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The British Association of Oral and Maxillofacial Surgeons (BAOMS) Quality and Outcomes in Oral and Maxillofacial Surgery (QOMS) reconstructive audit aims to provide surgical teams with risk adjusted comparative performance data. The goal is to enable surgeons to optimise surgical pathways. Risk adjustment requires that data on appropriate predictive variables are collected. This study looked at variables predicting major complications and flap failure in a single institution with the aim of determining whether the QOMS dataset adequately captures the appropriate data points. A prospective database of head and neck flap procedures and associated postoperative complications has been maintained in the maxillofacial surgery department since August 2009 up to August 2022 (n=1327). A total of 25 putative risk variables were extracted from the health records for each patient. The outcomes of interest were total flap failure and major complications. Independent predictors of flap failure were recipient site (sinonasal/anterior skull base), previous major surgery, previous major surgery and radiotherapy, and flap selection. For major complications ACE-27 comorbidity score, flap type, use of tracheostomy, elevated preoperative plasma C-reactive protein (CRP) and flap selection were independently predictive. Apart from preoperative activated innate immunity all relevant risk stratification variables identified in this study form part of the QOMS dataset. QOMS is therefore likely to adequately risk stratify patients based upon currently collected variables. [ABSTRACT FROM AUTHOR]

Case history: In 2023, the New Zealand Department of Conservation seized 63 endemic reptiles that were being held without a permit. This group included three adult female West Coast green geckos (Naultinus tuberculatus) that had been illegally removed from the wild 2 years earlier. They had been held in an outdoor enclosure with a pair of goldstripe geckos (Woodworthia chrysosiretica). Clinical findings: On physical examination, all three geckos had at least two soft palpable masses in the coelom. Repeated ultrasonographic examination over several months confirmed the diagnosis of pre-ovulatory follicular stasis (POFS) in each gecko, and in subsequent weeks, more ovarian follicles developed in each animal. Laboratory findings: All three geckos were negative on culture of cloacal swabs for Salmonella spp., and negative on PCR assay of a cloacal flush for Cryptosporidium spp., despite other reptiles in the seized group showing positive results for multiple Salmonella spp., and one other gecko being positive for Cryptosporidium parvum, subtype IIcA5G3. Treatment and outcome: For all three geckos, para-midline ventral coeliotomy was performed under general anaesthesia, and folliculectomy of degenerate ovarian follicles was performed. Post-operative complications were seen in all three animals, which developed suture-line infections following disruption of normal skin shedding and entrapment of shed keratin in the surgical sites. A second surgery was undertaken to remove impacted keratin and caseous inflammatory material from the surgical wounds of all three animals and buried sutures were placed to close the coelomic wounds. The geckos were treated with 20 mg/kg ceftazidime IM every second day for 2 weeks post-operatively. Subsequent ecdysis (skin shedding) occurred without complication and the geckos were released back to the wild 10 months after admission. Clinical relevance: The recommended treatment for POFS in reptiles is ovariectomy, which is not appropriate for wild animals. The use of folliculectomy to resolve preovulatory follicular stasis should be considered for animals where retaining reproductive ability is essential. [ABSTRACT FROM AUTHOR]

This study aims to investigate the association of time to oral and maxillofacial surgery after Covid-19 infection with the risk of postoperative complications in a population from China. In the current study, a total of 1342 consecutive patients underwent general anesthesia (GA) in the maxillofacial district of the Chinese Oral and Maxillofacial COVID Collaborative, which consists of 27 teaching hospitals. Pulmonary, cardiovascular and thrombotic complications were monitored for 1 month after GA surgery (GAS) and their incidence was reported for the first 30 days. Post-operative complications were observed in 4 of 1076 cases (0.37%) who had suffered from mild Omicron infection and in none of the controls. Results from the Quasi-Poisson multivariate regression models showed that Omicron infection was not associated with increased post-operative complications compared to controls. Among the infected patients, delays of >4 but not >6 weeks were associated with lower OR of complications (0.08, 95% CI 0.01–0.78 and 0.06, 95% CI 0.01–1.80, respectively). Findings of this study suggest that delaying surgery for a period of 4–6 weeks following infection can provide a protective effect. [ABSTRACT FROM AUTHOR]

This case report evaluates the possible reasons for early complications after guided bone regeneration, as well as options for their management. A thorough evaluation prior to surgery will help determine appropriate planning. Each clinician should be aware of the goals and possible limitations of the treatment to be performed to ensure optimal patient care. The management of the membrane, early exposure and contamination with a second bone augmentation surgery provided a sufficient amount of bone to place a dental implant in a correct three-dimensional position. CPD/Clinical Relevance: The correct approach for the management of the complications for regenerative bone therapy is highlighted. [ABSTRACT FROM AUTHOR]

BACKGROUND: The flow reaching the vocal folds may be lower than that at the output of high-flow nasal cannula (HFNC) system. This could be due to upper-respiratory obstruction, oxygen leakage, or other factors. The objective of this study was to observe the effect of flow through a nasopharyngeal airway on intrapharyngeal pressure (IPP) in subjects undergoing fiberoptic bronchoscopy (FOB). METHODS: Patients scheduled for FOB were invited to participate. Measurements were performed at flows of 0-60 L/min; the subjects wore WN-N95 folding medical protective masks (N95) and either underwent FOB or not. IPP at each flow was recorded following 15 s of ventilation, and the cross-sectional area (CSA) of the gastric sinus was measured before and after FOB. Hypoxemia, reflux aspiration, and other pertinent events were recorded. RESULTS: Sixty subjects undergoing FOB at the Affiliated Hospital of Jiaxing University participated in this trial from October 2022-September 2023. IPP increased significantly with an increase in flow and also increased after placing the N95 mask with the same flow (P < .001). When results from before to after FOB were compared, the difference in CSA was statistically significant 263.6 (220.7-300.5) mm² vs 305.5 (275.4-329.5) mm², P < .001, but the difference in the risk of reflux aspiration was not statistically significant (0% vs 6.7%, P = .13). Complication rates during treatment were 8.3% for hypoxemia, 0% for reflux aspiration, 1.7% for hypertension, 1.7% for hypotension, 6.7% for tachycardia, 5% for bradycardia, and 10% for postoperative nausea and vomiting. CONCLUSIONS: HFNC can provide effective oxygen therapy for people undergoing FOB, and increases in IPP with flow in the range of 0-60 L/min may not increase the risk of reflux aspiration. [ABSTRACT FROM AUTHOR]

Cauda equina syndrome is a rare presentation of lumbar spine disease that can result in significant lower limb neurological deficits and permanent bladder, bowel and sexual dysfunction. Delays in diagnosis and treatment can result in irreversible worsening of the condition. Therefore, this is a major cause of litigation against spinal surgeons in the NHS. Urgent MRI scanning is the diagnostic gold-standard and should be available at all hours in all hospitals where patients with potential cauda equina syndrome present. Imaging should be performed within 4 hours of requesting and if the scan is positive for cauda equina compression then treatment should be undertaken as a matter of urgency. Surgery to decompress the cauda equina can prevent further deterioration in symptoms but compared to elective lumbar surgery carries a much higher rate of complications owing to the nature of the disease. Despite rapid treatment, patients can suffer from significant long-term sequelae and require prolonged periods of rehabilitation. [ABSTRACT FROM AUTHOR]

Objective: Known as a major surgical complication, postoperative delirium (POD) has not been well studied in patients with intracranial atherosclerotic stenosis (ICAS). This study aimed to investigate the correlation between perioperative clinical characteristics and the occurrence of POD. Methods: Patients' demographic characteristics and perioperative testing data were collected. Binary logistic regression was conducted for assessing related risk factors. A nomogram was developed to predict the occurrence of POD after percutaneous transluminal angioplasty and stenting (PTAS) in patients with ICAS. Results: The occurrence of POD in this study was 30.67%. Among all the clinical and laboratory characteristics in patients, age (OR = 1.234, 95%CI = 1.004–1.517, p = 0.046), gender (OR = 5.676, 95%CI = 1.028–31.334, p = 0.046), preoperative MMSE scores (OR = 2.298, 95%CI = 1.005–5.259, p = 0.049), the degree of stenosis (OR = 6.294, 95%CI = 1.043–37.974, p = 0.045), operating time (OR = 1.088, 95%CI = 1.023–1.157, p = 0.006), and HbA1c levels (OR = 2.226, 95%CI = 1.199–4.130, p = 0.011) were the independent risk factors. Conclusion: Male patients with advanced-age, lower preoperative MMSE scores, severe stenosis, longer operating time, and higher HbA1c levels are closely related to POD after PTAS. Fully perioperative assessments may play an important role in predicting the occurrence of POD. [ABSTRACT FROM AUTHOR]

