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1.
Ichiro Tonogai Fumio Hayashi Yoshihiro Tsuruo Koichi Sairyo 《Foot and Ankle Surgery》2019,25(2):193-197
Background
The aims of this study were to identify the artery feeding the fifth metatarsal and determine how bunionette osteotomy could injure this vessel.Methods
The nutrient artery entering the fifth metatarsal was investigated in 10 adult cadaveric lower limbs by barium injection and enhanced computed tomography.Results
The nutrient artery entered the medial aspect of the fifth metatarsal around the junction of the middle and proximal thirds obliquely from a distal direction (mean?angle 36°) in the coronal plane in all cases; in the axial plane, the point of entry and direction of the artery was medial-plantar (mean?angle 49°).Conclusions
This report revealed direction and location of the nutrient artery entering the fifth metatarsal. 相似文献2.
Background
Few methods have been described for measuring hindfoot alignment from an anteroposterior view. The objective of this study was to compare two methods of angular measurement based on the views of Meary and Saltzman.Methods
Thirty asymptomatic volunteers were included. Four radiographs were performed: the views of Meary and Saltzman with parallel feet and with the Fick correction. The reproducibility was determined by the inter- and intraobserver variability (ICC).Results
Meary’s method revealed a mean valgus angulation of 3.9° (SD 3.47°). The reliability was extremely variable with a mean ICC of 0.59. The best reproducibility was obtained with Meary’s method with and without Fick correction.Conclusion
The results of this study show that the reliability of the angular measurements depends on the radiographic view and measurement method chosen. The lateral Fick correction did not counteract the influence of tibial rotation. The same method should be used consistently. 相似文献3.
Objective
To analyse whether early post-operative full weight bearing following syndesmotic ankle fixation affected radiographic outcomes suggestive of diastasis.Design
Retrospective comparative cohort study over a two year period.Setting
Level 1 trauma centrePatients/Participants
152 consecutive patients sustaining an unstable ankle fracture requiring syndesmotic stabilisation were included. Exclusions were 49 patients who had trimalleolar fixation without syndesmosis screws, one patient who had concomitant ankle and talar fracture. Five patients were lost to follow up and eleven patients were followed up in other centres. A total of 86 patients were analysedIntervention
Protected or full weight bearing.Main Outcome Measurement
The primary outcome measure was early diastasis. The secondary outcomes were late diastasis, wound complications and re-operation. Analysis of variance was used for the predictor variable of weight bearing status. We assumed a priori that p values of less than 0.05 were significant.Results
Median age was 36 (IQR 30), with 54 males and 32 females. Median follow up was 12 weeks (IQR 6). There was no significant difference when comparing weight bearing status and change in radiographic measurements intra-operatively compared to 6 and 12 week follow up radiographs (tibiofibular clear space p?=?0.799, tibiofibular overlap p?=?0.733 and medial clear space p?=?0.261).Conclusion
After surgical stabilization of an unstable syndesmotic injury, full weight bearing did not lead to syndesmotic diastasis in the early post-operative period. Full weight bearing is recommended following ankle fixation which includes syndesmotic fixation. 相似文献4.
Matthew R. Walker Ashraf N. El Naga Omar H. Atassi Christopher H. Perkins Scott A. Mitchell 《Injury》2019,50(3):686-689
Objectives
Hip dislocations are highly morbid injuries necessitating prompt reduction and post-reduction assessment for fracture and incarcerated fragments. Recent literature has questioned the need for initial pelvic radiographs for acute trauma patients, resulting in computed tomography (CT) scans as the initial evaluation. This study investigates the relationship between choice of pre-reduction imaging and treatment of acute hip dislocations.Design
Retrospective Case-Control.Setting
Single Academic Level I Trauma Center.Methods
All acute hip dislocations from 2011 to 2016 were reviewed. Exclusion criteria were diagnosis of dislocation at another facility, death prior to reduction, emergent surgical or ICU intervention, and periprosthetic dislocation. Patients were grouped by those with only a radiograph prior to reduction, Group I, versus those with a pre-reduction CT scan, Group II. The primary outcomes were time to reduction and the acquisition of a second CT scan.Results
Of the 123 hip dislocations identified, 35 patients were excluded, mostly for transfer with a known dislocation. Group I included 29 patients and Group II included 59 patients. The mean time to reduction was 74?min in Group I and 129?min in Group II for a difference of 55?min (p?<?0.001). The rate of repeat CT scan was 0 in Group I versus 48 (81%) in Group II (p?<?0.001).Conclusion
Initial trauma pelvic radiography prior to CT is still important in the setting of suspected hip pathology to decrease time to hip reduction and unnecessary radiation exposure.Level of evidence
Prognostic Level III. 相似文献5.
