Orthopedic Versus Podiatric Care of the Foot and Ankle Allen, Charlotte; Younger, Alastair; Veljkovic, Andrea ...
The Orthopedic clinics of North America,
April 2021, 2021-04-00, Letnik:
52, Številka:
2
Journal Article
Recenzirano
As the scope of podiatric surgery expands, the relative roles and outcomes of orthopedic surgeons and podiatrists need to be defined. With growing demand for foot and ankle services, the roles of ...podiatrists and orthopedic surgeons are increasingly overlapping. Few studies have examined the overlapping scope of practice of each of the groups or compared the relative costs and outcomes associated with each.
Oxford Nanopore sequencing has been widely used to achieve complete genomes of bacterial pathogens. However, the error rates of Oxford Nanopore long reads are high. Various polishing algorithms using ...Illumina short reads to correct the errors in Oxford Nanopore long-read assemblies have been developed. The impact of polishing the Oxford Nanopore long-read assemblies of bacterial pathogens with Illumina short reads on improving genomic analyses was evaluated using both simulated and real reads. Ten species (10 strains) were selected for simulated reads, while real reads were tested on 11 species (11 strains). Oxford Nanopore long reads were assembled with Unicycler to produce a draft assembly, followed by three rounds of polishing with Illumina short reads using two polishing tools, Pilon and NextPolish. One round of NextPolish polishing generated genome completeness and accuracy parameters similar to the reference genomes, whereas two or three rounds of Pilon polishing were needed, though contiguity remained unchanged after polishing. The polished assemblies of Escherichia coli O157:H7, Salmonella Typhimurium, and Cronobacter sakazakii with simulated reads did not provide accurate plasmid identifications. One round of NextPolish polishing was needed for accurately identifying plasmids in Staphylococcus aureus and E. coli O26:H11 with real reads, whereas one and two rounds of Pilon polishing were necessary for these two strains, respectively. Polishing failed to provide an accurate antimicrobial resistance (AMR) genotype for S. aureus with real reads. One round of polishing recovered an accurate AMR genotype for Klebsiella pneumoniae with real reads. The reference genome and draft assembly of Citrobacter braakii with real reads differed, which carried blaCMY-83 and fosA6, respectively, while both genes were present after one round of polishing. However, polishing did not improve the assembly of E. coli O26:H11 with real reads to achieve numbers of virulence genes similar to the reference genome. The draft and polished assemblies showed a phylogenetic tree topology comparable with the reference genomes. For multilocus sequence typing and pan-genome analyses, one round of NextPolish polishing was sufficient to obtain accurate results, while two or three rounds of Pilon polishing were needed. Overall, NextPolish outperformed Pilon for polishing the Oxford Nanopore long-read assemblies of bacterial pathogens, though both polishing strategies improved genomic analyses compared to the draft assemblies.
•Oxford Nanopore assemblies of pathogens were polished with Illumina short reads.•Pilon and NextPolish were compared for improving genomic analyses.•Both Pilon and NextPolish improved genomic analyses.•NextPolish outperformed Pilon for improving genomic analyses.•Advances in polishing algorithms allow for more accurate genomic analyses.
•The typical profile of the patient with a pilon fracture is age ranging from 27 to 57 years, male, with fibular fracture.•The pattern of fracture affects two or three pilon zones.•There is no ...typicality regarding the valgus or varus fracture displacement, although a difference was found in zone 1.
To map OTA/AO type 43C3 tibial pilon fractures by means of computed tomography and analyze the difference between varus and valgus fractures. We hypothesized that valgus fractures are less frequent than varus, and the affected zones of the tibial pilon are different among the patterns.
Retrospective, cross-sectional, observational study, using images of 73 computed tomographies of patients who had presented OTA/AO type 43C3 tibial pilon fractures. The radiographs and computed tomography were subdivided into two groups: varus and valgus fractures. Also, the presence or absence of fibula fractures. Both groups were subdivided into eight zones: four lateral to the pilon and four medial.
