Poor Functional Results Research Articles

Balance and functional disorders in geriatric patients after total hip prosthesis removal.

One of the most difficult complications of total hip arthroplasty is an infection in the area of the implant with an incidence of 0.5% to 2.5% resulting in the most severe situation in prosthesis removal. The aim of the study was to assess postural stability and functional disorders in patients after hip prosthesis removal. A group of 15 patients after hip prosthesis removal was compared to a control group of 15 healthy persons who were age-matched without any symptoms of degenerative disorders in the lower spine and lower extremities. The static balance test was conducted on a bi-modular stabilometric platform, registering the movement of the centre of foot pressure. The functional state of the patients was assessed on the basis of the Harris Hip Score (HHS). Patients had poor functional result (HSS mean 62.29 ± 12.92 points). Obtained results of postural stability of patients showed huge difficulties maintaining stability and showed statistically significant differences in a majority of the analysed parameters. Several stability parameters showed significantly worse results in patients after hip prosthesis removal. Special attention should be paid and focused physiotherapy should be undertaken for patients with a stability disorder and functional status to prevent falls and improve functioning.

Surgical Management of Supracondylar Fractures of the Humerus in Children by Closed Reduction and Percutaneous Pinning with Kirschnner Wires-A Cross-sectional Study

Introduction: Supracondylar Humerus Fracture (SCHF) is frequently encountered in paediatric age group and constitutes nearly three fourth of all upper extremity fractures. Most commonly used technique for surgical treatment in the displaced SCHF in children is closed reduction and stabilisation with percutaneous pins. Aim: To find out the outcome and safety of percutaneous pinning techniques in terms of functional and radiological outcome and to note the associated complications with this method of fixation. Materials and Methods: This was a cross-sectional study, conducted on patients admitted to Department of Orthopaedics, Hassan Institute of Medical Sciences, Hassan, between January 2017 to December 2019. Thirty paediatric cases were retrospectively reviewed. These were admitted with a supracondylar fracture and had reported to the hospital over a three-year period. All fractures were treated with closed reduction and fixation with percutaneus K-wire followed by immobilisation in above elbow slab for three weeks. K-wires were removed at three weeks and mobilisation with physiotherapy was advised. Outcome was measured by Flynn’s Criteria. The results were analyzed as per appropriate descriptive statistical tests. Results: The mean age of the patients was 7.4 years (range 3-15years). Males outnumbered females. Total 22 (73.3%) patients had left-sided fracture and 8 (26.6%) had fracture on right side. Fracture union was seen in all the patients at a mean interval of 4.2 weeks (range 3-5 weeks), in a follow up of 12 weeks. Most (90%) of the injuries were the result of trauma, including fall. 70% of the fractures were Gartland Type III supracondylar fracture. Cross K- wire fixation was done in 21 patients and lateral-only pin in 9 patients. Among the 21 patients, who had type III fracture, 4 of them were fixed with 2 Lateral K- wire pinning and 17 of them with crossed K-wire pinning configuration. The commonest post-operative complication observed was a superficial pin tract infection, seen in 4 (13.3%) patients. Outcome according to the Flynn’s criteria 25 patients (83.3%) had excellent result, 3 (10%) patients had good result, 1 (3.3%) had fair result and 1 (3.3%) patient had poor functional result. Conclusion: The present study concludes that close reduction and percutaneous k-wire pinning techniques give a favorable outcome in displaced supracondylar fractures of the humerus in children, without any serious complications.

Esophagus Decellularization.

In pathologies of the esophagus such as esophageal atresia, cancers and caustic injuries, methods for full thickness esophageal replacement require the sacrifice of healthy intra-abdominal organs such as the stomach and the colon. These methods are associated with high morbidity, mortality and poor functional results. The reconstruction of an esophageal segment by tissue engineering (TE) could answer this problem. For esophageal TE, this approach has been explored mainly by a combination of matrices and cells. In this chapter, we will discuss the studies on full organ esophageal decellularization, including the animal models, the methods of decellularization and recellularization.

