Visual Analog Scale Pain Scores Research Articles

Effects of different drugs in combination with PKP/PVP on postoperative pain in patients with osteoporotic compression fractures: a network meta-analysis.

This study was designed to evaluate the postoperative pain effect and clinical efficacy of different drugs combined with PKP or PVP in treating osteoporotic vertebral compression fractures (OVCFs) through a systematic review and network meta-analysis. We searched five electronic databases, namely, MEDLINE (PubMed), EMBASE, Web of Science, Google Scholar, and the Cochrane Central Register of Controlled Trials online, for the treatment of OVCFs through March 2023 with keywords zoledronic acid (ZOL), teriparatide (TPTD or PTH 1-34), and calcitonin (CT) combined with PKP/PVP. The visual analog scale (VAS) and Oswestry Disability Index (ODI) were the primary outcomes of the network meta-analysis, and the secondary outcome was the diagnostic marker bone mineral density (BMD). Eighteen studies involving 2,374 patients were included in this study. The network meta-analysis revealed that, in terms of reducing VAS scores, compared with PVP surgery alone, PVP combined with TPTD was most likely to be the treatment associated with the greatest pain relief [MD = -4.99, 95% CI = (-7.45, -2.52)]. In terms of reducing the ODI dysfunction score, compared with PKP combined with Cal, PKP combined with ZOL had the highest probability of being the best treatment option [MD = -9.11, 95% CI = (-14.27, -3.95)]. In terms of protecting against bone density loss, compared with PKP surgery alone, treatment with PKP combined with ZOL had the best effect [MD = 0.39, 95% CI = (0.13,0.65)]. Based on the network meta-analysis and SUCRA rankings, this study concluded that adding teriparatide has the advantage of reducing VAS pain scores compared with PVP alone and that adding zoledronate is a more effective treatment for reducing ODI scores compared with PKP combined with Cal and preserving BMD compared with PKP alone. However, additional high-quality studies are needed to verify our findings. https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=358445, identifier CRD42022358445.

Clinical efficacy of the bared external anal sphincter (BEAS) in high horseshoe-shaped anal fistulas: Protocol for a real-world, prospective cohort study

BackgroundHigh horseshoe-shaped anal fistula (HHAF) is a complex disease that manifests in the perianal region and typically requires surgical intervention for treatment. However, the current therapeutic approaches are limited by the high rates of postoperative recurrence and anal incontinence. To overcome the limitations of traditional surgical approaches, we introduce the bared external anal sphincter (BEAS) technique. Our study aims to compare the clinical efficacy of BEAS surgery with that of the modified Hanley procedure in a real-world setting. Materials and methodsThis single-centre, prospective cohort study will be conducted in a tertiary hospital in China and aims to evaluate the short-term clinical efficacy and safety of BEAS surgery and modified Hanley surgery in HHAF patients from March 2024 to March 2026. Data from the prospective database of this tertiary referral hospital will be used to obtain insights into the clinical outcomes of these surgical treatments. The primary outcome of this study will be the wound healing rate within six months, while the secondary outcomes will include the time to return to work, the maximum visual analogue scale pain score (VAS-PS) within 1–5 days postsurgery, and the Cleveland Clinic Florida Incontinence Score (CCF-IS) and Quality of Life in Anal Fistula Questionnaire Score (QoLAF-QS) at 1, 3, and 6 months postsurgery. Moreover, logistic regression analysis will be used to explore the risk factors for anal fistula recurrence after the BEAS procedure. DiscussionThis will be the first cohort study to evaluate the differences in therapeutic outcomes between patients who undergo BEAS surgery and patients who undergo surgery via the modified Hanley procedure. By conducting a detailed observation of the efficacy and treatment results of these two surgical methods, this study aims to reveal the differences the clinical effectiveness of these approaches and to provide evidence-based support for future randomized controlled trials (RCTs).

Surgical treatment of tardy ulnar nerve palsy due to non-neurogenic heterotopic ossification in the elbow.

Heterotopic ossification (HO) is characterized by the formation of pathological bone within the soft tissues. HO predominantly affects elbow joints and may be accompanied by tardy ulnar nerve palsy. This study aimed to explore the clinical and functional outcomes of patients with tardy ulnar nerve palsy caused by HO following surgical treatment, with a review of the relevant literature. A retrospective study was conducted on 4 patients with tardy ulnar nerve palsy caused by HO, who underwent anterior subcutaneous ulnar nerve transposition between 2015 and 2020. The patients were followed up for more than 1 year and the cause of HO was also identified. Clinical and functional outcomes were evaluating using the grip strength and pinch strength, visual analog scale (VAS) pain score and Quick disabilities of the arm, shoulder and hand (DASH) score. The causes of HO were repetitive micro-trauma in 1 case and excessive physical or rehabilitation therapy in 3 cases. The average follow-up period was 15.6 months (range; 12-21 months). The grip strength increased from an average of 14kg to 26.5kg. The pinch strength increased from an average of 1.5 kg to 3.63 kg. The Quick DASH score decreased from an average of 55.6 to 6.15. The VAS score for pain decreased from an average of 7 to 0.25. Rapid surgical treatment, including removal of the heterotopic bone and ulnar nerve anterior transposition, might improve outcomes in patients with tardy ulnar nerve palsy caused by HO.

