Treatment of stress fracture of the olecranon in throwing athletes with internal fixation through a small incision

Defining Percutaneous Dilational Tracheostomy

A Novel Surgical Correction Through a Small Transverse Incision for Pectus Excavatum

Objective: To evaluate the clinical outcomes of ulnar neuropathy, and cubital tunnel syndrome (CuTS) surgery via a small incision with that of anterior transposition of the ulnar nerve. Materials & Methods: In this comparative cross-sectional study, 108 patients were recruited from the Neurosurgery Department of Qazi Hussain Ahmad Medical Complex, Nowshera. Two Groups were made. Group A patients undergo either ulnar nerve anterior transposition or simple decompression via a small skin incision, while Group B patients undergo ulnar nerve subcutaneous anterior transposition through a classic skin incision. Results: Totally 108 patients were enrolled. Males were 67 and females were 41 with a mean age of 45.6 ± 12.97 years. During follow-up visits, an increase in clinical outcome measures was noted, but no statistically significant difference was seen in both groups. Nevertheless, in comparison to the two groups, complications were more in group B, in terms of superficial infection, numbness of skin at the medial elbow, revision surgery, and painful scar. Conclusion: It is concluded that keeping in view the stability/anatomical position of the ulnar nerve to undergo either simple decompression or anterior transposition through small skin incision is effective and an excellent procedure as compared to classic incision procedure in treating patients suffering from cubital tunnel syndrome.

The extended lymphadenectomy on esophagectomy for esophageal cancer contributed the improvement of late result but the operative invasion is very high, and the strict management was required postoperatively. Recently endoscopical surgeries are tried as the minimum invasive method in esophagectomy in Japan. Though, there are many problems in the accuracy of thoracoscopic lymphadenectomy and training period for stable technology. Then we have started a clinical trial of mini-thoraco-laparotomy (small incision) for the improvement of patient’s postoperative QOL without loosing any radicality since 1996. In mini-thoraco-laparotomy, thoracotomy was performed with small skin incision about 12–3 cm, and only the 5th intercostal muscle incision was necessary with other muscles preserved. In mini-laparotomy, intra-abdominal approach was made with 12–3 cm small skin incision in upper abdomen. Esophagectomy and lymphadenectomy was performed using super-long forceps and scissors over the gross view with the special light source device. Concerning to operation time, bleeding volume and quantity of lymphadenectomy, these were no difference between in Mini-type and Conventional-type operation. This mini-thoraco-laparotomy could have a certain advantage for early extubation, decrease of plumonal complication, shortening of SURS duration, and prevention of the wound infection. We believe our mini-thoraco-laparotomy could contribute for reduction of invasion of esophagectomy and improves the postoperative QOL with early recovery of postoperative pulmonal function. We will show these techniques of our mini-thoraco-laparotomy by video of middle thoracic advanced cancer case.

Three cases of compartment syndrome caused by Habu-Snake bite and stone fish sting are treated by fasciotomies through small skin incisions. In Okinawa, the most southern prefecture in Japan, many suffer animal envenomation including 140 cases of Habu-Snake bites. Some of them develop compartment syndrome but usually recover soon after the fasciotomy and take uneventful course if diagnosis is not delayed. Different from compartment syndrome caused by trauma, ischemia, or others, those caused by water-soluble toxins following animal envenomation were expected to be treated successfully with small incisions for fasciotomy. The consecutive three cases of compartment syndrome following Habu-Snake bite and stone fish sting had fasciotomies through 1.5 to 3 cm skin incisions, instead of long skin incisions which are usually made in the same length as the underlying compartment, under following close observations with high index of suspicion of recurrence. Through small skin incisions, compartment syndrome could be released completely and the wounds could be maintained uneventfully with negative pressure therapy without recurrence, infection, or contracture. This method should be considered as an option to treat compartment syndrome caused by animal envenomation and may allow victims to avoid large scars that they should carry for the rest of their life.

