Long-term Results Of Operative Treatment Research Articles

Analysis of long-term results of operative treatment of pathologically thickened mediopathellar synovial knee fold

BACKGROUND: The mediopatellar synovial fold (MPSF) of the knee joint is normally a thin and elastic structure, but under the influence of various factors, the MPSF thickens and turns into a fibrous cord, which injures nearby structures and clinically manifests with pain. One of the effective methods of treating MPSF in pediatric patients is an arthroscopic excision of the fold. AIM: Evaluation of long-term results of arthroscopic treatment of patients with pathologically thickened MPSF of the knee joint. MATERIALS AND METHODS: There was conducted an analysis of primary medical documentation, which included the study of hospital records and case histories of 73 patients. The survey questionnaires (based on VAS and WOMAC scales) were sent to these patients. Responses were received from 35 patients who were included in the study. RESULTS: When evaluating the long-term results of surgical intervention in 35 operated patients in 29 (82.1%) patients, it was found out that there were no exacerbations in postoperative period and, at the time of the data collecting, there weer no complaints for the pain syndrome. Dysplasia of the femoral condyle of type A and B was diagnosed in these patients. At the time of the evaluation, 6 (18.9%) patients had pain syndrome with decreased function of the knee joint. In these patients, dysplasia of the femoral condyle corresponded to type C in 4 cases, types D and B in 1 case. CONCLUSION: At the early stages of the disease, it is necessary to carry out a detailed differential diagnosis to identify the pathology of the knee joint. Attention should be paid to the combination of a pathologically thickened MPSS with dysplasia of the femoral condyle, which can lead not only to complications of conservative therapy and ineffectiveness of surgery, but also to the development of patellofemoral arthrosis.

Long-term Results of Operative Treatment of Calcaneal Fractures.

This paper presents the long-term results of surgical treatment of intra-articular calcaneal fractures, including subjective evaluation, orthopaedic examination and radiographic evaluation. A total of 126 patients with 135 calcaneal fractures were treated surgically at the Department of Traumatology of the Military Medical Institute in Warsaw between 2008 and 2012. The analysis involves 73 patients (53 persons were lost to follow-up), including 45 men (61.6%). The mean age of the patients was 46.2 years (18-77 years). Based on imaging studies, patients required specific surgical techniques: the minimally invasive Westhues method involving fixation with a bundle of K-wires or open reduction and internal fixation with a plate and screws. The outcomes of the surgical treatment of calcaneal fractures were assessed on the basis of a subjective evaluation and orthopaedic and radiographic examinations. Statistical analysis was performed using Microsoft Excel. Based on the Creighton-Nebraska scores, in the group of patients treated with a bundle of K-wires (minimally invasive Westhues method), there were 12 excellent results (42.8%), 5 good (17.9%), 6 satisfactory (21.4%) and 5 poor (17.9%). In the group of patients treated with a plate and screws, excellent and good results (58.1%) prevailed in Sanders type II fractures. Most of the poor results were recorded in patients with type IV fractures. In general, radiographic results were better than functional and subjective evaluation. A statistically significant relationship between the subjective outcome of treatment and patient age was found (p <0.001). The least satisfying results were found for patients younger than 39 years of age. 1. The key to success in the surgical treatment of calcaneal fractures is appropriate restoration of Bôhler's angle 2. A good or excellent radiographic outcome did not always coincide with good functional results and good subjective evaluation 3. The poorer subjective scores in younger patients resulted from their inability to return to pre-injury activity levels.

