Treatment of early cut-out of a lag screw using a trochanter supporting plate: 11 consecutive patients with unstable intertrochanteric fractures

Introduction Superior cut-out of a lag screw remains a serious complication in the treatment of intertrochanteric fractures. It is related to the stability of fracture reduction. We describe the application of a trochanter supporting plate (TSP) to restore the fracture stability after early cut-out of a lag screw in unstable intertrochanteric fractures.Materials and methods A total of 11 consecutive patients with superior cut-out of the lag screw of a dynamic hip screw (DHS) or a gamma nail in an unstable intertrochanteric fracture occurring within 6 months after surgery were included in the present study. They underwent repeat surgery for placement of a DHS and a laterally mounted TSP of our design. All patients were monitored for at least 6 months (median 15 months; range 6–28 months).Results There was no repeated cut-out of a lag screw, and 10 patients (91%) achieved bony union within 5 months. At the last follow-up, all patients could walk with or without aids.Conclusion It reveals that a TSP, as an adjuvant to a lag screw placed inferiorly, is an easy and safe solution for the treatment of early cut-out of a lag screw in unstable intertrochanteric fractures.     

All-cause and cause-specific mortality after hip fracture among Chinese women and men

Summary

All-cause mortality risk persisted for 5 years after hip fractures in both men and women. There may be gender-specific differences in effect and duration of excess risk for cause-specific mortality after hip fracture.

Introduction

To determine all-cause and cause-specific mortality risk in the first 5 years after hip fracture in an Asian Chinese population.

Methods

The Singapore Chinese Health Study is a population-based cohort of 63,257 middle-aged and elderly Chinese men and women in Singapore recruited between 1993 and 1998. This cohort was followed up for hip fracture and death via linkage with nationwide hospital discharge database and death registry. As of 31 December 2008, we identified 1,166 hip fracture cases and matched five non-fracture cohort subjects by age and gender for each fracture case. Cox proportional hazards and competing risks regression models with hip fracture as a time-dependent covariate were used to determine all-cause and cause-specific mortality risk, respectively.

Results

Increase in all-cause mortality risk persisted till 5 years after hip fracture (adjusted hazard ratio, aHR = 1.58 [95 % CI, 1.35–1.86] for females and aHR = 1.64 [95 % CI, 1.30–2.06] for males). Men had higher mortality risk after hip fracture than women for deaths from stroke and cancer up to 1 year post-fracture but women with hip fracture had higher coronary artery mortality risk than men for 5 years post-fracture. Men had higher risk of death from pneumonia while women had increased risk of death from urinary tract infections. There was no difference in mortality risk by types of hip fracture surgery.

Conclusions

All-cause mortality risk persisted for 5 years after hip fractures in men and women. There are gender-specific differences in effect size and duration of excess mortality risk from hip fractures between specific causes of death.     

Improvement of Nonalcoholic Fatty Liver Disease After Bariatric Surgery in Morbidly Obese Chinese Patients

Background

Obesity is a risk factor for nonalcoholic fatty liver disease (NAFLD), which appears to improve after weight loss induced by bariatric surgery in Western countries. The present study aims to determine the alterations of clinical measurements and liver histology of NAFLD after bariatric surgery in morbidly obese Chinese patients.

Methods

Between November 2006 and December 2007, 21 morbidly obese patients receiving intra-operative liver biopsy and follow-up liver biopsy 1?year after laparoscopic Roux-en-Y gastric bypass were enrolled. NAFLD activity score (NAS) and fibrosis stage were histologically evaluated.

Results

The mean body mass index fell from 43.8?±?7.5 to 28.3?±?4.6?kg/m² (P?P?P?<?0.01), but not aspartate aminotransferase (P?=?0.66). Histological improvement was noted in NAS (P?P?P?P?=?0.02). Pre-operatively, 4 (19.0%), 11 (52.4%), and 6 (28.6%) patients were found to have NAS ?R5, 3 or 4, and ?Q2, respectively. All patients had NAS ?Q2 after surgery. Fibrosis stage also showed significant improvement (P?Conclusions Bariatric surgery can achieve a dramatic improvement of NAFLD both biochemically and histologically in morbidly obese Chinese patients.     

