Category: Trauma Introduction/Purpose: Pilon and unstable ankle fractures are often treated initi... more Category: Trauma Introduction/Purpose: Pilon and unstable ankle fractures are often treated initially with an external fixator (ex-fix) due to soft tissue concerns. Typically, the second stage involves open reduction internal fixation of the fracture as the definitive management. Ex-fix application in the emergency department (ED) has been described previously. We aimed to determine if an ex-fix applied in the ED would have any difference in rate of ex-fix revision, deep infection, and hospital length of stay when compared to an ex-fix that is applied in the operating room (OR). Methods: This is a retroscpective, case-cohort study performed at an urban, level-1 trauma center. Using CPT codes in our billing database, we identified all patients from 2011-2015 who had operative fixation of pilon (AO classification 43B or 43C) or unstable ankle fractures (AO classification 44C) and had application of an ex-fix (either ED or OR) prior to definitive fixation. Patients with open injury, th...
ABSTRACT Introduction One of the leading issues facing persons with amputation is late developmen... more ABSTRACT Introduction One of the leading issues facing persons with amputation is late development of antibiotic-resistant bacterial infections of the residual limb. To reduce this infection risk, this study assessed the antimicrobial properties and profile of a silver carboxylate complex coating applied to samples of common prosthetic liner materials against pathogens frequently encountered in amputation-site infections. Methods The antimicrobial efficacy of the coating was measured utilizing a Kirby-Bauer assay with two different types of commercially available prosthetic liners. The assay was run against four pathogens including coagulase-negative Staphylococcus epidermidis, methicillin-sensitive Staphylococcus aureus, Enterococcus faecalis, and multidrug-resistant Acinetobacter baumannii. Observations of bacterial inhibition were made at 24-, 48-, and 72-hr time points for all four pathogens. Dose response curves were created to assess the relative efficacy of the coating against each pathogen independent of prosthetic liners. Graphite furnace atomic absorption spectroscopy (GFAAS) was utilized to measure coating silver elution at 24-, 48-, and 72-hr time points. Results All conditions of the coating were variably antimicrobial against all tested pathogens in the Kirby-Bauer analysis. Dose response analysis further demonstrated the coating's antimicrobial profile against all tested pathogens. GFAAS demonstrated consistent silver release of the coating throughout 72 hrs. Conclusions The results of this study suggest the tested antimicrobial coating is effective against a broad range of drug-resistant pathogens. Due to its ability to reduce and inhibit bacterial growth along the prosthetic liner surface, the coating shows promise as an effective tool toward mitigating infection and malodor found at the residual limb-liner interface among persons with amputation.
The Journal of the American Academy of Orthopaedic Surgeons, Jan 31, 2018
Basicervical femoral neck fractures are challenging fractures in geriatric populations. The goal ... more Basicervical femoral neck fractures are challenging fractures in geriatric populations. The goal of this study was to determine whether compression hip screw (CHS) constructs are superior to cephalomedullary constructs for the treatment of basicervical femoral neck fractures. Thirty cadaver femurs were osteotomized and received a CHS with derotation screw, a long cephalomedullary nail (long Gamma nail), or a short cephalomedullary nail (short Gamma nail). All constructs were loaded dynamically in compression until dynamic failure. All failed CHS constructs demonstrated superior femoral head cutout. In the long Gamma nail and short Gamma nail groups, constructs failed by nail cutout through the medial wall of the trochanter or rotationally. Normalized fluoroscopic distance was found to increase markedly with an increasing cycle count when considering all treatment groups. Given our results and those of previous studies, we could not determine superiority of one implant and recommend ...
The Journal of the American Academy of Orthopaedic Surgeons, Jan 9, 2018
Periprosthetic fractures around total knee arthroplasty have become an increasingly common and ch... more Periprosthetic fractures around total knee arthroplasty have become an increasingly common and challenging orthopaedic problem. Appropriate management of these fractures depends on careful scrutiny of radiographs and a thorough clinical history to exclude the diagnosis of a periprosthetic infection. In a periprosthetic tibial fracture with a stable, well-aligned tibial component and well-aligned mechanical tibial axis, the fracture can be successfully managed with closed reduction and cast immobilization; meticulous follow-up is essential to ensure that the alignment is maintained. Major fracture displacement, tibial component instability, and tibial component malalignment are all indications for surgical intervention. The ideal surgical intervention depends on the fracture characteristics and the stability and alignment of the tibial component.
