Spur Removal Research Articles

Use of Perpendicular Plate of Ethmoid Split Technique in Rhinoplasty and Septoplasty.

In recent years, the perpendicular plate of ethmoid (PPE) has become a prominent choice for bone-grafting materials. This study introduces the PPE split technique for efficient removal of the bony septum or the harvesting of partial PPE for septal batten grafts in rhinoplasty and septoplasty, particularly suited for cases with thick PPE. Herein, this technique was employed to minimize septal defects and prevent complications while achieving harvested bony grafts of the desired effective thickness. In this retrospective study, 36 patients underwent surgery using the PPE split technique (22 septoplasties and 14 rhinoplasties). The procedure involved detaching the PPE from the septal cartilage and performing a vertical plane osteotomy with a number 10 scalpel blade to remove bony spurs or prepare batten grafts. Paranasal sinus CT revealed that the average anteroinferior PPE thickness was 3.46 mm. This technique was used for both bony batten graft harvesting (26 cases) and bony spur removal, and septum reshaping (10 cases). Successful PPE harvesting was achieved in all cases except for three, which experienced graft breakage. This study demonstrates the viability and effectiveness of the PPE split technique as a supplementary maneuver in septoplasty and rhinoplasty procedures. Its diverse applications include reshaping, correcting deviated septum, harvesting bony batten grafts, and providing support for an aesthetically pleasing nasal profile.

Biplanar Acromioplasty: An Arthroscopic Spur Removal Technique Based on Original Bony Landmarks

In this study, we introduce an arthroscopic acromioplasty technique based on original bony landmarks, namely biplanar acromioplasty. This technique focuses on smoothing both the coronal and transverse plane of acromion, corresponding to the anterior and inferior acromial surface, and restores the acromion to its original shape. We believe this technique is effective, time-saving, and reproducible.

Characterizing Cleft Rhinoplasty Across Skeletal Maturity: A Systematic Review of Terminology and Surgical Techniques.

The purpose of this study is to assess cleft rhinoplasty terminology across phases of growth. A systematic review was performed on cleft rhinoplasty publications over 20 years. Studies were categorized by age at surgical intervention: infant (<1 year); immature (1 to 14 years); mature (>15 years). Collected data included terminology used and surgical techniques. The 288 studies included demonstrated a wide range of terminology. In the infant group, 51/54 studies used the term "primary." In the immature group, 7/18 studies used the term "primary," 3/18 used "secondary." In the mature group, 2/33 studies used the term "primary," 16/33 used "secondary," 2/33 used "definitive," 5/33 used terms such as "mature," "adult," and "late," and 8/33 did not use terminology. cleft rhinoplasty at infancy used nostril rim or no nasal incision, immature rhinoplasty used closed and open rhinoplasty incisions; and mature rhinoplasty used a majority of open rhinoplasty. Infant and immature cleft rhinoplasty incorporated septal harvest or spur removal in <10% of cases, whereas these procedures were common in mature rhinoplasty. No studies in infants or immature patients used osteotomies or septal grafts, common techniques in mature rhinoplasty. Current terminology for cleft rhinoplasty is varied and inconsistently applied across stages of facial development. However, cleft rhinoplasty performed at infancy, childhood, and facial maturity are surgically distinct procedures. The authors recommend the terminology "infant," "immature," and "mature" cleft rhinoplasty to accurately describe this procedure within the context of skeletal growth.

A Case of Empty Nose Syndrome Developed After Septal Spur Removal

Empty nose syndrome (ENS) is a rare complication of turbinate surgery, in which patients suffer from symptoms such as paradoxical nasal obstruction, nasal dryness, facial pain and feeling excessive nasal openness. Its occurrence is generally attributed to excessive turbinate reductive procedures. However, theoretically, any procedure which can cause increased nasal airflow and decreased nasal resistance may have a risk of causing ENS. We recently experienced a case of ENS developed after septal spur removal without turbinate reduction, which has not previously been reported in the literature. Here we present the case history of this unusual occurrence.

