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The black swan (Cygnus atratus, LATHAM, 1790) is a bird kept as an ornamental in zoos. Because of their long beaks they tend to have a reserved prognosis in musculoskeletal disorders such as beak trauma, secondary to skull bone fractures, presenting irreversible lesions. The aim of this report is present a clinical surgical innovation in the repair of a black swan’s gnathotheca fissure with the application of non-conventional materials used. It was observed that one of the swans kept in a zoo display area had difficulty feeding, with associated weight loss. It was observed tissue loss and a lacerative lesion in the caudal sublingual region of its beak. The lesion was corrected by a separate simple suture in the cranial region of the beak and with a x-clamping using steel surgical wire and the application of dental resin in the distal region to perform a sustentation bridge in the beak end-gap. After 12 days, the animal was able to feed again and remained perfectly adapted to the restoration, reestablishing the anatomical and physiological function of its beak. RESUMO O cisne-negro (Cygnus atratus, Latham, 1790) é uma ave mantida como ornamental em zoológicos. Por apresentar bicos longos, tende a ter prognóstico reservado em afecções musculoesqueléticas, como traumas de bico secundários e fraturas de ossos do crânio, com lesões irreversíveis. O objetivo deste relato é apresentar uma inovação clínica cirúrgica no reparo de fissura na gnatoteca de um cisne-negro, com a utilização de materiais não convencionais. Observou-se que um dos cisnes mantidos em uma área de exibição de um zoológico apresentava dificuldade para se alimentar, com perda de peso associada. Constatou-se perda tecidual e lesão lacerativa na região sublingual caudal de seu bico. A lesão foi corrigida por meio de sutura simples separada na região cranial do bico e posterior sutura em x com fio cirúrgico de aço, finalizando com aplicação de resina odontológica na região distal para realização de ponte de sustentação do bico. Após 12 dias, o animal conseguiu se alimentar novamente e se manteve perfeitamente adaptado à restauração, restabelecendo a função anatômica e fisiológica de seu bico.

BACKGROUND: The optimal age for endorectal pull-through (ERPT) surgery in infants with short-segment Hirschsprung disease varies, with a trend toward earlier surgery. However, it is unclear if the timing of surgery impacts functional outcomes. We undertook the present study to determine the optimal timing of ERPT in infants with short-segment Hirschsprung disease. METHODS: The NCBI PubMed database was searched for English-language manuscripts published between 2000–2019 analyzing functional outcomes for patient following the initial Soave ERPT for short-segment Hirschsprung disease. Raw data from these studies was obtained from the corresponding author for each manuscript. We combined data from these papers with our own institutional data and performed a meta-analysis. RESULTS: A total of 780 infants were included in our meta-analysis. Constipation occurred in 1.0–31.7%, soiling 1.3–26.0%, anastomotic stricture 0.0–14.6%, and anastomotic leak 0.0–3.4%. Regarding age at ERPT, younger infants at the time of initial corrective surgery had higher rates of soiling, stricture, and leak. On sub-group analysis, patients

BACKGROUND Right ventricular outflow tract (RVOT) obstruction relief is one of the major procedures during the total correction of tetralogy of Fallot (TOF). Pulmonary insufficiency (PI) is usually inevitable after a transannular incision with a patch repair is performed. Therefore, some surgeons advocate to place a monocusp valve within the transannular patch (TAP) in order to decrease the severity of the PI. However, the monocusp valve seemed not be very effective in some patients who underwent the complete TOF repair. METHODS Patients who had the classic form of TOF between January 2009 and January 2017 and underwent the corrective surgery with a TAP by the same cardiovascular surgeon were identified for further analysis. Clinical information including demographics at operation, perioperative data, and postoperative outcome were collected retrospectively and compared between the group with and without a monocusp valve. RESULTS A total of 24 TOF cases were included in the final analysis, and 16 (66.7%) patients received a monocusp valve placement. The patients' characteristics before and during the surgery were similar between the two groups. The median duration of chest tube drainage after the total correction in the monocusp group was longer than those without the valve (p = 0.04). There was no difference in the immediate postoperative data, including the inflammation/infection status, the duration of mechanical ventilation, and the length of ICU and hospital stay. CONCLUSION Implantation of a monocusp valve during the total TOF correction using a TAP did not bring benefit to improve the immediate postoperative outcomes, especially the duration of the pleural drainage. Further study with a prospective design and a larger number of cases is needed.

Introduction: Individuals with cleft palate can present with velopharyngeal dysfunction after primary palatoplasty and require a secondary treatment due to insufficiency. In these cases, the pharyngeal bulb prosthesis can be used temporarily while awaiting secondary surgery. Objective: This study aimed to investigate the outcome of treatment of hypernasality with pharyngeal bulb prosthesis in patients with history of cleft palate presenting with velopharyngeal insufficiency after primary palatal surgery. We hypothesized that the use of the pharyngeal bulb prosthesis is an effective approach to eliminate hypernasality related to velopharyngeal insufficiency in patients with cleft palate. Methods: Thirty speakers of Brazilian Portuguese (15 males and 15 females) with operated cleft palate, ages ranging from 6 to 14 years (mean: 9 years; SD = 1.87 years), participated in the study. All patients were fitted with a pharyngeal bulb prosthesis to manage velopharyngeal insufficiency while they were awaiting corrective surgery to be scheduled. Auditory-perceptual analysis of speech recorded in the conditions with and without pharyngeal bulb prosthesis were obtained from three listeners who rated the presence or absence of hypernasality for this study. Results: Seventy percent of the patients eliminated hypernasality while employing the pharyngeal bulb prosthesis, while 30% still presented with hypernasality. The comparison was statistically significant (p < 0.001). Conclusion: The use of the pharyngeal bulb prosthesis is an effective approach to eliminate hypernasality related to velopharyngeal insufficiency. Resumo Introdução: Indivíduos com fissura palatina podem apresentar disfunção velofaríngea após a palatoplastia primária e necessitam de um secundário devido à insuficiência velofaríngea. Nesses casos, o obturador faríngeo pode ser usado temporariamente enquanto se aguarda uma cirurgia secundária. Objetivo: Investigar o resultado do tratamento da hipernasalidade com o uso de obturador faríngeo em pacientes com histórico de fissura palatina que apresentam insuficiência velofaríngea após a palatoplastia primária. Nossa hipótese é que o uso do obturador faríngeo seja uma abordagem eficaz para eliminar a hipernasalidade relacionada à insuficiência velofaríngea em pacientes com fissura palatina Método: Participaram do estudo 30 indivíduos falantes do Português Brasileiro (15 homens e 15 mulheres) com fissura palatina operada, de 6 a 14 anos de idade (média: 9 anos; DP = 1,87 anos). Todos os pacientes receberam obturador faríngeo para o tratamento da insuficiência velofaríngea, enquanto aguardavam vaga para a cirurgia secundária. A análise perceptivo-auditiva da fala, realizada nas condições com e sem obturador faríngeo, foi realizada por três ouvintes, quanto à presença e ausência da hipernasalidade. Resultados: 70% dos pacientes eliminaram a hipernasalidade de fala com o uso do obturador faríngeo, enquanto 30% não eliminaram. A comparação foi estatisticamente significante (p < 0,001). Conclusão: O uso temporário do obturador faríngeo é uma abordagem efetiva para eliminar a hipernasalidade decorrente da insuficiência velofaríngea.

The prevalence of hallux valgus increases with age. However, few studies have compared the effectiveness of surgical correction among different age groups. The authors present a retrospective evaluation of the influence of age on clinical outcomes. Patients who underwent corrective surgery for hallux valgus at an academic hospital were stratified into 2 age groups: ≥70 years old (Group 1) and70 years old (Group 2). Following propensity score matching there were 106 patients: 53 patients in each group. Clinical outcomes, quality of life, and satisfaction questionnaires were collected preoperatively and at 6 months and 24 months postoperatively. There were no differences between both patient groups in preoperative biodata and clinical parameters. However, elderly patients had significantly poorer Physical Component Summary scores postoperatively at both 6 months (p = .001) and 24 months (p.001), and significantly poorer American Orthopaedic Foot and Ankle Society Hallux Metatarsophalangeal- Interphalangeal Scale at 24 months (p = .026). There was no difference between the 2 groups in patient satisfaction rates at 24 months postoperatively (70% vs 85%, p.05). Elderly patients display significant improvements in their clinical scores 24 months postoperatively with no significant difference between satisfaction rates with their younger counterparts. Elderly patients can stand to benefit from hallux valgus surgery.

