A modified mid-urethral sling technique for stress urinary incontinence: Three-year results of a prospective randomized trial in comparison with original transobturator tape procedure.

INTRODUCTION AND HYPOTHESIS: Stress urinary incontinence (SUI) is the most common subtype of urinary incontinence, which causes many social, psychological, and economic problems. Mid-urethral sling (MUS) surgery is popular worldwide for the treatment of SUI. We aimed to define a new modified mid-urethral sling technique (mMUS) in SUI treatment and to compare it with transobturator tape (TOT) surgery in terms of safety and efficiency. METHODS: A prospective, randomized study was planned with 126 women suffering from SUI. The patients were randomly divided into two groups, TOT and mMUS. In mMUS, the obturator membrane was not perforated. The objective and subjective symptoms, pain, quality-of-life measures, and side effect profiles were assessed in a 3-year follow-up. The visual analogue scale (VAS) was used for postoperative pain assessment. The International Consultation on Incontinence Questionnaire-Female Lower Urinary Tract Symptoms (ICIQ-FLUTS) and Patient Global Impression of Improvement (PGI-I) were used for cure assessment scales. RESULTS: In total, 96 patients completed 3-year follow-up (TOT, n = 49 and mMUS, n = 47). There was no statistical difference between the procedures in terms of cure rates (87.75% and 87.23%, respectively; p = 0.614). Mean VAS scores at 8 and 24 h postoperatively were significantly higher in the TOT group (p < 0.05). There was no significant difference between the groups in VAS scores after 24 h. There was no significant difference between groups in terms of pad test results, ICIQ, or PGI scores at baseline and 36 months after surgery. CONCLUSIONS: We showed that the mMUS procedure was as safe and effective as TOT, with less postoperative groin pain and complications.

Smile Incision-Modified Technique for Better Scrotal Outcome in Surgical Management of Penile Paraffinoma.

INTRODUCTION: Penile augmentation with foreign material injection is used to increase penile length, girth, or both. Most of these individuals develop complications due to an abnormal mass formation known as penile paraffinoma. Multiple surgical techniques for restoring penile function and correcting near-normal penile shape have been developed, but prior techniques have some post-operative complications. METHODS: We explained the smile incision-modified technique for penile paraffinoma reconstruction using illustrations to describe step-by-step procedures. This study aimed to describe our modified surgical technique for reconstruction to correct complications due to disastrous consequences of failed penile augmentation. RESULTS: A total of 16 patients aged 28-66 years (mean: 44.25 ± 2.63) were operated with a smile incision-modified technique from January 2017 until December 2020 in Semarang Dr. Kariadi tertiary hospital. There were no intraoperative complications observed. We found hematoma in 3 patients in a 1-week follow-up. After 2 weeks of post-operative surgery, all patients had no skin dehiscence or necrosis. Cosmetic appearance and functional improvement after reconstruction were acceptable by all patients. CONCLUSION: Penile paraffinoma reconstruction using the smile incision-modified technique was a feasible and effective technique to manage penile paraffinoma patients with good esthetic results and minor complications.

Clinical observations of EVO-ICL implantation and changes in corneal astigmatism using a modified technique.

