Conservative Treatment Modalities Research Articles

Study on duration of symptoms of anal fissure and its impact on response to conservative treatment – A systemic review

Conservative treatment is the main course of action for anal fissure. The goal of this review was to see how symptom duration affected the anal fissure's responsiveness to conservative treatment.In this systematic review, We evaluated the duration of symptoms related to anal fissure as well as their effect on the response to conservative treatment. The study was done by referring journals and articles from PUBMED, Scopus, web of science and Elsevier for a systemic review and references for additional studies. All the articles and literature other than in English language are excluded. Atypical fissures which occur due to conditions like cancer, anal infection and inflammatory bowel disease are excluded. The key search words used are Anal fissure , Fissure in anal and conservative treatment, symptoms of anal fissure , Anal fissure and Glycery l Tri Nitrate (GTN), Anal fissure and Botox, Anal fissure and pathophysiology, Anal fissure and calcium channel Blockers, classification of anal fissure. A total yielded 1048 articles on initial search; first 614 duplicate publications were removed. After screening additional 467 articles were excluded and 147 full articles were assessed for the study. After performing complete screening data analysis of total 14 literature were involved in this present systematic review.This Systemic review can be concluded by the above mentioned finding that if symptom duration is less or in other words in acute anal fissures conservative treatment methods can work very effectively especially with GTN. However, as the duration of symptoms exceed the healing rate decreases attributing to the chronicity of the anal fissures. This renders the conservative treatment modalities less effective and making surgical treatment alternatives like Lateral internal sphincterotomy (LIS) the mainstay for chronic anal fissure.

Recalcitrant Torticollis: A Formidable Treatment Challenge.

There are few evidence-based practice guidelines for recalcitrant torticollis (RT), defined as torticollis that persists past 1 year of age despite conservative therapy. Available evidence recommends a combination of physical therapy (PT), occupational therapy (OT), botulinum toxin injection (BTI), and in the most severe cases, surgical release. This is a single-center, retrospective study conducted with Institutional Review Board approval. Inclusion criteria were diagnosis of congenital muscular torticollis before 1 year old and persistence of symptoms past 1 year despite conservative treatment between January 1, 2005, and January 30, 2023. Patients with incomplete data, acquired torticollis, confounding diagnoses, or who did not receive a diagnosis or conservative therapy before 1 year of age were excluded. Seventy-seven patients met the inclusion criteria. The average age at diagnosis was 4.5 ± 2.5 months. Initial treatment consisted of PT for 61 patients (79.2%), stretching exercises for 11 patients (14.3%), and OT for 4 patients (5.2%). Regardless of timing, 74 patients in total (96.1%) received PT for an average of 13.3 ± 8.6 months. Conservative treatment modalities led to the resolution of symptoms for 40 patients (51.2%) and improvement of symptoms for 35 patients (45.5%). Two patients received at least 1 BTI which led to further improvement of symptoms. One patient underwent operative intervention which consisted of sternocleidomastoid release. RT is a challenging clinical entity that requires diligent multidisciplinary care. Patients who present and begin conservative therapy before 1 year of age are likely to have improvement or resolution of symptoms without more advanced therapies.

Retrospective Evaluation of Patients Who Received Surgery as the First Option in the Treatment of Green Type 3-4 Trigger Finger

AİM: To evaluate the clinical and functional outcomes of the patients with trigger finger patients who are treated by open surgery method without applying conservative treatment modalities METHODS: Open A1 pulley surgical release under local anesthesia was applied to 67 trigger finger patients ( 45 female, 22 male, mean age 53,82, range 11-81). The mean follow-up was 38,37 months (range 4-76 months). As assosiated pathologies, there were type 2 DM in 14 and chronic renal failure in 1 patients. RESULTS: In 67 patients pain and triggering were found to be treated by open surgical A1 pulley release. No recurrence seen in triggering nodularity. Postoperatively there were no significant neurovascular complications noted CONCLUSION: As similar to literature, we believe that in the treatment of trigger finger with open surgery method is a safe and effective method and also supplies fast return to daily life. We think that the surgery may be the first choice in selected cases.

Comparing Conservative and Early Surgical Treatments for Pyogenic Spondylodiskitis: An International Propensity Score-Matched Retrospective Outcome Analysis.

