Management of Acute Unilateral Nondisplaced Subaxial Cervical Facet Fractures

2017 ◽  
Vol 14 (2) ◽  
pp. 104-111 ◽  
Author(s):  
Aditya Vedantam ◽  
Jared Steven Fridley ◽  
Jovany Cruz Navarro ◽  
Shankar P Gopinath
Keyword(s):  
Nonoperative Management ◽  
Exact Test ◽  
Laminar Fracture ◽  
Facet Fracture ◽  
The Mean ◽  
Lateral Mass Fracture ◽  
Fracture Types ◽  
Cervical Facet ◽  
Spine Radiographs

Abstract BACKGROUND Few studies have focused on the management of patients with nondisplaced cervical facet fractures. OBJECTIVE To determine the rate of successful nonoperative management and risk factors for instability in patients with acute traumatic, unilateral, nondisplaced cervical facet fractures. METHODS We reviewed patients with single or multilevel unilateral nondisplaced or minimally displaced subaxial cervical facet fractures between 2008 and 2014. Facet fractures were classified as type A1 fractures: superior facet fracture of caudal vertebra; type A2: inferior facet fracture of rostral vertebral; and type A3: floating lateral mass (fracture of pedicle and vertical laminar fracture). All patients were given a trial of nonoperative management with external immobilization using a hard cervical collar. Follow-up clinical data and cervical spine radiographs were analyzed to determine factors associated with instability. RESULTS Thirty-five patients (34 males, mean age 40.2 ± 2.4 yr) were reviewed. The mean follow-up duration was 2.7 ± 0.4 mo. The distribution of fracture types was type A1 (n = 15), type A2 (n = 4), type A3 (n = 5), type A1 and A2 fractures (n = 10), and type A1 and A3 fractures (n = 1). Nonoperative management was successful in 29 patients (82.9%), and 6 patients developed instability requiring surgery. All patients who failed nonoperative management had associated injuries suggesting a more severe mechanism of injury. No significant association was found between the type of facet fracture and outcome (Fisher's exact test, P = .18). CONCLUSION In our series, more than 80% of the patients with unilateral, nondisplaced cervical facet fractures underwent successful nonoperative management in the short term.

scholarly journals Traumatic Cervical Unilateral and Bilateral Facet Dislocations Treated With Anterior Cervical Discectomy and Fusion Has a Low Failure Rate

2017 ◽  
Vol 7 (2) ◽  
pp. 110-115 ◽  
Author(s):  
Alireza K. Anissipour ◽  
Julie Agel ◽  
Matthew Baron ◽  
Erik Magnusson ◽  
Carlo Bellabarba ◽  
...  
Keyword(s):  
Risk Factor ◽  
Treatment Failure ◽  
Anterior Cervical Discectomy ◽  
Cervical Discectomy ◽  
Single Level ◽  
Surgical Data ◽  
Facet Fracture ◽  
The Mean ◽  
Cervical Facet

Study Design: Retrospective radiographic and chart review. Objective: To define the rate and associated risk factors of treatment failure of anterior cervical fusion for treatment of cervical facet dislocations. Methods: Between 2004 and 2014, a retrospective review at a single level 1 trauma center identified 38 patients with unilateral or bilateral dislocated facet(s) treated with anterior cervical discectomy and fusion (ACDF). Two patients were eliminated due to less than 30-day follow-up. Demographic data, initial neurological exams, surgical data, radiographic findings, and follow-up records were reviewed. Results: Of the 36 patients with facet dislocations treated with ACDF using a fixed locking plate, 16 were unilateral and 20 were bilateral. The mean age was 35 years (range 13-58). Mean follow-up was 323 days (range 30-1998). There were 3 treatment failures (8%). Three of 7 (43%) endplate fractures failed ( P < .01), and 1/28 (4%) facet fractures failed ( P = .13). The mean time to failure was 4 weeks (1-7 weeks). One treatment failure had a facet fracture, and all 3 failures had an associated endplate fracture. Conclusion: Treatment failure occurred in 3 out of 36 (8%) patients with facet fracture dislocations treated with anterior cervical discectomy, fusion, and plating. Rates of failure are lower than has been previously reported. Endplate fractures of the inferior level in jumped facets appears to be a major risk factor of biomechanical failure. However, a facet fracture may not be a risk factor for failure. In the absence of an endplate fracture, ACDF is a reasonable treatment option in patients with single-level cervical facet dislocation.

