scholarly journals PEDICLE MORPHOLOGY IN SCOLIOSIS: CLASSIFICATION AGREEMENT FOR PRE-OPERATIVE EVALUATION

2020 ◽  
Vol 19 (3) ◽  
pp. 176-179
Author(s):  
LUIZ EDUARDO PEREIRA COSTA ASSIS DE ALMEIDA ◽  
LUIS EDUARDO CARELLI TEIXEIRA DA SILVA ◽  
CAIQUE JAUHAR DE CASTRO ◽  
GIULIANA VASCONCELOS DE SOUZA FONSECA ◽  
ROBSON TEIXEIRA VITAL ◽  
...  
Keyword(s):  
Interobserver Agreement ◽  
Statistical Significance ◽  
Good Method ◽  
Level Of Evidence ◽  
Type D ◽  
Operative Evaluation ◽  
Pedicle Morphology ◽  
Type C ◽  
The Mean ◽  
Classification Agreement

ABSTRACT Objectives Although Watanabe morphological classification is well known, there is no consensus of its use among spine surgeons. We propose an analysis of the Watanabe classification by three observers, one senior and two recently graduated orthopedic spine surgeons, and its applicability in pre-operative evaluation. Methods An intraobserver and interobserver analysis of the classifications of 937 thoracic pedicles among 55 scoliosis patients treated surgically in two institutions. The average age at time of surgery was 16.3 years (10- 50 years). The etiologies of the scoliosis were: idiopathic (n= 47), congenital (n=4), syndromic (n= 3) and neuromuscular (n=1). The mean Cobb angle was 67 degrees (41- 120º). The evaluation of the thoracic pedicle was performed using pre-operative CT images. Results A total of 937 pedicles were classified by three observers with percentages of 47.5% type A, 28.6% type B, 17.1% type C and 6.9% type D for the total pedicles, convex and concave. Intraobserver agreement was fair to almost perfect (kappa 0.34 to 0.92) and interobserver agreement was fair to moderate (kappa 0.33 to 0.59) with statistical significance of p<0.001. Conclusion Watanabe classification remains a good method for predicting intraoperative difficulties, and has better agreement as the surgeon becomes more experienced. Level of evidence II; Prognostic Studies.

MRI analysis and surgical treatment of Wassel Type IV duplicated thumbs

2021 ◽  
pp. 175319342098321
Author(s):  
Anyuan Wang ◽  
Jian Ding ◽  
Long Wang ◽  
Tinggang Chu ◽  
Zhipeng Wu ◽  
...  
Keyword(s):  
Type A ◽  
Surgical Reconstruction ◽  
Mri Findings ◽  
Level Of Evidence ◽  
Type D ◽  
Type Iv ◽  
Secondary Operations ◽  
Type C

We present the MRI findings for 39 Wassel Type IV duplicated thumbs in 38 patients. We found that MRI revealed the morphology of the cartilaginous connection between the thumb anlages and the location of the deviation corresponding to the classification of Horii, which allowed precise preoperative planning of corrective osteotomies. All 39 thumbs were available for follow-up after surgical reconstruction at a mean of 29 months (range 25 to 39). Four out of nine Horii Type A cases and all 12 Type B, as well as the six Type C and the six Type D cases, achieved good results according to the Tada scoring system. Five Type A cases achieved fair results with residual stiffness of the interphalangeal joint. No secondary operations were needed. We conclude that MRI proved useful in subclassifying Wassel Type IV duplicated thumbs and may aid in planning the osteotomies needed for their reconstruction. Level of evidence: IV

The Die Punch Fragment: Analysis of Fragment Geometry and Need for Fixation

2020 ◽  
Author(s):  
Sezai Özkan ◽  
Svenna H. W. L. Verhiel ◽  
Samantha A. Jayasinghe ◽  
Chaitanya S. Mudgal
Keyword(s):  
Fragment Size ◽  
Distal Radioulnar Joint ◽  
Dorsal Approach ◽  
Level Of Evidence ◽  
Locked Plating ◽  
Fragment Analysis ◽  
Number Of Patients ◽  
Preoperative Ct ◽  
Type C ◽  
The Mean

