Average Visual Analogue Score Score Research Articles

Single posterior approach for circumferential debridement and anterior reconstruction using fibular allograft in patients with skipped multifocal spinal tuberculosis

BackgroundSkipped multifocal spinal tuberculosis (TB) is an atypical presentation of spinal TB. Surgical treatment for these unusual cases remains a challenge for spine surgeons. In our institute, we used single-stage circumferential debridement and anterior reconstruction with fibular allograft followed by posterior instrumentation through posterior-only approach for these patients. This study aimed to determine the efficacy and feasibility of this technique.MethodsTwelve patients with skipped multifocal spinal TB who received our treatment method from January 2012 to June 2020 were enrolled in this study. The visual analog score (VAS), laboratory data, comorbidities, complications, and neurologic status based on Frankel scale were recorded. The patients’ clinical conditions were evaluated based on modified Brodsky’s criteria and Oswestry Disability Index (ODI).ResultsAll the patients were infection free at the end of the treatment. The average VAS score was 7.5 (range, 7–8) before surgery and decreased to 2.1 (range, 1–3) one year postoperatively. No one experienced any severe complications such as neurologic deterioration, fixation failure, or bone graft dislodgement. Out of the three patients requiring debridement surgery, two had wound infection and one had seroma formation. The ODI score improved from 76.8 (range, 70–84) preoperatively to 25.5 (range, 22–28) one year after surgery. All patients achieved good or excellent outcome based on modified Brodsky’s criteria one year postoperatively.ConclusionsIn our study, the patients could achieve a good clinical outcome. This technique could be an alternative for patients with skipped spinal TB.

Results of in situ fixation of Andersson lesion by posterior approach in 35 cases.

Due to the rarity of the Andersson lesion (AL), the literature is ambiguous regarding the type of surgical fixation, need for debridement and deformity correction. The purpose of this retrospective study is to evaluate the efficacy, feasibility and functional outcome of posterior fixation in AL. This study included 35 patients having thoracolumbar AL operated for in situ fixation and fusion with minimum of 24-month follow-up. VAS (Visual Analogue Score) back pain, ODI (Oswestry Disability Index), Frankel's grade were compared and analyzed. Union status was noted with complications. The mean age of 35 patients was 56.34(± 11.3)years with average follow-up of 51.49months. Two patients had AL at two levels. 27/37 AL were at discal level. Average estimated blood loss (EBL) was 276.43ml and duration of surgery was 130.43min. On an average, operated segments needed 7.77 screws. There were ten minor complications without long-term sequel. Neurological improvement was noted in 30 patients. Average preoperative VAS score improved from 8.69 to 3.14, ODI score improved from 68.76 to 18.77 at final follow-up which were significant (p < 0.05). There was significant improvement in Frankel's grading (Z = - 4.354, P = 0.00). Surgical management of AL by posterior approach and posterior stabilization can give satisfactory results without the need of extensive anterior reconstruction, bone grafting or deformity correction procedures without added morbidity and complications.

Comparison between infrapatellar and suprapatellar approaches for intramedullary nailing for the fractures of the tibial shaft.

This study aimed to compare the outcomes at the clinical and functional levels of suprapatellar (SP) and infrapatellar (IP) approaches for intramedullary nailing in treating tibial shaft fracture. Patients who underwent tibial shaft fracture intramedullary nailing by the SP approach or IP approach in a trauma center were retrospectively reviewed. The demographics, intraoperative fluoroscopy time, operation time, blood loss, irrigation volume, postoperative X-ray alignment, and complications of patients were compared between the two groups under different approaches. Lysholm knee score, visual analog score (VAS), and incidence of anterior knee pain (AKP) were assessed 1year after surgery. The study finally included well-documented 81 patients (38 SP versus 43 IP). The SP group exhibited significantly shorter intraoperative fluoroscopy time than that of the IP group (81.7 ± 14.5s vs. 122.0 ± 24.3s, P < 0.001). Both aspects recorded a precise reduction of the fracture: angulation (2.1 ± 1.2° vs 3.1 ± 1.5°, P < 0.05) and translation (0.6 ± 0.8mm vs 1.4 ± 1.5mm, P < 0.05) in the coronal plane in the SP group. However, the sagittal plane recorded no such change (P > 0.05). The Lysholm knee score was higher in the SP group than that of the IP group (87 ± 8 vs. 80 ± 15, P < 0.05). The SP group displayed an evidently lower average VAS score than that of the IP approach group (0.3 ± 0.8 vs 1.3 ± 1.4, P < 0.001). Six cases (16%) in the SP group and 16 cases (37%) in the IP group experienced AKP 1-year post-operation (P < 0.05). As far as complications are concerned, neither group showed any significant difference (P > 0.05). Compared with the IP approach, the application of intramedullary nailing through the SP approach in treating tibial shaft fractures can effectively shorten the intraoperative fluoroscopy time, correct coronal plane angulation and translation deformity, reduce the incidence of AKP and improve postoperative function.

