Surgery Commons^™

Allograft Tendon Pretensioning Technique Guide., Joseph R Brown, Robert W Mendicino

Surgery Articles

In foot and ankle surgery, allograft tendons are frequently used in both primary and revision cases to enhance stability and function. However, postoperative complications, such as creep, can compromise the intended correction and stability over time. This paper presents a practical guide on pretensioning techniques prior to implantation, aiming to reduce creep and improve long-term outcomes. Using two common allograft specimens, we demonstrate pretensioning methods with specific focus on tendon stitching, techniques for securing the allograft to the graft board, optimal tensioning and time parameters. We recommend pretensioning at 80 N for approximately 30 min to effectively decrease creep and …

Comparing The Use Of Reverse Total Shoulder Arthroplasty For Glenohumeral Osteoarthritis, Irreparable Rotator Cuff Tears, And Rotator Cuff Tears With Arthritis: A 2-Year Clinical Outcome Analysis Using The Enovis Altivate Reverse., Matthew R Rohl, Christopher Miller, Taylor J Manes, Tyler Hasbrook, Molly Moor, Scott P Stephens, Brian L Badman

Surgery Articles

Background: The purpose of this study was to compare outcomes of patients undergoing reverse total shoulder arthroplasty (rTSA) for rotator cuff tears with arthritis, irreparable rotator cuff tears without arthritis, and primary glenohumeral osteoarthritis.

Methods: A retrospective review of prospectively collected data was performed of patients undergoing primary rTSA using the AltiVate Reverse (Enovis; Austin, TX) by a single surgeon from 2021 to 2023. Patients were categorized as irreparable rotator cuff tear without arthritis, rotator cuff tear with arthritis, or primary glenohumeral osteoarthritis. Outcomes included American Shoulder and Elbow Surgeons (ASES) score, Simple Shoulder Test (SST), visual analog scale (VAS) …

Serial Drilling Technique For Sequential Subtrochanteric Femur Fracture Fixation In Pediatric Osteopetrosis: A Technical Report., Adam Mansour, Josiah J Wolf, Ivan Slyepkan, Morgan Turnow, Michael Anderson, Anthony Wing, Jack Iandoli, Craig Goubeaux, Craig Smith, Allen Kadado

Surgery Articles

Pediatric osteopetrosis presents a significant technical challenge for fracture fixation due to the bone's dense yet brittle nature and frequently absent medullary canal. Traditional drilling methods risk excessive torque, drill-bit breakage, and iatrogenic fractures. Here, we describe a serial drilling technique for plate-and-screw fixation in a 5-year-old child with osteopetrosis who sustained sequential subtrochanteric femur fractures 8 months apart. By creating a small pilot hole, sequentially enlarging it with intermediate bits under copious irrigation, and inserting locking screws manually, we achieved stable fixation with no observed instrument failure or intraoperative complications. This method may provide a practical technical strategy for …

Long-Term Outcomes Of A Drug-Eluting Resorbable Scaffold Vs Angioplasty In Infrapopliteal Chronic Limb-Threatening Ischemia: 3-Year Results From The Life-Btk Trial., Sahil A Parikh, Brian G Derubertis, Marc P Bonaca, Prakash Krishnan, Richard H Pin, Jen-Kuang Lee, David C Metzger, Raghu Kolluri, Mehdi H Shishehbor, Andrew H Holden, Osamu Iida, Ehrin Armstrong, Steven W C Kum, David J O'Connor, Danielle R Bajakian, Lawrence A Garcia, Shih-Wa Ying, Jin Wang, Karine Ruster, Brad J Martinsen, Zsuzsanna Igyarto, Ramon L Varcoe

Surgery Articles

Background: Chronic limb-threatening ischemia (CLTI) caused by infrapopliteal disease is a major therapeutic challenge, with percutaneous transluminal angioplasty (PTA) associated with high rates of restenosis and reintervention. The LIFE-BTK trial previously demonstrated superior efficacy of the Esprit (Abbott Vascular) BTK drug-eluting resorbable scaffold (DRS) over PTA at 1 year, with sustained benefits at 2 years, with comparable safety at both time points. This report presents the 3-year outcomes.

Objectives: We aimed to compare the 3-year safety and efficacy of DRS vs PTA in patients with CLTI and infrapopliteal artery disease.

Methods: In this randomized trial, 261 patients with CLTI were …

Outcomes In Single Versus Two-Stage Surgical Stabilization Of Complex Bilateral Chest Wall Injury: A Single-Center Experience., Alexis A Schweibinz, Jaya S Varre, Anna Graham, William B Devoe

Surgery Articles

INTRODUCTION: Surgical stabilization of rib fractures (SSRF) continues to show benefit for severe chest wall injury (CWI) with improvement in morbidity and mortality following stabilization. Complex bilateral injuries pose a clinical and technical challenge. Currently, there is no formal recommendation for an approach to repair such injuries, whether that be bilateral SSRF within the index case or staged repair. We sought to describe our institutional experience with this subset of patients, identify factors that may influence the decision to pursue single- versus two-stage procedures, and assess the potential benefit of combined bilateral SSRF during the index operation.

