Multiple screw fixation versus cementless bipolar hemiarthroplasty for femur neck fracture using a nationwide hip fracture registry

AbstractCementless bipolar hemiarthroplasty (BHA) recently gained popularity as a treatment for femur neck fracture (FNF), but there have been few studies comparing this with multiple screw fixation (MSF) in the elderly population. The purpose of this study is to compare (1) surgery-related parameters, (2) reoperation rate as a local complication, (3) in-hospital systemic complication rate, and (4) mortality rate at 1 year after MSF and cementless BHA in patients with FNF using nationwide data. Six-hundred sixty-six hips (aged ≥ 50 years) extracted from nationwide Hip Fracture Registry were included in this study (133 MSF and 533 cementless BHA). One hundred fifty-six hips were divided into nondisplaced FNF (Group A) and 510 into displaced FNF (Group B). We evaluated (1) surgery-related parameters (anesthesia type, time to surgery, operation time, estimated blood loss and volume of postoperative transfusion), (2) the rate of and reasons for reoperation, (3) the rate and type of in-hospital systemic complications and (4) one-year mortality rate after surgery. In Group A, MSF showed shorter operation time (p = 0.004) and lower incidence of in-hospital systemic complications (p = 0.003). In Group B, cementless BHA demonstrated lower reoperation rate than MSF (p < 0.001). In both Group A and B, cementless BHA was associated with higher estimated blood loss than MSF (p < 0.001). Based on findings in our study, MSF might be a more favorable option for nondisplaced FNF, whereas cementless BHA might be a better one for displaced FNF in patients older than fifty. Nevertheless, our nationwide study also showed that numbers of cementless BHAs were being performed for nondisplaced FNF even in teaching hospitals.

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A Larger Sized Cup Accelerates Cartilage Erosion of Acetabulum after Bipolar Hemiarthroplasty in Elderly with Femur Neck Fracture

10.21203/rs.3.rs-242724/v1 ◽

2021 ◽

Author(s):

Sang Min Kim ◽

Saumil Ashvin Shah ◽

Jae Young Kim ◽

Hyun Woo Cho ◽

Won Yong Shon

Keyword(s):

Head Size ◽

Bipolar Hemiarthroplasty ◽

Femur Neck ◽

Femur Neck Fracture ◽

Neck Fracture ◽

Group A ◽

Cartilage Erosion ◽

Group B ◽

Acetabular Erosion

Abstract Purpose: Bipolar Hemiarthroplasty (BHA) is one of the common procedures done for the treatment of femur neck fracture. One of the frequently encountered complication with this surgery is erosion of the acetabular cartilage. This study was conducted to investigate acetabular erosion after BHA according to the difference in diameter between femoral head and implanted cup at minimum 10-year follow-up.Patients and Methods: We retrospectively reviewed 117 patients (117 hips) undergoing BHA with fracture of neck of the femur. Their mean age was 77.8 years (range, 65-96 years) and male: female ratio was 32:85. Patients were divided into 3 groups; Group A- bipolar cup size > actual head size, Group B- cup size < head size, Group C- cup size = head size. The degree of both superior and medial acetabular cartilage erosion was identified and calculated on postoperative radiographs using line of acetabular margin and Kohler’s line.Results: The mean superior and medial acetabular erosion were 1.62 ± 1.6 mm (range, 0 – 4.4) and 4.15 ± 2.7 mm (range, 0 – 8.2) in Group A, 1.30 ± 1.3 mm (range, 0 – 3.8) and 4.11 ± 2.7 mm (range, 0 – 7.8) in Group B, and 0.90 ± 1.1 mm (range, 0 – 2.6) and 3.16 ± 2.9 mm (range, 0 – 7.9) in Group C (p=0.039 and p=0.187, respectively). The superior acetabular erosion showed significant difference between the three groups. During mean follow-up period of 12.3 years, five patients (5/117, 4.3%) underwent conversion to THA due to superior acetabular erosion. All of three patient underwent BHA with a larger bipolar cup than the actual femoral head.Conclusion: A lager sized cup accelerated superior cartilage erosion of acetabulum after bipolar hemiarthroplasty. An optimal cup size should be considered when undergoing BHA in elderly patients.

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Laparoscopic versus open partial nephrectomy for the management of highly complex renal tumors with PADUA score ⩾10: A single center analysis.

Urologia Journal ◽

10.1177/03915603211001677 ◽

2021 ◽

pp. 039156032110016

Author(s):

Francesco Chiancone ◽

Marco Fabiano ◽

Clemente Meccariello ◽

Maurizio Fedelini ◽

Francesco Persico ◽

...