The distribution of total affected zones is significantly different in the male and female subgroups (p = 0.027). The incidence of cases in zone 1 is significantly different in varus and valgus displacement subgroups (p = 0.002). In the patients with valgus displacements, 61.9% of the fractures affect zone 1; in the patients with varus displacements, only 25.8% of the fractures affect zone 1. In the patients without fibula fracture, 58.3% of the fractures affect zone 2; in the patients with fibula fracture, 24.6% of the fractures affect zone 2.
The typical profile of the patient with a pilon fracture is age ranging from 27 to 57 years, male, with fibular fracture, and the injury affecting two or three pilon zones, with zones 6, 1, and 3 being the most affected ones. There is no typicality regarding the valgus or varus fracture displacement, although a difference was found in zone 1.
Abstract Pilon fractures result mainly from high energy injuries. Owing to this, the implications on the long-term prognosis are significantly affected by the damage inflicted during the event. ...Improving the prognosis will inevitably involve a multidisciplinary approach, taking into consideration a number of variables. Reducing the overall risk of complications through soft tissue protection whilst implementing appropriate treatment objectives through well timed surgery will aid the clinical outcome. In this article we review Pilon fractures, their aetiology, current classifications, and their management.
BACKGROUND: Biphasic treatment of pilon fractures has been accepted as standard modality of care.
AIM: The aim of the present study was to evaluate the effect of timing of definitive surgery for ...closed pilon fractures on the short-term functional outcome.
MATERIALS AND METHODS: Prospective study focused the patients suffering pilon fracture that has undergone treatment in a biphasic manner. Initially, spanning external fixator was applied, while the definitive osteosynthesis was performed within the next several days, in accordance with surgeon’s knowledge. The final functional outcome was evaluated using the American Orthopedic Foot and Ankle Society Ankle-Hindfoot Score.
RESULTS: Forty-two patients were included in the study. Mean time passed from injury to definitive surgery was 11.0 ± 3.4 days. Mean value of the functional score was 86.54 ± 13.2 points, with no significant differences with regard to the demographics and injury features. Pearson correlation coefficient demonstrated negative significant correlation between timing of definitive surgery and functional outcome (r = −0.428, p = 0.033). Complications were noted in 16% of the patients.
CONCLUSION: Definitive surgery should be planned as soon as possible, once the surgeon considers the soft-tissue status acceptable for surgery. Injudicious postponing has a negative effect on the short-term functional outcome.
Introduction
The aim of this study was to analyze the pathoanatomy of the posterior fragment on the basis of a comprehensive CT examination, including 3D reconstructions, in a large patient cohort.
...Materials and methods
One hundred and forty one consecutive individuals with an ankle fracture or fracture-dislocation of types Weber B or Weber C and evidence of a posterior tibial fragment in standard radiographs were included in the study. The mean patient age was 49 years (range 19–83 years). The exclusion criteria were patients below 18 years of age, inability to provide written consent, fractures of the tibial pilon, posttraumatic arthritis and pre-existing deformities. In all patients, post-injury radiographs were obtained in anteroposterior, mortise and lateral views. All patients underwent CT scanning in transverse, sagittal and frontal planes. 3D CT reconstruction was performed in 91 patients.
Results
We were able to classify 137 cases into one of the following four types with constant pathoanatomic features: type 1: extraincisural fragment with an intact fibular notch, type 2: posterolateral fragment extending into the fibular notch, type 3: posteromedial two-part fragment involving the medial malleolus, type 4: large posterolateral triangular fragment. In the 4 cases it was not possible to classify the type of the posterior tibial fragment. These were collectively termed type 5 (irregular, osteoporotic fragments).
Conclusion
It is impossible to assess the shape and size of the posterior malleolar fragment, involvement of the fibular notch, or the medial malleolus, on the basis of plain radiographs. The system that we propose for classification of fractures of the posterior malleolus is based on CT examination and takes into account the size, shape and location of the fragment, stability of the tibio-talar joint and the integrity of the fibular notch. It may be a useful indication for surgery and defining the most useful approach to these injuries.
