Cases Of Superficial Wound Infection Research Articles

Evaluation of efficacy and safety of perioperative tranexamic acid during Primary Total Knee Arthroplasty: A randomized, Clinical trial

Background Primary total knee arthroplasty (TKA) is the gold standard treatment for degenerative joint disease, but it carries a significant risk of blood loss that may require transfusion. Various techniques are implemented to reduce the possibility of the need for allogeneic blood transfusion (ABT). To this end, this study aims to assess the effectiveness of tranexamic acid (TXA) in decreasing blood loss following primary TKA. Materials and methods This study is a randomized controlled study of 100 cases of primary total knee arthroplasty conducted in Damascus from July 2021 to September 2022, followed up with every patient for six months. The patients were randomized into two groups. We compared intraoperative, postoperative, total, and hidden blood loss and perioperative complications. Results We observed a statistically significant difference between the two groups in total calculated, hidden, and postoperative blood loss. However, this difference does not seem clinically significant, as we didn’t find a significant difference in allogeneic blood transfusion between the groups. Regarding complications, the TXA group had five cases of superficial wound infection and six cases of deep venous thrombosis. In contrast, the control group had eight cases of superficial wound infection and five cases of deep venous thrombosis. Conclusion Our study suggests that the role of TXA in primary unilateral total knee arthroplasty in the hands of an experienced surgeon might be overrated. The reduced blood loss did not seem to have clinical importance and didn’t affect the transfusion rates.

Arteriovenous fistula access for dialysis using vessels of the arm

Background: Site selection, configuration of the access and technical performance of operation are keys to a successful arteriovenous fistula (AVF) for haemodialysis. Objective: To evaluate the primary success rate and complications of AVF performed in Port Harcourt using vessels of the arm. Materials and Methods: This was a prospective cross-sectional study on the success rate of the Arteriovenous fistulas done using vessels of the arm in patients with End Stage Renal Disease (ESRD) undergoing dialysis across public and private health facilities in Port Harcourt. The study was conducted between March 1, 2017, and February 29, 2024. Preoperatively, using a duplex scan (and sometimes through clinical examination) with and without a tourniquet, the selected vein size was ≥ 2.5mm and the artery ≥2mm with a healthy wall and good flow. Parameters monitored were thrill and bruit intra-operatively, immediate, one- week and 6-8 weeks post-operative periods; the size of the vein intra-operatively, one -week and 6-8 weeks post-operatively. In addition, the patients were monitored for complications. Data were analyzed using statistical packages for social sciences (SPSS) version 25. Th demographic data and medical information were summarized using descriptive statistics (mean, median, frequency percentage and standard deviation) as appropriate. Result: There were 87 patients during the period under review. The age range was 14-85years with mean age of 54 ± 6.4 years. Of these, 18 (20.69%) were females, and 69 (79.31%) were males; 92 AVFs were done in 87 patients (87 primary and 5 repeat) with ESRD for dialysis; 69 (75%) Brachiocephalic (BC) and 23 (25%) Brachiobasilic (BB)AVFs. The AVFs were primarily successful in 82 cases (94.25%), with 5 primary failures (5.75%), and a total of 5 repeat AVFs within this period, excluding secondary failures. Complications were 1 (1.15%) upper limb oedema, 6 (6.90%) delayed wound healing, 4 (4.60%) cases of seroma, 1 (1.15%) case of steal syndrome, 4 (4.60%) cases of spontaneous thrombosis and 3 (3.45%) cases of superficial wound infection. Conclusion: The primary success rate of AVF for dialysis in Port Harcourt using vessels of the arm is quite good with few complications.

Use of Fibula Nails With Proximal and Distal Fixation.

Ankle fractures are a frequent injury in the adult population and a quarter of all ankle fractures are classified as unstable, requiring surgical intervention. Plate-and-screw construct is the traditionally used fixation method for fibula fractures. The use of an intramedullary nail is an alternative fixation method, with current literature supporting very low complication rates and hardware removal surgeries. The purpose of this study was to evaluate the outcomes, including complication rates and implant removal rates, using a fibula nail with both proximal and distal fixation capabilities by an experienced surgeon. We retrospectively reviewed 203 consecutive fibula nail cases from a single surgeon using a mini-open technique for anatomic reduction. Demographic, operative, clinical, and radiographic outcome data were analyzed, specifically examining complication rates and need for implant removal. The average follow-up was 18.8 months (6-54 months). All fractures healed. We identified 2 cases of superficial wound infection, 1 superficial peroneal nerve irritation, and 1 case of implant removal. In the first 110 cases, 2 fractures were converted to a plate intraoperatively prior to a technique modification which has prevented this occurrence. No deep infection, delayed union, or nonunion occurred. Our data support that fibula nails with proximal and distal locking capabilities offer an alternative to plating with the potential for lower complication rates and lower need for implant removal. Level IV, case series.

