Delayed Bladder Perforation Resulting From Large Bladder Stone and Gluteal Abscess Caused by Pelvic Plate Loosening: A Case Report.

Delayed bladder injuries resulting from screw or plate loosening, following pelvic ring fractures are rare, and this complication could be prevented. A 63-year-old woman presented with dysuria and lower abdominal pain, 13 years after the open fixation of a pelvic injury. Computed tomography revealed a 5-cm bladder stone and two migrated screws. Six months after the stone was removed, an abscess was noted over the left gluteal region. During the removal of the screw and abscess debridement, we accidentally observed that the anterior pelvic bridge plate had eroded into the bladder and had multiple bladder stones attached. After the involved hardware was removed, the abscess was debrided and the bladder was repaired. The patient did not have further urinary tract infections or urinary symptoms. In patients with pelvic ring fractures, we recommend placing the bridge plate on the superior side of the pubic symphysis to reduce the risk of bladder perforation in the event of plate or screw loosening. When a patient with a history of pelvic fixation presents with symptoms such as urinary tract infections, bladder stones, or even an abscess around the gluteal region, possible bladder perforation caused by the loosening of plates or screws should be considered.

Percutaneous endoscopic lumbar discectomy versus open lumbar microdiscectomy for treating lumbar disc herniation: Using the survival analysis.

Objectives: This study compared the risk of symptomatic recurrent disc herniation and clinical outcomes of percutaneous endoscopic lumbar discectomy (PELD) versus open lumbar microdiscectomy (OLM) for lumbar disc herniation with 2 years of follow-up. Materials and Methods: We analyzed 23 patients who underwent PELD and 32 patients who underwent OLM for lumbar disc herniation. The numeric rating scale of back and leg pain, Oswestry Disability Index (ODI), and Roland-Morris Disability Questionnaire (RMDQ) were assessed before and at 12 and 24 months after the surgery. The wound pain and complications were also recorded. Survival analysis was performed to estimate the risk of symptomatic recurrent disc herniation. Results: In the comparison of groups, the reductions in back and leg pain, ODI, and RMDQ were not significantly different at 12 and 24 months. For patients who underwent PELD, the wound pain was significant lower at the day of surgery. The survival rate of patients who were free from symptomatic recurrent disc herniation at 24 months was 0.913 in PELD and 0.875 in OLM, and the log-rank test revealed no significant difference between the two survival curves. The incidence of complication was not significantly different between groups. Conclusion: Both PELD and OLM are effective treatments for lumbar disc herniation because they have similar clinical outcomes. PELD provided patients with less painful wounds. The survival analysis revealed that the risk of symptomatic recurrent disc herniation in 2 years of follow-up was not different between PELD and OLM.

Subcutaneous anterior pelvic bridge - an innovative technique for fixation of selective acetabular fracture: a case series and literature review.

INTRODUCTION: The aim of the study was to introduce an innovative technique involving the use of a subcutaneous anterior pelvic bridge (SAPB) in the treatment of selective acetabular fractures. METHODS: We performed a retrospective study of 21 patients with acetabular fracture who were treated with SAPB between January 2016 and March 2021. The patients' data were retrieved from electronic charts. Radiological results were evaluated according to the Matta system to assess the quality of the reduction and time of union. Functional outcomes were assessed in line with the d'Aubigné and Postel scoring system. Post-operative complications were also recorded. RESULTS: SAPB required around 60 minutes, with minimal blood loss and short learning curve. Matta score revealed excellent radiological outcomes in seventeen displaced fractures with seven excellent outcomes and nine good outcomes. Functional outcomes were excellent in twelve hips, good in seven hips, and fair in two hips. Six patients had transient lateral femoral cutaneous nerve palsy. DISCUSSION: The innovative SAPB method for the treatment of selective acetabular fracture is proven to be a feasible method with promising outcomes. SAPB is a minimally invasive technique and strengthens the stability of fixation, with less blood loss and fewer intra-operative/post-operative complications.

Full Endoscopic Uniportal Unilateral Laminotomy for Bilateral Decompression in Degenerative Lumbar Spinal Stenosis: Highlight of Ligamentum Flavum Detachment and Survey of Efficacy and Safety in 2 Years of Follow-up.

