Correlation between pre-anesthesia anxiety and emergence agitation in non-small cell lung cancer surgery patients.

BACKGROUND: Preoperative anxiety is a common emotional problem during the perioperative period and may adversely affect postoperative recovery. Emergence agitation (EA) is a common complication of general anesthesia that may increase patient discomfort and hospital stay and may be associated with the development of postoperative complications. Pre-anesthetic anxiety may be associated with the development of EA, but studies in this area are lacking. AIM: To determine the relationship between pre-anesthetic anxiety and EA after radical surgery in patients with non-small cell lung cancer (NSCLC). METHODS: Eighty patients with NSCLC undergoing surgical treatment between June 2020 and June 2023 were conveniently sampled. We used the Hospital Anxiety and Depression Scale's (HADS) anxiety subscale (HADS-A) to determine patients' anxiety at four time points (T1-T4): Patients' preoperative visit, waiting period in the surgical waiting room, after entering the operating room, and before anesthesia induction, respectively. The Riker Sedation-Agitation Scale (RSAS) examined EA after surgery. Scatter plots of HADS-A and RSAS scores assessed the correlation between patients' pre-anesthesia anxiety status and EA. We performed a partial correlation analysis of HADS-A scores with RSAS scores. RESULTS: NSCLC patients' HADS-A scores gradually increased at the four time points: 7.33 ± 2.03 at T1, 7.99 ± 2.22 at T2, 8.05 ± 2.81 at T3, and 8.36 ± 4.17 at T4. The patients' postoperative RSAS score was 4.49 ± 1.18, and 27 patients scored ≥ 5, indicating that 33.75% patients had EA. HADS-A scores at T3 and T4 were significantly higher in patients with EA (9.67 ± 3.02 vs 7.23 ± 2.31, 12.56 ± 4.10 vs 6.23 ± 2.05, P < 0.001). Scatter plots showed the highest correlation between HADS-A and RSAS scores at T3 and T4. Partial correlation analysis showed a strong positive correlation between HADS-A and RSAS scores at T3 and T4 (r = 0.296, 0.314, P < 0.01). CONCLUSION: Agitation during anesthesia recovery in patients undergoing radical resection for NSCLC correlated with anxiety at the time of entering the operating room and before anesthesia induction.

Reverse Shoulder Arthroplasty versus Non-Operative Treatment of Three-Part and Four-Part Proximal Humerus Fractures in the Elderly Patient: A Pooled Analysis and Systematic Review.

Background: The treatment of complex proximal humerus fractures in elderly patients is not yet fully elucidated. Of all treatment options, reverse shoulder arthroplasty (RSA) and non-operative treatment (NOT) appear to provide the best results. Evidence to guide the choice between the two is sparse. Therefore, this review provides an overview of the available evidence on RSA versus NOT. Methods: Studies comparing complex proximal humerus fractures in patients aged >65 years treated either with RSA or NOT were included for systematic review and direct comparison via pooled analysis of patient-rated outcome and range of motion. Indirect comparison of case series and non-comparative studies on either treatment was performed separately. Results: Three comparative studies including 77 patients treated with RSA and 81 treated non-operatively were analysed. The RSA group scored better for both the Constant-Murley score (mean difference 6 points) and DASH score (mean difference 8 points). No differences were detected in ASES, PENN score, pain scores, or range of motion between treatment groups. The most common complications for RSA were infection (3%), nerve injury (2%), and dislocation (2%). Reoperation was required in 5%. In the NOT group, common complications included malunion (42%), osteonecrosis (25%), and non-union (3%); no reoperation was required. Patient satisfaction was equal in both groups. Conclusions: The functional outcomes and range of motion after RSA seemed satisfactory and potentially superior to NOT in elderly patients. Patient satisfaction was comparable despite a high malunion and osteonecrosis rate in the non-operative treatment group, which did not require re-interventions.

Operative Management of Extensor Carpi Ulnaris Instability: A Systematic Review.