The Effects of Tibialis Anterior Tenotomy on Wound Problems after Anterior Fusion Plating for Severe Ankle Arthritis

Category: Ankle Arthritis; Ankle Introduction/Purpose: Because nonunion is known to be a relatively common complication following ankle arthrodesis, various fixation techniques have been introduced to enhance the stability and to improve fusion rate. With the use of anterior plate supplementation, postoperative wound problems have been frequently reported despite better fusion rate. This study was performed to determine the effects of tibialis anterior(TA) tenotomy on wound complications and functional outcomes after anterior fusion plating for severe ankle arthritis. Methods: Forty-six patients who underwent ankle arthrodesis using anterior fusion plate were followed for more than 3 years. TA tenotomy was performed prior to wound closure in all patients. As a control group, thirty-eight patients who underwent arthrodesis without TA tenotomy were analysed. Clinical outcomes were evaluated with Ankle Osteoarthritis Scale(AOS) and Foot and Ankle Ability Measure(FAAM). Wound complication rate, time to fusion, fusion rate, time to pain relief below 3 points in visual analog scale were evaluated. Results: Mean AOS and FAAM scores significantly improved to 32.6 and 69.4 points at final followup, respectively. As compared to control group (33.8 and 67.7 points), there were no significant differences in clinical outcomes. As postoperative wound complications, there were 1 case of wound dehiscence and 1 case of superficial wound infection. TA tenotomy group showed lower wound complication rate (4.3%) than control group (21.1%). While there were no significant differences in fusion rate, time to fusion, and time to pain relief between both groups, control group needed higher rate of implant removal. Conclusion: Ankle arthrodesis using anterior fusion plate in conjuction with TA tenotomy appears to be an effective surgical option for end-stage ankle arthritis, with higher fusion rate and less wound complication rate. Although there was no specific functional deficit related to a loss of the TA tendon, further studies are needed to determine the long-term effects of the TA tenotomy in patients with a fused ankle.

Evaluation of endoprosthetic reconstruction after distal femoral bone-tumor resection

Background Endoprosthetic reconstruction is considered a reliable reconstructive option after periarticular tumor resection as it provides component modularity, improved fixation, near-anatomic appearance, and good functional outcomes. This study aimed at evaluation of the outcomes of the cemented modular distal femoral tumor prosthesis after wide intra-articular resection of aggressive or malignant bone tumors. Patients and methods The mean age of the patients was 29.77 years. There were 12 males and six females. The final diagnosis was osteosarcoma in 13 patients, giant-cell tumor in three patients, and chondrosarcoma in two patients. All patients with osteosarcoma received neoadjuvant chemotherapy. Wide intra-articular tumor resection was done through the anteromedial approach of the femur with reconstruction by cemented modular endoprosthesis. Results One patient died with pulmonary metastasis. The 5-year cumulative patient-survival rate was 88.88% and 5-year cumulative implant-survival rate was 93.65%. Local recurrence occurred in one (5.5%) patient, while distant metastasis occurred in another. Both of those patients died and were consequently excluded from further statistical work. The mean functional score, the modified Musculoskeletal Tumor Society rating scale, was 73.7%. Complications occurred in five (27.7%) patients. One (5.5%) patient had had a deep infection with failure of reconstruction requiring two-staged revision. There were four cases of superficial wound infection that were successfully treated conservatively. There was no aseptic loosening, periprosthetic fracture or dislocation, soft-tissue problem, or vascular impairment in the operated limb till the final follow-up. Conclusion Modular prosthetic reconstruction after wide resection of aggressive and malignant bone tumors of distal femur offers satisfactory clinical and functional outcomes as it allows immediate postoperative stability, early mobilization, and rehabilitation, with reasonable complication rate. Level of evidence: IV case series.

A prospective study of arthroscopic primary ACL reconstruction with ipsilateral peroneus longus tendon graft: Experience of 439 cases.

