Functional Outcome Of Surgical Treatment Research Articles

Surgical treatment in patients with pelvic ring tumors

The results of treatment were analyzed in 34 patients with pelvic bone tumors. Extensive surgical treatment was performed as interiliac-abdominal exarticulation or amputation in 9 (26%) patients; pelvic bone-preserving surgery was made in 25 (74%) patients. Resections of the anterior or posterior pelvic semiring were carried out in 7 (28%) and 18 (72%) patients, respectively. Disease progression was diagnosed in 10 (29%) patients; 6 patients died at 6 to 16 months; 28 (82%) were alive with no signs of progression of the underlying disease at 4 to 46 months. Overall, the functional outcome of surgical treatment was rated as excellent in 17 (50%) patients, good in 8 (24%), and satisfactory in 4 (12%). Nine (26%) patients had a poor anatomic and functional status. Postoperative complications were diagnosed in 9 (26%) patients.

Long-Term Outcome After Surgical Treatment of Unresolved Osgood-Schlatter Disease in Young Men

Surgical treatment of Osgood-Schlatter disease is occasionally warranted, but its long-term prognosis remains poorly investigated. We studied the rate of occurrence of surgical treatment of unresolved Osgood-Schlatter disease as well as the clinical course, radiographic characteristics, and long-term outcomes after that treatment in a large population of military recruits. During a thirteen-year period, 178 consecutive recruits underwent surgery for unresolved Osgood-Schlatter disease, and 107 of them (117 knees) who met the inclusion criteria participated in a follow-up examination. We obtained data from the original medical records and radiographs as well as follow-up information from physical and radiographic examinations, interviews, and questionnaires to determine functional outcomes. The rate of occurrence of surgically treated unresolved Osgood-Schlatter disease was forty-two per 100,000 military recruits. The median age at the onset of symptoms was fifteen years. After a median duration of follow-up of ten years after the surgery, ninety-three patients (87%) reported no restrictions in everyday activities or at work and eighty (75%) had returned to their preoperative level of sports activity. The median modified Kujala score was 95 points, and the median visual analog score for pain was 7 mm. Forty-one patients (38%) reported a complete absence of pain when kneeling. Six patients had experienced minor postoperative complications, and two had undergone a reoperation for the treatment of the Osgood-Schlatter disease. After resection, the mean tibial tuberosity thickness decreased by 47%. The mean Insall-Salvati index was 1.0 preoperatively and 1.09 postoperatively (p = 0.003), and the corresponding mean Blackburne-Peel indexes were 0.85 and 0.95 (p = 0.003). With the numbers studied, the symptom duration, surgical methods, and radiographic indexes were not found to have an effect on the outcome of surgery. In the great majority of young adults, the functional outcome of surgical treatment of unresolved Osgood-Schlatter disease is excellent or good, the residual pain intensity is low, and postoperative complications or subsequent reoperations are rare.

Surgical treatment of “terrible triad of the elbow”: technique and outcome

To describe the authors' surgical technique and to evaluate the final functional outcome of surgical treatment of the "terrible triad of the elbow". Eight patients identified with "terrible triad" injury patterns, including posterior elbow dislocation, radial head fracture and coronoid fracture, were available for a minimum of 11 months follow-up. Evaluation of functional outcome was based on Mayo elbow performance, Broberg-Morrey scores, and the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire. Complications were also recorded. Five elbows redislocated while in a splint after manipulative reduction. Three had residual subluxation after operative treatment. The final mean extent of forearm movement was as follows: 21° of extension deficit (range, 5° to 45°), 126° of flexion (range, 110° to 140°), 75° of supination (range, 45° to 90°), and 71° of pronation (range, 30° to 90°). The mean Mayo, Broberg-Morrey, and DASH scores were 78.0 ± 13.4, 76.0 ± 14.0, and 28.0 ± 24.7, respectively. When an elbow joint is affected by the terrible triad, it is very unstable and prone to numerous complications. With operative treatment, the surgeon should attempt to perform internal fixation of the coronoid fracture, to regain normal radiocapitellar contact (either by preserving the radial head with open reduction and internal fixation (ORIF) or by replacing it with a prosthesis), and to repair the lateral collateral ligament (LCL). Thus early functional recovery and a successful final functional outcome can be achieved.

