Glenohumeral contact pressure is optimally restored with a flush iliac crest bone graft or with a flush Latarjet bone block with the inferior aspect of the coracoid becoming the glenoid surface. Bone grafts placed in a proud position not only increase the peak pressure anteroinferiorly, but also shift the articular contact pressure to the posterosuperior quadrant. Glenoid bone augmentation with a Latarjet bone block with the inferior aspect of the coracoid as the glenoid surface resulted in complete restoration of the 30% anterior glenoid defect to the intact state. These findings indicate the clinical utility of a flush iliac crest bone graft and utilization of the inferior surface of the coracoid as the glenoid face for glenoid bone augmentation with a Latarjet graft.

Suture anchor repair appears to offer superior biomechanical properties to transosseous repairs regardless of tunnel or suture configuration.

Objectives To describe the epidemiological and clinical characteristics and outcome of hospitalized children with COVID-19 during the initial phase of the pandemic. Methods This was a cross-sectional descriptive study conducted at the dedicated COVID-19 hospital of a tertiary care referral center in North India. Consecutive children aged 14 y or younger who tested positive for SARS-CoV-2 by RT-PCR from nasopharyngeal swab between 1 April 2020 and 15 July 2020 were included. Results Of 31 children with median (IQR) age of 33 (9-96) mo, 9 (29%) were infants. About 74% (n = 23) had history of household contact. Comorbidities were noted in 6 (19%) children. More than half (58%) were asymptomatic. Of 13 symptomatic children, median (IQR) duration of symptoms was 2 (1-5.5) d. Fever (32%) was most common followed by cough (19%), rapid breathing (13%), diarrhea (10%) and vomiting (10%). Severe [n = 4, 13%] and critical [n = 1, 3%] illnesses were noted more commonly in infants with comorbidities. Three (10%) children required PICU admission and invasive ventilation; one died. Median (IQR) length of hospital stay was 15 (11-20) d. Follow up RT-PCR before discharge was performed in 17 children and the median (IQR) duration to RT-PCR negativity was 16 (12-19) d. Conclusions In the early pandemic, most children with COVID-19 had a household contact and presented with asymptomatic or mild illness. Severe and critical illness were observed in young infants and those with comorbidities.

Deep brain stimulation (DBS) efficacy is related to optimal electrode placement. Several authors have quantified brain shift related to surgical targeting; yet, few reports document and discuss the effects of brain shift after insertion. Objective: To quantify brain shift and electrode displacement after device insertion. Twelve patients were retrospectively reviewed, and one post-operative MRI and one time-delayed CT were obtained for each patient and their implanted electrodes modeled in 3D. Two competing methods were employed to measure the electrode tip location and deviation from the prototypical linear implant after the resolution of acute surgical changes, such as brain shift and pneumocephalus. In the interim between surgery and a pneumocephalus free postoperative scan, electrode deviation was documented in all patients and all electrodes. Significant shift of the electrode tip was identified in rostral, anterior, and medial directions (p < 0.05). Shift was greatest in the rostral direction, measuring an average of 1.41 mm. Brain shift and subsequent electrode displacement occurs in patients after DBS surgery with the reversal of intraoperative brain shift. Rostral displacement is on the order of the height of one DBS contact. Further investigation into the time course of intraoperative brain shift and its potential effects on procedures performed with rigid and non-rigid devices in supine and semi-sitting surgical positions is needed.

This study determines the biomechanical advantage and the optimal configuration of a high tibial osteotomy (HTO) and meniscus transplantation performed concurrently. Six cadaver knees were placed in a spatial frame, and an HTO was completed. Loading points between a mechanical 6 degrees of varus and 8 degrees of valgus were loaded to 800 N for medial meniscal intact, meniscectomized, and transplanted states. Posterior slope was also increased by 3 degrees in these specimens. Contact data was recorded. Peak pressures significantly increased in the meniscectomized state in every degree of varus/valgus (p < 0.05). For both peak and total medial compartment pressures, there was a significant drop (p < 0.001) between neutral and 3 degrees of valgus. Lateral compartment pressures linearly increased from varus to valgus orientation. There was no significant change in the pressure profile of the knee with a 3-degree increase in posterior slope. This biomechanical study confirms the hypothesis that an HTO improves the peak pressures in the medial compartment at all degrees of varus/valgus alignment in the setting of meniscal transplantation. Furthermore, the largest decrease in medial pressures was between neutral and 3 degrees of valgus, suggesting that perhaps neutral aligned knees could benefit from an HTO.

UPJO causes hydronephrosis and progressive renal impairment may ensue if left uncorrected. Open pyeloplasty remains the standard against which new technique must be compared. We analyzed the comparison of Laparoscopic and open pyeloplasty in a randomized prospective trial. A prospective randomized study was done from January 2004 to January 2007 in which a total of 28 Laparoscopic and 34 open pyeloplasty were done. All laparoscopic pyeloplasties were performed transperitoneally. Standard open Anderson Hynes pyeloplasty, spiral flap or VY plasty was done depending on anatomic consideration. Patients were followed with DTPA scan at 3 months and IVP at 6 months. Perioperative parameters including operative time, analgesic use, hospital stay, and complication and success rates were compared. Mean total operative time with stent placement in LP group was 244.2 min (188-300 min) compared to 122 min (100-140 min) in open group. Compared to open pyeloplasty the post operative diclofenac requirement was significantly less in LP group (mean107.14 mg) and open group required mean of (682.35 mg) The duration of analgesic requirement was also significantly less in LP group. The post operative hospital stay in LP was mean 8.29 days (7-11) and was significantly less than open group (mean 3.14 Days (2-7 days). Open pyeloplasty has been the gold standard for UPJO repair and achieves success rates exceeding 90%. Laparoscopic pyeloplasty provides a minimally invasive alternative to repair UPJO and has developed world wide as the first minimally option to match success rate of open pyeloplasty. Its potential advantages including less post op pain, shorter hospital stay an improved cosmesis has been proved in some comparative series. The only disadvantage seems to be longer operative time. LP has a minimal level of morbidity and short hospital stay compared to open approach Although Laparoscopic pyeloplasty has the disadvantages of longer operative time and requires significant skill of intracorporeal knotting but it is here to stay and represents an emerging standard of care.

Use of bioabsorbable fixation can potentially eliminate future hardware problems after posterior cruciate ligament reconstruction using a tibial inlay technique.

Cystic hygroma is a disfiguring benign lesion commonly observed in the neck and face regions of children. The common complications of these malformations are respiratory obstruction, dysphagia, infection, and hemorrhage. Here, we present an uncommon complication of spontaneous rupture of a cystic hygroma. A two-day-old male baby presented with a swelling that was cystic, non-compressible, non-pulsatile and the transillumination was negative. With a clinical diagnosis of a massive cystic hygroma of the neck, CT scan was performed that demonstrated a large multiloculated cystic lesion. On the second day after admission, the swelling burst spontaneously with drainage of about 1000 ml of hemorrhagic fluid. The swelling shrunk considerably after that. The patient underwent surgical excision of the lesion and had an uneventful postoperative recovery. The histopathological examination confirmed the diagnosis of cystic hygroma.