REARFOOT ARTHRODESIS: the Podiatry Institute Technique
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Validation of a Clinical Prediction Rule for the Differentiation Between Septic Arthritis and Transient Synovitis of the Hip in Children by MININDER S
COPYRIGHT © 2004 BY THE JOURNAL OF BONE AND JOINT SURGERY, INCORPORATED Validation of a Clinical Prediction Rule for the Differentiation Between Septic Arthritis and Transient Synovitis of the Hip in Children BY MININDER S. KOCHER, MD, MPH, RAHUL MANDIGA, BS, DAVID ZURAKOWSKI, PHD, CAROL BARNEWOLT, MD, AND JAMES R. KASSER, MD Investigation performed at the Departments of Orthopaedic Surgery, Biostatistics, and Radiology, Children’s Hospital, Boston, Massachusetts Background: The differentiation between septic arthritis and transient synovitis of the hip in children can be difficult. The purpose of the present study was to validate a previously published clinical prediction rule for this differentiation in a new patient population. Methods: We prospectively studied children who presented to a major children’s hospital between 1997 and 2002 with an acutely irritable hip. As in the previous study, diagnoses of septic arthritis (fifty-one patients) and transient synovitis (103 patients) were operationally defined on the basis of the white blood-cell count in the joint fluid, the re- sults of cultures of joint fluid and blood, and the clinical course. Univariate analysis and multiple logistic regression were used to compare the two groups. The predicted probability of septic arthritis of the hip from the prediction rule was compared with actual distributions in the current patient population. The area under the receiver operating char- acteristic curve was determined. Results: The same four independent predictors of septic arthritis of the hip (a history of fever, non-weight-bearing, an erythrocyte sedimentation rate of 40 mm/hr, and a serum white blood-cell count of >12,000 cells/mm3 (>12.0 × 109/L)) were identified in the current patient population. -
Knee Joint Surgery: Open Synovectomy
Musculoskeletal Surgical Services: Open Surgical Procedures; Knee Joint Surgery: Open Synovectomy POLICY INITIATED: 06/30/2019 MOST RECENT REVIEW: 06/30/2019 POLICY # HH-5588 Overview Statement The purpose of these clinical guidelines is to assist healthcare professionals in selecting the medical service that may be appropriate and supported by evidence to improve patient outcomes. These clinical guidelines neither preempt clinical judgment of trained professionals nor advise anyone on how to practice medicine. The healthcare professionals are responsible for all clinical decisions based on their assessment. These clinical guidelines do not provide authorization, certification, explanation of benefits, or guarantee of payment, nor do they substitute for, or constitute, medical advice. Federal and State law, as well as member benefit contract language, including definitions and specific contract provisions/exclusions, take precedence over clinical guidelines and must be considered first when determining eligibility for coverage. All final determinations on coverage and payment are the responsibility of the health plan. Nothing contained within this document can be interpreted to mean otherwise. Medical information is constantly evolving, and HealthHelp reserves the right to review and update these clinical guidelines periodically. No part of this publication may be reproduced, stored in a retrieval system or transmitted, in any form or by any means, electronic, mechanical, photocopying, or otherwise, without permission from HealthHelp. -
Tibiocalcaneal Arthrodesis Using Screws in the Treatment of Equinovarus Deformity of the Foot in Adult: a Retrospective Study of 42 Cases L.Unyendje, M
