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Background: Socioeconomic status (SES) has been shown to influence the outcomes of surgical pathologies in areas with unequal access to health care. The purpose of this study was to measure the effect of SES on the urgency for inguinal hernia repair in an area with purported equitable access to health care in the context of a universal health care system. Methods: We included all adult patients who underwent surgical management of an inguinal hernia between 2012 and 2016 at 2 urban academic centres. We measured the SES using the Vancouver Area Neighbourhood Deprivation Index (VANDIX) score. Results: We included 2336 patients: 98 emergency surgery and 294 elective surgery cases. We matched patients without replacement on age, sex and American Society of Anesthesiology score, using optimized propensity score matching at a ratio of 1 case to 3 controls. We found no significant correlation between lower SES and emergency surgical management (p = 0.122). Secondary analysis assessed the impact of SES on morbidity and length of stay. We found no significant difference in the rate of complications, length of stay and recurrence by SES category. Patients from lower SES brackets had increased odds for readmission (odds ratio 1.979; 95% confidence interval 1.111-4.318). Conclusion: We found no correlation between a low SES and the need for emergency inguinal hernia repair, but found an increased rate of readmission in patients from lower SES brackets. This finding should be further scrutinized through a deeper dive into the barriers to access to nonacute care settings, such as home care. Contexte : Il a ete demontre que le statut socioeconomique (SSE) influe sur l'issue des maladies operables dans les regions ou on note un a[alpha]ces inequitable aux soins de sante. Cette etude avait pour but de mesurer l'effet du SSE sur l'urgence attachee aux reparations de hernie inguinale dans une region ou l'acces aux soins de sante est presume equitable en vertu du regime public de sante universel. Methodes : Nous avons inclus tous les patients adultes ayant subi une reparation chirurgicale de hernie inguinale entre 2012 et 2016 dans 2 centres universitaires urbains. Nous avons mesure le SSE a l'aide de l'indice VANDIX (Vancouver Area Neighbourhood Deprivation Index). Resultats : Nous avons inclus 2336 patients : 98 cas urgents et 294 cas non urgents. Nous avons procede a un appariement des patients sans remplacement selon l'age, le sexe et le score de l'American Society of Anesthesiology, par appariement optimise des coefficients de propension selon un rapport 1 cas:3 temoins. Nous n'avons observe aucune correlation significative entre un statut SSE plus defavorable et une prise en charge chirurgicale urgente (p = 0,122). L'analyse secondaire a permis d'evaluer l'impact du SSE sur la morbidite et la duree de l'hospitalisation. Nous n'avons note aucune difference significative pour ce qui est du taux de complications, de la duree du sejour et de la recurrence en fonction de la categorie de SSE. Les patients provenant de milieux plus defavorises presentaient un risque superieur de readmission (rapport des cotes 1,979; intervalle de confiance 1,111-4,318). Conclusion: Nous n'avons etabli aucune correlation entre un SSE faible et la necessite d'une reparation urgente des hernies inguinales, mais nous avons constate une hausse des taux de readmission chez les patients de milieux plus defavorises. Cette observation merite d'etre exploree plus en profondeur au plan des obstacles a l'acces aux services de soins non urgents, comme les soins a domicile., Inguinal hernias are commonly treated conditions in general surgery, with more than 20 million inguinal hernia repairs done per year worldwide. (1) Although the all-cause mortality rate of inguinal hernia [...]

Background: Unstable fractures of the distal radius fractures (DRFs) may result in malunion, usually consisting of subsequent shortening and angular deviations. Ulnar shortening osteotomy (USO) is assumed to be a simpler procedure than radial correction osteotomy, resulting in fewer complications and comparable outcomes. The aim of this study was to identify the best surgical technique to perform USO to restore distal radioulnar joint congruency after DRF malunion. Methods: A systematic review of the literature is performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines in February 2022 to identify studies reporting outcomes and surgical technique for isolated USO. The primary outcome was complication rates. Secondary outcomes included functional, radiologic, and patient-rated outcomes. The methodological index for nonrandomized studies criteria were used to assess the quality of evidence. Results: Included were 12 cohorts (185 participants). Due to substantial heterogeneity, a meta-analysis could not be performed. The overall complication rate was 33% (95% confidence interval, 16% to 51%). The most reported complication was implant irritation (22%), often requiring removal of the implant (13%). Only 3% nonunions were mentioned. Functional and patient-rated outcomes improved in most patients after USO. Quality of evidence of the papers was low to very low. Common methodological flaws were related to retrospective research. Conclusion: No evident differences in complication rates and functional outcomes between the surgical techniques were observed. Based on this literature, most complications are related to implant irritation. Nonunion and infection rates were rare. Therefore, a surgical technique with a buried implant might be preferred. This hypothesis requires further investigation. [ABSTRACT FROM AUTHOR]

