Trial Of Conservative Treatment Research Articles

Evaluation of the functional outcome following endoscopic decompression of retrocalcaneal bursitis

<b>Introduction:</b> Retro calcaneal bursitis is an inflammation of the bursa located between the posterior surface of the heel bone and the anterior surface of the Achilles tendon. This study was conducted to evaluate the clinical efficacy of endoscopic decompression and debridement in patients with retrocalcaneal bursitis who had not responded to conservative treatment. Our primary objective was to estimate the improvement in American Orthopaedic Foot and Ankle Society (AOFAS) score after surgery, and our secondary objectives were to estimate the average surgical duration and the incidence of post-operative complications.<br /> <b>Material and methods:</b> This was a single-centre intervention study at a tertiary institution's level. Included in the study were all patients who were diagnosed with retrocalcaneal bursitis and who had failed a minimum 6-month trial of conservative treatment. 36 patients (36 heels) underwent endoscopic decompression.<br /> <b>Results:</b> A prospective interventional cohort study was conducted on a total of 36 adult patients (18-70 years) with clinical and radiological findings suggestive of retrocalcaneal bursitis, duration of failed conservative treatment prior to surgery > 6 months, and refractoriness to other forms of non-operative treatment like steroid injections regardless of duration. There were no patients lost to follow-up. The mean duration of follow-up was 6 months [6 months to 2 years]. The average pre-operative AOFAS score was 56.42 6.8, ranging from 44 to 70. The difference between preoperative and postoperative AOFAS scores at 1 week, 2 weeks, 4 weeks, 3 months, and 6 months was statistically significant (p 0.0001).<br /> <b>Conclusion:</b> In patients with retrocalcaneal bursitis, arthroscopic decompression is a safe, effective, and simple procedure. Within the first three months, the majority of study participants experienced pain relief and a significant improvement in function.

O112 The COVID-19 pandemic-induced waiting list delays for shoulder and elbow surgery- analysis of the impact on patient reported EQ5D-5L data and their intention to proceed with the planned procedures

Abstract Introduction The aim of this comparative study was to evaluate patient reported outcome measures (PROMS) using the EQ5D-5L and EQ5D-5L visual analogue scale (VAS) following elective shoulder and elbow orthopaedic list delays arising from the COVID-19 pandemic. Methods Patients on the elective waiting list for more than 26 weeks were included in the study. Telephone interviews were conducted utilizing EQ5D-5L and the EQ5D-5L VAS data at the time of addition to the waiting list and current status. Results 75 out of 324 screened patients were eligible for inclusion. 62 (82.7%) patients still wanted to proceed with their planned procedure (group A) while 13 (17.3%) patients no longer wanted to proceed with surgery (group B). There was no statistically significant difference in the mean age, gender, initial trial of conservative treatment and limb laterality between these groups (P<0.05). There was a statistically significant difference in the mean duration of being on the waiting list between groups A and B (40.4 +/-19 weeks versus 62.9 +/-17.5 weeks respectively). Furthermore, statistically significant differences (P<0.05) in the current EQ5D-5L VAS scores were observed between these groups (52.4 versus 65.8 respectively). Conclusion This study has shown that majority of patients on elective shoulder and elbow orthopaedic lists with prolonged waiting list delays and improved EQ5D-5L scores are likely to decline the planned procedure and vice versa. Nevertheless, the unplanned “watchful waiting” caused by the COVID-19 pandemic and leading to patients deciding to decline surgery, is not a substitute for timely planned surgery to alleviate patients’ suffering.

Urinary incontinence: Comparison study to identify the type, incidence and risk factors between admitted women and the general population in Al-Kharj city, Saudi Arabia

