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Choi JY, Yu OJ, Suh JS. A Novel Technique of Medial Displacement Calcaneal Osteotomy Using the Intramedullary Fixation of a Conventional Low-Profile Locking Wedge Plate. Foot Ankle Int 2024; 45:506-516. [PMID: 38389308 DOI: 10.1177/10711007241230990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/24/2024]
Abstract
BACKGROUND Postoperative heel pain arising from prominent screw heads is a common complication following medial displacement calcaneal osteotomy (MDCO). This study aims to present the clinicoradiographic outcomes of a novel MDCO technique, wherein intramedullary fixation of a conventional low-profile locking wedge plate is employed. METHODS A retrospective analysis, involving a comparison of clinical and radiographic parameters among consecutive patients who underwent MDCO was conducted. The patients were subjected to either intramedullary wedge plate fixation through the osteotomy site (IWPF group, n = 45 cases) or conventional cannulated screw fixation from the heel (CCSF group, n = 51 cases). Radiographic evaluation included measurement of hindfoot alignment angle, alignment ratio, and moment arm. Clinical outcomes were measured with the American Orthopaedic Foot & Ankle Society ankle-hindfoot score, and the Foot and Ankle Ability Measure (FAAM) activities of daily living and sports subscales, before and at 6, 12, and ≥24 months postoperatively. The presence of heel pain was evaluated at the postoperative 6 and 12 months in both groups. RESULTS For both groups, a marked enhancement in all 3 radiographic parameters was observed. The extent of correction for all clinicoradiographic parameters demonstrated no statistically significant divergence between the 2 groups. However, the FAAM-Sports scores at the 6-month postoperative juncture exhibited a significant elevation in the IWPF group relative to the CCSF group. Importantly, no patient reported heel pain at postoperative 6 and 12 months in the IWPF group whereas the rates of patients having heel pain at postoperative 6 and 12 months were 56.8% (29 cases) and 33.3% (17 cases), respectively, in the CCSF group. CONCLUSION Both techniques yield analogous postoperative clinical and radiographic enhancements. However, the utilization of IWPF promotes a swifter clinical improvement with respect to sports activities when juxtaposed with the CCSF from the calcaneal tuberosity. LEVEL OF EVIDENCE Level III, retrospective comparative study.
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Affiliation(s)
- Jun Young Choi
- Department of Orthopedic Surgery, Inje University, Ilsan Paik Hospital, Goyang-si, Gyeonggi-do, South Korea
| | - Oh Jun Yu
- Department of Orthopedic Surgery, Inje University, Ilsan Paik Hospital, Goyang-si, Gyeonggi-do, South Korea
| | - Jin Soo Suh
- Department of Orthopedic Surgery, Inje University, Ilsan Paik Hospital, Goyang-si, Gyeonggi-do, South Korea
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Abbot H, George AR, McCarron L, Graham DJ, Sivakumar B. Intramedullary Screw Fixation of Proximal Phalangeal Fractures: Short- to Medium-term Outcomes. Hand (N Y) 2024:15589447241235339. [PMID: 38491777 DOI: 10.1177/15589447241235339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/18/2024]
Abstract
BACKGROUND Intramedullary screw fixation of phalangeal and metacarpal fractures has gained popularity as a method of providing rigid internal fixation with minimum tendon disturbance, allowing early mobilization and rehabilitation. Despite this, the literature on outcomes using this technique is limited. Thus, the aim of this study was to assess the short-term to medium-term outcomes of intramedullary screw fixation for proximal phalangeal fracture fixation in an Australian setting. METHODS A retrospective analysis of consecutive patients with a fracture(s) of the proximal phalanx fixated using intramedullary screws between January 2020 and March 2023 was conducted via telehealth. RESULTS Forty-six phalangeal fractures from 37 patients were included in this study. Mean Quick Disabilities of the Arm, Shoulder, and Hand score of 6.2 (range: 0-61.4, median: 0), mean pain visual analogue scale score of 1.8 (range: 1-7, median: 1), and mean total active motion of 231° (range: 132-282) were noted. A total of 4.4% of fractures sustained a major complication, and 94.6% of patients reported willingness to undergo intramedullary screw fixation again. CONCLUSION This study concurs with the prior literature that intramedullary screw fixation is a safe and effective method of stabilizing extra-articular proximal phalangeal fractures in the short to medium term. Superior clinical outcomes, as well as cost-effectiveness and time-effectiveness, render it a viable alternative to plate fixation in this setting.
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Affiliation(s)
- Hagen Abbot
- Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
| | - Adam R George
- Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
| | - Luke McCarron
- Department of Musculoskeletal Services, Gold Coast University Hospital, Southport, QLD, Australia
| | - David J Graham
- Department of Musculoskeletal Services, Gold Coast University Hospital, Southport, QLD, Australia
- Australian Research Collaboration on Hands (ARCH), Mudgeeraba, QLD, Australia
- School of Medicine and Dentistry, Griffith University, Southport, QLD, Australia
- Department of Orthopaedic Surgery, Queensland Children's Hospital, Brisbane, Australia
- School of Medicine, University of Queensland, Herston, Australia
| | - Brahman Sivakumar
- Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
- Australian Research Collaboration on Hands (ARCH), Mudgeeraba, QLD, Australia
- Department of Hand and Peripheral Nerve Surgery, Royal North Shore Hospital, St Leonards, NSW, Australia
- Department of Orthopaedic Surgery, Hornsby Ku-Ring-Gai Hospital, Hornsby, NSW, Australia
- Department of Orthopaedic Surgery, Nepean Hospital, Kingswood, NSW, Australia
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Maldonado-Pérez A, Estronza S, Maldonado HJ, Pastrana EA, De Jesus O. Cervical Intramedullary Spinal Cord Abscess Secondary to Discitis and Osteomyelitis in an Immunocompromised Patient. Cureus 2024; 16:e56477. [PMID: 38638746 PMCID: PMC11025874 DOI: 10.7759/cureus.56477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/19/2024] [Indexed: 04/20/2024] Open
Abstract
Intramedullary spinal cord abscess is a rare neurological condition, not commonly suspected and often misdiagnosed. Even after a prompt diagnosis and treatment, most patients persist with permanent neurological deficits. In adults, factors such as immunocompromised, intravenous drug use, endocarditis, and sepsis could be associated with its development. In this study, we present the case of a 63-year-old male patient who developed a chronic cervical intramedullary spinal cord abscess after being treated for multiple abscesses in the paravertebral and psoas muscles. A diagnosis of cervical intramedullary spinal cord abscess secondary to osteomyelitis and discitis was made. He underwent a two-stage cervical surgery, with drainage of the abscess, spinal stabilization, and intravenous antibiotics. Although rare, vertebral osteomyelitis and discitis may be related to its development. Early diagnosis, prompt abscess drainage, and appropriate antibiotic therapy are of utmost importance to improve prognosis and minimize the long-term sequelae and complications of permanent neurological deficits.
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Affiliation(s)
| | - Samuel Estronza
- Neurosurgery, University of Puerto Rico, Medical Sciences Campus, San Juan, PRI
| | - Hiram J Maldonado
- Neurosurgery/Critical Care Medicine, University of Puerto Rico, Medical Sciences Campus, San Juan, PRI
| | - Emil A Pastrana
- Neurosurgery, University of Puerto Rico, Medical Sciences Campus, San Juan, PRI
| | - Orlando De Jesus
- Neurosurgery, University of Puerto Rico, Medical Sciences Campus, San Juan, PRI
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Guo S. Surgical treatment and outcome of haematomyelia with a traumatic cause in a dog and a cat. Vet Med Sci 2024; 10:e1377. [PMID: 38358058 PMCID: PMC10867873 DOI: 10.1002/vms3.1377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 01/09/2024] [Accepted: 01/29/2024] [Indexed: 02/16/2024] Open
Abstract
Two surgically treated haematomyelia cases were documented. One dog and one cat were presented for acute progressive paraplegia following a fall from height incident. Neurological examinations suggested a L4-S3 myelopathy in both cases. Radiography and magnetic resonance imaging in both cases revealed no fracture or subluxation of the spine, but well-defined intramedullary mass lesions in lower lumbar regions compatible with haemorrhage and haematoma formation. Exploratory surgeries were performed over the lesions. Dark-red friable masses were removed via myelotomy. Histopathological examinations revealed organizing haematomas at the acute to subacute stage. Postoperatively, both cases improved and regained ambulation. The dog walked normally but remained urinary and faecal incontinent 9 months after the surgery. The cat was continent and ambulatory with a paraparetic gait 5 months after the surgery. In both cases, the outcomes and the patients' quality of life were considered satisfactory by the owners.
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Hollins AW, Dunworth K, Mithani SK, Pidgeon TS, Klifto CS, Ruch DS, Richard MJ. Comparison Between Intramedullary Nail and Percutaneous Pin Fixation in Proximal Phalanx Fractures. Hand (N Y) 2024:15589447241232009. [PMID: 38411093 DOI: 10.1177/15589447241232009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/28/2024]
Abstract
BACKGROUND Percutaneous pinning has been the predominant technique for fixation of proximal phalanx fractures, but stiffness is a reported complication. The introduction of intramedullary (IM) nail fixation of proximal phalanx fractures provides a stronger biomechanical fixation for amenable fracture patterns with the added benefit of not tethering the soft tissue. The goal of this study was to compare the surgical outcomes of IM nail and percutaneous pin fixation in isolated proximal phalanx fractures. METHODS A retrospective review was performed at our institution between the years 2018 and 2022 for patients treated for proximal phalanx fractures. Patients that underwent fixation with IM nails or percutaneous fixation for isolated extraarticular proximal phalanx fractures were included. Patients were excluded if they had concomitant hand fractures, tendon injury, or intraarticular extension. RESULTS A total of 50 patients were included in this study. Twenty-eight patients received percutaneous pin fixation, and 22 patients underwent IM nail or screw fixation. There was no significant difference in injury patterns or demographics between these two groups. Patients that underwent IM nail fixation had a significantly quicker return to active motion, shorter duration of orthosis treatment, and fewer occupational therapy visits. In addition, patients in the IM fixation group had significantly improved range of motion (ROM) at 6 weeks postoperatively. CONCLUSIONS This study demonstrates that patients receiving percutaneous pin or IM nail fixation have equivocal union and complication rates. The IM nail fixation group was able to have quicker return to mobilization, fewer required occupational therapy visits, and improved early ROM.
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Affiliation(s)
- Andrew W Hollins
- Division of Hand Surgery, Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Kristina Dunworth
- Division of Hand Surgery, Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Suhail K Mithani
- Division of Hand Surgery, Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Tyler S Pidgeon
- Division of Hand Surgery, Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Christopher S Klifto
- Division of Hand Surgery, Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, USA
| | - David S Ruch
- Division of Hand Surgery, Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Marc J Richard
- Division of Hand Surgery, Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, USA
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George AR, Abbot H, McCarron L, Graham DJ, Sivakumar BS. Intramedullary Compression Screw Fixation for Middle Phalangeal Fractures. J Hand Surg Am 2024:S0363-5023(23)00690-1. [PMID: 38310510 DOI: 10.1016/j.jhsa.2023.12.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 12/04/2023] [Accepted: 12/13/2023] [Indexed: 02/05/2024]
Abstract
PURPOSE This study aimed to evaluate short- and medium-term clinical and patient-reported outcomes of intramedullary compression screw fixation for extra-articular middle phalangeal fractures. METHODS A retrospective study was performed on a series of 20 patients (with a total of 23 fractured digits) who underwent fixation of middle phalangeal fractures between January 2020 and March 2023. The results from this cohort were compared against those for plate and K-wire fixation in the literature. RESULTS Total active motion was 246°; Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) score was 4.9; verbal numerical pain score was 1.1 of 10; mean time for return to work was 62.5 days; and a single complication was noted in the entire cohort. CONCLUSION Intramedullary screw fixation is a viable option in the treatment of extra-articular middle phalangeal fractures. It offers a favorable postoperative range of motion, good duration for return to function, excellent rates of complication, and low pain scores. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
- Adam R George
- Faculty of Medicine and Health, Sydney Medical School, The University of Sydney, Camperdown, NSW, Australia.
| | - Hagen Abbot
- Faculty of Medicine and Health, Sydney Medical School, The University of Sydney, Camperdown, NSW, Australia
| | - Luke McCarron
- Department of Musculoskeletal Services, Gold Coast University Hospital, Southport, QLD, Australia
| | - David J Graham
- Department of Musculoskeletal Services, Gold Coast University Hospital, Southport, QLD, Australia; Griffith University School of Medicine and Dentistry, Southport, QLD, Australia; Department of Orthopaedic Surgery, Queensland Children's Hospital, South Brisbane, QLD, Australia; Australian Research Collaboration on Hands (ARCH), Mudgeeraba, QLD, Australia; School of Medicine, University of Queensland, Herston, QLD, Australia
| | - Brahman S Sivakumar
- Faculty of Medicine and Health, Sydney Medical School, The University of Sydney, Camperdown, NSW, Australia; Department of Hand & Peripheral Nerve Surgery, Royal North Shore Hospital, St Leonards, NSW, Australia; Australian Research Collaboration on Hands (ARCH), Mudgeeraba, QLD, Australia; Department of Orthopaedic Surgery, Hornsby Ku-ring-gai Hospital, Hornsby, NSW, Australia; Department of Orthopaedic Surgery, Nepean Hospital, Kingswood, NSW, Australia
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Hoelscher VS, Milhoan M, Quiring M, Fix K, Dalton S, Pientka WF. Outcomes and Complications of Intramedullary Metacarpal Fixation. Hand (N Y) 2024:15589447231222518. [PMID: 38180026 DOI: 10.1177/15589447231222518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2024]
Abstract
BACKGROUND Metacarpal fractures are common orthopedic injuries with potentially debilitating outcomes. Ideal surgical treatment remains a topic of debate, with intramedullary fixation becoming popular as a technique to allow for earlier mobilization with few reported complications. The aim of this study was to report observed outcomes and complications of intramedullary metacarpal fixation using the ExsoMed INnate metacarpal nail. METHODS A retrospective chart review of 37 patients with 44 metacarpals treated with the ExsoMed INnate between July 2020 and December 2021 by a single fellowship-trained hand surgeon at a single level 1 trauma center was performed. Variables recorded included both patient and injury demographics, surgical complications, and postoperative outcomes. We also measured metacarpal isthmus diameter of the second to fifth metacarpals on all patients to determine the intramedullary canal diameter to assist in implant size selection. RESULTS Average follow-up was 5.84 weeks with average time to radiographic healing of 5.5 weeks, and time to full activity 6.32 weeks. The mean postsurgical active total arc of motion was 250°, while passive total arc of motion was 259.74°. A total of 10 complications (22%) were identified, including 4 bent screws which occurred as a result of a punching event postoperatively. CONCLUSIONS Intramedullary fixation of metacarpal fractures using the ExsoMed INnate metacarpal nail has shown to preserve range of motion and quick return to full activity, with a low rate of major complications. Our study highlights the potential major complication of the bent intramedullary screw and its association with an initial punching mechanism.
