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1.
J Orthop Trauma ; 38(7): e267-e271, 2024 Jul 01.
Article in English | MEDLINE | ID: mdl-38837214

ABSTRACT

SUMMARY: The inferior glenoid and scapular neck are common locations for scapular fractures. Operative exposures for reduction and fixation can be challenging, and frequently, the proximal fracture planes are not conducive to optimal fixation with a plate alone. The purpose of this article was to describe a new technique for enhancing fixation in specific inferior glenoid fractures using a single cortical lag screw.


Subject(s)
Bone Screws , Fracture Fixation, Internal , Fractures, Bone , Scapula , Humans , Scapula/injuries , Scapula/surgery , Fracture Fixation, Internal/methods , Fracture Fixation, Internal/instrumentation , Fractures, Bone/surgery , Male , Treatment Outcome , Female , Adult , Middle Aged , Glenoid Cavity/surgery , Glenoid Cavity/injuries
2.
JBJS Case Connect ; 14(1)2024 Jan 01.
Article in English | MEDLINE | ID: mdl-38452162

ABSTRACT

CASE: We present the case of a 25-year-old man with body mass index of 77 who underwent open reduction internal fixation (ORIF) of a displaced fracture dislocation of the acetabulum after a high-speed motor vehicle accident. Remarkably, he achieved full weight-bearing with minimal hip pain and has returned to independent mobility and meaningful work. CONCLUSION: ORIF of an acetabular fracture in a patient with class III obesity presents many challenges. Positioning, surgical approach, fracture manipulation, and postoperative morbidity and mortality can be managed through interdisciplinary collaboration and preoperative communication.


Subject(s)
Arthroplasty, Replacement, Hip , Hip Fractures , Male , Humans , Adult , Acetabulum/surgery , Body Mass Index , Fracture Fixation, Internal , Follow-Up Studies , Hip Fractures/surgery
3.
J Orthop Res ; 42(3): 678-684, 2024 Mar.
Article in English | MEDLINE | ID: mdl-37867256

ABSTRACT

There is a growing understanding and identification of costal cartilage injuries, however, diagnosis of these injuries remains difficult. We present a novel radiodensity based coloring technique, termed the True-Blue technique, to manipulate 3D CT imaging and more accurately diagnose costochondral injuries.


Subject(s)
Thoracic Wall , Thoracic Wall/diagnostic imaging , Ribs/diagnostic imaging , Tomography, X-Ray Computed
4.
J Orthop Trauma ; 38(2): e48-e54, 2024 Feb 01.
Article in English | MEDLINE | ID: mdl-38031277

ABSTRACT

OBJECTIVES: The purpose of this study was to report patterns of scapular fractures and define them with a contemporary methodology. METHODS: . DESIGN: Retrospective study, 2015-2021. SETTING: Single, academic, Level 1 trauma center. PATIENT SELECTION CRITERIA: Consecutive patients ≥18 years, presenting with unilateral scapula fracture, with thin-slice (≤0.5-mm) bilateral computed tomography (CT) scans of the entirety of both the injured and uninjured scapulae. OUTCOME MEASURES AND COMPARISONS: Thin-slice (0.5-mm) CT scans of injured and normal scapulae were obtained to create three-dimensional (3D) virtual models. 3D modeling software (Stryker Orthopedics Modeling and Analytics, Stryker Trauma GmbH, Kiel, Germany aka SOMA) was used to create a 3D map of fracture location and frequency. Fracture zones were delineated using anatomic landmarks to characterize fracture patterns. RESULTS: Eighty-seven patients were identified with 75 (86%) extra-articular and 12 (14%) intra-articular fractures. The dominant fracture pattern emanated from the superior lateral border (zone E) to an area inferior to the spinomedial angle (zone B) and was present in 80% of extra-articular fractures. A second-most common fracture line propagated from the primary (most-common) line toward the inferior medial scapular border with a frequency of 36%. Bare zones (with 1 or no fractures present) were identified in 4 unique areas. Furthermore, intra-articular fractures were found to be heterogenous. CONCLUSIONS: The 3D fracture map created in this study confirmed that extra-articular scapular fractures occur in certain patterns with a relatively high frequency. Results provide greater insight into scapular fracture locations and may help to study prognosis of injury and improve treatment strategy including operative approaches and surgical tactics.


