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1.
Foot Ankle Int ; 45(9): 931-939, 2024 Sep.
Article in English | MEDLINE | ID: mdl-39219246

ABSTRACT

BACKGROUND: Surgical treatment of insertional Achilles tendinopathy (IAT) historically consists of Achilles tendon debridement with reattachment and excision of the posterosuperior calcaneal prominence with or without a gastrocnemius recession. Zadek osteotomy (ZO) is an alternative to an open midline splitting approach. The purpose of this study was to analyze patient-reported outcomes and complications after percutaneously performed ZO with minimum 2 years' follow-up. METHODS: One hundred eight cases treated with percutaneous ZO with a minimum 2-year follow-up were retrospectively reviewed. Postoperative complications and patient satisfaction were evaluated. Foot Function Index (FFI) and visual analog scale (VAS) scores were recorded at preoperative and follow-up appointments to measure patients' functional outcomes and pain, respectively. RESULTS: Mean follow-up was 41.2 months (range, 24-65). Mean age was 51.8 years (range, 28-81). The mean FFI score improved from 56.1 (range, 47-88) to 11.0 (range, 7-59) postoperatively (P < .001). The mean VAS score improved from 7.7 (range, 5-10) to 0.4 (range, 0-7) postoperatively (P < .001). The overall complication rate was 3.8% (n = 4). Of 104 cases, 98.1% of patients said they were satisfied with their procedure (n = 102) when asked if they were satisfied with their ZO and recovery. CONCLUSION: We found the percutaneous ZO to be a safe and effective intervention for treatment of IAT. At a minimum of 2-year follow-up, this intervention is associated with minimal complications, improved function, reduced pain, and a high rate of patient satisfaction.


Subject(s)
Achilles Tendon , Osteotomy , Patient Satisfaction , Tendinopathy , Humans , Tendinopathy/surgery , Achilles Tendon/surgery , Osteotomy/methods , Retrospective Studies , Middle Aged , Female , Male , Adult , Aged , Aged, 80 and over , Pain Measurement , Postoperative Complications , Calcaneus/surgery , Treatment Outcome
2.
Poult Sci ; 103(11): 104169, 2024 Aug 11.
Article in English | MEDLINE | ID: mdl-39244785

ABSTRACT

Valgus-varus deformity (VVD) is a common long bone deformity in broilers. Imbalance in cartilage homeostasis is the main feature of leg disease. Exosomes act as an important intercellular communication vector that regulates chondrogenesis by encapsulating specific nucleic acids and proteins. However, the exact mechanism of how plasma exosomal miRNAs regulate cartilage homeostasis in VVD broilers remains unclear. This study first demonstrated the structural disorder, growth retardation, and reduced proliferative capacity of VVD cartilage in vitro and in vivo. Subsequently, VVD and Normal broiler plasma exosomes were collected for miRNA sequencing. Cartilage-specific miR-455-5p was extraordinarily emphasized by performing bioinformatics analysis on differential miRNA target genes and further validated by tissue expression profiling. PKH67 fluorescently labeled plasma exosomes were shown to be taken up by chondrocytes, deliver miR-455-5p, inhibit chondrocyte proliferation, and disrupt their homeostasis, and these effects could be inhibited by the miR-inhibitors. Mechanistically, MiR-455-5p targets Ribosomal Protein S6 Kinase B1 (RPS6KB1) to inhibit RPS6 phosphorylation and reduce the synthesis of key proteins for cartilage proliferation, which in turn inhibits cartilage proliferation and disrupts its homeostasis. In conclusion, the present study identified abnormalities in VVD cartilage tissue and clarified the specific mechanism by which plasma exosome-derived miR-455-5p regulates cartilage homeostasis.