Pyogenic spinal infections pose therapeutic challenges, with the optimal treatment approach remaining contentious. This study aimed to compare outcomes of conservative vs early surgical treatment (SuT) modalities in primary pyogenic spondylodiskitis through an international cohort analysis. A retrospective outcome analysis was conducted of 392 patients from the United Kingdom and Germany, treated between 2017 and 2022 with primary pyogenic spondylodiskitis. Patients were stratified by treatment modality. Propensity score matching, facilitated by a directed acyclic graph and principal component analysis, was used to balance risk factors between the compared patient cohorts. Primary outcome was mortality rate, while secondary outcomes included hospitalization duration, infection relapse, and neurological status at discharge. The study included 95 patients undergoing conservative treatment, primarily treated in the United Kingdom, and 297 receiving SuT, predominantly in Germany. The mortality rate was notably higher in the conservative group (P < .001), while the surgical cohort experienced a shorter hospitalization duration (P < .01). After propensity score matching, 2 comparable cohorts of 95 patients each emerged. Subsequent analysis revealed a markedly increased mortality in the conservative group (24.2% for conservative treatment vs 4.2% for SuT, P < .001). Neither relapse nor neurological status at discharge showed significant differences between the groups. The study indicates that early surgical intervention may be more effective than conservative management in reducing mortality and hospital stay for patients with primary pyogenic spondylodiskitis. These findings highlight the need for prospective trials and more definitive treatment guidelines.

Minimally Invasive Sacroiliac Joint Fusion versus Non Surgical Management in Chronic Sacroiliitis: A Systematic Review and Meta-Analysis

Abstract Background Sacroiliac joint fusion for low back pain attributed to sacroiliac joint is beneficial in a subset of patients. However, varied conservative treatments were measured in previous studies. Moreover, there are lack of well design and long-term follow-up studies. Aim of the Work The primary objective of this study was to determine whether sacroiliac joint fusion was superior to conservative treatment for patients with low back pain in pain and function. Materials and Methods In the current metaanalysis, the 18 studies included 1457 patients with chronic sacroiliitis, from which 841 patients underwent Non-surgical management &amp; 616 patients underwent minimally invasive SI fusion. The mean age of pooled sample is 50 years. The follow up period ranged from 2 weeks to 72 months. Results In our meta-analysis, there was significant decrease in pain scores in patient treated with minimally invasive sacroiliac joint fusion. The decrease reported in the included studies of VAS and ODI after MISJF is clinically relevant statistically significant. In terms of pain reduction: all conservative treatment modalities showed statistically significant reduction of pain at the end of follow up except in local anesthetic injection. In terms of disability score (ODI): all conservative treatment modalities showed statistically significant reduction of ODI score at the end of follow up. There was a dramatic relief of pain in cases treated with joint fusion than those treated with conservative treatment. Using EQ-5D time trade-off scale, there was improvement in patient quality of life on patient treated with joint fusion higher than in cases of conservative management, but was statistically insignificant. We found that proportion of patients who were able to walk for distance more than one kilometer were higher in case treated with joint fusion, but it was statistically insignificant. By month 24, we observed 39 severe adverse events after sacroiliac joint arthrodesis, including sacroiliac joint pain, postoperative gluteal hematoma, and postoperative nerve impingement. With conservative treatment there were no reported complications except in one study. In fusion group few complication reported mostly were : hematoma formation, piriformis syndrome, cellulitis, deep-soft tissue infection, Implant penetration, non-displaced fracture and persistent joint pain. Conclusion In cases of low back pain related to chronic sacroiliitis, improvements in pain, and disability, observed following minimally invasive SIJF surgery was statistically significant compared to non-surgical management.

Efficacy of Intra-articular Platelet-rich Plasma versus Hydrocortisone with Local Anaesthetic Injection in Temporomandibular Joint Disorders - A Prospective Study

