Single-stage Procedure Research Articles

Single-Stage Image-Guided Percutaneous Ablation with Thoracoscopic Resection for Multiple Pulmonary Lesions in a Hybrid Operating Room: A Retrospective Study.

Different approaches are required in treating patients with multiple pulmonary lesions. A multistage procedure may increase the risk of complications and patient discomfort. This study reports an initial experience with single-stage management of multiple lung lesions using percutaneous ablation with thoracoscopic resection in a hybrid operating room (HOR). We retrospectively evaluated patients who underwent combined ablation and resection in an HOR between May 2022 and July 2024. All patients received a single anesthesia via endotracheal tube intubation. The clinical data, operative findings, and pathological characteristics of the lung nodules were recorded. A total of 22 patients were enrolled in this study. Twenty patients underwent unilateral procedures, while the other two patients underwent bilateral procedures. Ablations were performed before lung resection in 21 patients; only 1 patient underwent surgery first. The median global operating room time was 227.0 min. The median total radiation dose (dose area product) was 14,076 μGym2. The median hospital postoperative length of stay was 2 days. The single-stage procedure of percutaneous ablation with thoracoscopic resection under general anesthesia in an HOR is feasible and safe. This procedure is an alternative method for managing multiple pulmonary lesions.

Incidental findings of borderline ovarian tumor or ovarian cancer - real-world data on surgical and oncological outcomes.

Centralization of ovarian cancer treatment is associated with higher rates of optimal surgery and longer survival. However, preoperative diagnosis of ovarian cancer is challenging and some diagnoses are made incidentally after surgery. This study investigated the surgical and oncological outcomes of patients with incidental findings of borderline ovarian tumors or ovarian cancer who were centralized postoperatively and treated with a two-stage surgical procedure, and compared these with those of patients with adnexal masses of suspected malignancy who were offered a single-stage surgical procedure with intraoperative frozen section in a tertiary hospital. A database of 390 patients with adnexal masses and surgical treatment at the Bern University Hospital, Switzerland was retrospectively reviewed to identify patients with borderline ovarian tumors or ovarian cancer between 2010 and 2020. Among 390 patients with adnexal masses, 223 were diagnosed with a borderline ovarian tumor or ovarian cancer. Compared with patients with suspected malignancy and a centralized single-stage surgical procedure, patients with an incidental postoperative malignancy diagnosis and a two-stage surgical procedure underwent more surgical interventions (1.3 vs. 2.1 p<.001) and had a longer time interval from diagnosis to initiation of chemotherapy (33.3 vs. 45.1 p=.005) and to completion of surgical cytoreduction (31.9 vs. 73.7 days, p<.001). However, there were no differences in the rates of complete cytoreduction (90.0% vs. 93.2%, p=.719), intraoperative (11.3% vs. 13.7%, p=.664) or postoperative (38.7% vs. 37.0%, p=.884) complication rates, and number of hospitalization days (11.1 vs. 12.0 days, p=.369). An incidental diagnosis of malignancy with postoperative referral was neither associated with an increased risk of recurrence (hazard ratio (HR) 0.8, 95% confidence interval (CI) 0.6-1.8, p=.839) nor death (HR 0.7, 95% CI 0.4-1.1, p=.113), and there was no difference in mean recurrence-free survival between the study subgroups. Although patients with incidental findings of borderline ovarian tumors or ovarian cancer treated with a two-stage surgical procedure had a longer time to completion of surgical staging and initiation of chemotherapy, our results showed no negative impact on oncological outcomes.

OSSEOINTEGRATIVE PROSTHETICS: OPPORTUNITIES, CHALLENGES, AND PROSPECTS FOR ITS APPLICATION IN THE REHABILITATION OF PATIENTS WITH AMPUTATED LIMBS (LITERATURE REVIEW)

