Average VAS Score Research Articles

Functional Outcome and Incidence of Osteoarthritis in Operated Tibial Plateau Fractures.

In the challenging tibial condyle fractures despite anatomical joint reconstruction, development of osteoarthritis may still occur secondary to the initial articular cartilage and meniscal injury. The aim of the study was to know incidence of osteoarthritis in our operated cases of tibial plateau fracture and to evaluate functional outcome. Our operated 60 patients of tibial plateau fractures between 2006 to 2013 were evaluated retrospectively. Pre-operative radiographs were classified using Schatzker classification. Patients were followed up clinically and radiologically and were assessed for functional outcome and development of osteoarthritis. The average duration of follow up was 76.32 months ranging from 42 to 130 months. The average age was 41.28 (20-73) years. According to Schatzker classification type VI accounted for 32.5% and type V for 20 %. Average VAS Score was 1.35 ranging from 0 to 4. According to American knee society scoring system, 47patients had excellent and 8 patients had good knee scores, while 52 patients had excellent, 4 patients had good and 1 patient had poor functional scores. According to Ahlback classification 25 patients had grade I, while 9 patients had grade II, 7 patients had grade III and 3 patients had grade IV osteoarthritis of knee. Incidence of osteoarthritis goes higher with Schatzker's grading. Despite presence of radiological arthritis patients can have good clinical function if the articular reduction and limb alignment are maintained. Treatment goals should include a congruent articular reduction, adequate knee stability, anatomical limb alignment and avoidance of complications. IV.

Ten years retrospective study of using primary microsurgery technology to treat patients with severe lower extremities injury

Objective To clarify the role of microsurgery in limb salvage procedure and its efficiency in longterm functional results through a retrospective review of patients who sustained severe injury of lower extremities and had been treated Shanghai 6th people's hospital, in recent 10 years. Methods Patients who sustained severe injury of lower extremities and treated with microsurgical techniques in January, 2006 to January, 2016 were studied. Patients' general information, classification of open fracture, and MESS were noted. The enrolled patients were divided into two groups(group A: primary microsurgical reconstruction; group B: non-microsurgical reconstruction) according to whether primary microsurgical reconstruction was performed or not. Each group were also further divided into subgroup according to preoperative MESS(MESS<7 and MESS≥7). The reconstruction methods, hospitalization days, operation times, postoperative complications, as well as the SIP were then recorded for each groups. The differences of these data among each groups were analyzed and compared. Results The main objection was patient with Gustilo grade III open fracture, totally 548 patients were admitted, with 312 males and 236 females. The main age was 35.6 years old. The main etiology was road traffic accident (79.7%). There were 211 patients (38.5%) in group A, and 337 patients (61.5%) in group B. In group A, there were 37 patients in subgroup one (MESS<7), and 174 patients in subgroup two(MESS ≥7). The rate of delayed amputation was 2.8%, while the complication rate was 11.8%. In group B, there were 181 patients in subgroup one(MESS<7), and 156 patients in subgroup two (MESS≥7). The rate of delayed amputation was 4.0%, while the complication rate was 13.3%. In long-term survey, the average VAS score of group B was higher than that of group A, but no significant difference was noted. The average VAS scores in 2 year postoperatively in the subgroups (MESS≥7) were higher than those in the other subgroups(MESS<7). The results of SIP scores were similar with VAS scores in two groups. Conclusion The techniques of microsurgery has been promoting the successful rates and outcomes for limb salvage procedure over the recent decades. Meanwhile, the current evaluating system for severe limb injury needs to be updated to meet the demands of ever-developing limb salvage techniques. Key words: Severe lower limb injury; Limb salvage; MESS; Microsurgical technique

Use of intrathecal midazolam or fentanyl as an adjunct to spinal anaesthesia with bupivacaine for lower limb surgery: A randomised controlled study

