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BACKGROUND: Due to the variability in evidence supporting either trans-syndesmosis fixation or deltoid ligament repair in unstable ankle fractures with medical clear space (MCS) widening makes it unclear which surgical technique leads to the best patient outcomes. The goal of our systematic review and meta-analysis was to compare clinical outcomes of trans-syndesmotic fixation versus anatomic deltoid ligament repair in the management of unstable ankle fractures with MCS widening. METHODS: Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were utilized in this study. A comprehensive and systematic search was conducted using the PubMed, Embase, Web of Science and Cochrane Library databases. Outcomes investigated in this review included the rates of syndesmotic malreduction, removal of hardware, postoperative complications including wound issues, and functional/pain scores. RESULTS: A total of five level-3 studies were selected in this review, with 280 unstable ankle fractures with MCS widening: 165 for the trans-syndesmotic fixation group and 115 for the anatomic deltoid ligament repair group. Three out of five studies evaluated syndesmotic malreduction using CT. Compared to the trans-syndesmosis fixation group, the deltoid repair group showed significant lower rates of syndesmotic malreduction rates and removal of hardware: 6.5 % (4/61) Vs. 27 % (16/59) (RR=0.26, 95 % CI=[0.10, 0.68]), and 2.6 % (3/115) Vs.54.5 % (90/165) (RR=0.06, CI=[0.02, 0.14]), respectively. No significant differences were found between the two groups in postoperative wound complications, reoperations, and functional scores including AOFAS and VAS pain score. CONCLUSIONS: Based on our findings, anatomic deltoid ligament repair was associated with a lower rate of syndesmotic malreduction and the need for hardware removal while there was no significant difference in terms of postoperative wound complications, reoperation, AOFAS score, or VAS pain score. These results should be interpreted with caution due to limitations related to heterogeneity among the studies. Further high-level RCTs with larger sample sizes are necessary to establish a robust consensus.

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This case report outlines the first reported case of bilateral paramedian thalamic infarct, likely stemming from a rare artery of Percheron (AOP) variant, secondary to uncontrolled atrial fibrillation with rapid ventricular response. We underscore the importance of considering hypoperfusion due to decreased cerebral perfusion as a potential mechanism in cryptogenic AOP infarcts, challenging the conventional association with embolic etiology. This report contributes to the limited literature on AOP infarctions, emphasizing the need for heightened awareness among healthcare providers for diverse clinical presentations and potential etiologies to improve diagnosis and management, ultimately enhancing patient outcomes.

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STUDY: Design Retrospective study Objective To observe and measure the safe distance between the uncinate process (UP) and the V2 vertebral artery (VA). METHODS: Two hundred and sixteen patients who underwent head and neck CTA date were selected and measured. The Upper Tip (UT) of the UP, the Posterior Tip (PT) of the UP and the Center of the VA (CA) were identified. Then, the width between the UT and the CA (WUA), the depth between the UT and the CA (DUA), the distance between the UT and the CA (LUA) were measured. Meanwhile, the width between the PT and the CA (WPA), the depth between the PT and the CA (DPA) and the length between the PT and the CA (LPA) were measured. The values above were compared between the left and right sides of the same vertebral body, also the results of the same side from C3 to C6 were compared. RESULTS: That WUA fluctuates between 6.1- 4.4 mm on the left side with the narrowest at C5 and C6 (4.4 mm), 6.5- 4.6 mm on the right side with the narrowest at C5 (4.6 mm). It could be concluded that the safe space for operation outside UP is about 4mm and more care should be taken when operating on the caudal spine. WPA fluctuates between 10.6- 10.0 mm on the left side with the narrowest at C3 (10mm), 11.0- 9.9 mm on the right side with the narrowest at C4 (9.9 mm). The safe space for operation outside the PT is about 10mm and more care should be taken when operating on the cephalad spine. DPA fluctuates between 6.5- 4.6 mm on the left and is narrowest at C3 (4.6 mm), 6.5- 4.7 mm on the right and narrowest at C3 (4.7 mm). The safe space for operation from the PT to the ventral side is about 4.5 mm, and more care should be taken when operating on the cephalad side of the cervical spine. CONCLUSION: UP and PT could be seen as the landmarks in the operations of ACDF. The safe space outside UP is about 4mm and more care should be taken when operating on the caudal spine. The safe space outside PT is about 10mm and more care should be taken when operating on the cephalad spine. The safe space for operation from the PT to the ventral side is about 4.5 mm, and more care should be taken when operating on the cephalad side of the cervical spine.

