Circumcision: postoperative complications that required reoperation

ABSTRACT Objective To evaluate post-operative complications of circumcision requiring surgical reintervention. Methods Retrospective analysis of medical records of patients submitted to circumcision from May 1st, 2015 to May 31st, 2016. Results A total of 2,441 circumcisions were performed; in that, 1,940 using Plastibell and 501 by the classic technique. Complications requiring surgical reintervention were found in 3.27% of patients. When separated by surgical technique, 3.4% of circumcisions using Plastibell device required reoperation, as compared to 3% of conventional technique (p=0.79). Preputial stenosis was most frequently found in classic circumcision, with statistical significance (p<0.001). Bleeding was more frequent when using Plastibell device, but the difference was not statistically different (p=0.37). Patients’ age was also evaluated to investigate if this variable influenced on the postoperative outcome, but no significant difference was found. Conclusion There was no statistically significant difference when comparing complications between the different techniques performed at this hospital. Preputial stenosis was most frequently found in the classic circumcision, while bleeding was more prevalent when using Plastibell device. Patients’ age did not influence in complications.

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STUDY CLINICAL FEATURE AND RESULT OF TREATMENT PHACOMORPHIC GLAUCOMA

Journal of Medicine and Pharmacy ◽

10.34071/jmp.2015.1.9 ◽

2015 ◽

pp. 71-75

Author(s):

Van Nam Phan ◽

Ba Ken Tran

Keyword(s):

Visual Acuity ◽

Intraocular Pressure ◽

Statistical Significance ◽

Corneal Edema ◽

Clinical Feature ◽

Anterior Chamber Angle ◽

Male Population ◽

Significant Difference ◽

Operative Complications ◽

Before And After

Purpose: Study clinical feature of phacomorphic glaucoma. To evaluate the result of treatment phacomorphic glaucoma. Method: The retrospective, interventional study on 36 cases with phacomorphic glaucoma who underwent treated at Hue Central Hospital from 6/2010 to 6/2011. Standard of research: visual, IOP, before and after surgery, accompanying lesions and post-operative complications. The surgery is considered successful when postoperative IOP less than 21 mmHg. Results: Age 50-59 presented 30.5 percent, ≥ 60 presented 91.7 percent. There was a slight female preponderance (66.7%) compared to the male population (33.3%) which implies a statistically marginally significant difference. However there was no statistical significance difference when compared by the two subgroups. Patient in country presented 61,1% and city presented 38,9%. The duration between the onset of pain and surgery from 0 to < 5 days (77.8%), from 6 to 10 (16.7%) and >10 days presented 5.5%. The preoperative intraocular pressure 35 to 45mmHg (47.2%), 46-55 (30.6%), 56-65 (13.9%) and more than 65 presented 8.3%. The visual acuity preoperation less than 1metre count finger (94.5%), less than 3 metre count finger presented 5.5%. Close anterior chamber angle presented 80.6% and shallow was presented 19.4%. Corneal edema presented 100%, iritis presented 94.4%, dilated pupil larger 5mm presented 83.3%, Synchynea iris and cataract presented 72.2%. ECCE, implantation IOL combined trabeculectomy presented 11.1%, Phaco, implantation IOL combined trabeculectomy presented 69,5%, ECCE implantation IOL presented 5.6%, Phaco, implantation IOL presented 13.8%. Postoperative visual acuity from 1/10 to 5/10 presented 72.2%, no case have VA larger than 5/10. Postoperative 3 months VA 1/10 to 5/10 presented 72.2%, larger VA 5/10 presented 8.3%. Postoperative 3 months intraocular pressure ≤ 21mmHg presented 91.7%, 22 to 24mmHg presented 8.3%, no case have IOP ≥25mmHg. Postoperative edema presented 58.3%, iritis presented 58.3%. Key words: phacomorphic Glaucoma

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Cyclic fatigue resistance of 2Shape, Twisted File and EndoSequence Xpress nickel-titanium rotary files at intracanal temperature

