BMC Surgery最新文献

Background: Femoral shaft fractures (FSFs) are critical injuries that impose a substantial burden on patients and society, frequently resulting in catastrophic loss of employment and long-term disability in low- and middle-income countries (LMICs). While clinical management often focuses on reactionary surgical fixation, the high incidence of road traffic injuries and geriatric falls in Ethiopia necessitates a shift toward systemic preventative medicine. This study aimed to determine the prevalence and associated factors of FSFs among adult patients at Ethiopia's largest trauma center to provide a bimodal evidence base for public health advocacy and injury prevention strategies.

Methods: A hospital-based cross-sectional study was conducted at Addis Ababa Burn, Emergency, and Trauma (AaBET) Hospital between September 2023 and August 2024. The study included adult patients (≥ 18 years) admitted for the management of extremity fractures. A systematic random sampling technique was used to select 419 medical records, of which 388 were complete and included in the final analysis. Data were extracted using a structured checklist and analyzed using SPSS version 27. Logistic regression was employed to identify factors associated with femoral shaft fractures.

Results: Among 388 patients admitted with extremity fractures, 192 (49.5%) sustained femoral fractures. Of these, 56 had femoral shaft fractures, resulting in a prevalence of 14.4% (95% CI: 10.9-17.9) among all extremity admissions and 29.1% (95% CI: 22.7-35.6) among femoral fractures. Proximal femur fractures were the most common femoral sub-type (54.7%). Road traffic accidents (42.0%) and falls (40.7%) were the leading mechanisms. Multivariable analysis revealed that older age was a significant protective factor against shaft fractures compared to younger adults (19-45 years): age 46-65 (AOR = 0.23; 95% CI: 0.08-0.65; p = 0.006) and age > 66 (AOR = 0.05; 95% CI: 0.01-0.22; p < 0.001). Ground-level falls were significantly less likely to result in shaft fractures compared to falls from height (AOR = 0.07; 95% CI: 0.02-0.30; p < 0.001).

Conclusions: Femoral fractures constitute a major proportion of the traumatic workload in Ethiopia. Our findings suggest that clinical excellence in surgical fixation is insufficient to address this burden. We advocate for a firm transition toward preventative medicine led by trauma and orthopedic associations. This must include a bimodal strategy: aggressive public campaigns for seatbelt and helmet enforcement to protect the young workforce from high-energy trauma, and the implementation of osteoporosis screening and fall-prevention programs to mitigate fragility fractures in the aging population.

Background: Wrist ganglion cysts (GCs) are the most common soft-tissue masses of the hand and wrist. Although surgical excision is considered the most effective treatment, recurrence remains a clinical concern. Anatomical and demographic predictors of postoperative recurrence are not well established.

Methods: We included 347 patients who underwent surgical excision of wrist GCs between 2015 and 2023, with a minimum follow-up of 24 months. Clinical data (age, sex, side, hand dominance) and magnetic resonance imaging (MRI)-based topographic features (volume, surface area, wall thickness, location, longest and shortest diameters, aspect ratio, and distance to the adjacent joint) were recorded retrospectively. The primary outcome was cyst recurrence at a minimum follow-up of 24 months, defined as clinically or radiologically confirmed return of the cyst. Statistical analyses included chi-square tests, t-tests or Mann-Whitney U tests, and univariable and multivariable logistic regression analyses. All analyses were performed in the Python (Google Colab) environment using the pandas, NumPy, SciPy, and statsmodels libraries.

Results: The overall recurrence rate at a minimum follow-up of 24 months was 8.6% (30 of 347). Dominant-hand involvement was significantly associated with recurrence (χ² p = 0.006). In age-adjusted logistic regression, dominant-hand involvement increased the risk (OR = 6.51; 95% CI, 1.87-22.63; p = 0.003). Cyst distance to the adjacent joint was significantly shorter in recurrent cases (mean 7.6 mm vs. 8.1 mm; t-test p = 0.001, Mann-Whitney U p = 0.021). Based on age-adjusted logistic regression, each additional millimeter of cyst-to-joint distance conferred a 41% relative reduction in recurrence risk (OR = 0.59; 95% CI, 0.39-0.90; p = 0.013).

Conclusions: MRI-based evaluation of cyst-to-joint distance and consideration of dominant-hand involvement may help identify patients at increased risk of recurrence after surgical excision of wrist GCs. Incorporating these factors into preoperative planning may optimize surgical strategy, guide follow-up, and improve patient counseling.

Background: Biliary complications (BCs) remain a frequent and clinically important cause of morbidity after living donor liver transplantation (LDLT), with adverse effects on graft function and long-term survival. However, evidence from Central Asia remains scarce.

Aim: To evaluate the incidence, risk factors, and survival impact of BCs in adult LDLT recipients at a Central Asian centre.

Methods: This retrospective observational cohort study included 205 adult recipients who underwent living donor liver transplantation between 2011 and 2024. Biliary complications were defined based on combined clinical, biochemical, and radiological criteria. Patients were stratified according to biliary anatomy and reconstruction technique. Risk factors for biliary complications were evaluated using logistic regression analysis. Overall survival was assessed using the Kaplan-Meier method and compared between groups using the log-rank test.

Results: BCs developed in 50 patients (24.4%). Biliary strictures occurred in 27 patients (54.0%), bile leakage in 15 (30.0%), and combined lesions in 8 (16.0%). Multivariate analysis identified male sex (odds ratio [OR] 2.11, 95% confidence interval [CI] 1.01-4.39; p = 0.045) and multiple bile ducts (OR 2.92, 95% CI 1.33-6.39; p = 0.008) as independent predictors of BCs. Prolonged cold ischaemia time was significant on univariate analysis but not after adjustment. Overall survival at 1, 3, and 5 years in the entire cohort was 85.7%, 81.0%, and 78.0%, respectively. Patients with BCs demonstrated reduced long-term survival compared with the overall transplant cohort, with survival rates of 93.3%, 78.3%, and 73.3% at the corresponding time points.

Conclusion: In this Central Asian LDLT cohort, multiple bile ducts and male sex were independent risk factors for biliary complications, which were associated with poorer long-term survival. Careful preoperative biliary evaluation, preservation of ductal blood supply, and tailored reconstruction techniques are critical to reducing biliary morbidity and improving outcomes following LDLT.