Publications by authors named "Shai Factor"

12 Publications

  • Page 1 of 1

Hip Fractures during the COVID-19 Pandemic: Demographics, Treatment Pathway, and Outcomes.

Isr Med Assoc J 2021 Aug;23(8):484-489

Department of Orthopedic Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.

Background: Surgery for hip fractures within 48 hours of admission is considered standard. During the lockdown period due to the coronavirus disease-2019 (COVID-19) epidemic, our medical staff was reduced.

Objectives: To compare the demographics, treatment pathways, and outcomes of patients with hip fractures during the COVID-19 epidemic and lockdown with the standard at routine times.

Methods: A retrospective study was conducted of all patients who were treated surgically for hip fracture in a tertiary center during the COVID-19 lockdown period between 01 March and 01 June 2020 and the equivalent period in 2019. Demographic characteristics, time to surgery, surgery type, hospitalization time, discharge destination, postoperative complications, and 30- and 90-day mortality rates were collected for all patients.

Results: During the COVID-19 period, 105 patients were operated due to hip fractures compared to 136 in the equivalent period with no statistical difference in demographics. The rate of surgeries within 48 hours of admission was significantly higher in the COVID-19 period (92% vs. 76%, respectively; P = 0.0006). Mean hospitalization time was significantly shorter (10 vs. 12 days, P = 0.037) with diversion of patient discharge destinations from institutional to home rehabilitation (P < 0.001). There was a significant correlation between the COVID-19 period and lower 90-day mortality rates (P = 0.034). No statistically significant differences in postoperative complications or 30-day mortality rates were noted.

Conclusions: During the COVID-19 epidemic, despite the limited staff and the lack of therapeutic sequence, there was no impairment in the quality of treatment and a decrease in 90-day mortality was noted.
View Article and Find Full Text PDF

Download full-text PDF

Source
August 2021

Combined endoscopic and mini-open repair of chronic complete proximal hamstring tendon avulsion: a novel approach and short-term outcomes.

J Hip Preserv Surg 2020 Dec 31;7(4):721-727. Epub 2021 May 31.

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

To evaluate the outcome of a novel, combined endoscopic and mini-open repair (CEMR) of a chronic complete retracted proximal hamstring tendon avulsion (PHA). A retrospective case series of a single-surgeon database for all patients, with a minimum of 1-year follow-up, who underwent CEMR between July 2015 and September 2019 was performed. Patients were evaluated for their functional outcome using the Perth Hamstring Assessment Tool (PHAT). At the latest follow-up, patients were evaluated for their muscle strength, subjective satisfaction and post-operative complications. Twelve patients who underwent endoscopic surgery for chronic PHA were identified, of which seven patients underwent CEMR. After exclusion of one patient from the study due to an open claim for health insurance, six patients (five males) with a mean age of 48 years (range 20-61 years) were evaluated. The mean time from injury to surgery was 12 months (range 2-43 months). At a mean follow-up of 28 months (range 12-55 months), the average PHAT score was 73 (range 70-80). The mean subjective activity level percentage improved from 34 (range 20-50) pre-surgery to 81 (range 75-90) post-surgery. The mean strength of the quadriceps, hamstring at 30°, and hamstring at 90° of the operated leg compared to the uninjured leg did not differ significantly. One patient underwent adhesiolysis 1 year after the index procedure for treatment of subcutaneous adhesions. CEMR is a viable and safe option for the treatment of chronic complete proximal hamstring tears, with good to excellent short-term functional outcome. Level of evidence: IV.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/jhps/hnab006DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8349587PMC
December 2020

Epidemiology of Fractures Sustained During Electric Scooter Accidents: A Retrospective Review of 563 Cases.

J Bone Joint Surg Am 2021 Jun;103(12):1125-1131

Division of Orthopedics, Tel-Aviv Sourasky Medical Center, Tel-Aviv, affiliated with the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.

Background: The use of electric scooters (e-scooters) has dramatically increased as they become an attractive alternative for public transportation in busy metropolitan areas worldwide. Despite their benefits, e-scooters challenge the health-care system with poorly understood forms of injuries, mainly orthopaedic fractures. To our knowledge, this study is the first to investigate e-scooter-related orthopaedic fracture patterns, mechanisms of injury, and management.

Methods: Data on 3,331 e-scooter-related admissions were retrospectively collected between May 2017 and February 2020 in a level-I trauma center. These admissions were analyzed for demographic variables, orthopaedic fracture diagnosis (using the AO/OTA classification), associated injuries, and surgical treatment.

