Removal Rate of the Tomofix® System after High Tibial Osteotomy is Higher Than Reported / A taxa de remoção do sistema Tomofix® após a osteotomia tibial alta é superior à relatada

Abstract Objective Medial open wedge high tibial osteotomy (MOWHTO) significantly relieves pain in the medial joint line in medial compartment osteoarthritis of the knee. But some patients complain of pain over the pes anserinus even 1 year after the osteotomy, which may require implant removal for relief. This study aims to define the implant removal rate after MOWHTO due to pain over the pes anserinus. Methods One hundred and three knees of 72 patients who underwent MOWHTO for medial compartment osteoarthritis between 2010 and 2018 were enrolled in the study. Knee injury and osteoarthritis outcome score (KOOS), Oxford knee score (OKS), and visual analogue score (VAS) were assessed for pain in the medial knee joint line (VAS-MJ) preoperatively, 12 months postoperatively, and yearly thereafter; adding VAS for pain over the pes anserinus (VAS-PA). Patients with VAS-PA ≥ 40 and adequate bony consolidation after 12 months were recommended implant removal. Results Thirty-three (45.8%) of the patients were male and 39 (54.2%) were female. The mean age was 49.4 ± 8.0 and the mean body mass index was 27.0 ± 2.9. The Tomofix medial tibial plate-screw system (DePuy Synthes, Raynham, MA, USA) was used in all cases. Three (2.8%) cases with delayed union requiring revision were excluded. The KOOS, OKS, and VAS-MJ significantly improved 12 months after MOWHTO. The mean VAS-PA was 38.3 ± 23.9. Implant removal for pain relief was needed in 65 (63.1%) of the103 knees. The mean VAS-PA decreased to 4.5 ± 5.6 3 months after implant removal (p < 0.0001). Conclusion Over 60% of the patients may need implant removal to relieve pain over the pes anserinus after MOWHTO. Candidates for MOWHTO should be informed about this complication and its solution.

Resumo Objetivo A osteotomia tibial alta com cunha de abertura medial (MOWHTO, do inglês medial open wedge high tibial osteotomy) alivia de forma significativa a dor na linha articular medial em casos de osteoartrite do compartimento medial do joelho. Alguns pacientes, porém, se queixam de dor nos tendões dos músculos sartório, grácil e semitendinoso (pata de ganso) mesmo 1 ano após a osteotomia, o que pode exigir a remoção do implante. Este estudo define a taxa de remoção do implante após a MOWHTO devido à dor nos tendões dos músculos sartório, grácil e semitendinoso. Métodos Cento e três joelhos de 72 pacientes submetidos à MOWHTO para tratamento da osteoartrite do compartimento medial entre 2010 e 2018 foram incluídos no estudo. A pontuação de desfecho de lesão no joelho e osteoartrite (KOOS, do inglês Knee Injury and Osteoarthritis Outcome Score), a pontuação dejoelho de Oxford (OKS, do inglês Oxford Knee Score) e a escala visual analógica (EVA) de dor na linha articular medial do joelho (EVA-MJ) foram avaliados antes da cirurgia. A EVA nos tendões dos músculos sartório, grácil e semitendinoso (EVA-PA) foi adicionada a essas avaliações, também realizadas 12 meses após o procedimento e, a seguir, anualmente. A remoção do implante foi recomendada em pacientes com EVA-PA ≥ 40 e consolidação óssea adequada em 12 meses. Resultados Trinta e três (45,8%) pacientes eram homens e 39 (54,2%), mulheres. A média de idade foi de 49,4 ±8,0, e o índice de massa corpórea (IMC) médio foi de 27,0 ± 2,9. O sistema placa-parafuso tibial medial Tomofix (DePuy Synthes, Raynham, MA, EUA) foi utilizado em todos os casos. Três (2,8%) casos foram excluídos devido ao retardo de consolidação e à necessidade de revisão. Os resultados nas escalas KOOS, OKS e EVA-MJ melhoraram significativamente 12 meses após a MOWHTO. A EVA-PA média foi de 38,3 ± 23,9. A remoção do implante para alívio da dor foi necessária em 65 (63,1%) dos 103 joelhos. Três meses após a remoção do implante, a EVA-PA média diminuiu para 4,5 ± 5,6 (p < 0,0001). Conclusão A remoção do implante pode ser necessária em mais de 60% dos pacientes para alívio da dor nos tendões dos músculos sartório, grácil e semitendinoso após a MOWHTO. Os candidatos à MOWHTO devem ser informados sobre esta complicação e sua resolução.

Intravenous malposition of double J stent: a case report and literature review / 现代泌尿外科杂志

【Objective】 To investigate the causes of intravenous malposition of double J stent and treatment strategies, in order to improve clinicians’ awareness of this complication. 【Methods】 Clinical data of a patient with intravenous malposition of double J stent were analyzed and relevant literature was reviewed. 【Results】 A 51-year-old female was admitted with post-hysterectomy urinary fistula and diagnosed with right intravenous malposition of double J stent and ureterovaginal fistula. Da Vinci robot-assisted laparoscopic right double J stent removal and ureteral reimplantation were performed. 【Conclusion】 Intravenous malposition is a rare and life threatening complication of double J stent placement, which can migrate further. The surgical method should be selected according to the location of the stent and general condition of the patients. Minimally invasive surgery is the first choice of treatment.