METHODS: A retrospective, …

Artelon Graft Augmentation In Revision Anterior Cruciate Ligament Reconstruction: Surgical Technique Guide., Taylor Manes, Morgan Turnow, Trent Davis, Anthony Perugini, Michael Anderson, Benjamin Taylor

Surgery Articles

INTRODUCTION: Revision anterior cruciate ligament (ACL) procedures are becoming more prevalent. Variable grafts for ACL reconstruction are available, including autograft, allograft, and synthetic graft options. Various augmentation techniques are also available and typically consist of synthetic material such as Artelon graft. This type of synthetic material has been used and shown to produce safe and reliable augmentation in ligament injuries. The purpose of this study was to describe our unique revision ACL reconstruction technique utilizing Artelon graft augmentation and report our short-term results.

MATERIALS AND METHODS: We retrospectively reviewed patients undergoing revision ACL reconstruction with Artelon graft augmentation, a Flexband …

Frailty Is A Predictor Of Inpatient Mortality And Unplanned Icu Admission Following Early Fixation Of Intertrochanteric Fractures., Victor Koltenyuk, Jared Sasaki, Nithin Gupta, Zachary Chanmin, Ruby G Patel, Taylor Manes, Jack W Weick

Surgery Articles

Purpose: This study sought to examine the role of frailty in predicting inpatient mortality following early surgical fixation of intertrochanteric (IT) fractures.

Methods: The ACS-TQIP (2017-21) database was queried for patients with intertrochanteric fractures undergoing surgical fixation within 48 h. Frailty status was determined using the 5-item modified frailty index (mFI-5) (0 = nonfrail, 1 = prefrail, and, 2 = frail, and > 2 = severely frail). The primary end point was inpatient mortality. Secondary end points were unplanned ICU admission and thromboembolic events (DVT or PE). Significance was considered a p-value < 0.05.

Results: Frailty, as determined by the mFI-5, was …

All-Inside Endoscopic Zone 1 Flexor Hallucis Longus Transfer: A Cadaveric Feasibility Study., Kevin D Martin, Yi Wei, Adam G F Smith, Franco Piscitani, Luke M Martin, Brian Steginsky, Brian Tscholl, Nathaniel A Bates

Surgery Articles

BACKGROUND: Endoscopic flexor hallucis longus (FHL) tendon transfer addresses chronic Achilles tendon ruptures. Traditional percutaneous plantar incisions gain FHL length but risk neurovascular injury. This study evaluated the feasibility of an all-inside endoscopic FHL zone 1 tenotomy and transfer technique, which avoids plantar incisions by using zone 1 of the FHL tendon. We hypothesized that this technique would (1) provide sufficient tendon length, (2) avoid neurovascular damage, and (3) securely anchor the FHL tendon without tunnel blowout.

METHODS: Ten cadaveric all-inside endoscopic zone 1 FHL tendon transfers were performed without fluoroscopic guidance. Specimens were independently assessed post hoc by 2 …

Impact Of Depression And Anxiety On Outcomes Following Muscle-Preserving Transforaminal Lumbar Interbody And Fusion., Sahil Garg, Sean M Muir, Kyle Jamar, Alexa Dietrich, Patrick Young, Sonny Gill

Surgery Articles

Background: The impact of concurrent diagnoses of anxiety and depression has not been extensively studied in spine surgery. We hypothesize that a muscle-sparing technique may be associated with decreased postoperative pain and improved strength postoperatively compared to open techniques, decreasing the stress of the postoperative recovery process. Therefore, this study aims to assess the benefits that a modified muscle-preserving lumbar fusion technique (Wiltse transforaminal lumbar interbody and fusion (W-TLIF)) would have on this subset of patients.

Methods: One hundred twenty subjects who underwent a single-level W-TLIF were identified with a recorded diagnosis status associated with mental health. The subjects underwent …

The Epidemiology Of Us Upper Extremity Amputations: An Analysis Of The Global Burden Of Disease Database (1990-2019)., Ambrose Loc T Ngo, Cameron J Sabet, Gabrielle Dykhouse, Ayah Ibrahim, Taylor J Manes, Arsalaan Sayyed, Shaheryar Asad, Benjamin C Taylor

Surgery Articles

Background Upper extremity amputations (UEAs) are medically, psychologically, and functionally devastating. This study aimed to evaluate region- and sex-specific differences in unilateral and bilateral upper extremity amputations in the United States (US) from 1990 to 2019. Methods The Global Burden of Disease (GBD) database was used to analyze years lived with disability (YLDs), prevalence, and incidence rates per 100,000 people for upper extremity amputations in the US from 1990 to 2019. Data were stratified into four US Census Bureau-defined regions: Northeast, Midwest, South, and West. Differences between regions and sexes were assessed, with statistical significance defined as p< 0.05. Results Between 1990 and 2019, unilateral upper extremity amputations in the US showed a 34.51% decrease in YLDs, 34.34% in prevalence, and 37.38% in incidence. Bilateral amputations decreased by 51.32%, 48.94%, and 56.80%, respectively. Men consistently had higher YLDs, prevalence, and incidence rates for unilateral amputations (p< 0.001). Regionally, the Northeast had the highest mean YLDs, prevalence, and incidence, while the South had the lowest. Men also experienced significantly higher rates of both unilateral and bilateral amputations across all regions compared to women (p< 0.05). Conclusions From 1990 to 2019, the US experienced declines in YLDs, prevalence, and incidence of upper extremity amputations. Men had higher rates than women across all regions. The Northeast exhibited the highest rates, while the South had the lowest. These findings underscore notable gender and regional disparities in upper extremity amputation trends.

