Total Humeral Endoprosthetic Replacement following Excision of Malignant Bone Tumors

Humerus is a common site for malignant tumors. Advances in adjuvant therapies and reconstructive methods provide salvage of the upper limb with improved outcomes. Reports of limb salvage with total humeral replacement in extensive humeral tumors are sparse. We undertook a retrospective study of 20 patients who underwent total humeral endoprosthetic replacement as limb salvage following excision of extensile malignant tumor from 1990 to 2011. With an average followup of 42.9, functional and oncological outcomes were analyzed. Ten patients were still alive at the time of review. Mean estimated blood loss was 1131 mL and duration of surgery was 314 minutes. Deep infection was encountered in one patient requiring debridement while mechanical loosening of ulnar component was identified in one patient. Subluxation of prosthetic humeral head was noted in 3 patients. Mean active shoulder abduction was 12.5° and active flexion was 15°. Incompetence of abduction mechanism was the major determinant of poor active functional outcome. Mean elbow flexion was 103.5° with 30.5° flexion contracture in 10 patients with good and useful hand function. Average MSTS score was 71.5%. Total humeral replacement is a reliable treatment option in restoring mechanical stability and reasonable functional results without compromising patient survival, with low complication rate.

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Modular endoprosthetic replacement for proximal tibia tumor patients

Zaporozhye Medical Journal ◽

10.14739/2310-1210.2021.2.224920 ◽

2021 ◽

Vol 23 (2) ◽

pp. 242-249

Author(s):

O. Ye. Vyrva ◽

I. O. Skoryk ◽

V. D. Tovazhnianska

Keyword(s):

Surgical Treatment ◽

Tumor Recurrence ◽

Proximal Tibia ◽

Malignant Tumors ◽

Tumor Resection ◽

Bone Allograft ◽

Functional Results ◽

Limb Salvage Surgery ◽

Endoprosthetic Replacement ◽

Modular Endoprosthesis

The major method of malignant bone tumors treatment is surgery. The most important task of an orthopedic surgeon is to preserve an adjacent joint. Currently, there are a large number of various reconstructive surgeries, including structural bone allograft, allocomposite and modular endoprosthetics replacement. The aim: to analyze the results of surgical treatment for proximal tibia malignant tumors using modular endoprosthesis. Materials and methods. The results of proximal tibia (PT) modular endoprosthetic replacement in 48 patients with PT tumor lesions were evaluated. The patients were divided into two groups: I (n = 36) – tumor resection and primary modular endoprosthesis, II (n = 12) – revision modular endoprosthetic replacement due to complications. Complications were divided into oncological, mechanical and non-mechanical. The functional outcomes were measured using the MSTS and TESS scores. Results. During the treatment, 10 (21.2 %) patients underwent myofascioplastic amputation at the middle third of the thigh: due to periprosthetic infection – 8 people and tumor recurrence – 2. It was found that the patients got back to regular way of life on average in 2.0–2.5 months. Functional results on the MSTS score were 73 ± 12 %, on the TESS score – 74 ± 16 %, which corresponds to good functional results. Among the patients, who underwent limb salvage surgery, no tumor recurrence was detected during a follow-up period from 6 months up to 11 years. Conclusions. The choice of surgical treatment depends on the size of tumor, its location, pathohistomorphological picture, age, presence of pathological fractures, vascular and nerve tumor invasion. The use of modern designs of PT modular tumor endoprostheses and perfect surgeries makes it possible to minimize complications.

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Limb Salvage in Proximal Humerus Malignant Tumors: The Place of Free Vascularized Fibular Graft

Yearbook of Orthopedics ◽

10.1016/s0276-1092(08)70269-4 ◽

2007 ◽

Vol 2007 ◽

pp. 283

Author(s):

C.P. Beauchamp

Keyword(s):

Limb Salvage ◽

Proximal Humerus ◽

Malignant Tumors ◽

Fibular Graft ◽

Vascularized Fibular Graft ◽

Free Vascularized Fibular Graft

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Traumatic Brachial Plexus Palsy in Children: Long-Term Outcome and Strategy of Reconstruction

Journal of Reconstructive Microsurgery ◽

10.1055/s-0041-1726029 ◽

2021 ◽

Author(s):

Tarek A. El-Gammal ◽

Amr El-Sayed ◽

Mohamed M. Kotb ◽

Waleed Riad Saleh ◽

Yasser Farouk Ragheb ◽

...

