Functional outcome of long proximal femoral nail versus short proximal femoral nail in peritrochanteric fractures

Background: Proximal femoral nail (PFN) is an intramedullary implant which has been commonly used in the fixation of intertrochanteric fractures. However, controversy comes about the effect of nail length on fracture union and other complications. A comparative evaluation of surgical treatment and functional outcome of patients with peritrochanteric fractures treated with short versus long PFN.Methods: Total of 100 patients have been included in study out of which 57 belonged to group 1 and were operated with short PFN and rest 43 were group 2 operated with long PFN. Patients were followed up for 6 months and were compared on various parameters.Results: There is no significant difference noted in the two group. However, the surgical duration and blood loss for short PFN was significantly less as compared to long PFN.Conclusions: Short PFN is better implant for peritrochantric fractures both stable and unstable with quicker surgical time and lesser blood loss.

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Clinical Outcome of Mid-Length Proximal Femoral Nail for Patients With Trochanteric Hip Fractures: Preliminary Investigation in a Japanese Cohort of Patients More Than 70 Years Old

Geriatric Orthopaedic Surgery & Rehabilitation ◽

10.1177/2151459320936444 ◽

2020 ◽

Vol 11 ◽

pp. 215145932093644

Author(s):

Tomohiro Matsumura ◽

Tsuneari Takahashi ◽

Mitsuharu Nakashima ◽

Yoshiya Nibe ◽

Katsushi Takeshita

Keyword(s):

Blood Loss ◽

Internal Fixation ◽

Clinical Outcomes ◽

Hip Fractures ◽

Preliminary Investigation ◽

Japanese Patients ◽

Proximal Femoral Nail ◽

Surgical Time ◽

Japanese Cohort ◽

Femoral Nail

Introduction: The TFN-ADVANCED Proximal Femoral Nailing System (TFNA) 235 mm (DePuySynthes) and Proximal Femoral Nail Antirotation (PFNA)-II 240 mm (DePuySynthes) were developed to obtain better stability for patients with trochanteric hip fractures without increasing surgical time and amount of blood loss. However, there are currently no studies concerning clinical and radiological outcomes of patients treated using these proximal femoral nails (PFNs) that have been performed in the Japanese population. The aim of this study was to retrospectively evaluate the clinical outcomes associated with 235 to 240 mm PFNs for Japanese patients >70 years old with trochanteric hip fractures who could walk independently before the injury. Materials and Methods: This study involved a retrospective analysis of data on trochanteric hip fracture patients who had undergone internal fixation from March 2016 to June 2018. The inclusion criteria were patients >70 years old with trochanteric hip fractures who could walk independently before the injury and were followed up for ≥3 months after surgery. Initially, 124 patients were identified, but 33 of these were excluded because other implants were used for internal fixation. Of the remaining 91 patients in whom PFNs were used at the time of internal fixation who were included for the perioperative evaluation, 66 patients followed up for ≥3 months were included in the clinical evaluations. Results: The average surgical time was 56.8 ± 19.6 minutes (range, 23-123 minutes). The average blood loss was 89 ± 41 mL (range, 0-245 mL). The union rate was 98%. Discussion: There were no cases of nail jamming, and all nails were successfully inserted below the end of the distal isthmus without additional reaming to dilate the canal. Conclusions: Proximal femoral nails were a useful implant in Japanese elderly patients with trochanteric hip fractures and gave comparable clinical outcomes despite the femoral length being short and occurrence of intensive bowing.

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A comparative analysis of outcomes after surgical reconstruction of stenoses in the upper respiratory tract in children

Russian Journal of Pediatric Surgery ◽

10.18821/1560-9510-2021-25-4-235-243 ◽

2021 ◽

Vol 25 (4) ◽

pp. 235-243

Author(s):

A. Yu. Razumovsky ◽

Z. B. Mitupov ◽

V. E. Rachkov ◽

N. S. Stepanenko ◽

A. V. Adler ◽

...

