Postoperative Functional Assessment Research Articles

Open Reduction of Displaced Radial Neck Fractures in Children by Internal Fixation Techniques: Comparison of Percutaneous Kirschner Wiring and Elastic Stable Intramedullary Nailing.

Although most paediatric radial neck fractures can be treated with closed reduction, some severely displaced fractures require open reduction. The purpose of this study is to compare the effects of ESIN and KW fixation in open reduction of radial neck fracture in children. Twenty-four patients with mean age of 8.5years were included. Four of the patients had a Judet type III fracture and 20 had a Judet type IV fracture. Ten patients who underwent percutaneous KW fixation were assigned to group A, while 14 patients who underwent ESIN fixation were assigned to group B. Variables of interest included age, sex, fracture type, associated lesions, surgical time, fracture reduction, cost, follow-up, healing time, X-rays, clinical outcomes, and complications. There were no significant between-group differences in sex, age, additional injuries, fracture type, and quality of reduction. Costs were significantly lower in Group A. Fracture healing was achieved in 23 of 24 patients (10/10 in group A and 13/14 in group B). In a postoperative elbow function assessment based on the Steele and Graham classification, 80% of patients in group A had a score of excellent or good, compared to 78.6% of patients in group B. Two cases of nail shifting and joint protrusion were observed in group B, one of which also presented with nonunion during follow-up. Both KW and ESIN may achieve good clinical outcomes, but KW is associated with lower costs, easier implant removal (without the need for a secondary surgery), and lower iatrogenic complications.

Patellofemoral arthroplasty: obesity linked to high risk of revision and progression of medial tibiofemoral osteoarthritis.

The purpose of this study was to determine the effect of obesity on patient outcome, procedure failure rate and osteoarthritis (OA) progression in the tibiofemoral compartments in a series of isolated patellofemoral arthroplasty (PFA) performed with a third-generation implant. The study population was patients who had undergone third-generation PFA at a specialized orthopedic center between 2007 and 2017. Patients were categorized by body-mass index (BMI) as obese (O, BMI > 30kg/m2) or nonobese (NO, BMI < 30kg/m2). Preoperative and postoperative clinical and functional assessment included knee range of motion, Knee Society Score (KSS), University of California Los Angeles (UCLA) Activity Score, Tegner Activity Level Scale, and visual analogue scale (VAS) for pain. Preoperative and postoperative radiographs were evaluated for progression of tibiofemoral compartment OA, changes in patellar height and in knee coronal alignment. Multiple logistic regression models were used to assess the effect of BMI on outcomes together with other covariates. A total of 120 PFAs with a mean follow-up of 6.9 ± 2.5years were included: 25 in the O group and 95 in the NO group. Significant improvement was noted in in knee range of motion (P < 0.001), clinical and functional KSS (P < 0.001), UCLA Activity Score (P < 0.001), Tegner score (P < 0.001) and VAS pain (P < 0.001) without inter-groups differences. Worsening of the medial Kellgren-Lawrence (KL) grade (but not the lateral KL grade) was more frequent in the O than the NO group during the follow-up period (P = 0.014). Failure occurred in 4.2% of NO and in 20% of O group patients; the difference was solely due to failure because of OA progression in the tibiofemoral compartment (16% in the O group). There were no between group differences in the failure rate for any cause other than OA progression (4.2% in the NO group, 4.0% in the O group). An equal improvement in function after PFA was noted in both obese and nonobese patients; however, the high failure rate due to OA progression in the medial tibiofemoral compartment warrants caution when considering PFA in obese patients.

Anti-Glide Plate Fixation for Lateral Malleolus Fractures by Minimally Invasive Technique in Geriatric Patients.

The objective was to evaluate the functional outcomes of anti-glide fixation by minimally invasive plate osteosynthesis (MIPPO) in lateral malleolus ankle fractures.The study was a retrospective cohort study conducted at a single trauma center. We reviewed 39 patients >60 years old with either isolated or non-isolated lateral malleolus Weber B ankle fractures.The main outcome measures were postoperative functional assessment performed with the American Orthopaedic Foot and Ankle Society (AOFAS) and Short Musculoskeletal Functional Assessment (SMFA) scores. Our results showed that the mean time to surgery was 1 day. Seventeen patients underwent surgery within 24 hours after sustaining the injury. The mean AOFAS and SMFA scores were 87.8 and 209.7, respectively. No patient developed implant failure or wound complications.It was concluded that the anti-glide plating of the lateral malleolus had better functional outcomes compared to lateral plating by open reduction and internal fixation (ORIF), as shown by the higher AOFAS scores and fewer postoperative complications.

