Use of Intramedullary Locking Nail for Displaced Intraarticular Fractures of the Calcaneus: What is the Evidence?

Category: Trauma Introduction/Purpose: There is increasing interest on how to best manage displaced intraarticular calcaneal fractures (DIACF). Intramedullary locking devices (ILDs) have recently been advocated since the technique adopts a minimally invasive approach which may minimise complications and therefore improve outcomes. We reviewed the literature of commercially available devices to identify their characteristics, efficacy and safety. Methods: Medline, Scopus and EMBASE databases were searched to identify studies reporting use of ILDs for treating DIACF. A PRISMA checklist was used to sort eligible studies. Technical notes and biomechanical studies were first reviewed. Cohort studies were then reviewed for demographics, surgical technique, postoperative protocol, clinical and radiographic scores, complications and reoperations. The modified Coleman Methodology Score (CMS) was used to assess the quality of studies. Results: Thirteen studies investigated two devices (Calcanail; C-Nail). Four technical notes described how to use these devices and three biomechanical studies proved they offered adequate primary stability, stiffness, interfragmentary motion and load to failure. Seven clinical studies (302 feet, 289 patients) demonstrated satisfactory clinical (AOFAS, VAS) and radiographic (Bohler’s angle, Gissane angle, Goldzak index, posterior facet step-off) outcome at 16-months average follow-up. Metalware irritation (up to 20%) and temporary nerve entrapment symptoms (up to 30%) were the most common complications; soft tissue issues were reported in 3-5% of cases. Conversion to subtalar fusion was necessary in 4-6% of cases. Four (57%) studies were authored by implant designers and in 5 (71%) relevant conflict of interest were disclosed. Mean CMS was 61 (moderate quality). Conclusion: Treating DIAFCs with ILDs leads to satisfactory clinical outcomes at short term follow-up, enabling restoration of calcaneal height and improved subtalar joint congruency. Metalware irritation and temporary nerve entrapment symptoms are common complications although wound complications including infection and wound breakdown are less frequent than after open lateral approaches. The quality of evidence provided so far is only moderate and biased by potential conflict of interest, raising concerns about the generalisability of results.

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A decision-making guide for the closure of myelomeningocele skin defects with or without primary repair

Journal of Neurosurgery Pediatrics ◽

10.3171/2016.2.peds15702 ◽

2016 ◽

Vol 18 (2) ◽

pp. 187-191 ◽

Cited By ~ 6

Author(s):

Cemal Alper Kemaloğlu ◽

İrfan Özyazgan ◽

Ömer Faruk Ünverdi

Keyword(s):

Decision Making ◽

Primary Closure ◽

Primary Repair ◽

Patient Characteristics ◽

Wound Complications ◽

Width Ratio ◽

Skin Defect ◽

Skin Defects

OBJECTIVE The closure of the skin defect in myelomeningocele (MMC) repair is an essential step that determines the quality of the surgical result. The success of surgical results is related to the decision to use the most suitable techniques, namely flaps or primary closure. The aim of this study was to evaluate the effectiveness of a decision-making guide to determine whether to use primary repair or a flap for the closure of skin defects that occur in MMC. METHODS Fifty patients underwent surgery after neurosurgical repair and closure of the placode. A simple guide was generated according to the defect height/width and posterior axillary lines/defect width ratio. These 2 ratios were considered to determine which closure technique (with or without primary repair) should be used for the MMC defect reconstruction. RESULTS By using this decision-making guide, 20 of the defects were repaired with various flaps, and those of the remaining 30 patients were repaired with primary closure. In all patients, a successful tension-free 1-stage closure was obtained. Except for 4 patients who had flap reconstruction with partial flap necrosis or minimal flap tip necrosis, healing was uneventful without any complications. There were no additional wound complications during the mean follow-up of 6.8 years (range 5 months to 14 years). CONCLUSIONS Because of various defect sizes and patient characteristics, no single protocol exists for the reconstruction of MMC defects. The guide suggested here might be effective in deciding which method is suitable for closure of MMC skin defects.

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Does the quality of preoperative closed reduction of displaced ankle fractures affect wound complications after surgical fixation?