Abstract Introduction: Temporomandibular joint (TMJ) is subjected to many disorders commonly termed temporomandibular disorders (TMDs) which include TMJ hypermobility, ankylosis and internal derangement. In the past, many non-invasive conservative treatment modalities were tried out for their treatment which include joint unloading, the use of anti-inflammatory agents and physiotherapy. In recent times, injections of corticosteroids and platelet-rich plasma (PRP) into the TMJ have been proposed as alternative therapeutic methods. The main objective of the prospective study was to compare the efficacy of intra-articular injection of PRP and hydrocortisone with local anaesthetic agents in reducing the symptoms in patients with TMDs. Materials and Methods: This prospective study included 30 patients with TMDs, out of which 15 patients (Group I) received PRP injections and 15 patients (Group II) received hydrocortisone with local anaesthetics for arthrocentesis in their affected joints. The patients were assessed for pain, maximum interincisal mouth opening, TMJ sound and disc displacement. Results: The pain was markedly reduced in patients who received PRP injections (Group I) as compared to those who received hydrocortisone injection (Group II). An increase in mouth opening was similar in both the groups, and TMJ sounds were reduced in patients who received PRP. Magnetic resonance imaging also showed that PRP-treated patients showed better articular disc repair than patients treated with hydrocortisone. Discussion: PRP increases chondrocyte proliferation and production of matrix molecules and helps maintain the integrity of the chondral surface, thereby facilitating joint movement, whereas corticosteroids are more potent anti-inflammatory agents and they act by inhibiting prostaglandin synthesis which is the mediator of inflammation. Thus, the use of PRP has been proven to show better results in reducing the symptoms of TMDs and also helped in articular disc repair.

Tailored lateral internal sphincterotomy (T-LIS) for chronic anal fissure by LigaSure Small Jaws©: a comparison with other non-conservative treatments for anal fissures

An anal fissure is a small tear in the thin tissue (mucosa) that lines the anus. Anal fissures typically cause pain and bleeding with bowel movements. The cause is not fully understood, but low intake of dietary fiber may be a risk factor. Chronic anal fissure was defined as a split or ulceration in the posterior or anterior anoderm for at least 6 weeks: have distinct anatomic features such as muscle fibers visible in the wound. Anal fissures can be attributed to constipation or repeated straining: a hard fecal bolus cut the mucosa of anal canal that is relatively thigh at sphincter level management and optimal treatment of the disease is controversial. Many studies recommend conservative and medical treatment modalities as the initial treatment options since they are non-invasive and do not have risks such as anal sphincter injury. Lateral internal sphincterotomy (LIS) is considered the gold standard for treatment of chronic anal fissure. Nonetheless, anal incontinence is one of the worrisome complications of LIS. Fissurectomy is another option among those techniques which address the issues with LIS. LigaSure© (Valleylab) is a bipolar electrosurgical device designed to deliver high current and very low voltage to tissue. It monitors tissue impedance between the jaws of the instrument and continuously adjusts the delivery of energy. The use of LigaSure Small Jaw was never reported for anal fissures in literature. We have applied the use of this device to a group of patients complaining for chronic anal fissure in order to verify if there is any advantage to perform it compared to traditional technique (blade, scissors, electrocautery).

Addressing the challenges of complex type III odontoid fractures: Clinical and radiological outcomes of various treatment modalities

BackgroundUnlike simple fractures, complex Type III odontoid fractures—characterized by intricate morphology and pathomechanics—pose significant management challenges. This study aims to evaluate the clinical and radiological outcomes of conservative and surgical treatment modalities for these complex fractures, with a focus on assessing factors influencing fracture union. MethodsFollowing approval of our institutional review board, this retrospective observational cohort study was conducted. All Patients with complex Type III odontoid fractures who were managed at our center from June 2016 to December 2022 were assessed for eligibility. The primary outcome was union status. Secondary outcomes included the ASIA impairment scale, neck disability index (NDI), and complications. Logistic regression analysis was conducted to identify risk factors for adverse union outcomes. ResultsA total of 39 patients were included in the final analysis, with a mean age of 36.10 years. Nine patients were managed conservatively, 12 patients underwent anterior odontoid screw (AOS) fixation, and 18 patients received posterior fusion (PF). The rate of bony union varied significantly across the treatment groups, 100 % in the PF group, 58 % in the AOS group and 22 % in the conservative group (p = 0.0012). The NDI revealed superior functional outcomes in the PF group compared to the other groups (p = 0.0436). Failure of primary treatment was observed in seven patients (three from the conservative group and four from the AOS), necessitating secondary treatment with PF. Lateral mass gap >2 mm, coronal tilt >5°, and atlantoaxial instability >50 % were identified as significant risk factors for adverse union outcomes. ConclusionsSurgical treatment, particularly PF, offers superior outcomes in terms of union rates and functional recovery for complex Type III odontoid fractures. The identification of specific radiological measurements as significant risk factors for non-union underscores the need for detailed imaging and careful patient selection for conservative versus surgical management.

