Brachial plexus injuries (BPIs) are present in 1.2
Accurate assessment of coronal alignment is essential for total knee arthroplasty (TKA) planning. The Coronal Plane Alignment of the Knee (CPAK) classification integrates mechanical alignment and joint line obliquity into nine phenotypes, but its reliability depends on measurement accuracy. This study aimed to compare the accuracy and reliability of CPAK classification and coronal alignment parameters obtained from computed tomography (CT) and long-leg standing radiographs. A prospective comparative study was conducted on 100 patients undergoing primary TKA for degenerative arthritis. Each patient underwent standardized long-leg standing radiographs and full-limb CT scans using MAKO robotic planning software. Measurements included the arithmetic hip–knee–ankle (aHKA) angle, lateral distal femoral angle (LDFA), medial proximal tibial angle (MPTA), and joint line obliquity (JLO). CPAK classification was determined from aHKA and JLO values. Two independent observers recorded all parameters. Inter-modality differences were analyzed using paired t-tests, and reliability was assessed using intraclass correlation coefficients (ICC) and Cohen’s kappa. A total of 100 patients were analyzed, with complete datasets for 86 patients. CT consistently produced different values for HKA, LDFA, and MPTA compared with radiographs (p < 0.001), while aHKA, JLO and CPAK classifications showed no significant difference. Both modalities demonstrated excellent interobserver reliability (ICC > 0.88) and near-perfect CPAK agreement (κ = 0.86–0.88) measurement without altering overall CPAK phenotype classification. CT-based measurements provide greater precision and reproducibility for coronal alignment parameters compared with radiographs. However, CPAK classification remains largely consistent between modalities, validating its robustness across imaging techniques. CT offers precise value for preoperative planning, particularly in robotic-assisted workflows or complex deformities, while radiographs remain adequate for routine phenotyping. Level II – Prospective comparative study.
Minor traumatic brain injury in infancy leading to fatal hemispheric cerebral infarction is a rare entity. We present the case of an 8-month-old child who developed a right-sided hemispheric infarction following trivial trauma, consistent with an acute ischemic stroke involving the territories of the right anterior, middle, and posterior cerebral arteries. The patient was initially managed conservatively, and surgical intervention was planned after resuscitation improved the Glasgow Coma Scale (GCS) score from 3/15 to 5/15. A right-sided decompressive hemicraniectomy was subsequently performed. The patient was discharged with a GCS of 11/15 on postoperative day 17. This case highlights the resilience and potential for recovery in pediatric patients with timely and appropriate intervention, despite severe radiological and clinical findings.
Total intravenous anaesthesia (TIVA) using propofol-remifentanil versus sevoflurane maintenance affects postoperative recovery, PONV and patient outcomes in laparoscopic surgery, though evidence varies. Hence, this randomised trial compared TIVA (n=60) versus sevoflurane (n=60) in 120 ASA I-III adults undergoing elective laparoscopic cholecystectomy with standardised protocols. TIVA accelerated extubation (7.4 ±2.1 vs 9.6±2.5 min; p<0.001), Aldrete ≥9 recovery (23.1±4.8 vs 29.2±6.1 min; p<0.001) and shortened PACU stay (40 [35-45] vs 50 [42-60] min; p=0.002). TIVA reduced PONV incidence (20% vs 38.3%; p=0.03) with less rescue antiemetic use, while pain scores and opioid requirements stayed comparable between groups. Propofol-remifentanil TIVA optimises early recovery, lowers PONV and boosts 24-hour QoR-15 scores versus sevoflurane, positioning it as the superior choice for enhanced postoperative outcomes.