Foot & Ankle Orthopaedics ◽

10.1177/2473011418s00187 ◽

2018 ◽

Vol 3 (3) ◽

pp. 2473011418S0018

Author(s):

Bonnie Chien ◽

Kristen Stupay ◽

Christopher Miller ◽

Jeremy Smith ◽

Jorge Briceno ◽

...

Keyword(s):

Classification System ◽

Closed Reduction ◽

Ankle Fracture ◽

Ankle Fractures ◽

Wound Complications ◽

Complication Rates ◽

Ankle Osteoarthritis ◽

Surgical Fixation

Category: Trauma Introduction/Purpose: Prompt reduction and stabilization of displaced ankle fractures is important to protect soft tissues, restore potential neurovascular deficits and prevent cartilage injury. Many of these injuries do eventually require surgical fixation. The purpose of this study is to determine whether the initial quality of ankle closed reduction based on radiographic criteria would affect outcomes such as ankle osteoarthritis and complications after surgery. Furthermore, we sought to develop a classification system for the quality of closed reduction that would be easy to use and provide interrater reliability. Methods: A retrospective analysis of patients who sustained isolated, closed ankle fractures with at least 3 months follow up postoperatively at two level 1 trauma centers was performed. Patient demographics and history, ankle fracture characteristics and reduction information as well as surgical outcomes and complications were collected. A grading classification for the quality of the initial closed reduction before surgery was developed based on standard AP or mortise and lateral ankle x-rays. The factors considered for rating the reduction included the degree of talar shift on the AP/mortise view, malleoli displacement, as well the relationship of a central plumb line to the center of the talar dome on the lateral x-ray. For ankle osteoarthritis, the Takakura classification was utilized. Three reviewers (1 resident, 2 attendings) independently reviewed and rated all imaging. Results: 161 patients were analyzed. 65% female, average age 50, average 4 days between injury and surgery, mean follow up of 12 months (3-58 months), and 17% wound complications. Psychiatric history was the single comorbidity significantly associated with complications (p=0.009). There was no difference in wound or infection complication rates based on initial closed reduction quality (p=0.17). Neither number nor quality of reductions correlated with increased osteoarthritis (p=0.19, 0.39 respectively). Worst graded reductions had shorter time to surgery, mean 1.4 vs 4.7 days for best reductions (p=0.03), suggesting a protective factor that may account for no association between reduction quality and wound complications. Interclass correlation coefficients for multiple observers showed very high consistency for grading of reduction quality based on the classification system (ICC >0.85, p<0.001). Conclusion: It is often emphasized that a displaced ankle fracture should be as perfectly reduced as possible, understandably for grossly dislocated ankle fracture dislocations potentially compromising skin and neurovascular structures. At the same time, this original study demonstrated contrary to common assumption that the initial quality of ankle closed reduction does not appear to affect the severity of ankle osteoarthritis or the rate of surgical complications. This study also developed a highly reproducible ankle reduction classification system. It opens the opportunity for future prospective application and analysis of this classification’s ultimate clinical utility.

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A Comparative Study of Video Endoscopic Inguinal Lymphadenectomy and Conventional Open Inguinal Lymphadenectomy for Treating Vulvar Cancer

International Journal of Gynecological Cancer ◽

10.1097/igc.0000000000001100 ◽

2017 ◽

Vol 27 (9) ◽

pp. 1983-1989 ◽

Cited By ~ 1

Author(s):

Menglei Zhang ◽

Limei Chen ◽

Xuyin Zhang ◽

Jingxin Ding ◽

Keqin Hua

Keyword(s):

