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1. Clinical and Biomechanical Effects of Femoral Neck Buttress Plate used for Vertical Femoral Neck Fractures

Author

Andrew, Steffensmeier, Nihar, Shah, Michael, Archdeacon, David, Watson, Roy W, Sanders, and Henry C, Sagi

Subjects
Male, Fracture Fixation, Internal, Femur Neck, Bone Screws, Humans, General Earth and Planetary Sciences, Female, Bone Plates, Aged, Femoral Neck Fractures, General Environmental Science
Abstract

To investigate both the biomechanical and clinical effect of an inferomedial femoral neck buttress plate (FNBP) used to augment a sliding hip screw (SHS) and anti-rotational screw (ARS) in the treatment of traumatic vertical femoral neck fractures.Part 1: Clinical - Retrospective review of patients under age 65 treated with open reduction of a vertical femoral neck fracture. Patients were divided into two groups: Group 1 patients (18 patients) had SHS/ARS fixation augmented with a FNBP, while Group 2 patients (18 patients) had SHS/ARS fixation alone and were matched for age and sex. Demographic data, OTA fracture classification, immediate post-operative and follow-up radiographs were analyzed for quality of reduction, femoral neck shortening (FNS), neck-shaft angle (NSA), avascular necrosis (AVN) and union. Part 2: Biomechanical - Pauwels III femoral neck osteotomy was created in five pairs of cadaveric specimens, then each fracture was reduced and stabilized with a SHS/ARS construct. Specimens were matched and split into Groups 1 and 2, similar to Part 1. Cadaveric specimens were axially loaded in cyclical fashion to analyze for construct stiffness, fracture displacement femoral neck shortening and changes in the neck shaft angle.Part 1: There were 18 matched patients (14 males and 4 females) in both Group 1 and Group 2. There were no statistically significant differences between the two groups with respect to Pauwels angle, femoral neck shortening, changes in neck-shaft angle, AVN or nonunion. One reoperation in Group 1 and four in Group 2. Part 2: All five cadaveric specimens in both groups survived the 10,000-cycle loading regimen. We were unable to detect any significant differences between the two groups with respect to construct stiffness, change in neck-shaft angle or amount of femoral neck shortening.Based on the results of both clinical case series and biomechanical testing, an inferomedial neck buttress plate does not appear to offer long-term benefits with respect to maintenance of alignment or achieving union but may potentially help in obtaining the reduction.

Published
2022
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2. An Organizational Approach to Addressing Racism in Orthopaedic Surgery

Author

Jaysson T, Brooks, Tonya, Dixon, Bonnie, Simpson Mason, and Michael, Archdeacon

Subjects
Orthopedics, Racism, Humans, Internship and Residency, Orthopedic Procedures, Orthopedics and Sports Medicine, Surgery, General Medicine, Personnel Selection, United States
Abstract

This article highlights the key topics that were presented at a symposium of the American Orthopaedic Association in May 2021, with the primary objectives of acknowledging the existence of systemic racism within the field of orthopaedic surgery, developing a plan for combating racism before it manifests within orthopaedic departments and practices, and understanding the benefit of pipeline programs in diversifying the orthopaedic surgeon workforce. When the word racism is mentioned among a group of orthopaedic surgeons, it may have the immediate effect of stifling honest conversations. Therefore, the crippling effects of racism within orthopaedic surgery are not addressed, and there are downstream effects that influence patient care by perpetuating disparities in health care. If orthopaedic departments want to fix the lack of diversity within the specialty, the magnitude of the problem must first be measured. Fortunately, through the efforts of the J. Robert Gladden Orthopaedic Society, data sets are being created that better measure the diversity of individual orthopaedic residency programs. In addition to hiring diverse faculty, orthopaedic departments and practices should focus on the mentorship, sponsorship, retention, and promotion of these faculty. Finally, pipeline programs such as Nth Dimensions have a proven track record for improving the diversity of the orthopaedic workforce and can serve as the primary mechanism employed by departments and practices in making their orthopaedic surgeon workforce look more like the demographics of the United States.

Published
2022
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3. Complex Proximal Tibia Fractures: Workup, Surgical Approaches, and Definitive Treatment Options

Author

Nirmal C, Tejwani, Michael, Archdeacon, Edward, Harvey, Steven F, Shannon, Ian, McAlister, and Marcus F, Sciadini

Subjects
Tibial Fractures, Fracture Fixation, Internal, Tibia, Fracture Fixation, Humans, Plastic Surgery Procedures
Abstract

Proximal tibia fractures including intra-articular plateau fractures are complex injuries that benefit from an algorithmic approach in terms of treatment to optimize outcomes and minimize complications. Certainly, nonsurgical treatment will be an option for some injuries; however, this chapter will focus on those injuries best addressed with surgicalsurgical treatment. Indications for surgical treatment include joint incongruity, joint instability and limb malalignment. In regard to surgical treatment, important considerations include appropriate management of the soft-tissue envelope, staged provisional reduction and stabilization versus immediate definitive fixation, single versus multiple surgical approaches, unilateral versus bicondylar fixation, and treatment of concomitant fracture-dislocation. This chapter describes surgical approaches to the proximal tibia ranging from the standard anterolateral to complex dual approaches or posterior approaches. Soft-tissue management becomes important due to the high-energy nature of these injuries with trauma both at the time of injury and then the surgical insult. Learning to identify and minimize these risks as well as addressing the soft-tissue defects that may require treatment is highlighted. Implant selection and fixation options for bicondylar plateau fractures will be discussed. Finally, use of nails, especially suprapatellar nails for proximal extra-articular proximal tibia fractures is described.