Urinary incontinence (UI) is defined as the involuntary loss of urine. The condition can happen in both genders, but more frequently in women. There are multiple known risk factors for UI. For women, multiparity, previous vaginal deliveries, and menopause are known risk factors for UI. To diagnose UI, three steps should be done, including the patient history, physical examination, and laboratory tests. The options management of UI includes conservative, medical, and surgical, a trial of conservative treatment is recommended by all guidelines before medical or invasive surgical therapy. Conservative therapies include behavioral therapy, physical therapy, and timed voiding. Our aim in this study is to estimate the prevalence of UI in admitted women and the general population and to compare UI between the general population and admitted women in Al-Kharj city. A quantitative cross-sectional study of 108 women admitted to maternity and children's hospital and 435 women from the general population of Al Kharj city, Saudi Arabia, between January and March 2021, aged 18+ years. A hard copy questionnaire was distributed to admitted patients at maternity and children's hospital, and an electronic questionnaire was distributed by social media to the general population. The prevalence of UI in the general population was reported by 132 women (30%). Seventy-four out of 132 women have stress UI (56%), 45 women have urge UI (34%), and the remaining 13 women have mixed UI (10%). The prevalence in admitted women was reported by 38 out of 108 women (35%). Twenty-four out of 38 women have stress UI (63%), 10 women have urgency UI (26%), and the remaining four women have mixed UI (11%). UI is a common health problem in our society. Risk factors for UI are advanced age, multi parity, chronic disease, and obesity.

The Effect of the Covid-19 Pandemic on the Epidemiology of Ankle Joint Injuries in Adults and Children

Ankle joint injuries are an important orthopedic issue due to their high incidence and the variety of treatment methods available. This study assessed the effect of the COVID-19 pandemic on the epidemiology and treatment of ankle joint injuries. There is lack of papers which address this problem. This study compared epidemiological data on ankle joint injuries in adults and children collected during the period of the COVID-19 pandemic (2020) and a corresponding prepandemic period (2019). Epidemiological data, demographic data, treatment methods, hospital stay duration, and injury-to-surgery time were analyzed. The total number of patients hospitalized for ankle fractures in the evaluated pandemic period was lower by 34% than that in the corresponding prepandemic period in 2019. The pediatric patient subpopulation showed a 70% decline during the analyzed period of COVID-19 pandemic. The number of hospitalized females declined by 12%, and the number of hospitalized males dropped by 53%. 1. Our study showed the impact of the COVID-19 pandemic on the epidemiology and treatment of ankle joint injuries. 2. The COVID-19 pandemic effected a decrease in the number of patients with ankle joint injuries, particularly pediatric and male patients with these injuries. 3. National lockdown measures had a considerable effect on lowering the numbers of pediatric patients with ankle joint injuries treated conservatively. 4. Importantly, the tendency can be noted among orthopedic surgeons and emergency room doctors to more readily qualify orthopedic patients for a trial of conservative treatment. This only prolongs the duration of treatment and time to the ultimate therapeutic surgery.

The impact of the post- COVID 19 pandemic elective waiting list delays on patient reported symptoms and intention to proceed with planned upper limb surgeries-A prospective cohort study.

The aim of this study was to evaluate patient reported outcome measures using the EQ5D-5L and EQ5D-5L visual analogue scale (VAS) following elective shoulder and elbow orthopaedic list delays. This was further correlated with patients' intention to proceed with the planned surgery. Patients on the waiting list for more than 26weeks were included in the study. Telephone interviews were conducted utilising the EQ5D-5L and the EQ5D-5L VAS at the time of addition to the waiting list and presently. 75 out of 324 screened patients were eligible. 62 (82.7%) patients still wanted to proceed with their planned procedure while 13 (17.3%) patients in the other group no longer wanted to proceed. There was no statistically significant difference in the mean age, gender, initial trial of conservative treatment and limb laterality between these groups (p<0.05). There was a statistically significant difference in the mean duration of being on the waiting list between these groups (40.4±19 vs. 62.9±17.5weeks respectively). Furthermore, statistically significant differences (p<0.05) in the current EQ5D-5L VAS scores were observed between these groups (52.4 vs. 65.8 respectively). This study has shown that majority of patients on elective shoulder and elbow orthopaedic lists with prolonged waiting list delays and improved EQ5D-5L scores are likely to decline the planned procedure and vice versa. Nevertheless, the unplanned 'watchful waiting' caused by the COVID-19 pandemic and leading to patients deciding to decline surgery, is not a substitute for timely planned surgery to alleviate patients' suffering.

Arthroscopic Management of the Hamate Proximal Pole Arthrosis.

