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Delayed Diagnosis of Syndesmotic Injury A treatment algorithm

FOOT AND ANKLE CLINICS 2025年第1期30卷 41-50页

作者： Gianakos, Arianna L. Symeonidis, Panagiotis D. Yale Orthopaed & Rehabil Dept Orthopaed Surg 47 Coll St New Haven CT 06510 USA St Lukes Hosp Thessaloniki Greece

A delay in diagnosis and management of syndesmotic injuries can result in a complex treatment challenge, leading to poorer clinical results and higher rates of unplanned, syndesmotic-related primary operations and reoperations. This article presents a simple and reproducible algorithm with case examples for the management of syndesmotic injuries with delay in diagnosis to help guide surgeons when determining the best treatment strategies for this complex injury.

关键词： Syndesmosis Delayed diagnosis Syndesmotic injury treatment algorithm

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Static and Dynamic Filler-Associated Tear Trough Deformities: Manifestations and treatment algorithm

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AESTHETIC PLASTIC SURGERY 2024年第14期48卷 2642-2650页

作者： Kang, Yuanbo Wang, Sifan Xia, Zenan Zhang, Xinran Yu, Nanze Liu, Zhifei Wang, Xiaojun Long, Xiao Zhu, Lin Chinese Acad Med Sci Peking Union Med Coll Hosp Dept Plast Surg Shuaifuyuan 1 Beijing 100730 Peoples R China Chinese Acad Med Sci Peking Union Med Coll Dongdan Santiao 9 Beijing 100730 Peoples R China

BackgroundFillers are popular substances for the correction of tear trough deformity. Despite well-documented complications increasing gradually, standardized treatment algorithm for deformity secondary to improper injection is still *** April 2020 and April 2023, a total of 22 patients with filler-associated tear trough deformity with static bulges or dynamic swells after injection of tear trough were enrolled. For patients who received hyaluronic acid (HA) and unknown fillers, hyaluronidase dissolution was performed. For patients who received non-HA fillers and unknown fillers that failed to dissolve, a magnetic resonance imaging (MRI) examination was conducted. Surgical approaches were selected based on the filler distribution and the condition of the lower eyelid. Ligament releasement and fat transposition were accomplished when fillers were excised. Aesthetic outcomes were evaluated by double-blind examiners using the Global Aesthetic Improvement Scale after patients were followed *** total, the study included 3 patients with simple static deformities, 1 patient with simple dynamic, and 18 patients with both. Fourteen patients underwent transconjunctival surgery and 8 patients underwent transcutaneous surgery, among which 18 patients underwent hyaluronidase dissolution and 8 patients underwent MRI prior to surgery. A total of 4 patients with self-limited complications recovered after conservative treatment. 90.9% of patients expressed satisfaction or high satisfaction with the treatment ***-associated tear trough deformities could be classified into static and dynamic deformities, which could appear separately or simultaneously. treatment of deformities should be based on characteristics of fillers, in which MRI could serve as a promising *** of Evidence IVThis journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please r

关键词： Filler Surgical approach Tear trough deformity treatment algorithm

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Non-surgical treatment of lateral malleolar fractures is safe: long-term follow-up of a comprehensive treatment algorithm

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BMC MUSCULOSKELETAL DISORDERS 2024年第1期25卷 1页

作者： Borjesson, Erik Johannesson, Karolina Ekelund, Jan Rydberg, Emilia Moller Univ Gothenburg Inst Clin Sci Sahlgrenska Acad Gothenburg Sweden Sahlgrens Univ Hosp Dept Orthopaed Goteborgsvagen 31 SE-43180 Molndal Sweden Ctr Registers Gothenburg Gothenburg Sweden

