scholarly journals Assessing the reliability of the modified Gartland classification system for extension-type supracondylar humerus fractures

2019 ◽  
Vol 13 (6) ◽  
pp. 569-574 ◽  
Author(s):  
T. L. Teo ◽  
E. K. Schaeffer ◽  
E. Habib ◽  
A. Cherukupalli ◽  
A. P. Cooper ◽  
...  
Keyword(s):  
Classification System ◽  
Treatment Options ◽  
Weighted Kappa ◽  
Nonoperative Treatment ◽  
Type I ◽  
Elbow Fracture ◽  
Type Ii ◽  
Level Of Evidence ◽  
Supracondylar Humerus Fractures ◽  
Paediatric Orthopaedic

Purpose The Gartland extension-type supracondylar humerus (SCH) fracture is the most common paediatric elbow fracture. Treatment options range from nonoperative treatment (taping or casting) to operative treatments (closed reduction and percutaneous pinning or open reduction). Classification variability between surgeons is a potential contributing factor to existing controversy over treatment options for type II SCH fractures. This study investigated levels of agreement in extension-type SCH fracture classification using the modified Gartland classification system. Methods A retrospective review was conducted on 60 patients aged between two and 12 years who had sustained an extension-type SCH fracture and received operative or nonoperative treatment at a tertiary children’s hospital. Baseline radiographs were provided, and surgeons were asked to classify the fractures as type I, IIA, IIB or III according to the modified Gartland classification. Respondents were then asked to complete a second round of classifications using reshuffled radiographs. Weighted kappa values were calculated to assess interobserver and intraobserver levels of agreement. Results In all, 21 paediatric orthopaedic surgeons responded to the survey and 15 completed a second round of ratings. Interobserver agreement for classification based on the Gartland criteria between surgeons was substantial with a kappa of 0.679 (95% confidence interval (CI) 0.501 to 0.873). Intraobserver agreement was substantial with a kappa of 0.796, (95% CI 0.628 to 0.864) Conclusion Radiographic classification of extension-type SCH fractures demonstrated substantial agreement both between and within surgeon raters. Therefore, classification variability may not be a major contributing factor to the treatment controversy for type II SCH fractures and treatment variability may be due to differences in surgeon preferences. Level of Evidence III

scholarly journals A new classification of talocalcaneal coalitions based on computed tomography for operative planning

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Anhong Wang ◽  
Weili Shi ◽  
Lixiang Gao ◽  
Linxin Chen ◽  
Xing Xie ◽  
...  
Keyword(s):  
Classification System ◽  
Main Type ◽  
Interobserver Reliability ◽  
Weighted Kappa ◽  
Type I ◽  
Type Ii ◽  
New Classification ◽  
Type Iv ◽  
Talocalcaneal Coalition ◽  
Operative Planning

Abstract Background Current classifications emphasize the morphology of the coalition, however, subtalar joint facets involved should also be emphasized. Objective The objective of this study was to develop a new classification system based on the articular facets involved to cover all coalitions and guide operative planning. Methods Patients were diagnosed with talocalcaneal coalition using a CT scan, between January 2009 and February 2021. The coalition was classified into four main types according to the shape and nature of the coalition: I, inferiorly overgrown talus or superiorly overgrown calcaneus; II, both talus and calcaneus overgrew; III, coalition with an accessory ossicle; IV, complete osseous coalition (I-III types are non-osseous coalition). Then each type was further divided into three subtypes according to the articular facets involved. A, the coalition involving the anterior facets; M, the coalition involving the middle facets, and P, the coalition involving the posterior facets. Interobserver reliability was measured at the main type (based on nature and shape) and subtype (articular facet involved) using weighted Kappa. Results There were 106 patients (108 ft) included in this study. Overall, 8 ft (7.5%) were classified as type I, 75 ft (69.4%) as type II, 7 ft (6.5%) as type III, and 18 ft (16.7%) as type IV. Twenty-nine coalitions (26.9%) involved the posterior facets only (subtype-P), 74 coalitions (68.5%) involved both the middle and posterior facets (subtype-MP), and five coalitions (4.6%) simultaneously involved the anterior, middle, and posterior facets (subtype-AMP). Type II-MP coalition was the most common. The value of weighted Kappa for the main type was 0.93 (95%CI 0.86–0.99) (p<0.001), and the value for the subtype was 0.78 (95%CI 0.66–0.91) (p<0.001). Conclusion A new classification system of the talocalcaneal coalition to facilitate operative planning was developed.