In this retrospective study, all patients with arthrosis of the proximal pole of the hamate encountered in a 10-year period treated with arthroscopy were reviewed. Patient demographics, arthroscopic details, associated injuries, and procedures were reviewed. Functional and patient-reported clinical outcomes after arthroscopic osteochondroplasty were analyzed. An analysis of 39 patients who underwent arthroscopic osteochondroplasty showed a type II lunate prevalence of 87.2%. On wrist arthroscopy, a triangular fibrocartilaginous complex tear was the most common diagnosis (64.1%), followed by scapholunate ligament tear (61.5%) and lunotriquetral ligament tear (35.9%). All patients were managed arthroscopically with 100% procedural success. Average follow-up of 42.8 ± 37.7 months showed statistically significant improvements in the visual analog score and Mayo wrist score postoperatively (P < 0.01). Three patients (7.7%) failed the procedure at a mean of 23 ± 31.4 months. Risk factors for salvage operations were nondominant wrist involvement 100% (P = 0.04), lunotriquetral ligament injury 100% (P = 0.04), the absence of triangular fibrocartilaginous complex injury 100% (P = 0.04), and the presence of scapholunate advanced collapse 100% (P < 0.01). Wrist arthroscopy is valuable for accurately diagnosing and treating hamate arthrosis and identifying a wide variety of pathologies associated. This study showed arthroscopic osteochondroplasty produced satisfactory clinical results. Furthermore, the presence of scapholunate advanced collapse wrist offers its prognostic value in determining treatment failure.

Carpal Tunnel Syndrome: Open or Endoscopic Release Surgery Method?

Carpal tunnel syndrome (CTS) or median nerve neuropathy is among the causes of numbness, paresthesia, and sensory and motor dysfunction in the affected hand. The objective of this study was to compare open and endoscopic carpal tunnel release (ECTR) methods. A multicenter, historical cohort study was performed on 47 hands in 46 patients with a clinical diagnosis of CTS and a failed trial of conservative treatment. Samples were divided into two groups consisting of 23 patients receiving open carpal tunnel release (OCTR) and ECTR. Outcome measurements had been carried out six weeks after the operation and included handgrip strength, post-op pain, and missing job days. Patients in both groups were comparable regarding baseline characteristics such as age, gender, and handgrip strength. Both methods significantly improved handgrip strength. No significant difference was detected between the two groups concerning handgrip strength improvement (P=0.700) and sick leave days (P=0.564). Open carpal tunnel release resulted in more significant post-op pain (mean 5.91±1.24 compared to 2.43±0.73 after endoscopic release), which was significant (P=0.000). No complications were reported with any technique. This study revealed that apart from post-op pain, other investigated endpoints were similar in both groups. Although the small sample size has limited our ability to draw a conclusive statement, these data suggest that there is no need to utilize the endoscopic technique for the optimum result, especially when this method requires more advanced equipment and could increase surgery costs. Therefore, both approaches can result in good clinical outcomes.

Nerve entrapment around elbow

Entrapment neuropathy around elbow is a common cause of disability across all age groups. The major nerves that traverse the elbow are ulnar, median and radial nerves and their branches. Cubital tunnel syndrome leading to ulnar nerve compression can often present with significant pain, paresthesia or weakness. Median and Radial nerve compression around the elbow, albeit less frequent, can also lead to significant morbidity and must be kept in the differential diagnosis when dealing with patients complaining of persistent pain around the elbow and weakness of forearm/hand muscles. Electrodiagnostic studies can be a useful adjunct to clinical examination, to help localize the site and quantify the grade of compression. Management should involve a trial of conservative treatment and failing that, surgical treatment should be considered. We hereby provide an overview of nerve entrapments around the elbow including their applied anatomy, etiology, clinical assessment and overview of the current concepts in surgical treatment.

Percutaneous distal clavicle excision for acromioclavicular joint arthritis: our experience and early results of a novel surgical technique.

Symptomatic acromioclavicular joint (ACJ) osteoarthritis causes pain and limitations in activities of daily living. Open and arthroscopic distal clavicle excision techniques have been described with good outcomes. However, both techniques have their own sets of advantages and disadvantages. This study describes a novel technique of percutaneous distal clavicle excision for symptomatic ACJ osteoarthritis and our two-year results. Fifteen consecutive patients underwent percutaneous distal clavicle excision for ACJ arthritis. These patients had failed a trial of conservative treatment. The ACJ was confirmed as the pain generator with an intraarticular steroid/lignocaine injection, and shoulder MRI was used to exclude alternative pain generators in the shoulder. They had a minimum of two years of follow-up. At a mean of 26.8months postoperatively, the mean VAS pain score was 0, and the mean Constant score for the shoulder was 87.3 points (range 50-94), which corresponded to 1 good, 1 very good and 13 excellent results. The mean SF-36 score was 94.9 points (range 65-100). There were statistically significant improvements in the VAS scores, Constant shoulder scores and SF-36 scores at one year and two years of follow-up (p < 0.05). Three unique complications, namely subcutaneous emphysema, "missing" of the distal clavicle and thermal skin injury, were encountered. Our surgical technique has since been modified to circumvent these complications. Our novel technique of percutaneous distal clavicle excision yields a 93.3% good-to-excellent results based on the Constant shoulder score and durable pain relief based on VAS at two years.

