Publications by authors named "Max Vaynrub"

14 Publications

  • Page 1 of 1

The Ankle-Pelvic Angle (APA) and Global Lower Extremity Angle (GLA): Summary Measurements of Pelvic and Lower Extremity Compensation.

Int J Spine Surg 2021 Feb 12;15(1):130-136. Epub 2021 Feb 12.

Hospital for Joint Diseases at NYU Langone Medical Center, New York, New York.

Background: Adult sagittal spinal deformity (SSD) leads to the recruitment of compensatory mechanisms to maintain standing balance. After regional spinal compensation is exhausted, lower extremity compensation is recruited. Knee flexion, ankle flexion, and sacrofemoral angle increase to drive pelvic shift posterior and increase pelvic tilt. We aim to describe 2 summary angles termed ankle-pelvic angle (APA) and global lower extremity angle (GLA) that incorporate all aspects of lower extremity and pelvic compensation in a comprehensive measurement that can simplify radiographic analysis.

Methods: Full-body sagittal stereotactic radiographs were retrospectively collected and digitally analyzed. Spinal and lower extremity alignment were quantified with existing measures. Two angles-APA and GLA-were drawn as geometrically complementary angles to T1-pelvic angle (TPA) and global sagittal axis (GSA), respectively. Regression analysis was used to represent the predictive relationship between TPA and APA and between GSA and GLA.

Results: A total of 518 propensity score-matched patient records were available for analysis. Patients with lower extremity compensation had higher APA (21.83° versus 19.47°, = .007) and GLA (6.03° versus 1.19°, < .001) than those without compensation. APA and GLA demonstrated strong correlation with TPA ( = 0.81) and GSA ( = 0.77), respectively. Furthermore, the change between preoperative and postoperative values were strongly correlative between ΔAPA and ΔTPA ( = 0.71) and between ΔGLA and ΔGSA ( = 0.77). APA above 20.6° and GLA above 3.6° were indicative of lower extremity compensation. Patients with increased GLA values had significantly higher Oswestry Disability Index scores (48.67 versus 41.04, = .005).

Conclusions: TPA and GSA are measures of global spinal alignment and APA and GLA, respectively, and are geometrically complementary angles that vary proportionately to SSD and balance the body. APA and GLA increase in SSD patients with lower extremity compensation and decrease with corrective surgery.

Level Of Evidence: 4.

Clinical Relevance: APA and GLA offer a concise and simple method of communicating pelvic and lower extremity compensation.
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http://dx.doi.org/10.14444/8017DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7931699PMC
February 2021

Postoperative extremity compartment syndrome in a cancer center: Incidence and risk factors.

Surg Oncol 2021 Apr 3;38:101563. Epub 2021 Apr 3.

Department of Surgery, Orthopaedic Service, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA.

Objective: Postoperative compartment syndrome is a reported complication with known patient- and treatment-specific risk factors. Cancer patients carry unique risk factors associated with their underlying disease and long, complex procedures. While elevated serum lactate in traumatic and intensive care settings portends higher risk, no laboratory parameter has demonstrated utility in postoperative risk stratification. Postoperative extremity compartment syndrome in the study institution's cancer population was examined and whether intraoperative serum lactate correlates with postoperative compartment syndrome risk was investigated.

Methods: A 1:2 case-control study was performed, which compared cancer patients with postoperative compartment syndrome to those who underwent similar surgical procedures without this complication. Twelve patients were matched to 24 controls by sex, age, surgical procedures, and duration of surgery. Patient and operative variables were analyzed for prognostic significance.

Results: The compartment syndrome rate was 0.09% of all cases (n = 13,491); 0.12% of cases ≥ 3 h' duration (n = 9,979), and 0.25% of cases ≥ 5 h (n = 4,811). Compared with controls, the case group had higher median BMI (31.7 kg/m2 vs. 25.4 kg/m2, P = 0.001), and median intraoperative lactate level (4.05 mmol/L vs. 1.5 mmol/L, P = 0.047).

