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Femoral shaft fracture is one of the most common injuries encountered. However, improper management can lead to significant long-term complications, of which is malunion. Patients with femoral malunion are at increased risk of developing knee osteoarthritis, and if arthroplasty is indicated, these extra-articular deformities pose a challenge as corrective osteotomy and soft tissue release are also required. In such circumstances, robotic arm-assisted total knee arthroplasty (RATKA) might be an appropriate option. In this case, we present a 66-year-old woman who had previously suffered a femur shaft fracture, which was treated conservatively, and developed a varus malunion and severe knee osteoarthritis, and who was treated with RATKA. [ABSTRACT FROM AUTHOR]

Background: Preterm birth is the most significant factor for infant morbidity and mortality. Preterm infants are highly vulnerable to substantial comorbidities and need to be admitted to the neonatal intensive care unit (NICU). Prematurity and low birth weight (LBW) of infants, in particular, have been found to have a higher substantial burden on family resources and health-care resources after discharge from the hospital. Objective: To obtain data as a basis for strategic planning and efficient delivery of health-care resources, this study aims to determine the extent of health-care facility utilization among preterm infants during their first 2 years of life after discharge from the NICU. Materials and Methods: This was a retrospective cohort study design by reviewing the electronic medical records of preterm infants (i.e., <37 weeks' gestation) who were discharged from the NICU. Their outcomes were compared to healthy term infants. All examined infants were delivered at King Abdulaziz Medical City, Jeddah, Saudi Arabia, from June 1, 2016, to April 30, 2018. Results: In this single-center study, the NICU admission rate was 8.6%, and 4.18% of those were premature. In terms of facility utilization, preterm infants had a significantly higher frequency of outpatient visits, laboratory, and radiology performed as compared to healthy term infants. Preterm infants were also significantly and more likely to be admitted to the inpatient department. In subgroup analysis, very preterm, extremely preterm, low birth weight (LBW), very LBW (VLBW), and extremely LBW (ELBW) infants had higher outpatient visits and higher laboratory and radiology performed. Conclusions: Preterm infants utilized more health-care resources than healthy term infants. Very preterm, extremely preterm, VLBW, and ELBW infants had more outpatient visits and utilized the laboratory and radiology services more often than other subgroups. This study suggests developing an innovative strategic plan to effectively meet preterm infants' health-care needs, particularly by improving services in mostly utilized hospital resources. [ABSTRACT FROM AUTHOR]

Objectives This study aims to evaluate the feasibility, safety, limitations, and outcomes of performing different surgical approaches and techniques for the bedside repair of congenital diaphragmatic hernia (CDH) in critically ill patients who cannot be transferred to the operating room. Study Design Between December 1997 and July 2013, medical charts of all neonates operated on at the bedside for CDH while on high-frequency oscillatory ventilation (HFOV) and nitric oxide were reviewed. Demographic data; contributing antenatal, perinatal, and postnatal factors; clinical presentation; associated anomalies; respiratory and hemodynamic status; operative details; complications, and outcome were analyzed. Results A total of 101 cases of CDH were operated on, of which 11 were in very critical condition and operated on at the bedside in the neonatal intensive care unit (NICU). The mean gestational age was 38.09 weeks, birth weight, 2.91 kg, and age at surgery, 10 days. All were on HFOV and inotropic support and had pulmonary hypertension. Nine of them were on nitric oxide. Mean preoperative parameters were as follows: O2, 52%; mean airway pressure, 15; pH, 7.40; PO2, 88.5 mm Hg; and PCO2, 47 mm Hg. Nine patients underwent laparotomy and two underwent thoracoscopy. All procedures were completed uneventfully. Conclusions Bedside repair of CDH in the NICU while on HFOV is feasible and safe. It is not associated with any compromise in the surgical approach or technique. [ABSTRACT FROM AUTHOR]