Significant Difference In Functional Outcome Research Articles

Functional outcome in patients with anorectal malformation with recto-prostatic or recto-bulbar urethral fistula and comparison between different surgical approaches: A multi-center study

PurposeTo analyze the outcome in patients with anorectal malformation with rectourethral fistula and compare between laparoscopic-assisted anorectoplasty (LAARP) versus posterior sagittal anorectoplasty (PSARP). MethodWe performed a retrospective review on all males with anorectal malformation (ARM) and recto-prostatic (ARM-RP) or recto-bulbar urethral fistula (ARM-RB) treated in five tertiary paediatric surgical centres in the past 25 years. Defecative function was assessed using the Krickenbeck classification and Kelly’s score. Functional outcomes between patients with LAARP and PSARP were compared. ResultsThere were a total of 136 males with ARM-RP and ARM-RB for analysis, among which 73 (53.7%) had ARM-RP and 63 (46.3%) had ARM-RB. The median age of the patients was 9.4 years (range 0.8-24.7 years) and the median age at operation was 0.4 years (0 day to 3.1 years). 57 (41.9%) and 79 patients (58.1%) underwent PSARP and LAARP respectively. 34 patients (25%) had VACTER association. 111 (81.6%) and 103 patients (75.7%) had sacral and spinal cord anomalies respectively. 19 patients (13.9%) eventually required Malone’s Antegrade Continence Enema (MACE).For the comparison between PSARP and LAARP, no difference in Kelly scores (4.58+/-1.63 versus 4.67 +/-1.36) was identified (p=0.79). Logistic regression for voluntary bowel movement showed that VACTER association (p=0.02) and fistula location (p=0.01) were significant prognostic factors, whereas the operation approach (PSARP or LAARP) was not (p=0.65). ConclusionVACTER association and fistula location were significant prognostic factors for voluntary bowel movement, and there appeared to be no significant difference in functional outcome between PSARP and LAARP. Level of evidenceIV

Conservative versus surgical treatment for displaced olecranon fractures in the elderly: a retrospective study and a review of the literature.

Surgery is the gold standard treatment of displaced olecranon fracture, but it presents a high rate of complications, especially in the elderly, including wound breakdown and fixation failure. Conservative treatment of these fractures has recently been proposed with good functional outcomes. The aim of this retrospective study was to compare the functional results and level of satisfaction of displaced olecranon fractures which were managed surgically or conservatively in geriatric patients. The rate of implant removal and reoperation in the surgical group were also calculated. Sixteen and eleven patients aged ≥ 75years (mean 83 and 86.2, respectively) with isolated Mayo IIA or IIB olecranon fracture were surgically and conservatively treated, respectively. All but 1 were females. Due to coronavirus pandemic, they were contacted by phone to validated clinical scores (QuickDASH, PREE and VAS), which were used to assess the outcome. At an average follow-up of 26.5months in the conservative group and 53.1 in the surgical group (range 4-82), the mean Quick DASH was 11.67 and 11.2, respectively, while the mean PREE was 11.36 and 12.67, respectively. There was no significant difference in functional outcomes between the two groups, and all patients were satisfied. Seven complications occurred in the surgical cohort (33.3%), requiring reoperation in 4 cases (19%). Displaced olecranon fractures can successfully be treated conservatively in low-demand geriatric patients with good functional results and high satisfaction rate.

Refining surgical strategies in ThuLEP for BPH: a propensity score matched comparison of En-bloc, three lobes, and two lobes techniques

