International orthopaedics
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Multicenter Study
Predictors of pain and disability outcomes in one thousand, one hundred and eight patients who underwent lumbar discectomy surgery.
A key component toward improving surgical outcomes is proper patient selection. Improved selection can occur through exploration of prognostic studies that identify variables which are associated with good or poorer outcomes with a specific intervention, such as lumbar discectomy. To date there are no guidelines identifying key prognostic variables that assist surgeons in proper patient selection for lumbar discectomy. The purpose of this study was to identify baseline characteristics that were related to poor or favourable outcomes for patients who undergo lumbar discectomy. In particular, we were interested in prognostic factors that were unique to those commonly reported in the musculoskeletal literature, regardless of intervention type. ⋯ For this study, several predictive variables were either unique or conflicted with those advocated in general prognostic literature, suggesting they may have value for clinical decision making for lumbar discectomy surgery. In particular, leg pain greater than back pain and older age may yield promising value. Other significant findings such as quality of life scores and prior surgery may yield less value since these findings are similar to those that are considered to be prognostic regardless of intervention type.
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The aim of our study was to assess the outcome of locking plate fixation of distal tibia fractures and evaluate which surgical approach and method of plate fixation is related to better functional result and lower complication rate. ⋯ Outcome of plate fixation of distal tibia fracture did not depend on the fixation method or surgical approach but, when possible, the medial plating via MIPO technique is a favourable method of treatment.
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Ligament, nerve, and blood vessel anatomy of the lateral zone of the lumbar intervertebral foramina.
To provide an anatomical basis for intrusive treatment using an approach through the lateral zones of the lumbar intervertebral foramina (LIF), especially for acupotomology lysis, percutaneous transforaminal endoscopy, and lumbar nerve root block. ⋯ Nerves and blood vessels are fixed and protected by transforaminal ligaments and/or corporotransverse ligaments. It is necessary to distinguish the ligaments from nerves using transforaminal endoscopy so that the ligaments can be cut without damaging nerves. Care needs to be taken in intrusive operations because of the veins running through Kambin's triangle. We recommend injecting into the lamina of the vertebral arch and the midpoint between the adjacent roots of the transverse processus when administering nerve root block. Blind percutaneous incision and acupotomology lysis is dangerous in the lateral zones of the LIF, as they are filled with nerves and blood vessels.
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The primary aim of this study was to report on the mid-term outcomes after quadrilateral plate reconstruction of acetabular fractures using a buttress/spring plate through an ilioinguinal approach. ⋯ Quadrilateral plate reconstruction with a buttress plate though the ilioinguinal approach remains a valid method of fixation in acetabular surgery. Additional studies are needed to compare the efficiency of this method to new surgical approaches and fixation implants.
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Despite the high-risk nature of orthopaedic trauma, there is a dearth of data exploring adverse events following these interventions. With the current shift towards a reimbursement model grounded on episode-based payments, physicians may face financial penalties for higher rates of peri-operative complications and subsequent hospitalisations. The purpose of this study was thus to assess whether complication rates varied by anatomic region of surgery and to subsequently determine the pre-operative risk factors that elevated patients' chances of developing complications in these regions. ⋯ prognostic level II.