Ultrasound-Guided Pigtail Catheter Drainage: An Effective Alternative to Exploratory Laparotomy.

Introduction It has been long established that open surgeries were the only options available for the management of intra-abdominal abscesses or collections. These were associated with increased morbidity and mortality. Traditionally, the idea of percutaneous needling could not gain popularity due to poor localization of collections. However, with the advent of ultrasound, percutaneous pigtail-catheter drainage has proven to be minimally invasive and allows precise localization of the drainage site. Objectives To study the effectiveness of ultrasound-guided pigtail catheter drainage as an alternative to exploratory laparotomy for the management of intra-abdominal abscesses or collections. Materials and methods A total of 48 patient cases, which included liver abscesses, perinephric collections, malignant ascites, splenic collections, pseudocysts, and psoas abscesses, were studied prospectively in a medical college in India from October 2020 to October 2021. The efficacy of the drainage was assessed by serial ultrasound. Results Out of 48 patients, 34 were male and 14 were female, ranging in age from 19 to 64 years, who were diagnosed with intra-abdominal abscesses or collections and underwent ultrasound-guided pigtail catheter drainage. The average hospital stay for patients was 2.5 days. They were followed up periodically for three months post-procedure, and none had significant complications or recurrence. Conclusion The pigtail catheter is the treatment of choice for liquefied intra-abdominal collections or abscesses, which helps to reduce post-procedure hospital stays and complications. Contribution This article reiterates the use of minimally invasive techniques in place of open surgeries with less morbidity.

Intraoperative Parameters of Comminuted Proximal Humerus Fractures: A Comparison Between Deltoid-Split and Deltopectoral Approaches.

Background and objective Many controversies exist in the literature regarding proximal humerus fractures treated with various surgical procedures. The chosen approach decides the level of comfort with which the surgeon can perform a particular surgery in orthopedics and the amount of reduction a surgeon can bring to a fractured bone. The purpose of this study was to compare variables such as time taken for surgery, achievement of reduction, and intraoperative blood loss between the two most frequently employed surgical approaches for proximal humerus in comminuted fractures: the deltoid-split (DS) approach and deltopectoral (DP) approach. Methods All patients with Neer III and IV types proximal humerus fractures treated with Proximal Humeral Interlocking System (PHILOS) plating from 2017 to 2020 were invited to participate in the study. The exclusion criteria were as follows: Neer type I and II fractures, pre-existing limb pathology, patient refusal or patient being unfit for surgery, and patient requiring a different modality of treatment like external fixator and pinning. After obtaining consent, the dark envelope method was used to randomize patients into one of the two treatment methods. The variables analyzed were time taken for the surgery, intraoperative blood loss, anatomical reduction in immediate postoperative X-ray, and complications. The results were analyzed and findings were recorded. Results A total of 42 patients were randomized into the two groups (22 DS, 20 DP; mean age of 44.85 years for DS and 49.61 years for DP). In terms of age, gender, and Neer fracture classification, the groups were comparable. The average blood loss estimated was less in the DS group compared to the DP group; however, the difference was not statistically significant. Intraoperative time was not significantly different between the DS and the DP groups. The surgeons were able to achieve a significantly higher anatomical reduction in the immediate postoperative X-ray with the DP approach compared to the DS approach. The complications (two in DS and two in DP) in either approach were equal in number although all of them were unique. Conclusions The proximal humerus fracture treatment with a PHILOS plate is considered to be a reliable option using either of the described approaches. Based on our findings, the choice of the approach has no impact on surgical time and blood loss. However, patients who were operated on with the DP approach fared better in terms of achieving reduction as assessed by immediate postoperative X-ray owing to limited exposure distally limited by the axillary nerve.

Incidental Identification of Vertebral Fragility Fractures by Chest CT in COVID-19-Infected Individuals.

Introduction It is critical to identify asymptomatic vertebral compression fractures (VCFs) as soon as possible in order to avoid subsequent fragility fractures. The purpose of the study was to see how many vertebral compression fractures there were in patients admitted to the COVID-19 pneumonia unit in a single tertiary care hospital who underwent chest computed tomography (CT) scans. Materials and methods Sagittal reconstruction of the thoracic spine was done in around 504 patients and classified into mild, moderate, and severe categories, and we compared it with the radiological reports of the same. Results In our study, the median age was 53 years (range: 31-91 years); 63% were men and 37% were women. Of the 504 patients, 76 (15%) had at least one vertebral compression fracture (VCF); 53 (10.2%) had one VCF, and 23 (4.8%) had multiple VCF, with 50 having mild fractures, 15 having moderate fractures, and 11 having severe fractures. Males (13.87%) and females (14.72%) had the same proportion of VCF (p = 0.83). Only 10% of the patients with VCFs we identified had a description in their report (eight patients). Conclusion The reporting of VCF is insufficient. VCF detection should be included in the search patterns of radiologists and physicians, regardless of the primary reason for performing chest CT. Although many patients are unable to come to the hospital during pandemic/epidemic, careful evaluation and inclusion of mild fractures in reports, as well as an explanation of the risk of subsequent fractures and treatment accordingly, would completely eliminate the risk of subsequent fractures.

Impact of Socioeconomic Factors on Patient's Adherence to Lifestyle Modifications Aimed at Reducing Future Fracture Risk in Geriatric Patients With Peritrochanteric Fragility Fractures of the Hip.

Introduction A history of fracture is a well-documented risk factor for sustaining future falls and subsequent fractures in geriatric patients. Orthopedic surgeons advocate various lifestyle modifications to reduce the risk of sustaining a recurrent fracture in this vulnerable group. However, it has been observed that patients seldom adhere to this advice and the rate of fragility fractures has thus continued to rise in this vulnerable subset of the population. The factors influencing the compliance of patients with various modifications have not been documented in any previous studies. In our study, we aimed to evaluate the factors influencing patient adherence to various lifestyle modifications advised by orthopedic surgeons for reducing future fracture risk. Material and methods A total of 112 patients aged >65 years who were diagnosed as having a peritrochanteric fragility fracture of the hip and were treated operatively for the same were included in this study. Upon discharge from the hospital, the patients were advised 10 lifestyle modifications to reduce the recurrent fracture risk. A data collecting form that graded the adherence on a 20-point scale (2 points for each lifestyle modification) was prepared by the investigators. Upon the six-month follow-up visit, adherence was assessed on the 20-point scale, and data were collected via the face-to-face interview method. Statistical analysis was accomplished by the Chi-square test and logistic regression analysis. Observations and results Of the 112 subjects included in the study, 58 (51.7%) were male and the mean age was 75 ± 8 (65 - 92) years. The adherence to less than 4 recommendations (Score <8) was seen in 39.2%, adherence to 4 - 6 recommendations (Score between 8 - 12) was seen in 30.86%, adherence to 6 - 8 recommendations (Score between 12 and 16) was seen in 29.94% and adherence to eight to 10 recommendations (score between 16 and 20) was seen in 0% of participants. According to the regression analysis, the presence of adherence to less than six recommendations was related to the low-income level (OR=0.298; 95%CI - 0.132-0.666; p<0.001) and lack of education and awareness (OR=2.329; 95% CI - 1.114-4.859; p=0.002). Conclusion The rates of adherence to advised lifestyle modifications were generally found to be low. Compliance was particularly reduced in patients belonging to the lower socioeconomic strata, which were less likely to be educated and had lower rates of income. The authors concluded that merely advising lifestyle modifications was not enough, and various social and public health measures are required to improve patient compliance, with the broader aim of ending the menace of recurrent fragility fractures.