scholarly journals Management and Outcomes of Bilateral Acetabular Fractures: A Critical Review of the Literature

2022 ◽  
Author(s):  
Vasileios K. Mousafeiris ◽  
Anastasia Vasilopoulou ◽  
George D. Chloros ◽  
Michalis Panteli ◽  
Peter V. Giannoudis
Keyword(s):  
High Energy ◽  
Injury Mechanism ◽  
Cochrane Library ◽  
Acetabular Fractures ◽  
Inclusion Criteria ◽  
Degenerative Arthritis ◽  
Patient Demographics ◽  
Included Patient ◽  
Injury Mechanisms

Abstract Background Bilateral acetabular fractures constitute a rare entity, and their optimal management is unknown. Materials and Methods A systematic literature search was conducted in PubMed, Embase and Cochrane Library between 1995 and 2020. Inclusion criteria were studies presenting cases of bilateral acetabular fractures and reporting outcomes. Extracted data included patient demographics, injury mechanism, fracture classification, associated injuries, management and outcomes. Results Thirty-seven studies (47 cases; 35 males vs 12 females) were included. Mean age was 46 years old (range 13–84) and mean follow-up was 19.8 months (range 1.5–56). High-energy injuries (49%) and seizures (45%) were the most common injury mechanisms. Fracture type distribution differed according to injury mechanism. Treatment was surgical in 70% of cases (75% open reduction and internal fixation vs 25% acute total hip arthroplasty). Outcomes were excellent/good in 58% of patients. Complications included heterotopic ossification (11%), nerve injury (11%), degenerative arthritis (6%), DVT (6%), and infection (3%). Conclusions Bilateral acetabular fractures most commonly occur either after trauma or seizures and are commonly managed operatively. They are not devoid of complications, however, more than half (58%) achieve complete functional recovery.

scholarly journals Value of Three-Dimensional Digital Subtraction Angiography for Detection and Classification of Intracranial Aneurysm Remnants After Clipping

2021 ◽  
Author(s):  
Serge Marbacher ◽  
Matthias Halter ◽  
Deborah R Vogt ◽  
Jenny C Kienzler ◽  
Christian T J Magyar ◽  
...  
Keyword(s):  
Intracranial Aneurysm ◽  
Digital Subtraction Angiography ◽  
Diagnostic Yield ◽  
Three Dimensional ◽  
P Value ◽  
Digital Subtraction ◽  
Patient Demographics ◽  
Included Patient ◽  
2D And 3D

Abstract BACKGROUND The current gold standard for evaluation of the surgical result after intracranial aneurysm (IA) clipping is two-dimensional (2D) digital subtraction angiography (DSA). While there is growing evidence that postoperative 3D-DSA is superior to 2D-DSA, there is a lack of data on intraoperative comparison. OBJECTIVE To compare the diagnostic yield of detection of IA remnants in intra- and postoperative 3D-DSA, categorize the remnants based on 3D-DSA findings, and examine associations between missed 2D-DSA remnants and IA characteristics. METHODS We evaluated 232 clipped IAs that were examined with intraoperative or postoperative 3D-DSA. Variables analyzed included patient demographics, IA and remnant distinguishing characteristics, and 2D- and 3D-DSA findings. Maximal IA remnant size detected by 3D-DSA was measured using a 3-point scale of 2-mm increments. RESULTS Although 3D-DSA detected all clipped IA remnants, 2D-DSA missed 30.4% (7 of 23) and 38.9% (14 of 36) clipped IA remnants in intraoperative and postoperative imaging, respectively (95% CI: 30 [ 12, 49] %; P-value .023 and 39 [23, 55] %; P-value = <.001), and more often missed grade 1 (< 2 mm) clipped remnants (odds ratio [95% CI]: 4.3 [1.6, 12.7], P-value .005). CONCLUSION Compared with 2D-DSA, 3D-DSA achieves a better diagnostic yield in the evaluation of clipped IA. Our proposed method to grade 3D-DSA remnants proved to be simple and practical. Especially small IA remnants have a high risk to be missed in 2D-DSA. We advocate routine use of either intraoperative or postoperative 3D-DSA as a baseline for lifelong follow-up of clipped IA.