Management of postreconstructive head and neck salivary fistulae: A review of current practices

Salivary fistulas are common complications after reconstructive head and neck surgery with significant morbidity. Yet, there are no established guidelines for their management. A comprehensive search of PubMed was performed from 01/01/2000 to 06/31/2019 to evaluate all treatment options in postreconstructive head and neck fistulas. Nineteen articles with 132 patients were included. Thirty-nine of 132(30%) patients were treated with conventional wound care. All fistulas closed after 51.6±54.0 days with no refistulations. Thirty-eight of 132(29%) patients were treated with negative pressure wound therapy (NPWT). Thirty-eight of 40(95%) fistula closed after 14.7±12.0 days with no refistulations. The reduced healing time was statistically significant as compared to patients on conventional wound care (p < 0.001). Fifty-three of 132(40%) patients received surgical management. Forty-four of 53(83%) patients had complete fistula closure without postoperative complications. A pedicled flap was used in 60% of cases (n = 32). Most salivary fistulas close with conservative management. NPWT potentially shortens fistula healing time while it achieves similar closure rates as conventional wound care. In the absence of contraindications, NPWT should be trialed on all salivary fistulas. Surgical management should be reserved for large, chronic, high-risk fistulas or those not responding to a trial of conservative treatment. Secondary reconstruction should be kept as simple as possible.

Post operative chronic breast seroma with mammary fistula: A case report

Introduction: A breast seroma can develop after trauma to the breast or following procedures such as breast surgery or radiation therapy. Most often, seromas are reabsorbed by the body over a period of several weeks, but in some cases, they can be very troublesome. Also, nipple discharge is very common in women, but a nipple discharge in a previously operated patient for carcinoma can be very alarming. We report a very rare presentation of chronic postoperative breast seroma with mammary duct fistula formation. Presentation of case: A thirty-eight years old female having a 2.1 cm lump in her right breast, presented to us a month after having an excision biopsy of this lump elsewhere. The histopathology report of that excision biopsy showed invasive ductal carcinoma grade III with involved margins. After being discussed in our multidisciplinary team meeting, she underwent re-excision of margins and sentinel lymph node biopsy. This showed no residual carcinoma and negative sentinel lymph nodes. She underwent adjuvant chemotherapy and radiation therapy. But a few months later she presented with pain and swelling in the scar. On her breast ultrasonography, a simple seroma was shown. She was reassured that given time this post-operative seroma should settle. Almost a year later she re-presented with the persistence of a seroma lump along with serous nipple discharge. This nipple discharge would increase on pressing the seroma site suggesting a communication or fistula had formed between the seroma cavity and mammary duct. After a trial of conservative treatment and failing that she was offered surgery. The seroma cavity was excised and the patient’s symptoms were relieved. Discussion: Seroma formation is very common after breast lumpectomies, the incidence being 3 to 85%. Not only it increases morbidity but it may lead to reoperation if not resolved. Also if there is nipple discharge, it should be evaluated thoroughly for its cause as it may represent an underlying serious pathology. Conclusion: Seroma can present with nipple discharge if it has a fistula with one of the mammary ducts. This is a rare entity and so far very few cases have been reported.

New possibilities: the LockDown device for distal clavicle fractures.

