Mean Postoperative Score Research Articles

In-Office Hyaluronic Acid Injection of Vocal Folds in Patients with Presbyphonia

Objective: to evaluate the advantages and disadvantages of injection laryngoplasty with hyaluronic acid in patients older than 65 years with presbyphonia. Study Design: a retrospective observational study. Setting: an academic secondary medical center. Methods: This study was performed using a group of patients diagnosed with presbyphonia who were treated using injection laryngoplasty with hyaluronic acid and underwent a minimum follow-up of 12 months. Subjective parameters such as the Voice Handicap Index–10 (VHI-10) and the GRBAS scale (grade, roughness, breathiness, asthenia, strain) were measured, as well as objective parameters such as the closure defect area. The medical records of patients undergoing this procedure during the 2020–2023 period were reviewed. An analysis of the demographic and clinical variables of the group was performed, as well as the values of the VHI-10, GRBAS, difference, and improvement of the area of closure defect before and after the procedure, along with the treatment duration and sensation of improvement. Results: The mean pre- and postoperative VHI-10 decreased from 26.8 to 19.6, showing significant differences (p = 0.007). The postoperative GRBAS mean score was 5.6 and normality can be assumed when it is below 9. Out of the 16 patients, 11 of them reported subjective improvement in their symptoms. More than half of them showed an improvement in the closure defect greater than 80%, with a significant reduction in the area (p < 0.001). Conclusions: hyaluronic acid injection in patients with presbyphonia produced a clear subjective improvement in voice quality and a decrease in the closure defect area.

The Use of Highly Porous 3-D-Printed Titanium Acetabular Cups in Revision Total Hip Arthroplasty: A Systematic Review and Meta-Analysis

Background/Objectives: As the rate of revision total hip arthroplasty (THA) has risen, there has been a drive to improve the technology in the manufacturing of the implants used. One recent advance has been 3-D printing of trabecular titanium implants to improve implant stability and osteointegration. The aim of this study was to review the clinical and radiological outcomes of these acetabular implants in revision THA. Methods: A manual search of the databases of the US National Library of medicine (PubMed/MEDLINE), Embase, and the Cochrane library was performed. The following keywords of “revision total hip arthroplasty” AND “acetabulum” AND “titanium” AND “porous” were utilised. Results: In total, 106 abstracts were identified during manual search of databases. In total, 11 studies reporting 4 different implants, with a total of 597 operated joints in 585 patients were included in this review. There were 349 (59.7%) female patients, and the mean age per study ranged from 56.0 to 78.4 years. The all-cause survival rate was 95.52% (95% CI: 92.37–97.96) at a mean follow up of 3.8 years (95% CI: 2.6–5.1). The 40 cases that required re-operation included 17 (2.8%) for infection, 14 (2.3%) instability, 2 (0.3%) for shell migration and 5 (0.8%) for aseptic loosening. The most commonly used patient reported outcome measure was the Harris Hip Score with the mean post-operative score of 86.7 (95% CI: 84.3–89.1). Conclusion: Trabecular titanium acetabular implants, when used in revision THA, resulted in excellent short- to mid-term outcomes with improved hip specific outcomes and a survivorship of 95.52% over the reported follow-up period. Future prospective studies evaluating long term outcomes are needed to make comparisons between more established solutions used in revision THA.

Arthroscopic all-inside wrapping repair of lateral meniscus bucket-handle tears: clinical and imaging outcomes

PurposeThis study aimed to assess the clinical and radiographic healing rates of the arthroscopic all-inside wrapping repair technique for lateral meniscus bucket-handle tears (LMBHTs).MethodsThis retrospective study examined patients diagnosed with LMBHTs who underwent all-inside wrapping repair with or without anterior cruciate reconstruction between 2012 and 2021. Patients with previous knee surgeries, multiligamentous knee injuries, or advanced osteoarthritis were excluded. Clinical follow-up was at least 2 years. Clinical healing was defined as no reoperation of LMBHTs following initial repair and the absence of symptoms related to the LMBHT during follow-up. Postoperative clinical outcomes were assessed using the International Knee Documentation Committee (IKDC) score. At 6 months postoperatively, the healing of the repaired meniscus was evaluated using Henning’s criteria through magnetic resonance imaging (MRI).ResultsOf the 34 patients included, two required re-operation for a re-tear of the BHT, resulting in a clinical healing rate of 94.1% (95% confidence interval [CI]: 82.9–99.2%) at a mean follow-up of 4.2 years. Among the remaining 32 patients, the mean postoperative IKDC score was 83.7 ± 8.2 (range, 70–95). MRI evaluations at 6 months postoperatively revealed complete healing in 64.7% (22/34; 95% CI: 47.9–79.5%), partial healing in 23.5% (8/34), and failure to heal in 12.5% (4/34, including the two re-tear cases). Subgroup analyses indicated no significant difference in the IKDC scores between patients with complete healing and those with partial healing on MRI (85.5 ± 7.9 vs. 82.3 ± 8.5; p = 0.53). Future studies with larger cohorts and stratified analyses are needed to explore potential predictors of healing outcomes.ConclusionsThe all-inside wrapping repair technique demonstrated favorable outcomes in patients with lateral BHTs and can be used as a viable alternative.

