No difference in mid-term outcome after superior vs. anteroinferior plate position for displaced midshaft clavicle fractures

AbstractTo compare outcomes, complications, revisions, and rates of implant removal of superior compared to anteroinferior plating in displaced midshaft clavicle fractures at mid-term follow-up. We retrospectively reviewed 79 patients who underwent operative treatment for displaced midshaft clavicle fractures (Group A: 28 patients with superior plating; Group B: 51 patients with anteroinferior plating) that were at least 2 years postoperatively. Adjusted Constant Score (aCS), Visual Analog Scale (VAS), and Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) score were compared. Bone union, implant removal, complications and revision surgeries were assessed. Group A had a significantly higher aCS compared to group B (90, IQR: 85.0–91.0 vs. 91, IQR: 90.0–93.0; P = 0.037). No significant differences between groups were seen in VAS (P = 0.283) and QuickDASH (P = 0.384). Bone union was achieved in 76 patients (96.2%) with no significant differences between groups (Group A: 96.4% vs. Group B: 96.1%; P > 0.999). There were no significant differences in implant removal rates (Group A: 60.7% vs. Group B: 66.7%; P = 0.630), complications (Group A: 46.4% vs. Group B: 31.4%; P = 0.226) and revisions (Group A: 25% vs. Group B: 9.8%; P = 0.102). Superior and anteroinferior plating result in high bone union rates and good clinical outcomes with similar rates of plate removal.

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Minimaly invasive mitral valve repair with Neochord system in patients with degenerative mitral disease: echocardiographic assessment and predictors for mid-term outcome

European Heart Journal ◽

10.1093/ehjci/ehaa946.2680 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

A Drasutiene ◽

V Janusauskas ◽

G Speziali ◽

D Zakarkaite ◽

M Budra ◽

...

Keyword(s):

Left Ventricle ◽

Left Atrium ◽

Beating Heart ◽

Mean Difference ◽

Volume Index ◽

Term Outcome ◽

Group A ◽

Group B ◽

Left Atrium Volume

Abstract Introduction Various minimally invasive mitral valve (MV) repair techniques are available to treat degenerative mitral regurgitation (MR). Transapical implantation of artificial chordae on a beating heart is performed using the NeoChord DS1000 device with real-time TEE guidance. Purpose 1)To assess preoperative and the mid-term follow-up echocardiographic data in patients after MV repair using the NeoChord DS1000 device; 2)to investigate the changes of left ventricle (LV), left atrium (LA) and mitral annulus dimensions during the follow-up period; 3)to assess the difference of baseline echocardiographic parameters between successful and not-successful (severe residual MR) MV repair groups; 4)to identify the preoperative echocardiographic variables that may be associated with recurrence of MR at mid-term follow. Methods All patients after transapical MV repair with Neochord implantation in Vilnius University hospital were prospectively entered into the study. The acquired preoperative and follow-up echocardiographic datasets were analysed. According to the residual MR at follow-up, patients were stratified to 2 groups: group A – successful durable MV repair (residual MR ≤2); group B – MV repair failure (recurrence of severe MR or reintervention). Values were expressed as Mean±SD. Univariable regression analysis was used to identify anatomical predictors of residual MR. Results 53 (70.67%) patients had a residual MR ≤2 (Group A) and 22 (29.33%) residual MR≥2+ (Group B) at 26±6 months follow-up. At baseline, Group B patients had significantly larger left ventricle end diastolic diameter (LVEDD) (mean difference 5.67±1.29mm, p<0.0001) left ventricle end systolic diameter (LVESD) (mean difference 4.08±1.57mm, p=0.012), LA volume index (mean difference 21.57±5.003 p<0.0001) and higher systolic pulmonary pressure values (mean difference 10.46±3.34, p<0.003) compared with group A. Overall, a significant reduction in LA volume index (mean change 15.69±4.15ml/m2, p<0.001), LA diameter (mean change 3.15±1.24, p=0.012), LV diameter (mean change in LVEDD 4.78±0.88mm p<0.000) was observed at 24 months follow up. There was no significant changes in MV annular parameters at follow up. Left atrium volume (OR 1.018; 95% CI 1.006–1.035; p=0.009), left atrium volume index (OR 1.038; 95% CI 1.013–1.072; p=0.010), LVEDD (OR 1.201; 95% CI 1.088–1.353; p=0.0008), LVESD (OR 1.122; 95% CI 1.02–1.248); p=0.0236) and sPAP (OR 1.418; 95% CI 1.139–2.016; p=0.0014) were all significantly associated with the worse outcome (MR >2) after mini-invasive MV repair in univariable regression analysis. Conclusions Minimaly invasive MV repair with Neochord system on beating heart is effective in patients with degenerative MR. Baseline echocardiographic characteristics predictive for a worse middle term outcome are mainly related to LV and LA remodeling. Reverse remodeling of LV and LA is observed during the follow-up period with no significant changes in MV annulus. Funding Acknowledgement Type of funding source: None

