Index Surgery Research Articles

Medialization at the Site of Varus Derotational Osteotomy of the Proximal Femur May Reduce Instability Recurrence in Cerebral Palsy.

Osseous reconstructive surgery for hip displacement in children with cerebral palsy (CP) consists of proximal femoral reorientation by varus derotational osteotomy (VDRO) combined with pelvic osteotomy when indicated. The rate of recurrent hip instability after the index surgery can be as high as 77%. We evaluated the association between femoral diaphyseal medialization at the VDRO site and recurrent instability. We hypothesized that medialization may modify the hip joint reaction force (HJRF), reducing the femoral remodeling that leads to recurrent coxa valga and instability. A retrospective evaluation of the clinical and radiographic records of 140 patients (280 hips) with CP, Gross Motor Function Classification System (GMFCS) Level IV or V, who had been treated with bilateral VDRO as the index surgery for hip displacement between 1998 and 2012 (mean follow-up, 11.3 years) was conducted. Radiographic measurement of medialization was performed using the medialization index (MeI) preoperatively, at 6 weeks and 12 months postoperatively, and at skeletal maturity. Recurrent instability was defined as the need for revision surgery before skeletal maturity or a final migration percentage (MP) of >40%.The influence of the MeI was determined by Poisson regression with multiple variances. The inter- and intra-observer reliability of the MeI, measured by 4 different observers, was assessed using the Cohen d test. Groups with and without relapse were comparable preoperatively regarding femoral and acetabular parameters. The baseline MP was higher in the relapse group (p < 0.001). The MeI at 6 weeks postoperatively was significantly lower in the relapse group (p = 0.004, relative risk [RR] = 0.07, 95% confidence interval [CI] = 0.01 to 0.42) than in the no-relapse group in multivariable analysis. The MeI showed good inter- and intra-observer reliability, with a Cohen d of <0.5. Patients with greater medialization had lower rates of recurrent hip instability at long-term follow-up. The MeI proved to be reliable as a radiographic measurement, and medialization did not increase mechanical instability. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Repeated Treatments for Chronic Colorectal and Coloanal Anastomotic Leaks are Associated With a Higher Chance of a Permanent Stoma.

BackgroundWe aimed to identify risk factors associated with chronic anastomotic leak (AL) treatment failure.MethodsAdult patients surgically treated for chronic AL after colorectal or coloanal anastomosis for benign and malignant indications were included. The primary outcome was predictors of AL treatment failure, defined as failure to restore bowel continuity and/or having a permanent stoma at completion of treatment. Step-wise multivariable logistic regression analysis of factors that reached statistical significance on univariable analyses was undertaken.Results60 patients [41 (68.3%) males; average age: 56 (SD 6.7) years; and average BMI: 24 (SD 2.1) kg/m2] were included. 61% of patients were referred for treatment; 46 (76.7%) had colorectal and 14 (23.3%) had coloanal anastomosis at index surgery. 38 (63.3%) had successful treatment; 22 (36.7%) required permanent stoma. Patients who failed treatment on univariable analysis were likely older (OR 1.06; P = 0.045), had >2 prior attempted AL treatments (OR 9.53; P = 0.042), and end colostomy at AL surgery (OR 25.4; P = 0.032). Predictors of failed treatment of chronic AL on multivariable analysis were older age and >2 prior treatments.ConclusionMore than 1/3 of patients with chronic AL eventually fail to achieve restored intestinal continuity. Risk factors on multivariable regression are >2 treatments for chronic AL before definitive therapy and older age at treatment. We recommend considering redoing the anastomosis earlier in the treatment of chronic AL.

Shilla Growth Guidance Surgery for Early Onset Scoliosis: Predictors of Optimal Versus Suboptimal Performers.

