Publications by authors named "Douglass W Tucker"

5 Publications

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Large Individual Bilateral Differences in Tibial Torsion Impact Accurate Contralateral Templating and the Evaluation of Rotational Malalignment.

J Orthop Trauma 2021 Apr 19. Epub 2021 Apr 19.

Keck School of Medicine of USC, Los Angeles, CA, USA Department of Orthopaedic Surgery, Keck School of Medicine of USC, Los Angeles, CA, USA Department of Orthopaedics, Cedars-Sinai Medical Center, Los Angeles, CA, USA.

Objective: To determine individual bilateral differences (IBDs) in tibial torsion in a diverse population.

Methods: Computed tomography scans of uninjured bilateral tibiae were used to determine tibial torsion and IBDs in torsion using four measurement methods. Age, sex, and self-identified race/ethnicity were also recorded for each subject. Mean tibial torsion and IBDs in torsion were compared in the overall cohort and when stratified by sex and race/ethnicity. Simple and multiple linear regression models were used to correlate demographic variables with tibial torsion and IBDs in torsion.

Results: 195 patients were evaluated. The mean tibial torsion was 27.5° ± 8.3° (range -3° to 47.5°). The mean IBD in torsion was 5.3° ± 4.0°(range 0 to 23.5°, P < 0.001). 12.3% of patients had IBDs in torsion of ≥10°. In the regression analysis, patients who identified as White had greater average torsion by 4.4° compared to Hispanic/Latinx patients (P = 0.001), whereas age and sex were not significantly associated with absolute torsion. Demographics were not associated with significant differences in IBDs in torsion.

Conclusions: Tibial torsion varies considerably and individual side-to-side differences are common. Race/ethnicity was associated with differences in the magnitude of tibial torsion, but no factors were associated with bilateral differences in torsion. The results of this study may be clinically significant in the context of using the uninjured contralateral limb to help establish rotational alignment during medullary nail stabilization of diaphyseal tibia fractures. Additionally, these findings should be considered in the evaluation of tibia rotational malalignment.

Level Of Evidence: Prognostic Level IV.
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http://dx.doi.org/10.1097/BOT.0000000000002041DOI Listing
April 2021

Treatment of tibial plateau fractures with a novel fenestrated screw system for delivery of bone graft substitute.

Eur J Orthop Surg Traumatol 2021 Jan 24. Epub 2021 Jan 24.

Department of Orthopaedic Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA.

Purpose: The purpose of this study was to describe the incidence of subsidence in patients with AO/OTA 41 (tibial plateau) fractures which were repaired with a novel fenestrated screw system to used to deliver CaPO4 bone substitute material to fill the subchondral void and support the articular reduction.

Methods: Patients with unicondylar and bicondylar tibial plateau fractures were treated according to the usual technique of two surgeons. After fixation, the Zimmer Biomet N-Force Fixation System®, a fenestrated screw that allows for the injection of bone substitute was placed and used for injection of the proprietary calcium phosphate bone graft substitute into the subchondral void. For all included patients, demographic information, operative data, radiographs, and clinic notes were reviewed. Patients were considered to have articular subsidence if one or more of two observations were made when comparing post-operative to their most recent clinic radiographs: > 2 mm change in the distance between the screw and the lowest point of the tibial plateau, > 2 mm change in the distance between the screw and the most superior aspect of the plate. Data were analyzed to determine if there were any identifiable risk factors for complication, reoperation, or subsidence using logistic regression. Statistical significance was set at p < 0.05.

Results: 34 patients were included with an average follow-up of 32.03 ± 22.52 weeks. There were no overall differences between height relative to the medial plateau or the plate. Two patients (5.9%) had articular subsidence. Six patients (15.2%) underwent reoperation, two (6%) for manipulations under anaesthesia due to arthrofibrosis, and four (12%) due to infections. There were 6 (19%) total infections as 2 were superficial and required solely antibiotics. One patient had early failure.

Conclusion: Use of a novel fenestrated screw system for the delivery of CaPO4 BSM results in articular subsidence and complication rates similar to previously published values and appears to be a viable option for addressing subchondral defects in tibial plateau fractures.

Level Of Evidence: IV.
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http://dx.doi.org/10.1007/s00590-021-02871-yDOI Listing
January 2021

Ballistic trauma patients have decreased early narcotic demand relative to blunt trauma patients: Blunt ballistic injury opioid use.

Injury 2021 May 15;52(5):1234-1238. Epub 2020 Sep 15.

Department of Orthopaedic Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, United States. Electronic address:

Objectives: Blunt and ballistic injuries are two common injury mechanisms encountered by orthopaedic traumatologists. However the intrinsic nature of these injures may necessitate differences in operative and post-operative care. Given the evolving opioid crisis in the medical community, considerable attention has been given to appropriate management of pain; particularly in orthopaedic patients. We sought to evaluate relative postoperative narcotic use in blunt injuries and ballistic injuries.

Design: Retrospective Cohort Study.

Setting: Academic Level-1 Trauma Center.

Patients: 96 Patients with blunt or ballistic fractures.

