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Emanuel Kaplan, MD: Greatness in Hand Surgery

Jejurikar, Neha; Hacquebord, Jacques; Posner, Martin A
PMID: 34842516
ISSN: 2328-5273
CID: 5152292

Luminos-103: A basket trial evaluating the safety and efficacy of PVSRIPO and PVSRIPO in combination with anti-PD-1/l1 checkpoint inhibitors in patients with advanced solid tumors [Meeting Abstract]

Inman, B; Milowsky, M; Pruthi, R; Posner, M; Polasek, M; Morris, S; Mixson, L; Orr, K; Woodson, E; Kelly, A; Nichols, G; Balar, A
Background PVSRIPO, a novel intratumoral viral immunotherapy, infects cells via CD155, which is widely expressed on solid tumors and antigen-presenting cells (APC). Infection is lethal in malignant cells, but a unique, activating, nonlethal infection of local APCs yields type-I/III interferon (IFN)-dominant inflammation with subsequent anti-tumor T-cell priming and activation resulting in anti-tumor efficacy. In preclinical models, PVSRIPO-dependent inflammation upregulated the PD-1/L1 pathway, and greater anti-tumor response was observed with PVSRIPO + anti-PD-1/L1 (aPD-1/L1). Promising clinical activity with PVSRIPO monotherapy was observed in patients with recurrent glioblastoma and advanced aPD-1- refractory melanoma.1 2 Collectively, these results warrant further clinical investigation of PVSRIPO +/- aPD-1/L1. Methods LUMINOS-103 (NCT04690699) is a phase (Ph) 1/2, open-label, multi-center, single-arm basket trial evaluating repeat administration of PVSRIPO +/- aPD-1/L1 in adults with solid tumors. Trial objectives are to assess the safety and tolerability of PVSRIPO monotherapy in each cohort in Ph 1 and the safety, tolerability, and antitumor efficacy of PVSRIPO + aPD-1/L1 in each cohort in Ph 2. The first two study cohorts include patients with muscle-invasive bladder cancer being treated in the neoadjuvant setting (A) and patients with metastatic bladder cancer being treated in the 1st/2nd line setting (B); these cohorts have been described previously.3 Cohort C includes patients with resectable, locally advanced head and neck squamous cell carcinoma (HNSCC) being treated in the neoadjuvant setting; Cohort D includes patients with recurrent/ metastatic HNSCC with a PD-L1 Combined Positive Score >=1 being treated in the 1st line setting. Eligibility: HNSCC patients must have histologically or cytologically-proven SCC of the oral cavity, oropharynx, hypopharynx, or larynx. All patients must have prior and boosted PV immunization and tumors amenable to injection and biopsy. Key exclusion criteria: Requirement for oxygen supplementation, systemic or intratumoral therapy <=6 months prior to the first dose of study drug, CNS metastases requiring immediate treatment, systemic immunosuppressive medications <=4 weeks prior to the first dose of study drug, and severe active comorbidities. Patients who are HIV+, HBV+ or HCV+ are eligible provided they meet certain criteria. Primary endpoints include safety (all cohorts), tolerability (all cohorts), surgical complication rate (A, C), pathologic treatment effect/response (A, C), and objective response rate (B, D). Secondary endpoints include overall survival (all cohorts), pathologic downstaging and relapse-free survival (A, C), duration of response and progression- free survival (B, D), and assessment of tumor/blood biomarkers (all cohorts)
ISSN: 2051-1426
CID: 5138502

Cerclage Wire Fixation for Fracture-Dislocations of the Proximal Interphalangeal Joint

Ayalon, Omri; Posner, Martin
Proximal interphalangeal (PIP) joint fracture dislocations are challenging injuries to treat. Multiple and varied treatments have been proposed. We present the use of cerclage wiring as a helpful technique in these challenging scenarios. The technique has the benefit of securing fracture fragments from the volar or dorsal base of middle phalanges or a comminuted fracture involving the entire articular surface. We report on the use of cerclage wires in eight patients (average: 43 years of age). Three patients had volar base fractures, three dorsal base fractures, and two impacted fractures involving the entire articular surface. All fractures healed, and average postoperative PIP active flexion motion arc was 21° to 95° (functional arc of 74°). We believe cerclage wire fixation is an effective and reproducible method to treat intra-articular fractures of middle phalanges, especially comminuted fractures involving the entire articular surface, and should be available to hand surgeons treating these difficult injuries.
PMID: 32857025
ISSN: 2328-5273
CID: 4586992

