Anterior Incision Research Articles

Medial Patellofemoral Ligament Reconstruction With Concomitant Tibial Tubercle Osteotomy

Background: Patellar instability, often associated with medial patellofemoral ligament rupture, is prevalent in adolescents. Risk factors include trochlear dysplasia, patella alta, abnormal patellar tilt, and increased tibial tubercle to trochlear groove (TT-TG) distance. Indication: A variety of surgical options are available for addressing patellar instability, and the selection of each technique should be tailored to the unique pathoanatomy of each patient. Medial patellofemoral ligament reconstruction (MPFLR) is indicated for patients with patellar instability, and tibial tubercle osteotomy (TTO) is indicated for patients with a TT-TG >20 mm. Technique Description: An anterior midline incision is performed to expose the patella, patellar tendon, and tibial tubercle. Diagnostic arthroscopy is performed to assess patellar engagement and cartilage integrity, followed by the TTO. Three guidewires are placed with 15° of obliquity, to guide a 6-cm osteotomy, from medial to lateral and from proximal to distal. A distal cortical hinge must be left intact. A 15-mm medial resection of the tibial tubercle is performed to avoid protrusion against the skin, which is followed by medialization of the tubercle and fixation with K-wires until dynamic testing ensures proper alignment and definitive fixation is achieved with cannulated headless screws. A lateral retinacular lengthening is performed to balance patellar forces. MPFLR is executed using a semitendinosus allograft. The graft is anchored to the patella and drawn through a surgically created plane to the medial femoral condyle. The femoral tunnel is created under fluoroscopy guidance, and the graft is then passed and secured. Graft tension and patellar mobility are adjusted according to dynamic testing. Once patellar stability is achieved and maintained through range of motion, the graft is then fixed. Results: Patients can expect improved clinical outcomes with a high return-to-sports rate following both isolated MPFLR and concomitant TTO. The combination of MPFLR + TTO significantly reduces revision rate, compared to isolated MPFLR in patients with increased TT-TG distance, and enhances postoperative patellofemoral tracking. Discussion/Conclusions: MPFLR + TTO improves patellofemoral tracking and corrects patellar instability, substantially improving postoperative outcomes compared to MPFLR alone. Patients with patellar instability and an increased TT-TG may be effectively treated with MPFLR + TTO. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.

Preliminary Application of Bilateral Submandibular Horizontal Incision in the Treatment of Upper Cervical Tumors.

The upper cervical spine has a complex anatomical structure, making anterior surgical approaches challenging and prone to complications. This study aims to explore the use of bilateral submandibular incisions to provide safer and more convenient exposure of the upper cervical spine and to assess the feasibility of this approach for anterior surgical treatment of complex upper cervical diseases. From November 2019 to August 2021, three patients with malignant tumors of the upper cervical spine were subjected to an anterior-posterior combined approach for cervical tumor resection. The cohort consisted of one male and two females, aged between 41 and 51 years. The anterior approach began with a submandibular incision, followed by blunt dissection through the prevertebral muscles to expose the diseased vertebra. Subsequently, the diseased vertebra was excised, and either a titanium cage or a pre-customized 3D-printed artificial vertebral body was implanted anteriorly. Then, posterior fixation of the cervical spine was performed using pedicle screws to provide additional stability. Follow-up ranged from 8 to 34 months. All patients experienced varying degrees of pain relief within 24 hours post-operation. Frankel grading showed improvement by at least one grade in all three cases. Regular X-ray and magnetic resonance imaging examinations revealed no tumor recurrence or involvement of adjacent vertebrae in the surgical area. The anterior bilateral submandibular horizontal incision approach offers comprehensive exposure of the anatomical structures of the upper cervical spine. This approach introduces a new option for the anterior treatment of upper cervical spine diseases.

