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Nonoperative treatment

Todd P Pierce, Jennifer Kurowicki, Kimona Issa, Antony Festa, Anthony J Scillia, Vincent K McInerney
PURPOSE: To evaluate the outcomes of surgical management for external snapping hip in terms of: (1) recurrence; (2) complications; and (3) return to pre-injury activities. METHODS: A thorough review of 4 electronic databases- EMBASE, CINAHL Plus, PubMed, and Scopus was performed to find all relevant studies for this review that were published between January 2000 and January 2017 that addressed surgical treatment for external snapping hip. The following reports were excluded: (1) non-English manuscripts; (2) n ⩽ 5; (3) clinical reviews; (4) surgical technique notes; (5) studies only analysing diagnosis; and (6) nonoperative management studies...
June 1, 2018: Hip International: the Journal of Clinical and Experimental Research on Hip Pathology and Therapy
Sultan Amrayev, Ussama AbuJazar, Justinas Stucinskas, Alfredas Smailys, Sarunas Tarasevicius
INTRODUCTION: Patients with hip fractures are usually treated operatively in Western Europe. However, in Mid-Asia different indications are used to decide whether this patient is suitable for operative treatment and those are related to specific traditions and rules in hospital. Thus, traditions and surgeon/patient fears seem to affect treatment choices in hip fractures and subsequent outcomes. The aim of our study was to investigate patients with hip fractures and compare outcome at 1-year follow-up in the operated and nonoperated patient groups...
March 2018: Hip International: the Journal of Clinical and Experimental Research on Hip Pathology and Therapy
Toshiaki Komo, Koichi Oishi, Toshihiko Kohashi, Jun Hihara, Mikihiro Kanou, Akira Nakashima, Mayumi Kaneko, Hidenori Mukaida, Naoki Hirabayashi
INTRODUCTION: Intraductal papillary mucinous neoplasms (IPMNs) occasionally involve formation of fistulas with other adjacent organs. Pancreatobiliary fistulas associated with IPMNs are rare, but affected patients often develop obstructive jaundice and cholangitis. PRESENTATION OF CASE: A 79-year-old man was referred to our hospital for evaluation of abnormal biliary enzymes. Contrast-enhanced computed tomography and endoscopic retrograde cholangiopancreatography demonstrated multiple cystic lesions with septa in the pancreatic head and fistulas between the cystic lesions and common bile duct...
June 4, 2018: International Journal of Surgery Case Reports
Jonas Pogorzelski, Erik M Fritz, Jonathan A Godin, Andreas B Imhoff, Peter J Millett
Economic pressure highlights the critical need for appropriate diagnosis and treatment of various shoulder pathologies since under-diagnosis and under-treatment can result in increased costs to society in the form of disability and lost production. On the other hand, aggressive over-treatment can further inflate already burgeoning health-care costs and potentially harm the patient. Therefore, it is crucial to distinguish the indications between operative and nonoperative management, especially in common shoulder pathologies such as rotator cuff tears, anterior shoulder instability, biceps tendinitis, lesions to the acromioclavicular joint, and proximal humeral fractures...
2018: Obere Extremität
Tun Hing Lui
Ankle, hindfoot, and toe stiffness can result from hindfoot trauma. It can be due to capsular fibrosis, tendon adhesion, muscle fibrosis, or malunion. For symptomatic stiffness that is resistant to nonoperative treatment, operative treatment should be considered. It is important to tackle the sources of stiffness, and careful preoperative clinical assessment is the key for proper formulation of the surgical plan. Whenever possible, arthroscopic/endoscopic surgery is preferable to open surgery because less extensive dissection and small surgical incisions allow immediate vigorous mobilization of the foot and ankle...
May 2018: Indian Journal of Orthopaedics
S R Sundararajan, Abdul Azeem Badurudeen, R Ramakanth, Shanmuganathan Rajasekaran
Fractures of talar body are uncommon injuries often associated with fractures of other long bones and in polytraumatized patients. The integrity of the talus is essential for the normal function of the ankle, subtalar, and midtarsal joints. The relative infrequency of this injury limits the number of studies available to guide treatment. They occur as a result of high-velocity trauma and are therefore associated with considerable soft tissue damage. Axial compression with supination or pronation is the common mechanism of injury...
May 2018: Indian Journal of Orthopaedics
Stefan Rammelt, Bruce J Sangeorzan, Michael P Swords
The best treatment for displaced, intraarticular fractures of the calcaneum remains controversial. Surgical treatment of these injuries is challenging and have a considerable learning curve. Studies comparing operative with nonoperative treatment including randomized trials and meta-analyses are fraught with a considerable number of confounders including highly variable fracture patterns, soft-tissue conditions, patient characteristics, surgeon experience, limited sensitivity of outcome measures, and rehabilitation protocols...
