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There have recently been multiple reports of late complications of femoral stem fractures occurring after total hip replacement arthroplasty of the hip. The case presented is the first case reported in the English literature of a subcapital prosthesis fracture involving a Charnley-Mueller design femoral component. Revision surgery was carried out with satisfactory replacement of the failed component.
The incidence of pulmonary emboli after a standardized technique of total hip replacement in a series of 7,959 hip arthroplasties operated on between 1962 and 1973 was 1.04% fatal and 7.89% non-fatal. 1,174 had no prophylaxis against embolism with a fatality rate of 2.3% and non-fatal embolism in 15.2%. Phenindione, intravenous heparin and dextran all reduced the complication rate to about 1% fatal and 8% non-fatal but none was statistically better than another. Statistically, plaquenil (hydroxychloroquine sulphate), was as good as any of the other methods used and had few complications. Analysis of the blood groups, pre and post-operative hemoglobin levels, major and revision surgery showed little relationship to the incidence of embolism. The most frequent time of onset of embolism (75%) occurred in the second and third postoperative weeks with only 10% in the first week.
The total extirpation of thyroglossal duct remnants with resection of the mid hyoid bone is reported as the only method for successful surgical therapy. Convoluted ducts of cysts and fistulae must be dissected to the base of the tongue and excised. As our cases demonstrate, recurrences will be avoided and revision surgery, when required, will be most successful.
Surgery of the maxillary sinus is one of the commonest in otorhinolaryngology. The classical Caldwell-Luc procedure however is not infrequently followed by infraorbital or some other facial neuralgia or discomfort. In 1976,246 patients were assessed for revision maxillary sinus surgery, and the symptomatology, clinical, transnasal endoscopic and radiological (polytomography) findings were documented. 59 revision operations were performed and a critical analysis of the preoperative, operative and postoperative findings are presented. Polytomography together with sinus endoscopy is a very valuable assessment of the need for revision surgery. Careful sublabial periosteal wound closure is emphasized, and as an alternative to the Caldwell-Luc procedure the intranasal antrostomy under endoscopic control is recommended.
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BACKGROUND: Legislation restricting surgical interventions in children with differences of sex development (DSD) has intensified debate about female genital restoration surgery (FGRS) in patients with congenital adrenal hyperplasia (CAH). Long-term patient-reported outcomes are needed regarding the optimal timing of surgery. OBJECTIVE: We aimed to assess health-related quality of life (HRQoL), gender identity, and family satisfaction regarding surgical timing and outcome in females with CAH following genital restoration surgery. STUDY DESIGN: Cross-sectional survey of CAH patients who underwent surgery between January 2007 to December 2016 at our institution. Validated instruments (KINDL questionnaire for HRQoL, Utrecht Gender Dysphoria Scale, UGDS) and structured telephone interviews were employed. RESULTS: Data on HRQoL was available for 25 patients (self- and/or parent-reported) out of 56 eligible patients (45% response rate). Median age at first surgery was 6 months (range: 3-137 months). Patients' age at time of participation ranged from 2 to 28 years. All had 21-hydroxylase deficiency (92% salt-wasting form) with Prader grades ranging from II-V. Wound dehiscence requiring secondary suturing occurred in 15% of patients with primary surgery at our center, while only one (4%) patient developed vaginal stenosis after early primary vaginoplasty. Two additional patients (8%) with prior outside surgery required vaginal revision after FGRS at age 12. HRQoL scores were comparable to healthy reference populations across most age groups. Children aged 3-6 and adolescents and young adults showed no significant difference from reference values, while children aged 7-13 showed a slight elevation. None of five patients ≥14 years demonstrated gender dysphoria (all UGDS scores <40, threshold ≥40). 14 patients and families were also interviewed by telephone. All preferred early surgical timing. No family expressed regret about the decision or preferred delayed surgery. DISCUSSION: This study provides validated intermediate-term patient- and parent-reported outcomes after FGRS in CAH. Key limitations include the small sample size, single-center design, and young age of most patients. Selection bias may exist, though participating families included those who underwent revision surgery. The absence of a non-operated comparison group reflects current clinical reality, as nearly all CAH patients with urogenital sinus underwent surgical correction. CONCLUSIONS: Females with CAH reported normal HRQoL and a comfortable female gender identity after early FGRS. The patients and their families expressed a preference for early surgery. However, there is need for longer-term follow-up to assess sexual function and reproductive outcomes as well comparison of outcomes with a non-operated group.
