Visual Analog Scale Pain Scores Research Articles

Lumbar fusion efficacy with local bone grafting and platelet-rich plasma: a clinical investigation in treating degenerative lumbar spinal stenosis in the elderly.

The focus of this study was to comprehensively assess the clinical outcomes of lumbar fusion utilizing autogenous bone grafting and platelet-rich plasma (PRP) for the management of degenerative lumbar spinal stenosis (DLSS) in elderly individuals. A cohort of 40 senior individuals diagnosed with DLSS, who underwent treatment at our hospital between January 2020 and March 2022. The control group consisted of 20 participants who underwent local bone grafting for intervertebral fusion, while the observation group comprised 20 individuals who received a combination of local bone grafting and PRP for lumbar fusion. MRI imaging was employed for a comprehensive assessment of spinal structure. The efficacy of spinal fusion was evaluated through MRI imaging. Clinical treatment outcomes were assessed using the Japanese Orthopaedic Association (JOA) and Oswestry Disability Index (ODI) scoring systems. Postoperative low back pain was quantified using a Visual Analog Scale (VAS). During the final follow-up, the observation group demonstrated a significant increase in the inner diameter of the spinal canal and the height of the disc space compared to the control group (P < 0.05).Moreover, the observation group displayed a larger spinal canal than the control group (P < 0.05).A reduced lesion score in the bone grafting region was observed in the observation group compared to the control group during the final follow-up (P < 0.05). Furthermore, the observation group displayed a higher intervertebral fusion continuity score than the control group (P < 0.05).The JOA score in the observation group was significantly higher than in the control group (P < 0.05), while the ODI score was significantly lower (P < 0.05). Of note, the back pain VAS score in the observation group was lower than in the control group at both the three months post-surgery mark and the final follow-up (P < 0.05).The satisfaction rate and overall satisfaction rate in the observation group were significantly higher than those in the control group (P < 0.05), while the dissatisfaction rate in the observation group was evidently lower than in the control group (P < 0.05). In the management of DLSS in elderly individuals, the utilization of local bone grafting and PRP in lumbar spinal fusion yields notable outcomes.

Single-Incision Direct Lateral Approach Versus Dual-Incision Approach for Distal Tibial and Fibular Fractures.

Distal tibial and fibular fractures are typically the result of high-energy trauma. Open reduction and internal fixation (ORIF) are often used to reconstruct and reduce displaced fractures, especially intra-articular ones. These fractures can be addressed either by a dual-incision approach (medial approach for the distal tibia and lateral approach for the fibula) or by a single-incision direct lateral approach to fix both the tibia and fibula. The direct lateral approach avoids injury to the medial soft tissues. This study was conducted to compare the postoperative clinico-radiological and functional outcomes of the single-incision direct lateral approach and the dual-incision approach for distal tibial and fibular fractures. A prospective comparative cohort study of 40 patients was conducted. The patients were classified into two cohorts of 20 each based on the surgical approach: those who underwent a single-incision direct lateral approach and those who underwent a dual-incision approach for distal tibial and fibular fractures (procedure: ORIF with plating). The study was conducted from September 2022 to March 2024. A follow-up period of at least 12 months was carried out, comparing operative time, discharge time, and postoperative outcomes using the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, ankle range of motion (ROM), Southampton wound score for wound healing, visual analog scale (VAS) pain score, and periodic radiographs at each follow-up. Complications were also studied. The mean operative time was 95.06 ± 7.04 minutes for thesingle-incision approach and 109.89 ± 7.88 minutes for the dual-incision approach. The average blood loss was 202.41 ± 32.76 mL for thesingle-incision approach and 248.39 ± 28.18 mL for the dual-incision approach. The hospital stay was shorter in the direct lateral approach group, and the AOFAS score at 12 months was better in the direct lateral approach group (91.47 ± 2.55 for thesingle-incision approach vs. 83.33 ± 8.71 for the dual-incision approach). Postoperative wound healing was observed, and the Southampton wound score was compared. Overall, soft tissue complications were fewer in the direct lateral approach group. The postoperative VAS pain score was consistently lower in the single-incision direct lateral approach group, which also demonstrated better ankle ROM. The p-value was significant (<0.05) for these parameters. At the six-month follow-up, all patients exhibited clinical and radiographic healing and bone union, except for one case in the dual-incision group. A medial compound wound, treated by plastic surgery with flap cover intervention, was identified as one of the definitive indications for single-incision plating. The single-incision approach was associated with better soft tissue healing, fewer wound complications, and superior ankle functional outcomes compared to the dual-incision approach.

