scholarly journals Vector Appropriate Distraction and Reduction of a Neglected Trimalleolar Fracture-Dislocation Performed with a Temporary Intraoperative External Fixator

2021 ◽  
Vol 2021 ◽  
pp. 1-5
Author(s):  
Jordan Brand ◽  
Jay Moran ◽  
Brad Yoo
Keyword(s):  
Soft Tissue ◽  
Postoperative Complications ◽  
External Fixator ◽  
Care Plan ◽  
Fracture Dislocation ◽  
Acute Injuries ◽  
Anatomic Reduction ◽  
Patient Reported ◽  
Trimalleolar Fracture ◽  
Open Injuries

Traumatic fractures of the ankle can occur with concomitant tibiotalar dislocations, necessitating complex treatment. These injuries have higher rates of loose bodies, open injuries, postoperative complications, and worse patient reported outcomes compared to ankle fractures without dislocation. Patients with neglected or delayed presentations are associated with even higher rates of postoperative complications and worse outcomes compared to acute injuries. The chronicity of the injury leads to soft tissue contractures and malunited fractures, obligating a care plan which involves gradual reduction with a multiplanar external fixator with or without internal fixation at a later date. We discuss a 60-year-old homeless man who presented four weeks after an open trimalleolar fracture-dislocation and was definitely treated with an acute one-stage procedure. Anatomic reduction and stable fixation was achieved through a lateral malleolus osteotomy, soft tissue releases, TAL, and a temporary intraoperative external fixator. This technique was advantageous in this instance of anticipated patient noncompliance. We advocate for the judicious use of the described technique in similar challenging situations.

scholarly journals Tibiotalocalcaneal Intramedullary Nailing for Unstable Geriatric Ankle Fractures

2021 ◽  
Vol 12 ◽  
pp. 215145932110207
Author(s):  
Elif Kulakli-Inceleme ◽  
David B. Tas ◽  
Diederik P.J. Smeeing ◽  
Roderick M. Houwert ◽  
Nicole M. van Veelen ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Postoperative Complications ◽  
Intramedullary Nailing ◽  
Weight Bearing ◽  
Primary Treatment ◽  
Ankle Fractures ◽  
Fixation Method ◽  
Soft Tissue Envelope ◽  
Patient Reported ◽  
The Mean

Background: Tibiotalocalcaneal (TTC) intramedullary nailing has been suggested as an alternative to open reduction and internal fixation (ORIF) for the primary treatment of unstable fragility ankle fractures with a poor soft tissue envelope. This study aims to investigate the clinical efficacy of TTC intramedullary nail fixation for the primary treatment of unstable ankle fractures in frail elderly patients with poor soft tissue condition, by assessing the number of postoperative complications and the patient-reported functional outcomes. Methods: A retrospective cohort study was performed including patients with an unstable ankle fracture treated between 2015 and 2019 with TTC stabilization using a retrograde intramedullary hindfoot nail that was inserted without joint preparation and allowing immediate weight-bearing postoperatively. The primary outcome was the total number of postoperative complications. Results: A total of 10 patients were included out of 365 operatively treated ankle fractures. The mean age was 85.2 years (range 66-92) with a mean follow-up of 11.2 months (range 6-16). Fracture types included AO/OTA 44-B2 (n = 1), 44-B3 (n = 6), 44-C1 (n = 2) and 44-C3 (n = 1). Postoperative complications were observed in 4 patients (40%), including 3 nonunions, 2 implant related complications and 1 wound infection. No wound healing disorder or below-the-knee amputation was observed. Four patients (40%) deceased between post-operative 6 to 16 months due to medical conditions unrelated to surgery. The mean Foot and Ankle Outcome Score was 52.6 (range 44.2-73.8). Conclusion: Hindfoot nailingis a viable treatment option in selected high-risk patients with an advanced age, unstable ankle fractures with significant bone loss, poor soft tissue condition and/or severely impaired pre-injury mobility. In a frail geriatric population, hindfoot nailing may be a safe alternative fixation method with a low risk of wound complication or major amputation. However, unprepared joint may lead to symptomatic nonunion after TTC intramedullary nailing.