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Surgical Treatment Outcomes for Everted Bursal Flap of Delaminated Supraspinatus Tear

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967121990423 ◽

2021 ◽

Vol 9 (3) ◽

pp. 232596712199042

Author(s):

Hyungsuk Kim ◽

Chu Hwan Byun ◽

Sung Bin Han ◽

Hyun Seok Song

Keyword(s):

Los Angeles ◽

Constant Score ◽

Early Postoperative Period ◽

Level Of Evidence ◽

Supraspinatus Tear ◽

Functional Scores ◽

Group A ◽

Vas Scores ◽

Group B

Background: Although everted bursal flaps of delaminated tears have been reported, few studies have reported radiologic images, arthroscopic findings, and clinical results after repair. Purpose: To compare the repair outcomes of everted delaminated tears with those of classic delaminated supraspinatus tears. Study Design: Cohort study; Level of evidence, 3. Methods: Among 153 patients who underwent arthroscopic rotator cuff repair for a delaminated supraspinatus tear, everted bursal flap tears were observed in 24 patients upon arthroscopy (group A). Another 24 patients with classic delaminated supraspinatus tears, matched for age and sex, were selected for group B. Magnetic resonance imaging (MRI) and ultrasonography were performed preoperatively and postoperatively. Patients were evaluated using a visual analog scale (VAS) for pain as well as functional scores (American Shoulder and Elbow Surgeons [ASES] score, Constant score, and University of California Los Angeles shoulder score). Scores were compared preoperatively and at final follow-up (mean follow-up, 32 months). Results: Patients in both groups A and B reported improved VAS and functional scores at the final follow-up. In group A, preoperative VAS scores were higher and functional scores were poorer than in group B. Subacromial effusions with tendon swelling on preoperative MRI were more common in group A. During follow-up ultrasonography, group A patients exhibited persistent subacromial effusion. However, VAS scores at final follow-up were significantly better in group A (0.4 ± 0.7) than in group B (1.6 ± 1.4) ( P < .001), and ASES scores at final follow-up were better in group A (84.3 ± 4.3) than in group B (77.0 ± 10.2) ( P = .005). Conclusion: Everted bursal flap delaminated tears were associated with higher VAS scores and poorer functional scores preoperatively. Although subacromial effusions were experienced by group A during the early postoperative period, clinical outcomes at final follow-up were significantly better for everted delaminated tears compared with classic delaminated tears.

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Management of fresh odontoid fractures using posterior C1–2 fixation without fusion: a long-term clinical follow-up study

Journal of Neurosurgery Spine ◽

10.3171/2021.9.spine21822 ◽

2021 ◽

pp. 1-11

Keyword(s):

