A Novel Approach to Upper Pole Correction in Otoplasty: Addressing the Surprisingly Neglected Inferior Crus.

Timing of Renal Replacement Therapy Initiation in Acute Renal Failure: A Meta-analysis

Outcome variation following surgery for nasal polyposis

Category:AnkleIntroduction/Purpose:Metal screw fixation remains a common and effective way to repair syndesmotic injuries. They are inexpensive, familiar, and provide superior torsional resistance to sagittal translation compared to other fixation modalities. Symptomatic screw breakage is one of the most common complications of metal screw fixation. Routine removal remains unsupported by literature. Consequently, many patients retain broken screws and are at risk for pain; particularly when the breakage occurs within the tibia or the fibula. The purpose of this study is to analyze outcomes of patients with intact syndesmosis screws and those with syndesmosis screw breakage.Methods:A total of 176 patients (260 screws) with syndesmotic disruption treated with syndesmosis screw fixation were included in the study. Half of the patients had broken syndesmosis screws while the other half had intact syndesmosis screws. Basic patient demographic data was collected including BMI, age, and gender. Further collection of patient comorbidities was compiled using two comorbidity indices (Charlson, Elixhauser). Outcome analysis included revision rate, removal secondary to pain, complication rate, range of motion deficits, and patient pain scores. In patients who had their screws removed, further analysis was conducted to compare strength, range of motion deficits, complication rates, pain scores and revision rates between the intact and breakage group.Results:BMI averages of 33.64 (SD=8.77) and 30.64 (SD=6.76) were seen in breakage and intact group, respectively. A complication rate of 24.0% was seen the breakage group versus 36.1% in the control group. Revision rates of 12.4% and 20.10% were seen in the breakage and control group, respectively. Range of motion deficits were seen in 50.2% in the intact group and 39.7% in the breakage group (P = 0.2253). Removal secondary to pain occurred in 60.30% (n = 73) in the broken group compared to 24.5% (n = 34) in the control group. Decreased complication rate (P =.002), increased BMI (P = <.001), and increased risk of removal secondary to pain (P = <.001) were all associated with screw breakage. Following screw removal, no difference was seen in range of motion, pain scores (P =.003) and complications rates (P = 0.147) were higher in the intact group.Conclusion:Metal screw fixation remains a popular treatment of syndesmotic disruption. Many patients retain broken screws and intact screws which can be associated with future complications. Patients with syndesmosis screw breakage are a high comorbid population. Syndesmosis screw breakage is associated with decreased complication rates, increased BMI, and increased risk of eventual removal secondary to pain. Range of motion deficits were seen more commonly when in patients with intact syndesmosis screws. Additionally, revisions rates were higher in the intact group compared to the breakage group. Following screw removal, the intact group had a non-statistically significant increase in complication rate and range.

Background New and improved surgical techniques are warranted to treat osteoarthritis of the thumb carpometacarpal joint (CMC-1). The Pyrocardan implant yields striking results but only few series exist, making the evidence scarce. Purpose The aim of this study was to conduct a prospective series using the Pyrocardan implant. Methods We compared the outcomes to a matched historical control group of patients operated on with ligament reconstruction and tendon interposition. The hypothesis was that the Pyrocardan implant would yield better patient-reported outcomes as well as the procedure would be safe and effective in relieving symptoms of CMC-1 osteoarthritis. In total, 30 patients were included in the prospective series. These 30 patients were compared, in a 1:3 design, to a matched historical group. Results Results were promising with visual analogue scale scores of 0.7 (rest) and 2.1 (function), key-pinch score of 5.1 kg, and shortened Disability of the Arm, Shoulder, and Hand score of 14.3 after 1 year when using the Pyrocardan implant. The revision rate was 10%. We found no evidence of subsidence of the thumb. We found no differences in patient-reported outcomes between the two groups. Conclusions In conclusion, the Pyrocardan implant is a viable option in the treatment of CMC-1 osteoarthritis but with a significant revision rate. When comparing the Pyrocardan implant to a historical control group, we failed to find any differences in patient-reported outcomes. Level of Evidence IV - case series.