Application of our self-made Kirschner wire connecting rod in difficult extraction of intramedullary implants / 中华创伤骨科杂志

Objective:To report the application of our self-made Kirschner wire connecting rod combined with a conventional intramedullary nail extractor in difficult extraction of intramedullary devices.Methods:From January 2012 to August 2017, 10 patients with a hard-to-remove intramedullary device were treated at Department of Orthopaedics, The Fifth Hospital Affiliated to Xinjiang Medical University. They were 7 males and 3 females with a mean age of (40.0±9.0) years. In cases where no relevant extractor was available for the intramedullary device or it was impossible to connect the extractor connecting rod to the tail of the intramedullary device, the Kirschner wire was bent and pulled through the screw hole or the hole newly drilled at the tail of the intramedullary device to be tied or fixed with a conventional extractor connecting rod to form an effective connection. Next, our self-made Kirschner wire connecting rod was used to pull out the intramedullary device. In this cohort, 7 intramedullary nails in the tibia, 1 femoral intramedullary nail, 1 humeral intramedullary nail, and 1 tibial elastic nail were removed. The difficult extraction was due to "cold welding" of the tail cap of the intramedullary nail in 3 cases, mismatch between the screw rod of the extractor and the tail screw hole of the intramedullary nail in 4 cases, and unavailability of relevant removal tools in 3 cases. The time for intramedullary device removal, blood loss and postoperative adverse reactions were recorded.Results:Of this cohort, 9 patients underwent simple removal of the intramedullary device and 1 patient replacement of the intramedullary device. The total time for removal of an intramedullary device was (2.3±0.8) h, ranging from 1.0 to 3.2 h. The amount of blood loss was (159.0±61.0) mL, ranging from 80 to 250 mL. The follow-up was (14.5±2.2) months, ranging from 11 to 18 months. There was no infection or fracture associated with implant removal.Conclusion:Application of our self-made Kirschner wire connecting rod in combination with a conventional intramedullary nail extractor is an easy operation to successfully extract hard-to-remove intramedullary implants, requiring no more special instruments.

Clinical Predictors of Postintubation Bilateral Vocal Fold Immobility

Abstract Introduction Iatrogenic bilateral vocal fold immobility (BVFI) often arises from posterior glottic stenosis (PGS) after endotracheal intubation, whereby posterior commissure mucosal disruption leads to fibrosis and ankylosis of the cricoarytenoid joints. Sequelae can be devastating, resulting in dyspnea, stridor, and death due to asphyxiation. Objectives We sought to review features associated with PGS to better understand how to prevent this condition. A secondary aim is to analyze factors correlating to tracheostomy dependence. Methods Charts from January 2010 to November 2020 were retrospectively reviewed, and adult patients with the diagnosis of BVFI after intubation were included. Data on comorbidities, duration of intubation, laryngoscopy, and decannulation status was analyzed. Results Out of the 68 patients included in the present study, 60.3% were male, and the mean duration of intubation 14.3 ± 8.5 days. A total of 94% of the patients were intubated for at least 7 days, diabetic, and/or obese. Although association with prolonged intubation >7 days was not significant (p = 0.064), complete BVFI on fiberoptic exam (n = 47) was significantly associated with tracheostomy dependence both in the entire cohort (p = 0.036) and in the 56 patients with tracheostomy (p = 0.0086). Patients without cardiovascular disease (CVD) were less likely to be tracheostomy dependent compared with those with CVD (odds ratio [OR]: 0.23 [0.053-0.79]; p = 0.028). Conclusions We identified duration of intubation, DM, and obesity as potential risk factors for PGS. Complete immobility and CVD were significantly associated with tracheostomy dependence. Our findings may have important implications for earlier tracheostomy in high-risk intubated patients, as well as for closer monitoring of disease progression and earlier intervention in those predisposed to tracheostomy dependence.

Clinical application of local anesthesia for TiRobot-assisted removal of sacroiliac screws / 中华创伤骨科杂志