Long-Term Outcome After Surgical Treatment of Unresolved Osgood-Schlatter Disease in Young Men

Surgical treatment of Osgood-Schlatter disease is occasionally warranted, but its long-term prognosis remains poorly investigated. We studied the rate of occurrence of surgical treatment of unresolved Osgood-Schlatter disease as well as the clinical course, radiographic characteristics, and long-term outcomes after that treatment in a large population of military recruits. During a thirteen-year period, 178 consecutive recruits underwent surgery for unresolved Osgood-Schlatter disease, and 107 of them (117 knees) who met the inclusion criteria participated in a follow-up examination. We obtained data from the original medical records and radiographs as well as follow-up information from physical and radiographic examinations, interviews, and questionnaires to determine functional outcomes. The rate of occurrence of surgically treated unresolved Osgood-Schlatter disease was forty-two per 100,000 military recruits. The median age at the onset of symptoms was fifteen years. After a median duration of follow-up of ten years after the surgery, ninety-three patients (87%) reported no restrictions in everyday activities or at work and eighty (75%) had returned to their preoperative level of sports activity. The median modified Kujala score was 95 points, and the median visual analog score for pain was 7 mm. Forty-one patients (38%) reported a complete absence of pain when kneeling. Six patients had experienced minor postoperative complications, and two had undergone a reoperation for the treatment of the Osgood-Schlatter disease. After resection, the mean tibial tuberosity thickness decreased by 47%. The mean Insall-Salvati index was 1.0 preoperatively and 1.09 postoperatively (p = 0.003), and the corresponding mean Blackburne-Peel indexes were 0.85 and 0.95 (p = 0.003). With the numbers studied, the symptom duration, surgical methods, and radiographic indexes were not found to have an effect on the outcome of surgery. In the great majority of young adults, the functional outcome of surgical treatment of unresolved Osgood-Schlatter disease is excellent or good, the residual pain intensity is low, and postoperative complications or subsequent reoperations are rare.

Long-term functional outcome of surgical treatment of juvenile pilocytic astrocytoma of the cerebellum in children

Increasing incidence of pediatric brain tumors and improving survival rates encouraged us to assess long-term functional outcome of patients with cerebellar juvenile pilocytic astrocytoma (JPA). Our study encompassed 105 children treated since 1980-2005 and consisted in analysis of mailed, custom-designed questionnaires. Mean follow-up time was 8.3 years. Sixty out of 104 patients presented permanent neurological deficits and 47/104 presented significant behavioral disorders. Eighty-nine children continued their education at primary, secondary or high school level. Most patients and their parents were satisfied with treatment outcome. Patients' and parents' notes were usually concordant. Long-term functional treatment outcome of cerebellar JPA is relatively favorable, in spite of permanent neurological deficits and emotional disorders in over half of the patients. Vermian tumors are associated with worse long-term functional outcome. Neurological deficits and emotional disorders do not preclude further education and independent functioning.

Surgical Results in Bronchiectasis: Analysis of 149 Patients

Bronchiectasis remains a serious problem in developing countries. We reviewed the morbidity, mortality, and functional outcome of surgical treatment for bronchiectasis in our institution. Between 1992 and 2003, 149 patients (105 males, 44 females) underwent pulmonary resection for bronchiectasis. Their mean age was 33.7 years (range, 5-66 years). The indications for surgery were failure of conservative treatment in 59 (40%) patients, recurrent hemoptysis in 53 (36%), bronchial obstruction by a tumor in 9 (6%), and destroyed lung in 28 (19%). Bilateral disease was seen in 24 (16%) patients. Surgical treatment included pneumonectomy in 55 (37%) patients, lobectomy in 55 (37%), bilobectomy in 37 (25%), and lobectomy and/or segmentectomy in 2 (1%). There was one operative death (mortality, 0.67%) and morbidity occurred in 22 (14.8%) patients. Follow-up was complete in 94 patients, for a mean of 4.8 years (range, 3 months to 12 years). After surgery, 51 (34%) patients were asymptomatic. Surgical treatment for bronchiectasis can achieve good results with acceptable morbidity and mortality, not only in localized disease but also in extensive disease, if complete resection can be achieved.

Functional outcome of surgical treatment of symptomatic nonunion and malunion of midshaft clavicle fractures

Disability caused by nonunited or malunited fracture of the midshaft clavicle is a rare condition that is expressed by local pain or neurovascular impairment. This condition is usually treated by reduction of the fracture and stable fixation with augmentation by autogenous bone graft. We evaluated the functional outcome in 13 patients who were treated by this method. The mean postsurgical follow-up was 41 months. In all patients, satisfactory osseous union was achieved. Only 46% of the patients returned to their previous professional and recreational activities. There was also evidence that the current Constant scores of the affected shoulders remained significantly lower than those of the normal contralateral side. Ten patients reported various degrees of pain, and only three patients were pain-free. We show that, although solid union after realignment of symptomatic nonunion or malunion of midshaft clavicle fractures is predictable, the patients can remain functionally impaired.