Outcome of surgical stabilisation of acetabular fractures in 16 cats

2018 ◽  
Vol 21 (6) ◽  
pp. 520-528 ◽  
Author(s):  
David L Haine ◽  
Kevin Parsons ◽  
Nicolas Barthelemy ◽  
Neil Burton ◽  
Sorrel L Langley-Hobbs
Keyword(s):  
Locking Plate ◽  
Dynamic Compression ◽  
Neurological Deficits ◽  
Acetabular Fractures ◽  
Inclusion Criteria ◽  
Perioperative Outcome ◽  
Short Term ◽  
Neurologically Normal ◽  
Orthopaedic Injuries

Objectives The aim of this study is to describe the presentation, surgical management and perioperative outcome of cats with acetabular fractures. Methods Case records and radiographs of cats with acetabular fractures were reviewed from presentation to the end of follow-up. Surgical technique, complications, radiographic reduction and the presence of neurological deficits were recorded. Results Sixteen cats with 17 acetabular fractures met the inclusion criteria. All fractures were associated with concurrent orthopaedic injuries. All cats were either moderately or severely lame on presentation. Five fractures were stabilised using screws, wire, pins and polymethylmethacrylate, nine were repaired using a straight dynamic compression plate and three were repaired using a locking plate. Two of seven cats that were neurologically normal prior to surgery developed transient neuropraxia following surgery. There were three major complications and no minor complications. At the end of follow-up 3/16 cats had full function, whereas 13/16 had acceptable function. Conclusions and relevance All cats undergoing surgical stabilisation of acetabular fractures returned to full or acceptable function by the end of the follow-up period and there was a low number of intraoperative and short-term complications. Neurological deficits were common preoperatively, but the majority of these deficits had resolved by follow-up.

scholarly journals The Incidence of Nonunion of the Hallux Interphalangeal Joint Arthrodesis

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0038
Author(s):  
Mark Prissel ◽  
Eric So ◽  
Anson Chu ◽  
Matthew Wilson
Keyword(s):  
Systematic Review ◽  
Complication Rate ◽  
Interphalangeal Joint ◽  
Effective Procedure ◽  
Review Of The Literature ◽  
Inclusion Criteria ◽  
Weighted Mean ◽  
Patient Demographics ◽  
Contributory Factors

Category: Midfoot/Forefoot Introduction/Purpose: Hallux interphalangeal joint (HIPJ) arthrodesis is an effective procedure to treat pain and provide stability, which is often performed for intrinsic pain to the HIPJ. Additionally, this procedure is typically employed in concert with the Jones tenosuspension. Despite that this is an accepted technique, the available literature is scant and questions remain regarding nonunion rates and contributory factors to poor healing. A systematic review of the literature was undertaken to determine the rate of nonunion for HIPJ arthrodesis. Methods: To acquire the highest quality and most relevant studies available, publications were eligible for inclusion only if they involved patients undergoing HIPJ arthrodesis. Studies additionally required mean follow-up of at least six weeks and inclusion of appropriate detail regarding complications, nonunion rates, and patient demographics. Ultimately, 7 studies involving 313 HIPJ arthrodeses met inclusion criteria. Results: A total of 291 patients with a weighted mean age of 48.9 were included. The nonunion rate was 28.3% at a weighted mean follow-up of 8.4 months. The overall complication rate was 33.0%. Conclusion: Considering the increased rate of complications and nonunions for this commonly employed procedure, additional prospective comparative analyses are needed to identify important patient demographics and to determine superior fixation constructs.