23-year experience on diagnosis and surgical treatment of benign and malignant cardiac tumors

IntroductionAlthough myxoma is the most frequent cardiac tumor, other conditions should be taken into consideration in the differential diagnosis. Transthoracic echocardiography (TTE), followed by transesophageal echocardiography (TEE) remain the principal methods for cardiac tumor screening and visualizing. The aim of the study was to compare the diagnostics, surgical treatment and prognosis of malignant and benign cardiac tumors.Material and methodsFrom 1986 to 2009 there were 121 patients with cardiac tumors operated on in the Cardiac Surgery Clinic of the Medical University in Lodz. Patients were referred to surgery mainly on the basis of the TTE and TEE image. In 4 cases valvular prosthesis implantation or valve repair were carried out. Patients remained under long-term observation in the Cardiac Surgery Outpatient Clinic.ResultsMyxoma was diagnosed in 114 cases. Malignancies were discovered in 7 cases. The left atrium was the most frequent localization. The echocardiographic image differed significantly in benign and malignant tumors. The postoperative period was complicated by embolic events or myocardial infarctions. Only malignant tumors were associated with mortality due to cardiovascular events. The survival for malignant tumors was significantly shorter.ConclusionsShort and long-term results of operative treatment are very good for benign tumors in contrast to cardiac malignancies. The TTE and TEE image can be very significant in the final diagnosis.

Long-term result after traumatic anterior shoulder dislocation: what works best?

Traumatic anterior shoulder dislocation is a common pathology. To inform the patient, it is therefore important to know the natural history of anterior dislocation and the long-term result of conservative treatment versus the long-term results of operative treatment. In this review article, we compare the effectiveness of various anatomical and non-anatomical interventions and between open and arthroscopic surgery. Evaluating of the result, we focused on the recurrence of instability, return to sport, and prevalence of articular cartilage degeneration in the several treatments.

The Long-Term Outcome of Open Reduction and Internal Fixation of Stable Displaced Isolated Partial Articular Fractures of the Radial Head

Excellent long-term results have been reported for nonoperative treatment of stable isolated displaced partial articular (Mason 2) fractures of the radial head, suggesting that the role of operative treatment can be questioned. This investigation reports the long-term outcome of operatively treated Mason 2 radial head fractures. Sixteen patients with stable displaced partial articular (Mason 2) fractures of the radial head not associated with fracture or dislocation of the proximal forearm were evaluated an average of 22 years (range, 14-30 years) after open reduction and internal fixation with screws (11 patients) or a plate and screws (5 patients). Complications included two infections (1 deep and 1 superficial), two patients with restriction of motion because of screws of excessive length, and one transient posterior interosseous nerve palsy. A second surgery for implant removal was routine (14 of 16 patients). The average flexion arc was 129 degrees (range, 110-145 degrees) and the average forearm rotation arc was 166 degrees (range, 120-180 degrees). According to the Mayo Elbow Performance Index, elbow function was excellent in nine patients, good in four, fair in two, and poor in one patient. According to the classification system of Steinberg et al., there were three good, eight fair, and five poor results. The average score on the Disabilities of the Arm, Shoulder, and Hand questionnaire was 12 points (range, 0-52). The long-term results of operative treatment of stable isolated displaced partial articular (Mason 2) fractures of the radial head demonstrate no appreciable advantage over the long-term results of nonoperative treatment of these fractures published in prior reports. Moreover, the appeal of operative treatment is diminished by the potential complications.

Long-term results of surgical release of de Quervain’s stenosing tenosynovitis

The management of de Quervain's disease (DD) is nonoperative in the first instance, but surgery should be considered if conservative measures fail. We present the long-term results of operative treatment of DD. From July 1988 to July 1998, 94 consecutive patients with DD were treated operatively by a single surgeon. There were 80 women and 14 men. Average age at the time of operation was 47.4 years (range 22-76). The right wrist was involved in 43 cases, the left in 51 cases. All operations were done under tourniquet control with local infiltration anaesthesia using a longitudinal incision and partial resection of the extensor ligament. There were six perioperative complications, including one superficial wound infection, one delayed wound healing, and four transient lesions of the radial nerve. A successful outcome was achieved in all cases with negative Finkelstein's test. Simple decompression of both tendons and partial resection of the extensor ligament with a maximum of 3 mm can be recommended in operative treatment of DD with excellent long-term results.