BACKGROUND: Implantable collamer lens (ICL) surgery techniques are constantly progressing. The purpose of this study was to investigate the application effect of the modified technique and its impact on the change in corneal astigmatism in EVO-ICL surgery. METHODS: The analysis of retrospective cohort data included 153 eyes of 81 patients with myopia from July 2018 to May 2020. An EVO-ICL was inserted by modified surgical skills, including a single 3.0 mm corneal incision and no ophthalmic viscosurgical device (OVD) before the insertion of the ICL (modified technique group: 41 cases, 80 eyes) and standard procedure (standard technique group: 40 cases, 73 eyes). Early postoperative intraocular pressure (IOP) was monitored at 2 and 24 h. IOP, corrected distance visual acuity (CDVA), uncorrected distance visual acuity (UDVA), vault, and anterior chamber depth (ACD) were measured 1, 6, and 12 months following the initial examination. The corneal endothelial cell density (ECD) was monitored at 6 and 12 months after the operation. Surgically induced astigmatism (SIA) in the total, anterior, and posterior corneal surfaces was analysed 1 month after the operation. RESULTS: No serious complications were detected. The two groups had no difference in visual outcomes, ICL vaults, or ACD at any time point (P > 0.05). Two hours postoperatively, IOP was significantly lower in the modified technique group (16.22 ± 2.22 vs. 18.37 ± 1.92 mmHg, P < 0.05) than in the standard technique group. IOP decreased gradually after 24 h to preoperative levels. The postoperative IOP remained stable over a 12-month period. The ECD at 6 and 12 months was not significantly different between the groups (P > 0.05). SIA in the total, anterior, and posterior corneal surfaces were assumed to have no clinically meaningful differences between groups at one month after operation (P > 0.05). CONCLUSIONS: The modified technique is efficient and safe, producing comparable visual and structural outcomes without adversely affecting ECD, and reduces fluctuations in IOP at the early postoperative stages. The auxiliary incision in the standard technique does not increase corneal SIA, which is also a factor to consider for inexperienced surgeons.

Successful Negative Pressure Therapy of Enteroatmospheric Fistula after Right Colectomy for Complicated Crohn's Disease -A Proposal for a Three-Drain Wound-Separation Technique.

Enteroatmospheric fistulas (EAFs) are still the worst complication of the open abdomen. They lead to a significantly prolonged intensive care unit and hospital stay and to high mortality. Despite the various techniques described in the literature EAFs remain "a nightmare" for the patient, the surgeon, and the hospital. Here we describe a case of right colectomy for obstructing Crohn's disease in a 26-year-old. On the 19th postoperative day, he developed a superficial EAF. Due to the frozen abdomen, neither resection of the anastomosis, nor implementation of the known techniques for treatment of EAFs were possible. This prompted us to modify the Pepe technique. The EAF was isolated from the upper and lower parts of the wound through deep-skin and subcutaneous sutures and the application of two small pieces of non-adherent plastic foil. The lower holes of a single drain, put through a piece of black foam, were placed over the fistula. The upper holes, which were enveloped with the foam, remained in contact with the wound. The drain was connected to a negative pressure of 125 mmHg. NPWT (negative pressure wound therapy) was also applied by two separate sponges and drains in the upper and lower part. The mainstay of EAF treatment is the isolation of the EAF from the abdominal cavity and subcutaneous tissue, supported by control of the sepsis and adequate nutrition. The proposed technique is applicable in cases with a single, superficial EAF on the background of the frozen abdomen with minimal lateral fascial retraction. As of today, due to the rarity of the condition and lack of randomized trials, EAFs still represents a unique challenge often requiring improvisation.

Surgical technique of uretero-ileal anastomosis in patients with bilateral duplex ureters undergoing radical cystectomy and ileal conduit urinary diversion: initial experience.

BACKGROUND: We present a simple technique for construction of wide ureteral plate, consisting of four ureters, incorporated in ureteroileal anastomosis of ileal conduit urinary diversion. METHODS: We retrospectively reviewed the charts of six cases of ureteral duplication (five bilateral and one unilateral) and muscle-invasive bladder cancer, treated with radical cystectomy and ileal conduit diversion, at our institution from 2015 to 2020. Briefly, our technique includes construction of wide ureteral plate, consisting of four ureters from two separate ureteral units, after previous construction of right and left ureteral plates for each unit, according to the standard Wallace technique. Additionally, during construction of definite ureteral anastomotic plate, we used a modified Wallace I technique consisted of eversion of posteromedial ureteral walls of both ureteral units, with muco-mucosal running suture. RESULTS: Four males and two females underwent radical cystectomy with ileal conduit for muscle invasive bladder cancer. A total of 12 complications (CDC I-III) were registered in 4/6 (66.6%) patients, whereby ten of them (83.3%) occurred within 90 days post-surgery. High-grade (CDC III) complications were registered in 33.3% of patients. Within the first three months post-surgery, hydronephrosis and high-grade vesicoureteral reflux were associated with pyelonephritis and observed in two patients (33.3%), while uretero-intestinal anastomotic stricture or leakage were not detected during follow-up in any patients. CONCLUSION: Modified Wallace uretero-ileal anastomosis after radical cystectomy and ileal conduit urinary diversion is functionally and cosmetically effective way to treat patients with bilateral duplex ureters harbouring muscle invasive bladder cancer.