BackgroundIntrathecal adjuncts have been used to prolong the quality and duration of subarachnoid anaesthesia. Midazolam given intrathecally is reported to have antinociceptive properties. The purpose of this study was to compare intrathecal midazolam with fentanyl for pain relief and patient comfort. MethodsIn this prospective, double-blind, randomised controlled trial, 90 patients for lower limb surgeries were randomly allocated to three groups: “control group” (3 ml 0.5% heavy bupivacaine), “fentanyl group” (3 ml 0.5% bupivacaine + 10 mcg fentanyl) and “midazolam group” (3 ml 0.5% bupivacaine + 1 mg midazolam). Level, duration, and quality of blocks were compared along with the duration and quality of postoperative analgesia. Haemodynamic stability and any associated complications were also noted. ResultsOnset of block was fastest in Group C (28.5 ± 13.48 min) vis-a-vis other groups (35.5 ± 26.05 min for Group “F” and 28.5 ± 23.68 min for Group “M”; P = 0.51). Duration of block was comparable in all groups (130.5 ± 39.3 min Group “C”; 126.5 ± 44.0 min Group “F” and 129.5 ± 45.7 min Group “M”; P > 0.5).Addition of adjuncts did not significantly defer the appearance of pain. Intensity of pain was lower in Group “M”. Average VAS scores were lower for Group “M” (3–4) than those for Group “C” (4–5) and Group “F” (4–6).Majority of patients required at least one dose of rescue analgesic; however, those receiving fentanyl reported better quality of postoperative analgesia than those in midazolam group. ConclusionAdjuvants improve quality of postoperative analgesia (fentanyl better than midazolam).

Mini-bandelette sous-urétrale versus bandelette transobturatrice : efficacité et morbidité

ObjectiveTo compare the effectiveness of an ALTIS® mini-sling and a conventionnal suburethral sling TVT-ABBREVO® for treatment of female stress urinary incontinence. MethodsA single-center retrospective study included all female patients fitted with a conventional transobturator tape (TVT-ABBREVO®) or mini-sling (ALTIS®), during 2015, in Angers university hospital. The success rate was defined by no urine leakage during a cough test on clinical examination, improved quality of life defined by a PGI-I (Patient Global Impression of Improvement) score of 1 to 3, and no stress urinary incontinence on USP (Urinary Symptom Profile) questionnaire. Morbidity associated with slings and perioperative data were also recorded. ResultsNinety-two patients were included (39 in the ALTIS group and 53 in the ABBREVO group). The average follow-up was 13.55 months. The success rate was not significantly different in ALTIS group for the negative cough test (89.7% vs 94.3% in ABBREVO group, P=0.45), for the absence of urinary leakage reported on the USP questionnaire (87.2% vs 90.6% in ABBREVO group, P=0.61), or for the improvement of the quality of life with a PGI-I score between 1 and 3 (82.1% vs 86.8% in ABBREVO group, P=0.53). On the other hand, more patients were fully satisfied, with a PGI-I quality of life score of 1, in ABBREVO group than in ALTIS group (67.9% compared with 46.2%, P=0.03). Immediate postoperative pain was significantly less intense in ALTIS group than in ABBREVO group (average VAS score of 0.5 comparated with 1.3, P=0.01), but this difference had disappeared one week after surgery. The rates of other complications were similar in both groups. ConclusionThe functional results of the ALTIS and TVT-ABBREVO® slings appear similar in the treatment of female stress urinary incontinence.

Five-Year Results of Suture Suspension Thumb CMC Arthroplasty

Ownership Interest: IlluminOss Medical (Weiss) Receipt of Intellectual Property: IlluminOss Medical (Weiss) Royalty: Medartis, Extremity Medical, Arthrosurface (Weiss) Most studies have demonstrated little difference in the outcome of the various techniques proposed for the treatment of thumb CMC arthritis. However, the difficulty and time required to perform each technique vary widely. In addition, the introduction of recent implants has increased the cost of the overall procedure. We hypothesize that using a simple, yet stable, suture suspension technique without tendon interposition or ligament reconstruction yields similar results to conventional approaches with far less operative time and economic cost. 320 consecutive patients underwent thumb CMC arthroplasty by trapezial excision and metacarpal suspension using number 2 high-strength orthopedic suture locked weave alone passed from the distal most APL and FCR insertions without K-wire fixation or tendon transfer by the senior surgeon. Average duration of preoperative symptoms was 17.8 months. Patient radiographs were graded for arthritis severity and a VAS pain score (scale 0–10) obtained. Average preoperative Eaton score was 2.6 with a VAS pain score of 7.9 (range of 5–10 on a 0–10 scale). Postoperative clinical and radiological follow-up averaged 5.4 years (minimum of 24 months). The average age at surgery was 57.3 years with 221 females (243 procedures) and 65 males (77 procedures). Average total operative time was 23.4 minutes. The dominant hand was involved in 52% of patients. All had prior treatment including orthoses and NSAIDs, with 312 having at least one steroid injection. Five patients had stage 1, 134 had stage 2, 164 had stage 3, and 17 had stage 4 disease on radiographs. Average trapezial space height on final follow-up radiographs was 0.8 cm. Two patients had complete trapezial space collapse and required a revision procedure (Figure 58-1). The average VAS score was 0.6 with pain eliminated in 269 thumbs, minimal in 49, and unchanged/worse in 2. All patients who were employed at the time of surgery returned to work at an average of 2.3 months (range 3–16 weeks). Suture suspension thumb CMC arthroplasty appears to provide equal clinical results and several advantages over many current techniques:•Shortened operative time•Inherent stability of the thumb metacarpal height•No requirement for K-wire fixation•No requirement for tendon transfer•No requirement for implants•Simple technique with minimal cost

