Revision Strategies Research Articles

Study on Management of the Life Cycle of Emergency Plan System Based on Effectiveness

The whole life cycle of the emergency plan includes compilation, examination and approval, use and exercise, revision. With changes of all kinds of factors, the effectiveness of the emergency plan will gradually reduce. It's necessary to study the full life cycle of emergency plan in order to dynamically and pertinently manage the plan. Based on other areas' study on the life cycle, this paper will analyze the effectiveness factors based on the whole life cycle, and then analyze how these factors affect the plans at different levels with different categories. Finally based on the effectiveness this paper presented the revision approach for the emergency plan system and the revision strategy for a single emergency plan.

Implant-related infection in the tibia: surgical revision strategy with vancomycin cement.

The development of a deep wound infection in the presence of internal hardware presents a clinical dilemma. The purpose of the present study was to evaluate the treatment outcomes of vancomycin cement with other advances of surgical techniques for implant-related infection (IRI) in the tibia. This study included 217 consecutive patients who had sustained IRI of the tibia. Of them, 152 patients had soft tissue defects and the internal hardware was exposed. Repeated debridement and negative pressure assisted closure were used. All the infected internal hardware was removed. External fixations and flaps were used. Custom-made vancomycin cement was inserted into the dead space of the wounds and left in site for a month. The follow-up was from 12 months to 108 months, averaging 37.5 months. For all the 217 patients, the general osteomyelitis healing rate and bone union rate were 86.6% and 97.2%, respectively. This study shows high rates of healing of IRI in the tibia if the new advances of surgery could be effectively combined into the treatment strategy with vancomycin cement as an important treatment.

Posttraumatic and postoperative osteomyelitis: surgical revision strategy with persisting fistula

Posttraumatic and postoperative osteomyelitis (PPO) with bacteria colonisation during trauma and associated surgery is an increasing clinical problem. This study investigated the treatment of PPO by surgical revision including irrigation, debridement, and temporary hardware maintenance. In addition, a drainage was inserted as persisting fistula to control osteomyelitis until fracture healing was achieved. Trauma- and osteomyelitis-related factors that influenced the study outcome were determined. 67 consecutive patients with PPO were included. At onset of PPO, patients had incomplete fracture healing. Patients were subdivided by time of PPO occurrence (acute, subacute or chronic), initial soft tissue trauma, anatomical location, and initial fracture type (AO classification). The study outcome measures included radiographic and clinical follow-up. 59 patients could be followed for an average of 23 months after revision surgery. A bone healing was achieved by 89% of patients after 14.7 ± 13.4 weeks. Fractures of the lower extremity, open fractures and comminuted C-type fractures took significantly longer to achieve bone healing (p < 0.05 each). Time of PPO occurrence did not influence bone healing. After fracture consolidation, no re-infection was found. This study showed high rates of bone healing, indicating that this strategy with persisting fistula should be considered as alternative treatment option in patients with PPO.

Early Failure of Metal-on-Metal Large-Diameter Head Total Hip Arthroplasty Revised with a Dual-Mobility Bearing: A Case Report.

Riviere, Charles MD1; Lavigne, Martin MD, MSc, FRCS1; Alghamdi, Ahmed MD, FRCS1; Vendittoli, Pascal-André MD, MSc, FRCS1 Author Information

Evaluación de las concepciones de escritura académica en doctorandos en educación

The purpose of this paper is to present a scale aimed to assessing the conceptions on academic writing of PhD students and to weight the psychometric qualities -reliability and discrimination of items- that enables sample size. It is made up of 33 items related to the nature and functions of writing and to the recursive strategies of planning, textualization, and revision: 24 translated into Spanish and adapted from standardized instruments, and 9 developed ad hoc. This set is divided into two subscales: writing as Elaboration (17 items) and as Reproduction (16 items). Using a pilot sample of 39 PhD students in Education of Argentina (Universidad Nacional de Cuyo, Mendoza, and Universidad Catolica de Cuyo, at San Juan and San Luis), the instrument was self- administered, via email, with prior consent of the students. It showed considerable reliability indices according to Cronbach alpha: a coefficient of 0.93 for Elaboration subscale and of 0.91 for writing as Reproduction. It also showed that all the items of the first and 87.5% of the second are discriminative. Its potential usefulness is that conceptions on writing, a research area of poor development, have a strong mediating role in cognitive-linguistic processes, attitudes towards writing, and motivation; which also affect writing activities. Hence the need for doctoral students to replace the surface approaches (41% in our sample) by the deep one.

