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Unfallchirurgie (Heidelberg, Germany) Aug 2022Medial end clavicle fractures are rare injuries and typically treated conservatively. In contrast, displaced fractures have a higher incidence of delayed healing or... (Review)
Review
Medial end clavicle fractures are rare injuries and typically treated conservatively. In contrast, displaced fractures have a higher incidence of delayed healing or non-union and might benefit from operative treatment. Thus, assessments of the stability and fracture morphology are essential for selection of the optimal treatment procedure. This article describes the diagnostics and surgical treatment of a displaced extra-articular fracture of the clavicle with a small medial fragment using an anatomically preformed radius plate.
Topics: Clavicle; Fracture Fixation, Internal; Fracture Healing; Fractures, Bone; Humans; Treatment Outcome
PubMed: 34480206
DOI: 10.1007/s00113-021-01074-8 -
Foot and Ankle Clinics Sep 2021Adult acquired flatfoot deformity is a complex pathologic condition that requires considerate and thoughtful surgical solutions. Medial column procedures are often... (Review)
Review
Adult acquired flatfoot deformity is a complex pathologic condition that requires considerate and thoughtful surgical solutions. Medial column procedures are often supplemented by a medializing calcaneal osteotomy and/or a lateral column lengthening because of the complex nature of progressive collapsing foot deformity and its resultant peritalar instability. Other osteotomies and fusions include a Cotton osteotomy and first tarsometatarsal fusion.
Topics: Adult; Arthrodesis; Calcaneus; Flatfoot; Foot Deformities; Humans; Osteotomy; Radiography
PubMed: 34332732
DOI: 10.1016/j.fcl.2021.06.001 -
Der Unfallchirurg Feb 2019The deltoid or medial collateral ligament consisting of superficial and deep components together with the spring ligament is the primary stabilizer of the ankle joint....
The deltoid or medial collateral ligament consisting of superficial and deep components together with the spring ligament is the primary stabilizer of the ankle joint. Injuries of these anatomical structures are more frequent than assumed but are nevertheless often overlooked. Inadequate treatment can lead to chronic pain, instability, hindfoot deformities and ankle arthritis. Patient history and clinical assessment can help to identify injuries of the deltoid ligament. Magnetic resonance imaging (MRI) is the diagnostic method of choice. Arthroscopy of the ankle joint can be a valuable tool in the assessment of the injury. Treatment should include accompanying injuries and deformities and can range from immobilization in a cast to ligament repair up to ligament reconstruction using a free tendon graft.
Topics: Ankle; Ankle Injuries; Ankle Joint; Humans; Joint Instability; Ligaments, Articular
PubMed: 30666345
DOI: 10.1007/s00113-018-0601-9 -
Sports Medicine and Arthroscopy Review Jun 2017Biomechanical studies are commonly performed to evaluate the influence of medial patellofemoral ligament (MPFL) reconstruction and tibial tuberosity medialization on... (Review)
Review
Biomechanical studies are commonly performed to evaluate the influence of medial patellofemoral ligament (MPFL) reconstruction and tibial tuberosity medialization on patellar tracking and patellofemoral contact pressures. The most common method is in vitro simulation of knee function, but computational simulation of knee function and computational reconstruction of in vivo motion can also be utilized. The current review of the biomechanical literature indicates that MPFL reconstruction and tibial tuberosity medialization reduce lateral patellar tracking. Decreased lateral patellofemoral contact pressures have also been noted. For MPFL reconstruction, the most commonly noted biomechanical concerns are graft overtensioning and nonanatomic attachment on the femur leading to overconstraint of the patella and elevated medial contact pressures. For tuberosity medialization, the influence of altered tibiofemoral kinematics on postoperative function is unknown. Future biomechanical studies should emphasize inclusion of anatomic features and tracking patterns related to patellar instability, with comparison between the surgical approaches for continued development of treatment guidelines.
Topics: Biomechanical Phenomena; Cadaver; Humans; Knee Joint; Ligaments, Articular; Patella; Patellofemoral Joint; Range of Motion, Articular; Tibia
PubMed: 28459747
DOI: 10.1097/JSA.0000000000000152 -
Zeitschrift Fur Orthopadie Und... Dec 2011The diagnosis and treatment of patellar dislocation is very complex. The aim of this study is to give an overview of the biomechanics of the patellofemoral joint and to... (Review)
Review
AIM
The diagnosis and treatment of patellar dislocation is very complex. The aim of this study is to give an overview of the biomechanics of the patellofemoral joint and to point out the latest developments in diagnosis and treatment of patellar dislocation.
