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Plastic and Reconstructive Surgery.... May 2024Soft tissue reconstruction using flaps in managing mangled injuries is occasionally insufficient due to large defects and low flap viability. Conversely, delaying the...
Soft tissue reconstruction using flaps in managing mangled injuries is occasionally insufficient due to large defects and low flap viability. Conversely, delaying the closure of the defect can elevate the risk of infection. Adjuvant therapy becomes essential in the management of mangled injuries. We aim to present the use of low-cost vacuum-assisted closure (VAC) as an adjuvant therapy for mangled injuries. We reported the case of a 20-year-old man who sustained a mangled injury to his left forearm in a traffic accident 4 hours before admission. The mangled extremity severity score was 9; however, the patient declined amputation. Although the initial reconstruction was done, the flap could only cover vital structures. VAC was utilized to address the uncovered portion of the defect, to promote optimal granulation and prevent infection. The reconstruction proceeded with a skin graft and wrist arthrodesis. At 1-year follow-up, viable tissue was obtained but contracture occurred at the metacarpophalangeal and proximal interphalangeal joints. We intend to perform functional reconstruction at a later stage. Although the benefits of VAC in wound management are well established, reports regarding its advantages in mangled injury management remain relatively scarce. The high cost of VAC is a limiting factor, particularly in developing countries. This prompts the need for an affordable VAC innovation with comparable efficiency to the commercial model. Reverse Aqua Pump VAC, our innovative low-cost VAC, shows satisfactory outcomes in managing patients with mangled injuries with mangled extremity severity score indicating amputation.
PubMed: 38798936
DOI: 10.1097/GOX.0000000000005826 -
Medicina (Kaunas, Lithuania) May 2024Klippel-Feil syndrome (KFS) is characterized by the congenital fusion of the cervical vertebrae and is sometimes accompanied by anomalies in the craniocervical junction....
Klippel-Feil syndrome (KFS) is characterized by the congenital fusion of the cervical vertebrae and is sometimes accompanied by anomalies in the craniocervical junction. In basilar invagination (BI), which is a dislocation of the dens in an upper direction, compression of the brainstem and cervical cord results in neurological defects and surgery is required. A 16-year-old boy diagnosed with KFS and severe BI presented with spastic tetraplegia, opisthotonus and dyspnea. CT scans showed basilar impression, occipitalization of C1 and fusion of C2/C3. MRI showed ventral compression of the medullocervical junction. Posterior occipitocervical reduction and fusion along with decompression were performed. Paralysis gradually improved postoperatively over 3 weeks. However, severe spasticity and opisthotonus persisted and intrathecal baclofen (ITB) therapy was initiated. Following this, opisthotonus disappeared and spasticity of the extremities improved. Rehabilitation therapy continued by controlling the dose of ITB. Five years after the surgery, self-propelled wheelchair driving was achieved and activities of daily life improved. The treatment strategy for patients with BI and congenital anomalies remains controversial. Posterior reduction and internal fixation using instrumentation were effective techniques in this case. Spasticity control achieved through a combination of surgery and ITB treatment enabled the amelioration of therapeutic efficacy of rehabilitation and the improvement of ADL.
Topics: Humans; Baclofen; Male; Klippel-Feil Syndrome; Adolescent; Cervical Vertebrae; Spinal Fusion; Injections, Spinal; Muscle Relaxants, Central; Occipital Bone; Treatment Outcome; Decompression, Surgical
PubMed: 38792938
DOI: 10.3390/medicina60050755 -
Journal of Orthopaedic Case Reports May 2024Traumatic open total extrusion of talus without soft-tissue attachment and not associated with surrounding fracture is a very rare injury which requires very high energy...
INTRODUCTION
Traumatic open total extrusion of talus without soft-tissue attachment and not associated with surrounding fracture is a very rare injury which requires very high energy impact. In literature, optimal treatment protocols are yet to be established. A few options described in literature are talectomy and tibiocalcaneal arthrodesis or reimplantation of talus which may be immediate or after some interval.
CASE REPORT
A 28-year-old female suffered road traffic accident and had total open extrusion of talus without soft-tissue attachment, and we managed it with thorough debridement of the wound, saline irrigation, and immediate reimplantation of the talus with stabilization by delta frame external fixator. Proper pre- and post-operative antibiotic coverage was given as per protocol. We did not face post-operative infection, wound complication, and until 12 months followed up, there are some signs of avascular necrosis of the talus but the good functional outcome.
CONCLUSION
With this case experience, we suggest that this is the valid treatment protocol for total extrusion of the talus, and it will provide a better hindfoot mechanism, heel height, and the patient can resume his/her daily routine activity as early as possible.