Prospective comparison of two surgical approaches for incarcerated and strangulated inguinal hernia: preperitoneal hernioplasty through the lower abdominal median incision and laparoscope (TAPP).

The optimal surgical approach of incarcerated and strangulated inguinal hernia is controversial. Retrospective studies showed that surgical approaches through lower abdominal median incision or laparoscopic are superior to the oblique inguinal incision, respectively. Whether transabdominal laparoscopic approach is superior to the lower abdominal median incision approach needs prospective research.Prospective comparative study of patients with incarcerated and strangulated groin hernia admitted to Jinshan hospital for emergency surgery from January 2018 to June 2022. They were divided into two groups according to different surgical approach. The open preperitoneal repair group (OPR) was operated through the lower abdominal median incision. Laparoscopic preperitoneal repair group (TAPP) was completed under transabdominal laparoscope. The perioperative complications and long-term results of the two groups were compared and analyzed. Eighty-two patients met the inclusion criteria, 40 in OPR group and 42 in TAPP group. Baseline data of the two groups were comparable. Thirteen cases (15.9%) of the two groups underwent intestinal resection and anastomosis. Seventy cases (90.2%) underwent the 1st stage mesh repair, including 5 cases of preperitoneal hernioplasty after intestinal resection. The average operation time of TAPP group was 13min longer (60.7 ± 13.7min vs 47.8 ± 19.8min P < 0.001), and the visual analogue scale pain score at 24h after operation was lower (3.5 ± 1.2 vs 4.4 ± 1.7 P = 0.019) than that of OPR group. There was 1 case of bladder injury (2.5%) in OPR group and 1 case of inferior abdominal artery injury (2.4%) in TAPP group. There was no difference in the rate of the 1st stage hernioplasty between the two groups. In OPR group, 2 cases (5%) extended the incision for more than 2cm, while in TAPP group, 1 case (2.4%) converted to laparotomy. The time of hospital stay (3.2 ± 1.8 d vs 4.3 ± 2.7 d, P = 0.036) and return to normal activities (7.9 ± 2.7 d vs 11.0 ± 4.4 d, P < 0.001) were shorter in TAPP group. The rate of total postoperative complications including chronic pain, surgical-site infection, seroma, hernia recurrence and so on was 11.9% in TAPP group, which was not significantly different from 25% in OPR group (P = 0.212). There were no cases of mesh related infection and death within 30days in both groups.TAPP is safe and feasible for the operation of acute incarcerated inguinal hernia. TAPP had better comfort and faster recovery over open preperitoneal repair for the appropriate patients with incarcerated/strangulated inguinal hernia, which can reduce acute pain, shorten hospital stay and return to normal activities earlier.

What Is the Trajectory of Recovery in the Early Postoperative Period after the Big 3 Shoulder Surgeries? Comparative Analysis Using 3 Previous Prospective Studies.

(1) Background: The aims of this study were to compare serial changes in outcome measures in the early postoperative period after rotator cuff repair (RCR), anatomical total shoulder replacement (ATSR), and reverse total shoulder replacement (RTSR). (2) Methods: In total, 143 patients who underwent RCR (n = 47), ATSR (n = 46), and RTSR (n = 50) were included. The visual analogue scale (VAS) for pain, the activity of daily living (ADL) score, and the American Shoulder and Elbow Surgeons (ASES) score were completed. (3) Results: At 3 months, the recovery rate for the VAS pain score was 43.7% in the RCR, 89.1% in the ATSR, and 78.4% in RTSR. The recovery rate for the ADL score was 36.3%, 69.5%, and 76.4%. The recovery rate for ASES score was 40.9%, 79.5%, and 77.4%. For all outcome measures, a lower recovery rate was observed in the RCR group than in the ATSR and RTSR groups. At 6 months after surgery, the recovery rate for the VAS pain score was 69.9%, 100%, and 90.3%. The recovery rate for the ADL score was 66.8%, 92.8%, and 91.5%. The recovery rate for the ASES score was 68.7%, 96.5%, and 90.9%. (4) Conclusion: Compared with ATSR and RTSR, a slower recovery rate was observed for RCR, measured to be approximately 40% at 3 months and 70% at 6 months after surgery. Rapid improvement in pain and shoulder function was achieved after ATSR and RTSR, with a recovery rate of over 70% at 3 months and over 90% at 6 months after surgery.