Protocol for Diagnostic Test Accuracy Study: Evaluation of Cone Beam Computed Tomography (CBCT) in Prediction of Inferior Alveolar Nerve Injury as Compared to Orthopantomography (OPG) Secondary to Surgical Removal of Impacted Mandibular Third Molars.

Introduction Impairment of the inferior alveolar/dental nerve (IAN) is a relatively uncommon complication after lower wisdom tooth removal. Studies report varying incidences of IAN injury, with dysesthesia being noted as particularly distressing and 0-0.9% cases extending for a long duration. Neurosensory disruptions can severely impact speech, chewing, swallowing, and social interactions, leading to chronic pain and a lower quality of life. It also poses a risk of inadvertent injuries during meals. Although orthopantomogram (OPG) is primarily used for diagnosis, but when the lower wisdom tooth and nerve are in close approximation, cone beam computed tomography (CBCT) is recommended, despite its higher cost and radiation exposure. A white paper on third molar management necessitates further research on CBCT's role, citing conflicting evidence. Further in a multicentric trial, the difference between the OPG versus CBCT group was not statistically significant due to the low incidence of IAN injuries. They have emphasized the need for more well-designed studies to reach a statistically significant conclusion by meta-analyses. Hence, this study aims to provide additional evidence. Methods It is a two-arm, parallel, diagnostic study design involving individuals between the ages of 18 and 50 years, requiring lower wisdom tooth removal that is closely approximated with the nerve. Eligible adults, based on the specified inclusion/exclusion criteria, will be recruited into the study; informed consent will be obtained; then assigned randomly to the OPG or CBCT group using a random computer-generated sequence. Extractions will be done under local anesthesia using a standard surgical protocol with odontectomy. Surgical variables will include the experience of the surgeon, amongst others. The outcome variables will be recorded using patient interviews (subjective) and objective examinations from day one up to six months after surgery. The primaryoutcome will comprise the number of patients reporting abnormal sensations post-surgery. Secondary outcomes will include objectively confirmed IAN injuries and permanent IAN injuries (>6 months). Results will be analyzed statistically to look for significance and possible risk factors associated with it. Results If a statistically significant result is obtained, then we can deliberately reduce CBCT referrals and reserve them only for high-risk cases, wherein the risk of IAN injury cannot be predicted by OPG alone. If the experience of the surgeon proves to be an important risk factor, then it can also help refer high-risk patients to surgeons with more experience. Conclusion If CBCT proves to be statistically superior to OPG in the prediction of nerve injury, then we will be able to avoid significant morbidity and improve the quality of life of such patients by either modifying the surgical steps or by choosing other conservative treatment modalities. Further, this may reduce unnecessary CBCT referrals, thus reducing radiation exposure, the cost to patients, and, in turn, national healthcare expenditure. Besides, CBCT is not available at all centers, so a lot of low-risk patients can be managed safely at primary health centers, thus reducing the urban patient load.

Effectiveness of Shoe Rotation in Managing Plantar Fasciitis in Patients.

Background/Objectives: Plantar fasciitis (PF) is a common condition that causes heel pain. While various conservative treatment modalities for PF exist, no previous studies have investigated the effectiveness of shoe rotation (ShR) in patients with PF pain. This study aimed to compare the therapeutic effectiveness of ShR with that of two conventional treatments for PF-namely, foot orthosis (FO) and physical therapy (PT). Methods: Charts of 42 patients with heel pain were retrospectively reviewed. Participants were allocated to one of three treatment groups: the ShR group, the customized FO group, and the PT group. Pain and functional outcomes were assessed using the Visual Analog Scale (VAS), Digital Pain Scale (DPS), Foot Function Index (FFI), Foot Pain and Function Scale (FPFS), and American Orthopedic Foot and Ankle Society Ankle-Hindfoot Scale (AOFAS-AHS) at baseline and at 4 and 12 weeks after the intervention. Results: The ShR, FO, and PT groups all showed improvements, with statistically significant decreases in VAS, DPS, and FFI scores and significant increases in FPFS and AOFAS-AHS scores over time (p < 0.05). All three interventions resulted in significant improvements from baseline to 4 weeks and further to 12 weeks (p < 0.05). The ShR group exhibited a slightly larger effect on all measurements than the other groups. Conclusions: ShR, FO, and PT contributed to pain reduction and functional improvement, and alternating the shoes alleviated PF pain. These results suggest a new approach to managing PF and serve as a basis for providing convenient treatment for patients with PF.

