Fractures of the upper part of the femur treated with Mitkovic selfdynamisable internal fixator (SIF)

Complex transtrochanteric and subtrochanteric fractures need dynamisation in two axis: in neck axis and in the long axis of the femur. In this study is present one new concept of the surgical treatment of the fractures of proximal femur using new double dynamic selfdynamisable internal fixator (SIF). Dynamisation along the femoral neck axis is available immediately after the fixation, while dynamisation in the long axis of the femur is activated spontaneously 4-6 weeks after the fixation. It is shown series of 30 consecutive fractures of the upper femur. The average operative time was 42 minutes and average blood loss was 70 (seventy) milliliters. All fractures healed within an average period of sixteen weeks (ranging from 12 to 24 weeks). There were no serious complications. Conclusion: SIF is one effective minimally invasive method for the treatment of complex trochanteric and subtrochanteric femoral fractures.

Download Full-text

A Comparative Outcome Analysis of Two Posterior Only Approach for Thoracolumbar Fracture

Indian Journal of Neurotrauma ◽

10.1055/s-0038-1676904 ◽

2018 ◽

Vol 15 (02/03) ◽

pp. 106-112

Author(s):

Deepak Kumar Singh ◽

Surendra Kumar Gupta ◽

Rakesh Kumar ◽

Faran Ahmad ◽

Kuldeep Yadav ◽

...

Keyword(s):

Blood Loss ◽

Functional Outcome ◽

Pedicle Screw ◽

Posterior Approach ◽

Operative Time ◽

Screw Fixation ◽

Pedicle Screw Fixation ◽

Thoracolumbar Fracture ◽

Posterior Decompression ◽

Average Operative Time

Abstract Objectives Most common surgical intervention in thoracolumbar fracture is pedicle screw fixation with posterior decompression through traditional posterior approach. Nowadays, we are doing combined anteroposterior decompression with anteroposterior fixation through posterior only approach. So, we attempt to compare these two approaches in terms of surgical and functional outcome. Method This is a retrospective study. We included 47 patients of traumatic thoracolumbar fracture between September 2016 and January 2018. Fourteen patients were treated by three-column fixation through posterior only approach and 33 patients were treated with traditional posterior approach. In three-column fixation, transpedicular corpectomy with dynamic mesh cage placement with B/L pedicle screw fixation with 360 canal decompression was done, whereas in traditional posterior approach, only posterior decompression with B/L pedicle screw fixation was done. Parameters for comparison include patients’ parameters, fracture types, operative duration, average blood loss, kyphotic correction, and neurological and functional improvement after 1 week and 3 months postoperatively. Result The average operative time (150 ± 13.01 minutes) and blood loss (263 ± 40.84 mL) in combined decompression and fixation through posterior only approach were higher than average operative time (120.3 ± 25.43 minutes) and average blood loss (108 ± 27.32 mL) in traditional posterior approach. In traditional surgeries, there was an observed correction of 11.7° ± 3.6° in kyphosis, while in combined surgeries the observed correction in kyphosis was 15.3° ± 4.3°. There is no statistically significant neurological and functional outcome than traditional posterior approach. Conclusion Combined anteroposterior decompression and stabilization through posterior only approach is convenient for complete decompression of cord, stabilization, and restoration of vertebral height, and there is statistically significant kyphotic correction, pain relief (visual analogue scale), but there is no statistically significant neurological and functional outcome than traditional posterior approach. Most neurosurgeons are familiar to posterior approach; hence, they should be used in unstable thoracolumbar fracture whenever needed, while avoiding various dreaded complication of combined approach.

Download Full-text

Efficacy of Routine Intraoperative Cranio-Femoral Traction in Surgical Treatment of Adolescent Idiopathic Scoliosis Curves Measuring Between 50° and 90°

Global Spine Journal ◽

10.1177/21925682211052969 ◽

2021 ◽

pp. 219256822110529

Author(s):

Jacob R. Carl ◽

Gurpal Pannu ◽

Evan Cherng-Yeh Chua ◽

Adam Bacon ◽

Blythe Durbin-Johnson ◽

...