Anterior cruciate ligament (ACL) tears are frequent ligamentous injuries that necessitate reconstruction in many cases. The patellar tendon and the hamstring tendon are the most frequently utilized autografts for reconstruction. However, both have certain disadvantages. We hypothesized that the peroneus longus tendon would be an acceptable graft for arthroscopic ACL reconstruction. The aim of this study is to determine whether a peroneus Longus tendon transplant is a functionally viable option for arthroscopic ACL reconstruction without compromising donor ankle activity. In this prospective study 439 individuals aged between 18 to 45 years, who underwent ACL reconstruction using ipsilateral Peroneus longus tendon autograft were observed. The injury to the ACL was initially assessed by physical examinations and further confirmed by magnetic resonance imaging (MRI). The outcome was assessed at 6, 12, and 24 months after the surgery using Modified Cincinnati, International Knee Documentation Committee (IKDC), and Tegner-Lysholm scores. The donor ankle stability was evaluated using foot and ankle disability index (FADI) and AOFAS scores, as well as hop tests. Significant (P < .001) improvement in the result of the IKDC score, Modified Cincinnati, and Tegner-Lysholm score was observed at the final follow-up. The Lachman test was mildly (1+) positive only in 7.70% of cases, the anterior drawer became negative in all cases, and the pivot shift test was negative in 97.43% of cases at 24 months after the surgery. FADI and AOFAS scores for donor's ankle functional assessment were impressive, as were single hop test, triple hop test, and cross over hop test results at 2 years. None of the patients had any neurovascular deficit. However, 6 cases of superficial wound infection were observed, 4 at the port site and 2 at the donor site. All resolved after appropriate oral antibiotic therapy. The peroneus longus tendon can be considered a safe, effective, and promising graft of choice for arthroscopic primary single-bundle ACL reconstruction because it has a good functional outcome and impressive donor ankle function after surgery.

Study on role of fibular graft in non-union and complex fractures of long bone

Background: Road traffic injuries are the seventh most common cause of long bone fractures. Following high velocity limb trauma, the defects in the long bone are usually associated with appreciable soft-tissue losses. These open long bone injuries always require multidisciplinary managements to reconstruct the composite defects of bone and soft tissue. Aims and Objectives: The aim of the study was to find out radiological and clinical outcome, complications, and union time in complex and non-union fractures of long bone managed by fibular graft. Materials and Methods: Out of 50 cases, 40 cases were of complex fractures and ten cases were of non-union. We used Fibular strut grafts in reconstruction of bone defects and soft tissue injury. Results: Thirty (60.0%) had excellent functional outcome, 10 (20.0%) had good, 6 (12.0%) had satisfactory, and 4 (8.0%) patients had poor outcome. Main complications were non-union 2 cases and 3 cases of superficial wound infection, which subsided by wound dressing and intravenous antibiotic treatment. Conclusion: Free fibular grafting has been proven to be an ideal choice in the management of large segmental bone defects as well as in situations of biological failure of bone healing.

Analysis of the surgical strategy and postoperative clinical effect of thoracic ossification of ligament flavum with dural ossification.

PurposeOur research was designed to analyse the postoperative clinical results of patients suffering from single-segment thoracic ossification of the ligamentum flavum (TOLF) combined with dural ossification (DO) who underwent posterior laminar decompression and internal fixation.MethodsThis retrospective research included thirty-two patients who underwent surgery for ossifying the ligamentum flavum in the thoracic spine between January 2016 and January 2020. Patients were fallen into one group included patients with evidence of DO during surgery, and the other group included patients without evidence of DO. We assessed and compared general clinical characteristics and health-related outcomes before surgery and during follow-up.ResultsThe DO group had a longer operation duration, more blood loss, and longer hospital stay (operation time: 94.75 ± 6.78 min vs. 80.00 ± 10.13 min, p < 0.001; blood loss: 331.67 ± 50.06 ml vs. 253.00 ± 48.24 ml, p < 0.001; length of hospital stay: 13.83 ± 2.76 days vs. 10.05 ± 2.33 days, p < 0.001).ComplicationsThere were 12 cases of cerebrospinal fluid leakage and 1 case of superficial wound infection in the DO group. However, the neurological recovery and health-associated quality of life (HRQOL) scores showed no statistically significant changes between the DO and non-DO groups (p > 0.05).ConclusionsPosterior laminectomy and internal fixation combined with intraoperative resection of the ossified ligamentum flavum and dura is an efficient and relatively safe method for treating TOLF with DO, which can provide satisfactory results. Moreover, DO had no significant effect on postoperative neurological recovery and health-related quality of life scores.

