Treatment of subacute/chronic ECU tendinopathy using wrist arthroscopy and open surgical repair

Purpose To report the arthroscopic and clinical findings of patients with extensor carpi ulnaris (ECU) tendinopathy treated with wrist arthroscopy and open surgical repair. Methods We retrospectively reviewed the medical records of seven patients with chronic ECU tendinopathy who were treated with diagnostic wrist arthroscopy and open surgical repair between 2010 and 2017. Seven cases diagnosed with ECU tendinopathy had undergone open procedure for the ECU tendinopathy, as well as wrist arthroscopy in the same session. Any pathology of the triangular fibrocartilage complex (TFCC) diagnosed by wrist arthroscopy were treated simultaneously with open procedure for the ECU tendinopathy. The functional outcome was evaluated by comparing the preoperative and final follow-up values of range of motion (ROM), grip strength, visual analog scale (VAS) for pain, modified Mayo wrist score and quick disabilities of the arm, shoulder, and hand (DASH) score. Results TFCC tears were identified in four patients of which repair was performed concomitantly. The average follow-up period was 39 months (range, 25–49 months). At the final follow-up, all the outcomes including average VAS score (6.4→1), the ROM (173→192°), quick DASH score (42.5→18.2), and modified Mayo wrist score (48.6→79.3) improved significantly. Conclusion When treating patients with ECU tendinopathy, the possibility of TFCC combined injury should always be considered. If surgical treatment is planned, we suggest a wrist arthroscopy for more accurate diagnosis an intra-articular pathology, particularly for patients whose MRI findings suggest a degenerative tear or degeneration at the periphery of the TFCC. Additionally, if ECU and DRUJ stability is obtained by repair or reconstruction of the concurrent pathologies in the ECU subsheath, TFCC and other intra-articular structures, the results will be favorable.

Comparative Study of 2 Bone Anchors Using a Limited Open Procedure for the Management of Distal Radioulnar Joint Instability

Background: Arthroscopic and open surgical procedures are commonly used to repair distal radioulnar joint (DRUJ) instability. Both may result in patient dissatisfaction and recurrence of DRUJ instability. An alternative treatment that yields improved outcomes is a limited open approach using a bone anchor to support the DRUJ. Methods: A retrospective chart review of 58 patients (59 extremities) aged 18 to 60 years with type 1B Palmer rupture (3 months or more after injury) of the triangular fibrocartilage complex (TFCC) without distal radius fracture was conducted. Inclusion criteria are: 3 to 12 months after injury, clinical DRUJ instability, and minimum of 6 months of postoperative follow-up. Operative fixation with Stryker Sonic or Depuy Mitek anchor was done by the same surgeon using a limited open procedure. Preoperative and postoperative assessments included Disability of the Arm, Shoulder, and Hand; Brief Pain Inventory; Wong-Baker FACES Pain Rating Scale; Numeric Pain Scale; range of motion; and recurrence of instability. A multivariate analysis of variance model was fit to imputed data to assess the effect of both anchors. Results: Clinical and statistical differences were found in preoperative and postoperative assessments for either the Stryker Sonic or the Depuy Mitek anchor but not between anchor types. There was no recurrence after 3 years with either anchor. Conclusion: Patients requiring TFCC repair using the Stryker Sonic or Depuy Mitek anchor experienced: (1) significant clinical and statistical improvement in postoperative assessments; (2) patient satisfaction; and (3) corrected DRUJ instability. Consequently, major determinants in deciding which bone anchor to use may be based on cost or surgeon’s preference.

Technical Note: Arthroscopic Resection of Snapping, Interponating Annular Ligament of the Elbow

The indication for surgical treatment of lateral snapping elbow syndrome is recurrent joint blockage in combination with pain of the affected elbow joint. Different parts of the lateral synovial capsule sleeve complex, including the annular ligament itself, a hypertrophic synovial fold, or meniscus-like soft tissue interposition can lead to painful entrapment. Surgical treatment options can include an arthroscopic or open procedure. The aim of this technical note is to provide a step-by-step illustration of the authorsʼ preferred arthroscopic approach with a comprehensive review of literature on clinical outcome.