Results: During the study period, a total of 716 fractures were diagnosed in 563 patients, with 46.4% of the patients requiring hospitalization. Of 492 upper-limb fractures, 89.2% occurred in a rider fall mechanism; and of 210 lower-limb fractures, 15.7% occurred in rider-vehicle collisions. Fifty-nine percent of long bone fractures were complex fragmentary and/or intra-articular fractures. Orthopaedic surgeons recommended that 225 fractures undergo surgical treatment. The most common upper-limb fracture was AO/OTA class 2R1A, with open reduction and internal fixation of the distal part of the radius being the most common upper-limb procedure (n = 58). The most common lower-limb fracture was AO/OTA class 41C, with open reduction and internal fixation of the proximal part of the tibia being the most common procedure (n = 28). A total of 22 patients (3.9%) required reoperation within 1 year.

Conclusions: This investigation provides unique information on demographic characteristics, patterns, and treatment of orthopaedic fractures secondary to the high-energy mechanism of e-scooter injuries. These new in-depth data are important, first, for health-care system preparedness with regard to management and resource allocation to treat these challenging injuries and, second, for legislators promoting safety and injury prevention strategies.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.2106/JBJS.20.01746DOI Listing
June 2021

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

Radial head excision and Achilles allograft interposition arthroplasty for the treatment of chronic pediatric radiocapitellar pathologies: A report of four cases.

Shoulder Elbow 2021 Apr;13(2):213-222

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

Background: Severe radiocapitellar pathologies represent a unique problem in the pediatric population, as radial head excision can lead to substantial long-term complications. We present a case series of four pediatric patients treated by a novel technique-radial head excision followed by Achilles allograft interposition arthroplasty.

Methods: Four children (ages 12-15 years) are described. Their clinical and radiographic outcomes were assessed by a visual analog scale, the Mayo Elbow Performance Score, the Disabilities of the Arm, Shoulder and Hand questionnaire, grip strength, and range of motion.

Results: At a mean follow-up of two years, the average flexion-extension arc of motion improved from 107° to 131°, and the rotation arc improved from 100° to 154°. The average visual analog scale, Mayo Elbow Performance Score, and Disabilities of the Arm, Shoulder and Hand scores were 2, 92.5, and 11.5, respectively. Two patients required subsequent additional procedures-manipulation under anesthesia and ulnar shortening osteotomy. Proximal migration of the radius was observed in three out of the four patients.

Discussion: Combined radial head excision and Achilles allograft interposition arthroplasty represents a viable option for the treatment of chronic pediatric radiocapitellar pathologies, with good results in terms of clinical and functional outcomes as well as patient satisfaction in the short-medium term.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/1758573219897859DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8039757PMC
April 2021

Dynamic locking plate vs. cannulated cancellous screw for displaced intracapsular hip fracture: A comparative study.

J Orthop 2021 Mar-Apr;24:15-18. Epub 2021 Feb 12.

Orthopedic Department, Tel Aviv Sourasky Medical Center, Ichilov Hospital, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.

Introduction: There is no consensus regarding the optimal device for displaced intracapsular hip fractures. This retrospective study compared two techniques (1) cannulated cancellous screw (CCS), and (2) Targon Femoral Neck (TFN) plate.

Materials And Methods: Data regarding gender, operational data, complications, pain, Quality of life and function scores were retrieved.

Results: 103 patients were included, 42 were treated using CCS, compared to 61 treated using TFN. Operative time shorter for CCS (p = 0.019). Complication rates were not different (p > 0.05).

Conclusion: As CCS method take shorter operating time and reduced costs, CCS should be used for the treatment of displaced ICHF.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jor.2021.02.008DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7902286PMC
February 2021

Midterm Outcomes and Satisfaction After Hip Arthroscopy Are Associated With Postoperative Rehabilitation Factors.

Orthop J Sports Med 2021 Jan 28;9(1):2325967120981888. Epub 2021 Jan 28.

Division of Orthopedic Surgery, Tel Aviv Medical Center Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.

Background: Arthroscopic hip-preservation surgery is commonly performed to address nonarthritic sources of hip pain in young, active individuals. However, there is little evidence to support postoperative rehabilitation protocols, including the most appropriate frequency and length of individual formal physical therapy sessions. There is also a lack of information to look at patients' perceived value of their home program/self-practice in relation to outcomes.

Purpose: To investigate postoperative rehabilitation factors after hip arthroscopy related to formal physical therapy and home program/self-practice and their correlation with patient outcomes and satisfaction.

Study Design: Cohort study; Level of evidence, 3.

