scholarly journals Operative Approaches to Ankle and Hindfoot Arthroscopy

2020 ◽  
Vol 5 (1) ◽  
pp. 247301141989496
Author(s):  
Dominic S. Carreira ◽  
Steven R. Garden ◽  
Thomas Ueland
Keyword(s):  
Operative Time ◽  
Improve Patient Safety ◽  
Arthroscopic Surgery ◽  
Complication Rates ◽  
Level Of Evidence ◽  
Improved Outcomes ◽  
Ankle Surgery ◽  
Lower Complication ◽  
Improve Patient

The role of arthroscopy in the management of ankle and hindfoot pathology management has increased greatly in recent years with the potential for lower complication rates, faster recovery, improved access, and improved outcomes when compared to open techniques. Procedural variations exist as techniques aim to optimize lesion access, decrease operative time, and improve patient safety. Our goal is to summarize the described approaches and patient positionings common in minimally invasive arthroscopic surgery for anterior, lateral, and posterior ankle pathologies. A survey of pathology organized by arthroscopic approach and a review of recent advances in concomitant lesion management may be useful when planning arthroscopic foot and ankle surgery. Level of Evidence: Level V, expert opinion.

scholarly journals Safety Performance in Acute Medical Care: A Qualitative, Explorative Study on the Perspectives of Healthcare Professionals

Healthcare ◽  
2021 ◽  
Vol 9 (11) ◽  
pp. 1543
Author(s):  
Lina Heier ◽  
Donia Riouchi ◽  
Judith Hammerschmidt ◽  
Nikoloz Gambashidze ◽  
Andreas Kocks ◽  
...  
Keyword(s):  
Patient Safety ◽  
Nursing Students ◽  
Healthcare Professionals ◽  
Improve Patient Safety ◽  
Safety Performance ◽  
Structured Interviews ◽  
Performance Skills ◽  
Work Environment Factors ◽  
Improve Patient

Healthcare professionals need specific safety performance skills in order to maintain and improve patient safety. The purpose of this study is to get a deeper understanding of healthcare professionals’ perspective in acute care on the topic of safety performance. This study was conducted using a qualitative approach. Healthcare professionals working in nursing were interviewed using semi-structured interviews. Using content analyzing, categories were identified which present aspects of safety performance; subcategories were developed deductively. A total of 23 healthcare professionals were interviewed, of which 15 were registered nurses, five were nursing students and three were pedagogical personnel. Nine (39.1%) were <30 years old, 17 (73.9%) were female, and 9 (39.1%) had a leadership function. Results highlight the importance of safety performance as a construct of occupational health rather than of patient safety, and the role of the organization, as well as the self-responsibility of healthcare professionals. Healthcare professionals should be more conscious of their role, have a deeper understanding of the interaction of individual, team, patient, organization and work environment factors.

scholarly journals Posterior-Only Approach with Pedicle Screws for the Correction of Scheuermann's Kyphosis

2017 ◽  
Vol 11 (4) ◽  
pp. 513-519 ◽  
Author(s):  
Adem Cobden ◽  
Akif Albayrak ◽  
Yalkin Camurcu ◽  
Hakan Sofu ◽  
Temel Tacal ◽  
...  
Keyword(s):  
Lumbar Lordosis ◽  
Thoracic Kyphosis ◽  
Pedicle Screws ◽  
Definitive Treatment ◽  
Sacral Slope ◽  
Complication Rates ◽  
Level Of Evidence ◽  
Radiological Results ◽  
Lower Complication ◽  
Clinical And Radiological Results

