 to 2014. The results were observed by clinical evaluation by the Visual Analogue Scale (VAS for low back and leg pain. We evaluated functional results and quality of life through the application of the Oswestry Disability Index (ODI and the Short Form-36 (SF-36 questionnaires, respectively. The pre and postoperative condition were compared in Group 1 (interbody fusion and Group 2 (posterolateral fusion, in addition to evaluation of fusion by means of post-operative radiograph. Results : A total of 30 patients of 36 were eligible, 12 in Group 1 and 18 in Group 2. The mean follow-up was 10.1 months. Statistical analysis showed similar scores for back and leg pain VAS, SF-36 function scores and Oswestry between groups with interbody and posterolateral fusion, and compared within these groups regarding the pre- and postoperative condition, and found no statistical significance. The successful fusion was similar in both groups, with 11 of 12 patients in Group 1 showing bone fusion and 17 of 18 in Group 2 showing arthrodesis. Conclusion : No clinical or radiographic differences between patients who underwent posterolateral or interbody fusion were observed. Both methods showed improvement in functional outcome and pain reduction.

  14. Avian luxations: occurrence, diagnosis and treatment.

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    Azmanis, Panagiotis N; Wernick, Morena B; Hatt, Jean-Michel

    2014-01-01

    Whereas the treatment of fractures in birds has been a matter of multiple studies and reviews, comparatively little information is available for the treatment of luxations in birds. In this article, we review the current knowledge regarding the frequency, etiology, clinical presentation, diagnosis, and treatment of luxations in birds, aiming to guide the clinician in private practice as well as future research. The type, the localization, and the frequency of luxation do not follow a concrete pattern. In general, pet and aviary birds are more susceptible to leg and spinal luxations while in wild birds wing luxations are more frequently observed. Diagnosis is made on the basis of detailed orthopedic and radiographic examinations. Conservative management and coaptation has been successfully used in carpal, minor elbow, shoulder, coracoid, and metatarsophalangeal luxations. Surgical management is recommended in palatine bone, metacarpophalangeal, severe elbow, coxofemoral, stifle, and intertarsal joint luxations. The techniques, which have been applied, include arthrodesis, femoral head osteotomy, polymer rods, bone plates, and internal and external fixation in various combinations. Currently, there are no controlled studies, which underline the advantages and disadvantages of each technique.

  15. Anterior transarticular screw fixation as a conventional operation for rigid stabilization

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    Manabu Sasaki

    2014-01-01

    Full Text Available Background: Anterior transarticular screw (ATS fixation is a useful surgical option for atlantoaxial (AA stabilization. This report presents a revised ATS method for AA fusion. Methods: A 79-year-old male presented with AA instability attributed both to an old odontoid fracture and severe degeneration of the lateral atlantoaxial joints (LAAJs. ATS fixation was performed through the conventional anterior cervical approach. The longest screw trajectories were planned preoperatively using multiplanar reconstruction computed tomography (CT scans, with entry points of the screws situated at the midpoint on the inferior border of the axial body. The surgical exposure was limited to opening at the entry points alone. Our retractor of choice was the Cusco speculum; it sufficiently secured space for utilizing the required instruments for screw placement while offering sufficient protection of soft tissues. Cannulated full-threaded bicortical screws stabilized the LAAJs. Screw insertion required a significant amount of coronal angulation up to the superior articular process of the atlas under open-mouth and lateral fluoroscopy image guidance. After ATS fixation, bone grafting was performed between the posterior laminae of the axis and the atlas through a conventional posterior approach. Results: Bony fusion between the atlas and the axis was confirmed radiographically. Arthrodesis of the LAAJs occurred despite no bone grafting. Conclusions: Rigid fixation of the LAAJs was obtained by our ATS technique, indicating that it is an alternative method for AA fixation when posterior rigid internal fixation is not applicable.

  16. Recurrence of an intra-articular osteoid osteoma of the great toe: a case report and review of the literature

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    Torrent, Josep; Bailez, Alberto; Asuncion, Jordi

    2017-01-01

    Osteoid osteoma (OO) is a benign tumor that it is not generally seen in the foot and even less frequently in the phalanx (2–4%). The diagnosis when its location is intra-articular is a challenge and often delayed because the symptoms mimic a real arthritis. We report a clinical case involving a 16-year-old male patient who complained of persistent pain of the interphalangeal joint (IPJ) of the left hallux. A juxta-articular OO of the condyle of the proximal phalanx was identified. The patient underwent surgery that included tumor removal preserving the articular cartilage. After a non-complete nidus resection, there was a recurrence. The patient underwent surgery with a removal en-block of the distal part of the proximal phalanx and fusion of the IPJ with interposition of a tricortical autograft. After a follow-up of 30 months, the X-ray showed total arthrodesis of the joint without signs of recurrence or pain. PMID:28064244

  17. The 100 Most Influential Articles in Cervical Spine Surgery.

    Science.gov (United States)

    Skovrlj, Branko; Steinberger, Jeremy; Guzman, Javier Z; Overley, Samuel C; Qureshi, Sheeraz A; Caridi, John M; Cho, Samuel K

    2016-02-01

    Study Design Literature review. Objective To identify and analyze the top 100 cited articles in cervical spine surgery. Methods The Thomson Reuters Web of Knowledge was searched for citations of all articles relevant to cervical spine surgery. The number of citations, authorship, year of publication, journal of publication, country of publication, and institution were recorded for each article. Results The most cited article was the classic from 1991 by Vernon and Mior that described the Neck Disability Index. The second most cited was Smith's 1958 article describing the anterior cervical diskectomy and fusion procedure. The third most cited article was Hilibrand's 1999 publication evaluating the incidence, prevalence, and radiographic progression of symptomatic adjacent segment disease following anterior cervical arthrodesis. The majority of the articles originated in the United States (65), and most were published in Spine (39). Most articles were published in the 1990s (34), and the three most common topics were cervical fusion (17), surgical complications (9), and biomechanics (9), respectively. Author Abumi had four articles in the top 100 list, and authors Goffin, Panjabi, and Hadley had three each. The Department of Orthopaedic Surgery at Hokkaido University in Sapporo, Japan, had five articles in the top 100 list. Conclusion This report identifies the top 100 articles in cervical spine surgery and acknowledges those individuals who have contributed the most to the advancement of the study of the cervical spine and the body of knowledge used to guide evidence-based clinical decision making in cervical spine surgery today.

  18. RESULTS OF THE USE OF PEEK CAGES IN THE TREATMENT OF BASILAR INVAGINATION BY GOEL TECHNIQUE

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    Luís Eduardo Carelli Teixeira da Silva

    2016-03-01

    Full Text Available ABSTRACT Objective: Analysis of the use of polyetheretherketone (PEEK cages for atlantoaxial facet realignment and distraction for treatment of basilar invagination by Goel technique. Method: Retrospective descriptive statistical analysis of the neurological status, pain, presence of subsidence and bone fusion with the use of PEEK cages in 8 atlantoaxial joints of 4 patients with basilar invagination. All patients were treated with atlantoaxial facet distraction and realignment and subsequent arthrodesis C1-C2 by the technique of Goel modified by the use of PEEK cage. Results: All patients showed improvement in Nurick neurological assessment scale and Visual Analogue Scale (VAS of pain. There were no cases of subsidence, migration, or damage to the vertebral artery during the insertion of the cage. All joints evolved with bone fusion, assessed by dynamic radiographs, and computed tomography. Two patients developed neuropathic pain in dermatome of C2 and one patient had unilateral vertebral artery injury during C2 instrumentation treated with insertion of pedicle screw to control the bleeding. Conclusion: The results of the treatment of basilar invagination by the Goel technique with the use of PEEK cages shown to be effective and safe although further studies are needed to confirm this use.

  19. Sea urchin spine arthritis in the foot.

    Science.gov (United States)

    Schefflein, Javin; Umans, Hilary; Ellenbogen, David; Abadi, Maria

    2012-09-01

    We present a case of sea urchin spine arthritis (SUSA) in a 33-year-old woman who sustained penetrating trauma to the interphalangeal (IP) joint of the hallux while snorkeling in Japan. Serial radiographs and MRI were obtained over a period from 7 weeks to 10 months following injury. At 7 weeks radiographs revealed periarticular osteopenia and subtle marginal erosion, similar to the appearance of tuberculous arthritis. Over the ensuing months, radiographs and MRI documented progressive marginal and periarticular erosions with synovitis, despite preservation of cartilage space and restoration of bone mineral density. Delayed radiographs and imaging features mimic gouty arthropathy. Only the history points to the proper diagnosis, which was confirmed by histopathology, demonstrating necrobiotic granuloma with central fibrinoid necrosis following synovectomy and arthrodesis. The majority of previous case reports affected the hand, with few cases in the feet. In all, radiographic illustrations were limited and demonstrated only minimal osteolysis and periosteal reaction. No other report included MRI or serial radiographs over a long period to illustrate the natural progression of the disease.

  20. [Reconstructive surgery following malunion of fractures of the proximal humerus in adults].

    Science.gov (United States)

    Gerber, C

    1990-11-01

    Malunion, avascular necrosis of the head segment and nonunion of the neck are the most frequent complications of displaced fractures of the proximal humerus. Malunion of the tuberosities may be well tolerated or it can require surgical treatment. Cranial displacement of the greater tuberosity appears to be much better tolerated than dorsal displacement. If power and active mobility are maintained but pain persists, the malunion may have led to impingement, which can be relieved by coraco-acromioplasty. If active mobility is reduced, tubercular osteotomy and relocation using tension band wiring techniques may be warranted. Malunion at the neck level may be treated with subcapital, usually flexion-abduction, osteotomies and yield excellent results. A collapsed head segment after avascular necrosis of the head requires either hemiarthroplasty or total joint replacement. As the nonunions are usually fairly distal and almost always extra-articular, they are treated with open reduction and internal fixation using tension band-wiring techniques and autogenous bone grafting. Arthrodesis has essentially lost its role in reconstructive surgery after fracture complications and is only used if severe additional problems are present such as infection, neurological problems, or severe soft tissue defects.

  1. Calcaneo-Scaphoid Coalition.

    Science.gov (United States)

    Seddon, H J

    1933-02-01

    Calcaneo-scaphoid coalition occurs in a number of forms, having one feature in common, namely, a skeletal abnormality of the calcaneo-scaphoid gap. The condition is congenital, but nothing is known of its causation. Ranking at first as merely an anatomical curiosity, it was later recognized to be frequently associated with spasmodic flat-foot. Probably 25% of all cases of spasmodic flat-foot show this skeletal anomaly in some form or other.Clinically, this variety of spasmodic flat-foot is indistinguishable from the better-known condition in which the bones are apparently normal. Diagnosis made radiographically; essential that an oblique lateral view of the foot should be taken.Causal relation of the condition to peroneal spasm.All the usual forms of treatment employed for the relief of spasmodic flat-foot fail when a calcaneo-scaphoid coalition is present. Resection of the offending bar is of no proven value, but may be worth further trial. If symptoms persist, subastragaloid arthrodesis is necessary.

  2. Chopart fractures.

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    Klaue, Kaj

    2004-09-01

    The Chopart articular space was described by François Chopart (1743-1795) as a practical space for amputations in cases of distal foot necrosis. It corresponds to the limit between the anatomical hind-foot and the mid-foot. The bones involved are the talus and the calcaneus proximally, and the navicular and the cuboid distally. This space thus holds two functionally distinct entities, the anterior part of the coxa pedis (an essential functional joint) and the calcaneo-cuboidal joint,which can be considered to be an "adaptive joint" within a normal foot. Trauma to this region may cause fractures and/or dislocations and, in high energy trauma,compartment syndromes. Principles of treatment are immediate reduction of dislocations and realignment of the medial and lateral column of the foot in length and orientation. Open reduction and internal fixation of talus and navicular fractures are often indicated to restore the "coxa pedis". Open reconstruction or fusion in correct length of the calcaneo-cuboidal joint is occasionally indicated. Salvage procedures in malunions include navicular osteotomies and calcaneo-cuboidal bone block fusions. Treatment of joint destructions, especially involving the talo-navicular joint, include triple arthrodesis.

  3. Results of the surgical treatment of calcaneo-navicular coalito.

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    Jerosch, J; Lindner, N; Finnen, D A

    1997-01-01

    We present the results after surgical treatment in 15 patients who suffered from calcaneo-navicular coalitio. A total of 20 operations were performed on 19 feet (3 T-arthrodesis, 5 simple resections, 9 resections with fat interposition, 3 resections with muscle interposition). At the time of follow-up, the patients were examined clinically and radiologically. In addition, different functional tests were performed (heel-tip test, balance test, single-leg high jump, single-leg jumping course). Ten of 17 patients who underwent radiographic study at the follow-up had a successful result. Patients who had a coalitio showed a tibial rotation (heel-tip test) of 11.5 degrees, and those patients without a coalitio had a tibia rotation of 20.3 degrees. Concerning the functional outcome, 12 of 17 patients had a successful result. The range of motion of the subtalar joint did not correlate with the functional capacity of the ankle. Seven of 20 patients subjectively judged the outcome as a failure. The worst results were found in patients with pre-existing degenerative changes at the time of resection.

  4. Total disc replacement.

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    Vital, J-M; Boissière, L

    2014-02-01

    Total disc replacement (TDR) (partial disc replacement will not be described) has been used in the lumbar spine since the 1980s, and more recently in the cervical spine. Although the biomechanical concepts are the same and both are inserted through an anterior approach, lumbar TDR is conventionally indicated for chronic low back pain, whereas cervical TDR is used for soft discal hernia resulting in cervicobrachial neuralgia. The insertion technique must be rigorous, with precise centering in the disc space, taking account of vascular anatomy, which is more complex in the lumbar region, particularly proximally to L5-S1. All of the numerous studies, including prospective randomized comparative trials, have demonstrated non-inferiority to fusion, or even short-term superiority regarding speed of improvement. The main implant-related complication is bridging heterotopic ossification with resulting loss of range of motion and increased rates of adjacent segment degeneration, although with an incidence lower than after arthrodesis. A sufficiently long follow-up, which has not yet been reached, will be necessary to establish definitively an advantage for TDR, particularly in the cervical spine.

  5. Late presentation of superior mesenteric artery syndrome following scoliosis surgery: a case report

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    Tsirikos Athanasios I

    2008-01-01

    Full Text Available Abstract Introduction Obstruction of the third part of the duodenum by the superior mesenteric artery (SMA can occur following surgical correction of scoliosis. The condition most commonly occurs in significantly underweight patients with severe deformities during the first few days to a week following spinal surgery. Case presentation We present the atypical case of a patient with normal body habitus and a 50° adolescent idiopathic thoracolumbar scoliosis who underwent anterior spinal arthrodesis with instrumentation and developed SMA syndrome due to progressive weight loss several weeks postoperatively. The condition manifested with recurrent vomiting, abdominal distension, marked dehydration, and severe electrolyte disorder. Prolonged nasogastric decompression and nasojejunal feeding resulted in resolution of the symptoms with no recurrence at follow-up. The spinal instrumentation was retained and a solid spinal fusion was achieved with good spinal balance in both the coronal and sagittal planes. Conclusion SMA syndrome can occur much later than previously reported and with potentially life-threatening symptoms following scoliosis correction. Early recognition of the condition and institution of appropriate conservative measures is critical to prevent the development of severe complications including the risk of death.

  6. Initial shortening and internal fixation in combination with a Sauvé-Kapandji procedure for severely comminuted fractures of the distal radius in elderly patients.

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    Arora, R; Gabl, M; Pechlaner, S; Lutz, M

    2010-11-01

    We identified 11 women with a mean age of 74 years (65 to 81) who sustained comminuted distal radial and ulnar fractures and were treated by volar plating and slight shortening of the radius combined with a primary Sauvé-Kapandji procedure. At a mean of 46 months (16 to 58), union of distal radial fractures and arthrodesis of the distal radioulnar joint was seen in all patients. The mean shortening of the radius was 12 mm (5 to 18) compared to the contralateral side. Flexion and extension of the wrist was a mean of 54° and 50°, respectively, and the mean pronation and supination of the forearm was 82° and 86°, respectively. The final mean disabilities of the arm, shoulder and hand score was 26 points. According to the Green and O'Brien rating system, eight patients had an excellent, two a good and one a fair result. The good clinical and radiological results, and the minor complications without the need for further operations related to late ulnar-sided wrist pain, justify this procedure in the elderly patient.

  7. Treatment of a Chronic Galeazzi Fracture-dislocation. A Case Report

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    Yaniel Truffin Rodríguez

    2016-10-01

    Full Text Available Galeazzi fracture-dislocation is a rare injury that may go unnoticed. It should be suspected when dealing with a displaced fracture of the junction of the distal and middle third of the radial shaft. For these reasons, we present the case of a 50-year-old patient who suffered a trauma with a cutting tool in the junction of the distal and middle third of his left forearm, which resulted in a wound on the dorsal aspect of the forearm and a Galeazzi fracture-dislocation. We could not determine whether the fracture had been open or not since the patient did not provide clear information during the assessment conducted in the Orthopedics Service of the hospital of Cienfuegos 55 days after the trauma. The open reduction and internal fixation of the fracture was performed. Given the time elapsed since the injury and the presence of degenerative lesions in the wrist, a distal radioulnar arthrodesis (the Sauvé-Kapandji procedure was carried out. The stabilization of the distal ulna was achieved by using a 3.5 mm malleolar screw placed in an ulnar to radial direction. The patient underwent physical rehabilitation and was discharged five months later with satisfactory results.

  8. Human Mesenchymal Stem Cell Morphology and Migration on Microtextured Titanium

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    Banik, Brittany L.; Riley, Thomas R.; Platt, Christina J.; Brown, Justin L.