The Shilla Growth Guidance surgery (SGGS) aims to correct a child's spinal deformity while allowing continued spinal growth. Our study used a multicenter early-onset-scoliosis database to determine significant predictors of best candidates. The Pediatric Spine Study Group multicenter database was analyzed for all patients who had undergone SGGS and had a minimum follow-up of 2 years. Patients without radiographic measurements preoperatively, postoperatively, and at the latest follow-up, as well as patients with myelo gibbus deformities, were excluded. These radiographs were evaluated for major curve, spinal length, and other parameters. Multivariate regressions were conducted to assess the effects of these parameters on the following 4 outcomes: (1) percent of initial curve correction, (2) scoliosis curve progression after surgery per year, (3) at least 1 unplanned SGGS-related reoperation, and (4) T1-S1 height change per year from 1st postoperative erect to final available follow-up. Included were 105 children; the average follow-up was 4.8±2.4 years. Scoliosis etiologies included neuromuscular (n=36; 34%), syndromic (n=31; 30%), idiopathic (n=30; 29%), and congenital (n=8; 8%). Average preoperative, 1st postoperative erect, and latest follow-up major curves measured 69, 32, and 49 degrees, respectively. Average T1-S1 postoperative height change per year was 7±9mm and average overall T1-S1 height change was 24±35mm. Forty-eight (46%) patients had C-shaped and 57 (54%) had S-shaped curves; 59 (56%) patients underwent ≥1 SGGS-related reoperation. Multivariate Cox-proportional hazard test revealed younger age at index surgery [hazard ratio (HR)=0.83, P=0.028] and S-shaped curves (HR=0.43, P=0.014) were associated with ≥1 reoperation. Further analysis revealed age younger than 7 years (HR=0.48, P=0.021) was correlated with an increased risk of SGGS-related reoperation. The preoperative major curve was not significantly associated with any outcome measure. A reoperation-free survival rate of 50% corresponded to 3.5 years. SGGS instrumentation in patients younger than 7 years and patients with an S-shaped curve were associated with SGGS-related unplanned surgical interventions. Despite younger age being associated with likely complications, this procedure still benefits these children and provides significant curve correction while allowing growth. Level III.

Prophylactic Operative Interventions for Preventing Parastomal Hernias after Colorectal Surgery

AbstractThe most common long-term stoma-related morbidity following colorectal surgery is parastomal hernia formation. Given the risk of developing parastomal hernias and the risk of postoperative complications following their repair, practices have evolved to incorporate prophylactic strategies to reduce the risk of parastomal hernia formation after colorectal surgery. The majority of the data forming the evidence base for parastomal hernia prophylaxis pertains to patients undergoing end colostomy formation in the setting of colorectal cancer. The only prophylactic intervention for prevention of parastomal hernia formation with substantial amounts of high-quality data is the insertion of prophylactic mesh at the index operation for patients undergoing formation of a permanent end colostomy. Other interventions that have been proposed but have less published data substantiating their use include lateral pararectus stoma placement, extraperitoneal stoma creation, circular stoma trephine, and small fascial defects. This chapter will review each of these interventions in detail, along with the associated literature supporting or refuting their use. Additionally, we will discuss other important issues regarding the evidence base for parastomal hernia prophylaxis, parastomal hernia classifications, and risk factors for developing parastomal hernias.

Is operative revision associated with favourable clinical outcomes in arthrofibrosis following total hip arthroplasty (THA)? A retrospective, single-centre data analysis of forty two cases.

There is a paucity of clinical studies examining outcomes following surgical revision in cases of histologically confirmed arthrofibrosis after total hip arthroplasty (THA). Consequently, the aim of this study is to present the clinical outcomes and to identify risk factors for poor clinical and functional outcome following surgical intervention for histologically confirmed arthrofibrosis following THA. This study included 51 patients (51 hips) with histologically confirmed arthrofibrosis of the hip based on the synovial-like interface membrane (SLIM) criteria. These were selected from 7983 revision THA cases performed during the study period After exclusion criteria were applied, 42 cases (59.5% women) with an average age of 63.6 years were included. The mean duration of follow up was 70 months (range 30-122 months). Of these, 73.8% underwent index surgery after primary THA implantation. The primary indication for revision surgery was predominantly the clinical suspicion of arthrofibrosis (n = 35). The Harris Hip Score (HHS) and the EQ-5D-3L scores were calculated for all cases at the time of follow-up. For the risk analysis of a poor clinical outcome, two groups were divided according to the Harris Hip Score. The group with a poor clinical outcome was defined as a HHS < 55. Open arthrolysis was performed in all cases with a modular component being replaced in 73.8% of cases (n = 31) and only two cases requiring additional revision of the femoral and acetabular components due to aseptic loosening.The mean pre op Harris Hip Score (HHS) was 53.2 before revision surgery. This increased to 65.7 post op (p < 0.001). Only 34.1% of patients achieved the minimum clinical significance difference (MCID) of 18 HHS points after surgical revision. The EQ-5D Visual Analogue Scale (VAS) score and the Time Trade-Off (TTO) score averaged 0.226 (SD 0.245) and 0.221 (SD 0.37). Complications occurred in seven cases (16.7%,), with dislocation in 2 cases and persistent AF symptoms in 3 cases. Six cases required further revision surgery (14.3%). In three cases, a further open arthrolysis was performed due to persistent symptoms. Increased BMI (30.1 vs. 26.7 BMI, p < 0.05) or higher body weight (88.4kg vs. 78.7kg, p = 0.086), smoking and a lower preoperative HHS (p = 0.022) were identified as risk factors for a poor clinical outcome, defined as HHS < 55. Results of this study suggest that mid-term clinical results following surgical intervention for arthrofibrosis following THA show a moderate to poor postoperative outcome with an acceptable complication rate. Risk factors for a poor outcome such as increased weight, BMI or smoking should be considered and critically assessed preoperatively.