Intervention: Inpatient narcotic pain management after orthopaedic fracture management.

Main Outcome Measurements: Morphine equivalent units (MEU).

Results: Patients with blunt injuries had a higher MEU compared to ballistic injuries in the first 24 hours postoperatively (35.0 vs 29.5 MEU, p=0.02). There were no differences in opiate consumption 24-48 hours (34.8 vs 28.0 MEU), 48 hours - 7 days post op (28.4 vs 30.4 MEU) or the 24 hours before discharge (30.0 vs 28.6 MEU). On multivariate analysis, during the 24-48 hours and 24 hours before discharge timepoints total EBL was associated with increased opioid usage. During days 3-7 (p<0.001) and in the final 24 hours prior to discharge (p=0.012), the number of orthopaedic procedures was a predictor of opioid consumption.

Conclusion: Blunt injuries required an increased postoperative narcotic consumption during the first 24 hours of inpatient stay following orthopedic fracture fixation. However, there was no difference at other time points. Immediate post-operative pain regimens may be decreased for patients with ballistic injuries.

Level Of Evidence: III.
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http://dx.doi.org/10.1016/j.injury.2020.09.005DOI Listing
May 2021

Long-Term Tumor Control Rates Following Gamma Knife Radiosurgery for Acoustic Neuroma.

World Neurosurg 2019 Feb 15;122:366-371. Epub 2018 Nov 15.

Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USA.

Background: Acoustic neuromas (ANs) are benign intracranial tumors that arise from myelin-forming Schwann cells surrounding the vestibular branch of the vestibulocochlear nerve (cranial nerve VIII). Treatment options for AN include observation, radiosurgery, and microsurgical resection. Gamma Knife radiosurgery (GKRS) for AN has well-documented short-term safety and efficacy for carefully selected patients. Recent innovations in GKRS technology may improve long-term outcomes. The aim of this study was to report long-term tumor control and complication rates after GKRS for sporadic AN.

Methods: A retrospective review was performed of patients with sporadic ANs at Keck Hospital of USC who underwent GKRS from 1995 to 2015 with a minimum follow-up of 12 months.

Results: Median age at treatment was 63.7 years (range, 19.4-84.2 years). Median follow-up time was 69 months. Median tumor diameter was 17.5 mm (range, 5.0-29.0 mm), and median treatment volume was 2.41 cm (range, 0.09-12.8 cm). Median prescribed dose was 12.50 Gy. Tumor control was achieved in 51 (98.1%) patients over the follow-up period (12-192 months). One patient experienced tumor progression at 22 months after GKRS, requiring surgical intervention, which ultimately resulted in remission. Complications included hearing loss (17.3%), worsened balance/ataxia (7.7%), and hydrocephalus (1.92%).

Conclusions: Patients undergoing GKRS for sporadic ANs had high rates of tumor control over a median follow-up time of >5 years. Improvements in radiosurgery treatment planning were seen in the most recent cohort of patients. GKRS is a safe and effective modality for treating sporadic ANs in selected patients.
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http://dx.doi.org/10.1016/j.wneu.2018.11.009DOI Listing
February 2019

Epigenetic Reprogramming Strategies to Reverse Global Loss of 5-Hydroxymethylcytosine, a Prognostic Factor for Poor Survival in High-grade Serous Ovarian Cancer.

Clin Cancer Res 2018 03 20;24(6):1389-1401. Epub 2017 Dec 20.

Department of Pathology, Division of Women's and Perinatal Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.

A major challenge in platinum-based cancer therapy is the clinical management of chemoresistant tumors, which have a largely unknown pathogenesis at the level of epigenetic regulation. We evaluated the potential of using global loss of 5-hydroxymethylcytosine (5-hmC) levels as a novel diagnostic and prognostic epigenetic marker to better assess platinum-based chemotherapy response and clinical outcome in high-grade serous tumors (HGSOC), the most common and deadliest subtype of ovarian cancer. Furthermore, we identified a targetable pathway to reverse these epigenetic changes, both genetically and pharmacologically. This study shows that decreased 5-hmC levels are an epigenetic hallmark for malignancy and tumor progression in HGSOC. In addition, global 5-hmC loss is associated with a decreased response to platinum-based chemotherapy, shorter time to relapse, and poor overall survival in patients newly diagnosed with HGSOC. Interestingly, the rescue of 5-hmC loss restores sensitivity to platinum chemotherapy and , decreases the percentage of tumor cells with cancer stem cell markers, and increases overall survival in an aggressive animal model of platinum-resistant disease. Consequently, a global analysis of patient 5-hmC levels should be included in future clinical trials, which use pretreatment with epigenetic adjuvants to elevate 5-hmC levels and improve the efficacy of current chemotherapies. Identifying prognostic epigenetic markers and altering chemotherapeutic regimens to incorporate DNMTi pretreatment in tumors with low 5-hmC levels could have important clinical implications for newly diagnosed HGSOC disease. .
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http://dx.doi.org/10.1158/1078-0432.CCR-17-1958DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5951622PMC
March 2018