Early Definitive Fixation of an Open Periprosthetic
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Influence of treatment modality on morbidity and mortality in periprosthetic femoral fracture. A comparative study of 71 fractures treated by internal fixation or femoral implant revision S. Cohen, X. Flecher, S. Parratte, M. Ollivier, Jean-Noël Argenson To cite this version: S. Cohen, X. Flecher, S. Parratte, M. Ollivier, Jean-Noël Argenson. Influence of treatment modality on morbidity and mortality in periprosthetic femoral fracture. A comparative study of 71 fractures treated by internal fixation or femoral implant revision. Orthopaedics and Traumatology -Surgery and Research, Elsevier, 2018, 104 (3), pp.363-367. 10.1016/j.otsr.2017.12.018. hal-01960509 HAL Id: hal-01960509 https://hal.archives-ouvertes.fr/hal-01960509 Submitted on 22 Apr 2019 HAL is a multi-disciplinary open access L’archive ouverte pluridisciplinaire HAL, est archive for the deposit and dissemination of sci- destinée au dépôt et à la diffusion de documents entific research documents, whether they are pub- scientifiques de niveau recherche, publiés ou non, lished or not. The documents may come from émanant des établissements d’enseignement et de teaching and research institutions in France or recherche français ou étrangers, des laboratoires abroad, or from public or private research centers. publics ou privés. Original article Influence of treatment modality on morbidity and mortality in periprosthetic femoral fracture. A comparative study of 71 fractures treated by internal fixation or femoral implant revision. S. Cohena, X. Flechera,*, S. Parrattea, M. Olliviera, -
Canadian Society of Plastic Surgeons Société Canadienne Des Chirurgiens Plasticiens
ABSTRACTS/RÉSUMÉS Canadian Society of Plastic Surgeons Société Canadienne des Chirurgiens Plasticiens Abstracts presented at the 69th Annual Meeting / 69e Réunion annuelle June 2 – 6, 2015, Victoria, British Columbia Dr Edward Tredget: President/Président Dr Howard Clarke: Vice President / Vice-président, Scientific Program Chair / Comité de programme scientifique Dr Chris Taylor: Local Organizing Committee Chair / Président, Comité d’accueil 02 EYE-OPENER SESSION FUNCTIONAL OUTCOMES OF ENOPHTHALMOS 00 CORRECTION PELVIC, PERINEAL AND VAGINAL RECONSTRUCTION M McRae, A Budning, C Lynham, O Antonyshyn C Butler Toronto, ON University of Texas MD Anderson Cancer Center, Houston, Texas, PURPOSE: Determine functional outcomes of late post-traumatic enoph- USA thalmos repair, specifically, ocular motility, diplopia, and strabismus. Learning Objectives: METHODS: The study series comprises 81 consecutive patients with late 1. Participants will recognize advantages and disadvantages of flap reconstruc- post-traumatic enophthalmos with functional impairment, that underwent tion of pelvic and perineal defects following abdominal perineal resection or enophthalmos repair by a single surgeon (OA) between May 2002 and pelvic exenteration. April 2014. Of those, 39 patients fulfilled study inclusion and exclusion 2. Participants will identify strategies to reconstruct the pelvic, perineal and vaginal criteria. Outcomes (diplopia, limitations of ocular motility, and strabismus) structures using flaps from various donor sites. were assessed independently by a single ophthalmologist who specializes in 3. Participants will understand the advantages and disadvantages of thigh-based strabismus surgery (AB), and were performed preop and postop for each and abdominal-based flaps for pelvic/perineal reconstruction. patient. Results: Average age was 43.1 (range 15-79) with 26 males, and 13 females. -
Periprosthetic Fractures Around Loose Femoral Components
Review Article Periprosthetic Fractures Around Loose Femoral Components Abstract Roshan P. Shah, MD, JD The development of periprosthetic fractures around loose femoral Neil P. Sheth, MD components can be a devastating event for patients who have undergone total hip arthroplasty (THA). As indications for THA expand Chancellor Gray, MD in an aging population and to use in younger patients, these fractures Hassan Alosh, MD are increasing in incidence. This review covers the epidemiology, risk Jonathan P. Garino, MD factors, prevention, and clinical management of periprosthetic femoral fractures. Treatment principles and reconstructive options are discussed, along with outcomes and complications. Femoral revision with a long-stem prosthesis or a modular tapered stem is the mainstay of treatment and has demonstrated good outcomes in the