Lateral versus posterior surgical approach for the treatment of supracondylar humeral fractures in children: a systematic review and meta-analysis

Background: Supracondylar humeral fracture (SHF) is the most common type of fracture in children. Moreover, lateral and posterior surgical approaches are the most frequently chosen approaches for open reduction surgery in displaced SHF when C-arm is unavailable. However, previous literature showed mixed findings regarding functional and cosmetic outcomes. Currently, no systematic review and meta-analysis has compared these two procedures. Methods: Our protocol was registered at PROSPERO (registration number CRD42021213763). We conducted a comprehensive electronic database search in MEDLINE, EMBASE, and CENTRAL. Two independent reviewers screened the title and abstract, followed by full-text reading and study selection based on eligibility criteria. The quality of the selected studies was analyzed with the ROBINS-I tool. Meta-analysis was carried out to compare the range of motion (functional outcome) and cosmetic outcome according to Flynn’s criteria. This systematic review was conducted based on PRISMA and Cochrane handbook guidelines. Results: Our initial search yielded 163 studies, from which we included five comparative studies comprising 231 children in the qualitative and quantitative analysis. The lateral approach was more likely to result in excellent (OR 1.69, 95% CI [0.97-2.93]) and good (OR 1.12, 95% CI [0.61-2.04]) functional outcomes and less likely to result in fair (OR 0.84, 95% CI [0.34-2.13]) and poor (OR 0.42, 95% CI [0.1-1.73]) functional outcomes compared to the posterior approach. In terms of cosmetic results, both approaches showed mixed findings. The lateral approach was more likely to result in excellent (OR 1.11, 95% CI [0.61-2.02]) and fair (OR 1.18, 95% CI [0.49-2.80]) but less likely to result in good (OR 0.79, 95% CI [0.40-1.55]) cosmetic outcomes. However, none of these analyses were statistically significant (p> 0.05). Conclusion: Lateral and posterior surgical approaches resulted in satisfactory functional and cosmetic outcomes. The two approaches are comparable for treating SHF in children when evaluated with Flynn’s criteria.

Volumetric comparative analysis of anatomy through far-lateral approach: surgical space and exposed tissues

Background The three-dimensional (3D) visualization model has ability to quantify the surgical anatomy of far-lateral approach. This study was designed to disclose the relationship between surgical space and exposed tissues in the far-lateral approach by the volumetric analysis of 3D model. Methods The 3D skull base models were constructed using MRI and CT data of 15 patients (30 sides) with trigeminal neuralgia. Surgical corridors of the far-lateral approach were simulated by triangular pyramids to represent two surgical spaces exposing bony and neurovascular tissues. Volumetric comparison of surgical anatomy was performed using pair t test. Results The morphometric results were almost the same in the two surgical spaces except the vagus nerve (CN X) exposed only in one corridor, whereas the volumetric comparison represented the statistical significant differences of surgical space and bony and neurovascular tissues involved in the two corridors (P<0.001). The differences of bony and neurovascular tissues failed to equal the difference of surgical space. Conclusions For far-lateral approach, the increase of exposure for the bony and neurovascular tissues is not necessarily matched with the increase of surgical space. The volumetric comparative analysis is helpful to provide more detailed anatomical information in the surgical design.

Approach-related anatomical differences in patients with lumbo-sacral transitional vertebrae undergoing lumbar fusion surgery at level L4/5

Introduction Lumbo-sacral transitional vertebrae (LSTV) are accompanied by changes in soft tissue anatomy. The aim of our retrospective study was to evaluate the effects of LSTV as well as the number of free lumbar vertebrae on surgical approaches of ALIF, OLIF and LLIF at level L4/5. Material and methods We assessed the CTs of 819 patients. Of these, 53 had LSTV from which 11 had six (6LV) and 9 four free lumbar vertebrae (4LV). We matched them for sex and age to a control group. Results Patients with LSTV had a higher iliac crest and vena cava bifurcation, a greater distance between the common iliac veins and an anterior translation of the psoas muscle at level L4/5. In contrast, patients with 6LV had a lower iliac crest and aortic bifurcation, no differences in vena cava bifurcation and distance between the iliac veins compared to the control group. Conclusions For patients with LSTV and five or four free lumbar vertebrae, the LLIF approach at L4/5 may be hindered due to a high riding iliac crest as well as anterior shift of the psoas muscle. Whereas less mobilization and retraction of the iliac veins may reduce the risk of vascular injury at this segment by ALIF and OLIF. For patients with 6LV, a lower relative height of the iliac crest facilitates lateral approach during LLIF. For ALIF and OLIF, a stronger vessel retraction due to the deeper-seated vascular bifurcation is necessary during ALIF and is therefore potentially at higher risk for vascular injury.

