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  • Ovid Technologies (Wolters Kluwer Health)  (17)
  • 2015-2019  (17)
  • 1
    Online Resource
    Online Resource
    Effectiveness of Treatment for Distal Tibial Nonunions With Associated Complex Deformities Using a Hexapod External Fixator
    Ovid Technologies (Wolters Kluwer Health) ; 2017
    In:  Journal of Orthopaedic Trauma Vol. 31, No. 2 ( 2017-02), p. e43-e48
    Details
    In: Journal of Orthopaedic Trauma, Ovid Technologies (Wolters Kluwer Health), Vol. 31, No. 2 ( 2017-02), p. e43-e48
    Abstract: To determine the efficacy of a hexapod external fixator (TSF) and its ability to perform 6-axis correction in restoring deformities associated with distal tibial nonunions. Design: Consecutive retrospective case review. Setting: St. Louis University Hospital. Level 1 Trauma Center. Patients/Participants: Thirty-seven patients with distal tibial nonunion with greater than 5 degrees of deformity in any plane. Patients were excluded who were less than 18 years of age, had tibial deformities less than 5 degrees, had proximal or middle tibial deformities, or had less than 1 year of follow-up. Intervention: Patients with distal tibial nonunions with combined deformities were treated by the senior author with a hexapod device. Preoperative mechanical axis deviation and union status were assessed. Postoperative parameters evaluated included anatomic and mechanical axis determination and adequacy of union. Metrics include long alignment films with routine clinical follow-up. Main Outcome Measurements: Assessment of deformity correction in 6 axes, restoration to union, and mechanical axis correction. Results: Average combined preoperative deformity was greater than 17.7 degrees. Average mechanical axis was restored within 5 degrees of the desired goal in all categories except in patients with severe preoperative valgus deformities. The complex nonunion group had a 94% union rate. Average time in the hexapod was 106.7 days. Average follow-up time was 2 years. Conclusions: Hexapod external fixators can be used as an accurate modality to heal complex distal tibia nonunions with multifocal deformities and significant mechanical axis deviation. These difficult reconstructions are accomplished with minimum complications using these devices. Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
    Type of Medium: Online Resource
    ISSN: 0890-5339
    URL: Article
    DOI: 10.1097/BOT.0000000000000726
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2017
    detail.hit.zdb_id: 2041334-8
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  • 2
    Online Resource
    Online Resource
    Previous Implant Fractures: A New Descriptive Classification System
    Ovid Technologies (Wolters Kluwer Health) ; 2019
    In:  Journal of Orthopaedic Trauma Vol. 33, No. 9 ( 2019-09), p. 423-427
    Details
    In: Journal of Orthopaedic Trauma, Ovid Technologies (Wolters Kluwer Health), Vol. 33, No. 9 ( 2019-09), p. 423-427
    Abstract: To propose a previous implant fractures (PIFs) classification system with good interobserver reliability. Design: Retrospective classification. Setting: Four academic medical centers. Patients/Participants: A retrospective review of PIFs treated at 4 academic medical centers over 10 years was performed. Data collected included initial implant and PIF radiographs. There were 103 PIFs in 96 patients during the study period. Seventy-three (70.9%) were about plate/screw (PS) constructs and 30 (29.1%) were about intramedullary (IM) devices. Intervention: Assignment of PIF classification. Main Outcome Measurements: PIFs were classified based on initial implant (PS or IM) and fracture location with respect to the initial implant (proximal or distal to the implant, at the tip of the construct, or within the construct). Reliability of this scheme was assessed among 5 observers using Fleiss' kappa tests. Results: Of PIFs about plate/screw constructs, 26.0% were proximal/distal to the implant (classification: PS1), 57.5% involved bone between the most proximal/distal screw and the same end of the plate (classification: PS2), and 16.4% involved only bone between the most proximal and distal screws (classification: PS3). Of PIFs about IM, 43.3% were distal to the device (classification: IM1), 46.7% involved bone between the most proximal/distal locking bolt and the same end of the device (classification: IM2), and 10.0% involved only bone between locking bolts (classification: IM3). Interobserver reliability for the classification system was excellent between observers, κ = 0.839, P 〈 0.0005. Conclusions: The proposed system offers a simple method to classify and describe fractures that occur about a previously implanted fracture device. Development of a classification system will allow for comparison of treatment modalities between injury types.
