We report the technique we used in extraction of a femoral intramedullary nail with impacted nail... more We report the technique we used in extraction of a femoral intramedullary nail with impacted nail cap. The extraction was done using a damaged screw extraction device and a bone hook, with no additional bone or soft tissue damage. This technique has not been reported before in the literature. We also review the cases reported for difficult nail extractions due to impacted nail end caps.
The Journal of Trauma Injury Infection and Critical Care, Apr 1, 2007
Whether pelvic fracture instability is correlated to mortality in blunt multiply-injured trauma p... more Whether pelvic fracture instability is correlated to mortality in blunt multiply-injured trauma patients is debatable. This is the first prospective study on patients with pelvic fractures aiming at finding whether pelvic fracture type affects mortality. There were 100 consecutive patients (77 males, mean age of 31 [3-73] years) studied between September 2003 and October 2004. Data were collected regarding mechanism of injury, associated injuries, Injury Severity Score (ISS), Revised Trauma Score, blood transfusions, and mortality. The fractures were classified according to instability, where type O is stable, type R is rotationally unstable, and type RV is both rotationally and vertically unstable. Because a pure acetabular fracture is a single break in the pelvic ring, we classified it as type O. Computer tomography was used for fracture classification in 73 patients and plain X-rays in 27 patients. There were 77 fractures caused by road traffic collisions. Type O fractures (n = 63) had lower median ISS (13 [4-48]) than type R (n = 19) (18 [9-75]) and type RV (n = 18) (18 [6-66]) (p = 0.019, Kruskall Wallis). There was no significant difference in ISS between type R and RV fractures. A logistic regression model has shown that ISS was the only significant factor that predicts mortality. ISS is the most important predictor in defining mortality in patients with pelvic fracture and not the type of pelvic instability.
Introduction. A method for the determination of safe angles for screws placed in the posterior ac... more Introduction. A method for the determination of safe angles for screws placed in the posterior acetabular wall based on preoperative computed tomography (CT) is described. It defines a retroacetabular angle and determines its variation in the population. Methods. The retroacetabular angle is the angle between the retroacetabular surface and the tangent to the posterior acetabular articular surface. Screws placed through the marginal posterior wall at an angle equal to the retroacetabular angle are extraarticular. Medial screws can be placed at larger angles whose difference from the retroacetabular angle is defined as the allowance angles. CT scans of all patients with acetabular fractures treated in our institute between September 2002 to July 2007 were used to measure the retroacetabular angle and tangent. Results. Two hundred thirty one patients were included. The average (range) age was 42 (15-74) years. The average (range) retroacetabular angle was 39 (30-47) degrees. The avera...
Tarsometatarsal (Lisfranc) fracture-dislocation is an uncommon foot injury. Subtle injuries are m... more Tarsometatarsal (Lisfranc) fracture-dislocation is an uncommon foot injury. Subtle injuries are more difficult to diagnose though they cause serious morbidity. Bilateral subtle tarsometatarsal injury has not been reported before. We report bilateral subtle tarsometatarsal dislocations that were caused by a work-related accident in a 25-year-old man. The injury was initially missed. Diagnosis was confirmed by computed tomography with curved reconstruction. Associated foot injuries are shown as a guide to the diagnosis.
The Journal of Trauma: Injury, Infection, and Critical Care, 2007
Whether pelvic fracture instability is correlated to mortality in blunt multiply-injured trauma p... more Whether pelvic fracture instability is correlated to mortality in blunt multiply-injured trauma patients is debatable. This is the first prospective study on patients with pelvic fractures aiming at finding whether pelvic fracture type affects mortality. There were 100 consecutive patients (77 males, mean age of 31 [3-73] years) studied between September 2003 and October 2004. Data were collected regarding mechanism of injury, associated injuries, Injury Severity Score (ISS), Revised Trauma Score, blood transfusions, and mortality. The fractures were classified according to instability, where type O is stable, type R is rotationally unstable, and type RV is both rotationally and vertically unstable. Because a pure acetabular fracture is a single break in the pelvic ring, we classified it as type O. Computer tomography was used for fracture classification in 73 patients and plain X-rays in 27 patients. There were 77 fractures caused by road traffic collisions. Type O fractures (n = 63) had lower median ISS (13 [4-48]) than type R (n = 19) (18 [9-75]) and type RV (n = 18) (18 [6-66]) (p = 0.019, Kruskall Wallis). There was no significant difference in ISS between type R and RV fractures. A logistic regression model has shown that ISS was the only significant factor that predicts mortality. ISS is the most important predictor in defining mortality in patients with pelvic fracture and not the type of pelvic instability.
