Operative treatment improves patient function in recalcitrant medial epicondylitis

The purpose of this retrospective study was to assess the outcome of open surgery for patients with recalcitrant medial epicondylitis following failed conservative management. The clinical results are presented for 15 patients (17 elbows) who were reviewed at a mean follow-up of 66 months. Operative treatment improved patient function significantly with a mean increase in grip strength of 10kg and a mean decrease (improvement) in DASH (Disabilities of the Arm, Shoulder and Hand) score of 25.7. All but one patient experienced little or no residual elbow discomfort and had excellent Mayo elbow performance scores postoperatively. Eleven of the twelve patients who were previously in employment were able to return to work within eight weeks of surgery. This study demonstrates that operative treatment for recalcitrant medial epicondylitis is effective in restoring patient function and strength.

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Tumour like lesions and their management: a retrospective study

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20175665 ◽

2017 ◽

Vol 4 (1) ◽

pp. 159

Author(s):

Kuriakku Puthur Dominic ◽

Davis Dijoe ◽

Libin Thomas Manathara

Keyword(s):

Retrospective Study ◽

Operative Treatment ◽

Conservative Management ◽

Pathological Fracture ◽

Long Term Follow Up ◽

Radical Approach

Background: Tumour like lesions of the bone is a frequently used term but has not yet been clearly defined. There are no definite guidelines available for their management. The present study was aimed to evaluate the tumour like lesions and their management.Methods: Cases of tumour like lesions managed in the Cancer Institute during the last two decades were systematically analyzed. By and large non aggressive and non-operative treatment was given in all conditions.Results: One hundred and twenty seven cases of tumour like lesions managed. As they are not tumours, basics of tumour surgery need not be applied to them. Outcome of conservative management of tumour like lesions was very encouraging on long term follow-up. Conclusions: Most of the cases with lesser interventions produced better results. They need to be treated only if they are symptomatic or likely to produce a pathological fracture. Even in such situations, one need not take a radical approach.

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Comparison of Minimally Invasive Operative Treatment with Conservative Treatment for Acute, Minimally Displaced Scaphoid Fractures at 12 Months' Follow-up

Journal of Wrist Surgery ◽

10.1055/s-0040-1722333 ◽

2021 ◽

Author(s):

Apostolos Fyllos ◽

George Komnos ◽

Athanasios Koutis ◽

Konstantinos Bargiotas ◽

Sokratis Varitimidis ◽

...

Keyword(s):

Minimally Invasive ◽

Return To Work ◽

Grip Strength ◽

Operative Treatment ◽

Level Of Evidence ◽

Scaphoid Fractures ◽

The Mean ◽

Wrist Function ◽

Nonoperated Group

Abstract Background Minimally displaced scaphoid fractures can be challenging to diagnose and treat. Cannulated scaphoid screws have made percutaneous stabilization highly effective. Questions Would minimally invasive operative treatment of minimally displaced scaphoid fractures yield faster return to work when compared with patients treated conservatively? How do functional and patient satisfaction scores compare between the two groups at 12-months follow-up? Patients and Methods Records from 18 patients (mean age 28.6 years) treated surgically were retrospectively reviewed and compared with a group of 10 patients (mean age 33.3 years, p = 0.74) treated nonoperatively. Inclusion criteria were a minimum follow-up period of 12 months and radiographic union. Time to return to work was compared between groups. At 12 months' follow-up, wrist range of motion (ROM) and grip strength were compared, as well as pain, satisfaction, and overall wrist function were evaluated by the visual analogue scale (VAS) and the Mayo modified wrist score (MMWS). Results The mean time to return to work for the operated group was 39.75 days, while for the nonoperated group it was 88.14 days (p = 0.002). At the 12 months' follow-up, mean ROM, grip strength, and VAS score did not differ between groups. The mean MMWS was 98.75 for the operated group and 87.5 for the nonoperated group, indicating a better result in patients treated operatively (p = 0.03). In addition, two failures of instrumentation were recorded, a seldom seen complication. Conclusion Percutaneous fixation of minimally displaced scaphoid fractures allows faster return to work and leaves patients more satisfied with their wrist function compared with plaster immobilization at 12 months' follow-up. Level of evidence This is a Level III, retrospective, case–control study.

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MANAGEMENT OF ACUTE APPENDICITIS DURING THE EARLY PHASE OF THE COVID-19 PANDEMIC: A SINGLE NHS CENTRE STUDYONE YEAR FOLLOW UP STUDY.