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Background: Anatomic anterior cruciate ligament (ACL) reconstruction is considered the gold standard treatment for ACL injuries because it aims to restore the knee's normal anatomy and stability, while also protecting long-term knee health. Long-term clinical and radiological outcomes after ACL reconstruction using the modified TT technique are unclear. Objective: To assess the clinical and radiological outcomes following ACL reconstruction using modified transtibial (TT) techniques at a minimum 12-month follow-up. Design: A systematic review with meta-analysis. Methods: PubMed, EMBASE, Web of Science, the Cochrane Library, and MEDLINE databases were searched from the inception to December 1, 2022. PICO search strategy was used to identify studies applying modified TT techniques on patients with ACL reconstruction and a minimum follow-up of 12 months. Eligible studies were identified independently by two reviewers. We extracted data on patient demographics, surgical characteristics, patient reported outcomes including subjective evaluations and clinical outcomes. Radiological data including femoral and tibial tunnel position, femoral and tibial tunnel length, and femoral tunnel angle were also extracted. The tunnel position was evaluated using the quadrant method based on three-dimensional computed tomography (3D CT) images. The standardized mean difference (SMD) and 95 % confidence interval (CI) were calculated for clinical and radiological outcomes. Results: Sixteen studies involving 628 patients were finally included. The SMD of Lysholm (90.39; 95 % CI 83.41-97.38), IKDC (86.07; 95 % CI 79.84-92.31), and Tegner (6.15; 95 % CI 3.96-8.33) scores were considered satisfactory. The depth of the femoral tunnel showed a pooled SMD of 30.08 % (95 % CI 28.25-31.91 %), and the height showed a pooled SMD of 37.72 % (95 % CI 35.75-39.70 %). The pooled SMD for the femoral tunnel angle in the coronal plane was 48.27°(95 % CI 43.14-53.40°), and the pooled SMD for the femoral tunnel length was 33.98 mm (95 % CI 29.03-38.93 mm). Conclusions: This investigation has shown that modified TT technique can create an anatomic femoral tunnel and maintain optimal tunnel length and angulation. Most patients had satisfactory subjective outcomes and physical examinations after ACL reconstruction using modified TT technique. This information may assist in guiding expectations of clinicians and patients following ACL reconstruction with modified TT technique.

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The indications for bone block augmentation of the glenoid following recurrent anterior shoulder instability are expanding. Arthroscopic anatomic glenoid reconstruction (AAGR) is an evolving technique with similar clinical results to the Latarjet procedure and other open bone block procedures. Multiple types of bone grafts and fixation techniques have been described, with varying results on bony integration, resorption, articular congruity, and recurrence rates. This review focuses on biomechanics, patient workup, indications, current evidence, and the authors' preferred surgical technique for AAGR.

