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1.
JBJS Case Connect ; 11(3)2021 09 24.
Article in English | MEDLINE | ID: mdl-34559696

ABSTRACT

CASE: A 12-year-old girl presented with a both-bone forearm fracture after a fall. Fracture healing occurred, but nerve injury was not addressed until 18 months after injury. Magnetic resonance imaging and electromyography yielded a median nerve injury, and she underwent nerve reconstruction with sural nerve grafting. She improved but continued to have deficits beyond her 1-year follow-up. CONCLUSION: Both-bone forearm fractures are a common fracture pattern with rare complications. Clinicians should have a high index of suspicion with persistent nerve symptoms and consider further investigation, given the importance of early nerve repair.


Subject(s)
Lacerations , Radius Fractures , Ulna Fractures , Child , Female , Forearm , Humans , Median Nerve/surgery , Radius Fractures/complications , Radius Fractures/diagnostic imaging , Radius Fractures/surgery , Ulna Fractures/complications , Ulna Fractures/diagnostic imaging , Ulna Fractures/surgery
2.
J Telemed Telecare ; 26(4): 223-231, 2020 May.
Article in English | MEDLINE | ID: mdl-30428766

ABSTRACT

INTRODUCTION: This study explores a novel smartphone application for postoperative care following carpal tunnel release (CTR). We hypothesized that a software-based 'virtual visit' for CTR could be safe, effective and convenient for the patient. METHODS: Our group developed the software application utilized in this study. Interactive steps with video instructions enabled patients to complete dressing and suture removal, capture a wound photo, answer a question about median nerve symptoms and capture a video of finger range of motion. Adult patients undergoing endoscopic or open CTR were enrolled. Prior to their scheduled postoperative visit, patients received and completed the module using their smartphone. Agreement between findings of the virtual visit and the corresponding in-person clinical visit was assessed using kappa values. RESULTS: Twenty-two patients were contacted regarding study enrolment and 17 patients were enrolled (ages 23-63, mean 48.2, 6M, 11F). Of 16 patients who participated, all completed dressing removal. Ten of 16 patients removed their sutures successfully. Fourteen patients captured a clinically adequate wound photo and 15 patients answered a question about median nerve symptoms. Fourteen patients captured a range of motion video. Software assessments of surgical wounds, nerve symptoms and physical exams agreed strongly with clinical assessments. DISCUSSION: Most patients were able to respond to a question about their symptoms, provide clinical assessment of their wound via a photo and record a video of their range of motion. Suture removal was the most difficult task. More investigation is needed to determine which patients can reliably remove their sutures.


Subject(s)
Carpal Tunnel Syndrome/rehabilitation , Postoperative Care/methods , Simulation Training/methods , Smartphone/statistics & numerical data , Adult , Aged , Carpal Tunnel Syndrome/surgery , Female , Humans , Male , Middle Aged , Range of Motion, Articular , Young Adult
3.
Iowa Orthop J ; 39(1): 77-80, 2019.
Article in English | MEDLINE | ID: mdl-31413678

ABSTRACT

Background: Vertebral fracture after posterior arthrodesis and instrumentation for idiopathic scoliosis is a rare occurrence with limited reported cases in the literature. Case Presentation: A 16-year-old female patient surgically treated for adolescent idiopathic scoliosis with T2-L1 posterior spinal fusion was in a low-energy fall resulting in fracture of L1 and new kyphosis and scoliosis of the thoracolumbar spine at the distal aspect of the fusion. The fracture was initially managed conservatively, however pain persisted and thus she was indicated for extension of the fusion and correction of the post-traumatic kyphosis. Conclusions: Fractures after posterior spinal fusion for idiopathic scoliosis are rare and evidence for the appropriate management remains limited in the literature.Level of Evidence: V.


