Publications by authors named "Ram Kiran Alluri"

8 Publications

  • Page 1 of 1

Single Versus Dual Headless Compression Screw Fixation of Scaphoid Nonunions: A Biomechanical Comparison.

Hand (N Y) 2021 Jan 7:1558944720974111. Epub 2021 Jan 7.

University of Southern California, Los Angeles, USA.

Background: Management of scaphoid nonunions with bone loss varies substantially. Commonly, internal fixation consists of a single headless compression screw. Recently, some authors have reported on the theoretical benefits of dual-screw fixation. We hypothesized that using 2 headless compression screws would impart improved stiffness over a single-screw construct.

Methods: Using a cadaveric model, we compared biomechanical characteristics of a single tapered 3.5- to 3.6-mm headless compression screw with 2 tapered 2.5- to 2.8-mm headless compression screws in a scaphoid waist nonunion model. The primary outcome measurement was construct stiffness. Secondary outcome measurements included load at 1 and 2 mm of displacement, load to failure for each specimen, and qualitative assessment of mode of failure.

Results: Stiffness during load to failure was not significantly different between single- and double-screw configurations ( = .8). Load to failure demonstrated no statistically significant difference between single- and double-screw configurations. Using a qualitative assessment, the double-screw construct maintained rotational stability more than the single-screw construct ( = .029).

Conclusions: Single- and double-screw fixation constructs in a cadaveric scaphoid nonunion model demonstrate similar construct stiffness, load to failure, and load to 1- and 2-mm displacement. Modes of failure may differ between constructs and represent an area for further study. The theoretical benefit of dual-screw fixation should be weighed against the morphologic limitations to placing 2 screws in a scaphoid nonunion.
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January 2021

A Survey to Assess Agreement Between Pelvic Surgeons on the Outcome of Examination Under Anesthesia for Lateral Compression Pelvic Fractures.

J Orthop Trauma 2020 09;34(9):e304-e308

Department of Orthopaedics, University of Southern California, Los Angeles, CA.

Objectives: To assess agreement among pelvic surgeons regarding the interpretation of examination under anesthesia (EUA), the methodology by which EUA should be performed, and the definition of a positive examination.

Design: Survey.

Patients/participants: Ten patients who presented to our Level 1 trauma center with a pelvic ring injury were selected as clinical vignettes. Vignettes were distributed to 15 experienced pelvic surgeons.

Intervention: Examination under anesthesia.

Main Outcome Measurements: Agreement regarding pelvic fracture stability (defined as >80% similar responses), need for surgical fixation, definition of an unstable EUA, and method of performing EUA.

Results: There was agreement that a pelvic fracture was stable or unstable in 8 (80%) of 10 cases. There was agreement that fixation was required or not required in 6 (60.0%) of 10 cases. Seven (46.7%) surgeons endorsed performing a full 15-part EUA, whereas the other 8 (53.3%) used an abbreviated or alternative method. Eight (53.3%) surgeons provided a definition of what constitutes a positive EUA, whereas the remaining 7 did not endorse adhering to a strict definition.

Conclusions: Pelvic surgeons generally agree on what constitutes a positive or negative EUA but not necessarily the implications of a positive or negative examination. There is no clear consensus among surgeons regarding the method of performing EUA nor regarding the definition of a positive EUA.

Level Of Evidence: Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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September 2020

Risk Factors and Complications Following Arthroscopic Tenotomy of the Long Head of the Biceps Tendon.

Orthop J Sports Med 2020 Feb 28;8(2):2325967120904361. Epub 2020 Feb 28.

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

Background: Controversy exits regarding performing a tenotomy versus a tenodesis of the long head of the biceps tendon (LHBT).

Purpose: To evaluate the complications after arthroscopic tenotomy of the LHBT and characterize the incidence of cosmetic deformity, cramping, subjective weakness, and continued anterior shoulder pain (ASP). Additionally, to identify patient-related factors that may predispose a patient to these complications.

Study Design: Case-control study; Level of evidence, 3.

Methods: Records of patients who underwent an arthroscopic LHBT tenotomy at an integrated health care system under the care of 55 surgeons were retrospectively reviewed. Exclusion criteria included LHBT tenodesis, arthroplasty, neoplastic, or fracture surgery; age younger than 18 years; incomplete documentation of physical examination; or incomplete operative reports. Characteristic data, concomitant procedures, LHBT morphology, and postoperative complications were recorded. Patients with and without postoperative complications-including cosmetic deformity, subjective weakness, continued ASP, and cramping-were analyzed by age, sex, dominant arm, body mass index (BMI), smoking status, workers' compensation status, and intraoperative LHBT morphology to identify risk factors for developing these postoperative complications.

Results: A total of 192 patients who underwent LHBT tenotomy were included in the final analysis. Tenotomy was performed with concomitant shoulder procedures in all but 1 individual. The mean ± SD patient age was 60.6 ± 9.5 years, and 55% were male. The overall complication rate was 37%. The most common postoperative complications include cosmetic (Popeye) deformity (14.1%), subjective weakness (10.4%), cramping (10.4%), and continued postoperative ASP over the bicipital groove (7.8%). Every 10-year increase in age was associated with 0.52 (95% CI, 0.28-0.94) times the odds of continued ASP and 0.59 (95% CI, 0.36-0.98) times the odds of cramping pain. Male patients had 3.9 (95% CI, 1.4-10.8) times the odds of cosmetic (Popeye) deformity. Patients who had active workers' compensation claims had 12.5 (95% CI, 2.4-63.4) times the odds of having continued postoperative ASP. Tenotomy on the dominant arm, BMI, and active smoking status demonstrated no statistically significant association with postoperative complications.

