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Hand (New York, N.Y.) Jan 2023The external rotation and abduction of shoulder are considered one of the priorities of reconstruction in brachial plexus injury. The aim of this study was to evaluate...
BACKGROUND
The external rotation and abduction of shoulder are considered one of the priorities of reconstruction in brachial plexus injury. The aim of this study was to evaluate the functional results and complications of shoulder arthrodesis in patients with brachial plexus injury to better comprehend the benefits of this procedure.
METHODS
Between 2015 and 2019, 15 shoulder arthrodesis were performed in patients with long-standing brachial plexus injury. The main indication for arthrodesis was absent or poor recovery of shoulder abduction and external rotation. Patients presented different levels of injury. Shoulder measurements of active abduction and external rotation were made based on image records of the patients. A long 4.5-mm reconstruction plate was fit along the scapular spine, acromion, and lateral proximal third of the humerus. Structured bone graft was fit into the subacromial space.
RESULTS
The mean preoperative abduction was 16°, and the mean postoperative abduction was 42°. The mean preoperative external rotation was -59°, and the mean postoperative external rotation was -13°. The mean increase in abduction and external rotation was 25° and 45°, respectively. Bone union was achieved in all cases at an average time of 5.23 months. We experienced humeral fractures in 26.66% of the cases, which were all successfully treated nonoperatively.
CONCLUSIONS
Shoulder arthrodesis is a rewarding procedure for patients with brachial plexus injuries. A marked improvement in the upper limb positioning was observed in all patients. It should be considered as the main therapeutic option in cases where nerve reconstruction is no longer possible.
Topics: Humans; Shoulder; Shoulder Joint; Brachial Plexus; Brachial Plexus Neuropathies; Arthrodesis
PubMed: 33880953
DOI: 10.1177/1558944721998008 -
Journal of the American Podiatric... Dec 2021This report discusses an unusual case of a 23-year-old woman with a painful bipartite medial cuneiform and severe arthritic and cystic changes at the partition with no...
This report discusses an unusual case of a 23-year-old woman with a painful bipartite medial cuneiform and severe arthritic and cystic changes at the partition with no history of trauma. Magnetic resonance imaging confirmed a large cyst with subchondral erosions at the dorsal and plantar segments with significant bone marrow edema. Definitive treatment consisted of arthrodesis on the dorsal to plantar segments using one lag screw, demineralized bone matrix grafting, and a bone stimulator.
Topics: Adult; Arthrodesis; Bone Marrow Diseases; Bone Screws; Female; Humans; Magnetic Resonance Imaging; Tarsal Bones; Young Adult
PubMed: 33355668
DOI: 10.7547/20-025 -
The Journal of the American Academy of... Dec 2020Tension band wiring is a simple, inexpensive, and effective technique to treat many upper extremity fractures. When tension forces result in a mechanical failure of... (Review)
Review
Tension band wiring is a simple, inexpensive, and effective technique to treat many upper extremity fractures. When tension forces result in a mechanical failure of bone, tension band wiring provides stability and promotes early mobilization by converting tensile forces across a fracture into compressive forces. The tension band principle has distinct advantages of reducing periosteal stripping, technical ease, and cost effectiveness when compared with other operative strategies. This technique can be implemented in a variety of fractures and avulsions about the upper extremity as well as small bone arthrodeses.
Topics: Arthrodesis; Biomechanical Phenomena; Bone Wires; Bone and Bones; Fractures, Bone; Humans; Orthopedic Procedures; Tensile Strength; Upper Extremity
PubMed: 32991386
DOI: 10.5435/JAAOS-D-19-00449 -
The Orthopedic Clinics of North America Jul 2020This article presents the indications, contraindications, preoperative surgical planning, surgical technique, and postoperative management of some of the most common... (Review)
Review
This article presents the indications, contraindications, preoperative surgical planning, surgical technique, and postoperative management of some of the most common percutaneous procedures in orthopedic foot and ankle surgery. The background of each procedure also is presented, supported by the latest in published literature to educate surgeons. Such topics include percutaneous bunionectomy, lesser toe deformity and bunionette correction, calcaneal osteotomy, cheilectomy, and first metatarsophalangeal joint arthrodesis.
