Hasil untuk "Orthopedic surgery"

R. Sihvonen, M. Paavola, A. Malmivaara et al.

L. Gleason, E. Schmitt, C. Kosar et al.

Boning Wang

We mainly use the d-invariant surgery formula established by Wu and Yang \cite{wu2025surgerieslensspacestype} to study the distance one surgeries along a homologically essential knot between lens spaces of the form $L(p,1)$ and $L(q,2)$ where $p,q$ are odd integers.

Ruben P. M. Deblier, Steven D M Colpaert, Debbie Van Renterghem et al.

Introduction: Preservation of forefoot length is crucial for gait mechanics and long-term function. However, soft-tissue defects in this region often lead to bone shortening or amputation. The superficial circumflex iliac artery perforator (SCIP) flap offers a thin and reliable reconstructive option with minimal donor-site morbidity. Case Report: We present three patients with complex forefoot soft tissue loss in whom SCIP flaps were used for reconstruction. In all cases, the flap provided stable coverage, preserved bone length, and allowed functional recovery. Conclusion: The SCIP flap is a valuable option in forefoot reconstruction, enabling preservation of viable structures while maintaining good functional and esthetic outcomes.

Manuel Alberto M. Ferreira

A method to study and evaluate the occupation of a Hospital Surgery Service, with some specificity in its activity, is outlined in this work. Its application is exemplified with real data, and it is shown that it is simple, practical, and useful and allows a practical management of the service occupation.

Kento Kawaharazuka, Kei Okada, Masayuki Inaba

In this study, we present an implementation strategy for a robot that performs peg transfer tasks in Fundamentals of Laparoscopic Surgery (FLS) via imitation learning, aimed at the development of an autonomous robot for laparoscopic surgery. Robotic laparoscopic surgery presents two main challenges: (1) the need to manipulate forceps using ports established on the body surface as fulcrums, and (2) difficulty in perceiving depth information when working with a monocular camera that displays its images on a monitor. Especially, regarding issue (2), most prior research has assumed the availability of depth images or models of a target to be operated on. Therefore, in this study, we achieve more accurate imitation learning with only monocular images by extracting motion constraints from one exemplary motion of skilled operators, collecting data based on these constraints, and conducting imitation learning based on the collected data. We implemented an overall system using two Franka Emika Panda Robot Arms and validated its effectiveness.

Holton C. Gwaltney BS, Joseph W. Harrington MS, Jose G. Anguiano-Hernandez MS et al.

Background: Diabetic patients with foot ulcers are commonly prescribed assistive walking devices to unload the affected foot and promote tissue healing. However, the effect on shear loads to the contralateral foot is unknown. This study investigated the effect of a wheeled knee walker (WKW), compared to common devices, on compressive and shear plantar forces carried by the propulsive foot during walking in patients with type 2 diabetes mellitus. A secondary objective investigated plantar forces’ correlations with body weight unloaded (BWU). Methods: Participants walked a maximum of 200 m per condition during normal walking or when using crutches, a standard walker, and a WKW in randomized order. Plantar forces were measured with force plates, and wireless force-sensitive pads measured BWU through the hands. The WKW was instrumented to measure BWU onto the seat and handlebars. Three-dimensional motion capture confirmed gait events. Results: The WKW produced the lowest vertical, braking, propulsive, and medial shear forces but the highest lateral shear force among all conditions. Using crutches or a walker had negligible medial and lateral shear (mean = −6.69 N and −7.80 N), with normal walking producing the highest medial shear. There was a poor relationship between BWU and assistive walking devices and shear force values. Conclusion: A WKW could be the preferred assistive device for unloading a diabetic foot ulcer. The magnitude of lateral force would need further investigation to determine ulceration risk, given patient susceptibility and neuropathy. Clinical Relevance: Understanding shear forces on the propulsive foot is important for minimizing contralateral limb tissue damage risk while treating an ulcer. Different assistive walking devices change walking patterns and affect shear forces on the plantar surface of the foot. Although the WKW minimizes several loading metrics, a clinical trial investigating assistive walking device compliance and wound healing in diabetic foot ulcer patients across devices is needed.

