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Bouaicha W, Jlidi M, Sbaihi S, Gharbi MH, Mallek K, Jaziri S, Daas S. A Modified Dynamic Fixation Technique for Acute Syndesmotic Injuries. Foot Ankle Orthop 2024; 9:24730114241232979. [PMID: 38426008 PMCID: PMC10903226 DOI: 10.1177/24730114241232979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024] Open
Affiliation(s)
- Walid Bouaicha
- Orthopedics and Traumatology Department, Mohamed Taher Maamouri Hospital, Nabeul, Tunisia
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Mohamed Jlidi
- Orthopedics and Traumatology Department, Mohamed Taher Maamouri Hospital, Nabeul, Tunisia
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Siwar Sbaihi
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
- Radiology Department, Mohamed Taher Maamouri Hospital, Nabeul, Tunisia
| | - Mohamed Hedi Gharbi
- Orthopedics and Traumatology Department, Mohamed Taher Maamouri Hospital, Nabeul, Tunisia
| | - Karim Mallek
- Orthopedics and Traumatology Department, Mohamed Taher Maamouri Hospital, Nabeul, Tunisia
| | - Salma Jaziri
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
- Department of Anaesthesia and Intensive Care, Mohamed Bourguiba Hospital, Kef, Tunisia
| | - Selim Daas
- Orthopedics and Traumatology Department, Mohamed Taher Maamouri Hospital, Nabeul, Tunisia
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
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Lim CM, Choi SW, Kim BS, Lee SJ, Kang HS. Dynamic Fixation versus Static Screw Fixation for Syndesmosis Injuries in Pronation External Rotation Ankle Fractures: A Retrospective Case Control Study. Malays Orthop J 2023; 17:48-58. [PMID: 38107359 PMCID: PMC10723001 DOI: 10.5704/moj.2311.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 12/02/2022] [Indexed: 12/19/2023] Open
Abstract
Introduction The current standard treatment for ankle syndesmosis injury is static screw fixation. Dynamic fixation was developed to restore the dynamic function of the syndesmosis. The purpose of this study was to determine that which of static screw fixation and dynamic fixation is better for treatment of ankle syndesmosis injury in pronation-external rotation fractures. Materials and methods Thirty patients were treated with dynamic fixation (DF group) and 28 patients with static screw fixation (SF group). The primary outcome was Olerud-Molander Ankle Outcome Score. The secondary outcome were Visual Analogue Scale score and American Orthopedic Foot and Ankle Society score, radiographic outcomes, complications and cost effectiveness. To evaluate the radiographic outcome, the tibiofibular clear space, tibiofibular overlap, and medial clear space were compared using the pre-operative and last follow-up plain radiographs. To evaluate the cost effectiveness, the total hospital cost was compared between the two groups. Results There was no significant difference in primary outcome. Moreover, there were no significant difference in secondary outcome including Visual Analogue Scale score and American Orthopedic Foot and Ankle Society score and radiographic outcome. Two cases of reduction loss and four cases of screw breakage were observed in the SF group. No complication in the DF group was observed. Dynamic fixation was more cost effective than static screw fixation with respect to the total hospital cost. Conclusion Although dynamic fixation provided similar clinical and radiologic outcome, dynamic fixation is more cost effective with fewer complications than static screw fixation in ankle syndesmosis injury of pronation-external rotation fractures.
