Observation of the curative effect of scleral suture fixation technique with four-loop foldable intraocular lens

The objective of the study was to evaluate the curative effect of a modified technique of scleral suture fixation with a four-loop foldable intraocular lens (IOL) for eye with inadequate capsule support. This was a retrospective study of 22 eyes with inadequate capsule support of 20 patients who underwent the scleral suture fixation technique with 9-0 polypropylene suture and foldable four-loop IOL implant. Preoperative and follow-up data were collected for all patients. The mean follow-up was 5.08 ± 0.48 months (range: 3–12 months). The mean pre- and postoperative log of minimum angle of resolution (logMAR) uncorrected distance visual acuity was 1.11 ± 0.32 versus 0.09 ± 0.09 (P < 0.001). The mean pre- and postoperative logMAR best corrected visual acuity was 0.37 ± 0.19 versus 0.08 ± 0.07 (P < 0.001). The intraocular pressure (IOP) increased briefly (range: 21–30 mmHg) in eight eyes on the first day postoperatively and returned to normal within 1 week. No IOP drops were used postoperatively. The IOP was 12–19.3 (13.72 ± 1.28) in this follow-up, which had no significant difference compared to the preoperative IOP (t = 0.34, P = 0.74). At this follow-up, there was no hyperemia, local hyperplasia, obvious scar, suture knots, or segment ends observed under the conjunctiva, as well as no pupil deformation or vitreous hemorrhage. The mean postoperative IOL decentration degree was 0.22 ± 0.08 mm. At the 7-day follow-up postoperatively, one side of the IOL was dislocated to the vitreous cavity in one case, which was resolved by reimplantation of a new IOL in time with the same technique. Scleral suture fixation technique of a four-loop foldable IOL was a feasible operation method for an eye with inadequate capsular support.

A modified fixation technique for the treatment of buried penis in children / 亚洲男科学杂志(英文版)

For many years, surgical treatment of buried penis in children has been researched by several scholars, and numerous methods exist. This study aimed to explore the clinical effect of a modified fixation technique in treating buried penis in children. Clinical data of 94 patients with buried penis who were treated using the modified penile fixation technique from March 2017 to February 2019 in Fujian Maternity and Child Health Hospital (Fuzhou, China) were retrospectively collected, compared, and analyzed. Clinical data of 107 patients with buried penis who were treated using traditional penile fixation technique from February 2014 to February 2017 were chosen for comparison. The results showed that at 6 months and 12 months after surgery, the penile lengths in the modified penile fixation group were longer than those in the traditional penile fixation group (both P < 0.05). The incidence of postoperative skin contracture and penile retraction in the modified penile fixation group was less than that in the traditional penile fixation group (P = 0.034 and P = 0.012, respectively). When the two groups were compared in terms of parents' satisfaction scores, the scores for penile size, penile morphology, and voiding status in the modified penile fixation group were higher than those in the traditional penile fixation group at 2-week, 6-month, and 12-month follow-ups after surgery (all P < 0.05). We concluded that the modified penile fixation technique could effectively reduce the incidence of skin contracture and penile retraction and improve the penile length and satisfaction of patients' parents.

Blefaroplastia inferior transcutánea con fijación muscular orbicular externa en pacientes con deformidades del párpado inferior / Transcutaneous lower blepharoplasty with external orbicularis oculi muscle fixation in patients with lower eyelid deformities

