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  • ISSN: 2373-9290
    Volume 4, Issue 3
    Research Article
    Imran Ahmed*, Louise Fraser, Andrew Sprowson, and Peter Wall
    Abstract:
    Background: Tourniquets are routinely used in total knee arthroplasty (TKA) with an estimated use by up to 93% of surgeons. Advantages include the ability to provide a bloodless field of view to facilitate cement application and increase the success of the procedure. Overall reduction in blood loss is another perceived advantage; however recent research has demonstrated no measurable reduction and conversely a substantial increase in complications such as deep vein thrombosis and systemic emboli. Given the significant complications of tourniquet use we aim to identify patients' views on tourniquets and of emphasis their awareness of the possible risks involved prior to the procedure.
    Method: A questionnaire - based study was carried out on 35 patients attending an elective orthopaedic centre for TKA surgery. Ethical approval was granted by NRES committee - East of England (REC Ref: 14/EE/1265). Patients were provided with an information sheet detailing the reasons for the tourniquet use and the associated risks and benefits. They were then provided with a questionnaire to ascertain their views and previous understanding of the subject. Simple statistical measures were implemented to analyse the data.
    Results: Only 32% of patients were aware of the use of tourniquets during the operation. 19% were aware of the benefits prior to reading the information sheet provided with 29% understanding the risks involved prior to their procedure. Finally we found 97% of patients would like more information on the use of tourniquets preoperatively.
    Conclusion: Tourniquets are widely used in TKA surgery; however, they carry significant risks which are not clearly relayed preoperatively to all patients. Given that 91,000 TKA operations are performed per year we believe it is of paramount importance that all patients are appropriately counselled on the risks and benefits of its use and fully informed consent, including risks of tourniquet use, should be obtained prior to the procedure.
    Coady-Fariborzian L*, McGreane A, Pagan C, and Jain S
    Abstract:
    Clostridium collagenase (trade name "Xiaflex", Auxilium Pharmaceuticals, Inc. Malvern, PA, USA) is an enzymatic, non-operative treatment for Dupuytren's disease that was approved by the FDA in February 2010. The purpose of the study is to determine our rate of success and complications with this treatment in the veteran population. An IRB approved (2015-00576) retrospective chart review of patients treated with Xiaflex for Dupuytren's disease between December 2010 and June 2015 was performed. Clinic records were reviewed for collagenase injection and cord rupture. Charts were reviewed for pre procedure joint measurements, cord rupture, post procedure measurements, and complications. There were no major complications. The most common complication other than bruising and edema was skin tears. A Fisher exact test found that skin tears were more likely to be found in patients with preexisting metacarpal phalangeal joint measurements = or > 60 degrees. Xiaflex is a reasonable and safe non operative treatment for the veteran population with digital contractures resulting from Dupuytren cords in the palm.
    Neel Anand*, Ryan B. Cohen, Jason Cohen, Khoi Than, Paul Park, Richard G. Fessler, Pierce Nunley, Stacie Nguyen, Praveen Mummaneni, Joseph Zavatsky, Dean Chou, Juan Uribe, Michael Y. Wang, Adam S. Kanter, David O. Okonkwo, Vedat Deviren, Behrooz Akbarnia, Robert K. Eastlack, Christopher Shaffrey, and Gregory M. Mundis Jr
    Abstract:
    Background: Current treatment strategies for the correction of adult spinal deformity (ASD) include the options of circumferential minimally invasive surgery (CMIS), open surgery, and hybrid correction. This study compares outcomes and complications of CMIS and hybrid surgery for the management of ASD.
    Methods: This is a retrospective analysis of a multicenter database using prospectively collected dataon patients with ASD. Patients were evaluated for early and late complications following treatment with CMIS or hybrid techniques.
    Results: Of the 190 patients in the study, 104 were in the CMIS group and 86 were in the hybrid group. Compared to the hybrid group, CMIS patients reported less blood loss, shorter operative time, fewer posterior levels fused, and lower follow-up ODI (p < .05). Radiographic parameters were similar between the two groups; however, the mean of 4.7 levels fused in the CMIS group was significantly less (p < 0.001) than the mean of 8.2 levels fused in the hybrid group.
    There was a significantly lower rate of early major (p < 0.01) and minor (p < 0.001) complications in the CMIS group (Major: 13.5%; Minor: 9.6%) compared to the hybrid group (Major: 29.1%; Minor: 36.0%). However, there was no statistically significant difference in the rate of late complications between the two groups. Patients who had an early major or early minor complication had a higher 2-year ODI compared with those that did not.
    Conclusion: Both CMIS and hybrid techniques are effective in the treatment of ASD. The greatest advantage of CMIS techniques may be in reducing the early morbidity associated with these surgeries. In the late period, both the CMIS and hybrid techniques fair similarly well as evidenced by an equivalent late complication rate. Hybrid deformity surgery was associated with a higher reoperation rate than circumferential minimally invasive surgery.
    Short Note
    Hassan Serhan and Melissa Kuhn*
    Abstract:
    Scoliosis is a complex three - dimensional spinal deformity that results from both known and unknown causes in patients of all ages. Scoliosis can be classified by etiology: idiopathic, congenital, or neuromuscular. Idiopathic scoliosis is the diagnosis when all other causes are excluded, and comprises about 80% of all cases. Idiopathic scoliosis progression is dependent on the patient's skeletal maturity, the curve pattern, and the curve magnitude, while the other forms of childhood scoliosis can have an unpredictable course, with most being progressive [1].
    Short Communication
    Piet JM van Loon*
    Abstract:
    Revision of older knowledge on spinal deformities shows causing factors in all day life and the source of rotational forces in men in respiration. The role of lordosis as a causative factor can change towards a correcting force, supported by different studies. The thoracolumbar spine is the originating area of many deforming processes.
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