scholarly journals Short and medium term outcome of surgical treatment of the floating shoulder

2020 ◽  
Vol 6 (4) ◽  
pp. 678
Author(s):  
Niranjan Tadvi
Keyword(s):  
Surgical Treatment ◽  
Functional Outcome ◽  
Traffic Accidents ◽  
Road Traffic ◽  
Bone Fractures ◽  
Rare Injury ◽  
Term Outcome ◽  
Floating Shoulder ◽  
The Mean

<p class="abstract"><strong>Background:</strong> Floating shoulder are rare injuries just because of high velocity of trauma and road traffic accidents. The aim of this study was to evaluate the functional outcome of surgically treated clavicle, glenoid and both bone injuries.</p><p class="abstract"><strong>Methods:</strong> This prospective study was conducted in the department of orthopaedics, Sir. T. Hospital, Bhavnagar from October 2009 to November 2013. Out of 25 patients all turned up for follow up. Functional and clinical assessments done with range of movements in surgically treated fractures of clavicle, glenoid and both bone group.<strong></strong></p><p class="abstract"><strong>Results:</strong> All bone fractures are united in all the patients. The mean follow up period was 30 months. The mean functional result was assessed using Rowe score to assesses the function, pain, stability and motion. All the cases showed excellent to fair results after follow up period.</p><p class="abstract"><strong>Conclusions:</strong> Surgical treatment for double disruption of the superior shoulder suspensory complex, which is inherently an unstable and rare injury, is a good option, allowing early rehabilitation and improving the functional outcome.</p>

scholarly journals Outcome of tibial diaphyseal fracture fixation with Surgical Implant Generation Network (SIGN) nail

2019 ◽  
Vol 6 (2) ◽  
pp. 5-11
Author(s):  
Balakrishnan M. Acharya ◽  
Rojan Tamrakar ◽  
Pramod Devkota ◽  
Abhishek K. Thakur ◽  
Suman K. Shrestha
Keyword(s):  
Road Traffic ◽  
Bone Fractures ◽  
Long Bone ◽  
Fracture Union ◽  
Surgical Implant ◽  
Non Union ◽  
Generation Network ◽  
Diaphyseal Fractures ◽  
The Mean

Introductions: Fractures of diaphyseal region of the tibial bone are amongst the most commonly seen extremity injuries in the developing countries. The surgical implant generation network (SIGN) intramedullary (IM) nail was designed for the treatment of long bone fractures in the developing nations. Methods: From March 2008 to December 2018, a total of 104 patients with 104 tibial diaphyseal fractures were treated with SIGN IM nail. The follow-up visits were arranged at 6, 12, 24 weeks and one-year post operatively. During follow-up visits, the signs of fracture union clinically as well as radiologically and the presence of complications any were recorded and analyzed. Results: The mean age of the patients was 32.81 (16 – 65) years, male 74 (71.2%) and female 30 (28.8%). Majority of the patients 70 (67.3%) had fractures after road traffic accidents. The mean time of surgery was 13.58 (1 – 463) days. Six (5.8%) patients had delayed union and no non-union was detected. We had 10 cases (9.6%) of mal-alignment but were on acceptable range. Conclusions: In the developing country like Nepal, the SIGN nail is an effective surgical implant for the management of the tibial diaphyseal fractures with good result of fracture union and low rates of nonunion, mal-alignment and manageable complications.

scholarly journals Long-term Outcome of Surgical Treatment with Various Reinforcement Material Grafts on Scleromalacia

2021 ◽  
Vol 62 (10) ◽  
pp. 1348-1354
Author(s):  
Sang Wook Jin ◽  
Hyun Chul Jeong ◽  
Hee Jung Cho ◽  
Woo Chan Park
Keyword(s):  
Surgical Treatment ◽  
Amniotic Membrane ◽  
Amniotic Membrane Transplantation ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Conjunctival Flap ◽  
Reinforcement Material ◽  
The Mean