Christina Liu Arvind Von Keudell Michael McTague Edward K. Rodriguez Michael J. Weaver 《Injury》2019,50(3):727-732
Background
It is common practice when placing cannulated screws within the femoral head when treating femoral neck fractures to avoid the thread-forms from crossing the fracture line. Despite the widespread use of cannulated screws in internal fixation of femoral neck fractures, there is no study to our knowledge that describes the ideal length of thread-forms.Purpose
The purpose of this study is to determine the thread length that will maximize purchase within the femoral head while minimizing risk of crossing the fracture line. Additional analysis was conducted to identify factors associated with the maximal possible length of treads in minimally and non-displaced femoral neck fractures.Methods
We performed a retrospective study of all patients treated for a minimally or non-displaced femoral neck fracture from April 1, 2004 through December 31, 2017. Only patients who had received a pre-operative CT or MRI scan were included. Fixation was then templated using radiographs and the distance from the subchondral bone to the fracture line was then measured.Results
The study included 127 patients. The average estimated length of lag screw threads was 33.2?±?6.67?mm, with lower quartile of 29.1?mm and higher quartile of 37.2?mm. The median was 32.0?mm and most frequently encountered estimate was 29?mm. Estimated lag screw size did not differ significantly based on age or BMI, but both height (p?<?0.001) and race (0.04) were positively correlated with estimated lag screw size and males had longer measurements compared to females, 37.2?±?7.0?mm vs 31.4?±?5.7?mm (p?<?0.001), respectively.Conclusion
In conclusion, we propose an additional lag screw thread form with length 26.0?mm to capture 90% of femoral neck fractures. 相似文献6.
Jordi Salvador Samer Amhaz-Escanlar Pablo Castillón Iban Clares Saioa Quintas Martí Bernaus Francesc Anglés Alberto Jorge-Mora 《Injury》2019,50(2):415-419
Purpose
Antegrade intramedullary nailing is an alternative for humeral shaft fracture treatment. This surgical technique can be especially demanding in some fracture patterns, leading to problems like malunion and non-union. The purpose of our study is to demonstrate that the use of a nail with cerclage wires could be a safe procedure that facilitate reduction, specially in fractures with abduction of the proximal fragment.Materials and methods
Fifty-six patients were included, from January 2007 to March 2016. In this cohort forty-two patients were females and eighteen males; mean age was sixty-seven (32–89). The fractures were reduced using a cerclage wire through a small lateral or anterior approach, then, antegrade intramedullary nailing was performed. Fracture healing was established by clinical and radiographic evaluation. Shoulder function was assessed using the Constant Score.Results
Fifty-three patients healed (94.6%) adequately. Two patients developed a non-union (3.5%). One patient developed an infection (1.8%). Transient radial nerve palsy was observed in two patients (3.5%). The mean Constant Score at the end of the study was 70 points (range from 34 to 98 points).Conclusions
Surgical treatment of humeral shaft fractures with cerclage wire and intramedullary nailing is a safe technique to improve fracture reduction. The use of cerclage wires leads to better bone contact while minimizing malunions. The rate of non-union in our study is lower than the rate reported in the literature for humeral shaft fractures treated by intramedullary nailing alone. 相似文献7.
