Stiffness measurement of the neocallus with the Fraktometer FM 100<Superscript>®</Superscript>

Introduction: The assessment of fracture healing is subjective, and neither radiology nor manual examination allows a reliable determination of bone healing. Fracture healing control in the treatment of tibia shaft fracture with external fixator by a stiffness measurement system (Fraktometer FM 100^®) is known from clinical studies. The purpose of this study was to follow stiffness control at external fixator in healing of callotasis with the stiffness measurement system. Materials and methods: From 1994 to 1997 stiffness measurements with the described system (Fraktometer FM 100) were performed in the BG-Clinic Ludwigshafen to assess the healing course in 11 cases of callotasis at lower limb. Results: In ten cases, regular healing could be followed by signal decrease; in one case, a persistent signal without tendency to decrease was able to reveal callotasis failure at an early point of time. The investigation could also show the importance of bending stiffness control. One case of late axis deformation after fixator removal occurred because of disregarding delayed bending signal decrease. Conclusion: Measurements of the external fixator’s stiffness after callotasis can provide useful additional information for further treatment strategy.     

Off-pump hemostasis for left ventricular rupture after myocardial infarction with Hydrofit<Superscript>®</Superscript> and Surgicel<Superscript>®</Superscript>

Left ventricular free wall rupture (LVFWR) is a catastrophic complication of myocardial infarction. In these cases, cardiopulmonary bypass (CPB) should be performed for left ventricular repair, but can impact hemodynamic stability. An 87-year-old man presented with acute shock. He was diagnosed with LVFWR after myocardial infarction. We describe a simple, effective, and reproducible technique to achieve hemostasis at the LVFWR site during emergency operation using Hydrofit^® and Surgicel^® surgical hemostatic agents. We simply placed and manually pressed the Hydrofit^® and Surgicel^® composite on the bleeding site. This technique provides complete hemostasis without CPB establishment.     

Repositioning the Lap-Band<Superscript>®</Superscript> for Proximal Pouch Dilatation

Background: Laparoscopic adjustable gastric banding (LAGB) procedures have proved their efficiency and reproducibility in several studies. The most frequent late complication is proximal pouch dilatation, with possible progression to total food intolerance. Materials and Methods: In a series of 727 laparoscopic bandings using the Lap-Band^? System, 54 patients presented proximal pouch dilatation and required laparoscopic reposition of the band. 2 patients who had had LAGB placed in another hospital received the same treatment. Results: No particular intra- or postoperative complications occurred during laparoscopic repositioning of the band. 2 conversions were necessary in the beginning of the experience to safely unlock the band. After a median follow-up of 74 months, there has been no recurrence of proximal dilatation. Conclusions: Laparoscopic repositioning of the Lap-Band^? System for proximal pouch dilatation is a safe and reproducible procedure which can be proposed as an interesting alternative to its replacement by a new one. An initial perigastric placement of the band allows, during the redo, safe dissection in a virgin pars flaccida tunnel. The calibration of the tiny proximal pouch, the presence of postoperative adhesions, and maintainance of strict control of dietary behavior are probably the reasons for the absence of recurrence of pouch dilatation.     

Codification of Techniques for Reoperation After Lap-Band<Superscript>®</Superscript>

Background: The Lap-Band^? is a safe, reversible, minimally invasive, and effective bariatric technique, whose main late complications are herniation/dilation of the pouch, erosion/migration of the band, and problems with the adjustment system (subcutaneous access port and connection tubing). We describe the surgical timing and techniques for dealing with the principal complications. Methods: Between October 1995 and September 2001, we treated 540 patients (mean age 43 years, mean BMI 42.6 kg/m²). All operations were completed laparoscopically, with no intra-operative complications or mortality. Late complications were: problems with the band adjustment system (n=35); herniation/dilations of the pouch (n=14); erosions/migration of the band into the stomach (n=3). Results: We dealt successfully with all complications using a minimally invasive technique. Herniation/dilations of the pouch necessitated 15 successful repositionings of the band, and 2 removals of the band at the patients' request. Erosion/migration was treated by endo-laparoscopic band removal. Problems with the band adjustment system had to be corrected laparoscopically, under general anesthesia in 17 patients. Conclusion: While emphasizing the rarity of complications, we have codified re-operation techniques to help Lap-Band^? users solve them using a minimally invasive procedure. In particular, problems with the port and connection tubing system can be completely avoided with a transverse subcutaneous positioning in a straight line.     