Clinical efficacy of enhanced recovery surgery in Da Vinci robot-assisted pancreatoduodenectomy

Da Vinci robot-assisted pancreaticoduodenectomy offers advantages, including minimal invasiveness, precise, and safe procedures. This study aimed to investigate the clinical effectiveness of implementing enhanced recovery after surgery (ERAS) concepts in Da Vinci robot-assisted pancreaticoduodenectomy. A retrospective analysis was conducted on clinical data from 62 patients who underwent Da Vinci robot-assisted pancreaticoduodenectomy between January 2018 and December 2022. Among these patients, 30 were managed with ERAS principles, while 32 were managed using traditional perioperative management protocols. Surgical time, intraoperative blood loss, postoperative oral intake time, time to return of bowel function, time to ambulation, visual analog scale (VAS) pain scores, fluid replacement volume, length of hospital stay, total hospital expenses, complications, and patient satisfaction were recorded and compared between the two groups. Postoperative follow-up included assessment of postoperative functional scores, reoperation rates, SF-36 quality of life scores, and survival rates. The average follow-up time was 35.6 months (range: 12–56 months). There were no statistically significant differences in general characteristics, including age, surgical time, intraoperative blood loss, and preoperative medical history between the two groups (P > 0.05). Compared to the control group, the intervention group had an earlier postoperative oral intake time, faster return of bowel function, rapid ambulation, and shorter hospital stays (P < 0.05). The intervention group also had lower postoperative VAS scores, lower fluid replacement volume, lower total hospital expenses, and a lower rate of complications (P < 0.05). Patient satisfaction was higher in the intervention group (P < 0.05). There were no statistically significant differences between the two groups in two-year functional scores, reoperation rates, quality of life scores, and survival rates (P > 0.05). Implementing ERAS principles in Da Vinci robot-assisted pancreaticoduodenectomy substantially expedited postoperative recovery, lowered pain scores, and diminished complications. However, there were no notable differences in long-term outcomes between the two groups.

Peri-operative outcomes of IlluminOss fixation for pelvic metastatic bone disease

BackgroundPelvic metastatic bone disease (MBD) leads to significant pain and functional impairment. Managing these lesions through an open approach involves invasive procedures linked to potential morbidity and complications. The IlluminOss system, a UV light-activated polymer implant, has shown efficacy and safety in managing various fractures. This study evaluates the effectiveness of IlluminOss photodynamic bone stabilization system (PBSS) in pelvic MBD. MethodsA retrospective cohort review was conducted, including all patients treated with the PBSS system for MBD of the pelvis and acetabulum. ResultsFifteen patients were included with a mean follow-up of 4.97 months (SD 3.05). In the thirteen patients treated with the IlluminOss without concurrent total hip arthroplasty, the mean operative time was 170.4 min (SD 90.6). The mean estimated blood loss was 52.3 mL (SD 73.7). No patients required transfusions. The mean visual analog scale (VAS) pain score at the latest follow-up was 2.29, significantly lower than the preoperative score of 9.07 (p < 0.001). Thirteen patients (92.9 %) had improved functional status at the latest follow-up. ConclusionPBSS offers similar operative times, reduced blood loss, and decreased need for transfusions compared to open pelvic fixation methods. It also demonstrates significant pain reduction and improved functional outcomes without increased complications.

Predictors of Clinical Outcomes and Quality of Life After Sternoclavicular Joint Reconstruction With Hamstring Tendon Autograft

Background: Anterior instability of the sternoclavicular joint (SCJ) is a rare but potentially devastating pathological condition, particularly when it occurs in young or active patients. SCJ reconstruction using hamstring tendon autograft is a commonly used treatment option, yet to date results are limited to small case series. Studies on baseline, preoperative factors and their association with postoperative outcome are limited. Purpose: To assess the midterm clinical outcomes and survivorship after SCJ reconstruction using hamstring tendon autograft in patients experiencing anterior SCJ instability and to determine whether baseline patient or causative factors are associated with postoperative outcomes or patient satisfaction. Study Design: Case series; Level of evidence, 4. Methods: Patients who underwent SCJ reconstruction with a hamstring tendon autograft for anterior SCJ instability between October 2005 and October 2020 were included in this retrospective single-center study. At a minimum of 2 years postoperatively, clinical outcomes were collected, including the following patient-reported outcomes (PROs): the 12-Item Short Form Survey (SF-12) score; American Shoulder and Elbow Surgeons (ASES) score; Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) score; Single Assessment Numeric Evaluation (SANE) score; and visual analog scale (VAS) pain score. Subjective postoperative satisfaction with the procedure was quantified on a scale from 0 (very unsatisfied) to 10 (very satisfied). The predictive role of patient factors, including age, sex, and injury in dominant arm, on postoperative PROs and satisfaction at short-term follow-up was evaluated using multiple linear regression. Results: A total of 49 patients (mean age, 29.6 ± 16.2 years; range 13.8-67.1 years; 27 females) were included in the final analysis. At a mean follow-up of 3.9 ± 2.1 years, all PROs had significantly improved, including the mean SF-12 Physical Component Summary score (40.4 ± 6.8 to 52.6 ± 6.9; P < .001), ASES score (54.9 ± 20.4 to 91.0 ± 11.3; P < .001), QuickDASH score (41.2 ± 18.5 to 10.2 ± 9.1; P < .001); SANE score (50.2 ± 21.1 to 88.3 ± 8.8; P < .001), VAS pain score (4.4 ± 2.6 to 0.8 ± 1.4; P < .001), and VAS pain score at its worst (7.4 ± 2.5 to 3.3 ± 2.6; P < .001). The median postoperative satisfaction score was 9 (range, 1-10). Revision-free survivorship was 95.9%. Male patients had a significantly lower VAS pain score at its worst compared with female patients (2.6 ± 2.6 vs 4.1 ± 2.4; P = .045); higher age was significantly correlated with a worse QuickDASH score (correlation coefficient, 0.314; P = .036). Overhead athletes had a significantly lower propensity to return to sport compared with nonoverhead athletes (P = .043), with only 45% of the overhead athletes returning to a level similar to their preinjury level, whereas 81% of the nonoverhead athletes were able to do so. Conclusion: The significant improvements in clinical and sport-specific outcomes and high patient satisfaction after SCJ reconstruction with a hamstring tendon autograft demonstrate the success of this procedure in treating anterior SCJ instability. Male sex and younger patient age are associated with superior outcomes, while overhead athletes have to be counseled about difficulties of returning to preinjury level of sport postoperatively.