The Effects of Tibialis Anterior Tenotomy on Wound Complications and Functional Outcomes After Anterior Fusion Plating for Severe Ankle Arthritis

Nonunion is known to be a relatively common complication following ankle arthrodesis. Various fixation techniques have been introduced to enhance the stability and to improve fusion rate. With the use of anterior plate supplementation, postoperative wound problems have been frequently reported despite better fusion rate. This study was performed to determine the effects of tibialis anterior (TA) tenotomy on wound complications and functional outcomes after anterior fusion plating for severe ankle arthritis. Forty-six patients who underwent ankle arthrodesis using anterior fusion plate were followed for more than 2 years. TA tenotomy was performed prior to wound closure in all patients. As a control group, 38 patients who underwent arthrodesis without TA tenotomy were analyzed. Functional outcomes were evaluated with Ankle Osteoarthritis Scale and Foot and Ankle Ability Measure. Wound complication rate, time to fusion, fusion rate, time to pain relief were evaluated. Mean Ankle Osteoarthritis Scale and Foot and Ankle Ability Measure scores significantly improved to 32.6 and 69.4 points at final follow-up, respectively. As compared to control group (33.8 and 67.7 points), there were no significant differences in functional outcomes. As postoperative wound complications, there were 1 case of wound dehiscence and 1 case of superficial wound infection. TA tenotomy group showed a significantly lower wound complication rate (4.3%) than control group (23.7%) (p < .001). While there were no significant differences in fusion rate, time to fusion, and time to pain relief between both groups, control group needed higher rate of implant removal. Ankle arthrodesis using anterior fusion plate in conjunction with TA tenotomy appears to be an effective surgical option for end-stage ankle arthritis, with excellent fusion rate and less wound complication rate. Although there were no specific functional deficits related to absence of TA tendon, further studies are needed to determine long-term effects of TA tenotomy in patients with a fused ankle.

Evaluation of Double Mesh Modification of Chevrel’s Technique in Management of Midline Incisional Hernia

Background: Chevrel’s technique provides tensionfree repair of midline incisional hernia, but wide skin and subcutaneous dissection increases rate of complications. Here, we evaluate the double mesh modification of Chevrel’s technique in midline incisional hernia repair.&#x0D; Methods: 22 patients with midline incisional hernia underwent double mesh modification of Chevrel’s technique. After excision of hernial sac with minimal dissection of the skin and subcutaneous tissue, the anterior rectus sheath is incised on both sides to create medial flaps that are sutured toeach other. Both recti abdominis muscles were dissected off the posterior rectus sheath, opening the retrorectus space. Prolene mesh was fixed in the retrorectus space with prolene sutures, and tailored to cover the bare area of anterior surface of both recti muscles and fixed to the lateral flaps of the anterior rectus sheath with interrupted prolene sutures.&#x0D; Results: We observed no recurrences, no skin necrosis, two cases of seroma, one case of superficial wound infection and one case of temporarychronic pain.&#x0D; Conclusion: Double mesh modification of Chevrel technique is an efficient method for treatment of midline incisional hernia, with minimal surgical site occurrences.&#x0D; Keywords: Chevrel technique, Double mesh technique, Midline incisional hernia

Functional and Radiographic Outcomes of Minimally Invasive Intramedullary Nail Device (MIIND) for Moderate to Severe Hallux Valgus.

This study was aimed at assessing clinical and radiographic outcomes of the Minimally Invasive Intramedullary Nail Device (MIIND) to correct moderate to severe hallux valgus (HV) and the long-term persistence of its effects. This case series study involved 100 patients, 84 women and 16 men (mean age, 59 years), who underwent the MIIND procedure with a mean follow-up of 97 months. Assessment was performed preoperatively, postoperatively, at 6 and 12 months, and at last follow-up. Clinical outcomes were evaluated with American Orthopaedic Foot & Ankle Society (AOFAS) scores, visual analog scale (VAS), and patient satisfaction. Intermetatarsal angle (IMA), metatarsophalangeal hallux valgus angle (HVA), distal metatarsal articular angle (DMAA), and tibial sesamoid position were assessed. Statistical analysis was performed. The mean AOFAS score improved from 57.9 to 90.5 points, VAS scale was 1.5 ± 2.0, and patients' satisfaction was 8.7 ± 1.4. The mean correction of the HVA and IMA showed a significant correction; however, the effect of time was not statistically significant on DMAA. Sex (P = .047), severity (P = .050), associated procedures (P = .000), and preoperative angle (P = .000) showed significant association with HVA correction and its persistence over time. Age was not statistically significant. Complications were 9 cases of superficial wound infection and 6 recurrences. The MIIND technique proved a viable procedure to correct moderate to severe HV with a low rate of complications and recurrence, producing significant correction of most radiographic parameters assessed and their persistence, even at long term. Level IV, case series study.