May 2018: Indian Journal of Orthopaedics
Young-Ji Seo, Sarah E Rudasill, Yas Sanaiha, Esteban Aguayo, Katherine L Bailey, Vishal Dobaria, Peyman Benharash
BACKGROUND: Thoracic aortic injuries have traditionally been associated with high morbidity and mortality. Thoracic endovascular aortic repair has emerged as a suitable alternative to open repair, but its impact at a national level remains ill defined. This study aimed to analyze the national trends of patient characteristics, outcomes, and resource utilization in the treatment of thoracic aortic injuries. METHODS: Patients admitted with thoracic aortic injuries from 2005-2014 were identified in the National Inpatient Sample...
June 6, 2018: Surgery
H J Christiaan Swellengrebel, David Saper, Paul Yi, Alexander A Weening, David Ring, Andrew Jawa
Diaphyseal fractures of the distal humerus have a high rate of union when treated with a functional brace or an above-elbow cast (AEC). This study compares alignment of the humerus and motion of the elbow after functional brace or AEC treatment. One-hundred and five consecutive patients with a closed, extra-articular fracture of the distal humeral diaphysis were identified in the orthopedic trauma databases of 3 hospitals between 2003 and 2012. Seventy-five patients with a follow-up of at least 6 months or with radiographic and clinical evidence of fracture union were included (51 treated with functional bracing and 24 treated with an AEC)...
May 2018: American Journal of Orthopedics
Peter Goljan, Todd P Pierce, Anthony J Scillia, Anthony Festa
Instability of the proximal tibiofibular joint (PTFJ) is a rare clinical condition that presents unique challenges to treatment. We present the case of an active 26-year-old woman with a 4-year history of recurrent PTFJ subluxations, treated surgically at our institution using a split biceps femoris tendon graft for PTFJ reconstruction. She underwent several attempts at nonoperative management until we decided to proceed with surgical intervention. A split biceps femoris graft was used to restore stability of the PTFJ...
May 2018: American Journal of Orthopedics
Chayanin Angthong
Malunion of calcaneal fractures is a common complication after improper nonoperative treatment. It may develop into posttraumatic subtalar osteoarthritis, lateral calcaneal wall prominence, and severe foot deformities. This Technical Note reports the technical aspects of lateral endoscopic calcaneoplasty with posterior arthroscopic subtalar arthrodesis for the treatment of malunited calcaneal fracture with lateral calcaneal wall prominence and posttraumatic subtalar osteoarthritis. This technique was chosen because it can reduce the risk of wound complication compared with a conventional lateral extensile approach...
March 2018: Arthroscopy Techniques
D H R Kempen, D Delawi, M C Altena, M C Kruyt, M P J van den Bekerom, F C Oner, R W Poolman
BACKGROUND: The purpose of this study was to determine the neurological outcome after transverse sacral fractures in patients with neurological impairment. METHODS: A systematic review of the English, French, German, and Dutch literature was conducted. All study designs, including retrospective cohort studies and case reports, describing transverse sacral fractures were included. Two authors independently extracted the predefined data and scored the neurological impairment according to the Gibbons classification after the trauma and at the time of follow-up...
June 5, 2018: JBJS Reviews
Chukwunonso Chime, Charbel Ishak, Kishore Kumar, Venkata Kella, Sridhar Chilimuri
Splenic rupture following colonoscopy is rare, first reported in 1974, with incidence of 1-21/100,000. It is critical to anticipate splenic trauma during colonoscopy as one of the causes of abdominal pain after colonoscopy especially when located in the left upper quadrant or left shoulder. Postoperative adhesions is a predisposing factor for splenic injury, and management is either operative or nonoperative, based on hemodynamic stability and/or extravasation which can be seen on contrast-enhanced CT scan of the abdomen...
2018: Case Reports in Gastrointestinal Medicine
Gregory D Schroeder, Mark F Kurd, Christopher K Kepler, Kris E Radcliff, Mitchell G Maltenfort, Hamadi Murphy, Jeffery A Rihn, D Greg Anderson, Alan S Hilibrand, Alexander R Vaccaro
STUDY DESIGN: Retrospective case-control study. BACKGROUND: Physician-owned specialty hospitals focus on taking care of patients with a select group of conditions. In some instances, they may also create a potential conflict of interest for the surgeon. The effect this has on the surgical algorithm for patients with degenerative cervical spine conditions has not been determined. METHODS: A retrospective review of all patients who underwent a 1- or 2-level anterior cervical discectomy and fusion between October 2009 and December 2014 at either a physician-owned specialty hospital or an independently owned community hospital were identified...
