Pub Date : 2021-07-14DOI: 10.1097/BTO.0000000000000563
A. Najafi, E. Seif, Salman Azarsina, T. Baghdadi, M. Zareie
Purpose: The Clubfoot, or the Congenital Talipes Equinovarus, is the most common congenital orthopedic disease, with 1 or 2 cases reported per 1000 live births. The purpose of this study is to assess the efficacy of the treatment of the complex equinovarus deformity of the feet, using the Ilizarov technique. Materials and Methods: In a prospective case series study from January 2012 to April 2016, 32 patients (35 feet) with rigid and complicated club feet have been included. The Ilizarov technique was applied in order to treat the mentioned deformity. These patients had no other congenital anomalies or systemic diseases. Outcomes were evaluated using the International Clubfoot Study Group (ICFSG) scoring system. Results: All of the patients were between 8 and 14 years of age, with the mean age of 10.9 years old. The mean of preoperative ICFSG score, morphological score, functional score, and radiologic score were 21.25±7, 6.2±2.4, 13.6±3.2, and 6.8±3.6, respectively. The postoperative mentioned scores were 11.88±6.18, 3.4±1.8, 4.7±2.1, and 3.8±1.9, respectively. The difference in the ICFSG scores before and after treatment was statistically significant (P=0.001). Conclusion: The Ilizarov technique can be considered as an efficient and successful treatment for recurrent or neglected clubfoot deformities, since it has provided satisfactory results.
{"title":"The Ilizarov Fixator: A Treatment for Relapsed Clubfoot, an Observational Study","authors":"A. Najafi, E. Seif, Salman Azarsina, T. Baghdadi, M. Zareie","doi":"10.1097/BTO.0000000000000563","DOIUrl":"https://doi.org/10.1097/BTO.0000000000000563","url":null,"abstract":"Purpose: The Clubfoot, or the Congenital Talipes Equinovarus, is the most common congenital orthopedic disease, with 1 or 2 cases reported per 1000 live births. The purpose of this study is to assess the efficacy of the treatment of the complex equinovarus deformity of the feet, using the Ilizarov technique. Materials and Methods: In a prospective case series study from January 2012 to April 2016, 32 patients (35 feet) with rigid and complicated club feet have been included. The Ilizarov technique was applied in order to treat the mentioned deformity. These patients had no other congenital anomalies or systemic diseases. Outcomes were evaluated using the International Clubfoot Study Group (ICFSG) scoring system. Results: All of the patients were between 8 and 14 years of age, with the mean age of 10.9 years old. The mean of preoperative ICFSG score, morphological score, functional score, and radiologic score were 21.25±7, 6.2±2.4, 13.6±3.2, and 6.8±3.6, respectively. The postoperative mentioned scores were 11.88±6.18, 3.4±1.8, 4.7±2.1, and 3.8±1.9, respectively. The difference in the ICFSG scores before and after treatment was statistically significant (P=0.001). Conclusion: The Ilizarov technique can be considered as an efficient and successful treatment for recurrent or neglected clubfoot deformities, since it has provided satisfactory results.","PeriodicalId":45336,"journal":{"name":"Techniques in Orthopaedics","volume":"206 1","pages":"154 - 158"},"PeriodicalIF":0.3,"publicationDate":"2021-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77111298","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-07-12DOI: 10.1097/BTO.0000000000000562
Karen Chui, M. Hashem, Nurul Ahad, A. Kapoor, Georgios Mazis, K. Chin
Background: The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which causes COVID-19 illness, is mainly transmitted because of close contact with respiratory droplets and airborne particles. Aerosol-generating procedures during general anesthesia can increase the risk of COVID-19 transmission. An effective alternative to general anesthesia for upper limb orthopedic surgery is regional anesthesia (RA) using brachial plexus block. Materials and Methods: Seventy-eight patients who received a brachial plexus block for upper limb trauma and elective operations before and during the COVID-19 pandemic, from 2017 to 2020, were included in this study. A protocol was devised for patient positioning, draping and equipment positioning for each location group—shoulder and upper arm; elbow and forearm; and distal extremities. Results: RA was effective for upper limb surgery in 77 of 78 (98.7%) patients. Sixty-five patients (83.3%) were discharged the same day, with the average time from leaving the operating theater to discharge from hospital of 2.8 hours. No postoperative complications were recorded, and no patient nor staff member contracted COVID-19 infection 2 weeks after the operation. Conclusion: We demonstrate the efficacy of awake RA for upper limb orthopedic procedures. We share our tips and tricks for implementing this into clinical practice and discuss the specific advantages of RA in the context of the COVID-19 global pandemic.