Rehabilitation of patients with amputated limbs is a pressing medical and social issue in modern society. A novel method for partial restoration of limb function is osseointegrative prosthetics. Its main advantage lies in the fact that the implant allows mechanical loads and forces to be transmitted directly to the bone, whereas in traditional prostheses, they mainly act on soft tissues. Despite nearly 30 years of experience with osseointegrative implants globally, these technologies have not yet been implemented in either scientific or clinical practice in Ukraine. Objective. To conduct a literature review of the global practical experience with the use of osseointegrative prosthetics in patients with amputations and to identify its main features, advantages, and disadvantages. Methods. The information search was performed in the bibliographic databases PubMed, Scopus, and Google Scholar. Results. The analysis of literature sources allowed us to distinguish the main types of osseointegrative implants, which differ in terms of design, materials, and surgical techniques: either single-stage or two-stage procedures, and fixation by threading or press-fitting. The rehabilitation period ranges from 6 months to 2 years. Within the first two years, certain complications such as bone infections and skin inflammation should be expected. Hфowever, most of these pathological conditions can be effectively managed. Conclusions. Successful fixation of osseointegrative implants requires optimizing the patient’s bone, the prosthetic surfaces, and the ‘skin-implant’ interface. The implementation of these technologies requires multidisciplinary teams of specialists, including physicians, engineers, and rehabilitation experts. Osseointegrative implants significantly enhance patients’ functional abilities and quality of life, opening up greater opportunities for the use of bionic and robotic prosthetics.

Osteoperiosteal fibular strut grafting - A technique to improve union rates.

Gap non-union of long bones are challenging problems in orthopaedic patients. Non-vascularized fibular grafting is a simple, cost effective, single stage procedure and is an accepted method of reconstruction for gap non unions in children. However, there is a risk of non-union when a long avascular strut of fibula is used. The periosteum, by itself has high biological activity and is helpful in osteointegration. Harvesting the fibula with the periosteum gives the advantage of mechanical and biological support in a gap non-union. During 2020 to 2022, 13 patients presented to us with gap nonunion of long bones due to various aetiology. The mean age of the patients was sixyears with a mean bone gap of 4.2cm. A modified technique of harvesting the fibula with the periosteum is described. The graft was stabilized with the recipient bone by intra medullary or extra medullary implants. Union occurred in average 12.7weeks in all except one patient with congenital pseudoarthrosis of tibia. The fibula on the harvest site regenerated completely in all other patients. One patient had a superficial infection. Children were followed were an average of 17.5months and there was no incidence of graft resorption or fracture. Osteoperiosteal fibula graft is a simple, effective and cost-effective procedure for the treatment of gap non-unions in children. It offers the advantage of both biological and mechanical support, with high union rates and low complication rates.

What happens after the free flap? Evaluation of aesthetic and functional elective revisions

BackgroundMicrovascular free flap reconstruction of a defect, as a single-stage procedure, does not always achieve the desired functional and esthetic result. Revisions may be necessary to achieve ideal contour, symmetry, and suspension of soft tissues, or to support dental rehabilitation. PurposeThe study purpose was to estimate the incidence and identify factors associated with elective free flap revisions.Study design, setting, sample: A retrospective cohort study of subjects who underwent free flap reconstruction was conducted to characterize the rate of elective free flap revision surgery. The study included subjects >18 years old, who underwent head and neck microvascular free flap surgery for any etiology, and both primary and secondary reconstructions, between 2014-2021. Subjects were excluded if they had incomplete records. Predictor variableThe predictor variable was composed of a set of variables, grouped into the following categories: subject demographic data, medical history, disease etiology, anatomical site, and postoperative complications. Main outcome variableThe outcome variable was time to elective revision surgery measured as months from the date of the initial operation to date of elective revision surgery. Elective revision surgery was defined as a procedure to enhance esthetics or function, which directly modifies the original surgical site, not including procedures to correct a complication, treat the original disease process, or emergencies. CovariatesNot applicable. AnalysisKaplan-Meier method was used to analyze the data, with p-value <0.05. Risk factors for elective revisions were analyzed with Cox Hazard ratio. ResultsThe sample was composed of 377 subjects that underwent free flap surgery, with a mean age of 55.9 +/- 15.9. Of these 67% were male, and 33% female, and sixty-two had an elective revision surgery (16.4%), with median follow-up period of 17 months (IQR 9-28). In the Cox regression model, only type of free flap was associated with an elective revision (p<0.05), where radial forearm had the lowest association with elective revision, and fasciocutaneous, latissimus dorsi, and scapula flaps had the highest. Conclusion and RelevanceAchieving basic wound coverage with free flaps can be a challenge, however, surgeons should prepare patients for the potential need for functional and esthetic revisions after free flap surgery to improve patient quality of life.