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Purpose: Stress shielding in short-stem arthroplasty can cause critical metaphyseal bone loss. If the size and shape of the humeral shaft are important factors, it is unknown whether the shape of the polyethylene component in reverse shoulder arthroplasty (RSA) affects bone stress around or within the stem. We explored the impact of polyethylene shape on humeral and scapular stress distribution using a finite element model. Methods: We developed a shoulder-specific finite element model. A defined set of muscle forces was applied to simulate movements. An intact rotator cuff state and a superior deficient rotator cuff state were modelled. We used the FX V135 short stem in three conditions: total shoulder arthroplasty (TSA), and RSA with symmetrical and asymmetrical polyethylene (145°/135°). We measured biomechanical markers related to bone stress for different implant sizes. Joint kinematics and the mechanical behaviour of the implant were compared. Results: Rupture of the supraspinatus muscle produced a functionally limited shoulder. The placement of an anatomic TSA with an intact rotator cuff restored function similar to that of a healthy shoulder. RSA in the rotator cuff-deficient shoulder restored function regardless of stem size and polyethylene shape. While stem size had an impact on the stress distribution in the bone and implant, it did not show significant potential for increasing or decreasing overall stress. For the same stem, stress distribution at the humerus is different between TSA and RSA. Polyethylene shape did not alter the transmission of stress to the bone in RSA. Asymmetric polyethylene produced a greater abduction range of motion. Conclusions: In terms of bone stress distribution, smaller stems seemed more appropriate for TSA, while larger stems may be more appropriate for RSA. Polyethylene shape resulted in different ranges of motion but did not influence bone stress. Level of Evidence: Diagnostic Tests or Criteria; Level IV.

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OBJECTIVE: Management of limb ischemia in the setting of malignancy with history of resection and/or radiation presents a unique challenge. Radiation arteritis contributing to limb ischemia may not respond to endovascular intervention. Furthermore, significant tissue scarring from extensive resection and/or radiation can increase the risk of complications with open intervention and limit revascularization options. Utilization of an axillary to popliteal artery bypass using a lateral approach to the popliteal artery has been described as a reasonable alternative in these challenging cases. CASE REPORT: The patient is a 68-year-old male with history of liposarcoma of the left groin, scrotum, and medial thigh for which he underwent multiple resections, flap reconstruction, and skin graft. He had a recurrence 2 years later and underwent repeat resection, placement of brachytherapy catheters, vertical rectus abdominal flap, and external beam radiation. He now presents with Rutherford 2B acute limb ischemia with associated left foot drop. Computed tomography angiography was performed and revealed an occluded left common femoral artery stent, proximal left superficial and deep femoral artery occlusion, and thrombosis of the left femoral vein. An attempt was made at endovascular recanalization without success. He subsequently underwent left axillary-to-lateral above knee popliteal artery bypass with a 6 mm ringed polytetrafluoroethylene graft, tibial thrombectomy, and 4 compartment fasciotomy. RESULTS: Post-operatively, his pain resolved. He continued to have left foot drop but recovered his ability to ambulate with a walker. He was ultimately discharged on post-operative day 11 to an inpatient rehabilitation facility on aspirin and apixaban. CONCLUSION: Hostile groin secondary to infection, malignancy requiring resection/radiation presents a unique challenge for revascularization. When endovascular revascularization or obturator bypass are not feasible options, axillary-to-lateral above knee popliteal artery bypass is a described, feasible alternative approach to restore blood flow in this challenging patient population.

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BACKGROUND: Primary glenohumeral osteoarthritis in young patients poses challenging treatment decisions. Arthroplasty options have different failure profiles and implant survivorship patterns. This registry study aims to analyze the cumulative per cent revision rate (CPR) of different types of arthroplasties conducted for primary osteoarthritis in patients under 55 years of age. METHODS: This comparative observational national registry study included all shoulder arthroplasty for osteoarthritis in patients under 55 years of age undertaken between January 1st, 2005, and December 31st, 2022. Partial hemi resurfacing and hemi stemless procedures were excluded. The cumulative percentage of revision (CPR) was determined using Kaplan-Meier estimates of survivorship and hazard ratios (HR) from Cox proportional hazard models adjusted for gender. Reasons for revision of each type of arthroplasty and cumulative incidence of revision diagnoses were analyzed. RESULTS: 2111 primary shoulder arthroplasties were compared. Glenoid erosion is the predominant cause of revision for humeral resurfacing (29.8%) and hemiarthroplasty (35.5%). Instability is the predominant cause of revision for stemmed anatomic total shoulder arthroplasty (ATSA) and reverse total shoulder arthroplasty (RTSA), while loosening is the predominant cause of revision for stemless ATSA. The 6-year CPR is 12.8% for humeral resurfacing (HRA), 14.1% for hemiarthroplasty (HA), 12.4% for stemmed (ATSA), 7.0% for stemless ATSA, and 6.5% for (RTSA). Stemmed ATSA had a higher revision rate than RTSA (entire period HR=2.04 (95% confidence interval (CI) 1.16, 3.57), p=0.012). In contrast, the revision rate of stemless ATSA was not different from RTSA (HR =1.05 (95% CI 0.51, 2.19), p=0.889). Males outnumber females for all shoulder arthroplasty categories. DISCUSSION: RTSA and stemless ATSA are viable options in young patients with primary osteoarthritis. Their short-to medium-term revision rates are comparable to those of older patients and lower than those associated with HRA, HA, and stemmed ATSA. CONCLUSION: In the predominantly male patient population under the age of 55, reverse shoulder arthroplasty and stemless ATSA have a lower short-term revision risk than stemmed ATSA.