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Affiliation(s)
| | | | - Mark Quiring
- The University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Kassidy Fix
- The University of North Texas Health Science Center, Fort Worth, TX, USA
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Beaumont CM, Beason DP, McKeon KE. Fracture Fixation Strength in Metacarpal Plating Versus Intramedullary Nailing Using a 3-Point Bending Model: A Cadaveric, Biomechanical Study. J Hand Surg Am 2024; 49:57.e1-57.e6. [PMID: 35803782 DOI: 10.1016/j.jhsa.2022.04.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 02/16/2022] [Accepted: 04/06/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of our study was to evaluate the ultimate load to failure for 2 metacarpal fracture fixation strategies, plating versus intramedullary nailing, and then compare them to the native metacarpal. Our hypothesis was that the intramedullary nail after fracture fixation would more closely restore the native strength of the metacarpal when compared to plate fixation. METHODS Matched pairs of cadaveric hands (age range, 19-49; 5 men and 6 women) were dissected to produce 88 intact and equally distributed metacarpals (little, ring, middle, and index fingers). The metacarpals were then randomly selected to undergo either plate fixation or intramedullary nail fixation. A 3-point bending model was used to test the native metacarpal strength to the point of fracture and, subsequently, the fracture fixation construct. The data were then compared against the native metacarpal for normalized load to failure, normalized displacement, and stiffness. RESULTS The normalized maximum force (ratio of fixation:native) for the intramedullary nail specimens was significantly closer to normal than for the plated specimens for the little, middle, and index fingers, as well as for all metacarpals combined. We did not detect a difference in maximum force for the ring finger. CONCLUSIONS When compared to plate fixation, metacarpal intramedullary nailing more closely restores the ultimate load to failure of the native metacarpal after midshaft fracture. CLINICAL RELEVANCE For metacarpal fracture patterns amenable to intramedullary screw fixation, an intramedullary nail has biomechanical properties that are superior to a plate and screws in a 3-point bending model.
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Amey JA, Liatis T, Cherubini GB, De Decker S, Foreman MH. Outcomes of surgically and conservatively managed thoracolumbar and lumbosacral intervertebral disc herniations in cats. J Vet Intern Med 2024; 38:247-257. [PMID: 38148600 PMCID: PMC10800212 DOI: 10.1111/jvim.16950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 11/10/2023] [Indexed: 12/28/2023] Open
Abstract
BACKGROUND Limited information is available regarding intervertebral disc herniation (IVDH) and its treatment in cats. OBJECTIVES Describe outcomes after surgical or conservative treatment of cats with thoracolumbar and lumbosacral IVDH. ANIMALS Ninety-two cats from 2 referral populations (2012-2022) with compressive IVDH between the T3 and S1 vertebrae. METHODS Retrospective cohort study evaluating outcomes of surgical (49 cats) and conservative (36 cats) management of IVDH; 7 cats were euthanized at diagnosis. Outcome was assessed using hospital and referring veterinarian records and client questionnaires. Successful outcome was defined as regained or improved ambulation, urinary and fecal continence, and no requirement for analgesic medication. RESULTS Incidence of IVDH during the study period was 0.44% (92/20849). Surgical treatment resulted in 62% (6 weeks) and 74% success (6 months). Conservative treatment resulted in 54% (6 weeks) and 65% success (6 months). Neurological grade at presentation was higher in cats treated surgically (median, 2; range, 1-5) than in those treated conservatively (median, 2; range, 0-4; P = .001). Regardless of treatment type, cats suffering trauma were more likely to have a successful outcome 6 weeks after treatment compared with those without history of trauma (odds ratio, 5.3; 95% confidence interval, 1.05-26.78; P = .04). Neurological deficits remained in the majority of cats for both treatment types (92%, conservative; 86%, surgical at 6 weeks). Acute-on-chronic IVDH with characteristics of both extrusion and protrusion were identified in 10% of cats. CONCLUSIONS AND CLINICAL IMPORTANCE Conservative treatment could be as effective as surgical decompression in cats with thoracolumbar or lumbosacral IVDH.
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Affiliation(s)
- Jack A. Amey
- Dick White ReferralsPart of Linnaeus Veterinary LimitedSix Mile BottomUK
| | | | - Giunio Bruto Cherubini
- Veterinary Teaching Hospital “Mario Modenato,” Department of Veterinary SciencesUniversity of PisaPisaItaly
| | | | - Max H. Foreman
- Dick White ReferralsPart of Linnaeus Veterinary LimitedSix Mile BottomUK
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Wagner F, Boeriu A, Eberz P, Weigert A, Holzapfel BM, Böcker W, Hubertus J, Muensterer O, Bergmann F, Ziegler CM. Intrainstitutional Changes of the Treatment of Supracondylar Humerus Fracture in Children over a Period of 9 Years. Children (Basel) 2023; 11:27. [PMID: 38255341 PMCID: PMC10814588 DOI: 10.3390/children11010027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Revised: 12/07/2023] [Accepted: 12/23/2023] [Indexed: 01/24/2024]
Abstract
To assess changes in treatment modalities for supracondylar humerus fractures (SCHFs) at a large pediatric university hospital, we analyzed patient data from 2014 to 2022. A total of 233 SCHFs treated surgically at our hospital were included. To evaluate postoperative outcome and quality of life, DASH and EuroQol-5D-Y questionnaires were sent to patients. In addition to a significant fluctuation in fracture severity, we found an increase in training interventions (more surgeries were performed by trainees) and a significant decrease in surgery times after 2016. From 2020, there was a significant shift in the type of surgical method away from closed reduction with elastic stable intramedullary nailing (ESIN) and towards closed reduction and crossed K-wire osteosynthesis (CRK). Surgeries performed in the morning and evening hours increased, while those performed in the afternoon and after midnight decreased. After a mean follow-up of 4 years, there was no difference in elbow function between ESIN and open reduction and K-wires (ORK). Treatment with ESIN was equivalent to ORK in terms of function, at least in the medium-term follow-up. In summary, the combination of shifting treatment from SCHF to daytime hours, increasing trainee participation and using cross K-wire fixation instead of ESIN had no negative impact on surgery times. In our setting, these measures have reduced resource utilization and increased efficiency without compromising patient care.
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Affiliation(s)
- Ferdinand Wagner
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), LMU University Hospital, Ludwig-Maximilians-Universität München, Marchioninistrasse 15, 81377 Munich, Germany (B.M.H.); (C.M.Z.)
- Institute of Health and Biomedical Innovation, Queensland University of Technology (QUT), Brisbane, QLD 4059, Australia
- Department of Pediatric Surgery, Dr. von Hauner Children’s Hospital, Ludwig-Maximilians-Universität München, Lindwurmstrasse 4, 80337 Munich, Germany; (J.H.); (O.M.)
| | - Amalia Boeriu
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), LMU University Hospital, Ludwig-Maximilians-Universität München, Marchioninistrasse 15, 81377 Munich, Germany (B.M.H.); (C.M.Z.)
| | - Pascal Eberz
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), LMU University Hospital, Ludwig-Maximilians-Universität München, Marchioninistrasse 15, 81377 Munich, Germany (B.M.H.); (C.M.Z.)
| | - Annabelle Weigert
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), LMU University Hospital, Ludwig-Maximilians-Universität München, Marchioninistrasse 15, 81377 Munich, Germany (B.M.H.); (C.M.Z.)
| | - Boris Michael Holzapfel
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), LMU University Hospital, Ludwig-Maximilians-Universität München, Marchioninistrasse 15, 81377 Munich, Germany (B.M.H.); (C.M.Z.)
| | - Wolfgang Böcker
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), LMU University Hospital, Ludwig-Maximilians-Universität München, Marchioninistrasse 15, 81377 Munich, Germany (B.M.H.); (C.M.Z.)
| | - Jochen Hubertus
- Department of Pediatric Surgery, Dr. von Hauner Children’s Hospital, Ludwig-Maximilians-Universität München, Lindwurmstrasse 4, 80337 Munich, Germany; (J.H.); (O.M.)
| | - Oliver Muensterer
- Department of Pediatric Surgery, Dr. von Hauner Children’s Hospital, Ludwig-Maximilians-Universität München, Lindwurmstrasse 4, 80337 Munich, Germany; (J.H.); (O.M.)
| | - Florian Bergmann
- Department of Pediatric Surgery, Dr. von Hauner Children’s Hospital, Ludwig-Maximilians-Universität München, Lindwurmstrasse 4, 80337 Munich, Germany; (J.H.); (O.M.)
| | - Christian Max Ziegler
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), LMU University Hospital, Ludwig-Maximilians-Universität München, Marchioninistrasse 15, 81377 Munich, Germany (B.M.H.); (C.M.Z.)
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Hurley ET, Wickman J, Crook BS, Cabell G, Rodriguez K, Boadi P, DeBaun MR, Pean C, Klifto C. Intramedullary nailing vs. open reduction-internal fixation for humeral shaft fractures: a meta-analysis of randomized controlled trials. J Shoulder Elbow Surg 2023; 32:2567-2574. [PMID: 37579941 DOI: 10.1016/j.jse.2023.07.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 06/23/2023] [Accepted: 07/10/2023] [Indexed: 08/16/2023]
Abstract
BACKGROUND The purpose of this study was to perform a meta-analysis of randomized controlled trials (RCTs) to compare outcomes following intramedullary nailing (IMN) vs. open reduction-internal fixation (ORIF) for humeral shaft fractures. METHODS A literature search of 3 databases was performed based on the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. RCTs comparing IMN and ORIF for humeral shaft fractures were included. Clinical outcomes were compared using RevMan. P < .05 was considered statistically significant. RESULTS Ten RCTs with 512 patients were included. Overall, 8.4% of patients treated with IMN and 6.4% of patients treated with ORIF had nonunion (P = .57, I2 = 0%), with a significantly faster time to union with IMN (10 weeks vs. 11.9 weeks, P < .05). There was no significant difference in the rate of reoperation (11.6% in IMN group vs. 7.6% in ORIF group, P = .26) or radial nerve palsy (2.8% in IMN group vs. 4.2% in ORIF group, P = .58). A lower rate of infection was noted with IMN (1.2% vs. 5.3%, P < .05). Additionally, there was a lower operative time with IMN (61 minutes vs. 88 minutes, P < .05). CONCLUSIONS The Level I evidence in the literature does not show a significant difference in rates of union, reoperation, or radial nerve palsy between IMN and ORIF for humeral shaft fractures. Overall, treatment with IMN results in a lower infection rate, less operative time, and a modestly quicker time to union. The optimal treatment strategy for humeral shaft fractures may be best informed by fracture pattern and surgeon preference.
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Affiliation(s)
- Eoghan T Hurley
- Department of Orthopedic Surgery, Duke University School of Medicine, Durham, NC, USA.
| | - John Wickman
- Department of Orthopedic Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Bryan S Crook
- Department of Orthopedic Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Grant Cabell
- Department of Orthopedic Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Kaitlyn Rodriguez
- Department of Orthopedic Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Prince Boadi
- Department of Orthopedic Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Malcolm R DeBaun
- Department of Orthopedic Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Christian Pean
- Department of Orthopedic Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Christopher Klifto
- Department of Orthopedic Surgery, Duke University School of Medicine, Durham, NC, USA
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12
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Wang G, Shen H, Chu Z, Shen J, Zhu KC. Benign cervical intramedullary cyst without an epithelial lining:a case report. Br J Neurosurg 2023; 37:1664-1666. [PMID: 34009086 DOI: 10.1080/02688697.2021.1927983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 05/06/2021] [Indexed: 10/21/2022]
Abstract
This paper presents a female, benign intramedullary cyst case aged 66-year-old. During the operation, it was found that the cystic wall was very thin, and the cystic fluid was colorless and transparent. The lesion with the capsule was removed partially. Surprisingly, there was no epithelial lining on the capsule wall. It is very rare and different from the benign intramedullary cysts reported in the literature.
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Affiliation(s)
- GengHuan Wang
- Neurosurgery, The Second Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - HePing Shen
- Neurology, The Second Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - ZhengMin Chu
- Neurosurgery, The Second Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - JianGuo Shen
- Neurosurgery, The Second Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - Kun Can Zhu
- Neurosurgery, The Second Affiliated Hospital of Jiaxing University, Jiaxing, China
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13
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Thomas TL, Kachooei AR, Ilyas AM. Intramedullary K-wires versus Alternate Techniques for Metacarpal Shaft and Neck Fractures: A Systematic Review and Meta-analysis. J Hand Microsurg 2023; 15:376-387. [PMID: 38152671 PMCID: PMC10751204 DOI: 10.1055/s-0042-1749410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
Intramedullary K-wire (IMKW) fixation is one of the mainstays for surgically treating metacarpal shaft and neck fractures. However, there remains a lack of literature comparing outcomes of the various available surgical repair techniques in all indicated metacarpals. Therefore, we conducted a systematic review and meta-analysis to investigate the clinical advantages and drawbacks of IMKW compared with alternate fracture repair techniques. A comprehensive systematic literature review was performed to identify studies that compared clinical outcomes of IMKW to alternate metacarpal fixation modalities. Outcomes included Disabilities of the Arm, Shoulder, and Hand (DASH/ quick DASH) scores, grip strength, union rate, visual analog scale pain, operative time, and complications. A random-effects model was used to compare IMKW to the pooled effect of other fixation techniques. A total of 10 studies were included in our analysis, comprising 497 metacarpal fractures (220 shafts and 277 necks). IMKW fixation was identified as the control group in all studies. The pooled experimental group included plates, transverse K-wires (TKWs), interfragmentary screws (IFSs), and K-wire cross-pinning (CP). In treating metacarpal shaft fractures, IMKW showed significantly shorter operative time ( p = 0.04; mean difference = - 13; 95% confidence interval = -26 to -0.64). No significant differences were observed in treating metacarpal neck fractures for disability, grip strength, healing rate, pain, operative time, or complication rate. This systematic review and meta-analysis found no difference in clinical outcomes among various surgical techniques for treating metacarpal shaft and neck fractures. Further high evidence studies are required that investigate the efficacy and safety of IFS, CP, TKW, and intramedullary screws versus IMKW for treating closed, unstable metacarpal fractures.
