Postoperative Functional Assessment Research Articles

Clinical Outcomes and Applicability of Serratus Anterior Muscle Flap With Split Thickness Skin Graft in Thin Resurfacing Reconstructive Surgeries: A Retrospective Analysis.

This retrospective study evaluates the efficacy of the serratus anterior muscle (SAm) free flap combined with a split thickness skin graft (STSG) for thin resurfacing in reconstructive surgery, presenting an alternative to pure skin perforator flaps. It analyzes 14 SAm free flap procedures performed between January 2015 and December 2023. The study cohort comprised 5 women and 9 men, aged 31-80 years, addressing defects caused by infection, malignancy, burn, and trauma, located in various body parts.The study involves harvesting the SAm flap while focusing on anatomical features such as the distinct direction of muscle fibers and the surface location of the vascular pedicle for efficient dissection. It emphasizes the anatomical advantages of the SAm flap, such as robust vascular supply, controlled flap thickness, and preservation of the long thoracic nerve, making it suitable for a range of surgical needs. Complications included STSG loss, partial necrosis, and infection, all managed effectively. Postoperative shoulder function assessment showed no significant impairment.Results demonstrated the successful application of the SAm flap in all cases, with an average flap dimension of 38.21 cm2 and pedicle length of 7.3 cm. The average operation time was 122.1 minutes. The study underscores the SAm flap's adaptability, versatility, and minimal donor site morbidity.It concludes that the SAm flap, in conjunction with STSG, is a viable alternative for thin resurfacing in reconstructive surgery. However, limitations such as the small sample size and procedural variability suggest the need for further research to fully establish the flap's potential in diverse surgical contexts.

Survivorship and Outcomes of Meniscal Ramp Lesions Repaired Through a Posteromedial Portal During Anterior Cruciate Ligament Reconstruction: Outcome Study With a Minimum 10-Year Follow-up

Background: Several studies have demonstrated suture repair of ramp lesions of the medial meniscus via a posteromedial approach was associated with a significantly lower rate of secondary meniscectomy. However, these studies are not long-term and highlight the need for extended follow-up research to better understand the outcomes over a more extended period. Purpose: To evaluate the long-term results and reoperation rate for the failure of arthroscopic all-inside suture repair of ramp lesions of the medial meniscus via a posteromedial approach during anterior cruciate ligament (ACL) reconstruction. Study Design: Case series; Level of evidence, 4. Methods: All patients who underwent all-inside suture repair of the posterior segment of the medial meniscus (ramp lesion) via a posteromedial approach during ACL reconstruction at a minimum follow-up of 10 years were included in the study. Side-to-side anterior laxity was assessed preoperatively and postoperatively. Pre- and postoperative functional assessment was based on the subjective International Knee Documentation Committee score for activities of daily living and the Tegner activity scale for sporting ability. Reinterventions for meniscal repair failure and other complications were also recorded at the last follow-up. Results: A total of 81 patients met the inclusion criteria for this study. Two patients had an ACL graft rupture with a new ramp lesion and were excluded from the analysis. Additionally, 15 patients were lost to follow-up, leaving a total of 64 patients in the final analysis. The mean follow-up was 124.8 months (range, 122.4-128.4 months). Mean side-to-side difference in anterior laxity significantly improved from 7.4 ± 1.5 mm (range, 5-12 mm) to 0.4 ± 1.3 mm (range, –3 to 4 mm) (P = .01). The mean subjective International Knee Documentation Committee score increased from 64.3 ± 13.4 (range, 34-92) before the operation to 91.1 ± 10.1 (range, 49-100) at the last follow-up (P = .001). The Tegner activity scale score at the last follow-up (6.3 ± 1.6) was lower than that before the trauma (7.1 ± 1.6) (P = .02). Fourteen patients (21.9%) had a failed meniscal repair and were reoperated. The mean time from initial repair to reoperation was 64.5 months (range, 13-126 months), and the median was 60.6 months. The multivariate analysis, including parameters such as lateral tenodesis (hazard ratio [HR], 1.62; P = .50), preoperative Tegner score (HR, 1.66; P = .41), preoperative laxity (HR, 1.75; P = .35), age at surgery (HR, 1.02; P = .97), and number of sutures (HR, 2.38; P = .19), did not reveal any factors associated with suture failure. Conclusion: The results show that arthroscopic repair of ramp lesions of the medial meniscus during ACL reconstruction using a posteromedial approach has a high failure rate at the 10-year follow-up, with half of these suture failures occurring within 5 years after the initial repair.

Iodine Assessment of Carbon Dioxide Angiography in Iliac Branched Repair.