Epidemiology Of Lower Extremity Amputations In The United States: An Analysis Of The Global Burden Of Disease Database From 1990 To 2019., Peter B Spencer, Cameron J Sabet, Gabrielle Dykhouse, Taylor J Manes, Phillip C Mckegg, Ambrose Loc T Ngo, Ayah Ibrahim, Jack Weick

Surgery Articles

BACKGROUND: Lower extremity amputations (LEAs) are medically, psychologically, and functionally devastating. The objective of our study was to evaluate region- and sex-specific differences of unilateral and bilateral LEAs across the United States (US) from 1990 to 2019.

METHODS: The Global Burden of Disease database was used to analyze years lived with disability (YLDs), prevalence, and incidence rates per 100,000 people for LEAs in the US from 1990 to 2019. Data were stratified into four US Census Bureau-defined regions: Northeast, Midwest, South, and West. Differences between regions and sexes were assessed, with statistical significance defined as p < 0.05.

RESULTS: From 1990 to …

Perioperative Antibiotic Administration Review: An Analysis Of Outpatient Surgeries At Ohiohealth Doctors Hospital., Rayyan Bhutta, Thomas Shneker, Samantha Currier, Alexander Caskey, Vincent Relli-Dempsey, Matthias Franzen, Samir Patel

Surgery Articles

INTRODUCTION: A vital part of preventing surgical site infections (SSIs) is perioperative antibiotic prophylaxis. Antibiotics must be administered within a certain window of time, usually 15 to 60 minutes prior to the surgical incision, for them to be effective. The most frequently utilized medication, cefazolin, can be administered quickly by intravenous push (IVP), but other medications, such as vancomycin and clindamycin, need longer infusion times. Antibiotic efficacy declines, and the risk of SSIs is increased when scheduling requirements are not followed. With special focus on time, dosage, and variation by surgery type, this study evaluates adherence to perioperative antibiotic administration …

Lumbar Microdiscectomy: A Rare Case Of A Duplicate L5 Exiting Nerve Root., Sahil Garg, Sean M Muir, Arianna K Gill, Komi E Afetse, Sanjitpal S Gill

Surgery Articles

The microdiscectomy procedure has been regarded as the preferred method for the treatment of lumbar disc herniation (LDH). Intraoperatively, the procedure may be further complicated due to underlying anatomical variations in the lumbar spine or nerve root variations. Nerve root anomalies (NRAs), in particular, are relatively underdiscussed within the literature. Despite the rarity of these variations to the exiting nerve root, the increased surgical risk that an NRA may add warrants the need for increased awareness and associated complication mitigation. This case describes a rare instance of a symptomatic duplicate L5 nerve root discovered preoperatively and highlights the steps taken …

Pseudocholinesterase Deficiency In Ambulatory Surgery: A Case Report., Elizabeth Johnson-Gray, Austin J Shaffer, Priyanka Pandey, Greeshma Allareddy, Matthias Franzen

Surgery Articles

Pseudocholinesterase (PCHE) deficiency is a rare condition that results in increased sensitivity to certain medications, including the paralytic agents succinylcholine and mivacurium. PCHE deficiency typically presents when patients cannot be weaned off the ventilator because of residual paralysis. These patients require mechanical ventilation and sedation until they are strong enough to be safely extubated. This report presents the case of a 53-year-old male patient whose only known surgical and anesthetic complication was post-op nausea and vomiting and who was diagnosed with PCHE deficiency after he could not be safely extubated in the operating room (OR) after a robotic inguinal hernia …

Levothyroxine-Associated Thyrotoxicosis And Hyperbilirubinemia On Preoperative Screening Evaluation., Carly J Suriano, Ian P Erkkila, Thomas M Vara

Surgery Articles

BACKGROUND: Levothyroxine is a commonly prescribed medication for treatment of hypothyroidism in the United States. This drug is titrated based on weight and serial laboratory evaluation and is often very well tolerated with few adverse effects. Levothyroxine-associated liver injury and cholestatic disease are regarded as rare phenomena. We report an additional case of levothyroxine-associated hepatic dysfunction with resolution upon decreased dosage and continued tolerance of the medication.

