Publications by authors named "Ely L Steinberg"

45 Publications

Addressing posterior tilt displacement during surgery to lower failure risk of sub-capital Garden types 1 and 2 femoral fractures.

Arch Orthop Trauma Surg 2021 May 6. Epub 2021 May 6.

Orthopedic Division, Department of Orthopedic Surgery, Affiliated with the Sackler Faculty of Medicine, Tel Aviv Medical Center, Tel Aviv University, 6 Weitzman St., 6423906, Tel Aviv, Israel.

Introduction: Sub-capital femoral fractures (SCFF) are impacted or non-displaced in Garden types 1 and 2, respectively. Non-surgical treatment is protected weight-bearing combined with physiotherapy and radiographic follow-up in selected patients. Traditionally, in situ pinning is the surgical treatment of choice. The aim of this study was to estimate whether the valgus deformity in Garden types 1 and 2 (AO classification 31B1.1 and 31B1.2) SCFF is a virtual perception of a posterior tilt deformity and if addressing this deformity improves patients' outcomes.

Materials And Methods: The records of 96 patients with Garden Types 1 and 2 SCFF treated in tertiary medical center between 1/2014 and 9/2017 were retrospectively reviewed. They all had preoperative hip joint anteroposterior and lateral radiographic views. 75 patients had additional computed tomography (CT) scans. Femoral head displacement was measured on an anteroposterior and axial radiograph projections and were performed before and after surgery. Preoperative 3D reconstructions were performed for a better fracture characterization, and assessment of the imaging was performed by the first author.

Results: The average age of the study cohort was 73 years (range 28-96, 68% females). There were 58 right-sided and 38 left-sided fractures. Ninety patients had Type 1 and six patients had Type 2 fractures. The average preoperative posterior tilt was 15 degrees and the average valgus displacement was 10 degrees on plain radiographs compared to 28 degrees and 11 degrees, respectively, on CT scans. Posterior tilt was found with a virtual perception as valgus-impacted fractures. The postoperative posterior tilt was corrected to an average of 3 degrees and the valgus displacement to 5 degrees.

Conclusion: CT provides an accurate modality for measuring femoral head displacement and fracture extent. The posterior tilt displacement should be addressed during surgery to lower failure risk and the need for additional procedures.

Irb Approval: TLV-0292-15.

Level Of Evidence: IV.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00402-021-03900-5DOI Listing
May 2021

Expandable Proximal Femoral Nail versus Gamma Proximal Femoral Nail for the treatment of hip reverse oblique fractures.

Arch Orthop Trauma Surg 2021 Jan 8. Epub 2021 Jan 8.

Department of Orthopaedic Surgery, Medical Center, Affiliated with the Faculty of Health and Science and Ben Gurion University, Ha-Refu'a St 7, 7747629, Ashdod, Israel.

Background: Reverse oblique intertrochanteric fractures are classified by the AO/OTA as 31A3 and account for 2-23% of all trochanteric fractures. The Gamma 3-Proximal Femoral Nail (GPFN) and the Expendable Proximal Femoral Nail (EPFN) are among the various devises used to treat this fracture. The aim of this study was to compare outcomes and complication rates in patients with AO/OTA 31A1-3 fractures, treated by either a GPFN or an EPFN.

Patients And Methods: A total of 67 patients (40 in the GPFN group and 27 in the EPFN group, average age 78.8 years) were treated in our institution between July 2008 and February 2016. Data on postoperative radiological variables, including peg location and tip-apex distance (TAD), as well as orthopedic complications, such as union rate, surgical wound infection and cut-outs rates were also recorded, along with the incidence of non-orthopedic complications and more surgical data. Functional results were evaluated and quantified using the Modified Harris Hip Score (MHHS) and by the Short Form 12 Mental Health Composite questionnaire (SF-12 MHC) in order to assess the quality of life.

Results: The total prevalence of postoperative orthopedic complications including postoperative infection showed a significant difference with a p-value of 0.016 in favor of the EPFN group. Nonetheless, the frequency of revision did not differ between the two groups, being 0.134. The main orthopedic complication in both groups was head cut-out of the GPFN lag screw and the EPFN expendable peg, which was 20% and 7.4%, respectively, and required a revision surgery using a long nail or total hip replacement (THR). However, the average TAD did not significantly differ between groups which might be due to a relatively low cohort to reach a significant difference. Nonunion rate of 5% occurred solely in the GPFN group, with similar results of intraoperative open reduction between both groups. The EPFN group achieved better scores in both questionnaires (p = 0.027 and p = 0.046, respectively). Both the MHHS and SF-12 MCS values significantly differed between groups, with the EPFN group achieving better scores than the GPFN group in both questionnaires (p = 0.027 and p < 0.05, respectively).

Conclusions: According to this study, the EPFN yields better results in comparison with the GPFN, with relatively less complications rate, for the treatment of unstable reverse oblique pertrochanteric fracture. In light of this results, we conclude that the EPFN might be as good as GPFN for the treatment of reverse oblique intertrochanteric fractures.

Level Of Evidence: Level III retrospective study. The local institutional review board of the Tel Aviv Medical Center approved this study and all the surgeries were done exclusively in this institution.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00402-020-03726-7DOI Listing
January 2021

Correlation between preoperative imaging parameters and postoperative basic kinematics-based functional outcome in patients with tibial plateau fractures.

Clin Biomech (Bristol, Avon) 2019 05 16;65:87-91. Epub 2019 Apr 16.

Division of Orthopedics, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel.

Background: Functional scores and radiographs are often used to assess function and predict development of osteoarthritis in patients with multi-fragmentary tibial plateau fractures (TPFs). Locomotion, which is the primary goal of fracture treatment, is rarely assessed. The objective of this study was to assess functional ability of patients after TPF fixation using spatio-temporal gait analysis (STGA), and to compare STGA variables with self-reported functional scores and preoperative fracture characteristics.

Methods: Preoperative CT scans of 21 patients with complete articular multi-fragmentary TPFs were evaluated for number of fragments, maximum gap between the fragments and maximum articular depression. All patients underwent STGA (velocity, cadence, step length of the affected and the unaffected leg, single-limb support by the affected and the unaffected leg, and double-leg support) and filled the Knee Society Score and the Short Form-12 questionnaires on average 3 years (SD = 1.56, range, 2-5.8) post-injury.