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BACKGROUND: Revision total elbow arthroplasty (TEA) is technically demanding and carries a substantial risk of postoperative neurological complications because of scarring, altered anatomy, implant removal, and repeated humeral and ulnar exposure. The incidence, nerve distribution, and recovery profile of nerve injury after revision TEA remain incompletely defined. This study aimed to systematically review the literature to define the incidence, recovery profile, and risk factors for nerve injury after revision TEA. METHODS: A systematic review of the literature was performed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidance. Thirteen retrospective case series were included, comprising 282 revision TEAs in 271 patients. Random-effects meta-analysis of proportions was undertaken where the data permitted. The primary outcome was postoperative nerve injury following revision TEA. Secondary outcomes included nerve type, recovery, secondary nerve-related procedures, infection, triceps insufficiency, metallosis, periprosthetic fracture, and re-revision. RESULTS: The pooled incidence of postoperative nerve injury was 22.3% (95% confidence interval [CI] 16.3 to 29.6; I2 = 34.6%). The crude incidence was 60 of 282 revisions (21.3%, 95% CI 16.6 to 26.5). The ulnar nerve was involved in 66.7% of all nerve injuries, the radial nerve in 31.7%, and the median nerve in 1.7%. No significant difference in pooled nerve-injury incidence was identified between studies published before 2010 and those published from 2010 onwards (22.9% vs. 21.4%, P = .837). Recovery reporting was heterogeneous; among injuries with numerically extractable outcomes, 85.4% improved partially or completely (95% CI 72.2 to 93.9). Secondary nerve-related procedures were reported in 7 studies. Pooled complication estimates were 10.2% for infection, 13.6% for triceps insufficiency, 25.5% for metallosis, 15.9% for periprosthetic fracture, and 14.0% for re-revision. CONCLUSIONS: Postoperative nerve injury is a common and clinically important complication of revision TEA, affecting approximately 1 in 5 cases. The ulnar nerve is most frequently involved, although radial nerve injury accounts for a substantial proportion of cases. Many neuropathies improve during follow-up, but persistent deficits and the need for secondary nerve-related procedures are not uncommon. Future studies should adopt standardized neurological definitions and reporting to improve comparability and guide preventive surgical strategies.
PURPOSE: Vertebral compression fractures (VCFs) are common complications of osteoporosis in elderly patients. Percutaneous vertebroplasty (PVP) provides pain relief and functional improvement, but some patients require revision due to refracture, cement failure, or new symptomatic levels. While outcomes of primary and multilevel augmentation have been described, systematic data on multilevel revision PVP remain rare. The aim of this study was to evaluate pain relief, functional improvement, and perioperative safety after three- and four-level revision PVP in elderly patients with osteoporotic thoracolumbar fractures. METHODS: This retrospective, single-center cohort included patients aged 75-85 years who underwent revision PVP between August 2019 and November 2023. Eligible cases had a history of prior PVP and required repeat augmentation of three or four vertebral levels in a single session. Visual Analogue Scale (VAS) scores for pain and Oswestry Disability Index (ODI) for functional disability were recorded preoperatively and at 1-, 3-, 6-, and 12-month follow-up. RESULTS: Nine patients were analyzed. Revision involved three levels in five patients and four levels in four patients, with a mean interval of 14.1 months after the index procedure. Mean VAS improved from 8.3 ± 0.7 preoperatively to 3.2 ± 0.6 at 12 months (61% reduction, p < 0.01). ODI improved from 75.2% ± 3.4% to 26.9% ± 2.7% (64% reduction, p < 0.01). All patients exceeded the minimal clinically important difference thresholds. No perioperative complications such as cement leakage, neurological deficits, or pulmonary events were observed. CONCLUSION: Three- and four-level revision PVP provided significant pain relief and functional improvement in elderly patients with osteoporotic fractures, without increased complication rates. To our knowledge, this represents one of the first reports addressing this topic, suggesting it is an effective option in carefully selected patients.
A new method of nephropexy with an autograft by the upper pole to the diaphragm from intercostal lumbotomy is described. The method induces little injury, is technically simple and can be employed in those patients who do not need a revision or surgery on the renal pelvis, ureter or vascular pedicle. The method was used in operations on 45 patients. Good immediate and remote results were obtained.
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Thermal injuries to the hand constitute not only one of the most common burns, but one of the most difficult for the burn surgeon to treat. Early wound closure is mandatory if maximum functional return is to be attained and scarring minimized. Over the last three and one-half years, 60 patients with deep dermal dorsal hand and finger burns were treated by tangential excision and immediate mesh autografting. All patients were admitted to the hospital within 24 hours of injury and excision was performed between the third to the tenth post burn day. Operative technique consisted of sequential eschar excision using the Humby knife or Goulian-Weck dermatome until viable dermis was visible. Mesh autograft, ratio 1 to 1(1/2) without expansion, was applied. There was 100% graft take in all but four hands. Hand function with full range of motion returned by the tenth postoperative day. Complications were minor. Patient follow-up ranged from six months to three and one-half years. No patient has required subsequent surgery for scar revision or contracture release. Range of motion in all patients has been excellent and all patients have continued to maintain normal hand function. The cosmetic appearance has been good except for the early "mesh" appearance of the graft which has become less apparent with time. In summary, early tangential excision and immediate mesh autografting of deep dermal dorsal hand burns has fulfilled the following burn principles-preservation of tissue, prevention of wound infection, maintenance of function and early wound closure.