Simultaneous Bilateral Surgery for Accessory Naviculars does not Have a Negative Effect on Postoperative Outcome.

Accessory navicular tends to occur bilaterally; however, unilateral surgery is performed more often than simultaneous bilateral surgery. The purpose of this study was to compare the clinical outcomes of unilateral and simultaneous bilateral surgeries. Between 2018 and 2022, 42 feet in 26 patients underwent resection for a type-II symptomatic accessory navicular. Patients were classified into 2 groups according to unilateral (group Uni) or bilateral (group Bi) surgery. Clinical outcomes and time to postoperative walking, jogging, and return to full athletic activities were compared between the groups. There were 10 and 16 patients in group Uni and group Bi, respectively. A comparison between group Uni and group Bi revealed no significant differences in the number of days until walking, jogging, or full athletic activity. There were no statistically significant differences between groups in terms of mean postoperative SAFE-Q scores for any of the subscales. To avoid the influence of age, stratified analysis was conducted by dividing the participants into those aged ≤ 16 years and those aged > 16 years. No statistically significant differences were observed between the group Uni and group Bi. Similar results were also observed in the t-test. In addition, we conducted a similar analysis by changing the age cutoff to 15 or 19 years, but no qualitative changes were observed in the results. There is no clear evidence that bilateral surgery for type-II symptomatic bilateral accessory navicular delays recovery, and there might be no need to avoid bilateral simultaneous surgery, regardless of age. LEVEL OF CLINICAL EVIDENCE: Level 4.

The Use of Knives With Versus Without Integrated Water-jet Function During Peroral Endoscopic Myotomy for Patients With Achalasia: A Meta-analysis.

Peroral endoscopic myotomy (POEM) is a well-established endoscopic treatment for achalasia, utilizing an endoscopic knife for dissection. Recently, new knives with an integrated water-jet (WJ) function have been introduced. This study aims to compare the technical, perioperative, and late postoperative outcomes between WJ knives and conventional (C) knives, which lack the WJ function, through a pairwise meta-analysis of published comparative studies. We conducted a systematic literature review following PRISMA guidelines to identify studies directly comparing knives with versus without a WJ function in POEM for achalasia. A random-effects model was employed, using odds ratios for dichotomous data and mean differences for continuous data as effect size metrics. The use of WJ knives demonstrated statistically significant reductions in the mean number of intraoperative instrument exchanges, mean intraoperative use of coagulation forceps, and operative times compared to the use of C knives. There were no significant differences in terms of the incidence of adverse events, subcutaneous emphysema, or mean hospital length of stay (LOS). Clinical success, defined as a postoperative Eckardt score <3, mean postoperative Eckardt scores, and the incidence of GERD requiring proton pump inhibitors (PPI) also showed no significant differences. The use of water-jet (WJ) knives demonstrates comparable efficacy to conventional (C) knives, with superior efficiency reflected in reduced operative time and fewer intraoperative instrument exchanges. In addition, in terms of safety, the lower use of coagulation forceps with WJ knives suggests reduced intraoperative bleeding. However, no significant differences were observed between the groups in terms of length of stay (LOS) and adverse events, despite a trend toward reduction. A larger number of studies with greater sample sizes is required to better assess potential differences in safety between the use of WJ and C knives.

