Pub Date : 2023-01-03DOI: 10.1097/bto.0000000000000620
K. Venkatadass, D. Jain, S. Rajasekaran
{"title":"Debulking of Ligamentum Teres—A Technique to Preserve the Ligamentum in Open Reduction of DDH","authors":"K. Venkatadass, D. Jain, S. Rajasekaran","doi":"10.1097/bto.0000000000000620","DOIUrl":"https://doi.org/10.1097/bto.0000000000000620","url":null,"abstract":"","PeriodicalId":45336,"journal":{"name":"Techniques in Orthopaedics","volume":"231 1","pages":""},"PeriodicalIF":0.3,"publicationDate":"2023-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76220894","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 : 2022-12-26DOI: 10.1097/BTO.0000000000000619
Anne A. Smartt, R. Sierra
Introduction: The optimal fixation method for greater trochanteric fractures after a total hip replacement remains controversial. We present the surgical technique of a novel fixation method for greater trochanteric fractures with the use of an olecranon locking plate and Achilles tendon allograft augmentation. Patients and Methods: Five patients who had previously undergone a total hip arthroplasty for primary osteoarthritis were identified as presenting with displaced (>2 cm) greater trochanter fractures between 2017 and 2021. They underwent open reduction internal fixation of the greater trochanter with an olecranon locking plate and Achilles tendon allograft augmentation an average of 8 months after their index procedure (range: 2 to 17 mo), all performed by a single surgeon. All 5 patients were women, the mean age was 59 years (range: 54 to 69 y) and the mean follow-up time was 16.1 months (range: 5 to 41 mo). Results: All 5 patients reported improved pain levels and functional status after open reduction internal fixation. Four of the patients demonstrated maintenance of the position of the trochanteric fragment with the olecranon plate whereas one patient who was unable to comply with postoperative restrictions had a catastrophic failure of the fixation. One of 5 trochanteric bones showed clear evidence of radiographic union. Conclusions: Utilization of olecranon locking plates is well suited for fixation of a greater trochanter fracture as this technique allows for the capture of small comminuted fragments by the proximal curvature of the plate. In addition, this minimizes the concurrent use of metallic cables close to or within the effective joint space. Weight-bearing restrictions and stability are of the utmost importance in the postoperative time period.
{"title":"Novel Use of Olecranon Locking Plate With Achilles Allograft Augmentation for Fixation of Greater Trochanter Fractures After Total Hip Replacement","authors":"Anne A. Smartt, R. Sierra","doi":"10.1097/BTO.0000000000000619","DOIUrl":"https://doi.org/10.1097/BTO.0000000000000619","url":null,"abstract":"Introduction: The optimal fixation method for greater trochanteric fractures after a total hip replacement remains controversial. We present the surgical technique of a novel fixation method for greater trochanteric fractures with the use of an olecranon locking plate and Achilles tendon allograft augmentation. Patients and Methods: Five patients who had previously undergone a total hip arthroplasty for primary osteoarthritis were identified as presenting with displaced (>2 cm) greater trochanter fractures between 2017 and 2021. They underwent open reduction internal fixation of the greater trochanter with an olecranon locking plate and Achilles tendon allograft augmentation an average of 8 months after their index procedure (range: 2 to 17 mo), all performed by a single surgeon. All 5 patients were women, the mean age was 59 years (range: 54 to 69 y) and the mean follow-up time was 16.1 months (range: 5 to 41 mo). Results: All 5 patients reported improved pain levels and functional status after open reduction internal fixation. Four of the patients demonstrated maintenance of the position of the trochanteric fragment with the olecranon plate whereas one patient who was unable to comply with postoperative restrictions had a catastrophic failure of the fixation. One of 5 trochanteric bones showed clear evidence of radiographic union. Conclusions: Utilization of olecranon locking plates is well suited for fixation of