1239 Postoperative Complication Rate of Facial Injury Repairs Treated by Maxillofacial On-Call Team: Surgical Audit

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
G Dhanjal ◽  
M Ghouri ◽  
S Crank
Keyword(s):  
Soft Tissue ◽  
Postoperative Complications ◽  
Postoperative Complication ◽  
Complication Rate ◽  
Maxillofacial Surgery ◽  
General Anaesthetic ◽  
Facial Injury ◽  
Postoperative Complication Rate ◽  
Female Ratio ◽  
Facial Injuries

Abstract Introduction A significant aspect of Oral and Maxillofacial Surgery workload relates to trauma, particularly soft-tissue injuries. Contingent on the aetiology of injury, facial wounds require debridement and rapid closure to reduce risk of infection and degree of scarring. The aim was to identify possible risks and frequency of postoperative complications, including problems identified by patients following treatment of facial injuries by the Maxillofacial on-call team. Method Data was retrospectively collected from patients who sustained soft-tissue facial injuries treated by the Maxillofacial team and provided with follow-up appointments from January to August 2020. Computerised clinical notes were accessed to determine patient demographics, mechanism and site of injury, location and time of repair, operator grade and postoperative complications (if any). Results 153 patients required debridement and suturing of a facial injury under local or general anaesthetic. Among these, the male to female ratio was 65:35. 47% of facial injuries resulted from mechanical fall. Lips were found to be the most common site (31%) of injury. Postoperative complication rate was 8% within the 8-month period, with reports of infection, wound dehiscence and haematoma requiring further treatment. 58% of complications resulted from treatment carried out between 5pm-5am with a sole operator (DCT/SHO). 83% of complications followed treatment carried out within the Emergency Department rather than Maxillofacial clinical setting. Conclusion Following facial injury repair, just less than 8% of patients experienced complications, which required corrective treatment. Although facial injuries require immediate care, careful planning and performing treatment in a specialised setup may improve perioperative care, thus clinical outcomes.

A Prospective Randomised Control Trial Comparing Functional with Mechanical Axis Alignment in Total Knee Arthroplasty: study protocol for an investigator initiated trial

2021 ◽  
Author(s):  
Richard Steer ◽  
Beth Tippett ◽  
R Nazim Khan ◽  
Dermot Collopy ◽  
Gavin Clark
Keyword(s):  
Total Knee Arthroplasty ◽  
Soft Tissue ◽  
Knee Arthroplasty ◽  
Functional Outcomes ◽  
Medical Information ◽  
Randomised Control Trial ◽  
Computer Assisted ◽  
Patient Reported ◽  
Total Knee ◽  
Alternative Alignment

Abstract Background: A drive to improve functional outcomes for patients undergoing total knee arthroplasty (TKA) has led to alternative alignment being used. Functional alignment (FA) uses intraoperative soft tissue tension to determine the optimal position of the prosthesis within the patients soft tissue envelope. Angular limits for bone resections are followed to prevent long term prosthesis failure. This study will use the aid of robotic assistance to plan and implement the final prosthesis position. This method has yet to be compared to the traditional mechanically aligned (MA) knee in a randomised trial. Methods: A blinded randomised control trial with 100 patients will be undertaken via Perth Hip and Knee clinic. Fifty patients will undergo a MA TKA and fifty will undergo a FA TKA. Both alignment techniques will be balanced via computer assisted navigation to assess prosthetic gaps, being achieved via the initial bony resection and further soft tissue releases as required to achieve satisfactory balance. The primary outcome will be the forgotten joint score (FJS) two years after surgery, with secondary outcomes being other patient reported outcome measures, clinical functional assessment, radiographic position and complications. Other data that will be collected will be patient demography (Sex, Age, level of activity) and medical information (grade of knee injury, any other relevant medical information). The linear statistical model will be fitted to the response (FJS), including all the other variables as covariates. Discussion: Many surgeons are utilising alternative alignment techniques with a goal of achieving better functional outcomes for their patients. Currently MA TKA remains the gold standard with good outcomes and excellent longevity. There is no published RCTs comparing FA to MA yet and only two registered studies are planned or currently in progress. This study utilizes a FA technique which differs from the two studies. This study will help determine if FA TKA has superior functional results for patients.Trial registration: This trial has been registered with the Australian New Zealand Clinical Trials Registry (ANZCTR) http://www.anzctr.org.au: U1111-1257-2291, registered 25th Jan 2021. It is also listed on www.clinicaltrials.gov: NCT04748510

Methylphenidate Treatment of Bulimia Nervosa after Surgery*

1989 ◽  
Vol 34 (8) ◽  
pp. 824-826 ◽  
Author(s):  
Edward Messner
Keyword(s):  
Postoperative Complications ◽  
Bulimia Nervosa ◽  
Emotional State ◽  
Safety And Efficacy ◽  
Patient Reported

Methylphenidate (MPT) was prescribed four days after an uncomplicated appendectomy in a 27 year old woman who had suffered from bulimia nervosa (BN) for at least nine years. Before the onset of appendicitis, her bingeing and self-induced vomiting had occurred several times daily. With MPT the patient reported a calm emotional state and an absence of temptation to binge or to induce vomiting. Previously published reports of treatment of BN with MPT could not be found. This may be the first. Vulnerability to surgical disorders and to postoperative complications as well as the safety and efficacy of MPT in patients suffering from BN deserve further study.

scholarly journals Delayed Peroneal Neuropathy After Bosworth Fracture Dislocation of the Ankle