Papillary thyroid microcarcinoma: Does management differ based on facility variables?

PurposePapillary thyroid carcinoma detection has increased dramatically in the United States. However, the indolent nature of papillary thyroid microcarcinoma (mPTC) has led the American Thyroid Association (ATA) to advocate for more conservative management. The 2015 ATA recommendations advocated for observation or lobectomy for mPTC. However, the majority of mPTCs continue to be treated with more aggressive surgical management. In this study, we aim to understand the management of mPTC based on facility variables. Materials and methodsA retrospective observational study of patients diagnosed with mPTC between 2004 and 2018 was performed using the National Cancer Database incidence data. We collected data on patient sex, age, tumor size, race, ethnicity, geographic location, thyroid surgical volume at the facility, and treatment modality for mPTC were collected. Conservative and non-conservative treatment modalities based on patient and facility characteristics were compared both longitudinally and cross-sectionally between pre- and post-2015 ATA recommendations. ResultsTotal thyroidectomy with or without radioactive iodine ablation (RAI) remains the treatment of choice regardless of patient and facility characteristics. Patients treated at low-volume facilities were actually more likely to be treated conservatively. ConclusionsDespite 2015 ATA recommendations advocating for observation or lobectomy for mPTC, patients with mPTC are still more likely to be treated with total thyroidectomy with or without RAI, especially at high-volume facilities.

Effect of Implant Maintenance on Incidence of Peri-implantitis and Early Implant Failure: Retrospective Cohort Study.

Maintaining dental implants and managing peri-implant tissues has become integral to dental practice. Owing to the larger number of implants placed, the number of peri-implant lesions is increasing. Periodontal implant maintenance therapy (PIMT) provides a conservative long-term treatment modality to monitor and maintain implants. This study aims to investigate periodontal maintenance effects on peri-implant tissue health to add to existing evidence. A retrospective analysis included implant patients with 1-7 years of follow-up, assessing peri-implantitis and early implant failure as outcome variables. The frequency of PIMT, implant characteristics, and demographics served as predictors, and associations between peri-implantitis, implant failure, and PIMT frequency were analyzed using Fisher exact tests with the significance level set at .05. Data were collected on 501 implants from 185 patients. Twenty-nine (6%) demonstrated peri-implantitis, whereas 22 (5%) experienced early implant failure. A significant association between PIMT and peri-implantitis was observed (p-value = .0169) with the rate of peri-implantitis at 9% (n = 20) for patients without PIMT and only 4% (n = 10) for those with PIMT. Whereas PIMT was not significantly associated with early implant failure (p-value = .4372), peri-implantitis was: 25% of implants with peri-implantitis experienced early failure compared with 4% without (p-value = .0062). Considering the limitations of the present study, the absence of PIMT was found to be associated with peri-implantitis, which was itself associated with early implant failure. Implant maintenance at 6-month intervals is important in maintaining peri-implant health.

Why is surgery not popular among medical students and young doctors? - Review of literature

Introduction: Contemporary medicine is witnessing significant advancements in conservative treatment modalities. However, surgery remains paramount for radical cancer treatment and emergent conditions such as trauma, peritonitis, gastrointestinal obstruction, and cholecystitis. Despite the essential role of surgeons, there is a global trend indicating waning interest among medical students in pursuing surgical specialties. Concurrently, practicing surgeons report heightened levels of professional burnout, and many regions face a looming shortage of surgical professionals, posing a threat to healthcare quality. Brief Overview of Current Knowledge: Research conducted across Poland, Germany, Argentina, the United Kingdom, and Japan highlights the declining inclination towards surgery among medical students. Students cite unattractive working conditions, poor work-life balance, elevated stress levels, and limited avenues for scholarly growth as deterrents. Gender plays a role, with females expressing heightened concerns regarding work-life balance and family aspirations. Furthermore, the surgical work environment, inadequate preparatory training in medical schools, and prolonged working hours are identified as factors exacerbating burnout risk among surgeons. Summary: Professional burnout represents a significant concern among surgeons, impacting both their work satisfaction and patient safety. Despite the strides made in conservative medical therapies, surgery remains indispensable, yet its allure as a specialty is diminishing among medical students. Understanding and addressing the discouraging factors, along with promoting healthy work practices, may mitigate burnout and encourage young physicians to consider surgical careers.