Human trial using the novel bioprosthetic VenoValve in patients with chronic venous insufficiency

BackgroundChronic venous insufficiency (CVI) is a disease characterized by failure of the venous valves that allow blood from the lower limbs to return to the heart. The more severe types of CVI (C4b-C6 disease) significantly influence patients' quality of life (QOL). The treatment options for CVI of the deep system are limited. The present study is the first-in-human study using a prosthetic venous valve, VenoValve, to initially evaluate patient outcomes. We evaluated the feasibility, initial safety, and performance outcomes of the VenoValve. MethodsTen patients with C5-C6 CVI of the deep venous system secondary to postthrombotic syndrome had had a VenoValve surgically implanted into the femoral vein in Bogota, Colombia, under approval of the local ethics committee and Colombian National Food and Drug Surveillance Institute, national health care regulatory body, or the Colombian National Food and Drug Surveillance Agency. Follow-up examinations were conducted postoperatively at 2 and 14 days and then every 30 days for 6 months. The results of the assessments for adverse events, reflux time, disease severity (venous clinical severity scores), pain scores (visual analog scale), and QOL (VEINES-QOL/Sym [venous insufficiency epidemiological and economic study–QOL/symptoms] questionnaire) were documented. ResultsTen patients underwent successful implantation of the VenoValve into the femoral vein as outpatients (100% technical success rate). Of the 10 patients, 9 had undergone VenoValve placement under regional anesthesia and 1 under local anesthesia. Six patients had required bovine patch angioplasty of the vein. Four adverse events occurred, including one case of hematoma at the incision site that was aspirated, 2 cases of superficial wound infection in C6 patients treated with antibiotics, and 1 case of a bleeding complication due to warfarin anticoagulation. One patient's VenoValve had thrombosed at 5 months due to nontherapeutic anticoagulation. Improvements in all 5 patients who had reached the 6-month follow-up mark with the VenoValve were demonstrated during the study period by decreases in the venous clinical severity scores (61% decrease from baseline), visual analog scale for pain scores (57% decrease), and reflux time (40% decrease) and a statistically significant improvement in the VEINES-QOL/Sym questionnaire. The patient with the occluded VenoValve had experienced improvements in all areas except for the reflux time. The latter patient had shown improvement because her ulcer had nearly healed before the occurrence of the thrombosis. ConclusionsThe early results of the first-in-human trial using the VenoValve appear promising, with improvements in clinical outcomes and QOL. The VenoValve is the first prosthetic valve that has shown success at 6 months of follow-up. These findings offer insight for creating better outcomes for these highly disabled patients.

Excellent outcomes after double-locked plating in very low periprosthetic distal femoral fractures.

Very low periprosthetic distal femur fractures (PPDFFs) are rare injuries and often have a relatively high failure rate after single lateral locked plating. The double plating technique yields good outcomes in osteoporotic fractures of the distal femur. To date, there is limited information on double-locked plate fixation of very low PPDFFs. This study aimed to evaluate the outcomes and complications of surgically treated very low PPDFFs using double-locked plate fixation. Between January 2013 and December 2018, sixty-one consecutive patients with PPDFFs have been conducted. Only Su type III PPDFFs with double-locked plate fixation through a lateral minimally invasive approach and a medial subvastus approach to the distal femur were analyzed. Patients were encouraged to perform straight leg raising exercises and active knee motion on the second postoperative day. Assisted weight bearing from the early postoperative days was supported, and full weight-bearing was allowed after healing the fracture site. All patients were evaluated according to the time to union, limb alignment, range of knee motion, Knee Society Score, and presence of complications. Twenty one patients (17 females and 4 males, mean age 76years, range 56-90) were included in the study. There were 10 of 33-A1, 6 of 33-A2 and 5 of 33 A3 fractures, according to the AO classification. Of 21 patients, 20 achieved union at an average of 14weeks postoperatively. Postoperative limb alignment was satisfactory in all cases, with an average mechanical distal lateral femur angle of 89° and average mechanical posterior distal femur angle of 86°. All patients recovered the knee joint motion similar to that of the contralateral side, and daily life pre-injury. The average knee and function scores were 94 and 89, respectively. There were one case of non-union and three cases of superficial wound infection, which resolved after intravenous antibiotic therapy. Double locked plating showed excellent radiographic and functional outcomes with few complications in patients with very low PPDFFs. Based on these promising results, we propose the consideration of double-locked plate fixation in the treatment of very low PPDFFs.