CASE PRESENTATION: We report a case of a 60-year-old male presenting for preoperative clearance for umbilical hernia repair with previous history of thyroidectomy for multinodular goiter. Laboratory work-up suggested thyrotoxicosis-associated hepatic dysfunction secondary …

Parenteral Nutritional Support In Surgical Patients: Expert Consensus Statements Regarding Intravenous Lipid Emulsions Containing Omega-3 Fatty Acids., Robert G Martindale, David C Evans, Dan Waitzberg, Malissa Warren, Manpreet S Mundi, Stanislaw Klek, Paul E Wischmeyer, Martin D Rosenthal

Surgery Articles

OBJECTIVES: The International Lipids in Parenteral Nutrition (PN) Summit was convened to offer practical guidance and expert consensus opinion regarding the use of intravenous lipid emulsions (ILEs) in various clinical settings. Herein, we briefly review aspects from this summit that are of particular importance for surgical/hospitalized patients.

METHODS: Summit participants identified and discussed new evidence, data, and analyses, that potentially influence the benefits and risks of ILEs in PN or their use in clinical practice. The summit meeting consisted of expert presentations that assessed recent clinical data and best practice, followed by periodic panel discussions to formulate consensus statements. Consensus …

A Primer On Anatomy, Biophysics, Pathology, Imaging And Treatment Of The Intervertebral Disc And The Anterior Spinal Column: The Discogenic, Intervertebral, Spinal Column (Disc) Aspn Workgroup., Jay S Grider, Timothy R Deer, Douglas P Beall, Melissa Z Murphy, Jacob W Fleming, Steven M Falowski, Christopher J Mallard, Hamzah A Ramawad, Rosa Amelia Garcia, Usman Latif, Chau M Vu, Anne Christopher, Michael E Harned, Raj G Patel, Anuj J Shah, Iden M Cowan, Kristin Jarzombek, Jordan L Tate, Nasir Khatri, Mateusz J Graca, Marcin K Karcz, Timothy T Davis, Kaku Barkoh, Olivier Clerk-Lamalice, Brian Durkin, Mark N Malinowski, Dagmar K Gross, Thomas Hedman, Matthew Green, Michael J Dorsi, Kasra Amirdelfan, Dawood Sayed

Surgery Articles

OBJECTIVE: As therapeutic options are rapidly expanding to treat pain of discogenic and vertebrogenic origin, it is important for the clinician to have an evidence-based understanding of the latest information regarding the normal and pathological anatomy of the intervertebral disc as well as imaging characteristics and treatment strategies. The American Society of Pain and Neuroscience (ASPN) commissioned the DISC project to inform and update the interventional spine community about anterior column pain syndromes.

METHODS: Using established literature review methods a clinical oversight group was convened to create an outline covering topics that will be key to meeting the objectives delineated …

Current State Of Frailty In Revision Arthroplasty., Brendan Kelly, Nicholas Stratigakis, Arsalaan Sayyed, Tyler K Williamson, Cameron Atkison, Taylor Manes, Nithin Gupta, Morgan Turnow, Frank A Buttacavoli

Surgery Articles

No abstract provided.

Angle Accuracy Of Intramedullary Bone Resection Guides For Total Knee Arthroplasty., Matthew C Kane, Harold E Cates, Iou-Ren Chang

Surgery Articles

The importance of proper prosthetic placement has been confirmed in numerous studies. The objective of this study was to compare the planned resection angles to the verified intraoperative angles of femoral and tibial varus/valgus, tibial slope, and femoral flexion for each total knee performed using intramedullary (IM) cut guides for both distal femur and proximal tibia cuts. A total of 1,000 total knee arthroplasties (TKAs) were evaluated for this study. Intraoperative cut-check technology was used to show real-time validation of these resection angles. Assuming an acceptable range of within 2° of the planned cuts, results show the femoral varus/valgus angles …

Chronic Recurrent Shoulder Instability Treated With A Hemiarthroplasty, Glenojet Allograft Glenoid Reconstruction, And Anterior Capsular Reconstruction: A Case Report., Matthew Glazier, Morgan Turnow, Peter Spencer, Vishvam Metha, Hunter Pharis, Nathaniel Long, Stephen Wiseman

Surgery Articles

No abstract provided.

Turn Up The Heat: A Case Report Of Malignant Hyperthermia During Ambulatory Surgery., Alexander Luong, Vincent Relli-Dempsey, Elizabeth Johnson, Dyanni Price, Andrew Gable, Matthias J Franzen

Surgery Articles

Malignant hyperthermia is a rare complication of general anesthesia involving the uncontrolled release of calcium when exposed to triggers such as depolarizing muscle relaxants or volatile anesthetics. It presents as a hypercatabolic skeletal muscle syndrome that results in tachycardia, hyperthermia, hypercapnia, muscle rigidity, acidosis, rhabdomyolysis, and hyperkalemia. This report presents the case of a 67-year-old female without a personal or family history of complications with anesthesia who experienced malignant hyperthermia during an elective hysterectomy. The patient was given multiple doses of dantrolene, with the ultimate resolution of her symptoms several days after surgery. She was discharged one week after surgery.