Trauma and orthopedic surgery commonly rely on intraoperative radiography or fluoroscopy, which are essential for visualizing patient anatomy and safely completing surgical procedures. However, these imaging methods generate ionizing radiation, which in high doses carries a potential health risk to patients and operating personnel. There is an established need for formal training in obtaining precise intraoperative imaging while minimizing radiation exposure. Virtual reality (VR) simulation serves as a promising tool for orthopaedic trainees to develop skills in safe intraoperative imaging, without posing harm to patients, operating room staff, or themselves. This paper aims to provide a brief overview of literature surrounding VR training for intraoperative imaging in orthopaedic surgery. In addition, we discuss areas for improvement and future directions for development in the field. [ABSTRACT FROM AUTHOR]

Background: Most of the literature on emergency general surgery (EGS) has investigated appendiceal and biliary disease; however, EGS surgeons manage many other complex conditions. This study aimed to describe the operative burden of these conditions throughout Canada. Methods: This multicentre retrospective cohort study evaluated EGS patients at 7 centres across Canada in 2014. Adult patients (aged > 18 yr) undergoing nonelective operative interventions for nonbiliary, nonappendiceal diseases were included. Data collected included information on patients' demographic characteristics, diagnosis, procedure details, complications and hospital length of stay. Logistic regression was used to identify predictors of morbidity and mortality. Results: A total of 2595 patients were included, with a median age of 60 years (interquartile range 46-73 yr). The most common principal diagnoses were small bowel obstruction (16%), hernia (15%), malignancy (11 %) and perianal disease (9%). The most commonly performed procedures were bowel resection (30%), hernia repair (15%), adhesiolysis (11%) and debridement of skin and soft tissue infections (10%). A total of 47% of cases were completed overnight (between 5 pm and 8 am). The overall in-hospital mortality rate was 8%. Thirty-three percent of patients had a complication, with independent predictors including increasing age (p = 0.001), increasing American Society of Anesthesiologists score (p = 0.02) and transfer from another centre (p = 0.001). Conclusion: This study characterizes the epidemiology of nonbiliary, nonappendiceal EGS operative interventions across Canada. Canadian surgeons are performing a large volume of EGS, and conditions treated by EGS services are associated with a substantial risk of morbidity and mortality. Results of this study will be used to guide future research efforts and set benchmarks for quality improvement. Contexte : La plupart des etudes sur les services de chirurgie generate d'urgence (CGU) s'interessent seulement aux atteintes de l'appendice et de la vesicule biliaire. Pourtant, les chirurgiens du domaine traitent beaucoup d'autres problemes complexes. L'objectif de Petude etait de decrire le travail chirurgical associe a ces problemes dans l'ensemble du Canada. Methodes : Notre etude de cohorte retrospective multicentrique inclut les patients adultes ([greater than or equal to] 18 ans) qui ont subi en 2014 une operation non planifiee pour une atteinte qui ne touchait ni l'appendice ni la vesicule biliaire dans 1 des 7 centres selectionnes, repartis un peu part out au pays. Nous avons recueilli les donnees suivantes : renseignements de base des patients, diagnostic, details de l'intervention, nature des complications et duree d'hospitalisation. Puis nous avons degage les facteurs predictifs de morbidite et de mortalite en appliquant un modele de regression logistique. Resultats : L'echantillon totalisait 2595 patients, pour un age median de 60 ans (ecart interquartile 46-73 ans). Les diagnostics principaux les plus courants etaient l'occlusion de l'intestin grele (16%), la hernie (15 %), la tumeur maligne (11 %) et les lesions perianales (9%). Les interventions les plus frequentes etaient la resection de l'intestin (30%), la reparation d'une hernie (15%), le debridement (11 %) et le debridement de tissus mous ou cutanes infectes (10 %). L'operation a eu lieu le soir ou la nuit (entre 17 h et 8 h) dans 47 % des cas. Le taux global de mortalite a l'hopital etait de 8 %. Des complications sont survenues chez 33% des patients, dont les facteurs predictifs independants etaient Page avance (p = 0,001), un score ASA (de l'American Society of Anesthesiologists) eleve (p = 0,02) et le transfert a partir d'un autre centre (p = 0,001). Conclusion : Cette etude dresse le profil epidemiologique des interventions effectuees par les services de CGU du Canada en presence d'atteintes autres que celles de l'appendice et de la vesicule biliaire. Les chirurgiens du pays font beaucoup d'interventions generates urgent es, pour traiter des affections associees a un risque eleve de morbidite et de mortalite. Les resultats de Petude guideront les prochaines recherches et serviront de points de reference en matiere d'amelioration de la qualite., Emergency general surgery (EGS) is associated with a tremendous burden of disease. In the United States, EGS admissions represent 7% of all hospital admissions, and in 2010 they cost the [...]