PurposeThis study compares the peri-operative and functional outcomes of three distinct surgical techniques in Thulium Laser Enucleation of the Prostate (ThuLEP) for benign prostatic hyperplasia (BPH). The main aim is to assess whether the En-bloc, Three-lobe, and Two-lobe techniques have differential effects on surgical efficacy and patient outcomes.MethodsA retrospective analysis was conducted on patients undergoing ThuLEP for BPH between January 2019 and January 2024 at two tertiary centers. Propensity score matching was utilized to balance baseline characteristics among patients undergoing the different techniques. Surgical parameters, including operative time, enucleation time, morcellation time, energy consumption, and postoperative outcomes, were compared among the groups.ResultsFollowing propensity score matching, 213 patients were included in the analysis. Intraoperative analysis revealed significantly shorter enucleation, laser enucleation, morcellation and operative times and total energy delivered in the En-bloc and Two-lobe groups compared to the Three-lobe group. No significant differences were observed among the groups in terms of intraoperative and postoperative complications. There were no significant differences in functional outcomes at the 3-month follow-up among the groups.ConclusionThe findings of this study suggest that while the En-bloc and Two-lobe techniques may offer efficiency benefits and could be considered safe alternatives in ThuLEP procedures, the reduction in laser enucleation time and energy delivered did not necessarily translate into improvements in post operative storage symptoms or other functional outcomes for the patients. Surgeon preference and proficiency may play a crucial role in selecting the most suitable technique for individual patients. Future research should focus on larger-scale prospective studies to further validate these findings and explore potential factors influencing surgical outcomes.

Comparative Study between Percutaneous Ilioilial Fixator versus Percutaneous Iliosacral Screw in Managing Sacral Fractures

Abstract Background The sacrum is the mechanical nucleus of the axial skeleton, located at the base of the lumbar spine and acts as the keystone at the centre of the pelvic ring. Traumatic sacral fractures are an increasingly recognized diagnosis. Sacral fractures remain a relative uncommon entity in the general population. Objective The aim of this work is to compare between percutaneous iliosacral screw and ilioilial fixation in sacral fractures fixation as regard operative time, need of intraoperative fluoroscopy, blood loss & related transfusion, infection, neurovascular complication, hardware failure and screws miss- displacement, clinical and radiological outcomes, revision rate and rate of non-union. Patients and Methods After obtaining the hospitals Research/Ethics Committee approval and written informed consents from the patients. This study was carried on 51 Patients with sacral fractures injuries through the period from August 2019 to November 2021. A prospective randomized controlled clinical trial was conducted to compare the functional and radiological outcome of closed reduction and percutaneous fixation of traumatic sacral fractures using iliosacral screw or ilioilial fixator. Results There is no statistically significant difference in functional outcome, radiological outcome operative time, blood loss, postoperative complication, union rate or follow up. There is statistically significant difference in incision length between the two groups as mean length of incision in iliosacral screw and Ilioilial fixator is 1.2 cm and 4.8 cm respectively. There is statistically significant relation between number of intraoperative fluoroscopic and fixation principles (P value <0.001) with higher risk for radiation exposure in IS screw group. Conclusion Iliosacral screw and ilioilial fixator have comparable functional and radiological outcome and similar biomechanical stability .We suggest the ilioilial fixator as an alternative to IS screw in sacral fracture management. The ilioilial fixator is a useful option in patients who do not qualify for IS screw fixation.

Effect of neoadjuvant chemoradiation on anorectal function assessed with anorectal manometry: A systematic review and meta-analysis.

Improvement in oncological survival for rectal cancer increases attention to anorectal dysfunction. Diagnostic questionnaires can evaluate quality of life but are subjective and dependent on patients' compliance. Anorectal manometry can objectively assess the continence mechanism and identify functional sphincter weakness and rectal compliance. Neoadjuvant chemoradiotherapy is presumed to affect anorectal function. We aim to assess anorectal function in rectal cancer patients who undergo total mesorectal excision, with or without neoadjuvant chemoradiation, using anorectal manometry measurements. MEDLINE, Embase, and Cochrane databases were searched for studies comparing perioperative anorectal manometry between neoadjuvant chemoradiation and upfront surgery for rectal cancers. Primary outcomes were resting pressure, squeeze pressure, sensory threshold volume and maximal tolerable volume. Eight studies were included in the systematic review, of which seven were included for metanalysis. 155 patients (45.3%) had neoadjuvant chemoradiation before definitive surgery, and 187 (54.6%) underwent upfront surgery. Most patients were male (238 vs. 118). The standardized mean difference of mean resting pressure, mean and maximum squeeze pressure, maximum resting pressure, sensory threshold volume, and maximal tolerable volume favored the upfront surgery group but without statistical significance. Currently available evidence on anorectal manometry protocols failed to show any statistically significant differences in functional outcomes between neoadjuvant chemoradiation and upfront surgery. Further large-scale prospective studies with standardized neoadjuvant chemoradiation and anorectal manometry protocols are needed to validate these findings.