14699 L.Unyendje et al./ Elixir Human Physio. 58 (2013) 14699-14702 Available online at www.elixirpublishers.com (Elixir International Journal) Human Physiology Elixir Human Physio. 58 (2013) 14699-14702 Tibiocalcaneal arthrodesis using screws in the treatment of equinovarus deformity of the foot in adult: a retrospective study of 42 cases L.Unyendje, M. Mahfoud, F.Ismael, A.Karkazan, MS. Berrada, M. EL Yaacoubi, A. El Bardouni, M. Kharmaz, MY.O.Lamrani, M.Ouadghiri and A. Lahlou Mohammed V University, Faculty of Medicine and Pharmacy, IBN SINA Hospital, Orthopedic Department Rabat-Morocco. ARTICLE INFO ABSTRACT Article history: The authors have retrospectively studied 42 cases of tibiocalcaneal arthrodesis using large Received: 6 March 2013; cannulated AO screws, staples and iliac crest graft mixed in treatment of fixed equinovarus Received in revised form: deformity of the foot in adult patients. There were 25 men and 17 women aged 22 to 70 17 April 2013; (mean, 45) years. All patients were reviewed with an average of 5 years. The operations Accepted: 3 May 2013; were performed between 2005 and 2012.Preoperatively, all patients had 50° of the mean calcaneal varus deformity and 75° (60-90°) of equinus deformity on Meary’s radiological. Keywords There were 24 idiopathic, 8 post traumatic,6 neurologic associated with IMC,4 polio. Tibiocalcaneal arthrodesis, Clinical and functional outcome was assessed with the kitaoka score, the x-rays included an Screw, AP and lateral view of the ankle and Meary view .Resultats were excellent in 73% , good in Equinovarus foot, 18 % , fair in 9%. X-rays showed 3 nonunions after 2 years and were reported. -
Ankle and Pantalar Arthrodesis
ANKLE AND PANTALAR ARTHRODESIS George E. Quill, Jr., M.D. In: Foot and Ankle Disorders Edited by Mark S. Myerson, M.D. Since reports in the late 19th Century, arthrodesis has been a successful accepted treatment method for painful disorders of the ankle, subtalar, and transverse tarsal joints. While the title of this chapter involves arthrodesis - the intentional fusion of a joint - as a form of reconstruction, this chapter will address not only surgical technique, but nonoperative methods of care as well. We will address the pathophysiology leading to ankle and hindfoot disability, succinctly review the existing literature on the topic of hindfoot and ankle arthrodesis, highlight the pathomechanics involved, and spend considerable time on establishing the diagnosis, indications, and preoperative planning when surgery is indicated. We also will discuss the rehabilitation of the postoperative patient, as well as the management of complications that may arise after ankle and pantalar arthrodesis. There are more than thirty different viable techniques that have been described in order to achieve successful ankle and hindfoot arthrodesis. It is not the purpose of this chapter to serve as compendium of all the techniques ever described. The author will, rather, attempt to distill into a useful amount of clinically applicable material this vast body of information that the literature and clinical experience provide. Ankle arthrodesis is defined as surgical fusion of the tibia to the talus. Surgical fusion of the ankle (tibiotalar) and subtalar (talocalcaneal) joints at the same operative sitting is termed tibiotalocalcaneal arthrodesis. Fusion of the talus to all the bones articulating with it (distal tibia, calcaneus, navicular, and cuboid) is termed pantalar arthrodesis. -
Knee Joint Surgery: Open Arthodesis of the Knee, Unspecified
Musculoskeletal Surgical Services: Open Surgical Procedures; Knee Joint Surgery: Open Arthodesis of the knee, unspecified POLICY INITIATED: 06/30/2019 MOST RECENT REVIEW: 06/30/2019 POLICY # HH-5623 Overview Statement The purpose of these clinical guidelines is to assist healthcare professionals in selecting the medical service that may be appropriate and supported by evidence to improve patient outcomes. These clinical guidelines neither preempt clinical judgment of trained professionals nor advise anyone on how to practice medicine. The healthcare professionals are responsible for all clinical decisions based on their assessment. These clinical guidelines do not provide authorization, certification, explanation of benefits, or guarantee of payment, nor do they substitute for, or constitute, medical advice. Federal and State law, as well as member benefit contract language, including definitions and specific contract provisions/exclusions, take precedence over clinical guidelines and must be considered first when determining eligibility for coverage. All final determinations on coverage and payment are the responsibility of the health plan. Nothing contained within this document can be interpreted to mean otherwise. Medical information is constantly evolving, and HealthHelp reserves the right to review and update these clinical guidelines periodically. No part of this publication may be reproduced, stored in a retrieval system or transmitted, in any form or by any means, electronic, mechanical, photocopying, or otherwise, without permission -