Keyword(s):

Surgical Treatment ◽

Adolescent Idiopathic Scoliosis ◽

Blood Loss ◽

Idiopathic Scoliosis ◽

Revision Surgery ◽

Operative Time ◽

Curve Correction ◽

Major Curve ◽

Estimated Blood Loss ◽

Retrospective Comparative Study

Study Design Retrospective Comparative Study, Level III. Objective In patients with scoliosis >90°, cranio-femoral traction (CFT) has been shown to obtain comparable curve correction with decreased operative time and blood loss. Routine intraoperative CFT use in the treatment of AIS <90° has not been established definitively. This study investigates the effectiveness of intraoperative CFT in the treatment of AIS between 50° and 90°, comparing the magnitude of curve correction, blood loss, operative time, and traction-related complications with and without CFT. Methods 73 patients with curves less than 90° were identified, 36 without and 37 with cranio-femoral traction. Neuromuscular scoliosis and revision surgery were excluded. Age, preoperative Cobb angles, bending angles, and curve types were recorded. Surgical characteristics were analyzed including number of levels fused, estimated blood loss, operative time, major curve correction (%), and degree of postoperative kyphosis. Results Patients with traction had significantly higher preoperative major curves but no difference in age or flexibility. Lenke 1 curves had significantly shorter operative time and improvement in curve correction with traction. Among subjects with 5 to 8 levels fused, subjects with traction had significantly less EBL. Operative time was significantly shorter for subjects with 5-8 levels and 9-11 levels fused. Curves measuring 50°-75° showed improved correction with traction. Conclusion Intraoperative traction resulted in shorter intraoperative time and greater correction of major curves during surgical treatment of adolescent idiopathic scoliosis less than 90°. Strong considerations should be given to use of intraoperative CFT for moderate AIS.

Download Full-text

Microdebrider-Assisted Supraglottoplasty for Laryngomalacia

Otolaryngology ◽

10.1016/j.otohns.2008.05.212 ◽

2008 ◽

Vol 139 (2_suppl) ◽

pp. P66-P66

Author(s):

Jan Casimir Groblewski ◽

Rahul K Shah ◽

George H Zalzal

Keyword(s):

Surgical Treatment ◽

Revision Surgery ◽

Retrospective Review ◽

Operative Time ◽

Demographic Characteristics ◽

Alternative Methods ◽

Esophageal Reflux ◽

Operative Outcome ◽

Operative Complications ◽

Average Operative Time

Objective To describe our series in the surgical treatment of laryngomalacia using a microdebrider. Methods A retrospective review of patients undergoing supraglottoplasty for laryngomalacia at a tertiary children's hospital between October 2004 and February 2008 was performed. Patients with complex co-morbidities and those undergoing alternative methods for supraglottoplasty were excluded. Patient charts and operative reports were reviewed to assess demographic characteristics, co-morbidities, procedural times, hospitalizations, intra-operative and post-operative complications, and post-operative outcome. Main outcome measures included complications, pain, resolution of stridor, presence of aspiration, and need for revision surgery. Results 27 patients underwent microdebrider-assisted supraglottoplasty. Mean age at diagnosis was 109 days; mean age at time of the procedure was 187 days. 18 Eighteen patients (67%) had gastro-esophageal reflux at the time the laryngomalacia was diagnosed. Average operative time was 35.7 minutes (std. dev. 12.9, range 11–65 minutes). No intra-operative complications or device problems were noted. Only 2 patients remained intubated at the conclusion of the procedure; no patient required tracheotomy or revision supraglottoplasty. One patient had post-operative aspiration, which later resolved. One patient was readmitted for stridor one month following her procedure. There was no pain from the procedure, as all patients immediately resumed a diet. All patients had eventual resolution of stridor. Conclusions This is the largest series of patients that underwent microdebrider-assisted supraglottoplasty for laryngomalacia. This procedure is safe, without pain, and effective in patients with laryngomalacia. Microdebrider- assisted supraglottoplasty is the method of choice for supraglottoplasty in our institution.

Download Full-text

A PROSPECTIVE STUDY OF FUNCTIONAL OUTCOMES IN CEMENTED VS. UNCEMENTED HEMIARTHROPLASTY IN FEMORAL NECK FRACTURES IN GERIATRIC AGE.

10.36106/paripex/1608537 ◽

2020 ◽

pp. 1-3

Author(s):

Siddhartha Shankar Mohanty ◽

Sunil Kumar Dash ◽

Hemanta Kumar Bamidi ◽

Kishore Chandra Dash

Keyword(s):

