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Merose O, Factor S, Gortzak Y, Dadia S, Segal O, Vituri A, Bussiba A, Sternheim A. Mechanical failure of distal femur mega prosthesis due to polyaryl-ether-ether-ketone (PEEK) hinge component. Arch Orthop Trauma Surg 2024:10.1007/s00402-024-05306-5. [PMID: 38642161 DOI: 10.1007/s00402-024-05306-5] [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: 12/29/2023] [Accepted: 03/24/2024] [Indexed: 04/22/2024]
Abstract
BACKGROUND Polyaryl-ether-ether-ketone (PEEK) has gained popularity as a substrate for orthopaedic hardware due to its desirable properties such as heat and deformation resistance, low weight, and ease of manufacturing. However, we observed a relatively high failure rate of PEEK-based hinges in a distal femur reconstruction system. In this study, we aimed to evaluate the proportion of patients who experienced implant failure, analyse the mechanism of failure, and document the associated clinical findings. METHODS We conducted a retrospective cohort study, reviewing the medical charts of 56 patients who underwent distal femur resection and reconstruction with a PEEK Optima hinge-based prosthesis between 2004 and 2018. Concurrently, we performed a clinical and biomechanical failure analysis. RESULTS PEEK component failure occurred in 21 out of 56 patients (37.5%), with a mean time to failure of 63.2 months (range: 13-144 months, SD: 37.9). The survival distributions of PEEK hinges for males and females were significantly different (chi-square test, p-value = 0.005). Patient weight was also significantly associated with the hazard of failure (Wald's test statistic, p-value = 0.031). DISCUSSION Our findings suggest that PEEK hinge failure in a distal femur reconstruction system is correlated with patient weight and male gender. Retrieval analysis revealed that failure was related to fretting and microscopic fractures due to cyclic loading, leading to instability and mechanical failure of the PEEK component in full extension. Further assessment of PEEK-based weight bearing articulating components against metal is warranted.
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Affiliation(s)
- Omri Merose
- Division of Orthopedic Surgery, Tel Aviv Medical Center, 6 Weizmann St, Tel Aviv, 6423906, Israel
- Affiliated to Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shai Factor
- Division of Orthopedic Surgery, Tel Aviv Medical Center, 6 Weizmann St, Tel Aviv, 6423906, Israel.
- Affiliated to Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Yair Gortzak
- Division of Orthopedic Surgery, Tel Aviv Medical Center, 6 Weizmann St, Tel Aviv, 6423906, Israel
- Affiliated to Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Solomon Dadia
- Division of Orthopedic Surgery, Tel Aviv Medical Center, 6 Weizmann St, Tel Aviv, 6423906, Israel
- Affiliated to Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ortal Segal
- Division of Orthopedic Surgery, Tel Aviv Medical Center, 6 Weizmann St, Tel Aviv, 6423906, Israel
- Affiliated to Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Aya Vituri
- Tel Aviv University Center for AI and Data Science (TAD), Tel Aviv, Israel
| | - Arie Bussiba
- Department of Materials Engineering, Ben Gurion of the Negev, P.O.Box 653, Beer Sheva, Israel
| | - Amir Sternheim
- Division of Orthopedic Surgery, Tel Aviv Medical Center, 6 Weizmann St, Tel Aviv, 6423906, Israel
- Affiliated to Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Factor S, Elbaz E, Kazum E, Pardo I, Morgan S, Ben-Tov T, Khoury A, Warschawski Y. Intertrochanteric (Reverse Oblique) Fracture Subclassifications AO/OTA 31-A3 Have No Effect on Outcomes or Postoperative Complications. Clin Orthop Surg 2024; 16:194-200. [PMID: 38562635 PMCID: PMC10973612 DOI: 10.4055/cios23204] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 10/03/2023] [Accepted: 10/03/2023] [Indexed: 04/04/2024] Open
Abstract
Background Reverse oblique intertrochanteric fractures (ROFs) are unstable extracapsular hip fractures that present a mechanical challenge. These fractures are classified as AO/Orthopaedic Trauma Association (OTA) 31-A3 according to the Trauma Association classification system and can further be subclassified into 3 subtypes based on their specific characteristics. The study aimed to evaluate and compare the radiographic and clinical outcomes of the 3 subtypes of ROFs. Methods A retrospective study was conducted at a single high-volume, tertiary center, where data were collected from electronic medical records of consecutive patients who underwent surgical fixation of AO/OTA 31-A3 fractures. Patients with less than 1-year follow-up, pathological fractures, and revision surgery were excluded. The subtypes of fractures were classified as 31-A3.1 (simple oblique), 31-A3.2 (simple transverse), and 31-A3.3 (wedge or multi-fragmentary). The operation was done using 4 different fixation methods, and radiological evaluation was performed at routine intervals. Results The final population consisted of 265 patients (60.8% women) with a mean age of 77.4 years (range, 50-100 years) and the mean follow-up time was 35 months (range, 12-116 months). The incidence of medical complications was similar across the groups. However, there was a trend toward a higher incidence of orthopedic complications and revision rates in the 31-A3.2 group, although this was not statistically significant (p = 0.21 and p = 0.14, respectively). Conclusions Based on the findings of this study, no significant differences were observed between the groups, indicating that the subclassifications of AO/OTA 31-A3 fractures do not have a significant impact on surgical outcomes or the occurrence of postoperative complications.
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Affiliation(s)
- Shai Factor
- Division of Orthopedics, Tel Aviv Sourasky Medical Center, Affiliated to the Faculty of Medicine Tel Aviv University, Tel Aviv, Israel
| | - Etay Elbaz
- Division of Orthopedics, Tel Aviv Sourasky Medical Center, Affiliated to the Faculty of Medicine Tel Aviv University, Tel Aviv, Israel
| | - Efi Kazum
- Division of Orthopedics, Tel Aviv Sourasky Medical Center, Affiliated to the Faculty of Medicine Tel Aviv University, Tel Aviv, Israel
| | - Itay Pardo
- Division of Orthopedics, Tel Aviv Sourasky Medical Center, Affiliated to the Faculty of Medicine Tel Aviv University, Tel Aviv, Israel
| | - Samuel Morgan
- Division of Orthopedics, Tel Aviv Sourasky Medical Center, Affiliated to the Faculty of Medicine Tel Aviv University, Tel Aviv, Israel
| | - Tomer Ben-Tov
- Division of Orthopedics, Tel Aviv Sourasky Medical Center, Affiliated to the Faculty of Medicine Tel Aviv University, Tel Aviv, Israel
| | - Amal Khoury
- Division of Orthopedics, Tel Aviv Sourasky Medical Center, Affiliated to the Faculty of Medicine Tel Aviv University, Tel Aviv, Israel
| | - Yaniv Warschawski
- Division of Orthopedics, Tel Aviv Sourasky Medical Center, Affiliated to the Faculty of Medicine Tel Aviv University, Tel Aviv, Israel
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Tordjman D, Younis M, Factor S, Eisenberg G, Atlan F, McBeth J, Pritsch T, Rosenblatt Y. Volar Locking Plating of Extra-articular Distal Radius Fracture: A Retrospective Clinical Study Comparing Locking Screws versus Smooth Locking Pegs. J Wrist Surg 2024; 13:151-157. [PMID: 38505202 PMCID: PMC10948244 DOI: 10.1055/s-0043-1771338] [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: 08/19/2022] [Accepted: 06/28/2023] [Indexed: 03/21/2024]
Abstract
Background Open reduction and internal fixation of distal radius fractures is one of the most common procedures performed in wrist surgery. The use of volar locking plate has gained increasing interest in the past decade. Epiphyseal fixation can be done either with locking screws or smooth locking pegs, with no evidence supporting the use of one rather than the other. Purpose The aim of this study is to compare the stability of distal radius fixation by volar locking plate using locking screws or smooth locking pegs. Methods Adult patients with A2-A3 AO fractures treated with a volar plate with locking screws only or smooth locking pegs only were retrospectively included. Radiographic assessment was performed to evaluate extra-articular parameters in the intraoperative postreduction and fixation period and after bony healing. Forty-seven distal radius fractures were included. Results Twenty-four fractures had fixation with locking screws and 23 had fixation with smooth locking pegs. For both groups, all radiographic parameters measured showed a statistically significant difference between the intraoperative postreduction and fixation period and the remote postoperative period after union of the fracture ( p < 0.05) attesting a slight loss of reduction. Nevertheless, there were no significant differences between the groups in radiographic extra-articular parameters. Conclusion This clinical study shows that there is no difference in stability fixation between locking screws or smooth locking pegs in A2-A3 distal radius fractures. Clinical Relevance The use of smooth locking pegs only for epiphyseal fixation appears to be safe in volar plating of A2-A3 distal radius fractures in adult patients and could be an alternative to locking screws. More clinical data are needed to confirm these results. Level of Evidence Level III; retrospective comparative study.