Marginal impaction as a determinant of functional outcome in acetabular fractures involving the posterior wall

Background Several variables have been accused for the poor functional results following posterior wall fractures. The authors conducted this study to identify the relative risk of marginal impaction fractures for developing a poor result. Patients Cases of acetabular fractures with posterior wall components associated with marginal impaction were compared with the same pattern of fractures without marginal impaction. Patients with recognized variables that may affect the outcome were excluded, including femoral head injuries, nonanatomic reductions, avascular necrosis, deep infection, heterotopic ossification grade III and IV, obesity, and problematic lower limb injuries. Marginal impaction injuries were openly elevated and autografted from the greater trochanter, followed by rigid internal fixation for early postoperative mobilization. A total of 40 cases were excluded for the aforementioned reasons, leaving 27 cases of marginal impaction and 38 cases of control. The average period of follow-up was 35.7 months. Results Based on the Merle D’Aubigne and Postel functional score, the marginal impaction grafting group revealed 11 (40.7%) excellent, 7 (25.9%) very good, 6 (22.2%) good, one (3.8%) fair, and two (7.4%) poor results. However, the control group showed 16 (42.1%) excellent, 10 (26.3%) very good, 8 (21.1%) good, one (2.6%) fair, and three (7.9%) poor results. Conclusion Taking marginal impaction as a sole variable, adequate grafting and fixation of the osteochondral fragment did not seem to make a statistically significant difference (P=0.9) regarding the end functional results of these patients.

Short-Term Outcomes of Lower Trapezius Tendon Transfer With Achilles Allograft for Irreparable Posterosuperior Rotator Cuff Tears

PurposeTo evaluate functional outcomes, return to work, and reoperations associated with lower trapezius tendon transfer (LTT) for irreparable rotator cuff tears.MethodsThis is a retrospective study performed by a single surgeon with minimum 1-year follow-up. LTT was performed using an open (n = 9; 60%) or arthroscopically assisted (n = 6, 40%) technique. Outcomes included failure rate, range of motion, satisfaction, return to work, and pre- and postoperative functional scores, as well as American Shoulder and Elbow Surgeons score, Single Assessment Numeric Evaluation, and the Simple Shoulder Test.ResultsFifteen patients were included. LTT was performed using an open or arthroscopically assisted technique. Mean age was 52 (range 31-62 years), 13 (92.9%) were manual laborers, and 9 (60%) had a worker’s compensation claim. Three patients (20%) underwent conversion to reverse shoulder arthroplasty. Of the remaining 12 patients, there were significant improvements in American Shoulder and Elbow Surgeons, Single Assessment Numeric Evaluation, and Simple Shoulder Test at 24.1 ± 9.6 (range 12-38.5) months. Active forward elevation, abduction, and external rotation were all significantly improved. Postoperative satisfaction ratings indicated 67% of the revision-free cohort was “very satisfied” and 33% was “somewhat satisfied” with their outcome. Seven (50%) returned to full duty, 4 (28.6%) returned to modified duty, and 3 (21.4%) were unable to return to work. Two patients (open techniques) underwent a superficial wound debridement for seroma and wound breakdown.ConclusionsLTT results in successful clinical outcomes with a high rate of return to work in a challenging patient population. However, only 67% of patients rated themselves as “very satisfied,” and 20% of patients were revised to reverse shoulder arthroplasty before 1 year. Limited preoperative active forward elevation (<90°) appears to predict poor functional results and risk for reoperation.Level of EvidenceLevel IV, therapeutic case series.

Assessing the Clinical Value of Performing CT Scan before Rhinoplasty Surgery.

Introduction The endonasal mucosal or anatomic pathologies could lead to poor functional results and dissatisfaction after rhinoplasty. Although computed tomography (CT) scan has become an integral part of the diagnostic paradigm for patients with pathologies of the paranasal sinuses, the use of CT scan for preoperative evaluation of patients seeking rhinoplasty is up for debate. Our aim in this study was to compare the efficacy of CT scan in diagnosing nasal pathologies with other evaluating tools in patients undergoing rhinoplasty. Design In this randomized controlled trial study, 74 consecutive patients seeking cosmetic rhinoplasty referred to otorhinolaryngology clinic were randomly assigned into three groups based on the perioperative evaluation method: the CT group, the nasal endoscopy group, and the control group (anterior rhinoscopy only). Surgical planning was made according to perioperative findings, and the identified endonasal pathologies were corrected during the surgery. The functional and aesthetic outcomes of the rhinoplasty were assessed by Nasal Obstruction Symptom Evaluation (NOSE), Rhinoplasty Outcome Evaluation (ROE), and the Visual Analogue Scale (VAS) tools before surgery and at 12-month follow-up. Results All outcome measures improved significantly in either group toward one year after rhinoplasty (all with p value <0.05). Subjects in the CT group demonstrated greater improvement in the NOSE, VAS, and ROE compared to other two groups (NOSE: p value = 0.17; VAS: p value = 0.024; ROE: p value = 0.042). Conclusions According to our study, perioperative CT is associated with greater patients' satisfaction and quality of life after rhinoplasty compared to either nasal endoscopy or anterior rhinoscopy. A preoperative CT scan may improve the outcomes of rhinoplasty.