Consequences in extracapsular fractures of hip treatment with cemented bipolar arthroplasty and dynamic hip screw techniques: A clinical study

Injuries like intertrochanteric factures are a common problem in the elderly. The management of comminuted intertrochanteric fractures is challenging because of excessive collapse, cut out of the lag screw and loss of fixation. Present study has been undertaken to evaluate the functional outcome of comminuted intertrochanteric fractures treated with cemented bipolar hemiarthroplasty compared with dynamic hip screw fixation. Objectives: To compare the results, efficacy in meeting the activities of daily routine, functional and clinical outcomes of cemented bipolar hemiarthroplasty and dynamic hip screw fixation as a treatment for comminuted intertrochanteric fractures in elderly patients. Methodology: This prospective study was conducted on 32 cases of intertrochanteric fractures of hip, 16 cases treated with cemented bipolar hemiarthroplasty and 16 cases with dynamic hip screw fixation. The cases were classified according to AO:OTA classification. Hardinge’s modification of anterolateral approach was used for cemented bipolar cases and lateral approach was used for dynamic hip screw fixation. Preoperative care, intraoperative care, postoperative care and complications during follow up period were observed. Functional evaluation was done by using Harris hip score (HHS) and data was analysed. Results: In the present study, age group range for patients was from 60 to 75 years. 56.17% were male & 43.75% were female. Harris hip score in cemented bipolar group showed 6(37.5%) excellent, 6 (37.5%) good, 4(25%) fair results while dynamic hip screw group showed 4(25%) excellent, 6(37.5%) good, 2(12.5%) fair and 4(25%) poor results. Complications noted in the study of cemented bipolar group were 1(6.25%) case of superficial wound infection, 4(25%) cases of shortening and 6(37.5%) cases of abductor weakness with Trendelenburg gait while complications in the dynamic hip screw group were 4(25%) cases of implant failure, 3(18.75%) cases of nonunion, 2(12.5%) cases of knee stiffness and 4 (25%) cases of varus angulation. 1(6.25%) patient died due to medical reasons. This study concludes that primary cemented bipolar hemiarthroplasty can be considered as one of the main treatment options in comminuted intertrochanteric fractures in elderly.

Minimally invasive lumbar decompression in an ambulatory surgery center.

There is limited data regarding clinical and surgical outcomes of minimally invasive lumbar decompression (MIS LD) as an outpatient procedure. In this context, our purpose is to evaluate a single surgeon's experience with performing MIS LD in the outpatient versus inpatient setting and determining if there are differences in surgical and clinical outcomes. Patients undergoing primary, one- to three-level MIS LD were retrospectively reviewed and stratified by surgical setting: ambulatory surgical center (ASC) versus hospital. The cohorts were compared with respect to demographics, perioperative characteristics, complications, postoperative pain and narcotics consumption, and improvements in patient-reported outcomes. Five hundred and nine patients were included: 332 patients underwent surgery at an ASC and 177 patients underwent surgery at a hospital. The ASC patients were younger, more likely to be male, and carry Workers' Compensation insurance. The hospital patients were older, more likely to be diabetic, and had a greater comorbidity burden. Patients undergoing MIS LD in an ASC were less likely to have multi-level procedures and more likely to have decompression with discectomy compared to patients in the hospital cohort. There were two cases of superficial wound infection in the ASC cohort and a single case of a pulmonary embolus in the hospital cohort. Additionally, a total of 28 patients had recurrent herniated nucleus pulposus in the ASC cohort compared to 12 patients in the hospital cohort. There was one case of residual stenosis in the ASC cohort compared to eight cases in the hospital cohort. Both cohorts demonstrated similar preoperative ODI, VAS back pain, and VAS leg pain scores through 12-month follow-up. MIS LD is a safe and effective procedure in an ASC, however, appropriate patient selection and postoperative protocols are imperative in minimizing complications and optimizing safety and efficacy in the outpatient setting.