Long-Term Outcome of Operatively Treated Fracture-Dislocations of the Olecranon

To report the long-term results of operative treatment of anterior and posterior olecranon fracture-dislocations and compare them with the results recorded fewer than 2 years after surgery. Retrospective case series with long-term evaluation. Level I trauma center. Ten patients with anterior olecranon fracture-dislocation and ten patients with posterior olecranon fracture-dislocation were evaluated after an average of 18 years (range, 11 to 28 years) after injury. Fifteen patients had an early follow-up available at an average 14 months (range, 6 to 24 months) after surgery. The average age at injury was 30 years (range, 14 to 53 years). Treatment included plate and screw fixation (11 patients), tension band wiring (8 patients), and radiocapitellar transfixation (1 patient). Six patients had additional elbow surgery before the final evaluation. Flexion arc, arthrosis, Mayo Elbow Performance Index (MEPI), Disability of Arm Shoulder and Hand questionnaire (DASH). The mean arc of elbow flexion was 105 degrees (range, 15 to 140 degrees) at 1 year and 122 degrees (range 10 to 145 degrees; P = 0.01) at final evaluation. Radiographic arthrosis was observed in 14 patients (70%): severe in 3, moderate in 2, and mild in 9 patients. Five patients (25%) had ulnar nerve dysfunction at the final evaluation. The MEPI was excellent in 13 patients, good in 4, fair in 2, and poor in 1. The mean DASH score was 9 points (range, 0 to 53 points). The initial results of operative treatment of fracture-dislocations of the olecranon are durable over time.

Multifragment fracture of the patellar apex: basket plate osteosynthesis compared with partial patellectomy

The purpose of the present study was to evaluate and compare the long-term results of operative treatment of a multifragment fracture of the inferior patellar pole by basket plate osteosynthesis and partial patellectomy. We retrospectively studied two groups of patients who had operative treatment of a multifragment fracture of the inferior patellar pole between 1988 and 2004. Seventy-one patients who had osteosynthesis by basket plate (Group 1) and 49 patients who had partial patellectomy (Group 2) were followed for an average of 5.3 years. The final evaluation was based on the modified Cincinnati Knee rating system test. The results were excellent or good in 90.1% patients of Group 1, and 73.5% patients of Group 2. Significant differences between the groups were noted with regard to knee pain, swallowing, level activity, compression pain, range of motion, muscular atrophy, muscular strength, and final patellofemoral score which confirms statistical analysis. The stability of the osteosynthesis by basket plate allows osseous consolidation of the fracture and permits immediate mobilization and early weight bearing. Osteosynthesis by basket plate can provide better clinical results.

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Introduction: The majority of studies report excellent or good short-term results of open reduction and internal fixation of intra-articular (AO Type C) distal humerus fractures. Reports on long-term results of operative treatment of complex intra-articular distal humerus fractures are scarce. The objective of our study was to assess the long-term (12-30 years) clinical and radiological outcome of surgically treated intra-articular distal humerus fractures (type C) with standardized outcome measures.

Long-Term Cosmetic and Sexual Outcome of Hypospadias Surgery: Norm Related Study in Adolescence

Even if performed early in life, hypospadias surgery may have a significant impact on self-esteem and sexual behavior in adolescence. We evaluated the long-term cosmetic and sexual outcomes of hypospadias surgery performed in childhood. A detailed questionnaire was mailed to 33 patients with hypospadias who were 18 to 26 years old and had undergone the first operation at age 6 years or younger. It was also mailed to 50 age matched controls. A total of 22 patients (66.7%) and 38 controls (76.0%) returned the questionnaire. Mean age in the hypospadias and control groups was 20.6 and 21.0 years, respectively. Eight of the 22 patients had mild hypospadias and 11 had severe hypospadias. Severity was unknown in 3 patients. Age at the first and final operations was 31 to 75 (mean 46) and 35 to 81 months (mean 53). The number of operation was 1 in 10 patients, 2 in 10 and 3 in 2. The rate of dissatisfaction with penile appearance was slightly higher in the hypospadias group than in the control group (40.9% vs 34.2%). The single reason for dissatisfaction in the hypospadias group was inadequate penile size, whereas in the control group penile size, phimosis and curvature were the major reasons for dissatisfaction (69.2%, 46.2% and 23.1%, respectively). Experience with masturbation (100% and 97.4%) and sexual intercourse (52.4% and 55.3%), and mean age at first masturbation (13.4 and 13.0 years) and first sexual intercourse (16.6 and 17.3 years) were similar in the hypospadias and control groups, respectively. Although patients with hypospadias had a slightly higher rate of dissatisfaction with penile size, their sexual behavior was not different from that in control subjects.