Subject(s)
Accidental Falls , Kyphosis/surgery , Scoliosis/surgery , Spinal Fractures/surgery , Spinal Fusion/methods , Adolescent , Female , Follow-Up Studies , Humans , Kyphosis/etiology , Lumbar Vertebrae/injuries , Lumbar Vertebrae/surgery , Radiography, Thoracic/methods , Reoperation/methods , Risk Assessment , Scoliosis/diagnosis , Scoliosis/etiology , Spinal Fractures/etiology , Thoracic Vertebrae/injuries , Thoracic Vertebrae/surgery , Treatment Outcome
4.
J Arthroplasty ; 33(10): 3138-3142, 2018 10.
Article in English | MEDLINE | ID: mdl-30077468

ABSTRACT

BACKGROUND: Institutional pathways in total joint arthroplasty (TJA) have been shown to reduce costs and improve patient care, but questions remain regarding their efficacy in certain populations. We sought to evaluate the comprehensive effect of a rapid recovery perioperative TJA protocol in the Veterans Health Administration (VA) setting. METHODS: In a VA hospital, a rapid recovery protocol was implemented for all patients undergoing primary total hip or knee arthroplasty. A retrospective chart review was performed comparing pre-protocol (n = 174) and protocol (n = 78) cohorts. Measured outcomes included length of stay (LOS), discharge destination, unplanned readmissions, overall complications, and total cost of healthcare during admission and at 30 and 90 days postoperatively. RESULTS: After implementation of the protocol, the average LOS decreased from 3.2 to 1.7 days (P < .0001). In the protocol group, there was a 12.3% increase in patients discharging directly home (85.1% vs 97.4%, P = .005). There were lower unplanned readmissions (6.3% vs 3.8%, P = .56) and overall complications (7.5% vs 3.8%, P = .40), but these were not statistically significant. The summative cost of all perioperative healthcare was lower after implementation of the protocol during the inpatient stay ($19,015 vs $21,719, P = .002) and out to 30 days postoperatively ($21,083 vs $23,420, P = .03) and 90 days postoperatively ($24,189 vs $26,514, P = .07). CONCLUSION: In the VA setting, implementation of a rapid recovery TJA protocol led to decreased LOS, decreased cost of perioperative healthcare, and an increase in patients discharging directly home without increased readmission or complication rates. Such protocols are essential as we transition into an era of value-based arthroplasty.


Subject(s)
Arthroplasty, Replacement, Hip/standards , Arthroplasty, Replacement, Knee/standards , Clinical Protocols/standards , Hospitals, Veterans/statistics & numerical data , Perioperative Care/standards , Aged , Arthroplasty, Replacement, Hip/adverse effects , Arthroplasty, Replacement, Hip/economics , Arthroplasty, Replacement, Hip/statistics & numerical data , Arthroplasty, Replacement, Knee/adverse effects , Arthroplasty, Replacement, Knee/economics , Arthroplasty, Replacement, Knee/statistics & numerical data , Cost-Benefit Analysis , Female , Health Care Costs/statistics & numerical data , Hospitals, Veterans/economics , Hospitals, Veterans/standards , Humans , Length of Stay/economics , Length of Stay/statistics & numerical data , Male , Middle Aged , Patient Discharge , Patient Readmission/economics , Patient Readmission/statistics & numerical data , Perioperative Care/economics , Perioperative Care/statistics & numerical data , Retrospective Studies , United States/epidemiology
5.
Orthop J Sports Med ; 5(3): 2325967117694818, 2017 Mar.
Article in English | MEDLINE | ID: mdl-28357408