<sec><title>Study Design</title><p>Retrospective study (level of evidence: level 3).</p></sec><sec><title>Purpose</title><p>The purpose of this study was to evaluate the clinical and radiological results of the posterior-only approach with pedicle screws for the treatment of Scheuermann's kyphosis (SK).</p></sec><sec><title>Overview of Literature</title><p>The correction of SK with instrumentation can be performed using posterior-only or combined anterior-posterior procedures. With the use of all-pedicle screw constructs in spine surgery, the posterior-only approach has become a popular option for the definitive treatment of SK. In a nationwide study involving 2,796 patients, a trend toward posterior-only fusion with lower complication rates was reported.</p></sec><sec><title>Methods</title><p>We retrospectively reviewed the data of patients who underwent posterior-only correction for SK between January 2005 and May 2013. Patients with a definite diagnosis of SK who fulfilled the minimum follow-up criterion of 24 months were included. The thoracic kyphosis (T5–T12), lumbar lordosis (L1–S1), and thoracolumbar junction (T10–L2) angles were measured from preoperative, postoperative, and last control radiographs. Sagittal balance, thoracic length, thoracic diameter, Voutsinas index and the sacral slope, pelvic tilt, proximal junction kyphosis, and distal junction kyphosis angles were also measured.</p></sec><sec><title>Results</title><p>Forty-five patients underwent surgery for the treatment of SK between 2005 and 2013. After applying the exclusion criteria, 20 patients (18 males and 2 females) with a mean age of 19 years were included. The mean thoracic kyphosis angle was 79.8 degrees preoperatively, 44.6 degrees postoperatively, and 44.9 degrees at the last control. There were statistically significant differences between preoperative and postoperative values in the thoracic kyphosis and lumbar lordosis angles, thoracic length, thoracic diameter, and Voutsinas index (<italic>p</italic>&lt;0.05).</p></sec><sec><title>Conclusions</title><p>The clinical and radiological results of the current study suggest that posterior-only fusion is an efficient technique for the treatment of SK.</p></sec>

Bone grafting in foot and ankle surgery. A review of 300 cases

1998 ◽  
Vol 88 (3) ◽  
pp. 109-118 ◽  
Author(s):  
KT Mahan ◽  
HJ Hillstrom
Keyword(s):  
Complication Rates ◽  
Allogeneic Bone ◽  
Graft Material ◽  
Foot And Ankle ◽  
First Metatarsal ◽  
Ankle Surgery ◽  
Significant Difference ◽  
Lower Complication ◽  
Lower Complication Rate ◽  
Bone Complications

Three hundred foot and ankle bone grafts were reviewed in three separate series of 100 consecutive grafts from two institutions. The series represent a period from 1977 to 1990 and demonstrate treatment patterns that varied over time and between institutions in indications, graft material, and perioperative management. Over 42% of the 300 grafts were for calcaneal osteotomies; most were Evans calcaneal osteotomies. Over 72% of the grafts were allogeneic bone-bank bone, which performed well in calcaneal osteotomies and for packing of defects. Upon review of the incidence of bone complications, no significant differences were observed between surgical procedures that used autogenous versus allogeneic grafts. However, four out of six failures of first metatarsal repair were with allogeneic bone. There was a significant difference in complication rates for the major indications for bone-graft surgery. Nonunions and arthrodeses resulted in higher complication rates than expected, whereas calcaneal osteotomies resulted in a lower complication rate than expected.

Comparison of 2-Octyl Cyanoacrylate Topical Skin Adhesive and Simple Interrupted Nylon Sutures for Wound Closure in Ankle Fracture Surgery

2018 ◽  
Vol 39 (11) ◽  
pp. 1283-1289
Author(s):  
Young Hwan Park ◽  
Jong Hyub Song ◽  
Gi Won Choi ◽  
Hak Jun Kim
Keyword(s):  
Patient Satisfaction ◽  
Ankle Fracture ◽  
Statistical Power ◽  
Wound Closure ◽  
Operative Time ◽  
Wound Complications ◽  
Complication Rates ◽  
Level Of Evidence ◽  
Retrospective Comparative Study ◽  
Fracture Surgery

