Cerclage

INTRODUCTION: Treatment of both simple and complex patella fractures is a challenging clinical problem. Although tension band wiring has been the standard of care, it can be associated with high complication rates. The aim of this study was to investigate the biomechanical performance of recently developed lateral rim variable angle locking plates versus tension band wiring used for fixation of simple and complex patella fractures. MATERIALS AND METHODS: Sixteen pairs of human anatomical knees were used to simulate either two-part transverse simple AO/OTA 34-C1 or five-part complex AO/OTA 34-C3 patella fractures by means of osteotomies, with each fracture model created in eight pairs...

BACKGROUND: Thumb metacarpophalangeal (MP) fusion is generally successful; however, complications have been reported to occur in 0% to 30% of cases, whereas nonunion rates vary by method but, overall, are reported to occur in 0% to 15% of cases. Many fixation techniques have been described, but there is no consensus on the optimal fusion technique. Our goal was to compare complication and union rates of different thumb MP arthrodesis techniques. METHODS: We performed a retrospective review of patients who underwent primary thumb MP fusion between 2000 and 2022...

Objective: Few reports exist on the treatment of transverse patellar fractures (TPFs) using absorbable cannulated screws and high-strength sutures, and most screws and sutures lack good biomechanics and clinical trials. Therefore, this study aimed to demonstrate the biomechanical stability and clinical efficacy of tension-band high-strength sutures combined with absorbable cannulated screws (TBSAS) in treating TPFs (AO/OTA 34 C1). Methods: Finite element models of five internal fixation schemes were established: tension-band wire with K-wire (TBW), TBW with cerclage wire (TBWC), TBW with headless pressure screws (TBWHS), TBW with full-thread screws (TBWFS), and TBSAS...

OBJECTIVE: We aimed to evaluate whether cerclage with progestogen therapy was superior to cerclage alone in the prevention of spontaneous preterm birth (sPTB) in singleton pregnancies METHODS: : This is an international retrospective cohort study of singleton pregnancies, without major anomaly or aneuploidy, and with cerclage placed at 10 different institutions in the United States and Colombia from June 2016-June 2020. Exclusion criteria were: lack of documentation regarding whether progestogen was or was not prescribed, delivery outcome unavailable, and pregnancy termination (spontaneous or induced) prior to 16 weeks' gestation...

UNLABELLED: This narrative review of the 2023 Gerard W. Ostheimer lecture presented at the Society for Obstetric Anesthesia and Perinatology 2023 annual meeting summarizes 2022 literature relevant to obstetric anesthesiologists. ANTENATAL STUDIES: Neonatal morbidity is reduced with antenatal maternal buprenorphine compared with methadone for treatment of opioid use disorder. Antenatal pregnancy allergy testing is safe and feasible. ANALGESIA AND ANESTHESIA STUDIES: Intrathecal (IT) 3% chloroprocaine for cervical cerclage results in faster sensory block resolution and discharge readiness compared with bupivacaine...

PRCIS: We developed a modified iris cerclage technique that improves best corrected visual acuity, pupillary parameters, self-assessed photophobia, and visual function index-14 questionnaire scores in patients with acute primary angle closure and permanent mydriasis after cataract surgery. PURPOSE: To evaluate the efficacy of a modified iris cerclage technique in patients with acute primary angle closure (PAC) and permanent mydriasis after cataract surgery. PATIENTS AND METHODS: 12 eyes of 12 patients with acute PAC and permanent mydriasis at more than 3 months after phacoemulsification combined with intraocular lens (IOL) implantation underwent modified iris cerclage...

RATIONALE: To report a peculiar case of vaginal delivery of a triplet after emergency transvaginal cerclage and to find a way to optimize some extreme situations encountered in clinical practice after evaluating feasibility. PATIENT CONCERNS: A 33-year-old gravida 6, para 0050 woman at 21 + 6 weeks of gestation was referred to the obstetric department for opening of the cervical canal. An emergency McDonald cerclage was performed at 22 weeks of gestation after a comprehensive assessment, and the pregnancy ended with vaginal delivery at 24 + 6 weeks of gestation...

OBJECTIVE: To compare the effectiveness of cervical pessary and vaginal progesterone in the prevention of adverse perinatal outcomes and preterm birth in pregnant women of singletons with no prior spontaneous preterm birth at less than 34 weeks' gestation and who have a short cervix of 35 mm or less. DESIGN: Open label, multicentre, randomised, controlled trial. SETTING: 20 hospitals and five obstetric ultrasound practices in the Netherlands...

The most common means of sternal closure after sternotomy is stainless steel wire cerclage. These wires, while inexpensive and simple in design, are known to be associated with low strength and sternal dehiscence. In this biomechanical analysis, we compare single sternal wires, double sternal wires, and a novel sternal closure device we have designed to mitigate sternal dehiscence. The device uses polymer grommets at the sternal interfaces to distribute load over a large surface area of bone. Samples of each closure device were installed in a bone model and distracted at a rate of 10 mm/min while tensile forces were continuously measured and compared...

