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Sedighim S, Sargent B, Grigorian A, Grabar C, Macherla AR, Oh M, Lee YP, Scolaro J, Chen J, Nahmias J. Neurosurgery compared to orthopedic spine consultation: A single level I trauma center experience. Brain Spine 2024; 4:102808. [PMID: 38618229 PMCID: PMC11010962 DOI: 10.1016/j.bas.2024.102808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 02/26/2024] [Accepted: 04/04/2024] [Indexed: 04/16/2024]
Abstract
Introduction Both Orthopedic Surgery (OS) and Neurosurgery (NS) perform spine surgery in the setting of trauma. However, it is unknown whether outcomes differ between these specialties. This study compares management and outcomes for vertebral fractures between NS and OS, hypothesizing similar operation rate, length of stay (LOS), and readmission. Research question Do outcomes differ between NS and OS in the management of vertebral fractures following trauma? Methods A retrospective single-center study was conducted on adult patients with cervical, thoracic, lumbar, and sacral fractures treated at a single trauma center, where no standardized pathway exists across NS and OS. Patients were compared for injury profile, diagnostic imaging, and operative techniques as well as LOS, mortality, and complications. Results A total of 630 vertebral fracture patients (OS:350 (55.6%); NS:280 (44.4%)) were included. NS utilized magnetic resonance imaging (MRI) more commonly (36.4% vs. 22.6%, p < 0.001). NS patients more often underwent operation (13.2% vs. 7.4%, p = 0.016) despite similar fracture number and severity (p > 0.05). Post-operative complications, LOS, and readmission rates were similar between cohorts (p > 0.05). Discussion and conclusion Despite similar injury profiles, NS had higher rates of MRI usage and operative interventions in the context of traumatic spine fractures. Despite differences in management, major clinical outcomes were similar between NS and OS. However, we do call for further standardization of evaluation and treatment of patients based on established algorithms from such as the AOSpine Thoracolumbar Spine Injury Classification System (ATLICS).
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Affiliation(s)
- Shaina Sedighim
- Division of Trauma, Burns, And Surgical Critical Care, Department of Surgery, University of California, Irvine, Orange, CA, USA
| | - Brynn Sargent
- Division of Trauma, Burns, And Surgical Critical Care, Department of Surgery, University of California, Irvine, Orange, CA, USA
| | - Areg Grigorian
- Division of Trauma, Burns, And Surgical Critical Care, Department of Surgery, University of California, Irvine, Orange, CA, USA
| | - Christina Grabar
- Division of Trauma, Burns, And Surgical Critical Care, Department of Surgery, University of California, Irvine, Orange, CA, USA
| | - Anvesh R. Macherla
- Division of Trauma, Burns, And Surgical Critical Care, Department of Surgery, University of California, Irvine, Orange, CA, USA
| | - Michael Oh
- Department of Neurosurgery, University of California, Irvine, Orange, CA, USA
| | - Yu-Po Lee
- Department of Orthopedic Surgery, University of California, Irvine, Orange, CA, USA
| | - John Scolaro
- Department of Orthopedic Surgery, University of California, Irvine, Orange, CA, USA
| | - Jefferson Chen
- Department of Neurosurgery, University of California, Irvine, Orange, CA, USA
| | - Jeffry Nahmias
- Division of Trauma, Burns, And Surgical Critical Care, Department of Surgery, University of California, Irvine, Orange, CA, USA
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Tedesco A, Sharma AK, Acharya N, Rublev G, Hashmi S, Wu HH, Lee YP, Scolaro J, Bhatia N. The Role of Perioperative Nutritional Status and Supplementation in Orthopaedic Surgery: A Review of Postoperative Outcomes. JBJS Rev 2024; 12:01874474-202404000-00004. [PMID: 38619394 DOI: 10.2106/jbjs.rvw.23.00242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/16/2024]
Abstract
» Identification of malnourished and at-risk patients should be a standardized part of the preoperative evaluation process for every patient.» Malnourishment is defined as a disorder of energy, protein, and nutrients based on the presence of insufficient energy intake, weight loss, muscle atrophy, loss of subcutaneous fat, localized or generalized fluid accumulation, or diminished functional status.» Malnutrition has been associated with worse outcomes postoperatively across a variety of orthopaedic procedures because malnourished patients do not have a robust metabolic reserve available for recovery after surgery.» Screening assessment and basic laboratory studies may indicate patients' nutritional risk; however, laboratory values are often not specific for malnutrition, necessitating the use of prognostic screening tools.» Nutrition consultation and perioperative supplementation with amino acids and micronutrients are 2 readily available interventions that orthopaedic surgeons can select for malnourished patients.