When is the circumferential stabilization necessary for subaxial cervical fracture dislocations? The posterior ligament-bone injury classification and severity score: a novel treatment algorithm.

To propose a novel classification and scoring system called the posterior ligament-bone injury classification and severity score (PLICS) that offers a quantitative score to guide the need for posterior stabilization in addition to anterior reconstruction for subaxial cervical fracture dislocations (SCFDs). A total of 456 patients with SCFDs were prospectively included. Patients with PLICS ≥ 7 together with extremely unstable lateral mass fracture (EULMF) were classified as high-risk group, and the other patients were classified as low-risk group. For patients in the low-risk group, anterior-only reconstruction was performed; for patients in the high-risk group, additional posterior lateral mass fixation and fusion was performed after anterior reconstruction. Clinical outcome evaluation included using the visual analogue score (VAS), the Neck Disability Index (NDI), and the American Spinal Injury Association (ASIA) impairment scale. The change in the local sagittal alignment kyphosis Cobb angle was also recorded. A total of 370 patients (81.1%) completed the minimal 12-month follow-ups, including 321 patients of low-risk group and 49 patients of high-risk group. Compared with the average VAS score preoperatively, the score at 12-month follow-up was significantly improved (from 6.1 + 0.3 to 1.1 + 0.2 in the low-risk group, P < 0.001; from 6.4 + 0.2 to 1.4 + 0.2 in the high-risk group, P < 0.001). The average NDI score at the 12-month follow-up was statistically low in the low-risk group (8.8 + 2.5 vs 13.8 + 3.4, P = 0.034). At least more than one grade improvement in the ASIA scale was observed in 80.5% of all patients. The local kyphosis Cobb angle at the injured segment averaged improved in both groups. A PLICS score ≥ 7 together with EULMF can be the threshold for posterior stabilization in addition to anterior reconstruction for the patients with SCFDs.

Relationship between disability and pain to post-traumatic stress disorder, depression, and anxiety in patient with postoperative brachial plexus injury (BPI)

Background Orthopedic trauma patients have the risk to experience mental disorders, including depression, anxiety, post-traumatic stress disorder (PTSD), and other mental disorders. However, studies that analyze the relationship between mental disorders in orthopedic trauma patients, especially post-operative brachial plexus injury (BPI), are still difficult to find. This study aims to evaluate the relationship between disability and pain to post-traumatic stress disorder, depression, and anxiety in patient with postoperative BPI. Materials and methods It was an observational analysis with cross-sectional design study. Data were collected from July 2019 to September 2019. All subjects were patients of Orthopedics Clinic Dr. Soetomo General Academic Hospital Surabaya. The Disabilities of the Arm, Shoulder, and Hand (DASH) score was used to determine the disability level in patients. Visual Analog Score (VAS) was an instrument for assessing pain scale and mental disorders used Mini International Psychiatry Interview (MINI). Results There were 41 subjects met the research criteria, consisted of 10 men (24.39%) and 31 women (75.61%), aged 12–63 years. Based on the status of education, most subjects were graduated from junior/senior high school with 28 subjects (68.29%). The most common cause of BPI was traffic accidents as many as 37 people (90.24%). Mental disorders diagnosed from MINI found ten people (24.39%) were diagnosed with major depression; two subjects (4.87%) had generalized anxiety disorder. The average VAS score was 5.15 and the average DASH score was 52.02. There was no significant difference in VAS scores in the major depression group and PTSD group. However, there was an association between DASH score and depression (p < 0.05). Surprisingly, this study found the risk of suicide among BPI (7.3%) and one person with psychotic disorders (2.43%). Conclusion The level of disability and pain in orthopedic trauma patients with depression tend to more severe than without depression.

Novel anterior curved incision combined with MIPO for Pilon fracture treatment

BackgroundsPoor prognosis was reported for complex Pilon fractures involving severe soft tissue damage. It is therefore useful to explore the evolution of different treatment strategies in an effort to reconstruct the axial alignment and articular surface, while minimizing additional damage to the surrounding soft tissues.MethodsSeventeen patients with Pilon fractures were enrolled in this retrospective study from December 2009 to October 2014. The injuries were graded according to AO Classification and the Gustilo-Anderson system. Patients were treated with minimally invasive plate osteosynthesis (MIPO) combined with curved incision on the anterior area of ankle. The ankle function and radiological outcome were assessed by the modified Mazur ankle score and Burwell-Charnley criteria, respectively. Visual analogue score (VAS) score was used to assess the degree of patient’s ankle pain, and related complications were also recorded.ResultsThe mean time for fracture healing was 3.6 months (range: 3–6 months). According to Mazur’s criteria, surgical treatment achieved good or excellent outcome in 15 (88.2%) cases, and the average VAS score was 1.19 ± 0.52. On the basis of Burwell-Charnley score, 12 (70.5%) patients achieved anatomic recovery, 4 (23.5%) obtained good reduction, and only 1 (5.9%) patient was diagnosed with valgus deformity. Additionally, 1 (5.9%) patient developed a superficial infection around incision, and 2 (11.8%) experienced superficial peroneal nerve damage. In addition, 2 (11.8%) patients showed radiographic evidence of existing ankle osteoarthritis at the final follow-up.ConclusionsThis retrospective study is the first to assess the application of a curved incision on the anterior area of ankle with MIPO for the treatment of Pilon fractures, which achieves high functional recovery with a low complication rate. However, large randomized controlled trials comparing different approaches and fixation methods are still needed to conclusively identify the optimal treatment protocol.