Electric Drilling versus Cold Steel Instruments in Correction of a Spur of the Maxillary Crest of the Nasal Septum

Objective: To compare electric drilling versus cold steel instruments in management of spur of maxillary crest of the nasal septum regarding operative details and postoperative complications.Patients and Methods: This was a prospective comparative study evaluating two techniques for management of spur of maxillary crest of the nasal septum. Patients of the study were divided into two groups 32 patients each. In group I, the spur of the maxillary crest was removed using surgical instruments. In group II, the spur was removed using electric drilling. The two groups were compared regarding duration of maxillary crest spur removal, the amount of blood loss, the incidence of unilateral and bilateral flap injury, the incidence of anesthesia of the upper incisors and the incidence of septal perforations.Results: In the current study, operative blood loss was less in group II with a highly significant difference (p =0.0002). However, operative duration was less in group I with a highly significant difference (p < 0.0001). There was a non-significant difference between the two groups regarding flap injury with higher incidence in group I (p = 0.6). The incidence of upper incisors anesthesia was significantly more in group I (p = 0.03). There was a non-significant difference regarding the incidence of septal perforation (p =1).Conclusion: Both techniques are effective for correction of spurs of the maxillary crest with significantly better control of intraoperative bleeding and less postoperative central incisors anesthesia with electric drilling. However, the drilling technique consumed significantly more time.

Retrocalcaneal Spur Removal and Achilles Tendon Reattachment for the Treatment of Haglund Deformity

Insertional Achilles tendinopathy frequently involves intratendinous calcification of the Achilles tendon insertion and a prominent superolateral calcaneus tuberosity known as a Haglund’s deformity. The incidence of insertional Achilles tendinopathy is up to 30%, affecting both recreational and elite athletes. The indications for surgical treatment of insertional Achilles tendinopathy is appropriate when a patient’s symptoms are recalcitrant to nonoperative therapies. Advancements in surgical treatment include the utilization of the midline longitudinal incision, improved soft tissue handling, and minimizing the detachment of the Achilles tendon insertion during surgery. Surgical treatment includes removal of the Haglund’s deformity, debridement of the Achilles insertion, and bone to tendon repair utilizing a double-row suture anchor construct. The authors are presenting a unique surgical technique for Haglund’s deformity excision, Achilles debridement, and repair without flexor hallucis longus augmentation. Level of Evidence: Diagnostic Level V. See Instructions for Authors for a complete description of levels of evidence.

Endoscopic fasciotomy for plantar fasciitis provides superior results when compared to a controlled non-operative treatment protocol: a randomized controlled trial.

Plantar fasciitis is a frequent and painful condition with a lifetime incidence of 10%. Good results have been reported for operative treatment of plantar fasciitis refractory to non-surgical interventions in uncontrolled studies. The aim of this study was to compare the results of operative treatment (endoscopic debridement, removal of the heel spur and partial resection of the plantar fascia) with those of a controlled and supervised non-operative rehabilitation program. Thirty consecutive patients with plantar fasciitis during more than 3months were randomized to either (1) non-operative treatment with corticosteroid injections and a controlled strength training program or (2) an endoscopic 2-incision operation with partial fasciotomy and heel spur removal followed by the same strength training program. Patients were evaluated at entry and 3, 6, 12 and 24months post-operatively with the foot function index (FFI) and pain score during activity on a 100mm VAS scale (VAS activity). FFI at 6 and 12months was defined a priori as primary endpoint. Both groups improved significantly over time. The FFI score was significantly better in the operated group compared to the non-surgically treated group 12months post-operatively (p = 0.033), at 24months this was, however, not significant (p = 0.06). VAS activity at 24months was significantly (p = 0.001) in favor of the operative group. More patients returned to running and jumping in the operative group (p = 0.04). This randomized controlled trial found significant and clinically relevant superior results for the operative treatment of plantar fasciitis as measured by Foot Function Index at 1year and by VAS activity at 2-year follow-up when compared to the results of a supervised rehabilitation program. I.