scholarly journals Long-Term Outcomes of Scaphoid Malunion

Hand ◽  
2016 ◽  
Vol 12 (1) ◽  
pp. 26-30 ◽  
Author(s):  
Blake P. Gillette ◽  
Peter C. Amadio ◽  
Sanjeev Kakar
Keyword(s):  
Nonoperative Management ◽  
Corrective Osteotomy ◽  
Nonoperative Treatment ◽  
Long Term Outcomes ◽  
Single Institution ◽  
Surgical Evaluation ◽  
Long Term Follow Up ◽  
The Mean

Background: The optimal treatment of patients with a scaphoid malunion remains controversial. The long-term outcomes of operative and nonoperative management have not been established. Methods: We conducted a retrospective review of the outcomes of all scaphoid malunions treated at single institution over a 30-year period. This included patients who underwent corrective osteotomy, salvage procedures (ie, dorsal cheilectomy, radial styloidectomy, and scaphoidectomy with midcarpal fusion), and those who refused operative intervention. The Mayo Wrist Score was determined at the time of surgical evaluation. Patient-Rated Wrist Evaluation (PRWE) and Disabilities of the Arm, Shoulder and Hand (QuickDASH) surveys were sent to all patients for long-term follow-up. Results: Seventeen patients had follow-up at a mean 21.4 years (range, 12-30 years). The mean initial lateral intrascaphoid angle was 58°. Of the 17 patients, 11 proceeded with surgery and 6 opted for nonoperative management. A corrective osteotomy was performed in 4 patients. Of the remaining 7 surgical patients, 5 patients underwent procedures such as cheilectomy and radial styloidectomy, whereas 2 patients had a scaphoidectomy with midcarpal fusion. The final mean PRWE and QuickDASH scores for corrective osteotomy, salvage procedures, and nonoperative treatment were 23 and 6, 18 and 10, and 33 and 22, respectively. Conclusion: Long-term outcomes were similar between operative and nonoperative management.

Prospective multicenter assessment of risk factors for rod fracture following surgery for adult spinal deformity

2014 ◽  
Vol 21 (6) ◽  
pp. 994-1003 ◽  
Author(s):  
Justin S. Smith ◽  
Ellen Shaffrey ◽  
Eric Klineberg ◽  
Christopher I. Shaffrey ◽  
Virginie Lafage ◽  
...  
Keyword(s):  
Risk Factors ◽  
Spinal Deformity ◽  
Adult Spinal Deformity ◽  
Full Length ◽  
Consecutive Series ◽  
Inclusion Criteria ◽  
The Mean ◽  
Spine Radiographs ◽  
Rod Fracture

