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1.
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2.
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3.
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4.
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5.
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6.
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7.
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8.
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9.
Nam Hoon Moon Won Chul Shin Jung Shin Kim Seung Hun Woo Seung Min Son Kuen Tak Suh 《Injury》2019,50(3):713-719
Background
The aim of this study was to investigate the postoperative outcomes of cementless Total hip arthroplasty (THA) following failed internal fixation for femoral neck and intertrochanteric fractures.Method
Ninety-six cementless THAs for failed internal fixation after femoral neck fracture (59, group I) and intertrochanteric fracture (37, group II) with a minimum follow-up of 3 years were analyzed. Clinical and radiologic evaluations were performed on all patients.Results
The intraoperative blood loss and operating time were significantly increased in group II (p?=?0.001, p?=?0.001, respectively). Harris hip score at last follow-up was significantly improved in group I (p?=?0.007) but, there were no differences in hospital stay, Koval score at last follow-up, and perioperative complications between both groups. Long femoral stems for diaphyseal fitting were frequently used in group II (32/37, 86%) (p?=?0.001). Radiographically, none of the acetabular cups showed evidence of migration, loosening. All cases showed stable fixation of the femoral stem at last follow-up.Conclusions
Outcomes of cementless THA following failed internal fixation for femoral neck and intertrochanteric fractures were satisfactory; increased intraoperative blood loss, operating time, and requirement of long femoral stem should be considered in the latter type of fracture. 相似文献10.
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11.
12.
V. Couteaux S. Si-Mohamed O. Nempont T. Lefevre A. Popoff G. Pizaine N. Villain I. Bloch A. Cotten L. Boussel 《Diagnostic and interventional imaging》2019,100(4):235-242
Purpose
This work presents our contribution to a data challenge organized by the French Radiology Society during the Journées Francophones de Radiologie in October 2018. This challenge consisted in classifying MR images of the knee with respect to the presence of tears in the knee menisci, on meniscal tear location, and meniscal tear orientation.Materials and methods
We trained a mask region-based convolutional neural network (R-CNN) to explicitly localize normal and torn menisci, made it more robust with ensemble aggregation, and cascaded it into a shallow ConvNet to classify the orientation of the tear.Results
Our approach predicted accurately tears in the database provided for the challenge. This strategy yielded a weighted AUC score of 0.906 for all three tasks, ranking first in this challenge.Conclusion
The extension of the database or the use of 3D data could contribute to further improve the performances especially for non-typical cases of extensively damaged menisci or multiple tears. 相似文献13.
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14.
Julien Dagenais Riccardo Bertolo Juan Garisto Matthew J. Maurice Pascal Mouracade Onder Kara Jaya Chavali Jianbo Li Ryan Nelson Amr Fergany Robert Abouassaly Jihad H. Kaouk 《European urology》2019,75(4):628-634
Background
Understanding physician-level discrepancies is increasingly a target of US healthcare reform for the delivery of quality-focused patient care.Objective
To estimate the relative contributions of patient and surgeon characteristics to the variability in key outcomes after partial nephrectomy (PN).Design, setting, and participants
Retrospective review of 1461 patients undergoing PN performed by 19 surgeons between 2011 and 2016 at a tertiary care referral center.Intervention
PN for a renal mass.Outcomes measurements and statistical analysis
Hierarchical linear and logistic regression models were built to determine the percentage variability contributed by fixed patient and surgeon factors on peri- and postoperative outcomes. Residual between- and within-surgeon variability was calculated while adjusting for fixed factors.Results and limitations
On null hierarchical models, there was significant between-surgeon variability in operative time, estimated blood loss (EBL), ischemia time, excisional volume loss, length of stay, positive margins, Clavien complications, and 30-d readmission rate (all p < 0.001), but not chronic kidney disease upstaging (p = 0.47) or percentage preservation of glomerular filtration rate (p = 0.49). Patient factors explained 82% of the variability in excisional volume loss and 0–32% of the variability in the remainder of outcomes. Quantifiable surgeon factors explained modest amounts (10–40%) of variability in intraoperative outcomes, and noteworthy amounts of variability (90–100%) in margin rates and patient morbidity outcomes. Immeasurable surgeon factors explained the residual variability in operative time (27%), EBL (6%), and ischemia time (31%).Conclusions
There is significant between-surgeon variability in outcomes after PN, even after adjusting for patient characteristics. While renal functional outcomes are consistent across surgeons, measured and unmeasured surgeon factors account for 18–100% of variability of the remaining peri- and postoperative variables. With the increasing utilization of value-based medicine, this has important implications for the goal of optimizing patient care.Patient summary
We reviewed our institutional database on partial nephrectomy performed for renal cancer. We found significant variability between surgeons for key outcomes after the intervention, even after adjusting for patient characteristics. 相似文献15.