An audit of thyroidectomy for Graves’ Disease, in a large UK tertiary centre

Abstract Aims Patients undergoing thyroidectomy for Graves’ disease are at increased risk of post-operative complications and therefore require additional pre-operative preparation and close post-operative assessment. This study aimed to assess the pre- and post-operative management and morbidity in a single UK tertiary centre. Method Retrospective analysis of patients undergoing thyroidectomy for Graves’ between 2014–19. The primary endpoint was thyroid status pre-operatively and post-operative morbidity. Secondary endpoints were administration of potassium iodide, vitamin D and beta blockers and assessment of post-operative parathyroid function. Results Ninety-two thyroidectomies were undertaken for Graves’ in the five-year period. Pre-operatively 98% were successfully rendered euthyroid or hypothyroid and 2% hyperthyroid but required emergency surgery. Post-operative hypocalcaemia occurred in 26% but was temporary in 92%. Vocal cord palsy was found in 11%, but in all cases was temporary (post-operative laryngoscopy was reported in 93%). 49% had received potassium iodide, 53% beta-blockers and 48% vitamin D. Post-operative calcium and PTH estimation was undertaken on day 0 in 99% and 97% respectively and day 1 in 100% and 98%. Conclusion This audit of specialist practice shows a majority of patients rendered eu- or hypothyroid pre-operatively and low complication rates, with the majority being temporary. Pre-operative medical optimization was not undertaken uniformly in all patients and although outcomes were good, a protocol to improve consistency has been developed in response.

Total knee arthroplasty with long tibial stem for tibial stress fractures with knee osteoarthritis: Two birds with one stone

PurposeThe treatment and outcome of tibial stress fractures concomitant with knee osteoarthritis (OA) are complicated. The aim of this study was to evaluate the functional and radiological outcome of total knee arthroplasty with long tibial stem as a treatment for patients having knee OA and tibial stress fracture. MethodsPatients who were diagnosed to have proximal tibia stress fracture along with knee OA at our institution between June 2013 and November 2018 were included in our study. All patients underwent total knee arthroplasty with long tibial stem. Preoperative and postoperative functional assessments were done according to range of movement of the knee joint, knee society score and knee injury and OA outcome score. Descriptive analysis was carried out by mean and standard deviation for quantitative variables, frequency and proportion for categorical variables. ResultsTwelve patients were included in the study. All patients were found to have stress fractures in the proximal half of tibia and extra-arthrosis. Four patients had non-union/delayed union, and 8 patients had acute fractures. The average preoperative range of movement was 88.1°, which improved to 116.3° at 3 months following surgery. It was found that the fracture has healed in all cases. Mean knee society score improved from 32.9 preoperatively to 89.3 at 1 year follow-up. Knee injury and OA outcome score improved from a mean score of 28.3 preoperatively to 81.1 at 1 year follow-up. ConclusionStress fractures can occur in the proximal tibia in patients with knee OA. Total knee arthroplasty with tibial stem provides a suitable solution for both conditions. Additional plating or bone graft is unlikely to be required.

Assessment of preoperative and postoperative cardiac function in children with adenotonsillar hypertrophy: a prospective cohort study.

Chronic upper airway obstruction caused by adenotonsillar hypertrophy is one of the major cause of morbidity in children. It can lead to Obstructive Sleep Apnoea Syndrome, Pulmonary Hypertension, Cor Pulmonale and right heart failure. The study aimed to evaluate and compare various parameters of cardiac function with the help of echocardiography preoperatively and postoperatively in children undergoing adenotonsillectomy. A prospective cohort study was conducted on 23 patients at an apex care institute, under the age group of 4-12years, who were diagnosed with adenotonsillar hypertrophy. Preoperative symptom analysis and Echocardiographic examination were done. After the assessment, all patients underwent surgery in the form of adenotonsillectomy. Follow-up symptom analysis and echocardiographic examination was done after 3months postoperatively. Significant improvement in the obstructive symptoms were noted in postoperative group as expected (p = < 0.001) and also in parameters such as mPAP (p = < 0.001), TAPSE (p = < 0.001), TAV (p = 0.001), Ejection fraction (p = 0.027) and RVMPI (p = 0.044) were improved in postoperative group. 4 patients had Grade 1 Right ventricular diastolic dysfunction, which disappeared in three patients postoperatively. We have concluded that there can be subclinical cardiac dysfunctions which occurs as a result of chronic upper airway obstruction due to untreated adenotonsillar hypertrophy. Routine cardiac screening in children presenting with sleep disordered breathing associated with adenotonsillar hypertrophy may be helpful in identifying and preventing the development of cardiopulmonary complication. These changes can be reversed by performing adenotonsillectomy.

