DOCSLIB.ORG

2015 Abstracts

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
2015 Abstracts MID-AMERICA ORTHOPAEDIC ASSOCIATION 33rd Annual Meeting April 22-26, 2015 The Westin Hilton Head Island Resort Hilton Head Island, SC Podium and Poster Abstracts NOTE: Disclosure information is listed at the end of this document. *Denotes presenter MAOA FIRST PLENARY SESSION April 23, 2015 Irrigation and Debridement Prior to a Two-Stage Revision TKA Does Not Increase Risk of Failure Abstract ID: Paper 001 Olubusola Brimmo, M.D. Nicholas Schlitz, Ph.D. Aiswarya Pillai Chandran, M.S. Siran Koroukian, Ph.D. *Alison K. Klika, M.S. Carlos A. Higuera, M.D. Wael K. Barsoum, M.D. Cleveland, OH INTRODUCTION: Studies have shown an increased rate of failure of two-stage revision total knee arthroplasty (rTKA) after a failed irrigation and debridement (I&D) for prosthetic joint infections (PJI) of the knee. The objective of this study was to compare failure rates of patients following two-stage rTKA with and without a previous I&D. METHODS: The 2005-2011 State Inpatient Database (SID) from 2 states (CA and NY) was used to identify patients who underwent two-stage rTKA for PJI between 2007-2009 (using ICD- 9-CM procedure and diagnosis codes). The main exposure was I&D. A two-year look back period was used to detect those patients who had an I&D prior to two-stage rTKA, and the outcomes of the two groups (with and without prior I&D) were compared. The primary outcome was failure of the two-stage rTKA (i.e., defined as the need for subsequent surgery due to infection, including ICD-9 diagnosis code 996.66). Follow-up time ranged from 2 - 4 years. Bootstrapping analysis and Kaplan-Meier curves were used to compare failure for groups treated with and without I&D prior to two-stage rTKA. RESULTS: A total of 628 two-stage rTKA patients were included, with n=45 (7.2%) who had an I&D prior to revision, and n=583 who did not. Overall rTKA failure rate was 74/628 (11.8%). Estimated failures by year two, was 9.0% (95% CI: 2.0% - 18.3%) for patients with a prior I&D, and 12.1% (9.3% - 14.8%) for patients with no I&D, which rose to 15.2% by four years postoperative. The mean time to failure was 119 days (standard deviation[SD]: 38) and 398 (SD: 46) days for patients with and without prior I&D, respectively (p=<.001). CONCLUSION: Patients who had an I&D prior to two-stage rTKA for infection did not have an increased need for surgery following the revision for infection-related reasons, although the time to failure was significantly shorter. Periarticular Injection Following TKA Using Liposomal Bupivacaine vs. a Modified Ranawat Suspension. A Prospective, Randomized Study Abstract ID: Paper 002 *Philip N. Collis, M.D. Allison Hunter, B.S. Derek Vaughn, M.D. Langan Smith, B.S. Leah Carreon, M.D. Jiapeng Huang, M.D. Jeffrey Stimac, M.D. Arthur L. Malkani, M.D. Louisville, KY INTRODUCTION: Many advancements have been made in an effort to decrease narcotic consumption while improve pain relief, including multimodal drug therapies, regional nerve blocks, and local periarticular injections following TKA. Liposomal bupivacaine has recently been introduced as a long acting local anesthetic. The purpose of this study is to compare liposomal bupivacaine to a modified (Ranawat’s) local injection for TKA. METHODS: This is a prospective, randomized study of 85 consecutive patients undergoing primary TKA. Group A patients received a periarticular injection with liposomal bupivacaine ($285) and Group B with a mixture of ropivacaine, epinephrine, ketorolac, and clonidine ($40). Both groups received the same preoperative teaching, implant type, and postoperative management. Outcome measures included knee pain at rest and with activity, amount of narcotics, knee range of motion, and walking distance. Measures were recorded at intervals of 24 hours, 48 hours, 72 hours, two weeks and four to eight weeks postoperatively. RESULTS: There were 44 patients in the Group A (liposomal bupivacaine) and 41 in group B. There were no differences in the groups with respect to age, sex, and preoperative knee scores. Pain levels at rest and activity showed no differences between groups at all time intervals. There were no differences with respect to narcotic usage and knee ROM. Liposomal bupivacaine group had a greater walking distance at 24, 48, and 72 hours, but only significant at 24 hours (p = 0.034). There was a trend towards increased discharge