Published
2020

4. Unstable Proximal Femur Fractures Treated With Proximal Femoral Locking Plates: A Retrospective, Multicenter Study of 111 Cases

Author

Cory A, Collinge, Robert, Hymes, Michael, Archdeacon, Phillip, Streubel, William, Obremskey, Timothy, Weber, J Tracy, Watson, David, Lowenberg, and Elyse, Brinkman

Subjects
Joint Instability, Male, Reoperation, musculoskeletal diseases, medicine.medical_specialty, Bone Screws, Bone healing, Locking plate, Fracture Fixation, Internal, 03 medical and health sciences, Postoperative Complications, 0302 clinical medicine, Risk Factors, Bone plate, Fracture fixation, Prevalence, Humans, Locked plate, Medicine, Orthopedics and Sports Medicine, Femur, Treatment Failure, 030212 general & internal medicine, Retrospective Studies, Fracture Healing, 030222 orthopedics, Proximal femur, Hip Fractures, business.industry, General Medicine, Middle Aged, musculoskeletal system, United States, Prosthesis Failure, Surgery, Treatment Outcome, Multicenter study, Female, business, Bone Plates
Abstract

A few small case series have found that proximal femur fractures treated with a proximal femur locking plate (PFLP) have experienced more failures than expected. The purpose of this study was to review the clinical results of patients with acute, unstable proximal femur fractures treated with proximal femoral locking plates in a large, multicenter patient cohort.This is a retrospective clinical study.The study included patients from 12 regional trauma centers and tertiary referral hospitals.One hundred eleven consecutive patients with unstable proximal femur fractures stabilized with a PFLP and having required clinical and radiographic follow-up at a minimum of 12 months after injury.Surgical repair of an unstable proximal femur fracture with a PFLP.Treatment failures (failure of fixation, nonunion, and malunion) and need for revision surgery.Forty-six patients (41.4%) experienced a major treatment failure, including failed fixation with or without nonunion (39), surgical malalignment or malunion (18), deep infection (8), or a combination of these. Thirty-eight (34%) patients underwent secondary surgeries, including 30 for failed fixation, nonunion, or both. Treatment failure was found to occur at a significantly higher rate in patients with major comorbidities, in femurs repaired in varus malalignment, and using specific plate designs.Proximal femoral locking plates are associated with a high complication rate, frequently requiring revision or secondary surgeries in the treatment of unstable proximal femur fractures. Given the high complication rate with PFLPs, careful attention to reduction, use of a PFLP implant, and consideration should be given to alternative implants or fixation techniques when appropriate.Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Published
2016
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5. Fracture fixation in the operative management of hip fractures (FAITH): an international, multicentre, randomised controlled trial

