Prematurity-Risk Factor or Coincidence in Congenital Glaucoma?

Background and Objective: To correlate the intraocular pressure with the postconceptional age and identify a statistically significant connection between congenital glaucoma and prematurity. Materials and Methods: The current paper is a retrospective, comparative, case-control study. Data collection featured maternal age, gestational age at birth, birth weight, and intraocular ocular pressure (IOP) measurements. Results: Forty-two eyes of 21 children underwent examination. The participants were assigned into two groups. The Preterm-Glaucoma (PG) group included eight preterm-born children diagnosed with glaucoma, whereas the Preterm (P) group was comprised of premature newborns without the aforementioned condition. There was no statistically relevant difference in birth weight (p = 0.691078) nor in mean gestational age (p = 0.752623) between the two groups. The mean IOP in the PG group was 23.813 ± 4.5493, whereas in the P group, it ranged around 13.231 ± 1.0699, p < 0.0001. Using mixed-effects models, we obtained a reduction in IOP of 0.45 mmHg per week in the first month of life. A further weekly reduction of 0.36 mmHg was achieved in the next two months. Conclusions: The mean IOP of prematurely born children decreased with age. Our findings correlate with previously conducted studies, however, the drop in IOP values exceeded any data published so far. We found no correlation between prematurity and the incidence of congenital glaucoma.

Short vs. long intramedullary nail systems in trochanteric fractures: A randomized prospective single center study.

In unstable pertrochanteric fractures, there are still debates regarding the complications and long-term benefits after internal fixation using short or long cephalomedullary nails. Therefore, a study was developed regarding this idea. From May 2017 to April 2020, 61 patients with unstable (AO 31-A2) and intertrochanteric fractures (AO 31-A3) were surgically operated on. During follow-up, 8 patients were excluded (lost or deceased). A total of 26 patients received internal short nail system fixation and 27 received a long nail system. All cases followed the standard 6-week rehabilitation protocol. Follow-up was at 3, 6 weeks, 3, 6 and 12 months, and clinical and functional assessment were determined by a different surgeon using the Visual Analogue Scale (VAS), Harris Hip Score (HHS) and Functional Ambulation Categories (FAC). A total of 42 (79.2%) had a 31.A2 fracture (21 in the long nail group and 21 in the short nail group) and 11 (20.8%) had a 31.A3 fracture (6 in long nail group and 5 in the short nail group). Surgical time was significantly longer (P<0.05) in the long nail group (an average of 81.38±12.01 min), compared with the short nail group (53.11±8.36 min). Blood loss was significantly higher (P<0.05) in the long nail group (210±12.1 ml) compared to the short nail group (75.4±14.8 ml). No statistical differences were noted regarding tip-apex distance (TAD) and VAS score. At 6 months, HHS was better for the short nail group (84.76±3.68) (P<0.05). Regarding the FAC scale, no significant statistical differences were identified. Cut-out occurred in 2 cases in the short nail group and 1 case from the long nail group. Only 1 peri-implant fracture occurred in a patient with a long cephalomedullary nail. In conclusion, the long cephalomedullary nail requires a longer surgical time and is associated with an increase in intraoperative blood loss without improving the functional outcome after 12 months postoperatively. A larger sample of cases is required to thoroughly analyze the postoperative complications.

Preclinical study analysis of massive magnesium alloy graft for calcaneal fractures.

The highly comminuted calcaneal fractures represent a challenge for surgeons and require bone grafts for a good clinical outcome. Postoperative results are generally associated with increased morbidity and long periods of inactivity. The biomedical community promotes the use of artificial materials for grafts in order to achieve improved results. In an era when cosmetic concerns as well as the satisfaction of patients are mandatory and the use of autologous bone grafts is not without complications, an artificial replacement appears to be a favorable option. Synthetic bone grafts are known to fail under stress shield or are associated with systemic side effects. The purpose of the present study was to investigate and determine an already commercially available magnesium (Mg) alloy whose design is most suitable for long-term use. The mechanical properties of Mg1Ca and MgYREZr compared with normal cortical and cancellous bone were assessed. Another discussed aspect was the influence of the alloy in the graft fixation. The results revealed that Mg1Ca and MgYREZr alloys had a low tensile strength of 75 and 250 MPa, respectively. For this reason, it was surmised that MgYREZr alloy could be an optimal choice with favorable corrosion resistance. Since calcaneal fractures are prone to skin necrosis and septic complications, the need for antibacterial procedures and antibiotic prophylaxis is highlighted. Thus, an in vivo attempt was also made to identify the relationship between Mg alloy products and bacterial load. However, the most important feature of the present study was the creation of a 3D model grafting, with an anti-sliding design, which can be potentially used with the preferred Mg alloy in this type of fractures. In conclusion, artificial materials are the future in medicine, replacing the body-limiting capabilities of grafts. They are safe and incur less comorbidities. This method could pave the way for reducing patient discomfort and increasing patient satisfaction. Although further testing is required, this research represents a great starting point for calcaneal fractures.