Object Improved understanding of rod fracture (RF) following adult spinal deformity (ASD) surgery could prove valuable for surgical planning, patient counseling, and implant design. The objective of this study was to prospectively assess the rates of and risk factors for RF following surgery for ASD. Methods This was a prospective, multicenter, consecutive series. Inclusion criteria were ASD, age > 18 years, ≥5 levels posterior instrumented fusion, baseline full-length standing spine radiographs, and either development of RF or full-length standing spine radiographs obtained at least 1 year after surgery that demonstrated lack of RF. ASD was defined as presence of at least one of the following: coronal Cobb angle ≥20°, sagittal vertical axis (SVA) ≥5 cm, pelvic tilt (PT) ≥25°, and thoracic kyphosis ≥60°. Results Of 287 patients who otherwise met inclusion criteria, 200 (70%) either demonstrated RF or had radiographic imaging obtained at a minimum of 1 year after surgery showing lack of RF. The patients' mean age was 54.8 ± 15.8 years; 81% were women; 10% were smokers; the mean body mass index (BMI) was 27.1 ± 6.5; the mean number of levels fused was 12.0 ± 3.8; and 50 patients (25%) had a pedicle subtraction osteotomy (PSO). The rod material was cobalt chromium (CC) in 53%, stainless steel (SS), in 26%, or titanium alloy (TA) in 21% of cases; the rod diameters were 5.5 mm (in 68% of cases), 6.0 mm (in 13%), or 6.35 mm (in 19%). RF occurred in 18 cases (9.0%) at a mean of 14.7 months (range 3–27 months); patients without RF had a mean follow-up of 19 months (range 12–24 months). Patients with RF were older (62.3 vs 54.1 years, p = 0.036), had greater BMI (30.6 vs 26.7, p = 0.019), had greater baseline sagittal malalignment (SVA 11.8 vs 5.0 cm, p = 0.001; PT 29.1° vs 21.9°, p = 0.016; and pelvic incidence [PI]–lumbar lordosis [LL] mismatch 29.6° vs 12.0°, p = 0.002), and had greater sagittal alignment correction following surgery (SVA reduction by 9.6 vs 2.8 cm, p < 0.001; and PI-LL mismatch reduction by 26.3° vs 10.9°, p = 0.003). RF occurred in 22.0% of patients with PSO (10 of the 11 fractures occurred adjacent to the PSO level), with rates ranging from 10.0% to 31.6% across centers. CC rods were used in 68% of PSO cases, including all with RF. Smoking, levels fused, and rod diameter did not differ significantly between patients with and without RF (p > 0.05). In cases including a PSO, the rate of RF was significantly higher with CC rods than with TA or SS rods (33% vs 0%, p = 0.010). On multivariate analysis, only PSO was associated with RF (p = 0.001, OR 5.76, 95% CI 2.01–15.8). Conclusions Rod fracture occurred in 9.0% of ASD patients and in 22.0% of PSO patients with a minimum of 1-year follow-up. With further follow-up these rates would likely be even higher. There was a substantial range in the rate of RF with PSO across centers, suggesting potential variations in technique that warrant future investigation. Due to higher rates of RF with PSO, alternative instrumentation strategies should be considered for these cases.

scholarly journals The Percutaneous Technique for the Treatment of Metatarsalgia with Metatarsophalangeal Dislocation of the Lesser Toes: Preliminary Results

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0020
Author(s):  
Gabriel F. Ferraz ◽  
Tatiana F. Santos ◽  
Daniel Oksman ◽  
Miguel V. Pereira Filho
Keyword(s):  
Foot Deformities ◽  
Percutaneous Technique ◽  
Exact Test ◽  
Preliminary Results ◽  
Satisfaction Index ◽  
High Satisfaction ◽  
Bilateral Case ◽  
The Mean ◽  
Lost To Follow Up

Category: Lesser Toes Introduction/Purpose: Minimally invasive surgery through percutaneous technique has developed significantly in recent years, increasing its indication for correction of foot deformities, especially in the forefoot region. The treatment of severe metatarsalgia remains a challenge for surgeons, especially in techniques requiring larger incisions. Methods: We prospectively evaluated 16 patients diagnosed with metatarsalgia with plantar keratosis associated with metatarsophalangeal dislocation of the lesser toes submitted to surgical correction by the distal metatarsal metaphyseal osteotomy (DMMO) technique. Clinical (AOFAS, FFI and VAS) and radiographic scores were used, as well as personal satisfaction criteria. Statistical analysis was performed using the Mann-Whitney U test and Fisher’s Exact Test with the R software ‘Stats’ package. Results: One participant was lost to follow-up, totaling a sample of 15 patients and 16 feet (a bilateral case). The mean follow-up was 14 months (6 - 23) and the mean age of the sample was 73.53 (62 - 85). There was a significant reduction in postoperative status with a reduction in VAS of 5.47 (p <0.001) and a difference in metatarsalgia after the procedure, ranging from 100% of cases to 13% (p <0.001). All patients stated that they would do the procedure again if necessary and most (73%) defined it as satisfied with the procedure (Coughlin Score). Conclusion: The DMMO technique for the treatment of metatarsalgia in patients with metatarsophalangeal dislocation of the lesser toes has shown good results, reducing pain and high satisfaction index, demonstrated by preliminary results.