Keyword(s):

Respiratory Tract ◽

Plastic Surgery ◽

Costal Cartilage ◽

Treatment Technique ◽

Upper Respiratory Tract ◽

Surgical Time ◽

Significant Difference ◽

Upper Respiratory ◽

Group 2 ◽

Group 1

Introduction. Definition " upper respiratory tract stenosis " (URTS) includes a large number of nosologies. The most common are cicatricial stenoses, in particular, post-intubation ones as well as bilateral paralysis of the larynx. An important issue for nowadays is choosing the curative modality for such patients.Purpose. To compare outcomes after treating children with URTS.Material and methods. The authors have assessed results of treatment of 110 patients who had reconstructive surgery in 2010-2019. Patients were divided into two groups depending on the nosology: stenosis of the upper respiratory tract (n = 71) and bilateral paralysis of the larynx (n-39). In each group, four types of surgeries were performed: costal cartilage plasty, plasty with T-tube (TT), a modified version of plasty with TT, plasty with a stent. The choice of treatment technique was determined mostly by the tendency to make this or that type of surgery in authors' departments, as well as by the nosology, severity of the disease and patient's age. Decannulation terms, surgical time, early and late postoperative complications as well as relapse-free period were assessed.Results. 66% patients were decannulated in Group 1; in Group 2 - 69%. Group 1 a statistically reliable comparison was possible between the following techniques: costal cartilage plasty and laryngeal stent plasty (p > 0.005) as well as plasty with TT implantation and the proposed modified technique (p > 0.005). While using Mann-Whitney test and Log Rank, the authors found out that in Group 1 there were no significant difference in surgical time, relapse-free period and stenosis degree (p > 0.005). However, decannulation terms after plastic surgery of the larynx with costal cartilage implantation are longer than after plastic surgery with stent implantation (p < 0.005). In Group 2, the authors compared three abovementioned curative modalities, excluding laryngeal plasty with TT implantation. Thus, surgical time for costal cartilage plasty is longer, if to compare to other two techniques (p < 0.005). There is also no significant difference in decannulation terms and relapse-free periods between all three techniques (p > 0.005).Conclusion. The results obtained have demonstrated the effectiveness of long-term stenting with TT placement in children, mainly with cicatricial stenoses, and in older children. The trial also revealed that laryngoplasty with costal cartilage in children with bilateral laryngeal paralysis is an effectiveness choice too.

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Application of Desmopressin and conjugated estrogens to reduce the volume of blood loss during arthroplsty of the hip joint in patients with end stage renal disease

The Scientific Notes of the I P Pavlov St Petersburg State Medical University ◽

10.24884/1607-4181-2019-26-3-57-63 ◽

2020 ◽

Vol 26 (3) ◽

pp. 57-63

Author(s):

N. E. Mushtin ◽

A. N. Tsed ◽

A. K. Dulaev ◽

A. A. Lednev ◽

K. G. Iljushenko ◽

...

Keyword(s):

Body Weight ◽

Renal Replacement Therapy ◽

Kidney Disease ◽

Blood Loss ◽

Replacement Therapy ◽

Hip Joint ◽

Conjugated Estrogens ◽

Significant Difference ◽

Group 2 ◽

Group 1

The objective was to determine the possibilities of using desmopressin and conjugated estrogens during primary hip joint arthroplasty in patients receiving renal replacement therapy.Methods and materials. The material for the study was data on 53 patients with pathology of the hip joint, who underwent primary arthroplasty from 2016 to 2018. All patients were divided into 2 groups. Group 1 (n=23) – patients not suffering from kidney diseases. Group 2 (n=30) – patients receiving renal replacement therapy. Each group was divided into 2 subgroups: 1 subgroup – comparisons, where the combination of desmopressin/conjugated estrogens was not used. 2 subgroup – control, where desmopressin was used at a dosage of 0.4 mg/kg 2 hours before the incision, conjugated estrogens was used at a dosage of 0.6 mg / kg of body weight within 5 days before the operation.Results. In group 1 (patients not suffering from kidney disease), there was no statistically significant difference between the subgroups. In group 2 (patients receiving hemodialysis), there was a statistically significant difference in the volume of blood loss. Thus, in the subgroup without using additional techniques, the volume of intraoperative blood loss was 769.5±389.3 ml; in the second subgroup (using desmopressin and estrogens) – 479.1±245.2 ml. The difference was statistically significant, p<0.05. The efficiency was 27.9 %.Conclusion. The additional use of conjugated estrogens at a dose of 0.6 mg/kg of body weight within 5 days before the operation, desmopressin at a dose of 0.4 mg/kg of body weight 2 hours before the incision reduced blood loss by 27.9 %. The use of combination of conjugated estrogens and desmopressin in patients not suffering from kidney disease did not affect the amount of blood loss.