Conclusion: Our institutional incidence of postoperative compartment syndrome was similar to that of non-oncologic institutions. While many traditional risk factors did not prove to be influential in our patients, elevated median body mass index and intraoperative serum lactate were identified as risk factors for postoperative compartment syndrome in a cancer population.
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http://dx.doi.org/10.1016/j.suronc.2021.101563DOI Listing
April 2021

Anti-IL17 antibody Secukinumab therapy is associated with ossification in giant cell tumor of bone: a case report of pathologic similarities and therapeutic potential similar to Denosumab.

BMC Musculoskelet Disord 2021 Apr 1;22(1):320. Epub 2021 Apr 1.

Department of Surgery, Orthopaedic Service, Memorial Sloan Kettering Cancer Center, 1275 York Ave., New York, NY, 10065, USA.

Background: Giant cell tumor of bone is a benign, locally aggressive neoplasm. Surgical resection is the preferred treatment method. However, for cases in which resection poses an increased risk to the patient, denosumab (anti-RANKL monoclonal antibody) is considered. Secukinumab is an anti-IL-17 antibody that is used in psoriatic arthritis to reduce bone resorption and articular damage.

Case Presentation: One case of giant cell tumor of bone (GCTB) in a patient treated with secukinumab for psoriatic arthritis demonstrated findings significant for intra-lesional calcifications. Histologic examination showed ossification, new bone formation, and remodeling. A paucity of osteoclast type giant cells was noted. Real-time quantitative polymerase-chain-reaction (qRT-PCR) analysis revealed decreased osteoclast function compared to treatment-naive GCTB.

Conclusions: Secukinumab may play a role in bone remodeling for GCTB. Radiologists, surgeons, and pathologists should be aware of this interaction, which can cause lesional ossification. Further research is required to define the therapeutic potential of this drug for GCTB and osteolytic disease.
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http://dx.doi.org/10.1186/s12891-021-04182-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8015053PMC
April 2021

Early palliative radiation versus observation for high-risk asymptomatic or minimally symptomatic bone metastases: study protocol for a randomized controlled trial.

BMC Cancer 2020 Nov 17;20(1):1115. Epub 2020 Nov 17.

Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, Box 22, New York, NY, 10065, USA.

Background: In patients with metastatic cancer, the bone is the third-most common site of involvement. Radiation to painful bone metastases results in high rates of pain control and is an integral part of bone metastases management. Up to one-third of inpatient consults are requested for painful bone metastases, and up to 60% of these patients had evidence of these lesions visible on prior imaging. Meanwhile recent advances have reduced potential side effects of radiation. Therefore, there is an opportunity to further improve outcomes for patients using prophylactic palliative radiation to manage asymptomatic bone metastases.

Methods/study Design: In this trial, 74 patients with metastatic solid tumors and high-risk asymptomatic or minimally symptomatic bone metastases will be enrolled and randomized to early palliative radiation or standard of care. This will be the first trial to assess the efficacy of prophylactic palliative radiation in preventing skeletal related events (SREs), the primary endpoint. This endpoint was selected to encompass patient-centered outcomes that impact quality of life including pathologic fracture, spinal cord compression, and intervention with surgery or radiation. Secondary endpoints include hospitalizations, Bone Pain Index, pain-free survival, pain-related quality of life, and side effects of radiation therapy.

Discussion: In this study, we propose a novel definition of high-risk bone metastases most likely to benefit from preventive radiation and use validated questionnaires to assess pain and impact on quality of life and health resource utilization. Observations from early patient enrollment have demonstrated robustness of the primary endpoint and need for minor modifications to Bone Pain Index and data collection for opioid use and hospitalizations. With increasing indications for radiation in the oligometastatic setting, this trial aims to improve patient-centered outcomes in the polymetastatic setting.