{"title":"Awake Regional Anesthesia for Upper Limb Orthopedic Surgery During the COVID-19 Pandemic: Tips, Tricks, and Results","authors":"Karen Chui, M. Hashem, Nurul Ahad, A. Kapoor, Georgios Mazis, K. Chin","doi":"10.1097/BTO.0000000000000562","DOIUrl":"https://doi.org/10.1097/BTO.0000000000000562","url":null,"abstract":"Background: The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which causes COVID-19 illness, is mainly transmitted because of close contact with respiratory droplets and airborne particles. Aerosol-generating procedures during general anesthesia can increase the risk of COVID-19 transmission. An effective alternative to general anesthesia for upper limb orthopedic surgery is regional anesthesia (RA) using brachial plexus block. Materials and Methods: Seventy-eight patients who received a brachial plexus block for upper limb trauma and elective operations before and during the COVID-19 pandemic, from 2017 to 2020, were included in this study. A protocol was devised for patient positioning, draping and equipment positioning for each location group—shoulder and upper arm; elbow and forearm; and distal extremities. Results: RA was effective for upper limb surgery in 77 of 78 (98.7%) patients. Sixty-five patients (83.3%) were discharged the same day, with the average time from leaving the operating theater to discharge from hospital of 2.8 hours. No postoperative complications were recorded, and no patient nor staff member contracted COVID-19 infection 2 weeks after the operation. Conclusion: We demonstrate the efficacy of awake RA for upper limb orthopedic procedures. We share our tips and tricks for implementing this into clinical practice and discuss the specific advantages of RA in the context of the COVID-19 global pandemic.","PeriodicalId":45336,"journal":{"name":"Techniques in Orthopaedics","volume":"54 1","pages":"16 - 21"},"PeriodicalIF":0.3,"publicationDate":"2021-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87737386","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-07-08DOI: 10.1097/BTO.0000000000000559
J. Connors, A. Lindsay, Dan Witmer
Introduction: Periprosthetic hip infections in the setting of massive proximal femoral bone loss pose a complex challenge to both patients and arthroplasty surgeons alike. As these patients are often multiply revised and can be infected with multidrug resistant organisms, the likelihood for a successful outcome with the gold-standard 2-stage revision is significantly diminished, and definitive management is often achieved with amputation or an antibiotic eluting cement spacer. With reduced bone stock and poor soft tissue tension, creation of such a spacer to not only provide local drug delivery, but also achieve length, stability, and confer some degree of mobility to these patients is technically demanding, and has been fraught with mechanical complications in recent literature. Materials and Methods: The purpose of this article is to report on a novel technique for definitive management of prosthetic joint infection in the setting of massive proximal femoral bone loss. This is a case of a 61-year-old medically complex patient with an infected proximal femoral endoprosthesis colonized with multidrug resistant bacteria, treated with creation of a novel articulating antibiotic eluting massive proximal femoral cement spacer with a cephalomedullary nail as definitive management. Results: In our patient we have had successful suppression of his life-threatening infection and enabled partial weight bearing on the affected extremity at 1 year postoperatively. Conclusion: Articulating antibiotic eluting cement proximal femoral spacer with a cephalomedullary nail is a viable surgical option for definitive management of prosthetic joint infection in the setting of massive proximal femoral bone loss.