The objective of this study was to investigate whether the use of carbon dioxide (CO2) angiography decreases the intraoperative use of iodine contrast medium (ICM), thereby decreasing the risk of developing postoperative renal damage in patients undergoing iliac branch device (IBD) implantation. Patients undergoing IBD implantation at a single tertiary center between May 2013 and August 2019 were screened for inclusion in the study. A cohort of patients in whom an intraoperative imaging protocol using predominantly CO2 was compared with a control group in whom ICM was used (CO2 and ICM groups). Fusion imaging was used in both groups. Retrospective review of the medical charts and all imaging was performed. Variables were expressed as median with interquartile range (IQR) or absolute number and percentage. Wilcoxon-Mann-Whitney and χ2 tests were used to compare continuous and categorical variables, respectively. P values of <0 .05 were considered statistically significant. Twenty-three patients were included in the CO2 group and 21 in the ICM group without significant differences in patient characteristics between the groups. Intraoperative iodine exposure was lower in the CO2 group than in the ICM group (8.2 g [IQR, 7.1-10.9 g) vs 15.8 g (IQR 7.6-21 g); P = 0.015, respectively). There were no differences in technical success, clinical success, fluoroscopy time, and dose-area product in the 2 groups. There were no adverse events that could be related to the intraoperative use of CO2. There was no difference in postoperative survival nor renal function assessment between the groups despite the higher number of accessory renal arteries embolized in the CO2 group (P = 0.221). Reduction of intraoperative ICM exposure during IBD implantation is feasible through the predominant use of CO2 automated angiography. This can be done safely without affecting the technical success or radiation exposure. The immediate postoperative renal damage was low when a modern intraoperative imaging protocol with ICM was used and was not significantly reduced by the use of CO2. Further and larger studies are needed to investigate the long-term effects. This study aimed to investigate how to minimize intraoperative risk during iliac branched repair exploring the intraoperative use of automated carbon dioxide angiography in order to decrease the use of contrast media protecting renal function and thereby potentially impacting long-term survival.

Efficacy of Surgical Intervention in Treating Pathological Fractures of the Upper Extremity: A Retrospective Case Series.

We conduct a retrospective analysis of patients with pathological fractures resulting from upper extremity malignancies, focusing on the evaluation of treatment strategies employed. We retrospectively studied 10 patients with metastatic bone tumors of the upper extremities. The study variables included tumor site, primary pathology, duration from the first diagnosis of the primary lesion to the occurrence of the pathological fracture, use of bone-modifying drugs, surgical technique, adjuvant therapy, postoperative functional assessment, Katagiri's score, American Society of Anesthesiologists physical status (ASA-PS), outcome, and correlations between the Eastern Cooperative Oncology Group Performance Status (ECOG-PS) and Musculoskeletal Tumor Society (MSTS) score. The sites involved were the humerus and radius in eight and two patients, respectively. Primary pathologies were liver cancer in three patients, lung cancer and renal cancer in two patients each, and one patient each with multiple myeloma, plasmacytoma, and Hodgkin's lymphoma. Nine patients experienced pathological fractures, and one had an impending fracture. The median time from primary tumor diagnosis to fracture was 12.5 months. Bone-modifying drugs were administered in all cases. Surgical procedures included intramedullary nails in seven patients and plate fixation in two. Chemotherapy served as adjuvant therapy in nine cases. The mean MSTS score was 26.5, and Katagiri's score averaged 6. The median ASA-PS stood at 2. Outcomes showed seven patients alive with disease and three dead from disease. A significant association between the ECOG-PS and MSTS score was not observed. Pathological fractures caused by malignant bone tumors of the upper extremity should be treated proactively with surgery regardless of prognosis.

Analysis of therapeutic effect of fibrocystic degeneration of vocal folds

Objective:To explore the differences in clinical presentation and therapeutic outcomes between vocal fold fibrocystic degeneration and other common benign lesions, such as vocal fold polyp and cyst. Methods:Vocal function was assessed before and after surgery in 10 cases of vocal fold fibrocystoids, 30 cases of vocal fold polyps and 10 cases of vocal fold cysts at Department of Voice Medicine, Xiamen University Zhongshan Hospital. The voice Assessments included GRBAS（G-scale）, VHI-10 scale, Reflux Symptom Index（RSI） scale, stroboscope, acoustic objective analysis, and aerodynamics measurements. The acoustice analysis parameters included fundamental frequency（F0）, fundamental frequency perturbation（Jitter）, amplitude perturbation（Shimmer） and voice disturbance severity index（DSI）, while the maximum phonation time（MPT） was assessed for aerodynamics. Stroboscopic parameters included vocal fold straightness, vocal fold color, glottic closure and mucosal wave. All three groups underwent phonomicrosurgery and a follow-up review was conducted one month later. Pre-and post-operative function assessment parameters were compared across the three groups. Results:Significant differences were founded in the G grade, Jitter, Shimmer, DSI, glottic closure and mucosal wave between the vocal fold fibrocystic degeneration group and the vocal fold polyp and vocal fold cyst group（P<0.05）. Most voice function parameters in all three groups showed significant improvement after surgery（P<0.05）. The improvement of VHI（10）, RSI and mucosal wave scores in the vocal fold fibrocystic lesion group was significantly different from that of the vocal fold polyp group（P<0.05）. Conclusion:Vocal fold fibrocystic degeneration is a more severe than that of vocal fold polyps and cysts, which are two common benign vocal fold lesions. Phonomicrosurgery is an effective treatment for vocal fold fibrocystic degeneration, but its curative effect are less favorable compared to those for vocal fold polyps and vocal fold cysts. Therefore, a detailed preoperative evaluation is essential for predicting surgical outcomes.