Findings: Step length and single-limb support time of the affected leg were shorter compared to the unaffected leg (p = 0.02 and p = 0.007, respectively). Number of fracture fragments correlated with cadence (R = -0.461, p = 0.04) and velocity (R = -0.447, p = 0.04).

Interpretation: Given that both higher fracture comminution and deformity on the one hand and the above gait parameter alterations on the other hand are associated with knee osteoarthritis, STGA may be used for routine postoperative evaluation of patients after TPF fixation.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.clinbiomech.2019.04.009DOI Listing
May 2019

Safety of urgent hip fracture surgery protocol under influence of direct oral anticoagulation medications.

Injury 2019 Feb 29;50(2):398-402. Epub 2018 Oct 29.

Division of Orthopedics, Tel Aviv Sourasky Medical Center, Affiliated with Tel Aviv University, Tel Aviv, Israel.

Introduction: Direct oral anticoagulation agents (DOACs) are increasingly prescribed to older adults. Concerns for perioperative blood loss dictate cessation of anticoagulation treatment and postponement of surgery until the coagulation system returns to normal state. The goal of this study is to compare the estimates of perioperative blood loss and mortality between patients using DOACs and patients receiving no anticoagultaion, in order to challenge the existing policy and question the need for surgery deferral.

Materials And Methods: This is a retrospective cohort of patients (age > 65) with proximal hip fractures treated with either closed reduction internal fixation (CRIF, n = 1143; DOAC use n = 60) or hemiarthroplasty (HA, n = 571; DOAC use n = 29). Baseline patient characteristics included age, gender, ASA score, socioeconomic level, type of surgica#1: In general a l treatment, duration of surgery and time from admission to surgery. The effect of anticoagulant prescription on percentage of hemoglobin change, odds of receiving blood transfusions and one-month and one-year mortality was evaluated separately for CRIF and HA patients.

Results: Patients receiving DOACs had similar perioperative hemoglobin change, transfusion rates and mortality, compared to subjects without anticoagulants in both CRIF and HA cohorts. DOAC patients undergoing CRIF had a longer delay to surgery (40.2 ± 26.9 vs 31.2 ± 22.2, p = 0.003) and higher mortality rates at one year postoperatively (26.7% vs 16.1%, p = 0.015).

Conclusions: DOAC use was not associated with an increased perioperative blood loss or mortality compared to controls. However, they had to wait longer for surgery, which itself was an independent predictor of mortality. It may be safe to shorten waiting time for surgery in patients using anticoagulation, with the goal to minimize surgery delay.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.injury.2018.10.033DOI Listing
February 2019

Financial impact and effect on the outcome of preoperative tests for at-risk older hip fracture patients.

Geriatr Gerontol Int 2018 Jun 7;18(6):937-942. Epub 2018 Mar 7.

Orthopedic Division, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.

Aim: Older patients with proximal femoral fractures often undergo preoperative tests due to coexisting morbidities. Our aim was to evaluate these tests and their impact on patient outcome and medical expenses.

Methods: This retrospective study includes data on head computed tomography, carotid ultrasound, echocardiography and pulmonary functional tests calculated according to the type of surgery (osteosynthesis or hip arthroplasty) carried out on 2798 patients. Time-to-surgery, test repeated postoperatively, American Society of Anesthesiology Physical Status score, additional procedures, hospitalization time, 30-day mortality and associated medical expenses were evaluated.

Results: A total of 921 preoperative tests were carried out in 780 (28%) patients, and 375 postoperative tests were carried out in 329 (12%) patients (P < 0.001). A total of 23 procedures were carried out after surgery, none related to the originally carried out tests. Significant group differences were found for American Society of Anesthesiology Physical Status score, days to surgery, hospitalization time (days) and mortality rates. The medical expenses of these tests were 1.3% of the average income per case, and 0.6% of the average study group income.

Conclusions: Non-routine preoperative tests prolong time-to-surgery, increased hospitalization time and contribute to 30-day mortality. No postoperative procedure was related to preoperative test findings. The financial cost for these tests does not burden the medical expenses per procedure. Geriatr Gerontol Int 2018; 18: 937-942.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/ggi.13295DOI Listing
June 2018

Functional outcomes after removal of hardware in patellar fracture: are we helping our patients?

Arch Orthop Trauma Surg 2018 Mar 28;138(3):325-330. Epub 2017 Nov 28.

Joint Arthroplasty and Sports Medicine Department, Tel Aviv Sourasky Medical Center, Affiliated with the Sackler Faculty of Medicine, Tel Aviv University, 6 Weitzman Street, 6423906, Tel-Aviv, Israel.

Purpose: Functional outcomes after Open Reduction Internal Fixation (ORIF) of the patella are variable. Common complications of patella ORIF include persistent anterior knee pain, limited range of motion and symptomatic hardware. The purpose of this study was to evaluate if removal of hardware is beneficial to symptomatic patients after patellar fracture fixation.

Methods: Patients who presented to our institution between December 2006 and November 2014 with patella fractures treated with ORIF were eligible for inclusion. Patella ORIF was performed using (1) K-wires (KW) with a tension band construct or (2) Cannulated Screws (CS) with a tension band construct. Radiological analyses included (1) AO classification and (2) measurements of prominent hardware length. Patient medical charts were reviewed for demographic and intraoperative data as well as peri/postoperative complications. All patients completed the SF-12 score, visual analog scale, Kujala score, Lysholm score and questionaries' regarding return to previous activity levels.

Results: Forty-seven patients met the inclusion criteria. The average time from fracture fixation to removal of hardware was 15.8 (SD ± 14.9) months. The mean follow-up was 43.1 (SD ± 27.1) months. Patella fixation was accomplished using tension band constructs with KW in 28 patients (59.5%) or with CS in 19 patients (40.5%). Patient reported quality of life and pain outcomes improved significantly after removal of hardware (p = 0.001, and p = 0.002 respectively). Functional outcome scores (Kujala and Lysholm) did not improve significantly after hardware removal in the KW or CS groups. Significantly more patients in the KW group returned to pre-injury activity (p = 0.005).

Conclusions: Hardware removal after patella ORIF significantly improves patient reported pain and quality of life outcomes but not functional outcomes. Patients should be counseled regarding the expected outcome of hardware removal following patella ORIF and diabetic patients should be given special consideration before undergoing this procedure.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00402-017-2852-2DOI Listing
March 2018

A double-plating approach to distal femur fracture: A clinical study.