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Effect of Sustained Uterine Compression versus Uterine Massage on Blood Loss after Vaginal Delivery: A Randomized Controlled Trial

American Journal of Perinatology ◽

10.1055/s-0041-1739409 ◽

2021 ◽

Author(s):

Labib M. Ghulmiyyah ◽

Alaa El-Husheimi ◽

Ihab M. Usta ◽

Cristina Colon-Aponte ◽

Ghina Ghazeeri ◽

...

Keyword(s):

Blood Loss ◽

Vaginal Delivery ◽

Postpartum Hemorrhage ◽

Primary Outcome ◽

Dropout Rate ◽

Significant Difference ◽

Uterine Massage ◽

Secondary Outcomes ◽

Group 2 ◽

Group 1

Objective This study aimed to compare the effectiveness of sustained uterine compression versus uterine massage in reducing blood loos after a vaginal delivery. Study Design This was a prospective randomized trial conducted at the American University of Beirut Medical Center (AUBMC) between October 2015 and October 2017. Inclusion criteria were women with a singleton pregnancy at ≥36 weeks of gestation, with less than three previous deliveries, who were candidates for vaginal delivery. Participants were randomized into two groups, a sustained uterine compression group (group 1) and a uterine massage group (group 2). Incidence of postpartum hemorrhage (blood loss of ≥500 mL) was the primary outcome. We assumed that the incidence of postpartum hemorrhage at our institution is similar to previously published studies. A total of 545 women were required in each arm to detect a reduction from 9.6 to 4.8% in the primary outcome (50% reduction) with a one-sided α of 0.05 and a power of 80%. Factoring in a 10% dropout rate. Secondary outcomes were admission to intensive care unit (ICU), postpartum complications, drop in hemoglobin, duration of hospital stay, maternal pain, use of uterotonics, or of surgical procedure for postpartum hemorrhage. Results A total of 550 pregnant women were recruited, 273 in group 1 and 277 in group 2. There was no statistically significant difference in baseline characteristics between the two groups. Type of anesthesia, rate of episiotomy, lacerations, and mean birth weight were also equal between the groups. Incidence of the primary outcome was not different between the two groups (group 1: 15.5%, group 2: 15.4%; p = 0.98). There was no statistically significant difference in any of the secondary outcomes between the two groups, including drop in hemoglobin (p = 0.79). Conclusion There was no difference in blood loss between sustained uterine compression and uterine massage after vaginal delivery. Key Points

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The Effect of Patient-Specific Instrumentation Incorporating an Extramedullary Tibial Guide on Operative Efficiency for Total Knee Arthroplasty

BioMed Research International ◽

10.1155/2017/2034782 ◽

2017 ◽

Vol 2017 ◽

pp. 1-7 ◽

Cited By ~ 1

Author(s):

Oh-Ryong Kwon ◽

Kyoung-Tak Kang ◽

Juhyun Son ◽

Dong-Suk Suh ◽

Dong Beom Heo ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Patient Specific ◽