    2016-01-01

    The implant used in spinal fusion procedures is an essential component to achieving successful arthrodesis. At the cellular level, the implant impacts healing and fusion through a series of steps: first, mesenchymal stem cells (MSCs) need to adhere and proliferate to cover the implant; second, the MSCs must differentiate into osteoblasts; third, the osteoid matrix produced by the osteoblasts needs to generate new bone tissue, thoroughly integrating the implant with the vertebrate above and below. Previous research has demonstrated that microtextured titanium is advantageous over smooth titanium and PEEK implants for both promoting osteogenic differentiation and integrating with host bone tissue; however, no investigation to date has examined the early morphology and migration of MSCs on these surfaces. This study details cell spreading and morphology changes over 24 h, rate and directionality of migration 6–18 h post-seeding, differentiation markers at 10 days, and the long-term morphology of MSCs at 7 days, on microtextured, acid-etched titanium (endoskeleton), smooth titanium, and smooth PEEK surfaces. The results demonstrate that in all metrics, the two titanium surfaces outperformed the PEEK surface. Furthermore, the rough acid-etched titanium surface presented the most favorable overall results, demonstrating the random migration needed to efficiently cover a surface in addition to morphologies consistent with osteoblasts and preosteoblasts. PMID:27243001

  9. The effect of Masai Barefoot Technology (MBT) footwear on lower limb biomechanics: A systematic review.

    Science.gov (United States)

    Tan, Jade M; Auhl, Maria; Menz, Hylton B; Levinger, Pazit; Munteanu, Shannon E

    2016-01-01

    This systematic review evaluated the available evidence for the effects of Masai Barefoot Technology (MBT) footwear on lower limb biomechanics during gait. Electronic databases (MEDLINE, EMBASE, CINAHL, SPORTDiscus, and PubMed) were searched in January 2015. Methodological quality of included studies was evaluated using the Quality Index. Standardised mean differences and 95% confidence intervals were calculated, and meta-analysis was conducted where possible. 17 studies satisfied the inclusion criteria; 16 cross-sectional studies and one randomised control trial (RCT). Quality Index scores ranged from 7 to 12 (out of 15). All 17 studies investigated walking gait only. Evidence showed that MBT footwear caused asymptomatic individuals to walk with a shorter stride length, reduced peak hip flexion, increased peak knee extension, and reduced hip and knee range of motion throughout gait. All kinematic effects occurred in the sagittal plane. There was a trend towards a decrease in internal and external joint moments and power, except for the foot, where increases in force were observed. There were only a small number of changes to lower limb muscle amplitude and timing. No statistically significant effects were observed in symptomatic individuals with knee osteoarthritis or following total knee replacement, but there was an increase in cadence and a decrease in step length in individuals following tibiotalar arthrodesis. These findings suggest that MBT footwear does change lower limb biomechanics in both asymptomatic and symptomatic individuals during gait. However, further clinical trials need to be undertaken to determine whether these changes are therapeutically beneficial.

  10. Guideline update for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 9: lumbar fusion for stenosis with spondylolisthesis.

    Science.gov (United States)

    Resnick, Daniel K; Watters, William C; Sharan, Alok; Mummaneni, Praveen V; Dailey, Andrew T; Wang, Jeffrey C; Choudhri, Tanvir F; Eck, Jason; Ghogawala, Zoher; Groff, Michael W; Dhall, Sanjay S; Kaiser, Michael G

    2014-07-01

    Patients presenting with stenosis associated with a spondylolisthesis will often describe signs and symptoms consistent with neurogenic claudication, radiculopathy, and/or low-back pain. The primary objective of surgery, when deemed appropriate, is to decompress the neural elements. As a result of the decompression, the inherent instability associated with the spondylolisthesis may progress and lead to further misalignment that results in pain or recurrence of neurological complaints. Under these circumstances, lumbar fusion is considered appropriate to stabilize the spine and prevent delayed deterioration. Since publication of the original guidelines there have been a significant number of studies published that continue to support the utility of lumbar fusion for patients presenting with stenosis and spondylolisthesis. Several recently published trials, including the Spine Patient Outcomes Research Trial, are among the largest prospective randomized investigations of this issue. Despite limitations of study design or execution, these trials have consistently demonstrated superior outcomes when patients undergo surgery, with the majority undergoing some type of lumbar fusion procedure. There is insufficient evidence, however, to recommend a standard approach to achieve a solid arthrodesis. When formulating the most appropriate surgical strategy, it is recommended that an individualized approach be adopted, one that takes into consideration the patient's unique anatomical constraints and desires, as well as surgeon's experience.

  11. Advantages of using volar vein repair in finger replantations.

    Science.gov (United States)

    Mersa, Berkan; Kabakas, Fatih; Pürisa, Hüsrev; Özçelik, Ismail Bülent; Yeşiloğlu, Nebil; Sezer, Ilker; Tunçer, Serdar

    2014-01-01

    Providing adequate venous outflow is essential in finger replantation surgeries. For a successful result, the quality and quantity of venous repairs should be adequate to drain arterial inflow. The digital dorsal venous plexus is a reliable source of material for venous repairs. Classically, volar digital veins have been used only when no other alternative was available. However, repairing volar veins to augment venous outflow has a number of technical advantages and gives a greater chance of survival. Increasing the repaired vein:artery ratio also increases the success of replantation. The volar skin, covering the volar vein, is less likely to be avulsed during injury and is also less likely to turn necrotic, than dorsal skin, after the replantation surgery. Primary repair of dorsal veins can be difficult due to tightness ensuing from arthrodesis of the underlying joint in flexion. In multiple finger replantations, repairing the volar veins after arterial repair and continuing to do so for each finger in the same way without changing the position of the hand and surgeon save time. In amputations with tissue loss, the size discrepancy is less for volar veins than for dorsal veins. We present the results of 366 finger replantations after volar vein repairs.

  12. Elbow dislocation and articular fracture of the distal humerus%肘关节脱位与肱骨远端关节内骨折

    Institute of Scientific and Technical Information of China (English)

    Andrés Arizmendi; Santiago Lozano-Calderón; David C. Ring; Jesse B. Jupiter

    2006-01-01

    Objective To describe dislocation of the elbow with articular fracture of the distal humerus, a type of elbow fracture-dislocation about which little has been written. Methods Four patients with a dislocation of the elbow and fracture of the distal humerus were identified. Three had dislocation and complex intraarticular fracture of the capitellum, trochlea, and lateral epicondyle. Results Two patients (one treated with a second operation to address avascular necrosis of the capitellum) achieved a functional arc of elbow motion and one patient was lost after removal of the implants 3 months after fracture with documented healing. The fourth patient had a complex open fracture dislocation involving the entire articular surface. An attempt to salvage the articular surface resulted in deep infection. Extensive heterotopic bone led to arthrodesis of the elbow. Conclusions Dislocations of the elbow with articular fracture of the humerus are uncommon. Most injuries involve the capitellum, lateral trochlea, and lateral epicondyle. Open reduction and internal fixation of the distal humerus fracture can restore stability without repairing the medial collateral ligament.

  13. Rotatory subluxation of the scaphoid in Kienböck's disease is not a cause of scapholunate advanced collapse (SLAC) in the wrist.

    Science.gov (United States)

    Taniguchi, Y; Tamaki, T; Honda, T; Yoshida, M

    2002-07-01

    We have examined whether the rotatory subluxation of the scaphoid which is seen in patients with advanced Kienböck's disease is associated with scapholunate advanced collapse (SLAC) wrist. We studied 16 patients (11 men, 5 women) who had stage-IV Kienböck's disease with chronic subluxation of the scaphoid. All had received conservative treatment. The mean period of affection with Kienböck's disease was 30 years (14 to 49). No wrist had SLAC. In eight patients, 24 years or more after the onset of the disease, the articular surface of the radius had been remodelled by the subluxed scaphoid with maintenance of the joint space. The wrists of six patients were considered to be excellent, nine good, and one fair according to the clinical criteria of Dornan. Our findings have shown that rotatory subluxation of the scaphoid in Kienböck's disease is not a cause of SLAC wrist and therefore that scaphotrapeziotrapezoid arthrodesis is not required for the management of these patients.

  14. Promising one- to six-year results with the Motec wrist arthroplasty in patients with post-traumatic osteoarthritis.

    Science.gov (United States)

    Reigstad, O; Lütken, T; Grimsgaard, C; Bolstad, B; Thorkildsen, R; Røkkum, M

    2012-11-01

    The Motec cementless modular metal-on-metal ball-and-socket wrist arthroplasty was implanted in 16 wrists with scaphoid nonunion advanced collapse (SNAC; grades 3 or 4) and 14 wrists with scapholunate advanced collapse (SLAC) in 30 patients (20 men) with severe (grades 3 or 4) post-traumatic osteoarthritis of the wrist. The mean age of the patients was 52 years (31 to 71). All prostheses integrated well radiologically. At a mean follow-up of 3.2 years (1.1 to 6.1) no luxation or implant breakage occurred. Two wrists were converted to an arthrodesis for persistent pain. Loosening occurred in one further wrist at five years post-operatively. The remainder demonstrated close bone-implant contact. The clinical results were good, with markedly decreased Disabilities of the Arm Shoulder and Hand (DASH) and pain scores, and increased movement and grip strength. No patient used analgesics and most had returned to work. Good short-term function was achieved using this wrist arthroplasty in a high-demand group of patients with post-traumatic osteoarthritis.

  15. Rib cartilage graft for posttraumatic or degenerative arthritis at wrist level: 10-year results.

    Science.gov (United States)

    Obert, Laurent; Lepage, Daniel; Ferrier, Maxime; Tropet, Yves

    2013-08-01

    Background Posttraumatic arthritides of the radiocarpal joint, secondary to scaphoid nonunion advanced collapse (SNAC), scapholunate advanced collapse (SLAC), or Kienböck disease or in cases of intraarticularmalunion of the distal radius, are classically solved by some type of arthrodesis procedure. Osteochondral grafting provides a possible motion-sparing option that can diminish pain in the active patient. Description of Technique A chondrocostal graft harvested from the ninth rib was inserted and fixed with a plate in place of the articular defect in cases of a malunited intra-articular distal radius fracture (7 cases) or to replace the proximal pole of the scaphoid in cases of SNAC or SLAC (18 cases). In Kienböck disease, the graft was inserted as a free cartilage spacer (4 cases). Results Harvesting the graft from the ninth rib had minimal morbidity without pleural injury in the reported series. Graft union was achieved in all cases of fixation. No graft resorption or necrosis were observed on X-ray and magnetic resonance imaging (MRI) evaluation at the longest follow-up of 10 years. Histological analysis performed at the time of plate removal showed the vitality of the graft. Two thirds of the patients had excellent or good results using the Green and O'Brien score. Conclusions Reconstruction of a partially destroyed articular surface using a costal graft is reliable and provides an alternative option for resurfacing the articular surface with viable cartilage.

  16. Isolated extrahepatic bile duct rupture: a rare consequence of blunt abdominal trauma. Case report and review of the literature

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    Balzarotti Ruben

    2012-05-01

    Full Text Available Abstract A 16-year-old girl suffered blunt abdominal trauma. Clinically, a severe motor impairment with paraesthesia of the legs was found. Posterior osteosynthesis in T10-L1 with laminectomy in T10-T12 and posterolateral arthrodesis in T11-T12 was performed because of a dorsal traumatic vertebral fracture. On hospital day 7, because of an acute abdomen, surgical laparoscopic exploration showed sterile bloody fluid without any evident hemorrhagic injury. On hospital day 11, the patient was reoperated on by the laparoscopic approach for increasing abdominal pain and fever: a peritoneal biliary fluid was aspirated. After conversion to open surgery, cholecystectomy was performed. Intraoperative cholangiography was considered as normal. On arrival at our institution 13 days after injury, the patient was operated on for a biliary peritonitis. Intraoperatively, a trans-cystic cholangiography showed a biliary leakage of the common bile duct; a T-tube was placed into the common bile duct; a subhepatic drainage was placed too. On postoperative day 30, a T-tube cholangiography showed a normal biliary tree, without any leakage, and the T-tube was subsequently removed. The patient had a complete recovery.

  17. The DAIR (debridement, antibiotics and implant retention) procedure for infected total knee replacement – a literature review

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    Qasim, Sultan Naseer; Swann, Andrew; Ashford, Robert

    2017-01-01

    Prosthetic joint infection (PJI) is a devastating complication in total knee arthroplasty (TKA) and third most common cause of revision of TKA with significant morbidity and surgical challenges. Treatment options include non-operative measures with long term antibiotic suppression, debridement and implant retention (DAIR), one- or two-stage revision arthroplasty, arthrodesis and amputation. Implant retention without infection is ideal and DAIR has been reported to have variable success rates depending on patient factors, duration of infection, infecting micro-organisms, choice of procedure, single or multiple debridement procedures, arthroscopic or open, antibiotic choice and duration of antibiotic use. We present a thorough literature review of DAIR for infected TKA. The important factors contributing to failure are presence of sinus, immunocompromised patient, delay between onset of infection and debridement procedure, Staphylococcal infection in particular Meticillin Resistant Staphylococcal aureus, multiple debridement procedures, retention of exchangeable components and short antibiotic duration. In conclusion DAIR can be successful procedure to eradicate infection in TKA in selective patients with factors contributing to failure taken into account. PMID:28074774

  18. Spinal penetration index: new three-dimensional quantified reference for lordoscoliosis and other spinal deformities.

    Science.gov (United States)

    Dubousset, Jean; Wicart, Ph; Pomero, V; Barois, A; Estournet, B

    2003-01-01

    We studied and conceptually analyzed a retrospective case series of patients with airway compression due to an anterior vertebral body protrusion. The goal was to describe the pathology, methods of management, and a new concept for quantifying deformity. Case reports have been published on this pathology, but there has been no case series to date. In this study 18 patients with ages ranging from 7.3 to 18.0 years had thoracic lordoscoliosis due to a variety of etiologies; most ( n = 10) had a neuromuscular disorder. Following treatment, which most commonly was anterior subtotal subperiosteal vertebral body resection followed by posterior instrumentation and arthrodesis, atelectasia disappeared and any abnormal blood gases normalized; however, the effect on vital capacity was variable. Based on computed tomographic studies, the concept of the deformity as an endothoracic vertebral hump was developed and quantified. Study of this series of patients with compression of the airway due to vertebral body protrusion into the thorax provided the opportunity to describe treatment, define a new concept (the spinal penetration index), and make general recommendations about the management of both the endothoracic hump and the exothoracic rib hump.

  19. Doppler spectrum analysis: a potentially useful diagnostic tool for planning the treatment of patients with Charcot arthropathy of the foot?

    Science.gov (United States)

    Wu, T; Chen, P-Y; Chen, C-H; Wang, C-L

    2012-03-01

    It is difficult to determine the safe timing of weight-bearing or reconstructive surgery in patients with Charcot arthropathy of the foot and ankle. In this study the Doppler spectrum of the first dorsal metatarsal artery was used to monitor the activity of the disease activity and served as a guideline for management. A total of 15 patients (seven men and eight women) with acute diabetic Charcot arthropathy of the foot and ankle were immobilised in a non-weight-bearing cast. They were followed at two-week intervals and bilateral Doppler spectra of the first dorsal metatarsal arteries were obtained using a 10 MHz linear ultrasound probe. The patients were allowed to start weight-bearing or undergo surgery after the Doppler spectrum had returned to normal pattern. The Doppler spectra in the unaffected limbs were triphasic in pattern, whereas those in limbs with active Charcot arthropathy showed monophasic forward flow. They returned to normal after a mean of 13.6 weeks (6 to 20) of immobilisation. Three patients underwent pan-talar arthrodesis to correct gross instability and deformity. Doppler spectrum analysis of the foot may reflect the activity of the disease in patients with Charcot arthropathy, and may be used as a guide to begin weight-bearing or undergo reconstructive surgery.

  20. Minimally invasive surgery of diabetic foot – review of current techniques

    Science.gov (United States)

    I, Botezatu; D, Laptoiu

    2016-01-01

    The term diabetic foot is usually used to indicate advanced foot pathology (complex clinical situations correlating diabetic foot ulcers, diabetic foot infections, Charcot foot, and critical limb ischemia). The early recognition of the etiology of these foot lesions is essential for the therapeutic decision in order to achieve a good functional result. Several surgical procedures involving the foot have been developed in order to promote healing and avoid complications. Traditionally, surgery has been performed in an open way. The literature regarding the performance and efficacy of classical osteotomies and arthrodesis is inconsistent. This can be attributed to several variables, such as differences in patient clinical aspects and the panel of surgical techniques utilized. As with other surgical specialties, fluoroscopic imaging and minimally invasive tools are now being incorporated in these procedures. The use of high speed burrs associated with specialized osteosynthesis implants, offers several advantages over classical techniques. The ability to associate these gestures to complex protocols is beginning to be currently developed. The respect for the soft tissues is considered one of the first advantages. Despite the limited time since they were introduced in clinical practice, functional results seemed to be consistent, supporting the use of this technology. PMID:27974928

  1. Biomechanical and radiographic comparison of demineralized bone matrix, and a coralline hydroxyapatite in a rabbit spinal fusion model.

    Science.gov (United States)

    Dodds, Robert A; York-Ely, Amanda M; Zhukauskas, Rasa; Arola, Travis; Howell, John; Hartill, Caroline; Cobb, Ronald R; Fox, Casey

    2010-09-01

    The use of bone grafts is an essential component in spinal fusion. Autologous bone has been shown to result in long-term stable arthrodesis between spinal motion segments. However, autograft can be associated with significant morbidity and a limited supply. Alternatives, such as allogeneic demineralized bone matrix (DBM), are a potential source and supplement to autograft bone. The current study compares the ability of a DBM product (BioSet RT) and a coralline hydroxyapatite (Pro Osteon 500R), for inducing spinal fusion in a rabbit model. BioSet RT, alone or in combination with autograft, and Pro Osteon 500R were implanted in the posterior lateral inter-transverse process region of the rabbit spine. The spines were evaluated at 18 weeks for fusion of the L4-L5 transverse processes using a total of 33 skeletally mature male rabbits; 4 naïve animals were also included in the study. Samples were evaluated radiographically, histologically, by palpation, and through mechanical strength testing. Radiographical, histological, and palpation measurements demonstrated the ability of BioSet RT to induce new bone formation and bridging fusion comparable to autograft. This material performed well alone or in combination with autograft material. Despite significantly higher biomechanical testing results, minimal bone formation and fusion was recorded for the Pro Osteon 500R-treated group. This in vivo study demonstrates the ability of BioSet RT to induce new bone formation, and there was a clear relationship between bridging bone and mechanical strength.