Injury 2017 Oct 25;48(10):2260-2265. Epub 2017 Jul 25.

Orthopaedic Division, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel.

Background: Locked plating is one of the latest innovative options for treating supracondylar femur fractures with relatively low failure rates. Single lateral plating was often found to have a relative higher failure rate. No clinical studies of double-plating distal femur fixation have thus far been reported. The aim of this study is to present our clinical experience with this surgical approach.

Patients And Methods: Thirty-two patients (26 females and 6 males, mean age 76 years, range 44-101) were included in the study. Eight of them patients had a periprosthetic stable implant fracture and two patients were treated for a nonunion.

Results: All fractures, excluding one that needed bone grafting and one refracture, healed within 12 weeks. One patient needed bone grafting for delayed union and one patient needed fixation exchange due to femur re-fracture at the site of the most proximal screw. Two patients developed superficial wound infection and one patient required medial plate removal after union due to deep infection.

Conclusions: Based on these promising results, we propose that the double-plating technique should be considered in the surgeon's armamentarium for the treatment of supracondylar femur fractures, particularly in patients with poor bone quality, comminuted fractures and very low periprosthetic fractures.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.injury.2017.07.025DOI Listing
October 2017

Corona mortis anastomosis: a three-dimensional computerized tomographic angiographic study.

Emerg Radiol 2017 Oct 10;24(5):519-523. Epub 2017 Apr 10.

Radiology Division, Tel-Aviv Medical Center, Tel-Aviv University, Tel-Aviv, Israel.

Purpose: We evaluated the corona mortis (CM) anatomy by means of three-dimensional computerized tomography angiographic (CTA).

Methods: Patient demographic, anastomosis incidence, artery diameter, artery distance from the symphysis pubis, and pelvic size (distance between both acetabular upper labrum) parameters were assessed. The 100 patients included 66 males and 34 females (average age of 67.8 years).

Results: There were 66 (33%) arterial anastomoses in the 200 evaluated arteries, 30 in the right side and 36 in the left side, 36 unilaterally and 15 bilaterally. No anastomoses were detected in 49 patients. The average diameter was 2.4 mm for the right-sided arteries and 2.24 in the left-sided ones. The distance was 55.2 mm from the right symphysis and 57.2 from the left symphysis (greater for females, 62.2 versus 55.85 mm [p = 0.037] only on the left side). The artery disappears in smaller-sized pelvises. There was a non-occluded arterial pattern in 47 (71%) and a partially occluded one in 19 (29%, all with peripheral vascular disease).

Conclusion: One-third of the evaluated CTAs revealed competent CMs. CMs were more lateral in females than in males and were absent in small-sized pelvises. It is highly recommended that the radiologist and the surgeon should be familiar with CM existence for decision-making with regard to emergency radiology imaging and intervention as well as when operating in proximity of that anatomic site.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s10140-017-1502-xDOI Listing
October 2017

Preoperative Planning of Orthopedic Procedures using Digitalized Software Systems.

Isr Med Assoc J 2016 Jun;18(6):354-8

The progression from standard celluloid films to digitalized technology led to the development of new software programs to fulfill the needs of preoperative planning. We describe here preoperative digitalized programs and the variety of conditions for which those programs can be used to facilitate preparation for surgery. A PubMed search using the keywords "digitalized software programs," "preoperative planning" and "total joint arthroplasty" was performed for all studies regarding preoperative planning of orthopedic procedures that were published from 1989 to 2014 in English. Digitalized software programs are enabled to import and export all picture archiving communication system (PACS) files (i.e., X-rays, computerized tomograms, magnetic resonance images) from either the local working station or from any remote PACS. Two-dimension (2D) and 3D CT scans were found to be reliable tools with a high preoperative predicting accuracy for implants. The short learning curve, user-friendly features, accurate prediction of implant size, decreased implant stocks and low-cost maintenance makes digitalized software programs an attractive tool in preoperative planning of total joint replacement, fracture fixation, limb deformity repair and pediatric skeletal disorders.
View Article and Find Full Text PDF

Download full-text PDF

Source
June 2016

Dynamic locking plate vs. simple cannulated screws for nondisplaced intracapsular hip fracture: A comparative study.

Injury 2016 Feb 30;47(2):424-7. Epub 2015 Oct 30.

Division of Orthopedic Surgery, Tel Aviv Medical Center, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. Electronic address:

Introduction: Intracapsular hip fractures (ICHF) are a common cause of morbidity and mortality and pose a great economic burden on the health care systems. Appropriate surgical treatment requires balancing optimal outcomes with the cost of treatment to the health care system. While in elderly patients with displaced ICHF arthroplasty became the standard of care, the internal fixation method for conserving the femoral head in younger patients or in nondisplaced ICHF is still in debate. We compared a dynamic locking plate with the standard cancellous cannulated screws (CCS) for treatment of nondisplaced ICHF.

Methods: All patients treated with internal fixation for nondisplaced ICHF between July 2009 and December 2012 at our level one trauma center were included in this study. Patients treated with Targon FN (Aesculap) implants and CCS (Synthes) were compared. Charts were reviewed for demographics, intraoperative data and peri/post operative complications retrospectively. Radiographical analysis, pain (VAS), quality of life (SF12) and function (MHHS) data were prospectively gathered.

Results: One hundred and fifteen non-displaced ICHFs were treated with internal fixation, 81 with CCS and 34 with Targon FN implant; the mean follow-up was 19 and 28 months, respectively. Group fracture characteristics (Garden/Powel classification), and demographics, excluding age, were not significantly different. Post-operative revision rates of the Targon FN and CCS groups, perioperative complications were not statistically different (p>0.05). Quality of life (SF-12), function (Modified Harris Hip Score) and Visual Analogue Scale (VAS) pain scores were not statistical different.

Conclusions: Complication rates and clinical outcomes for the treatment of nondisplaced ICHF with Targon FN and SCC showed no significant differences. Based on this evidence in consideration of the substantial cost differential between the Targon FN and SCC we suggest SCC for treatment of nondisplaced ICHF.

Level Of Evidence: III.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.injury.2015.10.054DOI Listing
February 2016

Control of the micromovements of a composite-material nail design: A finite element analysis.