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16.
Mattia Fortina Pietro Maniscalco Christian Carulli Luigi Meccariello Giovanni Battista Colasanti Serafino Carta 《Injury》2019,50(2):365-368
Introduction
Horse racing is a hazardous sport. We analyzed the incidence and characteristics of jockey injuries in a typical horse race.Methods
We analyzed all injuries sustained by 224 jockeys in the last 72 years.Results
It was found that in 96.1% of the races there was at least one fall and in 28.6% of the races 50% or more of the jockeys fell. In 43.4% of the falls, the jockey was taken to the emergency room. Comparing the Palio with traditional races in other countries, a higher injury incidence rate was observed for every 100 falls (109.884 vs 27–59) and a lower concussion rate/100 falls (0.97 vs 1.8-7.4).Conclusion
The Palio is one of the most threatening races that continues today. Jockeys are at greater risk for a fall than any other race in the world. 相似文献17.
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18.
Elise Burger Ruud Selles Shelly van Nieuwkasteele Gert Bessems Virginie Pollet Steven Hovius Christianne van Nieuwenhoven 《Foot and Ankle Surgery》2019,25(2):204-210
Background
The purpose of this study is to develop a Dutch version of the Oxford Ankle and Foot Questionnaire for Children (OxAFQ-c) to allow evaluation of pediatric foot care.Methods
The OxAFQ-c was translated into Dutch, according to the ISPOR-guidelines. Children with different foot and ankle complaints completed the OxAFQ-c at baseline, after two weeks, and after 4–6 months. Measurement properties were assessed in terms of reliability, responsiveness, and construct validity.Results
Test–retest reliability showed moderate intraclass correlation coefficients. Bland–Altman plots showed wide limits of agreement. After 4–6 months, the group that experienced improvement also showed improved questionnaire outcomes, indicating responsiveness. Moderate correlation between the OxAFQ-c and the Kidscreen and foot-specific VAS-scores were observed, indicating moderate construct validity.Conclusions
The Dutch OxAFQ-c showed moderate to good measurement properties. However, because we observed limited sensitivity to changes and wide limits of agreement in individual patients, we think the questionnaire should only be used in groups. 相似文献19.
B. Schmauch P. Herent P. Jehanno O. Dehaene C. Saillard C. Aubé A. Luciani N. Lassau S. Jégou 《Diagnostic and interventional imaging》2019,100(4):227-233
Purpose
The purpose of this study was to create an algorithm that simultaneously detects and characterizes (benign vs. malignant) focal liver lesion (FLL) using deep learning.Materials and methods
We trained our algorithm on a dataset proposed during a data challenge organized at the 2018 Journées Francophones de Radiologie. The dataset was composed of 367 two-dimensional ultrasound images from 367 individual livers, captured at various institutions. The algorithm was guided using an attention mechanism with annotations made by a radiologist. The algorithm was then tested on a new data set from 177 patients.Results
The models reached mean ROC-AUC scores of 0.935 for FLL detection and 0.916 for FLL characterization over three shuffled three-fold cross-validations performed with the training data. On the new dataset of 177 patients, our models reached a weighted mean ROC-AUC scores of 0.891 for seven different tasks.Conclusion
This study that uses a supervised-attention mechanism focused on FLL detection and characterization from liver ultrasound images. This method could prove to be highly relevant for medical imaging once validated on a larger independent cohort. 相似文献20.
V. Ruiz-Alcalá X. Onrubia C. García-Vitoria J. Baldó E. Martínez J.M. Seller 《Revista espa?ola de anestesiología y reanimación》2019,66(3):144-148