scholarly journals Comparison of Functional and MRI Outcomes of Microfracture with and without BioCartilage for Osteochondral Lesions of the Talus

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0038
Author(s):  
Yoshiharu Shimozono ◽  
Hao Huang ◽  
Timothy Deyer ◽  
John G Kennedy
Keyword(s):  
Treatment Strategy ◽  
Cartilage Regeneration ◽  
Cartilage Tissue ◽  
Categorical Variables ◽  
Osteochondral Lesions ◽  
Fisher Exact Test ◽  
Continuous Variables ◽  
Exact Test ◽  
The Mean

Category: Ankle, Arthroscopy, Sports Introduction/Purpose: Microfracture (MF) remains a dominant treatment strategy for symptomatic osteochondral lesions of the talus (OLT). Micronized cartilage allograft (BioCartilage) is a biologic scaffold and is utilized for MF augmentation to improve the quality for cartilage regeneration. However, there is still lack of evidence on efficacy of BioCartilage as an adjunct to MF, as no comparative studies have been reported to date. The purpose of this study is to clarify the effectiveness of BioCartilage as an adjuvant to MF compared to MF alone in the treatment of OLT. Methods: A retrospective cohort study comparing patients treated with MF with BioCartilage and MF alone between 2014 and 2017 was undertaken. Patients with a minimum follow-up time of 12 months were included. All patients received concentrated bone marrow aspirate injection at the time of surgery. Clinical outcome was evaluated with the Foot and Ankle Outcome Score (FAOS) pre- and postoperatively. Postoperative MRIs were evaluated using a modified Magnetic Resonance Observation of Cartilage Tissue (MOCART) score. Comparisons between groups were made with the Man-Whitney U test for continuous variables and the Chi-squared test or Fisher exact test for categorical variables. Results: Twenty-four patients underwent MF with BioCartilage (MF-BC group) and 24 patients underwent MF alone (MF group). The mean age was 40.8 years in MF-BC group and 47.8 years in MF group (p=0.068). The mean follow-up time was 19.2 months in MF-BC group and 24.5 months in MF group (p=0.042). Both groups showed significant improvements in all FAOS subscales. No significant differences between groups were found in postoperative FAOS subscales including symptoms, pain, daily activities, sports activities and quality of life (MF-BC; 72.8, 77.8, 87.4, 60.8, 56.6, MF; 73.3, 79.3, 86.0, 60.9, 60.6, respectively, p>0.05). The mean MOCART score in MF-BC group was higher (73.2vs64.1), but not statistically significant (p=0.315). When assessing each MOCART parameter individually, MF-BC group had significant better infill in the defect (p=0.028). Conclusion: MF with BioCartilage is an effective treatment strategy for the treatment of OLT and results in similar functional outcomes compared with MF alone in the short-term. However, MF with BioCartilage provides better cartilage infill in the defect on MRI. This finding suggests that the repair seen in a cartilage defect treated with BioCartilage augmentation may be superior to treatment with MF alone. Further long-term follow-up studies are warranted.