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Affiliation(s)
- Daniel Tordjman
- Hand Surgery Unit, Division of Orthopedic, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Mohammad Younis
- Hand Surgery Unit, Division of Orthopedic, Hillel Yaffe Medical Center, Hadera, Israel
| | - Shai Factor
- Hand Surgery Unit, Division of Orthopedic, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gilad Eisenberg
- Hand Surgery Unit, Division of Orthopedic, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Franck Atlan
- Hand Surgery Unit, Division of Orthopedic, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jessica McBeth
- Division of Orthopedic, Santa Clara Valley Medical Center, San Jose, California
- Stanford University School of Medicine, Palo Alto, California
| | - Tamir Pritsch
- Hand Surgery Unit, Division of Orthopedic, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yishai Rosenblatt
- Hand Surgery Unit, Division of Orthopedic, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Factor S, Gurel R, Dan D, Benkovich G, Sagi A, Abialevich A, Benkovich V. Validating a Novel 2D to 3D Knee Reconstruction Method on Preoperative Total Knee Arthroplasty Patient Anatomies. J Clin Med 2024; 13:1255. [PMID: 38592666 PMCID: PMC10931545 DOI: 10.3390/jcm13051255] [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] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 02/18/2024] [Accepted: 02/20/2024] [Indexed: 04/10/2024] Open
Abstract
BACKGROUND As advanced technology continues to evolve, incorporating robotics into surgical procedures has become imperative for precision and accuracy in preoperative planning. Nevertheless, the integration of three-dimensional (3D) imaging into these processes presents both financial considerations and potential patient safety concerns. This study aims to assess the accuracy of a novel 2D-to-3D knee reconstruction solution, RSIP XPlan.ai™ (RSIP Vision, Jerusalem, Israel), on preoperative total knee arthroplasty (TKA) patient anatomies. METHODS Accuracy was calculated by measuring the Root Mean Square Error (RMSE) between X-ray-based 3D bone models generated by the algorithm and corresponding CT bone segmentations (distances of each mesh vertex to the closest vertex in the second mesh). The RMSE was computed globally for each bone, locally for eight clinically relevant bony landmark regions, and along simulated bone cut contours. In addition, the accuracies of three anatomical axes were assessed by comparing angular deviations to inter- and intra-observer baseline values. RESULTS The global RMSE was 0.93 ± 0.25 mm for the femur and 0.88 ± 0.14 mm for the tibia. Local RMSE values for bony landmark regions were 0.51 ± 0.33 mm for the five femoral landmarks and 0.47 ± 0.17 mm for the three tibial landmarks. The RMSE along simulated cut contours was 0.75 ± 0.35 mm for the distal femur cut and 0.63 ± 0.27 mm for the proximal tibial cut. Anatomical axial average angular deviations were 1.89° for the trans epicondylar axis (with an inter- and intra-observer baseline of 1.43°), 1.78° for the posterior condylar axis (with a baseline of 1.71°), and 2.82° (with a baseline of 2.56°) for the medial-lateral transverse axis. CONCLUSIONS The study findings demonstrate promising results regarding the accuracy of XPlan.ai™ in reconstructing 3D bone models from plain-film X-rays. The observed accuracy on real-world TKA patient anatomies in anatomically relevant regions, including bony landmarks, cut contours, and axes, suggests the potential utility of this method in various clinical scenarios. Further validation studies on larger cohorts are warranted to fully assess the reliability and generalizability of our results. Nonetheless, our findings lay the groundwork for potential advancements in future robotic arthroplasty technologies, with XPlan.ai™ offering a promising alternative to conventional CT scans in certain clinical contexts.
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Affiliation(s)
- Shai Factor
- Division of Orthopedic Surgery, Tel Aviv Medical Center, Faculty of Medicine, Tel Aviv University, Tel Aviv 6423906, Israel
| | - Ron Gurel
- Division of Orthopedic Surgery, Tel Aviv Medical Center, Faculty of Medicine, Tel Aviv University, Tel Aviv 6423906, Israel
| | - Dor Dan
- Orthopedic Department, Meir Medical Center, Faculty of Medicine, Tel Aviv University, Tel Aviv 4428164, Israel
| | - Guy Benkovich
- Orthopedic Department, Sheba Medical Center, Faculty of Medicine, Tel Aviv University, Tel Aviv 5262000, Israel
| | - Amit Sagi
- Orthopedic Department, Barzilai Medical Center, Ashkelon 78278, Israel
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva 8499000, Israel
- South West London Elective Orthopaedic Centre, Epsom KT18 7EG, UK
| | - Artsiom Abialevich
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva 8499000, Israel
- Department of Orthopedic Surgery, Soroka Medical Center, Beer Sheva 84101, Israel
- Israeli Joint Health Center, Tel Aviv 69710, Israel
| | - Vadim Benkovich
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva 8499000, Israel
- Department of Orthopedic Surgery, Soroka Medical Center, Beer Sheva 84101, Israel
- Israeli Joint Health Center, Tel Aviv 69710, Israel
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Ashkenazi I, Amzallag N, Factor S, Abadi M, Morgan S, Gold A, Snir N, Warschawski Y. Age as a Risk Factor for Intraoperative Periprosthetic Femoral Fractures in Cementless Hip Hemiarthroplasty for Femoral Neck Fractures: A Retrospective Analysis. Clin Orthop Surg 2024; 16:41-48. [PMID: 38304210 PMCID: PMC10825253 DOI: 10.4055/cios23157] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 09/09/2023] [Accepted: 09/09/2023] [Indexed: 02/03/2024] Open
Abstract
Background Understanding the risk factors and outcomes of intraoperative periprosthetic femoral fractures (IPFF) during hip arthroplasty is crucial for appropriate perioperative management. Previous studies have identified risk factors for IPFF in total hip arthroplasty patients, but data for hip hemiarthroplasty (HA) is lacking. The aim of this study was to determine the age associated with increased rates of IPFF in patients undergoing HA. Methods We retrospectively reviewed patients aged 65 years and above who underwent a cementless HA for a displaced femoral neck fracture and had a minimum of 1-year follow-up. Patients were stratified into five age groups (65-79, 80-84, 85-89, 90-94, and ≥ 95 years) and further divided into two subgroups (under 95 years and 95 years or older). The presence, location, and treatment of IPFF, as well as the effect of IPFF on the postoperative weight-bearing status, were compared between groups. A multivariate logistic regression was also performed. A total of 1,669 met the inclusion criteria and were included in the study. Results The rates of IPFF were significantly higher for patients 95 years or older (p = 0.030). However, fracture location (greater trochanter fractures, p = 0.839; calcar fractures, p = 0.394; and femoral shaft fractures p = 0.110), intraoperative treatment (p = 0.424), and postoperative weight-bearing status (p = 0.229) were similar between the groups. While mortality and nonorthopedic-related readmissions were significantly higher for patients 95 years or older, orthopedic-related readmissions (p = 0.148) and revisions at the latest follow-up (p = 0.253) were comparable between groups. In a regression analysis, age over 95 years (odds ratio, 2.049; p = 0.049) and body mass index (odds ratio, 0.935; p = 0.016) were independently associated with IPFF. Conclusions The findings of this study suggest that age over 95 years is a significant, independent risk factor for IPFF in patients undergoing cementless HA. Although we were unable to show an impact on perioperative outcomes and orthopedic complications, when operating on patients 95 years or older, surgeons should be aware of the increased risk of IPFF and consider the use of stem designs and fixation types associated with decreased IPFF rates.
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Affiliation(s)
- Itay Ashkenazi
- Division of Orthopedics, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine Tel Aviv University, Tel Aviv, Israel
| | - Nissan Amzallag
- Division of Orthopedics, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine Tel Aviv University, Tel Aviv, Israel
| | - Shai Factor
- Division of Orthopedics, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine Tel Aviv University, Tel Aviv, Israel
| | - Mohamed Abadi
- Division of Orthopedics, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine Tel Aviv University, Tel Aviv, Israel
| | - Samuel Morgan
- Division of Orthopedics, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine Tel Aviv University, Tel Aviv, Israel
| | - Aviram Gold
- Division of Orthopedics, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine Tel Aviv University, Tel Aviv, Israel
| | - Nimrod Snir
- Division of Orthopedics, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine Tel Aviv University, Tel Aviv, Israel
| | - Yaniv Warschawski
- Division of Orthopedics, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine Tel Aviv University, Tel Aviv, Israel
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Factor S, Druckmann I, Kazum E, Atlan F, Tordjman D, Rosenblatt Y, Eisenberg G, Pritsch T. A novel pulsed electromagnetic field device as an adjunct therapy to surgical treatment of distal radius fractures: a prospective, double-blind, sham-controlled, randomized pilot study. Arch Orthop Trauma Surg 2024; 144:543-550. [PMID: 37971511 DOI: 10.1007/s00402-023-05117-0] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 10/20/2023] [Indexed: 11/19/2023]
Abstract
INTRODUCTION The purpose of this study is to evaluate whether using a Fracture Healing Patch (FHP) device that generates pulsed electromagnetic fields (PEMF), applied at the fracture site immediately after open reduction and internal fixation surgery, can accelerate healing of acute distal radius fractures. METHODS In a prospective, double-blind, randomized, and sham-controlled study, thirty-two patients with DRFs treated with ORIF were included. Patients were allocated to a PEMF (active) group (n = 15) or a control (sham) group (n = 17). All patients were assessed with regard to functional Patient-Rated Wrist Evaluation (PRWE), SF12, and radiological union outcomes (X-rays and computed tomography (CT) scans) at 2, 4, 6, and 12 weeks postoperatively. RESULTS Patients treated with the FHP demonstrated significantly bone bridging at 4 weeks as assessed by CT (70% vs 54%, p = 0.05). Mean grip strength in the active group was significantly higher as compared to control (16 ± 9 kg vs 7 ± 3.5 kg, respectively, p = 0. 02). The function subscale of the PRWE was significantly better in PEMF-treated group at 6 weeks after surgery (27.2 VS 35.5, p = 0.04). No statistically significant differences were found in SF12. CONCLUSION PEMF application after ORIF of DRFs is safe, may accelerate bone healing which could lead to an earlier return to daily life activities and work. LEVEL OF EVIDENCE I.
