Search Results (64)

Purpose: The purpose of this work was to conduct a comprehensive literature review of the challenges encountered in ocular biometry and intraocular lens (IOL) power calculations in patients with keratoconus undergoing cataract surgery and to evaluate the performance of various biometric techniques and IOL power calculation formulas in this population. Methods: A comprehensive literature search was conducted in PubMed for studies published until October 2025. Keywords included “keratoconus”, “biometry”, “IOL power calculation”, “cataract surgery”, “keratometry”, and related terms. Studies evaluating the repeatability of biometric measurement, the accuracy of IOL formulas, and surgical outcomes in keratoconus patients were included. Study quality was assessed using standardized criteria, including study design, measurement standardization, and statistical appropriateness. Results: Twenty studies comprising 1596 eyes with keratoconus were analyzed. Biometric challenges include reduced keratometry repeatability (especially with K > 55 D), altered anterior-to-posterior corneal curvature ratios, anterior chamber depth, unreliable corneal power measurements, and tear film instability affecting measurement consistency. Keratoconus-specific formulas (Barrett’s True-K for keratoconus and Kane’s formula for keratoconus) demonstrated superior accuracy compared to standard formulas. The Barrett True-K formula with predicted posterior corneal astigmatism showed median absolute errors of 0.10–0.35 D across all severity stages, with 39–72% of eyes within ±0.50 D of target refraction. Traditional formulas (excluding SRK/T) produced hyperopic prediction errors that increased with disease severity. Swept-source optical coherence tomography biometry with total keratometry measurements improved prediction accuracy, particularly in severe keratoconus. Conclusions: IOL power calculation in keratoconus remains challenging due to multiple biometric measurement errors. Keratoconus-specific formulas significantly improve refractive outcomes compared to standard formulas. The use of total keratometry and swept-source OCT biometry, as well as the incorporation of posterior corneal power measurements, enhances accuracy. A multimodal approach combining advanced biometry devices with keratoconus-specific formulas is recommended for optimal outcomes. Full article

Background: The occurrence of ALL rupture during posterior correction of adult spinal deformity (ASD) was rare before the introduction of lateral lumbar interbody fusion (LLIF) but has become more frequent recently. It remains unclear whether this phenomenon is unique to LLIF-combined procedures or primarily related to enhanced corrective ability. Methods: The research method used in this study is finite element analysis (FEA). Using preoperative computed tomography images, LLIF cage (L group) or posterior lumbar interbody fusion (PLIF) cage (P group) were placed in the disc space with identical lordotic angles and distances from the anterior vertebral body edge for the same patients’ samples. Finite element simulations of corrective procedures were conducted. A spring simulating the ALL was introduced into the FEA, and the load on the ALL was evaluated with either LLIF or PLIF cage placement. Spring elongation directly measured the load on the ALL, while the location of the rotation center served as an indirect evaluation. Two different types of corrective procedures were created, one of which is mimicking ASD correction. For both procedures, the load to ALL was measured using abovementioned parameters when either LLIF cage (L group) or PLIF cage (P group) was used. The load to ALL was compared between L group and P group. Results: The degree of spring elongation during the simulation of a corrective procedure significantly decreased in the L group compared to the P group only in the model which is mimicking ASD correction (p = 0.006, Cohen’s d = 2.33, Power (1−β) = 0.956). The rotation center was significantly more posteriorly located in the P group than that in the L group in both models. These differences were more obvious in the model mimicking ASD correction (p = 0.0013, Cohen’s d = 2.00, Power (1−β) = 0.891). Conclusions: Our findings suggest that the use of a PLIF cage, which has a longer anterior–posterior cage length, caused the posterior edge of the cage to act as a pivot point. This configuration places greater leverage on the ALL, potentially leading to rupture during posterior correction procedures. This phenomenon, ALL rupture during posterior correction for ASD, is thought to be associated with increased corrective capabilities rather than being specific to the geometry of the LLIF cage. Full article