Total umbilical reconstruction using a tri-radiate incision technique

BackgroundNeo-umbilicus aesthetics, often previously ignored or considered an afterthought, is now a major concern in abdominal surgical planning for abdominoplasty in morbid obesity and ventral hernia repairs. Umbilical loss or deformation is immediately recognised owing to its central position causing psychological discomfort, stress and low self-esteem in patients.Several umbilical surgical techniques are described, but there is no universally accepted “standard” technique for umbilical reconstruction.Our purpose was to describe a new method, the tri-radiate incision (TRI) which leads to the creation of an aesthetically pleasing navel, significantly improving the patient’s satisfaction and surgeon’s cosmetic standards. Methods and materialsThis study consisted of 21 consecutive cases of umbilical reconstruction of obese (18) and non-obese (3) patients during abdominoplasty (10) or ventral hernia repair (11) as the main indicators and patient satisfaction was rated post-operatively. ResultsNo major post-operative complications such as flap necrosis, umbilical stenosis, flattening or misplacement, cicatricial hypertrophic scarring, infection or haematoma, as recorded in various techniques requiring revision surgeries, were encountered. Serosanguineous discharge observed during the first week was very common.Patient satisfaction with the umbilicus was rated 10/10 by 17 patients and 9/10 by 4 patients from the obese and non-obese categories. ConclusionThe minimally scarring TRI neo-umbilicus technique offers a new option regardless of age, gender or body mass index in creating a neo-umbilicus that is safe, reliable and reproducible using a single-staged procedure. It achieves all the permanently desired aesthetic standards, with relatively little or no post-operative complications but high patient satisfaction in abdominoplasty and hernia repair.

Primary Anterior Sagittal Anorectoplasty Shift from Staged to Single-stage Procedure for Low Anorectal Malformations in Female Children: Our Initial Experience in Single Centre.

Anorectal malformation (ARM) is a common congenital anomaly found in the paediatric age group. Previously, the repair of the vestibular fistula (VF) was performed as three-stage procedure with initial colostomy followed by a definite procedure and, lastly, colostomy closure. At present, a single-stage procedure is preferred, especially in lower anomalies owing to the convenient and time-saving approach. The clinical profile and outcome of ASARP for treatment of ARM in females (vestibular anus and perineal fistula). A retrospective analytical study was conducted at Government Medical College, Jammu. A total of 60 patients were included in the study. Most of the patients were in the age group of 1-5 years (30%), followed by 6 months-1 year age group (25%). Forty-five (75%) females had VF while 15 (25%) had perineal fistula. Intraoperative complication was vaginal tear seen in 6 (10%) patients followed by rectal tear seen in 3 (5%) patients. Early post-operative complications were seen in 9 (15%) patients. Wound infection was the most common complication seen in 5 (8.3%) patients, wound dehiscence in 3 (5%) patients and retraction of rectum in 1 (1.6%) patient. Late post-operative complications were seen in 24 (40%) patients. Perineal excoriation was the most common complication seen in 6 (10%) patients, constipation seen in 5 (8.3%) patients, anal stenosis in 4 (6.6%) patients and mucosal prolapse in 4 (6.6%) patients. The single-staged ASARP procedure resulted in satisfactory outcomes. It is an excellent procedure for females with VF and perineal fistula. Appropriate selection, preparation of patient, optimal correction with minimal sphincter damage and needful post-operative care of wound give excellent cosmetic and functional outcomes in terms of continence. It also decreases the burden on treating the surgeon, family and psychological stress on the patients and parents.

ThP2.14 - Staged laparoscopic traction orchidopexy (SLTO) for impalpable testes

Abstract Aim SLTO enables elongation of the testicular vessels without division by Shehata (JPS 2015). We presented first UK data in 2020 assessing SLTO. It was suggested that a single stage traction procedure may be possible in some patients. We now present follow up data including the single stage traction technique. Methods Data was collected prospectively from a single centre and grouped into 2 time periods: Group A (March 2017 to July 2019), Group B (November 2020 to December 2023). The gubernaculum was divided. If the vascular pedicle was long enough to allow the testis to reach the contralateral inguinal ring the testis was brought down to the scrotum using an 11mm STEP port and secured in a subdartos pouch with 2/0 Ti-cron. If the vascular pedicle was short, 2-stage traction was performed by securing the intra-abdominal testis to the contralateral anterior abdominal wall using a 2/0 Ti-cron stitch. 3-6 months later the testis was brought down to the scrotum as described above. A prospective database was used for data collection and analysis. Outcome measures included presence of a palpable testis in the scrotum at follow-up, ultrasound determined testicular volumes and percentage difference compared to contra-lateral testis where applicable and complications. Follow up was 6 months following the 2nd stage procedure. Results The later cohort (Group B) demonstrated a higher proportion (32%) of single stage procedures compared to Group A (0%). The success rates for both groups were high 95-100%, with a significantly reduced complication rate (9%) seen in Group B compared to Group A (33%) p=0.048.