Is shockwave therapy effective in the management of greater trochanteric pain syndrome? A systematic review and meta-analysis.

Evidence is lacking for the efficacy of shockwave therapy (SWT) in the treatment of greater trochanteric pain syndrome (GTPS). To investigate the efficacy of SWT on pain and function in the management of GTPS. A systematic search of electronic databases and grey literature was conducted up to May 2023. Studies utilising SWT on adults for GTPS, providing measures of pain and/or function at baseline and at follow-up were considered for inclusion. Meta-analysis was undertaken using converted pain and functional outcomes. Studies were assessed for quality and risk of bias, and assigned a level of evidence as per the Grading of Recommendations, Assessment, Development and Evaluations criteria. Twelve articles (n=1121 subjects) were included, including five randomised controlled trials (RCTs) and seven non-RCTs. No statistical differences were observed for pain over time f(1,5)=1.349 (p=0.298) or between SWT and control f(1,5)=1.782 (p=0.238). No significant differences in functional outcomes in short- (H=2.591, p=0.181) and medium-term follow-up (H=0.189, p=0.664) were identified between SWT and control. Moderate magnitude treatment effects for pain (Hedges-G [HG] 0.71) favouring SWT groups over control was identified, decreasing to low for function (HG 0.20). Further pain and functional treatment effects were identified at higher magnitudes across follow-up time-points in SWT groups compared to control. Moderate-quality evidence demonstrated no statistically significant improvements in pain and function post-SWT compared to control. Low-quality evidence established clinical improvements throughout all included studies favouring SWT over control. Consequently, owing to relatively low incidence of side effects, SWT should be considered a viable option for the management of GTPS. Issues with both clinical and statistical heterogeneity of studies and during meta-analysis require consideration, and more robust RCTs are recommended if the efficacy of SWT for the management of GTPS is to be comprehensively determined.

Reconstruction for Salvage Laryngectomy With Limited Pharyngectomy

Closure technique for optimization of postoperative and functional outcomes following salvage laryngectomy remains an area of debate among head and neck surgeons. To investigate the association of salvage laryngectomy closure technique with early postoperative and functional outcomes. This retrospective cohort study included patients from 17 academic, tertiary care centers who underwent total laryngectomy with no or limited pharyngectomy after completing a course of definitive radiotherapy or chemoradiotherapy with curative intent between January 2011 and December 2016. Patients with defects not amenable to primary closure were excluded. Data were analyzed from February 14, 2021, to January 29, 2024. Total laryngectomy with and without limited pharyngectomy, reconstructed by primary mucosal closure (PC), regional closure (RC), or free tissue transfer (FTT). Patients were stratified on the basis of the pharyngeal closure technique. Perioperative and long-term functional outcomes were evaluated with bivariate analyses. A multivariable regression model adjusted for historical risk factors for pharyngocutaneous fistula (PCF) was used to assess risk associated with closure technique. Relative risks (RRs) with 95% CIs were determined. The study included 309 patients (256 [82.8%] male; mean age, 64.7 [range, 58.0-72.0] years). Defects were reconstructed as follows: FTT (161 patients [52.1%]), RC (64 [20.7%]), and PC (84 [27.2%]). A PCF was noted in 36 of 161 patients in the FTT group (22.4%), 25 of 64 in the RC group (39.1%), and 29 of 84 in the PC group (34.5%). On multivariable analysis, patients undergoing PC or RC had a higher risk of PCF compared with those undergoing FTT (PC: RR, 2.2 [95% CI, 1.1-4.4]; RC: RR, 2.5 [95% CI, 1.3-4.8]). Undergoing FTT was associated with a clinically meaningful reduction in risk of PCF (RR, 0.6; 95% CI, 0.4-0.9; number needed to treat, 7). Subgroup analysis comparing inset techniques for the RC group showed a higher risk of PCF associated with PC (RR, 1.8; 95% CI, 1.1-3.0) and predominately pectoralis myofascial flap with onlay technique (RR, 1.9; 95% CI, 1.2-3.2), but there was no association of pectoralis myocutaneous flap with cutaneous paddle interposition with PCF (RR, 1.2; 95% CI, 0.5-2.8) compared with FTT with cutaneous inset. There were no clinically significant differences in functional outcomes between the groups. In this study of patients with limited pharyngeal defects, interpositional fasciocutaneous closure technique was associated with reduced risk of PCF in the salvage setting, which is most commonly achieved by FTT in academic practices. Closure technique was not associated with functional outcomes at 1 and 2 years postoperatively.