Background: Craniofacial clefts represent the most common congenital malformation in the head and neck region. Although most patients undergo primary cleft repair in childhood, many still present midfacial growth deficiencies in adulthood. This study aimed to evaluate and compare the incidence and indications for orthognathic surgery in adult patients with cleft lip (CL), cleft lip and alveolus (CLA), cleft lip and palate (CLP), and isolated cleft palate (CP). Materials and Methods: Sixty adult cleft patients (36 males and 24 females) born with a cleft and with a mean age of 19.51 ± 1.83 years were retrospectively enrolled in this study. All patients had undergone primary lip and palate repair during childhood at the Oral and Maxillofacial Surgery Service of “Mother Teresa” University Hospital Centre in Tirana. Clinical records, orthodontic documentation, and cephalometric data were reviewed to determine the indication for orthognathic surgery. Results: The statistical analysis showed that orthognathic surgery was deemed necessary in 30% patients, including ten males (56%) and eight females (44%). The most prevalent type of cleft was CLP, accounting for 35% of all patients, and it showed the highest surgical indication rate (83.3%). Cleft patients and the need for orthognathic surgery were evaluated according to the skeletal malocclusion in three planes. The need for surgery was more prevalent in patients with skeletal class III malocclusion with maxillary hypoplasia (83.3% of surgical cases), those with anterior and posterior crossbite (21.7% of all patients), and in deep bite patients (16.7% of all patients). Additionally, all patients with facial asymmetry (15%) required orthognathic surgery, highlighting the strong association between asymmetry and surgical indication. Conclusions: Patients with craniofacial cleft, especially those with CLP and combined maxillary deficiencies, demonstrate a significantly higher need for orthognathic surgery. Quantitative assessment supports the necessity of a multidisciplinary treatment approach to address persistent skeletal discrepancies and optimize functional and aesthetic outcomes in adult cleft patients. Full article

Background: Hip fractures represent a major clinical challenge, particularly in elderly and frail patients, where postoperative pain control must balance effective analgesia with motor preservation to facilitate early mobilization. Various regional anesthesia techniques are used in this setting, including the pericapsular nerve group (PENG) block, fascia iliaca compartment block (FICB), femoral nerve block (FNB), and quadratus lumborum block (QLB), yet optimal strategies remain debated. Objectives: To systematically review the efficacy, safety, and clinical applicability of major regional anesthesia techniques for pain management in hip fractures, including considerations of fracture type, surgical approach, and functional outcomes. Methods: A systematic literature search was conducted following PRISMA 2020 guidelines in PubMed, Scopus, Web of Science, and the virtual library of the Hospital Central de la Defensa “Gómez Ulla” up to March 2025. Inclusion criteria were RCTs, systematic reviews, and meta-analyses evaluating regional anesthesia for hip surgery in adults. Risk of bias in RCTs was assessed using RoB 2.0, and certainty of evidence was evaluated using the GRADE approach. Results: Twenty-nine studies were included, comprising RCTs, systematic reviews, and meta-analyses. PENG block demonstrated superior motor preservation and reduced opioid consumption compared to FICB and FNB, particularly in intracapsular fractures and anterior surgical approaches. FICB and combination strategies (PENG+LFCN or sciatic block) may provide broader analgesic coverage in extracapsular fractures or posterior approaches. The overall risk of bias across RCTs was predominantly low, and certainty of evidence ranged from moderate to high for key outcomes. No significant safety concerns were identified across techniques, although reporting of adverse events was inconsistent. Conclusions: PENG block appears to offer a favorable balance of analgesia and motor preservation in hip fracture surgery, particularly for intracapsular fractures. For extracapsular fractures or posterior approaches, combination strategies may enhance analgesic coverage. Selection of block technique should be tailored to fracture type, surgical approach, and patient-specific functional goals. Full article

