Secondary Procedures Research Articles

Similar outcomes following scarf-Akin osteotomy compared to scarf-alone osteotomy for the treatment of hallux valgus: A systematic review and meta-analysis

BackgroundThe purpose of this systematic review and meta-analysis was to compare the clinical and radiographic outcomes between patients undergoing scarf osteotomy and scarf-Akin osteotomy for the management of hallux valgus deformity. MethodsA systematic review of the MEDLINE, EMBASE and Cochrane Library databases was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies reporting clinical data following scarf osteotomy and scarf-Akin osteotomy for the treatment of hallux valgus were included and assessed. The level and quality of evidence of the included studies were also evaluated. ResultsFour studies were included. In total, 388 patients (408 toes) underwent scarf osteotomy alone and 287 patients (295 toes) underwent scarf-Akin osteotomy for the treatment of hallux valgus deformity. There was no difference in postoperative American orthopedic foot and ankle society scores (p = 0.7828), visual analog scale scores (p = 0.4558), hallux valgus angle (p = 0.5116), intermetatarsal angle (p = 0.4830), proximal to distal phalangeal articular angle (p = 0.2411) between the scarf alone cohort and the scarf-Akin cohort. Similarly, there was no difference in complication rates (p = 0.6881) nor secondary surgical procedure rates (p = 0.3678) between the 2 cohorts. Finally, there was a higher recurrence rate in the scarf-alone cohort (11.4%) compared to the scarf-Akin cohort (5.7%), but this was not statistically significant (p = 0.4414). ConclusionThis systematic review demonstrates lower recurrence rates following scarf-Akin osteotomy compared to scarf osteotomy alone for the treatment of hallux valgus deformity. No difference in complication rates were noted between the 2 cohorts. Our review demonstrates that both the scarf osteotomy and the scarf-Akin osteotomy may be effective and safe procedures, however, the scarf-Akin osteotomy may provide more long-term benefit in the setting of moderate to severe hallux valgus.

Resident operative time as an independent predictor of early post-operative cataract surgery outcomes and supervising attending surgeon impact: a retrospective case series

BackgroundThe authors sought to determine if resident operative time in cataract extraction and intraocular lens insertion (CE/IOL) affects early visual outcomes and post-operative recovery. They further sought to investigate if attending surgeons can reduce resident operative time.MethodsThis retrospective, chart-review, case series at single Veterans Affairs Hospital (VA Tennessee Valley Healthcare System) studied resident cataract surgeries between March 1, 2018 and March 31, 2020. Following power analysis, 420 eyes of 400 patients from all resident cataract surgeries were included. Eyes with attending as primary surgeon, laser-assisted cataract surgery, or concurrent secondary procedures were excluded. Linear mixed effect models were used to study the association between operative time and visual outcomes while adjusting for covariates including cumulative dissipated energy, preoperative factors, and intraoperative complications.ResultsLonger operative time was statistically associated with worse post-operative-day 1 (POD1) pinhole visual acuity (PH-VA) adjusting for cumulative dissipated energy and other operative factors (p = 0.049). Although resident physicians were the primary surgeons, the operative times were different between the ten supervising attending surgeons in the study (p < 0.001).ConclusionThe results suggest that increased resident operative time is a significant, independent risk factor for decreased POD1 PH-VA. Increased resident operative time is not associated with worsened long term visual outcomes. Attending surgeons may be able to reduce resident operative time, which is associated with improved early visual outcomes.