to home vs. rehabilitation in the liposomal bupivacaine group, but this was not significant. CONCLUSION: Liposomal bupivacaine as a periarticular injection following TKA demonstrated similar pain levels, narcotic usage, and ROM compared to a modified Ranawat suspension, but improved walking distance and a trend towards home discharge. What Safe Zone? The Majority of 224 Dislocated THA were within the Lewinnek Zone Abstract ID: Paper 003 *Matthew P. Abdel, M.D. Philipp von Roth, M.D. Matthew T. Jennings, B.S. Arlen D. Hanssen, M.D. Mark W. Pagnano, M.D Rochester, MN INTRODUCTION: One long held tenet is that cup inclination and anteversion should be 40±10° and 15±10°, respectively, to minimize dislocations after primary total hip arthroplasty (THA). Recent interest in navigation, robotics, and advanced 3-D imaging has focused on those classic targets defined by Lewinnek in 1978. In contemporary THA practice (characterized by multiple femoral heads size options, multiple liner options, and the predominance of uncemented femoral fixation), we questioned whether those target values accurately predict dislocation remains poorly understood. METHODS: From a consecutive cohort of 11,246 primary THAs done at our institution between 2003 and 2012, we retrospectively identified 224 THAs (1.9%) which subsequently dislocated. Clinical demographics including age, gender, and BMI, as well as radiographic parameters including inclination, anteversion, center of rotation, and limb length discrepancy were analyzed. The mean age was 64 years, mean was BMI 29 kg/m2, and mean time to first dislocation was 18 months. Minimum follow-up was 2 years. RESULTS: The majority (58%) of these dislocated THAs had an acetabular socket position that was within the Lewinnek safe-zone. Mean cup inclination was 44 ± 8° (95% CI = 42-45°), with 84% within the safe zone. The mean anteversion was 15 ± 9° (95% CI = 13-16°), with 69% within the safe zone. The mean lateralization of the center of rotation was 6 ± 4 mm from the native center of rotation, and the mean limb length difference was 4 ± 7 mm longer. CONCLUSION: The historical target values for cup inclination and anteversion defined by Lewinnek may be useful, but should not be considered a safe-zone given that the majority of these contemporary THAs which dislocated were in fact within those target values. It is likely that the ideal cup position for some patients lies outside the Lewinnek zone and that more advanced analysis is required to identify the right target in that subgroup. Does Prior Cartilage Restoration Negatively Impact Outcomes of Knee Arthroplasty? Abstract ID: Paper 004 Rachel M. Frank, M.D. / Chicago, IL *Darren Plummer, M.S. / Chicago, IL Peter N. Chalmers, M.D. / Chicago, IL Scott M. Sporer, M.D. / Winfield, IL Brett R. Levine, M.D. / Chicago, IL Brian J. Cole, M.D. / Chicago, IL Craig J. Della Valle, M.D. / Chicago, IL INTRODUCTION: Cartilage restoration procedures are being performed with increasing frequency and if these procedures fail, patients may require unicompartmental (UKA) or total knee arthroplasty (TKA) to alleviate their symptoms. The purpose of this study was to compare patients who failed a cartilage restoration procedure to matched-controls undergoing primary knee arthroplasty. METHODS: A retrospective review of prospectively collected data on patients who underwent cartilage restoration by a single surgeon and subsequently progressed to arthroplasty was performed. Patients were matched to primary UKA/TKA controls based on gender, age ± 5 years, body mass index (BMI) ± 5, smoking status, and arthroplasty type and were followed for a minimum of 2 years (mean, 3.7; range, 2.0-7.2). The primary outcome was the Knee Society Score (KSS). Secondary outcomes were range of motion (ROM) and revision rate. Appropriate statistical analysis was performed for continuous data with between and within group comparisons. RESULTS: A total of 26 patients (13 per group: 8 TKAs and 5 UKAs) were included. There were no significant differences in age, gender, BMI, smoking status, worker's compensation status, preoperative ROM, postoperative ROM, or preoperative KSS scores between groups (P>0.05 in all cases), suggesting adequate matching. Patients in the cartilage group had a significantly lower pre-arthroplasty (post-cartilage) Kellgren and Lawrence grade (average 2.6±0.9) compared to matched controls (average 3.7 ± 0.5, P=0.004). There were no significant