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Affiliation(s)
- Terence L. Thomas
- Department of Orthopaedics, Thomas Jefferson University, Philadelphia, Pennsylvania, United States
| | - Amir R. Kachooei
- Department of Hand and Wrist, Rothman Orthopedic Institute, Philadelphia, Pennsylvania, United States
| | - Asif M. Ilyas
- Department of Hand and Wrist, Rothman Orthopedic Institute, Philadelphia, Pennsylvania, United States
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14
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Laws MT, Arhin M, Ampie L, Chittiboina P. Dorsal cervical approach for recurrent intradural anaplastic ependymoma. Neurosurg Focus Video 2023; 9:V2. [PMID: 37854648 PMCID: PMC10580737 DOI: 10.3171/2023.6.focvid2396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 06/21/2023] [Indexed: 10/20/2023]
Abstract
The video demonstrates an operative approach to a recurrent cervical anaplastic ependymoma. MYCN-amplified anaplastic ependymomas are locally aggressive, recurrent, and have a high risk of iatrogenic injury. In this case, the patient presented with local, aggressive tumor expansion, arachnoid adhesions, and pial invasion ventral to the spinal cord. Subcapsular decompression minimized cord retraction from a dorsal approach. Removal of the tumor capsule was guided by bipolar stimulation paired with neuromonitoring. Local gross-total resection was achieved, and the patient had a postoperative improvement in his neurological deficits and myelopathy.
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Affiliation(s)
- Maxwell T. Laws
- Department of Surgical Neurology
- Neurosurgery Unit for Pituitary and Inheritable Diseases, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland
- Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia; and
| | - Martin Arhin
- Department of Surgical Neurology
- Neurosurgery Unit for Pituitary and Inheritable Diseases, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland
- University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Leonel Ampie
- Department of Surgical Neurology
- Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia; and
| | - Prashant Chittiboina
- Department of Surgical Neurology
- Neurosurgery Unit for Pituitary and Inheritable Diseases, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland
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15
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Kuricova M, Fuchs J, Liptak T, Korim F, Hudakova NS, Bhattarai B, Kerekes Z, Revajova V. Spinal cord haemangiosarcoma in one dog - Case report. VET MED-CZECH 2023; 68:412-418. [PMID: 38028208 PMCID: PMC10666659 DOI: 10.17221/60/2023-vetmed] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 10/10/2023] [Indexed: 12/01/2023] Open
Abstract
A 5-year-old intact female Shih Tzu was presented with acute onset of hind leg paralysis. The neurologic examination revealed severe T3-L3 myelopathy. The differential diagnoses included degenerative, anomalous, traumatic, inflammatory, vascular, metabolic, and neoplastic changes. The results of the paraclinical examinations and diagnostic imaging narrowed the list of differential diagnoses and, along with the patient's deteriorating condition, led to the owner's decision to euthanise the dog. The histologic findings of the spinal cord specimens indicated a tumour of the blood vessels formed by the proliferation of endothelial cells, which may present as either capillary or cavernous structures. In this case, the tumour was a capillary-type haemangiosarcoma. The primary site of proliferation could not be determined in this case because no mass formation was noted while performing the necropsy.
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Affiliation(s)
- Maria Kuricova
- Small Animal Clinic, University of Veterinary Medicine and Pharmacy in Kosice, Kosice, Slovak Republic
| | - Jakub Fuchs
- Small Animal Clinic, University of Veterinary Medicine and Pharmacy in Kosice, Kosice, Slovak Republic
| | - Tomas Liptak
- Small Animal Clinic, University of Veterinary Medicine and Pharmacy in Kosice, Kosice, Slovak Republic
| | - Filip Korim
- Department of Morphological Disciplines, University of Veterinary Medicine and Pharmacy in Kosice, Kosice, Slovak Republic
| | - Natalia Surin Hudakova
- Department of Microbiology and Immunology, University of Veterinary Medicine and Pharmacy in Kosice, Kosice, Slovak Republic
| | - Bisal Bhattarai
- Moscow State Academy of Veterinary Medicine and Biotechnology MVA named after K. I. Skryabin, Ulitsa Akademika Skryabina, Moscow, Russia
| | - Zoltan Kerekes
- Zoltan Kerekes, VetScan, Veterinary Imaging Center, Budapest, Hungary
| | - Viera Revajova
- Department of Morphological Disciplines, University of Veterinary Medicine and Pharmacy in Kosice, Kosice, Slovak Republic
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16
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Erginoglu U, Keles A, Ataoglu C, Başarslan SK, Baskaya MK. A rapid clinical deterioration of a cervical exophytic intradural intramedullary sporadic hemangioblastoma diagnosed during pregnancy. Neurosurg Focus Video 2023; 9:V11. [PMID: 37854654 PMCID: PMC10580740 DOI: 10.3171/2023.7.focvid2354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 07/14/2023] [Indexed: 10/20/2023]
Abstract
Hemangioblastomas are benign CNS tumors that can occur sporadically or in conjunction with von Hippel-Lindau disease. While 2% of spinal cord tumors are hemangioblastomas, combined cervical hemangioblastomas and pregnancy is rare. Some reports suggest that hemodynamic and hormonal changes in pregnancy might increase hemangioblastoma growth and aggravate symptoms. Urgent tumor removal is required when neurological problems deteriorate after failed symptomatic treatment. Neurosurgeons should collaborate with anesthesiologists and obstetricians in such cases. Herein, the authors present the first known video case of a sporadic cervical hemangioblastoma diagnosed during pregnancy that required urgent surgery due to failed symptomatic treatment and progressive clinical deterioration.
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Affiliation(s)
- Ufuk Erginoglu
- Department of Neurological Surgery, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin
| | - Abdullah Keles
- Department of Neurological Surgery, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin
| | - Cagdas Ataoglu
- Department of Neurological Surgery, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin
| | - Seyit Kağan Başarslan
- Department of Neurological Surgery, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin
| | - Mustafa K Baskaya
- Department of Neurological Surgery, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin
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17
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Zhang H, Li HF, Duan HF, Huang KF, Tian ZH. Combination of a bronchogenic cyst in the thoracic spinal canal with chronic myelocytic leukemia. Open Life Sci 2023; 18:20220736. [PMID: 37791064 PMCID: PMC10543701 DOI: 10.1515/biol-2022-0736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 08/11/2023] [Accepted: 08/29/2023] [Indexed: 10/05/2023] Open
Abstract
The presented case report describes an incredibly rare instance of an intramedullary bronchial cyst located in the thoracic spinal canal on the dorsal side of the spinal cord, which was observed in a patient with chronic myelogenous leukemia. A 29-year-old man presented with back pain for half a month, along with numbness and pain below the chest and ribs for 1 week. Hypersensitivity was present in the inferior plane of the long xiphoid process in the nervous system. Magnetic resonance imaging (MRI) showed intramedullary cystic lesions in the vertebral body plane of the third to the fourth thoracic vertebra. There was no recurrence during the 6-month postoperative follow-up period. The histopathological findings were consistent with bronchogenic cysts. Cystic lesions were eliminated through the posterior median approach. After the cyst ruptured during surgery, gel liquid was seen, and the majority of the cyst walls were removed. One week after the surgery, the hypersensitivity fully subsided. Six months following surgery, an updated MRI revealed no recurrence. Intramedullary bronchogenic cysts on the dorsal side of the thoracic spine are extremely uncommon. Diagnosis requires histopathological evidence, and it is challenging to diagnose before surgery. Prompt surgical resection is recommended in case of positive diagnosis.
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Affiliation(s)
- Hao Zhang
- Department of Neurosurgery, Jin Cheng People’s Hospital, No. 1666 Baishui East Street, Jincheng, Shanxi 048026, China
| | - Hai-Feng Li
- Department of Neurosurgery, Jin Cheng People’s Hospital, No. 1666 Baishui East Street, Jincheng, Shanxi 048026, China
| | - Hai-Feng Duan
- Department of Neurosurgery, Jin Cheng People’s Hospital, No. 1666 Baishui East Street, Jincheng, Shanxi 048026, China
| | - Ke-Feng Huang
- Department of Neurosurgery, Jin Cheng People’s Hospital, No. 1666 Baishui East Street, Jincheng, Shanxi 048026, China
| | - Zhi-Hua Tian
- Department of Neurosurgery, Jin Cheng People’s Hospital, No. 1666 Baishui East Street, Jincheng, Shanxi 048026, China
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18
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Hussen E, Aboye S, Leake M, Nuredin Abrar F. Intramedullary Epidermoid Cyst of the Conus Medullaris: A Case Report and Literature Review. Int Med Case Rep J 2023; 16:521-527. [PMID: 37720363 PMCID: PMC10505022 DOI: 10.2147/imcrj.s430853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 09/05/2023] [Indexed: 09/19/2023] Open
Abstract
Background Central nervous system tumors are usually located in the brain, and spinal cord tumors account for approximately 20% of central nervous system tumors. Epidermoid cysts constitute <1% of all intraspinal tumors. It consists of squamous epithelial-lined cysts containing keratin, cholesterol, and cellular granules. Epidermoid cysts can be classified as congenital, acquired, extradural, extramedullary, or intramedullary according to etiology and location. The intradural intramedullary type is uncommon. Case Presentation An 11-year-old female patient had back pain with radiation to both lower extremities but worsened on the left side for 5 years. On neurological examination, motor strength was 3/5 for hip flexion and knee extension bilaterally and 5/5 for other key muscle groups. Contrast-enhanced lumbosacral magnetic resonance imaging (MRI) revealed T1 hypointense and T2 hyperintense lesions in the L2-L4 intramedullary conus and cauda equina. Laminectomy and near total resection were done, and histopathological examination revealed an epidermoid cyst. On the third postoperative day, the patient was discharged with completely resolved back pain and an improvement in lower extremity motor power. At monthly follow-up visits for a further 6 months, her back pain and weakness completely resolved, and she had no neurologic deficits. A postoperative lumbosacral MRI was done and confirmed near total excision of the tumor. Conclusion Intramedullary conus epidermoid cysts are rare but not unknown to neurosurgeons. MRI with diffusion-weighted images (DWI) is an imaging modality of choice. Asymptomatic patients can be conservatively treated. Once the patient has progressive symptoms and signs of compression, surgical excision is recommended. Meticulous electrocauterization may help decrease tumor regrowth in the remnant capsule, which is recommended. Avoiding leakage of cyst fluid into the subarachnoid space helps to avoid postoperative chemical meningitis. Radiotherapy is an option for the management of multiple recurrences.
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Affiliation(s)
- Endris Hussen
- Department of Neurosurgery, St. Paul’s Millennium Medical College, Addis Ababa, Ethiopia
| | - Samson Aboye
- Department of Neurosurgery, St. Paul’s Millennium Medical College, Addis Ababa, Ethiopia
| | - Merhawi Leake
- Minilik II Comprehensive Specialized Hospital, Addis Ababa, Ethiopia
| | - Fadil Nuredin Abrar
- Addis Ababa University College of Medicine and Health Sciences Hospital, Addis Ababa, Ethiopia
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19
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Santifort KM, Plonek M, Grinwis GCM, Carrera I, Platt S. Case report: Surgical treatment and long-term successful outcome of a spinal intramedullary vascular malformation in a dog. Front Vet Sci 2023; 10:1243882. [PMID: 37645678 PMCID: PMC10461059 DOI: 10.3389/fvets.2023.1243882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 08/02/2023] [Indexed: 08/31/2023] Open
Abstract
A 3.5-year-old male intact Staffordshire terrier crossbreed dog was presented with a one-week history of progressive paraparesis with fecal and urinary incontinence. Neurological examination was consistent with a T3-L3 myelopathy. A magnetic resonance imaging study revealed the presence of a well-circumscribed hemorrhagic space-occupying lesion at the level of T12, suspected to be a vascular malformation, such as cavernoma or arteriovenous fistula, primary hematoma or hamartoma; less likely considerations included hemorrhagic inflammation or hemorrhagic primary or secondary neoplasia. A dorsal laminectomy, durotomy, and midline dorsal myelotomy were performed with a surgical microscope, and the vascular lesion was identified and removed. Histological examination of surgical samples yielded fibrin, hemorrhage, hematoidin pigment, and some neural tissue. Although a lining wall was visualized during surgery consistent with a vascular malformation, there was no histological confirmation of such a structure, hampering definitive classification of the lesion. There was no gross or histopathological evidence that would support a diagnosis of a hamartoma or benign neoplasia. The dog was paraplegic with intact nociception the day following surgery. Ambulation was recovered within 2 weeks. Progressive and complete recovery of neurological function was seen over the next 12 weeks. No recurrence of neurological dysfunction was seen over a 12-month follow-up period. Surgical treatment should be considered in dogs with spinal intramedullary vascular lesions which can have a successful long-term outcome.
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Affiliation(s)
- Koen M. Santifort
- Neurology, IVC Evidensia Small Animal Referral Hospital Arnhem, Arnhem, Netherlands
- Neurology, IVC Evidensia Small Animal Referral Hospital Hart van Brabant, Waalwijk, Netherlands
| | - Marta Plonek
- Neurology, IVC Evidensia Small Animal Referral Hospital Arnhem, Arnhem, Netherlands
| | - Guy C. M. Grinwis
- Department of Biomedical Health Sciences, Faculty of Veterinary Medicine, Veterinary Pathology Diagnostic Centre, Utrecht University, Utrecht, Netherlands
| | - Ines Carrera
- Vet Oracle Teleradiology, Norfolk, United Kingdom
| | - Simon Platt
- Vet Oracle Teleradiology, Norfolk, United Kingdom
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20
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Nazzal EM, Mattar LT, Newell BW, Coutinho DV, Kaufmann RA, Baratz ME, Debski RE. Do Intramedullary Screws Provide Adequate Fixation for Humeral and Ulnar Components in Total Elbow Arthroplasty? A Cadaveric Analysis. J Hand Surg Am 2023:S0363-5023(23)00356-8. [PMID: 37552143 DOI: 10.1016/j.jhsa.2023.06.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 05/21/2023] [Accepted: 06/29/2023] [Indexed: 08/09/2023]
Abstract
PURPOSE The objective of this study was to determine the structural properties of the cadaver bone-screw interface for cementless intramedullary screw fixation in the context of total elbow arthroplasty. METHODS The intramedullary canals of seven humerus and seven ulna specimens from fresh-frozen cadavers were drilled using custom drill bits until the inner cortex was reached and then hand tapped for the corresponding thread size. Titanium screws were advanced into the tapped holes until securely seated. The bones were potted and then mounted on a uniaxial material testing machine. A tensile load was applied, and end-of-test elongation, failure load, energy absorbed, and stiffness were determined. End-of-test load and elongation were defined as the elongation and load experienced by the structure at 3,000 N or failure. Each specimen was inspected for evidence of pullout, loosening, or visible fractures. RESULTS The end-of-test load and elongation for the humerus specimens were 2721 ± 738 N and 3.0 ± 0.9 mm, respectively. The ulna specimens reached 92% of the humerus specimens' end-of-test load at 2,514 ± 678 N and 120% of their end-of-test elongation (3.6 ± 0.6 mm). The stiffness of the humerus specimens was 1,077 ± 336 N/mm, which was 1.3 times greater than the stiffness of the ulna specimens (790 ± 211 N/mm). Lastly, the energy absorbed by the humerus samples was 3.6 ± 1.6 J, which was 92% of the energy absorbed by the ulna samples at 3.9 ± 1.1 J. One humerus and three ulnas failed before the end-of-test load of 3,000 N. Two failures were caused by screw pullout and two by bone fracture. CONCLUSIONS Our findings demonstrate that intramedullary screw fixation is successful in withstanding forces that are greater than required for osseointegration. CLINICAL RELEVANCE Uncemented fixation may be beneficial in elbow arthroplasty.
