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Cureus Jun 2022Literature does not show any studies regarding plate placement problems in the coronal plane of patients with volar plating due to distal radius fracture diagnosis. We...
BACKGROUND AND OBJECTIVES
Literature does not show any studies regarding plate placement problems in the coronal plane of patients with volar plating due to distal radius fracture diagnosis. We aimed to investigate the functional and laboratory results of the coronal malposition of the volar locking plate in patients with distal radius fracture treated with internal fixation.
METHODS
In this retrospective study, we included patients who had volar plate fixation, were aged between 18 and 80, had no pathological fracture, had a minimum of six months of follow-up, and had the same rehabilitation protocol. We consider the angle subtended on the coronal axis between the distal radius long axis and the distal radius locking plate as coronal malposition. We named the coronal malposition angle the "AYE Angle." Patients with an AYE angle of over 1 degree were evaluated under group 1. Patients with an AYE angle of 0-1 degrees were evaluated under group 2. Radiological parameters were taken from AP-Lateral X-ray views. Superficial University System of Georgia (USG) examinations were applied to detect tendon problems. The DASH and QUICK-DASH scoring systems were used for clinical evaluation. Grip strength was measured with a dynamometer in all patients. All results were compared between the two groups.
RESULTS
Thirteen patients were female and 27 patients were male. Nineteen patients who had coronal malposition were added to group 1, while 21 patients who had no coronal malposition were added to group 2. Fifteen patients had normal USG results in group 2, while 18 patients had edema around the flexor pollicis longus (FPL) tendon as a result of USG in group 1. Statistically, a significant difference was detected between the two groups in terms of the amount of tenosynovitis around FPL (p=0.01). A statistically significant relationship was found between USG grading and malposition grading. The study revealed that a higher rate of USG grade 2 was found in patients with malposition grade 2 (90.9%), while a higher rate of USG grade 1 (50%) was observed in patients with malposition grade 1 (p=0.01). A statistically significant difference was not found between Soong grading and USG in terms of the level of tenosynovitis around the FPL tendon. The amount of tenosynovitis detected around the FPL tendon was 62.5% for Soong and grade 0 level, 60.7% for grade 1 level, and 50% for grade 2 level. There was no statistically significant difference between the two groups in the DASH and QUICK-DASH scoring systems (p=0.96). There was no statistically significant difference between the two groups in the grip strength (p=0.52).
CONCLUSION
Coronal plate position in the treatment of the distal radius fracture is important to avoid potential flexor tendon problems. The volar plate position should be adjusted properly both in the coronal and sagittal axes.
PubMed: 35915673
DOI: 10.7759/cureus.26444 -
Archives of Iranian Medicine Apr 2023Peripherally inserted central catheters (PICCs) are an effective method for medication and nutrition infusion in preterm neonates. The present study aimed to identify...
BACKGROUND
Peripherally inserted central catheters (PICCs) are an effective method for medication and nutrition infusion in preterm neonates. The present study aimed to identify the incidence of the most common complications of PICC implantation and evaluate the risk factors of each complication.
METHODS
This historical cohort study was conducted on 2500 neonates with birth weights (BWs)≥500 g and gestational age (GA)>24 weeks who had a history of PICC inserted in three NICUs between August 2015 and August 2018. Data were collected by reviewing medical records. Demographic data and indices of catheter placement, duration of catheter placement, and common complications were recorded. Data analysis was done using SPSS-21.
RESULTS
The median cubital vein had the most PICC placement (43%). The most common complication was tip malposition (48.2%). The incidence rates (95% CI) of the main complications such as malposition, edema/occlusion, and PICC migration were 0.0356 (0.0337-0.0377), 0.0134 (0.0122-0.0147), and 0.0088 (0.0079-0.0099), respectively. PICC insertion position was the strongest predictor of malposition for the cephalic vein. Besides, the incidence of malformation in the cephalic vein was about six times higher than in the median cubital vein. Independent risk factors for non-technical complications included BW (OR=0.59, 95% CI 0.44-0.79), administration of hyperosmolar medications (OR=3.43, 95% CI 2.62-4.51), position (OR=2.43, 95% CI 1.92- 3.08), and duration of catheter presence (OR=1.02, 95% CI 1.01-1.03) (<0.001).