Two-stage revision for the infected total knee arthroplasty: The gold standard

Infection in total knee arthroplasty is a devastating complication requiring the surgeon to weigh duration of symptoms, host factors, and the characteristics of the afflicting agent when devising a management strategy. Due to its well-documented success rate, most centers in North America prefer a two-stage revision strategy. This approach allows for higher likelihood of foreign material removal and eradication of the infecting pathogen. Although the success of single-stage exchange arthroplasty has been noted in the literature, its use should be relegated to a highly selective patient population.

Early postoperative dislocation of the anterior Maverick lumbar disc prosthesis

The authors report on 2 cases of anterior dislocation of the Maverick lumbar disc prosthesis, both occurring in the early postoperative period. These cases developed after experience with more than 50 uneventful cases and were therefore thought to be unrelated to the surgeon's learning curve. No similar complications have been previously reported. The anterior Maverick device has a ball-and-socket design made of cobalt-chromium-molybdenum metal plates covered with hydroxyapatite. The superior and inferior endplates have keels to resist translation forces. The patient in Case 1 was a 52-year-old man with severe L4-5 discogenic pain; and in Case 2, a 42-year-old woman with disabling L4-5 and L5-S1 discogenic back pain. Both patients were without medical comorbidities and were nonsmokers with no risk factors for osteoporosis. Both had undergone uneventful retroperitoneal approaches performed by a vascular access surgeon. Computed tomography studies on postoperative Day 2 confirmed excellent prosthesis placement. Initial recoveries were uneventful. Two weeks postoperatively, after stretching (extension or hyperextension) in bed at home, each patient suffered the sudden onset of severe abdominal pain with anterior dislocation of the Maverick prosthesis. The patients were returned to the operating room and underwent surgery performed by the same spinal and vascular surgeons. Removal of the Maverick prosthesis and anterior interbody fusion with a separate cage and plate were performed. Both patients had recovered well with good clinical and radiological recovery at the 6- and 12-month follow-ups. Possible causes of the anterior dislocation of the Maverick prosthesis include the following: 1) surgeon error: In both cases the keel cuts were neat, and early postoperative CT confirmed good placement of the prosthesis; 2) equipment problem: The keel cuts may have been too large because the cutters were worn, which led to an inadequate press fit of the implants; 3) prosthesis fault: Both plates of the dislocated implants looked normal and manufacturer analysis reported no fault; 4) patient factors: Both dislocations happened early in the postoperative period, after hyperextension of the spine while the patient was supine in bed. Bracing would not have reduced hyperextension. Dislocation of a lumbar spinal implant represents a life-threatening complication and should therefore be considered and recognized early. Radiographic and CT studies of both the lumbar spine (for prosthesis) and the abdomen (for hematoma) should be performed, as should CT angiography (for vessel damage or occlusion). Any anterior lumbar revision surgery is hazardous, and it is strongly advisable to have a vascular surgeon scrubbed. In cases of dislocation or extrusion of a lumbar interbody prosthesis, the salvage revision strategy is fusing the segment via the same anterior approach. Surgeons should be aware of the risk of anterior dislocation of the Maverick prosthesis. Keel cutters should be regularly checked for sharpness, as they may be implicated in the loosening of implants. Patients and their physical therapists should also avoid lumbar hyperextension in the early postoperative period.