differences in pre-cartilage to post-cartilage (pre-arthroplasty) Tegner (2.4 ± 2.4 to 2.3 ± 0.8, P=0.729), Lysholm (30.8 ± 17.1 to 38.2 ± 20.0, P=0.474), IKDC (26.4 ± 10.3 to 33.0 ± 10.3, P=0.847), or KOOS-pain (41.7 ± 19.4 to 59.0 ± 19.9, P=0.672) scores. Patients in the cartilage group had significantly lower postoperative KSS scores (78 ± 13 vs. 91 ± 5, P=0.005) and experienced significantly less improvement in KSS scores (30 ± 10 vs. 46 ± 10, P<0.001). Two patients (15%) in the cartilage group required revision TKA at 1.9 years (for pain) and 4.7 years (for infection) following the index TKA. DISCUSSION AND CONCLUSION: While patients with a failed cartilage procedure do still derive benefit from knee arthroplasty, the magnitude of improvement and final scores are lower than matched controls.
Load more

Recommended publications
  • Supracondylar Femoral Extension Osteotomy and Patellar Tendon Advancement in the Management of Persistent Crouch Gait in Cerebral Palsy
    Original Article Supracondylar femoral extension osteotomy and patellar tendon advancement in the management of persistent crouch gait in cerebral palsy Sakti Prasad Das, Sudhakar Pradhan, Shankar Ganesh1, Pabitra Kumar Sahu, Ram Narayan Mohanty, Sanjay Kumar Das ABSTRACT Background: Severe crouch gait in adolescent cerebral palsy is a difficult problem to manage. The patients develop loading of patellofemoral joint, leading to pain, gait deviation, excessive energy expenditure and progressive loss of function. Patella alta and avulsion of patella are the other complications. Different treatment options have been described in the literature to deal with this difficult problem. We evaluated outcome of supracondylar femoral extension osteotomy (SCFEO) and patellar tendon advancement (PTA) in the treatment of crouch gait in patients with cerebral palsy. Materials and Methods: Fourteen adolescents with crouch gait were operated by SCFEO and PTA. All subjects were evaluated pre and postoperatively. Clinical, radiographic, observational gait analysis and functional measures were included to assess the changes in knee function. Results: Cases were followed up to 3 years. The patients walked with increased knee extension and improvement in quadriceps muscle strength. Knee pain was decreased and improvements in functional mobility and radiologic improvement were found. Conclusion: SCFEO and PTA for adolescent crouch gait is effective in improving knee extensor strength, reducing knee pain and improving function. Key words: Crouch gait, patellar
    [Show full text]
  • Open Latarjet: Tried, Tested and True
    Review Article Page 1 of 14 Open Latarjet: tried, tested and true Owen Mattern1, Allan Young1, Gilles Walch2 1Sydney Shoulder Research Institute, Sydney, Australia; 2Centre Orthopédique Santy, Lyon, France Contributions: (I) Conception and design: G Walch, A Young; (II) Administrative support: A Young; (III) Provision of study materials or patients: None; (IV) Collection and assembly of data: None; (V) Data analysis and interpretation: None; (VI) Manuscript writing: All authors; (VII) Final approval of manuscript: All authors. Correspondence to: Allan Young. Sydney Shoulder Research Institute, Suite 201, 156 Pacific Highway, St Leonards, Sydney, New South Wales 2065, Australia. Email: [email protected]. Abstract: The open Latarjet procedure has proven to be an effective procedure in the treatment of anterior shoulder instability, particularly in patients with glenoid bone loss and/or an engaging Hill-Sachs lesion. The transfer of the coracoid bone block to the anterior glenoid provides stability via the “triple blocking effect”. We describe our indications and surgical technique for the open Latarjet procedure. Keywords: Latarjet; coracoid transfer; anterior shoulder instability Received: 04 June 2017; Accepted: 18 September 2017; Published: 08 November 2017. doi: 10.21037/aoj.2017.10.01 View this article at: http://dx.doi.org/10.21037/aoj.2017.10.01 Introduction Latarjet included a lower recurrence and dislocation rate, whilst loss of external rotation was less with Latarjet of Traumatic anterior shoulder instability is a common injury 11.5° compared to 20.9° with Bankart repair (11). for the contact athlete, with high rates of recurrence in some athletic populations (1-4). Anatomical Bankart repair procedures have been successful, however high recurrence Principles rates have been shown in certain patient groups (5,6).
