scholarly journals Bioabsorbable implants in forefoot surgery: a review of materials, possibilities and disadvantages

2021 ◽  
Vol 6 (12) ◽  
pp. 1132-1139
Author(s):  
Lorenz Pisecky ◽  
Matthias Luger ◽  
Antonio Klasan ◽  
Tobias Gotterbarm ◽  
Matthias C. Klotz ◽  
...  
Keyword(s):  
Randomized Clinical Trials ◽  
Mechanical Load ◽  
Load Capacity ◽  
Trauma Surgery ◽  
Case Series ◽  
Complication Rates ◽  
Forefoot Surgery ◽  
Pin Fixation ◽  
Titanium Screws ◽  
Tissue Reactions

Bioabsorbable and biodegradable implants offer new possibilities in orthopaedic and trauma surgery. As soon as the initial stability of the degradable implants has reached the qualities of conventional materials, new devices may find usage in younger and more demanding patients. Residual conventional osteosynthetic material or the necessity to remove metal increasingly seems to be more of an adverse event than daily practice in forefoot surgery. Nevertheless, some drawbacks need to be discussed. Recent literature screened for the use of bioabsorbable and biodegradable materials in forefoot surgery, available implants and indications in forefoot surgery were analysed and summarized. Apart from common indications in forefoot surgery, points of interest were the type of biomaterial, the process of biodegradation and biointegration, and possible adverse events. Materials were comprehensively discussed for each indication based on the available literature. Polylactide, polyglycoside and polydioxanone are considered safe and sufficiently stable for use in forefoot surgery. Low complication rates (e.g. 0.7% for pin fixation in hallux deformities) are given. Magnesium implants suffered from an extensive corrosive process in the first generation but now seem to be safe in forefoot surgery and offer good options compared with conventional titanium screws, especially in procedures of the first ray. Allograft bone has proven feasibility in small case series, but still lacks larger or randomized clinical trials. The first results are promising. Bioresorbable and osseointegrating devices offer attractive new possibilities for surgeons and patients. Despite all the known advantages, the difficulties and possible complications must not be forgotten, such as soft tissue reactions, unwanted osteolysis and a lower primary mechanical load capacity. Cite this article: EFORT Open Rev 2021;6:1132-1139. DOI: 10.1302/2058-5241.6.200157

scholarly journals Complications and Revisions After Spine Surgery in Patients With Skeletal Dysplasia: Have We Improved?

2021 ◽  
pp. 219256822199478
Author(s):  
Karim Shafi ◽  
Francis Lovecchio ◽  
Maria Sava ◽  
Michael Steinhaus ◽  
Andre Samuel ◽  
...  
Keyword(s):  
Spine Surgery ◽  
Skeletal Dysplasia ◽  
Spinal Surgery ◽  
Cardiovascular Health ◽  
Surgical Complication ◽  
Case Series ◽  
Neurologic Complication ◽  
Complication Rates ◽  
Retrospective Case ◽  
Average Patient

Study Design: Retrospective case series. Objective: To report contemporary rates of complications and subsequent surgery after spinal surgery in patients with skeletal dysplasia. Methods: A case series of 25 consecutive patients who underwent spinal surgery between 2007 and 2017 were identified from a single institution’s skeletal dysplasia registry. Patient demographics, medical history, surgical indication, complications, and subsequent surgeries (revisions, extension to adjacent levels, or for pathology at a non-contiguous level) were collected. Charlson comorbidity indices were calculated as a composite measure of overall health. Results: Achondroplasia was the most common skeletal dysplasia (76%) followed by spondyloepiphyseal dysplasia (20%); 1 patient had diastrophic dysplasia (4%). Average patient age was 53.2 ± 14.7 years and most patients were in excellent cardiovascular health (88% Charlson Comorbidity Index 0-4). Mean follow up after the index procedure was 57.4 ± 39.2 months (range). Indications for surgery were mostly for neurologic symptoms. The most commonly performed surgery was a multilevel thoracolumbar decompression without fusion (57%). Complications included durotomy (36%), neurologic complication (12%), and infection requiring irrigation and debridement (8%). Nine patients (36%) underwent a subsequent surgery. Three patients (12%) underwent a procedure at a non-contiguous anatomic zone, 3 (12%) underwent a revision of the previous surgery, and another 3 (12%) required extension of their previous decompression or fusion. Conclusions: Surgical complication rates remain high after spine surgery in patients with skeletal dysplasia, likely attributable to inherent characteristics of the disease. Patients should be counseled on their risk for complication and subsequent surgery.