Complete elbow ankylosis secondary to heterotopic ossification: operative management leads to fair to excellent long-term outcomes

BackgroundHeterotopic ossification (HO) in the elbow, often caused by trauma or neurogenic factors, can lead to limited range of motion and physical impairment, while severe cases may result in debilitating loss of function. Complete bony ankylosis of the elbow, though rare, presents challenges in treatment due to complex anatomy and high recurrence rates, with limited literature on management and outcomes. This study retrospectively investigates cases of elbow ankylosis secondary to HO, assessing long-term functional outcomes following operative intervention and standardized rehabilitation. MethodsA retrospective case series was performed on patients who underwent surgical excision of heterotopic ossification of the elbow at our institution. Outcomes of interest were intraoperative flexion-extension arc, flexion-extension arc at final long-term postoperative follow-up, visual analog scale pain scores at long-term follow-up, and Mayo Elbow Performance Scores at long-term follow-up. Wilcoxon signed-rank test was performed to identify a statistically significant difference between arc of motion achieved intraoperatively and the arc of motion maintained at final long-term postoperative follow-up. ResultsBetween September 1999 and July 2021, 107 patients underwent operative resection for heterotopic ossification around the elbow, with 13 patients (16 elbows) exhibiting complete ankylosis at time of surgery. Patients were followed for a minimum of two years. Long-term outcomes demonstrated an average VAS pain score of 1.4 +/- 1.7, and an average MEPS of 85.9 +/-12.8, with 75% of cases maintaining at least 100 degrees of flexion-extension arc at final long-term postoperative follow-up. On average, the flexion-extension arc of motion at final follow-up was preserved at 95% of intraoperative levels. Patients did have an average residual flexion contracture of 18 +/- 9 degrees at final follow-up. ConclusionSurgical excision for complete elbow ankylosis secondary to heterotopic ossification presents challenges due to potential complications. Our study shows favorable long-term outcomes in pain scores, range of motion, and Mayo Elbow Performance Scores (MEPS). Despite reported complications in the literature, our series exhibited no adverse events, supporting operative excision as a standard treatment with overall fair to excellent outcomes. Further research, particularly involving multicenter, randomized, prospective studies, is warranted to refine protocols and understand predictors for improved outcomes in this patient population.

Effect of dorsal capsular imbrication on intraoperative DRUJ instability following arthroscopic TFCC repair surgery

BackgroundTo assess the clinical outcomes and identify the ideal indication for implementing dorsal distal radioulnar joint (DRUJ) capsular imbrication after triangular fibrocartilage complex (TFCC) repair in cases of DRUJ instability.MethodsWe conducted a retrospective study on patients who underwent arthroscopic TFCC repair between 2016 and 2021. Inclusion criteria comprised a symptomatic ulna fovea sign for over 6 months and dorsal DRUJ subluxation on magnetic resonance imaging. A total of 225 patients were divided into two groups: Group 1 (135 cases) with a negative ballottement test after “Cross-form TFCC repair” (CR) and Group 2 (90 cases) with a positive ballottement test after “Cross-form TFCC repair” and augmented DRUJ stability through dorsal DRUJ capsular imbrication (CR + DCI). Pain visual analog scale score (VAS), grip strength, modified Mayo Wrist Score (MMWS), wrist range of motion (ROM), and patient-reported outcomes (PROMs) were assessed for a minimum of 3 years postoperatively.ResultsBoth groups showed significant improvements in pain VAS score, grip strength, wrist ROM, MMWS, and PROMs between the preoperative and postoperative periods (all P < 0.05). Recurrent DRUJ instability occurred in 3.7% and 1.1% of patients in the “CR” and “CR + DCI” groups, respectively, with a significant difference. Despite the “CR + DCI” group initially exhibiting inferior ROM compared with the “CR” group, subsequently, no significant difference was noted between them.ConclusionsDorsal DRUJ capsular imbrication effectively reduces postoperative DRUJ instability rates, enhances grip strength, and maintains wrist ROM in patients with a positive intra-operative ballottement test after arthroscopic TFCC repair.

Short-term effectiveness of unilateral biportal endoscopy technique in treatment of lumbar lateral saphenous fossa combined with intervertebral foramina stenosis via contralateral sublaminar approach