Long-term Outcomes With Macroplastique in Women With Stress Urinary Incontinence Secondary to Intrinsic Sphincter Deficiency

To evaluate the long-term outcomes of polydimethylsiloxane (Macroplastique (MPQ)) in women with stress urinary incontinence (SUI) secondary to intrinsic sphincter deficiency (ISD) using validated questionnaires. Following IRB approval, charts of non-neurogenic women with SUI secondary to ISD who underwent MPQ injection were reviewed from a prospectively maintained database. ISD was defined as positive stress test with a well-supported urethra and low Valsalva leak point pressure when available. Excluded were women with follow-up <5years. Baseline data included validated questionnaire scores (UDI-6 question 3 (0-3), VAS Quality of Life, Incontinence Impact Questionnaire (IIQ-7)) and urodynamic study findings. Patients were followed with same questionnaires and three-dimensional ultrasound evaluating volume/configuration of MPQ. All three-dimensional ultrasound measurements were performed by the same imaging team blinded to clinical outcomes. Outcomes were evaluated in four groups based on prior SUI treatment. Success was defined as UDI-6 question 3 score of 0-1 and not requiring additional anti-incontinence therapy at the last visit after the last MPQ injection. From April 2011-December 2016, 106 patients (median age 67) met study criteria. Median follow-up time was 7.4years. Median MPQ injected was 5mL. Overall success was 43%, with 54% successful after one injection and 46% requiring ≥2 injections. Across all groups, patients had improvement in Quality of Life and IIQ-7 Question 7 (frustration). Among the failure group, 17% opted for a secondary autologous sling procedure. MPQ demonstrated long-term favorable outcomes in a subset of women with SUI secondary to ISD.

Longer term follow up of outcomes following implantation of a modular rotating hinge knee prosthesis: 53 implants at mean 7.6 year follow up

BackgroundRotating hinge knee replacements are becoming more common but have historically had high complication and failure rates. This study is one of the largest to assess the implant survival and patient outcomes of a third-generation rotating hinge knee replacement at a single tertiary orthopaedic centre. MethodsData for consecutive operations at our tertiary unit between 2006 to 2020 were assessed with review of electronic patient and radiology records. The Oxford Knee Score was used to assess outcomes and the Kaplan Meier method used to estimate survivorship. Results53 rotating hinge knees were implanted in 46 patients (13 male, 33 female) at a mean age of 67.8 years. 21 were primary and 32 were revision procedures. Indications for use of this implant included instability, loosening, fracture and infection. Survivorship was 77.8% at the mean follow up of 7.6 years. A total of 29 complications were noted with ongoing pain, stiffness, infection and patellofemoral symptoms being the most common. 8% of unresurfaced patellas required a subsequent secondary resurfacing. The Oxford Knee Score demonstrated a significant improvement from 14.6 preoperatively to 27.5 at one year postoperatively, which was maintained in the longer term. ConclusionThe third-generation rotating hinge knee implant in use at our unit has improved outcomes for patients. The survivorship of the implant is comparable to the published literature, although there is a paucity of data. The complication rates remain relatively high and patients should be counselled appropriately. We advise resurfacing the patella to avoid the need for secondary procedures.

Results of a defined surgical protocol for treating pediatric neurogenic bladder incontinence in a single institution

Incontinent pediatric neurogenic bladder (NB) patients face social ostracization and potential renal deterioration. Reconstructive surgery, after maximal medical therapy, requires a difficult decision-making process. Current literature for NB surgeries is difficult to interpret given definitions of dryness, use of augmentation cystoplasty (AC) and the lack of renal preservation. This study assesses the results of a defined surgical protocol to treat incontinent NB patients, using a new composite outcome measure, which includes upper tracts status and a definition of dryness. This is a retrospective cohort study assessing 33 consecutive incontinent NB patients (Spina bifida 31, Sacral agenesis- 2) who underwent one of 2 procedures between 2008 and 2021. AC with a Mitrofanoff procedure (MP) was performed in patients who had a high detrusor leak point pressure (DLPP) and significant bladder trabeculations (N=21, Group 1). Children with a low DLPP and non-trabeculated bladders, underwent a modified Young-Dees-Leadbetter/Mitchell procedure with a 360° autologous rectus fascial sling (BOP) with concomitant AC and MP (N-12, Group 2). Post-operative success was defined using a composite grading of success assessing dryness, upper tract stability and medication use. The mean age at surgery was 11.6 years (SD=6 years), with 21 in Group 1 and 12 in Group 2. Mean follow-up was 3.25 years, with a minimum 24-month follow-up period. Success rate was 90% in Group 1 and 66% in Group 2. No patient had upper tract deterioration following surgery. Redo-surgical intervention, was required in 38% of Group 1 and 50% of Group 2 patients. These include 3 bladder neck injections in Group 1 and 2 bladder neck closure in Group 2, with a final success rate to 95 % in Group 1 and 83 % in Group 2. Achieving dryness and preserving upper tracts is a challenge in incontinent NB patients. Dryness rates achieved in this study is comparable, given complications and redo-surgery. Primary bladder neck closure is a radical intervention, but Group 2 patients, may benefit from an upfront discussion of the pros and cons of a bladder neck closure primarily or as a secondary procedure. Isolated AC obtains acceptable results for a selected subset of incontinent NB patients with significant bladder trabeculation. For those requiring a BOP, the success rate is relatively lower with the higher rate of potential complications and need for redo-surgery.