Quality Of Life ◽

Vulvar Cancer ◽

Life Quality ◽

Wound Complications ◽

Lymph Node Yield ◽

Oncological Outcomes ◽

Inguinal Lymphadenectomy ◽

The Veil

ObjectiveThis study aims to compare the complications, oncological outcomes, cosmetic satisfaction, and quality of life experienced by women with vulvar cancer undergoing video endoscopic inguinal lymphadenectomy (VEIL) versus conventional open inguinal lymphadenectomy (COIL).Patients and MethodsForty-eight consecutive patients with vulvar cancer who underwent COIL (n = 27) or VEIL (n = 21) at the Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China between 2003 and 2016 were included in this retrospective cohort study. The perioperative data, postoperative complications, oncological outcomes, cosmetic satisfaction, and quality of life of the COIL and VEIL groups were compared.ResultsTwenty patients (74.1%) in the COIL group and 19 patients (90.5%) in the VEIL group returned for follow-up after the operation. The median follow-up time was 73 months (8–162 months) for the COIL group and 28 months (8–58 months) for the VEIL group. The inguinal lymph node yield in the VEIL group was comparable with that in the COIL group (15 ± 5 vs 18 ± 6,P= 0.058). The VEIL and COIL groups had a similar 2-year recurrence rate (10.5% vs 10%,P= 0.957) and 2-year disease-specific survival rate (95.5% vs 93.3%,P= 0.724). The wound complication rate was significantly lower in the VEIL group than the COIL group (4.8% vs 55.6%,P= 0.000). The VEIL group had higher body image scores (16.27 ± 1.20 vs 13.16 ± 0.87,P< 0.0001) and cosmetic scores (20.13 ± 0.98 vs 16.92 ± 0.72,P< 0.0001) than the COIL group. The patients in the VEIL group had higher life quality scores on the Functional Assessment of Cancer Therapy—Vulvar questionnaire than those in the COIL group (165.9 ± 6.3 vs 160.5 ± 6.0,P= 0.026).ConclusionsCompared with COIL, VEIL can effectively reduce postoperative wound complications and improve patients' cosmetic satisfaction and life quality without compromising therapeutic efficacy. Hence, we believe that VEIL is a good alternative to COIL for vulvar cancer patients when surgical expertise is available.

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Results of the early and mid-term postoperative period after correction of total anomalous pulmonary venous connection

Patologiya krovoobrashcheniya i kardiokhirurgiya ◽

10.21688/1681-3472-2021-4-41-52 ◽

2021 ◽

Vol 25 (4) ◽

pp. 41

Author(s):

M. V. Plotnikov ◽

Yu. N. Gorbatykh ◽

A. N. Аrkhipov ◽

M. G. Galstyan ◽

A. V. Bogachev-Prokophiev ◽

...

Keyword(s):

Postoperative Period ◽

Conflict Of Interest ◽

Pulmonary Veins ◽

Sutureless Repair ◽

Randomised Study ◽

Data Collection And Analysis ◽

Anomalous Pulmonary Venous Connection ◽

Repair Group

Aim. To compare complications and outcomes in the postoperative period with two different methods for correcting total anomalous pulmonary venous connection.Methods. In this pilot, two-centre, simple, blind, prospective randomised study, the patients’ quality of life after correction of total anomalous pulmonary venous connection in infancy was evaluated using the sutureless (n = 20) and conventional repair methods (n = 20) in 40 patients. The overall mortality and complications in the mid-term were evaluated.Results. The average follow-up was 15 (13; 16) months. Mortality was noted only in the conventional repair group, amounting to 5 (25%) patients (p = 0.018). Severe obstruction of the pulmonary veins anastomosis was also noted only in the conventional repair group (n = 8, 40%; p = 0.0013). Infectious endocarditis was observed in one (6.6%) patient in the conventional repair group (p = 0.42). Arrhythmias were present in 4 (26.6%) patients in the conventional repair group (p = 0.02).Conclusion. The rates of obstruction of the pulmonary vein anastomosis, arrhythmias and death depend on the method of total anomalous pulmonary venous connection correction. The sutureless repair reduces the incidence of early and mid-term postoperative complications compared to conventional repair.Received 16 March 2021. Revised 8 June 2021. Accepted 11 June 2021.Funding: The study did not have sponsorship.Conflict of interest: The authors declare no conflict of interest.Contribution of the authors Conception and study design: Yu.N. Gorbatykh, A.V. Bogachev-Prokophiev, M.V. Plotnikov Data collection and analysis: M.V. Plotnikov, M.G. Galstyan, D.G. Tarasov Statistical analysis: M.V. Plotnikov Drafting the article: M.V. Plotnikov, Yu.N. Gorbatykh Critical revision of the article: I.A. Soynov Final approval of the version to be published: M.V. Plotnikov, Yu.N. Gorbatykh, A.N. Аrkhipov, M.G. Galstyan, A.V. Bogachev-Prokophiev, D.G. Tarasov, I.A. Soynov

