Secondary Surgery Research Articles

Comparison of Survival Outcomes Among Patients Receiving Chemotherapy with Secondary Cytoreductive Surgery Versus Chemotherapy Alone for Recurrent Epithelial Ovarian, Tubal, or Peritoneal Carcinoma: a Propensity Score-matched Cohort Study

Comparison of Survival Outcomes Among Patients Receiving Chemotherapy with Secondary Cytoreductive Surgery Versus Chemotherapy Alone for Recurrent Epithelial Ovarian, Tubal, or Peritoneal Carcinoma: a Propensity Score-matched Cohort Study

Comparison of locking plate and conservative treatment in elderly patients with displaced proximal humerus fractures.

This study aimed to compare the outcomes of conservative treatment and locking plate osteosynthesis in displaced proximal humerus fractures in elderly patients. The study included patients over the age of 60 who were admitted to a tertiary trauma centre between 2020 and 2023, all diagnosed with 2-, 3-, or 4-part proximal humerus fractures. A total of 45 patients underwent either conservative management or locking plate fixation. In the older cohort, patients with Neer Type 2-4 fractures were treated conservatively using Velpeau immobilization. Displaced fractures, specifically 3- and 4-part fractures per the Neer classification, were treated surgically with locking plate fixation. Functional outcomes were evaluated using the Constant Shoulder score, the Disabilities of the Arm, Shoulder, and Hand (DASH) score, and the American Shoulder and Elbow Surgeons (ASES) score, with a minimum follow-up period of one year. Radiographic assessment focused on varus collapse, medial cortex displacement, greater tubercle displacement, absence of fracture lines, and callus formation. Complications, including nonunion, malunion, and avascular necrosis, were also recorded. Of the 45 patients, 22 underwent locking plate fixation (Group A), while 23 were managed conservatively (Group B). In terms of fracture type, 20 patients were classified as Neer Type 2, 23 as Neer Type 3, and 2 as Neer Type 4. The mean patient age was 73.38 years. Functional scores (DASH, ASES, and Constant) were similar between the two groups, and no significant differences were observed in radiographic parameters. However, complications were significantly more frequent in the locking plate group compared to the conservative group. Two patients who underwent surgery experienced nonunion at the humeral neck. Additionally, secondary surgery was required in one patient due to postoperative infection and in another due to screw penetration into the joint. While no correlation was found between humeral neck malunions and functional outcomes, a negative correlation was observed between tubercle malunions and functional scores. In elderly patients with proximal humerus fractures, no significant differences in functional outcomes were observed between locking plate fixation and conservative treatment. However, locking plate fixation was associated with a higher incidence of complications and secondary surgeries. Thus, it appears that locking plate fixation does not offer superior outcomes compared to conservative management in this patient population.

Longitudinal outcomes of iStent inject with cataract surgery compared with cataract surgery alone: real-world data from the Fight Glaucoma Blindness registry.

To compare combined phacoemulsification and iStent inject with phacoemulsification alone. Fight Glaucoma Blindness (FGB) registry, Sydney, Australia. Prospective observational registry study. Eyes that had combined phacoemulsification with iStent inject (iStent group), n = 1257 were compared with eyes that had phacoemulsification only (cataract alone, n = 163). The primary outcome was percentage of eyes achieving >20% intraocular pressure (IOP) reduction from baseline 12 months postoperatively. Secondary outcomes included mean IOP and medication reduction, adverse events, and secondary procedures. At 12 months, the percentage of eyes achieving >20% reduction of IOP was significantly higher in the iStent group compared with the cataract-alone group (40.9% vs 30.1% P < .001). Adverse events occurred at a low rate in both groups, and secondary IOP-lowering procedures were significantly less frequent in the iStent group compared with cataract alone. Real-world outcomes from the FGB registry at 12 months show that phacoemulsification combined with iStent inject has a higher efficacy and reduced need for secondary IOP-lowering surgery compared with phacoemulsification alone.

Use of Indocyanine Green Fluorescence Angiography to Assess Bowel Anastomosis in Ovarian Cancer Surgery.