Journal of Dental Research Dental Clinics Dental Prospects ◽

10.15171/joddd.2018.044 ◽

2018 ◽

Vol 12 (4) ◽

pp. 283-287 ◽

Cited By ~ 1

Author(s):

Gülşah Uslu ◽

Taha Özyürek ◽

Mustafa Gündoğar ◽

Koray Yılmaz

Keyword(s):

Fatigue Resistance ◽

Statistical Significance ◽

Cyclic Fatigue ◽

Nickel Titanium ◽

Bonferroni Correction ◽

Significant Difference ◽

Inner Diameter ◽

The Difference ◽

Number Of Cycles ◽

Analyze Data

Background. The aim of this study was to compare the cyclic fatigue resistance of 2Shape, Twisted File (TF) and EndoSequence Xpress (ESX) nickel-titanium rotary files at intracanal temperature (35°C). Methods. Twenty 2Shape TS1 (25/.04), 20 TF (25/.04) and 20 ESX (25/.04) files were tested for cyclic fatigue at intracanal temperature (35°C). All the instruments were rotated in artificial canals which were made of stainless steel with an inner diameter of 1.5 mm, 60° angle of curvature and a radius curvature of 5 mm until fracture occurred; the time to fracture was recorded in seconds using a digital chronometer and the number of cycles to fracture (NCF) for each file was calculated. Kruskal-Wallis test with Bonferroni correction was performed to statistically analyze data using SPSS 21.0. Statistical significance was set at P<0.05. Results. NCF values revealed that the 2Shape had significantly the highest cyclic fatigue resistance, followed by TF and ESX at intracanal temperature (P<0.05). The difference was significant between the TF and ESX groups (P<0.05). There was no significant difference among the 2Shape, TF and ESX files with respect to the lengths of the fractured file fragments (P>.05). Conclusion. Within the limitations of present study, it was concluded that the cyclic fatigue resistance of 2Shape files at the intracanal temperature is higher than that of TF and ESX files.

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Mechanical Thrombectomy in Stroke. Experience from Switching from Stent Retriever Only to Stent Retriever Combined with Aspiration Catheter

Journal of Clinical Medicine ◽

10.3390/jcm10091802 ◽

2021 ◽

Vol 10 (9) ◽

pp. 1802

Author(s):

Grzegorz Meder ◽

Paweł Żuchowski ◽

Wojciech Skura ◽

Violetta Palacz-Duda ◽

Milena Świtońska ◽

...

Keyword(s):

Endovascular Treatment ◽

Clinical Outcomes ◽

Mechanical Thrombectomy ◽

Statistical Significance ◽

Stent Retriever ◽

Single Center Experience ◽

Significant Difference ◽

First Pass ◽

Need To Evaluate ◽

The Difference

Endovascular treatment is a rapidly evolving technique; therefore, there is a constant need to evaluate this method and its modifications. This paper discusses a single-center experience and the results of switching from the stent retriever only (SO) mechanical thrombectomy (MT) to the combined approach (CA), with a stent retriever and aspiration catheters. Methods: The study involved a retrospective analysis of 70 patients undergoing MT with the use of either SO or CA. The primary endpoint was the frequency of perfect reperfusion defined as grade 3 of the modified Thrombolysis in Cerebral Infarction scale (mTICI) after the first pass. The secondary endpoints were the procedure success, defined as mTICI grades 2b-3; time of the procedure; clinical outcome, measured by 90 days’ modified Rankin Scale (mRS) score; Δ NIHSS, defined as the difference between National Institutes of Health Stroke Scale (NIHSS) score at patients’ admission and discharge; and the total number of device passes. Results: Out of the 70 patients included, 33 were treated with SO and 37 with CA. In both groups, a total number of 42 patients received intravenous recombined tissue plasminogen activator (iv-rTPA: 20 patients (60.6%) in the SO group and 22 patients (59.5%) in the CA group (p = 1.000). There was a significant difference between the groups regarding first-pass success rate, with 46% in the CA group and 18% in the SO group, (OR 3.83, 95% CI 1.28 to 11.44, p = 0.016). Complete procedure success tended to be more frequent in the CA group than in the SO group—94.6% vs. 84.8% (OR 3.13, 95% CI 0.56 to 17.34, p = 0.193)—and CA tended to require a lower number of passes than SO (mean 1.76 vs. 2.09 passes per procedure, p = 0.114), yet these differences did not reach statistical significance. Mean duration of the procedure was significantly shorter in the CA group than in the SO group (49 min vs. 64 min, p = 0.017). There was a significant difference in clinical outcomes, with higher Δ NIHSS (9.3 in the CA group vs. 6.7 in the SO group, p = 0.025) after the procedure and 90-day mRS (median 2 in the CA group vs. 4 in the SO group, p = 0.031). Conclusions: Combining stent retrievers with aspiration catheters may offer a beneficial effect on angiographic results and clinical outcomes in stroke patients undergoing endovascular treatment.