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Affiliation(s)
- Ehab M Nazzal
- Orthopedic Robotics Laboratory, University of Pittsburgh, Pittsburgh, PA; University of Pittsburgh Medical Center Department of Orthopedic Surgery, Pittsburgh, PA
| | - Luke T Mattar
- Orthopedic Robotics Laboratory, University of Pittsburgh, Pittsburgh, PA; Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, PA
| | - Benjamin W Newell
- Orthopedic Robotics Laboratory, University of Pittsburgh, Pittsburgh, PA; Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, PA
| | - Dominic V Coutinho
- University of Pittsburgh Medical Center Department of Orthopedic Surgery, Pittsburgh, PA
| | - Robert A Kaufmann
- Orthopedic Robotics Laboratory, University of Pittsburgh, Pittsburgh, PA; University of Pittsburgh Medical Center Department of Orthopedic Surgery, Pittsburgh, PA.
| | - Mark E Baratz
- University of Pittsburgh Medical Center Department of Orthopedic Surgery, Pittsburgh, PA
| | - Richard E Debski
- Orthopedic Robotics Laboratory, University of Pittsburgh, Pittsburgh, PA; Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, PA
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21
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Chanbour H, Kelly PD, Topf MC, Dewan MC, Morone PJ, Zuckerman SL. Resection of a ventral intramedullary spinal cord ependymoma through an anterior cervical approach: illustrative case. J Neurosurg Case Lessons 2023; 6:CASE23243. [PMID: 37392766 PMCID: PMC10555634 DOI: 10.3171/case23243] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 05/30/2023] [Indexed: 07/03/2023]
Abstract
BACKGROUND Although posterior myelotomy leaves patients with dorsal column deficits, few reports have explored the anterior cervical approach for cervical intramedullary tumors. The authors describe the resection of a cervical intramedullary ependymoma through an anterior approach with a two-level corpectomy and fusion. OBSERVATIONS A 49-year-old male presented with a C3-5 ventral intramedullary mass with polar cysts. Because of the ventral location of the tumor and the added benefit of avoiding a posterior myelotomy and dorsal column deficits, an anterior C4-5 corpectomy offered a direct route and excellent visualization of the ventrally located tumor. After a C4-5 corpectomy, microsurgical resection, and C3-6 anterior fusion with a fibular allograft filled with autograft, the patient remained neurologically intact. Magnetic resonance imaging (MRI) on postoperative day (POD) 1 confirmed gross-total resection. The patient was extubated on POD 2 and was discharged home on POD 4 with a stable examination. At 9 months, the patient developed mechanical neck pain refractory to conservative treatment and underwent a posterior fusion to address pseudarthrosis. MRI at 15 months showed no evidence of tumor recurrence with the resolution of neck pain. LESSONS An anterior cervical corpectomy provides a safe corridor to access ventral cervical intramedullary tumors and avoids posterior myelotomy. Although the patient required a three-level fusion, we believe the tradeoff of decreased motion compared to dorsal column deficits is preferred.
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Affiliation(s)
| | | | | | | | | | - Scott L. Zuckerman
- Departments of Neurological Surgery
- Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
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22
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Abbas T, Batool S, Muzaffar B, Ahsan Z, Hamid FB, Hameed A, Tariq MR. Primary Spinal Intradural Melanocytoma of the Thoracic Region: A Rare Case. Cureus 2023; 15:e41019. [PMID: 37519491 PMCID: PMC10372852 DOI: 10.7759/cureus.41019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/27/2023] [Indexed: 08/01/2023] Open
Abstract
While the presence of metastatic melanocytoma in the central nervous system (CNS) is relatively common, primary spinal melanocytoma (PSM) is an extremely rare entity. Only 70 cases have been reported, and its usual position is the cervical region. We report a case of a 35-year-old male with primary spinal intramedullary melanocytoma with a dorsal exophytic component. The tumor was first opened in the periphery and was closed without being operated upon due to it being an uncommon pathology.
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Affiliation(s)
- Talha Abbas
- Department of Neurosurgery, Sir Ganga Ram Hospital, Lahore, PAK
| | - Sakina Batool
- Department of Internal Medicine, Sir Ganga Ram Hospital, Lahore, PAK
| | - Bireera Muzaffar
- Department of Internal Medicine, Sir Ganga Ram Hospital, Lahore, PAK
| | - Zainab Ahsan
- Department of Internal Medicine, Combined Military Hospital (CMH) Lahore Medical College and Institute of Dentistry, Lahore, PAK
| | - Fahad B Hamid
- Department of Medicine, Combined Military Hospital (CMH) Lahore Medical College and Institute of Dentistry, Lahore, PAK
| | - Abdul Hameed
- Department of Neurosurgery, Sir Ganga Ram Hospital, Lahore, PAK
| | - Mah R Tariq
- Department of Medicine, Combined Military Hospital (CMH) Lahore Medical College and Institute of Dentistry, Lahore, PAK
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23
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Yazol M, Derinkuyu BE, Boyunaga O. Three Different Faces of Schwannoma in Pediatric Patients. Curr Med Imaging 2023:CMIR-EPUB-130936. [PMID: 37066779 DOI: 10.2174/1573405620666230414115555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 03/06/2023] [Accepted: 03/20/2023] [Indexed: 04/18/2023]
Abstract
BACKGROUND Schwannomas arise from nerve sheaths of cranial, peripheral, and spinal nerve or nerve roots. Most intracranial schwannomas arise from the cranial nerves, predominantly the vestibulocochlear nerve. In addition to cranial nerve schwannomas, intraparenchymal schwannomas of the brain and intramedullary schwannomas of the spinal cord are extremely rare. CASE REPORT In this case report, we describe the imaging findings of three diverse cases of schwannoma at different locations and unique presentations with acute neurological symptoms in the pediatric age group. CONCLUSION Schwannomas should be considered and included in the differential diagnosis of intracranial or intraspinal intramedullary space-occupying lesions in pediatric patients.
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Affiliation(s)
- Merve Yazol
- Department of Radiology, Gazi University School of Medicine, Ankara, Turkey
| | | | - Oznur Boyunaga
- Department of Radiology, Gazi University School of Medicine, Ankara, Turkey
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24
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Şensöz E, Ergun S, Kayaalp ME, Eceviz E. The Comparison of Dynamic Condylar Screw Plate to Proximal Femoral Nail in Reverse Oblique and Transverse Intertrochanteric Fractures: A Retrospective Study on 61 Patients. Cureus 2023; 15:e36397. [PMID: 37090379 PMCID: PMC10115748 DOI: 10.7759/cureus.36397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/20/2023] [Indexed: 04/25/2023] Open
Abstract
OBJECTIVE Reverse oblique (RO) and transverse intertrochanteric fracture patterns constitute a challenge for the operating surgeon. Currently, no gold standard fixation method exists. This study aimed to retrospectively compare proximal femoral nail (PFN) to dynamic condylar screw (DCS) plating in the treatment of RO and transverse intertrochanteric fractures. METHODS A total of 61 patients fixated by PFN or DCS were included. Of these, 36 were treated with PFN (21 females and 15 males; mean age: 65.52 years), and 25 were treated with DCS (12 females and 13 males; mean age: 59.36 years). The mean follow-up time was 33.8 and 42.6 months (range: 24-108). Radiological evaluation included the quality of fracture reduction, neck-shaft angle change, posteromedial support presence, and bone union time. Complications such as mechanical failure, nonunion, and infection were noted. RESULTS The only significant differences between the fixation methods were the superiority of DCS over PFN in earlier fracture union time (mean values: 8.9 versus 14.1 weeks) and the superiority (p=0.007) of PFN in shorter hospital stay (3.4 days versus 5.1 days). No significant difference was observed in radiological parameters. While similar mechanical complication rates were found, a significantly higher nonunion rate was detected with the DCS. CONCLUSION The most crucial disadvantage of DCS was the high rate of nonunion. Closed fracture reduction in PFN seems to be the most critical parameter to prevent severe complications. The open reduction using DCS showed no advantages over closed reduction and PFN fixation in providing a more anatomical alignment in AO/Orthopaedic Trauma Association (OTA) 31-A3 fractures. However, we recommend PFN application in this type of fracture, since nonunion is more common in DCS.
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Affiliation(s)
- Ersin Şensöz
- Orthopedics and Traumatology, Dr. Lutfi Kirdar Kartal City Hospital, Istanbul, TUR
| | - Selim Ergun
- Orthopedics and Traumatology, Dr. Lutfi Kirdar Kartal City Hospital, Istanbul, TUR
| | - Mahmut Enes Kayaalp
- Orthopedics and Traumatology, Dr. Lutfi Kirdar Kartal City Hospital, Istanbul, TUR
| | - Engin Eceviz
- Orthopedics and Traumatology, Dr. Lutfi Kirdar Kartal City Hospital, Istanbul, TUR
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Sivakumar B, Graham DJ. Reverse Instrumentation for Headless Compression Screw Fixation of Basal Proximal Phalangeal Fractures. J Hand Surg Am 2023:S0363-5023(23)00002-3. [PMID: 36828763 DOI: 10.1016/j.jhsa.2022.12.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 07/18/2022] [Accepted: 12/23/2022] [Indexed: 02/26/2023]
Abstract
Intramedullary headless compression screw fixation of proximal phalangeal fractures permits semirigid stabilization through a minimally invasive approach with negligible tendon disturbance, allowing early mobilization and rehabilitation. Antegrade insertion is preferred for basal fractures, but various concerns and technical difficulties have been identified with both intra- and transarticular instrumentation. We describe a technical tip to facilitate easier guidewire insertion and instrumentation with a screw via an intra-articular approach.
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Affiliation(s)
- Brahman Sivakumar
- Department of Hand and Peripheral Nerve Surgery, Royal North Shore Hospital, St. Leonards NSW, Australia; Australian Research Collaboration on Hands (ARCH), 4/75 Railway St, Mudgeeraba QLD, Australia; Department of Surgery, Faculty of Medicine, University of Sydney, Camperdown NSW, Australia; Department of Orthopaedic Surgery, Hornsby Ku-ring-gai Hospital, Hornsby NSW, Australia; Department of Orthopaedic Surgery, Nepean Hospital, Kingswood, NSW, Australia.
| | - David J Graham
- Australian Research Collaboration on Hands (ARCH), 4/75 Railway St, Mudgeeraba QLD, Australia; Department of Musculoskeletal Services, Gold Coast University Hospital, Southport QLD Australia; Griffith University School of Medicine and Dentistry, Southport QLD, Australia; Department of Orthopaedic Surgery, Queensland Children's Hospital, South Brisbane QLD, Australia
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26
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Andrews EG, Hect JL, Mittal AM, Nowicki KW, Agarwal V, Gerszten PC. Tetra-compartmental spinal infection with conus medullaris syndrome: illustrative case. J Neurosurg Case Lessons 2023; 5:CASE22447. [PMID: 36748756 PMCID: PMC10550562 DOI: 10.3171/case22447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Accepted: 12/12/2022] [Indexed: 06/18/2023]
Abstract
BACKGROUND Recent literature suggests that spinal infections are increasing in prevalence. Any compartment can be infected in the spine; however, multicompartmental infections are rare. OBSERVATIONS To the authors' knowledge, this report is the only reported case of a tetra-compartmental spinal infection consisting of epidural, subdural, subarachnoid, and intramedullary components with a contiguous lumbar spondylodiscitis resulting in conus medullaris syndrome requiring surgical intervention. LESSONS This case highlights the importance of surgical intervention in severe cases such as the one illustrated in this report. Second, magnetic resonance imaging with and without contrast is required to check for spreading of the infection as these findings may change the surgical approach. Last, the use of intraoperative ultrasound is paramount to evaluate the subdural and intramedullary compartments in severe cases.
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Affiliation(s)
| | | | | | | | - Vikas Agarwal
- Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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Li M, Li J, Hu S, Jia B. Comparison of intramedullary versus extramedullary alignment technique in total knee arthroplasty: A PRISMA-compliant meta-analysis. Medicine (Baltimore) 2023; 102:e32277. [PMID: 36749264 PMCID: PMC9901995 DOI: 10.1097/md.0000000000032277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND This meta-analysis aimed to compare the efficacy of intramedullary and extramedullary femoral alignment technique in treating total knee arthroplasty (TKA) patients. METHODS PubMed, Embase, Cochrane library, Chinese National Knowledge Infrastructure, and Weipu databases were electronically searched. Potential clinical studies that investigated the effect and safety of intramedullary versus extramedullary femoral alignment technique in TKA patients were searched. The primary outcome was lower limb coronal alignment. Stata 12.0 was used for meta-analysis. RESULTS This meta-analysis included 12 prospective randomized controlled studies that reported data on 935 TKA patients. No significant difference was noted in lower limb coronal alignment, coronal alignment of femoral component, sagittal alignment of femoral component and tibial slope between intramedullary and extramedullary alignment techniques ( P > .05). Further, extramedullary alignment technique significantly decrease the total blood loss than intramedullary alignment technique (weighted mean difference: -86.52; 95% confidence interval: -115.05--57.99; P = .000) and subsequently transfusion rate (risk ratio: 0.57; 95% confidence interval: 0.41-0.79; P = .000). Finally, there was no significant difference between intramedullary and extramedullary alignment techniques in terms of the total complications ( P > .05). CONCLUSIONS The present meta-analysis showed that intramedullary and extramedullary femoral alignment technique had comparable precise profiles. And extramedullary femoral alignment technique could reduce blood loss and blood transfusion. Total complications were comparable between the groups. More randomized controlled trials with large samples are required to verify the comparison of intramedullary and extramedullary femoral alignment technique in TKA patients.