Open reduction and internal fixation (ORIF) remains the gold standard for adult distal humerus fractures (DHF). However, indications for total elbow arthroplasty (TEA) continue to expand and the incidence of primary and salvage TEA for DHF has increased. The objective of this study was to compare complication and reoperation rate for acute vs. delayed primary and salvage TEA performed for DHF. Patients who underwent TEA for DHF were identified in the PearlDiver database. Patients were sorted into 3 cohorts: (1) acute TEA (within 2 weeks of diagnosis), (2) delayed TEA (between 2 weeks and 6 months after diagnosis), and (3) salvage TEA (after failed ORIF, malunion, nonunion, delayed treatment between 6 months and 1 year or post-traumatic arthritis). Multivariate analysis was used to assess for confounding variables and covariates when identifying differences in complications between cohorts. A total of 788 patients underwent acute TEA, 213 patients underwent delayed TEA, and 422 patients underwent salvage TEA after DHF. The incidence of periprosthetic joint infection (PJI) (8.5% vs. 3.4%, odds ratio [OR] 2.60, P =.002) and triceps injury (2.4% vs. 0.4%, OR 6.29, P =.012) were higher in the delayed compared to acute cohort. The incidence of revision (8.5% vs. 2.1%, OR 3.76, P < 0.001), periprosthetic fracture (4.3% vs. 1.1%, OR 3.64, P =.002), PJI (14.7% vs 3.4%, OR 4.36, P <.001), triceps injury (2.6% vs. 0.4%, OR 5.70, P =.008), and wound complications (6.9% vs 2.9%, OR 2.33, P =.002) were higher in the salvage compared to acute cohort. There was an increased rate of revision (8.5% vs. 1.9%, OR 6.08, P =.002) in the salvage compared to delayed cohort. Patients undergoing salvage TEA after DHF have increased rates of revision, periprosthetic fracture, PJI, triceps injury, and wound complications at 2 years post-operatively. The salvage cohort also had an increased risk of revision when compared to the delayed cohort. However, other than revision rates, patients in the salvage and delayed cohorts have similar postoperative complication rates. [ABSTRACT FROM AUTHOR]

Background: Frailty is independently associated with adverse patient outcomes after surgery. The current standards of postoperative care rarely consider frailty status. Local Problem: There was no standardized protocol to optimize specialized postoperative care for frail patients at an academic medical center. Methods: A quasi-experimental pre-/postimplementation study design, using the Reach, Effectiveness, Adoption, Implementation, Maintenance implementation framework, was utilized. Interventions: A frailty-specific postoperative order set (FPOS) was developed, including tailored nursing care, activity levels, and nutritional goals. Results: There were significant improvements in nurse's self-reported familiarity with frailty (P = .003) and FPOS awareness (P < .001). The number of orders for delirium prevention, elimination, nutrition, sleep promotion, and sensory support increased (P < .001). Conclusions: Implementing an FPOS showed improvements in nurse frailty knowledge, awareness, and order set utilization. [ABSTRACT FROM AUTHOR]

Older adults often present with multiple comorbidities and face significant postoperative complications. This study aimed to describe the role of Nurse Practitioner (NP)-led orthogeriatric services in managing hip fracture patients. We conducted a review of health records of older adults with hip and proximal femoral fractures between July 2017 and June 2018, presenting descriptive statistics on patient characteristics, surgical outcomes, and the involvement of orthogeriatric services. A total of 197 participants were included, with a majority being female (n = 132; 67.0%). Most patients (53.8%; n = 106) had between five and nine pre-existing conditions. Among the 192 patients who underwent surgery, 69.8% (n = 134) experienced up to four surgical complications. The Nurse Practitioner provided care to 89.1% (n = 163) of the patients within the orthogeriatric service, with half of the patients (n = 82) requiring at least five NP interventions to manage complex pre- and postoperative needs. Refining the NP-led model could potentially help reduce the burden on physicians and surgeons in treating complex medical conditions, especially in settings where geriatricians may not be readily available. [ABSTRACT FROM AUTHOR]

To describe the key points of cervical resection for prestyloid parapharyngeal pleomorphic adenoma and to discuss the role of modern imaging. Retrospective case series of 10 patients (4 women and 6 men, age 29–63 years) with prestyloid parapharyngeal pleomorphic adenoma with 2 to 8 cm largest diameter on MRI, consecutively resected via a cervical approach between 2000 and 2020 in a French tertiary university referral care center. Seven patients had a minimum 10 years' follow-up, and one was lost to follow-up before the fifth postoperative year. Peri- and postoperative complications comprised great auricular nerve transection without subsequent symptomatic neuroma (2 patients), associated transoral approach to free the upper pole of the adenoma (2 patients), capsule effraction (3 patients), and hematoma (1 patient). There were no cases of facial paresis or palsy, other cranial nerve impairment, trismus, auriculotemporal or first-bite syndrome. One of the three patients with capsule effraction showed local recurrence at month 17. In agreement with previous reports, the present case series confirmed the role of the cervical approach to resect prestyloid parapharyngeal pleomorphic adenoma, and hence the need to continue teaching it. [ABSTRACT FROM AUTHOR]

BACKGROUND: The widespread use of agricultural machinery in China has increased the incidence of agricultural machinery-related injuries, posing challenges to on-site medical rescue. This study explores resuscitative endovascular balloon occlusion of the aorta (REBOA) as a life-saving intervention for a patient with severe trauma from agricultural machinery. CASEPRESENTATION: This study reviews the emergency medical response for a 70-year-old male who suffered machinery entanglement injuries in an agricultural field in western China. The intervention involved a tiered multidisciplinary medical response, including the implementation of REBOA. CONCLUSION: This case demonstrates the successful use of REBOA in the prehospital setting in China. While prehospital REBOA use is rare, it is increasingly reported in both military and civilian contexts in austere environments in different countries. Further research is required to validate the feasibility and efficacy of REBOA as a prehospital resuscitation strategy. [ABSTRACT FROM AUTHOR]

As the population ages, vascular surgeons are treating progressively older, multimorbid patients at risk of peri-operative complications. An embedded physician has been shown to improve outcomes in general and orthopaedic surgery. This systematic review and meta-analysis aimed to investigate the impact of surgeon–physician co-management models on morbidity and mortality rates in vascular inpatients. PubMed, Scopus, Embase, conference abstract listings, and clinical trial registries. Studies comparing adult vascular surgery inpatients under co-management with standard of care were eligible. The relative risks (RRs) of death, medical complications, and 30 day re-admission between co-management and standard care were calculated. The effect of co-management on the mean length of stay was calculated using weighted means. Risk of bias was assessed using the Methodological Index for Non-Randomised Studies, and certainty assessment with the GRADE analysis tools. No randomised controlled trials were identified. Eight single institution studies between 2011 and 2020 with 7 410 patients were included. All studies were observational using before–after methodology. Studies were of high to moderate risk of bias, and outcomes were of very low GRADE certainty of evidence. Co-management was associated with a statistically significant lower relative risk of death (RR 0.64, 95% confidence interval [CI] 0.44 – 0.92; p =.02), cardiac complications (RR 0.47, 95% CI 0.25 – 0.87; p =.02), and infective complications (RR 0.49, 95% CI 0.35 – 0.67; p <.001) in vascular inpatients. No statistically significant differences in length of stay (standard mean difference –0.6 days, 95% CI –1.44 – 0.24 days; p =.16) and 30 day re-admission (RR 0.96, 95% CI 0.84 – 1.08; p =.49) were noted. Early results of physician and surgeon co-management for vascular surgery inpatients showed promising results from very low certainty data. Further well designed, prospective studies are needed to determine how to maximise the impact of physicians within a vascular service to improve patient outcomes while using hospital resources effectively. [ABSTRACT FROM AUTHOR]