Topics: Ankle; Arthrodesis; Foot; Foot Bones; Hallux Valgus; Humans; Minimally Invasive Surgical Procedures; Orthopedic Procedures; Osteotomy; Toe Phalanges
PubMed: 32498959
DOI: 10.1016/j.ocl.2020.02.004 -
International Orthopaedics Jun 2023Total ankle replacement (TAR) or ankle arthrodesis (AA) is the main surgical treatment for end-stage ankle osteoarthritis. However, the therapeutic effect of the two... (Meta-Analysis)
Meta-Analysis Review
PURPOSE
Total ankle replacement (TAR) or ankle arthrodesis (AA) is the main surgical treatment for end-stage ankle osteoarthritis. However, the therapeutic effect of the two surgical procedures at different follow-up times remains controversial. The purpose of this meta-analysis is to compare the short-term, medium-term, and long-term safety and efficiency of the two modern surgical treatments.
METHODS
We conducted a comprehensive search in PubMed, EMBASE, Cochrane library databases, Web of Science, and Scopus. The main results were the patient's reported outcome measure (PROM) score, satisfaction, complications, reoperation, and surgery success rate. Different follow-up times and implant designs were used to evaluate the source of heterogeneity. We used a fixed effects model for meta-analysis and I statistic for evaluating heterogeneity.
RESULTS
Thirty-seven comparative studies were included. In the short term, TAR significantly improved clinical scores (AOFAS score: WMD = 7.07, 95% Cl: 0.41-13.74, I = 0.0%; SF-36 PCS score: WMD = 2.40, 95% Cl: 2.22-2.58, I = 0.0%; SF-36 MCS score: WMD = 0.40, 95% Cl: 0.22-0.57, I = 0.0%; VAS for pain: WMD = - 0.50, 95% Cl: - 0.56-0.44, I = 44.3%) and had the lower incidence of revision (RR = 0.43, 95% CI: 0.23-0.81, I = 0.0%) and complications (RR = 0.67, 95% Cl: 0.50-0.90, I = 0.0%). In the medium term, there were still higher improvements in both the clinical scores (SF-36 PCS score: WMD = 1.57, 95% Cl: 1.36-1.78, I = 20.9%; SF-36 MCS score: WMD = 0.81, 95% Cl: 0.63-0.99, I = 48.8%) and the patient satisfaction (RR = 1.24, 95% Cl: 1.08-1.41, I = 12.1%) in the TAR group, but its total complications rate (RR = 1.84, 95% Cl: 1.26-2.68, I = 14.9%) and revision rate (RR = 1.58, 95% CI: 1.17-2.14, I = 84.6%) were significantly higher than that of the AA group. In the long term, there was no significant difference in clinical score and satisfaction, and a higher incidence of revision (RR = 2.32, 95% Cl: 1.70-3.16, I = 0.0%) and complications (RR = 3.18, 95% Cl: 1.69-5.99, I = 0.0%) was observed in TAR than in AA. The result of the third-generation design subgroup was consistent with that of the above pooled results.
CONCLUSION
TAR had advantages over AA in the short term due to better performance in terms of PROMs, complications, and reoperation rates, but its complications become a disadvantage in the medium term. In the long term, AA seems to be favored because of lower complications and revision rates, although there is no difference in clinical scores.
Topics: Humans; Arthroplasty, Replacement, Ankle; Ankle Joint; Follow-Up Studies; Ankle; Treatment Outcome; Osteoarthritis; Arthrodesis; Retrospective Studies
PubMed: 36897362
DOI: 10.1007/s00264-023-05753-6 -
Journal of Equine Veterinary Science Mar 2023The aim of this study was to determine the clinical outcomes reported in retrospective studies of proximal interphalangeal arthrodesis (PIA) in horses through a... (Meta-Analysis)
Meta-Analysis Review
The aim of this study was to determine the clinical outcomes reported in retrospective studies of proximal interphalangeal arthrodesis (PIA) in horses through a meta-analysis of retrospective studies. CAB Abstracts, PubMed, ScienceDirect, Web of Science, and Scopus were searched. The primary outcomes included survival and surgical site infection (SSI) rates, return to activities, and time of hospital stay and casting. Subgroups were formed for fractures and other conditions. Meta-analyses were performed with fixed and random effects models to estimate proportions, mean values, and effect size by odds ratio (OR) with 95% confidence intervals (CI). Twenty-one full articles were included, totaling 458 horses. The survival rate was 90% (95% CI [86%-93%]), return to activities was 65% (95% CI [61%-70%]), and SSI was 12% (95% CI [8%-16%]). The mean hospitalization was 25 days (95% CI [18-35 days]) and time of casting was 29 days (95% CI [21-42 days]). The OR of survival (P = .769), return to activities (P = .576), and SSI (P = .467) were similar between cases of fractures and other conditions. PIA is an efficient and safe method to treat injuries in the pastern region, with a high survival rate and low SSI. However, the rate of return to soundness for intended use was modest, being potentially lower for fracture cases. Thus, investigations of more efficient interventions are needed to improve this outcome.