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Affiliation(s)
- Ming Li
- Department of Joint Surgery, The First Affiliated Hospital of Hainan Medical University, Haikou, Hainan, China
| | - Jun Li
- Department of Joint Surgery, The First Affiliated Hospital of Hainan Medical University, Haikou, Hainan, China
| | - Shuai Hu
- Department of Joint Surgery, The First Affiliated Hospital of Hainan Medical University, Haikou, Hainan, China
| | - Bingshen Jia
- Department of Joint Surgery, The First Affiliated Hospital of Hainan Medical University, Haikou, Hainan, China
- * Correspondence: Bingshen Jia, Department of Joint Surgery, The First Affiliated Hospital of Hainan Medical University, No. 31, Longhua Road, Longhua District, Haikou, Hainan 570000, China (e-mail: )
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Scalia G, Costanzo R, Viola A, Bonosi L, Porzio M, Giovannini A, Graziano F, Iacopino DG, Maugeri R, Nicoletti GF, Umana GE. Intramedullary Spinal Cord Metastases from Breast Cancer: A Systematic Review. Anticancer Res 2023; 43:523-535. [PMID: 36697093 DOI: 10.21873/anticanres.16189] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 12/17/2022] [Accepted: 12/20/2022] [Indexed: 01/26/2023]
Abstract
BACKGROUND/AIM Intramedullary spinal cord metastases (ISCM) are deemed extremely aggressive, as confirmed by the low life expectancy since the diagnosis. Up to 26.5% of total ISCM stem from breast cancer (BC), representing the second most frequent primary site after the lung. The increasing incidence of BC and the widespread use of MRI for the diagnosis could therefore lead to an earlier diagnosis and, therefore, to a progressively longer survival in patients affected by ISCM from BC. This systematic review is intended to provide an orientation through a management algorithm for the most appropriate therapeutic approach in these patients. MATERIALS AND METHODS The research strategy initially relied on title and abstract analysis. The article's full text was retrieved for further investigation if the title and abstract met the inclusion criteria. The extracted data included the following: authors, publication time, study design, patient characteristics, ISCM location, treatment modalities, time interval from initial cancer diagnosis to ISCM diagnosis, clinical outcomes, and survival time. RESULTS This systematic search regarding ISCM from BC yielded 574 articles. After screening, a total of 44 studies were included in this systematic review. A total of 123 patients were evaluated. The mean patient age was 53.2 years with a standard deviation of 10.4 years. Female patients were 122. There was only one male patient. CONCLUSION ISCM from BC have a better prognosis than lung metastases and, thanks to recent advances in diagnostic imaging and intraoperative planning and neuromonitoring, an early diagnosis and a prompt multidisciplinary treatment may be accomplished. Prospective studies to generate evidence-based data regarding the most appropriate treatment for ISCM are mandatory.
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Affiliation(s)
- Gianluca Scalia
- Department of Neurosurgery, Garibaldi Hospital, Catania, Italy;
| | - Roberta Costanzo
- Neurosurgical Clinic, AOUP "Paolo Giaccone", Post Graduate Residency Program in Neurologic Surgery, Department of Biomedicine Neurosciences and Advanced Diagnostics, School of Medicine, University of Palermo, Palermo, Italy
| | - Anna Viola
- Fondazione Istituto Oncologico del Mediterraneo, Viagrande, Italy
| | - Lapo Bonosi
- Neurosurgical Clinic, AOUP "Paolo Giaccone", Post Graduate Residency Program in Neurologic Surgery, Department of Biomedicine Neurosciences and Advanced Diagnostics, School of Medicine, University of Palermo, Palermo, Italy
| | - Massimiliano Porzio
- Neurosurgical Clinic, AOUP "Paolo Giaccone", Post Graduate Residency Program in Neurologic Surgery, Department of Biomedicine Neurosciences and Advanced Diagnostics, School of Medicine, University of Palermo, Palermo, Italy
| | - Andrea Giovannini
- Neurosurgical Clinic, AOUP "Paolo Giaccone", Post Graduate Residency Program in Neurologic Surgery, Department of Biomedicine Neurosciences and Advanced Diagnostics, School of Medicine, University of Palermo, Palermo, Italy
| | | | - Domenico Gerardo Iacopino
- Neurosurgical Clinic, AOUP "Paolo Giaccone", Post Graduate Residency Program in Neurologic Surgery, Department of Biomedicine Neurosciences and Advanced Diagnostics, School of Medicine, University of Palermo, Palermo, Italy
| | - Rosario Maugeri
- Neurosurgical Clinic, AOUP "Paolo Giaccone", Post Graduate Residency Program in Neurologic Surgery, Department of Biomedicine Neurosciences and Advanced Diagnostics, School of Medicine, University of Palermo, Palermo, Italy
| | | | - Giuseppe Emmanuele Umana
- Department of Neurosurgery, Trauma Center, Gamma Knife Center, Cannizzaro Hospital, Catania, Italy
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Albanese KM, Schreck MJ, Werner FW, Esper GW, Ordway NR. A Biomechanical Comparison of Fixation Techniques in Metacarpal Shaft Fractures. J Wrist Surg 2023; 12:46-51. [PMID: 36644722 PMCID: PMC9836774 DOI: 10.1055/s-0042-1751077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 05/24/2022] [Indexed: 01/18/2023]
Abstract
Background Typically, metacarpal shaft fractures are treated with closed reduction percutaneous pinning, intramedullary nails, or plate fixation. Recently some surgeons have begun using intramedullary headless compression screws. Questions/Purposes The purpose of this study was to compare intramedullary screw fixation to K-wire fixation, which is the standard of care in a transverse metacarpal midshaft fracture, using a cadaveric model. Our hypothesis was that intramedullary screw fixation would have a biomechanical advantage (higher stiffness and peak load to failure) when compared with dual Kirschner wire fixation of transverse metacarpal shaft fractures. Methods Four-point bend testing was performed to compare stiffness and failure load values of seven paired 2nd and 3rd metacarpals instrumented with headless intramedullary compression screw fixation or Kirschner wire fixation. Similar testing was performed on 14 unpaired 4th metacarpals. Results There was no significant difference in peak load ( p = 0.60) or stiffness ( p = 0.85) between fixation groups for the 2nd and 3rd instrumented metacarpals. For the instrumented 4th metacarpals, there was no significant difference in peak load ( p = 0.14), but the stiffness was significantly greater ( p = 0.01) for the compression screw group compared with the Kirschner wire fixation. Conclusions/Clinical Relevance In this study, the load to failure was not different between the two fixation methods and likely both techniques can sustain physiologic loads needed for rehabilitation. The greater stiffness in the 4th metacarpal compression screw group may be related to the smaller canal morphology than in the 2nd and 3rd metacarpals. Larger diameter screws may be needed to obtain a better fit particularly in the 2nd and 3rd metacarpals.
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Affiliation(s)
- Kevin M. Albanese
- Department of Orthopedic Surgery, SUNY Upstate Medical University, Syracuse, New York
| | - Michael J. Schreck
- Department of Orthopedic Surgery, SUNY Upstate Medical University, Syracuse, New York
| | - Frederick W. Werner
- Department of Orthopedic Surgery, SUNY Upstate Medical University, Syracuse, New York
| | - Garrett W. Esper
- Department of Orthopedic Surgery, SUNY Upstate Medical University, Syracuse, New York
| | - Nathaniel R. Ordway
- Department of Orthopedic Surgery, SUNY Upstate Medical University, Syracuse, New York
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Liao D, Li D, Wang R, Xu J, Chen H. Hemilaminectomy for the removal of the spinal tumors: An analysis of 901 patients. Front Neurol 2023; 13:1094073. [PMID: 36712439 PMCID: PMC9874286 DOI: 10.3389/fneur.2022.1094073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 12/28/2022] [Indexed: 01/13/2023] Open
Abstract
Objective We report our experience with the use of hemilaminectomy approach for the removal of benign intraspinal tumors. Method A retrospective review of 1,067 patients who underwent hemilaminectomy in our hospital between 2013 and 2019 was analyzed. Baseline medical data were collected. One hundred sixteen patients were excluded due to degenerative diseases, spinal bone tumors, and malignant tumors. The remaining 901 patients (916 tumors) were enrolled. The Dennis Pain Scale (DPS) was used to assess improvement in pain before surgery and during long-term follow-up. Neurological status was assessed using the American Spinal Injury Association (ASIA) impairment scale. Results The age of the patients was 48.7 ± 15.3 years, the duration of symptoms was 16.5 ± 32.0 months, and the tumor size was 2.6 ± 1.4 cm. Three hundred two tumors were located in the cervical region, 42 in the cervicothoracic region, 234 in the thoracic region, 57 in the thoracolumbar region, and 281 in the lumbar and lumbosacral region. Twenty-three tumors were ventrally located, 677 were dorsal or dorsolateral, 63 were intramedullary, 87 were epidural, and the rest were dumbbell-shaped. The most common pathologies were schwannomas (601, 66.7%) and meningiomas (172, 19.1%). Total excision was achieved at 97.8%. The operative time was 94.3 ± 32.6 min and the blood loss during surgery was 96.9 ± 116.5 ml. The symptom of pain improved in 87.0% of patients during long-term follow-up, neurological function improved in 68.3% and remained unchanged at 30.5%. Conclusion The hemilaminectomy approach was a rapid and safe procedure to remove intradural and extradural tumors. This approach has offered several advantages. It could be used for the resection of most extradural or intradural extramedullary lesions, even some intramedullary tumors.
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Affiliation(s)
- Dengyong Liao
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
| | - Dan Li
- Department of Physiology, School of Basic Medical Sciences, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Ruoran Wang
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
| | - Jianguo Xu
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China,Jianguo Xu ✉
| | - Haifeng Chen
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China,*Correspondence: Haifeng Chen ✉
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Golpayegani M, Edalatfar M, Ahmadi A, Sadeghi-Naini M, Salari F, Hanaei S, Shokraneh F, Ghodsi Z, Vaccaro AR, Rahimi-Movaghar V. Complete Versus Incomplete Surgical Resection in Intramedullary Astrocytoma: Systematic Review with Individual Patient Data Meta-Analysis. Global Spine J 2023; 13:227-241. [PMID: 35486519 PMCID: PMC9837510 DOI: 10.1177/21925682221094766] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
STUDY DESIGN Systematic reviewBackground: Considering the infiltrative nature of intramedullary astrocytoma, the goal of surgery is to have a better patient related outcome. OBJECTIVE To compare the overall survival (OS) and neurologic outcomes of complete vs incomplete surgical resection for patients with intramedullary astrocytoma. METHODS A comprehensive search of MEDLINE, CENTRAL and EMBASE was conducted by two independent reviewers. Individual patient data (IPD) analysis and multivariate Cox Proportional Hazard Model was developed to measure the effect of surgical strategies on OS, post-operative neurological improvement (PNI), and neurological improvement in the last follow up (FNI). RESULTS We included 1079 patients from 35 studies. Individual patient data of 228 patients (13 articles) was incorporated into the integrative IPD analysis. Kaplan-Meier survival analysis showed complete resection (CR) significantly improved OS in comparison with the incomplete resection (IR) (log-rank test, P = .004). In the multivariate IPD analysis, three prognostic factors had significant effect on the OS: (1) Extent of Resection, (2) pathology grade, and (3) adjuvant therapy. We observed an upward trend in the popularity of chemotherapy, but CR, IR, and radiotherapy had relatively stable trends during three decades. CONCLUSION Our study shows that CR can improve OS when compared to IR. Patients with spinal cord astrocytoma undergoing CR had similar PNI and FNI compared to IR. Therefore, CR should be the primary goal of surgery, but intraoperative decisions on the extent of resection should be relied on to prevent neurologic adverse events. Due to significant effect of adjuvant therapy on OS, PNI and FNI, it could be considered as the routine treatment strategy for spinal cord astrocytoma.
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Affiliation(s)
- Mehdi Golpayegani
- Sina Trauma and Surgery Research
Center, Tehran University of Medical
Sciences, Tehran, Iran
| | - Maryam Edalatfar
- Sina Trauma and Surgery Research
Center, Tehran University of Medical
Sciences, Tehran, Iran
| | - Ayat Ahmadi
- Knowledge Utilization Research
Center, Tehran University of Medical
Sciences, Tehran, Iran
| | - Mohsen Sadeghi-Naini
- Sina Trauma and Surgery Research
Center, Tehran University of Medical
Sciences, Tehran, Iran,Department of Neurosurgery, Lorestan University of Medical
Sciences, Khoram-Abad, Iran
| | - Farhad Salari
- Eye Research Center, Farabi Eye
Hospital, Tehran University of Medical
Sciences, Tehran, Iran
| | - Sara Hanaei
- Department of Neurosurgery, Imam
Khomeini Hospital Complex, Tehran University of Medical Sciences
(TUMS), Tehran, Iran,Universal Scientific Education and
Research Network (USERN), Tehran, Iran
| | - Farhad Shokraneh
- Cochrane Schizophrenia Group, The Institute of Mental
Health, Nottingham, UK
| | - Zahra Ghodsi
- Sina Trauma and Surgery Research
Center, Tehran University of Medical
Sciences, Tehran, Iran
| | - Alex R. Vaccaro
- Department of Orthopedics and
Neurosurgery, Thomas Jefferson University and the
Rothman Institute, Philadelphia, PA, USA
| | - Vafa Rahimi-Movaghar
- Sina Trauma and Surgery Research
Center, Tehran University of Medical
Sciences, Tehran, Iran,Universal Scientific Education and
Research Network (USERN), Tehran, Iran,Brain and Spinal Cord Injury
Research Center, Neuroscience Institute, Tehran University of Medical
Sciences, Tehran, Iran,Department of Neurosurgery,
Shariati Hospital, Tehran University of Medical
Sciences, Tehran, Iran,Institute of Biochemistry and
Biophysics, University of Tehran, Tehran, Iran,Visiting Professor, Spine
Program, University of Toronto, Toronto, ON, Canada,Vafa Rahimi-Movaghar, MD, Sina Trauma and
Surgery Research Center, Tehran University of Medical Sciences, Hassan-Abad
Square, Tehran 1136746911, Iran.
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Huang Q, Zhang C, Bai H, Wang Q, Li Z, Lu Y, Ma T. Biomechanical evaluation of two modified intramedullary fixation system for treating unstable femoral neck fractures: A finite element analysis. Front Bioeng Biotechnol 2023; 11:1116976. [PMID: 36896014 PMCID: PMC9989215 DOI: 10.3389/fbioe.2023.1116976] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 02/10/2023] [Indexed: 02/25/2023] Open
Abstract
Purpose: The existing implants for fixation of femoral neck fractures have poor biomechanical stability, so the failure rate is high. We designed two modified intramedullary implants for treating unstable femoral neck fractures (UFNFs). We tried to improve the biomechanical stability of fixation by shortening the moment and reducing stress concentration. Each modified intramedullary implant was compared with cannulated screws (CSs) through finite element analysis (FEA). Methods: Five different models were included: three cannulated screws (CSs, Model 1) in an inverted triangle configuration, the dynamic hip screw with an anti-rotation screw (DHS + AS, Model 2), the femoral neck system (FNS, Model 3), the modified intramedullary femoral neck system (IFNS, Model 4), and the modified intramedullary interlocking system (IIS, Model 5). Three-dimensional (3D) models of femur and implants were constructed by using 3D modelling software. Three load cases were simulated to assess the maximal displacement of models and fracture surface. The maximal stress at the bone and implants was also evaluated. Results: FEA data showed that Model 5 had the best performance in terms of maximum displacement while Model 1 had the worst performance for this index under axial load of 2100 N. With respect to Maximum stress, Model 4 had the best performance while Model 2 had the worst performance under axial load. The general trends under bending and torsion load were consistent with that under axial load. Our data demonstrated that the two modified intramedullary implants exhibited the best biomechanical stability, followed by FNS and DHS + AS, and then three cannulated screws in axial, bending, and torsion load cases. Conclusion: The two modified intramedullary designs showed the best biomechanical performance among the five implants included in this study. Therefore, this might provide some new options for trauma surgeons to deal with unstable femoral neck fractures.