Subject(s)
Fractures, Bone , Intra-Articular Fractures , Shoulder Fractures , Humans , Intra-Articular Fractures/surgery , Retrospective Studies , Scapula/diagnostic imaging , Scapula/injuries , Fractures, Bone/diagnostic imaging , Fractures, Bone/surgery , Tomography, X-Ray Computed
5.
JBJS Case Connect ; 13(3)2023 07 01.
Article in English | MEDLINE | ID: mdl-37561659

ABSTRACT

CASE: We report on a 35-year-old man presenting with disabling pain secondary to multiple rib nonunions and a costochondral dislocation 5 months after sustaining a chest wall crush injury. He underwent surgical reconstruction of the chest and was followed for 2 years. Surgical exposure to the heart was necessary during open reduction of the flail segment, followed by costochondral joint fixation with plates and screws. Although he was a workers' compensation patient, he returned to full gainful employment. CONCLUSION: Open reduction and internal fixation of a symptomatic, chronically displaced, precordial, flail segment can relieve pain and promote return to baseline function.


Subject(s)
Flail Chest , Rib Fractures , Thoracic Wall , Male , Humans , Adult , Flail Chest/etiology , Flail Chest/surgery , Rib Fractures/diagnostic imaging , Rib Fractures/surgery , Rib Fractures/complications , Fracture Fixation, Internal/adverse effects , Ribs/injuries
6.
J Trauma Acute Care Surg ; 95(6): 861-867, 2023 12 01.
Article in English | MEDLINE | ID: mdl-37405817

ABSTRACT

BACKGROUND: Rarely, traumatic sternum fractures may result in nonunion, which can have drastic, negative implications. Literature on traumatic sternal nonunion reconstruction outcomes is limited to case reports. We present the surgical principles and report clinical outcomes for seven patients following surgical reconstruction of a traumatic sternal body nonunion. METHODS: Consecutive adult patients with a nonunion after a traumatic sternum fracture who underwent reconstruction using locking plate technology and iliac crest bone graft at a Level I trauma center from 2013 to 2021 were identified. Demographic, injury, and surgery data was collected, and postoperative patient-reported outcome (PRO) scores were obtained. Patient-reported outcome scores included the one-question single assessment numeric evaluation (SANE), and the combined 10-question global physical health and global mental health values. Injuries were classified and all fractures were mapped onto a sternum template. Postoperative radiographs were reviewed for union. RESULTS: Of the study's seven patients, five were female, and the mean age was 58 years. Mechanism of injury included motor vehicle collision (5) and blunt object chest trauma (2). The mean time from initial fracture to nonunion fixation was 9 months. Four of the seven patients achieved in-clinic follow-up at ≥12 months (mean = 14.3 months), while the other three achieved ≥6 months of in-clinic follow-up. Six patients completed outcomes surveys ≥12 months after surgery (mean = 28.9 months). Mean PRO scores at final follow-up included: SANE of 75 (out of 100), and global physical health and global mental health of 44 and 47, respectively (US population mean = 50).Six of seven patients achieved known radiographic union. CONCLUSION: We describe an effective and practical method of achieving stable fixation in traumatic sternal body nonunions as evidenced by the positive clinical outcomes of a seven-patient series. Despite the variation in presentation and fracture morphology of this rare injury, the surgical technique and principles outlined can serve as a useful tool for chest wall surgeons. LEVEL OF EVIDENCE: Therapeutic/Care Management; Level IV.


Subject(s)
Fractures, Bone , Thoracic Injuries , Thoracic Wall , Wounds, Nonpenetrating , Adult , Humans , Female , Middle Aged , Male , Fractures, Bone/diagnostic imaging , Fractures, Bone/surgery , Sternum/surgery , Thoracic Injuries/surgery
7.
J Orthop Trauma ; 37(7): e288-e293, 2023 07 01.
Article in English | MEDLINE | ID: mdl-36728021

ABSTRACT

OBJECTIVE: Orthopaedic trauma implants may be electively explanted after fracture healing; reasons include symptomatic implants, cosmetic/functional concerns, or personal expectations. Certain institutions provide the option to keep implants after removal, although this has been retracted in others. This study examines patients' desire for return of implants, reasons for desiring return, and influence of return on perceptions of care. METHODS: A cohort of adult patients who underwent elective orthopaedic implant removal by a single surgeon at a Level I trauma center between 2008 and 2019, with the option to keep their removed implants, was identified. Surveys were sent to patients with contact information. Demographics, reasons for removal, satisfaction, and perceptions of care were studied. RESULTS: The overall response rate was 47.4% (117 of 247). Respondents' mean age was 46.9 years, and 50% were female. Ninety-one percent kept their implants. Eighty-nine percent of patients felt that removal achieved their desired outcome, with decreasing pain cited as primary motivation for explantation (62%). Forty-five percent reported a strong desire to keep their implants, most commonly to show to family (49%). Seventy-four percent were happy to have this option. Thirty-seven percent of patients reported respecting their provider more for having this option, and 27% reported that this positively impacted their satisfaction. CONCLUSIONS: Patients perceive elective implant removal as highly effective. A majority were pleased to have the option to keep their implants, and many reported increased respect and satisfaction. Thus, providing patients with this option should be strongly considered to honor patient choice and optimize outcomes when feasible.