91. Can the proposed posterior ligament-bone injury classification and severity score predict the failure of anterior-only surgery for subaxial cervical facet dislocations?

BACKGROUND CONTEXT The approach selection for subaxial cervical fracture dislocations (SCFD) is controversial. While spinal surgeons increasingly prefer a single anterior approach, the complication of postoperative cervical kyphosis is worrisome. Hence, identification of suitable candidates requiring a second posterior reconstruction is necessary, thus preventing the failure of anterior-only surgery in patients with SCFD. PURPOSE To introduce a novel classification and scoring system called the posterior ligament-bone injury classification and severity (PLICS) score and verify whether this system can be generally utilized for the treatment of the SCFD to predict the failure of anterior-only surgery. STUDY DESIGN/SETTING A retrospective cohort study. PATIENT SAMPLE A total of 394 patients with SCFD who underwent anterior decompression, reduction, and fusion between January 2002 and December 2017 in one center were retrospectivelyenrolled in the study. The inclusion criteria included: 1. the preoperative magnetic resonance imaging (MRI) detected facture dislocation accompanying with an extruded disc, which deformed the dural sac beyond the line between the postero-inferior corner of cranial vertebrae and the postero-superior corner of caudal vertebrae; 2. the clinical level of neural dysfunction corresponds to the segment of reconstruction without the requirement of an extensive posterior decompression; 3. the reduction can be achieved under an attempt at the awake skull traction preoperatively or via anterior approach after the removal of herniated disc intraopertively. The exclusion criteria included: reduction can't be by preoperative skull traction, or by an anterior approach intraoperatively; the patients obtained a posterior reconstruction surgery when the intramedullary edema may extend beyond the segment of dislocation; severe traumatic cervical spondylolisthesis (over grade 3); the patients are accompanying by ankylosing spondylitis. OUTCOME MEASURES Clinical outcomes with respect to neck pain and function were recorded for each patient according to visual analog score (VAS) and the Neck Disability Index (NDI). We paired the equal number of patients between successful and unsuccessful groups to compare the difference in the clinical outcome. The American Spinal Injury Association (ASIA) impairment scale was recorded at each follow-up interval. Additionally, lateral radiography computed tomography (CT) and MRI were also recommended. METHODS Patients were divided into successful and unsuccessful groups according to whether failure of internal fixation was observed during follow-up. PLICS is based on the injury severity of the ligament-bone structure of three elements. Anatomically, the posterior column of cervical spine can be subdivided into three-column structure, including bilateral facet joints and the outside joint capsules, and posterior spinous processes and the attached ligament structures, so-called posterior ligamentous complex, including the supraspinal ligament and interspinous ligament. In this score system, a specific point value (0 - 3) is assigned to a particular variable within each element reflective of the severity of injury and its contribution to stability of posterior column of cervical spine. The preoperative PLICS score of all patients are recorded respectively. RESULTS Among 354 patients, 89.8% fulfilled the follow-up. Fifteen patients (4.2%) experienced hardware failure and progressive cervical kyphosis at the postoperative follow-up. The patients were divided into successful (15 patients) and unsuccessful (339 patients) groups. The average VAS score in the satisfactory group decreased from 6.7+0.8 to 1.3+0.6. The average VAS score in the unsatisfactory group decreased from 4.9+0.8 to 0.3+0.5. The average NDI score at the12-month follow-up was statistically low in the satisfactory group (6.2+2.1 vs 15.5+3.8, P= .028). It is worth noting that, except for only one patient with a PLICS score of 6, the PLICS score for the other 14 patients who experienced postoperative hardware failure was >7. However, the PLICS score for the other 339 patients (except for 2 cases) who obtained satisfactory radiological outcome was CONCLUSIONS When a PLICS score >7 is accompanied by severe lateral mass fracture, the risk of postoperative failure after an anterior-only reconstruction is high and supplemental posterior strengthening can be considered. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

Comparison of conservative treatment and full thread hollow screw for treatment of Ekrol 2 fracture of the fifth metatarsal bone

