Comparison of Conservative and Surgical Treatment of Grade III Acromio-Clavicular Dislocation

2021 ◽  
Vol 15 (12) ◽  
pp. 3358-3360
Author(s):  
Adnan Latif Malik ◽  
Saif ur Rehman ◽  
Safdar Iqbal ◽  
Muhammad Zain-ul- Abidin ◽  
Farhan Aslam ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Conservative Treatment ◽  
Constant Score ◽  
Outcome Variable ◽  
Female Ratio ◽  
Female Patients ◽  
Ac Dislocation ◽  
The Mean ◽  
Conservative And Surgical Treatment ◽  
Grade Iii

Objectives: To compare the mean of constant score between conservative and surgical treatment in patients with Grade-III acromio-clavicular dislocation. Design: This was an RCT (randomized controlled trial). Study Settings: It was conducted at the Orthopedic Department of Sir Ganga Ram Hospital Lahore over 1 year from July 2020 to June 2021. Study Procedure: This study involved 94 both male and female patients aged between 18-60 years presenting in orthopedic emergency with Grade-III AC dislocation. These patients were assigned into two treatment groups randomly. Patients in Group-A were managed conservatively while those in Group-B were managed surgically with hook plate. Outcome variable was functional shoulder outcome which was assessed after 6 weeks of treatment using constant score. An informed written consent was gained from every patient. Results: The mean age of the patients was 29.9±9.5 years. Majority (n=44, 46.8%) of the patients were young and were aged between 18-30 years followed by 31-40 years (36.2%) and 41-50 years (17.0%). There were 89 (94.7%) male and 5 (5.3%) female patients in the study group with a male to female ratio of 17.8:1. The mean BMI of these patients was 25.2±2.2 Kg/m2. Right side was more frequently involved (54.3%) as compared to the left side (45.7%). Upon follow-up, the mean constant score was significantly higher in patients treated surgically as compared to conservative treatment (86.72±6.75 vs. 67.43±8.93; p-value<0.001). Similar substantial difference was observed through different subgroups based on patient’s age, gender, BMI and side involved. Conclusion: Surgical treatment of patients with Grade-III acromioclavicular dislocation was associated with better functional shoulder outcome as compared to conservative treatment and should be preferred in future practice if there is no contraindication to surgery. Keywords: Grade-III AC Dislocation, Conservative Treatment, Surgical Treatment, Shoulder Function

scholarly journals CONSERVATIVE TREATMENT OF HEMORRHOIDS. AN ALTERNATIVE TO SURGICAL METHODS OR COMPONENTS? CHORUS PROGRAM RESULTS

2018 ◽  
pp. 27-35
Author(s):  
E. A. Zagryadskiy ◽  
A. M. Bogomazov ◽  
E. B. Golovko
Keyword(s):  
Surgical Treatment ◽  
Conservative Treatment ◽  
Clinical Manifestations ◽  
Entire Observation Period ◽  
Surgical Methods ◽  
Micronized Purified Flavonoid Fraction ◽  
Flavonoid Fraction ◽  
Observational Group ◽  
Grade Iii ◽  
Observation Period

OBJECTIVE. Determine the frequency of clinical manifestations of hemorrhoids and constipation in people seeking advice about hemorrhoids. In the course of the treatment of patients with hemorrhoids phlebotropic evaluate the effectiveness of therapy micronized purified flavonoid fraction (MPFF). MATERIALS AND METHODS. This multicenter study, including screening and observation part, which is part of the International Research «CHORUS» (Chronic venous and hemorrhoid diseases evaluation and scientific research), conducted in nine centers in different regions of Russia, 80 doctors of Coloproctology. In the screening group included 2668 patients who had investigated the incidence of constipation, as a risk factor for hemorrhoids. Conservative treatment, the foundation of which was, Moffitt therapy, received 1952 patients with stage I-IV hemorrhoids. Evaluating the effectiveness of the treatment was evaluated on the basis of a questionnaire. RESULTS. The questionnaire shows that constipation suffered - 766 (28,8 %) patients. Violation of defecation patterns and changes in stool consistency was observed in 1155 (43,9%) and 633 (25.5 %), respectively. At the same time, 288 (11,1 %) indicated a tendency to loose stools and diarrhea. Conservative treatment, the foundation of which is phlebotropic MPFF therapy conducted in patients of observational group has shown its efficiency in all grades of hemorrhoids. During the entire observation period of conservative treatment was effective in 1489 (76,3 %) patients. Surgical treatment was performed in 463 (23 %) patients grade I-IV hemorrhoids, the main part of patients with grade III -199 (43,1 %) and grade IV hemorrhoids - 68 (64,2 %). CONCLUSION. Conservative treatment of hemorrhoid disease, which is the basis on phlebotropic MPFF therapy, is effective at all stages of hemorrhoids, but in patients with grade III and grade IV disease requires surgical treatment.

