1,720,963 research outputs found
Valenti resection arthroplasty for hallux rigidus: A systematic review
No full textValente Valenti proposed in 1976 a "V" resection of the first metatarsophalangeal joint (MPT1) on the sagittal plane for advanced stages of hallux limitus/rigidus, preserving length of the first ray, flexor hallux brevis and sesamoid function. The available literature concerning correct indications, management and clinical outcomes of the Valenti procedure (VP) and its modifications in patients affected by hallux limitus/rigidus was systematically analyzed
Interposition arthroplasty with bovine collagenous membrane for hallux rigidus: A long-term results retrospective study
No full textHallux rigidus (HR) is a degenerative arthritis of the first metatarsophalangeal joint (MTP1) with progressive loss of range of movement (ROM). Interposition arthroplasty (IA) is a technique widely used for the treatment of HR;however, few studies reported long-term clinical results. This study aims to report the clinical results of IA using a bovine pericardium collagen matrix for HR with a minimum 10-years follow-up
Medium-term clinical results in the treatment of supracondylar humeral fractures in children: does the surgical approach impact outcomes?
Full text linkBackground Recent literature has found a consensus in favor of conservative treatment for type II supracondylar humeral fractures (SCHF). This retrospective observational study compares the short- to medium-term functional outcomes of conservative versus surgical treatment in 31 patients with SCHF (Gartland II and III) to assess the potential superiority of one approach over the other. Materials and methods Thirty-one pediatric patients treated for SCHF-19 classified as Gartland II and 12 as Gartland III-were assessed in our department. Eight patients underwent closed reduction and cast immobilization, 22 were treated with closed reduction and percutaneous pinning, and one underwent open reduction and internal fixation with plates. Clinical and functional data were collected during follow-up, including elbow and forearm range of motion (ROM), grip strength, carrying angle, Flynn's criteria, and Disabilities of the Arm, Shoulder, and Hand (DASH) score. Results The average follow-up was 3.3 years (+/- 1.4 years). All patients demonstrated good functional recovery. According to Flynn's criteria, 85% and 81% of the patients achieved a satisfactory outcome in elbow flexion and carrying angle, respectively. No cases of nerve injuries were reported.Four patients developed cubitus varus in the Gartland II group, which was treated with closed reduction and casting with the initial alignment maintained (without a loss of reduction during the first week). However, compared to this group that was conservatively treated, functional and clinical outcomes were significantly better in the group with SCHF Gartland II treated with reduction and pinning (p < 0.05). Conclusions Although some recent studies have demonstrated positive outcomes with conservative treatment for both Gartland IIA and IIB fractures, the short- to medium-term functional results in our study emphasize that superior outcomes were obtained with surgical treatment for Gartland II fractures when compared to those treated conservatively.Trial registration: This study was performed in line with the principles of the Declaration of Helsinki. Ethics approval was obtained from our institute's ethics committee (registry no. 3511).Level of evidence: Therapeutic level II
Effectiveness of corticosteroid injections in Civinini-Morton's Syndrome: A systematic review
Full text linkBACKGROUND: The aim of this paper is to analyze the effectiveness of corticosteroid injections (CI), in combination with or without a local anaesthetic, for Civinini-Morton's Syndrome to determine which protocol could be the most appropriate among conservative treatments.METHODS: All selected articles were screened using a thorough database search of PubMed, EMBASE and SCOPUS to assess their suitability to the research focus.RESULTS: Selection produced 10 articles as full-text, for a total of 590 patients, with a mean follow-up of 14 ± 14.2 (range 3-48) months. Johnson satisfaction scale, resulting from 6 studies, scored 25.6% (range 5-38) and 39.4% (range 15-51.8), respectively completely satisfied and satisfied with minor reservations. Mean VAS, declared in 5 studies, decreased from 70.7 ± 16.5 (range 67-89) to 33.4 ± 7.6 (26-42.5) points (p < 0.01). Most common complication was skin depigmentation in 7 (2.6%) cases.CONCLUSIONS: CI appear to be a safe treatment allowing good results with a very low complications rate. A neuroma of 6.3 mm seems to be the cut-off size; below which CI could have best indications and be considered as an intermediate treatment between shoe modifications and more invasive procedures such as percutaneous alcoholization or surgery.LEVEL OF EVIDENCE: Level II, systematic review
May footwear be a predisposing factor for the development of hallux rigidus? A review of recent findings
No full textHallux rigidus (HR) is the clinical manifestation of osteoarthritis of the first metatarsophalangeal (MTP1) joint and affects about 2.5% of people older than 50 years. The condition may significantly impact patients' quality of life, leading to debilitating pain and limited range of motion (ROM). Numerous hypotheses have been postulated about contributing factors to the development of the disease, but with poor proven association. Some types of footwear over others may transmit altered pressure and stress toward the forefoot and this can significantly contribute to development of the condition. The purpose of this review is therefore to analyze the importance of correct footwear and if an incorrect shoe can influence the development and/or worsening of symptoms in patients affected by HR. From the results of the studies, it appears that symptoms improve with rigid-soled low-heeled shoes such as boots and worsen with flat flexible-soled shoes such as sandals and tennis shoes, which should therefore be avoided. Despite this, although incorrect footwear increases symptoms, a direct correlation with the development of the condition has not been detected but rather an improvement in comfort in some types of shoes than in others. In predisposed patients, incorrect footwear is more a way to increase symptoms than a real risk factor for the development of the disease, remaining in a very low risk percentage to be considered indicative
