Browsing by Subject "Orthopedic Procedures"
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Item Assessing Complications of Epiphysiodesis for Leg Length Discrepancy(2014-02-04) Terrill, Tyler A.; Dunn, Samuel H.; Birch, John; Makarov, MarinaINTRODUCTION: Leg length discrepancy in children and adolescents is a serious orthopedic problem that can cause leg and back problems due to abnormal gait. This condition may be congenital or caused by disease or trauma. One method to correct leg length discrepancies in children is to perform an epiphysiodesis. This surgical procedure removes one or more growth plates from the femur, tibia, or fibula. This operation slows down the growth of the long leg to allow the shorter leg to catch up, or at least prevent the discrepancy from increasing. As there has been no large study of epiphysiodesis patients in the literature, the rates for surgical complications and errors associated with this surgery are not well known. These complications may include infections, nerve damage, and incomplete epiphysiodesis, which often results in an angular deformity. Because of the lack of understanding for rate of complications and characteristics associated with these, we studied a large patient population to gain insight into these aspects of the procedure. METHODS: The patient population at Texas Scottish Rite Hospital for Children undergoing epiphysiodesis for the treatment of leg length discrepancy from 1980 to 2008 was examined by a retrospective review of both charts and radiographs, with a total of 755 patients included in the study. The information recorded in the study included the extent of leg length discrepancy, angular measurements of the joints, method of epiphysiodesis, postoperative development of angular deformities, underlying etiology, length correction prediction, and other clinical features. RESULTS: Of the 755 patients examined, 38 had surgical complications, (5%). Of these patients, 27 had incomplete epiphysiodesis, 6 had neurological problems, 3 had overcorrection of the leg length discrepancy, and 2 had other complications not specific to this procedure. Patients incurring complications had statistically significant risk factors that include greater leg length discrepancies at the time of epiphysiodesis, congenital defects instead of acquired ones, and younger age. There were also trends towards open curettage method, epiphysiodesis involving the femoral growth plate, and male gender as risk factors, though these did not achieve statistical significance. DISCUSSION: It is important that surgeons understand which populations of patients are at greater risk for complications during this procedure, so that extra caution may be taken to prevent harm. Also, parents should be aware that there is a 5% risk of surgical complication, so that they may be fully informed before committing to the procedure.Item Neurosurgery in Resource-Poor Settings: Improving Access to Surgical Education and Outcomes Analysis of Spine Surgery in a Training Hospital in Cambodia(2019-03-26) Still, Megan Elizabeth Hermann; Bagley, Carlos; Patel, Toral; Lega, Bradley C.BACKGROUND: Access to basic surgical care, and neurosurgery in particular, has historically been a neglected topic in the global health sphere. However, up to 30% of the global burden of disease is surgical in nature and great strides have been made in the past few years to spotlight and begin to rectify the huge gap in access to safe, timely, and affordable surgical care around the globe. Spine pathology is a common reason for admission to neurosurgical units in low- and middle- income countries (LMICs) and can have high morbidity rates from lack of specialized institutes. However, good surgical outcomes and quality of life scores have been reported in LMICs. OBJECTIVE: This study details the complication rates and predictive factors from spine surgery at a large hospital in Cambodia, aiming to identify high-risk patients to improve surgeon understanding of these complications for improved pre-operative planning and patient counseling. METHODS: This is a retrospective review of patients admitted for spine conditions to Preah Kossamak Hospital, in Phnom Penh (2013-2017). Univariate analysis was conducted on potential predictive factors; variables with p<0.1 were entered into multivariate logistic regression models. RESULTS: 773 patients were included. 46 patients had complications including wrong level surgery, hardware failure, and infection. On multivariate analysis, patients from the provinces of Kratie (p=0.009) or Sihanoukville (p=0.036), and delay to evaluation of over one year (p=0.027) were significant predictive factors of postoperative complications and ASIA A injury (p=0.020) was a predictive factor of poor outcome. CONCLUSION: Many factors play a role in spine surgery complications in LMICs, including limited access to intra-operative technology, low follow-up rates, and minimal physiotherapy and rehabilitation capabilities. Patients with long delays in presentation, ASIA A injuries, and lumbar-level surgery may be especially susceptible to complications and post-operative morbidity. Despite this, institutions have reported encouraging spine trauma outcomes, and spine surgeries are becoming more accepted and safe operations in many LMICs. Additionally, various groups are working towards equality and training in neurosurgery around the globe using different approaches towards education.Item [News](1983-08-10) Willding, LizItem [News](1983-03-23) Williams, AnnItem [News](1984-07-02) Rutherford, SusanItem [UT News](1986-07-30) Rutherford, Susan