scholarly journals Lateral Plantar Arch Reconstruction Using Vascularized Fibula Osteocutaneous Flap

2021 ◽  
Vol 4 (6) ◽  
pp. 01-05
Author(s):  
Srivatsa M Shet ◽  
Subin Joseph ◽  
Kader Kalathinga ◽  
Hafiz Muhammed Koyappathody ◽  
Srikant Aruna Samantaray ◽  
...  
Keyword(s):  
Road Traffic ◽  
Weight Bearing ◽  
Full Weight Bearing ◽  
Partial Weight Bearing ◽  
Post Surgery ◽  
Vascularized Fibula ◽  
One Stage Reconstruction ◽  
Arch Reconstruction ◽  
Partial Weight ◽  
Osteocutaneous Flap

A Sixteen-year-old male had a road traffic accident resulting in crush and loss of lateral two metatarsals of the left foot. The Lateral plantar arch was reconstructed with a vascularized fibula osteocutaneous flap. Flap survived and partial weight-bearing was started by 3 months and full weight-bearing was started 6-months post-surgery. At a 16-month follow-up patient had a normal gait and integrity of the lateral plantar arch was maintained. Vascularized fibula osteocutaneous flap is an excellent option for one-stage reconstruction of the lateral arch of the foot and gives satisfactory results in terms of functions of foot and in avoiding long-term morbidity.

scholarly journals Outcome of Intramedullary Interlocking Nailing in the Management of Gustillo-I Diaphyseal Fracture of Tibia

2021 ◽  
pp. 161-166
Author(s):  
Santosh Kumar ◽  
Faheem Ahmed Memon ◽  
Siraj Ahmed Butt ◽  
Shakeel Ahmed Memon ◽  
Iftikhar Ahmed Memon ◽  
...  
Keyword(s):  
Road Traffic ◽  
Weight Bearing ◽  
Full Weight Bearing ◽  
Type I ◽  
Diaphyseal Fracture ◽  
Partial Weight Bearing ◽  
Interlocking Nailing ◽  
Traumatic Fracture ◽  
Surgery Department ◽  
Partial Weight

Objective: To evaluate the outcome of intramedullary interlocking nailing in the management of Gustillo-I diaphyseal fracture of tibia. Study Design: This is an observational study. Setting: Study carried out at Orthopaedic Surgery department, Liaquat University of Medical and Health Sciences Jamshoro, form March 2018 to February 2021. Materials & Methods: 72 consecutive patients of Gustillo Type-I diaphyseal fracture of tibia. All patients age between 18-60 years with traumatic fracture like Gustillo Type-I diaphyseal fracture of tibia were included in this study. Patients reported chest, abdominal and head trauma with neurovascular deficit were excluded. Patients were prepared for surgery after relevant investigation and radiographs. Results: Out of 72 patients included in this study 11.11% were female (N=8) and 88.88% male (N=64); with mean age was 38.26±8.20 years (Range 18 to 60 years). Road traffic accident was common cause of tibia fracture (Gustillo Type-I). Postoperative mean union time of tibial fractures were 9.9±3. 2 week.Postoperatively started partial weight bearing associated with help of two axillary crutches. The patients walking with partial weight bearing allowed at 4.1±1.12 weeks. While patients walking with full weight bearing allowed at 10.8±2.4 weeks. Postoperatively 11(15.27%) patients were complaining of pain. Wound infection observed in 7(9.72%) cases. Clinically excellent results were found in 24(33.33%) patients, while good results remained in 30(41.66%) patients and fairs in 18(25%) patients.   Conclusion: We conclude that interlocking intra-medullary nailing may be considered as a suitable option for treatment of Gustilo-I diaphyseal fracture of tibia.

scholarly journals Differences in femoral component subsidence rate after THA using an uncemented collarless femoral stem: full weight-bearing with an enhanced recovery rehabilitation versus partial weight-bearing

2021 ◽  
Author(s):  
Franziska Leiss ◽  
Julia Sabrina Götz ◽  
Matthias Meyer ◽  
Günther Maderbacher ◽  
Jan Reinhard ◽  
...  
Keyword(s):  
Risk Factors ◽  
Enhanced Recovery ◽  
Weight Bearing ◽  
Femoral Stem ◽  
Full Weight Bearing ◽  
Partial Weight Bearing ◽  
Fill Ratio ◽  
Stem Subsidence ◽  
Partial Weight