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Background: Meandering main pancreatic duct (MMPD) refers to an uncommon ductal variant of the normal smooth curvilinear course of the pancreatic duct. More specifically, MMPD is characterized by a hairpin (reverse Z-type) or loop (loop-type) turn in the pancreatic head. It has been suggested as a predisposing factor for the development of pancreatitis. Studies regarding treatment are scarce. Methods: We conducted a narrative review of the current literature regarding MMPD. Additionally, we present a cohort of 9 symptomatic patients treated endoscopically at our tertiary center. Results: Seven retrospective cohort studies and 4 case reports were included in our review. Only 1 study focuses on the clinical significance of MMPD and describes a positive association between MMPD and the onset of pancreatitis, especially recurrent acute pancreatitis. Only 1 case reports an endoscopic treatment. In our cohort of 9 MMPD patients, 7 did indeed present with recurrent acute pancreatitis. Endotherapy provided substantial regression of symptoms in 6 patients, all of whom had signs of ductal hypertension. Conclusions: Our review shows the scarcity of data regarding MMPD, especially concerning treatment, in the current literature. With our cohort, we not only hope to raise awareness of this often-neglected entity of recurrent acute pancreatitis, but also support the case for endotherapy for the first time in 9 symptomatic MMPD patients, especially in the presence of ductal hypertension.

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Background: Despite the increasing use of revision reverse total shoulder arthroplasty (RTSA), studies directly comparing revision RTSA performed for different failed index procedures are limited. We therefore compared the results of revision RTSA between patients with a failed primary anatomic arthroplasty (total shoulder arthroplasty and hemiarthroplasty) and those with a failed primary RTSA to explore revision of which index procedure resulted in better long-term clinical outcomes. Methods: In this prospective, multicenter, observational study, patients underwent revision RTSA using an inverted-bearing prosthesis. We recorded clinical scores, active range of motion, pain, satisfaction, and the rate of scapular notching. Complications and prosthesis survival were also noted. Results: We included 45 patients (45 shoulders) with revision RTSA for failed primary anatomic shoulder arthroplasty (30 patients) and RTSA (15 patients). Clinical and radiographic outcomes were recorded from 36 patients at a median follow-up of 101.6 months, and prosthesis survival was assessed from all 45 patients. At final follow-up, clinical scores (P < .05), abduction (P = .032), re-revision rate (P = .018), and prosthesis survival (P = .015) were significantly better in patients revised from failed primary anatomic shoulder arthroplasty than those from RTSA. However, pain, satisfaction, and overall complication rates were similar in both groups (P > .05). Conclusions: We found better long-term clinical scores, abduction, and prosthesis survival rates after failed primary anatomic shoulder arthroplasty than after RTSA. Pain reduction and complication rates were comparable in both groups. Thus, anatomic shoulder arthroplasty remains an attractive option for primary arthroplasty in selected cases.