{"title":"Cephalomedullary Nail as a Definitive Antibiotic Spacer for Multidrug Resistant Periprosthetic Infection of a Proximal Femoral Endoprosthesis","authors":"J. Connors, A. Lindsay, Dan Witmer","doi":"10.1097/BTO.0000000000000559","DOIUrl":"https://doi.org/10.1097/BTO.0000000000000559","url":null,"abstract":"Introduction: Periprosthetic hip infections in the setting of massive proximal femoral bone loss pose a complex challenge to both patients and arthroplasty surgeons alike. As these patients are often multiply revised and can be infected with multidrug resistant organisms, the likelihood for a successful outcome with the gold-standard 2-stage revision is significantly diminished, and definitive management is often achieved with amputation or an antibiotic eluting cement spacer. With reduced bone stock and poor soft tissue tension, creation of such a spacer to not only provide local drug delivery, but also achieve length, stability, and confer some degree of mobility to these patients is technically demanding, and has been fraught with mechanical complications in recent literature. Materials and Methods: The purpose of this article is to report on a novel technique for definitive management of prosthetic joint infection in the setting of massive proximal femoral bone loss. This is a case of a 61-year-old medically complex patient with an infected proximal femoral endoprosthesis colonized with multidrug resistant bacteria, treated with creation of a novel articulating antibiotic eluting massive proximal femoral cement spacer with a cephalomedullary nail as definitive management. Results: In our patient we have had successful suppression of his life-threatening infection and enabled partial weight bearing on the affected extremity at 1 year postoperatively. Conclusion: Articulating antibiotic eluting cement proximal femoral spacer with a cephalomedullary nail is a viable surgical option for definitive management of prosthetic joint infection in the setting of massive proximal femoral bone loss.","PeriodicalId":45336,"journal":{"name":"Techniques in Orthopaedics","volume":"26 1","pages":"137 - 141"},"PeriodicalIF":0.3,"publicationDate":"2021-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85781467","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-06-29DOI: 10.1097/BTO.0000000000000544
Benjamin W. Hoyt, DesRaj M. Clark, Sarah A. Walsh, R. Pensy
Introduction: Surgical access to lateral column fractures of the distal humerus is difficult via traditional approaches due to limited anterior articular exposure for direct reduction and fixation. We have refined a surgical elbow dislocation approach to the articular surface of the distal humerus for fixation of lateral column injuries, which may permit improved access for operative fixation. Materials and Methods: We performed a retrospective review of lateral column fractures treated with open reduction internal fixation at our institution between 2009 and 2019. We divided patients into 3 cohorts based on surgical approach: surgical dislocation (n=10), lateral (n=17), and posterior (n=9). Surgical reports, radiographs, and patient records were reviewed for hardware positioning, tourniquet time, estimated blood loss, postoperative reduction quality, and patient outcomes including range of motion, neurovascular injury, development of heterotopic ossification, and pain on a visual analog scale. Results: With the numbers available, we were unable to detect a significant difference in outcomes including pain, range of motion, or blood loss. No patients treated with this approach experienced neurovascular injury, instability, or nonunion at follow-up. Conclusions: The surgical elbow dislocation is a powerful tool to aid reduction and osteosynthesis of intra-articular fractures of the lateral distal humerus. It may enable greater articular access for complex distal humerus patterns without deleterious effects on surgical or patient reported outcomes.