Our experience in postoperative management of totallaryngectomy – A case series

Total Laryngectomy (TL) is recommended as a treatment for advanced laryngeal cancers, while salvage totallaryngectomy is performed as a secondary procedure after recurrence following laser surgery, radiation, orchemoradiation. Establishing comprehensive standards of care for patients undergoing total laryngectomy in thepostoperative period has proved challenging. Perioperative care continues to exhibit considerable variability, oftenrelying on anecdotal practices. The objective of this study was to disseminate our knowledge and expertise ona case series of patients who have undergone TL and the challenges we encountered during the postoperativeperiod and to identify postoperative complications risk factors and their management in the perioperative careof total laryngectomy patients. A retrospective analysis of 10 patients who underwent total laryngectomy at RajivGandhi Government General Hospital, Chennai, was included in the study. Four of them were cases of recurrentlaryngeal carcinoma following the initial failure of definitive radiation (RT), either with or without chemotherapy. 4out of 10 patients developed complications. Complications, primarily pharyngocutaneous fistulas were observedin 3 patients, which were managed surgically by flap cover closure. Complications occurred among patientswith risk factors for inadequate wound healing, such as comorbidities like diabetes mellitus and radiation, whichincreased hospital stay, antibiotic duration, and time to initiate oral feeds among reconstructed patients. Thisanalysis contributes insights into postoperative challenges and risk factors associated with complications in TLpatients.

Comparing Participation and Interim Effectiveness of Endoscopy and Biomarker-Based Screening for Gastric Cancer: A Cluster Randomized Controlled Trial.

Background: To improve compliance with endoscopic screening for gastric cancer (GC), we assessed five biomarkers-pepsinogen I (PG I), pepsinogen II (PG II), PG I/II ratio, helicobacter pylori antibody (HP-Ab), and gastrin 17 (G17) - for secondary GC screening by comparing participation and effectiveness of traditional endoscopy and biomarker-based screening in a randomized trial with baseline results. Methods: Seventy-four communities were randomly assigned to traditional endoscopy arm (TEA) or biomarker-based endoscopy arm (BEA). TEA uses a questionnaire for risk assessment, and BEA combines a questionnaire with biomarker detection. High-risk individuals in both arms underwent endoscopic screening. Participation and interim screening effectiveness in two arms were reported with baseline analysis. Results: In total, 5,798 participants in TEA and 5,158 in BEA were recruited, with a participation rate of 26.9%. BEA showed a significantly lower high-risk rate than TEA (15.2% vs. 38.9%) and a higher endoscopic participation rate for high-risk individuals (64.9% vs. 53.0%). The endoscopic screening results showed that there was no significant difference in detection rate of GC abnormalities between the two arms. Education level, frequent drinking, hot, rough and hard food consumption, family history of GC, and history of reflux esophagitis or gastropathy influenced participation rates in biomarker-based screening. Age group, sex and regular consumption of meat, eggs and milk products were associated with stomach abnormalities.Cumulative incidence and specific death rates did not significantly differ in intention-to-screen and per-protocol analyses. Conclusions: Biomarker-based screening effectively identifies high-risk individuals and increases endoscopic participation, providing value insights for improving screening efficiency as a secondary procedure.