Air under pressure: a case report on tension pneumomediastinum arising from traumatic injury

Abstract Background Tension pneumomediastinum (TPM) is a rare but critical condition characterized by the accumulation of air in the mediastinum, leading to increased intrathoracic pressure and cardiovascular compromise. This case report is novel due to the rarity of TPM arising from blunt chest trauma and the necessity for emergent surgical intervention after initial conservative management failed. Case presentation A 63-year-old male presented with severe chest pain and dyspnea following a high-impact motor vehicle collision. Initial assessment revealed tachypnea, tachycardia, and hypotension, along with extensive subcutaneous emphysema over the chest and neck. Imaging confirmed pneumomediastinum and bilateral pneumothoraxes, consistent with TPM. Despite initial management with high-flow oxygen and bilateral chest tube insertion, the patient’s condition deteriorated, necessitating emergent mediastinal decompression via an anterior subxiphoid incision. This intervention resulted in immediate hemodynamic improvement. Conclusions This case underscores the importance of recognizing TPM in patients with chest trauma and highlights the need for prompt surgical intervention in cases of hemodynamic instability. Early and accurate diagnosis and timely surgical management are crucial for improving patient outcomes in TPM.

Association between postoperative pain and analgesic use in minimally invasive cardiac surgery.

This study aimed to investigate the effects of surgical methods on pain duration and oral analgesic administration in patients who underwent cardiac surgery using various minimally invasive methods. We included 90 patients who underwent an anterior incision with costal cartilage transection, lateral incision without costal cartilage transection, or total endoscopic cardiac surgery using a lateral incision and no retractor. Oral analgesics were postoperatively administered upon patient request. All the patients were instructed to rate their pain during the daytime 3 and 7 days postoperatively. Between-group differences included surgical method, wound size, operation/cardiopulmonary bypass time/cardiac arrest time, and intraoperative fentanyl dose. No differences were found in sex, age, diabetes status, paravertebral block use, or blood loss. The number of postoperative days, postoperative analgesic use, and pain 3 days postoperatively demonstrated no difference. Pain ratings were most severe for the costal cartilage resection group and least severe for the total endoscopic cardiac surgery group 7 days postoperatively. Similarly, patients who underwent costal cartilage research exhibited the highest rate of analgesic use for 30 days postoperatively, whereas patients who underwent total endoscopic cardiac surgery demonstrated the lowest. We revealed significant between-group differences in pain prevalence and postoperative oral analgesic administration in patients who underwent cardiac surgery relative to the minimally invasive surgical method used.

Patellar Tendon Debridement and Reconstruction With Hamstring Tendon Autografts in the Setting of Severe Patellar Tendinopathy

Background: Patellar tendinopathy is a multifactorial condition characterized by micro-degenerative changes in the patellar tendon. This results from repeated stress to the knee extensor mechanism from explosive movement, axial malalignment, and/or abnormal patellar height. Currently, there is no standard surgical procedure for the treatment of severe patellar tendinopathy. Indications: Patellar tendon reconstructions for patellar tendinopathy may be indicated when >50% of the tendon attachment is degenerative and detached from the distal patella and non-operative treatment, like physical therapy, bracing, and injections, have not relieved symptoms. Debridement may not offer long-term viability against augmentation of the patellar tendon with autografts, with a risk of recurrent breakdown of the patellar tendon attachment with resumption of previous activities that initially lead to overload. Technique Description: An anterior incision was made from the superior pole of the patella to the tibial tubercle. Then, dissection was performed medially to harvest the gracilis and semitendinosus tendons. Open harvesters were used, and the hamstring tendons were released proximally, keeping the tibial insertions attached. A horizontal pin was drilled across the tibial tubercle and reamed with a 4.5 mm reamer. A passing stitch was fed through the tunnel. The proximal and distal margins of the patella were localized with spinal needles and a pin was drilled across its midportion, 5 mm deep to the dorsal cortical margin, and then rearmed. Degenerative tissue at the patellar tendon was excised. The gracilis tendon was passed medial to lateral through the tibial tubercle, and a Q-Fix anchor anchored the grafts medially and laterally. The semitendinosus graft was passed medial to lateral through the patella followed by the gracilis tendon lateral to medial. Appropriate reconstruction graft tension was confirmed and grafts were whipstitched together. Results: Clinical outcomes for the debridement of severe patellar tendinopathy report 77% symptomatic relief. With many unable to return to activity, patellar tendon reconstruction can be indicated. Outcomes for reconstructions for severe patellar tendinopathy are not reported. Discussion: Patellar tendon reconstruction with hamstring autografts for the treatment of severe patellar tendinopathy can provide a strong reconstruction graft to allow for the resumption of high-level activities. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.

