The double-twist knot: A new arthroscopic sliding knot

A safe and easy-to-tie sliding knot is necessary for arthroscopic repair of rotator cuff tears and glenoid labrum lesions. We describe the double-twist knot (DTK) technique, having tested the knot's tensile strength and compared it with other commonly used arthroscopic knots. The DTK is a modified Lark's head knot that can be tied only on a double suture. A No. 2 braided polyester suture was used to test the DKT against the Tennessee slider knot and Snyder's knot by means of a material testing system. Results showed a statistically significant (P < .001) higher tensile strength with the DTK than with the other 2 knots. The rationale for using a stitch with a double suture is to double the tensile strength while using the same number of surgical steps and operating time as with single-suture stitches.Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 18, No 7 (September), 2002: pp 815–820     

Simple surgical technique to prevent direct secondary aortoenteric fistulas.

To prevent direct secondary aortoenteric fistulas, a devastating complication of abdominal aortic surgery, we describe here a rapid, very easy to perform and no cost operating technique. A part about 4 cm long of the vascular prosthesis was cut to obtain a partial tailored ring which was passed through the prosthesis. After the anastomosis was realized, the tailored ring was hitched up to totally cover proximal anastomosis and prevent direct contact between aorto-prosthetic anastomosis and the bowel.     

Epiglottopexy: a new surgical technique to prevent intractable aspiration

Severe derangement of the protective function of the larynx results in intractable aspiration with secondary life-threatening pneumonia. The new surgical technique of epiglottopexy is described, which in addition to achieving protection of the laryngeal inlet, allows preservation of speech and in certain cases an adequate laryngeal airway. The advantages over current alternative treatment methods is discussed, and the results of five cases of gross laryngeal incompetence managed by epiglottopexy are presented.     

肌腱环扎缝合法修复手二区屈肌腱损伤

目的 观察肌腱环扎缝合法修复手二区屈肌腱损伤的疗效。方法 在清晰术野下,暴露肌腱两断端,用0/4尼龙线,距肌腱断端1 cm处横行穿针,在距横穿线靠断端方向1 mm处以肌腱宽度和厚度的1/3环绕出针后把针靠断端方向套入缝线内,在附近靠断端方向1 mm处刺入肌腱,与肌腱纵轴平行自断面穿出,相对侧同法缝合,另一断端也同法缝合,然后相对应缝线拉拢打结。两断端用0/9无损伤缝合线间断或连续缝合,彻底止血后修复腱鞘及闭合创口,术后背侧石膏托制动3周,进行有计划的功能练习。结果 本组18例26指,随访2～16个月,按TAM评定标准18例26指中优23指、良3指,疗效满意。结论 肌腱环扎缝合法修复手二区屈肌腱损伤,手术操作简便符合早期功能练习的要求,值得推广应用。     

Strategies to prevent surgical site infections

Surgical site infections (SSI) are a severe complication following surgical or orthopaedic procedures and are associated with significant increases in hospital length of stay (LOS), additional costs, morbidity and mortality. Hence, the prevention of SSI is essential and poses a major challenge in the healthcare system. Strategies and key points are presented and discussed. Infection control measures such as active surveillance of SSI, implementation of a checklist, compliance observations and instruction/training of healthcare workers as well as Staphylococcus aureus/MRSA screening, clipping instead of shaving, adherence to perioperative antibiotic prophylaxis, maintaining intraoperative normothermia and blood glucose control are essential for a comprehensive bundle in order to prevent SSI.     

Lower pole divergence of kidney: A new surgical technique to prevent recurrent renal calculus

Gravity and natural position of the kidney have emerged as important factors in the nucleation, growth and postoperative recurrences of renal stones. A new operation technique is described to alter the position of the kidney, hence countering all obstacles to urinary flow. Recurrence of stones after the new operation (8.1%) were compared with controls (15.0%). Recurrence rates revealed from history data at two years (15–28%) and life-time recurrences deduced therefrom (25–80% or more) were used for comparison. Postnephropexy figures were 5.97% and 10–25% respectively. It strengthened our belief that to check inevitable postoperative recurrences, this new operation should be applied whenever open surgery is performed for nephrolithiasis.     

The modified racking hitch(MRH) knot: a new sliding knot for arthroscopic surgery

Sliding knots are commonly used in arthroscopic surgery and can be problematic in terms of strength and loop security. A new sliding knot for arthroscopic surgery, a modified racking hitch (MRH) knot, is described. The knot is essentially a modified cow's hitch knot that includes two self-locking loops. By tensioning the loop strands, a snug knot is created without backward sliding and provides excellent knot and loop security. In laboratory testing, the MRH knot provided comparable strength and security to other sliding knots. Experience gained from approximately 5 years of clinical use has added to the promise of the useful application of the MRH knot in arthroscopy.     

Technical note: a "new" arthroscopic sliding knot

Sliding knots are an essential element of arthroscopic shoulder surgery. The authors have been using a previously undescribed arthroscopic sliding knot with good clinical success. This knot has been used in arthroscopic rotator cuff repair, arthroscopic shoulder stabilization, and arthroscopic SLAP repair. The technique of this knot is illustrated.     

A technique to prevent Ender nail back-out

Ender nails are advantageous in the treatment of certain fractures; however, inadequate fixation and back-out are frequent complications. This article presents a simple looping technique that prevents Ender nail back-out.