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Affiliation(s)
- Amanda Tedesco
- School of Medicine, University of California, Irvine, Irvine, California
| | - Abhinav K Sharma
- Department of Orthopaedic Surgery, University of California Irvine Medical Center, Orange, California
| | - Nischal Acharya
- School of Medicine, University of California, Irvine, Irvine, California
| | - George Rublev
- David Tvildiani Medical University, Tbilisi, Georgia
| | - Sohaib Hashmi
- Department of Orthopaedic Surgery, University of California Irvine Medical Center, Orange, California
| | - Hao-Hua Wu
- Department of Orthopaedic Surgery, University of California Irvine Medical Center, Orange, California
| | - Yu-Po Lee
- Department of Orthopaedic Surgery, University of California Irvine Medical Center, Orange, California
| | - John Scolaro
- Department of Orthopaedic Surgery, University of California Irvine Medical Center, Orange, California
| | - Nitin Bhatia
- Department of Orthopaedic Surgery, University of California Irvine Medical Center, Orange, California
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Van Rysselberghe NL, Seltzer R, Lawson TA, Kuether J, White P, Grisdela P, Daniell H, Amirhekmat A, Merchan N, Seaver T, Samineni A, Saiz A, Ngo D, Dorman C, Epner E, Svetgoff R, Terle M, Lee M, Campbell S, Dikos G, Warner S, Achor T, Weaver MJ, Tornetta P, Scolaro J, Wixted JJ, Weber T, Bellino MJ, Goodnough LH, Gardner MJ, Bishop JA. Retrograde Intramedullary Nailing Versus Locked Plating for Extreme Distal Periprosthetic Femur Fractures: A Multicenter Retrospective Cohort Study. J Orthop Trauma 2024; 38:57-64. [PMID: 38031262 DOI: 10.1097/bot.0000000000002730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/14/2023] [Indexed: 12/01/2023]
Abstract
OBJECTIVES To compare clinical and radiographic outcomes after retrograde intramedullary nailing (rIMN) versus locked plating (LP) of "extreme distal" periprosthetic femur fractures, defined as those that contact or extend distal to the anterior flange. METHODS DESIGN Retrospective review. SETTING Eight academic level I trauma centers. PATIENT SELECTION CRITERIA Adult patients with periprosthetic distal femur fractures at or distal to the anterior flange (OTA/AO 33B-C[VB1]) treated with rIMN or LP. OUTCOME MEASURES AND COMPARISONS The primary outcome was reoperation to promote healing or to treat infection (reoperation for elective removal of symptomatic hardware was excluded from this analysis). Secondary outcomes included nonunion, delayed union, fixation failure, infection, overall reoperation rate, distal femoral alignment, and ambulatory status at final follow-up. Outcomes were compared between patients treated with rIMN or LP. RESULTS Seventy-one patients treated with rIMN and 224 patients treated with LP were included. The rIMN group had fewer points of fixation in the distal segment (rIMN: 3.5 ± 1.1 vs. LP: 6.0 ± 1.1, P < 0.001) and more patients who were allowed to weight-bear as tolerated immediately postoperatively (rIMN: 45%; LP: 9%, P < 0.01). Reoperation to promote union and/or treat infection was 8% in the rIMN group and 16% in the LP group ( P = 0.122). There were no significant differences in nonunion ( P > 0.999), delayed union ( P = 0.079), fixation failure ( P > 0.999), infection ( P = 0.084), or overall reoperation rate ( P > 0.999). Significantly more patients in the rIMN group were ambulatory without assistive devices at final follow-up (rIMN: 35%, LP: 18%, P = 0.008). CONCLUSIONS rIMN of extreme distal periprosthetic femur fractures has similar complication rates compared with LP, with a possible advantage of earlier return to weight-bearing. Surgeons can consider this treatment strategy in all fractures with stable implants and amenable prosthesis geometry, even extreme distal fractures. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Noelle L Van Rysselberghe
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, CA
- Department of Orthopaedics and Sports Medicine, Harborview Medical Center, Seattle, WA
| | - Ryan Seltzer
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, CA
| | - Taylor A Lawson
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, CA
| | - Justin Kuether
- OrthoIndy Trauma, St. Vincent Trauma Center, Indianapolis, IN
| | - Parker White
- OrthoIndy Trauma, St. Vincent Trauma Center, Indianapolis, IN
| | - Phillip Grisdela
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Hayley Daniell
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Arya Amirhekmat
- Department of Orthopaedic Surgery, University of California, Irvine School of Medicine, Orange, CA