Treatment of supracondylar fractures of the humerus in adults using a novel anatomical locking plate on the anterior distal humerus: a case report

BackgroundDue to its unique anatomical characteristics, supracondylar fractures of the humerus are often difficult to achieve firm fixation with internal fixation equipment, resulting in delayed functional exercise, often leaving cubitus varus deformity, elbow stiffness, contractures, and other complications. Here, we report an adult patient with a supracondylar fracture of the humerus who underwent internal fixation through an anterior median incision in the humerus with our self-developed anterior anatomical locking plate of the distal humerus.Case presentationA 29-year-old male patient of Chinese ethnicity with trauma-induced right supracondylar fracture of the humerus and multiple soft tissue contusions, without nerve damage, blood vessel damage, or other injuries, underwent an internal incision in our hospital using a new anatomical locking plate for the anterior distal humerus fixed treatment. During the 16-month follow-up period, the patient’s elbow range of motion was almost completely restored, functional scores were excellent, and there were no minor or major postoperative complications.ConclusionIn this study, we propose a surgical reconstruction strategy for adult patients with supracondylar humeral fractures. Through the anterior median incision of the humerus, open reduction and internal fixation were performed with an anatomic locking plate on the anterior side of the distal humerus to restore and fix the structure of the distal humerus, and satisfactory clinical results were achieved in our case.

Postoperative Horner Syndrome: A Case Report Describing a Rare Complication After Anterior Cervical Discectomy and Fusion

The gold standard for correcting cervical degenerative disc disease (CDDD) is anterior cervical discectomy and fusion (ACDF), which is a safe, effective procedure. Horner syndrome (HS) is an extremely rare complication immediately post-ACDF due to impairment of the sympathetic trunk. Herein, we present the case of a 48-year-old woman with CDDD-related pain and radiculopathy who was counselled and consented for C5–6 and C6–7 ACDF. ACDF was performed with standard anterior left-sided incisions at appropriate levels. Unlike our usual practice, deeper-toothed retractors were employed for better exposure. Two cages were inserted at C5–6 and C6–7. The procedural time was standard (180 minutes), without intraoperative complications. The patient experienced significant symptom relief immediately post-ACDF, but developed sudden onset left-sided HS, with ptosis, miosis, and anhidrosis, approximately 48 hours post-ACDF. At a 2-week postoperative follow-up, she exhibited clinical improvement, and by 12 weeks, her HS had completely resolved. To our knowledge, this case is the first documented instance of delayed-onset HS post-ACDF. It may be associated with the type of retractors used, resulting in neuropraxia or strain on the sympathetic chain ganglia. We recommend adequate exposure while minimizing excessive retraction of the longus colli muscle to reduce irritation to the sympathetic trunk.

Liposuction Through an Axillary Fold Incision Combined with a Small Areola Incision to Treat Gynecomastia.

Gynecomastia is a progressive disease characterized by enlarged breasts, affecting a significant proportion of men. Persistent gynecomastia negatively affects the psychological and emotional development of patients; therefore, surgical intervention is required. In this article, we describe a surgical technique, where liposuction through an axillary incision is used in combination with a single small periareolar incision, to obtain the most minimal scars in the treatment of gynecomastia. Between June 2021 and June 2023, 125 patients with different Simon grades of gynecomastia were enrolled. The patients' basic conditions and operation processes were recorded. Following surgery, a score was assigned according to the five main aesthetic aspects of the surgical procedure. In total, 125 patients with gynecomastia were treated with a pre-axillary fold incision combined with a small areolar incision. There were 17 cases of Simon grade I, 46 grade IIA, 42 grade IIB, and 20 grade III. The average operation time was 45.8min, the average liposuction volume was 250.5mL, the average glandular tissue volume was 50.5g, intraoperative blood loss ranged from 15 to 60mL, and the average hospital stay was 3.2days. Regarding the postoperative aesthetic effect, doctors scored > 4 points, and the patient satisfaction score was > 7.5, which fully affirmed the aesthetic effect of this method. Treatment of gynecomastia through an anterior axillary fold incision combined with a small areolar incision is safe and feasible, involving a simple procedure, short operation time, and few complications. Its efficacy and cosmetic effects could lead to its use as a primary surgical method to treat gynecomastia. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine Ratings, please refer to Table of Contents or online Instructions to Authors www.springer.com/00266 .