Background: Utilizing expanded endoscopic approaches to the maxillary sinus for the endonasal management of a variety of tumors is increasing in popularity. The nasolacrimal duct (NLD) may be injured inadvertantly or need to be removed during tumor resection or to augment visualization. Management of the NLD can take the form of transection alone, transection with stenting, or performing a formal dacryocystorhinostomy to avoid postoperative sequelae of injury. The purpose of this study was to review the literature and determine the optimal management of the NLD during expanded maxillary sinus approaches. Methods: A systematic review of Ovid, Embase, Medline, and Cochrane databases was performed to identify studies involving expanded approaches to the maxillary sinus and that explicitly reported the status of the NLD and postoperative outcomes. Results: Nineteen studies were included in the analysis and divided into two groups: NLD-preserving (n = 9 studies; n = 191 patients in aggregate) and NLD-involving (n = 10 studies; n = 296 patients in aggregate). In the NLD-preserving subgroup, one patient out of a subgroup aggregate of 191 patients (0.5%) developed epiphora. In the NLD-involving subgroup, sharp transection alone was the most common method of NLD removal and was associated with a low rate of epiphora (study rates: 0 to 18.2%; aggregated subgroup rate: 7.0%, 21 / 296). Spontaneous resolution of symptoms was common (60%-100% cases). Conclusions: The NLD should be preserved when feasible from an exposure and tumor-control perspective. When pathology or approach requires the removal of the NLD, rates of persistent epiphora are very low, regardless of surgical technique. When expanded maxillary approaches are employed, particularly for benign tumors, and require removal of the NLD, sharp transection is the simplest method of removal, provides a low rate of postoperative epiphora, and is supported by the available literature. [ABSTRACT FROM AUTHOR]

Objective: The surgical treatment of Eagle syndrome involves an intra- or extraoral approach. This systematic review set out to consolidate current knowledge on the prevalence of complications associated with intraoral and external approaches. Methods: Seven main electronic and two gray literature databases were searched. Studies were blindly selected by two reviewers based on pre-defined eligibility criteria. Studies evaluating any type of complication in the treatment of Eagle syndrome were considered eligible. Risk of bias was assessed using the Joanna Briggs Institute Critical Appraisal Checklist for studies reporting prevalence data, case reports, and case series. The Comprehensive Meta-Analysis software (Software version 3.0 – Biostat, Englewood, NJ, USA) was used to perform all meta-analyses. Results: Out of 1728 articles found on all databases, 36 were included for qualitative analysis. Twenty were included for quantitative analysis and meta-analysis. Conclusion: In this study, the highest rate of complications was found in the intraoral approach. [ABSTRACT FROM AUTHOR]

Statement of the Problem: The satisfaction of patients with dentures on implants has different points of view that become fundamental aspects for the development of research on the quality of life of these patients, the eventual biomechanical complications to which these prostheses and implants can be subjected, and design considerations for cantilever extensions. Purpose: The objective of research was to assess the implants and prosthesis survival rates, biomechanical complications relative to the length of the distal extensions (cantilevers), and the satisfaction of the patients with a fixed implant-supported full-arch fiber-reinforced composites prosthesis. Materials and Method: A retrospective clinical and radiographic cohort study was developed. Clinical records of a selected cohort were analyzed according to inclusion and exclusion criteria. Data on a patient who underwent to fixed implant-supported full-arch fiber reinforced composites prosthesis at least of five years of function were collected. Data analysis was performed using Kaplan-Meier curves and Fisher's Exact Test. P values less than 0.05 were considered statistically significant. Results: After insertion, 1 of 29 prostheses failed, the overall prosthetic survival rate observed at 5 years was 96.5%. Of the 120 implants placed in 28 patients, only 4 patients experienced loss of an implant during the 5 years of observation; the implant survival rate throughout the observation period was 86.2%. Distal extension seems to negatively affect the prognosis of implant-supported rehabilitation. Regarding the level of satisfaction of the patient with the prosthesis, none reported being uncomfortable or dissatisfied neither with their appearance nor with the taste of food throughout the studied period. Conclusion: No relevant associations were found between the variables involved. The study found the improvement in quality of life following the installation of fixed rehabilitation on the patients. Once the potential benefits of patients are obtained, controlled clinical trials are encouraged. [ABSTRACT FROM AUTHOR]

Statement of the Problem: Conventional injection technique with adrenaline during removal of impacted third molar of mandible had proportionally increased pain during administration with slow onset of action and shorter duration of anesthesia. Purpose: The purpose of this study was to compare the effective nature of 8.4% and 7.5% buffered lidocaine hydrochloride during surgical removal of mandibular impacted third molar. Materials and Method: This prospective crossover study included 50 patients requiring bilateral removal of impacted mandibular third molars. Group I included 50 impacted mandibular third molars that were administered with 8.4% buffered lidocaine hydrochloride and group II included 50 impacted mandibular third molars were administered with 7.5% buffered lidocaine hydrochloride. The outcome variables were pain on injection, time of onset of anesthesia, and duration of action of anesthesia. The above parameters were recorded by the investigator and statistically analyzed through Chi-square test using SPSS software. Results: Patients in group I had mild pain (1.02) and patients in group II (5.74) had moderate pain with a statistical significance of p< 0.05 for group I respectively. The mean onset of action of anesthesia in group I was 0.08 seconds and 0.59 seconds in group II (p< 0.05). The duration of anesthesia was 342.51 minutes from group I and 122.06 minutes in group II (p< 0.05) respectively. Conclusion: Lidocaine hydrochloride buffered with 8.4 % sodium bicarbonate was found to be more effective in reduction of pain during injection, also had a faster onset of action and longer duration of the action of anesthesia when compared to 7.5% buffered lidocaine hydrochloride. [ABSTRACT FROM AUTHOR]

The Nexel total elbow arthroplasty (TEA) is an evolution of the Coonrad-Morrey linked TEA. Theoretically, the new design has shown better mechanical properties, but the first clinical studies showed concerning rates of implant loosening, leading the authors to advocate for the discontinued use of the implant. The purpose of this study was to evaluate the short to mid-term results with the Nexel TEA in a single center cohort. Between 2016 and 2020, 41 consecutive patients received 45 Nexel primary TEA at one institution. The cohort consisted of 5 men and 36 women with a mean age at surgery was 70 years (range, 42-93 years). The indications for primary TEA included 18 cases of rheumatoid arthritis, 24 acute fractures, and 3 cases of primary osteoarthritis. Follow-up assessment included the Mayo Elbow Performance Score, Oxford Elbow Score, range of motion, radiographic evaluation of implant loosening, complications, reasons for revision. The mean follow-up was 35 months (range 12-75 months). The median Mayo Elbow Performance Score was 82.5 points (range, 65- 100 points) and the Oxford Elbow Score was median 41.5 points (range, 17- 48 points). Mean range of motion at follow-up was; flexion 134° (range, 90°-140°), extension deficit 16° (range, 0°-90°), supination 71° (range, 30°-90°) and pronation 71° (range, 30°-90°). Radiolucent lines were observed in five cases around the humeral component and in one case around the ulnar component. There were four minor complications including prominent medial epicondyle, superficial infection, and transient ulnar nerve dysesthesia. Five elbows underwent revision surgery, three due to aseptic loosening of the humeral component, one due to periprosthetic fracture of the humerus, and one due to deep infection. The implant survival rate was 93.8% at 3 years. The short- to mid-term clinical and functional results with the Nexel TEA in this series are promising. The study could not demonstrate a similar high revision rate as reported by other authors. However, longer follow-up time and larger series are warranted. [ABSTRACT FROM AUTHOR]