Sialendoscopy in the Management of Radioiodine Induced Sialadenitis: A Systematic Review

2017 ◽  
Vol 126 (11) ◽  
pp. 768-773 ◽  
Author(s):  
Thai-Duong Cung ◽  
Wanda Lai ◽  
Peter F. Svider ◽  
Curtis Hanba ◽  
Julie Samantray ◽  
...  
Keyword(s):  
Systematic Review ◽  
Salivary Gland ◽  
Minimally Invasive ◽  
Clinical Improvement ◽  
Therapeutic Modality ◽  
Cochrane Library ◽  
Inclusion Criteria ◽  
Patient Demographics ◽  
Intervention Patient ◽  
Pooled Sample

Objectives: Salivary gland dysfunction as a consequence of radioiodide ablation is present in as many as two-thirds of patients, and unfortunately, many of these individuals do not respond to conservative measures. Sialendoscopy as a minimally invasive therapeutic modality may have utility in the treatment of radioiodide induced sialadenitis (RAIS). Our aim was to explore whether sialendoscopy resulted in clinical improvement in patients with RAIS. Methods: A systematic review of studies on sialendoscopy for RAIS was conducted using MEDLINE database, Embase, and Cochrane Library. The outcomes of interest included the proportion of patients demonstrating clinical improvement after intervention, patient demographics, radiation dose, specific procedural variations, specific salivary gland, failure rate, and recurrence. Results: Eight studies met inclusion criteria. Data reviewed showed an increased predilection of parotid sialadenitis relative to submandibular gland sialadenitis. All but 2 studies employed sialendoscopy only after failure of conservative measures. An overall rate of clinical improvement ranging from 75% to 100% was reported. Conclusion: This systematic review encompassing 122 patients represents the largest pooled sample to date of patients undergoing sialendoscopy for RAIS. Sialendoscopy represents an invaluable minimally invasive modality that may obviate the need for more invasive surgery as intervention was associated with a high success rate.

scholarly journals Injury Mechanism Affects the Stability of Suture-Button Syndesmosis Fixation.

2020 ◽  
Author(s):  
Kuan-Hao Chen ◽  
Chih-Hwa Chen ◽  
Yu-Min Huang ◽  
Hsieh-Hsing Lee ◽  
Yang-Hwei Tsuang
Keyword(s):  
Injury Mechanism ◽  
Level Of Evidence ◽  
Suture Button ◽  
Clear Space ◽  
Anatomic Reduction ◽  
Injury Mechanisms ◽  
Syndesmosis Injury ◽  
Registration Number ◽  
The Stability

Abstract Background: Ankle syndesmosis injury is a common condition, and the injury mechanism can be sorted into pure-syndesmosis injury, Weber-B and Weber-C type fractures. This study aims to evaluate the treatment outcomes and stability of suture-button fixation for syndesmosis injury with different injury mechanisms. We hypothesized that injury mechanisms would alter the stability of suture-button fixation.Methods: We retrospectively reviewed 63 patients with ankle syndesmosis injury underwent surgery with TightRope (Arthrex, Naples, FL, USA) from April 2014 to February 2019. The stability of suture-button fixation with TightRope were evaluated by comparing the preoperative, postoperative, and final follow-up measurements of tibiofibular clear space (TFCS), tibiofibular overlap (TFO), and medial clear space (MCS). A subgroup analysis for each demographic group and injury type including pure-syndesmosis injury, Weber-B and Weber-C type fractures were performed. Results: Syndesmosis was effectively reduced using TightRope. After the index surgery, the tibiofibular clear space was reduced from 7.73 mm to 4.04 mm, the tibiofibular overlap was increased from 3.05 mm to 6.44 mm, and the medial clear space was reduced from 8.12 mm to 3.54 mm. However, syndesmosis widening was noted at the final follow-up, especially in Weber-C type fractures (TFCS: 3.82 to 4.45 mm, p < 0.01 and TFO: 6.86 to 6.29 mm, p = 0.04). Though widened, the final follow-up values of tibiofibular clear space and tibiofibular overlap were in the acceptable range. Postoperatively and at the final follow-up, medial clear space was found to be significantly larger in the Weber-C group than in the pure syndesmosis and Weber-B groups (p < 0.05). Conclusions: Suture-button fixation can offer anatomic reduction and dynamic fixation in syndesmosis injuries. However, when using this modality for Weber-C type fractures, more attention should be focused on the accuracy of reduction, especially of medial clear space, and rediastasis should be carefully monitored.Trial registration: This trial was retrospectively approved by TMU-JIRB. Registration number N202004122, and the date of approval was May 06, 2020.Level of evidence: III