  2. Sagittal curve and high metal density in adolescent idiopathic scoliosis

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    Fabio Araújo Fernandes

    2014-01-01

    Full Text Available Objectives: To analyze radiographically the postoperative kyphosis from patients undergoing surgical treatment for AIS with pedicle screws in all vertebrae included in the arthrodesis. Methods: Retrospective study. The following measurements were evaluated: Cobb angle in anteroposterior radiograph of the three curves (proximal thoracic, main thoracic, and lumbar, Cobb angle in the lateral view of the two curves: thoracic kyphosis (T5-T12 and lumbar lordosis (T12-S1. Results: Of the 25 patients evaluated preoperatively, four (16% were hypokyphotic, 20 patients (80% were normokyphotic and only one (4% was hyperkyphotic. For hypokyphotic and hiperkyphotic patients a satisfactory correction of thoracic kyphosis was obtained in 100% of cases, which was preserved in the final result. The same pattern of thoracic kyphosis was observed for all normokyphotic patients throughout the follow-up. Conclusion: Radiographic evaluation of thoracic kyphosis in patients with AIS treated surgically with pedicle screws in all vertebrae showed satisfactory results with respect to the correction of thoracic kyphosis.

  3. How Sublaminar Bands Affect Postoperative Sagittal Alignment in AIS Patients with Preoperative Hypokyphosis? Results of a Series of 34 Patients with 2-Year Follow-Up

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    Chalopin, Antoine; Peltier, Emilie; Choufani, Elie; Ollivier, Matthieu; Fuentes, Stéphane; Jouve, Jean-Luc

    2016-01-01

    Hypokyphosis is currently observed in thoracic idiopathic scoliosis. The use of sublaminar bands allows a good restoration of sagittal balance of the spine. The aim of the study was to provide a middle-term radiographic analysis of patients with adolescent idiopathic scoliosis with preoperative hypokyphosis treated by posterior arthrodesis with sublaminar bands. This retrospective study included 34 patients with Lenke 1 scoliosis associated with hypokyphosis (TK lumbar lordosis, and pelvic parameters were measured preoperatively, postoperatively, and at 6-month and 2-year follow-up. The mean preoperative thoracic kyphosis was 10.5° versus 24.1° postoperatively (p lumbar lordosis, preoperative measurement was 39.7° versus 41.3° postoperatively (p = 0.27). At 6-month follow-up, lumbar lordosis significantly increased to 43.6° (p = 0.03). All parameters were stable at final follow-up. Correction performed by sublaminar bands is efficient for both fontal and sagittal planes. Moreover, the restoration of normal thoracic kyphosis is followed by an adaptation of the adjacent curvatures with improved cervical lordosis and lumbar lordosis. PMID:27999791

  4. Results and complications of vertebrectomy with posterior approach after 2-year follow-up

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    Juliano Almeida e Silva

    2015-06-01

    Full Text Available OBJECTIVE: To describe the surgical technique for vertebrectomy by posterior single approach in the thoracic and thoracolumbar spine with circumferential reconstruction and arthrodesis, and evaluate retrospectively the results and complications after 2 years of follow-up in patients undergoing this technique.METHODS: Retrospective analysis of medical records and imaging studies of 12 patients with vertebrectomy indication for various pathologies, undergoing this surgical technique.RESULTS: Eight (66.67% patients were male and four patients (33.33% were females aged 13-66 years (mean 40 years. There were nine patients with involvement of the thoracic spine and three of the lumbar, and one patient with two consecutive vertebrae affected. All patients had improved or remained with the neurological condition. Surgical complications were two cases of hemothorax, two cases of loosening of the screws, one of them requiring surgical revision, and a case of material failure and pseudarthrosis.CONCLUSION: Vertebrectomy by posterior approach in thoracolumbar spine with circumferential reconstruction and fusion can be performed safely for a variety of indications.

  5. FUNCTIONAL DISABILITY, SAGITTAL ALIGNMENT AND PELVIC BALANCE IN LUMBAR SPONDYLOLISTHESIS

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    Luis Muñiz Luna

    2016-03-01

    Full Text Available ABSTRACT Objectives: To demonstrate the recovery of lumbar sagittal pelvic alignment and sagittal pelvic balance after surgical reduction of lumbar spondylolisthesis and establish the benefits of the surgery for reduction and fixation of the lumbar spondylolisthesis with 360o circumferential arthrodesis for 2 surgical approaches by clinical and functional evaluation. Method: Eight patients with lumbar spondylolisthesis treated with surgical reduction and fixation of listhesis and segmental circumferential fusion with two surgical approaches were reviewed. They were evaluated before and after treatment with Oswestry, Visual Analogue for pain and Odom scales, performing radiographic measurement of lumbar sagittal alignment and pelvic sagittal balance with the technique of pelvic radius. Results: Oswestry scales and EVA reported improvement of symptoms after treatment in 8 cases; the Odom scale had six outstanding cases reported. The lumbar sagittal alignment presented a lumbosacral lordosis angle and a lumbopelvic lordosis angle reduced in 4 cases and increased in 4 other cases; pelvic sagittal balance increased the pelvic angle in 4 cases and decreased in 3 cases and the sacral translation of the hip axis to the promontory increased in 6 cases. Conclusion: The surgical procedure evaluated proved to be useful by modifying the lumbar sagittal alignment and the pelvic balance, besides reducing the symptoms, enabling the patient to have mobility and movement and the consequent satisfaction with the surgery.

  6. Minimally Invasive Transforaminal Lumbar Interbody Fusion: A Perspective on Current Evidence and Clinical Knowledge

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    Ali Habib

    2012-01-01

    Full Text Available This paper reviews the current published data regarding open transforaminal lumbar interbody fusion (TLIF in relation to minimally invasive transforaminal lumbar interbody fusion (MI-TLIF. Introduction. MI-TLIF, a modern method for lumbar interbody arthrodesis, has allowed for a minimally invasive method to treat degenerative spinal pathologies. Currently, there is limited literature that compares TLIF directly to MI-TLIF. Thus, we seek to discuss the current literature on these techniques. Methods. Using a PubMed search, we reviewed recent publications of open and MI-TLIF, dating from 2002 to 2012. We discussed these studies and their findings in this paper, focusing on patient-reported outcomes as well as complications. Results. Data found in 14 articles of the literature was analyzed. Using these reports, we found mean follow-up was 20 months. The mean patient study size was 52. Seven of the articles directly compared outcomes of open TLIF with MI-TLIF, such as mean duration of surgery, length of post-operative stay, blood loss, and complications. Conclusion. Although high-class data comparing these two techniques is lacking, the current evidence supports MI-TLIF with outcomes comparable to that of the traditional, open technique. Further prospective, randomized studies will help to further our understanding of this minimally invasive technique.

  7. Flexible Stabilisation of the Degenerative Lumbar Spine Using PEEK Rods

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    Jacques Benezech

    2016-01-01

    Full Text Available Posterior lumbar interbody fusion using cages, titanium rods, and pedicle screws is considered today as the gold standard of surgical treatment of lumbar degenerative disease and has produced satisfying long-term fusion rates. However this rigid material could change the physiological distribution of load at the instrumental and adjacent segments, a main cause of implant failure and adjacent segment disease, responsible for a high rate of further surgery in the following years. More recently, semirigid instrumentation systems using rods made of polyetheretherketone (PEEK have been introduced. This clinical study of 21 patients focuses on the clinical and radiological outcomes of patients with lumbar degenerative disease treated with Initial VEOS PEEK®-Optima system (Innov’Spine, France composed of rods made from PEEK-OPTIMA® polymer (Invibio Biomaterial Solutions, UK without arthrodesis. With an average follow-up of 2 years and half, the chances of reoperation were significantly reduced (4.8%, quality of life was improved (ODI = 16%, and the adjacent disc was preserved in more than 70% of cases. Based on these results, combined with the biomechanical and clinical data already published, PEEK rods systems can be considered as a safe and effective alternative solution to rigid ones.

  8. Early Identification of Traumatic Durotomy Associated with Atlantooccipital Dislocation May Prevent Retropharyngeal Pseudomeningocele Development

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    Robert S. Qiu

    2015-01-01

    Full Text Available Atlantooccipital dislocation can be complicated by a traumatic durotomy that may lead to the rare development of a retropharyngeal pseudomeningocele. To our knowledge this has been reported only five times previously. We present the case of a 60-year-old man involved in a motor vehicle accident who suffered an atlantooccipital dislocation and C5-C6 three-column injury. A unique MRI image of a defect in the ventral dura posterior to C2 was appreciated. He underwent occiput to T2 internal fixation and arthrodesis. During surgery, CSF egress was seen caudal to the right C2 nerve root. A DuraMatrix onlay patch reinforced with DuraSeal was placed to stop the CSF leak. A lumbar subarachnoid drain was also placed. The patient made a satisfactory recovery with residual mild weakness of his right upper extremity. In this report, we demonstrate that careful MRI review can reveal a ventral durotomy in a traumatic atlantooccipital dislocation and, if discovered, effective treatment including a lumbar subarachnoid drain for CSF diversion may prevent progression to a retropharyngeal pseudomeningocele. The literature on this rare presentation and associated durotomy is provided.

  9. Minimally Invasive Sacroiliac Joint Fusion: One-Year Outcomes in 40 Patients

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    Donald Sachs

    2013-01-01

    Full Text Available Background. SI joint pain is difficult to diagnose due to overlapping symptoms of the lumbar spine, and until recently, treatment options have been limited. The purpose of this retrospective study is to report on the safety and effectiveness of MIS SI joint arthrodesis using a series of triangular, porous plasma coated implants in patients refractory to conservative care. Methods. We report on the first 40 consecutive patients with one-year follow-up data that underwent MIS SI joint fusion with the iFuse Implant System (SI-BONE, Inc., San Jose, CA by a single surgeon. Medical charts were reviewed for demographics, perioperative metrics, complications, pain scores, and satisfaction. Results. Mean age was 58 years (range 30–81 and 75% of patients were female. Postoperative complications were minimal and included transient trochanteric bursitis (5%, facet joint pain (20%, and new low back pain (2.5%. There were no reoperations at one year. Mean pain score improved from 8.7 (1.5 SD at baseline to 0.9 (1.6 at 12 months, a 7.8-point improvement (P<.001. Patient satisfaction was very high. Conclusions. The results of this case series reveal that MIS SI joint fusion using the iFuse Implant System is a safe and effective treatment option in carefully selected patients.

  10. Quantitative morphometric analysis of the lumbar vertebral facets and evaluation of feasibility of lumbar spinal nerve root and spinal canal decompression using the Goel intraarticular facetal spacer distraction technique: A lumbar/cervical facet comparison

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    Savni R Satoskar

    2014-01-01

    Full Text Available Objective : The authors evaluate the anatomic subtleties of lumbar facets and assess the feasibility and effectiveness of use of ′Goel facet spacer′ in the treatment of degenerative spinal canal stenosis. Materials and Methods : Twenty-five lumbar vertebral cadaveric dried bones were used for the purpose. A number of morphometric parameters were evaluated both before and after the introduction of Goel facet spacers within the confines of the facet joint. Results : The spacers achieved distraction of facets that was more pronounced in the vertical perspective. Introduction of spacers on both sides resulted in an increase in the intervertebral foraminal height and a circumferential increase in the spinal canal dimensions. Additionally, there was an increase in the disc space or intervertebral body height. The lumbar facets are more vertically and anteroposteriorly oriented when compared to cervical facets that are obliquely and transversely oriented. Conclusions : Understanding the anatomical peculiarities of the lumbar and cervical facets can lead to an optimum utilization of the potential of Goel facet distraction arthrodesis technique in the treatment of spinal degenerative canal stenosis.

  11. Decisive factor in increase of loading at adjacent segments after lumbar fusion: operative technique, pedicle screws, or fusion itself: biomechanical analysis using finite element

    Science.gov (United States)

    Park, Joon-Hee; Kim, Ho-Joong; Kang, Kyoung-Tak; Kim, Ka-yeon; Chun, Heoung-Jae; Moon, Seong-Hwan; Lee, Hwan-Mo

    2010-03-01

    The aim of this study is to investigate the change in biomechanical milieu following removal of pedicle screws or removal of spinous process with posterior ligament complex in instrumented single level lumbar arthrodesis. We developed and validated a finite element model (FEM) of the intact lumbar spine (L2-4). Four scenarios of L3-4 lumbar fusion were simulated: posterolateral fusion (PLF) at L3-4 using pedicle screw system with preservation of PLC (Pp WiP), L3-4 lumbar posterolateral fusion state after removal of pedicle screw system with preservation of PLC (Pp WoP), L3-4 using pedicle screw system without preservation PLC (Sp WiP), L3-4 lumbar posterolateral fusion state after removal of pedicle screw system without preservation of PLC (Sp WoP). For these models, we investigated the range of motion and maximal Von mises stress of disc in all segments under various moments. All fusion models demonstrated increase in range of motion at adjacent segments compared to the intact model.For the four fusion models, the WiP model s P had the largest increase in range of motion at each adjacent segment. This study demonstrated that removal of pedicle screw system and preservation of PLC after complete lumbar spinal fusion could reduce the stress of adjacent segments synergistically and might have beneficial effects in preventing ASD.

  12. Lumbopelvic fixation: a surgical alternative for lumbar stability

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    Gabriel Virgilio Ortiz García

    2014-09-01

    Full Text Available OBJECTIVE: Lumbopelvic fixation is a valid surgical option to achieving great stability in cases where it is particularly demanded, such as in patients with poor quality bone, degenerative scoliosis, and revision surgeries with modern materials and techniques. It enables simple integration of the iliopelvic systems with the rest of the spinal structure, maintaining hemorrhagia at acceptable levels, as well as surgery time. METHODS: We analyzed a case series of 15 patients of our center, who required major construction and/or presented poor quality bone. RESULTS: A total of 15 patients was studied, of which 12 (80% were women and three (20%, men. Nine (60% of these were revision surgeries, maintaining a surgery time of 5 hours (±1 h, with average blood loss of 1380 ml (±178 ml. All the patients received six to eight transpedicular screws, including iliac screws, and in all cases, a bone graft was inserted. CONCLUSION: Lumbopelvic fixation in patients with characteristics associated with osteopenia and osteoporosis, and in major instrumentations, particularly revision surgeries, three-dimensional correction is achieved, constructing a strong, stable pelvic base that is very useful, in patients with fragile surgical anatomy, for changes of implant or extensive decompression, provided the arthrodesis technique is adequate and with the insertion of a sufficient bone graft, and obviously, taking care to maintain the sagittal balance.

  13. Pyogenic sacroiliitis: diagnosis, management and clinical outcome

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    Kucera, Tomas; Sponer, Pavel [Charles University in Prague, Faculty of Medicine and University Hospital in Hradec Kralove, Department of Orthopaedic Surgery, Hradec Kralove (Czech Republic); Brtkova, Jindra [Charles University in Prague, Faculty of Medicine and University Hospital in Hradec Kralove, Department of Diagnostic Radiology, Hradec Kralove (Czech Republic); Ryskova, Lenka [Charles University in Prague, Faculty of Medicine and University Hospital in Hradec Kralove, Department of Clinical Microbiology, Hradec Kralove (Czech Republic); Popper, Eduard [Charles University in Prague, Faculty of Medicine and University Hospital in Hradec Kralove, Department of Rehabilitation, Hradec Kralove (Czech Republic); Frank, Martin [Charles University in Prague, Faculty of Medicine and University Hospital in Hradec Kralove, Department of Surgery, Hradec Kralove (Czech Republic); Kucerova, Marie [Regional Hospital in Pardubice, Department of Neurosurgery, Hradec Kralove (Czech Republic)

    2015-01-15

    The purpose of the present study was to evaluate the role of diagnostic tools and management options for patients with pyogenic sacroiliitis, including potential complications. This retrospective study included 16 patients with pyogenic sacroiliitis who were admitted to a single orthopaedic centre between 2007 and 2012. The following data were collected: demographics, history, radiography, magnetic resonance images (MRI), biological data, type of pathogenic agent, abscess formation, type of management, and clinical outcome. Our study demonstrated that only one-fifth of the patients with lumbogluteal or hip pain had established diagnoses of suspected pyogenic sacroiliitis upon admission. MRIs confirmed this diagnosis in all cases. MRI examinations revealed joint fluid in the sacroiliac joint and significant oedema of the adjacent bone and soft tissues. In 12 of the 16 cases, erosions of the subchondral bone were encountered. Contrast-enhanced MRI revealed that 9 patients had abscesses. All patients received antibiotic therapy. Antibiotic treatment was only successful in 9 cases. The other 7 patients underwent computed tomography (CT)-guided abscess drainage. Drainage was sufficient for 4 patients, but 3 patients required open surgery. One patient required sacroiliac arthrodesis. The clinical outcomes included minimal disability (n = 10), moderate disability (n = 5), and full disability (n = 1) of the spine. Contrast-enhanced MRI is mandatory for a reliable diagnosis. Abscess formation was observed in approximately half of the MRI-diagnosed sacroiliitis cases and required minimally invasive drainage under CT guidance or frequently open surgery. (orig.)

  14. Simultaneous anterior and posterior screw fixations confined to the axis for stabilization of a 3-part fracture of the axis (odontoid, dens, and hangman fractures): report of 2 cases.

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    Shinbo, Jun; Sameda, Hiroaki; Ikenoue, Sumio; Takase, Kan; Yamaguchi, Takeshi; Hashimoto, Eiko; Enomoto, Takahiro; Kanazuka, Aya; Mimura, Masaya

    2014-03-01

    Fractures of the axis are considered to be one of the most common injuries to the cervical spine, accounting for more than 20% of all cervical spine fractures. Multiple fractures of the axis are much rarer, accounting for 1% of all cervical fractures. Management of such complex fractures is still challenging, and there is no strong consensus for the treatment. The authors describe the cases of 2 patients who presented with 3-part fractures of the axis consisting of an odontoid Type II fracture and a Levine-Edwards Type IA fracture, which were treated with concurrent insertion of an anterior odontoid screw and bilateral posterior pedicle screws. The cases presented were characterized by 1) a Type II odontoid fracture; 2) a Type IA traumatic spondylolisthesis with no or a little translation and angulation of C-2 on C-3 in a ring fracture of the axis; and 3) no disorders at the C2-3 disc on MR images. Therefore, the authors performed surgery confined to the axis by concurrently inserting an anterior odontoid screw and posterior bilateral pedicle screws without arthrodesis of C2-3. This was followed with cervical soft collar fixation for only 1-2 weeks. The outcomes were favorable, including good osteosynthesis, high primary stability, early patient mobilization, and preserved range of motion of the cervical spine at C2-3 as well as at C1-2.