The main goal of this study was to investigate the influence of patient age on humeral implant fixation in stemless reverse shoulder arthroplasty (RSA). The secondary goals were to investigate the influence on the occurrence of complications and on clinical outcomes. We performed a retrospective multicenter study, including a series of patients operated on for stemless RSA. All patients were reviewed at a minimum of 2 years, with clinical and radiographic evaluation. The primary endpoint was the occurrence of migration of the humeral implant at the final follow-up. Secondary endpoints were clinical scores, occurrence of postoperative complications, need for revision surgery, and radiographic changes. Each patient ≥70 year old was matched on gender and body mass index,with a patient < 70 year old on a 1:1 basis. Forty-five patients aged ≥70 years were included and matched, with 45 patients aged <70 years, giving a total of 90 patients (54.4% men) with the mean age being 68.5 ± 7.9 years. There was no difference between the 2 groups in terms of surgical modalities. There was no correlation between age and clinical outcomes. Three migrations of the humeral implant occurred, none leading to a revision, without any influence of age (P = 1.0). We found no correlation between patient age and the occurrence of a postoperative complication (P = 1.0), reoperation (P = 1.0) or any of the other radiographic parameters assessed. This study reported the stability of stemless RSA implants in elderly patients. Clinical outcomes, complication, and revision rates were not affected by age either. [ABSTRACT FROM AUTHOR]

Within reverse total shoulder arthroplasty (RSA), prior studies have suggested that smaller glenosphere diameters may result in higher rates of scapular notching and polyethylene wear, while lateralized glenospheres may allow for better range of motion (ROM); however, supportive data remains limited. Therefore, the purpose of this study was to report the outcomes of a prospective randomized clinical trial comparing 4 different glenosphere configurations based on diameter and lateral offset. Between 2016 and 2020, 113 primary RSAs with a diagnosis of either rotator cuff tear arthropathy (n = 48, 42%), irreparable rotator cuff tears (n = 22, 19%), or primary glenohumeral osteoarthritis with subluxation or glenoid bone loss (n = 43, 38%) were enrolled into a blinded prospective randomized clinical trial. The mean age of the patients included in the study was 73 ± 7 (range, 50-89) years, and 58 (51.3%) were males. All procedures were performed by two surgeons utilizing the ReUnion RSA system (Stryker, Mahwah, NJ, USA). Patients were randomized into four possible groups based on the diameter and lateral offset of the glenosphere implanted: 36 mm diameter with 2 mm (n = 34, 30.1%) or 6 mm (n = 28, 24.8%) of lateralization and 40 mm diameter with 2 mm (n = 29, 25.7%) or 6 mm (n = 22, 19.5%) of lateralization. Outcomes collected included pain, active ROM, strength, satisfaction, patient-reported outcome measures (PROMs), complications, reoperations, and revisions. PROMs included the Oxford Shoulder Score, the American Shoulder and Elbow Surgeons, and the quick Disabilities of the Arm, Shoulder and Hand questionnaire. All patients were followed for a minimum of 2 years. With the numbers available, glenosphere diameter and lateralization resulted in no differences in pain, ROM, strength, satisfaction, and PROMs at 1 year, 2 years, or final follow-up (All P >.05). However, all 3 complications (10.7% vs. 0% vs. 0% vs. 0%; P =.025) and 2 revision surgeries (7.1% vs. 0% vs. 0% vs. 0%; P =.103) occurred in males, with the 36 + 6 cohort. Using this particular RSA design, implantation of glenospheres with 36 mm or 40 mm of diameter and 2 mm or 6 mm of sphere lateralization did not translate into significant differences when primary RSA was performed in shoulders with rotator cuff tear arthropathy, irreparable cuff tears, or primary glenohumeral osteoarthritis. However, all observed complications occurred in males with the smallest diameter and lateralized glenosphere. [ABSTRACT FROM AUTHOR]

Parkinson's disease (PD) is a neurodegenerative disorder that causes resting tremor and rigidity. Total shoulder arthroplasty (TSA) in patients with PD has proven to be a challenging clinical scenario and is associated with a high risk of complications. The purpose of this study is to explore the relationship between patients diagnosed with PD and outcomes following shoulder arthroplasty (SA). Institutional records were queried for patients with PD who underwent SA from 2009 to 2020. Patient medical documentation was retrospectively reviewed to assess demographic information, comorbidity status, preoperative and postoperative range of motion measurements, and complications. Mean ± standard deviation was reported for continuous variables. A total of 17 patients were identified that met the inclusion criteria. The mean age of the cohort was 57.6 ± 10.6 years at the time of PD diagnosis and 68.1 ± 6.9 years at the time of surgery. The mean follow-up was 1.6 ± 1.2 years. The most common indications for surgery were degenerative joint disease, osteoarthritis, rotator cuff arthropathy, proximal humerus fracture, and rotator cuff tear (1). Mean forward elevation improved from 126.6 ± 24.8° to 131.2 ± 27.8°; mean external rotation improved from 29.4 ± 17.3° to 38.8 ± 10.5°. SA is an effective method of improving pain and function in PD patients. Patients undergoing anatomic TSA exhibited the most robust functional improvement in this cohort; however, anatomic TSA was associated with postoperative complications and similar functional measurements were achieved at final follow-up in patients who underwent reverse TSA. Thus, significant care must be taken to ensure the correct implant is chosen on an individual basis to maximize the potential for functional improvement. [ABSTRACT FROM AUTHOR]

Sleep apnea (SA) has been shown to negatively affect cognition, immunity, and bone mineralization. There is conflicting evidence for the contribution of SA to outcomes following total shoulder arthroplasty. However, the impact of SA on reverse shoulder arthroplasty (RSA) has not been elucidated. A substantial increase in utilization of RSA is projected through the 2030s. Our objective was to assess postoperative medical and implant-related complications and healthcare utilization in patients with SA undergoing RSA. A retrospective review of a private insurance claims database was conducted from 2010 to 2021. All cases of RSA and those with a prior diagnosis of SA were identified using their corresponding diagnosis and procedural codes. Patients undergoing RSA with a diagnosis of SA were matched to control patients 1:2 based on demographic and comorbidity profiles. A total of 18,229 SA patients were matched to 35,988 control patients. The SA cohort had significantly greater odds of all medical complications assessed compared to the control cohort. The SA cohort had greater odds of all implant-related complications including dislocation and mechanical loosening when compared to the control cohort. Mean length of stay was significantly greater in the SA group. The current data demonstrate that SA patients may have an increased risk of complications and healthcare burden following RSA compared to RSA patients without SA. These findings indicate potential value in preoperative screening for SA prior to RSA. [ABSTRACT FROM AUTHOR]

Lateralizing the center of rotation in reverse shoulder arthroplasty (RSA) decreases the risk of scapular notching due to inferior impingement but may limit range of motion (ROM) in abduction and forward flexion related to superior acromial impingement. Our primary hypothesis was that, using a 3-dimensional (3D) computer model, a virtual acromioplasty (with or without tuberoplasty) could improve abduction and forward flexion following RSA for cuff tear arthritis (CTA) or massive cuff tear. Our secondary hypothesis was that, based on the virtual planning, a surgical acromioplasty could be performed safely during RSA, without increasing the risk of postoperative acromial fracture. Eighty seven patients with CTA scheduled for RSA were analyzed with a 3D software and impingement-free ROM was measured. After virtual prosthesis implantation, early acromio-humeral impingement (abduction ≤ 80° or forward flexion ≤ 120°) was observed in 25% of the cases (22/87). A virtual acromioplasty (with or without tuberoplasty) was then performed and glenohumeral ROM was measured again. Based on this 3D planning, a surgical acromioplasty (with or without tuberoplasty) was performed to improve ROM in the vertical plane in these 22 patients with early acromial impingement. Patients were followed with minimum 24 months of follow-up to assess final shoulder ROM and complications. After virtual acromioplasty alone (n = 11) or acromioplasty with tuberoplasty (n = 11), glenohumeral abduction significantly increased from 75° ± 6.9 before to 89.5° ± 23.4, and forward flexion from 119.3° ± 12 to 135.2° ± 10 (P <.001). After surgical acromioplasty/tuberoplasty, the final mean global forward flexion was 148° ± 5 and mean global abduction 150° ± 8 in these patients. At last follow-up, no acromial fracture was observed. In a 3D model, early acromial impingement may limit abduction (≤80°) or forward flexion (≤120°) after virtual RSA implantation for CTA or massive cuff tear. Virtual acromioplasty (with or without tuberoplasty) shows improved ROM in abduction and flexion. In patients with early impingement, a surgical acromioplasty can be performed safely during RSA, through a deltopectoral approach, without increasing the risk of postoperative acromial fracture. [ABSTRACT FROM AUTHOR]