COMPARISON OF TRANS-RIGHT ATRIAL VERSUS COMBINED (TRANS-RIGHT ATRIAL, TRANS-RIGHT VENTRICULAR) APPROACH FOR INTRA-CARDIAC REPAIR OF TETRALOGY OF FALLOT: SINGLE-CENTER EXPERIENCE

Background and Objective: We compared trans-right atrial (t-RA) versus combined (trans-right-atrial and trans-ventricular (t-RA/RV) approaches for intra-cardiac repair of Tetralogy of Fallot (TOF) for the pre-operative and post-operative right ventricular (RV) function. The RV function was calculated using a tricuspid annular plane systolic excursion (TAPSE) using two-dimensional (2-D) echocardiography.&#x0D; Materials and Methods: This was a retrospective study. Fifty-three patients operated for the intra-cardiac repair of TOF between August 2019 and March 2021 were included in the study and divided into two groups based on the approach for repair as follows: t-RA or combined (t-RA/RV) approach. The first group (t-RA) had twenty-one patients, and the second group (combined t-RA/RV approach) had thirty-two patients. The assessment of pre-operative and post-operative RV function was done using TAPSE. Records of follow-up at 1 month and 3 months were evaluated.&#x0D; Results: Age, body surface area (BSA), preoperative saturation, cardiopulmonary bypass time, aortic cross?clamp time, postoperative intensive care unit (ICU) stay, and hospital stay&#x0D; were similar in both groups. However, t?RA/RV group had more pleural effusions (9 vs. 1 patients, P &lt; 0.05), but had more improvements in Right Ventricular outflow tract (RVOT) gradients. There were no differences in arrhythmias in either group. Pre-operative TAPSE for both groups was similar (1.46 ± 0.27 vs. 1.61 ± 0.31, P &gt; 0.05) and so was the post?operative TAPSE at discharge (1.54 ± 0.31 vs. 1.49 ± 0.33, P &gt; 0.05), at 1 months (1.64 ± 0.25 vs. 1.48 ± 0.32, P &gt; 0.05) and 3months (1.75 ± 0.19 vs. 1.7 ± 0.15, P &gt; 0.05).&#x0D; Conclusion: Both approaches provide adequate palliation with effective improvements in RVOT gradients for patients with TOF. A limited right ventriculotomy does not adversely affect early RV function or increase the incidence of arrhythmias at the immediate post-operative period and early follow-up. More extensive studies with prospective randomized design and longer follow-ups are needed to address these issues further.&#x0D; Keywords: Tetralogy of Fallot, transatrial approach, intracardiac repair.

The feasibility and added value of mapping music during awake craniotomy: A systematic review.

The value of mapping musical function during awake craniotomy is unclear. Hence, this systematic review was conducted to examine the feasibility and added value of music mapping in patients undergoing awake craniotomy. An extensive search, on 26 March 2021, in four electronic databases (Medline, Embase, Web of Science and Cochrane CENTRAL register of trials), using synonyms of the words “Awake Craniotomy” and “Music Performance,” was conducted. Patients performing music while undergoing awake craniotomy were independently included by two reviewers. This search resulted in 10 studies and 14 patients. Intra‐operative mapping of musical function was successful in 13 out of 14 patients. Isolated music disruption, defined as disruption during music tasks with intact language/speech and/or motor functions, was identified in two patients in the right superior temporal gyrus, one patient in the right and one patient in the left middle frontal gyrus and one patient in the left medial temporal gyrus. Pre‐operative functional MRI confirmed these localizations in three patients. Assessment of post‐operative musical function, only conducted in seven patients by means of standardized (57%) and non‐standardized (43%) tools, report no loss of musical function. With these results, we conclude that mapping music is feasible during awake craniotomy. Moreover, we identified certain brain regions relevant for music production and detected no decline during follow‐up, suggesting an added value of mapping musicality during awake craniotomy. A systematic approach to map musicality should be implemented, to improve current knowledge on the added value of mapping musicality during awake craniotomy.

