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Journal of Pediatric Orthopedics Jul 2021Pedicle screws have long been part of the continued advancements in spine surgery. Despite the many techniques that have been devised for their safe placement,... (Review)
Review
BACKGROUND/INTRODUCTION
Pedicle screws have long been part of the continued advancements in spine surgery. Despite the many techniques that have been devised for their safe placement, malposition of screws continues to occur. Studies have evaluated the possible safe limits of screw malposition, and have given some insight on anatomic variation in spinal deformity. Review of the literature reveals several cases of deleterious long-term sequelae of malpositioned screws.
DISCUSSION
With the current experience, proposed recommendations are provided to detect and avoid the potential long-term sequelae. Though the literature has helped to define possible concerning screws, there are no good studies predicting long-term risk.
CONCLUSION
Improvements in technology and techniques, advancements in intraoperative confirmation and postoperative surveillance, studies that assist risk stratification, and expert consensus evaluations will help guide surgeons in their decision for addressing misplaced screws.
Topics: Child; Equipment Failure; Humans; Pedicle Screws; Postoperative Complications; Risk Adjustment; Spinal Diseases; Spinal Fusion
PubMed: 34096543
DOI: 10.1097/BPO.0000000000001828 -
Emergency Radiology Jun 2024Artificial Intelligence (AI) has emerged as a transformative force within medical imaging, making significant strides within emergency radiology. Presently, there is a... (Review)
Review
Artificial Intelligence (AI) has emerged as a transformative force within medical imaging, making significant strides within emergency radiology. Presently, there is a strong reliance on radiologists to accurately diagnose and characterize foreign bodies in a timely fashion, a task that can be readily augmented with AI tools. This article will first explore the most common clinical scenarios involving foreign bodies, such as retained surgical instruments, open and penetrating injuries, catheter and tube malposition, and foreign body ingestion and aspiration. By initially exploring the existing imaging techniques employed for diagnosing these conditions, the potential role of AI in detecting non-biological materials can be better elucidated. Yet, the heterogeneous nature of foreign bodies and limited data availability complicates the development of computer-aided detection models. Despite these challenges, integrating AI can potentially decrease radiologist workload, enhance diagnostic accuracy, and improve patient outcomes.
Topics: Humans; Artificial Intelligence; Foreign Bodies
PubMed: 38530436
DOI: 10.1007/s10140-024-02222-4 -
Acta Anaesthesiologica Scandinavica Feb 2021Oropharyngeal leak pressure (OLP) is considered a measure of successful placement, adequate performance and is a useful comparator between supraglottic airway devices...
Oropharyngeal leak pressure (OLP) is considered a measure of successful placement, adequate performance and is a useful comparator between supraglottic airway devices (SADs). OLP measurement is based on the premise that the SAD is sited properly in the hypopharynx after blind placements, but the evidence suggests otherwise. Several limitations and controversies surround OLP. This editorial addresses the uses and pitfalls of OLP, the rationale for and methods of ascertaining OLP, the pros and cons of OLP measurement and newer modalities to improve its accuracy.
Topics: Humans; Laryngeal Masks; Oropharynx
PubMed: 33141956
DOI: 10.1111/aas.13727 -
Plastic and Reconstructive Surgery.... May 2020Implant malposition is one of the most common causes for revision after prosthetic breast reconstruction. There is a paucity of research on the incidence, etiology and...
UNLABELLED
Implant malposition is one of the most common causes for revision after prosthetic breast reconstruction. There is a paucity of research on the incidence, etiology and risk factors for implant malposition in this setting.
METHODS
Retrospective review of a single surgeon's prosthetic breast reconstructions was performed. Variables collected included age, BMI, radiation, chemotherapy, implant characteristics and malposition location (inferior or lateral). Binary logistic regression identified risk factors for malposition. Chi-square test assessed malposition rate as a function of implant volume to BMI subgroups.
RESULTS
Of 836 breasts, 82 (9.8%) exhibited implant malposition. Risk factors for any malposition were older age (OR 1.05, 95% CI 1.02-1.07), BMI<25 (OR 1.64, 95% CI 1.00-2.70) and bilateral reconstruction (OR 13.41, 95% CI 8.50-21.16). Risk factors for inferior malposition were older age (OR 1.04, 95% CI 1.01-1.06), BMI<25 (OR 3.43, 95% CI 1.88-6.26) and bilateral reconstructions (OR 11.50, 95% CI 6.79-19.49), while risk factors for lateral malposition were only older age (OR 1.05, 95% CI 1.02-1.08) and bilateral reconstructions (OR 7.08, 95% CI 4.09-12.26). Post-mastectomy radiation was protective against lateral malposition (OR 0.30, 95% CI 0.10-0.88). Stratification by implant volume and BMI demonstrated patient subgroups with distinct patterns of malposition (incidence 0.0% versus 10.9%, = 0.001).