Glossary of Terms for Evidence-Based Orthopaedics*

To The Editor: While we agree with many of the points brought forth in the article, “Hallux Rigidus. Grading and Long-Term Results of Operative Treatment” (2003;85:2072-88), by Coughlin and Shurnas, others bring up questions. The authors indicated that metatarsus primus elevatus was not present in the majority of the patients in their study. However, their method of measuring the distance between the dorsal cortices of the first and second metatarsals to evaluate metatarsus primus elevatus is susceptible to error. A study by Camasta et al.1 illustrated that differences in the x-ray tube head angle can cause distortion of the radiographic image. We believe, therefore, that the authors' conclusion that metatarsus primus elevatus is not a factor in the etiology of hallux rigidus should be reconsidered. Seiberg et al.2 described a reproducible radiographic method of evaluating metatarsus primus elevatus that measures the difference between the dorsal cortices of the first and second metatarsals at two sites. The first measurement is made 1.5 cm distal to the first metatarsal cuneiform joint, and the second measurement is made 1.5 cm proximal to the first metatarsal head. If the distal value is greater than the proximal one, then a true metatarsal elevation is present. Coughlin … Corresponding author: Michael J. Coughlin, MD 901 North Curtis Road Suite 503 Boise, ID 83706 footmd{at}aol.com

Does Gender Affect Outcome of Surgery in Adolescent Idiopathic Scoliosis?

A retrospective follow-up study comparing 2 matched groups. To compare long-term results of operative treatment of adolescent idiopathic scoliosis (AIS) between males and females matched for age, curve magnitude and type, and the instrumentation used. It has been suggested that in AIS, the spine is more rigid in males than in females, because brace treatment fails to halt progression of the curves in males. However, there are no studies comparing the results of surgical treatment of AIS between males and females. Thirty male and female pairs were matched for age (+/-1 year), major curve magnitude (+/-5 degrees), curve type according to the King classification, and the instrumentation used (Harrington in 11 pairs, Cotrel-Dubousset in 9 pairs, and Universal Spine System in 10 pairs). The mean age at the time of operation was 16.2 +/- 2.6 years for the males and 15.5 +/- 2.3 years for the females. The mean follow-up times were 14.3 years (range 6.7-23.0 years) and 14.1 year (range 6.4-23.7 years), respectively. Radiographs were obtained presurgery and after surgery, at the 2-year follow-up assessment, and at the final follow-up visit. In addition, a physical examination was performed, and the Scoliosis Research Society (SRS) questionnaire was completed. Spine mobility and nondynamometric trunk strength were measured at the final follow-up visit. Before surgery, the mean Cobb angle of the thoracic curve was 55 degrees (range 42-83 degrees) in the males and 56 degrees (range 43-80 degrees) in the females. In bending radiographs, the major curve reduced significantly more in females than in males (P = 0.027). The mean angles of the thoracic and lumbar curves were similar at all follow-up visits. The final correction of the thoracic curves was 30% (range -19-65%) in the males and 33% (range -7-71%) in the females (not significant). No significant difference was observed in thoracic kyphosis or lumbar lordosis between the study groups at the final follow-up. The total SRS questionnaire score averaged 96 (range 66-113) in the males and 95 (range 75-108) in the females. None of the males and 2 of the females reported back pain often or very often in the questionnaire. Nondynamometric trunk strength measurements corresponded with reference values, on average, and were similar in both groups. Abnormal trunk side bending tended to be more common in the males than in the females (43% vs. 23%, P = 0.10, not significant). Curves in males appear to be more rigid than in females with AIS. However, posterior surgery for AIS provides similar short and long-term results in males and females.

Long-term results of operative treatment for cervical spondylotic myelopathy in patients with athetoid cerebral palsy: an over 10-year follow-up study.