The aim of this study was to investigate the efficacy of indocyanine green (ICG) fluorescence angiography in preventing anastomotic leaks and reducing the need for ostomies during cytoreductive surgery in ovarian cancer. This was a retrospective study of patients with 2014 International Federation of Obstetrics and Gynecology stage IIB-IVB ovarian cancer requiring a bowel resection during primary or secondary cytoreductive surgery at our institution between July 2021 to April 2023. Rates of ostomy performance and anastomotic leak were assessed in the ICG angiography group and the non-ICG angiography group. Frequency distributions between categorical variables were compared using Fisher's exact or Chi-squared test. Wilcoxon rank-sum test and t-test were used to compare continuous variables. During the study period, we reviewed the data of 59 consecutive patients with ovarian cancer with bowel resection; in 30 (50.85%) patients, bowel anastomosis was assessed using ICG angiography and in 29 (49.15%) patients, bowel anastomosis was not assessed using ICG angiography. Anastomotic leak rate was found to be 6.9% (n=2) in the non-ICG angiography group, and 3.33% in the ICG angiography group (n=1) (p=0.612). More diverting ostomies were performed in the non-ICG angiography group (n=6, 20.69%) compared to the ICG angiography group in which no ostomies were performed (p=0.011). ICG angiography is not associated with a decrease in anastomotic leak rates, but it may avoid ostomy formation.

Optimizing skull base defect repair: leveraging the reused nasoseptal flap as a reliable material.

The escalating number of endoscopic skull base procedures necessitates exploring additional materials to reduce postoperative cerebrospinal fluid (CSF) leaks in revision or staged surgeries. This study evaluates the effectiveness of reused nasoseptal flaps (NSFs) in such clinical scenarios. A retrospective review was conducted on patients who previously underwent surgery involving NSFs and later had revision or secondary skull base surgeries via endoscopic endonasal approaches (EEAs) at a tertiary medical center. Patients were divided into two groups: one with reused NSFs and the other without. Demographics, intraoperative CSF leaks, reconstruction materials, postoperative morbidity, and time to complete mucoepithelialization of the defect were analyzed. The study included 20 patients with prior NSF usage who underwent secondary EEAs. Thirteen cases utilized reused NSFs alone or with inlay fat or fascia lata, while the remaining seven employed other materials. Pathology type disparity was significant (p = 0.031). Reused NSF demonstrated a 100% success rate in reducing CSF leaks. The average time for mucoepithelization was 61 days (SD = 34 days). Reusing NSF in revision or staged surgeries is a reliable technique for skull base repair, potentially reducing nasal morbidity and obviating the need for harvesting other vascular flaps.

Prediction of implant failure risk due to periprosthetic femoral fracture after primary elective total hip arthroplasty : a simplified and validated model based on 154,519 total hip arthroplasties from the Swedish Arthroplasty Register.

While cementless fixation offers potential advantages over cemented fixation, such as a shorter operating time, concerns linger over its higher cost and increased risk of periprosthetic fractures. If the risk of fracture can be forecasted, it would aid the shared decision-making process related to cementless stems. Our study aimed to develop and validate predictive models of periprosthetic femoral fracture (PPFF) necessitating revision and reoperation after elective total hip arthroplasty (THA). We included 154,519 primary elective THAs from the Swedish Arthroplasty Register (SAR), encompassing 21 patient-, surgical-, and implant-specific features, for model derivation and validation in predicting 30-day, 60-day, 90-day, and one-year revision and reoperation due to PPFF. Model performance was tested using the area under the curve (AUC), and feature importance was identified in the best-performing algorithm. The Lasso regression excelled in predicting 30-day revisions (area under the receiver operating characteristic curve (AUC) = 0.85), while the Gradient Boosting Machine (GBM) model outperformed other models by a slight margin for all remaining endpoints (AUC range: 0.79 to 0.86). Predictive factors for revision and reoperation were identified, with patient features such as increasing age, higher American Society of Anesthesiologists grade (> III), and World Health Organization obesity classes II to III associated with elevated risks. A preoperative diagnosis of idiopathic necrosis increased revision risk. Concerning implant design, factors such as cementless femoral fixation, reverse-hybrid fixation, hip resurfacing, and small (< 35 mm) or large (> 52 mm) femoral heads increased both revision and reoperation risks. This is the first study to develop machine-learning models to forecast the risk of PPFF necessitating secondary surgery. Future studies are required to externally validate our algorithm and assess its applicability in clinical practice.