The Journal of Trauma: Injury, Infection, and Critical Care, 2010
Marginal posterior wall fractures are often fixed by lag screws, which may be technically difficu... more Marginal posterior wall fractures are often fixed by lag screws, which may be technically difficult and risks articular penetration. Spring plates are used to avoid articular penetration. Both lag screws and spring plates are usually buttressed by reconstruction plates. The aim of this report is to describe a technique for fixing those fractures using locking reconstruction plate and monocortical screws avoiding articular penetration and sparing spring plates. A locking reconstruction plate is placed in a position that allows buttressing of the fracture fragment and fixed proximally and distally first using non-locking screws. The marginal fracture is fixed using monocortical locking head screws. This technique has been performed on three patients; none had secondary displacement or nonunion. Fixing marginal posterior acetabular wall fractures using locking reconstruction plates and monocortical screws saves additional lag screws or spring plates without risking articular penetration.
The Journal of Trauma: Injury, Infection, and Critical Care, 2007
We aimed to study the relationship between the number of fractured scapular regions, and the seve... more We aimed to study the relationship between the number of fractured scapular regions, and the severity and distribution of associated injuries in blunt trauma patients. One hundred seven consecutive patients with fractured scapulae (100 men) with a mean age of 35 (8-65) years were prospectively studied between January 2003 and December 2005. Mechanism of injury, associated injuries, Injury Severity Score (ISS), and the number of anatomic scapular regions involved in each fracture were studied. Patients were divided into single-region fracture (SRF), two-region fracture, and more than two-region fracture groups. Computer tomography was used for fracture classification in 99 patients and plain radiographs were used for the remaining 8. Road traffic collisions were the most common cause of scapular fracture. Ninety-five patients (89%) sustained associated injuries. The most frequent was chest injury (68 [64%]). The median ISS was 9 (4-57) for the SRF group (n = 55), 20 (4-59) for the two-region fracture group (n = 30), and 22.5 (4-54) for the more than two-region fracture group (n = 22) (p = 0.02, Kruskal-Wallis test). The median values of the Abbreviated Injury Scale for chest injuries for the three groups were 1 (0-4), 3 (0-5), and 3 (0-5), respectively (p = 0.001, Kruskal-Wallis test). The SRF group had significantly less posterior structure injury (9 of 55) compared with the multiple-region fracture group (46 of 52) (p < 0.001, Fisher's exact test). Associated injuries are common in patients with scapular fractures. ISS and Abbreviated Injury Scale score for chest injuries are higher and posterior structure injuries are more frequent in patients with fractures involving multiple scapular regions.
We present three cases of overlapping pubic symphysis dislocation and revise all the fully report... more We present three cases of overlapping pubic symphysis dislocation and revise all the fully reported similar ones in the literature. The mechanism of injury, clinical presentation, radiographic assessment, associated injuries, management and complications of this uncommon injury are discussed.
To analyze the usefulness of chest and scapular trauma radiographs, axial computed tomography (CT... more To analyze the usefulness of chest and scapular trauma radiographs, axial computed tomography (CT), and two- and three-dimensional (2D and 3D) reconstruction CT in detecting fractures of the six anatomical regions of the scapula. Forty-four patients, with a median age (range) of 34 (16-60) years, with scapular fractures caused by blunt trauma were prospectively collected between January 2003 and December 2005. Their chest and scapula radiographs, and axial, 2D, and 3D CTs were reviewed blindly and independently by two observers. Each modality was compared with a gold standard to determine its diagnostic usefulness. Our gold standard was consensus reached by all authors together examining all modalities at the same time. We also compared 3D CTs reconstructed from chest and scapula axial views. Axial and 3D reconstruction tomographic studies were the only useful modalities in assessing fractures in all six anatomical scapular regions. Three-dimensional CTs reconstructed from chest and scapula axial views were equally sensitive and specific. CT scanning with 3D reconstructions is the most useful imaging modality to detect and define the extent of scapular injury, and this can be done as part of a chest trauma computed tomography protocol.