Secondary Cervicofacial Soft Tissue Reconstruction With Upper Trapezius Myocutaneous Flap in "Frozen Neck" With Bone Flap and Reconstructive Plate Exposure.

A frozen neck is a scarred neck with severe fibrosis with a loss of tissue planes secondary to prior irradiation with or without surgery. The purpose of this study was to evaluate the outcomes of cervicofacial reconstruction in patients with soft tissue defects and bone flap and reconstruction plate exposure with the upper trapezius myocutaneous flap. Fifteen oncologic patients with prior surgery and radiotherapy developed soft tissue dehiscence with bone and osteosynthesis material exposure. All patients had either a frozen neck or a vessel-depleted neck. The soft tissue defects were reconstructed, the osteosynthesis material was removed and the bone flap exposure was covered in all patients. One patient developed a seroma and 1 patient reported wound dehiscence. In terms of esthetic results, 6 patients referred a good esthetic result, whereas 8 patients referred a fair result and 1 patient a poor result. Two patients with prior radical neck dissection reported a poor functional result in the ipsilateral shoulder, previously to secondary reconstruction. Functional neck dissection was performed in 10 patients, 8 patients referred a good functional outcome and 2 patients reported a fair result. The upper trapezius flap is an extremely reliable source for secondary cervicofacial soft tissue reconstruction in "frozen neck." In comparison with other locoregional flaps, the upper trapezius flap fulfills all aesthetic and functional criteria for secondary cervicofacial soft tissue reconstruction.

Trapeziometacarpal osteoarthritis: Arthroscopic hemitrapeziectomy using the Thenar Portal

BackgroundAlthough the standard 1Radial and 1Ulnar portals allow for visualisation of most of the trapezium articular surface, the proximity of these two portals can often make arthroscopic triangulation and visualisation of the most lateral capsule and joint surface challenging. Despite its already reported advantages in improving visualisation, there is little literature reporting the clinical experience with the Thenar Portal. The purpose of this study is to describe potential complications and the short-term clinical-radiographic outcomes of arthroscopic hemitrapeziectomy using the Thenar Portal in order to determine its safety and efficacy as a standard working portal. Patients and methodsA retrospective chart review was conducted for all patients diagnosed with first carpometacarpal (CMC) osteoarthritis who were treated surgically with an arthroscopic hemitrapeziectomy. Only patients with stage II or III osteoarthritis and a minimum of 1-year follow-up were included. Twenty-two patients (24 thumbs) with an average age of 62 years met the inclusion criteria. The average follow-up was 52 months. Intra-operative and post-surgical complications were recorded. Objective evaluation consisted of an assessment of range of motion (ROM), grip and pinch strength. Subjective evaluation consisted of a DASH questionnaire and the visual analog scale to score pain at rest, during activities, and function. ResultsThere were no intra- or post-surgical complications. In one case, pain persisted with a poor functional result, requiring a revision surgery. Average range of motion (compared with the contralateral) showed a statistically significant improvement in palmar abduction and radial abduction of the CMC joint: 50° vs. 55° (p=0.01235), and 50° vs. 55° (p=0.06009), respectively. There was no statistically significant improvement in thumb adduction, grip strength, or lateral and tip-pinch. All patients achieved retropulsion with their affected thumb. According to the VAS, average rest pain improved from 7.5 to 0 (p<0.001) and from 9 to 0 (p<0.001) during activity. The average final function and QuickDASH were 9 (VAS) and 8, respectively (p<0.001). The average radiographic proximal migration of the first metacarpal was 2.9mm (range: 0.7–5.8mm). DiscussionArthroscopic hemitrapeziectomy using the Thenar portal: 1) improved visualisation of the trapeziometacarpal joint, 2) facilitated arthroscopic triangulation, and 3) represents a safe and effective alternative for the treatment of thumb osteoarthritis, with pain relief and function improvement in most patients without a higher risk of complications. Level of evidenceIV.