Objective To report the treatment effects of open reduction and internal fixation with bone plate through a small posterior heel plus tarsal canal incision on closed calcaneal fractures. Methods A retrospective study was done of the 20 patients (25 feet) who had been treated at Ward One, Department of Orthopaedics, People's Hospital of Yunfu from February 2016 to February of 2019 for closed calcaneal fractures by open reduction and internal fixation with bone plate through a small posterior heel plus tarsal canal incision. They were 16 males and 4 females, aged from 16 to 60 years. According to the Sanders classification, there were 3 cases of type Ⅱ, 15 cases of type Ⅲ and 2 cases of type Ⅳ. Their fractures were reduced by traction, extruding, prying and direct visualization through the tarsal canal window; the bone plates were inserted through a small incision at the back of the heel and fixated by screws. Postoperative observation was done to address fracture healing, and length, width, height, Bohler angle and Gissane angle of the affected calcaneus, as well as functional recovery of the ankle-hindfoot by the American Orthopaedic Foot and Ankle Society (AOFAS) evaluation. Results The operation time for a single foot ranged from 45 min to 70 min, averaging 64.5 min; the intraoperative fluoroscopy for a single foot ranged from 3 times to 6 times, averaging 4.5 times. Local skin necrosis of about 0.5 cm×0.3 cm appeared in one foot after operation but responded to dressing change. No other wound complications occurred. Their follow up was carried out for 6 to 36 months (average, 17.3 months). The fractures healed well with well-shaped bony callus and flat articular surface after 4 to 6 months. The length (80.5 mm±4.2 mm), width (44.8 mm±5.2 mm), height (44.4 mm±3.0 mm), Bohler angle (25.0°±5.1°) and Gissane angle (113.8°±8.6°) of the calcaneus at the last follow up were significantly improved than the preoperative values (79.4 mm ± 4.5 mm, 50.5 mm ± 6.3 mm, 40.0 mm±4.4 mm, 12.0°±13.8° and 107.0°±13.3°) (all P<0.05). By the AOFAS ankle-hindfoot scale, functional recovery of the foot was excellent in 20, good in 3 and fair in 2 cases, giving an excellent to good rate of 92%. Conclusion In the treatment of closed calcaneal fractures, open reduction and internal fixation with bone plate through a small posterior heel plus tarsal canal incision may lead to fine outcomes due to its advantages of small incision and fine fracture reduction. Key words: Calcaneus; Fractures, bone; Fracture fixation, internal; Tarsal Canal; Small incision

Research Type: Level 3 - Retrospective cohort study, Case-control study, Meta-analysis of Level 3 studies Introduction/Purpose: Tibial fractures, often accompanied by fibula fractures, are commonly treated with open reduction and internal fixation (ORIF) to restore lower limb function. Fibula fractures are sometimes managed with intramedullary (IM) nailing, which involves inserting a rod through a smaller percutaneous incision. This minimally invasive technique contrasts with ORIF, which requires a larger incision to secure the fibula with plates and screws. The smaller incision in fibula IM nailing may reduce soft tissue disruption and complications such as wound dehiscence, infection, and delayed healing, which are more frequent with ORIF. However, the optimal fixation method for fibula fractures in the context of tibial ORIF remains debated. This study uses the Nationwide Readmission Database (NRD) to compare complications and readmissions between the two surgical approaches. Methods: A retrospective cohort study was conducted using the NRD to examine 1,996 propensity-score matched patients who underwent tibia ORIF, with either fibular IM nailing or ORIF for associated fibula fractures. The incidence of total complications, including wound dehiscence, thromboembolism, cellulitis, surgical site infection, hardware failure, malunion, pseudoarthrosis, abscess formation, and the need for surgical debridement, were analyzed. Additionally, 30-day and 90-day readmission rates were compared between the two groups using chi-square tests or Fisher’s exact tests for statistical significance. Readmissions, both within 30 days and within 90 days, for specific complications were also analyzed. All results are in Table 1. Results: The study included 1,996 patients in both the IM and ORIF groups. The IM group demonstrated a significantly lower incidence of infectious complications (1.40% vs. 2.76%, p = 0.003) along with a lower incidence of 30-day readmission for a surgical site infection (0.6% vs 1.45%, p = 0.008). The IM group also demonstrated a significantly reduced rate of 31–90-day readmission for wound dehiscence (0.25% vs 0.85%, p = 0.01) and infection (0.4% vs. 1%, p &lt; 0.023). Although the IM group demonstrated a greater rate of 30-day readmissions (11.72% vs. 9.62%, p = 0.031), no significant difference was observed in 90-day readmission rates (7.11% vs. 7.36%, p = 0.76). All results are shown in Table 1. Conclusion: Fibula intramedullary (IM) nailing, in the context of tibial open reduction and internal fixation (ORIF), demonstrates a favorable outcome profile with fewer surgical site complications. The significant reduction in wound dehiscence and infectious complications in the IM nailing group underscores its utility in cases where the risk of local, surgical-site complications is elevated. IM nailing may provide a promising alternative to ORIF, especially in patients with comorbidities or in clinical scenarios, such as polytrauma, where the risk of soft tissue complications is heightened. This minimally invasive approach offers potential benefits in improving recovery and minimizing complications in these high-risk populations.