Risk Factors Associated with Revision Microdiscectomy or Subsequent Spinal Fusion within 2 Years of Index Lumbar Microdiscectomy.

Retrospective review of insurance claims and electronic medical records of a major blended health organization in the eastern United States. Primary objective was to report rates of revision microdiscectomy and fusion within 2 years of index lumbar microdiscectomy. Secondary objectives were to identify patient characteristics and comorbidities predictive for revision surgeries. Incidence of disc reherniation following lumbar microdiscectomy ranges from 3% to 18%. Although rates of revision microdiscectomy are well reported, rates of fusion after index microdiscectomy and risk factors for subsequent fusion beyond history of prior discectomy warrants further investigation. Retrospective review of health insurance claims data for index lumbar microdiscectomy between January 2016, and December 2019. Rates of revision microdiscectomy and fusion within 2 years were reported, and cohort demographics and Charlson Comorbidity Index (CCI) comorbidities were analyzed using Pearson's chi-square analyses and Fisher exact tests. Time-to-event modeling and multivariate Cox proportional hazards regression assessed for predictors of revision surgery. The full sample consisted of 8,158 members. The rate of revision microdiscectomy was 3.5% within 1 year and 5.5% within 2 years of index surgery. The rate of fusion was 2.9% within 1 year and 6.6% within 2 years of index surgery. Age 40-59 (P<0.001), female sex (P=0.024), and presence of ≥ 1 CCI comorbidities (P<0.001) were significantly associated with time-to-fusion but not revision microdiscectomy. Increasing CCI score was associated with a significantly greater likelihood of need for fusion (CCI=1, HR 1.35, P=0.045; CCI=2, HR 1.85, P<0.001; CCI ≥ 3, HR 2.47, P<0.001). Rates of revision microdiscectomy and fusion within 2 years of index lumbar microdiscectomy were 5.5% and 6.6%, respectively. Age 40-59 years, female sex, and having ≥ 1 CCI comorbidity, were significantly predictive of time-to-fusion but not revision microdiscectomy. Having at least one comorbidity increased the likelihood of fusion by 80%.

Clinical Effect of Button Plate Fixation in the Treatment of Anterior Sternoclavicular Joint Dislocations.

Multiple reconstruction approaches for the anterior sternoclavicular joint have been described. No gold standard technique has been established. Owing to the well-established role of open reduction and internal fixation by means of plates and/or screws, rigid fixation is associated with the risk of implant failure, migration, and need for removal. This study aimed to evaluate the safety and efficacy of using button plates for the treatment of anterior sternoclavicular joint dislocation. From January 2018 to May 2021, seven patients with a median age of 47 (range 37-57) years were treated for traumatic anterior sternoclavicular joint dislocations. The American Shoulder and Elbow Surgeons score (ASES), the visual analog scale (VAS) for pain and abduction, and forward elevation of the shoulder were used to evaluate clinical outcomes before the index surgery, at the removal of the implant, and at the latest follow-up. The satisfaction of patients was measured with the standard of Marsh. Open surgical reduction and sternoclavicular joint repair were successfully achieved in all the patients. They were also followed up, for a mean duration of 16.14 months. The mean postoperative abduction angle of the glenohumeral joint was 165.43 (range, 149°-173°), and the angle of one glenohumeral joint was less than 160 (149). The mean posterior extension angle of the glenohumeral joint was 26° (range, 24°-30°). The mean forward flexion was 161.25° (range, 150°-168°), and the horizontal extension was 39.57° (range, 35°-45°), respectively. According to the ASES scoring system, the mean postoperative physical function was 89.58, which was an improvement from the mean preoperative function, which was 25.48. There were no complications, wound infections, blood vessel or nerve injuries, or fixation failure. The patient satisfaction rate was 100%. Button plate fixation technique is safe, simple, and effective and has been successfully used in treating sternoclavicular joint dislocation, with excellent functional outcome.

