PurposeA tendoachilles lengthening (TAL) is indicated in over 85 % of cases treated with the Ponseti technique. A percutaneous TAL is often performed in the clinic. Reported complications from a TAL performed in the clinic include: bleeding due to injury to the peroneal artery, posterior tibial artery, or lesser saphenous vein; injury to the tibial or sural nerves; and incomplete release. The purpose of the present study is to report the results and complications of a mini-open TAL performed in the operating room (OR).MethodsThe current study is a retrospective review performed among infants with idiopathic clubfoot who underwent a mini-open TAL from 2008 to 2015.ResultsForty-one patients underwent 63 TALs via a mini-open technique in day surgery. The average Pirani score was 5.8 prior to casting. The average number of casts applied prior to surgery was 5.2. The average age at the time of the TAL was 12.5 weeks (range 5–48 weeks). The average weight at the time of surgery was 7.3 kg (range 3.6–13 kg). No child had a delay in discharge or stayed overnight in the hospital. No anesthesia-related complications or neurovascular injuries occurred. No child needed a repeat TAL due to an incomplete tenotomy.ConclusionsIn conclusion, mini-open TAL performed in the OR is safe and effective in infants with clubfeet. No complications occurred and all patients were discharged on the day of surgery. Direct visualization of the Achilles tendon via a mini-open technique minimizes the risk of neurovascular injury and incomplete tenotomy.
Synovial fluid (SF) contains various cytokines that regulate chondrocyte metabolism and is dynamically associated with joint disease. The objective of this study was to investigate the effects of diluted normal SF on catabolic metabolism of articular cartilage under inflammatory conditions. For this purpose, SF was isolated from healthy bovine joints, diluted, and added to cartilage explant cultures stimulated with interleukin-1 (IL-1) for 12 days. The kinetic release of sulfated glycosaminoglycan (sGAG) and collagen, as well as nitric oxide and gelatinase matrix metalloproteinases were analyzed in the supernatant. Chondrocyte survival and matrix integrity in the explants were evaluated with Live/Dead and histological staining. Diluted synovial fluid treatment suppressed sGAG and collagen release, downregulated the production of nitric oxide and matrix metalloproteinases, reduced IL-1-induced chondrocyte death, and rescued matrix depletion. Our results demonstrate that normal SF can counteract inflammation-driven cartilage catabolism. This study reports on the protective function of healthy SF and the therapeutic potential of recapitulation of SF for cartilage repair.
Introduction:
Orthopaedic surgery can be a physically demanding occupation with high rates of fatigue and burnout. Fatigue has been shown to affect surgeon performance with higher rates of errors in fatigued surgeons. The metabolic cost of performing surgery has yet to be quantified. A better understanding of these costs may provide insights into surgeon fatigue and its effect on patient safety.
Methods:
Eight subjects performed a one-level lumbar laminectomy and fusion on cadavers. Oxygen consumption (VO2) was measured via indirect calorimetry and used to calculate energy expenditure (EE). Substrate utilization was estimated from measurements of inspired and expired gases (ie, O2 and CO2, respectively). EE was also measured with the use of triaxial accelerometers.
Results:
The peak VO2 was 11.3 ± 0.4 mL/kg/min. The EEtotal was 132 ± 6 kcal corresponding to the EEtotal/hr of 142 ± 7 kcal/hr. Upper arm accelerometers (154.8 ± 9.8 kcal; r = 0.54) accurately estimated total EE. Subjects used, on average, 53% ± 4% CHO versus 47% ± 7% fat, with peak utilization of 65% ± 5% CHO versus 35% ± 15% fat.
Discussion:
Simulated orthopaedic spine surgery elicited modest but significant increases in EE over resting. Surgeons used a higher percentage of carbohydrate than would be expected for the intensity of the activity.
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