Objective:To explore the feasibility and advantages and disadvantages of local anesthesia for TiRobot-assisted removal of sacroiliac screws by comparison with general anesthesia for TiRobot-assisted removal of sacroiliac screws.Methods:A retrospective study was performed in 39 patients with posterior pelvic ring fracture-dislocation who had undergone removal of percutaneous sacroiliac screws after fracture union from January 2017 to December 2020 at Department of Orthopaedic Surgery, Hospital Affiliated to Chengdu University. Their sacroiliac screws were removed with TiRobot assistance under local anesthesia (LA group) or general anesthesia (GA group). In the LA group of 18 cases, there were 10 males and 8 females, aged (43.3 ± 8.4) years (from 25 to 58 years); in the GA group of 21 cases, there were 12 males and 9 females, aged (44.9 ± 9.0) years (from 23 to 60 years). The 2 groups were compared in terms of time for planning screw removal path, fluoroscopy frequency, fluoroscopy time, operation time, anesthesia time, anesthesia cost, postoperative visual analogue scale (VAS) and postoperative ambulation time.Results:There was no statistically significant difference in baseline data between the 2 groups, showing comparability ( P>0.05). Follow-ups revealed grade A wound healing in all patients. There were no significant differences between the 2 groups in time for planning screw removal path, fluoroscopy frequency, fluoroscopy time or operation time ( P>0.05). The anesthesia time [(41.6 ± 8.3) min], anesthesia cost [(653.5 ± 102.6) yuan] and postoperative ambulation time [(2.6 ± 0.6) h] in the LA group were significantly less than those in the GA group [(52.3 ± 9.5) min, (2,475.6 ± 261.8) yuan and (8.7 ± 2.4) h] while the VAS score in the former group (3.8 ± 1.5) was significantly higher than that in the latter group (2.5 ± 1.3) (all P<0.05). Conclusions:It is feasible to use local anesthesia for TiRobot-assisted removal of sacroiliac screws. In TiRobot-assisted removal of sacroiliac screws, compared with general anesthesia, local anesthesia may lead to shorter anesthesia time, lower anesthesia cast and shorter ambulation time, but the patients need to be compliant enough.

Energy Required for Fracture in Synthetic Proximal Femoral Models After Synthesis Material Removal: a Biomechanical Study Using Cannulated Screws, Dynamic Hip Screws, and Proximal Femoral Nails / Energia necessária para a ocorrência de fratura em modelos sintéticos de fêmur proximal após retirada de material de síntese: Um estudo biomecânico com parafuso canulado, parafuso dinâmico do quadril e haste femoral proximal

Abstract Objective The present study aims to identify the energy required for synthetic proximal femoral fracture after removal of three implant types: cannulated screws, dynamic hip screws (DHS), and proximal femoral nail (PFN). Methods Twenty-five synthetic proximal femur bones were used: 10 were kept intact as the control group (CG), 5 were submitted to the placement and removal of 3 cannulated screws in an inverted triangle configuration (CSG), 5 were submitted to the placement and removal of a dynamic compression screw (DHSG), and 5 were submitted to the placement and removal of a proximal femur nail (PFNG). All samples were biomechanically analyzed simulating a fall on the greater trochanter using a servo-hydraulic machine to determine the energy (in Joules [J]) required for fracture. Results All samples presented basicervical fractures. The energy required for fracture was 7.1 J, 6.6 J, 6 J, and 6.7 J for the CG, CSG, DHSG and PFNG, respectively. There was no statistically significant difference (considering a 95% confidence interval) in energy among the study groups (p = 0.34). Conclusion There was no statistically significant difference in the energy required to cause a synthetic proximal femoral fracture after removing all three implant types and simulating a fall over the greater trochanter.

Resumo Objetivo Identificar a energia necessária para ocorrência de fratura do fêmur proximal em osso sintético após retirada de três modelos de implantes: parafusos canulados, parafuso dinâmico do quadril (dynamic hip screw-DHS) e haste femoral proximal (proximal femoral nail-PFN). Métodos Foram utilizados 25 modelos de ossos sintéticos da extremidade proximal do fêmur: 10 unidades de grupo controle (GC), 5 unidades após colocação e retirada de 3 parafusos canulados colocados em configuração de triângulo invertido (GPC), 5 unidades após colocação e retirada do parafuso de compressão dinâmico (GDHS), e 5 unidades após colocação e retirada da haste de fêmur proximal (GPFN). Uma análise biomecânica foi realizada em todas as amostras simulando uma queda sobre o grande trocânter utilizando uma máquina servo-hidráulica com o objetivo de verificar a energia (em Joules [J]) necessária até a ocorrência de fratura nos diferentes grupos. Resultados Todos os grupos apresentaram fratura basocervical. Os grupos GC, GPC, GDHS e GPFN apresentaram, respectivamente, valores de 7.1J, 6.6J, 6J e 6.7J de energia até ocorrência da fratura. Não houve diferença estatisticamente significativa (intervalo de confiança de 95%) na energia entre os grupos de estudo (p = 0,34). Conclusão Não houve diferença estatisticamente significativa nos valores de energia necessária para ocorrência de fratura da extremidade proximal do fêmur após a retirada de três tipos de implantes utilizando modelos sintéticos simulando queda sobre o grande trocânter.

Prevalencia y factores asociados al abandono del implante subdérmico de Etonogestrel, Azogues, Ecuador, 2014-2017 / Prevalence and associated factors of subdermal Etonogestrel implant discontinuation, Azogues, Ecuador, 2014-2017