Total shoulder arthroplasty (TSA) is a common orthopedic procedure that can be performed as an anatomic total shoulder arthroplasty (aTSA) or reverse total shoulder arthroplasty (rTSA). These are effective procedures that are being performed with increasing frequency. Understanding the overall 90-day reimbursement variability and their drivers may help the health care systems better understand related considerations to reduce health-care expenditure. The current study predicts there will be large variability in reimbursement highlighting the need for further understanding. Using the 2015-2021 Q1 M151 PearlDiver dataset, patients who underwent aTSA or rTSA were isolated. Patients were excluded if they were aged less than 18 years, had an indication of traumatic, infectious, or oncologic diagnoses within 90-days of surgery, or were not in the dataset for at least 90 days before and after surgery. Patient demographics, comorbidities, 90-day postoperative events, insurance type, and geographic region were abstracted. The overall 90-day reimbursements were then assessed and correlated with these variables having multivariable linear regression. A total of 112,188 TSA patients (aTSA: 36,164 [32.2%]; rTSA: 76,024 [67.8%]) were identified. The average ± standard deviation 90-day overall postoperative reimbursement for aTSA was $6714.26 ± 9587.46 and rTSA was $6246.45 ± 9506.59. The total reimbursement for aTSA was $242,814,515 and for rTSA was $474,836,301. Variables independently associated with greater 90-day overall reimbursement were mostly related to 90-day postoperative events, including hospital readmission [+$6694.51], emergency department visit [+$2129.89], and adverse events [+$2055.84]), geographic region of the country where the procedure was performed (relative to West, South [+$4302.88], Midwest [+$3428.84], and Northeast [+$530.92]), and insurance plan (relative to commercial, Medicare [-$1268.01], and Medicaid [-$901.79]) (P <.0001 for each). Lesser factors included male sex (relative to female +$207.30), Elixhauser-Comorbidity Index (+$51.93 per point increase), age (-$77.16 per year increase), and rTSA surgery type (relative to aTSA -$556.17). The current study leveraged a large, administrative database to evaluate over 100,000 TSA patients and found large variations in 90-day overall reimbursements. The variables mostly associated with increased reimbursement were related to 90-day postoperative events (as might be expected and underscoring the need to minimize such events) and geographic regions and insurance plan (highlighting differences that might be able to be addressed). Interestingly, while patient demographics, comorbidities, and anatomic vs. reverse total shoulder were associated with reimbursements, these were to lesser extents. Understanding these results may help health-care systems further target variables associated with greater cost/reimbursement to the system. [ABSTRACT FROM AUTHOR]

The goal of this study is to examine the impact of antibiotic and other drug allergies on the incidence of complications and revisions following shoulder arthroplasty (SA). Our hypothesis posits that patients with antibiotics or other drug allergies will have a higher rate of complications and revision surgeries following SA. All data collection involved utilizing the PearlDiver national database and Current Procedural Terminology code 23472 to identify individuals who had undergone primary anatomic or reverse SA within the period of 1/1/2010-10/31/2021. The initial population was categorized into three groups: patients with antibiotic allergies, patients with other drug allergies, and patients with no reported drug allergies. The two allergy groups were examined against the nonallergy group to draw comparisons concerning surgical complications, medical complications, and revision surgeries. The evaluation of complications took place at the 30 day and 90 day postoperative time points, while revisions were assessed at the 30 day, 1 year, 3 year, 5 year, and 10 year postoperative time points. This database study identified 153,384 patients (10,106 with antibiotic allergies, 16,982 with other drug allergies, and 126,296 with no allergies) who had received SA. Compared to patients without allergies, patients in both allergy cohorts were more likely to require revision surgery across all analyzed time points (P <.001). Patients with antibiotic allergies experienced higher rates of surgical site infections (SSI) (30 days: 1.0% vs. 0.8%, odds ratio 1.25 [95% confidence interval 1.02-1.53], P =.04; 90 days: 1.3% vs. 1.1%, 1.26 [1.06-1.51], P =.011) and prosthetic joint infections (30 days: 0.6% vs. 0.2%, 2.57 [2.06-3.27], P <.001; 90 days: 0.9% vs. 0.3%, 2.60 [2.06-3.27], P <.001) at both time points. Patients with allergies to other drugs were more likely to develop prosthetic joint infection (30 days: 0.6% vs. 0.2%, 2.57 [2.06-3.21], P <.001; 90 days: 0.8% vs. 0.3%, 2.51 [2.08-3.04], P <.001), but there was no statistical difference in SSI rates compared to patients without allergies (30 days: 0.9% vs. 0.8%, 1.10 [0.93-1.31], P =.279; 90 days: 1.2% vs. 1.1%, 1.16 [1.00-1.34], P =.055). Patients with antibiotic and other drug allergies demonstrated a higher likelihood of requiring revision surgery after undergoing SA. Patients with antibiotic allergies displayed an increased susceptibility to all complications analyzed apart from bleeding, while patients with other drug allergies displayed an increased susceptibility to all complications except for SSIs. [ABSTRACT FROM AUTHOR]

Postoperative cognitive recovery is deeply important to patients and perioperative clinicians. Despite decades of data on "postoperative cognitive decline" (POCD), a research diagnosis based on objective cognitive test performance, perspectives on subjective cognitive complaints (SCC) after modern surgery/anesthesia have not been systematically collected or studied despite their recent inclusion in the 2018 redefinition of "postoperative neurocognitive disorder." The authors describe the alignment between SCC anecdotes and the research diagnosis of POCD, contextualizing these findings using recent literature within and outside anesthesiology. This article prepares anesthesiologists to discuss what is, and is not, known about subjective cognitive recovery after surgery/anesthesia. [ABSTRACT FROM AUTHOR]

Background: Ventricular tachycardia (VT) remains a risk in repaired Tetralogy of Fallot (rTOF); however, long‐term benefits of VT ablation have not been established. This study compares the outcomes of rTOF patients with and without VT ablation. Methods: We searched multiple databases examining the outcomes of rTOF patients who had undergone VT ablation compared to those without ablation. Primary outcomes were VT recurrence, sudden cardiac death (SCD), and all‐cause mortality. Subgroup analysis was conducted based on the type of ablation (catheter and surgical). Slow‐conducting anatomical isthmus (SCAI)‐based catheter ablation (CA) was also analyzed separately. The secondary outcome was the risk factors for the pre‐ablation history of VT. Results: Fifteen cohort studies with 1459 patients were included, 21.4% exhibited VTs. SCAI was found in 30.4% of the population, with 3.7% of non‐inducible VT. Factors significantly associated with VT before ablation included a history of ventriculostomy, QRS duration ≥180 ms, fragmented QRS, moderate to severe pulmonary regurgitation, high premature ventricular contractions burden, late gadolinium enhancement, and SCAI. Ablation was only beneficial in reducing VTs recurrence in SCAI‐based CA (risk ratio (RR) 0.11; 95% CI 0.03 to 0.33. p < 0.001; I2 = 0%) with no recurrence in patients with preventive ablation (mean follow‐up time 91.14 ± 77.81 months). The outcomes of VT ablation indicated a favorable trend concerning SCD and all‐cause mortality (RR 0.49 and 0.44, respectively); however, they were statistically insignificant. Conclusions: SCAI‐based CA has significant advantages in reducing VT recurrence in rTOF patients. Risk stratification plays a key role in determining the decision to perform ablation. [ABSTRACT FROM AUTHOR]