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Affiliation(s)
- Shai Factor
- Hand Surgery Unit, Division of Orthopedic Surgery, Tel Aviv Medical Center, 6423906, Tel Aviv, Israel.
- Affiliated to Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Ido Druckmann
- Division of Radiology, Tel Aviv Medical Center, 6 Weitzman St., 6423906, Tel Aviv, Israel
| | - Efi Kazum
- Hand Surgery Unit, Division of Orthopedic Surgery, Tel Aviv Medical Center, 6423906, Tel Aviv, Israel
- Affiliated to Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Franck Atlan
- Hand Surgery Unit, Division of Orthopedic Surgery, Tel Aviv Medical Center, 6423906, Tel Aviv, Israel
- Affiliated to Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Daniel Tordjman
- Hand Surgery Unit, Division of Orthopedic Surgery, Tel Aviv Medical Center, 6423906, Tel Aviv, Israel
- Affiliated to Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yishai Rosenblatt
- Hand Surgery Unit, Division of Orthopedic Surgery, Tel Aviv Medical Center, 6423906, Tel Aviv, Israel
- Affiliated to Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gilad Eisenberg
- Hand Surgery Unit, Division of Orthopedic Surgery, Tel Aviv Medical Center, 6423906, Tel Aviv, Israel
- Affiliated to Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tamir Pritsch
- Hand Surgery Unit, Division of Orthopedic Surgery, Tel Aviv Medical Center, 6423906, Tel Aviv, Israel
- Affiliated to Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Factor S, Albagli A, Bebin A, Druckmann I, Bulkowstein S, Stahl I, Shichman I. Influence of residency discipline and seniority on traumatic musculoskeletal radiographs interpretation accuracy: a multicenter study. Eur J Trauma Emerg Surg 2023; 49:2589-2597. [PMID: 37573536 DOI: 10.1007/s00068-023-02347-0] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Accepted: 08/01/2023] [Indexed: 08/15/2023]
Abstract
OBJECTIVES Imaging studies are a significant and integral part of the initial assessment of patients admitted to the emergency department. Developing imaging diagnostic abilities early in residency is of paramount importance. The purpose of this study was to evaluate and compare diagnosis accuracy of common musculoskeletal X-rays (XR) between residency disciplines and seniority. METHODS A multicenter study which evaluated orthopedic surgery, emergency medicine (EM), and radiology residents, through a test set of common MSK XR. Residents were classified as "beginner" or "advanced" according to postgraduate year per residency. Residents were asked to answer whether the radiograph shows normal or pathological findings (success rate) and what is the diagnosis ("diagnosis accuracy"). Residents' answers were analyzed and assessed compared to experts' consensus. RESULTS A total of 100 residents (62% beginners) participated in this study. Fifty-four were orthopedic surgeons, 29 were EM residents and 17 were radiologists. The entire cohort's overall success rate was 88.5%. The overall mean success rates for orthopedic, EM, and radiology residents were 93.2%, 82.8%, and 83.3%, respectively, and were significantly different (p < 0.0001). Orthopedic residents had significantly higher diagnostic accuracy rates compared with both radiology and EM residents (p < 0.001). Advanced orthopedic and EM residents demonstrated higher diagnostic accuracy rates compared to beginner residents (p = 0.001 and p = 0.03, respectively). CONCLUSION Orthopedic residents presented higher diagnosis accuracy of MSK imaging compared to EM and radiology residents. Seniority had a positive effect on diagnosis accuracy. The development of an educational program on MSK XR is necessary to enhance the competency of physicians in their daily practice.
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Affiliation(s)
- Shai Factor
- Division of Orthopedic Surgery, Tel Aviv Medical Center, 6 Weitzman St., 6423906, Tel Aviv, Israel.
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Assaf Albagli
- Division of Orthopedic Surgery, Tel Aviv Medical Center, 6 Weitzman St., 6423906, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Alex Bebin
- Division of Orthopedic Surgery, Tel Aviv Medical Center, 6 Weitzman St., 6423906, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ido Druckmann
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Division of Radiology, Tel Aviv Medical Center, 6423906, Tel Aviv, Israel
| | - Shlomi Bulkowstein
- Division of Orthopedics, Soroka University Medical Center, Beer-Sheva, P.O. Box 151, 84101, Beer-Sheva, Israel
- Affiliated to the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Ido Stahl
- Division of Orthopedic Surgery, Rambam Healthcare Campus, 3109601, Haifa, Israel
- Affiliated to the Rappaport Faculty of Medicine, Technion-Israeli Institute of Technology, Haifa, Israel
| | - Ittai Shichman
- Division of Orthopedic Surgery, Tel Aviv Medical Center, 6 Weitzman St., 6423906, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Amzallag N, Ashkenazi I, Factor S, Abadi M, Morgan S, Graif N, Snir N, Gold A, Warschawski Y. Addition of gentamicin for antibiotic prophylaxis in hip hemiarthroplasty does not decrease the rate of surgical site infection. Eur J Trauma Emerg Surg 2023:10.1007/s00068-023-02406-6. [PMID: 38006566 DOI: 10.1007/s00068-023-02406-6] [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] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 11/13/2023] [Indexed: 11/27/2023]
Abstract
BACKGROUND The addition of Gram-negative coverage to antibiotic prophylaxis protocols prior to elective total hip arthroplasty (THA) has been reported to reduce periprosthetic joint infection (PJI). However, it is unknown whether adding a Gram-negative-targeted antibiotic agent improves outcomes in the trauma population. This study aimed to investigate whether the addition of a single, pre-operative dose of Gentamicin is associated with lower rates of PJI in patients undergoing hemiarthroplasty (HA) as treatment for a hip fracture. METHODS We retrospectively reviewed cases of patients who underwent HA as treatment for a hip fracture from January 2011 to January 2022, and had a minimum 1-year of follow-up. Patients were divided into two groups based on the antibiotic prophylaxis they received during surgery: cefazolin (control group) or cefazolin with addition of Gentamicin (case group). The primary outcome was the rate of surgical site infections (SSI), and secondary outcomes included rates of prosthetic joint infection (PJI) and superficial SSIs. RESULTS The final study population consisted of 1521 patients. 336 patients (22.1%) were in the case group and 1185 (77.9%) patients were in the control group. Rates of SSI were comparable between the groups (3.8% for the case group vs. 2.8% in the control group, p = 0.34). This held true for both PJIs (3.5 vs. 2.5%, p = 0.3) and superficial SSIs (0.29 vs. 0.33%, p = 0.91). The distribution of the causing pathogen was similar between the groups (p = 0.84). Gentamicin susceptibility rates of the Gram-negative bacteria associated with PJI were similar between the cohorts (p = 0.51). CONCLUSIONS The addition of a single, pre-operative dose of Gentamicin to the antibiotic prophylaxis protocol of patients undergoing HA as treatment for a hip fracture was not associated with lower rates of SSI, PJI or superficial SSI. The findings of this study indicate that the prophylactic benefits of Gentamicin may not apply to HA as they do to THA.
