Indian J Orthop
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STITCHLESS percutaneous endoscopic cervical discectomy s[PECD] is safe, precise, targeted, and a complete endoscopic procedure to treat soft cervical disc herniation with unilateral radiculopathy. It allows direct visualization of herniated fragment and its removal, inspection of decompressed nerve root in an awake and aware patient. It reduces the risk related to general anesthesia and to the neurological structures. However, all the patients treated with PECD can be candidates for anterior cervical discectomy and fusion (ACDF). ACDF requires a longer period of stay, expense, and more risk to neurological structures and ultimately loss of the disc space by fusion. ⋯ Potential benefits of sPECD include safety as it is done under local anesthesia, smaller incision, short hospitalization, fewer complications, avoidance of fusion, preservation of segmental motion, preventing the adjacent segment degeneration, and avoidance of the risk related to the hardware (nonunion and pseudarthrosis). sPECD is an effective treatment modality for soft cervical disc herniation.
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Advanced ankylosing spondylitis is often associated with thoracolumbar kyphosis, resulting in an abnormal spinopelvic balance and pelvic morphology. Different osteotomy techniques have been used to correct AS deformities, unfortunnaly, not all AS patients can gain spinal sagittal balance and good horizontal vision after osteotomy. ⋯ Two-level PSO using a preoperative computer simulation is a feasible, safe, and effective technique for the treatment of severe thoracolumbar kyphosis in AS patients with normal cervical motion.
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Current surgical treatment of acetabular fractures is open reduction and internal fixation and requires a large incision resulting in considerable blood loss and a potentially long duration of recovery. We report a case of an acetabular fracture that received laparoscopic internal fixation after three-dimensional (3D) modelling and printing of the acetabulum. A 43 year old male fell from a height of 3 m resulting in a right acetabulum anterior column fracture. ⋯ The steel reconstruction plate was prebent in vivo and placed into the optimized position based on the 3D modelling and the optimized insert orientation and measured screw length were determined. The fracture was reduced and the plate placed laparoscopically without complications, and the patient had excellent functional recovery. Acetabular fractures are complex injuries, and while minimally invasive surgical techniques are used in many fields, they are not common for the treatment of acetabular fractures. 3D modelling is commonly used in medicine, and although 3D printing is used in some fields, it has not found widespread use in orthopedics.
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Calcaneum is the most commonly fractured tarsal bone. The optimal treatment for displaced calcaneus fractures involving the posterior facet is surgical. The extensile lateral approach is commonly preferred because it provides sufficient exposure of the subtalar facet. However, this technique has the risk of complications such as wound necrosis and sural nerve injury. Various minimally invasive approaches, such as sinus tarsi approach, limited posterior approach, and percutaneous approach, have been introduced to reduce possible complications. This study was prospectively performed to evaluate the results of the sinus tarsi approach for Sanders Type 2 calcaneal fractures using postoperative computed tomography (CT). ⋯ Surgical management using a sinus tarsi approach produced good clinical and radiographic results and low wound complications for Sanders type 2 calcaneal fractures. It is important to have stable fixation and to achieve sufficient reduction of calcaneal width for the prevention of loss of reduction and lateral subfibular impingement.
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Pain after total knee arthroplasty (TKA) is a big problem in orthopaedic surgery. Although opioids and continuous epidural analgesia remain the major options for the postoperative pain management of TKA, they have some undesirable side effects. Epidural analgesia is technically demanding, and the patient requires close monitoring. Different types of local anesthetic applications can successfully treat TKA pain. Local anesthetics have the advantage of minimizing pain at the source. This study investigates the efficacy of different local anesthetic application methods on early, (1st day) pain control after total knee arthroplasty. ⋯ The intraoperative periarticular application of local anesthetics in addition to one-shot femoral block is an efficient way of controlling postsurgical pain after TKA.