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Trans-septal quilting suture versus intranasal silicone splint for preventing complications post endoscopic septoplasty

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20213274 ◽

2021 ◽

Vol 7 (9) ◽

pp. 1415

Author(s):

Rana F. Al Muslem ◽

Mohammad R. Al Eid ◽

Hussain A. Al Baharna

Keyword(s):

Medical Records ◽

Retrospective Cohort ◽

Simple Technique ◽

Common Procedure ◽

Endoscopic Septoplasty ◽

Video Recordings ◽

Endoscopic Video ◽

Operative Complications ◽

The Difference ◽

Quilting Suture

Background: Septoplasty is a common procedure in the field of otolaryngology for treatment of septal deviations. Intranasal splints and trans-septal quilting suture are commonly utilized to prevent post-operative complications. The silicone splint is a quick and simple technique to aid in cartilage support; however, it can cause discomfort. Trans-septal quilting suture is more available, well-tolerated and can help in mucosal tear closure, though is time-consuming. This study aimed to compare the efficacy of intranasal silicone splints versus quilting suture in the prevention of post endoscopic septoplasty complications.Methods: This was a retrospective COHORT study comprised of patients who underwent endoscopic septoplasty between January 2017 and December 2019 at Qatif central hospital. The patients were assigned into two groups: group S, who received intranasal splints and group Q, who received trans-septal quilting suturing. Patients’ medical records were reviewed for evaluation of post-operative visits and post-operative nasal endoscopic video recordings from the image archive software were evaluated to document complications. Statistical analysis was conducted using SPSS 23.0 software.Results: The study included 65 patients, of whom 41 were in group S and 24 were in group Q. None of the patients had major bleeding, local infection or mucosal synechia. There was a higher complication rate in terms of mucosal crustation, septal hematoma and perforation among group S; however, the difference was not statistically significant.Conclusions: We conclude that trans-septal quilting suture and intranasal silicone splints are both equally effective in preventing complications following septoplasty.

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Pengaruh Teknik Mind Mapping Terhadap Motivasi Belajar dan Keterampilan Menulis Bahasa Inggris Siswa Kelas VIII SMP Negeri 4 Abang

Jurnal Teknologi Pembelajaran Indonesia ◽

10.23887/jtpi.v8i1.2250 ◽

2018 ◽

Vol 8 (1) ◽

Author(s):

ANAK AGUNG AYU SRI MARTINI . ◽

PROF.DR. NASWAN SUHARSONO, M.Pd. . ◽

DR. I MADE KIRNA, M.Si. .

