Surgical Volume and Postoperative Complications of Acromioclavicular Joint Separations: Analysis of the ABOS Part II Examination

2018 ◽  
Vol 46 (13) ◽  
pp. 3174-3181 ◽  
Author(s):  
K.J. Hippensteel ◽  
Robert Brophy ◽  
Matthew Smith ◽  
Rick Wright
Keyword(s):  
Surgical Treatment ◽  
Surgical Procedure ◽  
Open Reduction ◽  
Screw Fixation ◽  
Nonoperative Treatment ◽  
Open Reduction Internal Fixation ◽  
Readmission Rates ◽  
Ac Joint ◽  
Suspensory Fixation ◽  
Specific Factors

Background: High-grade acromioclavicular (AC) joint separations are relatively rare injuries that are often treated surgically, yet more information is needed about the risks of various surgical procedures in terms of considering and counseling patients regarding operative versus nonoperative treatment. Purpose: To calculate whether the volume of surgical treatment of AC joint separations increased over a recent 12-year period; to examine the nature and frequency of complications, reoperations, and readmissions associated with these procedures; and to assess whether patient- and surgeon-specific factors or surgical technique affected these rates. Study Design: Cross-sectional study; Level of evidence, 3. Methods: The American Board of Orthopaedic Surgery (ABOS) database for orthopaedic surgeons taking the Part II examination was reviewed from 2005 to 2016 to identify surgical treatment of AC joint separations. The authors calculated the percentage of all surgical cases in the ABOS database and rates of complications, reoperations, and readmissions. Association of these sequelae with patient- and surgeon-specific factors and surgical techniques was assessed. Results: There was no difference in the number or percentage of cases per year over the study period. There was an overall complication rate of 24.5%, a reoperation rate of 7.3%, and a readmission rate of 1.9%. Patients ≥40 years of age had significantly higher complication, reoperation, and readmission rates as compared with patients <40 years of age. There were significant differences in complication, reoperation, readmission, and displacement rates dependent on the type of surgical procedure performed. The highest complication rates were seen with open suspensory fixation, screw fixation, open reduction internal fixation, and arthroscopic coracoclavicular ligament repair or reconstruction. The highest reoperation rates were seen with screw fixation, open reduction internal fixation, and open suspensory fixation. Conclusion: The volume of surgical treatment for AC joint separations did not change significantly over the study period. Complication, reoperation, and readmission rates were dependent on the type of surgical procedure performed and patient age. This information should assist surgeons in discussing risks when considering and counseling patients regarding operative versus nonoperative treatment.

Scaphoid Non-Union: Factors Affecting the Functional Outcome of Open Reduction and Wedge Grafting with Herbert Screw Fixation

1993 ◽  
Vol 18 (2) ◽  
pp. 219-224 ◽  
Author(s):  
R. NAKAMURA ◽  
E. HORII ◽  
K. WATANABE ◽  
K. TSUNODA ◽  
T. MIURA
Keyword(s):  
Surgical Treatment ◽  
Functional Outcome ◽  
Open Reduction ◽  
Screw Fixation ◽  
Functional Results ◽  
Bony Union ◽  
Proximal Fragment ◽  
Factors Affecting ◽  
Non Union ◽  
Herbert Screw

50 patients with scaphoid non-union were treated by open reduction, anterior wedge bone grafting and internal fixation using the Herbert screw. Intra-operative image intensiner control enabled us to insert the screw into the scaphoid accurately. An excellent or good functional outcome was less likely when more than 5 years had elapsed since injury, the non-union was in the proximal third, when sclerosis of the proximal fragment was present, and when reduction of carpal and scaphoid deformity was unsatisfactory. These four factors are believed to be the primary determinants affecting the functional results of the surgical treatment of scaphoid non-union, even when bony union is achieved.

scholarly journals Developmental dislocation of the hip is still important problem: Therapeutic guidelines

2006 ◽  
Vol 53 (4) ◽  
pp. 17-19 ◽  
Author(s):  
Z. Vukasinovic ◽  
C. Vucetic ◽  
G. Cobeljic ◽  
Z. Bascarevic ◽  
N. Slavkovic
Keyword(s):  
Surgical Treatment ◽  
Open Reduction ◽  
Nonoperative Treatment ◽  
Leg Length ◽  
Leg Length Inequality ◽  
Important Complication ◽  
Therapeutic Guidelines ◽  
Second Year ◽  
Dislocation Of The Hip ◽  
Hip Necrosis