Objective
Symptomatic distal interlocking screws in retrograde femoral nailing are common due the difficulties of imaging the trapezoidal femur. Screws appearing to have appropriate length on imaging may possibly be prominent, creating symptoms. Screw trajectory may influence the degree of this radiographic error. We hypothesize that external rotation of screw trajectory will increase measurement error of screw length.Design
Retrospective.Setting
Urban Level I Tertiary Trauma Center.Participants
283 patients with Computer Tomography (CT) scans of the native knee were retrospectively identified. Simulation was done of the trajectory of an interlock at 20?mm and 40?mm proximal to the nail entry point, which represent common screw positions associated/not associated respectively, with removal. The distance between the radiographic medial cortex and the tip of the transverse screw was calculated (D). The angle (Ψ) between the transverse trajectory and a modified trajectory aimed at the most medial cortex to avoid radiographic measurement error was calculated. Geometric modeling was utilized to calculate the measurement error (D) in the event of accidental external rotation. The angle of the medial slope was also measured (Θ).Intervention
Review of CT imaging of normal distal femora.Main Outcome Measurements
CT measurements of distal femora.Results
The mean distance (D) at 20/40?mm was 4.21 [95%CI 4.02–4.402] and 2.03?mm [95%CI 1.78–2.83], respectively (p?<?0.0001). The mean angle (Ψ) between the transverse and modified trajectory at 20/40?mm was 12° [95%CI 11.5–12.5] and 9.60° [95%CI 9–10.2], respectively (p?<?0.0001). External rotation by a similar amount nearly triples the measured difference (D). The measured medial slope was significantly increased as screws were placed more proximal (Θ20 mm 46.5 vs Θ40 mm: 48.7?°, p?<?0.00001).Conclusion
The distance between the perceived medial cortex and the tip of the most transverse screw is 4.21?mm and could account for painfully prominent screws. In more proximal screws this distance is decreased. Internal rotation of the screw trajectory 12° can reduce this distance (D), which has implications in nail design. External rotation, amplifies this difference nearly three-fold. Surgeons should avoid external rotation of the aiming arm to prevent prominent screws. 相似文献8.
Christina Marie Joseph Chandrasekaran Gunasekaran Abel Livingston Hepsy Chelliah Thilak Samuel Jepegnanam P.R.J.V.C. Boopalan 《Injury》2019,50(3):784-789
Background
Contrary to acute posterior cruciate ligament (PCL) bony tibial avulsions, surgical management of chronic injuries is technically challenging and appears to be controversial. We sought to assess the outcome of a novel screw post augmentation technique in neglected cases.Methods
16 patients were followed up in a tertiary single-center retrospective study. The bony fragment was fixed using a lag screw with a spiked washer and an additional screw post through an open posterior approach. The pre- and postoperative knee range of movement (ROM), laxity, and modified Tegner–Lysholm (TL) scores were compared.Results
The median time from injury to surgery was 10 weeks (range, 3–260). The mean clinical follow-up time was 24.25?±?9.21 months. At the final follow-up, the mean knee ROM flexion was 130°?±?11.55° with no extension lag. 3 patients had grade 1 laxity. The TL grade was predominantly excellent, and the overall median score improved from 76 preoperatively to 95 postoperatively (p?<?0.0004). Bony union was achieved in all cases.Conclusion
The described screw post fixation technique results in an excellent outcome for these rare injuries.Level of evidence
Level IV, case series. 相似文献9.
Simon Matthew Graham Maheshi P. Wijesekera Maritz Laubscher Sithombo Maqungo Michael Held Nando Ferreira William J. Harrison 《Injury》2019,50(2):235-243
Introduction
The management of long bone lower limb fractures secondary to gunshot wounds (GSWs) in the civilian setting are complex and there is currently no consensus regarding the optimal approach to managing such fractures. This study aims to address the relationship of implant related sepsis in fractures secondary to GSWs.Methods
A systematic review of the literature was performed on both Pubmed and Scopus databases that look at fractures caused by GSWs in the lower limb. A total of 14 studies met the inclusion criteria set in this study.Results
Current literature suggests that low and high velocity injuries managed with internal fixation, such as intramedullary nails, may carry a low risk of superficial and deep infection, with no obvious risk of osteomyelitis. However, infection was poorly defined across all studies and no study used a validated scoring system for infection making it difficult to draw any valid conclusion on the rate of infection following internal fixation of lower limb fractures following both high and low velocity GSWs.Conclusion
There is no clear evidence to confirm or refute that internal fixation is the ideal method of management in these complex injuries and guidance is needed due to the high and increasing proportion of patients presenting with these complex injuries worldwide. 相似文献10.
11.
Ahmed Latif Baljinder S. Dhinsa Benjamin Lau Ali Abbasian 《Foot and Ankle Surgery》2019,25(2):132-136
Background
This study reports the outcome of a plating system for arthrodesis of the first metatarsophalangeal joint (1st MTPJ) that incorporates a lag compression screw within a low profile titanium plate with a predetermined contour. This is the first report of the outcomes of this implant from a non-affiliated centre.Patient and methods
This is a prospective cohort study of 40 consecutive primary 1st MTPJ arthrodesis procedures. The mean age of the cohort was 56 years (range, 20–74 years). The diagnosis was hallux rigidus in 31 patients and inflammatory arthropathy in 7 patients.Results
All patients achieved clinical union at 6 weeks and radiological union was confirmed on plain radiographs between 6–16 weeks. One case of hardware removal was reported.Conclusion
The cohort achieved consistently satisfactory results with a reliable and reproducible MTPJ position and a 100% union rate. There was a low rate of hardware removal.Level of evidence
Level IV evidence. Prospective cohort study. 相似文献12.