Multidisciplinary Approach To The Management Of Renal Angiomyolipoma With Inferior Vena Cava Thrombus And Pulmonary Embolism: A Case Report., Jordyn Perdue, Alexandra Wells, Krishna Patel, Wihan Du Plessis, Jaya Varre, Patrick Salibi

Surgery Articles

Renal angiomyolipoma (AML) is a benign tumor with rare venous extension. We present a case of a patient with renal AML with inferior vena cava (IVC) tumor thrombus and acute pulmonary embolism (PE). A 34-year-old female presented with chest pain. Imaging revealed a 5 cm right renal AML, with tumor thrombus into the renal vein and IVC, and acute left lower lobe PE. Right radical nephrectomy and caval thrombectomy were performed using intraoperative ultrasound. Rarely, these benign tumors generate thrombus with caval extension. The location of IVC thrombus guides surgical planning, which may involve suprahepatic IVC control or cardiopulmonary bypass. …

The Safety And Efficacy Of Posterior Lumbar Interbody Fusions In The Outpatient Setting., Hunter F Pharis, Daniel T Degenova, Braden J Passias, Taylor J Manes, Grace Parizek, Daryl Sybert

Surgery Articles

Introduction Outpatient surgical procedures have shown reduced costs, improved patient outcomes, and decreased postoperative complications. Interest in moving orthopedic and neurosurgical spine procedures to the outpatient setting has grown in recent years because of these factors. Studies investigating open posterior lumbar interbody fusions (PLIFs) in the outpatient setting are sparse. Methods The patients who underwent an open PLIF with pedicle screw and rod construct from 2014 to 2018 were retrospectively reviewed. Outpatient procedures were defined by patient discharge being on the same day of the procedure, without admittance to an inpatient ward. Pertinent demographic, clinical, radiographic, and surgical data were …