To investigate the short-term effectiveness of unilateral biportal endoscopy (UBE) in treatment of lumbar lateral saphenous fossa combined with intervertebral foramina stenosis via contralateral sublaminar approach. A clinical data of 15 patients with lumbar lateral saphenous fossa combined with intervertebral foramina stenosis, who were admitted between September 2021 and December 2023 and met selective criteria, was retrospectively analyzed. There were 5 males and 10 females with an average age of 70.3 years (range, 46-83 years). Surgical segment was L 4, 5 in 12 cases and L 5, S 1 in 3 cases. The disease duration was 12-30 months (mean, 18.7 months). All patients were treated by UBE via contralateral sublaminar approach. The operation time, intraoperative blood loss, postoperative hospital stay, and the occurrence of complications were recorded. The visual analogue scale (VAS) score was used to evaluate the degree of lower back and leg pain before and after operation; the Japanese Orthopaedic Association (JOA) score and the Oswestry disability index (ODI) were used to evaluate the lumbar function; and the clinical outcome was evaluated using the MacNab criteria at 6 months after operation. Postoperative MRI and CT were taken to observe whether the lateral saphenous fossa and intervertebral foramen stenosis were removed or not, and the cross-sectional area of the spinal canal (CSA-SC), cross-sectional area of the intervertebral foramen (CSA-IVF), and cross-sectional area of the facet joint (CSA-FJ) were measured. The operation time was 55-200 minutes (mean, 127.5 minutes); the intraoperative blood loss was 10-50 mL (mean, 27.3 mL); the length of postoperative hospital stay was 3-12 days (mean, 6.8 days). All patients were followed up 6-12 months (mean, 8.9 months). At 1 day, 1 month, 3 months, and 6 months after operation, the VAS scores of low back and leg pain and ODI scores after operation were significantly lower than preoperative scores and showed a gradual decrease with time; the JOA scores showed a gradual increase with time; the differences in the above indexes between different time points were significant ( P<0.05). The clinical outcome was rated as excellent in 10 cases, good in 4 cases, and poor in 1 case according to the MacNab criteria at 6 months after operation, with an excellent and good rate of 93.33%. Imaging review showed that the compression on the lateral saphenous fossa and intervertebral foramina had been significantly relieved, and the affected articular process joint was preserved to the maximum extent; the CSA-SC and CSA-IVF at 3 days after operation significantly increased compared to the preoperative values ( P<0.05), and the CSA-FJ significantly reduced ( P<0.05). The UBE via contralateral sublaminar approach can effectively reduce pressure in the lateral saphenous fossa and the intervertebral foramina of the same segment while preserving the bilateral articular process joints. The short-term effectiveness is good and it is expected to avoid fusion surgery caused by iatrogenic instability of the lumbar spine. However, further follow-up is needed to clarify the mid- and long-term effectiveness.

Balance chiropractic therapy for cervical spondylotic radiculopathy: A randomized controlled trial

ObjectiveTo assess the clinical effectiveness of the balance chiropractic therapy (BCT) compared with traction therapy (TT) for patients with cervical spondylotic radiculopathy. MethodsSubjects were enrolled from four hospitals. Eligible patients will be randomized to one of the two arms: the treatment group and the control group. In the treatment group, patients received the BCT for 20 days, while patients in the control group received TT. Patients visited the physician at 1- and 3-month follow-up. The primary outcome was pain severity measured with a Visual Analog Scale (VAS). Secondary outcomes included cervical curvature measured using the Borden method, a composite of functional status measured by the Neck Disability Index (NDI), patient health status (evaluated by the SF-36 health survey) and adverse events (AEs) as reported in the trial. ResultsOf the 240 randomly assigned patients, 120 participants were assigned to the BCT and 120 to the TT. 231 (96.3 %) provided follow-up data at 1 and 3 months. There were no significant differences in baseline data between the two groups (P > 0.05), indicating good comparability. According to the results, after BCT and TT treatment, the pain VAS score, cervical curvature, NDI scores and SF-36 scores of two groups was significantly improved (P < 0.05). Furthermore, at 20 days of treatment and 1 and 3 months of follow-up, the participants in the BCT group showed superior treatment outcomes on both primary and secondary measures. ConclusionThe BCT may be a novel strategy for the treatment of the cervical spondylotic radiculopathy. Trial registrationClinical Trials.gov Identifier: NCT02705131. Registered on March 10, 2016, https://clinicaltrials.gov/study/NCT02705131?cond=NCT02705131&rank=1&tab=table.

Efficacy of tibial cortex transverse transport in treating diabetic foot ulcer and its effect on serum omentin-1 and irisin levels

ObjectiveDiabetic foot ulcer (DFU) is a common and debilitating complication of diabetes that is associated with an increased risk of lower-limb amputation and a reduced life expectancy. Tibial cortex transverse transport (TTT) has become a newly alternative surgical method to facilitate ulcer healing and prevent lower limb amputation. Herein, we investigated the efficacy of TTT in treating DFU and changes of serum omentin-1 and irisin levels.MethodsThis study prospectively recruited 52 consecutive patients with DFU who were treated with TTT. The follow-up was performed weekly during the first 12 weeks postoperatively and every 3 months until 1 year after TTT. The serum levels of vascular endothelial growth factor (VEGF), omentin-1, and irisin in DFU patients undergoing TTT were determined by ELISA methods on the preoperative 1st day, postoperative 2nd week and 4th week.ResultsThe wound healing rate was 92.3% (48/52) at the 1-year follow-up. The visual analog scale (VAS) pain scores of patients showed a significant reduction at the 4th week after TTT (p < 0.001). The dorsal foot skin temperature, ankle brachial index, and dorsal foot blood flow of patients were significantly increased at the 4th week after TTT (p < 0.001). Results of ELISA methods showed the serum levels of VEGF, omentin-1, and irisin on the 2nd week and 4th week after TTT were notably elevated compared to the levels determined on the preoperative 1st day (p < 0.001). The serum levels of VEGF, omentin-1, and irisin on the 4th week after TTT were also significantly higher than the levels determined on the 2nd week after TTT (p < 0.001).ConclusionTTT could promote the wound healing and reduce the risk of lower limb amputation, demonstrating promising clinical benefits in the treatment of DFU. Increased expressions of serum proangiogenic factors including VEGF, omentin-1, and irisin were noted in the early stage after TTT, which may provide a new mechanism of TTT promoting wound heal.