Objetivo: Describir el resultado de la técnica de fijación muscular orbicular externa en la Blefaroplastia inferior. Método: Se realizó una investigación descriptiva, prospectiva en pacientes que asistieron a la consulta de Cirugía Plástica del Hospital "Camilo Cienfuegos" entre enero 2018 a enero 2019, la muestra estuvo constituida por 43 pacientes. Para diagnosticarlos se utilizó la clasificación de Ginsbach, con criterios de exclusión el hábito de fumar. Se tuvo en cuenta variables como edad, sexo, deformidad palpebral inferior, complicaciones en el post operatorio a las 24 h y a los 30 días, y grado de satisfacción de los pacientes intervenidos. Se utilizaron métodos de revisión documental, observación, análisis y síntesis y empírico (encuesta), utilizadas para evaluar los resultados. La investigación se realizó siguiendo procedimientos éticos. Resultados: Mostraron que la mayor cantidad de pacientes estuvo en el grupo edad entre 46-50 años todos femeninos, el exceso de piel y las patas de gallina fueron las deformidades que predominaron. La complicación que se presentó fue el sangramiento posoperatorio resuelto en las primeras horas, 42 pacientes refirieron estar satisfechos. Conclusiones: La blefaroplastia es una técnica que se ha venido modificando junto a la necesidad de brindar procedimientos que ofrezcan seguridad y efectividad, en cuanto a la corrección de deformidades en el parpado inferior, con un adecuado tiempo de recuperación, resultados con menor riesgo de complicaciones(AU)

Objective: To describe the outcome of the external orbicularis oris muscle fixation technique in lower blepharoplasty. Methods: A descriptive, prospective research was conducted in patients who attended the Plastic Surgery consultation of the Hospital "Camilo Cienfuegos" from January 2018 to January 2019, the sample consisted of 43 patients. In order to diagnose them, the Ginsbach classification was used, with smoking as exclusion criteria. Variables such as age, gender, lower palpebral deformity, postoperative complications at 24 h and 30 days, and degree of satisfaction of the operated patients were taken into account. Documentary review, observation, analysis and synthesis and empirical (survey) methods were used to evaluate the results. The research was carried out following ethical procedures. Results: They showed that the greatest number of patients was in the age group between 46-50 years old, all of them female; excess skin and goose bumps were the predominant deformities. The complication that occurred was postoperative bleeding resolved in the first hours, 42 patients reported to be satisfied. Conclusions: Blepharoplasty is a technique that has been modified along with the need to provide procedures that offer safety and effectiveness, in terms of correction of deformities in the lower eyelid, with adequate recovery time, results with lower risk of complications(AU)

Ilizarov external fixation without bone graft for atrophic femoral shaft nonunion / 中国修复重建外科杂志

Objective: To explore the effectiveness of Ilizarov external fixation without bone graft in the treatment of atrophic femoral shaft nonunion. Methods: The clinical data of 12 patients with atrophic femoral shaft nonunion admitted between October 2010 and January 2017 were retrospectively analyzed. There were 8 males and 4 females, aged from 24 to 61 years, with an average age of 41.7 years. The nonunion sites located in the middle and upper femur in 7 cases and in the distal femur or supracondylar in 5 cases. The disease duration ranged from 1 to 9 years, with an average of 3.7 years. Previous operations ranged from 1 to 9 times, with an average of 2.8 times. The original fixator was removed, the fracture end of nonunion was debrided, and Ilizarov external fixator was installed. In patients with the length of bone defect less than 4 cm, direct compression fixation was performed during operation; in patients with limb shortening more than 2.5 cm, proximal femoral osteotomy and bone lengthening components were required to prepare limb lengthening after operation; all patients did not receive bone graft. The wearing time of external fixator, clinical bone healing time of nonunion fracture end, and complications were recorded. The effectiveness was evaluated by Paley's nonunion evaluation criteria. Results: All patients were followed up 24-50 months, with an average of 30 months. Bony union was achieved in all 12 cases with a healing time of 6.0-23.5 months (mean, 11.5 months). The wearing time of external fixator ranged from 7 to 25 months, with an average of 13.5 months. At last follow-up, according to Paley's nonunion evaluation criteria, the results were excellent in 6 cases, good in 4 cases, and fair in 2 cases, with an excellent and good rate of 83.3%. Sagittal angulation deformity of femur more than 7° occurred in 4 cases, with no significant effect on knee extension function, and no special treatment such as osteotomy was performed. Two patients had shorter limbs (>2.5 cm) after operation and were replaced by high shoes; 4 patients with trans-knee fixation lost knee joint mobility of 10-30° after operation; 10 cases of needle tract infection occurred, of which 4 cases with infection and loosening of fixed needle were replaced and re-fixed after needle extraction, the remaining 6 cases of infection without loosening of fixed needle were controlled by local dressing change, needle nursing, and oral cephalosporin anti-inflammatory drugs. No complications such as deep infection and vascular nerve injury occurred. Conclusion: Ilizarov external fixation has a high healing rate for atrophic femoral shaft nonunion, which is relatively minimally invasive and can avoid bone grafting. Its preliminary effectiveness is exact, and it is also effective for patients who have experienced multiple failed operations. It is necessary to pay attention to the nursing and rehabilitation training after external fixation.