Background and hypothesisThe majority of distal clavicle fractures are displaced fractures and constitute a treatment challenge because they have a 30% chance of delayed union or nonunion. Although several options for surgical reconstruction have been described, in patients with a comminuted and/or small distal fragment, these reconstructive options have proved to be prone to failure. Moreover, secondary surgery for removal is necessary in most cases. We hypothesized that the LockDown device, a braided synthetic ligament device, combined with resection of the distal fracture fragment is a suitable alternative in specified patients with distal clavicle fractures.MethodsEleven patients with distal clavicle fractures were treated with distal fracture resection and the LockDown procedure. All patients underwent regular follow-up with data collection; additionally, 7 were assessed at 1-year follow-up according to the study protocol. On the basis of radiography, these patients had a clear coracoclavicular ligament disruption and subsequent cranial dislocation of the medial fragment. Regular follow-up was performed at 6 weeks, 3 months, and 6 months. Control radiographs were taken at 3 and 6 months. Furthermore, the 7 enrolled patients were assessed at 1 year, when the Disabilities of the Arm, Shoulder and Hand score, Constant shoulder score, Nottingham Clavicle Score, and range of motion were recorded. Residual pain was ascertained by a visual analog scale score.ResultsIn total, 11 patients were treated with distal clavicle resection and the LockDown procedure. Eight patients underwent surgery within 3 weeks after presentation at the emergency department. The other 3 patients were operated on after a trial of conservative treatment (due to persisting pain and delayed union). None of the patients had postoperative complications. At 3 months, 9 of the 11 patients had made a full recovery.DiscussionAll 11 patients had good short-term clinical outcomes. None showed acromioclavicular instability. Furthermore, secondary surgery was avoided, and hardware complications did not occur. In low-demand patients or patients with a high risk of nonunion, this technique may be a favorable alternative to other known techniques.

Conversion to anatomic coracoclavicular ligament reconstruction (ACCR) shows similar clinical outcomes compared to successful non-operative treatment in chronic primary type III to V acromioclavicular joint injuries.

To compare the clinical outcomes of patients who underwent successful nonoperative treatment for type III-V acromioclavicular joint (ACJ) injuries to those who eventually required conversion to anatomic coracoclavicular ligament reconstruction (ACCR)at a minimum 5-year follow-up. Patients with primary, chronic type III-V ACJ injuries who either underwentsuccessful conservative treatment or conversion to ACCR after failing a trail of conservative management between 2003 and 2014 with a minimum 5-year follow-up were included in the study. Clinical outcome measures comprised the American Shoulder and Elbow Surgeons (ASES) and Simple Shoulder Test (SST) score, collected preoperatively and at final visit for the ACCR group. Outcome scores for patients with successful conservative treatment were only collected at final visit. A Self- Assessment Numeric Evaluation (SANE) score was obtained at terminal follow-up for both groups. Twenty-twopatients (mean age: 40.1 ± 15.6 years) with successful nonoperative treatment and twenty-one patients (mean age: 43.6 ± 12.0 years) who required conversion to ACCR were included in the study. At final follow-up, patients with successful non-operative treatment achieved similar ASES (93.0±12.0NonOPvs. 86.1±16.8ACCR), SST (11.2±1.4NonOPvs. 10.7±2.0ACCR) and SANE scores (80.9±19.7NonOPvs. 90.5±14.7ACCR) compared to those who were converted to ACCR. Additionally, patients who underwent conversion to ACCR showed significant improvement in ASES (49.8±18.1prevs. 86.1±16.8post; Δ36.3±19.7) and SST scores (6.5±3.2prevs. 10.7±2.0post; Δ4.2±4.0) from pre- to postoperative. At a minimum 5-year follow-up, patients with successful non-operative treatment for type III-V ACJ injuries achieved similar clinical outcomes compared to those who were converted to ACCR. In patients with chronic severe ACJ dislocation a trial of conservative treatment may be attempted, astime from injuryto eventual conversion to ACCR had no significant influence on postoperative clinical outcomes. Level IV.

Chordoma of the Sacrum - A Case Report of Enbloc High Sacrectomy and Review of Literature

“Coccydynia” unresponsive to a trial of conservative treatment should be evaluated promptly. Otherwise we may be fraught with the danger of serious complications. Sacral tumors are often quiescent to start with. They may achieve enormous size before they become symptomatic. Here is a case report and literature review of such a case in a 63 year old male, which was initially treated as coccydynia, till he became severely symptomatic. Chordomas are the most common primary tumor of the sacrum in adults. They are locally aggressive with immense potential for local recurrence and metastasis to lungs and other bones. If they get to the right hands at the right time, they are mostly curable. Total sacrectomy (Enbloc resection) is the treatment of choice for sacral chordomas. In early stages, a low sacral resection all from behind is possible. Lesions extending higher than S3 requires high sacrectomy and lumbopelvic fixation depending on the integrity of the sacroiliac joints. High sacrectomy has high morbidity of permanent colostomy and bladder catheterization.A 63 year old man presented with coccydynia of long duration and was diagnosed as chordoma of the sacrum upon imaging and image guided biopsy. He was treated with anterior, posterior and anterior surgeries in a single sitting, through a multi disciplinary approach.

