Hasil untuk "Orthopedic surgery"

Nuria Senar, Stavros Makrodimitris, Michel H. Hof et al.

Detection of minimal residual disease (MRD) in cancer patients after surgery can provide an early marker for disease recurrence and guide subsequent treatment decisions. Accurate and sensitive estimation of tumour burden after cancer surgery may be obtained through liq- uid biopsies, measuring circulating tumour DNA (ctDNA) using, for example, mutation-based Variant Allele Frequency (VAF) values. However, to be applicable to all patients this ei- ther requires tumour-informed, patient-specific mutation panels or sensitive, tumour-agnostic genome-wide measurements. We propose a solution that accounts for patient-specific charac- teristics in genome-wide screens. For that, we introduce a bivariate deconvolution model to estimate tumour proportion from circulating cell-free DNA (cfDNA) methylation profiles of patients before and after surgery. The observations are modelled as a convolution of two bivariate latent variables, corresponding to tumour and background signals, mixed by the tumour proportion at each measurement. This bivariate approach links pre- and post-surgery measurements improving estimation of the tumour proportion after surgery, when the tumour signal is potentially very weak, or absent. We approximate likelihood of the convolution through a discretisation of the bivariate density for each latent variable into a two-dimensional grid for each pair of observations which allows for fast maximum likelihood estimation. We evaluate the predictive performance of the estimated post-surgery tumour proportions based on cfDNA methylation against available mutation-based VAF values in one-year recurrence-free survival.

Yao-Yi Kuo, Si-Qi Chiu, Wen-Pei Chang et al.

Abstract Background Full-thickness cartilage defects have a significant impact on the function of joints in young adults, and the treatment of cartilage defects has been a challenge, as cartilage tissue is an avascular tissue. This study aimed to compare the clinical and radiological outcomes of Biphasic Cartilage Repair Implant (BiCRI) and microfracture treatments for knee cartilage defects. Methods This randomized controlled clinical trial enrolled patients with symptomatic knee chondral lesions smaller than 3 cm2. They were randomized to either the BiCRI (n = 11) or microfracture (n = 10) treatment groups. BiCRI or microfracture surgical procedures were performed on the patients, who were subsequently followed for a period of five years. Primary outcome measures included the International Knee Documentation Committee (IKDC) score, Knee Injury and Osteoarthritis Outcome Score (KOOS), Visual Analog Scale (VAS) score, Magnetic Resonance Imaging (MRI) measured cartilage thickness, and the Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) score. Results 21 patients were enrolled, who were subsequently followed for a period of five years. Both BiCRI and microfracture treatments demonstrated significant improvements in IKDC, KOOS and VAS scores, with no significant differences between the two. MRI analysis indicated a significant increase in minimum cartilage thickness with BiCRI treatment (median of difference: 1 mm, P = 0.026)), in contrast to the nonsignificant change in the microfracture group (median of difference: 1 mm, P = 0.102). The MOCART scores revealed a significant increase percentage of isointense signal intensity identical to the adjacent articular cartilage (P = 0.03) in the BiCRI group from the 2-year to the 5-year mark, while the scores remained stable in the microfracture group. Moreover, the BiCRI technique displayed superior performance in graft infill at 5 years (P = 0.008), border integration at 5 years (P = 0.04), surface contour at 2 years (P = 0.04) compared to microfracture. Conclusions Both BiCRI and microfracture treatments showed significant effectiveness in improving clinical outcomes in patients with small symptomatic articular cartilage defects of the knee, with the BiCRI group demonstrating a superior radiological outcome than microfracture, over a five-year period. However, the sample size of our study is relatively small to reach a definite conclusion, and further studies with larger sample size and longer follow up are recommended. Trial registration The trial was registered on ClinicalTrials.gov under the identifier NCT01477008.

Ashley Jones, Farzan Kamdin, Declan Eastwood et al.