ThP3.14 - Four-Year Experience of Laparoscopic Transcystic common bile duct exploration at a District Hospital

Abstract Aim This study aims to assess the outcomes of Laparoscopic Common Bile Duct Exploration (LCBDE) as a single-stage procedure for symptomatic choledocholithiasis. Methods In this retrospective analysis we included 87 patients with high suspicion of common bile duct (CBD) stones, imaging proven choledocholithiasis or failed Endoscopic Retrograde cholangiopancreatography (ERCP). These patients underwent either LCBDE or CBD exploration under fluoroscopy between 2019 and 2023. Results Among the 87 patients selected for a single stage procedure, 59 underwent Laparoscopic transcystic CBDE. Successful CBDE was achieved in 40 cases (68%), with four patients after failed ERCP. In one case on table ERCP with rendez-vous technique was used to complete CBD clearance. Two of them needed complementary post operative ERCP to remove impacted stones. Most cases with unsuccessful CBDE, 19 in total (32%), was due to difficult cannulation of a narrow cystic duct. Three were managed with on table ERCP and five had post-operative ERCP. Six patients (7%) experienced unplanned readmissions, three with retained stones post-successful stone clearance and two after clear on table cholangiogram, who were managed with ERCP. Bile leak occurred in two cases and it was self-limited within 14 days. The mean hospital length of stay (LOS) was 5,3 days with a median LOS of 4 days. Conclusion Transcystic LCBDE, when surgical expertise and experience are available, is an effective and safe procedure for treating choledocholithiasis, providing comprehensive CBD clearance while avoiding the risks associated with ERCP.

Single-stage procedure of carotid artery stenting and transcatheter aortic valve implantation.

Single-stage procedure of carotid artery stenting and transcatheter aortic valve implantation.

Single-stage Differential Template Technique for the Repair of Palpebral Neurofibromatosis With Severe Blepharoptosis in Adults.

To report the surgical outcomes of single-stage differential template technique for the correction of palpebral neurofibromatosis associated with severe blepharoptosis in adults. This is a retrospective interventional case series. Adult patients with severe unilateral palpebral neurofibromatosis, severe blepharoptosis, and lateral canthal dystopia underwent a single-stage repair. The excess anterior and posterior lamellae of the eyelid tissue were excised in a differential manner, using the other eyelid as a template (differential template technique). The levator muscle was resected and reattached to the tarsus during the reconstruction. The surgical outcomes and complications were evaluated. A total of 5 patients underwent the differential template technique. The median age at presentation was 24 years, and 4 were males. All had severe blepharoptosis, with excess upper eyelid and temporal plexiform neurofibroma. All underwent a single-stage procedure with an average follow-up of 17.8 months. The average palpebral fissure height improved from 0 mm preoperatively to 8.25 mm postoperatively, with a well-formed eyelid crease and an average lagophthalmos of 2 mm. Good functional and cosmetic outcome was noted in all patients, with no exposure keratopathy. Two patients had a lateral canthal "stand-off," and 1 patient developed mild upper eyelid retraction, which was managed conservatively. A single-stage differential template technique can correct palpebral neurofibromatosis with severe blepharoptosis providing good cosmetic and functional outcomes.

Autologous matrix-induced chondrogenesis provides better outcomes in comparison to autologous minced cartilage implantation in the repair of knee chondral defects.