Nicola Krähenbühl Lena Siegler Manja Deforth Lukas Zwicky Beat Hintermann Markus Knupp 《Foot and Ankle Surgery》2019,25(2):143-149
Background
Although it has been proposed that in mid-stage ankle osteoarthritis, the subtalar joint can compensate for deformities above the ankle joint, the evidence is weak. We thus investigated subtalar joint alignment in different stages of ankle osteoarthritis using weightbearing computed tomography (CT) scans.Methods
The subtalar joint of 88 patients with osteoarthritis of the ankle joint and a control group of 27 healthy volunteers were assessed. Subgroups were performed according to the ankle deformity (varus and valgus) and stage of ankle joint osteoarthritis. Subtalar joint alignment was assessed on weightbearing CT scans.Results
A more valgus subtalar joint alignment was found in patients with varus ankle osteoarthritis. No significant difference of the subtalar joint alignment was evident when comparing different stages of ankle osteoarthritis.Conclusions
Varus ankles compensate in the subtalar joint for deformities above the ankle joint. Compensation does not correlate with the stage of ankle osteoarthritis. 相似文献13.
Ben A. Hickey Andrew Cleves Raza Alikhan Neil Pugh Len Nokes Anthony Perera 《Foot and Ankle Surgery》2019,25(1):59-62
Background
Our aim was to determine whether plasma levels of Tissue Factor (TF), Vascular Cell Adhesion Molecule 1 (VCAM-1), Interleukin 6 (IL-6) or D-dimer after foot and ankle injury could predict which patients would develop deep vein thrombosis (DVT).Methods
Patients aged 18–60 years with acute foot and ankle injury had venous blood sample to measure TF, VCAM-1, IL-6 and D-dimer within 3 days of injury. Patients had bilateral lower limb venous ultrasound to assess for DVT on discharge from clinic.Results
21 of 77 patients were found to have DVT (27%). There was no statistically significant association between levels of TF, VCAM-1, IL-6 or D-dimer and subsequent development of DVT.Conclusion
Tissue Factor (TF), Vascular Cell Adhesion Molecule-1 (VCAM-1), Interleukin-6 (IL-6) and D-dimer levels were not associated with development deep vein thrombosis in patients with acute foot and ankle injury. 相似文献14.
Introduction
Surgery or trauma may induce extensive arthrofibrosis around joints and tendon for the restrictive range of motion. Although some approaches were proposed, this problem is not solved satisfactorily. Extracorporeal shock wave therapy (ESWT) has been used for orthopedic, musculoskeletal, and fibrotic disorders. Whether it could prevent the formation of arthrofibrosis during the joint repair is unknown.Methods
Intra-articular adhesions were created in the right knee of the rabbit by cortical bone shaving and subsequent cast immobilization. Arthrofibrosis in the control and ESWT group was evaluated and compared at week 4.Results
Macroscopic score of arthrofibrosis and contracture angle of the control group are significantly higher. Histologically, the apparent gap between patella and tibia, loose connective tissue, and much less density of the blood vessel are found in the ESWT group.Conclusions
ESWT could noninvasively, effectively, and safely prevent the formation of arthrofibrosis during the knee repair. 相似文献15.
P. Gach L. Tuchtan-Torrents C. Delteil P. Adalian M.D. Piercecchi L.C. Ebert G. Gorincour 《Diagnostic and interventional imaging》2019,100(3):163-168
Purpose
The purpose of this study was to report the feasibility of computed modelization and reconstitution of the paranasal sinuses, before and after trauma, from CT data.Materials and methods
We modeled and reconstructed the paranasal sinuses of two patients (A and B), before and after trauma, using two different softwares (3DSlicer® and Blender®). Both patients had different numbers and locations of fractures. The 3DSlicer® software was used to create a 3D model from CT data. We then imported the 3D data into the Blender® software, to reconstruct and compare the dimensions of the paranasal sinuses before and after trauma.Results
The 3 fragments of patient A and the 7 fragments of patient B could be repositioned in the pre-traumatic configuration. Distance measurements proved to be similar between pre- and post-traumatic 3D volumes.Conclusion
After simple trauma, bone facial anatomy reconstruction is manually feasible. The whole procedure could benefit from automatization through machine learning. However, this feasibility must be confirmed on more severely fractured paranasal sinuses, to consider an application in forensic identification. 相似文献16.