scholarly journals Posteromedial Corner Reconstruction

2017 ◽  
Vol 5 (1_suppl) ◽  
pp. 2325967117S0001
Author(s):  
Gonzalo Ferrer ◽  
Agustín Leon ◽  
Hans Wirth ◽  
Adolfo Mena ◽  
María José Tuca ◽  
...  
Keyword(s):  
Cruciate Ligament ◽  
Preoperative Evaluation ◽  
Delayed Diagnosis ◽  
Lateral Collateral Ligament ◽  
High Energy ◽  
Inclusion Criteria ◽  
Chronic Instability ◽  
Posteromedial Corner ◽  
Functional Scores

Objective: Report the experience, after 1-year follow-up, of 30 patients who underwent anatomical knee reconstruction of posteromedial corner (PMC) injuries, using La Prade´s Technique. Methods: Retrospective cohort study of 30 consecutive patients with PMC injuries operated between November 2010 and May 2014 by the same surgical team. Inclusion criteria: patients with clinical presentation and images (stress radiographs and MRI) compatible with PMC injury, who maintained a grade III chronic instability in spite of at least 3 months of orthopedic treatment, who were reconstructed using La Prade’s anatomical technique, and completed at least 12 months of follow-up. Exclusion criteria: discordance between clinical and image studies, grade I or II medial instability, and surgery performed through a different technique. Data was collected by reviewing the electronic files and images. Functional scores (IKDC and Lysholm) were applied and registered in the preoperative evaluation, and then 6 and 12 months after surgery. Results: Thirty patients (28 men and 2 women) met the inclusion criteria. Mean age was 43 years (24-69). The vast majority (28 patients) had a high-energy mechanism of injury. Twenty patients were diagnosed in the acute setting, while 10 had a delayed diagnosis after poor results of concomitant ligament reconstructions. With the exception of 2 patients, who presented with isolated PMC injury, the majority had associated injuries as detailed: 11 cases had PMC + anterior cruciate ligament (ACL) injury, 3 patients had PMC + posterior cruciate ligament (PCL) injury, 3 patients had PMC + meniscal tears, 9 patients had PMC + ACL + PCL injuries, and there were 2 cases of PMC + ACL + PCL + lateral collateral ligament injuries. Mean time for PMC reconstruction surgery was 5 months (range 2-32). Lysholm and IKDC scores were 18,2 (2-69) and 24,3 (9,2-52,9) respectively in the preoperative setting, improving to 76,7 (44-94) and 70,7 (36,8-95,4) after 1-year follow-up. At the end of follow-up, average ROM was 113º (90-140) the majority (24 patients) had type A IKDC stability, and the remaining 6 patients type D IKDC stability. Conclusion: Acceptable results were achieved following reconstruction of PMC injuries in patients with chronic posteromedial knee instability. Improvement in stability and functional scores were observed in all the patients of this cohort after surgery.

scholarly journals Injury Mechanism Affects the Stability of Suture-Button Syndesmosis Fixation.

2020 ◽  
Author(s):  
Kuan Hao Chen ◽  
Chih Hwa Chen ◽  
Yu Min Huang ◽  
Hsieh Hsing Lee ◽  
Yang Hwei Tsuang
Keyword(s):  
Injury Mechanism ◽  
Suture Button ◽  
Demographic Group ◽  
Clear Space ◽  
Anatomic Reduction ◽  
Injury Mechanisms ◽  
Syndesmosis Injury ◽  
Registration Number ◽  
The Stability