J Mech Behav Biomed Mater 2016 Feb 8;54:223-8. Epub 2015 Oct 8.

Orthopaedic Division, Sourasky, Tel-Aviv Medical Center, Tel-Aviv University, Israel. Electronic address:

Background: Intramedullary nail fixation is the most accepted modality for stabilizing long bone midshaft fractures. The commercially used nails are fabricated from Stainless Steel or Titanium. Composite-materials (CM) mainly carbon-fiber reinforced polymers (CFRP) have been gaining more interest and popularity due to their properties, such as modulus of elasticity close to that of bone, increased fatigue strength, and radio-opacity to irradiation that permits a better visualization of the healing process. The use of CFRP instead of metals allows better control of different directional movements along a fracture site. The purpose of this analysis was to design a CM intramedullary nail to enable micromovements as depicted on a finite element analysis method.

Methods: We designed a three-dimentional femoral nail model. Three CFRP with different laminates arrangements, were included in the analysis. The finite element analysis involved applying vertical and horizontal loads on each of the designed and tested nails.

Results: The nails permitted a transverse micromovement of 0.75mm for the 45° lay-up and 1.5mm for the 90° lay-up for the CM, 1.38mm for the Titanium and 0.74mm for the Stainless Steel nails. The recorded axial movements were 0.53mm for the 45° lay-up, 0.87mm for the 90° lay-up, 0.46mm for the unsymmetrical lay-up CM, 0.046 for the Titanium and 0.02 for the Stainless Steel nails. Overall, the simulations showed that nail transverse micromovements can be reduced by using 45° carbon fiber orientations. Similar results were observed with each metal nails.

Interpretation: We found that nail micromovements can be controlled by changing the directional stiffness using different lay-up orientations. These results can be useful for predicting nail micromovements under specified loading conditions which are crucial for stimulating callus formation in the early stages of healing.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jmbbm.2015.09.011DOI Listing
February 2016

Anchor suture fixation of distal pole fractures of patella: twenty seven cases and comparison to partial patellectomy.

Int Orthop 2016 Jan 26;40(1):149-54. Epub 2015 Apr 26.

Orthopedic Division, Tel Aviv Sourasky Medical Center, 6 Weizmann St, Tel Aviv, 64239, Israel.

Purpose: Partial patellectomy (PP) and reattachment of the patellar ligament with transosseous suturing is the mainstay of surgical treatment for distal pole patellar fractures. An anchor suturing (AS) technique has recently been reported as an alternative to PP in such fractures and allows for bone-to-bone interface and possibly superior fracture healing than bone-to-tendon interface with PP. We present our experience with AS and compare it to PP.

Methods: Between 2006 and 2011, 60 patients with distal pole patellar fracture underwent either AS (n = 27) or PP (n = 33). We retrospectively gathered their demographic data and information on fracture type, fixation technique, operation time, postoperative complications and knee range of motion. A telephone survey was performed to grade functional outcomes with standard questionnaires (the SF-12 for quality of life, the Kujala score for patellofemoral function and a visual analog scale [VAS] pain score).

Results: AS was equivalent to PP in terms of residual pain and functional outcomes (VAS: 2.45 vs. 2.26, p = 0.83 and Kujala score: 74.3 vs. 69, p = 0.351, respectively) as well as for knee range of motion. Complications included three cases of infection in each group, two cases of early hardware failure and one case of non-union in the AS group. Operation time was significantly shorter for AS compared to PP (68.5 vs. 79.1 min, p = 0.03).

Conclusions: AS is non-inferior to PP for function and pain after distal pole patellar fractures and is superior to PP with regard to operative time. Common complications of this technique are hardware failure and infections.

Level Of Evidence: Therapeutic Level III.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00264-015-2776-9DOI Listing
January 2016

Limb position significantly affects safety distance during cast removal.

Orthop Nurs 2015 Mar-Apr;34(2):110-2

Yasmin Abu-Ghanem, MD, M. Med. Sc., Division of Orthopaedics, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. Nora Abu-Ghanem, M. Med. Sc, Division of Orthopaedics, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. Asaf Albagly, MD, Division of Orthopaedics, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. Gil Eyal, MD, Department of Orthopaedics, Beilinson Campus, Rabin Medical Center, Petah-Tiqva, Israel. Ely L. Steinberg, MD, Division of Orthopaedics, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. Ofir Chechik, MD, Division of Orthopaedics, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.

Background: Unintentional cast saw injuries are attributable to casting material or improper removal technique. Another factor associated with the risk of injury is the "safety distance," the distance between the inner perimeter of the cast and the patient's skin.

Methods: Nine patients with lower leg casts around the knee/ankle were examined. Safety distance was measured using a standard depth gauge at 6-10 spots along the limb. The safety distance at each spot was measured in both supine and lateral-decubitus positions. Limb position was termed "safe" with the saw coming directly from above; a "dangerous" position was considered when the saw was coming from the side.

Results: The mean safety distance in the "safe position" was 17.02 mm ± 4.66 mm, compared with 14.34 mm ± 3.85 mm in the "dangerous position" (Δ = 2.7 mm; p < .0001).

Conclusions: Proper positioning of a patient during cast-splitting, with the saw in the nondependent, safe aspect of the limb, can significantly increase the safety distance and minimize skin injuries.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/NOR.0000000000000137DOI Listing
January 2017

Capsular closure does not affect development of heterotopic ossification after hip arthroscopy.

Arthroscopy 2015 Feb 8;31(2):225-30. Epub 2014 Nov 8.

Department of Orthopedics, Sackler Faculty of Medicine, Tel Aviv Medical Center, Tel Aviv University, Tel Aviv, Israel.

Purpose: The purpose of this study was to evaluate the role of capsular closure after hip arthroscopy in reduction of the incidence of heterotopic ossification (HO).

Methods: One hundred (50 study group, 50 control group) consecutive hip arthroscopy procedures with radiographic follow-up of more than 9 weeks were included in the study. The study group consisted of 50 patients in whom capsular closure with 2 No. 1 polydioxanone (PDS) sutures was performed, and a control group consisted of 50 patients in whom the capsule remained open after capsulotomy. HO was assessed by radiographs using the Brooker classification. Statistical analysis of the data was carried out with the χ-square or Fisher exact test and Student t test, when appropriate, at a significance level of .05.