Modified split tendon transfer of posterior tibialis muscle in the treatment of spastic equinovarus foot deformity: long-term results and comparison with the standard procedure.

INTRODUCTION: Split tendon transfer of tibialis posterior (SPOTT) is a treatment option for the hindfoot varus deformity in patients with cerebral palsy (CP). The purpose of this study was to present the long-term results of the newly modified SPOTT procedure developed by our senior author and compare it with the standard SPOTT technique in equinovarus foot deformity due to CP. METHOD: Our retrospective cohort study included patients with spastic foot deformity due to CP treated with the standard or modified SPOTT technique. Patients' age at the time of the surgery was ≥ five years with follow-up period of at least four years. Surgical outcomes were evaluated using Kling's criteria during the patient's last follow-up visit. RESULTS: The analysis included 124 patients (146 feet), where 105 feet were treated by the standard SPOTT technique and 41 feet by the modified SPOTT technique. Patients' median age at the time of the surgery was 11 years. Patients were followed-up for a median period of eight years during which the modified SPOTT technique showed significantly better surgical outcomes compared with the standard group (excellent/good results in 38 feet, 92.7%, vs. 79 feet, 75.2%, p = 0.02). Two groups of patients did not significantly differ in GMFCS level, age at the time of the surgery, or patient gender. There was similar distribution in CP patterns in the standard and modified groups; spastic hemiplegia was the most prevalent form, followed by spastic diplegia and spastic paraplegia. Overall, better surgical success was achieved in patients with GMFCS levels I-III (100%, 94.8%, and 69.8%, respectively). SPOTT procedure failure was frequently noticed in patients with GMFCS level IV (90.9%). CONCLUSION: The modified SPOTT procedure demonstrated efficiency and safety in patients with equinovarus foot deformity due to CP during the long-term follow-up. Compared with the standard procedure, the newly modified SPOTT technique showed significantly better surgical outcome, irrespective of the patients' gender, age, initial GMFCS level, and CP type.

A comparison between modified and conventional surgical techniques for surgical lip repositioning in the management of the gummy smile.

AIM: The aim of this study was to evaluate and compare conventional and modified lip repositioning surgical techniques used for management of gummy smile involving hyperactive lip elevator muscles. METHODS AND MATERIALS: A prospective study was conducted between April 2016 and May 2017. Twenty two adult patients aged 18-38 years with gummy smile ranging from 4 to 6 mm because of soft tissue disorders were included in the study. All patients were treated in the oral and maxillofacial department at Damascus University. The sample was divided into two groups of 11 patients. The first group was treated by the conventional standard technique, and the second group treated by a modified study technique. The amount of gingival display in full smile was evaluated in both groups following each intervention. RESULTS: Both groups exhibited a statistically significant reduction in the measurement of gummy smile at month 1 and 6 postoperatively (P < .05), but there was no significant difference in gingival display at 3 months in either group postoperatively (P > .05). The recent study showed a significant difference in gingival display between 3 and 6 months postoperatively in group 1, but no significant difference in group 2. CONCLUSION: This study showed that the modified technique utilized in treating gummy smile has less relapse after surgery, shows excellent cosmesis and compared to the conventional technique, greater sustainability. CLINICAL SIGNIFICANCE: The recent increase in demand for an esthetic smile has led to the development a modification of conventional lip repositioning for correcting gummy smile by myotomy of lip elevator muscles. This modified technique offers less relapse and greater stability post-operatively than the conventional technique.

Scleral fixated intraocular lens implantation with a modified Z-suture technique.