Abstract Background: Ankle syndesmosis injury is a common condition, and the injury mechanism can be sorted into pure-syndesmosis injury, Weber-B and Weber-C type fractures. This study aims to evaluate the treatment outcomes and stability of suture-button fixation for syndesmosis injury with different injury mechanisms. We hypothesized that injury mechanisms would alter the stability of suture-button fixation.Methods: We retrospectively reviewed 63 patients with ankle syndesmosis injury underwent surgery with TightRope (Arthrex, Naples, FL, USA) from April 2014 to February 2019. The stability of suture-button fixation with TightRope were evaluated by comparing the preoperative, postoperative, and final follow-up measurements of tibiofibular clear space (TFCS), tibiofibular overlap (TFO), and medial clear space (MCS). A subgroup analysis for each demographic group and injury type including pure-syndesmosis injury, Weber-B and Weber-C type fractures were performed.Results: Syndesmosis was effectively reduced using TightRope. After the index surgery, the tibiofibular clear space was reduced from 7.73 mm to 4.04 mm, the tibiofibular overlap was increased from 3.05 mm to 6.44 mm, and the medial clear space was reduced from 8.12 mm to 3.54 mm. However, syndesmosis widening was noted at the final follow-up, especially in Weber-C type fractures (TFCS: 3.82 to 4.45 mm, p < 0.01 and TFO: 6.86 to 6.29 mm, p = 0.04). Though widened, the final follow-up values of tibiofibular clear space and tibiofibular overlap were in the acceptable range. Postoperatively and at the final follow-up, medial clear space was found to be significantly larger in the Weber-C group than in the pure syndesmosis and Weber-B groups (p < 0.05). Conclusions: Suture-button fixation can offer anatomic reduction and dynamic fixation in syndesmosis injuries. However, when using this modality for Weber-C type fractures, more attention should be focused on the accuracy of reduction, especially of medial clear space, and rediastasis should be carefully monitored.Trial registration: This trial was retrospectively approved by TMU-JIRB. Registration number N202004122, and the date of approval was May 06, 2020.

scholarly journals Survival Rates for Porcelain Laminate Veneers: A Systematic Review

2020 ◽  
Author(s):  
Yousra H. AlJazairy
Keyword(s):  
Systematic Review ◽  
Current Literature ◽  
Survival Rates ◽  
In Vivo Studies ◽  
Cochrane Library ◽  
Inclusion Criteria ◽  
Term Survival ◽  
Study Designs ◽  
Laminate Veneers

AbstractThe aim of this systematic review was to analyze and compare the most up-to-date information available on long-term, medium-term, and short-term survival rates of porcelain laminate veneers (PLVs) and investigate the homogeneity in current studies or lack of it. An electronic search was performed using PubMed, Ovid MEDLINE, Cochrane Library, Web of Science, EBSCO, Science Direct, Wiley, and Scopus databases. Based on the PRISMA guidelines, the main inclusion criteria consisted of research articles published after the year 2000, in vivo studies with a follow-up period of at least 1 year and reporting of the Kaplan–Meier estimated cumulative survival rates. Quality assessment of the included studies was performed using the modified systematic assessment list consisting of 24 items. Thirty full-text articles were reviewed in detail. A total of 30 articles met the inclusion criteria and were selected for qualitative synthesis. The remaining 27 publications were retained to discuss the heterogeneity in the current literature and reported longevity of veneer restorations. A conclusive estimation of the longevity of PLVS beyond 20 years is lacking. The availability of evidence in the current literature is limited in terms of sample size and duration of follow-up. However, the majority of studies have concluded that PLVs have high-success rates and predictable patient outcomes. The present literature indicates an increased heterogeneity among research study designs. Researchers should aim for homogeneous study designs that can be included in systematic reviews and meta-analyses.

scholarly journals Pipeline Flex embolisation device with Shield Technology for the treatment of patients with intracranial aneurysms: periprocedural and 6 month outcomes

2020 ◽  
Vol 33 (6) ◽  
pp. 471-478
Author(s):  
James Yeomans ◽  
Lilian Sandu ◽  
Anand Sastry
Keyword(s):  
Antiplatelet Therapy ◽  
Case Series ◽  
Interventional Neuroradiology ◽  
Flow Diverter ◽  
Patient Demographics ◽  
Post Procedure ◽  
Time Period ◽  
Included Patient ◽  
Procedural Complications