Outcomes of different surgical procedures for optic disc pit: a meta-analysis

Objective To assess the surgical outcomes of pars plana vitrectomy (PPV) in conjunction with various adjuvant procedures for optic disc pit maculopathy (ODPM). Methods We conducted a literature search to identify clinical studies and case series of surgically treated OPM patients. (1) greater than two patients, (2) surgical treatment and (3) reporting of pre and postoperative visual acuity data were inclusion criteria. We excluded review articles and studies unavailable in the English language. One-way analysis of variance, Pearson’s chi-squared test and straightforward linear regression were used to analyze the results. Results A total of 838 studies were initially identified as potentially relevant studies. After removing duplicates and screening titles and abstracts, the eligibility of 86 full-text articles was evaluated. There were 50 studies included in the meta-analysis. We identified the following commonly reported techniques: juxtapapillary laser alone, PPV alone or with juxtapapillary laser (PPV/JPL), internal limiting membrane peeling (PPV/ILMP), both ILMP and JPL (PPV/ILMP/JPL), inner retinal fenestration (PPV/IRF), autologous platelet concentrate (PPV/APC), macular buckling alone or with PPV, PPV with ocriplasmin (PPV/OCR) and PPV with autologous scleral flap. All groups showed an improvement in best-corrected visual acuity compared with baseline, with no significant differences between groups. The average OPM resolution rate for all groups was 70% (range: 56–100%), and the average resolution duration was 9.1 months. Central macular thickness was diminished in the PPV, PPV/JPL, and PPV/ILMP groups, but there were no significant differences between groups. There was no effect on the outcomes. Analyses of linear regression revealed significant correlations between preoperative best-corrected visual acuity and the aforementioned outcome measures. The rate of complete anatomic success and visual improvement following PPV is ∼85%. Anatomic and visual success rates for PPV alone are 89% and 100%, respectively, according to subgroup analysis. Gas tamponade, laser and ILMP during vitrectomy are less promising, whereas PPV with ILM flap stuffing may yield better results than cases without it. Conclusion We did not find a significant difference in functional outcomes between the various surgical procedures used to treat OPM. Based on the available evidence, PPV is effective for ODPM, while gas tamponade, laser and ILMP should be used with caution. This study is limited by its reliance on retrospective studies and publication bias towards positive outcomes.

Treatment of Distal Radius Fractures in Elderly Patients:
 A Review

Background. Distal radius fractures (DRF) are one of the most common injuries in the elderly population. Their incidence increases steadily, with epidemiologists predicting further growth. Despite its growing prevalence, the efficacy of surgical treatment for this pathology in elderly patients remains debatable.
 Aim — to determine the optimal method for treating distal radius fractures in the elderly population basing on a comparative analysis of the literature data on various treatment methods, including conservative and surgical ones.
 Methods. A search was performed in PubMed/MEDLINE, Scopus, Google Scholar, and eLIBRARY databases according to the following keywords, their derivatives and combinations in the titles and abstracts: treatment, distal radius fracture, elderly. Initial analysis for meeting the inclusion criteria was performed on the article titles and abstracts, followed by analysis of the full-text articles. The sources with unavailable full-text versions were excluded from the analysis.
 Results. Current epidemiological data were studied, specific aspects of physical examination of elderly patients with distal radius fractures were described, the main treatment methods were determined. The main treatment method remains the conservative one: closed reduction and immobilisation. Open reduction and internal fixation with a volar locking plate has become the leading surgical treatment method in recent decades, replacing such methods as closed reduction and fixation with wires or external fixation. At early follow-up, elderly patients operated on with volar locking plate show better functional results than those who received conservative treatment. However, at long-term follow-up, most studies show no significant differences in functional outcomes after surgical and conservative treatment, despite the differences in radiological data in favour of surgical treatment.
 Conclusion. For the majority of elderly patients, conservative treatment may be the optimal treatment option. Surgical intervention using a volar locking plate may be justified for certain groups of elderly patients, as this method may accelerate rehabilitation after injury.