Subject(s)
Orthopedics , Patient Satisfaction , Prostheses and Implants , Adult , Female , Humans , Male , Middle Aged , Perception , Surveys and Questionnaires
8.
JBJS Case Connect ; 13(1)2023 01 01.
Article in English | MEDLINE | ID: mdl-36719947

ABSTRACT

CASE: A 47-year-old man crushed between 2 cars during a demolition derby, a nonracing North American motorsport, underwent open reduction and internal fixation, iliosacral screw fixation, arterial embolization, and multiple urologic procedures after massive pelvic ring injury, remarkably recovering nearly full function. Sixteen years after injury, he developed an abscess emanating from an iliosacral screw requiring irrigation, debridement, and hardware removal. CONCLUSION: Deep surgical infections from iliosacral screws may present late, even more than 15 years after the original surgery. Obesity, preoperative embolization, diabetes, and urethral injuries are relevant risk factors. Similar patients should have a low threshold for infection workup when presenting with symptoms, even years after surgery.


Subject(s)
Fractures, Bone , Pelvic Bones , Male , Humans , Middle Aged , Pelvic Bones/surgery , Pelvic Bones/injuries , Fractures, Bone/surgery , Fractures, Bone/etiology , Sacrum/injuries , Automobiles , Bone Screws/adverse effects
9.
Clin Neurophysiol ; 129(9): 1819-1831, 2018 09.
Article in English | MEDLINE | ID: mdl-29981957

ABSTRACT

OBJECTIVES: Somatosensory evoked potentials (SSEPs) have proven useful as an intraoperative modality to predict perioperative stroke during carotid endarterectomy (CEA). However, the predictive value of SSEPs for predicting stroke 30 days postoperatively remains unclear. The primary objective is to evaluate the efficacy of intraoperative SSEP change in predicting the risk of stroke in the postoperative period beyond 24 h but within 30 days. Our secondary aim is to evaluate the predictive value of each subcategory of SSEP change. METHODS: We performed a meta-analysis of 25 prospective/retrospective studies from PubMed, Web of Science, and Embase regarding SSEP monitoring for postoperative outcomes in symptomatic and asymptomatic CEA patients. RESULTS: A 8307-patient cohort composed the total sample population, of which 54.17% had symptomatic CS. For SSEP change and stroke greater than 24 h but within 30 days, the diagnostic odds ratio was 8.68. The diagnostic odds ratio was 3.88 for transient SSEP change and stroke; 49.29 for persistent SSEP change and stroke; 36.45 for transient SSEP loss and stroke; and 281.35 for persistent SSEP loss and stroke. CONCLUSIONS: Patients with SSEP changes are at increased risk of perioperative stroke within the entire 30-day period. There is a noticeable step-wise increase in the predicted risk of stroke with the severity of SSEP changes. SIGNIFICANCE: SSEP changes can serve as a predictor for 30-day perioperative stroke during CEA.


Subject(s)
Carotid Stenosis/surgery , Endarterectomy, Carotid , Evoked Potentials, Somatosensory/physiology , Intraoperative Neurophysiological Monitoring/methods , Stroke/diagnosis , Carotid Stenosis/physiopathology , Humans , Risk Factors , Stroke/physiopathology
10.
World Neurosurg ; 115: e523-e531, 2018 Jul.
Article in English | MEDLINE | ID: mdl-29689391