BackgroundWe analysed clinical factors that are predictive of a diagnosis of parotid abscess among patients with bacterial parotitis. Material and methodsThis retrospective study included 64 hospitalised patients who were diagnosed with parotid abscess, or bacterial parotitis. Data on patient demographics, clinical characteristics, and clinical management were collected. Predictive factors for parotid abscess were evaluated using univariate and multivariate analysis. ResultsThere were 25 patients with parotid abscess and 39 with bacterial parotitis. All patients presented with moderate-to-severe disease, required parenteral antibiotics, or had indicators for surgical drainage. Patient profiles and immune status were not significantly associated with parotid abscess. However, parameters that were significantly related to parotid abscess were subacute presentation (approximate 10.4 days) (p value = 0.016), fluctuation (p value < 0.001), and normal (haemoglobin) Hb level >12–13 g/dL (p value = 0.035). Imaging indicated the abscess location, extension and evaluated the complications. Surgical drainage with small skin incision and antibiotic coverage for possible pathogens, in particular Staphylococcus spp. and Streptococcus spp. produced favourable patient outcomes. Complication was identified in 3 cases with included septicaemia and cellulitis of the face and parapharyngeal space. ConclusionsAmong bacterial parotitis patients, parotid abscess should be considered in whom presented with subacute duration of symptoms, enlarged glands with fluctuation, and non-anaemic problem. Instead of standard skin incision of parotidectomy, small vertical skin incision over a well localised abscess pocket or fluctuated area achieved the good results.

Acute stable scaphoid fracture (Herbert type A2) is generally managed conservatively with a plaster cast. However, long-term immobilization causes inconveniences of daily living and, more importantly, prohibits an early return to work even for the person who is not a heavy laborer and could resume working had the wrist not been fixed in a cast. Since the Herbert bone screw gives rigid internal fixation of bone fragments and allows early mobilization of the wrist, acute stable scaphoid fracture is treated using this screw, without requiring a cast, in order to solve the problems mentioned above. The screw is inserted into the scaphoid through a small skin incision just over the scaphotrapezial joint using a free-hand procedure monitored under an image intensifier. Thirteen wrists of 13 patients were operated upon from May, 1988 until November 1990. The average age of the patients was 29.4 years. The average time for returning to work after surgery was 3.2 weeks (range 1 day to 6 weeks). The average hand-grasping power was 94.6% and the average range of motion of the wrist was 98.1% compared with the non-affected side. According to Herbert’s assessment system, the results of all the cases were graded as excellent.

The authors developed a method for retroperitoneal placement of a lumboperitoneal (LP) shunt with the aid of endoscopic monitoring. To perform this procedure, the patient is positioned laterally, the retroperitoneum is entered and dilated with a balloon through a small incision in the flank, and the space is maintained with CO2 insufflation. A peritoneal catheter is introduced into the cavity from the lumbar incision, through which the spinal catheter has been inserted. With the aid of a percutaneous nephroscope inserted in the cavity, the peritoneum is opened with endoscopically guided forceps through the manipulation channel. The shunt tube is then inserted into the pelvic peritoneum with the same forceps. Only two small skin incisions are needed for this method, and the shunt system is shorter compared with the conventional LP setup, which may lessen the risk of obstruction. This method is advantageous in patients who have undergone previous abdominal surgery, because it provides access to the peritoneum without concern for the presence of peritoneal adhesions.