| | - Nelson Merchan
- Carl J. Shapiro Department of Orthopaedic Surgery and Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Thomas Seaver
- Department of Orthopaedic Surgery, Boston University Medical Center, Boston, MA
| | - Aneesh Samineni
- Department of Orthopaedic Surgery, Boston University Medical Center, Boston, MA
| | - Augustine Saiz
- Department of Orthopaedic Surgery, McGovern Medical School, University of Texas Health, Houston, TX; and
| | - Daniel Ngo
- Department of Orthopaedic Surgery, McGovern Medical School, University of Texas Health, Houston, TX; and
| | - Clark Dorman
- Department of Orthopaedic Surgery, McGovern Medical School, University of Texas Health, Houston, TX; and
| | - Eden Epner
- Department of Orthopaedic Surgery, McGovern Medical School, University of Texas Health, Houston, TX; and
| | - Reese Svetgoff
- Department of Orthopaedic Surgery, McGovern Medical School, University of Texas Health, Houston, TX; and
| | - Megan Terle
- Department of Orthopaedic Surgery, University of California Davis School of Medicine, Sacramento, CA
| | - Mark Lee
- Department of Orthopaedic Surgery, University of California Davis School of Medicine, Sacramento, CA
| | - Sean Campbell
- Department of Orthopaedic Surgery, University of California Davis School of Medicine, Sacramento, CA
| | - Gregory Dikos
- OrthoIndy Trauma, St. Vincent Trauma Center, Indianapolis, IN
| | - Stephen Warner
- Department of Orthopaedic Surgery, McGovern Medical School, University of Texas Health, Houston, TX; and
| | - Timothy Achor
- Department of Orthopaedic Surgery, McGovern Medical School, University of Texas Health, Houston, TX; and
| | - Michael J Weaver
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Paul Tornetta
- Department of Orthopaedic Surgery, Boston University Medical Center, Boston, MA
| | - John Scolaro
- Department of Orthopaedic Surgery, University of California, Irvine School of Medicine, Orange, CA
| | - John J Wixted
- Carl J. Shapiro Department of Orthopaedic Surgery and Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Timothy Weber
- OrthoIndy Trauma, St. Vincent Trauma Center, Indianapolis, IN
| | - Michael J Bellino
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, CA
| | - L Henry Goodnough
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, CA
| | - Michael J Gardner
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, CA
| | - Julius A Bishop
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, CA
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Tay E, Grigorian A, Schubl SD, Lekawa M, de Virgilio C, Scolaro J, Kabutey NK, Nahmias J. Brachial Plexus Injury Significantly Increases Risk of Axillosubclavian Vessel Injury in Blunt Trauma Patients With Clavicle Fractures. Am Surg 2020; 87:747-752. [PMID: 33169619 DOI: 10.1177/0003134820952832] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND A national analysis of clavicle fractures is lacking and the risk of concomitant axillosubclavian vessel injury (ASVI) in patients with clavicle fractures is unknown. A minority of patients may have a combined brachial plexus injury (BPI). We sought to describe risk factors for concomitant ASVI in patients with a clavicle fracture; hypothesizing patients with combined clavicle fracture and BPI has a higher risk of ASVI. METHODS The Trauma Quality Improvement Program (2010-2016) was queried for blunt trauma patients with a clavicle fracture. A multivariable logistic regression model was used to determine risk factors for ASVI. A subset analysis on patients with isolated clavicle fractures was additionally performed. RESULTS From 59 198 patients with clavicle fractures, 341 (.6%) had concomitant ASVI. Compared to patients without ASVI, patients with ASVI had a higher median injury severity score (24 vs. 17, P < .001) and rates of pulmonary contusions (43.4% vs. 37.7%, P = .029) and BPI (18.2% vs. .4%, P < .001). After controlling for associated chest wall injuries and humerus fracture, the BPI odds ratio (OR 49.17, 35.59-67.92, P < .001) was independently associated with risk for ASVI. In a subset analysis of isolated clavicle fractures, BPI remained associated with risk of ASVI (OR 60.01, confidence intervals 25.29-142.39, P < .001). CONCLUSION The rate of concomitant ASVI in patients with a clavicle fracture is <1%. Patients presenting with a clavicle fracture had a high rate of injuries including pulmonary contusion. Patients with findings suggestive of underlying BPI had a nearly 50 times increased associated risk of ASVI. Thus, a detailed physical exam in this setting including brachial-brachial index appears warranted.
