A Systematic Review Demonstrates High Variation of Terminology, Surgical Techniques, Preoperative Diagnostic Measures, and Geographic Differences in the Treatment of Athletic Pubalgia/Sports Hernia/Core Muscle Injury/Inguinal Disruption

Author(s):  
Matthew J. Kraeutler ◽  
Omer Mei-Dan ◽  
John W. Belk ◽  
Christopher M. Larson ◽  
Toghrul Talishinskiy ◽  
...  
Author(s):  
Matthew J Kraeutler ◽  
Omer Mei-Dan ◽  
Iciar M Dávila Castrodad ◽  
Toghrul Talishinskiy ◽  
Edward Milman ◽  
...  

ABSTRACT In recent years, there has been increased awareness and treatment of groin injuries in athletes. These injuries have been associated with various terminologies including sports hernia, core muscle injury (CMI), athletic pubalgia and inguinal disruption, among others. Treatment of these injuries has been performed by both orthopaedic and general surgeons and may include a variety of procedures such as rectus abdominis repair, adductor lengthening, abdominal wall repair with or without mesh, and hip arthroscopy for the treatment of concomitant femoroacetabular impingement. Despite our increased knowledge of these injuries, there is still no universal terminology, diagnostic methodology or treatment for a CMI. The purpose of this review is to present a detailed treatment algorithm for physicians treating patients with signs and symptoms of a CMI. In doing so, we aim to clarify the various pathologies involved in CMI, eliminate vague terminology, and present a clear, stepwise approach for both diagnosis and treatment of these injuries.


2014 ◽  
Vol 25 (4) ◽  
pp. 321-326 ◽  
Author(s):  
William C. Meyers ◽  
Brooke K. Havens ◽  
Gregory J. Horner

2015 ◽  
Vol 54 (03) ◽  
pp. 101-105 ◽  
Author(s):  
F. A. Verburg

SummaryThyroid surgery is one of the more common surgical procedures in Germany. This is in contrast with the situation in some other countries, where this procedure is performed comparatively rarely. In this paper the number of thyroid surgeries in Germany is compared with other western countries (Netherlands, USA, England). In contrast to e. g. the USA and England the number of thyroid surgeries in Germany is declining, however with approximately 109/100 000/year in 2012 is still elevated (Netherlands: 16/100 000/year, USA: at least 42/100 000/year, England: at least 27/100 000/year).Possible contributing factors to this higher number of thyroid surgeries in Germany are explored. These factors include iodine deficiency, the frequent use of advanced diagnostics such as ultrasound, insufficient use of preoperative diagnostic measures such as fine needle biopsy and the practice of “defensive medicine”. How much each of these factors contributes is however unclear.


2020 ◽  

In recent years, there have been many advances in the safe management of the patient's airway, a cornerstone of anesthetic practice. An Update on Airway Management brings forth information about new approaches in airway management in many clinical settings. This volume analyzes and explains new preoperative diagnostic methods, algorithms, intubation devices, extubation procedures, novelties in postoperative management in resuscitation and intensive care units, while providing a simple, accessible and applicable reading experience that helps medical practitioners in daily practice. The comprehensive updates presented in this volume make this a useful reference for anesthesiologists, surgeons and EMTs at all levels. Key topics reviewed in this reference include: New airway devices, clinical management techniques, pharmacology updates (ASA guidelines, DAS algorithms, Vortex approach, etc.), Induced and awake approaches in different settings Updates on diagnostic accuracy of perioperative radiology and ultrasonography Airway management in different settings (nonoperating room locations and emergency rooms) Airway management in specific patient groups (for example, patients suffering from morbid obesity, obstetric patients and critical patients) Algorithms and traditional surgical techniques that include emergency cricothyrotomy and tracheostomy in ‘Cannot Intubate, Cannot Ventilate’ scenarios. Learning techniques to manage airways correctly, focusing on the combination of knowledge, technical abilities, decision making, communication skills and leadership Special topics such as difficult airway management registry, organization, documentation, dissemination of critical information, big data and databases


2021 ◽  
pp. 175319342110017
Author(s):  
Saskia F. de Roo ◽  
Philippe N. Sprangers ◽  
Erik T. Walbeehm ◽  
Brigitte van der Heijden

We performed a systematic review on the success of different surgical techniques for the management of recurrent and persistent carpal tunnel syndrome. Twenty studies met the inclusion criteria and were grouped by the type of revision carpal tunnel release, which were simple open release, open release with flap coverage or open release with implant coverage. Meta-analysis showed no difference, and pooled success proportions were 0.89, 0.89 and 0.85 for simple open carpal tunnel release, additional flap coverage and implant groups, respectively. No added value for coverage of the nerve was seen. Our review indicates that simple carpal tunnel release without additional coverage of the median nerve seems preferable as it is less invasive and without additional donor site morbidity. We found that the included studies were of low quality with moderate risk of bias and did not differentiate between persistent and recurrent carpal tunnel syndrome.