Fragility fractures of the pelvis (FFPs) are common in elderly patients, particularly those with osteoporosis. FFPs can be associated with high mortality, morbidity, and functional decline. Known risk factors include being over 80 years old and delays in surgical intervention when this is required. While the role of surgery in FFPs remains less defined than in proximal femoral fractures in the elderly, studies indicate that surgical fixation offers improved survival and functional outcomes. Similarly, the choice of fixation method, whether posterior or anterior, and their combinations, vary between clinicians. It depends on the fracture type and patient-specific factors, such as bone quality and comorbidities, as well as the surgeon’s experience and the availability of resources. Additionally, orthobiologic adjuncts such as cement augmentation and sacroplasty can enhance the stability of an osteoporotic fracture during surgical intervention. Furthermore, medical treatments for osteoporosis, especially the use of teriparatide, have demonstrated beneficial effects in reducing fractures and promoting healing of the FFPs. Return to pre-injury activities is often limited, with independence rates remaining low at mid-term follow-up. Factors that influence clinical outcomes include fracture type, with Type III and IV fractures generally leading to poorer outcomes, and patient age, functional reserve, and comorbidities. The present tutorial aims to summarise the relevant evidence on all aspects of FFPs, inform an updated management strategy, and provide a template of the reconstruction ladder referring to the most available surgical techniques and treatment methods. Further research, based on large-scale studies, is needed to address the open questions described in this manuscript and refine surgical techniques, as well as determine optimal treatment pathways for this vulnerable patient population. Full article

Background/Objectives: This retrospective study assessed the accuracy of implant positioning with dynamic computer-aided implant surgery (dCAIS) for Toronto Bridge fabrication, using a conometric prosthetic concept and a new intraoral splinting technique (CLIKSS). It compared discrepancies across various anatomical regions, bone qualities, and implant sites. Methods: This study involved 52 patients undergoing full-arch rehabilitation (17 in the mandible, 30 in the maxilla, and 5 in both), with 366 implants placed (125 in the mandible, 241 in the maxilla; 128 in post-extraction sites, and the remainder in healed sites). All implants were immediately loaded. Precision was assessed by measuring linear and three-dimensional (3D) angular deviations between planned and actual implant positions. Results: Measurement errors for apical linear and 3D deviations at the apex and entry point ranged from 0.24 ± 0.10 to 0.55 ± 0.57 mm, and angular deviations varied from 0.32 ± 0.65° to 0.35 ± 0.71°. Maxillary measurements were significantly higher at the entry, apical, and vertical levels, even when comparing anterior and posterior regions with the corresponding mandibular areas, while no differences were found in the angular deviation. Significant discrepancies were observed among different mandibular bone types. Maxillary post-extraction sites exhibited significantly greater deviations than mandibular sites in all parameters except angular deviation. No significant differences were found between healed and post-extraction sites within the same jaw. Conclusions: dCAIS improved implant placement accuracy, leading to predictable prosthetic outcomes, especially during parallel multi-implant insertions. This report introduced dCAIS for conometric/biconometric implant placement combined with the innovative CLIKSS technique as an effective intraoral split method for this prosthesis connection. Full article

Background: The brachial plexus is a network of nerves responsible for the motor and sensory innervation of the upper limb. Variations in the formation and course of the brachial plexus are well documented, though combinations of multiple unilateral abnormalities are rare. The complex pathology of this structure nerve may result in clinical consequences. We present a unique set of brachial plexus abnormalities involving the C4–C6 nerve roots, superior and middle trunks, additional communicating branches, and delayed median nerve union. Case Presentation: During the routine dissection of a 70-year-old female cadaver, several unique variations in the brachial plexus anatomy were identified. The C4 root contributed to C5 before the superior trunk formed, resulting in a superior trunk composed of C4–C6. The C5 root was located anterior to the anterior scalene muscle, whereas C6 maintained its usual posterior position. Additionally, an anterior communicating branch from the middle trunk to the posterior cord was observed. A communicating branch between the lateral and medial cords split into two terminal branches: one merged with the ulnar nerve, and the other joined the medial contribution of the median nerve. The median nerve contributions from the lateral and medial cords merged approximately two inches above the elbow. Conclusions: This rare combination of brachial plexus anomalies has not been previously described in the literature and is of significant clinical relevance. The additional anterior communicating branch from the middle trunk may suggest potential flexor muscle innervation by the posterior cord, which typically innervates extensor muscles. Additionally, the delayed convergence of the median nerve may provide a protective mechanism in cases of midshaft humeral fracture. Awareness of these peripheral nerve abnormalities is important for diagnostic imaging, surgery, or peripheral nerve blocks. Knowledge of such variations is critical for clinicians managing upper limb pathologies. Full article