INTRODUCCIÓN: El plan nacional de reducción de muerte materna y neonatal considera a la pla-nificación familiar como una de las mejores tácticas para reducir los embarazos no deseados, los abortos no terapéuticos y las muertes maternas; en este sentido el abandono precoz del implante subdérmico de Etonogestrel constituye un problema de salud pública. El objetivo de este estudio es determinar la prevalencia y factores asociados al abandono del implante subdérmico de Etonoges-trel en pacientes atendidas en el Distrito de salud 03D01 de Azogues, durante el 2014-2017. MATERIALES y MÉTODOS: Estudio observacional, descriptivo, transversal. El universo estuvo cons-tituido por todas las usuarias del implante subdérmico de Etonogestrel, la muestra incluyó 234 pacientes, seleccionada de forma aleatoria simple. Los datos se obtuvieron y se analizaron con el Software SPSS, versión 2015. La asociación significativa fue considerada con valor de p < 0.005. RESULTADOS: La edad de la población en estudio fluctuó entre 13 y 46 años, el 58.5 % eran casadas, el 49.1 % residían en el área urbana. La prevalencia de retiro precoz del implante fue del 33.3% [IC 95 % 26.98 ­ 39.02] y estuvo asociado a alteraciones del sangrado menstrual que afectan la calidad de vida [RP 3.9; IC 95 % 3.1 ­ 5.0; p < 0.001 ], incremento de peso > 10 Kg [RP 3.5; IC 95 % 2.8 ­ 4.0; p < 0.001], cefalea intensa [ RP 3.7; IC 95 % 3.0 ­ 5.0; p < 0.001], dolor en el sitio de inserción [RP 3.1; IC 95 % 2.6 - 4.0; p 0.004] y deseo de embarazo [RP 3.3; IC 95 % 2.7 ­ 4.0; p < 0.001]. CONCLUSIÓN: La prevalencia de abandono precoz del implante subdérmico de Etonogestrel en nuestro medio es del 33.3% y está asociado a la presencia de efectos no deseados del mismo.

BACKGROUND: The national plan for maternal and neonatal death reduction considers birth control as one of the best methods to reduce unwanted pregnancies, non-therapeutic abortions and maternal deaths, in this way the discontinuation of subdermal Etonorgestrel implant is a public health issue. The aim of this study is to determine the prevalence and associated factors of contraceptive discontinua-tion, of subdermal Etonorgestrel implant, in patients from Azogues (03D01 Health District), from 2014 to 2017. METHODOlOGY: Observational, descriptive, cross-sectional study. The study universe included all sub-dermal Etonorgestrel implant users, the study sample included 234 patients, selected by simple ran-dom sampling. The data was obtained and analyzed with the SPSS Software, 2015 version. Significant association was considered with a value of p < 0.005. RESUlTS:The sample age was between 13 and 46 years, 58.5 % were married, 49.1 % lived in the urban area. The prevalence of contraceptive discontinuation for Etonorgestrel implant was 33.3 % [95 % CI 26.98 - 39.02]; and it was associated with: menstrual cycle disturbances that affected quality of life [PR 3.9, 95 % CI 3 .1 ­ 5.0, p < 0.001], with weight increase> 10 kg [RP 3.5, 95 % CI 2.8 ­ 4.0,p < 0.001], severe headache [RP 3.7, 95 % CI 3.0 ­ 5.0, p < 0.001], pain at the insertion site [RP 3.1, 95 % CI 2.6 ­ 4.0, p 0.004] and pregnancy planning [RP 3.3, 95 % CI 2.7 ­ 4.0, p < 0.001]. CONClUSION: The prevalence of contraceptive discontinuation of the subdermal Etonogestrel implant in our population was 33.3% and it is associated with the drug side effects.

Percutaneous Pedicle Screw Fixation in Thoracolumbar Fractures: Comparison of Results According to Implant Removal Time

BACKGROUND: The purpose of this study was to determine whether restoration of range of motion (ROM) could be achieved by implant removal after natural bone healing and consolidation of fractured vertebrae and examine whether early removal of the implant could maximize restoration of ROM. METHODS: This study included 30 cases of thoracolumbar fractures without neurological deficit requiring surgery (nine cases of flexion-distraction injuries and 21 cases of burst fractures). Percutaneous pedicle screw fixation (PPSF) was performed at the fractured vertebrae and one level above and one level below the fracture level. Pedicle screws were removed at an average of 12 months after surgery upon healing of fractured vertebrae. The following radiological and clinical findings were evaluated: restoration of anterior vertebral height ratio (AVHR), Cobb angle (CA), ROM, and complications. Sixteen patients who were checked for ROM were divided into two groups based on the time of implant removal: nine patients within 12 months and seven patients after 12 months. Restoration of vertebral height loss and ROM were compared between the two groups. RESULTS: At the final follow-up, significant pain relief and restoration of AVHR and CA were achieved in patients who underwent PPSF. Patients who had implant removed within 12 months after surgery had better ROM recovery than those who had implant removed after 12 months postoperatively. There were no significant differences in AVHR and CA between the two groups. CONCLUSIONS: PPSF followed by implant removal after healing of fractured body appears to be effective in achieving restoration of ROM. In our study, early removal of implant within 12 months after surgery was associated with better achievement of ROM than removal after 12 months. In addition, there were no significant differences in restoration of vertebral height between the two groups.