Abstract Background Femoral component subsidence is a known risk factor for early failure of total hip arthroplasty (THA) using cementless stems. The aim of the study was to compare an enhanced recovery concept with early full weight-bearing rehabilitation and partial weight-bearing on stem subsidence. In addition, the influence of patient-related and anatomical risk factors on subsidence shall be assessed. Methods One hundred and fourteen patients underwent primary cementless THA and were retrospectively analyzed. Sixty-three patients had an enhanced recovery rehabilitation with early full weight-bearing and 51 patients had rehabilitation with partial weight-bearing (20 kg) for 6 weeks. Postoperative subsidence was analyzed on standing pelvic anterior–posterior radiographs after 4 weeks and 1 year. Subsidence was measured in mm. Anatomical and prosthetic risk factors (stem size, canal flare index, canal fill ratio as well as BMI and demographic data) were correlated. Results Femoral stem subsidence rate was significantly higher for the group with an enhanced recovery concept compared to the group with partial weight-bearing at the first radiological follow up after 4 weeks [2.54 mm (SD ± 1.86) vs. 1.55 mm (SD ± 1.80)] and the second radiological follow up after 1 year [3.43 mm (SD ± 2.24) vs. 1.94 (SD ± 2.16)] (p < 0.001, respectively). Stem angulation > 3° had a significant influence on subsidence. Canal flare index and canal fill ratio showed no significant correlation with subsidence as well as BMI and age. Conclusion In the present study, cementless stem subsidence was significantly higher in the group with enhanced recovery rehabilitation compared to partial weight-bearing. Small absolute values and differences were demonstrated and therefore possibly below clinical relevance. Anatomical radiological parameters and anthropometric data did not appear to be risk factors for stem subsidence.

scholarly journals Femoral neck stress fracture in a young female recruit: case report

SICOT-J ◽  
2018 ◽  
Vol 4 ◽  
pp. 16 ◽  
Author(s):  
Hélder Fonte ◽  
Ricardo Rodrigues-Pinto
Keyword(s):  
Femoral Neck ◽  
Stress Fracture ◽  
Early Recognition ◽  
Weight Bearing ◽  
Full Weight Bearing ◽  
Imaging Studies ◽  
Partial Weight Bearing ◽  
Military Recruit ◽  
Femoral Neck Stress Fracture ◽  
Partial Weight

Introduction: Femoral neck stress fractures are uncommon and depending on their location, can be at high risk for non-union and significant morbidity.  Their prevalence is higher among runners and military recruits, and women seem to be at higher risk. Methods: A 27-year-old female, who was enrolled in military recruit, reported left side groin pain after a strenuous running exercise. Due to persistent pain an X-Ray was ordered, which revealed no signs of acute lesions. Further imaging studies with CT scan and MRI identified a compression-type femoral neck stress fracture. Results: The patient was submitted to conservative treatment consisting of restricting from full weight-bearing. Six weeks after she initiated partial weight-bearing, becoming asymptomatic at seven months. Follow-up imaging studies revealed union of the fracture. Discussion: This diagnosis should be considered when evaluating military and athlete populations. Early recognition of these injuries is crucial because complication and morbidity rates are high.

scholarly journals Comparison of two reinforcement rings for primary total hip arthroplasty addressing displaced acetabular fractures: a biomechanical analysis

2020 ◽  
Vol 140 (12) ◽  
pp. 1947-1954
Author(s):  
Johannes Becker ◽  
M. Winkler ◽  
C. von Rüden ◽  
E. Bliven ◽  
P. Augat ◽  
...  
Keyword(s):  
Acetabular Fracture ◽  
Weight Bearing ◽  
Biomechanical Analysis ◽  
Acetabular Fractures ◽  
Full Weight Bearing ◽  
Acetabular Cup ◽  
Partial Weight Bearing ◽  
Quadrilateral Plate ◽  
Stable Conditions ◽  
Partial Weight