a greater trochanter fracture as this technique allows for the capture of small comminuted fragments by the proximal curvature of the plate. In addition, this minimizes the concurrent use of metallic cables close to or within the effective joint space. Weight-bearing restrictions and stability are of the utmost importance in the postoperative time period.","PeriodicalId":45336,"journal":{"name":"Techniques in Orthopaedics","volume":"46 1","pages":"115 - 119"},"PeriodicalIF":0.3,"publicationDate":"2022-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76825412","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 : 2022-12-21DOI: 10.1097/BTO.0000000000000618
S. Young, C. Willis, Turner Sankey, T. Sanchez, A. Wilson, Ezan A. Kothari, S. Murali, Ashish B. Shah
S ome nerves of the lower extremity are superficial in nature and are susceptible to damage after a traumatic injury or surgical intervention. Peripheral nerve injury can result in neuroma formation, in which the damaged nerve undergoes an inflammatory reaction followed by unorganized regeneration of the distal segment, forming a bulbous ending.1 The milieu of the neuroma increases nerve fiber sensitivity through a decreased threshold for excitability.2 Thus, neuromas can be a significant source of pain and often require multiple therapeutics for symptom management. First-line management of neuromas consists of pharmacological modalities to decrease nerve excitation with other adjunctive treatments added for persistent symptoms. In cases refractory to pharmacologic management, surgical intervention may be required. Common surgical interventions described include targeted muscle reinnervation and regenerative peripheral nerve interfaces. Both of these have been reported on in the literature as successful management techniques for traumatic neuromas. The theory, during surgical management of neuromas, of transferring the proximal nerve segment into an adjacent structure such as muscle or bone is widely supported. This process protects the nerve from mechanical stressors that can trigger neuropathic pain. For some neuromas of the foot and ankle, as will be described in this case, transfer into an adjacent structure is not feasible as there is limited anatomic space and surrounding musculature for adequate burial and nerve immobilization.3 A solution for treating neuromas in areas of limited space is neuroma excision with the placement of the proximal nerve segment into a collagen conduit. This enables the proximal end of the nerve to remain protected and independent of the surrounding anatomy. Gould and colleagues published the largest cohort of foot and ankle neuromas treated with excision and collagen nerve-conduit placement. In a retrospective review of 69 nerveconduit constructs, patients reported significant improvement in 59/69 cases (85%). The nerves involved included the 2,3 intermetatarsal (28), 3,4 intermetatarsal (26), tibial (2), lateral plantar (1), a middle branch of the lateral plantar nerve (1), dorsomedial hallucal (medial branch of the superficial peroneal nerve) (2), lateral hallucal (1), superficial peroneal (1), a calcaneal branch of the tibial (4), deep peroneal (1), common peroneal (1), and sural (1).3 In this report, we use the technique described by Gould and colleagues for the excision and transposition of the saphenous nerve into the periosteum under the protection of a collagen conduit for the treatment of a symptomatic neuroma. To our knowledge, this is the first case describing this technique for the surgical treatment of a distal saphenous nerve neuroma.
{"title":"The Use of a Collagen Conduit for Transposing an Iatrogenic Saphenous Nerve Neuroma: A Surgical Technique","authors":"S. Young, C. Willis, Turner Sankey, T. Sanchez, A. Wilson, Ezan A. Kothari, S. Murali, Ashish B. Shah","doi":"10.1097/BTO.0000000000000618","DOIUrl":"https://doi.org/10.1097/BTO.0000000000000618","url":null,"abstract":"S ome nerves of the lower extremity are superficial in nature and are susceptible to damage after a traumatic injury or surgical intervention. Peripheral nerve injury can result in neuroma formation, in which the damaged nerve undergoes an inflammatory reaction followed by unorganized regeneration