Novel MRI-Based Pedicle Bone Quality Score Independently Predicts Pedicle Screw Loosening after Degenerative Lumbar Fusion Surgery.

To introduce and evaluate an MRI-based PBQ score to determine its effectiveness in predicting pedicle screw loosening following lumbar fusion surgery. The retrospective study analyzed 244 patients who underwent posterior lumbar interbody fusion (PLIF) with pedicle screws between December 2017 and December 2021, with CT and MRI imaging before surgery. Data collected included patient demographics and preoperative radiological data. Radiographic screw loosening was measured at 12 months postoperatively. Clinical assessments included pain visual analog scale (VAS) and Oswestry Disability Index (ODI) scores. The PBQ score was measured using MRI scans. We use univariate analysis for preliminary screening of the risk factors of screw loosening. Subsequent analysis involved multivariate logistic regression to identify independent predictive factors for screw loosening. We constructed the receiver operating characteristic (ROC) curve to ascertain the discriminative capacity of the PBQ score. The area under the curve (AUC) quantified its predictive accuracy. Additionally, we evaluated the association between PBQ score and screw loosening using Spearman's correlation analysis. Overall, 244 patients who underwent PLIF with pedicle screw fixation participated in this study, including 35 in the loosening group and 209 in the non-loosening group. PBQ score in the loosening group was significantly higher than that in the non-loosening group. On multivariate logistic regression, the higher PBQ score (OR = 8.481, 95% CI: 3.158-22.774; p < 0.001) and the lower mean Hounsfield unit (HU) value of L1-4 (OR = 0.967, 95% CI 0.951-0.984; p < 0.001) were the variables that significantly predicted screw loosening. The AUC for the PBQ score and HU value were 0.751 (95% CI: 0.673-0.828) and 0.702 (95% CI: 0.612-0.791). The PBQ score optimal cutoff to differentiate patients with loosening and with non-loosening was calculated as 3.045 with a sensitivity of 85.7% and specificity of 76.9%, while the optimal cutoff of the HU value was 151.5 with a sensitivity of 64.6% and specificity of 89.5%. The association between the PBQ score and the propensity for lumbar pedicle screw loosening was found to be substantial. As a predictive measure, the PBQ score outperformed the HU value in forecasting the likelihood of screw loosening post-posterior lumbar fusion.

Clinical outcomes of patients with unilateral internal derangement of the temporomandibular joint following arthrocentesis and stabilization splint therapy

BackgroundThe management of internal derangement (ID) of the TMJ is challenging because of multiple etiologic factors and varying degrees of severity. The aim of this study was to evaluate the clinical outcomes of patients with unilateral ID treated with arthrocentesis and stabilization splint therapy during a 6-month period.MethodsA total of 105 patients (87 females, 18 males) with unilateral ID were included in this study. Patients were divided into unilateral anterior disc displacement with reduction (ADDwR) and unilateral anterior disc displacement without reduction (ADDwoR). Patients with ADDwoR were subdivided according to the erosive bone changes. Objective parameters on mandibular movement and subjective parameters on pain were obtained and assessed.Their clinical outcomes before and after arthrocentesis and stabilization splint therapy were compared with the chi-square, Fisher’s exact test, paired t-test, or Wilcoxon singed-rank test.ResultsAll objective parameters of unilateral ID patients significantly increased at the 6-month follow-up. The differences in mean visual analog scale (VAS) pain scores were statistically significant in all subjective variables (p < 0.01). In joints with ADDwoR, preoperative maximal mouth opening, and maximal protrusive movement in both groups, with erosive and non-erosive changes were significantly increased after 6 months (p < 0.01). However, right and left maximal lateral movement increased after treatment in both groups but without significant differences. All VAS pain scores on jaw movement and palpation of associated muscles showed a significant decrease regardless of erosive changes.ConclusionsThe combination of arthrocentesis and subsequent stabilization splint therapy was shown to be highly effective in pain reduction and improvement of mandibular movements in both unilateral ADDwR and ADDwoR, as well as in cases with both erosive and non-erosive bony changes associated with unilateral ADDwoR.