Abstract Purpose The aim of the study was to investigate the incidence, nature and burden of injury in a cohort of male ice hockey players competing in the National Ice Hockey League (NIHL) over two seasons. Methods A prospective single‐site cohort study was conducted on 50 players (age: 22.3 ± 3.7) competing over the 2022–2023 and 2023–2024 seasons. All injuries (medical attention and time loss) and illnesses were recorded. Match and training exposure were also recorded. Injury incidence was expressed as injuries per 1000 h of exposure while burden was the number of time loss days per 1000 h of exposure. Prevalence was reported as percentages for: body area, injury type, diagnosis, mechanism, mode of onset and injury episode. One‐variable chi‐squared tests were used to determine if observed values were as expected for each prevalence subcategory. Results One hundred and eighty‐two injuries were recorded, of which 26 injuries (26/182) led to time‐loss. Seven illnesses were reported. The injury incidence rate for all injuries was 54.18 (95% confidence interval [CI]: 7.87–62.0)/1000 h, while the time‐loss was 7.74 (95% CI: 2.97–10.71)/1000 h. More injuries were recorded during matches than in training (35.63 [95% CI: 13.81–48.34]/1000 h vs. 0.75 [95% CI: –1.04 to 1.79]/1000 h). Injuries to the head occurred most often (17.6%), although the shoulder was the most burdensome (16.3 severity score). Bone contusions were the most frequent diagnosis (19.8%), although the most days were lost per injury were following muscle contusion injuries (18.3 severity score). Most injuries occurred from (direct and indirect) contact (70.8%) mechanisms, were acute in nature (77.5%) and were classed as first occurrences (86.8%). Conclusion The overall incidence of injury was 54.18/1000 h, yet time‐loss injury incidence was much lower at 7.74/1000 h. The most injured body area was the head, and the most injured tissue type was muscle and tendon. Bone contusions were the most common pathology recorded. Level of Evidence Level II.

Nouédyn Baspin, Lucas Berent, Lawrence Z. Cohen

Quantum LDPC codes promise significant reductions in physical qubit overhead compared with topological codes. However, many existing constructions for performing logical operations come with distance-dependent temporal overheads. We introduce a scheme for performing generalized surgery on quantum LDPC codes using a constant number of rounds of syndrome measurement. The merged code in our scheme is constructed by taking the total complex of the base code and a suitably chosen homomorphic chain complex. We demonstrate the applicability of our scheme on an example multi-cycle code and assess the performance under a phenomenological noise model, showing that fast surgery performs comparably to standard generalized surgery with multiple rounds. Our results pave the way towards fault-tolerant quantum computing with LDPC codes with both low spatial and temporal overheads.

S. Chatterjee, M. Bhattacharya, S. Pal et al.

ChatGPT has quickly popularized since its release in November 2022. Currently, large language models (LLMs) and ChatGPT have been applied in various domains of medical science, including in cardiology, nephrology, orthopedics, ophthalmology, gastroenterology, and radiology. Researchers are exploring the potential of LLMs and ChatGPT for clinicians and surgeons in every domain. This study discusses how ChatGPT can help orthopedic clinicians and surgeons perform various medical tasks. LLMs and ChatGPT can help the patient community by providing suggestions and diagnostic guidelines. In this study, the use of LLMs and ChatGPT to enhance and expand the field of orthopedics, including orthopedic education, surgery, and research, is explored. Present LLMs have several shortcomings, which are discussed herein. However, next-generation and future domain-specific LLMs are expected to be more potent and transform patients’ quality of life.