  15. The pediculated gastrocnemius muscle flap as a treatment for soft tissue problems of the knee – indication, placement and results

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    Moebius, Boris

    2012-01-01

    Full Text Available With the increase of endoprosthetic knee replacements, there is also an increase of critical wounds to the knee due to a high incidence of soft tissue problems (ranging from wound healing defects to severe wound infections. The literature describes a general rate of soft tissue complications of up to 20% [1], [2], with 5% [3] involving exposed bone. These complications are an increasingly important problem for surgeons. Since sufficient coverage of bones, tendons and prosthetic material with soft tissue is a necessity, the use of a pediculated muscle flap is the only solution in some cases. The gastrocnemius muscle is very useful for this purpose. It is an elaborate procedure which is associated with a high rate of complications. However, this procedure can establish a secure coverage with soft tissue, and the function of the prosthesis and the patient’s extremity can be saved. We have treated 23 patients with a gastrocnemius rotation flap after knee prosthesis or knee arthrodesis infection with consecutive soft tissue damage at our hospital from 8/2004 through 3/2011. The overall rate of healing of the knee infections with stable soft tissue status is almost 87%. The revision rate with lifting of the flap and revision of the sutures at the point of insertion as well as the point of extraction was about 35% with long-term conservative or additional surgical treatments.

  16. Ilizarov method as limb salvage in treatment of massive femoral defect after unsuccessful tumor arthroplasty

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    Radunović Aleksandar

    2016-01-01

    Full Text Available Introduction. Surgical management of massive bone defects is very challenging in terms of estimating possibilities of saving the extremity and adequate method that can make it possible. Selection of methods is additionally limited in the presence of infection at site of defect. Case report. The female patient, diagnosed with Ewing sarcoma was treated by segmental bone resection and implantation of Kotz modular tumor endoprosthesis. After 5 years the signs of infection occured and persisted with low grade intensity. After falling, 12 years following implantation, the patient acquired periprosthetic fracture. Then endoprosthesis was removed, all along with surgical debridement of wound and application of the Ilizarov apparatus. The apparatus was applied, osteotomy of callus and the tibia performed with transport of bone segments, untill reconstruction of defect and arthrodesis of the knee was achieved. Conclusion. The Ilizarov apparatus offered us huge possibilities for management of massive bone defects with natural bone which has superior biomechanical characteristics comparing to the implant. The most frequent complication of this method is a prolonged treatment period that demands good patient selection and preparation and wide surgical experience.

  17. 手术治疗成人足舟骨缺血性坏死的临床分析%Surgical treatment for Müller-Weiss disease

    Institute of Scientific and Technical Information of China (English)

    赵良军; 劳山; 赵劲民; 薄占东; 花奇凯; 罗高斌

    2015-01-01

    目的 探讨手术治疗成人足舟骨缺血性坏死的手术方式和疗效. 方法 对2008年12月至2013年12月采用舟骨关节植骨融合内固定手术治疗的9例成人舟骨缺血性坏死患者的临床资料进行回顾性分析,男2例,女7例;年龄32 ~ 60岁,平均42岁;按Maceira分期:Ⅱ期1例,Ⅲ期4例,Ⅳ期3例,Ⅴ期1例;6例行距舟-舟楔关节融合术,2例行单纯距舟关节融合术,1例行三关节融合术.结果 9例患者术后获12 ~ 18个月(平均15.8个月)随访,患足疼痛及间歇性跛行等症状消失,患足均获骨性融合,融合时间12 ~ 17周(平均14.6周);术后1年美国足踝外科协会的踝-后足评分为80分,其中优1例,良7例,可1例.术后1年患足的足长度[(15.5±0.8) cm]、足弓高度[(18.6±0.9) mm]、内侧纵弓顶角(119.2°±6.4°)分别与术前[(14.3±0.9) cm、(10.2±0.7) mm、136.5°±7.8°]比较,差异均有统计学意义(P<0.05). 结论 对于成人足舟骨缺血性坏死的治疗,根据术前及术中评估舟骨及相关联的关节病变累及程度选择合适的手术方式,可以取得满意疗效.%Objective To evaluate surgical treatment of Müller-Weiss disease.Methods From December 2008 to December 2013,9 cases of Müller-Weiss disease were treated at our department with arthrodesis of the scaphoid joint and internal fixation.They were 2 males and 7 females,32 to 60 years of age (average,42 years).According to the Maceira classification,there were one case of phase 2,4 cases of phase 3,3 cases of phase 4,and one case of phase 5.Six cases received arthrodesis of the talo-naviculo-cuneiform joints,2 cases arthrodesis of the talonavicular joint and one case triple arthrodesis.Results The 9 patients were followed up for 12 to 18 months (average,15.8 months).Pain and intermittent claudication disappeared in all the patients.The bony fusion was achieved in all the affected feet after 12 to 17 months (average,14.6 months).The American Orthopaedic Foot and Ankle

  18. Conversion arthroplasty of the hip: mid-term results are good.

    Science.gov (United States)

    Zahar, Akos; Cross, Michael B; Lakatos, Tamas; Lakatos, Jozsef; Major, Balint; Kendoff, Daniel; Szendröi, Miklos

    2015-01-01

    The historical mid-term results of conversion total hip arthroplasty (THA) are acceptable; however, the complication rates are high. In total, 39 patients (45 hips) from 2 institutions underwent conversion THA from 1993-2006 and were retrospectively evaluated. The mean age was 48.3 years, the mean follow-up time was 8.7 years, and the mean duration arthrodesis prior to conversion THA was 18.2 years. The outcomes included operative time, blood loss, leg-length discrepancy (LLD), thigh circumference, Harris Hip Score (HHS), complications, and radiographic evaluation. A total of 34 THAs were cemented, and 11 were uncemented. The mean operative time was 102 minutes, and the mean blood loss was 1019 ml. The mean HHS improved from 32.4 to 82.5 (pTrendelenburg gait (6), early haematoma that required surgical evacuation (5), dislocation (2), deep infection (1), and early aseptic loosening of the components (2). In conclusion, the functional results of the conversion THA using predominantly cemented components are good at mid-term follow-up; although the complication rates remain higher than a standard primary THA, aseptic loosening rates of the cemented components is low at mid-term follow-up.

  19. Massive bone loss from fungal infection after anterior cruciate ligament arthroscopic reconstruction.

    Science.gov (United States)

    Muscolo, D Luis; Carbo, Lisandro; Aponte-Tinao, Luis A; Ayerza, Miguel A; Makino, Arturo

    2009-09-01

    Although there are numerous reports of septic pyogenic arthritis after arthroscopic anterior cruciate ligament (ACL) reconstruction, there is limited information regarding the outcomes of fungal infection. We determined the outcomes of six patients with mycotic infection after regular ACL reconstruction. There were four males and two females with a mean age of 33 years. We determined the number of procedures performed, bone loss originating to control infection, and final reconstruction in these patients. An average of five arthroscopic lavage procedures had been performed at the referring centers. Fungal infection was diagnosed based on pathologic samples; five infections were the result of mucormycosis and one was Candida. After final débridement, the mean segmental bone loss was 12.8 cm. All patients were treated with intravenous antifungal coverage and cement spacers before final reconstruction. At final followup, all patients were free of clinical infection. Three had reconstruction with an allograft-prosthesis composite, two with hemicylindrical allografts, and one with an intercalary allograft arthrodesis. Despite the extremely unusual presentation of this complication, surgeons should be aware of potential and catastrophic consequences of this severe complication after ACL reconstruction.

  20. Management of idiopathic and nonidiopathic flatfoot.

    Science.gov (United States)

    Frances, Jenny M; Feldman, David S

    2015-01-01

    Flatfoot in a child may be normal before development of the arch, but the prevalence decreases with age. Treatment is indicated only in the presence of pain and should begin with nonsurgical management options such as stretching of the Achilles tendon and the use of soft shoe orthotics. If pain persists, a modified Evans procedure, together with additional procedures to address forefoot supination, can be successful in correcting deformity and addressing pain. A thorough understanding of the pathology and correction desired will help minimize complications and recurrence. If neuromuscular pathology is present, treatment principles are altered and greatly depend on the severity of the deformity, the association of tibialis posterior spasticity, and ambulatory status. In mild to moderate pathology in walking patients with cerebral palsy, osteotomies can be successful. Various forms of arthrodesis can decrease recurrence when the deformity is severe in a nonambulatory patient with cerebral palsy and a symptomatic valgus foot deformity. In cases of collagen disorders, where soft-tissue laxity complicates management, deformity correction may be of higher importance. Overall alignment always should be evaluated and corrected when necessary to optimize the outcome in patients with valgus foot deformities. The successful treatment of flexible or rigid flatfoot deformity must take into account underlying pathology to optimize outcomes.

  1. Assessment of spontaneous correction of lumbar curve after fusion of the main thoracic in Lenke 1 adolescent idiopathic scoliosis☆

    Science.gov (United States)

    Mizusaki, Danilo; Gotfryd, Alberto Ofenhejm

    2016-01-01

    Objective To evaluate the clinical and radiographic response of the lumbar curve after fusion of the main thoracic, in patients with adolescent idiopathic scoliosis of Lenke type 1. Methods Forty-two patients with Lenke 1 adolescent idiopathic scoliosis who underwent operations via the posterior route with pedicle screws were prospectively evaluated. Clinical measurements (size of the hump and translation of the trunk in the coronal plane, by means of a plumb line) and radiographic measurements (Cobb angle, distal level of arthrodesis, translation of the lumbar apical vertebral and Risser) were made. The evaluations were performed preoperatively, immediately postoperatively and two years after surgery. Results The mean Cobb angle of the main thoracic curve was found to have been corrected by 68.9% and the lumbar curve by 57.1%. Eighty percent of the patients presented improved coronal trunk balance two years after surgery. In four patients, worsening of the plumb line measurements was observed, but there was no need for surgical intervention. Less satisfactory results were observed in patients with lumbar modifier B. Conclusions In Lenke 1 patients, fusion of the thoracic curve alone provided spontaneous correction of the lumbar curve and led to trunk balance. Less satisfactory results were observed in curves with lumbar modifier B, and this may be related to overcorrection of the main thoracic curve. PMID:26962505

  2. Assessment of spontaneous correction of lumbar curve after fusion of the main thoracic vertebrae in Lenke 1 adolescent idiopathic scoliosis

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    Danilo Mizusaki

    2016-02-01

    Full Text Available ABSTRACT OBJECTIVE: To evaluate the clinical and radiographic response of the lumbar curve after fusion of the main thoracic vertebrae, in patients with adolescent idiopathic scoliosis of Lenke type 1. METHODS: Forty-two patients with Lenke 1 adolescent idiopathic scoliosis who underwent operations via the posterior route with pedicle screws were prospectively evaluated. Clinical measurements (size of the hump and translation of the trunk in the coronal plane, by means of a plumb line and radiographic measurements (Cobb angle, distal level of arthrodesis, translation of the lumbar apical vertebral and Risser were made. The evaluations were performed preoperatively, immediately postoperatively and two years after surgery. RESULTS: The mean Cobb angle of the main thoracic curve was found to have been corrected by 68.9% and the lumbar curve by 57.1%. Eighty percent of the patients presented improved coronal trunk balance two years after surgery. In four patients, worsening of the plumb line measurements was observed, but there was no need for surgical intervention. Less satisfactory results were observed in patients with lumbar modifier B. CONCLUSIONS: In Lenke 1 patients, fusion of the thoracic curve alone provided spontaneous correction of the lumbar curve and compensation of the trunk. Less satisfactory results were observed in curves with lumbar modifier B, and this may be related to overcorrection of the main thoracic curve.

  3. Pediatric Pes Planus: A State-of-the-Art Review.

    Science.gov (United States)

    Carr, James B; Yang, Scott; Lather, Leigh Ann

    2016-03-01

    Flatfoot (pes planus) is common in infants and children and often resolves by adolescence. Thus, flatfoot is described as physiologic because it is usually flexible, painless, and of no functional consequence. In rare instances, flatfoot can become painful or rigid, which may be a sign of underlying foot pathology, including arthritis or tarsal coalition. Despite its prevalence, there is no standard definition for pediatric flatfoot. Furthermore, there are no large, prospective studies that compare the natural history of idiopathic, flexible flat feet throughout development in response to various treatments. The available literature does not elucidate which patients are at risk for developing pain and disability as young adults. Current evidence suggests that it is safe and appropriate to simply observe an asymptomatic child with flat feet. Painful flexible flatfoot may benefit from orthopedic intervention, such as physical therapy, bracing, or even a surgical procedure. Orthotics, although generally unproven to alter the course of flexible flatfoot, may provide relief of pain when present. Surgical procedures include Achilles tendon lengthening, bone-cutting procedures that rearrange the alignment of the foot (osteotomies), fusion of joints (arthrodesis), or insertion of a silicone or metal cap into the sinus tarsi to establish a medial foot arch (arthroereisis). It is important for a general pediatrician to know when a referral to an orthopedic specialist is indicated and which treatments may be offered to the patient. Updated awareness of the current evidence regarding pediatric flatfoot helps the provider confidently and appropriately counsel patients and families.

  4. Development and treatment of spinal deformity in patients with cerebral palsy

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    Tsirikos Athanasios

    2010-01-01

    Full Text Available Scoliosis is a common deformity in children and adolescents with cerebral palsy. This is usually associated with pelvic obliquity due to extension of the curve to the sacrum. Sagittal plane deformity is less common and often develops along with scoliosis. Spinal deformity in patients with severe neurological handicaps can affect their ability to sit and cause significant back pain or pain due to rib impingement against the elevated side of the pelvis on the concavity of the curvature. Surgical correction followed by spinal arthrodesis is indicated in patients with progressive deformities which interfere with their level of function and quality of life. Spinal deformity correction is a major task in children with multiple medical co-morbidities and can be associated with a high risk of complications including death. A well-coordinated multidisciplinary approach is required in the assessment and treatment of this group of patients with the aim to minimize the complication rate and secure a satisfactory surgical outcome. Good knowledge of the surgical and instrumentation techniques, as well as the principles of management is needed to achieve optimum correction of the deformity and balancing of the spine and pelvis. Spinal fusion has a well-documented positive impact even in children with quadriplegia or total body involvement and is the only surgical procedure which has such a high satisfaction rate among parents and caregivers.

  5. Human Mesenchymal Stem Cell Morphology and Migration on Micro-Textured Titanium

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    Brittany eBanik

    2016-05-01

    Full Text Available The implant used in spinal fusion procedures is an essential component to achieving successful arthrodesis. At the cellular level, the implant impacts healing and fusion through a series of steps: first, mesenchymal stem cells (MSCs need to adhere and proliferate to cover the implant; second, the MSCs must differentiate into osteoblasts; third, the osteoid matrix produced by the osteoblasts needs to generate new bone tissue, thoroughly integrating the implant with the vertebrate above and below. Previous research has demonstrated that micro-textured titanium is advantageous over smooth titanium and PEEK implants for both promoting osteogenic differentiation and integrating with host bone tissue; however, no investigation to date has examined the early morphology and migration of MSCs on these surfaces. This study details cell spreading and morphology changes over 24 hours, rate and directionality of migration 6 to 18 hours post seeding, differentiation markers at 10 days, and the long term morphology of MSCs at 7 days, on micro-textured, acid-etched titanium (Endoskeleton, smooth titanium, and smooth PEEK surfaces. The results demonstrate in all metrics, the two titanium surfaces outperformed the PEEK surface. Furthermore, the rough acid-etched titanium surface presented the most favorable overall results, demonstrating the random migration needed to efficiently cover a surface in addition to morphologies consistent with osteoblasts and preosteoblasts.

  6. Post-traumatic instability of the metacarpophalangeal joint of the thumb.

    Science.gov (United States)

    Smith, R J

    1977-01-01

    Of eithty-six patients with collateral ligament instability of the metacarpophalangeal joint of the thumb, sixty-six (77 per cent) had ulnar and twenty (23 per cent) had radial instability, while in addition twenty-four had fractures and twenty-nine had volar subluxation of the proximal phalanx. Of the sixty-nine patients operated on, sixty-five had an abnormality of the ulnar or radial collateral ligament proper or of its attachment; two, subluxation of the extensor pollicis longus; and two, stretching of the adductor expansion. Stability was restored by collateral ligament repair or reconstruction, by fixation of a fracture fragment with a Kirschner wire, or by arthrodesis in all but five thumbs. Of the five patients who did not have stability of the metacarpophalangeal joint following surgery, three had had the collateral ligament sutured more than three weeks after injury and two had had reconstruction of the collateral ligament using a tendon graft. Early surgical treatment is recommended for all patients with post-traumatic instability of the metacarpophalangeal joint greater than 45 degrees and for those with volar subluxation of the proximal phalanx or a displaced fracture of the base of the proximal phalanx. Collateral ligament repair is indicated for patients operated on within three weeks of injury, and reconstruction of the ligament by means of a tendon graft is recommended for those treated more than three weeks after injury.

  7. Trapezium excision and suture suspensionplasty (TESS) for the treatment of thumb carpometacarpal arthritis.

    Science.gov (United States)

    Putnam, Matthew D; Meyer, Nicholas J; Baker, Daniel; Brehmer, Jess; Carlson, Brent D

    2014-06-01

    Basilar thumb arthritis, or first carpometacarpal arthritis, is a common condition affecting older women and some men. It is estimated that as many as one third of postmenopausal woman are affected. Surgical treatment of this condition includes options ranging from arthrodesis to prosthetic arthroplasty. Intermediate options include complete or partial trapezial excision with or without interposition of a cushioning/stabilizing material (auto source, allo source, synthetic source). A multitude of methods appear to offer similar end results, although some methods definitely involve more surgical work and perhaps greater patient risk. Through retrospective evaluation of a cohort of patients who underwent suture suspensionplasty, we determined the postoperative effect on strength, motion, patient satisfaction, complications, and radiographic maintenance of the scaphoid-metacarpal distance. This review shows the method to be clinically effective and, by comparison with a more traditional ligament reconstruction trapezial interposition arthroplasty, the method does not require use of autograft or allograft tendon and has fewer surgical steps. Forty-four patients were included in this retrospective study. The results showed that 91% of patients were satisfied with the procedure. Pinch and grip strength remained the same preoperatively and postoperatively. A Disabilities of the Arm, Shoulder, and Hand patient-reported outcome instrument (DASH) scores averaged 30 at final follow-up. Three patients developed a late complication requiring further surgical intervention. In summary, this technique appears to be technically reproducible, requires no additional tendon material, and achieves objectively and subjectively similar results to other reported procedures used to manage first CMC Arthritis.