Treatment of Subtrochanteric Fractures Using the Proximal Femoral Locked Plate

AbstractBackground: Subtrochanteric femur fractures are one of the most devastating injuries. Most of the fractures in the elderly results from trivial fall while in the younger age group it is mainly due to high energy trauma. Fixing subtrochanteric fractures properly is clinically challenging. Various implants both intramedullary and extramedullary are available for their fixation.Aim of Study: To evaluate the short-term outcomes of proximal femoral locking compression plate (PF-LCP) fixation for subtrochanteric femoral fractures.Material and Methods: 30 patients with subtrochanteric fractures were operated upon with open reduction and internal fixation with proximal femoral locked plate. The Harris Hip score was used to document hip function at final follow-up.Results: 28 patients were available for final follow-up after death of two patients. The mean age was 46.20 years. The mean operative time was 125.6 minutes, mean incision length was 18.33cm, mean blood loss was 360ml and mean follow-up was 9.66 month. Union was achieved in all cases in 18.25 weeks. Complications included three cases of delayed union, five cases of superficial wound infection, two cases of malunion with varus deformity and shortening of 1.5 and 2cm. Final evaluation according to Harris Hip score was excellent in 15 cases (53.6%), good in 11 (39.3%) and fair in 2 (7.1%).Conclusion: The Proximal femoral LCP is a satisfactory and feasible method of treatment in subtrochanteric femur fractures.

Laparoscopic Surgery for Colovesical Fistula Due to Sigmoid Colon Diverticulitis

Introduction: Colonic diverticular disease is widespread in Western countries and its incidence increases with aging. Colonic resection for diverticula-related fistulas is frequently technically demanding because of the associated acute or chronic inflammation. This study aimed to evaluate the safety and efficacy of our standardized laparoscopic procedure. Methods: A retrospective analysis was reviewed of 44 consecutive patients undergoing laparoscopic surgery for colovesical fistula during the period October 2006 to June 2018. Results: The median age was 61 years (range 32-84 years) and the patients comprised 40 men and 4 women. The most common presenting first symptom was pneumaturia (49%), followed by urinary tract infection (44%), and diverticulitis (21%). Twelve (31%) patients had history of previous abdominal surgery. Surgical procedures were sigmoidectomy: thirty-eight, Hartmann’s operation: four, low anterior resection: two, respectively. The median operating time was 201 min (range 91-587 min) and the estimated blood loss was 65.5mL (range 0-569 mL). There were no intraoperative complications and conversion to open surgery. No bladder wall repairs were required. Six patients had minor postoperative complications comprising a postoperative abscess and three cases of superficial wound infection and three cases of anastomotic bleeding. The median length of postoperative stay was 11days. No patients had recurrence of diverticulitis or fistula at median follow-up of 5.5 years. Conclusion: We demonstrated that laparoscopic surgery for colovesical fistula can be safely performed. The magnified vision and minimal invasiveness make a laparoscopic approach the ideal means of managing colovesical fistula. To our knowledge, this is the largest study of colovesical fistula managed by a standardized laparoscopic procedure.157_A Figure 1. Demographics of patients157_B Figure 2. The fistula was encircled with cotton tape157_C Figure 3. Divide the sigmoid colon and bladder

Clinical study of the application of enhanced recovery after surgery in cervical spondylotic myelopathy

