Joo-Yul Bae M.D. completed his medical degree in University of Ulsan College of Medicine and was an assistant professor at University of Ulsan College of Medicine. He now works in Gangneung Asan Hospital in Department of Orthopedic Surgery has his 3 years’ service in Korean Armed force Gangneung Hospital. His research interest and commitment are in the field of Orthopedic Surgery.
We encountered 11 patients with bipolar clavicle injuries including dislocation of both ends of the clavicle, dislocation of the sternoclavicular joint with distal clavicle fracture, dislocation of the acromioclavicular joint with medial clavicle fracture and segmental fracture of the clavicle. The purpose of this study was to report the clinical outcomes with a literature review of bipolar clavicle injury. We retrospectively reviewed 11 patients with bipolar clavicle injuries. Non-operative treatment was performed in five patients and surgical treatment in six patients. The fracture or dislocation of the lateral end of the clavicle was fixed with AO hook plate and closed reduction of the medial end was performed. If the dislocation was still present, open reduction and anterior sternoclavicular ligament repair was performed. Visual Analog Scale (VAS) pain score, constant score, active range of motion, and radiological images were evaluated to determine the results. Mean VAS pain score was 0.7±0.9 (range, 0-2). Mean constant score was 89.7±7.6 (range, 72-96). Mean constant score of conservatively treated patients was 84.2±8.5 (range, 72-96) and that of surgically treated patients was 94.3±1.9 (range, 92-96). The mean constant score of patients in whom optimal reduction of one or both ends was not achieved was 83.4±7.2 (range, 72-92). Residual pain or deformity was seen in five patients. We suggest operative treatment of bipolar clavicle injuries in younger, active patients when anatomical reduction cannot be achieved and when residual deformity, pain or functional limitations are not accepted.
Yip Swee Yan is currently a Medical Student in University of Glasgow and has an interest in innovative surgical techniques and areas regarding improvement of patient outcomes.
Introduction & Aim: Per-Oral Endoscopic Thyroidectomy (POET) is a developing novel technique based on the principles of minimally invasive surgery offering scar-free thyroidectomy. To date, results from various individual centers have been published internationally but none from Malaysia or Singapore. This paper discusses the surgical outcomes of POET compared to conventional thyroidectomy to investigate the feasibility of POET as a safe alternative. Methodology: This is a single tertiary hospital, single surgeon based retrospective analysis of 98 selected patients (mean age: 43.5 years old) undergoing POET in 14 months (May 2017 to July 2018). It records the complication rates post-operatively until day of discharge. Inclusion criteria: Benign cyst, benign follicular adenoma or nodule, multinodular goiter, toxic goiter, thyroiditis (Hashimoto’s and Lymphocytic), thyroid carcinoma (papillary and follicular). Exclusion criteria: Size of lesion >10 cm either dimension on ultrasound neck. Results: The average length of stay (2 days) and average time of operation (72 minutes) was comparable to that of conventional Video Assisted Thyroidectomy (VAT). There was no blood loss >500 ml (0%) and no wound infection (0%) recorded among the 98 patients. Only 1 out of 98 patients (1%) had permanent recurrent laryngeal nerve palsy. Clinical hypocalcemia described as cramp and lip paresthesia was experienced by 6 patients (6%). However, only 1 out of 98 (1%) had corresponding low blood calcium levels, defined as less than 2.1 mmol/L of calcium. 5% had transient mental nerve injury described as mental paresthesia. Conclusion & Significance: POET is a promising safe alternative technique to thyroidectomy with significantly better surgical outcome as compared to video assisted endoscopic thyroidectomy. It can be an option to offer patients who are especially driven to achieve perfect cosmesis. In terms of operation time and identification of RLN, it is comparable to VAT. This technique has a strong potential to be useful when lowering the rate of developing keloidal scar and hypertrophic scaring.