Background Posttraumatic extensor carpi ulnaris (ECU) instability is an increasingly recognized cause of ulnar-sided wrist pain that occurs when the ECU subsheath is disrupted. Purpose The purpose of this systematic review was to assess outcomes of operatively treated posttraumatic ECU instability. Methods A systematic search of Medline, Embase, Web of Science, and CINAHL (Cumulative Index to Nursing and Allied Health Literature) databases was performed using "extensor carpi ulnaris" as the keyword. Studies were systematically screened and data extracted independently by two reviewers. Results Eight retrospective studies met the inclusion criteria with a total of 97 wrists. The mean age was 32 years (13-61). Patients underwent either primary repair (40%) using sutures and anchors, or reconstruction (60%) using extensor retinaculum flaps. One study performed deepening of the osseous ulnar groove. Two studies compared preoperative and postoperative values. They both reported a significant improvement in pain scores, functional scoring instruments, satisfaction, and grip strength. The rest of the studies reported similarly favorable outcomes across the same outcomes. Concomitant pathologies were identified in 66% of the study population. Complications occurred in 9% of the sample size, including ECU tendinitis, ulnar sensory nerve irritation, and reintervention for concomitant pathology. None of the studies reported recurrence or reruptures. However, five patients (6.7%) did not return to their previous activity level. Conclusion Patients can expect favorable outcomes with a potentially low complication rate. Nevertheless, the heterogeneity of the sample population, operative techniques, and outcome measures warrant further standardized studies. Level of Evidence IV.

Surgical Outcomes in Charcot Arthropathy.

Treatment of Charcot neuroarthropathy (CN) of the foot and ankle remains challenging for both patients and surgeons. Nonoperative treatment with cast/orthosis immobilization has long been the mainstay of treatment, but surgical intervention has gained interest to improve poor long-term outcomes. A review of existing data on the operative management of CN demonstrates the potential benefits but also the continued risks associated with treatment. Additionally, a retrospective review of cohorts managed with limited surgical interventions (wound debridements, exostectomies, and other surgical procedures) compared to reconstructive procedures provides additional insight into the surgical management of CN.

Immobilization Period for the Non-Operative Treatment of Proximal Humerus Fractures: Systematic Review and Meta-Analysis.

Objectives: Proximal humerus fractures (PHFs) are common fractures in the elderly and are typically treated conservatively with immobilization. However, there is no consensus on whether to choose early or late conventional mobilization, taking their outcomes into account. This paper reviews comparative studies on the clinical outcomes of one- and three-week immobilization periods in terms of limb function, pain intensity, and complications following the adoption of the non-surgical treatment of PHF. Methods: The current systematic review started with searching PubMed, Scopus, and Web of Science databases for randomized clinical trials (RCTs) on PHF patients to compare the clinical outcomes between patients receiving the one-week mobilization (early mobilization) and those receiving the three-week mobilization (late mobilization). We also performed a meta-analysis to compare the two groups' limb function and pain levels at three and six months of follow-up. Results: Five of the seven RCTs had adequate data to be included in the meta-analysis. The quantitative results showed that the early mobilized patients had improved limb function at three [weighted mean difference (WMD): 5.15 (CI 95%: 0.68-9.62)] and six [WMD: 3.51 (CI 95%: 0.43-6.60)] months, but not at 12 months of follow-up. At either three, six, or 12 months, there was no difference in pain intensity between the two groups. Conclusion: This review supports the adoption of early mobilization at one week for the non-operative management of PHFs. However, to compare the long-term effects, more clinical trials with longer follow-ups are needed.

Is open anterior advantageous to posterior decompression and reconstruction in fresh A3 to C3/AO type thoracolumbar junction fractures? A systematic review.

INTRODUCTION: Surgical outcomes of open anterior and open posterior approaches, for thoracolumbar A3 to C3/AO type fractures, are compared. METHODS: A PubMed search was conducted from 1990 to 2024 related to anterior, posterior, and combined approaches. Inclusion criteria: Fresh traumatic T10 to L2 fractures, age ≥13 years, ≥10 cases, minimum follow-up 6 months. Exclusion criteria: Cadaveric studies, pathological fractures, reviews, thoracoscopy-assisted, mini-open lateral (MOLA) and minimal invasive anterior or posterior approaches. Coleman Methodology Scores (CMS) (modified for spinal trauma) indicated potential selection bias in the selected studies. PRISMA guidelines were adapted. RESULTS: Nineteen studies with 847 participants were selected. The average CMS quality score was fair. The anterior approach, although it better decompresses the compromised spinal canal, it is also associated with increased surgical complications compared to the posterior approach. The neurological outcome, the loss of correction and the reoperation rate, were similar to both approaches. This systematic review favors posterior approach. CONCLUSIONS: The anterior approach is demanding and is associated with a higher rate of surgical complications compared to the posterior approach. The limitations of the selected studies included inconsistence in the: 1) approaches selection, 2) classifications of the fracture types and the neurological status and 3) variety of instrumentations used. PROSPERO ID: CRD42023484222.