In symptomatic mid-sized focal chondral defects, autologous matrix-induced chondrogenesis (AMIC) and minced cartilage implantation (MCI) offer two versatile treatment options. This study aimed to conduct a matched-patient analysis of patient-reported outcome measures to compare these two surgical treatment methods for focal chondral defects. At the first centre, patients underwent a single-stage procedure in which autologous cartilage was hand-minced, implanted into the defect and fixed with fibrin glue. At the second centre, patients underwent AMIC, which was fixed in place with fibrin glue. All patients were seen 2-4 years postoperatively. Postoperative outcomes were assessed using the visual analogue scale for pain (VAS), the Lysholm score and the five domains of the knee osteoarthritis outcome score (KOOS). Patients from each surgical centre were matched by age, sex, defect size and defect localisation. In total, 48 patients from two surgical centres (24 from each site) were matched for sex, age (MCI 30.3 ± 14.9 years vs. AMIC 30.8 ± 13.7 years) and defect size (MCI 2.49 ± 1.5 cm2 vs. AMIC 2.65 ± 1.1 cm2). Significantly better scores in the AMIC cohort were noted for VAS (p = 0.004), Lysholm (p = 0.043) and the KOOS subscales for pain (p = 0.016) and quality of life (p = 0.036). There was a significantly greater proportion of positive responders for Lysholm in the AMIC group (92%) compared with the MCI group (64%). The AMIC procedure delivers superior patient outcomes compared with hand-minced autologous cartilage implantation. These are mid-term outcomes, with follow-up between 2 and 4 years. Level III.

Enhancing Pathogen Detection in Implant-Related Infections through Chemical Antibiofilm Strategies: A Comprehensive Review.

Implant-related infections (IRIs) represent a significant challenge to modern surgery. The occurrence of these infections is due to the ability of pathogens to aggregate and form biofilms, which presents a challenge to both the diagnosis and subsequent treatment of the infection. Biofilms provide pathogens with protection from the host immune response and antibiotics, making detection difficult and complicating both single-stage and two-stage revision procedures. This narrative review examines advanced chemical antibiofilm techniques with the aim of improving the detection and identification of pathogens in IRIs. The articles included in this review were selected from databases such as PubMed, Scopus, MDPI and SpringerLink, which focus on recent studies evaluating the efficacy and enhanced accuracy of microbiological sampling and culture following the use of chemical antibiofilm. Although promising results have been achieved with the successful application of some antibiofilm chemical pre-treatment methods, mainly in orthopedics and in cardiovascular surgery, further research is required to optimize and expand their routine use in the clinical setting. This is necessary to ensure their safety, efficacy and integration into diagnostic protocols. Future studies should focus on standardizing these techniques and evaluating their effectiveness in large-scale clinical trials. This review emphasizes the importance of interdisciplinary collaboration in developing reliable diagnostic tools and highlights the need for innovative approaches to improve outcomes for patients undergoing both single-stage and two-stage revision surgery for implant-related infections.

Personalized total knee arthroplasty in patients with extra-articular deformities.

Over the years, with a better understanding of knee anatomy and biomechanics, superior implant designs, advanced surgical techniques, and the availability of precision tools such as robotics and navigation, a more personalized approach to total knee arthroplasty (TKA) has emerged. In the presence of extra-articular deformities, performing personalized TKA can be more challenging and specific considerations are required, since one has to deal with an acquired pathological anatomy. Performing personalized TKA surgery in patients with extra-articular deformities, the surgeon can: (1) resurface the joint, omitting the extra-articular deformity; (2) partially compensate the extra-articular deformity with intra-articular correction (hybrid technique), or (3) correct the extra-articular deformity combined with a joint resurfacing TKA (single stage or two-stage procedure). Omitting the acquired lower limb malalignment by resurfacing the knee has the advantages of respecting the joint surface anatomy and preserving soft tissue laxities. On the other hand, it maintains pathological joint load and lower limb kinematics with potentially detrimental outcomes. The hybrid technique can be performed in most cases. It circumvents complications associated with osteotomies and brings lower limb axes closer to native alignment. On the other hand, it creates some intra-articular imbalances, which may require soft tissue releases and/or constrained implants. Correcting the extra-articular deformity (through an osteotomy) in conjunction with joint resurfacing TKA represents the only true kinematic alignment technique, as it aims to reproduce native knee laxity and overall lower limb axis.

Human Acellular Collagen Matrices-Clinical Opportunities in Tissue Replacement.