Comparative study of stabilization of a displaced midshaft clavicle fracture with either an intramedullary nail fixation or a superiorly placed plate.

This retrospective study compares two techniques of fixation of midshaft clavicle fractures: nail fixation versus plate fixation. We compared titanium elastic nail fixation with plate fixation in patients with uncomplicated midshaft clavicle fractures. In total, 84 patients were included in our study: 35 in the nail fixation group and 49 in the plate fixation group. We compared the 12-month postoperative shoulder function and scar assessment. Primary outcome was measured by the DASH score and POSAS score. Secondary outcome was measured by Constant score, surgery complications, implant removal, hospitalization days, and size and quality of the scar. Here was no significant difference in DASH and Constant scores between the two groups. However, the nail group leads in the POSAS (12 (12 - 12) 25 (17 - 30) p < 0.001) and in all scar parameters (size, scar influence). There were no significant differences in the complications despite implant removal where more removals were noted in the nail group (16 (44.4%) 4 (8.3%) p < 0.001). Fixation of uncomplicated midshaft clavicle fractures with nail provides better cosmetic results and scar quality than fixation with plate, and presents no significant differences in functional ability or complications.

Predicting the Risk of Postoperative Delirium in Elderly Patients Undergoing Hip Arthroplasty: Development and Assessment of a Novel Nomogram

Objective To construct and internally validate a nomogram that predicts the likelihood of postoperative delirium in a cohort of elderly individuals undergoing hip arthroplasty. Methods Data for a total of 681 elderly patients underwent hip arthroplasty were retrospectively collected and divided into a model (n = 477) and a validation cohort (n = 204) according to the principle of 7:3 distribution temporally. The assessment of postoperative cognitive function was conducted through the utilization of The Confusion Assessment Method (CAM). The nomogram model for postoperative cognitive impairments was established by a combination of Lasso regression and logistic regression. The receiver operating characteristic (ROC) curve, calibration plot, and decision curve analysis (DCA) were used to evaluate the performance. Results The nomogram utilized various predictors, including age, body mass index (BMI), education, preoperative Barthel Index, preoperative hemoglobin level, history of diabetes, and history of cerebrovascular disease, to forecast the likelihood of postoperative delirium in patients. The area under the ROC curves (AUC) for the nomogram, incorporating the aforementioned predictors, was 0.836 (95% CI: 0.797–0.875) for the training set and 0.817 (95% CI: 0.755–0.880) for the validation set. The calibration curves for both sets indicated a good agreement between the nomogram’s predictions and the actual probabilities. Conclusion The use of this novel nomogram can help clinicians predict the likelihood of delirium after hip arthroplasty in elderly patients and help prevent and manage it in advance.

Poster 180: TXA Administration After Hip Arthroscopy: Preliminary Data of a Randomized Controlled Trial

