Shorter Surgical Time Research Articles

Allogeneic versus autogenous shell technique augmentation procedures: a prospective-observational clinical trial comparing surgical time and complication rates

ObjectivesAutogenous and allogeneic blocks for shell augmentation of the jaw have shown comparable results. This observational clinical study aimed to compare both materials for shell augmentation concerning surgery time and intra- and postoperative complications.Material and methodsBone augmentation with the shell technique using autogenous or allogenous bone was performed in 117 patients with segmental jaw atrophy. The primary study parameter was the surgical time, comparing both materials. Subsequently, intra- and postoperative complications were recorded.ResultsAllogeneic (n = 60), autogenous (n = 52), or both materials (n = 5) were used. The use of allogeneic material led to a significantly shorter operation time (p < 0.001). A more experienced surgeon needed significantly less time than a less experienced surgeon (p < 0.001). An increasing number of bone shells (p < 0.001), an additional sinus floor elevation, and intraoperative complications also significantly increased the operation time (p = 0.001). Combining allogeneic and autogenous shells (p = 0.02) and simultaneous sinus floor elevation (p = 0.043) significantly impacted intraoperative complications. No correlations were found between the included variables for postoperative complications (all p > 0.05). In total, 229 implants were inserted after a healing time of 4–6 months, with a survival of 99.6% after a mean follow-up duration of 9 months.ConclusionsCompared to the autogenous technique, allogeneic shell augmentation has a shorter surgical time and a similar rate of intra- and postoperative complications as autogenous bone. Together with its promising clinical results, this technique can be recommended.Graphical

Arthroscopic-Assisted Treatment of Bennett Fractures: A Potentially Advantageous Operative Procedure?

Articular fractures of the base of the first metacarpal (Bennett fractures) have been studied for years to determine the best method of reduction and fixation. This study aims to show the application of the percutaneous reduction and internal fixation technique with cannulated screws and arthroscopic assistance in articular fractures of the base of the first metacarpal. Descriptive cohort study in a series of 30 patients, the first cohort in our country and the largest series published so far, in which 8 patients presented with type 2A fracture and 19 patients with type 2B of the Torres-Becerra classification underwent the mentioned technique under direct vision and control of the articular reduction by arthroscopy evaluating the intraoperative characteristics of the articular surface, stability of de reduction and fixation. Assessment of functional and rehabilitation results with a minimum postoperative follow-up of 6 to 12 months. The senior author has used this technique with consistent clinical outcomes to improve reduction and fixation of intra-articular base fractures of first metacarpal bone (Bennett), reducing the articular step-off and gapping permitting an early rehabilitation progress with satisfactory functional results. We can suggest that this surgical method for the treatment of Bennett fractures may offer multiple advantages: adequate debridement of the trapeziometacarpal joint, direct visualization of the articular surface during reduction, achieving greater precision in fixation with minimum morbidity, imperceptible incisions and scars, shorter surgical time, and fewer associated complications.

Comparative Analysis of Open Transforaminal Lumbar Interbody Fusion and Wiltse Transforaminal Lumbar Interbody Fusion Approaches for Treating Single-Level Lumbar Spondylolisthesis: A Single-Center Retrospective Study

Background: The aim of this study is to compare the surgical outcomes of two different surgical approaches, open transforaminal lumbar interbody fusion (TLIF) and Wiltse TLIF, in the treatment of single-level lumbar spondylolisthesis and also to provide the advantages and disadvantages of each approach. Methods: This retrospective study included 600 patients with single-level lumbar spondylolisthesis who underwent fusion surgery at a single academic institution between January 2018 and December 2022. Patients were divided into two groups: traditional open TLIF (group A; 300 patients) and the Wiltse TLIF approach (group B; 300 patients). Preoperative diagnostic tests were performed on all patients. Results: The fluoroscopy time for the Wiltse TLIF group was longer, whereas the mean blood loss for the Wiltse TLIF approach was less. Both techniques resulted in significant improvements in pain relief and functional disability, with no significant difference between the two groups in terms of their pre- or post-operative (Oswestry Disability Index) ODI scores. The Wiltse TLIF technique resulted in significantly shorter hospital stays and had a lower rate of complications compared with the open TLIF technique. Conclusion: The Wiltse TLIF approach showed advantages in shorter surgical times, reduced blood loss, and shorter hospital stays, whereas the traditional open TLIF approach exhibited shorter fluoroscopy times.