Scale Score ◽

Neck Disability Index ◽

Implant Removal ◽

Odontoid Fractures ◽

Significant Difference ◽

Flexion Extension ◽

Group A ◽

Group B

OBJECTIVE Posterior C1–2 fixation without fusion makes it possible to restore atlantoaxial motion after removing the implant, and it has been used as an alternative technique for odontoid fractures; however, the long-term efficacy of this technique remains uncertain. The purpose of the present study was to explore the long-term follow-up outcomes of patients with odontoid fractures who underwent posterior C1–2 fixation without fusion. METHODS A retrospective study was performed on 62 patients with type II/III fresh odontoid fractures who underwent posterior C1–2 fixation without fusion and were followed up for more than 5 years. The patients were divided into group A (23 patients with implant removal) and group B (39 patients without implant removal) based on whether they underwent a second surgery to remove the implant. The clinical outcomes were recorded and compared between the two groups. In group A, the range of motion (ROM) of C1–2 was calculated, and correlation analysis was performed to explore the factors that influence the ROM of C1–2. RESULTS A solid fracture fusion was found in all patients. At the final follow-up, no significant difference was found in visual analog scale score or American Spinal Injury Association Impairment Scale score between the two groups (p > 0.05), but patients in group A had a lower Neck Disability Index score and milder neck stiffness than did patients in group B (p < 0.05). In group A, 87.0% (20/23) of the patients had atlantoodontoid joint osteoarthritis at the final follow-up. In group A, the C1–2 ROM in rotation was 6.1° ± 4.5° at the final follow-up, whereas the C1–2 ROM in flexion-extension was 1.8° ± 1.2°. A negative correlation was found between the C1–2 ROM in rotation and the severity of tissue injury in the atlantoaxial region (r = –0.403, p = 0.024) and the degeneration of the atlantoodontoid joint (r = –0.586, p = 0.001). CONCLUSIONS Posterior C1–2 fixation without fusion can be used effectively for the management of fresh odontoid fractures. The removal of the implant can further improve the clinical efficacy, but satisfactory atlantoaxial motion cannot be maintained for a long time after implant removal. A surgeon should reconsider the contribution of posterior C1–2 fixation without fusion and secondary implant removal in preserving atlantoaxial mobility for patients with fresh odontoid fractures.

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Intraoperative duplex ultrasonography in carotid endarterectomy: The impact on indication for immediate revision and intermediate-term outcome

VASA ◽

10.1024/0301-1526.37.2.151 ◽

2008 ◽

Vol 37 (2) ◽

pp. 151-156 ◽

Cited By ~ 4

Author(s):

Ott ◽

Heller ◽

Odermatt ◽

Furrer

Keyword(s):

Duplex Ultrasonography ◽

Low Grade ◽

High Grade ◽

Term Outcome ◽

Technical Errors ◽

Group A ◽

Group B ◽

The Impact ◽

Symptomatic Stenosis

Background: Thromboembolic complications in relation to carotid endarterectomies (CEA) are frequently associated with technical errors. We analyzed prospectively the impact of intraoperative duplex ultrasonography (IODS) in CEA on immediate revision and postoperative results. Patients and methods: We have observed 70 patients with 74 CEA. Indications for surgery were asymptomatic high grade stenosis (70–99%) or symptomatic stenosis of > 50%. IODS findings were rated as "relevant", "minor" or "normal". Relevant findings were immediately repaired. Peri- and postoperative neurological events were analyzed in Duplex Scans controls in a median length of follow-up of 17.3 months. Outcome of patients with "minor" findings (group A) were compared with patients having "normal" or corrected "relevant" findings (group B). Results: In 8/74 cases (11%) we found relevant findings leading to immediate revision. In 25/74 (34%) cases minor findings were detected which were not revised. In group A (n = 25, 34%) two asymptomatic occlusions and one recurrent high grade stenosis were found during follow-up. In group B (n = 49, 66%) we detected two high and two low grade stenosis. The 30 day death and stroke rate was 1.4% (n = 1). Conclusions: IODS is a sensitive method to detect immediately pathological findings. Its correction seems to reduce the incidence of early occlusions and therefore early neurological events.

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Comparison of Short Term Results of Type IIB2 Middle Third Clavicular Fractures Treated with Figure of Eight Bandage and Locked Plate Fixation

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967114s00265 ◽

2014 ◽

Vol 2 (11_suppl3) ◽

pp. 2325967114S0026

Author(s):

Melih Malkoc ◽

Ozgur Korkmaz ◽

Erhan Bayram ◽

Ali Seker ◽

Murat Yılmaz ◽

...

