Faculty Bibliography
Searched for:
in-biosketch:true
person:egolk01
Total Results:
776
Tibial plateau fractures with and without meniscus tear--results of a standardized treatment protocol
OBJECTIVES: The purpose of this study was to determine what patient and injury factors are associated with the presence of a meniscus tear in tibial plateau fractures. We also sought to compare functional outcome, pain scores, and range of motion between patient groups with and without meniscal injury. MATERIALS AND METHODS: A total of 99 patients with 101 acute tibial plateau fractures were included in the study cohort. Patients were divided into two groups: those with and without meniscus tears at the time of initial injury. Statistical analysis with Student's t-test for continuous variables and chi square test for categorical variables was performed to compare those with and without a meniscal tear. Logistic regression was performed to identify the variables that predicted the presence of a meniscus tear and repeated ANOVA measures were used to assess functional outcome scores. RESULTS: Fifty-four patients with 56 tibial plateau fractures (55%) were found to have an associated meniscal tear. The average amount of joint depression in this group was 12.3 mm (range: 2.0 to 29.5 mm). The remaining 45 patients with 45 fractures (45%) had an average depression of 5.4 mm (range: 0.0 to 12.8 mm). Degree of tibial plateau depression was the only significant predictor of meniscal injury. CONCLUSIONS: Our findings suggest that amount of depression in tibial plateau fractures is a significant predictor of the occurrence of a meniscus tear with an odds ratio of 1.36. We also found no significant difference in the functional outcome, pain scores, and knee range of motion between the group with and without meniscus tears at the longest follow-up interval. These findings suggest that acute repair of meniscal injury following traumatic fracture of the tibial plateau could produce functional results similar to those patients that did not sustain a meniscus tear.
PMID: 24032616
ISSN: 2328-4633
CID: 779642
Re-displacement of extraphyseal distal radius fractures following initial reduction in skeletally immature patients--can it be prevented?
PURPOSE: The purpose of this study was to evaluate the efficacy of sugar tongs splints to maintain reduction of pediatric distal radius and distal both bones forearm fractures compared to acute casting. MATERIALS AND METHODS: The trauma database of an urban level-one trauma center was queried for skeletally immature patients who had sustained a displaced extraphyseal distal radius fracture. Inclusion criteria included: complete radiographs, skeletal immaturity, and presence of a displaced fracture of the radius within the metaphyseal segment, proximal to the distal radial physis, with or without an associated ulna fracture. All patients were seen in the emergency department and treated with a standardized protocol of closed reduction and immobilization. All radiographs were reviewed for initial and residual displacement. Baseline demographic data was also collected, including age at time of injury, handedness, and mechanism of injury. Need for operative intervention and associated complications were noted. All fractures were followed until union. RESULTS: Thirty-three patients were treated with closed reduction and immobilization in a sugar tongs splint, 10 patients were acutely casted, and 2 patients were placed into a short arm volar splint. Twenty-five patients who were initially splinted were treated to completion without the need for operative intervention. Eight of the patients treated with sugar tongs splints (24%) required surgery. Eight patients who were initially casted were treated to completion closed. Two of the patients who were initially casted (22%) required operative intervention for loss of reduction. Both of the patients who were initially immobilized using a volar splint were treated to completion without operative intervention. There was no statistically significant difference in the need for operative intervention amongst these groups. CONCLUSIONS: This study demonstrates that use of closed reduction and placement of a sugar tongs splint can effectively maintain reduction of extraphyseal distal radius fractures with rates of displacement similar to that seen with acute casting.
PMID: 24032614
ISSN: 2328-4633
CID: 779652
HSS journal : the musculoskeletal journal of Hospital for Special Surgery. 2013:9(1):12-6.DOI: 10.1007/s11420-012-9314-8
Bilateral disruption of soft tissue extensor mechanism of knee: functional outcome and comparison to unilateral injuries
BACKGROUND: Bilateral ruptures of the extensor mechanism are rare. QUESTIONS/PURPOSE: The purpose of this study was to compare the clinical outcomes of operatively treated unilateral and bilateral knee soft tissue extensor mechanism injuries and to identify risk factors for bilateral disruption. METHODS: All patients operatively treated for a knee extensor mechanism injury were entered into a database and prospectively followed. Postoperative protocol was standardized for all patients. Demographic data, baseline characteristics, range of motion, complications, pain, and functional status were assessed. The main patient-reported outcome measures used in this study were the SF-36 Health Survey and the Lysholm Scale. RESULTS: Patients who sustained bilateral injuries were more likely to have one or more systemic medical conditions. There was no statistical difference between the groups with regard to mechanism of injury or body mass index. The average follow-up was 29 months (range 6-60 months). Patient-reported outcomes, in the form of the SF-36 Health Survey and Lysholm scores, were not significantly different between the two groups at final follow-up. Range of motion and quadriceps strength was also similar between the two cohorts. At latest follow-up, 88% of patients with unilateral injuries and 83% of patients with bilateral disruption were able to return to their pre-injury employment. CONCLUSION: Operatively treated bilateral knee extensor mechanism disruptions fare similar to unilateral injuries with regard to ultimate functional outcome. The presence of one of more preexisting medical conditions was identified as a risk factor for bilateral tendinous disruption.
