A Comparative Analysis of the Early and Late Complication Rates and the Effect of Calcification on the Efficacy of MANTA and ProGlide Vascular Closure Devices.

Introduction The Perclose ProGlide and, more recently, MANTA Large-Bore Closure Device are commonly used vascular closure devices (VCDs) for managing large-bore vascular access haemostasis. The extent of calcification in the common femoral artery (CFA) plays a crucial role in choosing between these devices. ProGlide may face challenges with anterior calcification, while MANTA may have issues with posterior calcification. Our study compared their effectiveness, adjunct usage, calcification impact and early/late complications. Methods A retrospective analysis of procedures involving large-bore CFA access from 2017 to 2022 was conducted. Closure was grouped according to VCD as Group A (ProGlide) and Group B (MANTA). Calcification was designated as anterior and posterior and combined on pre-operative computed tomography angiography along 10 mm segments with 0.625 mm slice thickness. The success of haemostasis was graded as Grade 1 (haemostasis without adjuncts), Grade 2 (haemostasis with adjuncts) and Grade 3 (failed haemostasis needing rescue); Grades 1 and 2 were pooled as successful haemostasis. Statistical analysis was undertaken in Minitab 21 for Windows, particularly analysing calcification and its impact on the success of haemostasis. Results We evaluated 370 large-bore CFA accesses, distributed across two groups: Group A(64.9%, n=243) and Group B (35.1%, n=127), for a total of 205 endovascular procedures (93.1% (191) EVAR and 5.3% (11) TEVAR). The mean age was 74.9±8 years, predominantly males (88.2%, n=181). The average body mass index (BMI) was 28±5.8, with 20.9% (43) individuals having diabetes and 18.5% (37) current smokers. The mean sheath size OD was 16±2.5, with 4.5% (11) re-do groins in Group A and 6.2% (8) in Group B. Successful haemostasis was achieved in 91.8% (n=223) in Group A (44.8%, n=109 Grade 2) and 90.5% (n=115) in Group B (21%, n=27 Grade 2). Rescue operations were needed in 8.2% (20) in Group A and 9.1% (12) in Group B. Pseudoaneurysms developed more commonly in Grade 2 haemostasis with 9.9% (11) in Group A and 1.6% (2) in Group B (p=0.3). Anterior calcification was observed in 14.8% (36) in Group A and 18.8% (24) in Group B. In comparison, posterior calcification was present in 62.5% (152) in Group A and 66.9% (85) in Group B. Notably, calcification did not significantly impact haemostasis (p=0.79). Additional VCD deployment was necessary due to device failure in 4.5% (11) cases in Group A and 1.5% (2) cases in Group B. Conclusion The overall success rate was comparable between the two groups. However, Group A required more adjuncts to achieve successful haemostasis. The site of calcification did not impact the efficacy of closure devices. Pseudoaneurysm formation was more frequent when adjuncts were needed.

The incidence of medial end clavicle fractures is higher than had previously been considered.

BACKGROUND: Previous X-ray epidemiological studies have estimated the incidence of medial end clavicle fractures to account for 2-3% of all clavicle fractures. MATERIALS AND METHODS: At our institution X-rays of every patient attending the Emergency Department are reviewed at a Virtual Fracture Clinic by a Consultant Orthopaedic Surgeon. Patients with a fracture are referred to the Shoulder and Elbow Fracture Clinic. Patients without a fracture are contacted and, if there are on-going concerns, are referred to the Shoulder and Elbow Fracture Clinic. Over an 18-month period we identified every patient that attended our Emergency Department that had sustained a clavicle fracture. RESULTS: In total 558 clavicle fractures were identified (139 (24.9%) - lateral, 360 (64.5%) - middle, 59 (10.6%) - medial). Of the 59 medial end fractures, 31 (52.5%) were identified on presentation at the Emergency Department, 13 (22%) at the Virtual Fracture Clinic, 6 (10.2%) on computed tomography scan at the Shoulder and Elbow Fracture Clinic and 9 (15.3%) were admitted directly to the trauma unit. CONCLUSION: The results of this study suggest that the incidence of medial end clavicle fractures in the general population is higher than had previously been considered. LEVEL OF EVIDENCE: IV.

The role of iliocapsularis in hip pathology: a scoping review.

The iliocapsularis is a relatively unheard-of muscle, located deep in the hip covering the anteromedial capsule of the hip joint. Little is known about this constant muscle despite its clinical relevance. The aims of this scoping review are to collate the various research studies reporting on the detailed anatomy and function of iliocapsularis and to demonstrate how inter-individual differences in iliocapsularis can be used as a clinical adjunct in guiding diagnosis and treatment of certain hip joint pathologies. A computer-assisted literature search was conducted based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Our review found 13 studies including 384 cases meeting our inclusion criteria. About 53.8% of the studies involved human cadavers. The current scoping review indicates the relevant anatomy of the iliocapsularis, being a small muscle which arises from the inferior border of the anterior inferior iliac spine and anteromedial capsule of the hip joint, inserting distal to the lesser trochanter. Therefore, based upon these anatomical attachments, iliocapsularis acts as a dynamic stabilizer by tightening the anterior capsule of the hip joint. Implications of this association may be that the muscle is hypertrophied in dysplastic or unstable hips. Determining the size of the iliocapsularis could be of conceivable use in patients with hip symptoms featuring signs of both borderline hip dysplasia and subtle cam-type deformities. Although future research is warranted, this study will aid physicians to understand the clinical importance of the iliocapsularis.