Risk factors for surgical site infection after closed proximal humerus fractures.

Proximal humerus fractures are common in clinical practice, and there are relatively a few studies on postoperative incision infections of such fractures. The purpose of this study was to explore the risk factors for surgical site infection (SSI) after internal fixation in patients with closed proximal humerus fractures. Patients with closed proximal humerus fractures who underwent surgery from January 2016 to January 2022 were retrospectively analysed. Cases with superficial or deep infections within 3 months after surgery were in the infection group and the remaining cases were in the non-infection group. The types of pathogenic bacteria in the infection group were analysed. The potential risk factors for SSI in all patients were recorded: (1) patient-related factors: gender, age, body mass index (BMI), smoking, comorbidities; (2) trauma-related factors: mechanism of injury, Injury Severity Score, visual analogue scale, fracture type, soft tissue condition and combined dislocation; (3) laboratory-related indexes: haemoglobin, albumin; (4) surgery-related factors: time from injury to surgery, American Society of Anesthesiologists anaesthesia classification, surgical time, fixation mode, intraoperative blood loss, suture method, bone graft and postoperative drainage. The risk factors for the occurrence of SSI were analysed using univariate analysis and multivariate logistic regression. The incidence of SSI was 15.7%. The most common bacterium in the infection group was Staphylococcus aureus. High BMI (p = 0.033), smoking (p = 0.030), an increase in mean time from injury to definitive surgery (p = 0.013), and prolonged surgical time (p = 0.044) were independent risk factors for the development of SSI after closed proximal humeral fractures. In patients with closed proximal humerus fractures, weight loss, perioperative smoking cessation, avoidance of delayed surgery, and shorter surgical time may be beneficial in reducing the incidence of SSI.

Treatment of unstable pelvic fractures in children with an external fixator: Retrospective study of 56 patients.

We retrospectively analyzed the data of patients who underwent external fixation treatment for unstable pelvic fractures and evaluated the clinical effects of this treatment and factors influencing pelvic function recovery. The data of patients with unstable pelvic fractures treated with an external fixator between January 2006 and December 2018 were retrospectively analyzed. The analyzed parameters included demographic data, fracture healing, pelvic asymmetry, deformity index, and complications. Fractures were categorized using the Tiles classification. Pelvic function was evaluated using the Cole score. Pelvic risk factors were identified using univariate and multivariate logistic regression analyses. Fifty-six patients (29 and 27 with type B and C fractures, respectively) were included. All fractures were healed at the time of the final follow-up. Nine and three patients had pin tract infections and loosened external fixators postoperatively, respectively. Pelvic asymmetry was reduced from 1.34 ± 0.15 cm to 0.70 ± 0.19 cm (p < 0.01), and the deformity index decreased from 0.13 ± 0.03 to 0.07 ± 0.02 (p < 0.01). The Cole score was excellent and good in 41 and 15 patients, respectively. Risk factors for pelvic function recovery included injury severity score > 25.5, age > 11.3 years, and lower-extremity fractures. External fixation is an effective method for treating unstable pelvic fractures in children, with the advantages of a simple operation, short surgical time, no interference with treatments for associated injuries, and avoidance of re-trauma caused by open reduction. An ISS > 25.5, patient age > 11.3 years, and associated lower-extremity fractures are predictors of pelvic function recovery. Level IV.

SCOLIOSIS SURGERY WEEK: A SOUTH AFRICAN TERTIARY INSTITUTION EXPERIENCE

Orthopaedic paediatric deformities, globally, are often corrected later than initial identification due to resource constraints (bed availability, investigative modalities, surgical skill set). The study aims to analyse experiences and challenges met with running a flagship scoliosis surgery week in a tertiary public health care facility, with the goal of reducing patient waiting time on the waiting list.In this retrospective study, patients from an existing deformity correction waiting list were selected for a 5 day scoliosis surgery week. Investigations relevant to clinical findings were carried out and patients were scheduled on a “one patient per day” surgery list. Inclusion criteria was any patient with adolescent idiopathic scoliosis of varying degree that was symptomatic. Exclusion criteria was any other deformity of any age.Outcomes measured include: Administrative hurdles (obtaining funding, organising ward and ICU beds, getting nursing staff), Surgical challenges (severity of the curve, intraoperative time, approach chosen) and perioperative management (anaesthesia, pain management, cost of equipment) will be looked at to better define the experiences and challenges.All scheduled surgeries were completed. This meant more cases were carried out than what was done in the last 2 years at the facility combined. Lack of Nursing staff availability and few ICU beds delayed starting cases. Anterior fusion took a shorter surgical time in comparison to posterior and cost far less to carry out owing to deformity severity. Intra and post operative management also varied due to daily changes in theatre staff and a lack of standardized protocols.Running a scoliosis surgery week helps to lower the waiting time for deformity correction in public health care facilities. Pre organising resources results in more successful outcomes and an increase in the number of cases done over a shorter period.