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Affiliation(s)
- Qiang Huang
- Department of Orthopedics, Hong Hui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - CongMing Zhang
- Department of Orthopedics, Hong Hui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - HuanAn Bai
- Department of Orthopedics, Hong Hui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Qian Wang
- Department of Orthopedics, Hong Hui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Zhong Li
- Department of Orthopedics, Hong Hui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Yao Lu
- Department of Orthopedics, Hong Hui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Teng Ma
- Department of Orthopedics, Hong Hui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China
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Hoshimaru T, Takagi F, Tsuji Y, Yagi R, Hiramatsu R, Kameda M, Nonoguchi N, Furuse M, Kawabata S, Takami T, Wanibuchi M. Occult Germinoma of the Intramedullary Spinal Cord: A Case Report. NMC Case Rep J 2023; 10:27-32. [PMID: 36937498 PMCID: PMC10017122 DOI: 10.2176/jns-nmc.2022-0346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 12/20/2022] [Indexed: 02/24/2023] Open
Abstract
Primary germ cell tumors of the central nervous system (CNS) typically occur in the neurohypophysis, hypothalamus, or pineal gland and rarely in the spinal cord. We report a case of a spinal intramedullary tumor, which was first detected on magnetic resonance imaging (MRI) 41 months after the initial symptoms, with a verified pathological diagnosis of germinoma. The initial symptom was an abnormal sensation in the left plantar region that gradually worsened, resulting in severe sensory disturbance, difficulty in standing, and even bladder rectal disturbance. Repeated MRI after the onset failed to provide an imaging diagnosis. The MRI was performed 41 months after the onset and revealed a previously undiagnosed, contrast-enhancing spinal intramedullary neoplastic lesion at the Th11-12 level. Gross total resection of the tumor was successfully performed, and the pathology confirmed the diagnosis of pure germinoma. Postoperative chemotherapy, followed by local radiation, was successfully administered. Among primary germinomas of the CNS, occult germinoma that lacks imaging findings suggestive of tumors in the early stages of onset and becomes apparent over time is often reported as a primary neurohypophyseal germinoma, particularly in adolescents presenting with diabetes insipidus. In the present case, the lesion appeared to correspond to a primary occult germinoma of the intramedullary spinal cord.
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Affiliation(s)
- Takumi Hoshimaru
- Department of Neurosurgery, Osaka Medical and Pharmaceutical University, Takatsuki, Osaka, Japan
| | - Fugen Takagi
- Department of Neurosurgery, Osaka Medical and Pharmaceutical University, Takatsuki, Osaka, Japan
| | - Yuichiro Tsuji
- Department of Neurosurgery, Osaka Medical and Pharmaceutical University, Takatsuki, Osaka, Japan
| | - Ryokichi Yagi
- Department of Neurosurgery, Osaka Medical and Pharmaceutical University, Takatsuki, Osaka, Japan
| | - Ryo Hiramatsu
- Department of Neurosurgery, Osaka Medical and Pharmaceutical University, Takatsuki, Osaka, Japan
| | - Masahiro Kameda
- Department of Neurosurgery, Osaka Medical and Pharmaceutical University, Takatsuki, Osaka, Japan
| | - Naosuke Nonoguchi
- Department of Neurosurgery, Osaka Medical and Pharmaceutical University, Takatsuki, Osaka, Japan
| | - Motomasa Furuse
- Department of Neurosurgery, Osaka Medical and Pharmaceutical University, Takatsuki, Osaka, Japan
| | - Shinji Kawabata
- Department of Neurosurgery, Osaka Medical and Pharmaceutical University, Takatsuki, Osaka, Japan
| | - Toshihiro Takami
- Department of Neurosurgery, Osaka Medical and Pharmaceutical University, Takatsuki, Osaka, Japan
| | - Masahiko Wanibuchi
- Department of Neurosurgery, Osaka Medical and Pharmaceutical University, Takatsuki, Osaka, Japan
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Cheung YC, Yee DK, Fang C. Defining the fit and ideal entry site of the fibula rod system--a computed tomography based study in elderly patients with lower limb infections, vascular diseases or tumors. J Orthop Surg (Hong Kong) 2023; 31:10225536231157129. [PMID: 36924112 DOI: 10.1177/10225536231157129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/18/2023] Open
Abstract
OBJECTIVES To determine the configuration of the distal fibula anatomy and the fitness of the Fibula Rod System (Acumed®, Hillsboro, Oregon) in a series of fibula models and to determine the optimal entry site of the rod. METHODS Consecutive series of computed tomography (CT) of tibias and fibulae with no fracture or deformity were converted to stereo-lithograph format, and imported into Meshmixer software (Autodesk, San Rafael, California). A 3.6 × 180 mm fibula rod model was virtually inserted to best fit the intramedullary canal of the fibula model and to a depth of 0 mm proud at the distal fibula. The location of the entry point in relationship to the fibular tip, and the distance between the rod and the lateral fibula cortex were measured. RESULTS CT of 41 fibulae (23 male and 18 female patients) contributed to the three-dimensional fibula modeling. The entry point was 3.5 mm (SD 2.0) medial to (in mortise view) and 1.0 mm (SD 2.1) anterior to (in lateral view) the fibular tip. The fibula rod was inserted to a depth of 6.2 mm (SD 2.1) proximal to the fibula tip. The mean shortest distance of the rod to the outer cortex was 1.88 mm (SD 0.87). There was a breach of the posterolateral cortex in one patient. CONCLUSION The guide pin entry site of fibula rod should be medial and anterior offset with reference to the fibula tip, in contrary to the distal tip as recommended in the manual. There is a chance of breaching the posterolateral cortex with rod entry.
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Affiliation(s)
- Yan Chun Cheung
- Department of Orthopaedics and Trauamatology, 37062Alice Ho Miu Ling Nethersole Hospital, Pokfulam, Hong Kong
| | - Dennis Kh Yee
- Department of Orthopaedics and Trauamatology, 37062Alice Ho Miu Ling Nethersole Hospital, Pokfulam, Hong Kong
| | - Christian Fang
- Department of Orthopaedics and Trauamatology, 25809The University of Hong Kong, Pokfulam, Hong Kong
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Abstract
Common forms of fixation of metacarpal fractures have historically included percutaneous Kirschner wire fixation, plates and screws, and, more recently, intramedullary screw fixation. Retrograde intramedullary screws (RISs) are a novel modality first described 10 years ago. The purpose of this review is to critically evaluate the published literature assessing outcomes of RIS fixation for metacarpal fractures and create a complication profile for this novel technique. A comprehensive literature search was performed using electronic databases for both clinical and biomechanical studies in relation to RIS fixation published from 2000 to 2020. A total of 19 studies (13 clinical and 6 biomechanical) met the inclusion criteria. The clinical studies examined 603 metacarpal fractures and demonstrated adequate functional outcomes in terms of grip strength, total active motion, and time to return to work. The biomechanical studies examined 80 metacarpal fractures, finding that load to failure in RISs was often equal to or higher than Kirschner wires but less than plate and screws. The complication rate in reviewed studies was 2.8%, with the most prevalent complications being stiffness and extension lag. RIS use in metacarpal fractures appears to provide adequate stability with satisfactory clinical outcomes and minimal complications, although more high-quality studies are needed to fully examine this modality.
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Affiliation(s)
| | - Taylor Rider
- Philadelphia College of Osteopathic
Medicine, PA, USA
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Tas DB, Smeeing DPJ, Keizer J, Houwert RM, Emmink BL. Postoperative Complications of Minimally Invasive Intramedullary Nail Fixation Versus Plate Fixation for Distal Fibular Fractures in Elderly Patients: A Retrospective Double Cohort Study in a Geriatric Trauma Unit in the Netherlands. J Foot Ankle Surg 2022; 61:1170-1176. [PMID: 34802911 DOI: 10.1053/j.jfas.2021.10.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Revised: 03/12/2021] [Accepted: 10/11/2021] [Indexed: 02/03/2023]
Abstract
Intramedullary fixation using a fibular nail is a minimally invasive alternative to conventional plate fixation that provides superior biomechanical strength and allows immediate full weightbearing postoperatively. The study aim was to compare the postoperative complications of minimally invasive intramedullary fibular nail fixation to plate fixation for Lauge-Hansen supination external rotation type 4 (Weber B) fractures in patients aged 65 years or older treated in a single geriatric trauma unit in the Netherlands. A retrospective cohort study was performed including patients aged 65 years or older with a Lauge-Hansen supination external rotation type 4 (Weber B) fracture treated with either intramedullary fibular fixation or plate fixation between January 2017 and January 2019. A total number of 58 patients were included with a mean age of 73.9 years (range 65-95). The intramedullary fixation-cohort (n = 13) had a significantly higher mean age (82.5 vs 71.4 years, p = .002) and Charlson Co-morbidity Index (4.7 vs 3.6, p = .005) compared to the plate fixation-cohort (n = 45). The total number of postoperative complications was lower after intramedullary fixation (n = 2, 15%) compared to plate fixation (n = 15, 33%), although this relative difference was not significant (p = .307). All 2 complications observed after intramedullary fixation were wound infections demanding no debridement or implant removal. No implant related complications, hospital-acquired complications or mortality were observed after intramedullary fixation. Despite the higher mean age and co-morbidity status of patients treated with minimally invasive intramedullary fibular nailing, the total number of postoperative complications was lower after intramedullary fixation compared to plate fixation. This technique might be a promising alternative in selected patients.
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Affiliation(s)
- David B Tas
- Department of Trauma Surgery, Antonius Hospital, Utrecht, The Netherlands; Department of Trauma Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.
| | | | - Jort Keizer
- Department of Trauma Surgery, Antonius Hospital, Utrecht, The Netherlands
| | - Roderick M Houwert
- Department of Trauma Surgery, University Medical Center Utrecht, Utrecht, The Netherlands; Utrecht Traumacenter, Utrecht, The Netherlands
| | - Benjamin L Emmink
- Department of Trauma Surgery, Gelre Hospital, Apeldoorn, The Netherlands
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Najafi A, Shahbazi P, Azarsina S, Zargar D, Kahrizi MS, Hadavi D, Minaei-Noshahr R. Cortical bridging a union predictor: A prospective study after intramedullary nailing of the femoral shaft fractures. Eur J Transl Myol 2022; 32:10835. [PMID: 36305702 PMCID: PMC9830402 DOI: 10.4081/ejtm.2022.10835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Accepted: 10/12/2022] [Indexed: 01/13/2023] Open
Abstract
Early prediction of the union helps for timely intervention, reduction of hospitalization, treatment costs, and disability in cases of nonunion. With this in mind, we tried to find how long any cortical bridging predicts the union in femoral shaft fractures. A prospective study of 113 femoral shaft fractures treated with reamed, locked intramedullary nailing was performed. Radiographs were taken during months 2 to 4, 6, 9, and one-year follow-up. The cortical bridging (presence and number) was assessed by anterior-posterior and lateral views. The ROC curve provides the prediction of the union. The overall nonunion rate was 10.6% (12 of 113 fractures). Age and diabetes mellitus were statistically significant with nonunion (p value < 0.001). The final analysis demonstrated that any cortical bridging at four months postoperatively was the most accurate and earlier indicator (105 of 113, 92.9% accuracy), while it was 84.9% at six months in bicortical and 80.5% accuracy at nine months in tricortical bridging. Low-cost and simple radiographic imaging presents cortical bridging in any form 4 months after surgery that precisely predicts a union in femoral shaft fractures.
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Affiliation(s)
- Arvin Najafi
- Department of Orthopedic Surgery, Shahid Madani Hospital, Alborz University of Medical Sciences, Karaj, Iran
| | - Parmida Shahbazi
- Department of Orthopedic Surgery, Shahid Madani Hospital, Alborz University of Medical Sciences, Karaj, Iran
| | - Salman Azarsina
- Department of Orthopedic Surgery, Shahid Madani Hospital, Alborz University of Medical Sciences, Karaj, Iran
| | - Danoosh Zargar
- Department of Orthopedic Surgery, Shahid Madani Hospital, Alborz University of Medical Sciences, Karaj, Iran
| | - Mohammad Saeed Kahrizi
- Department of Orthopedic Surgery, Shahid Madani Hospital, Alborz University of Medical Sciences, Karaj, Iran
| | - Dorsa Hadavi
- Department of Orthopedic Surgery, Shahid Madani Hospital, Alborz University of Medical Sciences, Karaj, Iran
| | - Reza Minaei-Noshahr
- Bone, Joint and Related Tissues Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran,Assistant Professor of orthopedic surgery, Bone, Joint and Related Tissues Research Center, Shahid Beheshti University of Medical Sciences, Velenjak St., Shahid Chamran Highway Tehran, Iran. Phone: +98912 857 6268. ORCID iD: 0000-0002-7851-842X
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Shetty S, Nelson B, Knopp B, Schneppendahl J, Kaufmann RA. Strength of Humeral and Ulnar Intramedullary Screw Fixation. J Hand Surg Am 2022; 47:1014.e1-1014.e8. [PMID: 34579980 DOI: 10.1016/j.jhsa.2021.07.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 07/19/2021] [Accepted: 07/21/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE The goal of this study was to test the pullout strength of intramedullary (IM) screws from within the humerus to establish their ability to seat an uncemented elbow arthroplasty. METHODS Six humerus and 6 ulna Sawbones specimens were drilled with a drill bit diameter of 5/16 inches, and the inner cortex was hand tapped for a ⅜-16 thread. A ⅜-16 custom-made titanium screw with an outer bolt diameter of 3/8 inches and 16 threads per inch was inserted by hand into the tapped holes. The specimens were then axially tensile loaded at a rate of 5 mm per minute until either the screw began to pull out from the bone or a fracture was noted. RESULTS Intramedullary screw fixation in the humerus achieved an average pullout strength of 1,439 pound-force (6,401 N), and IM screw fixation in the ulna achieved an average pullout strength of 882 pound-force (3,923 N). A fracture was noted in 3 humeral specimens, with 3 screws pulling out. In the ulna, the IM axial load caused a fracture in 5 specimens, and in 1 specimen, the screw pulled out. CONCLUSIONS Our findings demonstrate that IM screw fixation can create a tensile force within the screw that is greater than that required to generate the calculated level of compression between the implant and bone. CLINICAL RELEVANCE This may be beneficial in ensuring fixation between arthroplasty components and bone.