Intermediate-term clinical effects of two-staged revision for hip periprosthetic joint infection / 国际外科学杂志

Objective To explore the validity of two-staged revision for hip periprosthetic joint injection and intermediate-term clinical effects.Methods The clinical data of 31 cases who were underwent two-staged revision for unilateral hip periprosthetic joint infection in Department of Orthopaedics,Beijing Friendship Hospital,Capital Medical University from March 2014 to September 2016 were analyzed retrospectively.There were 13 males and 18 females,aged (67.5 ±7.8) years,with an age range of 52-79 years.All patients underwent two-staged revision,taking preoperative and intraoperative joint puncture fluid,intraoperative infection of soft tissue for bacterial culture was to clear medication.In first stage,prosthesis removed,debridement performed and antibiotic spacer implanted were performed.Antibiotics were used for 8 to 12 weeks for infection.In second stage,total hip arthroplasty revision was performed while infection was controlled.Harris hip scores,Short form 36 health status scores (SF-36),white blood cell counts,C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR)were compared between preoperative and postoperative follow-up in all patients,and postoperative complications were recorded.Postoperative outpatient follow-up was 30.1 to 59.3 months,and reviewed every 12 months after 3 months,6 months,and 12 months.The follow-up deadline was April 2019.Measurement data were expressed as mean ± standard deviation (Mean ± SD).The t test was used to compare the preoperative and postoperative follow-up.Results All 29 patients were followed up for follow-up except 2 patients were lost to follow-up.Preoperative Harris hip score,SF-36,white blood cell count,CRP and ESR were (39.4 ± 5.6) scores,(398.8 ± 39.2) scores,(12.5 ± 0.6) × 109/L,(63.3 ± 10.1) mg/L and (83.7 ± 12.5) mm/h,respectively.The last follow-up oftbe above indicators were (76.9 ±9.3) scores,(649.3 ±67.5) scores,(9.1 ±0.5) × 109/L,(5.3 ± 1.7) mg/L and (10.2 ± 1.6) mm/h,respectively.The results of final followed-up were much better than the preoperative results and there were significant differences between postoperation and preoperation for all indexes.One patient developed postoperative hip dislocation and was treated with manual reduction under general anesthesia.The two patients were diagnosed hip periprosthetic joint infection of joint at 8 months and 15 months respectively after two-staged revision and treated by removing the hip prosthesis.One patient was performed revision again and the other was not performed any operation for poor health condition.The remaining 26 patients had no complications.Conclusions Two-staged revision for periprosthetic joint infection of hip joint can not only treat infection effectively but also can recover hip function significantly.The early and intermediate-term clinical effects of the surgical treatment is satisfied.

Successful removal of permanent spinal cord stimulators in patients with complex regional pain syndrome after complete relief of pain

BACKGROUND: It is uncommon for patients who have received a permanent implant to remove the spinal cord stimulator (SCS) after discontinuation of medication in complex regional pain syndrome (CRPS) due to their completely painless state. This study evaluated CRPS patients who successfully removed their SCSs. METHODS: This 10-year retrospective study was performed on patients who had received the permanent implantation of an SCS and had removed it 6 months after discontinuation of stimulation, while halting all medications for neuropathic pain. Age, sex, duration of implantation, site and type of CRPS, and their return to work were compared between the removal and non-removal groups. RESULTS: Five (12.5%, M/F = 4/1) of 40 patients (M/F = 33/7) successfully removed the permanent implant. The mean age was younger in the removal group (27.2 ± 6.4 vs. 43.5 ± 10.7 years, P < 0.01). The mean duration of implantation in the removal group was 34.4 ± 18.2 months. Two of 15 patients (13.3%) and 3 of 25 patients (12%) who had upper and lower extremity pain, respectively, had removed the implant. The implants could be removed in 5 of 27 patients (18.5%) with CRPS type 1 (P < 0.01). All 5 patients (100%) who removed their SCS returned to work, while only 5 of 35 (14.3%) in the non-removal group did (P < 0.01). CONCLUSIONS: Even though this study had limited data, younger patients with CRPS type 1 could remove their SCSs within a 5-year period and return to work with complete pain relief.

Experiences of localization and removal of non-palpable subdermal contraceptive implants with ultrasound

OBJECTIVE: The aim of this study was to present experiences in localization and removal of non-palpable subdermal contraceptive implants with ultrasonography. METHODS: Medical records from January 1, 2016, to April 30, 2018, were retrospectively reviewed for 21 patients who were referred to a single institution and had an impalpable implant despite following the removal instruction. In all the cases, more than one attempt was made to remove the implant before referral. The rod was detected using radiography and ultrasonography. In all the cases, localization of the single implant was achieved with ultrasonography. The distal depth of the rod was measured, and skin marking was made following the echogenicity. The implants were subsequently removed under anesthesia. RESULTS: In 18 cases, the rods were localized using ultrasonography and successfully removed under local anesthesia. In the other three cases, removal with local anesthesia failed. Although the rod was detected successful with ultrasonography, the implants were removed under general anesthesia in the operating room. The depth from skin to rod, measured with ultrasonography, was >12.0 mm in all the cases and located deep in the muscular layer in the failure cases. The depth of the implants positively correlated with the time spent for removal (r=0.525; P=0.015). CONCLUSION: High frequency ultrasonography is a highly accurate tool for localization and measurement of the skin-to-rod depth. It is also useful for removing non-palpable implants. If the depth of the implant is >12.0 mm, removal of the implant in the operating room under general anesthesia is recommended.