With rising rates of obesity in the United States (U.S.), the burden of knee dislocations in this... more With rising rates of obesity in the United States (U.S.), the burden of knee dislocations in this population remains unknown. This national epidemiologic study was designed to analyze the association of obesity with closed knee dislocation and vascular complications. Retrospective cohort study. The de-identified Nationwide Inpatient Sample (NIS) database was utilized to access U.S. inpatient data from 2000 to 2012. Patients with non-congenital closed knee dislocations were included. Examined variables included patient age, sex, vascular injury and obesity status. Outcome measures included hospital length of stay (LOS), amputation, and inpatient hospitalization charge. From 2000-2012, a total of 19,087 knee dislocations were identified, including 2,265 in overweight/obese patients (11.9%). The annual incidence of knee dislocations reported in patients diagnosed as either obese or morbidly obese increased over the 13-year time period (p<0.0001). The overall average rate of vascular...
Journal of the American Academy of Orthopaedic Surgeons, 2016
Patients who are immobilized for a prolonged period are at risk for developing joint contractures... more Patients who are immobilized for a prolonged period are at risk for developing joint contractures, which often affect functional outcomes. Nonsurgical interventions are useful for preventing joint contractures. However, once contractures develop, these interventions frequently fail to restore function over the long term. To increase the rehabilitation potential of an extremity with refractory function-limiting contractures, surgery is often required.
Complacency and lack of preparation are major barriers to an effective disaster response. Leaders... more Complacency and lack of preparation are major barriers to an effective disaster response. Leadership assignments and departmental organization for a response should be outlined in advance. Response rehearsal and after-action reviews allow for thoughtful change to a response plan. Hospital disaster alert notification systems should be standardized and should be understood. Communication systems used in a disaster should have redundancy. A department’s response plan must be integrated into the overall hospital plan. Large casualty volumes require appropriate triage and resource allocation. Response provider emotional and health support is an important consideration.
Several fracture patterns with resulting bony defects require augmentation with bone graft or oth... more Several fracture patterns with resulting bony defects require augmentation with bone graft or other orthobiologics. Accurate placement of graft may be difficult when the area to be augmented is not readily accessible. In such a case, a quickly modified 3-mL plastic syringe may be a useful and efficient delivery method for accurate placement and impacting of the graft.
Informed consent is a pillar of ethical medicine which requires patients to fully comprehend rele... more Informed consent is a pillar of ethical medicine which requires patients to fully comprehend relevant issues including the risks, benefits, and alternatives of an intervention. Given the average reading skill of US adults is at the 8th grade level, the American Medical Association (AMA) and the National Institutes of Health (NIH) recommend patient information materials should not exceed a 6th grade reading level. We hypothesized that text provided in invasive procedure consent forms would exceed recommended readability guidelines for medical information. To test this hypothesis, we gathered procedure consent forms from all surgical inpatient hospitals in the state of Rhode Island. For each consent form, readability analysis was measured with the following measures: Flesch Reading Ease Formula, Flesch-Kincaid Grade Level, Fog Scale, SMOG Index, Coleman-Liau Index, Automated Readability Index, and Linsear Write Formula. These readability scores were used to calculate a composite Text ...
Statement of Purpose: Biomaterials are to replace and/or repair damaged tissue or organs. The mos... more Statement of Purpose: Biomaterials are to replace and/or repair damaged tissue or organs. The most two common biomaterials are metals and polymers. Each of these materials has its own strength and weakness. Metals offer good mechanical strength and bioactivity but lack flexibility. Polymers are flexible and useful in soft tissue applications, but do not provide good tissue integration. In some cases, it is desirable to have a material that shares the properties of both, flexibility with improved bioactivity. The bioactivity of hybridized polymer and metal oxide materials remains largely unexplored. The objective of this study is to investigate the effects of adding transition metal oxides from zirconium and tantalum to a silicone-base polymer, on growth of human cells. Methods: Rapid screening methods were employed in this study to evaluate cellular bioresponses to hybridized polymer coatings applied directly to the bottom of tissue culture plates using a Patent Pending wet chemistr...
Advertisement. Close Window. Close Window. Thank you for choosing to subscribe to the eTOC for Te... more Advertisement. Close Window. Close Window. Thank you for choosing to subscribe to the eTOC for Techniques in Knee Surgery. Enter your Email address: Wolters Kluwer Health may email you for journal alerts and information ...