Accuracy of screw fixation using the O-arm<Superscript>®</Superscript> and StealthStation<Superscript>®</Superscript> navigation system for unstable pelvic ring fractures

Purpose

Screw fixation for unstable pelvic ring fractures is generally performed using the C-arm. However, some studies reported erroneous piercing with screws, nerve injuries, and vessel injuries. Recent studies have reported the efficacy of screw fixations using navigation systems. The purpose of this retrospective study was to investigate the accuracy of screw fixation using the O-arm^® imaging system and StealthStation^® navigation system for unstable pelvic ring fractures.

Methods

The participants were 10 patients with unstable pelvic ring fractures, who underwent screw fixations using the O-arm StealthStation navigation system (nine cases with iliosacral screw and one case with lateral compression screw). We investigated operation duration, bleeding during operation, the presence of complications during operation, and the presence of cortical bone perforation by the screws based on postoperative CT scan images. We also measured the difference in screw tip positions between intraoperative navigation screen shot images and postoperative CT scan images.

Results

The average operation duration was 71 min, average bleeding was 12 ml, and there were no nerve or vessel injuries during the operation. There was no cortical bone perforation by the screws. The average difference between intraoperative navigation images and postoperative CT images was 2.5 ± 0.9 mm, for all 18 screws used in this study.

Conclusion

Our results suggest that the O-arm StealthStation navigation system provides accurate screw fixation for unstable pelvic ring fractures.

     

Laparoscopic Management of Lap-Band<Superscript>®</Superscript> Slippage

Background. The Lap-Band^? is generally associated with a low morbidity rate. Although gastric slippage through the band remains a concern, the rate has diminished with new band placement techniques. Methods. Between November 2000 and June 2002, 198 Lap-Band? Systems were inserted in patients in the Houston, Texas, area. 4 of these patients, plus an additional patient whose Lap-Band^? had been inserted by another surgeon, developed slippages, and in each case the gastric slip was corrected and the band was salvaged and repositioned laparoscopically. To facilitate dissection and repositioning of the band in 3 of these patients, the band had to be unlocked using a simple laparoscopic technique. Results. All patients were discharged the morning following surgery with no complications and good position of the band as evidenced by esophagogram study and resolution of symptoms. After 2 to 12 months follow-up, all 5 patients remain symptom-free and continue to lose weight. Conclusions. Gastric slippage with the Lap-Band^? can be managed by laparoscopic salvage and repositioning of the slipped band.     

High Incidence of Migration with Poor Initial Fixation of the Accolade<Superscript>®</Superscript> Stem

Background  

Numerous cementless femoral stem design variations are in clinical use. Because initial implant instability and micromotion are associated with aseptic loosening of the femoral component, migration analysis provides an early assessment of implant survivorship.     

Locked nailing for the treatment of displaced articular fractures of the calcaneus: description of a new procedure with calcanail<Superscript>®</Superscript>

Although open reduction and internal fixation is considered the best method for treating displaced articular fractures of the calcaneus, lateral approach is at high risk for wound healing complications. For this reason, the authors developed a posterior approach and a new implant to perform both intrafocal reduction and internal fixation. The aim of this technical note is to describe this method of treatment for displaced articular fractures of the calcaneus, which offered the following advantages: (a) the creation of a working channel that provides also a significant bone autograft, (b) the intrafocal reduction of the displaced articular surface, (c) the insertion of a locking nail that maintains the reduced articular surface at the right height, (d) the possibility to switch from an ORIF to a reconstruction arthrodesis with the same approach and instrumentation in case of severely damaged posterior facet.     