Laparoscopic Incisional Hernia Mesh Repair With And Without Defect Closure

Objectives: As a systematic review, the present paper is designed to compare laparoscopic incisional hernia mesh repair with or without mesh defect after evaluating the rates of recurrence, complications, and postoperative recovery. Study Design: A prospective study. Place and duration of study: From May 2024 to October 2024 General Surgery Department Jinnah Post Graduate Medical Centre Karachi. Methodology: 100 patients drawn through random sampling. Two groups of fifty patients each were operated, the first having Laparoscopic hernia repair with defect closure, the second having it without defect closure. Mesh positioning and location were aligned; follow-up extended to 12 months majoring on recurrence, bulge, and pain after surgery. Quantitative data analysis as well as qualitative data analysis included use of p-values and standard deviations for comparison between the groups. Results: Table 3 demonstrated the mean times to first recurrent event; the recurrence rate in defect closure group was 6% and in non-closure group it was 10% with p value 0.04; statistically significant. New wall formation was symmetrical in 18% of patients with defect closure and 34% without (p=0.03). The mean postoperative pain scores were also comparable (3.2± 0.6 vs 3.4 ± 0.7; p=.35; not significant). There were no postsurgical complications of the noted surgery as a whole. Conclusions: Closure of the defect in laparoscopic incisional hernia repair is associated with a lower recurrence rate and minimal bulging in comparison to non-closure laparoscopic incisional hernia repair with similar pain scores. Defect closure should be entertained for patients who desire better esthetic and clinical appearance, and the study demonstrated feasibility in patients with moderate size of hernias. Keywords: Incisional hernia, Laparoscopy, Defect closure, Mesh repair

RETORNO AO ESPORTE APÓS OSTEOTOMIA DO JOELHO EM ATLETAS EM NÍVEL COMPETITIVO – SÉRIE DE CASOS

Abstract Objectives: To analyze the return to the sport and the level of sports practice in a longitudinal cohort of athletes treated with osteotomy around the knee. Methods: Active athletes who underwent osteotomy or knee surgery to treat knee osteoarthritis were included, and their data was collected retrospectively. The primary outcomes were maximum physical activity level before and after the surgery (Tegner score), time to return to maximum activities and reoperation. Results: Twenty athletes with a mean age of 33 years at the time of surgery (standard deviation 8.9 (SD)) and with a mean follow-up of 9.8 years (SD 4) were included. The mean maximum Tegner score achieved before surgery was 8.6 (SD 1.4). Nineteen patients returned to sports (95%), and 13 returned to the same prior level (65%). The median time to return to the maximum level was 13 months (mean 17.9, SD 12.4). The mean maximum postoperative Tegner score was 7.5 (SD 2.0), slightly lower than the maximum achieved before surgery (mean difference:1.1, CI:0.2-1.9, P=0.026). Conclusion: The results of this study suggest that, after osteotomies around the knee, athletes present a high rate of return to sports activities, with most returning at the same level as before the surgery. Level of Evidence IV; Case series.

Medialized vs. Lateralized Reverse Total Shoulder Arthroplasty for Proximal Humerus Fractures: A Systematic Review and Meta-Analysis.

Reverse shoulder arthroplasty (RSA) is increasingly used in the treatment of proximal humerus fractures (PHFs) with reliable clinical improvement. Lateralized RSA implants have conferred superior outcomes compared with the original Grammont design in patients with nontraumatic indications. However, in the setting of a PHF, lateralized components can place increased tension across the tuberosity fracture site and potentially compromise tuberosity healing and outcomes. This systematic review and meta-analysis sought to determine the effect of implant design on clinical outcomes after RSA for PHFs. A systematic review was performed per Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed/MEDLINE, EMBASE, Web of Science, and Cochrane were queried for clinical studies on RSA performed for PHFs that reported implant manufacturer details. Our primary outcomes included postoperative external rotation (ER), forward elevation (FE), abduction, Constant score, rate of greater tuberosity (GT) healing, and the incidence of complications compared between medialized vs. lateralized global implant design. Globally lateralized RSA cohorts (478 RSAs total with cumulative lateral offset achieved through humeral or glenoid lateralization or both humeral and glenoid lateralization) were found to have a greater mean postoperative Constant score compared with globally medialized (medialized glenoid and medialized humerus) RSA cohorts with 1,494 total medialized RSAs (66 vs. 59, p = 0.006), but there was no significant difference regarding mean postoperative ER (30° vs. 22°, p = 0.078), FE (117° vs. 119°, p = 0.708), or abduction (103° vs. 107°, p = 0.377). On meta-regression, neither implant design nor tuberosity status significantly influenced postoperative ER, FE, abduction, or Constant score on meta-regression independent of mean follow-up and age at surgery. The rate of GT healing was greater in lateralized compared with medialized RSAs (88% vs. 72%, p < 0.001). On meta-regression, medialized RSA design was associated with a 73% lower odds of GT healing (odds ratio = 0.27, 95% confidence interval = 0.11-0.68, p = 0.007) independent of mean follow-up and age at surgery. Lateralized RSA implants conferred no significant functional benefit over medialized implants when used in patients with PHFs. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

