Limb salvage reconstruction: Radiologic features of common reconstructive techniques and their complications.

Limb salvage surgery refers to orthopaedic procedures designed to resect tumors and reconstruct limbs. Improvements in managing malignant bone lesions have led to a dramatic shift in limb salvage procedures. Orthopaedic surgeons now employ four main reconstructive procedures: endoprosthesis, autograft, bulk allograft, and allograft prosthetic composite. While each approach has its advantages, each technique is associated with complications. Furthermore, knowledge of procedure specific imaging findings can lead to earlier complication diagnosis and improved clinical outcomes. The aim of this article is to review leading reconstructive options available for limb salvage surgery and present a case series illustrating the associated complications.

Extensor Tendon Entrapment on Computed Tomography Imaging of Distal Radius Fractures.

Objective To examine the association between distal radius fractures and tendon entrapment identified on computed tomography (CT) imaging. Patients and Methods After Institutional Review Board approval, we retrospectively reviewed distal radius fractures that underwent CT imaging from an electronic database between January 2006 to February 2018 at a single level 1 hospital trauma center. We categorized all distal radial fractures according to the AO-OTA (AO Foundation/Orthopaedic Trauma Association) classification. Distal upper extremity tendons were assessed for entrapment. Fisher's exact test was used for statistical analysis with significance at p < 0.05. Results A total of 183 distal radius fractures were identified in 179 patients. A total of 16 fractures (13 males and 3 females) were associated with tendon entrapment. Mechanism of injury included falls ( n = 7), motor vehicle accidents ( n = 6), dog bites ( n = 2), and gunshot wound ( n = 1). Entrapped tendons were limited to the extensor compartment and included the extensor pollicis longus (EPL; n = 11), extensor pollicis brevis ( n = 1), extensor carpi ulnaris ( n = 1), extensor carpi radialis longus ( n = 1), and extensor digitorum communis ( n = 2). The most commonly associated AO-OTA fracture pattern with tendon entrapment was complete articular radial fractures (2R3C; 69%), eight of which were simple articular with metaphyseal multifragmentary fractures (2R3C2). Of the distal radius fractures, 81% were associated with additional ulnar fractures of varying severity and displacement. Conclusion Approximately 8.7% of distal radius fractures were retrospectively identified to have tendon entrapment compared with a previously reported incidence of 1.3%. Wrist surgeons and radiologists should have higher suspicion for tendon entrapment and carefully review preoperative CT imaging for tendon entrapment in distal radius fractures especially if there is an intra-articular, multifragmentary injury pattern. Wrist surgeons and radiologists should also have increased suspicion for EPL tendon entrapments given its high incidence in association with distal radius fractures. Level of Evidence This is a Level III, retrospective cross-sectional study.

Utility of diffusion-weighted magnetic resonance imaging in the diagnosis of cholesteatoma and the influence of the learning curve.

OBJECTIVE: The aim of this study is to assess the usefulness and reliability of this technique in our center, correlating the radiological and surgical findings and to study the influence of the learning curve by comparing the initial results with a radiological analysis performed 3 years after. STUDY DESIGN: Retrospective cohort study. METHODS: 67 patients with clinical cholesteatoma suspicion were included in the study, 24 with previously not operated cholesteatoma and 43 with suspicion of recurrent or residual cholesteatoma. All of them underwent diffusion-weighted magnetic resonance imaging, comparing these results with the histological confirmation after surgery. At 3 years, a blind radiological review of these cases was performed and the results were compared with those obtained after the first assessment to objectify the influence of the learning curve. RESULTS: The sensitivity, specificity, positive predictive value, and negative predictive value of the total sample were 93.9, 77.8, 92 and 82.4. The overall results after the blind review of the cases were 95.9, 94.4, 97.9 and 89.5, respectively. CONCLUSION: The diffusion-weighted magnetic resonance imaging is a very useful technique during the diagnostic process of doubtful cases of cholesteatoma, especially in cases of follow-up. As for the influence of the learning curve, we observed a clear improvement in the specificity of the test.

Cochlear implantation in the elderly: outcomes, long-term evolution, and predictive factors.

OBJECTIVE: Our goal in this study is to find out the outcomes of cochlear implantation in elderly (> 60 years) and check if this improvement is similar to that of their younger counterparts in short- and long-term evolution. In addition, we have attempted to ascertain the predictive factors that might affect the verbal comprehension results of older patients. STUDY DESIGN: Retrospective cohort study. METHODS: Ninety-four patients older than 40 years, divided into two groups. 40-60 years n = 55 and > 60 years n = 39. A pure-tone audiometry, a disyllabic word test, and the test of phonetically balanced sentences of Navarra were made in silence to each patient. These measurements were made pre-implantation and 1, 5, and 10 year post-implantation. Peri- and postoperative complications were registered. The hypothetic predictive factors of post-implanted performance were evaluated in the elderly. RESULTS: Our study shows no significant difference between young and old adult´s outcomes in short- and long-term evolutions, nor in the complication rate. Furthermore, we proved the significant influence of the side of implantation, use of hearing aids, and duration of hearing loss in the short- and long-term results in the elderly. CONCLUSION: This study shows that cochlear implantation in the elderly is as safe, useful, and worthwhile as in young adults. Age has a low influence in cochlear implant outcomes; however, we have found the significant influence of the side of implantation, the use of hearing aids, and the duration of hearing loss in the short- and long-term results.