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Affiliation(s)
- C M Lim
- Department of Orthopaedic Surgery, Jeju National University Hospital, Jeju, South Korea
| | - S W Choi
- Department of Orthopaedic Surgery, Jeju National University Hospital, Jeju, South Korea
| | - B S Kim
- Department of Orthopaedic Surgery, Jeju National University Hospital, Jeju, South Korea
| | - S J Lee
- Department of Orthopaedic Surgery, Jeju National University Hospital, Jeju, South Korea
| | - H S Kang
- Department of Orthopaedic Surgery, Jeju National University Hospital, Jeju, South Korea
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Dong QY, Wu Y, Wang CH, Park YW. A Novel Flexible Fixation Method for Syndesmotic Injury. Foot Ankle Int 2023; 44:854-861. [PMID: 37329236 DOI: 10.1177/10711007231177044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
BACKGROUND This study aims to evaluate the results and the safety of a novel fixation method we developed for syndesmosis injuries that we call the "embrace" technique. METHODS Between March 2018 and October 2020, a total of 67 patients with ankle fractures and syndesmotic injuries underwent syndesmosis fixation with the embrace technique at our institute. Plain radiographs and computed tomographic (CT) scans were obtained preoperatively. Postoperative radiographic assessment included anteroposterior (AP) and lateral radiographs and CT scans of both ankles. Additionally, the American Orthopaedic Foot & Ankle Society (AOFAS) Ankle-Hindfoot Score, Olerud-Molander Ankle Score, and visual analog scale (VAS) score were used for postoperative assessment. RESULTS The mean age was 27.6 ± 10.9 (range, 14-56) years. The mean follow-up time was 30.3 ± 6.2 (range, 24-48) months. There were no malreductions indicated by any CT parameter except fibular rotation in a postoperative comparison between 2 sides. We found significant preoperative-postoperative changes in anterior difference, posterior difference, and fibular rotation but no significant preoperative-postoperative difference in fibular translation. There was no significant postoperative difference between the affected-side and normal-side measurements of any parameter. Complications included delayed wound healing, lateral pain because of wire knot irritation (11.9%), and medial fiber wire irritation (7.5%). The mean AOFAS, Olerud-Molander, and VAS scores at the last follow-up were 94.4 ± 6.8 (range, 84-100), 95.4 ± 6.1 (range, 80-100), and 0.68 ± 1.0 (range, 0-3) points, respectively. CONCLUSION In our cohort, this novel technique proved to be an effective method for syndesmosis fixation in patients with ankle fractures associated with very good radiologic and patient-reported outcomes. LEVEL OF EVIDENCE Level IV, case series.
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Affiliation(s)
- Quan Yu Dong
- Department of Hand, Foot and Microsurgery, the Affiliated Hospital of Qingdao University, Qingdao City, Shandong Province, China
| | - Yong Wu
- Department Foot and Ankle Surgery, Yueyang People's Hospital of Hunan Province, Yue Yang, China
| | - Chen Han Wang
- Department of Hand, Foot and Microsurgery, the Affiliated Hospital of Qingdao University, Qingdao City, Shandong Province, China
| | - Yong Wook Park
- Department of Hand, Foot and Microsurgery, the Affiliated Hospital of Qingdao University, Qingdao City, Shandong Province, China
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Pavone V, Papotto G, Vescio A, Longo G, D'Amato S, Ganci M, Marchese E, Testa G. Short and Middle Functional Outcome in the Static vs. Dynamic Fixation of Syndesmotic Injuries in Ankle Fractures: A Retrospective Case Series Study. J Clin Med 2023; 12:jcm12113637. [PMID: 37297832 DOI: 10.3390/jcm12113637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 05/16/2023] [Accepted: 05/22/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND Syndesmotic injuries are common lesions associated with ankle fractures. Static and dynamic fixation are frequently used in syndesmotic injury-associated ankle fractures. The purpose of this study is to compare short- and mid-term quality of life, clinical outcomes, and gait after static stabilization with a trans-syndesmotic screw or dynamic stabilization with a suture button device. METHODS Here, 230 patients were enrolled in a retrospective observational study. They were divided in two groups according to the fixation procedure (Arthrex TightRope®, Munich, Germany) synthesis vs. osteosynthesis with a 3.5 mm trans-syndesmotic tricortical screw). They then underwent clinical assessment using the American Foot and Ankle Score (AOFAS) at 1, 2, 6, 12, and 24 months after surgery. Quality of life was assessed according to the EuroQol-5 Dimension (EQ-5D) at 2 and 24 months after surgery in the follow-up; gait analysis was performed 2 and 24 months postoperatively. RESULTS Significant differences were found at a two-month follow-up according to the AOFAS (p = 0.0001) and EQ-5D (p = 0.0208) scores. No differences were noted in the other follow-ups (p > 0.05) or gait analysis. CONCLUSION The dynamic and static fixation of syndesmotic injuries in ankle fracture are both efficacious and valid procedures for avoiding ankle instability. The suture button device was comparable to the screw fixation according to functional outcomes and gait analysis.