Oropharyngeal free flap reconstruction: Transoral robotic surgery versus open approach.

Transoral robotic surgery (TORS) has evolved since its 2009 US Food and Drug Administration approval for use in local stage T1-T2 oropharyngeal carcinoma. The ability to resect increasingly larger and more complex lesions has led to the need to introduce reconstructive techniques through this route, avoiding the classic transmandibular or pull-through approach. Few studies have compared the safety, efficacy, and advantages of TORS versus classic open approaches in oropharyngeal salvage surgery with reconstruction using microanastomosed flaps. Here we retrospectively compare our center's experience with the open approach and TORS and describe the technical variations used. Between 2013 and 2021, 30 stage III-IV oropharyngeal cancer patients underwent salvage surgery with reconstruction in our center. From 2013 to 2017, 15 patients underwent surgery with the classic open approach, and from 2018 to 2021, an additional 15 patients underwent TORS. We have compared surgical outcomes, post-surgical results, and survival in the two groups. Patient characteristics were similar in the two groups. TORS was associated with shorter surgical time (p < .001), fewer complications (p = .01), shorter hospital stay (p < .001), and lower feeding tube requirements (p = .003). No significant differences were observed between the two groups in the free margin rate or survival. Oropharyngeal salvage surgery with TORS with free flap reconstruction reduced associated morbidity compared to the open approach in a patient cohort with poor prognosis. 4.

Research Progress on Titanium Implants for External Maxillary Sinus Augmentation

In patients with missing maxillary posterior teeth, the negative pressure generated by breathing leads to an increase in the gasification of the maxillary sinus cavity, as well as the absorption of alveolar bone due to the lack of physiological stimulation due to missing teeth. This often leads to insufficient bone height during implant restoration in the maxillary posterior tooth area, and maxillary sinus floor elevation surgery can effectively solve this problem. At present, there are two main techniques for lifting the maxillary sinus floor: internal lifting through the top of the alveolar ridge approach and external lifting through the lateral wall approach. Among them, the maxillary sinus alveolar ridge lifting surgery is widely used due to its advantages of small wound size, short surgical time, fewer postoperative complications, low cost, and easy acceptance by patients. With technological innovation, the indications for maxillary sinus floor elevation surgery have gradually expanded to cases with residual bone height (RBH) greater than 2 mm.

A COMPARATIVE STUDY TO EVALUATE THE CLINICAL OUTCOME OF CONJUNCTIVAL LIMBAL AUTOGRAFT AND AMNIOTIC MEMBRANE TRANSPLANT FOR THE TREATMENT OF PRIMARY PTERYGIUM

Aim: The aim of the study was to assess the safety and effectiveness of the conjunctival limbal autograft (CLAG) and amniotic membrane transplantation (AMT). Methods: After a full pre-operative assessment 100 patients with primary pterygium attending the ophthalmology outpatient department of a teaching hospital in Eastern India, fulfilling the inclusion and exclusion criteria were selected for our study. The patients were explained the procedure of the study and possible outcomes. They were divided into two groups. Group A: Where 10-0 nylon was to be used for CLAG after pterygium excision. Group B: Where 10-0 nylon was to be used for AMT after pterygium excision. Results: There was marked improvement in vision postoperatively more in the AMT group than CLAG. In the AMT group: 34% had a visual acuity of LogMAR 0.00, 30% had LogMAR 0.12, 12% had LogMAR 0.18, and 24% had LogMAR 0.30 after the surgery. In the CLAG group: 52% had a visual acuity of LogMAR, 20% had LogMAR 0.12, 22% had LogMAR 0.18, and 6% had LogMAR 0.30 after the surgery. Graft and suture-related complications were more in the CLAG group than in the amniotic membrane (AM) graft group. Conclusion: In the present study, The CLAG group was found to be associated with more discomfort, and more post-operative complications than AMT. AM may provide a basement membrane rich in various growth factors and matrix proteins, which promotes epithelial cell migration, adhesion, and differentiation. It is also believed to have anti-inflammatory and antifibrotic effects and exerts anti-scarring effects through the transforming growth factor-β pathway. AMT may be a superior treatment in primary pterygium due to lower recurrence rate, shorter surgical times, and better visual and cosmetic outcomes.