Background: Our objective was to establish a sustainable educational partnership and clinical exchange between the trauma services at Vancouver General Hospital (VGH) and the Mexican Red Cross hospital in Mexico City (Hospital Central de la Cruz Roja [HCCR] Polanco). Methods: In 2017, a general surgery resident in postgraduate year 4 travelled from VGH to HCCR Polanco for the initial exchange, followed by a trauma fellow. The surgical case volumes in a month at VGH and a month at HCCR Polanco were compared. At the end of the exchange, a 36-item Likert style questionnaire was administered to the Mexican surgeons and residents who interacted with the Canadian resident and fellow during the exchange. Results: The most commonly performed procedures on the VGH acute care surgery service were laparoscopic cholecystectomy (35%) and laparoscopic appendectomy (17%). The most commonly performed procedures on the VGH trauma service were chest tube insertions (24%) and tracheostomies (24%). The most commonly performed procedures at HCCR Polanco were surgery for penetrating abdominal trauma (19%) and extremity trauma (13%). The survey results indicated that the costs of travel and accommodation were obstacles to future exchanges. All survey respondents wanted to continue collaborating with Canadians on clinical and research endeavours, felt that hosting Canadian residents was a valuable experience and felt that visiting VGH would also be valuable. Conclusion: Canadian surgical trainees gained valuable exposure to operative trauma during the exchange. The mix of operations performed at VGH and HCCR Polanco was vastly different; therefore, the exchange broadened the trainees' surgical experience. There was a unanimously positive response to the exchange among the Mexican survey respondents. This exchange is part of a long-term collaboration between our surgical centres. Contexte : Notre objectif était d'établir un partenariat pédagogique et un échange clinique durables entre les services de traumatologie de l'Hôpital général de Vancouver (VGH) et de l'hôpital de la Croix-Rouge mexicaine à Mexico (Hospital Central de la Cruz Roja [HCCR] Polanco). Méthodes : En 2017, un résident R4 en chirurgie générale du VGH s'est rendu au HCCR Polanco pour l'échange inaugural; un fellow en traumatologie l'a suivi peu après. Les volumes de cas de chirurgie par mois dans les 2 hôpitaux ont été comparés. À la fin de l'échange, les chirurgiens et les résidents mexicains qui ont interagi avec le résident et le fellow canadiens ont répondu à un questionnaire en 36 points s'apparentant à l'échelle de Likert. Résultats : Les interventions les plus fréquemment effectuées au service chirurgical d'urgence du VGH étaient la cholécystectomie laparoscopique (3 5 %) et l'appendicectomie laparoscopique (17 %); au service de traumatologie, les plus fréquentes étaient l'insertion d'un drain thoracique (24 %) et la trachéotomie (24 %). Au HCCR Polanco, les interventions chirurgicales les plus courantes étaient la chirurgie pour un traumatisme abdominal pénétrant (19 %) et un traumatisme aux extrémités (13 %). Les résultats du questionnaire suggèrent que les coûts associés aux déplacements et à l'hébergement seraient un obstacle pour les échanges futurs. Cela dit, tous les répondants ont dit vouloir poursuivre leur collaboration avec les Canadiens dans des projets cliniques et de recherche, considérer que l'accueil de résidents canadiens était une expérience profitable et qu'ils gagneraient à se rendre eux-mêmes au VGH. Conclusion : Durant l'échange, les chirurgiens en formation canadiens ont reçu une exposition précieuse à la chirurgie traumatologique. Puisque la nature et la fréquence relative des opérations effectuées au VGH étaient très différentes de celles observées au HCCR Polanco, l'échange a contribué à diversifier l'expérience chirurgicale des apprenants. Tous les répondants mexicains au questionnaire avaient une expérience positive de l'échange. Le programme fait partie d'une collaboration à long terme entre les 2 centres chirurgicaux., Participation in international clinical électives by medical and surgical trainees has doubled over the past decade. (1-4) Clinical electives abroad are opportunities to promote cross-cultural collaboration while improving trainees' communication [...]