Preoperative Factors on Loss of Range of Motion after Posterior Cervical Foraminotomy.

Background and Objectives: Posterior cervical foraminotomy (PCF) aims to resolve cervical radiculopathy while preserving range of motion (ROM). However, its effectiveness in maintaining ROM is uncertain. This study investigates the changes in ROM after PCF and identifies preoperative factors that influence ROM reduction post surgery. Materials and Methods: This retrospective cohort study included patients treated at our hospital from August 2016 to September 2021. Clinical outcomes were assessed using the visual analog scale (VAS) for neck and arm pain and the neck disability index (NDI). Radiological outcomes included the segmental angle (SA), cervical angle (CA), C2-C7 SVA, Pfirrmann grade, extent of facetectomy, foraminal stenosis, and ROM. Patients were categorized into two groups based on segmental ROM changes: decreased (Group D) and maintained (Group M). Radiological and clinical outcomes were compared between the groups. Univariate and multivariate regression analyses were performed to identify risk factors for ROM loss after PCF. Results: 76 patients were included: 34 in Group D and 42 in Group M, with no demographic differences. Preoperatively, Group D had significantly larger flexion segmental and cervical angles than Group M (segmental, p < 0.001; cervical, p = 0.001). Group D also had a higher Pfirrmann grade (p = 0.014) and more bony bridge formations (p = 0.004). While no significant differences were observed in arm pain VAS and NDI scores, Group D exhibited worse neck pain VAS at the last follow-up (p = 0.03). Univariate linear regression indicated that preoperative segmental ROM (p < 0.001, B = 0.82) and bony bridge formation (p = 0.046, B = 5.33) were significant predictors of ROM loss post PCF. Conclusions: Patients with higher preoperative flexion angles and Pfirrmann grades at the operative level are at an increased risk for ROM loss and neck pain and often exhibit bony bridge formation. Accounting for these factors can improve surgical planning and patient outcomes.

Percutaneous endoscopic transforaminal decompression surgery for symptomatic double-level lumbar spinal stenosis with ossification.

This study aimed to explore the short-term effects of percutaneous endoscopic transforaminal decompression (PETD) for the treatment of symptomatic double-level lumbar spinal stenosis (LSS) with ossification. Twenty-eight patients diagnosed with double-level lumbar spinal stenosis who underwent double-level PETD surgery between January 2021 and January 2023 at our institution. General information, such as age, sex, disease duration, hospitalization time, and operation time, was recorded. Magnetic resonance imaging (MRI) dural sac cross-sectional area (DSCA) was recorded to assess the degree of spinal canal decompression. The White-Panjabi scoring system (WP) was used to assess preoperative and postoperative lumbar spine stability. Pre- and postoperative visual analog scale (VAS) and Oswestry Disability Index (ODI) scores were recorded to assess symptom improvement, and surgical efficacy was evaluated using the modified Macnab evaluation criteria at the 1-year postoperative follow-up. The types and risks of complications were also recorded. The patient's 1-year postoperative follow-up MRI showed that both L3/4 and L4/5 DSCA were significantly enlarged compared with preoperative values (P < .001). There was no significant difference in the WP scores at 3 months postoperatively compared with those preoperatively (P > .05). The VAS scores for hip and lower extremity pain at 3 days, 3 months, and 1 year postoperatively were significantly lower than those preoperatively (P < .001), and the ODI scores at 3 months and 1 year postoperatively were significantly lower than those preoperatively (P < .001). There were no significant differences in hip pain, lower extremity pain VAS scores, or ODI scores between the postoperative follow-up time points (P > .05). There was 1 case of lower limb numbness and 1 case of neuroedematous pain in the postoperative period, and all patients had no complications, such as dural sac tear, infection, or recurrence. The 1-year postoperative follow-up was assessed as excellent in 17 cases, good in 9 cases, and possible in 2 cases using the modified Macnab criteria, with an excellent rate of 92.9%. The efficacy of double-level PETD for symptomatic double-level LSS is clear, the local stability of the lumbar spine is less affected, and the risk is low, which can reduce the chances of reoperation in patients. Thus, it is a recommended surgical procedure.

