Current Issue : October - December Volume : 2016 Issue Number : 4 Articles : 5 Articles
Background: Since we are very successful in the operation of hallux valgus using a transverse subcapital\nosteotomy fixated with an intramedullary angle-stable locking plate, and a tailors bunion is\nunderstood as a reversed hallux valgus, we have applied the operation also for such indication.\nMethod: The osteotomy was carried out at a straight V. metatarsal subcapitally, and in case of an\noutwardly curved V. metatarsal at the bending location. The intramedullary plates are available in\ndifferent designs and the plate and screws disappear completely in the bone, so the soft tissues are\nnot disturbed. The head of the plate is either straight or curved in order to shift the distal fragment\nsufficiently. Results: 26 patients were operated within a period of 5 years (2008-2012). 21\npatients were followed up after an average of 34.4 months. The IM angle IV/V could be improved\nby an average of 11.76 to an average of 4.10. This is a highliy significant pre- to postoperative\ndifference of 7.66 (t = 15.07, p < 0.001). The AOFAS score was improved by an average of 42.24\npoints from 55.76 points preoperatively to 98.00 points postoperative. There was no pseudoarthrosis\nand no wound healing impairment. All patients were either satisfied or very satisfied\nwith the surgery. Conclusion: This method does not have the disadvantages of the other common\noperations of the Tailors bunion and is applied now as a standard method in this deformity....
Articular surface partial-thickness rotator cuff tears (PTRCTs) are commonly repaired using two different surgical techniques:\ntranstendon repair or repair after completion of the tear. Although a number of studies have demonstrated excellent clinical\noutcomes, it is unclear which technique may provide superior clinical outcomes and tendon healing. The purpose was to evaluate\nand compare the clinical outcomes following arthroscopic repair of articular surface PTRCT using a transtendon technique or\ncompletion of the tear. A systematic review of the literature was performed following PRISMA guidelines and checklist. The\nobjective outcome measures evaluated in this study were the Constant Score, American Shoulder and Elbow Surgeons score,\nVisual Analogue Scale, physical examination, and complications.Three studies met our criteria. All were prospective randomized\ncomparative studies with level II evidence and published from 2012 to 2013. A total of 182 shoulders (mean age 53.7 years;\nmean follow-up 40.5 months) were analyzed as part of this study. Both procedures provided excellent clinical outcomes with no\nsignificant difference in Constant Score and other measures between the procedures. Both procedures demonstrated improved\nclinical outcomes.However, therewere no significant differences between each technique. Further studies are required to determine\nthe long-term outcome of each technique....
Background: There has been no report to date regarding retraction patterns of delaminated rotator cuff tears. The\npurpose of this study was to evaluate the incidence and tearing patterns of delamination and repair integrity after\nthe dual-layer repair of delaminated cuff tears.\nMethods/design: A consecutive series of 64 patients with posterosuperior rotator cuff tears underwent\narthroscopic rotator cuff repair from August 2011 to September 2012. Among the patients, 53 who received either\ndual-layer double-row (DLDR) repair or dual-layer suture bridge (DLSB) repair and 11 who received a single-layer\nrepair were evaluated. The mean follow-up period after surgery was 26.5 months. The retraction direction of the\ndeep and superficial layers was analyzed, and the integrity of the repaired constructs was determined in 37 patients\nthrough magnetic resonance imaging at a mean of 12.1 months after surgery.\nResults: The incidence of delamination was 82.8 %. Posteromedial retraction of the deep and superficial layers was\nobserved in 98.1 and 88.5 % of cases, respectively. The Constant score and UCLA score increased preoperatively to\npostoperatively, showing no significant differences between the dual-layer repair group and single-layer repair\ngroup. Retear was found in two (7.6 %) patients in the dual-layer repair group and three (27.2 %) patients in the\nsingle-layer repair group (p = 0.016).\nConclusions: Differential rotator cuff repair strategies are needed to address rotator cuff tears, since recent studies\nhave changed our concept of rotator cuff tears. We have focused on three areas: incidence, retraction patterns, and\nclinical outcomes. The incidence of delamination was extremely high. Both the superficial layer and deep layer were\nmainly retracted posteromedially. The retraction of the deep layer and superficial layer may be affected by the\ninfraspinatus. Dual-layer rotator cuff repair based on the retraction pattern of delamination is recommended for\nimprovement of repair integrity and of clinical outcomes....
