scholarly journals Implant removal associated complications after ESIN osteosynthesis in pediatric fractures

2021 ◽  
Author(s):  
Justus Lieber ◽  
Markus Dietzel ◽  
Simon Scherer ◽  
Jürgen F. Schäfer ◽  
Hans-Joachim Kirschner ◽  
...  
Keyword(s):  
Complication Rate ◽  
Metal Removal ◽  
Intraoperative Complications ◽  
Statistical Significance ◽  
Major Complication ◽  
Safe Procedure ◽  
Pediatric Fractures ◽  
Femur Fractures ◽  
Outlet Angle ◽  
Implant Length

Abstract Purpose ESIN (elastic stable intramedullary nailing) is considered the gold standard for various pediatric fractures. The aim of this study was to analyze the incidence and type of complications during or after TEN (titanium elastic nail) removal. Methods A retrospective data analysis was performed. Metal removal associated complications and preoperative extraosseous length/outlet angle of TENs as possible causes of complications were assessed. Results The complication rate in 384 TEN removals was 3.1% (n = 12). One major complication (rupture of M. extensor pollicis brevis) was documented. One refracture at the forearm occurred, however, remodeling prior TEN removal was completed. Ten minor complications were temporary or without irreversible restrictions (3 infections, 5 scaring/granuloma, 2 temporary paraesthesia). In 38 cases (16 forearms, 10 femora, 9 humeri, 3 lower legs), intra-operative fluoroscopy had to be used to locate the implants. In patients with forearm fractures, extraosseous implant length was relatively shorter than in cases without fluoroscopy (p = 0.01), but outlet angle of TENs was not significantly different in these two groups (28.5° vs 25.6°). In patients with femur fractures, extraosseous implant length and outlet angle were tendentially shorter, respectively, lower, but this did not reach statistical significance. Conclusion Removal of TENs after ESIN is a safe procedure with a low complication rate. Technically inaccurate TEN implantation makes removal more difficult and complicated. To prevent an untimely removal and patient discomfort, nail ends must be exactly positioned and cut. Intraoperative complications may be minimized with removal of TENs before signs of overgrowth. Evidence Level III, retrospective.

scholarly journals Complications in Treatment of 31-A Fractures with Trochanteric Gamma Nail (TGN) Versus Gamma3 Nail (G3N) - A Review of 217 Cases

2016 ◽  
Vol 10 (1) ◽  
pp. 389-395 ◽  
Author(s):  
R. Schupfner ◽  
L.T. Käsmann ◽  
W. Wagner ◽  
A.P. Schulz
Keyword(s):  
Complication Rate ◽  
Statistical Significance ◽  
Gamma Nail ◽  
Consecutive Series ◽  
Related Complication ◽  
Surgical Time ◽  
Adequate Treatment ◽  
Femur Fractures ◽  
Two Generations

Introduction:The aim of this study was to clinically evaluate two generations of intramedullary gamma-nail used in the treatment of 31-A femur fractures.Materials and Methods:In two consecutive series, 117 trochanteric gamma nails (TGN) and 100 Gamma3 nails (G3N) were implanted for the treatment of inter- and subtrochanteric fractures between 2009 and 2011. Clinical and radiological follow-up examinations were assessed. An analysis of surgical time, hemoglobin drop and complications were performed.Results:Average surgical time, fluoroscopy time, haemoglobin drop and length-of-stay (LOS) were similar in both groups. No significant differences were found in surgery-related complications like wound hematomas (p=0,59), abscesses (p=0,38), wound infections (p=0,69) and Cut-outs (p=0,69) between the two groups. The cumulative surgery-related complication rate was higher in the TGN group compared to the G3N group (13,68%vs.8%) but this did not reach statistical significance (p=0,2).Conclusion:Our findings suggest that both TGN and G3N allow adequate treatment of trochanteric fractures with an acceptable complication rate.

scholarly journals P25 AVN and complication rate following Intracapsular fracture Neck of Femur fixation in the under 60s. – Derby experience

BJS Open ◽  
2021 ◽  
Vol 5 (Supplement_1) ◽  
Author(s):  
Ross Sian ◽  
Conal Keane ◽  
Amol Tambe ◽  
Ross Sian
Keyword(s):  
Complication Rate ◽  
Major Complication ◽  
Time Range ◽  
Fixation Time ◽  
Neck Of Femur ◽  
Factors Affecting ◽  
Non Union ◽  
Femur Fractures ◽  
Fixation Type ◽  
Hip Screw