The Effect of Topical Structure Analysis Instruction on University Students’ Writing Quality

Coherence is considered one of the characteristics of effective writing. Topical structure analysis (TSA) has been taught to students as a revision strategy to raise their awareness of importance of textual coherence and helps them clearly understand its concept. This study aimed to investigate the effectiveness of TSA instruction in improving university students’ writing quality and to explore the proportions of topical progression in essays written by high and low proficiency students. It also examined the opinions of the students on TSA instruction. The participants consisted of two groups of 20 third year students majoring English Education at Chiangrai Rajabhat University. Data were collected through the pretest and the posttest of essay writing, two selected essays of high and low proficiency students, a questionnaire and an interview. The results indicated that TSA instruction had a significantly positive effect on students’ writing quality. More specifically, TSA instruction was more beneficial to the low proficiency students than the high proficiency ones. Further, both successful and less succesful students employed the sequential progression the most in the essays. The students had positive opinions on TSA instruction.

Results of a French multicentre retrospective experience with four hundred and eighteen failed unicondylar knee arthroplasties.

By means of a multicentre retrospective study based on the failure of 418 aseptic unicondylar knee arthroplasties (UKA) our aims were to present the different types of revision procedure used in failed UKAs, to establish a clear operative strategy for each type of revision and to better define the indications for each type of revision. Aseptic loosening was the principal cause of failure (n = 184, 44%) of which 99 cases were isolated tibial loosening (23.5 % of the whole series and 54% of all loosening), 25 were isolated femoral loosening (six and 13.6%) and 60 were both femoral and tibial loosening (14.3 and 32.6%). The next most common causes of failure were progression of arthritis (n = 56, 13.4%), polyethylene wear (n = 53, 12.7%), implant positioning errors (n = 26), technical difficulties (n = six) and implant failure (n = 16, 3.8% of cases). Data collection was performed online using OrthoWave software (Aria, Bruay Labuissiere, France), which allows collection of all details of the primary and revision surgery to be recorded. A total of 426 revisions were performed; 371 patients underwent revision to a total knee arthroplasty (TKA) (87%), 33 patients (7.7%) were revised to an ipsilateral UKA, 11 (2.6%) patients underwent contralateral UKA (ten) or patellofemoral arthroplasty (one) and 11 patients (2.6%) underwent revision without any change in implants. Before considering a revision procedure it is important to establish a definite cause of failure in order to select the most appropriate revision strategy. Revision to a TKA is by far the most common strategy for revision of failed UKA but by no means the only available option. Partial revisions either to an alternative ipsilateral UKA or contralateral UKA are viable less invasive techniques, which in carefully selected patients and in experienced hands warrant consideration.

Reducing Tick Size One the Stock Exchange of Tunis

the spread, the authorities reduced it for certain stocks by adopting a single level of 10 millimes whatever the price level and trading frequency. While referring to results of several researchers, we used to doubt that such a decision had ever been justified. Consequently, we have studied the impact of the reduction in tick size on return characteristics, liquidity and order revision strategy adopted by investors. We found that the change of tick size has not affected the return characteristics of the stocks in the three months following the date of the change and this result is due to a certain conservatism of the investors who carry on submitting their orders mainly to the prices authorized before the change of the tick. On the other hand, our results emphasize a deterioration of the liquidity for the stocks whose tick size was reduced and have a change in order strategy (for the stocks listed on the continuous) adopted by the investors who became more aggressive by revising frequently their orders.

Outcomes of two surgical revision techniques for recurrent anterior shoulder instability following selective capsular repair

Conventional capsulolabral reconstruction for anterior shoulder instability fails with recurrent instability in up to 23% of cases. Few studies have evaluated surgical revision strategies and outcomes. The objective of this study was to evaluate clinical and radiographic outcomes in a homogeneous series of surgical revisions after selective capsular repair (SCR). Observed anatomic lesions can guide the choice between repeat SCR and coracoid transfer (Latarjet procedure). From January 2005 to January 2009, 11 patients with trauma-related recurrent anterior shoulder instability (episodes of subluxation and/or dislocation) after SCR were included. Mean age was 31 years (range, 19-45 years). At revision, a glenoid bony defect was present in six patients. Repeat SCR was performed in five patients and coracoid transfer in six patients. After a mean follow-up of 40 months (range, 24-65 months), no patient had experienced further episodes of instability. However, four patients had a positive apprehension test. External rotation decreased significantly by more than 20° after both techniques. The Simple Shoulder Test, Walch-Duplay, and Rowe scores were 10.5, 79, and 85, respectively. No patient had a subscapularis tear. Of these 11 patients, nine were able to resume their sporting activities and eight reported being satisfied or very satisfied with the subjective outcome. Radiographs showed fibrous non-union of the coracoid transfer in one patient. In patients with recurrent anterior shoulder instability after SCR, repeat SCR and coracoid transfer produce similarly satisfactory outcomes. The size of the glenoid bone defect may be the best criterion for choosing between these two procedures. However, open revision surgery may decrease the range of motion, most notably in external rotation. Level IV.