A study on the outcome of arthroscopic synovial biopsy and synovectomy in the management of chronic synovitis of the knee

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Synovitis of the knee can be very difficult to treat especially when the diagnosis remains elusive. Synovitis occurs because of various causes. We assess the patients presenting to our hospital with synovitis of the knee, who underwent arthroscopic synovial biopsy and partial arthroscopic synovectomy and did a review of literature.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This retrospective study included 25 patients with chronic synovitis of the knee presenting to our institution between July 2012 to January 2016. Inclusion criteria were patients presenting with persistent swelling of the knee; not responding to conservative measures. We excluded patients who had recurrent synovitis, patients who had septic arthritis. All patients underwent Arthroscopic synovial Biopsy and partial synovectomy. Preoperative and postoperative VAS score was calculated.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; In n=6 patients the histopathological diagnosis was Tuberculosis, which improved with Anti tuberculous drug treatment. In n=1 patient the diagnosis was lipoma arborescens, in n=1 patient the diagnosis was plant thorn synovitis, in n=3 patient the diagnosis was Juvenile rheumatoid arthritis; all 5 patients improved with synovectomy and NSAIDS. In n=14 patients the biopsy report came as chronic non-specific synovitis, 8 of these patients did well with arthroscopic synovectomy while the other 6 had a recurrence. The average VAS score improved from 8.8- pre surgery to 4.7 post surgery.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Arthroscopic synovial biopsy and synovectomy gives good results in patients with chronic synovitis of the knee. It may be recommended as a treatment for chronic synovitis of the knee, which is not responding to conservative measures of treatment.&lt;/p&gt;

Wednesday, September 26, 2018 3:35 PM – 5:05 PM Preserving Spinal Motion: 89. Impact of range of motion on patient outcomes five years following lumbar TDR at L5-S1

BACKGROUND CONTEXT Total disc replacement (TDR) is an alternative to fusion that preserves index level motion. A common misconception is that L5-S1 should be fused because TDR implants do not move at this level. Previously, we reported TDR at L5-S1 preserves motion at this level 5 years postimplantation, and that mobile core devices maintained better motion than constrained core devices. This study aimed to relate clinically significant improvements in patient outcomes (VAS and ODI) to the degree of motion at the L5-S1 index level. METHODS This is a post-hoc analysis of data collected from a large, multicenter clinical trial. Eligible patients were randomly allocated (2:1) to treatment with an investigational TDR device (activL) or a control TDR device (ProDisc-L or Charite). Range of motion (ROM), back pain (VAS) and Oswestry Disability Index (ODI) scores were available at the 5-year time point for 119 patients in the investigational group and 50 patients in the control group with L5-S1 TDR. RESULTS ROM was significantly better at L5-S1 at 5 years for patients implanted with the activL device (6.6° at baseline vs. 6.7° at 5 years, NS) than it was using the control devices (6.7°at baseline vs. 4.8°at 5 years, p=.002). Average ODI and VAS scores for back pain significantly decreased at 5 years from baseline for both groups. There were no differences in ODI or VAS scores between groups at 5 years, but each incremental improvement in ROM correlated with incremental clinical improvement. The percentage of patients demonstrating clinically significant (CS) improvements in ODI and VAS back pain scores (≥ 15% from baseline) at 5 years for every two degrees of ROM at L5-S1 was determined. For patients with 0-2° of motion, 81% and 86% of activL and control patients, respectively, demonstrated a CS improvement in ODI. CS improvement in ODI was observed in all patients with 8-10o of motion at L5-S1. Similarly, an average of 81% TDR patients with 0-2° of motion at L5-S1 demonstrated CS improvements in back pain. Compared to ODI scores, CS improvement for back pain was achieved in 100% of patients at just 6-8° and 4-6° for activL and control patients, respectively. CONCLUSIONS These data show that for patients with TDR at L5-S1, a greater proportion exhibited clinically significant improvements in lower back disability and pain when there was more motion at the index level at 5 years postsurgery, suggesting motion preservation has an impact on function and pain for L5-S1 index level procedures. ActivL improved L5-S1 ROM significantly better than ProDisc-L or Charite. FDA DEVICE/DRUG STATUS ActivL, Prodisc-L, and Charite: Approved for this indication.

