Management of incidental durotomies in an integrated Orthopaedic and Neurosurgical Spinal Unit.

Introduction: Incidental durotomy (ID) is an intraoperative event associated to prolonged bed rest and hospital stay, antibiotic use, higher patient dissatisfaction, and leg pain among other complications of its postoperative course. Several repair techniques and postsurgical care have been proposed for its management. This study was designed to develop an agreed protocol in cases of ID among Orthopaedic Surgeons (OS) and Neurosurgeons (NS) integrated into a Spinal Surgery Unit. Research question: Incidental durotomies management protocol. Materials and methods: From 997 eligible cases operated in Hospital del Mar (Barcelona, Spain) from April 2018 to March 2022, demographic, clinical, surgical and postoperative data was collected for statistical analysis from the morbidity and mortality database, with 79 identified IDs. Redo procedures were significantly associated to OS, and cervical and anterior/lateral approaches to NS, both groups were not comparable. Results: ID occurred in 7.9% of cases, more frequently after the lockdown (p=0.03), in females (p=0.04), during posterior approaches (p=0.003), and less frequently in the cervical spine (p=0.009). IDs were linked to postoperative infections (p< 0.001) and nerve root damage (p< 0.001). Patients without ID evolved more satisfactorily during the postoperative period (p=0.002), and those with CSF leak (20/79) spent on bed rest more than twice the time as those without (p<0.001). Multivariable logistic regression showed strong association between posterior approaches and ID, between complicated postoperative courses and ID. Discussion and conclusions: ID is linked to an adverse postoperative recovery, and it should be primarily repaired under microscope, with early mobilization of patients after surgery.

Surgical technique and outcomes for bilateral humeral lengthening for achondroplasia: 26-year experience.

BACKGROUND: Elongation in patients with achondroplasia provides better overall skeletal proportionality and significantly improves such individuals' access to their perineal region to self-manage personal hygiene. This paper describes our surgical technique and outcomes for bilateral humeral lengthening in achondroplasia patients over 26 years. METHODS: Ours was a retrospective study of 55 patients with achondroplasia-related short stature, in whom bilateral humeral lengthening was performed from 1990 to 2016. We describe the surgical technique and analyze mean gain in humeral length, days using an external fixator, mean percentage of lengthening, external fixation index, type of callus, and complications. Pre- and postoperative radiographic measurements were obtained. Patients also were contacted by telephone and asked about their ability to perform peri-anal self-hygiene and about their overall satisfaction. RESULTS: In total, 110 humeri were lengthened (28 males and 27 females) with medium elongation of 9.5 cm on the right and 9.6 cm on the left, while averaging 220 days in an external fixator. We observed 14 minor complications. There was no significant association between pin position and type of callus, and elongation most often external and in the presence of a straight callus. Before elongation, 77.1% of patients reported difficulties with perineal hygiene and 85.4% could not put their hands in their pockets. Upon completion of lengthening, 100% could perform both tasks and 94.5% were very satisfied. CONCLUSIONS: Bilateral humeral elongation yields significant improvements in patient autonomy, with a relatively low complication rate and very high patient satisfaction.

Alta recidiva y buenos resultados funcionales tras la resección artroscópica de la sinovitis villonodular pigmentaria de la rodilla / High recurrence and good functional results after arthroscopic resection of pigmented villonodular synovitis