A retrospective radiographic and medical record analysis of patients followed for more than 10 years after operative treatment for cervical spondylotic myelopathy complicating athetoid cerebral palsy. To describe the incidence of late neurologic deterioration and spinal deformity after operative treatment for cervical spondylotic myelopathy in athetoid cerebral palsy. The possibility of recurrence of symptoms after operative treatment for cervical spondylotic myelopathy seems greater in patients with athetoid cerebral palsy because of their involuntary neck movements. Although there are several reports of surgical results, long-term follow-up studies are very rare. Ten patients with athetoid cerebral palsy were evaluated over an average of 15 years after anterior decompression (corpectomy) and fusion (three patients), laminectomy (one patient), and laminoplasty (six patients, four with accompanying posterior fusion). They averaged 45 years of age at surgery. Surgical results were assessed using Kurokawa's method. Late neurologic deterioration was based on decrement in the JOA score, and the evolution of kyphosis or instability of the cervical spine was observed radiographically. Surgical results at the most improved period were good or excellent in all 10 patients. Eight showed late neurologic deterioration, however, and six of them deteriorated from 8 to 13 years after surgery, largely because of progressive deformity. Long-term follow-up evaluation is essential in any type of operation, particularly with patients with athetoid cerebral palsy who often undergo this operation in their 30s or 40s.

Dega's transiliac osteotomy in the treatment of spastic hip subluxation and dislocation in cerebral palsy.

The study presents the long-term results of operative treatment of spastic subluxation and dislocation of hip joints in cerebral palsy children with open reduction and pelvic transiliac osteotomy by Dega. The subjects were 25 patients (30 hips) and the follow-up lasted from 3 to 25 years (average 12 years). Final examinations were carried out after the end of body growth. Detailed analysis covered a patient's function, occurrence and intensity of pain in the hip joint, value of radiological parameters such as angle of centre-edge of the roof after Wiberg (CE), acetabular index (AI), neck-shaft angle (NS) and migration percentage (MP). The final evaluation of radiological results was carried out in accordance with Severin's classification. The clinical and radiological results obtained showed gradual deteriorations in comparison with the early postoperative results (dating from 12 months after surgery). In the final examination, in one patient a recurrent dislocation of the hip joint was diagnosed and subluxation was diagnosed in six patients (23%). Only the values of the CE angle went up (from -16 degrees in the early postoperative examination to 20 degrees in the final assessment), which we consider to be due to the change of sphericity of the head of femur. The remaining radiological parameters did not change significantly: AI from 22 degrees to 23 degrees, MP from 11% to 23%, NS from 133 degrees to 140 degrees. The surgical method presented is currently applied in a modified form, with a wider release within the soft tissues, more radical varusderotation osteotomy and greater shortening of the femur.

Long-term results of the operative treatment of clubfoot: a representative study.

This study reports the long-term results of operative treatment of clubfoot. Of the patients who underwent posteromedial release for congenital clubfoot between 1972 and 1975 at the Medical University in Pécs, Hungary, 41 feet of 30 patients have been under control examination. Control consisted of the distribution of questionnaires, physical examination, and in some cases, radiologic analysis. At an average of 20 years postsurgery, good clinical results were observed in 31 (75%) feet. In these patients, satisfying foot form and good function were achieved, yet the characteristic atrophy of the calf and shortening of the foot were visible. Abnormal conditions were found in 10 feet, consisting of overcorrection in 6 and undercorrection in 4 cases. Subjective judgment of the patients was considerably better; only 5 (12%) feet had no satisfying results. Data of feet in an incorrect position were analyzed and compared with other cases. In cases of feet operated on in patients aged > or = 1 year and in patients who underwent multiple operations, abnormalities were found in a significantly higher percentage.

Results of surgical treatment of cervical esophageal diverticula.