PROSPECTIVE RANDOMIZED EVALUATION OF THE IMPACT OF MULTIMODAL ANALGESIA AND TRANEXAMIC ACID ON POSTOPERATIVE PAIN AND BLOOD LOSS IN KNEE ARTHROPLASTY PATIENTS

The most prevalent type of arthritis and a major contributor to disability is osteoarthritis. One of the most successful surgical treatments is total knee arthroplasty (TKA), which improves function and relieves pain in most patients. Objectives: The aim of this study is to evaluate the effects of intra-articular tranexamic acid and multimodal cocktail on postoperative blood loss and pain in patients undergoing total knee replacement. Methods: Enrolled were ninety-six male or female individuals with knee osteoarthritis who intended to have a total knee replacement. Group A received conventional anaesthetic medications only; tranexamic acid was not administered. Patients in Group B received an intraarticular injection of tranexamic acid weighing three grammes. Patients in Group C received a multimodal cocktail consisting of bupivacaine, tramadol, and ketorolac. Following TKA, patients had a 72-hour follow-up period. For 72 hours, blood loss and a pain score were recorded every 24 hours. Results: Patients in the cocktail group were 50.22±9.63 years old, those in the TXA group were 52.31±14.69 years old, and those in the control group were 48.92±13.22 years old. In three groups, the male-to-female ratios were, respectively, 11:21, 14:18, and 10:22. Within the first 72 hours, the control group lost 1030.1±177.27ml of blood, the TXA group lost 453.7±80.4ml, and the cocktail group lost 607.7±122.5ml. There was a significant difference (p&lt;0.05) between TXA and cocktail groups and in all three groups. In the control group, the mean postoperative pain score was 4.4±2.3, in the TXA group it was 2.4±1.5, and in the cocktail group, it was 1.8±1.0 over the first 72 hours. The TXA and cocktail groups showed negligible differences (p&gt;0.05), whereas the three groups showed substantial differences (p&lt;0.05). Conclusion: Compared to the control group, the use of an intraarticular TXA injection was found to be effective in lowering blood loss. Although the multimodal cocktail allowed for better pain management than the other two groups.

Repair Fails More Frequently Than Reconstruction in Acute Posterolateral Corner Knee Injuries: A Systematic Review of Outcomes Following Surgical Management.

To synthesize the current literature on PLC reconstruction and repair, focusing on a comparison of surgical techniques and outcomes based on injury chronicity in the setting of sports-related ligament tears. A systematic review of the literature including queries of the PubMed/MEDLINE, Embase, and Cochrane Library databases was performed in March of 2024. Studies were included if they were of level IV evidence or greater, reported PLC reconstruction or repair outcomes, and had a minimum 2-year follow-up. Patient demographics, injury type, time from injury to surgery, surgical technique, subjective patient outcomes, objective physical exam findings, and complications were obtained. Postoperative physical exam findings of varus and posterolateral rotatory stability and reoperation for instability were used to determine surgical success or failure. Means and ranges were recorded for continuous variables. Forest plots were generated for failure rates by subgroup and an I-squared statistic was used as a measure of heterogeneity. Except for 3 studies, injuries were considered acute when treated within 3 weeks of injury. Quality assessment was conducted using the Newcastle-Ottawa Scale (NOS) for cohort studies and the National Institute of Health (NIH) Quality Assessment Tool for case series studies. Twenty-nine of the sixty-three reviewed studies (791 patients) met inclusion criteria. Two of the studies were level II, eleven level III, and sixteen level IV evidence. Mean patient age ranged from 19 to 69.1 years. Mean time from injury to surgery ranged from 8.1 to 19 days (acute) and 7.2 weeks to 70.2 months (chronic). Mean postoperative Lysholm scores ranged from 80.8 to 97.0 (acute) and 76.5 to 94.5 (chronic). Mean postoperative IKDC scores ranged from 59.8 to 87.3 (acute) and 64 to 91.9 (chronic). Within the acute PLC group, 114 (59.3%) patients were treated with isolated repair and the remaining 78 (40.7%) were treated with reconstruction. Within this group, failure rates, defined by varus stress examination or reoperation, ranged from 0 to 40%. More specifically , reconstruction failure rates ranged from 0 to 15%, whereas repair failure rates ranged from 0 to 40%. All 602 chronic PLC patients were treated with reconstruction and the failure rate ranged from 0 to 27%, with a single outlier study of two patients reporting a 50% failure rate. The findings of this review suggest that repair of PLC injuries in the acute setting may fail at higher rates than reconstruction. Additionally, chronic PLC injuries are predominantly treated with reconstruction and experience greater variability in their rates of success compared to acute injuries. High-quality, well-controlled studies are needed to determine optimal management of both acute and chronic PLC injuries.