Comparison of the Latarjet Procedure With the Modified Putti-Platt Surgery for Recurrent Anterior Shoulder Dislocation With Respect to Functional Outcome.

Introduction Shoulder dislocation is the most common injury encountered in orthopedic outpatient department. The choice of procedure depends on the expertise of surgeons.The objective of this study was tocompare the Latarjet procedure with the modified Putti-Platt surgery for recurrent anterior shoulder dislocation in terms of functional outcomes. Materials and methods A quasi-experimental study evaluated 60 patients with recurrent anterior shoulder instability. Patients were assigned to either Latarjet or modifiedPutti-Platt surgery. Functional outcomes were assessed at sixmonths using the Constant-Murley shoulder score. Results This study encompassed 60 patients (mean age:23.93±5.88 years) undergoing shoulder procedures.Functional outcomes exhibited a majority of 55% excellent, 35% good, 6.7% fair, and 3.3% poor outcomes. No significant differences in functional outcomes were found between the procedures. Conclusion Both procedures may be viable options for recurrent shoulder instability. The choice may depend on patient factors and surgeon preference. Further research is needed to refine techniques and identify ideal candidates.

Billroth-II modified with hinged anti-peristaltic afferent loop versus Roux-en-Y reconstruction after distal gastrectomy for gastric cancer: A propensity-score match analysis

BackgroundThis study aimed to evaluate the effectiveness of modified Billroth-II with a hinged anti-peristaltic afferent loop by comparing it with the Roux-en-Y method. MethodsWe retrospectively analyzed 344 patients with gastric cancer who underwent distal gastrectomy between 2016 and 2021. Propensity score matching was conducted to balance baseline characteristics. ResultsAfter propensity score matching, there were 117 patients in each group. The Billroth-II group was significantly better regarding operating time (184.7 vs 225.3 minutes), postoperative hospital stays (7.9 vs 9.2 days), and time to semi-solid diet tolerance (2.8 vs 3.8 days). The Billroth-II group demonstrated comparable results with the Roux-en-Y group in weight loss, hemoglobin changes, reflux esophagitis, food residue, and gastritis severity. Presentation of bile in gastric remnant was significantly higher in the Billroth-II group (42.9% vs 10.3%). ConclusionThere were no significant differences in functional outcomes between Billroth-II and Roux-en-Y reconstructions. The Billroth-II was superior to Roux-en-Y in operating time, hospital stays, and time to semi-solid diet tolerance. The Billroth-II could be considered an acceptable alternative reconstruction after distal gastrectomy.

Surgical treatment of pituitary neuroendocrine tumors with coexisting intracranial lesions: A case series and review of the literature.

Pituitary neuroendocrine tumors (PitNETs) are a diverse group of benign neoplasms that account for a significant proportion of intracranial tumors (13%). The coexistence of PitNET with other intracranial lesions, such as meningiomas and intracranial aneurysms, has been constantly reported in the literature; yet, the pathophysiological mechanisms remain unknown, and the appropriate management is controversial. This study aims to describe the clinical characteristics, surgical treatment, and outcomes of patients with PitNET with coexisting intracranial lesions in a single healthcare center. A retrospective analysis was conducted on 12 patients who underwent surgical treatment for PitNET and another intracranial lesion at our single tertiary referral center over 15 years from January 2008 to May 2023. Among these coexisting lesions, aneurysms were the most commonly found (41.67%), followed by meningiomas (33.33%). Surgical intervention for both lesions was performed in a single-stage procedure for most cases (75%), employing transcranial, endoscopic endonasal, and combined approaches. We found low preoperative Karnofsky Performance Scale scores in three patients, with significant differences in functional outcomes. These findings contribute to the limited knowledge about PitNET coexisting with other intracranial lesions and emphasize the importance of patient-tailored, multidisciplinary management in these unusual scenarios.