Trial Registration: ISRCTN Number/Clinical trials.gov, ID: NCT03523351 . Registered on 14 May 2018.
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http://dx.doi.org/10.1186/s12885-020-07591-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7670812PMC
November 2020

Replacing 30 Gy in 10 fractions with stereotactic body radiation therapy for bone metastases: A large multi-site single institution experience 2016-2018.

Clin Transl Radiat Oncol 2020 Nov 8;25:75-80. Epub 2020 Oct 8.

Department of Radiation Oncology, Precision Radiation for Oligometastatic and Metastatic Disease (PROMISE) Program, Memorial Sloan Kettering Cancer Center, New York, NY, USA.

Background: Bone metastases cause significant morbidity in patients with cancer, and radiation therapy (RT) is an effective treatment approach. Indications for more complex ablative techniques are emerging. We sought to evaluate RT trends at a large multi-site tertiary cancer center.

Methods: Patients who received RT for bone metastases at a single institution (including regional outpatient clinics) from 2016 to 2018 were identified. Patients were grouped by RT regimen: single-fraction conventional RT (8 Gy × 1), 30 Gy in 10 fractions, SBRT, and "other". Multinomial logistic regression was performed to assess trends in regimens over time. Binary logistic regression was performed to evaluate factors associated with receipt of SBRT.

Results: Between 2016 and 2018, 5,952 RT episodes were received by 2,969 patients with bone metastases. Overall, 76% of episodes were ≤ 5 fractions. The median number of fractions planned for SBRT and non-SBRT episodes was 3 (IQR 3-3) and 5 (IQR 5-10), respectively. Use of SBRT increased from 2016 to 2018 (39% to 53%, p < 0.01) while use of 30 Gy in 10 fractions decreased (26% to 12%, p < 0.01), and 8 Gy × 1 was stable (5.3% to 6.9%, p = 0.28). SBRT was associated with higher performance status (p < 0.01) and non-radiosensitive histology (p < 0.01). Use of SBRT increased in the regional network (19% to 48%, p < 0.01) and at the main center (52% to 59%, p = 0.02), but did not increase within 30 days of death. More patients treated with 8 Gy × 1 than SBRT died within 30 days of treatment (24% vs 3.8%, respectively, p < 0.01).

Conclusions: SBRT is replacing 30 Gy in 10 fractions for bone metastases, especially among patients with high performance status and non-radiosensitive histologies. Better prognostic algorithms could further improve patient-centered treatment selection at the end of life.
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http://dx.doi.org/10.1016/j.ctro.2020.10.001DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7575833PMC
November 2020

Visualization of the Cervicothoracic Junction With EOS Imaging Is Superior to Conventional Lateral Cervical Radiographs.

Global Spine J 2020 Jul 7:2192568220934486. Epub 2020 Jul 7.

New York University Langone Orthopaedic Hospital, New York, NY, USA.

Study Design: Single-center retrospective review.

Objectives: The cervicothoracic junction (CTJ) is typically difficult to visualize using traditional radiographs. Whole-body stereoradiography (EOS) allows for imaging of the entire axial skeleton in a weightbearing position without parallax error and with lower radiation doses. In this study we sought to compare the visibility of the vertebra of the CTJ on lateral EOS images to that of conventional cervical lateral radiographs.

Methods: Two fellowship-trained spine surgeons evaluated the images of 50 patients who had both lateral cervical radiographs and EOS images acquired within a 12-month period. The number of visible cortices of the vertebral bodies of C6-T2 were scored 0-4. Patient body mass index and the presence of spondylolisthesis >2 mm at each level was recorded. The incidence of insufficient visibility to detect spondylolisthesis at each level was also calculated for both modalities.

Results: On average, there were more visible cortices with EOS versus XR at T1 and T2, whereas visible cortices were equal at C6 and C7. Patient body mass index was inversely correlated with cortical visibility on XR at T2 and on EOS at T1 and T2. There was a significant difference in the incidence of insufficient visibility to detect spondylolisthesis on EOS versus XR at C7-T1 and T1-2, but not at C6-7.

