Has the time to reinstate elective orthopedic procedures come?

SummaryPurer factor IX (FIX) concentrates have been produced for the treatment of hemophilia B in the attempt to reduce the risk of thrombotic complications associated with the use of prothrombin complex concentrates. To evaluate ex vivo whether or not FIX concentrates activate the coagulation system in conditions associated with a high risk for thrombosis, we measured markers of hypercoagulability in 10 patients with hemophilia B who underwent surgery, mainly orthopedic procedures, covered by multiple concentrate infusions (40-80 U/kg/day). Postinfusion plasma levels of prothrombin fragment 1+2 and factor X activation peptide did not differ significantly from the presurgical levels, neither before nor after each concentrate dose. Therefore, it appears that prolonged treatment of patients with hemophilia B undergoing high risk surgical procedures with high doses of FIX concentrate does not cause systemic activation of coagulation. This suggests that purified FIX concentrates are preferable to prothrombin complex concentrates for conditions associated with an increased risk of thrombosis.

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Delivering Essential Surgical Care for Lower-limb Musculoskeletal disorders in the Low-Resource Setting

World Journal of Surgery ◽

10.1007/s00268-021-06211-3 ◽

2021 ◽

Author(s):

Deeptiman James ◽

Faye M. Evans ◽

Ekta Rai ◽

Nobhojit Roy

Keyword(s):

Musculoskeletal Disorders ◽

Lower Limb ◽

Surgical Care ◽

Central India ◽

Orthopedic Procedures ◽

Nerve Blocks ◽

Low Resource ◽

Resource Setting ◽

Retrospective Audit ◽

Essential Surgical Care

Abstract Background Mismatched surgeon-anesthesiologist ratios often exist in low-resource settings making safe emergency essential surgical care challenging. This study is an audit of emergency essential procedures performed for lower-limb (LL) musculoskeletal disorders (MSD) when an anesthesiologist was unavailable. It aims to identify strategies for safe anesthesia. Methods A 5-year retrospective audit of emergency essential LL orthopedic procedures performed at remote mission hospital in Central India was performed. Out of necessity, a regional anesthesia (RA) protocol was developed in collaboration with anesthesiologists familiar with the setting. The incidence of intraoperative surgical and perioperative anesthesia complications when RA was administered by a surgeon was evaluated. Results During this period, 766 emergency essential LL MSDs procedures were performed. An anesthesiologist was available for only 6/766. RA was administered by a surgeon for 283/766. This included spinal anesthesia (SA) for 267/283 patients, peripheral nerve blocks for 16/283. Local infiltration and/or sedation was administered to 477/766. There were 17 intraoperative surgical complications. Anesthesia-related complications included 37/267 patients who required multiple attempts to localize subarachnoid space and SA failure in 9/267 patients all of whom had successful re-administration. Additional sedation and infiltration of local anesthetic was required in 5/267 patients. Conclusion Remote pre-anesthesia consultation for high-risk patients, local surgeon-anesthesiologist networking, protocol-guided management, and dedicated short duration of training in anesthesia may be considered as an alternative for delivering RA for emergency essential surgery for LL MSDs due to unavailability of anesthesiologists.

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Pediatric Anesthesia Concerns and Management for Orthopedic Procedures

Pediatric Clinics of North America ◽

10.1016/j.pcl.2019.09.006 ◽

2020 ◽

Vol 67 (1) ◽

pp. 71-84

Author(s):

Jeffrey P. Wu

Keyword(s):

Pediatric Anesthesia ◽

Orthopedic Procedures

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Extension of the temporomandibular joint space by methods derived from general orthopedic procedures

Journal of Prosthetic Dentistry ◽

10.1016/s0022-3913(57)80084-5 ◽

1957 ◽

Vol 7 (3) ◽

pp. 386-399 ◽

Cited By ~ 11

Author(s):

J. Campbell

Keyword(s):

Temporomandibular Joint ◽

Joint Space ◽

Orthopedic Procedures

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Profile of hip arthroplasty patients in a teaching hospital

Revista do Colégio Brasileiro de Cirurgiões ◽

10.1590/0100-69912015002007 ◽

2015 ◽

Vol 42 (2) ◽

pp. 106-110

Author(s):

Vania Regina Goveia ◽

Isabel Yovana Quispe Mendoza ◽

Bráulio Roberto Gonçalves Marinho Couto ◽

Jose Antonio Guimarães Ferreira ◽

Edson Barreto Paiva ◽

...