Osteochondritis Dissecans of the Capitellum: Management in the Throwing Athlete

Young overhead athletes, such as baseball players and gymnasts, are at risk of developing osteochondritis dissecans lesions of the capitellum. Repetitive microtrauma in conjunction with limited local blood supply likely contribute to the development of these lesions. Adolescent and young adult throwing athletes presenting with lateral-sided elbow pain and stiffness should undergo prompt evaluation and imaging with elbow radiographs. Advanced imaging with computed tomography and magnetic resonance imaging or arthrography can further diagnose these lesions and determine lesion size and stability. Skeletally immature individuals with early, stable lesions should be given a trial of conservative treatment. Lesions failing nonoperative management and unstable lesions may be treated operatively with arthroscopic debridement and microfracture, fragment fixation, or osteochondral autograft transplantation surgery depending on lesion stability, size, and location. A wide variety of surgical techniques and outcomes have been reported. Overall these techniques result in excellent outcomes with good return to sport rates, diminished pain, and improved range of motion.

Outcome of a 980-nm diode laser coagulation in women with radiation-induced hemorrhagic cystitis: a single-center retrospective study.

The purpose of this study was to evaluate the efficacy of a 980-nm diode laser coagulation in women with radiation-induced hemorrhagic cystitis (RHC). We conducted a retrospective study of 21 RHC patients treated with a 980-nm diode laser between July 2014 and December 2017 at our institution. Data was collected with regard to age, sex, lower urinary tract symptoms, use of transfusions, a drop in hemoglobin levels, indication of radiotherapy, median time between radiation therapy and presentation, previous treatments, operative time, mean energy used, number of coagulated areas, catheterization time, discharge time after treatment, hospital stay, and surgical outcome. All 21 patients were women with a median age of 52years (range 36-68years). Eighteen patients complained of frequency and urgency, four patients had dysuria, and one patient developed urinary retention. Radiation therapy was primarily indicated in the treatment of cervical cancer in 18 patients (85.7%) and endometrial cancer in three patients (14.3%). Nine patients (42.8%) received blood transfusion before surgery and three patients (14.3%) needed blood transfusion after the procedure. The mean decrease in hemoglobin prior to the procedure was 4.08 ± 2.04g/dL. The median length of time from completion of radiotherapy to the presentation of hematuria was 38months (range 8-65months). All patients had failed an adequate trial of conservative treatment which included adequate hydration, hemostatics, continuous bladder irrigation (CBI), and clot evacuation at the bedside. Eleven patients (52.4%) had previously been treated with endoscopic electrocoagulation; the mean number of procedures was 1.73 ± 0.78 (range 1-3 sessions). Six patients (28.6%) underwent HBO, and sodium hyaluronate solution irrigation was administered to 3 patients (14.3%). The mean number of HBO sessions was 26.3 ± 16.8 (range 8-50), and the mean number of sodium hyaluronate solution irrigation procedures was 4.33 ± 1.53 (range 3-6). All operations were successful. The mean operative time was 45.6 ± 12.3min, the mean number of coagulated areas was 11.7 ± 4.4, the mean energy used was 2.74 ± 1.14kJ, the mean catheterization time was 6.2 ± 0.9days, the mean discharge time after treatment was 6.8 ± 1.2days, and the average length of a hospital stay was 7.4 ± 1.3days. In 16 patients (76.2%), hematuria was completely resolved after one session of diode laser coagulation. Four patients (19.0%) underwent multiple sessions of laser treatment due to recurrent gross hematuria (three patients required two sessions and one patient required three sessions). Only one patient (4.8%) who had persistent gross hematuria after diode laser treatment (two sessions) underwent a radical cystectomy, which resolved the hematuria. The median hematuria-free interval of patients who had multiple procedures was 9months (range 1-13months). In total, 21 patients underwent 27 sessions of diode laser coagulation, and the median hematuria-free interval was 16months (range 1-45months) with a median follow-up of 25months (range 7-48months). Our study shows promising results for the management of patients with RHC; however, further evaluation with a larger cohort is required to confirm the efficacy of this treatment.