Purpose: To investigate the long-term efficacy and stability of the use of various reinforcement material grafts on scleromalacia.Methods: This retrospective study was conducted on scleromalacia patients who underwent surgical treatment with reinforcement material grafts from January 2012 to March 2019. The choice of amniotic membrane, Tenon’s capsule, acellular sclera, or collagen matrix implanted in the area of scleromalacia was made based on disease severity. Amniotic membrane transplantation with a pedicular rotatory inferior conjunctival flap was performed to prevent having a bare sclera. The patient demographics, cause of scleromalacia, best-corrected visual acuity (BCVA), recurrence rate, postoperative complications, and restoration appearance were evaluated.Results: A total of 58 patients (58 eyes) were enrolled in this study. The mean age of patients was 65.7 ± 9.6 years, and 32 patients (55.2%) were women. The mean follow-up period was 28.1 ± 17.3 months. The most common cause of scleromalacia was pterygium operation (53 patients, 91.4%). The reinforcement materials were mainly amniotic membrane (31 patients, 53.4%) and acellular sclera (15 patients, 25.7%). There was no recurrence of scleromalacia or structural instability during the follow-up period. The preoperative and postoperative mean BCVA values were 0.24 ± 0.24 and 0.21 ± 0.23 logMAR, respectively. Wound dehiscence (three patients, 5.2%) and conjunctival cyst (three patients, 5.2%) occurred with the highest frequency.Conclusions: The use of the appropriate reinforcement material graft according to the severity of scleromalacia and amniotic membrane transplantation using a pedicular rotatory inferior conjunctival flap to prevent a bare sclera can be effective for treating scleromalacia, without long-term recurrence.

A Differential Approach to the Choice of Treatment of Facial Bone Fractures in the Children

10.12737/3564 ◽  
2014 ◽  
Vol 8 (1) ◽  
pp. 1-5
Author(s):  
Тихонов ◽  
E. Tikhonov ◽  
Харитонов ◽  
D. Kharitonov ◽  
Гаршина ◽  
...  
Keyword(s):  
High Speed ◽  
Traffic Accidents ◽  
Road Traffic ◽  
Bone Fractures ◽  
Facial Bone ◽  
Differential Approach ◽  
Fractures In Children ◽  
Choice Of Treatment ◽  
Post Traumatic

The choice of treatment of facial bone fractures in the early age remains a challenge for dentists and maxillofacial surgeons due to the peculiarities of child organism. The purpose of this study was to develop a differential approach to the choice of treatment of children´s facial bone fractures taking into account the age of a child, location of injury and possible complications. This paper presents the analysis of current epidemiological situation regarding to facial bone fractures in children in Voronezh city and Voronezh region. It is shown that the most common injuries is a fall from a height of its own growth, i.e. low-trauma; at the same time the number of high-speed traumas, such as road-traffic accidents, high falls, has decreased. The analysis was carried out 58 cases of facial bone fractures in a group of children from 1 month to 16 years being treated in Maxillofacial Department of Voronezh Regional Pediatric Hospital №2. The developed model of differential choice of treatment of facial bone fractures in children allows to choosing the method taking into account a child age, location of injury and severity, as well as possible consequences of surgery. The clinical monitoring has proved the efficacy of the model which gives an opportunity to decrease post-traumatic complications associated with growth and occlusion deformations as well as complications of inflammatory genesis. It was convincingly shown the need for follow-up care of children with facial fracture that the doctor-orthodontist should continue. The presented data of this study about correlation between surgical and conservative treatment of facial bone fractures in children coincide with the worldwide statistics showing the current tendency to a wide application of mini-invasive methods of fractures fragments immobilization.

Long-term functional outcome of surgical treatment for degenerative cervical myelopathy

2021 ◽  
pp. 1-11
Author(s):  
Mark D. Dijkman ◽  
Martine W. T. van Bilsen ◽  
Michael G. Fehlings ◽  
Ronald H. M. A. Bartels
Keyword(s):  
Surgical Treatment ◽  
Functional Outcome ◽  
Cervical Myelopathy ◽  
Minimal Clinically Important Difference ◽  
Clinically Important Difference ◽  
Surgical Data ◽  
The Mean ◽  
Degenerative Cervical Myelopathy