Functional outcomes of patients undergoing successful redo surgery after failed primary colorectal or coloanal anastomosis for rectal cancer

BackgroundAfter a failure of a colorectal or coloanal anastomosis, redo anastomotic surgery aims to avoid the risk of permanent stoma but, overall, to provide a satisfactory functional result and quality of life. Very limited data exist regarding the long-term results after a successful redo anastomosis. The present study aimed to report the long-term functional outcomes and quality of life in patients after a successful redo colorectal anastomosis or coloanal anastomosis. MethodsBetween 2007 and 2018, all patients who had a successful restoration of bowel continuity after a failed primary anastomosis performed for a rectal cancer were included. Functional outcomes and quality of life were assessed using the low anterior rectal syndrome score and the Gastrointestinal Quality of Life Index. ResultsOne hundred and twenty-seven patients were eligible for inclusion in this study, with long-term functional outcomes assessed in 73 patients (57%). After a median follow-up of 69 months, 31 patients presented no or minor low anterior rectal syndrome (42%), whereas 31 patients reported a major low anterior rectal syndrome (42%). A definitive stoma was confectioned in 11 patients (15%), despite the technical success of redo anastomosis due to poor functional results. Only operative interval <36 months was associated with a poor functional outcome (P = .001), whereas all other factors such as pelvic radiotherapy were not (P = .848). An absence of major low anterior rectal syndrome was the only factor associated with improved quality of life (P = .001). ConclusionAfter successful redo colorectal anastomosis or coloanal anastomosis, good functional outcomes can be achieved in almost half of patients with a well-preserved quality of life but requires a prolonged postoperative period of rehabilitation.

Results and complications of head-preserving techniques in chronic neglected shoulder dislocation: a systematic review

Humeral head-preserving procedures may be needed for chronic neglected shoulder dislocation because the presenting age of the patient is often reported to be less than 45 years. The aim of this systematic review was to evaluate the results of the various head-preserving procedures for chronic anterior dislocation (CAD) and chronic posterior dislocation (CPD). This review also aimed to evaluate the results of conservative neglect for CAD. PubMed, Embase, and Cochrane library databases were queried for studies that reported on results of head-preserving procedures for CAD or CPD and for studies that reported on the results of conservative neglect for CAD. Case reports, review articles, acute dislocations, and fracture-dislocations were excluded. The results of the different techniques were pooled for further evaluation. Seventeen studies were selected for qualitative analysis. These were further subdivided into 9 studies for the CAD group and 11 studies for the CPD group. In the CAD intervention group, 53 shoulders in 7 studies were managed by 5 different head-preserving techniques. The choice of procedure to stabilize the shoulder after open reduction varied between coracoid transfer, capsulolabral repair, remplissage, and Putti-Platt procedure and acromiohumeral K-wire fixation. High resubluxation rates and early arthrosis were reported after open reduction techniques for CAD. In the CAD conservative group, 8 shoulders in 2 studies were managed by conservative methods. In the CPD group, the 2 most common techniques, McLaughlin or modified McLaughlin and bone grafting, were used to treat 74 shoulders in 7 studies and showed good functional outcomes. The choice of open reduction and stabilization technique for CAD was highly variable between the different studies and led to a wide variation in the reported outcomes with a high number of complications such as resubluxation and early arthrosis. The conservative treatment of CAD led to poor functional results. The choice of treatment for CPD was mostly between 2 techniques-McLaughlin and modified McLaughlin reconstruction or the bone graft reconstruction-and they consistently led to good functional outcomes with less complications.

Comparing Outcomes between Arthroscopic-Assisted Reduction and Fluoroscopic Reduction in AO Type C Distal Radius Fracture Treatment.