    Type of Medium: Online Resource
    ISSN: 0890-5339
    URL: Article
    DOI: 10.1097/BOT.0000000000001499
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2019
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  • 3
    Online Resource
    Online Resource
    Bone Grafting : Sourcing, Timing, Strategies, and Alternatives
    Ovid Technologies (Wolters Kluwer Health) ; 2015
    In:  Journal of Orthopaedic Trauma Vol. 29, No. Supplement 12 ( 2015-12), p. S10-S14
    Details
    In: Journal of Orthopaedic Trauma, Ovid Technologies (Wolters Kluwer Health), Vol. 29, No. Supplement 12 ( 2015-12), p. S10-S14
    Type of Medium: Online Resource
    ISSN: 0890-5339
    URL: Article
    DOI: 10.1097/BOT.0000000000000460
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2015
    detail.hit.zdb_id: 2041334-8
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  • 4
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    Online Resource
    Unstable Proximal Femur Fractures Treated With Proximal Femoral Locking Plates: A Retrospective, Multicenter Study of 111 Cases
    Ovid Technologies (Wolters Kluwer Health) ; 2016
    In:  Journal of Orthopaedic Trauma Vol. 30, No. 9 ( 2016-09), p. 489-495
    Details
    In: Journal of Orthopaedic Trauma, Ovid Technologies (Wolters Kluwer Health), Vol. 30, No. 9 ( 2016-09), p. 489-495
    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. Design: This is a retrospective clinical study. Setting: The study included patients from 12 regional trauma centers and tertiary referral hospitals. Patients: 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. Intervention: Surgical repair of an unstable proximal femur fracture with a PFLP. Main outcome measurements: Treatment failures (failure of fixation, nonunion, and malunion) and need for revision surgery. Results: 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. Conclusions: 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. Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
    Type of Medium: Online Resource
    ISSN: 0890-5339
    URL: Article
    DOI: 10.1097/BOT.0000000000000602
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2016
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  • 5
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    Online Resource
    Staged Prone/Supine Fixation of High-Energy Multicolumnar Tibial Plateau Fractures: A Multicenter Analysis
    Ovid Technologies (Wolters Kluwer Health) ; 2018
    In:  Journal of Orthopaedic Trauma Vol. 32, No. 4 ( 2018-04), p. e117-e122
    Details
    In: Journal of Orthopaedic Trauma, Ovid Technologies (Wolters Kluwer Health), Vol. 32, No. 4 ( 2018-04), p. e117-e122
    Abstract: We present a surgical strategy to manage multicolumnar tibial plateau fracture variants by addressing the predominant posterior fragment employing a Lobenhoffer approach in the prone position followed by supine patient repositioning for anterolateral column access. Design: Multicenter retrospective analysis. Setting: Three academic Level 1 trauma centers. Patients/Methods: Twenty-eight cases (28 patients/28 knees) met inclusion criteria between 2003 and 2014. Patient demographic information was retrospectively reviewed with a mean follow-up time of 16.6 months (range 12–34 months). Postoperative radiographic analysis, physical examination findings, and patient outcome scores from the Knee Injury and Osteoarthritis Outcome Score questionnaire were recorded. Results: The average time to union was 3.6 months (range 3–9 months). Eighty-two percent of patients had satisfactory articular reduction (less than 2 mm articular step off). All patients demonstrated satisfactory coronal (medial proximal tibia angle 87 ± 5 degrees) and sagittal alignment (posterior proximal tibia angle 9 ± 4 degrees). Condylar width averaged 2.2 mm. Twenty percent of cases required posterior lateral columnar plating (in addition to posterior medial columnar plating), with none of these cases requiring an extensile exposure modification (medial gastrocnemius origin detachment) to expose posterior laterally. In 12 cases, the posterior approach was staged to allow for anterior soft tissue recovery before subsequent staged supine positioning and lateral column fixation. The knee range of motion averaged 123 degrees (ranged from 2 degrees of extension to 125 degrees flexion). The average Knee Injury and Osteoarthritis Outcome Score was 78/100 (range 29–95). Eleven percent of the patients in the series developed a surgical site infection (n = 3) with 2 requiring formal irrigation and debridement. The most common aseptic complication was radiographic posttraumatic arthrosis (18%). Clinically, 1 patient eventually required a total knee arthroplasty. Conclusions: High-energy multicolumnar tibial plateau fractures with significant posterior articular surface involvement may be predictably addressed with prone positioning, exposure, and fixation followed by supine repositioning and the inclusion of an anterior approach. This study demonstrates excellent postoperative radiographic results and acceptable clinical outcomes resulting from the described staged protocol. Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
    Type of Medium: Online Resource
    ISSN: 0890-5339
    URL: Article
    DOI: 10.1097/BOT.0000000000001109
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2018
    detail.hit.zdb_id: 2041334-8
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  • 6
    Online Resource
    Online Resource
    Cell-Based Therapies for the Treatment of Fractures
    Ovid Technologies (Wolters Kluwer Health) ; 2019
    In:  Journal of Orthopaedic Trauma Vol. 33, No. 3 ( 2019-06), p. S39-S43
    Details
    In: Journal of Orthopaedic Trauma, Ovid Technologies (Wolters Kluwer Health), Vol. 33, No. 3 ( 2019-06), p. S39-S43
    Abstract: Ongoing studies investigating fracture healing have uncovered and allowed investigators to gain a better understanding of where the variety of cells, which participate in this process, originate, and how they communicate as well as how they can be enhanced to successfully heal a fracture when the process has slowed or failed completely. This brief review will highlight some of the recent findings regarding the role the immune system in fracture healing and how these cells communicate with each other during the healing process. In addition, two 2 methods that have recently been shown to be promising techniques in supporting fracture when it stalls or reversing the process, when the fracture has failed to heal, will also be described.