of the distal segment, forming a bulbous ending.1 The milieu of the neuroma increases nerve fiber sensitivity through a decreased threshold for excitability.2 Thus, neuromas can be a significant source of pain and often require multiple therapeutics for symptom management. First-line management of neuromas consists of pharmacological modalities to decrease nerve excitation with other adjunctive treatments added for persistent symptoms. In cases refractory to pharmacologic management, surgical intervention may be required. Common surgical interventions described include targeted muscle reinnervation and regenerative peripheral nerve interfaces. Both of these have been reported on in the literature as successful management techniques for traumatic neuromas. The theory, during surgical management of neuromas, of transferring the proximal nerve segment into an adjacent structure such as muscle or bone is widely supported. This process protects the nerve from mechanical stressors that can trigger neuropathic pain. For some neuromas of the foot and ankle, as will be described in this case, transfer into an adjacent structure is not feasible as there is limited anatomic space and surrounding musculature for adequate burial and nerve immobilization.3 A solution for treating neuromas in areas of limited space is neuroma excision with the placement of the proximal nerve segment into a collagen conduit. This enables the proximal end of the nerve to remain protected and independent of the surrounding anatomy. Gould and colleagues published the largest cohort of foot and ankle neuromas treated with excision and collagen nerve-conduit placement. In a retrospective review of 69 nerveconduit constructs, patients reported significant improvement in 59/69 cases (85%). The nerves involved included the 2,3 intermetatarsal (28), 3,4 intermetatarsal (26), tibial (2), lateral plantar (1), a middle branch of the lateral plantar nerve (1), dorsomedial hallucal (medial branch of the superficial peroneal nerve) (2), lateral hallucal (1), superficial peroneal (1), a calcaneal branch of the tibial (4), deep peroneal (1), common peroneal (1), and sural (1).3 In this report, we use the technique described by Gould and colleagues for the excision and transposition of the saphenous nerve into the periosteum under the protection of a collagen conduit for the treatment of a symptomatic neuroma. To our knowledge, this is the first case describing this technique for the surgical treatment of a distal saphenous nerve neuroma.","PeriodicalId":45336,"journal":{"name":"Techniques in Orthopaedics","volume":"52 1","pages":"160 - 163"},"PeriodicalIF":0.3,"publicationDate":"2022-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88720333","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 : 2022-12-05DOI: 10.1097/bto.0000000000000617
Ryan Falbo, Elizabeth Simmons, A. Singleton, Samuel D. Stegelmann, Richard M. Miller
Introduction: Injuries to the medial patellofemoral ligament (MPFL) and patellar tendon in isolation are well-documented entities. There is a paucity of literature describing this combination of injuries and treatment of this concomitant injury pattern. Objective: The intent of this manuscript was to document the combined injury pattern of a concomitant MPFL rupture and patellar tendon disruption. We also aimed to describe a treatment option for this rarely documented injury pattern. Materials and Methods: Our MPFL reconstruction technique utilized a gracilis allograft and 2 biocomposite anchors for the patella. Our patellar tendon repair utilized Ethibond suture in a Krakow stitch fashion, which was subsequently incorporated into the anchors used for the MPFL reconstruction. Results: Our patient successfully transitioned through a specific postoperative range of motion protocol by increasing knee flexion 30 degrees every 2 weeks, beginning at 0 to 30 degrees at the first postoperative visit. Our patient was able to straight leg raise by 6 weeks, began formal physical therapy at 8 weeks, and resumed all normal activity at 6 months. Conclusion: We demonstrated a novel technique to repair a combined injury of the MPFL and patellar tendon that produced good clinical outcomes through 6 months.