Background: Evidence regarding the association between hyperuricemia and arrhythmia recurrence after catheter ablation for paroxysmal atrial fibrillation (AF) is scarce. We investigated whether hyperuricemia predicts arrhythmia recurrence after catheter ablation for paroxysmal AF and the relationship between hyperuricemia and alcohol consumption in AF recurrence. Methods: Patients who underwent catheter ablation for paroxysmal AF were divided into the hyperuricemia (index serum uric acid [UA] >7.0 mg/dL; n = 114) and control (UA ≤7.0 mg/dL; n = 609) groups and were followed for a median of 24 (12–48) months after ablation. Results: The hyperuricemia group had more patients with an alcohol intake of ≥20 g/day (33.3% vs. 22.7%, p =.017) and a lower incidence of AF‐free survival (p =.019). Similarly, those with an alcohol intake of ≥20 g/day had a lower incidence of AF‐free survival than other patients. Multivariate Cox regression analysis revealed the following independent predictors of AF recurrence (adjusted hazard ratio, 95% confidence interval): hyperuricemia (1.64, 1.12–2.40), female gender (1.91, 1.36–2.67), brain natriuretic peptide level >100 pg/mL (1.59, 1.14–2.22), and alcohol consumption ≥20 g/day (1.49, 1.03–2.15) (all p <.05). In addition, causal mediation analysis revealed that alcohol consumption of ≥20 g/day directly affected AF recurrence, independent of hyperuricemia. Conclusions: Patients with hyperuricemia may be at a high risk of arrhythmia recurrence after catheter ablation for paroxysmal AF. Although high alcohol consumption may contribute to increased UA levels, the presence of hyperuricemia may independently predict AF recurrence. [ABSTRACT FROM AUTHOR]

Background: Laser balloon (LB) pulmonary vein isolation (PVI) is an established ablation technique for atrial fibrillation (AF). We report long‐term follow‐up and procedural data of LB‐PVI and we compare the first and second LB generation. Methods: Patients undergoing LB ablation with first‐ (LB1) or second‐generation LB (LB2) for AF were retrospectively enrolled and divided into two groups. Procedural endpoint was complete PVI. Clinical success was defined as no recurrence of AF/atrial tachycardia after a 90 days blanking period. Results: 538 patients were included (age 66 ± 10 years, 58% paroxysmal AF), 427 in LB1 and 111 in LB2. 2079 PVs were targeted and 2073 (99.7%) were successfully isolated; 2027 (97.5%) using solely the LB. Additional touch‐up ablation was limited (46 PVs; 2.2%) with no difference between the groups. Procedural (LB1: 120 ± 33 minutes vs. LB2: 99 ± 22 min; p <.001) and fluoroscopy time (LB1: 11.2 ± 5 min vs. LB2: 8.5 ± 3 min; p <.001) were shorter with LB2. The complication rate was 8.9% (LB1: 10.1% vs. LB2: 4.5%; p =.067) with most complications resulting from the access site (21/48). Overall freedom from AF after 1‐year was 73.7% (paroxysmal AF: 76.9%; persistent AF: 69.3%; p <.001) with no difference between the groups (LB1: 73.4% vs. LB2: 74.7%; p =.491). Conclusion: LB showed a high efficacy and acceptable safety, with numerically lower complication rates with the second‐generation LB. Procedure and fluoroscopy times were shorter with LB2. Overall, 73.7% of patients were free from AF at 1‐year, with comparable results among both generations. [ABSTRACT FROM AUTHOR]

Introduction: Atrial fibrillation (AF) represents the most common arrhythmia in the postoperative setting. We aimed to investigate the incidence of postoperative AF (POAF) and determine its predictors, with a specific focus on inflammation markers. Methods: We performed a retrospective single tertiary center cohort study including consecutive adult patients who underwent a major surgical procedure between January 2016 and January 2020. Patients were divided into four subgroups according to the type of surgery. Results: Among 53,387 included patients (79.4% male, age 64.5 ± 9.5 years), POAF occurred in 570 (1.1%) with a mean latency after surgery of 3.4 ± 2.6 days. Ninety patients died (0.17%) after a mean of 13.7 ± 8.4 days. The 28‐day arrhythmia‐free survival was lower in patients undergoing lung and cardiovascular surgery (p <.001). Patients who developed POAF had higher levels of C‐reactive protein (CRP) (0.70 ± 0.03 vs. 0.40 ± 0.01 log10 mg/dl; p <.001). In the multivariable Cox regression analysis, adjusting for confounding factors, CRP was an independent predictor of POAF [HR per 1 mg/dL increase in log‐scale = 1.81 (95% CI 1.18–2.79); p =.007]. Moreover, independent predictors of POAF were also age (HR/1 year increase = 1.06 (95% CI 1.04–1.08); I <.001), lung and cardiovascular surgery (HR 23.62; (95% CI 5.65–98.73); p <.001), and abdominal and esophageal surgery (HR 6.26; 95% CI 1.48–26.49; p =.013). Conclusions: Lung and cardiovascular surgery had the highest risk of POAF in the presented cohort. CRP was an independent predictor of POAF and postsurgery inflammation may represent a major driver in the pathophysiology of the arrhythmia. [ABSTRACT FROM AUTHOR]

To evaluate results and failure factors in endonasal surgery in a private outpatient setting in a tropical environment. A single-center observational study included 337 patients consecutively undergoing endonasal surgery in a private hospital on Réunion Island, a French overseas administrative Département in the Indian Ocean between 2019 and 2021. The main objective was to assess the success rate of the outpatient pathway. Secondary objectives comprised analysis of complications and identification and management of factors for failure of outpatient management. The study was conducted according to the STROBE editorial guideline. The 337 surgeries notably comprised 112 septoplasties (37.5%), 104 meatotomies (30.3%), 15 unilateral total ethmoidectomies (4.6%), 48 bilateral total ethmoidectomies with sphenoidotomy (14.3%), and 18 Draf procedures (5.5%). Seventy-five percent of patients (252/337) were operated on as outpatients, with a success rate of 90% (227/252 patients). The rate of severe intraoperative complications was 1.5% (5/337). On multivariate analysis, 3 variables were identified as influencing risk of failure of the outpatient pathway: emergency analgesia in the operating room [odds ratio (OR): 91.61; 95% confidence interval (CI): 22.8–540.3], operating time (OR: 1.05; 95% CI: 1.01–1.09), and recovery room time (OR: 1.02; 95% CI: 1.01–1.03). Our study in a tropical environment found eligibility and success rates for outpatient endonasal surgery similar to those in metropolitan France. This makes surgical and anesthesiological training a key factor in the success of outpatient care, while the location of the care structure and the climate seem to have little impact. [ABSTRACT FROM AUTHOR]

Surgical meshes play a significant role in the treatment of various medical conditions, such as hernias, pelvic floor issues, guided bone regeneration, and wound healing. To date, commercial surgical meshes are typically made of non-absorbable synthetic polymers, notably polypropylene and polytetrafluoroethylene, which are associated with postoperative complications, such as infections. Biological meshes, based on native tissues, have been employed to overcome such complications, though mechanical strength has been a main disadvantage. The right balance in mechanical and biological performances has been achieved by the advent of bioresorbable meshes. Despite improvements, recurrence of clinical complications associated with surgical meshes raises significant concerns regarding the technical adequacy of current materials and designs, pointing to a crucial need for further development. To this end, current research focuses on the design of meshes capable of biomimicking native tissue and facilitating the healing process without post-operative complications. Researchers are actively investigating advanced bioresorbable materials, both synthetic polymers and natural biopolymers, while also exploring the performance of therapeutic agents, surface modification methods and advanced manufacturing technologies such as 4D printing. This review seeks to evaluate emerging biomaterials and technologies for enhancing the performance and clinical applicability of the next-generation surgical meshes. In the ever-transforming landscape of regenerative medicine, the embracing of engineered bioabsorbable surgical meshes stands as a key milestone in addressing persistent challenges and complications associated with existing treatments. The urgency to move beyond conventional non-absorbable meshes, fraught with post-surgery complications, emphasises the necessity of using advanced biomaterials for engineered tissue regeneration. This review critically examines the growing field of absorbable surgical meshes, considering their potential to transform clinical practice. By strategically combining mechanical strength with bioresorbable characteristics, these innovative meshes hold the promise of mitigating complications and improving patient outcomes across diverse medical applications. As we navigate the complexities of modern medicine, this exploration of engineered absorbable meshes emerges as a promising approach, offering an overall perspective on biomaterials, technologies, and strategies adopted to redefine the future of surgical meshes. [Display omitted] [ABSTRACT FROM AUTHOR]

