Modified Surgical Technique of Making Posteromedial Portal in Knee Arthroscopy Using a Radiofrequency Device.

In knee arthroscopy, a posteromedial portal is used for various indications including arthroscopic posterior cruciate ligament reconstruction, posterior cruciate ligament avulsion fracture fixation, posterior medial meniscal repair, medial ramp lesion repair, and synovectomy. Making the posteromedial portal is challenging for young and even experienced surgeons. Creating the posteromedial portal in knee arthroscopy is challenging and technically demanding for surgeons because of the thick muscular cover, proximity of the neurovascular bundle, tenacious tough capsule, and excessive fat deposition in the posteromedial knee and thigh region. Access for viewing the posteromedial compartment during different procedures is made simple, safe, and replicable with this technique of creating the posteromedial portal. This article describes a simple way to create the posteromedial portal using a radiofrequency device by a modified outside-in surgical technique.

Comparison of aprotinin and tranexamic acid in adult scoliosis correction surgery.

PURPOSE: A retrospective review of consecutive adult patients undergoing scoliosis correction surgery was performed to compare the effects of aprotinin and tranexamic acid in blood conservation and to define a comprehensive blood conservation strategy for such surgery. METHODS: Medical records of all patients who underwent scoliosis correction surgery in this unit between January 2003 and December 2008 were reviewed. The patients were divided into three cohorts: group 1 receiving no antifibrinolytics, group 2 aprotinin and group 3 tranexamic acid. Information was collected regarding number of vertebral levels fused, pre- and post-operative haemoglobin, intra-operative blood loss and peri-operative autologous and allogenic blood transfusion performed. RESULTS: Aprotinin was used in 28 patients (38%), tranexamic acid in 26 (36%), while 19 (26%) received no antifibrinolytics. 21 patients had anterior surgery, 34 patients had posterior surgery and 18 had combined anterior and posterior procedures. Mean blood loss in the patients who received aprotinin and tranexamic acid was 710 and 738 ml, respectively. This was significantly less than the patients receiving no antifibrinolytics (972 ml, p = 0.037). Blood transfusion was required in only two patients undergoing anterior correction surgery. CONCLUSION: Aprotinin and tranexamic acid reduce blood loss in adult spinal deformity correction surgery. With aprotinin being unavailable for clinical use, we recommend the use of tranexamic acid along with other blood conservation measures for adult spinal deformity correction surgery.

The anatomy of anatomy: a review for its modernization.

Anatomy has historically been a cornerstone in medical education regardless of nation or specialty. Until recently, dissection and didactic lectures were its sole pedagogy. Teaching methodology has been revolutionized with more reliance on models, imaging, simulation, and the Internet to further consolidate and enhance the learning experience. Moreover, modern medical curricula are giving less importance to anatomy education and to the acknowledged value of dissection. Universities have even abandoned dissection completely in favor of user-friendly multimedia, alternative teaching approaches, and newly defined priorities in clinical practice. Anatomy curriculum is undergoing international reformation but the current framework lacks uniformity among institutions. Optimal learning content can be categorized into the following modalities: (1) dissection/prosection, (2) interactive multimedia, (3) procedural anatomy, (4) surface and clinical anatomy, and (5) imaging. The importance of multimodal teaching, with examples suggested in this article, has been widely recognized and assessed. Nevertheless, there are still ongoing limitations in anatomy teaching. Substantial problems consist of diminished allotted dissection time and the number of qualified anatomy instructors, which will eventually deteriorate the quality of education. Alternative resources and strategies are discussed in an attempt to tackle these genuine concerns. The challenges are to reinstate more effective teaching and learning tools while maintaining the beneficial values of orthodox dissection. The UK has a reputable medical education but its quality could be improved by observing international frameworks. The heavy penalty of not concentrating on sufficient anatomy education will inevitably lead to incompetent anatomists and healthcare professionals, leaving patients to face dire repercussions.

Comparison of transverse wires and half pins in Taylor Spatial Frame: a biomechanical study.