Close Reduction Percutaneous Pinning (CRPP) versus Open Reduction Internal Fixation (ORIF) for Pediatric Supracondylar Humerus Fractures Gartland Type II and III: A Systematic Review and Meta-analysis

2021 ◽  
Vol 71 (4) ◽  
pp. 187-193
Author(s):  
Putu Astawa ◽  
Made Agus Maharjana ◽  
Surya Adisthanaya ◽  
Made Winatra Satya Putra ◽  
Agus Suarjaya Putra ◽  
...  
Keyword(s):  
Systematic Review ◽  
Case Reports ◽  
Meta Analysis ◽  
Fixed Effect Model ◽  
Cosmetic Outcome ◽  
Type I ◽  
Type Ii ◽  
Supracondylar Humerus Fractures ◽  
Significant Difference ◽  
Humerus Fractures

Introduction: Displaced supracondylar fracture in children is a challenging injury that may result in impaired functional and cosmetic outcome if not well-treated. Utilization of Closed Reduction and Percutaneus Pinning (CRPP) increased for this pathology, some authors believe ORIF results better anatomical reduction and lower rate of loss of reduction. Study aims to compare CRPP and ORIF for pediatric supracondylar humerus fracture. Method: Systematic review was conducted based on PRISMA guideline. Inclusion criteria were age <18 years old, comparing CRPP and ORIF for Supracondylar Humerus Fractures Gartland Type II, II.Studies of one surgical technique, Gartland type I, case reports were excluded. For meta-analysis, 6 studies were included and fixed effect model used to pool the result. In each study, mean difference (MD) with 95% confidence interval (CI) was calculated for dichotomous outcomes using Review Manager. Result: Total of 252 patients aged 0-15 years old were included. CRPP more often performed than ORIF. Satisfactory outcomes measured by Flynn’s criteria were achieved in 87.74% in CRPP and 86.73% in ORIF patient group, indicating significant difference (Heterogeneity, I2 = 23%; WMD, 1.26; 0.58 to 2.73; P =0.56). Conclusion: Current systematic review and meta-analysis suggest that for displaced supracondylar humerus fractures, ORIF offers a comparable functional and cosmetic outcome compared to CRPP.

scholarly journals Targeted Therapies in Type II Endometrial Cancers: Too Little, but Not Too Late

2018 ◽  
Vol 19 (8) ◽  
pp. 2380 ◽  
Author(s):  
Michiel Remmerie ◽  
Veerle Janssens
Keyword(s):  
Clinical Trials ◽  
Endometrial Cancer ◽  
Targeted Therapies ◽  
Kinase Inhibitors ◽  
Therapeutic Potential ◽  
Treatment Options ◽  
Genetic Alterations ◽  
Mitogen Activated Protein Kinase ◽  
Type I ◽  
Type Ii