Anna E van der Windt, Lisette C Langenberg, Joost W Colaris et al.

Despite the common occurrence of radial head fractures, there is still a lack of consensus on which radial head fractures should be treated surgically. The radial head is an important secondary stabilizer in almost all directions. An insufficient radial head can lead to increased instability in varus–valgus and posterolateral rotatory directions, especially in a ligament-deficient elbow. The decision to perform surgery is often not dictated by the fracture pattern alone but also by the presence of associated injury. Comminution of the radial head and complete loss of cortical contact of at least one fracture fragment are associated with a high occurrence of associated injuries. Nondisplaced and minimally displaced radial head fractures can be treated non-operatively with early mobilization. Displacement (>2 mm) of fragments in radial head fractures without a mechanical block to pronation/supination is not a clear indication for surgery. Mechanical block to pronation/supination and comminution of the fracture are indications for surgery. The following paper reviews the current literature and provides state-of-the-art guidance on which radial head fractures should be treated surgically.

Nick. D. Clement, Ewen Fraser, Alisdair Gilmour et al.

Aims: To perform an incremental cost-utility analysis and assess the impact of differential costs and case volume on the cost-effectiveness of robotic arm-assisted unicompartmental knee arthroplasty (rUKA) compared to manual (mUKA). Methods: This was a five-year follow-up study of patients who were randomized to rUKA (n = 64) or mUKA (n = 65). Patients completed the EuroQol five-dimension questionnaire (EQ-5D) preoperatively, and at three months and one, two, and five years postoperatively, which was used to calculate quality-adjusted life years (QALYs) gained. Costs for the primary and additional surgery and healthcare costs were calculated. Results: rUKA was associated with a relative 0.012 QALY gain at five years, which was associated with an incremental cost per QALY of £13,078 for a unit undertaking 400 cases per year. A cost per QALY of less than £20,000 was achieved when ≥ 300 cases were performed per year. However, on removal of the cost for a revision for presumed infection (mUKA group, n = 1) the cost per QALY was greater than £38,000, which was in part due to the increased intraoperative consumable costs associated with rUKA (£626 per patient). When the absolute cost difference (operative and revision costs) was less than £240, a cost per QALY of less than £20,000 was achieved. On removing the cost of the revision for infection, rUKA was cost-neutral when more than 900 cases per year were undertaken and when the consumable costs were zero. Conclusion: rUKA was a cost-effective intervention with an incremental cost per QALY of £13,078 at five years, however when removing the revision for presumed infection, which was arguably a random event, this was no longer the case. The absolute cost difference had to be less than £240 to be cost-effective, which could be achieved by reducing the perioperative costs of rUKA or if there were increased revision costs associated with mUKA with longer follow-up. Cite this article: Bone Jt Open 2023;4(11):889–899.

Guillaume Mestdagh, Stéphane Cotin

The nonrigid alignment between a pre-operative biomechanical model and an intra-operative observation is a critical step to track the motion of a soft organ in augmented surgery. While many elastic registration procedures introduce artificial forces into the direct physical model to drive the registration, we propose in this paper a method to reconstruct the surface loading that actually generated the observed deformation. The registration problem is formulated as an optimal control problem where the unknown is the surface force distribution that applies on the organ and the resulting deformation is computed using an hyperelastic model. Advantages of this approach include a greater control over the set of admissible force distributions, in particular the opportunity to choose where forces should apply, thus promoting physically-consistent displacement fields. The optimization problem is solved using a standard adjoint method. We present registration results with experimental phantom data showing that our procedure is competitive in terms of accuracy. In an example of application, we estimate the forces applied by a surgery tool on the organ. Such an estimation is relevant in the context of robotic surgery systems, where robotic arms usually do not allow force measurements, and providing force feedback remains a challenge.

Daniel Quintero, BS, Nikhil Patel, BS, Griffin Harris, BS et al.