Robot-Assisted Radical Prostatectomy Using the KangDuo Surgical Robot-1500: A Prospective, Multicenter, Single-Arm Clinical Study.

Introduction: The KangDuo Surgical Robot-1500 (KD-SR-1500) is a newly developed surgical robot. We aim to evaluate the feasibility and efficiency of the KD-SR-1500 system for robot-assisted radical prostatectomy (RARP). Materials and Methods: This prospective, multicenter, single-arm clinical study was conducted among 18-75-year-old patients with suspected T1-2N0M0 prostate cancer scheduled for RARP. The perioperative and follow-up data were prospectively recorded. Early oncologic outcomes were assessed according to surgical margin status and prostate-specific antigen (PSA) at 6 weeks after surgery. Continence was defined as no more than one pad daily. Ergonomics were assessed with the National Aeronautics and Space Administration task load index (NASA-TLX). Perioperative complications were recorded according to the Clavien-Dindo classification. Results: A total of 31 patients were involved in the trial. One patient with severe abdominal adhesion withdrew from the trial. All surgeries were performed successfully without any conversion or secondary surgery due to surgical complications. The median docking time and console time were 3.8 (3.3-5.2) and 104.6 (80.0-145.6) minutes, with a median estimated blood loss of 50 (20-100) mL. Positive surgical margin was observed in 6 (20%) patients. One (3.4%) patient experienced PSA persistence at 6 weeks after surgery. The urinary continence rate was 75.9% (22/29) at 4 weeks after catheter removal. There were no major complications (grade ≥ III) or equipment-related adverse events. The mean NASA-TLX score was 23.9 ± 11.7. Conclusions: The KD-SR-1500 is feasible and effective for the management of T1-T2 prostate cancer.

Sex-Specific Differences in Sepsis Development in Polytrauma Patients Undergoing Stand-Alone Definitive Surgery

Background and Objectives: In the triaging of polytrauma, patients with less severe injuries and lower somatic stress often undergo isolated definitive orthopedic surgery without damage-control procedures. Adverse events, particularly sepsis, should be minimized. We aimed to identify sex-specific predictors for sepsis in polytrauma patients undergoing stand-alone definitive surgery. Materials and Methods: Our institutional trauma database, containing data from 3653 patients between 1996 and 2022, was filtered for polytrauma patients who underwent definitive surgery, were aged ≥16 years, and had an Injury Severity Score (ISS) ≥16. Injury and physiological parameters were documented upon admission, as well as on the first and second days thereafter. Surgical data were also recorded. All factors were evaluated for their association with sepsis development. Results: Among the 276 patients (71.1% male; mean age 45.0 years, 95% confidence interval 42.7–47.2 years; median ISS of 27, interquartile range, 20–34), the rate of sepsis was 13.8% (n = 38), with a higher incidence in males (16.7%; n = 33) than in females (6.8%; n = 5) (p = 0.026). Head and thorax injuries were more common and severe in septic males, with thorax injuries being predictive. Male patients who developed sepsis also had a higher ISS, an increased heart rate (HR), and lower pH at admission, with ISS and HR being predictive of sepsis. On the first day post-admission, septic males showed higher Base Excess and lower Prothrombin Time. Lactate levels were elevated on both the first and second days post-admission. Surgical predictors for males included less primary extremity surgeries and later secondary spine surgeries. Conclusions: Sepsis is more common in males undergoing stand-alone definitive surgery. Several factors, particularly acidosis and coagulopathy, are associated with this phenomenon. Fewer primary extremity surgeries and delayed secondary spine surgeries were also linked to a higher sepsis risk in males. These findings may help identify patients eligible for stand-alone definitive surgery and underscore the need for more data on female polytrauma patients.

Morphological Characteristics of Inferior Pole Patellar Fractures and a Finite-Element Analysis Combined With a Retrospective Clinical Study of Anchor Suture and Titanium Cable Cerclage Treatment.