Functional outcomes of patients receiving total hip arthroplasty for ankylosing spondylitis

To assess the functional outcomes of patients undergoing total hip arthroplasty for ankylosing spondylitis (AS). Between March, 2013 and May, 2016, 75 AS patients with ankylosed hip (involving 92 hips) underwent unilateral biological artificial total hip arthroplasty. The patients were followed up for 12-24 months and the changes in VAS score of the affected hip were evaluated. The changes in the range of motion (ROM) of hip, employment, BASFI and BASDAI score, and Harris score were analyzed after the operations. Significant improvements in general joint mobility, clinical symptoms and hip joint functions were achieved in all the patients. The average VAS score was significant reduced from 6.51± 1.32 preoperatively to 2.47±0.38 after the operation. Significant improvements were also achieved after the operation in the average Harris hip score (from 22.51±3.32 to 89.17±2.52), the total ROM (from 0 to 171.50±30.30), and mean BASFI score (from 6.2±2.6 to 2.3±1.2; all P < 0.05). At the final follow up, 42 hips showed excellent outcomes, 38 hips had good outcomes, and 12 hips had acceptable outcomes, with a good outcome rate of 87%. By 6 and 12 months after the operation, 6 and 32 of the 75 patients returned to work. No neurovascular injuries, infections or dislocations was found in the patients during the follow-up; 1 patient had prosthesis loosening found by X-ray ordered for complaint of pain in the affected hip 4 months postoperatively. Five patients had heterotopic ossifications, including 3 grade Ⅰ hips and 2 grade Ⅱ hips according to the Brooker grading system. Biological artificial total hip arthroplasty is effective for treatment of ankylosing spondylitis with hip stiffness with good functional outcomes of the hip joint.

Chronic Symptomatic Ankle Avulsion Fracture

Category: Ankle Introduction/Purpose: Persistent pain and instability following inversion or eversion injuries of the ankle is not rare. Besides injury of lateral or medial ligaments, avulsion fracture of lateral or medial malleolus could be found in some cases. The avulsion fracture may result in nonunion and/or ligamentous laxity which could lead to chronic ankle pain. The purpose of this study was to evaluate the intraoperative findings and long-term outcomes of patients of symptomatic ankle avulsion fracture. Methods: 23 patients of ankle avulsion fracture along with chronic ankle pain and instability were studied. Tenderness and swollen at lateral and/or medial gutter were found and radiographic images were taken for the diagnosis. After at least 6 months of unsuccessful non-operative treatment, all patients underwent surgery of osseous fragments excision and anatomic ankle ligaments reconstruction. AOFAS-AH and VAS Score were given to assess the outcomes of surgery. Results: There were 21 males and 9 females among the patients. The average age of the patients was 24.6 years (range, 18-45 years) at the time of injury and 27.3 years (range, 18-46) at the time of surgery, indicating a mean delay in diagnosis and/or treatment of 2.7 years. At a mean follow-up of 2.6 years (range, 1 to 5.2 years), the average AOFAS-AH Score increased from 72.5 to 93.2 out of 100 (P&lt;0.05), the average VAS score decreased from 6.2 to 1.2 (P&lt;0.05). Conclusion: For those patients of ankle avulsion fracture presenting with chronic ankle pain and instability, surgical excision of the bony fragment combined with reconstruction of ankle ligaments were effective in eliminating pain, restoring ankle stability, and helping return to the pre-injury functional level.