Type II endometrial carcinomas (ECs) are responsible for most endometrial cancer-related deaths due to their aggressive nature, late stage detection and high tolerance for standard therapies. However, there are no targeted therapies for type II ECs, and they are still treated the same way as the clinically indolent and easily treatable type I ECs. Therefore, type II ECs are in need of new treatment options. More recently, molecular analysis of endometrial cancer revealed phosphorylation-dependent oncogenic signalling in the phosphatidylinositol-4,5-bisphosphate 3-kinase (PI3K) and mitogen-activated protein kinase (MAPK) pathways to be most frequently altered in type II ECs. Consequently, clinical trials tested pharmacologic kinase inhibitors targeting these pathways, although mostly with rather disappointing results. In this review, we highlight the most common genetic alterations in type II ECs. Additionally, we reason why most clinical trials for ECs using targeted kinase inhibitors had unsatisfying results and what should be changed in future clinical trial setups. Furthermore, we argue that, besides kinases, phosphatases should no longer be ignored in clinical trials, particularly in type II ECs, where the tumour suppressive phosphatase protein phosphatase type 2A (PP2A) is frequently mutated. Lastly, we discuss the therapeutic potential of targeting PP2A for (re)activation, possibly in combination with pharmacologic kinase inhibitors.

Stent-Graft Treatment of Penetrating Thoracic Aortic Ulcers

2002 ◽  
Vol 9 (2_suppl) ◽  
pp. II-25-II-31 ◽  
Author(s):  
Xavier Kos ◽  
Louis Bouchard ◽  
Philippe Otal ◽  
Valérie Chabbert ◽  
Patricia Chemla ◽  
...  
Keyword(s):  
Stent Graft ◽  
Treatment Options ◽  
Neurological Complication ◽  
Computed Tomographic Angiography ◽  
Aortic Diameter ◽  
Type I ◽  
Type Ii ◽  
Computed Tomographic ◽  
Clinical Complications

Purpose: To evaluate the efficacy of stent-graft placement for the treatment of penetrating thoracic aortic ulcers. Methods: Ten patients (7 men; mean age 73.8 years, range 69–79) were treated for penetrating thoracic aortic ulcers using Talent or Excluder stent-grafts. Preoperative examinations included computed tomographic angiography (CTA), transesophageal echography, and digital subtraction angiography (DSA). Follow-up included predischarge multimodal imaging and periodic CTA scans after discharge. Endoleaks, aortic diameter changes, and clinical complications were tracked. Results: Technical success was achieved in 100%, but 1 major neurological complication led to death 3 months after the procedure. Radiological follow-up detected 4 early endoleaks (3 type I and a type II), all of which spontaneously regressed, and 1 secondary type II endoleak. The mean aortic diameter decreased by 22% over a mean 9-month follow-up. Conclusions: Aortic ulcers are potentially lethal lesions. Considering its low morbidity and mortality, endovascular repair could widen the treatment options for these lesions.

scholarly journals Association Between Subtalar Articular Surface Typing and Flat Foot Deformity: Which Type is More Likely to Cause Flat Foot Deformity

2021 ◽  
Author(s):  
Lei Zhang ◽  
Xiaoyao Peng ◽  
Siyuan He ◽  
Xin Zhou ◽  
Gang Yi ◽  
...  
Keyword(s):  
Articular Surface ◽  
Type I ◽  
Type Ii ◽  
Foot Deformity ◽  
Imaging Data ◽  
Level Of Evidence ◽  
Flat Foot ◽  
Wide Range ◽  
Retrospective Comparative Study ◽  
Böhler’S Angle

Abstract Background Previous studies have shown a wide range of anatomical classifications of the subtalar joint (STJ) in the population and this is related to the different force line structures of the foot. Different subtalar articular surface morphology may affect the occurrence and development of flat foot deformity, and there are fewer studies in this area. The main objective of our study was to determine the association of different subtalar articular surface with the occurrence and severity of flat foot deformity. Methods We analyzed the imaging data of 289 cases of STJ. The articular surface area, Gissane's angle and Bohler's angle of subtalar articular surface of different types were counted. The occurrence and severity of flat foot deformity in different subtalar articular surface were judged by measuring the Meary angle of foot. Results We classified 289 cases of subtalar articular surface into five types according to the morphology. According to Meary angle, the flat foot deformity of Type Ⅰ and Type Ⅳ are significantly severer than Type Ⅱ (P < 0.05). Type II (7.65 ± 1.38 cm2) was significantly smaller than Type I (8.40 ± 1.79 cm2) in the total joint facet area(P < 0.05). Type III (9.15 ± 1.92 cm2) was smaller than Type I (8.40 ± 1.79 cm2), II(7.65 ± 1.38 cm2) and Ⅳ(7.81 ± 1.74 cm2 ) (P < 0.05).Type II (28.81 ± 7.44∘) was significantly smaller than Type I (30.80 ± 4.61 degrees), and IV (32.25 ± 5.02 degrees) in the Bohler’s angle (P < 0.05). Type II (128.49 ± 6.74 degrees) was smaller than Type I (131.58 ± 7.32 degrees), and IV (131.94 ± 5.80 degrees) in the Gissane’s angle (P < 0.05). Conclusions After being compared and analyzed the measurement of morphological parameters, joint facet area and fusion of subtalar articular surface were closely related to the severity of flat foot deformity and Type I and IV were more likely to develop severer flat foot deformity. Level of evidence: Level III, retrospective comparative study.