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Affiliation(s)
- Erika Tay
- Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, University of California, CA, USA
| | - Areg Grigorian
- Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, University of California, CA, USA
| | - Sebastian D Schubl
- Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, University of California, CA, USA
| | - Michael Lekawa
- Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, University of California, CA, USA
| | | | - John Scolaro
- Department of Orthopedics, University of California, CA, USA
| | - Nii-Kabu Kabutey
- Department of Surgery, Division of Vascular Surgery, University of California, CA, USA
| | - Jeffry Nahmias
- Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, University of California, CA, USA
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Alpert M, Grigorian A, Scolaro J, Learned J, Dolich M, Kuza CM, Lekawa M, Nahmias J. Fat embolism syndrome in blunt trauma patients with extremity fractures. J Orthop 2020; 21:475-480. [PMID: 33716415 PMCID: PMC7923246 DOI: 10.1016/j.jor.2020.08.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 06/02/2020] [Accepted: 08/25/2020] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE This study sought to provide a national, descriptive analysis to determine fat embolism syndrome (FES) risk factors, hypothesizing that femur fractures and multiple fractures are associated with an increased risk. METHODS The Trauma Quality Improvement Program was queried (2010-2016) for patients with extremity fractures. A multivariable logistic regression analysis model was used. RESULTS From 324,165 patients, 116 patients (0.04%) were diagnosed with FES. An age ≤30, closed femur fracture, and multiple long bone fractures were associated with an increased risk of FES. CONCLUSION Future research to validate these findings and develop a clinical risk stratification tool appears warranted.
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Affiliation(s)
- Miriam Alpert
- Western University of Health Sciences, College of Osteopathic Medicine of the Pacific, 309 E. Second St, Pomona, CA, 91766, USA
| | - Areg Grigorian
- University of California, Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, 333 the City Blvd West, Suite 1600, Orange, CA, 92868, USA
| | - John Scolaro
- University of California, Department of Orthopaedic Surgery, Division of Trauma, 101 the City Blvd South, Building 29A, Orange, CA, 92868, USA
| | - James Learned
- University of California, Department of Orthopaedic Surgery, Division of Trauma, 101 the City Blvd South, Building 29A, Orange, CA, 92868, USA
| | - Matthew Dolich
- University of California, Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, 333 the City Blvd West, Suite 1600, Orange, CA, 92868, USA
| | - Catherine M. Kuza
- University of Southern California, Keck School of Medicine, Department of Anesthesiology, 1450 San Pablo St, Suite 3600, Los Angeles, CA, 90033, USA
| | - Michael Lekawa
- University of California, Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, 333 the City Blvd West, Suite 1600, Orange, CA, 92868, USA
| | - Jeffry Nahmias
- University of California, Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, 333 the City Blvd West, Suite 1600, Orange, CA, 92868, USA
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Kleweno CP, Scolaro J, Sciadini MF, McAlister I, Shannon SF, Chip Routt ML. Management of Pelvic Fractures. Instr Course Lect 2020; 69:489-506. [PMID: 32017748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Pelvic fractures are often the result of high-energy trauma and can result in significant morbidity. Initial management is focused on patient resuscitation and stabilization given the potential for life-threatening hemorrhage that is associated with these injuries. Radiographic evaluation and classification of the pelvic injury guides initial management, provisional stabilization, and preoperative surgical planning. Definitive reduction and fixation of the posterior and anterior pelvic ring is sequentially performed to restore stability and allow for mobilization and healing. Open techniques are commonly used for the pubic symphysis and displaced anterior and posterior ring injuries for which an acceptable reduction is unable to be obtained with closed or indirect techniques. Percutaneous fixation has become increasingly more common for both the anterior and posterior ring and utilizes screw placement within the osseous fixation pathways of the pelvis.
