Common Surgical Treatment Research Articles

Trends in Geographic Utilization of Total Ankle Arthroplasty and Ankle Arthrodesis

Category: Ankle Arthritis Introduction/Purpose: Total ankle arthroplasty (TAA) and ankle arthrodesis (AA) are common surgical treatment options for end-stage ankle arthritis. Previous studies of trends in TAA utilization have shown a rapid increase in use from 2000-2010, likely due to improvements in implants and surgical techniques. The purpose of this study is to assess relative rates of TAA and AA utilization, investigate these trends in across populations and hospital settings, and project these trends in 2030. Methods: The National Inpatient Sample database was queried from 2016-2019 using International Classification of Diseases codes for TAA and AA to identify 8,787 patients (TAA=4,664, AA=4,123). Patient information collected included age, sex, race, primary payer status, year of surgery, length of hospital stay, and median household income quartile. The latter was determined by the NIS database using patient zip code, with the first quartile being the poorest and fourth quartile the richest. Hospital information included bed size, census region, teaching status, and ownership. Results: The ratio of TAA to AA increased from 0.90 in 2016 to 1.33 in 2019. Compared to AA patients, TAA patients were more significantly likely to be male (p=.004), white (p <.001), older (p <.001), and have higher income (p <.001). TAA was more likely to be performed over AA at hospitals which were either smaller (p <.001), urban non-teaching (p <.001), in the western U.S. (p <.001) or with a private, for-profit ownership structure (p=.002). The overall highest volume of both TAAs and AAs were performed in large (TAA=45.6%, AA=55.6%), southern (TAA=31.5%, AA=34.9%), urban-teaching (TAA=75.9%, AA=78.9%) hospitals with private, non-profit ownership (TAA=75.8%, AA=75.0%). TAA utilization is estimated to increase by 79.5% and AA to decline by 63.8%. (Table 1) Conclusion: TAA has continued to grow in utilization from 2016-2019 and is projected to continue this growth to 2030, while AA is expected to decrease in use. Furthermore, patients more likely to receive a TAA than AA are disproportionally white, male, and have a higher income and hospitals more likely to preform TAA are small, urban, for-profit hospitals in the western United States.

Interdisciplinary aspects of abdominal and plastic surgery- what does the (abdominal) surgeon need to know?

The aim was to reflect the established interdisciplinary aspects of general/abdominal and plastic surgery by means of a narrative review. Methods: (i) With specific references out of the medical literature and (ii) own clinical and perioperative as well as operating technical and tactical management experiences obtained in surgical daily practice, we present a choice of options for interdisciplinary cooperation that could be food of thought for other surgeons. - Decubital ulcers require pressure relieve, debridement and plastic surgery coverage, e.g., by a rotation flap plasty, V-Y flap or"tensor-fascia-lata"(TFL) flap depending on localization (sacral/gluteal defects, ischiadic tuber).-Coverage of soft tissue defects, e.g., after lymph node dissection, tumor lesions or disturbance of wound healing can be managed with fasciocutaneous or muscle flaps.-Bariatric surgery: Surgical interventions such as butt lift, tummy tuck should be explained and demonstrated in advance and performed commonly after reduction of the body weight.-Abdominoperineal rectum extirpation (APE): Holm's procedure with greater circumferential extent of resection at the mesorectum and the insertion site of the levator muscle at the anal sphicter muscle resulting in a substantial defect is covered by myocutaneous flap plasty.-Hernia surgery: Complicated/recurrent hernias or abdominal wall defect can be covered by flap plasty to achieve functional reconstruction, e.g., using innervated muscle. Thus, abdominal wall can respond better onto changes of pressure and tension.-Necrotising fasciitis: Even in case of suspicious fasciitis, an immediate radical debridement must be performed, followed by intensive care with calculated antibiotic treatment; after appropriate stabilization tissue defects can be covered by mesh graft of flap plasty.-Soft tissue tumor lesions cannot be resected with primary closure to achieve appropriate as intended R0 resection status by means of local radical resection all the time-plastic surgery expertise has to be included into interdisciplinary tumor concepts.-Liposuction/-filling: Liposuction can be used with aesthetic intention after bariatric surgery or for lipedema. Lipofilling is possible for reconstruction and for aesthetic purpose.-Reconstruction of lymphatic vessels: Lymphedema after tumor operations interrupting or blocking lymphatic drainage can be treated with microsurgical reconstructions (such as lympho-venous anastomoses, lympho-lymphatic anastomoses or free microvascular lymph node transfer).-Microsurgery: It is substantial part of modern reconstructive plastic surgery, i.e.,surgery of peripheral nerves belongs to this field. For visceral surgery, it can become important for reconstruction of the recurrent laryngeal nerve.-Sternum osteomyelitis: Radical debridement (eventually, complete sternal resection) with conditioning of the wound by vacuum-assisted closure followed byplastic surgery coveragecan prevent chronification, threatening mediastinitis, persisting infectious risk, long-term suffering or limited quality of life. The presented selection of single topics can only be an excerpt of all the options for surgical cooperation in daily clinical and surgical practice. An interdisciplinary approach of abdominal and plastic surgery is characterized bya highly developed cooperationin common surgical interventions including various techniques and tactics highlighting the specifics of the two fields.