Results: Thirty-six (36%) patients had radiographic evidence of postoperative HO (14 patients in the capsular closure group). No significant difference was found regarding sex, side of operation, age, or HO rate between the study and the control groups (P = .778, P = .123, P = .744, and P = .144, respectively). Furthermore, no significant difference was found in the rate of HO with potential clinical significance (Brooker classification > I) between the control and study groups (P = .764).

Conclusions: Capsular closure did not seem to alter the rate of HO when compared with a control group of patients in whom the capsulotomy was not repaired.

Level Of Evidence: Level III, retrospective comparative study.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.arthro.2014.08.026DOI Listing
February 2015

The impact of serum albumin and serum protein levels on POSSUM score of patients with proximal femur fractures.

Injury 2014 Dec 7;45(12):1928-31. Epub 2014 Aug 7.

Orthopaedic Division, Tel-Aviv Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.

Background: POSSUM was developed to predict risk-adjusted mortality and morbidity rates for surgical procedures. We evaluated the impact of serum albumin and serum protein levels on POSSUM scores.

Methods: Medical files of 2269 patients operated for proximal femur fractures were reviewed. Preoperative serum albumin levels were available for 387 patients (mean 35.1g/l, range 22-49) and serum protein levels for 279 patients (mean 61.6g/l, range 40-86).

Results: Serum albumin and protein levels were inversely associated with mortality in multivariate models (albumin, OR=0.89, p=0.009; protein, OR=0.92, p=0.009) and in composite outcome models as well (albumin, OR=0.955, p=0.219, protein, OR=0.94, p=0.014). The area under the curve (AUC) for POSSUM prediction of mortality (n=1770) was 0.632 (95% CI: 0.580-0.684, p<0.001). The AUC for a model including serum protein levels was 0.742 (95% CI: 0.649-0.834, p<0.001). Hospitalisation time was longer for patients with lower serum proteins levels (p=0.045), with an inverse correlation (Pearson correlation -0.164, p=0.011).

Conclusions: Lower preoperative serum albumin and serum protein levels were associated with increased risk for mortality, increased hospitalisation time and poorer outcomes in patients operated for proximal femoral fractures. Including those values to POSSUM scores would increase their predictive power.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.injury.2014.07.030DOI Listing
December 2014

Favorable radiographic outcomes using the expandable proximal femoral nail in the treatment of hip fractures - A randomized controlled trial.

J Orthop 2014 Jun 10;11(2):103-9. Epub 2014 May 10.

Division of Orthopaedics, Tel Aviv Sourasky Medical Center, Tel Aviv 64239, Israel.

Aim: To compare the functional and radiographic results of dynamic hip screw (DHS) and expandable proximal femoral nail (EPFN) in the treatment of extracapsular hip fractures.

Methods: A randomized controlled trial of sixty hip fracture patients. Outcomes included mortality, residency, independence, mobility, function and radiographic results at a minimum of 1 year.

Results: Twenty-nine EPFN patients demonstrated fewer cases of shaft medialization or femoral offset shortening compared to the 31 DHS patients. Mortality, complications and functional outcomes were similar.

Conclusion: EPFN provides stable fixation of pertrochanteric hip fractures and prevents neck shortening that is commonly observed after DHS fixation.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jor.2014.04.004DOI Listing
June 2014

Decreasing the occurrence of intraoperative technical errors through periodic simple show, tell and learn method.

Injury 2014 Aug 28;45(8):1242-5. Epub 2014 Apr 28.

Orthopaedic Division, Tel-Aviv Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.

Background: Technical errors (TE) that occur during surgery for treating fractures are considered as being preventable by good preoperative planning and surgeon education. This prospective study evaluated a new instructional method for improving surgical outcomes that involved assessing surgeons' own recent performances.

Methods: Postoperative radiographs from two groups of patients were assessed during consecutive 4-month periods. 350 operations were included in the Early Group and 411 operations in the Late Group. All the TE that occurred during the first period were reviewed and discussed among the residents and the consultant surgeons who had performed those operations. The same procedure was followed 4 months later. The TE were classified as minor, moderate and major.

Results: The two groups included the same 41 surgeons. The most common TE were: insufficient reduction, varus and valgus malalignment and prominent hardware. The total number of errors dropped significantly, from 52 (14.7%) during the first period to 26 (6.3%) during the second period (p = 0.0003). The TE score severity dropped from 81 to 38, respectively (p = 0.0001). The most affected regions were, the humerus (p < 000.1), midshaft femur (p = 0.007), proximal femur (p = 0.004) and radius (p = 0.008). Most of the gains were made in the moderate category (p = 0.0001). The consultants performed statistically better than the residents in the first period (12% vs. 20%, p = 0.036), but almost similar to the residents in the second period (5.3% vs. 9%, p = 0.164). A TE index was calculated by dividing the accumulated sum by the number of operations and it dropped in both groups from 0.2 and 0.3 to 0.09 and 0.09, respectively.

Conclusion: Intraoperative TE can be significantly reduced by periodic performance evaluations in a seminar setting during which groups of surgeons can review the TE that they and their colleagues had made during recent orthopaedic surgical procedures.

Level Of Evidence: Level II.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.injury.2014.04.035DOI Listing
August 2014

Transient sternoclavicular joint arthropathy, a self-limited disease.

J Shoulder Elbow Surg 2014 Apr 10;23(4):548-52. Epub 2013 Dec 10.

Orthopedics Division, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel. Electronic address:

Background: The sternoclavicular joint (SCJ) is a true diarthrodial synovial joint and therefore vulnerable to the same disease processes as in other synovial joints. We identified a group of patients with monarticular arthritis of the SCJ that had a benign process and a self-limited disease course.

Methods: This retrospective study included 25 female patients who presented with pain or swelling of the SCJ between January 2000 and December 2010. Their mean age was 59 years, and the average follow-up was 44 months. All patients underwent baseline radiographic imaging, technetium bone scan, computed tomography, and magnetic resonance imaging. Blood profiles were negative for rheumatoid factor in all patients. Functional outcome was assessed with the Rockwood SCJ score.