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INTRODUCTION AND IMPORTANCE: Iatrogenic bile duct injury is a serious complication of laparoscopic cholecystectomy, often due to misinterpretation of biliary tree anatomy. Anatomical variations, patient condition, gallbladder pathology, and surgeon-related factors are key risk factors for bile duct injury. CASE PRESENTATION: A 68-year-old male with a history of hypertension and type 2 diabetes mellitus underwent Laparoscopic cholecystectomy for symptomatic gallstones. One-month post-surgery, he developed right upper quadrant pain, jaundice, and elevated liver enzymes. Magnetic resonance cholangiopancreatography (MRCP) showed a hilar confluence stricture affecting the right posterior and left hepatic ducts, with mild-to-moderate dilation of upstream intrahepatic bile ducts. CLINICAL DISCUSSION: Trifurcation of the hepatic duct is a rare but clinically significant anatomical variation that can predispose patients to common bile duct injuries. Preoperative MRCP can identify such variations, aiding in surgical planning. However, intraoperative recognition and management of these anatomical differences are crucial to prevent bile duct injuries. This is particularly important in low-resource settings where routine preoperative imaging may not be feasible. CONCLUSION: Accurate intraoperative identification of biliary tree anatomical variations is essential to prevent iatrogenic injuries during surgery. Preoperative imaging, when available, can provide valuable information to assist in surgical planning. Additionally, the use of intra-operative cholangiogram (IOC) should be considered to help identify and manage anatomical variations, thereby reducing the risk of bile duct injuries.

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BACKGROUND: Subscapularis tendon (SSc) dysfunction following total shoulder arthroplasty (TSA) results in poor functional outcomes. There have been numerous SSc repair constructs tested biomechanically and clinically, however, none has been demonstrated as superior. Newer techniques and implants have emerged, but have not been fully tested. HYPOTHESIS: We hypothesized that the unicortical button (UB) fixation will provide significantly improved restoration of the anatomic footprint and biomechanical properties when compared to transosseous (TO) repair of the SSc. METHODS: A digital footprint of SSc humeral insertion was obtained in 6 pairs of fresh-frozen cadaveric shoulders using a three-dimensional (3-D) digitizer. A complete SSc tear was created, and each pair of shoulders was randomized to either SSc repair with UB or TO repair. Each specimen underwent a cyclic loading protocol followed by pull-to-failure. The failure load, elongation at failure, gapping failure, number of cycles until failure, the load at key gapping points (1 mm, 3 mm, 5 mm, and 10 mm) and the failure mode were recorded using high-resolution video recording. 3-D surfaces of the insertion footprint and repair site were obtained, and surface areas were calculated using a custom MATLAB script and laser scanner. Paired t-tests were conducted to compare differences between two repair groups. RESULTS: Failure load was significantly higher in the UB group (382.4 N ± 56.5 N) than in the TO group (253.6 N ± 103.4 N, p=0.005). TO repair provided higher gapping at failure (28.8 mm ± 8.2 mm) than UB repair (10.4 mm ± 6.8 mm, p=0.0017). UB repair had significantly higher load at the 1-mm, 5-mm, and 10-mm gapping compared with TO repair with p=0.042, p=0.033, and p=0.0076, respectively. There were no significant differences between elongation failure, the difference in footprint area from native to repair states, or the percentage of restored footprint area between groups. (p=0.26, p=0.18 and p=0.21 respectively) CONCLUSION: The UB fixation showed a significantly lower gap at failure, higher failure load and number of cycles until failure, and higher gap loads compared with the traditional TO repair for SSc. Although more clinical research is necessary, the UB fixation that utilizes cortical bone presents promising results.