Acromioplasty combined with arthroscopic rotator cuff repair can reduce the risk of reoperation: a systematic review and meta-analysis

ABSTRACT Background Whether to perform acromioplasty in arthroscopic rotator cuff repair (ARCR) is controversial, and the optimal surgical approach for rotator cuff tear repair is unknown. The purpose of this study was to compare the reoperation rate, retear rate and patient-reported outcomes (PROs) of ARCR with those of ARCR combined with acromioplasty (ARCR-A). Methods PubMed, Embase and Cochrane Library were searched for relevant literature dated between database inception and 4 December 2023. The primary outcomes of this study were the reoperation rate and the retear rate. The secondary outcomes were PROs, including the visual analogue scale (VAS) pain score, the American Shoulder and Elbow Surgeons (ASES) score, the University of California-Los Angeles (UCLA) score, the Constant score and the Western Ontario Rotator Cuff (WORC) score. The quality of the included studies was evaluated by using the risk of bias assessment tool. RevMan 5.3 software was used for meta-analysis. Fixed (I2 <50%) or random (I2 ≥50%) effects models were applied to calculate the effect size. Results Meta-analysis revealed that ARCR-A had a lower reoperation rate (OR = 0.35, 95%CI: 0.15-0.85, p = 0.02), but the difference in the retear rate between ARCR-A and ARCR was not significant (p = 0.25). In type 2 acromion patients, the reoperation rate was not significantly different between ARCR and ARCR-A (p = 0.12), but, for type 3 acromion patients, the retear rate was lower for ARCR-A than for ARCR (OR = 0.12, 95%CI: 0.01-0.94, p = 0.04). There were statistically significant differences in the 6-month postoperative Constant scores (p < 0.001), VAS pain scores (p = 0.003) 12-month postoperative ASES scores (p = 0.02) and 24-month postoperative WORC scores (p = 0.04), but these differences were not clinically significant. Conclusions Combining ARCR with acromioplasty can reduce the rate of reoperation, especially in patients with type 3 acromion, but it provides no clinically important change in the retear rate and postoperative PRO compared with ARCR.

Clinical outcomes of total hip arthroplasty after femoral neck fractures vs. osteoarthritis at one year follow up—A comparative, retrospective study

PurposeThe objective of the study is to determine if there was a difference in medical complications and in-hospital mortality among the patients who underwent THA for femoral neck fracture relative to same procedure for elective patients with coxarthrosis.MethodsWe compared characteristics and short-term outcomes during the rehabilitative postsurgical period. We included all patients older than 45 years who underwent THA for primary/secondary hip arthritis and displaced femoral neck fractures type Garden III and IV. Clinical examination, functional outcome and radiographic evaluation were performed during follow-up. Patients were evaluated at the following time points: preoperatively, postoperatively at three days, six weeks, 12 weeks and one year and we registered Visual Analogue Scale (VAS) pain score, Harris Hip Score (HHS), the Western Ontario McMaster Osteoarthritis Index (WOMAC), internal and external rotation of the hip and operated limb length compared with the opposite.ResultsThere is no significant statistically differences between the two groups regarding the preoperative comorbidities. The frequencies of patients experiencing in-hospital and 30-day postoperative complications were generally low and same in groups we studied. The mean quantity of surgical blood loos during the operation was significantly higher in the hip fracture group compared with elective patient group with OA (340.09 ± 86.03 vs 309.43 ± 102.52). With respect to postoperative recovery the patients with THA after FNF were mobilized by active walking a little bit faster as the patient with OA (2.77 ± 1.18 days vs 3.1 ± 1.14 days). The average inpatient hospital length of stay after THA for OA was 11.07 days compared to 13.41 days following a THA for FNF.ConclusionOur study showed that THA for treatment of an acute fracture of the femoral neck in an elderly patient can provide results comparable to those of patients who received THA for OA and we found that the results are similar.

Distal Positioning of the Ulnar Shortening Plate Increases Symptomatic Removal: A Comparative Analysis of Ulnar Shortening Osteotomy Plate Positioning and Symptomatic Hardware Removal

Abstract Background Ulnar shortening osteotomy (USO) is a common procedure to treat symptomatic ulnar-sided wrist symptoms in patients with positive ulnar variance who fail nonoperative management. Plate placement on the volar, dorsal, or subcutaneous border of the ulna has been described. There remains debate regarding the optimal plate placement to minimize soft tissue irritation and the need for plate removal. The goal of this study is to determine whether plate position along the volar cortex versus along the subcutaneous border, as well as the distance of the plate from the ulnar styloid, affects the risk of symptomatic hardware requiring removal. Methods In total, 112 USO procedures on 107 patients performed between 2017 and 2023 were retrospectively reviewed. The position of the plate on the ulna and the distance of the plate from the ulnar styloid were assessed radiographically. Demographic information, visual analog scale pain scores, disability of the arm, shoulder, and hand scores, and incidence of hardware removal were collected and compared between plate location groups. Results The overall symptomatic hardware removal rate was 79%. There was no difference in the rate of symptomatic hardware removal between volar (80%) and subcutaneous (77%) plate locations (p = 0.69) at a mean follow-up time of 26 months. The mean distance from the distal plate to the ulnar styloid was higher in cases in which hardware was retained (p = 0.03). Conclusion We found no difference in hardware removal rates based on volar versus subcutaneous plate placement after USO. Cases in which hardware was not removed had a higher mean distance from the distal plate to the ulnar styloid. Further prospective studies are warranted to determine optimal plate positioning to minimize hardware irritation after USO.