I. Kamel, M. F. Ahmed, A. Sethi

Regional anesthesia is an integral component of successful orthopedic surgery. Neuraxial anesthesia is commonly used for surgical anesthesia while peripheral nerve blocks are often used for postoperative analgesia. Patient evaluation for regional anesthesia should include neurological, pulmonary, cardiovascular, and hematological assessments. Neuraxial blocks include spinal, epidural, and combined spinal epidural. Upper extremity peripheral nerve blocks include interscalene, supraclavicular, infraclavicular, and axillary. Lower extremity peripheral nerve blocks include femoral nerve block, saphenous nerve block, sciatic nerve block, iPACK block, ankle block and lumbar plexus block. The choice of regional anesthesia is a unanimous decision made by the surgeon, the anesthesiologist, and the patient based on a risk-benefit assessment. The choice of the regional block depends on patient cooperation, patient positing, operative structures, operative manipulation, tourniquet use and the impact of post-operative motor blockade on initiation of physical therapy. Regional anesthesia is safe but has an inherent risk of failure and a relatively low incidence of complications such as local anesthetic systemic toxicity (LAST), nerve injury, falls, hematoma, infection and allergic reactions. Ultrasound should be used for regional anesthesia procedures to improve the efficacy and minimize complications. LAST treatment guidelines and rescue medications (intralipid) should be readily available during the regional anesthesia administration.

Flavio dos Santos Cerqueira, M.D., Felipe Holanda Junqueira, M.D., Guilherme Blois Vasconcelos Pereira, M.D. et al.

Correction of the varus deformities in the tibia is necessary because of the excessive pressure exerted on the medial compartment of the knee, which intensifies the degenerative process. Correction strategies encompass a variety of approaches and depend on the patient’s individual characteristics, age, soft tissue condition, and the orthopaedic surgeon’s experience with different surgical materials. Size and location of the deformity, whether gradual or acute, play crucial roles in choosing the most appropriate material and shape. The gradual correction is especially indicated for patients with severe deformities, soft tissue involvement, and a history of bone infections. This study aimed to introduce a gradual correction technique for varus deformities in the tibia using a unilateral external fixator and to describe the postoperative follow-up. This technique offers notable advantages, including accurate correction, better patient acceptance, lighter assembly, less risk of pseudarthrosis, and shorter distraction process owing to the use of a single piece. In addition, the operated limb can support the load on the day after surgery, and dynamic follow-up is performed on an outpatient basis.

Tadatsugu Morimoto, Takaomi Kobayashi, Toshihiko Kakiuchi et al.

As society ages, the number of patients with spinal degenerative diseases (SDD) is increasing, posing a major socioeconomic problem for patients and their families. SDD refers to a generic term for degenerative diseases of spinal structures, including osteoporosis (bone), facet osteoarthritis (joint), intervertebral disk degeneration (disk), lumbar spinal canal stenosis (yellow ligament), and spinal sarcopenia (muscle). We propose the term “gut-spine axis” for the first time, given the influence of gut microbiota (GM) on the metabolic, immune, and endocrine environment in hosts through various potential mechanisms. A close cross-talk is noted between the aforementioned spinal components and degenerative diseases. This review outlines the nature and role of GM, highlighting GM abnormalities associated with the degeneration of spinal components. It also summarizes the evidence linking GM to various SDD. The gut-spine axis perspective can provide novel insights into the pathogenesis and treatment of SDD.

Rongfeng She, Bin Zhang, Kundou Jiang et al.