Correcting facial asymmetry through guided plate assisted mandibular angle osteotomy.

Asian women prefer a smooth and narrowed mandibular appearance. The purpose of the retrospective cohort study is to evaluate guide plate-assisted mandibular angle ostectomy (MAO) in improving mandibular symmetry for Asian female patients with mandibular angle hypertrophy (MAH) with normal occlusal relationship. We retrospectively examined 11 patients with asymmetry MAH with normal occlusal relationship who received MAO at Shanghai Ninth People's Hospital between September, 2020, and January, 2022. Preoperative plans were designed based on CT data and executed using metal guide plate during the operation. Preoperative and one-week postoperative CT scans were used to assess measurements including Height_Go, Divergence_Go, ∠ZyZy-GoGo, and osteotomy volume, to evaluate symmetry. For precision, compare the postoperative CT with the preoperative design, assessing osteotomy distance, angle, and volume error. Patient satisfacation was evaluated with Likert Scale in 6-month follow-up. Secondary lipofilling procedures were given as appropriate. Statistical analysis was performed using paired t-tests in SPSS. The mean age of the 11 patients was 28.5 years (range 23-34 years). 2 of these underwent lipofilling procedures. No complications were observed during the following-up. Postoperative results were not statistically different from the design, demonstrating a precision of within 2 mm. Height_Go disparity within 5 mm get corrected notably, reducing asymmetry from 15.09% preoperatively to 2.74% postoperatively. Patients satisfaction was rated at 4.5 out of 5 in 6 month follow-up. Guide plate-assisted mandibular angle osteotomies achieve effective and precise surgery. This approach demonstrates a safe option for correction for mandibular asymmetry, achieving patient satisfaction.

An Experience in Managing an open Fracture Shaft of the Femur Due to a Gunshot with Intramedullary Interlocking Nailing

Objective: To evaluate functional outcomes and complications in gunshot femur shaft fractures treated with intramedullary nailing primarily. Study Design: Prospective longitudinal study Place and Duration of Study: Department of Orthopaedic Combined Military Hospital, Nowshera, Combined Military Hospital Sialkot, Combined Military Hospital, Rawalpindi Pakistan, from Jan 2016 to Dec 2021. Methodology: A total number of 53 cases of open fracture of the femur shaft due to gunshot were included in the study. After initial wound debridement, an X-ray was taken, and fractures were classified according to the Gustilo–Anderson classification. All fractures were fixed with titanium I/M I/L Nail in static mode by the same orthopaedic surgeon. Rehabilitation was instituted immediately after the operation, and the outcome was assessed in regards to infection, range of motion at the knee, full weight bearing and radiological union achieved. Results: Thirty-four (64.15%) patients had Type-1 fractures of the femur shaft, and 19(35.8%) patients had Type-2 fractures. Fracture union was observed in 47(88.67%) patients after three months and 6(11.32%) over the next five months. Complications were wound infections 5(9.44%), leg length discrepancy 4(7.53%), and non-union 2(3.77%) at six months. In these two cases, bone grafting was done, and union was achieved. Conclusion: Primary intramedullary (IM) is the preferred mode of treatment of Type 1 and 2 shafts of femur fractures if early good debridement is done. It avoids secondary procedures, has fewer complications and helps in early mobilization.

Outcomes of treatment for developmental dislocation of the hip when the Pavlik method has failed.