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Intramedullary Fixation of Calcaneal Fractures: Early US Experience

Foot & Ankle Orthopaedics ◽

10.1177/2473011420s00104 ◽

2020 ◽

Vol 5 (4) ◽

pp. 2473011420S0010

Author(s):

Kevin C. Anderson

Keyword(s):

Soft Tissue ◽

Soft Tissues ◽

Articular Surface ◽

Case Series ◽

Intramedullary Fixation ◽

Wound Complications ◽

Invasive Approach ◽

Fracture Stabilization ◽

Intraarticular Fractures ◽

Anatomic Reduction

Category: Hindfoot; Trauma Introduction/Purpose: The fixation of displaced intraarticular fractures of the calcaneus have posed many challenges for the surgeon, including an anatomic reduction, fracture stabilization, and soft tissue concerns. The extensible lateral and sinus tarsi approaches must be delayed until soft tissues concerns resolve and despite this are susceptible to wound necrosis and skin infections. Intramedullary fixation allows immediate fixation without soft tissue compromise. Methods: The retrospective case series is comprised of 23 patients; 19 intramedullary fixation of the calcaneus and 4 primary arthrodesis with the FH Orthopedics CalcaNail. Fracture classification, timing to surgery, accuracy of reduction, complications, and outcome were recorded. Results: There were zero wound complications. Bohler’s angle was restored as well as articular surface. One patient required implant removal after healing seconding to prominent hardware. One patient required conversion to a subtalar arthrodesis. There were no implant mechanical failures. Conclusion: The intramedullary fixation of calcaneus fractures has been performed extensively outside the US with documented success. This series of early US experience exhibits similar utility. The ability to reduce the fracture intrafocally and stabilize with a minimally invasive approach have proven useful with no incidence of wound complications. Not to mention no delay from time of injury to surgery is needed.

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Premature Ventricular Contraction in Children

Педиатрическая фармакология ◽

10.15690/pf.v15i6.1981 ◽

2019 ◽

Vol 15 (6) ◽

pp. 435-446 ◽

Cited By ~ 1

Author(s):

Alexander A. Baranov ◽

Elena S. Vasichkina ◽

Roza A. Ildarova ◽

Dmitry S. Lebedev ◽

Leyla S. Namazova-Baranova ◽

...

Keyword(s):

Conflict Of Interest ◽

Pediatric Patients ◽

Premature Ventricular Contraction ◽

Evidence Based ◽

Russian Society ◽

Ventricular Contraction ◽

Premature Ventricular Contractions ◽

Based Medicine

The article presents updated data on the problem of premature ventricular contractions in children based on the clinical guidelines of the Russian Society of Cardiology and the Union of Pediatricians of Russia for the diagnosis, treatment and management of pediatric patients with premature ventricular contraction. The issues of diagnosis and treatment based on the principles of evidence-based medicine as well as important aspects of prevention of exacerbations and follow-up have been clarified in detail. The criteria for assessing the quality of care for patients with premature ventricular contractions have been presented.CONFLICT OF INTEREST. Not declared.

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Safety and efficacy of targeted intraoperative radiotherapy (TARGIT) for early breast cancer: First report of a randomized controlled trial at 10-years maximum follow-up.

Journal of Clinical Oncology ◽

10.1200/jco.2010.28.18_suppl.lba517 ◽

2010 ◽

Vol 28 (18_suppl) ◽

pp. LBA517-LBA517 ◽

Cited By ~ 2

Author(s):

M. Baum ◽

D. J. Joseph ◽

J. S. Tobias ◽

F. K. Wenz ◽

M. R. Keshtgar ◽

...