10.36106/ijsr/5430960 ◽

2021 ◽

pp. 87-89

Author(s):

Yamen Jabri ◽

Md Mahfooz Buksh ◽

Alicia Skrervin

Keyword(s):

Operative Treatment ◽

Open Surgery ◽

Ct Scanning ◽

Disease Recurrence ◽

Diagnostic Value ◽

Complicated Appendicitis ◽

Risk Patients ◽

Risk Of Disease ◽

One Year

Introduction: Early during the COVID-19 pandemic, the royal college of surgeons advised to use Non-Operative Treatment of appendicitis NOTA or otherwise open surgery for appendicitis. This study has explored the resulted management differences, and the outcome after one year follow up. Methods: Retrospective study covering Pre-pandemic data over March-May,2019 & COVID-19 pandemic data over March-May,2020. We compared the outcome of non-operative treatment approach (NOTA), open and laparoscopic surgical outcome between the 2 groups. Results: The number of admissions was lower in the COVID compared to the Pre-COVID Group (35 vs 43). In the COVID group had more CT scanning of the abdomen and pelvis (65.7% vs 42.2%; p=0.036). There was no difference in the diagnostic value for these imaging methods between the 2 groups (87.5% vs 86.6%) During COVID period Signicantly fewer patients underwent surgery (77.1 vs 92.8; p<0.04), There were signicantly more complicated appendicitis cases in the COVID group compared to Pre-COVID group (59.2 vs 28.2; p:0.021). There was in reduction LOS when comparing Laparoscopic to NOTA (1.7 vs 2.6 days; p:0.03). There has been higher complication rate in the open and NOTA treatments compared to Laparoscopic, but this was not statistically signicant (24.3 % vs 14.8%; p: 0.29). In the NOTA group 41 % of the patients had emergency or interval appendectomy in after one year follow up period. Conclusions: There was a tendency towards conservative approach/open surgery during the pandemic. Our study suggests that Laparoscopic surgery should remain the preferred method of management of appendicitis during COVID-19 pandemic considering the more complicated appendicitis. NOTA should be limited to selected high risk patients. accepting the risk of disease recurrence and need for further interval or emergency surgery

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Intramedullary Screws versus Kirschner Wires for Metacarpal Fixation, Functional, and Patient-Related Outcomes

The Surgery Journal ◽

10.1055/s-0038-1637002 ◽

2018 ◽

Vol 04 (01) ◽

pp. e29-e33 ◽

Cited By ~ 7

Author(s):

Jose Couceiro ◽

Higinio Ayala ◽

Manuel Sanchez ◽

Maria De la Red ◽

Olga Velez ◽

...

Keyword(s):

Return To Work ◽

Grip Strength ◽

Kirschner Wire ◽

Kirschner Wires ◽

Active Motion ◽

Contralateral Hand ◽

Total Active Motion ◽

Quick Dash ◽

Dash Questionnaire

Purpose The purpose of our study is to compare the intramedullary fixation of metacarpal fractures with cannulated headless screws and antegrade Kirschner wires in terms of final total active motion, grip strength, patient-related outcomes, need for casting, and return to work times. Methods The authors performed a retrospective review of the hospital records. Thirty fractures were included in the study, 19 in the screw fixation group, and 11 in the Kirschner wire group. Grip strength, and total active motion, was measured at the latest follow-up for both the injured and contralateral hand. Pain was measured on the visual analog scale. Patients were requested to fill a Quick disabilities of the arm and hand score (DASH) questionnaire at the latest follow-up. Satisfaction was measured on a scale from 0 to 10. The time to return to work was quantified from the accident to the point when the patient was back to active duty. Postoperative casting time was also quantified. Results The authors did not find any differences between the two groups in total active motion, grip strength, pain, satisfaction, or Quick DASH scores. We did find a difference in the return to work and casting times; these appeared to be shorter in the screw group. Conclusion Due to the small number of cases, we have been unable to clearly conclude that there were any benefits in the application of one particular technique when compared with the other.

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AN ACCOUNT OF 15 YEARS EXPERIENCE OF LAPAROSCOPIC COMMON BILE DUCT EXPLORATION IN CHOLEDOCHOLITHIASIS FOLLOWED BY PRIMARY REPAIR AND ITS COMPARISON WITH OPEN CHOLEDOCHOLITHOTOMY IN DISHARI HEALTH POINT PRIVATE LIMITED, MALDA

10.36106/gjra/1400687 ◽

2021 ◽

pp. 15-16

Author(s):

Arkaprovo Roy ◽

Manabesh Pramanik

Keyword(s):

Retrospective Study ◽

Bile Duct ◽

Common Bile Duct ◽

Open Surgery ◽

Primary Repair ◽

Common Bile Duct Exploration ◽

Laparoscopic Bile Duct Exploration

A retrospective study of 4628 patients who underwent laparoscopic cholecystectomies with choledocholithotomy with primary repair of common bile duct , with a mean follow-up of 23.2 months is carried outto evaluate the safety and feasibility of laparoscopic choledocholithotomy via choledochotomy for the treatment of choledocholithiasis in Dishari Health Point Private Limited, a multispeciality hospital in Malda from January 2004 to January 2019. We had to convert to open surgery in 27 patients and could complete the operation laparoscopically in rest 4621 patients. We also did open surgery in 30 patients apart from this. We analyse the results and it was found that Laparoscopic bile duct exploration via choledochotomy followed by primary duct closure is feasible and safe for the treatment of choledocholithiasis.