Abordaje por fosa media para el cierre de fístulas de líquido cefalorraquídeo espontáneas a oído medio / Middle cranial fossa approach for the repair of spontaneous cerebrospinal fluid leaks to the middle ear

Introducción. Las fístulas espontáneas de líquido cefalorraquídeo (LCR) al oído medio por dehiscencias espontáneas óseas del tegmen pueden ser origen de hipoacusia de transmisión y complicarse con meningitis u otras complicaciones intracraneales. El tratamiento quirúrgico para el cierre de estas comunicaciones anómalas puede realizarse por vía transmastoidea o por abordaje por fosa craneal media (FCM). Material y métodos. Se realiza un estudio retrospectivo de los pacientes intervenidos en nuestro servicio de fístulas de LCR espontáneas a oído medio por medio de abordaje por FCM en un período de 6años (2009-2014). Resultados. Se intervienen 13 pacientes con fístulas espontáneas por este abordaje, siendo el síntoma de presentación de todos ellos la hipoacusia de transmisión. En todos los casos se realiza un cierre multicapa (músculo, fascia temporal y cortical ósea) para cerrar el defecto o defectos existentes. El seguimiento mínimo en todos ellos es de 14meses, con cierre de la fístula en todos los casos salvo en uno, que precisó reintervención. No hubo complicaciones intraoperatorias ni postoperatorias debido a la técnica empleada, y la audiometría se normaliza en todos los casos, salvo en el caso de fracaso mencionado. Conclusiones. El abordaje por FCM y cierre en multicapa es una técnica adecuada y eficaz para el cierre de fístulas de LCR espontáneas a oído medio y consigue, además del cierre de la comunicación, el re-establecimiento de la audición (AU)

Introduction. Spontaneous cerebrospinal fluid (CSF) leaks to the middle ear due to tegmen tympani defects can result in hearing loss or hypoacusis and predispose to meningitis as well as other neurological complications. Surgical repair of the defect can be performed through a middle cranial fossa (MCF) approach or a transmastoid approach. Material and methods. We conducted a retrospective study of the patients in our Department due to a spontaneous CSF leak to the middle ear treated using a MCF approach during a 6-year period (2009-2014). Results. Thirteen patients with spontaneous CSF leak to the middle ear were treated with this approach. The primary and first symptom in all of them was conductive hearing loss. In all cases, the defect or defects were closed in a multilayer manner using muscle, temporalis fascia and cortical bone. Minimum follow-up in this series was 14 months, with successful closure in all but one patient (who required reintervention). We found no intra- or postoperative complications due to the craniotomy, and the audiometry improved and normalised in all cases except for the failed case. Conclusions. The MCF approach with a multilayer closure of the defect is an effective technique for repairing spontaneous CSF leaks to the middle ear and for restoring hearing in these patients (AU)

Middle cranial fossa approach for the repair of spontaneous cerebrospinal fluid leaks to the middle ear. / Abordaje por fosa media para el cierre de fístulas de líquido cefalorraquídeo espontáneas a oído medio.

INTRODUCTION: Spontaneous cerebrospinal fluid (CSF) leaks to the middle ear due to tegmen tympani defects can result in hearing loss or hypoacusis and predispose to meningitis as well as other neurological complications. Surgical repair of the defect can be performed through a middle cranial fossa (MCF) approach or a transmastoid approach. MATERIAL AND METHODS: We conducted a retrospective study of the patients in our Department due to a spontaneous CSF leak to the middle ear treated using a MCF approach during a 6-year period (2009-2014). RESULTS: Thirteen patients with spontaneous CSF leak to the middle ear were treated with this approach. The primary and first symptom in all of them was conductive hearing loss. In all cases, the defect or defects were closed in a multilayer manner using muscle, temporalis fascia and cortical bone. Minimum follow-up in this series was 14 months, with successful closure in all but one patient (who required reintervention). We found no intra- or postoperative complications due to the craniotomy, and the audiometry improved and normalised in all cases except for the failed case. CONCLUSIONS: The MCF approach with a multilayer closure of the defect is an effective technique for repairing spontaneous CSF leaks to the middle ear and for restoring hearing in these patients.