literature. Other reconstruction options are available, depending on bone From Columbia University, New York, quality. Surgeons must have a sound understanding of the diagnosis NY (Dr. Shah), the University of and treatment of periprosthetic femoral fractures. Pennsylvania, Philadelphia, PA (Dr. Sheth, Dr. Gray, and Dr. Alosh), and the Pennsylvania Orthopedic Center, Alvern, PA (Dr. Garino). otal hip arthroplasty (THA) The incidence of periprosthetic hip Dr. Shah or an immediate family Treliably treats hip pain caused by fractures is increasing. Bhattacharyya member has stock or stock options articular cartilage degeneration; et al5 found a 216% increase between held in Pfizer, Merck, GlaxoSmithKline, Alnylam, and Intuitive Surgical. however, the development of peri- 2002 and 2006. Several reasons for Dr. Sheth or an immediate family prosthetic femoral fractures after the increase have been proposed.1,2 member serves as a paid consultant to THA is a devastating complication. -
2012-2013 Research Abstracts CASE SURGERY a Compilation of Investigations Made by Case Surgery Physicians, Research Scientists and Distinguished Colleagues
2012-2013 Research Abstracts CASE SURGERY A compilation of investigations made by Case Surgery physicians, research scientists and distinguished colleagues. 12-13Abstracts.indd 1 10/22/13 12:51 PM Dear Colleague: I am pleased to share with you our 2012-2013 research abstracts. The Department of Surgery provides a multi-specialty academic environment where ideas are exchanged and cooperative research programs are planned. The 2012-13 academic year has been a productive one for the Department and its members. The work produced has been presented at national and international forums and published in prestigious journals. The Department of Surgery will continue to expand its research and educational endeavors in the coming year. We welcome your interest in our Department’s research and clinical studies. If you would like additional information, please call 216.844.3209 or visit our website at www.casesurgery.com. Sincerely, Jeffrey L. Ponsky, MD Oliver H. Payne Professor and Chair 12-13Abstracts.indd 2 10/22/13 12:51 PM Special thanks to the Case School of Medicine Biologic Research Unit for their continued support. Section 1: Cardiac Surgery CONCURRENT ASYMPTOMATIC CARDIAC MYXOMA AND RENAL CELL CARCINOMA ......................................................................................................................... 3 Vineeta Gahlawat, MD, Yakov Elgudin, MD Table of Contents Table Section 2: Colorectal Surgery PROCESS IMPROVEMENT IN COLORECTAL SURGERY: MODIFICATIONS TO AN ESTABLISHED ENHANCED RECOVERY PROTOCOL ................................................... -
Early Appropriate Care of Orthopaedic Injuries in Elderly Multiple-Trauma Patients Michael S
Scientific Poster #115 Polytrauma OTA 2014 Early Appropriate Care of Orthopaedic Injuries in Elderly Multiple-Trauma Patients Michael S. Reich, MD; Andrea J. Dolenc, BS; Timothy A. Moore, MD; Heather A. Vallier, MD; MetroHealth Medical Center, Cleveland, Ohio, USA Background/Purpose: This study was designed to evaluate clinical predictors of complications in multiply injured elderly trauma patients with orthopaedic injuries. Previous work from our institution has established resuscitation parameters that minimize complications with early fracture management. Protocol recommendations included definitive management of mechanically unstable fractures of the pelvis, acetabulum, spine, and femur within 36 hours, provided the patient demonstrated a positive response to resuscitative efforts, including lactate <4.0, pH ≥7.25, or base excess (BE) ≥–5.5 mmol/L. This protocol has been applied to all skeletally mature patients, but patients with advanced age or preexisting medical issues may require unique parameters to mitigate risk of complications and mortality. Methods: Between October 2010 and March 2013, 376 skeletally mature patients with 426 unstable fractures of the pelvis (n = 73), acetabulum (n = 58), spine (n = 112), and/or proximal or diaphyseal femur fractures (n = 183) were treated at a Level I trauma center and were prospectively studied. Subgroups of patients age ≤30 years (n = 114) and ≥60 years (n = 37), treated within 36 hours of injury, were compared. Low-energy fractures were excluded. The ISS, Glasgow Coma Score (GCS), and American Society of Anesthesiologists (ASA) classification were determined. Lactate, pH, and BE were measured at 8-hour intervals and perioperatively. Complications included pneumonia, pulmonary embolism (PE), acute renal failure (ARF), acute respiratory distress syndrome (ARDS), multiple organ failure (MOF), deep vein thrombosis (DVT), infection, sepsis, and death. -
