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Guirguis J, El Sayad M, Kakwani M, Townshend D, Kakwani R. Safety of the neurovascular bundles when performing minimally invasive calcaneal osteotomy: A cadaveric study. Foot Ankle Surg 2024; 30:161-164. [PMID: 37993357 DOI: 10.1016/j.fas.2023.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 10/16/2023] [Accepted: 11/01/2023] [Indexed: 11/24/2023]
Abstract
BACKGROUND Calcaneal osteotomies correct hindfoot deformities and are often performed using a minimally invasive technique. The aim was to compare the safety of three calcaneal osteotomy techniques (oblique, chevron with apex anterior and chevron with apex posterior). METHODS Each osteotomy technique was performed on five cadavers (n = 15). These were then dissected to identify any injury to the neurovascular bundles. The distance between the burr and these structures was measured. RESULTS Using the apex posterior technique, the burr was closer to the medial and lateral neurovascular structures, and in one case the sural nerve was injured. There were no neurovascular injuries using the other techniques. CONCLUSIONS Minimally invasive surgery using a burr is generally a safe, reliable method for performing calcaneal osteotomies. The chevron with apex posterior osteotomy should be performed with caution given the closer relationship between the burr and neurovascular bundles. The other two techniques provide safer alternatives. LEVEL OF EVIDENCE: 4
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Affiliation(s)
- J Guirguis
- Northumbria NHS Foundation Trust, Wansbeck General Hospital Department of Trauma & Orthopaedics, Woodhorn Lane, Northumberland NE63 9JJ, UK.
| | - M El Sayad
- Gateshead Health NHS Foundation Trust, Queen Elizabeth Hospital, Gateshead, Tyne and Wear NE9 6SX, UK.
| | - M Kakwani
- University of Leeds, Woodhouse, Leeds, West Yorkshire LS2 9JT, UK.
| | - D Townshend
- Northumbria NHS Foundation Trust, North Tyneside General Hospital, Rake Lane, Tyne and Wear NE29 8NH, UK.
| | - R Kakwani
- Northumbria NHS Foundation Trust, North Tyneside General Hospital, Rake Lane, Tyne and Wear NE29 8NH, UK.
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Ridha Z, Guirguis J, Ouchene L, Chergui M, Litvinov IV, Netchiporouk E. Acute generalized exanthematous pustulosis overlapping with toxic epidermal necrolysis successfully treated with etanercept. J Eur Acad Dermatol Venereol 2021; 35:e894-e896. [PMID: 34310752 DOI: 10.1111/jdv.17540] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Z Ridha
- Faculty of Medicine, Université Laval, Quebec, QC, Canada
| | - J Guirguis
- Division of Dermatology, McGill University Health Centre, Montreal, QC, Canada
| | - L Ouchene
- Division of Dermatology, McGill University Health Centre, Montreal, QC, Canada
| | - M Chergui
- Department of Pathology, McGill University Health Centre, Montreal, QC, Canada
| | - I V Litvinov
- Division of Dermatology, McGill University Health Centre, Montreal, QC, Canada
| | - E Netchiporouk
- Division of Dermatology, McGill University Health Centre, Montreal, QC, Canada
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Abstract
PURPOSE In 1959, Maroteaux and Lamy initially designated pseudoachondroplasia as a distinct dysplasia different from achondroplasia the most common form of skeletal dysplasia. Pseudoachondroplasia is caused by a mutation in the collagen oligomeric matrix protein gene (COMP) gene on chromosome 19p13.1-p12 encoding the COMP. The COMP gene mutations result in rendering the articular and growth plate cartilages incapable of withstanding routine biomechanical loads with resultant deformity of the joints. The purpose of the study was to characterize the typical orthopaedic findings in pseudoachondroplasia. METHODS The charts and radiographs of 141 patients with pseudoachondroplasia were analyzed. This cohort, to our knowledge, represents the largest group of patients describing the typical orthopaedic manifestations of pseudoachondroplasia. RESULTS Patients with pseudoachondroplasia have normal craniofacial appearance with normal intelligence. Short stature is not present at birth and generally appears by two to four years of age. The condition is a form of spondyloepiphyseal dysplasia and the long bones are characterized by dysplastic changes in the epiphysis, metaphysis and vertebral bodies. Radiographically the long bones have altered the appearance and structure of the epiphyses with small irregularly formed or fragmented epiphyses or flattening. The metaphyseal regions of the long bones show flaring, widening or 'trumpeting'. The cervical (89%) and thoracic and lumbar vertebrae show either platyspondyly, ovoid, 'cod-fish' deformity or anterior 'beaking'. Kyphosis (28%), scoliosis (58%) and lumbar lordosis (100%) are commonly seen. The femoral head and acetabulum are severely dysplastic (100%). The knees show either genu valgum (22%), genu varum (56%) or 'windswept' deformity (22%). CONCLUSION Most commonly these distortions of the appendicular and the axial skeleton lead to premature arthritis particularly of the hips and often the knees not uncommonly in the 20- to 30-year-old age group. LEVEL OF EVIDENCE III.