Conclusions: EOS imaging is superior at imaging the vertebra of the CTJ. EOS imaging deserves further consideration as a diagnostic tool in the evaluation of patients with cervical deformity given its ability to produce high-quality images of the CTJ with less radiation exposure.
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http://dx.doi.org/10.1177/2192568220934486DOI Listing
July 2020

Full endoscopic resection of a lumbar osteoblastoma: technical note.

J Neurosurg Spine 2020 Apr 3:1-4. Epub 2020 Apr 3.

Departments of1Neurological Surgery and.

Osteoblastomas are a rare, benign primary bone tumor accounting for 1% of all primary bone tumors, with 40% occurring within the spine. Gross-total resection (GTR) is curative, although depending on location, this can require destabilization of the spine and necessitate instrumented fixation. Through the use of minimally invasive, muscle-sparing approaches, these lesions can be resected while maintaining structural integrity of the spine. The authors present a case report and technical note of a single patient describing the use of a purely endoscopic technique to resect a right L5 superior articulating process osteoblastoma in a 45-year-old woman. The patient underwent an image-guided endoscopic resection of her superior articulating facet osteoblastoma. Intraoperative CT demonstrated GTR. On postoperative examination, she remained neurologically intact with resolution of her pain. At follow-up, she remained pain free. Resection of lumbar osteoblastoma through a fully endoscopic approach was a safe and effective technique in this patient. This technique allowed for GTR without compromising spinal structural integrity, thus eliminating the need for instrumented fixation.
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http://dx.doi.org/10.3171/2020.2.SPINE191091DOI Listing
April 2020

The role of chemotherapy and radiotherapy in localized extraskeletal osteosarcoma.

Eur J Cancer 2020 01 2;125:130-141. Epub 2019 Dec 2.

Japanese Musculoskeletal Oncology Group, Tokyo, Japan.

Purpose: The role of chemotherapy (CT) and radiotherapy (RT) for management of extraskeletal osteosarcoma (ESOS) remains controversial. We examined disease outcomes for ESOS patients and investigated the association between CT/RT with recurrence and survival.

Patients And Methods: Retrospective review at 25 international sarcoma centers identified patients ≥18 years old treated for ESOS from 1971 to 2016. Patient/tumour characteristics, treatment, local/systemic recurrence, and survival data were collected. Kaplan-Meier survival and Cox proportional-hazards regression and cumulative incidence competing risks analysis were performed.

Results: 370 patients with localized ESOS treated definitively with surgery presented with mainly deep tumours (n = 294, 80%). 122 patients underwent surgical resection alone, 96 (26%) also received CT, 70 (19%) RT and 82 (22%) both adjuvants. Five-year survival for patients with localized ESOS was 56% (95% CI 51%-62%). Almost half of patients (n = 173, 47%) developed recurrence: local 9% (35/370), distant 28% (102/370) or both 10% (36/370). Considering death as a competing event, there was no significant difference in cumulative incidence of local or systemic recurrence between patients who received CT, RT, both or neither (local p = 0.50, systemic p = 0.69). Multiple regression Cox analysis showed a significant association between RT and decreased local recurrence (HR 0.46 [95% CI 0.26-0.80], p = 0.01).

Conclusion: Although the use of RT significantly decreased local recurrences, CT did not decrease the risk of systemic recurrence, and neither CT, nor RT nor both were associated with improved survival in patients with localized ESOS. Our results do not support the use of CT; however, adjuvant RT demonstrates benefit in patients with locally resectable ESOS.
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http://dx.doi.org/10.1016/j.ejca.2019.07.029DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7261507PMC
January 2020

Trends in Treatment of Scheuermann Kyphosis: A Study of 1,070 Cases From 2003 to 2012.

Spine Deform 2019 01;7(1):100-106

Department of Orthopaedics, NYU Langone Orthopedic Hospital, 301 East 17th St, New York, NY 10003, USA. Electronic address:

Study Design: Retrospective review of KID Inpatient Database (KID) from 2003, 2006, 2009, and 2012.

