Implementing 3D fluoroscopy in the management of tibial plateau fractures: Shorter hospitalization and decline in revision surgery, but increase in the duration of surgery and radiation exposure.

BACKGROUND: Intraoperative 3D fluoroscopy (3DRX) is increasingly used in fracture management instead of conventional fluoroscopy (RX), but its effect on the treatment and outcome of tibial plateau fractures (TFs) is not well known. This study aims to evaluate whether the use of 3DRX in the treatment of tibial plateau fractures reduces the number of revision surgeries. METHODS: This retrospective cohort study includes all patients who underwent surgical treatment for TF in a single center from 2014 to 2018. Patient-, fracture-, and treatment characteristics were compared between the 3DRX and RX subgroups. The primary endpoint was the number of patients requiring revision surgery. Secondary endpoints were surgery duration, hospital length of stay, radiation exposure, postoperative complications, and secondary total knee arthroplasty. RESULTS: Eighty-seven patients were included, of which 36 were treated with 3DRX. Three patients in the RX group required revision surgery, while no revision surgery was performed in the 3DRX group (p = 0.265). The use of 3DRX resulted in significantly more intraoperative adjustments (25% versus 6%; p = 0.024) and an increase in surgery duration (by average of 28 min, p = 0.001), without a significant increase in postoperative wound infections (12% versus 19%; p = 0.374) or fracture-related infections (2% versus 2.8%; p = 0.802). The 3DRX group had an average radiation exposure of 7,985 mGy versus 1,273 mGy in the RX group (p<0.001). The hospital length of stay was 1 day shorter in the 3DRX group (5 days versus 4 days; p = 0.058). CONCLUSIONS: Implementing 3DRX in treating TFs improves the assessment of fracture alignment and implant position perioperatively, resulting in more intraoperative corrections and no revision surgeries within 6 weeks postoperatively. However, using 3DRX significantly increases perioperative radiation exposure and surgery duration without a significant rise in postoperative infections and a shorter hospital length of stay.

Case report: an unwanted leftover after laparoscopic cholecystectomy.

BACKGROUND: A 72-year-old female patient with a history of laparoscopic cholecystectomy presented at the gastroenterology consultation with intermittent complaints of abdominal pain since two months in the right hemi abdomen. METHODS: Imaging discovered a subhepatic abscess. Explorative surgery showed multiple gallstones as the cause of the abscess. A brief literature study was conducted and after a thorough selection based on title and abstract, we ended up with 14 articles. These were compared in the discussion with the literature concerning incidence, range of complications, risk factors and prevention and management. RESULTS: Spilled gallstones are an unusual complication of a frequently performed procedure. CONCLUSIONS: This case report elaborates on the incidence, different complications, prevention and management of spilled gallstones by means of a brief literature study. In case spillage happens removal of as many gallstones as possible is indicated the spillage should also be communicated to the patient to ease the diagnosis of a possible complication.