PURPOSE: To evaluate visual outcomes and complications in scleral fixated intraocular lens (IOL) implantation with the modified Z-suture technique. MATERIALS AND METHODS: Thirty-five eyes of 35 patients (20 male, 15 female) were included in the study. Patients underwent scleral fixated IOL implantation using the modified Z-suture technique and were followed in terms of visual acuity and complications. RESULTS: Mean postoperative follow-up time was 12.46 ± 7.46 months. Mean best corrected visual acuity was 1.35 ± 0.91 logMAR preoperatively and 0.48 ± 0.39 logMAR postoperatively, and difference was statistically significant (p < 0.001). No suture-related complications were observed during follow-up in any of the patients. Slight infero-temporal dislocation of the IOL was observed at postoperative 5 months in one patient (2.85%) who experienced blunt trauma. It caused no optical disturbance, and repeated surgery was not advised. Transient intravitreal hemorrhage was observed in two patients (5.7%) who underwent combined scleral fixation and pupilloplasty. DISCUSSION: The modified Z-suture technique is simple, fast, and was determined to be safe in terms of complications. However, long-term outcomes should be evaluated in larger patient groups.

[Surgical plane positioning with a disposable circumcision suture device for the treatment of phimosis and redundant prepuce].

OBJECTIVE: To investigate the clinical effects of circumcision by surgical plane positioning with a disposable circumcision suture device in the treatment of phimosis and redundant prepuce. METHODS: From September 2016 to June 2017, we treated 250 patients with phimosis or redundant prepuce, 127 by conventional circumcision (the control group) and the other 123 by surgical plane positioning with a disposable circumcision suture device (the observation group). We compared the operation time, intra-operative bleeding, preputial frenulum alignment, postoperative ecchymosis, and postoperative penile appearance between the two groups of patients. RESULTS: Compared with the controls, the patients in the observation group showed significantly longer operation time (ï¼»4.48 ± 1.18ï¼½ vs ï¼»7.17 ± 1.42ï¼½ min, P<0.05), lower rates of intra-operative frenulum bleeding (15.0% ï¼»19/127ï¼½ vs 4.1% ï¼»5/123ï¼½, P<0.05) and frenulum misalignment (26.8% ï¼»34/127ï¼½ vs 0.8% ï¼»1/123ï¼½, P<0.05), higher incidence of postoperative ecchymosis (41.7% ï¼»53/127ï¼½ vs 21.1% ï¼»26/123ï¼½, P<0.05), and higher satisfaction of the patients with the postoperative penile appearance (92.9% ï¼»18/127ï¼½ vs 98.4% ï¼»121/123ï¼½, P<0.05). However, no statistically significant difference was found between the control and observation groups in intra-operative non-frenulum bleeding (4.7% ï¼»6/127ï¼½ vs 1.6% ï¼»2/123ï¼½, P = 0.164). CONCLUSIONS: Circumcision by surgical plane positioning with a disposable circumcision suture device can effectively avoid preputial frenulum misalignment, reduce intra-operative bleeding, and improve postoperative penile appearance.

A modified scleral dissection technique with suprachoroidal drainage for canaloplasty.

PURPOSE: A modified canaloplasty technique is described that may facilitate the surgical procedure and potentially maximizes the intraocular pressure (IOP)-lowering effect by altering both the trabecular and uveoscleral aqueous outflow. METHODS: The second deeper layer in the modified technique (about 3.5 × 4 mm, Fig. 1a, b) is not prepared in a lamellar fashion, but is cut down full-thickness to the choroid, hence opening the suprachoroidal space. Furthermore, this second deep scleral flap creates an additional aqueous outflow and drainage into the suprachoroidal space, thus possibly lowering the postoperative IOP by improving the natural uveoscleral outflow facility. RESULTS: Seventy-eight eyes operated with this modified technique in the last 12 months were retrospectively analysed. Mean IOP before surgery was 19.10 mmHg and patients applied 3.0 topical medications. Twelve months after surgery, the IOP was 13.5 mmHg and patients applied 1.0 topical medication; 52.6 % of patients did not use any topical therapy. DISCUSSION: The modified dissection canaloplasty technique potentially improves the IOP-lowering effect due to the creation of additional suprachoroidal drainage and simplifies the most complicated step of the surgery, as the scleral spur and the Schlemm's canal can be located using suprachoroidal access.

Modified translaminar screw fixation in the cervicothoracic junction (C7-T2): a technical note.