Is it safe and practical to use a Foley catheter as a chest tube for lung cancer patients after lobectomy? A prospective cohort study with 441 cases

ObjectiveThis study was conducted to explore the feasibility and safety of postoperative chest drainage with a Foley catheter for lung cancer patients undergoing a video-assisted thoracoscopic surgery (VATS) lobectomy. MethodsData from lung cancer patients who underwent a VATS lobectomy with insertion of a catheter (Foley catheter or 28-F chest tube) were analysed. A total of 441 patients were included preoperatively for participation, with 208 patients in the Foley catheter group and 233 in the 28-F group. ResultsIn the Foley catheter group, a shorter mean number of days was required until chest tube removal after lobectomy (2.6 ± 1.3 vs. 3.5 ± 2.0 d, P < 0.001) and postoperative length of stay was shorter (3.8 ± 2.5 vs. 5.2 ± 4.1 d, P < 0.001); The 28-F group had a higher average VAS score than did the Foley catheter group at 6 h (P = 0.025), and 48 h (P < 0.001) after VATS lobectomy as well as at 6 h, 24 h, 48 h, 72 h, 30 days and 90 days after chest tube removal (P < 0.001). Regarding postoperative pulmonary complications (PPCs) and chest tube removal-related complications, the rate of PPCs was not found to be significant, and a significantly higher proportion of disordered wound healing at the drainage site was observed in the 28-F group (5.8%, 12/208 vs. 11.6%, 27/233; P = 0.043). ConclusionThe study indicated that placement of Foley catheter vs. 28-F chest tube was associated with a statistically significant but clinically modest reduction in pain, with shorter mean days until chest tube removal after lobectomy, shorter in-hospital stay, and a smaller proportion of disordered wound healing at the drainage site. These results indicate the feasibility and safety of postoperative chest drainage with a Foley catheter for lung cancer patients undergoing VATS lobectomy. Clinical registration numberChiCTR1800014816

Percutaneous Kirschner wire fixation combined with mini external fixation for treatment of the fifth metacarpal base fractures

Objective To evaluate the clinical outcomes of the minimally invasive technique of percutaneous Kirschner wire fixation combined with mini external fixation in the treatment of the fifth metacarpal base fractures. Methods Eleven patients underwent this minimally invasive technique were enrolled and followed up. All of the patients were diagnosed as the fifth metacarpal base fractures according to the typical X-ray manifestation. In this modified procedure, the fracture was reduced by mini external fixation traction and manual manipulation, and the fifth metacarpal was then fixed to the fourth and third metacarpal by 2 percutaneous Kirschner wires. All the fixation devices were removed 6 weeks postoperatively. The mean follow-up period was 15.7 weeks. X-ray, VAS score, range of motion (ROM) as well as the grip strength of the affected hand were checked for all the patients and the TAM scoring system was used for the function evaluation. Results All the 11 patients achieved satisfied union for the fifth metacarpal base fractures without wire tract infection or screw rod loosening and break. The average postoperative VAS score was 1.13. The patients achieved an averaged 89.3% grip strength compared to the healthy side. According to the TAM scoring system, the results were excellent in 6 cases, good in 4 cases and fair in 1 case. Conclusion The minimally invasive technique of percutaneous Kirschner wire fixation combined with mini external fixation appears to be an effective and safe procedure for treatment of the fifth metacarpal base fractures. Key words: Fractures,bone; External fixators; Fifth metacarpal base; Minimally invasive technique

EVALUATION OF THE PAIN MANAGEMENT EFFICIENCY AFTER PRIMARY HIP ARTHROPLASTY: RESULTS OF KVEST PROJECT

Introduction. Celecoxibum being one of high-selective COX-2 inhibitors is specifically inhibiting COX-2 in vivo not influencing protective effect of COX-1. Celecoxibum systemic administration after primary arthroplasty in combination with local infiltration anesthesia has a number of advantages. Purpose of the study. To evaluate the efficiency of postoperative pain relief by Celecoxibum in primary hip arthroplasty using standard and minimally invasive approaches as well as to analyze the pain syndrome dynamics by a method of local infiltration anesthesia (LIA).Material and methods. The study included 91 patients with hip arthritis of grade III-IV without severe anatomical alterations who underwent primary hip arthroplasty in the Vreden Research institute of traumatology and orthopaedics during 2017. Patients were randomized by type of surgical approach used (standard or minimally invasive), the authors compared monotherapy by Celecoxibum with a multimodal anesthesia which included systemic Celecoxibum administration in combination with LIA. Additional evaluation of two LIA methods was conducted in the group of patients with standard approach.Results. Pain syndrome dynamics was comparable in all groups — minimal intensity within first day after the surgery and almost complete absence of pain on day 7. However, on day 3 variance between the subgroups increased: the best outcome was observed in the group of minimally invasive approach combined with LIA VAS score was 1.0 (95% CI, 0–1); in the group with standard approach without LIA VAS score was 4.5 (95% CI, 2–7); in the group with standard approach with a single LIA VAS score was 2.6 (95%CI, 0–5); in the group with standard approach with threestage LIA VAS score was 2.4 (95%CI, 0–5); in the group with minimally invasive approach without LIA VAS score was 3,9 (95% CI, 0–2). On day 7 the parameters in all groups demonstrated no statistically significant variances with a minor elevation in cases when LIA was not performed and with average VAS score of 0.8 (95% CI, 0–4). By day 14 pain syndrome was absent or within a range of 1 point in all patients, by this treatment stage Celecoxibum medication was stopped in 37 out of 91 patients (40.7%).Conclusion. Administration of Celecoxibum per os (200 mg twice per 24 hours) in combination with LIA by Ropivacaine and dexamethasone solution in primary hip arthroplasty provides fast relief of pain facilitating early mobilization of patients and accelerated rehabilitation. Celecoxibum safety in therapeutic dose was also proven.

