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Extensile lateral approach

John Y Kwon, Tyler Gonzalez, Matthew D Riedel, Ara Nazarian, Mohammad Ghorbanhoseini
BACKGROUND: The extensile lateral approach (EL) has been associated with increased wound complications such as apical necrosis which may be due partially from violation of the lateral calcaneal artery (LCA). Traditionally, the vertical limb has been placed half-way between the fibula and Achilles tendon, which may be suboptimal given the proximity to the LCA. We hypothesized that placing the vertical limb further posterior (ie, modified EL [MEL]) would increase the distance from the LCA...
October 23, 2016: Foot & Ankle International
Khatri Kavin, Sharma Vijay, Lakhotia Devendra, Farooque Kamran
AIM: To determine patient satisfaction in the patients of displaced intraarticular calcaneal fractures treated with standard lateral approach. METHOD: The patients of displaced calcaneal fractures (Sander's type II and III) treated between March 2009 and March 2012 were included in the retrospective review and functional outcome was evaluated using American Orthopaedic Foot and Ankle Society (AOFAS) hind foot score, Creighton Nebraska Health Foundation Assessment (CNHFA) scale and foot function index (FFI)...
October 2016: Journal of Clinical Orthopaedics and Trauma
Michael A Del Core, Emily Mills, Lisa K Cannada, David E Karges
The purpose of this article is to report midterm follow-up of operatively treated calcaneus fractures. All patients with a calcaneus fracture, treated with open reduction and internal fixation (ORIF) using the extensile lateral approach, were identified. Functional outcomes were assessed using the American Orthopaedic Foot and Ankle Society's (AOFAS) ankle-hindfoot assessment, SF-36, and a questionnaire. There were 20 patients (25 fractures): 16 males and four females. The average age was 42 years (range, 16-73 years) and the mean follow-up time was 40 months (range, 13-73 months)...
December 0: Journal of Surgical Orthopaedic Advances
Mark E Hake, James A Goulet
Fractures of the tibial plateau are challenging injuries to treat. The lateral tibial plateau is fractured more commonly than the medial plateau and the workhorse approach for these fractures is the anterolateral approach. This approach allows visualization of the lateral joint, metaphysis, and can be extensile if there is shaft extension. We present our technique for performing the anterolateral approach while treating a Schatzker III tibial plateau fracture. Special attention is given to performing a submeniscal arthrotomy to view the joint surface and judge the reduction...
August 2016: Journal of Orthopaedic Trauma
Kandhari V K, Desai M M, Bava S S, Wade R N
INTRODUCTION: Chances of avascular necrosis of acetabulum are rare as it enjoys a rich blood supply. But cases of post - traumatic avascular necrosis of acetabulum following fracture of posterior column have been well documented. Importance of identifying and suspecting the avascular necrosis of acetabulum is essential in cases of failed fixation of fracture acetabulum, previously operated using extensile approach to acetabulum; either extended anterior ilio - femoral or tri - radiate approach...
October 2015: Journal of Orthopaedic Case Reports
Aaron T Scott, David A Pacholke, Kamran S Hamid
BACKGROUND: The lateral extensile incision for fixation of displaced intra-articular calcaneus fractures allows for fracture reduction but has been associated with high rates of soft tissue complications. This has prompted a search for less invasive methods of fracture fixation. The purpose of the present study was to determine the adequacy of reduction and rate of complications associated with operative fixation of calcaneal fractures using a limited sinus tarsi approach. METHODS: A limited sinus tarsi incision with plate fixation was utilized for treatment of 39 displaced intra-articular calcaneal fractures in 35 consecutive patients as part of a single surgeon series...
September 2016: Foot & Ankle International
Chien-Shun Wang, Yun-Hsuan Tzeng, Chun-Cheng Lin, Ching-Kuei Huang, Ming-Chau Chang, Chao-Ching Chiang
BACKGROUND: The aim of this prospective study was to evaluate the influence of sectioning the calcaneofibular ligament (CFL) during an extensile lateral approach during open reduction and internal fixation (ORIF) of calcaneal fractures on ankle joint stability. METHODS: Forty-two patients with calcaneal fractures that received ORIF were included. Talar tilt stress and anterior drawer radiographs were performed on the operative and contralateral ankles 6 months postoperatively...