Critical Care Management of Traumatic Brain Injury
Critical care management of traumatic brain injury Handbook of Clinical Neurology 2017 Final submitted version corrected for changes during editorial processing (with the permission of the publishers) DK Menon1,* and A Ercole1 1Division of Anaesthesia, University of Cambridge and Neurosciences/Trauma Critical Care Unit, Addenbrooke's Hospital,Cambridge, UK *Corresponding author. Email [email protected] Abstract Traumatic brain injury (TBI) is a growing global problem, which is responsible for a substantial burden of disability and death, and which generates substantial healthcare costs. High-quality intensive care can save lives and improve the quality of outcome. TBI is extremely heterogeneous in terms of clinical presentation, pathophysiology, and outcome. Current approaches to the critical care management of TBI are not underpinned by high-quality evidence, and many of the current therapies in use have not shown benefit in randomized control trials. However, observational studies have informed the development of authoritative international guidelines, and the use of multimodality monitoring may facilitate rational approaches to optimizing acute physiology, allowing clinicians to optimize the balance between benefit and risk from these interventions in individual patients. Such approaches, along with the emerging impact of advanced neuroimaging, genomics, and protein biomarkers, could lead to the development of precision medicine approaches to the intensive care management of TBI. 1 Introduction Traumatic brain injury (TBI) is an important cause for admission to intensive care units (ICUs) in general, and to neurocritical care units in particular. National population-based figures for ICU caseload (as opposed to more specific stratification into mild, moderate, or severe TBI) are difficult to find, but the UK Intensive Care National Audit and Research Centre (ICNARC, 2015) reported that in 2014{2015, approximately 2% of all ICU admissions and about 10% of admissions to neurocritical care units were due to TBI. -
Complications Are Reduced with a Protocol to Standardize Timing of Fixation Based on Response to Resuscitation Heather A
Vallier et al. Journal of Orthopaedic Surgery and Research (2015) 10:155 DOI 10.1186/s13018-015-0298-1 RESEARCH ARTICLE Open Access Complications are reduced with a protocol to standardize timing of fixation based on response to resuscitation Heather A. Vallier1*, Timothy A. Moore1,2, John J. Como3, Patricia A. Wilczewski3, Michael P. Steinmetz4, Karl G. Wagner5, Charles E. Smith5, Xiao-Feng Wang1 and Andrea J. Dolenc1 Abstract Background: Our group developed a protocol, entitled Early Appropriate Care (EAC), to determine timing of definitive fracture fixation based on presence and severity of metabolic acidosis. We hypothesized that utilization of EAC would result in fewer complications than a historical cohort and that EAC patients with definitive fixation within 36 h would have fewer complications than those treated at a later time. Methods: Three hundred thirty-five patients with mean age 39.2 years and mean Injury Severity Score (ISS) 26.9 and 380 fractures of the femur (n = 173), pelvic ring (n = 71), acetabulum (n = 57), and/or spine (n = 79) were prospectively evaluated. The EAC protocol recommended definitive fixation within 36 h if lactate <4.0 mmol/L, pH ≥7.25, or base excess (BE) ≥−5.5 mmol/L. Complications including infections, sepsis, DVT, organ failure, pneumonia, acute respiratory distress syndrome (ARDS), and pulmonary embolism (PE) were identified and compared for early and delayed patients and with a historical cohort. Results: All 335 patients achieved the desired level of resuscitation within 36 h of injury. Two hundred sixty-nine (80 %) were treated within 36 h, and 66 had protocol violations, treated on a delayed basis, due to surgeon choice in 71 %. -
Fat Embolism Syndrome – a Qualitative Review of Its Incidence, Presentation, Pathogenesis and Management