Keyword(s):

Random Sampling ◽

Conventional Technique ◽

Learning Motivation ◽

Mapping Technique ◽

Control Group ◽

Mind Mapping ◽

Control Group Design ◽

Significant Difference ◽

Writing Skill ◽

The Difference

Penelitian ini bertujuan untuk mendeskripsikan perbedaan motivasi belajar dan keterampilan menulis secara bersama-sama diantara siswa yang mengikuti teknik mind mapping dengan siswa yang mengikuti teknik pembelajaran menulis konvensional, perbedaan motivasi belajar antara siswa yang mengikuti teknik mind mapping dengan siswa yang mengikuti teknik pembelajaran menulis konvensional, dan perbedaan keterampilan menulis antara siswa yang mengikuti teknik mind mapping dengan siswa yang mengikuti teknik pembelajaran menulis konvensional. Populasi penelitian ini adalah siswa kelas VIII SMP Negeri 4 Abang dengan 2 kelas dipilih sebagai sampel. Pemilihan sampel dilakukan dengan teknik Random Sampling. Penelitian ini merupakan penelitian quasi experiment dengan rancangan Non Equivalent Pretest-Posttest Control Group Design. Pengumpulan data dilakukan menggunakan angket motivasi belajar menulis dan tes keterampilan menulis. Data yang diperoleh dianalisis dengan MANCOVA dengan menggunakan motivasi belajar awal dan keterampilan menulis awal sebagai kovariat. Pengujian hipotesis dilakukan pada taraf signifikansi 5%. Hasil penelitian menunjukkan bahwa: pertama terdapat perbedaan yang signifikan pada motivasi belajar dan keterampilan menulis secara bersama-sama antara siswa yang mengikuti teknik mind mapping dengan siswa yang mengikuti teknik pembelajaran menulis konvensional; kedua terdapat perbedaan yang signifikan pada motivasi belajar antara siswa yang mengikuti teknik mind mapping dengan siswa yang mengikuti teknik pembelajaran menulis konvensional; ketiga terdapat perbedaan yang signifikan pada keterampilan menulis antara siswa yang mengikuti teknik mind mapping dengan siswa yang mengikuti teknik pembelajaran menulis konvensional.Kata Kunci : Teknik Mind Mapping, Motivasi Belajar, Keterampilan Menulis This study aimed at describing the difference in learning motivation and writing skill simultaneously of the students who learned by mind mapping technique and those who learned by conventional technique, the difference in learning motivation of the students who learned by mind mapping technique and those who learned by conventional technique, the difference in writing skill of the students who learned by mind mapping technique and those who learned by conventional technique. This is a quasi-experimental research with non-equivalent pretest-posttest control group designed. The population of the study was eighth grade students consisting of three classes. The selection of the sample for this study was based on random sampling technique, two classes were selected as the sample, one as the experimental group and the other was the control group. The data was collected by administering students’ learning motivation questionaire and writing test. The data was analyzed by using MANCOVA in which pre-students’ learning motivation and pre-students’ writing skill used as covariat. The hypothesis was tested at 5% level of significance. The results indicated that (1) there was a significant difference in learning motivation and writing skill simultaneously of the students who learned by mind mapping technique and by conventional technique, (2) there was a significant difference learning motivation in writing of the students who learned by mind mapping technique and by conventional technique, (3) there was a significant difference in writing skill of the students who learned mind mapping technique and by conventional technique.keyword : Mind Mapping Technique, Learning Motivation, Writing Skill

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Effects of Orthokeratology Lens On Axial Length Elongation in Myopia With Anisometropia Children

10.21203/rs.3.rs-741927/v1 ◽

2021 ◽

Author(s):

Ziyang Chen ◽

Kai-Ming Chen ◽

Ying Shi ◽

Zhao-Da Ye ◽

Sheng Chen ◽

...

Keyword(s):