Surgical Time ◽

Patient Specific Instrumentation ◽

Significant Difference ◽

Total Knee ◽

Group 3 ◽

Group 2 ◽

Group 1

This retrospective study was to determine if patient-specific instrumentation (PSI) for total knee arthroplasty (TKA) leads to shortened surgical time through increased operating room efficiency according to different tibial PSI designs. 166 patients underwent primary TKA and were categorized into three groups as follows: PSI without extramedullary (EM) tibial guide (group 1, n=48), PSI with EM tibial guide (group 2, n=68), and conventional instrumentation (CI) group (group 3, n=50). Four factors were compared between groups, namely, operative room time, thickness of bone resection, tibial slope, and rotation of the component. The mean surgical time was significantly shorter in the PSI with EM tibial guide group (group 2, 63.9±13.6 min) compared to the CI group (group 3, 82.8±24.9 min) (P<0.001). However, there was no significant difference in the PSI without EM tibial guide group (group 1, 75.3±18.8 min). This study suggests that PSI incorporating an EM tibial guide may lead to high operative efficiency in TKA compared to CI. This trial is registered with KCT0002384.

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Comparison of perioperative parameters in one-handed rotational phacoemulsification versus conventional phacoemulsification and femtosecond laser-assisted cataract surgery

International Journal of Ophthalmology ◽

10.18240/ijo.2021.12.09 ◽

2021 ◽

Vol 14 (12) ◽

pp. 1868-1875

Author(s):

Samuele Gigliola ◽

◽

Alfredo Niro ◽

Carmela Palmisano ◽

Pasquale Puzo ◽

...

Keyword(s):

Endothelial Cell ◽

Femtosecond Laser ◽

Cataract Surgery ◽

The Other ◽

Dissipated Energy ◽

Surgical Time ◽

Significant Difference ◽

Group 3 ◽

Group 2 ◽

Group 1

AIM: To compare perioperative parameters of one-handed rotational phacoemulsification technique (one-handed phaco-roll) with each of other two techniques, “Divide et Conquer” and femtosecond laser-assisted cataract surgery (FLACS) METHODS: In this retrospective and comparative cohort study, eyes with uncomplicated cataract (nuclear density grade 2 to 3) treated routinely with one-handed phaco-roll (n=23; Group 1) or “Divide et Conquer” (n=23; Group 2) or FLACS (n=23; Group 3) were enrolled. Intraoperative parameters including effective phaco-time (EPt), ultrasound time (USt), aspiration time, surgical time, phacoemulsification (phaco)-power, balanced salt solution (BSS) use, cumulative dissipated energy (CDE) were recorded and compared. Clinical outcomes including best corrected visual acuity (BCVA), corneal endothelial cell density (ECD), endothelial cell loss (ECL), central corneal thickness (CCT) and central macular thickness (CMT), were assessed and compared pre-operatively and at 1mo after surgery. RESULTS: Aspiration and surgical time, and BSS used were lower in Group 1 (P<0.01) than other groups. EPt, phaco-power and CDE were lower in Group 1 (P<0.05) than Group 2 but not significantly different from Group 3. In Group 1, USt was lower (P<0.05) than Group 2 but higher (P<0.05) than Group 3. BCVA improved in all groups without significant difference between Group 1 and the other ones. No significant differences regarding all post-operative morphologic outcomes (ECD, ECL, CCT, CMT) were reported. No clinical complications occurred. CONCLUSION: One-handed phaco-roll seems to be less time-consuming than “Divide et Conquer” and FLACS and less energy-consuming than “Divide et Conquer”. Furthermore, one-handed phaco-roll seems to have an equal safety profile compared to the other two techniques.

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Evaluation of Clinical Parameters in FMT-Application of a Vibrant Soundbridge® at the Short Incus Process Compared to Conventional FMT-Application

Surgical Case Reports ◽

10.31487/j.scr.2020.05.04 ◽

2020 ◽

pp. 1-4

Author(s):

Markus Pirlich ◽

Andreas Dietz ◽

Markus Pirlich ◽

Viktor Kunz

Keyword(s):