CONCLUSION
The most common complication was malposition related to catheter placement in an emergency. Moreover, BW, administration of hyperosmolar medications, and duration of catheter presence were the most critical risk factors for non-technical complications. Therefore, it is recommended to educate the PICC insertion team to reduce tip malposition and replace long-term catheters.
Topics: Infant, Newborn; Humans; Cohort Studies; Catheterization, Central Venous; Risk Factors; Catheters; Catheterization, Peripheral; Retrospective Studies
PubMed: 38301082
DOI: 10.34172/aim.2023.33 -
Journal of Thoracic Disease Aug 2019One-lung ventilation (OLV) in thoracic anesthesia is required to provide good surgical exposure. OLV is commonly achieved through a double lumen tube (DLT) or a...
BACKGROUND
One-lung ventilation (OLV) in thoracic anesthesia is required to provide good surgical exposure. OLV is commonly achieved through a double lumen tube (DLT) or a bronchial blocker (BB). Malposition is a relevant issue related to these devices use. No prospective studies with adequately large sample size have been performed to evaluate the malposition rate of DLTs and BBs.
METHODS
A total of 2,127 patients requiring OLV during thoracic surgery were enrolled. The aim of this multicenter prospective observational study performed across 26 academic and community hospitals is to evaluate intraoperative malposition rate of DLTs and BBs. We also aim to assess: which device is the most used to achieve OLV, the frequency of bronchoscope (BRO) use, the incidence rate of desaturation during OLV and the role of other factors that can correlate to this event, and incidence of difficult airway.
RESULTS
Malposition rate for DLTs was 14%, for BBs 33%. DLTs were used in 95% of patients and BBs in 5%. Mean positioning time was shorter for DLT than BB (156±230 321±290 s). BRO was used in 54% of patients to check the correct positioning of the DLT. Desaturation occurred in 20% of all cases during OLV achieved through a DLT. Predicting factors of desaturation were dislocation (OR 2.03) and big size of DLT (OR 1.15). BRO use (OR 0.69) and left surgical side (OR 0.41) proved to be protective factors. Difficult airway prevalence was 16%; 10.8% predicted and 5.2% unpredicted.
CONCLUSIONS
DLT has a low malpositioning rate and is the preferred device to achieve OLV. BRO use recorded was unexpectedly low. The possibility of encountering a difficult airway is frequent, with an overall prevalence of 16%. Risk factors of desaturation are malposition and increased size of DLT. Left procedures and BRO use could lead to fewer episodes of desaturation.
PubMed: 31559028
DOI: 10.21037/jtd.2019.08.57 -
Frontiers in Cardiovascular Medicine 2022Transcatheter aortic valve replacement (TAVR) in the treatment of patients with pure native aortic valve regurgitation (NAVR) has been based on the "off-label"...
Anatomic predictor of severe prosthesis malposition following transcatheter aortic valve replacement with self- expandable Venus-A Valve among pure aortic regurgitation: A multicenter retrospective study.
BACKGROUND
Transcatheter aortic valve replacement (TAVR) in the treatment of patients with pure native aortic valve regurgitation (NAVR) has been based on the "off-label" indications, while the absence of aortic valve calcification and difficulty in anchoring was found to significantly increase the risk of prosthesis malposition. The aim of this study was to explore the anatomical predictors of severe prosthesis malposition following TAVR with the self-expandable Venus-A Valve among patients with NAVR.
METHODS
A total of 62 patients with NAVR who underwent TAVR with Venus-A Valve at four Chinese clinical centers were retrospectively observed. The clinical features, aortic multidetector computed tomography (MDCT) data, and clinical outcomes were compared between non-/mild malposition and severe malposition groups. Univariate logistic regression analysis was used to identify the risk factors of severe prosthesis malposition, and the receiver operating characteristic (ROC) curve was used to explore the predictive value of the risk factors.