{"title":"Combining Medial Patellofemoral Ligament Reconstruction With Patellar Tendon Repair Using Biocomposite Swivel Lock Anchors: Surgical Technique and Case Report","authors":"Ryan Falbo, Elizabeth Simmons, A. Singleton, Samuel D. Stegelmann, Richard M. Miller","doi":"10.1097/bto.0000000000000617","DOIUrl":"https://doi.org/10.1097/bto.0000000000000617","url":null,"abstract":"Introduction: Injuries to the medial patellofemoral ligament (MPFL) and patellar tendon in isolation are well-documented entities. There is a paucity of literature describing this combination of injuries and treatment of this concomitant injury pattern. Objective: The intent of this manuscript was to document the combined injury pattern of a concomitant MPFL rupture and patellar tendon disruption. We also aimed to describe a treatment option for this rarely documented injury pattern. Materials and Methods: Our MPFL reconstruction technique utilized a gracilis allograft and 2 biocomposite anchors for the patella. Our patellar tendon repair utilized Ethibond suture in a Krakow stitch fashion, which was subsequently incorporated into the anchors used for the MPFL reconstruction. Results: Our patient successfully transitioned through a specific postoperative range of motion protocol by increasing knee flexion 30 degrees every 2 weeks, beginning at 0 to 30 degrees at the first postoperative visit. Our patient was able to straight leg raise by 6 weeks, began formal physical therapy at 8 weeks, and resumed all normal activity at 6 months. Conclusion: We demonstrated a novel technique to repair a combined injury of the MPFL and patellar tendon that produced good clinical outcomes through 6 months.","PeriodicalId":45336,"journal":{"name":"Techniques in Orthopaedics","volume":"9 1","pages":"96 - 98"},"PeriodicalIF":0.3,"publicationDate":"2022-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81407799","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 : 2022-12-05DOI: 10.1097/BTO.0000000000000616
A. Fergany, A. Khalifa
T he general aim of fracture management is to obtain proper reduction and alignment (axial and rotational), followed by fixation, which should eventually lead to fracture union in an accepted position that helps the patient return to his/her preinjury level of activity and function.1 These aims could be more challenging when dealing with intra-articular fractures, where fracture reduction should be anatomic to avoid secondary osteoarthritis; this makes acetabular fractures to be one of the most challenging intraarticular fractures to treat owing to their complex anatomy, various injury patterns, and patient-related factors such as obese or muscular patients, which adds to the complexity of the surgery.2,3 To obtain an anatomic reduction of complex acetabular fractures, a lot of reduction assisting tools and clamps were introduced, such as the ball spike pusher, Farabeuf clamp, pointed reduction forceps, and offset clamps.4 Here, we describe a modification we performed on a standard cancellous bone impactor to be used more efficiently during open reduction and internal fixation of acetabular fractures.
{"title":"A Modified Cannulated Cancellous Bone Impactor Is a Helpful Tool During Acetabular Fractures ORIF, a Technical Note","authors":"A. Fergany, A. Khalifa","doi":"10.1097/BTO.0000000000000616","DOIUrl":"https://doi.org/10.1097/BTO.0000000000000616","url":null,"abstract":"T he general aim of fracture management is to obtain proper reduction and alignment (axial and rotational), followed by fixation, which should eventually lead to fracture union in an accepted position that helps the patient return to his/her preinjury level of activity and function.1 These aims could be more challenging when dealing with intra-articular fractures, where fracture reduction should be anatomic to avoid secondary osteoarthritis; this makes acetabular fractures to be one of the most challenging intraarticular fractures to treat owing to their complex anatomy, various injury patterns, and patient-related factors such as obese or muscular patients, which adds to the complexity of the surgery.2,3 To obtain an anatomic reduction of complex acetabular fractures, a lot of reduction assisting tools and clamps were introduced, such as the ball spike pusher, Farabeuf clamp, pointed reduction forceps, and offset clamps.4 Here, we describe a modification we performed on a standard cancellous bone impactor to be used more efficiently during open reduction and internal fixation of acetabular fractures.","PeriodicalId":45336,"journal":{"name":"Techniques in Orthopaedics","volume":"9 1","pages":"106 - 109"},"PeriodicalIF":0.3,"publicationDate":"2022-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82233457","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 : 2022-11-28DOI: 10.1097/BTO.0000000000000615
Antonio Madrazo-Ibarra, David A. Kolin, T. Hunter, Joseph A. Ogyaadu, H. Duah, H. O. Tutu, Anthony Bandoh, Prudence Nutsuklo, K. Boachie‐Adjei, Kaitlin M. Carroll, Amoli Vad, Eric Zhao, V. Vad
Knee osteoarthritis affects ~16% of adults in the world and is considered one of the most incapacitating diseases. Despite the advances in scientific knowledge and biological treatments in the field of orthopedics, available nonsurgical treatments for knee osteoarthritis are limited and still ineffective in delaying or stopping the progression of arthritis. Biologics such as platelet-rich plasma, bone marrow aspirate, and progenitor cells have emerged as potential treatments for osteoarthritis; however, the results are still not as expected. Carboplasty is a new treatment that involves the application of bone marrow aspirate into the bone-cartilage interface and intra-articularly, with the intention of stopping the progression of osteoarthritis and delaying the need for total knee replacement. By applying bone marrow directly in the bone-cartilage interface, the communication between subchondral bone and articular cartilage may be reestablished, promoting the delivery of nutrients to the cartilage, and it is hoped that preserving, regenerating, and restoring knee cartilage. Thirteen patients with knee osteoarthritis underwent carboplasty. Patients showed a statistically significant improvement in the Veterans RAND 12 Item Health Survey, the visual analog scale for knee pain, the Western Ontario and McMaster University Osteoarthritis Index, and the Knee Injury and Osteoarthritis Outcome Score for Joint Replacement at 3 and 6 months postprocedure. No adverse events were reported during the follow-up. Carboplasty is promising and worthy of further research.