scholarly journals Anastomotic Leakage Following Colorectal Cancer Surgery: Comparison Between Conservative and Surgical Treatment

2020 ◽  
Author(s):  
Yasuhiro Ishiyama ◽  
Masaki Oneyama ◽  
Yuki Tomizawa ◽  
Manabu Amiki ◽  
Shingo Ito ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Overall Survival ◽  
Surgical Treatment ◽  
Conservative Treatment ◽  
Anastomotic Leakage ◽  
Disease Free Survival ◽  
Colorectal Cancer Surgery ◽  
Free Survival ◽  
Conservative And Surgical Treatment ◽  
Disease Free

Abstract Backgrounds Anastomotic leakage following colorectal cancer is associated with significant morbidity and mortality. However, whether the choice of the treatment for anastomotic leakage may affect the oncological outcomes is under debate. We evaluated the oncological outcomes after colorectal cancer surgery for anastomotic leakage between conservative and surgical treatment. Methods We retrospectively analyzed data for patients with colorectal cancer who underwent curative colectomy from April 2010 to January 2020. Results A total 1039 patients underwent surgery colorectal cancer in our hospital. After exclusion, a total of 915 patients underwent a low anastomosis with diverting stoma for colorectal cancer of which 92 (10.0%) anastomotic leakage occurred. After stage Ⅳ and emergency surgery case were excluded, a total of 75 patients were included for the analysis. The surgical treatment group was 25 cases. The conservative treatment group was 50 cases. Early anastomotic leakage was more than in surgical treatment compared to conservative treatment (84% vs 54%, P =0.008). The 5-year overall survival rates and the 5-year disease free survival did not differ significantly between the two groups. The recurrence location of liver metastasis was more than in surgical treatment compared to conservative treatment (20% vs 2 %, P=0.02). On a multivariable analysis, anastomotic leak did not impact overall survival and disease free survival. Conclusion We found that the treatment for anastomotic leakage was not depended on increased local, distance recurrence, overall survival, and disease free survival. Our findings may help surgeons determine which AL treatment is most appropriate, when the decision is unclear.

A Comparison of Splint Versus Pinning the Distal Interphalangeal Joint for Acute Closed Tendinous Mallet Injuries

2020 ◽  
Vol 25 (02) ◽  
pp. 172-176
Author(s):  
Shigeki Nagura ◽  
Taku Suzuki ◽  
Takuji Iwamoto ◽  
Noboru Matsumura ◽  
Masaya Nakamura ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Treatment Group ◽  
Conservative Treatment ◽  
Interphalangeal Joint ◽  
Distal Interphalangeal Joint ◽  
Custom Made ◽  
Wire Fixation ◽  
Distal Interphalangeal ◽  
The Mean ◽  
Better Than

Background: The vast majority of acute closed tendinous mallet injuries are treated with a splint. Very few studies have directly compared splinting versus pinning the distal interphalangeal joint for this injury. The aim of this cohort study is to determine the outcomes of both methods. Methods: A total of 59 patients with acute tendinous mallet injury were retrospectively enrolled (29 patients in conservative treatment and 30 patients in surgical treatment). Conservative treatment was performed using custom-made thermoplastic splint and surgical treatment was conducted with oblique K-wire fixation of the distal interphalangeal (DIP) joint. The DIP joint was immobilized for eight weeks in both treatments. Active ranges of motion of the affected finger and Miller’s classification were evaluated postoperatively. Results: The mean extension lag of the DIP joint in the surgical treatment group was significantly better than it was with conservative treatment (2.1° vs 13.8°). Three patients who were noncompliant with the splint showed poor results, while no patients in the surgical treatment group had a poor result. Conclusions: Surgical treatment with K-wire fixation leads to satisfactory results for acute tendinous mallet injury.