PurposeThe quadriceps tendon (QT) has recently gained increasing interest as an anterior cruciate ligament reconstruction (ACLR) graft due to minimally invasive harvesting techniques and low donor site morbidity. QT grafts can be used both with a patella bone block and as complete soft tissue grafts. However, it is unknown whether the QT graft type affects clinical outcomes. This study used data from the Danish Knee Ligament Reconstruction Registry (DKRR) to compare revision rates, knee stability and subjective clinical outcomes in patients who underwent ACLR with QT graft with bone block (QT‐B) or soft tissue only (QT‐S).MethodsPatients who underwent primary ACL reconstruction with QT autografts documented in the DKRR were included and divided into the QT‐B (n = 925) and QT‐S (n = 659) groups. The clinical outcome was evaluated using objective‐instrumented knee stability, pivot shift test, knee injury osteoarthritis outcome score (KOOS) and Tegner activity scores for the two cohorts performed at the 1‐year follow‐up. The overall revision rates were determined as well.ResultsRevision rates at 2 years were equally low in both graft groups at 2.8%. Similarly, post‐operative knee laxity was equal at 1.5 (1.4) and 1.6 (1.4) mm side‐to‐side laxity, respectively. However, QT‐B exhibited a reduced post‐operative positive pivot shift of 22% compared with 31% for QT‐S. Although the subjective outcomes were equal for the KOOS and Tegner activity scale scores at the 1‐year follow‐up, reduced improvements in KOOS were observed for QT‐B compared to QT‐S.ConclusionACL with a QT autograft harvested either with a bone block or as a soft tissue graft exhibited comparable revision rates and sagittal knee stability. Furthermore, ACL reconstruction using a QT graft with a bone block achieved better rotational stability with less pivot shift than ACL reconstruction using complete soft tissue QT grafts.Level of EvidenceLevel III.

Background: Anterior cruciate ligament (ACL) injuries are common in athletes, but their prevalence has also increased among adults. ACL reconstruction (ACLR) is a key treatment option, with graft choice playing a critical role in recovery. The study evaluates the clinical and functional outcomes of ACLR using the Ligament Augmentation and Reconstruction System (LARS) in patients over 35 years old. It assesses implant survival, failure rate, and revision rate, and measures quality of life and subjective outcomes. Methods: Fifty-three patients were finally included in this retrospective two-center study. The study assessed quality of life (QoL) and subjective outcomes using IKDC and Lysholm scores, evaluated implant survival and revision rates, and assessed the difference in activity levels between the two years before ACL injury and at follow-up. Results: The study found high Lysholm (90.61) and IKDC (80.25) scores, indicating positive clinical results. However, about 40% of patients did not return to their pre-injury activity levels. The graft failure rate was low at 3.8%, with no cases of infection or implant rejection. Conclusions: The study concluded that LARS ACLR is an effective option for middle-aged patients, offering faster recovery and fewer complications. However, it may not be suitable for younger, professional athletes due to its mechanical limitations. Further research with larger sample sizes and longer follow-up is recommended.

A Retrospective Comparison of Single-Bundle Anterior Cruciate Ligament Reconstruction With Lateral Extra-Articular Tenodesis With Double-Bundle Anterior Cruciate Ligament Reconstruction

Length of Stay, Discharge Disposition, and 90-Day Complications and Revisions Following Primary Total Hip Arthroplasty: A Comparison of the Direct Anterior, Posterolateral, and Direct Superior Approaches

Intracranial arachnoid cysts: What is the appropriate surgical technique? A retrospective comparative study with 61 pediatric patients

Primary reverse total shoulder arthroplasty for fractures requires more revisions than for degenerative conditions 1 year after surgery: an analysis from the Dutch Arthroplasty Register.

This 2024 update aims to compare the clinical outcomes, recurrence, and revision rates between simple decompression (SD) and subcutaneous anterior transposition (SAT) of the ulnar nerve for treating cubital tunnel syndrome (CuTS). A systematic review of articles from PubMed, Scopus, and Google Scholar was performed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We selected all English-language comparative studies published from January 2000 to June 2024, comparing SD and SAT concerning postoperative outcomes of surgical treatment for CuTS. Ten articles met the inclusion criteria. We found no statistical difference in the clinical outcomes of SD and SAT. Two studies indicated SD was superior to SAT. Four studies concluded that both techniques were equally effective for CuTS treatment. Three studies were inconclusive, and one study reported in situ decompression as inferior to SAT, with a high recurrence rate. As of 2025, the surgical approach to CuTS remains consistent with current practice. Both SD and SAT of the ulnar nerve continue to demonstrate good clinical outcomes. Although SD may be associated with higher rates of recurrences and revision surgeries, no clear superiority of one technique over the other has been established.