Proposed alternative revision strategy for broken S1 pedicle screw: radiological study, review of the literature, and case reports

Background contextThere have been many reports outlining differing methods for managing a broken S1 screw. To the authors' best knowledge, the technique used in the present study has not been described previously. It involves insertion of a second pedicle screw without removing the broken screw shaft. Study designRadiological study, literature review, and two case reports of the surgical technique. PurposeTo report a proposed new surgical technique for management of broken S1 pedicle screws. MethodsComputed tomography (CT) scans of 50 patients with a total of 100 S1 pedicles were analyzed. There were 25 male and 25 female patients with an average age of 51 years ranging from 36 to 68 years. The cephalad-caudal length, medial-lateral width, and cross-sectional area of the S1 pedicle were measured and compared with the diameter of a pedicle screw to illustrate the possibility of inserting a second screw in S1 pedicle without removal of the broken screw shaft. Two case reports of the proposed technique are presented. ResultsThe left and right S1 pedicle cross-sectional area in female measured 456.00±4.00 and 457.00±3.00 mm2, respectively. The left and right S1 pedicle cross-section area in male measured 638.00±2.00 and 639.00±1.00 mm2, respectively. There were statistically significant differences when comparing male and female S1 pedicle length, width, and cross-sectional area (p<.05). At 2-year follow-up, the two case reports of the proposed technique showed resolution of low back pain and radicular pain. Plain radiograph and CT scan showed posterolateral fusion mass and hardware in good position with no evidence of screw loosening. ConclusionsThe S1 pedicle dimensions measured on CT scan reviewed in the present study showed that it may be anatomically feasible to place a second screw through the S1 pedicle without the removal of the broken screw shaft. This treatment method will reduce the complications associated with other described revision strategies for broken S1 screws.

A STUDY OF FIRST YEAR TERTIARY STUDENTS’ MATHEMATICAL KNOWLEDGE- CONCEPTUAL AND PROCEDURAL KNOWLEDGE, LOGICAL THINKING AND CREATIVITY

This study focuses on students in first year enviro nmental science degree programs where traditionally mathematical emphasis has been much less than the strict science or math majors. The importance now placed in applied mathematics means that students n eed to gain more conceptual and quantitative knowledge in not only the environmental degree programs but also in most if not all non-mathematical majors. In this study, the authors attempt to gain insights into why students fail in mathematical cou rses where the mathematical requirements are not as demanding as other strict math degree programs. This is done by examining student conceptual thinking patte rns and strategies as evident in student prepared scripts. A total of 133 students were requested to prepare a focus sheet to summarize their knowledge on topics learned but they were also told that the foc us sheets could be used in exams for notes. This motivated their sheet preparation. The students pre pared weekly summaries and later revised and summarized them for later use. Detailed examination of such sheets allowed researchers to study students’ knowledge in terms procedural work, math skills, strategies and conceptual knowledge. A stud y of linear, quadratic and limit sections led to inte resting insights not only regarding revision strate gies, knowledge of content, but also conceptual and proce dural knowledge base and higher order skills such a s problem solving focus. Logical and creative competencies were assessed in terms of how and what studen t focused upon or linked to in order to facilitate ap plication of knowledge. The results show average le vels of procedural and conceptual competence but rather low levels in logical and creative competence in preparation of scripts. Almost 50% lacked competency in procedural work while around 54% lacked conceptual competency. Given the emphasis placed procedural skills by students, the levels were lower than expected. However, the lack of structure in their w ork and deeper levels of understanding of links bet ween the topics learned was concerning. These findings h ave implications for the first year mathematics tea ching teams at universities especially the non-specialist mathematical majors.