{"title":"Carboplasty, a Minimally Invasive Procedure for Knee Osteoarthritis: Surgical Technique and Clinical Evidence","authors":"Antonio Madrazo-Ibarra, David A. Kolin, T. Hunter, Joseph A. Ogyaadu, H. Duah, H. O. Tutu, Anthony Bandoh, Prudence Nutsuklo, K. Boachie‐Adjei, Kaitlin M. Carroll, Amoli Vad, Eric Zhao, V. Vad","doi":"10.1097/BTO.0000000000000615","DOIUrl":"https://doi.org/10.1097/BTO.0000000000000615","url":null,"abstract":"Knee osteoarthritis affects ~16% of adults in the world and is considered one of the most incapacitating diseases. Despite the advances in scientific knowledge and biological treatments in the field of orthopedics, available nonsurgical treatments for knee osteoarthritis are limited and still ineffective in delaying or stopping the progression of arthritis. Biologics such as platelet-rich plasma, bone marrow aspirate, and progenitor cells have emerged as potential treatments for osteoarthritis; however, the results are still not as expected. Carboplasty is a new treatment that involves the application of bone marrow aspirate into the bone-cartilage interface and intra-articularly, with the intention of stopping the progression of osteoarthritis and delaying the need for total knee replacement. By applying bone marrow directly in the bone-cartilage interface, the communication between subchondral bone and articular cartilage may be reestablished, promoting the delivery of nutrients to the cartilage, and it is hoped that preserving, regenerating, and restoring knee cartilage. Thirteen patients with knee osteoarthritis underwent carboplasty. Patients showed a statistically significant improvement in the Veterans RAND 12 Item Health Survey, the visual analog scale for knee pain, the Western Ontario and McMaster University Osteoarthritis Index, and the Knee Injury and Osteoarthritis Outcome Score for Joint Replacement at 3 and 6 months postprocedure. No adverse events were reported during the follow-up. Carboplasty is promising and worthy of further research.","PeriodicalId":45336,"journal":{"name":"Techniques in Orthopaedics","volume":"508 1","pages":"102 - 105"},"PeriodicalIF":0.3,"publicationDate":"2022-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76399201","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 : 2022-11-24DOI: 10.1097/BTO.0000000000000614
D. Edwards, Juan Pablo Casas-Cordero, J. Alonso, Daniel Cerda, F. Cornejo, Gerardo Zelaya
P atellar instability is a common pathology with an estimated incidence in the general population of 5.8 cases per 100,000, increasing to 29 cases per 100,000 in younger groups (10 to 17 y). This condition presents a rate of recurrence after the first dislocation episode of 15% to 44% and over 50% after the second episode. It also presents a high persistence of mechanical symptoms after the first episode of dislocation, where 50% of patients not resuming their previous physical activity are described and up to 70% suffer some degree of functional limitation.1 This pathology has a multifactorial etiology, with anatomic and biomechanical aspects involved, within which a patellar malalignment, genu valgus, patella alta, and increased patellar tilt can be found, in addition to predictors of redislocation such as the presence of trochlear dysplasia. The medial patellofemoral ligament (MPFL) is deemed as 1 of the main stabilizing structures of the patella, mainly in the first 30 degrees of flexion, which is frequently injured in cases of patellar instability, up to 94% in some series.2 Reconstruction of the MPFL can be performed alone or in combination with a tibial tubercle osteotomy, usually carried out with a tibial tuberosity-trochlear groove measurement > 20 mm. Our group generally performs an isolated reconstruction of the MPFL, reserving the distal realignment only for those cases with clinical lateral patellar chondrosis, as recommended by Elizabeth Arendt.3 Regarding MPFL reconstruction, we present a technique that to the best of our knowledge, has not been published, with which we have had good preliminary clinical results with a low rate of redislocation (3 cases in 86 operated knees) and improvement in Kujala scores (37 to 79 in our series). ANATOMY