Background: Multiple options are available for closure of incisions in ankle fracture surgery. The aim of our study was to compare postoperative outcomes between conventional simple interrupted nylon sutures and 2-octyl cyanoacrylate as a topical skin adhesive to close the incision after ankle fracture surgery. Methods: We retrospectively reviewed the records of 367 consecutive patients (174 simple interrupted nylon suture patients and 193 topical skin adhesive patients) who underwent operative treatment for ankle fracture between 2010 and 2015. Development of wound complications, operative time, Olerud–Molander Ankle Score (OMAS), and patient satisfaction with the wound were compared. The demographics between the 2 groups were not different. Results: There were no differences in complication rates ( P = .861), OMAS at 3 months or 12 months following surgery ( P = .897 and .646, respectively) between the 2 types of wound closure. Operative time was 9 minutes shorter when topical skin adhesive was used compared to nylon sutures ( P = .003). Patient satisfaction with their wound was significantly higher in the topical skin adhesive group than the nylon skin suture group ( P = .012). Conclusions: The use of 2-octyl cyanoacrylate topical skin adhesive for wound closure following ankle fracture surgery was effective, safe, and showed higher patient satisfaction compared to simple interrupted nylon sutures. Although caution should be taken because of the insufficient statistical power of complications, this method was an additional safe option for wound closure in ankle fracture surgery. Level of Evidence: Level III, retrospective comparative study.

Incorporating 3D Printing Into Your Practice: Lessons Learned

2020 ◽  
pp. 193864002098091
Author(s):  
Akhil Sharma ◽  
Kyle S. Kirkland ◽  
Robert M. Holloway ◽  
Selene G. Parekh
Keyword(s):  
3D Printing ◽  
Operative Time ◽  
Three Dimensional ◽  
Lessons Learned ◽  
Foot And Ankle ◽  
Level Of Evidence ◽  
Ankle Surgery ◽  
Engineering Team ◽  
3D Printed ◽  
Successful Technology

Three-dimensional (3D) printing has greatly benefited medicine, manufacturing vital organs like skin, hearts, kidneys, and livers. Early studies on 3D printing in surgery have consistently reported decreased operative time and improved precision. This technology has gained popularity with orthopaedic surgeons in knee, hip, and shoulder surgeries because 3D printing is associated with enhancing osseointegration. However, this innovation is still not commonly used among foot and ankle surgeons; one reason is that whereas the literature on 3D printing–assisted surgery is populated with studies on operative techniques and clinical outcomes, there exists an ambiguity on how to incorporate this feature into the clinic. Thus, the aim of this technology column is to consolidate and standardize a workflow to guide foot and ankle surgeons on integrating 3D printing into one’s practice. We describe a model developed by a single surgeon at one institution who directs a large caseload of 3D-printed foot and ankle surgeries. From the initial patient visit to the interaction between the surgeon and the implant engineering team, to documentation of data adding to the preliminary literature, this work has great implications on streamlining the assimilation of a highly successful technology to improve foot and ankle surgery for both surgeons and patients. Level of Evidence: Level V

Emergent urinary decompression in acute stone-related urinary obstruction: A systematic review and meta-analysis

2021 ◽  
pp. 205141582110170
Author(s):  
David Eugenio Hinojosa-Gonzalez ◽  
Mauricio Torres-Martinez ◽  
Sergio Uriel Villegas-De Leon ◽  
Cecilia Galindo-Garza ◽  
Andres Roblesgil-Medrano ◽  
...  
Keyword(s):  
Systematic Review ◽  
Length Of Stay ◽  
Operative Time ◽  
Meta Analysis ◽  
Treatment Strategies ◽  
Percutaneous Nephrostomy ◽  
Complication Rates ◽  
Success Rates ◽  
Level Of Evidence ◽  
Cell Counts