Comparison between transradial and transfemoral mechanical thrombectomy for ICA and M1 occlusions: insights from the Stroke Thrombectomy and Aneurysm Registry (STAR)

BackgroundThe role for the transradial approach for mechanical thrombectomy is controversial. We sought to compare transradial and transfemoral mechanical thrombectomy in a large multicenter database of acute ischemic stroke.MethodsThe prospectively...

Impact of sustentaculum tali screw positioning on radiographic and functional outcomes in calcaneal fractures

BackgroundTo investigate whether accurate placement of sustentaculum tali screws have the impacts on the clinical efficacy of calcaneal fractures.MethodsA retrospective analysis of 72 cases (73 feet) of calcaneal fractures from September 2015 to September 2019 treated with open reduction and internal fixation with sustentaculum tali screws was conducted. Patients were divided into the sustentaculum tali fixation group (ST group) and the sustentaculum fragment fixation group (STF group) according to the location of the sustentaculum tali screw placement. The functional outcomes at preoperative, 7 days and 1 year postoperative were collected and analyzed.ResultsIn the ST group (40 feet), the Gissane's angle altered from (109.89 ± 12.13)° to (121.23 ± 9.34)° and (119.08 ± 8.31)° at 7 days and 1 year postoperative, respectively. For Böhler’s angles altered from (11.44 ± 5.94)°, to (31.39 ± 7.54)°, and (30.61 ± 7.94)° at 7 days and 1 year postoperative, respectively. In the STF group (33 feet), Gissane’s angle altered from (110.47 ± 14.45)°, to (122.08 ± 8.84)°, and (120.67 ± 9.07)° and Böhler’s angle altered from (11.32 ± 6.77)°, to (28.82 ± 8.52)°, and (28.25 ± 9.13)° (P < 0.001). However, there was no statistically significant difference in functional outcomes at 1 week after surgery and 1 year after surgery (P > 0.05). The AOFAS scores at the final follow-up of the two groups: ST group (88.95 ± 6.16) and STF group (89.78 ± 8.76); VAS scores, ST group (0.83 ± 0.98) and STF group (1.03 ± 1.59), all differences were not statistically significant (P > 0.05).ConclusionThe position of sustentaculum tali screws has no significant difference on the short-term clinical outcome in patients with calcaneal fractures, while reliable fixation of screws to sustentaculum tali fragment can achieve similar clinical outcome.Level of evidence V.

Evaluating outcome associations with race after mechanical thrombectomy: an analysis of the NVQI-QOD acute ischemic stroke registry

BackgroundMechanical thrombectomy has become the standard of care for acute ischemic stroke due to large vessel occlusions. Racial differences in outcomes after mechanical thrombectomy for acute ischemic stroke have not...

Does platelet-rich plasma enhance fusion in transforaminal lumbar interbody fusion? A prospective clinico-radiological comparative study

Abstract Background: Several animal studies have shown that platelet-rich plasma (PRP) is effective in enhancing bone fusion. However, the role and efficacy of PRP in spinal fusion surgery remain uncertain. The objective was to evaluate the efficacy of PRP in bone fusion and to compare the clinical and radiological outcomes of transforaminal lumbar interbody fusion (TLIF) with and without PRP. Materials and Methods: This prospective study was done on 50 patients who underwent TLIF surgery for various spinal pathologies. Patients were divided into the control group (underwent TLIF with interbody cage and local bone grafts alone) and the study group (underwent TLIF with interbody cage, local bone grafts, and PRP). Functional outcome was evaluated using visual analog score (VAS) and Oswestry disability index (ODI). Radiological outcome was assessed by Bridwell’s grading system for fusion on computed tomography scan at the end of 2 years. Results: The average bone fusion rate was significantly higher in the PRP group compared to the control group; however, the average duration of fusion was not statistically significant. There was no difference in VAS and ODI at 1 and 2 years. There was also no significant difference in lower back pain, leg pain, and numbness in both groups at the end of 1 year. Conclusion: Although there is no statistically significant difference in functional outcome between both groups, local application of PRP along with autologous bone grafts increases bone fusion rates with good clinical and radiological outcomes.