Despite the success rate of the Pavlik method in the treatment of developmental dislocation of the hip, there is a subset of hips that do not reduce with harness use. The purpose of this study was to determine the outcomes after closed reduction (CR), open reduction (OR) and combined open reduction and pelvic osteotomy (OR+PO) in patients with infantile hip dislocations who initially failed the Pavlik method. This was a retrospective cohort study of patients with infantile hip dislocations who failed the Pavlik method and subsequently underwent a secondary procedure for persistent hip dislocation. The primary outcome measure was the Severin classification of the involved hip 3 years after the secondary procedure. Other outcomes assessed included rates of redislocation, residual acetabular dysplasia and proximal femoral growth disturbance. Twenty-three patients were included; seven subsequently underwent CR, three underwent isolated OR and 13 proceeded directly to OR+PO. The overall successful outcome rate at final follow-up (as determined by radiographic Severin class I or II) was 11/23 (48%). However, patients undergoing OR+PO had significantly higher rates of successful outcomes (77%) compared with CR (15%) and OR (0%), P < 0.05. The rate of residual acetabular dysplasia and proximal femoral growth disturbance was significantly lower in patients treated with OR+PO compared with CR and isolated OR, P < 0.05. Patients with dislocated hips who failed Pavlik harness treatment had better radiographic outcomes 3 years after OR+PO in comparison to patients undergoing CR or isolated OR.

Forehead Flap Practices: A Cross-Sectional Survey of Facial Plastic and Reconstructive Surgeons.

Background: The paramedian forehead flap (PMFF) is a well-established technique utilized for reconstruction of complex nasal defects. Objective: To identify the different techniques and management of patients undergoing PMFF reconstruction and compare these with current literature. Methods: Members of the American Academy of Facial Plastic and Reconstructive Surgery were sent a practice survey highlighting various nuances in PMFF reconstruction. The survey included questions about flap design, operative techniques, and perioperative care. Results: In total, 172 responses were received (14% response rate). Mean years of practice after fellowship was 15.8 years with most respondents performing either 1-5 (33.1%) or 6-10 (27.3%) PMFFs per year. Common practices included the use of general anesthesia, elevation of PMFF in the subgaleal plane (59.6%), and pedicle division at 3 weeks (80%) (p < 0.001). Complication rates ranged between 1% and 5%. The nose was the most common site for revision (p < 0.001) and the average number of secondary procedures after forehead flap division was 1.1 (standard deviation 0.81). The most variability in responses was seen for methods of internal lining reconstruction. Conclusion: Reconstructive surgeons frequently divide the PMFF pedicle at 3 weeks or later and have variable approaches to reconstruction of the internal lining with low complication rates overall.

Outcomes of Scleral Buckling After Failed Pneumatic Retinopexy.

Purpose: To assess the visual and anatomic outcomes of eyes that had secondary scleral buckle (SB) surgery after unsuccessful pneumatic retinopexy (PR) for rhegmatogenous retinal detachment (RRD). Methods: A retrospective study, performed over a 12-year period, comprised patients who had secondary SB procedures after failed primary PR. Clinical parameters (eg, best-corrected visual acuity [BCVA], lens status, macula status, details of RRD and subretinal fluid) were assessed at presentation, before additional procedures, and at follow-up (6 months, 1 year, and last visit). Statistical comparisons were made using Brown-Forsythe and Welch analysis-of-variance tests, with significance levels set at P < .05. Results: Fifty-four eyes with adequate follow-up were included. Forty-four (81.5%) of 54 eyes had successful retinal reattachment with secondary SB alone. The remaining eyes had subsequent pars plana vitrectomy (PPV). Patients presenting with macula-on RRD who had successful secondary SB had no statistically significant change in BCVA from baseline (mean final, 0.23 ± 0.25 logMAR [Snellen 20/34]; P = .999). There was a statistically significant improvement in BCVA in patients presenting with macula-off RRD who had successful secondary SB (mean final, 0.32 ± 0.36 logMAR [20/42]; P < .001 and mean change, -1.06 ± 0.85 logMAR). Ten patients presenting with macula-off RRD who had failed secondary SB had a significant improvement in the final BCVA (mean final, 0.22 ± 0.28 logMAR [20/33]; P = .044), despite the need for an additional PPV to achieve reattachment. Conclusions: Secondary SB remains a good option for RRD repair after unsuccessful PR and may avoid the need for PPV.