Effectiveness of F-shaped screw fixation technique in treatment of Pauwels type Ⅲ femoral neck fractures / 中国修复重建外科杂志

Objective: To summarize the effectiveness of F-shaped screw fixation technique in treatment of Pauwels type Ⅲ femoral neck fractures. Methods: Between January 2013 and December 2016, 43 patients with Pauwels type Ⅲ femoral neck fractures were treated with F-shaped screw fixation technique. There were 32 males and 11 females with an average age of 38.9 years (range, 20-55 years). The fractures located on the left side in 21 patients and on the right side in 22 patients. The cause of injury included traffic accident in 19 patients and falling from height in 24 patients. There were 25 patients of Garden type Ⅲ and 18 of Garden type Ⅳ. The time from injury to operation was 2-3 days (mean, 2.2 days). These data were recorded, including operative time, fluoroscopy time, postoperative hospital stay, quality of reduction, postoperative complications (nonunion, varus deformity, femoral neck shortening, avascular necrosis of femoral head, screws back-out), and Harris scores. Results: The operative time was 28-45 minutes (mean, 37.5 minutes). The fluoroscopy time was 13-20 seconds (mean, 14.7 seconds). The postoperative hospital stay was 2-3 days (mean, 2.7 days). All incisions healed by first intention. All patients were followed up 18-58 months with an average of 38.7 months. All patients have anatomical reduction of fractures. Fracture healing occurred in 42 patients; the union time was 3-5 months with an average of 3.6 months. Nonunion occurred in 1 patient who was treated with total hip arthroplasty. Of the 42 patients with fracture healing, 11 cases had a femoral neck shortening, 9 cases had varus deformity, 3 cases had avascular necrosis of femoral head, and 8 cases had screws back-out. There was no significant difference in complication incidences between Garden type Ⅲ fractures and Garden type Ⅳ fractures ( P>0.05). Conclusion: Treatment of femoral neck fractures by using the F-shaped screw fixation technique, can achieve satisfactory effectiveness with less postoperative complication.

Clinical application of orbicularis oculi-levator aponeurosis fixation technique (Park) in double-eyelid operation / 中华医学美学美容杂志

Objective To investigate the application of orbicularis oculi-levator aponeurosis fixation technique (Park) in double-eyelid operation.Methods From June 2014 to March 2016,136 male and 1248 female patients (436 patients with ptosis) were selected to receive the treatment.Results The incision healed well without obvious postoperative hematoma.The patients were followed up to 4-22 months (mean 10m) after operation.Most patients had smooth upper eyelid crease,upturned lashes and dynamic fold.The skin tended to spread evenly without dimple.The ptosis were also corrected.Still,there were 16 patients with the crease disappeared,11 patients with asymmetry crease,10patients showing an incomplete line,and 9 patients with the accordion effect.Conclusions The orbicularis oculi-levator aponeurosis fixation technique is a minimally-invasive procedure and decreases the recovery time.It is more solid compared with suturing technique,and can avoid sunken,depression,puffiness compared with a traditional full-cutting method.It looks more like a natural double eyelid because of protecting the orbicularis oculi muscle.