OBJECTIVE Degenerative cervical myelopathy (DCM) is a major global cause of spinal cord dysfunction. Surgical treatment is considered a safe and effective way to improve functional outcome, although information about long-term functional outcome remains scarce despite increasing longevity. The objective of this study was to describe functional outcome 10 years after surgery for DCM. METHODS A prospective observational cohort study was undertaken in a university-affiliated neurosurgery department. All patients who underwent surgery for DCM between 2008 and 2010 as part of the multicenter Cervical Spondylotic Myelopathy International trial were included. Participants were approached for additional virtual assessment 10 years after surgery. Functional outcome was assessed according to the modified Japanese Orthopaedic Association (mJOA; scores 0–18) score at baseline and 1, 2, and 10 years after surgery. The minimal clinically important difference was defined as 1-, 2-, or 3-point improvement for mild, moderate, and severe myelopathy, respectively. Outcome was considered durable when stabilization or improvement after 2 years was maintained at 10 years. Self-evaluated effect of surgery was assessed using a 4-point Likert-like scale. Demographic, clinical, and surgical data were compared between groups that worsened and improved or remained stable using descriptive statistics. Functional outcome was compared between various time points during follow-up with linear mixed models. RESULTS Of the 42 originally included patients, 37 participated at follow-up (11.9% loss to follow-up, 100% response rate). The mean patient age was 56.1 years, and 42.9% of patients were female. Surgical approaches were anterior (76.2%), posterior (21.4%), or posterior with fusion (2.4%). The mean follow-up was 10.8 years (range 10–12 years). The mean mJOA score increased significantly from 13.1 (SD 2.3) at baseline to 14.2 (SD 3.3) at 10 years (p = 0.01). A minimal clinically important difference was achieved in 54.1%, and stabilization of functional status was maintained in 75.0% in the long term. Patients who worsened were older (median 63 vs 52 years, p < 0.01) and had more comorbidities (70.0% vs 25.9%, p < 0.01). A beneficial effect of surgery was self-reported by 78.3% of patients. CONCLUSIONS Surgical treatment for DCM results in satisfactory improvement of functional outcome that is maintained at 10-year follow-up.

scholarly journals P014: Incidental findings in trauma whole-body CT scans: a systematic review

CJEM ◽  
2020 ◽  
Vol 22 (S1) ◽  
pp. S69-S69
Author(s):  
V. Tsang ◽  
K. Bao ◽  
J. Taylor
Keyword(s):  
Systematic Review ◽  
Incidental Findings ◽  
Traffic Accidents ◽  
Road Traffic ◽  
Subsequent Treatment ◽  
Whole Body ◽  
Trauma Patients ◽  
Patient Demographics ◽  
Study Results

Introduction: Whole-body computed tomography scans (WBCT) are a mainstay in the work-up of polytrauma or multiple trauma patients in the emergency department. While incredibly useful for identifying traumatic injuries, WBCTs also reveal incidental findings in patients, some of which require further diagnostic testing and subsequent treatment. Although the presence of incidental findings in WBCTs have been well documented, there has been no systematic review conducted to organize and interpret findings, determine IF prevalence, and document strategies for best management. Methods: A systematic review was conducted using MEDLINE, PUBMED, and EMBASE. Specific journals and reference lists were hand-mined, and Google Scholar was used to find any additional papers. Data synthesis was performed to gather information on patient demographics, prevalence and type of incidental findings (IFs), and follow-up management was collected. All documents were independently assessed by the two reviewers for inclusion and any disagreements were resolved by consensus. Results: 1231 study results were identified, 59 abstracts, and 12 included in final review. A mean of 53.9% of patients had at least one IF identified, 31.5% had major findings, and 68.5% had minor findings. A mean of 2.7 IFs per patient was reported for articles that included number of total IFs. The mean age of patients included in the studies were 44 years old with IFs more common in older patients and men with more IFs than women. IFs were most commonly found in the abdominal/pelvic region followed by kidneys. Frequency of follow-up documentation was poor. The most common reported mechanisms of injury for patients included in the study were MVA and road traffic accidents (60.0%) followed by falls from >3m (23.2%). Conclusion: Although there is good documentation on the mechanism of injury, patient demographics, and type of IF, follow-up for IFs following acute trauma admission lacks documentation and follow-up and is an identified issue in patient management. There is great need for systematic protocols to address management of IFs in polytrauma patients.