Category: Trauma Introduction/Purpose: Pilon and unstable ankle fractures are often treated initi... more Category: Trauma Introduction/Purpose: Pilon and unstable ankle fractures are often treated initially with an external fixator (ex-fix) due to soft tissue concerns. Typically, the second stage involves open reduction internal fixation of the fracture as the definitive management. Ex-fix application in the emergency department (ED) has been described previously. We aimed to determine if an ex-fix applied in the ED would have any difference in rate of ex-fix revision, deep infection, and hospital length of stay when compared to an ex-fix that is applied in the operating room (OR). Methods: This is a retroscpective, case-cohort study performed at an urban, level-1 trauma center. Using CPT codes in our billing database, we identified all patients from 2011-2015 who had operative fixation of pilon (AO classification 43B or 43C) or unstable ankle fractures (AO classification 44C) and had application of an ex-fix (either ED or OR) prior to definitive fixation. Patients with open injury, th...
ABSTRACT Introduction One of the leading issues facing persons with amputation is late developmen... more ABSTRACT Introduction One of the leading issues facing persons with amputation is late development of antibiotic-resistant bacterial infections of the residual limb. To reduce this infection risk, this study assessed the antimicrobial properties and profile of a silver carboxylate complex coating applied to samples of common prosthetic liner materials against pathogens frequently encountered in amputation-site infections. Methods The antimicrobial efficacy of the coating was measured utilizing a Kirby-Bauer assay with two different types of commercially available prosthetic liners. The assay was run against four pathogens including coagulase-negative Staphylococcus epidermidis, methicillin-sensitive Staphylococcus aureus, Enterococcus faecalis, and multidrug-resistant Acinetobacter baumannii. Observations of bacterial inhibition were made at 24-, 48-, and 72-hr time points for all four pathogens. Dose response curves were created to assess the relative efficacy of the coating against each pathogen independent of prosthetic liners. Graphite furnace atomic absorption spectroscopy (GFAAS) was utilized to measure coating silver elution at 24-, 48-, and 72-hr time points. Results All conditions of the coating were variably antimicrobial against all tested pathogens in the Kirby-Bauer analysis. Dose response analysis further demonstrated the coating's antimicrobial profile against all tested pathogens. GFAAS demonstrated consistent silver release of the coating throughout 72 hrs. Conclusions The results of this study suggest the tested antimicrobial coating is effective against a broad range of drug-resistant pathogens. Due to its ability to reduce and inhibit bacterial growth along the prosthetic liner surface, the coating shows promise as an effective tool toward mitigating infection and malodor found at the residual limb-liner interface among persons with amputation.
The Journal of the American Academy of Orthopaedic Surgeons, Jan 31, 2018
Basicervical femoral neck fractures are challenging fractures in geriatric populations. The goal ... more Basicervical femoral neck fractures are challenging fractures in geriatric populations. The goal of this study was to determine whether compression hip screw (CHS) constructs are superior to cephalomedullary constructs for the treatment of basicervical femoral neck fractures. Thirty cadaver femurs were osteotomized and received a CHS with derotation screw, a long cephalomedullary nail (long Gamma nail), or a short cephalomedullary nail (short Gamma nail). All constructs were loaded dynamically in compression until dynamic failure. All failed CHS constructs demonstrated superior femoral head cutout. In the long Gamma nail and short Gamma nail groups, constructs failed by nail cutout through the medial wall of the trochanter or rotationally. Normalized fluoroscopic distance was found to increase markedly with an increasing cycle count when considering all treatment groups. Given our results and those of previous studies, we could not determine superiority of one implant and recommend ...
The Journal of the American Academy of Orthopaedic Surgeons, Jan 9, 2018
Periprosthetic fractures around total knee arthroplasty have become an increasingly common and ch... more Periprosthetic fractures around total knee arthroplasty have become an increasingly common and challenging orthopaedic problem. Appropriate management of these fractures depends on careful scrutiny of radiographs and a thorough clinical history to exclude the diagnosis of a periprosthetic infection. In a periprosthetic tibial fracture with a stable, well-aligned tibial component and well-aligned mechanical tibial axis, the fracture can be successfully managed with closed reduction and cast immobilization; meticulous follow-up is essential to ensure that the alignment is maintained. Major fracture displacement, tibial component instability, and tibial component malalignment are all indications for surgical intervention. The ideal surgical intervention depends on the fracture characteristics and the stability and alignment of the tibial component.