Background: Nowadays, there is an increasing desire among women suffering from pelvic organ prolapse (POP) to choose a uterus-sparing surgical treatment in order to preserve their fertility. The objective of this study was to conduct a systematic review of the literature to assess how pregnancy and delivery affect the recurrence of POP in women who had previously undergone laparoscopic hysteropexy as well as to improve and individualise the future counselling of patients of reproductive age desiring uterine-preserving treatment for POP. Methods: A comprehensive literature review was conducted using the MEDLINE (PubMed), Web of Science, and Scopus databases for articles published until January 2025, without previous historical limits. The research strategy adopted included different combinations of the following terms: hysteropexy, pregnancy, laparoscopy, and prolapse. Results: A total of ten case reports and three case series met the inclusion criteria for the review, comprising 26 patients. All authors used laparoscopic sacral hysteropexy (LSHP) for the treatment of POP. All patients underwent caesarean delivery at a mean gestational age of 38 weeks. Over a mean follow-up period of 9 months, only 4% of patients developed a recurrent uterine prolapse. A total of 8% of the patients developed de novo anterior compartment prolapse, 8% developed a recurrence of anterior compartment prolapse, and 4% developed posterior compartment prolapse. Conclusions: LSHP seems to be a safe option for women of reproductive age with incomplete family planning, as it does not seem to negatively impact foetal growth. Pregnancy does not appear to affect the long-term efficacy of hysteropexy in maintaining apical support. Given the limited data on the safety and efficacy of uterine-sparing surgery for POP followed by a subsequent pregnancy, further evidence is of great importance towards evaluating safety, efficacy, and providing better counselling for women. Full article

Background: Primary malignant bone tumors are exceedingly rare, with an incidence of 0.5 to 1 per million, and sacral localization is even more uncommon, representing only 1–3.5% of these tumors. These malignancies are often diagnosed late due to their asymptomatic nature until they present as large, advanced intrapelvic tumors. Management is complicated by the need for precise surgical intervention and the consideration of adjuvant therapies based on tumor histology and patient factors. Methods: We conducted a single-center, retrospective analysis of patients who underwent complete, partial, or hemisacrectomy for primary malignant bone tumors or recurrent sacral metastases. Excluded were patients with metastatic disease not necessitating sacrectomy. Data collected included demographics, clinical characteristics, tumor types, resection status, adjuvant therapies, recurrence, metastasis, and complications. Surgical approaches were categorized as posterior, anterior, or combined anterior–posterior. The primary outcomes were overall survival and disease-free survival, while the secondary outcomes focused on complication rates and functional outcomes. Results: The study included 19 patients (7 females, 12 males) with a mean age of 48.9 years at the time of surgery. Primary malignancies were present in 90% of patients. Surgical approaches varied: 20% underwent double access and 5% anterior access only, and the remainder had posterior approaches. High partial sacrectomy (above S3) was performed in 20%, while low sacrectomy (at or below S3) was performed in 80%. Complete resection with clean margins (R0) was achieved in 65% of cases, while 35% had R1 resections with microscopic tumor remnants. Root resection was necessary in 25% of patients. Local recurrence occurred in 25% of patients, with two requiring reoperation and neurological sacrifice. Distant metastases were observed in 20% of cases. Postoperative complications affected 60% of patients. The most common issues were surgical wound dehiscence with delayed healing (35%) and visceral changes affecting the bowel and urination (25%). No mechanical complications were reported. Conclusions: Sacrectomy remains a challenging procedure with substantial morbidity and variability in outcomes. The choice of surgical approach—posterior, anterior, or combined—depends on tumor location and extent. While posterior-only approaches are often preferred for lower sacral lesions, combined approaches may be necessary for more extensive tumors. Survival and disease-free survival rates are influenced by resection margins and the biological behavior of the tumor. Wide-margin resections (R0) are associated with lower local recurrence rates but do not eliminate the risk of distant metastases. Full article