METHOD
The authors electronically searched Medline, Cochrane and Embase for studies on the biomechanics of the patellofemoral joint and for conservative and surgical treatments after patellar dislocation. We extracted baseline demographics, biomechanical, conservation and surgical details.
RESULTS
Understanding the biomechanics of the patellofemoral joint is necessary to understand the pathology of patellar dislocation. The patellofemoral joint consists of a complex system of static, active and passive stabilising factors. Patellar instability can result from osseous and soft-tissue abnormalities, such as trochlear dysplasia, patella alta, a high tibial tuberosity trochlear groove (TTTG) distance, weaknesses of the vastus medialis obliquus or a lesion of the medial retinaculum. Recent studies have focused on the medial patellofemoral ligament (MPFL) and have shown that the MPFL is the most significant passive stabiliser of the patella. Following patellar dislocation, an MRI should be standard practice to detect an MPFL rupture, osteochondral lesions or other risk factors for redislocation. An acute first-time patellar dislocation without osteochondral lesions and without severe risk factors for a redislocation should follow a conservative treatment plan. If surgical treatment is required, the best postoperative results occur when the MPFL is reconstructed, leading to a redislocation rate of 5%, this includes cases that have a dysplastic trochlea. Duplication of the medial retinaculum show very inconsistent results in the literature, possibly due to the fact that the essential pathomorphology of patellar dislocation is not addressed. Addressing the exact location of the rupture of the MPFL with a suture is possibly more convenient, especially after first-time dislocation with associated risk factors for a redislocation. Recent literature does not encourage the use of lateral release, since this can increase patellar instability. Indications for lateral release include persistent patellar instability or pain reduction in an older arthritic subject. For correcting a patellofemoral malalignment, the TTTG distance should be measured and a medial transposition of the anterior tibial tubercle hinged on a distal periosteal attachment should be considered. Cartilage lesions on the medial facet of the patella are a contra-indication for medial tubercle transposition. For cartilage lesions of the lateral facet, antero-medialization of the tibial tubercle can be successful. A tubercle osteotomy can be efficiently combined with MPFL reconstruction. We believe that patients with open epiphyseal plates should be treated with duplication of the medial retinaculum. In the presence of patellar maltracking, an additional subperiostal soft tissue release with medialisation of the distal part of the patellar tendon can be performed.
CONCLUSION
It seems that the predominating factors for patellar dislocation are heterogenic morphology in combination with individual predisposition. Non-surgical treatment is typically recommended for primary patellar dislocation without any osteochondral lesions and in the absence of significant risk factors for redislocation. If surgical treatment is deemed necessary, addressing the essential pathomorphology has become the primary focus.
Topics: Arthroscopy; Humans; Patellar Dislocation; Physical Therapy Modalities
PubMed: 21544786
DOI: 10.1055/s-0030-1250691 -
Plastic and Reconstructive Surgery Dec 2002Periorbital reconstruction following skin cancer ablation represents a challenging problem. A thorough understanding of the complex periorbital anatomy is necessary to... (Review)
Review
Periorbital reconstruction following skin cancer ablation represents a challenging problem. A thorough understanding of the complex periorbital anatomy is necessary to preserve lid function and protect the ocular surface. The medial canthal region represents the most difficult periorbital zone to reconstruct. This area has a complex anatomy involving both the medial canthus itself and the lacrimal apparatus. The authors present their experience with a versatile technique for reconstruction of the medial canthal periorbital region, namely, a medially based upper eyelid myocutaneous flap. In the 10 patients in whom this procedure was used, there was one partial and no complete flap losses. The authors believe that the medially based upper lid myocutaneous flap offers an excellent solution to the difficult problem of medial canthal periorbital reconstruction.
Topics: Aged; Eyelids; Female; Humans; Male; Middle Aged; Nose; Nose Neoplasms; Plastic Surgery Procedures; Surgical Flaps
PubMed: 12447042
DOI: 10.1097/01.PRS.0000033020.40691.B2 -
Journal of the American Podiatric... 2011A medially deviated axis has been cited as an etiologic factor in increasing pronatory moments across the subtalar joint axis. Orthoses are often used to reduce these... (Review)
Review
A medially deviated axis has been cited as an etiologic factor in increasing pronatory moments across the subtalar joint axis. Orthoses are often used to reduce these pronatory moments, aiming to off-load related injured structures. By aligning the posting or incline of an orthosis shell medial to the axis and parallel to it, the amount of moments applied will be theoretically greater than if prescribed at a less-than-optimal angle. We first published the medial oblique shell inclination as a method to increase supinatory moments to a medially deviated subtalar joint axis in 2008. This paper summarizes the theoretical reasons for use and introduces original methods of construction.