2012 ◽  
Vol 81 (12) ◽  
pp. 3780-3792 ◽  
Author(s):  
Frank E. Mullens ◽  
Adam C. Zoga ◽  
William B. Morrison ◽  
William C. Meyers

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
D Scroggie ◽  
K S Lee ◽  
R Purves ◽  
E Sewart ◽  
S Van Laarhoven ◽  
...  

Abstract Aim Pancreaticoduodenectomy (PD) is most commonly performed using open surgical techniques. Minimal access approaches have reduced the morbidity of many types of surgery, however technical limitations have hindered the widespread adoption of laparoscopic methods for PD. There has been increasing use of surgical robots to facilitate a minimal access approach, motivated by improved visualisation, ergonomics and dexterity compared to standard laparoscopic methods. Methods for the safe introduction of novel techniques are lacking, and the way in which surgical innovations are reported may affect adoption into clinical practice. The aim of this study is to understand how robotic PD has been reported as a surgical innovation. Method A systematic review is being conducted by the trainee led RoboSurg Collaborative. A literature search was performed to identify primary research reporting outcomes of robotic PD. Articles are being screened in duplicate by title and abstract, then by full text review. The following data will be extracted: study methodology and rationale; centre, surgeons and patient details; governance and ethical considerations; learning curves; details of the intervention, including modifications; and how outcomes were reported, including use of core outcome sets. The data will be analysed using a narrative synthesis method. Results The search identified 1305 articles reporting on robotic pancreas surgery. An interim report of progress will be presented. Conclusions A rich narrative synthesis will enable innovators to understand how robotic PD has been reported. This will encourage transparent, methodical, and meaningful reporting of robotic PD, increasing the quality of clinical evidence.


2016 ◽  
Vol 8 (1) ◽  
Author(s):  
Andreas Panagopoulos ◽  
Irini Tatani ◽  
Dimitrios Ntourantonis ◽  
Ioannis Seferlis ◽  
Antonis Kouzelis ◽  
...  

The valgus-impacted (VI) 4-part fractures are a subset of fractures of the proximal humerus with a unique anatomic configuration characterized by a relatively lower incidence of avascular necrosis after operative intervention. We systematically reviewed clinical studies assessing the benefits and harms of least possible fixation techniques (LPFT) for this unique fracture type. Such information would be potentially helpful in developing an evidence-based approach in the management of these complex injuries. We performed analytic searches of PubMed, Embase, Web of Science, Google Scholar and the Cochrane Library, restricting it to the years 1991-2014. Included studies had to describe outcomes and complications after primary osteosynthesis with any type of LPFT apart from plate-screws and intramedullary nailing. Eligibility criteria were also included English language, more than 5 cases, minimum follow up of one year and report of clinical outcome using at least one relevant score (Constant, Neer or ASES). Based on 292 database hits we identified 12 eligible studies including 190 four-part valgus impacted fractures in 188 patients. All eligible studies were case series composed of min 8 to max 45 patients per study. The gender distribution was 60% (112) female and 40% (76) male. The average age of the patients at the time of injury was 54.5 years. In 8/12 studies an open reduction was used for fracture fixation using different surgical techniques including KW, cerclage wires, cannulated screws and osteosutures. Closed reduction and percutaneous fixation was used in 4 studies. Mean follow-up time ranged from 24 to 69 months. A good functional outcome (constant score >80) was reported in 9/12 studies. The most common complication was avascular necrosis of the humeral head with an overall incidence of 11% (range, 0-26.3%). Total avascular necrosis (AVN) was found in 15/188 patients (7.9%) and was more common in percutaneous techniques and partial AVN in 6/188 (3.1%) being more common in open techniques. The overall re-operation rate was very low (3.7%). Insufficient study designs cannot provide definite treatment recommendations and quantitative data synthesis of outcome. In general, LPFT for 4-part VI fractures leads to satisfactory outcomes with low incidence of complications. A considerable risk of biases can be attributed to fracture classification, proper radiological control, mean age of patients, mixed types of fixation methods, nonage adjusted clinical scoring and small follow up periods. These factors are discussed in detail. Level of evidence: systematic review of literature (level IV) as most of the studies were level IV.


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