Topics: Horses; Animals; Retrospective Studies; Horse Diseases; Arthrodesis; Extremities; Hospitalization
PubMed: 36649830
DOI: 10.1016/j.jevs.2023.104226 -
Techniques in Hand & Upper Extremity... Dec 2020Wrist treatment in spastic cerebral palsy includes splints, botulinum toxin, tendon transfers, tendon lengthening, capsular liberations, and arthrodesis. A...
Wrist treatment in spastic cerebral palsy includes splints, botulinum toxin, tendon transfers, tendon lengthening, capsular liberations, and arthrodesis. A well-indicated wrist arthrodesis corrects deformity improving function and cosmetic appearance in patients with fixed deformities. It is indicated in patients with cerebral palsy, older than 12 years with a fixed deformity in wrist flexion. We report 11 clinical cases with the wrist arthrodesis with a plate of 3.5 with 2.7 mm by dorsal approach and technical resources to minimize the complications of tendon irritation and dorsal discomfort. We present an illustrative clinical case. It is a known procedure, its execution must be careful to avoid complications.
Topics: Adolescent; Arthrodesis; Bone Plates; Cerebral Palsy; Child; Female; Humans; Joint Deformities, Acquired; Male; Wrist Joint
PubMed: 32349096
DOI: 10.1097/BTH.0000000000000288 -
The Journal of Foot and Ankle Surgery :... 2023Regarding the treatment of ankle arthritis, the choice of arthroscopic ankle arthrodesis (AAA) or open ankle arthrodesis (OAA) remains controversial. To guide clinical... (Meta-Analysis)
Meta-Analysis Review
Regarding the treatment of ankle arthritis, the choice of arthroscopic ankle arthrodesis (AAA) or open ankle arthrodesis (OAA) remains controversial. To guide clinical decision-making, we conducted a meta-analysis on the optimal treatment of ankle arthrodesis. We identified eligible studies published from June 1, 1969 to June 1, 2020 using the Cochrane Library, PubMed, OVID, Embase, and Medline searched the references of relevant studies. Randomized and non-randomized studies that compared outcomes of AAA and OAA were included. After the methodologic assessment, available data were extracted and statistically reviewed. The primary outcomes were overall complications rate, tourniquet time, length of the hospital stay, non-union rate, and rate to fusion. The secondary outcomes were delayed union and postoperative infection rate. We included 9 studies comparing arthroscopic and open in patients with ankle arthrodesis, comprising 467 participants. AAA had the advantage of demonstrating a lower overall complication rate (odds ratio [OR], 0.44 [95% confidence interval [CI], 0.26-0.73]; p = .002), shorter intraoperative tourniquet time (mean difference [MD], -16.49 [95% CI, -23.51 to -9.46]; p < .001), shorter length of the hospital stay (MD -1.75, 95% CI -1.94 to -1.2, p < .001),lower non-union rate (OR, -0.07 [95% CI, -0.13 to -0.02]; p <.01) and higher rate to fusion (OR, 4.2 [95% CI, 1.96-8.99]; p < .001) in comparison with OAA. Yet, no significant differences were found in delayed union (OR, 0.46 [95% CI, 0.10-2.04]; p = .30) and postoperative infection rate (OR, 0.45 [95% CI, 0.17-1.15]; p = .09) between the groups. Our results suggest that arthroscopic ankle arthrodesis is superior to open ankle arthrodesis alone in the treatment of ankle arthritis based on the overall complication rate, intraoperative tourniquet time, length of the hospital stay, non-union rate and rate to fusion. However, further high-quality randomized controlled trials with appropriate blinding methods are needed to confirm the findings.
Topics: Humans; Ankle; Ankle Joint; Treatment Outcome; Arthroscopy; Retrospective Studies; Arthritis; Arthrodesis; Postoperative Complications
PubMed: 36588066
DOI: 10.1053/j.jfas.2022.12.001 -
Foot and Ankle Surgery : Official... Apr 2024Hallux rigidus is the most frequent arthritis of the foot, due to multiple factors. Arthrodesis and interposition arthroplasty are treatments considered in advanced... (Review)
Review
UNLABELLED
Hallux rigidus is the most frequent arthritis of the foot, due to multiple factors. Arthrodesis and interposition arthroplasty are treatments considered in advanced stages of the disease, when conservative treatment has failed. Although arthrodesis may be considered the technique recommended by multiple authors, for patients in whom joint mobility is to be preserved, arthroplasty could represent a reliable alternative. The purpose of this systematic review is to investigate and compare the clinical outcomes and complications of arthrodesis and interposition arthroplasty for moderate and severe stages of hallux rigidus.