{"title":"A Novel Technique for Medial Patellofemoral Ligament Reconstruction Using Vertical Patellar Tunnels and Use of a Single Implant. Technical Note","authors":"D. Edwards, Juan Pablo Casas-Cordero, J. Alonso, Daniel Cerda, F. Cornejo, Gerardo Zelaya","doi":"10.1097/BTO.0000000000000614","DOIUrl":"https://doi.org/10.1097/BTO.0000000000000614","url":null,"abstract":"P atellar instability is a common pathology with an estimated incidence in the general population of 5.8 cases per 100,000, increasing to 29 cases per 100,000 in younger groups (10 to 17 y). This condition presents a rate of recurrence after the first dislocation episode of 15% to 44% and over 50% after the second episode. It also presents a high persistence of mechanical symptoms after the first episode of dislocation, where 50% of patients not resuming their previous physical activity are described and up to 70% suffer some degree of functional limitation.1 This pathology has a multifactorial etiology, with anatomic and biomechanical aspects involved, within which a patellar malalignment, genu valgus, patella alta, and increased patellar tilt can be found, in addition to predictors of redislocation such as the presence of trochlear dysplasia. The medial patellofemoral ligament (MPFL) is deemed as 1 of the main stabilizing structures of the patella, mainly in the first 30 degrees of flexion, which is frequently injured in cases of patellar instability, up to 94% in some series.2 Reconstruction of the MPFL can be performed alone or in combination with a tibial tubercle osteotomy, usually carried out with a tibial tuberosity-trochlear groove measurement > 20 mm. Our group generally performs an isolated reconstruction of the MPFL, reserving the distal realignment only for those cases with clinical lateral patellar chondrosis, as recommended by Elizabeth Arendt.3 Regarding MPFL reconstruction, we present a technique that to the best of our knowledge, has not been published, with which we have had good preliminary clinical results with a low rate of redislocation (3 cases in 86 operated knees) and improvement in Kujala scores (37 to 79 in our series). ANATOMY","PeriodicalId":45336,"journal":{"name":"Techniques in Orthopaedics","volume":"19 1","pages":"99 - 101"},"PeriodicalIF":0.3,"publicationDate":"2022-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83409145","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 : 2022-11-24DOI: 10.1097/BTO.0000000000000613
J. Dengler, Carrie L. Roth Bettlach, Margot Riggi, A. Moore
Introduction: The extensor digiti quinty (EDQ) opponensplasty, although previously described, is not widely used by hand surgeons. This tendon transfer was used selectively in cases of combined median-ulnar nerve palsies at our center over the last 4 years, with the primary goal to preserve the extensor indices proprius (EIP) for pinch plasty. We present our technique and the series of 8 patients that underwent EDQ opponensplasty here. Materials and Methods: A retrospective chart review identified patients with combined median-ulnar nerve palsies that underwent EDQ opponensplasty between 2015 and 2019 at our institution by a single surgeon. Primary outcome measures collected were pinch, grip, disabilities of the arm, shoulder, and hand (DASH) scores, thumb position, palmar abduction angle, and thumb span. Secondary outcomes included donor site morbidity and complications. Results: Eight patients (9 hands) ages 21 to 53 underwent EDQ opponensplasty, with an average follow-up of 8 months. Postoperative pinch and grip on the affected side improved from preoperative values. All 9 transfers were functional with the thumb positioned in the palmar plane of the hand. Palmar abduction ranged from 45 to 70 degrees. Motor reeducation was achieved without any difficulty in all patients. No patients had evidence of donor site morbidity. Discussion: The EDQ opponensplasty is satisfactory in achieving thumb opposition in the setting of combined median-ulnar neuropathy, without evidence of donor site morbidity. The EDQ is expendable, has adequate length, an optimal line of pull, minimal donor site morbidity, and leaves the extensor indices proprius available for pinch plasty.