Objectives: Previous studies in shoulder and knee arthroscopy have reported that tranexamic acid (TXA) may improve early functional recovery, prevent postoperative intra-articular bleeding, reduce subjective pain, and improve intra-operative visual field clarity. However, there is a paucity of literature describing the use of TXA in hip arthroscopy. Previous studies have reported statistically significant improvements in VAS pain and Modified Hip Harris scores. However, they used a limited subset of Patient Reported Outcome Measures (PROMs) and did not characterize the effects of TXA on visibility during arthroscopy. The primary objective of this study is to determine the role of TXA in hip arthroscopy based on assessment of postoperative pain and function. A second objective of this study is to determine whether TXA influences intra-operative visual clarity and pump pressures. Methods: This double blinded randomized controlled trial is enrolling 70 patients undergoing primary hip arthroscopy. Subjects are randomized to receive TXA (n=35) or not receive TXA (n=35). The TXA group receives 1g of TXA intravenously at the time of incision and another 1g of TXA during closure. For the duration of the surgery, arthroscopic visual field clarity is rated by the surgeon every 15 minutes as poor, fair, or good and assigned a score of 1, 2, and 3, respectively. Each time the visual clarity is rated, pump pressure is also recorded. Range of motion, VAS Pain, iHOT-12, HOS Sport and activities of daily living, PROMIS Physical Function (PF), and PROMIS Pain Interference (PI) scores are collected preoperatively and postoperatively at days 14 and 42. Additionally, VAS pain is assessed at postoperative day 1. At the completion of all study activities, patient charts are reviewed to determine whether they have requested any additional analgesic medication during the study. Results: The preliminary data for this study includes completed data from 16 (9 female, 7male) patients with a mean age of 44 years. The TXA and control groups had 9 and 7 patients, respectively. No significant difference in VAS pain scores were observed preoperatively, at 1 day postoperatively, or at 42 days postoperatively. There was a significant difference (p=0.01) in VAS pain scores between the two groups at 14 days postoperatively, with the TXA and control groups having mean scores of 2.22 ± 1.48 and 4.33 ± 1.21, respectively. Both groups have shown improvements in PROMs between preoperative scores and postoperative day 42, with larger improvements being seen in the TXA group (although failing to meet statistical significance). Complete preliminary data for PROMs can be seen in Table 1. The average visual score in the TXA group (2.85 ± 0.25) was better than that of the control group (2.67 ± 0.2) but failed to meet statistical significance (p=0.132). The frequency that each rating was assigned was calculated for each group and can be seen in Table 2. A chi-squared test of independence was conducted to examine the relationship between the distribution of grades (Good, Fair, Poor) and the treatment groups (TXA and Control). The test indicated no association between the two variables (Pearson’s χ² = 5.6, df = 2, p = 0.06). Although the p-value did not reach significance level (α&lt;0.05), the preliminary data favored the TXA group in terms of visibility. Pump pressures did not show any significant difference between the TXA group and the control group at any of the time points. No patients have requested additional pain medications during their involvement in this study at this time. Conclusions: The use of TXA in hip arthroscopy descriptively demonstrated improvements in post-operative pain and function, but not intraoperative visual clarity. The trends in the preliminary data, particularly for visual clarity and the measures of pain such as VAS Pain (Figure 1) and PROMIS-PI (Figure 2), suggest a clinical benefit to intraoperative TXA use. Larger sample sizes are needed to establish the significance of these findings and further explore the relationship between TXA and postoperative outcomes, visual clarity, and pump pressures in hip arthroscopy.

Assessment of average femoral component rotation for balancing functionally aligned total knee replacement in varus deformity: Robotic image guidance study

Introduction and purposeEnsuring proper femoral component alignment post-Total Knee Arthroplasty (TKA) is crucial for normal patellofemoral (PF) kinematics. However, the customary 3° external rotation relative to the Posterior Condylar Axis (PC Axis) may not universally apply, and the expected final femoral component rotation remains unclear in functionally aligned knees. This study examines the relation between the Transepicondylar Axis (TEA) and PC axis, known as Posterior Condylar Angle (PCA) in Indian patients along with factors influencing PCA, and the feasibility of reproducing patient-specific PCA using image-guided Cuvis joint robot. MethodsForty patients (52 Knees) with primary osteoarthritis and varus deformity were prospectively evaluated. Native PCA was determined using CT-based J planner. Pre-operative patellar shape, PF tilt, PF shift, final femoral component rotation (representing post-operative PCA), final patellar tracking, and post-operative functional and radiological assessment at 3 months were recorded. ResultsStudy participants averaged 64.3 years of age, with a female-to-male ratio of 23 to 17. Varus deformities varied, with IA2 being most prevalent, and sagittal plane deformities included fixed flexion (34.6 %) and hyperextension (44.2 %). The average PCA was 1.9° (range: 0°–7.3°), with most knees (41 out of 52) below 3°. The majority had Wiberg type 1 patellae, with pre-operative patellar tilt averaging 5.63°, reducing post-operatively to 4.43°. Most patients (37 out of 40) achieved excellent Knee Society functional scores at the 3-month mark. Complications included one case of delayed wound healing and one femoral array pin breakage. Notably, our study revealed a significant deviation in PCA from the commonly reported 3° in Western literature, underscoring the need for region-specific considerations in TKA planning. ConclusionPCA of our population is statistically different from customary 3° followed with jig system. Image guided Robotics helps to identify patients specific PCA and reproducing the same was more commonly possible in patients with reducible Varus deformity.

Optimizing erectile function evaluation pattern in postoperative pelvic fracture-urethral injury patients: introducing PFUI pEF PROM.