Estudio prospectivo de la evolución del acúfeno tras exéresis por vía translaberíntica del neurinoma del acústico / Change in tinnitus after acoustic neuroma removal using a translabyrinthine approach. A Prospective study

Introducción: El acúfeno es uno de los síntomas más prevalentes entre los pacientes afectos de neurinoma del acústico y su evolución tras cirugía es difícilmente predecible. Material y métodos: Se realiza un estudio prospectivo de los pacientes intervenidos por vía translaberíntica en nuestro centro en un período de 4 años (2009-2013). Los pacientes contestan al cuestionario de incapacidad del tinnitus (THI). Se recogen de la historia clínica la edad, sexo, tamaño tumoral, audiometría prequirúrgica y función facial postoperatoria. Resultados: Participaron en el estudio 39 pacientes. El 71,8% de pacientes padecían acúfeno. El 50% de los pacientes presentaban un deterioro muy leve, el 17,9% leve, el 10,7% moderado, el 21,4% severo y el 0% muy severo. No encontramos asociación estadísticamente significativa entre ninguna de las variables estudiadas y el acúfeno preoperatorio. El porcentaje total de pacientes con acúfeno postoperatorio fue del 48,7%. El 31,6% presentaron un deterioro muy leve, el 36,8% leve, el 10,5% moderado, el 15,8% severo y el 5,3% muy severo. La diferencia de medias entre el THI pre y postoperatorio resultó estadísticamente significativa (p = 0,011), siendo esta diferencia de mayor magnitud en pacientes jóvenes. Asimismo, existió una correlación negativa y significativa (r = ---0,335; p = 0,037) entre la audición preoperatoria y el THI postoperatorio. Conclusiones: No encontramos asociación significativa entre el tinnitus y la edad, sexo, tamaño tumoral y función facial postoperatoria. La exéresis del neurinoma del acústico por vía translaberíntica disminuye la percepción del acúfeno en esta serie, siendo los pacientes que mejoran más jóvenes. Los mejores resultados del THI posquirúrgico los encontramos entre pacientes con peor audición prequirúrgica (AU)

Introduction: Tinnitus is one of the primary symptoms of vestibular schwannoma (VS) and the effect of surgery is unpredictable. Materials and methods: We conducted a prospective study of the patients who underwent a translabyrinthine approach for the treatment of their VS (2009-2013) at our Hospital. Patients answered the Tinnitus Handicap Inventory (THI) questionnaire pre- and postoperatively. The clinical charts provided data such as age, gender, tumour size, preoperative audiometry and postoperative facial function. Results: The study included 39 patients. Of these, 71.8% suffered from tinnitus: 50% grade I, 17.9% grade II, 10.7% grade III, 21.4% grade IV and 0% grade V. We found no statistical association between tinnitus and the different variables measured preoperatively. Postoperatively, 48.7% of the patients suffered from tinnitus: 31.6% grade I, 36.8% grade II, 10.5% grade III, 15.8% grade IV and 5.3% grade V. The difference between mean pre- and postoperative THI was statistically significant (P = .011); this difference was greater in younger patients. We have found a significant negative correlation (r = ---0.335; P = .037) between preoperative audiometry and postoperative THI. Conclusions: We did not find any significant association between tinnitus and age, gender, tumour size and postoperative facial function. Translabyrinthine surgical removal of VS in these patients led to better THI results, with the younger patients having better outcomes. The patients with poorest preoperative audition were the ones that had the best results in the postoperative THI questionnaire (AU)

Change in tinnitus after acoustic neuroma removal using a translabyrinthine approach. A Prospective study. / Estudio prospectivo de la evolución del acúfeno tras exéresis por vía translaberíntica del neurinoma del acústico.

INTRODUCTION: Tinnitus is one of the primary symptoms of vestibular schwannoma (VS) and the effect of surgery is unpredictable. MATERIALS AND METHODS: We conducted a prospective study of the patients who underwent a translabyrinthine approach for the treatment of their VS (2009-2013) at our Hospital. Patients answered the Tinnitus Handicap Inventory (THI) questionnaire pre- and postoperatively. The clinical charts provided data such as age, gender, tumour size, preoperative audiometry and postoperative facial function. RESULTS: The study included 39 patients. Of these, 71.8% suffered from tinnitus: 50% grade I, 17.9% grade II, 10.7% grade III, 21.4% grade IV and 0% grade V. We found no statistical association between tinnitus and the different variables measured preoperatively. Postoperatively, 48.7% of the patients suffered from tinnitus: 31.6% grade I, 36.8% grade II, 10.5% grade III, 15.8% grade IV and 5.3% grade V. The difference between mean pre- and postoperative THI was statistically significant (P=.011); this difference was greater in younger patients. We have found a significant negative correlation (r=-0.335; P=.037) between preoperative audiometry and postoperative THI. CONCLUSIONS: We did not find any significant association between tinnitus and age, gender, tumour size and postoperative facial function. Translabyrinthine surgical removal of VS in these patients led to better THI results, with the younger patients having better outcomes. The patients with poorest preoperative audition were the ones that had the best results in the postoperative THI questionnaire.