Keyword(s):

Partial Nephrectomy ◽

Operation Time ◽

Renal Tumors ◽

Open Partial Nephrectomy ◽

Estimated Blood Loss ◽

Significant Difference ◽

Operative Complications ◽

Group A ◽

Group B ◽

Post Operative Complications

Introduction: The aim of this study was to compare laparoscopic and open partial nephrectomy (PN) for renal tumors of high surgical complexity (PADUA score ⩾10). Methods: We retrospectively evaluated 93 consecutive patients who underwent PN at our department from January 2015 to September 2019. 21 patients underwent open partial nephrectomy (OPN) (Group A) and 72 underwent laparoscopic partial nephrectomy (LPN) (Group B). All OPNs were performed with a retroperitoneal approach, while all LPNs were performed with a transperitoneal approach by a single surgical team. Post-operative complications were classified according to the Clavien-Dindo system. Results: The two groups showed no difference in terms of patients’ demographics as well as tumor characteristics in all variables. Group A was found to be similar to group B in terms of operation time ( p = 0.781), conversion to radical nephrectomy ( p = 0.3485), and positive surgical margins ( p = 0.338) while estimated blood loss ( p = 0.0205), intra-operative ( p = 0.0104), and post-operative ( p = 0.0081) transfusion rates, drainage time ( p = 0.0012), pain score at post-operative day 1 (<0.0001) were significantly lower in Group B. The rate of enucleation and enucleoresection/polar resection was similar ( p = 0.1821) among the groups. Logistic regression analysis indicated that preoperative factors were not independently associated with the surgical approach. There was a statistically significant difference in complication rate (<0.0001) between the two groups even if no significant difference in terms of grade ⩾3 post-operative complications ( p = 0.3382) was detected. Discussion: LPN represents a feasible and safe approach for high complex renal tumors if performed in highly experienced laparoscopic centers. This procedure offers good intraoperative outcomes and a low rate of post-operative complications.

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Estimation and influence of blood loss under endoscope for percutaneous endoscopic lumbar discectomy (PELD): a clinical observational study combined with in-vitro experiment

10.21203/rs.3.rs-23638/v1 ◽

2020 ◽

Author(s):

DongDong Sun ◽

Dan Lv ◽

Wei Zhou Wu ◽

HeFei Ren ◽

BuHe Bao ◽

...

Keyword(s):

Blood Loss ◽

Clinical Research ◽

Operation Time ◽

Vitro Experiment ◽

In Vitro Experiment ◽

Estimated Blood Loss ◽

Group A ◽

Group B ◽

Endoscopic Lumbar Discectomy

Abstract Purpose: The purpose of this study is to come up with new methods to quantitate the blood loss under endoscope and explore the influence of blood loss on percutaneous endoscopic lumbar discectomy (PELD). Methods: Clinical research and in-vitro experiment are combined. In the in-vitro experiment, 2.0 ml blood was diluted in different ratio to simulate the rinse solution of PELD, the hematocrit method (HCT-M) and red blood cell count method (RBC-M) were came up to estimate blood loss and the new methods were calibrated with the directly measurement method (Direct-M). In clinical research, 74 patients with L5/S1 disc herniation were treated with PELD, HCT-M and the empirical method (EMP-M) were used to estimate the blood loss under endoscope. According to blood loss, all patients were divided into group A (≤10 ml) and group B (>10 ml). The blood loss, operation time, fluoroscopy frequency, visual analog scale (VAS) and oswestry disability index (ODI) scores were compared between the two groups. Results: In the in-vitro experiment, the hematocrit of the rinse solution was always stable over time. The estimated blood loss by HCT-M was stable and quite approximate to actual blood volume (2.0 ml) whatever the blood dilution ratio, while according to RBC-M, the estimated blood loss was close to the actual blood volume only when the dilution ratio was greater than 300 times. In clinical research, the blood loss estimated by HCT-M was higher than that by EMP-M in both groups (P<0.05). There was a significant difference between group A and group B in blood loss (7.40±1.61 vs 19.91±10.94 ml), operation time (80.51±34.70 vs 136.51±41.88 min), and fluoroscopy frequency (6.92±1.52 vs 11.11±2.32 times) (P<0.05). The VAS and ODI scores in group B were higher than that in group A 1 week after operation (P<0.05), however the scores were not different between the two groups at pre-operation (P>0.05). Conclusion: HCT-M is a reliable method to estimate endoscopic blood loss in PELD. The amount of endoscopic blood loss affects the operative procedure in operation time and fluoroscopy frequency, as well as clinical effects in VAS and ODI scores after operation in short-term