METHODS
For this systematic review we searched COCHRANE, EMBASE, PUBMED databases. Twenty-six research papers were obtained, with a total of 1348 feet, which were included for qualitative analysis. The following groups were included: Cartiva hemiarthroplasty (286), double stem silicone arthroplasty (276), total metallic arthroplasty (394) and arthrodesis (392).
RESULTS
In the arthrodesis group, the AOFAS-HMI score was the most used, ranging from 36 to 45 in the preoperative period and from 79 to 89 in the postoperative period. The greatest improvement in the VAS PAIN score was from 86 to 4. The fusion rate was 98.6% of the total number of cases, the most frequent complication was pain due to material discomfort. In the total metallic arthroplasty group, the ROTO-GLIDE system reported an AOFAS score of 95 points, with low complication rates; but, with the TOEFIT-PLUS and BIOMED-MERCK systems, despite the good postoperative value, they report 37% and 15% revision due to aseptic loosening in the series with the longest follow-up, respectively. The Cartiva group showed a significative increase in FAAM ADL and FAAM SPORT from 59.4 to 90.4 and from 60.9 to 89.7, respectively; similarly, 20.5% implant removal and conversion to arthrodesis were reported. Finally, the double stem silicone arthroplasty group, in the series with the longest follow-up, it manages to improve the MOXFQ score from 78.1 to 11.0, with an average range of mobility of 22.3 degrees. Lysis was reported in 10% of cases.
CONCLUSIONS
Arthrodesis has proven to be the best option for the treatment of advanced hallux rigidus. Arthroplasty can be a valid option for patients who demand to maintain the range of mobility of the joint; however, it is important to inform about the complications that may arise in the short and medium term.
LEVEL OF CLINICAL EVIDENCE
II.
Topics: Humans; Hallux Rigidus; Metatarsophalangeal Joint; Arthroplasty; Hemiarthroplasty; Arthrodesis; Silicones; Treatment Outcome; Follow-Up Studies; Retrospective Studies
PubMed: 38262785
DOI: 10.1016/j.fas.2023.12.002 -
Foot & Ankle International Jan 2023The aim of this study was to compare outcome (clinical, patient-reported outcome measures, radiologic, joint motion and pedographic) of total joint replacement with...
BACKGROUND
The aim of this study was to compare outcome (clinical, patient-reported outcome measures, radiologic, joint motion and pedographic) of total joint replacement with Roto-Glide (RG) and arthrodesis (A) for severe osteoarthritis of the first metatarsophalangeal joint (MTP1).
METHODS
All consecutive patients with arthrodesis and RG from January 23, 2011, until September 18, 2019, at the authors' institution were considered for inclusion in the study. Preoperatively and at follow-up (FU), radiographs, and/or weightbearing computed tomographic imaging were obtained. Standard dynamic pedography was performed. Visual analog scale foot and ankle (VASFA), European Foot and Ankle Society (EFAS) score, MTP1 range of motion for dorsiflexion/plantarflexion (DF/PF) were registered and compared preoperatively and at FU.
RESULTS
Seventy RG and 72 arthrodesis patients were included. Preoperative VASFA and EFAS scores did not differ between the RG and arthrodesis groups (average scores: VASFA, 50.6 and 45.6; EFAS score, 10.7 and 10.6, respectively; each > .05). Wound healing delays without further operative measures were registered in 4 patients (6%) for RG and 5 (7%) for arthrodesis ( = .67), and 5 revisions in 5 patients (7%) for RG and 12 in 8 (11%) for arthrodesis ( = .05). The longest available FU was higher in RG than in arthrodesis (47 vs 37 months on average, < .001). Pedography showed higher first metatarsal head or sesamoids and lower great toe force percentage from force of entire foot in RG than in arthrodesis ( = .05) resulting in physiological pattern in RG only. VASFA and EFAS scores at FU was higher in RG than in arthrodesis (average scores: VASFA, 72.6 and 63.6; EFAS score, 16.1 and 14.1, respectively; each < .05). DF/PF measurement was only possible in RG (average value: DF/PF, 36.1/14.0).
CONCLUSION
We found marginally lower revision rates and higher patient-reported outcome measures, joint motion (DF/PF), and more physiologic force distribution at slightly longer FU for the RG group than the arthrodesis group. Longer follow-up and broader clinical reporting are needed to identify the potential deficits of RG.
LEVEL OF EVIDENCE
Level III, retrospective cohort study.
Topics: Humans; Hallux; Retrospective Studies; Arthroplasty, Replacement; Metatarsophalangeal Joint; Arthrodesis; Treatment Outcome
PubMed: 36346072
DOI: 10.1177/10711007221125219