Abstract Introduction Neck of femur fractures (NOF#) are common in Trauma and Orthopaedics and Avascular necrosis (AVN) is a major complication. Guidance advises fixation within 48 hours, with no separate guidance for under 60 years of age. We reviewed factors affecting the complication rate in intracapsular NOF#’s undergoing fixation under the age of 60. Methodology We retrospectively reviewed a 5 year cohort (2013-2017) of intracapsular NOF#’s with native femoral head retention. 49 patients were identified. The following were determined: • Time to fixation from presentation in ED - 0-6hrs, 6-12hrs, 12-18hrs, 18-24hrs, 24-48hrs, 48+hrs: • Fixation type - Cannulated screw (CS), Dynamic Hip Screw (DHS), DHS + CS: • Complications – AVN, Non-union: • Displaced/Undisplaced Results 31 were undisplaced, 18 displaced. 82% (N = 40) were treated with CS, 10% (N = 5) with DHS and 8% (N = 4) with DHS + CS. Overall 21% developed AVN and 10% developed non-union. After undisplaced fractures 19% developed AVN and 10% developed non-union. After displaced fractures 22% developed AVN and 11% developed non-union. 40 patients were fixed using CS, 20% developed AVN and 12.5% had non-union. AVN occurred in 20% of those fixed with a DHS and 25% fixed with DHS and CS. No AVN was identified in the 0-6 hr fracture fixation time range. Conclusion No patients receiving fixation in less than 6 hours went on to have AVN or non-union, with higher rates after this time. There was no difference in outcome regarding AVN when looking at different fixation methods. There was no difference in complications when comparing fracture displacement.

The Adjunctive Use of Half-Pin (Type I) External Skeletal Fixators in Combination with Intramedullary Pins for Femoral Fracture Fixation

1991 ◽  
Vol 4 (03) ◽  
pp. 77-85 ◽  
Author(s):  
P. D. Schwarz ◽  
M. D. Salman ◽  
Melissa Foland
Keyword(s):  
Complication Rate ◽  
Femoral Fracture ◽  
Major Complication ◽  
Bony Union ◽  
Type I ◽  
Femur Fractures ◽  
Impaired Limb ◽  
Lower Complication ◽  
Lower Complication Rate ◽  
One Year

SummaryA half-pin (type I) external skeletal fixator was used in conjunction with an intramedullary pin(s) for management of 29 femur fractures in 15 dogs and 14 cats. Eighty percent of the dogs and 100% of the cats achieved bony union using this combination of implants. However, because of the development of major complications which permanently impaired limb function (e.g. quadriceps tie-down), only 67% of the dogs and 93% of the cats were considered to have successful outcomes. The overall complication rate was 87% for dogs and 43% for cats. Dogs weighing <6.8 kg had a significantly lower complication rate than dogs weighing ≥6.8 kg. Dogs < one year of age were significantly more likely to develop a major complication resulting in an unsuccessful outcome, than dogs ≥ one year of age. A significant association was not established between any of the study variables and the complication incidence in cats.

scholarly journals Outcomes Following Calcaneal Autograft with a Reaming Graft Harvester

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0026
Author(s):  
Travis M. Langan ◽  
Devon Consul ◽  
Rona Law ◽  
Christopher F. Hyer
Keyword(s):  
Bone Graft ◽  
Complication Rate ◽  
Intraoperative Complications ◽  
Donor Site ◽  
Major Complication ◽  
Autogenous Bone ◽  
Foot And Ankle ◽  
Moderate Amount ◽  
Radiographic Findings