scholarly journals Open Appendicectomy under Spinal Anesthesia—A Valuable Alternative during COVID-19

2021 ◽  
Vol 07 (02) ◽  
pp. e69-e72
Author(s):  
Dinh Van Chi Mai ◽  
Alex Sagar ◽  
Oliver Claydon ◽  
Ji Young Park ◽  
Niteen Tapuria ◽  
...  
Keyword(s):  
United Kingdom ◽  
Patient Satisfaction ◽  
Spinal Anesthesia ◽  
Stated Preference ◽  
Case Series ◽  
District General Hospital ◽  
Complication Rates ◽  
Open Appendicectomy ◽  
Surgical Department ◽  
The United Kingdom

Abstract Introduction Concerns relating to coronavirus disease 2019 (COVID-19) and general anesthesia (GA) prompted our department to consider that open appendicectomy under spinal anesthesia (SA) avoids aerosolization from intubation and laparoscopy. While common in developing nations, it is unusual in the United Kingdom. We present the first United Kingdom case series and discuss its potential role during and after this pandemic. Methods We prospectively studied patients with appendicitis at a British district general hospital who were unsuitable for conservative management and consequently underwent open appendicectomy under SA. We also reviewed patient satisfaction after 30 days. This ran for 5 weeks from March 25th, 2020 until the surgical department reverted to the laparoscopic appendicectomy as the standard of care. Main outcomes were 30-day complication rates and patient satisfaction. Results None of the included seven patients were COVID positive. The majority (four-sevenths) had complicated appendicitis. There were no major adverse (Clavien-Dindo grade III to V) postoperative events. Two patients suffered minor postoperative complications. Two experienced intraoperative pain. Mean operative time was 44 minutes. Median length of stay and return to activity was 1 and 14 days, respectively. Although four stated preference in hindsight for GA, the majority (five-sevenths) were satisfied with the operative experience under SA. Discussion Although contraindications, risk of pain, and specific complications may be limiting, our series demonstrates open appendicectomy under SA to be safe and feasible in the United Kingdom. The technique could be a valuable contingency for COVID-suspected cases and patients with high-risk respiratory disease.

scholarly journals Single-use versus reusable flexible ureteroscopes: a comprehensive cost-analysis decision model

2018 ◽  
Vol 97 (3) ◽  
pp. 323-333
Author(s):  
Giovanni Scala Marchini ◽  
Fábio César Miranda Torricelli ◽  
Manoj Monga ◽  
Carlos Alfredo Batagello ◽  
Fábio Carvalho Vicentini ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Case Series ◽  
Final Analysis ◽  
Flexible Ureteroscopy ◽  
Complication Rates ◽  
Ureteral Access Sheath ◽  
Flexible Scope ◽  
Surgical Costs ◽  
Single Use ◽  
The Cost