Spine Jack® System for Percutaneous Stabilization of Osteoporotic Vertebral Compression Fractures: Clinical and Radiological Results

Abstract Background Data: Balloon Kyphoplasty allows surgeons to directly reduce the fractured vertebral body using inflatable balloons. However, the reduction cannot be maintained following balloon deflation and removal. Therefore, mechanical kyphoplasty techniques we Background Data: Balloon kyphoplasty allows surgeons to directly reduce the fractured vertebral body using inflatable balloons. However, the reduction cannot be maintained following balloon deflation and removal. Therefore, mechanical kyphoplasty techniques were designed to avoid loss of the reduction before cement injection and restore the vertebral body indefinitely. Study Design: A prospective cohort clinical case study. Purpose: To assess efficacy and safety of mechanical kyphoplasty using the Spine Jack® system in treatment of osteoporotic vertebral compression fractures (VCFs) of the thoracolumbar spine. Patients and Methods: During the period from April 2016 to March 2018, seventeen patients who sustained recent osteoporotic VCFs of the thoracolumbar spine, presenting with intractable back pain following one-month trial of conservative treatment, were included. Patients with pathological fractures, those with neurological deficits, or those medically unfit were excluded. The study included 6 males and 11 females with mean age of 60.37 years. Fractures were surgically treated using the Spine Jack® system that was inserted percutaneously through the transpedicular approach. Back pain intensity and degree of functional recovery were assessed using the Visual Analogue Scale (VAS) and the Oswestry Disability Index (ODI), respectively, whereas segmental deformity of the fractured vertebra was evaluated using standing plain X-rays and CT scan, including measurement of the local kyphotic angle and Beck Index. Results: Patients were followed for at least 6 months (mean 7.4±1.2). At final follow-up, there was significant improvement in mean VAS score (7.3 to 2.9) and mean ODI score (61.4 to 28.7). Postoperative imaging showed significant improvements in mean Beck Index (0.68 to 0.77) and mean local kyphotic angle (21.4° to 14.3°). Cement leakage was noted in 2 patients (11.7%) with no clinical relevance. None of the patients developed neurological deterioration, adjacent fracture, or hardware-related complication during the follow-up. Conclusion: Percutaneous stabilization of osteoporotic VCFs of the thoracolumbar spine using the Spine Jack® system is effective and safe even with posterior wall involvement, with significantly better outcome in terms of pain relief, functional recovery, and vertebral body restoration. (2019ESJ182) re designed to avoid loss of the reduction before cement injection, and restore the vertebral body indefinitely. Study Design: A prospective cohort clinical case study. Purpose: To assess efficacy and safety of mechanical kyphoplasty using the Spine Jack® system in treatment of osteoporotic vertebral compression fractures (VCFs) of the thoraco-lumbar spine. Patients and Methods: During the period from April 2016 to March 2018, seventeen patients who sustained recent osteoporotic VCFs of the thoraco-lumbar spine, and presented with intractable back pain following one month trial of conservative treatment were included. Patients with pathological fractures, neurological deficits or medically unfit were excluded. The study included 6 males and 11 female with mean age of 60.37 years. Fractures were surgically treated using the Spine Jack® system that was inserted percutaneously through the transpedicular approach. Back pain intensity and degree of functional recovery were assessed using the Visual Analogue Scale (VAS) and the Oswestry Disability Index (ODI) respectively, whereas segmental deformity of the fractured vertebra was evaluated using standing plain X-rays and CT scan, and included measurement of the local kyphotic angle and Beck Index. Results: Patients were followed for at least 6 months (mean; 7.4 ±1.2). At final follow up, there was significant improvement in mean VAS score (7.3 to 2.9) and mean ODI score (61.4 to 28.7). Postoperative imaging as well showed significant improvements in mean Beck index (0.68 to 0.77) and mean local kyphotic angle (21.4° to 14.3°). Cement leakage was noted in 2 patients (11.7%) with no clinical relevance. None of the patients developed neurological deterioration, adjacent fracture or hardware-related complication during the follow up. Conclusion: Percutaneous stabilization of osteoporotic VCFs of the thoraco-lumbar spine using the Spine Jack system® is effective and safe even with posterior wall involvement, with significantly better outcome in terms of pain relief, functional recovery and vertebral body restoration.

Return to Play Following Nonoperative Treatment of Partial Ulnar Collateral Ligament Injuries in Professional Baseball Players: A Critically Appraised Topic.