Author

Aaron Nauth, Aaron T. Creek, Abby Zellar, Abdel-Rahman Lawendy, Adam Dowrick, Ajay Gupta, Akhil Dadi, Albert van Kampen, Albert Yee, Alexander C. de Vries, Alexander de Mol van Otterloo, Alisha Garibaldi, Allen Liew, Allison W. McIntyre, Amal Shankar Prasad, Amanda W. Romero, Amar Rangan, Amber Oatt, Amir Sanghavi, Amy L. Foley, Anders Karlsten, Andrea Dolenc, Andrew Bucknill, Andrew Chia, Andrew Evans, Andrew Gong, Andrew H. Schmidt, Andrew J. Marcantonio, Andrew Jennings, Angela Ward, Angshuman Khanna, Anil Rai, Anke B. Smits, Annamarie D. Horan, Anne Christine Brekke, Annette Flynn, Aravin Duraikannan, Are Stødle, Arie B. van Vugt, Arlene Luther, Arthur W. Zurcher, Arvind Jain, Asgeir Amundsen, Ash Moaveni, Ashley Carr, Ateet Sharma, Austin D. Hill, Axel Trommer, B. Sachidananda Rai, Barbara Hileman, Bart Schreurs, Bart Verhoeven, Benjamin B. Barden, Bernhard Flatøy, Berry I. Cleffken, Berthe Bøe, Bertrand Perey, Birgit C. Hanusch, Brad Weening, Bram Fioole, Bram Rijbroek, Brett D. Crist, Brett Halliday, Brett Peterson, Brian Mullis, C. Glen Richardson, Callum Clark, Carlos A. Sagebien, Carmen C. van der Pol, Carol Bowler, Catherine A. Humphrey, Catherine Coady, Cees L. Koppert, Chad Coles, Chadi Tannoury, Charles J. DePaolo, Chris Gayton, Chris Herriott, Christina Reeves, Christina Tieszer, Christine Dobb, Christopher G. Anderson, Claire Sage, Claudine Cuento, Clifford B. Jones, Coks H.R. Bosman, Colleen Linehan, Cor P. van der Hart, Corey Henderson, Courtland G. Lewis, Craig A. Davis, Craig Donohue, Cyril Mauffrey, D.C. Sundaresh, Dana J. Farrell, Daniel B. Whelan, Daniel Horwitz, Daniel Stinner, Darius Viskontas, Darren M. Roffey, David Alexander, David E. Karges, David Hak, David Johnston, David Love, David M. Wright, David P. Zamorano, David R. Goetz, David Sanders, David Stephen, David Yen, Davide Bardana, Davy J Olakkengil, Deanna Lawson, Deborah Maddock, Debra L. Sietsema, Deeba Pourmand, Dennis Den Hartog, Derek Donegan, Diane Heels-Ansdell, Diane Nam, Dominic Inman, Dory Boyer, Doug Li, Douglas Gibula, Dustin M. Price, Dylan J. Watson, E. Mark Hammerberg, Edward T.C.H. Tan, Eelco J.R. de Graaf, Elise Berg Vesterhus, Elizabeth Roper, Elton Edwards, Emil H. Schemitsch, Eric R. Hammacher, Eric R. Henderson, Erica Whatley, Erick T. Torres, Erik G.J. Vermeulen, Erin Finn, Esther M.M. Van Lieshout, Eugene K. Wai, Evan R. Bannister, Evelyn Kile, Evert B.M. Theunissen, Ewan D. Ritchie, Farah Khan, Farhad Moola, Fiona Howells, Frank de Nies, Frank H.W.M. van der Heijden, Frank R.A.J. de Meulemeester, Frede Frihagen, Fredrik Nilsen, G. Ben Schmidt, G.H. Robert Albers, Garland K. Gudger, Garth Johnson, Gary Gruen, Gary Zohman, Gaurav Sharma, Gavin Wood, Geert W.M. Tetteroo, Geir Hjorthaug, Geir Jomaas, Geoff Donald, Geoffrey Ryan Rieser, Gerald Reardon, Gerard P. Slobogean, Gert R Roukema, Gijs A. Visser, Gilbert Moatshe, Gillian Horner, Glynis Rose, Gordon Guyatt, Graham Chuter, Greg Etherington, Gregory J. Della Rocca, Guri Ekås, Gwendolyn Dobbin, H. Michael Lemke, Hamish Curry, Han Boxma, Hannah Gissel, Hans Kreder, Hans Kuiken, Hans L.F. Brom, Hans-Christoph Pape, Harm M van der Vis, Harvinder Bedi, Heather A. Vallier, Heather Brien, Heather Silva, Heike Newman, Helena Viveiros, Henk van der Hoeven, Henry Ahn, Herman Johal, Herman Rijna, Heyn Stockmann, Hong A. Josaputra, Hope Carlisle, Igor van der Brand, Imro Dawson, Ivan Tarkin, Ivan Wong, J. Andrew Parr, J. Andrew Trenholm, J. Carel Goslings, J. David Amirault, J. Scott Broderick, Jaap P. Snellen, Jacco A.C. Zijl, Jaimo Ahn, James Ficke, James Irrgang, James Powell, James R. Ringler, James Shaer, James T. Monica, Jan Biert, Jan Bosma, Jan Egil Brattgjerd, Jan Paul M. Frölke, Jan Wille, Janakiraman Rajakumar, Jane E. Walker, Janell K. Baker, Janos P. Ertl, Jean Paul P.M. de Vries, Jean W.M. Gardeniers, Jedediah May, Jeff Yach, Jennifer T. Hidy, Jerald R. Westberg, Jeremy A. Hall, Jeroen van Mulken, Jessica Cooper McBeth, Jochem Hoogendoorn, Jodi M. Hoffman, Joe Joseph Cherian, John A. Tanksley, John Clarke-Jenssen, John D. Adams, John Esterhai, John F. Tilzey, John Murnaghan, John P. Ketz, John S. Garfi, John Schwappach, John T. Gorczyca, John Wyrick, Jonas Rydinge, Jonathan L. Foret, Jonathan M. Gross, Jonathan P. Keeve, Joost Meijer, Joris J.G. Scheepers, Joseph Baele, Joseph O'Neil, Joseph R. Cass, Joseph R. Hsu, Jules Dumais, Julia Lee, Julie A. Switzer, Julie Agel, Justin E. Richards, Justin W. Langan, Kahn Turckan, Kaili Pecorella, Kamal Rai, Kamran Aurang, Karl Shively, Karlijn van Wessem, Karyn Moon, Kate Eke, Katie Erwin, Katrine