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Affiliation(s)
- Vito Pavone
- Department of General Surgery and Medical-Surgical Specialties, Section of Orthopaedics and Traumatology, A.O.U. Policlinico Rodolico-San Marco, University of Catania, 95123 Catania, Italy
| | - Giacomo Papotto
- Department of Orthopedic Surgery, Trauma Center, Cannizzaro Hospital, 95100 Catania, Italy
| | - Andrea Vescio
- Department of General Surgery and Medical-Surgical Specialties, Section of Orthopaedics and Traumatology, A.O.U. Policlinico Rodolico-San Marco, University of Catania, 95123 Catania, Italy
| | - Gianfranco Longo
- Department of Orthopedic Surgery, Trauma Center, Cannizzaro Hospital, 95100 Catania, Italy
| | - Salvatore D'Amato
- Department of General Surgery and Medical-Surgical Specialties, Section of Orthopaedics and Traumatology, A.O.U. Policlinico Rodolico-San Marco, University of Catania, 95123 Catania, Italy
| | - Marco Ganci
- Department of Orthopedic Surgery, Trauma Center, Cannizzaro Hospital, 95100 Catania, Italy
| | - Emanuele Marchese
- Department of General Surgery and Medical-Surgical Specialties, Section of Orthopaedics and Traumatology, A.O.U. Policlinico Rodolico-San Marco, University of Catania, 95123 Catania, Italy
| | - Gianluca Testa
- Department of General Surgery and Medical-Surgical Specialties, Section of Orthopaedics and Traumatology, A.O.U. Policlinico Rodolico-San Marco, University of Catania, 95123 Catania, Italy
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Xu K, Zhang J, Zhang P, Liang Y, Hu JL, Wang X, Wang J. Comparison of Suture-Button Versus Syndesmotic Screw in the Treatment of Distal Tibiofibular Syndesmosis Injury: A Meta-analysis. J Foot Ankle Surg 2021; 60:555-566. [PMID: 33518505 DOI: 10.1053/j.jfas.2020.08.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 06/09/2020] [Accepted: 08/08/2020] [Indexed: 02/03/2023]
Abstract
Traditionally screw fixation is an effective surgical procedure for the treatment of unstable syndesmosis injuries. However, it is still a controversy whether suture-button (SB) device can achieve better clinical outcomes and decrease the risk of complications compared with syndesmotic screw (SS). The present meta-analysis was conducted to figure out whether SB fixation was superior to traditionally screw fixation. Twelve clinical studies were identified, involving 320 patients in the SB group and 334 patients in the SS group. Among patients treated with SB, the American Orthopaedic Foot & Ankle Society (AOFAS) score was significantly higher at 3-month follow-up (p = .01) and 2-year follow-up (p = .02), and the Olerud-Molander Ankle (OMA) score at 1-year follow-up (p = .002). In addition, the SB group had significantly better results in the malreduction (p = .0008), implant failure (p < .01), implant removal (p < .01), and local irritation (p = .004). No statistical differences were found in the AOFAS at 6 months follow-up (p = .33) and 1-year follow-up (p = .33), OMA at 3 months follow-up (p = .09), 6 months follow-up (p = .14) and 2 years follow-up (p = .36), the Foot and Ankle Disability Index (p = .73), Euro Qol 5-dimension questionnaire (p = .33), dorsiflexion (DF; p = .91), plantarflexion (p = .23), medial clear space (p = .42), tibiofibular clear space (p = .60), tibiofibular overlap (p = .84), and other complications (p = .95). Based on this meta-analysis, there was no significant difference in postoperative radiological measurements, and no sufficient evidence was found to support the improved clinical outcomes compared with SS fixation group. However, SB technique could improve functional outcomes, reduce the rate of implant removal, implant failure, local irritation, and malreduction without increasing risk of other complications. Therefore, the SB technique should be recommended in the treatment of syndesmosis injuries.