Ultrasound-guided erector spinae plane catheter versus video-assisted paravertebral catheter placement in minimally invasive thoracic surgery: comparing continuous infusion analgesic techniques on early quality of recovery, respiratory function and chronic persistent surgical pain: study protocol for a double-blinded randomised controlled trial

BackgroundCompared to conventional thoracotomy, minimally invasive thoracic surgery (MITS) can reduce postoperative pain, reduce tissue trauma and contribute to better recovery. However, it still causes significant acute postoperative pain. Truncal regional anaesthesia techniques such as paravertebral and erector spinae blocks have shown to contribute to postoperative analgesia after MITS. Satisfactory placement of an ultrasound-guided thoracic paravertebral catheter can be technically challenging compared to an ultrasound-guided erector spinae catheter. However, in MITS, an opportunity arises for directly visualised placement of a paravertebral catheter by the surgeon under thoracoscopic guidance. Alongside with thoracic epidural, a paravertebral block is considered the “gold standard” of thoracic regional analgesic techniques. To the best of our knowledge, there are no randomised controlled trials comparing surgeon-administered paravertebral catheter and anaesthesiologist-assisted erector spinae catheter for MITS in terms of patient-centred outcomes such as quality of recovery.MethodsThis trial will be a prospective, double-blinded randomised controlled trial. A total of 80 eligible patients will be randomly assigned to receive either an anaesthesiologist-assisted ultrasound-guided erector spinae catheter or a surgeon-assisted video-assisted paravertebral catheter, in a 1:1 ratio following induction of general anaesthesia for minimally assisted thoracic surgery. Both groups will receive the same standardised analgesia protocol for both intra- and postoperative periods. The primary outcome is defined as Quality of Recovery (QoR-15) score between the two groups at 24 h postoperative. Secondary outcomes include assessment of chronic persistent surgical pain (CPSP) at 3 months postoperative using the Brief Pain Inventory (BPI) Short Form and Short Form McGill (SF-15) questionnaires, assessment of postoperative pulmonary function, area under the curve for Verbal Rating Score for pain at rest and on deep inspiration versus time over 48 h, total opioid consumption over 48 h, QoR-15 at 48 h, and postoperative complications and morbidity as measured by the Comprehensive Complication Index.DiscussionDespite surgical advancements in thoracic surgery, severe acute postoperative pain following MITS is still prevailing. This study will provide recommendations about the efficacy of an anaesthesia-administered ultrasound-guided erector spinae catheter or surgeon-administered, video-assisted paravertebral catheter techniques for early quality of recovery following MITS.Trial registrationClinicalTrials.govNCT04729712. Registered on 28 January 2021. All items from the World Health Organization Trial Registration Data Set have been included.

Evaluation of myocardial perfusion and systolic function in patients with coronary heart disease by myocardial contrast echocardiography and 2-dimensional speckle tracking imaging.

The high prevalence and high fatality rate of coronary heart disease seriously endanger the safety of human life. The key to its treatment is to restore the perfusion of the narrowed coronary arteries as soon as possible. Two-dimensional echocardiography is limited for assessment of postoperative myocardial function. Myocardial contrast echocardiography (MCE) and 2-dimensional speckle tracking imaging (2D-STI) possess good value in assessing myocardial perfusion and systolic function. We used MCE and 2D-STI to explore the changes of myocardial perfusion and systolic function after percutaneous coronary intervention (PCI) in patients with coronary heart disease, and to evaluate the clinical value of MCE and 2D-STI. Twenty patients with coronary heart disease undergoing PCI were selected. MCE was performed before and one day after PCI, and 2D-STI and conventional ultrasound were performed before and a month after PCI. The recovery of left ventricular wall motion was used as a standard to evaluate the ability of MCE semi-quantitative analysis and to predict the recovery of myocardial segment motion. The quantitative value of MCE (signal intensity of contrast medium in plateau phase, slope of curve, and their product) one day after PCI and the contractile function of one month after PCI were significantly improved (all P<0.05). There were 90 myocardial segments with abnormal motion dominated by the coronary artery with stent implantation before PCI, and 54 segments recovered 1 month after PCI. The sensitivity and specificity of MCE score ≤2 to predict recoverable wall motion were 93% and 53%, respectively. MCE and 2D-STI can evaluate the improvement of myocardial perfusion and systolic function in patients with coronary heart disease after PCI, and MCE semi-quantitative analysis can effectively predict the ability of ventricular wall recovery.