Milner, Kees Jan Ponsen, Kelli Mills, Kelly Apostle, Kelly Johnston, Kelly Trask, Kent Strohecker, Kenya Stringfellow, Kevin K. Kruse, Kevin Tetsworth, Khalis Mitchell, Kieran Browner, Kim Hemlock, Kimberly Carcary, Knut Jørgen Haug, Krista Noble, Kristin Robbins, Krystal Payton, Kyle J. Jeray, L. Joseph Rubino, Lauren A. Nastoff, Lauren C. Leffler, Laurents P.S. Stassen, Lawrence K. O'Malley, Lawrence M. Specht, Lehana Thabane, Leo M.G. Geeraedts, Leslie E. Shell, Linda K. Anderson, Linda S. Eickhoff, Lindsey Lyle, Lindsey Pilling, Lisa Buckingham, Lisa K. Cannada, Lisa M. Wild, Liz Dulaney-Cripe, Lodewijk M.S.J. Poelhekke, Lonneke Govaert, Lu Ton, Lucksy Kottam, Luke P.H. Leenen, Lydia Clipper, Lyle T. Jackson, Lynne Hampton, Maarten C. de Waal Malefijt, Maarten P. Simons, Maarten van der Elst, Maarten W.G.A. Bronkhorst, Mahesh Bhatia, Marc Swiontkowski, Margaret J. Lobo, Marilyn Swinton, Marinis Pirpiris, Marius Molund, Mark Gichuru, Mark Glazebrook, Mark Harrison, Mark Jenkins, Mark MacLeod, Mark R. de Vries, Mark S. Butler, Markku Nousiainen, Martijne van 't Riet, Martin C. Tynan, Martin Campo, Martin G. Eversdijk, Martin J. Heetveld, Martin Richardson, Mary Breslin, Mary Fan, Matt Edison, Matthew Napierala, Matthias Knobe, Matthias Russ, Mauri Zomar, Maurits de Brauw, Max Esser, Meghan Hurley, Melissa E. Peters, Melissa Lorenzo, Mengnai Li, Michael Archdeacon, Michael Biddulph, Michael Charlton, Michael D. McDonald, Michael D. McKee, Michael Dunbar, Michael E. Torchia, Michael Gross, Michael Hewitt, Michael Holt, Michael J. Prayson, Michael J.R. Edwards, Michael L. Beckish, Michael L. Brennan, Michael P. Dohm, Michael S.H. Kain, Michelle Vogt, Michelle Yu, Michiel H.J. Verhofstad, Michiel J.M. Segers, Michiel P.C. Siroen, Mike Reed, Milena R. Vicente, Milko M.M. Bruijninckx, Mittal Trivedi, Mohit Bhandari, Molly M. Moore, Monica Kunz, Morten Smedsrud, Naveen Palla, Neeraj Jain, Nico J.M. Out, Nicole Simunovic, Niels W.L. Schep, Oliver Müller, Onno R. Guicherit, Oscar J.F. Van Waes, Otis Wang, Pascal G. Doornebosch, Patricia Seuffert, Patrick J. Hesketh, Patrick Weinrauch, Paul Duffy, Paul Keller, Paul M. Lafferty, Paul Pincus, Paul Tornetta, Paul Zalzal, Paula McKay, Peter A. Cole, Peter D. de Rooij, Peter Hull, Peter M.N.Y.M. Go, Peter Patka, Peter Siska, Peter Weingarten, Philip Kregor, Philip Stahel, Philip Stull, Philippe Wittich, Piet A.R. de Rijcke, Pim Oprel, PJ Devereaux, Qi Zhou, R. Lee Murphy, Rachel Alosky, Rachel Clarkson, Raely Moon, Rajanikanth Logishetty, Rajesh Nanda, Raymond J. Sullivan, Rebecca G. Snider, Richard E. Buckley, Richard Iorio, Richard J Farrugia, Richard Jenkinson, Richard Laughlin, Richard P.R. Groenendijk, Richard W. Gurich, Ripley Worman, Rob Silvis, Robert Haverlag, Robert J. Teasdall, Robert Korley, Robert McCormack, Robert Probe, Robert V. Cantu, Roger B. Huff, Rogier K.J. Simmermacher, Rolf Peters, Roman Pfeifer, Ronald Liem, Ronald N. Wessel, Ronald Verhagen, Ronald Vuylsteke, Ross Leighton, Ross McKercher, Rudolf W. Poolman, Russell Miller, Ryan Bicknell, Ryan Finnan, Ryan M. Khan, Samir Mehta, Sandy Vang, Sanjay Singh, Sanjeev Anand, Sarah A. Anderson, Sarah A. Dawson, Scott B. Marston, Scott E. Porter, Scott T. Watson, Sebastiaan Festen, Shane Lieberman, Shannon Puloski, Shea A. Bielby, Sheila Sprague, Shelley Hess, Shelley MacDonald, Simone Evans, Sofia Bzovsky, Sondre Hasselund, Sophie Lewis, Stein Ugland, Stephanie Caminiti, Stephanie L. Tanner, Stephanie M. Zielinski, Stephanie Shepard, Stephen A. Sems, Stephen D. Walter, Stephen Doig, Stephen H. Finley, Stephen Kates, Stephen Lindenbaum, Stephen P. Kingwell, Steve Csongvay, Steve Papp, Steven E. Buijk, Steven J. Rhemrev, Steven M. Hollenbeck, Steven M. van Gaalen, Steven Yang, Stuart Weinerman, null Subash, Sue Lambert, Susan Liew, Sven A.G. Meylaerts, Taco J. Blokhuis, Tammo S. de Vries Reilingh, Tarjei Lona, Taryn Scott, Teresa K. Swenson, Terrence J. Endres, Terry Axelrod, Teun van Egmond, Thomas B. Pace, Thomas Kibsgård, Thomas M. Schaller, Thuan V. Ly, Timothy J. Miller, Timothy Weber, Toan Le, Todd M. Oliver, Tom M. Karsten, Tor Borch, Tor Magne Hoseth, Tor Nicolaisen, Torben Ianssen, Tori Rutherford, Tracy Nanney, Trevor Gervais, Trevor Stone, Tyson Schrickel, Tyson Scrabeck, Utsav Ganguly, V. Naumetz, Valda Frizzell, Veronica Wadey, Vicki Jones, Victoria Avram, Vimlesh Mishra, Vineet Yadav, Vinod Arora, Vivek Tyagi, Vivian Borsella, W. Jaap Willems, W.H. Hoffman, Wade T. Gofton, Wesley G. Lackey, Wesley Ghent, William Obremskey, William Oxner, William W. Cross, Yvonne M. Murtha, Zoe Murdoch, and Surgery