3.
Sci Rep ; 14(1): 21716, 2024 09 17.
Article in English | MEDLINE | ID: mdl-39289378

ABSTRACT

Functional assessment is a key element in evaluating adult spinal deformity (ASD) patients. The multitude of 3D kinematic parameters provided by movement analysis can be confusing for spine surgeons. The aim was to investigate movement patterns of ASD based on key kinematic parameters. 115 primary ASD and 36 controls underwent biplanar radiographs and 3D movement analysis during walking, sit-to-stand and stair ascent to calculate joint and segment kinematics. Principal component analysis was applied to identify the most relevant kinematic parameters that define movement strategies adopted by ASD. Pelvis and head relative to pelvis kinematics were the most relevant parameters. ASD patients adopted four different movement strategies. Class 1: normative head and pelvis kinematics. Class 2: persistent pelvic backward tilt. Class 3: persistent forward shift of the head. Class 4: both pelvic backward tilt and forward shift of the head. Patients in class 3 and 4 presented sagittal malalignment on static radiographs with increased pelvic tilt, pelvic incidence-lumbar lordosis mismatch and sagittal vertical axis. Surprisingly, patients in class 3 had normal pelvic kinematics during movement, showing the importance of functional evaluation. In addition to being key segments in maintaining static global posture, head and pelvis were found to define movement patterns.


Subject(s)
Head , Pelvis , Humans , Pelvis/physiopathology , Pelvis/diagnostic imaging , Female , Male , Biomechanical Phenomena , Middle Aged , Adult , Activities of Daily Living , Posture/physiology , Aged , Spinal Curvatures/physiopathology , Spinal Curvatures/diagnostic imaging , Spine/physiopathology , Spine/diagnostic imaging , Movement/physiology , Walking/physiology
4.
Article in English, Spanish | MEDLINE | ID: mdl-39237032

ABSTRACT

Osteoporosis and fragility play a significant role in the treatment and planning of patients with deformity secondary to osteoporotic vertebral fracture (OVF). The resulting deformity can present significant challenges for its management, both from a medical and surgical perspective. The need for a specific classification for these deformities, including the potential for the development of artificial intelligence and machine learning in predictive analysis, is emerging as a key point in the coming years. Relevant aspects in preoperative optimization and management of these patients are addressed. A classification with therapeutic guidance for the management of spinal deformity secondary to OVF is developed, emphasizing the importance of personalized treatment. Flexibility and sagittal balance are considered key aspects. On the other hand, we recommend, especially with these fragile patients, management with minimally invasive techniques to promote rapid recovery and reduce the number of complications.

5.
Front Psychol ; 15: 1426820, 2024.
Article in English | MEDLINE | ID: mdl-39319069

ABSTRACT

Introduction: Changes in facial appearance due to orthognathic surgery are known to improve a patient's postoperative quality of life, however, potential changes in cognitive function are unknown. This study examined the effects of changes in facial appearance due to orthognathic surgery on the sensitivity to self and to outside objects in patients with jaw deformities. Methods: Patients with jaw deformities (n = 22) and healthy controls (n = 30) were tested at 3 months preoperatively, at 1 month preoperatively, and at 1 month postoperatively to assess their impression of objects (positive, negative, and neutral pictures) and their evaluation of their own face and body. Results: The results showed that changes in facial appearance improved self-evaluation and increased their sensitivity to emotional objects even when the objects were identical. Furthermore, the improving rating for own face was associated with the sensitivity for objects. Discussion: The changes in facial appearance in patients may have helped to clear the sensitivity to these emotional objects. These findings may provide a new indicator of efficacy in orthognathic surgery.