Abstract Introduction Die punch (DP) fragments are among the most common fracture fragments to lose reduction after volar locked plating of articular distal radius fractures (DRFs). We aimed to report the number of patients in our institution who had a computed tomography (CT)-confirmed DP fragment and who had open reduction and internal fixation (ORIF) through a dorsal approach; to report the length of the radioulnar portion of the DP fragment relative to the total distal radioulnar joint (DRUJ) length; and to identify if an association exists between this length and the choice for a volar versus a dorsal operative approach to the DP fragment. Materials and Methods We performed measurements on the preoperative CT scans of 94 skeletally mature patients with a DP fragment. We also collected data related to their demographics, injury, and treatment. Of the 94 patients in this study, 84 (89%) had AO type C fractures. Results Thirteen out of 94 patients (14%) who had ORIF of their DRF with a DP fragment had a separate dorsal incision. The mean proportion of the DP fragment length relative to the total DRUJ length was 0.51 ± 0.19. There was no association between the length of the DP fragment and volar versus dorsal approach. Conclusion DP fragment size is not an indicator of the need for or use of a dorsal approach in DRF fixation. Level of Evidence This is a Level IV,—retrospective study.

scholarly journals How Reliable is the Radiographic Diagnosis of Mild Madelung Deformity?

2017 ◽  
Vol 07 (03) ◽  
pp. 227-231 ◽  
Author(s):  
Thierry Guitton ◽  
David Ring ◽  
Sebastian Farr ◽  
Keyword(s):  
Online Survey ◽  
Interobserver Agreement ◽  
Study Group ◽  
Diagnostic Study ◽  
Level Of Evidence ◽  
Madelung Deformity ◽  
The Mean ◽  
Sensitivity Specificity ◽  
Relationship Of ◽  
The Relationship

Background Patients with Madelung deformity exhibit a spectrum of mild to severe deformity and distortion of wrist geometry. It may be difficult to reliably distinguish mild Madelung deformity from normal. Purpose This study thus tested the reliability of the diagnosis of mild Madelung deformity on a single posteroanterior (PA) radiograph. Materials and Methods An online survey was sent to hand and wrist surgeons of the Science of Variation Study Group for evaluation of 25 PA wrist radiographs comprising five adults with suspected mild Madelung deformity and 20 radiographs without any evident wrist pathology. Interobserver agreement was evaluated both via average percent agreement and Fleiss' kappa. To evaluate the relationship of rater characteristics and accuracy, a linear regression model was computed. Results The interobserver agreement among the 69 participating surgeons was low (Κ = 0.12). The overall sensitivity, specificity, and accuracy were 0.30, 0.86, and 0.75, respectively. The mean confidence was 7.4 ± 0.4 for mild Madelung and 7.8 ± 0.5 for normal (p = 0.112). The observers' confidence level was the only factor which had a mild but significant effect on the accuracy of the ratings. Conclusion The diagnosis of mild Madelung deformity on a single PA radiograph is unreliable. Level of Evidence The level of evidence is II, diagnostic study.

Clinical and Radiographic Outcomes of Percutaneous Chevron-Akin Osteotomies for the Correction of Hallux Valgus Deformity

2021 ◽  
pp. 107110072110312
Author(s):  
Christopher M. Mikhail ◽  
Jonathan Markowitz ◽  
Luca Di Lenarda ◽  
Javier Guzman ◽  
Ettore Vulcano
Keyword(s):  
Hallux Valgus ◽  
Breakthrough Pain ◽  
Good Method ◽  
Valgus Deformity ◽  
Level Of Evidence ◽  
Radiographic Outcomes ◽  
Hallux Valgus Deformity ◽  
Large Patient ◽  
Valgus Angle ◽  
The Mean

Background: Hallux valgus is a common cause of pain and dysfunction of the foot, sometimes requiring surgical correction when conservative measures fail. Although there are many methods of correction, one of the newer techniques is minimally invasive chevron-Akin (MICA). The aim of the current study is to evaluate clinical and radiographic effectiveness of MICA and narcotic use in a large patient cohort. Methods: All patients in this retrospective study were treated by a single fellowship-trained foot and ankle orthopedic surgeon. Patient demographics were collected for all cases. Preoperative and postoperative intermetatarsal angle (IMA) and hallux valgus angle (HVA) were measured in all patients on weightbearing 3-views radiographs. The Foot Function Index (FFI) was obtained pre- and postoperatively at each visit. All patients were prescribed regular use of ibuprofen for 3 days with acetaminophen and oxycodone reserved for breakthrough pain. Use of narcotic pain medication was recorded. Results: A total of 274 feet in 248 patients were included in the study. Overall, 87.9% were female and 12.1% were male. The mean preoperative IMA and HVA were 13.4 and 29.1 degrees, respectively. The postoperative IMA and HVA were 4.9 and 8.9 degrees, respectively. The mean FFI score part A was 92 preoperatively and 43 postoperatively. Patient satisfaction was 91.6%. The mean postoperative 5 mg oxycodone pill consumption was 2.2. Conclusion: MICA is good method to correct hallux valgus deformity with low postoperative narcotic use. Level of Evidence: Level III, this is a restrospective cohort study of a single surgeon practice.