Surgical treatment of flexible flatfoot in adolescents: Sinotarsic endorthesis

Objectives: The surgical procedure of arthroereisis for flexible flatfoot involves placing a screw or spacer between the talus and calcaneus, limiting the excessive inclination of the calcaneus. This study aimed to evaluate the clinical results of patients treated using an endosenotarsal screw. Methods: Seventy-three patients were treated with arthroereisis (54 unilateral and 19 bilateral) using the Fit-As subtalar screw (Gemes®). A total of 92 screws were implanted. Pre- and post-operative clinical evaluations were performed before and 3 months after the operation. Results: The median follow-up period was 46 months (12–80 months). The average age at the time of surgery was 12 years (range 8–19 years). The mean pre-operative American Orthopedic Foot and Ankle Society (AOFAS) score was 63.7/100, while the mean post-operative AOFAS score was 98.6/100. The average pre-operative disability index Foot and Ankle Disability Index Questionnaire was 77.7/104, whereas the average post-operative index was 102.3/104. None of the treated patients required surgical screw removal at the time of the final follow-up. Conclusion: The results obtained in this series of patients with Fit-As titanium endorthesis are in accord with those reported in the literature and lead to good clinical results, the absence of complications, and the unnecessary removal of the device.

Hemorrhoidectomy Using the Harmonic Scalpel versus the Ferguson Technique

Abstract Introduction Hemorrhoidal disease is an anorectal condition commonly encountered in the clinical practice. Various instruments, such as circular staplers, harmonic scalpels, lasers, and bipolar electrothermal devices, are used in different modalities of hemorrhoidectomy in cases of high-grade hemorrhoids. Objective T compare the results of hemorrhoidectomy using the Ferguson technique and the harmonic scalpel. Materials and Methods The present is a randomized prospective study involving 60 patients submitted to hemorrhoidectomy from February 2022 to January 2024. The patients were randomly grouped: group I was composed of 30 patients who underwent the operation through the conventional Ferguson technique, and group II was composed of 30 patients submitted to hemorrhoidectomy with the use of the harmonic scalpel. Results The demographic and clinical features of the patients in the two groups were identical. We found a significant difference in the mean operative time: for the Ferguson technique, it was of 21.9 ± 4.6 minutes, while for the harmonic scalpel, it was of 17.9 ± 3.1 minutes (p = 0.003). The mean postoperative pain scores on the Visual Analog Scale (VAS) were of 7.1 ± 1.2 points for group I, and of 6.5 ± 0.5 points for group II (p = 0.024). And the mean hospital stay was of 1.23 ± 2.1 days for group I, and of 1.03 ± 0.1 for group II (p = 0.023). No statistical significance was observed regarding the other parameters. Conclusion Hemorrhoidectomy using the harmonic scalpel seems to be a superior approach to treat high-grade hemorrhoids; it has the advantage of reduced hospital stay, decreased postoperative pain, and shorter operative time.

Patient-Reported Outcomes Following Periacetabular Osteotomy versus Hip Arthroscopy for Borderline Acetabular Dysplasia Are Comparable: A Systematic Review.