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Affiliation(s)
- Keteng Xu
- Surgeon, Department of Orthopedics, Clinical Medical College, Yangzhou University, Northern Jiangsu People's Hospital, Yangzhou, China
| | - Jiale Zhang
- Surgeon, Department of Orthopedics, Clinical Medical College, Yangzhou University, Northern Jiangsu People's Hospital, Yangzhou, China
| | - Pei Zhang
- Surgeon, Department of Orthopedics, Clinical Medical College, Yangzhou University, Northern Jiangsu People's Hospital, Yangzhou, China
| | - Yuan Liang
- Surgeon, Department of Orthopedics, Clinical Medical College, Yangzhou University, Northern Jiangsu People's Hospital, Yangzhou, China
| | - Jin-Long Hu
- Surgeon, Department of Orthopedics, Clinical Medical College, Yangzhou University, Northern Jiangsu People's Hospital, Yangzhou, China
| | - Xu Wang
- Surgeon, Department of Orthopedics, Clinical Medical College, Yangzhou University, Northern Jiangsu People's Hospital, Yangzhou, China.
| | - Jingcheng Wang
- Professor, Department of Orthopedics, Clinical Medical College, Yangzhou University, Northern Jiangsu People's Hospital, Yangzhou, China.
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Kawaguchi Y, Otani T, Marumo K, Saito M. A Five-Year-Old Slipped Capital Femoral Epiphysis Treated With Dynamic Single Screw Fixation. Cureus 2021; 13:e12992. [PMID: 33659126 PMCID: PMC7916986 DOI: 10.7759/cureus.12992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Slipped capital femoral epiphysis (SCFE) commonly occurs during puberty. Onset of SCFE at either less than 10 years old or over 16 years is defined as atypical. As in our patient, atypical onset at less than 10 years occurred in 9%, and the age of onset has been decreasing in recent years and that the probability of concomitant obesity is particularly high in young patients without obvious underlying disease or background factors. In the treatment of SCFE, preventing further slipping and permitting femoral bone growth by physeal closure is difficult, especially for young patients. We adopted 'dynamic single screw fixation' using SCFE short thread screw for continuous fixation without disturbing the growth of proximal femur or damaging to growth plate. Refixation was necessary once. The screw worked for 7 years 4 months while physeal closure was avoided. At the 10-year follow-up, her growth had stopped. She had no problem clinically, no increase in the posterior sloping angle (PSA), and no obvious growth disturbance of the femur.
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Affiliation(s)
- Yasuhiko Kawaguchi
- Orthopaedic Surgery, The Jikei University School of Medicine, Tokyo, JPN
| | - Takuya Otani
- Orthopaedic Surgery, The Jikei University School of Medicine, Tokyo, JPN
| | - Keishi Marumo
- Orthopaedic Surgery, The Jikei University School of Medicine, Tokyo, JPN
| | - Mitsuru Saito
- Orthopaedic Surgery, The Jikei University School of Medicine, Tokyo, JPN
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Grassi A, Samuelsson K, D'Hooghe P, Romagnoli M, Mosca M, Zaffagnini S, Amendola A. Dynamic Stabilization of Syndesmosis Injuries Reduces Complications and Reoperations as Compared With Screw Fixation: A Meta-analysis of Randomized Controlled Trials. Am J Sports Med 2020; 48:1000-1013. [PMID: 31188642 DOI: 10.1177/0363546519849909] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Several devices for obtaining dynamic fixation of the syndesmosis have been introduced in recent years, but their efficacy has been tested in only a few randomized controlled trials (RCTs), without demonstrating any clear benefit over the traditional static fixation with screws. PURPOSE To perform a level 1 meta-analysis of RCTs to investigate the complications, subjective outcomes, and functional results after dynamic or static fixation of acute syndesmotic injuries. STUDY DESIGN Meta-analysis of RCTs. METHODS A systematic literature search was performed of the Medline/PubMed, Cochrane Central Register of Controlled Trials, and Embase electronic databases, as well as ClinicalTrials.gov for unpublished studies. Eligible studies were RCTs comparing dynamic fixation and static fixation of acute syndesmosis injuries. A meta-analysis was performed, while bias and quality of evidence were rated according to the Cochrane Database questionnaire and the Grading of Recommendations Assessment, Development and Evaluation guidelines. RESULTS Dynamic fixation had a significantly reduced relative risk (RR = 0.55, P = .003) of complications-in particular, the presence of inadequate reduction at the final follow-up (RR = 0.36, P = .0008) and the clinical diagnosis of recurrent diastasis or instability (RR = 0.10, P = .03). The effect was more evident when compared with permanent screws (RR = 0.10, P = .0001). The reoperation rate was similar between the groups (RR = 0.64, P = .07); however, the overall risk was reduced after dynamic fixation as compared with static fixation with permanent screws (RR = 0.24, P = .007). The American Orthopaedic Foot & Ankle Society score was significantly higher among patients treated with dynamic fixation-6.06 points higher (P = .005) at 3 months, 5.21 points (P = .03) at 12 months, and 8.60 points (P < .00001) at 24 months-while the Olerud-Molander score was similar. The visual analog scale for pain score was reduced at 6 months (-0.73 points, P = .003) and 12 months (-0.52 points, P = .005), and ankle range of motion increased by 4.36° (P = .03) with dynamic fixation. The overall quality of evidence ranged from "moderate" to "very low," owing to a substantial risk of bias, heterogeneity, indirectness of outcome reporting, and evaluation of a limited number of patients. CONCLUSION The dynamic fixation of syndesmotic injuries was able to reduce the number of complications and improve clinical outcomes as compared with static screw fixation-especially malreduction and clinical instability or diastasis-at a follow-up of 2 years. A lower risk of reoperation was found with dynamic fixation as compared with static fixation with permanent screws. However, the lack of patients or personnel blinding, treatment heterogeneity, small samples, and short follow-up limit the overall quality of this evidence.