The epidemiology and trends in the surgical management of calcaneal fractures in England between 2000 and 2017

2019 ◽  
Vol 101-B (2) ◽  
pp. 140-146 ◽  
Author(s):  
J. A. Humphrey ◽  
A. Woods ◽  
A. H. N. Robinson
Keyword(s):  
Surgical Treatment ◽  
Internal Fixation ◽  
Calcaneal Fracture ◽  
Recent Change ◽  
Calcaneal Fractures ◽  
Female Ratio ◽  
The United Kingdom ◽  
The Mean ◽  
The Uk ◽  
Male To Female

Aims This paper documents the epidemiology of adults (aged more than 18 years) with a calcaneal fracture who have been admitted to hospital in England since 2000. Secondary aims were to document whether publication of the United Kingdom Heel Fracture Trial (UK HeFT) influenced the proportion of patients admitted to hospital with a calcaneal fracture who underwent surgical treatment, and to determine whether there has been any recent change in the surgical technique used for these injuries. Patients and Methods In England, the Hospital Episode Statistics (HES) data are recorded annually. Between 2000/01 and 2016/17, the number of adults admitted to an English NHS hospital with a calcaneal fracture and whether they underwent surgical treatment was determined. Results During this 17-year period, 62 858 patients were admitted to hospital with a calcaneal fracture. The male-to-female ratio was 2.66:1. The mean annual incidence was 10.5/100 000 for men and 3.8/100 000 for women. The results of the UK HeFT were published in July 2014. The percentage of patients admitted with a calcaneal fracture undergoing internal fixation was 7.31% (3792/51 859) before and 7.38% (534/7229) after its publication. This difference was not statistically significant (p = 0.94). Since 2015, there has been a significant increase in the percentage of calcaneal fractures treated by closed reduction and internal fixation, as opposed to open reduction and internal fixation, from 7.7% (292/3792) to 13.29% (71/534) (p < 0.001). Conclusion This study documents the epidemiology and trends in surgical treatment of calcaneal fractures in England. We established that surgeons did not change their practice in terms of offering surgery to these patients in response to the results of the UK HeFT. There has been a significant (p < 0.001) increase in the number of calcaneal fractures being treated surgically using less invasive procedures.

Suprainguinal retroperitoneal approach for the successful surgical treatment of meralgia paresthetica

2009 ◽  
Vol 110 (4) ◽  
pp. 768-774 ◽  
Author(s):  
Olaf Alberti ◽  
Jürgen Wickboldt ◽  
Ralf Becker
Keyword(s):  
Surgical Treatment ◽  
Complete Remission ◽  
Cutaneous Nerve ◽  
Lateral Femoral Cutaneous Nerve ◽  
Retroperitoneal Approach ◽  
Meralgia Paresthetica ◽  
Female Ratio ◽  
Femoral Cutaneous Nerve ◽  
The Mean

Object Neurosurgical textbooks describe an infrainguinal approach as the standard or preferred option for the surgical treatment of meralgia paresthetica (MP), the most frequent entrapment neuropathy of the lower limb. However, inhomogeneous results led the authors to adopt a suprainguinal, retroperitoneal approach for decompression of the lateral femoral cutaneous nerve. In this paper the authors' aim was to study the outcome of patients harboring MP treated via this different surgical approach. Methods The outcome of 55 consecutive patients who underwent surgery for MP via the suprainguinal retroperitoneal approach during a 15-year period was ascertained through postal questionnaires (in 47 patients) and follow-up visits (in 8 patients). The male to female ratio was 1:0.67, and the mean patient age was 50 ± 12.9 years. The mean follow-up was 3.2 ± 3.3 years. Seven of the patients underwent bilateral surgery. Results Intraoperatively the lateral femoral cutaneous nerve was consistently found in close anatomical relationship to the anterior superior iliac spine, although some variations regarding the diameter, number of branches, and underlying pathological entity were observed. Eighty-seven percent of patients showed improvement (21 patients) or complete remission (27 patients) of painful dysesthesia in the anterolateral thigh, and 13% (7 patients) remained unchanged. In addition 82% had improvement (31 patients) or complete remission (14 patients) of hypesthesia, leaving 18% with unchanged (9 patients) or worsened (1 patient) hypesthesia. In the patient-evaluated group 66% (31 of 47) were completely satisfied with the outcome, 23% (11 of 47) were partially satisfied, and 11% (5 of 47) were not satisfied with the outcome. Two cases each of recurrence, seroma, wound infection, and 1 case of hematoma requiring revision were encountered as complications. Conclusions The suprainguinal retroperitoneal approach is a viable first-choice option for the surgical relief of MP.

scholarly journals DEGENERATIVE SPINE DISORDERS COMPLICATED BY RADICULAR SYNDROME IN CHILDREN: AN EPIDEMIOLOGICAL AND CLINICAL ANALYSIS OF A 17-YEAR REGIONAL COHORT STUDY