Objectives: The aim of this study was to evaluate the impact of advances in spinal surgery on patient outcomes in the treatment of Scheuermann kyphosis (SK).

Summary Of Background Data: SK is one of the most common causes of back pain in adolescents. Trends in diagnoses and surgical treatment and approach to SK have not been well described.

Methods: SK patients aged 0-20 years in KID were identified by ICD-9 code 732.0. KID-supplied year- and hospital-trend weights were used to establish prevalence. Patient demographics, surgical details, and outcomes were analyzed with analysis of variance.

Results: A total of 1,070 SK patients were identified (33.2% female), with increasing incidence of SK diagnosed from 2003 to 2012 (3.6-7.5 per 100,000, p < .001). The average age of operative patients was 16.1±2.0 years and did not change (16.27-16.06 years, p = .905). The surgical rate has not changed over time (72.8%-72.8%, p = .909). Overall, 96.3% of operative patients underwent fusion, with 82.2% of cases spanning ≥4 levels; in addition, 8.6% underwent an anterior-only surgery, 74.6% posterior-only, and 13.6% combined approach. From 2003 to 2012, rates of posterior-only surgeries increased (62.4%-84.4%, p < .001) whereas the rate of combined-approach surgeries decreased (37.6%-8.8%, p < .001). Overall complication rates for SK surgeries have decreased (2003: 20.9%; 2012: 11.9%, p = .029). Concurrently, the rate of ≥4-level fusions has increased (43.5%-89.6%, p < .001), as well as the use of Smith-Peterson (7.8%-23.6%, p < .001) and three-column osteotomies (0.0%-2.7%, p = .011). In subanalysis comparing posterior to combined approaches, complication rates were significantly different (posterior: 9.88%, combined: 19.46%, p = .005). Patients undergoing a combined approach have a longer length of stay (LOS) than patients undergoing a posterior-only approach (7.8 vs. 5.6 days, p < .001).

Conclusions: Despite unchanged demographics and operative rates in SK, there has been a shift from combined to isolated posterior approaches, with a concurrent increase in levels treated. A combined approach was associated with increased complication rates, LOS, and total charges compared to isolated approaches. Awareness of these inherent differences is important for surgical decision making and patient education.

Levels Of Evidence: Level III.
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http://dx.doi.org/10.1016/j.jspd.2018.06.004DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7102192PMC
January 2019

The value of sitting radiographs: analysis of spine flexibility and its utility in preoperative planning for adult spinal deformity surgery.

J Neurosurg Spine 2018 Oct 6;29(4):414-421. Epub 2018 Jul 6.

Departments of1Orthopedic Surgery and.

Sitting radiographs are a valuable tool to consider the thoracic compensatory mechanism in patients who are candidates for thoracolumbar correction surgery.
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http://dx.doi.org/10.3171/2018.2.SPINE17749DOI Listing
October 2018

Validation of prone intraoperative measurements of global spinal alignment.

J Neurosurg Spine 2018 08 18;29(2):187-192. Epub 2018 May 18.