Keyword(s):

Controlled Trial ◽

External Beam Radiotherapy ◽

Primary Tumour ◽

Intraoperative Radiotherapy ◽

Breast Conserving Surgery ◽

Partial Breast Irradiation ◽

Wound Complications ◽

Duct Carcinoma ◽

Wound Breakdown

LBA517 Background: After breast conserving surgery, 90% of local recurrences (LR) occur within the index quadrant. Hence, restricting the radiation therapy to the immediate area around the tumour bed after removal of the primary tumour may be adequate (Vaidya JS, et al. Br Cancer.1996;74:820-4) Methods: Having safely piloted a new technique of partial breast irradiation (Vaidya JS, Baum M, Tobias JS et al Ann Oncol 2001;12:1075-80) we launched the TARGIT-A trial in March 2000 comparing TARGIT vs. standard whole breast external beam radiotherapy (EBRT) after breast conserving surgery in patients ≥45 years with invasive duct carcinoma. LR was the primary outcome measure (core protocol: www.thelancet.com/protocol-reviews/99PRT-47 ). Trial accrual from 31 international centers is complete (n=2232), with 80% power to detect a difference in relapse rate of 2.5% - the non-inferiority margin. Results: Median age was 63 (IQR 57-69), median tumor size 13mm (IQR 9-18mm), lymph nodes 17%+ve. Median follow-up is 24.6 months (max 10 years). Wound breakdown or delayed healing were reported in 28 of the TARGIT group and 20 in the EBRT group (p=0.24). RTOG grade 3 toxicity (nil grade 4) was seen in 6 vs. 21 (p=0.004) respectively. Overall local toxicity was equivalent (34/1092 TARGIT v. 41/1096 EBRT, p=0.42). The Kaplan-Meier estimate of LR in the breast, was 0.31% (CI 0.08-1.26) for TARGIT versus 0.29% for EBRT (CI 0.07-1.16) at 24 months. Conclusions: In the TARGIT group, the radiotherapy toxicity was significantly lower than in the EBRT group, while the increase in wound complications was not statistically significant. This analysis suggests that at a median follow-up of 24 months the local control with TARGIT is comparable to EBRT. Longer term follow-up is essential and accrual in similar studies is encouraged. [Table: see text]

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Effectiveness of negative pressure wound therapy in the prevention of surgical wound complications in the cesarean section at-risk population: a parallel group randomised multicentre trial—the CYGNUS protocol

BMJ Open ◽

10.1136/bmjopen-2019-035727 ◽

2020 ◽

Vol 10 (10) ◽

pp. e035727 ◽

Cited By ~ 1

Author(s):

Kylie Sandy-Hodgetts ◽

Richard Parsons ◽

Richard Norman ◽

Mark W Fear ◽

Fiona M Wood ◽

...

Keyword(s):