Comparative study in vivo of the osseointegration of 3D-printed and plasma-coated titanium implants.

Total hip arthroplasty is a common surgical treatment for elderly patients with osteoporosis, particularly in postmenopausal women. In such cases, highly porous acetabular components are a favorable option in achieving osseointegration. However, further discussion is needed if use of such acetabular components is justified under the condition of normal bone mass. To determine the features of osseointegration of two different types of titanium implants [3-dimensional (3D)-printed and plasma-coated titanium implants] in bone tissue of a distal metaphysis in a rat femur model. This study was performed on 20 white male laboratory rats weighing 300-350 g aged 6 mo. Rats were divided into two groups of 10 animals, which had two different types of implants were inserted into a hole defect (2 × 3 mm) in the distal metaphysis of the femur: Group I: 3D-printed titanium implant (highly porous); Group II: Plasma-coated titanium implant. After 45 and 90 d following surgery, the rats were sacrificed, and their implanted femurs were extracted for histological examination. The relative perimeter (%) of bone trabeculae [bone-implant contact (BIC%)] and bone marrow surrounding the titanium implants was measured. Trabecular bone tissue was formed on the 45th day after implantation around the implants regardless of their type. 45 d after surgery, group I (3D-printed titanium implant) and group II (plasma-coated titanium implant) did not differ in BIC% (83.51 ± 8.5 vs 84.12 ± 1 .73; P = 0.838). After 90 d, the BIC% was higher in group I (87.04 ± 6.99 vs 81.24 ± 7.62; P = 0.049), compared to group II. The relative perimeter of the bone marrow after 45 d did not differ between groups and was 16.49% ± 8.58% for group I, and 15.88% ± 1.73% for group II. Futhermore, after 90 d, in group I the relative perimeter of bone marrow was 1.4 times smaller (12.96 ± 6.99 vs 18.76 ± 7.62; P = 0.049) compared to the relative perimeter of bone marrow in group II. The use of a highly porous titanium implant, manufactured with 3D printing, for acetabular components provides increased osseointegration compared to a plasma-coated titanium implant.

Surgical Outcomes of Rhegmatogenous Retinal Detachment and Fellow Eye Involvement in Adolescent and Young Adult Patients

To investigate the associations, fellow eye retinal tear or detachment, and surgical outcomes of rhegmatogenous retinal detachments (RRDs) in young adults. Retrospective Consecutive Case Series. Patients ≤30 years old who underwent surgical repair for RRD between 2014 and 2021 at a single practice. The mean age was 23.85 years (Range 12-30 years old). Data collected included demographics, pre-operative clinical features of the RRD, visual acuity (VA), type of surgery performed, anatomic outcomes, optical coherence tomography (OCT) findings, fellow eye retinal tear or detachment, and post-operative complications. Post-operative VA and single surgery anatomic success rate. 101 patients (109 eyes) were included. 67 patients (74 eyes) and 17 patients (19 eyes) were followed for at least 1 year and 5 years respectively. The most common associations were myopia (66 eyes, 60.6%), trauma (8 eyes, 7.3%), and prior ocular surgery (7 eyes, 6.4%). Median pre-op Snellen VA was 20/70. The macula was attached in 31 eyes. Scleral buckle alone (SB) was performed in 75 eyes, PPV+SB in 27 eyes, PPV alone in 6 eyes, and Cryo-PnR in 1 patient. Single surgery anatomical success was 88.7% for SB, 89.7% for PPV+SB and 75% for PPV. The median final post-operative Snellen VA was 20/50. Twelve patients presented with bilateral RRDs and sequential surgery was performed in 8 patients followed by 4 patients who underwent surgery with fellow eye laser barricade. Fourteen eyes (12.8%) developed a retinal tear or detachment in the fellow eye with a mean interval of 8 months from presentation. Of the 17 patients that were followed for at least 5 years, 3 patients (17.6%) developed a fellow eye retinal tear or detachment. After initial anatomical success, 6 eyes (5.5%) developed PVR. The most common association of RRD in this study was myopia. SB alone was the most common surgical intervention. However, outcomes were generally favorable with SB only and PPV+SB. Surgeons and patients should be aware of the risk of bilateral retinal detachment and the risk of fellow eye retinal tear and detachment. These patients require long term surveillance in both eyes.

Risk Factor Analysis of Cryopreserved Autologous Bone Flap Resorption in Adult Patients Undergoing Cranioplasty with Volumetry Measurement Using Conventional Statistics and Machine-Learning Technique.