Pure Tone ◽

Revision Rate ◽

University Hospital ◽

Complication Rates ◽

Vibrant Soundbridge ◽

Surgical Time ◽

Pure Tone Audiogram ◽

Significant Difference ◽

Group 2 ◽

Group 1

Background: The application of the Floating Mass Transducer (FMT) of a Vibrant Soundbridge (VSB) to the short incus process is intended to reduce both the surgery time and the complication and revision rate compared to other forms of application. In addition to collecting these parameters, the aim of this study is to investigate the primary audiological outcome of patients with an FMT application to the short process compared to the conventional methods. Methods: The present study retrospectively examined a total of n=36 patients who received a VSB between 01/2015 and 08/2018 at the ENT University Hospital Leipzig. In n=12 patients (group 1) the FMT was coupled to the short process, in n=24 patients (group 2) to other ear structures. The audiological results were evaluated pre- and postoperatively in the pure tone audiogram according to the recommendations of the AAO-HNS (1995) and the intelligibility (Freiburger, monosyllabic) was measured at 65 dB in the speech audiogram. In addition, the revision and complication rates as well as the surgical time were evaluated. Results: The audiological outcome of group 2 was significantly better postoperatively in both the pure tone (p<.001) and speech audiogram (p=.012). The surgery time of group 1 was significantly shorter (p=.002), but with a slightly increased revision rate (p=.519). The complication rate of group 2 was slightly higher, with no statistically significant difference to group 1 (p=.185). Conclusions: The FMT application on the short ambos process does not seem to offer any advantage in terms of audiological outcome, but at the same time is associated with a significantly shorter surgery time. There are no statistically significant differences in revision and complication rates.

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Comparative study to identify the safety, effectiveness and ease of obstetric forceps for delivery of floating head in cesarean section

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20181575 ◽

2018 ◽

Vol 7 (5) ◽

pp. 1760 ◽

Cited By ~ 1

Author(s):

Sonali Jitendra Ingole ◽

Saloni Manwani

Keyword(s):

Caesarean Section ◽

Blood Loss ◽

Apgar Score ◽

Uterine Artery ◽

Fetal Head ◽

Uterine Incision ◽

Assisted Delivery ◽

Significant Difference ◽

Group 2 ◽

Group 1

Background: Difficulty is frequently encountered in extraction of floating fetal head. This study will focus on comparison of Forceps assisted fetal head extraction during Lower segment caesarean section (LSCS) with manual method of extraction in LSCS.Methods: The ANC patients attending antenatal OPD and admitted for elective caesarean section fulfilling the inclusion criteria were randomly divided into two groups each of 400 patients: Group 1 of patients undergoing manual extraction of fetal head during LSCS; and Group 2 consisting of patients with forceps assisted delivery of fetal head in LSCS. Following factors will be evaluated in patients: maternal blood loss, any extension of uterine incision, difference in pre and post op hemoglobin levels of the patient and Apgar score of baby at 1 and 5 minutes.Results: Patients in both the groups were matched demographically. The demographic variables such as maternal age, weight, parity and MGA (Mean Gestational age) were comparable in both the groups. Blood loss was significant in Group 1 (manual delivery) as compared with Forceps assisted delivery. This is also reflected in difference in pre and post op Hemoglobin levels. Although baby outcome in terms of Apgar score was similar in both groups, however morbidity in terms of uterine artery trauma, extension of uterine incision was much less in group 2 (Forceps assisted LSCS delivery)Conclusions: Although there was no statistically significant difference in outcome of babies (APGAR score), complication(s) were less (blood loss, uterine artery trauma) in Forceps assisted LSCS delivery group. Proper selection of patient(s), early anticipation for application for Forceps can help for better outcome of caesarean delivery.

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A study of management of trochanteric fracture of femur treated with dynamic sliding hip screw-plate device vs. proximal femoral nail

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20171896 ◽

2017 ◽

Vol 3 (3) ◽

pp. 524

Author(s):

Upal Banerjee ◽

Abhishek Chattopadhyay ◽

Nirmal Kumar Dey ◽

Prashant Kumar Sinha ◽

Writtika Chattaraj ◽

...