Towards a tailored approach for patients with acute diverticulitis and abscess formation. The DivAbsc2023 multicentre case-control study.

BACKGROUND: This multicentre case-control study aimed to identify risk factors associated with non-operative treatment failure for patients with CT scan Hinchey Ib-IIb and WSES Ib-IIa diverticular abscesses. METHODS: This study included a cohort of adult patients experiencing their first episode of CT-diagnosed diverticular abscess, all of whom underwent initial non-operative treatment comprising either antibiotics alone or in combination with percutaneous drainage. The cohort was stratified based on the outcome of non-operative treatment, specifically identifying those who required emergency surgical intervention as cases of treatment failure. Multivariable logistic regression analysis to identify independent risk factors associated with the failure of non-operative treatment was employed. RESULTS: Failure of conservative treatment occurred for 116 patients (27.04%). CT scan Hinchey classification IIb (aOR 2.54, 95%CI 1.61;4.01, P < 0.01), tobacco smoking (aOR 2.01, 95%CI 1.24;3.25, P < 0.01), and presence of air bubbles inside the abscess (aOR 1.59, 95%CI 1.00;2.52, P = 0.04) were independent predictors of failure. In the subgroup of patients with abscesses > 5 cm, percutaneous drainage was not associated with the risk of failure or success of the non-operative treatment (aOR 2.78, 95%CI - 0.66;3.70, P = 0.23). CONCLUSIONS: Non-operative treatment is generally effective for diverticular abscesses. Tobacco smoking's role as an independent risk factor for treatment failure underscores the need for targeted behavioural interventions in diverticular disease management. IIb Hinchey diverticulitis patients, particularly young smokers, require vigilant monitoring due to increased risks of treatment failure and septic progression. Further research into the efficacy of image-guided percutaneous drainage should involve randomized, multicentre studies focussing on homogeneous patient groups.

Comparing survival rates and mortality in operative versus nonoperative treatment for femoral neck fractures among Alzheimer's disease patients: A retrospective cohort study.

Introduction: Addressing femoral neck fractures resulting from ground-level falls in older adults with Alzheimer's disease (AD) involves a personalized treatment plan. There is considerable ongoing debate concerning the relative advantages and disadvantages of surgical treatment (internal fixation or arthroplasty) vs nonoperative treatment for femoral neck fractures in older persons with AD. Methods: This retrospective cohort study compared the mortality, hazard ratio, and survival rate between operative and nonoperative treatments, controlling for patients' demographic information and baseline health status. The study population consisted of Optum beneficiaries diagnosed with AD who experienced an initial femoral neck fracture claim between January 1, 2012, and December 31, 2017. Kaplan-Meier survival curves were applied to compare the treatment groups' post-fracture survival rates and mortality. Cox regression was used to examine the survival period by controlling the covariates. Results: Out of the 4157 patients with AD with femoral neck fractures, 59.8% were women (n = 2487). The median age was 81 years. The 1-year survival rate for nonoperative treatment (70.19%) was lower than that for internal fixation (75.27%) and arthroplasty treatment (82.32%). Compared with the nonoperative group, arthroplasty surgical treatment had significant lower hazard risk of death (arthroplasty hazard ratio: 0.850, 95% CI: 0.728-0.991, P < 0.05). Discussion: The findings suggest that the operative treatment group experiences higher survival rates and lower mortality rates than the nonoperative group. This paper provides insights into treatment outcomes of older adults with AD receiving medical care for femoral neck fractures.

Bony Mallet Thumb Treated With the Ishiguro Extension Block Technique: A Case Report.

