Acceptable Functional Recovery Research Articles

Local muscle or myocutaneous flap transfer for emergent repair of Gustilo IIIB open tibiofibular fractures

This study aimed to investigate the clinical outcomes of local muscle or myocutaneous flap transfer for emergent repair of Gustilo IIIB open tibiofibular fractures. This retrospective case series study included patients with Gustilo IIIB open tibiofibular fractures treated by local muscle or myocutaneous flap transfer in Weifang People’s Hospital between May 2016 and April 2021. Fifteenpatients (11 males aged 19–72 years) were included. The follow-up ranged from 8 to 24 months. The ranges of bone healing time and wound healing time were 6–17 months and 1–3 weeks, respectively. The length of hospital stay was 26 days (11–50 days). All patients reported acceptable functional recovery and satisfactory leg appearance, with Johner-Wruhs scores of excellent, good, and fair in 10, four, and one patients, respectively. The excellent-good rate was 93.3%. The complications included one case of infection and one case of nonunion. In conclusion, local muscle or myocutaneous flap transfer for emergent repair of Gustilo IIIB open tibiofibular fractures may be useful in providing adequate soft tissue coverage and fracture healing with low complication and infection rates.

Two-year multidisciplinary follow-up of COVID-19 patients requiring invasive and noninvasive respiratory support.

COVID-19 patients frequently develop respiratory failure requiring mechanical ventilation. Data on long-term survival of patients who had severe COVID-19 are insufficient. We assessed and compared two-year survival, CT imaging, quality of life, and functional recovery of COVID-19 ARDS patients requiring respiratory support with invasive (IMV) versus noninvasive ventilation (NIV). Patients with COVID-19 pneumonia admitted up to May 28th, 2020, who required IMV or NIV, and survived to hospital discharge were enrolled. Patients were contacted two years after discharge to assess vital status, functional, psychological, and cognitive outcomes using validated scales. Patients with persistent respiratory symptoms or high burden of residual lung damage at previous CT scan received a two-year chest CT scan. Out of 61 IMV survivors, 98% were alive at two-year follow-up, and 52 completed the questionnaire. Out of 82 survivors receiving NIV only, 94% were alive at two years, and 47 completed the questionnaire. We found no major differences between invasively and noninvasively ventilated patients, with overall acceptable functional recovery. Among the 99 patients completing the questionnaire, 23 have more than moderate exertional dyspnea. Chest CT scans showed that 4 patients (all received IMV) had fibrotic-like changes. Patients who received mechanical ventilation due to COVID-19 and were discharged from hospital had a 96% survival rate at the two-year follow-up. There was no difference in overall recovery and quality of life between patients who did and did not require IMV, although respiratory morbidity remains high.

Force Plate Gait Analysis and Clinical Results after Tibial Plateau Levelling Osteotomy for Cranial Cruciate Ligament Rupture in Small Breed Dogs

The aim of this study was to evaluate objective limb function using force plate gait analysis after tibial plateau levelling osteotomy (TPLO) in small breed dogs with cranial cruciate ligament rupture (CCLR). Small breed dogs (15 kg or less) with unilateral CCLR treated with TPLO were evaluated using symmetry index (SI) of peak vertical force (PVF), vertical impulse and vector magnitude at PVF performed preoperatively and at 1, 2, 4 and 6 months postoperatively after routine TPLO surgery. Twelve dogs met the inclusion criteria. Hindlimb function was markedly improved after TPLO, with all three postoperative SI significantly higher after a month than preoperative values (p < 0.01). At 2 months after surgery, the SI was nearly normalized to 1.0 (preoperative SI: 0.50 ± 0.20, 0.44 ± 0.19 and 0.51 ± 0.19, and 2 months postoperative SI: 0.92 ± 0.16, 0.90 ± 0.18 and 0.92 ± 0.16 respectively). Complications were noted in two dogs (fibular fracture and a partial implant failure), neither of which required a revision surgery for acceptable functional recovery. The objective limb function of the affected hindlimb improved continuously after surgery and reached a near normal value at 6 months after surgery. It was suggested that TPLO for small breed dogs had good outcomes based on force plate gait analysis.