    [Show full text]
  • A Case of Bilateral Calcaneal Fracture, Following Fall from 35 Feet
    rauma & Sastry et al., J Trauma Treat 2015, 4:3 f T T o re l a t a m DOI: 10.4172/2167-1222.1000254 n r e u n o t J Journal of Trauma & Treatment ISSN:ISSN: 2167-1222 2167-1222 CaseResearch Report Article OpenOpen Access Access A Case of Bilateral Calcaneal Fracture, Following Fall from 35 Feet Purushothama Sastry, Sujana Theja JS, Supreeth N and Arjun Markanday* Department of Orthopaedics, JSS Hospital, Mysore, India Abstract Introduction: Called Lover’s Fractures, the calcaneus commonly fractures due to fall from height. The calcaneus is the most frequently fractured tarsal bone. Tarsal bone fractures account for about 2% of all adult fractures. Of these, 60% are calcaneus fractures.The heel bone is often injured in a high-energy collision where other parts of the skeleton are also injured. In up to 10% of cases, the patient can also sustain a fracture of the spine, hip, or the other calcaneus. Injuries to the calcaneus often damage the subtalar joint and cause the joint to become stiff. This makes it difficult to walk on uneven ground or slanted surfaces. Case Report: A 24 year old male, working as a lift operator presented to the casualty of the hospital after the elevator broke down and came down in a free fall from about a height of 4 stories (35 feet). He presented along with the other occupants of the lift who also sustained calcaneal fractures.The case on arrival was subjected to ATLS protocol and through radiologic work up was done. Following a period of 12 days post trauma he was operated for bilateral calcaneal fractures and discharged 10 days post operatively.
    [Show full text]
  • Clinical Excellence Series Volume V an Evidence-Based Approach to Traumatic Emergencies
    Clinical Excellence Series n Volume V An Evidence-Based Approach To Traumatic Emergencies Inside Neck Trauma: Don’t Put Your Neck On The Line Orthopedic Sports Injuries: Off The Sidelines And Into The Emergency Department Blunt Abdominal Trauma: Priorities, Procedures, And Pragmatic Thinking Wrist Injuries: Emergency Imaging And Management Brought to you exclusively by the publisher of: An Evidence-Based Approach To Traumatic Emergencies CEO: Robert Williford President & Publisher: Stephanie Ivy Associate Editor & CME Director: Jennifer Pai • Associate Editor: Dorothy Whisenhunt Director of Member Services: Liz Alvarez • Marketing & Customer Service Coordinator: Robin Williford Direct all questions to EB Medicine: 1-800-249-5770 • Fax: 1-770-500-1316 • Non-U.S. subscribers, call: 1-678-366-7933 EB Medicine • 5550 Triangle Pkwy Ste 150 • Norcross, GA 30092 E-mail: [email protected] • Web Site: www.ebmedicine.net The Emergency Medicine Practice Clinical Excellence Series, Volume V: An Evidence-Based Approach To Traumatic Emergencies is published by EB Practice, LLC, 5550 Triangle Pkwy Ste 150, Norcross, GA 30092. Opinions expressed are not necessarily those of this publication. Mention of products or services does not constitute endorsement. This publication is intended as a general guide and is intended to supplement, rather than substitute, professional judgment. It covers a highly technical and complex subject and should not be used for making specific medical decisions. The materials contained herein are not intended to establish policy, procedure, or standard of care. Emergency Medicine Practice, The Emergency Medicine Practice Clinical Excel- lence Series, and An Evidence-Based Approach to Traumatic Emergencies are trademarks of EB Practice, LLC.