A bony mallet thumb is an extremely rare injury. An 82-year-old man fell from a standing height and injured his right thumb. Imaging examinations revealed a rare intra-articular fracture at the dorsal side of the base of the distal phalanx of the thumb called the bony mallet thumb. Conservative treatment was adopted initially; however, surgery was deemed necessary because of the redislocation of the bone fragment. Thus, the Ishiguro extension block technique was used, and three months later, satisfactory thumb function was achieved. The Ishiguro technique is a relatively simple procedure often performed for bony mallet fingers. The current case indicated that it can also be used to treat cases of bony mallet thumbs successfully.

A Novel Surgical Technique for the Reconstruction of Chronic Tennis Leg Injury.

Tennis leg, a rupture of the medial head of the gastrocnemius muscle at the musculotendinous junction (MTJ), is common, particularly among middle-aged sports enthusiasts. While acute cases usually resolve with conservative care, optimal surgical strategies for the treatment of chronic injuries remain undefined. This study reviews the current literature and details the successful operative treatment of a 37-year-old male with a 12-month history of tennis leg, employing a novel reverse flap technique from the MTJ's aponeurosis and augmented by a facia lata allograft.

Silver compounds used in pediatric dentistry for caries arrest: A review of current materials and new technologies.

Silver compounds have been used in medicine and dentistry for centuries. Their use in pediatric dentistry has long been restricted because of some drawbacks, chief among them being the discoloration of teeth with black stains. However, recent advances in technology have resulted in the development of new silver agents that do not have the limitations of previously used ones. This led to the reintroduction of silver compounds in pediatric dentistry. The aim of the present review was to examine the evidence supporting the therapeutic use of silver compounds in pediatric dentistry for caries arrest, as well as the mode of action and biocompatibility, characteristics, advantages, and disadvantages of different silver-containing agents.

Tratamiento conservador no invasivo del traumatismo esplénico / Non-invasive conservative treatment of splenic trauma

RESUMEN Antecedentes: el tratamiento conservador no invasivo del traumatismo esplénico disminuye intervenciones quirúrgicas innecesarias y depende centro asistencial donde es aplicado. Objetivo: describir los resultados del tratamiento conservador no invasivo de pacientes con traumatismo abdominal cerrado con lesión esplénica y correlacionarlos con variables preoperatorias. Material y métodos: trabajo observacional descriptivo de pacientes con traumatismo abdominal cerrado con lesión esplénica ingresados entre 2012-2022. Se analizaron cinemática del traumatismo, lesiones asociadas, grado de lesión tomográfica y de hemoperitoneo, lugar de internación y resultado del tratamiento conservador no invasivo. Resultados: en 102 pacientes la cinemática del traumatismo de mayor frecuencia fue moto/auto (47,1%); el porcentaje de éxito del tratamiento conservador no invasivo fue 66,6%, y se relacionó con el grado de lesión tomográfica (p <0,001), grado de hemoperitoneo (p <0,001), presencia de otras lesiones (p <0,001), traumatismo encéfalo craneano grave (p <0,009), y lugar de internación (p <0,002). Conclusión: a pesar de no contar con todos los recursos humanos y tecnológicos recomendados, el tratamiento conservador no invasivo en esta serie tuvo resultados comparables con centros de mayor complejidad.

ABSTRACT Background: Non-invasive conservative treatment of splenic trauma reduces the rate of unnecessary surgical interventions and depends on the type of healthcare center involved. Objective: The aim of this study is to describe the outcomes of non-invasive conservative treatment in patients with blunt abdominal trauma and splenic injury and their correlation with the preoperative variables. Material and methods: We conducted a retrospective and observational study of patients admitted with blunt abdominal trauma and splenic injury between 2012 and 2022. The variables analyzed were kinematics of trauma, lesion severity on computed tomography images, amount of hemoperitoneum, type of unit of hospitalization and results of non-invasive conservative treatment. Results: Among 102 patients, the most common kinematics of trauma was motorcycle-to-car collisions (47.1%); the success rate of non-invasive conservative treatment was 66.6%, and was associated with lesion severity on computed tomography images (p < 0.001), amount of hemoperitoneum (p < 0.001), presence of other injuries (p < 0.001), severe trauma brain injury (p < 0.009), and type of unit of hospitalization (p < 0.002). Conclusion: Despite the absence of recommended human and technological resources, the results of non-invasive conservative treatment in this series were comparable to those obtained in high complexity centers.

[Translated article] Type III acromioclavicular dislocation: Mid term results after operative and non-operative treatment.