Introducción. La sinovitis villonodular pigmentaria (SVP) es un trastorno de la proliferación sinovial de etiología incierta, con un tratamiento controvertido. El objetivo del estudio es valorar los resultados funcionales y la tasa de recurrencia en una serie de pacientes diagnosticados de SVP de rodilla, tanto en su forma difusa como en su forma localizada, tratados mediante resección artroscópica. Material y métodos. Estudio retrospectivo de 24 pacientes diagnosticados por resonancia magnética de SVP local/difusa entre 1996 y 2011. Se trataron 11 casos de forma localizada y 13 de forma difusa. Tras un seguimiento medio de 60 meses (rango: 34-204). Se intervinieron mediante sinovectomía artroscópica y se valoraron funcionalmente en el postoperatorio con los test IKDC, WOMET, Kujala y Tegner. Resultados. Ocho pacientes afectados de SVP difusa recidivaron (un 61,5% de las formas difusas). De ellos 2 requirieron radioterapia, uno cirugía abierta por afectación extraarticular y 5 nueva resección artroscópica sin detectarse posteriormente nueva recidiva. En 6 pacientes se observaron lesiones asociadas (en 3 meniscopatía y en 3 lesiones condrales). No hubo recidivas en la forma localizada. El IKDC mejoró de media 30,6 puntos, el WOMET 37,4 puntos y Kujala 34,03 puntos. Discusión. La SVP resecada mediante técnica artroscópica presenta buenos resultados funcionales y curativos a medio plazo con una baja morbilidad. La forma difusa de la SVP requiere con frecuencia una segunda intervención quirúrgica por su alta tasa de recidiva tras su resección artroscópica (AU)

Introduction. Pigmented villonodular synovitis (PVS) is a synovial proliferation disorder of uncertain aetiology, with some controversy as regards its proper treatment. The purpose of the study was to evaluate the functional outcome and recurrence rate in a series of patients diagnosed with both the diffuse and the localised type of PVS and treated by arthroscopic resection. Material and methods. Twenty-four patients diagnosed with PVS were retrospectively assessed. There were 11 cases with the diffuse type, and 13 cases with the localised type of PVS. They were followed-up for a median of 60 months (range, 34-204). They underwent arthroscopic synovectomy, and were functionally evaluated with IKDC, WOMET, and Kujala scores. Results. There was recurrence in 8 out of 13 (61.5%) cases with the diffuse type of PVS. Two of these patients were treated with radiation. One patient underwent surgical resection with an open procedure due to extra-articular involvement. The remaining 5 patients underwent a second arthroscopic resection, and no recurrence was subsequently observed. Cases with localised PVS did not recur after a single arthroscopic resection. IKDC, WOMET and Kujala scores improved by 30.6, 37.4 and 34.03 points, respectively. Discussion. Pigmented villonodular synovitis treated by arthroscopic resection showed good functional results at mid-term follow-up. A single arthroscopic resection was sufficient to treat the localised PVS, whereas the diffuse type of PVS required a second arthroscopic resection in most cases, due to its high rate of recurrence (AU)

[High recurrence and good functional results after arthroscopic resection of pigmented villonodular synovitis]. / Alta recidiva y buenos resultados funcionales tras la resección artroscópica de la sinovitis villonodular pigmentaria de la rodilla.

INTRODUCTION: Pigmented villonodular synovitis (PVS) is a synovial proliferation disorder of uncertain aetiology, with some controversy as regards its proper treatment. The purpose of the study was to evaluate the functional outcome and recurrence rate in a series of patients diagnosed with both the diffuse and the localised type of PVS and treated by arthroscopic resection. MATERIAL AND METHODS: Twenty-four patients diagnosed with PVS were retrospectively assessed. There were 11 cases with the diffuse type, and 13 cases with the localised type of PVS. They were followed-up for a median of 60 months (range, 34-204). They underwent arthroscopic synovectomy, and were functionally evaluated with IKDC, WOMET, and Kujala scores. RESULTS: There was recurrence in 8 out of 13 (61.5%) cases with the diffuse type of PVS. Two of these patients were treated with radiation. One patient underwent surgical resection with an open procedure due to extra-articular involvement. The remaining 5 patients underwent a second arthroscopic resection, and no recurrence was subsequently observed. Cases with localised PVS did not recur after a single arthroscopic resection. IKDC, WOMET and Kujala scores improved by 30.6, 37.4 and 34.03 points, respectively. DISCUSSION: Pigmented villonodular synovitis treated by arthroscopic resection showed good functional results at mid-term follow-up. A single arthroscopic resection was sufficient to treat the localised PVS, whereas the diffuse type of PVS required a second arthroscopic resection in most cases, due to its high rate of recurrence.