To establish a psychometric validated pelvic fracture-urethral injury postoperative erectile function patient reported outcome measure (PFUI pEF PROM). We also aim to explore PFUI patients' potential classification and suitable postoperative erectile function assessment pattern. A total of 93 PFUI patients who treated by excisionandprimaryanastomotic (EPA) urethroplasty from January 2020 to August 2022 were enrolled to this study. Patients who had intercourse completed the IIEF-5, those who had sexual stimulation other than intercourse finished PFUI pEF PROM, and those who performed both completed the IIEF-5, and PFUI pEF PROM. Erection Hardness Score (EHS) was completed by all patients. This PROM was performed psychometric validation and used to find PFUI patients potential classification through latent class analysis. Then, we determined the cut-off value though receiver-operating characteristic (ROC) curve and performed univariate analysis subgroups feature. The PFUI pEF PROM demonstrated high reliability and validity with a Cronbach's alpha of 0.928. It correlated significantly with IIEF-5 (r = 0.550, p < 0.001) and EHS (r = 0.909, p < 0.001). The latent class analysis identified three patient subgroups, with 14.5 as the subgroup cut-off value. Urethral stricture length, IIEF-5, and EHS score were identified as influence factors for maximal erection potential. An assessment pattern combining IIEF-5, EHS, and the PFUI pEF PROM covered 92.5% of patients. This PROM effectively addresses the current limitation in assessing erectile function in PFUI patients. This study provides a promising tool for stratified assessment, prediction erection recovery, and treatment guidance in the PFUI Erectile dysfunction field.

Lateral Femoral Cutaneous Nerve Block or Wound Infiltration Combined with Pericapsular Nerve Group (PENG) Block for Postoperative Analgesia following Total Hip Arthroplasty through Posterior Approach: A Randomized Controlled Trial.

Background: Pericapsular nerve group (PENG) block, although effective for pain management following total hip arthroplasty (THA), does not cover skin analgesia. In this randomized controlled trial, we compared the effectiveness of PENG block combined with lateral femoral cutaneous nerve (LFCN) block or wound infiltration (WI) on postoperative analgesia and functional outcomes. Methods: Fifty patients undergoing posterior-approached THA under spinal anesthesia were randomly allocated to receive LFCN block with 10 mL of 0.5% ropivacaine or WI with 20 mL of 0.5% ropivacaine. In both groups, PENG block was performed by injecting 20 mL of 0.5% ropivacaine. Primary outcomes were static and dynamic pain scores (0-10 numeric rating scale) measured in the first 24 h after surgery. Secondary outcomes included postoperative opioid consumption, functional assessment and length of hospital stay. Results: Postoperative static NRS of patients receiving LFCN was higher than that of patients receiving WI at 6 h but lower at 24 h, with a median (IQR) of 3 (2-4) vs. 2 (1-2) (p < 0.001) and 2 (2-3) vs. 3 (3-4) (p = 0.02), respectively. Static pain scores at 12 h did not show significant differences, with an NRS of 3 (2-4) for WI vs. 3 (3-4) for LFCN (p = 0.94). Dynamic pain and range of movement followed a similar trend. No significant differences were detected in other outcomes. Conclusions: LFCN block was not inferior to WI for postoperative analgesia and functional recovery in association with PENG block during the first postoperative day, although it had worse short-term pain scores. Based on these results, it is reasonable to consider LFCN block as a valid alternative to WI or even a complementary technique added to WI to enhance skin analgesia during the first 24 h after THA. Future studies are expected to confirm this hypothesis and find the best combination between PENG block and other techniques to enhance analgesia after THA.

Clinical application of computed tomographic volumetric imaging in postoperative lung function assessment in patients with lung cancer.

To evaluate the effectiveness of the computed tomographic (CT) volumetric analysis in postoperative lung function assessment and the predicting value for postoperative complications in patients who had segmentectomy for lung cancer. CT scanning and pulmonary function examination were performed for 100 patients with lung cancer. CT volumetric analyses were performed by specific software, for the volume of the inspiratory phase (Vin), the mean inspiratory lung density (MLDin), the volume of expiratory phase (Vex), and the mean lung density at expiratory phase (MLDex). Pulmonary function examination results and CT volumetric analysis results were used to predict postoperative lung function. The concordance and correlations of these values were assessed by Bland-Altman analysis and Pearson correlation analysis, respectively. Multivariate binomial logistic regression analysis was executed to assess the associations of CT data with complication occurrence. Correlations between CT scanning data and pulmonary function examination results were significant in both pre- and post-operation (0.8083 ≤ r ≤ 0.9390). Forced vital capacity (FVC), forced expiratory volume in the first second (FEV1), and the ratio of FVC and FEV1 estimated by CT volumetric analyses showed high concordance with those detected by pulmonary function examination. Preoperative (Vin-Vex) and (MLDex- MLDin) values were identified as predictors for post-surgery complications, with hazard ratios of 5.378 and 6.524, respectively. CT volumetric imaging analysis has the potential to determine the pre- and post-operative lung function, as well as to predict post-surgery complication occurrence in lung cancer patients with pulmonary lobectomy.

Outcome of patients with epithelialized cavity formation after excessive vesicourethral anastomotic leak post radical prostatectomy.