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Affiliation(s)
- Nissan Amzallag
- Division of Orthopedics, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine Tel Aviv University, 6 Weizman Street, 6423906, Tel-Aviv, Israel
| | - Itay Ashkenazi
- Division of Orthopedics, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine Tel Aviv University, 6 Weizman Street, 6423906, Tel-Aviv, Israel
| | - Shai Factor
- Division of Orthopedics, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine Tel Aviv University, 6 Weizman Street, 6423906, Tel-Aviv, Israel.
| | - Mohamed Abadi
- Division of Orthopedics, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine Tel Aviv University, 6 Weizman Street, 6423906, Tel-Aviv, Israel
| | - Samuel Morgan
- Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Nadav Graif
- Division of Orthopedics, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine Tel Aviv University, 6 Weizman Street, 6423906, Tel-Aviv, Israel
| | - Nimrod Snir
- Division of Orthopedics, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine Tel Aviv University, 6 Weizman Street, 6423906, Tel-Aviv, Israel
| | - Aviram Gold
- Division of Orthopedics, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine Tel Aviv University, 6 Weizman Street, 6423906, Tel-Aviv, Israel
| | - Yaniv Warschawski
- Division of Orthopedics, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine Tel Aviv University, 6 Weizman Street, 6423906, Tel-Aviv, Israel
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9
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Gurel R, Shehadeh K, Elbaz E, Benady A, Factor S, Ashkenazi I, Gortzak Y, Sternheim A, Dadia S, Segal O. Intraoperative three-dimensional navigation for surgical treatment of osteoid osteoma in the upper extremity: A series of 19 cases. J Orthop Surg (Hong Kong) 2023; 31:10225536231217123. [PMID: 37976541 DOI: 10.1177/10225536231217123] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2023] Open
Abstract
The surgical treatment for osteoid osteoma (OO) in the upper extremity is challenging due to the difficulty in locating the lesion and the crowding of sensitive structures within the anatomy. This study aimed to describe the outcomes of navigated minimally invasive radiofrequency ablation and those of navigated mini open-intralesional curettage in treating these lesions. Nineteen consecutive patients with OO in the upper limb who underwent navigated surgery were included. The average QuickDASH and Numeric Pain Rating Scale improved from 62.2 ± 23.7 to 11.7 ± 16.9 and from 8.1 ± 1.6 to 0.5 ± 1.8, respectively (p < .01 each) following the procedure. Two complications were recorded: one patient had persistent radial nerve palsy, and one patient had transient partial radial nerve weakness. In conclusion, navigation is an important tool in the surgical treatment of OO in the upper limb. A mini open approach to identify and protect neurovascular structures is recommended.
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Affiliation(s)
- Ron Gurel
- Departments of Orthopedic Surgery and Orthopedic Oncology, Tel Aviv Sourasky Medical Center, affiliated with Tel Aviv University, Tel Aviv, Israel
| | - Kathrine Shehadeh
- Departments of Orthopedic Surgery and Orthopedic Oncology, Tel Aviv Sourasky Medical Center, affiliated with Tel Aviv University, Tel Aviv, Israel
| | - Etay Elbaz
- Departments of Orthopedic Surgery and Orthopedic Oncology, Tel Aviv Sourasky Medical Center, affiliated with Tel Aviv University, Tel Aviv, Israel
| | - Amit Benady
- Departments of Orthopedic Surgery and Orthopedic Oncology, Tel Aviv Sourasky Medical Center, affiliated with Tel Aviv University, Tel Aviv, Israel
| | - Shai Factor
- Departments of Orthopedic Surgery and Orthopedic Oncology, Tel Aviv Sourasky Medical Center, affiliated with Tel Aviv University, Tel Aviv, Israel
| | - Itay Ashkenazi
- Departments of Orthopedic Surgery and Orthopedic Oncology, Tel Aviv Sourasky Medical Center, affiliated with Tel Aviv University, Tel Aviv, Israel
| | - Yair Gortzak
- Departments of Orthopedic Surgery and Orthopedic Oncology, Tel Aviv Sourasky Medical Center, affiliated with Tel Aviv University, Tel Aviv, Israel
| | - Amir Sternheim
- Departments of Orthopedic Surgery and Orthopedic Oncology, Tel Aviv Sourasky Medical Center, affiliated with Tel Aviv University, Tel Aviv, Israel
| | - Solomon Dadia
- Departments of Orthopedic Surgery and Orthopedic Oncology, Tel Aviv Sourasky Medical Center, affiliated with Tel Aviv University, Tel Aviv, Israel
| | - Ortal Segal
- Departments of Orthopedic Surgery and Orthopedic Oncology, Tel Aviv Sourasky Medical Center, affiliated with Tel Aviv University, Tel Aviv, Israel
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10
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Lichtenstein A, Amar E, Halperin D, Factor S, Ohana N, Albagli A, Efrima B, Rath E. The anterior superior iliac spine is a reliable novel landmark for preemptive periacetabular analgesia in hip arthroscopy. J Hip Preserv Surg 2023; 10:119-122. [PMID: 37900892 PMCID: PMC10604053 DOI: 10.1093/jhps/hnad011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 02/16/2023] [Accepted: 04/07/2023] [Indexed: 10/31/2023] Open
Abstract
Appropriate post-operative (post-op) pain control has been shown to reduce length of stay and facilitate day case surgery. Periacetabular injection of bupivacaine is effective in pain reduction after hip arthroscopy. This study aims to evaluate the anterior superior iliac spine (ASIS) as an anatomical landmark to facilitate needle insertion prior to fluoroscopy. The meeting point derived from a vertical line one fingerbreadth distal to the ASIS and a longitudinal line from the greater trochanter (GT) was used as a landmark in 30 consecutive hip arthroscopy patients for periacetabular analgesia. The distance between the tip of the needle and the acetabular roof was measured via fluoroscopy. Needle location was corrected if needed, followed by periacetabular bupivacaine injection (at anterior, lateral and posterior joint aspects). Post-op pain was measured using the Visual Analog Scale (VAS) 4-6 h post-op and at discharge. The ASIS and GT were identified and used for periacetabular analgesia landmarks in all cases. Results revealed that 93.3% of needle entries fell within 10 mm of the lateral acetabular rim and only one case had fallen distal to it. The post-op mean VAS score was 1.03 (range 0-6, standard error - 0.30, median = 0). At hospital discharge, 90% (27/30 of patients) reported VAS score ≤ 5. Twenty-six of the 30 patients were discharged on the same day as the operation (remaining four patients stayed due to accommodation/traveling issues). The ASIS and GT can be used as an anatomical landmark for periacetabular analgesia in hip arthroscopy with reproducible needle location, significant analgesic effect and minimal radiation.
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Affiliation(s)
- Adi Lichtenstein
- Orthopedic Department, Tel Aviv Sourasky Medical Center, Ichilov Hospital, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, 6 Weizmann Street, Tel Aviv 6423906, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Eyal Amar
- Orthopedic Department, Tel Aviv Sourasky Medical Center, Ichilov Hospital, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, 6 Weizmann Street, Tel Aviv 6423906, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Dania Halperin
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Shai Factor
- Orthopedic Department, Tel Aviv Sourasky Medical Center, Ichilov Hospital, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, 6 Weizmann Street, Tel Aviv 6423906, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Nissim Ohana
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- Orthopedic Department, Meir Medical Center Kfar Saba, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tchernichovsky St 59, Kefar Sava 4428164, Israel
| | - Assaf Albagli
- Orthopedic Department, Tel Aviv Sourasky Medical Center, Ichilov Hospital, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, 6 Weizmann Street, Tel Aviv 6423906, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Ben Efrima
- Orthopedic Department, Tel Aviv Sourasky Medical Center, Ichilov Hospital, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, 6 Weizmann Street, Tel Aviv 6423906, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Ehud Rath
- Orthopedic Department, Tel Aviv Sourasky Medical Center, Ichilov Hospital, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, 6 Weizmann Street, Tel Aviv 6423906, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
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11
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Factor S, Snopik PG, Albagli A, Rath E, Amar E, Atlan F, Morag G. The "Selfie Test": A Novel Test for the Diagnosis of Lateral Epicondylitis. Medicina (Kaunas) 2023; 59:1159. [PMID: 37374364 DOI: 10.3390/medicina59061159] [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] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Revised: 06/12/2023] [Accepted: 06/14/2023] [Indexed: 06/29/2023]
Abstract
Background: Lateral epicondylitis (LE) is one of the most diagnosed elbow pathologies. The purpose of this study was to determine the diagnostic test accuracy of a new test (selfie test) for the diagnosis of LE. Methods: Medical data were collected from adult patients who presented with LE symptoms and ultrasound findings that supported the diagnosis. Patients underwent a physical examination, including provocative tests for diagnosis as well as the selfie test, and were asked to fill out the Patient-Rated Tennis Elbow Evaluation (PRTEE) questionnaire and subjectively rate the activity of their affected elbow. Results: Thirty patients were included in this study (seventeen females, 57%). The mean age was 50.1 years old (range of 35 to 68 years). The average duration of symptoms was 7 ± 3.1 months (range of 2 to 14 months). The mean PRTEE score was 61.5 ± 16.1 (range of 35 to 98), and the mean subjective elbow score was 63 ± 14.2 (range of 30 to 80). Mill's, Maudsley's, Cozen's, and the selfie tests had sensitivities of 0.867, 0.833, 0.967, and 0.933, respectively, with corresponding positive predictive values of 0.867, 0.833, 0.967, and 0.933. Conclusions: The selfie test's active nature, which allows patients to perform the assessment themselves, could be a valuable addition to the diagnostic process, potentially improving the accuracy of the diagnosis of LE (levels of evidence: IV).