Partial two?stage exchange for periprosthetic joint infection after total hip arthroplasty / 中华骨科杂志

Objective To evaluate the early stage effects of partial two?stage exchange (PTE) for infection after total hip arthroplasty (THA) in order to improve surgical treatment outcomes. Methods Twelve patients (7 males and 5 females) of infect?ed THA treated by PTE between September 2000 and February 2016 were included with an average of 59 years old (range, 40-74 years old). The femoral stem prosthesis was preserved when we ensured that it was not infected and with well fixation during opera?tion. The acetabular prosthesis was totally replaced. Furthermore, the secondary surgery was performed on patients who were free from infection for at least 3 months. At the follow?up duration, the pelvic X?ray was examined to access the presence of loosening of the prosthesis. The inflammatory index was recorded. Hip function was assessed by the Harris hip score, and the visual analogue score (VAS) and patient's subjective satisfaction were recorded by the questionnaire. Results All of the 12 patients were fol?lowed up for a mean of 33.3 months (range, 24-48 months). We achieved a 92% (11/12) success rate. One patient resuffered infec?tion, which was controlled after the second debridement. The preoperative Harris score of 12 patients was 23-57, with an average of 40.83±10.62. All patients had significant improvement in hip function after PTE. The Harris score reached 59.58±4.34 at one month after surgery, and reached 64.58±9.08 after three months and 86.75±4.58 at the last follow?up. There was significantly dif?ferent when compared with the preoperative Harris score. At the last follow?up, the length difference between the lower limbs was less than 1cm in all patients. Two patients did not complain of pain, while other 10 patients got a VAS score of less than 2 points. The patient's subjective satisfaction rating was 100%. Conclusion PTE could be a valuable alternative treatment for infection af?ter THA. The infection control rate and clinical outcomes are comparable to those of two?stage exchange.

Breakdown of complications related to the use of central venous catheters in intensive therapy units / Desfecho das complicações relacionadas ao uso de cateteres venosos centrais em unidades de terapia intensiva

The ICU is a highly complex sector, and among the wide range of interventions performed in the intensive care patient, we highlight the use of the central venous catheter (CVC). Maintaining the CVC requires knowledge and ability to ensure safe and long-lasting vascular access. However, during the permanence time of the device, some complications related to the catheter material, caliber, puncture site, dressing used, type of medication administered and length of stay may occur. Knowing the possible complications that occur with the catheter during its stay and the outcome of these complications favors the health professional in the elaboration of prevention strategies. Therefore, this research aims to elucidate the occurrence of non-elective removal, the main complications and outcomes related to the use of CVC in clients hospitalized in the ICU. This is a descriptive, observational, prospective study with a quantitative approach. The study was carried out in a teaching hospital in Uberaba-MG, from March to August 2016. The population of the study consisted of CVCs inserted in clients hospitalized in the ICUs. As a result, 75 (38.3%) catheters presented complications, being the outcome of 55 (73.3%) non-elective removal when the complication was discovered. The other 121 (61.7%) catheters had the outcome of removal on discharge from the client to the ward 59 (48.7%), death of the client 25 (20.6%), discharge from the client to the ward with the device (Risk benefit) 27 (22.3%) and removal at the physician's discretion 10 (8.2%). The permanence time of the device was 7.65. The greater the number of complications the catheter presented, the greater the chances of catheter loss (63.4). This study emphasizes the importance of conducting other studies that may contribute to the reduction of complications resulting from the use of CVC, and emphasize that complications demand higher expenses for the health system and increase the risk of infection of clients hospitalized in the ICU.

A UTI é um setor de alta complexidade, dentre a vasta gama de intervenções realizadas no cliente dentro da terapia intensiva destacamos o uso do cateter venoso central (CVC). A manutenção do CVC exige conhecimento e habilidade para garantir um acesso vascular seguro e duradouro. No entanto, durante o tempo de permanência do dispositivo algumas complicações relacionadas ao material do cateter, calibre, local de punção, curativo utilizado, tipo de medicamento administrado e tempo de permanência podem acontecer. Conhecer as possíveis complicações que ocorrem com o cateter durante a sua permanência e o desfecho dessas complicações favorece o profissional de saúde na elaboração de estratégias de prevenção. Diante disso, essa pesquisa tem por objetivo elucidar a ocorrência de retirada não eletiva, as principais complicações e os desfechos relacionados à utilização do CVC nos clientes internados na UTI. Trata-se de um estudo descritivo, observacional, prospectivo, com abordagem quantitativa. A pesquisa foi desenvolvida em um Hospital de ensino de Uberaba-MG no período de março a agosto de 2016. A população do estudo foi constituída por CVC inseridos em clientes internados nas UTI's. Como resultado 75 (38,3%) cateteres apresentaram complicações, onde o desfecho de 55 (73,3%) foi à retirada não eletiva frente à descoberta da complicação. Os outros 121 (61,7%) cateteres tiveram como desfecho a retirada na alta do cliente para enfermaria 59 (48,7%), o óbito do cliente 25 (20,6%), a alta do cliente para enfermaria com o dispositivo (risco benefício) 27 (22,3%) e a retirada a critério médico 10 (8,2%). O tempo de permanência do dispositivo foi de 7,65. Quanto maior foi o número de complicações que o cateter apresentou, maiores foram às chances de perda do cateter (63,4). Este estudo vem destacar a importância da realização de outras pesquisas que possam contribuir para redução de complicações advindas do uso do CVC, e ressaltar que as complicações demandam maiores gastos para o sistema de saúde e aumentam os riscos de infecção dos clientes internados na UTI.