Category: Hindfoot Introduction/Purpose: Autogenous bone graft remains the standard bone graft in foot and ankle surgery when filling a bone void or adding biology to an arthrodesis site. Harvesting autograft can have serious donor site morbidity with an average complication rate of 8% and reports as high as 25%. Complications range from persistent pain to severe infection. Most procedures in the foot and ankle require only a small volume of graft. Using a small reaming graft harvester, surgeons can harvest autograft from the ipsilateral calcaneus. This is done within the same surgical field and requires minimal additional operative time. The purpose of this article is to review a population of patients who underwent calcaneal autograft harvesting with a reaming graft harvester and evaluate the outcomes of the procedure. Methods: From August 2015 to February 2018, all patients who underwent calcaneal autograft harvesting by a single surgeon were identified and reviewed. Patients were included if they had autograft harvested from the calcaneus on the ipsilateral operative limb using a reamer bone graft harvester and if they had complete clinical follow up of at least 6 months. Patients were excluded if they had autograft from a site other than the ipsilateral calcaneus, had a previous harvest from the ipsilateral calcaneus, or if they did not have full follow up of at least 6 months. Outcomes of interest were major and minor complications, intra- operative complications, and long term radiographic findings. Patients required graft for numerous primary procedures including a variety of arthrodesis or filling of bone voids. Postoperative protocols and return to weightbearing times varied with the accepted protocols for the primary procedure. Results: 300 patients were identified and met inclusion criteria. Average follow up was 12.6 months. There was 1 major complication (0.3%) consisting of a calcaneal stress fracture that healed with a period of 4 weeks of non weightbearing followed by 4 weeks of protected weightbearing. There were 3 minor complications (1%) consisting of transient painful scar and medial heel pain that all resolved uneventfully. There were no intraoperative complications while performing the 300 procedures. There were no incidences of neurovascular damage. Of the patients with over 1 year radiographic follow up, all harvest sites were still visible on lateral plain film radiographs. Conclusion: Using a small reamer to harvest calcaneal autograft for foot and ankle surgeries that require a small to moderate amount of bone graft is safe and effective. Approximately 4 cc of graft can be harvested very quickly without needing to prepare another surgical site for harvesting. The complication rate for harvesting calcaneal autograft was found to be extremely low in this study, despite the harvest site remaining visible on radiographs past 1 year. The proposed technique can be extremely useful to the foot and ankle surgeon.

Robotic Pneumonectomy for Lung Cancer: Perioperative Outcomes and Factors Leading to Conversion to Thoracotomy

2021 ◽  
pp. 155698452097822
Author(s):  
Byron D. Patton ◽  
Daniel Zarif ◽  
Donna M. Bahroloomi ◽  
Iam C. Sarmiento ◽  
Paul C. Lee ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Statistical Significance ◽  
Patient Characteristics ◽  
Perioperative Outcomes ◽  
Safe Procedure ◽  
Open Approach ◽  
Robotic Approach ◽  
Robotic Group ◽  
Robot Assisted ◽  
Estimated Blood Loss

Objective In the tide of robot-assisted minimally invasive surgery, few cases of robot-assisted pneumonectomy exist in the literature. This study evaluates the perioperative outcomes and risk factors for conversion to thoracotomy with an initial robotic approach to pneumonectomy for lung cancer. Methods This study is a single-center retrospective review of all pneumonectomies for lung cancer with an initial robotic approach between 2015 and 2019. Patients were divided into 2 groups: surgeries completed robotically and surgeries converted to thoracotomy. Patient demographics, preoperative clinical data, surgical pathology, and perioperative outcomes were compared for meaningful differences between the groups. Results Thirteen total patients underwent robotic pneumonectomy with 8 of them completed robotically and 5 converted to thoracotomy. There were no significant differences in patient characteristics between the groups. The Robotic group had a shorter operative time ( P < 0.01) and less estimated blood loss ( P = 0.02). There were more lymph nodes harvested in the Robotic group ( P = 0.08) but without statistical significance. There were 2 major complications in the Robotic group and none in the Conversion group. Neither tumor size nor stage were predictive of conversion to thoracotomy. Conversions decreased over time with a majority occurring in the first 2 years. There were no conversions for bleeding and no mortalities. Conclusions Robotic pneumonectomy for lung cancer is a safe procedure and a reasonable alternative to thoracotomy. With meticulous technique, major bleeding can be avoided and most procedures can be completed robotically. Larger studies are needed to elucidate any advantages of a robotic versus open approach.

The Emerging Role of Robotic Single-site Approach for Myomectomy: A Systematic Review of the Literature

2021 ◽  
pp. 155335062098822
Author(s):  
Eirini Giovannopoulou ◽  
Anastasia Prodromidou ◽  
Nikolaos Blontzos ◽  
Christos Iavazzo
Keyword(s):  
Blood Loss ◽  
Minimally Invasive ◽  
Complication Rate ◽  
Operative Time ◽  
Intraoperative Complications ◽  
Single Site ◽  
Minimally Invasive Technique ◽  
Invasive Technique ◽  
Robotic Myomectomy ◽  
The Mean