OBJECTIVE Verifying the adequacy of surgical correction of adult spinal sagittal deformity (SSD) leads to improved postoperative alignment and clinical outcomes. Traditionally, surgeons relied on intraoperative measurements of lumbar lordosis (LL) correction. However, T-1 pelvic angle (TPA) and its component angles more reliably predict postoperative alignment. While TPA is readily measured on standing radiographs, intraoperative radiographs offer poor resolution of the bicoxofemoral axis. A method to recreate this radiographic landmark by extrapolating preoperative measurements has been described. The authors aimed to assess the reliability of measurements of global spinal alignment obtained via geometrical reconstitution of the bicoxofemoral axis on prone intraoperative radiographs. METHODS A retrospective review was performed. Twenty sets of preoperative standing full-length and intraoperative prone 36-inch lateral radiographs were analyzed. Pelvic incidence (PI) and sacral to bicoxofemoral axis distance (SBFD) were recorded on preoperative films. A perpendicular line was drawn on the intraoperative radiograph from the midpoint of the sacral endplate. This was used as one limb of the PI, and the second limb was digitally drawn at an angle that reproduced the preoperatively obtained PI, extending for a distance that matched the preoperative SBFD. This final point marked the obscured bicoxofemoral axis. These landmarks were used to measure the L-1, T-9, T-4, and T-1 pelvic angles (LPA, T9PA, T4PA, and TPA, respectively) and LL. Two spine fellows and 2 attending spine surgeons made independent measurements and repeated the process in 1 month. Mixed-model 2-way intraclass correlation coefficient (ICC) and Cronbach's α values were calculated to assess interobserver, intraobserver, and scale reliability. RESULTS Interobserver reliability was excellent for preoperative PI and intraoperative LPA, T9PA, and T4PA (ICC = 0.88, 0.84, 0.84, and 0.93, respectively), good for intraoperative TPA (ICC = 0.68), and fair for preoperative SBFD (ICC = 0.60) and intraoperative LL (ICC = 0.50). Cronbach's α was ≥ 0.80 for all measurements. Measuring PI on preoperative standing images had excellent intraobserver reliability for all raters (ICC = 0.89, range 0.80-0.93). All raters but one showed excellent reliability for measuring the SBFD. Reliability for measuring prone LL was good for all raters (ICC = 0.71, range 0.64-0.76). The LPA demonstrated good to excellent reliability for each rater (ICC = 0.76, range 0.65-0.81). The thoracic pelvic angles tended to be more reliable at more distal vertebrae (T9PA ICC = 0.71, range 0.49-0.81; T4PA ICC = 0.62, range 0.43-0.83; TPA ICC = 0.56, range 0.31-0.86). CONCLUSIONS Intraoperative assessment of global spinal alignment with TPA and component angles is more reliable than intraoperative measurements of LL. Reconstruction of preoperatively measured PI and SBFD on intraoperative radiographs effectively overcomes poor visualization of the bicoxofemoral axis. This method is easily adopted and produces accurate and reliable prone intraoperative measures of global spinal alignment.
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http://dx.doi.org/10.3171/2018.1.SPINE17808DOI Listing
August 2018

Prognostic value of necrosis after neoadjuvant therapy for soft tissue sarcoma.

J Surg Oncol 2015 Feb 30;111(2):152-7. Epub 2014 Aug 30.

Department of Orthopaedic Surgery, Los Angeles County - University of Southern California Medical Center, Keck School of Medicine, Los Angeles, California.

Background And Objectives: While treatment-induced tissue necrosis is a well-documented predictor of patient survival in malignant bone tumors, its prognostic value in soft tissue sarcomas is controversial. A prior study from our institution did not find a prognostic value to tumor necrosis. We analyze a more extensive database of high-grade soft tissue sarcomas treated with neoadjuvant chemotherapy, radiation therapy, or both to re-evaluate if the degree of tumor necrosis alone can be used as a predictive factor for local recurrence, metastasis, and disease-specific survival.

Methods: Two hundred and seven patients with high-grade extremity soft tissue sarcoma received neoadjuvant chemotherapy and/or radiation therapy and wide excision. Tumor treatment response was determined by histopathologic analysis, and patients were followed for local recurrence, metastasis, or death.

Results: Tumor necrosis ≥ 90% correlates with improved disease-free survival with univariate analysis, but this does not reach statistical significance on multivariate analysis. Age and tumor volume were found to be the only independent predictors of disease-free survival on multivariate analysis.

Conclusions: There is insufficient evidence to support the use of necrosis to prognosticate survival and alter chemoradiation regimens in high grade soft tissue sarcomas of the extremity. Larger studies are needed to definitively address the prognostic value of necrosis.

Level Of Evidence: Level II, Prognostic
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http://dx.doi.org/10.1002/jso.23775DOI Listing
February 2015

Volar percutaneous screw fixation of the scaphoid: a cadaveric study.