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Grigorian A, Schubl S, Scolaro J, Jasperse N, Gabriel V, Hu A, Petrosian G, Joe V, Nahmias J. No increased risk of acute osteomyelitis associated with closed or open long bone shaft fracture. J Clin Orthop Trauma 2019; 10:S133-S138. [PMID: 31700209 PMCID: PMC6823910 DOI: 10.1016/j.jcot.2019.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 04/09/2019] [Accepted: 04/09/2019] [Indexed: 10/27/2022] Open
Abstract
OBJECTIVES Osteomyelitis of the long bones can result from hematogenous spread, direct inoculation or from a contiguous focus of infection. The association of osteomyelitis after long bone fractures has widely been believed to be true by practicing surgeons since the 1950s, even though the evidence has been poor. We hypothesized that long bone shaft fracture and major bone surgery are independent risk factors for osteomyelitis in adult trauma patients. METHODS The National Trauma Data Bank (NTDB) was queried between 2007 and 2015 for patients ≥18 years of age presenting after trauma. Patients with long bone shaft fractures (femur, tibia/fibula, humerus) were identified and rate of acute osteomyelitis was calculated. Univariable logistic regression was performed. A multivariable logistic regression was performed to identify risk factors for development of acute osteomyelitis. RESULTS From 5,494,609 patients, 358,406 were identified to have long bone shaft fractures (6.5%) with the majority being tibia/fibula (44.3%). The osteomyelitis rate in long bone shaft fractures was 0.05%. Independent risk factors for osteomyelitis included major humerus surgery and major tibia/fibula surgery. The strongest risk factor was non-pseudomonas bacteremia. Long bone shaft fractures were not found to be an independent risk factor for osteomyelitis (p > 0.05). CONCLUSIONS Long bone shaft fractures are not independently associated with increased risk for osteomyelitis. Major extremity surgery on the humerus and tibia/fibula, but not femur, are independent risk factors for osteomyelitis. However, the strongest risk factor is non-pseudomonas bacteremia.
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Affiliation(s)
- Areg Grigorian
- University of California, Irvine, Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, Orange, CA, USA
| | - Sebastian Schubl
- University of California, Irvine, Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, Orange, CA, USA
| | - John Scolaro
- University of California, Irvine, Department of Orthopedic Surgery, Orange, CA, USA
| | - Nathan Jasperse
- University of California, Irvine, Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, Orange, CA, USA,Corresponding author. Division of Trauma, Burns and Surgical Critical Care, Department of Surgery, University of California, Irvine Medical Center, 333 The City Blvd West, Suite 1600, Orange, CA, 92868-3298, USA.
| | - Viktor Gabriel
- University of California, Irvine, Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, Orange, CA, USA
| | - Allison Hu
- University of California, Irvine, Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, Orange, CA, USA
| | - Gino Petrosian
- University of California, Irvine, Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, Orange, CA, USA
| | - Victor Joe
- University of California, Irvine, Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, Orange, CA, USA
| | - Jeffry Nahmias
- University of California, Irvine, Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, Orange, CA, USA
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Courtney PM, Taylor R, Scolaro J, Donegan D, Mehta S. Displaced inferior ramus fractures as a marker of posterior pelvic injury. Arch Orthop Trauma Surg 2014; 134:935-9. [PMID: 24740699 DOI: 10.1007/s00402-014-1993-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2013] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Injuries to the anterior or posterior pelvic ring rarely occur in isolation. Disruption to the anterior pelvic ring, indicated by a fracture of the superior or inferior pubic ramus, or injury to the pubic symphysis, may be indicative of additional pelvic ring disruption. The purpose of this retrospective study was to determine whether displaced inferior pubic ramus fractures warrant a more detailed investigation of the posterior ring in an effort to predict unstable posterior pelvic ring injuries. MATERIALS AND METHODS All patients with a displaced inferior ramus fracture on AP pelvic radiograph were identified at a single level I trauma center over a 5-year period. Complete pelvic radiographs and computed tomography scans were then evaluated for additional pelvic ring injuries. The data were analyzed using the chi-square test to determine the association between inferior ramus fractures and posterior pelvic ring injury. RESULTS Sixty-three of the 93 patients with a fracture of the inferior ramus (68 %) were found to have a posterior ring injury; 60 % of these injuries were unstable. Patients with concurrent superior ramus fractures were more likely to have a posterior ring injury (p < 0.001) and an unstable pelvis (p = 0.018). Of those with a displaced unilateral inferior ramus fracture, parasymphyseal involvement was associated with higher incidence of posterior ring injury (p = 0.047) and pelvic instability (p = 0.028). CONCLUSION The anterior pelvic ring can be used to help identify unstable injuries to the posterior pelvis. Patients with displaced inferior pubic ramus fractures warrant a detailed examination of their posterior ring to identify additional injuries and instability.