Background: Determining accurate intraoperative screw length in complex distal radius fractures may pose difficulties. With volar plate fixation, excessive screw length may result in extensor pollicis longus injury and this can be challenging to determine via intraoperative imaging. This study aims to identify the precise anatomic location and parameters of Lister's tubercle on the dorsal aspect of the radius., Methods: The anatomy and location of Lister's tubercle was evaluated in 26 cadaveric arms, of which 27% were female, with a mean age of 73.6 years. Additionally, Lister's tubercle was evaluated on 198 computed tomography (CT) scans using a quantitative distal radius surface map. Median age was 28 years, and 28% of the patients were female., Results: As measured in cadaveric arms, the mean Lister's tubercle length was 12.6 mm, and width was 5.4 mm. The distance from the radial styloid to the distal and proximal border of Lister's tubercle averaged 23.0 and 10.4 mm, respectively. Of the total distal radial width, Lister's tubercle begins 43% from the radial border and spans to 42% of the ulnar border, encompassing 16% of the entire width of the dorsal distal radius. On CT mapping, the distance between the peak of Lister's tubercle and the ulnar and radial border of the radius was 46% and 54%, respectively. Female sex was associated with a smaller distal radius width, but not with a smaller Lister's tubercle., Conclusions: Knowledge of Lister's tubercle anatomy may assist in more precise screw placement in volar locked plating of distal radius fractures., Level of Evidence: IV-Therapeutic., Competing Interests: Declaration of Conflicting InterestsThe authors declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: This work was in part supported by the Jesse B. Jupiter Research Fund/Wyss Medical Foundation. CL, FR, HK, DW and JP have nothing to disclose. NC is a consultant for Biedermann Motech. KE is a consultant for Axogen Inc, Integra Lifesciences Corporation, Checkpoint Surgical Inc, and Tulavi Therapeutics Inc, Tissium, and BioCircuit.

This retrospective cohort study evaluates the concordance between Soong grades classified from radiographs and computed tomography (CT) scans and whether a Soong grade ≥1 is associated with flexor pollicis longus (FPL) injury and reoperation incidence. We included 181 patients with 185 dorsally displaced distal radial fractures treated with anterior locking plates. For the analysis of binary Soong grades, grade 0 was compared with grades 1 and 2. A moderate correlation was found between Soong grades on radiographs and CT scans (MCC 0.66). FPL injury occurred in 3% (6/185) and reoperation in 15% (28/185) of cases. There was no statistically significant difference between Soong grades when correlated with the incidence of FPL injury or reoperation, but no patients with a Soong grade 0 had an FPL injury. Binary Soong grading is non-inferior in predictive value and has a better correlation between radiographs and CT scans. Using the Soong classification as a binary system may be easier than a ternary system in clinical practice. Level of evidence: IV., Competing Interests: Declaration of conflicting interestsThe authors declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: AFDO and JBJ are affiliated with the ICUC library. AFDO has a Royal Agreement with Depuy Synthes. JBJ is a consultant at the AO Foundation and TriMed; he also provides research support to the AO Foundation, Materialize Textbook and Elsevier. ARB is a consultant for Synthes/Trimed.

Purpose: This study aimed to evaluate the incidence of, and factors associated with, reoperation after distal radius nonunion repair., Methods: We conducted a retrospective cohort study at a multicenter academic institution and identified adult patients who underwent open reduction and internal fixation for distal radius nonunion between January 2005 and August 2021. Thirty-three patients were included in this study. The cohort consisted of 13 males (13/33) and had a median age of 56 years (interquartile ranges: 49-64). Median follow-up was 59 months (interquartile ranges: 23-126)., Results: Unplanned reoperations occurred in eight of 33 patients. The most common reasons for reoperation were irrigation and debridement for infection, revision surgery for persistent nonunion, and unplanned hardware removal. In total, 10 complications occurred in nine patients. The most common complications were infection and persistent nonunion; both occurred in three cases., Conclusions: Complications after distal radius nonunion repair are common. Reoperation after distal radius nonunion repair is required in approximately one of four cases., Type of Study/level of Evidence: Prognosis IV., Competing Interests: Conflicts of Interest No benefits in any form have been received or will be received related directly to this article., (Copyright © 2024 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.)