Objective To compare the curative effect of conservative treatment and full thread hollow screw in the treatment of Ekrol 2 fracture of the fifth metatarsal bone. Methods From April 2013 to May 2015, 42 patients with avulsion fractures of the fifth metatarsal basement of type 2 fractures in Ekrol division were treated in our hospital. 23 patients underwent full thread hollow screw surgery (surgical treatment group), and there were12 males and 11 females, with an average age of 43.4±9.2 years, and the fracture displacement length was 2.3±0.2 mm. 19 patients treated with plaster fixation (conservative group), including 10 males and 9 females, with an average age of 45.7±8.9 years and fracture displacement length was 2.1±0.2 mm. During follow-up, X-ray examination was performed to evaluate the time of fracture healing and forefoot score of American Orthopaedic Foot and Ankle Society (AOFAS), visual analogue score (VAS) and quality of life questionnaire (SF-36) were compared between the two groups. Results All 42 patients were followed up for 12 to 24 months with an average of 18 months. At the latest follow-up, the fracture healing time of the surgical group was 9.3±2.0 weeks, with AOFAS score of 84.1±3.9, VAS score of 0.1±0.2, and the SF-36 score of 95.1±2.9 points, and the shortening of length after treatment was 2.1±2.5 mm; the average healing time of the conservative treatment group was 12.2±2.1 weeks, with the average AOFAS score of 84.2±4.2 points, and the average VAS score of 0.2±0.2 points, the average SF-36 score of 94.1±5.2 points, and the shortening of length after treatment was 0.4±2.5 mm. The results of each short-term score and the shortening of the length of the fracture after treatment was statistically significant. The results of the mid- and long-term scores showed no significant difference between the two groups; the fractures of both groups reached bone healing.3 cases of sural nerve stimulation occurred in the operation group, while 1 case occurred in the conservative group. Abnormal healing occurred in 2 cases of conservative treatment, and the fractures of the surgical treatment group were anatomic reduced. Conclusion Usingfull thread hollow screwfor the treatment of Ekrol 2 fracture of the fifth metatarsal bone is better than the con- servative treatment in the short term, but there is no significant difference in the long-term effect. Key words: Metatarsal bones; Fractures, bone; Fracture fixation, internal; Comparative study

Role of narrow band ultra violet radiation as an add-on therapy in peritoneal dialysis patients with refractory uremic pruritus

AIMTo assess the role of narrow band ultraviolet B (UVB) as a treatment option in peritoneal dialysis patients with refractory uremic pruritus.METHODSIn this retrospective study, 29 adult patients with end stage renal failure on peritoneal dialysis, and who had refractory uremic pruritus, were given narrow band UVB radiation as an add-on therapy to standard care for a duration of 12 wk. The response to the pruritus was assessed both weekly and at the end of the study period using a visual analogue score (VAS).RESULTSThe average VAS score at the end of the study was 3.14 ± 1.59, which was significant compared to the baseline value of 7.75 ± 1.02 (P < 0.05). Improvements in symptoms were noted in 19 out of 21 (90.4%) patients. However, relapse occurred in six out of the 19 patients who responded. The dropout rate was high during the study period (33.3%).CONCLUSIONNarrow band UVB is effective as an add-on therapy in peritoneal dialysis patients with refractory uremic pruritus. However, the present regime is cumbersome and patient compliance is poor.

Early and mid-term results of transarticular external fixation in the treatment of supination-external rotation type IV equivalent ankle fractures

PurposeTo investigate the early and mid-term results of open reduction and internal fixation (ORIF) with transarticular external fixation (TEF) but no deltoid ligament repair (DLR) in the treatment of supination-external rotation type IV equivalent (SER IV E) ankle fractures (AO/OTA classification 44-B 3.1) and provide evidence for clinical practice. MethodsThis study cohort consisted of 22 patients with SER IV E ankle fractures that underwent ORIF with TEF but no DLR between December 2011 and December 2014. There were 13 males and 9 females, mean age 38.9 years (range, 17–73 years). Eight cases involved the left side and 14 the right side. The causes of fractures included road traffic accidents (11 cases), falling from height (6 cases) and sports injuries (5 cases). The mean period of hospitalization was 9.8 days (range, 6–14 days). For all the patients, MRI and three-dimensional CT were done before surgery and X-rays done preoperatively and during follow-ups. The external frame was kept for 8–10 weeks. The preoperative American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot score was 56.86 ± 4.400, the Medical Outcomes Short Form 36-item (SF-36) questionnaire score was 57.41 ± 4.102 and the visual analog score (VAS) was 5.50 ± 1.058. Patients' main complaints about inconvenience of daily life were also recorded. ResultsAll the 22 patients were followed up for 24–63 months (mean, 33.6 months). None of them developed nonunion during the follow-up; pin site infection was observed in one patient and posttraumatic osteoarthritis in another. At the final follow-up, the average AOFAS score, SF-36 score and VAS score were respectively 90.59 ± 5.096, 79.59 ± 5.394 and 1.82 ± 1.181, which were significantly improved compared with the preoperative data (t = 26.221, p < 0.001; t = 11.910, p < 0.001; t = 11.571, p < 0.001). The therapeutic effect was excellent in 13 cases, good in 7 cases and fair in 2 cases, with a good-excellent rate of 90.9%. Patients' main complaints were inconvenience of clothing (17 cases) and extremity cleaning (5 cases). ConclusionIn the treatment of SER IV E ankle fractures, ORIF with TEF but no DLR can achieve satisfactory outcome, but long-term effect should be confirmed by large sample randomized controlled trials.