Decompressive craniectomy (DC) with duroplasty is one of the common surgical treatments for life-threatening increased intracranial pressure (ICP). Once ICP is controlled, cranioplasty (CP) with reinsertion of the cryopreserved autologous bone flap or a synthetic implant is considered for protection and esthetics. Although with the risk of autologous bone flap resorption (BFR), cryopreserved autologous bone flap for CP is one of the important material due to its cost effectiveness. In this article, we performed conventional statistical analysis and the machine learning technique understand the risk factors for BFR. Patients aged >18 years who underwent autologous bone CP between January 2015 and December 2021 were reviewed. Demographic data, medical records, and volumetric measurements of the autologous bone flap volume from 94 patients were collected. BFR was defined with absolute quantitative method (BFR-A) and relative quantitative method (BFR%). Conventional statistical analysis and random forest with hyper-ensemble approach (RF with HEA) was performed. And overlapped partial dependence plots (PDP) were generated. Conventional statistical analysis showed that only the initial autologous bone flap volume was statistically significant on BFR-A. RF with HEA showed that the initial autologous bone flap volume, interval between DC and CP, and bone quality were the factors with most contribution to BFR-A, while, trauma, bone quality, and initial autologous bone flap volume were the factors with most contribution to BFR%. Overlapped PDPs of the initial autologous bone flap volume on the BRF-A crossed at approximately 60 mL, and a relatively clear separation was found between the non-BFR and BFR groups. Therefore, the initial autologous bone flap of over 60 mL could be a possible risk factor for BFR. From the present study, BFR in patients who underwent CP with autologous bone flap might be inevitable. However, the degree of BFR may differ from one to another. Therefore, considering artificial bone flaps as implants for patients with large DC could be reasonable. Still, the risk factors for BFR are not clearly understood. Therefore, chronological analysis and pathophysiologic studies are needed.

A population-based retrospective cohort study of surgical trends and outcomes of pediatric urolithiasis in Ontario, Canada (2002–2019)

The worldwide incidence of pediatric urinary stone disease (PUSD) is increasing. However, there is no commensurate data on whether this translates to an increasing need for surgical intervention for PUSD, given the role of conservative management. We aimed to evaluate the trends and outcomes of clinically significant PUSD, using administrative databases to identify patients surgically treated for PUSD. This retrospective population-based cohort study assessed the incidence and trends of surgically treated PUSD and outcomes in Ontario, Canada in patients <18 years of age who underwent their first PUSD procedure between 2002 and 2019 utilizing administrative databases held at the Institute of Clinical Evaluative Sciences (ICES). We assessed the incidence of surgically treated PUSD, demographics, initial surgical treatment and imaging modality, and risk factors for repeat intervention within 5 years. Statistical analyses summarized demographics, surgical trends, and logistic regression was used to identify risk factors for repeat surgical intervention. We identified 1149 patients (mean age 11.3 years), with 59.6% older than 12 years. There was a decrease in the number of PUSD procedures performed per year that was close to statistical significance (p=0.059) and a trend towards increased utilization of ureteroscopy (URS) compared with Shockwave Lithotripsy (SWL). In addition, there was a significant increase in the proportion of females surgically treated with PUSD (p=0.001). In the 706 patients followed for 5 years, 17.7% underwent a repeat procedure within 6 months, while 20.4% underwent a repeat procedure from 6-months to 5 years. Renal stone location (OR 2.79, 95% confidence interval (CI) 1.62-4.80, p=0.0002) and index SWL (OR 1.66, 95% CI 1.20-2.31, p=0.0025) were risk factors for repeat surgical intervention within the first 6-months. There was an increasing utilization of ultrasound (US) compared to computerized tomography (CT) (p=0.0008). Despite the literature reporting increasing PUSD incidence, we observed a non-significant decrease in the number of surgical PUSD procedures performed. Exclusion of those treated conservatively may explain our results. The increase in the proportion of females treated reflects the narrowing gender gap in stone disease. A trend towards increased URS utilization was observed and re-intervention rates were similar to previous studies. The overall rate of surgically treated PUSD did not show an increasing trend in Ontario, Canada from 2002 to 2019. URS was the most common surgical treatment modality, with a corresponding decline in SWL rates. PUSD was associated with a high surgical re-intervention rate within 6 months.

Enhanced recovery protocols for ambulatory surgery.