Background Distal radius fracture is one of the most common injuries. Poor functional result with restricted wrist motion can be developed when there is intra-articular fibrous tissue development arising from articular step-off and gapping. Objectives The aim of this study is to compare the functional and radiological outcome between arthroscopic-assisted reduction and fluoroscopic reduction in treating unstable intra-articular distal radius fracture. Methods We retrospectively analyzed 12 patients with intraarticular AO type C distal radius fracture treated with arthroscopic-assisted fracture reduction and internal fixation and compared them with another group of 12 patients in which fracture reduction is assessed by fluoroscopy alone (15 males and 9 females, mean age 57.3, range 27-73). The two cohorts were analyzed for differences in radiological parameters including articular stepping and gapping, palmar tilt, radial inclination, ulnar variance as well as functional outcome in range of motion, grip strength, modified mayo wrist score, and Quick Disabilities of the Arm, Shoulder, and Hand (DASH) score at an average of 12.5 months (range 5-26) after surgery. Results Arthroscopic-assisted fracture reduction group has statistically better restoration of articular stepping and gapping, volar tilt and ulnar variance. Range of motion, grip strength, modified mayo wrist score and Quick DASH score also had statistically significant improvement in arthroscopic group. Conclusion Our study showed arthroscopic-assisted technique can precisely restore radiological parameters in highly comminuted distal radius fracture with good functional outcome. Also, associated intra-articular soft tissue injury can be detected and treated simultaneously. Level of Evidence This is a level III, retrospective cohort study.

Prognostic factors for intramedullary nailing in radial neck fracture in children

IntroductionRadial fracture accounts for 1% of fractures in children. It is potentially serious, and treatment is controversial. Several studies assessed prognostic factors, only one of which used exclusive intramedullary nailing, despite this being the gold standard. HypothesisOpen surgery provides poor functional results in radial neck fracture. Material and methodAll patients undergoing reduction and internal fixation of radial neck fracture between 2005 and 2015 were analysed. Inclusion criteria comprised Jeffery type 1 fracture with open growth plate, complete file, and ≥1 year's follow-up. Treatment systematically comprised Métaizeau intramedullary nailing, with crossover to open reduction only in case of failure. Good results were defined as full range of motion and pain-free elbow. ResultsFifty-six patients were included: 33 girls, 23 boys; mean age, 9 years. On the Judet classification modified by Métaizeau, 4 fractures were grade 2, 29 grade 3, 15 grade 4A and 8 grade 4B. Closed reduction was performed in 48 cases, including 8 with the help of percutaneous leverage effect. Eight required a surgical approach. Twenty-three showed postoperative reduction defect. At a mean 74 months’ follow-up, at a mean age of 15 years, 37 patients had reached full skeletal maturity. Sixteen had poor results. Open reduction was associated with poor outcome (p<0.01). Age, initial epiphyseal tilt, associated lesions, immobilisation time, time to nail removal and residual tilt after reduction did not significantly affect outcome (p-values>0.05). Percutaneous leverage effect had no impact on the quality of results (p=1). DiscussionOpen reduction is to be avoided in radial neck fracture. A prospective study is needed to assess remodelling potential according to age. Level of evidenceIV, retrospective study.

Ankle Arthroscopy in Acute Ankle Fractures: Does It Make Sense?

Introduction: Displaced ankle fractures require surgery, bone healing generally occurs with satisfactory outcomes. In some cases, poor results are recorded related to posttraumatic arthritis or other complications. Occult lesions (osteochondral lesions, loose bodies, impingement syndrome) may be among the common causes of unsatisfactory outcomes. Most of them may be detected by a computed tomography (CT) scan at the emergency room; however, such evaluation is not routinely performed. The aim of this study was to evaluate the clinical results of patients undergoing open reduction and internal fixation (ORIF) and ankle arthroscopy for fractures associated with intra-articular lesions. Materials and Methods: Among 397 patients evaluated for displaced ankle fracture, we selected 13 patients who also presented with intra-articular alterations at the CT scan performed in the Emergency room. All subjects underwent ORIF and arthroscopy. Patients were evaluated by NRS and AO-FAS score for at least of 1-year of follow-up. Results: The mean follow-up was 2.7 years; all fractures fully healed. The mean age at the time of surgery was 33.5 years. A single complication was recorded (complex regional pain syndrome, healed 6 months after surgery). All subjects reported satisfaction with improvements of the scores and return to their daily life activities. Discussion: Occult injuries associated with ankle fractures should be suspected and ruled out by a CT scan at the emergency room. Probably many occult injuries are underestimated because CT scan is not commonly performed, explaining cases of bone healing but poor functional results. In case of confirmation, these alterations should be treated in association with ORIF; arthroscopy may represent a valid and minimally invasive procedure, with low rates of complications.