2021 ◽  
Vol 111 (4) ◽  
Author(s):  
Sung Hoon Choi ◽  
Jeong Min Hur ◽  
Kyu-Tae Hwang
Keyword(s):  
Soft Tissue ◽  
Internal Fixation ◽  
Closed Reduction ◽  
Open Reduction ◽  
Fracture Dislocation ◽  
Tibial Tubercle ◽  
Proximal Fragment ◽  
Rare Injury ◽  
Soft Tissue Swelling ◽  
Severe Soft Tissue

The Bosworth ankle fracture-dislocation is a rare injury and is often irreducible because of an entrapped proximal fragment of the fibula behind the posterior tibial tubercle. Repeated closed reduction or delayed open reduction may result in several complications. Thus, early open reduction and internal fixation enable a better outcome by minimizing soft-tissue damage. We report on a 27-year-old man who underwent open reduction and internal fixation after multiple attempts at failed closed reduction, complicated by severe soft-tissue swelling, rhabdomyolysis, and delayed peroneal nerve palsy around the ankle.

Patient‐reported outcome measures following soft‐tissue grafting at implant sites: A systematic review

2021 ◽  
Vol 32 (S21) ◽  
pp. 157-173
Author(s):  
Martina Stefanini ◽  
Lorenzo Tavelli ◽  
Shayan Barootchi ◽  
Matteo Sangiorgi ◽  
Giovanni Zucchelli
Keyword(s):  
Systematic Review ◽  
Soft Tissue ◽  
Outcome Measures ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Patient Reported

scholarly journals Comparison of MPFL Repair Versus MPFL Reconstruction for Refractory Patella Instability in Patients Under 18 Years Old

2020 ◽  
Vol 8 (4_suppl3) ◽  
pp. 2325967120S0018
Author(s):  
Seth L. Sherman ◽  
Derek W. Geeslin ◽  
Daniel W. Hogan ◽  
John W. Welsh ◽  
Joseph M. Rund ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Primary Repair ◽  
Mpfl Reconstruction ◽  
Patella Instability ◽  
Subjective Outcome ◽  
Recurrent Instability ◽  
Patient Reported ◽  
Outcome Scores ◽  
Reconstruction Group

Background: The medial patellofemoral ligament (MPFL) is the primary soft-tissue restraint against lateral patellar displacement. Surgery to address MPFL incompetence is the current gold standard for recurrent patellofemoral instability. In the young patient, controversy remains regarding the role of MPFL repair in the setting of recurrent patella instability. Hypothesis/Purpose: Our purpose was to investigate subjective outcomes and complication profile of consecutive cohorts under age 18 undergoing MPFL repair or MPFL reconstruction. Our hypothesis was that the MPFL reconstruction group would have higher subjective outcome scores and a lower complication profile. Methods: Following IRB approval, a retrospective review of prospectively collected data identified a consecutive cohort of patients undergoing soft tissue stabilization for recurrent patella instability. Surgery was performed by a single sports fellowship trained surgeon between 2011-2019. MPFL repair was performed on patients prior to November 2015 and MPFL reconstruction with allograft from December 2015 to present. Patients undergoing concomitant bony realignment procedures were included. Patient reported outcomes (PROs) were collected including PROMIS, KOOS, IKDC, Marx, Tegner, and SANE scores. Complications requiring re-operation (i.e., infection, stiffness, recurrent instability) were recorded. Results were analyzed statistically. Results: The cohort was comprised of 43 patients (53 knees), with 15 males (34.9%), and 28 females (65.1%). The MPFL-Repair cohort had 22 patients (24 knees) and the MPFL-Reconstruction had 25 patients (29 knees). The average age of the MPFL-Repair cohort was 14.82 (range 10.5-17.8) and the average age of the MPFL-Reconstruction group was 15.59 (13.0-17.7). At final follow-up (minimum 6 months), there were no statistically significant differences between cohorts for KOOS Pain (p=0.4126), KOOS symptoms (p=0.7990), KOOS ADL (p=0.4398), KOOS Sport Rec (p=0.3357), KOOS QOL (p=0.8707), Global Physical Health (p=0.9736), Global Mental Health (p=0.1724), Physical Function (p=0.8077), Pain Interference (p=0.9740), Mobility T-Score (p=0.0634), Marx activity score (p=0.0844), Tegner Score (p=0.0752), IKDC (p=0.2646), and SANE score (p=0.0811). Regarding complications requiring re-operation, there was 1 knee in the MPFL-Reconstruction group (3.4%) that required further surgery (1 for fracture) and 9 knees in the MPFL-Iso cohort (37.5%) that required re-operation (1 for fracture, 8 for recurrent instability). The difference in complication rate was statistically significant (p=0.0012). Conclusion: In patients under 18 years old undergoing surgery for refractory patella instability, both MPFL allograft reconstruction and MPFL primary repair demonstrated no difference in subjective outcome scores at midterm follow-up. MPFL primary repair had significantly increased rate of complication requiring re-operation, particularly recurrent patella instability requiring revision to MPFL reconstruction. Tables/Figures: [Table: see text][Table: see text][Table: see text]

scholarly journals Patient-Reported Opioid Pill Consumption After an ED Visit: How Many Pills Are People Using?