Objectives The mid‐ and long‐term clinical outcomes of cement‐augmented screws in the treatment of osteoporotic proximal humeral fractures have rarely been reported. The aim of this study was to observe the mid‐ and long‐term efficacy of combined cement‐augmented screw fixation and PHILOS plating in the treatment of osteoporotic fractures of the proximal humerus. Methods This study retrospectively analyzed data from 19 patients with osteoporotic fractures of the proximal humerus who had undergone internal fixation at the Guizhou Provincial People's Hospital from February 2017 to May 2021. The cohort was comprised of six males and 13 females, aged 75–87 (mean age: 82.52 ± 1.24) years. According to the Neer classification, three, 12, and four patients had two‐part, three‐part, and four‐part fractures, respectively. All patients were treated with open reduction internal fixation with cement‐augmented screws and PHILOS plating. Time until fracture healing was recorded postoperatively. Patients were observed for postoperative complications, including humeral head necrosis, loosening or breaking of the augmented screws, screw perforation of the humeral head, and varus fracture displacement. Visual analog scale and Constant scores of the shoulder joint were compared 1, 3, 6, and 12 months after surgery. Scores at the most recent follow‐up were used to evaluate shoulder joint function. Measured data conforming to a normal distribution were expressed as mean ± SD. Analysis of variance or rank sum tests were used for intergroup comparisons. A value of p < 0.05 was considered significant. Results All 19 patients followed up for 1–4 (average: 2.13 ± 0.61) years. Fractures united in all cases, with a healing time of 8–14 (average: 10.25 ± 1.72) weeks. There were no cases of humeral head necrosis, screw loosening, fractures, or perforation of the humeral head. One patient had mild varus fracture displacement with a reduced neck‐shaft angle. There were significant differences in visual analog scale and Constant scores 1, 3, and 6 months after surgery (p < 0.05). The visual analog scale score was 0 at final follow‐up in all cases. The Constant score of the shoulder joint was excellent, good, fair, and poor in two, 12, four, and one case, respectively, yielding an excellent and good rate of 73.68%. Conclusions Cement‐augmented screw fixation combined with PHILOS plating of osteoporotic proximal humeral fractures had good mid‐ and long‐term clinical efficacy. It should be considered a new option for fracture treatment in such patients.

Ryo Hachiuma, Tomohiro Shimizu, Hideo Saito et al.

Recording surgery in operating rooms is an essential task for education and evaluation of medical treatment. However, recording the desired targets, such as the surgery field, surgical tools, or doctor's hands, is difficult because the targets are heavily occluded during surgery. We use a recording system in which multiple cameras are embedded in the surgical lamp, and we assume that at least one camera is recording the target without occlusion at any given time. As the embedded cameras obtain multiple video sequences, we address the task of selecting the camera with the best view of the surgery. Unlike the conventional method, which selects the camera based on the area size of the surgery field, we propose a deep neural network that predicts the camera selection probability from multiple video sequences by learning the supervision of the expert annotation. We created a dataset in which six different types of plastic surgery are recorded, and we provided the annotation of camera switching. Our experiments show that our approach successfully switched between cameras and outperformed three baseline methods.

Shiying Wang, Huixian Zhan, Liping Xu et al.

Abstract Objective The aim of this study was to investigate the potential role of serum nicotinamide phosphoribosyltransferase (NAMPT) in non-traumatic osteonecrosis of femoral head (NONFH). Methods A total of 113 NONFH patients and 81 healthy individuals were included in this study. The NAMPT levels in serum were measured by a commercial enzyme-linked immunosorbent assay kit. Radiographic progression was determined using Association Research Circulation Osseous (ARCO) classification system. Clinical severity was assessed by Harris hip score (HHS) and visual analogue scale (VAS). Correlations between serum NAMPT and radiographic progression as well as clinical severity were evaluated statistically. Receiver operating characteristic (ROC) curves were performed to evaluate the diagnostic values of NAMPT in NONFH potential and disease severity. Results The serum NAMPT levels in NONFH patients were significantly lower than that in healthy controls. There were no significant differences among alcohol-induced group, steroids-induced group, and idiopathic group. NONFH patients with ARCO stage 4 had significant lower serum NAMPT levels in comparisons with ARCO stage 3 and 2, respectively. Lower serum NAMPT levels were also observed in bilateral NONFH cases compared with cases with unilateral NONFH. In addition, serum NAMPT was negatively correlated with ARCO stages and VAS scores, and positively correlated with HHS. ROC curve analysis indicated that serum NAMPT may serve as a novel biomarker for diagnosing early NONFH and for monitoring disease severity. Conclusions Our results suggest that serum NAMPT may serve as a novel biomarker for NONFH potential and disease severity.

Anne-Marie Hutchison, Owen Bodger, Rhys Whelan et al.