Clinical Scenario: Ulnar collateral ligament (UCL) injuries are highly prevalent in professional baseball players with the success of operative management being well known in the literature. Return to play (RTP) rates following nonoperative management of partial UCL injuries in professional baseball players are not well established in the literature. With a UCL tear being a potential career-ending injury, it is imperative that the best treatment option is provided to these throwing athletes. There is an increase in the incidence of UCL surgical rates and a lack of general agreement on nonoperative treatment of partial UCL injuries as reported by the American Shoulder and Elbow Surgeons in 2017. There is also a lack of clarity on when to initiate rehabilitation, which may be due to the limited amount of studies reporting success of RTP rates and time to RTP following conservative interventions of partial UCL injuries. Evidence on the RTP rates seen following conservative management of partial UCL tears injuries can help guide health care providers in deciding on the best treatment option for professional baseball athletes who desire to return to their athletic careers. These rates of RTP will add valuable objective input when determining if conservative management is the best choice. To determine the current evidence, inclusion criteria for the literature search consisted of RTP rates following conservative treatment in professional baseball players between inception and 2018. Clinical Question: Is there evidence for successful RTP rates in professional baseball players following conservative treatment of a UCL injury? Summary of Key Findings: Three retrospective studies met the inclusion criteria and were included. Of those, 2 reported RTP rates following a nonoperative rehabilitation program of a UCL injury, whereas 1 reported RTP rates after injection therapy in subjects who attempted a trial of conservative treatment. All 3 studies considered location and grade of UCL tear. Successful RTP rates (66%-100%) were reported in professional baseball players following nonoperative treatment of partial UCL injuries. Clinical Bottom Line: Current evidence supports high success with RTP rates up to 100% after nonoperative treatment of grade 1 UCL injuries in professional baseball players and between 66% and 94% for a grade 2 and above. Strength of Recommendation: There is level C evidence for high RTP rates following nonoperative treatment of partial UCL injuries in professional baseball players.

NON-OPERATIVE MANAGEMENT OF INDIVIDUALS WITH NON-ARTHRITIC HIP PAIN: A LITERATURE REVIEW

Non-arthritic hip pain is defined as being related to pathologies of the intra-articular structures of the hip that can be symptomatic. A trial of non-operative management is commonly recommended before consideration of surgery for individuals with non-arthritic hip conditions. There is a need to describe a non-operative or conservative treatment plan for individuals with non-arthritic hip pain. The purpose of this literature review was to systematically examine the literature in order to identify and provide evidence for non-operative or conservative management of individuals with non-arthritic hip pain. A proposed home exercise program will be provided for individuals with non-arthritic hip pain. Review of the Literature. A literature search of PubMed, Medline, SPORTSDiscus, and CINAHL was conducted. Keywords included: "hip" AND "femoroacetabular impingement" OR "labral tear." Studies were included if they described non-operative management for individuals with non-arthritic hip pain. Studies were excluded if they recommended a trial of conservative treatment without specific management or interventions and/or activity modification without specific details for intervention. A total of 49 studies met the eligibility criteria and were included in the review. Rehabilitation recommendations were identified from manuscripts including clinical trials, case series, discussion articles, or systematic reviews related to the non-operative or conservative management of non-arthritic hip pain. Rehabilitation interventions focused on patient education, activity modification, limitation of aggravating factors, an individualized physical therapy protocol, and use of a home exercise program. Rehabilitation should address biomechanical deficiencies with neuromuscular training of the hip and lumbopelvic regions. While the current literature on non-operative management is limited, future randomized control trials will establish the effectiveness of specific physical therapy protocols for individuals with non-arthritic hip pain. 3b.

Intervertebral disc herniation in elite athletes.

Intervertebral disc herniations are a common cause of neck and back pain in athletes. It is thought to be more prevalent in athletes than in the general population due to the consistent pressure placed on the spine and concurrent microtraumas that are unable to heal. Prevention focuses on neck and trunk stability and flexibility, training on proper technique, and rule changes to minimize catastrophic injuries. The evaluation for athletes includes a full neurologic exam and imaging. The imaging modality of choice is MRI, but CT myelography can be a useful alternative. Standard management includes a sixweek trial of conservative treatment with hiatus from injurious activity and anti-inflammatory medication. If nonoperative management fails, operative treatment has been shown to lead to excellent clinical outcomes in this patient population. Special consideration to prevention needs to be further analyzed. Furthermore, more robust studies on alternative non-operative and operative treatment modalities for this patient population are also needed.