We report the technique we used in extraction of a femoral intramedullary nail with impacted nail... more We report the technique we used in extraction of a femoral intramedullary nail with impacted nail cap. The extraction was done using a damaged screw extraction device and a bone hook, with no additional bone or soft tissue damage. This technique has not been reported before in the literature. We also review the cases reported for difficult nail extractions due to impacted nail end caps.
The Journal of Trauma Injury Infection and Critical Care, Apr 1, 2007
Whether pelvic fracture instability is correlated to mortality in blunt multiply-injured trauma p... more Whether pelvic fracture instability is correlated to mortality in blunt multiply-injured trauma patients is debatable. This is the first prospective study on patients with pelvic fractures aiming at finding whether pelvic fracture type affects mortality. There were 100 consecutive patients (77 males, mean age of 31 [3-73] years) studied between September 2003 and October 2004. Data were collected regarding mechanism of injury, associated injuries, Injury Severity Score (ISS), Revised Trauma Score, blood transfusions, and mortality. The fractures were classified according to instability, where type O is stable, type R is rotationally unstable, and type RV is both rotationally and vertically unstable. Because a pure acetabular fracture is a single break in the pelvic ring, we classified it as type O. Computer tomography was used for fracture classification in 73 patients and plain X-rays in 27 patients. There were 77 fractures caused by road traffic collisions. Type O fractures (n = 63) had lower median ISS (13 [4-48]) than type R (n = 19) (18 [9-75]) and type RV (n = 18) (18 [6-66]) (p = 0.019, Kruskall Wallis). There was no significant difference in ISS between type R and RV fractures. A logistic regression model has shown that ISS was the only significant factor that predicts mortality. ISS is the most important predictor in defining mortality in patients with pelvic fracture and not the type of pelvic instability.
Introduction. A method for the determination of safe angles for screws placed in the posterior ac... more Introduction. A method for the determination of safe angles for screws placed in the posterior acetabular wall based on preoperative computed tomography (CT) is described. It defines a retroacetabular angle and determines its variation in the population. Methods. The retroacetabular angle is the angle between the retroacetabular surface and the tangent to the posterior acetabular articular surface. Screws placed through the marginal posterior wall at an angle equal to the retroacetabular angle are extraarticular. Medial screws can be placed at larger angles whose difference from the retroacetabular angle is defined as the allowance angles. CT scans of all patients with acetabular fractures treated in our institute between September 2002 to July 2007 were used to measure the retroacetabular angle and tangent. Results. Two hundred thirty one patients were included. The average (range) age was 42 (15-74) years. The average (range) retroacetabular angle was 39 (30-47) degrees. The avera...
Tarsometatarsal (Lisfranc) fracture-dislocation is an uncommon foot injury. Subtle injuries are m... more Tarsometatarsal (Lisfranc) fracture-dislocation is an uncommon foot injury. Subtle injuries are more difficult to diagnose though they cause serious morbidity. Bilateral subtle tarsometatarsal injury has not been reported before. We report bilateral subtle tarsometatarsal dislocations that were caused by a work-related accident in a 25-year-old man. The injury was initially missed. Diagnosis was confirmed by computed tomography with curved reconstruction. Associated foot injuries are shown as a guide to the diagnosis.
The Journal of Trauma: Injury, Infection, and Critical Care, 2007
Whether pelvic fracture instability is correlated to mortality in blunt multiply-injured trauma p... more Whether pelvic fracture instability is correlated to mortality in blunt multiply-injured trauma patients is debatable. This is the first prospective study on patients with pelvic fractures aiming at finding whether pelvic fracture type affects mortality. There were 100 consecutive patients (77 males, mean age of 31 [3-73] years) studied between September 2003 and October 2004. Data were collected regarding mechanism of injury, associated injuries, Injury Severity Score (ISS), Revised Trauma Score, blood transfusions, and mortality. The fractures were classified according to instability, where type O is stable, type R is rotationally unstable, and type RV is both rotationally and vertically unstable. Because a pure acetabular fracture is a single break in the pelvic ring, we classified it as type O. Computer tomography was used for fracture classification in 73 patients and plain X-rays in 27 patients. There were 77 fractures caused by road traffic collisions. Type O fractures (n = 63) had lower median ISS (13 [4-48]) than type R (n = 19) (18 [9-75]) and type RV (n = 18) (18 [6-66]) (p = 0.019, Kruskall Wallis). There was no significant difference in ISS between type R and RV fractures. A logistic regression model has shown that ISS was the only significant factor that predicts mortality. ISS is the most important predictor in defining mortality in patients with pelvic fracture and not the type of pelvic instability.
