OBJECTIVE: To explore the early clinical efficacy of a three-stage external treatment with traditional Chinese medicine (TCM) in the treatment of talar bone contusion caused by acute ankle sprain. METHODS: A retrospective analysis was performed on 360 patients with primary lateral ankle sprain admitted from September 2021 to July 2024. Patients with talar bone contusion were selected based on MRI examination, and 73 cases were finally included. According to different treatment methods, they were divided into the observation group and the control group. The observation group consisted of 35 cases, including 16 males and 19 females, aged 24 to 37 years old with an average of (30.34±2.68) years old, and received the three-stage external TCM treatment combined with the "POLICE" protocol. The control group included 38 cases, including 18 males and 20 females, aged 24 to 35 years old with an average of (29.87±2.57) years old, and was treated with the "POLICE" protocol alone. The volume of bone marrow edema (BME) area shown by MRI before treatment and 6 weeks after treatment was measured using 3D Slicer software, and the BME improvement rate was calculated. The "Figure of 8" measurement method was used to assess ankle swelling before treatment and at 1 and 3 weeks after treatment. The visual analogue scale (VAS) was used to evaluate ankle pain before treatment and at 1 and 6 weeks after treatment. At 6 weeks after treatment, the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score and Karlsson ankle function score system were used to evaluate the improvement of ankle function. RESULTS: A total of 73 patients with talar bone contusion caused by ankle sprain completed the 6-week follow-up. At 6 weeks after treatment, the BME improvement rate in the observation group was (39.18±0.06)%, which was higher than (26.75±0.03)% in the control group, with a statistically significant difference (P<0.05). After 1 week of treatment, the VAS score in the observation group was (2.89±0.72) points, lower than (3.37±0.79) points in the control group, and the difference was statistically significant (P<0.05). The ankle swelling degree in the observation group was (50.20±3.19) cm, lower than (52.00±3.60) cm in the control group, with a statistically significant difference (P<0.05). After 3 weeks of treatment, there was no statistically significant difference in ankle swelling between the two groups. At 6 weeks after treatment, there was no statistically significant difference in VAS scores between the two groups. At 6 weeks after treatment, the AOFAS ankle-hindfoot score and Karlsson score in the observation group were (87.43±4.18) and (82.77±5.93) points, respectively, which were higher than (82.92±4.87) and (76.45±6.85) points in the control group, with statistically significant differences (P<0.05). According to the AOFAS ankle-hindfoot score, 8 cases were excellent and 27 cases were good in the observation group;2 cases were excellent, 33 cases were good, and 3 cases were fair in the control group. The difference between the two groups was statistically significant (χ²=7.089, P=0.029). CONCLUSION The three-stage external TCM treatment combined with the "POLICE" protocol has a significant early clinical efficacy. It can significantly reduce ankle pain and swelling in patients with bone contusion caused by acute lateral ankle sprain, promote the absorption of bone marrow edema, and accelerate the recovery of ankle function.
Ankle Injuries/drug therapy* ; Drugs, Chinese Herbal/administration & dosage* ; Talus/injuries* ; Retrospective Studies ; Administration, Cutaneous ; Magnetic Resonance Imaging ; Humans ; Male ; Female ; Young Adult ; Adult ; Contusions/etiology* ; Visual Analog Scale ; Musculoskeletal Pain/etiology* ; Recovery of Function/drug effects* ; Treatment Outcome ; Follow-Up Studies

Objective: To report an alternative combined gingivobuccal and endoscopic endonasal approach to treating ossifying fibroma of the left maxilla. Methods: Design: Case Report. Setting: Tertiary Private University Hospital. Patient: A 19-year-old girl with a progressively enlarging left cheek mass for 3 years. Results: Our patient underwent left medial maxillectomy via a combined gingivobuccal and endoscopic endonasal approach with complete resection and significant improvement of symptoms, with good functional outcome. Conclusion Large ossifying fibromas of the maxilla can be completely and successfully excised via a combined gingivobuccal and endoscopic endonasal approach.
Cementoma ; Sino-Nasal Outcome Test ; Visual Analog Scale