Cold reducing acupuncture as adjunctive therapy for wrist joint disorder of active rheumatoid arthritis with dampness-heat obstruction：a randomized controlled trial

To compare the clinical efficacy between cold reducing acupuncture combined with western medication and western medication alone for wrist joint disorder of active rheumatoid arthritis (RA) with dampness-heat obstruction. A total of 80 patients with wrist joint disorder of active RA with dampness-heat obstruction were randomly divided into a combination group (40 cases, 3 cases dropped out) and a western medication group (40 cases, 3 cases dropped out). The western medication group was treated with methotrexate tablets, 15 mg each time, once a week. The combination group was treated with cold reducing acupuncture at bilateral Hegu (LI 4), Houxi (SI 3), Waiguan (TE 5), etc. on the basis of the western medication group, once a day, 5 times a week. Both groups were treated for 8 weeks. The pain visual analogue scale (VAS) score, swelling score, morning stiffness score, Cooney wrist joint function score, ultrasound of wrist joint and serum level of C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) before and after treatment were compared in the two groups. After treatment, the pain VAS scores, swelling scores, morning stiffness scores, grey scale ultrasound (GSUS) grade of synovitis, power doppler ultrasound (PDUS) grade of synovitis of wrist joint and serum levels of CRP and ESR in the two groups were reduced compared with those before treatment (P<0.05), the Cooney wrist joint function scores were increased compared with those before treatment (P<0.05); the pain VAS score, swelling score, PDUS grade of synovitis of wrist joint and serum level of CRP and ESR in the combination group were lower than those in the western medication group (P<0.05), the Cooney wrist joint function score was higher than that in the western medication group (P<0.05). Cold reducing acupuncture combined with western medication could improve clinical symptoms and joint function, reduce inflammatory response in patients with wrist joint disorder of active RA with dampness-heat obstruction, and the efficacy is better than that of western medication alone.

Levels of Synovial Fluid Inflammatory Biomarkers on Day of Arthroscopic Partial Meniscectomy Predict Long-Term Outcomes and Conversion to TKA: A 10-Year Mean Follow-up Study.

The purpose of the present study was to evaluate the relationships of the concentrations of pro- and anti-inflammatory biomarkers in the knee synovial fluid at the time of arthroscopic partial meniscectomy (APM) to long-term patient-reported outcomes (PROs) and conversion to total knee arthroplasty (TKA). A database of patients who underwent APM for isolated meniscal injury was analyzed. Synovial fluid had been aspirated from the operatively treated knee prior to the surgical incision, and concentrations of pro- and anti-inflammatory biomarkers (RANTES, IL-6, MCP-1, MIP-1β, VEGF, TIMP-1, TIMP-2, IL-1RA, MMP-3, and bFGF) were quantified. Prior to surgery and again at the time of final follow-up, patients were asked to complete a survey that included a visual analog scale (VAS) for pain and Lysholm, Tegner, and Knee injury and Osteoarthritis Outcome Score-Physical Function Short Form (KOOS-PS) questionnaires. Clustering analysis of the 10 biomarkers of interest was carried out with the k-means algorithm. Of the 82 patients who met the inclusion criteria for the study, 59 had not undergone subsequent ipsilateral TKA or APM, and 43 (73%) of the 59 completed PRO questionnaires at long-term follow-up. The mean follow-up time was 10.6 ± 1.3 years (range, 8.7 to 12.4 years). Higher concentrations of individual pro-inflammatory biomarkers including MCP-1 (β = 13.672, p = 0.017) and MIP-1β (β = -0.385, p = 0.012) were associated with worse VAS pain and Tegner scores, respectively. K-means clustering analysis separated the cohort of 82 patients into 2 groups, one with exclusively higher levels of pro-inflammatory biomarkers than the second group. The "pro-inflammatory phenotype" cohort had a significantly higher VAS pain score (p = 0.024) and significantly lower Lysholm (p = 0.022), KOOS-PS (p = 0.047), and Tegner (p = 0.009) scores at the time of final follow-up compared with the "anti-inflammatory phenotype" cohort. The rate of conversion to TKA was higher in the pro-inflammatory cohort (29.4% versus 12.2%, p = 0.064). Logistic regression analysis demonstrated that the pro-inflammatory phenotype was significantly correlated with conversion to TKA (odds ratio = 7.220, 95% confidence interval = 1.028 to 50.720, p = 0.047). The concentrations of synovial fluid biomarkers on the day of APM can be used to cluster patients into pro- and anti-inflammatory cohorts that are predictive of PROs and conversion to TKA at long-term follow-up. Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Effect of oblique insertion at ashi point with long needle on joint function in female patients with knee osteoarthritis of early and middle stages

