Canadian journal of surgery. Journal canadien de chirurgie
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Severe obesity is reaching epidemic proportions throughout the world, including Canada. The only permanent treatment of severe or morbid obesity is bariatric surgery. Access to bariatric surgery is very limited in Canada. We sought to collect accurate data on waiting times for the procedure. ⋯ The waiting times for bariatric surgery are the longest of any surgically treated condition. Given the significant reduction in the relative risk of death with bariatric surgery (40%-89% depending on the study), the current waiting times for the procedure in Canada are unacceptable.
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Conventional internal fixation entails the use of an interfragmentary lag screw along with a plate. Not all acetabular fractures are amenable to the placement of an interfragmentary lag screw, and the fracture may be displaced during tightening of the interfragmentary lag screw. Locking plates are a possible solution. We sought to determine whether a locking plate construct can provide stability equivalent to that provided with a conventional construct for transverse acetabular fractures. ⋯ The locking plate construct is as strong as the conventional plate plus interfragmentary lag screw construct for fixing transverse acetabular fractures. Locking plates may improve management of acetabular fractures by eliminating the need for placement of an interfragmentary lag screw. Furthermore, they may be helpful in revision hip arthroplasty in patients with pelvic discontinuity.
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A loss of reduction due to inadequate support of the anterior column when using short-segment instrumentation to treat burst fracture and novel methods for support of the anterior column through a posterior approach to augment posterior instrumentation have been reported in the literature. We hypothesized that if anterior column support is an important adjunct to posterior short-segment instrumentation, then avoidance of axial load until sufficient anterior column healing occurs, allowing load-sharing with the implant, would improve spinal alignment at follow-up. ⋯ Bedrest improves the maintenance of intraoperative sagittal alignment correction, which is in agreement with the theory that inadequate support of the anterior spinal column is the mechanism for loss of reduction when using short-segment instrumentation to treat burst fractures. Therefore, addressing the anterior column directly through anterior surgery or by employing novel techniques in posterior surgery is recommended if one of the goals of treatment is to maintain the sagittal correction achieved at the time of surgery. Trying to achieve this goal by addressing posterior implant design or bone quality alone will not be successful because instrumentation and bone failure occur together.
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There are no current standards of care guiding perioperative fluid administration, and clinicians continue to debate restrictive versus liberal fluid administration. We sought to simultaneously evaluate the opinions and practice of surgeons, intensivists and anesthesiologists in a single centre regarding perioperative fluid resuscitation. ⋯ The presence of substantial variability of both opinion and practice of perioperative fluid resuscitation in a single centre supports the need for further research to identify objective methods to define perioperative fluid requirements and standards of perioperative resuscitation.
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Blunt diaphragmatic rupture (BDR) is a rare event and represents a diagnostic challenge. The purpose of our study was to review our experience with BDR at the Sunnybrook Health Sciences Centre (Sunnybrook), the largest trauma centre in Canada, and to highlight recent changes in the diagnosis and management of the condition. ⋯ Blunt diaphragmatic rupture is rare and difficult to diagnose; however, certain MVC characteristics along with severe associated injuries should raise the index of suspicion. These associated injuries include injuries to the head, chest (including the aorta), abdomen and pelvis. Computed tomographic angiography is essential to rule out associated aortic injury and to increase the diagnostic accuracy of BDR.