Periprosthetic fractures (PPF) of the femur in connection with total hip arthroplasty are becoming common and also frequently challenging to repair. Such patients typically are frail, elderly, and have osteoporosis. Owing to a scarcity of research there are no clear strategies for its effective management. However, the Vancouver classification may help in facilitating treatment decisions. For fractures around a loose femoral prosthesis (types B2 and B3), revision using a modular uncemented long stem, with or without additional fracture fixation, has been known to provide a reliable outcome...

RATIONALE: Uterine rupture is extremely hazardous to both mothers and infants. Diagnosing silent uterine rupture in pregnant women without uterine contractions is challenging due to the presence of nonspecific symptoms, signs, and laboratory indicators. Therefore, it is crucial to identify the elevated risks associated with silent uterine rupture. PATIENT CONCERNS: on admission, case 1 was at 37 gestational weeks, having undergo laparoscopic transabdominal cerclage 8 months prior to the in vitro fertilization embryo transfer procedure, case 2 was at 38 4/7 gestational weeks with a history of 5 previous artificial abortion and 2 previous vaginal deliveries, case 3 was at 37 6/7 gestational weeks with a history of laparoscopic myomectomy...

OBJECTIVES: The embedded Qualitative Process Evaluation (QPE) within the CSTICH- Pilot RCT explored facilitators and barriers to recruitment within the Pilot. This study reports a secondary analysis of the overarching theme of Fluidity of Equipoise and the influences on individual and community clinical equipoise around the use of Emergency Cervical Cerclage (ECC). STUDY DESIGN: RCT recruitment assumes clinical equipoise and is defined as genuine uncertainty about an intervention...

Recurrent pregnancy loss, premature birth, and associated complications exhibit a multifactorial etiology and persist as substantial challenges during pregnancy, despite the notable advancements in the medical field. Among several factors, cervical insufficiency or incompetence emerges as a prominent causal factor, characterized by painless softening and shortening of the cervix associated with absent contractions. The implementation of emergency cerclage represents a pivotal intervention in mitigating preterm birth among individuals with advanced cervical insufficiency...

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OBJECTIVES: To report the perinatal outcomes of high-risk asymptomatic women who attended a specialist preterm surveillance clinic (PSC) to undergo screening for spontaneous preterm birth (PTB) in Ireland. METHODS: Single center, retrospective cohort study of asymptomatic high risk women who attended the PSC between January 2019 and December 2022. A comprehensive database of all patients who attended the clinic during the study period was constructed and analyzed...

OBJECTIVE: To examine whether a history of hysteroscopic adhesiolysis (HA)-treated intrauterine adhesions (IUAs) was associated with an increased risk of adverse obstetrical outcomes in subsequent pregnancies. DESIGN: Retrospective cohort study. SETTING: A tertiary-care hospital in Shanghai, China. POPULATION: A cohort of 114 142 pregnant women who were issued an antenatal card and received routine antenatal care in Shanghai First Maternity and Infant Hospital, between January 2016 and October 2021...

The objective of this study was to re-examine the effect of cerclage on the possible factors associated with preterm delivery in women who had cervical conization. This was a retrospective cohort study comparing the obstetric outcomes of women with or without prophylactic cervical cerclage in pregnancy following a prior conization and managed at our institute between 2004 and 2023. In this study, there were 75% of pregnant women with a history of cervical conization. In 13 women of these (17%), prophylactic cervical cerclage was performed at 12-17 weeks' gestation...

Cervical cerclage is a common procedure employed to prevent preterm birth in women with cervical insufficiency. Complications such as injuries to the cervix and bladder, and premature membrane rupture are well-documented, while genitourinary fistulas are a rare occurrence. This article reports a rare case of vesicovaginal fistula (VVF) formation in a 27-year-old woman following the placement of a McDonald cervical cerclage. The patient presented with continuous watery vaginal leakage, which began during the last 2 months of her pregnancy...

BACKGROUND: Intraoperative calcar fractures (IOCF) are an established complication of cementless total hip arthroplasty (THA). Prompt recognition and management may prevent subsequent postoperative complications. This study aimed to evaluate the outcomes and revision rates of THAs with IOCFs identified and managed intraoperatively. METHODS: There were 11,438 primary cementless THAs performed at a single institution from 2009 to 2022. Prospectively collected data on cases with an IOCF was compared to cases without the complication...

PURPOSE: Despite various existing surgical techniques, treatment of facial nerve palsy remains difficult. The purpose of this report is to present the cerclage sling technique using temporalis fascia to manage paralytic lagophthalmos. METHODS: A series of six patients underwent a cerclage sling technique using temporalis muscle fascia to treat paralytic lagophthalmos. The technique is presented in detail. Symptoms, palpebral fissures, and lagophthalmos were assessed pre- and postoperatively...