Unplanned shunt readmission: what does it really look like?

Readmission after an operation has garnered considerable attention within the neurosurgical literature. In this study, the authors sought to analyze the reasons why children are readmitted after shunt surgery and to identify key population characteristics and potential drivers. The authors' single-institution shunt surgery administrative database was used to identify procedures performed from January 1, 2018, to December 31, 2021. Only de novo or revision cranial shunt operations were included. Each surgery within the database represents an index case, and each patient was followed for a 90-day period. The authors categorized an unplanned readmission after shunt surgery as falling into one of 4 groups: 1) definitely unrelated to the index surgery; 2) possibly related but ultimately deemed unrelated; 3) directly related but no return to the operating room; and 4) directly related and requiring repeat surgery. Groups 3 and 4 were combined for statistical purposes. A total of 715 shunt operations were performed with 148 (20.7%) unplanned readmissions within 90 days in 139 patients. The median age was 3.2 years with 58%, 53%, and 58% being male, Caucasian, and having some form of public health insurance, respectively. The majority of African-American children had government insurance (80%) compared to Caucasian (41%) and Hispanic/other (55%) children (p < 0.001). The proportion of new versus revision surgical procedures was 45% versus 55%. Surgeon C did the most operations (n = 52 [37%]). The median number of days to readmission and length of readmission were 26.5 (IQR 9.5-47.0) days and 3.0 (IQR confidence interval 1.0-5.0) days, respectively. Multinomial analysis found that public insurance, revision surgery, and prior admission to the neonatal intensive care unit (NICU) were associated with definitely unrelated readmissions. Private insurance, no prior NICU admission, and an individual surgeon were associated with directly related readmissions. Survival analyses showed no differences in time to readmission among all patients and among only those who had prior NICU admission. The 90-day readmission rate after index shunt surgery was 21%. Drivers of readmission-including socioeconomic status and hydrocephalus severity-were a function of the type of readmission.

Cost-Effectiveness of Instrumented Versus Uninstrumented Posterolateral Fusion for Single-Level Degenerative Spondylolisthesis.

Randomized controlled trial. The aim of this study was to investigate whether instrumented posterolateral fusion is cost-effective compared with uninstrumented posterolateral fusion in elderly patients who undergo fusion surgery for one-level degenerative spondylolisthesis with spinal stenosis. For patients with persistent symptoms due to degenerative spondylolisthesis, surgical intervention may be recommended, typically decompression and fusion. Evidence on cost-effectiveness of choice of fusion method, related complications, and outcome is sparse. This cost-effectiveness analysis is based on a single-center, open-label, randomized controlled trial, where patients with symptomatic degenerative spondylolisthesis were randomly assigned 1:1 to either instrumented or un-instrumented posterolateral fusion. Quality-Adjusted Life Years were obtained from EQ-5D. Use of health services was obtained from patient charts and accumulated until 2 years after index surgery. Of the 108 patients included in the study, 107 patients received the allocated intervention. There were no differences in preoperative demographics. Although the base price for the index instrumented surgery was significantly higher than the index uninstrumented surgery, average cost of surgery was only €146 higher in the instrumented group based on two-year cost data. The instrumented fusion group had a significantly lower reoperation rate [1/54 (1.9%)] than the uninstrumented fusion group 7/53 (13.2%), significantly less visits to the outpatient clinic, less magnetic resonance imaging performed and fewer days of hospitalization. The base case incremental cost-effectiveness ratio was estimated at €1536 per QALY gained over a two-year time horizon. Instrumented fusion was favored over uninstrumented fusion in sensitivity analyses including all reoperations or using hospital reimbursement rate. Instrumented fusion is cost-effective compared uninstrumented fusion, with an incremental cost-effectiveness ration well below the standard range of cost-effectivenes, the difference in cost was driven by lower reoperation rates and less health care resource utilization over a two-year time horizon.

Variables associated with 90-day readmission following craniotomy for tumor in the pediatric population.