Proximal fibular osteotomy to treat medial compartment knee osteoarthritis: Preoperational factors for short-term prognosis.

ObjectiveThe purpose of this study was to determine the association between preoperational factors and patients’ short-term outcome after proximal fibular osteotomy (PFO) and to provide a basis for detailed surgical indication and patient selection.MethodsThis was a retrospective study of patients undergoing PFO between January 2015 and December 2015. Preoperational clinical data including gender, age, duration of disease, visual analogue score (VAS) and American Knee Society (KSS) score were collected. The radiological factors including hip-knee-ankle angle (HKA angle), condyle-plateau angle (CP angle), Kellgren and Lawrence grade (KL grade), joint space width of both compartments and settlement value were also considered. Patients were followed for at 12 months postoperatively. Both clinical and functional KSS scores were obtained. The outcome of interest was divided into clinical outcome and functional outcome. For each, two criteria were defined: satisfaction and significant improvement. Satisfaction is characterized by a KSS clinical or functional score over 70 points (excellent and good results); significant improvement refers to an increase in KSS scores of more than 15 points. Bivariate logistic regression for the association between preoperational factors and outcomes of interest was performed. Multivariable logistic regression analyses were used to detect the independent factors affecting the outcomes.ResultsA total of 84 patients and 111 knees were followed-up. Of these, 17 knees were from males and 94 were from females. The average age was 59.45±8.82 years. The average preoperational VAS score, KSS clinical and functional score were 7.08±1.41 points, 49.14±10.95 points and 44.97±17.71 points, respectively. According to KL grading, there were 17 knees of grade 2, 47 knees of grade 3, and 47 knees of grade 4. In clinical outcomes, there were 51 knees in the satisfaction group and 77 knees in the significant improvement group. In functional outcomes, 43 knees were in the satisfaction group and 76 knees in the significant improvement group. KSS clinical score (OR = 1.134, 95%CI = 1.067–1.205, P = 0.000) was the independent factor associated with clinical satisfaction. Age (OR = 1.072, 95%CI = 1.000–1.150, P = 0.048), VAS score (OR = 1.679, 95%CI = 1.041–2.706, P = 0.033), KSS clinical (OR = 1.072, 95%CI = 1.005–1.144, P = 0.034) and functional (OR = 1.100, 95%CI = 1.044–1.159, P = 0.000) score, HKA angle (OR = 1.345, 95%CI = 1.119–1.617, P = 0.002) and settlement value (OR = 7.540, 95%CI = 1.307–43.484, P = 0.024) were the independent factors associated with functional satisfaction. KSS clinical (OR = 0.905, 95%CI = 0.850–0.963, P = 0.002) score, CP angle (OR = 0.760, 95%CI = 0.593–0.973, P = 0.030) and medial joint space width (OR = 0.001, 95%CI = 0.000–0.107, P = 0.003) were the independent factors associated with significant clinical improvement; VAS score (OR = 1.582, 95%CI = 1.042–2.402, P = 0.031), KSS functional (OR = 0.888, 95%CI = 0.838–0.942, P = 0.000) score, HKA angle (OR = 1.292, 95%CI = 1.101–1.518, P = 0.002) and settlement value (OR = 9.990, 95%CI = 1.485–67.197, P = 0.018) were the independent factors associated with significant functional improvement.ConclusionsThe independent factors affecting postoperative clinical outcome after PFO were KSS clinical score, CP angle and medial joint space width. In addition, the independent factors that influenced functional outcome included age, VAS score, KSS score, HKA angle and settlement value. As objective radiological evidence, HKA angle and settlement value could be used as an important basis for patient selection for PFO.

Single-stage anterior debridement and reconstruction with tantalum mesh cage for complicated infectious spondylitis.

AIMTo evaluate the clinical and radiographic results of patients with complicated infectious spondylitis treated with single-stage anterior debridement and reconstruction using tantalum mesh cage (TaMC) followed by immediate instrumentation.METHODSSingle-stage radical debridement and subsequent reconstruction with TaMC instead of autograft or allograft were performed to treat 20 patients with spinal deformity or instability due to complicated infectious spondylitis. Clinical outcomes were assessed by careful physical examination and regular serological tests to determine the infection control. In addition, the visual analog score (VAS), neurologic status, length of vertebral body reconstruction, and the correction of sagittal Cobb angle on radiography were recorded and compared before and after surgery. The conditions of the patients were evaluated based on the modified Brodsky’s criteria.RESULTSThe average VAS score significantly decreased after the surgery (from 7.4 ± 0.8 to 3.3 ± 0.8, P < 0.001). The average Cobb angle correction was 14.9 degrees. The neurologic status was significantly improved after the surgery (P = 0.003). One patient experienced refractory infection and underwent additional debridement. Eighteen patients achieved good outcome based on the modified Brodsky’s criteria and significant improvement after the surgery (P < 0.001). No implant breakage or TaMC dislodgement was found during at least 24 mo of follow-up.CONCLUSIONSingle-stage anterior debridement and reconstruction with TaMC followed by immediate instrumentation could be an alternative method to manage the patients with spinal deformity or instability due to complicated infectious spondylitis.