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Affiliation(s)
- P Maxwell Courtney
- Orthopaedic Trauma and Fracture Service, Department of Orthopaedic Surgery, Hospital of the University of Pennsylvania, 3400 Spruce Street, 2 Silverstein, Philadelphia, PA, 19104, USA,
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Namdari S, Rabinovich R, Scolaro J, Baldwin K, Bhandari M, Mehta S. Absorbable and non-absorbable cement augmentation in fixation of intertrochanteric femur fractures: systematic review of the literature. Arch Orthop Trauma Surg 2013; 133:487-94. [PMID: 23315070 DOI: 10.1007/s00402-012-1677-2] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2012] [Indexed: 11/30/2022]
Abstract
We conducted a systematic review of the literature on the use of both resorbable and non-resorbable cement as an adjunct to internal fixation of intertrochanteric hip fractures. Two reviewers independently assessed the methodological quality and extracted relevant data from each included study. In cases in which the outcomes data were similar between studies, data were pooled and analyzed. Seven studies were included after fulfilling all inclusion and exclusion criteria. Two hundred and eighty patients were treated with augmentation and 175 were treated without augmentation. Studies were variable in their ability to demonstrate better functional outcomes in patients who underwent augmentation. However, radiographic parameters (mean lag screw sliding distance and varus deformity) were better in the augmentation group. In terms of complications, failure to use augmentation with a sliding hip screw device in five studies led to 10.8-fold higher likelihood of construct failure (p < 0.01). Augmentation of intertrochanteric femur fractures with polymethyl methacrylate or calcium-phosphate may provide benefits in terms of radiographic parameters and complication rates; however, more stringent research methodology is necessary to determine the extent of the benefit.
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Affiliation(s)
- Surena Namdari
- Department of Orthopaedic Surgery, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA
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Donegan DJ, Scolaro J, Matuszewski PE, Mehta S. Staged bone grafting following placement of an antibiotic spacer block for the management of segmental long bone defects. Orthopedics 2011; 34:e730-5. [PMID: 22049954 DOI: 10.3928/01477447-20110922-16] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Segmental long bone defects resulting from injury or surgical intervention are difficult problems to manage. Amputation, external fixators, vascularized fibular grafts, acute limb shortening, and various quantities of allograft and autograft have historically been the mainstays of treatment. Recently, the use of osteoinductive substances such as recombinant bone morphogenic proteins, and osteoconductive scaffolds such as calcium phosphate have found use in the treatment of these clinical situations. More recently, Masquelet described the use of a cement spacer placed within the osseous void followed by staged bone grafting within the induced biomembrane formed around the spacer as a potential treatment strategy to manage these large defects.This article describes a series of 11 patients for which we used this technique of staged bone grafting following placement of an antibiotic spacer to successfully manage osseous long bone defects ranging from 4 to 15 cm. The limbs were stabilized and aligned at the time of initial spacer placement with a plate and screw construct, intramedullary nail, or fine wire fixator. Osteoinductive substances including bone morphogenic protein-2 and platelet rich concentrate were used in addition to allograft to improve bony healing. In our series, osseous consolidation and full weight bearing was achieved in 10 of 11 patients. Two patients developed heterotopic ossification. There was 1 non-union and 1 infection, which occurred in the same patient. Staged bone grafting within an induced biomembrane created after the use of a cement spacer is a reasonable option in the management of both acute and delayed segmental long bone defects.