{"title":"The Extensor Digiti Quinty (EDQ) Opponensplasty—Revisited","authors":"J. Dengler, Carrie L. Roth Bettlach, Margot Riggi, A. Moore","doi":"10.1097/BTO.0000000000000613","DOIUrl":"https://doi.org/10.1097/BTO.0000000000000613","url":null,"abstract":"Introduction: The extensor digiti quinty (EDQ) opponensplasty, although previously described, is not widely used by hand surgeons. This tendon transfer was used selectively in cases of combined median-ulnar nerve palsies at our center over the last 4 years, with the primary goal to preserve the extensor indices proprius (EIP) for pinch plasty. We present our technique and the series of 8 patients that underwent EDQ opponensplasty here. Materials and Methods: A retrospective chart review identified patients with combined median-ulnar nerve palsies that underwent EDQ opponensplasty between 2015 and 2019 at our institution by a single surgeon. Primary outcome measures collected were pinch, grip, disabilities of the arm, shoulder, and hand (DASH) scores, thumb position, palmar abduction angle, and thumb span. Secondary outcomes included donor site morbidity and complications. Results: Eight patients (9 hands) ages 21 to 53 underwent EDQ opponensplasty, with an average follow-up of 8 months. Postoperative pinch and grip on the affected side improved from preoperative values. All 9 transfers were functional with the thumb positioned in the palmar plane of the hand. Palmar abduction ranged from 45 to 70 degrees. Motor reeducation was achieved without any difficulty in all patients. No patients had evidence of donor site morbidity. Discussion: The EDQ opponensplasty is satisfactory in achieving thumb opposition in the setting of combined median-ulnar neuropathy, without evidence of donor site morbidity. The EDQ is expendable, has adequate length, an optimal line of pull, minimal donor site morbidity, and leaves the extensor indices proprius available for pinch plasty.","PeriodicalId":45336,"journal":{"name":"Techniques in Orthopaedics","volume":"24 1","pages":"90 - 95"},"PeriodicalIF":0.3,"publicationDate":"2022-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88576643","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 : 2022-11-21DOI: 10.1097/BTO.0000000000000612
Rachel A. Thomas, Tommy Pan, M. Garner
Purpose: Femoral fractures in geriatric patients have a high 1-year mortality rate. Early mobilization without restrictions and full weight-bearing in elderly periprosthetic femoral fractures may improve mortality, morbidity, and accelerate functional recovery. The purpose of this study was to evaluate periprosthetic femoral fractures treated with biplanar plating and early ambulation. Materials and Methods: We conducted a retrospective study of periprosthetic femoral fractures treated with biplanar plating and immediate weight-bearing over a 4-year period. All patients were treated with anatomic reduction and primary bone healing, with biplanar fixation through a single, lateral-based incision. The primary outcome was radiographic union. Secondary outcomes were preinjury level and postinjury level of functional independence and need for revision surgery. Results: Seven patients met the inclusion criteria. The average age was 79.7 (range, 63 to 88) years. The average follow-up period was 18 months. Bony union occurred in all patients after the index procedure, with no revision surgeries documented. Five patients (71%) returned to preoperative ambulatory status, and all patients returned to their preoperative living environment. Conclusion: Our study supports the possibility of immediate weight-bearing in geriatric periprosthetic femur fractures treated with anatomic reduction and biplanar plating through a single lateral-based incision, although additional studies are needed.