DISSERTATION INVESTIGATION of CATIONIC CONTRAST-ENHANCED COMPUTED TOMOGRAPHY for the EVALUATION of EQUINE ARTICULAR CARTILAGE Su
DISSERTATION INVESTIGATION OF CATIONIC CONTRAST-ENHANCED COMPUTED TOMOGRAPHY FOR THE EVALUATION OF EQUINE ARTICULAR CARTILAGE Submitted by Bradley B. Nelson Department of Clinical Sciences In partial fulfillment of the requirements For the Degree of Doctor of Philosophy Colorado State University Fort Collins, Colorado Fall 2017 Doctoral Committee: Advisor: Christopher E. Kawcak Co-Advisor: Laurie R. Goodrich C. Wayne McIlwraith Mark W. Grinstaff Myra F. Barrett Copyright by Bradley Bernard Nelson 2017 All Rights Reserved ABSTRACT INVESTIGATION OF CATIONIC CONTRAST-ENHANCED COMPUTED TOMOGRAPHY FOR THE EVALUATION OF EQUINE ARTICULAR CARTILAGE Osteoarthritis and articular cartilage injury are substantial problems in horses causing joint pain, lameness and decreased athleticism resonant of the afflictions that occur in humans. This debilitating joint disease causes progressive articular cartilage degeneration and coupled with a poor capacity to heal necessitates that articular cartilage injury is detected early before irreparable damage ensues. The use of diagnostic imaging is critical to identify and characterize articular cartilage injury, though currently available methods are unable to identify these early degenerative changes. Cationic contrast-enhanced computed tomography (CECT) uses a cationic contrast media (CA4+) to detect the early molecular changes that occur in the extracellular matrix. Glycosaminoglycans (GAGs) within the extracellular matrix are important for the providing the compressive stiffness of articular cartilage and their degradation is an early event in the development of osteoarthritis. Cationic CECT imaging capitalizes on the electrostatic attraction between CA4+ and GAGs; exposing the proportional relationship between the amount of GAGs present within and the amount of CA4+ that diffuses into the tissue. The amount of CA4+ that resides in the tissue is then quantified through CECT imaging and estimates tissue integrity through nondestructive assessment. -
Quantitative 3-Dimensional CT Analyses of Intramedullary Headless Screw Fixation for Metacarpal Neck Fractures
SCIENTIFIC ARTICLE Quantitative 3-Dimensional CT Analyses of Intramedullary Headless Screw Fixation for Metacarpal Neck Fractures Paul W. L. ten Berg, MSc, Chaitanya S. Mudgal, MD, Matthew I. Leibman, MD, Mark R. Belsky, MD, David E. Ruchelsman, MD Purpose Fixation countersunk beneath the articular surface is well accepted for periarticular fractures. Limited open intramedullary headless compression screw (HCS) fixation offers clinical advantages over Kirschner wire and open techniques. We used quantitative 3-di- mensional computed tomography to assess the articular starting point, surface area, and subchondral volumes used during HCS fixation of metacarpal neck fractures. Methods We simulated retrograde intramedullary insertion of 2.4- and 3.0-mm HCS and 1.1-mm Kirschner wires for metacarpal neck fracture fixation in 3-dimensional models from 16 adults. We used metacarpal head articular surface area (mm2) and subchondral volumes (mm3) and coronal and sagittal plane arcs of motion, during which we analyzed the center and rim of the articular base of the proximal phalanx engaging the countersunk entry site. Results Mean metacarpal head surface area mated to the proximal phalangeal base in neutral position was 93 mm2; through the coronal plane arc (45°), 129 mm2, and through the sagittal plane arc (120°), 265 mm2. The mean articular surface area used by countersunk HCS threads was 12%, 8%, and 4%, respectively, in each of these arcs. The 1.1-mm Kirschner wire occupied 1.2%, 0.9%, and 0.4%, respectively. Mean metacarpal head volume was 927 mm3. Mean subchondral volume occupied by the countersunk portion was 4%. The phalan- geal base did not overlap the dorsally located countersunk entry site through most of the sagittal plane arc. -