Methods: A total of 125 patients who underwent hip arthroscopy for femoroacetabular impingement syndrome and a labral tear (75 men) were included. The mean age was 34.6 ± 14.4 years, and the mean follow-up time was 4.9 ± 1.6 years. Hip Outcome Score-Activities of Daily Living subscale (HOS-ADL) scores, overall satisfaction scores, and factors related to supervised physical therapy and home program/self-practice were collected. Correlations between continuous variables and differences in the length of individual formal physical therapy and patients' rating of the importance of their home program/self-practice between those who would and those who would not undergo surgery again were assessed.

Results: The frequency and length of individual formal physical therapy sessions were significantly correlated with postoperative HOS-ADL scores ( = 0.22, = .014; and = 0.24, = .007, respectively) and level of satisfaction ( = 0.24, = .007; and = 0.21, = .02, respectively). The length of individual formal physical therapy sessions was significantly greater in those who noted they would undergo surgery again (35.3 vs 26.3; = .033). A significant correlation was identified between the rating of the importance of their home program/self-practice and postoperative HOS-ADL scores ( = 0.29; = .001) and their level of satisfaction ( = 0.23; = .009). There was a significant difference in the rating of the importance of their home program/self-practice between those who would undergo surgery again and those who would not (8.9 vs 7.8; = .007).

Conclusion: Surgeons and physical therapists should emphasize the value of home program/self-practice when it comes to outcomes and may want to encourage their patients to participate in more frequent, longer, formal physical therapy sessions.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/2325967120981888DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7869163PMC
January 2021

Self-reduction techniques taught via smartphone are effective for anterior shoulder dislocation: prospective randomized study.

Knee Surg Sports Traumatol Arthrosc 2021 Jul 8;29(7):2338-2341. Epub 2020 Oct 8.

Shoulder Unit, Division of Orthopaedic Surgery, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, 6 Weizman Street, 6423906, Tel Aviv, Israel.

Purpose: To prospectively compare the effectiveness of three methods for self-assisted shoulder reduction demonstrated using a smartphone video link.

Background: Anterior shoulder dislocation is very common among young adults. Patients often seek medical assistance in the emergency department to reduce their shoulder. Many techniques for shoulder reduction had been described, some of which do not require professional assistance and can be performed by patients themselves.

Methods: Patients admitted with anterior shoulder dislocation were randomized to either the Stimson, Milch or the Boss-Holtzach-Matter technique. Each patient was given a link to watch a short instructional video on his smartphone and instructed to attempt self-reduction. Success of the reduction, pain level, patient satisfaction and complications were recorded.

Results: The study cohort consisted of 58 patients (mean age was 31.6 (18-66, median = 27), 82% males, 88% right hand dominant). Success rate using Boss-Holtzach-Matter (10 of 19, 53%) and self-assisted Milch (11 of 20, 55%) were significantly higher than with the self-assisted Stimson method (3 of 19, 16%), p < 0.05. Pain levels improved from 8.4 (2-10) to 3.1 (0-10) following the reduction. Patient subjective satisfaction from the reduction attempt was 6.7 (0-10). No complications were observed.

Conclusion:  Both the Self-assisted Milch and the Boss-Holtzach-Matter techniques are ideal for reduction of anterior shoulder dislocation without medical assistance. Both methods can be successfully performed without assistance or previous education and taught using an instructional video.

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

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00167-020-06310-zDOI Listing
July 2021

Effects of surgeon experience and patient characteristics on accuracy of digital pre-operative planning in total hip arthroplasty.

Int Orthop 2020 10 22;44(10):1951-1956. Epub 2020 Jul 22.

Adult Reconstruction Unit, Division of Orthopedics, Sackler Faculty of Medicine, Tel Aviv Sourasky Medical Center,, Tel Aviv University, 6 Weizman Street, 6423906, Tel Aviv, Israel.

Background: The effect of surgeon experience on accuracy of digital pre-operative planning for total hip arthroplasty (THA) remains unclear. The aims of our study were to compare pre-operative planning accuracy between fellow-trained orthopaedic surgeons and residents and to explore whether surgery indication effects the prediction accuracy.

Methods: We prospectively reviewed 101 patients who underwent pre-operative digital templating for THA in our center from January 2019 to January 2020 with King Mark device. Extracted data included baseline characteristics and indication for primary arthroplasty. Pre-operative digital templating was performed separately by both a fellow-trained surgeon and a resident. Accuracy of each group was compared with the implanted components.