Retrospective comparison of open vs minimally invasive cystotomy in 28 cats using a composite outcome score

Objectives The aim of this study was to compare the outcomes of cats undergoing open cystotomy with those undergoing minimally invasive surgery (MIS) for removal of cystic calculi by use of a composite outcome score. Methods Twenty-eight cats were retrospectively enrolled and divided into two groups: open cystotomy (n = 14) and MIS (n = 14). The primary outcome measure was a composite outcome score, including three variables: pain scores ⩾2 at either 6 or 12 h postoperatively; failure to remove all stones as determined by postoperative radiographs; and postoperative complications requiring a visit to the hospital separate from the planned suture removal appointment. Other data collected included signalment, history, other procedures performed during anesthesia, willingness to eat the day after surgery and the financial cost of the procedures. Results There was no significant difference in age, weight, sex or breed between the two groups. The risk of experiencing the composite outcome was 3/14 (21.4%) in the MIS group and 10/14 (71%) in the open procedure group ( P = 0.02). The cats in the open surgery group had 8.3 times greater odds of developing the composite outcome than cats in the MIS group (odds ratio 8.3, 95% confidence interval 1.3–74.4; P = 0.02). In the MIS group, 10/14 cats were eating the day after surgery vs 3/14 in the open procedure group ( P = 0.02). The procedural cost was higher in the MIS group, with a median cost of US$945 (interquartile range [IQR] US$872–1021) vs US$623 (IQR US$595–679) in the open group ( P <0.01). Conclusions and relevance In this study the composite outcome score provided evidence to support the use of MIS techniques in cats with cystic calculi. The composite outcome score should be considered in future veterinary studies as a promising method of assessing clinically relevant outcomes.

PUBLIC CONTRACTS IN HOLDING COMPANIES OPERATING IN THE CONSTRUCTION INDUSTRY – A CASE OF THE CZECH REPUBLIC

This paper is produced as an exploratory study with the aim of carrying out a taxonomy of construction companies operating in the Czech Republic, taking into account the type and number of concluded public procurement contracts. In processing the multidimensional matrix describing the companies, a cluster analysis was used to identify the dependence between the set of variables. Results of the analysis suggest that the prevailing types of public procurement procedures include negotiated procedure without prior publications, open procedure and simplified below-threshold procedure, while from the point of view of the contracted value, the open procedure is of the highest importance. As for the cluster analysis conducted for the types of public procurement analysis, one can conclude that there is a relation between the number of public contracts concluded and the scope of the types. On the other hand, the extension of the conducted cluster analysis did not provide any conclusive evidence regarding the relationship between the types of public procurement contracts and the types of holding structures. Such a study has not been realised in the Czech Republic yet. Thus, the results of this study provide a background for research in the area of public procurement in the Czech Republic. Some potential research questions have been stated in the discussion part of the paper.

Retrospective study of minimally invasive surgery verses open laminectomy or laminectomy with diskectomy

Background: Minimally invasive spine surgeries (MIS) are often considered superior to their open counterparts in view of smaller incisions, reduced blood loss, less post-operative pain and less hospital stay. In this study, we compared the clinical outcome of MIS and open procedure of lumbar laminectomy/discectomy. The objective of this study was to compare clinical outcome between the MIS and open procedure of lumbar laminectomy/discectomy.Methods: This was a retrospective study conducted at Government medical college, Kottayam, Kerala, India where we studied the patients who underwent MIS and open laminectomy/laminectomy with discectomy during the period January 2018 to January 2020.Results: We studied a total of 200 patients, among which 60% were males with a mean age of 50.58 years and 40% were females with a mean age of 53.59 years, 45.5% had L5 S1 IVDP, 30% had L4/5 IVDP, and 24.5% had L4/5 lumbar canal stenosis, 75.5% underwent laminectomy with discectomy and the rest (24.5%) underwent laminectomy with foraminotomy, 60% underwent open surgery and 40% underwent MIS.Conclusions: MIS was superior to its open analog in terms of intra operative blood loss as well as hospital stay. But open surgeries required less operation time, less C arm exposure, had better pain control and functional outcome and less recurrence in our study.