Microsurgical Anatomy of the Hypoglossal Nerve in the Lateral Approaches to the Craniovertebral Junction: A Study on Fresh Non-Formalin-Fixed Human Specimens

The aim of this anatomical study is to describe the anatomy of the hypoglossal nerve (HN) from its origin to the extracranial portion as it appears by performing a combined posterolateral and anterolateral approach to the craniovertebral junction (CVJ). Twelve fresh, non-formalin-fixed adult cadaveric heads (24 sides) were analyzed for the simulation of the combined lateral approach to the CVJ. The HN is divided into three main parts: cisternal, intracanalicular, and extracranial The anatomical relationships between the HN and other nerves, muscles, arteries and veins were carefully recorded, and some measurements were made between the HN and related structures. Thus, various landmarks were determined for the easy identification of the HN. Understanding the detailed anatomy of the HN and its relationships with the surrounding structures is crucial to prevent some complications during CVJ surgery.

Laparoscopic retropubic colpopexy in the treatment of stress incontinence

The results of treating urinary stress incontinence in women with the help of some combined methods are demonstrated. Original methods laparoscopic retropubic colpopexy by lateral approach, MESH-vaginopexy, laparoscopic retropubic colpopexy are analyzed considering the type of urinary incontinence to substantiate pathogenetically the prophylaxis of stress incontinence recurrence.

Dental implants survival after nasal floor elevation: a systematic review

Purpose The aim of this work is to assess the clinical outcomes of implants placed after a nasal floor elevation procedure. Methods A systematic review was conducted using four electronic databases; Medline (Pubmed), Cochrane library, DOAJ and SCOPUS, following the PRISMA statement recommendations to answer the PICO question: “In patients undergoing dental implant placement in the maxillary anterior region (P), Do implants placed after nasal floor elevation (I) have a different survival (O) from those implants placed without grafting procedures (C)?. The study was pre-registered in PROSPERO (CRD42021229479). Included articles quality was assessed using the “NIH quality assessment tool”, “The Newcastle-Ottawa scale” and “JBI critical appraisal tools for case reports''. Results Twelve articles were finally selected, including 151 patients and 460 implants. The weighted mean follow-up was 32.2 months, and the weighted survival rate after this period was 97.64% (range 89.2-100%). No statistical differences could be inferred between the treatments performed in one-stage or two-stage, following a lateral approach or a transcrestal approach or using different grafting materials. A great heterogeneity was found in terms of study design and methodological aspects. For this reason, a quantitative analysis followed by meta-analysis was not possible. Conclusion Within the limitations of this study, implants placed after a nasal floor elevation present a good survival and a low range of complications. In absence of randomized studies, the level of evidence was low, attending the GRADE system and based on the study quality level, the strength of evidence attending the SORT taxonomy was B.

What Do the Australian Black Summer Fires Signify for the Global Fire Crisis?

The 2019–20 Australian fire season was heralded as emblematic of the catastrophic harm wrought by climate change. Similarly extreme wildfire seasons have occurred across the globe in recent years. Here, we apply a pyrogeographic lens to the recent Australian fires to examine the range of causes, impacts and responses. We find that the extensive area burnt was due to extreme climatic circumstances. However, antecedent hazard reduction burns (prescribed burns with the aim of reducing fuel loads) were effective in reducing fire severity and house loss, but their effectiveness declined under extreme weather conditions. Impacts were disproportionately borne by socially disadvantaged regional communities. Urban populations were also impacted through prolonged smoke exposure. The fires produced large carbon emissions, burnt fire-sensitive ecosystems and exposed large areas to the risk of biodiversity decline by being too frequently burnt in the future. We argue that the rate of change in fire risk delivered by climate change is outstripping the capacity of our ecological and social systems to adapt. A multi-lateral approach is required to mitigate future fire risk, with an emphasis on reducing the vulnerability of people through a reinvigoration of community-level capacity for targeted actions to complement mainstream fire management capacity.