Surgical decision-making depending solely on the radiological volume of the ischemic brain can be misleading in the management of patients with malignant stroke

Recent studies suggest that a total ischemic brain tissue volume >300 cm3 observed on CT is a significant indicator of an unfavorable outcome with a sensitivity of 100% after DC in patients with malignant ischemic stroke. In this article, we reported a 61-year-old male patient with poor preoperative clinical status and most predictive factors pointed to an unfavorable outcome who nonetheless demonstrated an acceptable functional recovery after DC. On cranial computer tomography, CT angiography, and diffusion MRI, his cortical and subcortical MCA and anterior cerebral artery (ACA) vascular territories showed infarctions that extended toward the basal ganglion. The volume of the ischemic cerebral tissue was calculated using ROI (region of interest) manager tool of OsiriX® DICOM image processing software (Pixmeo SARL, Bernex, Switzerland) and found to be 411 cm3. Decompressive craniectomy decision-making depending solely on the radiological volume of the ischemic brain can be misleading in the management of patients with malignant ischemic stroke.

Evaluation of Functional Outcome of Elbows after Resection Arthroplasty of Failed Total Elbow Replacement.

Background:Recovery of elbow function is a challenging problem following resection arthroplasty after failure of total elbow prosthesis. The objective of this study is to evaluate long term functional outcome in a series of such patients.Materials and Methods:Nineteen patients with twenty elbows who had failed total elbow arthroplasty (TEA) following the use of Baksi total elbow prosthesis needed removal of prosthesis during the period from 1978 to 2003. As two patients were lost to followup, 17 patients with 18 elbows (bilateral in one) were included in this study with a mean age of 44.3 years. Nine cases had uncontrolled infection, seven cases of aseptic loosening including one occurred after TEA for bilateral postburns ankylosis, and two had broken humeral stems. After removal of the prosthesis and its adjacent surrounding bone cement, the cut ends of humerus and ulna were approximated with number 5 Ethibond suture. Postoperatively, the elbow was immobilized in a plaster slab in 110° elbow flexion for 6 weeks followed by physiotherapy. The patients were evaluated for 15–19.4 (mean 16.3) years where functional results were compared at 10 years and 15 years following resection arthroplasty.Results:The resected elbow initially remained flail but gradually regained stability, especially in the sagittal plane. Both the groups showed overall improvement from preoperative Mayo Elbow Performance Score (MEPS) 26.5 to postoperative mean MEPS at 10 years (69.6) and at 15 years (70) (P = 0.001). Postoperative mean DASH score was 36.62 at 10 years’ and 36.38 at 15 years’ followup, suggesting persistence of function of resected elbow in the passage of time. The results were good in 9 (50%), fair in 7 (38.8%), and poor in 2 (11.1%) patients. None had recurrence of infection. Transient ulnar nerve palsy was seen in three patients. Postoperatively, power of Biceps recovered up to Medical Research Council grade 4 and Triceps 2–3.Conclusion:Resection arthroplasty of elbow provided acceptable functional recovery in our series of patients with failed elbow prosthesis.

A 20-year multicentre outcome analysis of salvage mechanical circulatory support for refractory cardiogenic shock after cardiac surgery.

BackgroundRefractory post-cardiotomy cardiogenic shock (PCCS) is a relatively rare phenomenon that can lead to rapid multi-organ dysfunction syndrome and is almost invariably fatal without advanced mechanical circulatory support (AMCS), namely extra-corporeal membrane oxygenation (ECMO) or ventricular assist devices (VAD). In this multicentre observational study we retrospectively analyzed the outcomes of salvage venoarterial ECMO (VA ECMO) and VAD for refractory PCCS in the 3 adult cardiothoracic surgery centres in Scotland over a 20-year period.MethodsThe data was obtained through the Edinburgh, Glasgow and Aberdeen cardiac surgery databases. Our inclusion criteria included any adult patient from April 1995 to April 2015 who had received salvage VA ECMO or VAD for PCCS refractory to intra-aortic balloon pump (IABP) and maximal inotropic support following adult cardiac surgery.ResultsA total of 27 patients met the inclusion criteria. Age range was 34–83 years (median 51 years). There was a large male predominance (n = 23, 85 %). Overall 23 patients (85 %) received VA ECMO of which 14 (61 %) had central ECMO and 9 (39 %) had peripheral ECMO. Four patients (15 %) were treated with short-term VAD (BiVAD = 1, RVAD = 1 and LVAD = 2). The most common procedure-related complication was major haemorrhage (n = 10). Renal failure requiring renal replacement therapy (n = 7), fatal stroke (n = 5), septic shock (n = 2), and a pseudo-aneurysm at the femoral artery cannulation site (n = 1) were also observed. Overall survival to hospital discharge was 40.7 %. All survivors were NYHA class I-II at 12 months’ follow-up.ConclusionAMCS for refractory PCCS carries a survival benefit and achieves acceptable functional recovery despite a significant complication rate.