Functional Outcome of Distal Femoral Fractures using NEER Scoring Managed by Distal Femoral Locking Plate versus Retrograde Intramedullary Nail: A Cross-sectional Study

Introduction: Distal femur fractures are a group of fractures that have been a topic of debate for the past decade, were traditionally treated mainly using conservative methods. However, with advancements in surgical techniques and implants, operative intervention has now become the preferred treatment approach. There are various methods for treating distal femur fractures and the present study compares the treatment of distal femoral fracture using distal femur nailing versus the use of locking plate. Aim: To compare the functional outcomes of stabilising distal femur fractures using locking compression plating versus retrograde nailing and to evaluate the merits and drawbacks of each procedure. Materials and Methods: A cross-sectional comparative study was conducted in the Department of Orthopaedics at Calcutta National Medical College and Hospital, Kolkata, West Bengal, India, over a one-year period from (January 2021 to January 2022. Total 46 patients with distal femur fractures were included, with six lost to follow-up. Two groups were divided in which total 20 patients underwent distal femoral nailing, while 20 were treated with distal femoral locking plates. Functional outcomes were assessed using the NEER Score, aiming for perfect restoration of the articular surface, stable fixation, full knee range of motion, and good functional results. Data were entered into a Microsoft Excel spreadsheet for statistical analysis using Statistical Packages for Social Sciences (SPSS) (version 27.0; SPSS Inc., Chicago, IL, USA). Numerical variables were summarised as mean and standard deviation, while categorical variables were presented as counts and percentages. A p-value of ≤0.05 was considered statistically significant. Results: The study population consisted of 70% males with a mean age of approximately 55 years. Road traffic accidents were the most common mode of injury. The mean time for radiological union in the nailing group was 14.05 weeks, significantly shorter than the 16 weeks in the plating group. The mean range of knee flexion was 111° in the nailing group and 114.5° in the plating group. The average NEER score was 84.10 for the plating group and 83.30 for the nailing group. There was no statistically significant difference in functional outcomes between the two groups. Conclusion: Both retrograde intramedullary nailing and the use of locking compression plates can be considered as suitable treatment options. Early weight-bearing can be initiated with retrograde nailing. No significant difference was observed in terms of outcome, fracture healing, or NEER score. The time taken for radiological union of fractures using both techniques was comparable. Proper operative planning, execution, and adherence to a strict rehabilitation protocol play crucial roles in the overall patient outcome.

Efficacy of Lumbar Transforaminal Epidural Steroid Injections for Lumbosacral Radiculopathy in Individuals with Spine Surgery: A Retrospective Comparative Study

Introduction: Transforaminal epidural steroid injections (TFESI) have demonstrated their efficacy in both short-term and long-term treatment of radicular pain with their targets being the anterolateral epidural space and dorsal root ganglion. Although the evidence for transforaminal injections in treating radiculitis secondary to discherniation and lumbar stenosis is strong, evidence is limited regarding its effect on axial pain and in patients with failed back surgery syndrome (FBSS). Methodology: 61 patients were registered in this retrospective comparative study who underwent lumbar TFESI for lumbosacral radiculopathy from March 2021 to March 2022. All patients were assessed for difference in pain relief, disability and functional outcome at baseline and at the time of follow up using NRS, ODI &amp; PROMIS. As a secondary objective the patients were divided into two groups those with previous history of spine surgery (Group A) and non-operated patients (Group B) to Compare the mean levels of pain relief, functional outcome and disability in spine surgery patients compared to non-operated patients. After Ethical committee approval and informed consent from patient baseline scores (NRS, ODI &amp; PROMIS) were accessed from the MRD and follow up scores were obtained by sending a questionnaire across to the patient by email. The average follow up time was 1 year and 4 months (Mean). Results and Observations: A minimum clinically important difference (MCID) of &gt;2.0 was selected for the change in NRS to further determine the proportion of responders who experienced a clinically significant reduction of pain. Success in achieving MCID is defined by ≥3 t score change for all PROMIS instruments. Success in achieving MCID for ODI is defined as at least 30% score change at follow up from baseline score. There is no significant difference in pain relief, disability improvement, functional outcome as assessed by NRS, ODI &amp; PROMIS between the two groups. In this study the success in achieving MCID for NRS was 70% in Group A and 63% in group B and overall 67% indicating that total 41 patients (67%) had significant reduction in NRS after TFESI. In this study success of achieving MCID for ODI was 38.7% among Group A which was comparable to 23.3% among Group B and the difference was not statistically significant. The overall success of achieving MCID for ODI was total 19 patients (31.1%) indicating only 31% patients had significant improvement in disability post TFESI. There is no significant difference in functional outcome as assessed by PROMIS instruments between the two groups. For PROMIS PF, PI, SD the success of achieving MCID was greater than 70% overall and for both the groups. Conclusion: There is no doubt regarding the efficacy and therapeutic effect of TFESI in axial lumbosacral pain/radicular pain in non-operated patients. This study demonstrates the success rate of TFESI in spine surgery patients (FBSS) as well by utilizing PROMIS as an outcome measure and by use of a control group demonstrating improved Physical Function, less pain interference &amp; improved sleep.