Cerebral Ischemic Coma Model Induced by Modified Four-Vessel Occlusion.

Coma caused by cerebral ischemia is the most serious complication of cerebral ischemia. Four-vessel occlusion can establish a cerebral ischemic coma model for disease research and drug development. However, the commonly used four-vessel occlusion method mainly involves inserting an electrocoagulation pen into the bilateral pterygoid foramen of the first cervical vertebra behind the neck to electrocoagulate the vertebral arteries. This process carries the risk of incomplete electrocoagulation, bleeding, and damage to the brainstem and spinal cord. Twenty-four hours after surgery, re-anesthetized rats undergo carotid artery ligation in front of the neck. Two surgeries expose the rats to a higher risk of infection and increase the experimental period. In this study, during a single surgical procedure, an anterior cervical incision was used to locate the key site where the vertebral artery penetrates the first cervical vertebra. The bilateral vertebral arteries were electrocauterized under visual conditions, while the bilateral common carotid arteries were separated to place loose knots. When the rats showed consciousness of the inversion reaction, the bilateral common carotid arteries were quickly ligated to induce ischemic coma. This method can avoid the risk of infection caused by two surgical operations and is easy to perform with a high success rate, providing a useful reference for relevant practitioners.

Morphological characteristics and reduction techniques of sagittal beak-like deformity of head-neck fragment in femoral intertrochanteric fractures

To summarize the morphological characteristics of sagittal beak-like deformity of head-neck fragment in femoral intertrochanteric fractures and to investigate the technical skills in fracture reduction. A clinical data of 31 patients with femoral intertrochanteric fractures between May 2021 and April 2023 was retrospectively analyzed. The fractures had sagittal beak-like deformity of head-neck fragment in all patients. There were 13 males and 18 females, with an average age of 76.2 years (range, 68-83 years). The time from injury to operation was 36-76 hours (mean, 51.2 hours). Fractures were classified as type A1.2 in 10 cases, type A1.3 in 11 cases, type A2.2 in 6 cases, and type A2.3 in 4 cases according to the AO/Orthopaedic Trauma Association (AO/OTA)-2018 classification; and as type A1.3 in 10 cases, type A2.1 in 11 cases, type A2.2 in 6 cases, type A2.3 in 2 cases, and type A2.4 in 2 cases according to a novel comprehensive classification for femoral intertrochanteric fractures proposed by the "Elderly Hip Fracture" Research Group of the Reparative and Reconstructive Surgery Committee of the Chinese Rehabilitation Medical Association. Based on preoperative X-ray films, CT scan and three-dimensional reconstruction, the fractures were classified into two types: type 1 (14 cases), with uncomplicated fracture morphology, severe bone interlocking and (or) soft tissue incarceration; type 2 (17 cases), with severe fracture crushing, obvious dissociation between bone blocks, and severe soft tissue hinge destruction. After the failure of the closed reduction, all patients underwent fracture reduction assisted with instrument via anterior minimal incision and proximal femoral nail antirotation nails internal fixation. The operation time, intraoperative fluoroscopy, intraoperative visible blood loss, length of hospital stay, and incidence of complications were recorded. The fracture reduction quality and stability score were assessed at immediate after operation under fluoroscopy. The fracture healing was evaluated and healing time was recorded by X-ray films. The pain visual analogue scale (VAS) score was performed at 48 hours after operation and Parker-Palmer activity score at 3 months after operation for function evaluation. The operation time was 39-58 minutes (mean, 46.3 minutes); fluoroscopy was performed 13-38 times (mean, 23.5 times) during operation; the intraoperative visible blood loss was 45-90 mL (mean, 65.3 mL). The fracture reduction quality and stability score were rated as good in 29 cases and acceptable in 2 cases. The pain VAS score was 2-6 (mean, 3.1) at 48 hours after operation. Eleven patients developed deep vein thrombosis of the lower limbs after operation. Patients were hospitalized for 6-10 days (mean, 7.3 days). All patients were followed up 5-8 months (mean, 6.5 months). All fractures healed at 3.5-8.0 months after operation (mean, 4.5 months). Parker-Palmer activity score at 3 months after operation was 9 in 28 cases and 6 in 3 cases. The femoral intertrochanteric fracture with sagittal beak-like deformity of head-neck fragment is difficult to manually reduce. The pin combined with cannulated screw insertion to the neck cortex can hold the fragment and assist fracture reduction, which is a simple and effective technique.