2024 Canadian Surgery Forum: Sept. 25-28, 2024., Christine Li, Michael Guo, Ahmer Karimuddin, Michael Guo, Christine Li, Ahmer Karimuddin, Jason Sutherland, Bright Huo, Tyler Mckechnie, Monica Ortenzi, Yung Lee, Stavros Antoniou, Julio Mayol, Hassaan Ahmed, Vanessa Boudreau, Karim Ramji, Cagla Eskicioglu, Pieter De Jager, David Urbach, Meredith Poole, Aghiles Abbad, Hussain Al-Shamali, Zainab Al-Faraj, Chuck Wen, Radu Pescarus, Robert Bechara, Dennis Hong, Lily J Park, Maura Marcucci, Sandra Ofori, Jessica Bogach, Pablo E Serrano, Marko Simunovic, Ilun Yang, Margherita Cadeddu, Michael J Marcaccio, Flavia K Borges, Rahima Nenshi, P J Devereaux, Peter Urbanellis, Joanne Douglas, Evan Nemeth, James Ellsmere, Richard Spence, Joshua Cunningham, Ryan Falk, Tom Skinner, Nicole Ebert, Lauren Galbraith, Mark Prins, Shahrzad Joharifard, Emilie Joos, Adele Orovec, Lynn Lethbridge, Richard Spence, Marius Hoogerboord, Heather Stuart, Anne-Marie Bergeron, Ilun Yang, Jessica Bogach, Laura Nguyen, Clare Reade, Lua Eiriksson, Michelle Morais, Gillian Hanley, Sarah Mah, Karanbir Brar, Keri A Seymour, Shaina R Eckhouse, Ranjan Sudan, Jacob A Greenberg, Dana Portenier, James J Jung, Anne Light, Brittany Dingley, Megan Delisle, Sameer Apte, Ranjeeta Mallick, Trevor Hamilton, Heather Stuart, Martha Talbot, Gregory Mckinnon, Evan Jost, Eve Thiboutot, Carolyn Nessim, Neha Katote, Ashley Drohan, Richard Spence, Katerina Neumann, Ge Shi, Regina Leung, Christina Lim, Matthew Van Oirschot, Aaron Grant, Sarah Knowles, Julie Ann Van Koughnett, Karine Brousseau, Leah Monette, Daniel Mcisaac, Christopher Wherrett, Ranjeeta Mallick, Aklile Workneh, Tim Ramsay, Alan Tinmouth, Julie Shaw, François Martin Carrier, Dean Fergusson, Guillaume Martel, Matthew Cornacchia, Victoria Ivankovic, Shahad Abdulkhaleq Mamalchi, Dexter Choi, Peter Glen, Maher Matar, Fady Balaa, Natasha Caminsky, Sarah Mashal, Nathalie Boulanger, Larry Watt, Jonathon Campbell, Jeremy Grushka, Paola Fata, Evan Wong, Michael Guo, Ahmer Karimuddin, Jason Sutherland, Christine Li, Wenjie Lin, Ahmer Karimuddin, Bright Huo, Elisa Calabrese, Sunjay Kumar, Bethany Slater, Danielle S Walsh, Wesley Vosburg, Uzair Jogiat, Simon Turner, Vickie Baracos, Dean Eurich, Heather Filafilo, Eric Bedard, Sam Khan, Tom Waddell, Kazuhiro Yasufuku, Andrew Pierre, Shaf Keshavjee, Elliot Wakeam, Laura Donahoe, Marcelo Cypel, Najib Safieddine, Michael Ko, Natasha Leighl, Jamie Feng, Jonathan Yeung, Marc De Perrot, Alexandra Salvarrey, Negar Ahmadi, Carmine Simone, Gazala Sayf, David Parente, Victoria Cheung, Mary R Rabey, Michael Cabanero, Lisa W Le, Christodoulos Pipinikas, Amber Chevalier, Richard Chaulk, David Sahai, Richard Malthaner, Mehdi Qiabi, Dalilah Fortin, Richard Inculet, Rahul Nayak, John Campbell, Peter White, Adam Bograd, Alexander Farivar, Brian Louie, Geraint Berger, Daniel French, Simon Houston, Flyn Gallardo, Bryce Macek, Richard Liu, Biniam Kidane, Nader M Hanna, Yogita S Patel, Ikennah Browne, Esther Provost, Forough Farrokhyar, Ehsan Haider, Waël C Hanna, Garrett Johnson, George Okoli, Nicole Askin, Ahmed Abou-Setta, Harminder Singh, Alexandra Coxon-Meggy, Julie Cornish, Lars Icat Study Management Group, Sahil Sharma, Jigish Khamar, Jo-Anne Petropolous, Amandeep Ghuman, Wenjie Lin, Christine Li, Carl Brown, Terry Phang, Manoj Raval, Amandeep Ghuman, Elizabeth Clement, Ahmer Karimuddin, Tyler Mckechnie, Jigish Khamar, Christopher Chu, Amin Hatamnejad, Ghazal Jessani, Yung Lee, Aristithes Doumouras, Dennis Hong, Cagla Eskicioglu, Giancarlo Sticca, Madeleine Poirier, Jean-François Tremblay, Jean-François Latulippe, Yves Bendavid, Jean-Sébastien Trépanier, Ariane Lacaille-Ranger, Margaret Henri, Tyler Mckechnie, Tania Kazi, Victoria Shi, Shan Grewal, Ahmed Aldarraji, Kelly Brennan, Sunil Patel, Nalin Amin, Aristithes Doumouras, Sameer Parpia, Cagla Eskicioglu, Mohit Bhandari, Gaurav Talwar, Tyler Mckechnie, Jigish Khamar, Luke Heimann, Swati Anant, Cagla Eskicioglu, Victoria Shi, Tyler Mckechnie, Swati Anant, Moeiz Ahmed, Sahil Sharma, Gaurav Talwar, Dennis Hong, Cagla Eskicioglu, Tania Kazi, Tyler Mckechnie, Yung Lee, Rehab Alsayari, Gaurav Talwar, Aristithes Doumouras, Dennis Hong, Cagla Eskicioglu, Lily J Park, Husein Moloo, Tim Ramsay, Kednapa Thavorn, Justin Presseau, Terry Zwiep, Guillaume Martel, P J Devereaux, Robert Talarico, Daniel I Mcisaac, Madeline Lemke, Wenjie Lin, Carl Brown, Elizabeth Clement, Anu Ghuman, Terry Phang, Manoj Raval, Ahmer Karimuddin, Christine Li, Wenjie Lin, Elizabeth Clement, Amandeep Ghuman, Cameron Hague, Ahmer Karimuddin, P Terry Phang, Manoj Raval, Pari Tiwari, Patrick Vos, Carl Brown, Alessandro Ricci, Ameer