2019 ◽  
Vol 16 (1) ◽  
pp. 38-47 ◽  
Author(s):  
V. P. Snishchuk ◽  
A. Yu. Mushkin
Keyword(s):  
Surgical Treatment ◽  
Conservative Treatment ◽  
Clinical Manifestations ◽  
Clinical Analysis ◽  
Leningrad Region ◽  
Operating Table ◽  
Degenerative Diseases ◽  
Epidemiological Analysis ◽  
Radicular Syndrome ◽  
Conservative And Surgical Treatment

Objective.To analyze epidemiological and clinical features of degenerative disease of the spine complicated by radicular syndrome in children, as well as the effectiveness of its treatment on the example of one of the largest regions of the Russian Federation.Material and Methods.Design of the study corresponds to a retrospective cohort clinical and epidemiological study for 17 years. The study included 201 patients aged 10–17 years with degenerative changes in the spine complicated by radicular syndrome. An epidemiological analysis included the assessment of the regional incidence of degenerative diseases of the spine in children, and clinical analysis – the effectiveness of conservative and surgical treatment. The age and sex structure of the cohort, the level of pathology, the effectiveness of surgical treatment, and age-related features of early spinal discosis in children as compared with degenerative lesions of the spine in adults were analyzed.Results.The epidemiological frequency of degenerative diseases accompanied by clinical manifestations and requiring special treatment in the Leningrad Region was assessed as 8.7 per 100 thousand children aged 10–17 years. Conservative treatment was effective in 172 patients, and 29 patients were treated with surgery. Surgical results were followed up for 1 to 16 years after surgery and were evaluated as excellent, good, and satisfactory respectively in 4 (14 %), 20 (69 %), and 5 (17 %) cases. Complications were reported in two cases: migration of the interbody stabilizing implant and positional neuropathy of the peroneal nerve associated with the position on the operating table.Conclusion. The epidemiological analysis conducted on a regional cohort of the Leningrad Region can be used in assessing the potential need for conservative and surgical treatment of children with degenerative pathology in other regions of Russia. Conservative treatment of this pathology is quite effective, and surgical decompression of nerve roots was required only in 14.4 % of cases.

scholarly journals A comparative study on outcome of conservative and surgical treatment of type III supracondylar fracture of humerus in children

2020 ◽  
Vol 6 (4) ◽  
pp. 817
Author(s):  
Vinay N. ◽  
Manjunatha A. ◽  
Anand Kumar B. S.
Keyword(s):  
Surgical Treatment ◽  
Conservative Treatment ◽  
Supracondylar Fracture ◽  
Type Iii ◽  
Wire Fixation ◽  
Group A ◽  
Group B ◽  
Cross Wire ◽  
Conservative And Surgical Treatment ◽  
Better Than

<p class="abstract"><strong>Background:</strong> Supracondylar fracture of humerus is most common of all the fractures around the elbow in children. They occur most commonly in children more so in male child with the peak around 5-8 years. Objective of this study was to compare the outcome of 3 different modalities of treatment for supracondylar fracture of humerus.</p><p class="abstract"><strong>Methods:</strong> Children with type III supracondylar fracture of humerus were categorized into group A, group B, group C based on conservative, closed reduction and percutaneous K wire fixation and open reduction and K wire fixation modalities of treatment given. All the children were followed for 6 months and the outcome of treatment was evaluated using Flynn’s criteria.<strong></strong></p><p class="abstract"><strong>Results:</strong> 40 children were treated with 3 different modalities of treatment. The rate of complications was less in children who were operated on first day of admission (p=0.02). Group B and group C had 80% and 61.11% excellent results and group A had 47.05% poor results. The outcome was better with cross K wire pinning than lateral pinning (p=0.015).</p><p class="abstract"><strong>Conclusions:</strong> Supracondylar fracture of humerus should be operated as early as possible to reduce the rate of complications. The outcome of surgical treatment was better than conservative treatment evaluated in terms of Flynn’s criteria. Cross wire pinning was better than lateral pinning in terms of outcome, but the rate of neuropraxias was more with cross wire pinning.</p>

scholarly journals MODERN TREATMENTS FOR PCOS (LITERATURE REVIEW)

2020 ◽  
pp. 27-34
Author(s):  
A.I. Korkan ◽  
A.D. Turekhanova ◽  
Y.L. Tyugay
Keyword(s):  
Endometrial Cancer ◽  
Surgical Treatment ◽  
Conservative Treatment ◽  
Literature Review ◽  
Polycystic Ovary Syndrome ◽  
Polycystic Ovary ◽  
Reproductive Age ◽  
Metabolic Dysfunction ◽  
Ovary Syndrome ◽  
Conservative And Surgical Treatment

According to world statistics, polycystic ovary syndrome (PCOS) is one of the most common forms of endocrinopathy in women of mainly reproductive age. PCOS can cause metabolic dysfunction, ovulatory infertility, endometrial cancer, pre- mature birth, perinatal mortality, and other serious consequences. The article discusses various methods of conservative and surgical treatment of PCOS. The main focus is on conservative treatment of infertility caused by PCOS.