Readmission is a vital component of healthcare quality and is one of the core group metrics for quality-dependent outcomes. Currently, variables predictive of readmission following elective craniotomies for intracranial tumors in the pediatric population are not known. We sought to identify such variables in our population of children and young adults. All elective craniotomies for tumor resection performed at our children's hospital from January 1, 2010, through December 31, 2022, were included for review, excluding those patients > 21 years of age. Demographic, clinical, and procedural covariates for each elective craniotomy for tumor resection were collected. Readmission was defined as readmission for any reason and to any service following discharge from the index admission (i.e., elective craniotomy). Readmission events were characterized as occurring within 90 days from discharge. A total of 1,276 patients underwent a total of 1,497 elective craniotomies for tumor resection. The median age of the population at their index operations was 9.45 years, of which 58.5% of patients were male, 68.5% Caucasian, and 76.5% had private insurance. Most tumor resections were supratentorial (63.4%). There were 208 (13.9%) readmissions within 90 days of index operation, with 154 (74%) of those returning within the first 30 days. Bivariate analysis identified a number of associations, but multivariate testing found four significant predictors: age 0 to < 5 years (OR 1.55, p = 0.02), surgical time (OR 1.002, p = 0.02), high tumor grade (OR 3.15, p = 0.03), and return to the neurosurgical OR due to postoperative event (POE) (OR 2.81, p = 0.005). Utilizing our large pediatric tumor database, we identified key drivers of readmission following elective tumor resection. These were young children (0 to < 5 years), surgical time, high tumor grade, and return to the neurosurgical OR due to POE, of which high tumor grade was the strongest. Future studies are warranted to explore the specific ways that these predictors increase readmission risk.

Impact of Endoscopic Bladder Outlet Procedures on Medical and Surgical Retreatment: A Large Population Analysis.

Purpose: Many men undergo operation for benign prostatic hyperplasia (BPH) with lower urinary tract symptoms (LUTS). Although most procedures relieve symptoms, some patients experience recurrence or persistence. This study explores rates of and factors contributing to medical and surgical retreatment after index BPH procedure. Methods: This longitudinal, retrospective, population-based cohort study used MarketScan commercial insurance claims data. From 2009, men with BPH/LUTS diagnosis were evaluated for medical and surgical retreatment after index operation. Index procedures included holmium laser enucleation of the prostate (HoLEP), laser ablation of the prostate, and transurethral resection of the prostate grouped as traditional procedures, whereas transurethral microwave thermotherapy (TUMT), transurethral needle ablation, water vapor thermal therapy, and prostatic urethral lift (PUL) were minimally invasive surgical therapies (MISTs). Multivariable Cox hazard models (p < 0.05) were used to determine factors associated with retreatment after index procedure. Results: We evaluated 10,938 men with median age at diagnosis of 58 years (minimum-maximum 35-65). Five-year surgical retreatment rates were highest for TUMT and PUL (24.5% and 22.3%) and lowest for HoLEP (7%; p < 0.001). One-year medical retreatment rates with bladder outlet medications (i.e., alpha-blockers, 5-alpha reductase inhibitors) were higher after MIST compared with traditional procedures (42.9% vs 27.3%; p < 0.001). Conclusion: Surgical and medical retreatment rates are higher than previously reported in clinical trials. MIST procedures and older age were predictive of both medical and surgical retreatment after index operation. HoLEP had the lowest rate of retreatment compared with TUMT and PUL, which had the highest.

Diffuse glioneuronal tumor in Lynch syndrome: illustrative case.

Lynch syndrome (LS) is an autosomal dominant disorder caused by impaired DNA mismatch repair during the DNA replication process. The condition increases the risk of gastrointestinal and gynecological cancers as well as oligodendrogliomas and astrocytoma. Herein, the authors report the case of a patient with LS with an unusual tumor with features of both glial and neuronal differentiation. The authors present the case of a 34-year-old female who presented with headaches and was found to have a large right anterior frontal lobe mass with patchy enhancement. The patient underwent a right-sided craniotomy for tumor resection, with final pathology revealing a low-grade-appearing glioneuronal tumor. Subsequent molecular testing showed an MSH2 mutation in the tumor, and germline testing confirmed a diagnosis of LS. The patient was monitored without adjuvant treatment and subsequently had tumor progression 12 months after her index surgery. A re-resection was performed. Since tumors arising in this setting typically have an aggressive course, Ki-67 was measured, showing an increase from 2%-5% to 15%-20%. The patient has since been started on concurrent temozolomide and radiation therapy. Although most glioneuronal tumors typically have an indolent course relative to their diffuse glial counterparts, this case suggests that those arising in the setting of LS can have a worse prognosis. https://thejns.org/doi/10.3171/CASE24811.