BACKGROUND: The aim of this study was to compare the stiffness characteristics of Taylor Spatial Frame (TSF) fixed with transverse wires and half pins. DESIGN & METHODS: Experiments were carried out at the biomechanics laboratory at Cardiff University. All mechanical testing was performed with a servo hydraulic test frame (MTS 858 Mini Bionix II(R), MTS Corp., Mineapolis, USA). Custom built mounts were used to attach the bone rigidly to the one end of machine and the TSF ring to the other. Rings were fixed with 1.8 mm transverse wires or hydroxy-apatite coated 6.5 mm half pins in 45 degrees, 60 degrees, 75 degrees and 90 degrees divergence angles. Bone was loaded with axial load to 400 N and torque to 20 Nm in an indestructible manner. Load/displacement curve data were analyzed for slope and axial and angular displacements. RESULTS: For larger diameter rings (180 mm), for axial stiffness there was no statistically significant difference between the transverse wires (4 wires with 2 rings) and the half pins (2 pins with 1 ring) (p > 0.05). For 155 mm internal diameter rings, half pins provided statistically higher axial stiffness than transverse wires (p = 0.036). The half pins show significantly more torsion stiffness in both ring diameters (p < 0.05) in comparison to transverse wires. As in axial stiffness, small diameter rings show increased stiffness in torsion. There is increase in axial and torsion stiffness with the increase in the divergence angle between the wires or pins (p < 0.05). CONCLUSION & CLINICAL RELEVANCE: Half pins provide greater stiffness to TSF frames and allow for axial micro motion as well. This work provides a rationale for clinical decision making about the use of tensioned transverse wires in comparison to half pins in construction of a TSF frame.

Retrograde Ender nailing for humerus shaft fractures.

Humerus fractures are common; their management remains controversial. Infection, neurovascular injury, joint problems and non-union are recognised complications of surgical treatment. These complications can be decreased by opting for a surgical treatment that is less invasive and safe. We present a series of 59 patients treated with retrograde Ender nailing; 56 healed in an average of 9.1 weeks, 2 had delayed union (> 15 weeks) and one went on to non-union, which healed after secondary plate fixation. Nail back out occurred in 8 cases, of which only 3 required nails repositioning. The mean Constant score at final follow-up (mean 19 months) was 91; it was significantly lower in patients over 50 years of age and in those with segmental fractures. In this series, Ender retrograde nailing gave overall satisfactory results and appeared as a safe and efficient technique.

Dermabond wound closure in primary hip arthroplasty.

Cyanoacrylate glues have been used in various surgical specialties for primary wound closure or as a supplement to other methods. We assessed the overall results and safety of this technique following primary hip arthroplasty. Ninety-three patients undergoing primary total hip replacement were studied. The surgical wound had been closed with subcuticular vicryl followed by the application of topical dermabond adhesive, without any additional dressings. The mean follow-up was 7.2 months. One patient suffered wound dehiscence on the third post operative day. Two patients had serous oozing from the wound for the initial 3-4 days. This technique provides an immediate water tight seal in a sterile operative environment and provides a barrier to micro organisms. It has good tensile strength, aesthetic value and patient satisfaction.

Rheumatoid forefoot reconstruction: 1st metatarsophalangeal fusion and excision arthroplasty of lesser metatarsal heads.

This is a retrospective review of 66 feet (mean follow-up of 3 years) in 43 patients with painful severe rheumatoid forefoot deformities. All were treated by arthrodesis of the first metatarsophalangeal (MTP) joint through a dorsomedial incision and excision of the lesser metatarsal heads through a separate plantar approach. The mean post-operative AOFAS scores were 65.94 (range: 32 to 82). The mean post-operative Foot Function Index (FFI) was 0.47 (range: 0.23 to 0.63). Eighty five percent (57/67 feet) reported excellent or good pain relief, improved cosmetic appearance, and improved footwear comfort. The mean hallux valgus angles improved from 39 degrees to 16 degrees and the intermetatarsal angle from 16 degrees to 8 degrees. Five feet had nonunion of the 1st MTP joint arthrodesis. There were five re-operations for non-union of the 1st MTP joint arthrodesis. The success of the operation as evidenced by this study depends upon attention to metatarsal length harmonisation, stabilisation of the 1st MTP joint and thereby even distribution of loading of the forefoot. The poor results in this study were as a result of a failure to secure the stability of the 1st MTP joint.