Keyword(s):

Constant Score ◽

Plate Fixation ◽

Locked Plate ◽

Significant Difference ◽

Lower Complication ◽

Lower Complication Rate ◽

Group A ◽

Student’S T ◽

Group B

Objectives: Most acute displaced midshaft clavicular fractures conventionally have been treated nonoperatively with the expectation of a high probability of fracture union, good functional outcomes, and a high level of patient satisfaction . However, the outcome of nonoperative treatment is not as favorable as once thought and there has been a growing trend to treat these fractures surgically We aimed to evaluate and compare the short term results of conservative treatment and locked plate fixation in the treatment of type IIB2 clavicula fractures according to Robinson classification in this study. Methods: Thirty eight patients with type IIB2 clavicula fractures according to Robinson classification were retrospectively reviewed. 20 patients who were treated conservatively were enrolled as group A and 18 patients who were operated with locked plate and screws were enrolled as group B. All patients were evaluated with Constant and Oxford scores in their last follow up control. For the patients that were treated conservatively (Group A) figure of eight bandage were applied for six week. Patients (Group B) were operated under general anesthesia in the beach chair position. A straight incision was made over the fracture line. Butterfly or free fragments in comminuted fractures were fixed to the main fragment with a lag screw in 3 patients before fracture reduction and plate fixation. Fracture reduction was performed with taking care of minimal periosteal stripping. After reduction of the main fragments, titanium alloy, locked anatomic compression plate were applied on the superior surface of the clavicle. A minimum of six cortexes were fixed with 3.5 mm locked cortical screws on the medial and lateral sides of the fracture. We did not need any Auto- or allografts during the surgery. Statistical analysis was performed between the scores of two groups. Conservative and surgical treated groups Oxford scores and Constant scores had normal distribution. For this reason Student's t test, and Non-parametric version of Student’s t test Mann Whitney U test were performed. 95% confidence interval and p <0.05 was considered significant as statistically. Results: Mean follow up period is 18 months (12-24 months). At the last follow-up, mean Constant score is 79.5 (98-43) and mean Oxford score was 46.35(49-44) for group A. In group B mean Constant score is 89.3(100-77) and mean Oxford score is 46,6(48-44) at the last follow-up. There were no patients who require any revision surgery in group B. Bone healing was detected in all fractures radiologically in both groups. There was no statistically significant difference between Oxford scores of the two groups (p=0,570). There was statistically significant difference between Constant scores of the two groups whereas results of Group B were better than group A (p=0,013) Surgical treatment with locked plate fixation in type IIB2 clavicle fractures according to Robinson Classification, can be the first treatment choice with better cosmetics, lower complication rate, and better outcomes. Conclusion: Surgical treatment with locked plate fixation in type IIB2 clavicle fractures according to Robinson Classification, can be the first treatment choice with better cosmetics, lower complication rate, and better outcomes.

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Prognosis of Schizophrenia Before and After Pharmacotherapy: II. Three-Year Follow-Up

The British Journal of Psychiatry ◽

10.1192/bjp.113.505.1353 ◽

1967 ◽

Vol 113 (505) ◽

pp. 1353-1359 ◽

Cited By ~ 6

Author(s):

Michael Pritchard

Keyword(s):

Length Of Stay ◽

Short Term ◽

Term Outcome ◽

Short Term Outcome ◽

Before And After ◽

Schizophrenic Patients ◽

Group A ◽

Group B

In the previous paper a comparison was made between short-term outcome of two groups of 50 schizophrenic patients each, admitted to the Professorial Unit of the Maudsley Hospital before and after the introduction of reserpine and phenothiazines into treatment. It was shown that patients admitted in 1956/57 (Group B) had a better prognosis in terms of condition on discharge and length of stay in hospital than those admitted in 1952/53 (Group A).

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Are there any differences between the shoulder-arm sling and figure-of-eight bandage in the conservative treatment of paediatric clavicle fractures?

