Secondary operation for tubercular Peritonitis

Dr. da-Costa, Noble. Montgomery. Idem, in the Tresactions of the Section of Gync., College of phisicians of Philadelphia. - About the same. (Ibidem, p. 562-566).

Artificial expansion of the narrow pelvis

Frank, director of the obstetric institute in Cologne, performed in 1894 on a patient who, due to a narrow pelvis, underwent symphysiotomy and who could hardly walk due to nonunion of the pubic articulation, a secondary operation, and he refreshed the articular surfaces of the joint and inserted a piece of bone taken between them them together with a skin flap from the right horizontal branch of the pubic bone.

A Multicenter Study of Radiographic Measures Predicting Failure of Arthroscopy in Borderline Hip Dysplasia: Beware of the Tönnis Angle

Background: Hip arthroscopy has been previously demonstrated to be an effective treatment for adult mild hip dysplasia. There are many radiographic parameters used to classify hip dysplasia, but to date few studies have demonstrated which parameters are of most importance for predicting surgical outcomes. Purpose: To identify preoperative radiographic parameters that are associated with poor outcomes in the arthroscopic treatment of adult mild hip dysplasia. Study Design: Case-control study; Level of evidence, 3. Methods: Radiographic analysis was performed in patients with mild hip dysplasia who underwent arthroscopic surgery between 2009 and 2015. Preoperative radiographic measurements included lateral center edge angle, Tönnis angle, neck shaft angle, anterior center edge angle, alpha angle, femoral head extrusion index, and acetabular depth-to-width ratio. Failure was defined as failure to achieve the minimal clinically important difference (MCID) utilizing the modified Harris Hip Score or as the need for secondary operation. The equal variance t test was used to analyze radiographic parameters. Statistical significance was determined using a P value of .05. Results: A total of 373 hips underwent analysis with an average follow-up of 41 months (range, 24-102 months). Of these, 46 hips (12%) required secondary operation, and 95 (25%) failed to meet the MCID. The overall failure rate was 32.4%. There was no single measurement or combination thereof associated with failure to reach the MCID. Higher preoperative Tönnis angles were associated with secondary operation, with a mean of 6.7° (95% CI, 5.3°-8.1°) in the secondary operation group versus 4.8° (95% CI, 4.4°-5.3°) in the nonsecondary operation group ( P = .006). The odds ratio was 1.12 (95% CI, 1.0-1.2; P = .05) per degree increase in Tönnis angle for secondary operation. In patients with a Tönnis angle >10°, 84% required secondary operation. Conclusion: Higher Tönnis angles portend a higher risk for revision surgery. The probability of secondary operation was increased by a magnitude of 1.12 with each degree increase in the Tönnis angle. In patients with a Tönnis angle >10°, 84% required a secondary operation.

Does failure to meet threshold scores for mHHS and iHOT-12 correlate to secondary operations following hip arthroscopy?

The purpose of this study was to determine (i) if failing to achieve a patient-reported outcome (PRO) threshold at 1 year was associated with secondary operations at minimum 2-year follow-up and (ii)what outcome measure and threshold has the highest association with future surgeries. Inclusion criteria for this study were cases of primary hip arthroscopy between July 2014 and April 2017. Included patients had recorded pre-operative and 1-year post-operative modified Harris Hip Score (mHHS) and 12-item international Hip Outcome Tool (iHOT-12) scores. Patients were classified based on their ability to achieve minimal clinical important difference (MCID), substantial clinical benefit (SCB) and patient acceptable symptom state (PASS) for each PRO and the status of secondary operations at minimum 2-year follow-up. The sensitivity, specificity, accuracy, positive likelihood ratio and negative likelihood ratio for these thresholds were calculated. Of 425 eligible cases, 369 (86.8%) had minimum 2-year follow-up. Of the included patients, 28 underwent secondary operations (7.59%), with 14 undergoing secondary arthroscopies (3.79%) and 14 converting to total hip arthroplasty (3.79%). For mHHS, 267 (72.4%), 173 (46.9%) and 277 (75.1%) hips met MCID, SCB and PASS, respectively. For iHOT-12, 234 (63.4%), 218 (59.1%) and 280 (75.9%) hips met the respective thresholds. The highest specificity, sensitivity and accuracy were identified as for iHOT-12 MCID (0.79), iHOT-12 PASS (0.79) and iHOT-12 MCID (0.77), respectively. Patients not attaining MCID and PASS for mHHS and iHOT-12 at 1-year post-operatively are at increased risk of secondary operation. The most accurate threshold associated with secondary operation (0.77) is not achieving iHOT-12 MCID. Level of evidence: retrospective case series: level IV.

Successful ankle replantation in two cases with different presentations

We report our experience of treating two patients with ankle amputation with different presentations. The first case was a clean-cut sharp amputation. The second case was an avulsion injury following a motor vehicle accident in a patient who arrived 8 hours after the injury. Replantation was successful in both cases. In avulsion injuries, a secondary operation for wound coverage is required at a later stage. With good strategy and a support team, encouraging limb survival outcomes are possible post-replantation.

Candy Closure Technique for Chronic Open Infective Lateral Malleolus Bursitis

The aim of this study was to report the effectiveness of the Candy closure technique as a treatment for chronic open infective lateral malleolus bursitis. From June 2014 to March 2018, we performed the Candy closure technique as a treatment for chronic open infective lateral malleolus bursitis in nine patients without secondary operation. We first performed infectious tissue debridement to control infection, and if primary closure was not possible, we performed the Candy closure technique for small wounds. The duration of the wound prior to surgery varied from 4 weeks to 2 years. Seven cases were due to infection on the bursa and two cases were ulcer-type bursitis. All the wounds were small (average, 3.80 cm2; range, 2.25-4 cm2) and circular. Seven wounds showed complete healing at 4 weeks after surgery, one wound showed complete healing at 8 weeks after surgery, and one wound with infected state was lost to missing follow-up. Of the seven wounds that showed complete healing, one wound recurred 6 months after surgery. The Candy closure technique is a simple method for ensuring healing and coverage of chronic open lateral malleolus bursitis, especially for small wounds with dead space.