Acute compartment syndrome of the lower limb following childbirth: a case report

BackgroundAcute compartment syndrome is a limb-threatening and occasionally life-threatening emergency that is rarely reported as a complication following childbirth. Prompt diagnosis is crucial to avoid permanent functional restriction or even the loss of the affected limb. Clinical signs and symptoms might be nonspecific, especially in the early stages; therefore, knowledge of predisposing risk factors and signs and symptoms of acute compartment syndrome is necessary to prevent long-term complications and amputation.Case presentationThis paper presents a case of a 26-year-old primiparous Sri Lankan woman who developed acute compartment syndrome of the lower right limb following childbirth by cesarean section.ConclusionAcute compartment syndrome is an important differential diagnosis in the setting of sudden onset of lower limb pain following childbirth. Predisposing factors for its manifestation within an obstetric environment are augmented labor, the lithotomy position, postpartum hemorrhage, hypotension following epidural analgesia, and the use of vasoconstrictive agents. If left undiagnosed and untreated, acute compartment syndrome may cause permanent neurovascular deficit, leading to a poor functional result, tissue ischemia, limb amputation, and rhabdomyolysis. If severe, and in large compartments, it can lead to renal failure and death. Alertness and a high index of clinical suspicion for the possibility of acute compartment syndrome are required to avoid a delay in diagnosis, and intracompartmental pressure measurement can be used to confirm the diagnosis.

To evaluate the outcome of Ilizarov ring fixator using hybrid technique in Tibial trauma

Introduction: The management of infected nonunion of the tibia is challenging, particularly with segmental bone loss, multiple draining sinuses, poor soft tissue cover, osteopenia, adjacent joint stiffness, limb deformity, or multidrug-resistant polymicrobial infection. The Ilizarov method permits early rehabilitation and addresses all the problems such as non-union, infection, shortening, soft tissue loss and deformity simultaneously at single stage. The conventional all wire Ilizarov frame has certain disadvantages when done in diaphysis such as Muscle and tendon transfixation which leads to pain and contracture of adjacent joints, neurovascular injury and patient discomfort. Half pins used in hybrid Ilizarov causes minimal transfixation of the surrounding soft tissues and neurovascular injury thus causing less morbidity and increased range of motion. Methods: The present study was a prospective randomized open study in which aim was to evaluate outcome of Ilizarov ring fixator using Hybrid technique in tibial trauma. The study was conducted in 30 skeletally mature patients in Department of Orthopaedics, SGRD University of health sciences, Amritsar from July 2017 to May 2019. The patients were assessed clinically based on history and physical examination. Radiological evaluation using plain antero-posterior and true lateral radiographs of the involved leg was done and evaluated by ASAMI score and complications. Results: Mean age was 37.7 years. Out of 30 cases 24(80%) were male and 6(20%) were female. Right tibia was involved in 24 cases out of 30 cases. 29 cases had history of road side accident and 1 had history of fall from height. The bone results were excellent in 21 cases (70%), good in 6 cases (20%), fair in 2 cases(6.67%) and poor in 1 case(3.33%). Functional results were excellent in 17 cases (56.67%), good in 9 cases (30%) and fair in 4 cases (13.33%). No poor functional result was noted. In present study following complications were noted, limp in 12 cases(40%), ankle stiffness in 7 cases(23.33%), pin site infection in 9 cases(30%), limb oedema in 7 cases(23.33%), knee stiffness in 3 cases(10%), loosening of pins in 2 cases(6.67%), deformity in 2 cases(6.67%) and refracture in 1 case(3.33%). There was no complication of neurovascular injury, malunion, breakage of wires, axial deviation or limb length discrepancy. Conclusion: It is thus concluded in present study that with the use of hybrid Ilizarov fixator, bone results are same, functional results are better, post-operative pain is less, less neurovascular injury, decreased joint stiffness, increased range of movements as compared to conventional all wire Ilizarov fixator. Although studies state that pins increase the stiffness of the frame thus decreasing union rate, we found that union rate in hybrid Ilizarov fixator was same as compared to conventional all wire Ilizarov fixator. Thus we conclude that hybrid Ilizarov fixator is better than conventional Ilizarov fixator in all aspects. Keywords: hybrid ilizarov,half pins,ASAMI Score