AimsWe introduced a self-care pathway for minimally displaced distal radius fractures, which involved the patient being discharged from a Virtual Fracture Clinic (VFC) without a physical review and being provided with written instructions on how to remove their own cast or splint at home, plus advice on exercises and return to function.MethodsAll patients managed via this protocol between March and October 2020 were contacted by a medical secretary at a minimum of six months post-injury. The patients were asked to complete the Patient-Rated Wrist Evaluation (PRWE), a satisfaction questionnaire, advise if they had required surgery and/or contacted any health professional, and were also asked for any recommendations on how to improve the service. A review with a hand surgeon was organized if required, and a cost analysis was also conducted.ResultsOverall 71/101 patients completed the telephone consultation; no patients required surgery, and the mean and median PRWE scores were 23.9/100 (SD 24.9) and 17.0/100 (interquartile range (IQR) 0 to 40), respectively. Mean patient satisfaction with treatment was 34.3/40 (SD 9.2), and 65 patients (92%) were satisfied or highly satisfied. In total there were 16 contact calls, 12 requests for a consultant review, no formal complaints, and 15 minor adjustment suggestions to improve patient experience. A relationship was found between intra-articular injuries and lower patient satisfaction scores (p = 0.025), however no relationship was found between PRWE scores and the nature of the fracture. Also, no relationship was found between the type of immobilization and the functional outcome or patient satisfaction. Cost analysis of the self-care pathway V traditional pathway showed a cost savings of over £13,500 per year with the new self-care model compared to the traditional model.ConclusionOur study supports a VFC self-care pathway for patients with minimally displaced distal radius fractures. The pathway provides a good level of patient satisfaction and function. To improve the service, we will make minor amendments to our patient information sheet.Cite this article: Bone Jt Open 2022;3(9):726–732.

Eric Tille, L. Seidel, A. Schlüßler et al.

Abstract Background Monteggia fractures and Monteggia-like lesions result after severe trauma and have high complication rates. Preliminary biomechanical studies suggested a correlation between ulnar fracture localization and clinical result. Objectives Key objective was to evaluate whether the site of the ulnar fracture can be correlated to clinical outcome after open reduction and internal stabilization. Methods In a retrospective, monocentric study 35 patients who underwent surgical treatment after suffering a Monteggia injury or Monteggia-like lesion were included. Fractures were classified according to Bado and Jupiter, the site of the fracture location at the proximal ulna and regarding the potential accompanying ligamentary injury. In a follow-up examination validated patient-reported outcome measures and functional parameters were evaluated. Furthermore, treatment strategy and complications were analysed. Results Mean patient age was 51.9 years (± 18.0). 69% were females (n = 24). Follow-up took place after 50.5 months (± 22.1). Fractures were classified according to Bado (I:2, II:27, III:4, IV:2). Bado II-fractures were further classified according to Jupiter (A:7, B:16, C:3, D:1). Cases were divided into subgroups depending upon the distance of the ulnar fracture site in respect to its distal endpoint (A: < 7 cm and B: > 7 cm). Average overall MEPS was 84.1 (± 19.0). Oxford elbow score and DASH were 37.2 (± 10.5) and 20.4 (± 20.5). Average extension capability reached − 7° (± 7.5). Mean flexion was 134.8° (± 19.7). Average pain according to visual analogue scale was 1.6 (± 1.9). We found no differences between the subgroups regarding the PROMs. Subgroup A displayed a worse extension capability (p = 0.027) and patients were significantly older (p < 0.01). Comparing patients with and without fracture of the radial head, we observed no differences. Patients with an accompanying injury of the coronoid process displayed higher pain levels (p = 0.011), a worse functionality (p = 0.027) and overall lower scoring in PROM. Conclusion The presented results suggest that in Monteggia fractures and Monteggia-like lesions, the localization of the ulna fracture can give a hint for its postoperative outcome. However, we could not confirm the hypothesis of an increasing instability in ulnar fractures located further distally (high severity of the potential ligamentous injury). Intraarticular fractures or injuries with a close relation to the joint have a worse prognosis, especially if the coronoid process is injured. Trial registration Registration was done with ClinicalTrials.gov under NCT05325268.