OBJECTIVE: Conventional laminectomy for spine decompression involves inherent complications resulting from perioperative traumatization of posterior structures. Minimally invasive decompression was developed to address these issues. Full endoscopic spine surgery has shifted the paradigm from disc pathology to spinal stenosis by overcoming the limitation of bony procedures with evolving endoscopic instruments. However, a steep learning curve restricts the development of endoscopic decompression. The purpose of this study is to describe full endoscopic uniportal unilateral laminotomy for bilateral decompression through the interlaminar approach and to evaluate its efficacy and safety in 2 years of follow-up. METHODS: A total of 106 patients (45 men, 61 women) with degeneration lumbar stenosis involving 165 segments were enrolled from April 2015 to June 2017, and treated by full endoscopic uniportal unilateral laminotomy for bilateral decompression. We made an 8-mm incision and used a general-size endoscope (working channel 4.3 mm) to avoid neurological compromise during the demonstration. RESULTS: The visual analogue scale (VAS) results for back pain revealed a significant reduction from preoperative 6.8 ± 2.1 to 1.7 ± 1.7 after 2 years (P < 0.001). The VAS results for leg pain revealed a significant reduction from preoperative 7.6 ± 1.3 to 1.3 ± 1.6 after 2 years (P < 0.001). The Oswestry Disability Index showed significant improvement from preoperative 62.0 ± 13.9 to 14.6 ± 15.7 after 2 years (P < 0.001). The average operation time was 68.9 ± 10.0 minutes per level. One case had iatrogenic durotomy, 1 case underwent revision surgery due to incomplete decompression, and 2 cases had delayed wound healing. CONCLUSIONS: This procedure obtained successful and satisfactory outcomes for patients, and was more feasible for surgeons.

Epidermal Inclusion Cyst following Percutaneous Trigger Finger Release.

Epidermal inclusion cyst is a benign lesion that commonly occurs due to inclusion of epidermal cells into the dermal or deeper layers in a trauma event. Percutaneous release is a minimally invasive technique, and good surgical outcomes can be achieved. However, the percutaneous procedure is a puncture injury, and the epidermal inclusion cyst is reasonable to become a possible complication. In this article, we presented a case of trigger finger in left middle finger. The patient underwent percutaneous release as the treatment and a second percutaneous release 5 months later due to recurrence of the symptoms. An epidermal inclusion cyst was noted 5 months thereafter, and it was treated with excision. With this case, we need to be more aware of this possibility if a mass lesion without infection signs occurs in the released area and recommend sonography if there is a mass lesion a few months after the procedure.

New tool for applying traction during open reduction and internal fixation of acetabular fractures.

Open reduction and internal fixation is used to treat complex acetabular fractures. Traction on the femur is necessary to reduce the acetabulum and is accomplished by surgical assistants or with mechanical devices. To overcome the disadvantages of various traction methods, the author designed a simple, novel traction device that can be used on an ordinary orthopedic or radiolucent operating table and has advantages over manual traction and commercial traction tables. The device consists of a horizontal cross-bar supported over the patient by 2 free-standing legs and is constructed from commercially available parts.

Sequential avulsions of the tibial tubercle in an adolescent basketball player.

Tibial tubercle avulsion is an uncommon fracture in physically active adolescents. Sequential avulsion of tibial tubercles is extremely rare. We reported a healthy, active 15-year-old boy who suffered from left tibial tubercle avulsion fracture during a basketball game. He received open reduction and internal fixation with two smooth Kirschner wires and a cannulated screw, with every effort to reduce the plate injury. Long-leg splint was used for protection followed by programmed rehabilitation. He recovered uneventfully and returned to his previous level of activity soon. Another avulsion fracture happened at the right tibial tubercle 3.5 months later when he was playing the basketball. From the encouragement of previous successful treatment, we provided him open reduction and fixation with two small-caliber screws. He recovered uneventfully and returned to his previous level of activity soon. No genu recurvatum or other deformity was happening in our case at the end of 2-year follow-up. No evidence of Osgood-Schlatter disease or osteogenesis imperfecta was found. Sequential avulsion fractures of tibial tubercles are rare. Good functional recovery can often be obtained like our case if we treat it well. To a physically active adolescent, we should never overstate the risk of sequential avulsion of the other leg to postpone the return to an active, functional life.

Hyperbaric oxygen therapy for cyclophosphamide-induced intractable refractory hemorrhagic cystitis in a systemic lupus erythematosus patient.

Hemorrhagic cystitis is a complication of systemic lupus erythematosus and is also a common side effect after cyclophosphamide therapy. Intractable hemorrhagic cystitis is not unusual and may be a life-threatening condition; it has no effective noninvasive treatment at present. We report a case of hemorrhagic cystitis with intractable refractory bleeding that occurred in a 40-year-old woman after cyclophosphamide treatment for systemic lupus erythematosus. The hemorrhage was resistant to various therapies but resolved after hyperbaric oxygen therapy. There was no recurrent hematuria after hyperbaric oxygen therapy during 6 months of follow-up.