INTRODUCTION: Controversy exists in the literature about the best treatment for type III acromioclavicular dislocations. The aim of this study is to compare functional results between surgical and conservative treatment in type III acromioclavicular joint dislocations. MATERIAL AND METHOD: We retrospectively evaluated the records of 30 patients from our area with acute type III acromioclavicular dislocations that were treated from January 1st, 2016 to December 31st, 2020. Fifteen patients were treated surgically and 15 conservatively. Follow-up mean time was 37.93 months in operative group and 35.73 months in non-operative group. Results obtained on the Constant score was the main variable analysed and results obtained on the Oxford score and the Visual Analogue Scale for pain were the secondary variables. Epidemiological variables were analysed, as well as range of mobility in injured shoulder and subjective and radiological variables (distance between the superior border of the acromion and the superior border of the clavicle's distal end and presence of osteoarthritis in the acromioclavicular joint). RESULTS: Functional evaluation scores did not show differences between the two groups (Constant: operative 82/non-operative 86.38, p 0.412; Oxford: operative 42/non-operative 44.80, p 0.126) nor did Visual Analogue Scale (operative 1/non-operative 0.20, p 0.345). Subjective evaluation of the injured shoulder was excellent or good in 80% of the patients in both groups. Measurement of the distance between the superior border of the acromion and the superior border of the clavicle's distal end were significantly higher in non-operative group (operative 8.95/non-operative 14.21, p 0.008). CONCLUSIONS: Although radiographic results were better in the surgical treatment group, functional evaluation scores did not show significant differences between the two groups. These results do not support the routine use of surgical treatment for grade III acromioclavicular dislocations.

The value of preoperative diagnostic testing and geriatric assessment in frail institutionalized elderly with a hip fracture; a secondary analysis of the FRAIL-HIP study.

PURPOSE: The aim of this study was to provide a comprehensive overview of (preoperative and geriatric) diagnostic testing, abnormal diagnostic tests and their subsequent interventions, and clinical relevance in frail older adults with a hip fracture. METHODS: Data on clinical consultations, radiological, laboratory, and microbiological diagnostics were extracted from the medical files of all patients included in the FRAIL-HIP study (inclusion criteria: hip fracture, > 70 years, living in a nursing home with malnourishment/cachexia and/or impaired mobility and/or severe co-morbidity). Data were evaluated until hospital discharge in nonoperatively treated patients and until surgery in operatively treated patients. RESULTS: A total of 172 patients (88 nonoperative and 84 operative) were included, of whom 156 (91%) underwent laboratory diagnostics, 126 (73%) chest X-rays, and 23 (13%) CT-scans. In 153/156 (98%) patients at least one abnormal result was found in laboratory diagnostics. In 82/153 (50%) patients this did not result in any additional diagnostics or (pharmacological) intervention. Abnormal test results were mentioned as one of the deciding arguments for operative delay (> 24 h) for 10/84 (12%) patients and as a factor in the decision between nonoperative and operative treatment in 7/172 (4%) patients. CONCLUSION: A large number and variety of diagnostics were performed in this patient population. Abnormal test results in laboratory diagnostics were found for almost all patients and, in majority, appear to have no direct clinical consequences. To prevent unnecessary diagnostics, prospective research is required to evaluate the clinical consequences and added value of the separate elements of preoperative diagnostic testing and geriatric assessment in frail hip fracture patients.

Complications of operatively treated distal radial fractures.

Distal radial fractures represent the most common fractures of the upper extremity. Operative treatment is performed for approximately one-third of distal radial fractures in the adult population. Complications following operative treatment of distal radial fractures vary depending on the treatment modality and can be stratified into preoperative and postoperative complications. Complications can occur in the near, intermediate and long term. The most common complications seen are tendon irritation and rupture, chronic regional pain syndrome (CRPS), carpal tunnel syndrome, ulnar or radial neuropathy, compartment syndrome, malunion, inadequate fixation or loss of fixation, symptomatic hardware, post-traumatic arthritis, stiffness and infection. Careful planning, treatment and patient selection can help to mitigate these complications.Level of evidence: V.

Complications and secondary operations after non-operative and operative treatment of tibial plateau fractures: a population-based study of 562 patients with mean follow-up of 7 years.

