Material and Methods: The study included 66 patients with hip fracture over the age of 60 years, presented between 1st March and 15th May 2020 and matched with the patients with hip fractures (75 patients) managed during the corresponding period in 2019 as control. Data was collected on demographics, comorbidities, COVID-19 status, procedures and mortality and complications.
Results: Thirty-day mortality following hip surgery was 13.6% during COVID-19 pandemic with all the mortalities in patients with ASA Grade 3 and 4. Mortality was considerably high for intracapsular fracture (20%) but highest in cemented hemiarthroplasty (20%). One third of the hip fractures operated in COVID-19 designated theatre died within 30 days of surgery. Thirty-day mortality rate for COVID-19 positive hip fracture patients were 55.5%. There has been higher 30-day mortality for hip surgeries during COVID-19 pandemic with positive correlation between patient's COVID-19 test status and 30-day mortality following hip surgeries.
Conclusion: There is strong association between 30-day mortality and the designated theatre (Clean/COVID) where the patients were operated on with higher mortality for intracapsular neck of femur fractures with significant mortality associated with cemented hemiarthroplasty particularly among symptomatic or COVID-19 positive patients. Therefore, adoption of a multidisciplinary approach is recommended to optimally balance the risk-benefit ratio for planning of management of hip fractures while considering patient's peri-operative outcomes.
Material and Methods: We conducted a retrospective review of patients who underwent surgery for isolated scaphoid fractures over a 15 years period from December 2000 to December 2015. Only patients who underwent open surgery with bone grafting were included. They were divided into a group treated with a single screw fixation, and another group treated with screw and K-wire fixations.
Results: Forty-four (58.7%) patients had single screw fixation and 31 (41.3%) had screw augmented with K-wire fixation. The overall union rate was 88.0%, with an overall mean time to union of 5.3 months. There was no difference in union rate (p=0.84) and time to union (p=0.66) between the single screw group and combined screw and K-wire group. Univariate analysis found that older age (t=-2.11, p=0.04) had a significant effect on union rate. Regression model showed that age had a significant effect on months to union.
Conclusion: In open fixation of scaphoid fractures with compression screw and bone grafting, union rate and time to union is comparable whether or not screw fixation was augmented with an intracarpal K-wire. There was no increased risk of complications associated with augmented screw. Age of patient affected time to union and union rate.
Materials and Methods: Thirteen consecutive patients who underwent pre-operative embolisation of a musculoskeletal tumour followed by surgical intervention at our institution from May 2012 to January 2016 were enrolled into the study. Patient demographics, tumour characteristics, embolisation techniques and type of surgery were recorded. Technical success of embolisation, amount of blood loss during surgery and transfusion requirements were estimated.
Results: There were five female and eight male patients who underwent pre-operative embolisation during the study period. The age ranged between 16 to 68 years, and the median age was 54. Technical success was achieved in all patients. Mean intra-operative blood loss was 1403ml, with a range of 150ml to 6900ml. Eight patients (62%) required intra-operative blood products of packed red blood cells and fresh frozen plasma. No major complications occurred during embolisation.
Conclusion: Pre-operative trans-arterial embolisation is feasible and safe for a variety of large and hypervascular musculoskeletal tumours. Our small series suggests that preoperative embolisation could contribute to the reduction of the intra-operative and post-operative blood product transfusion. It should be considered as a pre-operative adjunct for major tumour resections with a high risk of bleeding. The use of the haemoglobin gap complemented the assessment of perioperative blood loss.
MATERIALS AND METHODS: Twelve consecutive patients with severe myelopathy (JOA-score less than 11) from ventral CVJ compression were operated between 2014-2020 using a tubular retractor assisted transoral decompression.
RESULTS: All patients improved neurologically statistically (p=0.02). There were no posterior pharynx wound infections or rhinolalia. There was one case with incomplete removal of the lateral wall of odontoid and one incidental durotomy.
CONCLUSIONS: A Tubular retractor provides adequate access for decompression of the ventral compression of CVJ. As the tubular retractor pushed away the uvula, soft palate and pillars of the tonsils as it docked on the posterior pharyngeal wall, the traditional complications associated with traditional transoral procedures is completely avoided.