A Rosid Is a Rosid Is a Rosid . . . or Not

The current structure of 583 Magnoliopsida (Dicotyledons) and 584 Liliopsida (Monocotyledons) in the Dewey Decimal Classification (DDC) system reflects changes made when the life sciences were thoroughly revised in 1996. Since that time, considerable progress has been made in the phylogenetic classification of angiosperms (flowering plants). In particular, APG III, the 2009 version of the classification developed by the Angiosperm Phylogeny Group, is finding use as a tool to organize both botanical information and botanical collections. The Dewey Editorial Office has received a request to revise 583–584 in light of this taxonomy ―as appropriate‖; relevant revisions would be likely to include both structural and terminological changes. In deciding how to provide accommodation for APG III, the Dewey editorial team must address many issues: Is APG III now stable enough and accepted broadly enough to be adopted as the basis for a major revision of the DDC? Should revisions in 583–584 be coordinated with parallel revisions in other parts of the life sciences? What revision strategies can be considered in revising 583-584 to accommodate APG III? What are their various strengths and weaknesses? How have other major classification schemes (e.g., the UDC) accommodated APG III? Discussion of these issues is guided by the principles (―editorial rules‖) that govern development of the DDC.

Subtrochanteric fracture non-unions with implant failure managed with the “Diamond” concept

BackgroundSubtrochanteric femoral non-unions in the setting of failed metalwork pose a challenging clinical problem. This study assessed the clinical outcome of patients treated according to the principles of the “Diamond” concept. MethodsBetween 2007 and 2011 all patients presented with a subtrochanteric atrophic aseptic non-union in the setting of metalwork failure (broken cephalomedullary reconstruction nail), and treated in a single tertiary referral unit were included to this study. The hypertrophic and the non-unions of pathologic fractures were excluded. The revision strategy was based on the “Diamond concept”; optimisation of the mechanical and the biological environment (implantation of growth factor (rhBMP-7), scaffold (RIA bone graft from contralateral femur) and concentrated mesenchymal stem cells (MSCs) harvested from the iliac crest). The minimum follow up was 26 months (16–48). ResultsFourteen patients met the inclusion criteria. A specific sequence of metalwork failure was noted with initial breakage of the distal locking screws followed by nail breakage at the lag screw level. The intraoperative examination of the removed nails revealed no gross structural damage indicative of inappropriate drilling at the time of the initial intramedullary nailing. Varus mal-alignment was present in the majority of the cases, with an average of 5.2 degrees (0–11). The average time to distal locking screw failure was 4.4 months (2–8.5) and nail failure was 6.5 months (4–10). The time to union after the revision surgery was 6.8 months (5–12). Complications included two deaths in elderly patients (due to unrelated causes), one pulmonary embolism, one myocardial infarction, one below the knee deep vein thrombosis and one blade plate failure that required further revision with double plating and grafting. ConclusionVarus mal-alignment must be avoided in the initial stabilisation of subtrochanteric fractures. Distal locking screw failure is predictive of future fracture non-union and nail breakage. In the absence of sepsis, a single stage procedure based on the “Diamond concept” that simultaneously optimizes the mechanical and biological environment is a successful method for managing complex subtrochanteric atrophic non-unions with failed metalwork.

The Development of Counterfactual Reasoning in Belief Revision

The present study examines how children revise beliefs in the face of a new piece of information that they must accept as true and under what circumstances their belief-revision processes differ from college-aged adults. Results suggest that overall, 7-year-old children (children at Stage 2 reasoning; Moshman, 1990) revise beliefs as do adults, by rejecting particular beliefs in favour of more general ones. However, only adults adjust their revision strategy as a consequence of the logical structure of the initial belief set. Adults, but not children, tend to organise their revised beliefs to be consistent with general statements more often when the set of beliefs create a Modus Tollens logic structure than when they create a Modus Ponens structure. This difference in belief revision by the two age groups reflects their sensitivity to logical structure.