Tricalcium phosphate and hydroxyapatite treatment for benign cavitary bone lesions: A prospective clinical trial.

Benign bone tumors are surgically treated by curettage and by filling the defect using bone grafts or bone substitutes, such as hydroxyapatite crystals and tricalcium phosphate. The tricalcium phosphate mixed with hydroxyapatite, although fragile, is a good alternative with good integration. Fifteen patients with benign bone lesions were randomized in two groups surgically treated by curettage and filling of the bone defect using allograft (7 cases) or a mixture of 35% tricalcium phosphate, with 60-85% pore volume, and 65% hydroxyapatite (8 cases). After the surgery, all patients were followed up every 3 weeks until 6 months, and then at 2 months interval until one year for the clinical and radiological assessment. The average age was 35.4 years (from 18 to 54) for the allograft group and 41 years (from 22 to 58) for the patients treated with bone substitute. Eight patients were male and seven female, with relatively equal distribution between both groups. The average bone defect was relatively equal: 14 cc (4-25 cc) for the allograft group and 15.1 cc (4-33 cc) for the ceramic group (P>0.1). During the follow-up, all the lesions gradually disappeared after 12 months, with a time of healing of 18.8 weeks (15-24 weeks) for the allograft group and 20.37 weeks (15-28) for the bone substitute group. There were no significant differences regarding the clinical status and the radiological assessment after 12 months. No patient required extra pain medication after 2 weeks. No complications have been recorded. The surgical treatment of small and medium sized lytic benign tumors has good results with both types of graft that were studied. Using tricalcium phosphate mixed with hydroxyapatite as bone substitute represents a good and low cost alternative, but it is a relatively fragile material with a slower time to integrate compared to the allograft.

A new perspective towards failure of gamma nail systems.

Uncommon causes of nail failures and surgical reinterventions were determined. The study included 23 osteoporotic patients, 13 of whom followed a fast recovery program with early walking (FWB group). The other 10 patients were not allowed full weight bearing until 6 weeks (NFWB group). The T-score was determined before surgery for all cases. A case with a nail breakage after a failed DCS implant fixed in another clinic was also analyzed. The nail was revised and the broken implant underwent a metallurgic and microscopic examination. The average T-score was 2.5 for the patients that followed the fast recovery program and 2.7 for the patients from non-full weight bearing. Four patients, 1 from the NFWB group and 3 from FWB group, presented a screw cut-out. It was found that the errors of the guiding instruments may create dents, scratches or micro-fractures on the titanium coating that lead to an early implant failure. Imperfect reduction leads to incorrect implant placement and a high incidence of failure. Damaging the titanium protective coating, in a low force, high cycles scenario can cause structural failure. Delays in fracture healing and material fatigue are the most common causes of nail failure and can lead to catastrophic complications.

Comparison of 360° circumferential trabeculotomy and conventional trabeculotomy in primary pediatric glaucoma surgery: complications, reinterventions and preoperative predictive risk factors.

PURPOSE: To quantify the postoperative complications and the need of re-operation after a single circumferential trabeculotomy versus a single conventional trabeculotomy, in 5 years follow-up, in patients who underwent primary pediatric glaucoma surgery. For each complication and each re-operation case, we calculate the risk of appearance pointing out the possible preoperative risk factors by establishing a statistical connection between the result and the values of preoperative IOP, corneal diameter, or axial length. METHODS: This was a retrospective study of patients aged 1 day to 3 years who underwent primary pediatric glaucoma surgery. A total of 45 patients (79 eyes) were followed up for at least 5 years. There were two groups: the 360° circumferential trabeculotomy with illuminated catheter group and the conventional trabeculotomy group. RESULTS: Hyphema was the most common post-operative complication occurring in 64 eyes (81.01%) 30 (78.95%) in the conventional group and 34 (82.93%) in the circumferential group. There have been 5 eyes (6.3%) that needed re-operation: 1 case of hypotony (7 mmHg) and 4 cases of postop hypertension, 1 case (2.43%) in the circumferential group and the rest of 4 cases (10.53%) in the conventional group. CONCLUSIONS: A preop IOP of 25 mmHg or more in the conventional group is statistically significant predictive (p = 0.023) for postop hyphema, as well as a preop IOP of 28 mmHg or more is predictive (p = 0.02) for the need of reintervention. Circumferential trabeculotomy has better results in time, similar complications and lower failure rates meaning less eyes requiring re-operation than conventional trabeculotomy.