Subjects
Male, Bone Screws, Avascular necrosis, Kaplan-Meier Estimate, law.invention, Fracture Fixation, Internal, 0302 clinical medicine, Randomized controlled trial, Femur Head Necrosis, law, Fracture Fixation, Fracture fixation, Medicine and Health Sciences, 80 and over, Single-Blind Method, 030212 general & internal medicine, Non-U.S. Gov't, Aged, 80 and over, Fracture Healing, 030222 orthopedics, Hip fracture, Research Support, Non-U.S. Gov't, Hazard ratio, General Medicine, Equipment Design, Femur Head Necrosis/etiology, 3. Good health, Pulmonary embolism, Multicenter Study, Treatment Outcome, Randomized Controlled Trial, Fracture Fixation, Internal/adverse effects, Female, Reoperation, musculoskeletal diseases, medicine.medical_specialty, Femoral Neck Fractures/surgery, Internal/adverse effects, Bone healing, Research Support, N.I.H, 03 medical and health sciences, Research Support, N.I.H., Extramural, medicine, Journal Article, Humans, Adverse effect, Aged, business.industry, Extramural, medicine.disease, Femoral Neck Fractures, Surgery, Reconstructive and regenerative medicine Radboud Institute for Health Sciences [Radboudumc 10], Reoperation/statistics & numerical data, Quality of Life, business
Abstract