IntroductionA study at Sahlgrenska University Hospital (SU) found significant variation in the treatment of ankle fractures, leading to the development of a structured treatment algorithm (TA). The TA aimed to standardise treatment and reduce the number of unnecessary surgical procedures. A follow-up study concluded that the number of surgeries had significantly decreased since the TA was introduced. However, the long-term effects of the TA and the reduced number of surgical procedures remain unclear. The aim of the study was to analyse the long-term effects of a structured TA for ankle fractures, focusing on complications and reoperation *** present study is a long-term follow-up of the same two cohorts of patients with lateral malleolar fractures of type AO/OTA44-B1, as studied in the previous studies on the TA for ankle fractures at SU. The current study compares a group of AO/OTA 44B1 fractures treated before introducing the TA, the pre-TA cohort (n = 410), with a group treated after introducing the TA, the post-TA cohort (n = 333). Both cohorts were followed for at least four years, and the outcomes were reoperation or complication. Reoperation was defined as any surgical procedure performed >= 30 days after the *** results highlight a statistically significant reduction in the reoperation rate for lateral malleolar ankle fractures from 7.1 to 2.4% (p = 0.006) after introducing a TA that reduced the number of primary surgical procedures. Hardware-related issues were identified as the dominant cause of reoperation in both cohorts. Three major reoperations were observed in the pre-TA cohort compared to none in the post-TA cohort. The present study revealed no increase in the frequency of reoperations (late surgeries) due to *** non-surgical treatment of stable ankle fractures does not lead to an increase in reoperations caused by non-union. A TA that reduces the need for primary surgical procedures for lateral malleol

关键词： Ankle fracture Swedish fracture register Epidemiology Fracture management treatment algorithm

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treatment algorithm of Postsurgical Fat Necrosis of the Breast-Revisited

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SEMINARS IN PLASTIC SURGERY 2022年第2期36卷 94-100页

作者： Haran, Oriana Legarda, Carolina Gofstein, Dina Adelson, Dana Singolda, Roei Madah, Ehab Arad, Ehud Grush, Andrew E. Barnea, Yoav Tel Aviv Univ Sackler Fac Med Tel Aviv Sourasky Med Ctr Dept Plast & Reconstruct Surg Tel Aviv Israel Baylor Coll Med Michael E DeBakey Dept Surg Div Plast Surg Houston TX 77030 USA Texas Childrens Hosp Dept Surg Div Plast Surg Houston TX USA

Fat necrosis is a common complication of breast surgery, with the potential to cause both functional and aesthetic repercussions that can affect patient satisfaction. Although several fat necrosis classification systems have been proposed, fat necrosis management varies widely across institutions, requiring revisiting of existing treatment protocols. We evaluated the postoperative outcomes on 335 breasts following either breast reduction or reconstruction with deep inferior epigastric perforator (DIEP) flaps at our institution between 2016 and 2020, with particular attention to the development of fat necrosis and the need for subsequent surgical intervention. Fat necrosis was diagnosed in 36 (10.74%) breasts, of which 16 (44.4%) were surgically removed and 20 (55.5%) were conservatively managed. Time of fat necrosis diagnosis: early (<= one-month after breast surgery) or late (>1 month) was the only variable associated with surgical intervention. Fat necrosis management should be approached on a case-by-case basis. Whenever possible, conservative management with regular clinical and radiological follow-up, and patient reassurance, should be pursued even for large masses, in the absence of concomitant complications.

关键词： fat necrosis treatment algorithm breast surgery

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The treatment algorithm for Chronic Multiple Ligament Knee Injury

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INDIAN JOURNAL OF ORTHOPAEDICS 2024年第11期58卷 1512-1517页

作者： Pardiwala, Dinshaw N. Desouza, Clevio Jesia, Arzan Kokilaben Dhirubhai Ambani Hosp & Med Res Inst Ctr Bone & Joint Arthroscopy & Knee Preservat Serv Mumbai Maharashtra India