• Among patients with CRP > 125 mg/L at D4, 25% presented with anastomotic leakage and 16% with another type of infection; in 47% of cases on D6, CRP had spontaneously fallen below the threshold. • With CRP > 125 mg/L on the 4th day following colorectal surgery, it is urgent to carry out a CT-scan with opacification of the anastomosis. • A protocol expressly drawn up for management of these patients enables them to derive maximum benefit from early diagnosis and decreases length of hospital stay (fewer than 15 d for 68% of patients). • In our experimental setting, early endoscopy for the diagnosis and treatment of colorectal and colocolic fistulas did not turn out to be feasible. To evaluate the feasibility and benefit of a diagnostic and therapeutic algorithm for management of patients presenting with a high C-reactive protein (CRP) level after colorectal surgery. Prospective study including patients with CRP > 125 mg/L at the 4th postoperative day following elective colorectal surgery. The protocol involved CT-scan of which the results were to orient subsequent management: antibiotics, radiological drainage, endoscopy or surgical redo. Success (primary endpoint) consisted in the proportion of patients with total duration of hospitalization fewer than 15 d. Secondary endpoints were: applicability of the protocol in real-life conditions, number of stomas created, duration of hospitalization in an intensive care unit. One hundred and six (106) patients were included: 51 patients (48%) presented with postoperative complications, of which 21 (41%) were severe. No death occurred. Among the included patients, 68% had a hospital stay < 15 d. Major deviations from the management algorithm occurred in 38% of cases. No patients had an early endoscopy. There was no significant difference with regard to the secondary endpoints according to whether or not the protocol was strictly observed. It is necessary to define a protocol for management of patients presenting with high CRP levels after colorectal surgery, the objective being to reduce the impact of complications and to avoid excessive lengthening of hospital stay. The protocol begins with CT-scan, which is to orient subsequent management. [ABSTRACT FROM AUTHOR]

Distal biceps tendons are a potential source of anterior elbow pain, with pathology ranging from tendinopathy to degenerative ruptures and acute traumatic ruptures. In some instances, non-surgical management is appropriate, but the majority of acute ruptures should be managed surgically for superior outcomes. This article will discuss distal biceps pathology, the relevant surgical anatomy, fixation and approach options and the potential complications following repair and reconstruction. [ABSTRACT FROM AUTHOR]

Introduction: Post-operative frenectomy care is often focused on active wound management (AWM) and followed by neuromuscular re-education (NMR). The standard practices of AWM are varied amongst providers. AWM is often expected to be performed by caregivers who have little to no experience with AWM. In contrast, NMR is individualized to patient needs and has been emerging in external evidence as a beneficial modality for the functional implications of tethered oral tissues (TOTs). It is guided by licensed professionals but is not often accessible or recommended. New Perspective: AWM and NMR often are similar in execution but differ in goals. AWM is focused on wound debridement and avoiding scarring or reattachment of the frena, whereas NMR is focused on airway, sleep, feeding, swallowing, speech, and optimal orofacial growth. AWM has little consensus or external evidence compared to NMR which has both internal and external evidence. AWM for oral care is also limited by scope of practice (SOP) which few licensed professionals have. NMR has a broader range of professionals such as International Board-Certified Lactation Consultants (IBCLCs), speech-language pathologists (SLPs), physical and occupational therapists (PT/OT) and registered dental hygienists (RDHs). Conclusions: NMR has multiple benefits post-operatively, is individualized and performed by multiple professionals. It is suggested that release providers consider gentle, functionally directed post-operative NMR techniques that are individualized, and research the impact these approaches have on wound care goals. [ABSTRACT FROM AUTHOR]

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Halo gravity traction (HGT) is a preoperative modality for children with severe spinal deformity used to optimize spine flexibility and balance while decreasing the likelihood of neurologic injury. HGT is a dependable solution for these challenging spinal deformities. Aligning treatment guidelines and providing resources, education, and training for staff are key components for a successful HGT program. The HGT program at Children's Mercy Hospital was then developed with a systems approach with the holistic goal of multidisciplinary collaboration with physical/occupational therapy, hospital medicine, pulmonology, psychology, nutrition, child life, and complex care management. Education, research, and national collaboration to standardize this therapy should improve patient safety and support quality improvement. [ABSTRACT FROM AUTHOR]

The functional restoration of Brown class III maxillary defects is a challenging endeavour in oral and maxillofacial surgery. Conventional reconstruction techniques with osseous free flaps have certain limitations, such as the need for multiple operations and greater patient morbidity. This study introduces a single-stage computer-assisted approach for tumour resection and functional restoration of these defects using titanium mesh, zygomatic implants, and a vascularized anterolateral thigh flap (ALTF). Virtual surgical planning was used to simulate tumour resection, titanium mesh placement, and zygomatic implant insertion. Surgery was performed under the guidance of mixed reality and surgical navigation. The tumour was resected by total hemimaxillectomy, and the reconstruction was performed using a pre-bent patient-specific titanium mesh for the orbital floor and two zygomatic implants placed and exposed through tunnels in an ALTF. The ALTF survived without any perioperative complications. A fixed prosthesis with built-in titanium frame was delivered 4 months postoperatively. At the 1-year follow-up, there was no tumour recurrence, the implants were osseointegrated, and aesthetics and masticatory function were satisfactory. An occlusal force of 155 N was attained on the reconstructed side, compared to 127 N on the non-surgical side. [ABSTRACT FROM AUTHOR]

There are several treatment options available to restore function and appearance in patients with combined mid-facial defects. Owing to the size of the defect and the associated size and weight of the prostheses, adequate retention can be challenging to achieve. Retention of a facial prosthesis can be improved using several techniques, such as medical grade adhesives, attachments, or osseo-integrated implants. For patients with a history of radiotherapy, surgical rehabilitation may be less favourable than non-surgical approaches owing to the risk of osteoradionecrosis and a reduced blood supply in the surgical fields. This clinical case report highlights the conservative rehabilitation of a combined mid-facial defect using a magnet-retained intra-oral and extra-oral prosthesis. CPD/Clinical Relevance: A thorough medical and clinical assessment will highlight factors that will influence the treatment planning process when managing a combined mid-facial defect. [ABSTRACT FROM AUTHOR]

The unilateral sagittal split osteotomy may not be a particularly popularized method to access and remove impacted mandibular third molars (M3Ms). However, in unusual cases of deep impaction, it can provide a surgical option that minimizes bone removal and may reduce the risk of iatrogenic mandibular fracture and inferior alveolar nerve (IAN) injury, depending on the position of the third molar relative to the neurovascular bundle. CPD/Clinical Relevance: The unilateral sagittal split osteotomy may present an alternative method for removing impacted mandibular third molar teeth in certain situations. [ABSTRACT FROM AUTHOR]

Postoperative colorectal imaging studies play an important role in the detection of surgical complications and disease recurrence. In this pictorial essay, we briefly describe methods of surgery, imaging findings of their early and late complications, and postsurgical recurrence of cancer and inflammatory bowel disease. [ABSTRACT FROM AUTHOR]

