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  • 1
    Language: English
    In: Operative Techniques in Orthopaedics
    Description: The surgical strategy for the patient with distal femur nonunion needs to be individualized respecting both host and injury-related factors. Prehabilitation prior to nonunion reconstruction is essential, focusing on optimization of general health, nutrition, and cessation of negative social behaviors. Surgical tactic is dictated by the type of nonunion and previous surgical method. Considerations should include enhancing both the mechanical and biological environment towards bone union and ultimate functionality. Strategies include addition of medial plate to existing laterally based hardware, plating over pre-existing intramedullary nail, exchange nail, and thin wire fixation. Revision internal fixation with or without bone grafting is preferable while arthroplasty, specifically distal femoral replacement has a role in the more infirm patient
    Keywords: Distal Femur Fracture ; Nonunion ; Malunion ; Open Distal Femur Fracture ; Distal Femoral Replacement
    ISSN: 1048-6666
    E-ISSN: 1558-3848
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  • 2
    In: Clinical Orthopaedics and Related Research, 2013, Vol.471(9), pp.2831-2840
    Description: BACKGROUND: Extramedullary and intramedullary implants have improved in recent years, although consensus is lacking concerning the definition and classification of unstable intertrochanteric fractures, with uncertainties regarding treatment. QUESTIONS/PURPOSES: We conducted a national survey of practicing chairpersons of German institutions to determine current perspectives and perceptions of practice in the diagnosis, management, and surgical treatment of unstable intertrochanteric fractures. METHODS: Between January and February 2010, we emailed 575 German chairpersons of trauma and/or orthopaedic departments, asking them to complete a 26-question web-based survey regarding three broad domains: fracture classification and instability criteria, implants and surgical treatment algorithms, and timing of operations. Response rate was 42%. RESULTS: There was a clear preference for use of the AO/OTA fracture classification with geographic variations. Absence of medial support was considered the main criterion for fracture instability (84%), whereas a broken lateral wall and detached greater trochanter were considered by 4% and 5% of the respondents, respectively, to determine instability. Two percent routinely fixed unstable intertrochanteric fractures with extramedullary devices. Ninety-eight percent of German hospitals reportedly perform surgery within 24 hours after admission. Time to surgery was dependent on hospital level, with more direct surgeries in Level I hospitals. CONCLUSIONS: Despite varying opinions in the literature in recent years, we found some instability criteria (lateral wall breach, a detached greater trochanter) played a minor role in defining an unstable intertrochanteric fracture pattern. Despite recent meta-analyses suggesting clinical equivalence of intra- and extramedullary implants, few respondents routinely treat unstable intertrochanteric fractures with extramedullary plates. Additional studies are required to specify the influence of fracture characteristics on complication rate and function and to establish a classification system with clear treatment recommendations for unstable intertrochanteric fractures. LEVEL OF EVIDENCE: Level V, expert opinion. See the Instructions for Authors for a complete description of levels of evidence.
    Keywords: Fractures (Injuries);
    ISSN: 0009-921X
    E-ISSN: 15281132
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  • 3
    Article
    Article
    Language: English
    In: Operative Techniques in Orthopaedics, 2011, Vol.21(4), pp.261-264
    ISSN: 1048-6666
    E-ISSN: 1558-3848
    Source: ScienceDirect Journals (Elsevier)
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  • 4
    Language: English
    In: Clinical Orthopaedics and Related Research®, 2013, Vol.471(9), pp.2831-2840
    ISSN: 0009-921X
    E-ISSN: 1528-1132
    Source: Springer Science & Business Media B.V.