ABSTRACT

BACKGROUND: Management of the medial collateral ligament (MCL) in the setting of a multiligamentous knee injury (MLKI) represents an area of great controversy. PURPOSE: Our study was designed to compare long-term patient-reported outcomes (PROs) after MCL repair versus reconstruction in the setting of a multiligamentous injury of the knee. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: At a single institution, 68 patients were identified over a 10-year period as having MCL intervention in the setting of MLKI. Of these patients, 34 (50%) were successfully contacted via telephone to collect Lysholm and International Knee Documentation Committee (IKDC) scores. A retrospective chart review of these subjects was also conducted to identify patient and surgical factors affecting PROs. RESULTS: At a mean 6-year follow-up (range, 2-11 years), the mean Lysholm score was 77.4 ± 23.1 and mean IKDC score was 72.6 ± 23.6. Univariate analyses identified time to surgery (P = .005) and MCL reconstruction (P = .001) as risk factors for Lysholm score ≤75. Univariate analyses identified patient age (P = .049), time to surgery (P = .018), and MCL reconstruction (P = .004) as risk factors for IKDC score ≤75. On subsequent multivariate analysis, MCL reconstruction was found to be a predictor of Lysholm or IKDC score of ≤75. CONCLUSION: Patients undergoing MCL repair in the setting of MLKI generally had higher PROs than those undergoing reconstructions at a mean 6 years of follow-up. Further work is needed to elucidate patient and surgical factors that may influence subjective outcomes after multiligament knee injuries.

6.
Iowa Orthop J ; 36: 1-6, 2016.
Article in English | MEDLINE | ID: mdl-27528827

ABSTRACT

BACKGROUND: Interpreting two-dimensional radiographs to ascertain the three-dimensional (3D) position and orientation of fracture planes and bone fragments is an important component of orthopedic diagnosis and clinical management. This skill, however, has not been thoroughly explored and measured. Our primary research question is to determine if 3D radiographic image interpretation can be reliably assessed, and whether this assessment varies by level of training. A test designed to measure this skill among orthopedic surgeons would provide a quantitative benchmark for skill assessment and training research. METHODS: Two tests consisting of a series of online exercises were developed to measure this skill. Each exercise displayed a pair of musculoskeletal radiographs. Participants selected one of three CT slices of the same or similar fracture patterns that best matched the radiographs. In experiment 1, 10 orthopedic residents and staff responded to nine questions. In experiment 2, 52 residents from both orthopedics and radiology responded to 12 questions. RESULTS: Experiment 1 yielded a Cronbach alpha of 0.47. Performance correlated with experience; r(8) = 0.87, p<0.01, suggesting that the test could be both valid and reliable with a slight increase in test length. In experiment 2, after removing three non-discriminating items, the Cronbach coefficient alpha was 0.28 and performance correlated with experience; r(50) = 0.25, p<0.10. CONCLUSIONS: Although evidence for reliability and validity was more compelling with the first experiment, the analyses suggest motivation and test duration are important determinants of test efficacy. The interpretation of radiographs to discern 3D information is a promising and a relatively unexplored area for surgical skill education and assessment. The online test was useful and reliable. Further test development is likely to increase test effectiveness. CLINICAL RELEVANCE: Accurately interpreting radiographic images is an essential clinical skill. Quantitative, repeatable techniques to measure this skill can improve resident training and improve patient safety.


Subject(s)
Clinical Competence , Fractures, Bone/diagnostic imaging , Orthopedics/education , Tomography, X-Ray Computed , Educational Measurement , Humans , Reproducibility of Results
7.
Org Biomol Chem ; 8(24): 5620-7, 2010 Dec 21.
Article in English | MEDLINE | ID: mdl-20938511

ABSTRACT

Chromophores ranging from simple small molecule π-conjugated systems comprised of phenylene ethynylene or fluorenylethynyl units to cross-conjugated Bunz-type cruciforms have been derivatized to include 1,3-bis(dimethylaminomethyl)phenyl moieties. The photophysical responsiveness of these diamino-substituted chromophores to metal ions has been examined. Both emission enhancement (turn-on) and ratiometric fluorescence detection of Cu(2+) and Zn(2+) ions have been achieved in THF.

8.
Chem Commun (Camb) ; 46(28): 5136-8, 2010 Jul 28.
Article in English | MEDLINE | ID: mdl-20539881

ABSTRACT

Modular oxacyclophanes featuring m-terphenyl units scaffold inter-pi-system interaction in face-to-face stacked or orthogonal orientations, leading to distinct photophysical properties.

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