The Journal of Trauma: Injury, Infection, and Critical Care, 2010
Marginal posterior wall fractures are often fixed by lag screws, which may be technically difficu... more Marginal posterior wall fractures are often fixed by lag screws, which may be technically difficult and risks articular penetration. Spring plates are used to avoid articular penetration. Both lag screws and spring plates are usually buttressed by reconstruction plates. The aim of this report is to describe a technique for fixing those fractures using locking reconstruction plate and monocortical screws avoiding articular penetration and sparing spring plates. A locking reconstruction plate is placed in a position that allows buttressing of the fracture fragment and fixed proximally and distally first using non-locking screws. The marginal fracture is fixed using monocortical locking head screws. This technique has been performed on three patients; none had secondary displacement or nonunion. Fixing marginal posterior acetabular wall fractures using locking reconstruction plates and monocortical screws saves additional lag screws or spring plates without risking articular penetration.
The Journal of Trauma: Injury, Infection, and Critical Care, 2007
We aimed to study the relationship between the number of fractured scapular regions, and the seve... more We aimed to study the relationship between the number of fractured scapular regions, and the severity and distribution of associated injuries in blunt trauma patients. One hundred seven consecutive patients with fractured scapulae (100 men) with a mean age of 35 (8-65) years were prospectively studied between January 2003 and December 2005. Mechanism of injury, associated injuries, Injury Severity Score (ISS), and the number of anatomic scapular regions involved in each fracture were studied. Patients were divided into single-region fracture (SRF), two-region fracture, and more than two-region fracture groups. Computer tomography was used for fracture classification in 99 patients and plain radiographs were used for the remaining 8. Road traffic collisions were the most common cause of scapular fracture. Ninety-five patients (89%) sustained associated injuries. The most frequent was chest injury (68 [64%]). The median ISS was 9 (4-57) for the SRF group (n = 55), 20 (4-59) for the two-region fracture group (n = 30), and 22.5 (4-54) for the more than two-region fracture group (n = 22) (p = 0.02, Kruskal-Wallis test). The median values of the Abbreviated Injury Scale for chest injuries for the three groups were 1 (0-4), 3 (0-5), and 3 (0-5), respectively (p = 0.001, Kruskal-Wallis test). The SRF group had significantly less posterior structure injury (9 of 55) compared with the multiple-region fracture group (46 of 52) (p < 0.001, Fisher's exact test). Associated injuries are common in patients with scapular fractures. ISS and Abbreviated Injury Scale score for chest injuries are higher and posterior structure injuries are more frequent in patients with fractures involving multiple scapular regions.
We present three cases of overlapping pubic symphysis dislocation and revise all the fully report... more We present three cases of overlapping pubic symphysis dislocation and revise all the fully reported similar ones in the literature. The mechanism of injury, clinical presentation, radiographic assessment, associated injuries, management and complications of this uncommon injury are discussed.
To analyze the usefulness of chest and scapular trauma radiographs, axial computed tomography (CT... more To analyze the usefulness of chest and scapular trauma radiographs, axial computed tomography (CT), and two- and three-dimensional (2D and 3D) reconstruction CT in detecting fractures of the six anatomical regions of the scapula. Forty-four patients, with a median age (range) of 34 (16-60) years, with scapular fractures caused by blunt trauma were prospectively collected between January 2003 and December 2005. Their chest and scapula radiographs, and axial, 2D, and 3D CTs were reviewed blindly and independently by two observers. Each modality was compared with a gold standard to determine its diagnostic usefulness. Our gold standard was consensus reached by all authors together examining all modalities at the same time. We also compared 3D CTs reconstructed from chest and scapula axial views. Axial and 3D reconstruction tomographic studies were the only useful modalities in assessing fractures in all six anatomical scapular regions. Three-dimensional CTs reconstructed from chest and scapula axial views were equally sensitive and specific. CT scanning with 3D reconstructions is the most useful imaging modality to detect and define the extent of scapular injury, and this can be done as part of a chest trauma computed tomography protocol.
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Papers by Ayman Tadros