Keyword(s):

Brachial Plexus ◽

External Rotation ◽

Hand Function ◽

Functional Restoration ◽

Shoulder Abduction ◽

Wrist Flexion ◽

Term Outcome ◽

Long Term Outcome ◽

Age At Surgery ◽

Flexion And Extension

Abstract Background Traumatic brachial plexus injuries in children represent a definite spectrum of injuries between adult and neonatal brachial plexus injuries. Their characteristics have been scarcely reported in the literature. The priority of functional restoration is not clear. Materials and Methods In total, 52 children with surgically treated traumatic brachial plexus injuries, excluding Erb's palsy, were reviewed after a minimum follow-up of 2 years. All children except nine were males, with an average age at surgery of 8 years. Forty-five children had exclusive supraclavicular plexus injuries. Twenty-one of them (46%) had two or more root avulsions. Seven children (13.5%) had infraclavicular plexus injuries. Time from trauma to surgery varied from 1 to 15 months (mean = 4.7 months). Extraplexal neurotization was the most common surgical technique used. Results Shoulder abduction and external rotation were restored to an average of 83 and 26 degrees, respectively. Elbow flexion and extension were restored to grade ≥3 in 96 and 91.5% of cases, respectively. Finger flexion and extension were restored to grade ≥4 in 29 and 32% of cases, respectively. Wrist flexion and extension were restored to grade ≥4 in 21 and 27% of cases, respectively. Results of neurotization were superior to those of neurolysis and nerve grafting. Among the 24 children with insensate hands, 20 (83.3%) recovered S3 sensation, 3 recovered S2, and 1 recovered S1. No case complained of neuropathic pain. Functional recovery correlated negatively but insignificantly with the age at surgery and time from injury to surgery. Conclusion Brachial plexus injuries in children are associated with a high incidence root avulsions and no pain. Neurotization is frequently required and the outcome is not significantly affected by the delay in surgery. In total plexus injuries, some useful hand function can be restored, and management should follow that of obstetric palsy and be focused on innervating the medial cord.

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Obesity Is Associated with Significant Morbidity after Multiligament Knee Surgery

The Journal of Knee Surgery ◽

10.1055/s-0039-1681027 ◽

2019 ◽

Vol 33 (06) ◽

pp. 525-530

Author(s):

Jayson Lian ◽

Neel K. Patel ◽

Michael Nickoli ◽

Ravi Vaswani ◽

James J. Irrgang ◽

...

Keyword(s):

Wound Infection ◽

Lateral Meniscus ◽

Hospital Length Of Stay ◽

Categorical Variables ◽

Future Research ◽

Complication Rates ◽

Obese Patients ◽

Estimated Blood Loss ◽

Duration Of Surgery ◽

Nonobese Patients

AbstractThe objective was to report the effect of obesity, utilizing a body mass index (BMI) threshold of 35 kg/m2, on outcomes and complications of multiple ligament knee injury (MLKI). It was hypothesized that obese patients would have longer intraoperative times and hospital length of stay, greater estimated blood loss, and higher rates of wound infection requiring irrigation and debridement (I&D) and revision ligament surgery. A retrospective review was performed on 143 individuals who underwent surgery for an MLKI between 2011 and 2018 at a single academic center. Patients were included if there was a plan for potential surgical repair/reconstruction of two or more ligaments. Patients with prior surgery to the affected knee or intra-articular fracture requiring reduction and fixation were excluded. Comparisons between obese and nonobese patients were made using two-sample t-test and either chi-square or Fisher's exact test for continuous and categorical variables, respectively. Significance was set at p < 0.05. Of 108 patients meeting inclusion criteria, 83 had BMI < 35 kg/m2 and 25 had BMI ≥ 35 kg/m2. Obese patients sustained higher rates of MLKI due to ultralow velocity mechanisms (28.0 vs. 1.2%; p = 0.0001) and higher rates of concomitant lateral meniscus injury (48.0 vs. 25.3%; p = 0.04). Among patients undergoing single-staged surgery, obese patients had significantly longer duration of surgery (219.8 vs. 178.6 minutes; p = 0.02) and more wound infections requiring I&D (20.0 vs. 4.8%; p = 0.03). In contrast, nonobese patients had higher rates of arthrofibrosis requiring manipulation under anesthesia and/or arthrolysis (25.3 vs. 0%; p = 0.003). Obese patients undergoing surgery of an MLKI have longer operative times, greater rates of wound infection requiring I&D, and lower rates of arthrofibrosis. Surgeons may consider these results when counseling patients on their postoperative course and risk for complications. Future research might focus on strategies to reduce complication rates in obese patients with MLKI. This is a Level III, retrospective comparative study.