Inferior pole patellar fractures (IPPFs) pose a significant challenge due to their complex fracture patterns and high risk of complications associated with current treatment methods. This study aims to (1) characterize the fracture patterns of IPPFs using fracture mapping and (2) compare the biomechanical stability and clinical outcomes of treatment with anchor suture with patellar cerclage versus Kirschner-wire tension band combined with patellar cerclage. (1) A retrospective analysis was conducted on 61 patients with IPPF. For each case, fracture reduction was manually simulated, with fracture lines and fragments overlaid onto a complete patella template to identify fracture patterns. (2) Finite-element models were used to analyze the mechanical properties of anchor suture and titanium cable cerclage treatment and Kirschner-wire tension band combined with patellar cerclage in treating IPPFs. Additionally, a retrospective analysis of clinical data was performed on 57 patients with IPPF (AO/OTA 34 A1) treated at our institution between January 1, 2023, and December 25, 2023. Of these, 18 patients underwent anchor suture and titanium cable cerclage (Group A), and 39 underwent Kirschner-wire tension band combined with patellar cerclage (Group B). We compared operative time, final knee range of motion, incidence of secondary surgery, postoperative complications, and functional recovery between the two groups based on medical records and follow-up results. (1) IPPFs were predominantly comminuted, with fracture lines on the anterior view concentrated laterally and near the superior surface of the inferior pole. Fracture lines became more sparse as they approached the distal patella. The posterior view was similar to the anterior, with the majority of fractures near the superior surface of the inferior pole. (2) Finite-element analysis revealed no significant differences between the two groups in terms of displacement and stress. Operative time was similar between the groups (p > 0.05), as were final knee range of motion (p > 0.05) and postoperative Bostman scores (p > 0.05). Group A had no postoperative complications or readmissions, while Group B had two cases of hardware irritation and one case of knee joint infection. The fracture lines of IPPF are varied, often comminuted, and correlate with the mechanism of injury. Biomechanical and clinical outcomes suggest that anchor suture with patellar cerclage is a viable option for stabilizing IPPF. ClinicalTrials.gov identifier: NCT06736639.

Isolated Tibial Tubercle Fracture With and Without Combined Patellar Tendon Avulsion: Early Outcomes, Complications, and Reoperations.

Tibial tubercle fractures (TTF) are uncommon injuries, comprising <3% of proximal tibial fractures. Rarely, they occur in conjunction with patellar tendon avulsion (PTA). We aimed to compare reoperation rates and short-term postoperative outcomes in patients with TTF versus combined injuries. A retrospective review of patients presenting to a single tertiary pediatric hospital with a TTF who underwent open treatment and fixation of tibial tuberosity fractures was performed. Demographics, operative details, injury patterns, complications, and postoperative milestones were analyzed. Operative reports were reviewed to identify concomitant PTA. Outcomes analyzed included reoperation rates, weeks to full weight-bearing (FWB), full range of motion (FROM), and return to sport (RTS). Patients with <4 months of clinical follow-up were excluded from the analysis. We identified 117 fractures in 111 patients (mean age: 13.75 ± 1.27, 5% female). One-hundred and one fractures were isolated TTF and 16 were combined TTF with PTA. There was no significant difference in secondary surgery (P=0.13) or complication rates (P=0.20). The duration in the hinged knee brace was significantly higher in the combined injury group (12.95 wk) than in the isolated injury group (9.77 wk) (P=0.0024). There was no significant difference in time to FWB (P=0.25), FROM (P=0.86) or time to RTS (P=0.40). No current postoperative guidelines exist for combined TTF and PTA. Our data suggest that combined injury can be largely managed similarly to isolated TTF. However, combined injuries may require a longer bracing period. Level II prognostic study.