BackgroundMultiple ligament knee injuries (MLKI) are a complex group of injuries ideally treated in the acute phase, though delayed presentation is common. Chronic MLKI varies in presentation, requiring individualized management strategies. This review aims to differentiate chronic MLKI types and propose an algorithm that facilitates a tailored treatment *** MLKI is classified into three types based on knee joint status and limb alignment. Type 1 involves ligament deficiency in a reduced knee with normal alignment, treated with soft-tissue ligament reconstruction. Type 2 includes ligament deficiency with malalignment, where deformity correction precedes ligament surgery. Type 3 entails chronic unreduced knee dislocations, necessitating open reduction and extensive release prior to *** depends on classification, emphasizing realignment for Type 2 and reduction for Type 3 before soft-tissue procedures. Individualized approaches are critical due to the complexity and variability of chronic *** treatment algorithm is essential to manage chronic MLKI. Joint reduction, limb realignment, and ligament reconstruction are important to ensure optimal functional outcomes.

关键词： Chronic multiple ligament knee injury (MLKI) Multiple ligament reconstruction Chronic knee dislocation Limb malalignment Deformity correction treatment algorithm

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Externally validated treatment algorithm acceptably predicts nonoperative treatment success in patients with anterior cruciate ligament rupture

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KNEE SURGERY SPORTS TRAUMATOLOGY ARTHROSCOPY 2024年第9期32卷 2228-2238页

作者： de Vos, Floris H. Meuffels, Duncan E. Baart, Sara J. van Es, Eline M. Reijman, Max Erasmus MC Univ Med Ctr Dept Orthopaed & Sports Med Dr Molewaterpl 40 NL-3015 GD Rotterdam Netherlands Erasmus MC Univ Med Ctr Dept Biostat Rotterdam Netherlands

PurposeThis study aims to develop and externally validate a treatment algorithm to predict nonoperative treatment success or failure in patients with anterior cruciate ligament (ACL) rupture. MethodsData were used from two completed studies of adult patients with ACL ruptures: the Conservative versus Operative Methods for Patients with ACL Rupture Evaluation study (development cohort) and the KNee osteoArthritis anterior cruciate Ligament Lesion study (validation cohort). The primary outcome variable is nonoperative treatment success or failure. Potential predictor variables were collected, entered into the univariable logistic regression model and then incorporated into the multivariable logistic regression model for constructing the treatment algorithm. Finally, predictive performance and goodness-of-fit were assessed and externally validated by discrimination and calibration measures. ResultsIn the univariable logistic regression model, a stable knee measured with the pivot shift test and a posttrauma International Knee Documentation Committee (IKDC) score <50 were predictive of needing an ACL reconstruction. Age >30 years and a body mass index > 30 kg/m(2) were predictive for not needing an ACL reconstruction. Age, pretrauma Tegner score, the outcome of the pivot shift test and the posttrauma IKDC score are entered into the treatment algorithm. The predictability of needing an ACL reconstruction after nonoperative treatment (discrimination) is acceptable in both the development and the validation cohort: area under the curve = resp. 0.69 (95% confidence interval [CI]: 0.58-0.81) and 0.68 (95% CI: 0.58-0.78). ConclusionThis study shows that the treatment algorithm can acceptably predict whether an ACL injury patient will have a(n) (un)successful nonoperative treatment (discrimination). Calibration of the treatment algorithm suggests a systematical underestimation of the need for ACL reconstruction. Given the limitations regarding the sample size of this study, la

关键词： ACL rupture nonoperative treatment treatment algorithm validation

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Missed Monteggia pathology. Corrective options and treatment algorithm

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ARTHROSKOPIE 2024年第2期37卷 87-91页

作者： Cramer, Christopher Haettich, Annika Wintges, Kristofer Dust, Tobias Frosch, Karl-Heinz Mader, Konrad Univ Klinikum Hamburg Eppendorf UKE Klin & Poliklin Unfallchirurg Orthopadie Hamburg Germany Univ Klinikum Hamburg Eppendorf UKE Klinik & Poliklin Kinderchirurg Hamburg Germany Univ Klinikum Hamburg Eppendorf UKE Klinik & Poliklin Unfallchirurg & Orthopadie Sekt Hand Unterarm & Ellenbogentraumatol Martinistr 52 D-20246 Hamburg Germany