Ankle Fusion Protocol
Phone: 574.247.9441 ● Fax: 574.247.9442 ● www.sbortho.com ANKLE FUSION PROTOCOL This is the fusion of the tibia and the talus for ankle joint arthritis. Your ankle will lose the majority of its up and down motion, but typically retain some side to side motion. Occasionally the subtalar joint (between the talus and calcaneus) also needs to be fused, which further stiffens the ankle. Bone graft (typically allograft/cadaver bone or Augment, a synthetic graft) is used, and screws, staples, plates, and/or a metal rod are inserted to hold the bones together as they heal. Below is a general outline for these fusion procedures. MD recommendations and radiographic evidence of healing can always affect the timeline. **This is a guideline for recovery, and specific changes may be indicated on an individual basis** Preoperative Physical Therapy Pre surgical Gait Training, Balance Training, Crutch Training and Knee Scooter Training Phase I- Protection (Weeks 0 to 6) GOALS: - Cast or boot for 6 weeks - Elevation, ice, and medication to control pain and swelling - Non-weight bearing x 6 weeks - Hip and knee AROM, hip strengthening - Core and upper extremity strengthening WEEK 0-2: Nonweightbearing in splint - elevate the leg above the heart to minimize swelling 23 hours/day - ice behind the knee 30 min on/30 min off (Vascutherm or ice bag) - minimize activity and focus on rest 1ST POSTOP (5-7 DAYS): Dressing changed, cast applied - continue strict elevation, ice, NWB WEEKS 2-3: Sutures removed, cast changed WEEKS 4-5: Return for another cast change -
CMM-314: Hip Surgery-Arthroscopic and Open Procedures Version 1.0.2019
CLINICAL GUIDELINES CMM-314: Hip Surgery-Arthroscopic and Open Procedures Version 1.0.2019 Clinical guidelines for medical necessity review of speech therapy services. © 2019 eviCore healthcare. All rights reserved. Comprehensive Musculoskeletal Management Guidelines V1.0.2019 CMM-314: Hip Surgery-Arthroscopic and Open Procedures CMM-314.1: Definitions 3 CMM-314.2: General Guidelines 4 CMM-314.3: Indications and Non-Indications 4 CMM-314.4 Experimental, Investigational, or Unproven 6 CMM-314.5: Procedure (CPT®) Codes 7 CMM-314.6: References 10 © 2019 eviCore healthcare. All rights reserved. Page 2 of 13 400 Buckwalter Place Boulevard, Bluffton, SC 29910 • (800) 918-8924 www.eviCore.com Comprehensive Musculoskeletal Management Guidelines V1.0.2019 CMM-314.1: Definitions Femoroacetabular Impingement (FAI) is an anatomical mismatch between the head of the femur and the acetabulum resulting in compression of the labrum or articular cartilage during flexion. The mismatch can arise from subtle morphologic alterations in the anatomy or orientation of the ball-and-socket components (for example, a bony prominence at the head-neck junction or acetabular over-coverage) with articular cartilage damage initially occurring from abutment of the femoral neck against the acetabular rim, typically at the anterosui per or aspect of the acetabulum. Although hip joints can possess the morphologic features of FAI without symptoms, FAI may become pathologic with repetitive movement and/or increased force on the hip joint. High-demand activities may also result in pathologic impingement in hips with normal morphology. s It ha been proposed that impingement with damage to the labrum and/or acetabulum is a causative factor in the development of hip osteoarthritis, and that as many as half of cases currently categorized as primary osteoarthritis may have an etiology of FAI. -
Consensus of the 3 Round Table Barcelona June 2013