Perinatal factors and early neonatal outcomes of abnormal birthweight infants in Hangzhou, China, 2015–2021: a retrospective cohort study

BackgroundThis study aimed to investigate the perinatal factors and early neonatal outcomes of abnormal birth weight (ABW) in Hangzhou, China from 2015 to 2021.MethodsA retrospective cohort study was designed to...

Controversies in Thyroid Surgery: Debating Transoral Endoscopic Thyroidectomy versus Small Incision Thyroidectomy

In the ever-evolving landscape of thyroid surgery, one cannot ignore the ongoing debate surrounding the optimal approach for thyroidectomy. minimally invasive thyroidectomy techniques have been developed. However, there is currently no single accepted technique in minimally invasive thyroidectomy (MIT) [1]. Proponents of transoral endoscopic thyroidectomy via vestibular approach (TOETVA) advocate for its minimally invasive nature and favorable cosmetic outcomes [2]. Experienced thyroid surgeons performing thyroidectomy with an anterior incision, shortening the classic Kocher incision by 2-3 cm without the need for additional complex instruments with simple preparation and minimal costs, have obtained better cosmetic results compared to open surgery [1]. Supporters of open thyroidectomy with or without endoscopic assistance through a 3 to 4-cm incision (small incision thyroidectomy; SIT) argue that their approach achieves similar minimally invasive results while maintaining the safety and efficacy of traditional open surgery [3,4]. TOETVA has garnered attention for its innovative approach, utilizing a natural orifice—the mouth—as the entry point for thyroidectomy. Advocates of TOETVA highlight its cosmetic advantages, as the incisions are hidden within the oral cavity, resulting in virtually scarless necks. Furthermore, TOETVA offers reduced postoperative pain and faster recovery times than traditional open surgery, enhancing patient satisfaction and quality of life. Proponents argue that the evolution of TOETVA represents a paradigm shift in thyroid surgery, offering patients a less invasive alternative with comparable oncological outcomes [5]. Conversely, proponents of SIT through a 3 to 4-cm incision contend that their approach achieves similar minimally invasive results while preserving the safety and efficacy of traditional open surgery. They argue that the smaller incision size of open thyroidectomy minimizes tissue trauma and postoperative pain, leading to faster recovery times and superior cosmetic outcomes compared to larger incisions (Figure 1,2). Moreover, advocates of SIT emphasize the importance of tactile feedback and direct visualization in ensuring optimal surgical outcomes, which may be compromised in endoscopic approaches such as TOETVA [2,3,5]. Among these contrasting viewpoints, it is essential to recognize that TOETVA and SIT have their respective strengths and limitations. While TOETVA offers the attraction of scarless necks and enhanced cosmetic outcomes, concerns remain regarding its learning curve and technical challenges, particularly in cases of large or multifocal thyroid tumors. Conversely, SIT boasts a long-standing safety and efficacy track record, with established surgical technique and perioperative care principles. However, its neck incision may be perceived as a drawback by patients seeking minimally invasive alternatives. Addressing these controversies requires understanding patient preferences, tumor characteristics, and surgeon expertise. Individualized decision-making is paramount, carefully considering the risks and benefits of each approach. Moreover, ongoing research and innovation are essential to refining surgical techniques and optimizing outcomes in thyroid surgery.