Abdominal wall hernia repair: a comparison of Permacol<Superscript>®</Superscript> and Surgisis<Superscript>®</Superscript> grafts in a rat hernia model

Background

This study compared two porcine-derived grafts Permacol (Tissue Science Laboratory, Covington, GA, USA) and Surgisis (Cook Surgical, Bloomington, IN, USA) in terms of strength of incorporation (SOI), incorporation of host tissue, and adhesion formation using a rat model.

Methods

A prospective randomized study using 48 Sprague–Dawley rats. A standardized 1.5 × 5 cm fascial defect was created and repaired with either Permacol or Surgisis grafts. The rats were then sacrificed at 3, 14, 28, or 60 days. The specimens were examined for SOI, neovascularization, collagen deposition, collagen organization, and adhesion formation.

Results

Surgisis had significantly greater SOI than Permacol at 28 (0.115 vs. 0.0754 Mpa) and 60 days (0.131 vs. 0.635 Mpa). Surgisis had significantly more collagen deposition and neovascularization than Permacol at 60 days. The area of adhesions was not significantly different between Surgisis and Permacol.

Conclusion

Surgisis is superior to Permacol in terms of SOI and tissue ingrowth at 60 days. Furthermore, Surgisis strengthened over time whereas Permacol decreased in strength.

     

The Repicci II<Superscript>®</Superscript> Unicondylar Knee Arthroplasty: 9-year Survivorship and Function

Background  

Unicompartmental knee arthroplasty (UKA) is a recognized procedure for treatment of medial compartment osteoarthritis. UKA using minimally invasive surgery (MIS) has the theoretical advantage of less bone resection and quicker rehabilitation. Whether the function of patients with UKA compares with that of patients with conventional TKA is unclear.     

Self-pressurized air-Q<Superscript>®</Superscript> intubating laryngeal airway <Emphasis Type="Italic">versus</Emphasis> the LMA<Superscript>®</Superscript> Classic™: a randomized clinical trial

Purpose

The self-pressurized air-Q® (air-Q SP) intubating laryngeal airway is a relatively new supraglottic airway (SGA) device. The intracuff pressure of air-Q dynamically equilibrates with the airway pressure and adjusts to the patient’s pharyngeal and periglottic anatomy, potentially providing improved airway fit and seal. The aim of this prospective randomized study was to compare the clinical performance of air-Q to the LMA® Classic? SGA.

Methods

Adult patients requiring general anesthesia for elective surgery were prospectively enrolled and randomly assigned to either air-Q SP or the LMA Classic SGA. Oropharyngeal leak pressure (primary endpoint), success rate, insertion features (insertion time, ease of insertion, requirement for device manipulation), sealing function, gastric insufflation, bronchoscopic view, and oropharyngeal complications at device insertion and following its removal (sore throat, dysphagia, dysphonia) were compared.

Results

The mean (standard deviation [SD]) oropharyngeal leak pressure just after insertion was similar in the air-Q SP and LMA [16.8 (4.9) vs 18.6 (5.5) cm H₂O, respectively; mean difference, 1.8 cm H₂O; 95% CI, ?0.5 to 4.2; P = 0.13] and did not differ at ten minutes following device insertion. Median [interquartile range (IQR)] peak inspiratory pressure just after insertion was lower in the air-Q SP (11.0 [10.0-13.0] vs 13.0 [11.0-14.0] cmH₂O, median difference, 1.0 cm H₂O; 95% CI, 0.0 to 2.0; P = 0.03) but no difference was observed at ten minutes. The median [IQR] insertion time was faster with the air-Q SP (15.9 [13.6-20.3] sec vs 24 [21.2-27.1] sec; median difference, 8.1 sec; 95% CI, 5.6 to 9.9; P < 0.001) and improved bronchoscopic viewing grade were seen with the air-Q SP immediately after insertion (P < 0.001). No differences between the groups were observed with respect to the rate of successful insertion at first attempt, overall insertion success rate, ease of insertion, and complications.