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INTRODUCTION: Optimal management of retroversion in anatomic total shoulder arthroplasty (aTSA) remains controversial and limited attention has been directed to the impact of glenoid inclination. Prior biomechanical study suggest that residual glenoid inclination generates shear stresses that may lead to early glenoid loosening. Combined biplanar glenoid deformities may complicate anatomic glenoid reconstruction and affect outcomes. The goal of this matched-cohort analysis was to assess the relationship between biplanar deformities and mid-term radiographic loosening in aTSA. METHODS: The study cohort was identified via an institutional repository of 337 preoperative CT scans from 2010-2017. Glenoid retroversion, inclination, and humeral head subluxation were assessed via 3D-planning software. Patients with retroversion ≥ 20˚ and inclination ≥ 10˚ who underwent aTSA with eccentric reaming and non-augmented components were matched by age, sex, retroversion, and Walch classification to patients with retroversion ≥ 20˚ only. Primary outcome was glenoid component Lazarus radiolucency score. RESULTS: Twenty-eight study subjects were matched to 28 controls with retroversion only. No difference in age (61.3 vs. 63.6 years, p=0.26), sex (19 [68%] vs. 19 [68%] male, p=1.0), or follow-up (6.1 vs. 6.4 years, p=0.59). Biplanar deformities had greater inclination (14.5˚ versus 5.3˚, p<0.001), retroversion (30.0˚ versus 25.6˚, p=0.01) and humeral subluxation (86.3% versus 82.1%, p=0.03). Biplanar patients had greater postoperative implant superior inclination (5.9 [4.6] vs. 3.0 [3.6] degrees, p=0.01) but similar rate of complete seating 24 [86%] vs. 24 [86%] p=1.0). At final follow-up, biplanar subjects had higher Lazarus radiolucent scores (2.4 [1.7] vs. 1.6 [1.1], p=0.03) and higher proportion of patients with glenoid radiolucency (19 [68%] vs. 11 [39%], p=0.03). No difference in complete component seating (86% versus 86%, p=0.47) or initial radiolucency grade (0.21 versus 0.29, p=0.55) on immediate postop radiographs. Biplanar patients demonstrated a greater amount of posterior subluxation at immediate postop(3.5% [1.3%] versus 1.8% [0.6%]; p=0.03) and final follow-up (7.6% [2.8%] versus 4.0% [1.8%]; p=0.04). At final radiographic follow-up, biplanar subjects had higher Lazarus radiolucent scores (2.4 [1.7] vs. 1.6 [1.1], p=0.03; ICC=0.82). Bivariate regression analysis demonstrated biplanar deformity was the only significant predictor (OR 3.3, p=0.04) of glenoid radiolucency. CONCLUSION: Biplanar glenoid deformity resulted in time-zero glenoid implant superior inclination and increased mid-term radiographic loosening and posterior subluxation. Attention to glenoid inclination is important for successful anatomical glenoid reconstruction. Future research is warranted to understand the long-term implications of these findings and impact of utilizing augmented implants or reverse shoulder arthroplasty to manage biplanar deformities.

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BACKGROUND: Melanoma is increasingly recognized as a heterogeneous disease, with conflicting evidence regarding whether cutaneous head and neck melanoma (CHNM) represents a distinct entity. OBJECTIVE: Comparison of clinicopathological features and treatment outcomes of CHNM and cutaneous melanomas of other sites (CMOS). METHODS: Patients with CHNM and CMOS diagnosed between 2000-2018 were included. Locoregional control (LRC), distant metastasis-free survival (DMFS), melanoma-specific survival (MSS), and overall survival (OS) were described using the Kaplan-Meier method. Cox regression analyses were performed to examine associations between prognostic factors and outcomes. Additional analyses of survival from time of stage IV disease diagnosis were undertaken, stratified by receipt of BRAF-targeted therapy and immune checkpoint inhibitor (ICI) immunotherapy. RESULTS: Of 3007 CHNM and 10637 CMOS patients, CHNM had more adverse pathological features (median age 65.9 vs. 58.5, p<0.001, median Breslow thickness 1.7mm vs. 1.2mm, p<0.001, ulceration 21.2% vs. 18.2%, p<0.001). CHNM had worse LRC (HR 1.17, p<0.001) and DMFS (HR 1.25, p<0.001) but there were no significant differences in MSS or OS. Amongst stage IV patients who received ICI, CHNM had better MSS (HR 0.56, p=0.001) and OS (HR 0.57, p<0.001) on multivariable analyses. LIMITATIONS: Retrospective study, offset by prospective data collection. CONCLUSION: CHNM is associated with a distinct clinicopathological and prognostic profile.