September 2016: Foot & Ankle International
Sean Molloy, Joseph S Butler, Adam Benton, Karan Malhotra, Susanne Selvadurai, Obiekezie Agu
BACKGROUND CONTEXT: A variety of surgical approaches have been used for cage insertion in lumbar interbody fusion surgery. The direct anterior approach requires mobilization of the great vessels to access the intervertebral disc spaces cranial to L5/S1. With the lateral retroperitoneal transpsoas approach, it is difficult to access the L4/L5 intervertebral disc space due to the lumbar plexus and iliac crest, and L5/S1 is inaccessible. We describe a new anterolateral retroperitoneal approach, which is safe and reproducible to access the disc spaces from L1 to S1 inclusive, obviating the need for a separate direct anterior approach to access L5/S1...
June 2016: Spine Journal: Official Journal of the North American Spine Society
Attilio Basile, Francesco Albo, Alessio Giai Via
The purpose of our investigation was to prospectively review and compare the early outcomes of Sanders II and III closed displaced intra-articular calcaneal fractures (DIACFs) in a group of patients treated by open reduction and internal fixation with plate and screws using the extended lateral approach or the sinus tarsi approach (STA). Thirty-eight patients with DIACFs were prospectively enrolled and operatively treated using either the extended lateral approach or the STA. Patients underwent a careful clinical and radiographic examination and were evaluated according to the American Orthopaedic Foot and Ankle Society score, visual analog scale, and the Foot Function Index...
May 2016: Journal of Foot and Ankle Surgery: Official Publication of the American College of Foot and Ankle Surgeons
John Wong-Chung, Diarmaid O'Longain, Matthew Lynch-Wong, Harriet Julian
We present a rare case of interposition of the flexor hallucis longus (FHL) tendon blocking percutaneous closed reduction of a displaced tongue-type calcaneal fracture, and necessitating open repositioning of the tendon and internal fixation through a single extensile lateral approach. Although not recognized until during surgery, with a high index of suspicion, preoperative diagnosis of this injury combination should be possible on high resolution CT, thus enabling better planning of the procedure. The presence of a small sustentacular fragment, especially if markedly displaced or rotated, should further alert the physician as to increased likelihood of such tendon entrapment within the fracture...
June 2016: Foot
Ajay Pal Singh, Arun Pal Singh
Coronal shear fractures of distal humerus involving the capitellum and the trochlea are rare injuries with articular complexity, and are technically challenging for management. With better understanding of the anatomy and imaging advancements, the complex nature of these fractures is well appreciated now. These fractures involve metaphysealcomminution of lateral column and associated intraarticular injuries are common. Previously, closed reduction and excision were the accepted treatment but now preference is for open reduction and internal fixation with an aim to provide stable and congruent joint with early range of motion of joint...
December 18, 2015: World Journal of Orthopedics
Shai Shemesh, Mark Yan Loebenberg, Yona Kosashvili, Eliezer Sidon, Steven Velkes, Nir Cohen
This article describes an extensile surgical exposure to the distal humerus that is suitable for complex fractures involving the articular surface and extending into the humeral diaphysis proximal to the radial nerve. This method combines 2 approaches: olecranon osteotomy and the lateral paratricipital approach. This combination allows an appropriate exposure of both the articular surface and the humeral diaphysis up to the level of the deltoid tuberosity, while maintaining the extensor mechanism unharmed.
July 1, 2015: Orthopedics
Ettore Vulcano, J Kent Ellington, Mark S Myerson
The preferred surgical approaches to subtalar fusion are the sinus tarsi incision, the medial incision, and the extensile lateral approach. The choice of one over the other depends on the underlying pathology, previous surgeries, associated foot pathologies, soft tissue quality, and medical comorbidities. This article reports on several cases of subtalar joint fusion.
June 2015: Foot and Ankle Clinics
Shahram S Yari, Nathan L Bowers, Miguel A Craig, Lee M Reichel
Coronal shear fractures of the distal humerus are rare, complex fractures that can be technically challenging to manage. They usually result from a low-energy fall and direct compression of the distal humerus by the radial head in a hyper-extended or semi-flexed elbow or from spontaneous reduction of a posterolateral subluxation or dislocation. Due to the small number of soft tissue attachments at this site, almost all of these fractures are displaced. The incidence of distal humeral coronal shear fractures is higher among women because of the higher rate of osteoporosis in women and the difference in carrying angle between men and women...