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Affiliation(s)
- Shai Factor
- Department of Orthopedic Surgery, Tel Aviv Medical Center, 6 Weitzman St., Tel Aviv 6423906, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6423906, Israel
| | | | - Assaf Albagli
- Department of Orthopedic Surgery, Tel Aviv Medical Center, 6 Weitzman St., Tel Aviv 6423906, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6423906, Israel
| | - Ehud Rath
- Department of Orthopedic Surgery, Tel Aviv Medical Center, 6 Weitzman St., Tel Aviv 6423906, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6423906, Israel
| | - Eyal Amar
- Department of Orthopedic Surgery, Tel Aviv Medical Center, 6 Weitzman St., Tel Aviv 6423906, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6423906, Israel
| | - Franck Atlan
- Department of Orthopedic Surgery, Tel Aviv Medical Center, 6 Weitzman St., Tel Aviv 6423906, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6423906, Israel
| | - Guy Morag
- Department of Orthopedic Surgery, Tel Aviv Medical Center, 6 Weitzman St., Tel Aviv 6423906, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6423906, Israel
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12
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Elbaz E, Morgan S, Factor S, Shaked O, Graif N, Ben-Tov T, Khoury A, Warschawski Y. Reduced cutout for reverse oblique intertrochanteric hip fractures treated with trochanteric fixation advanced (TFN-A) nail compared to the short gamma-3 nail. SICOT J 2023; 9:16. [PMID: 37276028 DOI: 10.1051/sicotj/2023013] [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: 12/01/2022] [Accepted: 04/23/2023] [Indexed: 06/07/2023] Open
Abstract
BACKGROUND Reverse oblique fractures (AO/OTA 31-A3) account for 5-23% of all intertrochanteric fractures and are challenging to manage. The Gamma 3-Proximal Femoral Nail (GPFN) and the Trochanteric Fixation Nail Advanced (TFNA) are two common cephalomedullary systems used to treat this fracture. No study has reported on outcomes with the TFN-A for reverse oblique fractures. This study aimed to compare outcomes and complication rates in patients with reverse oblique fractures, treated with either TFNA or GPFN. PATIENTS AND METHODS A total of 203 patients with reverse oblique fractures (137 in the GPFN group and 66 in the TFNA group), were treated in our institution between June 2010 and May 2019. Data was collected on postoperative radiological variables including screw or blade location, and tip-apex distance (TAD). Data were also collected for non-orthopaedic complication rates and orthopaedic complications. A sub-group analysis was additionally performed for different nail lengths. RESULTS We found no significant difference in the overall rate of complications and revisions between the two groups. Patients treated with the 235 mm TFN-A nail sustained lower rates of cutout, compared to 180 mm GPFN (GPFN: 6% TFN-A: 0%, p = 0.043). The frequency of revision surgeries and malunions/non-unions did not differ significantly between the two groups and additionally showed no difference in the subgroup analysis. CONCLUSION The 235 mm TFN-A was associated with lower rates of cut-out compared to the short GPFN for reverse oblique intertrochanteric fractures. Future well-designed prospective studies are warranted to investigate the role of the TFN-A in improving outcomes for such fractures.
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Affiliation(s)
- Etay Elbaz
- Division of Orthopedics, Tel Aviv Sourasky Medical Center, Tel-Aviv, Affiliated to the Sackler Faculty of Medicine Tel Aviv University, Tel Aviv 6423906, Israel
| | - Samuel Morgan
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6423906, Israel
| | - Shai Factor
- Division of Orthopedics, Tel Aviv Sourasky Medical Center, Tel-Aviv, Affiliated to the Sackler Faculty of Medicine Tel Aviv University, Tel Aviv 6423906, Israel
| | - Or Shaked
- Division of Orthopedics, Tel Aviv Sourasky Medical Center, Tel-Aviv, Affiliated to the Sackler Faculty of Medicine Tel Aviv University, Tel Aviv 6423906, Israel
| | - Nadav Graif
- Division of Orthopedics, Tel Aviv Sourasky Medical Center, Tel-Aviv, Affiliated to the Sackler Faculty of Medicine Tel Aviv University, Tel Aviv 6423906, Israel
| | - Tomer Ben-Tov
- Division of Orthopedics, Tel Aviv Sourasky Medical Center, Tel-Aviv, Affiliated to the Sackler Faculty of Medicine Tel Aviv University, Tel Aviv 6423906, Israel
| | - Amal Khoury
- Division of Orthopedics, Tel Aviv Sourasky Medical Center, Tel-Aviv, Affiliated to the Sackler Faculty of Medicine Tel Aviv University, Tel Aviv 6423906, Israel
| | - Yaniv Warschawski
- Division of Orthopedics, Tel Aviv Sourasky Medical Center, Tel-Aviv, Affiliated to the Sackler Faculty of Medicine Tel Aviv University, Tel Aviv 6423906, Israel
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13
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Factor S, Rutenberg TF, Garceau S, Gold A, Morgan S, Snir N, Warschawski Y. Long term results of total hip arthroplasty with cemented and cementless tapered femoral component. SICOT J 2023; 9:17. [PMID: 37278510 DOI: 10.1051/sicotj/2023014] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 05/07/2023] [Indexed: 06/07/2023] Open
Abstract
BACKGROUND Excellent midterm results for total hip arthroplasties (THA) with cementless, tapered porous Taperloc® femoral stems have been reported. Reports regarding such cemented stems, however, are lacking. OBJECTIVES To evaluate the long-term outcomes of both cemented and cementless THAs with the Taperloc femoral component. METHODS The medical records of 71 patients (76 hips), operated on between January 1991 and December 2003, who had a minimum follow-up of 10 years were available for analysis. Functional analysis was performed with the Harris hip score (HHS) questionnaire and the numerical analogue scale (NAS). Radiographic analysis was performed for subsidence, radiolucent lines and osteolysis. RESULTS The cohort was comprised of 47 female and 24 male patients, with a mean age of 59.7 ± 12.4 years. The mean follow-up was 17.8 ± 4.4 years. 52.6% of THAs analyzed were cementless and 47.4% were cemented. Post-operative radiographs were available for 57 surgeries. Subsidence, hypertrophic ossification, radiolucent lines and osteolysis were noted in 4 (7%), 2 (2.6%), 14 (18.4%) and 11 (14.5%) hips respectively. The average HHS score at a mean follow-up of 20.1 ± 3.9 years was 62.1 (±27.7) and the NAS score was 4.6 (±3.6). During the study period, five revision surgeries were performed due to stem-related problems, one of which was for aseptic loosening. CONCLUSIONS Our long-term experience with the Taperloc stem, both cemented and cementless, demonstrates good outcomes, with low rates of failure. This makes this prosthesis an attractive option for THAs. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Shai Factor
- Division of Orthopedic Surgery, Tel Aviv Medical Center, Tel Aviv 6423906, Israel; Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Simon Garceau
- Mount Sinai Hospital, Division of Orthopaedics - Joseph and Wolf Lebovic Health Complex, Toronto, ON, Canada
| | - Aviram Gold
- Division of Orthopedic Surgery, Tel Aviv Medical Center, Tel Aviv 6423906, Israel; Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Samuel Morgan
- Division of Orthopedic Surgery, Tel Aviv Medical Center, Tel Aviv 6423906, Israel; Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nimrod Snir
- Division of Orthopedic Surgery, Tel Aviv Medical Center, Tel Aviv 6423906, Israel; Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yaniv Warschawski
- Division of Orthopedic Surgery, Tel Aviv Medical Center, Tel Aviv 6423906, Israel; Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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14
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Gurel R, Vidra M, Elbaz E, Factor S, Kazum E, Bivas A, Maman E, Chechik O, Rotman D. Arthroscopic rotator cuff repair in fibromyalgia patients had comparable outcomes to a matched control group. J Orthop Traumatol 2023; 24:21. [PMID: 37169977 PMCID: PMC10175519 DOI: 10.1186/s10195-023-00706-6] [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: 01/06/2023] [Accepted: 05/01/2023] [Indexed: 05/13/2023] Open
Abstract
BACKGROUND Although fibromyalgia is associated with poor outcomes following orthopedic surgeries, several studies show some benefit from surgical intervention and nevertheless recommend operative treatment when indicated. There is sparse evidence of the effect of fibromyalgia on the outcomes of shoulder surgery. The purpose of this study was to investigate the effect of fibromyalgia on patient-reported outcomes of arthroscopic rotator cuff repair (ARCR). METHODS All patients with a confirmed diagnosis of fibromyalgia who underwent ARCR in one institution between 2010 and 2021 were included. Data retrieved from medical records included demographics, characteristics of the cuff tear and the surgical procedure, and preoperative and last follow-up (minimum 1 year) postoperative Disabilities of the Arm, Shoulder and Hand (DASH) score, Subjective Shoulder score (SSV), and Numeric Pain Rating Scale (NPRS). A matched controlled group of patients without fibromyalgia who had undergone ARCR was selected according to age, sex, and preoperative DASH, SSV, and NPRS scores. RESULTS There were no significant differences in demographics, cuff tear and surgical procedure characteristics, and preoperative scores between the fibromyalgia and control groups. The fibromyalgia patients' postoperative scores for all 3 measurements showed significant improvement: SSV by 32.1 (P = 0.004), DASH by 20.3 (P = 0.016), and NPRS by 2.33 (P = 0.017). There were no significant differences in the postoperative DASH, SSV, and NPRS between the fibromyalgia and control groups. CONCLUSION Fibromyalgia patients with rotator cuff tears who undergo ARCR do not have inferior patient-reported outcomes compared with non-fibromyalgia controls. Fibromyalgia should not be a considered a contraindication for ARCR. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Ron Gurel
