Risk Of Soft Tissue Complications Research Articles

Percutaneous reduction and screw fixation of fracture neck talus

Fracture neck talus is a rare fracture represents about 1% of all fractures and usually due to high energy trauma. These fractures are usually associated with compromised soft tissues, concomitant skeletal fractures, or life threatening injuries. Talus has a tenuous blood supply which is affected by fracture displacement. Urgent fracture reduction±fracture fixation is mandatory. The associated injuries may make the conventional open reduction and internal fixation is impossible to be done in urgent base as it may impacts the already tenuous blood supply of talus increasing the risk of AVN and non union. Percutaneous fracture reduction and fixation can overcome this problem, and decrease complications associated with conventional open reduction and internal fixation. Between 2006 and 2008, 16 patients with talar neck fractures were operated on by percutaneous reduction of fracture and percutaneous fixation with 3.5mm cannulated screws. Injuries were classified according to modified Hawkins classification system. Patients were followed up over an average of 48 months. 87.5% of the patients were satisfied and resumed their preoperative activities. The mean AOFAS Hind Foot Scale was 89.25 points (range: 74-100) and no poor outcomes. Although the number of patients in this study is small, the results showed that, percutaneous reduction and fixation is a good treatment modality in treatment of fracture neck talus, especially in cases with increased risk of soft tissue complications and open reduction should be resort only when percutaneous reduction was failed.

Soft Tissue Complications After Pediatric Cochlear Implantation in Children Younger Than 12 Months

Children are undergoing cochlear implantation younger than ever before. There has been some concern that young children may have an increased risk of soft tissue complications than older age groups. We aim to review the major and minor soft tissue complications after pediatric cochlear implantation in the age group of younger than 12 months. Retrospective case review. Patients were identified from the cochlear implant program database of more than 1,000 children at the Hospital for Sick Children, Toronto, Canada. Demographic data, cause of hearing loss, and time of the onset of hearing loss were recorded. A total of 66 patients were identified (94 implants) in the age group of younger than 12 months. Of these, there was 1 minor complication (implanted at 8 mo)-skin infection around implant 14 days later treated with antibiotics. There were no major complications. Cochlear implantation in children younger than 12 months does not increase the risk of soft tissue complications.

Percutaneous Reduction and Injection of Norian Bone Cement for the Treatment of Displaced Intra-articular Calcaneal Fractures

The treatment of intra-articular calcaneal fractures remains controversial. Although open reduction and fixation are favored by many authors, increased risk of soft tissue complications makes this method of treatment a challenge. Conversely, conservative treatment frequently leads to severe functional impairment and disability. Percutaneous surgical techniques have been employed to reduce the incidence of soft tissue complications but carry the risk of inadequate reduction and fracture stabilization. Norian SRS bone cement is an injectable calcium phosphate cement. Recent clinical studies have demonstrated the safe use of Norian SRS bone cement to augment standard plate fixation of calcaneal fractures. The authors describe their method of combining a percutaneous technique of fracture reduction with stabilization using Norian SRS bone cement. A total of 10 patients with 12 displaced intra-articular calcaneal fractures underwent this method of treatment. All 12 cases achieved adequate reduction on postoperative radiographs. Full weight bearing was started at 1 month postoperation, and none of the cases demonstrated loss of reduction on serial postoperative radiographs. No wound complications or cement-related soft tissue reactions were encountered. A 6-month assessment using the visual analog scale, the Maryland Foot Score, and the Short Form 36 general health survey showed encouraging results. Early results of treating displaced intra-articular calcaneal fractures using this method of a percutaneous technique of fracture reduction combined with Norian SRS bone cement stabilization are encouraging and promising.

Limb salvage reconstruction of the ankle with fusion and simultaneous tibial lengthening using the Ilizarov/Taylor spatial frame.