OBJECTIVE The aim of this study was to evaluate the clinical outcomes and the coronal correction rate of the main and accompanying curves of adolescent idiopathic scoliosis (AIS) corrected with pedicle screws inserted consecutively or intermittently. METHODS The prospectively collected data of 60 patients (8 men and 52 women; mean age: 14.6±2.5 years) who underwent corrective surgery for AIS between January 2010 and December 2015 were reviewed retrospectively. Two groups were constituted according to the pedicle screw construct type: consecutive pedicle screw construct (CPSC) and intermittent pedicle screw construct (IPSC) groups. The preoperative, early postoperative, and 24-month follow-up radiographs and the Scoliosis Research Society-22 (SRS-22) scores were reevaluated. The Cobb angle of the main and accompanying curves, the correction rate, and the flexibility of the curves were calculated. RESULTS The mean preoperative Cobb angles were 57.03° and 57.46°, the mean postoperative Cobb angles were 14.93° and 14.4°, and the mean correction rates were 76.22% and 75.31% in IPSC and CPSC groups, respectively (p>0.05). The preoperative and postoperative accompanying curve magnitudes and correction rates were similar (p>0.05). These radiographic outcomes were also consistent with the SRS-22 scores. CONCLUSION Both the pedicle screw constructs had satisfactory outcomes following the surgery, which were confirmed by both the SRS-22 scores and radiographs taken perioperatively and at follow-ups. The IPSC and CPSC groups did not demonstrate a significant change in the correction rate of the main and minor or major accompanying structural and nonstructural curves, and also in the SRS-22 scores. LEVEL OF EVIDENCE Level III, Retrospective comparative study.

As the number of fusion levels increases, the complexity of spinal correction surgery also increases. Thus, we conducted this study to determine the safety and efficacy of tranexamic acid (TXA) involving eight or more spinal fusion levels. According to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and Assessing the Methodological Quality of Systematic Reviews (AMSTAR) guidelines, a search of the PubMed, Embase, CENTRAL, Web of Science, and ClinicalTrials.gov databases was conducted for relevant studies published prior to May 30, 2019. The primary outcomes, including blood loss and transfusion requirement, and the secondary outcomes, including general indices, postoperative hemoglobin, and coagulation function, were analyzed using Rev Man 5.3.5 software and STATA version 12.0. Eight randomized controlled trials (473 participants) were included in the study. Compared to the control treatments, TXA reduced intraoperative blood loss, total blood loss, transfusion volume, and prothrombin time. There were no significant differences between the TXA and non-TXA groups in transfusion rate, operative time, hospital stay, complications, hemoglobin level, and other coagulation function parameters. In the pediatric subgroup analysis, TXA additionally improved hemoglobin levels, platelet count, and prothrombin time international normalized ratio. The present meta-analysis showed that TXA reduced blood loss and transfusion volume in both adults and children. In pediatric patients, TXA led to a greater benefit in postoperative hemoglobin levels and coagulation function. Intravenous TXA is safe and effective in children with eight or more spinal corrective levels.

Introduction: Before corrective surgery for idiopathic scoliosis, the stress x-rays are indispensable to collect information regarding the reducibility of deformity, deciding fusion levels, and categorizing curve types and so on. The hanging radiograph has not been conducted preoperatively so far as known. The objective of this study was to investigate retrospectively the significance of the hanging radiograph for prediction of the curve correction with surgical procedure by comparing with the side-bending and the traction radiographs. Methods: The subjects enrolled in current study were 22 cases of idiopathic scoliosis who performed posterior instrumentation and fusion by ISOLA method between 2008 and 2014. They included 2 males and 20 females, with a mean age of 16 years and 8 months. The type of curves by Lenke classification were type 1 in 20 cases, type 2 in 1 case, and type 3 in 1 case. We investigated the correction rates of main thoracic curves in side-bending, traction, and hanging positions and compared them with that after surgery. In addition, correction indices were also calculated and compared among these stress x-rays. Results: The correction rate after surgery was 65.9% that was statistically higher than those in side-bending (44.2%), traction (46.6%), and hanging (22.1%) positions. There were statistical correlations between the correction rates after surgery and in side-bending position (R=0.73) and those after surgery and in traction position (R=0.57). However, there was no statistical correlation between the correction rates after surgery and in hanging position (R=-0.01). With regard to the correction indices, that in hanging position (3.67) was statistically higher than those in side-bending (1.51) and traction (1.45) positions. Conclusion: The correction rates in side-bending and traction positions seem to be useful to estimate the amount of curve correction before surgery whereas, that in hanging position did not have any significance as preoperative evaluation.

Összefoglaló. Bevezetés: Nincs egységesen elfogadott álláspont, hogy a serdülőkori idiopathiás gerincferdülés sebészi korrekcióját melyik életkorban optimális elvégezni. Világszerte 11 éves kortól akár (kezeletlen esetben) 50–60 éves korig végeznek fúziós műtétet a betegségben, 63–83%-os átlagos koronális síkú korrekciós hatékonysággal. Célkitűzés: Célul tűztük ki, hogy felmérjük a gerinckorrekciós műtétek hatékonyságát három dimenzióban, illetve a páciens életkorának függvényében. Módszerek: A vizsgálatba 23, serdülőkori idiopathiás gerincferdüléssel diagnosztizált beteget (12 fő 17 évnél fiatalabb, 11 fő 17 évnél idősebb) vontunk be. Minden betegnél csavaros derotációt és spondylodesist végeztünk, és a beavatkozás előtt és után EOS 2D/3D felvételeket, majd sterEOS 3D rekonstrukciókat készítettünk. A következő paramétereket számítottuk: Cobb-fok, háti kyphosis, ágyéki lordosis, apicalis csigolyarotáció, maximális csigolyarotáció. A különböző életkorú csoportok közötti különbséget kétmintás t-próbával, illetve Wilcoxon-féle próbával vizsgáltuk. Eredmények: A gerinckorrekciós műtétek során a koronális síkú eltérést 78,2%-ban (átlagosan 55,1 Cobb-fokról 12,0 Cobb-fokra), az apicalis csigolyarotációt 56,7%-ban (átlagosan 21,0 fokról 9,1 fokra) tudtuk korrigálni. A 17 éves életkor után operált páciensek esetén átlagosan 79,2%-os Cobb-fok-csökkenést értünk el, míg a fiatalabb betegcsoportban 77,0%-ban korrigáltuk a koronális főgörbületet (p = 0,614). Az idősebb betegcsoportban szignifikánsan kevésbé sikerült az apicalis csigolyarotáció korrekciója (átlagosan 38,1%; 21,8 fokról 12,4 fokra), mint a fiatalabb pácienseknél (átlagosan 68,5%; 20,2 fokról 6,2 fokra; p = 0,016). Következtetés: Összességében a nemzetközi publikációknak megfelelő korrekciót értünk el. A koronális síkban közel azonos korrekciós hatékonyság figyelhető meg a különböző életkorú betegcsoportok között, a csigolyarotáció azonban 17 éves életkor előtt hatékonyabban korrigálható. Orv Hetil. 2021; 162(39): 1573–1578. Summary. Introduction: There is no clear recommendation for the optimal age to perform corrective surgery in adolescent idiopathic scoliosis. Fusion surgery is performed from the age of 11 to 50–60 years, with an average coronal plane correction efficiency of 63–83%. Objective: We aimed to evaluate the effectiveness of correction surgeries in three dimensions in adolescent idiopathic scoliosis. In addition, our objective was to examine the influence of the patient’s age on the correction. Methods: The study included 23 patients with adolescent idiopathic scoliosis (12 patients younger than 17 years, 11 patients older than 17 years). All patients underwent screw-derotation and spondylodesis and underwent EOS 2D/3D imaging before and after the operation, followed by sterEOS 3D reconstructions. The following parameters were calculated: Cobb degree, thoracic kyphosis, lumbar lordosis, apical vertebral rotation, maximal vertebral rotation. Differences between different age groups were examined by paired-sample t-test and Wilcoxon rank sum test. Results: The mean efficiency of correction surgeries was 78.2% in the coronal plane (from an average of 55.1 Cobb degrees to 12.0 Cobb degrees) and 56.7% in the axial plane (from an average of 21.0 degrees to 9.1 degrees). We achieved an average 79.2% reduction of Cobb angle in patients operated after the age of 17 years, which was 77.0% in the younger group (p = 0.614). Apical vertebral rotation correction was significantly less successful in the elderly group (mean 38.1%; from 21.8 degrees to 12.4 degrees) than in patients operated before the age of 17 years (mean 68.5%; from 20.2 degrees to 6.2 degrees; p = 0.016). Conclusion: We achieved scoliosis correction in line with the international publications. Nearly the same correction efficiency was observed between different age groups of patients in the coronal plane. However, vertebral rotation can be derotated more effectively before the age of 17 years. Orv Hetil. 2021; 162(39): 1573–1578.