Cerebral commissurotomy or the "split-brain" procedure may be a valuable adjunct to anticonvulsants for the control of seizures in people whose epilepsy cannot be relieved by anticonvulsants alone, and who are not candidate for the standard methods of surgery. Corpus callosotomy, a revised form of the usual division of many commissures, is a safer operation and appears to be equally effective. The complex clinical aspects of cure and treatment are emphasized.
INTRODUCTION: Studies have shown promising results using bone graft as a carrier for local administration of antibiotics to reduce the risk of prosthetic joint infection (PJI). The objective of this clinical trial is to determine if tobramycin and vancomycin-impregnated bone graft is safe and effective in reducing the rate of PJI after total hip arthroplasty (THA). METHODS AND ANALYSIS: This study is an international, randomised, double-blinded, placebo-controlled clinical drug trial. Patients scheduled for THA (n=1100) requiring bone grafting (excluding revisions due to an ongoing infection) are randomised in a 1:1 ratio to prophylactic treatment with tobramycin and vancomycin or placebo-impregnated bone graft.The primary outcome is the time to reoperation due to infection or diagnosis of PJI, expressed as a relative risk difference between the two groups. A risk reduction of at least 50% is considered clinically relevant. Secondary outcomes are time to and reason for reoperation and implant revision, type of micro-organism and antibiotic susceptibility pattern within 2 and 5 years after surgery. Safety outcomes are the number of adverse events and revision rate due to aseptic loosening. The primary analysis will be performed using proportional hazard models. ETHICS AND DISSEMINATION: The study has been approved under the Clinical Trial Regulation No 536/2014 (EU CT; 2024-510921-25-00). Results will be published in open-access peer-reviewed journals and disseminated to patient organisations and the media, and de-identified individual participant data will be curated and shared on reasonable request in accordance with the Findability, Accessibility, Interoperability and Reuse principles, subject to the laws and regulations governing data protection in each participating country. TRIAL REGISTRATION NUMBER: NCT05169229.
The purpose of this report is to aid physicians as they consider performances of coronary arteriography in individual patients. The recommendations are largely based on published reports about the procedure, coronary disease and current approaches to treatment. The fact that relevant information is accumulation rapidly has been taken into account and it is hoped that the guidelines will be adaptable in this time of change. However, the results of clinical trials of coronary bypass surgery now in progress could necessitate a revised point of view in the future. A guiding principle in preparation of this document was that the findings from arteriography should resolve diagnositic problems, or serve to evaluate patients for treatment which has known therapeutic outcomes. These goals should be readily apparent. An example is arteriography to evaluate the feasibility for coronary surgery for intractable angina pectoris. In a few areas, arteriography as preparation for coronary bypass surgery is suggested as a promising plan to deal with desperate illness, despite incomplete information about outcomes. The role of coronary arteriography is explored in various clinical syndromes which include chest pain of uncertain origin, chronic stable angina pectoris, main left coronary artery disease, unstable angina, latent coronary disease, after recovery from myocardial infarction, recurrent ventricular arrhythmias, the problem of sudden death, after aorto-coronary bypass surgery and acute myocardial infarction. Alternative opinions are mentioned in various sections of the report, but whenever possible, a concensus of the committee's opinion is given.
We have discussed composite grafts and some of their uses in secondary rhinoplastic procedures, the donor sites, and methods of application as to the dynamics of the iatrogenic problems and large septal perforations. A technique for nasal tip revisions as well as a safer septoplasty surgery that we have used for some years has also been shown.
To study the effects of vascular reconstruction or sympathectomy, or both, on the level of amputation, the number of revision procedures performed and the mortality following amputation, the authors reviewed the records of 504 patients from three Toronto teaching hospitals who had one or both limbs removed at or above the below-knee level. It appears that (a) previous vascular surgery or sympathectomy, or both, actually increases the number of patients in whom a below-knee amputation is successful, (b) the number of revision procedures necessary is increased after failed vascular surgery or sympathectomy, or both and (c) revision procedures following amputation do not affect the mortality from lower limb amputation.
The authors compared the clinical and pathoanatomical diagnoses in 1399 patients, operated upon for catarrhal appendicitis. In 123 children the clinical diagnosis was revised as a result of further observations following surgery. In 1276 patients the clinical diagnosis of catarrhal appendicitis was remained. An exploration of the appendicular process in these patients supported the diagnosis in 748 cases (58.6%). In 16 cases chronic appendicitis was recognized, in 111 -- phlegmonous and gangrenous appendicitis (8.7%).