scholarly journals COMPARISON BETWEEN RADIOGRAPHIC METHODS OF MEASURING FLEXIBILITY IN SCOLIOSIS

2021 ◽  
Vol 20 (2) ◽  
pp. 84-88
Author(s):  
André Sousa Garcia ◽  
Fábio Antonio Vieira ◽  
José Thiago Portella Kruppa ◽  
Renato Hiroshi Salvioni Ueta ◽  
Eduardo Barros Puertas
Keyword(s):  
Cohort Study ◽  
Idiopathic Scoliosis ◽  
Cobb Angle ◽  
Retrospective Cohort ◽  
Statistical Significance ◽  
Diagnostic Study ◽  
Level Of Evidence ◽  
Postoperative Result ◽  
Scoliotic Deformity ◽  
The Mean

ABSTRACT Objective: To determine the preoperative radiographic method for measuring the Cobb angle that is closest to the postoperative result in patients with scoliotic deformity. Methods: Retrospective cohort study of radiographic spinal evaluation (preoperative posteroanterior (PA), bending, traction, traction under anesthesia and immediate postoperative posteroanterior (PO)) of 26 patients treated surgically for scoliotic deformities during the period from January 2017 to September 2019. The final mean Cobb angle and its decrease in relation to the PA value were evaluated in the three curves in patients with idiopathic (IS) and non-idiopathic scoliosis. Results: All the mean curve values were statistically significant, except for bending in non-idiopathic scoliosis (non-IS). The mean traction under anesthesia values were closer to the PO values. Regarding the delta (decrease) of the maneuvers in relation to the PA, no statistical significance was observed in the non-IS group. The traction under anesthesia maneuver had a greater delta in all curves. Conclusions: The traction under anesthesia maneuver in patients with idiopathic scoliosis is the method with the greatest flexibility and which best predicts the postoperative result. Level of evidence III; Diagnostic study.

scholarly journals Surgical management and follow up of patients with bile duct injuries in tertiary health care institute

2021 ◽  
Vol 8 (3) ◽  
pp. 954
Author(s):  
Shahnawaz Akram ◽  
Sadaf Ali ◽  
Omer Javid Shah ◽  
Anzar Santosh
Keyword(s):  
Bile Duct ◽  
Bile Duct Injury ◽  
Type D ◽  
Bile Duct Injuries ◽  
Definitive Repair ◽  
Type C ◽  
The Mean ◽  
Surgical Unit

Background: Bile duct injury is an iatrogenic catastrophe associated with significant mortality, morbidity, decrease quality of life and higher rates of subsequent litigation. We conducted a study to analyse the presentation and pattern of bile duct injury managed at our surgical unit. Operative details, type of surgery, complications associated with the repair and Follow up in terms of liver function tests.Methods: The study included evaluation of 56 patients who had suffered bile duct injuries and then were subsequently being managed surgically at our institute retrospectively from October-2009 to 2012 and prospectively onwards till October- 2014. The mean follow up period in case of our study was 26.8 months. The follow up LFTs were performed at regular intervals. MRCP was used as a gold standard investigation.Results: jaundice (64.2%) was the most common presentation. Injuries noted were, type E1 in 16 (28.5%),type E2 in 11(19.6%), type E3 in 1 (1.8%), type A in 2 (3.6%), type B in 3 (5.4%), type C in 5 (9%) and type D in 18 (32.1%) of patients. Roux-en-y Hepatico-jejunostomy was the common definitive repair performed (85.7%) with various modifications. The mean bilirubin levels and ALP levels showed a downward trend in follow up .5 patients were readmitted with features of cholangitis in which 2 patients were reoperated and 3 patients were managed conservatively, 2 patients died.Conclusions: The management of patients with BDI is a challenge for a surgeon and often requires the skills of experienced hepatobiliary surgeons at tertiary referral canters.  