Anterior knee pain following BPTB graft harvest. Reality or overhyped

IntroductionThe patellar tendon graft has long been the gold standard for ACL reconstruction. Recently semitendinosus and gracilis tendons graft have been used increasingly. We hypothetise that the Bone-Patella Tendon-Bone graft is a good and economical graft for the Indian population with no adverse effects of anterior knee pain or patellar tendon shortening. We believe that the early squatting and cross-legged sitting causes early and constant stretching of the tendon in our patients. This is responsible for the lesser incidences of adverse effects in the Indian population. Material and MethodIn a retrospective study, the hospital database was scrutinized to shortlist patients who had undergone a bone-patella tendon-bone harvest for ACL or PCL reconstruction before 2013. Each patient was evaluated using the Lysholm score and the KOOS Score. VAS was also used, to evaluate for the amount of pain experienced by patients. The analysis of the quadriceps power along with the presence or absence of any extensor lag was made too. The modified Insall Salvati index was also calculated. ResultsForty-seven patients were shortlisted of which 25 patients were followed up with an average follow up of 94.5 months. Although some patients did complain of occasional pain with the average VAS score of 1.45; on analyzing the data it was evident that all our patients had excellent quadriceps power (5/5) with no extensor lag. The mean Lysholm score was 95.55, while the mean KOOS score was 94.17. The mean Insall index of 1.05 showed no significant patella baja in any of our patients. ConclusionIt is ascertained that no significant retro-patellar pain or shortening of the patellar tendon occurs following a bone patella tendon bone harvest. The bone patella bone tendon graft is a suitable graft for ligament reconstruction with good functional outcome, and no significant adverse effect of patella baja or anterior knee pain in the Indian patients. Level of EvidenceLevel IV.

Mid-term results of fixation of coronoid fractures via modified anterior elbow neurovascular interval approach

Objective To explore the efficacy and complication prevention of operative fixation of coronoid fractures via neurovascular interval of anterior elbow approach. Methods From March 2006 to September 2009, data of 21 patients with coronoid process fractures associated with complex elbow dislocation who were treated via neurovascular interval of anterior elbow approach in my ward were retrospectively analyzed. There were 14 males and 7 females. The mean age of the patients was 31.6 years (range, 18-52 years). Injury was caused by walk falling in 10 cases, falling from standing-height in 3 cases and sports events in 8 cases; 7 patients were left side and 14 patients were right side, including 16 prominent sides and 5 non-prominent sides. There were 3 type Ia, 3 type IIa, 8 type IIb, 4 type IIc, 3 type IIIa coronoid process fractures according to the O'Driscoll's classification. Pre-operative 3D-CT scans were conducted to clarify if there were subluxations or sign of instabilities in elbows. Operative fixation of coronoid process fractures with cannulated screws and/or mini plates and/or suture anchors were carried out via the anterior interval between humeral vessels and median nerve, and then lateral collateral ligaments were repaired if instability still existed. Results The average operation time was 72 min, and the follow-up time was 52-74 months. Only 1 case of type Ia fracture got nonunion because of early postoperative activities from the first day after the operation and the elbow was fixed at 0 degree of extension with brace. At the latest follow-up, in suture anchor fixation group (3 cases), the average VAS was 1.8±0.5, Broberg-Morrey score 90.2±6.6, extension deficiency 11.2°±3.6°, flexion 133.4°±8.8°, and the excellent-good-rate was 66.7% (2 cases excellent and 1 fair). In the screw-fixation group (10 cases), the average VAS was 1.6±0.8, Broberg-Morrey score 89.2±6.6, extension deficiency 15.2°±4.6°, flexion 130.8°±10.8°, and the excellent-good-rate was 90% (6 cases excellent, 3 good, and 1 fair). In the mini plate fixation group (8 cases), the average VAS score was 1.6±0.7, Broberg-Morrey score 88.6±6.7, extension deficiency 11.8°±5.6°, flexion 134.2°±8.6°, and the excellent-good-rate was 87.5% (4 cases excellent, 3 good, and 1 fair). In the lateral ligament repaired group (14 cases), the average VAS was 1.3±0.9, Broberg-Morrey score 91.5±6.3, extension deficiency 10.2°±3.4°, flexion 135.2°±4.2°, and the excellent-good-rate was 100% (8 cases excellent, 6 good). In the lateral ligament non-repaired group (7 cases), the average VAS was 2.2±1.6, Broberg-Morrey score 80.2±13.8, extension deficiency 13.6°±4.4°, flexion 126.6°±4.0°, and the excellent-good-rate was 71.4% (3 cases excellent, 2 good, 1 fair). There were 5 cases which had early osteoarthritis changes in the elbow joint in 3 years’ follow-up, with the incidence rate 23.8% (5/21), and the incidence of mid-term osteoarthritis in the 5 and 7 years after operation was 4.8% (1/21). Conclusion Operative fixation of coronoid fractures with suture anchor and/or cannulated screw and/or mini plate via neurovascular interval of anterior elbow approach was confirmed to be efficient and safe. Lateral collateral ligaments should be repaired if the elbow is unstable. Key words: Elbow joint; Dislocations; Joint instability; Ulna fractures