Definitive Treatment of Infected Shoulder Arthroplasty With a Cement Spacer

Infection in the setting of shoulder arthroplasty can result in significant pain, loss of function, and the need for additional surgery. As the use of shoulder arthroplasty increases, the medical and economic burdens of periprosthetic joint infection increase as well. The ideal management of infected shoulder prostheses has not been established. This report describes 9 patients from a single institution who had an infected shoulder arthroplasty that was definitively managed with a cement spacer. All patients had a minimum of 2 years of follow-up. Of the 9 patients in this study, 6 were men. Mean age was 73±9 years. Of the study patients, 1 had diabetes, 2 presented with Parkinson's disease, and 5 had a history of tobacco use. Average body mass index was 27.9±7 kg/m(2). After mean follow-up of 4 years, none of the patients had clinical or radiographic evidence of infection. Functional outcomes, as measured by American Shoulder and Elbow Surgeons scores, were good or fair in 89% of patients, and the average American Shoulder and Elbow Surgeons score was 57. A review of recent literature suggested that the current findings were similar to those in studies reporting 1- or 2-stage revision procedures. Although cement spacers are typically used as part of a 2-stage revision procedure, the current findings suggest that cement spacers can be used effectively to eradicate infection and allow for acceptable functional recovery and range of motion in patients who have severe medical comorbidities and cannot tolerate additional surgery. [Orthopedics. 2016; 39(5):e924-e930.].

Total hip arthroplasty to treat fracture neck of femurs – Are nice guidelines being implemented?

sion approach was used and repaired with anchor sutures. Results: Time to surgery, mean of 13.6 days, follow up mean 13.5 weeks, range 9 26 weeks. 2 patients lost to follow up at 9 weeks. Full range of movement in 15/17 patients. Pre-injury strength regained in 12/17 patients. 2 patients had reasonable power at 12 weeks. Slow improvement in 2 patients at week 12. 2 patients had complications, 1 had injury to lateral cutaneous nerve of the forearm, and 1 had a superficial blister proximal to the wound. Conclusions: Single incision approach has a low complication rate and a high satisfaction outcome. It provides acceptable functional recovery of elbow and forearm mechanics and we believe it a safe repair for distal biceps tendon injuries.

The use of tranexamic acid results in decreased blood loss in patients undergoing primary lower limb arthroplasty

The use of tranexamic acid results in decreased blood loss in patients undergoing primary lower limb arthroplasty

Predictors of outcome in civilian gunshot wounds to the head

Civilian gunshot wounds to the head (GSWH) are often deadly, but some patients with open cranial wounds need medical and surgical management and are potentially good candidates for acceptable functional recovery. The authors analyzed predictors of favorable clinical outcome (Glasgow Outcome Scale scores of 4 and 5) after GSWH over a 24-month period. The authors posited 2 questions: First, what percentage of civilians with GSWH died in the state of Maryland in a given period of time? Second, what were the predictors of favorable outcome after GSWH? The authors examined demographic, clinical, imaging, and acute care data for 786 civilians who sustained GSWH. Univariate and logistic regression analyses were used to analyze the data. Of the 786 patients in this series, 712 (91%) died and 74 (9%) completed acute care in 9 trauma centers. Of the 69 patients admitted to one Maryland center, 46 (67%) eventually died. In 48 patients who were resuscitated, the Injury Severity Score was 26.2, Glasgow Coma Scale (GCS) score was 7.8, and an abnormal pupillary response (APR) to light was present in 41% of patients. Computed tomography indicated midline shift in 17%, obliteration of basal cisterns in 41.3%, intracranial hematomas in 34.8%, and intraventricular hemorrhage in 49% of cases. When analyzed for trajectory, 57.5% of bullet slugs crossed midcoronal, midsagittal, or both planes. Two subsets of admissions were studied: 27 patients (65%) who had poor outcome (25 patients who died and 2 who had severe disability) and 15 patients (35%) who had a favorable outcome when followed for a mean period of 40.6 months. Six patients were lost to follow-up. Univariate analysis indicated that admission GCS score (p < 0.001), missile trajectory (p < 0.001), surgery (p < 0.001), APR to light (p = 0.002), patency of basal cisterns (p = 0.01), age (p = 0.01), and intraventricular bleed (p = 0.03) had a significant relationship to outcome. Multivariable logistic regression analysis indicated that GCS score and patency of the basal cistern were significant determinants of outcome. Exclusion of GCS score from the regression models indicated missile trajectory and APR to light were significant in determining outcome. Admission GCS score, trajectory of the missile track, APR to light, and patency of basal cisterns were significant determinants of outcome in civilian GSWH.