Subtuberosity anterior closing wedge osteotomy to correct the increased posterior slope of the tibial plateau

Reduction of increased reclination of the tibial plateau (posterior slope) to improve the anterior stability of the knee joint. Increased posterior reclination of the tibial plateau greater than 12° in combination with recurrent instability after anterior cruciate ligament (ACL) reconstruction. Hyperextension of more than 15° (relative). Anterior skin incision approximately 8-10 cm above the tibial tuberosity. Insertion of two converging guidewires directly below the patellar tendon ending obliquely in the area of the posterior cruciate ligament (PCL) insertion. Control of the wire position with the image intensifier core. Oscillating saw osteotomy. Removal of the wedge and closure of the osteotomy. Osteosynthesis with interfragmentary screw and medial angle-stable plate. Partial load with 10-20 kg for 2 weeks, then step by step increase in load. Mobility: free. To date we have operated on 36patients with recurrent instability after ACL reconstruction (20men, 16women, average age 34.4 years) in the manner described in this article. In 25cases, enlarged bone tunnels were filled with allogeneic bone at the same time. The posterior slope of the tibial plateau could be reduced from an average of 14.5° to8.8°. In 28cases another ACL reconstruction was performed after an interval of 4-12months. The Lysholm score significantly increased from 76.3 points to 89.2 points.

Cutibacterium avidum: A Potent and Underestimated Pathogen in Prosthetic Hip Joint Infections.

Cutibacterium avidum has recently been reported as a rare cause of prosthetic joint infections (PJIs), contrary to Cutibacterium acnes, which is well established as a cause of PJIs, especially in shoulder arthroplasties. Two specific risk factors for PJI due to C. avidum have been reported: obesity and the skin incision approach. Here, we report four cases of hip PJIs caused by C. avidum admitted over a 30-month period at a single center. Whole-genome sequencing revealed that the four C. avidum strains were all individual strains and did not originate from a common source, such as an outbreak. Antibiotic susceptibility tests showed that the isolates were fully susceptible, and none carried known antibiotic resistance genes. In conclusion, the occurrence of four cases of PJI caused by C. avidum over a limited time at a single center may indicate that this pathogen is underestimated and is either emerging or more common than previously recognized. The patients presented overt signs of infection during surgery, indicating that C. avidum is a virulent pathogen. None of the previously reported risk factors for C. avidum PJI applied to these patients as only one was obese and none were operated on using a direct anterior skin incision approach.

Lacrimal Sac Characteristics in Patients With Punctal and Canalicular Agenesis: Punctum Update (PUP) Study-Paper 3.

To explore the endoscopic and histopathologic characteristics of the lacrimal sac (LS) and the nasolacrimal duct in cases with punctal agenesis presenting with LS swellings. This is a prospective, interventional study of 13 LSs of 8 patients presenting with punctal agenesis and LS swellings over a 5-year study period (June 2018-July 2023). Complete ophthalmic examination was performed along with CT scans of the orbits. The LS was exposed with an anterior lacrimal crest incision and explored. The exterior and interior of the sac swelling were examined and LS flaps were sent for histopathological analysis. The mean age of the patients was 23 years with a male:female ratio of 5:3. All patients presented with swelling in the LS region. Occasional epiphora was the presenting feature in 6 patients. All patients had both upper and lower punctal agenesis on the affected side with associated LS swelling. CT scans showed a hypodense cystic swelling with expansion of the LS fossa and bony nasolacrimal duct ending abruptly short of the inferior meatus. Intraoperatively, the LS had thin, translucent walls with mucoid secretion and an absence of common canalicular opening. Histopathological analysis showed epithelium consistent with LS with less robust development of the sac walls and poorly structured lacrimal drainage-associated lymphoid tissue with scanty stromal inflammation. The development of LS and the nasolacrimal duct is structurally affected in patients with punctal agenesis. Retrograde approaches for epiphora resolution are not logical in such cases but conjunctivodacryocystorhinostomy with Jones tube can be a feasible option.

Comparison of radiological and functional results in osteoporotic distal femur fractures operated with single plating, lateral incision, and double plating, anterior paramedial incision: A retrospective study.