Jianzhong Kong, Yupeng Chu, Chengwei Zhou et al.

Abstract Background Anterior-posterior compression (APC) type II pelvis fracture is caused by the destruction of pelvic ligaments. This study aims to explore ligaments injury in APC type II pelvic injury. Method Fourteen human cadaveric pelvis samples with sacrospinous ligament (SPL), sacrotuberous ligament (SBL), anterior sacroiliac ligament (ASL), and partial bone retaining unilaterally were acquired for this study. They were randomly divided into hemipelvis restricted and unrestricted groups. We recorded the separation distance of the pubic symphysis and anterior sacroiliac joint, external rotation angle, and force when ASL ruptured. We observed the external rotation damage to the pelvic bone and ligaments. Result When ASL failed, there was no significant difference in pubic symphysis separation (28.6 ± 8.4 mm to 23.6 ± 8.2 mm, P = 0.11) and anterior sacroiliac joint separation (11.4 ± 3.8 mm to 9.7 ± 3.9 mm, P = 0.30) between restricted and unrestricted groups. The external rotation angle (33.9 ± 5.5° to 48.9 ± 5.2°, P < 0.01) and force (553.9 ± 82.6 N to 756.6 ± 41.4 N, P < 0.01) were significantly different. Pubic symphysis separation between two groups ranged from 14 to 40 mm. In the restricted group, both SBL and SPL were injured. SPL ruptured first, and then SBL and the interosseous sacroiliac ligament were damaged while the posterior ligament remained unharmed. In the unrestricted group, interosseous sacroiliac ligament and posterior sacroiliac ligaments were damaged, while SBL and SPL were not. When the ASL, SBL, and SPL all failed, pubic symphysis and anterior sacroiliac joint separation between two groups increased significantly (from 28.6 ± 8.4 to 42.0 ± 7.6 mm, 11.4 ± 3.8 to 16.7 ± 4.2 mm respectively, all P < 0.05). Conclusion Pelvic external rotation injury is either hemipelvic restricted or unrestricted, which can result in different outcomes. When the ASL ruptures, the unrestricted group needs greater external rotation angle and force, without SBL or SPL injury, while both SBL and SPL were injured in another group. When ASL fails in two groups, pubic symphysis separation fluctuates considerably. Finally, when the ASL ruptures, SBL and SPL may be undamaged.

Ricardo Trueba

Paciente de 67 años que consulta por dolor en la región glútea izquierda, de varios meses de evolución, que altera su calidad de vida, porque refiere dolor al estar sentado, al comenzar la marcha y al dormir del lado comprometido. Se presentan imágenes para discutir el caso.

Karmel S. Shehadeh

We study elective surgery planning in flexible operating rooms (ORs) where emergency patients are accommodated in the existing elective surgery schedule. Specifically, elective surgeries can be scheduled weeks or months in advance. In contrast, an emergency surgery arrives randomly and must be performed on the day of arrival. Probability distributions of the actual durations of elective and emergency surgeries are unknown, and only a possibly small set of historical realizations may be available. To address distributional uncertainty, we first construct an ambiguity set that encompasses all possible distributions of surgery durations within a 1-Wasserstein distance from the empirical distribution. We then define a distributionally robust surgery assignment (DSA) problem to determine optimal elective surgery assignment decisions to available surgical blocks in multiple ORs, considering the capacity needed for emergency cases. The objective is to minimize the total cost consisting of the fixed cost related to scheduling or rejecting elective surgery plus the maximum expected cost associated with OR overtime and idle time over all distributions defined in the ambiguity set. Using the DSA model's structural properties, we derive an equivalent mixed-integer linear programming (MILP) reformulation that can be implemented and solved efficiently using off-the-shelf optimization software. In addition, we extend the proposed model to determine the number of ORs needed to serve the two competing surgery classes and derive a MILP reformulation of this extension. We conduct extensive numerical experiments based on real-world surgery data, demonstrating our proposed model's computational efficiency and superior out-of-sample operational performance over two state-of-the-art approaches. In addition, we derive insights into surgery scheduling in flexible ORs.