Comparison Between Relative Efficacy of Erector Spinae Plane Block and Caudal Epidural Block for Postoperative Analgesia in Lumbar Fusion Surgery- A Prospective Randomized Controlled Study.

Prospective, randomized controlled double-blinded study. To compare the relative efficacy of ultrasound-guided ESPB and CEB for postoperative analgesia after a single-level lumbar fusion surgery and compared it with conventional multimodal analgesia. 81 patients requiring single-level lumbar fusion surgery were randomly allocated into 3 groups (ESPB group, CEB group, and the control group). Demographic and surgical data (blood loss, duration of surgery, perioperative total opioid consumption, muscle relaxants used) were assessed. Postoperatively, the surgical site pain, alertness scale, satisfaction score, time to mobilization, and complications were recorded. The total opioid consumption in the first 24 hours was significantly lower in both the block groups than in the control group (103.70 ± 13.34 vs 105 ± 16.01 vs 142.59 ± 40.91mcg; P < .001). The total muscle relaxant consumption was also significantly less in block groups compared to controls (50.93 ± 1.98 vs 52.04 ± 3.47 vs 55.00 ± 5.29mg; P < .001). The intraoperative blood loss was significantly less in both the block group (327.78 ± 40.03mL, 380.74 ± 77.80mL) than the control group (498.89 ± 71.22mL) (P < .001). Among the block groups, the immediate postoperative pain relief was better in the CEB group, however, the ESPB group had a longer duration of postoperative pain relief. Both ESPB and CEB produce adequate postoperative analgesia after lumbar fusion however the duration of action was significantly longer in the ESPB group with relatively shorter surgical time and lesser blood loss compared to the CEB group.

Three-dimensional guided lateral window sinus lift and simultaneous implant placement: A dental technique

Lateral window sinus floor elevation is typically performed blind, and complications may be encountered. Guided surgery can help make the procedure more predictable with fewer complications and a shorter surgical time. The presented technique uses a surgical template for simultaneous implant placement and sinus floor elevation. An implant platform is used for determining the size, shape, and location of the window and the osteotomy depth. The technique uses a Ø5mm bone profiler with a stop compatible with the surgical guide design to conduct the osteotomy, conservatively guiding the lateral window osteotomy in 3 dimensions.

A systemic review and meta-analysis of pararectus versus ilioinguinal approach for the management of acetabular fractures.

The complex anatomy of acetabular fracture needs a surgical approach that can achieve anatomical reduction with fewer complications for the fixation of these fractures. Current literature suggests that both Pararectus (PR) approach and Ilioinguinal (IL) approach can be used for the fixation of these fractures safely. However, superiority of the PR approach over the IL approach is not established. Hence, this meta-analysis aimed to compare the PR versus IL approach. A literature search was performed on five databases Medline/PubMed, Scopus Embase, Cinhal, and Cochrane Library, from the inception to January 14, 2023. A qualitative and quantitative analysis was done for the five eligible studies from the literature search. Individual study characteristics data and outcomes were extracted, and Software version 5.4.1 of Review Manager was used for statistical analysis. Five articles, one Randomized trial (RCT), and four retrospective articles were included and analyzed in this meta-analysis. PR approach has a shorter surgical time [mean difference (MD) -48.4 with 95% CI -74.49, -22.30; p = 0.0003], less intraoperative blood loss (MD -123.22 with 95% CI -212.28, -34.15; p = 0.007), and smaller surgical incision (MD -9.87 with 95% CI -15.21, -4.52; p = 0.0003) than the IL approach. However, the meta-analysis failed to show a difference between the two surgical approaches concerning the quality of reduction, overall complications, nerve injury, vascular injury, heterotopic ossification, deep vein thrombosis, and pulmonary embolism. The PR approach has a shorter surgical duration, less blood loss, and a smaller surgical incision than the IL approach. However, both surgical approaches have equivocal results regarding fracture reduction quality, complication rates, and functional outcomes for acetabular fracture fixation. Hence, for acetabular fractures fixation, PR approach can be considered a safe and feasible alternative to the IL approach.