  8. Pelvic instability after bone graft harvesting from posterior iliac crest: report of nine patients

    Energy Technology Data Exchange (ETDEWEB)

    Chan, K.; Pathria, M.; Jacobson, J. [Dept. of Radiology, Univ. of California, San Diego, CA (United States); Resnick, D. [Dept. of Radiology, Veterans Affairs Medical Center, San Diego, CA (United States)

    2001-05-01

    Objective. To report the imaging findings in nine patients who developed pelvic instability after bone graft harvest from the posterior aspect of the iliac crest.Design and patients. A retrospective study was performed of the imaging studies of nine patients who developed pelvic pain after autologous bone graft was harvested from the posterior aspect of the ilium for spinal arthrodesis. Plain films, bone scans, and CT and MR examinations of the pelvis were reviewed. Pertinent aspects of the clinical history of these patients were noted, including age, gender and clinical symptoms.Results. The age of the patients ranged from 52 to 77 years (average 69 years) and all were women. The bone graft had been derived from the posterior aspect of the iliac crest about the sacroiliac joint. All patients subsequently developed subluxation of the pubic symphysis. Eight patients had additional insufficiency fractures of the iliac crest adjacent to the bone graft donor site, and five patients also revealed subluxation of the sacroiliac joint. Two had insufficiency fractures of the sacrum and one had an additional fracture of the pubic ramus.Conclusions. Pelvic instability is a potential complication of bone graft harvesting from the posterior aspect of the iliac crest. The pelvic instability is manifested by insufficiency fractures of the ilium and subluxation of the sacroiliac joints and pubic symphysis. (orig.)

  9. Current Concepts in the Management of Rheumatoid Hand

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    Umile Giuseppe Longo

    2015-01-01

    Full Text Available Rheumatoid arthritis (RA is a chronic inflammatory disease caused by a T cell-driven autoimmune process, which majorly involves the diarthrodial joints. It affects 1% of the US population, and approximately 70% of patients with RA develop pathologies of the hand, especially of the metacarpophalangeal joints (MCP. Furthermore, also the extensor and flexor tendons of the fingers are frequently involved. The first line of treatment should be conservative. Three general classes of drugs are currently available for RA: nonsteroidal anti-inflammatory agents (NSAIDs, corticosteroids, and disease modifying antirheumatic drugs (DMARDs. Encouraging results have been obtained using DMARDs. However, when severe deformities occur or when patients are unresponsive to medical management and injections therapy, surgical intervention should be performed to relieve pain and restore function. Several surgical options have been described for the management of MCP joint deformities, including soft tissue procedures, arthrodesis, and prosthetic replacement. Tendons ruptures are generally managed with tendon transfer surgery, while different surgical procedures are available to treat fingers deformities. The aim of the present review is to report the current knowledge in the management of MCP joint deformities, as well as tendons damage and fingers deformities, in patients with RA.

  10. Tratamento da instabilidade lombar com parafusos pediculares Treatment of lumbar instability with pedicular screws

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    Osmar Avanzi

    2005-01-01

    posterior vertebral arthrodesis treatment by using melttalic fixation with pedicular screws. METHODS: Data from medical records of the Service of Medical Files (S.A.M.E of the Irmandade da Santa Casa de Misericórdia de São Paulo and evaluation through single radiographs (front, lateral, and oblique sections for image studies besides a pre- and postoperative functional evaluation, with minimal follow-up of two years. RESULTS: From November 1995 to June 2000 ten patients with degenerative lumbar unstableness (48%, five patients with isthmic spondylolisthesis (23% and six with degenerative lumbar stenosis (29% were evaluated. As for functional evaluation, excellent and good results were obtained in 76%. Complications included superficial infection, pseudoarthrosis, and inappropriate positioning of screws (19%. CONCLUSIONS: The authors conclude that this fixation method is effective with arthrodesis fusion seen in 95% of patients.

  11. Surgical treatment of lumbar spinal canal stenosis%腰椎椎管狭窄症的外科治疗

    Institute of Scientific and Technical Information of China (English)

    庞晓东; 彭宝淦; 杨洪; 李端明; 高春华

    2011-01-01

    目的 探讨腰椎椎管狭窄症外科治疗的临床疗效.方法 回顾性研究手术治疗退变性腰椎椎管狭窄患者共172例,其中10例有脊柱侧凸改变,22例I~Ⅱ度滑脱.单节段狭窄者90例,双节段狭窄者51例,3个节段狭窄者31例.采用单纯开窗减压者5例,后路融合固定者100例,后路椎间融合固定62例,Dynesys弹性内固定5例.临床疗效评定采用疼痛视觉模拟量表(visual analogue scale,VAS)评分,功能评分采用北美脊柱外科学会改良腰椎功能障碍指数(modified Oswestry low back pain disability questionaire index,MODI),从腰腿痛、生活自理、行走和举重物等10个方面评估患者腰椎的ODI分数.结果 所有病例随访6~72个月,平均50个月.术前腰腿痛平均评分为7.5分,术后3个月为3.2分,末次随访时为3.6分.术后3个月随访,MODI改善的优良率为94.3%;末次随访时优良率为87.6%.结论 对退行性腰椎椎管狭窄根据术前临床及影像学检查,有针对性地进行椎管减压或联合椎弓根螺钉内固定治疗均可取得较好疗效.%Objective To evaluate the clinical outcomes of surgical treatment for the patients with degenerative lumbar spinal stenosis ( DLSS ). Methods A retrospective study was conducted with a total of 172 DLSS patients who underwent decompression surgery with or without arthrodesis. The patients included 90 with single segment stenosis, 51 with double stenoses, and 31 with triple stenosis. Ten of the patients also had scoliosis and 22 had Ⅰ - Ⅱ degrees of spondylolysis. Five patients underwent simple decompression, 100 patients underwent posterior spinal fusion and fixation, 62 underwent posterior spinal fusion and fixation, and 5 underwent Dynesys semirigid fixation. The symptom relief and function improvement were assessed with a visual analogue scale ( VAS ) and modified Oswestry low back pain disability questionaire index ( MODI ), respectively. Results The patients were followed-up for 6

  12. Correlation of posterior occipitocervical angle and surgical outcomes for occipitocervical fusion.

    Science.gov (United States)

    Maulucci, Christopher M; Ghobrial, George M; Sharan, Ashwini D; Harrop, James S; Jallo, Jack I; Vaccaro, Alexander R; Prasad, Srinivas K

    2014-10-01

    Study Type Retrospective cohort study. Introduction Craniocervical instability is a surgical disease, most commonly due to rheumatoid arthritis, trauma, erosive pathologies such as tumors and infection, and advanced degeneration. Treatment involves stabilization of the craniovertebral junction by occipitocervical instrumentation and fusion. However, the impact of the fixed occipitocervical angle on surgical outcomes, in particular the need for revision surgery and the incidence of dysphagia, remains unknown. Occipitocervical fusions (OCFs) at a single institution were reviewed to evaluate the relationships between postoperative neck alignment, the need for revision surgery, and dysphagia. Objective The objective of this study is to determine whether an increased posterior occipital cervical angle results in an increase in the need for revision surgery, and secondary, dysphagia. Methods A retrospective review of spinal surgery patients from January 2007 to June 2013 was conducted searching for patients who underwent an occipitocervical instrumented fusion utilizing diagnostic and procedural codes. Specifically, a current procedural code of 22590 (arthrodesis, posterior technique [craniocervical]) was queried, as well those with a description of "craniocervical" or "occipitocervical" arthrodesis. Ideal neck alignment before rod placement was judged by the attending surgeon. A review of all cases for revision surgery or evidence of dysphagia was then conducted. Results From January 2007 to June 2013, 107 patients were identified (31 male, 76 female, mean age 63). Rheumatoid arthritis causing myelopathy was the most common indication for OCF, followed by trauma. Twenty of the patients were lost to follow-up and seven died within the perioperative period. Average follow-up for the remaining 80 patients was 16.4 months. The mean posterior occipitocervical angle (POCA), defined as the angle formed by the intersection of a line drawn tangential to the posterior

  13. Uso de morfina intratecal en artrodesis lumbar Uso da morfina intratecal na artrodese lombar Intrathecal morphine in lumbar spine fusion

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    Ronald Schulz Ibaceta

    2009-12-01

    controle da dor nas primeiras 12 horas pós-operatórias na cirurgia de artrodese lombar.OBJECTIVE: to determine the efficacy and safety of low-dose intrathecal morphine use in lumbar instrumented arthrodesis. METHODS: prospective, randomized, blind and controlled study, comparing two groups of patients, with and without the administration of intrathecal morphine at the end of surgery. RESULTS: statistically significant differences were found in the visual analogue score (VAS between the two groups, 12 hours after surgery. Average VAS (at rest in the Study Group was 2.15 cm versus 5 cm in the Control Group (p=0.013. In activity, average, VAS in the Study Group was 4.36 cm and in the Control Group, 6.9 cm (p=0.029. No differences were found when comparing complication rates. CONCLUSION: the use of low-dose intrathecal morphine in instrumented lumbar arthrodesis, for postoperative pain management, is safe and effective.

  14. A comparative study of surgical outcomes between fresh injury and obsolete injury of the tarsometatarsal joint%跖跗关节新鲜损伤与陈旧损伤的手术疗效对比研究

    Institute of Scientific and Technical Information of China (English)

    余霄; 蒋鲁勇; 刘丙根; 庞清江; 杨长春

    2015-01-01

    Objective To compare the surgical outcomes between fresh injury and obsolete injury of the tarsometatarsal joint. Methods From October 2010 to October 2013, 22 patients with tarsometatarsal joint injuries were adopted. Among them, 10 patients with fresh injuries of the tarsometatarsal joint underwent open reduction and internal ifxation within 7 days after injuries. The other 12 patients with obsolete injuries of the tarsometatarsal joint were misdiagnosed at 4-24 weeks after injuries, and then underwent open reduction and internal fixation or tarsometatarsal joint arthrodesis. All the patients were followed up for a mean period of 24 months ( range: 12-48 months ). The foot function was evaluated by the American Orthopedic Foot and Ankle Society ( AOFAS ) midfoot score system. Results The mean AOFAS score was 94.08 in fresh injury group and 79.92 in obsolete injury group. The fresh injury group was superior to the obsolete injury group in the scores of pain, range of motion ( ROM ) and walking distance ( P<0.05 ). The main cause of obsolete injury was the misdiagnosis by emergency physicians at the ifrst visit. Conclusions As long as accurate anatomical reduction and good ifxation are achieved, more satisfactory results can be obtained in the patients with fresh tarsometatarsal joint injuries than in the patients with obsolete injuries. However, pain can also be significantly relieved and function can be improved with open reduction and internal fixation or arthrodesis in the patients with obsolete tarsometatarsal joint injuries.%目的:比较跖跗关节新鲜损伤与陈旧损伤的手术疗效。方法选取2010年10月至2013年10月,我科收治的22例跖跗关节损伤患者,其中10例为新鲜损伤,并在伤后7天内进行了切开复位内固定治疗,另外12例为陈旧损伤,在伤后4~24周发现漏诊,予切开复位内固定或跖跗关节融合治疗。所有患者平均随访24(12~48)个月。采用AOFAS ( american orthopedic

  15. Safety and 6-month effectiveness of minimally invasive sacroiliac joint fusion: a prospective study

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    Duhon BS

    2013-12-01

    Full Text Available Bradley S Duhon,1 Daniel J Cher,2 Kathryn D Wine,2 Harry Lockstadt,3 Don Kovalsky,4 Cheng-Lun Soo5On behalf of the SIFI Study Group1Neurosurgical and Spine Specialists, Parker, CO, 2SI-BONE, Inc, San Jose, CA, 3Bluegrass Orthopaedics and Hand Care, Lexington, KY, 4Orthopaedic Center of Southern Illinois, Mount Vernon, IL, 5Health Research Institute, Oklahoma City, OK, USABackground: Sacroiliac (SI joint pain is an often overlooked cause of low back pain. SI joint arthrodesis has been reported to relieve pain and improve quality of life in patients suffering from degeneration or disruption of the SI joint who have failed non-surgical care. We report herein early results of a multicenter prospective single-arm cohort of patients with SI joint degeneration or disruption who underwent minimally invasive fusion using the iFuse Implant System®.Methods: The safety cohort includes 94 subjects at 23 sites with chronic SI joint pain who met study eligibility criteria and underwent minimally invasive SI joint fusion with the iFuse Implant System® between August 2012 and September 2013. Subjects underwent structured assessments preoperatively, immediately postoperatively, and at 1, 3, and 6 months postoperatively, including SI joint and back pain visual analog scale (VAS, Oswestry Disability Index (ODI, Short Form-36 (SF-36, and EuroQoL-5D (EQ-5D. Patient satisfaction with surgery was assessed at 6 months. The effectiveness cohort includes the 32 subjects who have had 6-month follow-up to date.Results: Mean subject age was 51 years (n=94, safety cohort and 66% of patients were women. Subjects were highly debilitated at baseline (mean VAS pain score 78, mean ODI score 54. Three implants were used in 80% of patients; two patients underwent staged bilateral implants. Twenty-three adverse events occurred within 1 month of surgery and 29 additional events occurred between 30 days and latest follow-up. Six adverse events were severe but none were device

  16. Total elbow arthroplasty: a radiographic outcome study

    Energy Technology Data Exchange (ETDEWEB)

    Bai, Xue Susan [University of Washington, Department of Radiology, Box 357115, Seattle, WA (United States); Petscavage-Thomas, Jonelle M. [Penn State Hershey Medical Center, Department of Radiology, Hershey, PA (United States); Ha, Alice S. [University of Washington, Department of Radiology, Box 354755, Seattle, WA (United States)

    2016-06-15

    Total elbow arthroplasty (TEA) is becoming a popular alternative to arthrodesis for patients with end-stage elbow arthrosis and comminuted distal humeral fractures. Prior outcome studies have primarily focused on surgical findings. Our purpose is to determine the radiographic outcome of TEA and to correlate with clinical symptoms such as pain. This is an IRB-approved retrospective review from 2005 to 2015 of all patients with semiconstrained TEA. All available elbow radiographs and clinical data were reviewed. Data analysis included descriptive statistics and Kaplan-Meier survival curves for radiographic and clinical survival. A total of 104 total elbow arthroplasties in 102 patients were reviewed; 75 % were in women and the mean patient age was 63.1 years. Mean radiographic follow-up was 826 days with average of four radiographs per patient. Seventy TEAs (67 %) developed radiographic complications, including heterotopic ossification (48 %), perihardware lucency (27 %), periprosthetic fracture (23 %), hardware subluxation/dislocation (7 %), polyethylene wear (3 %), and hardware fracture/dislodgement (3 %); 56 patients (55 %) developed symptoms of elbow pain or instability and 30 patients (30 %) underwent at least one reoperation. In patients with radiographic complications, 66 % developed elbow pain, compared to 19 % of patients with no radiologic complications (p = 0.001). Of the patients with radiographic complications, 39 % had at least one additional surgery compared to 0 % of patients without radiographic complications (p = 0.056). Radiographic complications are common in patients after total elbow arthroplasty. There is a strong positive association between post-operative radiographic findings and clinical outcome. Knowledge of common postoperative radiographic findings is important for the practicing radiologist. (orig.)

  17. U.S. survey of surgical capabilities and experience with surgical procedures in patients with congenital haemophilia with inhibitors.

    Science.gov (United States)

    Shapiro, A; Cooper, D L

    2012-05-01

    General guidelines exist for the use of recombinant activated factor VII (rFVIIa) to maintain haemostasis during surgery in congenital haemophilia A and B patients with high responding inhibitors (CHwI). Individual surgical plans are required and based upon historical therapy response, adverse events and anticipated procedure. Surgical interventions are feasible, yet it remains unclear how many US hemophilia treatment centres (HTCs) perform procedures in this fragile population. To better understand the US HTC surgical experience in CHwI patients and the number/types of procedures performed, a 21-question survey was sent to 133 US HTCs, with follow-up for response clarification and to non-responders. 98/133 HTCs (74%) responded, with 87 currently treating CHwI patients. In the last decade, 76/85 HTCs performed 994 surgeries on CHwI patients. Sites were experienced in the following procedures: central line insertion/removal (73 HTCs), dental (58), orthopaedic (52), abdominal (23), cardiovascular (14) and otolaryngologic (11). Experience with orthopaedic surgeries included synovectomies - arthroscopic (23 HTCs), radioisotopic (22), and open (7); joint replacement (18); fracture repair (14); and arthrodesis (8). Treatment modalities included rFVIIa bolus (83 HTCs) or continuous infusions (9), plasma-derived activated prothrombin complex concentrate (pd-aPCC) (55), antifibrinolytics (51), topical haemostatic agents (29), factor VIII (16) and fibrin sealants (14). Protocols for bypassing agents were used by 31/92 (33%) HTCs. Most US HTCs surveyed care for CHwI patients (74%) and have experience in minor surgery; fewer HTCs reported complex orthopaedic surgical experience. Identification of best practices and surgical barriers is required to guide future initiatives to support these patients.

  18. 《骨与关节杂志》(美国版)(J Bone Joint Surg Am)2001年第83卷第5期目录

    Institute of Scientific and Technical Information of China (English)

    2001-01-01

    Reverse Obliquity Fractures of the Intertrochanteric Region of the Femur George J Haidukewych, et al. 643 Fluorine-18 Fluorodeoxyglucose-Positron Emission Tomography:A Highly Accurate Imaging Modality for the Diagnosis of Chronic Musculoskeletal Infections F De Winter, et al. 651 Position of Immobilization After Dislocation of the Glenohumeral Joint: A Study with Use of Magnetic Resonance Imaging Eiji Itoi, et al. 661 Impact of Smoking on the Outcome of Anterior Cervical Arthrodesis with Interbody or Strut-Grafting Alan S Hilibrand, et al. 668 Radiation Exposure With Use Of the Inverted-C-Arm Technique in Upper-Extremity Surgery Michael R Tremains, et al. 674 Clinical Determinants of the Outcome of Manual Stretching in the Treatment of Congenital Muscular Torticollis in Infants : A Prospective Study of Eight Hundred and Twenty-one Cases JCY Cheng, et al. 679 Histopathologic Changes in Growth-Plate Cartilage Following Ischemic Necrosis of the Capital Femoral Epiphysis: An Experimental Investigation in Immature Pigs Harry KW Kim, et al. 688 Arthroscopically Assisted Treatment of Avulsion Fractures of the Posterior Cruciate Ligament from the Tibia Sung-Jae Kim, et al. 698 Influence of Metacarpophalangeal Joint Position on Basal Joint-Loading in the Thumb Mark JR Moulton, et al. 709 Improvement of the Bone-Pin Interface Strength in Osteoporotic Bone with Use of Hydroxyapatite-Coated Tapered External-Fixation Pins: A Prospective, Randomized Clinical Study of Wrist Fractures Antonio Moroni, et al. 719 A Brief Note. Ask Yourself, Why?: A Cost-Effective Look at Routine Pathologic Examination of Specimens Using the Trapezium Jeffrey A Culp, et al. 722 The Effect of Placing a Tensioned Graft Across Open Growth Plates: A Gross and Histologic Analysis T Bradley Edwards, et al. 725 Operative Treatment of Supracondylar Fractures of the Humerus in Children: The Consequences of Pin Placement David L Skaggs, et al. 735

  19. Extreme lateral lumbar interbody fusion. Surgical technique, outcomes and complications after a minimum of one year follow-up.