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Affiliation(s)
- Sameer Shetty
- Department of Orthopedics, University of Pittsburgh Medical Center, Bethel Park, PA
| | | | | | - Johannes Schneppendahl
- Department of Orthopaedics and Trauma Surgery, University of Duesseldorf, Düsseldorf, Germany
| | - Robert A Kaufmann
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA.
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Hernández-Pascual C, Santos-Sánchez JÁ, Hernández-Rodríguez J, Silva-Viamonte CF, Pablos-Hernández C, Villanueva-Martínez M, Mirón-Canelo JA. New Prognostic Factors in Operated Extracapsular Hip Fractures: Infection and GammaTScore. Int J Environ Res Public Health 2022; 19:11680. [PMID: 36141949 PMCID: PMC9517159 DOI: 10.3390/ijerph191811680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Revised: 09/12/2022] [Accepted: 09/14/2022] [Indexed: 06/16/2023]
Abstract
There is no universal postoperative classification of extracapsular hip fractures (ECFs). We wondered if infection (according to infection after fracture fixation criteria (IAFF)), immediate partial weight bearing (PWB) and/or the new GammaTScore tool could predict early cut-out. We also examined the correlation between GammaTScore and time to consolidation and studied long-term survival. This was a retrospective cohort study of low-energy complete ECFs operated with Gamma3T nailing in 2014 and fully monitoring, in patients aged over 65. Ten not distally locked cases, one late cut-out, one cut-through, one osteonecrosis and one pseudarthrosis were discarded. Patients were classified into early cut-out (7/204; 3.55%) and no early cut-out (197/204; 96.45%). There was a lower percentage of A2 fractures according to the AO Foundation/Orthopaedic Trauma Association classification (AO/OTA, 1997) in early cut-out. IAFF and only the GammaTScore reduction parameter were different for early cut-out, in opposition to immediate PWB, tip-to-apex distance (TAD) or the Baumgaertner-Fogagnolo classification. GammaTScore inversely correlated with consolidation (p < 0.01). Long-term survival time was not statistically significantly lower in the early cut-out group. Small sample of cases may limit our results. Apart from an important role of IAFF, GammaTScore would be useful for predicting consolidation, avoiding complications and reducing costs. Further studies are needed for reliability.
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Affiliation(s)
- Carlos Hernández-Pascual
- Department of Human Anatomy and Histology, Faculty of Medicine, Campus Miguel de Unamuno, Universidad de Salamanca, Avda, Alfonso X el Sabio s/n, 37007 Salamanca, Spain
- Department of Traumatology and Orthopaedic Surgery, Hospital Universitario de Salamanca, Pso. San Vicente 58-182, 37004 Salamanca, Spain
| | - José Ángel Santos-Sánchez
- Department of Biomedical and Diagnostic Sciences (Area of Radiology and Physical Medicine), Faculty of Medicine, Campus Miguel de Unamuno, Universidad de Salamanca, Avda, Alfonso X el Sabio s/n, 37007 Salamanca, Spain
| | - Jorge Hernández-Rodríguez
- Department of Biomedical and Diagnostic Sciences (Area of Radiology and Physical Medicine), Faculty of Medicine, Campus Miguel de Unamuno, Universidad de Salamanca, Avda, Alfonso X el Sabio s/n, 37007 Salamanca, Spain
| | - Carlos Fernando Silva-Viamonte
- Department of Statistics, Faculty of Medicine, Campus Miguel de Unamuno, Universidad de Salamanca, Avda, Alfonso X el Sabio s/n, 37007 Salamanca, Spain
| | - Carmen Pablos-Hernández
- Department of Geriatrics, Hospital Universitario de Salamanca, Pso. San Vicente 58-182, 37004 Salamanca, Spain
| | | | - José Antonio Mirón-Canelo
- Department of Preventive Medicine and Public Health, Faculty of Medicine, Campus Miguel de Unamuno, Universidad de Salamanca, Avda, Alfonso X el Sabio s/n, 37007 Salamanca, Spain
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Saini R, Pahwa B, Agrawal D, Singh P, Gurjar H, Mishra S, Jagdevan A, Misra MC. Safety and feasibility of intramedullary injected bone marrow-derived mesenchymal stem cells in acute complete spinal cord injury: phase 1 trial. J Neurosurg Spine 2022; 37:331-338. [PMID: 35395638 DOI: 10.3171/2022.2.spine211021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Accepted: 02/10/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The intramedullary route holds the potential to provide the most concentration of stem cells in cases of spinal cord injury (SCI). However, the safety and feasibility of this route need to be studied in human subjects. The aim of this study was to evaluate the safety and feasibility of intramedullary injected bone marrow-derived mesenchymal stem cells (BM-MSCs) in acute complete SCI. METHODS In this prospective study conducted over a 2-year period, 27 patients with acute (defined as within 1 week of injury) and complete SCI were randomized to receive BM-MSC or placebo through an intramedullary route intraoperatively at the time of spinal decompression and fusion. Institutional ethics approval was obtained, and informed consent was obtained from all patients. Safety was assessed using laboratory and clinicoradiological parameters preoperatively and 3 and 6 months after surgery. RESULTS A total of 180 patients were screened during the study period. Of these, 27 were enrolled in the study. Three patients withdrew, 3 patients were lost to follow-up, and 8 patients died, leaving a total of 13 patients for final analysis. Seven of these patients were in the stem cell group, and 6 were in the control group. Both groups were well matched in terms of sex, age, and weight. No adverse events related to stem cell injection were noted for laboratory and radiological parameters. Five patients in the control group and 3 patients in the stem cell group died during the follow-up period. CONCLUSIONS Intramedullary injection of BM-MSCs was found to be safe and feasible for use in patients with acute complete SCI.
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Affiliation(s)
- Renu Saini
- 1Stem Cell & Translational Neurosciences Laboratory, Department of Neurosurgery, JPNA Trauma Center, All India Institute of Medical Sciences, New Delhi, India; and
| | - Bhavya Pahwa
- 2University College of Medical Sciences and GTB Hospital, Dilshad Garden, Delhi, India
| | - Deepak Agrawal
- 1Stem Cell & Translational Neurosciences Laboratory, Department of Neurosurgery, JPNA Trauma Center, All India Institute of Medical Sciences, New Delhi, India; and
| | - Pankaj Singh
- 1Stem Cell & Translational Neurosciences Laboratory, Department of Neurosurgery, JPNA Trauma Center, All India Institute of Medical Sciences, New Delhi, India; and
| | - Hitesh Gurjar
- 1Stem Cell & Translational Neurosciences Laboratory, Department of Neurosurgery, JPNA Trauma Center, All India Institute of Medical Sciences, New Delhi, India; and
| | - Shashwat Mishra
- 1Stem Cell & Translational Neurosciences Laboratory, Department of Neurosurgery, JPNA Trauma Center, All India Institute of Medical Sciences, New Delhi, India; and
| | - Aman Jagdevan
- 1Stem Cell & Translational Neurosciences Laboratory, Department of Neurosurgery, JPNA Trauma Center, All India Institute of Medical Sciences, New Delhi, India; and
| | - Mahesh Chandra Misra
- 1Stem Cell & Translational Neurosciences Laboratory, Department of Neurosurgery, JPNA Trauma Center, All India Institute of Medical Sciences, New Delhi, India; and
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Yang T, Wu H, Xia C. Adult Intramedullary Pilocytic Astrocytomas: Clinical Features, Management, and Outcomes. Neurol India 2022; 70:S206-S210. [PMID: 36412370 DOI: 10.4103/0028-3886.360936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Purpose Adult intramedullary pilocytic astrocytomas (PAs) are exceedingly rare. The aim of this study was to summarize our experiences in treating adult intramedullary PAs. Materials and Methods We retrospectively reviewed the records of seven adult patients who underwent microsurgery for intramedullary PAs between 2010 and 2017. Magnetic resonance imaging was the standard radiological investigation. The diagnosis of PAs was based on pathology. All the follow-up data were obtained during office visits. Results There were three males and four females with the mean age of 40.9 years. The tumors generally exhibited hypointensity on T1-weighted images (WI) and hyperintensity on T2WI. Contrast-enhanced T1WI showed heterogeneous enhancement. Gross total resection (GTR) of the tumor was achieved in four cases and subtotal resection (STR) was achieved in three cases. Two cases of STR received postoperative radiotherapy. One STR case had mildly residual tumor regrowth. At the last follow-up, neurological status was improved in six patients. Conclusion The accurate diagnosis of adult intramedullary PAs depends on pathology. GTR is the best treatment and the outcome is favorable. STR increases the risk of tumor recurrence, and regular follow-up is necessary. Due to uncertain therapeutic efficacy, radiotherapy should be considered carefully for cases of STR.
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Affiliation(s)
- Tao Yang
- Department of Neurosurgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China
| | - HaiBo Wu
- Department of Neuropathology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China
| | - ChengYu Xia
- Department of Neurosurgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China
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Hersh AM, Patel J, Pennington Z, Porras JL, Goldsborough E, Antar A, Elsamadicy AA, Lubelski D, Wolinsky JP, Jallo G, Gokaslan ZL, Lo SFL, Sciubba DM. Perioperative outcomes and survival after surgery for intramedullary spinal cord tumors: a single-institution series of 302 patients. J Neurosurg Spine 2022; 37:252-262. [PMID: 35213831 DOI: 10.3171/2022.1.spine211235] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 01/03/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Intramedullary spinal cord tumors (IMSCTs) are rare neoplasms whose treatment is often technically challenging. Given the low volume seen at most centers, perioperative outcomes have been reported infrequently. Here, the authors present the largest single-institution series of IMSCTs, focusing on the clinical presentation, histological makeup, perioperative outcomes, and long-term survival of surgically treated patients. METHODS A cohort of patients operated on for primary IMSCTs at a comprehensive cancer center between June 2002 and May 2020 was retrospectively identified. Data on patient demographics, tumor histology, neuraxial location, baseline neurological status, functional deficits, and operative characteristics were collected. Perioperative outcomes of interest included length of stay, postoperative complications, readmission, reoperation, and discharge disposition. Data were compared across tumor histologies using the Kruskal-Wallis H test, chi-square test, and Fisher exact test. Pairwise comparisons were conducted using Tukey's honest significant difference test, chi-square test, and Fisher exact test. Long-term survival was assessed across tumor categories and histological subtype using the log-rank test. RESULTS Three hundred two patients were included in the study (mean age 34.9 ± 19 years, 77% white, 57% male). The most common tumors were ependymomas (47%), astrocytomas (31%), and hemangioblastomas (11%). Ependymomas and hemangioblastomas disproportionately localized to the cervical cord (54% and 59%, respectively), whereas astrocytomas were distributed almost equally between the cervical cord (36%) and thoracic cord (38%). Clinical presentation, extent of functional dependence, and postoperative 30-day outcomes were largely independent of underlying tumor pathology, although tumors of the thoracic cord had worse American Spinal Injury Association (ASIA) grades than cervical tumors. Rates of gross-total resection were lower for astrocytomas than for ependymomas (54% vs 84%, p < 0.01) and hemangioblastomas (54% vs 100%, p < 0.01). Additionally, 30-day readmission rates were significantly higher for astrocytomas than ependymomas (14% vs 6%, p = 0.02). Overall survival was significantly affected by the underlying pathology, with astrocytomas having poorer associated prognoses (40% at 15 years) than ependymomas (81%) and hemangioblastomas (66%; p < 0.01) and patients with high-grade ependymomas and astrocytomas having poorer long-term survival than those with low-grade lesions (p < 0.01). CONCLUSIONS The neuraxial location of IMSCTs, extent of resection, and postoperative survival differed significantly across tumor pathologies. However, perioperative outcomes did not vary significantly across tumor cohorts, suggesting that operative details, rather than pathology, may have a stronger influence on the short-term clinical course, whereas pathology appears to have a stronger impact on long-term survival.
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Affiliation(s)
- Andrew M Hersh
- 1Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jaimin Patel
- 1Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Zach Pennington
- 2Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota
| | - Jose L Porras
- 1Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Earl Goldsborough
- 1Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Albert Antar
- 1Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Daniel Lubelski
- 1Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jean-Paul Wolinsky
- 4Department of Neurological Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - George Jallo
- 5Department of Neurosurgery, Johns Hopkins Medicine, Institute for Brain Protection Sciences, Johns Hopkins All Children's Hospital, St. Petersburg, Florida
| | - Ziya L Gokaslan
- 6Department of Neurosurgery, Brown University, Providence, Rhode Island; and
| | - Sheng-Fu Larry Lo
- 7Department of Neurosurgery, Donald and Barbara Zucker School of Medicine at Hofstra, Long Island Jewish Medical Center and North Shore University Hospital, Northwell Health, Manhasset, New York
| | - Daniel M Sciubba
- 1Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
- 7Department of Neurosurgery, Donald and Barbara Zucker School of Medicine at Hofstra, Long Island Jewish Medical Center and North Shore University Hospital, Northwell Health, Manhasset, New York
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Mousavi SR, Farrokhi MR, Eghbal K, Dehghanian A, Rezvani A, Ghaffarpasand F. Metastatic thoracic and lumbar intramedullary and extramedullary Ewing's sarcoma: a rare case report and literature review. J Int Med Res 2022; 50:3000605221108095. [PMID: 35938475 PMCID: PMC9364211 DOI: 10.1177/03000605221108095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Ewing sarcoma (ES) is a highly aggressive bone and soft tissue tumor that occurs
mainly in young children and adolescents and is associated with primary and
metastatic disease. Intramedullary ES (either primary or secondary) is rare, and
the ideal management remains inconclusive. We herein report intramedullary and
extramedullary metastatic ES in a single patient. A 46-year-old woman was
referred to our outpatient clinic from the oncology clinic with progressive
paraparesis and paresthesia for 1 week prior to presentation. She had developed
left clavicular ES 2 years earlier for which surgery and chemoradiotherapy had
been performed. At the present evaluation, she was diagnosed with intramedullary
thoracic and lumbar extradural masses. Thoracic surgery was performed, and a
biopsy of the lesion was obtained. The diagnosis of ES was confirmed
histopathologically, and she underwent adjuvant chemotherapy. Her neurological
status did not improve after surgery, and she underwent rehabilitation and
physical therapy. The lumbar lesion resolved with chemotherapy. Metastasis of ES
to the spinal cord, especially intramedullary lesions, is extremely rare, and
there is no standard management guideline. However, surgical decompression and
adjuvant chemotherapy are the main treatments in these cases.