Morbimortalidad en fracturas de húmero proximal tratadas quirúrgicamente / Morbidity and mortality of surgically treated proximal humerus fractures

Introducción. El objetivo de este estudio es analizar los factores que se correlacionan con la mortalidad y la capacidad para realizar actividades de la vida diaria (AVD) en las fracturas de húmero proximal tratadas quirúrgicamente. Métodos. Se estudiaron retrospectivamente a 94 pacientes con fractura de húmero proximal intervenidas quirúrgicamente con un seguimiento medio de 8 años (2-12 años). De la muestra, se estudió el tipo de fractura, el tratamiento aplicado y sus comorbilidades. Se correlacionan los parámetros con la mortalidad y el nivel de las actividades de la vida diaria. Resultados. Se localizaron a 72 pacientes, de los cuales el 18,6% habían fallecido. Un 85,4% de los pacientes presentan comorbilidades. El 79,5% de los pacientes eran totalmente independientes para las actividades de la vida diaria. No encontramos correlación entre la mortalidad, el tipo de fractura y el tratamiento aplicado. No se encontró relación significativa entre las AVD y las comorbilidades con el tipo de fractura, pero sí que se encontró una reducción significativa de la función de las actividades de la vida diaria en pacientes tratados con hemiartroplastia y en pacientes con trastornos neurológicos. Conclusiones. Encontramos una mortalidad del 18,6% en los pacientes con fractura de húmero proximal tratada quirúrgicamente. La mayoría de los pacientes intervenidos son totalmente independientes para las actividades de la vida diaria, con un seguimiento a largo plazo (AU)

Background. The aim of the present study is to analyse the factors associated with mortality and the capacity to perform daily life activities (DLA) in patients with surgically treated proximal humeral fractures. Methods. A retrospective study was conducted on 94 patients with a surgically treated proximal humeral fracture, with a mean follow-up of 8 years (2 - 12 years). A correlation analysis was performed to determine the relationship between the type of fracture, surgical technique, comorbidities and mortality and DLA. The Student t test was used for statistical analysis. Results. A total of 72 patients were identified, 18.6% of them died during follow-up, all diagnosed with some comorbidity. There was no correlation between mortality, type of fracture or the technique used. Most of the patients (85.4%) had comorbidities, and 79.5% were completely independent for DLA. Although there was no relationship with the type of fracture, there was a significant reduction in the performing of DLA in patients treated with hemiarthroplasty, and in patients with neurological disorders. Conclusions. There was a mortality of 18.6% among patients with surgically treated proximal humerus fractures. The majority of surgically treated patients were fully independent for DLA at long-term follow-up (AU)

[Morbidity and mortality of surgically treated proximal humerus fractures]. / Morbimortalidad en fracturas de húmero proximal tratadas quirúrgicamente.

BACKGROUND: The aim of the present study is to analyse the factors associated with mortality and the capacity to perform daily life activities (DLA) in patients with surgically treated proximal humeral fractures. METHODS: A retrospective study was conducted on 94 patients with a surgically treated proximal humeral fracture, with a mean follow-up of 8 years (2 - 12 years). A correlation analysis was performed to determine the relationship between the type of fracture, surgical technique, comorbidities and mortality and DLA. The Student t test was used for statistical analysis. RESULTS: A total of 72 patients were identified, 18.6% of them died during follow-up, all diagnosed with some comorbidity. There was no correlation between mortality, type of fracture or the technique used. Most of the patients (85.4%) had comorbidities, and 79.5% were completely independent for DLA. Although there was no relationship with the type of fracture, there was a significant reduction in the performing of DLA in patients treated with hemiarthroplasty, and in patients with neurological disorders. CONCLUSIONS: There was a mortality of 18.6% among patients with surgically treated proximal humerus fractures. The majority of surgically treated patients were fully independent for DLA at long-term follow-up.