Introduction: Emergent urinary decompression through percutaneous nephrostomy (PCN) or ureteric stent (URS) remains a mainstay in the management of urethral calculi-related obstruction with associated signs of infection or renal injury. Available evidence has shown similar performance, and current guidelines endorse both treatment strategies. Methods: A systematic review was performed following Preferred Reporting Items for Systematic Reviews and Meta-Analysis criteria up until August 2020. Studies included data on stone size and location, operative time, complications, length of stay, analgesic consumption, quality of life (QoL), and clinical outcomes between URS and PCN. Results: Ten studies with a total population of 772, of which 420 were treated with URS and 352 with PCN, were included. No statistical difference in operative time between both techniques was found. Nevertheless, length of stay in PCN was longer than in USR, with a mean difference of −1.87 days ((95% CI −2.69 to −1.06), Z=4.50, p=0.00001). No differences were found in the time to normalization of temperature or white blood cell counts. There were no significant differences in success rates, with an overall odds ratio (OR) of 0.60 ((95% CI 0.26 to −1.40), Z=1.17, p=0.24), or spontaneous passage after emergent drainage between groups. Complication rates ranged from 5% to 25% in URS and from 0% to 38% in PCN. In the studied population, out of the 157 patients from four studies describing complications, only 5% of URS procedures presented complications compared to 2% in PCN, showing a relatively low complication rate for either group (OR=2.07 (95% CI 0.89–4.84), Z=1.68, p=0.09). Differences in QoL were not significant. Conclusion: Both methods are equally effective, with no clear advantage for PCN over URS. Level of evidence: IV

scholarly journals Unicompartmental knee arthroplasty: A PearlDiver study evaluating complications rates, opioid use and utilization in the Medicare population

2021 ◽  
Vol 8 (1) ◽  
Author(s):  
Brandon L. Morris ◽  
Jack M. Ayres ◽  
Daniel Reinhardt ◽  
Armin Tarakemeh ◽  
Scott Mullen ◽  
...  
Keyword(s):  
Knee Arthroplasty ◽  
Unicompartmental Knee Arthroplasty ◽  
Complication Rates ◽  
Opioid Use ◽  
Level Of Evidence ◽  
Medicare Population ◽  
Unicompartmental Knee ◽  
Lower Complication ◽  
Icd 10 ◽  
Outcome Differences

Abstract Purpose Despite increased utilization of unicompartmental knee arthroplasty (UKA) for unicompartmental knee osteoarthritis, outcomes in Medicare patients are not well-reported. The purpose of this study is to analyze practice patterns and outcome differences between UKA and TKA in the Medicare population. It is hypothesized that UKA utilization will have increased over the course of the study period and that UKA will be associated with reduced opioid use and lower complication rates compared to TKA. Methods Using PearlDiver, the Humana Claims dataset and the Medicare Standard Analytic File (SAF) were analyzed. Patients who underwent UKA and TKA were identified by CPT codes. Postoperative complications were identified by ICD-9/ICD-10 codes. Opioid use was analyzed by the number of days patients were prescribed opioids postoperatively. Survivorship was defined as conversion to TKA. Results In the Humana dataset, 7,808 UKA and 150,680 TKA patients were identified. 8-year survivorship was 87.7% (95% CI [0.861,0.894]). Postoperative opioid use was significantly higher after TKA (186.1 days) compared to UKA (144.7 days) (p < 0.01, Δ = 41.1, 95% CI = [30.41, 52.39]). In the SAF dataset, 20,592 UKA patients and 110,562 TKA patients were identified. Survivorship was highest in patients > 80 years old and lowest in patients < 70 years old. In both datasets, postoperative complication rates were higher in TKA patients compared to UKA patients in nearly all categories. Conclusions UKA represents an increasingly utilized treatment for osteoarthritis in the Medicare population and may be comparatively advantageous to TKA due to reduced opioid use and complication rates after surgery. Level of evidence Level III

Making the Operating Room of the Future Safer

2006 ◽  
Vol 72 (11) ◽  
pp. 1102-1108
Author(s):  
Caprice C. Greenberg ◽  
Emilie M. Roth ◽  
Thomas B. Sheridan ◽  
Tejal K. Gandhi ◽  
Michael L. Gustafson ◽  
...  
Keyword(s):  
Patient Safety ◽  
Operating Room ◽  
Improve Patient Safety ◽  
Point Of Care ◽  
Process Variations ◽  
Limited Data ◽  
Improved Outcomes ◽  
Increasing Demand ◽  
Future Work ◽  
Improve Patient

There is an increasing demand for interventions to improve patient safety, but there is limited data to guide such reform. In particular, because much of the existing research is outcome-driven, we have a limited understanding of the factors and process variations that influence safety in the operating room. In this article, we start with an overview of safety terminology, suggesting a model that emphasizes “safety” rather than “error” and that can encompass the spectrum of events occurring in the operating room. Next, we provide an introduction to techniques that can be used to understand safety at the point of care and we review the data that exists relating such studies to improved outcomes. Future work in this area will need to prospectively study the processes and factors that impact patient safety and vulnerability in the operating room.