Uniplanar External Fixator as a Definitive Treatment for Open Fracture of Tibia

Aim: Tibia is exposed to majority of trauma and accidents due to its location in the body. That’s why most of time it sustains open fracture in trauma and have high frequency of infected non union due to precarious blood supply. Definitive treatment with ex fix is a very good idea for poor people as one can save money and avoid multiple surgeries as the patient cannot afford it Objective: To evaluate the results of Definitive treatment with uniplanar external fixator in open fracture management of tibia in terms of healing. Material and Method: This Case Series study was conducted from January 2017 to December 2022 in Akbar Medical Center Dabgari Garden Peshawar Pakistan. A total number of 97 patients of either gender having age range of 15 to 60 years with open fracture of tibia were included. All patients were admitted from outpatient department of the center. All the data collected was entered and analyzed with help of SPSS version 23. The results were evaluated using Association for the Study and Application of the Methods of Ilizarov (ASAMI) scoring system. Results: There was total 97 patients having age range of 44(15-59) with mean age 31.23.(Std Deviation 11.58). Male patients were 74(76.3%) while female were 23( 23.7%). Delayed union was noted in 11(11.3%), External Rotation in 3(3.1%) Healed without complication in 72(74.2%), Infection in 4(4.1%), one pin broken in 4 (4.1%) and Shortening of less than 1.5 cm was noted 3(3.1%) cases. In 4(4.1%) cases debridement was done as secondary procedure, in one case NA fixator was applied 1(1%) while in 7(7.2%) case bone grafting was done as secondary procedure. Practical Implication: Definitive treatment with ex fix is a very good idea for poor people as one can save money and avoid multiple surgeries as the patient cannot afford it. Conclusion: External fixator is used as a definitive treatment method for open fractures of the tibial shaft caused by high energy trauma either in war times or in motor vehicle accidents has good bone and functional results. Keywords: Tibia, Fracture, Fixator, Uniplanar, Ilizarov

Modeling and aggregated control of large-scale 5G base stations and backup energy storage systems towards secondary frequency support

A significant number of 5G base stations (gNBs) and their backup energy storage systems (BESSs) are redundantly configured, possessing surplus capacity during non-peak traffic hours. Moreover, traffic load profiles exhibit spatial variations across different areas. Proper scheduling of surplus capacity from gNBs and BESSs in different areas can provide sustainable frequency support for the power system without compromising the operation of 5G network. In this paper, a comprehensive strategy is proposed to safely incorporate gNBs and their BESSs (called “gNB systems”) into the secondary frequency control procedure. Initially, an aggregated model is developed using a state space method to capture the state of a cluster of heterogeneous gNB systems (gNBs-cluster). Subsequently, a utility function is defined to evaluate the quality of 5G network operation in a normalized manner. Based on this utility function, an aggregated control method is proposed, including real-time available power estimation and model predictive control (MPC) for the gNBs-cluster, which ensures the 5G network operation within the security constraint during demand response processes. Simulations, utilizing actual device data, demonstrate the effectiveness of the proposed method in improving power system frequency performance while guaranteeing the safety and reliability of the 5G network.

Secondary Hip Labral Reconstruction Yields Inferior Minimum 2-Year Functional Outcomes to Primary Reconstruction Despite Comparable Intraoperative Labral Characteristics