INTRODUCTION: The incidence of tibial plateau fractures (TPF) is 1% of all fractures and increases with age. Whether non-operatively or operatively treated, complications (infection, malalignment, loss of reduction and delayed union or nonunion) and post-traumatic osteoarthritis are not uncommon, and the risk for complications has generally been assumed to rise with age. This study investigated all post-TPF complications and secondary surgery after non-operative and operative treatment. Secondary aims were to determine the incidence and epidemiology of TPF in the population of the Central Finland region. MATERIALS AND METHODS: All patients over age 18 years with a TPF, including incidence, etiology, fracture type, and possible complications and reoperations, sustained during the period 1998-2019 were retrospectively identified from hospital records. RESULTS: The annual mean incidence of TPF was 14.4/100,000, with older women at highest risk. The proportions of non-operative and operatively treated patients who had undergone at least one additional surgical operation were 6% and 26%, respectively. Age and female gender were identified as risk factors for complications and secondary operations. The risk peaked in patients aged 60-65 years, decreasing thereafter. Non-operative treatment showed low risk for both non-union and loss of reduction. CONCLUSIONS: Older women were at the highest risk for TPF and for subsequent complications and secondary operations after TPF. Secondary operations after operatively treated TPF were not uncommon and patients aged 60-65 years were at highest risk. Given the low rates of complications and re-operations, non-operative treatment may be a safe option in cases of all minimally displaced TPF.

In-house 3D-printed custom splints for non-operative treatment of distal radial fractures: a randomized controlled trial.

We compared patient satisfaction and clinical effectiveness of 3D-printed splints made of photopolymer resin to conventional fibre glass casts in treating distal radial fractures. A total of 39 patients with minimally displaced distal radius fractures were included and randomized. Of them, 20 were immobilized in a fibre glass cast and 19 in a 3D-printed forearm splint. The 3D-printed splints were custom-designed based on forearm surface scanning with a handheld device and printed in-house using digital light processing printing technology. Patient satisfaction and clinical effectiveness were assessed with questionnaires 1 and 6 weeks after the initiation of immobilization. Fracture healing, pain, range of motion, grip strength and the DASH and PRWE scores were assessed up to 1-year follow-up. 3D-printed splints proved to be equally well tolerated by the patients and equally clinically effective as conventional fibre glass casts although there was a higher rate of minor complications. 3D-printed splints present a safe alternative, especially in young, active patients, for non-operative treatment of distal radial fractures.Level of evidence: I.

Efficiency of a virtual fracture care protocol in non-operative treatment of adult patients with a distal radial fracture.

This study aimed to determine the effects of virtual fracture care (VFC) on secondary healthcare utilization in non-operative treatment of adult patients with a distal radial fracture. A retrospective cohort study was performed, including those who received non-operative treatment without VFC (pre-VFC) and with VFC (VFC). Outcomes included secondary healthcare utilization, calculated treatment costs, emergency department (ED) reattendances and complication rates. In total, 88 pre-VFC and 99 VFC patients were included. Pre-VFC patients had more follow-up appointments, with a median of 4 (IQR: 3) versus a median of 4 (IQR: 1) in VFC patients. In addition, 3% of follow-up appointments for pre-VFC patients were performed remotely compared to 18% for VFC patients. Complications and ED reattendances were comparable between groups. In this study, non-operative treatment of adult patients with a distal radial fracture through VFC reduced secondary healthcare utilization, with similar reported complication and ED reattendance rates compared with treatment without VFC.Level of evidence: III.

Duration of sick leave after operated and non-operated distal radial fracture: a Finnish cohort study of 19,995 patients.

The purpose of this study was to investigate whether operative treatment for distal radial fracture reduces the length of sick leave and the costs of treatment. We identified 19,995 patients from a registry who received a state sick leave allowance between 2010 and 2019 owing to distal radial fractures. We compared these patients to a registry of operations and identified 4346 operated patients. Operated patients had a mean sick leave of 75 days, whereas non-operated patients had a sick leave of 63 days. In the operated group, the cost of sick leave was €7505 (UK£6419; US$8070), which was 34% higher than in the non-operated group. Over the analysed period, the duration of sick leave decreased. Although several studies have shown better early functional outcomes after operation, this does not seem to shorten sick leave.Level of evidence: III.