Treatment for T1-2 Oral Squamous Cell Carcinoma with or Without Perineural Invasion: Neck Dissection and Postoperative Adjuvant Therapy

Background

Although perineural invasion (PNI) has been a poor prognostic factor for head and neck cancers, few studies have focused on oral squamous cell carcinoma (OSCC). The independent significance of PNI in early T1-2 OSCC and the benefit of treatment modification based on PNI status have not been assessed. This study investigated the role of PNI in T1-2 OSCC patients, with focus on the controversial issues of neck management and postoperative adjuvant therapy.

Methods

PNI status was re-reviewed under hematoxylin and eosin staining in tumors of 307 consecutive T1-2 OSCC patients. Oncologic and survival outcomes were analyzed by univariate and multivariate analyses.

Results

PNI was identified in 84 (27.4%) patients, correlating with several established poor prognostic factors. In multivariate analysis, PNI remained an independent predictor for neck metastasis, neck recurrence, and a worse 5-year disease-specific survival. Elective neck dissection contributed to a significantly better 5-year disease-specific survival only in cN0 patients with PNI-positive tumors (P?=?0.0071) but not in those with PNI-negative tumors (P?=?0.3566). In low-risk patients who were treated by surgery alone, including neck dissection, the 5-year disease-specific survival rates were almost the same in those with PNI-positive tumors and those with PNI-negative tumors (92.0 vs. 92.9%; P?=?0.9104).

Conclusions

Elective neck dissection is indicated for cN0 patients with PNI-positive tumors for the efficacy of improving disease-specific survival as well as neck control. However, low-risk PNI-positive patients who undergo neck dissection do not need postoperative adjuvant therapy, because the residual risk from PNI is minimal.     

近肾动脉腹主动脉下段闭塞症的手术方法探讨

目的探讨近肾动脉腹主动脉下段闭塞症（juxtarenal aortic occlusion）的手术治疗方法。方法总结自1995年以来作者收治的27例腹主动脉末端闭塞症的临床治疗，术中暂时阻断肾上主动脉（平均7min），纵行切开主动脉，迅速清理近肾主动脉病灶，缝合上段纵行切口后改为肾动脉下主动脉阻断，完成人工血管主-股动脉转流手术。结果术后22例触及股动脉和胭动脉搏动，术后7d患肢缺血症状均得以改善。手术后3月复查，患肢缺血症状消失，25例阳痿现象得到改善，彩色超声显示血管吻合口及人工血管内均未见血栓。25例获得1年以上的随访，吻合口通畅率为100％；18例获得5年以上随访，吻合口通畅率为94．4％。结论将肾上主动脉暂时阻断后纵行切开主动脉，迅速去除病灶，主动脉缝合成型，然后在肾下主动脉阻断后完成主-股动脉转流是治疗腹主动脉末端闭塞性疾病较好的手术方案。     

Who needs a fine-needle biopsy? A comparison of the ATA and ACR TI-RADS guidelines in a single-centre retrospective study

The 2015 American Thyroid Association (ATA) and 2017 American College of Radiology: Thyroid Imaging, Reporting and Data System (ACR TI-RADS) guidelines are two popular guidelines adopted to stratify sonographic risk of malignancy for thyroid nodules, and to select cases for fine-needle aspiration (FNA). To understand the test performance of the two systems in predicting thyroid malignancy, 164 thyroidectomy cases performed in a regional hospital in Hong Kong between January 2021 and June 2022 were reviewed. Sonographic images of the index nodule in each case were retrospectively classified into different risk categories using the ATA and ACR TI-RADS guidelines, respectively, followed by retrieval of cytological and pathological results, for comparison. The index nodule was proven malignant in 26.8% of cases in the final pathology. There was a strong and positive correlation between the ATA and ACR TI-RADS risk categories assignment (r_s = .931, p < .001). Recommending FNA according to the ATA had a better sensitivity for malignancy than using the ACR TI-RADS (81.8% vs 72.7%), at the expense of a lower specificity (10.8% vs 40.8%). The sensitivity for malignancy of both systems could be further improved if all fluorodeoxyglucose (FDG)-avid nodules were investigated with FNA regardless of sonographic features and size. There was a statistically significant association between “nodules with FDG avidity and nodules recommended for FNA by the ACR TI-RADS guideline” and an eventual malignant thyroid nodule (p = .002).