Evolution of Surgical Management of Metastatic Disease of the Pelvis.

The surgical management of acetabular and pelvic lesions due to metastatic bone disease is complex in nature. These patients are typically in a frail state, having severe pain, limited mobility, and impaired wound healing. This causes a potential for complications, a high concern for the surgeon. Compounding these issues is limited life span for these patients given the advancement of the disease. Considerations for patients undergoing surgical treatment are achievement of significant pain relief and restoration of ambulation, all while having minimal complications during the postoperative period. Management may also include nonsurgical and interventional methods. A multidisciplinary approach is required for the successful treatment of these patients. Although there have been various surgical methods described, there is still no standardized modality that has been noted. These lesions often require complex decision making, imaging, and surgical reconstruction.

Distal biceps ruptures in National Football League players: return to play and performance analysis.

BACKGROUND: Distal biceps ruptures are rare injuries that tend to occur at a younger age in high-level athletic populations. Data analyzing athletes' ability to return to play, as well as performance, after surgery for a distal biceps rupture are lacking. METHODS: All National Football League (NFL) players from the 2000-2016 seasons who were found to have a surgically treated distal biceps rupture were included. Analysis of performance and career length was conducted with a control group matched for position, age, experience, and performance statistics. Data for the cohort vs. control group, as well as before vs. after injury, were analyzed with the paired-samples Student t test, with P < .05 deemed statistically significant. RESULTS: We identified 35 NFL players for the study; 33 (94%) were able to return to sport at an average of 351.4 ± 123.9 days. Offensive linemen undergoing surgery played fewer games per season compared with the control group (P = .04). However, the average number of seasons after surgery and after the index date was not found to be significant (P > .05). Mean career length, as well as number of games per season, did not differ in the postsurgical group vs. control group (P > .05) for all other positions. Performance scores within skill players did not prove to be significant between the postoperative and control groups (P > .05). CONCLUSIONS: Distal biceps ruptures treated surgically in NFL players allow for return to play at a high rate. The level of performance after surgery is similar to that of the player before injury. On average, NFL career length does not appear to be affected after distal biceps surgery.

Arterial ligation versus embolization in epistaxis management: Counterintuitive national trends.

OBJECTIVES/HYPOTHESIS: Arterial ligation and embolization are treatment modalities indicated in severe and refractory epistaxis. The purpose of this study was to examine temporal trends and compare outcomes in treatment of hospitalized epistaxis patients with ligation or embolization. METHODS: This retrospective cohort analysis utilized the 2008 to 2013 National Inpatient Sample to identify patients admitted with a primary diagnosis of epistaxis, and an associated procedure code for ligation or embolization. RESULTS: A total of 1,813 cases met the inclusion criteria, with 57.1% undergoing ligation. During the study period, treatment with ligation has trended downward, whereas treatment with embolization has remained constant. Overall, ligated patients were older (64.1 vs. 62.4 years; P = 0.027) and had higher rates of congestive heart failure (15.1% vs. 9.8%; P = 0.001). No significant differences in rates of chronic pulmonary disease, coagulopathy, liver disease, or hereditary hemorrhagic telangiectasia were observed between cohorts. No differences were observed in rates of blood transfusion, stroke, blindness, or in-hospital mortality; however, ligated patients had lower rates of intubation/tracheostomy (2.8% vs. 5.3%; P = 0.009). Ligated patients also experienced shorter hospital stays (3.6 vs. 4.0 days; P = 0.014) and incurred lower hospital charges ($33,029 vs. $69,304; P < 0.001). CONCLUSION: Compared to embolization, ligation is associated with significantly decreased hospital charges and shorter hospital stay, without an increase in complication rates. Counterintuitively, ligation appears to be trending downward nationally in its use relative to embolization. LEVEL OF EVIDENCE: 2C Laryngoscope, 127:1017-1020, 2017.