A Comparative Study of Pediatric Fracture Shaft Femur Fixating by Plate and Screws Using Lateral Approach Between Subvastus Lateralis and Transvastus Lateralis Outcome

BACKGROUND: Femoral shaft fracture is a common fracture in pediatric age group reaching 62% of all fracture shaft femur in children in spite of rapid union rate and successful conservative treatment but some cases need surgical intervention and one of the methods using plate and screw by the lateral approach. AIM: This study aims to compare functional outcome fixation of mid-shaft femur fracture in children by plate and screws between (subvastus lateralis and transvastus lateralis) regarding infection, union, and limitation of knee movement. PATIENT AND METHOD: The study was done on 30 children who had diaphyseal fracture femur in Al-Kindy Teaching Hospital in period (April 2018–April 2020) with 6 months follow-up, and the patient was divided into two groups: Group A first treated by subvastus lateral approach 15 patients and the second group, Group B by transvastus lateral approach 15 patients and follow-up done for them after 2 weeks, 4 weeks, 6 weeks, 3 months, and 6 months. RESULTS: At week 16 of follow-up all patients in Group A had union, while in Group B, 14 of 50 patients had union and one patient had no union and one patient in Group B had an infection when compared to Group A. From 15 patients of Group A, two patients had limitation of knee movement in the 1st month of follow-up then in the 3rd month of follow-up, no patient had limitation of knee joint movement, while five patients had limitation of knee joint movement in Group B in the 1st month of follow-up and one patient had limitation knee joint movement in the 3rd month of follow-up. CONCLUSIONS: The subvastus lateralis approach results better than transvastus lateralis in union.

Instability in Patients with Lumbar Spine Disease or Fusion Undergoing Posterior Approach vs. Lateral Approach Primary Total Hip Arthroplasty

Background and Hypothesis: Dislocation rates after total hip arthroplasty (THA) in patients with fixed spinopelvic motion due to lumbar spine disease or fusion have been reported as high as 20%. Few studies exist that compare dislocation rates in patients with spine pathology undergoing THA via different surgical approaches. The purpose of this study was to compare postoperative dislocation rates in patients with lumbar spine disease or fusion between those undergoing a primary THA using a posterior versus direct lateral surgical approach. Experimental Design or Project Methods: With IRB approval, 1,205 primary THAs performed by two surgeons were retrospectively reviewed. One surgeon routinely performs THAs with a posterior approach while the other surgeon routinely uses a direct lateral approach. Chart review from the electronic medical record was conducted to identify patients who have lumbar spine disease or a lumbar spine fusion. Dislocations for patients with and without lumbar spine disease were compared by posterior approach and direct lateral approach. Results: 767 posterior approach and 431 direct lateral approach THAs were available for analysis. 43.6% of all THAs had lumbar spine pathology (337/767 posterior and 185/431 direct lateral). The overall dislocation rate was 1.26% (15/1195). The main predictors of dislocation in binary logistic regression were the presence of lumbar spine pathology (OR 5.24, 95% CI: 1.47–18.69, p=0.018) and posterior surgical approach (OR 7.93, 95% CI: 1.04–60.6, p=0.046). The dislocation rate for direct lateral approach THAs with lumbar spine pathology was significantly lower compared to posterior approach THAs with lumbar spine pathology (0.0% vs 3.6%, p=0.011). Conclusion and Potential Impact: Although there were few dislocations, the study results suggest a direct lateral approach for primary THA may be beneficial to reduce postoperative dislocation for patients with limited spinopelvic motion due to lumbar spine pathology.