The field of regenerative medicine is increasingly in need of effective and biocompatible materials for tissue engineering. Human acellular dermal matrix (hADM)-derived collagen matrices stand out as a particularly promising candidate. Their ability to preserve structural integrity, coupled with exceptional biocompatibility, positions them as a viable choice for tissue replacement. However, their clinical application has been largely confined to serving as scaffolds. This study aims to expand the horizon of clinical uses for collagen sheets by exploring the diverse cutting-edge clinical demands. This review illustrates the clinical utilizations of collagen sheets beyond traditional roles, such as covering skin defects or acting solely as scaffolds. In particular, the potential of Epiflex®, a commercially available and immediately clinically usable allogeneic membrane, will be evaluated. Collagen sheets have demonstrated efficacy in bone reconstruction, where they can substitute the induced Masquelet membrane in a single-stage procedure, proving to be clinically effective and safe. The application of these membranes allow the reconstruction of substantial tissue defects, without requiring extensive plastic reconstructive surgery. Additionally, they are found to be apt for addressing osteochondritis dissecans lesions and for ligament reconstruction in the carpus. The compelling clinical examples showcased in this study affirm that the applications of human ADM extend significantly beyond its initial use for skin defect treatments. hADM has proven to be highly successful and well-tolerated in managing various etiologies of bone and soft tissue defects, enhancing patient care outcomes. In particular, the application from the shelf reduces the need for additional surgery or donor site defects.

Is It Safe to Operate without Frozen Section Biopsies in Short-Segment Hirschsprung's Disease? An Overview of 60 Cases.

Background: Advancements in surgical management in a single-stage procedure made intraoperative frozen section biopsies critical for determining of level of resection to avoid the potential risk of leaving a retained aganglionic segment. However, in most low-income countries, due to the lack of this facility, the surgeon's intraoperative judgment is used for the determination of the resection level. Objective: This study aims to evaluate the accuracy of determining the level of bowel resection in short-segment Hirschsprung's disease based on macroscopic changes. Materials and methods: Intraoperative macroscopic evaluations were assessed using postoperative microscopic findings to determine whether the surgeons' intraoperative judgments were accurate in determining the level of bowel resection in 60 cases of operated short-segment Hirschsprung's disease. In addition, Pearson's correlation coefficient was used to determine whether the sensitivity and specificity of both methods were significantly correlated. Results: The microscopic results showed that the level of resection based on the macroscopic evaluation was performed in normally ganglionated segment in cases of short-segment Hirschsprung's disease. Conclusions: Macroscopic intraoperative assessment by an experienced surgeon is highly accurate method of determining the level of bowel resection in short-segment HSCR.

The use of peroneus brevis in lower limb reconstruction—What we have learned from 49 cases

IntroductionThere are many suitable techniques for the treatment of soft tissue defects of the lower limb. Older subjects often with multiple comorbidities, presenting with a laterally located and complex defect, can be challenging to treat. This cohort are often unsuited to long procedures or multi-stage reconstruction and so one is faced with a paucity of options. In such instances, we use the peroneus brevis (PB) muscle flap as a single stage procedure. MethodsWe performed a retrospective study evaluating the use of PB flaps in lower limb injury. Subjects were collated using a database and multiple variables were assessed including: patient demographics, comorbidities, defect size, peri-operative timings, time in theatre, use of inotropes / blood transfusion, mean hospital stay, patient morbidity / mortality, flap survival. ResultsDuring 2015–2023, 49 patients underwent lower limb reconstruction using PB muscle flaps. 42 cases involved PB and skin graft alone whilst seven were more complex requiring additional local and free tissue techniques. The most common indication (n = 28) was infection after closed fracture fixation, followed by open trauma (n = 21).Median patient age was 59 (20–93 years), and ASA grade 3. Median defect size was 4 × 7 cm (2–18 cm) and time from admission to definitive closure 4 days (0–21 days) with median time in theatre 120 min (45–520 min). 17 patients required inotropes and 13 had blood transfusion. Median length of hospital stay was 12 days (0–58 days), one patient (aged 90) died. 100 % of flaps survived and median Enneking score was 65. Heterotopic ossification was not identified in the post-operative imaging within the first year. DiscussionOur experience highlights the benefits and risks of using the PB flap and advocates it as a reliable, cost-effective, 1-stage technique for reconstructing small lateral defects in the distal third of the lower limb.