{"title":"Immediate Weight-Bearing Following Biplanar Plating of Periprosthetic Femoral Fractures","authors":"Rachel A. Thomas, Tommy Pan, M. Garner","doi":"10.1097/BTO.0000000000000612","DOIUrl":"https://doi.org/10.1097/BTO.0000000000000612","url":null,"abstract":"Purpose: Femoral fractures in geriatric patients have a high 1-year mortality rate. Early mobilization without restrictions and full weight-bearing in elderly periprosthetic femoral fractures may improve mortality, morbidity, and accelerate functional recovery. The purpose of this study was to evaluate periprosthetic femoral fractures treated with biplanar plating and early ambulation. Materials and Methods: We conducted a retrospective study of periprosthetic femoral fractures treated with biplanar plating and immediate weight-bearing over a 4-year period. All patients were treated with anatomic reduction and primary bone healing, with biplanar fixation through a single, lateral-based incision. The primary outcome was radiographic union. Secondary outcomes were preinjury level and postinjury level of functional independence and need for revision surgery. Results: Seven patients met the inclusion criteria. The average age was 79.7 (range, 63 to 88) years. The average follow-up period was 18 months. Bony union occurred in all patients after the index procedure, with no revision surgeries documented. Five patients (71%) returned to preoperative ambulatory status, and all patients returned to their preoperative living environment. Conclusion: Our study supports the possibility of immediate weight-bearing in geriatric periprosthetic femur fractures treated with anatomic reduction and biplanar plating through a single lateral-based incision, although additional studies are needed.","PeriodicalId":45336,"journal":{"name":"Techniques in Orthopaedics","volume":"24 1","pages":"1 - 4"},"PeriodicalIF":0.3,"publicationDate":"2022-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72726589","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 : 2022-11-17DOI: 10.1097/BTO.0000000000000611
M. Hungerford, P. Neubauer, Jordan Ochs, M. Jackson, A. Boner
Introduction: We propose a novel clinical technique to easily obtain a radiographic measurement for terminal passive knee extension based upon a weight-bearing lateral radiograph. Materials and Methods: Lateral radiographs were obtained with the patient in the standing position. The leg was positioned with slight hip flexion and full passive extension of the knee by instructing the patient to bear partial weight through their heel, with simultaneous use of a wooden wedge to dorsiflex the foot to neutral and to aid in balance. A Terminal extension was measured radiographically with digital imaging software. Fifty postoperative knee radiographs were used in assessing inter-observer and intra-observer reliability. Results: Inter-observer reliability yielded an Intraclass Correlation Coefficient of 0.973. The correlation coefficient for intra-observer reliability was 0.980. Conclusion: With the use of weight-bearing extension radiographs and our measurement technique, we present a method that can easily be applied across any setting in total knee arthroplasty to obtain accurate, objective data on patient knee extension.
{"title":"Radiographic Technique for Routine Clinical Measurement of Postoperative Total Knee Extension","authors":"M. Hungerford, P. Neubauer, Jordan Ochs, M. Jackson, A. Boner","doi":"10.1097/BTO.0000000000000611","DOIUrl":"https://doi.org/10.1097/BTO.0000000000000611","url":null,"abstract":"Introduction: We propose a novel clinical technique to easily obtain a radiographic measurement for terminal passive knee extension based upon a weight-bearing lateral radiograph. Materials and Methods: Lateral radiographs were obtained with the patient in the standing position. The leg was positioned with slight hip flexion and full passive extension of the knee by instructing the patient to bear partial weight through their heel, with simultaneous use of a wooden wedge to dorsiflex the foot to neutral and to aid in balance. A Terminal extension was measured radiographically with digital imaging software. Fifty postoperative knee radiographs were used in assessing inter-observer and intra-observer reliability. Results: Inter-observer reliability yielded an Intraclass Correlation Coefficient of 0.973. The correlation coefficient for intra-observer reliability was 0.980. Conclusion: With the use of weight-bearing extension radiographs and our measurement technique, we present a method that can easily be applied across any setting in total knee arthroplasty to obtain accurate, objective data on patient knee extension.","PeriodicalId":45336,"journal":{"name":"Techniques in Orthopaedics","volume":"6 1","pages":"63 - 65"},"PeriodicalIF":0.3,"publicationDate":"2022-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82034849","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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