Treatment of osteoporotic distal femur fractures is often complicated by a high rate of nonunion and varus collapse. For such fractures, lateral plating with lateral incision and double plating with anterior paramedial incision have shown promising results in the recent literature. The hypothesis of this study was that bilateral plating of comminuted distal femur fractures in osteoporotic patients would result in higher union rates and lower revision rates compared to an isolated lateral locking plate. The study included 56 patients (23 males, 33 females) with supracondylar femur fracture. According to the OA/OTA classification, 9 were type A3, 8 were A2, 13 were C1, 16 were C2, and 10 were C3. The mean follow-up period was 12 months, with 29 patients treated using lateral mini-incision, lateral locking plate, and 27 patients treated with anterior paramedial incision, dual plating. The clinical and radiological results were evaluated. The mean duration of radiological union in the studied population was 15 ± 2.1 months (range, 11-21 months) in the single plate group (Group A), and 13.5 ± 2.6 months (range, 9-19 months) in the double plate group (Group B). Mean ROM was 112.3° and flexion contracture 4° in Group A, and ROM 108.3° and flexion contracture 6.7° in Group B. (P = .15). The average Western Ontario and McMaster Universities Arthritis Index (WOMAC) score was 85.6 points in Group A and 83.5 points in Group B (P = .2278). The postoperative anteversion measurement in the operated extremity ranged from -15 to 19 in Group A, and from 5 to 18 in Group B. When the anteversion degrees were compared between the injured and uninjured extremities in the postoperative period, a significant difference was observed within Group A (P = .0018), but no significant difference was observed in Group B (P = .2492). Dual plate fixation using the anterior paramedial approach is an effective operative method for osteoporotic distal femur fractures. This has many advantages such as precise exposure, easy manipulation, anatomic reduction, and stable fixation. However, for surgical indications and medial bone defects > 1 cm, grafting should be performed.

Surgical Approach to Acute Osteochondral Fracture With Patellar Instability in Skeletally Immature Patients

Background: Patellar instability is a common condition that affects many young, active patients and can lead to long-term disability. This video aims to provide insights in the treatment of acute osteochondral fractures in skeletally immature patients after acute patellar dislocation. Indications: Patients who present with acute patellar dislocation and evidence of osteochondral fracture or osteochondral fracture with a loose body are potential candidates for medial patellofemoral ligament reconstruction (MPFLR) with osteochondral fragment fixation. Technique Description: In case 1, arthroscopy revealed a medial patellar facet defect. A medial patellar incision was made with dissection down to the vastus medialis oblique fascia and medial retinaculum. Before continuing to capsulotomy, the dissection for the MPFLR is completed by dissecting down to create a plane between layers 2 and 3. Capsulotomy is then performed with retrieval of the loose body, preparation of the patellar defect, and fixation of the osteochondral fragment. The MPFLR is then performed. An allograft is fixed to the patella with 2 pushlock anchors, and to a distally directed femoral tunnel using a 7-mm pitchfork SwiveLock tenodesis anchor, with care to avoid the medial femoral physis. The capsulotomy is then closed underneath the graft, with layer 2 closed above it. In case 2, a large osteochondral fracture of the lateral femoral condyle with loose cartilage flaps was arthroscopically identified. An anterior incision was made and a lateral lengthening was completed to perform a laterally based arthrotomy to expose the defect on the lateral femoral condyle. The defect site was prepared and the loose body was secured and fixated into the donor site lesion using bioabsorbable screws. The MPFLR was completed as in case 1, and the wound was closed in standard fashion. Results: Acute patellar dislocation with osteochondral fracture has been shown to lower both subjective and functional patient outcome measures. A recent study suggests that in large osteochondral fractures after patella dislocation, internal fixation improves mid- and long-term outcomes when compared with debridement alone. Conclusion: The MPFLR with concurrent osteochondral fracture fixation in patients with open physes is a reliable option for improving patellar stability and protecting articular cartilage from further injury. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form.

Early Clinical Efficacy of Small Incision Reduction and Superior Closed Pin Fixation of Goss-Ideberg Type III Glenoid Fractures using X-ray and CT Scan.