PurposeTo compare intraoperative labral characteristics and minimum 2-year functional outcomes of allograft labral reconstruction in primary versus revision hip arthroscopy across multiple orthopedic centers. MethodsA retrospective multicenter hip arthroscopy registry was queried for patients with completed labral reconstruction surgeries from January 2014 to March 2023 with completed 2-year international Hip Outcome Tool-12 (iHOT-12) reports. Age, sex, and major intraoperative variables were also collected. Patients were placed in cohorts based on whether their arthroscopic allograft labral reconstruction was a primary procedure or secondary procedure (reconstruction following failed hip arthroscopy). One-way ANOVA was performed on continuous variables. Chi-squared test was performed on categorical variables. Achievement of minimal clinically important difference (MCID), Patient Acceptable Symptom State (PASS), and Substantial Clinical Benefit (SCB) was also assessed. ResultsIn total, 77 patients met the inclusion and exclusion criteria and had complete information. The primary reconstruction group (n=50) was significantly older than the secondary reconstruction group (n=27) (47.5 ± 10.5 vs 39.1 ± 8.8 years; P = 0.001). In both cohorts, most patients had labral bruising, advanced labral degeneration, and/or grade III complexity of labral tearing. There was no difference in any recorded intraoperative findings (P = 0.160, P = 0.783, P = 0.357, respectively). Each cohort experienced significant improvement in iHOT-12 scores (P < .0001). However, patients undergoing secondary labral reconstruction reported inferior iHOT-12 scores (60.1 ± 29.2 vs 74.8 ± 27.0; P = 0.030). Patients undergoing primary reconstruction were more likely to reach MCID, PASS, and nearly normal SCB (92 vs 66.7%, P = 0.024; 68.0 vs. 40.7%, P = 0.021; 76.0 vs 48.1%, P = 0.014, respectively). ConclusionsPrimary and secondary allograft labral reconstruction show clinical improvement, but primary reconstruction demonstrates better outcomes and higher percentage of patients reaching MCID, PASS and nearly normal SCB than reconstruction in the revision setting. Level of EvidenceIII, retrospective comparative prognostic case-control study.

Reconstruction of Scroll and Pitanguy's Ligaments in Open Rhinoplasty: A Controlled Randomized Study.

In the preservation rhinoplasty era, ligament management represents a hot topic. The aim of this study is to analyze the role of ligaments as indispensable elements of support of the nasal tip to have an adequate, safe, and predictable aesthetic and functional result. Patients meeting the following criteria were included in the study: primary rhinoplasty, minimum 2-year follow-up, proficiency in Italian language, signed consent, and standardized pre- and postoperative photographic documentation. The study was performed with a double-blinded randomized design; both the patients and two of the authors measuring outcomes were blinded to the treatment methods. All patients were asked to answer the FACE-Q satisfaction with the nose postoperative scale. Two plastic surgeons reviewed all postoperative photographs, rating the outcome on a 1-5 VAS scale. One hundred and twelve patients were enrolled, 47 males and 65 females, aged between 20 and 50years. Patients were randomly divided in three groups: group 1, ligament reconstruction and grafts; group 2, only grafts (shield, single and double onlay, umbrella); and group 3, only ligament reconstruction with columellar strut. All rhinoplasties were performed with an open approach. Both the FACE-Q and VAS scores were in groups 1 and 2, which were also the ones undergoing fewer secondary procedures compared to group 3. The best surgical option appears to be the combination of ligament repair and grafts. It reduces dead space and enables a better redraping of soft tissues, obtaining a better control of tip projection, position, and rotation. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

The value of ultrasonography in predicting the outcomes of simple long bone fractures treated by closed intramedullary nail fixation