Robotic-assisted total knee arthroplasty reduced mid-term incidences of multiple orthopaedic complications: A large database study.

Robotic-assisted total knee arthroplasty (rTKA) provides surgeons the ability to make more accurate bone cuts and reduce outliers associated with conventional, jig-based total knee arthroplasty (cTKA). Despite its increase in popularity there continues to be insufficient data showing an improvement in mid-term patient outcomes. The TriNetX Research Database was retrospectively queried for patients undergoing primary TKA with a follow up of at least 5 years after index surgery. Patient records with surgeries performed between January 1, 2012, to December 31, 2019. Records with comorbid indications other than primary TKA were excluded such as distal femur fractures, pathologic fractures, or revision arthroplasty. Propensity score matching at one-to-one ratio was performed to reduce confounding of preoperative risks. Outcomes of aseptic loosening, prosthetic joint infection, instability, periprosthetic fracture, and revision were queried at 1, 3, and 5 years. In this study, 141,613 patients met all study eligibility requirements with 129,622 patients and 11,991 patients in the cTKA and rTKA cohorts, respectively. At 5 years, patients in the rTKA cohort had lower incidence of aseptic loosening (OR 0.335, 95% CI 0.224-0.501), prosthetic joint infection (OR 0.529, 95% CI 0.417-0.672), revisions (OR 0.758, 95% CI 0.609-0.943), and all complications combined (OR 0.640, 95% CI 0.550-0.745). Robotic TKA was found to be associated with a reduction in aseptic loosening, prosthetic joint infections, revisions, and all complications combined. This improvement in mid-term patient outcomes is observed at multiple time points out to 5 years, both before and after propensity score matching.

ETAD: a case series of endoscopic transanastomotic drainage of anastomotic leak by colonoscopy.

Transanal drain placement is the preferred treatment for coloanal and low colorectal anastomotic leaks (AL). Endoscopic placement of double-pigtail stents (DPS) has been described sparingly in the colorectal literature for more proximal AL. Our objective was to investigate the efficacy of endoscopic transanastomotic drain (ETAD) placement in leaks after colorectal surgery. This is a case series of 12 patients who underwent ETAD placement for AL (12 patients) between May 2020 and July 2023. Patients with contained leaks were treated with ETAD if they were hemodynamically stable without peritonitis. Outcomes we evaluated included length of stay, need for readmission, need for reoperation, duration of drain placement, and reversal of diverting stomas. Of the 12 patients, 5 were female and had a median age of 63. Indications for index surgery included diverticulitis (n = 9), inflammatory bowel disease (n = 1), rectal cancer (n = 1), and uncertain diagnosis (n = 1). 5 patients had stomas created (loop ileostomies,) at the index operation. Leaks were identified a median of 80days (range 9-211) for diverted patients and a median of 15days (range 5-18) for non-diverted patients. At the time of ETAD, three patients required readmission, four patients remained admitted from index operation, and five patients were treated as outpatients. All diverting loop ileostomies were reversed. The median duration of ETAD was 55days (range 38-115days). All were successfully managed with ETAD; no patients required revision of their anastomoses or new diverting stoma. Endoscopic DPS placement into contained colorectal leaks was successful in promoting healing and avoiding reoperation in 100% of our patients. All ostomies but one have been reversed. Larger studies are necessary to evaluate safety and efficacy, long-term outcomes, and the appropriate patient population for consideration.

"Natural history of low velocity ballistic nerve injuries to the humerus".