PURPOSE: To describe and illustrate a modified technique for using translaminar screw in the cervicothoracic junction (C7-T2). METHODS: 12 patients (8 males and 4 females, average age was 52 years) underwent insertion of unilateral or bilateral translaminar screws by using our modified technique. With this modified technique, a tiny unicortical "hole" was made at the middle of the contralateral lamina, and the screw can be directly visualized through the unicortical "hole" to prevent violating the spinal canal. RESULTS: With this modified technique, the mean operation time was 205 min (range 145-360) and mean estimated blood loss was 445 ml (range 260-1250). The mean length of the laminar screws was 27 (range 24-30) mm. The results of the 12 patients with an average follow-up of 17 (6-33) months demonstrated this modified technique to be safe and effective in the fixation of cervicothoracic junction. CONCLUSION: In this modified technique, a tiny unicortical "hole" which was made at the middle of the dorsal lamina of cervicothoracic junction (C7-T2). By directly visualizing the screw inserting against the dorsal cortices of the lamina, this modified technique can reduce the risk of violation of the spinal canal and shorten the operation time.

Pocket technique or pocket technique combined with modified orbital rim anchorage for the replacement of a prolapsed gland of the third eyelid in dogs: 353 dogs.

The aim of this retrospective study was to evaluate the results obtained in 353 dogs (420 eyes) using two different surgical techniques for correction of a prolapsed gland of the third eyelid: the Morgan's pocket technique and a technique combining Morgan's approach with a slightly modified periosteal anchoring technique of Stanley and Kaswan. The pocket technique was used in 234 eyes and the combined technique in 186 eyes. Successful repositioning was obtained in 95% of all cases, with recurrence occurring in 5%. The recurrence rate in large breed dogs such as the English Bulldog and Boxer was lower with the combined technique than with the pocket technique.

Delineation the anatomy of posterior tibial artery perforator flaps using human cadavers with a modified technique.

BACKGROUND: To delineate the distribution and course layer of the perforator vessels using a modified technique. METHODS: Twelve perforator flaps were obtained from the crura of six fresh adult cadavers. The flaps were randomized into three groups (n = 4 per group): the full-thickness flap group; the deep fascia-free flap group, and the subcutaneous adipose layer-free group. The flaps were smoothened on a silk screen on a batten frame and the isolated flaps were perfused at a perfusion pressure of 140 mmHg for 10 min via the trunk of the posterior tibial artery. Perforator flaps were photographed using a digital camera and radiographed using a mammography device. The imaging data were processed by digital software system. RESULTS: The mean number of the posterior tibial artery perforator was 4.17 ± 0.94. The three relatively constant perforators varied in the projection points as well as the diameter and the length. The vascular branches and courses of the perforators were clearly visible on the mammograms. Elimination of all the deep fascia or the subcutaneous adipose tissues in the distal portion had no significant impact on the blood supply of posterior tibial artery perforator flaps while the vascular areas of the artery perforators were significantly reduced after the subcutaneous adipose tissue was eliminated in the proximal portion. CONCLUSIONS: We developed an effective modified technique for delineating the vascular territory on perforator flaps of different thicknesses. Our results provide significant guidance for clinical surgeons by providing them with more detailed anatomical knowledge of perforator flaps.

A modified technique for arteriovenous fistula anastomosis: Preserving the surrounding tissue of the vein without the use of vascular clamps.

BACKGROUND: This pilot study describes a new technique for creating an arteriovenous fistula (AVF) and presents the preliminary outcomes after 1 year of follow-up. METHODS: The study included 19 patients (10 males, 9 females) with a mean age of 62 years (range 26-88 years). All patients received an AVF using a modified technique in which the surrounding tissues were not removed from the veins and no elastic loops or vascular clamps were used. RESULTS: Immediate patency was obtained for all patients. The proportion of patients experiencing primary patency at 30 days and 6 months was 89.5% and 83.1%, respectively, and cumulative patency at 30 days and 6 months was 100%. At 1 year of follow-up, primary patency was 83.1% and cumulative patency was 100%. CONCLUSIONS: Complete preservation of the surrounding venous tissue in the absence of vascular clamps successfully established AVF, with a high surgical success rate.

The Clinical and Imaging Outcome of the Tandem Growing Rod Technique in Early-Onset Scoliosis With the Proximal Upper Thoracic Curve Progression: A Modified Technique of Growing Rod.