Minimally Invasive Glaucoma Surgery: A Review of the Literature.

Minimally invasive glaucoma surgery (MIGS) has emerged as a novel approach in the glaucoma treatment spectrum, offering a range of diverse procedures and devices aimed at reducing intraocular pressure (IOP). MIGS can be broadly classified into several categories: those that enhance trabecular outflow (Trabectome, iStent, Hydrus Microstent, Kahook Dual Blade, high frequency deep sclerotomy, and gonioscopy-assisted transluminal trabeculotomy), those that augment suprachoroidal outflow (CyPass Microstent and iStent Supra), those that target Schlemm's canal (TRAB360 and the OMNI Surgical System, Streamline, and Ab Interno Canaloplasty), and conjunctival bleb-forming procedures (EX-PRESS Glaucoma Filtration Device, Xen Gel Stent and PreserFlo MicroShunt). MIGS is considered to have a shorter surgical time and fewer severe complications when compared to traditional glaucoma surgeries such as trabeculectomy and glaucoma drainage device implantation (Ahmed, Baerveldt, and Molteno valves). This literature review comprehensively examines the distinct MIGS devices and procedures, their underlying mechanisms, and clinical outcomes, emphasizing the importance of evaluating the efficacy and complications of each approach individually. As the field of MIGS continues to evolve, it is crucial to prioritize high-quality, long-term studies to better understand the safety and effectiveness of these innovative interventions in glaucoma management.

Trapeziectomy with Ligament Reconstruction/ Suspensionplasty Compared to Suture Tape Suspensionplasty for the Surgical Treatment of Advanced Thumb Carpometacarpal Osteoarthritis

Trapeziectomy with tendon reconstruction/suspensionplasty (TRS) is the most commonly performed surgical procedure in the United States for treatment of thumb carpometacarpal (CMC) osteoarthritis (OA). Trapeziectomy with suture tape suspensionplasty (STS) has been used recently at the study institution as an alternative surgical treatment option with perceived benefits of earlier return to function and reduced operative time. The purpose of this study was to compare patient outcomes following TRS versus STS for treatment of thumb CMC OA. All patients who underwent primary, isolated TRS or STS for treatment of thumb CMC OA between 1/1/2014 and 9/1/2020 were analyzed. We assessed demographics and preoperative and postoperative patient-rated outcome scores including Patient-reported outcomes measurement information system scores as well as pain outcomes, satisfaction, and appearance at a mean of 2.6 years after surgery (minimum 6 months). Time to return to work and activities was compared between groups. Bivariate statistics compared outcomes between groups. Ninety-four patients were included in the final study cohort, of which 53 underwent TRS and 41 underwent STS. There were no differences in preoperative, postoperative, or final patient-rated outcome scores between groups. Patients reported high global and appearance satisfaction scores at final follow-up in both groups. Mean tourniquet time was 15 minutes (26%) shorter and return to work was on average 3 weeks faster for the STS group. There were no differences in postoperative patient-rated outcome scores between the STS and TRS groups. The STS group had a shorter surgical time and faster return-to-work after surgery. Therapeutic III.

A New Technique for Use Instead of Lateral Crural Overlay for Reduction of Nasal Tip Projection in Revision Rhinoplasty.

Correction of nasal tip projection (NTP) deformities involve techniques for the lower lateral cartilage of the nose. Previously, it would have been surgically difficult to perform the lateral crural overlay (LCO) technique for the second time in revision rhinoplasty in patients who already had undergone rhinoplasty with the LCO technique because of the length of the NTP. In this study, we evaluated the lateral crural segmental excision (LCSE) technique in patients with overprojected nasal tip in revision rhinoplasty. We retrospectively studied the cases of 19 patients who had initially undergone rhinoplasty with the LCO technique for overprojected nasal tip, and later underwent revision rhinoplasty with the LCSE technique after insufficient NTP was observed on facial analysis between 2018 and 2022. Of the patients, 12 (63%) were male, with an average age of 29.6 years, and 7 (17%) patients were female, with an average age of 25.3 years. Using Goode's formula, NTP indexes of patients measured 79.4±1.8 preoperatively and 56.0±1.3 postoperatively. Stastically significant difference was observed between preoperative and postoperative values. None of the patients had malnutrition at the incision margins, and all patients recovered on time and without any problems. Granulation tissue was detected in the mucosa in only one patient. The LCSE technique, with a short surgical time, recovery period without complications, and satisfactory nasal respiratory function, is preferred over a second LCO application in cases of NTP.