    [Show full text]
  • November 13, 2010 Prices Realized
    SCP Auctions Prices Realized - November 13, 2010 Internet Auction www.scpauctions.com | +1 800 350.2273 Lot # Lot Title 1 C.1910 REACH TIN LITHO BASEBALL ADVERTISING DISPLAY SIGN $7,788 2 C.1910-20 ORIGINAL ARTWORK FOR FATIMA CIGARETTES ROUND ADVERTISING SIGN $317 3 1912 WORLD CHAMPION BOSTON RED SOX PHOTOGRAPHIC DISPLAY PIECE $1,050 4 1914 "TUXEDO TOBACCO" ADVERTISING POSTER FEATURING IMAGES OF MATHEWSON, LAJOIE, TINKER AND MCGRAW $288 5 1928 "CHAMPIONS OF AL SMITH" CAMPAIGN POSTER FEATURING BABE RUTH $2,339 6 SET OF (5) LUCKY STRIKE TROLLEY CARD ADVERTISING SIGNS INCLUDING LAZZERI, GROVE, HEILMANN AND THE WANER BROTHERS $5,800 7 EXTREMELY RARE 1928 HARRY HEILMANN LUCKY STRIKE CIGARETTES LARGE ADVERTISING BANNER $18,368 8 1930'S DIZZY DEAN ADVERTISING POSTER FOR "SATURDAY'S DAILY NEWS" $240 9 1930'S DUCKY MEDWICK "GRANGER PIPE TOBACCO" ADVERTISING SIGN $178 10 1930S D&M "OLD RELIABLE" BASEBALL GLOVE ADVERTISEMENTS (3) INCLUDING COLLINS, CRITZ AND FONSECA $1,090 11 1930'S REACH BASEBALL EQUIPMENT DIE-CUT ADVERTISING DISPLAY $425 12 BILL TERRY COUNTERTOP AD DISPLAY FOR TWENTY GRAND CIGARETTES SIGNED "TO BARRY" - EX-HALPER $290 13 1933 GOUDEY SPORT KINGS GUM AND BIG LEAGUE GUM PROMOTIONAL STORE DISPLAY $1,199 14 1933 GOUDEY WINDOW ADVERTISING SIGN WITH BABE RUTH $3,510 15 COMPREHENSIVE 1933 TATTOO ORBIT DISPLAY INCLUDING ORIGINAL ADVERTISING, PIN, WRAPPER AND MORE $1,320 16 C.1934 DIZZY AND DAFFY DEAN BEECH-NUT ADVERTISING POSTER $2,836 17 DIZZY DEAN 1930'S "GRAPE NUTS" DIE-CUT ADVERTISING DISPLAY $1,024 18 PAIR OF 1934 BABE RUTH QUAKER
    [Show full text]
  • Multidirectional Shoulder Instability with Bone Loss and Prior Failed
    Technical Note Multidirectional Shoulder Instability With Bone Loss and Prior Failed Latarjet Procedure: Treatment With Fresh Distal Tibial Allograft and Modified T-Plasty Open Capsular Shift Liam A. Peebles, B.A., Zachary S. Aman, B.A., Fletcher R. Preuss, B.S., Brian T. Samuelsen, M.D., M.B.A., Tyler J. Zajac, M.S., A.T.C., O.T.C., Mitchell I. Kennedy, B.S., and Matthew T. Provencher, M.D., C.A.PT., M.C., U.S.N.R. Abstract: Recurrent multidirectional shoulder instability (MDI) is a challenging clinical problem, particularly in the setting of connective tissue diseases, and there is a distinct lack of literature discussing strategies for operative management of this unique patient group. These patients frequently present with significant glenoid bone loss, patulous and abnormal capsulolabral structures, and a history of multiple failed arthroscopic or open instability procedures. Although the precise treatment algorithm requires tailoring to the individual patient, we have shown successful outcomes in correcting recurrent MDI in the setting of underlying connective tissue disorders by means of a modified T-plasty capsular shift and rotator interval closure in conjunction with distal tibial allograft bony augmentation. The purpose of this Technical Note was to describe a technique that combines a fresh distal tibial allograft for glenoid bony augmentation with a modified T-plasty capsular shift and rotator interval closure for the management of recurrent shoulder MDI in patients presenting with Ehlers-Danlos syndrome or other connective tissue disorders after failed Latarjet stabilization. ecurrent multidirectional shoulder instability Conversely, MDI without hyperlaxity is more likely to R(MDI) is a difficult clinical problem and becomes present with anterior and/or posterior capsulolabral even more challenging in the face of connective tissue pathology1,2 in addition to bony lesions.