Abstract Introduction Aim of this study was to biomechanically compare two different acetabular cup fixation constructs in terms of fracture fixation for displaced acetabular fractures involving the anterior column with hemitransverse fracture under partial and full weight-bearing conditions. Methods Two different reinforcement rings designed as cages for primary THA were biomechanically tested in terms of managing a complex acetabular fracture. Single-leg stance cyclic loading was performed to assess fracture gap movement and fragment rotation. Twelve hemi pelvis Sawbones were divided into two groups: primary THA with acetabulum roof reinforcement plate (ARRP) (n = 6) and primary THA with Burch–Schneider reinforcement cage (BSRC) (n = 6). Results During loading under partial weight-bearing (250 N) fracture gap movement tended to be larger in the BSRC group as compared to the ARRP group. Under full weight-bearing conditions, the ARRP showed 60% significantly less motion (p = 0.035) of the os ilium to os ischii gap compared to BSRC. Fracture gap movements between the os ilium and spina iliaca fragments were significantly reduced by 76% (p = 0.048) for ARRP in contrast to BSRC. The ARRP group also demonstrated significantly less movement in the fracture gaps os ischii to quadrilateral plate (62% reduction, p = 0.009) and quadrilateral plate to spina iliaca (87% reduction, p < 0.001). Significantly less rotational movement of the quadrilateral plate to the os ilium was exhibited by the ARRP group (p = 0.015). Conclusions The presented acetabulum roof-reinforcement plate (ARRP) provides stable conditions at the acetabular component with adequate stabilization of a displaced acetabular fracture.

scholarly journals Displaced Femoral Neck Stress Fracture in a 7-year-old Child: A Case Report

2020 ◽  
Vol 1 (1) ◽  
pp. 68-72
Author(s):  
Raymond Massaad ◽  
Said El Orra ◽  
Mohammed Dabbous ◽  
Ali Ibrahim ◽  
Antonella Massaad
Keyword(s):  
Case Report ◽  
Femoral Neck ◽  
Stress Fracture ◽  
Weight Bearing ◽  
Full Weight Bearing ◽  
Partial Weight Bearing ◽  
Radiographic Images ◽  
Femoral Neck Stress Fracture ◽  
Displaced Fracture ◽  
Partial Weight

Background: Stress fracture of the femoral neck is rare in children. Its differential diagnosis includes muscle strain, synovitis, infection, dysplasia, etc. Since physicians rarely see this type of fracture in children, they often overlook it or misdiagnose it.  Case Report: A seven-year-old girl presented to our service with right groin pain following a fall on her right hip 15 days ago. Pelvic and knee radiographs of her right limb showed a fracture line with sclerosis at the femoral neck. Magnetic-resonance imaging (MRI) confirmed the diagnosis of a stress fracture of the femoral neck. We opted for conservative management and gave the patient analgesics and limited weight-bearing with the help of crutches for eight weeks. Three weeks after her first visit, the patient presented with severe limping and inability to bear weight on her right leg. Right hip radiographic imaging showed a varus displaced fracture of the femoral neck, which we managed surgically with an open reduction and internal fixation using plate and screws, followed by immobilization of the right hip with a hip spica cast. Six weeks following the surgery, the patient had no complaints, and the radiographic images showed an appropriate reduction and signs of union. The patient was allowed to start partial weight-bearing for a further six weeks before proceeding to full weight-bearing. Conclusion: Our case emphasizes the importance of considering femoral neck stress fracture in children, through a thorough clinical evaluation and imaging analysis, especially for those carrying classical risk factors. Failure to do so can complicate the disease course and may lead to a displaced fracture requiring more invasive and timely management.

scholarly journals Double-Level Osteotomy in Severe Varus Malalignment to Optimize Knee Joint Restoration

2021 ◽  
Vol 1 (6) ◽  
pp. 263502542110466
Author(s):  
Jörg Harrer ◽  
Max Schenke ◽  
Christoph Lutter ◽  
Jörg Dickschas ◽  
Matthias Feucht ◽  
...  
Keyword(s):  
Weight Bearing ◽  
Varus Deformity ◽  
Joint Line ◽  
Full Weight Bearing ◽  
Tibial Osteotomy ◽  
Open Wedge ◽  
Partial Weight Bearing ◽  
Angle Stable ◽  
Angle Stable Plate ◽  
Partial Weight