Several studies have previously documented the development of complications stemming from injection with one of the various COVID-19 vaccines. No study, however, has discussed the spontaneous development of a soft tissue mass shortly after a COVID-19 vaccine injection. We report on 66-year-old female with concerns of a growing shoulder mass, 2 weeks after receiving a COVID-19 vaccine booster. Initial work-up with X-ray and MRI was concerning for a soft tissue neoplasm, specifically a soft tissue sarcoma. Subsequent ultrasound guided biopsy demonstrated a benign granulomatous lesion. No further management was required as the lesion spontaneously resolved during a 3-month follow-up period.

Sunjun Hu, Shijie Li, Shimin Chang et al.

Abstract Background Management of posterolateral tibial plateau quadrant fractures can be challenging, and two posterior approaches were frequently used for exposure, reduction, and fixation: posterolateral approach and posteromedial approach. The purpose of this study was to compare their deep anatomical structure and analyze their limits and the risk of injury to important structures during surgical dissection of two approaches. Method Five lower limb specimens were used in this study. After dissection of the skin and superficial fascia of each specimen, deep structures were dissected via posteromedial and posterolateral approach, and several parameters including perpendicular distance from the anterior tibial artery coursing through the interosseous membrane fissure to the lateral joint line and apex of fibular head and so on were measured and analyzed. Result The perpendicular distance from the ATA coursing through the interosseous membrane fissure to the lateral joint line was 49.3 ± 5.6 mm (range 41.3–56.7 mm), while the distance to the apex of fibular head was 37.7 ± 7.2 mm (range 29.0–48.0 mm). The transverse distance of the anterior tibial vascular bundle is around 10 mm. The perpendicular distance from the top accompanying vein of the ATA bundle to lateral joint line and apex of fibular head was 44.1 ± 6.3 mm and 32.5 ± 7.6 mm, respectively. The maximum proportion of posterolateral tibial plateau shielded by the fibular head from the posterior view was 61.7 ± 4.9% (range 55.6–64.1%). The average length of popliteus muscle outside the joint was 83.1 ± 6.0 mm (range 76.5–92.2 mm), and the width in the middle was 28.1 ± 4.3 mm (range 26.6–29.1 mm). Conclusion Although posterolateral approach seems more direct for exposure of posterolateral quadrant tibial plateau fracture, it has three major disadvantages in deep dissection. Posteromedial approach through the medial board of medial head of gastrocnemius–soleus may be safer, but it was hard for direct visualization of articular surface which limits it usage for only a few cases.

Denis S. Yakushev, Victor G. Protsko, Nikolai V. Zagorodny et al.

Introduction This study is a comparative assessment of early and long-term results of two different methods of surgical treatment of hallux extensus. Materials and methods The results of surgical treatment of 22 patients with Hallux extensus at the orthopedic department of the Moscow Yudin City Hospital from 2017 to 2019 were studied. The patients were divided into 2 groups depending on the tactics of surgical treatment. The main goal of this study is a comparative assessment of the functional results of two surgical techniques. The first group of patients, which included 11 subjects, underwent needle percutaneous tenotomy of the extensor tendon of the big toe, the second group, which also consisted of 11 people, underwent tenodesis of the tendon-muscular part of the short flexor of the big toe according to the proposed by us technique. Results The study results are based on the assessment of subjective patient satisfaction and radiography images, as well as on the ACFAS score. In the group of patients who underwent percutaneous tenotomy of the extensor tendon of the big toe, there was a recurrence of deformity in 4 patients (36 %) and insufficient correction of the deformity in 2 patients (18 %). In the group of patients who underwent tenodesis of the tendon-muscle part of the short flexor of the big toe, 100 % showed good functional results, pain relief and esthetic effect. Good treatment results were observed in 73.3 % of the patients. Conclusions Analysis of the clinical results of surgical treatment showed a high efficacy of tenodesis of the tendon-muscle part of the short flexor of the big toe in comparison with percutaneous tenotomy of the extensor tendon of the big toe. Positive results were achieved in 100 % of cases. No recurrence of deformity was observed. The patients did not complain of pain, and there were no problems with footwear in the postoperative period.