CONCLUSIONS
This is the first study to identify risk factors for implant malposition after prosthetic breast reconstruction. Different risk factors contributed to malposition in different directions. The effect of implant size on malposition was mediated through BMI, highlighting the interplay of implant and patient characteristics with respect to malposition.
PubMed: 33133885
DOI: 10.1097/GOX.0000000000002752 -
Arthroscopy : the Journal of... Sep 2023To systematically review the current literature regarding the indications, techniques, and outcomes after 2-stage revision anterior cruciate ligament reconstruction... (Review)
Review
PURPOSE
To systematically review the current literature regarding the indications, techniques, and outcomes after 2-stage revision anterior cruciate ligament reconstruction (ACLR).
METHODS
A literature search was performed using SCOPUS, PubMed, Medline, and the Cochrane Central Register for Controlled Trials according to the 2020 Preferred Reporting Items for Systematic Reviews and Meta Analyses statement. Inclusion criteria was limited to Level I-IV human studies reporting on indications, surgical techniques, imaging, and/or clinical outcomes of 2-stage revision ACLR.
RESULTS
Thirteen studies with 355 patients treated with 2-stage revision ACLR were identified. The most commonly reported indications were tunnel malposition and tunnel widening, with knee instability being the most common symptomatic indication. Tunnel diameter threshold for 2-stage reconstruction ranged from 10 to 14 mm. The most common grafts used for primary ACLR were bone-patellar tendon-bone (BPTB) autograft, hamstring graft, and LARS (polyethylene terephthalate) synthetic graft. The time elapsed from primary ACLR to the first stage surgery ranged from 1.7 years to 9.7 years, whereas the time elapsed between the first and second stage ranged from 21 weeks to 13.6 months. Six different bone grafting options were reported, with the most common being iliac crest autograft, allograft bone dowels, and allograft bone chips. During definitive reconstruction, hamstring autograft and BPTB autograft were the most commonly used grafts. Studies reporting patient-reported outcome measures showed improvement from preoperative to postoperative levels in Lysholm, Tegner, and objective International Knee and Documentation Committee scores.
CONCLUSIONS
Tunnel malpositioning and widening remain the most common indications for 2-stage revision ACLR. Bone grafting is commonly reported using iliac crest autograft and allograft bone chips and dowels, whereas hamstring autograft and BPTB autograft were the most used grafts during the second-stage definitive reconstruction. Studies showed improvements from preoperative to postoperative levels in commonly used patient reported outcomes measures.
LEVEL OF EVIDENCE
Level IV, systematic review of Level I, III, and IV studies.
Topics: Humans; Bone-Patellar Tendon-Bone Grafting; Anterior Cruciate Ligament Reconstruction; Knee Joint; Patellar Ligament; Transplantation, Autologous; Anterior Cruciate Ligament Injuries; Autografts
PubMed: 36863622
DOI: 10.1016/j.arthro.2023.02.009 -
Aesthetic Surgery Journal Nov 2020Implant-based breast reconstruction is the most common means to rebuild the breast following mastectomy. Although largely successful in restoring breast shape,... (Review)
Review
Implant-based breast reconstruction is the most common means to rebuild the breast following mastectomy. Although largely successful in restoring breast shape, suboptimal results may occur secondary to inadequate size or projection, malposition, rippling and contour irregularities, nipple malposition, capsular contracture, or implant rotation/flipping. This article reviews common strategies to improve implant reconstruction outcomes with revisional surgery.
Topics: Breast Implantation; Breast Implants; Breast Neoplasms; Humans; Mammaplasty; Mastectomy; Retrospective Studies
PubMed: 33202008
DOI: 10.1093/asj/sjaa132 -
Annals of Plastic Surgery Mar 2022Eyelid scarring after severe burn injury of the face is a significant complication endangering vision in addition to the burn scar sequelae. Scar contraction leads to...
BACKGROUND
Eyelid scarring after severe burn injury of the face is a significant complication endangering vision in addition to the burn scar sequelae. Scar contraction leads to asymmetry and malposition of the eyelid axis, resulting in corneal exposure, eyelid retraction, and incomplete eyelid closure. In consequence, dryness and irritation of the cornea can lead to keratitis, corneal opacity, and vision impairment. In this study, we present our surgical technique for lateral canthopexy in combination with full-thickness skin grafting (FTSGing) in patients with eyelid axis distortion after scar contraction of the periorbital region after severe burn injuries of the face.