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  • 5
    In: The Journal of Trauma: Injury, Infection, and Critical Care, 2011, Vol.71(3), pp.585-590
    Description: BACKGROUND:: Pelvic ring injuries can be associated with severe blood loss and hemodynamic instability. The increase in pelvic volume in disrupted pelvic ring injuries is thought to cause accumulation of large volumes of blood in the retroperitoneal cavity. Extra abdominal compression for reduction of the pelvic ring may affect intrapelvic pressure. We examined the effects of pelvic volume changes on retroperitoneal pressures (RPP) and intra-abdominal pressures (IAPs) in the intact and unstable pelvic ring. METHODS:: In a cadaver study, unembalmed human torsos were used. Infusion lines were placed adjacent to the sacroiliac joint in the retroperitoneum and in the abdominal cavity. IAP and RPP measurements were performed with sequential infusion of crystalloid solution in 1,000 mL increments. Measurements were performed in the intact pelvic ring and after induction of unilateral and bilateral instability by disruption of the pubic symphysis, the sacroiliac joints, the sacrotuberous ligaments, and sacrospinous ligaments. RESULTS:: After infusion of 4,000 mL of saline, we observed a pressure increase in the retroperitoneal cavity (RPP) of 19.64 mm Hg ± 6.43 mm Hg in the intact pelvis, 5.22 mm Hg ± 1.74 mm Hg in unilateral instability, and 2.78 mm Hg ± 0.57 mm Hg in bilateral instability. The RPP response in the case of instability decreased significantly (p = 0.019). The IAP showed a change of 4.63 mm Hg ± 2.64 mm Hg in the intact pelvis, 3.88 mm Hg ± 1.84 mm Hg in unilateral instability, and 2.30 mm Hg ± 0.36 mm Hg in bilateral instability. Further infusion revealed a close association between RAPs and IAPs. CONCLUSIONS:: In the intact pelvis, RPP rises rapidly with increasing volume. The results seem to support the idea that disrupted pelvic ring fractures may lead to a significant volume uptake that is reversed during reduction.
    Keywords: Pressure ; Abdominal Cavity -- Physiopathology ; Compartment Syndromes -- Etiology ; Hemoperitoneum -- Complications ; Pelvis -- Pathology ; Retroperitoneal Space -- Physiopathology;
    ISSN: 0022-5282
    E-ISSN: 15298809
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  • 6
    Language: English
    In: Operative Techniques in Orthopaedics
    Description: Open fractures of the distal femur present several challenges to the treating surgeon as well as the patient. Patients who sustain this injury are at risk for a variety of complications including nonunion, malunion, post-traumatic arthritis, limited function, need for multiple surgical procedures and in some cases, amputation. This article will review initial care of the injured patient, important facets of open fracture care, management of injured soft tissues, strategies for internal fixation in order to optimize outcomes and minimize complications. Additionally, management of nonunion and malunion of the distal femur, including the role for creation of anticipated nonunion following aggressive debridement of nonviable bone, are addressed.
    Keywords: Open Distal Femur Fracture ; Distal Femur Nonunion ; Distal Femur Malunion
    ISSN: 1048-6666
    E-ISSN: 1558-3848
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  • 7
    Language: English
    In: The Journal of Arthroplasty, February 2014, Vol.29(2), pp.422-427
    Description: To examine the mortality and implant survivorship of proximal femoral replacement (PFR), revision total hip arthroplasty (REV) and open reduction internal fixation (ORIF) in the treatment of acute periprosthetic fractures of the proximal femur, we retrospectively reviewed 97 consecutive acute periprosthetic proximal femoral fractures from 2000 to 2010. Three groups were defined: PFR (n = 21), REV (n = 19), and ORIF (n = 57). Outcome measures were all-cause mortality, implant failure, and reoperation. Competing Risks survival analysis of overall mortality during the mean 35-month follow-up showed no statistical difference between the three groups ( = 0.65; 12 and 60 month mortality for PFR: 37%, 45%; REV: 16%, 46%; ORIF: 14%, 100%). Implant survival was worse for the PFR group ( = 0.03, 12 and 60-month implant failure rate for PFR: 5%, 39%; REV: 7%, 7%; ORIF 2%, 2%). We conclude that PFR as compared with REV or ORIF may have worse medium-term implant survival, primarily due to instability and dislocation.