Fei Pei, Ren-Qi Yao, Chao Ren et al.

Abstract Emerged evidence has indicated that immunosuppression is involved in the occurrence and development of sepsis. To provide clinical practice recommendations on the immune function in sepsis, an expert consensus focusing on the monitoring and treatment of sepsis-induced immunosuppression was developed. Literature related to the immune monitoring and treatment of sepsis were retrieved from PubMed, Web of Science, and Chinese National Knowledge Infrastructure to design items and expert opinions were collected through an online questionnaire. Then, the Delphi method was used to form consensus opinions, and RAND appropriateness method was developed to provide consistency evaluation and recommendation levels for consensus opinions. This consensus achieved satisfactory results through two rounds of questionnaire survey, with 2 statements rated as perfect consistency, 13 as very good consistency, and 9 as good consistency. After summarizing the results, a total of 14 strong recommended opinions, 8 weak recommended opinions and 2 non-recommended opinions were produced. Finally, a face-to-face discussion of the consensus opinions was performed through an online meeting, and all judges unanimously agreed on the content of this consensus. In summary, this expert consensus provides a preliminary guidance for the monitoring and treatment of immunosuppression in patients with sepsis.

L. C. Grandizio, Elizabeth J. Pavis, Daniel S. Hayes et al.

Adnan Sevencan, F. Volkan Oztuna

Abstract The treatment of scaphoid fracture is determined by the amount of fracture displacement and stability. All acceptable closed or open methods consist of long term immobilisation and secondary tissue damage. The trapezio-lunate mini external fixation for acute scaphoid fracture is a novel method which does not require any extra immobilization or secondary tissue damage. Two cases of trapezial-pin breakage in trapezio-lunate external fixation of scaphoid fractures which resulted in non-union are described. Careful manufacturing and clinical application are mandatory to avoid this previously undescribed complication. Özet Skafoid kırıkarının tedavisi kırık ayrılma miktarına ve stabilitesine göre belirlenmektedir. Uygulanmakta olan tüm açık veya kapalı yöntemlerde uzun süreli immobilizasyon ve ikincil doku hasarı önemli bir dezavantajdır. Akut skafoid kırıklarının tedavisinde yeni bir yöntem olan trapezio-lunat mini eksternal fiksasyon ile ek immobilizasyona ve ikincil doku hasarına gerek kalmamaktadır. Akut skafoid kırığı nedeniyle trapezio-lunat eksternal fiksasyon (TLEF) uygulanan ve kaynama yokluğu ile sonuçlanan iki olguda gözlenen trapezial çivi kırılmaları sunulmaktadır. Klasik eksternal fiksasyon uygulamalarında çivi kırılmaları seyrek olarak gözlenmektedir. TLEF uygulamasında, daha ince yapıda olan bu cihazların üretimlerinde kalite ve dikkatli klinik uygulamalarıyla daha önce tanımlanmamış olan bu komplikasyondan korunmak mümkün olacaktır.

Jianhua Xu, Lu Yin, Shuming Cao et al.