Plantar fasciitis treated with endoscopic partial plantar fasciotomy—One-year clinical and ultrasonographic follow-up

BackgroundEndoscopic operations for plantar fasciitis generally have good clinical outcome. The aim of this study was to record the effect of endoscopic partial fasciotomy and heel spur removal and evaluate by ultrasonography whether the fascia regenerates and the heel spur reforms. MethodsEleven consecutive patients were evaluated before and 3, 6 and 12 months after surgery. Operations were performed endoscopically using a deep fascial approach with a medial and a lateral portal. Bony spurs were removed and the medial half of the plantar fascia was transected. All patients followed a standardized rehabilitation program. ResultsMedian Foot Function Index values decreased from 119 pre-surgery to 69 and 12 (p=0.004), at 3 months and 1year post-operatively respectively. Median VAS-score for first step pain was likewise reduced from median 71mm to 29mm and 7mm (p=0.004), respectively. Median fascial thickness at the medial insertion was 6.0mm (range 4.6–6.8mm) pre-operatively. A heel spur was present in 9 cases. One year postoperatively a well-defined fascia in the area of resection was demonstrated in 8 cases. In the rest of the cases scar tissue made it impossible to clearly outline the fascia. Nine of the feet showed good medial fascial tensioning. There was no evidence of recurrence of the bony spur. ConclusionsEndoscopic partial plantar fascia resection reduced pain symptoms and increased function significantly 3 months after operation, with additional effect achieved 12 months after surgery. Based on ultrasonography the resected fascia regenerated/healed, and a calcaneal spur did not recur.

The early term functıonal results of calcaneal spur removal, calcaneal drilling and plantar fascıa release combined technıques ın painful heel syndrome

The early term functıonal results of calcaneal spur removal, calcaneal drilling and plantar fascıa release combined technıques ın painful heel syndrome

Surgical Outcomes for Resection of the Dorsal Exostosis of the Metatarsocuneiform Joints

A retrospective case series testing the efficacy of surgical resection of the dorsal exostosis deformity of the metatarsocuneiform joints was performed. Surgery was performed in 26 consecutive patients (28 feet), in whom previous conservative therapy had failed. All 26 patients had bursitis at the level of the dorsal exostosis deformity. The patients were separated into 2 groups: group 1, those with bursitis and neuritis before surgery (n = 13; 46.4%), and group 2, those with bursitis without neuritis (n = 15; 53.5%). Both groups were evaluated using an 11-point visual analog scale administered preoperatively and ≤1 year postoperatively. The mean pain rating in the patients with neuritis and bursitis before surgery (7.31 ± 2.8) and in those with bursitis without neuritis (6.67 ± 3.4) had both decreased to 0 at 6 months and 1 year after surgery. After surgery, 7 patients (25.2%) experienced neuritis. Of these 7 patients, 4 (57.1%) had continuation of neuritis that was present before surgery and 3 (42.9%) had an onset of neuropraxia that was secondary to the surgery itself. This might have resulted from retraction of the nerves during spur removal. Eventually, all the cases of neuritis resolved. One patient (3.6%) experienced regrowth of their dorsal exostosis deformity, 1 (3.6%) developed an abscess at the surgical site, and 1 (3.6%) developed pain elsewhere at the Lisfranc joint. All patients were subsequently treated at our institution and were pain free and had returned to full activity within 1 year. These results suggest that resection of the dorsal exostosis deformity of the metatarsocuneiform joints is an effective surgical procedure for patients with this deformity.

Classification of Calcaneal Spurs and Their Relationship With Plantar Fasciitis

Calcaneal spurs, as a cause of plantar fasciitis, are currently debatable. A prospective study was performed to classify calcaneal spurs according to the findings from an investigation of the relationship between calcaneal spurs and plantar fasciitis. Thirty patients with calcaneal spurs and plantar heel pain underwent calcaneal spur removal and endoscopic plantar fasciotomy. The relationship between the classification of calcaneal spurs and plantar fasciitis was evaluated by endoscopic findings, clinical symptoms, radiographic images, and biopsy findings. The visual analog scale for pain and the American Orthopedic Foot and Ankle Society ankle-hindfoot scores for functional evaluation were used preoperatively and postoperatively, respectively. The mean follow-up period was 24 months. Two separate types of calcaneal spurs were recognized. Type A calcaneal spurs were located superior to the plantar fascia insertion, and type B calcaneal spurs were located within the plantar fascia. Magnetic resonance imaging results showed a more severe plantar fasciitis grade in type B calcaneal spurs preoperatively. Histologic examination showed that the numbers of granulocytes per image in type B spurs were significantly increased compared with those in type A spurs. Statistically significant improvements were found in the mean visual analog scale and American Orthopedic Foot and Ankle Society scores and magnetic resonance imaging results in both groups. The amount of change in the visual analog scale score and American Orthopedic Foot and Ankle Society score, the number of granulocytes per image, and calcaneal spur length showed a high association with the classification of the calcaneal spurs. Calcaneal spurs were completely removed and did not recur in any of the patients on radiographic assessment during the follow-up period. Calcaneal spurs can be classified into 2 distinct types that are indicative of the severity of plantar fasciitis.