PubMed: 38784894
DOI: 10.13107/jocr.2024.v14.i05.4430 -
Journal of Orthopaedic Case Reports May 2024If not corrected, the first metatarsal pronation rotation deformity is deemed responsible for the high hallux valgus (HV) deformity recurrence rate. Its correction...
INTRODUCTION
If not corrected, the first metatarsal pronation rotation deformity is deemed responsible for the high hallux valgus (HV) deformity recurrence rate. Its correction method by osteotomy and arthrodesis has been recommended, just like the metatarsus primus varus (MPV) deformity correction. Since the pathogenesis of the first metatarsal pronation is not well understood, there may be other surgical approaches to correct it.
CASE REPORT
A 53-year-old female's HV feet presented with severe left hallux pronation, and positive radiological round head and inferior tubercle shift signs of the first metatarsal. She underwent a non-osteotomy non-arthrodesis soft-tissue procedure that was expected to correct the MPV deformity but not the pronation deformity. Post-operative hallux pronation was reversed, and round head and inferior tubercle signs were corrected.
CONCLUSION
The first metatarsal hypermobility and displacement of HV feet are probably in all three planes. Correction of MPV in the first metatarsal entirety in the transverse plane without osteotomy or arthrodesis can also induce a correction effect on its sagittal and frontal planes.
PubMed: 38784892
DOI: 10.13107/jocr.2024.v14.i05.4442 -
Journal of Orthopaedic Case Reports May 2024Spina bifida is a rare neurological condition that, if uncorrected, may cause chronic valgus knee stress difficulty with independent ambulation and significant pain....
INTRODUCTION
Spina bifida is a rare neurological condition that, if uncorrected, may cause chronic valgus knee stress difficulty with independent ambulation and significant pain. Current literature lacks comprehensive guidance on surgically correcting progressive hip and knee deformities in spina bifida patients, which include osteotomy and primary. When these options are contraindicated, alternative approaches such as arthrodesis may be indicated, although they remain understudied in this population.
CASE REPORT
A 47-year-old man presented with bilateral hip and knee pain. Radiographs demonstrated valgus knee deformities with severe arthrosis and bilateral femoral head subluxation. The patient had a history of spina bifida with chronic lower extremity weakness and neurogenic bladder. He underwent staged bilateral instrumented knee arthrodesis and staged bilateral total hip arthroplasty (THA).
CONCLUSION
This is the first reported case of bilateral instrumented knee arthrodesis in a patient with spina bifida. Orthopedic care of these patients is complex. Surgical correction of symptomatic knee and hip deformities through instrumented arthrodesis and THA may permit an improved functional outcome.
PubMed: 38784872
DOI: 10.13107/jocr.2024.v14.i05.4440 -
Acta Ortopedica Mexicana 2024pain in the pubic symphysis, even if studied in athletes, still sets out diagnostic and therapeutic challenges in other patient groups. Within this context, refractory... (Review)
Review
INTRODUCTION
pain in the pubic symphysis, even if studied in athletes, still sets out diagnostic and therapeutic challenges in other patient groups. Within this context, refractory osteorthritis of the pubic symphysis presents itself as an issue lacking clear therapeutic consensus.
MATERIAL AND METHODS
two women over 65 years old and presenting osteoarthritis of the pubic symphysis were evaluated. Following unsuccessful conventional therapies, arthrodesis via subpubic plate, wire suture and autologous graft from the iliac crest was performed.
RESULTS
after a one-year of following, both patients experienced clinical and radiographic improvement. Bone arthrodesis was achieved without significant complications, proving to be a viable surgical option.
CONCLUSION
this study supports the medium and long-term efficacy of arthrodesis of the pubic symphysis in refractory cases of osteoarthrisis. Therefore, the technique can be considered a surgical option in the management of said condition.
Topics: Humans; Arthrodesis; Female; Osteitis; Pubic Symphysis; Aged; Osteoarthritis
PubMed: 38782480
DOI: No ID Found -
Orthopaedic Surgery Jul 2024For precise and minimally invasive treatment of ossification of the posterior longitudinal ligament of the cervical spine, the lifting segment is minimized, anterior... (Comparative Study)
Comparative Study
The CT Classification of Multilevel Cervical Ossification of the Posterior Longitudinal Ligament to Guide Hybrid Anterior Controllable Antedisplacement and Fusion vs. Posterior Laminoplasty.
OBJECTIVE
For precise and minimally invasive treatment of ossification of the posterior longitudinal ligament of the cervical spine, the lifting segment is minimized, anterior controllable antedisplacement and fusion (ACAF) was refined and improved. In addition, the development of appropriate surgical procedures for the ossification of each segment was rarely reported. Therefore, this study aimed to compare the efficacy and safety of hybrid anterior controlled antedisplacement fusion (Hybrid ACAF) with laminoplasty for multilevel ossification of the posterior longitudinal ligament (OPLL).