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Affiliation(s)
- Alberto Grassi
- IIa Clinica Ortopedica e Traumatologica, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Kristian Samuelsson
- Department of Orthopaedics, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Pieter D'Hooghe
- Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Matteo Romagnoli
- IIa Clinica Ortopedica e Traumatologica, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Massimiliano Mosca
- IIa Clinica Ortopedica e Traumatologica, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Stefano Zaffagnini
- IIa Clinica Ortopedica e Traumatologica, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.,Dipartimento di scienze Biomediche e Neuromotorie DIBINEM, Università di Bologna, Bologna, Italy
| | - Annunziato Amendola
- Michael W. Krzyzewski Human Performance Laboratory, Department of Orthopaedic Surgery, Duke University, Durham, North Carolina, USA
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Liu G, Chen L, Gong M, Xing F, Xiang Z. Clinical Evidence for Treatment of Distal Tibiofibular Syndesmosis Injury: A Systematic Review of Clinical Studies. J Foot Ankle Surg 2019; 58:1245-1250. [PMID: 31494030 DOI: 10.1053/j.jfas.2019.01.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Indexed: 02/03/2023]
Abstract
No consensus had been reached about the optimal treatment for syndesmotic fixation. We performed a review of randomized controlled trials (RCTs) to assist in clarifying many of the controversies that were debated for years despite new technology and options. PubMed, Embase, and the Cochrane Library were searched through specific terms and limits. Only RCTs were selected for final inclusion. Study screening and data extraction were performed independently by 2 reviewers. Thirteen RCTs, including 828 cases, met the inclusion criteria and are summarized in this review. Pooled results demonstrated that dynamic fixation had better functional outcomes as well as lower rates of malreduction and complications compared with syndesmotic screw fixation. Both absorbable screw and tricortical screw fixation showed similar results to quadricortical metallic screws. Therefore, dynamic fixation is recommended for the treatment of syndesmosis injuries.
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Affiliation(s)
- Guoming Liu
- Surgeon, Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu, China
| | - Li Chen
- Surgeon, Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu, China
| | - Min Gong
- Surgeon, Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu, China
| | - Fei Xing
- Surgeon, Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu, China
| | - Zhou Xiang
- Professor, Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu, China.