© 2017 Elsevier Ltd Background Reoperation rates are high after surgery for hip fractures. We investigated the effect of a sliding hip screw versus cancellous screws on the risk of reoperation and other key outcomes. Methods For this international, multicentre, allocation concealed randomised controlled trial, we enrolled patients aged 50 years or older with a low-energy hip fracture requiring fracture fixation from 81 clinical centres in eight countries. Patients were assigned by minimisation with a centralised computer system to receive a single large-diameter screw with a side-plate (sliding hip screw) or the present standard of care, multiple small-diameter cancellous screws. Surgeons and patients were not blinded but the data analyst, while doing the analyses, remained blinded to treatment groups. The primary outcome was hip reoperation within 24 months after initial surgery to promote fracture healing, relieve pain, treat infection, or improve function. Analyses followed the intention-to-treat principle. This study was registered with ClinicalTrials.gov, number NCT00761813. Findings Between March 3, 2008, and March 31, 2014, we randomly assigned 1108 patients to receive a sliding hip screw (n=557) or cancellous screws (n=551). Reoperations within 24 months did not differ by type of surgical fixation in those included in the primary analysis: 107 (20%) of 542 patients in the sliding hip screw group versus 117 (22%) of 537 patients in the cancellous screws group (hazard ratio [HR] 0·83, 95% CI 0·63–1·09; p=0·18). Avascular necrosis was more common in the sliding hip screw group than in the cancellous screws group (50 patients [9%] vs 28 patients [5%]; HR 1·91, 1·06–3·44; p=0·0319). However, no significant difference was found between the number of medically related adverse events between groups (p=0·82; appendix); these events included pulmonary embolism (two patients [

Published
2017
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7. Contributors