STUDY DESIGN: Retrospective cohort study. OBJECTIVE: The orthopaedic ability of traditional GR for severe EOS is limited. The proximal upper thoracic curve may progress during the lengthening procedure, which may lead to coronal imbalance and inhibit the longitudinal growth of the spine. In this retrospective cohort study, we investigated the clinical outcome of tandem GR. METHODS: We modified the traditional technique by using two groups of GR devices to control the major and the proximal upper thoracic curve, connected the two groups of GR in series, and named it tandem GR. The clinical and imaging outcomes of the new technique were evaluated and compared with traditional technique. RESULTS: Twenty one patients were enrolled in the tandem GR group, and 30 patients were treated with traditional GR as the control. The baseline parameters were consistent between the two groups. In the tandem GR group, the secondary curve progressed from 24.9 ± 3.9° to 31.4 ± 3.2° (P = .006) in the procedure with the traditional GR and improved to 18.4 ± 4.5° (P = .001) after the switch. Meanwhile, the clavicular angle aggravated from 1.6 ± 1.0° to 2.6 ± .7° (P = .041), and improved to 1.7 ± .8° after changed to the tandem GR (P = .033). At the final of the follow-up, the secondary curve was higher in the control group (27.1 ± 8.3° vs 18.4 ± 4.5°, P = .034), the clavicle angle was 2.4 ± 1.1° in control and 1.7 ± .8° in the tandem GR group (P = .028), the T1-S1 height was 28.2 ± 4.8 cm in the control and 33.3 ± 3.0 cm in the tandem GR group (P = .027). The average growth rate was 1.0 ± .3 cm/year in the control and 1.2 ± .4 cm/year in the tandem GR group (P = .046). CONCLUSION: Tandem GR can effectively improve the proximal upper thoracic curve progression during the treatment of EOS. Compared with the traditional GR, tandem GR can achieve better curve correction, better shoulder balance, and retains more capacity for longitudinal spine growth.

Perinatal Outcomes Associated With the Modified Shirodkar Cervical Cerclage Technique.

OBJECTIVE: The objective of this study was to describe demographic and clinical characteristics and surgical and neonatal results related to the modified Shirodkar cervical cerclage technique. MATERIALS AND METHODS: This was an observational descriptive and retrospective study. Data was called from anonymized medical records of women who were pregnant and diagnosed with cervical incompetence and who had also undergone cervical cerclage procedures using the modified Shirodkar technique. The variables recorded included demographics such as the maternal age of patients, clinical features like obstetric history, physical examination, and ultrasound findings, and surgical and neonatal outcomes. The qualitative variables were processed using frequencies and percentages, and the quantitative variables were obtained through median, interquartile range, mean, and standard deviation. RESULTS: Our study included 39 anonymized medical records. The main indication for cervical cerclage placement was prophylactic (56%). The median gestational age at cerclage placement was 16 weeks, with a median gestational age at birth of 38 weeks; only 13% had complications related to prematurity, and 5% were admitted to the neonatal intensive care unit. CONCLUSION: The modified Shirodkar technique is associated with favorable surgical, maternal, and neonatal outcomes.

Modified versus three-level technique of retroperitoneal laparoscopic adrenalectomy for all patients with adrenal lesions ≤ 6cm: a retrospective, case-controlled study.