Femoral Neck ◽

Blood Loss ◽

Prospective Study ◽

Functional Outcomes ◽

Operative Time ◽

Study Groups ◽

Femoral Neck Fractures ◽

Uncemented Hemiarthroplasty ◽

Uncemented Group

Introduction: The optimum treatment choice for femoral neck fractures is often contested. In this study, we aimed to compare the functional outcome in geriatric patients who underwent either cemented or uncemented hemiarthroplasty in our department. Methods: This prospective study included patients who were scheduled to undergo hemiarthroplasty for femoral neck fracture in the Department of Orthopaedics, Hi-Tech Medical College, Bhubaneswar, Odisha. Two study groups were made. One group had patients who underwent uncemented hemiarthroplasty and the second group had patients who underwent cemented hemiarhtroplasty. Surgery related information was collected from the operative notes of the surgeon. Post-operative complications, Visual Analogue Scale (VAS) scores and Harris Hip Score (HHS) were noted during the follow up period. Results: There were 30 patients in the uncemented group and 31 in the cemented group. All the baseline demographic and clinical variables were similar in both the study groups. Mean intraoperative blood loss and operative time was significantly higher among the patients who underwent cemented hemiarthroplasty as compared to uncemented group. Mean VAS score at the first month and sixth month follow up was significantly higher among patients in the uncemented group as compared to cemented group. Functional outcome was not significantly different according to the HHS performed 6 months post-operatively. Conclusions: Patients in the cemented group had a higher intra-operative blood loss and longer operative time. However, the pain score on the VAS were significantly lower at first and sixth month follow up. Functional outcomes were not significantly different between the two study groups.

Download Full-text

Microdebrider-Assisted Supraglottoplasty for Laryngomalacia

Annals of Otology Rhinology & Laryngology ◽

10.1177/000348940911800811 ◽

2009 ◽

Vol 118 (8) ◽

pp. 592-597 ◽

Cited By ~ 23

Author(s):

Jan C. Groblewski ◽

Rahul K. Shah ◽

George H. Zalzal

Keyword(s):

Surgical Treatment ◽

Gastroesophageal Reflux ◽

Outcome Measures ◽

Revision Surgery ◽

Retrospective Review ◽

Operative Time ◽

Intraoperative Complications ◽

Age At Diagnosis ◽

Average Operative Time ◽

The Mean

Objectives We describe our series in the surgical treatment of laryngomalacia using a microdebrider. Methods We performed a retrospective review of patients who underwent microdebrider-assisted supraglottoplasty for laryngomalacia between October 2004 and February 2008. Patients with neurologic conditions and secondary airway lesions were excluded. The main outcome measures included complications, pain, resolution of stridor, presence of aspiration, and need for revision surgery. Results Twenty-eight patients underwent microdebrider-assisted supraglottoplasty. The mean age at diagnosis was 109 days, and the mean age at the time of the procedure was 182 days. Nineteen patients (68%) had gastroesophageal reflux at diagnosis. The average operative time was 35.7 minutes (range, 11 to 65 minutes). No intraoperative complications or device problems occurred. Two patients remained intubated after the procedure. One patient required a tracheotomy, and 1 patient underwent revision supraglottoplasty. Three patients had aspiration that resolved. There was negligible pain from the procedure, as all patients immediately resumed a diet. All patients had immediate or eventual resolution of stridor. Conclusions This is the largest series of patients who underwent microdebrider-assisted supraglottoplasty for laryngomalacia. This procedure is relatively safe, with minimal pain, and effective in patients with laryngomalacia. Microdebrider-assisted supraglottoplasty is the method of choice for supraglottoplasty in our institution.

Download Full-text

Transpseudarthrosis Osteotomy with Interbody Fusion for Kyphotic Spinal Pseudarthrosis in Ankylosing Spondylitis by a Single Posterior Approach: A Retrospective Study and a Brief Relevant Literature Review

BioMed Research International ◽

10.1155/2017/4079849 ◽

2017 ◽

Vol 2017 ◽

pp. 1-8 ◽

Cited By ~ 1

Author(s):

Erzhu Yang ◽

Liangliang Cao ◽

Guowang Zhang ◽

Xiaofeng Lian ◽

Jianguang Xu

Keyword(s):

Ankylosing Spondylitis ◽

Blood Loss ◽

Posterior Approach ◽

Interbody Fusion ◽

Operative Time ◽

Relevant Literature ◽

Clinical Results ◽

Average Operative Time ◽

Single Posterior Approach

Objective. To explore the safety and efficacy of transpseudarthrosis osteotomy with interbody fusion in the treatment of Ankylosing Spondylitis (AS) patients with kyphotic spinal pseudarthrosis by a single posterior approach. Methods. Twelve consecutive patients with spinal pseudarthrosis underwent transpseudarthrosis osteotomy and interbody fusion with a polyetheretherketone (PEEK) cage by a single posterior approach. The operative time, intraoperative blood loss, and complications were recorded. Radiographic and clinical results were assessed preoperatively and at the final follow-up. Results. The average operative time was 201.9 min and the mean blood loss was 817.5 ml. The visual analogue scale (VAS) improved significantly from 6.7 preoperatively to 1.1 at the final follow-up. The average correction of the segmental kyphosis at the level of the pseudarthrosis was 22.3°. Bony fusion was achieved in all patients, and there was no obvious loss of correction at follow-up. Conclusion. Transpseudarthrosis osteotomy at the level of the pseudarthrosis can be safely performed and surgical repair of pseudarthrosis with interbody fusion by a single posterior approach was feasible.