Setup error of Orfit versus vacuum bag in radiotherapy for cervical cancer / 中华放射肿瘤学杂志

Objective To compare the setup errors of the negative pressure vacuum air cushion (vacuum bag) and the Orfit body foam fixator (Orfit frame) in radiotherapy for cervical cancer.Methods A total of 40 patients receiving three-dimensional radiotherapy for cervical cancer were enrolled in this study and equally and randomly divided into vacuum bag group and Orfit frame group.And the two groups were divided into Orfit-1 group, Orfit-2 group, vacuum-1 group, and vacuum-2 group according to the treatment course.The Orfit-1 group and vacuum-1 group were the data in the first 12 treatments, while the Orfit-2 group and vacuum-2 group were the data in the following 13 treatments.A cone-beam computed tomography scan was performed before each treatment to analyze setup error and then the body position was corrected to start the treatment.Comparison of continuous data between groups was made by paired t-test, while comparison of categorical data was made by chi-square test.Results There was a significant difference in the setup error in y-axis direction between the Orfit-1 group and the Orfit-2 group (P=0.003) and the setup error in r-axis direction between the vacuum-1 group and the vacuum-2 group (P=0.013).There were no significant differences in the setup errors in four directions (x-axis, y-axis, z-axis, and r-axis) between the Orfit-1 group and the vacuum-1 group (P>0.05).There were significant differences in the setup errors in y-axis and z-axis directions between the Orfit-2 group and the vacuum-2 group (P=0.007;P=0.001).Conclusions The Orfit frame and the vacuum bag have their own advantages and disadvantages in the fixation of body position in radiotherapy for cervical cancer.The setup error can be improved by long vacuum bags, ultrasound bladder capacity scanner, image-guided radiotherapy, or sectional radiotherapy plan.

Treatment of Scaphoid Nonunion Using 2 Small Diameter (2.2 mm) Headless Compression Screws

PURPOSE: To assess union and complication rates associated with the use of 2 small diameter headless compression screws and volar wedge bone grafting for the treatment of scaphoid fracture waist nonunions with collapse. METHODS: A total of 12 patients (11 male and 1 female) at an average age of 32.5 years were treated with open reduction and internal fixation with 2 small diameter headless compression screws for scaphoid nonunions with a mean follow-up of 11 months. Tricortical wedge shaped autograft were harvested from the iliac crest and placed into the nonunion site to restore length and alignment in all patients. Union was determined by radiographs and computed tomography, and scapholunate and radiolunate angles, and height-to-length ratio were calculated on final radiographs and follow-up computed tomography. RESULTS: All 12 scaphoids united with a mean time for 2.8 months. The mean postoperative scapholunate angle was significantly reduced from 73° preoperatively to 56° postoperatively. The mean radiolunate angle was significantly improved from 21° from neutral preoperatively to 12° postoperatively. The height-to-length ratio was also demonstrated significant improvement from 0.73 preoperatively to 0.60 postoperatively. No hardware problems were identified and no revision procedures have been necessary. CONCLUSION: Our results indicate that the use of 2 small diameter headless compression screws with volar structural bone graft stabilizes the fracture for predictable union, while reducing the deformity reliably from a collapsed scaphoid nonunion. The presented technique is safe and effective, and may provide superior biomechanical stability, especially against the torsional force.

Biomechanical Comparison Study of Three Fixation Methods for Proximal Chevron Osteotomy of the First Metatarsal in Hallux Valgus

BACKGROUND: Fixation of proximal chevron metatarsal osteotomy has been accomplished using K-wires traditionally and with a locking plate recently. However, both methods have many disadvantages. Hence, we developed an intramedullary fixation technique using headless cannulated screws and conducted a biomechanical study to evaluate the superiority of the technique to K-wire and locking plate fixations. METHODS: Proximal chevron metatarsal osteotomy was performed on 30 synthetic metatarsal models using three fixation techniques. Specimens in group I were fixated with K-wires (1.6 mm × 2) and in group II with headless cannulated screws (3.0 mm × 2) distally through the intramedullary canal. Specimens in group III were fixated with a locking X-shaped plate (1.3-mm thick) and screws (2.5 mm × 4). Eight metatarsal specimens were selected from each group for walking fatigue test. Bending stiffness and dorsal angulation were measured by 1,000 repetitions of a cantilever bending protocol in a plantar to dorsal direction. The remaining two samples from each group were subjected to 5 mm per minute axial loading to assess the maximal loading tolerance. RESULTS: All samples in group I failed walking fatigue test while group II and group III tolerated the walking fatigue test. Group II showed greater resistance to bending force and smaller dorsal angulation than group III (p = 0.001). On the axial loading test, group I and group II demonstrated superior maximum tolerance to group III (54.8 N vs. 47.2 N vs. 28.3 N). CONCLUSIONS: Authors have demonstrated proximal chevron metatarsal osteotomy with intramedullary screw fixation provides superior biomechanical stability to locking plate and K-wire fixations. The new technique using intramedullary screw fixation can offer robust fixation and may lead to better outcomes in surgical treatment of hallux valgus.