May 16, 2015: World Journal of Clinical Cases
Abby B Maxwell, John R Owen, Todd M Gilbert, Michael M Romash, Jennifer S Wayne, Robert S Adelaar
Given the high rates of wound complications with a standard lateral extensile incision, small dual incision techniques might result in less soft tissue destruction. The goal of the present study was to compare the biomechanical performance between a single locking plate and a dual locking plating system for an intra-articular calcaneal fracture model. A Sanders IIB type joint depression calcaneal fracture was created in 10 paired, fresh-frozen, cadaveric calcanei (age 47 ± 12, range 35 to 78 years). The calcanei of each pair were randomly assigned for fixation using either a lateral locking reconstruction plate or lateral and medial locking reconstruction plates...
September 2015: Journal of Foot and Ankle Surgery: Official Publication of the American College of Foot and Ankle Surgeons
Je-Hyoung Yeo, Hyun-Jong Cho, Keun-Bae Lee
BACKGROUND: Two common surgical approaches included the sinus tarsi and extensile lateral are used for displaced intra-articular calcaneal fractures. However, few studies have compared outcome of treated by the two approaches. The purpose of this study was to compare the outcome between these two approaches for Sanders type-II and type-III fractures. METHODS: This retrospective cohort study was performed from 2004 to 2011. Open reduction and internal fixation using the sinus tarsi and extensile lateral approach was studied in 100 cases (40 sinus tarsi and 60 extensile lateral) with displaced intra-articular calcaneal fractures...
March 19, 2015: BMC Musculoskeletal Disorders
Ye-ming Wang, Wan-fu Wei
OBJECTIVE: The purpose of this study was to compare the clinical results of percutaneous reduction and Steinman pin fixation for Sanders II calcaneal fractures with those of operative management through an extensile lateral approach. METHODS: Fifty-three patients treated with standard open reduction and internal fixation (ORIF group) and 54 patients who had undergone percutaneous reduction and Steinman pin fixation (CRIF group) were retrospectively reviewed. There were no differences between the groups regarding sex, age or fracture classification...
February 2015: Orthopaedic Surgery
Paul C McAfee, Erin Shucosky, Liana Chotikul, Ben Salari, Lun Chen, Dan Jerrems
BACKGROUND: This is a retrospective review of 25 patients with severe lumbar nerve root compression undergoing multilevel anterior retroperitoneal lumbar interbody fusion and posterior instrumentation for deformity. The objective is to analyze the outcomes and clinical results from anterior interbody fusions performed through a lateral approach and compare these with traditional surgical procedures. METHODS: A consecutive series of 25 patients (78 extreme lateral interbody fusion [XLIF] levels) was identified to illustrate the primary advantages of XLIF in correcting the most extreme of the 3-dimensional deformities that fulfilled the following criteria: (1) a minimum of 40° of scoliosis; (2) 2 or more levels of translation, anterior spondylolisthesis, and lateral subluxation (subluxation in 2 planes), causing symptomatic neurogenic claudication and severe spinal stenosis; and (3) lumbar hypokyphosis or flat-back syndrome...
2013: International Journal of Spine Surgery
John Y Kwon, Daniel Guss, Darius E Lin, Mostafa Abousayed, Clifford Jeng, Steve Kang, J Kent Ellington
BACKGROUND: There are conflicting data regarding the benefits of delaying operative fixation of calcaneus fractures to decrease wound complication rates. The purpose of this study was to examine the effect of delaying fixation on wound complication rates as well as to identify other risk factors. METHODS: A retrospective review at 4 institutions, including 24 surgeons, identified 405 closed, operatively treated, intra-articular calcaneus fractures. We compared fractures with and without wound complications with regards to patient demographics, medical risk factors, fracture severity, time to fixation, operative approach, primary subtalar arthrodesis, and surgeon experience...
May 2015: Foot & Ankle International
Harry Hoyen, Rick Papendrea
Extensile and adequate exposures of the shoulder and upper humerus are important in trauma surgery. The standard deltopectoral approach can be extended distally to expose the whole humerus if necessary. Often, wide exposures of the upper humerus are necessary to reduce complex fractures and apply the plate on the lateral aspect of the humerus. A thorough knowledge of the anatomy as well as strategies of nerve mobilization is necessary for achieving adequate exposures in this area. This article details the many exposure methods for the shoulder, upper humerus, and their extensile extensions...
November 2014: Hand Clinics
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