With rising rates of obesity in the United States (U.S.), the burden of knee dislocations in this... more With rising rates of obesity in the United States (U.S.), the burden of knee dislocations in this population remains unknown. This national epidemiologic study was designed to analyze the association of obesity with closed knee dislocation and vascular complications. Retrospective cohort study. The de-identified Nationwide Inpatient Sample (NIS) database was utilized to access U.S. inpatient data from 2000 to 2012. Patients with non-congenital closed knee dislocations were included. Examined variables included patient age, sex, vascular injury and obesity status. Outcome measures included hospital length of stay (LOS), amputation, and inpatient hospitalization charge. From 2000-2012, a total of 19,087 knee dislocations were identified, including 2,265 in overweight/obese patients (11.9%). The annual incidence of knee dislocations reported in patients diagnosed as either obese or morbidly obese increased over the 13-year time period (p<0.0001). The overall average rate of vascular...
Journal of the American Academy of Orthopaedic Surgeons, 2016
Patients who are immobilized for a prolonged period are at risk for developing joint contractures... more Patients who are immobilized for a prolonged period are at risk for developing joint contractures, which often affect functional outcomes. Nonsurgical interventions are useful for preventing joint contractures. However, once contractures develop, these interventions frequently fail to restore function over the long term. To increase the rehabilitation potential of an extremity with refractory function-limiting contractures, surgery is often required.
Complacency and lack of preparation are major barriers to an effective disaster response. Leaders... more Complacency and lack of preparation are major barriers to an effective disaster response. Leadership assignments and departmental organization for a response should be outlined in advance. Response rehearsal and after-action reviews allow for thoughtful change to a response plan. Hospital disaster alert notification systems should be standardized and should be understood. Communication systems used in a disaster should have redundancy. A department’s response plan must be integrated into the overall hospital plan. Large casualty volumes require appropriate triage and resource allocation. Response provider emotional and health support is an important consideration.
Several fracture patterns with resulting bony defects require augmentation with bone graft or oth... more Several fracture patterns with resulting bony defects require augmentation with bone graft or other orthobiologics. Accurate placement of graft may be difficult when the area to be augmented is not readily accessible. In such a case, a quickly modified 3-mL plastic syringe may be a useful and efficient delivery method for accurate placement and impacting of the graft.
Informed consent is a pillar of ethical medicine which requires patients to fully comprehend rele... more Informed consent is a pillar of ethical medicine which requires patients to fully comprehend relevant issues including the risks, benefits, and alternatives of an intervention. Given the average reading skill of US adults is at the 8th grade level, the American Medical Association (AMA) and the National Institutes of Health (NIH) recommend patient information materials should not exceed a 6th grade reading level. We hypothesized that text provided in invasive procedure consent forms would exceed recommended readability guidelines for medical information. To test this hypothesis, we gathered procedure consent forms from all surgical inpatient hospitals in the state of Rhode Island. For each consent form, readability analysis was measured with the following measures: Flesch Reading Ease Formula, Flesch-Kincaid Grade Level, Fog Scale, SMOG Index, Coleman-Liau Index, Automated Readability Index, and Linsear Write Formula. These readability scores were used to calculate a composite Text ...
Statement of Purpose: Biomaterials are to replace and/or repair damaged tissue or organs. The mos... more Statement of Purpose: Biomaterials are to replace and/or repair damaged tissue or organs. The most two common biomaterials are metals and polymers. Each of these materials has its own strength and weakness. Metals offer good mechanical strength and bioactivity but lack flexibility. Polymers are flexible and useful in soft tissue applications, but do not provide good tissue integration. In some cases, it is desirable to have a material that shares the properties of both, flexibility with improved bioactivity. The bioactivity of hybridized polymer and metal oxide materials remains largely unexplored. The objective of this study is to investigate the effects of adding transition metal oxides from zirconium and tantalum to a silicone-base polymer, on growth of human cells. Methods: Rapid screening methods were employed in this study to evaluate cellular bioresponses to hybridized polymer coatings applied directly to the bottom of tissue culture plates using a Patent Pending wet chemistr...
Advertisement. Close Window. Close Window. Thank you for choosing to subscribe to the eTOC for Te... more Advertisement. Close Window. Close Window. Thank you for choosing to subscribe to the eTOC for Techniques in Knee Surgery. Enter your Email address: Wolters Kluwer Health may email you for journal alerts and information ...
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