Conclusion: Patients experiencing complications after tenotomy were significantly younger and more likely to be male and to have a workers' compensation injury. LHBT tenotomy may best be indicated for elderly patients, female patients, and those without active workers' compensation claims.
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February 2020

Response to Letter to the Editor Concerning "The True Effect of a Lumbar Dural Tear on Complications and Cost".

Spine (Phila Pa 1976) 2020 Apr;45(7):E414

Department of Orthopaedic Surgery, Keck Medical Center of University of Southern California, Los Angeles, CA.

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April 2020

Increasing Rate of Surgical Fixation in Four- and Five-year-old Children With Femoral Shaft Fractures.

J Am Acad Orthop Surg 2019 Jan;27(1):e24-e32

From the Keck School of Medicine of the University of Southern California, Los Angeles, CA.

Background: The purpose of this study was to identify temporal trends in the management of pediatric femoral shaft fractures in 4- and 5-year-old children.

Methods: The Kids' Inpatient Database was used to extract data on patients aged 4 and 5 years with closed femoral shaft fractures. The frequency of nonsurgical and surgical management was calculated, and temporal trends were evaluated.

Results: Between 1997 and 2012, the absolute increase in surgical fixation was 35% and 58% in 4- and 5-year-old patients, respectively. The surgical rate increased every 3 years by 13.8% in 4-year-old patients and 7.6% in 5-year-old patients. Significant associations were noted based on demographics, comorbidities, and hospital characteristics with management decisions.

Conclusions: A clear and significant increase was noted in internal fixation for pediatric femoral shaft fractures in 4- and 5-year-old children, and the lower age limit for surgical management of these fractures is decreasing.

Level Of Evidence: Level III. Retrospective comparative study.
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January 2019

Review of Internal Radiocarpal Distraction Plating for Distal Radius Fracture Fixation.

Hand (N Y) 2020 01 13;15(1):116-124. Epub 2018 Jul 13.

Keck Medical Center at the University of Southern California, Los Angeles, USA.

Internal radiocarpal distraction plating is a versatile tool in the treatment of distal radius fractures that are not amenable to nonoperative treatment or operative fixation with standard volar or dorsal implants. Internal distraction plates may also be indicated in the setting of polytrauma or osteopenic bone. The plate functions as an internal fixator, using ligamentotaxis to restore length and alignment while providing relative stability for bony healing. The plate can be fixed to either the second or the third metacarpal, and anatomic and biomechanical studies have assessed the strengths and weaknesses of each strategy. This operative fixation technique leads to acceptable radiographic results and functional outcomes. Following fracture union, the plate is removed, and wrist range of motion is resumed.
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January 2020

Effect of Insurance on Rates of Total Ankle Arthroplasty Versus Arthrodesis for Tibiotalar Osteoarthritis.

Foot Ankle Int 2017 Feb 22;38(2):133-139. Epub 2016 Oct 22.

1 Department of Orthopaedic Surgery, Keck School of Medicine at USC, Los Angeles, CA, USA.

Background: Several studies have examined the effect of insurance on the management of various orthopedic conditions. The purpose of our study was to assess the effect of insurance and other demographic factors on the operative management of tibiotalar osteoarthritis.

Methods: The National Inpatient Sample (NIS) database was used to identify patients who underwent a total ankle arthroplasty (TAA) or tibiotalar arthrodesis (TTA) for tibiotalar osteoarthritis. Insurance status was identified for each patient, and the proportions of each insurance type were computed for each operative modality. A multivariate analysis was performed to account for confounding variables to isolate the effect of insurance type on operative treatment.

Results: From 2007 to 2012, a total of 10 010 patients (35.6%) were identified who underwent a total ankle replacement (TAR) procedure and 18 094 patients (64.4%%) who underwent TTA for tibiotalar osteoarthritis. Patients receiving a TAR were older (65.8 vs 64.2, P < .001), more likely to be female (54% vs 51%, P < .001), and had fewer comorbidities (4.2 vs 4.5, P < .001) than patients who underwent a TTA. After controlling for baseline differences, patients with Medicare (odds ratio [OR] 3.00, P < .001), and private insurance (OR 3.19, P < .001) were approximately 3 times more likely to undergo TAR than patients with Medicaid.

Conclusions: Patients with tibiotalar osteoarthritis were more likely to receive a TAR procedure if they had Medicare or private insurance compared with patients who had Medicaid. Further research should be done to better understand the drivers of this phenomenon if equitable care is to be achieved.

Level Of Evidence: Level II, prognostic study.
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February 2017

A randomized controlled trial of high-fidelity simulation versus lecture-based education in preclinical medical students.

Med Teach 2016 21;38(4):404-9. Epub 2015 Apr 21.

a David Geffen School of Medicine at UCLA , USA.

Purpose: The purpose of this study was to compare the efficacy of simulation versus lecture-based education among preclinical medical students.

Methods: Twenty medical students participated in this randomized, controlled crossover study. Students were randomized to four groups. Each group received two simulations and two lectures covering four different topics. Students were administered a pre-test, post-test and delayed post-test. The mean percentage of questions answered correctly on each test was calculated. The mean of each student's change in score across the three tests was used to compare simulation- versus lecture-based education.

Results: Students in both the simulation and lecture groups demonstrated improvement between the pre-test and post-test (p < 0.05). Students in the simulation group demonstrated improvement between the immediate post-test and delayed post-test (p < 0.05), while students in the lecture group did not demonstrate improvement (p > 0.05). When comparing interventions, the change in score between the pre-test and post-test was similar among both the groups (p > 0.05). The change in score between the post-test and delayed post-test was greater in the simulation group (p < 0.05).

Conclusions: High-fidelity simulation may serve as a viable didactic platform for preclinical medical education. Our study demonstrated equivalent immediate knowledge gain and superior long-term knowledge retention in comparison to lectures.
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January 2017