INTRODUCTION: Unmet psychosocial concerns are associated with emotional distress among cancer patients. This longitudinal study aimed to identify specific psychosocial concern profiles and trajectories of emotional distress, and examine their association among newly diagnosed adult cancer patients across the first year of diagnosis. METHODS: Adult patients aged 21-64 years were screened to determine their eligibility for this study. Psychosocial concerns and psychological distress were measured using the Problem List and the Distress Thermometer, respectively (n = 221). Latent transition mixture analysis was used to determine specific psychosocial concern profiles and trajectories of emotional distress, and examine associations with adjustments made for demographic and medical variables. RESULTS: Two classes of psychosocial concerns were identified: low (81%) and high (19%) concerns. Two trajectories of distress were identified: low stable (69%) and high stable (31%) trajectories. Patients in the high concerns class were significantly more likely to demonstrate the high stable trajectory of distress. CONCLUSION Our findings highlight the importance of concurrent assessment of multiple psychosocial concerns and screening of emotional distress throughout a cancer patient's treatment journey. Such assessments can effectively guide interventions to address individual concerns and alleviate emotional distress among newly diagnosed cancer patients.
Adult ; Emotions ; Humans ; Longitudinal Studies ; Neoplasms/psychology* ; Stress, Psychological/psychology* ; Visual Analog Scale

PURPOSE: Retrospectively, the purpose of this study is to investigate the necessity for early operation for patients with rotator cuff tears and concomitant adhesive capsulitis. METHODS: From March 2013 to March 2017, we conducted a retrospective study on patients with rotator cuff tears and concomitant adhesive capsulitis. We analyzed 32 cases out of 39 cases who have small to medium rotator cuff tears, excluding patients who were unable to follow up over 1 years. We evaluated range of motion, visual analog scale (VAS) score, and Constant score. We compared patients of non-symptom and symptomatic patients related to rotator cuff tear. RESULTS: Among patients in the 32 cases, 21 cases of total patients improved without discomfort after recovering their range of motion and pain (group 1), and 11 cases were developed symptoms related to rotator cuff tear for the last 1 year (group 2). Average age of group 1 patients was 53.4 years old, and recovered from forward elevation 95.5° to 163.2°, external rotation from 8.5° to 68.7°, mean VAS score improved from 6.2 to 1.2. Average age of group 2 patients was 58.4 years old, and recovered from forward elevation 96.2° to 162.2°, external rotation from 8.1° to 67.8°, mean pain VAS score improved from 6.4 to 4.4. But there was statistically significant difference in pain reduction after restoration of motion compared to asymptomatic group. CONCLUSION: We do not need surgical treatment at the same time because the symptoms of rotator cuff tear may not be manifested in patients with rotator cuff tear associated with adhesive capsulitis. Sufficient follow-up should be considered after restoration of shoulder motion related to adhesive capsulitis.
Adhesives ; Bursitis ; Follow-Up Studies ; Humans ; Range of Motion, Articular ; Retrospective Studies ; Rotator Cuff ; Shoulder ; Tears ; Visual Analog Scale

BACKGROUND: Despite the growing use of reverse shoulder arthroplasty (RSA), it is associated with relatively frequent complications and uncertain clinical outcomes. We investigated radiological factors affecting clinical outcomes of RSA in the Korean population. METHODS: We evaluated physical findings, radiographic findings, visual analog scale scores for pain and satisfaction, and several functional scores in 179 consecutive patients who underwent RSA at two centers between 2008 and 2014. RESULTS: In 146 included RSAs, pain and forward flexion improved with deltoid lengthening (average, 23.5 ± 9.1 mm; p = 0.039). External rotation decreased with medialization (average, 16.8 ± 6.0 mm, p = 0.025), whereas internal rotation showed no correlation with humeral retroversion. Scapular notching (n = 44, 30%) significantly decreased with greater inferior glenosphere overhang (average, 2.94 ± 3.0 mm; p = 0.001), greater prosthesis scapular neck angle (average, 104° ± 10.3°; p = 0.001), greater glenoid neck length (average, 9.8 ± 2.54 mm; p = 0.012), lower inferior baseplate tilt angle (average, 105.5° ± 9.2°; p = 0.009), and varus humeral neck-shaft angle (p = 0.046), and it did not affect ranges of motion and pain, satisfaction, and functional scores. At the final follow-up, medialization was related to improvement in pain and satisfaction, and inferior glenosphere overhang to functional scores. CONCLUSIONS: Proper amount of deltoid lengthening (mean, 2.3 cm) and inferior glenosphere overhang (mean, 2.9 mm) should be chosen for the better outcomes, while the center of rotation should be individualized according to patient characteristics in the Korean population.
Arthroplasty ; Follow-Up Studies ; Humans ; Neck ; Prostheses and Implants ; Shoulder ; Visual Analog Scale