Titanium- and Strontium-Infused Calcium Silicates Toward Restorative and Regenerative Purposes.

Dental materials with dentine regenerative properties are preferred over conventional materials. Calcium silicate cements, such as Biodentine, are bioactive and offer excellent sealing ability, making them ideal for various dental treatments. This study aimed to fabricate bioactive calcium silicates infused with titanium (Ti) and strontium (Sr) to optimize their neo-angiogenic, antimicrobial, and regenerative propertieswhile maintaining mechanical stability. Ti- and Sr-infused calcium silicate cements were synthesized, and their mineral phases were characterized using X-ray diffraction. Morphological and elemental analyses were performed using field emission scanning electron microscopy (FESEM) and energy dispersive X-ray spectroscopy (EDS). Raman spectroscopy was used to confirm the formation of bioactive material. A hemocompatibility assessment was conducted to evaluate blood compatibility. The presence of Ca2, SiO4, and SrTiO3 mineral phases indicated the successful infusion of Ti and Sr into the calcium silicate cement. FESEM and EDS revealed interconnected small spheres and rods in the silicate network with the relevant elemental compositions. Raman spectra verified that Si-O-Si and Ti-O-Ti vibrations exist, validating the formation of a bioactive material. The hemocompatibility assessment demonstrated optimal blood compatibility. This study successfully fabricated an improved calcium silicate-based material with enhanced regenerative properties and excellent biocompatibility. This newly formed substrate holds promise for providing superior restorative solutions and aiding in conservative treatment modalities during dental procedures.

Ulnar Nerve Hydrodissection at the Elbow With Ultrasound Guidance

Background: Ulnar neuropathy at the elbow (UNE) is common, and treatment ranges from bracing and nonsteroidal anti-inflammatory drugs (NSAIDs) to surgical decompression. Prior to surgical intervention, some patients may opt to receive perineural injections to the ulnar nerve. The goal of this injection is to reduce pain, improve symptoms, and decrease nerve cross-sectional area through mechanical decompression. While the use of hydrodissection as a treatment for carpal tunnel syndrome has been well studied, there are few studies evaluating its utility in UNE. Indications: Ultrasound-guided perineural injections can be used to alleviate symptoms of UNE caused by compression. The use of a gel stand-off technique is helpful in maintaining adequate visualization of the needle with a steeper needle angle. Technique Description: The procedure was carried out with patient supine, shoulder abducted to 90°, and the forearm supinated. A 15-6 MHz linear array ultrasound transducer was used to localize the right ulnar nerve proximal to the retrocondylar groove at an area of focal hypoechogenicity and increased nerve cross-sectional area. A 3 mL mixture of 2 mL of 1% lidocaine and 1 mL of 10 mg/mL dexamethasone was injected using a sonographically guided in-plane anterior-to-posterior technique. Results: Our patient was seen 3 weeks after her right-sided ulnar nerve hydrodissection and had experienced temporary reduction in symptoms. Discussion/Conclusion: UNE is a common cause of focal neuropathy. Most patients will experience adequate relief of symptoms with conservative treatment modalities. If patients do not experience adequate symptom relief, ultrasound-guided ulnar nerve injection is a minimally invasive option that can provide symptom relief. However, if patients continue to experience significant symptom burden, it is reasonable to discuss surgical options for ulnar nerve decompression. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.

Anatomic location of the first dorsal extensor compartment for surgical De-Quervain's tenosynovitis release: A cadaveric study.