Robotic and open partial nephrectomy for tumors in a solitary kidney

2020 ◽  
Vol 13 (5) ◽  
pp. 349-355
Author(s):  
Zain A Abedali ◽  
M Francesca Monn ◽  
Brent E Cleveland ◽  
Jay Sulek ◽  
Clinton D Bahler ◽  
...  
Keyword(s):  
Standard Deviation ◽  
Partial Nephrectomy ◽  
Statistical Significance ◽  
Solitary Kidney ◽  
Level Of Evidence ◽  
Safe Alternative ◽  
Open Partial Nephrectomy ◽  
Robotic Assisted ◽  
The Mean ◽  
Robotic Assisted Partial Nephrectomy

Introduction and objective: Traditionally, patients with renal masses in solitary kidneys were managed with an open partial nephrectomy. With improving techniques, robotic-assisted partial nephrectomy in the setting of a solitary kidney is increasingly utilized. The objective of this study was to compare open partial nephrectomy and robotic-assisted partial nephrectomy outcomes in solitary kidney patients. Methods: A retrospective study of 536 total patients who underwent partial nephrectomy between 2004–2016 was performed. Of these patients, 23 had a renal mass in a solitary kidney. Patient demographics, perioperative values, and surgical outcomes were analyzed using descriptive statistics to compare open partial nephrectomy to robotic-assisted partial nephrectomy. Results: Of the 23 patients in the cohort, 52% ( n=12) underwent open partial nephrectomy and 48% ( n=11) underwent robotic-assisted partial nephrectomy. Patient characteristics were not significantly different. The mean (standard deviation) nephrometry score was 6.9 (1.8) for open partial nephrectomy and 6.1 (1.9) for robotic-assisted partial nephrectomy ( p=0.290). The mean (standard deviation) pre-operative creatinine was 1.2 (0.3) in open partial nephrectomy and 1.5 (0.4) in robotic-assisted partial nephrectomy, which did not reach statistical significance ( p=0.110). No difference in postoperative kidney function, Clavien grade 3 or higher complication rate, blood loss, or hospitalization length was noted. Conclusion: Although traditionally patients with a tumor in a solitary kidney are counseled to undergo open partial nephrectomy, robotic-assisted partial nephrectomy is a safe alternative with no decrease in postoperative renal function when compared with a similar cohort of patients undergoing open partial nephrectomy in a solitary kidney. Level of evidence: Level II

scholarly journals EVALUATION OF ROD BREAKAGE AFTER THREE-COLUMN OSTEOTOMY

2020 ◽  
Vol 19 (1) ◽  
pp. 44-47
Author(s):  
FERNANDO BRENO DE OLIVEIRA RIBEIRO ◽  
ALDERICO GIRÃO CAMPOS DE BARROS ◽  
JUAN DANIEL PAZOS AQUINO ◽  
RODRIGO JOSÉ FERNANDES DA COSTA ◽  
LUIS EDUARDO CARELLI TEIXEIRA DA SILVA
Keyword(s):  
Logistic Regression ◽  
Regression Analysis ◽  
Logistic Regression Analysis ◽  
Statistical Significance ◽  
Pedicle Subtraction Osteotomy ◽  
Categorical Variables ◽  
Level Of Evidence ◽  
Vertebral Column Resection ◽  
Rod Breakage ◽  
The Mean

ABSTRACT Objective To identify the incidence and possible risk factors associated with rod breakage in patients who underwent vertebral column resection (VCR) or pedicle subtraction osteotomy (PSO) to treat complex deformities of the spine. Methods Retrospective analysis of a series of 32 patients operated from 2014 to 2018 in a single center. The patients were analyzed for demographic (sex, age), biometric (BMI), radiographical (pre- and postoperative angular variations), and surgical (arthrodesed and osteotomized levels) characteristics. Descriptive analyses were performed for the numerical variables (mean, standard deviation, maximum, median, and minimum) and frequency analysis was performed for the categorical variables. Logistic regression analysis was performed for the dependent variable “rod breakage”, using a stepwise technique to select the variables for the best model, assuming statistical significance of 0.05. Results Of the 32 patients selected, rod breakage occurred in 34.4%. Mean age was 36.6 years (± 19.8), ranging from 10 to 74 years, and the mean BMI was 25.1 (±6.0). Most patients were subjected to VCR (75.0%), were males (56.2%) and did not smoke (90.6%). Logistic regression analysis showed that “arthrodesed levels” were was positively associated with rod breakage (OR 1.72; CI95%: 1.13-3.10; p<0.05). The other factors were not associated with breakage. Conclusion Rod breakage is a frequent complication after three-column osteotomy, especially in long constructions. Level of evidence III; Retrospective Study.