Megaprosthesis in large bone defects: Opportunity or chimaera?

IntroductionThe development of new megaprosthesis for the treatment of large bone defects provides important options to orthopaedic oncologic surgeons for the replacement of skeletal segments, such as the long bones of the upper and lower limbs and the relative joints. We implanted megaprosthesis using either a one-step or two-step technique depending on the patient's condition. The aim of this study was to evaluate retrospectively both clinical and radiological outcomes in patients who underwent lower limb megaprosthesis implant. Materials and methodsA total of 32 patients were treated with mono- and bi-articular megaprosthesis subdivided as follows: proximal femur, distal femur, proximal tibia and total femur. The mean follow-up of patients was about 18 months (range 3 months to 5 years). Clinical and serial radiographic evaluations were conducted using standard methods (X-ray at 45 days, 3, 6, 12, 18 and 24 months) and blood parameters of inflammation were monitored for at least 2 months. ResultsAlthough the mean length of follow-up was only 18 months, the first patients to enter the study were monitored for 5 years and showed encouraging clinical results, with good articulation of the segments, no somato-sensory or motor deficit and acceptable functional recovery. During surgery and, more importantly, in pre-operative planning, much attention should be given to the evaluation of the extensor apparatus, preserving it and, when necessary, reinforcing it with tendon substitutes. DiscussionMegaprosthesis in extreme cases of severe bone loss and prosthetic failure is a potential solution for the orthopaedic surgeon. In oncological surgery, the opportunity to restore functionality to the patient (although not ad integrum) is important for both the patient and the surgeon. The high mortality associated with cancer precludes long-term patient follow-up; therefore, there is a lack of certainty about the survival of this type of prosthesis and any medium- to long-term complications that may occur. Nevertheless, patients should be considered as an oncologic patient, not because of the disease, but because of the limited therapeutic options available. ConclusionsMegaprosthesis provides a valuable opportunity to restore functionality to patients with highly disabling diseases.

Gastrocnemius flap reconstruction of soft-tissue defects following infected total knee replacement

A soft-tissue defect over an infected total knee replacement (TKR) presents a difficult technical problem that can be treated with a gastrocnemius flap, which is rotated over the defect during the first-stage of a revision procedure. This facilitates wound healing and the safe introduction of a prosthesis at the second stage. We describe the outcome at a mean follow-up of 4.5 years (1 to 10) in 24 patients with an infected TKR who underwent this procedure. A total of 22 (92%) eventually obtained a satisfactory result. The mean Knee Society score improved from 53 pre-operatively to 103 at the latest follow-up (p < 0.001). The mean Western Ontario and McMaster Universities osteoarthritis index and Short-Form 12 score also improved significantly (p < 0.001). This form of treatment can be used reliably and safely to treat many of these complex cases where control of infection, retention of the components and acceptable functional recovery are the primary goals.

Thirty cases of distal humerus intra-articular fractures treated by open reduction and internal fixation: A 3-year review

Introduction: Fractures of the distal humerus involving articular surface remains one of the challenging situations for any orthopedic surgeon. Congruent articular reconstruction is mandatory for an acceptable functional recovery. Materials and Methods: This was a case series of 30 patients of distal humeral intraarticular fractures treated by open reduction and internal fixation and followed up at the end of 3 years.Fractures were classified according to AO [Arbeitsgemeinschaft fur Osteosynthesefragen] and the results were evaluated using Cassebaums rating system, and other parameters. Results: Majority of the patients had a favourable outcome.There was no neurovascular complications and majority had a sound union. One case developed postoperative infection. Two cases resulted in nonunion. Conclusion: Open reduction and internal fixation with congruent articular reconstruction in young patients resulted in acceptable and good functional recovery. This was achieved with the use of recent AO ASIF plates. [AO/ASIF - Arbeitsgemeinschaft fuer Osteosynthesefragen - Association for the Study of Internal Fixation].