The Perioperative Continuation of Aspirin in Patients Undergoing Arthroscopic Surgery of the Knee

2019 ◽  
Vol 47 (9) ◽  
pp. 2138-2142
Author(s):  
Ljiljana Bogunovic ◽  
Amanda K. Haas ◽  
Robert H. Brophy ◽  
Matthew J. Matava ◽  
Matthew V. Smith ◽  
...  
Keyword(s):  
Cohort Study ◽  
Knee Arthroscopy ◽  
Surgical Complication ◽  
Arthroscopic Surgery ◽  
Wound Complications ◽  
Complication Rates ◽  
Level Of Evidence ◽  
Hematoma Formation ◽  
Significant Difference ◽  
Daily Aspirin

Background: The perioperative withdrawal of aspirin increases the risk of cardiac, neurologic, and vascular thromboembolic events. The safety of continuing aspirin in patients undergoing knee arthroscopy is unknown. Hypothesis: Perioperative continuation of aspirin does not increase surgical complications or worsen outcomes in patients 50 years of age and older undergoing knee arthroscopy. Study Design: Cohort study; Level of evidence, 3. Methods: This is a single-center, institutional review board–approved, prospective matched dual-cohort study comparing the surgical complication rates and postoperative outcomes of patients taking daily aspirin with those of unmedicated controls. Ninety patients who were 50 years of age or older and taking 81 mg or 325 mg daily aspirin were matched to 90 controls. Patients were matched on age, surgery type, and the use of a tourniquet. A complication was defined as bleeding, wound dehiscence, or wound infection requiring reoperation. Postoperative outcome measures including hematoma formation, extent of ecchymosis (mm), visual analog scale (VAS) scores for pain and swelling, and the Knee Injury and Osteoarthritis Outcome Score (KOOS) were collected preoperatively and postoperatively (10-14 days and 4-6 weeks). Results: There were no complications (0%) in either cohort. There was no difference in hematoma formation (aspirin, 1.8%; controls, 2.4%; P = .79), incidence of ecchymosis (aspirin, 17%; controls, 21%; P = .70), or the average extent of ecchymosis (aspirin, 124.6 mm; controls, 80.3 mm; P = .36) between patients taking aspirin and controls. There was no significant difference in pre- or postoperative knee range of motion between controls and patients taking aspirin. The KOOS subscores and VAS pain scores were similar between patients taking aspirin and controls at baseline and at follow-up. Conclusion: The perioperative continuation of daily aspirin in patients 50 years of age and older undergoing arthroscopic procedures of the knee is safe and does not result in an increased rate of bleeding or wound complications requiring reoperation. Continued aspirin use in patients 50 years of age and older had no significant effect on postoperative physical examination measures or patient-rated outcome scores.

scholarly journals Real-Time Ultrasound-Guided Subclavian Vein Cannulation in Intensive Care Patients

2013 ◽  
Vol 14 (1) ◽  
pp. 79-81
Author(s):  
Nader Ibrahim ◽  
Rajnish Saha
Keyword(s):  
Intensive Care ◽  
Real Time ◽  
Subclavian Vein ◽  
Complication Rates ◽  
Ultrasound Guided ◽  
Level Of Evidence ◽  
Intensive Care Patients ◽  
Vein Cannulation ◽  
Lower Complication

Real-time ultrasound-guided subclavian vein cannulation in intensive care patients has higher success and lower complication rates compared to the traditional landmark method. Level of evidence: 1B (RCT with narrow CIs)

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