Sex-Based Differences in the Arthroscopic Treatment of Femoroacetabular Impingement Syndrome: 10-Year Outcomes With a Nested Propensity-Matched Comparison

Background: Sex has been associated with different pathologic characteristics in painful hips undergoing hip arthroscopic surgery. Purpose: To compare minimum 10-year patient-reported outcomes (PROs) and survivorship in patients who underwent primary hip arthroscopic surgery for femoroacetabular impingement syndrome and labral tears according to sex. Study Design: Cohort study; Level of evidence, 3. Methods: Data from patients who underwent primary hip arthroscopic surgery between March 2009 and May 2011 were reviewed. Patients with minimum 10-year PROs for the modified Harris Hip Score (mHHS), Non-Arthritic Hip Score (NAHS), Hip Outcome Score–Sports-Specific Subscale (HOS-SSS), and visual analog scale (VAS) for pain were eligible. Exclusion criteria included previous ipsilateral hip conditions or surgical procedures, Tönnis grade >1, or dysplasia (lateral center-edge angle <25°). In the subanalysis, female patients were matched to male patients using a 1:1 ratio by age, sex, and body mass index. Results: A total of 375 hips had a minimum 10-year follow-up. There were 249 female (mean age, 36.8 ± 13.1 years) and 126 male (mean age, 38.9 ± 13.1 years) hips. Survivorship was defined as no conversion to total hip arthroplasty. Female and male hips exhibited similarly high rates of survivorship (80.3% vs 72.2%, respectively; P = .076). Female hips underwent secondary arthroscopic surgery at a statistically higher rate of 14.5% (P = .021) and had higher rates of capsular repair and iliopsoas fractional lengthening (P < .0001 and P < .001, respectively). Male hips had a significantly higher rate of acetabular labrum articular disruption/Outerbridge grade 3 and 4 damage at 54.0% compared with female hips (both P < .001) and underwent femoroplasty and acetabular microfracture at significantly higher rates of 88.1% versus 51.0%, respectively, and 16.7% versus 4.8%, respectively (both P < .001). In the subanalysis, both groups showed significant improvements in all PROs from baseline (all P < .001). Even though female patients demonstrated a higher rate of secondary arthroscopic surgery, they had a higher self-reported mean satisfaction score of 9.0 compared with 8.4 (P = .003) and a greater magnitude of improvement in 10-year PROs (ΔmHHS: 29.3 ± 17.5 vs 23.1 ± 19.8, respectively [P = .036]; ΔNAHS: 33.2 ± 21.3 vs 25.1 ± 19.5, respectively [P = .012]; ΔHOS-SSS: 47.0 ± 32.0 vs 32.7 ± 31.9, respectively [P = .008]; and ΔVAS: –4.6 ± 2.7 vs −3.5 ± 2.0, respectively [P = .009]). However, all PROs at a minimum 10-year follow-up were similar between the groups. Conclusion: After undergoing hip arthroscopic surgery for femoroacetabular impingement syndrome, both female and male patients reported significant improvements in all PROs at a minimum 10-year follow-up and high patient satisfaction, with similar final functional scores. Even though female patients demonstrated a higher rate of secondary arthroscopic surgery, they had a higher satisfaction score and a greater magnitude of improvement in PROs postoperatively.

Comparison of Postoperative Strength Progression and Outcomes Following Primary Versus Secondary ACL Reconstruction in the Young Athlete.

Return to sport testing after ACL reconstruction (ACLR) is becoming increasingly popular. Anecdotally, some believe that patients who undergo a second ACL surgery on either the ipsilateral or contralateral leg progress through their rehabilitation goals faster the second time through. The purpose of this study was to evaluate the rate of strength progression in return to sport testing after primary and secondary ACLR surgeries in a young, active population. A retrospective review of patients who underwent ACLR between September 2013 and December 2022 was performed. Patients were included if they underwent an ACLR and completed at least 2 postoperative strength tests. Strength testing was commonly performed at 3, 6, and 9 months. Exclusion criteria included age older than 30 and those who had a contralateral graft harvest. Structural equation modeling was performed for each strength assessment by the timepoint it was performed. A linear combination of parameters was performed to compare the path coefficients between the primary and secondary ACL groups for each strength test to assess statistical differences in the rate of change of each strength test over time. Three hundred ninety-six patients in the primary ACLR group and 50 patients in the secondary ACLR group met the inclusion criteria. Patients who received secondary ACL surgery were older, had a higher percentage of BTB grafts, lateral augments, and internal brace augments. Months from surgery had a significant positive correlation with nearly all strength tests in both groups. There was no difference between primary and secondary surgery in the progression of any postoperative strength test. There was no difference in progression of IKDC or RSI scores between groups. This study suggests that patients who undergo a second ACL surgery do not progress their strength faster or slower than after primary ACLR. This implies that these patients do not require different return-to-play protocols from a strength perspective. Retrospective study, level III evidence.