Feasibility of biological acetabular component with high placement technique in hip revision arthroplasty

Objective To investigate the feasibility of biological acetabular component with high placement technique in hip revision arthroplasty. Methods From March 2006 to March 2015, 34 patients (35 hips) underwent hip revision arthroplasty with biological acetabular components with high placement technique. There were 15 males (15 hips) and 19 females (20 hips) with an average of 55 years (range, 26-74 years). There were 22 hips caused by aseptic loosening and 13 hips by infection. The acetabular bone defects included Paprosky IIA in 3 cases, IIB in 4, IIC in 2, IIIA in 17, and IIIB in 9. Modular tapered stems with distal fixation were performed in most femoral sides. The height of hip center was greater than 2.5 cm for all the patients, which were divided into two groups according to the degree of placement: 2.5-3.5 cm for the high placement group, greater than 3.5 cm for the high hip center group. Harris hip score, pain visual analogue score (VAS), leg length difference, gait characteristics were compared between two groups postoperatively and at the final follow-up respectively. The height of hip center and the horizontal distance between hip center and teardrop were measured in the hip X-ray. Radiolucent lines and migrations were also recorded. Results The average operation time and blood loss was 108 min (100-220 min) and 525 ml (300-1 200 ml) in two groups respectively. All the patients were followed up for average 49.2 months (range, 12-116 months). At the final follow-up, the average Harris hip score improved from 36.52±17.17 points preoperatively to 83.46±7.63 (t=18.99, P=0.001). The average VAS score decreased from 8.06±1.24 points preoperatively to 1.91±1.62 postoperatively (t=18.57, P=0.001). The height of hip center was 1.47±0.33 cm preoperatively and 3.85±1.13 cm postoperatively (t=12.15, P=0.001). The horizontal distance was 3.33±0.53 cm pre-operatively and 3.23±0.63 cm post-operatively (t=0.98, P=0.640). At the final follow-up, Trendelenburg sign improved from 25/10 (positive/negative, hips) preoperatively to 7/28 (χ2=18.65, P=0.001). There was 1 case of severe limp, moderate in 1, mild in 8 and other cases had no limp. The leg length discrepancy decreased from 1.84±1.92 cm preoperatively to 0.71±1.57 postoperatively (t=4.24, P=0.001). There were 6 cases of Paprosky IIIb with the use of ultra small cup and extremely high placement. The average Harris hip score improved from 26.65±13.46 points preoperatively to 79.83±10.55 (t=12.33, P=0.001). The average VAS score decreased from 8.50 ± 1.38 points preoperatively to 2.83 ± 2.64 postoperatively (t=4.61, P=0.006). One case had acetabular loosening at 4 years later postoperatively and re-revision surgery was performed. Other patients had no infection, dislocation, periprosthetic fracture or any other complications at the final follow-up. Conclusion Highly placement of biological acetabular component with a distal tapered modular stem can get enough contact with the host bone and achieve optimal clinical outcomes, regardless of the degree of high placement. Particularly, using ultra small cup in extremely high placement shows good effectiveness in simplified operation, and it can be used in many complicated or even impossible acetabular reconstruction. Key words: Arthroplasty, replacement, hip; Reoperation; Acetabulum; Osteolysis; Prosthesis-related infections

Treatment of transforaminal wedge osteotomy for correction of the thoracolumbar kyphosis