6.
Foot Ankle Int ; : 10711007241271283, 2024 Sep 26.
Article in English | MEDLINE | ID: mdl-39324819

ABSTRACT

BACKGROUND: Charcot-Marie-Tooth (CMT) disease is a progressive inherited neurologic disorder causing muscle weakness and lower extremity deformity. The goal of foot and ankle surgical treatment is to create a stable, plantigrade foot, with the potential elimination of brace-wear for ambulation. The aim of this study was to report baseline CMT patient function and subsequent outcome improvement from surgical treatment, as determined by PROMIS physical function (PF), pain interference (PI), and mental health/depression (D) scores. METHODS: Retrospective data were collected on consecutive CMT patients older than 18 years receiving surgical treatment by a single surgeon from 2018 to 2022 with minimum 1-year follow-up. Each patient prospectively completed PROMIS preoperatively and postoperatively after all planned surgical treatment was completed. Prospective clinical and radiographic data were collected to describe complications and correlation to outcome. RESULTS: Ninety-five feet in 64 patients older than 18 years were included for analysis. Mean follow-up was 21 months (range, 12-31) with 100% minimum 1-year follow-up. CMT patients had worse preoperative and baseline scores in all domains except PROMIS-D compared with population normal PROMIS scores. Significant improvements were identified in all PROMIS domains following surgical treatment. The mean PROMIS-PF score increased (40 to 45, delta = 4.9, P < .001), the mean PROMIS-PI score decreased (59 to 52, delta = 7.1, P < .001), and the mean PROMIS-D score decreased (50 to 47, delta = 3.0, P = .004). Subgroup analysis was performed for patients with severe radiographic deformity and those treated with arthrodesis in an attempt to demonstrate the impact of disease severity on outcome. Subgroup analysis demonstrated that arthrodesis led to worse overall PROMIS-PF outcome with the same change score. CONCLUSION: Surgical treatment for CMT patients provides significant clinical improvement in all measured outcome domains. CMT patients can be restored to normal population physical function and pain interference outcome scores. Patients with more severe deformity have similar improvement from surgical treatment, although their ultimate functional improvement is blunted due to a lower baseline.

7.
Spine Deform ; 2024 Sep 26.
Article in English | MEDLINE | ID: mdl-39325331

ABSTRACT

PURPOSE: Cerebral Palsy (CP) often presents with a sweeping thoracolumbar scoliosis and pelvic obliquity. With severe pelvic obliquity, the ribs come into contact with the high side of the oblique pelvis, termed rib-on-pelvis deformity (ROP). ROP can result in costo-iliac impingement, or pain associated with ROP, and can also adversely affect breathing and sitting balance. The goal of this study was to evaluate whether CP patients with ROP have worse health-related quality of life (HRQOL) before surgery and a greater improvement in HRQOL after surgery. METHODS: A retrospective analysis of a prospectively collected, multicenter, international registry was performed for all nonambulatory patients with CP treated with spinal fusion with at least two-year follow-up. HRQOL was measured via the Caregiver Priorities & Child Health Index of Life with Disabilities (CPCHILD) questionnaire domains (0 = most disability, 100 = least disability). ROP was defined as having a rib distal to the superior portion of the iliac crest on preop upright radiographs. The ROP group and control group without ROP were compared regarding six domain scores and total score of CPCHILD. Multiple linear regression was used to control for curve apex location, major coronal Cobb angle, type of tone, and pelvic obliquity. RESULTS: 340 patients met inclusion criteria (52% female, mean age 14.0 years). The mean major coronal Cobb angle was 81 degrees and mean pelvic obliquity was 22 degrees. 176 patients (51.8%) had ROP while 164 patients (48.2%) did not. ROP was independently associated with worse preoperative Positioning/Transfers/Mobility (PTM), Comfort & Emotions (C&E), and total CPCHILD score via the CPCHILD questionnaire (p < 0.05). Patients with preoperative ROP experienced a greater improvement in the C&E and PTM domains as well as total CPCHILD score than patients without ROP (p < 0.05). CONCLUSION: CP patients with rib-on-pelvis deformity experience more pain and worse HRQOL than patients without this deformity. These patients experienced a greater improvement in HRQOL after spinal fusion measured via the CPCHILD questionnaire.