    Keywords: Periprosthetic Fracture ; Proximal Femoral Arthroplasty ; Revision Arthroplasty ; Proximal Femur
    ISSN: 0883-5403
    E-ISSN: 1532-8406
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  • 8
    Language: English
    In: Journal of Shoulder and Elbow Surgery, Dec, 2010, Vol.19(8), p.e11-e13
    Description: To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.jse.2010.05.019 Byline: Steven W. Thorpe, Ivan S. Tarkin Author Affiliation: Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
    Keywords: Surgery
    ISSN: 1058-2746
    Source: Cengage Learning, Inc.
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  • 9
    Language: English
    In: Current Reviews in Musculoskeletal Medicine, 2018, Vol.11(3), pp.439-444
    Description: To access, purchase, authenticate, or subscribe to the full-text of this article, please visit this link: http://dx.doi.org/10.1007/s12178-018-9507-y Byline: Ivan S. Tarkin (1), Mitchell S. Fourman (1) Keywords: Geriatric ankle fracture; Hindfoot nail; Tibio-talar calcaneal nail; Primary ankle fusion; Limb salvage Abstract: Purpose of Review The role of retrograde hindfoot nailing in the treatment of acute orthopedic trauma is explored. Recent Findings Tibio-talar calcaneal (TTC) nailing is an acceptable treatment alternative for the low-demand geriatric patient with peri-articular ankle trauma permitting immediate weight-bearing with low rates of complication and return to functionality. Hindfoot nailing can be used for limb salvage in the younger active patient yet, joint-preserving reconstruction is preferred when feasible. Summary Retrograde TTC nailing is a reliable option for hindfoot/distal tibia stabilization especially in the elderly frail population. Hindfoot nailing is reserved for a select subset of active patients when severity of bone, joint, and soft tissue injury are not amenable to more conventional reconstruction. Author Affiliation: (1) 0000 0001 0650 7433, grid.412689.0, Department of Orthopedic Surgery, University of Pittsburgh Medical Center, 3471 Fifth Avenue, 911 Kaufmann Building, Pittsburgh, PA, 15213, USA Article History: Registration Date: 21/06/2018 Online Date: 26/07/2018 Article note: This article is part of the Topical Collection on Foot and Ankle Trauma
    Keywords: Geriatric ankle fracture ; Hindfoot nail ; Tibio-talar calcaneal nail ; Primary ankle fusion ; Limb salvage
    ISSN: 1935-973X
    E-ISSN: 1935-9748
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  • 10
    Language: English
    In: Injury, November 2013, Vol.44(11), pp.1620-1624
    Description: The study aimed (1) to examine if there are equivalent results in terms of union, alignment and elbow functionally comparing single- to dual-column plating of AO/OTA 13A2 and A3 distal humeral fractures and (2) if there are more implant-related complications in patients managed with bicolumnar plating compared to single-column plate fixation. This was a multi-centred retrospective comparative study. The study was conducted at two academic level 1 trauma centres. A total of 105 patients were identified to have surgical management of extra-articular distal humeral fractures Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association (AO/OTA) 13A2 and AO/OTA 13A3). Patients were treated with traditional dual-column plating or a single-column posterolateral small-fragment pre-contoured locking plate used as a neutralisation device with at least five screws in the short distal segment. The patients’ elbow functionality was assessed in terms of range of motion, union and alignment. In addition, the rate of complications between the groups including radial nerve palsy, implant-related complications (painful prominence and/or ulnar nerve neuritis) and elbow stiffness were compared. Patients treated with single-column plating had similar union rates and alignment. However, single-column plating resulted in a significantly better range of motion with less complications. The current study suggests that exposure/instrumentation of only the lateral column is a reliable and preferred technique. This technique allows for comparable union rates and alignment with increased elbow functionality and decreased number of complications.
    Keywords: Distal Humeral Fracture ; Extra-Articular ; Single-Column Plating ; Dual-Column Plating
    ISSN: 0020-1383
    E-ISSN: 1879-0267
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