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Background and aims: To evaluate a novel multimodal treatment (TLP) that integrates the use of a thulium laser, bipolar transurethral resection of the prostate (TURP), and "button-type" bipolar plasma vaporization for the endoscopic treatment of benign prostatic hyperplasia (BPH). Methods: From March 2018 to December 2021, we prospectively evaluated 220 patients with symptomatic BPH who underwent TLP. Patients were assessed based on the International Prostate Symptom Score (IPSS), quality of life (QoL), maximum urinary flow rate (Qmax), and postvoid residual urine (PVR). Perioperative and postoperative follow-up data were analyzed. Results: The mean age at surgery was 66.74 years (SD 8.21). The median prostate size was 80 (IQR 70 - 110). The median operative time was 45 (IQR 35 - 55) minutes and the hospital stay was 2 (IQR 1 - 2) days. Patients were discharged with the urinary catheter in place, which was removed approximately 7 days after surgery when the histopathological result was discussed with the patient. Postoperatively, IPSS, QoL, Qmax and PVR showed a significant improvement starting at 3 months and continued through the postoperative follow-up visits (6-12-24-36-48-60 months). Urethral stricture and bladder neck contracture occurred in 1 (0.45%) and 2 (0.91%) patients, respectively. Recurrence of BPH occurred in 2 patients (0.91%) who underwent a second procedure. Conclusions: In conclusion, we report that the multimodal surgical treatment of BPH consisting of combining Thulium laser vaporization, bipolar TURP and plasma vaporization (TLP) represents an efficient and durable therapeutic method for BPH patients with low a complication rate at 5-year follow-up.

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OBJECTIVES: Prior studies have associated morbidity following anatomic lung resection with prolonged postoperative length of stay; however, each complication's individual impact on length of stay as a continuous variable has not been studied. The purpose of this study was to determine the risk-adjusted increase in length of stay associated with each individual postoperative complications following anatomic lung resection. METHODS: Patients who underwent anatomic lung resection cataloged in the prospectively collected American College of Surgeons National Surgical Quality Improvement Program participant use file, 2005-2018, were targeted. The association between preoperative characteristics, postoperative complications and length of stay in days was tested. A negative binomial model adjusting for the effect of preoperative characteristics and 18 concurrent postoperative complications was used to generate incidence rate ratios. This model was fit to generate risk-adjusted increases in length of stay by complication. RESULTS: Of 32 133 patients, 5065 patients (15.8%) experienced at least one post-operative complication. The most frequent complications were pneumonia (n = 1829, 5.7%), the need for transfusion (n = 1794, 5.6%) and unplanned reintubation (n = 1064, 3.3%). The occurrence of each of the 18 individual complications was associated with significantly increased length of stay. This finding persisted after risk-adjustment, with the greatest risk-adjusted increases being associated with prolonged ventilation (+17.4 days), followed by septic shock (+17.2 days), acute renal failure (+16.5 days) and deep surgical site infection (+13.2 days). CONCLUSIONS: All 18 postoperative complications studied following anatomic lung resection were associated with significant risk-adjusted increases in length of stay, ranging from an increase of 17.4 days with prolonged ventilation to 2.6 days following the need for transfusion.