8.
Aesthetic Plast Surg ; 2024 Sep 23.
Article in English | MEDLINE | ID: mdl-39313662

ABSTRACT

Level of Evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

9.
J Plast Reconstr Aesthet Surg ; 98: 263-271, 2024 Sep 10.
Article in English | MEDLINE | ID: mdl-39303343

ABSTRACT

Lower eyelid reconstruction using skin flaps sometimes results in undesirable deformities due to postoperative flap drooping. We aimed to examine the effectiveness of a novel procedure for reconstructing the skin-tarsoligamentous sling of the lower eyelid. We included 37 patients who underwent anterior lamellar reconstruction with a cheek rotation flap for full-thickness lower eyelid defect. They were divided into two groups: Group A included 19 patients who underwent tarsoligamentous sling reconstruction with a fascia lata strip and buccal mucosa grafting, and Group B comprised 18 patients who underwent skin-tarsoligamentous sling reconstruction using an additional combination of a periosteal flap and de-epithelialized triangular flap at the lateral canthal region, representing our novel approach. To evaluate the severity of postoperative deformities, we used the drooping index, the ratio of drooping compared to the healthy side, along with the angular difference in canthal tilt, obtained between the reconstructed and healthy sides, using photographs taken ≥6 months post-reconstruction. Group B demonstrated superior outcomes, with mean drooping indices of 1.13 compared to 1.33 in Group A (P = 0.031) and mean angular differences in canthal tilt of -0.73° compared to -2.45° in Group A (P = 0.021). Patient satisfaction was significantly higher in Group B than in Group A (P = 0.042). Furthermore, patients with drooping index <1.2 and an angular difference in canthal tilt ≥-1.0° exhibited higher satisfaction scores. Our novel approach to lower eyelid reconstruction using a skin-tarsoligamentous sling yielded improved aesthetic outcomes, fewer complications, and higher patient satisfaction.

10.
Diagnostics (Basel) ; 14(17)2024 Aug 29.
Article in English | MEDLINE | ID: mdl-39272681

ABSTRACT

Since the early 2000s, minimally invasive forefoot surgery (MIS), particularly hallux valgus correction, has significantly advanced with the introduction of the Shannon burr. However, despite numerous relevant studies being published, no comprehensive review articles have summarized MIS for various forefoot conditions. Therefore, in this comprehensive review, we examined the relevant studies about the application of MIS (excluding arthroscopy and endoscopy) for various forefoot conditions. Additionally, we discuss the essential considerations for achieving favorable surgical outcomes and preventing complications associated with each technique. We analyzed the characteristics of each surgical procedure and identified areas for future focus. Effective surgical treatment not only requires MIS, but also the appropriate selection of patients based on suitable indications and executing procedures within the surgeon's capabilities. We hope that this review will help readers to enhance their expertise in this field.

11.
J Clin Orthop Trauma ; 56: 102526, 2024 Sep.
Article in English | MEDLINE | ID: mdl-39286007

ABSTRACT

Background: Majority of patients with Progressive Collapsing Foot Deformity(PCFD) have symptoms pertaining to the knee. Malalignment at the foot will have effects on the alignment of the knee. In this case control study, we compare the alignment of the knees between patients with PCFD and controls. Materials: Sixty subjects, 30 PCFD and 30 controls, underwent radiographs in which the tibiofemoral angle and radiological parameters of PCFD were assessed. Parameters of PCFD were correlated with the tibiofemoral angle. Results: Mean tibiofemoral angle was 3.8° among the cases and 4.8° among the controls which was statistically significant(P = 0.001). Varus knee alignment was seen in 41 out of 60 limbs with PCFD which was statistically significant(P < 0.001). The tibiofemoral angle correlated significantly with the Meary angle(P = 0.03) and the talonavicular coverage angle(P = 0.003). Conclusions: PCFD is associated with varus knee malalignment. This varus deformity early in adulthood may lead to deleterious effects like medial compartment osteoarthritis in later life. Early intervention for such patients may help avoid this knee damage. Level of evidence: Level 3-prognostic.

12.
N Am Spine Soc J ; 19: 100531, 2024 Sep.
Article in English | MEDLINE | ID: mdl-39286293

ABSTRACT

Background: The aging spine often presents multifaceted surgical challenges for the surgeon because it can directly and indirectly impact a patient's spinal alignment and quality of life. Elderly and osteoporotic patients are predisposed to progressive spinal deformities and potential neurologic compromise and surgical management can be difficult because these patients often present with greater frailty. Methods: This was a literature review of spinal alignment changes, preoperative considerations, and spinal alignment considerations for surgical strategies. Results: Many factors impact spinal alignment as we age including lumbar lordosis flexibility, hip flexion, deformity, and osteoporosis. Preoperative considerations are required to assess the patient's overall health, bone mineral density, and osteoporosis medications. Careful radiographic assessment of the spinopelvic parameters using various classification/scoring systems provide the surgeon with goals for surgical treatment. An individualized surgical strategy can be planned for the patient including extent of surgery, surgical approach, extent of the constructs, fixation techniques, vertebral augmentation, ligamentous augmentation, and staging surgery. Conclusions: Surgical treatment should only be considered after a thorough assessment of the patient's health, deformity, bone quality and corresponding age matched alignment goals. An individualized treatment approach is often required to tackle the deformity and minimize the risk of hardware related complications and pseudarthrosis. Anabolic agents offer a promising benefit in this patient population by directly addressing and improving their bone quality and mineral density preoperatively and postoperatively.