RESULTS
Valve migration to ascending aortic direction occurred in 1 patient, and the remaining 61 patients (including 19 severe malposition cases and 42 non-/mild malposition cases) were included in the analysis. The diameter and height of the sinotubular junction (STJ) and STJ cover index (STJCI, calculated as 100%*STJ diameter/nominal prosthesis crown diameter) were all greater in the severe malposition group (all < 0.05). Logistic regression showed that STJ diameter (OR = 1.23, 95% CI 1.04-1.47, = 0.017), STJ height (OR = 1.24, 95% CI 1.04-1.47, = 0.017), and STJCI (OR = 1.08, 95% CI 1.01-1.16, = 0.032) were potential predictors for severe prosthesis malposition. The area under the ROC curve was 0.72 (95% CI 0.58-0.85, = 0.008) for STJ diameter, 0.70 (95% CI 0.55-0.86, = 0.012) for STJ height, and 0.69 (95% CI 0.55-0.83, = 0.017) for STJCI, respectively. The cutoff value was 33.2 mm for STJ diameter (sensitivity was 84.2% and specificity was 65.8%), 24.1 mm for STJ height (sensitivity was 57.9% and specificity was 87.8%), and 81.0% for STJCI (sensitivity was 68.4% and specificity was 68.3%), respectively.
CONCLUSION
Larger and higher STJ, as well as greater STJ to valve crown diameter ratio, may help identify patients at high risk for severe prosthesis malposition among patients with NAVR undergoing TAVR with Venus-A prosthesis valve.
PubMed: 36568558
DOI: 10.3389/fcvm.2022.1002071 -
Aesthetic Plastic Surgery Dec 2020Improving the shape and contour of the nasal tip is a major goal in rhinoplasty. Extreme bulbosity and parenthesis deformity of the nasal tip are both frequently...
BACKGROUND
Improving the shape and contour of the nasal tip is a major goal in rhinoplasty. Extreme bulbosity and parenthesis deformity of the nasal tip are both frequently encountered. However, the underlying anatomical features that cause this kind of tip deformity are still not fully understood.
OBJECTIVES
To evaluate the relation between the shape of the nasal tip and the anatomical position, orientation and shape of the lateral crura of the lower lateral cartilages and to estimate the incidence of cephalic malposition of lateral crura in Caucasian noses.
MATERIALS AND METHODS
Nineteen Caucasian cadaver noses were studied, and the alar cartilages were measured and evaluated using a standardized method.
RESULTS
Fourteen of the total 38 lateral crura evaluated had cephalic malposition (long axis angle with the midline equal to or less than 30°). Of the nasal tips classified as having parenthesis deformity, 84.6% had cephalic malposition of lateral crura and 46.2% had convex lateral crura. Vertical orientation of the short axis of the lateral crura was no more common in noses with parenthesis deformity of the nasal tip than in other kinds of nasal tip.
CONCLUSIONS
The incidence of cephalic malposition of the lateral crura in this series of Caucasian noses was 36.8%. There was a statistically significant association between parenthesis deformity of the nasal tip and cephalic malposition of the lateral crura, as well as with convex shape of the lateral crura. No statistically significant association was found between the sagittal angle of the lateral crura and the type of nasal tip.
LEVEL OF EVIDENCE V
This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
Topics: Cadaver; Humans; Leg; Nasal Cartilages; Nasal Septum; Nose; Rhinoplasty
PubMed: 32632624
DOI: 10.1007/s00266-020-01845-5 -
Foot & Ankle International Aug 2022We previously reported an increase in pronation of the first metatarsal (M1) head relative to the ground in hallux valgus (HV) patients compared to controls. Still, the...