SU‐E‐J‐182: A Feasibility Study Evaluating Automatic Identification of Gross Tumor Volume for Breast Cancer Radiotherapy Using Dynamic Contrast‐Enhanced MR Imaging

Purpose:To develop a computerized pharmacokinetic model‐free Gross Tumor Volume (GTV) segmentation method based on dynamic contrastenhanced MRI (DCE‐MRI) data that can improve physician GTV contouring efficiency.Methods:12 patients with biopsy‐proven early stage breast cancer with post‐contrast enhanced DCE‐MRI images were analyzed in this study. A fuzzy c‐means (FCM) clustering‐based method was applied to segment 3D GTV from pre‐operative DCE‐MRI data. A region of interest (ROI) is selected by a clinician/physicist, and the normalized signal evolution curves were calculated by dividing the signal intensity enhancement value at each voxel by the pre‐contrast signal intensity value at the corresponding voxel. Three semi‐quantitative metrics were analyzed based on normalized signal evolution curves: initial Area Under signal evolution Curve (iAUC), Immediate Enhancement Ratio (IER), and Variance of Enhancement Slope (VES). The FCM algorithm wass applied to partition ROI voxels into GTV voxels and non‐GTV voxels by using three analyzed metrics. The partition map for the smaller cluster is then generated and binarized with an automatically calculated threshold. To reduce spurious structures resulting from background, a labeling operation was performed to keep the largest three‐dimensional connected component as the identified target. Basic morphological operations including hole‐filling and spur removal were useutilized to improve the target smoothness. Each segmented GTV was compared to that drawn by experienced radiation oncologists. An agreement index was proposed to quantify the overlap between the GTVs identified using two approaches and a thershold value of 0.4 is regarded as acceptable.Results:The GTVs identified by the proposed method were overlapped with the ones drawn by radiation oncologists in all cases, and in 10 out of 12 cases, the agreement indices were above the threshold of 0.4.Conclusion:The proposed automatic segmentation method was shown to be promising and might be used to improve physician contouring efficiency.J Horton receives grant from NIH and Varian Medical Systems; F‐F Yin receives grant from Varian Medical Systems

Hallux valgus interphalangeus deformity: A case series in the pediatric population

The objective of this report is to describe three cases (four feet) of hallux valgus interphalangeus deformity in the pediatric population. A retrospective review was completed to identify three patients (four feet) with a deformity consistent with hallux valgus interphalangeus. Patients were followed at regular intervals for a minimum of 6 months. Treatment modalities and clinical results were reviewed for all patients for this relatively rare entity in the skeletally immature population. All patients in this report had a deformity that was not consistent with a traumatic etiology. Case number 1 had a significantly symptomatic deformity that failed conservative treatment, and eventually necessitated full surgical correction of the deformity. Symptom free unrestricted activity was obtained post-operatively, however final follow-up radiographs have demonstrated early changes consistent with arthritis. Case numbers 2 & 3 were relatively asymptomatic throughout their course of treatment, and responded well to non-operative intervention. Based on these findings excision of the exostosis and soft-tissue realignment appears to be a reliable option for symptom relief for patients who present with a painful symptomatic hallux valgus interphalangeus deformity. However, the risk of degenerative changes following spur removal must be entertained prior to the procedure. On the contrary a pain free deformity that does not impact functionality of toe, or impair shoe ware may be treated successfully with conservative measures.