13.
N Am Spine Soc J ; 19: 100544, 2024 Sep.
Article in English | MEDLINE | ID: mdl-39286294

ABSTRACT

Background: Flatback deformity, or lumbar hypolordosis, can cause sagittal imbalance, causing back pain, fatigue, and functional limitation. Surgical correction through osteotomies and interbody fusion techniques can restore sagittal balance and relieve pain. This study investigated sagittal vertical alignment (SVA) and lumbar lordosis correction achieved through sequential procedures on human spine specimens. Methods: Human T10-sacrum specimens were stratified into 2 groups: degenerative flatback specimens had smaller L1-S1 lordosis compared to the iatrogenic group (26.1°±15.0° vs. 47.8°±19.3°, p<.05). Specimens were mounted in the apparatus in simulated standing posture with a nominal sacral slope of 45 degrees and subjected to a 400N compressive follower preload. Sequential correction of degenerative lumbar flatback deformity involved: anterior lumbar interbody fusion (ALIF) at L5-S1, ALIF at L4-5, lateral lumbar interbody fusion (LLIF) at L2-3 and L3-4, and posterior column osteotomy (PCO) at L2-3 and L3-4. In iatrogenic specimens, flatback deformity was created by performing a posterior in-situ immobilization using pedicle screw instrumentation at L4-L5-S1 followed by distraction across the pedicle screws. We then performed LLIF at L2-3 and L3-4, followed by PCO at L2-3 and L3-4. Results: Statistically significant incremental corrections were noted in SVAs and lordosis after L5-S1 ALIF, L4-5 ALIF, and PCO in degenerative flatback specimens. For the iatrogenic group, statistically significant worsening was noted in measures of standing alignment after L4-L5-S1 hypolordotic fusion. Subsequent LLIF at L2-3 and L3-4 did not significantly improve sagittal alignment. However, after PCO at L2-3 and L3-4, final alignment parameters were not significantly different than preoperative baseline values prior to hypolordotic fusion. Conclusions: ALIF cages in the lower lumbar segments significantly improved sagittal alignment in degenerative flatback specimens. In the upper lumbar segments, LLIF cages alone were ineffective at enhancing lumbar lordosis. LLIF cages in conjunction with PCO improved alignment parameters in degenerative and iatrogenic flatback deformities.

14.
Orphanet J Rare Dis ; 19(1): 347, 2024 Sep 17.
Article in English | MEDLINE | ID: mdl-39289684

ABSTRACT

BACKGROUND: Achondroplasia is the most common form of skeletal disorder with disproportionate short stature. Vosoritide is the first disease-specific, precision pharmacotherapy to increase growth velocity in children with achondroplasia. Limb surgery is a standard approach to increase height and arm span, improve proportionality and functionality, as well as correcting deformities. The aim of this study was to gain expert opinion on the combined use of vosoritide and limb surgery in children and adolescents with achondroplasia. METHODS: An international expert panel of 17 clinicians and orthopaedic surgeons was convened, and a modified Delphi process undertaken. The panel reviewed 120 statements for wording, removed any unnecessary statements, and added any that they felt were missing. There were 26 statements identified as facts that were not included in subsequent rounds of voting. A total of 97 statements were rated on a ten-point scale where 1 was 'Completely disagree' and 10 'Completely agree'. A score of ≥ 7 was identified as agreement, and ≤ 4 as disagreement. All experts who scored a statement ≤ 4 were invited to provide comments. RESULTS: There was 100% agreement with several statements including, "Achieve a target height, arm span or upper limb length to improve daily activities" (mean level of agreement [LoA] 9.47, range 8-10), the "Involvement of a multidisciplinary team in a specialist centre to follow up the patient" (mean LoA 9.67, range 7-10), "Planning a treatment strategy based on age and pubertal stage" (mean LoA 9.60, range 8-10), and "Identification of short- and long-term goals, based on individualised treatment planning" (mean LoA 9.27, range 7-10), among others. The sequence of a combined approach and potential impact on the physes caused disagreement, largely due to a lack of available data. CONCLUSIONS: It is clear from the range of responses that this modified Delphi process is only the beginning of new considerations, now that a medical therapy for achondroplasia is available. Until data on a combined treatment approach are available, sharing expert opinion is a vital way of providing support and guidance to the clinical community.