Pain Medicine ◽  
2020 ◽  
Author(s):  
Danielle M McCarthy ◽  
Howard S Kim ◽  
Scott I Hur ◽  
Patrick M Lank ◽  
Christine Arroyo ◽  
...  
Keyword(s):  
Emergency Department ◽  
Back Pain ◽  
Acute Pain ◽  
Renal Colic ◽  
Opioid Consumption ◽  
Fracture Dislocation ◽  
Opioid Use ◽  
Use Patterns ◽  
Patient Demographics ◽  
Patient Reported

Abstract Objectives Recent guidelines advise limiting opioid prescriptions for acute pain to a three-day supply; however, scant literature quantifies opioid use patterns after an emergency department (ED) visit. We sought to describe opioid consumption patterns after an ED visit for acute pain. Design Descriptive study with data derived from a larger interventional study promoting safe opioid use after ED discharge. Setting Urban academic emergency department (>88,000 annual visits). Subjects Patients were eligible if age >17 years, not chronically using opioids, and newly prescribed hydrocodone-acetaminophen and were included in the analysis if they returned the completed 10-day medication diary. Methods Patient demographics and opioid consumption are reported. Opioid use is described in daily number of pills and daily morphine milligram equivalents (MME) both for the sample overall and by diagnosis. Results Two hundred sixty patients returned completed medication diaries (45 [17%] back pain, 52 [20%] renal colic, 54 [21%] fracture/dislocation, 40 [15%] musculoskeletal injury [nonfracture], and 69 [27%] “other”). The mean age (SD) was 45 (15) years, and 59% of the sample was female. A median of 12 pills were prescribed. Patients with renal colic used the least opioids (total pills: median [interquartile range {IQR}] = 3 [1–7]; total MME: median [IQR] = 20 [10–50]); patients with back pain used the most (total pills: median [IQR] = 12 [7–16]; total MME: median [IQR] = 65 [47.5–100]); 92.5% of patients had leftover pills. Conclusions In this sample, pill consumption varied by illness category; however, overall, patients were consuming low quantities of pills, and the majority had unused pills 10 days after their ED visit.

scholarly journals Gradual correction of proximal tibia deformity for Blount disease in adolescent and young adults

2019 ◽  
Vol 27 (3) ◽  
pp. 230949901987398 ◽  
Author(s):  
Aik Saw ◽  
Zi Hao Phang ◽  
Mohammed Khalid Alrasheed ◽  
Roshan Gunalan ◽  
Mohammed Ziyad Albaker ◽  
...  
Keyword(s):  
Young Adults ◽  
Soft Tissue ◽  
External Fixator ◽  
Surgical Outcome ◽  
Tissue Injury ◽  
Femoral Condyle ◽  
Soft Tissue Injury ◽  
Gradual Correction ◽  
Soft Tissue Complication ◽  
Blount Disease

Purpose: Management of Blount disease in adolescents and young adults is complex and associated with high risk of morbidities. Gradual correction with external fixator can minimize soft tissue injury and allow subsequent adjustment in degree of correction. This study investigates the surgical outcome and complication rate of gradual correction of neglected Blount disease through single-level extra-articular corticotomy. Methods: Patients treated for Blount disease using external fixator from 2002 to 2016 were recruited for the study. We used Ilizarov and Taylor Spatial Frame (TSF) external fixator to perform simultaneous correction of all the metaphyseal deformities without elevating the tibia plateau. Surgical outcome was evaluated using mechanical axis deviation (MAD), tibial femoral angle (TFA), and femoral condyle tibial shaft angle (FCTSA). Results: A total of 22 patients with 32 tibias have been recruited for the study. The mean MAD improved from 95 ± 51.4 mm to 9.0 ± 37.7 mm (medial to midpoint of the knee), mean TFA improved from 31 ± 15° varus to 2 ± 14° valgus, and mean FCTSA improved from 53 ± 14° to 86 ± 14°. Mean duration of frame application is 9.4 months. Two patients developed pathological fractures over the distracted bones, one developed delayed consolidation and other developed overcorrection. Conclusions: Correction of Blount disease can be achieved by gradual correction using Ilizarov or TSF external fixator with low risk of soft tissue complication. Longer duration of frame application should be considered to reduce the risk of pathological fracture or subsequent deformation of the corrected bone.

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