SECEC Grammont Award 2017: the prejudicial effect of greater tuberosity osteotomy or excision in reverse shoulder arthroplasty for fracture sequelae

The aim was to evaluate risk factors for complications, revision, and mid- to long-term outcomes after reverse shoulder arthroplasty (RSA) implanted for proximal humeral fracture sequelae (PHFS). The radiographs of 98 patients (mean age, 68 years) who underwent RSA for the treatment of PHFS were reviewed at a minimum 5-year follow-up. PHFS were divided into 4 types according to the Boileauclassification: type 1 (46 cases), type 2 (6 cases), type 3 (12 cases), and type 4 (34 cases). The tuberosities underwent osteotomy in 28 cases and excision in 12 (all type 3 or 4 PHFS). The mean follow-up period was 8.4 years (range, 5-14 years). The functional results and rate of RSA survival without revision (85% vs. 100% at 10 years, P = .007) were significantly lower for types 3 and 4 vs. types 1 and 2. Overall, our findings showed that RSA for PHFS is not the panacea that surgeons once believed: At a mean follow-up of 8.5 years (range, 5-14 years), 59% of the patients in our series had fair or poor results. Patients who underwent tuberosity osteotomy or excision had lower functional results (adjusted Constant score, 69% vs. 88%; P < .001), more postoperative complications (32% vs. 9%, P = .003), and a higher revision rate (15% vs. 2%, P = .017). Patients who underwent tuberosity osteotomy or excision at the time of RSA were at risk of postoperative prosthetic instability and humeral stem loosening. The absence of the greater tuberosity at last radiographic follow-up was predictive of higher rates of complications and revisions, as well as a poorer final outcome. Previous fracture fixation was associated with a higher rate of complete tuberosity resorption (56% vs. 33%, P = .026)and with higher rates of postoperative complications (27% vs. 13%, P = .099) and reinterventions (17% vs. 2%, P = .018). The functional results and rates of complications and revision depend on the type of fracture sequelae and tuberosity management. Patients with more severe (type 3 and 4) fracture sequelae who undergo tuberosity osteotomy or excision are at risk of having a poorer functional result and higher rates of complications and revision with lower survival. Previous fracture fixation is also a prejudicial factor.

Locking compression plating for osteoporotic and peri-articular fractures: a short term outcome analysis

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Peri-articular and osteoporotic fractures of long bones are becoming more&lt;strong&gt; &lt;/strong&gt;common and are very challenging injuries to treat even for a veteran orthopaedician. In young patients, peri-articular fractures occur due to high-velocity injuries such as road traffic accidents, firearm injuries, and sports injuries while in elderly patients with osteoporosis it occurs usually due to low-velocity injury like fall during walking. The aim of the study is to analyze the short term results in terms of union and functional outcome for osteoporotic and periarticular fractures treated with locking compression plating.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This is a study conducted in the Department of Orthopaedics, Government Tiruvarur medical college. Tiruvarur. This study is a prospective study conducted in the Department of Orthopaedics from June 2017 to May 2018 with a sample size of 21 cases. The fracture is classified using the various classification systems earlier described.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Solid union was observed in 18 out of the 21 cases (86%) which are similar to other&lt;strong&gt; &lt;/strong&gt;studies. The range of movements attained at an average follow-up of 15.5 months was 87% of which 17 had excellent results, 2 had a good outcome, 1 had the fair outcome and 1 case had poor functional results.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; The results of our study have confirmed earlier reports that locking compression plates provide better fixation in osteoporotic fractures. The chances of implant failure are less as the screws are firmly positioned inside the bone.&lt;/p&gt;

A clinical-grade acellular matrix for esophageal replacement.

