Nasotracheal fibreoptic intubation: a randomised controlled trial comparing the GlideRite® (Parker-Flex® Tip) nasal tracheal tube with a standard pre-rotated nasal RAE™ tracheal tube.

In a randomised controlled study, we compared the ease of railroading a GlideRite® nasal tracheal tube over a fibrescope with that of a pre-rotated RAE™ nasal tracheal tube. We studied 110 anaesthetised patients with no known airway difficulties undergoing elective dental or maxillofacial surgery. Impingement was more common with the GlideRite tubes (11/55 (20%)) compared with the pre-rotated RAE tubes (3/55 (5%); p=0.02). The median (IQR [range]) time to intubation (GlideRite 7.6 (4.7-10.8 [3.0-46.2]) s; RAE 8.0 (6.2-10.7 [2.4-30.0]) s) and postoperative sore throat numerical ratings (GlideRite 2 (0-3 [0-10]); RAE 2 (0-5 [0-8])) were similar. A 90° anticlockwise pre-rotation of a standard nasal RAE tube has a higher initial rate of successful railroading at first attempt and is therefore superior to a GlideRite nasotracheal tube during nasal fibreoptic intubation.

Outcomes of femoral de-rotation osteotomy for treatment of femoroacetabular impingement in adults with decreased femoral anteversion.

Decreased femoral anteversion is an often overlooked factor in femoroacetabular impingement (FAI), with potential to exacerbate both cam and pincer type impingement, or itself be the primary cause. Femoral de-rotation osteotomy (FDO) is a surgical option for symptomatic patients with such underlying bony deformity. This study aimed to investigate outcomes of FDO for management of symptomatic FAI in the presence of decreased (<5°) femoral anteversion. Secondary aims were to describe the surgical technique and assess complications. This study included 33 cases (29 patients) with average pre-operative anteversion measuring -3.1° (true retroversion). At an average follow-up of 1.5 years (19.8 months), 97% reported significant improvement. The overall average post-operative International Hip Outcome Tool (iHOT-33) score of 70.6 points (r: 23-98) compared to the average pre-operative score of 42.8 points (r: 0-56) for the 11 patients with available pre-operative scores suggests an overall improvement. The minimal clinically important difference for the iHOT-33 is 6.1 points. Patients with both pre- and post-operative iHOT-33 scores available demonstrated a statistically and clinically significant improvement of 37.7 (r: 13-70) points. There were three cases (9%) of delayed union and two cases (6%) of non-union early in the series which prompted evolution of the technique. Locking screw removal was performed in 33% of patients for a resultant overall re-operation rate of 45%. The findings suggest improvement in patient-reported outcomes can be achieved with FDO for symptomatic FAI in the setting of decreased femoral anteversion (<5°).

Shape Analysis of the Patellar Bone Surface and Cutting Plane for Knee Replacement Surgery.

Geometry of the patella (kneecap) remains poorly understood yet is highly relevant to performing the correct patellar cut to reduce pain and to improve function and satisfaction after knee replacement surgery. Although studies routinely refer to "parallel to the anterior surface" and "the patellar horizon," a quantitative definition of these is lacking and significant variability exists between observers for this irregularly-shaped bone. A 2D-3D shape analysis technique was developed to determine the optimal device configuration for contacting the patellar surface. Axial and sagittal pseudo-X-rays were created from 18 computed tomography (CT) scans of cadaveric knees. Four expert surgeons reviewed three repetitions of the X-rays in randomized order, marking their desired cut plane and their estimate of the anterior surface. These 2D results were related back to the 3D model to create the desired plane. There was considerable variability in perceptions, with intra- and intersurgeon repeatability (standard deviations) ranging from 1.3° to 2.4°. The best configuration of contact points to achieve the desired cutting plane was three pegs centred on the patellar surface, two superior and one inferior, forming a 16 mm equilateral triangle. This configuration achieved predicted cut planes within 1° of the surgeon ranges on all 18 patellae. Implementing this, as was done in a subsequent prototype surgical device, should help improve the success and satisfaction of knee replacement surgery.