PMCID:3640716
PMID: 24426838
ISSN: 1556-3316
CID: 741272
Calcium phosphate cement augmentation of proximal humerus fractures
Proximal humerus fractures are common injuries in the elderly. Although the majority of these injuries may be treated conservatively, those who are treated with surgical fixation pose challenges because of decreased bone mineral density and bone voids encountered from cancellous impaction. Calcium phosphate cement (CPC) is a bone graft substitute that has recently garnered significant attention in the trauma literature because of its availability, mechanical strength, osteoconductivity, biocompatibility, and ability to custom-fill defects. It has shown excellent results in the augmentation of fractures with subarticular defects in multiple anatomic sites. Although there is limited evidence currently available for CPC augmentation in proximal humerus fractures, what does exist shows promising results. In this article, the authors present a preferred technique for surgical fixation of proximal humerus fractures and augmentation with CPC. 2013 by Lippincott Williams & Wilkins
EMBASE:2013769613
ISSN: 0885-9698
CID: 712832
Journal of the American Academy of Orthopaedic Surgeons. 2013:21(10):592-600.DOI: 10.5435/JAAOS-21-10-592
Objective structured clinical examinations: a guide to development and implementation in orthopaedic residency
Objective Structured Clinical Examinations (OSCEs) have been used extensively in medical schools and residency programs to evaluate various skills, including the six core competencies outlined by the Accreditation Council for Graduate Medical Education (ACGME). Orthopaedic surgery residency programs will be required by the ACGME to assess residents on core competencies in the Milestone Project. Thus, it is important that evaluations be made in a consistent, objective manner. Orthopaedic residency programs can also use simulation models in the examination to accurately and objectively assess residents' skills as they progress through training. The use of these models will become essential as resident work hours are decreased and opportunities to observe skills become more limited. In addition to providing a method to assess competency, OSCEs are a valuable tool for residents to develop and practice important clinical skills. Here, we describe a method for developing a successful OSCE for use in orthopaedic surgical resident training.
PMID: 24084433
ISSN: 1067-151x
CID: 585542
Intraoperative syndesmotic reduction: three-dimensional versus standard fluoroscopic imaging
BACKGROUND: The quality of reduction of the syndesmosis is an important factor in the outcome of ankle fractures associated with a syndesmotic injury. The purpose of this study was to directly compare the accuracy of syndesmotic reductions obtained using intraoperative standard fluoroscopic techniques against reductions obtained using three-dimensional imaging of the Iso-C3D fluoroscope. METHODS: We prospectively reviewed imaging studies of patients who were diagnosed as having preoperative or intraoperative evidence of syndesmotic diastasis (on the basis of the fluoroscopic Cotton test and/or a manual external rotation stress test) who underwent syndesmotic fixation at one of two level-I trauma centers. Center A used intraoperative computed tomography (CT) imaging to assess reduction (
PMID: 24132357
ISSN: 1535-1386
CID: 574232
Diagnosis and treatment of bisphosphonate-induced atypical femoral fractures
Atypical femoral fractures, deformities of the subtrochanteric region of the femur identified with plain anteroposterior or lateral lower extremity radiographs and characterized by a specific fracture pattern, are uncommon manifestations in osteoporotic patients. However, the high prevalence of these fractures in patients receiving long-term bisphosphonate therapy led to the many investigations of this association. The purpose of this article is to evaluate and address the link between this fracture type with long-term bisphosphonate therapy, outline the clinical scenario and better define treatment options for optimal care and recovery. In order to do this, a PubMed search was carried out for significant articles using the following keywords: 'alendronate', 'fracture', 'atypical' and 'femur'. 2013 Future Medicine Ltd
EMBASE:2013503999
ISSN: 1745-509x
CID: 551102
Outcomes Following Operative Treatment of open Fractures of the Distal Radius: A Case Control Study
PURPOSE: To report radiographic, clinical, and patient-based functional outcomes following contemporary operative treatment of patients who sustained an open distal radius fracture and compare them to a similar group of patients treated operatively for closed distal radius fractures. METHODS: Over five years, 601 patients with a distal radius fracture presented to our academic medical center, including one Level 1 trauma hospital, and were prospectively enrolled in an upper extremity trauma database. Patients with open distal radius fractures underwent irrigation, debridement, and operative fixation within 24 hours of presentation. Closed distal radius fractures requiring operative fixation were treated electively. Retrospective review of the database identified eighteen open fractures of the distal radius (11 type I, 6 type II, 1 type IIIa). The open fracture patients were individually matched with eighteen closed distal radius fracture patients who underwent surgical fixation based on age, sex, injury to dominant extremity, fracture pattern, and method of fracture fixation. Clinical, radiographic, patient- based functional outcomes, and complications were recorded at routine postoperative intervals. RESULTS: Follow-up was greater than 77% in both groups at all time points. The open and closed groups were similar in regards to age, gender, BMI, race, tobacco use, income, employment status, hand dominance, injury to dominant extremity, mechanism of injury, fracture classification, method of fracture fixation, and presence of concomitant injury. Postoperative complications and reoperation rates were similar between the open and closed groups. Union rates and radiographic alignment one year postoperatively were similar between the open and closed fracture groups. At final follow-up, range of motion parameters, grip strengths, DASH indices, and subjective pain scores were similar between both groups. DISCUSSION: Open distal radius fractures treated with early debridement and fixation achieved similar outcomes to surgically treated closed fractures of the distal radius when followed for a year or more postoperatively.