Robotic-Assisted Patellofemoral Replacement—Correlation of Preoperative Planning with Intraoperative Implant Position and Early Clinical Experience: A Minimum 2-Year Follow-up

2020 ◽  
Author(s):  
Veenesh Selvaratnam ◽  
Andrew Cattell ◽  
Keith S. Eyres ◽  
Andrew D. Toms ◽  
Jonathan R. P. Phillips ◽  
...  
Keyword(s):  
Functional Outcome ◽  
Preoperative Planning ◽  
Trochlear Dysplasia ◽  
Oxford Knee Score ◽  
Implant Position ◽  
Robotic Assisted ◽  
Implant Positioning ◽  
Flexion Extension ◽  
The Mean

AbstractPatello-femoral arthroplasty (PFA) is successful in a selected group of patients and yields a good functional outcome. Robotic-assisted knee arthroplasty has been shown to provide better implant positioning and alignment. We aim to report our early outcomes and to compare Mako's (Robotic Arm Interactive Orthopaedic System [RIO]) preoperative implant planning position to our intraoperative PFA implant position. Data for this study was prospectively collected for 23 (two bilateral) patients who underwent robotic-assisted PFA between April 2017 and May 2018. All preoperative implant position planning and postoperative actual implant position were recorded. Presence of trochlear dysplasia and functional outcome scores were also collected. There were 17 (two bilateral) female and 6 male patients with a mean age of 66.5 (range: 41–89) years. The mean follow-up period was 30 (range: 24–37) months. Eighteen knees (72%) had evidence of trochlear dysplasia. The anterior trochlear line was on average, 7.71 (range: 3.3–11.3) degrees, internally rotated to the surgical transepicondylar axis and on average 2.9 (range: 0.2–6.5) degrees internally rotated to the posterior condylar line. The preoperative planning range was 4-degree internal to 4-degree external rotation, 4-degree varus to 6-degree valgus, and 7-degree flexion to 3-degree extension. The average difference between preoperative planning and intraoperative implant position was 0.43 degrees for rotation (r = 0.93), 0.99 degrees for varus/valgus (r = 0.29), 1.26 degrees for flexion/extension (r = 0.83), and 0.34 mm for proudness (r = 0.80). Six patients (24%) had a different size component from their preoperative plan (r = 0.98). The mean preoperative Oxford Knee Score (OKS) was 16 and the mean postoperative OKS was 42. No patient had implant-related revision surgery or any radiological evidence of implant loosening at final follow-up. Our early results of robotic PFA are promising. Preoperative Mako planning correlates closely with intraoperative implant positioning. Longer follow-up is needed to assess long-term patient outcomes and implant survivorship.

Long-Term Outcomes of Patients with Hydrocephalus Secondary to Tectal Plate Glioma versus Idiopathic Aqueductal Stenosis: Results from a Single Center

2021 ◽  
pp. 1-11
Author(s):  
Hamid Reza Niknejad ◽  
Melissa Frederickx ◽  
Emiel Salaets ◽  
Jurgen Lemiere ◽  
Lieven Lagae ◽  
...  
Keyword(s):  
Aqueductal Stenosis ◽  
Maximum Diameter ◽  
Benign Tumors ◽  
Term Outcome ◽  
Adequate Treatment ◽  
Long Term Outcome ◽  
Tectal Plate ◽  
The Mean

