A Systematic Review of the Management of Upper Extremity Orthopaedic Injuries in Epileptic Patients.

Background: During seizures, injury of the upper extremities may occur. Standardized guidelines are deficient for diagnosis and perioperative care. Methods: PubMed, Embase, Cochrane, Scopus, and Web of Science databases were systematically screened using predefined search terms. Results: Of the 59 patients included, 36 (61.0%) involved a posterior shoulder dislocation. Associated fractures were observed in 34 (57.6%) cases with surgical procedures performed in 30 (50.8%) patients. Functional outcomes were reported in 44 patients, with over half (23 of 44, [52.2%]) endorsing range of motion deficits. Conclusion: Standardized guidelines, to guarantee timely management of injury in post-seizure patients, are needed with a customized treatment approach that accommodates the various aspects of their condition.

The Effect of L5-S1 Degenerative Disc Disease on Outcomes of L4-L5 Fusion.

STUDY DESIGN: Retrospective cohort study. OBJECTIVE: The aim was to investigate the clinical relevance of preoperative caudal adjacent segment degeneration (ASD) in patients undergoing isolated L4-5 fusion to determine a threshold of degeneration at which a primary L4-S1 fusion would be warranted. SUMMARY OF BACKGROUND DATA: Increased motion and biomechanical forces across the adjacent caudal segment in isolated L4-L5 fusion leads to concerns regarding the increased incidence of revision surgery because of the development of ASD. METHODS: Patients who underwent isolated L4-L5 fusion between 2014 and 2019 were reviewed. Pfirrmann grading and the disc heights of the caudal level relative to the rostral level were used to quantify preoperative adjacent degenerative disc disease. To assess the influence of preoperative caudal degenerative disc disease, preoperative disc height ratios (DHRs) were compared for patients who reported minimal, moderate, and severe Oswestry disability index (ODI) sores on postoperative assessment. For each patient-reported outcome measure (PROM), adjacent DDD was compared for those who did and did not meet MCID. An area under curve analysis was used to identify a threshold of degeneration impacting outcomes from the preoperative DHR. RESULTS: A total of 123 patients were studied with an average follow-up of 2.11 years. All patients demonstrated a significant improvement in all PROMs after surgery. When categorizing patients based on the severity of postoperative ODI scores, there were no preoperative differences in the L5-S1 Pfirrmann grading or DHRs. There was a significant association between greater preoperative anterior DHR and an increased number patients who met MCID for visual analog scale back. There were no radiographic differences in preoperative L5-S1 Pfirrmann grade or DHR for ODI, visual analog scale leg, MCS-12, or PCS-12. area under curve analysis was not able to identify a preoperative DHR threshold that reflected worse MCID for any PROM. CONCLUSION: No preoperative radiographic indicators of caudal ASD were predictive of worse clinical outcomes after isolated L4-5 fusion. LEVEL OF EVIDENCE: Level III.

Current Concepts and Advances of Three-Dimensional Printing in Reconstructive Musculoskeletal Oncology: A Systematic Review.

Three-dimensional printing has the potential to advance current surgical practice, by way of anatomical and pathological structure analysis and customized implant manufacturing. Applications for this technology include pre-operative planning, prosthesis customization, and bioprinting. A comprehensive literature review of PubMed, Embase, Cochrane Library, Scopus, and Web of Science databases was conducted to extract all studies adopting three-dimensional printing in the operative management of primary and metastatic musculoskeletal tumors. A total of 73 articles reporting on 449 patients were deemed eligible for analysis. Indications of three-dimensional printing use consisted mainly of challenging tumor locations and proximity to neighboring neurovascular structures (232 [51.7%] patients) or anticipated high complication rates (142 [31.6%] patients). Operative time and follow-up averaged 240 minutes (4 hours) and 25.8 months, respectively. The majority of patients (327 [72.8%] of 449) in whom three-dimensional printing technology was used did not exhibit any complication or adverse event during or after their surgery, and most (354 [97.3%] of 364) subjects achieved convenient functional and oncological outcomes at last follow-up. The implementation of three-dimensional printing technology in the treatment of bone and soft tissue tumors is safe and efficient, as evidenced by the satisfactory functional and oncological outcomes, as well as the decrease in operative time and complication rates at 2-year follow-up. With recent innovations, three-dimensional printing has become cost-effective and reliable, so it is suitable for applications in orthopedic oncology.

Management of lower extremity orthopaedic injuries in epileptic patients: A systematic review.

Lower-extremity injuries may occur during seizures. There is a lack of standardized guidelines when diagnosing and planning perioperative care. Databases were systematically screened using predefined search terms. Of the 13 patients included, seven (53.8%) involved bilateral femoral neck fractures. Associated fractures were observed in all cases with surgical intervention performed in eight (61.5%) patients. Eleven patients reported functional outcomes, with over a quarter (three of 11, [27.3%]) endorsing mild range of motion deficits or issues with ambulation. Post-seizure patients may require standardized diagnostic protocols to ensure prompt management with a specialized treatment approach that accommodates the nuances of their condition.