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Affiliation(s)
- Derek J Donegan
- Department of Orthopaedic Surgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
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Affiliation(s)
- John Scolaro
- Department of Orthopaedic Surgery, University of Pennsylvania, 2 Silverstein Pavilion, Philadelphia, PA 19104 USA
| | - Jaimo Ahn
- Department of Orthopaedic Surgery, University of Pennsylvania, 2 Silverstein Pavilion, Philadelphia, PA 19104 USA
| | - Samir Mehta
- Department of Orthopaedic Surgery, University of Pennsylvania, 2 Silverstein Pavilion, Philadelphia, PA 19104 USA
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Affiliation(s)
- John Scolaro
- Department of Orthopaedic Surgery, University of Pennsylvania School of Medicine, 2 Silverstein Pavilion, Philadelphia, PA 19104 USA
| | - Joseph Bernstein
- Department of Orthopaedic Surgery, University of Pennsylvania School of Medicine, 2 Silverstein Pavilion, Philadelphia, PA 19104 USA
| | - Jaimo Ahn
- Department of Orthopaedic Surgery, University of Pennsylvania School of Medicine, 2 Silverstein Pavilion, Philadelphia, PA 19104 USA
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Affiliation(s)
- John Scolaro
- Department of Orthopaedic Surgery, University of Pennsylvania, 2 Silverstein Pavilion, Philadelphia, PA 19104, USA.
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14
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Melvin JS, Matuszewski PE, Scolaro J, Baldwin K, Mehta S, Mehta S. The role of computed tomography in the diagnosis and management of femoral neck fractures in the geriatric patient. Orthopedics 2011; 34:87. [PMID: 21323283 DOI: 10.3928/01477447-20101221-18] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Femoral neck fractures are common in the elderly; however, agreement on classification and treatment varies. It was hypothesized that computed tomography (CT) would increase agreement for Garden Classification and treatment plan over plain radiographs alone. This article presents results of an online survey completed by 32 respondents at a single institution. The survey was comprised of 5 elderly patients with femoral neck fractures using plain radiographs and CT images. Cases were randomly presented in 3 formats: (1) plain radiograph, (2) CT, and (3) plain radiograph and CT together. Patients were described as low-energy trauma, 65 years or older, and cleared for surgery. Garden Classification and treatment plans were queried. A single case was repeated for intraobserver reliability. Kappa was calculated for inter- and intraobserver reliability. The addition of CT and modification of the Garden Classification (nondisplaced vs displaced) improved interobserver agreement in all cases. Participants were 1.7× more likely (P=.042) to change their Modified Garden Classification when CT was added to plain radiograph compared to plain radiograph added to CT. Treatment agreement was slight to fair. Intraobserver agreement varied from slight to moderate. The rate of arthoplasty recommendations was similar across attending subspecialties; however, arthroplasty-trained surgeons were 20 to 60 times more likely to recommend total hip arthroplasty (P=.009) over hemiarthroplasty compared to nonarthroplasty-trained surgeons. The addition of CT to plain radiograph after femoral neck fracture improves Garden Classification agreement. However, treatment agreement was not impacted by CT. Factors other than improved classification agreement appeared to direct surgeons' treatment recommendations.
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Affiliation(s)
- J Stuart Melvin
- Department of Orthopedic Surgery, Carolinas Medical Center, Charlotte, North Carolina 28203, USA.
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Handy DE, Hang G, Scolaro J, Metes N, Razaq N, Yang Y, Loscalzo J. Aminoglycosides decrease glutathione peroxidase-1 activity by interfering with selenocysteine incorporation. J Biol Chem 2009. [DOI: 10.1074/jbc.a511295200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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16
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Handy DE, Hang G, Scolaro J, Metes N, Razaq N, Yang Y, Loscalzo J. Aminoglycosides decrease glutathione peroxidase-1 activity by interfering with selenocysteine incorporation. J Biol Chem 2005; 281:3382-8. [PMID: 16354666 PMCID: PMC1472404 DOI: 10.1074/jbc.m511295200] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Cellular glutathione peroxidase is a key intracellular antioxidant enzyme that contains a selenocysteine residue at its active site. Selenium, a selenocysteine incorporation sequence in the 3'-untranslated region of the glutathione peroxidase mRNA, and other translational cofactors are necessary for "read-through" of a UGA stop codon that specifies selenocysteine incorporation. Aminoglycoside antibiotics facilitate read-through of premature stop codons in prokayotes and eukaryotes. We studied the effects of G418, an aminoglycoside, on cellular glutathione peroxidase expression and function in mammalian cells. Insertion of a selenocysteine incorporation element along with a UGA codon into a reporter construct allows for read-through only in the presence of selenium. G418 increased read-through in selenium-replete cells as well as in the absence of selenium. G418 treatment increased immunodetectable endogenous or recombinant glutathione peroxidase but reduced the specific activity of the enzyme. Tandem mass spectrometry experiments indicated that G418 caused a substitution of l-arginine for selenocysteine. These data show that G418 can affect the biosynthesis of this key antioxidant enzyme by promoting substitution at the UGA codon.
