Computed Tomography-Guided Pericardiocentesis: A Practical Guide.

PURPOSE OF REVIEW: The purpose of this article is to serve as a practical guide to computed tomography (CT)-guided pericardiocentesis and to discuss the role of this approach in current clinical practice. An overview of indications, technique, advantages, and limitations specific to CT-guided pericardiocentesis will be provided. The reader will have an enhanced understanding of the use of this imaging modality to guide pericardial drainage. RECENT FINDINGS: Use of CT guidance to drain the pericardial space is safe, especially when adequate echocardiographic evaluation is precluded and when echocardiography-guided pericardiocentesis is deemed unsafe and or not feasible. Our review and experience indicate that CT-guided pericardiocentesis is technically successful in more than 94% of patients, with a low risk (<1%) of significant complications. CT-guided pericardiocentesis is therefore a viable alternative when echocardiographic guidance is insufficient and can obviate the need for surgery in most patients.

Revision of Syndesmosis Screw Fixation.

Background: Many syndesmosis screw fixations do not achieve success at the first attempt. Currently, there are no data available to evaluate revision of syndesmosis screw failure. Methods: A total of 160 consecutive patients who underwent syndesmosis screw fixation from 2014 to 2016 were reviewed. The current study focuses on 13 of 160 patients who underwent revision surgery and analyzes reasons, methods, and outcomes of syndesmotic screw revisions. Results: Thirteen out of 160 patients had revision surgeries. Incidence of recurrent diastasis was 92.3%. Seven out of 19 screws had broken. Two patients had screw loosening, 9 patients underwent early weightbearing, 1 patient developed osteomyelitis, 1 patient developed osteoarthritis, and 1 patient had fibular nonunion. Eleven patients underwent removal, 3 patients underwent clamp reduction, and 4 patients underwent fibular osteotomy. Six patients experienced good reduction with 0/10 pain, 3 patients experienced good reduction with some pain, 1 patient experienced poor reduction; 1 patient developed osteomyelitis and subsequent 7/10 pain; 1 patient underwent fusion with 5/10 pain, and 1 patient experienced medial malleolar mal-union with 3/10 pain. Conclusion: It was found that the main reason for syndesmosis revision was reoccurring diastasis. Most patients ultimately experienced good reduction and were able to ambulate, despite some residual pain. Levels of Evidence: Level IV: Case series.

Horizontal Forehead Lines: A Reflection of Eyelid Ptosis or Blepharodermachalasia.

BACKGROUND: In his facial aesthetics practice, the senior author (B.G.) observed that many patients presenting with horizontal forehead lines also demonstrated upper eyelid ptosis or enough blepharodermachalasia to require compensation. This study was conducted to investigate this observation. METHODS: Photographs of patients presenting for facial rejuvenation were retrospectively reviewed for the presence of forehead lines, ptosis, brow ptosis, and blepharodermatochalasia. Patient age, gender, and race were reported. Only patients over age 50 were included. Patients who had previous eyelid or forehead surgery, congenital abnormalities, or post-traumatic deformities were excluded. Ptosis was defined as more than 1.5-mm overlap between the upper eyelid and the iris. Patients were divided into two groups based on presence of forehead lines for comparative analysis. RESULTS: One hundred sixty patients, including 100 patients with and 60 patients without horizontal forehead lines, were included. Patients with forehead lines were likely to be older (age 61.56 ± 8.93 vs. 58.58 ± 7.59; P = 0.0337), male (36 vs. 11.67%; P = 0.0008), have ptosis (90 vs. 76.67%; P = 0.0377), and have blepharodermatochalasis (20 vs. 5%; P = 0.0097). All 28 patients with unilateral forehead lines (17 left, 11 right) had ipsilateral ptosis. CONCLUSIONS: Ptosis and blepharodermatochalasis may result in the development of horizontal forehead lines through compensatory frontalis activation. Whenever horizontal forehead rhytids are noted, it is imperative to search for ptosis or blepharodermachalasia in repose. Otherwise, forehead rejuvenation may fail to eliminate these compensatory forehead lines, and chemodenervation may have significant adverse effects on the visual field by forcibly blocking frontalis compensation. LEVEL OF EVIDENCE III: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Complications of Talar Neck Fractures by Hawkins Classification: A Systematic Review.

The goal of the present study was to perform a systematic review of the published data on talar neck fractures for a better understanding of the postoperative clinical outcomes using open reduction and internal fixation stratified by Hawkins type. A PubMed search was performed using the keywords "talar," "neck," and "fracture." This search identified 209 potential studies, which were reviewed to yield 16 studies that met the criteria. The surgical outcomes of talar neck fractures stratified by the Hawkins classification analyzed in the present study were as follows: American Orthopaedic Foot and Ankle Society scale score was 77.00 for type I, 86.10 for type II, 68.30 for type III, 68.30 for type IV, and 76.50 for all talar neck fractures. Avascular necrosis presented in 0.00% of type I fractures, 15.91% of type II fractures, 38.89% of type III fractures, 55.00% of type IV fractures, and 26.47% of all fractures. Osteoarthritis presented in 25.00% of type I fractures, 41.33% of type II fractures, 54.23% of type III fractures, 72.73% of type IV fractures, and 51.69% of all fractures. Subtalar arthritis presented in 0.00% of type I fractures, 54.29% of type II fractures, 46.43% of type III fractures, 45.45% of type IV fractures, and 44.97% of all fractures. The malunion prevalence was 13.29% and the nonunion prevalence was 3.97% for all fractures. Type II fractures were the most common (50.88%) fracture type reported in the reports reviewed in the present study.