Retrospective Study ◽

Axial Length ◽

Statistical Significance ◽

Spherical Equivalent ◽

Significant Difference ◽

The Mean ◽

The Difference ◽

Better Than ◽

Group 1

Abstract AimTo investigate the effect of orthokeratology (OK) lens on axial length (AL) elongation in myopia with anisometropia children.MethodsThirty-seven unilateral myopia (group 1) and fifty-nine bilateral myopia with anisometropia children were involved in this 1-year retrospective study. And bilateral myopia with anisometropia children were divided into group 2A (diopter of the lower SER eye under − 2.00D) and group 2B(diopter of the lower SER eye is equal or greater than − 2.00D). The change in AL were observed.The datas were analysed using SPSS 21.0.Results(1) In group 1, the mean baseline AL of the H eyes and L eye were 24.70 ± 0.89 mm and 23.55 ± 0.69 mm, respectively. In group 2A, the mean baseline AL of the H eyes and L eyes were 24.61 ± 0.84 mm and 24.00 ± 0.70 mm respectively. In group 2B, the mean baseline AL of the H eyes and L eyes were 25.28 ± 0.72 mm and 24.70 ± 0.74 mm. After 1 year, the change in AL of the L eyes was faster than the H eyes in group 1 and group 2A (all P<0.001).While the AL of the H eyes and L eyes had the same increased rate in group 2B. (2) The effect of controlling AL elongation of H eyes is consistent in three groups (P = 0.559).The effect of controlling AL elongation of L eyes in group 2B was better than that in group 1 and group 2A (P < 0.001). And the difference between group 1 and group 2A has no statistical significance. (3) The AL difference in H eyes and L eyes decreased from baseline 1.16 ± 0.55mm to 0.88 ± 0.68mm after 1 year in group 1.And in group 2A, the AL difference in H eyes and L eyes decreased from baseline 0.61 ± 0.34mm to 0.48 ± 0.28mm. There was statistically significant difference (all P<0.001). In group 2B, the baseline AL difference in H eyes and L eyes has no significant difference from that after 1 year (P = 0.069).ConclusionsMonocular OK lens is effective on suppression AL growth of the myopic eyes and reduce anisometropia value in unilateral myopic children. Binocular OK lenses only reduce anisometropia with the diopter of the low eye under − 2.00D. Binocular OK lenses cannot reduce anisometropia with the diopter of the low eye equal or greater than − 2.00D. Whether OK lens can reduce refractive anisometropia value is related to the spherical equivalent refractive of low refractive eye in bilateral myopia with anisometropia children after 1-year follow-up.

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The Effect of Bedside Presentations in the Emergency Department on Patient Satisfaction

Journal of Graduate Medical Education ◽

10.4300/jgme-d-11-00020.1 ◽

2011 ◽

Vol 3 (4) ◽

pp. 481-486 ◽

Cited By ~ 3

Author(s):

Craig I. Schranz ◽

Robert J. Sobehart ◽

Kiva Fallgatter ◽

Robert H. Riffenburgh ◽

Michael J. Matteucci

Keyword(s):

Emergency Department ◽

Patient Satisfaction ◽

Resident Education ◽

Statistical Significance ◽

Future Research ◽

First Year ◽

Convenience Sample ◽

Visual Analog Scales ◽

Significant Difference ◽

The Difference

Abstract Background Due to increasing time constraints, the use of bedside presentations in resident education has declined. We examined whether patient satisfaction in the emergency department is affected when first-year residents present at the bedside with attendings. Methods We performed an observational, prospective, nonblinded study in the emergency department of a military teaching hospital. We alternately assigned first-year residents to present a convenience sample of 248 patients to the attending physician at the patient's bedside or away from the patient. We measured patient satisfaction by using the Patient Satisfaction Questionaire-18 (PSQ-18), a validated survey instrument that utilizes a Likert scale, and additional nonvalidated survey questions involving Likert and visual analog scales. Results While the median PSQ-18 score of 74 (95% confidence interval [CI], 72–76) was higher for patient satisfaction when residents made bedside presentations than that for standard presentations, 72 (95% CI, 70–74), the difference did not reach statistical significance (P = .33). Conclusion There was no significant difference in overall patient satisfaction between residents' bedside presentations and presentations to attendings away from the patient. Although not significant, the differences noted in PSQ-18 subscales of communication, general satisfaction, and interpersonal manner warrant further investigation. Patients did not appear to be uncomfortable with having their care discussed and with having subsequent resident education at the bedside. Future research on patient satisfaction after implementation of standardized bedside teaching techniques may help further elucidate this relationship.