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Clinical Results of Intraarticular Fractures of the Base of the Fifth Metacarpal Treated by Closed Reduction and Cast Immobilization

Journal of Hand Surgery (European Volume) ◽

10.1054/jhsb.2000.0413 ◽

2000 ◽

Vol 25 (3) ◽

pp. 258-261 ◽

Cited By ~ 33

Author(s):

J. M. LUNDEEN ◽

A. Y. SHIN

Keyword(s):

Retrospective Study ◽

Closed Reduction ◽

Clinical Results ◽

Fracture Type ◽

Carpometacarpal Joint ◽

Cast Immobilization ◽

Intraarticular Fractures

This retrospective study evaluated the results of closed reduction and cast immobilization for isolated intraarticular fractures of the base of the fifth metacarpal. Twenty-two of 37 such fractures were available for follow-up at an average of 43 months, and these had all healed at an average of 5 weeks without any cast complications. Twenty patients reported excellent or good results, and two reported fair or poor results. At follow-up, 13 had no arthrosis and nine had mild arthrosis of the carpometacarpal joint. However, outcome was not influenced by fracture type, the degree of subluxation or articular step off, or the presence of arthrosis. We conclude that isolated fractures of the base of the fifth metacarpal can be reliably treated with closed reduction and cast immobilization.

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CLINICAL RESULTS OF EARLY ACTIVE MOBILISATION AFTER FLEXOR TENDON REPAIR

Hand Surgery ◽

10.1142/s0218810408003761 ◽

2008 ◽

Vol 13 (01) ◽

pp. 45-50 ◽

Cited By ~ 9

Author(s):

C. H. Yen ◽

W. L. Chan ◽

J. W. C. Wong ◽

K. H. Mak

Keyword(s):

Grip Strength ◽

Tendon Repair ◽

Clinical Results ◽

Flexor Digitorum Profundus ◽

Pinch Strength ◽

Paired Samples ◽

Full Flexion ◽

Zone Ii ◽

Flexor Digitorum

Between 2005 and 2006, ten patients with flexor digitorum profundus zone II injuries were included. The mean age was 41 (19–84) years. One thumb, two index, four middle, one ring and two little fingers were injured. Repair method comprised four-strand core suture and 6-0 circumferential sutures. Post-operative rehabilitation included immediate active extension, progressive passive full flexion and active hold in dorsal block splint. Follow-up was four (three to seven) months. Grip strength, pinch strength, ROM was 90% (70%–90%), 90% (60%–110%) and 90% (80%–100%) of normal digit, respectively. Mayo wrist scores were five excellent, two good and three fair. All patients were satisfied. Compared with another group of ten patients with the same suture method and Kleinert splintage, grip strength, pinch strength and ROM were 50%, 40% and 40% of normal side, respectively. All differences between these two groups were statistically significant (p < 0.01) by paired samples T-test. There was no re-rupture.

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Efficacy of percutaneous short segment fixation on the treatment of Magerl A3 thoracolumbar fractures: a retrospective study

10.21203/rs.3.rs-31598/v1 ◽

2020 ◽

Author(s):

hongheng lin ◽

Xiaoting Ou ◽

Wenchao Li ◽

Minyuan Chen ◽

Caijun Liu ◽

...

Keyword(s):

Retrospective Study ◽

Blood Loss ◽

Operation Time ◽

Clinical Results ◽

Radiographic Evaluation ◽

Correction Loss ◽

Short Segment ◽

Significant Correction ◽

Short Segment Fixation

Abstract BackgroundThis is a retrospective study to evaluate the efficacy of percutaneous short segment fixation (PSSF) with or without intermediate screws in Magerl A3 thoracolumbar (TL) fractures accompanied with low bone mineral density (BMD).Methods From January 2017 to December 2018, 30 patients diagnosed with Magerl A3 TL fractures having a BMD between 0.5/cm2 and 1g/cm2 in the lumbar vertebrae with intact neurological functions and a history of major trauma who underwent PSSF with or without intermediate screws were enrolled in this study. The patients were divided into two groups of those with intermediate screws (group F) or without (group S). The operation time and intra-operation blood loss were recorded. Oswestry disability index (ODI) questionnaire and visual analogue scale (VAS) were employed as clinical assessments and quantified. Radiographic follow-up assessed according to the Cobb angle (CA), Vertebral wedge angle (VWA), and anterior vertebral body height (AVBH).ResultsLoose screws were observed in 4 of the 30 enrolled patients. Significant differences were observed in operation time and intra-operative blood loss between the two groups. The enrolled patients’ clinical results (VAS and ODI scores) were good, however, no significant differences during all follow-up periods were present between the two groups. Radiographic evaluation (CA, VWA and AVBH) improved immediately after surgery, but significant correction loss was observed in the follow-up periods, especially in the first month. Radiographic evaluation demonstrated no significant differences between the two groups.Conclusion Although the patients’ clinical results were satisfactory, PSSF could not resist the correction loss in Magerl A3 TL fractures accompanied with BMD below 1g/cm2. Accordingly, the use of intermediate pedicle screws may be unnecessary due to their limited ability in resisting correction loss and increasing operation time as well as intra-operation blood loss.