Purpose: The significant improvements in flexible ureterorenoscopes have made flexible ureteroscopy the main treatment modality to target upper urinary pathologies. The purpose of this study was to critically evaluate all literature concerning the cost-effectiveness of flexible ureteroscopy comparing single-use with reusable scopes. Methods: A systematic online literature review was performed in PubMed, Embase and Google Scholar databases. Two separate urologists (GSM and FCT) performed the online search and reviewed all papers considered suitable and relevant for this analysis. Because of the paucity of high quality publications, not only prospective assessments but also case control and case series studies were included in the final analysis. All factors potentially affecting surgical costs or clinical outcomes were considered in the analysis. Results: 741 studies with the previously elected terms were found. Of those, 18 were duplicated and 77 were not related to urology procedures and were excluded. Of the remaining 646 studies, 59 published between 2000 and 2018 were considered of relevance to the pre-defined queries and were selected for further analysis. Stone free and complication rates were similar between single-use and reusable scopes. In special, urinary tract infection rate following flexible ureteroscopy is not inferior if a single-use device is used instead of a reusable scope. Operative time was in average 20% shorter if a digital scope was used, single-use or not. There is a suggestion that the learning curve is shorter with single-use devices but this is not consistent in the literature. Surgeon expertise impacts the longevity of the flexible scope. Reusable digital scopes seem to last longer than optic ones, though scope longevity is very variable worldwide. New scopes usually last three to four times more than refurbished ones and single-use ureterorenoscopes have good resilience throughout long cases. Both sterilization method and cleaning process impact scope longevity, the best results being achieved with Cidex and a dedicated nurse to take care of the sterilization process. The main factors that negatively impact device longevity regarding patient and disease are lower pole pathologies, large stone burden and non-use of a ureteral access sheath. Conclusions: The cost-effectiveness of a flexible ureteroscopy program is dependent of several aspects that must be considered when deciding whether to choose between a single-use and a reusable ureterorenoscope. Disposable devices are already a reality and will progressively become the standard as manufacturing price falls significantly.

A Retrospective Case Series of Carbon Fiber Plate Fixation of Ankle Fractures

2017 ◽  
Vol 11 (3) ◽  
pp. 223-229 ◽  
Author(s):  
Zachariah W. Pinter ◽  
Kenneth S. Smith ◽  
Parke W. Hudson ◽  
Caleb W. Jones ◽  
Ryan Hadden ◽  
...  
Keyword(s):  
Carbon Fiber ◽  
Fracture Fixation ◽  
Complication Rate ◽  
Ankle Fracture ◽  
Case Series ◽  
Complication Rates ◽  
Union Rate ◽  
Retrospective Case ◽  
Retrospective Case Series

Distal fibula fractures represent a common problem in orthopaedics. When fibula fractures require operative fixation, implants are typically made from stainless steel or titanium alloys. Carbon fiber implants have been used elsewhere in orthopaedics for years, and their advantages include a modulus of elasticity similar to that of bone, biocompatibility, increased fatigue strength, and radiolucency. This study hypothesized that carbon fiber plates would provide similar outcomes for ankle fracture fixation as titanium and steel implants. A retrospective chart review was performed of 30 patients who underwent fibular open reduction and internal fixation (ORIF). The main outcomes assessed were postoperative union rate and complication rate. The nonunion or failure rate for carbon fiber plates was 4% (1/24), and the union rate was 96% (23/24). The mean follow-up time was 20 months, and the complication rate was 8% (2/24). Carbon fiber plates are a viable alternative to metal plates in ankle fracture fixation, demonstrating union and complication rates comparable to those of traditional fixation techniques. Their theoretical advantages and similar cost make them an attractive implant choice for ORIF of the fibula. However, further studies are needed for extended follow-up and inclusion of larger patient cohorts. Levels of Evidence: Level IV: Retrospective Case series

scholarly journals Is Allograft Reconstruction of the Medial Ulnar Collateral Ligament of the Elbow a Viable Option for Nonelite Athletes? Outcomes at a Mean of 8 Years

2020 ◽  
Vol 8 (10) ◽  
pp. 232596712095914
Author(s):  
Justin C. Kennon ◽  
Erick M. Marigi ◽  
Chad E. Songy ◽  
Chris Bernard ◽  
Shawn W. O’Driscoll ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Case Series ◽  
Ulnar Collateral Ligament ◽  
Ulnar Neuropathy ◽  
Complication Rates ◽  
Collateral Ligament ◽  
Level Of Evidence ◽  
Functional Scores ◽  
The Mean