Real-time analgesic efficacy and factors determining drug requirements of combined spinal-epidural analgesia for labor: a prospective cohort study

PurposeCombined spinal-epidural analgesia (CSEA) is effective but not sufficient for labor pain. This study was conducted to assess the real-time analgesic efficacy, side effects of anesthetic drug dosage, and maternal satisfaction in labor to provide reference for the optimization of labor analgesia.MethodsThis was a prospective, cohort, single-center study that included 3020 women who received CSEA for labor analgesia. The visual analogue scale (VAS) for labor pain, real-time anesthetic drug dosage, side effects, adverse labor outcomes, factors influencing average drug dosage, and maternal satisfaction with CSEA were assessed.ResultsOverall, the VAS labor pain score was lowest at the first hour after the anesthesia was given. After 4 h for primiparas and 3 h for multiparas, the VAS score was greater than 3 but the anesthetic drug dosage did not reach the maximum allowed dosage at the same time. The average anesthetic drug dosage was positively correlated with fever, urinary retention, uterine atony, prolonged active phase, prolonged second stage, assisted vaginal delivery, and postpartum hemorrhage. The average anesthetic drug dosage was the highest in women ≤ 20 years old, those with a body mass index (BMI) ≥ 24.9 kg/m2, and those with a primary or secondary education level.ConclusionAppropriate age guidance and emphasis on education of labor analgesia, weight management during pregnancy, and real-time anesthetic dosage adjustment during labor based on VAS pain score may have positive effects on the satisfaction of labor analgesia.Clinical trial number and registryClinicaltrials.gov (ChiCTR2100051809).

How does Fixation Alignment Affect Surgical Outcomes in Arthrodesis for Thumb Carpometacarpal Osteoarthritis?

Abstract Purpose Arthrodesis is a traditional surgical procedure for treating thumb carpometacarpal (CMC) osteoarthritis. Previous studies have investigated surgical outcomes, focusing on the fixation technique, bone union rate, and surgical complications but not on the postoperative alignment of the thumb CMC joints. Therefore, we aimed to investigate how thumb fixation alignment affects the surgical outcomes of thumb CMC arthrodesis. Patients and Methods Twenty-six patients (28 thumbs) who achieved bone union after arthrodesis with more than 1-year follow-up were retrospectively analyzed. We measured the radial abduction and palmar abduction angles and change in thumb length (Δthumb length) on postoperative radiographs and the first metacarpal rotation angle on postoperative computed tomography. Moreover, we investigated the 1-year clinical outcomes, including the Disabilities of Arm, Shoulder, and Hand (DASH) score, Hand20 questionnaire score, visual analog scale (VAS) score for pain, Δgrip strength, Δpulp pinch, and Δkey pinch strength. The correlation between the postoperative alignment and clinical outcomes was also statistically analyzed. Results The mean radial abduction, palmar abduction, first metacarpal rotation angles, and Δthumb length were 20.8 degrees, 34.4 degrees, 109.4 degrees, and −1.8 mm, respectively. Radial abduction and palmar abduction angles were positively and negatively correlated with Δgrip strength (r = 0.37 and −0.37), respectively. The first metacarpal rotation angle was positively correlated with the DASH score (r = 0.51), Hand20 score (r = 0.48), and VAS score for pain (r = 0.42). ΔThumb length had no correlation with clinical outcomes at 1-year follow-up. Conclusion Thumb fixation alignment has an impact on the surgical outcomes of thumb CMC arthrodesis. To obtain a successful outcome, it is important to add slight pronation and avoid excessively small radial abduction and excessively large palmar abduction.

Intravenous Dexamethasone versus intrathecal Dexamethasone in Prolonging the Duration of Spinal Anesthesia and Postoperative Analgesia in Elective Cesarean Section

