The histopathological spectrum and molecular changes associated with KRAS G12C mutation in non-small cell lung carcinoma.

KRAS G12C is the most common KRAS mutation in non-small cell lung carcinoma (NSCLC), for which targeted therapy has recently been developed. From the 732 cases of NSCLC that underwent next-generation sequencing at the Department of Anatomical Pathology, Liverpool Hospital, between July 2021 and May 2023, we retrieved 83 (11%) consecutive cases of KRAS G12C mutated NSCLC, and analysed their clinical, pathological, and molecular features. Of the 83 cases of KRAS G12C mutated NSCLC, there were 46 (55%) men and 37 (45%) women, with mean age of 72 years.

Case report: Management of infiltrative basosquamous carcinoma of the sternum.

Introduction And Importance: Basosquamous carcinoma (BSC) is a rare cutaneous cancer defined as a basal-cell carcinoma that has differentiated into a squamous-cell carcinoma. It is aggressive and infiltrative, and known for its multiple recurrences and risk for metastasis.

Case Presentation: This article describes the case of a 78-year-old man who presented with a several-year history of an infiltrative BSC of his chest-wall invading into his sternum.

Bronchial artery pseudoaneurysm presenting with hoarseness: Diagnosis and endovascular management.

Bronchial artery pseudoaneurysm is a rare entity which is diagnosed radiologically; with or without symptoms. Symptoms of phonation changes with bronchial artery pseudoaneurysm are yet to be reported. This article describes the case of a 56-year-old man who presented with a history of a hoarse voice.

Operative fixation of rib fracture nonunions.

Introduction: Rib fractures are common injuries in trauma patients that often heal without intervention. Infrequently, symptomatic rib fracture nonunions are a complication after rib fractures. There is a paucity of literature on the surgical treatment of rib fracture nonunion.

First Extensor Compartment Tendon Rupture in the Setting of a Radial Styloid and Both-Bone Forearm Fracture: A Case Report.

Case: We report on the rare occurrence of first extensor compartment tendon injury at the myotendinous junction after fractures of the radial styloid and both-bone forearm in a healthy 59-year-old man. Here, a novel technique for repair of this unique injury and an additional proposed mechanism of tendon rupture are discussed.

Conclusion: We advocate for the suspicion of tendon rupture in the first dorsal compartment with fractures of the radial styloid and both-bone forearm.

Independent Predictors of Postoperative Stroke With Cardiopulmonary Bypass.

Objective: To assess predictive factors of postoperative stroke in cardiac surgery using cardiopulmonary bypass (CPB).

Design: This study was a retrospective observational study.

Setting: This study was conducted at a single institution (Liverpool Hospital, NSW, Australia).

Balanced Chest Drainage Prevents Post-Pneumonectomy Pulmonary Oedema.

Background: Pneumonectomy in the adult patient is associated with a mortality of 1-9%. Death is often due to post pneumonectomy pulmonary oedema (PPPO). The use of balanced chest drainage system (BCD) in the setting of post pneumonectomy has been reported to be of benefit in the prevention of PPPO.

Central airway obstruction caused by adenoid cystic carcinoma in pregnancy: a case report and review of the literature.

Malignancy complicates one in a thousand pregnancies. The most frequently diagnosed of these are breast, cervical, melanoma, ovarian, and haematological neoplasms. Tumours of respiratory origin are very uncommon during pregnancy.

Midshaft clavicle fractures with associated ipsilateral acromioclavicular joint dislocations: Incidence and risk factors.

Introduction: Simultaneous ipsilateral clavicle and acromioclavicular (AC) joint injury have been infrequently reported in the literature at this time. The purpose of this study was to assess incidence as well as assess risk factors for this dual injury pattern.

Methods: We performed a retrospective review of a prospectively collected database (Level III evidence), evaluating 383 adult patients without previous shoulder girdle injury or trauma with a minimum 1-year follow-up who sustained a displaced diaphyseal clavicle fracture.

Clinical Outcomes of Surgical Stabilization of Flail Chest Injury.

Introduction: Recent reported success in surgical stabilization of flail chest has been described in small series, but scant evidence exists for this procedure in the orthopaedic literature.

Methods: We reviewed 88 consecutive patients who underwent surgical stabilization of flail chest, along with 88 consecutive patients with flail chest who underwent traditional closed management before initiation of our algorithm change to surgical management.

Results: Surgical stabilization of flail chest injuries led to statistically significant decreases in hospital length of stay, ventilator-dependency time, pneumonia, tracheostomy, and mortality rate.

Equivalent outcomes after coronary artery bypass graft surgery performed by consultant versus trainee surgeons: A systematic review and meta-analysis.

Objective: In recent years, concerns have been raised about the learning opportunities available to cardiac surgical trainees. This meta-analysis was conducted to assess the impact of trainee operator status on clinical outcomes after coronary artery bypass graft (CABG) surgery.

Methods: Medline, EMBASE, and the Cochrane Library were systematically searched for studies that reported CABG outcomes according to the training status of the primary operator (consultant vs trainee).

Clinical Comparison of Minifragment Plates Versus Conventional Semitubular Plates for Fixation of Distal Fibula Fractures.