In the United States, ambulatory surgeries account for up to 87% of all surgical procedures. (1) It was estimated that 19.2 million ambulatory surgeries were performed in 2018 (https://www.hcup-us.ahrq.gov/reports/statbriefs/sb287-Ambulatory-Surgery-Overview-2019.pdf). Cataract procedures and musculoskeletal surgeries are the most common surgical interventions performed in ambulatory centers. However, more complex surgical interventions, such as sleeve gastrectomies, oncological, and spine surgeries, and even arthroplasties are routinely performed as day cases or in a model of an ambulatory extended recovery. (2-5) The ambulatory surgery centers industry has grown since 2017 by 1.1% per year and reached a market size of $31.2 billion. According to the Ambulatory Surgery Center Association, there is a potential to save $57.6 billion in Medicare costs over the next decade (https://www.ibisworld.com/industry-statistics/market-size/ambulatory-surgery-centers-united-states/). These data suggest an expected rise in the volume of ambulatory (same day) or extended ambulatory (23h) surgeries in coming years. Similar increases are also observed in other countries. For example, 75% of elective surgeries are performed as same-day surgery in the United Kingdom. (6) To reduce costs and improve the quality of care after those more complex procedures, ambulatory surgery centers have started implementing patient-centered, high-quality, value-based practices. To achieve those goals, Enhanced Recovery After Surgery (ERAS) protocols have been implemented to reduce the length of stay, decrease costs, increase patients' satisfaction, and transform clinical practices. The ERAS fundamentals for ambulatory surgery are based on five pillars, including (1) preoperative patient counseling, education, and optimization; (2) multimodal and opioid-sparing analgesia; (3) nausea and vomiting, wound infection, and venous thromboembolism prophylaxis; (4) maintenance of euvolemia; and (5) encouragement of early mobility. Those pillars rely on interdisciplinary teamwork led by anesthesiologists, surgery-specific workgroups, and safety culture. (2) Research shows that a team of ambulatory anesthesiologists is crucial in improving postoperative nausea and vomiting (PONV) and pain control. (7) This review will summarize the current evidence on the elements and clinical importance of implementing ERAS protocol for ambulatory surgery.

GERD as a Complication of Laparoscopic Sleeve Gastrectomy for the Treatment of Obesity: A Systematic Review and Meta-Analysis.

The incidence of obesity is increasing in developed societies, and surgical treatment is one treatment option. The most common surgical treatment for obesity is laparoscopic sleeve gastrectomy (LSG). Gastroesophageal reflux disease (GERD) is a complication of both obesity and the surgical treatment of obesity. In this study, the PubMed database was searched using the keywords "GERD" and "bariatric surgery", and 987 papers published between 1 July 2017 and 30 June 2022 were retrieved. Nine papers met the inclusion criteria and were included in the meta-analysis. The articles were analyzed for the de novo occurrence of GERD after the treatment of its symptoms, the occurrence of erosive esophagitis, and Barrett's esophagus. In addition, interesting conclusions are presented from the papers that did not meet the inclusion criteria but shed light on the pathophysiology of GERD in obese patients undergoing LSG. In conclusion, the authors draw attention to the need for endoscopic surveillance in patients undergoing LSG, even in the absence of clinical signs of GERD.

Diagnosis and treatment of patellofemoral joint instability

Background: Patellofemoral instability, by definition, is a condition where the patella bone pathologically disarticulates out from the patellofemoral joint, either through subluxation or complete dislocation. The overall incidence of patellofemoral instability ranges between 5.8 and 29 per 100,000. Over time, patients with patellar instability can have debilitating pain, limitations in basic function, and long-term arthritis.Current Concepts: Risk factors for patellofemoral instability include trochlear dysplasia, patella alta, increased tibial tubercle-to-trochlear groove distance, abnormal patella lateral tilt, and coronal and torsional malalignment. The proper treatment is often debatable. Conservative treatment is suitable for acute dislocation but has a high failure rate for chronic instability, which usually necessitates surgical treatment. Today’s common surgical treatments focus on fixing anatomical defects, relieving symptoms of instability, and allowing patients to return to a suitable level of activity.Discussion and Conclusion: In this review, we summarize the relevant pathophysiology, categorization, clinical features, physical examination, imaging, and treatment options for patellofemoral instability.

Increased complication rates for salvage RTSA after failed locked plate fixation compared to primary RTSA in the treatment of proximal humeral fractures in elderly patients.

Common surgical treatment options for proximal humeral fractures in the elderly include locked plate fixation (LPF) and reverse total shoulder arthroplasty (RTSA). It was hypothesized that secondary RTSA after LPF was associated with higher complication rates and costs compared to primary RTSA. Health insurance data of patients ≥65 years of age that received a RTSA due to a proximal humeral fracture between 01/2013 and 09/2019 with a pre-study phase of five years were analyzed. Multivariable Cox, logistic and linear regression models were used to evaluate the association between treatment group, complications, length of hospital stay (LOS), charges and mortality during 34 months follow-up. 14,220 patients received a primary and 1.282 a secondary RTSA after prior surgery using LPF for treatment of a proximal humeral fracture. After adjustment to patient's characteristics, more surgical complications were observed after secondary RTSA during index hospitalization (OR 4.62, 95% CI 4.00 - 5.34, p<0.001) and long-term follow-up (HR 1.52, 95% CI 1.27 - 1.81, p<0.001). Moreover, secondary RTSA was associated with an increased cumulative total cost of 6638.1€ (95% CI 6229.9 - 7046.5€, p<0.001). If conversion from LPF to secondary RTSA occurred during index hospitalization more major adverse, thromboembolic events as well as a higher mortality was found during short and long-term (all p<0.05). Secondary RTSA is associated with higher total costs and more complications. Hence, if surgical treatment of a proximal humeral fracture in the elderly is needed, prognostic factors for LPF need to be evaluated carefully. In doubt, patients will profit from primary RTSA in long term.