The authors are describing currently important problem - developmental dislocation of the hip. Guidelines for the treatment have been given according to literature date and upon their own experience. Therapeutic suggestions for the first twelve months of life are based on the ultrasound typing - it is advised to perform nonoperative treatment (abduction devices, "over head" traction, Pavlik harnesses). During the second year of life a pause in the treatment should be advised in order to avoid postreduction avascular hip necrosis as a very important complication. After that period surgical treatment has to be done (open reduction, pelvic and femoral osteotomies). Special suggestions have been given for the treatment of consecutive leg length inequality and the deformities caused by postreduction avascular hip necrosis.

scholarly journals Comparison of surgical and non-surgical treatments for 3- and 4-part proximal humerus fractures: A network meta-analysis

2019 ◽  
Vol 12 (2) ◽  
pp. 99-108 ◽  
Author(s):  
Sebastian Orman ◽  
Amin Mohamadi ◽  
Joseph Serino ◽  
Jordan Murphy ◽  
Philip Hanna ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Adverse Events ◽  
Shoulder Arthroplasty ◽  
Open Reduction ◽  
Proximal Humerus ◽  
Total Shoulder Arthroplasty ◽  
Open Reduction Internal Fixation ◽  
Reverse Total Shoulder Arthroplasty ◽  
Reverse Total Shoulder ◽  
Non Surgical Treatment

Introduction Common treatment strategies for proximal humerus fractures include non-surgical treatment, open reduction internal fixation, hemiarthroplasty, and reverse total shoulder arthroplasty. There is currently no consensus regarding the superiority of any one surgical strategy. We used network meta-analysis of randomized controlled trials to determine the most successful treatment for proximal humerus fractures. Methods MEDLINE, EMBASE, Web of Science, and Cochrane Central electronic databases were searched for randomized controlled trials comparing 3- and 4-part proximal humerus fracture treatments. Data extraction included the mean and standard deviation of clinical outcomes (Constant, DASH), adverse events, and additional surgery rates. Standard Mean Difference was used to compare clinical outcome scores, and pooled risk ratios were used to compare adverse events and additional surgeries. Results Eight randomized controlled trials were included for network meta-analysis. Non-surgical treatment was associated with a lower rate of additional surgery and adverse events compared to open reduction internal fixation. Reverse total shoulder arthroplasty resulted in fewer adverse events and a better clinical outcome score than hemiarthroplasty. Non-surgical treatment produced similar clinical scores, adverse event rates, and additional surgery rates to hemiarthroplasty and reverse total shoulder arthroplasty. Conclusion Non-surgical treatment results in fewer complications and additional surgeries compared to open reduction internal fixation. Preliminary data supports reverse total shoulder arthroplasty over hemiarthroplasty, but more evidence is needed to strengthen this conclusion.

Functional Outcome of Patients Following Open Reduction Internal Fixation for Bilateral Calcaneus Fractures

2002 ◽  
Vol 23 (10) ◽  
pp. 917-921 ◽  
Author(s):  
Matthew G. Zmurko ◽  
David E. Karges
Keyword(s):  
Internal Fixation ◽  
Functional Outcome ◽  
Open Reduction ◽  
Work Capacity ◽  
Nonoperative Treatment ◽  
Open Reduction Internal Fixation ◽  
Functional Evaluation ◽  
American Orthopaedic ◽  
Improved Function ◽  
Calcaneus Fractures

Treatment of displaced intra-articular calcaneus fractures has historically been controversial, but recent developments have led to resurgence in open reduction internal fixation (ORIF) for displaced calcaneus fractures. Recent functional outcome studies comparing operative to nonoperative treatment of unilateral calcaneus fractures has shown a trend towards improved function with ORIF. No studies have investigated the functional outcome of patients who have required operative treatment of bilateral displaced calcaneus fractures. The purpose of this study was to review our operative experience with bilateral displaced intra-articular calcaneal fractures. A retrospective review of medical charts indicated 13 patients had undergone ORIF for bilateral calcaneus fractures. Nine patients could be contacted and brought to the clinic for functional evaluation and radiographic CT studies. Functional outcome was assessed by the Musculoskeletal Functional Assessment Score (MFA) and the American Orthopaedic Foot and Ankle Hindfoot Score (AOFAS). The average follow-up was 56 months. Over half of the patients required additional surgeries. The average MFA and AOFAS scores were 31.1 and 71.8, respectively. Functional outcome decreased for patients with multiple traumatic fractures and surgical procedures of the calcaneus. Our results show a diminished functional outcome for patients sustaining bilateral calcaneus fractures treated with ORIF when compared to patients managed surgically for unilateral calcaneus fractures, but better functional outcomes than patients who do not undergo ORIF for unilateral calcaneus fractures. This diminished function limits work capacity and ability to perform daily activities that require standing.