- Department of Orthopedic Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Matias Vidra
- Department of Orthopedic Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Etay Elbaz
- Department of Orthopedic Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shai Factor
- Department of Orthopedic Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Efi Kazum
- Department of Orthopedic Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Assaf Bivas
- Department of Orthopedic Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eran Maman
- Department of Orthopedic Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ofir Chechik
- Department of Orthopedic Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dani Rotman
- Department of Orthopedic Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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15
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Factor S, Druckmann I, Atlan F, Rosenblatt Y, Tordjman D, Krespi R, Kazum E, Pritsch T, Eisenberg G. The Effects of Novel Pulsed Electromagnetic Field Therapy Device on Acute Distal Radius Fractures: A Prospective, Double-Blind, Sham-Controlled, Randomized Pilot Study. J Clin Med 2023; 12:jcm12051866. [PMID: 36902653 PMCID: PMC10003714 DOI: 10.3390/jcm12051866] [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] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 02/20/2023] [Accepted: 02/22/2023] [Indexed: 03/03/2023] Open
Abstract
BACKGROUND this pilot study aimed at determining whether the application of a novel new method of generating pulsed electromagnetic field (PEMF), the Fracture Healing Patch (FHP), accelerates the healing of acute distal radius fractures (DRF) when compared to a sham treatment. METHODS 41 patients with DRFs treated with cast immobilization were included. Patients were allocated to a PEMF group (n = 20) or a control (sham) group (n = 21). All patients were assessed with regard to functional and radiological outcomes (X-rays and CT scans) at 2, 4, 6 and 12 weeks. RESULTS fractures treated with active PEMF demonstrated significantly higher extent of union at 4 weeks as assessed by CT (76% vs. 58%, p = 0.02). SF12 mean physical score was significantly higher in PEMF treated group (47 vs. 36, p = 0.005). Time to cast removal was significantly shorter in PEMF treated patients, 33 ± 5.9 days in PEMF vs. 39.8 ± 7.4 days in sham group (p = 0.002). CONCLUSION early addition of PEMF treatment may accelerate bone healing which could lead to a shorter cast immobilization, thus allowing an earlier return to daily life activities and work. There were no complications related to the PEMF device (FHP).
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Affiliation(s)
- Shai Factor
- Division of Orthopedic Surgery, Tel Aviv Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6423906, Israel
- Correspondence: ; Tel.: +972-52-7360753; Fax: +972-74-7219810
| | - Ido Druckmann
- Division of Radiology, Tel Aviv Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6423906, Israel
| | - Franck Atlan
- Division of Orthopedic Surgery, Tel Aviv Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6423906, Israel
| | - Yishai Rosenblatt
- Division of Orthopedic Surgery, Tel Aviv Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6423906, Israel
| | - Daniel Tordjman
- Division of Orthopedic Surgery, Tel Aviv Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6423906, Israel
| | - Raphael Krespi
- Division of Orthopedic Surgery, Tel Aviv Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6423906, Israel
| | - Efi Kazum
- Division of Orthopedic Surgery, Tel Aviv Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6423906, Israel
| | - Tamir Pritsch
- Division of Orthopedic Surgery, Tel Aviv Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6423906, Israel
| | - Gilad Eisenberg
- Division of Orthopedic Surgery, Tel Aviv Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6423906, Israel
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16
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Factor S, Shaked O, Atlan F, Pritsch T, Shichman I. Electric Scooter-Related Upper Limb Fractures: Analysis of 458 Cases. J Hand Surg Am 2023; 48:197.e1-197.e6. [PMID: 34852957 DOI: 10.1016/j.jhsa.2021.09.033] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [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: 03/11/2021] [Revised: 08/13/2021] [Accepted: 09/23/2021] [Indexed: 02/07/2023]
Abstract
PURPOSE To perform an analysis of electric scooter (e-scooter)-related upper limb fractures (ULFs), which have increased dramatically in parallel with the rapid rise in the use of e-scooters and shared e-scooter services in recent years. METHODS We retrospectively reviewed the medical charts of e-scooter-related emergency department visits between January 2017 and January 2020 at a level I trauma center. All patients with ULFs were included in the study, and their data were analyzed for demographics, fracture diagnosis, associated injuries, and required surgical treatment. RESULTS This study included 356 patients (50% men) with 458 ULFs, of which 23 (5%) were open fractures. The mean age of the cohort was 32.9 years (standard deviation, 10.1 years). The most common mechanism of injury was rider fall (92.1%). The nondominant hand was injured in 53.1% of cases, and 32.1% of all fractures were treated with surgery. A total of 120 (33.7%) patients sustained more than 1 ipsilateral ULF, and 27 (7.6%) patients had a concomitant contralateral ULF. Radial head fracture was the most common fracture type (n = 123, 26.8%), of which 16 (13%) were bilateral. The fifth ray was injured most frequently among the metacarpal and phalangeal fractures (n = 33, 47.1%). Most of the nonextremity-associated injuries were those of the head and maxillofacial bones. CONCLUSIONS The most common ULF associated with e-scooters was the radial head fracture. Physicians should be alert to and seek associated fractures during initial assessments of e-scooter-related upper limb injuries. Further investigation may be warranted to evaluate the effectiveness of protective measures in reducing the number of injuries. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
- Shai Factor
- Department of Orthopedic Surgery, Tel Aviv Medical Center, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Or Shaked
- Department of Orthopedic Surgery, Tel Aviv Medical Center, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Franck Atlan
- Department of Orthopedic Surgery, Tel Aviv Medical Center, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tamir Pritsch
- Department of Orthopedic Surgery, Tel Aviv Medical Center, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ittai Shichman
- Department of Orthopedic Surgery, Tel Aviv Medical Center, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Shichman I, Shaked O, Factor S, Ashkenazi I, Elbaz E, Aviv Mordechai R, Khoury A. The association between electric scooter riding position and injury characteristics. J Safety Res 2023; 84:347-352. [PMID: 36868663 DOI: 10.1016/j.jsr.2022.11.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 08/31/2022] [Accepted: 11/18/2022] [Indexed: 06/18/2023]
Abstract
BACKGROUND The popularity of electric scooters (e-scooters) and the shared e-scooter services as new means of transportation worldwide led to high numbers of injuries requiring emergency department (ED) visits. Private and rental e-scooters have different sizes and capabilities, offering several possible riding positions. While the rising use of e-scooters and their associated injuries have been reported, little is known about the influence of riding position on injury characteristics. The purpose of this study was to characterize e-scooter riding positions and their related injuries. METHODS E-scooters related ED admissions were retrospectively collected between June 2020 and October 2020, in a level-I trauma center. Demographics, ED presentation data, injury information, e-scooter design, and clinical course were collected and compared according to e-scooter riding position ("foot-behind-foot" vs "side-by-side"). RESULTS During the study period, 158 patients were admitted to the ED with e-scooter related injuries. The majority of riders used the foot-behind-foot position (n = 112, 71.3 %) compared to the side-by-side position (n = 45, 28.7 %). Orthopedic fractures were the most common injuries (n = 78, 49.7 %). "Foot-behind-foot" group had a significantly higher fracture rate compared to "side-by-side" group (54.4 % vs 37.8 % within group, respectively; p = 0.03). CONCLUSIONS Riding position is associated with different injury types, with orthopedic fracture rates significantly higher in the more commonly used "foot-behind-foot" riding position. PRACTICAL APPLICATION These study findings suggest that the common e-scooter narrow-based design is considerably more dangerous, calling for further research to introduce safer e-scooter designs and update recommendations for safer riding positions.