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Affiliation(s)
- Seyed Reza Mousavi
- Department of Neurosurgery, 48435Shiraz University of Medical Sciences, Shiraz, Iran
| | - Majid Reza Farrokhi
- Shiraz Neurosciences Research Center, Department of Neurosurgery, 48435Shiraz University of Medical Sciences, Shiraz, Iran
| | - Keyvan Eghbal
- Department of Neurosurgery, 48435Shiraz University of Medical Sciences, Shiraz, Iran
| | - Amirreza Dehghanian
- Trauma research center, Shiraz University of Medical Sciences, Shiraz, Iran.,Department of Pathology, 48435Shiraz University of Medical Sciences, Shiraz, Iran
| | - Alireza Rezvani
- Hematology Research Center, Shiraz University of Medical Science, Shiraz, Iran
| | - Fariborz Ghaffarpasand
- Research Center for Neuromodulation and Pain, 48435Shiraz University of Medical Sciences, Shiraz, Iran
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Zhao Z, Zheng J, Zhou Y. Intradural extramedullary capillary hemangioma with intramedullary component: A case series. Medicine (Baltimore) 2022; 101:e29862. [PMID: 35905223 PMCID: PMC9333478 DOI: 10.1097/md.0000000000029862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
RATIONALE Capillary hemangioma in the spinal cord is an exceedingly rare entity that is liable to be misdiagnosed. To summarize the clinical presentation, radiological characteristics, and pathological features of capillary hemangioma in the spinal cord and to share our experience for the diagnosis and treatment of intradural extramedullary capillary hemangioma. PATIENT CONCERNS Three patients underwent surgical treatment at our hospital between January 2020 and August 2020. All patients were male[median age at presentation: 57 years (range: 56-60)]. Two patients were experiencing pain and numbness in the lower back, and 1 patient was experiencing numbness and weakness in the left lower limb. The duration of symptoms ranged from 1 to 5 months. DIAGNOSIS All patients were diagnosed with spinal cord capillary hemangioma after treatment. All lesions were in an intradural extramedullary location and involved spinal cord components. Two patients had lesions in thoracic segments (T8, Th9-10), and 1 patient had a lesion in lumbar segment (L1). INTERVENTIONS All patients underwent microscopic laminectomy and complete resection of the extramedullary and intramedullary components of the spinal cord capillary hemangiomas. OUTCOMES Postoperatively, all patients experienced transient numbness and pain in the lower limbs, which gradually decreased over time. None of the patients experienced bleeding, severe numbness or pain, or recurrence of symptoms at 3-month follow-up. CONCLUSION Intradural extramedullary capillary hemangioma has unique morphological characteristics. Gross-total resection of the extramedullary and intramedullary components of spinal cord capillary hemangioma is recommended for patients with symptoms of spinal cord compression. Careful preoperative imaging and intraoperative decision-making may help avoid residual lesions or reoperation.
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Affiliation(s)
- Zhen Zhao
- Department of Neurosurgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Jin Zheng
- Department of Neurosurgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Yingchun Zhou
- Department of Neurosurgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
- * Correspondence: Yingchun Zhou, MD, No. 1277, Jiefang Street, Jianghan District, Wuhan 430022, China (e-mail: )
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Abstract
Background: The use of retrograde intramedullary headless compression screw fixation for metacarpal neck and shaft fractures has been described in the literature. The purpose of this study was to perform a computed tomography (CT)-based morphological analysis of metacarpal size to help surgeons anticipate expected hardware needs. Methods: In all, 108 consecutive hand CT scans were evaluated for the medullary diameter in the volar-dorsal and radial-ulnar planes at the narrowest point of the canal, as well as for the distance from the articular surface to this point. Results were then analyzed by finger and by sex. Results: The ring finger had the smallest average medullary canal diameter for both men and women (2.7 and 2.6 mm, respectively); the small finger had the largest average diameter (3.9 mm) for men and the middle finger (3.6 mm) for women. Radial-ulnar was the rate-limiting dimension in the index, middle, and ring fingers, whereas volar-dorsal was the smallest dimension in the small finger, regardless of sex. Medullary diameter tended to be larger in patients aged more than 50 years. More than 50% of fingers have diameters >3.0 mm, and at least 40% of index, middle, and small fingers have diameters >3.5 mm, which are common diameters of commercially available headless compression screws. Conclusions: When preparing to perform open reduction internal fixation of a metacarpal using retrograde intramedullary headless compression screws, the surgeon needs to be prepared with screws of larger diameters to optimize fixation. Screws of larger diameters are needed to achieve endosteal purchase, regardless of sex.
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Affiliation(s)
| | - Xavier Candela
- Penn State Health Milton S. Hershey Medical Center, PA, USA
| | - Michael Darowish
- Penn State Health Milton S. Hershey Medical Center, PA, USA,Michael Darowish, Department of Orthopaedics, Penn State Health Milton S. Hershey Medical Center, 30 Hope Drive, Suite 2400, Building B, PO Box 859, Hershey, PA 17033, USA.
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Cristiani-Winer M, Allende-Nores C, Paganini F, Gutiérrez N. [Bone revascularization: structural allograft intramedullary vs extramedullary. Experimental work]. Acta Ortop Mex 2022; 36:223-229. [PMID: 36977641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 03/30/2023]
Abstract
INTRODUCTION successful treatment in patients with significant bone defects secondary to infection, non-union and osteoporotic fractures resulting from previous trauma is challenging. In the current literature we did not find any reports that compare the use of intramedullary allograft boards versus the same ones placed lateral to the lesion. MATERIAL AND METHODS we worked on a sample of 20 rabbits (2 groups of 10 rabbits each). Group 1 underwent surgery using the extramedullary allograft placement technique, while group 2 with the intramedullary technique. Four months after surgery, imaging and histology studies were performed to compare between groups. RESULTS the analysis of the imaging studies showed a statistically significant difference between both groups with greater resorption and bone integration of the intramedullary placed allograft. Regarding histology, there were no statistically significant differences, but there was a significant prediction with a p value < 0.10 in favor of the intramedullary allograft. CONCLUSION through our work we were able to show the great difference between the allograft placement technique with respect to imaging and histological analysis using revascularization markers. Although the intramedullary placed allograft shows us greater bone integration, the extramedullary graft will provide more support and structure in patients who require it.
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Affiliation(s)
- M Cristiani-Winer
- Instituto Allende de Cirugía Reconstructiva. Sanatorio Allende, Córdoba, Argentina
| | - C Allende-Nores
- Instituto Allende de Cirugía Reconstructiva. Sanatorio Allende, Córdoba, Argentina
| | - F Paganini
- Instituto Allende de Cirugía Reconstructiva. Sanatorio Allende, Córdoba, Argentina
| | - N Gutiérrez
- Instituto Allende de Cirugía Reconstructiva. Sanatorio Allende, Córdoba, Argentina
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Apra C, El Arbi A, Montero AS, Parker F, Knafo S. Spinal Solitary Fibrous Tumors: An Original Multicenter Series and Systematic Review of Presentation, Management, and Prognosis. Cancers (Basel) 2022; 14:cancers14122839. [PMID: 35740510 PMCID: PMC9221085 DOI: 10.3390/cancers14122839] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 05/28/2022] [Accepted: 06/02/2022] [Indexed: 02/06/2023] Open
Abstract
All solitary fibrous tumors (SFT), now histologically diagnosed by a positive nuclear STAT6 immunostaining, represent less than 2% of soft tissue sarcomas, with spinal SFT constituting a maximum of 2% of them, making these tumors extremely rare. We provide an up-to-date overview of their diagnosis, treatment, and prognosis. We included 10 primary STAT6-positive SFT from our retrospective cohort and 31 from a systematic review. Spinal pain was the most common symptom, in 69% of patients, and the only one in 34%, followed by spinal cord compression in 41%, radicular compression, including pain or deficit, in 36%, and urinary dysfunction specifically in 18%. Preoperative diagnosis was never obtained. Gross total resection was achieved in 71%, in the absence of spinal cord invasion or excessive bleeding. Histologically, they were 35% grade I, 25% grade II, and 40% grade III. Recurrence was observed in 43% after a mean 5.8 years (1 to 25). No significant risk factor was identified, but adjuvant radiotherapy improved the recurrence-free survival after subtotal resection. In conclusion, spinal SFT must be treated by neurosurgeons as part of a multidisciplinary team. Owing to their close relationship with the spinal cord, radiotherapy should be considered when gross total resection cannot be achieved, to lower the risk of recurrence.
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Affiliation(s)
- Caroline Apra
- Sorbonne Université, 75013 Paris, France;
- Neurosurgery Department, Pitie Salpêtrière Hospital, 75013 Paris, France
- Correspondence: (C.A.); (S.K.)
| | - Amira El Arbi
- Neurosurgery Department, Bicêtre Hospital, 94270 Kremlin-Bicêtre, France; (A.E.A.); (F.P.)
| | - Anne-Sophie Montero
- Sorbonne Université, 75013 Paris, France;
- Neurosurgery Department, Pitie Salpêtrière Hospital, 75013 Paris, France
| | - Fabrice Parker
- Neurosurgery Department, Bicêtre Hospital, 94270 Kremlin-Bicêtre, France; (A.E.A.); (F.P.)
- University Paris-Saclay, 91190 Gif-sur-Yvette, France
| | - Steven Knafo
- Neurosurgery Department, Bicêtre Hospital, 94270 Kremlin-Bicêtre, France; (A.E.A.); (F.P.)
- University Paris-Saclay, 91190 Gif-sur-Yvette, France
- Correspondence: (C.A.); (S.K.)
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Abstract
BACKGROUND To determine the clinical outcomes following fibula nail fixation and to identify the indication for the use of fibula nails in lower limb fractures. METHODS Retrospective study of adult patients from 2 major trauma centers (MTCs) and 9 trauma units (TUs) who underwent fibula nail fixation for AO/OTA 44 fractures between January 1, 2018, and October 31, 2020. Outcome measures included infection, metalwork complications, nonunion or malunion, time to union, and length of inpatient hospital stay. RESULTS Ninety-five patients were included, with a mean age of 66 years; 57.9% of patients were female. The average body mass index was 30. Sixty-nine patients (72.6%) sustained a Weber B and 24 (27.4%) sustained a Weber C fracture. In addition, 26.3% were open fractures and all patients had soft tissue compromise affecting the lateral malleolus. The calculated infection rate for fibula nail was 4.2% and metalwork complication rate was 5.2%. The nonunion and malunion rate was 8.4% and rate of removal of hardware was 2.1%. The average time to union was 12.5 weeks, and length of inpatient stay was 9.4 days (SD 10). CONCLUSION This multicenter study demonstrates that use of a fibula nail appears to be a safe approach to treating patients who have a physiologically higher risk of surgery, poor skin condition, and a complex fracture pattern. LEVEL OF EVIDENCE Level III, case-control study.
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Affiliation(s)
- Maryam Ahmed
- University Hospitals Sussex, Brighton, United Kingdom
| | - Andrew Barrie
- University Hospitals Sussex, Brighton, United Kingdom
| | | | | | - Sebastian Ho
- Croydon University Hospital, Thornton Heath, United Kingdom
| | | | - Enis Guryel
- University Hospitals Sussex, Brighton, United Kingdom
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Nakamae T, Kamei N, Tanaka N, Nakanishi K, Tsuchikawa Y, Harada T, Maruyama T, Adachi N. Primary Spinal Cord Melanoma: A Two-Case Report and Literature Review. Spine Surg Relat Res 2022; 6:717-720. [PMID: 36561164 PMCID: PMC9747206 DOI: 10.22603/ssrr.2022-0024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 03/05/2022] [Indexed: 12/25/2022] Open
Affiliation(s)
- Toshio Nakamae
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Naosuke Kamei
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Nobuhiro Tanaka
- Department of Orthopaedic Surgery, JR Hiroshima Hospital, Hiroshima, Japan
| | - Kazuyoshi Nakanishi
- Department of Orthopedic Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Yuji Tsuchikawa
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Takahiro Harada
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Toshiaki Maruyama
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Nobuo Adachi
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
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Okoli M, Chatterji R, Ilyas A, Kirkpatrick W, Abboudi J, Jones CM. Intramedullary Headless Screw Fixation of Metacarpal Fractures: A Radiographic Analysis for Optimal Screw Choice. Hand (N Y) 2022; 17:245-253. [PMID: 32432499 PMCID: PMC8984717 DOI: 10.1177/1558944720919897] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
Background: The purpose of this study was to investigate variations in radiographic metacarpal anatomy as it relates to intramedullary (IM) fixation of metacarpal fractures and to compare this anatomy with available headless screw dimensions. Methods: We radiographically analyzed posteroanterior and lateral (LAT) radiographs of 120 metacarpals across 30 patients without structural abnormalities. Primary outcomes included IM isthmus diameter, isthmus location, metacarpal cascade, and head entry point collinear with IM canal. Measurements were compared with a list of commercially available headless screws used for IM fixation. Results: The average largest isthmus diameter was in the small metacarpal (3.4 mm), followed by the index (2.8 mm), long (2.7 mm), and ring (2.7 mm) metacarpals. The average cascade angle between long and index, long and ring, and long and small metacarpals was 0°, 24°, and 27°, respectively. The appropriate head entry point ranged between 25% and 35% from the dorsal surface of the metacarpal head on a LAT view. The retrograde isthmus location of the index and long finger was 39.2 and 38.1 mm, respectively. Twenty-five screws from 7 manufacturers were analyzed with sizes ranging from 1.7 to 4.5 mm. Only 8 of 17 screws between 2.3 and 3.5 mm had a length range above 35 mm. Conclusions: Metacarpal head entry point and cascade angle can help identify the appropriate reduction with the guide pin starting point in the dorsal 25% to 35% of the metacarpal head. Surgeons should be mindful to choose the appropriate fixation system in light of the variations between metacarpal isthmus size, isthmus location, and available screw lengths.
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Affiliation(s)
- Michael Okoli
- Sidney Kimmel Medical College,
Philadelphia, PA, USA,Thomas Jefferson University Hospital,
Philadelphia, PA, USA,Bryn Mawr Hospital, PA, USA,The Rothman Institute, Philadelphia, PA,
USA
| | - Rishi Chatterji
- Sidney Kimmel Medical College,
Philadelphia, PA, USA,Thomas Jefferson University Hospital,
Philadelphia, PA, USA
| | - Asif Ilyas
- Sidney Kimmel Medical College,
Philadelphia, PA, USA,Thomas Jefferson University Hospital,
Philadelphia, PA, USA,Bryn Mawr Hospital, PA, USA,The Rothman Institute, Philadelphia, PA,
USA
| | | | - Jack Abboudi
- Bryn Mawr Hospital, PA, USA,The Rothman Institute, Philadelphia, PA,
USA
| | - Christopher M. Jones
- Sidney Kimmel Medical College,
Philadelphia, PA, USA,Thomas Jefferson University Hospital,
Philadelphia, PA, USA,Bryn Mawr Hospital, PA, USA,The Rothman Institute, Philadelphia, PA,
USA,Christopher M. Jones, 825 Old Lancaster
Road, Suite140, Bryn Mawr, PA 19010, USA.
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