OSP Journal of Surgery

Methods: Elective spine patients booked before the outbreak of COVID-19 were included. Patients with pathologies other than degenerative spine diseases were excluded, as were spine injections. Validated depression screening score-patient health questionnaire 2 (PHQ2) was used to screen patients for depression before and after the outbreak. Oswestry disability scores (ODI) were calculated prospectively.

Results: 42 patients were included M: F=24:18. Mean age was 62.57 years. There were no significant differences between age and PHQ2 (P=0.89); sex and depression (Fischer exact test=1; P>0.05); ODI (P=0.41) and type of procedure (decompression, two level-decompression, fusion and disc surgery; p= 0.05) when related to diagnosis of depression. However, the PHQ2 was significantly in favour of depression (score >3) in 71.4% patients compared to the pre- COVID-19 outbreak (Fisher exact test=0.02; p<0.05)

Conclusion: This study reports the mental health effects on patients awaiting elective spine surgery in the NHS secondary to delays and uncertainties surrounding elective surgery services related to outbreak of COVID-19 patients.

Technical advance of computerized tomography creates a new problem. A lot of adults (70-90%) show wide spread of pulmonary nodules. The therapeutic management development needs great progresses. This article provides new insights into this phenomenon.

Introduction:
The open carpal tunnel release (oCTR) with no tourniquet using a local anesthetic with epinephrine for hemostasis, has been used for decades. We examined multiple methods and elected to implement oCTR with no tourniquet and compare to the current practice technique in our facility (oCTR with tourniquet) with the hypothesis that there would be no difference in clinical outcomes.

Methods:
One hundred and four adult patients with carpal tunnel syndrome were randomized to either oCTR with no tourniquet or oCTR with tourniquet. The Levine-Katz symptom severity and functional status scale was used preoperatively and postoperatively to compare the clinical change in each cohort. Demographics, procedure length, blood loss, incision length, outcomes were also gathered and compared.

Results:
The no tourniquet (N=52) and tourniquet (N=45) groups were similar on age, sex, procedure length, blood loss, and incision length, hematoma, nerve damage, and self- reported symptom resolution. The difference in Levine-Katz symptom severity and functional status scales between groups (tourniquet & no tourniquet) was not statistically significant. The main effect showed a statistically significant difference in mean improvement from pre to post of both symptom severity and function (P<.0005) for both groups (no tourniquet and tourniquet).

Conclusion:
These results support the use of oCTR with no tourniquet for patients and surgeons that prefer this method. Both can be reassured that the outcomes will be similar with either procedure. Moving forward oCTR with no tourniquet is being implemented in our practice with further plans to implement wide wake oCTR with no tourniquet.

Introduction: Hand fractures are responsible for billions in healthcare costs annually. During 2007, hand and finger injuries accounted for $278 million, ranking first as the most expensive injury type. The vulnerability of the hand to injury is significant, especially in a trauma situation, and are often overlooked while life-threatening injuries are being addressed. Identifying a pattern of injury will likely be of benefit to the treatment and outcomes of trauma patients.

Methods: We sought to investigate the patterns of injury, with specific inclusion criteria, and whether this pattern would provide an insight into which injuries occurred most frequently, and lend itself for further investigation in order to identify injuries to the hand quickly and provide timely and appropriate management. The following patient characteristics were collected: age, gender, Injury Severity Score (ISS), Length of Stay (LOS), Mechanism of Injury (MOI), operative vs non-operative management, type and fracture location, delay in diagnosis and patient outcome.

Results: During a four-year period, 4,378 patients received trauma evaluation, of which 2% (80/4,378) experienced 107 fractures of the hand with 39% being phalangeal and 61% metacarpal (21% being the fifth metacarpal). The most common MOI was Motor Vehicle Accident (MVA), 59%. The most common fracture for those involved in an MVA was also the fifth metacarpal, accounting for 22% of those fractures. A delay in diagnosis occurred in 10% (8/80) of these patients, with only one requiring operative repair.

Conclusion: Clinically significant missed injuries are those that if left untreated may cause a significant amount of physical disability, lessen quality of life, and impede one’s ability to maintain meaningful employment. In the literature, the percentage of these injuries ranges from approximately 15 to 22%. Our study revealed the rate at our institution to be 10% (8/80). Although our observed percentage of missed hand injuries was consistent with published values, we identified a unique fracture pattern that was statistically significant from that found in the literature, possibly due to the insight gained by isolating metacarpal and phalangeal fractures. Our findings imply that a timely and thorough tertiary evaluation is critical to improving patient outcomes hindered by missed hand fractures sustained during trauma.