Reversal of Roux-en-Y Gastric Bypass: A Multi-Centric Analysis of Indications, Techniques, and Surgical Outcomes.

Roux-en-Y gastric bypass may present long-term complications that require revisional surgery or even reversal to normal anatomy. Data on the indications, surgical technique, and outcomes of RYGB reversal remain scarce. We identified 48 cases of RYGB reversals with complete 90-day follow-up within a multi-centric international retrospective database of elective secondary bariatric surgery. The operations were performed between 2010 and 2024 in high-volume referral centers in Europe and USA. Data were collected on body weight, associated diseases, and on surgical outcomes up to 1-year postoperatively. Patients were mainly female (81.3%) with a median age of 50 years (IQR 39-56). RYGB reversal was performed 7 years (median) after primary RYGB in patients with a BMI of 23.9 kg/m2 (IQR 20-27). Half of the patients underwent at least 1 bariatric revision before the reversal. Main indications for reversal were dumping syndrome (33.3%), excessive weight loss (29.2%), marginal ulcer (14.6%), malabsorption (12.5%), and abdominal pain (10.4%). Rate of conversion to open surgery was 8.3%, and the postoperative complications during the first year reached 50%, including 31.3% Clavien-Dindo grade I-II, 16.7% grade III-IV complications, and one death. At 1 year, the mean BMI of the cohort increased by 18% to 28.25 kg/m2; only 1 patient reached pre-RYGB BMI. Although RYGB is a theoretically reversible procedure, normal anatomy is re-established only in selected cases which are refractory to medical therapy and often also to revisional bariatric surgery. RYGB reversals entail high morbidity, while the extent of recurrent weight gain at 1-year post-reversal seems to allow patients to remain below the threshold of severe obesity.

Results of Bioabsorbable Screws for the Fixation of Chevron Osteotomy in the Treatment of Hallux Valgus Deformities.

This study aimed to investigate the safety and reliability of using bioabsorbable screws for the fixation of chevron osteotomy in the treatment of hallux valgus (HV) deformity. Clinical cases of chevron osteotomy in the treatment of HV deformities in our hospital between December 2018 and August 2022 were retrospectively summarised to compare preoperative imaging indices with those at the final follow-up session, including the hallux valgus angle (HVA), intermetatarsal angle (IMA) and tibial sesamoid position (TSP). The American Orthopaedic Foot and Ankle Society (AOFAS) hallux metatarsophalangeal-interphalangeal scale, short-form health survey questionnaire (SF-36) and European Foot and Ankle Society (EFAS) scale were used to assess therapeutic efficacy. The visual analogue scale (VAS) was used to assess pain relief. Moreover, complications were recorded. Twenty-six patients (39 feet) were included, and the mean follow-up period was 24.0 months. No infection, delayed healing or non-healing was recorded. The osteotomy ends healed well without non-union or delayed union. Four cases of recurrence (HVA ≥20°), two of numbness in the distal toe, one of necrosis of the first metatarsal head and one of osteoarthritis of the first metatarsophalangeal joint occurred. No patients underwent secondary surgery. The HVA, IMA and TSP significantly reduced at the final follow-up session compared with their preoperative values, and significant improvement was seen in clinical scores. The use of bioabsorbable screws for the fixation of chevron osteotomy is safe and effective in the treatment of HV deformities.

Impact of optimal secondary cytoreductive surgery on survival outcomes in women with recurrent endometrial carcinoma: A systematic review and meta-analysis.