Topics: Biomechanical Phenomena; Equipment Design; Foot Injuries; Heel; Humans; Materials Testing; Orthotic Devices; Subtalar Joint; Supination
PubMed: 22106201
DOI: 10.7547/1010523 -
Arthroscopy : the Journal of... Oct 2023Medialization of the rotator cuff insertion as a technique to manage massive rotator cuff tears has been described for decades. However, "extreme medialization" as a...
Medialization of the rotator cuff insertion as a technique to manage massive rotator cuff tears has been described for decades. However, "extreme medialization" as a means to manage massive rotator cuff tears with significant atrophy warrants caution. Nonanatomic reconstruction almost always carries a price. Biomechanical studies show extreme medialization results in significant and obligate restriction of motion, and it is difficult to imagine how extreme medialization would allow normal clinical motion without substantial scapulothoracic compensation. Similarly, obligatory loss of strength could be expected. Based on the current evidence, I will not indicate this technique for my own patients at the present time.
Topics: Humans; Rotator Cuff Injuries; Rotator Cuff; Atrophy; Motion
PubMed: 37716788
DOI: 10.1016/j.arthro.2023.05.010 -
Journal of Voice : Official Journal of... Apr 2022Voice production in pathological conditions or after surgical intervention often involves undesired medial surface shape such as reduced vertical thickness and/or...
OBJECTIVES
Voice production in pathological conditions or after surgical intervention often involves undesired medial surface shape such as reduced vertical thickness and/or left-right asymmetry in medial surface shape. The effect of such undesired medial surface on voice production remains unclear, and is often not taken into consideration during planning of surgical intervention, due to difficulty of imaging the medial surface in patients. This study aims to better understand how voice outcomes are impacted by undesired medial surface shape.
METHODS
Computational simulations were conducted to parametrically manipulate medial surface shape and stiffness and observe its consequence on voice production.
RESULTS
The results showed that undesired medial surface shape can result in incomplete glottal closure, weak voice production, increased phonation threshold, and significantly reduced vocal efficiency, particularly in the presence of left-right stiffness asymmetry.
CONCLUSIONS
In addition to approximating the vocal folds, medialization laryngoplasty should additionally aim to sufficiently increase medial surface thickness, which may improve voice outcomes in patients whose voices remain unsatisfactory or suboptimal after initial intervention. While a divergent implant may increase medial surface thickness, precise implant placement in anticipation of tissue and implant deformation during the insertion process is equally important in order to achieve desired medial surface shape and optimal voice outcomes.
PubMed: 35410779
DOI: 10.1016/j.jvoice.2022.03.010 -
Regional Anesthesia and Pain Medicine May 2022Fluoroscopic-guided radiofrequency ablation of the lumbar medial branches is commonly performed to manage chronic low back pain originating from the facet joints. A...
INTRODUCTION
Fluoroscopic-guided radiofrequency ablation of the lumbar medial branches is commonly performed to manage chronic low back pain originating from the facet joints. A detailed understanding of the course of medial branches in relation to bony and soft tissue landmarks is paramount to optimizing lumbar denervation procedures, particularly parallel placement of the radiofrequency electrode. The objectives of this study were to investigate the relationship of medial branches to anatomical landmarks and discuss the implications for lumbar denervation.
METHODS
Ten cadaveric specimens were meticulously dissected. The origin, course, and relationship of lumbar medial branches to bony and soft tissue landmarks were documented.
RESULTS
The medial branches followed the lateral neck of superior articular process deep to the intertransversarii mediales muscle at each lumbar vertebral level. In all specimens, the medial branches coursed laterally on the anterior half of the neck and transitioned from parasagittal-to-medial on the posterior half to reach the mamillo-accessory notch. The mamillo-accessory ligament was found to not occlude the nerve on the posterior quarter of the lateral neck but rather at the mamillo-accessory notch located at the posterior margin of the superior articular process.
DISCUSSION
A detailed understanding of the relationship of medial branches to anatomical landmarks is essential to optimizing needle placement for lumbar denervation procedures. The current study suggests that a parasagittal placement, with increased cranial-to-caudal angulation of the electrode, may improve parallel tip alignment with the targeted medial branch and represent a potential alternative to the traditional technique.
PubMed: 35589133
DOI: 10.1136/rapm-2022-103653