Displaced Intra-Articular Fractures Involving the Volar Rim of the Distal Radius

Marcano, Alejandro; Taormina, David P; Karia, Raj; Paksima, Nader; Posner, Martin; Egol, Kenneth A
PURPOSE: To describe the features of displaced intra-articular fractures confined to the volar rim of the distal radius and compare outcomes after their operative fixation to complete intra-articular and extra-articular fractures treated with operative fixation. METHODS: A total of 627 distal radius fractures were treated over a 6-year period. Twenty-eight patients had volar rim fractures (type 23-B3, as classified by the Orthopaedic Trauma Association [OTA]), all treated with operative reduction and fixation using a volar buttress plate. Clinical outcome information including radiographs, Short Form-36 health survey, and Disabilities of the Arm, Shoulder, and Hand questionnaire were collected at regular postoperative intervals. Patients with volar rim fractures were compared with patients who sustained other types of operatively managed distal radius fractures (OTA types 23-A, 23-B1/B2, and 23-C). RESULTS: The most common type of volar rim fracture consisted of a single large fragment (OTA 23-B3.2; 46%), followed by comminuted fractures (OTA 23-B3.3; 36%). Restoration of radiographic parameters was similar between groups except for an increased volar tilt in volar rim fractures compared with group 23-B1/B2. Active wrist and finger motion improved in all groups except for wrist extension, which was less in the 23-B1/B2 groups. The 23-B1/B2 group had the greatest pain and worst Short Form-36 scores. Disabilities of the Arm, Shoulder, and Hand questionnaire scores were similar and without differences between groups. CONCLUSIONS: Our data suggest that patients with volar rim distal radius fractures can expect a rapid return to function with minimal risk for complications and have outcomes similar to other types of operatively treated distal radius fractures. Further investigation of type 23-B fractures (23-B1/B2) is warranted owing to evidence of diminished outcomes. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic III.
PMID: 25446998
ISSN: 0363-5023
CID: 1370352

Commentary on Farah et al. Secondary displacement of distal radius fractures treated by bridging external fixation

Shaftel, N D; Posner, M A
PMID: 24742742
ISSN: 0266-7681
CID: 917912

Hand transplantation--a review

MacKay, Brendan J; Nacke, Elliot; Posner, Martin
Hand transplantation is a treatment option for complex injuries that leave patients with structural, functional, and aesthetic deficits that cannot be addressed by other means. It is a form of vascularized composite tissue allotransplantation (CTA). CTA is the highest rung the reconstructive ladder due to its complex technical and immunologic challenges. Despite completion of the first successful hand transplant in 1999, our understanding of hand transplantation is still evolving. Ongoing research is needed to improve functional outcomes and decrease the morbidity associated with long-term immunosuppression. This review will discuss the current protocols for upper extremity donation, transplant receipt, surgical technique, postoperative rehabilitation and immunosuppression, nerve regeneration, functional outcomes, ethical issues, and financial considerations.
PMID: 25150330
ISSN: 2328-5273
CID: 3568452

Diagnosis and treatment of finger deformities following injuries to the extensor tendon mechanism

Posner, Martin A; Green, Steven M
Injuries to the finger extensor apparatus are very common and may produce chronic deformity and loss of function. Diagnosis is contingent on an understanding of the complex anatomy of this region as well as the ability to perform a careful physical examination. Immobilization is usually the most effective treatment of acute problems. Surgery is often necessary for chronic conditions, but the results are much less predictably corrective.
PMID: 23660063
ISSN: 0749-0712
CID: 346532

Restoration of opposition

Posner, Martin A; Kapila, Deepak
Opposition is not grasp but a preposition for grasp that involves 3 components of thumb movements: abduction, flexion, and pronation. Thumb opposition is usually lost with paralysis of the thenar muscles innervated by the median nerve. Many opposition transfers have been described that differ in the donor tendon, route of transfer, and method of attachment to the thumb. No one transfer is applicable for every clinical condition, and each transfer has its advantages and disadvantages. Many factors must be evaluated to decide if surgery is likely to be beneficial and then decide on the optimum treatment
PMID: 22117922
ISSN: 1558-1969
CID: 141987

Benign extraosseous cartilage tumours of the hand and wrist

Christoforou, D; Strauss, E J; Abramovici, L; Posner, M A
Benign extraosseous cartilage tumours of the hand and wrist comprise soft tissue chondromas, synovial chondromatosis and tenosynovial chrondromatosis. These tumours can significantly affect patients as they are often painful, functionally limiting and cosmetically displeasing. Although each tumour is generally considered to be a distinct entity, they share radiological and histopathological similarities. Occasionally, all three tumours may be seen in the same patient. This is an important consideration because of the risk of recurrence that may not necessarily occur at the same anatomical site but instead extend to different sites, such as a tendon sheath and/or joint
PMID: 21987274
ISSN: 2043-6289
CID: 149795

Risks of HLA Incompatible Kidney Transplants by Antibody Strength: Initial Results from a National Study of 603 Patients [Meeting Abstract]

Segev, D; Wang, JGaronzik; Gloor, J; Stegall, M; Kapur, S; Dunn, T; Pelletier, R; Singh, P; Posner, M; Shapiro, R; El-Amm, JM; Light, J; Marsh, C; Melancon, JK; Lipkowitz, G; Wellen, J; Oberholzer, J; Montgomery, RA
ISSN: 1600-6135
CID: 1982892