1,721,009 research outputs found
Letter Regarding: Endoscopic Flexor Hallucis Longus Transfer for Chronic Noninsertional Achilles Tendon Rupture
No full textHistory of total ankle replacement.
No full textAttempts at ankle replacement have existed for at least 50 years. Time has essentially eliminated constrained, cemented, first-generation ankle replacements. Although some two-component, more anatomic, designs are still used with varying success, three-component "mobile bearing" ankle prostheses are winning the race of evolution. Not only have implants change over the years, but also the patients and surgeons. Surgeons specialize, improving their surgical outcomes and expanding the indications for total ankle replacement in technically demanding complex ankles. High-demand, younger patients, but also obese ones, are potential candidates for a total ankle replacement. This article provides a review of the history of total ankle replacement
Osteotomies for Managing Varus and Valgus Malalignment with Total Ankle Replacement
No full textTotal ankle replacement remains an option for varus and valgus ankles, provided that it results in a balanced, neutrally aligned ankle. Accurate preoperative assessment of the deformity is essential for appropriate selection of adjuvant procedures. Osteotomies performed proximal (tibial), within (malleolar), or distal to (calcaneal, metatarsal) the ankle, allow deformity correction. Outcomes can be expected to be as good as of those ankles without coronal plane malalignment, at least in the short-term
Open tibial fractures in the paediatric population: a systematic review of the literature.
No full textINTRODUCTION:
Open tibial fractures have been studied extensively in adults, and detailed treatment strategies have been developed: wound irrigation and debridement, fracture stabilization and delayed primary wound closure or early flap coverage are basic principles of management. No clear guidelines regarding the management of open tibial fractures in children exist.
SOURCES OF DATA:
We searched Medline, Embase, Cochrane, CINAHL and Google Scholar databases using the keywords: 'open', 'tibia', 'fracture', 'children', 'paediatric', 'pediatric', 'external fixation', 'nailing'. Fourteen clinical studies were included. Quality of the studies was assessed using the Coleman Methodology Score.
AREAS OF AGREEMENT:
Age above 10 years and grade III (severe) open fractures are associated with complications and outcomes similar to those in adults.
AREAS OF CONTROVERSY:
It is unclear whether open fractures of the tibia in children should be managed according to the principles followed in adults. Many authors support primary skin closure and non-operative management for grade I open fractures. There is no clear effect of fracture fixation method on time to union.
GROWING POINTS:
The quality of the studies was relatively poor. Patients' age affects outcome; adolescents should probably be managed as adults.
AREAS TIMELY FOR DEVELOPING RESEARCH:
Carefully designed prospective cohort studies including a large number of children would be of value. Adequate follow-up is necessary to assess the long-term effects in the growing skeleton. The efficacy of flexible intramedullary nailing for open fractures needs further evaluation. Outcome studies based on general health measures are needed
Intermittent pneumatic compression in fracture and soft-tissue injuries healing.
No full textINTRODUCTION:
Current methods of fracture care use various adjuncts to try and decrease time to fracture union, improve fracture union rates and enhance functional recovery. Intermittent pneumatic compression (IPC), one such modality, is used in the management of both fractures and soft-tissue injuries.
METHODS AND RESULTS:
A search of PubMed, Medline, CINAHL, DH data and Embase databases was performed using the following keywords 'intermittent pneumatic compression', 'fracture healing' and 'soft tissue healing'. Sixteen studies on the use of IPC in fracture and soft-tissue healing were identified. These studies demonstrated that IPC facilitates both fracture and soft-tissue healing with rapid functional recovery.
CONCLUSIONS:
IPC appears to be an effective modality to enhance fracture and soft-tissue healing. However, the number of subjects in human studies is small, and adequately powered randomized controlled trials in humans are required to produce stronger clinically relevant evidence
How successful are current ankle replacements?: a systematic review of the literature.
No full textTotal ankle arthroplasty provides an alternative to arthrodesis for management of ankle arthritis. What is the outcome of total ankle arthroplasty implants currently in use? We conducted a systematic literature search of studies reporting on the outcome of total ankle arthroplasty. We included peer-reviewed studies reporting on at least 20 total ankle arthroplasties with currently used implants, with a minimum followup of 2 years. The Coleman Methodology Score was used to evaluate the quality of the studies. Thirteen Level IV studies of overall good quality reporting on 1105 total ankle arthroplasties (234 Agility, 344 STAR, 153 Buechel-Pappas, 152 HINTEGRA, 98 Salto, 70 TNK, 54 Mobility) were included. Residual pain was common (range, 27%-60%), superficial wound complications occurred in 0% to 14.7%, deep infections occurred in 0% to 4.6% of ankles, and ankle function improved after total ankle arthroplasty. The overall failure rate was approximately 10% at 5 years with a wide range (range, 0%-32%) between different centers. Superiority of an implant design over another cannot be supported by the available data.