The purpose of this systematic review was to compare patient populations and outcomes in studies treating borderline hip dysplasia (BHD) with either hip arthroscopy or periacetabular osteotomy (PAO). We hypothesized that studies would show significant postoperative improvement following both PAO and arthroscopy for BHD, and that subjects undergoing arthroscopy would have a higher rate of Cam morphology. A literature review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was conducted to identify studies published after 2014 that reported patient-reported outcome measures (PROMs) following hip arthroscopy or PAO for BHD. Preoperative demographics, radiographic variables, operative findings, procedures, postoperative outcomes, and complications were recorded. Forest plots were constructed of disaggregated data to identify study heterogeneity using the I2 statistic. 26 studies (8 PAO; 18 Arthroscopy) were included. Acetabular morphology was comparable between the PAO and arthroscopy studies while the arthroscopy studies reported higher alpha angles (range 48.3-75.3°) compared to the PAO studies (range 47.6-55°). No PAO studies reported an average alpha angle greater than 60° while this was reported in 71% of arthroscopy studies. The most common PROMs were the modified Harris Hip Score (mHHS), with average improvement ranging from 20-29 for PAO and 17.9-34.4 for arthroscopy, and the International Hip Outcome Tool-12 (iHOT-12), with mean postoperative scores ranging from 73.3-74.3 for PAO and 67.5-85.4 for arthroscopy. Postoperative PROM improvement was significant for all studies with significant heterogeneity for the mHHS (I2=0.90) and iHOT-12 (I2=0.98). There was significant postoperative improvement following both PAO and modern hip arthroscopy for the surgical management of BHD with high levels of heterogeneity limiting comparability between study groups. Hip arthroscopy studies recorded higher alpha angles suggesting that cam deformities in the setting of BHD can be managed arthroscopically, however further study on optimizing indications between procedures is required.

Comparison of the efficacy of the modified internal brace and the arthroscopic Broström-Gould procedure for chronic lateral ankle instability.

To compare the efficacy of an internal brace and the arthroscopic Broström-Gould procedure for chronic lateral ankle instability (CLAI). The clinical data of 71 patients who were diagnosed with chronic lateral ankle instability between May 2020 and May 2022 were retrospectively analyzed. The American Orthopedic Foot and Ankle Society (AOFAS) scale, Foot and Ankle Ability Measure (FAAM), and Visual Analogue Scale (VAS) were used to assess clinical outcomes. A total of 59 patients were followed up for a mean of 21 months (range, 16-24 months). Thirty-seven patients underwent the modified Broström-Gould (IB) procedure, and twenty-two patients underwent the arthroscopic Broström-Gould (ABG) procedure. The mean postoperative VAS score (P = 0.790), AOFAS score (P = 0.252), FAAM daily activity score (P = 0.983), and FAAM for sports activity score (P = 0.379) were not significantly different between the ABG and IB groups at the final follow-up. However, the FAAM sports score was better in the internal brace group than in the arthroscopy group at the 1-year postoperative follow-up (P = 0.025). Patients treated with an internal brace recovered faster than those who underwent the arthroscopic ABG procedure. However, no other significant differences were observed between the two methods. Level IV, retrospective case series.

Case–control Comparative Study of Porous Metal Augments versus Bone Graft in Management of Segmental Acetabular Defect in Hip Arthroplasty Procedures

Abstract Introduction: Acetabular bone loss represents a great challenge during hip arthroplasty procedures. This study aims at evaluating the efficacy and functional outcome of cost-friendly alternatives (autograft or allograft) when compared to the porous metal augments during reconstruction of acetabular defects in either complex primary or revision total hip replacement. Patients and Methods: This is a retrospective matched control study for evaluation of short and midterm results of metal augments versus bone graft during hip arthroplasty procedures. Inclusion criteria included adult patients who suffered from segmental acetabular defect and underwent hip arthroplasty procedure. The study included 34 cases divided into 2 groups. Group 1 cases were reconstructed with augment reconstruction. Group 2 was the control group which was reconstructed using graft reconstruction. Results: The mean age for Group 1 was 52.29 years (range: 30–68) and for Group 2 was 52.1 years, (range from 32 to 71 years). The mean follow-up period was 74.8 months in Group 1 (range: 66–85 months) and 71.5 months in Group 2 (range: 60–102 months). Both the groups included 13 males and 4 females. Group 1 had a mean postoperative Harris Hip Score (HHS) of 90.5 (range from 85 to 94), and Group 2 had a mean postoperative HHS of 88.7 (range from 80 to 94) with P = 0.236. Conclusion: Acetabular reconstruction using cost-friendly alternatives shows similar short-to-midterm results when compared to trabecular metal augments in a budget-conscious health setting.

Sports Activity with Ankle Osteoarthritis and Total Ankle Arthroplasty.