    [Show full text]
  • Deep Tissue Injury
    Deep Tissue Injury Overview Deep tissue injury is a term proposed by NPAUP to describe a unique form of pressure ulcers. These ulcers have been described by clinicians for many years with terms such as purple pressure ulcers, ulcers that are likely to deteriorate and bruises on bony prominences (Ankrom, 2005). NPAUP’s proposed definition, is “A pressure-related injury to subcutaneous tissues under intact skin. Initially, these lesions have the appearance of a deep bruise. These lesions may herald the subsequent development of a Stage III-IV pressure ulcer even with optimal treatment.”(NPAUP, 2002). Why is it important to have another label for pressure ulcers? Aren’t four stages enough? Perhaps not, because deep tissue injury represents a dangerous lesion due to its potential for rapid deterioration. Proper labeling will afford clinicians a more accurate diagnosis, and lay a foundation for the development of efficacious interventions. Background Shea (1975) is often credited with labeling the stages of pressure ulcers, and his descriptions of four depths of ulcers were adapted by IAET, AHCPR, and NPUAP. Missing from that four stage system label is deep tissue injury. However, Shea did not forget them in his review. He described ulcers that appear innocent yet conceal a deep, potentially fatal lesion. In 1873 Paget may have been the first to describe deep tissue injury describing purple areas with sloughing of tissue and large cavities once they open. In 1942, Groth created deep, “malignant pressure sores” in an animal model in a series of experiments that began in deeper tissues and spread to the surface.
    [Show full text]
  • 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 ...................................................
    [Show full text]
  • The Open Eden-Hybinette Procedure for Recurrent Anterior Shoulder Instability with Glenoid Bone Loss Joseph W
    The Open Eden-Hybinette Procedure for Recurrent Anterior Shoulder Instability With Glenoid Bone Loss Joseph W. Galvin, DO,* Zachary R. Zimmer, MD,* Alexander M. Prete, BS,* and Jon J.P. Warner, MD* In the setting of significant glenoid bone loss, soft tissue stabilization procedures for recur- rent anterior shoulder instability have high failure rates. The open or arthroscopic Eden- Hybinette procedure with tricortical iliac crest autograft has been shown to provide good results with low rates of recurrent instability. Indications for this technique include severe glenoid bone loss (>40%), recurrent instability following a Latarjet or distal tibial allograft procedure, or patients with abnormal coracoid morphology. In this technique article, we review the indications, contraindications, surgical technique, postoperative care, out- comes, and complications of the open Eden-Hybinette procedure. Oper Tech Sports Med 27:95-101 © 2019 Elsevier Inc. All rights reserved. KEYWORDS Eden-Hybinette, recurrent anterior instability Introduction through advanced imaging with MRI and 3-dimensional recon- struction computed tomography (CT) scans has likely led to nterior shoulder instability is a common problem in young increased utilization of bone augmentation techniques such as A active individuals with an incidence in the United States the Latarjet procedure, distal tibial allograft (DTA), and distal 1,2 (US) general population of 0.08 per 1000 person-years. Cer- clavicular autograft.13-17 The Latarjet and DTA procedures have tain at-risk populations involved in contact and collision activi- showntobeeffectiveandprovidegoodoutcomeswithlow ties, such as American football players and military athletes, rates of recurrent instability in primary and revision instability have anterior instability at an order of magnitude greater of scenarios,18-20 with the Latarjet showing long-term durability.