Journal of Children s Orthopaedics ◽

10.1302/1863-2548.15.210139 ◽

2021 ◽

pp. 1-6

Author(s):

Ali Sisman ◽

Caner Poyraz ◽

Ali Can Cicek ◽

Suleyman Kor ◽

Emre Cullu

Keyword(s):

Muscle Strength ◽

Conservative Treatment ◽

Age Group ◽

Level Of Evidence ◽

Significant Difference ◽

Paediatric Age ◽

Group A ◽

Clavicle Fractures ◽

Group B

Purpose Clavicle fractures are treated conservatively in the paediatric age group, except in rare types of fractures. We investigated whether there was a difference between using shoulder-arm sling and figure-of-eight bandage in this age group. Methods This study was designed as a retrospective study. In all, 41 children among 53 who underwent conservative treatment with a shoulder-arm sling or figure-of-eight bandage between 2014 and 2019 were included in the study and divided into two groups. Treatment results were compared clinically with respect to pain intensity, muscle strength and radiological examinations. Results Group A comprised 20 children with a figure-of-eight bandage and group B comprised 21 children with shoulder sling. According to the Robinson classification, ten fractures were displaced in group A and 12 in group B (p = 0.647). The mean time until the first appointment after the index visit that started the management course was 25.5 days (21 to 31) in group A and 24 days (20 to 30) in group B (p = 0.129). Fracture healing was observed in all patients at the first follow-up and the treatment was discontinued. There was no difference between the groups in the muscle strength examination and shoulder joint range of movement examination at the first-year follow-up (p = 1.00). Conclusion In the paediatric age group, there was no significant difference between shoulder-arm sling and figure-of-eight bandage in the conservative treatment of clavicle fractures. Since the shoulder-arm sling is more suitable for treatment, it may be the primary preference. Level of Evidence Level III (retrospective comparative study)

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Outcomes in Thoracolumbar and Lumbar Traumatic Fractures: Does Restoration of Unfused Segmental Mobility Correlated to Implant Removal Time？：a retrospective study

10.21203/rs.3.rs-157715/v1 ◽

2021 ◽

Author(s):

Jian Wu ◽

Jun Zhu ◽

Zhong Wang ◽

Huaijian Jin ◽

Yingbo Wang ◽

...

Keyword(s):

Quality Of Life ◽

Patient Satisfaction ◽

Implant Removal ◽

Pain Patient ◽

Posterior Fixation ◽

Removal Time ◽

Group A ◽

Group B

Abstract Background Posterior fixation without fusion can treat thoracolumbar and lumbar traumatic fractures effectively. However, whether patients benefit from implant removal, as well as the correlation between the range of motion (ROM) of the involved segments and the removal time, has not been determined. Methods Fifty consecutive cases with thoracolumbar traumatic fractures that had undergone implant removal at different times were enrolled. We found 17 patients (Group A), 21 patients (Group B), and 12 patients (Group C) underwent implant removal following the index surgery within 12 months, between 12 to 24 months, and over 24 months, respectively. Clinical and radiological outcomes, including visual analog scale (VAS) for back pain, patient satisfaction, the Oswestry disability index (ODI) and EuroQol five dimensions questionnaire (EQ-5D) for quality of life and segmental ROM were analyzed. Results The average follow-up time was 9.1 ± 5.7 months after implant removal. There were no significant differences in VAS and patient satisfaction among the three groups at the same observation time points. Patients of group A gained the lowest ODI and highest EQ-5D scores after removal and at final follow-up than those in group B and C. The best ROM was obtained in Group A followed by Group B and C (11.5 ± 6.2°, 5.5 ± 1.6° and 2.4 ± 0.6°, respectively). Conclusions Immobilization of the involved segments over 24 months may lead to ankylosis. Regained segmental ROM is correlated negatively with implant removal time. Patients have implant removal within 12 months can gain a better quality of life.