Background/Objectives: The interest in performing total ankle arthroplasty (TAA) to address end-stage ankle osteoarthritis (OA) is continuously growing. Sports activity plays an important role in our world. The literature is sparse regarding return-to-sports activity following TAA. The levels and types of sports in TAA are rarely reported. The purpose of this prospective case series study is to investigate sports activity in ankle osteoarthritis (OA) and TAA in terms of rate, frequency, type, and clinical outcomes with a minimum 2 years of follow-up after surgery. Methods: A total of 103 patients (105 implants, 52 female, and 51 male), mean age 60.5 years (range, 23-84 years) with end-stage ankle OA were treated using a three-component, uncemented, mobile-bearing VANTAGE Total Ankle System. The mean follow-up was 2.9 years (range, 2-5 years). Visual Analogic Scale Pain Score (VAS, 0-10 points), Ankle Dorsiflexion/Plantarflexion (DF/PF) range of motion (ROM; degrees), functional American Orthopaedic Foot and Ankle Society (AOFAS) Ankle/Hindfoot Score (0-100 points), Subjective Patients' Satisfaction Score (0-10 points), Sports Activity Rate, Sports Frequency Score, and sports type were assessed. Results: The mean preoperative VAS Pain Score was 6.7 points (range, 3-10 points) and 0.2 points for postoperative (range, 0-3 points) (p < 0.001). The mean DF/PF ROM was 24.9° preoperative (range, 0-60°) and 52.9° postoperative (range, 15-85°) (p < 0.001). The mean preoperative functional AOFAS Ankle/Hindfoot Score was 39.5 points (range, 4-57 points) and 97.8 points for postoperative (range, 75-100 points) (p < 0.001). The mean postoperative Subjective Patients' Satisfaction Score was 9.7 points (range, 7-10 points). The preoperative Sports Activity Rate was 31.1%, with 85.4% for postoperative (p < 0.001). All the groups exhibited substantial Sports Frequency Score increases (p < 0.001). The most practised sports were hiking, biking, fitness, and swimming. Conclusions: total ankle arthroplasty (TAA) is an effective treatment for end-stage ankle OA. TAA facilitates a noteworthy increase in sports activity. This research offers important sports insights to patients with ankle OA and TAA.

Osteosynthesis using Scorpion plate for neer type V distal clavicle fracture

BackgroundNeer type V distal clavicle fractures are considered the most unstable fracture type and are characterized by the disruption of continuity between the coracoclavicular (C-C) ligaments and proximal or distal bone fragments. However, owing to the rarity of such fractures, there is currently no universally accepted surgical procedure for their treatment. Recently, the scorpion plate, an anatomical, non-locking, pre-contoured plate with two grasping arms to fix the distal or inferior clavicular fragments, was introduced. This study aimed to investigate the postoperative functional and radiological outcomes of osteosynthesis using only scorpion plates in Neer type V fractures.MethodsWe retrospectively identified 23 patients who underwent scorpion plate fixation for Neer type V fractures at two general hospitals. All patients underwent only plate fixation without C-C ligament augmentation. Subsequently, we investigated their postoperative functional outcomes, complication rates, and modified C-C distance ratio at 1 year.ResultsThe mean postoperative Constant score was 96 ± 5, with all cases achieving bone union. Complications within 1 year postoperatively included plate loosening in one patient (4.3%) and plate irritation in two patients (8.7%). Additionally, the modified C-C distance ratio averaged 114 ± 15%.ConclusionsThis study offers novel insights into the management of Neer type V distal clavicle fractures. Our findings indicate that osteosynthesis using only scorpion plates can lead to satisfactory functional outcomes with minimal complications.

INTRAOPERATIVE LOCAL BUPIVACAINE WOUND INFILTRATION VERSUS TRADITIONAL SYSTEMATIC ANALGESIA: A COMPARISON IN TERM OF POST-OPERATIVE PAIN