Consensus of the 3rd Round Table Barcelona June 2013 Mark Rogers FRCS (Tr & Orth) Derek Park FRCS (Tr & Orth) Dishan Singh FRCS (Orth) Aspects of Orthopaedic Foot & Ankle Surgery Preface The 1st Round Table meeting was held in Padua in June 2011, followed by the 2nd Round Table meeting in Paris in June 2012. The 3rd Round Table in Barcelona in June 2013 has once again followed a format where all attendees review the literature and present their individual experience on a topic with ample time for an informal discussion of the subject. There is no distinction between faculty and delegates. Mark Rogers and Derek Park were responsible for recording opinions and capturing the essence of the debates, many of which resulted in consensus being reached on areas of foot and ankle practice. This booklet collates the literature review and the views of all those who participated. The opinions on consent, particularly, will hopefully guide practice and form the basis for a wider discussion at BOFAS. This booklet does not represent Level 1 evidence derived from prospective randomized controlled trials but represents the compilation of anecdotal reports and small case studies based on the combined experience of 34 British orthopaedic surgeons as well as Judith Baumhauer from the USA and Harvinder Bedi from Australia. I hope that you will find something of use and relevant to your own practice. Dishan Singh, MBChB, FRCS, FRCS (Orth) Consultant Orthopaedic Surgeon Royal National Orthopaedic Hospital Stanmore, UK Consensus of the 3rd Round Table Barcelona 2013 Mark Rogers Derek Park Dishan Singh Aspects of Orthopaedic Foot & Ankle Surgery 1. -
Icd-9-Cm (2010)
ICD-9-CM (2010) PROCEDURE CODE LONG DESCRIPTION SHORT DESCRIPTION 0001 Therapeutic ultrasound of vessels of head and neck Ther ult head & neck ves 0002 Therapeutic ultrasound of heart Ther ultrasound of heart 0003 Therapeutic ultrasound of peripheral vascular vessels Ther ult peripheral ves 0009 Other therapeutic ultrasound Other therapeutic ultsnd 0010 Implantation of chemotherapeutic agent Implant chemothera agent 0011 Infusion of drotrecogin alfa (activated) Infus drotrecogin alfa 0012 Administration of inhaled nitric oxide Adm inhal nitric oxide 0013 Injection or infusion of nesiritide Inject/infus nesiritide 0014 Injection or infusion of oxazolidinone class of antibiotics Injection oxazolidinone 0015 High-dose infusion interleukin-2 [IL-2] High-dose infusion IL-2 0016 Pressurized treatment of venous bypass graft [conduit] with pharmaceutical substance Pressurized treat graft 0017 Infusion of vasopressor agent Infusion of vasopressor 0018 Infusion of immunosuppressive antibody therapy Infus immunosup antibody 0019 Disruption of blood brain barrier via infusion [BBBD] BBBD via infusion 0021 Intravascular imaging of extracranial cerebral vessels IVUS extracran cereb ves 0022 Intravascular imaging of intrathoracic vessels IVUS intrathoracic ves 0023 Intravascular imaging of peripheral vessels IVUS peripheral vessels 0024 Intravascular imaging of coronary vessels IVUS coronary vessels 0025 Intravascular imaging of renal vessels IVUS renal vessels 0028 Intravascular imaging, other specified vessel(s) Intravascul imaging NEC 0029 Intravascular -
Triple Arthrodesis
DR JEFF LING MBBS BSc (Med) FRACS (Orth) Adult and Paediatric Orthopaedic Surgeon Specialising in the Foot and Ankle Triple Arthrodesis INTRODUCTION Triple arthrodesis (fusion) involves fusing 3 joints, hence the use of the term “triple”. The 3 joints are the “subtalar joint”, the “calcaneocuboid joint”, and the “talonavicular joint”. The indications for this operation include correction of a fixed cavovarus deformity (See Information Sheet on Cavovarus Foot Reconstruction) or a fixed flatfoot deformity (See Information Sheet on Flatfoot Correction), or end-stage arthritis. After a triple arthrodesis, most patients are much more comfortable and have an improved quality of life. THE PROCEDURE There are a number of steps to this procedure: 1. General Anaesthetic 2. Administration of intravenous antibiotics 3. Nerve block at knee for post-operative pain relief 4. Bone graft taken from small 1cm incision at side of heel 5. Incisions made over subtalar joint/calcaneocuboid joint/talonavicular joint and diseased cartilage removed 6. Bone graft and growth hormone inserted into joints to stimulate fusion 7. Above joints held in appropriate position and stabilized with screws and staples 8. Intra-operative check xray 9. Wound Closure with sutures 10. Plaster Backslab RISKS & COMPLICATIONS Every surgical procedure carries some risk. These risks are largely uncommon and many are rare. They include: Anaesthetic complications Drug reactions Wound infection Deep Vein Thrombosis (DVT)/Pulmonary embolism (PE) Sensory nerve injury Chronic Regional Pain