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OBJECTIVES: The abnormal anatomical alterations of blood vessels during DSA angiography in patients with hematological disorders were retrospectively examined, and the influencing factors of short-term (≤ 6 months) recurrent hemoptysis were statistically analyzed, and the consistency between admission diagnosis and intraoperative diagnosis was evaluated. METHODS: The intraoperative angiography data of patients who underwent selective bronchial artery embolization for hemoptysis in our hospital from January 2022 to December 2022 were reviewed. They were divided into the observation group and the control group based on whether there was recurrent hemoptysis. The Logistic regression model and forest map were employed to analyze the factors influencing the recurrence rate. RESULTS: A total of 104 patients were encompassed in this study (12 cases of tuberculosis, 35 cases of infection, 4 cases of lung cancer, 8 cases of bronchiectasis, 22 cases of arteriovenous fistula, 16 cases of aneurysm, and 7 cases of pulmonary hypertension). The coincidence rate of preoperative and intraoperative diagnoses was 73.1%. Pulmonary arteriovenous fistula and aneurysm were the predominant types of diseases that were misdiagnosed. The short-term recurrence rate was 16.3%, mainly attributed to the reopening of responsible vessels related to embolization, angiography leakage, and leaky embolization of specific types of vessels. The recurrence rate of only patients with arteriovenous fistula and aneurysm accounted for 47% of the total recurrence rate. The right bronchial artery, right internal thoracic artery, right thyroid neck trunk, and age were the independent factors influencing the recurrence of hemoptysis (p < 0.05). CONCLUSIONS: The main reason for angiographic leakage and embolization leakage in cases of hemoptysis is the lack of understanding of the anatomic variations of the vessels responsible. Careful examination of the specific types and locations of the vessels is the principal approach to reducing secondary operations.

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Objective: Tibial plateau fractures are common intra-articular fractures that pose classification and treatment challenges for orthopedic surgeons. Objective: This study examines the value of 3D printing for classifying and planning surgery for complex tibial plateau fractures. Methods: We reviewed 54 complex tibial plateau fractures treated at our hospital from January 2017 to January 2019. Patients underwent preoperative spiral CT scans, with DICOM data processed using Mimics software. 3D printing technology created accurate 1:1 scale models of the fractures. These models helped subdivide the fractures into seven types based on the tibial plateau's geometric planes. Surgical approaches and simulated operations, including fracture reduction and plate placement, were planned using these models. Results: The 3D models accurately depicted the direction and extent of fracture displacement and plateau collapse. They facilitated the preoperative planning, allowing for precise reconstruction strategies and matching intraoperative details with the pre-printed models. Post-surgery, the anatomical structure of the tibial plateau was significantly improved in all 54 cases. Conclusion: 3D printing effectively aids in the classification and preoperative planning of complex tibial plateau fractures, enhancing surgical outcomes and anatomical restoration. Level of Evidence IV, Prospective Study.

Objetivo: As fraturas do planalto tibial são fraturas intra-articulares comuns de classificação e tratamento desafiadores aos cirurgiões ortopédicos. Objetivo: Este estudo investiga o uso de impressão 3D para classificar e planejar a cirurgia de fraturas complexas do planalto tibial. Métodos: 54 fraturas complexas do planalto tibial tratadas em nosso hospital de janeiro de 2017 a janeiro de 2019 foram revisadas. Os pacientes foram submetidos a tomografias computadorizadas em espiral pré-operatórias, com dados DICOM processados usando o software Mimics. A tecnologia de impressão 3D gerou modelos precisos em escala 1:1 das fraturas. Estes modelos ajudaram a subdividir as fraturas em sete tipos com base nos planos geométricos do planalto tibial. As abordagens cirúrgicas e as operações simuladas, incluindo a redução da fratura e a colocação de placa, foram planejadas utilizando estes modelos. Resultados: Os modelos 3D representaram com precisão a direção e a extensão da deslocação da fratura e do colapso do planalto. Os modelos facilitaram o planejamento pré-operatório, viabilizando estratégias de reconstrução precisas e a correspondência dos detalhes intraoperatórios com os modelos pré-impressos. Após a cirurgia, a estrutura anatômica do planalto tibial melhorou significativamente em todos os 54 casos. Conclusão: A impressão 3D ajuda na classificação e no planejamento pré-operatório de fraturas complexas do planalto tibial, melhorando os resultados cirúrgicos e a restauração anatômica. Nível de Evidência IV, Estudo Prospectivo.