Background: The rate of elbow medial ulnar collateral ligament (MUCL) injury and surgery continues to rise steadily. While authors have failed to reach a consensus on the optimal graft or anchor configuration for MUCL reconstruction, the vast majority of the literature is focused on the young, elite athlete population utilizing autograft. These studies may not be as applicable for the “weekend warrior” type of patient or for young kids playing on high school leagues or recreationally without the intent or aspiration to participate at an elite level. Purpose: To investigate the clinical outcomes and complication rates of MUCL reconstruction utilizing only allograft sources in nonelite athletes. Study Design: Case series; Level of evidence, 4. Methods: Patient records were retrospectively analyzed for individuals who underwent allograft MUCL reconstruction at a single institution between 2000 and 2016. A total of 25 patients met inclusion criteria as laborers or nonelite (not collegiate or professional) athletes with a minimum of 2 years of postoperative follow-up. A review of the medical records for the included patients was performed to determine survivorship free of reoperation, complications, and clinical outcomes with use of the Summary Outcome Determination (SOD) and Timmerman-Andrews scores. Statistical analysis included a Wilcoxon rank-sum test to compare continuous variables between groups with an alpha level set at .05 for significance. Subgroup analysis included comparing outcome scores based on the allograft type used. Results: Twenty-five patients met all inclusion and exclusion criteria. The mean time to follow-up was 91 months (range, 25-195 months), and the mean age at the time of surgery was 25 years (range, 12-65 years). There were no revision operations for recurrent instability. The mean SOD score was 9 (range, 5-10) at the most recent follow-up, and the Timmerman-Andrews scores averaged 97 (range, 80-100). Three patients underwent subsequent surgical procedures for ulnar neuropathy (n = 2) and contracture (n = 1), and 1 patient underwent surgical intervention for combined ulnar neuropathy and contracture. Conclusion: Allograft MUCL reconstruction in nonelite athletes demonstrates comparable functional scores with many previously reported autograft outcomes in elite athletes. These results may be informative for elbow surgeons who wish to avoid autograft morbidity in common laborers and nonelite athletes with MUCL incompetency.

scholarly journals Donor Screening for Fecal Microbiota Transplantation

2020 ◽  
Vol 95 (3) ◽  
pp. 181-187
Author(s):  
Han Hee Lee ◽  
Young-Seok Cho
Keyword(s):  
Randomized Clinical Trials ◽  
Fecal Microbiota Transplantation ◽  
Case Series ◽  
Fecal Microbiota ◽  
Resistant Bacteria ◽  
Screening Process ◽  
Antibiotic Resistant ◽  
Donor Screening ◽  
Large Case Series ◽  
Large Case

Fecal microbiota transplantation (FMT), which has been established as the standard treatment for recurrent <i>Clostroides</i> difficile infection, may also play a role in the management of other diseases associated with dysbiosis of the gut microbiota. To ensure efficacy and safety of FMT, an appropriate donor screening process is required. The main purpose of donor screening is to check for infectious diseases that could be transmitted to the recipient. The screening process involves a medical history questionnaire, and blood and stool testing. Several randomized clinical trials and large case series on FMT reported no, or few, adverse events related to infection by following this donor screening process. However, there is still concern over the transmission of antibiotic-resistant bacteria. In addition, a low donor acceptance rate due to rigorous screening makes donor recruitment difficult, and also imposes a significant cost burden. A consensus on the most crucial elements of donor screening is needed for wide application of FMT.

scholarly journals Catheter Directed Thrombolytic Therapy for Pediatric Cerebral Sinus Vein Thrombosis

Blood ◽  
2019 ◽  
Vol 134 (Supplement_1) ◽  
pp. 3666-3666
Author(s):  
Marcela Torres ◽  
Tyler Hamby ◽  
Sarah Philip ◽  
Jo Ann Tilley
Keyword(s):  
Pediatric Patients ◽  
Randomized Clinical Trials ◽  
Conflicts Of Interest ◽  
Case Series ◽  
Protein S ◽  
Cerebral Veins ◽  
Vein Thrombosis ◽  
Partial Resolution ◽  
Neurologic Deficits ◽  
Cerebral Sinus