BACKGROUND
We previously reported an increase in pronation of the first metatarsal (M1) head relative to the ground in hallux valgus (HV) patients compared to controls. Still, the origin and location of this hyperpronation along the medial column is unknown. Recent studies showed that presence of progressive collapsing foot deformities (PCFDs), which is a condition frequently associated with HV, can strongly influence the medial column coronal plane alignment. The objective of this study was to assess the coronal rotation of the medial column bones in HV feet, HV feet with radiologic markers of PCFD, and controls. We hypothesized that hyperpronation in HV will originate from a combination of M1 intrinsic torsion and first tarsometatarsal joint malposition.
METHODS
The same cohort of 36 HV and 20 controls matched on age, gender, and body mass index was used. Previously, a validation of the measurements was carried out through a cadaveric study. Using these metrics, we assessed the coronal plane rotation of the navicular, medial cuneiform, and the M1 at its base and head with respect to the ground using weightbearing CT images. We measured the Meary angle and the calcaneal moment arm in our 36 HV subjects. We subdivided our cohort into an HV group and a potential PCFD HV group according to these measurements. Comparisons on medial column bones coronal rotation were performed between HV, PCFD HV, and control groups.
RESULTS
Twenty-two HV cases were included in the HV group and 14 in the PCFD HV group. Both groups presented an increase in pronation of the first metatarsal head relative to the ground when compared to the control group ( < .001). Comparing HV and controls showed an 8.3 degrees increase in pronation of M1 intrinsic torsion ( < .001) and a 4.7 degrees pronated malposition of the first tarsometatarsal joint ( = .02) in HV. A 9.7 degrees supinated malposition of the first naviculocuneiform joint ( < .001) was also observed in HV. Comparing PCFD HV and controls showed a significant increase in pronation of the navicular (respectively, 17.2 ± 5.4 and 12.3 ± 3.4 degrees, = .007) and a 5.5 degrees increase in pronation of M1 intrinsic torsion ( = .02) in PCFD HV, without malposition of the first tarsometatarsal and naviculocuneiform joints.
CONCLUSION
Hyperpronation of the M1 head relative to the ground originated from both increases in pronation of M1 intrinsic torsion and first tarsometatarsal joint malposition in HV, although partially counterbalanced by a supinated malposition of the first naviculocuneiform joint. On the other hand, PCFD HV patients showed a generalized pronated position throughout the medial column from the navicular to the M1 head and may be related to the midfoot and hindfoot deformities frequently present in PCFD.
LEVEL OF EVIDENCE
Level III, retrospective comparative study.
Topics: Bunion; Case-Control Studies; Hallux Valgus; Humans; Metatarsal Bones; Retrospective Studies; Rotation
PubMed: 35502523
DOI: 10.1177/10711007221091810 -
Beyoglu Eye Journal 2022The aim of the study was to evaluate the effect of changes in the horizontal and vertical palpebral fissure dimensions on surgical success performed due to entropion and...
OBJECTIVES
The aim of the study was to evaluate the effect of changes in the horizontal and vertical palpebral fissure dimensions on surgical success performed due to entropion and ectropion of the lower eyelid.
METHODS
The present research was conducted as a retrospective and interventional case series who had undergone involutional lower eyelid malposition repair with a lateral tarsal strip (LTS) alone, LTS with a medial spindle, and LTS with the advancement of the lower eyelid retractors. The subjects' medical records, including demographic and clinic characteristics, pre-operative assessment of horizontal eyelid laxity, and surgical outcomes, were reviewed. The distance between the pupillary light reflex and the lower-eyelid margin marginal reflex distance 2 (MRD-2) and the horizontal palpebral aperture (HPA) width were measured using the Image J program in the pre-operative and post-operative 6-month follow-up. The correlation between surgical success, changes in pre-operative and post-operative MRD-2, and HPA width was assessed by the Spearman rank correlation test.
RESULTS
A total of 66 eyelids of 48 patients were included in the study. This cohort comprised of 41 males (86.4%) and 7 females (13.6%), 18 of whom underwent bilateral surgery. The pre-operative mean MRD-2 was 7.13 ± 1.98 mm, and the post-operative 6-month mean MRD-2 was 6.21±1.19 mm (p<0.01). The mean post-operative HPA width was statistically significantly higher in comparison with the mean pre-operative HPA width (27.35±2.41, 26.89±2.39, p=0.02, respectively). There was no correlation between success rate and changes in horizontal and vertical palpebral fissure dimensions.