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Loss of Consciousness at Onset of Subarachnoid Hemorrhage as Marker of Short Term Outcome

Journal of National Institute of Neurosciences Bangladesh ◽

10.3329/jninb.v7i1.54746 ◽

2021 ◽

Vol 7 (1) ◽

pp. 20-24

Author(s):

Rahat Amin Chowdhury ◽

Md Habibur Rahman ◽

ATM Hashibul Hasan ◽

Iftikher Alam ◽

Mansur Habib

Keyword(s):

Subarachnoid Hemorrhage ◽

Hospital Stay ◽

Loss Of Consciousness ◽

College Hospital ◽

Term Outcome ◽

Poor Outcome ◽

Group A ◽

Group B ◽

The Impact

Background: Studies assessing the impact of loss of consciousness (LOC) on prognosis of subarachnoid hemorrhage (SAH) has been limited. Objective: This scientific assessment was done to determine the effect of LOC on outcome of SAH. Methodology: This hospital based observational study was done in Department of Neurology of Dhaka Medical College Hospital, Dhaka, Bangladesh from January 2018 to December 2018. Patients with the diagnosis of SAH admitted in the in-patient wards of Neurology, Neurosurgery and Internal Medicine were taken as study population. The patients were divided in two groups with either presence (B) or absence of loss of consciousness (A). Group B was further subdivided into 3 subgroup depending admission WFNS scale grades (BI= WFNS II &III, BII=WFNS IV and BIII=WFNS V). Follow up was done in the stroke clinic, outpatient department of Neurology or by telephone interviews of patients, caregivers or family members. Outcome was measured by modified Rankin Scale (mRS). Result: A total of 75 patients were divided into group A and Group B. Six (8.0%) patients died during hospital stay, 6 died after 3 months. All those died during hospital stay were from group B. At 3 months, 16(21.3%) patients were lost during follow up. In group A at discharge 28.6% patients had poor outcome whereas 36% of patients in group B had poor outcome. Within group B most of the patients having poor outcome were in subgroup BIII (75.0%) compared to 33.0% cases in BI (p=0.023). About 16.7% cases in group A had poor outcome at 3 months and 75.0% cases in Group BIII. Furthermore, 8.3% patients died in Group A, however, 25.0% died in Group BIII. WFNS grade (IV or V) had statistically significant influence on poor outcome among patients having LOC (adjusted Odds ratio is 2.20, p=0.04 and 95% CI 1.03–4.71). Conclusion: Loss of consciousness at onset of SAH is an important marker for p oor outcome. Journal of National Institute of Neurosciences Bangladesh, January 2021, Vol. 7, No. 1, pp. 20-24

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Intramedullary Fixation of Diaphyseal Clavicle Fractures Using the Rockwood Clavicle Pin: Review of 86 Cases

The Open Orthopaedics Journal ◽

10.2174/1874325001206010482 ◽

2012 ◽

Vol 6 (1) ◽

pp. 482-487 ◽

Cited By ~ 9

Author(s):

William J Marlow ◽

Peter Ralte ◽

Syam PK Morapudi ◽

Rashpal Bassi ◽

Jochen Fischer ◽

...

Keyword(s):

Invasive Technique ◽

Common Complication ◽

Non Union ◽

Intramedullary Device ◽

Group A ◽

Clavicle Fractures ◽

The Common ◽

Group B ◽

Second Procedure

Aim:This study reports the safety, efficacy and functional and patient centred outcomes of the largest published series of patients treated with the Rockwood clavicle pin (intramedullary device) to date.Patients and Methods:A retrospective review of case notes, radiographs and follow-up by questionnaire was conducted. 86 patients were operated upon, 70 for acute fractures (group A) and 16 for non-union (group B).Results: Rate of non-union was 2 (2.9%) in group A and 0 in group B. Mean Disability of the Arm, Shoulder and Hand (DASH) scores were 5.9 for group A and 8.7 for group B. Satisfaction was rated as good or excellent in 61 (96.8%) of responders and all patients would have the procedure again. Pin prominence was the predominant complication in both groups and all patients underwent a second procedure for metalwork removal.Discussion:Rockwood clavicle pins are as effective as plates in achieving union and maintaining length, however the advantages of this less invasive technique should be weighed against the common complication of pin prominence and the inconvenience of removal of metalwork in all cases.

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