    [Show full text]
  • Staged Management of Tibial Plateau Fractures
    A Review Paper Staged Management of Tibial Plateau Fractures Douglas R. Dirschl, MD, and Daniel Del Gaizo, MD also warrant staged management because of patient, soft tissue, ABSTRACT or biologic factors. A low-energy injury in a patient with com- Careful and thorough assessment of injury severity, promised physiology (uncontrolled diabetes, smoking, morbid with particular attention paid to identifying high-energy obesity, immunocompromised state, etc) may have a greater risk injuries, is critical to achieving optimal outcomes and of complications than a high-energy injury in a healthy patient.2 avoiding complications following tibial plateau fractures. Performing acute open reduction internal fixation will increase Staged management of tibial plateau fractures refers the risk of soft tissue complications (Figure 1).3 to the use of temporizing methods of care (often span- ning external fixation) in high-energy injuries, as well as delaying definitive fracture surgery until such a time History as the risk of soft tissue complications is decreased. A focused, yet complete, history and physical examination This article discusses the principles and techniques of is the first step in evaluating any patient with a fracture. It is staged management, including the use of less invasive crucial to recognize whether or not the patient was in a situ- methods for definitive stabilization. ation where a large amount of energy was imparted to the limb. Motor vehicle/motorcycle collisions, falls from heights ractures of the tibial plateau encompass a wide greater than 10 feet, or being struck by a vehicle while range of severity, from stable nondisplaced frac- walking are some of the more common high-energy mecha- tures with minimal soft tissue injury to highly nisms.2 An appropriate history also includes investigation comminuted unstable fractures with massive soft of patient factors (comorbid conditions) that could impact Ftissue injury that threaten limb viability.1 Careful and the treatment plan or affect the patient’s overall prognosis.
    [Show full text]
  • 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.
    [Show full text]
  • Thieme: Teaching Atlas of Musculoskeletal Imaging
    Teaching Atlas of Musculoskeletal Imaging Teaching Atlas of Musculoskeletal Imaging Peter L. Munk, M.D., C.M., F.R.C.P.C. Professor Departments of Radiology and Orthopaedics University of British Columbia Head Section of Musculoskeletal Radiology Vancouver General Hospital and Health Science Center Vancouver, British Columbia, Canada Anthony G. Ryan, M.B., B.C.H., B.A.O., F.R.C.S.I., M.Sc. (Engineering and Physical Sciences in Medicine), D.I.C., F.R.C.R., F.F.R.R.C.S.I. Consultant Musculoskeletal and Interventional Radiologist Waterford Regional Teaching Hospital Ardkeen, Waterford City, Republic of Ireland Radiologic Tutor and Clinical Instructor in Radiology The Royal College of Surgeons in Ireland Dublin, Republic of Ireland Thieme New York • Stuttgart [email protected] 66485438-66485457 Thieme Medical Publishers, Inc. 333 Seventh Ave. New York, NY 10001 Editor: Birgitta Brandenburg Assistant Editor: Ivy Ip Vice President, Production and Electronic Publishing: Anne T. Vinnicombe Production Editor: Print Matters, Inc. Vice President, International Marketing: Cornelia Schulze Sales Director: Ross Lumpkin Chief Financial Officer: Peter van Woerden President: Brian D. Scanlan Compositor: Compset, Inc. Printer: The Maple-Vail Book Manufacturing Group Library of Congress Cataloging-in-Publication Data Munk, Peter L. Teaching atlas of musculoskeletal imaging / Peter L. Munk, Anthony G. Ryan. p. ; cm. Includes bibliographical references and index. ISBN-13: 978-1-58890-372-3 (alk. paper) ISBN-10: 1-58890-372-9 (alk. paper) ISBN-13: 978-3-13-141981-1 (alk. paper) ISBN-10: 3-13-141981-4 (alk. paper) 1. Musculoskeletal system—Diseases—Imaging—Atlases. 2. Musculoskeletal system—Diseases—Case studies.
    [Show full text]