Download Full-text

Femoral neck system versus inverted cannulated cancellous screw for the treatment of femoral neck fractures in adults: a preliminary comparative study

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-021-02659-0 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Yunfeng Tang ◽

Zhen Zhang ◽

Limin Wang ◽

Wei Xiong ◽

Qian Fang ◽

...

Keyword(s):

Femoral Head ◽

Femoral Neck ◽

Blood Loss ◽

Operative Time ◽

Length Of Hospital Stay ◽

Femoral Neck Fractures ◽

Intraoperative Blood Loss ◽

Incision Length ◽

Cancellous Screws

Abstract Background The femoral neck system (FNS) may be a valid alternative for treating femoral neck fractures, but few studies have compared the outcomes between FNS and cannulated cancellous screws. This study aimed to compare the clinical efficacy and complications of FNS with those of inverted cannulated cancellous screws (ICCS) for the treatment of femoral neck fractures in adults. Methods This retrospective study evaluated patients with femoral neck fractures who underwent FNS or ICCS internal fixation between June 2019 and January 2020. The operative time, intraoperative blood loss, number of fluoroscopies, length of surgical incision, length of hospital stay, time to fracture healing, and other indicators were compared between the two groups. The incidence of complications such as nonunion, avascular necrosis of the femoral head, loosening of the internal fixation, and shortening of the femoral neck during follow-up was also assessed in both groups. Results Among the 92 patients included, 47 and 45 patients were categorized into the FNS and ICCS groups, respectively. Follow-up ranged from 14 to 24 months. There were no significant between-group differences in sex, age, side of the injured limb, and type of fracture and in operative time, intraoperative blood loss, incision length, and length of hospital stay (all P > 0.05). The incidence of complications such as fracture nonunion, avascular necrosis of the femoral head, and screw loosening was also comparable between the two groups. However, the number of fluoroscopies was significantly lower in the FNS group than in the ICCS group (P < 0.05). The fracture healing time was also significantly lower in the FNS group than in the ICCS group (P < 0.05). Furthermore, the femoral neck shortening and Harris hip score at the last follow-up were significantly better in the FNS group than in the ICCS group (P < 0.05). Conclusions FNS for femoral neck fractures improves hip functional recovery and reduces the femoral neck shortening rate and fluoroscopy exposure postoperatively. Thus, FNS can be an alternative to ICCS for the treatment of femoral neck fractures.

Download Full-text

Ultra-early synostectomy and cranial remodeling orthoses in the management of craniosynostoses

Neurosurgical FOCUS ◽

10.3171/2021.1.focus201014 ◽

2021 ◽

Vol 50 (4) ◽

pp. E8

Author(s):

Aaron Mohanty ◽

Thomas S. Frank ◽

Sharif Mohamed ◽

Kristalynne Godwin ◽

Gautam G. Malkani

Keyword(s):

Blood Transfusion ◽

Blood Loss ◽

Operative Time ◽

Repeat Surgery ◽

Syndromic Craniosynostosis ◽

Average Operative Time ◽

Time Required ◽

Incidental Durotomy ◽

Single Suture

OBJECTIVE The advent of endoscopic synostectomy has enabled early surgery for infants with craniosynostosis. Even though diagnosis is often made at birth, endoscopic synostectomy has traditionally been delayed until the infant is 3 months of age. There have been very few published reports of this procedure being performed in the early neonatal period. The authors discuss their experience with ultra-early endoscopic synostectomy, defined as an operation for infants aged 8 weeks or younger. METHODS A retrospective analysis of infants who underwent operations at or before 8 weeks of age between 2011 and 2020 was done. RESULTS Twenty-five infants underwent operations: 11 were 2 weeks of age or younger, 8 were between 3 and 4 weeks of age, and 6 were between 5 and 8 weeks of age. The infants weighed between 2.25 and 4.8 kg. Eighteen had single-suture synostosis, and 7 had multiple sutures involved. Of these 7, 4 had syndromic craniosynostosis. The average operative time was 35 minutes, and it was less than 40 minutes in 19 cases. The estimated operative blood loss was 25 ml or less in 19 cases; 5 infants required an intraoperative blood transfusion. In 1 child with syndromic multisuture craniosynostosis, the surgery was staged due to blood loss. Two children experienced complications related to the procedure: one had an incidental durotomy with skin infection, and the other had postoperative kernicterus. All infants were fitted for cranial remodeling orthoses following surgery. Three of the 25 infants required reoperations, with 2 patients with syndromic craniosynostosis needing repeat surgery for cranial volume expansion and cosmetic appearance. Another child with syndromic craniosynostosis is awaiting cranial expansion surgery. Follow-up varied between 6 months and 8 years. CONCLUSIONS The data show that ultra-early synostectomy is safe and not associated with increased complications compared with surgery performed between 3 and 6 months of age. Infants with multisuture synostosis had increased operative time, required blood transfusion, and were more likely to require a second operation.