2-RA_OA1 3/24/21 6:00 PM Page 1 Malaysian Orthopaedic Journal 2021 Vol 15 No 1 Timon C, et al doi: https://doi.org/10.5704/MOJ.2103.001 REVIEW ARTICLE Fat Embolism Syndrome – A Qualitative Review of its Incidence, Presentation, Pathogenesis and Management Timon C, MCh, Keady C, MSc, Murphy CG, FRCS Department of Trauma and Orthopaedics, Galway University Hospitals, Galway, Ireland This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited Date of submission: 12th November 2020 Date of acceptance: 05th March 2021 ABSTRACT DEFINITION AND INTRODUCTION Fat Embolism Syndrome (FES) is a poorly defined clinical Fat embolism 1 occurs when fat enters the circulation, this fat phenomenon which has been attributed to fat emboli entering can embolise and may or may not produce clinical the circulation. It is common, and its clinical presentation manifestations. may be either subtle or dramatic and life threatening. This is a review of the history, causes, pathophysiology, FES is a poorly defined clinical phenomenon which has been presentation, diagnosis and management of FES. FES mostly attributed to fat emboli entering the circulation. It classically occurs secondary to orthopaedic trauma; it is less frequently presents with respiratory, neurological and dermatological associated with other traumatic and atraumatic conditions. features. It typically occurs after long-bone fractures and There is no single test for diagnosing FES. Diagnosis of FES total hip arthroplasty, less frequently it is caused by burns is often missed due to its subclinical presentation and/or and soft tissue injuries 2. -
Medical Student Research Project
Medical Student Research Project Supported by The John Lachman Orthopedic Research Fund and Supervised by the Orthopedic Department’s Office of Clinical Trials Acute Management of Open Long Bone Fractures: Clinical Practice Guidelines ELIZABETH ZIELINSKI, BS;1 SAQIB REHMAN, MD2 1Temple University School of Medicine; 2Temple University Hospital, Department of Orthopaedic Surgery, Philadelphia, PA syndrome,1, 2 often resulting in loss of function of the limb. Abstract Infection rates can range from 0–50% depending on fracture Introduction: The acute management of an open frac- severity and location2–5 and nonunion rates are reported at an ture aims to promote bone and wound healing through a incidence of 18–29%.6, 7 Historically, amputation of the frac- series of key steps; however, lack of standardization in tured limb and mortality were commonly associated with these steps prior to definitive treatment may contribute to open fractures.8, 9 However, due to developments in its man- complications. agement, outcomes for open fractures have generally Methods: A literature review was conducted to deter- improved, as limbs are often salvaged and patients can retain mine the best practice in the acute management of open function of the injured extremity. Despite generalized stan- long bone fractures to be implemented at Temple Univer- dards for open fracture treatment, there remains variation sity Hospital, with a primary focus on prophylactic anti- and controversy over the initial management of open frac- biotic administration, local antibiotic delivery, time to tures, which may contribute to complications following debridement and irrigation techniques. treatment. Results: A computerized search yielded 2,037 results, Open fractures occur when the fractured bone penetrates of which a total of 21 articles were isolated and reviewed through the skin, involving damage to the bone and soft tis- based on the study criteria. -
Optimal Timing of Femur Fracture Stabilization in Polytrauma Patients: a Practice Management Guideline from the Eastern Association for the Surgery of Trauma
GUIDELINES Optimal timing of femur fracture stabilization in polytrauma patients: A practice management guideline from the Eastern Association for the Surgery of Trauma Rajesh R. Gandhi, MD, Tiffany L. Overton, MPH, Elliott R. Haut, MD, PhD, Brandyn Lau, MPH, Heather A. Vallier, MD, Thomas Rohs, MD, Erik Hasenboehler, MD, Jane Kayle Lee, MD, Darrell Alley, MD, Jennifer Watters, MD, Frederick B. Rogers, MD, and Shahid Shafi, MD, Fort Worth, Texas BACKGROUND: Femur fractures are common among trauma patients and are typically seen in patients with multiple injuries resulting from high-energy mechanisms. Internal fixation with intramedullary nailing is the ideal method of treatment; however, there is no consensus regarding the optimal timing for internal fixation. We critically evaluated the literature regarding the benefit of early (G24 hours) versus late (924 hours) open reduction and internal fixation of open or closed femur fractures on mortality, infection, and venous thromboem- bolism (VTE) in trauma patients. METHODS: A subcommittee of the Practice Management Guideline Committee of the Eastern Association for the Surgery of Trauma conducted a systematic review and meta-analysis for the earlier question. RevMan software was used to generate forest plots. Grading of Recom- mendations, Assessment, Development, and Evaluations methodology was used to rate the quality of the evidence, using GRADEpro software to create evidence tables. RESULTS: No significant reduction in mortality was associated with early stabilization, with a risk ratio (RR) of 0.74 (95% confidence interval [CI], 0.50Y1.08). The quality of evidence was rated as ‘‘low.’’ No significant reduction in infection (RR, 0.4; 95% CI, 0.10Y1.6) or VTE (RR, 0.63; 95% CI, 0.37Y1.07) was associated with early stabilization. -
