RESUMO
Nontraumatic atlantoaxial rotatory fixation after microtia reconstruction surgery is a rare complication. Intraoperative cervical hyperextension and/or excessive rotation and postoperative inflammation have been reported as causes of atlantoaxial rotatory fixation. We herein describe cases of atlantoaxial rotatory fixation after microtia reconstruction surgery. METHODS: This was a retrospective study of 80 patients (165 surgeries) who underwent microtia reconstruction surgery in Dokkyo Medical University Hospital between April 2006 and December 2012. The patient- and operation-related variables were obtained from medical charts. Neck radiographs and computed tomography scans of patients with atlantoaxial rotatory fixation were evaluated to check for cervical spine abnormalities. RESULTS: Five cases of atlantoaxial rotatory fixation after microtia reconstruction surgery were recorded. Three of these five cases were diagnosed with Klippel-Feil syndrome after the onset of atlantoaxial rotatory fixation. No significant difference was found in the operative duration and other variables between patients with atlantoaxial rotatory fixation and those without. All patients immediately underwent conservative treatment and showed complete recovery and no recurrences. CONCLUSIONS: Although atlantoaxial rotatory fixation is a rare complication, surgeons should consider it in patients with neck problems following microtia reconstruction surgery. A patient with microtia may have unrecognized Klippel-Feil syndrome. Patients with Klippel-Feil syndrome are more likely to develop atlantoaxial rotatory fixation, which may have severe consequences. Thus, it is crucial to preoperatively identify Klippel-Feil syndrome with neck radiography and to detect atlantoaxial rotatory fixation at the earliest.
RESUMO
In the treatment of pressure ulcers, assessment of systemic problems is an important yet difficult step in selecting either conservative or surgical therapeutic intervention. The surgical auditing system called the Physiological and Operative Severity Score for enUmeration of Mortality and Morbidity (POSSUM) and its orthopedic version (O-POSSUM), which gives a predictive mortality rate for the first 30 postoperative days, may be useful for assessing systemic status, but have yet to be sufficiently validated for patients with pressure ulcers. To assess the validity of POSSUM and O-POSSUM, 71 procedures on 50 cases were retrospectively statistically analyzed using receiver operating characteristic curves and goodness-of-fitness testing with the Hosmer-Lemeshow chi(2) test for logistic regression modeling. POSSUM and O-POSSUM showed satisfactory discriminatory power in receiver operating curve analysis. The validity of the values obtained by POSSUM and O-POSSUM was also confirmed. O-POSSUM was superior to POSSUM in both analyses. O-POSSUM is useful in assessing the systemic status of patients with pressure ulcers. Some patients with pressure ulcers show extreme systemic conditions. Assessment of systemic status with O-POSSUM contributes to daily clinical practice and future studies of treatments for pressure ulcers.