Lipoma Arborescens: can we afford to miss it?

Lipoma Arborescens is an extremely rare, benign lesion effecting the synovial tissue of joints. It is characterized by villous lipomatous proliferation of the synovial tissue. The aim of our study was to evaluate its diagnostic features and analyse the functional outcome of arthroscopic management. We studied 13 patients who were diagnosed to have lipoma arborescens at our institution during the period from October 2005 to October 2019. All patients underwent arthroscopic synovectomy. Histopathological examination confirmed the diagnosis. Pre-operative and post-operative functional assessment was done using Tegner Lysholm score. Mean age was 46.6 years. All patients presented with progressive swelling of knee joint, while 6 patients also complained of pain. Average duration of symptoms was 34 months. All the patients were diagnosed based on MRI findings. Tegner Lysholm scoring at last follow up visit, had 11 patients with excellent outcome, 1 patient with good outcome, and 1 patient with fair outcome. None of the patients had recurrence, nor underwent any subsequent procedure of the operated joint. Lipoma arborescens is a rare condition which should be a differential in patients with mono-articular swelling of the knee joint, and can be confirmed with MRI. It should not be misdiagnosed or missed at early stages as prolonged duration of symptoms and delay in treatment is likely to lead to development of secondary arthritis of the joint. Arthroscopic synovectomy showed good functional outcome and no recurrence.

Robotic versus transanal total mesorectal excision in sexual, anorectal, and urinary function: a multicenter, prospective, observational study

PurposeImproved long-term survival after low anterior resection (LAR) for rectal cancer highlights the importance of functional outcome. Urogenital and anorectal dysfunction is frequently reported after conventional LAR. Advanced minimally invasive techniques such as robotic (RoTME) and transanal total mesorectal excision (TaTME) might improve functional results by precisely dissecting and preserving autonomic nerves. We compared functional outcomes after RoTME or TaTME in a multicenter study.MethodsOne hundred twenty patients (55 RoTME/65 TaTME) were prospectively included in four participating centers. Anorectal (Wexner and low anterior resection syndrome (LARS) Score), urinary (International Consultation on Incontinence—Male/Female Lower Urinary Tract Symptoms Score (ICIQ-MLUTS/ICIQ-FLUTS) and International Prostate Symptom Scale (IPSS)), and sexual (International Index of Erectile Function (IIEF), Female Sexual Function Index (FSFI)) outcomes at 12 months after surgery were compared to preoperative scores. The response rate to the 1-year postoperative functional assessment by questionnaire was 79.5%.ResultsRoTME enabled better anorectal function compared to TaTME (LARS score 4.3 ± 2.2 vs. 9.8 ± 1.5, p = 0.038, respectively). TaTME proved superior at preserving male urinary function, while female urinary function was comparable in both groups, with only mild postoperative impairment (RoTME vs. TaTME, respectively: ICIQ-MLUTS 13.8 ± 4.9 vs. 1.8 ± 5.8, p = 0.038; ICIQ-FLUTS Incontinence Score − 0.3 ± 1.0 vs. − 0.2 ± 0.9, p = 0.844). Both techniques demonstrated comparable male (RoTME − 13.4 ± 2.7 vs. TaTME − 11.7 ± 3.4, p = 0.615) and female (RoTME 5.2 ± 4.6 vs. TaTME 10.5 ± 6.4, p = 0.254) sexual function.ConclusionAfter adjustment for risk factors, RoTME provided better anorectal functional results, whereas TaTME was better at preserving male urinary function. Overall, both techniques demonstrated only mild postoperative functional impairment.

Functional outcomes of arthroscopic transosseous rotator cuff repair using a 2-mm tape suture in a 137-patient cohort.