Percutaneous endoscopic interlaminar lumbar discectomy for high-grade inferiorly migrated L5-S1 disc: A case report with technical review

L5-S1 disc has always been a difficult disc to target by rigid endoscope because of anatomical limitations. In this study, we have described the technique to overcome difficulty faced during endoscopic disc decompression of high-grade inferior migrated disc at L5-S1. We performed percutaneous endoscopic inter-laminar lumbar discectomy (PEILD) for removal of high grade inferiorly migrated disc and preserved the functional structures. After institutional review board approval, details of the patient with high-grade inferior migration at L5-S1 disc were reviewed. The patient was operated by a single specialist with use of the percutaneous endoscopic inter-laminar technique for high-grade inferior migrated extruded disc. Description of our technique & result is the focus of this study. The average VAS score was reduced from 9 pre-operatively to 3 post-operatively & to 1-2 within 2 weeks. Post-operative plantar flexion of foot improved from 2 to 4 immediately and up to 5 within 2 weeks. Ankle jerk reflex improved from 1+ to 2+. The pain severity score on BPI reduced from 9 to 3 postoperatively. Post-operative MRI showed that the high grade inferiorly ruptured disc had been successfully removed. We obtained excellent results in treating inferior extruded disc at L5-S1 using endoscopic inter-laminar approach. Inter-laminar endoscopic discectomy can be used as a safe yet minimally invasive technique for the treatment of lumbar radiculopathy in the setting of a high grade inferior migrated lumbar disc herniation.

Full-endoscopic lumbar discectomy for high canal compromised disc at upper lumbar level: A technical review

Objective: In this study, we have described the technique to overcome difficulty faced during trans-foraminal endoscopic discectomy for the treatment of lumbar radiculopathy in patients who have herniated discs at the upper lumbar level & thoracolumbar junction. Method: After institutional review board approval, A retrospective analysis of 27 patients operated between March 2013- September 2017, by a single specialist for disc herniation at upper lumbar levels D12-L1, L1-2, L2-3 with or without high canal compromise by outside in technique (using rigid endoscope, sequential reamers) along with detailed description of our technique is the focus of this study. Results: Out of 27 patients there were 11 cases for L1-2 & 16 cases of L2-3 disc herniation respectively. There were 21 cases of broad-based, high canal compromised disc herniation with significant neurological deficit & only 6 cases were of focal herniation type. The average preoperative VAS score of 8.5 (range 6-10) reduced to 4 (range 2-7) immediate postoperatively & it further reduced to 2 (range 0-4) at one month follow up. The average preoperative ODI score of 65 (range 28- 88) reduced to 27 (range 12-40) immediate postoperatively & it further reduced to 10 (range 3- 18) at one month follow up. Post-operative MRI showed that the ruptured disc had been successfully removed. Conclusion: An anatomically modified surgical technique promote a more successful outcome after percutaneous endoscopic discectomy for upper lumbar disc herniation. Foraminotomy is recommended for all intra-canalicular herniation. Transforaminal endoscopic discectomy and foraminotomy can be used as a safe yet minimally invasive technique for the treatment of lumbar radiculopathy in the setting of an upper lumbar disc herniation.