Abstract Background Spinal anesthesia is the most commonly used technique for cesarean section as it is very economical and easy to administer. The short duration of action of local anesthetic drugs has created a matter of concern for anesthesiologists. Aim of the Work To compare the efficacy of intrathecal dexamethasone with intravenous dexamethasone as an adjuvant to prolong the sensory block obtained by spinal anesthesia and postoperative analgesia in cesarean section. Participants and Methods 66 pregnant women scheduled for cesarean section were randomly allocated to one of three groups including (22) patients each. All the patients received injection of heavy bupivacaine 0.5% 10 mg through spinal anesthesia, with adding 1 mL of 0.9% saline and normal saline 2 mL intravenously (control group), or 0.5 mL (2mg) dexamethasone diluted in 0.5 ml of 0.9% saline intrathecally with normal saline 2 mL intravenously (IT group ), or dexamethasone 2 mL (8mg) intravenously with intrathecal injection of heavy bupivacaine 0.5% 2 mL plus 1 mL of 0.9% saline (IV group ) with overall 3 ml volume intrathecally in each group. Duration of sensory block, postoperative analgesia, visual analog pain scale (VAS) score, time of rescue analgesia in the first 24 h, intra- and post-operative hemodynamics, and side effects if any were recorded. Results The study groups, There was significantly higher post-operative analgesic duration (8.73 ± 2.64) hours compared to addition of Intravenous Dexamethasone (4.91 ± 1.02) hours or using hyperbaric bupivacaine alone (3.43 ± 0.71) hours with p-value &amp;lt;0.001. There was no effect on the time of onset of sensory block with no significant complications were detected. Conclusion The addition of 2mg dexamethasone intrathecally as an adjuvant to spinal anesthesia during cesarean section prolong the duration of sensory block and postoperative analgesia.

Conversion hip arthroplasty in the treatment of adverse effects of proximal femoral fractures

INTRODUCTION. Currently, there are no uniform algorithms for surgical tactics of conversion hip arthroplasty.The OBJECTIVE was to evaluate the mid-term results of conversion hip arthroplasty in patients with adverse effects of proximal femoral fractures.METHODS AND MATERIALS. A retrospective study of the treatment results of 58 patients who underwent conversion hip arthroplasty was conducted. All patients underwent bacteriological examination before and during surgery, blood tests for ESR and CRP. Patients were divided into two groups: Group 1 (low risk of infections) – 29 patients in one stage, group 2 (high risk of infections) – 29 patients with a two-stage technique using a cement spacer. Randomization criteria: positive preoperative culture, elevated CRP (&gt;10 mg/L) and ESR (&gt;30 mm/hour). Efficacy was assessed using the visual analogue pain scale and Oxford Hip Score after 6, 12 and 24 months, as well as the frequency and nature of complications.RESULTS. The average age of patients was 58.7 years. The average follow-up period was 4.5±1.3 years. The average surgery time – 115 minutes in group 1 and 100 minutes in group 2. The average blood loss was 650±123 ml in group 1 and 630±108 ml in group 2. Pain syndrome according to the VAS scale after 6, 12 and 24 months was 2.5–1.2–1.2 points in both groups, respectively (p=0.001). Periprosthetic hip fracture occurred in 7 cases (12 %); dislocation – in 1 case (1.7 %); deep infection – 3 patients (5.1 %); aseptic loosening – in 2 cases (3.4 %). Revision arthroplasty was required in 5 cases (8.6 %).CONCLUSION. The mid-term results of conversion arthroplasty are significantly lower compared to the results of primary arthroplasty. Conversion is associated with a higher number of intraoperative hip fractures and infections. The use of a two-stage conversion technique with temporary installation of a cemented spacer allows to reduce the number of infectious complications after the final arthroplasty by 3 times.

Effects of ultrasound-guided serratus plane block combined with general anesthesia on postoperative early quality of recovery and analgesia in patients undergoing transapical transcatheter aortic valve implantation surgery: study protocol for a randomized controlled trial

BackgroundCompared to traditional thoracotomy, transapical transcatheter aortic valve implantation (TAVI) surgery offers reduced trauma and faster recovery, fostering the adoption of enhanced recovery after surgery (ERAS) protocols in cardiac surgery. Despite these advancements, postoperative pain management has received insufficient attention. The potential effects of multi-mode analgesia, including ultrasound-guided serratus anterior plane block (SAPB), on postoperative pain and early quality of recovery have not been widely studied, lacking comprehensive prospective evidence. Therefore, this study aims to investigate the impact of SAPB combined with general anesthesia on early recovery quality and analgesic efficacy in transapical TAVI patients.MethodsThis prospective, randomized controlled study will enroll 70 patients undergoing transapical TAVI, randomly allocated to either the SAPB group or the control group. The primary outcome, assessed using Quality of Recovery-40 (QOR-40) scale, focuses on the quality of recovery at 24 h and 48 h postoperatively. Secondary outcomes include the visual analog scale (VAS) pain scores at rest and during coughing at 6 h, 12 h, 24 h, and 48 h after surgery, frequency of patient-controlled analgesia (PCA) utilization at 24 h and 48 h, opioid consumption at 24 h and 48 h, time and frequency of rescue analgesia and severe pain at 24 h and 48 h, incidence of nausea and vomiting at 48 h after surgery, and dosage of antiemetic drugs.DiscussionThe purpose of our study is to evaluate the effects of ultrasound-guided SAPB combined with general anesthesia on postoperative early quality of recovery and analgesia in transapical TAVI patients. The results obtained may provide valuable insight for the implementation of multi-mode analgesia and enhanced ERAS in this specific patient population.Trial registrationChina Clinical Trial Register ChiCTR2300068584. Registered on 24 February 2023.