Management of recurrent endometrial carcinoma (EC) represents a challenge. Although a complete resection of visible disease at secondary surgery (R0) is recommended, the impact of R0 on survival outcomes is unclear and pooled data are lacking. To quantitatively assess the impact of R0 on survival outcomes in women with EC recurrence. A systematic review and meta-analysis was performed searching eight electronic databases from their inception up to January 2024. All peer-reviewed studies that assessed quantitatively the impact of R0 on survival outcomes in women at first EC recurrence were included. Hazard ratio (HR) with 95% confidence interval (CI) for death of any cause and secondary recurrent or progressive disease in women with EC recurrence who underwent R0 compared to non-optimal secondary surgical cytoreduction (R1) were pooled and assessed at both univariable and multivariable analyses. Three studies with 442 patients were included. At univariate analysis, in women with EC recurrence and R0 compared to women with EC recurrence and R1, pooled HR was 0.451 (95% CI: 0.319-0.638) for death from any cause, and 0.517 (95% CI: 0.298-0.895; p = 0.019) for recurrent or progressive disease. At multivariate analysis, in women with EC recurrence and R0 compared to women with EC recurrence and R1, pooled HR was 0.447 (95% CI: 0.255-0.783; p = 0.005) for death from any cause, and 0.585 (95% CI: 0.359-0.952; p = 0.031) for recurrent or progressive disease. In women with EC recurrence, R0 is an independent prognostic factor, decreasing the risk of death from any cause by approximatively 55%, and of recurrent or progressive disease by approximatively 40%, compared to R1.

Comparative Outcomes Between Three Different Techniques in the Fixation of Ulnar Styloid Fractures.

This study aims to compare the clinical and radiological outcomes of three different techniques used in the surgical treatment of ulnar styloid fractures. Ulnar styloid fractures treated surgically between 2012 and 2022 were evaluated retrospectively. There were three groups in the study: Group I (Kirschner wire, N= 19), Group II (tension band, N= 27) and Group III (headless compression screw, N= 25). The Gaulke classification was applied to categorise the fractures. After a follow-up period of at least one year, range of motion, Modified Mayo Wrist Score (MMWS), Quick Disabilities of the Arm, Shoulder and Hand Score (QDASH), Visual Analogue Scale (VAS) and grip strength were measured. In addition, radiological union, bone resorption and dorsal subluxation of the DRUJ were evaluated. There was no difference between the three groups in terms of demographic data. Gaulke type 2 A was more frequently observed in all three groups (47.4%, 74.1%, 64%, respectively). Range of motion (flexion, extension, supination, pronation) was similar in all three groups (p>0.05). QDASH and MMWS were similar in all three groups. Grip strength was significantly lower in Group I than in Group II (p=0.039). Radiological outcomes (nonunion, dorsal subluxation, bone resorption) were similar in all three groups. Implant irritation was significantly higher in Group II (p=0.026). K-wires, tension band wiring and headless compression screws yield similar clinical and radiological outcomes in the surgical treatment of unstable ulnar styloid fractures. However, the need for secondary surgery is more frequent when a tension band is used. Level IV.

An algorithm for identifying causes of reoperations after orthopedic fracture surgery in health administrative data: a diagnostic accuracy study using the Danish National Patient Register.

Disease- or procedure-specific registers offer valuable information but are costly and often inaccurate regarding outcome measures. Alternatively, automatically collected data from administrative systems could be a solution, given their high completeness. Our primary aim was to validate a method for identifying secondary surgical procedures (reoperations) in the Danish National Patient Register (DNPR) within the first year following primary fracture surgery. The secondary aim was to evaluate the accuracy of the diagnosis and procedure codes used to determine the causes of these reoperations. Finally, we developed algorithms to enhance precision in identifying the reasons for reoperations. In a national cohort of 11,551 patients with primary fracture surgery, reoperations were identified through subsequent surgical procedure codes in the DNPR. Each patient record was reviewed to confirm the reoperations and causes. To improve accuracy, a stepwise algorithm was developed for each cause. We identified 2,347 possible reoperations; 2,212 were validated as true reoperations by review of patient record, i.e., a 94% positive predictive value (PPV). However, the coding for the causes of these reoperations was inaccurate. Our algorithm identified major reoperations with a sensitivity/PPV of 89/77%, minor reoperations 99%/89%, infections 77/85%, nonunion 82/56%, early re-osteosynthesis 90/75%, and secondary arthroplasties 95/87%. While the overall reported reoperations in the DNPR had a high PPV, the predefined diagnosis and procedure codes alone were not sufficient to accurately determine the causes of these reoperations. An algorithm was developed for this purpose, yielding acceptable results for all causes except nonunion.

Clear cell borderline ovarian tumor: A retrospective study and literature review.