BackgroundAlthough being the historical gold standard for rotator cuff repair, open transosseous (TO) repair was largely replaced by anchor-based methods with the advent of arthroscopic surgery owing to their comparative ease of use. However, suture anchors are at risk of dislodgement, especially among older patients, who have more osteopenic bone or those presenting large tears. Considering the ever-increasing active life expectancy and associated increased quality of life expectations by older generations, the need to offer safe and efficient surgical treatments to these patients imposes itself. Arthroscopic TO repairs would combine the best of both worlds and be well adapted to these populations. The primary objective of this study was to evaluate the functional outcome and complication rate of the TO arthroscopic repair technique when using a 2-mm braided suture tape. The secondary objective of this study was to assess functional outcome of TO repair in older patients and patients with >3-cm tears.MethodsOne hundred thirty-seven consecutive patients with full-thickness rotator cuff tear who underwent arthroscopic TO (anchorless) rotator cuff repair between January 2011 and December 2013 were reviewed. The surgery was performed by a single surgeon with a reusable curved suture passer and 2-mm braided tape suture. Follow-up was 3 to 5 years (mean = 50 months). All patients underwent preoperative and postoperative functional assessments (American Shoulder and Elbow Surgeons and Quick Dash) and were questioned with their overall satisfaction.ResultsThirty-eight (28%) of the 137 patients were 65 years and older, and 62 (45%) had a large or massive tear. One patient (0.7%) had early retear at the suture-tendon interface after trauma 3 weeks postoperatively. The average Quick Dash score improved by 55.6 points and the average American Shoulder and Elbow Surgeons score improved by 69.7 points 3.5 and 6.3 times their minimal clinically important differences, respectively. There was no significant difference in final functional outcomes between patients 65 years and older and younger patients or between patients with large and massive (>3 cm) and smaller tears (≤3 cm). Mean operative time was 68 min ± 16.ConclusionsArthroscopic TO repair using a 2-mm tape material has achieved significant mid-term functional improvement, with results statistically unaffected by larger tear size (>3 cm) or older age (≥65 years).

Evaluation of functional outcome of intracapsular fracture neck of femur with Austin Moore prosthesis at a tertiary care hospital in Srikakulam

Introduction: Fractures of the femoral neck are common injuries occurring in the elderly population due to osteoporosis. They present a significant challenge to Orthopaedic surgeons because of the high rate of complications like nonunion, avascular necrosis, and associated comorbidities. Historically, Austin Moores prosthesis has served as an exemplary implant over the years in the management of intracapsular fracture neck of femur in older individuals. Our aim of the study is to asses postoperative function in these population and to validate the use of AMP in current Orthopaedic practice. Methods & Materials: This is a hospital-based cohort study. We did this study in thirty patients who had the fractured neck of the femur using Austin Moore Prosthesis, who are admitted to the Department of Orthopaedics in Great Eastern Medical School & Hospital, Srikakulam from Dec 2017 to Dec 2019. All patients were followed for twelve months. It is a patient-reported outcome study based on a questionnaire using a Harris hip score. Results: Harris hip score, which is the gold standard in the assessment of postoperative function in hip surgeries was used in this study. We graded the patients as excellent, good, fair, and poor depending on the functional outcome based on each criterion in this scoring system. The functional results were excellent in 50%, good in 23.3%, fair in 23.3%, and poor in 3.3% of cases. The poor results are due to moderate hip pain after surgery. The complication rate was low. Conclusion: Hemiarthroplasty with Austin Moore Prosthesis proved to be a good choice for the management of fracture neck femur in the elderly population with limited physical demand and low economic background. The mortality and morbidity are low; the operative procedure is simple with satisfactory functional results and fewer complications.

Assessment of factors resulting to functional outcome of intertrochanteric fracture of femur managed by proximal femoral nail: Antirotation 2 (PFNA 2)

Background: Intertrochanteric femur fracture management in elderly needs more attention to reduce malunion and increase early mobilisation to reduce mortality and morbidity. Ideal choice of treatment is internal fixation by intramedullary or extramedullary devices. Intramedullary devices provide more stable proximal femoral anatomical fixation. Between PFN and PFNA; helical blade in PFAN provides more stability, better compression and rotational control with lower cut-out rate. Aim: a) To assess the factors for functional outcome of PFNA2. b) Evaluation of effectiveness and stability of PFNA 2. Material and Methods: 30 patients with unstable Intertrochanteric femur fracture between Nov 2020 to July 2021 fulfilling inclusion and exclusion criteria were included in this study and underwent closed reduction and intermal fixation by PFNA(n=30). Assessment was done in terms of demography, preoperative and intraoperative variables, postoperative parameters mainly functional outcome till 1 year postoperative. Results: Preoperative variables, AO fracture type were assessed preoperatively. Duration of surgery, blood loss and fluoroscopy imaging were significantly lower in PFNA as compared to PFN. Postoperative complications like cut-out rate, shortening, varus malalignment, return to pre-fracture state were also lower in PFNA group than PFN. Postoperative functional assessment done by Harris Hip Score shows better outcome in PFNA than other fixation devices. Conclusion: PFNA reduces duration of surgery, blood loss, fluoroscopy imaging as compared to other implants. PFNA also offers better postoperative functional outcome.