Endoscopic plantar fascia release, calcaneal drilling and calcaneal spur removal for management of painful heel syndrome

Background The pathogenesis of painful heel syndrome is multifactorial including plantar fasciitis, increased intra-osseous pressure of the os calcis, calcaneal periostitis and presence of calcaneal spur. The currently used endoscopic treatment of painful heel syndromes involves endoscopic plantar fascia release alone without addressing other pathological changes. Objectives To evaluate the clinical outcome of endoscopic plantar fascia release, calcaneal drilling and calcaneal spur removal. Methods The study was conducted on 22 cases/24 feet with idiopathic painful heel syndrome resistant to conservative treatment. All cases were treated by plantar fasciotomy; calcaneal drilling and calcaneal spur removal using a modified cannula trocar system. Evaluation of pain was done using VAS and functional evaluation was done using the Modified Mayo Scoring System for Plantar Fasciotomy. Also patient's satisfaction was evaluated by direct questionnaire. Results There was statistically significant improvement in the mean VAS from 82.81 (±7.8 std) preoperative to 6.63 (±2.75 std) and the Mayo score form 7.05 (±3.67 std) preoperative to 87.5 (±4.81 std) at 2 years follow up ( P < 0.05). The satisfaction rate was 85% with no major complications. Conclusion Endoscopic plantar fascia release with calcaneal drilling and calcaneal spur removal has high success rate and patient's satisfaction rate when compared to published reports on isolated endoscopic plantar release.

Application of Active Contours on Metallurgical Microstructures

Employing computer algorithms for finding and outlining the boundaries between phases or grain boundaries (referred to as edge detection) is a widely used technique employed as an intermediate step in microstructure analysis. Having an outlined region of interest enables the user to extract data about the region or use it in the reconstruction of three-dimensional models. Because traditional edge detection relies on a user-selected threshold value, the results often are subjective. Furthermore, traditional edge detection frequently results in outlines that are incomplete, requiring additional processing steps, such as edge linking and spur removal. Active contouring is an edge-detection-based technique that typically yields results superior to that of a traditional edge detector. High noise tolerance and built-in flexibilities of active contours make the technique desirable to use across a broad range of applications. Although initially used for meteorological applications, several uses of active contours are presented for metallurgical microstructural data obtained using optical and electron microscopies to demonstrate robustness and the range of applications that can employ active contours.

Rock joint image segmentation based on fractional differential and multi-grade combination in mathematical morphology

Rock joint network is very complex and there is much noise in a rock image.The traditional image segmentation methods cannot obtain satisfactory results.A new edge detection algorithm was proposed based on fractional differential and multi-grade synthesis of mathematical morphology.It needs to pretreat the rock fracture image first by image processing operation such as noise filtering,image segmentation,cavity filling,spur removal,etc.Then fractional differential algorithm and multi-grade synthesis of mathematical morphology were used to get the results.The experimental results,compared with the traditional morphological methods,show that the studied algorithm maintains good detected edges of rock joint images and can increase the denoising power as well.

In-office laser septal spur removal

In-office laser septal spur removal

Rock fracture skeleton extract based on ultraviolet image

To extract skeleton based on ultraviolet rock fracture image using digital image processing technique,it needs to pretreat the rock fracture image first by image processing operation such as noise filtering,image segmentation,cavity filling,spur removal etc.Then an algorithm based on the structural elements of the layers thinning was proposed on the basis of the analysis of the skeleton characteristic and the skeleton of extraction algorithm.This algorithm can extract rock fractures of the skeleton very well.The experimental results show that the algorithm can extract a better skeleton of rock fracture efficiently and steadily.

In‐Office Laser Septal Spur Removal

In‐Office Laser Septal Spur Removal

Variations in the origin of the medial calcaneal nerve.

Previous anatomic studies of the medial heel region were done on embalmed human cadavers. Here, the innervation of the medial heel region was studied by dissecting living tissue with the use of 3.5-power loupe magnification during decompression of the medial ankle for tarsal tunnel syndrome in 85 feet. The medial heel was found to be innervated by just one medial calcaneal nerve in 37% of the feet, by two medial calcaneal nerves in 41%, by three medial calcaneal nerves in 19%, and by four medial calcaneal nerves in 3%. An origin for a medial calcaneal nerve from the medial plantar nerve was found in 46% of the feet. This nerve most often innervates the skin of the posteromedial arch, where it is at risk for injury during calcaneal spur removal or plantar fasciotomy. Knowledge of the variations in location of the medial calcaneal nerves may prevent neuroma formation during surgery and provide insight into the variability of heel symptoms associated with tarsal tunnel syndrome.