Injury Characteristics and the Clinical Outcome of Subtalar Dislocations: A Clinical and Radiographic Analysis of 25 Cases

2003 ◽  
Vol 24 (2) ◽  
pp. 158-163 ◽  
Author(s):  
Christopher Bibbo ◽  
Robert B. Anderson ◽  
W. Hodges Davis
Keyword(s):  
Subtalar Joint ◽  
Motor Vehicle ◽  
High Energy ◽  
Aofas Score ◽  
Exact Test ◽  
Subtalar Dislocation ◽  
Vehicle Accidents ◽  
The Mean ◽  
Radiographic Changes

The objective of this study was to determine the mechanisms of injury and pattern of associated foot and ankle injuries and systemic injuries associated with subtalar dislocations, and, correlate these data with the radiographic and clinical/functional outcome of patients after subtalar dislocation. Results: Twenty-five patients with a subtalar dislocation were identified over a seven year period. The mean patient age was 38 years. Males (n=19) comprised 76% of patients, with a mean age of 36 years. High energy mechanisms (motor vehicle accidents, falls) accounted for 68% of subtalar dislocations. Although high energy mechanisms showed a strong trend toward open subtalar dislocations, the association was not statistically significant (p=0.0573, Fisher's exact test). Closed dislocations predominated (75%). Left and right-sided dislocations were nearly equally distributed, even among motor vehicle accidents. Medial dislocations predominated (65%): these were not influenced by mechanism of injury and did not result in statistically lower AOFAS ankle/hindfoot scores. Subtalar dislocation was irreducible (requiring open reduction) in 32%, with higher energy mechanisms of injury being statistically associated with an irreducible subtalar dislocation (p=0.0261, Fisher's exact test). Block to reduction was evenly distributed among soft tissue elements (posterior tibial tendon, flexor hallucis longus tendon, capsule, extensor retinaculum) and osseous elements. Eighty-eight percent of patients incurred concomitant injuries to the foot and ankle (95% of which were closed injuries), namely, the ankle and talus. Systemic injuries occurred in 88% of patients. At a mean follow-up of five years, the mean AOFAS score of the subtalar dislocation side was significantly lower (mean=71 vs. 93, p=0.0007, unpaired Student's t-test). No statistical relation was found between the number of associated extremity injuries and AOFAS score (Spearman correlation coefficient, r=(–)0.236, p=0.331). Radiographic follow-up demonstrated 89% of ankles with radiographic changes (31% symptomatic); however, the majority of these patients (61%) had an associated ankle injury. The subtalar joint demonstrated radiographic changes in 89% of patients, with 63% being symptomatic; 75% of patients with subtalar joint changes incurred a fracture about the subtalar joint at the time of dislocation. Four patients went on to subtalar fusion at an average of 8.8 months post-dislocation. The midfoot showed radiographic changes in 72% of patients, with only 15% of these patients being symptomatic. All patients with midfoot symptoms were well controlled by nonsurgical measures.

scholarly journals Nonoperative Treatment for Partial Ruptures of the Lateral Collateral Ligament Occurring in Combination With Complete Ruptures of the Anterolateral Ligament: A Common Injury Pattern in Brazilian Jiu-Jitsu Athletes With Acute Knee Injury

2019 ◽  
Vol 7 (1) ◽  
pp. 232596711882245
Author(s):  
Eduardo Frois Temponi ◽  
Adnan Saithna ◽  
Lúcio Honório de Carvalho ◽  
Bruno Presses Teixeira ◽  
Bertrand Sonnery-Cottet
Keyword(s):  
Knee Injury ◽  
Nonoperative Management ◽  
Nonoperative Treatment ◽  
Anterolateral Ligament ◽  
Injury Pattern ◽  
Functional Scores ◽  
The Mean ◽  
Acute Knee ◽  
Acute Knee Injury