Download Full-text

Cemented versus cementless bipolar hemiarthroplasty for femoral neck fractures in the elderly

EFORT Open Reviews ◽

10.1302/2058-5241.6.200057 ◽

2021 ◽

Vol 6 (5) ◽

pp. 380-386

Author(s):

Ahmed Fikry Elmenshawy ◽

Khaled Hamed Salem

Keyword(s):

Femoral Neck ◽

Blood Loss ◽

Operative Time ◽

Treatment Options ◽

The Elderly ◽

Similar Rate ◽

Femoral Neck Fractures ◽

Bipolar Hemiarthroplasty ◽

Systemic Complications ◽

Uncemented Hemiarthroplasty

The management of femoral neck fractures remains controversial. Treatment options include a wide variety of internal fixation methods, unipolar or bipolar hemiarthroplasty or total hip replacement. We carried out a systematic review of the available literature to detect differences between cemented and cementless fixation of bipolar prostheses in treating femoral neck fractures in patients aged 60 years or older. Thirteen studies involving a total of 1561 bipolar hemiarthroplasties (770 cemented and 791 uncemented) were identified. Uncemented hemiarthroplasty was associated with significantly lower blood loss (p < 0.0001), shorter operative time (p < 0.0001), less infection (p = 0.03) and lower risk of heterotopic ossification (p = 0.007). On the other hand, patients with cemented hemiarthroplasty suffered significantly less postoperative thigh pain than those with cementless implantation (p < 0.00001). The existing evidence indicates that uncemented bipolar hemiarthroplasty offers shorter operative time, less blood loss, lower local complications and a similar rate of systemic complications and reoperations as compared to cemented implantation. Cite this article: EFORT Open Rev 2021;6:380-386. DOI: 10.1302/2058-5241.6.200057

Download Full-text

Comparing outcomes in cemented vs uncemented hemiarthroplasty in femoral neck fractures

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20185338 ◽

2018 ◽

Vol 5 (1) ◽

pp. 152

Author(s):

Udit Kapoor ◽

Amit Chug ◽

Govind Baranwal ◽

Shaunak Patil ◽

Shubham Kumar

Keyword(s):

Femoral Neck ◽

Blood Loss ◽

Functional Outcome ◽

Operative Time ◽

Study Groups ◽

Femoral Neck Fractures ◽

Uncemented Hemiarthroplasty ◽

Operative Notes ◽

Uncemented Group

Background: The optimal treatment choice for femoral neck fractures is often debated. In this study, we aimed to compare the functional outcome in elderly patients who underwent either cemented or uncemented hemiarthroplasty in our department.Methods: This prospective study included patients who were scheduled to undergo hemiarthroplasty for femoral neck fracture in the Department of Orthopedics, Dr DY Patil University School of Medicine, Navi Mumbai. Two study groups were made. One group had patients who underwent uncemented hemiarthroplasty and the second group had patients who underwent cemented hemiarhtroplasty. Surgery related information was collected from the operative notes of the surgeon. Post-operative complications, Visual Analogue Scale (VAS) scores and Harris Hip Score (HHS) were noted during the follow up period.Results: There were 30 patients in the uncemented group and 31 in the cemented group. All the baseline demographic and clinical variables were similar in both the study groups. Mean intraoperative blood loss and operative time was significantly higher among the patients who underwent cemented hemiarthroplasty as compared to uncemented group. Mean VAS score at the first month and sixth month follow up was significantly higher among patients in the uncemented group as compared to cemented group. Functional outcome was not signicantly different according to the HHS performed 6 months post-operatively.Conclusions: Patients in the cemented group had a higher intra-operative blood loss and longer operative time. However, the pain score on the VAS were significantly lower at first and sixth month follow up. Functional outcomes were not significantly different between the two study groups.

Download Full-text