Literature Review: Comparison between Open and Closed Techniques in Rhinoplasty

Rhinoplasty, a popular cosmetic surgery, offers two primary techniques: open and closed. This literature review compares the theoretical framework, surgical treatment, and complications of both approaches. While the closed technique provides no visible external scars and shorter surgical time, the open technique offers improved precision for complex cases. Both techniques have unique advantages, and the choice should be tailored to individual patient characteristics and desired outcomes. Ongoing research will continue to enhance rhinoplasty techniques and outcomes.

Radiographic parameters of pelvic and proximal femoral morphology do not predict outcomes for direct anterior total hip arthroplasty

BackgroundRadiographic predictors of outcomes associated with direct anterior approach (DAA) total hip arthroplasty (THA) are largely unknown. Anecdotally, some surgeons limit surgery to patients with low body mass index (BMI) or “favorable” bony morphology. Objective data on the impact of these factors is limited. We sought to determine radiographic and demographic predictors of outcomes after DAA arthroplasty. MethodsA consecutive series of patients undergoing unilateral, elective DAA THA, who had linked pre- and post-operative patient reported outcome scores, from January 1, 2017 to March 30, 2019 were included. Radiographic measurements, including proxies for pelvic overhang, femoral canal access, acetabular morphologic changes, and markers of disease severity, were performed on calibrated radiographs. Intra-observer consistency was also evaluated. Outcome measures included disease specific and general health patient-reported outcomes scores, while surgical difficulty was approximated by estimated blood loss and surgical time. Multivariate analyses were performed to determine statistically significant correlations. Results168 patients were included. Overall, patients experienced significant improvement in outcome scores (mean ∆ HOOS-JR 39.4, PROMIS-physical 12.3). There were two reoperations (1.2%), for recurrent dislocation. Female sex (p = 0.015) and increasing age (p == 0.019) were associated with shorter surgical times. No statistically significant correlations were found between the radiographic parameters and outcome measures. Intraclass correlation coefficients of the radiographic measurements were overall strong (0.73–1.0). ConclusionWe demonstrated consistent results in this series of patients despite variation in bony morphology. Our findings suggest that DAA THA can be safely performed on a broader patient population.

Perioperative complications and secondary retethering after pediatric tethered cord release surgery.

Tethered cord syndrome refers to a constellation of symptoms characterized by neurological, musculoskeletal, and urinary symptoms, caused by traction on the spinal cord, which can be secondary to various etiologies. Surgical management of simple tethered cord etiologies (e.g., fatty filum) typically consists of a single-level lumbar laminectomy, intradural exploration, and coagulation and sectioning of the filum. More complex etiologies such as lipomyelomeningoceles or scar formation after myelomeningocele repair involve complex dissection and dural reconstruction. The purpose of this study was to evaluate operative complications and long-term outcomes of secondary retethering related to pediatric tethered cord release (TCR) at a tertiary children's hospital. Medical records of children who underwent surgery for TCR from July 2014 to March 2023 were retrospectively reviewed. Data collected included demographics, perioperative characteristics, surgical technique, and follow-up duration. Primary outcomes were 60-day postoperative complications and secondary retethering requiring repeat TCR surgery. Univariate and multivariate analyses were performed to identify risk factors associated with complications and secondary retethering. A total of 363 TCR surgeries (146 simple, 217 complex) in 340 patients were identified. The mean follow-up was 442.8 ± 662.2 days for simple TCRs and 733.9 ± 750.3 days for complex TCRs. The adjusted 60-day complication-free survival rate was 96.3% (95% CI 91.3%-98.4%) for simple TCRs and 88.7% (95% CI 82.3%-91.4%) for complex TCRs. Lower weight, shorter surgical times, and intensive care unit admission were associated with complications for simple TCRs. Soft-tissue drains increased complications for complex TCRs. The secondary retethering rates were 1.4% for simple TCRs and 11.9% for complex TCRs. The 1-, 3-, and 5-year progression-free survival rates in complex cases were 94.7% (95% CI 89.1%-97.4%), 77.7% (95% CI 67.3%-85.3%), and 62.6% (95% CI 46.5%-75.1%), respectively. Multivariate analysis revealed that prior detethering (OR 8.15, 95% CI 2.33-28.50; p = 0.001) and use of the operative laser (OR 10.43, 95% CI 1.36-80.26; p = 0.024) were independently associated with secondary retethering in complex cases. This is the largest series to date examining postoperative complications and long-term secondary retethering in TCR surgery. Simple TCR surgeries demonstrated safety, rare complications, and low secondary retethering rates. Complex TCR surgeries presented higher risks of complications and secondary retethering. Modifiable risk factors such as operative laser use influenced secondary retethering in complex cases.