PurposeUltrasonography has been used increasingly in orthopaedic practice credited to its low cost, easy accessibility, non-invasiveness, reproducibility, and safety from radiation. The purpose of this study was to test the validity and efficacy of ultrasonography as an adjunct in the assessment of fracture healing in long bones treated with intramedullary interlocking devices and its predictive value in determining the need for a secondary surgical procedure. MethodsThis was a descriptive longitudinal study of 40 skeletally mature patients who sustained long bone fractures of the tibia or femur treated using intramedullary interlocking nails. Patients with comminuted and segmental fracture patterns were excluded from the study. Each patient was evaluated at 6- and 12-week post-surgery using standard orthogonal radiographs and ultrasonography to assess fracture healing. Patients were then followed up until fracture union. Quantitative data was analyzed using frequency statistics and descriptive data with inferential statistics. ResultsUltrasonography predicted 87.5% union and 12.5% delayed or non-union as early as 6 weeks after surgery, while radiographs predicted 22.5% union as late as 3 months of follow-up. The sensitivity and specificity of ultrasonography in assessing fracture healing were 100% and 97.2%, respectively, with a positive predictive value of 80.0%. Vascular resistance index was less than 0.5 in all patients who developed delayed or non-union. ConclusionUltrasonography is able to predict fracture outcomes much earlier than standardized radiographs with comparable sensitivity and specificity. Vascular resistance index is an objective parameter in assessing callus quality and predicting fracture outcomes.

Locking plate versus retrograde intramedullary headless compression screw for unstable extra-articular metacarpal base fractures of the thumb

The purpose was to compare clinical and radiological outcomes between two fixation techniques used to treat extra-articular fractures involving the base of the thumb metacarpal: retrograde intramedullary cannulated headless screw (RICHS) and locking plate (LP). Fifty-one patients who underwent RICHS (n = 22) or LP fixation (n = 29) from January 2010 through 2020 were included in this retrospective case-control study with mean follow-up 39 months. No inter-group differences were observed comparing mean time to radiological union, grip strength, range of motion, pain severity or QuickDASH scores. Mean surgery time was shorter with RICHS (18.9 min) than with LP fixation (44.4 min). Mean time to return to work or routine activities was less in RICHS than LP (22 vs. 32 days), as was the percentage of patients requiring hardware removal (0% vs. 44.8%). We conclude that RICHS fixation requires less operating time and yields faster post-operative return to full function and fewer secondary procedures.

A Comparative Analysis of the Minimally Invasive Approach against the Traditional Open Harvesting Technique for Obtaining Iliac Bone Grafts in Secondary Alveolar Bone Grafting Procedures for Patients with Cleft Palate

Abstract: Secondary alveolar bone grafting (SABG) is an important surgery that people with cleft palate must have in order to have good dental rehabilitation. The goal of SABG is to create a stable alveolar ridge. The choice of graft picking method has a big effect on how well the surgery invasive harvesting methods used in iliac bone graft (SABG) procedures. The main points of the study are how happy the patients are, how these works and how well the patients do in the long run. This review study looks at the pros and cons of both traditional open harvesting and minimally methods have improved, and the results and problems that have happened.

Rates of subsequent surgeries after meniscus repair with and without concurrent anterior cruciate ligament reconstruction.

The purpose of this study was to compare the rates of secondary knee surgery for patients undergoing meniscus repair with or without concurrent anterior cruciate ligament reconstruction (ACLr). Utilizing a large national database, patients with meniscal repair with or without concurrent arthroscopic ACLr were identified. The two cohorts were then queried for secondary surgical procedures of the knee within the following 2 years. Frequency, age distribution, rates of secondary surgery, and type of secondary procedures performed were compared. In total, 1,585 patients were identified: meniscus repair with ACLr was performed for 1,006 (63.5%) and isolated meniscal repair was performed for 579 (36.5%). Minimum of two year follow up was present for 487 (30.7% of the overall study population). Secondary surgery rates were not significantly different between meniscus repair with concurrent ACLr and isolated meniscus repairs with an overall mean follow up of 13 years (1.5-24 years) (10.6% vs. 13.6%, p = 0.126). For the 2 year follow up cohort, secondary surgery rates were not significantly different (19.3% vs. 25.6%, p = 0.1098). There were no differences in survivorship patterns between the two procedures, both in the larger cohort (p = 0.2016), and the cohort with minimum 2-year follow-up (p = 0.0586). The current study assessed secondary surgery rates in patients undergoing meniscus repair with or without concurrent ACLr in a large patient database. Based on this data, no significant difference in rates of secondary knee surgery was identified.