Comparative study of posterior malleolus fixation in trimalleolar ankle fractures treated with anterior to posterior screw versus posterolateral plate

Objectives: To compare radiographic and clinical midterm outcomes of posterior malleolar fractures treated with anterior to posterior lag screw versus posterior buttress plating fixation. Patients: Between June 2017 and June 2021, patients with posterior malleolar fractures were identified by the Current Procedural Terminology code and their charts were reviewed for eligibility. Intervention: Posterior malleolar fixation using either anterior to posterior (AP) lag screws or posterior buttress plating. Main Outcome Measurements: Demographic data, length of follow-up, range of motion, and postoperative Short Musculoskeletal Function Assessment (SMFA) scores were the main outcome measurements. Immediate postoperative radiographs for residual gap/step-off and final follow-up radiographs for the degree of arthritis that developed were evaluated.Results: 37 patients were eligible for the study, and 27 choose to participate. 16 patients underwent posterior buttress plating, and 11 underwent AP screw fixation with mean follow-up times of 26 and 20 months, respectively. Demographic data were similar between groups. The posterolateral plating group demonstrated superior postoperative SMFA scores compared with the AP screw group with statistically significant differences in the SMFA bother index (26.7 vs. 9.2, P = 0.03) and trends toward improvement in the mobility (28.3 vs. 12.9, P = 0.08) and functional indices (20.2 vs. 9.4, P = 0.08). There were no significant differences in the range of motion or the development of ankle arthritis over time. Conclusions: Patients with trimalleolar ankle fractures in whom the posterior malleolus was treated with posterolateral buttress plating had superior clinical outcomes at follow-up compared with those treated with AP screws.

Primary total knee replacement using dished polyethylene with resected posterior cruciate ligament

&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;The choice between preserving, sacrificing or substituting the posterior cruciate ligament (PCL) is always a controversial topic in total knee replacement (TKR). Dished polyethylene insert with PCL resection enables correction of the commonly present fixed flexion and varus deformities. Additionally, the risk of premature wear of polyethylene is less because of the confirming articular geometry between the femoral and tibial component.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This is a retrospective study in which we studied 120 knees in 95 consecutive patients undergoing primary TKR by the senior author at our institute. We used TKR system with dished metal backed polyethylene tibial component. PCL resection was performed in all cases. Pre-operative and post-operative functional assessment were done using knee society clinical scores and Western Ontario and McMaster universities osteoarthritis index (WOMAC). All radiographs were assessed using the knee society Roentgenographic scoring system (KSRES). Statistical analysis was performed using paired student t tests. Survivorship was determined using Kaplan-Meier survivorship curves. &lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Mean follow-up was 8 years. Range of motion increased from 75 degrees to 110 degrees. The knee society pain score increased from 30 to 94. The knee society function score increased from 35 to 75. WOMAC score increased in terms of pain, stiffness and physical function.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;We conclude that deep dish bearing is a viable option in presence of deficient PCL and provides adequate stability and functional outcome. We need a larger sample size, multicentre trial and longer follow-up to see for complication rate, revision rate and survival.&lt;/p&gt;

Effects of Continuous-Flow Left Ventricular Assist Device Therapy on Peripheral Vascular Function