    Science.gov (United States)

    Domínguez, I; Luque, R; Noriega, M; Rey, J; Alia, J; Marco-Martínez, F

    «Minimally invasive» techniques have been recently been developed in order to achieve good clinical results with a low incidence of complications. The extralateral interbody fusion or direct transpsoas is a minimally invasive anterior arthrodesis. A total of 97 patients with 138 segments received surgery between May 2012 and May 2015. The follow-up was from 12-44 months. The mean age was 68 years (41-86). The most common cause of intervention was the adjacent segment (30%), deformity (22%), and lumbar disc disease (21%). The interbody cage was implanted as: Single (stand-alone) in 33%, and additional fixation was used in the others: Screws, percutaneous unilateral (11%), bilateral (27%), or with a lateral plate (62%). The mean stay was 3.2 days (2-6). The score on a lumbar visual analogue scale decreased from 9 to 4.1, and dropped to 3 after one year. The improvement in disc height was from 8.4mm to 13.8mm, and a larger increase in the foramen diameter from 10.5 to 13.1mm, which were statistically significant. The early major complications recorded were, three motor femoral nerve injuries and retroperitoneal haematoma (4%), and the early minor were: two fractures (2%). As major late complications there was an abdominal hernia, a mobilization of 10mm and three radiculopathy (5%), and as minor late, three fracture, two mobilisations greater than 10mm, four mobilisations of less than 10mm, and one mobilisation of a screw plate (10%). The extralateral interbody fusion technique is a safe and reliable when performing a lumbar fusion by an alternative minimally invasive route.

  20. Combined Internal and External Fixation for Diabetic Charcot Reconstruction: A Retrospective Case Series.

    Science.gov (United States)

    Hegewald, Kenneth W; Wilder, Megan L; Chappell, Todd M; Hutchinson, Byron L

    2016-01-01

    Diabetic Charcot neuroarthropathy is a complex, limb-threatening disease process with major lifestyle-altering repercussions for patients. When Charcot neuroarthropathy leads to unstable deformity, ulceration, and potential infection despite conservative therapies, foot and ankle surgeons often consider reconstructive limb salvage procedures to restore function. The purpose of the present study was to evaluate the clinical and radiographic outcomes of diabetic Charcot reconstruction using combined internal and external fixation. A total of 22 patients were reviewed; 16 (72.73%) midfoot and 6 (27.27%) tibiotalocalcaneal arthrodesis procedures were consecutively performed from March 2009 to May 2013. All surgical procedures were performed in nonacute phases of the Charcot process in patients with diagnosed diabetes mellitus and documented peripheral neuropathy. Patients were excluded from the study if they were not diabetic despite having undergone Charcot reconstruction, regardless of the fixation method, or if they did not complete radiographic imaging. During a mean follow-up period of 58.60 ± 42.37 (range 16 to 164) weeks, limb salvage was achieved in 20 patients (90.91%), and 2 (9.09%) required below-the-knee amputation at a mean of 42 ± 14.14 weeks. Wound dehiscence occurred in 8 (36.36%), pin tract infection in 10 (45.45%), and superficial wound infection in 9 (40.91%) and peaked in bimodal fashion at 4 and 8 weeks postoperatively. Radiographic analysis of the pre- versus postoperative alignment showed statistically significant changes in the lateral talo-first metatarsal angle (p = .02) and lateral talar declination angle (p = .01). The limb salvage rates with diabetic Charcot reconstruction are improving in part because of the continued development of increasingly superior modalities for both internal and external fixation.

  1. Oncological and functional results following operation for giant cell tumour of bone

    Institute of Scientific and Technical Information of China (English)

    Yongzhong Wei; Eugene T.H. Ek; Lipeng Yu; Guoyong Yin

    2008-01-01

    Objective:Giant cell tumours(GCT) represent one of the most common benign turnouts of bone. However, despite its benign nature they are aggressive lesions that have a tendency to recur. This study aims to report experience with the treatment of GCTs, and reviews the relationship between surgical management and clinical outcome. Methods:A retrospective review was performed with 70 patients (32 males and 38 females) who presented to our institution between 1991 and 2001 with GCT of bone. An evaluation of the oncological and functional results was conducted and patients were divided into three groups according to the treatment method; Group Ⅰ:(46 patients) intralesional curettage and adjuvant therapy and packing with filling materials. Group Ⅱ:(18 patients) en-bloc resection and arthrodesis or reconstruction. Group Ⅲ:(6 patients) amputation. Results:The mean follow-up period was 10 years (range, 5-15 years). The overall rate of local recurrence was 14%, 22% in Group Ⅰ, and only 4% in Group Ⅱ and Group Ⅲ According to the Musculoskeletal Tumour Society(MSTS) score for functional outcome, the mean overall score for Group Ⅰ was 27.9 (out of 30), 15.9 for Group Ⅱ. Of note, the 9 patients within Group Ⅱ who received endoprosthetic reconstruction, the mean overall MSTS functional score was 25.5. Conclusion:Intralesional curettage with adjuvant therapies and filling agents is often associated with a relatively high recurrence rate, however joint function is well preserved. Patients with more extensive, biologically aggressive, and/or recurrent tumours are best treated with en-bloc resection.

  2. Preliminary gait analysis results after posterior tibial tendon reconstruction: a prospective study.

    Science.gov (United States)

    Brodsky, James W

    2004-02-01

    The purpose of this study was to investigate the effect on gait in patients who underwent reconstruction for stage II posterior tibial tendon (PTT) dysfunction. Twelve patients with stage II PTT dysfunction underwent surgical reconstruction consisting of debridement of the posterior tibial tendon, flexor digitorum longus tendon transfer to the navicular tuberosity, medial displacement calcaneal osteotomy, and spring ligament reconstruction. Midfoot arthrodesis was performed in six patients and gastrocnemius recession in three. Gait analysis was performed 2 weeks prior to surgery and 1 year postoperatively. Preoperative and postoperative data were compared to determine differences in temporal-spatial parameters, lower limb kinematics, and ankle push-off power. Step length for the operated side increased from 52.6 +/- 9.6 cm before the surgery to 57.5 +/- 7.1 cm after the surgery (p =.048). Cadence improved from 100.2 +/- 10.7 steps/min to 109.1 +/- 8.5 steps/min (p =.05), thus increasing velocity from 87.6 +/- 22.6 cm/s to 103.4 +/- 15.9 cm/s (p =.042). Single support percentage was unchanged. Maximum sagittal ankle joint power at push-off increased from 0.79 +/- 0.35 W before surgery to 1.2 +/- 0.5 W after surgery (p =.042). There were statistically significant improvements in all radiographic parameters studied. This is the first prospective study to evaluate the in vivo effects on gait in patients undergoing this common surgical procedure. Analysis demonstrated statistically significant improvement in kinetic and kinematic parameters of gait function.

  3. End-stage hindfoot arthrosis: outcomes of tibiocalcaneal fusion using internal and Ilizarov fixation.

    Science.gov (United States)

    Crawford, Brooke; Watson, J Tracy; Jackman, James; Fissel, Brian; Karges, David E

    2014-01-01

    End-stage post-traumatic pantalar arthrosis from ankle, pilon, and talus fractures has often been complicated by infection, bone loss, and a soft tissue deficit. Patients can present with neuropathy, diabetes, tobacco use, and previously failed arthrodesis. Fusion in this population has been challenging, with nonunion rates up to 30%, often leading to amputation. We reviewed the results of a standardized protocol that combined simultaneous internal fixation with the Ilizarov technique to achieve fusion in high-risk patients. With institutional review board approval, a retrospective review of the patients treated with simultaneous internal fixation and an Ilizarov frame was undertaken. The records and radiographs allowed identification of the comorbidities and the presence or absence of successful fusion. Complications were acknowledged and treated. Fifteen patients had undergone the procedure. The mean follow-up period was 27.9 (range 9 to 67) months. Thirteen patients (86.67%) had had previous fusion failure. Twelve patients (80%) had developed post-traumatic arthrosis, 5 (33.33%) of whom had open injuries. All patients had 1 comorbidity, and 10 (66.67%) had multiple, including rheumatoid arthritis, diabetes (types 1 and 2), and smoking. Four patients (26.67%) presented with deep infection and bone loss. Union was achieved in 11 (73.33%), with 12 (80%) patients experiencing profound pain relief. Seven patients (46.67%) required symptomatic hardware removal. Three patients (20%) eventually underwent below-the-knee amputation for recalcitrant nonunion. Statistically significant correlations were found between smoking and wound infection and revision and between nonunion and amputation. Our results have indicated that combined internal fixation with Ilizarov application can provide a strong surgical option for the management of end-stage, pantalar arthritis. More studies are needed to compare the cohort outcomes and gait analysis in these patients with those who have

  4. Reconstruction of lower end of radius using vascularized upper end of fibula

    Directory of Open Access Journals (Sweden)

    Koul Ashok

    2007-01-01

    Full Text Available Background: Giant cell tumor is a fairly common locally invasive tumor in young adults. The lower end of the radius is the second commonest site for this tumor. The most common treatment for this tumor is curettage with or without bone grafting but it carries a significant rate of recurrence. Excision is the treatment of choice, especially for cases in which the cortex has been breached. After excision of the distal end of the radius, different procedures have been described to reconstruct the defect of distal radius. These include partial arthrodesis and hemiarthroplasty using the upper end of the fibula. The upper end of the fibula has a morphological resemblance to the lower end of the radius and has been used to replace the latter. Traditionally it was used as a ′free′ (non-vascularized graft. More recently the upper end of the fibula has been transferred as a vascularized transfer for the same purpose. Though vascularized transfer should be expected to be more physiological, its superiority over the technically simpler non-vascularized transfer has not been conclusively proven. Materials and Methods: Two patients are presented who had giant cell tumor of distal radius. They underwent wide local excision and reconstruction with free vascularized upper end of the fibula. Result: Follow-up period was two and a half years and 12 months respectively. Both patients have returned to routine work. One patient has excellent functional result and the other has a good result. Conclusion: Vascularized upper end of fibula transfer is a reliable method of reconstruction for loss of the distal end of the radius that restores local anatomy and physiology.

  5. Surgical treatment of hallux valgus%(足母)外翻的手术治疗

    Institute of Scientific and Technical Information of China (English)

    盛锟琨; 王宸

    2009-01-01

    Hallux valgus is a frequent forefoot disease, which has the high incidence, more happened among females, hallux valgus becomes more serious along with the age increasing, it usually needed to be done with surgery treatment owing to deformity and pain. The surgery with regard to hallux valgus had emerged widespread at the end of the 18~(th) century, most of the operation styles had been eliminated due to their disadvantages along with the carried out and the follow up judgment of the operation styles , however, some operation styles had been certified effective, which have been modified and consummated endlessly, have been added in the contemporary therapeutic methods. Operation styles mostly consist of soft issue repairment, osteotomy, arthroplasty and arthrodesis , selecting the operation styles reasonably is the key point of guarantee the treatment effectiveness.%(足母)外翻是一种常见的前足疾病,发病率较高,多见于女性,常随年龄增长而呈加重趋势,由于畸形和疼痛,常需手术治疗.(足母)外翻的手术治疗早在18世纪末已广泛兴起,随着各种术式的广泛开展及对其效果的追踪评价,大多数手术方式由于弊大于利被淘汰,而一些术式被证实有效,且经过不断改良与完善,已融入现代治疗方法中,手术方式主要包括软组织修复手术、截骨术、关节成形术及关节融合术,手术方法的合理选择是保证治疗效果的关键.

  6. Hypermobility of the first metatarsal bone in patients with Rheumatoid arthritis treated by lapidus procedure

    Directory of Open Access Journals (Sweden)

    Popelka Stanislav

    2012-08-01

    Full Text Available Abstract Background Foot deformities and related problems of the forefoot are very common in patients with rheumatoid arthritis. The laxity of the medial cuneometatarsal joint and its synovitis are important factors in the development of forefoot deformity. The impaired joint causes the first metatarsal bone to become unstable in the frontal and sagittal planes. In this retrospective study we evaluated data of patients with rheumatoid arthritis who underwent Lapidus procedure. We evaluated the role of the instability in a group of patients, focusing mainly on the clinical symptoms and X-ray signs of the instability. Methods The study group included 125 patients with rheumatoid arthritis. The indications of the Lapidus procedure were a hallux valgus deformity greater than 15 degrees and varus deformity of the first metatarsal bone with the intermetatarsal angle greater than 15 degrees on anterio-posterior weight-bearing X-ray. Results Data of 143 Lapidus procedures of 125 patients with rheumatoid arthritis, who underwent surgery between 2004 and 2010 was evaluated. Signs and symptoms of the first metatarsal bone instability was found in 92 feet (64.3% in our group. The AOFAS score was 48.6 before and 87.6 six months after the foot reconstruction. Nonunion of the medial cuneometatarsal joint arthrodesis on X-rays occurred in seven feet (4.9%. Conclusion The Lapidus procedure provides the possibility to correct the first metatarsal bone varus position and its instability, as well as providing the possibility to achieve a painless foot for walking. We recommend using the procedure as a preventive surgery in poorly symptomatic patients with rheumatoid arthritis in case of the first metatarsal bone hypermobility.

  7. Incidence of revision after primary implantation of the Salto ® mobile version and Salto Talaris ™ total ankle prostheses: a systematic review.

    Science.gov (United States)

    Roukis, Thomas S; Elliott, Andrew D

    2015-01-01

    The incidence of revision of total ankle replacement prostheses remains unclear. We undertook a systematic review to identify the material relating to the incidence of revision after implantation of the Salto(®) mobile version and Salto Talaris™ total ankle prostheses. Studies were eligible for inclusion only if they had involved primary total ankle replacement with these prostheses and had included the incidence of revision. Eight studies involving 1,209 Salto(®) mobile version prostheses, with a weighted mean follow-up period of 55.2 months, and 5 studies involving 212 Salto Talaris™ total ankle prostheses, with a weighted mean follow-up period of 34.9 months, were included. Forty-eight patients with Salto(®) mobile version prostheses (4%) underwent revision, of whom 24 (70.5%) underwent ankle arthrodesis, 9 (26.5%) metallic component replacement, and 1 (3%) below-the-knee amputation. Five (2.4%) Salto Talaris™ total ankle prostheses underwent revision (3 metallic component replacement and 2 ankle arthrodeses). Restricting the data to the inventor, design team, or disclosed consultants, the incidence of revision was 5.2% for the Salto(®) mobile version and 2.6% for the Salto Talaris™ total ankle prostheses. In contrast, data that excluded these individuals had an incidence of revision of 2.8% for the Salto(®) mobile version and 2.0% for the Salto Talaris™ total ankle prostheses. We could not identify any obvious difference in the etiology responsible for the incidence of revision between these mobile- and fixed-bearing prostheses. The incidence of revision for the Salto(®) mobile version and Salto Talaris™ total ankle prostheses was lower than those reported through systematic review for the Agility™ and Scandinavian Total Ankle Replacement™ systems without obvious selection (inventor) or publication (conflict of interest) bias.

  8. Proximal row carpectomy on manual workers: 17 patients followed for an average of 6 years.

    Science.gov (United States)

    Delclaux, S; Israel, D; Aprédoaei, C; Rongières, M; Mansat, P

    2016-12-01

    Proximal row carpectomy (PRC) is indicated for the treatment of SNAC or SLAC wrist with preservation of the midcarpal joint. Our hypothesis was that PRC is not appropriate for treating advanced wrist osteoarthritis in patients who carry out heavy manual work. Twenty-three PRCs were performed on 21 patients, 5 women and 16 men with an average age of 54 years (33-77). All patients performed manual work; 11 of them performed heavy manual work. Etiologies were: SLAC wrist in 14 cases (2 stage III, 11 stage II, and 1 stage I) and SNAC wrist in 9 cases (6 stage IIIB and 3 stage IIB). At an average 75 months' follow-up (24-153), five patients were lost to follow-up. Radiocarpal arthrodesis was performed in one patient 10 years after the PRC. In the 17 remaining patients (18 wrists), pain (VAS) averaged 2.2, with residual pain of 5. Flexion-extension range was similar to preoperative levels (67% of contralateral wrist). Wrist strength was decreased by 34% compared to preoperative. The QuickDASH score averaged 26 points and the PRWE 20 points. Radiocapitate distance decreased by 0.3mm on average with joint line narrowing in 6 patients. The carpal translation index was 0.33mm, which was unchanged relative to preoperative values. Three patients had work-related limitations that required retraining and one patient had to be reassigned. PRC preserved the preoperative range of motion and reduced pain levels. However, significant loss of strength was observed, resulting in 23% of manual workers needing retraining or reassignment.

  9. Personal technique for wrist dorsal approach.

    Science.gov (United States)

    Marcuzzi, A; Leigheb, M; Russomando, A; Landi, A

    2014-09-24

    In hand disorders surgical procedures are more and more widely used and often it's necessary to approach the wrist by the dorsal way. Beneath anatomy of this region is well known, there is still room enough to develop new surgical exposure techniques mostly related to physiology and biomechanics. Our goals are to present an innovative surgical dorsal exposure of the wrist, to show its use for different problems solving, and to evaluate its mini-invasive and functional outcome. Our inedited surgical technique is presented. Since November 1999 to February 2008, this technique has been used by the same surgeon in 60 cases for different pathologies and procedures: 14 SNAC-SLAC wrists III-IV treated by proximal row resection and Resurface-Capitate Pyrocarbon Implant (RCPI), 2 Fenton syndromes by bone graft and RCPI, 6 SNACSLAC II by proximal row resection +/- radial styloidectomy, 2 SLAC III by scaphoidectomy and capito-lunate arthrodesis, 12 scapho-lunate recent dissociations by ligamentoplasty (double approach), 4 scapho-lunate inveterate dissociations by Cuenod Saffar-Romano modified technique and 4 by synthetic ligaments, 1 fracture of the scaphoid proximal pole by synthesis-revascularization-S.L.ligament reconstruction, 15 Kienbock's diseases revascularized by II m.c. artery +/- radial osteotomy. Patients have been evaluated at follow up through the DASH disability questionnaire, the Mayo score for the force, ROM, pain, satisfaction grade. Results are good and encouraging for these applications. In conclusion this new technique with its limited exposure permits an early mobilization with a lower risk of stiffness and can be considered mini-invasive.