Background: Combined partial lateral collateral and complete anterolateral ligament (PLCCALL) injuries are a specific injury pattern seen in Brazilian jiu-jitsu (BJJ) because of the knee varus-flexion mechanism that frequently occurs during grappling. Purpose/Hypothesis: The purpose of this study was to evaluate the incidence of this injury pattern in a series of BJJ athletes with an acute knee injury and to evaluate clinical and functional outcomes after nonoperative management at a minimum follow-up of 1 year. Our hypotheses were that PLCCALL injuries are common in BJJ and that nonoperative treatment is associated with excellent clinical outcomes and return to the preinjury level of sport. Study Design: Case series; Level of evidence, 4. Methods: All BJJ athletes who presented with an acute knee injury between July 2013 and June 2017 and who underwent magnetic resonance imaging (MRI) of the knee were included. A specific emphasis was placed on identifying those whose imaging demonstrated PLCCALL injury. Clinical evaluation included physical examination as well as Lysholm and International Knee Documentation Committee (IKDC) scores. Results: Of the 27 patients analyzed, 7 (25.9%) had MRI-proven PLCCALL injuries. The mean follow-up after nonoperative management was 41.3 months. The mean IKDC and Lysholm scores were 94 and 92 before the injury, 26 and 36 at the initial assessment after the injury, and 83 and 78 at 12-month follow-up, respectively ( P < .00001). All 7 patients had returned to their preinjury level of sports by the 12-month follow-up. The mean time between injury and return to competition level was 4.7 months (range, 4-6 months). Conclusion: PLCCALL injury is a specific but infrequent injury pattern in BJJ. The prognosis of this injury after nonoperative treatment appears to be excellent. Improved functional scores (IKDC and Lysholm) and changes on MRI demonstrated that the anterolateral ligament has intrinsic healing potential, as the images showed complete healing of the previously documented rupture of the anterolateral ligament from its proximal attachment.

Surgical Treatment of Tympanic Membrane Retractions

2008 ◽  
Vol 139 (2_suppl) ◽  
pp. P59-P60
Author(s):  
Venkat R Srinivasan ◽  
Mihirangi Shamane Rubasinghe ◽  
Christopher Low
Keyword(s):  
Tympanic Membrane ◽  
Modified Technique ◽  
Exact Test ◽  
High Incidence ◽  
Before And After ◽  
Severe Group ◽  
The Mean ◽  
The Difference ◽  
Age Range

Objective To report a modified technique of cartilage reinforcement tympanoplasty. To assess the safety and efficacy of this technique for symptomatic tympanic membrane retractions. Methods Retrospective analysis of patients with Pars Tensa retractions treated surgically between 2001 and 2007. The indications were discharge and hearing loss. Surgery involved excision of retracted segment, exposure of facial recess, removal of keratin and reinforcement with thinned tragal cartilage graft (cartilage thinned by cartilage cutter) and temporalis fascia. Paired T test was used to compare the mean ABG before and after surgery. Results 34 ears were operated on in 33 patients with an age range of 8 to 66 (mean 38). Full extent of the retraction was visible (Moderate) in 12 ears and not visible in 22 ears (Severe). Cholesteatoma was found in 10 ears (all in Severe group) and ossicular erosion was noticed in 29 ears. Follow-up ranged from 12 to 66 months (mean of 36 months). The success rate was 97% with recurrence of retraction in 1 ear. Air-bone gap improved in 31 ears, remained the same in 1 ear, and worsened in 2 ears. The pre- and postoperative mean ABG values were 24.3 (SD 9.5) and 17 (8.7). The difference was 7.3 p<0.0001(95% CI=4.8,9.9). Cholesteatoma recurred in 1 patient. Cholesteatoma presence and severity of retraction did not have any influence on the recurrence rate (Fisher's Exact Test). Conclusions High incidence of per-operative discovery of cholesteatoma (30%) in our series supports early, aggressive management of symptomatic retractions. Thinned cartilage is more effective with less chances of migration.