The peripheral vascular effects of continuous-flow left ventricular assist device (CF-LVAD) implantation are still unclear. The aim of the current study was to determine peripheral vascular function before and after implantation of CF-LVAD in patients with end-stage heart failure (HF), and to compare this data to age- and sex-matched chronic heart failure with reduced ejection fraction (HFrEF) patients. Forty-three consecutive end-stage HF patients (New York Heart Association [NYHA] class III/IV; three women and 40 men; mean age 53 ± 11 years) who planned to receive CF-LVAD implantation comprised the LVAD patient population, and their clinical characteristics, preoperative and third postoperative month peripheral vascular function assessment data including flow-mediated dilation (FMD) and pulsatility index (PI) assessed by ultrasound Doppler in brachial artery were compared to age- and sex-matched chronic, stable HFrEF patients (NYHA class II; five women and 30 men; mean age 51 ± 10 years). After CF-LVAD implantation, median FMD decreased from 5.4 to 3.7% (p &lt; 0.001), and median PI decreased from 6.9 to 1.4 (p &lt; 0.001). In patients with end-stage HF before CF-LVAD implantation, FMD and PI were significantly lower compared to the chronic HFrEF patients (FMD: 5.4% ± 0.9% vs. 7.6% ± 1.1%; p &lt; 0.001, respectively) and (PI: 6.9 ± 1.3 vs. 7.4 ± 1.2; p = 0.023, respectively). The current study revealed impaired peripheral vascular function in the end-stage HF patients compared to stable HFrEF patients, and documented the deterioration of peripheral vascular function after CF-LVAD implantation. These results suggest that impaired peripheral vascular function in the CF-LVAD patients compared to preoperative assessment is a consequence of the nonpulsatile blood flow due to the continuous-flow mechanical support.

The quantitative evaluation of cortico-spinal tract involvement in malignant intracerebral tumors

The aim of the study was development of the method for preoperative quantitative evaluation of pyramidal tract and tumor relationship in malignant intracerebral tumors.Materials and methods. The retrospective analysis of 62 patients underwent surgery at the Department of Neurosurgery of Privolzhsky Research Medical University in 2017–2019, was performed. The patients were divide in 3 groups: metastatic brain tumor (n = 16); contrast-enhanced gliomas (grade III–IV); contrast-nonenhanced gliomas (grade II–III). The following protocol was implemented for all patients: preoperative DTI-tractography; intraoperative direct subcortical electrical stimulation with fixation of the minimum current intensity at receiving the motor response; pre- and postoperative motor function assessment using MRC-scale. Tract Involvement Index (TII) based on the ratio of the perimeter of the part of the tract involvement in pathological MRI-signal to its cross-section area was calculated using image processing of preoperative MRI and MRI-tractography data.Results. The association between TII values (from 0 to 1.75) and the severity of pre-operative paresis was demonstrated. We have discovered that the greater value of the pyramidal TII was corresponded to the greater severity of the paresis in MRC (p &lt;0.001, n = 62). The analysis of TII values and intraoperative motor direct subcortical mapping results showed an increase in risk of contact with a tract at higher TII value (B0 = −1.6; Bi = 6.61; χ2 = 30.53; n = 62, p &lt;0.001). The TII demonstrates better prognostic value in patients without radiation therapy in anamnesis.Conclusions. The method for preoperative quantitative evaluation of pyramidal tract and tumor relationship using TII calculation can provide additional information for planning surgical treatment in patients with intracerebral tumors without radiation treatment in the history.

134 Quantitative Assessment of Visual Function for Pituitary Macroadenomas: A Practical Scoring Algorithm

Abstract Introduction There is a myriad of existing terms by which visual capacity is recorded. The lack of a standardised categorisation of observations commonly results in ambiguities. We report the utility of a visual function score (VFS) in patients managed by transsphenoidal surgery. Method A VFS (expressed as a percentage) with a maximum score of 20 was calculated for each eye using the Snellen VA (40% weighting: score 0-8) and Humphrey Allergan 30-2 automated visual field (60% weighting: score 0-12). Results 280 patients (560 eyes) underwent transsphenoidal pituitary adenoma resections with complete pre- and post-operative visual function assessment. Mean age 56 years; 56.4% male. 26.1% were treated by endoscopic technique and 73.9% were treated by microscopic technique. Pre-operative vision was normal in 38.0% eyes. All these had full post-operative vision. In patients with pre-operative visual loss (347 eyes), the mean pre-operative VFS rose from 70.8% to 87.5% post-operatively. 43.8% eyes attained full post-operative vision, 28% improved, and 25.6% remained unchanged. 9 patients (2.6%) had worse immediate post-operative vision. Conclusions The VFS is a convenient single measure of visual function that may facilitate local and national audit of transsphenoidal surgery. Studies are planned to correlate this with patient reported visual quality of life measures.