To compare the improvement of joint function in female patients with early-middle-stage knee osteoarthritis (KOA) treated by oblique insertion at ashi point with long needle and oral celecoxib capsule. A total of 105 female patients with early-middle-stage KOA were randomly divided into an observation group (65 cases, 6 cases dropped out, 3 cases were discontinued) and a control group (40 cases, 6 cases dropped out, 2 cases were discontinued). Patients in the observation group were treated with oblique insertion at ashi point (hard knots of quadriceps femoris, hamstring muscle, popliteal muscle, etc.) with long needle, once every other 3 days, twice a week, for a total of 2 weeks. Patients in the control group were treated with oral celecoxib capsules, 0.2 g each time, once a day for 2 weeks. Both groups started functional exercise after 2 weeks of treatment. The joint function score of Western Ontario and McMaster Universities osteoarthritis index (WOMAC) and pain visual analogue scale (VAS) score of the two groups were observed before and after treatment and after 6 weeks of treatment completion (follow-up), the 12-item short-form health survey (SF-12) score was compared between the two groups before treatment and in follow-up, and the safety of the two groups was evaluated. After treatment and during the follow-up, the joint function scores of WOMAC and VAS scores of the two groups were lower than those before treatment (P<0.05). During the follow-up, the joint function scores of WOMAC and VAS scores were lower than those after treatment (P<0.05), and the SF-12 scores were higher than those before treatment (P<0.05) in the two groups. After treatment, the joint function score of WOMAC of the observation group was lower and the VAS score was higher than those of the control group (P<0.001, P<0.01). During the follow-up, the SF-12 score of the observation group was higher than that of the control group (P<0.05). No serious adverse reactions occurred in both groups. The treatment of oblique insertion at ashi point with long needle can improve the knee joint function and quality of life of female patients with early-middle-staqe KOA, which is better than oral celecoxib capsule.

Minimally invasive versus mini-open transforaminal lumbar interbody fusion in managing low-grade degenerative spondylolisthesis

Data backgroundBecause the traditional open-TLIF approach has several drawbacks, minimally invasive surgery (MIS) approaches for TLIF (MISTLIF) have been developed to speed up recovery after surgery and minimize pressure on the para-spinal muscles, necessitating a cost-utility analysis for comparison in healthcare reforms.Objectives and aim of the workThis study aimed to compare the radiological and clinical parameters between mini-open TLIF and minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) surgery in patients with single-level lumbar degenerative spondylolisthesis.HypothesisThis study hypothesizes that both minimally invasive and mini-open methods using sublaminar trimming laminoplasty (SLTL) (while preserving midline structures) and interbody cages have comparable mid- and long-term clinical and radiological outcomes.MethodsRetrospective analyses were performed on 120 patients who underwent single-level TLIF procedures with a minimum of two years of follow-up utilizing either the mini-open (n = 60) or MIS (n = 60) technique. Records of the operation's time frame, intraoperative fluoroscopy, blood loss, postoperative drainage volume, duration of bed rest, and complications were recorded. The Oswestry Disability Index (ODI) and visual analog scale (VAS) scores for both groups were utilized to assess improvements in clinical scores, and t tests were employed to statistically compare the outcomes. For comparison, radiological parameters, including lumbar lordosis, pelvic incidence (PI), and localized lordosis at the index level, were measured preoperatively, postoperatively, and at the final follow-up. To assess postoperative interbody fusion, the Bridwell grading system was used.ResultsIn the Mini-open TLIF group, the average follow-up time was 24.91 ± 5.7 months, while in the MIS-TLIF group, the average follow-up time was 25.15 ± 4.2 months. In the MIS-TLIF group, the mean operation and radiological time were longer. However, compared to the Mini-open TLIF group, the MISTLIF group experienced less blood loss and a shorter hospital stay. The MIS-TLIF group outperformed the Open-TLIF group in terms of the VAS score for back pain and the ODI at less than 6 months following surgery, and the differences were statistically significant. However, at the final follow-up, there were no statistically significant differences in the VAS score for the back between the two groups, but the ODI score was significantly greater in the MIS-TLIF group. Both groups' lumbar lordosis and focal lordosis significantly improved at the index level, with the Mini-open-TLIF group showing more focal lordosis. The interbody fusion rate did not significantly differ between the two groups.ConclusionMIS-TLIF and mini-open-TLIF can be surgically effective in treating single-level degenerative lumbar spine spondylolisthesis.

Investigating combined acupuncture and transcranial direct current stimulation in patients with poststroke shoulder pain from China: protocol for a randomised controlled trial

IntroductionPoststroke shoulder pain is a common complication that severely affects the recovery of upper limb motor function. Acupuncture has positive analgesic effects in treating poststroke shoulder pain, and studies have...