Results: The patients presented with complaints of pain (72%), local swelling (88%), and redness (8%) that progressed during 4 weeks. The physical examination revealed tenderness (84%), swelling (88%), and limited range of motion (16%). These findings persisted for a median of 5 months. Plain radiographs showed arthritic changes in 5 patients (20%). Increased uptake was observed in all 9 patients who underwent a bone scan. Soft tissue swelling was demonstrated on computed tomography in 5 patients (20%) and on magnetic resonance imaging in 5 patients (20%). One patient had osteoarthritic changes on magnetic resonance imaging. Pain resolved spontaneously in all patients, leaving only swelling in 9 patients and tenderness in 1 patient.

Conclusion: Our experience is that SCJ arthropathy may often be a self-limited disease. After being treated solely with nonsteroidal anti-inflammatory medication, 24 of the 25 study patients showed complete regression of pain and return to full function without recurrence of symptoms. Basic blood tests and radiographs are sufficient to rule out a septic joint.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jse.2013.08.013DOI Listing
April 2014

Early operative intervention is associated with better patient survival in patients with intracapsular femur fractures but not extracapsular fractures.

J Arthroplasty 2014 May 26;29(5):1072-5. Epub 2013 Oct 26.

Orthopaedic Division, Tel Aviv Medical Center, Tel-Aviv University, Tel Aviv, Israel.

The purpose of this study was to determine patients' survival after undergoing an early or delayed operation. We retrospectively assessed 1849 files of patients operated for proximal femoral fracture, divided into two diagnostic groups: intracapsular (n = 640) and extracapsular (n = 1209). 1163 (63%) were treated within 48 h from hospital admission and 686 (37%) were treated >48 h afterwards. Delayed operation in patients with intracapsular fractures was associated with a 1.8-fold excess risk for 1-year mortality (HR = 1.83, P = 0.008), while no effect was observed for patients with extracapsular fractures. Males had a higher HR for mortality in both diagnostic groups. Early surgical intervention is beneficial for intra-capsular femoral fractures; male gender and a high ASA score are associated with an increased mortality hazard risk.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.arth.2013.10.021DOI Listing
May 2014

The anterior aspect is the safest area to split a leg cast in the supine position: a study protocol.

Orthop Nurs 2013 Nov-Dec;32(6):316-9

Yasmin Abu-Ghanem, MD, M Med Sc, Division of Orthopaedics, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. Ely L. Steinberg, MD, Division of Orthopaedics, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. Eran Maman, MD, Division of Orthopaedics, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. Michael Drexler, MD, Division of Orthopaedics, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. Ofir Chechik, MD, Division of Orthopaedics, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.

Background: Involuntary cast-saw burns are attributable to poorly padded casts, cast material, or improper technique. Another factor potentially associated with the risk of injury is the distance between the inner perimeter of the cast and the patient's skin (safety distance).

Methods: Eighty computed tomographic scans of the lower limb following cast application were analyzed. Safety distance was measured above, below, and at the level of the knee and ankle joints at 4 different aspects (posterior, anterior, medial, and lateral).

Results: The highest safety distance measured was at the anterior aspect, 5 cm beneath the ankle joint (8.13 ± 3.73 mm). The lowest distance measured was consistently at the posterior aspect at all levels, especially 5 cm below the ankle joint (2.02 ± 1.31 mm).

Conclusions: The anterior aspect of the leg is the safest area to split a cast based on safety distance measurements. Patient and limb position may also affect the safety distance at various areas along the limb.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/NOR.0000000000000005DOI Listing
February 2015

Superior outcome of strut allograft-augmented plate fixation for the treatment of periprosthetic fractures around a stable femoral stem.

Injury 2013 Nov 10;44(11):1556-60. Epub 2013 Jun 10.

Department of Orthopedic Surgery, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. Electronic address:

Purpose: This study was designed to compare the outcome of two surgical approaches for treating femoral periprosthetic fractures around a stable femoral stem. The hypothesis was that plate fixation alone might be associated with a higher complication rate due to insufficient mechanical stability. We also considered that the addition of a strut allograft would contribute to fracture healing by means of osteoconduction.

Methods: We retrospectively assessed the outcome of 21 patients who sustained periprosthetic fractures around a total hip replacement system (Vancouver type B1 and type C fractures) and who were treated in our department (January 2006 and August 2011) either by plate fixation alone or by plate fixation and a strut allograft. The mean postoperative follow-up was 23 months (range 9-69 months). Eleven patients were treated by plate fixation alone (Plate Group), and 10 patients were treated by plate fixation and a deep frozen cortical strut allograft (AG Group). Functional outcome was rated by the Harris Hip scoring system. Postoperative radiographs were assessed for evidence of fracture union. Surgical failure was defined as any complication requiring surgical revision.

Results: The 21 patients included 17 females and 4 males. The average age was 79 years (range, 73-88) for the Plate Group and 82 years (range, 53-94) for the AG Group, and the average time to fracture union was 12 weeks (range, 2.5-6 months) and 12.95 weeks (range, 1.5-3) respectively. The overall failure rate was significantly higher in the Plate Group: 5 of them required revision surgery compared to none in the AG Group (p=0.014).

Conclusion: The results of this analysis indicate that a strut allograft augmentation approach to Vancouver type B1 and type C periprosthetic fractures results in a better outcome than plate fixation alone by apparently adding mechanical stability and enhancing the biological healing process.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.injury.2013.04.025DOI Listing
November 2013

Sequelae of underdiagnosed foot compartment syndrome after calcaneal fractures.

J Foot Ankle Surg 2013 Mar-Apr;52(2):158-61. Epub 2013 Jan 13.

Graduate School of Medicine, Tel Aviv University Sackler Faculty of Medicine, Tel Aviv, Israel.

The calcaneus is the most frequently fractured tarsal bone. Compartment syndrome (CS) complicates fractures and other injuries and is most commonly described in association with the lower leg. The long-term sequelae of CS of the foot can include toe clawing, permanent loss of function, persistent pain, muscle atrophy, contracture, painful warts, weakness, and sensory disturbances. The incidence and clinical significance of untreated CS after calcaneal fractures were questioned. All compliant patients treated by us for a calcaneus fracture underwent a physical examination and medical interview: 47 (49 fractures) were included in the final cohort (36 males, 11 females, mean age 49 ± 14.5 years, mean follow-up 23 ± 16 months). Missed CS sequelae were diagnosed by the presence of claw toes and plantar sensory deficits. The functional outcome and pain at rest and during activity were scored. Five patients (10%) had missed CS, and their functional score was significantly lower than for those without CS (52 ± 21.5 versus 77.4 ± 22 for no CS, p < .05). All missed CS cases were diagnosed in patients with a Sanders type 3 or 4 fracture. Intra-articular fracture was a significant factor associated with developing CS sequelae (p = .045). Untreated CS can cause muscle and nerve injury and contribute to a poor functional outcome. Because CS is more likely to develop after highly comminuted intra-articular fractures, these patients warrant close monitoring for CS development. Early detection and treatment might result in fewer late disabling sequelae of this injury.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1053/j.jfas.2012.11.016DOI Listing
August 2013

Carbon fiber reinforced PEEK Optima--a composite material biomechanical properties and wear/debris characteristics of CF-PEEK composites for orthopedic trauma implants.