INTRODUCTION True isolated lambdoid craniosynostosis is rare. It requires corrective surgery to prevent intracranial pressure and aesthetic stigma by significant dyscrania. We summarize our case series for lambdoid craniosynostosis outlining the pathophysiology, clinical findings and surgical approaches and outcomes. METHODOLOGY A retrospective analysis of our data from 2010 to 2020 summarized our cases of true lambdoid synostosis. We have used the medical notes and the radiological findings from computed tomography scans to summarize a case series of isolated lambdoid synostosis. RESULTS Our case series demonstrated 7 patients with true isolated lambdoid craniosynostosis. In most cases surgical intervention in the form of posterior cranial vault remodeling utilizing a bandeau, based on occipital advancement techniques, has demonstrated the most consistently favorable aesthetic outcome. CONCLUSIONS Surgical referral to a craniofacial center should be sought early in difficult to diagnose cases. Although rare, surgical intervention is indicated to correct potentially increased intracranial pressure and to ameliorate cranial dyscrania.

BackgroundSurgical correction of the webbed penis is challenging. We presented the safety and feasibility of webbed penis correction for neonates under local anesthesia using a simple principle of leaving equal cylindrical shaft skin.MethodsThis retrospective study included 530 patients who presented for circumcision to three pediatric surgery centers between May 2017 and January 2020. We included male patients aged less than four weeks old who had circumcision with a minimum of 6 months follow-up. We compared patients with normal penile anatomy (n = 451, Group 1) to a simple webbed penis (n = 79, Group 2).ResultsThere were no differences in age and weight between groups. The procedure time was significantly longer in Group 2 (8.05 ± 3.11 vs. 7.48 ± 2.07 min;P = 0.04). There were no differences in bleeding (P = 0.38), redundant foreskin (P > 0.99), need for corrective surgery (P = 0.38), and re-suturing (P = 0.28) between groups. The procedure success was significantly higher in Group 1 (449 (99.56%) vs. 70 (88.6%);P ConclusionSimple penoscrotal web is not a contraindication for neonatal circumcision. Circumcision of the penoscrotal web had good esthetic results with comparable outcomes to those with a normal penis without a web.

OBJECTIVE The Klotho protein family plays important roles in several metabolic pathways. Soluble Klotho has been recently put forward as an antiaging protein, demonstrating renal and cardiovascular protective traits. Cardiopulmonary bypass (CPB) support during cardiac surgery has been implicated in several adverse outcomes in pediatric and adult patients. Our goal was to assess whether serum Klotho levels can be used to predict outcomes in children undergoing cardiac surgery with CPB due to congenital heart defects (CHDs). METHODS This prospective study was conducted on pediatric patients admitted to two Pediatric Cardiac Intensive Care Units, between 2012 and 2018. All patients were born with CHD and underwent corrective surgery with CPB. Sequential blood samples were analyzed by enzyme-linked immunosorbent assay for soluble Klotho levels at baseline, 2, 6, and 24 h after surgery. The association between Klotho levels and several demographic, intraoperative, and postoperative clinical and laboratory parameters was studied. RESULTS Twenty-nine children undergoing cardiac surgery with CPB support were included. Serum Klotho levels were shown to significantly decrease 2 h after surgery and increase to baseline levels after 6 h (p

Mitral valve repair is infrequently performed in patients undergoing corrective surgery for failed mitral transcatheter edge-to-edge repair in current United States practice. This article describes surgical techniques for reconstructive surgery after failed transcatheter edge-to-edge repair. Nine patients underwent robotic-assisted mitral surgery after failed transcatheter edge-to-edge repair between 2008 and 2020 at a single center. Repair was completed in 88.9% (n = 8) patients, and freedom from2+ mitral regurgitation was 87.5% (n = 7) at a median follow-up of 1.9 years.

Zusammenfassung Hintergrund Die Trichterbrust ist eine angeborene Deformität des Thoraxskeletts, bei der das Sternum und die angrenzenden Rippen trichterförmig in Richtung Wirbelsäule einsinken. Die Pathogenese ist bisher nicht eindeutig geklärt. Es gibt verschiedene Therapieansätze, von konservativen Maßnahmen über minimalinvasive Eingriffe bis hin zur offenen Korrektur-OP. Die betroffenen Patienten leiden unter der ästhetischen Beeinträchtigung sowie kardiopulmonalen Einschränkungen durch die Einengung des Mediastinalraumes. Die Indikationsstellung zur Trichterbrust-Korrektur-OP unterliegt funktionellen und ästhetischen Gründen. Patienten Wir berichten über einen 23-jährigen männlichen Patienten mit einer subjektiv beeinträchtigenden und objektiv mäßiggradigen Trichterbrust. Präoperativ wurde ein CT des Thorax angefertigt. Der sternovertebrale Abstand betrug 8 cm, der Thoraxquerdurchmesser 28,9 cm (Haller-Index 3,6). Im präoperativen Lungenfunktionstest zeigte sich eine leichte Restriktion. Anamnestisch beschrieb der sonst gesunde Patient Kurzatmigkeit bei stärkerer Anstrengung. Die Indikation zur Trichterbrust-Korrektur-OP wurde gestellt. Diese erfolgte in kombinierter Operationstechnik: untere Sternotomie und Knorpelkeilresektion nach Brunner/Grob sowie Implantation eines Metallbügels ohne seitliche Antirotationsplatte. Ein zeitaufwendiger Schritt der OP besteht in der intraoperativen Anpassung des Metallbügels. Daher fertigten wir im Vorfeld der OP anhand des Thorax-CTs eine 3-D-Rekonstruktion des knöchernen Thorax mittels 3-D-Drucker an. Der Metallbügel wurde daran angepasst und im OP eingesetzt. Dies verkürzte die Operationsdauer um mindestens 15 min. Ergebnisse In den postoperativen Nachuntersuchungen zeigten sich ein aufgerichteter Trichter und ein zufriedenstellendes ästhetisches Ergebnis. Sieben Monate nach Implantation erfolgte die planmäßige Stabexplantation. Die postoperative CT-Kontrolle ergab nun einen Haller-Index von 3,25, der Lungenfunktionstest eine funktionelle Verbesserung. Subjektiv war der Patient allzeit beschwerdefrei. Schlussfolgerung Die Implantatanfertigung am 3-D-Modell hilft, OP-Zeit zu sparen. Die Praktikabilität ist noch nicht etabliert, da durch die Erstellung eines 3-D-Modells des knöchernen Thorax ein anderweitig höherer Aufwand entsteht. Mit zunehmender Digitalisierung der medizinischen Welt ist es jedoch vorstellbar, dass zukünftig die Erstellung von digitalen und realen 3-D-Modellen einfacher und kostengünstiger wird.

Hallux valgus is a common forefoot deformity that affects function of foot and quality of life (QoL). This study aims to identify factors associated with clinically important improvements in QoL after hallux valgus corrective surgery.A retrospective analysis on 591 cases of hallux valgus corrective surgery performed between 2007 and 2013 was conducted. Patients' preoperative and 2-year postoperative Physical Component Score (PCS) and Mental Component Score (MCS) were compared to identify the presence of clinically significant improvements in patient-reported QoL. A multiple logistic regression model was developed through a stepwise variable-selection model building approach. Age, BMI, preoperative patient reported outcome score, PCS, MCS, pain score, gender, side of surgery, type of surgery, and presence of lesser toe deformities or metatarsalgia were considered.Median PCS significantly improved from 49 to 53 (p0.001), and median MCS remained at 56 (p = 0.724). Age, preoperative MCS and PCS were independent predictors for significant improvements of PCS at 2-year postoperatively.Three groups of patients were more likely to have significant QoL improvements after hallux valgus corrective surgery. These were the younger patients, those with better preoperative mental health or those with poorer preoperative physical health.III.