SP2.1 - Endoscopic retrograde appendicitis therapy for peri-appendiceal abscess

Abstract Aims ERAT is a novel technique primarily for uncomplicated appendicitis, but it is starting to be used also for peri-appendiceal abscesses. The aim of this study was to evaluate the efficacy and clinical outcomes of ERAT in treating patients with peri-appendiceal abscess. Methods Between January 2018 and April 2023, twenty-eight patients with peri-appendiceal abscess were treated with ERAT. We retrospectively analyzed the location and size of the peri-appendiceal abscess, success rate of ERAT, median operative time, postoperative hospital stay and complications. We defined success of ERAT as finding the appendiceal orifice and successful performance of ERAT without conversion to appendectomy or percutaneous drainage of the appendiceal abscess within one month. All patients were followed up at least 6 months, with a median follow-up of 31.5 months. Results The success rate of ERAT was 75.0% (95% CI, 54.8%-88.6%; n = 21/28). 35.7% (95% CI, 19.3%-55.9%; n = 10/28) of peri-appendiceal abscesses were located in the lower ileum, and the median size of appendiceal abscesses was 43.5 mm (95% CI: 33-53). 80.8% (95% CI, 60.0%-92.7%; n = 21/26) of patients had a visual analogue scale pain score of ≤3 at 24 hours after treatment. The median procedure time was 69.5 minutes (95% CI: 51-76), and the median hospital stay was 6.5 days (95% CI: 5-9). During the follow-up period, a total of four (17.1%; 95% CI, 0.9%-13.1%; 4/21) patients presented with abdominal pain associated with peri-appendiceal abscesses. Conclusions ERAT is a technically feasible treatment for peri-appendiceal abscesses.

Compartment Syndrome in Association with Tibial Plateau Fracture: Standardized Protocols Ensure Optimal Outcomes.

The purpose of this study was to report on the treatment, results, and longer-term outcomes of patients who sustained a tibial plateau fracture with an associated leg compartment syndrome (CS). A total of 766 patients who sustained 766 tibial plateau fractures met inclusion criteria. Fourteen patients (1.8%) were diagnosed with CS in association with a tibial plateau fracture during their initial hospitalization, 13 at the time of presentation and 1 delayed. The treatment protocol consisted of initial external fixation and fasciotomy, followed by irrigation and debridement, and eventual closure. Fasciotomy cases included 2/14 (14.3%) single incision approaches and 12/14 (85.7%) dual incision approaches. Operative treatment of the tibial plateau fracture was performed at the time of final closure or once soft tissues were permitted. One case of CS that developed following definitive fixation was treated with fasciotomy and delayed primary closure after initial stabilization. Ten (71.4%) were available at 1-year follow-up. We compared these 10 cases to the patients with operative tibial plateau fractures without CS to assess for surgical, radiographic, clinical, and functional outcomes. We used a propensity match based on age, body mass index, sex, Charleson comorbidity index, and fracture type to reduce the presence of confounding biases. Standard statistical methods were employed. Those in the CS cohort were younger males (p < 0.05). At latest follow-up, function did not differ between those in the CS group compared with the non-CS cohort (p > 0.05). Clinically, knee flexion (130.7 vs. 126; p = 0.548), residual depression (0.5 vs. 0.2; p = 0.365), knee alignment (87.7 vs. 88.3; p = 0.470), and visual analog scale pain scores (3.0 vs. 2.4; p = 0.763) did not differ between the cohorts. Although infection was higher in the CS cohort, the overall complication rates did not differ between the CS patients and non-CS cohort (p > 0.05). Early identification and standardized treatment protocols for the management of CS that develops in association with a tibial plateau fracture lead to outcome scores that were not significantly different from patients who did not develop CS.

Outcomes of One-Stage Arthroscopic Ankle and Tibiotalocalcaneal Arthrodesis with External Fixation for Septic Ankle and Hindfoot Arthritis: A Case-Series Study.

The occurrence of infection in the ankle and hindfoot presents a formidable surgical challenge. Currently, there is a lack of consensus regarding its treatment strategies. The purpose of this study was to investigate the outcomes of one-stage arthroscopic ankle and tibiotalocalcaneal (TTC) arthrodesis with external fixation in the treatment of septic ankle and hindfoot arthritis. A retrospective consecutive case-series study was conducted involving six patients diagnosed with acute or chronic septic ankle or hindfoot arthritis, who underwent operative intervention entailing thorough debridement, arthroscopically assisted one-stage ankle or TTC fusion, and external fixation. The American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot score and visual analog scale (VAS) pain score were determined preoperatively and at the final follow-up. Demographic and clinical data, inclusive of perioperative and postoperative complications, were recorded. Comparisons of AOFAS ankle-hindfoot score and VAS pain score between preoperative measures and those at the final follow-up were conducted using paired t-tests or paired Wilcoxon rank-sum tests. The study cohort comprised two males and four females, with a mean age of 48.7 years (range, 26-75) at the time of surgical intervention. At the final follow-up (mean, 26.5 months; range, 16-48), the AOFAS scores exhibited a significant improvement, ascending from an initial mean of 38.8 (range, 12-57) to 80.0 (range, 54-92) (p = 0.007). VAS scores indicated a substantial reduction in pain, decreasing from 6.5 (range, 4-9) to 0 (range, 0-5) (p = 0.046). All patients had achieved osseous consolidation, with a hindfoot infection control rate of 100%. One-stage arthroscopic ankle and TTC arthrodesis with external fixation is as an effective therapeutic choice for septic ankle or hindfoot arthritis. This approach yields favorable outcomes characterized by effective infection control, favorable osseous consolidation, and significant functional restoration of the affected limb.

Magnesium sulfate enhances the effect of the peripheral analgesic cocktail in total knee arthroplasty: a systematic review and meta-analysis of randomized controlled trials.