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Evaluation of survival by ADCC status: Subgroup analysis of SB3 (Trastuzumab Biosimilar) and reference trastuzumab in patients with HER2-positive early breast cancer at three-year follow-up.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.15_suppl.580 ◽

2019 ◽

Vol 37 (15_suppl) ◽

pp. 580-580 ◽

Cited By ~ 1

Author(s):

Xavier Pivot ◽

Mark D. Pegram ◽

Javier Cortes ◽

Diana Lüftner ◽

Gary H. Lyman ◽

...

Keyword(s):

Breast Cancer ◽

Early Breast Cancer ◽

Statistical Significance ◽

Phase Iii ◽

Breast Cancer Patients ◽

Her2 Positive ◽

Follow Up Study ◽

Significant Difference ◽

The Difference

580 Background: SB3 is an approved biosimilar of reference trastuzumab (TRZ). At additional 2-year follow-up after completing neoadjuvant and adjuvant treatment, there was a difference in event-free survival (EFS), but no difference in overall survival (OS) between SB3 and TRZ. Upon monitoring quality attributes of TRZ, a marked downward shift in antibody-dependent cell-mediated cytotoxicity activities (ADCC) was observed in TRZ lots with expiry dates from Aug 2018 to Dec 2019. Some of the lots were used in the Phase III study. This is a post-hoc analysis of EFS and OS by ADCC status from a 3-year follow-up to investigate the difference in EFS between SB3 and TRZ. Methods: After completion of neoadjuvant and adjuvant therapy in patients with HER2 positive early breast cancer, patients from selected countries participated in a 5-year follow-up study (NCT02771795). Within the TRZ group, patients exposed to at least one shifted ADCC lot and those never exposed to shifted ADCC lot during neoadjuvant period were considered as “Exposed” and “Unexposed,” respectively. EFS and OS after 3-year follow-up was analyzed by ADCC status in the long-term follow-up set. Results: 367 patients (SB3, N = 186; TRZ, N = 181) were enrolled in the follow-up study. Within TRZ, 55 patients were Unexposed and 126 patients were Exposed. At a median follow-up duration of 40.8 months in SB3 and 40.5 months in TRZ, 3-year EFS rates were 92.5% in SB3, 94.5% in Unexposed, and 82.5% in Exposed and OS rates were 97.0%, 100%, and 90.6%, respectively. Exposed was associated with decreased EFS compared to Unexposed (HR 0.14, 95% CI 0.04-0.51, p= 0.003). There was a trend of decreased OS in Exposed compared to Unexposed, however, there was no significant difference (HR 0.14, 95% CI 0.02-1.15, p= 0.068). Between SB3 and Unexposed, no difference was observed in EFS (HR 1.06, 95% CI 0.33-3.44, p= 0.923), or OS (HR 0.54, 95% CI 0.05-5.44, p= 0.600). Conclusions: Within the TRZ group, Exposed showed significantly lower EFS compared to Unexposed, and a similar trend was observed in OS with no statistical significance. Between SB3 and Unexposed, no significant difference in EFS or OS was observed. Clinical trial information: NCT02771795.

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Psychological factors of delinquent adolescent girls and suicide attempters

Medicina ◽

10.3390/medicina44020019 ◽

2008 ◽

Vol 44 (2) ◽

pp. 147

Author(s):

Virginija Ribakovienë ◽

Virginija Adomaitienë ◽

Diana Danytë ◽

Rûta Kalkytë

Keyword(s):