<b><i>Introduction:</i></b> Tectal plate gliomas (TPG) constitute a distinct entity of benign tumors of the brain stem which show an indolent clinical course. Adequate treatment of secondary hydrocephalus is undoubtedly a major factor in the outcome. However, little is known about to what degree the tumor itself determines the long-term outcome of these patients. <b><i>Methods:</i></b> We retrospectively analyzed and compared the clinical and radiological data of 16 pediatric TPG patients with data of 12 pediatric idiopathic aqueductal stenosis (IAS) patients treated in our center from 1988 to 2018. For both groups, we assessed the long-term outcome in terms of hydrocephalus management, and for the TPG group, we assessed tumor growth during follow-up. In a separate prospective part of the study, we performed a neuropsychological evaluation in a subgroup of patients using a standardized testing battery, covering intelligence, learning, memory, executive functions, and an inventory on depression. <b><i>Results:</i></b> In the TPG group, the mean clinical and radiological follow-up was 84 and 70 months, respectively. On average, the maximum diameter of the tumor increased by 11% (<i>p</i> = 0.031) and the estimated tumor volume with 35% (<i>p</i> = 0.026) on radiological follow-up. The fronto-occipital horn ratio (FOHR) decreased by 23% on average after treatment. In the IAS group, the mean clinical and radiological follow-up was 117 and 85 months, respectively. In this group, the FOHR decreased by 21% on average. Neurocognitive testing revealed significant higher scores in the TPG group on global intelligence (TPG = 109, IAS = 85.5, <i>U</i> = 3, <i>p</i> &#x3c; 0.01, <i>z</i> = −2.71), performance (TPG= 100, IAS = 85, <i>U</i> = 7, <i>p</i> = 0.03, <i>z</i> = −2.2), and verbal intelligence (TPG = 122, IAS = 91.5, <i>U</i> = 2, <i>p</i> &#x3c; 0.00, <i>z</i> = −2.87) as well as working memory (TPG = 109.5, IAS = 77, <i>U</i> = 0.5, <i>p</i> = 0.01, <i>z</i> = −2.46). <b><i>Conclusion:</i></b> Our results suggest that the long-term outcome in TPG patients is acceptable and that cognition is substantially better preserved than in patients with IAS. This puts the idea of a significant contribution of the tumoral mass to disease outcome on the long term in question. Adequate and prompt management of hydrocephalus is the most important factor in long-term cognitive outcome.

Mandibular Bone Fractures in elderly patients with reference to etiology of trauma

2021 ◽  
Vol 15 (8) ◽  
pp. 1920-1922
Author(s):  
Nabeela Riaz ◽  
Samreen Younas ◽  
Ijaz Ur Rehman ◽  
Ahmad Abdul Haseeb ◽  
Saba Hanif ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Traffic Accidents ◽  
Road Traffic ◽  
Bone Fractures ◽  
Financial Burden ◽  
Maxillofacial Surgery ◽  
Oral And Maxillofacial Surgery ◽  
Mandibular Fractures ◽  
Mandibular Bone ◽  
Mandibular Injuries

Aim: to explore the mandibular bone fractures in elderly patients with reference to etiology of trauma. Methodology: This was a descriptive study conducted in the department of Oral and Maxillofacial Surgery KEMU/ Mayo Hospital Lahore. Elderly patients (age 60-100years) with mandibular bone fractures. Results: Aetiology of trauma leading to mandibular fractures was as follows; there were 79(65.83%) cases of RTA, 32(26.66%) falls, 4(3.33%) assaults and there were only 3(2.5%) cases of industrial injury. Conclusion: To conclude, this study depicts that road traffic accidents were the predominant cause of injury in the studied age group. Elderly patients need more care and attention, especially after traumatic incidents and lead to financial burden in hospitals Keywords: Maxillofacial trauma, Elderly population, Mandibular injuries, Elderly fractures

scholarly journals Long-Term Outcome after Successful Lower Extremity Free Flap Salvage

2018 ◽  
Vol 35 (04) ◽  
pp. 263-269 ◽  
Author(s):  
Amir Bigdeli ◽  
Emre Gazyakan ◽  
Volker Schmidt ◽  
Christoph Bauer ◽  
Günter Germann ◽  
...  
Keyword(s):  
Lower Extremity ◽  
Free Flap ◽  
Free Flaps ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Component Score ◽  
Sf 36 ◽  
The Mean

Background Vascular occlusion after free flap surgery has become a rare complication but still poses a major challenge. It necessitates urgent re-exploration, but the logistic challenge to provide sufficient resources for the emergency intervention remains. The aim of this study was to analyze the long-term outcome after successful lower extremity free flap salvage. Methods A single-center retrospective study including long-term follow-up was approved by the local ethics committee. From January 1999 to December 2010, a total of 581 free flaps were performed for lower extremity reconstruction. Eighty-six flaps required emergency re-exploration, of which 65 could be salvaged. Fifteen salvaged flaps were excluded from the study because of secondary amputation. Of 50 patients, 29 (6 females and 23 males) were eligible for follow-up. The mean follow-up time was 54.5 ± 32.9 months. Health-related quality of life (Short Form 36 [SF-36]) and scar quality (Vancouver Scar Scale [VSS]) were analyzed. Results The overall flap survival rate was 94.7% and the total loss rate was 5.3%. The re-exploration rate was 14.8% (86 of 581 flaps). The salvage rate was 75.6% (65 of 86 flaps). Twenty-one free flaps were totally lost (24.4%). Partial flap loss occurred in 12 cases (14.0%); 67.5% of the vascular complications occurred during the first 24 hours, 20.9% between 24 and 72 hours, and 11.6% after more than 72 hours. The mean time from the first signs of impaired flap perfusion to re-exploration was 1.3 ± 0.4 hours, and from free tissue transfer to re-exploration was 16.2 ± 1.9 hours. The overall scar appearance was good with an average VSS score of 4.0 points. The average SF-36 physical component score was 54.4 ± 5.4 and the mental component score was 63.1 ± 10.7. Conclusion Careful monitoring and the opportunity for urgent re-exploration are the key to success for free flaps salvage. Following these principles, an acceptable long-term outcome can be achieved.