Background: Although operative stabilization of unstable distal fibula fractures is frequently performed and discussed, the ideal implant and technique for these injuries is still debated.

Questions/purposes: The purpose of this study was to determine if minifragment plating of distal fibula fractures would clinically provide equivalent fixation and cost and minimize hardware prominence when compared with standard one-third tubular plating.

Patients And Methods: A retrospective review was conducted on 44 patients who had undergone operative stabilization of a displaced fibula fracture.

Successful treatment of a recalcitrant pleural effusion with rib fracture fixation.

Pulmonary complications of rib fractures typically occur in the immediate postinjury period, as a result of the forces causing the injury or subsequent rib fracture displacement. Pneumothorax, hemothorax, pulmonary contusions, or parenchymal lacerations are frequently seen with significant chest wall trauma. Hemopneumothorax is typically treated with tube thoracostomy, and full resolution of the pleural injury is expected; continued pleural fluid accumulation despite these measures is unanticipated, rare, and quite problematic.

Treatment of acetabulum fractures through the modified Stoppa approach: strategies and outcomes.

Background: Since the original description by Letournel in 1961, the ilioinguinal approach has remained the predominant approach for anterior acetabular fixation. However, modifications of the original abdominal approach described by Stoppa have made another option available for reduction and fixation of pelvic and acetabular fractures.

Questions/purposes: We evaluated our results in patients with acetabulum fractures with the modified Stoppa approach in terms of (1) hip function as measured by the Merle d'Aubigne hip score; (2) complications; and (3) quality of fracture reduction and percentage of fractures that united.

Plating of patella fractures: techniques and outcomes.

Operative treatment of displaced patella fractures with tension band fixation remains the gold standard, but is associated with a significant rate of complications and symptomatic implants. Despite the evolution of tension band fixation to include cannulated screws, surprisingly little other development has been made to improve overall patient outcomes. In this article, we present the techniques and outcomes of patella plating for displaced patella fractures and patella nonunions.

Surgical approaches for rib fracture fixation.

Operative management of thoracic injuries is an increasingly accepted technique, with multiple reports of improved patient outcomes as compared with nonoperative treatment. Despite the evolving support of rib fracture fixation, descriptions of surgical approaches and tactics remain limited. We present this information to allow surgeons to begin or improve treatment of these injuries.

Gritti-Stokes Amputation in the Trauma Patient: Tips and Techniques.

Introduction: The Gritti-Stokes amputation establishes osseous continuity between the patella and the distal part of the femur with maintenance of the intact prepatellar soft tissues.

Step 1 Preoperative Planning: As with all orthopaedic surgery, preoperative planning is essential to obtaining an optimal outcome with this procedure.

Step 2 Flap Design: Use an asymmetric flap consisting of the undisturbed prepatellar soft tissues and rotate it posteriorly to achieve closure.

Gritti-stokes amputations in the trauma patient: clinical comparisons and subjective outcomes.

Background: The Gritti-Stokes amputation procedure is a modification of the traditional transfemoral amputation, with resection of the bone at a supracondylar femoral level and fixation of the patella to the distal part of the femur as an end-cap. Although well-established in patients with vascular compromise, no evidence exists on its use in the trauma setting.

Methods: Fourteen consecutive patients who underwent Gritti-Stokes amputation and fifteen consecutive patients who underwent traditional transfemoral amputation by fellowship-trained orthopaedic traumatologists at a level-I trauma center were evaluated at more than fourteen months postoperatively.

Induced membrane technique for reconstruction to manage bone loss.

Multiple surgeries are often required to manage segmental bone loss because of the complex mechanics and biology involved in reconstruction. These procedures can lead to prolonged recovery times, poor patient outcomes, and even delayed amputation. A two-stage technique uses induced biologic membranes with delayed placement of bone graft to manage this clinical challenge.

Medial malleolar fractures: a biomechanical study of fixation techniques.

Fracture fixation of the medial malleolus in rotationally unstable ankle fractures typically results in healing with current fixation methods. However, when failure occurs, pullout of the screws from tension, compression, and rotational forces is predictable. We sought to biomechanically test a relatively new technique of bicortical screw fixation for medial malleoli fractures.

Plating of acute humeral diaphyseal fractures through an anterior approach in multiple trauma patients.

Objective: We evaluated the clinical and long-term functional outcomes of humeral diaphyseal fractures treated with acute anterior plating in a trauma population.

Design: Single-center, retrospective cohort analysis with long-term prospective follow-up.

Setting: Urban, Level I trauma center.

Osteomyoplastic and traditional transtibial amputations in the trauma patient: perioperative comparisons and outcomes.

We hypothesized that patients undergoing transtibial amputation osteomyoplasty would have better functional outcomes than patients undergoing traditional transtibial amputation. We conducted a retrospective review of the medical and radiographic records to evaluate and compare 26 patients who underwent transtibial amputation osteomyoplasty and 10 patients who underwent traditional transtibial amputation, with specific attention to perioperative complications and functional outcomes. At >1 year follow-up, patients who underwent amputation osteomyoplasty had significantly improved rates of return to work and decreased rates of revision than patients who underwent traditional transtibial amputation.