Conclusions

The air-Q SP had similar leak pressures but a faster insertion time and superior bronchoscopic viewing grade when compared with the LMA Classic. The air-Q SP is a suitable alternative to the LMA Classic in adult patients and may be a superior conduit for tracheal intubation.

Trial registration

www.clinicaltrials.gov (NCT02206438). Registered 1 August 2014.

     

Histological osseointegration of Tutobone<Superscript>®</Superscript>: first results in human

The aim of this study was to evaluate the histological and radiological osseointegration characteristics of implanted solvent-preserved cancellous bovine bone substitution material Tutobone after opening-wedge osteotomy and hip arthroplasty in human. The baseline hypothesis connected to the usage of bovine bone substitute materials is the assumption of temporary structural support, integration in the surrounding bone, bioresorption and replacement with vital bone. This hypothesis is based on numerous studies evaluating sintered bovine grafts showing good osseointegration and stability. Studies analyzing cancellous bovine grafts such as Tutobone hardly exist. The only rabbit defect model showed 100% remodeling of Tutobone after 26 weeks. However, no histological data are available on application of this xenograft in patients. In this study, nine patients biopsies were collected about 11 months after application of Tutobone. Unlike animal studies, the results showed incorporated avital graft remnants (47%) as well as new bone formation (53%) of the total mineralized area. Radiological evaluation confirmed increasing signs of osseointegration and an incomplete resorption. In conclusion, degradation and replacement of bovine graft seems to be less accelerated in patients than the animal study indicated. Nevertheless, Tutobone shows an excellent biocompatibility, good osteoconductive characteristics and may represent a useful alternative to autogenous graft.     

Crura augmentation with Bio-A<Superscript>®</Superscript> mesh for laparoscopic repair of hiatal hernia: single-institution experience with 100 consecutive patients

Background

The potential utility of both non-absorbable and absorbable meshes to reinforce the esophageal hiatus and prevent recurrent hernia has been investigated in observational studies and a few randomized clinical trials. Use of absorbable mesh has been associated with lesser side-effects, but the long-term safety and effectiveness are still debated. This rather scanty clinical evidence is due to heterogeneity and bias regarding the type of mesh and operation used, the modalities of follow-up, and the reporting of objective results.

Objectives

The aim of the study was to assess safety, quality of life, and recurrence-free probability after laparoscopic repair of hiatal hernia reinforced with a synthetic absorbable mesh.

Methods

Observational, retrospective, single-center cohort study. All patients with hiatal hernia who underwent laparoscopic crura repair using a biosynthetic mesh (Gore Bio A^® tissue reinforcement, Flagstaff, AZ) were included. Pre- and post-operative symptoms were assessed with the GERD-HRQL questionnaire. Objective follow-up consisted of upper gastrointestinal endoscopy and barium swallow study.

Results

From September 2011 to March 2016, a total of 100 patients underwent hiatal hernia repair using a Bio-A^® mesh. All surgical procedures were completed laparoscopically. Postoperative morbidity rate was 10%. All patients had a minimum follow-up of 6 months, and the median follow-up was 30 (IQR = 22) months. No mesh-related complications occurred. The incidence of recurrent hernia ≥2 cm was 9%, and eight of the nine patients had a preoperative type III hernia. The median GERD-HRQL score was significantly reduced after operation (p < 0.001). The recurrence-free probability at 1 and 5 years was, respectively, 0.99 (CI 0.97–1.00) and 0.84 (CI 0.74–0.97), and no reoperation was required. No association was found between age, BMI, hernia size, previously failed surgical repairs and hernia recurrence.

Conclusions

The use of a synthetic absorbable mesh to reinforce the esophageal hiatus is safe and appears to be effective and durable over a medium-term follow-up.