scholarly journals A New Classification of Talocalcaneal Coalitions Based On Computed Tomography For Operative Planning

2021 ◽  
Author(s):  
Anhong Wang ◽  
Weili Shi ◽  
Linxin Chen ◽  
Xing Xie ◽  
Feng Zhao ◽  
...  
Keyword(s):  
Classification System ◽  
Subtalar Joint ◽  
Type I ◽  
Type Ii ◽  
New Classification ◽  
Type Iv ◽  
Talocalcaneal Coalition ◽  
Operative Planning ◽  
Accessory Ossicle

Abstract Background Current classifications emphasize the morphology of the coalition, however, subtalar joint facets involved should also be emphasized.Objective The objective of this study was to develop a new classification system based on the articular facets involved to cover all coalitions and guide operative planning.Methods Patients were diagnosed with talocalcaneal coalition using a CT scan, between January 2009 and February 2021. We classified the coalition into four main types according to the shape and nature of the coalition: I, inferiorly overgrown talus or superiorly overgrown calcaneus; II, both talus and calcaneus overgrew; III, coalition with an accessory ossicle; (I-III types are non-osseous coalition) IV, complete osseous coalition. Then each type was further divided into three subtypes according to the articular facets involved. A, the coalition involving the anterior facets; M, the coalition involving the middle facets, and P, the coalition involving the posterior facets.Results There were 106 patients (108 feet) included in this study. Overall, 8 feet (7.5%) were classified as type I, 75 feet (69.4%) as type II, 7 feet (6.5%) as type III, and 18 feet (16.7%) as type IV. Twenty-nine coalitions (26.9%) involved the posterior facets only (subtype-P), 74 coalitions (68.5%) involved both the middle and posterior facets (subtype-MP), and five coalitions (4.6%) simultaneously involved the anterior, middle, and posterior facets (subtype-AMP). Type II-MP coalition was the most common.Conclusion A new classification system of the talocalcaneal coalition to facilitate operative planning was developed.

scholarly journals Effectiveness of Non-operative Treatment of Symptomatic Accessory Navicular in Pediatric Patients

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0034
Author(s):  
Malynda Messer ◽  
Candice Brady ◽  
Kristin Cola ◽  
Jaime Rice-Denning
Keyword(s):  
Pain Relief ◽  
Operative Treatment ◽  
Pediatric Patients ◽  
Surgical Intervention ◽  
Treatment Options ◽  
Nonoperative Treatment ◽  
Type I ◽  
First Line ◽  
Complete Pain Relief ◽  
Accessory Navicular