METHODS
In this retrospective, single-center case study, we present 5 consecutive patients who experienced severe burn injuries to the face between 2014 and 2019. Patients were suffering from ectropion and malposition of the eyelid axis. In all cases, we performed lateral transosseous canthopexy and FTSGing.
RESULTS
Improved symmetry and complete eyelid closure were restored in all 5 patients. The following ophthalmological examinations showed resolved corneal erosions, as well as reduction of chemosis and epiphora. Further vision impairment was successfully prohibited. Surgical revision with FTSGing was required in 2 patients because of recurrence of unilateral lower eyelid retraction.
CONCLUSIONS
Lateral transosseous canthopexy represents a suitable surgical method to durably correct eyelid malposition, ectropion, and incomplete lid closure in patients with severe scarring of the periorbital region after burns of the face. Early detection of patients at risk and timing of surgical intervention are of great importance.
Topics: Blepharoplasty; Burns; Cicatrix; Ectropion; Humans; Retrospective Studies
PubMed: 35130205
DOI: 10.1097/SAP.0000000000003047 -
Radiology. Artificial Intelligence Mar 2023To develop and validate a deep learning model for detection of nasogastric tube (NGT) malposition on chest radiographs and assess model impact as a clinical decision...
PURPOSE
To develop and validate a deep learning model for detection of nasogastric tube (NGT) malposition on chest radiographs and assess model impact as a clinical decision support tool for junior physicians to help determine whether feeding can be safely performed in patients (feed/do not feed).
MATERIALS AND METHODS
A neural network ensemble was pretrained on 1 132 142 retrospectively collected (June 2007-August 2019) frontal chest radiographs and further fine-tuned on 7081 chest radiographs labeled by three radiologists. Clinical relevance was assessed on an independent set of 335 images. Five junior emergency medicine physicians assessed chest radiographs and made feed/do not feed decisions without and with artificial intelligence (AI)-generated NGT malposition probabilities placed above chest radiographs. Decisions from the radiologists served as ground truths. Model performance was evaluated using receiver operating characteristic analysis. Agreement between junior physician and radiologist decision was determined using the Cohen κ coefficient.
RESULTS
In the testing set, the ensemble achieved area under the receiver operating characteristic curve values of 0.82 (95% CI: 0.78, 0.86), 0.77 (95% CI: 0.71, 0.83), and 0.98 (95% CI: 0.96, 1.00) for satisfactory, malpositioned, and bronchial positions, respectively. In the clinical evaluation set, mean interreader agreement for feed/do not feed decisions among junior physicians was 0.65 ± 0.03 (SD) and 0.77 ± 0.13 without and with AI support, respectively. Mean agreement between junior physicians and radiologists was 0.53 ± 0.05 (unaided) and 0.65 ± 0.09 (AI-aided).
CONCLUSION
A simple classifier for NGT malposition may help junior physicians determine the safety of feeding in patients with NGTs. Neural Networks, Feature Detection, Supervised Learning, Machine Learning Published under a CC BY 4.0 license.
PubMed: 37035435
DOI: 10.1148/ryai.220165 -
British Journal of Nursing (Mark Allen... Oct 2020Peripherally inserted central catheters (PICCs) may be used to administer contrast injection during CT (computed tomography) scans to improve diagnostic accuracy. This... (Review)
Review
Peripherally inserted central catheters (PICCs) may be used to administer contrast injection during CT (computed tomography) scans to improve diagnostic accuracy. This is usually done with the use of a power injector. Research has shown that misplacement of catheters following contrast injection can occur. The aim of this review was to analyse appropriately positioned pre-scan PICCs that malposition following injection of contrast media during a CT scan, evaluate whether tip location or right or left insertion plays a part in the displacement of PICCs after CT, and to ensure those involved are aware of the risks and the safety checks required following such procedures. A quantitative method was used, gathering information from the team's insertion database to review 2045 records of contrast-injectable PICCs between 1 January 2015 and 30 April 2020. Analysis of the data indicated that 1% of appropriately sited PICCs malposition following contrast CT injection and that the catheter is able to self-correct back to its original position at an average interval of 24-72 hours without any other intervention. Further research is needed to explore other factors that could influence the rate of self-correction and complications of prolonged catheter malposition.
Topics: Catheterization, Central Venous; Catheterization, Peripheral; Contrast Media; Humans; Retrospective Studies; Risk Factors; Tomography, X-Ray Computed
PubMed: 33104421
DOI: 10.12968/bjon.2020.29.19.S4