ETHICAL DILEMMAS IN THE NEUROLOGIC ICU

ETHICAL DILEMMAS IN THE NEUROLOGIC ICU

Laryngeal function after supracricoid laryngectomy

The purpose of this study was to assess laryngeal function after supracricoid laryngectomy. Case series. Supracricoid laryngectomy (SCL) has been performed in our institution for 24 selected patients with laryngeal cancer since December 2000. Reconstruction was performed through cricohyoidoepiglottopexy for 23 patients and cricohyoidopexy for 1 patient. Seven patients had ipsilateral arytenoid removal, and 15 patients underwent SCL as salvage surgery. A retrospective chart review was performed to assess postoperative speech and swallowing function. Stroboscopy and/or fiberscopy of the neoglottis were used to assess postoperative speech kinetics. Acoustic parameters were measured to evaluate vocal function, and several questionnaires were used to evaluate postoperative quality of life (QOL). In the absence of postoperative complications, stoma closure and normal diet intake were achieved 1 month after surgery. The neoglottis comprises the arytenoid(s), epiglottis, and pyriform sinus mucosa. Several different combinations of vibrating regions were observed among patients during phonation. Although vocalization sounded rough and breathy, vocal communication was possible with little inconvenience. Acceptable functional recovery and tolerable QOL can be achieved after SCL.

Functional microsurgical reconstruction in a severe case of contact burn of the forearm

The most common causes of muscle loss of the forearm are direct trauma, Volkmann’s ischemic paralysis, electrical burns, post-replantation and gas gangrene [1–4]. Forearm injuries caused by prolonged contact with hot surfaces are quite rare, but can cause severe damage to skin, muscles, tendons, nerves and bones. When the extension of the lesions is limited, with involvement of single muscletendinous units, functional recovery can be achieved by relatively simple palliative surgical procedures. However in the presence of complete loss of dorsal or ventral compartments of the forearm with loss of functionality of the hand, free innervated-muscle transplantation is the only surgical option to achieve acceptable functional recovery [5,12].

喉頭亜全摘出術 (Supracricoid Laryngectomy with Cricohyoidoepiglottopexy : CHEP) 後の音声と嚥下

Twenty-four supracricoid laryngectomies with cricohyoidoepiglottopexy (CHEP) were performed for selected patients with laryngeal cancer in our institutions since December 2000. A retrospective chart review was performed to assess postoperative speech and swallowing function. Strobography and video fluorography of the neoglottis were utilized to assess speech and swallowing kinetics. Acoustic parameters were measured to evaluate vocal function and furthermore, several questionnaires were employed to evaluate the postoperative quality of life (QOL) of the patients. Without postoperative complications, stoma closure and normal diet intake were achieved 1 month after surgery. The neoglottis consists of the arytenoid (s), epiglottis and pyriform sinus mucosa. Several different combination patterns of these regions were observed between patients. The distance of laryngeal elevation and the width of the entrance to the esophagus were not affected by the surgical procedure, making normal diet intake possible. Even though vocalization sounded rough and breathy, vocal communication was possible with little inconvenience. Acceptable functional recovery and a tolerable QOL could be obtained after CHEP.

Neuronal survival, regeneration and musclemorphology after posterior C7 nerve transfer:An experimental study

C7 nerve transfer has been widely used in treating brachial plexus avulsion injuries. Little is known regarding the survival and regeneration of C7 motor and sensory neurons including their morphological changes after this procedure and also the possible change of muscle fibre phenotype. In this experimental study, the posterior division of C7 nerve was transferred to the musculocutaneous nerve ipsilaterally, and using fluorescent tracing techniques, the C7 spinal cord segment and dorsal root ganglion were found to contain 630.9 +/- 86.7 motor neurons and 3916.0 +/- 517.3 sensory neurons, respectively. Six months following transfer, 90% of the motor neurons and 78% of the sensory neurons survived and approximately 40% of them had regenerated and all displayed normal soma size. After posterior C7 transfer and reinnervation, the target muscles showed a percentage pattern of distribution and mean fibre diameters similar to those seen in normal biceps muscle. The present study suggests that the posterior C7 nerve transfer provides sufficient number of neurons and satisfactory results for regeneration to obtain an acceptable functional recovery.