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Affiliation(s)
- Diane E Handy
- Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts 02115, USA.
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17
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Handy DE, Scolaro J, Chen J, Huang P, Loscalzo J. L-arginine increases plasma homocysteine in apoE-/-/iNOS-/- double knockout mice. Cell Mol Biol (Noisy-le-grand) 2004; 50:903-9. [PMID: 15704254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
Previous studies have shown that L-arginine (L-Arg) administration to apoE-/-/iNOS-/- double knockout mice (dKO) on a Western diet paradoxically results in an increase in atherosclerotic lesion size. We hypothesized that the potential beneficial effects of L-Arg could be offset, in part, by the byproducts of L-Arg catabolism, especially the atherogenic risk factor, homocysteine. In the kidney, L-Arg is converted to L-ornithine and guanidinoacetate (GAA) by L-arginine-glycine amidinotransferase. The efficient transmethylation of GAA by an S-adenosyl-methionine (SAM)-dependent methyltransferase in liver yields creatine and S-adenosylhomocysteine (SAH), which is readily hydrolyzed to homocysteine and adenosine. We, therefore, measured total plasma homocysteine in the dKO mice and control mice. We found that L-Arg supplementation caused a 37% increase in total plasma homocysteine (tHcy) levels in dKO mice compared to controls not treated with L-Arg (5.2+/-2.2 vs 3.8+/-1.5 microM Hcy, p<0.04). In a liver cell line, HepG2, addition of 10 and 50 microM GAA in the presence of 50 microM L-methionine (L-Met) increased tHcy production by approximately 1.47 (p<0.0001) and 2.3-fold (p<0.0001), respectively. In the presence of additional 100 microM L-Met, baseline homocysteine production was elevated by 20% (p<0.005), and 10 and 50 microM GAA augmented homocysteine production by an additional 1.88- (p<0.0001) and 3.4-fold (p<0.001), respectively, compared with 50 microM L-Met. These data suggest that increased concentrations of a methyl acceptor, such as L-Arg-derived GAA, drives SAM-dependent-methylation and consequent homocysteine formation. Furthermore, L-Met levels can also influence homocysteine production likely by regulating the synthesis of the methyl donor SAM. Epidemiological studies have suggested that homocysteine is a graded risk factor. In animal models, modestelevations of homocysteine can cause endothelial dysfunction and augment atherosclerosis. Our data suggest that L-arginine supplementation may contribute to vascular injury and atherogenesis under some circumstances by elevating homocysteine levels.
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Affiliation(s)
- D E Handy
- Whitaker Cardiovascular Institute and Evans Department of Medicine, Boston University School of Medicine, Boston, MA 02118, USA
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Morrissey C, Buser A, Scolaro J, O'Sullivan J, Moquin A, Tenniswood M. Changes in hormone sensitivity in the ventral prostate of aging Sprague-Dawley rats. J Androl 2002; 23:341-51. [PMID: 12002436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/18/2023]
Abstract
The adult rat ventral prostate, which has been used extensively as a model for hormone-dependent prostate cancer, is composed of hormone-dependent columnar secretory epithelial cells and a mixture of hormone-independent cuboidal epithelial cells, basal epithelial cells, and stromal cells. Androgen ablation causes the gland to regress due to the selective loss of the secretory luminal epithelial cells that undergo apoptosis. Most, if not all, of the studies examining the induction of apoptosis and the mechanism of regression have used young adult males at around 3 months of age. Prostate cancer, however, is a disease of older males, and we have therefore investigated whether age-related changes in hormone sensitivity and apoptosis occur in the ventral prostate of aged animals (12 months old) compared to young animals (3 months old). We have observed distinct differences in the morphology of the prostate between young and old rats prior to castration and a significant slowing in the rate of regression after castration in older animals. These changes are accompanied by changes in lipofuscin accumulation and levels of the antioxidant enzymes catalase and manganese (Mn) superoxide dismutase in the gland.
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Affiliation(s)
- Colm Morrissey
- Department of Biological Sciences, University of Notre Dame, Indiana, USA.
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