Background: The missed Monteggia injury is a rare but highly complex complication of an apparently harmless and sometimes overlooked injury in childhood. Objective: What are the options for conservative and surgical treatment? Which one is mainly used according to the current literature? What is the treatment algorithm? Material and method: Evaluation of the current literature, presentation of our own surgical method as well as the complete treatment algorithm. Results: A total of 15 patients underwent surgery during the period 2007-2023 with corrective osteotomy of the ulna and open reposition of the radial head in a one-stage procedure. All patients showed no preoperative radiological signs of humeroradial osteoarthritis. No significant complications occurred during this procedure. Conclusion: Corrective osteotomy of the ulna with open reduction of the radial head represents the current gold standard in the management of chronic Monteggia imjuries;however, it is challenging and requires a high level of expertise.

关键词： Elbow Osteotomy Childhood Plate osteosynthesis treatment algorithm

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Traumatic odontoid fracture - Proposal of a treatment algorithm

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CLINICAL NEUROLOGY AND NEUROSURGERY 2025年 254卷 108951-108951页

作者： Rizvi, Syed Ali Mujtaba Linnerud, Hege Brommeland, Tor Aarhus, Mads Mirzamohammadi, Jalal Harr, Marianne Efskind Stenset, Vidar Tveit Vasfaret Evjensvold, Magnus Helseth, Eirik Oslo Univ Hosp Dept Neurosurg Postboks 4956 Nydalen N-0424 Oslo Norway Univ Oslo Inst Clin Med Fac Med Postboks 1078 N-0316 Oslo Norway Oslo Univ Hosp Dept Neuroradiol Postboks 4956 Nydalen N-0424 Oslo Norway

Background: Current management guidelines for odontoid fractures (OFx) lack emphasis on age, comorbidity, and frailty, leading to variability in clinical practice and highlighting the need for guideline reevaluation. We began implementing a new treatment algorithm for OFx management at Oslo University Hospital (OUH) in 2022 with the aim of making it part of standard care for OFx. The main objective of this study was to determine our department's compliance with the new treatment algorithm for OFx. Methods: In this population-based cohort study, we examine all traumatic OFx diagnosed in Southeast Norway from 2022-2023 and assess the rate of compliance with a new treatment algorithm implemented at OUH. Patient demographics, injury characteristics, treatment decisions, and outcomes, including union rates, rate of conversion from external immobilization to surgery, and long-term disability rates, were collected. Follow-up evaluations included imaging examinations and clinical and functional assessments. Results: One hundred eighty-one patients with acute odontoid fractures (OFx) were registered from 2022 to 2023, and the median age of the patients was 78 years. Most fractures were caused by falls (92.3 %), and 70 % of the patients had some form of vulnerability (ASA >= 3 and/or CFS >= 4 and/or dependent living). Type II fractures were the most common (55.3 %), and 9.4 % of all OFx patients underwent surgical fixation. The treatment compliance rate was 97.2 %. At follow-up, 77.9 % of patients were alive, and 80.6 % of patients exhibited union, either bony or fibrous. Most patients (79.9 %) reported little neck pain (VAS score <= 3), and 87.8 % reported mild or no neck stiffness. The survival rate was 87 % at 30 days and 78 % at 6 months. There were no significant differences in the rates of disability, pain, bony union or fibrous union between the treatment groups. The new treatment algorithm resulted in favorable clinical outcomes. Conclusions: In this observational coh

关键词： Odontoid fracture treatment algorithm Outcome Elderly Trauma Survival

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Acute mesenteric ischemia-Diagnostic and treatment algorithm

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COLOPROCTOLOGY 2023年第2期45卷 120-124页