Background: Lower extremity alignment-correcting procedures for unicompartmental osteoarthritis are experiencing a rapid rise. Medial open-wedge high tibial osteotomy (MOW-HTO) thereby represents the most common technique among osteotomies but is limited in cases of severe malalignment. Some cases make a double-level osteotomy necessary. Indications: If planning of malalignment correction using a MOW-HTO results in a mechanical medial proximal tibial angle (mMPTA) of more than 93° (causing an oblique joint line), double-level osteotomy is indicated to avoid nonphysiological knee kinematics. Technique Description: After clinical examination and detailed analysis of malalignment (full-weight-bearing long-leg radiograph: hip-knee-angle [HKA], mMPTA, mechanical lateral distal femoral angle [mLDFA], joint line convergence angle [JLCA]), as well as individualized planning of the correction, the surgical procedure starts with an arthroscopy to evaluate the cartilage conditions and eventually treat intraarticular pathologies. Then, the femoral supracondylar correction is performed (closed wedge, biplanar osteotomy [ to increase bony healing]) according to the presurgical planning by resecting the osteotomy wedge with the measured length. K-wires are placed to check the correction. An angle-stable plate is used for osteosynthesis. The wedge taken out will be used as bone stock for the MOW-HTO afterward. The biplanar open-wedge tibial osteotomy is then performed subsequently using a medial tibial approach and an angle-stable plate. Opening of the osteotomy is then performed and double checked with intraoperative fluoroscopy using an alignment rod. Postoperative partial weight bearing for 6 weeks is recommended. Results: In recent literature, only few publications report on results of double-level osteotomies. Babis et al reports that it is a valuable procedure for patients with large varus deformity. Nakayama et al noted a significant improvement in patient-registered clinical outcomes in early postoperative evaluation of 20 patients. Schröter et al reports on 37 knees and findings include good clinical results, despite progressive osteoarthritis. Discussion/Conclusion: In cases of severe malalignment, adequate axis correction may require a double-level osteotomy. Exact preoperative planning is essential. Results reported in recent publications are promising. By splitting 1 large correction into 2 smaller ones, complications like hinge fracture and delayed bone healing are lowered.

scholarly journals Immediate Full Weight-Bearing Versus Partial Weight-Bearing After Plate Fixation of Distal Femur Fractures in Elderly Patients. A Randomized Controlled Trial

2021 ◽  
Vol 12 ◽  
pp. 215145932110558
Author(s):  
Martin Paulsson ◽  
Carl Ekholm ◽  
Eythor Jonsson ◽  
Mats Geijer ◽  
Ola Rolfson
Keyword(s):  
Elderly Patients ◽  
Distal Femur ◽  
Plate Fixation ◽  
Weight Bearing ◽  
Full Weight Bearing ◽  
Partial Weight Bearing ◽  
Femur Fractures ◽  
Function Index ◽  
The Mean ◽  
Partial Weight

Introduction After surgery for distal femur fractures in elderly patients, weight-bearing is commonly restricted. Immediate non-restrictive weight-bearing might have beneficial effects. There are no randomized studies on the topic. The purpose of this study was to compare the functional outcome between immediate full weight-bearing (FWB) as tolerated and partial weight-bearing (PWB) during the first 8 weeks following plate fixation of distal femur fractures in elderly patients. Methods Patients aged 65 years or older with distal femur fractures of AO/OTA types 33 A2, A3, B1, B2, C1, and C2 were included. Exclusion criteria were impaired cognitive function, concomitant injuries, or inability to follow the postoperative regimen. Internal fixation was achieved with an anatomical lateral distal femur plate applied as a strictly bridge-plating construct. The primary outcome measure was the function index of the short musculoskeletal functional assessment (SMFA) after 52 weeks from injury. Results Thirty-two patients were randomized to FWB (n = 11) or PWB (n = 21). After 16 and 52 weeks, there were no differences in the mean SMFA function index between FWB and PWB (36 vs 43, P = .42 and 52 vs 40, P = .18, respectively) nor in the mean EuroQol 5-dimension index or range of motion (ROM). Overall, the SMFA function index was higher at 52 weeks compared with before injury (44 vs 30, P = .001) as was the mean bothersome index (37 vs 21, P = .011). There was no clear difference in the occurrence of adverse events between the treatment groups. Conclusions There were no differences in functional outcome, adverse events, or ROM between immediate FWB and PWB following plate fixation for a distal femur fracture in elderly patients. A distal femur fracture has a negative effect on the functional status of elderly patients that persists at least up to 1 year following injury.