Farooq, Sunil Patel, Kelly Brennan, Vanessa Wiseman, Tyler Mckechnie, Allison Keeping, Paul Johnson, Heidi Bentley, Karim Messak, Jessica Bogach, Gregory Pond, Shawn Forbes, Vanja Grubac, Scott Tsai, Christian Van Der Pol, Marko Simunovic, Adom Bondzi-Simpson, Ramy Behman, Tiago Ribeiro, Sheron Perera, Aisha Lofters, Rinku Sutradhar, Rebecca Snyder, Callisia Clarke, Natalie Coburn, Julie Hallet, Natasha Caminsky, Alex Chen, Jeongyoon Moon, Paul Brassard, Daniel Marinescu, Teodora Dumitra, Ebram Salama, Carol-Ann Vasilevsky, Marylise Boutros, Kelly Brennan, Tyler Mckechnie, Vanessa Wiseman, Alessandro Ricci, Ameer Farooq, Sunil Patel, Tania Kazi, Tyler Mckechnie, Ghazal Jessani, Victoria Shi, Niv Sne, Aristithes Doumouras, Dennis Hong, Cagla Eskicioglu, Manisha Jogendran, Jennifer Flemming, Maya Djerboua, Martin Korzeniowski, Brooke Wilson, Shaila Merchant, Sean Bennett, Kala Hickey, Stephanie Gill, Zoë Breen, Kaitlyn Harding, Hannah Yaremko, Patti Power, Alex Mathieson, David Pace, Joannie Neveu, Sean Bennett, Brooke Wilson, Nan Chen, Weidong Kong, Sunil Patel, Christopher Booth, Shaila Merchant, Sean Bennett, Georgia Nelson, Nouf Almarzooqi, Manisha Jogendran, Maya Djerboua, Brooke Wilson, Jennifer Flemming, Shaila Merchant, Lily J Park, Carol Wang, Vicki Archer, Tyler Mckechnie, Dan Cohen, Jessica Bogach, Marko Simunovic, Pablo E Serrano, Rodney H Breau, Paul Karanicolas, P J Devereaux, Georgia Nelson, Nouf Almarzooqi, Shaila Merchant, Sean Bennett, Janyssa Charbonneau, Mai-Kim Gervais, Alexandre Brind'amour, Narcisse Singbo, Mikaël Lefebvre Soucisse, Lucas Sidéris, Guy Leblanc, Jean-François Tremblay, Pierre Dubé, Ekaterina Kouzmina, Matthew Castelo, Nicole Look Hong, Julie Hallet, Natalie Coburn, Frances Write, Lena Nguyen, Sonal Gandhi, Katarzyna Jerzak, Andrea Eisen, Amanda Roberts, Dejan Vidovic, Brianne Cruickshank, Lucy Helyer, Carman Giacomantonio, Zuhaib Mir, Matheus Faleiro, Stephanie Hiebert, Scott Livingstone, Mark Walsh, Boris Gala-Lopez, Sukhdeep Jatana, Daniel Krys, Uzair Jogiat, Janice Kung, Kevin Verhoeff, Tori Lenet, François Martin Carrier, Karine Brousseau, Franck Vandenbroucke-Menu, Yves Collin, Richard W D Gilbert, Maja Segedi, Jad Abou Khalil, Kimberly A Bertens, Fady Balaa, Dean A Fergusson, Guillaume Martel, Christopher Wherrett, Katlin Mallette, Leah Monette, Aklile Workneh, Monique Ruel, Elham Sabri, Heather Maddison, Melanie Tokessym, Patrick B Y Wong, Luc Massicotte, Michaël Chassé, Michel-Antoine Perrault, Élodie Hamel-Perreault, Jeieung Park, Shirley Lim, Véronique Maltais, Philemon Leung, Timothy Ramsay, Alan Tinmouth, Zofia Czarnecka, Nidheesh Dadheeech, Rena Pawlick, Haide Razavy, James Shapiro, Panthea Pouramin, Susan Allen, Boris Gala-Lopez, Nawal Amhis, Rachel Liu Hennessey, Yuwei Yang, Rochelle Guan, Yolanda Zhang, Adam Meneghetti, Chieh Chiu, Dhuvaraha Srikrishnaraj, Jeffrey Hawel, Christopher Schlachta, Ahmad Elnahas, Ayse Yilbas, Marguerite Mainprize, Anton Svendrovski, Christoph Paasch, Fernando Spencer Netto, Jigish Khamar, Tyler Mckechnie, Amin Hatamnejad, Yung Lee, Bright Huo, Edward Passos, Niv Sne, Cagla Eskicioglu, Dennis Hong, Sean Bennett, Jennifer Flemming, Maya Djerboua, Vanessa Wiseman, Jonah Moore, Peter Szasz, Sulaiman Nanji, Jonah Moore, Vanessa Wiseman, Peter Szasz, Isis Lunsky, Sulaiman Nanji, Jennifer A Flemming, Sean Bennett, Sandra Mckeown, Omar Mouhammed, Colton Gibb, Kevin Verhoeff, Michael Kim, Matt Strickland, Ram Anantha, Ilinca Georgescu, Yung Lee, Thomas Shin, Lea Tessier, Arshia Javidan, James Jung, Dennis Hong, Tyler Mckechnie, Andrew Strong, Matthew Kroh, Jerry Dang, Muhammad Faran, Tyler Mckechnie, Emma O'Callaghan, Sama Anvari, Taylor Hughes, Mark Crowther, Mehran Anvari, Aristithes Doumouras, Amin Andalib, Ali Safar, Philippe Bouchard, Sebastian Demyttenaere, Olivier Court, Simran Parmar, Brianna Brand, Noah Switzer, Richdeep Gil, Sunawer Aujla, Morgan Schellenberg, Natthida Owattanapanich, Brent Emigh, Jan-Michael Van Gent, Tanya Egodage, Patrick B Murphy, Chad Ball, Audrey L Spencer, Kelly N Vogt, Jessica A Keeley, Stephanie Doris, Kenji Inaba, Jordan Nantais, Nancy Baxter, Refik Saskin, Andrew Calzavara, David Gomez, Alex Le, Philip Dawe, Morad Hameed, Amir Hassanpour, Eran Shlomovitz, David Gomez, Eisar Al-Sukhni, Vanessa Wiseman, Sunil Patel, Sean Bennett, Zuhaib Mir, Stephanie Roberts, Harvey Hawes, Khalil Merali, Rachel Morris, Marc De Moya, Todd Neideen, Andrew Kastenmeier, Lewis Somberg, Dan Holena, Patrick Murphy, Jordan Nantais, Nancy Baxter, Refik Saskin, Andrew Calzavara, David Gomez, Asad Naveed, Umang Deshpande, David Gomez, Joao Rezende-Neto, Najma Ahmed, Andrew Beckett