作者： Wolk, Steffen Kapalla, Marvin Weitz, Juergen Reeps, Christian Tech Univ Dresden Klin Poliklin Viszeral Thorax & Gefasschirurg Univ Klinikum Carl Gustav Carus Fetscherstr 74 D-01307 Dresden Germany

Acute mesenteric ischemia is an emergency with a high mortality. The incidence is age-dependent and increases with pre-existing cardiovascular risk factors. Because of the low tolerance to ischemia, especially of the intestines, progressive intestinal necrosis with transmigratory peritonitis and multiorgan failure occurs in the natural course of the disease. Therefore, mesenteric ischemia should always be considered in patients with acute abdomen. The disease typically progresses in three clinical phases, whereby improvement of symptoms initially occurs, which is why the diagnosis is difficult. Computed tomography angiography (CTA) is considered the gold standard for confirming the diagnosis. Depending on the etiology, such as embolism, arterial thrombosis, or nonocclusive mesenteric ischemia, treatment can be carried out as an open surgical or endovascular procedure. Establishment of a diagnostic and treatment algorithm improves the prognosis. After successful revascularization, resection of bowel and organ sections may become necessary. In this case, the rules of damage control surgery apply, which may necessitate a planned relaparotomy (second look).

关键词： Bowel ischemia treatment algorithm Computed tomography angiography Mortality Damage control surgery

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Surgical outcomes and proposal for a treatment algorithm for urethral strictures in transgender men

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BJU INTERNATIONAL 2022年第1期129卷 63-71页

作者： de Rooij, Freek P. W. Peters, Femke R. M. Ronkes, Brechje L. van Der Sluis, Wouter B. Al-Tamimi, Muhammed van Moorselaar, R. Jeroen A. Bouman, Mark-Bram Pigot, Garry L. S. Univ Amsterdam Med Ctr Dept Urol Amsterdam Netherlands Univ Amsterdam Med Ctr Ctr Expertise Gender Dysphoria Amsterdam Netherlands Univ Amsterdam Med Ctr Locat VUmc Dept Plast Reconstruct & Hand Surg Amsterdam Netherlands

Objectives To assess our results of surgical treatment for urethral strictures in transgender men, and to provide a surgical treatment algorithm. Patients and methods A single centre, retrospective cohort study was conducted of transgender men who underwent surgical correction of their urethral stricture(s) between January 2013 and March 2020. The medical charts of 72 transgender men with 147 urethral strictures were reviewed. The primary outcomes were the success and recurrence rates after surgical treatment for urethral strictures. Results The median (interquartile range [IQR]) follow-up was 61 (25-202) months. At last follow-up, 50/72 (69%) were able to void while standing (after one [60%], two [20%], three [6%], four [8%], five [4%], or seven [2%] procedures), 10/72 (14%) await further treatment, two of the 72 (3%) sat to void despite good urodynamic function, and 10/72 (14%) had a definitive urethrostomy. Of 104 surgical treatments included in separate success rate analysis, 65 (63%) were successful (43/75 [57%] after phalloplasty, 22/29 [76%] after metoidioplasty). The highest success rates in short urethral strictures were seen after a Heineke-Mikulicz procedure (six of seven cases), and in longer or more complicated urethral strictures after two-stage with graft (four of six), two-stage without graft (10/12), pedicled flap (11/15, 73%), and single-stage graft (seven of seven) urethroplasties. Grafts used were buccal mucosa or full-thickness skin grafts. Success rates improved over time, with success rates of 38% and 36% in 2013 and 2014, to 71% and 73% in 2018 and 2019, respectively. We concluded with a surgical treatment algorithm based on previous literature, stricture characteristics, and our surgical outcomes. Conclusion The highest success rates were seen after a Heineke-Mikulicz procedure in short urethral strictures;and after graft, pedicled flap, or two-stage urethroplasties in longer or more complicated urethral strictures. Finally, most of the tran

关键词： genital gender-affirming surgery metoidioplasty phalloplasty surgical outcome transgender men treatment algorithm urethral stricture

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