Adolescent Girls ◽

Externalizing Behavior ◽

Statistical Significance ◽

Delinquent Behavior ◽

Social Competency ◽

Suicide Attempters ◽

Delinquent Girls ◽

Significant Difference ◽

Social Difficulties ◽

The Difference

The aim of this study was to study and compare externalizing and internalizing difficulties, clinical problems of adolescent girls who attempted a suicide and delinquent girls. A total of 100 adolescent girls aged 11–18 years have participated in this study: 50 of them were suicide attempters, and the other 50 girls had problems of delinquent behavior. In this study, the questionnaire ASEBA YSR 11–18 was used. To compare averages, Student’s t and Mann-Whitney’s U tests were applied with a 0.05 level of statistical significance. For adolescent girls who attempted a suicide, more prominent internal difficulties were identified. They were more depressive/anxious, presented more somatic complains, and were more closed/anxious. Those girls felt more anxiety and presented more affective problems. The difference in the average scores of scales of the both groups was statistically significant (P<0.05). Externalizing problems of adolescent suicide attempters did not significantly differ from ones of the girls with delinquent behavior. The average scores of scales on braking of rules and aggression were not significantly different. Girls with delinquent behavior had a higher social competency, and the girls who attempted a suicide more often presented significant social difficulties, though there was no statistically significant difference in the scores on the activity competence scale. Conclusions. The adolescent girls who attempted a suicide have more evident internal difficulties than delinquent girls do, though externalizing behavior difficulties of the suicide attempters are similar to those of girls with delinquent behavior. The girls who attempted a suicide experience more social difficulties, and their social competency is lower when comparing to delinquent girls of the same age.

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Biomechanical Comparison of Plantar-To-Dorsal and Dorsal-To-Plantar Screw Fixation Strength for Subtalar Arthrodesis

Foot & Ankle Orthopaedics ◽

10.1177/2473011419s00363 ◽

2019 ◽

Vol 4 (4) ◽

pp. 2473011419S0036

Author(s):

Ramon Rodriguez ◽

Schouchen Dun ◽

Jun Kit He ◽

Haley McKissack ◽

Glenn S. Fleisig ◽

...

Keyword(s):

Subtalar Joint ◽

Statistical Significance ◽

Fixation Strength ◽

Hard Data ◽

Subtalar Arthrodesis ◽

Significant Difference ◽

Fixation Techniques ◽

The Difference ◽

Student’S T ◽

Dorsal Fixation

Category: Basic Sciences/Biologics, Hindfoot Introduction/Purpose: Arthrodesis of the subtalar joint is performed for various arthritic and instability problems to correct alignment and relieve pain. For talocalcaneal pathologies, isolated subtalar arthrodesis has been advocated with the advantages of lower risk of adjacent joint arthritis and nonunion of the transverse tarsal joint. Internal fixation techniques have varied over time and use of compression screws is common. The screws may be oriented from dorsal to plantar or plantar to dorsal. Arguments favoring one approach over another are based more on “expert opinion” than hard data. The goal of this study was to compare the biomechanical stability of these two constructs to evaluate which creates a more stable construct. Methods: Eight matched pairs of cadaver feet underwent subtalar joint arthrodesis with two 7.3-mm cannulated screws. Randomization was used to assign screw orientation, such that one foot in each pair was assigned dorsal to plantar screw orientation (DP group), and the other foot plantar to dorsal orientation (PD group). Standard surgical technique with fluoroscopy was used for each approach. Following fixation, each specimen was loaded to failure with a Bionix 858 MTS device, applying a downward axial force at a distance to create torque. Torque to failure was compared between DP and PD groups using Student’s T-test, with p = 0.05 used to determine statistical significance. Results: The force to failure was 585.9 ± 201.1 N for the plantar-to-dorsal fixation and 667.2 ± 449.4 N for the dorsal-to-plantar fixation. The moment arm was 55.1 ± 4.7 mm for the dorsal-to-plantar fixation and 54.8 ± 3.9 mm for the plantar-to-dorsal fixation. Statistical analysis demonstrated that the mean torque to failure slightly favored the DP group (37.3 N-m) to the PD group (32.2 N-m). However, the difference between the two groups was not statistically significant (p = 0.55). Conclusion: There is no significant difference in strength between subtalar arthrodesis performed with dorsal-to-plantar screw orientation and plantar-to-dorsal screw orientation. This suggests that selection of technique should depend on the situation and the required advantages of each. Placing the screw from the heel up has the benefit of being an easier approach, allows access to tenser talar bone once the screw is through, and has less risk of neurovascular injury. The dorsal-to-plantar technique allows simple supine positioning of the patient, needs only two fluoroscopic views to check pin position, and allows the surgeon to manipulate the foot more easily.

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