17.
Joost C. Schrier Noel L. Keijsers Giovanni A. Matricali Cees C.P.M. Verheyen Jan Willem K. Louwerens 《Foot and Ankle Surgery》2019,25(1):37-46
Background
Despite impressive results of the pharmacological management of rheumatoid arthritis, still certain patients suffer from rheumatoid forefoot problems. Surgical treatment of these forefoot deformities can be an option. In literature no high-quality studies on this topic can be found.The goal of present study is to compare the results of a metatarsal head (MTH) resecting technique with a MTH preserving technique in the operative treatment of severe rheumatoid forefoot deformity.Methods
Patients suffering from well-defined rheumatoid forefoot deformity were prospectively enrolled in three institutions. This non-blinded study had a randomised clinical design and eligible patients were randomly assigned to undergo either resection of preservation of the MTH. The primary outcome measure consisted of the AOFAS score. Secondary outcome measures were: the FFI, the VAS for pain and the SF-36.Results
Twenty-three patients (10 in MTH preservation group) were included and analysed. After one year follow-up no significant differences in AOFAS score and additional outcome factors were found. A total of 10 complications in 23 patients were reported.Conclusions
This randomised clinical study did not show significant clinical difference between a MTH resecting and a preserving procedure in patients suffering from rheumatoid forefoot deformity. Both procedures resulted in considerable improvement of pain and activity scores. 相似文献18.
Background and purpose
The treatment of paediatric distal radius diaphyseal metaphyseal junction (DRDMJ) fractures is a challenge. The purpose of this study was to introduce a new operative approach at the proximal “safe zone” of the posterior interosseous nerve (PIN) to treat paediatric DRDMJ fractures and analyse the safety and efficacy of antegrade elastic stable intramedullary nail (ESIN) fixation.Methods
Thirty paediatric patients with unstable and displaced DRDMJ fractures were treated by antegrade ESIN fixation from November 2015 to September 2017. We created the entrance site at the posterolateral side of the proximal radius and 2?4?cm distal to the articular surface of the radius, using the ESIN to immobilise the fractures. In the study, we reviewed patient demographics, complications, time until removal, and intraoperative time for hardware removal.Results
Complete fracture healing was achieved between 6 and 12 weeks after surgery. Except for 3 patients presenting with irritation of the skin, we did not observe any complications. Radiologically, no secondary displacement, nail migration, loss of fixation, consolidation delay, non-union, or refracture was noted.Conclusions
The antegrade ESIN fixation is a minimally invasive, easy-to-learn, alternative operative method to treat paediatric DRDMJ fractures.Level of evidence
Therapeutic Level IV. 相似文献19.
BaiHang Chen Chao Chen ZeTian Yang PeiZhen Huang Hang Dong ZhanPeng Zeng 《Foot and Ankle Surgery》2019,25(1):63-70
Background
To compare the efficacy between fixation with suture-button and screw in the treatment of syndesmotic injuries: a meta-analysis.Methods
We comprehensively searched PubMed, Embase, and the Cochrane Library and performed a meta-analysis of randomized controlled trials (RCTs) and retrospective comparative studies (RTCs). We performed using Review Manager 5.2.Results
Three RCTs and six retrospective studies were conducted, including a total of 397 patients. The significant differences of the fixation of suture-button were reported for AOFAS scores (at 3, 6 and 12 months follow-up), full-weight time, reoperation, malreduction and the rate of failure of fixation. There were no significant differences between the groups regarding complications of infection, VAS, OMAS, range of motion, TFCS, TFO and MCS.Conclusions
Neither the functional outcome nor complications significantly differed between the fixation methods, but suture-button might lead to a quicker return to work. This analysis needs to be confirmed and updated by larger sample data and rigorously designed RCTs. 相似文献20.
Akira Hara Toshiya Kudo Satoshi Ichihara Hideaki Iwase Masashi Nagao Yuichiro Maruyama Kazuo Kaneko 《Injury》2019,50(2):256-262