Cement Fixation Technique for a Femoral Stem

Cemented total hip arthroplasty was first introduced by Sir John Charnley in 1961 and it has become one of the principal fixation techniques for fixation of an implant. The surgical technique has since been modified and this has resulted in improved longevity and reliability. The clinical success of the cemented technique has varied in literature, and this has been reported as 30~40% failure to 2% failure for 14 years of follow up using the 2nd generation cement technique. Currently, the successful clinical results can be contributed to the better developed design of the femoral stem and the advancement of the 3rd and 4th generation cement fixation techniques. As society gains more elderly people, for the older patients who have osteoporosis, a wide and thin femur would be the best indication for cement fixation in order to achieve early stability and better clinical results. It is imperative to learn and practice performing the exact cement fixation technique to achieve the best clinical results.

OPEN REDUCTION AND TRANSORAL FIXATION USING TROCHAR FOR MANDIBULAR SUBCONDYLE FRACTURE

The Treatment of Nonunion of the Scaphoid with a Horse-Shoe Bone Graft and Fixation with Two Screws / 대한정형외과학회잡지

PURPOSE: Three dimensional anatomical reconstruction of an old scaphoid nonunion injury with a humpback deformity is not an easy procedure. The single interpositional bone graft technique has its limitation for accurate anatomic reconstruction. We report here on the effect of a cortical interpositional horse-shoe graft using two screws and a volar cancellous chip bone graft for the treatment of scaphoid nonunion with a humpback deformity or a miss-match fracture surface in scaphoid nonunion. MATERIALS AND METHODS: We retrospectively reviewed nineteen patients who were treated for scaphoid nonunion using a cancellous chip bone graft and a cortical interpositional horse-shoe graft with 2 screws (a Herbert's screw and a mini screw). The mean follow up period was 24 months (range: 14-36 months). The mean age was 30.5 years (range: 17-52 years) and 18 patients were male and 1 patient was female. The mean period between injury and operation was 6.7 years (range: 1 to 30 years). The nonunion sites were located in the waist in 15 wrists and in the distal third in 4 wrists. The volar approach was used in 18 cases and the dorsal approach was used in 1 case. In 2 cases, one additional kirschner's wire was used due to the instability of fixation. The clinical results were assessed by the criteria of Maudesley and Chen at the last follow-up. RESULTS: Bony union was obtained in 18 (95%) cases. The average time for union was 13 weeks. There were improvements in the scapholunate angle (from 65.2 degrees to 49.5 degrees) and the intrascaphoid angle (from 43.5 degrees to 29.6 degrees). There are 3 cases with excellent results, 10 cases with good results and 6 cases with fair results. There was one complication. In 1 case, a nonunion gap was seen at 7 months after operation, but there were no clinical symptoms. CONCLUSION: A cortical interpositional horse-shoe graft using two screws and a cancellous chip bone graft for treating scaphoid nonunion with a humpback deformity or a large defect seems to be an encouraging procedure for regaining the normal anatomy of the scaphoid.