De-Quervain's tenosynovitis is a disorder arising from the compression and irritation of the first dorsal extensor compartment of the wrist. Patients who fail conservative treatment modalities are candidates for surgical release. However, risks with surgery include damage to the superficial radial nerve and an incomplete release due to inadequate dissection. Currently, there is a paucity of literature demonstrating the exact anatomic location of the first dorsal extensor compartment in reference to surface anatomy. Thus, this cadaveric study was performed to determine the exact location of the first extensor compartment and to devise a reliable surgical incision to prevent complications. To describe the location of the first dorsal compartment in relation to bony surface landmarks to create replicable surgical incisions. Six cadaveric forearms, including four left and two right forearm specimens were dissected. Dissections were performed by a single fellowship trained upper extremity orthopaedic surgeon. Distance of the first dorsal compartment from landmarks such as Lister's tubercle, the wrist crease, and the radial styloid were calculated. Other variables studied included the presence of the superficial radial nerve overlying the first dorsal compartment, additional compartment sub-sheaths, number of abductor pollicis longus (APL) tendon slips, and the presence of a pseudo-retinaculum. Distance from the radial most aspect of the wrist crease to the extensor retinaculum was 5.14 mm ± 0.80 mm. The distance from Lister's tubercle to the distal aspect of the extensor retinaculum was 13.37 mm ± 2.94 mm. Lister's tubercle to the start of the first dorsal compartment was 18.43 mm ± 2.01 mm. The radial styloid to the initial aspect of the extensor retinaculum measured 2.98 mm ± 0.99 mm. The retinaculum length longitudinally on average was 26.82 mm ± 3.34 mm. Four cadaveric forearms had separate extensor pollicis brevis compartments. The average number of APL tendon slips was three. A pseudo-retinaculum was present in four cadavers. Two cadavers had a superficial radial nerve that crossed over the first dorsal compartment and retinaculum proximally (7.03 mm and 13.36 mm). An incision that measures 3 mm proximal from the radial styloid, 2 cm radial from Lister's tubercle, and 5 mm proximal from the radial wrist crease will safely place surgeons at the first dorsal compartment.

Modern Internet Search Analytics: Is There a Difference in What Patients are Searching Regarding the Operative and Nonoperative Management of Scoliosis?

Observational Study. This study aimed to investigate the most searched types of questions and online resources implicated in the operative and nonoperative management of scoliosis. Six terms related to operative and nonoperative scoliosis treatment were searched on Google's People Also Ask section on October 12, 2023. The Rothwell classification was used to sort questions into fact, policy, or value categories, and associated websites were classified by type. Fischer's exact tests compared question type and websites encountered between operative and nonoperative questions. Statistical significance was set at the .05 level. The most common questions concerning operative and nonoperative management were fact (53.4%) and value (35.5%) questions, respectively. The most common subcategory pertaining to operative and nonoperative questions were specific activities/restrictions (21.7%) and evaluation of treatment (33.3%), respectively. Questions on indications/management (13.2% vs 31.2%, P < .001) and evaluation of treatment (10.1% vs 33.3%, P < .001) were associated with nonoperative scoliosis management. Medical practice websites were the most common website to which questions concerning operative (31.9%) and nonoperative (51.4%) management were directed to. Operative questions were more likely to be directed to academic websites (21.7% vs 10.0%, P = .037) and less likely to be directed to medical practice websites (31.9% vs 51.4%, P = .007) than nonoperative questions. During scoliosis consultations, spine surgeons should emphasize the postoperative recovery process and efficacy of conservative treatment modalities for the operative and nonoperative management of scoliosis, respectively. Future research should assess the impact of website encounters on patients' decision-making.

Study protocol for a prospective, randomized, multicenter trial to investigate the influence of peripheral nerve stimulation on patients with chronic sacroiliac joint syndrome (SILENCING)