Keyword(s):

Femoral Neck ◽

Femoral Neck Fracture ◽

Teaching Hospital ◽

Hip Arthroplasty ◽

Hip Prosthesis ◽

Average Length ◽

Standing Position ◽

Orthopedic Procedures ◽

Neck Fracture ◽

Hip Arthroplasties

OBJECTIVE: to characterize the epidemiological profile of patients undergoing hip replacement, primary or revisional. METHODS: we conducted a retrospective, descriptive study, including hip arthroplasties performed from January 2009 to June 2012 in a Belo Horizonte teaching hospital, Minas Gerais State - MG, Brazil. Data were analyzed using descriptive statistics. RESULTS: orthopedic procedures represented 45% of the operations at the hospital in the period, 1.4% hip arthroplasties. There were 125 hip replacements, 85 total, 27 partial and 13 reviews. Among the patients, 40% were male and 60% were female. Age ranged between 20 and 102 years, mean and median of 73 and 76 years, respectively. The most frequent diagnosis (82%) was femoral neck fracture by low-energy trauma caused by falling form standing position. In 13 revision operations, 12 required removal of the prosthesis. The infectious complication led to revision in 54% of the time, followed by dislocation (15%), peri-prosthetic fracture (15%) and aseptic loosening (15%). The infection etiologic agent was identified in 43% of occasions. The average length of the prosthesis to a revision operation was eight months. CONCLUSION: patients undergoing hip arthroplasty are elderly, with femoral neck fracture caused by falling form standing position, affecting more women. The incidence of hip prosthesis loosening was 10%. The main cause of the infection was loosening. The incidence of revisional hip arthroplasty was 10% and the incidence of hospital mortality in patients undergoing hip arthroplasty was 7.2%.

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Deep Brachial Artery Pseudoaneurysm Following Arthroscopic Shoulder Debridement

Vascular and Endovascular Surgery ◽

10.1177/1538574418762922 ◽

2018 ◽

Vol 52 (5) ◽

pp. 378-381

Author(s):

Andrew E. Yang ◽

Jamie M. Hall ◽

Gilford S. Vincent ◽

Lowell Chambers

Keyword(s):

Brachial Artery ◽

Orthopedic Procedures ◽

Vascular Injuries ◽

Review Of The Literature ◽

Artery Pseudoaneurysm ◽

Pseudoaneurysm Formation ◽

Arthroscopic Procedures

Vascular injuries resulting from arthroscopic surgeries are rare with a reported incidence of 0.005% of elective orthopedic procedures. We report a case of a 49-year-old male who developed a deep brachial artery pseudoaneurysm following an arthroscopic shoulder debridement and lysis of adhesions. He was successfully embolized with resolution of the pseudoaneurysm within 6 weeks of treatment. A review of the literature demonstrates that pseudoaneurysm formation after arthroscopic procedures is rare and pseudoaneurysms of the deep brachial artery have yet to be reported.

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Perioperative goal-directed therapy and postoperative complications in different kind of surgical procedures: an updated meta-analysis

Journal of Anesthesia, Analgesia and Critical Care ◽

10.1186/s44158-021-00026-3 ◽

2021 ◽

Vol 1 (1) ◽

Author(s):

Mariateresa Giglio ◽

Giandomenico Biancofiore ◽

Alberto Corriero ◽

Stefano Romagnoli ◽

Luigi Tritapepe ◽

...

Keyword(s):