Imaging techniques such as X-rays and 3D Computed Tomography (CT) are used to diagnose and evaluate a patient's shoulder before and after surgery. Identifying the kind, location, and severity of a shoulder fracture helps surgeons choose the right treatment and surgery. The study examines the effectiveness of small incision reduction and superior closure pinning in treating Ideberg type III glenoid fractures identified by X-ray and CT scans. From October 2017 to June 2022, 40 patients with Ideberg type III glenoid fractures underwent mini-incision reduction and superior closed pinning fixation using the Anterior (AA) and Posterior (PA) approaches. Pre- and post-surgery shoulder scores and imaging data were analyzed. Outpatient review and shoulder anteroposterior radiographs were collected at 1, 3, 6, and 12 months after surgery. We assessed shoulder joint function using the American Shoulder and Elbow Society (ASES) shoulder score, VAS score, Constant-Murley Shoulder Outcome (Constant) score, and DASH score. A total of 40 patients were monitored for 14-16 months, averaging 15.2 ± 0.3 months. All fractures were healed between 14-25 weeks from X-rays, averaging 17.6 ± 5.4 weeks. Both the AA and PA groups had similar shoulder score changes. However, the AA group did better. In all cases, ASES shoulder scores were outstanding at 80%. Radiographs demonstratedno traumatic arthritis or internal fixation failure consequences like screw loosening or breakage. It was concluded that Ideberg type III glenoid fracture reduction with an anterior small incision and superior closed pinning hollow lag screw internal fixation could be successful.

Is the Complication Rate in the Surgical Repair of the Distal Biceps Tendon Rupture Influenced by the Timing, Type of Incision and Method of Fixation?

Distal biceps tears are uncommon injuries, typically leading to significant loss of elbow flexion and supination strength; surgical repairs restore muscular strength and endurance. The aim of this study was to compare the complication rate of early (< 21 days) vs delayed (> 21 days) repair and the effect of types of incision and fixation methods used in the repair. A total of 86 cases were retrospectively reviewed, and 66 cases were included in the study after exclusion. Different preoperative and intraoperative variables and postoperative outcome measures were recorded. We analysed the effects of early and delayed repair, types of incision and fixation methods on the complications. 31 had an early, and 35 had delayed distal biceps repair. The mean follow-up was 14.92 weeks. 13.6% had major, and 40.9% had minor complications. No significant difference was noted in complications between the two groups (54.8% vs 54.3%). Higher complications were observed when surgery was done using a single anterior incision compared to 2 anterior incisions (68.8% vs 16.7%, p=0.0002). Overall, higher (76.3% vs 25.9%, p=0.0001) complications were noted in patients where fixation was done using a cortical button & interference screw in comparison to the cortical button alone. No significant difference in complication was noted between early and delayed repair. However, more complications were noted in the single anterior incision compared to the two anterior incision technique. Higher complications were also observed with the cortical button and interference screw fixation method compared to the cortical button alone.

Cutaneous Layer and SMAS Suspension (CaSS) Lift as a Minimally Invasive Lateral Midface Lift.

In our prior study, the authors determined that pulling on the superficial adipose layer is more effective in lifting the skin than pulling on the superficial musculoaponeurotic system (SMAS). Applying this concept of using the superficial adipose layer to transmit the lifting force to the skin, this study examined improvements in patients who underwent lateral midface lifting using our minimally invasive multilayer lifting technique and measured the duration of those improvements. Along the hairline in front of the sideburns, a W-shaped zigzag incision of 3 to 8mm in width and 3 to 4cm in length was made. On the temporal scalp, 3 to 4cm away from the first incision, a second incision was made more lateral/posterior to the first incision, and an elliptical excision of 3 to 5mm in width and 3 to 4cm in length was made. From the medial cut margin of the anterior first incision, the superficial temporal fascia/SMAS (the deep layer), and the superficial adipose layer (the superficial layer) were purchased with 3-0 polyester sutures, tunneled under the soft tissue, and fixed to the deep temporal fascia of the second posterior temporal incision. Prior to the excised temporal scalp closure, the dermis in the medial cut margin of the second incision was pulled to the rear as much as possible and fixed to the deep temporal fascia. The effects of surgery were monitored for 6 to 42 months after surgery. The nasolabial folds were improved. Skin elasticity also showed significant improvements, which lasted throughout the follow-up period (up to 42mo). Unlike traditional wide dissection SMAS facelift, our method requires minimal incisions and does not require skin undermining. Therefore, the operating time is shorter, and postoperative swelling is minimized. In our technique, the superficial adipose layer, the superficial temporal fascia/SMAS, and the dermis were pulled individually to lift all layers of the lateral midface soft tissues. This results in a significant and long-lasting lateral midface rejuvenation.