METHODS
Between May 2018 and May 2021, 70 patients with multilevel OPLL were divided into a hybrid ACAF group and a laminoplasty group according to surgical methods. All patients were followed up for at least 1 year. Japanese Orthopaedic Association (JOA) score and recovery rate (JOARR), (VAS, NDI) score and C2-C7 Cobb angle, the sagittal vertical axis of the neck (SVA), and complications (cerebrospinal fluid leakage, C5 paralysis, etc.) were compared between the two groups by t test or non-parametric test.
RESULTS
The operation time of hybrid ACAF was longer. C5 paralysis and axial pain were more common in the laminoplasty group, while dysphagia and hoarseness were more common in the hybrid ACAF group. At the last follow-up, the hybrid ACAF group had better recovery and maintenance of cervical lordosis and sagittal plane balance and a higher JOA score and recovery rate than the laminoplasty group.
CONCLUSIONS
Hybrid ACAF can reduce the number of vertebral bodies and expand the decompression range, which is safe, effective, and tailored to local conditions. Compared with laminoplasty, hybrid ACAF is a precise alternative for patients with OPLL.
Topics: Humans; Ossification of Posterior Longitudinal Ligament; Laminoplasty; Male; Female; Spinal Fusion; Cervical Vertebrae; Middle Aged; Aged; Tomography, X-Ray Computed; Retrospective Studies
PubMed: 38773680
DOI: 10.1111/os.14088 -
BMC Musculoskeletal Disorders May 2024The frequency of anterior cervical discectomy and fusion (ACDF) has increased up to 400% since 2011, underscoring the need to preoperatively anticipate adverse...
BACKGROUND
The frequency of anterior cervical discectomy and fusion (ACDF) has increased up to 400% since 2011, underscoring the need to preoperatively anticipate adverse postoperative outcomes given the procedure's expanding use. Our study aims to accomplish two goals: firstly, to develop a suite of explainable machine learning (ML) models capable of predicting adverse postoperative outcomes following ACDF surgery, and secondly, to embed these models in a user-friendly web application, demonstrating their potential utility.
METHODS
We utilized data from the National Surgical Quality Improvement Program database to identify patients who underwent ACDF surgery. The outcomes of interest were four short-term postoperative adverse outcomes: prolonged length of stay (LOS), non-home discharges, 30-day readmissions, and major complications. We utilized five ML algorithms - TabPFN, TabNET, XGBoost, LightGBM, and Random Forest - coupled with the Optuna optimization library for hyperparameter tuning. To bolster the interpretability of our models, we employed SHapley Additive exPlanations (SHAP) for evaluating predictor variables' relative importance and used partial dependence plots to illustrate the impact of individual variables on the predictions generated by our top-performing models. We visualized model performance using receiver operating characteristic (ROC) curves and precision-recall curves (PRC). Quantitative metrics calculated were the area under the ROC curve (AUROC), balanced accuracy, weighted area under the PRC (AUPRC), weighted precision, and weighted recall. Models with the highest AUROC values were selected for inclusion in a web application.
RESULTS
The analysis included 57,760 patients for prolonged LOS [11.1% with prolonged LOS], 57,780 for non-home discharges [3.3% non-home discharges], 57,790 for 30-day readmissions [2.9% readmitted], and 57,800 for major complications [1.4% with major complications]. The top-performing models, which were the ones built with the Random Forest algorithm, yielded mean AUROCs of 0.776, 0.846, 0.775, and 0.747 for predicting prolonged LOS, non-home discharges, readmissions, and complications, respectively.
CONCLUSIONS
Our study employs advanced ML methodologies to enhance the prediction of adverse postoperative outcomes following ACDF. We designed an accessible web application to integrate these models into clinical practice. Our findings affirm that ML tools serve as vital supplements in risk stratification, facilitating the prediction of diverse outcomes and enhancing patient counseling for ACDF.
Topics: Humans; Diskectomy; Machine Learning; Spinal Fusion; Cervical Vertebrae; Male; Female; Postoperative Complications; Middle Aged; Internet; Length of Stay; Treatment Outcome; Aged; Patient Readmission; Adult; Databases, Factual
PubMed: 38773464
DOI: 10.1186/s12891-024-07528-5 -
BMC Musculoskeletal Disorders May 2024This study aimed to evaluate the biomechanical effects of reinserted or revised subaxial cervical vertebral screws.
BACKGROUND
This study aimed to evaluate the biomechanical effects of reinserted or revised subaxial cervical vertebral screws.
METHODS
The first part aimed to gauge the maximum insertional torque (MIT) of 30 subaxial cervical vertebrae outfitted with 4.0-mm titanium screws. A reinsertion group was created wherein a screw was wholly removed and replaced along the same trajectory to test its maximum pullout strength (MPOS). A control group was also implemented. The second part involved implanting 4.0-mm titanium screws into 20 subaxial cervical vertebrae, testing them to failure, and then reinserting 4.5-mm revision screws along the same path to determine and compare the MIT and MPOS between the test and revision groups.