Objective. To review the existing studies on single-site robotic myomectomy and test the safety and feasibility of this innovative minimally invasive technique. Data Sources. PubMed, Scopus, Google Scholar (from their inception to October 2019), as well as Clinicaltrials.gov databases up to April 2020. Methods of Study Selection. Clinical trials (prospective or retrospective) that reported the outcomes of single-site robotic myomectomy, with a sample of at least 20 patients were considered eligible for the review. Results. The present review was performed in accordance with the guidelines for Systematic Reviews and Meta-Analyses (PRISMA). Four (4) studies met the inclusion criteria, and a total of 267 patients were included with a mean age from 37.1 to 39.1 years and BMI from 21.6 to 29.4 kg/m2. The mean operative time ranged from 131.4 to 154.2 min, the mean docking time from 5.1 to 5.45 min, and the mean blood loss from 57.9 to 182.62 ml. No intraoperative complications were observed, and a conversion rate of 3.8% was reported by a sole study. The overall postoperative complication rate was estimated at 2.2%, and the mean hospital stay ranged from 0.57 to 4.7 days. No significant differences were detected when single-site robotic myomectomy was compared to the multiport technique concerning operative time, blood loss, and total complication rate. Conclusion. Our findings support the safety of single-site robotic myomectomy and its equivalency with the multiport technique on the most studied outcomes. Further studies are needed to conclude on the optimal minimally invasive technique for myomectomy.

scholarly journals Retropubic, laparoscopic, and robot-assisted radical prostatectomy: a multi-institutional comparative study

2020 ◽  
Vol 26 (1) ◽  
Author(s):  
Amr A. Faddan ◽  
Mahmoud M. Shalaby ◽  
Mohamed Gadelmoula ◽  
Younis Alshamsi ◽  
Daniar K. Osmonov ◽  
...  
Keyword(s):  
Radical Prostatectomy ◽  
Complication Rate ◽  
Perioperative Complications ◽  
Statistical Significance ◽  
Operating Time ◽  
Perioperative Outcomes ◽  
Academic Institutions ◽  
Robot Assisted ◽  
Surgical Specimen ◽  
Significant Difference

Abstract Background The standard surgical treatment of localized prostate cancer (PCa) has been rapidly changed along the last two decades from open to laparoscopic and finally robot-assisted techniques. Herein, we compare the three procedures for radical prostatectomy (RP), namely radical retropubic (RRP), laparoscopic (LRP), and robot-assisted laparoscopic (RALRP) regarding the perioperative clinical outcome and complication rate in four academic institutions. Methods A total of 394 patients underwent RP between January 2016 and December 2018 in four academic institutions; their records were reviewed. We recorded the patient age, BMI, PSA level, Gleason score and TNM stage, type of surgery, the pathological data from the surgical specimen, the perioperative complications, unplanned reoperating, and readmission rates within 3 months postoperatively. Statistical significance was set at (P < 0.05). All reported P values are two-sided. Results A total of 123 patients underwent RALRP, 220 patients underwent RRP, and 51 underwent LRP. There was no statistically significant difference between the three groups regarding age, BMI, prostatic volume, and preoperative PSA. However, there were statistically significant differences between them regarding the operating time (P < .0001), catheterization period (P < .001), hospital stay (P < .0001), and overall complications rate (P = .023). Conclusions The minimally invasive procedures (RALRP and LRP) are followed by a significantly lower complication rate. However, the patients’ factors and surgical experience likely impact perioperative outcomes and complications.

Quantification of tool chatter and metal removal rate using wavelet denoising and statistical approach

2018 ◽  
Vol 49 (2) ◽  
pp. 62-81 ◽  
Author(s):  
Shailendra Kumar ◽  
Bhagat Singh
Keyword(s):  
Response Surface Methodology ◽  
Response Surface ◽  
Metal Removal ◽  
Removal Rate ◽  
Statistical Significance ◽  
Depth Of Cut ◽  
Machining Parameters ◽  
Metal Removal Rate ◽  
Chatter Index ◽  
Tool Chatter

Tool chatter is an unavoidable phenomenon encountered in machining processes. Acquired raw chatter signals are contaminated with various types of ambient noises. Signal processing is an efficient technique to explore chatter as it eliminates unwanted background noise present in the raw signal. In this study, experimentally recorded raw chatter signals have been denoised using wavelet transform in order to eliminate the unwanted noise inclusions. Moreover, effect of machining parameters such as depth of cut ( d), feed rate ( f) and spindle speed ( N) on chatter severity and metal removal rate has been ascertained experimentally. Furthermore, in order to quantify the chatter severity, a new parameter called chatter index has been evaluated considering aforesaid denoised signals. A set of 15 experimental runs have been performed using Box–Behnken design of experiment. These experimental observations have been used to develop mathematical models for chatter index and metal removal rate considering response surface methodology. In order to check the statistical significance of control parameters, analysis of variance has been performed. Furthermore, more experiments are conducted and these results are compared with the theoretical ones in order to validate the developed response surface methodology model.

