Journal of clinical orthopaedics and trauma
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J Clin Orthop Trauma · Sep 2020
The impact of long-term corticosteroid use on acute postoperative complications following lumbar decompression surgery.
Corticosteroids have a negative impact on the human immune system's ability to function at an optimal level. Studies have shown that patients on long-term corticosteroids have higher infection rates. However, the rates of infection and other complications following lumbar decompression surgery remains under-investigated. The aim of our study was to determine the impact of preoperative long-term corticosteroid usage on acute, 30-day postoperative complications in a subset of patients undergoing lumbar spine decompression surgery, without fusion or instrumentation. We hypothesize that patients on long-term corticosteroids will have higher rates of infection and other postoperative complications after undergoing lumbar decompression surgery of the spine. ⋯ Long-term corticosteroid usage is associated with a significant increased risk of acute postoperative complication development, including urinary tract infection, sepsis and septic shock, thromboembolic complications, and extended length of hospital stay, but not with superficial or deep infection in patients undergoing lumbar decompression procedures. Spine surgeons should remain vigilant regarding postoperative complications in patients on long-term corticosteroids, especially as it relates to UTI and propensity to decompensate into sepsis or septic shock. Thromboembolic risk attenuation is also imperative in this patient group during the postoperative period and the surgeon should weigh the risks and benefits of more intensive anticoagulation measures.
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J Clin Orthop Trauma · Sep 2020
Axis vertebral dimensions for safe screw placement: A CT normative data analysis.
Morphometric evaluation of the pedicle and isthmus of second cervical vertebra (C2) (Axis) is extremely vital before contemplating any surgical stabilization involving the Craniovertebral region, in view of its proximity to the vertebral artery and the cervical nerve root. The dimensions of pedicles and isthmuses in C2 vary between individuals and there is paucity of data in the Indian population. This study strives to measure the average pedicle and isthmus dimensions in a sample of population, which would enable selection of screws with safest diameters to be used in C2; thereby avoiding injury to adjacent neurovascular structures. ⋯ Isthmic height < 4.5 mm could potentially violate the vertebral foramen when a 3.5 mm screw is used. In our study 22.5% isthmuses were narrow (<4.5 mm). The mean maximum safe diameter for a potential transarticular screw in the present study was 5.11 mm. Though our patients had smaller isthmus dimensions compared with literature, 77.5% of C2 could take a 4 mm transarticular screw quite comfortably considering the 0.5 mm margin on either side. In the present study, 28% of pedicles were found to be inappropriately sized (<4.5 mm) to accommodate the standard 3.5 mm screw. The mean maximum diameter of a potential pedicle screw in our study was 5.09 mm; and in 72% of patients a 4 mm screw could be placed with confidence. Though our patients on an average can accommodate a 4 mm screw comfortably, we suggest a protocol of obtaining CT measurements of C2 prior to operative intervention for identifying those individuals at risk of neurovascular injury; 22.5% for transarticular screw and 28% for pedicle screw.
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J Clin Orthop Trauma · Sep 2020
Role of transforaminal epidural injections or selective nerve root blocks in the management of lumbar radicular syndrome - A narrative, evidence-based review.
Lumbar radicular Syndrome (LRS) is a common spinal pathology and is attributed to complex interplay of mechanical, inflammatory and immunological processes. Epidural injection of steroids has a significant therapeutic role in mitigating the inflammatory component of LRS. Trans-foraminal approach under image guidance enables a targeted drug delivery. The current narrative review discusses the various aspects related to lumbar trans-foraminal epidural injection of steroid (LTFIS). ⋯ The overall success rate of SNRB is reported to be 76-88%. The majority of benefits are observed during immediate and early post-injection period. Clinical factors including duration and severity of symptoms, and radiological factors like presence of osteophytes, location, size and type of disc prolapse influence outcomes. The radiculogram "splash" pattern is associated with poor outcomes.
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J Clin Orthop Trauma · Jul 2020
Can displaced extra-articular fractures of the scapula be stabilized through a direct lateral-column approach.
Displaced extraarticular fractures of the scapula are uncommon, and rarely require operative fixation. When managed operatively, a posterior Judet approach with detachment of the deltoid muscle from the scapular spine and elevation of the infraspinatus from its fossa, is often performed. This approach is invasive and involves extensive soft tissue dissection. This paper describes the utility of single-column fixation with a direct lateral column approach, with mobilisation of the deltoid, and elevation of the interval between the infraspinatus and teres minor. Our aim is to assess the functional and radiological outcomes of this alternative approach. ⋯ The direct lateral-column approach is an alternative technique for fixation of the extra-articular neck and body scapular fracture. Plating of the lateral column of the scapula through this single approach is associated with correction of scapular angular deformity, no complications and good clinical results at more than 12 months' follow-up.
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J Clin Orthop Trauma · Jul 2020
ReviewInternet of Medical Things (IoMT) for orthopaedic in COVID-19 pandemic: Roles, challenges, and applications.
Internet of Medical Things (IoMT) is an innovative mean of amalgamating medical devices and their applications to connect with the healthcare information technology systems by using networking technologies. We have explored the possibilities of confronting the ongoing COVID-19 pandemic by implementing the IoMT approach while offering treatment to orthopaedic patients. ⋯ It can completely change the working layout of the healthcare facilities while treating orthopaedic patients with a superior level of care and more satisfaction, especially during this pandemic COVID-19 lockdown. Remote-location healthcare has also become feasible with the proposed IoMT approach.