Background: Aggressive squamous cell carcinoma (SCC) of the head and neck presents a therapeutic challenge due to its high recurrence and progression rates. While radiotherapy is a standard postoperative treatment, the addition of concurrent chemotherapy may enhance outcomes by improving locoregional control and overall survival. Cetuximab, an epidermal growth factor receptor (EGFR) inhibitor, has demonstrated efficacy in enhancing the therapeutic response in head and neck cancers. Objective: To compare the efficacy and safety of concurrent radiotherapy and cetuximab chemotherapy with radiotherapy alone in the treatment of aggressive squamous cell carcinoma of the head and neck. Study Design: Retrospective comparative study. Setting: Oncology Department, Nishtar Hospital, Multan, Pakistan. Duration of Study: February 2023 to February 2025. Methods: A total of 200 adult patients with histologically confirmed aggressive head and neck squamous cell carcinoma who underwent surgical resection were included through consecutive sampling. Patients were divided into two groups: Group A (n=100) received concurrent radiotherapy (average dose: 60 Gy in 2–2.25 Gy fractions) and cetuximab chemotherapy (400 mg/m² initial dose followed by 250 mg/m² weekly), and Group B (n=100) received radiotherapy alone. Key outcomes included local and metastatic recurrence rates, progression-free survival (PFS), overall survival (OS), and treatment-related adverse events. Statistical analysis was performed using chi-square and t-tests, with p &lt; 0.05 considered statistically significant. Results: Local Non-Recurrence Rates: 1-year: 92% (Group A) vs. 94% (Group B); 2-year: 84% vs. 75%. Metastatic Non-Recurrence Rates: 1-year: 98% vs. 100%; 2-year: 94% vs. 89%. Progression-Free Survival: 1-year: 85% vs. 76%; 2-year: 73% vs. 55%. Overall Survival: 1-year: 99% (Group A) vs. 80% (Group B); 2-year: 79% vs. 74%. Adverse Events: Grade 3 dermatitis occurred in 15% of Group A and 30% of Group B patients. Conclusion: Concurrent radiotherapy with cetuximab chemotherapy demonstrated improved 2-year progression-free and overall survival in patients with aggressive head and neck squamous cell carcinoma compared to radiotherapy alone, with an acceptable safety profile. These findings support the use of combined modality treatment for better clinical outcomes.

Long-term results of shoulder resurfacing hemiarthroplasty: Poor functional outcomes in rotator cuff deficient patients

Background: Breast cancer is the most prevalent form of cancer in women worldwide and the second-leading cause of death from cancer in women. Because the estrogen receptor, progesterone receptor, and HER2 are not expressed, triple-negative breast cancer (TNBC) has an aggressive clinical history. The highest rates of recurrence and survival, higher average grades, and larger tumor sizes at diagnosis are all characteristics of TNBC. Objective: To compare between breast conserving surgery (BCS) and mastectomy patients with early stage Triple negative breast cancer (TNBC). Materials and Methods: We conducted a comparative retrospective monocentric study that evaluated TNBC patients treated with upfront surgery at CMH Dhaka, CMH Bogura and Kurmitola General Hospital, Dhaka. The observation period was from 1 January 2021 to 31 December 2022. All patients received biopsy to obtain the pathological tissue before treatment, and their immunohistochemical results met the diagnostic criteria for TNBC. Study patients divide din to two group 40 surgeries with primary site were categorized as receiving BCS and other hand 40 surgeries with categorized as receiving mastectomy. BCSS and OS were the primary outcomes of our study. Results: Tumor grade II, tumor size &gt;20.0 mm and lymph node 2 were significantly associated with breast cancer-specific survival. Tumor size &gt;20.0 mm and lymph node 2 were significantly associated with TNBC survival. Conclusion: TNBC is a breast cancer type that is aggressive and has a bad prognosis. With regard to breast cancer-specific survival, advanced age, being single, left side of laterality, tumor grades II and III, large tumor size, and lymph node 2 were all substantially related.

Retrospective comparative study. This study aimed to determine whether the degree of preoperative gait disturbance remains following surgical resection in patients with intradural extramedullary spinal cord tumors (IDEMSCTs), and to investigate any factors that may influence poor improvement in postoperative gait disturbance. The single institution in Japan. In total, 78 IDEMSCTs patients who required surgical excision between 2010 and 2019 were included. According to the degree of preoperative gait disturbance using modified McCormick scale (MMCS) grade, they were divided into the Mild and Severe groups. The mean postoperative follow-up period was 50.7 ± 17.9 months. Data on demographic and surgical characteristics were compared between the two groups. There was no significant difference in terms of age at surgery, sex, tumor size, surgical time, estimated blood loss, tumor histopathology, and postoperative follow-up period between the Mild and Severe groups. At the final follow-up, 84.6% of IDEMSCTs patients were able to walk without support. Gait disturbance improved after surgery in most of the patients with preoperative MMCS grades II-IV, but remained in approximately half of patients with preoperative MMCS grade V. Age at surgery was correlated with poor improvement in postoperative gait disturbance in the Severe group. Regardless of the degree of preoperative gait disturbance, it improved after tumor resection in most of the IDEMSCTs patients. However, in the preoperative MMCS grade III-V cases, older age at surgery would be an important factor associated with poor improvement in postoperative gait disturbance.