Postoperative Complications ◽

Postoperative Complication ◽

Surgical Procedures ◽

Orthopedic Surgery ◽

Meta Analysis ◽

Orthopedic Procedures ◽

Neurosurgical Procedures ◽

Goal Directed Therapy ◽

Number Of Patients ◽

Risk Patients

Abstract Background Goal-directed therapy (GDT) aims to assure tissue perfusion, by optimizing doses and timing of fluids, inotropes, and vasopressors, through monitoring of cardiac output and other basic hemodynamic parameters. Several meta-analyses confirm that GDT can reduce postoperative complications. However, all recent evidences focused on high-risk patients and on major abdominal surgery. Objectives The aim of the present meta-analysis is to investigate the effect of GDT on postoperative complications (defined as number of patients with a least one postoperative complication) in different kind of surgical procedures. Data sources Randomized controlled trials (RCTs) on perioperative GDT in adult surgical patients were included. The primary outcome measure was complications, defined as number of patients with at least one postoperative complication. A subgroup-analysis was performed considering the kind of surgery: major abdominal (including also major vascular), only vascular, only orthopedic surgery. and so on. Study appraisal and synthesis methods Meta-analytic techniques (analysis software RevMan, version 5.3.5, Cochrane Collaboration, Oxford, England, UK) were used to combine studies using odds ratios (ORs) and 95% confidence intervals (CIs). Results In 52 RCTs, 6325 patients were enrolled. Of these, 3162 were randomized to perioperative GDT and 3153 were randomized to control. In the overall population, 2836 patients developed at least one complication: 1278 (40%) were randomized to perioperative GDT, and 1558 (49%) were randomized to control. Pooled OR was 0.60 and 95% CI was 0.49–0.72. The sensitivity analysis confirmed the main result. The analysis enrolling major abdominal patients showed a significant result (OR 0.72, 95% CI 0.59–0.87, p = 0.0007, 31 RCTs, 4203 patients), both in high- and low-risk patients. A significant effect was observed in those RCTs enrolling exclusively orthopedic procedures (OR 0.53, 95% CI 0.35–0.80, p = 0.002, 7 RCTs, 650 patients. Also neurosurgical procedures seemed to benefit from GDT (OR 0.40, 95% CI 0.21–0.78, p = 0.008, 2 RCTs, 208 patients). In both major abdominal and orthopedic surgery, a strategy adopting fluids and inotropes yielded significant results. The total volume of fluid was not significantly different between the GDT and the control group. Conclusions and implications of key findings The present meta-analysis, within the limits of the existing data, the clinical and statistical heterogeneity, suggests that GDT can reduce postoperative complication rate. Moreover, the beneficial effect of GDT on postoperative morbidity is significant on major abdominal, orthopedic and neurosurgical procedures. Several well-designed RCTs are needed to further explore the effect of GDT in different kind of surgeries.

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Orthopaedic Management of Bladder Exstrophy

Turkish Association of Pediatric Surgeons ◽

10.5222/jtaps.2021.25986 ◽

2021 ◽

Author(s):

R. Özgür Özer

Keyword(s):

Abdominal Wall ◽

Bladder Exstrophy ◽

Pelvic Osteotomy ◽

Orthopedic Procedures ◽

Suture Materials ◽

Cloacal Exstrophy ◽

Surgical Interventions ◽

Pubic Rami ◽

Multi Stage ◽

Pubic Diastasis

Bladder exstrophy is an embryologic malformation that affects urogenital and skeletal systems. Non-operative treatment of this rare problem is impossible. Urogenital reconstructions can be facilitated by orthopedic procedures. These reconstructions can be performed in a single stage as a complete repair or multi-stage approaches. The goal of the treatment is closure of the bladder and abdominal wall for the achievement of continence, preservation of renal functions, and cosmetic and functional reconstruction of genital organs. Orthopedic procedures are performed to decrease the tension that complicates the bladder and abdominal wall closure by approximating the pubic rami to achieve a secure closure and a low recurrence rate. Surgical interventions consist of the approximation of the pubic rami with different materials such as suture materials and plaque or the application of different osteotomy types such as posterior iliac, anterior pelvic (pubic), diagonal iliac, horizontal iliac and posterior pelvic resection osteotomies. The age of the patient, the amount of pubic diastasis and history of previous operations that the patient has undergone should be considered during the operation planning. Pubic rami can be approximated without performing pelvic osteotomy in patients who are operated within the first 72 hours after birth. But, osteotomy is required in children older than 2 years of age with severe pubic diastasis, concomitant cloacal exstrophy and unsuccessful operation history. The surgical team should have enough knowledge and experience to perform different osteotomy types in case of need to combine anterior and posterior iliac osteotomies. With these multidisciplinary approaches, much more successful outcomes could be achieved.

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Posterior Shoulder Instability After Infraclavicular Block for Outpatient Hand Surgery

Hand ◽

10.1177/15589447211065072 ◽

2021 ◽

pp. 155894472110650

Author(s):

Ajay C. Kanakamedala ◽

Jared S. Bookman ◽

David L. Furgiuele ◽

Jacques H. Hacquebord

Keyword(s):

Regional Anesthesia ◽

Shoulder Instability ◽

Case Reports ◽

Hand Surgery ◽

Orthopedic Procedures ◽

Postanesthesia Care Unit ◽

Posterior Shoulder Instability ◽

Posterior Shoulder Dislocation ◽

Posterior Shoulder ◽

Increased Risk

Regional blocks are being increasingly utilized for anesthesia for various orthopedic procedures. Several studies have shown that regional anesthesia has fewer side effects and improved postoperative pain relief compared to general anesthesia, but regional blocks are not without risks. We present case reports of 2 patients who experienced posterior shoulder instability, one of whom had a posterior shoulder dislocation, immediately in the postanesthesia care unit after undergoing hand surgery with regional anesthesia. This paper highlights the importance of being aware that patients might be at increased risk of shoulder instability after upper extremity regional anesthesia, and appropriate perioperative precautions should be taken.

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