{"title":"Surgical Elbow Dislocation: Technique and Comparative Outcomes","authors":"Benjamin W. Hoyt, DesRaj M. Clark, Sarah A. Walsh, R. Pensy","doi":"10.1097/BTO.0000000000000544","DOIUrl":"https://doi.org/10.1097/BTO.0000000000000544","url":null,"abstract":"Introduction: Surgical access to lateral column fractures of the distal humerus is difficult via traditional approaches due to limited anterior articular exposure for direct reduction and fixation. We have refined a surgical elbow dislocation approach to the articular surface of the distal humerus for fixation of lateral column injuries, which may permit improved access for operative fixation. Materials and Methods: We performed a retrospective review of lateral column fractures treated with open reduction internal fixation at our institution between 2009 and 2019. We divided patients into 3 cohorts based on surgical approach: surgical dislocation (n=10), lateral (n=17), and posterior (n=9). Surgical reports, radiographs, and patient records were reviewed for hardware positioning, tourniquet time, estimated blood loss, postoperative reduction quality, and patient outcomes including range of motion, neurovascular injury, development of heterotopic ossification, and pain on a visual analog scale. Results: With the numbers available, we were unable to detect a significant difference in outcomes including pain, range of motion, or blood loss. No patients treated with this approach experienced neurovascular injury, instability, or nonunion at follow-up. Conclusions: The surgical elbow dislocation is a powerful tool to aid reduction and osteosynthesis of intra-articular fractures of the lateral distal humerus. It may enable greater articular access for complex distal humerus patterns without deleterious effects on surgical or patient reported outcomes.","PeriodicalId":45336,"journal":{"name":"Techniques in Orthopaedics","volume":"28 1","pages":"82 - 89"},"PeriodicalIF":0.3,"publicationDate":"2021-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74554024","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-06-08DOI: 10.1097/BTO.0000000000000558
Nitish Bansal, P. Dev, P. Tiwari, Ayush Jain
Introduction: The conventional approach to treat a chronic Achilles tendon tear with a wide gap is associated with many problems, primarily difficulty in filling the gap and skin complications. We used a minimally invasive technique to circumvent the problems. Materials and Methods: The study included 10 patients with chronic Achilles tendon tears with a wide gap (>6 cm, Kuwada type 4), who underwent reconstruction using free semitendinosus tendon graft transfer by a minimally invasive technique. Patients were followed up for 12 months. Toe walking, loss of dorsiflexion, and the American Orthopedic Foot and Ankle Score were assessed. The technique was also evaluated for any complications. Results: The age of the patients ranged from 40 to 53 years. The time since injury varied from 18 to 33 weeks. Full weight-bearing was achieved by 8 weeks in all the patients. All patients were able to walk on toes without assistance at 6 months. The mean American Orthopedic Foot and Ankle Score increased from 40.8 to 80.4 after the operation. Only 1 patient developed a superficial skin infection, which resolved with treatment. Conclusions: Semitendinosus graft transfer is a reliable method to treat chronic Achilles tendon rupture with a wide gap, as this wide gap can be covered easily, has a low risk of donor-site morbidity, and can be used even in tears at the insertion site, with good results. With the minimally invasive technique, the intervening skin bridge is maintained, leading to fewer skin complications.
传统的治疗慢性跟腱撕裂的方法有许多问题，主要是难以填补间隙和皮肤并发症。我们采用了微创技术来解决这些问题。材料与方法:本研究纳入10例宽间隙慢性跟腱撕裂(>6 cm, Kuwada 4型)患者，采用微创技术行游离半腱肌腱移植重建。随访12个月。评估脚趾行走、背屈丧失和美国骨科足踝评分。该技术还评估了任何并发症。结果:患者年龄40 ~ 53岁。受伤后的时间从18周到33周不等。所有患者均在8周时达到完全负重。所有患者在6个月时都能在没有辅助的情况下用脚趾行走。术后平均American orthopaedic Foot and Ankle Score由40.8上升至80.4。仅有1例患者出现浅表皮肤感染，经治疗后痊愈。结论:半腱肌移植是治疗大面积间隙慢性跟腱断裂的一种可靠的方法，这种大面积间隙易于覆盖，供区发病风险低，即使在插入部位有撕裂也可使用，效果良好。采用微创技术，可以维持中间的皮肤桥，减少皮肤并发症。