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Yao Y, Ye D, Liang W, Miao H, Wu J, Zhou Z. [Mid-term effectiveness of Coflex interspinous dynamic internal fixation combined with spinal fusion for lumbar disc degeneration]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2019; 33:280-286. [PMID: 30874382 DOI: 10.7507/1002-1892.201807099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To evaluate the effectiveness of Coflex interspinous dynamic internal fixation combined with spinal fusion for lumbar disc degeneration. Methods The clinical data of 39 patients with two-level lumbar disc degeneration who met the selection criteria between June 2010 and December 2011 was retrospectively analyzed. They were divided into group A (20 cases, simple lumbar decompression and fusion) and group B (19 cases, Coflex interspinous dynamic internal fixation combined with spinal fusion) according to different surgical methods. There was no significant difference in age, gender, disease diagnosis, lesion segment, disease duration, Oswestry disability index (ODI), visual analogue scale (VAS) score, and the intervertebral height, foramen intervertebral height (FIH), and range of motion (ROM) of upper operative segment and adjacent segment between the two groups ( P>0.05). ODI and VAS score were used to evaluate the effectiveness before operation and at last follow-up, and the improvement rates were calculated. The intervertebral height [anterior disc height (ADH), middle disc height (MDH), and posterior disc height (PDH)], FIH, and ROM were measured and compared between the two groups. Results The operation time and intraoperative blood loss in group A were significantly more than those in group B ( P<0.05), and there was no significant difference in hospitalization time between the two groups ( t=0.992, P=0.328). All patients were followed up; the follow-up time was 33-50 months (mean, 40.5 months) in group A and 39-51 months (mean, 42.6 months) in group B. No complication such as displacement, loosening, or rupture of internal fixator was found in both groups. At last follow-up, ODI and VAS score of the two groups significantly improved when compared with preoperative scores ( P<0.05). At last follow-up, there was no significant difference in ODI, VAS score, and improvement rate of ODI between the two groups ( P>0.05); the improvement rate of VAS score in group B was significantly higher than that in group A ( t=2.245, P=0.031). There was no significant difference in the intervertebral height and FIH of the upper operative segment at last follow-up between the two groups and between preoperation and last follow-up in the two groups ( P>0.05). At last follow-up, the ADH of adjacent segment in group B was significantly higher than that in group A, and MDH, PDH, and FIH were significantly lower than those in group A ( P<0.05). Compared with preoperation, the ADH of adjacent segment in group A decreased and MDH, PDH, and FIH increased at last follow-up ( P<0.05), while all indexes in group B did not change significantly ( P>0.05). The ROM of adjacent segment in group A increased significantly at last follow-up ( t=2.318, P=0.026). There was significant difference in ROM of adjacent segment between the two groups ( P<0.05). Conclusion The mid-term effectiveness of Coflex interspinous dynamic internal fixation combined with spinal fusion is similar to that of simple decompression fusion. For those patients whose adjacent segments of the responsible segments have degeneration but have no symptoms or mild symptoms, this treatment can slow down the adjacent segment degeneration.
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Affiliation(s)
- Yicun Yao
- Department of Orthopedics, Guangzhou Red Cross Hospital, Guangzhou Red Cross Hospital Affiliated to Jinan University, Guangzhou Guangdong, 510220, P.R.China
| | - Dongping Ye
- Department of Orthopedics, Guangzhou Red Cross Hospital, Guangzhou Red Cross Hospital Affiliated to Jinan University, Guangzhou Guangdong, 510220, P.R.China
| | - Weiguo Liang
- Department of Orthopedics, Guangzhou Red Cross Hospital, Guangzhou Red Cross Hospital Affiliated to Jinan University, Guangzhou Guangdong, 510220,
| | - Haixiong Miao
- Department of Orthopedics, Guangzhou Red Cross Hospital, Guangzhou Red Cross Hospital Affiliated to Jinan University, Guangzhou Guangdong, 510220, P.R.China
| | - Jinfeng Wu
- Department of Orthopedics, Guangzhou Red Cross Hospital, Guangzhou Red Cross Hospital Affiliated to Jinan University, Guangzhou Guangdong, 510220, P.R.China
| | - Ziqiang Zhou
- Department of Orthopedics, Guangzhou Red Cross Hospital, Guangzhou Red Cross Hospital Affiliated to Jinan University, Guangzhou Guangdong, 510220, P.R.China
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Stiene A, Renner CE, Chen T, Liu J, Ebraheim NA. Distal Tibiofibular Syndesmosis Dysfunction: A Systematic Literature Review of Dynamic Versus Static Fixation Over the Last 10 Years. J Foot Ankle Surg 2019; 58:320-327. [PMID: 30612866 DOI: 10.1053/j.jfas.2018.08.050] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Indexed: 02/03/2023]
Abstract
The goal of the present work was to perform a systematic review of the literature of the past 10 years regarding dynamic and static fixation of the distal tibiofibular syndesmosis to determine any clinical differences between the 2 procedures. A literature search of the PubMed MEDLINE database was conducted to identify relevant studies related to distal tibiofibular syndesmosis. Studies before January 1, 2007, were excluded to limit the project to the recent literature. Clinical outcomes, device removal rates, time to weightbearing after the initial procedure, and the cost effectiveness of each device were explored. In these 26 studies, 350 patients were treated using a dynamic technique and 845 were treated using a static technique. The weighted American Orthopedic Foot and Ankle Score was 91.70 (standard error [SE] 1.87) for dynamic fixation patients and the weighted average was 86.48 (SE 2.17) for static fixation patients (p = .068). A secondary procedure to remove the fixation device was performed in 7.7% of dynamic fixation patients and in 39.4% of static fixation patients when studies with 100% device removal were excluded (p < .0001). The mean time to weightbearing was 5.96 (SE 0.72) weeks for patients who underwent dynamic fixation and 10.45 (SE 0.99) weeks for those who had static fixation (p = .0002). The cost for dynamic fixation was found to be less than that for static fixation when secondary procedures for device removal were considered. Based on similar clinical functional scores, lower secondary procedure rates, faster time to full weightbearing, and lower costs to patients, dynamic fixation of the distal tibiofibular syndesmosis may be a superior option compared with static fixation.