PMCID:3748867
PMID: 24027455
ISSN: 1541-5457
CID: 529162
The use of a multiplanar, multi-axis external fixator to achieve knee arthrodesis in a worst case scenario: a case series
BACKGROUND: One of the most catastrophic outcomes following total knee arthroplasty (TKA) is a chronic periprosthetic infection with concomitant failure of the knee extensor mechanism. This study retrospectively reviewed the clinical records of 7 patients who were treated with a 6 axis circular external fixation frame (Taylor Spatial Frame (TSF)) for this condition. Fusion was achieved in 5 of 7 patients (71%) at an average of 8.4 months after surgery. Complications occurred in the treatment of 5 of 7 patients (71%). Infection was controlled in all cases. The TSF presents another valuable tool, which the orthopaedic surgeon should consider when treating these difficult cases. PURPOSE: To evaluate the use of the Taylor Spatial Frame (TSF) to achieve knee arthrodesis in patients with chronically infected total knee arthroplasties (TKAs) with concomitant failure of the knee extensor mechanism. METHODS: We retrospectively evaluated the clinical records of 7 patients who were referred to our tertiary care orthopaedic medical center with multiple failed knee arthroplasties, chronic draining infection and complete loss of the extensor mechanism. All patients were treated with a similar protocol including, debridement and bony stabilization with an adjustable, 6 axis circular external fixation frame (TSF). Hospital charts were reviewed for sociodemographic information, surgical details, hospital course and complications. Radiographs were reviewed for healing and alignment. Follow up included clinical examination and radiographs. RESULTS: The mean age of the patients was 70.9 years (range, 59 - 83 years) at the time of application of the TSF. There were 3 men and 4 women. The average time between TKA and diagnosis of infection was 30.7 months (range, 2.6 - 67.0 months). The 7 patients had undergone an average of 3.3 prior surgical procedures (range, 2-4 procedures) on the ipsilateral extremity. Fusion was achieved in 5 of 7 patients (71%) at an average of 8.4 months after surgery (range, 6 - 10.5 months). Complications occurred in the treatment of 5 of 7 patients (71%) and included infection at the site of the pin tracks (5 patients), antibiotic- induced acute renal failure (1 patient), wound breakdown requiring flap closure (1 patient), and femur fracture secondary to a fall after placement of the antibiotic spacer but before application of the TSF (1 patient). The 2 patients in whom failure of fusion occurred returned to ambulation with an assistive device. Infection was controlled in all cases. CONCLUSION: Fusion and complication rates in this cohort are comparable to those reported in previous studies using other techniques to achieve external fixation. The TSF is a versatile external fixator that offers another tool, which the orthopaedic surgeon should consider when treating these difficult cases.
PMCID:3748878
PMID: 24027456
ISSN: 1541-5457
CID: 529172
Outcomes After Fixation of Proximal Humerus (OTA Type 11) Fractures in the Elderly Patients Using Modern Techniques
PURPOSE: To investigate the effects of age on the clinical, functional, and radiographic outcomes of patients with proximal humerus fractures treated operatively with locking plates. METHODS: Between February 2003 and July 2012, all patients who sustained a proximal humerus fracture who presented to our institution were enrolled into a database. Patients were followed up at 1, 6, 12, 26, and 52 weeks postoperatively with physical examination and radiographs. Validated functional outcomes scores were collected at 6 and 12 months. Complications were recorded as they occurred. Statistical analysis was conducted to assess for functional, physical, or radiographic differences between patients age younger than 65 and patients age 65 or older. RESULTS: Of the 147 consecutive patients treated operatively for a proximal humerus fracture, 115 (78%) patients with an average follow-up of 16 months met the inclusion criteria for this study. The young cohort (patients < 65) included 70 patients with an average age of 53, whereas the elderly cohort (patients >/= 65) included 45 patients with an average age of 73. The older cohort had significantly more women (P = .04), but there was no statistical difference in fracture type between the age groups. There were no differences in the radiographic measures of screw penetration, humeral head height, and neck-shaft angle between the age groups. There were no differences in physical examination scores between the age groups. There were no significant differences in functional outcomes or complication rates between the age groups. CONCLUSION: Treating proximal humerus fractures operatively with locked plates can overcome the challenges of poor bone quality that often occur with increasing age. Age should not play a significant role in the decision-making process for treating proximal humerus fractures that would otherwise be indicated for surgical fixation.
PMCID:3739412
PMID: 23936736
ISSN: 2151-4585
CID: 495062