ABSTRACT

OBJECTIVE: This study aimed to determine risk factors for inpatient seizures and long-term epilepsy in patients receiving coil embolization for aneurysm-associated subarachnoid hemorrhage. METHODS: A retrospective chart review was conducted for patients admitted to the University of Pittsburgh Medical Center from 2010 to 2014 for subarachnoid hemorrhage. Only patients with coil embolization were included. Variables such as subdural hematoma, cerebral infarction, postoperative vasospasm, cerebral edema, and mass effect were collected. After discharge, patients were followed up to determine whether epilepsy had developed. The χ2 test was used to assess univariate associations. Multivariable associations were assessed with a binary logistic regression model. RESULTS: The study included 175 patients, of whom 16 (9.1%) of the patients had seizures while they were inpatients. Five out of 73 patients met the criteria for epilepsy at follow-up. None of the patients with epilepsy after discharge had electrographic seizures while hospitalized. Vasospasm (odds ratio [OR] 6.88, 95% confidence interval [CI] 1.81-26.25), and Hunt and Hess grade 5 (OR 26.16, 95% CI 3.95-173.49) were significantly associated with in-hospital seizures in a multivariable analysis. Epileptiform discharges on electroencephalogram (EEG) were significantly associated with mass effect findings on brain imaging (OR 3.5, CI 1.05-11.69). CONCLUSION: Hunt and Hess grade 5 and vasospasm are independent risk factors for in-hospital seizures. In addition, mass effect is an independent risk factor for epileptiform discharges on EEG. Patients with these risk factors may benefit from continuous EEG. Our results may indicate that there is no association between electrographic seizures and development of epilepsy.


Subject(s)
Embolization, Therapeutic/adverse effects , Epilepsy/epidemiology , Hospitalization , Seizures/epidemiology , Subarachnoid Hemorrhage/epidemiology , Subarachnoid Hemorrhage/therapy , Adult , Aged , Embolization, Therapeutic/trends , Epilepsy/diagnostic imaging , Female , Follow-Up Studies , Hospitalization/trends , Humans , Male , Middle Aged , Retrospective Studies , Risk Factors , Seizures/diagnostic imaging , Smoking/adverse effects , Smoking/epidemiology , Subarachnoid Hemorrhage/diagnostic imaging , Vasospasm, Intracranial/diagnostic imaging , Vasospasm, Intracranial/epidemiology
11.
Neurol India ; 65(4): 708-715, 2017.
Article in English | MEDLINE | ID: mdl-28681737

ABSTRACT

OBJECTIVE: To evaluate three commonly used alarm criteria for interpreting the significance and diagnostic value of transcranial motor evoked potential (TcMEP) changes during spinal surgery. MATERIALS AND METHODS: A systematic literature search was performed using PubMed/MEDLINE, Web of Science, and EMBASE from 1945 to January 2014. We included all those studies that were (1) randomized controlled trials, prospective studies, or retrospective cohort studies, (2) conducted among patients undergoing surgery on the spine or spinal cord with TcMEP monitoring, (3) conducted in a group of ≥50 patients, (4) that were inclusive of immediate postoperative neurological assessment (within 24 h), and (5) which were published in English. RESULTS: Twenty-five studies involving 9409 patients were included. The incidence of neurological deficits was 1.82%. The overall sensitivity and specificity of all reported TcMEP changes was 82.1% (95% confidence interval [CI]: 73-88.6%) and 95.7% (95% CI: 93.7-97.1%), respectively. The sensitivity and specificity of each alarm criteria were evaluated: 50% reduction in amplitude, sensitivity 63.2% (95% CI: 47-76.8%), and specificity 96.7% (95% CI: 96.4-99.2%); 80% reduction in amplitude, sensitivity 71.7% (95% CI; 42-89.9%), and specificity 98.3% (95% CI: 96.4-99.2%); total signal loss, sensitivity 30% (95% CI: 17.6-46.4%), and specificity 99.3% (95% CI: 98.6-99.7%). CONCLUSIONS: No statistically significant differences between using reductions in amplitude of 50% and 80% as alarm criteria were found in terms of sensitivity and specificity. Total loss was found to have a statistically significant increase in specificity. TcMEP monitoring is a highly specific and sensitive diagnostic tool for the detection of neurological defects during spinal surgery.


Subject(s)
Evoked Potentials, Motor , Intraoperative Neurophysiological Monitoring/methods , Neurosurgical Procedures/adverse effects , Spinal Cord Injuries/diagnosis , Spinal Cord Injuries/etiology , Humans , Iatrogenic Disease/prevention & control , Sensitivity and Specificity , Transcranial Direct Current Stimulation/methods
12.
Genome Announc ; 3(3)2015 Jun 18.
Article in English | MEDLINE | ID: mdl-26089415

ABSTRACT

Momo is a newly discovered phage of Mycobacterium smegmatis mc(2)155. Momo has a double-stranded DNA genome 154,553 bp in length, with 233 predicted protein-encoding genes, 34 tRNA genes, and one transfer-messenger RNA (tmRNA) gene. Momo has a myoviral morphology and shares extensive nucleotide sequence similarity with subcluster C1 mycobacteriophages.

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