Although magnesium sulfate (MgSO4) is widely used as an analgesic adjuvant to peripheral analgesic cocktails, its efficacy in total knee arthroplasty (TKA) is still controversial. Therefore, we systematically reviewed and meta-analyzed the literature to assess the analgesic efficacy of MgSO4 as an adjuvant to the analgesic cocktail in TKA. The PubMed, EMBASE, Web of Science, and Cochrane Library databases were searched. The meta-analysis was performed according to the PRISMA guidelines. Data were qualitatively synthesized or meta-analyzed using a random-effects model. Five randomized controlled trials involving 432 patients were included. Meta-analyses detected significant differences between the MgSO4 and control groups in the visual analog scale (VAS) pain scores (rest) at 6, 12, and 24 h postoperatively; VAS pain scores (motion) at 12, 24, and 48 h postoperatively; morphine consumption within 24 h, 24-48 h, and during the total hospitalization period; time to first rescue analgesia after TKA; and length of hospital stay. Regarding the functional recovery, the meta-analysis demonstrated significant differences between groups in terms of knee range of motion on postoperative day 1; daily mobilization distance on postoperative day 1; and daily mobilization distance. There was no significant intergroup difference in surgical complications. The findings suggest that MgSO4 is a promising adjunct to the analgesic cocktail, achieving significant improvements in pain scores and total opioid consumption during the early postoperative period after TKA.

An Opioid-Sparing Pain Protocol of Intravenous and Oral Ketorolac Reduces Opioid Consumption and Pain Levels After Arthroscopic Meniscus Surgery: A Prospective, Randomized Controlled Trial

The primary purpose was to compare ketorolac to oxycodone-acetaminophen with respect to pain and opioid consumption after arthroscopic meniscus surgery. The secondary purpose was to compare short-term functional outcomes between the 2 protocols. A power analysis demonstrated that 43 patients were required. In this randomized control trial, patients with meniscal pathology undergoing arthroscopic meniscus surgery were included. Group 1 received oxycodone-acetaminophen alone. Group 2 received 1 dose of intravenous ketorolac intraoperatively, oral ketorolac upon discharge, and "rescue" oxycodone-acetaminophen. Patients recorded the number of opioid tablets consumed and visual analog pain scale (VAS) scores 3 times per day for 5 days postoperatively. Opioids were converted to morphine milligram equivalents (MMEs). VAS, Lysholm Knee Scoring Scale, and Knee injury and Osteoarthritis Outcome Score were obtained. Forty-eight patients were randomized. There were 25 patients in the control group and 23 patients in the ketorolac group. The mean (SD) age was 47.9 (14.3) years. Fifty-two percent (n= 25) of the population were female. Three patients (6.3%) underwent meniscal repair. During the first 5 days postoperatively, the mean VAS score (β= -13.2, SE= 5.97, P= .029) and the MMEs consumed were significantly lower (β= -4.7, SE= 1.93, P= .015) per time point in the ketorolac group relative to the control group. The control group had better Lysholm Knee Scoring Scale (mean [SD] 80.6 [18.5] vs 65 [21.5], P= .016) and Knee injury and Osteoarthritis Outcome Score (mean [SD], 74.1 [16.7] vs 61.9 [18.6], P= .029) scores at 6 weeks. There were no significant differences in the rates of side effects. An opioid-sparing pain protocol of intravenous and oral ketorolac is associated with significant reductions in VAS scores and MME consumption in the first 5 days after arthroscopic meniscus surgery. There were significant differences in patient-reported outcomes at final follow-up, favoring the control group. There were no significant differences in adverse reactions and side effects. Therapeutic Level II, prospective randomized controlled trial.

Topical lidocaine for pessary removal and reinsertion pain reduction: a randomized clinical trial

BackgroundVaginal pessaries are an inexpensive non-surgical treatment for pelvic organ prolapse and stress urinary incontinence. Pessary maintenance includes periodic removal, cleaning, and reinsertion, which can be painful. Lidocaine-prilocaine cream has been shown to significantly reduce pain during pessary maintenance exams. In some practices, Lidocaine HCl 2% jelly may be more readily available and serve as an alternative to lidocaine-prilocaine cream. However, the effect of Lidocaine HCl 2% jelly use during pessary maintenance exams has not been tested. ObjectiveTo estimate the effect of Lidocaine HCl 2% jelly versus lubricating jelly on pain at the time of office pessary removal and reinsertion. Study DesignThis study is a single-blind, randomized clinical trial among patients presenting to a urogynecology office at a tertiary care center. Participants were randomized to the application of 5cc of Lidocaine HCl 2% jelly or a water-based lubricating jelly five minutes before pessary removal. Visual analog scale pain scores were collected from the participants at baseline, at pessary removal, and at pessary reinsertion. The primary outcome was the visual analog scale pain score at the time of pessary removal. A sample size of 33 per group (n=66) was planned to estimate an absolute mean difference in visual analog pain scale of 2.05 cm at the time of pessary removal. ResultsBetween September 2022 and June 2023, 192 women were screened, and 66 were enrolled. Thirty-three participants were randomized into the lubricating jelly group and 33 participants were randomized into the Lidocaine HCl 2% jelly group. The two groups were similar in baseline characteristics. Most participants were postmenopausal, using vaginal estrogen, wearing a 70 mm ring pessary with support for pelvic organ prolapse, and reported being very satisfied with the pessary. Other pessaries worn included ring without support, incontinence rings with and without support, Gellhorn, and donut. The pessary sizes ranged from 51 mm to 96 mm. There was no significant difference in pessary type and size between groups. Visual analog scale pain scores at pessary removal were low in both groups: 3.23±3.00 cm in the lubricating group and 2.66±2.77 cm in the lidocaine group. After adjusting for baseline pain, there was no significant difference in pain at pessary removal between the lidocaine jelly and the lubricating jelly groups (mean difference=-0.56 cm, 95% CI: -1.97 to 0.85; p=0.44). Despite no significant difference in visual analog scale pain scores, 71.2% of participants reported a desire for numbing jelly at future pessary examinations. ConclusionPain during pessary removal and reinsertion is low. Compared to lubricating jelly, lidocaine jelly did not further reduce pain during pessary examinations.