Category: Midfoot/Forefoot Introduction/Purpose: Initial management of symptomatic accessory naviculae in pediatric patients is nonoperative. Common first line treatments include casting, shoe wear modification, limiting strenuous activities, and nonsteroidal anti-inflammatories. When nonoperative treatments fail to mitigate symptoms, surgery is indicated. Surgical treatment of symptomatic accessory navicular bones has been extensively studied. However, the efficacy of nonoperative treatment for alleviating pain or preventing surgery in effected patients has not been established. We believe that nonoperative treatment is frequently unsuccessful or does not give lasting pain relief, thus questioning whether surgery could be offered as first line treatment. Our study retrospectively reviews outcomes of adolescents treated non-operatively for symptomatic accessory naviculae in an effort to provide clinicians success rates for their discussion of treatment options with patients and their families. Methods: This is an IRB approved, retrospective study of adolescent patients diagnosed and treated non-operatively for symptomatic accessory navicular bones at Cincinnati Children’s Hospital Medical Center between the dates 8/1/2006 and 8/24/2016. Medical records were used to identify demographic information, type, duration, and total trials of conservative treatment, additional foot comorbidities, response to conservative management, and surgery if non-operative management failed. Included patients were under 18 years of age with medial sided foot pain, radiographic evidence of an accessory navicular, and had undergone at least 1 course of non-operative treatment. Patients with previously operated on accessory naviculars or other diagnosed painful foot conditions were excluded. Outcome measures consisted of pain relief, no surgical intervention, or need for surgical intervention. Available radiographic imaging for each patient was also used to identify type of accessory navicular and determine pes planus incidence. Statistical analysis using measures of central tendency was then performed. Results: 169 patients were included, with 226 symptomatic accessory naviculae. Average age at diagnosis was 11.8 years, with 78.2% females, and 22% males. 53 (32%) were left symptomatic accessory naviculae, 56 (33%) right, and 60 (36%) bilateral. Type II accessory naviculae were most frequent (72.7%), with Type I and Type III in 9.7% and 17.4%, respectively. 56% were chronic in nature, with 31% due to acute injury. Average number of non-operative trials was 2.08, with 28% experiencing complete pain relief, 30% requiring surgical intervention, and 41% that did not require surgical intervention, but were without documented pain relief. Of those that achieved complete pain relief, average length of non-operative treatment was 8.03 months. Conclusion: Results of this study can be used by clinicians to frame discussions surrounding treatment options for symptomatic accessory navicular bones with both patients and their families. Further research is warranted to determine the necessary duration and type of non-operative treatment, among those most commonly used, that is most successful in providing pain relief.

Comparison of clinical outcomes of three-corner arthrodesis and bicolumnar arthrodesis for advanced wrist osteoarthritis

2020 ◽  
Vol 45 (7) ◽  
pp. 679-686 ◽  
Author(s):  
Marc Olivier Gauci ◽  
Thomas Waitzenegger ◽  
Pierre-Emmanuel Chammas ◽  
Bertrand Coulet ◽  
Cyril Lazerges ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Revision Surgery ◽  
Functional Outcomes ◽  
Type I ◽  
Type Ii ◽  
Level Of Evidence ◽  
Wrist Motion

We retrospectively compared results of 27 wrists with bicolumnar arthrodesis with mean follow-up of 67 months to 28 wrists with three-corner arthrodesis adding triquetral excision with mean follow-up of 74 months in 54 patients (55 wrists). Minimal follow-up was 2 years for all patients. Capitolunate nonunion occurred in three wrists with bicolumnar arthrodesis and six wrists with three-corner arthrodesis, and radiolunate arthritis developed in four wrists with three-corner arthrodesis. Among patients with bicolumnar arthrodesis, hamatolunate arthritis occurred in seven wrists, all with a Viegas type II lunate; and pisotriquetral arthritis occurred in three wrists. At mean 5 years after surgery, 45 wrists had not needed revision surgery, and both groups had similar revision rates. The wrists with three-corner arthrodesis and bicolumnar arthrodesis had similar functional outcomes, and range of wrist motion was not significantly different between the two groups. We concluded that bicolumnar arthrodesis results in greater longevity than three-corner arthrodesis for a type I lunate. We do not recommend bicolumnar arthrodesis for type II lunate. We also concluded that three-corner arthrodesis has a greater incidence of radiolunate arthritis and capitolunate nonunion. Level of evidence: III

scholarly journals Efficacy of passive helmet therapy for deformational plagiocephaly: report of 1050 cases