Excessive vesicourethral anastomotic leak (EVAL) is a rare but severe complication after radical prostatectomy (RP). Epithelialized vesicourethral cavity formation (EVCF) usually develops during prolonged catheterization. To our knowledge, there is no description of postoperative outcomes, complications, or functional assessment of these patients who received conservative therapy after EVAL. We identified 70 patients (0.56%) with radiographic evidence of EVCF out of 12,434 patients who received RP in 2016-2020 at our tertiary care center. Postoperative radiographic cystograms (CG) were retrospectively re-examined by two urologists individually. We assessed urinary continence (UC), the need for intervention due to anastomotic stricture formation, urinary tract infection (UTI), and symphysitis during the first year of follow-up post-RP. The median age was 66years [interquartile range (IQR) 61-70years], the median body mass index was 27.8kg/m2 (IQR 25.5-30.3kg/m2), and the median prostate specific antigen before RP was 7.1ng/ml (IQR 4.7-11.8ng/ml). The median catheter insertion time was 44.5days (IQR 35.2-54days). One-year continence follow-up was available for 27 patients (38.6%), of which 22 (81.5%) reported the use of ≤ one pad, two patients reported the use of two (7.4%) pads/24h, and three (11.1%) patients reported use > two pads/24h. Overall, four (5.7%) patients needed surgical reintervention for anastomotic stricture, eight (11.5%) patients presented with symphysitis, and 55 (77.1%) presented with UTI. UC in 81.5% 1-year post-RP suggests that conservative treatment in EVAL is a treatment option with an acceptable outcome on UC and should be considered before reintervention for anastomotic insufficiency.

Three dimension high definition manometry evaluated postoperative anal canal functions in children with congenital anorectal malformations.

We aimed to evaluate the function of the reconstructed anal canal in postoperative anorectal malformations (ARMs) patients through three dimension (3D) high-definition anorectal manometry. From January 2015 to December 2019, 3D manometry was performed as a postoperative functional assessment of patients with ARMs divided into age subgroups based on the time of manometry. Manometric parameters, such as the length of the anorectal high-pressure zone (HPZ-length), the mean resting and squeeze pressure of HPZ (HPZ-rest and HPZ-sqze), recto-anal inhibitory reflex (RAIR), and strength distribution of the anal canal, were collected and compared with age-matched controls. Their functional outcomes were analyzed with SPSS 23.0 software for statistical analysis. 171 manometric measurements were performed on 142 postoperative patients (3 months∼15 years). The HPZ-rest in all patients was significantly lower than in age-matched controls (p < 0.05). HPZ-sqze was notably decreased in patients older than 4 years, whereas other age groups were comparable to controls (p < 0.05). The proportions of asymmetric strength distribution and negative RAIR were higher in ARMs patients. The type of anorectal malformations and lower HPZ-rest were the impact factors affecting postoperative functional outcomes. The majority of the ARMs patients had acceptable functional outcomes. 3D manometry can objectively assess the reconstructed anal canal function. The patients with fecal incontinence had a high proportion of extremely low HPZ-rest and HPZ-sqze, negative RAIR, and asymmetric strength distribution. The manometric details will help the clinicians explore the causes of defecation complications and guide further management.

Quantitative analysis of diplopia following orbital fracture repair

Orbital fractures can result in devastating functional complications to sight and well-being, yet our understanding of functional sequelae post reconstruction is not well understood in the literature. This research retrospectively analysed the activity of a specialist orbital surgeon over five years to evaluate the incidence of, and risk factors for, debilitating complications such as diplopia and restriction of extraocular movement. Orbital fracture cases repaired between 1 January 2015 and 31 December 2019 were retrospectively analysed. Demographics, orthoptic assessment, injury classification, timing, operative details, outcomes, and complications were recorded. Preoperative and postoperative binocular single vision scores (BSV) were recorded to calculate the effect of orbital repair on residual diplopia. Of 582 patients undergoing orbital access, 472 cases of orbital wall reconstruction satisfied the inclusion criteria, of which 162 (34%) were Jaquiéry 4 or 5. Overall, 10.6% had complications, 4.9% had diplopia, and 5.7% were returned to theatre. All those with residual diplopia had had it preoperatively, and had evidence of an improvement in BSV score. Time to surgery, material, and pure orbital fractures had a significant impact on the incidence of diplopia. Defect size did not. Whilst complication rates were low we conclude that strict adherence to a defined surgical protocol, postoperative imaging, and objective assessment of postoperative function are central to maintaining these standards. Objective orthoptic analysis of patients before and after orbital repair is critical to our understanding of this pathology. Whilst preoperative prediction of the persistence of long-term diplopia currently eludes us, further research should target it.