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Comparison of mechanochemical ablation versus ligation and stripping for the treatment of incompetent small saphenous vein

Phlebology The Journal of Venous Disease ◽

10.1177/02683555211045191 ◽

2021 ◽

pp. 026835552110451

Author(s):

Luca Apruzzi ◽

Victor Bilman ◽

Vincenzo Ardita ◽

Nicola Favia ◽

Concetta Saracino ◽

...

Keyword(s):

Retrospective Study ◽

Postoperative Pain ◽

Return To Work ◽

Saphenous Vein ◽

Neurological Symptoms ◽

Recurrence Rates ◽

Early Return ◽

Mechanochemical Ablation

Objective to compare the outcomes of mechanochemical ablation (MOCA) versus saphenopopliteal junction ligation and stripping (OS) for symptomatic small saphenous vein (SSV) insufficiency. Methods This is a retrospective study including symptomatic SSV patients treated with MOCA using the ClariVein catheter (Merit Medical, South Jordan, Utah, USA) or OS from 2015 to 2019. Results A total of 60 limbs (73.3% women, mean age 54.7 ± 14.4 years) were treated with MOCA and 58 limbs (63.8% women, mean age 54 ± 11.6 years) with OS. At 18 months follow-up, recurrence rates were 7.5% (4/53) for MOCA vs. 5.7% (3/52) for the OS group. MOCA group was associated with less pain at first postoperative day, and an early return to work (MOCA 3.5 ± 2.3 days vs. OS 14.2 ± 3.8 days, p < .0001). No cases of leg paresthesia/dysesthesia were observed in the MOCA group, while two patients (3.4%) presented neurological symptoms after OS treatment. Conclusion MOCA and OS are both safe and effective techniques for symptomatic SSV insufficiency. MOCA group demonstrated to be associated with less postoperative pain and early return to work compared to OS.

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Managing Small Ureteral Stones: A Retrospective Study on Follow-Up, Clinical Outcomes and Cost-Effectiveness of Conservative Management vs. Early Surgery

Current Urology ◽

10.1159/000442849 ◽

2015 ◽

Vol 9 (1) ◽

pp. 36-43 ◽

Cited By ~ 1

Author(s):

Aristeidis Alevizopoulos ◽

Dimitrios Zosimas ◽

Lamprini Piha ◽

Milad Hanna ◽

Konstantinos Charitopoulos

Keyword(s):

Retrospective Study ◽

Cost Effectiveness ◽

Conservative Management ◽

Ureteral Stone ◽

Cost Benefit ◽

Early Surgery ◽

Ureteral Stones ◽

Global Cost ◽

The Cost

Introduction: The management of ureteral calculi has evolved over the past decades with the advent of new surgical and medical treatments. The current guidelines support conservative management as a possible approach for ureteral stones sized = 10 mm. Objectives: We purport to follow the natural history of ureteral stones managed conservatively in this retrospective study, and attempt to ascribe an estimated health-care and cost-effectiveness, from presentation to time of being stone-free. Materials and methods: 192 male and female patients with a single ureteral stone sized = 10 mm were included in this study. The clinical and cost-related outcome was analyzed for different stone sizes (0-4, 4-6 and 6-10 mm). The effectiveness of selected follow-up (FU) scans was also analyzed. Results: Stone size was found to be related to the degree of hydronephrosis and to the likelihood of need for a surgical management. Conservative management was found to be clinically effective, as 88% of the patients did not require surgery for their stone. 96.1% of the patients with a stone 0-4mm managed to expel their ureteral stone. Bigger ureteral stones were found to be more costly. The cost-effectiveness of the single FU scans was found to be related to their efficiency, while the global cost-effectiveness of conservative management vs. early surgery was higher for smaller stones (26.8 vs. 17.32% for stones 0-4 vs. 6-10 mm). Conclusion: Conservative management is clinically effective with a significant cost-benefit, particularly for the subgroup of stones sized 0-4 mm, where a need for FU scans is in dispute.

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