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Affiliation(s)
- Andrew Stiene
- Medical Student, University of Toledo, College of Medicine and Life Sciences, Toledo, OH
| | - Charles E Renner
- Medical Student, University of Toledo, College of Medicine and Life Sciences, Toledo, OH
| | - Tian Chen
- Assistant Professor, University of Toledo, Department of Mathematics and Statistics, Toledo, OH
| | - Jiayong Liu
- Assistant Professor, University of Toledo Medical Center, Department of Orthopedic Surgery, Toledo, OH.
| | - Nabil A Ebraheim
- Professor, Surgeon, and Chair, University of Toledo Medical Center, Department of Orthopedic Surgery, Toledo, OH
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Byval'tsev VA, Kalinin AA, Stepanov IA, Pestryakov YY, Shepelev VV. [Analysis of the results of total cervical disc arthroplasty using a M6-C prosthesis: a multicenter study]. Zh Vopr Neirokhir Im N N Burdenko 2017; 81:46-55. [PMID: 29076467 DOI: 10.17116/neiro201781546-55] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
UNLABELLED Cervical spondylosis and intervertebral disc (IVD) degeneration are the most common cause for compression of the spinal cord and/or its roots. Total IVD arthroplasty, as a modern alternative to surgical treatment of IVD degeneration, is gaining popularity in many neurosurgical clinics around the world. Aim - the study aim was to conduct a multicenter analysis of cervical spine arthroplasty with an IVD prosthesis M6-C ('Spinal Kinetics', USA). MATERIAL AND METHODS The study included 112 patients (77 males and 35 females). All patients underwent single-level discectomy with implantation of the artificial IVD prosthesis M6-C. The follow-up period was up to 36 months. Dynamic assessment of the prosthesis was based on clinical parameters (pain intensity in the cervical spine and upper extremities (visual analog scale - VAS); quality of life (Neck Disability Index - NDI)); and subjective satisfaction with the results of surgical treatment (Macnab scale) and instrumental data (range of motion in the operated spinal motion segment, degree of heterotopic ossification (McAfee-Suchomel classification), and time course of degenerative changes in the adjacent segments).
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Affiliation(s)
- V A Byval'tsev
- Irkutsk State Medical University, Irkutsk, Russia; Railway Clinical Hospital, Irkutsk-Passenger Station, Irkutsk, Russia; Irkutsk Scientific Center of Surgery and Traumatology, Irkutsk, Russia; Irkutsk State Medical Academy of Postgraduate Education', Irkutsk, Russia
| | - A A Kalinin
- Irkutsk State Medical University, Irkutsk, Russia; Railway Clinical Hospital, Irkutsk-Passenger Station, Irkutsk, Russia; Irkutsk Scientific Center of Surgery and Traumatology, Irkutsk, Russia
| | - I A Stepanov
- Irkutsk State Medical University, Irkutsk, Russia
| | | | - V V Shepelev
- 1477th Naval Clinical Hospital of the Ministry of Defense of the Russian Federation, Vladivostok, Russia
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