Assessment of Flap Viability and Post-operative Hand Function After Resurfacing of Acute Soft Tissue Injury onthe Palm of Hand byGroin Flap and Reverse Pedicled RadialForearm Flap

Background: Many flaps have been described and used for coverage of various soft tissue defects of hand, which can be regional or distant. Objective: In this study main goal is to evaluate the assessment of flap viability and post-operative hand function by Total Active Motion (TAM) and Hand grip strength. Method: This was a comparative observational study, conducted at department of Orthopaedic Surgery and Burn and Plastic surgery in Sylhet MAG Osmani Medical College Hospital (SOMCH) from January 2018 to October, 2019. A total of 16 patients with acute hand injury or pathology in the palm which may create surgical wound, admitted in the study place during the study period were the study population. Where those who had Acute wound in palm with exposed tendon, nerve and bones or degloving hand injury were included in the study. Patient were divided into two group namely Group-A and Group-B. Patient chosen for groin flap were allocated in group-A and for reverse pedicled radial forearm flap were in group-B. Results: During the study, complete flap survival was 100% in both group A and B. At all the follow-ups hand grip strength was more in group B and the difference was statistically significant (p&lt;0.05, obtained by unpaired t-test). At final follow-up (12 weeks) hand grip strength was 22.38 (SD±5.26) kg in Group A and 30.13 (SD±10.15) kg in Group B.There is no(0.0%) excellent result of index and middle finger in group A patient compared to 3 (37.5%) and 6 (75.0%) patients respectively in group B. Ingroup A3 patient had excellent outcome in ring fingercompared to 7 (87.5%) patients in group B. Majority (87.5%) patient‘s little finger was excellent in group A and 8(100.0%) in group B.The difference of index finger and middle finger were statistically significant between groups (p&lt;0.05 obtained by Fisher Exact test). Conclusion: From this study we can say that, both the handgrip strength and TAM score was better in patients who underwent radial forearm flap and the difference was statistically significant (p&lt;0.05). It is concluded that reverse pedicled radial forearm flap has better outcome regarding flap viability and post-operative hand function than groin flap.

Initial Experience With Extraperitoneal Laparoscopic Radical Cystectomy With Pelvic Organ-Preserving and Orthotopic Neobladder Techniques for Bladder Cancer in Female Patients

To present the extraperitoneal laparoscopic radical cystectomy (ELRC) technique, and initial outcomes of organ-preserving and orthotopic neobladder (ONB) techniques for bladder cancer in selected females. Data including patient characteristics, operative time, blood loss, transfusion rate, length of hospital stay, and pathologic outcomes, as well as 30- and 90-day complications were collected between April 2018 and May 2021 from females who underwent ONB after ELRC.. Regular follow-up focused on patients' oncological and functional outcomes, and postoperative sexual function status was assessed using the Female Sexual Function Index (FSFI). Eleven females with a mean age of 53 years who underwent ELRC with pelvic organ-preservation and ONB were analyzed retrospectively. All procedures were completed successfully. The mean operative time was 264.82 ± 33.81 min, and the average intraoperative blood loss was 128 ± 18.19 mL. All patients had negative pathological margins and no lymph node metastases. The average hospital stay was 10.72 days. The single J ureteral stent and catheter were usually removed 3 - 4 weeks after the procedure. The FIFS assessment of postoperative sexual function showed that the patients were relatively satisfied. ELRC with pelvic organ preservation and ONB technology was a safe and feasible surgical strategy for the selected female patients. Preserving organs and vascular nerve bundles seemed to be safe in oncological and produced encouraging functional results. Further rigorous prospective studies with more patients and long-term follow-up data are needed to assess the oncologic and functional results.

How effective is occipital transtentorial approach for pineal region lesions? An assessment of occipital lobe functions & surgical outcome

Background and objectivesThe occipital transtentorial approach (OT) is a useful surgical approach for the treatment of lesions of the pineal region. Because the approach provides wide operative views of superior cerebellar, splenium, quadrigeminal regions can also be operated using this technique. However it may be associated with complications due to damage to the occipital lobe, which can be caused by brain retraction injury. The study evaluates the effectiveness of the OT approach in terms of surgical outcome with special emphasis on occipital lobe functions which may be affected using this approach. MethodologySeventeen patients of pineal region lesions were operated by OT approach, and preoperative evaluation of the anatomy of the tentorial angle was performed and its significance was studied. Various occipital lobe functions were evaluated postoperatively and compared with preoperative status. Surgical outcome was evaluated in terms of extent of tumour resection, postoperative occipital lobe functions and modified Rankin scale. ResultsThe mean angle between the tentorium and occipital surface of cerebellum (tentorial angle) was 62.08 ± 7.17 degrees. The maximum and minimum tentorial angle was 83 and 51 degrees respectively. Out of 13 patients in which the postoperative functional assessment of occipital lobe functions was possible, 2 patients developed homonymous hemianopia (one transient, one permanent). Other functions remain unaffected. Near and gross total resection was possible in 4 (23.5 %) and 8 (47.1 %) patients respectively. The mean modified Rankin scale score was 1.8 indicating slight post-operative disability. ConclusionsAmongst the various occipital lobe functions, the visual field defects are the most common functions affected postoperatively in the occipital transtentorial approach. The OT approach is an appropriate and reasonable approach for the surgical management of pineal region lesions where high resectability rates can be achieved irrespective of the status of anatomical factors like tentorial angle; with slight postoperative morbidity with respect to occipital lobe functions.