scholarly journals Influence of mobilization and weight bearing on in-hospital outcome in geriatric patients with hip fractures

SICOT-J ◽  
2019 ◽  
Vol 5 ◽  
pp. 4 ◽  
Author(s):  
Manuel Baer ◽  
Valentin Neuhaus ◽  
Hans Christoph Pape ◽  
Bernhard Ciritsis
Keyword(s):  
Length Of Stay ◽  
Weight Bearing ◽  
Early Mobilization ◽  
Full Weight Bearing ◽  
Complication Rates ◽  
Partial Weight Bearing ◽  
Early Recovery ◽  
Hospital Outcome ◽  
Lower Complication ◽  
Partial Weight

Introduction: Early recovery of mobilization after a fracture of the hip is associated with improved long-term ability to walk, lower complication rates, and mortality. In this context, early mobilization and full weight bearing are favorable. The aim of this study was (1) to analyze the influence of time between operation and first mobilization on in-hospital outcome and (2) the influence of early mobilization, full weight bearing, and ASA on pain, mobility of the hip, and ability to walk during the in-hospital phase of recovery. Methods: This is a retrospective in-hospital study of 219 patients aged 70 years or older who were treated with surgery after a hip fracture. Data were collected by a review of medical records. The outcomes were mortality, complications, length of stay, and the Merle d’Aubigné score which evaluates pain, mobility of the hip, and ability to walk. Factors were sought in bivariate and multivariate analyses. Results: A shorter time between operation and first mobilization was significantly associated with lower in-hospital mortality and complications. Early mobilization (within 24 h after the operation) and full weight bearing had no influence on pain, mobility of the hip, and ability to walk as well as length of stay in our cohort. Fracture type and treatment influenced mobility of the hip, while age as well as physical health status affected the ability to walk. Discussion: Patients with femoral neck fractures, respectively after total hip arthroplasty, had less pain and showed better mobility of the hip and ability to walk during hospitalization than patients with trochanteric fractures; these results were irrespective of early vs. late mobilization and full vs. partial weight bearing. Foremost, a shorter time between operation and first mobilization is associated with lower complication and mortality rates.

scholarly journals Partial weight suspension: a novel murine model for investigating adaptation to reduced musculoskeletal loading

2010 ◽  
Vol 109 (2) ◽  
pp. 350-357 ◽  
Author(s):  
Erika B. Wagner ◽  
Nicholas P. Granzella ◽  
Hiroaki Saito ◽  
Dava J. Newman ◽  
Laurence R. Young ◽  
...  
Keyword(s):  
Weight Bearing ◽  
Biomechanical Properties ◽  
Full Weight Bearing ◽  
The Novel ◽  
Partial Weight Bearing ◽  
New Model ◽  
Normal Body Weight ◽  
Mars Analog ◽  
Clinical Conditions ◽  
Partial Weight

We developed a new model of hypodynamic loading to support mice in chronic conditions of partial weight bearing, enabling simulations of reduced gravity environments and related clinical conditions. The novel hardware allows for reduced loading between 10 and 80% of normal body weight on all four limbs and enables characteristic quadrupedal locomotion. Ten-week-old female BALB/cByJ mice were supported for 21 days under Mars-analog suspension (38% weight bearing) and compared with age-matched and jacketed (100% weight bearing) controls. After an initial adaptation, weight gain did not differ between groups, suggesting low levels of animal stress. Relative to age-matched controls, mice exposed to Mars-analog loading had significantly lower muscle mass (−23% gastrocnemius wet mass, P < 0.0001); trabecular and cortical bone morphology (i.e., trabecular bone volume: −24% at the distal femur, and cortical thickness: −11% at the femoral midshaft, both P < 0.001); and biomechanical properties of the femoral midshaft (i.e., −27% ultimate moment, P < 0.001). Bone formation indexes were decreased compared with age-matched full-weight-bearing mice, whereas resorption parameters were largely unchanged. Singly housed, full-weight-bearing controls with forelimb jackets were largely similar to age-matched, group-housed controls, although a few variables differed and warrant further investigation. Altogether, these data provide strong rationale for use of our new model of partial weight bearing to further explore the musculoskeletal response to reduced loading environments.

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