Subject(s)
Delphi Technique , Humans , Achondroplasia/surgery , Achondroplasia/drug therapy , Child , Adolescent , Expert Testimony , Female , Male
15.
Cureus ; 16(8): e67177, 2024 Aug.
Article in English | MEDLINE | ID: mdl-39295710

ABSTRACT

Constrained implants have become more common in difficult primary total knee arthroplasty (TKA) cases in recent years because they may more effectively and conveniently handle the substantial instability that is evident in osteoarthritis of knees with severe varus deformity. However, the need for a constrained TKA in such conditions is controversial, as constraint implants come with a bargain of stability for longitivity. In this case report, we have successfully shown that even in cases of significant instability and bone loss, intraoperative conversion to a restricted device is rarely necessary. In our case report, a 83-year-old female had complaints of severe pain in bilateral knees, with the right knee more than the left knee, since 12 years with severe varus deformity in the right knee. Physical examination revealed swelling and medial joint line tenderness with restriction of range of motion in bilateral knees. Pre-anesthetic checkup of the patient was done and patient was given clearance for surgery under American Society of Anesthesiologist (ASA)-2, total knee arthroplasty with a long stem was done, extreme varus deformity was corrected, osteophytes removed and tibial bone loss was repaired with bone cement. Post operatively patient showed significant improvement and McMaster University and Western Ontario Osteoarthritis Index (WOMAC) and Knee Society Scores (KSS) for pain, stiffness, and physical function during everyday activities were significantly improved compared to pre-operative assessment.

17.
Ear Nose Throat J ; : 1455613241287281, 2024 Sep 25.
Article in English | MEDLINE | ID: mdl-39319859

ABSTRACT

Objectives: Of all the face surgeries, rhinoplasty is known to be the most difficult. The aim of this paper is to review open-roof deformity. Methods: PubMed, EBSCO, UpToDate, Proquest Central at Kirikkale University, and Google and Google Scholar were used in the literature review. The search was performed with the keywords "open roof deformity," "rhinoplasty," "fillers" between 2024 and 1980. Results: Rhinoplasty is a surgery that requires a combination of art and science, unlike other procedures that may have challenging anatomic access, requiring an excessive amount of physical strength, or a long operating period that causes surgeon fatigue. It is common for people undergoing primary rhinoplasty to have their hump removed, which can lead to open-roof deformity. Lateral osteotomies and the use of grafts are crucial in the prevention of open-roof abnormalities. It is common practice to perform lateral osteotomies to seal this space. However, lateral osteotomy becomes tricky when the patient's bony vault is small. Another well-known option is to shape and replace the hump or to use a spreader graft, flap, sliced cartilage, or some combination of these. HA filler can also be administered to achieve the same effect as a spreader graft. Along the length of the dorsum on both sides, HA is injected retrogradely. Conclusion: If there are dorsal irregularities after surgery or if there is a need to fix the look of nasal bridge, this therapy can help.