CONCLUSION
LTS surgery is a method that turns the shortened HPA width to normal and enables the successful correction of the lower eyelid malpositions.
PubMed: 35692271
DOI: 10.14744/bej.2022.75537 -
Arthroscopy : the Journal of... Dec 2019The arthroscopic Latarjet has been proposed in the past decade to reduce the rate of bone block malpositioning, decrease soft-tissue damage associated with open...
The arthroscopic Latarjet has been proposed in the past decade to reduce the rate of bone block malpositioning, decrease soft-tissue damage associated with open approach, and possibly decrease intraoperative complications. Several recent studies have reported similar or even superior results with arthroscopic Latarjet compared with those achieved with open technique. However, arthroscopic Latarjet is known to be more technically demanding and some feel that it should be performed by expert shoulder surgeons with advanced arthroscopic skills. Surgical innovations should be adopted when they have potential advantages for patients. Despite the initial challenges and learning curve of arthroscopic Latarjet, experience and technical skills may reduce the rate of intraoperative complications for this technically demanding procedure.
Topics: Arthroscopy; Humans; Joint Instability; Learning Curve; Shoulder Dislocation; Shoulder Joint
PubMed: 31785750
DOI: 10.1016/j.arthro.2019.08.018 -
Arthroscopy : the Journal of... Jun 2024Femoral tunnel malposition has been shown to be a risk factor for medial patellofemoral ligament reconstruction failure. Palpation of the "saddle point" between the...
Femoral tunnel malposition has been shown to be a risk factor for medial patellofemoral ligament reconstruction failure. Palpation of the "saddle point" between the adductor tubercle and medial epicondyle can be an effective strategy; however, compared to using fluoroscopy, tunnel placement using palpation alone may result in significantly more frequent malposition. Accordingly, use of radiographic landmarks has gained in popularity. However, the technique is not without its pitfalls. The first issue lies with obtaining an adequate x-ray. Deviation from a true lateral x-ray by as little as 5° can result in significant tunnel malposition. Including sufficient visible femoral shaft is also required; a minimum requirement is 4 cm. The literature widely varies as to the anatomic, fluoroscopic position. Schottle's point (1.3 mm anterior to the posterior cortical extension line) is the most well studied.
Topics: Humans; Femur; Plastic Surgery Procedures; Patellofemoral Joint; Fluoroscopy; Ligaments, Articular; Radiography; Patellar Ligament
PubMed: 38284957
DOI: 10.1016/j.arthro.2023.12.024 -
Neurosurgical Review Dec 2021Aortic injury is a rare, yet underreported and underestimated complication of spine surgery. Anatomical relation between the aorta and the spine changes under... (Review)
Review
Aortic injury is a rare, yet underreported and underestimated complication of spine surgery. Anatomical relation between the aorta and the spine changes under physiological (positional) as well as pathological (deformity) conditions, which puts the aorta at risk of injury during spine surgery. Clinical presentation of aortic injury ranges from asymptomatic perforation of the aorta to acute fatal bleeding. Although several diagnostic methods have been reported, CT-angiography remains an important diagnostic study. Several advancements in the open and the endovascular surgical management have been reported to be successfully used in the management of aortic injury following spine surgery. Management approach of malpositioned screws abutting the aorta is still controversial. Anatomical knowledge and understanding of the previously reported mechanisms of aortic injury are important to be integrated in the preoperative planning process. If the complication occurs, time-to- recognition and to-appropriate-management are important factors for predicting mortality. If unrecognized and untreated in the acutely injured patients, mortality can approach 100%.
Topics: Humans; Spine; Surgeons; Vascular System Injuries
PubMed: 33851267
DOI: 10.1007/s10143-021-01527-z