This study aimed to compare the degree of posterior malleolar exposure, the tension of the flap containing the posteromedial neurovascular bundle (NVB), and the distance between the surgical incision ...and the NVB using three different posteromedial ankle approaches.
Three approaches were compared: medial posteromedial (MePM) modified posteromedial (MoPM) and posteromedial (PM). We measured the minimal tension of the flap containing the NVB that allowed proper exposure. In the second stage, an axial cut was performed, and we measured the degree of posterior malleolar exposure and the distance between the incision and the NVB
There were significant differences between the three approaches examined regarding the degree of posterior malleolar exposure and distance from the incision to the NBV,favoring the PM approach (71,00% ± 1.83 and 25.50 mm ± 4.20). The PM approach provided a significantly lower tension to the flap containing the posteromedial NVB (6.18 N ± 1.28) compared to the other two approaches
The PM approach achieved the highest degree of posterior malleolar exposure, the lowest tension to the posteromedial NVB, and the greatest distance between the incision and the NBV. Thus, we believe it should be considered the approach of choicefor large fractures of the posteromedial aspect of the PM.
Les fractures du pilon tibial sont des fractures polymorphes et posent un problème thérapeutique et pronostic .Le but de notre travail est d´étudier le profil épidémiologique de ces fractures, ...d´évaluer nos résultats sur le plan anatomique et fonctionnel. Nous avons colligé 50 fractures du pilon tibial traitées et suivies entre 2004 et 2013 au Service d´Orthopédie et de Traumatologie de l´hôpital Habib Bourguiba de Sfax. Les résultats fonctionnels ont été évalués par le score Ankle-Hindfoot. Les résultats radiologiques ont évalué la consolidation. Le traitement était par ostéosynthèse interne dans 30 cas, par fixateur externe dans 11 cas et par un traitement combinant les deux techniques dans 9 cas. Au terme de cette étude, nos résultats fonctionnels ont été jugé bons et très bons dans 36 cas. Nous avons noté 30 cas de consolidation, avec 18 cas de cal vicieux et deux cas de pseudarthrose. La prise en charge thérapeutique des fractures du pilon tibial est difficile dans certain cas, une ostéosynthèse solide avec une réduction anatomique est le garant d´un résultat fonctionnel satisfaisant.
The authors developed a simple extensible external fixator, which has the advantages of easy application and inexpensiveness. The present study aimed to make a comparison between this external ...fixator and calcaneal traction in preoperative temporary fixation for malaligned ankle fractures and pilon fractures.
From May 2020 to February 2022, patients with malaligned ankle fractures or Rüedi-Allgöwer type 2 or 3 pilon fractures with obvious soft tissue swelling were retrospectively reviewed and divided into the calcaneal traction group and the external fixation group. The two groups of patients were matched 1:1 before making comparisons.
A total of 38 patients were included. Higher General Comfort Questionnaire score and lower visual analog scale score were noticed in the external fixation group during hospitalization (p < 0.05), while the operation latency time, total cost, patient satisfaction, and functional outcomes one year after surgery were not significantly different between the two groups. No wound complications were observed.
Preoperative temporary fixation for fractures around the ankle using this simple extensible external fixator significantly improves patient comfort when compared to calcaneal traction.
III, retrospective comparative study.
ObjectiveTo compare the effectiveness between the posterolateral approach and the posterolateral combined posteromedial approaches in the treatment of Mason type 2B posterior malleolar ...fracture.MethodsA retrospective analysis was performed on the clinical data of 79 patients with posterior ankle fracture who met the selection criteria between January 2015 and January 2022. There were 62 cases of Mason 2B Pilon subtype and 17 cases of avulsion subtype. Among Mason 2B Pilon subtype patients, 35 were treated with posterolateral approach (group A), 27 patients were treated with combined approach (group B). There was no significant difference in gender, age, injured side, cause of injury, time from injury to operation, preoperative hospital stay, preoperative visualanalogue scale (VAS) score, and intraoperative internal fixation between the two groups ( P>0.05). All patients with Mason 2B avulsion subtype were treated by posterolateral approach, including 7 males and 10 females, aged from 25 to 68 years, with an a
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