The influence of first ray instability and hindfoot valgus in the development of hallux rigidus: state of art
No full text: Hallux rigidus (HR) is a painful condition associated with degenerative arthritis of the first metatarsophalangeal (MTP1) joint, leading to a progressive loss of dorsiflexion. The etiological factors leading to the development of the condition are not yet fully understood in the literature. When the hindfoot is aligned in excessive valgus, the medial border of the foot tends to roll over, which brings to increased stress on the medial side of the MTP1 joint, and consequently on the first ray (FR), thus potentially influencing the development of HR deformity. This state of art aims to analyze the influence of FR instability and hindfoot valgus in HR development. From the results of the analyzed studies, it appears that a FR instability may predispose the big toe to increased stress and to narrow the proximal phalanx motion on the first metatarsal, which brings to compression and ultimately degeneration of the MTP1 joint, mostly in advanced stages of disease, less in mild or moderate HR patients. A strong correlation between a pronated foot and MTP1 joint pain was found; forefoot hypermobility during the propulsion phase may promote MTP1 joint instability and increase pain. Thus, the increased moment of pronation of the foot with the overload of the medial column, when present, should be corrected conservatively or surgically; this, most likely, would be useful not only to eliminate or at least limit the painful symptoms but above all to prevent the worsening of the condition, also after the surgical treatment of HR
Total ankle replacement in young patients
Full text linkHigh physical demand and younger age are currently considered contraindications for total ankle replacement. The number of Total Ankle Replacements (TAR) is widespread increasing and indications are expanding thanks to a steady improvement in prosthetic designs and better outcome. Commentary of the literature: in 1999 a study of 100 uncemented STARTM (Waldemar-Link, Hamburg, Germany) prostheses showed a survival rate of 75% at 6.8 years in patients under 50 years old. Other studies (es, Barg et Al.) shows the risk of failure age-related in young patients compared to older group. A report of 780 TAR from the Swedish Ankle Register showed patients with primary or post-traumatic osteoarthritis under 60 years of age to have a 1.8 higher chance of revision compared to older patients. Discussion: ankle replacement has been traditionally reserved for patients older 50 years old and with low physical demand. Contrariwise this belief, TAR have already been used with a wide range of ages, sometimes even patients younger than 30 years old. Most of the "negative" score and results showed before are related to "second-generation" prosthetic designs, while recent studies used a "third-generation" prosthetic design. Conclusions: recent evidences showed better clinical results and higher satisfaction in people under the age of 50 compared to ankle arthrodesis with comparable rate of complications and survivorship. Younger people will have however a higher rate of reoperation but in the meantime, they will prevent progressive degeneration of adjacent joints
Revision arthroplasty with megaprosthesis after Girdlestone procedure for periprosthetic joint infection as an option in massive acetabular and femoral bone defects
No full textBACKGROUND AND AIM: To evaluate the clinical outcomes of patients treated with Girdlestone procedure (GP) or excision arthroplasty (EA) for periprosthetic infection with massive bone defects and undergoing revision arthroplasty. METHODS: All patients treated with EA or GP for hip periprosthetic infection between 2014 and 2017 and sustaining revision arthroplasty (RA) were included in the study. Patients with less than 24 months of follow-up or less than 12 months between GP or EA and RA were excluded. Any sign of implant mobilization or periprosthetic fracture was assessed through X-ray. Patients were evaluated with D’aubigne-Postel hip score before RA and at the last follow-up. Mann-Whitney U test was used to assess differences between pre-RA surgery and last follow-up. P value was set as <0.05. RESULTS: Twelve patients meet the inclusion criteria (mean follow-up 58+/-9.72 months). No radiographic sign of implant mobilization or periprosthetic fracture was reported. A significant difference was found for each parameter of the D’Aubigne-Postel score (p < 0.0001); none of the patients reached more than fair results in the absolute hip score. The difference between pre and post-operative global status showed a fair improvement. A significant difference was found for leg length discrepancy between pre and post RA (p<0.0001). CONCLUSIONS: Conversion from EA or GP to RA in patients suffering from massive acetabular and femur defects is challenging; conversion procedure is able to reduce patients’ disability and to improve walking ability. (www.actabiomedica.it
Brachial plexus schwannomas
No full textBACKGROUND: Schwannoma is a rare tumor that can be found in the brachial plexus. Despite the fact it is benign it can cause inflammatory reaction or compression of the nerves’ fascicles causing altered muscular or sensitive performance of the upper limb. Diagnosis of Schwannoma in the brachial plexus is difficult due to confounding interpretation with other lesions, that makes important magnetic resonance imaging (MRI) and histopathological examination for a complete diagnostic assessment. Surgical treatment is challenging, but, currently, microsurgical approach using the microscope, microsurgical tools and skills allow tumor removal with an acceptable risk of injury to neurovascular structures. METHODS: In our multicenter study we reported brachial plexus Schwannoma of six patients treated by surgical excision. Medical records and MRI data of all patients were reviewed and outcomes analyzed. RESULTS: We confirm that current precise surgical techniques represent an important approach to remove Schwannomas occurring around brachial plexus. CONCLUSIONS: Schwannomas of the brachial plexus are curable lesions and the use of precise surgical techniques allows these tumors to be removed with minimal morbidity
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