Treatment of spontaneous anterior interosseous nerve palsy

2020 ◽  
Vol 132 (4) ◽  
pp. 1243-1248
Author(s):  
Narihito Kodama ◽  
Kosei Ando ◽  
Yoshinori Takemura ◽  
Shinji Imai
Keyword(s):  
Surgical Treatment ◽  
Conservative Treatment ◽  
Symptom Onset ◽  
Nerve Palsy ◽  
Manual Muscle Test ◽  
Anterior Interosseous Nerve ◽  
The Mean ◽  
Initial Recovery ◽  
Grade 3

OBJECTIVEThe purpose of this study was to clarify the clinical outcomes of spontaneous anterior interosseous nerve palsy (AINP) treated nonsurgically or surgically.METHODSThe authors retrospectively evaluated the clinical course of 27 patients affected with AINP, treated nonsurgically or surgically. Thirteen patients underwent surgical treatment (interfascicular neurolysis), and 14 patients underwent conservative nonsurgical treatment. The mean patient age at the onset of symptoms was 49 years (range 17–77 years). The mean follow-up duration from onset to the latest follow-up examination was 23 months (range 12–38 months).RESULTSIn 12 of 14 patients receiving conservative treatment, signs of recovery from the palsy were obtained within 6 months. These patients showed a recovery of manual muscle test (MMT) grade ≥ 3. In contrast, 2 patients who took more than 12 months from symptom onset to initial recovery showed poor recovery (MMT grade ≤ 2). Surgical treatment was performed in 13 patients because of no sign of recovery from palsy. The mean period from symptom onset to the operation was 8.4 months (range 6–14 months). Ten of 13 patients who underwent surgical treatment within 8 months after symptom onset showed good recovery, with MMT grade ≥ 4. However, 3 patients who underwent surgical treatment more than 12 months after onset showed recovery with MMT grade ≤ 3.CONCLUSIONSConservative treatment for AINP may be continued when patients show signs of recovery within 6 months after symptom onset. In contrast, surgical treatment may be performed within 8 months from the onset of symptoms when the patients show no recovery signs for 6 months.

Upward fixation of the patella in the horse

2007 ◽  
Vol 02 (02) ◽  
pp. 119-125
Author(s):  
F. Pille ◽  
P. Desmet ◽  
J. Dewulf ◽  
M. Steenhaut ◽  
F. Gasthuys ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Conservative Treatment ◽  
Medical Records ◽  
Different Types ◽  
Permanent Fixation ◽  
Gait Abnormalities ◽  
Conservative And Surgical Treatment ◽  
Resting Period

SummaryThe objective of the present study was to assess the incidence of upward fixation of the patella (UFP) in different types of patients and to evaluate the outcome of conservative and surgical treatment for correcting this condition. A particular attempt was made to find out whether corrective trimming and/or shoeing (CTS) is efficient in the conservative treatment of UFP, and whether a longer postoperative resting period reduces the risk of complications after medial patellar desmotomy (MPD). Medical records of 78 horses with intermittent or permanent UFP were analyzed retrospectively. Young animals and ponies were mostly affected, mainly during winter (P<0.05). Seventy-six horses with UFP were treated conservatively, with follow-up being possible in 64 of them. This treatment, in which CTS seemed the most important aspect, was fully successful in 51.6% of these patients; 20.3% of them improved partially. In case of no response to conservative treatment, or in case of a permanent fixation, MPD was performed in 20 horses, which corrected UFP completely in 17 of the 18 followed-up patients. However, gait abnormalities were seen in seven of those 17 horses postsurgically, but with the incidence being lower in horses that had rested for at least three months (25%) compared to horses that had only rested for less than one month (66.6%). Results indicate that conservative treatment, with special attention for CTS, is worth trying before performing more radical procedures to correct UFP, and that a longer convalescence period after MPD is desirable.

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