Keyword(s):

Proximal Femoral Nail ◽

Complication Rates ◽

Trochanteric Fractures ◽

Treatment Groups ◽

Femoral Nail ◽

Duration Of Surgery ◽

Hip Screw ◽

Group 2 ◽

Overall Mortality ◽

Group 1

Background: The incidence of intertrochanteric fractures has been increasing significantly due to the rising age of modern human populations. Generally, intramedullary fixation [proximal femoral nail (PFN) and gamma nail] and extra-medullary fixation [dynamic hip screw (DHS)] are the 2 primary options for treatment of such fractures. Objectives: The goal of this study is to compare the clinical and radiographical results of DHS and PFN for the treatment of trochanteric hip fractures. Methods: Patients with trochanteric fractures were treated either with DHS or PFN in the Department of Orthopaedics, M.G.M. Medical College and L.S.K Hospital, Kishanganj, Bihar from October 2010 to October 2012 were included for this study.Results: Forty three patients (24 male and 19 female, ratio of M:F 1.26:1) surgically treated for trochanteric fractures were divided into two groups. Group 1: 25 hips treated with DHS and group 2: 18 hips treated with PFN. The outcome for each group was analyzed, and total operative time, time to union, complications (early and late), and mortality were recorded. The results were statistically compared. Out of 25 cases of DHS, majority cases (13) took between 1 hour 36 minutes to 2 hours. Whereas, out of 18 cases of PFN, majority (8) took 1 hour to 1 hour 30 minutes. The mean time to union for group 1 was 2.09 months and 1.69 months for group 2. Early and late complication rates between treatment groups revealed no statistically significant differences. Total duration of surgery was significantly lower for PFN than it was for DHS. A comparison of time to union and overall mortality demonstrated no statistically significant differences. Conclusions: We detected no differences between the two treatment groups in regard to early versus late complications, time to union, and overall mortality; however, with its shorter operative period, PFN is a good alternative to the DHS.

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Modified Stapled Transanal Rectal Resection Procedure for Limited Rectal Prolapse: A Viable Alternative to the Delorme Operation

Surgical Innovation ◽

10.1177/1553350620929470 ◽

2020 ◽

pp. 155335062092947

Author(s):

Hua-Xian Chen ◽

Zu-Qing Chen ◽

Liang Huang ◽

Chang-Peng Han ◽

Ruo-Xu Dou ◽

...

Keyword(s):

Blood Loss ◽

Rectal Prolapse ◽

Operative Time ◽

Rectal Resection ◽

Stapled Transanal Rectal Resection ◽

Significant Difference ◽

Delorme’S Procedure ◽

Group 2 ◽

Delorme's Procedure ◽

Group 1

Purpose. The optimal surgical approach for full-thickness rectal prolapse (FTRP) remains controversial. In China, patients with limited FTRP (<5 cm in length) are usually managed by perineal surgery. We retrospectively assessed the outcome of Delorme’s procedure and compared it with modified stapled transanal rectal resection (STARR). Methods. The study was conducted in 2 public tertiary referral centers in China with modified STARR or Delorme's procedure performed by experienced surgeons. Outcomes assessed recurrence, operative times, blood loss, complications, length of hospital stay, and continence and constipation scoring. Results. Between December 2012 and May 2019, 65 patients were assessed, including 48 with modified STARR (group 1) and 17 with Delorme’s procedure (group 2). The median follow-up was 22 months (range, 3-86 months). The mean operative time for group 1 was 37.4 ± 17.5 minutes vs 74.3 ± 30.6 minutes for group 2 ( P < .001). The blood loss for group 1 was significantly lower than that for group 2 (17.4 ± 15.9 mL vs 27.8 ± 16.7 mL, respectively; P = .028). There was no significant difference between groups in recurrence (group 1 18.8% vs group 2 23.5%; P = .944) with no effect of operation type. Both procedures showed improvement in constipation and continence scoring with a similar impact. Conclusions. Modified STARR and the Delorme operation are comparable in managing limited FTRP with superior results in operative time and blood loss for STARR.

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