Classification of Esophageal Strictures following Esophageal Atresia Repair

2017 ◽  
Vol 28 (03) ◽  
pp. 243-249 ◽  
Author(s):  
Francesco Macchini ◽  
Giovanni Parente ◽  
Giorgio Farris ◽  
Valerio Gentilino ◽  
Ernesto Leva ◽  
...  
Keyword(s):  
Esophageal Atresia ◽  
Linear Regression Analysis ◽  
Type D ◽  
Anastomotic Strictures ◽  
Esophageal Strictures ◽  
Type C ◽  
The Mean

Introduction The aim of this study was to stratify anastomotic strictures (AS) following esophageal atresia (EA) repair and to establish predictors for the need of dilations. Materials and Methods A retrospective study on children operated on for EA between 2004 and 2014 was conducted. The stricture index (SI) was measured both radiologically (SIXR) and endoscopically (SIEND). A correlation analysis between the SI and the number of dilations was performed using Spearman's test and linear regression analysis. Results In this study, 40 patients were included: 35 (87.5%) presented with Gross's type C EA, 3 (7.5%) type A, 1 (2.5%) type B, and 1 (2.5%) type D. The mean follow-up time was 101 ± 71.1 months (range: 7.8–232.5, median: 97.6). The mean SIXR was 0.56 ± 0.16 (range: 0.15–0.86). The mean SIEND was 0.45 ± 0.22 (range: 0.15–0.85). Twenty-four patients (60%) underwent a mean of 2 endoscopic dilations (range: 1–9). The number of dilations was poorly correlated with SIXR, while significantly correlated with SIEND. Patients who did not need dilations had a SIEND < 0.33, patients who needed only one dilation had 0.33 ≤ SIEND < 0.44, and those with SIEND ≥ 0.44 needed two or more dilations. No significant association with other clinical variables was found. All patients were asymptomatic at the time of the first endoscopy. Conclusion SIEND is a useful tool to classify AS and can represent a predictor of the need for endoscopic dilation. The role of the SIEND becomes even more important as clinical characteristics have a low predictive value for the development of an AS and the need for subsequent endoscopic esophageal dilatations.

scholarly journals Subtalar arthrodesis

2019 ◽  
Vol 13 (1) ◽  
pp. 28-34
Author(s):  
Jim Paiva ◽  
Henrique Mansur ◽  
Túlio Vieira Coimbra ◽  
Isnar Moreira Castro Junior
Keyword(s):  
Statistical Significance ◽  
Calcaneal Fracture ◽  
Fusion Rate ◽  
Etiologic Factor ◽  
P Value ◽  
Level Of Evidence ◽  
Subtalar Arthrodesis ◽  
Evaluation Time ◽  
Final Sample ◽  
The Mean

Objective: To evaluate whether there is a difference in the fusion rates of subtalar arthrodesis using one or two compression screws. Methods: A retrospective study evaluated the fusion rate of patients subjected to subtalar arthrodesis between January 2012 and December 2016. Fusion was determined clinically using radiographs and, in the case of doubt, computed tomography. Results: The final sample consisted of 80 patients, 78.8% of whom were male, and the mean final evaluation time was 23.27 months. Subtalar arthrosis due to a calcaneal fracture was the etiologic factor in 95% of the patients. The group subjected to arthrodesis with one screw represented 68.75% of the patients, and the group with two screws represented 31.25% of the patients. The incidence of nonfusion was 10.9% in the group where one screw was used against 4.0% in the group where two screws were used, without statistical significance (p-value = 0.425). Conclusion: The use of a second screw did not improve the fusion rates of subtalar arthrodesis. Level of Evidence III; Therapeutic Studies; Retrospective Comparative Studies.

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