LEVEL OF EVIDENCE:
Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence
Modalities in prevention of flexor tendon adhesion in the hand: what have we achieved so far?
No full textSeveral modifications in surgical techniques and various pharmacological and non pharmacological modalities have been introduced to prevent adhesions formation in surgery on flexor tendons of the hand. However, most studies have been carried out in animals with very few human trials. Only early postoperative rehabilitation is supported by clinical evidence, while the optimal rehabilitation protocol remains controversial. Innovations in surgical techniques and other modalities need to be tested with adequately powered human trials, before their potential benefit in clinical practice is accepted
Sports activities after lower limb osteotomy.
No full textINTRODUCTION:
Active sports participation can be important in some patients with degenerative joint disease in the lower limb. We investigated whether this is possible after an osteotomy for osteoarthritis of the hip, knee and ankle joints.
SOURCES OF DATA:
We performed a literature search using Medline, Cochrane, CINAHL and Google Scholar with no restriction to time period or language using the keywords: 'osteotomy and sports'. Eleven studies (all level IV evidence) satisfied our inclusion and exclusion criteria. Nine reported on high tibial osteotomies, one on periacetabular osteotomies and one on distal tibial osteotomies. The Coleman Methodology Score to assess the quality of studies showed much heterogeneity in terms of study design, patient characteristics, management methods and outcome assessment.
AREAS OF AGREEMENT:
Participation in recreational sports is possible in most patients who were active in sports before lower limb osteotomy. In no study were patients able to participate in competitive sports.
AREAS OF CONTROVERSY:
Intensive participation in sports after osteotomy may adversely affect outcome and lead to failures requiring re-operation.
GROWING POINTS:
Patients may be able to remain active in selected sports activities after a lower limb osteotomy for osteoarthritis. More rapid progression of arthritis is however a possibility.
AREAS TIMELY FOR DEVELOPING RESEARCH:
Prospective comparative studies investigating activities and sports participation in age-matched patients undergoing osteotomy or joint replacement could lead to useful conclusions. Increased activity and active sports participation may lead to progression of arthritis and earlier failure requiring additional surgery
Sport injuries: a review of outcomes.
No full textInjuries can counter the beneficial aspects related to sports activities if an athlete is unable to continue to participate because of residual effects of injury. We provide an updated synthesis of existing clinical evidence of long-term follow-up outcome of sports injuries. A systematic computerized literature search was conducted on following databases were accessed: PubMed, Medline, Cochrane, CINAHL and Embase databases. At a young age, injury to the physis can result in limb deformities and leg-length discrepancy. Weight-bearing joints including the hip, knee and ankle are at risk of developing osteoarthritis (OA) in former athletes, after injury or in the presence of malalignment, especially in association with high impact sport. Knee injury is a risk factor for OA. Ankle ligament injuries in athletes result in incomplete recovery (up to 40% at 6 months), and OA in the long term (latency period more than 25 years). Spine pathologies are associated more commonly with certain sports (e.g. wrestling, heavy-weight lifting, gymnastics, tennis, soccer). Evolution in arthroscopy allows more accurate assessment of hip, ankle, shoulder, elbow and wrist intra-articular post-traumatic pathologies, and possibly more successful management. Few well-conducted studies are available to establish the long-term follow-up of former athletes. To assess whether benefits from sports participation outweigh the risks, future research should involve questionnaires regarding the health-related quality of life in former athletes, to be compared with the general population
Endoscopic debridement for non-insertional Achilles tendinopathy with and without platelet-rich plasma
No full textBackground: When non-operative management fails to improve symptoms in patients with non-insertional Achilles tendinopathy, surgery may be required. Various open and endoscopic techniques have been proposed, and platelet-rich plasma (PRP) injections have been proposed as an adjunct to aid tendon healing. Methods: Thirty-six patients with mid-portion Achilles tendinopathy were randomized to undergo endoscopic debridement alone (n = 19) or in combination with intraoperative PRP application (n = 17). Clinical outcome measures included the Visual Analogue Scale for pain, function, and satisfaction and the Victorian Institute of Sports Assessment – Achilles (VISA-A) questionnaire. Patients were followed-up at 6 weeks, 3 months, 6 months, and 12 months after surgery. An MRI examination at 3 and 12 months was used to assess signal alterations within the tendon. Results: Both groups showed significant clinical improvement (p < 0.05) after surgery, with no difference between the 2 groups. Tendon diameter increased at 3 months and decreased at 12 months. The tendinopathy area increased at 3 months and decreased at 12 months below baseline level in both groups. There was no significant difference between the groups regarding the MRI parameters. Nodular thickening and MRI-detected signal alteration persisted after surgery, with no association between imaging and clinical outcome. Five minor complications were reported: 2 in the PRP group and 3 in the control group. Conclusion: Endoscopic debridement of the Achilles tendon improved clinical outcomes in patients with mid-portion tendinopathy. The addition of PRP did not improve outcomes compared to debridement alone. MRI parameters showed no association with clinical outcomes
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