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Browsing by Author "Chang, Joshua H."
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Item A Novel Use of a Schanz Pin-Rectal Foreign Body Extraction: A Case Report(JOCR, 2024) Chang, Joshua H.; Haag, Luke; Mohanty, Sanjay; Natoli, Roman M.; Surgery, School of MedicineIntroduction: Retained rectal foreign bodies (RFBs) can be difficult to extract, forcing the surgeon to get creative. This is the first case report utilizing orthopedic drilling and joystick manipulation techniques for foreign body extraction. Case report: A 63-year-old male presented to the emergency department with a pool ball in his rectum for two days. Extraction attempts under anesthesia both transanally and through a low midline laparotomy were unsuccessful due to the patient's pelvic anatomy. Orthopedic surgery was consulted to see if any manipulation or resection of the pelvis might aid in extraction. Ultimately, a Schanz pin was drilled retrogradely from the rectum into the pool ball and successfully manipulated the pool ball out of the patient. Conclusion: Techniques such as drilling and joystick manipulation are common in orthopedic surgery but rarely used in other surgical fields. This case presented a novel use of a Schanz pin in RFB extraction. Application of orthopedic surgical technique in a colorectal surgery in this case saved the patient from more invasive interventions such as pubic symphysiotomy or ischial tuberosity resection.Item Early Treatment of Acetabular Fractures via an Anterior Approach Increases Blood Loss but not Packed Red Blood Cell Transfusion(Wolters Kluwer, 2024-01) Mullis, Brian H.; Chang, Joshua H.; Shah, Nihar; Sabbagh , Ramsey S.; Yu, Qing; Archdeacon, Michael T.; Sagi, H. Claude; Natoli, Roman M.; Orthopaedic Surgery, School of MedicineOBJECTIVE: The objective of this study was to determine whether time from hospital admission to surgery for acetabular fractures using an anterior intrapelvic (AIP) approach affected blood loss. METHODS: Design: Retrospective review. Setting: Three level 1 trauma centers at 2 academic institutions. Patient Selection Criteria: Adult (18 years or older) patients with no pre-existing coagulopathy treated for an acetabular fracture via an AIP approach. Excluded were those with other significant same day procedures (irrigation and debridement and external fixation were the only other allowed procedures). Outcome Measures and Comparisons: Multiple methods for evaluating blood loss were investigated, including estimated blood loss (EBL), calculated blood loss (CBL) by Gross and Hgb balance methods, and packed red blood cell (PRBC) transfusion requirement. Outcomes were evaluated based on time to surgery. RESULTS: 195 patients were studied. On continuous linear analysis, increasing time from admission to surgery was significantly associated with decreasing CBL at 24 hours (−1.45 mL per hour by Gross method, P = 0.003; −0.440 g of Hgb per hour by Hgb balance method, P = 0.003) and 3 days (−1.69 mL per hour by Gross method, P = 0.013; −0.497 g of Hgb per hour by Hgb balance method, P = 0.010) postoperative, but not EBL or PRBC transfusion. Using 48 hours from admission to surgery to define early versus delayed surgery, CBL was significantly greater in the early group compared to the delayed group (453 [IQR 277–733] mL early versus 364 [IQR 160–661] delayed by Gross method, P = 0.017; 165 [IQR 99–249] g of Hgb early versus 143 [IQR 55–238] g Hgb delayed by Hgb balance method, P = 0.035), but not EBL or PRBC transfusion. In addition, in multivariate linear regression, neither giving tranexamic acid nor administering prophylactic anticoagulation for venous thromboembolism on the morning of surgery affected blood loss at 24 hours or 3 days postoperative (P > 0.05). CONCLUSION: There was higher blood loss with early surgery using an AIP approach, but early surgery did not affect PRBC transfusion and may not be clinically relevant. LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.