BACKGROUND: In lumbar spinal stenosis, spinous process-splitting decompression has demonstrated good clinical outcomes with preservation of the posterior ligamentous complex and paraspinal muscles in comparison to conventional laminectomy, but the radiological consequence and clinical impact of the split spinous processes have not been fully understood. METHODS: Seventy-three patients who underwent spinous process-splitting decompression were included. The bone union rate and pattern were evaluated by computed tomography performed 6–18 months after surgery and compared among subgroups divided according to the number of levels decompressed and the extent of spinous process splitting. The bone union pattern was classified into three categories: complete union, partial union, and nonunion. The visual analog scale (VAS) score, Oswestry disability index (ODI), and walking distance assessed both before and 24–36 months after surgery were compared among subgroups divided according to the union pattern of the split spinous process. RESULTS: Overall, the rates of complete union, partial union, and nonunion were 51.7%, 43.2%, and 5.1%, respectively. In the subgroup with partial splitting of the spinous process, the rates were 85.7%, 14.3%, and 0%, respectively; those of the subgroup with total splitting of the spinous process were 32.9%, 59.2%, and 7.9%, respectively. With single-level decompression, a higher rate of union was observed compared with multilevel decompression. The VAS, ODI, and walking distance were significantly improved after surgery and did not differ according to the degree of union of the split spinous process. CONCLUSIONS: We found that the single-level operation and partial splitting of the spinous process were favourable factors for obtaining complete restoration of the posterior bony structure of the lumbar spine in spinous process-splitting decompression.
Decompression ; Humans ; Laminectomy ; Ligaments ; Paraspinal Muscles ; Spinal Stenosis ; Spine ; Visual Analog Scale ; Walking

BACKGROUND: Buttock pain is common, and there are no fixed guidelines for its diagnosis and treatment. This study compared a selective nerve root block and a facet joint block for patients with degenerative spinal disease and buttock pain. METHODS: Patients with degenerative spinal disease who presented with buttock pain, received a selective nerve root block (group A) or a facet joint block (group B) from June 2017 to September 2017, and were able to be followed up for more than 3 months were prospectively enrolled. Clinical results were assessed using a visual analog scale for comparative analysis. RESULTS: One day after the procedure, an excellent response was found in 7% and 6% of groups A and B, respectively; a good response was found in 41% and 13% of groups A and B, respectively. Two weeks later, an excellent response was found in 11% and 4% of groups A and B, respectively; a good response was found in 41% and 20% of groups A and B, respectively. Six weeks later, an excellent response was found in 11% and 7% of groups A and B, respectively, and a good response was found in 41% and 20% of groups A and B, respectively. At the final follow-up, more than 47% and 46% of patients showed a good response in groups A and B, respectively. In group A, the visual analog scale score improved compared to the pre-procedure value of 5.01 to 2.74 on day 1, 2.51 at week 2, 2.38 at week 6, and 2.39 at week 12. In group B, the visual analog scale score improved compared to the preprocedure value of 5.24 to 3.94 on day 1, 3.99 at week 2, 3.24 at week 6, and 2.59 at week 12. On day 1 and at weeks 2 and 6, group A showed a significantly better outcome than group B (p < 0.05). CONCLUSIONS: The selective nerve root block showed superior results up to 6 weeks post-procedure. Considering that the selective nerve root block is effective for treating radiculopathy, the primary cause of buttock pain can be thought to be radiculopathy rather than degenerative changes of the facet joint.
Buttocks ; Diagnosis ; Follow-Up Studies ; Humans ; Nerve Block ; Pain, Referred ; Prospective Studies ; Radiculopathy ; Spinal Diseases ; Spinal Stenosis ; Visual Analog Scale ; Zygapophyseal Joint