  10. Excision of extensive midfoot pigmented villonodular synovitis with microvascular anastamosis of iliac crest bone graft using external fixation: a case report.

    Science.gov (United States)

    Oloff, Lawrence; Miller, Kevin

    2011-10-01

    Pigmented villonodular synovitis (PVNS) is a relatively rare lesion in the foot and ankle, most commonly involving the ankle joint and atypically, the subtalar and midtarsal joints. It is a benign proliferative disease characterized by an increase in villous or nodular synovium in joints. Resection of the tumor is often indicated in most cases because of the potentially aggressive joint destructive nature of this lesion. This report presents a case of chronic enlarging pervasive midtarsal and metatarsal-cuneiform joint PVNS in a 28-year-old male. This patient had a midtarsal mass that enlarged over a period of 2 years, causing increased pain, deformity, and difficulty with ambulation. Cross-sectional imaging studies identified evidence of erosive disease through much of the midfoot articulations, with biopsy confirming the mass as PVNS. The dimensions of the mass approximated 5.5 cm × 4.1 cm × 2.8 cm. Simple resection was problematic because of the size and multiple joints involved. Amputation was most commonly advised by multiple consultants. The patient preferred attempt at limb salvage. En bloc resection and placement of a revascularized iliac crest bone graft was used to fill the defect. The graft was microvascularly anastamosed and fixated with standard external fixation. Pathologic and histologic specimens from surgical biopsy reconfirmed the diagnosis of PVNS postoperatively. Second-stage arthrodesis was performed when the patient was stable and disease free. The patient was followed postoperatively for 10 years without recurrence and was able to return to full function and partake in moderate athletic activity at last visit. This case describes a retrospective review of the procedure and reconstruction, as well as an overview of current surgical management of PVNS.

  11. Bone grafting: An overview

    Directory of Open Access Journals (Sweden)

    D. O. Joshi

    2010-08-01

    Full Text Available Bone grafting is the process by which bone is transferred from a source (donor to site (recipient. Due to trauma from accidents by speedy vehicles, falling down from height or gunshot injury particularly in human being, acquired or developmental diseases like rickets, congenital defects like abnormal bone development, wearing out because of age and overuse; lead to bone loss and to replace the loss we need the bone grafting. Osteogenesis, osteoinduction, osteoconduction, mechanical supports are the four basic mechanisms of bone graft. Bone graft can be harvested from the iliac crest, proximal tibia, proximal humerus, proximal femur, ribs and sternum. An ideal bone graft material is biologically inert, source of osteogenic, act as a mechanical support, readily available, easily adaptable in terms of size, shape, length and replaced by the host bone. Except blood, bone is grafted with greater frequency. Bone graft indicated for variety of orthopedic abnormalities, comminuted fractures, delayed unions, non-unions, arthrodesis and osteomyelitis. Bone graft can be harvested from the iliac crest, proximal tibia, proximal humerus, proximal femur, ribs and sternum. By adopting different procedure of graft preservation its antigenicity can be minimized. The concept of bone banking for obtaining bone grafts and implants is very useful for clinical application. Absolute stability require for successful incorporation. Ideal bone graft must possess osteogenic, osteoinductive and osteocon-ductive properties. Cancellous bone graft is superior to cortical bone graft. Usually autologous cancellous bone graft are used as fresh grafts where as allografts are employed as an alloimplant. None of the available type of bone grafts possesses all these properties therefore, a single type of graft cannot be recomm-ended for all types of orthopedic abnormalities. Bone grafts and implants can be selected as per clinical problems, the equipments available and preference of

  12. Minimally Invasive Early Operative Treatment of Progressive Foot and Ankle Deformity Associated With Charcot-Marie-Tooth Disease.

    Science.gov (United States)

    Boffeli, Troy J; Tabatt, Jessica A

    2015-01-01

    Charcot-Marie-Tooth disease is a neuromuscular disorder that commonly results in a predictable pattern of progressive bilateral lower extremity weakness, numbness, contracture, and deformity, including drop foot, loss of ankle eversion strength, dislocated hammertoes, and severe cavus foot deformity. Late stage reconstructive surgery will be often necessary if the deformity becomes unbraceable or when neuropathic ulcers have developed. Reconstructive surgery for Charcot-Marie-Tooth deformity is generally extensive and sometimes staged. Traditional reconstructive surgery involves a combination of procedures, including tendon lengthening or transfer, osteotomy, and arthrodesis. The described technique highlights our early surgical approach, which involves limited intervention before the deformity becomes rigid, severe, or disabling. We present 2 cases to contrast our early minimally invasive technique with traditional late stage reconstruction. Charcot-Marie-Tooth disease affects different muscles at various stages of disease progression. As 1 muscle becomes weak, the antagonist will overpower it and cause progressive deformity. The focus of the early minimally invasive approach is to decrease the forces that cause progressive deformity yet maintain function, where possible. Our goal has been to maintain a functional and braceable foot and ankle, with the hope of avoiding or limiting the extent of future major reconstructive surgery. The presented cases highlight the patient selection criteria, the ideal timing of early surgical intervention, the procedure selection criteria, and operative pearls. The early minimally invasive approach includes plantar fasciotomy, Achilles tendon lengthening, transfer of the peroneus longus to the fifth metatarsal, Hibbs and Jones tendon transfer, and hammertoe repair of digits 1 to 5.

  13. Instrumentação anterior da coluna em espondilite tuberculosa mal de pott: Relato de caso Anterior instrumentation in tuberculous spondylitis (Pott's disease: case report

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    Luciano Farage

    2002-03-01

    Full Text Available Relatamos caso de tratamento cirúrgico com instrumentação anterior em espondilite tuberculosa (mal de Pott, em mulher de 71 anos, que se encontrava em tratamento para tuberculose na forma pulmonar e evoluiu com dor lombar, dificuldade progressiva para deambular, cifose e disfunção vesical. A ressonância magnética revelou lesão nos corpos vertebrais de T12 e L1 com abcesso paravertebral. A paciente foi tratada cirurgicamente por acesso tóraco-abdominal lateral. Os corpos vertebrais foram ressecados, foi instalado uma gaiola vertical (mesh cage e a coluna foi estabilizada com placa lateral (Z plate e parafusos fixados em T11 e L2. Essa técnica permite boa artrodese dos corpos vertebrais remanescentes e boa estabilidade da coluna, sem comprometer a eficácia dos tuberculostáticos. A paciente foi avaliada um ano após a operação e não apresentava déficit motor, dor residual e a cifose foi desfeita.We report a case of a surgical treatment with anterior instrumentation in tuberculous spondylitis (Pott's disease, in a 71 years old woman, that was in treatment for pulmonary tuberculosis, with lumbar pain, progressive disability to walk, kyphotic deformit and vesical dysfunction. Magnetic resonance image presents a lesion in the bodies of T12 and L1, with paravertebral abscess. The patient was treated surgically by transthoracic-abdominal approach. The vertebral bodies were cut off and the spine were instrumented anteriorly with a mesh cage and a Z plate. This procedure permits a good arthrodesis and a immediately stabilization of the spine, without any complication of the infection. The patient was seen a year after the surgery and is free of infection, without motor deficit, pain or reminiscent kyphosis.

  14. Comparison of inpatient vs. outpatient anterior cervical discectomy and fusion: a retrospective case series

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    Friedman Jonathan A

    2009-03-01

    Full Text Available Abstract Background Spinal surgery is increasingly being done in the outpatient setting. We reviewed our experience with inpatient and outpatient single-level anterior cervical discectomy and fusion with plating (ACDF+P. Methods All patients undergoing single-level anterior cervical discectomy and fusion with plating between August 2005 and May 2007 by two surgeons (RPB or JAF were retrospectively reviewed. All patients underwent anterior cervical microdiscectomy, arthrodesis using structural allograft, and titanium plating. A planned change from doing ACDF+P on an inpatient basis to doing ACDF+P on an outpatient basis was instituted at the midpoint of the study. There were no other changes in technique, patient selection, instrumentation, facility, or other factors. All procedures were done in full-service hospitals accommodating outpatient and inpatient care. Results 64 patients underwent ACDF+P as inpatients, while 45 underwent ACDF+P as outpatients. When outpatient surgery was planned, 17 patients were treated as inpatients due to medical comorbidities (14, older age (1, and patient preference (2. At a mean follow-up of 62.4 days, 90 patients had an excellent outcome, 19 patients had a good outcome, and no patients had a fair or poor outcome. There was no significant difference in outcome between inpatients and outpatients. There were 4 complications, all occurring in inpatients: a hematoma one week post-operatively requiring drainage, a cerebrospinal fluid leak treated with lumbar drainage, syncope of unknown etiology, and moderate dysphagia. Conclusion In this series, outpatient ACDF+P was safe and was not associated with a significant difference in outcome compared with inpatient ACDF+P.

  15. How Sublaminar Bands Affect Postoperative Sagittal Alignment in AIS Patients with Preoperative Hypokyphosis? Results of a Series of 34 Patients with 2-Year Follow-Up

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    Sébastien Pesenti

    2016-01-01

    Full Text Available Hypokyphosis is currently observed in thoracic idiopathic scoliosis. The use of sublaminar bands allows a good restoration of sagittal balance of the spine. The aim of the study was to provide a middle-term radiographic analysis of patients with adolescent idiopathic scoliosis with preoperative hypokyphosis treated by posterior arthrodesis with sublaminar bands. This retrospective study included 34 patients with Lenke 1 scoliosis associated with hypokyphosis (TK < 20°. A radiographic evaluation was performed with a 2-year follow-up. Cobb angle, cervical lordosis, thoracic kyphosis, lumbar lordosis, and pelvic parameters were measured preoperatively, postoperatively, and at 6-month and 2-year follow-up. The mean preoperative thoracic kyphosis was 10.5° versus 24.1° postoperatively (p<0.001, representing a mean gain of 13°. Cobb angle ranged from 59.3° to 17.9° postoperatively (mean correction 69%, p<0.001. Cobb angle increased between the immediate postoperative measurement and the 6-month follow-up (17.9 versus 19.9, p=0.03. Cervical curvature changed from a 5.6° kyphosis to a 3.5° lordosis (p=0.001. Concerning lumbar lordosis, preoperative measurement was 39.7° versus 41.3° postoperatively (p=0.27. At 6-month follow-up, lumbar lordosis significantly increased to 43.6° (p=0.03. All parameters were stable at final follow-up. Correction performed by sublaminar bands is efficient for both fontal and sagittal planes. Moreover, the restoration of normal thoracic kyphosis is followed by an adaptation of the adjacent curvatures with improved cervical lordosis and lumbar lordosis.

  16. Microdecompression for lumbar synovial cysts: an independent assessment of long term outcomes

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    Torretti Joel

    2007-04-01

    Full Text Available Abstract Background Outcomes of surgical intervention for lumbar synovial cysts have been evaluated in the short and intermediate term. Concerns regarding cyst recurrence, the development of late instability at the involved level, and instability/stenosis at adjacent levels (when concomitant fusion is performed suggest that long term follow-up is needed. This study aims to fill that void. Methods Forty-six patients operated by a single surgeon not involved in the study were followed up long term at an average of 9.7 years (range 5 to 22 years post-operatively. All patients underwent decompression (+/- concomitant arthrodesis in the presence of associated degenerative spondylolisthesis using the operative microscope for magnification/illumination. Outcomes were assessed using a customized questionnaire evaluating: relief of pain/claudicant symptoms, numbness/parasthesias, and weakness; as well as late onset low back pain, new radicular symptoms, need for additional surgery, and patient satisfaction. Outcomes in patients with or without fusion were compared as well. Results 87% of patients noted resolution of their pre-operative pain, numbness, and weakness. 28% of patients developed late onset low back pain. 17% developed late onset radicular symptoms in a new nerve root distribution. 15% required subsequent additional surgery. 89% of patients were satisfied with the surgical outcome. No differences were found for any outcome measure between patients undergoing concomitant fusion and those undergoing decompression alone using the two-sample t-test. Conclusion This study provides outcome data at an average of nearly ten years post-operative. This information should allow surgeons to provide realistic expectations for their patients regarding outcomes and should enhance the informed consent and surgical decision-making process.

  17. Experimental posterolateral spinal fusion with beta tricalcium phosphate ceramic and bone marrow aspirate composite graft

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    Gupta Ankit

    2010-01-01

    Full Text Available Background: Beta tricalcium phosphate is commonly used in metaphyseal defects but its use in posterolateral spinal fusion remains controversial. There are very few published animal studies in which use of beta tricalcium phosphate has been evaluated in the posterolateral lumbar arthrodesis model. Hence we conducted a study to evaluate the potential of composite graft of beta tricalcium phosphate and bone marrow aspirate in comparison to autologous bone graft, when used for posterolateral spinal fusion. Materials and Methods: Single level posterolateral lumbar fusion was performed in 40 adult male Indian rabbits, which were assigned randomly into one of the four groups based on graft materials implanted; a 3 gm beta tricalcium phosphate plus 3 ml bone marrow aspirate (Group I; b 3 ml bone marrow aspirate alone (Group II; c 3 gm beta tricalcium phosphate (Group III and d 3 gm autologous bone graft (Group IV. Each group had 10 rabbits. Half of the rabbits were sacrificed by injecting Phenobarbitone intraperitoneally after eight weeks and the remaining after 24 weeks, and were evaluated for fusion by X-rays, computed tomography (CT scans, manual palpation test and histology. Results: Beta tricalcium phosphate used with bone marrow aspirate produced best results when compared to other groups (P =.0001. When beta tricalcium phosphate was used alone, fusion rates were better as compared to fusion achieved with autologous iliac crest bone graft though statistically not significant (P =0.07. Autologous bone graft showed signs of new bone formation. However, the rate of new bone formation was comparatively slow. Conclusion: Composite graft of beta tricalcium phosphate and bone marrow aspirate can be used as an alternative to autologous iliac crest bone graft.

  18. Rubinstein-Taybi syndrome with scoliosis

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    Miyasaka Kazuyoshi

    2011-09-01

    Full Text Available Abstract Study Design Case report. Objective The authors present the case of a 14-year-old boy with Rubinstein-Taybi syndrome (RSTS presenting scoliosis. Summary of Background Data There have been no reports on surgery for RSTS presenting scoliosis. Methods The patient was referred to our hospital for evaluation of a progressive spinal curvature. A standing anteroposterior spine radiograph at presentation to our hospital revealed an 84-degree right thoracic curve from T6 to T12, along with a 63-degree left lumbar compensatory curve from T12 to L4. We planned a two-staged surgery and decided to fuse from T4 to L4. The first operation was front-back surgery because of the rigidity of the right thoracic curve. The second operation of lumbar anterior discectomy and fusion was arranged 9 months after the first surgery to prevent the crankshaft phenomenon due to his natural course of adolescent growth. To avoid respiratory complications, the patient was put on a respirator in the ICU for several days after both surgeries. Results Full-length spine radiographs after the first surgery revealed no instrumentation failure and showed that the right thoracic curve was corrected to 31 degrees and the left lumbar curve was corrected to 34 degrees. No postoperative complications occurred after both surgeries. Conclusions We succeeded in treating the patient without complications. Full-length spine standing radiographs at one year after the second operation demonstrated a stable bony arthrodesis with no loss of initial correction.

  19. 老年腰椎间盘突出症的手术疗效观察%Surgical results of lumbar disc herniation in elderly patients

    Institute of Scientific and Technical Information of China (English)

    马学晓; 岳斌; 相宏飞; 张国庆; 胡有谷; 杨克石; 陈伯华

    2012-01-01

    followed up for 3 months to 10 years with a mean follow-up of 35.7 months. The standards of Scoring System of Spinat Section of Chinese Orthopaedic Association (SSCOA) and Japan Orthopaedic Association (JOA) were used to investigate the differences in therapeutic effects between various surgery methods(discectomy or arthrodesis), decompression tactics(fenestration, hemilamine ctomy or laminectomy) and follow up time(within 3 years, 3 to 5 years, or up 5 years). Results According to SSCOA, the total efficiency rate for lumbar disc herniation was 84.2%, whereas the rates in discectomy group and arthrodesis group were 80.5% and 87.0% respectively, without significant difference (P=0.694). Meanwhile according to JOA, the improvement rates in discectomy group and arthrodesis group were (60.89 ± 32.62)% and (65.74 ± 26.32)% respectively, without significant difference (P=0.636). The efficiency rates in fenestration group, hemilaminectomy group and laminectomy group were 80.6%, 91.3% and 85.4% respectively and without significant difference among groups (P=0.958), meanwhile the improvement rates were (59.84 ± 29.84)%, (62.30 ± 27.10)% and (62.94 ±31.96)% respectively, without significant difference (^=0.835). Of patients receiving follow-up within 3 years, 3 to 5 years , and up 5 years, the efficiency rates were 90.6%, 77.8% and 79.2% respectively, without significant difference (P=0.660), meanwhile, the improvement rates were (62.01 ±25.97)%, (55.06 ± 35.89)% and (60.83 + 33.73)% respectively, without significant difference (P=0.811). Conclusion Discectomy group and arthrodesis group may achieve satisfactory results as treatment of lumbar disc herniation in elderly patients. Fenestration, hemilaminectomy and laminectomy may all have good effect. There is no significant difference in curative effects between various follow-up times.