Study design: Retrospective study. Objective of the study: The objective of this study was to evaluate the results of minimal invasive patellofemoral ligament reconstruction via two small incisions in cases of recurrent dislocation of the patella. Background: Patellar dislocation is one of the problems encountered in orthopedic practice. The annual incidence is 78 in 100,000. Most of the patients are adolescents and young adults. The medial patellofemoral ligament is the most important static stabilizer of the patella in extension. Patients and methods: This study included 8 patients who were consecutively operated on. Patients underwent surgery from May 2011 to June 2012. Mean follow-up was 24 months. The patients’ median age was 22 years (range, 18 to 32 years). There were 5 males and 3 females patients. All patients had chronic patellar instability with a minimum of 2 times total patellar dislocations. Semitendinosus tendon was harvested and prepared. Patellar and femoral tunnels were drilled through two small skin incisions. The graft was fixed to the patella by interference screw then extra synovial passage of the graft was created between the patellar and femoral incisions. The graft was fixed to the femur by interference screw. Results: The median follow-up was 24 months. The Kujala knee function score improved overall from 46 points (range, 12 to 67 points) to 84 points (range, 62 to 100 points) at 24 months follow-up. Conclusions: Minimal invasive medial patellofemoral ligament reconstruction by semitendinosus tendon autograft and single patellar tunnel technique is effective, reproducible and reliable method for the treatment of lateral patellar instability.

Two new total hip replacement (THR) procedures have been termed minimally invasive. It is claimed that these smaller incision techniques reduce soft-tissue trauma, decrease postoperative pain and blood loss, speed recovery, and reduce the length of the hospital stay compared with hip replacement using the standard incision technique. These new procedures use either one small 6- to 10-cm incision through a posterior, lateral, or anterior approach or two very small (a 2.5 cm posterior incision for placement of the femoral component and a 5-cm anterior incision for placement of the acetabular component) incisions to accomplish the same THR procedure that requires a standard length incision of 15 to 20 cm. Controversy exists on whether these small incision THRs are actually minimally invasive. It is debated whether a small skin incision that requires the application of high forces on the soft tissues for exposure of the joint but less muscle dissection will produce less overall trauma to the patient than a larger incision with wider muscle dissection but with lower retraction forces. If small incision THR techniques are less traumatic overall, then they should produce less pain, lower transfusion requirements, a shorter hospital stay, and a faster recovery for patients. The other important issues regarding small incision procedures are whether the decreased visualization provided by these techniques is adequate to prevent a higher complication rate from damage to the surrounding neurovascular structures and outcomes that are equivalent to those found for THR using the standard technique. A review of the literature to date provides no convincing evidence of any significant advantages of small incision THR compared with standard incision THR other than a shorter surgical scar. Comparison studies that prove both significant advantages and low complication rates for small incision THR are needed before these procedures can be recommended for general use.

Small incision external levator repair: technique and early results

Conclusion. Endoscope-assisted partial-superficial parotidectomy is a feasible method for treatment of benign parotid superficial lobe tumors located at the anterior or the inferior of the auricular lobule. The main advantage of this procedure is that the small operative scar resulted in improved cosmetic results. Objectives. This study evaluated the feasibility of endoscope-assisted partial parotidectomy through two small skin incisions. Patients and methods. Thirty cases with benign parotid superficial lobe tumors with a diameter < 30 mm located at the anterior or the inferior of the auricular lobule underwent endoscope-assisted partial-superficial parotidectomy via retrograde approach through two small skin incisions. Results. All 30 operations were successfully performed endoscopically. All the patients were satisfied with the cosmetic results. Only three patients had transient facial paresis and recovered in 1–2 months. The endoscopic surgery lasted for 106.48±12.62 min. There was no tumor recurrence during the follow-up after 26–50 months.

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