Objective To evaluate the operation methods and effects of transforaminal wedge osteotomy (TWO) combined with intervertebral grafting bone for correcting the rigid thoracolumbar kyphosis. Methods From January 2003 to June 2013, treatment of 52 cases of the rigid thoracolumbar kyphosis by TWO combined with intervertebral bone graft were studied (including 33 males and 19 females, and the age range was from 15 to 72 with average age of 42.3 years old). In these 52 cases, there were 17 cases of ankylosing spondylitis, 25 cases of obsolete thoracolumbarvertebral fractures, 7 cases of chronic thoracolumbar tuberculosis and 3 cases of congenital vertebral malformations. 52 cases presented as lumbar kyphosis, low back pain aggravated, with an average VAS score of 8.6; 24 cases were accompanied with different extent of neurological dysfunction which obviously influenced daily life or work. Osteotomy was located at thoracolumbar intervertebral disc. Pedicle screws internal fixation system combined with intervertebral grafting bone was used to compress the vertebra and fuse after TWO for correction. Preoperative and postoperative low back pain was evaluated by visual analog score (VAS), Frankel score and Oswestry disability index(ODI) in patients with neurological dysfunction. The above indexes were compared with the PSO osteotomy group. Results Preoperative mean kyphosis Cobb angle was 65.6°(31°-137°). The average post-operative kyphosis Cobb angle was 19.2° (8°-35°), and the average correction rate was 68.4%. The mean operation time was 3.8 h (2.2-5.3 h), and the mean intraoperative blood loss was 1220 ml (500-2 900 ml). Preoperative VAS score was 8.6±1.2 while the last follow-up was 1.8±0.5; preoperative Oswestry dysfunction index was 75.6±8.2 while the last follow-up was 18.4±8.1. The results were statistically significant. The spinal function was 4 cases of Frankel C and 20 cases of Frankel D before operation, all of which dropped to E level after operation. 52 patients were followed up with the average time of 41 months (from 6 to 60 months). The bony fusion rate was 94.23% at 6 months after operation. All of the patients were fused in 3 years after operation. The average loss of kyphosis Cobb angle was 5.5°(4°-12°). Compared with PSO, the average operation time, the amount of bleeding and the improvement of neurological function after surgery all had some advantages. Conclusion Transforaminal wedge osteotomy has many advantages, such as less bleeding wounds, less nerve interference and limited multi-segmental osteotomy, with little trauma and high bony fusion rate. Key words: Thoracic vertebrae; Lumbar vertebrae; Kyphosis; Osteotomy; orthopedic surgery; Spinal fusion

A prospective review of the labor analgesia programme in a teaching hospital

BackgroundThe structured labor analgesia programme in our tertiary care hospital has been in place for the past few years. We undertook this study to analyze the programme and to draw conclusions to further improve the outcomes. MethodsA prospective analysis of the data pertaining to 200 patients participating in an ongoing labor analgesia programme in a tertiary care hospital from Nov 2008 to Aug 2009 was performed. ResultsMean visual analog score (VAS) before epidural block was 8.34 ± 0.79. Post procedure the average VAS score was 2.20 ± 0.79. One hundred and fifty six (78%) parturients delivered vaginally, 18 (9%) required instrumentation with vacuum including 1 forceps delivery in a multiparous parturient. In 17parturients (8.7%) fetal distress led to a decision to perform LSCS for delivery. Multiparous patients were significantly more satisfied as compared to nulliparous patients (p = 0.010). ConclusionThe study demonstrated excellent pain relief and patient satisfaction with minimal complications. The safety and efficacy of epidural bupivacaine in concentrations less than 0.625% combined with 25 mcg of fentanyl demonstrated in our study should be considered are commendation for the widespread adoption of the procedure in tertiary care hospitals.

Analysis of VPL/VPM DBS combined PAG/PVG DBS for treatment of neuropathic pain

Objective To discuss the treatment of neuropathic pain with ventral posteromedial thalamic nucleus/ventral posterolateral thalamic nucleus (VPL/VPM) DBS combined periventricular/ periaqueductal grey matter (PAG/PVG) DBS. Methods A retrospective analysis of 24 patients with neuropathic pain was performed. At the early time,two patients just accepted PVG - DBS.The other patients were treated by VPL/VPM DBS combined PAG/PVG DBS.The effects of stimulation were studied right after electrode insertion or the stimulation trials was done after 5 - 7days after surgery.Patients with a greater than 50％ reduction in pain visual analogue score (VAS) were implanted with a pulse generator (IPG).VAS was also recorded before operation and three months after the operation.Results All the patients tolerated the procedure very well.17 of them received good outcome.The instrument had to be removed in the other 7 patients because of infection ( n =1 ) or invalid efficacy ( n =6 ).The average VAS score before surgery was 8.04 ±0.86 and the average VAS score after surgery was 3.13 ± 1.44.There was significant difference.All effective patients had good outcomes when the VPL - DBS was on and 12 patients received good outcomes when the PVG - DBS was on.7 patients with PVG - DBS had severe side effects.There was no significant side effect in patients with VPL - DBS. Conclusions Many doctors prefer to combine VPL and PVG DBS to treat chronic neuropathic pain.But the efficacy and side effects of PVG target are not so satisfied.VPL DBS used alone may be accepted by more and more doctors. Key words: Neuropathic pain; Deep brain stimulator (DBS) ; Treatment outcome

Is Patch It&amp;reg; better than placebo in alleviating swelling and ache in the lower legs and feet? A randomized, placebo-controlled, double blind, crossover, sequential trial