Background: Uterine artery embolization is proven to be an effective treatment for symptomatic uterine fibroids. Yet, its role in the management of dysfunctional uterine bleeding is still debatable. Patients with dysfunctional uterine bleeding have abnormal bleeding from the uterine vascular bed with variable underlying mechanisms. Uterine artery embolization will reduce/prevent bleeding by occlusion of the vascular bed, with subsequent cutoff of the effect of hormones on the endometrium. The aim of this work is to demonstrate the safety, efficacy and possible short-term complications of uterine artery embolization in the treatment of dysfunctional uterine bleeding (DUB) as a first-line treatment modality rather than the current treatment options (hormonal and surgical treatment). Methods: Thirty patients included in the study were clinically and laboratory diagnosed based on FIGO classification system (PALM-COEIN) as DUB, and the diagnosis was confirmed by MRI imaging. All patients were subjected to transcatheter uterine artery embolization with subsequent clinical and radiological follow-up to assess the treatment outcome. Results: Uterine artery embolization was able to control bleeding in patients diagnosed as DUB, with subsequent complete cessation of medical treatment; no surgical interference was needed with much less morbidity. We had 93.3% improvement in the frequency, volume of bleeding and 100% improvement of the presenting anemia. No significant change in uterine volume or in endometrial thickness has been noted. Conclusions: Uterine artery embolization is safe, effective procedure to control dysfunctional uterine bleeding with the preservation of the uterus especially in critical age groups. [ABSTRACT FROM AUTHOR]

Steroid injections are a well-known first-line treatment for glenohumeral osteoarthritis; however, many patients eventually require definitive management with surgery. Recent literature has called into question the safety of steroid injections before shoulder surgery due to increased infections and revisions. Conclusive data regarding the relationship between preoperative injection and postoperative outcomes is lacking. This study aimed to determine the impact of ipsilateral injections on clinical outcomes following shoulder arthroplasty (SA). A retrospective study was performed on patients who underwent SA by a single fellowship-trained orthopedic surgeon from 2017 to 2021. Patients were divided into two cohorts based on preoperative corticosteroid injection: (1) injection group (IG) and (2) no injection (control group (CG)). The IG was further stratified based on number of injections (1 vs. ≥2 injections) and timing of injections relative to surgery (<3 months, 3-12 months, and >12 months). Patient-reported pain and satisfaction, simple shoulder test, shoulder pain and disability index, visual analog scale for pain, University of California-Los Angeles score, American Shoulder and Elbow Surgeons score, Constant-Murley score, range of motion, complications, and reoperations were collected preoperatively and at final follow-up. Comparisons were made between groups and the minimal clinically important difference (MCID) and substantial clinical benefit (SCB) were calculated for each score. 421 patients (IG = 98 patients, CG = 323 patients) were included, with mean follow-up of 22 months. The IG had more females (69.1% vs. 48.9%; P <.001) and older age (75 vs. 70; P <.001). There was significantly greater preoperative range of motion in the IG for forward elevation (80° vs. 70°; P =.025) and abduction (70° vs. 60°; P =.004). At final follow-up, all groups had a high percentage (mean 80.26%) of patients exceeding both MCID and SCB for all measures. More patients in the IG exceeded MCID and SCB for visual analog scale for pain (P =.009 and P =.007, respectively), and MCID for American Shoulder and Elbow Surgeons (P =.046) compared to the CG. The group with ≥2 injections reported worse shoulder pain and disability index scores (P =.024). Complication and reoperation rates were comparable between groups. Our study indicates that a single ipsilateral shoulder injection did not worsen postoperative outcomes or complication rates following SA. However, patients who received two or more injections had inferior patient-reported outcomes. Surgeons can continue to use injections as a viable first-line management option before shoulder arthroplasty for reliable pain relief without concerns for increased complications. [ABSTRACT FROM AUTHOR]

The purpose of this systematic review was to characterize the association between tobacco use and postoperative outcomes, complications, and revision rates following shoulder arthroplasty through a systematic review of the literature. The PubMed/MEDLINE and Embase databases were queried for studies published between January 1, 1985, and April 18, 2023, comparing outcomes following both anatomic and reverse total shoulder arthroplasty (TSA) between tobacco users and nontobacco users. Studies with a level of evidence IV or greater were included, while case reports, systematic reviews, basic science studies, and studies including revision arthroplasty were excluded. American Shoulder and Elbow Surgeons scores, simple shoulder test scores, visual analog scale for pain, complications, readmissions, and reoperations were reported. A total of 20 unique studies including 338,117 shoulder arthroplasties (38,225 [11.3%] performed on tobacco users) were included in this review. Patient-reported outcome measures, including American Shoulder and Elbow Surgeons, simple shoulder test, and visual analog scale, were overall superior in nontobacco users compared to tobacco users. Similarly, tobacco users had lower patient acceptable symptomatic state achievement, worse Single Assessment Numeric Evaluation scores (odds ratio 0.647; 95% confidence interval, 0.324-1.293; P =.0221), and worse constant scores (odds ratio, 0.478; 95% confidence interval, 0.251-0.909; P =.027). Tobacco users demonstrated a higher rate of complications in four of the eight included studies. Two included studies found higher rates of readmission in tobacco users (15.3% vs. 13.6%, P =.007 and 7.8% vs. 7.1%, P =.001), though six included studies found no significant difference in readmissions. Nine of 11 studies that included reoperation as a variable found higher rates of reoperation in tobacco users, with three reaching statistical significance (P <.05). Tobacco users experienced higher rates of gastrointestinal complications (0.07% vs. 0.01%, P =.021), acute renal failure (2.5% vs. 1.9%, P =.005), acute respiratory distress (1.3% vs. 0.9%, P =.002), need for ventilator assistance (1.2% vs. 0.7%, P <.001), instability of the prosthesis (P <.001), pneumonia (P <.001), sepsis (P =.001), and myocardial infarction (P <.001). Smokers also demonstrated increased postoperative opioid use (2643 mg oral morphine equivalents) compared to nonsmokers (2121 mg) and former smokers (2015 mg; P =.04). Tobacco use is associated with inferior outcomes after TSA, including lower patient-reported outcome measures, increased complications, and higher reoperation rates. Further high-level, prospective studies with long-term follow-up are required to further elucidate the impact of tobacco use on long-term postoperative outcomes following TSA. [ABSTRACT FROM AUTHOR]

As reverse total shoulder arthroplasty (rTSA) has evolved, the use of augmented glenoid baseplates has increased. While there are benefits of metal augmentation, literature concerning the mid- to long-term follow-up of these implants is emerging. The purpose of this study is to report early to short-term radiographic follow-up of patients with glenoid deformity treated with a metal-augmented glenoid baseplate. Our hypothesis is that we will see a low incidence of osteolysis, loosening, complications, and revision of these implants regardless of diagnosis, augment type, or patient demographics. We performed a single-center retrospective review of all patients undergoing primary reverse shoulder arthroplasty with an augmented metallic baseplate for rotator cuff arthropathy and glenohumeral arthritis. Patients undergoing revision procedures or reverse arthroplasty for fractures were excluded. All patients had a minimum of 1-year radiographic follow-up. Preoperative imaging was reviewed to confirm the diagnosis and glenoid deformity classification. Postoperative radiographs were reviewed for evidence of complications, revisions, osteolysis, baseplate loosening, and failure. Clinical data were reviewed for complications. Primary rTSA with a metal-augmented baseplate (38 full wedge and 22 half wedge augments) was performed on 60 patients who met inclusion criteria (mean age 74 ± 7). The average radiographic follow-up of all patients was 17 months. In our cohort, there was one patient with aseptic loosening of a full wedge implant that was not revised. There were no other complications, revision surgeries, baseplate failures, or acromial stress fractures. Six patients developed scapular notching, and five patients were found to have asymptomatic glenoid osteolysis. Two patients with full wedge implants developed aseptic humeral loosening. Pearson chi-square post hoc analysis found no correlation between augment type, gender, or glenoid deformity classification and radiographic changes such as glenoid or humeral osteolysis, loosening, or scapular notching. We did find a statistically significant correlation (P =.018) between patients with body mass index > 35 and glenoid osteolysis. Primary rTSA for patients with rotator cuff arthropathy or glenohumeral arthritis with glenoid deformity corrected with metal-augmented glenoid baseplates results in a low complication rate and an acceptable outcome at a minimum 1-year follow-up. Compared to other similar cohorts, our patients did not experience any acromial stress fractures, and only one patient had loosening of the glenoid component that was not ultimately revised. Further studies with longer follow-up will be needed, but early outcomes are promising and support the increase in the use of these implants. [ABSTRACT FROM AUTHOR]