Long-Term Outcomes Following Freehand Minimally Invasive Aspiration for Deep Supratentorial Intracerebral Hemorrhage: A Multicenter Cohort Study.

The aim of this study was to compare the therapeutic effects of non-navigated freehand minimally invasive aspiration and conservative medical care in patients with deep supratentorial intracerebral hemorrhage (ICH). We analyzed data from a prospective multicenter cohort study. Propensity score matching was performed to adjust for possible confounding factors. A total of 122 patients with first-onset deep supratentorial ICH with a volume ≥ 20ml were enrolled. All patients were followed up at 30days, 90days, and 1year. The mortality rate, functional outcomes, complications, and treatment costs were compared between the two groups. After propensity score matching, 122 patients with a mean age of 56.0years were included, 77.9% of whom were male. The median ICH volumes were 45.5ml in the surgery group and 48.0ml in the conservative group. The mortality rate at 30days was significantly lower in the surgery group than in the conservative group (P = 0.0127). There were no significant differences in functional outcomes at the 90-day and 1-year follow-ups between the two groups (P > 0.05). There was no significant difference in complications, including recurrent bleeding (6.6% vs. 4.9%), pulmonary infection (57.4% vs. 41.0%), deep venous thrombosis (9.8% vs. 11.5%), heart failure (1.6% vs. 6.6%), and cerebral infarction (4.9% vs. 3.3%), between the two groups. For deep supratentorial ICH, non-navigated freehand minimally invasive aspiration was safe and reduced short-term mortality but did not effectively improve long-term functional outcomes.

Bankart Repair Versus Bristow-Latarjet Procedure in Treating Anterior Shoulder Dislocation: A Systematic Review

Introduction: Anterior shoulder dislocation affects an estimated 11/100,000 individuals annually, primarily involving the inferior glenohumeral ligament and causing recurrent instability. Surgical approaches like anatomical labral repair and the Bristow-Latarjet procedure are common for managing these issues. This systematic review aimed to compare the clinical and functional outcomes of Bankart repair and the Bristow-Latarjet procedure in treating anterior shoulder dislocation. Methods: Following PRISMA guidelines, a comprehensive search was conducted across PubMed, Google Scholar, Science Direct, and the Cochrane Library, resulting in 154 studies. From these, 4 studies were selected: two retrospective cohorts, one prospective cohort, and one case-control, encompassing 414 patients. Among them, 257 patients underwent the Bristow-Latarjet procedure, while 157 received Bankart repair. Inclusion criteria covered English-language studies evaluating clinical outcomes such as SSV, WOSI, Rowe scores, movement loss, and arthropathy rates, with no demographic restrictions, while non-English studies were excluded. Quality evaluation employed classifications by the Oxford Center for Evidence-based Medicine, GRADE criteria, and AHRQ for assessing evidence strength, bias, and quality. Results: The systematic review selected 4 studies from the 154 identified, incorporating a total of 414 patients. Of these, 257 underwent the Bristow-Latarjet procedure, and 157 received Bankart repair. The studies comprised two retrospective cohorts, one prospective cohort, and one case-control study. Conclusion: The review revealed no significant difference in functional outcomes between Bankart repair and the Bristow-Latarjet procedure for anterior shoulder dislocation. The choice between these methods depends largely on surgeon preference and technological accessibility. However, more comprehensive, high-quality studies are needed to better guide the selection between these procedures. Keywords: Anterior shoulder dislocation; Glenohumeral ligament; Bankart repair; Bristow-Latarjet procedure.