scholarly journals Evaluation of the Outcome of Different Surgical Techniques in the Treatment of Distal Femur Intra-articular Fractures: A Retrospective Study

2021 ◽  
Vol 8 (1) ◽  
pp. 1-8
Author(s):  
Abolfazl Bagherifard ◽  
◽  
Shoeib Majdi ◽  
Paniz Motaghi ◽  
Mohamad Reza Heidarikhoo ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Distal Femur ◽  
Screw Fixation ◽  
Surgical Techniques ◽  
Type B ◽  
Articular Fractures ◽  
Satisfactory Outcome ◽  
The Mean ◽  
Fracture Types

Background: A preferred surgical approach to distal femur intra-articular fractures is still controversial. Objectives: In the current study, we assessed the outcome and complications of three different surgical techniques, including screw fixation, Retrograde Intramedullary Nailing (RIN), and Locking Compression Plate (LCP). Methods: A total of 63 patients with distal femur intra-articular fractures were included in this retrospective study. AO/OTA fracture and dislocation classification was used to categorize patients. Type B fractures were treated with screw fixation and type C fractures were treated using LCP and RIN. Outcome measures, including the knee range of motion (ROM) and pain level, were Results: The mean±SD age of patients was 36.7±15.7 years. The fracture types B and C were detected in 22 (32.4%) and 46 (67.6%) patients. The mean follow-up period was 27.2±15.9 months. Mild knee pain was the only complication of screw fixation that was observed in 21% of patients. LCP was associated with some complications, including pain (19.4%), infection (9.7%), limited ROM (47.4%), malunion (47.4%), and nonunion (6.5%). RIN was also associated with several complications, including pain (44.4%), infection (11.1%), limited ROM (33.3%), and malunion (41.2%). A comparison of the outcome in matched fracture types of LCP and RIN groups revealed no superiority of each technique. Conclusion: Screw fixation alone results in a satisfactory outcome in the treatment of type B distal femur intra-articular fractures. LCP and RIN are associated with a variety of complications with no superiority over each other.

Predictive Value of Alvarado Score and Pediatric Appendicitis Score in the Success of Nonoperative Management for Simple Acute Appendicitis in Children

2020 ◽  
Author(s):  
Audelia Eshel Fuhrer ◽  
Igor Sukhotnik ◽  
Yoav Ben-Shahar ◽  
Mark Weinberg ◽  
Tal Koppelmann
Keyword(s):  
High Risk ◽  
Acute Appendicitis ◽  
Nonoperative Management ◽  
Alvarado Score ◽  
Duration Of Symptoms ◽  
The Mean ◽  
Complications Rate ◽  
Appendicitis Score

Abstract Introduction During the past decade, nonoperative management (NOM) for simple acute appendicitis (SAA) in children has been proven safe with noninferior complications rate. The aim of this study was to examine Alvarado score and pediatric appendicitis score (PAS) together with other factors in predicting failure of NOM in children presenting with SAA. Materials and Methods Patients aged 5 to 18 years admitted to our department between 2017 and 2019 diagnosed with SAA were given a choice between surgical management and NOM. We divided the NOM patients into two groups: successful treatment and failed NOM, comparing their files for Alvarado score and PAS and other clinical and demographic factors, with a mean follow-up of 7 months. Failure was determined as need for appendectomy following conservative treatment due to any reason. Results A total of 85 patients answered criteria and chose NOM. Overall failure rate was 32.9%. We found no difference in the mean Alvarado score and PAS as well as in each component of both scores between success and failed NOM groups. However, when using the risk classification of the scores, we found a significant correlation between high-risk Alvarado score and failed NOM. After adjusting for age, gender, duration of symptoms, diagnosis of tip appendicitis, and presence of appendicolith, the odds of failure were four times higher among high-risk Alvarado group. Conclusion Alvarado score of 7 or higher, older age, and diagnosis of an appendicolith on imaging are possible predictors for failure of NOM for SAA in children.

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