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Safety and efficacy of retroperitoneal sutureless zero ischemia laparoscopic partial nephrectomy for low nephrometry score masses

Archivio Italiano di Urologia e Andrologia ◽

10.4081/aiua.2019.3.157 ◽

2019 ◽

Vol 91 (3) ◽

Cited By ~ 2

Author(s):

Emanuele Corongiu ◽

Pietro Grande ◽

Angelo Di Santo ◽

Giorgio Pagliarella ◽

Stefano Squillacciotti ◽

...

Keyword(s):

Partial Nephrectomy ◽

Intraoperative Complications ◽

Functional Results ◽

Laparoscopic Partial Nephrectomy ◽

Tumor Diameter ◽

Selective Embolization ◽

Renal Masses ◽

Nephrometry Score ◽

Estimated Blood Loss ◽

Zero Ischemia

Objectives: To evaluate oncological feasibility and oncological and functional results of retroperitoneal sutureless zero ischemia laparoscopic partial nephrectomy (LPN). Patients and methods: Patients with posterior renal masses with low nephrometry score (RENAL ≤ 7) treated who underwent retroperitoneal sutureless zero ischemia.in a single center from January 2016 to November 2017. Clinical, surgical and pathological data were prospectively collected. Complications were reported according to the modified Clavien classification. Results: Retroperitoneal sutureless zero ischemia laparoscopic partial nephrectomy was performed on 15 patients. The indication for nephron-sparing surgery was elective in 11 (73%) patients and imperative in 4 (27%). Median RENAL score was 5 (IQR: 5-7), median tumor diameter 25 mm (IQR: 20-35). In 11 cases, the tumor was located polar (85%), and in 2 cases hilar (15%). There were no intraoperative complications. No cases were converted to radical nephrectomy, and in no case parenchyma suture was necessary. Median operative time was 90 min (IQR:40-150), in no case clamping of the renal artery was necessary, median hospital stay was 4 days, median estimated blood loss (EBL) was 310 (180-500) ml. Pathological analysis showed renal cell carcinoma in 11 patients (85%), 9 (60%) staged T1a and 2 (13%) T1b. In 4 (27%) an oncocytoma was found. There were no positive surgical margins. One patient developed a major postoperative complication (postoperative renal bleeding requiring super-selective embolization). Trifecta rate was 93%. Conclusions: Sutureless retroperitoneal zero ischemia LPN for the treatment of low-complexity posterior renal masses showed to be safe and feasible. Longer follow-up and higher numbers of patients are, however, warranted to draw definitive conclusions on functional outcomes.

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Non Descent Vaginal Hysterectomy: A Rational Surgical Approach

KYAMC Journal ◽

10.3329/kyamcj.v6i2.33743 ◽

2017 ◽

Vol 6 (2) ◽

pp. 637-641

Author(s):

Arifa Akter Zahan ◽

Kh Shahnewaz ◽

Ummay Salma

Keyword(s):

Blood Loss ◽

Hospital Stay ◽

Vaginal Hysterectomy ◽

Average Duration ◽

Uterine Prolapse ◽

Rational Approach ◽

Medical College ◽

Gynecological Disorders ◽

Estimated Blood Loss ◽

Duration Of Surgery

Aims: To evaluate the rational approach of non-descent vaginal hysterectomy in advancing gynaecology practice.Study Design: Retrospective study and period from 1st July 2013 to 31st June 2014. Setting Kumudini Women's Medical College & Hospital, Mirzapur, Tangail.Patients: All selective patients requiring hysterectomy for benign gynecological disorders who did not have any uterine prolapse were recruited for this study. In bigger size uterus morcellation techniques like bisection, debulking, myomectomy, slicing, or combination of these were used to remove the uterus.Main outcome measures: Data regarding indication, age, parity, uterine size, estimated blood loss, length of operation, complication and hospital stay were recorded.Results: A total of 50 cases were selected for non-descent vaginal hysterectomy all of them successfully underwent non-descent vaginal hysterectomy. Commonest age group was (41-45 years) i.e. 46%. All patients were parous. Uterus size was less then 8 wks 21 cases, 8wks to 12 wks in 27 cases, more then 12 wks 02 cases. Commonest indication was DUB of uterus (44%). Mean duration of surgery was 50.5 minutes. Mean blood loss was 100ml. Blood transfusion was required in four cases. Average duration of hospital stay was 3.1 days. Complications were minimal which included UTI and Vault infection.Conclusions: NDVH is safe feasible and patient friendly. We suggest that our modern gynecologist will be more expertise and familiar to this procedure in near future.KYAMC Journal Vol. 6, No.-2, Jan 2016, Page 637-641

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