Clear cell borderline ovarian tumor is a rare subtype of borderline ovarian tumor for which the clinicopathological characteristics, management, and prognosis remain unclear. Herein, we describe the clinical features, treatment options, and prognosis of clear cell borderline ovarian tumors. This was a retrospective study of nine patients with pathologically confirmed clear cell borderline ovarian tumors treated at Peking Union Medical College Hospital between 2006 and 2023. Data regarding the patients' clinicopathological features, management, and prognosis were analyzed. We also reviewed previously published studies in English of patients with clear cell borderline ovarian tumors who underwent fertility-sparing surgery. The median age at diagnosis was 52years (range, 35-72) and the median tumor size was 6.5cm (range, 2.7-13). Seven patients had unilateral tumors and two patients had bilateral tumors. Seven patients underwent radical surgery and two patients underwent fertility-preserving surgery. All patients had stage I disease. Pathological analysis revealed synchronous endometriosis or adenomyosis in five patients. Endometrial hyperplasia with atypia was found in two of the seven patients who underwent hysterectomy. During a median follow-up time of 54months (range, 14-200), only one patient suffered a recurrence, which was treated successfully with secondary surgery. The prognosis of clear cell borderline ovarian tumors is favorable, and fertility-sparing surgery is acceptable for young patients who may desire future pregnancies. Unilateral salpingo-oophorectomy is recommended for patients in whom ovarian cystectomy was the initial surgery.

Clinical outcomes of reconstruction on tissue defects with thin anterolateral thigh flap versus commonly used free soft flaps: A meta-analysis.

The thin anterolateral thigh flap (tALTF) is gaining attention in reconstructive surgery due to its aesthetic and functional advantages. However, its clinical safety and outcomes compared to other commonly used free soft flaps (CUFSFs) remain unclear. Studies were systematically searched from PubMed, EMBASE, Medline, Cochrane, Web of Science, and China National Knowledge Infrastructure Database up to November 2, 2024. Flap failure, donor and recipient site morbidity, secondary salvage surgery, and patient satisfaction were evaluated. A total of 416 cases from 7 studies were included in our analysis. No significant difference was observed between the two groups in flap failure and secondary salvage surgery. However, tALTF showed significant advantages over CUFSFs in skin grafting, donor and recipient site morbidity, and patient satisfaction. This meta-analysis highlights the clinical safety and superior outcomes of tALTF compared to CUFSFs in reconstructive surgery, suggesting its viability as a preferred option for surgeons. However, the retrospective design of the included studies and limited sample sizes necessitate further large-scale prospective studies to validate these results.

Comparison of the effect of early versus late surgical strategies on outcomes in patients with hand enchondromas complicated with pathological fractures.

This study aimed to evaluate the advantages and disadvantages of early versus delayed single-stage surgery in patients with hand enchondromas who developed pathological fractures, focusing on local tumor control and hand function, to determine the optimal timing for surgery. Delayed surgical curettage may offer advantages regarding both local tumor control and hand function outcomes.Thirty-five patients who developed pathological fractures due to solitary hand enchondromas and underwent surgical treatment between 2015 and 2021 were analysed. Patients were divided into two groups based on the timing of surgery. Patients who underwent surgical treatment immediately after a pathological fracture were assigned to the early-surgery group, and those who underwent surgical treatment after waiting for fracture union were assigned to the late-surgery group. Demographic data, lesion characteristics, and fixation methods were analysed. Parameters affecting outcome measurements were analysed, including visual pain scale, fracture healing time, recurrence, ROM, time to return to daily activities, and secondary surgical procedures.The study included 35 patients, of whom 24 were female, with a median age of 33 years. Fifteen patients were included in the early-surgery group and 20 in the late-surgery group, with a follow-up period of 36.3 and 38.9 months, respectively. The duration of surgery, time to fracture union, and total physical therapy duration during treatment were lower in the late-surgery group (p<0.05). At the final follow-up, the mean loss of ROM was 17.6˚ in the early-surgery group and 3.3˚ in the late-surgery group (p=0.00). The rate of secondary surgery was higher in the early-surgery group (p=0.040).In patients with hand enchondromas presenting with pathological fractures, early surgery resulted in higher complication rates, poorer functional outcomes, and an increased need for secondary surgeries.