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Affiliation(s)
- Ittai Shichman
- Division of Orthopedics, Tel-Aviv Sourasky Medical Center, Tel-Aviv, affiliated to the Sackler Faculty of Medicine Tel-Aviv University, Tel-Aviv, Israel
| | - Or Shaked
- Division of Orthopedics, Tel-Aviv Sourasky Medical Center, Tel-Aviv, affiliated to the Sackler Faculty of Medicine Tel-Aviv University, Tel-Aviv, Israel
| | - Shai Factor
- Division of Orthopedics, Tel-Aviv Sourasky Medical Center, Tel-Aviv, affiliated to the Sackler Faculty of Medicine Tel-Aviv University, Tel-Aviv, Israel.
| | - Itay Ashkenazi
- Division of Orthopedics, Tel-Aviv Sourasky Medical Center, Tel-Aviv, affiliated to the Sackler Faculty of Medicine Tel-Aviv University, Tel-Aviv, Israel
| | - Etay Elbaz
- Division of Orthopedics, Tel-Aviv Sourasky Medical Center, Tel-Aviv, affiliated to the Sackler Faculty of Medicine Tel-Aviv University, Tel-Aviv, Israel
| | - Reut Aviv Mordechai
- Department of Emergency Medicine, Tel-Aviv Sourasky Medical Center, Tel-Aviv, affiliated to the Sackler Faculty of Medicine Tel-Aviv University, Tel-Aviv, Israel
| | - Amal Khoury
- Division of Orthopedics, Tel-Aviv Sourasky Medical Center, Tel-Aviv, affiliated to the Sackler Faculty of Medicine Tel-Aviv University, Tel-Aviv, Israel
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Portnoy Y, Koren J, Khoury A, Factor S, Dadia S, Ran Y, Benady A. Three-dimensional technologies in presurgical planning of bone surgeries: current evidence and future perspectives. Int J Surg 2023; 109:3-10. [PMID: 36799780 PMCID: PMC10389328 DOI: 10.1097/js9.0000000000000201] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 11/20/2022] [Indexed: 02/18/2023]
Abstract
BACKGROUND The recent development of three-dimensional (3D) technologies introduces a novel set of opportunities to the medical field in general, and specifically to surgery. The preoperative phase has proven to be a critical factor in surgical success. Utilization of 3D technologies has the potential to improve preoperative planning and overall surgical outcomes. In this narrative review article, the authors describe existing clinical data pertaining to the current use of 3D printing, virtual reality, and augmented reality in the preoperative phase of bone surgery. METHODS The methodology included keyword-based literature search in PubMed and Google Scholar for original articles published between 2014 and 2022. After excluding studies performed in nonbone surgery disciplines, data from 61 studies of five different surgical disciplines were processed to be included in this narrative review. RESULTS Among the mentioned technologies, 3D printing is currently the most advanced in terms of clinical use, predominantly creating anatomical models and patient-specific instruments that provide high-quality operative preparation. Virtual reality allows to set a surgical plan and to further simulate the procedure via a 2D screen or head mounted display. Augmented reality is found to be useful for surgical simulation upon 3D printed anatomical models or virtual phantoms. CONCLUSIONS Overall, 3D technologies are gradually becoming an integral part of a surgeon's preoperative toolbox, allowing for increased surgical accuracy and reduction of operation time, mainly in complex and unique surgical cases. This may eventually lead to improved surgical outcomes, thereby optimizing the personalized surgical approach.
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Affiliation(s)
- Yotam Portnoy
- First Faculty of Medicine, Charles University in Prague, Prague, Czechia
| | - Jonathan Koren
- First Faculty of Medicine, Charles University in Prague, Prague, Czechia
| | - Amal Khoury
- Sackler School of Medicine, Tel Aviv University
- Division of Orthopaedic Surgery
| | - Shai Factor
- Sackler School of Medicine, Tel Aviv University
- Division of Orthopaedic Surgery
| | - Solomon Dadia
- Sackler School of Medicine, Tel Aviv University
- Levin Center of 3D Printing and Surgical Innovation
- National Unit of Orthopedic Oncology
| | - Yuval Ran
- Sackler School of Medicine, Tel Aviv University
- Office of the Deputy Medical Manager, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Amit Benady
- Sackler School of Medicine, Tel Aviv University
- Division of Orthopaedic Surgery
- Levin Center of 3D Printing and Surgical Innovation
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Factor S, Rachevsky G, Amzallag N, Elbaz E, Vidra M, Morag G, Shichman I. THE COVID-19 PANDEMIC DID NOT AFFECT REHABILITATION FOLLOWING ACL RECONSTRUCTION. REV BRAS MED ESPORTE 2023. [DOI: 10.1590/1517-8692202329022021_0543p] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
ABSTRACT Objective: To assess postoperative rehabilitation patterns in patients who underwent Anterior Cruciate Ligament Reconstruction (ACLR) during the COVID-19 pandemic. Methods: A retrospective study of patients who underwent primary isolated ACLR between February 2019 and July 2020. Two different periods were evaluated. The “COVID group” represents the period from February 1st to July 1st of 2020 and the “non-COVID group” represents the equivalent period in 2019. Rehabilitation features and the effect of the COVID-19 pandemic on rehabilitation habits were assessed. Patient outcome scores were assessed using the Lysholm, Tegner, and International Knee Documentation Committee (IKDC) questionnaires. Subjective satisfaction, post-operative complications, and subsequent surgeries were recorded. Results: The groups did not differ significantly in demographics, functional outcome scores, or subjective satisfaction. There was no significant difference in rehabilitation patterns between the groups. In the COVID group, only one patient (4%) reported participation in online physiotherapy. Conclusions: There were no differences in the post-operative rehabilitation patterns, including duration, length, and environment of the training, between patients who underwent primary isolated ACLR during the COVID-19 pandemic and those who underwent the treatment in the preceding non-COVID year. Patient outcome scores, subjective satisfaction, and subsequent surgery rates did not differ between the groups. Level of evidence IV; Therapeutic studies - investigation of treatment results.
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Factor S, Barriga J, Halperin D, Krespi R, Ben-Tov T. Displaced femoral neck fracture in a pregnant patient diagnosed with transient osteoporosis of the hip. SICOT J 2022; 8:44. [PMID: 36426960 PMCID: PMC9879124 DOI: 10.1051/sicotj/2022045] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Accepted: 11/06/2022] [Indexed: 11/27/2022] Open
Abstract
Transient osteoporosis of pregnancy (TOP) is a self-limiting pathology with unspecified etiology. It is typically found in women in late pregnancy or early postpartum. A femoral neck fracture is an infrequent complication. Herein, we describe a TOP case in a 38-year-old female who suffered a displaced sub-capital femoral neck fracture without obvious trauma at 28 weeks of gestation. The patient underwent operative treatment using closed reduction and internal fixation (CRIF), using cannulated screws, with no intraoperative complications. The postoperative radiograph revealed a collapse and further displacement of the femoral neck. A decision was made to postpone a definitive treatment to a postpartum date. The patient underwent a cesarean section at 38-week of gestation with no complications. At her latest follow-up, 24 months postoperatively, the patient was asymptomatic. Pelvic and hip radiographs demonstrated consolidation of the fracture. Level of evidence: IV.
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Factor S, Neuman Y, Vidra M, Shalom M, Lichtenstein A, Amar E, Rath E. Violation of expectations is correlated with satisfaction following hip arthroscopy. Knee Surg Sports Traumatol Arthrosc 2022; 31:2023-2029. [PMID: 36181523 DOI: 10.1007/s00167-022-07182-1] [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: 07/05/2022] [Accepted: 09/26/2022] [Indexed: 11/07/2022]
Abstract
PURPOSE The mechanism by which preoperative expectations may be associated with patient satisfaction and procedural outcomes following hip preservation surgery (HPS) is far from simple or linear. The purpose of this study is to better understand patient expectations regarding HPS and their relationship with patient-reported outcomes (PROs) and satisfaction using machine learning (ML) algorithms. METHODS Patients scheduled for hip arthroscopy completed the Hip Preservation Surgery Expectations Survey (HPSES) and the pre- and a minimum 2 year postoperative International Hip Outcome Tool (iHOT-33). Patient demographics, including age, gender, occupation, and body mass index (BMI), were also collected. At the latest follow-up, patients were evaluated for subjective satisfaction and postoperative complications. ML algorithms and standard statistics were used. RESULTS A total of 69 patients were included in this study (mean age 33.7 ± 13.1 years, 62.3% males). The mean follow-up period was 27 months. The mean HPSES score, patient satisfaction, preoperative, and postoperative iHOT-33 were 83.8 ± 16.5, 75.9 ± 26.9, 31.6 ± 15.8, and 73 ± 25.9, respectively. Fifty-nine patients (86%) reported that they would undergo the surgery again, with no significant difference with regards to expectations. A significant difference was found with regards to expectation violation (p < 0.001). Expectation violation scores were also found to be significantly correlated with satisfaction. CONCLUSION ML algorithms utilized in this study demonstrate that violation of expectations plays an important predictive role in postoperative outcomes and patient satisfaction and is associated with patients' willingness to undergo surgery again. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Shai Factor
- Orthopedic Division, Department of Orthopedic Surgery, Affiliated with the Sackler Faculty of Medicine, Tel Aviv Medical Center, 6 Weitzman St., 6423906, Tel Aviv, Israel.