Functional outcome of surgical treatment for multilevel lumbar spinal stenosis

Background There is no consensus regarding the best treatment of patients with multilevel lumbar stenosis. We evaluated the clinical and radiological findings in 41 patients with complex degenerative spinal stenosis of the lumbar spine who were treated surgically.Methods Between 1997 and 2003, 41 patients suffering from degenerative lumbar spinal stenosis were included in a prospective clinical study. The spinal stenosis was multilevel in all patients and in 13 of them there was degenerative scoliosis, in 18 there was degenerative spondylolisthesis, and in 10 there was segmental instability. Plain radiographs, MRI and/or CT myelograms were obtained preoperatively. The patients were assessed clinically with the Oswestry disability index (ODI) and visual analog scale (VAS). Surgery included wide posterior decompression and fusion using a trans-pedicular instrumentation system and bone graft.Results After a mean follow-up of 3.7 (1–6) years, the patients' clinical improvement on the ODI and VAS was statistically significant. Recurrent stenosis was not observed, and 39 of 41 patients were satisfied with the outcome. 3 patients with improvement initially had later surgery because of instability.Interpretation The above-mentioned technique gives good and long lasting clinical results, when selection of patients is done carefully and when the spinal levels that are to be decompressed are selected accurately.

Chronic Recurrent Anterior Sternoclavicular Joint Instability

Chronic anterior sternoclavicular joint (SCJ) instability may cause pain and persistent functional limitation in active patients. Although SCJ reconstruction and medial clavicular resection have been advocated in these situations, the results of surgical treatment are not well characterized. The purpose of this investigation was to determine the functional outcome of surgical treatment in adolescent and young adult patients with chronic recurrent anterior SCJ instability. Fifteen patients with chronic recurrent anterior SCJ instability refractory to nonoperative therapy who underwent joint reconstruction or medial clavicular resection were evaluated for pain and function using the American Shoulder and Elbow Surgeons (ASES) Standard Shoulder Assessment Form and the Simple Shoulder Test (SST). At average follow-up of 55 months, the mean ASES score was 85 and the mean SST score was 10.9. Sixty percent of patients reported stable, pain-free joints, although 87% (n = 13) reported some limitations of athletic or recreational activity. There were no surgical complications, and no patient underwent subsequent revision procedures. Although subsequent activity modification is often required, surgical treatment of chronic anterior SCJ instability in adolescents and young adults can provide near-complete pain relief and return of shoulder and upper extremity function.

Posterior reduction and anterior lumbar interbody fusion in symptomatic low-grade adult isthmic spondylolisthesis: short-term radiological and functional outcome.

The aim of this study was to evaluate the short-term radiological and functional outcome of surgical treatment for symptomatic, low-grade, adult isthmic spondylolisthesis. Twelve patients underwent a monosegmental fusion for symptomatic spondylolisthesis. Posterior reduction with pedicle screw instrumentation was followed by second-stage anterior interbody fusion with a cage. All patients underwent a decompressive laminectomy. At an average of 2.1 (range 1.4-3.0) years following surgery, all patients completed the Oswestry questionnaire, VAS back pain score and a questionnaire detailing their work status. Radiographs were evaluated for maintenance of reduction and fusion. The patients (nine male, three female; mean age 42, range 22-54 years) had experienced preoperative symptoms for an average of 38 (range 6-96) months. An average preoperative slip of 21% (range 11-36%) was reduced to 7% (range 0-17%). Reduction of slip was maintained at latest follow-up, at which time the average VAS score was 2.8 (range 0-8) and the average Oswestry score was 13 (range 0-32). All patients achieved a successful fusion. There were no postoperative nerve root deficits. All patients stated that they would be prepared to undergo the same procedure again if required. Seventy-five percent returned to their pre-symptom work status. Our findings suggest that posterior reduction and anterior fusion for low-grade adult isthmic spondylolisthesis may yield good functional short-term results. A high fusion rate and maintenance of reduction with a low complication rate may be expected. Further follow-up is necessary to evaluate long-term outcome.

Symptomatic and functional outcome of surgical treatment of cervical dystonia

OBJECTIVESPrevious studies of surgical treatment for cervical dystonia have reported highly variable rates of postoperative symptomatic benefit and morbidity. Little is known about functional improvement and long term results. This...