{"title":"Clinical Evaluation of a Minimally Invasive Technique Using a Free Semitendinosus Tendon Graft for Reconstruction of a Chronic Achilles Tendon Tear With Wide Gap","authors":"Nitish Bansal, P. Dev, P. Tiwari, Ayush Jain","doi":"10.1097/BTO.0000000000000558","DOIUrl":"https://doi.org/10.1097/BTO.0000000000000558","url":null,"abstract":"Introduction: The conventional approach to treat a chronic Achilles tendon tear with a wide gap is associated with many problems, primarily difficulty in filling the gap and skin complications. We used a minimally invasive technique to circumvent the problems. Materials and Methods: The study included 10 patients with chronic Achilles tendon tears with a wide gap (>6 cm, Kuwada type 4), who underwent reconstruction using free semitendinosus tendon graft transfer by a minimally invasive technique. Patients were followed up for 12 months. Toe walking, loss of dorsiflexion, and the American Orthopedic Foot and Ankle Score were assessed. The technique was also evaluated for any complications. Results: The age of the patients ranged from 40 to 53 years. The time since injury varied from 18 to 33 weeks. Full weight-bearing was achieved by 8 weeks in all the patients. All patients were able to walk on toes without assistance at 6 months. The mean American Orthopedic Foot and Ankle Score increased from 40.8 to 80.4 after the operation. Only 1 patient developed a superficial skin infection, which resolved with treatment. Conclusions: Semitendinosus graft transfer is a reliable method to treat chronic Achilles tendon rupture with a wide gap, as this wide gap can be covered easily, has a low risk of donor-site morbidity, and can be used even in tears at the insertion site, with good results. With the minimally invasive technique, the intervening skin bridge is maintained, leading to fewer skin complications.","PeriodicalId":45336,"journal":{"name":"Techniques in Orthopaedics","volume":"17 1","pages":"104 - 108"},"PeriodicalIF":0.3,"publicationDate":"2021-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77047936","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-06-04DOI: 10.1097/BTO.0000000000000553
G. Maale, A. Srinivasaraghavan, Daniel K. Mohammadi, Nicole Kennard, Diego Angobaldo
Introduction: No good mechanisms are available for reconstruction of large anterior soft tissue defects associated with infected total knees [periprosthetic joint infections of the knee (PJI-K)]. Patellectomy is usually required due to involvement with adjacent large anterior soft tissue defects left after radical debridement, free flaps are required for closure. This type of flap necessitates the use of a drop lock brace in ambulation. Our question is whether the proximal placement of the knee joint with longer tibial segments can reduce the number of free flaps and reduce the need for a drop lock brace by reattaching the quadriceps directly to the hinged tibial component. Methods: We retrospectively analyzed 35 cases with a minimum 2-year follow-up. Of 1-stage total knee revisions for PJI-K with the proximal placement of the knee joint for large anterior soft tissue defects left after debridement. Results: The average knee joint displacement was 85 mm. Eleven recurred with infection and 4 required amputation. Eighteen had enough extensor power to walk with a cane or walker as opposed to requiring a drop lock brace. Fifteen patients did not need any free or local flaps, rather these patients only required adjacent soft tissue transfer during surgery. Discussion: This novel proximal placement of the knee joint in patients with PJI-K who have large anterior soft tissue defects lessens the need for free flaps. The proximal placement also allows for reconstruction of what is left of the quadriceps mechanism into the tibial component and usually provides enough extensor power to lock the hinge joint.
{"title":"The Proximal Placement of the Knee Joint in the 1-Stage Treatment of Infected Knee Revisions With Large Anterior Soft Tissue Defects","authors":"G. Maale, A. Srinivasaraghavan, Daniel K. Mohammadi, Nicole Kennard, Diego Angobaldo","doi":"10.1097/BTO.0000000000000553","DOIUrl":"https://doi.org/10.1097/BTO.0000000000000553","url":null,"abstract":"Introduction: No good mechanisms are available for reconstruction of large anterior soft tissue defects associated with infected total knees [periprosthetic joint infections of the knee (PJI-K)]. Patellectomy is usually required due to involvement with adjacent large anterior soft tissue defects left after radical debridement, free flaps are required for closure. This type of flap necessitates the use of a drop lock brace in ambulation. Our question is whether the proximal placement of the knee joint with longer tibial segments can reduce the number of free flaps and reduce the need for a drop lock brace by reattaching the quadriceps directly to the hinged tibial component. Methods: We retrospectively analyzed 35 cases with a minimum 2-year follow-up. Of 1-stage total knee revisions for PJI-K with the proximal placement of the knee joint for large anterior soft tissue defects left after