Background and purpose The Pipeline Flex embolisation device with Shield Technology (Pipeline Shield) is a novel flow diverter which reduces intra-vessel thrombogenicity. This study summarises periprocedural outcomes and 6-month follow-up results following its introduction in a tertiary interventional neuroradiology centre. Materials and methods This prospective, single-arm study assessed 32 aneurysms treated over a 21-month time period from the time of procedure to 6 months post-procedure. Data collected included patient demographics, aneurysm features and intraprocedural and 6-month post-procedural complications. Results The mean age of the cohort was 58.8 ± Standard Deviation 8.5 years. Twenty-eight aneurysms were treated electively and four acutely. The elective cases received dual antiplatelet therapy post-procedure. The acute cases received single antiplatelet therapy post-procedure. Of the target aneurysms, 16/32 (50%) were small (<10 mm), 13/32 (41%) were large (10–25 mm) and 3/32 (9%) were giant (≥25 mm). There was no mortality in the series. There were two periprocedural complications (2/32, 6.2%): a stroke and a dissection. There were no post-procedural complications. At 6 months post-procedure, satisfactory occlusion (defined as Raymond–Roy 1 or 2) was achieved in 90.6% and 93.8% by way of magnetic resonance angiography and digital subtraction angiography assessment, respectively. There was no implant migration, no significant intraluminal hyperplasia or in-stent stenosis and no cases of aneurysm recurrence. Conclusion The Pipeline Shield has an excellent 6- month safety profile with an acceptable rate of intraprocedural complications, no post-procedure complications and no mortality in this case series of 32 acute and elective cases.

scholarly journals Use of Integra for Reconstruction after Nevi Resection: A Systematic Review and Pooled Analysis of Reported Cases

2019 ◽  
Vol 2019 ◽  
pp. 1-5
Author(s):  
Jude Opoku-Agyeman ◽  
Kayla Humenansky ◽  
Wellington Davis ◽  
Paul Glat
Keyword(s):  
Systematic Review ◽  
Case Reports ◽  
Skin Grafting ◽  
Pooled Analysis ◽  
The Body ◽  
Cochrane Library ◽  
Significant Heterogeneity ◽  
Inclusion Criteria ◽  
Closure Rate

Background. The use of Integra Dermal Reconstruction Template has emerged as an option for wound reconstruction, after resection of congenital nevi, especially giant congenital nevi. There have been many reports on Integra use in the literature for this purpose. This systematic review with pooled analysis examines the current literature regarding Integra use after resection of congenital nevi, including patient characteristics and reported outcomes. Methods. Systematic electronic searches were performed using PubMed, Ovid, Embase, and Cochrane library databases for studies reporting the use of Integra to reconstruct defects after nevi resection. Studies were analyzed if they met the inclusion criteria. Pooled descriptive statistics were performed. Results. Thirteen studies that met the inclusion criteria were included for analysis, yielding 31 procedures in 31 patients. Eleven of the thirteen studies were case reports representing 17 of the 31 patients. One study was retrospective, and the other study was a prospective study. The mean follow-up was 2.67 years (range, 0.2–13 years). The overall wound closure rate was 100%. The overall initial Integra take rate was 90.3% and the skin graft take rate was 100%. The rate of reported complications was 14.8%. The average age of patients was 7.36 years. The average size of the nevus was 6.29% TBSA (range, 0.005%–26%), and the time to definitive skin grafting was 3.28 weeks. Significant heterogeneity was found among the published studies. Conclusion. We conclude that the use of Integra appears to be a safe and viable option for defect reconstruction after the primary or secondary excision of congenital nevi of different sizes and on most parts of the body. Long-term follow-up studies and prospective cohort studies are required in order to fully estimate the incidence of complications. However, the rarity of this condition make these types of studies very difficult.

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