Author

Khalid M. Abbed, Kalil G. Abdullah, Paul D. Ackerman, Yunus Alapan, Vincent J. Alentado, Matthew D. Alvin, Christopher P. Ames, Neel Anand, Paul A. Anderson, Lilyana Angelov, Alireza K. Anissipour, John A. Anson, Ronald I. Apfelbaum, Michael Archdeacon, Paul M. Arnold, Mike W.J. Arun, Harel Arzi, Ahmed J. Awad, Basem I. Awad, Biji Bahuleyan, Mark D. Bain, Lissa C. Baird, Jamie Baisden, Nevan G. Baldwin, Perry A. Ball, Karl E. Balsara, Eli M. Baron, H. Hunt Batjer, Andrew M. Bauer, Thomas W. Bauer, Joshua M. Beckman, Gordon R. Bell, Carlo Bellabarba, E. Emily Bennett, Edward C. Benzel, Darren L. Bergey, Tarun Bhalla, Karin S. Bierbrauer, Mark Bilsky, Harjus Birk, Erica F. Bisson, Christopher Bono, Richard J. Bransford, Darrel S. Brodke, Nathaniel Brooks, Cristian Brotea, Jared R. Brougham, Samuel R. Browd, Robert T. Buckley, Shane Burch, John Butler, Mohamad Bydon, Steven Casha, Jeroen Ceuppens, Andrew K. Chan, Thomas C. Chen, Joseph Cheng, Dean Chou, Tanvir Choudhri, Aaron J. Clark, Adam M. Conley, Paul R. Cooper, Domagoj Coric, Mark Corriveau, Ian P. Côté, Jean-Valery C.E. Coumans, Charles H. Crawford, William T. Curry, Scott D. Daffner, Sedat Dalbayrak, Russell C. DeMicco, Harel Deutsch, Sanjay S. Dhall, Denis J. DiAngelo, Curtis A. Dickman, Shah-Nawaz M. Dodwad, Siena M. Duarte, Zeyd Ebrahim, Gerald W. Eckardt, Bruce L. Ehni, Kurt M. Eichholz, Marc Eichler, Samer K. Elbabaa, Benjamin D. Elder, James B. Elder, Richard G. Ellenbogen, Nancy Epstein, Thomas J. Errico, Yoshua Esquenazi, Daniel K. Fahim, Ehab Farag, Chad W. Farley, Michael G. Fehlings, Frank Feigenbaum, Eoin Fenton, Lisa A. Ferrara, R. David Fessler, Richard G. Fessler, Michael A. Finn, Ryan Finnan, Jeffrey S. Fischgrund, Kevin T. Foley, Ricardo B.V. Fontes, Todd B. Francis, Brett A. Freedman, Frederick Frost, John George, John W. German, Peter C. Gerszten, George M. Ghobrial, Zoher Ghogawala, Justin L. Gibson, Christopher C. Gillis, Vijay K. Goel, Jan Goffin, Ziya L. Gokaslan, Sohrab Gollogly, C. Rory Goodwin, Carlos R. Goulart, Vadim Goz, Yair M. Gozal, Randall B. Graham, Gerald A. Grant, Jian Guan, Ilker Gulec, Yazeed M. Gussous, Richard D. Guyer, David Gwinn, Sung Ha, Eldad Hadar, Clayton L. Haldeman, Alexander Y. Halim, Kimberly M. Hamilton, Christine L. Hammer, Fadi Hanbali, Shannon W. Hann, Jurgen Harms, James S. Harrop, Blaine L. Hart, David J. Hart, Daniel Harwell, Reyaad A. Hayek, Robert F. Heary, Fraser C. Henderson, Patrick W. Hitchon, Daniel J. Hoh, Paul J. Holman, Noboru Hosono, Clifford Houseman, John K. Houten, Joseph C. Hsieh, Wellington K. Hsu, Meng Huang, R. John Hurlbert, Lee Hwang, Steven Hwang, Serkan İnceoğlu, Libby Kosnik Infinger, Tatiana von Hertwig Fernandes de Oliveira, Devesh Jalan, Neilank Jha, J. Patrick Johnson, Charles I. Jones, G. Alexander Jones, Michael Jones, Rupa G. Juthani, Christopher D. Kager, Maziyar A. Kalani, M. Yashar S. Kalani, Iain H. Kalfas, Ricky R. Kalra, Reza J. Karimi, Osama Kashlan, Manish K. Kasliwal, Vikas Kaul, Mayank Kaushal, Tyler J. Kenning, Saad Khairi, Tagreed Khalaf, Jad G. Khalil, Larry T. Khoo, Ali Kiapour, Daniel H. Kim, David H. Kim, Kristopher T. Kimmell, Steven Kirshblum, Sameer A. Kitab, Paul Klimo, Eric O. Klineberg, Tyler R. Koski, Thomas A. Kosztowski, Robert J. Kowalski, Ajit A. Krishnaney, Kelly Krupa, Kristin Krupa, Varun R. Kshettry, Sunil Kukreja, Charles Kuntz, Shekar N. Kurpad, Srinivasu Kusuma, Michael LaBagnara, Frank La Marca, Ilya Laufer, Elizabeth Demers Lavelle, William F. Lavelle, W. Thomas Lawrence, Darren R. Lebl, Bryan S. Lee, Sun-Ho Lee, Lawrence G. Lenke, Steven P. Leon, Amy Li, Yiping Li, Isador H. Lieberman, James K.C. Liu, Victor P. Lo, S. Scott Lollis, Miguel Lopez-Gonzalez, Daniel Lubelski, Mark G. Luciano, Andre G. Machado, Raghu Maddela, Ravichandra A. Madineni, Casey Madura, Dennis J. Maiman, David G. Malone, Antonios Mammis, Satyajit Marawar, Nicolas Marcotte, Joseph C. Maroon, Michael D. Martin, Eduardo Martinez-del-Campo, Eric M. Massicotte, Tobias A. Mattei, Paul K. Maurer, Eric A.K. Mayer, Miguel Mayol del Valle, Daniel J. Mazanec, Paul C. McCormick, William McCormick, Zachary A. Medress, Ehud Mendel, Umesh S. Metkar, Vincent J. Miele, Ahmed Mohyeldin, Jad Bou Monsef, Timothy A. Moore, Hikaru Morisue, Peter Morone, Thomas E. Mroz, Jeffrey P. Mullin, F. Reed Murtagh, Ryan D. Murtagh, Sait Naderi, Usha D. Nagaraj, Charles C. Nalley, Anil Nanda, Richard J. Nasca, Anick Nater, Matthew T. Neal, Russ P. Nockels, John A. Norwig, Solomon M. Ondoma, Akinwunmi Oni-Orisan, Jonathan H. Oren, Jennifer Orning, R. Douglas Orr, Katie Orrico, Joseph A. Osorio, Ernesto Otero-Lopez, John O'Toole, Paul Park, Vikas Parmar, Robert S. Pashman, Rakesh D. Patel, Smruti K. Patel, Mick J. Perez-Cruet, Noel I. Perin, David B. Pettigrew, H. Westley Phillips, Rick Placide, Paul Porensky, Joshua P. Prager, Srinivas Prasad, Mark L. Prasarn, Rakesh Ramakrishnan, Ashwin G. Ramayya, Y. Raja Rampersaud, Peter A. Rasmussen, John K. Ratliff, Wolfgang Rauschning, Glenn R. Rechtine, Pablo F. Recinos, Daniel K. Resnick, Jay Rhee, Laurence D. Rhines, Alexander R. Riccio, Marlin Dustin Richardson, Bertram Richter, Ron Riesenburger, K. Daniel Riew, Matthew Rogers, Fanor M. Saavedra, Mina G. Safain, Rajiv Saigal, Paul D. Sawin, Justin K. Scheer, Joshua Scheidler, David W. Schippert, Richard Schlenk, Bradley Schmidt, Meic H. Schmidt, Daniel M. Sciubba, Christopher I. Shaffrey, Mark E. Shaffrey, Anoli Shah, Alok Sharan, Ashwini D. Sharan, Daniel Shedid, Steven Shook, Michael P. Silverstein, Venita M. Simpson, Anthony Sin, Harminder Singh, Donald A. Smith, Gabriel A. Smith, Justin S. Smith, Kyle A. Smith, Volker K.H. Sonntag, Hector Soriano-Baron, Robert F. Spetzler, W. Ryan Spiker, Blake Staub, Michael P. Steinmetz, Charles B. Stillerman, Andrea Strayer, Gandhivarma Subramaniam, Hamdi G. Sukkarieh, Andrew Sumich, Derrick Y. Sun, Tarek P. Sunna, Durga R. Sure, Richard A. Tallarico, Lee A. Tan, Claudio E. Tatsui, Fernando Techy, Nicholas Theodore, Alexander A. Theologis, Nicholas W.M. Thomas, Brian D. Thorp, Scott Tintle, Stavropoula Tjoumakaris, William D. Tobler, Daisuke Togawa, David Traul, Vincent C. Traynelis, A. Sophia Tritle, Gregory R. Trost, Eve C. Tsai, Kene Ugokwe, Kutlauy Uluc, Juan S. Uribe, Alexander R. Vaccaro, Alex Valadka, Aditya Vedantam, Anand Veeravagu, Kushagra Verma, Todd Vitaz, Jean-Marc Voyadzis, Scott Wagner, Trevor C. Wahlquist, Robert Waldrop, Kevin M. Walsh, Jeffrey C. Wang, Michael Y. Wang, Patrick T. Wang, John D. Ward, Zabi Wardak, Connor Wathen, Philip R. Weinstein, Michael Weisman, William C. Welch, Simcha J. Weller, L. Erik Westerlund, Jonathan A. White, Robert G. Whitmore, Jack E. Wilberger, Kim A. Williams, Ethan A. Winkler, Christopher D. Witiw, Christopher E. Wolfla, Jean-Paul Wolinsky, Cyrus Wong, Eric J. Woodard, Vijay Yanamadala, Daniel S. Yanni, Philip A. Yazbak, Chun-Po Yen, Mesut Yilmaz, Narayan Yoganandan, Kenneth S. Yonemura, Kazuo Yonenobu, Hansen A. Yuan, John K. Yue, Adam M. Zanation, Salvatore M. Zavarella, Seth M. Zeidman, Mehmet Zileli, Scott Zuckerman, and Holly Zywicke