J Mech Behav Biomed Mater 2013 Jan 11;17:221-8. Epub 2012 Oct 11.

Orthopaedic Division, Tel-Aviv Sourasky Medical Center, 6 Weizmann Street, Tel-Aviv 64239, Israel.

Background: The advantageous properties of carbon fiber reinforced polyetheretherketone (CF-PEEK) composites for use as orthopedic implants include similar modulus to bone and ability to withstand prolonged fatigue strain.

Methods: The CF-PEEK tibial nail, dynamic compression plate, proximal humeral plate and distal radius volar plate were compared biomechanically (by four-point bending, static torsion of the nail, and bending fatigue) and for wear/debris (by amount of the debris generated at the connection between the CF-PEEK plate and titanium alloy screws) to commercially available devices.

Results: Four-point bending stress of the tibial nail and dynamic and distal radius plates yielded characteristics similar to other commercially available devices. The distal volar plate bending structural stiffness of the CF-PEEK distal volar plate was 0.542 Nm2 versus 0.376 Nm2 for the DePuy's DVR anatomic volar plate. The PHILOS proximal humeral internal locking system stainless steel plate was much stronger (6.48 Nm2) than the CF-PEEK proximal humeral plate (1.1 Nm2). Tibial nail static torsion testing showed similar properties to other tested nails (Fixion, Zimmer and Synthes). All tested CF-PEEK devices underwent one million fatigue cycles without failure. Wear test showed a lower volume of generated particles in comparison to the common implants in use today.

Interpretation: Thus, these tested implants were similar to commercially used devices and can be recommended for use as implants in orthopedic surgery.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jmbbm.2012.09.013DOI Listing
January 2013

Accuracy study of new computer-assisted orthopedic surgery software.

Eur J Radiol 2012 Dec 9;81(12):4029-34. Epub 2012 Aug 9.

Department of Orthopaedic Surgery, Beilinson-Rabin Medical Center, Petach Tikva, Israel.

Purpose: The new computerized system is based on image analysis and designed to aid in orthopedic surgeries by virtual trajectory of the guide wire, intra-operative planning and various measurements. Validation of the accuracy and safety of any computer-aided surgery system is essential before implementing it clinically. We examined the accuracy of guide-wire length and angle measurements and fusion of multiple adjacent images (panoramic view image, PVI(®)) of the new software.

Methods: This is a 2-part study. Part I: twenty guide wires were drilled to various depths in a synthetic femur model and the results obtained by the software measurements were compared with manual measurements by a caliper and a depth gauge. Part II: a sawbone femur shaft was osteotomized and various inclinations of > 10° to the varus or valgus angles were tested. The manually obtained measurements of angles and lengths were compared to the new computerized system software PVI.

Results: There was a significant positive linear correlation between all groups of the computerized length and the control measurements (r>0.983, p<0.01). There was no significant difference among different distances, angles or positions from the image intensifier. There was a significant positive linear correlation between the angle and length measurement on the PVI and the control measurement (r>0.993, p<0.01).

Conclusions: The new computerized software has high reliability in performing measurements of length using an aiming, positioning and referring device intra-operatively.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ejrad.2012.07.016DOI Listing
December 2012

Expandable proximal femoral nails versus 95° dynamic condylar screw-plates for the treatment of reverse oblique intertrochanteric fractures.

Injury 2012 Aug 20;43(8):1313-7. Epub 2012 May 20.

Department of Orthopedic Surgery, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.

The treatment of a simple (AO/OTA classification 31A3.1) reverse oblique intertrochanteric hip fracture is a challenge for the orthopaedic surgeon. The surgical options include the use of side plates with various angled leg screws or intramedullary devices. The purpose of this study was to retrospectively assess our results of treating reverse oblique fracture with an expendable proximal femoral nail (EPFN) or with a dynamic condylar screw-plate (DCS: 95°) between January 2006 and July 2009. Thirty-three patients (6 males and 27 females, mean age 78 years) met the study inclusion criteria and comprised the two study groups: 19 had been treated by EPFNs and 14 had received DCSs. They were followed for a mean of 28 months (range 6-47). Eight patients (5 EPFN and 3 DCS) died during the follow-up period from causes not related to the operation. Two ESPN patients and 5 DCS patients had malunions. Functional outcome scores showed better results in the EPFN group, but the difference was statistically significant only for the sitting subcategory (p=0.04). Based on our results and experience, we propose that the EPFN is at least as good as the DCS for treating reverse oblique fractures of the femur.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.injury.2012.05.004DOI Listing
August 2012

The effect of clopidogrel and aspirin on blood loss in hip fracture surgery.

Injury 2011 Nov 16;42(11):1277-82. Epub 2011 Feb 16.

Department of Orthopedics B, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.

Introduction: Anti-platelet drugs are commonly used for primary and secondary prevention of thrombo-embolic events and following invasive coronary interventions. Their effect on surgery-related blood loss and perioperative complications is unclear, and the management of trauma patients treated by anti-platelets is controversial. The anti-platelet effect is over in nearly 10 days. Notably, delay of surgical intervention for hip fracture repair for >48 h has been reported to increase perioperative complications and mortality.

Patients And Methods: Intra-operative and perioperative blood loss, the amount of transfused blood and surgery-related complications of 44 patients on uninterrupted clopidogrel treatment were compared with 44 matched controls not on clopidogrel (either on aspirin alone or not on any anti-platelets).

Results: The mean perioperative blood loss was 899±496 ml for patients not on clopidogrel, 1091±654 ml for patients on clopidogrel (p=0.005) and 1312±686 ml for those on combined clopidogrel and aspirin (p=0.0003 vs. all others). Increased blood loss was also associated with a shorter time to operation (p=0.0012) and prolonged surgical time (p=0.0002). There were no cases of mortality in the early postoperative period.