Safe surgical strategy for extracardiac conduit replacement in common arterial trunk

Repair of common arterial trunk using an extracardiac right ventricular to pulmonary arterial conduit is the preferred method in most cardiac surgical centres. Reoperation is a fact of life for survivors of common arterial trunk and related cardiac lesions who have undergone such repairs. Long-term survivors may require periodic conduit revisions, with a potentially escalating technical difficulty and risk. Herein we present an analysis of the currently available choices for extracardiac conduits, and outline what we consider to be a safe and reliable surgical strategy for conduit revision.

Anterograde Revision of Cervical Spinal Cord Stimulator Paddle Electrode: A Case Report

To illustrate a new surgical revision strategy for malfunctioning spinal cord stimulation (SCS) paddle electrodes. SCS is a treatment for chronic neuropathic pain that delivers therapeutic doses of electric current to the dorsal columns resulting in dermatomal paresthesia and pain reduction. Reasons for SCS failure include hardware malfunction or breakage and medical complications. A 34-year-old woman presented with a two-year history of intractable pain in the left upper extremity and thoracic region which was previously controlled by SCS. Imaging demonstrated breakage of the cervical electrode wire that had been advanced in the caudal direction from the C1 spinal level. Revision of the broken electrode was performed by hemilaminectomy of C3-C4 and the replacement electrode was advanced in the cephalad direction. Ideal and exact paresthesia pattern was confirmed intraoperatively and the patient maintained successful pain reduction at five-year follow-up. Advancing SCS electrodes into the upper cervical spine in the cephalad direction, using the previously formed scar capsule, offers an alternate strategy for revision of malfunctioning SCS paddle electrodes.

Teaching Memoir in the Elementary School Classroom: A Genre Study Approach

AbstractThis article describes how one teacher implemented a memoir genre study in her sixth grade classroom using a writing workshop approach. It begins by outlining the author's philosophy and rationale for teaching writing in this manner. This is followed by a discussion of how one could organize one's classroom for a memoir genre study. Several significant mini‐lessons are then described which focus on brainstorming, planning, developing effective titles, leads and conclusions, structuring a memoir texts, the use of the senses in memoir writing and strategies for revision. The aim of this article is to equip practitioners with the practical knowledge they need if they are seeking to implement a memoir genre study in their elementary school classroom.

Factors and revision strategy for failure of thoracolumbar spine internal fixation after burst fracture

To analyze the reasons for the failure of thoracolumbar spine internal fixation after burst fracture, and to discuss the strategy for revision surgery. From January 2005 to September 2010, 21 patients with thoracolumbar burst fracture received revision surgery after the failure of internal fixation. The etiology included loose of the fixation after anterior surgery in 4 patients, involving malunion with severe kyphosis in 1 patient, pedicle screw malposition in 3, fracture of adjacent segment vertebra in 2, broken of the fixation as non-union of the fracture vertebra in 10 comprising obvious kyphotic deformity in 5, and 2 had developing kyphosis for over distraction of the vertebra followed by pseudarthrosis after removing the internal fixation. After the first operation, symptoms remained in 6 patients, deteriorated in 7, light to moderate improved in 8. Surgical procedures such as anterior corpectomy and reconstruction, replacement of the internal fixation and canal decompression, vertebroplasty, and posterior pedicle subtraction osteotomy were directed based on individual situation. Patients were followed-up for 6-68 (27.0±13.2) months, and demonstrated solid fusion 6 to 12 months postoperatively. No failure of the internal fixation reccurred. No major complications or deterioration of neurologic status were noted. At the last follow-up, the improvement of Frankel grade was 0-2 (1.3±0.7). The mean visual analog scale (VAS) dropped down from 7.6 to 2.1, and the mean oswestry disability index (ODI) decreased from 48.7 to 10.3. Preoperative angle of 7 kyphotic deformity patients was 10 degree-75 degree (42.5 degree±15.3 degree), and was improved to -3 degree-10 degree (2.3 degree±3.7 degree). At the last follow-up, the loss of correction was 0 degree-1.3 degree (0.7 degree±0.3 degree), with the correction rate of 92.3%. Solid reconstruction of the anterior and middle column of the spine is the imperative procedure to prevent failure of internal fixation in thoracolumbar burst fractures. Revision surgery with reasonable strategy is beneficial and rewarding with few complications.