Congenital genu recurvatum (CGR) is a rare congenital knee deformity that can be diagnosed pre- or postnatally. Most CGR cases are treated during infancy by manipulation and serial casting or splinting. Only a few neglected cases of CGR in adults with the necessity of surgical treatment have been reported. This study presents the first case of neglected bilateral severe CGR combined with bilateral talipes equinocavovarus (BTE) in a 25-year-old woman. This case is unique, because BTE is secondary to CGR with persistent progression into adulthood. The patient underwent two-stage surgeries with 1.5-month intervals to correct the knee and foot/ankle deformities. For CGR, a novel technique that combines posterior closing and anterior open wedge osteotomy was carried out to separately address the issues of 80° and 60° deformity, achieving a total correction of 140° for both knee hyperextension deformities. For BTE, the modified Lambrinudi triple arthrodesis and almost complete plantar fascia release were performed for the treatment of foot/ankle deformities. The patient had no neurovascular problems, and the wounds healed well. After 1 year of hospital-based rehabilitation training, the patient could stand and walk without the help of any walking-assist devices. The outcomes of the three- and nine-year follow-ups were highly satisfactory. Our patient represents a technically challenging case for orthopaedic surgeons because of the complexity of the surgical plan and techniques for the treatment of a patient concurrently having CGR and BTE. Full article

Cervical disc arthroplasty (CDA) is a motion-preserving alternative to anterior cervical discectomy and fusion (ACDF) for cervical degenerative disease, reducing adjacent segment degenerative disease (ASD). Despite its benefits, some patients experience CDA failure due to prosthesis-related complications, heterotopic ossification, segmental kyphosis, ASD, or facet joint degeneration, necessitating revision surgery. Reoperation strategies depend on the failure mechanism, instability, sagittal malalignment, and neural compression. Anterior revision is suited for prosthesis failure, recurrent disc herniation, or ASD, enabling prosthesis removal, decompression, and fusion. In select cases, reimplantation may restore motion. Posterior approaches are preferred for facet degeneration, multilevel stenosis, or posterior hypertrophy, with options including foraminotomy, laminoplasty, or laminectomy and fusion. Complex cases may require combined anterior and posterior surgery for optimal decompression and stability. This narrative review outlines revision strategies, emphasizing biomechanical assessment, radiographic evaluation, and patient-specific considerations. Despite surgical challenges, meticulous planning and execution can optimize outcomes. Full article

Background and Objectives: Multilevel cervical spondylotic myelopathy (MCSM) presents complex challenges for surgical management, particularly in patients with kyphosis or significant anterior pathology. This study aimed to assess the long-term efficacy of modified expansive open-door laminoplasty (MEOLP) combined with short-level anterior cervical fusion (ACF) in providing decompression, preserving alignment, and maintaining range of motion (ROM) over a nine-year follow-up. Materials and Methods: A retrospective analysis was conducted on 124 MCSM patients treated with MEOLP combined with ACF between 2011 and 2015. MEOLP, a muscle-sparing posterior approach, was combined with ACF to correct sagittal misalignment and address anterior compression. Key outcome measures included the Pavlov ratio, C2–C7 angle, Japanese Orthopedic Association (JOA) score, and Visual Analog Scale (VAS) for neck pain. Patients were monitored for adjacent segment degeneration (ASD) and other postoperative changes over the long-term follow-up. Results: At nine years post-surgery, patients demonstrated significant improvements in decompression and cervical alignment. The mean C2–C7 angle increased, reflecting enhanced lordotic curvature, while the Pavlov ratio showed maintained canal expansion. JOA scores improved significantly, indicating reduced myelopathy symptoms, and VAS scores for neck pain decreased, reflecting symptom relief. Despite these positive outcomes, ASD was noted, especially in patients with reduced preoperative disk height, highlighting the need for strategies to mitigate degeneration at adjacent segments. Conclusions: MEOLP combined with short-level ACF is a viable and durable option for managing complex MCSM cases, offering effective decompression, alignment correction, and ROM preservation. The limitations of this study, including its retrospective, single-center design and the lack of quality-of-life assessments, underscore the need for future multi-center studies with broader outcome measures. These findings support MEOLP with ACF as an alternative approach in cases where traditional laminoplasty may be insufficient. Full article