Conclusions: Patients receiving anti-platelet drugs can safely undergo hip fracture surgery without delay, regardless of greater perioperative blood loss and possible thrombo-embolic/postoperative bleeding events.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.injury.2011.01.011DOI Listing
November 2011

Braided cerclage wires: a biomechanical study.

Injury 2011 Apr;42(4):347-51

Department of Orthopaedic Surgery B, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, 6 Weizmann St., Tel-Aviv 64239, Israel.

Background: One of the drawbacks that makes many surgeons reluctant to use cerclage wires is the risk of periosteal vascular compromise. A new, easily applied braided wire configuration has been developed to improve mechanical wire gripping and to decrease the contact area between the hardware and the bony surface.

Materials And Methods: Braided wires with two diameters (1 mm and 1.5 mm) were compared to single strand and double-strand wire configurations. The biomechanical properties, peak and elongation loads,and wire pressure imprint points of this new configuration were evaluated in the current study.

Results: The braided wire was found to have the same peak load as the double-strand wire (P = 0.315) and more than twice the peak load than the single-strand wire (P = 0.0001), but a much shorter elongation peak than the other two. The imprint test showed that the braided wire has an interrupted dotted pattern compared to the continuous circular one that characterises the single-strand and double strand wires, indicating less potential damage to the bone.

Conclusions: The braided cerclage wire may decrease the extent of insult to the bone by decreasing the contact area between the hardware and the bony surface and by enhancing stability by reducing the elongation peak, affording increased fracture fixation stability.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.injury.2010.05.022DOI Listing
April 2011

Femoral head density on CT scans of patients following hip fracture fixation by expandable proximal peg or dynamic screw.

Injury 2010 Jun 12;41(6):647-51. Epub 2010 Mar 12.

Department of Orthopedic Surgery B, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, 6 Weizmann St., Tel-Aviv 64239, Israel.

Computed tomography (CT) is currently considered to be an accurate method for evaluating bone density. We evaluated the CT measurements of bone density using the Hounsfield units (HUs) in 23 patients who had been operated in the past for an extra-capsular hip fracture. Twelve patients were treated with a dynamic hip screw and 11 with a proximal femoral expandable hip nail. All the CTs had been performed for non-orthopedic purposes. Bone density with a region of interest (ROI) could be assessed for both hips. We compared the bone density between the operated versus the non-operated sides as well as between the two surgical groups. Bone density was higher in the hip peg (the femoral component of the expandable nail) side 262.5 (range, 169-351) HU, compared to the opposite non-operated side and to the hip screw group 194 (range, 99-283) HU. The hip screw side had decreased bone density compared to the opposite non-operated side. We were able to define a density index and a difference index: both were higher in the hip peg group. These findings persisted over time. It would be interesting to speculate that increased bone density around an expandable peg provides better fracture stabilization and probably faster healing than a dynamic hip screw.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.injury.2010.02.012DOI Listing
June 2010

Treatment of diaphyseal nonunion of the femur and tibia using an expandable nailing system.

Injury 2009 Mar 27;40(3):309-14. Epub 2009 Feb 27.

Department of Orthopaedic Surgery B, Tel-Aviv Sourasky Medical Center, Tel-Aviv University, 6 Weizmann Street, Tel-Aviv 64239, Israel.

Introduction: We evaluated the efficacy of the expandable nailing system for treating femur and tibia shaft nonunions.

Patients And Methods: Records of 24 patients (25 fractures) were retrospectively reviewed: 16 with femur and 8 with tibia nonunions. The bones underwent reaming, and the largest possible nail sizes were inserted during re-operation. Bone debris obtained from the reaming was used for bone graft at the site of the nonunion.

Results: The mean age of the patients was 32 years for the tibia group and 49 years for the femur group. The respective intervals between trauma and re-operation were 11 and 13 months, the operation times 60 and 78 min, and the fluoroscopy times 21 and 32s. Twenty-four of the 25 nonunions healed satisfactorily without requiring additional procedures. In 1 case, demineralised bone matrix was injected percutaneously and the femoral nonunion resolved. Healing time was 23 weeks (6-52) and 17 weeks (6-40) in the tibia and femur groups, respectively. We were able to reduce the need of an autologous bone graft to only two cases by using reamed debris in 17 of the 19 patients who required grafting.

Conclusions: Our results demonstrated satisfactory healing for the treatment of diaphyseal nonunions of the femur and tibia. The expandable nail offers the theoretical advantages of improved load sharing and rotational control without the need for interlocking screws. We recommend expandable nail systems for femur and tibia shaft nonunions and the use of reamed debris in order to decrease the use of autogenous bone graft.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.injury.2008.07.029DOI Listing
March 2009

Computer-assisted surgery for dynamic hip screw, using Surgix, a novel intraoperative guiding system.

Int J Med Robot 2009 Mar;5(1):45-50

Department of Orthopaedic Surgery, Sheba Medical Centre, Tel Hashomer, Israel.

Background: We present Surgix, a new computer-assisted surgery system (CASS). This system uses image analysis technology in order to measure three-dimensional (3D) distances, visualize implant templates and view the guided trajectory on standard fluoroscopy. Our purpose was to compare surgery results and technique with and without the Surgix CASS.

Methods: The study included 61 dynamic hip screw (DHS) procedures. The Surgix system was used in 41 procedures. We compared the number of guide wire insertion trials and the time needed for each trial, the number of X-ray pulses, tip-apex index, nine-quadrant position and shaft-neck angle.

Results: The procedures were carried out by experienced users (> or = five operations, using the system) and had a first-trial guide wire insertion success rate of 77.8%, compared to a rate of 10% for the control group (p = 0.001) and fewer insertion trials (1.33 vs. 3.05, respectively; p = 0.001). The mean number of fluoroscopy pulses was 41.5% lower for the experienced group than for the control (17.6 vs. 30.1; p = 0.009). There were no significant differences in tip-apex distance, favourable quadrant screw placement or neck-shaft angle.

Conclusion: The results of this study demonstrate that the Surgix CASS significantly improves the accuracy of hardware positioning and reduces radiation exposure time, thus enhancing patient outcome.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/rcs.231DOI Listing
March 2009
-->