Comparative evaluation of postoperative pain and periapical healing after root canal treatment using three different endodontic sealers: A randomized controlled clinical trial.

A randomized controlled clinical trial to evaluate postoperative pain and investigate periapical healing after root canal treatment using eugenol, resin-based, and calcium silicate-based sealers (CSBSs) sealers. Sixty-three individuals diagnosed with apical periodontitis confirmed using cold test and electronic pulp tester, periapical pathology with periapical index score of 2 or more, previous endodontic treatment failure exhibiting a visual analog scale pain score of 3 or above, were enrolled in this investigation. The patients were randomly allocated into three groups and following biomechanical preparation, the canals were obturated using Meta CeraSeal, AH plus, and eugenol-based sealers. Postprocedural pain intensity was assessed at 24 h, 48 h, and 7 days, while periapical healing was evaluated at 3- and 6-month follow-ups. Statistical analysis was done using the Chi-square and Friedman's test. The mean of periapical lesions for Meta CeraSeal (4.7, 1.6), AH Plus (4.68, 3.19), 24 and eugenol-based (2.66, 1.75) at 3 months and 6 months, respectively. The mean & std. deviation of pain scores at 24 h for Meta CeraSeal (0.62 ± 1.857), AH Plus (1.62 ± 1.962), and eugenol-based (0.48 ± 1.250). At 48 h for Meta CeraSeal (0.33 ± 1.528), AH Plus (1.33 ± 1.798). On the 7th day, Meta CeraSeal (0.24 ± 1.091) and AH Plus (0.71 ± 1.384) for eugenol-based at 48 h, and on the 7th day, none of the patients had pain. Evaluation of the apical sealer puff displayed no suggestive variations (P = 0.634). Notably, no analgesics were taken. No suggestive dissimilarity was noted between eugenol, resin-based, and CSBSs sealers.

Analysis of Patients Who Undergo Index Arthroscopy With Biopsy but Not Implantation for Staged Chondrocyte Cell Transplantation.

Autologous chondrocyte implantation (ACI) and matrix-induced autologous chondrocyte implantation (MACI) are 2-stage procedures requiring an index full-thickness cartilage biopsy. Only a portion of patients ultimately undergo second-stage ACI/MACI. To identify patients with articular cartilage defects who underwent arthroscopic debridement with biopsy for ACI/MACI and compare those who did with those who did not proceed with implantation within 2 years after biopsy. Additionally, the authors sought to identify why patients did not proceed with implantation. Case-control study; Level of evidence, 3. Patients who underwent arthroscopy and autologous chondrocyte biopsy from January 1, 2015, to December 31, 2019, and who had minimum 2-year follow-up data were grouped into those who proceeded with second-stage ACI/MACI (implant group; n = 97) and those who did not (biopsy group; n = 63). Demographic factors, cartilage defect characteristics, and preoperative International Knee Documentation Committee (IKDC) scores were analyzed. Patients in both groups were evaluated postoperatively using the IKDC, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Single Assessment Numeric Evaluation (SANE), and visual analog scale (VAS) for pain, and patients who did not undergo implantation were asked for their reasoning. Body mass index (BMI) (P < .001) and Outerbridge grades at index arthroscopy (P = .047) were significantly higher for the implant group than the biopsy group. Both groups had significantly improved IKDC scores from their initial presentation to final follow-up (implant group: 46.4 ± 16.2 preoperative vs 69.6 ± 20.6 postoperative [P < .001]; biopsy group: 47.2 ± 15.9 preoperative vs 70.7 ± 19.1 postoperative [P < .001]); however, the level of improvement did not differ significantly between groups. Postoperative WOMAC, SANE, and VAS pain scores were also similar between groups. In the biopsy group, 23 patients (37%) cited symptom resolution or activity level improvement after initial arthroscopy as the reason for not proceeding with implantation. Patients who proceeded to the second stage of chondrocyte implantation via either ACI or MACI had higher-grade articular defects and higher BMI compared with those who underwent biopsy with concomitant debridement chondroplasty alone. Postoperative outcomes were similar between the groups.