Intramedullary Nail or Primary Arthroplasty? A System Review and Meta-Analysis on the Prognosis of Intertrochanteric Femoral Fractures Based on Randomized Controlled Trials.

IntroductionThere is no consensus regarding the superiority between intramedullary nailing and primary arthroplasty in the management of intertrochanteric femoral fractures. This systematic review was performed to investigate and compare the clinical efficacy of intertrochanteric femoral fractures treated with these 2 methods.Materials and methodsWe systematically searched PubMed, Embase, Cochrane, Web of science core collection and ClinicalTrials.gov for randomized controlled trials which compared the clinical outcomes of intertrochanteric fractures treated with either intramedullary nails or primary arthroplasty. Relevant data of the postoperative complications, reoperations, mortality and functional assessment, were pooled and presented graphically.ResultsA total of 6 trials with 427 participants were identified and included in the analyses. The pooled estimates suggested these 2 techniques have comparable risks in terms of overall complications (pooled risk ratio [RR] .80; 95% confidence interval [CI] .43 to 1.43; I2 = 79.94%), the rate of patients with orthopedic complications (RR .71, 95% CI .40 to 1.27; I2 = .00%), reoperations (RR 1.33, 95% CI .48 to 3.71; I2 = .00%), the overall mortality (RR .52; 95%CI .26 to 1.02; I2 = 31.35%) and 1-year mortality (RR .67; 95%CI .38 to 1.19; I2 = .00%). Primary arthroplasty associated with higher HHS at 3 months postoperatively (MD -21.95, 95% CI -28.29 to −15.60; I2 = 70.44%). While the difference was not significant at 6 months (MD 2.32, 95% CI -1.55 to 6.18; I2 = .00%), and even reversed at 12 months postoperatively (MD 13.02, 95% CI 8.14 to 17.90; I2 = 73.42%).ConclusionsMeta-analytic pooling of current evidences demonstrated that primary arthroplasty is related to a better early functional recovery at the early stage postoperatively, but the long-term result tends to favor to intramedullary nailing. The differences in overall complications, the rate of patients with orthopedic complications, reoperations, overall and 1-year mortality did not reach a significant level.

Poster 141: Novel Equation to Accurately Compute the Glenoid Bone Loss with a Bony Bankart

Objectives:The glenohumeral joint is the most frequently injured joint, with anterior dislocations occurring in 98% of cases. There is often an osseous Bankart fragment (OBF) of the glenoid rim that remains in both acute and chronic instability. By calculating the percent bone loss (%BL) of the glenoid surface, the best reconstruction method is selected. Reported values of the critical %BL range from 13.5 to 25%. This study validates a new geometric equation to compute the glenoid %BL for patients undergoing shoulder stabilization surgery and accounting for the decrease in bone loss expected with incorporation of the OBF into the anticipated repair. The goal of the study was to determine if the accuracy of the %BL computed with the novel equation would improve compared to the diameter ratio, as well as if the inclusion of the OBF would indicate a pre-operative selection of more conservative reconstructive management.Methods:This retrospective radiographical validation study reviewed pre-operative CT scans for 36 patients who underwent surgical reconstruction for shoulder dislocations with Bankart lesions, with and without OBFs. Two independent raters measured the dimensions required for the novel equation, the diameter ratio, and the ‘true’ area from pre-operative CT scans three months apart. The %BL for these three methods and the reduction in %BL by including the OBF were compared. As well, the validity of the measurement technique was assessed through inter-and intra-rater analyses.Results:Our findings revealed the novel equation was more accurate in determining the %BL versus the diameter ratio. Without the OBF, the %BL was most similar for the novel equation (23.514% ± 13.613%) and area method (21.223% ± 9.842%), and there was no statistically significant difference between the %BL for these two methods (p-value = 0.423). Instead, the diameter ratio had larger values of %BL (27.774% ± 12.00%) and there was a statistically significant difference compared to the %BL obtained with the area method (p-value = 0.015). Furthermore, by including the OBF in the reconstruction this would have led to a change in pre-operative surgical plan for 50% of patients, favouring more conservative repairs since the %BL would have been below the selected critical cut-off value of 13.5%.Conclusions:By accounting for the area overestimate of the diameter ratio and incorporating the OBF, our novel equation reduced the %BL in general, even below the critical threshold for half of our cohort. Future studies will investigate the clinical implications of our novel equation, and its impact in pre-operative planning through large scale randomized-controlled trials with long term post-operative functional outcomes assessment. This research paves the way for potentially less invasive treatment options, and improvement in post-repair outcomes, such as greater long-term shoulder stability, decreased incidence of re-tearing and faster recovery time.