BackgroundThe prevalence of sacroiliac joint pain (SIJP) is estimated to be 10–30% in patients with chronic low back pain. Numerous conservative and surgical treatment modalities for SIJP have been described with limited evidence regarding long-term pain relief.Spinal cord stimulation (SCS) is a well-established technique to treat patients with chronic low back pain. However, the effect on patients with SIJP is not consistent. Therefore, peripheral nerve stimulation (PNS) for chronic SIJP was implemented in experimental trials. Clinical data on PNS for SIJP is still lacking. The authors present a case series and a protocol for a prospective, multicenter study to determine the effect of PNS in patients with chronic intractable SIJP.MethodA multicenter, prospective randomized controlled trial was designed. Patients with chronic intractable SIJP will be recruited and randomized in a 4:3 ratio to either the peripheral nerve stimulation group or to the best medical treatment group. A total of 90 patients are planned to be enrolled (52 in the PNS group and 38 in the BMT group). Patients in the intervention group receive a percutaneous implantation of a unilateral or bilateral lead which is externalized for a trial phase for 3–14 days. After trial phase only patients with at least 50% reduction of pain receive an impulse generator for permanent stimulation. Regular visits for participants are planned on day 0, after 3 months (± 30 days), 6 months (± 30 days), and 12 months (± 60 days). The primary outcome measurements is the difference in Numeric Pain Rating Scale (NRS) between baseline and after 6 months. Secondary outcomes is improvement of pain associated disability (ODI) and improvement of health-related quality of life after 6 and 12 months.DiscussionWe have described the protocol for a prospective, multicenter, randomized trial evaluating the influence of PNS on patients with chronic sacroiliac joint syndrome. We believe that PNS on patients with chronic sacroiliac joint syndrome will show promising results regarding pain relief and quality of life in comparison to BMT after 12 months. The design of this trial promises high evidence in comparison to the data to date.Trial registrationClinicalTrials.gov, NCT05357300. Registered on April 26, 2022.

Application of a Novel 3D-Printed Nasal Plug as a Conservative Treatment for Empty Nose Syndrome.

Empty nose syndrome (ENS) is commonly treated by surgery, albeit with limited success. Herein, we introduce our experience of applying a newly developed "3D-printed nasal plug" as an alternative conservative treatment modality. This retrospective study included 20 patients (14 males, 6 females; mean age 46.5 ± 13.5 years) with ENS who underwent the application of the 3D-printed nasal plug at Asan Medical Center between June 2022 and May 2023. Symptom improvement was assessed by Empty Nose Syndrome 6-Item Questionnaire (ENS6Q) before and after applying the nasal plug. Clinical results, such as duration and frequency of plug use, discomfort, and level of satisfaction, were investigated. The mean follow-up duration was 40.3 ± 24.2 weeks. The average duration of nasal plug usage was 10.8 h per day and 5.3 days a week. The ENS6Q scores improved from 19.6 ± 4.6 to 6.8 ± 5.1 (mean reduction 12.8 ± 5.9) after 30 minutes of wearing. Symptom "nose feelings too open" was improved most by a score of 3.0 ± 1.5 (p < 0.001). Thirteen patients (65.0%) reported that the effectiveness of the plug, initially confirmed at the first wearing, was well maintained during the entire follow-up. Four patients (20.0%) wore the nasal plug uninterruptedly throughout the week, whereas nine patients (45.0%) wore it intermittently as needed. Frequently reported complaints with plug usage were 'displacement of the plug' and 'cosmetic concerns' about the visible hook portion. A 3D-designed nasal plug can be a useful conservative treatment option for ENS patients. 4 Laryngoscope, 134:3935-3940, 2024.

Effectiveness of corticosteroid injection vs platelet rich plasma (PRP) injection in the treatment of plantar fasciitis

Introduction: Plantar fasciitis is one of the most common causes for inferior heel pain in adults. Many noninvasive and invasive treatment modalities are available for its treatment. Local injection of corticosteroid and Platelet-rich plasma (PRP) is usually used in the treatment of chronic plantar fasciitis not responding to noninvasive conservative treatments. Objectives: To compare the efficacy of local injection of corticosteroids and platelet rich plasma (PRP) in the treatment of plantar fasciitis. Methodology: Patients diagnosed as plantar fasciitis and treated conservatively for at least 3 months and had no response to conservative treatment modalities were involved in this study and randomly allocated into 2 groups of 38 each (Group A and Group B). Patients were treated with local corticosteroid injection in group A and autologous PRP injection in group B. Clinical assessment was done prior to the injection and at 3 weeks and 3 months following the injection, which included visual analog pain scale (VAS), subjective rating using the modified Roles and Maudsley score (MRMS), functional outcome score by the Foot function Index (FFI). Results: The mean age, sex and body mass index was comparable for both groups. Postinjection, there was significant improvement (p &lt; 0.05) of visual analog score (VAS), modified Roles and Maudsley score (MRMS), Foot Function Index in both the groups. However, there was no significant difference (p &gt; 0.05) in improvement of VAS, MRMS and FFI when compared between the 2 groups. Conclusion: This study revealed that the treatment of plantar fasciitis with steroid or PRP injection was equally effective in patients who do not respond to conservative treatment.