First Attempt

This chapter begins with detailing the author's travel to Rochester for the upcoming surgery and the final pre-op tests. The chapter recounts the experience the author went through from the rigorous process and evaluation of managing the evaluation and testing schedule, working to get the blood pressure down, handling the packing and shipping for the lab kits, and staying healthy. It then presents all the risks of the surgery including the possibilities of bleeding and infection, and the unlikely event of needing to convert to an open procedure with a much more significant incision and longer recovery time. It also highlights the author's final appointment scheduled with a social worker assigned to her donor advocate. Ultimately, the chapter focuses on how the author managed her time in Rochester after the recipient's doctors found a lung infection and postponed the surgery. With the sudden turn of events, the chapter narrates the author's plan to just attend Yom Kippur Kol Nidre services, drive to the Twin Cities, and spend Yom Kippur day with her son and daughter-in-law.

634 Review of Nephroureteric Surgical Service in a District Urological Center

Background New Cross hospital has been offering radical/partial nephrectomy, nephro-ureterectomy for cancer patients and simple nephrectomy for non-functioning kidney with availability of robotic system facilities since 2016. Methodology Retrospective analysis of data collected prospectively between January 2019 and September 2019. All patients underwent nephrectomy/nephroureterectomy and their demographic, comorbidities and surgical outcomes data analysed. Results 7 underwent lap robotic nephroureterectomy, 27 underwent laparoscopic radical nephrectomy, 4 underwent laparoscopic simple nephrectomy, compared to total of 13 combined cases in 2018. FtM ratio- 1:1.92(13:25). Mean cohort age 64. Mean cohort BMI is 28.3. Mean pre-op HB is 132.9. Average op time for nephroureterectomy is 247 minutes, nephrectomy is 108.2 minutes. Average blood lost is 70mls, no patient of the cohort required any blood transfusion. 1 case sustained splenic laceration had surgical repair, 1 case was abandoned due to extensive bowel involvement. No cases required conversion from laparoscopic to open procedure. Post operatively, 1 patient developed VT, 1 patient had subcut haematoma, Average increase in serum creatinine is 42, and average Hb drop is 10.7. Average admission period were 3.7 days. Conclusions Our urological centre manage to perform more laparoscopic nephroureteric procedures as compare to previous year without much decline in terms of patient surgical outcome.

575 Management of Acute Appendicitis During the COVID-19 Pandemic. Our Experience at The General Surgery Department in Queen Elizabeth Hospital, London

Introduction The pandemic of CoViD-19 had a major impact on provision of emergency services. National (CoViD-19) Guidelines (NG) were issued by the Colleges of Surgeons for the management of surgical patients. Aim To assess the impact of CoViD-19 in the management of patients with acute appendicitis (AA) and review patients’ characteristics and compliance with NG. Method A single-centre retrospective analysis of prospectively collected data on surgical admissions with suspected AA between March and May 2020. Main outcomes of interest were the pre-operative investigation, the type of operation and the negative appendicectomy rate (NAR) comparing to 2019. Results A total of 109 patients were referred for suspected AA. Out of 39 patients who had surgery 21 (53.8%) were investigated with a CT and 13 (33%) with an ultrasound. There was a 31.6% reduction in appendicectomies compared to 2019. 30 patients (76.9%) had an open procedure vs 9 laparoscopic (23.1%) in alignment with the NG2. Histology showed AA in 37 out of 39 of the cases. The NAR was 5.12 vs 12.2 for 2019. Conclusions There was a 31.6% reduction in appendicectomies during CoViD-19. Most patients were investigated with a CT and underwent an open procedure. Pre-operative investigation with a CT led in reduction of NAR.