Simulated Weightbearing and Articular Injury From Transarticular Screws in a Ligamentous Lisfranc Injury Model.

Transarticular screw fixation is a common surgical treatment for tarsometatarsal ligamentous (Lisfranc) injuries. Iatrogenic damage to articular cartilage from screw placement, however, has been thought to potentially lead to increased risk of tarsometatarsal (TMT) joint arthritis after initial injury. To date, no study has evaluated the effect of weightbearing on articular cartilage after screw fixation. The aim of this study was to create a Lisfranc injury and quantify and compare articular damage due to screw fixation before and after simulated weightbearing. A ligamentous Lisfranc injury was created in 10 cadaveric specimens and treated with transarticular screws. Specimens were cycled for 1000 cycles at 250 N to simulate 2 weeks of physiologic weightbearing. Rotation and diastasis across the Lisfranc complex were measured. Articular injury as a percentage of total articular surface was measured using digital imaging of the first and second TMT joint before and after simulated weightbearing. Comparisons between articular damage were made and statistical analysis was performed. Simulated partial weightbearing increased articular injury 1.44-fold (P < .001). The second metatarsal (M2) showed the greatest increase (1.54-fold, P = .0047), whereas the first (M1) showed the least (1.35-fold, P = .0083). Increases seen at the medial (1.43-fold, P = .0387) and middle cuneiform (1.44-fold, P = .0292) were intermediate between the values seen at M2 and M1. Articular damage from transarticular screw fixation significantly increased after simulated partial weightbearing. This may increase the risk of arthritis and future morbidity when using transarticular screws for the treatment of ligamentous Lisfranc injuries. Iatrogenic damage to articular cartilage due to screw fixation of ligamentous Lisfranc injuries may be increased with weightbearing.

The effect of ding’s screw and tension band wiring for treatment of olecranon fractures: a finite element study

BackgroundTension band wiring (TBW) is a common surgical intervention for olecranon fractures. However, high rate of complications such as loss of reduction, skin irritation, and migration of the K-wires were reported up to 80%. Ding’s screw tension band wiring (DSTBW) is a new TBW technique that has shown positive results in the treatment of other fracture types. The objective of this study was to evaluate the stability of DSTBW in the treatment of olecranon fractures by finite element analysis.MethodWe used Ding’s screw tension band fixation (DSTBW) and K-wire tension band fixation (TBW) to establish a finite element model to simulate and fix olecranon fractures. The stress distribution, opening angle, twisting angle, and pullout strength of K-wires or screws were analyzed and compared.ResultsThe maximum von Mises stress was observed on the internal fixation for 90° elbow motion in both groups. The von Mises value of the screw in DSTBW was 241.2 MPa, and the von Mises value of k-wire in TBW was 405.0 MPa. Opening angle: TBW was 0.730° and DSTBW was 0.741° at 45° flexion; TBW was 0.679° and DSTBW was 0.693° at 90° flexion. Twisting angle: TBW was 0.146° and DSTBW was 0.180° at 45° flexion; TBW was 0.111° and DSTBW was 0.134° at 90° flexion. The pullout strength of DSTBW was significantly higher than that of TBW. Maximum pullout strength of Ding’s screw was 2179.1 N, maximum pullout strength of K-wire was 263.6 N.ConclusionDSTBW technology provides stable fixation for olecranon fractures, reducing the risk of internal fixation migration and failure.

Arthroscopic Resection Arthroplasty for Scapholunate Advanced Collapse Wrist.