Abstract Background Wide-awake local anesthesia no tourniquet (WALANT) technique has emerged among hand surgeons with other indications. Surgeries involving pedicled flap and revascularization are no longer used as contraindications. The present study aimed to evaluate the feasibility and merits of the WALANT technique in random skin flap surgery. Methods From May 2018 to March 2019, 12 patients with finger skin defects repaired with random skin flaps were reviewed. Abdominal skin flaps or thoracic skin flaps were used to cover the wound. Both the fingers and the donor sites were anesthetized by the WALANT technique. A 40-mL conventional volume consisted of a mixture of epinephrine and lidocaine. A volume of 5 mL was injected at the distal palmar for nerve block, the other 5 mL was injected around the wound for hemostasis, and the remaining was injected at the donor site of flaps for both analgesia and hemostasis. Baseline data with respect to sex, age, side, type of finger, donor sites, flap size, dosage of anesthetics, usage of finger tourniquet, intraoperative and postoperative pain, hemostasis effect, operation time, Disabilities of the Arm, Shoulder, and Hand Questionnaire (QuickDASH) score, and hospitalization expense, were collected. Results All patients tolerated the procedure, and none of them needed sedation. Single finger skin defect in 8 patients and double finger skin defect occurred in 4 patients; 5 patients were repaired by abdominal skin flaps, and 7 patients were repaired by thoracic skin flaps. The good surgical field visibility was 91.7%. All flaps survived adequately, without necrosis, pulling fingers out, and other complications. The average visual analog scale (VAS) score of the maximal pain was 1.1 in fingers vs. 2.1 in donor sites during the operation. On postoperative day one, the average VAS score of the maximal pain in fingers and donor sites was 1.3 and 1.1, respectively. The average hospitalization expense before reimbursement of the whole treatment was 11% less expensive compared to the traditional method. The average QuickDASH score was 9.1. Conclusions Under wide-awake anesthesia, patients have the ability to control their injured upper extremities consciously, avoiding the complications due to pulling flap pedicles. With the merits of safety, painlessness, less bleeding, and effectivity, the WALANT technique in random skin flaps is feasible and a reliable alternative to deal with finger skin defect.

Yang Li, Shuting Yang, Ling Qin et al.

Abstract Chondrogenesis is a major contributor to skeletal development and maintenance, as well as bone repair. Transcriptional coactivator with PDZ-binding motif (TAZ) is a key regulator of osteogenesis and adipogenesis, but how TAZ regulates chondrogenesis and skeletal development remains undefined. Here, we found that TAZ expression is gradually increased during chondrogenic differentiation. Deletion of TAZ in chondrocyte lineage impaired articular and growth plate, as well as the bone development in TAZ-deficient mice. Consistently, loss of TAZ impaired fracture healing. Mechanistically, we found that ectopic expression of TAZ markedly promoted chondroprogenitor proliferation, while deletion of TAZ impaired chondrocyte proliferation and differentiation. TAZ associated with Sox5 to regulate the expression and stability of Sox5 and downstream chondrocyte marker genes’ expression. In addition, overexpression of TAZ enhanced Col10a1 expression and promoted chondrocyte maturation, which was blocked by deletion of TAZ. Overall, our findings demonstrated that TAZ is required for skeletal development and joint maintenance that provided new insights into therapeutic strategies for fracture healing, heterotopic ossification, osteoarthritis, and other bone diseases.

E. Ellison, B. Satiani, D. Way et al.

BACKGROUND In 2011, we predicted that surgeon shortages for rural hospitals would contribute to closures of rural hospitals. Here, we update population trends, the distribution of rural and urban hospitals, and surgeon supply to estimate surgeon demand for rural and urban hospital settings by 2040. METHODS Surgeon supply was based on new certifications for general surgery, orthopedic surgery, and obstetrics and gynecology adjusted for retirement. Surgeon demand from 2020 to 2040 was projected based on the US Census and published practice ratios: general surgery 10.7/100,000, orthopedic surgery 7.9/100,000, and obstetrics and gynecology 13.0/100,000. RESULTS The US population grew from 309 million in 2011 to 327 million in 2017 with rural populations unchanged at 56 million. By 2040, the US population will be 374 million (urban 85% and rural 15%) creating shortages of general surgery (-31.5%), orthopedic surgery (-34.3%), and obstetrics and gynecology (-25.3). Future hiring needs for urban hospitals will be 5 times greater than rural hospitals. Urban hospitals will likely recruit most newly certified surgeons. CONCLUSION Increases in surgery trainees will not meet the demand. The continued urbanization of American surgery may push rural hospitals into a vicious financial cycle leading to additional closures of rural hospitals and worsening issues of access. An alternative training paradigm for the rural surgeon is recommended to meet the unique demands of rural hospitals.

Rod J. Rohrich, Min-Jeong Cho