J Hand Surg Am 2014 May 5;39(5):867-71. Epub 2014 Mar 5.

Department of Orthopaedic Surgery and the Division of Plastic Surgery, Los Angeles County and University of Southern California Medical Center, Keck School of Medicine of University of Southern California, Los Angeles, CA.

Purpose: To test the efficacy of a previously described technique of angiocatheter-assisted instrument positioning in achieving a central screw position in a cadaveric model for volar percutaneous screw fixation (PSF) of the scaphoid and to quantify the damage to surrounding soft tissue and articular cartilage associated with the procedure.

Methods: We performed fluoroscopically guided volar PSF of the scaphoid on 10 fresh cadaveric wrists. We then dissected the specimens, analyzed screw position in cross sections of the scaphoid, and described injury to nearby soft tissue structures as well as articular cartilage of the scaphotrapezial joint.

Results: All 10 screws were positioned within the central third of the scaphoid on at least 2 of 3 cross sections, and 8 of 10 screws were positioned within the central third of the proximal pole. Two wrists required a transtrapezial trajectory for satisfactory screw positioning. None of the specimens sustained visible neurovascular damage, and 2 wrists revealed minor tendon damage. Trajectories involving the scaphotrapezial joint violated, on average, 7% of the scaphoid articular cartilage. With a transtrapezial trajectory, 11% of the trapezial cartilage was violated

Conclusions: Central positioning of the screw is biomechanically superior, and screw position within the central one third of the proximal pole has been associated with faster time to union. Volar PSF achieved satisfactory screw position in the scaphoid. The majority of wrists were amenable to PSF via the scaphotrapezial joint, though a transtrapezial approach was a viable alternative for wrists with restrictive anatomy. Both approaches minimally disrupted the scaphotrapezial joint and surrounding soft tissues.

Type Of Study/level Of Evidence: Therapeutic IV.
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http://dx.doi.org/10.1016/j.jhsa.2014.01.018DOI Listing
May 2014

Quality-control culture system restores diabetic endothelial progenitor cell vasculogenesis and accelerates wound closure.

Diabetes 2013 Sep 13;62(9):3207-17. Epub 2013 May 13.

Division of Regenerative Medicine, Department of Basic Clinical Science, Tokai University School of Medicine, Kanagawa, Japan.

Delayed diabetic wound healing is, in part, the result of inadequate endothelial progenitor cell (EPC) proliferation, mobilization, and trafficking. Recently, we developed a serum-free functional culture system called the quality and quantity culture (QQc) system that enhances the number and vasculogenic potential of EPCs. We hypothesize that QQc restoration of diabetic EPC function will improve wound closure. To test this hypothesis, we measured diabetic c-kit(+)Sca-1(+)lin(-) (KSL) cell activity in vitro as well as the effect of KSL cell-adoptive transfer on the rate of euglycemic wound closure before and after QQc. KSL cells were magnetically sorted from control and streptozotocin-induced type I diabetic C57BL6J bone marrow. Freshly isolated control and diabetic KSL cells were cultured in QQc for 7 days and pre-QQc and post-QQc KSL function testing. The number of KSL cells significantly increased after QQc for both diabetic subjects and controls, and diabetic KSL increased vasculogenic potential above the fresh control KSL level. Similarly, fresh diabetic cells form fewer tubules, but QQc increases diabetic tubule formation to levels greater than that of fresh control cells (P < 0.05). Adoptive transfer of post-QQc diabetic KSL cells significantly enhances wound closure compared with fresh diabetic KSL cells and equaled wound closure of post-QQc control KSL cells. Post-QQc diabetic KSL enhancement of wound closure is mediated, in part, via a vasculogenic mechanism. This study demonstrates that QQc can reverse diabetic EPC dysfunction and achieve control levels of EPC function. Finally, post-QQc diabetic EPC therapy effectively improved euglycemic wound closure and may improve diabetic wound healing.
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http://dx.doi.org/10.2337/db12-1621DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3749357PMC
September 2013