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Comparison of functional and oncological outcomes of innovative “three-port” and traditional “four-port” laparoscopic radical prostatectomy in patients with prostate cancer

BMC Urology ◽

10.1186/s12894-021-00787-7 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Ben Xu ◽

Si-da Cheng ◽

Yi-ji Peng ◽

Qian Zhang

Keyword(s):

Prostate Cancer ◽

Radical Prostatectomy ◽

Biochemical Recurrence ◽

Laparoscopic Radical Prostatectomy ◽

Positive Surgical Margin ◽

Oncological Outcomes ◽

Estimated Blood Loss ◽

Significant Difference ◽

Group A ◽

Group B

Abstract Background To compare the functional and oncological outcomes between innovative “three-port” and traditional “four-port” laparoscopic radical prostatectomy (LRP) in patients with prostate cancer (PCa). Methods We retrospectively collected the data of PCa patients treated at our institutions from June 2012 to May 2016. According to the inclusion criteria, a total of 234 patients were included in the study, including 112 in group A (four-port) and 122 in group B (three-port). The perioperatively surgical characteristics, functional and oncological outcomes were compared between groups. Results There were no statistical differences in the baseline parameters between these two groups. Compared with group A, the operative time (OT) and estimated blood loss (EBL) were significantly less in group B. On follow-up, the rate of positive surgical margin (PSM), prostate specific antigen (PSA) biochemical recurrence and continence after LRP did not show any statistically significant difference between the groups. An identical conclusion was also received in comparison of overall survival (OS) and biochemical recurrence-free survival (BRFS) between both groups. Conclusions Innovative “three-port” LRP can significantly shorten the OT and reduce the EBL compared with the traditional “four-port” LRP. Meanwhile, it does not increase the rate of PSM and PSA biochemical recurrence. “Three-port” LRP could be popularized in the future in view of its superior surgical technique, considerably better functional outcomes and remarkable oncological control.

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Infective complications after percutaneous nephrolithotomy in relation to preoperative urine culture status

Journal of Patan Academy of Health Sciences ◽

10.3126/jpahs.v6i1.27070 ◽

2019 ◽

Vol 6 (1) ◽

pp. 8-13

Author(s):

Birendra Kumar Yadav ◽

Robin Bahadur Basnet ◽

Anil Shrestha ◽

Parish Mani Shrestha

Keyword(s):

Hospital Stay ◽

Percutaneous Nephrolithotomy ◽

Urine Culture ◽

Operation Time ◽

Group A ◽

One Year ◽

Group B ◽

Stone Characteristics ◽

Negative Urine Culture ◽

Infective Complications

Introductions: Fever and sepsis after percutaneous nephrolithotomy (PCNL) secondary to urinary tract infection is a major determinant of overall post PCNL complications. This study aims to analyse infective complications after PCNL in relation to pre-operative urine culture status. Methods: A comparative analysis of post PCNL infective complications in pre-operative urine culture positive (Group A) and negative (Group B) was done for one year during June 2017 to May 2018 in department of urology, Bir Hospital, National Academy of Medical Sciences, Kathmandu, Nepal. Demographics, stone characteristics, mean operative time, post-operative hospital stay and post-operative complications as per Modified Clavien classification were compared between the two groups. Results: Out of total 136 PCNL patients, 51 were in Group A and 85 in Group B. Infective complications were significantly high, 28 (54.90%) in group A compared to 20 (23.53%) in group B, p=0.004. The most common isolate was Escherichia coli 19 (37.25%), sensitive to amikacin 37 (72.55%). The mean operation time, transfusion and hospital stay was not statically different in two groups. Morality occurred in 1 (1.96%) in group A. Conclusions: Infective complications were significantly high after PCNL in patients with preoperative positive urine culture, even when it was treated to sterile with sensitive antibiotics, compared to patients with preoperative negative urine culture.

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Femur neck fracture in young adults, is it really an urgent surgery indication: retrospective clinical study

Pan African Medical Journal ◽

10.11604/pamj.2018.30.112.13643 ◽

2018 ◽

Vol 30 ◽

Cited By ~ 6

Author(s):

Seyitali Gumustas ◽

Haci Bayram Tosun ◽

Mehmet Isyar ◽

Sancar Serbest ◽

Kadir Oznam ◽

...