Objectives: The modified three-level technique for retroperitoneal laparoscopic adrenalectomy (RLA) has proven beneficial in the treatment of adrenal lesions in patients with BMI≥25 Kg/m2. This paper aims to summarize our institution's seven-year experience using this technique for all patients with Adrenal Lesions ≤ 6cm. Patients and methods: Between January 2016 and December 2022. The patients underwent laparoscopic adrenal surgery were categorized into Zhang's technique (ZT) (Three-level Technique) group and modified technique (MT) group. The fundamental characteristics and perioperative data were analyzed, with statistical significance set at p<0.05. Results: In total, 731 patients were stratified into two groups: ZT (n=448) and MT (n=283). Statistically significant distinctions were not detected between the two groups regarding sex, BMI, tumor location, tumor size, tumor type, or American Society of Anesthesiologists (ASA) score (p>0.05). The MT group demonstrated superior outcomes compared to the ZT group in terms of operative time, estimated blood loss, drainage volume, diet recovery time, complication rates, and postoperative hospitalization duration (p<0.05). 17 (4.34%) in the ZT group required unplanned adrenalectomy, while there was none in MT group (P<0.05). Conclusion: MT retroperitoneal laparoscopic adrenalectomy has demonstrated its benefits in the treatment of adrenal lesions across all patients with adrenal lesions ≤ 6cm, serving as a valuable point of reference for the surgical management of adrenal diseases. Patient summary: We have made modifications to the classic retroperitoneal laparoscopic adrenalectomy and achieved superior surgical outcomes, resulting in a procedure known as modified retroperitoneal laparoscopic adrenalectomy. This technique is suitable for both obese individuals and the general population with adrenal lesions ≤ 6cm.

Modified elastic intramedullary nail internal fixation for distal tibial metaphyseal junction fracture.

Objective: To investigate the application of modified elastic intramedullary nail and the outcomes between modified elastic stable intramedullary nailing and traditional elastic stable intramedullary nailing in children with distal tibial metaphyseal junction fracture. Methods: A retrospective study was conducted. From January 2018 to January 2021, a total of 36 children with distal tibial metaphyseal junction fracture were treated in our hospital. All of them were treated with closed reduction and elastic stable intramedullary nailing internal fixation. A total of 18 children were treated by modified elastic stable intramedullary nailing and 18 children were treated by traditional elastic stable intramedullary nailing. Postoperative imaging, clinical efficacy, and complications were analyzed. Results: The mean follow-up time was 20 (15-36) months in modified group and 22 (16-33) months in traditional group. There were no complications such as infection, loss of reduction, and unequal length of lower limbs in modified group while loss of reduction occurred in two cases in traditional group. In these two cases of loss of reduction, we preformed manual reduction and replacement of long leg casts, and there was no loss of reduction, and the patient achieved a good prognosis. In the last follow-up, American Orthopaedic Foot & Ankle Society score was used. In modified group, excellent outcome achieved in 17 cases, good outcome achieved in 1 case, and satisfactory therapeutic effect was achieved. In traditional elastic stable intramedullary nailing group, excellent outcome achieved in 14 cases, and good outcome achieved in 4 cases. There was no statistical difference in the scores between the two groups. Conclusion: It was concluded that modified elastic stable intramedullary nailing fixation is a safe and effective treatment.

Modified Atlantoaxial Arthrodesis Technique for Atlantoaxial Instability via Intraarticular Autografting Using Structural Iliac Bone: Technical Nuances and Case Series.

OBJECTIVE: The present study described a modified technique of atlantoaxial arthrodesis in patients with atlantoaxial instability (AAI) along with the postoperative clinical and radiological results. METHODS: Five patients underwent this method for their AAI concurrent with C1 arch hypoplasia and/or the development of odontoid pannus causing myelopathy. After thorough exposure of the posterior surface of the C1-2 complex, the bilateral C2 nerve roots were sectioned to allow for easier access to the C1/2 facet joints. To prepare a suitable grafting bed, the C1/2 facet capsule was opened, and then the articular cartilaginous and synovial tissues were thoroughly removed. After being properly fashioned to match the gap between the C1/2 facet joint spaces, the structural bone grafts from the iliac crest were directly inserted into the facet joint spaces. To alleviate cord compression caused by concomitant odontoid pannus and/or hypoplastic C1 arch, C1 laminectomy was necessitated in all cases. Subsequently, posterior screw-rod instrumental fixation was conducted. RESULTS: All 5 patients underwent this procedure successfully. Clinical and radiological follow-up data of all patients indicated favorable relief of clinical symptoms and early rigid C1-2 stability. The sequelae of C2 nerve resection were not remarkable. No other neural or vascular damage associated with this technique was observed. CONCLUSIONS: Modified atlantoaxial arthrodesis via intraarticular autografting using the structural iliac bone combined with posterior instrumentation appears to be an efficient alternative treatment method for AAI patients with concurrent pathologies, even when the C1-2 posterior arches are unavailable for the grafting bed.