Outcomes of Implant-Arthrodesis as Limb Salvage for Failed Total Knee Arthroplasties with Significant Bone Loss: Case Series.

We sought to evaluate our consecutive series of knee-implant arthrodesis patients for failed total knee arthroplasties with medium term clinical and radiographic outcomes. We conducted a retrospective review of a consecutive series of 4 patients (average age, 75 years; range, 69-79) with failed knee arthroplasties and deficient extensor mechanism who underwent implant arthrodesis with a minimum 2-year follow-up. The primary outcome measure was the patient's reported outcome measures (Short-Form 12) and visual analogue scale for knee pain at final follow-up. All patients had multiple medical comorbidities, multiple previous knee surgeries with failed nonfunctional knee arthroplasties. Three patients had chronic infections and one had chronic pain and instability, and all had deficient extensor mechanism. Average follow-up was 5.5 years (range, 2-8), and the primary goal of surgery was achieved in all four patients. The average VAS score for knee pain was 3 of 10, and SF-12 was 36.16 (physical score) and 55.70 (mental score), indicating satisfactory outcomes. Satisfactory clinical and patient-reported outcomes can be achieved with implant arthrodesis as limb salvage for failed total knee arthroplasties with significant bone loss at medium-term follow-up.

Acupuncture for neuropathic pain in adults.

Acupuncture for neuropathic pain in adults.

Inhaled nitrous oxide can reduce the pain perception in post Caldwell-Luc operation patients\u2013a randomised trial

To assess the efficiency of inhaled nitrous oxide (N2O) for the reduce the perception pain in extraction of iodoform gauze packing strips in post Caldwell-Luc operation patients. This randomized single blind trial included a total of 47 patients, aged between 14–82 years, in which undergoing radical maxillary sinusotomy. Based on the randomization procedure, patients were treated with (experimental) or without (control) inhaled N2O. The visual analogue scale scores (VAS scores) of the pain perception and the headache duration time were comparatively studied. The average VAS score for pain perception was 3.92 in the N2O group and 7.87 in the control group. The average headache duration time was 0.12 hour in the N2O group and 13.09 hours in the control group. Both VAS scores for pain perception during the treatment and the average headache duration time were significantly reduced in the inhaled N2O group (P < 0.01). Reduced pain perception and headache duration time indicated that, the inhaled N2O method might be viable in extraction of iodoform gauze packing strips in post Caldwell-Luc operation patients.

Relevant Anatomy, Morphology, and Implantation Techniques of the Dorsal Root Ganglia at the Lumbar Levels

While dorsal root ganglion (DRG) stimulation has been available in Europe and Australia for the past five years and in the United States for the past year, there are no published details concerning the optimal procedures for DRG lead implantation. We describe several techniques that can be applied to implant cylindrical leads over the DRG, highlighting some tips and tricks according to our experiences. Focus is mainly shifted toward implantations in the lumbar area. We furthermore give some insights in the results we experienced in Spain as well as some worldwide numbers. A 14-gauge needle is placed using a "2-Level Technique (2-LT)" or exceptionally a "1-Level Technique (1-LT)" or a "Primary- or Secondary Technique" at the level of L5. The delivery sheath, loaded with the lead, is advanced toward the targeted neural foramen. The lead is placed over the dorsal aspect of the DRG. A strain relief loop is created in the epidural space. Sheath and needle are retracted and the lead is secured using an anchor or anchorless technique. In Spain, 87.2% (N = 78) of the selected patients have been successfully implanted. Seven (8.9%) had a negative trial and three (4.2%) were explanted. Average VAS score decreased from 8.8 to 3.3 and on average 94.5% of the pain area was covered. In our center's subjects (N = 47 patients, 60.3% of all implanted patients in Spain), VAS scores decreased from an average of 8.8-1.7 and pain coverage averaged 96.4%. We used an average of 1.8 electrodes. Worldwide more than 4000 permanent cases have been successfully performed. We present implantation techniques whereby a percutaneous lead is placed over the DRG through the use of a special designed delivery sheath. Further investigation of the safety, efficacy, and sustainability of clinical outcomes using these devices is warranted.