Evaluation of chronic perilunate dislocations: A comparative study of single-stage, two-stage ORIF, and salvage procedures

ObjectiveThis study aims to evaluate the outcomes of open reduction and internal fixation (ORIF) for chronic perilunate dislocations using single-stage, two-stage, and salvage procedures. The study also compares these approaches with each other and with results from existing literature. MethodsA total of 15 patients with chronic perilunate injuries from 2013 to 2019 were included in the study. Pre-operative and post-operative assessments were conducted using plain radiographs, with CT scans performed selectively for detailed morphology and fracture pattern analysis. Among the patients, 13 underwent ORIF, while 2 underwent salvage procedures. Among the ORIF cases, single-stage procedures were performed in 4 patients, and two-stage procedures in 9 patients. External fixators, including unilateral uniplanar external fixators (UUEF) and bilateral uniplanar external fixators (BUEF), were applied in 5 and 4 patients, respectively. Our methodology of treating chronic perilunate injuries has evolved over the years. We started with single stage ORIF then graduated to a two staged procedure initially using a external fixator as a carpal distractor applied only on the radial side and finally settling down with bilateral carpal distraction using external fixators both on the radial and ulnar sides. ResultsAmong the 15 patients, 3 were lost to follow-up. Of these, one underwent four-corner fusion, while the remaining two had UUEF. The mean time interval between injury and surgery was 3.60 months. The post-operative mean scapholunate angle measured 52.46°, with a negative radio-lunate angle (indicating flexion) observed in two patients, while others showed a positive angle (indicating extension). Two cases exhibited nonunion and avascular necrosis (AVN) of the scaphoid, while one case presented with lunate AVN. Mid-carpal and radio-carpal arthritis was observed in 4 and 2 patients, respectively. Functional outcomes were evaluated using Mayo's wrist score categorized as good for two-stage BUEF cases and satisfactory for UUEF and single-stage procedures. ConclusionStaged reduction utilizing the BUEF followed by open reduction has demonstrated superior outcomes when compared to UUEF, single-stage open reduction and salvage procedures. Level of evidence: 4

An Experimental Study of the Frictional Behavior at the Interface Soil-Structure with Regards to Wall Friction Effect and Clogging Related to Surface Roughness Form

Abstract The interactions between soil-structure are largely governed by the shear strength at the soil-structure interface, particularly in situations involving large displacements, known as shear residual strength. This latter can be influenced by a range of factors, including normal stress, physical properties, surface roughness, wall friction. The main objective of this study is to investigate clogging related to surface roughness form, in addition to wall friction arises from consolidation. In order to investigate the impact of wall friction, experiments involving ring shear tests were carried out on kaolin. Four different consolidation durations were employed to induce varying settlements of the upper platen, while three distinct testing procedures, including single stage, multistage, and preshearing, were utilized. Additionally, different levels of surface roughness were incorporated to investigate the effect of clogging. The test results obtained from various testing procedures indicate that employing a single stage procedure with zero consolidation time is the most suitable approach for mitigating the influence of wall friction. For clogging effect, is dependent on the materials used, namely, the kaolin and the mixture, as well as, the interfaces involved.

MEDIUM- AND LONG-TERM OUTCOMES OF SURGICAL RECONSTRUCTION IN ACUTE CHARCOT NEUROARTHROPATHY

IntroductionCharcot neuroarthropathy (CN) of foot and ankle presents significant challenges to the orthopaedic foot and ankle surgeon. Current treatment focuses on conservative management during the acute CN phase with offloading followed by deformity correction during the chronic phase. However, the deformity can progress in some feet despite optimal offloading resulting ulceration, infection, and limb loss. Our aim was to assess outcomes of primary surgical management with early reconstruction.MethodsBetween December 2011 and December 2019, 25 patients underwent operative intervention at our specialist diabetic foot unit for CN with progressive deformity and or instability despite advanced offloading. All had peripheral neuropathy, and the majority due to diabetes. Twenty-six feet were operated on in total - 14 during Eichenholtz stage 1 and 12 during stage 2. Fourteen of these were performed as single stage procedures, whereas 12 as two-stage reconstructions. These included isolated hindfoot reconstructions in seven, midfoot in four and combined in 14 feet. Mean age at the time of operation was 54. Preoperative ulceration was evident in 14 patients.ResultsMean follow up was 45 months (Range 12–98). There was 100% limb salvage. One-year ambulation outcomes demonstrate FWB in bespoke footwear for 17 patients and in an ankle foot orthosis (AFO), Charcot restraint orthopaedic walker (CROW) or bivalve cast for seven. All preoperative ulceration had healed. Union was achieved in 18/21 hindfoot reconstructions and 7/18 midfoot reconstructions. There were nine episodes of return to theatre, of which five were within the first 12 months. There was one episode of new ulceration.ConclusionSurgical management of acute CN (Eichenholtz one and two) of the foot provides functional limb salvage. In particular, hindfoot reconstruction shows good rates of bony union. It should be considered in ‘foot at risk’ presentations of acute CN foot.