scholarly journals Colonic carcinoid tumors: a clinicopathologic study of 23 patients from a single institution

2009 ◽  
Vol 46 (4) ◽  
pp. 288-293 ◽  
Author(s):  
Daniel Reis Waisberg ◽  
Antonio Sergio Fava ◽  
Lourdes Conceição Martins ◽  
Leandro Luongo Matos ◽  
Maria Isete Fares Franco ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Abdominal Mass ◽  
Survival Rates ◽  
Muscularis Propria ◽  
Venous Invasion ◽  
Carcinoid Tumors ◽  
Intestinal Bypass ◽  
Curative Intent ◽  
The Mean

CONTEXT: Colonic carcinoids, excluding those arising in the appendix, have proved to be extremely rare. Due to their rarity, the characteristics and behavior of this unusual malignancy remain unclear. OBJECTIVE: To review the clinicopathologic features of patients operated on carcinoid tumors of the colon. METHODS: Twenty-three patients (12 males and 11 females) were operated on colonic carcinoids. The mean age of the patients was 63.0 ± 12.9 years (42 to 85 years). The clinical and histopathological data of patients who were pathologically diagnosed as having carcinoid tumors and submitted to surgical treatment over a 30-year period (1977-2007) were gathered. Actuarial patient survival was estimated using the Kaplan-Meier method, with carcinoid-specific death as the outcome. RESULTS: The mean time elapsed between onset of symptoms and surgical treatment was 8.3 months (1.5 to 20 months). The most frequent symptoms or signs encountered were abdominal pain followed by anorexia or weight loss, diarrhea, abdominal tenderness, palpable abdominal mass, and rectal bleeding. No carcinoid syndrome was noted. The lesion was located in the cecum in 16 (69.6%) patients, in the sigmoid in 3 patients (13.0%), in the ascending colon in 3 patients (13.0%), and in the transverse colon in one patient (4.3%). Twenty-one (91.3%) patients were operated on curative intent. Spreading of the disease to the liver and peritoneum was found in two (8.7%) patients who submitted to intestinal bypass. The mean size of the largest mass was 3.7 ± 1.2 cm (1.5 to 6.2 cm). There were multiple (two or more) lesions in three cases (13.0%). In the resected cases, the lymph nodes were compromised in 10 patients (47.6%) and disease-free in 11 (52.4%). Venous invasion and neural infiltration were both present in five (23.8%) patients. The tumors had penetrated the muscularis propria in all resected cases. Four (17.4%) patients had a second non-carcinoid primary tumor. Three (13.0%) patients died due to postoperative complications and five (21.7%) patients died from metachronous metastases or local recurrence. Fifteen patients (65.2%) remain alive without evidence of active disease. The mean follow-up period was 12 years (1.2 to 18 years), whereas the mean global survival was 50.7 ± 34.2 months and the crude survival rate at 5 years was 62.7%. CONCLUSIONS: Carcinoid tumors of the colon are frequently right-sided and may be clinically occult until an advanced stage is reached. Based on the relatively poor survival rates reported, it is recommended that, in addition to standard surgical resection, vigorous surveillance for metastatic disease must be performed, particularly during the first 2 years after surgery. In addition, these patients require evaluation of the entire gastrointestinal tract for evidence of coexisting malignancy, along with an extended period of follow-up, because tumor recurrences after 5 years are not uncommon.

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