June 2018: Clinical Spine Surgery
Nikhil R Kalva, Vishwas Vanar, David Forcione, Matthew L Bechtold, Srinivas Reddy Puli
Background: Patients with acute cholecystitis are treated with early cholecystectomy. A subset of patients are unfit for surgery due to comorbidities and late presentation. Prompt gall bladder drainage (GBD) with percutaneous or endoscopic approach remains a viable therapeutic option for nonoperative candidates. Endoscopic ultrasound (EUS) guided transluminal gall bladder drainage (EUS-GBD) continues to evolve as an alternative approach to percutaneous drainage. With continued refinement in stent technology, lumen apposing self-expandable metal stent (LAMS) offers several advantages...
2018: Canadian Journal of Gastroenterology & Hepatology
Andrew Nataraj, Andrew S Jack, Ihsan Ihsanullah, Shawn Nomani, Frank Kortbeek, Richard Fox
STUDY DESIGN: This is a single-center, retrospective, observational cohort study. OBJECTIVE: To determine whether surgery or nonoperative treatment has better clinical outcomes in neurologically intact patients with an intermediate severity thoracolumbar burst fracture. SUMMARY OF BACKGROUND DATA: Optimal management, whether initial operative or nonoperative treatment, for thoracolumbar injury classification score (TLICS) 4 burst fractures remains controversial...
May 25, 2018: Clinical Spine Surgery
Marie Askenberger, Eva Bengtsson Moström, Wilhelmina Ekström, Elizabeth A Arendt, Anna Hellsten, Christina Mikkelsen, Per-Mats Janarv
BACKGROUND: A lateral patellar dislocation (LPD) is the most common traumatic knee injury with hemarthrosis in children. The redislocation rate is high. Varying operative and nonoperative treatments have been advocated with no consensus on the best treatment. PURPOSE: (1) To evaluate if arthroscopic-assisted repair of the medial patellofemoral ligament (MPFL) in patients with an acute first-time traumatic LPD would reduce the recurrence rate and offer better objective/subjective knee function compared with a knee brace without repair...
May 1, 2018: American Journal of Sports Medicine
Kiera Kingston, Emily J Curry, Joseph W Galvin, Xinning Li
BACKGROUND: Adhesive capsulitis is characterized by a gradual, painful loss of shoulder motion. This study evaluated patient variables significantly associated with developing adhesive capsulitis compared with a sex-matched control group without adhesive capsulitis. We also sought to determine those factors associated with adhesive capsulitis patients requiring surgical intervention. METHODS: All patients presenting to our hospital with adhesive capsulitis between 2004 and 2014 were identified...
May 25, 2018: Journal of Shoulder and Elbow Surgery
Héctor J Aguado, Blanca Ariño, Fernando Moreno-Mateo, Elías Y Bustinza, Clarisa Simón-Pérez, Mario Martínez-Zarzuela, Virginia García-Virto, Paula S Ventura, Miguel Ángel Martín-Ferrero
BACKGROUND: Nonoperative management of proximal humeral fractures (PHFs) is the most common treatment, but its functional outcome may improve with early mobilization. In frail osteoporotic patients, quick recovery of prefracture independency is mandatory. This study assessed fracture displacement in PHFs managed with conservative treatment after early mobilization and a home-based self-exercise program. METHODS: We retrospectively analyzed the radiologic displacement of fracture fragments of PHFs treated conservatively with early mobilization and a home-based self-exercise program...
May 23, 2018: Journal of Shoulder and Elbow Surgery
Ronny Kalash, Scott M Glaser, John C Flickinger, Steven Burton, Dwight E Heron, Peter C Gerszten, Johnathan A Engh, Nduka M Amankulor, John A Vargo
OBJECTIVE Akin to the nonoperative management of benign intracranial tumors, stereotactic body radiation therapy (SBRT) has emerged as a nonoperative treatment option for noninfiltrative primary spine tumors such as meningioma and schwannoma. The majority of initial series used higher doses of 16-24 Gy in 1-3 fractions. The authors hypothesized that lower doses (such as 12-13 Gy in 1 fraction) might provide an efficacy similar to that found with the dose de-escalation commonly used for intracranial radiosurgery to treat acoustic neuroma or meningioma and with a lower risk of toxicity...
May 25, 2018: Journal of Neurosurgery. Spine
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