Due to the data paucity about the functional outcomes post pyeloplasty for patients diagnosed with ureteropelvic junction obstruction (UPJO) with a preoperative age above the age of 45 years and according to the elderly definition (age ≥ 65 years), we conducted this study to clarify the different outcomes in adults presented with late hydronephrosis. We included patients who were managed by pyeloplasty with a preoperative age ≥ 45 years. We further subdivided those patients into; group (A) patient’s age ≥ 65 years and group (B) patient’s age ≥ 45 and

Background Three-dimensional printing is a process enabling computer-assisted conversion of imaging data from patients into physical “printed” replicas. This has been extrapolated to reconstructing patient-specific cardiac models in congenital heart diseases. The aim of this study was to analyze the impact of three-dimensional printing in surgical decision making in selected cases of complex congenital heart disease by creating patient-specific printed models. Methods Patients with complex congenital heart diseases with unresolved management decisions after evaluation by echocardiography, cardiac catheterization, and cardiac computed tomography were included with intent to aid in surgical decision making. Three-dimensional models were created from computed tomographic images by an outsourced firm using computer applications. All cases were reviewed by the same team before and after the cardiac models were prepared. The management decisions were grouped as either “corrective surgery” or “no surgery or palliation” The impact of the surgical decision pre and post three-dimensional cardiac model was analyzed by applying Cohen’s kappa test of agreement. Results Ten patients were included, of which five were of increased pulmonary blood flow, and five were of decreased pulmonary flow. The commonest indication for three-dimensional printed models was to establish the routability of the aorta and pulmonary artery to their respective ventricles (in five patients). The nonagreement between the decision taken before and after the cardiac model was 80%, with kappa −0.37 and P value 0.98. Conclusions Three-dimensional printed cardiac models contribute to better decision making in complex congenital heart diseases enabling safer execution of any complex congenital heart surgery.

Study Design: Comparative cohort study. Objective: Factors that influence the lower instrumented vertebra (LIV) selection in adult cervical deformity (ACD) are less reported, and outcomes in the cervicothoracic junction (CTJ) and proximal thoracic (PT) spine are unclear. Methods: A prospective ACD database was analyzed using the following inclusion criteria: LIV between C7 and T5, upper instrumented vertebra at C2, and at least a 1-year follow-up. Patients were divided into CTJ (LIV C7-T2) and PT groups (LIV T3-T5) based on LIV levels. Demographics, operative details, radiographic parameters, and the health-related quality of life (HRQOL) scores were compared. Results: Forty-six patients were included (mean age, 62 years), with 22 and 24 patients in the CTJ and PT groups, respectively. Demographics and surgical parameters were comparable between the groups. The PT group had a significantly higher preoperative C2-C7 sagittal vertical axis (cSVA) (46.9 mm vs 32.6 mm, P = 0.002) and T1 slope minus cervical lordosis (45.9° vs 36.0°, P = 0.042) than the CTJ group and was more likely treated with pedicle-subtraction osteotomy (33.3% vs 0%, P = 0.004). The PT group had a larger correction of cSVA (−7.7 vs 0.7 mm, P = 0.037) and reciprocal change of increased T4-T12 kyphosis (8.6° vs 0.0°, P = 0.001). Complications and reoperations were comparable. The HRQOL scores were not different preoperatively and at 1-year follow-up. Conclusions: The selection of PT LIV in cervical deformities was more common in patients with larger baseline deformities, who were more likely to undergo pedicle-subtraction osteotomy. Despite this, the complications and HRQOL outcomes were comparable at 1-year follow-up.

A prospective, observational single-center study was carried out. Pediatric patients undergoing congenital heart defect surgery were evaluated before, during, and after surgery. At each time point, sublingual microcirculation and clinical parameters were assessed, along with analytical variables. Twenty-four patients were included. All microcirculatory parameters worsened during cardiopulmonary bypass and returned to baseline values after surgery (p ≤ 0.001). In the intraoperative evaluation, body temperature correlated with perfused small vessel density (p = 0.014), proportion of perfused small vessels (p < 0.001), small vessel microvascular flow index (p = 0.003), and small vessel heterogeneity index (p < 0.002). Patients with cyanotic disease exhibited higher small vessel density (p < 0.008) and higher density of perfused small vessels (p < 0.022) at baseline, and a lower microvascular flow index (p = 0.022) and higher heterogeneity (p = 0.026) in the intraoperative phase. Children with congenital heart disease exhibited decreased vascular density and microvascular blood flow and increased heterogeneity during cardiopulmonary bypass. All these parameters returned to baseline values after surgery.

AIM: To analyze the influence of total femtosecond laser small incision lenticule extraction(SMILE)on corneal surface regularity index(SRI).METHODS:Totally 210(401 eyes)myopic patients treated in Qinhuangdao Optometry Ophthalmology Hospital between January 2017 and December 2019 were enrolled in the study. Among them, patients treated with total femtosecond laser SMILE were included in the observation group(n=110, 205 eyes), while those treated with femtosecond laser-assisted in situ keratomileusis(FS-LASIK)were includded in the control group(n=100, 196 eyes). The uncorrected visual acuity(UCVA), best corrected visual acuity(BCVA), anterior corneal surface asphericity index(Q-value)at a diameter of 6mm and SRI were compared between the two groups before and after operation.RESULTS: The UCVA and BCVA of both groups were improved at 3mo and 6mo after operation(P0.05). The observation group had higher SRI than the control group at 3mo, 6mo and 1a(P

Objective: Adult cervical deformity (ACD) is a debilitating spinal condition that causes significant pain, neurologic dysfunction, and functional impairment. Surgery is often performed to correct cervical alignment, but the optimal amount of correction required to improve patient-reported outcomes (PROs) are not yet well-defined.Methods: A review of the literature was performed and Fisher z-transformation (Zr) was used to pool the correlation coefficients between alignment parameters and PROs. The strength of correlation was defined according to the following: poor (0 < r ≤ 0.3), fair (0.3 < r ≤ 0.5), moderate (0.5 < r ≤ 0.8), and strong (0.8 < r ≤ 1).Results: Increased C2–7 sagittal vertical axis was fairly associated with increased Neck Disability Index (NDI) (pooled Zr = 0.31; 95% confidence interval [CI], -0.03 to 0.58). Changes in T1 slope minus cervical lordosis poorly correlated with NDI (pooled Zr = -0.04; 95% CI, -0.23 to 0.30). Increased C7–S1 was poorly associated with worse EuroQoL 5-Dimension (pooled Zr = -0.22; 95% CI, -0.36 to -0.06). Correction of horizontal gaze did not correlate with legacy metrics. Modified Japanese Orthopedic Association correlated with C2-slope, C7–S1, and C2–S1.Conclusion: Spinal alignment parameters variably correlated with improved health-related quality of life and myelopathy after corrective surgery for ACD. Further studies evaluating legacy PROs, Patient-Reported Outcomes Measurement System, and ACD specific instruments are needed for further validation.

Introduction: Residual acetabular dysplasia of the hip after open reduction can complicate the treatment of developmental dysplasia of the hip (DDH) due to the potential need for corrective surgery. This retrospective study aimed to determine the predictive factors for acetabular development using postoperative radiographs and magnetic resonance imaging (MRI). Methods: We retrospectively investigated 74 hips of patients with DDH who underwent open reduction after reaching walking age and were followed up radiologically until skeletal maturity. We evaluated the cartilaginous acetabulum and labrum using a new method that measures the cartilaginous and labral landmarks on coronal and axial MR T2*-weighted images in patients aged 5 years. The mean age at the time of surgery was 22 months and that at the final survey was 20 years. Severin classification was determined at the final follow-up. Groups with good (53 hips) and poor (21 hips) outcomes were compared using the postoperative radiographic and MRI parameters recorded at 5 years of age. Factors predicting acetabular development were identified using univariate and multiple logistic analyses. Results: There were no significant differences in the bony-acetabular index (AI) and centre-edge (CE) angle between the good and poor outcome groups. However, the poor outcome group had significantly larger cartilaginous- and labral-AIs but significantly smaller cartilaginous- and labral-CE angles than the good outcome group (both p Discussion: Normal cartilaginous acetabulum development occurs in childhood, and evaluation using only radiographs is difficult. However, labral-AI ⩾4° and labral-CE angle

Congenital clubfoot is a common congenital malformation, whose conservative treatment using the Ponseti method achieves excellent initial correction rates and good long-term results. On the other hand, neglected clubfeet, which are typically more frequent in underdeveloped and developing countries, pose treatment difficulties and render corrective surgery necessary. The main problems with correction are raised by the increasing stiffness present in the soft tissues and the dysplastic development of bones. Furthermore, the hyperlaxity of young children decreases with growth, contributing to the reduced overall elasticity of the affected soft tissues and clubfeet. Deciding upon which type of treatment would be appropriate is not always facile. In our clinic, we tend to start the treatment of neglected clubfeet with the modified Ponseti method, which can achieve partial correction or full correction in most cases, diminishing the need for extensive surgical procedures. The case report of a long time neglected bilateral clubfoot successfully corrected using the modified Ponseti method is presented below, followed by a relevant review of the literature.