In pathologies of the esophagus such as esophageal atresia, cancers, and caustic injuries, methods for full thickness esophageal replacement require the sacrifice of healthy intra-abdominal organs such as the stomach and the colon and are associated with high morbidity, mortality, and poor functional results. To overcome these problems, tissue engineering methods are developed to create a substitute with scaffolds and cells. The aim of this study was to develop a simple and safe decellularization process in order to obtain a clinical grade esophageal extracellular matrix. Following the decontamination step, porcine esophagi were decellularized in a bioreactor with sodium dodecyl sulfate and ethylenediaminetetraacetic acid for 3days and were rinsed with deionized water. DNA was eliminated by a 3-hr DNase treatment. To remove any residual detergent, the matrix was then incubated with an absorbing resin. The resulting porcine esophageal matrix was characterized by the assessment of the efficiency of the decellularization process (DNA quantification), evaluation of sterility and absence of cytotoxicity, and its composition and biomechanical properties, as well as the possibility to be reseeded with mesenchymal stem cells. Complete decellularization with the preservation of the general structure, composition, and biomechanical properties of the native esophageal matrix was obtained. Sterility was maintained throughout the process, and the matrix showed no cytotoxicity. The resulting matrix met clinical grade criteria and was successfully reseeded with mesenchymal stem cells..

A New Reference to Evaluate Syndesmosis in Sagittal Plane Radiographs of the Ankle: The Lateral Posterior Ankle Ratio.

Confirmation of anatomical reduction of ankle syndesmosis is mandatory because improper reduction leads to poor functional results. Coronal plane evaluation of syndesmosis is well described in the literature, but there is little information about sagittal plane evaluation. We sought to evaluate the relationship of fibula and tibia in the sagittal plane and create a new reference that can be applied easily and reliably. Lateral ankle radiographs of 337 individuals with no history of ankle fracture were evaluated. A line was drawn between the anterior and posterior cortices of the distal lateral tibia, and the length of this line was measured (line 1). The distance between the anterior and posterior cortices of the fibula on this line was measured, and the center of this second distance was identified and marked. The posterior half of the fibular width was divided by line 1 and was named the lateral posterior ankle ratio (LPAR). Statistical analysis was performed by side and sex. Mean patient age was 38.6 years; mean LPAR was 0.48. There was a significant difference between men and women by age (P < .001) and LPAR (P = .01). There was no significant difference between right and left ankles by age (P = .63) and LPAR (P = .64). The LPAR was less than 0.40 in 6.8% of the radiographs, 0.40 to 0.50 in 57.9%, and greater than 0.50 to 0.60 in 32.9%. The LPAR should approximate 50% in normal lateral ankle images and, by extrapolation, after syndesmotic reduction.

Correction of persistent cloaca in children: experience and analysis of treatment results

Introduction. Cloaca is one of the most difficult to be corrected varieties of the pathology of the anorectal zone, occurring with a frequency of 1 case per 40 000–25 000 live births. Purpose: аnalysis of diagnostic methods and surgical correction, treatment outcomes of children with cloacal malformations. Materials and methods . The article analyzed 16 cases of surgical treatment of cloacal anomalies based on the Irkutsk Municipal Pediatric Clinical Hospital in Irkutsk for the period from 2008 to the present. Gender composition: girls – 14 (87,5%), genotype (46XX – 13; 46XX, del (6) – 1), boys – 2 (12,5%). Results. The most common cloacal anomaly was a persistent cloaca – 11 (68,8%), the extrophy of the cloaca was 4 – 25 (25%) and the posterior cloaca – 1 (6,25%) was much less common. Aggravated obstetric history was found in reliable data on the presence of teratogenic factors is associated with a lack of information on obstetric history. In 93,8% of cases, cloacal anomalies were combined with other congenital malformations. In 100% (11) of cases the posterior-sagittal anorectovaginourethroplasty was performed in its various modifications, including LAPassisted – 3 (27,3%). When evaluating long-term results, it was revealed that 3 (27,3%) patients developed chronic recurrent pyelonephritis, 2 (18,2%) had urinary incontinence and first-degree anal incontinence, 1 (9,1%) had sphincter-detrusor insufficiency and anal incontinence of 3 degrees. Conclusion. According to the authors, the issues of surgical strategy for the correction of cloacal anomalies remain unresolved. The morphology of blemish, the spectrum of concomitant pathology are important in the choice. The results of treatment in favorable cases should be considered quite satisfactory. However, in severe forms, poor functional results occur, which often requires repeated reconstructive interventions and long-term rehabilitation of patients.