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Compared with 12 months earlier, 206 patients (32.7%) said they found their current health to be "much better", 209 patients (33.1%) felt "somewhat better", 123 patients (19.5%) felt "about the same", 75 patients (11.9%) felt "somewhat worse", and 18 patients (2.9%) felt "much worse." Predictors of poor postoperative patient satisfaction in patients unde... Background A significant number of patients who undergo spine surgery have pre-existing compensation claims. The feasibility of a multidisciplinary transitional pain service in pa... Background Patients who undergo spine surgery have high rates of perioperative opioid consumption compared with patients undergoing other types of surgery, and unfortunately many opioid-naive patients going into spine surgery remain on opioids long term. Spine surgery in patients with morbid obesity: tips and tricks Background Patients with obesity are becoming more prevalent in our society, and spine surgery in patients with morbid obesity presents a challenge in several aspects. Background Cobb angle measurement is a standard method for quantification of scoliosis in patients with adolescent idiopathic scoliosis (AIS). [Extracted from the article]

Background: Over the past decade, revelations of inappropriate financial relationships between surgeons and surgical device manufacturers have challenged the presumption that surgeons can collaborate with surgical device manufacturers without damaging [...]

Background Supracondylar humerus (SCH) fractures are the most common operatively treated paediatric fracture in Canada. Previous literature describing the low-energy (Gartland type II) subtype reports varying complication rates from a variety of practice settings. We sought to examine complications of type II SCH fractures treated at a Canadian specialized paediatric centre. Methods We conducted a retrospective cohort study of patients aged 0 to 14 admitted to SickKids, Toronto, Ontario for surgical treatment of a type II SCH fracture from 2008 to 2015. The primary outcome of this study was relevant perioperative complications including: open fracture, compartment syndrome, pre- and postoperative vascular compromise, pre- and postoperative neurological compromise, failure to obtain a closed reduction (i.e., open reduction), postoperative infection, and reoperation within 3 months. Results There were 370 patients included in the study with mean (standard deviation) age 5.14 years (±2.51). The overall rate of relevant complications in the study cohort was 3.6% (13/358, 12 missing), with 12 cases of nerve palsy (3.3%; 2 iatrogenic [0.6%]) that resolved by final follow-up and one case of preoperative nerve palsy (0.3%) that did not. Importantly, there were no cases of vascular compromise, open fracture, compartment syndrome, or infection. Discussion and conclusion Complications associated with type II SCH fractures managed at a specialized paediatric centre that result in long-term morbidity are extremely rare (0.3%). Perioperative inpatient monitoring for patients with these fractures may not be justified based on these data. Prospective studies are required to confirm safety, evaluate patient perspectives, and demonstrate cost savings of outpatient surgical management. [ABSTRACT FROM AUTHOR]

Background: The surgical anatomy of upper-extremity peripheral nerves in adults has been well described as "safe zones" or specific distances from osseous landmarks. In pediatrics, relationships between nerves and osseous landmarks remain ambiguous. The goal of our study was to develop a model to accurately predict the location of the radial and axillary nerves in children to avoid iatrogenic injury when approaching the humerus in this population.Methods: We conducted a retrospective review of 116 magnetic resonance imaging (MRI) scans of entire humeri of skeletally immature patients; 53 of these studies met our inclusion criteria. Two independent observers reviewed all scans. Arm length was measured as the distance between the lateral aspect of the acromion and the lateral epicondyle. We then calculated the distances (defined as the percentage of arm length) between the radial nerve and distal osseous landmarks (the medial epicondyle, transepicondylar line, and lateral epicondyle) as well between the axillary nerve and the most lateral aspect of the acromion.Results: The axillary nerve was identified at a distance equaling 18.6% (95% confidence interval [CI], ±0.62%) of arm length inferior to the lateral edge of the acromion. The radial nerve crossed (1) the medial cortex of the posterior part of the humerus at a distance equaling 63.19% (95% CI: ±0.942%) of arm length proximal to the medial epicondyle, (2) the middle of the posterior part of the humerus at a distance equaling 53.9% (95% CI: ±1.08%) of arm length proximal to the transepicondylar line, (3) the lateral cortex of the posterior part of the humerus at a distance equaling 45% (95% CI: ±0.99%) of arm length proximal to the lateral epicondyle, and (4) from the posterior to the anterior compartment at a distance equaling 35.3% (95% CI: ±0.92%) of arm length proximal to the lateral epicondyle. A strong linear relationship between these distances and arm length was observed, with an intraclass correlation coefficient of >0.9 across all measurements.Conclusions: The positions of the radial and axillary nerves maintain linear relationships with arm lengths in growing children. The locations of these nerves in relation to palpable osseous landmarks are predictable.Clinical Relevance: Knowing the locations of upper-extremity peripheral nerves as a proportion of arm length in skeletally immature patients may help to avoid iatrogenic injuries during surgical approaches to the humerus. [ABSTRACT FROM AUTHOR]