Do Prophylactic Inferior Vena Cava Filters Affect the Rates of Venous Thromboembolism and Pulmonary Embolism in Patients Undergoing Major Spine Surgery?

Global Spine Journal · 2022-02-14 · 5 citations

Study Design Retrospective Analysis Background Venous thromboembolism (VTE) represents a significant cause of morbidity and mortality in major spine surgery. Placement of prophylactic inferior vena cava filters (IVCF) in patients undergoing major spine surgery was previously adopted at our institution. This study reports our experience and compares VTE rates between patients with and without preoperative IVCF placement. Methods A Retrospective comparative study was conducted on adult patients who underwent IVCF placement and those who did not prior to their spinal fusion procedure, between 2013 and 2016. Thoracolumbar fusions (anterior and/or posterior) of 7 or more levels, spinal osteotomies, and a minimum of a 3-month follow-up were included. Traumatic, oncologic, and cervical pathology were excluded. Primary outcomes measured included the incidence of overall VTE (DVT/PE), death, IVCF related complications, and IVCF retrieval. Results 386 patients who underwent major spine surgery, 258 met the eligibility criteria. Of those patients, 105 patients (40.7%) had prophylactic IVCF placement. All patients had postoperative SCDs and chemoprophylaxis. The presence of an IVCF was associated with an increased rate of overall VTE (14.3% vs 6.5%, P ≤ .05) and DVT episodes (8.6% vs 2.6%, P = .04). The rate of PE for the IVCF group and non-IVCF group was 8.6% and 4.6%, respectively, which was not statistically significant ( P = .32). The all-cause mortality rate overall of 2.3% was statistically similar between both groups ( P = 1.0). The IVCF group had higher rates of hematoma/seroma vs the non-IVCF group (12.4% vs 3.9%, P ≤ .05). 99 IVCFs were retrievable designs, and 85% were successfully retrieved. Overall IVCF-related complication rate was 11%. Conclusions No statistical difference in PE or mortality rates existed between the IVCF and the control group. Patients with IVCF placement experienced approximately twice the rate of VTE and three times the rate of DVT compared to those without IVCF. The IVCF-related complication rate was 11%. Based on the results of this study, the authors recommend against the routine use of prophylactic IVCFs in adults undergoing major spine surgery. Level of Evidence III.

Tips and Tricks in Plastic Surgery

Springer eBooks · 2021 · 8 citations

• Medicine
• Surgery
• Family medicine

Dynamic Thumb Circumduction Measured With a Wearable Motion Sensor: A Prospective Comparison of Patients With Basal Joint Arthritis to Controls

Journal of Hand Surgery Global Online · 2021-06-04 · 3 citations

PurposeThe purpose of this study was to compare the active range of motion in patients with thumb carpometacarpal (CMC) arthritis to healthy controls. A secondary objective of this study was to examine the feasibility of using wearable motion sensors in a clinical setting.MethodsAsymptomatic controls and patients with radiographic and clinical evidence of thumb CMC joint arthritis were recruited. The experimental setup allowed participants to rest their forearm in neutral pronosupination with immobilization of the second through fifth CMC joints. An electromagnetic motion sensor was embedded into a thumb interphalangeal joint immobilizer, and participants were asked to complete continuous thumb circumduction movements. Data were continuously recorded, and circumduction curves were created based on degrees of motion. Peak thumb abduction and extension angles were also extracted from the data.ResultsA total of 29 extremities with thumb CMC arthritis and 18 asymptomatic extremities were analyzed. Bilateral disease was present in 64% of patients. Patient age range was 35–83 years, and the control group age range was 26–83 years. The most affected extremities had Eaton stage 3 disease (38%, N = 11). The average maximum thumb abduction was 53.9° ± 19.6° in affected extremities and 70.8° ± 10.1° for controls. Average maximum thumb extension was 50.0° ± 15.2° in affected extremities and 58.4° ± 9.1° for controls. When comparing patients with Eaton stage 3 and 4 disease to controls, average maximum abduction and extension decreased with increasing disease stage (42.3°, 46.1°, and 70.8° for abduction, respectively, and 58.4°, 43.3°, and 41.3° for extension, respectively).ConclusionsWe observed more severe motion limitations with increasing Eaton stage, and statistically significant differences were seen with stage 3 and 4 disease. A wearable motion sensor using a portable experimental setup was used to obtain measurements in a clinical setting.Type of study/level of evidenceDiagnostic II. The purpose of this study was to compare the active range of motion in patients with thumb carpometacarpal (CMC) arthritis to healthy controls. A secondary objective of this study was to examine the feasibility of using wearable motion sensors in a clinical setting. Asymptomatic controls and patients with radiographic and clinical evidence of thumb CMC joint arthritis were recruited. The experimental setup allowed participants to rest their forearm in neutral pronosupination with immobilization of the second through fifth CMC joints. An electromagnetic motion sensor was embedded into a thumb interphalangeal joint immobilizer, and participants were asked to complete continuous thumb circumduction movements. Data were continuously recorded, and circumduction curves were created based on degrees of motion. Peak thumb abduction and extension angles were also extracted from the data. A total of 29 extremities with thumb CMC arthritis and 18 asymptomatic extremities were analyzed. Bilateral disease was present in 64% of patients. Patient age range was 35–83 years, and the control group age range was 26–83 years. The most affected extremities had Eaton stage 3 disease (38%, N = 11). The average maximum thumb abduction was 53.9° ± 19.6° in affected extremities and 70.8° ± 10.1° for controls. Average maximum thumb extension was 50.0° ± 15.2° in affected extremities and 58.4° ± 9.1° for controls. When comparing patients with Eaton stage 3 and 4 disease to controls, average maximum abduction and extension decreased with increasing disease stage (42.3°, 46.1°, and 70.8° for abduction, respectively, and 58.4°, 43.3°, and 41.3° for extension, respectively). We observed more severe motion limitations with increasing Eaton stage, and statistically significant differences were seen with stage 3 and 4 disease. A wearable motion sensor using a portable experimental setup was used to obtain measurements in a clinical setting.