Background: Cerebral sinus vein thrombosis (CSVT) involves the thrombosis of the dural sinus and/or cerebral veins and it is considered a form of stroke. The estimated incidence of CSVT in children is 0.6 per 100,000 children per year. Poor outcomes, including death, happen in 9 to 29% of patients affected by CSVT. In addition, neurologic deficits, affecting primarily cognition and behavior, are seen in 50% of affected children. No randomized clinical trials have been conducted on pediatric CSVT so current guidelines for treatment have been extrapolated primarily from adult studies. Published guidelines by the American College of Chest Physicians, American Heart Association and American Society of Hematology, support the use of anticoagulation with unfractionated heparin (UFH) or low molecular weight heparin (LMWH). These same guidelines also suggest that catheter directed thrombolysis (CDT) with tissue plasminogen activator (tPA) and mechanical thrombectomy (MT) could be used when there has been clinical deterioration or no improvement (clot progression) despite anticoagulation. In all cases, these are based on uncontrolled case series and expert opinion. There is very little data on the safety and efficacy of CDT and/or MT for pediatric CSVT. Method: Pediatric patients with CSVT seen at Cook Children's Medical Center from January 1, 2008 to December 31, 2018 were identified by searching EMR using ICD-9 and ICD-10 codes. From this group, patients treated with MT and CDT in addition to anticoagulation were selected and reviewed. Results: Five children (4 to 14 y/o) were treated with MT and CDT after failing anticoagulation with UFH or LMWH. Diagnosis was made by MRI/MRV and all had CSVT of multiple sinuses. Four patients had more than one underlying disorders/factors that increased their risk for thrombosis including: Ulcerative Colitis in 2, severe anemia in 2, Systemic Lupus Erythematosus (SLE) in 1, use of oral contraceptives together with obesity and bacterial sepsis in 1. Two patients did have a thrombophilia: Protein S deficiency in 1 and Protein S and C deficiency in another. One patient with SLE had a positive hexagonal phase neutralization test but rest of evaluation was negative. Three patients had systemic bleeding prior initiation of UFH and MT/CDT. All children were treated with UFH, and due to clinical neurologic deterioration and/or worsening of imaging findings (4 comatose and 1 with persistent increased ICP), all underwent thromboaspiration and catheter directed infusion of tPA for 17 to 48 hours at a dose of 1 to 2 mg/hr. All patients continued anticoagulation with UFH during catheter directed tPA infusion and after the catheter was removed. All cases had partial resolution of the sinus vein thrombosis, although 1 had quick reocclusion. Post procedure bleeding happened in 1 patient who had also had an external ventricular drainage placed and developed parenchymal and intraventricular hemorrhage that led to discontinuation of tPA infusion, and 2 patients developed petechial brain hemorrhages. Four patients had great neurologic recovery and minimal deficits, but 1 had significant neurologic deficits. One patient died from lupus complications. (Table) Conclusion: Endovascular therapy including MT and CDT with tPA in conjunction with systemic UFH, may have a role in pediatric patients with CSVT who have deterioration despite initial anticoagulation. In our series, after procedures, all patients had partial resolution of their CSVT (but 1 had quick reocclusion) and 4 out of 5 patients had good neurologic outcomes despite bad predictor signs (coma, extensive CSVT). Further studies are needed to identify which patients would benefit from early endovascular treatment. Table Disclosures No relevant conflicts of interest to declare.