Despite early appropriate treatment with modern orthopedic trauma surgery protocols, distal tibia and ankle injuries do not uncommonly result in posttraumatic ankle arthritis. Ankle fusion offers reliable pain relief and improved function for many of these patients [1]. Ilizarov reconstruction with ankle arthrodesis has been used successfully to treat the more complex ankle pathology in many cases as an alternative to amputation [2–7]. These complex fusions can be limb salvage undertakings, as the treatments are often complicated by the presence of bone loss, osteomyelitis, associated deformity, and a poor soft tissue envelope with compromised healing potential. Most of these patients had failed multiple previous surgeries including open reduction with plates and screws, attempted ankle fusion, total ankle replacement, and external fixation with limited internal fixation. Various techniques for achieving complex ankle fusion have been reported including fixation with crossed lag screws, a fixed angle plate and screws, retrograde intramedullary nailing, and external fixation [8–16]. Although all of these methods can be used to obtain bony union, bone loss remains a challenging problem in these patients. Leg length inequality commonly results in altered gait and symptomatic malalignment of the pelvis and spine. Large shoe lifts are difficult to manage and poorly tolerated, and compliance is low. The use of structural allografts with internal or external fixation has been advocated to reestablish length [17–19]. Problems with graft collapse, infection, and nonunion accompany this technique. Proximal tibial lengthening provides an alternative means of equalizing leg lengths and improving function and self-perception. The need to implant large devitalized bone graft at a compromised healing site is obviated by the use of the patients own bony regenerate at a separate lengthening site. This technique allows for bony contact at the fusion site without intervening graft that is thought to facilitate union. In cases of severe bone loss, acute shortening to obtain bony contact at the fusion site may not be possible, and bone transport may become necessary. The use of circular fixation for ankle fusion was first described by Ilizarov [20]. The rationale for using the Ilizarov frame is to provide fixed angle stable fixation of the bone fragments, a percutaneous approach that is particularly useful in the presence of poor skin, and avoid the use of internal implants in the presence of infection. Using these frames, chronic deformity can be corrected with reduced risk of soft tissue complications, compression can be maintained throughout the postoperative period, and limb function is preserved through early weight bearing and physical therapy. The Taylor spatial frame (TSF) is a newer version of the Ilizarov fixator and has greatly simplified our ability to combine fusion with gradual simultaneous deformity correction and/or lengthening. Lengthening at a proximal osteotomy site can be done at the time of ankle fusion or staged a few weeks later as the clinical situation dictates. Staged lengthening requires returning to the operating room (OR) for frame modification and osteotomy. In complex ankle arthrodesis, it is not uncommon to be faced with having to close a large defect that is not amenable to bone grafting. The Ilizarov/TSF can be used to simplify this otherwise daunting problem by performing a gradual shortening with or without simultaneous lengthening or bone transport.

Technique of Prone Ankle and Subtalar Arthroscopy

Intra-articular and periarticular lesions in the posterior aspect of the ankle and subtalar joints are challenging to address surgically. Open approaches to this area often require neurovascular dissection or malleolar osteotomies that may result in considerable postoperative pain and risk of soft tissue complications. Arthroscopy of the hindfoot in the prone position is a novel approach using posteromedial, posterolateral, and, if needed, accessory posterolateral portals. This approach has been successfully used for the treatment of various clinical entities with low complications. The key to its use is meticulous arthroscopic technique together with the awareness of important anatomical structures. Especially important are the flexor hallucis longus tendon, the posteromedial neurovascular bundles, and the sural nerve. This article describes the authors' preferred technique and its applications with literature reviews.

Minimally invasive plating for high energy tibial plateau fractures

目的 通过前瞻性研究了解微创钢板法治疗复杂胫骨平台骨折的临床效果.方法从 2002年 1月～ 2002年 10月共有 17例( 17膝)闭合性高能量胫骨平台骨折采用微创钢板法治疗.患者平均年龄 45.3岁 (20～ 66岁 );其中左膝 12例,右膝 5例;男 8例,女 9例.按 AO分型, 41 B型 3例, 41 C型 14例;按 Schatzker分型,Ⅱ型 2例,Ⅴ型 4例,Ⅵ型 11例.用改良内外侧联合切口,行微创钢板固定.术后 1、 3、 6个月及 1年随访患者,行摄片及关节活动度检查,测定胫骨平台内翻角( TPA)及胫骨平台后倾角( PA);术后 1年行膝关节 HSS评分.结果患者术后与术后 1年 TPA及 PA平均值的差异无显著性( TPA: t= 0.979, P=0.342; PA: t= 0.659, P=0.519).术后 1年膝关节 HSS评分平均为 88.7分( 75～ 98分).本组患者无深部感染及内固定失败.结论微创钢板技术具有手术创伤小,切口及软组织并发症明显减少,骨折固定及时,长期的稳定性良好,关节功能恢复满意等优点,是治疗高能量胫骨平台骨折安全、有效的方法.