The management of patients with apical fenestration and clinical symptoms has always been limited to apical root resection and placement of the root tip within the bony crypt. This result would often present resolution of clinical symptoms based on a few case studies. In this case report, we present a case in which apical resection alone did not resolve the patient's discomfort; on the contrary, it resulted in further bone loss and persistence of clinical symptoms. A corrective surgery was performed with the use of guided bone regeneration in conjunction with decortication of the cortical plate to induce bleeding. The patient symptoms resolved within a few weeks after the surgery, and the follow-up scan showed apical root coverage. Three-dimensional analysis was performed to compare the bony changes between the 2 surgeries and showed a significant amount of bone gain of around 200 mm3 and a 2-mm linear bone gain opposite the distobuccal root. The case presents a conservative approach to manage root fenestration of the buccal plate without further compromising the root apex.

Objective The following is a clinical report addressing when to save or remove implants with esthetic deficiencies in the smile zone as well as the sequence and timing of interdisciplinary treatment. Clinical considerations Key factors in the decision-making process in treating implants in malposition are whether the implants are (1) in a reasonable restorative position, (2) free of disease, and (3) placed with adequate depth. This clinical report encompassed periodontal corrective surgery, non-surgical soft tissue sculpting through subgingival crown contour, material selection for definitive restorations, and cementation techniques for cement-retained restorations. Clinical significance Knowledge and understanding of interdisciplinary treatment planning, sequencing, and respective techniques that can be implemented when confronting implants in malposition in the smile zone will allow the interdisciplinary team to achieve the desired esthetic restorative result.

The aim of the study was to evaluate flexible flatfoot (FFF) diagnostic and current therapeutic modalities, as well as treatment expectations, among members of the European Paediatric Orthopaedic Society (EPOS). A 59-questions survey on FFF diagnosis and treatment preferences was distributed to EPOS members. The survey consisted of six sections (1) general clinical parameters; (2) foot aspects; (3) X-ray angles (or lines); (4) expectations; (5) standard clinical assessment; and (6) management options. Descriptive statistics were performed. A total of 93 responses were analysed. In general, clinical parameters, age (91.4% of cases), laxity (81.7%), diffuse pain (84.9%), and pain at the ankle joint (81.7%) were rated as 'average' and 'crucial importance' by the vast majority of respondents. Meary's angle (47.3% of cases), talonavicular coverage (35.5%), and lateral talocalcaneal angle (35.5%) were assessed as main radiological tools in the FFF evaluation. Among respondents, 61.3% rated 'improved ability to walk longer without symptoms' as of 'crucial importance'. Eighty-two percent of the respondents felt less than 10% of patients with FFF are candidates for corrective surgery. Arthroereisis (29.3%) was the most common surgical procedure (16.4% for subtalar and 12.9% for extra-articular arthroereisis, respectively), followed by lateral column lengthening (17.9%) and medializing calcaneal osteotomy (12.3%). There is great variation among respondents in diagnostic and treatment preferences in the management of children with FFF. The results of the EPOS 2019 FFF survey clearly show that large-scale, multicentric, international studies are necessary to elucidate which diagnostic and treatment practices lead to the best outcomes.

Introduction: The Kinesio Taping method (KT) was created by the Japanese chiropractor Kenso Kase in the 70s. He was trying to develop a tape which could help the normal function of the muscle tissue in order to give an external support without cause limitations to these tissues. Objectives: To evaluate the strength of extensor musculature of patients’ knees in the post-operatory of the anterior cruciate ligament (ACL) and compare the strength, power and resistance of the extensor musculature of the knee with and without the use of the tapes of the KT method. Method: The studying of the kind of the reported case, where it was applied the KT tape on the extensor musculature of a patient’s knee who was undergone corrective surgery of ACL, it was used the Biodex SYSTME 3 PRO. Results: It was verified that in the first exam the left femoral quadriceps presented the deficit of strength, power and resistance related to the right one. In the third exam it was applied the KT tape and there was a decrease of the deficits of strength and power and an increase of the deficit of resistance. Conclusion: The use of the KT tape potentiates the gain of the strength and power of the weakened musculature and increase the values of the deficit of the muscle resistance and it can be a auxiliary resource in the physiotherapic treatment.

A 20-year-old right-handed woman was seen in neurology clinic for evaluation of progressive unsteadiness. Her symptoms began at age 10, with clumsiness and frequent falls. Her toes gradually became clawed, requiring bilateral cavovarus foot corrective surgery. She reported no sensory symptoms or visual or sphincter disturbance.

Background Postcircumcision penile gangrene is a devastating complication that may lead to total or subtotal penile loss requiring penile reconstruction. Pediatric penile reconstruction poses diverse challenges for most plastic surgeon.Patients and Methods Retrospective cohort study of 12 children ranged from 6 to 36 months old suffered from total or partial penile loss secondary to electrocautery burn during circumcisions. Reconstruction was done by island groin flap for phallus in first stage and urethral reconstruction by tubularized scrotal flap 6 months later. The outcome was evaluated by assessment of flap survival, the esthetic appearance, urethral competence and rate of complication.Results Follow-up was ranged from 6 to 24 months. A new phallus of satisfactory dimensions was achieved in all cases. Complications included partial necrosis of the flap in two cases, fistulas in two cases, and stenosis of the urethral anastomosis in one case. These complications were successfully resolved by corrective surgery. Good satisfactory result regarded as shape and urination stream.Conclusion Penile reconstruction can be performed in children with good results and low complication rate. The use of island groin flap for phallus reconstruction followed by urethral reconstruction by tubularized scrotal flap 6 months later was found effective, time saving, and with minor complication.

BACKGROUND Collagenase clostridium histolyticum is a recognized non-surgical management for Peyronie's disease, licenced for use in the UK for patients with a palpable plaque and a curvature deformity of at least 30°. However, it is not currently funded for use within the National Health Service. Collagenase clostridium histolyticum has also recently been withdrawn from the European and other markets worldwide, but there is potential for this to be produced off-patent in the future. OBJECTIVES To determine whether collagenase clostridium histolyticum is cost-neutral when compared to surgical management within a public health care system, using the National Health Service as an example. MATERIALS AND METHODS Two published protocols for the administration of collagenase in Peyronie's disease were identified-the 'IMPRESS protocol' and the 'London protocol'. Costs were taken from published NHS literature. Surgical intervention rates after collagenase clostridium histolyticum administration and primary penile plication were taken from published literature. The costs of the two published protocols were calculated with costs of any repeat surgical intervention were included within each protocol per patient cost. RESULTS At the current cost per vial of collagenase to the National Health Service, the IMPRESS protocol per patient costs £3,832.77 (143.7%) more than primary surgery, whilst the London protocol costs £70.77 (2.7%) more than primary surgery. DISCUSSION At a cost of £548.41 per vial, collagenase administered under the London protocol would be a management option for Peyronie's disease cost neutral to primary corrective surgery. CONCLUSION Central funding of collagenase in a public healthcare system would enable the management of Peyronie's disease to be moved to the outpatient setting. For this to be done at no additional cost to the NHS, it would require a cost reduction per vial of collagenase of £23.59 (4.1%), to a cost of £548.41.