Soft Tissue Coverage for the Hand and Upper Extremity

2021-12-01 · 2 citations

Measuring Functional Outcomes After Bilateral Vascularized Composite Hand Allotransplantation: A Report of 3 Cases

The Journal Of Hand Surgery · 2020-07-16 · 8 citations

Radial Head Replacement for an Acute Complex Radial Head Fracture

2019-01-01

The Association of Clavicle Fracture With Brachial Plexus Birth Palsy

The Journal Of Hand Surgery · 2019-01-25 · 48 citations

Management of the “Failed” Cubital Tunnel Release

2019-01-01

A Review on the Orthoplastic Approach to Lower Limb Reconstruction

Indian Journal of Plastic Surgery · 2019-01-01 · 24 citations

Just as in the craft of carpentry, a stable foundation and framework are absolutely essential to the final function of a building, but no more important than the drywall, trim, and paint that make the building functional, durable, and livable. Reconstruction of the lower extremity is similar; the orthopaedic surgeon must obtain stable fixation of the damaged or diseased bone once a thorough debridement of nonviable bone is performed, while the plastic or orthopaedic soft tissue surgeon must provide vascularized, stable coverage. These two components are complementary and both contribute to the success or failure of functional limb restoration. The stability of bone repair will predict the ultimate functional status, while the vascularized envelope will enhance the biology of bone and soft tissue healing. When both components are properly attended to, the result is often a functional limb with an acceptable appearance. While a single surgeon need not perform both of these tasks (although some may choose to do so), the orthopaedic and plastic surgeon involved in this care must have a clear understanding of each other's role and their importance for a good outcome. This is what we call the orthoplastic approach to reconstructive surgery of the extremities, that is, the application of principles and practice of both specialties applied simultaneously to optimize the outcomes in limb reconstruction. In this review article, we discuss the history of orthoplastic surgery, the key elements of orthoplastic surgery, and thoughts on factors that lead to good outcomes through select cases.

Flap Reconstruction of the Hand

Plastic & Reconstructive Surgery · 2019-12-24 · 36 citations

LEARNING OBJECTIVES: After studying this article, the participant should: 1. Be familiar with local, regional, and free flaps for reconstruction of the hand. 2. Be able to identify potential sources of tissue for vascularized coverage using an algorithmic approach to provide stable and functional reconstruction of the hand. 3. Recognize the controversies and complications unique to flap reconstruction of the hand. SUMMARY: The goal of this continuing medical education module is to provide the practicing reconstructive surgeon with a framework in which to think about reconstruction of the hand. The hand has unique functional and aesthetic characteristics that must be considered when choosing the optimal methods for reconstruction. There are a number of reliable local and regional flaps that can be used to treat the hand requiring soft-tissue coverage and/or vascularized bone graft. The "reconstructive ladder," originally described by Mathes and Nahai, is based on the principle of using the simplest approach that adequately restores form and ideally optimizes function. In cases where the simplest techniques prove to be inadequate, local and regional flaps and, ultimately, microsurgical tissue transfer should be considered.