Caesarean Delivery ◽

Negative Pressure Wound Therapy ◽

Wound Dehiscence ◽

Deep Infection ◽

Wound Complications ◽

Surgical Wound ◽

Wound Therapy ◽

Parallel Group

IntroductionCaesarean delivery is steadily becoming one of the more common surgical procedures in Australia with over 100 000 caesarean sections performed each year. Over the last 10 years in Australia, the caesarean section rate has increased from 28% in 2003 to 33% in 2013. On the international stage, the Australian caesarean delivery rates are higher than the average for the Organisation for Economic Co-operation and Development, Australia ranked as 8 out of 33 and is second to the USA. Postoperative surgical site infections (SSIs) and wound complications are the most common and costly event following a caesarean section. Globally, complication rates following a caesarean delivery vary from 4.9% to 9.8%. Complications such as infection and wound breakdown affect the postpartum mother’s health and well-being, and contribute to healthcare costs for clinical management that often spans the acute, community and primary healthcare settings. Published level one studies using advanced wound dressings in the identified ‘at-risk’ population prior to surgery for prophylactic intervention are yet to be forthcoming.Methods and analysisA parallel group randomised control trial of 448 patients will be conducted across two metropolitan hospitals in Perth, Western Australia, which provide obstetric and midwifery services. We will recruit pregnant women in the last trimester, prior to their admission into the healthcare facility for delivery of their child. We will use a computer-generated block sequence to randomise the 448 participants to either the interventional (negative pressure wound therapy (NPWT) dressing, n=224) or comparator arm (non-NPWT dressing, n=224). The primary outcome measure is the occurrence of surgical wound dehiscence (SSWD) or SSI. The Centres for Disease Control reporting definition of either superficial or deep infection at 30 days will be used as the outcome measure definition. SWD will be classified as per the World Union of Wound Healing Societies grading system (grade I–IV). We will assess recruitment rate, and adherence to intervention and follow-up. We will assess the potential effectiveness of NPWT in the prevention of postpartum surgical wound complications at three time points during the study; postoperative days 5, 14 and 30, after which the participant will be closed out of the trial. We will use statistical methods to determine efficacy, and risk stratification will be conducted to determine the SWD risk profile of the participant. Follow-up at day 30 will assess superficial and deep infection, and wound dehiscence (grade I–IV) and the core outcome data set for wound complications. This study will collect health-related quality of life (European Quality of Life 5-Dimensions 5-Level Scale), mortality and late complications such as further surgery with a cost analysis conducted. The primary analysis will be by intention-to-treat. This clinical trial protocol follows the Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT) and the Consolidated Standards of Reporting Trials guidelines.Ethics and disseminationEthics approval was obtained through St John of God Health Care (HREC1409), Western Australia Department of Health King Edward Memorial Hospital (HREC3111). Study findings will be published in peer-reviewed journals and presented at international conferences. We used the SPIRIT checklist when writing our study protocol.Trial registration numberAustralian and New Zealand Clinical Trials Registry (ACTRN12618002006224p).

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Quality of life after aortic valve replacement with biological prostheses in elderly patients

Patologiya krovoobrashcheniya i kardiokhirurgiya ◽

10.21688/1681-3472-2017-3-40-47 ◽

2017 ◽

Vol 21 (3) ◽

pp. 40 ◽

Cited By ~ 1

Author(s):

D. P. Demidov ◽

D. A. Astaspov ◽

A. V. Bogachev-Prokophiev ◽

S. I. Zheleznev

Keyword(s):

Quality Of Life ◽

Aortic Valve ◽

Aortic Valve Replacement ◽

Elderly Patients ◽

Valve Replacement ◽

Conflict Of Interest ◽

Group I ◽

Biological Prostheses

Aim. The paper aims to assess the quality of life of patients subjected to aortic valve replacement with a stented/stentless biological prosthesis. Methods. The research was done at the Acquired Heart Disease Department of Meshalkin National Medical Research Center. The inclusion criteria were patient age older than 65 years and severe stenosis of the aortic valve. 114 patients were randomized 1:1 in two groups: group I patients received stentless biological prostheses, while group II patients — stented xenopericardial ones. All patients underwent aortic valve replacement under normothermic cardiopulmonary bypass. Mean follow-up was 3.9 [2.77; 4.55] years, mean age 71.5±4 (65–84) years, mean left ventricle ejection fraction 65.5 (40–86) % and mean preoperative Log.Euroscore 5.4±1.3 (1.4–12.4). The quality of life was assessed by using a standard questionnaire SF-36. Results. Peak transprosthetic gradients at 1-year follow-up amounted to 16.22±4.34 and 24.66±4.74 mm Hg for group I and group II respectively. The 5-year survival rate was 90 [81; 99] % and 96 [90; 100] % for the two groups respectively and did not differ statistically (log rank test, p = 0.226). A statistically significant improvement of quality of life among patients in both groups was observed at 1-year follow-up, as compared to the preoperative values, however, marked intergroup differences in any of the parameters were not recorded. Conclusion. The quality of life after aortic valve replacement with stented and stentless biological prostheses in elderly patients confirms clinical and functional efficiency of both methods, does not show sound advantages of any of them and improves both the physical component of health and subjective emotional level.Received 25 July 2017. Revised 18 August 2017. Accepted 28 August 2017.Funding: The study was carried out with the support of a grant of the President of the Russian Federation (МД–6967.2016.7) created to provide government assistance to the leading research centers in Russian Federation.Conflict of interest: The authors declare no conflict of interest.

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