Burak Demirag, Ali Onur Tirelioglu, Bartu Sarisozen et al.

Abstract Objectives: The aim of this retrospective study was to evaluate patients who developed necrotizing fasciitis (NF) in the lower extremity secondary to diabetic wounds.\nMethods: The study included sixteen patients (11 men, 5 women; mean age 63 years; range 50 to 82 years) who were treated for NF arising from diabetic wounds. Associated diseases were coronary heart disease in three patients, and chronic renal failure due to diabetic nephropathy in three patients. The patients were evaluated by physical examination, direct radiographs, blood pressure measurements, and cultures, and with respect to treatment methods and results. The mean hospitalization period was 26 days (range 5 to 59 days).\nResults: Necrotizing fasciitis was confined to the leg in four patients, extended to the thigh in 10 patients, and was bilateral in two patients. Pain was encountered in 10 patients (68.8%). Fourteen patients (87.5%) had increased creatine kinase levels. Direct radiographs showed gas appearance in soft tissues in seven patients (43.8%). Cultures showed a single microorganism in four patients (25%), and multiple microorganisms in five patients (31.3%). Of seventeen microorganisms isolated, 10 (58.8%) were Enterobacter species. Eleven patients (68.8%) underwent above-the-knee, and three patients (18.8%) underwent below-the-knee amputations. Disarticulation of the hip was performed in four patients. The mean number of debridements was five (range 2 to 21) following the initial surgical intervention. Nine patients developed septic shock. Seven patients (43.8%) died due to multiple organ failure. Increased creatine kinase levels were significantly associated with mortality (p<0.05).\nConclusion: Early and accurate diagnosis and prompt surgical treatment may be life-saving in diabetic patients with NF of the lower extremity. Özet Amaç: Bacaktaki diyabetik yaralara bağlı gelişen nekrozitan fasiit (NF) nedeniyle tedavi edilen hastalar retrospektif olarak incelendi.\nÇalışma planı: Çalışmaya bacağında diyabetik yaralara bağlı olarak NF gelişen 16 hasta (11 erkek, 5 kadın; ort. yaş 63; dağılım 50-82) alındı. Ek olarak, üç hastada koroner arter hastalığı, üç hastada ise diyabetik nefropatiye bağlı kronik böbrek yetmezliği vardı. Tüm hastalar fizik muayene, laboratuvar bulguları, direkt grafiler, kan basıncı, alınan kültür sonuçları, uygulanan tedaviler ve sonuçları açısından değerlendirildi. Hastaların hastanede kalış süresi ortalaması 26 gündü (dağılım 5-59 gün).\nSonuçlar: Dört hastada NF bacakla sınırlıyken, 10 hastada fasiit uyluğa uzanmıştı. İki olguda iki taraflı bacak tutulumu vardı. On bir hastada (%68.8) ağrı yakınması vardı. On dört hastada (%87.5) kretin kinaz değerinde artış görüldü. Direkt grafilerde yedi hastada (%43.8) yumuşak dokuda gaz görüldü. İlk cerrahi müdahale sırasında alınan kültürlerde dört hastada (%25) bir mikroorganizma, beş hastada (%31.3) ise birden fazla mikroorganizma üredi. İzole edilen 17 mikroorganizmanın 10’u (%58.8) enterobakter ailesinden idi. On bir hastaya (%68.8) dizüstü, üç hastaya (%18.8) dizaltı amputasyon yapıldı. Dört hastada ilk tedavi olarak kalça dezartikülasyonu uygulandı. İlk cerrahi girişimlerinden sonra ortalama beş kez (dağılım 2-21) debridman yapıldı. Dokuz hastada septik şok gelişti. Çoklu organ yetmezliği gelişen yedi hasta (%43.8) kaybedildi. Ölen hastalarda kreatin kinaz düzeyleri diğer hastalara göre anlamlı derecede yüksek bulundu (p<0.05).\nÇıkarımlar: Diyabetik hastaların bacaklarında gelişen ve ölümcül bir enfeksiyon olan NF’de erken ve doğru tanı ve acil cerrahi tedavi hastalar için yaşam kurtarıcı olabilir.