Purpose Scapholunate advanced collapse (SLAC) wrist results from an untreated scapholunate dissociation and is the most common type of degenerative arthritis of the wrist. The most common surgical treatments for SLAC wrist are proximal row carpectomy and four-corner fusion with scaphoid excision. Arthroscopic surgical treatment for SLAC wrist has been reported; however, only limited data on functional outcomes are available. The purpose of this study is to report our 5-year follow-up clinical outcomes for arthroscopic treatment for SLAC wrist. Methods Thirty-one consecutive cases of arthroscopic resection arthroplasty for SLAC wrist were reviewed. Preoperative and postoperative Disabilities of the Arm, Shoulder, and Hand (DASH) scores, range of motion, grip strength, and pain (on 0-10 scale) as well as postoperative satisfaction (0 = not satisfied, 5 = completely satisfied) were recorded. Grip and range of motion were measured by an occupational therapist. Results The preoperative pain score was 7 and 0.18 postoperatively. The mean satisfaction at final follow-up was 4.8. Preoperative and final follow-up scores of the mean DASH was 48 and 3, respectively. The total arc of motion was 114 degrees preoperatively and 126.5 degrees postoperatively. Mean grip strength before surgery was 41 and 49 kg at final follow-up. Conclusion Arthroscopic resection arthroplasty for SLAC wrist results in significant improvement in patient function as measured by DASH and pain scores. Type of Study/Level of Evidence Therapeutic IV.

Evaluation of the Effectiveness of Trigeminal Ganglion Ablation Using Pulse Radiofrequency in the Treatment of Trigeminal Neuralgia

Background: Trigeminal neuralgia is a sudden, severe condition characterized by stabbing and recurrent pain. Radiofrequency thermocoagulation (RFT) and pulsed radiofrequency (PRF) are common surgical interventions used to treat trigeminal neuralgia. This study aimed to investigate the therapeutic effects and associated complications of PRF in the treatment of trigeminal neuralgia.&#x0D; Methods: Pulsed radiofrequency was performed on 20 patients with primary trigeminal neuralgia. One months later, pain relief and complication status were evaluated. All patients who referred to the pain clinic of Amir Alam Hospital with a diagnosis of primary TN and after failure of conservative treatment or intolerance to drug side effects were candidates for trigeminal ganglion destruction by PRF method were the study population.&#x0D; Results: In this study, the female to male ratio was 1.5. The mean age of patients was 50.70 years. The highest prevalence was reported in 50-75 years (45%). 7 patients (35%) had pain in the right and 13 patients (65%) had pain in the left. In 18 patients there was involvement in one nerve root and in 2 patients there was involvement in 2 nerve roots. 1 patient (5%) had V1 root involvement, 13 patients (65%) had V2 root involvement and 8 patients (40%) had V3 root involvement. The mean pain score of patients before the procedure was 8.8. The mean pain of patients one hour after surgery was 3.95 and on days 7 and 30 after surgery were 3.3 and 4.25, respectively. One hour after the operation, effective pain relief was observed in 75% of patients. The effective response rate was observed one week after the procedure in 80% of patients and one month later in 60% of patients. There was no significant relationship between patients' gender and the effectiveness or ineffectiveness of the procedure after one month. With age, the effective response to treatment in patients increases. In 2 patients, infection was reported at the procedure site. Four patients reported paresthesia at the procedure site one month after surgery.&#x0D; Conclusion: PRF treatment was an effective, safe and non-destructive method for patients with TN. Primary PRF treatment can be considered as a first-line option before more invasive treatments, such as neurodegenerative procedures and MVD surgery.

Articular Cartilage After Toe Amputation-Protective Barrier or Source of Infection?: A Retrospective Chart Review.

Digital and ray amputations are common surgical treatments for infected bone and traumatic injuries in the foot. When disarticulated, the exposed articular cartilage can be addressed by either leaving the cartilage cap as a "protective barrier" to infection or by remodeling the exposed bone, removing the cartilage to bleeding bone to better fight infection. Our objective is to provide the first study in the foot to determine whether leaving exposed articular cartilage after toe amputation results in more returns to surgery and delayed healing. We performed a review of the electronic database of patients who had undergone toe amputation and/or metatarsal head amputation with the inclusion criteria of Current Procedural Terminology codes 28825, 28820, and 28810. Excluded patients were those who had multiple osteomyelitic bones or more than one-digit amputations because of the difficulty of controlling the extent of infection. Sixty-three procedures were included in the study (group 1, n = 47; group, n = 216). The time to healing between group 1 (44.0 ± 40.6 days) and group 2 (51.7 ± 48.0 days) was not statistically significant (t test, 0.54392), with reinfection rate being low in both group 1 (8.51%) and group 2 (6.25%). Our study showed a low reinfection rate in both groups (8.51% vs 6.25%). Age, A1C, and BMI were also similar between both groups. The PAD difference (55.3% vs 81.3%) could have contributed to the time to heal (44.0 vs 51.7 days) but not to infection rate between both groups. Tobacco use did not seem to affect time to heal or infection rate between both groups. From our results, there doesn't seem to be a difference in infection rates between each group.