debridement. Results: The average knee joint displacement was 85 mm. Eleven recurred with infection and 4 required amputation. Eighteen had enough extensor power to walk with a cane or walker as opposed to requiring a drop lock brace. Fifteen patients did not need any free or local flaps, rather these patients only required adjacent soft tissue transfer during surgery. Discussion: This novel proximal placement of the knee joint in patients with PJI-K who have large anterior soft tissue defects lessens the need for free flaps. The proximal placement also allows for reconstruction of what is left of the quadriceps mechanism into the tibial component and usually provides enough extensor power to lock the hinge joint.","PeriodicalId":45336,"journal":{"name":"Techniques in Orthopaedics","volume":"15 1","pages":"10 - 15"},"PeriodicalIF":0.3,"publicationDate":"2021-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84059451","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-05-18DOI: 10.1097/BTO.0000000000000557
P. Park, Michael K. Matthew, M. Nadeem, W. Seitz
L oss of elbow flexion can be disabling and have a significant impact on daily function. It occurs as a result of an injury to the brachial plexus, the musculocutaneous nerve, or occasionally direct damage to the biceps and brachialis muscles. The most common mechanisms include obstetric injury, iatrogenic injury, trauma, infection, and congenital disorders such as arthrogryposis. In the setting of isolated an musculocutaneous nerve palsy, restoration of elbow flexion power and excursion without loss of upper extremity function is of paramount importance for patient functional status. Surgical techniques to correct loss of elbow flexion are either nerve repairs/transfers or muscle transfers. Nerve repair with or without grafting, nerve transfers, or a combination of the 2 are commonly used in the treatment of traumatic brachial plexus injuries. Seddon used an ulnar nerve graft to connect the third and fourth intercostal nerves to the musculocutaneous nerve.1 Other well described nerve transfer donors include an ulnar nerve fascicle (Oberlin transfer) and/or a median nerve fascicle, intercostal nerves, and the phrenic nerve.2 However, when > 18 months have elapsed since injury, muscle atrophy makes nerve repairs or transfers ineffective, necessitating a muscle transfer. In addition, nerve transfers may provide limb excursion but with diminished power. For muscle transfers, one must consider the size, force vector, strength, and donor site morbidity of the transferred muscle. A variety of muscle transfers have been described for elbow flexion, including free gracilis transfer, pectoralis major transfer, pronator-flexor transfer (Steindler flexorplasty), triceps transfer, rectus femoris transfer and bipolar latissimus dorsi transfer. Pectoralis major transfer creates a nonphysiological vector with weaker and shorter elbow excursion. Triceps transfers naturally limit elbow extension after surgery. Latissimus transfer for restoration of elbow flexion or extension was first reported in 1956 by Hovnanian3; he proposed a unipolar technique that freed the latissimus from its origins in the trunk. The latissimus dorsi transfer has the advantage of maintaining its neurovascular pedicle after transfer, obviating the need for neurotization. Since the insertion of the latissimus on the proximal humerus is in close proximity to the biceps origin, an ipsilateral unipolar transfer with maintained proximal attachment may result in ideal biomechanics. Here, we describe our novel modification of the original unipolar latissimus dorsi transfer technique.3 Our technique encompasses 3 key concepts. The first addresses the critical distal anastomosis of the latissimus to the biceps tendon. Our weaving technique maintains desired rest-length tension and creates a robust repair that is less likely to fail. Second, tubularization of the latissimus muscle improves flexion strength by aligning the pull vector of muscle fibers linearly in the plane of flexion. Tubularization