Objectives: This study aimed to describe the outcomes of a staged procedure combining Descemet membrane endothelial keratoplasty (DMEK) and sutureless scleral fixation (SSF) of a one-piece intraocular lens (IOL) in a case series. Co-performing endothelial keratoplasty (EK) and SSF is associated with intraoperative and postoperative complications such as graft deployment difficulties, air migration, graft detachment, and IOL opacification or tilt, all of which are evaluated in this study. Methods: This is a retrospective observational case series. Clinical data were collected from eight eyes of eight patients who underwent DMEK for endothelial failure and had previously received an SSF with one-piece IOL following complete vitrectomy. During DMEK surgery, an air leak test was conducted to check for air migration into the posterior chamber. If instability was detected, pupilloplasty was performed. Intraoperative and postoperative data, including DMEK graft unfolding time, were collected. Corrected Distance Visual Acuity (CDVA), refraction, endothelial cell density (ECD), central corneal thickness (CCT), intraocular pressure (IOP), and complications were recorded over a 12-month follow-up period. Results: We performed pupilloplasty in four patients (50%). The median CDVA improved from preoperative 0.85 logMAR (range: 0.60 to 1.00) at baseline to 0.18 logMAR (range: 0.10 to 0.70, p = 0.012) at 12 months. The median refraction value changed significantly from −1.00 to −0.50 at 12 months. The median percentage reduction in ECD after 12 months was 33.4% (range 30 to 40). The median baseline CCT was 689 μm (range: 651 to 701) at baseline visit and 541.5 μm (range: 525 to 591, p = 0.008) at 12 months. The median IOP was reduced significantly during follow-up. The median graft unfolding time was 6 min (5 to 9). One patient required rebubbling for partial detachment on postoperative day one. No complications occurred within 12 months. Conclusions: The effective compartmentalization of the anterior and posterior chambers in vitrectomized eyes with an SSF one-piece IOL and pupilloplasty can facilitate critical steps of DMEK surgery in complex eyes. Additionally, the air leak test could prove useful in identifying the need for iris-lens diaphragm reconstruction. Full article

Class III malocclusion prevalence varies significantly among racial groups, with the highest prevalence observed in southeast Asian populations at 15.80%. These malocclusions often involve maxillary retrognathism, mandibular prognathism, or both, accompanied by maxillary constriction and crossbites. Comprehensive treatment should address anteroposterior, transverse, and vertical imbalances. Microimplant-assisted rapid palatal expansion (MARPE) has shown high success rates for transverse maxillary expansion in late adolescents and adults, presenting a viable alternative to surgically-assisted rapid palatal expansion (SARPE). This case report aims to demonstrate the successful treatment of a young adult female with borderline Class III malocclusion using MARPE and mandibular backward rotation (MBR) techniques. A 21-year-old female presented with a Class III skeletal pattern, anterior/posterior crossbites, and mild dental crowding. Despite her concerns about a concave facial profile, the patient declined orthognathic surgery due to a negative experience reported by a friend. The treatment plan included MARPE to correct maxillary transverse deficiency and MBR to alleviate Class III malocclusion severity. Lower arch distalization was performed using temporary anchorage devices (TADs) on the buccal shelves, and Class II elastics were used to maintain MBR and prevent retroclination of the lower labial segment during anterior retraction. Significant transverse correction was achieved, and the severity of Class III malocclusion was reduced. The lower dentition was effectively retracted, and the application of Class II elastics helped maintain MBR. The patient’s final facial profile was harmonious, with well-aligned dentition and a stable occlusal relationship. The treatment results were well-maintained after one year. The MARPE with MBR approach presents a promising alternative for treating borderline Class III cases, particularly for patients reluctant to undergo orthognathic surgery. This case report highlights the effectiveness of combining MARPE and MBR techniques in achieving stable and satisfactory outcomes in the treatment of Class III malocclusion. Full article