Ting Zhang, MD, Michael Christopher, MD, Natasha M. Simske, BS et al.

Abstract. The authors present the case of a patient who developed an Aspergillosis flavus (A flavus) superficial cutaneous infection which was identified at the time of cast removal, 2 weeks after immobilization of a closed distal third humerus fracture. Clinical and microbiological findings, as well as the treatment of this patient, are reported. An otherwise healthy 27-year-old male presented to the orthopaedic surgery clinic 2 weeks after a closed distal humerus fracture, which was initially immobilized with a functional removable brace. Upon cast removal, the patient was noted to have significant brown hyperkeratotic patches and plaques, studded with pustules in an annular configuration on his left posterior and lateral arm. Fungal culture later grew A flavus. The patient was started on both oral and topical antifungals and operative management of the displaced fracture was delayed until skin lesions resolved. Once clinical examination and negative repeat bedside potassium hydroxide were confirmed, open reduction and internal fixation was performed. The fracture healed uneventfully, and the patient did not develop any signs or symptoms of postoperative infection.

Man Soo Kim, In Jun Koh, Sueen Sohn et al.

Abstract Background There have been no studies comparing patient-reported outcome measures including end-of-stem tip pain and patient satisfaction based on the use of cementing techniques in revision total knee arthroplasty (TKA). The purpose of this study was to compare end-of-stem tip pain and PROMs with hybrid and modified hybrid cementing techniques in revision TKAs. Method Sixty-two cases of revision TKA performed by a single surgeon were divided into two groups based on the cementing technique with a minimum follow-up of 2 years. Two types of cementing technique for femoral and tibial stems were used as follows: (1) a hybrid cementing technique (33 cases), in which cement was applied immediately distal to the modular junction of the stem and the component while the distal stem was press-fitted into the diaphysis without using cement; and (2) a modified hybrid cementing technique (29 cases), in which cement was applied to the tip of femoral and tibial stems. The thigh and shin were assessed for the end-of-stem tip pain. Patient satisfaction was evaluated based on the satisfaction items of New Knee Society Score. Results Modified hybrid cementing significantly lowered the percentage of patients manifesting shin pain (3.4% vs. 24.2%, p = 0.029). Patients treated with the modified hybrid cementing technique showed a higher satisfaction rate (p = 0.003). Multivariate logistic regression analysis showed an increase in the odds of satisfaction 32.686-fold (p = 0.004) in patients without pain at the end-of-stem tip in the shin and 9.261-fold (p = 0.027) in patients treated with the modified hybrid cementing technique. Conclusion The modified hybrid cementing technique for fixation of long-stem in revision TKAs reduced the end-of-stem tip pain in the shin, leading to significantly higher satisfaction compared with the hybrid cementing technique after revision TKA. Level of evidence Level III

Friedrich Hegenbarth, Dušan Repovš

The aim of this paper is to show the importance of the Steenrod construction of homology theories for the disassembly process in surgery on a generalized $n$-manifold $X^n$, in order to produce an element of generalized homology theory, which is basic for calculations. In particular, we show how to construct an element of the $n$-th Steenrod homology group $H^{st}_{n} (X^{n}, \mathbb{L}^+),$ where $\mathbb{L}^+$ is the connected covering spectrum of the periodic surgery spectrum $\mathbb{L}$, avoiding the use of the geometric splitting procedure, which is standardly used in surgery on topological manifolds.