Percutaneous lead extraction in infection of cardiac implantable electronic devices: a systematic review

Abstract Introduction: In the last two decades, the increased number of implants of cardiac implantable electronic devices has been accompanied by an increase in complications, especially infection. Current recommendations for the appropriate treatment of cardiac implantable electronic devices-related infections consist of prolonged antibiotic therapy associated with complete device extraction. The purpose of this study was to analyze the importance of percutaneous extraction in the treatment of these devices infections. Methods: A systematic review search was performed in the PubMed, BVS, Cochrane CENTRAL, CAPES, SciELO and ScienceDirect databases. A total of 1,717 studies were identified and subsequently selected according to the eligibility criteria defined by relevance tests by two authors working independently. Results: Sixteen studies, describing a total of 3,354 patients, were selected. Percutaneous extraction was performed in 3,081 patients. The average success rate for the complete percutaneous removal of infected devices was 92.4%. Regarding the procedure, the incidence of major complications was 2.9%, and the incidence of minor complications was 8.4%. The average in-hospital mortality of the patients was 5.4%, and the mortality related to the procedure ranged from 0.4 to 3.6%. The mean mortality was 20% after 6 months and 14% after a one-year follow-up. Conclusion: Percutaneous extraction is the main technique for the removal of infected cardiac implantable electronic devices, and it presents low rates of complications and mortality related to the procedure.

Procedimiento endoscópico en la migración al recto de un dispositivo intrauterino. Reporte de un caso / Endoscopic management in the migration to rectum of an intrauterine device. Case report

Resumen ANTECEDENTES La perforación es la complicación más temida durante la aplicación de un dispositivo intrauterino; cuando esto sucede debe retirarse el dispositivo debido al potencial riesgo de perforación y obstrucción intestinal. CASO CLÍNICO Paciente de 26 años, con trastorno del ciclo menstrual y dispareunia. La radiografía abdominal mostró el dispositivo intrauterino en posición anómala. La tomografía simple de abdomen evidenció el dispositivo en la zona intraluminal del recto, en la pared anterior, a 10 cm del esfínter anal. Se extrajo el dispositivo mediante colonoscopia. Los hallazgos intraoperatorios fueron: migración del dispositivo intrauterino, a 12 cm del margen anal, con adecuada exposición del brazo vertical. La extracción del dispositivo fue exitosa, con evolución satisfactoria de la paciente pues no hubo dolor ni alteraciones intestinales. CONCLUSIÓN La colonoscopia es una técnica diagnóstica y terapéutica efectiva en pacientes con migración del dispositivo intrauterino y afectación intestinal sin perforación, incluso puede considerarse antes de recurrir a la laparoscopia o laparotomía.

Abstract BACKGROUND Perforation is the most important complication during the application of an intrauterine device, which should be removed because of the potential risk of perforation and intestinal obstruction. CASE REPORT Female patient of 26 years of age, who presents menstrual rhythm disorders as well as dyspareunia. The tomography revealed the intrauterine device in the rectum, in the anterior wall, intraluminal, and 10 cm from the anal sphincter. It was scheduled for colonoscopy and device removal. The intraoperative findings were: migration of the intrauterine device, 12 cm from the anal margin, with adequate exposure of the vertical arm. The extraction of the device was successful. The patient had a satisfactory evolution, showed no pain or intestinal alterations. CONCLUSION Colonoscopy is a study of great help in all patients in whom migration of IUD with bowel disease without perforation and related complications is suspected, since it provides diagnostic and even therapeutic support, prior to considering a laparoscopy or laparotomy.

Remoção não eletiva do cateter central de inserção periférica em unidade neonatal / Non-elective removal of the peripherally inserted central catheter in the neonatal unit

Objetivou-se identificar os fatores determinantes da remoção não eletiva do cateter central de inserção periférica em recém-nascidos internados em Unidade de Terapia Intensiva Neonatal. Estudo transversal, realizado em uma maternidade referência no atendimento materno-infantil de alto risco situada no Nordeste do Brasil. A coleta foi realizada com 108 neonatos e ocorreu no período de fevereiro a novembro de 2016. Observou-se a prevalência de neonatos do sexo masculino (60,19%), nascidos de parto cesárea (74,07%) e baixo peso ao nascer (29,62%). A remoção não eletiva ocorreu em 41,66% neonatos por infiltração (12,03%), tração acidental (11,11%), ruptura externa (9,25%), oclusão (5,55%), mau posicionamento (1,85%) e suspeita de infecção (1,85%). A prevalência e os fatores de remoção não eletiva indicam a necessidade de estratégias por parte da Enfermagem na prevenção de complicações evitáveis relacionadas ao cateter, destacando-se a capacitação e aprimoramento de habilidades quanto à inserção, manutenção, retirada e observação desse dispositivo.