Background: Reports of the efficacy of open reduction and Zigzag Osteotomy combined Fibular\nAllograft (ZOFA) for developmental dysplasia of the hip. The purposes of this study were to evaluate\nthe long-term outcomes and complications after surgery. Methods: We performed a retrospective\nmatch-controlled study in which 158 patients had 181 hips with developmental dysplasia\nof the hip. Radiographs were found of acetabular index, height of dislocation, \n\n\n-\ntion angle in the spica cast, and Severin grade. At final follow-up, deformity of femoral head or\nneck or acetabulum was evaluated according to the Severin. Avascular necrosis was rated according\nto Kalamchi. Clinical evaluation was made according to modified McKay criteria. Results:\nBetween 2009 and 2012, 133 girls (84.2%) and 25 boys (15.8%) with developmental dysplasia of\nthe hip underwent open reduction and ZOFA; 135 (85.4%) were unilateral, and 23 (14.6%) were\nbilateral. Patients were divided into 2 groups: group 1 included 54 patients (62 hips) aged 12\nmonths - \n ed 84 patients (119 hips), aged >18 months - ths.\nAccording to T�¶nnis system: type 3 appeared in 127 hips (70.2%), and Type 4 in 54 hip (29.8%).\nThe anterior approach was used to expose inner table of the ilium and ZOFA in all cases. Acetabular\nindex was improved; preoperation was 42.95, and latest follow-up 17.26. The Kirschner\nWires (KW) were not used to fix the fibular allograft at the pelvic osteotomy site. All of the fibular\nallografts were completely incorporated in mean time of 14 weeks (range, 12 weeks - 17 weeks)\npost-surgery. Clinical evaluation according to modified McKay criteria: satisfactory result (excellent\nand good) was achieved in 141 hips (77.9%). Avascular Necrosis (AVN) happened in 61 hips\n(33.7%), redislocation in 18 hips (9.9%), coxa vara in 4 hips (2.2%), trendelenburg gait in 4 hips\n(2.2%), and supracondylar femoral fractures in 2 hips (1.1%). Conclusions: On the basis of this study, ZOFA was strength and graft was not resorption, graft problems; without medial displacement\nof the distal fragment. Acetabular index was improved, without KW problem. Surgical technique\nwith ZOFA did not expose outer table of the illium, limiting abductor muscle injury with\nnegative trendelenburg gait; on the other hand, the blood loss from this procedure is acceptable.\nSome complications have been seen in this study: AVN, redislocation, coxa magna, coxa vara,\ntrendelenburg gait, and distal femoral fracture....
Abstract\nBackground: Proper limb and component alignments as well as soft tissue balance are vital for the longevity and\noptimal long-term outcomes of total knee arthroplasty (TKA). This procedure is technically demanding in patients\nwith Ranawat type-II valgus arthritic knees with marked coronal femoral bowing. Computer-assisted surgery (CAS)\nand intra-articular bone resection with TKA are the treatments of choice for patients with ipsilateral extra-articular\ndeformity. In theory, both CAS and intra-articular bone resection are beneficial in Ranawat type-II valgus arthritic\nknees with marked coronal femoral bowing deformity, but the literature on this topic is sparse. We compared the\nbenefits of using these two techniques for TKA under this circumstance.\nMethods: Patients who had Ranawat type-II valgus arthritic knees and marked coronal femoral bowing deformity\nand had undergone TKA at our hospital between 2005 and 2013 were enrolled in this retrospective study. Patients\ntreated with CAS were assigned to the CAS-TKA group; patients treated with intra-articular bone resection were\nassigned to the Bone-Resect-TKA group. Radiographic parameters and clinical outcomes (International Knee Society\n(IKS) scores and patellar scores) in both groups were compared.\nResults: Forty-seven patients (50 knees) met the inclusion criteria: 22 knees in the CAS-TKA group and 28 knees in\nthe Bone-Resect-TKA group. Lateral retinaculum release was significantly (P = 0.008) higher in the Bone-Resect-TKA\ngroup. The joint-line was significantly properly restored in the CAS-TKA group (P = 0.011). The reconstructed\nmechanical axis was significantly (P = 0.012) closer to normal in the CAS-TKA group than in the Bone-Resect-TKA\ngroup. For component alignment, the femoral valgus and femoral flexion angles were significantly better in the\nCAS-TKA group (P = 0.002 and P = 0.006, respectively), but not the tibial valgus, tibial flexion, or patellar tilting\nangles. IKS scores and patellar scores were not significantly different between groups at a mean follow-up of\n60.2 months. Conclusions: CAS-TKA was effective for obtaining proper alignment and joint-line restoration in patients with\nRanawat type-II valgus arthritic knees and marked coronal femoral bowing deformity, but not for yielding better\nclinical outcomes. Additional large-scale prospective randomized cohort studies with long-term follow-ups are\nnecessary to make evidence-based recommendations....
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