Surgery Articles

No abstract provided.

Far Posterior Approach For Rib Fracture Fixation: Surgical Technique And Tips., Taylor J Manes, Daniel T Degenova, Benjamin C Taylor, Jignesh N Patel

Surgery Articles

BACKGROUND: The present video article describes the far posterior or paraspinal approach to posterior rib fractures. This approach is utilized to optimize visualization intraoperatively in cases of far-posterior rib fractures. This technique is also muscle-sparing, and muscle-sparing posterolateral, axillary, and anterior approaches have been shown to return up to 95% of periscapular strength by 6 months postoperatively

DESCRIPTION: Like most fractures, the skin incision depends on the fracture position. The vertical incision is made either just medial to a line equidistant between the palpable spinous processes and medial scapular border or directly centered over the fracture line in this region. …

Inflammation And Fibrosis In Orbital Inflammatory Disease: A Histopathologic Analysis., Rohan Verma, Allison J Chen, Dongseok Choi, David J Wilson, Hans E Grossniklaus, Roger A Dailey, John D Ng, Eric A Steele, Stephen R Planck, Craig N Czyz, Bobby S Korn, Don O Kikkawa, Jill A Foster, Michael Kazim, Gerald J Harris, Deepak P Edward, Azza Al Maktabi, James T Rosenbaum

Surgery Articles

PURPOSE: The purpose of this study was to compare the histopathologic inflammation and fibrosis of orbital adipose tissue in orbital inflammatory disease (OID) specimens.

METHODS: In this retrospective cohort study, inflammation, and fibrosis in orbital adipose tissue from patients with thyroid-associated orbitopathy (TAO), granulomatosis with polyangiitis (GPA), sarcoidosis, nonspecific orbital inflammation (NSOI), and healthy controls were scored by 2 masked ocular pathologists. Both categories were scored on a scale of 0 to 3 with scoring criteria based on the percentage of specimens containing inflammation or fibrosis, respectively. Tissue specimens were collected from oculoplastic surgeons at 8 international centers representing 4 …

Mild Biceps Tendonitis May Be Managed Nonoperatively During Shoulder Arthroscopy., Jonathan J Light, Wihan Du Plessis, Matthew H Adsit, Alexander T Eckstrom, Amanda B Firoved, Justin W Griffin, Kevin F Bonner

Surgery Articles

PURPOSE: The purposes of this study were to determine whether patients with mild biceps tendonitis required revision surgery after the biceps tendon was not surgically treated, while addressing concomitant pathology, and to evaluate whether preoperative groove pain affected patient-reported outcomes.

METHODS: Patients who underwent shoulder arthroscopy between 2015 and 2018 by a single surgeon for rotator cuff pathology, debridement, and distal clavicular excision (DCE), with or without subacromial decompression (SAD), and where the biceps tendon was not surgically addressed were retrospectively identified. Inclusion criteria were mild LS (< 50% hyperemic appearing biceps tendon arthroscopically), and a minimum 2-year follow-up. The primary outcome measure was the incidence of revision surgery. Secondary outcomes included American Shoulder and Elbow Surgeons (ASES) score, simple shoulder test (SST), pain level, and satisfaction scores. Two sample

RESULTS: Sixty-four of 69 eligible subjects (93%) were evaluated at a minimum …

Operative Technique For A Successful Laparoscopic En-Bloc Resection Of Gastrogastric Fistula Following Roux-En-Y Gastric Bypass., Krishna Patel, Jordyn Perdue, Jaya Varre, Vinnie Serapiglia, Anthony Rizzo, Thomas Sonnanstine

Surgery Articles

Gastrogastric fistulas are rare complications following Roux-en-Y gastric bypass surgery and are characterized by a fistulous connection between the gastric pouch and the remnant stomach. The presentation is often variable and a high-index of suspicion must be maintained for accurate and timely diagnosis. In this case report, we provide a detailed review of the technical steps taken to successfully resect a gastrogastric fistula en-bloc laparoscopically with an unremarkable post-operative course.

A Paradoxical Internal Hernia At Brolin's Anti-Obstruction Stitch Following Roux-En-Y Gastric Bypass: A Case Report., Krishna Patel, Vinnie Serapiglia, Anthony N Rizzo, Jaya Varre, Thomas Sonnanstine

Surgery Articles

Internal hernias are a rare but morbid complication following Roux-en-Y gastric bypass surgery. The incorporation of Brolin's anti-obstruction stitch has historically demonstrated a significant reduction in the incidence of internal hernias following Roux-en-Y gastric bypass. We present an ironic and unique case of a patient with small bowel herniation into a defect between Brolin's stitch and the stapled closed common enterotomy of the jejunojejunostomy and technical considerations to decrease internal hernias at this site in the future.

Surgical Management Of Congenital Malrotation Presenting In Adulthood., Jacob Holzemer, Krishna Patel, Oscar Ruiz, Jodi Oostra

Surgery Articles

Intestinal malrotation is characterised by positional and congenital fixation abnormalities resulting from a failure in embryonic development in the normal 270° rotation around the axis of the superior mesenteric artery. Intestinal malrotation is primarily thought to affect neonates with an incidence of 1 in 500, however, only 1 in 6000 live births are symptomatic, and these usually present within the first month of life in 40% of cases and within the first year in over 5% of cases as an obstructive pathology or volvulus. In adults, however, the incidence has been documented at 0.2%. These patients usually present with postprandial …