{"title":"Modified Unipolar Latissimus Transfer to Restore Elbow Flexion in Musculocutaneous Nerve Palsy","authors":"P. Park, Michael K. Matthew, M. Nadeem, W. Seitz","doi":"10.1097/BTO.0000000000000557","DOIUrl":"https://doi.org/10.1097/BTO.0000000000000557","url":null,"abstract":"L oss of elbow flexion can be disabling and have a significant impact on daily function. It occurs as a result of an injury to the brachial plexus, the musculocutaneous nerve, or occasionally direct damage to the biceps and brachialis muscles. The most common mechanisms include obstetric injury, iatrogenic injury, trauma, infection, and congenital disorders such as arthrogryposis. In the setting of isolated an musculocutaneous nerve palsy, restoration of elbow flexion power and excursion without loss of upper extremity function is of paramount importance for patient functional status. Surgical techniques to correct loss of elbow flexion are either nerve repairs/transfers or muscle transfers. Nerve repair with or without grafting, nerve transfers, or a combination of the 2 are commonly used in the treatment of traumatic brachial plexus injuries. Seddon used an ulnar nerve graft to connect the third and fourth intercostal nerves to the musculocutaneous nerve.1 Other well described nerve transfer donors include an ulnar nerve fascicle (Oberlin transfer) and/or a median nerve fascicle, intercostal nerves, and the phrenic nerve.2 However, when > 18 months have elapsed since injury, muscle atrophy makes nerve repairs or transfers ineffective, necessitating a muscle transfer. In addition, nerve transfers may provide limb excursion but with diminished power. For muscle transfers, one must consider the size, force vector, strength, and donor site morbidity of the transferred muscle. A variety of muscle transfers have been described for elbow flexion, including free gracilis transfer, pectoralis major transfer, pronator-flexor transfer (Steindler flexorplasty), triceps transfer, rectus femoris transfer and bipolar latissimus dorsi transfer. Pectoralis major transfer creates a nonphysiological vector with weaker and shorter elbow excursion. Triceps transfers naturally limit elbow extension after surgery. Latissimus transfer for restoration of elbow flexion or extension was first reported in 1956 by Hovnanian3; he proposed a unipolar technique that freed the latissimus from its origins in the trunk. The latissimus dorsi transfer has the advantage of maintaining its neurovascular pedicle after transfer, obviating the need for neurotization. Since the insertion of the latissimus on the proximal humerus is in close proximity to the biceps origin, an ipsilateral unipolar transfer with maintained proximal attachment may result in ideal biomechanics. Here, we describe our novel modification of the original unipolar latissimus dorsi transfer technique.3 Our technique encompasses 3 key concepts. The first addresses the critical distal anastomosis of the latissimus to the biceps tendon. Our weaving technique maintains desired rest-length tension and creates a robust repair that is less likely to fail. Second, tubularization of the latissimus muscle improves flexion strength by aligning the pull vector of muscle fibers linearly in the plane of flexion. Tubularization ","PeriodicalId":45336,"journal":{"name":"Techniques in Orthopaedics","volume":"69 1","pages":"199 - 202"},"PeriodicalIF":0.3,"publicationDate":"2021-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72520072","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-05-13DOI: 10.1097/BTO.0000000000000555
S. Metikala, Zena Saleh, Dov A. Bader, W. Sebastianelli, P. Sherbondy
Introduction: Distal biceps repair is commonly performed using various fixation devices, each having its advantages and drawbacks. All-suture soft anchor (ASSA) is a recent device mitigating some of the issues associated with previous devices. Materials and Methods: This retrospective study including 20 patients (21 ruptures) aims to evaluate the safety and functionality of ASSA by modified tension-slide technique. All operations were performed through a single-incision anterior approach using two 2.9 mm anchors. All but 1 were men with a mean age of 50.5 years. The mean duration from injury to surgery was 14 days. Results: At a mean follow-up of 11.8 months, compared with contralateral extremity, 18 (86%) of 21 regained full biceps strength with 5/5 flexion-supination power, while 3 displayed 4/5 power. All, except 1, returned to the previous level of function at an average of 24 weeks. As per the modified Mayo Elbow Performance Index, 18 (86%) achieved excellent and 3 (14%) had good results. Complications included lateral antebrachial cutaneous nerve palsy in 12 (resolved in 10), superficial radial nerve palsy in 1 (resolved), and heterotopic ossification in 1. No device-related complications or reruptures were noted. Conclusion: Primary repair of distal biceps tendon ruptures through the use of the ASSA is a viable option, which in conjunction with the proposed modification of tension-slide suture fixation technique yields clinically objective and functional results. Level of Evidence: Level IV—therapeutic.