To evaluate the role of enhanced recovery after surgery in treating cervical spondylotic myelopathy. The clinical data of 55 patients with cervical spondylotic myelopathy underwent surgical treatment from January 2012 to December 2015 were retrospectively analyzed. There were 30 males and 25 females, age from 36 to 71 years old with an average of (45.2±3.2) years, course of disease was for 1 to 12 months with an average of (4.5±1.8) months. The concept of enhanced recovery after surgery and perioperative management were applied to surgical treatment in 35 patients (study group), and the same period, 20 patients without strategy of enhanced recovery after surgery (control group). Thirty-eight patients were treated by anterior cervical discectomy decompression and fixation(ACDF), 17 patients were treated by posterior single-open door laminoplasty decompression. The activity time out of bed, hospitalization days after surgery were compared between two groups. Japanese Orthopaedic Association (JOA) score and visual analogue score(VAS) before operation, after operation at 1, 7, 30 days and 6, 12 months was respectively used to evaluate the neurological function and pain. All the patients were followed up for 12 to 18 months with an average of (14.3±1.5) months. There was no significant difference in age, gender, surgical methods, preoperative VAS, JOA score between two groups (P>0.05). The activity time out of bed was 3 to 8 h with an average of (5.54±1.54) h, postoperative hospitalization time was 3 to12 d with an average of (5.62±1.59) d in study group, while in control group, the activity time out of bed was 24 to 48 h with an average of (18.80±4.78) h, and postoperative hospitalization time was 7 to 17 d with an average of (9.85±1.94) d; there was significant difference between two groups (P<0.01). There was significant difference in VAS and JOA scores between two groups at 1, 7, 30 d after operation (P<0.01), and there was no significant difference at 6, 12 months after operation(P>0.05). There were no neurologic function deterioration, hematoma, wound infection, internal fixation loosening and other complications in study group during hospitalization and following-up;there were 2 cases of superficial wound infection in the control group, who healed by dressing change for 2 weeks;there was no significant difference between two groups(P>0.05). The strategy of enhanced recovery after surgery in treating cervical spondylotic myelopathy can promote the early recovery, shorten the length of stay and improve the patient's degree of satisfaction.

Management of fracture calcaneum by reconstruction locking plate

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;There is a considerable amount of literature on calcaneal fractures and their treatment; however the best management approach has yet to be determined. The results of ORIF and conservative treatment have been described and compared in several studies.These studies show improved outcome after operative management.&lt;/span&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;This is a study of 30 patients with ages ranged from 18 to 65 years with displaced intraarticular fractures of the calcaneus treated by open reduction and internal fixation. 4 patients had bilateral fractures. Out of 34 fractures in 30 patients, 22 fracture calcaneum were joint depression type and 12 fractures were tongue type&lt;/span&gt;.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;In 17 cases normal Bohler angle (i. e. 20&lt;sup&gt;0&lt;/sup&gt;-40&lt;sup&gt;0&lt;/sup&gt;) was achieved. There were 3 cases of post operative delayed wound healing, 2 cases of superficial wound infection and 1 case of sural nerve complication in the form of loss of sensation on lateral aspect of foot. According to American Orthopaedic Foot And Ankle Society (AOFAS) score, 13.33% of the patients had excellent results, 63.33% had good results, 13.33% had fair result and 10% had poor results. &lt;/span&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;Operative fixation of displaced intra-articular fractures of the calcaneus by reconstruction locking plate, restores the calcaneal height, allows early mobilization and weight-bearing, and maximizes the chances for good joint function&lt;/span&gt;&lt;span lang="EN-IN"&gt;.&lt;/span&gt;&lt;/p&gt;

Results of operative 4-in-1 patella realignment in children with recurrent patella instability

PurposeRecurrent patellar instability is a cause of knee dysfunction, limitation and pain for children. If nonoperative treatment fails to stabilise the patella, operative realignment and stabilisation have been advocated. Operative techniques in the paediatric population must preserve physeal growth while ensuring stability. We aimed to determine the outcome of children and adolescents who underwent a 4-in-1 patellar realignment (lateral release, medial reefing, Insall tube realignment and Roux-Goldthwaite patella ligament transfer). MethodsConsecutive skeletally immature patients operated in our institution were included in the study. A total of 16 operated knees in 12 patients were recruited. All patients underwent the same procedure after attempting a minimum period of 6 months of non-operative treatment with unsatisfactory results. The main outcome measured was recurrent dislocations. Functional outcomes were assessed using the Kujala score and the Paediatric form of the International Knee Documentation Committee Subjective Knee Form (Pedi-IKDC). ResultsPatients were followed up for a minimum of 3 years. None of the patients sustained further patella dislocations following the operation. In 3 cases, minor patellar maltracking was noted post-operatively but all 3 remained asymptomatic. Three patients had a small area of numbness lateral to the operative incision, which coincided with hypertrophic scarring. There was one case of superficial wound infection. The mean Kujala score was 83.4 ± 11.47 and the mean Pedi-IKDC was 79.5 ± 12.56 at the latest follow-up (minimum of 36 months). ConclusionsThe 4-in-1 patellar realignment is a good procedure in paediatric and adolescent patients with recurrent patella instability. Satisfactory results were observed with a minimal complication and redislocation rate in our series.