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Sacral Fractures
Published in Kelechi Eseonu, Nicolas Beresford-Cleary, Spine Surgery Vivas for the FRCS (Tr & Orth), 2022
Kelechi Eseonu, Nicolas Beresford-Cleary
The external fixation pins can also help in reduction of the displaced fracture at the time of definitive fixation. Sagittal plane fractures can be managed percutaneously with sacroiliac, trans-sacral (Figure 12.6) or trans-iliac trans-sacral screws. The major structureat risk is the L5 nerve root. In the presence of significant instability or spino-pelvic dissociation, sacral screws can be augmented by lumbo-pelvic fixation (Figure 12.7) to maxim-ise stiffness and reduce the rate of screw failure. Lumbo-sacral fixation classically involves the use of pedicle screws into the lumbosacral spine, with pelvic fixation using S2 alar-iliac (S2AI) screws or iliac screws.
Calcaneal fractures
Published in Maneesh Bhatia, Essentials of Foot and Ankle Surgery, 2021
Devendra Mahadevan, Adam Sykes
The goal of primary subtalar fusion is not only to achieve a solid arthrodesis, but also to restore the normal shape and alignment of the hindfoot. Reduction of the fracture is the initial step in the procedure in order to return to a more anatomical shape before the fusion is undertaken. The choice of reduction technique can be either open or minimally invasive; the articular cartilage is then removed using flexible osteotomes, nibblers and/or high speed burrs. The use of structural bone graft may be required if there are large defects created by the fracture pattern. Internal fixation is undertaken using screws alone or in combination with a plate to maintain fracture reduction and secure the fusion.
Intussusception
Published in Mark Davenport, James D. Geiger, Nigel J. Hall, Steven S. Rothenberg, Operative Pediatric Surgery, 2020
Melanie Hiorns, Joseph I. Curry
Indications for operative reduction include: Initial evidence of peritonism or perforationPerforation during radiological reductionFailure of radiological reductionThird-time presentation (presentation well beyond the usual age range)
Development of a New Model of Humeral Hemiarthroplasty in Rats
Published in Journal of Investigative Surgery, 2023
Efi Kazum, Eran Maman, Zachary T. Sharfman, Reut Wengier, Osnat Sher, Amal Khoury, Ofir Chechik, Oleg Dolkart
Anasthesia carried out with isoflurane under high flow oxygen. The trans-deltoid lateral approach was used. Skin incision was performed proximal and distal to the lateral border of the acromion, in a parallel axis to the humerus. The middle third (acromial) part of the deltoid muscle was exposed and split between its longitudinal fibers (Figure 1A + B). The muscle was then retracted to allow exposure of the cranial third of the humerus. The anatomical landmarks (subscapularis tendon, lesser tuberosity, bicipital groove with the bicipital tendon and the greater tuberosity) were identified. Gentle sharp dissection of the anterior fibers of the supraspinatus and the superior fibers of the subscapularis tendons at the rotator interval was performed. Biceps tendon tenotomy followed by dislocation of the humeral head was performed. The center of the humeral head was identified and burred with a dremel tool and conical burr (Skill Tools, Mt. Prospect, Illinois, USA). The burr hole was expanded to create a round cavity with thin cortices in the proximal humeral head at the level of the rotator cuff insertion to the tuberosities (Figure 1C). After measurements of the native humeral head, a 2.7–2.9 mm stainless steel metal bearing ball was inserted into the cavity (Figure 1D, F). Joint reduction was then performed. Stability and joint mobility were tested. Closure of the supraspinatus and subscapularis were performed with 4/0 vicryl. The deltoid was then closed with 4/0 vicryl and the skin with 4/0 nylon sutures.
Oncology Volunteers in a Comprehensive Cancer Center: An Observational Study of Compassion and Well-Being
Published in Hospital Topics, 2022
Tina M. Mason, Richard R. Reich, Junmin Whiting
The roles of volunteers at cancer centers are numerous and include providing companionship, a sense of worth, information, and respite (Marcus 2013). Volunteers complement the healthcare team when working to meet patients’ emotional, practical, and informational needs (Lorhan, van der Westhuizen, and Gossmann 2015). Additional benefits include a reduction in symptoms and possibly enhanced survival (Marcus 2013). For example, utilizing the assistance of volunteers with mealtime and dietary intake (Huang et al. 2015; Steunenberg et al. 2016; Roberts et al. 2017; Howson et al. 2018; Ottrey et al. 2018), mobility (Le et al. 2014; Steunenberg et al. 2016; Denomme et al. 2018), and other care skills such as breastfeeding (Hopper and Skirton 2016) have demonstrated benefit to patients and the healthcare system. The impact of volunteers also includes preventing and reducing the incidence of delirium (Steunenberg et al. 2016; Sandhaus et al. 2010) and improving the hospital experience of patients with dementia, including reducing the length of stay and readmissions (Bateman et al. 2016; Blair, Anderson, and Bateman 2018; Hall et al. 2019). Another study found that volunteers trained as lay-navigators were able to help address the multifaceted needs of newly diagnosed lung cancer patients beginning prior to their first appointment to the initiation of treatment (Lorhan et al. 2014).
Doing More with Less: Surgical Training in the COVID-19 Era
Published in Journal of Investigative Surgery, 2022
Triantafyllos Doulias, Gaetano Gallo, Ines Rubio-Perez, Stephanie O. Breukink, Dieter Hahnloser
In European countries, responses of the Health Systems to the outbreak have involved redeployment of staff, reassignment of resources, triage and major cancelations of surgeries, training and events (including all meetings, courses and congresses). The introduction of the surgical trainees to elective cases has been dramatically reduced secondary to the initial reaction to minimize the exposure of patients and healthcare professionals to the virus by postponing elective surgical procedures and endoscopy. The reduction of the “hands on” surgical training, has also been determined by the redeployment of the surgical trainees to other departments and COVID-19 units. Even when some National Health Systems decided to recommence the elective cancer operating, the presence of the trainees in operating theaters was minimal. Service provision, the need for shortening the operating time (and subsequently the exposure of the theater staff), but also the COVID-19 “new” measure for dual consultant operating were some of the reasons for it.