Effective management of post-operative pain is essential for patient recovery and satisfaction, especially in procedures like appendectomies where pain management can influence overall outcomes. Traditional systemic analgesia, while effective, often comes with side effects and limitations. Local infiltration of anesthetics like bupivacaine may provide a targeted approach to pain control with fewer systemic effects. Objective: To compare the effectiveness of intraoperative local bupivacaine wound infiltration versus traditional systemic analgesia in managing post-operative pain in patients undergoing appendectomies. Methods: This randomized controlled trial was conducted at Lady Reading Hospital, Peshawar, following approval from the hospital's Ethical Committee. A total of 60 patients, who consented and met eligibility criteria, were enrolled. All patients underwent appendectomy under general anesthesia, followed by random allocation into two groups. Group A received 0.5% bupivacaine for local wound infiltration, while Group B did not. Both groups were administered intravenous tramadol on demand, with a maximum dose of 400 mg per 24 hours. Post-operative pain was assessed using a Visual Analog Scale (VAS) at 4, 12, and 24 hours post-surgery. Stratified analysis by age and gender was also performed. Results: The study population (mean age: 41.13 ± 7.96 years) included 34 males (56.7%) and 26 females (43.3%). Group A (bupivacaine group) had a significantly lower mean post-operative pain score (3.33 ± 0.66) compared to Group B (systemic analgesia group) with a score of 5.30 ± 0.95 (p=0.00). Age-based stratification revealed significant differences: among 22-30-year-olds, Group A scored 3.00 versus 6.00 in Group B (p=0.00); for 31-50-year-olds, Group A scored 3.36 compared to 5.33 in Group B (p=0.00); and for those over 50, scores were 3.33 in Group A and 4.50 in Group B (p=0.04). Both male and female patients in Group A experienced significantly lower pain scores compared to Group B (p=0.00 for both). Conclusion: Intraoperative bupivacaine wound infiltration significantly reduces post-operative pain in appendectomy patients compared to traditional systemic analgesia. These findings support its use as an effective pain control method. Further research is recommended to optimize dosing and assess the combined use with other analgesics to enhance pain management across various surgical procedures.

Laparoscopic Repair of Duodenal Perforation Using the Falciform Ligament: A Cross-Sectional Study.

Background Duodenal perforation is a life-threatening condition. Laparoscopic repair using the falciform ligament is a minimally invasive technique that has shown promising results. We present a case series of patients who underwent laparoscopic repair of duodenal perforation using the falciform ligament as an alternative to conventional techniques. Methodology The present study was a cross-sectional study carried out in the Department of General Surgery, Sree Balaji Medical College and Hospital, Chennai, India, between January 2023 and August 2024. The study was carried out among all the patients who underwent laparoscopic repair of duodenal perforation using the falciform ligament. The data collection was done by the principal investigator, himself, using a semi-structured proforma. Results The mean operative time among the participants was 86.25 ± 17.07 minutes. The mean time to start liquids was 21.42 ± 3.26 hours, and the mean time to start solids was 37.67 ± 2.06 hours. No post-operative complications were reported or identified. The post-operative pain score was 2.55 ± 1.31. The mean post-operative satisfaction score was 8.59 ± 2.84. The mean duration of hospital stay was 5.51 ± 1.21 days. No participants had any complications or died during the follow-up period. The technical success rate was 100%. Conclusion Laparoscopic repair of duodenal perforation using the falciform ligament is a feasible and effective technique. This approach offers minimal invasiveness, reduced morbidity, and faster recovery. Our case series demonstrates the efficacy of this technique in managing duodenal perforation.

Maxillary Sinus Mucosa Preservation Versus Mucosal Sacrifice: Radiographic Outcomes After Inferior Maxillectomy and Soft-Tissue Free Flap Reconstruction.

This study evaluates the impact of maxillary sinus mucosa preservation on radiographic outcomes after an inferior maxillectomy and soft-tissue free flap reconstruction. A total of 90 patients in two cohorts (mucosal sacrifice versus mucosa preservation) were evaluated from an institutional dataset. Imaging was reviewed at set time points and sinus scores were allotted based on a modification of the Lund-MacKay system. Patients were evaluated for changes in sinus scores. A univariate (UVA) and multivariate (MVA) analysis was performed. In gp1 (mucosal sacrifice), mean postoperative sinus score was 1.21 ± 1.30 (p = < 0.001) at 24 months. On UVA, advanced T-stage at 12 months (OR 7.143, 95% CI 1.484-34.384, p = 0.014) and 24 months (OR 5.500, 95% CI 1.219-24.813, p = 0.027), and on MVA, advanced T-stage were associated with increased odds for higher sinus score (OR 4.993, 95% CI 1.084-22.995, p = 0.039). In Gp2 (Mucosa preserved), the mean postoperative sinus score was 0.31 ± 0.47 (p = 0.021) at 24 months. On UVA and MVA, no predictors were identified for a higher sinus score. Following an inferior maxillectomy and soft-tissue free flap reconstruction, notably reduced sinus scores were seen in patients with preservation of the remaining maxillary sinus mucosa.