Craniofacial malignant tumors, their extensions, and surgical strategy for their treatment

Purpose: To identify extension routes of craniofacial malignancies and formulate a surgical treatment plan based thereupon. Material and Methods: We retrospectively reviewed the medical records of 253 patients with craniofacial malignancies who underwent surgical treatment at the Romodanov Neurosurgery Institute from 2002 through 2022. Of the 253 patients, 112 had a primary tumor, and 141, a secondary tumor. Preoperative Karnofsky performance scores ranged from 50 to 70 points. Patients underwent neurological and ophthalmological status assessment, as per routine protocols. Results: Epithelial malignancies were the most common (53.7%), whereas anaplastic meningioma and embryonal malignancies were rather uncommon (1.2% and 0.4%, respectively) craniofacial malignancies. The presence of certain clinical symptoms was associated primarily with tumor origin and extension. A high rate of general brain and rhinological symptoms in our study sample was caused by a high percentage of intracranial and paranasal sinus tumors. Craniofacial malignancies most commonly originate from the midline (particularly, anterior midline skull base). Ethmoidal labyrinth was the most common site of origin (45.0%), followed by a sphenoid sinus (12.2%), pterygopalatine and infratemporal fossae (9.9%), whereas the cavernous sinus and olfactory fossa were the least common sites of origin (0.4% and 1.2%, respectively). Craniofacial tumors extended most commonly intracranially (transdurally, epidurally, via adhesion to the dura mater, and/or cavernous sinus growth) or intraorbitally. Anterior craniofacial resection (bifrontal craniotomy with combined with either lateral rhinotomy or supraorbital advancement; or a subcranial approach) was the most common surgical treatment. Postoperative cerebrospinal fluid rhinorrhea and infectious complications (meningitis and meningoencephalitis) were the most frequent complications. The overall postoperative mortality rate was 2.0%. Conclusion: First, compared to the transcranial and facial approaches, the craniofacial resection is advantageous in terms of the radicality of tumor excision. Second, the subcranial approach is preferable to the bifrontal approach in the presence of marked extracranial tumor component, whereas the transbasal Derome approach is effective in the presence of marked extracranial and/or intracranial tumor components. Finally, both the orbitozygomatic and infratemporal approaches allow for the radicality of excision of lateral skull base malignancies, but the latter approach is associated with a lower rate of complications.

Pain, function and quality of life are impaired in adults undergoing periacetabular osteotomy (PAO) for hip dysplasia: a systematic review and meta-analysis.

Hip dysplasia is a common condition in active adults with hip pain that can lead to joint degeneration. Periacetabular osteotomy (PAO) is a common surgical treatment for hip dysplasia. The effect of this surgery on pain, function and quality of life (QOL) has not been systematically analysed. In adults with hip dysplasia: (1) evaluate differences in pain, function and QOL in those undergoing PAO and healthy controls; (2) evaluate pre- to post-PAO changes in pain, function and QOL; (3) evaluate differences in pain, function and QOL in those with mild versus severe dysplasia, undergoing PAO; and (4) evaluate differences in pain, function and QOL in those having primary PAO versus those with previous hip arthroscopy. A comprehensive, reproducible search strategy was performed on 5 different databases. We included studies that assessed pain, function and QOL in adults undergoing PAO for hip dysplasia, using hip-specific patient reported outcomes measures. From 5017 titles and abstracts screened, 62 studies were included. Meta-analysis showed PAO patients had worse outcomes pre- and post-PAO compared to healthy participants. Specifically, pain (standardised mean difference [SMD] 95% confidence interval [CI]): -4.05; -4.78 to -3.32), function (-2.81; -3.89 to -1.74), and QOL (-4.10; -4.43 to -3.77) were significantly poorer preoperatively.Meta-analysis found patients experienced improvements following PAO. Pain improved from pre-surgery to 1-year (standardised paired difference [SPD] 1.35; 95% CI, 1.02-1.67) and 2 years postoperatively (1.35; 1.16-1.54). For function, the activities of daily living scores at 1 year (1.22; 1.09-1.35) and 2 years (1.06; 0.9-1.22) and QOL at 1 year (1.36; 1.22-1.5) and 2 years (1.3; 1.1-1.5) all improved. No difference was found between patients undergoing PAO with mild versus severe dysplasia. Before undergoing PAO surgery, adults with hip dysplasia have worse levels of pain, function and QOL compared to healthy participants. These levels improve following PAO, but do not reach the same level as their healthy participants. PROSPERO (CRD42020144748).

Cerclage haubanage versus fixation par vis pour le traitement des fractures de la malléole médiale : revue systématique et méta-analyse