  20. Fibrohistiocitoma benigno ósseo na coluna lombar Benign fibrous histiocytoma of the lumbar spine

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    Osmar Avanzi

    2005-01-01

    Full Text Available CONTEXTO: O fibrohistiocitoma benigno intra-ósseo é uma neoplasia rara, caracterizada por proliferação fibroblástica e fibras colágenas. A dor na região lombar é uma queixa freqüente em muitos pacientes, mas, na maioria das vezes está relacionada com causa muscular ou degenerativa. RELATO DE CASO: Relata-se aqui o caso de um paciente com diagnóstico de fibrohistiocitoma benigno ósseo na coluna lombar que apresentava queixa de lombalgia há cinco meses antes do diagnóstico. Foi submetida à biópsia aberta transpedicular na quarta vértebra lombar ,e, posteriormente realizada curetagem da lesão via anterior retroperitonial e artrodese vertebral de L3-L5 com enxerto de fíbula. CONCLUSÃO: Apesar de raro, o fibrohistiocitoma benigno intra-ósseo deve ser uma das hipóteses quando observamos uma lesão primária na coluna vertebral.CONTEXT: Benign intraosseous fibrous histiocytoma is a rare neoplasia, characterized by fibroblastic and collagenous fiber proliferation. Pain in the lumbar region is a frequent complaint in many patients, but most of times it is associated to muscular or degenerative causes. CASE REPORT: Here we report a case of a patient diagnosed with benign bone fibrous histiocytoma in the lumbar spine who complained of lumbar pain dating five months prior to diagnosis. The patient was submitted to open transpedicular biopsy in the forth lumbar vertebra, and subsequently, lesion curettage was performed via anterior retroperitoneal and L3-L5 vertebral arthrodesis using a fibular graft. CONCLUSION: Although rare, benign intraosseous fibrohistiocytoma should be taken into consideration when a primary lesion is observed in the spine.

  1. High signal intensity of intervertebral calcified disks on T1-weighted MR images resulting from fat content

    Energy Technology Data Exchange (ETDEWEB)

    Malghem, Jacques; Lecouvet, Frederic E.; Berg, Bruno C. Vande; Duprez, Thierry; Cosnard, Guy; Maldague, Baudouin E. [Universite Catholique de Louvain, Cliniques Universitaires St. Luc, Brussels (Belgium); Francois, Robert [Belgian Military Hospital, Department of Rheumatology, Brussels (Belgium)

    2005-02-01

    To explain a cause of high signal intensity on T1-weighted MR images in calcified intervertebral disks associated with spinal fusion. Magnetic resonance and radiological examinations of 13 patients were reviewed, presenting one or several intervertebral disks showing a high signal intensity on T1-weighted MR images, associated both with the presence of calcifications in the disks and with peripheral fusion of the corresponding spinal segments. Fusion was due to ligament ossifications (n=8), ankylosing spondylitis (n=4), or posterior arthrodesis (n=1). Imaging files included X-rays and T1-weighted MR images in all cases, T2-weighted MR images in 12 cases, MR images with fat signal suppression in 7 cases, and a CT scan in 1 case. Histological study of a calcified disk from an anatomical specimen of an ankylosed lumbar spine resulting from ankylosing spondylitis was examined. The signal intensity of the disks was similar to that of the bone marrow or of perivertebral fat both on T1-weighted MR images and on all sequences, including those with fat signal suppression. In one of these disks, a strongly negative absorption coefficient was focally measured by CT scan, suggesting a fatty content. The histological examination of the ankylosed calcified disk revealed the presence of well-differentiated bone tissue and fatty marrow within the disk. The high signal intensity of some calcified intervertebral disks on T1-weighted MR images can result from the presence of fatty marrow, probably related to a disk ossification process in ankylosed spines. (orig.)

  2. Current concepts and controversies on adolescent idiopathic scoliosis: Part I

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    Alok Sud

    2013-01-01

    Full Text Available Adolescent idiopathic scoliosis is the most common spinal deformity encountered by General Orthopaedic Surgeons. Etiology remains unclear and current research focuses on genetic factors that may influence scoliosis development and risk of progression. Delayed diagnosis can result in severe deformities which affect the coronal and sagittal planes, as well as the rib cage, waistline symmetry, and shoulder balance. Patient′s dissatisfaction in terms of physical appearance and mechanical back pain, as well as the risk for curve deterioration are usually the reasons for treatment. Conservative management involves mainly bracing with the aim to stop or slow down scoliosis progression during growth and if possible prevent the need for surgical treatment. This is mainly indicated in young compliant patients with a large amount of remaining growth and progressive curvatures. Scoliosis correction is indicated for severe or progressive curves which produce significant cosmetic deformity, muscular pain, and patient discontent. Posterior spinal arthrodesis with Harrington instrumentation and bone grafting was the first attempt to correct the coronal deformity and replace in situ fusion. This was associated with high pseudarthrosis rates, need for postoperative immobilization, and flattening of sagittal spinal contour. Segmental correction techniques were introduced along with the Luque rods, Harri-Luque, and Wisconsin systems. Correction in both coronal and sagittal planes was not satisfactory and high rates of nonunion persisted until Cotrel and Dubousset introduced the concept of global spinal derotation. Development of pedicle screws provided a powerful tool to correct three-dimensional vertebral deformity and opened a new era in the treatment of scoliosis.

  3. Midcarpal instability: a radiological perspective

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    Toms, Andoni Paul [Norfolk and Norwich University Hospital NHS Trust, Department of Radiology, Norwich, Norfolk (United Kingdom); Radiology Academy, Cotman Centre, Norwich, Norfolk (United Kingdom); Chojnowski, Adrian [Norfolk and Norwich University Hospital NHS Trust, Department of Orthopaedic Surgery, Norwich, Norfolk (United Kingdom); Cahir, John G. [Norfolk and Norwich University Hospital NHS Trust, Department of Radiology, Norwich, Norfolk (United Kingdom)

    2011-05-15

    Midcarpal instability (MCI) is the result of complex abnormal carpal motion at the midcarpal joint of the wrist. It is a form of non-dissociative carpal instability (CIND) and can be caused by various combinations of extrinsic ligament injuries that then result in one of several subtypes of MCI. The complex patterns of injury and the kinematics are further complicated by competing theories, terminology and classifications of MCI. Palmar, dorsal, ulna midcarpal instability, and capitolunate or chronic capitolunate instability are all descriptions of types of MCI with often overlapping features. Palmar midcarpal instability (PMCI) is the most commonly reported type of MCI. It has been described as resulting from deficiencies in the ulna limb of the palmar arcuate ligament (triquetrohamate-capitate) or the dorsal radiotriquetral ligaments, or both. Unstable carpal articulations can be treated with limited carpal arthrodesis or the ligamentous defects can be treated with capsulorrhaphy or ligament reconstruction. Conventional radiographic abnormalities are usually limited to volar intercalated segment instability (VISI) patterns of carpal alignment and are not specific. For many years stress view radiographs and videofluoroscopy have been the methods of choice for demonstrating carpal instability and abnormal carpal kinematics respectively. Dynamic US can be also used to demonstrate midcarpal dyskinesia including the characteristic triquetral ''catch-up'' clunk. Tears of the extrinsic ligaments can be demonstrated with MR arthrography, and probably with CT arthrography, but intact yet redundant ligaments are more difficult to identify. The exact role of these investigations in the diagnosis, categorisation and management of midcarpal instability has yet to be determined. (orig.)

  4. The Kapandji-Sauvé operation. Its techniques and indications in non rheumatoid diseases.

    Science.gov (United States)

    Kapandji, I A

    1986-01-01

    The Kapandji-Sauvé operation consists in the arthrodesis of the distal radioulnar joint surmounted with a segmentary resection of the lower ulna. This technique may be used not only in rheumatoid dislocations of the distal radioulnar joint instead of the resection of the distal end of the ulna (Moore-Darrach) but also in traumatic diseases such as dislocations, sprains, chronical instabilities of this joint and stiffness secondary to Colles fractures. Two techniques are described, following the original one proposed in 1936. The first one (Technique I) indicated to chronical instabilities secondary to sprains and distal radioulnar dislocations. In this case, the ulnar head is in right situation at the sigmoid notch level and may be blocked at this place with two screws in mid position of prono-supination. The gap between the two extremities of the ulna must be filled by the pronator quadratus to avoid bony reconstruction. The second one (Technique II) is especially designed for the limitations of the prono-supination motion after Colles fractures, with shortening of the radius which causes an incongruency of the distal radioulnar joint and a positive ulnar variance. In this case it is necessary to lift up the ulnar head before blocking it in the sigmoid notch. A proceeding doing this automatically is described. Technique I was used in three cases and Technique II in four. In all cases the range of the prono-supination motion was normal in three to six weeks. The pains disappeared except a slight one when holding a load in supination position and when resting the hand unsteadily. The stability of the wrist was recovered allowing to unwind screw caps and to turn door knobs.

  5. The modified Pirogoff's amputation in treating diabetic foot infections: surgical technique and case series

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    Aziz Nather

    2014-04-01

    Full Text Available Background: This paper describes the surgical technique of a modified Pirogoff's amputation performed by the senior author and reports the results of this operation in a single surgeon case series for patients with diabetic foot infections. Methods: Six patients with diabetic foot infections were operated on by the National University Hospital (NUH diabetic foot team in Singapore between November 2011 and January 2012. All patients underwent a modified Pirogoff's amputation for diabetic foot infections. Inclusion criteria included the presence of a palpable posterior tibial pulse, ankle brachial index (ABI of more than 0.7, and distal infections not extending proximally beyond the midfoot level. Clinical parameters such as presence of pulses and ABI were recorded. Preoperative blood tests performed included a glycated hemoglobin level, hemoglobin, total white blood cell count, C-reactive protein, erythrocyte sedimentation rate, albumin, and creatinine levels. All patients were subjected to 14 sessions of hyperbaric oxygen therapy postoperatively and were followed up for a minimum of 10 months. Results: All six patients had good wound healing. Tibio-calcaneal arthrodesis of the stump was achieved in all cases by 6 months postoperatively. All patients were able to walk with the prosthesis. Conclusions: The modified Pirogoff's amputation has been found to show good results in carefully selected patients with diabetic foot infections. The selection criteria included a palpable posterior tibial pulse, distal infections not extending proximally beyond the midfoot level, ABI of more than 0.7, hemoglobin level of more than 10 g/dL, and serum albumin level of more than 30 g/L.

  6. Posterolateral dislocation of the knee joints:analysis of 9 cases

    Institute of Scientific and Technical Information of China (English)

    顾敏琪; 邓磊; 刘沂

    2004-01-01

    Objective: To analyze the traumatic pathological characteristics of posterolateral dislocation of knee joints and its treatment.Methods: Nine cases of posterolateral dislocation of knee joint, 5 cases of fresh injuries (the fresh injury group) and 4 cases of old injuries ( the old injury group) were reviewed and analyzed. In the fresh injury group 4 cases failed in close reduction due to "buttonholing" through the medial joint, among them 3 cases underwent repair of the damaged ligaments. In the old injury group 2 cases underwent ACL and MCL repair only in acute stage, but re-dislocated. Of the rest 2 cases 1 was associated with peroneal nerve injury and the other was not treated in acute stage. One case was associated with comminuted fracture of the tibial condyle and popliteal artery injury. Open reduction was performed in 3 cases. One case was fixed with 2-crossed pin and another was fixed with one pin through the tibial and femoral condyle and second pin with olecranization fixation. Plaster immobilization for 6-8 weeks respectively was required. In the old injury group in 1 case ACL and PCL repair ( Augustine method ) and posterolateral structure were performed and olecranization fixation and plaster immobilization for 6 weeks was needed.Arthrodesis of the knee was done for the patient with comminuted fracture of the tibial condyle and popliteal artery injury.Results: All the cases were followed up for 1-23 years ( average 6 years). Knee stability in 4 cases with repair of the ligaments was improved, although PDT showed ( + ) with different degrees. The results of the patients treated with ligamentous reconstruction were much better than those of the patients without any repair. Conclusions: Well understanding of the traumatic pathological characteristics, repair of the damaged ligaments, augmentation of olecranization fixation and postoperative immobilization for 6 weeks are the key points of successful treatment.

  7. Biomechanical evaluation of lumbosacral reconstruction after subtotal sacrectomy: A three-dimensional finite element analysis%骶骨次全切除术后腰骶部重建的生物力学研究:三维有限元分析

    Institute of Scientific and Technical Information of China (English)

    Quan Li; Longpo Zheng; Zhiyu Zhang; Zhengdong Cai

    2009-01-01

    favorable for lumboiliac arthrodesis than titanium instruments.

  8. Conservative Surgical Treatment of Infected Ulceration of the First Metatarsophalangeal Joint With Osteomyelitis in Diabetic Patients.

    Science.gov (United States)

    Dalla Paola, Luca; Carone, Anna; Morisi, Claudio; Cardillo, Sara; Pattavina, Marco

    2015-01-01

    Ulceration of the plantar aspect of the first metatarsophalangeal joint is a common localization in the diabetic foot. Conservative treatment of this lesion is a challenging problem, performed through the soft tissues and osseous debridement. The present study included a cohort of 28 patients affected by diabetes mellitus and a first ray lesion penetrating the bone. After surgical debridement with removal of the infected bone, we positioned antibiotic-loaded bone cement and stabilized the treated area with an external fixator. All patients with critical limb ischemia had their vascular disease treated before the procedure. The mean follow-up was 12.2 ± 6.9 months. Four patients developed a relapse of the ulceration after the procedure. In the postoperative period, 1 patient (3.57%) developed dehiscence of the surgical site and underwent a second procedure. In the follow-up period, 2 patients (7.14%) experienced bone cement dislocation. In 1 of these patients, a new ulceration was observed dorsally to the surgical site. The approach was surgical revision with bone cement replacement and stabilization with a new external fixator. In the other patient, given the absence of ulcerations, the cement was removed, and arthrodesis with internal stabilization using 2 cannulated screws was performed. One patient (3.57%), who had developed a relapse of ulceration after recurrent critical ischemia, underwent a percutaneous revascularization procedure and transmetatarsal amputation. During the follow-up period, no ulceration recurrences, transfer ulcerations, shoe fit problems, or gait abnormalities were detected in the other 24 patients. Our study presents the results of a technique requiring a 1-stage surgical approach to a relatively common problem, which is often difficult to solve.

  9. Epidemiology of Total Ankle Arthroplasty: Trends in New York State.

    Science.gov (United States)

    Seaworth, Christine M; Do, Huong T; Vulcano, Ettore; Mani, Sriniwasan B; Lyman, Stephen L; Ellis, Scott J

    2016-05-01

    The rate of total ankle arthroplasty (TAA) is increasing in the United States as its popularity and indications expand. There currently is no national joint registry available to monitor outcomes, and few studies have addressed the challenges faced with TAA. The purpose of this study was to evaluate the incidence, complications, and survival rates associated with TAA using a large statewide administrative discharge database. Individuals who underwent primary TAA from 1997 to 2010 were identified in the Statewide Planning and Research Cooperative System database from the New York State Department of Health. The age, sex, comorbidities, state of residence, primary diagnosis, and readmissions within 90 days were analyzed for patients with an ICD-9-CM procedure code of 81.56 (TAA). Failure of a TAA implant was defined as revision, tibiotalar arthrodesis, amputation, or implant removal. During the 14-year period, 420 patients underwent 444 TAAs (mean patient age of 61 years, 59% women, mean Charlson-Deyo comorbidity score of 0.45, and 86% New York State residents). The primary diagnosis was 37.4% osteoarthritis, 34.3% traumatic arthritis, and 15.5% rheumatoid arthritis. Surgery for failure was associated only with a younger age (56.5 vs 62 years, P=.005). The rate of subsequent failure procedures following TAAs performed in New York State was 13.8%. The incidence of TAAs is steadily increasing. The overall survival rate in New York State is better than rates reported in other national registries, but it is not yet comparable to those of hip and knee replacements. [Orthopedics. 2016; 39(3):170-176.].

  10. Incidence and management of ulcers in diabetic Charcot feet.

    Science.gov (United States)

    Larsen, K; Fabrin, J; Holstein, P E

    2001-09-01

    This study followed 115 patients with diabetes--who between them had 140 feet with Charcot's arthropathy--over six to 114 months (median: 48). A total of 43 patients (37%) developed ulcers in 53 feet. Their treatment was multifactorial. An offloading regimen was adopted, with the use of crutches and therapeutic sandals with soft, individually moulded insoles, followed by adjusted or bespoke shoes. Recalcitrant ulcers were treated with surgery in 16 patients (37%). Antibiotics were needed by 21 patients (49%). The incidence of ulceration was 17% per year. The median time interval between the acute component of Charcot's arthropathy and ulcer development was 36 months (range: 0-120 months). In seven patients, the ulcer developed during the acute phase. In 12 patients the ulcers were localised to the rockerbottom deformity in the mid-foot region, but in 31 patients other regions were affected. Dynamic footprint analysis was used to help adjust the offloading shoe/insole on the rockerbottom deformity. Such ulcers took twice as long to heal as other ulcers. Surgical treatment comprised: major amputation (two patients), arthrodesis for unstable ankle (three patients), toe amputations (seven patients), resection of the rockerbottom deformity (one patient) and other revisions (three patients). One patient died with an unhealed ulcer. There is a four-fold risk of ulcers in diabetic Charcot deformity compared with the overall risk of foot ulcers in diabetic feet. Healing was achieved in 40 patients (93%). The surgical intervention rate of 37% in ulcer cases in Charcot feet was low compared with the literature.

  11. Surgeon-Based 3D Printing for Microvascular Bone Flaps.

    Science.gov (United States)

    Taylor, Erin M; Iorio, Matthew L

    2017-03-04

    Background Three-dimensional (3D) printing has developed as a revolutionary technology with the capacity to design accurate physical models in preoperative planning. We present our experience in surgeon-based design of 3D models, using home 3D software and printing technology for use as an adjunct in vascularized bone transfer. Methods Home 3D printing techniques were used in the design and execution of vascularized bone flap transfers to the upper extremity. Open source imaging software was used to convert preoperative computed tomography scans and create 3D models. These were printed in the surgeon's office as 3D models for the planned reconstruction. Vascularized bone flaps were designed intraoperatively based on the 3D printed models. Results Three-dimensional models were created for intraoperative use in vascularized bone flaps, including (1) medial femoral trochlea (MFT) flap for scaphoid avascular necrosis and nonunion, (2) MFT flap for lunate avascular necrosis and nonunion, (3) medial femoral condyle (MFC) flap for wrist arthrodesis, and (4) free fibula osteocutaneous flap for distal radius septic nonunion. Templates based on the 3D models allowed for the precise and rapid contouring of well-vascularized bone flaps in situ, prior to ligating the donor pedicle. Conclusions Surgeon-based 3D printing is a feasible, innovative technology that allows for the precise and rapid contouring of models that can be created in various configurations for pre- and intraoperative planning. The technology is easy to use, convenient, and highly economical as compared with traditional send-out manufacturing. Surgeon-based 3D printing is a useful adjunct in vascularized bone transfer. Level of Evidence Level IV.