Simple External & Internal Fixation for the Zygoma Tripod Fracture

Precise reduction and rigid fixation is essential in preventing facial asymmetry in zygoma fracture patients. Numerous methods are used for treating zygoma fractures categorized largely as open reduction and simple external reduction. The conventional three point open reduction method has drawbacks such as long operating time, visible scar, cheek drooping and soft tissue violence. Simple external reduction has drawbacks such as inadequate mechanical fixation, long lasting external fixation, long term deviation of malar eminence and poor visualization. To avoid drawbacks of the conventional method, we combined one point plate fixation method and one point external fixation with double K wire technique. Total 25 patients were treated with this technique. Follow up time was 3 months to 3 year. All cases showed very good cosmetic symmetry without any complications. Advantages of this technique include, simple procedure, smaller incisional scar, early removal of pin, early return to mastication, prevention of malar eminence deviation, and less soft tissue violence. This internal and external fixation technique is a simple and effective method in treatment of uncomminuted zygoma fracture.

Operative Treatment of Patellar Fractures

PURPOSE: To establish a general guide line in the treatment of the patellar fracture MATERIALS AND METHODS: Twenty three patellar fractures followed for 2.2 years in average, treated with internal fixation were evaluated retrospectively. The primary fixations were the metal screw fixation in 7, the Dall-Miles' cable circumferential fixation in 14 and combination of both methods in 2 cases. The additional fixations were the tension band wiring in 9, the load sharing cable fixation in 3 and combination of both methods in 5 cases. The initial postoperative immobilazation of the knee joint in flexion, preferably 90degrees, for 7 days was effective to gain full range of motion RESULTS: Complete union without displacement was achieved in all cases. Full ROM was achieved in all cases except one. CONCLUSION: The choice of internal fixation need to be individualized according to the level of comminution, bone strength, fracture site and soft tissue damage. A strong internal fixation, initial immobilization in flexion followed by early ROM exercise were important factors to gain good result.

Simple Fixation Technique Using Double Kirschner's Wires for the Uncomminuted Zygoma Fracture

Zygoma fracture is very common in facial trauma because zygoma composes a prominent part of the midface. For the zygoma fracture, its precise reduction and fixation is very important to prevent residual facial asymmetry. There are various modalities of treatment of fractured zygoma and now open reduction with multiple rigid fixation technique is widely accepted. The method of internal fixation enables accurate reduction and stable fixation. However, closed reduction can be used in simple and uncomminuted cases. Although the closed reduction has some advantages of simplicity, it has lost popularity because of the inadequate mechanical fixation and poor visualization. We designed an improved technique of the closed reduction and fixation using double Kirschner's wires. 19 patients were treated with this technique and all cases showed successful results without any complications. The potential advantages of this technique include simple procedure, short operation time, less incisional scar and soft tissue violation and fairly low price without use of foreign materials like miniplates. We conclude that double Kirschner's wire suspension technique is a simple and effective method in the treatment of uncomminuted zygoma fracture.

Postoperative Recurrence Rate of Scleral Fixation Technique and Bare Scleral Technique in Primary Pterygium Operation

Pterygium is a common surgical ocular disease which recurs frequently postoperatively. Numerous different techniques have been developed for the successful surgical treatment of pterygium. It was theorized that the pterygium recurrence after surgery would be prevented if scar tissue is formed on the bare sclera and if the corneal epithelium heals before the conjunctival epithelium reaches the limbus. We compared the recurrence rate of pterygium and complications after bare sclera technique with those after scleral fixation technique by which remaining conjunctiva was anchored tightly to the adjacent sclera with sutures. In the first group, 94 patients (103 eyes) operated by scleral fixation technique were composed of 45 male and 49 female. Their mean age was 57.2+/-9.7 years and mean follow-up period was 12.50+/-2.53 months. In the second group, 96 patients(101 eyes) operated by bare sclera technique were composed of 47 male and 49 female. Their mean age was 56.3+/-9.2 years and mean follow-up period was 12.12+/-2.41 months. The recurrence rate was 9.7%(10 eyes) in scleral fixation technique group and 32.7%(33 eyes) in bare sclera technique group. This difference was statistically significant(p<0.05). A case of postoperative scleromalacia was observed in the former group. The scleral fixation technique (as modified bare sclera technique) seems to be more effective for reducing postoperative recurrence of primary pterygium than simple bare sclera technique.