The objective was to identify the determinant factors of the non-elective removal of the peripherally inserted central catheter in newborns admitted to a Neonatal Intensive Care Unit. A cross-sectional study conducted in reference maternity for high-risk maternal-infant attention located in Northeastern Brazil. The data collection was conducted with 108 neonates during February to November 2016. We observed the prevalence of male neonates (60.19%), born from cesarean section birth (74.07%) and low weight at birth (29.62%). The non-elective removal occurred in 41.66% neonates by infiltration (12.03%), accidental traction (11.11%), external rupture (9.25%), occlusion (5.55%), bad positioning (1.85%) and infection suspicion (1.85%). The prevalence and non-elective removal factors indicated the need for Nursing strategies to prevent avoidable complications catheter-related, noting the training and improvement of abilities regarding insertion, maintenance, removal and, observation of this device.

Efficacy evaluation of early debridement implant removal for infection after internal fixation of tibial fracture / 中华创伤杂志

Objective To compare the efficacy of early and delayed removal of debridement implant for infection after internal fixation of tibial fracture.Methods A retrospective case control study was conducted on the clinical data of 27 patients with tibial fractures who received plate or screw internal fixation admitted to the East Hospital Affiliated to Tongji University from March 2005 to September 2016.There were 21 males and six females,aged 18-81 years [(41.6 ± 14.3)years].According to the treatment methods,the patients were divided into the delayed implant removal group (Group A,10 patients) and the early implant removal group (Group B,17 patients).Group A was given debridement and anti infection treatment followed by continuous dressing change,and the implant was removed after the fractures were healed.Group B was given debridement and implant removal after one month of anti infection treatment and continuous dressing change when the infection was not clearly controlled.Patients with stable fracture ends were given only negative pressure closed drainage (VSD),and those with instable fracture ends were given external fixation and VSD.The time from infection to implant removal,the time of infection control,the fracture nonunion rate,the chronic bone infection rate,the knee joint function score of the American Hospital for Special Surgery (HSS),and the American Orthopedic Foot and Ankle Society (AOFAS) ankle hindfoot scale were compared between the two groups.Results All patients were followed up for 13-47 months,with the average of 28.4 months.There were significant differences between Group A and Group B in terms of the time from infection to implant removal [(49.9 17.1) weeks ∶ (19.3 ± 9.2) weeks],the time of infection control [(85.3 ±78.3)days∶ (6.3 ±2.8)days],fracture nonunion rate (30％ ∶ 0),and the chronic osteomyelitis incidence (30％ ∶ 0) (all P ＜0.05).No significant differences were found in HSS knee joint function score and AOFAS ankle hindfoot scale between the two groups (both P ＞ 0.05).Conclusion For patients with postoperative infection after internal fixation for tibial fracture,early thorough debridement and implant removal can quickly control the infection and reduce the incidence of nonunion and osteomyelitis.

Impact on Retrievability by Cement Variety for Implant Restorations Equipped with a Lingual Slot

PURPOSE: The purpose of this study is to measure and compare the removal torques of different cements applied in attachments of zirconia restorations on titanium (Ti) abutments fitted with retrievable cement-type slot (RCS) on the lingual side for the better retrievablity by use of a slot driver. MATERIALS AND METHODS: Three types of cements were used in the experiment: two permanent cements in RelyX™ U200 (RU) (3M ESPE) which is a resin cement and FujiCem™ (FC) (GC) which is a resin-modified glass ionomer cement, and a temporary cement in Freegenol™ temporary cement (TC) (GC). Measurements of removal torques were conducted as follows; an attached sample was fixed on the equipment customized for the experiment; a slot driver was connected to a MGT12 (Mark-10 Corp.), a torque measurement instrument; the sample had the driver fitted to its RCS and then was rotated until the it was removed; and finally, the maximum torque value was recorded. RESULT: As for the removal torque measurement results, the average values were 47.9±2.6 Ncm for RU, 43.4±1.5 Ncm for FC, and 20.9±1.0 Ncm for TC. The statistical analysis using Kruskal-Wallis test yielded the significance probability of P < 0.05 (P=0.002), which confirmed the presence of significant differences between the three groups. CONCLUSION: All three cements exhibit clinically acceptable levels of removal torque when applied to an upper zirconia implant restoration fitted with a lingual slot, with RU and FC, the two permanent cements, having the significantly higher values than that of TC, the temporary cement.

Application of Lateral Approach for the Removal of Migrated Interbody Cage: Taphole and Fixing Technique

When a revision surgery related with removal of failed interbody cage is required, going through the previous passage can lead to a higher risk of neurological deficits or incidental dural injuries. Recently, the lateral approach has become a popular method instead of the conventional anterior or posterior approaches. The lateral approach is also useful method to remove failed interbody cage previously placed and re-do interbody fusion with lower risks compared to revision surgery via previous passage. However, there is still some difficulty in retrieving the interbody cage from the intervertebral space because of no spacious passage, subsidence, and uncontrolled movable cage. In this study, we introduce our experience that we removed failed interbody cage more easily with only the simple additional steps of making a taphole and fixing the cage using a thread-tipped stick.