scholarly journals Number of screws in the articular segment of distal humerus AO/OTA C-type fractures treated with open reduction internal fixation is associated with complication rate

SICOT-J ◽  
2021 ◽  
Vol 7 ◽  
pp. 25
Author(s):  
Brian F. Grogan ◽  
Nicholas C. Danford ◽  
Cesar D. Lopez ◽  
Stephen P. Maier ◽  
Pinkawas Kongmalai ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Internal Fixation ◽  
Surgical Approach ◽  
Revision Surgery ◽  
Complication Rate ◽  
Open Reduction ◽  
Distal Humerus ◽  
Open Reduction Internal Fixation ◽  
Humerus Fractures ◽  
Distal Humerus Fractures

Introduction: Surgical treatment of distal humerus fractures can lead to numerous complications. Data suggest that the number of screws in the distal (articular) segment may be associated with complication rate. The purpose of this study is to evaluate the association between a number of screws in the distal segment and complication rate for surgical treatment of distal humerus fractures. We hypothesize that the number of screws in the articular segment of distal humerus AO/OTA C-type fractures treated with open reduction internal fixation (ORIF) will be inversely proportional to the complication rate. Methods: We performed a single-center retrospective cohort study of 27 patients who underwent ORIF of distal humerus fractures C-type with at least six months of radiographic and clinical follow-up. Clinical outcomes including a range of motion, pain, revision surgery for stiffness and/or heterotopic ossification (HO), nonunion, and persistent ulnar nerve symptoms requiring revision neurolysis were recorded. Results: In C-type fractures, the use of three or fewer articular screws was significantly associated with nonunion or loss of fixation (RR 17, p = 0.006). Nineteen of 36 (53%) patients experienced at least one complication. The surgical approach, plate configuration, age, and ulnar nerve treatment (none, in situ release, transposition) were not associated with the need for revision surgery. Men had a higher risk of requiring surgical contracture release due to improving post-operative stiffness (RR 12, p = 0.02). Conclusion: In this retrospective study, the use of three or fewer screws to fix articular fragments in AO type C fractures was a significant risk for nonunion or loss of fixation. Plate configuration and surgical approach did not correlate with outcomes. Men had higher rates of complications and required more frequent revision surgery compared to women.

scholarly journals Postoperative Complications and Reoperation Rates Following Open Reduction and Internal Fixation of Ankle Fracture

Joints ◽  
2018 ◽  
Vol 06 (02) ◽  
pp. 110-115 ◽  
Author(s):  
Armando Macera ◽  
Christian Carulli ◽  
Luigi Sirleo ◽  
Massimo Innocenti
Keyword(s):  
Surgical Treatment ◽  
Postoperative Complications ◽  
Internal Fixation ◽  
Surgical Procedure ◽  
Ankle Fracture ◽  
Open Reduction ◽  
Impaired Wound Healing ◽  
Major Complications ◽  
And Function ◽  
Reoperation Rates

Purpose The purpose of this study was to determinate the overall postoperative complication and reoperation rates related to open reduction and internal fixation (ORIF) of ankle fractures. Methods All patients who had undergone an ankle fracture operation at our institution from January 2005 through December 2013 were identified by querying the hospital surgical procedure database for diagnoses codes. Medical records, surgical procedure, and outpatient control reports were reviewed to collect pre-, intra-, and postoperative details. All data obtained were retrospectively analyzed by the authors to evaluate the postoperative complications and the type of further surgical treatment required to treat them. Results A total of 378 consecutive patients were included in the study. Overall complications rate was 36.0%. Minor complications (4.5%) were represented by superficial infection (1.3%) and impaired wound healing (3.2%). All these patients required advanced wound care and prolonged oral antibiotics. Major complications (31.5%) included: residual pain (17.2%), deep infection (3.4%), malunion (2.4%), posttraumatic ankle osteoarthritis (5.0%), implant breakage (0.3%), complex regional pain syndrome (1.3%), and arthrofibrosis (1.9%). Note that 21.7% of major complications required further surgical procedure. Reoperations included arthroscopic debridement (15.1%), hardware removal and debridement of all necrotic tissue (4.5%), and ankle fusion (2.1%). Surgery was necessary mainly for pain removal and function recovery. Conclusion Ankle fracture ORIF represents a satisfying surgical treatment. Nevertheless, postoperative complications are not uncommon. Minor complications can be easily managed with medications and repeated outpatient controls. Reoperation is occasionally required to treat major complications. Revision surgery is mandatory to ensure pain relief and function improvement. Level of Evidence Level II, retrospective cohort study.

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