Three-Dimensional Printed Plate Template Versus Hemipelvis Model in Patient-Specific Plate Preparation for Posterior Wall Acetabular Fractures.

The application of three-dimensional (3D) printing technology in the management of posterior wall acetabular fractures can greatly reduce surgical invasiveness and operative time and simplify the procedure of reconstruction plate contouring, but the cost and time of patient-specific plate preparation on the basis of traditional 3D-printed pelvis model should not be neglected. We described a new method for patient-specific plate preparation by using 3D-printed plate template. The study aimed to assess the effectiveness and feasibility of the 3D-printed plate template in patient-specific plate preparation for posterior wall acetabular fractures. A total of 65 cases of posterior wall acetabular fractures with surgical treatment from December 2012 to December 2020 were chosen. According to the different plate contouring methods, the 65 cases were divided into three groups, which were group A (21 cases), group B (20 cases), and group C (24 cases). In group A, the 3D-printed plate template was used to contour the patient-specific reconstruction plate before surgery, whereas the 3D-printed hemipelvis model was adopted for group B. In group C, the reconstruction plate was contoured intraoperatively. Among the three groups, the instrumentation time, surgical time, blood loss, patient-specific plate preparation time, complications, reduction quality, and hip function were compared. The Kruskal-Wallis test was used to analyze the reduction quality and hip function among three groups. In comparison with group C, patients in groups A and B were featured by obviously shorter instrumentation time (-22, -23 min), shorter surgical time (-46, -44 min), and less intraoperative blood loss (-110, -122 mL). Compared to the hemipelvis model in group B (2.29 ± 0.56 vs. 12.70 ± 3.79 days), the 3D printing time for plate templates in group A was significantly shorter. The reduction quality and hip function had no obvious statistical difference among the three groups. The complication rate within group A (3/21) and group B (3/20) were both slightly lower than group C (5/24), with no obvious difference. Both the patient-specific pre-contoured plate fixation methods based on the 3D-printed hemipelvis model and plate template can achieve satisfactory clinical efficacy, with the advantage of shorter instrumentation and surgical time, and less intraoperative blood loss. However, 3D printing of plate template is easier and less time-consuming, considering the shorter time and less cost for 3D printing of physical model.

Does a dedicated "Scoliosis Team" and surgical standardization improve outcomes in adolescent idiopathic scoliosis surgery and is it reproducible?

The objective of this study was to determine if standardization improves adolescent idiopathic scoliosis (AIS) surgery outcomes and whether it is transferrable between institutions. A retrospective review was conducted of AIS patients operated between 2009 and 2021 at two institutions (IA and IB). Each institution consisted of a non-standardized (NST) and standardized group (ST). In 2015, surgeons changed institutions (IA- > IB). Reproducibility was determined between institutions. Median and interquartile ranges (IQR), Kruskal-Wallis, and χ2 tests were used. 500 consecutive AIS patients were included. Age (p = 0.06), body mass index (p = 0.74), preoperative Cobb angle (p = 0.53), and levels fused (p = 0.94) were similar between institutions. IA-ST and IB-ST had lower blood loss (p < 0.001) and shorter surgical time (p < 0.001). IB-ST had significantly shorter hospital stay (p < 0.001) and transfusion rate (p = 0.007) than IB-NST. Standardized protocols in IB-ST reduced costs by 18.7%, significantly lowering hospital costs from $74,794.05 in IB-NST to $60,778.60 for IB-ST (p < 0.001). Annual analysis of surgical time revealed while implementation of standardized protocols decreased operative time within IA, when surgeons transitioned to IB, and upon standardization, IB operative time values decreased once again, and continued to decrease annually. Additions to standardized protocol in IB temporarily affected the operative time, before stabilizing. Surgeon-led standardized AIS approach and streamlined surgical steps improve outcomes and efficiency, is transferrable between institutions, and adjusts to additional protocol changes.