To assess ballistic humerus fractures with nerve injuries, their associated characteristics, and functional recovery. Retrospective review SETTING: Level 1 trauma center over 10-year period. 143 patients presenting with low-velocity ballistic humerus fractures. Operative intervention and clinical examination of nerve function. Nerve injury incidence and recovery. The overall incidence of nerve injury was 21% (30 injuries/143 fractures) with 66.7% of fractures treated operatively. Nerve injury varied based on anatomic region: 28.6% (12/42) distal humerus; 20% (15/75) shaft and, 11.5% (3/26) proximal humerus. Arterial injury (p = 0.011) and bone loss (p = 0.0001) were significantly associated with nerve injury. The nerve was visualized during index surgery in 15 patients, with 4 transections. Multiple nerve injuries (n = 6) were most common around the distal humerus: 41.7% (5/12). The radial nerve comprised 52.9% (n = 9) of injuries in the distal humerus and 62.5% (n = 10) in the shaft with spontaneous recovery occurring in 75% (6/8) with distal fractures and 66.7% (6/9) with shaft fractures. The ulnar nerve accounted for 35.3% (n = 6) of injuries in the distal humerus and 25% (n = 4) in the shaft. Spontaneous recovery occurred in 60% (3/5) of ulnar nerve injuries around distal fractures but in only 25% (1/4) in the shaft. Half of ulnar nerve injuries were associated with additional nerve or vascular injury. The median nerve was the least likely to be injured: 40% (n = 2) distal humerus, 40% (n = 2) shaft, and 20% (n = 1) proximal humerus and 40% (2/5) spontaneously recovered. In the setting of ballistic humerus fractures, arterial injury and bone loss were significantly associated with nerve injury. Multiple nerve injury occurred most commonly at the distal humerus. There was a 60-75% recovery rate of most nerve injuries however, ulnar nerve injuries around the shaft and median nerve injuries had lower rates of recovery. Level III.

The impact of vascular injuries on the management ofbileduct injury following laparoscopic cholecystectomy- insights from a prospective study.

The impact of vascular injuries on the management ofbileduct injury following laparoscopic cholecystectomy- insights from a prospective study.

Effects of naloxegol on transit recovery in patients undergoing cardiac surgery: A randomized, double-blind, placebo-controlled trial.

Effects of naloxegol on transit recovery in patients undergoing cardiac surgery: A randomized, double-blind, placebo-controlled trial.

What Is the Diagnostic Performance and Accuracy of Serum Inflammatory Biomarkers and Synovial Fluid Analysis in Megaprosthetic Periprosthetic Joint Infections?

What Is the Diagnostic Performance and Accuracy of Serum Inflammatory Biomarkers and Synovial Fluid Analysis in Megaprosthetic Periprosthetic Joint Infections?

528 Burned While Buzzed: The Impact of Alcohol Intoxication on Stem Cell Cytokines with Major Burns

Abstract Introduction The combined effects of acute ethanol intoxication on the outcomes of patients with severe burn injuries have been documented in earlier studies. However, the underlying molecular mechanisms driving this relationship remain unclear. Adipose-derived stem cells (ADSCs) play a crucial role in promoting the healing of burn wounds by releasing paracrine factors that enhance the wound healing process, including various cytokines. In this research, we aimed to investigate the hypothesis that acute ethanol intoxication at the moment of a burn injury influences the profile of paracrine factors secreted by ADSCs derived from affected adipose tissue. Methods Adipose tissue was collected from adult patients with severe burn injuries at the index operation (n=28). ADSCs were extracted and cultured in vitro. Supernatants were harvested 30 hours after plating and used for cytokine determinations by Multiplex assay. Fluorescence activated single cell sorting (FACS) confirmed their phenotype with markers CD 90, CD 166, and CD 73. Univariate analyses were performed to compare two cohorts, patient with ethanol intoxication (n=15) vs those with no ethanol intoxication (n=15) at time of burn. Results Blood ethanol concentrations averaged 121 +/- 41.7 mg/dL. The analyte assay demonstrated a significant decrease noted of fibroblast growth factor (FGF)-2 in patients with elevated blood ethanol content. No significant differences in supernatant concentrations of IL-1 beta, IL-6, IL-8, and IL-13 were observed (p&amp;gt;0.05) Conclusions The results from this study suggest that ethanol intoxication at the time of major burn injury may alter the profile of paracrine factors secreted from ADSCs, especially as this relates to FGF-2 which has been shown to contribute to many cell functions including smooth muscle cell growth, wound healing, and cell migration. These results highlight the need for additional analysis of the effects of alcohol intoxication on long term healing potential of burn wounds. Applicability of Research to Practice Understanding the importance of cytokine changes in patients with elevated blood alcohol level may allow clinicians to direct resuscitation and treatment with additional intentionality Funding for the Study N/A

Outcomes of iCAST Bridging Stents in Zenith Fenestrated Endografts - A Single Center Experience.

Outcomes of iCAST Bridging Stents in Zenith Fenestrated Endografts - A Single Center Experience.