ANNUAL ACHIEVEMENTS REPORT 2017/18 the Office of Pediatric Surgical Evaluation and Innovation at BCCH
ANNUAL ACHIEVEMENTS REPORT 2017/18 The Office of Pediatric Surgical Evaluation and Innovation at BCCH Partnership | Integrity | Curiosity | Enthusiasm | Achievement | Service THE OFFICE OF PEDIATRIC SURGICAL EVALUATION AND INNOVATION ANNUAL ACHIEVEMENTS REPORT TABLE OF CONTENTS LETTER FROM THE EXECUTIVE DIRECTOR 4 REVIEW OF SSRP AND BCCHR RESEARCH AWARD FUNDING (2005-2018) 6 DEPARTMENT OF PEDIATRIC DENTISTRY 8 DEPARTMENT OF PEDIATRIC NEUROSURGERY 18 DEPARTMENT OF PEDIATRIC ORTHOPAEDIC SURGERY 32 DEPARTMENT OF PEDIATRIC OTOLARYNGOLOGY 88 DIVISION OF PEDIATRIC PLASTIC SURGERY 100 DEPARTMENT OF PEDIATRIC SURGERY 104 DIVISION OF PEDIATRIC UROLOGY 120 DIVISION OF PEDIATRIC OPHTHALMOLOGY 130 PEDIATRIC DENTRISTRY DEPARTMENT OF PEDIATRIC DENTISTRY 2016-2018 FACULTY MEMBERS: Dr. Karen Campbell, Dr. Raymon Dr. Winnie Zhao Department Head Grewal, Division Head Oral & Maxillofacial Surgery Dr. Elsa Hui-Derksen Dr. WaSham Dr. Joy Richman, Cheung Professor UBC Dr. Rosamund Dr. Phoebe Tsang Dr. Kavita Mathu-Muju Harrison Dr. Jennifer Park Dr. Shan Sun Dr. Graham Grabowski Dr. Ben Kang Dr. Jason Choi 2016/18 PEDIATRIC DENTISTRY Dr. Ahmed Hieawy, Consulting Endodontist STAFF MEMBERS: Dr. Anuradha Korada, Consultant Pediatric dentist Dr. Martin Braverman, Consultant Oral and maxillofacial Dr. Angelina Loo, Consultant Orthodontist surgeon Dr. David MacDonald, Consultant Oral radiologist Dr. Mark Casafrancisco, Consultant Pediatric dentist Dr. Chris Olynik, Active Oral and maxillofacial surgeon Dr. Peter Chan, Consultant Pediatric dentist Dr. Benjamin Pliska, Consultant Orthodontist Dr. Kunal Chander, Consultant Pediatric dentist Dr. Paul Pocock, Consultant Orthodontist Dr. Jeff Coil, Active Endodontist Dr. Dorothy Sonya-Hoglund, Consultant Orthodontist and Oral Dr. Leo Fung, Consultant Prosthodontist radiologist Dr. Janice Garrett, Associate General dentist Dr. Priscilla Walsh, Consultant Periodontist Dr. -
Orthopaedic Injuries from Snowmobile Accidents: a Multi-Centre Analysis Of
European Journal of Orthopaedic Surgery & Traumatology (2019) 29:1617–1621 https://doi.org/10.1007/s00590-019-02514-3 ORIGINAL ARTICLE • EMERGENCY - TRAUMA Orthopaedic injuries from snowmobile accidents: a multi‑centre analysis of demographics, injury patterns, and outcomes Paul Whiting1 · Christopher Rice1 · Alexander Siy1 · Benjamin Wiseley1 · Natasha Simske1 · Richard Berg2 · Madeline Lockhart1 · Abbey Debruin1 · David Polga2 · Christopher Doro1 · David Goodspeed1 · Gerald Lang1 Received: 30 April 2019 / Accepted: 22 July 2019 / Published online: 29 July 2019 © Springer-Verlag France SAS, part of Springer Nature 2019 Abstract Purpose More than 2 million people in North America use snowmobiles, resulting in an estimated 200 fatalities and 14,000 injuries annually. The purpose of this study is to document the demographics, orthopaedic injury patterns, and short-term outcomes of patients with snowmobile-related injuries. Materials and methods A retrospective review was performed at two regional trauma centres in a region where snowmobile use is prevalent. Patients who sustained snowmobile-related injuries over a 12-year period were identifed from the hospitals’ trauma registries using E-codes (E820-E820.9). Patient demographics were recorded, as were injury characteristics including rates of substance use, open fractures, Injury Severity Score (ISS), Abbreviated Injury Score (AIS) for the extremities, and mortality. Rates of inpatient surgery, as well as hospital and ICU length of stay (LOS), were also recorded. Results We identifed 528 patients with snowmobile-related injuries. Average age was 37 years, and 418 patients (79%) were male. Eighty-eight per cent of all patients with snowmobile injuries were admitted to the hospital with an average LOS of 5.7 days.