125 Staged Endovascular Treatment of Ruptured Intracranial Aneurysms: Acute Coiling Followed By Delayed Flow Diversion

Neurosurgery ◽  
2017 ◽  
Vol 64 (CN_suppl_1) ◽  
pp. 228-228
Author(s):  
Erick Michael Westbroek ◽  
Matthew Bender ◽  
Narlin B Beaty ◽  
Bowen Jiang ◽  
Risheng Xu AB ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Complication Rate ◽  
Coil Embolization ◽  
Intracranial Aneurysms ◽  
Major Complication ◽  
Flow Diversion ◽  
Neurological Deficits ◽  
Major Complication Rate ◽  
Ruptured Intracranial Aneurysms

Abstract INTRODUCTION ISAT demonstrated that coiling is effective for aneurysm treatment in subarachnoid hemorrhage (SAH); however, complete occlusion of wide-necked aneurysms frequently requires adjuvants relatively contraindicated in SAH. As such, a limited “dome occlusive” strategy is often pursued in the setting of SAH. We report a single institution series of coiling of acutely ruptured aneurysms followed by delayed flow diversion for definitive, curative occlusion. METHODS A prospectively collected IRB-approved database was screened for patients with aneurysmal SAH who were initially treated by coil embolization followed by planned flow diversion at a single academic medical institution. Peri-procedural outcomes, complications, and angiographic follow-up were analyzed. RESULTS >50 patients underwent both acute coiling followed by delayed, planned flow diversion. Average aneurysm size on initial presentation was 9.5 mm. Common aneurysm locations included Pcomm (36%), Acomm (30%), MCA (10%), ACA (10%), and vertebral (5%). Dome occlusion was achieved in all cases following initial coiling. Second-stage implantation of a flow diverting stent was achieved in 49/50 cases (98%). Follow-up angiography was available for 33/50 patients (66%), with mean follow-up of 11 months. 27 patients (82%) had complete angiographic occlusion at last follow up. All patients with residual filling at follow-up still had dome occlusion. There were no mortalities (0%). Major complication rate for stage I coiling was 2% (1 patient with intra-procedural aneurysm re-rupture causing increase in a previous ICH). Major complication rate for stage 2 flow diversion was 2% (1 patient with ischemic stroke following noncompliance with dual antiplatelet regimen). Minor complications occurred in 2 additional patients (4%) with transient neurological deficits. CONCLUSION Staged endovascular treatment of ruptured intracranial aneurysms with acute dome-occlusive coil embolization followed by delayed flow diversion is a safe and effective treatment strategy.

scholarly journals Hartmann’s procedure, reversal and rate of stoma-free survival

2018 ◽  
Vol 100 (4) ◽  
pp. 301-307 ◽  
Author(s):  
S Hallam ◽  
BS Mothe ◽  
RMR Tirumulaju
Keyword(s):  
Length Of Stay ◽  
Complication Rate ◽  
Major Complication ◽  
Wound Dehiscence ◽  
Hartmann’S Procedure ◽  
Hartmann's Procedure ◽  
Retrospective Audit ◽  
Audit Period ◽  
American Society ◽  
American Society Of Anesthesiologists

Background Hartmann’s procedure is a commonly performed operation for complicated left colon diverticulitis or malignancy. The timing for reversal of Hartmann’s is not well defined as it is technically challenging and carries a high complication rate. Methods This study is a retrospective audit of all patients who underwent Hartmann’s procedure between 2008 and 2014. Reversal of Hartmann’s rate, timing, American Society of Anesthesiologists grade, length of stay and complications (Clavien–Dindo) including 30-day mortality were recorded. Results Hartmann’s procedure (n = 228) indications were complicated diverticular disease 44% (n = 100), malignancy 32% (n = 74) and other causes 24%, (n = 56). Reversal of Hartmann’s rate was 47% (n = 108). Median age of patients was 58 years (range 21–84 years), American Society of Anesthesiologists grade 2 (range 1–4), length of stay was eight days (range 2–42 days). Median time to reversal of Hartmann’s was 11 months (range 4–96 months). The overall complication rate from reversal of Hartmann’s was 21%; 3.7% had a major complication of IIIa or above including three anastomotic leaks and one deep wound dehiscence. Failure of reversal and permanent stoma was less than 1% (n = 2). Thirty-day mortality following Hartmann’s procedure was 7% (n = 15). Where Hartmann’s procedure wass not reversed, for 30% (n = 31) this was the patient’s choice and 70% (n = 74) were either high risk or unfit. Conclusions Hartmann’s procedure is reversed less frequently than thought and consented for. Only 46% of Hartmann’s procedures were stoma free at the end of the audit period. The anastomotic complication rate of 1% is also low for reversal of Hartmann’s procedure in this study.

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