2013 ◽  
Vol 35 (4) ◽  
pp. E4 ◽  
Author(s):  
Daniel E. Couture ◽  
John C. Crantford ◽  
Aravind Somasundaram ◽  
Claire Sanger ◽  
Anne E. Argenta ◽  
...  
Keyword(s):  
Classification System ◽  
Deformity Correction ◽  
Older Age ◽  
Type I ◽  
Age Group ◽  
Type Ii ◽  
Deformational Plagiocephaly ◽  
Pressure Therapy ◽  
Helmet Therapy ◽  
Significant Difference

Object There has been a tremendous increase in the incidence of deformational plagiocephaly in children throughout the world. Therapeutic options include observation, active counterpositioning, external orthotics, and surgery. The current treatment in the US is highly debated, but it typically includes external orthotic helmets in patients with moderate to severe plagiocephaly presenting between 4 and 10 months of age or in children with significant comorbidities limiting passive (no-pressure) therapy. The present study was designed to evaluate 3 key issues: 1) the accuracy of the Argenta classification in defining a progressive degree of severity, 2) identification of an upper age limit when treatment is no longer effective, and 3) the effectiveness of an off-the-shelf prefabricated helmet in correcting deformational plagiocephaly. Methods An institutional review board–approved retrospective study was conducted of all patients at the authors' clinic in whom deformational plagiocephaly was assessed using the Argenta classification system over a 6-year period; the patients underwent helmet therapy, and a minimum of 3 clinic visits were recorded. Inclusion criteria consisted of an Argenta Type II–V plagiocephalic deformity. Patients' conditions were categorized both by severity of the deformity and by patients' age at presentation. Statistical analysis was conducted using survival analysis. Results There were 1050 patients included in the study. Patients with Type III, IV, and V plagiocephaly required progressively longer for deformity correction to be achieved than patients with Type II plagiocephaly (53%, 75%, and 81% longer, respectively [p < 0.0001]). This finding verified that the Argenta stratification indicated a progressive severity of deformity. No statistically significant difference in the time to correction was noted among the different age categories, which suggests that the previously held upper time limit for correction may be inaccurate. An overall correction rate to Type I plagiocephaly of 81.6% was achieved irrespective of severity and degree of the original deformity. This suggests that an inexpensive off-the-shelf molding helmet is highly effective and that expensive custom-fitted orthoses may not be necessary. The patients in the older age group (> 12 months) did not have a statistically significant longer interval to correction than the patients in the youngest age group (< 3 months). The mean length of follow-up was 6.3 months. Conclusions Patients treated with passive helmet therapy in the older age group (> 12 months) had an improvement in skull shape within the same treatment interval as the patients in the younger age group (< 3 months). This study supports the use of passive helmet therapy for improvement in deformational plagiocephaly in infants from birth to 18 months of age and verifies the stratification of degree of deformity used in the Argenta classification system.

Mallet fingers with bone avulsion and DIP joint subluxation

2014 ◽  
Vol 40 (1) ◽  
pp. 8-15 ◽  
Author(s):  
T. Wada ◽  
T. Oda
Keyword(s):  
Closed Reduction ◽  
Open Reduction ◽  
Treatment Options ◽  
Surgical Techniques ◽  
Nonoperative Treatment ◽  
Injury Pattern ◽  
Distal Phalanx ◽  
Percutaneous Pinning ◽  
Insufficient Evidence ◽  
Level Of Evidence

One-third of all mallet fingers are associated with a fracture. Mallet fractures associated with large fracture fragments may result in volar subluxation of the distal phalanx. The management of mallet fractures varies based on injury pattern and surgeon preference. These treatment options include splinting regimens, closed reduction and percutaneous pinning and open reduction and internal fixation. Although numerous surgical techniques have been described, there is little clear consensus on operative treatment. Moreover, there is insufficient evidence to support operative over nonoperative treatment for mallet fractures. Level of evidence: Level V

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