BACKGROUND: The literature is scanty on reports directly comparing the outcomes of anterior open reduction (AOR) and medial open reduction (MOR) in the management of developmental dysplasia of the hip (DDH). PURPOSE OF THE STUDY: To compare clinical and radiographic outcomes of surgical treatment using either AOR or MOR in children with DDH aged

Scapular winging is a rare, painful and debilitating condition that leads to limited functional activity of the upper extremity. The composite scapular movement of rotation, abduction, and tilting is necessary for proper shoulder function. Weakness or loss of scapular mechanics can lead to difficulties with elevation of the arm and lifting objects. It can result from numerous causes, including traumatic, iatrogenic, and idiopathic processes that most often result in nerve injury of either the serratus anterior, trapezius, or rhomboid muscles. Diagnosis is easily made by inspection of the scapula from back, with serratus anterior paralysis resulting in medial winging of the scapula while lateral winging is caused by trapezius and rhomboid paralysis. Most cases of serratus anterior and rhomboid paralysis spontaneously resolve within 24 months, while conservative treatment of trapezius paralysis is less effective. Patients become candidates for corrective surgery if they fail a 6–24 month course of conservative treatment. This review explores the causes of scapula winging, with overview of the relevant anatomy, proposed aetiology and treatment.

Pediatric patients with cyanotic congenital heart disease who underwent open heart corrective surgery, were unfortianetly suffering from postoperative clinical deterioration which may leads to morbidity and mortality.

Background:Bunionette is a common foot disorder, and several types of corrective surgery have been described. With the popularization of minimally invasive surgeries, the forefoot region has become a suitable area for this type of technique. The aim of this study was to evaluate the results of oblique distal osteotomy of the fifth metatarsal adapted for a percutaneous approach.Methods:We prospectively evaluated 31 consecutive tailor’s bunion patients who underwent operative correction on a total of 42 feet between 2017 and 2019 after failure of conservative treatment. Clinical outcomes such as pain (visual analog scale [VAS]), function (American Orthopaedic Foot & Ankle Society [AOFAS] Lesser Toe Metatarsophalangeal-Interphalangeal Scale scoring system), personal satisfaction, and complications were evaluated. Radiographic aspects were also examined. Shapiro and Mann-Whitney statistical tests were conducted. The average age of the patients was 69.5 years, and the average follow-up was 13.1 months.Results:After the operative procedure, there was a decrease of 6.6 points on the VAS for pain ( P < .001) and an increase of 34.9 in the AOFAS score ( P < .001). Radiographic correction was achieved for both the fifth metatarsophalangeal angle ( P < .001) and the intermetatarsal angle ( P < .001), which showed decreased values. There was 1 case of superficial infection and 2 cases of nonunion (asymptomatic). A large majority of patients regarded the procedure outcome as satisfactory.Conclusion:This percutaneous oblique distal osteotomy of the fifth metatarsal for bunionette deformity produced improvements in pain and function and a high rate of satisfaction, with a low incidence of complications and a high capacity for correcting the deformity.Level of Evidence:Level II, prospective cohort study.

Background:Pulmonary vascular disease resulting from CHDs may be the most preventable cause of pulmonary artery hypertension worldwide. Many children in developing countries still do not have access to early closure of clinically significant defects, and the long-term outcomes after corrective surgery remain unclear. Focused on long-term results after isolated ventricular septal defect repair, our review sought to determine the most effective medical therapy for the pre-operative management of elevated left-to-right shunts in patients with an isolated ventricular septal defect.Methods:We identified articles specific to the surgical repair of isolated ventricular septal defects. Specific parameters included the pathophysiology and pre-operative medical management of pulmonary over-circulation and outcomes.Results:Studies most commonly focused on histologic changes to the pulmonary vasculature and levels of thromboxanes, prostaglandins, nitric oxide, endothelin, and matrix metalloproteinases. Only 2/44 studies mentioned targeted pharmacologic management to any of these systems related to ventricular septal defect repair; no study offered evidence-based guidelines to manage pulmonary over-circulation with ventricular septal defects. Most studies with long-term data indicated a measurable frequency of pulmonary artery hypertension or diminished exercise capacity late after ventricular septal defect repair.Conclusion:Long-term pulmonary vascular and respiratory changes can occur in children after ventricular septal defect repair. Research should be directed at providing an evidenced-based approach to the medical management of infants and children with ventricular septal defects (and naturally all CHDs) to minimise consequences of pulmonary artery hypertension, particularly as defect repair may occur late in underprivileged societies.

Simultaneous biplanar radiographic scanning technique (EOS) (EOS Imaging, Paris, France) variability has previously been evaluated for spinal parameters, however limited EOS data exist regarding accuracy of 3-dimensional (3D) rib cage reconstruction. The purpose of this study was to compare the evaluation of ribcage parameter between EOS 3D images and 3D computed tomography (CT) images from adolescent idiopathic scoliosis (AIS) patients, and validate the accuracy of EOS 3D ribcage reconstruction images. In total, 31 AIS patients (27 females, 4 males; mean age 14.4 years) with Lenke types 1 or 2 who underwent corrective surgery were enrolled. EOS 3D images were assessed preoperatively for all patients. Rib cage parameters were measured, including surface spinal penetration index (sSPI), endothoracic hump ratio (EHR), vertebra-sternum angle (VSA), rib-vertebral angle difference (RVAD) at apex and vertebral lateral decentering (VLD). Measurements were subsequently compared with CT images. No significant differences were observed in sSPI or EHR measurements between EOS and CT images. Measured VSA values from EOS and CT were −28.1 degrees and −26.1 degrees, respectively. Measured RVAD values from EOS and CT were 13.0 degrees and 12.0 degrees, respectively. No significant differences were observed for measured VSA or RVAD values between EOS and CT images. Measured VLD values from EOS and CT were 68.5% and 67.5%, respectively, representing similar values. The accuracy of rib cage parameters measured with EOS software is similar to the measurements obtained with CT. The results of this study provide surgeons with important evidence pertaining to this novel imaging technology.

Fractures of the distal femur carry a significant risk of physeal arrest and resulting growth complications which often require additional surgeries to correct the deformity. This study examines the risk of needing corrective procedures as a child approaches skeletal maturity. A retrospective analysis of patients treated at a single institution for distal femoral physeal fractures from 2000 to 2015 was performed. Association between sex, age, Salter-Harris (SH) class, and fracture displacement with the risk of physeal arrest were examined. Association between years of growth remaining to skeletal maturity and the risk of needing additional corrective surgery (defined by leg length difference >2 cm or angular deformity (>5°) was examined using a logistic regression model. One hundred one patients were available for review with an average age of 12.6 ± 3.2 years. Twenty-six patients (25.7%) developed a physeal arrest. Seventy-six percent of these required subsequent surgical intervention to address length and angular deformities Sex, age, and SH class were not significantly associated with physeal arrest (P > 0.05). Percent fracture displacement was significantly associated with physeal arrest (P = 0.02). Years of growth remaining to skeletal maturity were significantly associated with an increased risk of requiring corrective surgery for growth complications (odds ratio: 0.758; 95% confidence interval 0.587-0.979; P = 0.03), however, this association failed to persist when accounting for age. Years of growth remaining to skeletal maturity may predict the need for future interventions and should be accounted for when planning treatment of these challenging injuries.

Gastroesophageal reflux disease (GERD) is reported as one of the symptoms of adult spinal deformity (ASD). Little is known about the mid- to long-term improvement in GERD symptoms after ASD surgery. Therefore, this retrospective study from prospectively collected database aimed to investigate GERD symptoms in patients for a minimum of 2 years after ASD corrective surgery. Records from 230 patients (mean age: 64 years) who underwent ASD surgery were examined using the frequency scale for the symptoms of GERD (FSSG) questionnaires for the diagnosis of GERD. FSSG scores and radiographic parameters were investigated preoperatively and postoperatively at 6 months and 1, 2, and 5 years. In total, 90 (39%) patients were preoperatively diagnosed with GERD defined by FSSG score ≥ 8 points. Radiographic results showed that the corrective surgeries improved local and global alignments. In the GERD patients, preoperative FSSG scores (16.1 ± 7.3 points) significantly improved to 7.7 ± 7.4 points within 6 months postoperatively (p

Background To discuss the clinical efficacy and safety of scapuloplasty treating the shoulder imbalance in scoliosis patients. Methods A retrospective analysis was made on 21 patients who underwent scoliosis corrective surgery combined with scapuloplasty from September 2013 to March 2015. The average follow-up was 31.4 ± 5.3 months (24–42 months). The shoulder vertical difference (SVD), adjusted Constant-Murley score, range of shoulder motion function, Cavendish grade, and the overall satisfaction were compared among the pre-surgery, post-surgery, and the final follow-up periods. Results The shoulder vertical difference (SVD) significantly decreased at the time of post-surgery and the final follow-up, comparing the score of the pre-surgery. The SVD of all patients were decreased from preoperatively 3.2 ± 1.1 cm to 0.4 ± 0.3 cm, with the Cavendish grade improved to grade 1 at the final follow-up. The adjusted Constant-Murley score and range of shoulder motion function showed no significant difference during the three time periods (p > 0.05). And no severe complications had occurred over 2 years follow-up. Conclusion The scapuloplasty surgery shows to be an effective and safety procedure to improve the shoulder imbalance, cosmetic appearance, and the overall satisfaction in scoliosis patients without impairing the shoulder function, which can be widely applied in clinic.