18.
Iran J Otorhinolaryngol ; 36(5): 587-593, 2024 Sep.
Article in English | MEDLINE | ID: mdl-39323500

ABSTRACT

Introduction: Hypertrophy of adenoids is a common condition in childhood, resulting in obstructive symptoms such as sleep apnea, snoring, and rhinosinusitis. Adenotonsillectomy is recommended to improve prognosis and quality of life. This case-control study compared facial angles and lip position related to dentofacial and mouth growth in symptomatic children with adenoid hypertrophy and asymptomatic control groups. Materials and Methods: The study included children aged 5 to 7 who presented with obstructive symptoms and confirmed severe adenoid hypertrophy in lateral neck radiography. Standard lateral photography was taken. The Nasofacial and Nasomental angles, and upper and lower lip positions and their distance behind the Ricketts line, were measured and compared with the normal control group. Results: This study included 54 children with severe adenoid hypertrophy and 66 normal children. Facial angles were not significantly different between the two groups, but the mean horizontal position of the upper and lower lip in children with adenoid hypertrophy was significantly lower than in the control group (P value = 0.05). The lips were too close to the Ricketts line compared with the control group. Conclusions: This research demonstrates that children with severe adenoid hypertrophy have more dentofacial disorders than others. Adenotonsillectomy surgery is necessary for children with obstructive symptoms caused by tonsil enlargement, and if symptoms like snoring persist post-surgery, complementary orthodontic treatments should be considered.

19.
Front Pediatr ; 12: 1362142, 2024.
Article in English | MEDLINE | ID: mdl-39323508

ABSTRACT

Tarsal coalition refers to the union of two or more tarsal bones, which mostly involves the calcaneonavicular and talocalcaneal joints; it is rarely found in multiple unions or unions extended to the metatarsal bones. Nearly 50% of cases occur bilaterally and can be either symmetrical or asymmetrical. We described a rare case of symmetrically bilateral tarsal coalitions involving all the tarsal bones, except for the medial cuneiform, and extending to the fourth metatarsal bones in a 5-year-old boy. This patient exhibited no obvious symptoms and had not received any further intervention, only regular follow-up. To our knowledge, this is the first report of this type of massive coalition involving the union of six tarsals and one tarsometatarsal bilaterally.

20.
J Orthop Surg (Hong Kong) ; 32(3): 10225536241289313, 2024.
Article in English | MEDLINE | ID: mdl-39326385

ABSTRACT

Background: Adult spinal deformity (ASD) surgery has gained popularity, with significant improvements in patient-reported outcomes. Posterior lumbar interbody fusion with multiple grade II osteotomies (PLIF + MOs) and lateral lumbar interbody fusion (LLIF) have been utilized to correct ASD; however, no studies have compared these methods with regard to the pre- and postoperative changes in length and volume of the spinal canal. This study aimed to investigate the 3-dimensional changes in the anterior vertical column length (AVCL), spinal canal length (SCL), and spinal canal volume (SCV) in patients with ASD after surgery, employing LLIF and PLIF + MOs. Methods: This retrospective study examined 44 patients with ASD who underwent surgery between 2010 and 2021 using two corrective surgical methods, LLIF and PLIF + MOs. Radiographic parameters and clinical outcomes were assessed, and three-dimensional models were created from computed tomography images to analyze changes in AVCL, SCL, and SCV. Results: We compared the effects of LLIF and PLIF + MOs on spinal canal dimensions during ASD surgery. LLIF demonstrated an increase in lumbar segment (L1-S1) AVCL and whole spine (T1-S1) SCL by 6.5 ± 8.0 mm and 13.8 ± 7.6 mm, respectively, compared with PLIF + MOs. However, PLIF + MOs exhibited a reduction in the lengths of the lumbar segment AVCL. Postoperative differences were significant for AVCL (L1-S1), SCL fusion level, and first-standing lumbar lordosis between the groups (p < 0.0001, 0.002, and 0.016, respectively). LLIF significantly increased the SCV at the fusion level and whole spine T1-S1 by 14.5% and 10.6%, respectively, outperforming PLIF + MOs. Despite changes in dimensions, the postoperative Oswestry disability index scores showed no significant difference between the two groups. Conclusions: Our study suggests that LLIF can increase spinal canal space, lumbar lordosis, and anterior column length in the lumbar spinal segment. Knowledge of these variations may be critical for enhancing surgical outcomes and preventing neurological complications.


Subject(s)
Lumbar Vertebrae , Osteotomy , Spinal Fusion , Humans , Female , Spinal Fusion/methods , Retrospective Studies , Male , Middle Aged , Osteotomy/methods , Lumbar Vertebrae/surgery , Lumbar Vertebrae/diagnostic imaging , Aged , Adult , Tomography, X-Ray Computed , Spinal Curvatures/surgery , Spinal Curvatures/diagnostic imaging , Spinal Canal/diagnostic imaging , Spinal Canal/surgery
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