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Affiliation(s)
- D. S. Weiner
- Department of Orthopaedics, Akron Children’s Hospital, Akron, Ohio, USA,Correspondence should be sent to D. S. Weiner, Department of Orthopaedics, Akron Children’s Hospital, 300 Locust Street, Ste. 250, Akron, OH 44302-1821, USA.
| | - J. Guirguis
- Department of Orthopaedics, Akron Children’s Hospital, Akron, Ohio, USA
| | - M. Makowski
- Department of Orthopaedics, Cleveland Clinic/Akron General, Akron, Ohio, USA
| | - S. Testa
- Rebecca D. Considine Research Institute/Akron Children’s Hospital, Akron, Ohio, USA
| | - L. Shauver
- Rebecca D. Considine Research Institute/Akron Children’s Hospital, Akron, Ohio, USA
| | - D. Morgan
- Rebecca D. Considine Research Institute/Akron Children’s Hospital, Akron, Ohio, USA
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Hajibandeh S, Hajibandeh S, Deering R, McEleney D, Guirguis J, Dix S, Sreh A, Toner E, El Muntasar A, Kausar A, Sheikh G, OShea D, Shafiq A, Kelly A, Khan A, Arumugam D, Evans A. Accuracy of co-morbidity data in patients undergoing abdominal wall hernia repair: a retrospective study. Hernia 2017; 22:243-248. [PMID: 29243213 DOI: 10.1007/s10029-017-1713-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2017] [Accepted: 12/09/2017] [Indexed: 01/19/2023]
Abstract
OBJECTIVES To determine the baseline accuracy, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of routinely collected co-morbidity data in patients undergoing abdominal wall hernia repair. METHODS All patients aged > 18 who underwent umbilical, para-umbilical, inguinal or incisional hernia repair between 1 January 2015 and 1 November 2016 were identified. All parts of the clinical notes were searched for co-morbidities by two authors independently. The following co-morbidities were considered: hypertension, ischaemic heart disease (IHD), diabetes, asthma, chronic obstructive pulmonary disease (COPD), cerebrovascular disease (CVD), chronic kidney disease (CKD), hypercholesterolemia, obesity and smoking. The co-morbidities data from clinical notes were compared with corresponding data in hospital episode statistics (HES) database to calculate accuracy, sensitivity, specificity, PPV and NPV of HES codes for co-morbidities. To assess the agreement between clinical notes and HES data, we also calculated Cohen's Kappa index value as a more robust measure of agreement. RESULTS Overall, 346 patients comprising 3460 co-morbidity codes were included in the study. The overall accuracy of HES codes for all co-morbidities was 77% (Kappa: 0.13). When calculated separately for each co-morbidity, the accuracy was 72% (Kappa: 0.113) for hypertension, 82% (Kappa: 0.232) for IHD, 85% (Kappa: 0.203) for diabetes, 86% (Kappa: 0.287) for asthma, 91% (Kappa: 0.339) for COPD, 92% (Kappa: 0.374) for CVD, 94% (Kappa: 0.424) for CKD, 74% (Kappa: 0.074) for hypercholesterolemia, 71% (Kappa: 0.66) for obesity and 24% (Kappa: 0.005) for smoking. The overall sensitivity, specificity, PPV and NPV of HES codes were 9, 100, 100, and 77%, respectively. The results were consistent when individual co-morbidities were analyzed separately. CONCLUSIONS Our results demonstrated that HES co-morbidity codes in patients undergoing abdominal wall hernia repair are specific with good positive predictive value; however, they have substandard accuracy, sensitivity, and negative predictive value. The presence of a relatively large number of false negative or missed cases in HES database explains our findings. Better documentation of co-morbidities in admission clerking proforma may help to improve the quality of source documents for coders, which in turn may improve the accuracy of coding.
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Affiliation(s)
- S Hajibandeh
- Department of General Surgery, Royal Blackburn Hospital, Haslingden Rd, Blackburn, UK.
- Department of General Surgery, Salford Royal Foundation Trust, Salford, UK.
| | - S Hajibandeh
- Department of General Surgery, Royal Blackburn Hospital, Haslingden Rd, Blackburn, UK
- Department of General Surgery, North Manchester General Hospital, Manchester, UK
| | - R Deering
- Department of General Surgery, Royal Blackburn Hospital, Haslingden Rd, Blackburn, UK
| | - D McEleney
- Department of General Surgery, Royal Blackburn Hospital, Haslingden Rd, Blackburn, UK
| | - J Guirguis
- Department of General Surgery, Royal Blackburn Hospital, Haslingden Rd, Blackburn, UK
| | - S Dix
- Department of General Surgery, Royal Blackburn Hospital, Haslingden Rd, Blackburn, UK
| | - A Sreh
- Department of General Surgery, Royal Blackburn Hospital, Haslingden Rd, Blackburn, UK
| | - E Toner
- Department of General Surgery, Royal Blackburn Hospital, Haslingden Rd, Blackburn, UK
| | - A El Muntasar
- Department of General Surgery, Royal Blackburn Hospital, Haslingden Rd, Blackburn, UK
| | - A Kausar
- Department of General Surgery, Royal Blackburn Hospital, Haslingden Rd, Blackburn, UK
| | - G Sheikh
- Department of General Surgery, Royal Blackburn Hospital, Haslingden Rd, Blackburn, UK
| | - D OShea
- Department of General Surgery, Royal Blackburn Hospital, Haslingden Rd, Blackburn, UK
| | - A Shafiq
- Department of General Surgery, Royal Blackburn Hospital, Haslingden Rd, Blackburn, UK
| | - A Kelly
- Department of General Surgery, Royal Blackburn Hospital, Haslingden Rd, Blackburn, UK
| | - A Khan
- Department of General Surgery, Royal Blackburn Hospital, Haslingden Rd, Blackburn, UK
| | - D Arumugam
- Department of General Surgery, Royal Blackburn Hospital, Haslingden Rd, Blackburn, UK
| | - A Evans
- Department of General Surgery, Royal Blackburn Hospital, Haslingden Rd, Blackburn, UK
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