Is Patch It&reg; better than placebo in alleviating swelling and ache in the lower legs and feet? A randomized, placebo-controlled, double blind, crossover, sequential trial Aliya Shakeel1, Hoong Keong Hui2, Chetan S Patil3, Manojkumar V Chaudhari4, Yogesh D Kadam5, Shrikant V Pensalwar6, Suhas G Erande7, Rajesh M Kewalramani81Vedic Lifesciences Pvt Ltd, Mumbai, Maharashtra, India; 2Nutriworks Limited, Kowloon, Hong Kong; 3Muktai Hospital, Nasik, 4Bhagirathi Medical Foundation, 5Poona Diabetes Center, 6Balaji Clinic, Mumbai, 7Akshay Hospital, Pune, 8Shanti Niketan, Kandar Pada, Dahisar, Mumbai, Maharashtra, IndiaBackground: Existing therapeutic measures for swelling, aching and discomfort in the lower limbs, which include compression stockings and leg elevation, are difficult to use and inconvenient. Patch It&reg;, a proprietary herbomineral patch is an easy-to-use alternative therapy. This trial was conducted to compare it&#39;s efficacy against that of a placebo in swollen and aching lower legs and feet.Methods: This randomized, placebo-controlled, double blind, crossover, sequential trial was conducted in the private clinics of physicians. A total of 100 patients (24 men and 76 women), aged 25 to 60 years, with recurring swelling in the feet and (optionally) up to two more related complaints, having an average visual analog score (VAS) of at least 60 (scale 0&ndash;100) for each complaint were recruited into the study. Patches (active or placebo) were applied to both soles overnight for 8 weeks: 4 consecutive weeks each with active or placebo in randomized sequence. Outcome measures included the average VAS score (baseline to week 4, and week 5 to week 8), preference for either patch (difference of &gt;5 mm in average VAS score reduction), ankle figure-of-eight measures, investigator&#39;s global assessment (good, fair, poor), patient&#39;s willingness to continue using the patch after the trial (yes, no), and adverse events.Results: Out of 100 patients, 86 completed the trial, while ten were excluded for noncompliance, three withdrew, and one was lost to follow-up. The active placebo boundary of the sequential chart was crossed when 82 patients completed the trial. Active patch was also superior to placebo patch by mean reductions in average VAS scores (13.14 versus 9.6, P = 0.02), mean reduction in figure-of-eight ankle measurements (1.21 cm versus 0.79 cm, P = 0.003), investigator&#39;s global assessment (P &lt; 0.01), and by proportion of patients willing to continue using the patch after the trial (P &lt; 0.01). Ten percent of patients experienced localized itching with each patch, but this did not require interruption of treatment.Conclusion: Patch It had greater efficacy than the placebo in alleviating recurring swelling and aching in the legs and feet, and is well tolerated.Keywords: ankle swelling, leg ache, dermal patch, reflexology, sequential analysis, figure-of-eight

Pain perception during and after VNUS ClosureFAST™ procedure

The objective of the study was first to quantify the level of pain that patients experience during VNUS ClosureFAST™ and in the first week following treatment. Secondly, to investigate the use of pain medication. Thirdly, to identify after how many days patients return to daily activities and whether pain is a factor of influence. A prospective descriptive cohort study was carried out. In all, 104 consecutive VNUS ClosureFAST procedures for greater saphenous vein (GSV) incompetence between 18 May and 28 August 2009 in the HagaZiekenhuis were included. A visual analogue score (VAS) was recorded immediately after the procedure. These patients were asked to register pain scores during the week following the procedure, the amount of pain medication if used and the time elapsed between the procedures and resuming daily activities. The average VAS score during the VNUS Closure procedure was four. The first three days after the procedure the VAS score was 2. After four days, the average score was 1. The average return to daily activities was on day two after the procedure. In total, 24% of all patients used paracetamol after the procedure. In summary, VNUS ClosureFAST procedure for GSV incompetence is not a painless treatment. After an average of two days, patients return to their daily activities. Pain does not seem to be a major factor in the resumption. Seventy-six percent of patients do not use any pain medication.

Pain perception during the rehabilitation phase following traumatic hip fracture in the elderly is an important prognostic factor and treatment tool

Purpose. To evaluate the role of pain perception on admission to geriatric rehabilitation on the functional recovery after rehabilitation treatment in elderly patients with hip fracture and on the length of stay.Method. One hundred and sixty-five community dwelling elderly 65-year-old and over (mean age of 78 years), following recent operated traumatic hip fracture without clinical evidence for another acute medical or surgical condition were assessed regarding age, sex, chronic medical conditions, pre-fracture functional status, type of fracture and of operation, pain perception, and cognitive status. Pain was measured using the Visual Analogue Score (VAS). Functional status was measured using the Functional Independence Measurement (FIM). Activities of Daily Living (ADL) were assessed using the Katz index.Results. The average VAS score on admission was 7.38 ± 1.20 and on discharge 3.67 ± 1.18. Pain on admission inversely correlated to family support, function prior to fracture and cognitive status on admission, and correlated positively with depressed mood. With every increase of one point in VAS on admission above 4 points, the FIM on discharge decreased by 8.77 and the length of stay increased by 4.76 days.Conclusions. Pain intensity may add a valuable dimension for the prognostic evaluation of the patients with hip fractures. Inadequate early patient assessment and associated treatment impact on the patients' functional outcome, prolonged duration of rehabilitation treatment, and therefore, in addition to socio-economic effect, increase the cost to the local health care setting.