RESULTS
Part I findings: No significant difference was observed in the initial insertion's maximum insertion torque (MIT) and maximum pull-out strength (MPOS) between the control and reinsertion groups. However, the MIT of the reinsertion group was substantially decreased compared to the first insertion. Moderate to high correlations were observed between the MIT and MPOS in both groups, as well as between the MIT of the first and second screw in the reinsertion group. Part II, the MIT and MPOS of the screw in the test group showed a strong correlation, while a modest correlation was observed for the revision screw used in failed cervical vertebrae screw. Additionally, the MPOS of the screw in the test group was significantly higher than that of the revision screw group.
CONCLUSION
This study suggests that reinsertion of subaxial cervical vertebrae screws along the same trajectory is a viable option that does not significantly affect fixation stability. However, the use of 4.5-mm revision screws is inadequate for failed fixation cases with 4.0-mm cervical vertebral screws.
Topics: Cervical Vertebrae; Humans; Biomechanical Phenomena; Bone Screws; Torque; Male; Female; Reoperation; Spinal Fusion; Middle Aged; Adult; Aged; Titanium; Materials Testing
PubMed: 38773452
DOI: 10.1186/s12891-023-07158-3 -
Orthopaedic Surgery Jul 2024Both two-level anterior cervical corpectomy and fusion (t-ACCF) and posterior open-door laminoplasty (ODLP) are effective surgical procedures for the treatment of... (Comparative Study)
Comparative Study
Two-level Anterior Cervical Corpectomy and Fusion versus Posterior Open-door Laminoplasty for the Treatment of Cervical Ossification of Posterior Longitudinal Ligament: A Comparison of the Clinical Impact on the Occipito-Atlantoaxial Complex.
OBJECTIVE
Both two-level anterior cervical corpectomy and fusion (t-ACCF) and posterior open-door laminoplasty (ODLP) are effective surgical procedures for the treatment of ossification of the posterior longitudinal ligament (OPLL). Previous studies have identified different effects of different surgical procedures on the upper and subaxial cervical spine (UCS, SCS), however, there are no studies on the effects of t-ACCF and ODLP on the occipito-atlantoaxial complex. Therefore, the purpose of this study is to compare the changes in sagittal parameters and range of motion (ROM) of the occipito-atlantoaxial complex in OPLL patients treated with t-ACCF and ODLP.
METHODS
This was a retrospective study that included 74 patients who underwent t-ACCF or ODLP for the treatment of OPLL from January 2012 to August 2022 at our institution. Preoperative, 3-month, and 1-year postoperative cervical neutral, flexion-extension, and lateral flexion radiographs were taken. Sagittal parameters including Cobb angle of C2-7, C0-2, C0-1, C1-2, C2 slope, and the ROM were measured. The clinical outcome was assessed using the JOA, VAS, and NDI scores preoperatively and at 3 and 12 months postoperatively. Multiple linear regression was employed to identify factors influencing changes in UCS.
RESULTS
In the ODLP group, the SCS (C2-7) Cobb angle was significantly reduced (12.85 ± 10.0 to 7.68 ± 11.27; p < 0.05), and the UCS (C0-2) Cobb angle was significantly compensated for at 1 year postoperatively compared with the t-ACCF group (3.05 ± 4.09 vs 0.79 ± 2.62; p < 0.01). The SCS and lateral flexion ROM of the ODLP group was better maintained than t-ACCF (14.51 ± 6.00 vs 10.72 ± 3.79; 6.87 ± 4.56 vs 3.81 ± 1.67; p < 0.01). The compensatory increase in C0-2, C0-1, and C1-2 ROM was pronounced in both groups, especially in the ODLP group. The results of multiple linear regression showed that only the surgical procedure was a significant factor influencing UCS.
CONCLUSION
The loss of the SCS Cobb angle was more pronounced in ODLP relative to t-ACCF, resulting in a significant compensatory increase in UCS and atlantoaxial Cobb angle. The ROM of the UCS, atlantooccipital, and atlantoaxial joints was significantly increased in both groups, this may accelerate degenerative changes in the occipital-atlantoaxial complex, may leading to poorer outcomes in the long-term; of these, ODLP should receive more attention. In contrast, t-ACCF better maintains normal curvature of the SCS and occipito-atlantoaxial complex but loses more ROM.
Topics: Humans; Ossification of Posterior Longitudinal Ligament; Male; Retrospective Studies; Female; Middle Aged; Laminoplasty; Spinal Fusion; Cervical Vertebrae; Aged; Range of Motion, Articular; Adult; Atlanto-Axial Joint
PubMed: 38770906
DOI: 10.1111/os.14092