Study design Case-control study. Objective To examine factors influencing cervical alignment after corrective surgery for adult patients with adolescent idiopathic scoliosis (AdIS) SUMMARY OF BACKGROUND DATA.: Corrective surgery for spinal deformity influences postoperative cervical spinal alignment, but changes in the cervical alignment in adults with AdIS are scarcely reported. Methods We retrospectively examined 85 patients with AdIS who underwent posterior corrective surgery for thoracic or lumbar major curve and were followed up for 2 years. Clinical characteristics, radiographic parameters, and health-related quality of life (HRQOL) were evaluated. Cervical deformity (CD) was defined as one of the following cases: (1) T1 tilt minus C2-C7 angle more than 20°, (2) C2-C7 SVA more than 40 mm, (3) and C2-C7 angle less than -10°. Patients were divided into those with and without CD based on the defined criteria; statistically relevant factors were analyzed. Results There were 19 patients in the postoperative CD group. The average age at the time of surgery was lower in the CD group (26.5 vs. 31.4). In the CD group, the average preoperative T1 tilt was smaller (1.1° vs. 12.5°), and the C2-C7 angle was kyphotic (-16.1° vs. 3.0°). The average kyphotic angle at thoracic spine (T5-T12) was lower in the CD group preoperatively (12.5° vs. 19.5°) and postoperatively (15.2° vs. 20.8°). HRQOL outcomes were comparable between the groups. Of the patients with preoperative CD, 51.5% (n = 17) maintained their deformity at the final follow-up, and baseline C2-C7 angle was lower than those who converted to non-CD following surgery (n = 16) (-17.0° vs. -10.3°). Conclusion More than half of the patients with baseline CD maintained their cervical malalignment postoperatively. Patients with postoperative CD presented cervical kyphotic and thoracic hypokyphotic alignments before surgery. Because CD has the potential to lead to cervical degeneration, careful follow-up observation is necessary for these young patients. Level of evidence 3.

Study Design: Narrative review. Objective: The high rate of complications associated with the surgical management of neuromuscular spinal deformities is well documented in the literature. This is attributed to attenuated protective physiological responses in multiple organ systems. Methods: Review and synthesis of the literature pertaining to optimization of patients with neuromuscular scoliosis undergoing surgery. Our institutional practice in the perioperative assessment and management of neuromuscular scoliosis is also described along with a clinical vignette. Results: Respiratory complications are the most common to occur following surgery for neuromuscular disorders. Other categories include gastrointestinal, cardiac, genitourinary, blood loss, and wound complications. A multidisciplinary approach is required for perioperative optimization of these patients and numerous strategies are described, including respiratory management. Conclusion: Perioperative optimization for patients with neuromuscular disorders undergoing corrective surgery for spinal deformity is multifaceted and complex. It requires a multidisciplinary evidence-based approach. Preadmission of patients in advance of surgery for assessment and optimization may be required in certain instances to identify key concerns and formulate a tailored treatment plan.

Background:Little is known about emotional quality-of-life in paediatric heart disease in low- and middle-income countries where the prevalence of uncorrected lesions is high. Research on emotional quality-of-life and its predictors in these settings is key to planning interventions.Methods:Ten-year retrospective cross-sectional study of children aged 6–17 years with uncorrected congenital or acquired heart disease in 12 low- and middle-income countries was conducted. Emotional functioning score of the PedsQL TM 4.0 generic core scale and data on patient-reported limitation in sports participation were collected via in-person interview and analysed using regression analyses.Results:Ninety-four children reported mean emotional functioning scores of 71.94 (SD 25.32) [95% CI 66.75–77.13] with lower scores independently associated with having a parent with a chronic illness or who had died (p = 0.005), having less than three siblings (p = 0.007), and reporting a subjective limitation in carrying an item equivalent to a 4 lb load (p = 0.021). Patient-reported limitation in sports participation at least “sometimes” was present in 69% and was independently associated with experiencing symptoms at least once a month (p < 0.001).Conclusion:Some of the factors which were associated with better emotional quality-of-life were similar to those identified in previous studies in patients with corrected defects. Patient-reported limitation in sports participation is common. In addition to corrective surgery and exercise, numerous other interventions which are practicable during surgical missions might improve emotional quality-of-life.

Hypoplastic left heart syndrome consists of several structural abnormalities in the left side of the heart and may be associated with a hereditary genetic cause, possibly related to the connexin gene GJA1; however, only a few studies have investigated it. The present study aimed to analyse the expression of connexin-43 in the cardiac muscle of hypoplastic left heart syndrome children by Western blot method and confocal laser scanning microscopy. For that, tissue samples were taken during corrective surgery to treat heart defects. Patients of control group (8) presented any type of heart defect not related to hypoplastic left heart syndrome, connexin-43, or its gene and those of hypoplastic left heart syndrome group (9) presented this disease singly, without any other associated congenital diseases. By means of confocal laser scanning microscopy, it was noticed no connexin-43 qualitative differences in positioning and location pattern between both groups. From Western blot analysis, the connexin-43 expression did not show a statistically significant difference (p = 0.0571) as well. Within the limits of this study, it is suggested that cardiomyocytes of hypoplastic left heart syndrome children are similar in connexin-43 location, distribution, and structural and conformational patterns to those of children with heart defects not related to this protein and its genes.

Modelo de estudo: Estudo de prevalência. Objetivo do estudo: Avaliar o perfil epidemiológico dos casos de hipospádia atendidos no Hospital São Francisco na Providência de Deus da Universidade São Francisco (HUSF), Bragança Paulista/SP nos últimos 10 anos (2007-2017), relacionando os tipos de hipospádia com as malformações associadas e idade à primeira cirurgia corretiva. Metodologia: Foi realizado um levantamento de casos de hipospádia atendidos entre 2007 e 2017 no HUSF, com pacientes oriundos das cidades da Região Bragantina do estado de São Paulo. Os tipos de hipospádia foram relacionados com as malformações associadas. Foram pesquisados nos prontuários: tipo de hipospádia, idade à primeira cirurgia, laudo de exame ultrassonográfico, etnia, local de nascimento e malformação associada. Os dados foram analisados estatisticamente utilizando os testes Qui-quadrado, teste F e de Kruskal-Wallis. Resultados: Em 1401 atendimentos pediátricos no período avaliado, foram encontrados 45 casos de hipospádia com prevalência igual a 0,7/1000 nascidos vivos. Do total de casos, 29 foram classificados como do tipo distal, seis casos de hipospádia média e 10 casos do tipo proximal [F-test (2,8)=5,552; P=0,003; χ2=9,3117; P=0,009]. Nos casos de hipospádia distal, foram detectadas 16 malformações associadas e, nos tipos média e proximal, foram observadas sete malformações associadas em cada uma (KW=3,322, P=0,19). O maior número de casos foi abordado cirurgicamente no intervalo entre os três e quatro anos de idade. Conclusão: A hipospádia distal foi a mais prevalente, com idade à primeira cirurgia em desacordo com o intervalo proposto para a correção da hipospádia.