IntroductionTension band wiring (TBW) and screw fixation (SF) are common surgical treatments for medial malleolar fractures (MMFs); however, no systematic review has identified which fixation method is superior. This study aimed to determine the most optimal MMF fixation method by comparing the clinical and radiological outcomes of TBW and SF through a systematic review and meta-analysis of the literature. HypothesisWe hypothesized that there may be differences in outcomes between TBW and SF for treating MMFs. MethodsMEDLINE, Embase and the Cochrane Library were systematically searched for studies that compared TBW and SF for MMF treatment published through June 8, 2021. Fracture union, outcome scores, and postoperative complications were analyzed. ResultsWe included 10 studies with 512 MMF cases; 218 and 294 patients were treated with TBW and SF, respectively. Pooled analysis revealed no significant differences between them for all outcome variables, including the time to fracture union (mean difference=-0.59 weeks; 95% confidence interval [CI], -1.82 to 0.64; p=0.35; I2=70%), number of excellent or good outcomes based on the final Olerud and Molander Ankle score (odds ratio [OR], 1.46; 95% CI, 0.53–5.02; p=0.47; I2=0%), delayed union rate (OR, 0.94; 95% CI, 0.34–2.59; p=0.91; I2=17%), superficial infection rate (OR, 1.19; 95% CI, 0.33–4.26; p=0.79; I2=0%) and number of fixation failures (OR, 0.53; 95% CI, 0.16–1.74; p=0.29; I2=13%). ConclusionsBoth TBW and SF are excellent clinical and radiological methods for MMF fixation. However, an appropriate fixation method should be chosen according to the fracture type and size and bone quality considering the advantages and disadvantages of each method. Level of evidenceIII, meta-analysis.

Pickleball- and Paddleball-Related Injuries to the Upper Extremity.

Introduction While pickleball and paddleball are rapidly growing as popular sports in the United States, research on the incidence of hand and upper extremity injuries and treatments in outpatient clinics are lacking. This study evaluates the incidence rates and treatment options, both surgically and nonsurgically, for patients presenting with pickleball/paddleball-related injuries. Methods A retrospective database search of our multispecialty, multilocation electronic medical record (EMR) system from 2015 to 2022 identified 204 patients with outpatient pickleball- and paddleball-related injuries. The data from these patients' charts were reviewed for injury incidences, treatment trends, and demographics. Results The majority of patients suffered wrist fractures due to a fall/dive and were treated nonsurgically. The most common surgical treatment, when required, was open reduction and internal fixation of the distal radius. We found that pickleball and paddleball players who sustained wrist fractures required surgery at a higher rate than the general population if above the age of 65. Conclusion As pickleball and paddleball continue to gain popularity, hand surgeons should be aware of the types of injuries that can occur and, when possible, counsel patients accordingly to try to prevent them.Additionally, hand surgeons should recognize the common treatments and outcomes that arise from pickleball/paddleball-related injuries.

A SYSTEMATIC REVIEW OF REHABILITATION TECHNIQUES FOR ADULT PATIENTS UNDERGOING EXTERNAL FIXATOR TREATMENT FOR LIMB RECONSTRUCTION OF THE LOWER LIMB

IntroductionExternal fixators are common surgical orthopaedic treatments for the management of complex fractures and in particular, the use of circular frame fixation within patients requiring limb reconstruction. It is well known that common complications relating to muscle length and patient function without rehabilitation can occur. Despite this there remains a lack of high-quality clinical trials in this area investigating the role of physiotherapy or rehabilitation in the management of these patients. We aim to complete a systematic review of rehabilitation techniques for patients undergoing external fixator treatment for Limb Reconstruction of the lower limb.Materials &amp; MethodsA comprehensive search of AMED, CINAHL, MEDLINE and COCHRANE databases was conducted to identify relevant articles for inclusion, using a search strategy developed in collaboration with a research librarian. Inclusion criteria consisted of adults aged 18 years and over who have experienced leg trauma (open fracture, soft tissue damage), elective leg deformity corrective surgery, bone infection or fracture non-union who have been treated with the use of an external fixator for fixation. Specific exclusion criteria were patients below the age of 18 years old, patients with cancer, treatment of the injury with internal nail, patients who underwent amputation, the use of external fixators for soft tissue contracture management, editorials, comment papers, review papers, conference proceedings and non-English papers.Titles, abstracts, and full texts were screened for suitability by pairs of reviewers according to the inclusion and exclusion criteria using Rayyan QCRI online software. Any conflicts were resolved through discussion with three independent specialist senior reviewers. Following full text screening, references lists of included articles were manually searched to ensure that all relevant studies were identified. Due to lack of evidence, forward searching was also completed for studies included in the review. Data quality was assessed using the mixed methods appraisal tool and the CERT assessment tool was utilised to look at completeness of reporting of exercise interventions.ResultsA total number of 832 articles were initially retrieved from our search once duplicate articles removed. After title and abstract screening, 45 articles remained for full text screening. Of these, 11 articles met our inclusion criteria and included for data extraction.ConclusionsWe expect high variability of results due to our inclusion criteria and therefore plan to conduct a narrative synthesis to summarise the findings whilst measing against the mixed methods appraisal tool and CERT assessment scores to assess the data quality. We anticipate lower assessment scores within the fewer articles found and therefore poorer-quality data. We currently are in the process of finalising this data extraction. This will be completed ready for submission and potential presentation at the BLRS conference in March 2023.