Published
2017
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8. Lower Extremity Fracture Reduction: Tips, Tricks, and Techniques So That You Leave the Operating Room Satisfied

Author

Hassan R, Mir, Christina L, Boulton, George V, Russell, and Michael, Archdeacon

Subjects
Patient Outcome Assessment, Radiography, Fractures, Bone, Intraoperative Care, Lower Extremity, Fracture Fixation, Patient Selection, Humans, Orthopedic Fixation Devices
Abstract

It can be challenging for surgeons to obtain proper alignment and to create stable constructs for the maintenance of many lower extremity fractures until union is achieved. Whether lower extremity fractures are treated with plates and screws or intramedullary nails, there are numerous pearls that may help surgeons deal with these difficult injuries. Various intraoperative techniques can be used for lower extremity fracture reduction and stabilization. The use of several reduction tools, tips, and tricks may facilitate the care of lower extremity fractures and, subsequently, improve patient outcomes.

Published
2016

9. Incidence, Risk Factors, and Outcome Trends of Acute Kidney Injury in Elective Total Hip and Knee Arthroplasty

Author

Girish N, Nadkarni, Achint A, Patel, Yuri, Ahuja, Narender, Annapureddy, Shiv Kumar, Agarwal, Priya K, Simoes, Ioannis, Konstantinidis, Sunil, Kamat, Michael, Archdeacon, and Charuhas V, Thakar

Subjects
Adult, Male, Adolescent, Databases, Factual, Arthroplasty, Replacement, Hip, Incidence, Comorbidity, Acute Kidney Injury, Middle Aged, United States, Young Adult, Treatment Outcome, Elective Surgical Procedures, Risk Factors, Humans, Female, Arthroplasty, Replacement, Knee, Aged
Abstract

Over the past decade, there has been a marked increase in the number of primary and revision total hip and knee arthroplasties performed in the United States. Acute kidney injury (AKI) is a common complication of these procedures; however, little is known about its epidemiology in the elective arthroplasty population. We conducted a study to determine the incidence, risk factors, and outcomes of AKI after elective joint arthroplasty. Drawing on the Nationwide Inpatient Sample database, we found that the proportion of hospitalizations complicated by AKI increased rapidly from 0.5% in 2002 to 1.8% to 1.9% in 2012. Multivariate analysis revealed that the key risk factors for AKI were chronic kidney disease and the postoperative events of sepsis, acute myocardial infarction, and blood transfusion. Moreover, codiagnosis with chronic kidney disease increased the risk for AKI associated with all 3 postoperative events. After adjusting for confounders, we found an association between AKI and a significantly increased risk for in-hospital mortality and discharge to long-term facilities. AKI serves as an important quality indicator in elective hip and knee surgeries. With elective arthroplasties expected to rise, carefully planned approach to interdisciplinary perioperative care is essential to reduce both the risk and consequences of AKI.

Published
2016

10. A Prospective Functional Outcome and Motion Analysis Evaluation of the Hip Abductors After Femur Fracture and Antegrade Nailing

Author

John D. Wyrick, Mark V. Paterno, Michael Archdeacon, Kevin R. Ford, Shelley Hampton, Timothy E. Hewett, and Mary Beth Ludwig

Subjects
musculoskeletal diseases, medicine.medical_specialty, Movement, Bone healing, Bone Nails, law.invention, Intramedullary rod, law, Fracture fixation, medicine, Humans, Orthopedics and Sports Medicine, Femur, Prospective Studies, Range of Motion, Articular, Muscle, Skeletal, Prospective cohort study, Gait, Fracture Healing, Orthodontics, Femur fracture, integumentary system, business.industry, Recovery of Function, General Medicine, Biomechanical Phenomena, Fracture Fixation, Intramedullary, Surgery, body regions, Treatment Outcome, Hip Joint, Range of motion, business, Femoral Fractures
Abstract

To determine if dynamic hip abductor weakness during gait, evaluated through component measures of hip kinematics and hip kinetics, demonstrate longitudinal improvement after antegrade intramedullary nailing of femoral shaft fractures and if these improvements correlate with patient reported functional outcomes.Prospective patient protocol.University-based, level I trauma center.Eight nonconsecutive, isolated femur fracture patients.Antegrade intramedullary nailing of isolated femoral shaft fractures.Hip kinematics (hip abduction angle and ipsilateral lateral trunk lean), hip kinetics (hip abductor moment), and patient-reported functional outcome measures (Short Form-Musculoskeletal Function Assessment Survey) were assessed at 2 time points [Time1=independent ambulation without ambulatory aide, 2.0 (+/-0.6) months; Time2=approximately 6 months after injury with clinical and radiographic fracture healing, 7.2 (+/-1.5) months].After surgical fixation of a femoral shaft fracture, subjects demonstrated significant time-dependent, negative effects on gait secondary to dynamic hip abductor weakness measured in terms of hip kinematics [hip abduction angle (P=0.012) and lateral trunk lean (P=0.046)] and hip kinetics [hip abductor moment (P=0.029 at loading response; P=0.022 at terminal stance)]. A significant improvement in the dysfunction index was found between the early and late assessments (21.3+/-15.0, 6.5+/-8.9, P=0.008). At late assessment of functional outcome (22.5+/-3.7 months), a significant correlation was observed between the dysfunction index and hip kinematics (ipsilateral trunk lean) at both Time1 (R=-0.811, P=0.015) and Time2 (R=-0.713, P=0.047).After isolated femur fracture, patients treated with antegrade intramedullary nailing demonstrated a significant negative effect on hip kinematics and kinetics, and this effect was time-dependent. Early postsurgical ipsilateral trunk lean correlated with long-term functional outcome scores; therefore, excessive frontal plane movement during gait in the early postoperative stages may be indicative of a poorer self-reported longer-term functional outcome.

Published
2008
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