    Type of Medium: Online Resource
    ISSN: 0890-5339
    URL: Article
    DOI: 10.1097/BOT.0000000000001478
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2019
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  • 7
    Online Resource
    Online Resource
    Update on Ilizarov’s Circular External Fixator and Method
    Ovid Technologies (Wolters Kluwer Health) ; 2015
    In:  Techniques in Orthopaedics Vol. 30, No. 3 ( 2015-09), p. 131-
    Details
    In: Techniques in Orthopaedics, Ovid Technologies (Wolters Kluwer Health), Vol. 30, No. 3 ( 2015-09), p. 131-
    Type of Medium: Online Resource
    ISSN: 0885-9698
    URL: Article
    DOI: 10.1097/BTO.0000000000000148
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2015
    detail.hit.zdb_id: 2055188-5
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  • 8
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    Online Resource
    Antibiotic Spacer for Infected Structural Flail Elbow: A New Surgical Technique
    Ovid Technologies (Wolters Kluwer Health) ; 2017
    In:  Techniques in Shoulder & Elbow Surgery Vol. 18, No. 1 ( 2017-03), p. 25-28
    Details
    In: Techniques in Shoulder & Elbow Surgery, Ovid Technologies (Wolters Kluwer Health), Vol. 18, No. 1 ( 2017-03), p. 25-28
    Type of Medium: Online Resource
    ISSN: 1523-9896
    URL: Article
    DOI: 10.1097/BTE.0000000000000085
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2017
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  • 9
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    Online Resource
    Nailing Proximal Femur Fractures : How to Choose Starting Point and Proximal Screw Configuration
    Ovid Technologies (Wolters Kluwer Health) ; 2015
    In:  Journal of Orthopaedic Trauma Vol. 29, No. Supplement 4 ( 2015-04), p. S22-S27
    Details
    In: Journal of Orthopaedic Trauma, Ovid Technologies (Wolters Kluwer Health), Vol. 29, No. Supplement 4 ( 2015-04), p. S22-S27
    Type of Medium: Online Resource
    ISSN: 0890-5339
    URL: Article
    DOI: 10.1097/BOT.0000000000000285
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2015
    detail.hit.zdb_id: 2041334-8
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  • 10
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    Online Resource
    Critical-Size Bone Defects: Is There a Consensus for Diagnosis and Treatment?
    Ovid Technologies (Wolters Kluwer Health) ; 2018
    In:  Journal of Orthopaedic Trauma Vol. 32, No. 3 ( 2018-03), p. S7-S11
    Details
    In: Journal of Orthopaedic Trauma, Ovid Technologies (Wolters Kluwer Health), Vol. 32, No. 3 ( 2018-03), p. S7-S11
    Abstract: There is a significant burden of disease associated with bone defects, and their management is challenging. These injuries have a profound clinical and economic impact, and outcomes are limited by high rates of complication and reoperation, as well as poor functional outcomes. There remains a lack of consensus around definitions, reliable models, and best practices for the surgical management of bone defects. The current state of the literature on bone defects is reviewed here, with a focus on defining critical-size bone defect, the use of the induced membrane technique, the role of biologics, and the management of infected bone defects.
    Type of Medium: Online Resource
    ISSN: 0890-5339
    URL: Article
    DOI: 10.1097/BOT.0000000000001115
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2018
    detail.hit.zdb_id: 2041334-8
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