BACKGROUND: Biportal endoscopic spine surgery (BESS) is a recent addition to minimally invasive spine surgery treatments. It boasts excellent magnification and fine discrimination of neural structures. Selective decompression with preservation of facet joints for structural stability is also feasible owing to access to the spinal canal and foramen deeper inside. This study has a purpose to investigate clinical benefits of BESS for spinal stenosis in comparison to the other common surgical treatments such as microscopic decompression-only (DO) and fusion and instrumentation (FI). METHODS: From December 2013 to March 2015, 30 cases of DO, 48 cases of FI, and 66 consecutive cases of BESS for lumbar spinal stenosis (LSS) were enrolled to evaluate the relative clinical efficacy of BESS. Visual analog scale (VAS) for back pain and leg pain, postoperative hemoglobin, C-reactive protein (CRP) changes, transfusion, and postoperative complications were examined. RESULTS: All the patients were followed up until 6 months, and 98 patients (86.7%) for 2 years. At the 6-month follow-up, VAS for back pain improved from 6.8 to 2.8, 6.8 to 3.2, and 6.8 to 2.8 (p = 0.078) for BESS, DO, and FI, respectively; VAS for leg pain improved from 6.3 to 2.2, 7.0 to 2.5, and 7.2 to 2.5 (p = 0.291), respectively. Two cases in the BESS group underwent additional foraminal decompression, but no fusion surgery was performed. Postoperative hemoglobin changes for BESS, DO, and FI were −2.5, −2.4, and −1.3 mL, respectively. The BESS group had no transfusion cases, whereas 10 cases (33.3%) in DO and 41 cases (85.4%) in FI had transfusion (p = 0.000). CRP changes for BESS, DO, and FI were 0.32, 6.53, and 6.00, respectively, at day 2 postoperatively (p = 0.000); the complication rate for each group was 8.6% (two dural tears and one root injury), 6.7% (two dural tears), and 8.3% (two dural tears and two wound infections), respectively. CONCLUSIONS: BESS for LSS showed clinical results not inferior to those of the other open surgery methods in the short-term. Stable hemodynamic changes with no need for blood transfusion and minimal changes in CRP were thought to cause less injury to the back muscles with minimal bleeding. Foraminal stenosis decompression should be simultaneously conducted with central decompression to avoid an additional surgery.
Back Muscles ; Back Pain ; Blood Transfusion ; C-Reactive Protein ; Constriction, Pathologic ; Decompression ; Discrimination (Psychology) ; Endoscopy ; Follow-Up Studies ; Hemodynamics ; Hemorrhage ; Humans ; Leg ; Lumbar Vertebrae ; Minimally Invasive Surgical Procedures ; Pain, Postoperative ; Postoperative Complications ; Spinal Canal ; Spinal Stenosis ; Spine ; Tears ; Treatment Outcome ; Visual Analog Scale ; Wounds and Injuries ; Zygapophyseal Joint

In comminuted patellar fractures, we performed modified tension band wiring using a FiberWire (Arthrex) instead of the conventional methods. From March 2016 to March 2018, 63 patients with patellar fractures who needed surgical treatment were treated with modified tension band wiring using two Kirschner wires (K-wires) and FiberWire. We inserted two 1.6-mm K-wires perpendicular to the fracture line after accurate reduction. With the knee flexed over 90°, we sutured around the patella using a FiberWire. Visual analog scale score and Levack's score were improved postoperatively. The mean bone union time was 5.6 months. None of the patients had breakage of wires, and nonunion with deformity occurred in one patient. We think that our method can be easier to handle and reduce irritation or breakage of the wires than conventional methods. In addition, early rehabilitation can be allowed. Therefore, we suggest that this method could be a useful method for the treatment of patellar fractures.
Bone Wires ; Congenital Abnormalities ; Humans ; Knee ; Methods ; Patella ; Rehabilitation ; Visual Analog Scale

STUDY DESIGN: Single-center, retrospective cohort study. PURPOSE: We aimed to evaluate and compare the clinical outcomes in patients who underwent palliative posterior instrumentation (PPI) versus those who underwent corpectomy with cage reconstruction (CCR) for thoracolumbar pathological fracture. OVERVIEW OF LITERATURE: The requirement for anterior support after corpectomy has been emphasized in the treatment of pathological fractures of the vertebrae. However, for patients with a relatively short life expectancy, anterior reconstruction may not be required and posterior instrumentation alone may provide adequate stabilization. METHODS: A total of 43 patients with metastases of the thoracolumbar spine underwent surgery in the department of orthopaedic and traumatology of Istanbul University Faculty of Medicine from 2003 to 2016. Surgical outcomes were assessed on the basis of survival status, pre- and postoperative pain, complication rate, and operation time. RESULTS: PPI was performed for 22 patients and CCR was performed for 21 patients. In the PPI group, the follow-up period of the five surviving patients was 32 months. The remaining 17 patients died with a mean survival duration of 12.3 months postoperatively. In the CCR group, the five surviving patients were followed up for an average of 14.1 months. The remaining 16 patients died with a mean survival duration of 18.7 months postoperatively. No statistically significant difference (p=0.812) was noted in the survival duration. The Visual Analog Scale scores of the patients were significantly reduced after both procedures, with no significant difference noted on the basis of the type of surgical intervention (p>0.05). The complication rate in the CCR group (33.3%) was higher compared with that in the PPI group (22.7%); however, this difference was not noted to be statistically significant (p=0.379). The average operation time in the PPI group (149 minutes) was significantly shorter (p=0.04) than that in the CCR group (192 minutes). CONCLUSIONS: The PPI technique can decompress the tumor for functional improvement and can stabilize the spinal structure to provide pain relief.
Cohort Studies ; Follow-Up Studies ; Fractures, Spontaneous ; Humans ; Life Expectancy ; Neoplasm Metastasis ; Pain, Postoperative ; Palliative Care ; Retrospective Studies ; Spine ; Traumatology ; Visual Analog Scale