It’s increasingly common for surgeons to operate on more challenging cases and higher risk patients, resulting in longer op-time and inpatient LOS. Factors predicting extended op-time and LOS for cervical deformity (CD) patients are understudied. This study identified predictors of extended op-time and length of stay (LOS) after CD-corrective surgery. CD patients with baseline (BL) radiographic data were included. Patients were stratified by extended LOS (ELOS; >75th percentile) and normal LOS (N-LOS; 12 h. A Conditional Variable Importance Table used non-replacement sampling set of Conditional Inference trees to identify influential factors. Mean comparison tests compared LOS and op-time for top factors. 142 surgical CD patients (61 yrs, 62%F, 8.2 levels fused). Op-time and LOS were 358 min and 7.2 days; 30% of patients experienced E-LOS (14 ± 13 days). Overlapping predictors of E-LOS and op-time included levels fused (>7 increased LOS 2.7 days; >5 increased op-time 96 min, P 38 kg/m2 increased LOS 8.1 days; >39 kg/m2 increased op-time 17 min), and osteotomy (LOS 2.0 days, op-time 62 min, P 42 mm increased LOS; >50 mm increased op-time, P @−0.9° increased LOS, >0.3° increased op-time, P

An adequate planning of the curative measures is an important factor providing good functional results in the treatment of consequences of long bones injuries, in particular, malunions (post traumatic deformities). 3D-modeling in the preoperative planing gives an opportunity to assess both deformity itself and joint status. Visua­lization of injured segment with three-dimensional model manufactured using 3D-print in actual size (1:1 scale) provides additional capacities. Objective. To analyze the capacity provided by the usage of three-dimensional models of damaged segments in scale 1:1 while the planning of corrective surgery. Methods. Practicability of the usage of 3D-models, that was worked out on thebase of CT-scanning, was studied in the treatment of 52 patients with different post traumatic extraarticular deformities of femur and tibia, after the fractures with intraarticular extension. Clinical results were evaluated using SF-36 and AOFAS scales. Results. Calculation for 3D-modeling was performed mostly virtually using standard computer programs with 3D-reconstruction, but 3D-print technology was used for 5 patients with the most severe and sophisticated deformities of the lower extremities. Changes in functional outcomes, according to SF-36 and AOFAS, for the patients undergone opera- tive treatment, were positive at 12 month offollow-up. Fore­ign colleagues expose analogous results oftheinvestigations and suggest that the modeling with 3D-print provides mostly more safe, reliable and standardized clinical decisions for every particular patient. Conclusions. Preoperative usage of 3D-print on thestage of preoperative planing allows the surgeons tosimulate different stages ofoperative intervention on the physical model, thus, help him torealize possible technical problems, choose adequate fixation device and proper instrumentation. It facilitates theshortening of surgery time, elimination of possible complications rate and achievement, in sum, good functional results in thetreatment of this kind of patients., Під час лікування наслідків ушкоджень довгих кісток, зокрема, деформації, украй важливою запорукою отримання хороших функціональних результатів є адекватне планування лікувальних заходів. Використання 3D-моделювання в процесі передопераційного планування дає змогу повніше оцінити як деформацію, так і стан суглобів. Додаткові можливості для планування надає візуалізація ушкодженого сегмента за допомогою об’ємної моделі в реальному розмірі, виготовленої методом 3D-друку в масштабі 1:1. Мета. Проаналізувати можливості використання об’ємних моделей деформованого сегмента в масштабі 1:1 під час планування коригувальних операцій. Методи. Вивчено доцільність використання 3D-моделей, розроблених за результатами КТ-обстеження, у лікуванні 52 хворих із різними післятравматичними поза­суглобовими деформаціями стегна ігомілки, де під час первинної травми лінія перелому була поширена на ділянку суглоба. Клінічні результати оцінювали за класифікаціями SF-36 іAOFAS. Результати. Розрахунок 3D-моделей проводили переважно віртуально за допомогою стандартних комп’ютерних програм із 3D-реконструкцією, а технологію 3D-друку використано для 5 пацієнтів із найскладнішими випадками післятравматичних деформацій нижніх кінцівок. Динаміка функціональних результатів прооперованих хворих за SF-36 іAOFAS за 12 міс. була позитивною. Аналогічні результати досліджень демонструють зарубіжні колеги та вважають, що моделювання за допомогою 3D-друку здебільшого може сприяти розробленню безпечних, надійних істандартизованих клінічних рішень для конкретного пацієнта. Висновки. Передопераційне використання 3D-друку на етапах планування хірургічного втручання дозволяє хірургу моделювати його етапи на фізичній моделі, усвідомити можливі технічні проблеми, адекватно вибрати конструкцію та інструментарій для її встановлення. Це сприяє скороченню часу операції, уникненню потенційних ускладнень ідосягненню позитивних результатів функціонального лікування таких пацієнтів.

Background: Corrective surgery for flexible flatfoot deformity (FD) remains controversial, and one of the main reasons for this is the lack of standardized radiographic measurements to define an FD. Previously published radiographic parameters to differentiate between a foot with and without an FD do not have a commonly accepted and distinct threshold. Methods: The plantar fascia–talar head correlation (PTC) with its defined threshold was assessed by measuring the distance between the medial border of the plantar fascia and the center of the talar head (DPT) on conventional dorsoplantar and lateral weightbearing radiographs; the authors were blinded to the clinical diagnosis of the 189 patients’ first visits. Feet were sorted into groups with and without an FD based on their clinical examination. The effect of operative corrections of FD on the PTC was retrospectively evaluated on an additional 38 patients. Results: The sensitivity of the PTC was 0.98 (95% CI: 0.9-1) and specificity 0.96 (95% CI: 0.92-0.98), respectively, to identify an FD, consistent with the clinical examination. Thirty-five of 38 surgeries sufficiently corrected the FD and the PTC comparable to that in subjects without an FD. Three corrections with a residual FD did not adequately correct the PTC. Conclusion: The PTC is a reliable radiographic parameter with a distinct threshold that is sensitive and specific for the differentiation of feet with and without an FD including feet with and without residual FD after corrective surgery. The PTC is applicable to monitor the needed intraoperative amount of correction using simulated weightbearing fluoroscopy. Level of Evidence: Level III, diagnostic.

Study design Retrospective study. Objective To evaluate the predictive effect of the 3 global sagittal parameters (Sagittal Vertical Axis [SVA], T1 Pelvic Angle [TPA], and relative TPA [rTPA]) in the surgical outcome of patients with adult degenerative scoliosis (ADS), then to define the optimum corrective goal based on the best of them. Methods 117 ADS patients were included in this study and followed-up for an average of 3 years. Functional evaluation and radiographs were assessed preoperatively and postoperatively. The predictive accuracy of SVA, TPA, and relative TPA was analyzed through receiver operating characteristic (ROC) curve. The cutoff value of TPA was obtained at the maximal Youden index from ROC curve. Results TPA most highly correlated with postoperative oswestry disability index (ODI). The best cutoff value of TPA was set at 19.3° (area under curve =0.701). TPA >19.3° was the highest risk factor in multivariate logistic regression analysis (OR = 7.124, P = 0.022). Patients with TPA 19.3°. Correcting TPA less than 19.3° for patients with preoperative TPA >19.3° attributed to a better health related quality of life (HRQOL) and sagittal balance at last follow-up. The formula “Postoperative TPA = 0.923 × PI - 0.241 × postoperative LL - 0.593 × postoperative SS - 2.471 ( r = 0.914, r2 = 0.836, P < .001)” described the relation between SS, LL, PI, and TPA. Conclusion TPA was a useful global parameter for the prediction of postoperative HRQOL for patients with ADS. Keeping TPA 19.3°, and TPA

Given the importance of the spine in carrying out daily movements, adolescent idiopathic scoliosis (AIS) can significantly limit the range of motion (ROM). Severe forms of AIS are treated surgically, most commonly with posterior spinal fusion and instrumentation, which may also reduce spine ROM. This review is the first to describe the literature on total spine ROM in patients with AIS before and after corrective surgery. A systematic literature search was performed using PubMed and Google Scholar to identify articles reporting global spine ROM in AIS patients. Following the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), 486 articles were initially identified. Two independent reviewers (YM and JH) assessed eligibility for inclusion. A total of 11 articles fit the inclusion criteria. AIS in untreated patients seems to limit axial and coronal plane ROM based on the degree of curve severity, with more severe curves having less ROM. More research comparing total spine ROM in untreated AIS patients to that of healthy controls is needed. In those undergoing spinal fusions, the lowest instrumented vertebra and surgical approach appear to minimize further reductions in ROM; however, the findings are mixed. Vertebral body tethering (VBT) shows promising preliminary results in treating AIS while preserving motion; however, long-term outcomes have yet to be assessed for this novel procedure. The results of this systematic review suggest that further research is required before treatment strategies can be modified for surgically treating patients with AIS to take into account the effects of treatment on changes in spine mobility.