Keyword(s):

Young Adults ◽

Clinical Study ◽

Femur Neck ◽

Urgent Surgery ◽

Femur Neck Fracture ◽

Retrospective Clinical Study ◽

Neck Fracture

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Surgery for thoracolumbar junction (T12-L1) tuberculosis a multicentre, retrospective study

10.21203/rs.2.13914/v1 ◽

2019 ◽

Author(s):

Yanping Zeng ◽

Peng Cheng ◽

Jiulin Tan ◽

Zhilin Li ◽

Yuan Chen ◽

...

Keyword(s):

Blood Loss ◽

Posterior Approach ◽

Spinal Tuberculosis ◽

Surgical Techniques ◽

Operation Time ◽

Thoracolumbar Junction ◽

Group A ◽

The Mean ◽

Group B ◽

Approach Group

Abstract Purpose A multicentre, retrospective study was conducted to evaluate the safety and efficacy of different surgical techniques for thoracolumbar junction (T12-L1) tuberculosis. Methods The medical records of thoracolumbar junction tuberculosis patients (n = 257) from January 2005 to January 2015 were collected and reviewed. A total of 45 patients were operated on by an anterior approach (Group A), 52 by a combined anterior and posterior approach (Group B) and 160 by a posterior approach (Group C). Anti-tuberculosis therapy was performed both before and after surgery. Clinical outcomes, laboratory indexes and radiological results of the three groups were compared. Results All three surgical approaches achieved bone fusion, pain relief and neurological recovery. The mean loss of correction in group A at last follow-up was higher than in groups B and C (P < 0.05), and the difference between groups B and C was not significant (P > 0.05). The mean operation time and blood loss in group B were greater than in groups A and C. Conclusions For patients with thoracolumbar junction (T12-L1) tuberculosis, the posterior-only approach is superior to the anterior-only approach in the correction of kyphosis and maintenance of spinal stability. The posterior-only approach is recommended because it achieves the same efficacy as the anterior-only or combined approach but with shorter operation times, less trauma and less blood loss. Keywords Spinal tuberculosis; Thoracolumbar junction; Three approaches.

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Comparison of marsupialization under nasal endoscopy versus Lacrimal probing for treatment of congenital dacryocystoceles: a report of 40 cases

10.21203/rs.2.9860/v1 ◽

2019 ◽

Author(s):

Yanhui Cui ◽

Peng Sun ◽

Lixing Tang ◽

Chengyue Zhang ◽

Qian Wu ◽

...

Keyword(s):

Success Rate ◽

Reoperation Rate ◽

Nasal Endoscopy ◽

Efficacy And Safety ◽

Group A ◽

Group B

Abstract Introduction This study was performed to compare the efficacy of marsupialization under nasal endoscopy versus Lacrimal probing in the treatment of congenital dacryocystocele. Methods Forty neonates (43 eyes) diagnosed with congenital dacryocystoceles were divided into Group A (nasal endoscopic marsupialization) and Group B (Lacrimal probing). The patients were followed up for 1 year after surgery. The efficacy, incidence of complications, and reoperation rate were compared between the two groups. Results The male:female ratio was 25:15 patients (27:16 eyes). In Group A, the success rate was 100%, the incidence of complications was 5%, and the reoperation rate was 0%. In Group B, the success rate was 90%, the incidence of complications was 20%, and the reoperation rate was 30%. Conclusion Compared with Lacrimal probing, marsupialization under nasal endoscopy provides greater efficacy and safety for congenital dacryocystoceles.

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SIMULTANEOUS INSUFFICIENCY FRACTURE OF BILATERAL NECK OF FEMUR WITH COXA VARA

10.36106/ijsr/3801776 ◽

2020 ◽

pp. 41-42

Author(s):

Rishabh Surana ◽

Saurabh Singh ◽

Alok Rai

Keyword(s):

Weight Bearing ◽

Insufficiency Fracture ◽

Young Female ◽

Full Weight Bearing ◽

Coxa Vara ◽

Neck Of Femur ◽

Femur Neck ◽

Femur Neck Fracture ◽

Neck Fracture

Simultaneous insufficiency fracture of bilateral neck of femur with displacement and coxa vara is very uncommon , and very challenging. Osteomalacia is a known cause of insufficiency fracture. We present a case of a young female with non traumatic simultaneous bilateral femur neck fracture. On radiological and laboratory investigation fracture was diagnosed as insufficiency fracture due to osteomalacia with coxa vara. Treatment was done by intertrochanteric valgus osteotomy and fixation by dynamic condylar screw with a prebend plate along with oral and parentral vitamin D therapy. On six month follow up both side fractures were well united and patient was able to walk without pain with full weight bearing and with normal gait .Her lab investigations also returned to normal during follow up.

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