On the basis of 20 years' experience, the authors present the immediate and long-term results of operative treatment of Zenker's diverticulum. Comparison of two methods of surgery - diverticulopexia (in 21 patients) and excision (in 16), both associated with upper esophageal sphincter myotomy - shows good immediate and longterm results (from 1 to 19 years), with disappearance of symptoms (dysphagia) in all patients. There was no perioperative mortality. Postoperative complications were most commonly of pulmonary origin and were observed in a third of patients in both groups. In two patients from the group treated with excision, a leak from the suture line occurred, which healed spontaneously. These two patients had transient dysphagia in the postoperative period. On the basis of this analysis, the authors conclude that diverticulopexia is a safer surgical procedure than excision, giving less complications and a very good long-term functional result.

Disc herniation in the lumbar spine during growth: long-term results of operative treatment in 18 patients.

We studied 18 patients who had undergone surgery for herniated lumbar discs between the ages of 11 and 17 years. The inclusion criteria for girls was an age of 15 years or below and for boys 17 or below at surgery. The mean follow-up time was 10 years and the clinical outcome was good. Age at surgery and length of the follow-up had no effect on the result. The radiological disc height at follow-up did not correlate with the follow-up time or age of the patient at operation. MRI scans at follow-up from ten patients operated at less than 15 years of age revealed multilevel disc degeneration but favourable clinical results.

Operative treatment of medical epicondylitis. Influence of concomitant ulnar neuropathy at the elbow.

We performed a retrospective review of the long-term results of operative treatment of medial epicondylitis in thirty elbows (twenty-six patients). Sixteen elbows had concomitant ulnar neuropathy. All of the patients had tenderness over the medial epicondyle. The most sensitive provocative maneuver was resisted pronation of the forearm (a positive result for twenty-eight elbows), followed by resisted flexion of the wrist (a positive result for twelve elbows). The operative findings included an inflammatory focus in seventeen elbows and focal ulnar-nerve compression in nine. Débridement of the origin of the flexor-pronator tendon mass, with decompression or transposition of the ulnar nerve when indicated, was associated with an 87 per cent rate (twenty-six elbows) of good or excellent results at an average of seven years (range, two to fifteen years) after the operation. Twenty-four of the twenty-five elbows that had no or mild associated ulnar neuropathy (type-IA or IB medial epicondylitis) had a good or excellent result, while two of the five elbows that had moderate or severe associated ulnar neuropathy (type-II medial epicondylitis) had a good or excellent result. This difference was significant (p = 0.009). Nine patients (nine elbows) needed more than six months before maximum improvement was obtained.

Prospective long-term results of operative treatment in primary dislocation of the patella.

Among 53 prospectively studied patients who had undergone operative treatment of primary patellar dislocation, 9 (17%) suffered recurrence within an average follow-up of 6.5 years. All the redislocations occurred in female patients. The patients with recurrence also suffered first-time patellar dislocation in their unoperated knee during the follow-up significantly more often (P < 0.01) than the patients with stable knees. Patients with redislocations were more often dissatisfied with their outcome than the stable group, mainly because of annoying anterior knee pain (P < 0.05). Preoperatively the patients with redislocation had had more pronounced pathological patellofemoral congruity (Laurin's projections) in both the operated knee (P < 0.05) and the, at the time uninjured, control knee (P < 0.05). To improve the results of operative treatment for acute patellar dislocation, surgery should be aimed at correcting the underlying pathology. In grossly and symmetrically pathological cases of patellofemoral articulation, a distal realignment procedure should be considered. Otherwise conservative treatment may be justified.

Long-term Results of Operative Treatment of Congenital Muscular Torticollis

We reviewed 29 cases of the congenital muscular torticollis which had been treated by open tenotomy during the period of 1956-1972 in our clinic and evaluated by direct examination in 1978.The treatment consisted of open tenotomy, immobilization in plaster brace to maintain the overcorrected position for 3 to 4 weeks and physical therapy etc.The following conclusion was drawn.1) Facial asymmetry was improved satisfactorily when the operation was done before 2 years of age.2) Correlation between improvement of facial asymmetry and that of rotatory motion of the neck was suspected.3) In majority of cases the contour of the sternocleidomastoid muscle of the operated side located more laterally than that of the contralateral side.4) The scar of the skin incision had tendency to move upward. Therefore, we think it had better to make the incision at the inferior margin of the clavicle.5) Cause of the residural wry neck was mainly incomplete resection of the muscles.