{"title":"Retrospective Study of the Distal Biceps Tendon Repair Using “All-suture” Soft Anchors","authors":"S. Metikala, Zena Saleh, Dov A. Bader, W. Sebastianelli, P. Sherbondy","doi":"10.1097/BTO.0000000000000555","DOIUrl":"https://doi.org/10.1097/BTO.0000000000000555","url":null,"abstract":"Introduction: Distal biceps repair is commonly performed using various fixation devices, each having its advantages and drawbacks. All-suture soft anchor (ASSA) is a recent device mitigating some of the issues associated with previous devices. Materials and Methods: This retrospective study including 20 patients (21 ruptures) aims to evaluate the safety and functionality of ASSA by modified tension-slide technique. All operations were performed through a single-incision anterior approach using two 2.9 mm anchors. All but 1 were men with a mean age of 50.5 years. The mean duration from injury to surgery was 14 days. Results: At a mean follow-up of 11.8 months, compared with contralateral extremity, 18 (86%) of 21 regained full biceps strength with 5/5 flexion-supination power, while 3 displayed 4/5 power. All, except 1, returned to the previous level of function at an average of 24 weeks. As per the modified Mayo Elbow Performance Index, 18 (86%) achieved excellent and 3 (14%) had good results. Complications included lateral antebrachial cutaneous nerve palsy in 12 (resolved in 10), superficial radial nerve palsy in 1 (resolved), and heterotopic ossification in 1. No device-related complications or reruptures were noted. Conclusion: Primary repair of distal biceps tendon ruptures through the use of the ASSA is a viable option, which in conjunction with the proposed modification of tension-slide suture fixation technique yields clinically objective and functional results. Level of Evidence: Level IV—therapeutic.","PeriodicalId":45336,"journal":{"name":"Techniques in Orthopaedics","volume":"42 1","pages":"142 - 148"},"PeriodicalIF":0.3,"publicationDate":"2021-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76737970","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-05-13DOI: 10.1097/BTO.0000000000000556
P. Grobost, T. Chevillotte, T. Schlösser, Clément Silvestre, P. Roussouly
Introduction: Numerous corrective osteotomy techniques have been reported in lumbar area. Owing to mechanical difficulties and reputation of higher neurological risk, L5 pedicle subtraction osteotomy (PSO) has been poorly used and described. Until now, there was no reported specific method of PSO in L5 to manage the shape of the lordosis with respect of local anatomy. The objective of this study was to describe a new partial PSO technique in L5 to manage the lower arc of lordosis in high pelvic incidence patients with fixed sagittal imbalance. Materials and Methods: We describe, here, the surgical technique for a partial PSO at L5 level and the associated technique of instrumentation and correction of lordosis. Results: Two different cases were reviewed retrospectively to illustrate this new technique to manage lordosis. The described technique is feasible either in first intention or in a revision surgery. Radiologic results on lordosis and sagittal balance are exposed. Conclusion: A partial resection of the pedicles at L5 is often sufficient to create enough lordosis, maybe more effective than complete L3 and L4 PSO for restoration of sagittal balance and less aggressive than complete L5 PSO.
{"title":"L5 Partial Pedicle Subtraction Osteotomy in High Pelvic Incidence Patients: A New Way to Manage Lordosis","authors":"P. Grobost, T. Chevillotte, T. Schlösser, Clément Silvestre, P. Roussouly","doi":"10.1097/BTO.0000000000000556","DOIUrl":"https://doi.org/10.1097/BTO.0000000000000556","url":null,"abstract":"Introduction: Numerous corrective osteotomy techniques have been reported in lumbar area. Owing to mechanical difficulties and reputation of higher neurological risk, L5 pedicle subtraction osteotomy (PSO) has been poorly used and described. Until now, there was no reported specific method of PSO in L5 to manage the shape of the lordosis with respect of local anatomy. The objective of this study was to describe a new partial PSO technique in L5 to manage the lower arc of lordosis in high pelvic incidence patients with fixed sagittal imbalance. Materials and Methods: We describe, here, the surgical technique for a partial PSO at L5 level and the associated technique of instrumentation and correction of lordosis. Results: Two different cases were reviewed retrospectively to illustrate this new technique to manage lordosis. The described technique is feasible either in first intention or in a revision surgery. Radiologic results on lordosis and sagittal balance are exposed. Conclusion: A partial resection of the pedicles at L5 is often sufficient to create enough lordosis, maybe more effective than complete L3 and L4 PSO for restoration of sagittal balance and less aggressive than complete L5 PSO.","PeriodicalId":45336,"journal":{"name":"Techniques in Orthopaedics","volume":"25 1","pages":"131 - 136"},"PeriodicalIF":0.3,"publicationDate":"2021-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80511138","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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