Results: The overall adequate pre-operative planning of the acetabular cup (exact or +/-1 size match) by the fellow-trained group was higher compared with the resident's group (77.2 and 64.3% respectively, p = 0.037), whereas the overall adequate pre-operative planning of the femoral stem (exact or +/-1 size match) was higher in the resident's group compared with the fellow-trained group (83.2 and 61.4% respectively, p < =0.001). The fellow-trained group showed better pre-operative planning of complex cases (developmental dysplasia of the hip and avascular necrosis of femoral head) than the resident's group.

Conclusions: The experience of the planner does not significantly affect the accuracy of correctly predicting component sizes. However, in complex cases, fellow-trained surgeons should assist residents in digital pre-operative templating for THA.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00264-020-04733-4DOI Listing
October 2020

Postoperative Weightbearing Protocols After Arthroscopic Surgery for Femoroacetabular Impingement Does Not Affect Patient Outcome: A Comparative Study With Minimum 2-Year Follow-up.

Arthroscopy 2020 01;36(1):159-164

Orthopedic Division, Souraski Medical Center, Tel-Aviv, Israel.

Purpose: To evaluate the effects of immediate postoperative weightbearing protocols after hip arthroscopy for femoroacetabular impingement (FAI) with minimum 2-year follow-up, as measured by patient-reported outcome measures and satisfaction rates.

Methods: Between January 2011 and June 2016, patients undergoing hip arthroscopy for FAI and labral tears were reviewed. Exclusion criteria was previous hip pathology or arthroscopy, active Workers' Compensation claims, and concomitant pathologies impeding weightbearing. Patients who were operated on before September 2013 were treated with 3 weeks of postoperative non-weightbearing (NWB), with weightbearing as tolerated (WBAT) thereafter. From October 2013, patients were allowed immediate postoperative WBAT.

Results: A total of 351 hip arthroscopic surgeries were performed; 133 of these patients met the inclusion criteria. Of the 133 included patients, 69 were in the NWB group and 64 were in the WBAT group. No differences were found in terms of sex (P = .603) or age (P = .241). No differences were found in postoperative scores (the Modified Harris Hip Score was 84.5 [range 79-89] for NWB vs 86.7 [78-89] for WBAT [P = .0.523], and the Hip Outcome Score was 83.1 [78-88] vs 88.4 [80-90], respectively; P = .130). Subjective rates of improvement, satisfaction score and the will to undergo surgery again did not differ between the groups (P = .674, P = .882, P = .730). The rate of subjects who met or exceeded the MCID in the NWB and WBAT groups was 82.6% and 81.2% for the Modified Harris Hip Score (P = .838) and 79.7% and 82.8% for the Hip Outcome Score (P = .647). There were no reported complications. Limitations include the possibility of the study being underpowered.

Conclusions: After a 2-year minimum follow-up, patient-reported outcome measures and satisfactory rates with immediate weightbearing after hip arthroscopy for isolated FAI syndrome and labral tears do not differ significantly from results after strict NWB rehabilitation protocols. Revising weightbearing restrictions may allow for a more comfortable rehabilitation process after arthroscopic hip surgery for FAI and labral repair.

Level Of Evidence: Level 3 - case-control study.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.arthro.2019.08.012DOI Listing
January 2020

Manipulation under anesthesia for the postsurgical stiff elbow: a case series and review of literature.

Eur J Orthop Surg Traumatol 2019 Dec 6;29(8):1679-1685. Epub 2019 Jul 6.

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

Introduction: Elbow joint stiffness is a common complication following elbow trauma or surgery. Current practices include first-line treatment with physiotherapy and various types of splints. In cases where early postoperative loss of elbow motion interferes with activities of daily living, manipulation under anesthesia (MUA) is considered a viable treatment option, but there is currently only limited data on the results of this procedure and its complications.

Materials And Methods: This retrospective study was comprised of 12 consecutive patients who underwent MUA for the treatment of postsurgical elbow stiffness in one institution between 2010 and 2017. Their pre- and post-manipulation range of motion and their functional scores were assessed.

Results: MUA was performed at a mean of 52 days (range 39-91 days) following the last surgical intervention, and the patients were followed for a mean of 3 years (range 0.75-7 years). The average flexion-extension arc of motion improved by 53.8°, and the average rotation arc improved by 57°. The average Mayo Elbow Performance Score was 73 (range 0-100) at the latest follow-up. Two patients eventually underwent an open elbow contracture release due to poor post-manipulation results. There were no post-MUA complications.

Conclusions: MUA of a postoperative stiff elbow can improve both flexion-extension and rotatory arc of motion in cases of early evolving postoperative stiffness and should be part of the armamentarium for the treatment of this often debilitating condition.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00590-019-02492-6DOI Listing
December 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
-->