Clinical characteristics and long-term outcome of lung lobe torsions in cats: a review of 10 cases (2000–2021)

2021 ◽  
pp. 1098612X2110548
Author(s):  
Catherine Tindale ◽  
Filippo Cinti ◽  
Matteo Cantatore ◽  
Alistair Freeman ◽  
Leonardo Cavaliere ◽  
...  
Keyword(s):  
Intraoperative Complications ◽  
Clinical Signs ◽  
Case Series ◽  
The Other ◽  
Complication Rates ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Lung Lobe ◽  
Lung Lobes

Case series summary Lung lobe torsion is rare in cats. The aim of this multi-institution retrospective study was to describe clinical and diagnostic findings, treatments and outcomes of lung lobe torsion (LLT) in 10 cats. Dyspnoea and tachypnoea were the most common clinical signs. Pleural effusion was present in nine cats at presentation. Fluid analysis confirmed chylothorax in three cats. Nine cats underwent CT and five cats had thoracic radiographs taken. A diagnosis was made preoperatively in six cats, while in the other four cats it was made at exploratory thoracotomy. Affected lung lobes were the right cranial (n = 4/11), left cranial (n = 4/11) and right middle (n = 3/11). One cat had a concurrent torsion of two lung lobes. Lung lobectomy was successfully performed in all cases. Based on clinical, diagnostic and lung histopathology findings, three cats had idiopathic and seven cats secondary LLT. Intraoperative complications included hypotension and hypothermia in four and five cats, respectively. Postoperative complications occurred in six cats and lead to euthanasia or death in four cats, whereas complications resolved in the other two cats. Three cats were euthanased within 5 weeks of discharge. For the three cats surviving long term, including one euthanased at 252 days postoperatively, owner-described outcomes and quality of life were considered good to excellent. Relevance and novel information Secondary LLT associated with underlying thoracic pathology was associated with high complication rates and poor outcomes. Long-term outcomes of cats undergoing surgery for LLT and surviving the perioperative period were deemed good to excellent.

Adoption of Robotic Arm-Assisted Total Hip Arthroplasty Results in Reliable Clinical and Radiographic Outcomes at Minimum Two-Year Follow Up

2021 ◽  
Author(s):  
Matthew Hepinstall ◽  
Harrison Zucker ◽  
Chelsea Matzko ◽  
Morteza Meftah ◽  
Michael Mont
Keyword(s):  
Total Hip Arthroplasty ◽  
Clinical Outcomes ◽  
Hip Arthroplasty ◽  
Case Series ◽  
Robotic Arm ◽  
Complication Rates ◽  
Total Hip ◽  
Surgical Assistance ◽  
Published Evidence

Introduction: Longevity and success of total hip arthroplasty (THA) is largely dependent on component positioning. While use of robotic platforms can improve this positioning, published evidence on its clinical benefits is limited. Therefore, the aim of this study was to assess the clinical outcomes of THA with robotic surgical assistance. Materials and Methods: We conducted an analysis of robotic arm-assisted primary THAs performed by a single surgeon utilizing a posterior approach. A total of 99 patients (107 cases) who had a minimum two-year follow up were identified. Their mean age was 61 years (range, 33 to 84 years), and their mean body mass index was 30.5 kg/m2 (range, 18.5 to 49.1 kg/m2). There were 56% female patients and primary osteoarthritis was the principal hip diagnosis in 88.8%. Operative times, lengths of hospital stay, and discharge dispositions were recorded, along with any complications. Modified Harris Hip Scores (HHS) were calculated to quantify clinical outcomes. Results: Mean postoperative increases in HHS at 2- to 5.7-year follow up was 33 points (range, 6 to 77 points). There were no complications attributable to the use of robotic assistance. Surgical-site complications were rare; one case underwent a revision for prosthetic joint infection (0.93%) but there were no dislocations, periprosthetic fractures, or cases of mechanical implant loosening. There was no evidence of progressive radiolucencies or radiographic failure. Discussion: Robotic arm-assisted THA resulted in low complication rates at minimum two-year follow up, with clinical outcomes comparable to those reported with manual surgery.1–4 The haptically-guided acetabular bone preparation enabled reliable cementless acetabular fixation and there were no adverse events related to the use of the robot. Dislocations were avoided in this case series. Randomized controlled clinical trials are needed to compare manual to robotic surgery and to investigate whether the precision found with this functional planning will reliably reduce the incidence of dislocations.

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