| | - Yair Neuman
- Department of Cognitive and Brain Sciences and the Zlotowski Center for Neuroscience, Ben-Gurion University of the Negev, 84105, Beer-Sheva, Israel
| | - Matias Vidra
- Orthopedic Division, Department of Orthopedic Surgery, Affiliated with the Sackler Faculty of Medicine, Tel Aviv Medical Center, 6 Weitzman St., 6423906, Tel Aviv, Israel
| | - Moshe Shalom
- Orthopedic Division, Department of Orthopedic Surgery, Affiliated with the Sackler Faculty of Medicine, Tel Aviv Medical Center, 6 Weitzman St., 6423906, Tel Aviv, Israel
| | - Adi Lichtenstein
- Orthopedic Division, Department of Orthopedic Surgery, Affiliated with the Sackler Faculty of Medicine, Tel Aviv Medical Center, 6 Weitzman St., 6423906, Tel Aviv, Israel
| | - Eyal Amar
- Orthopedic Division, Department of Orthopedic Surgery, Affiliated with the Sackler Faculty of Medicine, Tel Aviv Medical Center, 6 Weitzman St., 6423906, Tel Aviv, Israel
| | - Ehud Rath
- Orthopedic Division, Department of Orthopedic Surgery, Affiliated with the Sackler Faculty of Medicine, Tel Aviv Medical Center, 6 Weitzman St., 6423906, Tel Aviv, Israel
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Krespi R, Maman E, Factor S, Benshabat D, Dolkart O, Ashkenazi I, Beyth S, Chechik O. Combined Bankart and SLAP repair: patient-reported outcome measurements after a minimum 5-year follow-up. Arch Orthop Trauma Surg 2022; 143:2621-2626. [PMID: 36018369 DOI: 10.1007/s00402-022-04599-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Accepted: 08/20/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Anterior shoulder instability is typically characterized by detachment of the anteroinferior labrum (Bankart lesion). Some patients also sustain a superior labrum anterior-to-posterior (SLAP) injury. The purpose of this study was to compare the medium-term clinical results of isolated anterior Bankart repairs (ABR) with those of combined Bankart and SLAP repair (ABR + SLAP). METHODS Data on all patients treated surgically for recurrent anterior shoulder instability between 2006 and 2011 were retrospectively collected from medical charts. The minimum follow-up was 5 years. Patients were interviewed to assess patient-reported outcome measurements (PROM) as determined by the American Shoulder and Elbow Surgeons Score (ASES), the Subjective Shoulder Score (SSV), and the Disabilities of the Arm, Shoulder, and Hand Score (DASH), as well as their quality of life (QOL: SF12 questionnaire). Information on complications, re-operations, and recurrent instability was recorded and evaluated as well. RESULTS A total of 150 patients (88% males) with a mean age 23.7 years (range 15-40) were included. Forty-two patients following ABR + SLAP repair were compared to 108 patients following ABR alone, with a mean follow-up of 7.8 years (range 5-10.7). The rate of re-dislocation was similar in both groups (26% for ABR + SLAP vs 20% for ABR, p = .44). There were no significant differences in functional outcome between the ABR + SLAP and the ABR alone groups (SSV 86.7 vs 86.5, p = .93, ASES 89.6 vs 86.5, p = .11, and DASH 4.9 vs 7, p = .17), or in QOL outcome (SF12 physical 95.6 vs 93.3, p = .27, SF12 mental 84.4 vs 85.7, p = .63). CONCLUSION Surgical repair for anterior shoulder instability and a coexisting SLAP lesion yields clinical results as good as those of isolated ABR, as evidenced by similar PROM and re-dislocation rates after medium-term follow-up. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Raphael Krespi
- 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
| | - Eran Maman
- 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
| | - Shai Factor
- 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.
| | - Dvir Benshabat
- 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
| | - Oleg Dolkart
- 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
| | - Itay Ashkenazi
- 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
| | - Shaul Beyth
- Department of Orthopedic Surgery, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Ofir Chechik
- 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
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Factor S, Vidra M, Shalom M, Clyman S, Roth Y, Amar E, Rath E. Preoperative Expectations Do Not Correlate With Postoperative iHOT-33 Scores and Patient Satisfaction Following Hip Arthroscopy for the Treatment of Femoroacetabular Impingement Syndrome. Arthroscopy 2022; 38:1869-1875. [PMID: 34838646 DOI: 10.1016/j.arthro.2021.11.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 07/20/2021] [Revised: 11/13/2021] [Accepted: 11/14/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE To examine the correlation between preoperative patient expectation and International Hip Outcome Tool (iHOT-33) score and postoperative satisfaction of patients undergoing hip arthroscopy for the treatment of femoroacetabular impingement syndrome. METHODS Patients scheduled for surgery completed the Hip Preservation Surgery Expectations Survey (HPSES), as well as the preoperative and a minimum 2-year postoperative iHOT-33. Patient demographics that were collected included gender, age, occupation, and body mass index (BMI). At the latest follow-up, patients were evaluated for their subjective satisfaction and postoperative complications. An in-depth analysis was performed to assess the correlation between HPSES, iHOT-33, and patient satisfaction. RESULTS Sixty-nine patients (62.3% males; mean age: 33.7 ± 13.1 years; BMI: 23.9 ± 3.5 kg/m2) were included in this study. The mean HPSES score was 83.8 ± 16.5. The mean iHOT-33 improved from 31.6 ± 15.8 preoperatively to 73 ± 25.9 postoperatively (95% CI = 35.2,47.8; P < .01), and the mean patient satisfaction was 75.9 ± 26.9. There were no statistically significant differences in mean HPSES score between males and females (95% CI = 79.9,87.8; P = .35) nor between different occupational groups (95% CI = 79.4,87.6, P = .095). No correlation was found between age and HPSES score (r = .036; P =.76). There was a negligible correlation between HPSES score and postoperative iHOT-33 score (r = -.117; P = .34) and patient satisfaction (r = -.042; P = .73). Postoperative iHOT-33 score had a significant high correlation with patient satisfaction (r = .8; P < .001). CONCLUSION Preoperative expectations do not correlate with postoperative iHOT-33 scores and patient satisfaction with surgery at 2 years after surgery. Gender and occupation did not differ significantly with regard to preoperative expectations, and there was no correlation between age and HPSES score. LEVEL OF EVIDENCE IV, retrospective case series.
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Affiliation(s)
- Shai Factor
- Department of Orthopedic Surgery, Tel Aviv Medical Center, Tel Aviv, Israel, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Matias Vidra
- Department of Orthopedic Surgery, Tel Aviv Medical Center, Tel Aviv, Israel, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Moshe Shalom
- Department of Orthopedic Surgery, Tel Aviv Medical Center, Tel Aviv, Israel, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shay Clyman
- Adelson School of Medicine, Ariel University, Ariel, Israel
| | - Yael Roth
- Adelson School of Medicine, Ariel University, Ariel, Israel
| | - Eyal Amar
- Department of Orthopedic Surgery, Tel Aviv Medical Center, Tel Aviv, Israel, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ehud Rath
- Department of Orthopedic Surgery, Tel Aviv Medical Center, Tel Aviv, Israel, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Factor S, Atlan F, Pritsch T, Rumack N, Golden E, Dadia S. In-hospital production of 3D-printed casts for non-displaced wrist and hand fractures. SICOT J 2022; 8:20. [PMID: 35608413 PMCID: PMC9128606 DOI: 10.1051/sicotj/2022021] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Accepted: 05/01/2022] [Indexed: 11/29/2022] Open
Abstract
Objectives: To examine the clinical feasibility and results of a multidisciplinary workflow, employing rapid three-dimensional (3D) scanning and modeling software along with a high-speed printer, for in-hospital production of patient-specific 3D-printed casts, for the treatment of non-displaced wrist and hand fractures. Methods: Consenting adult patients admitted to the emergency department (ED) due to wrist or hand fractures between January and February 2021 were prospectively enrolled. The study participants underwent conversion of the standard plaster of Paris cast to a 3D-printed cast one week after the ED visit, and follow-up examinations were performed around two, six, and twelve weeks later. The primary objective was to examine the clinical feasibility in terms of complexity and length of the overall procedure. Secondary outcomes were patient-reported impressions and radiological results. Results: Twenty patients (16 males, mean age 37 ± 13.1 years) were included. The entire printing workflow took a mean of 161 ± 8 min. All patients demonstrated clinical improvement and fracture union at final follow-up, with no pressure sores or loss of reduction. Patient-reported comfort and satisfaction rates were excellent. The mean Visual Analog Scale was 0.9 ± 1.1 and 0.6 ± 1, and the mean Disabilities of the Arm, Shoulder, and Hand score was 18.7 ± 9.5 and 7.6 ± 7.6 at 2 and 6 weeks after application of the 3D-printed cast, respectively. Conclusion: The in-hospital workflow was feasible and efficient, with excellent clinical and radiographic results and high patient satisfaction and comfort rates. Our medical center now routinely provides this cast option for non-displaced wrist and hand fractures. Level of evidence: IV, Therapeutic Study
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Affiliation(s)
- Shai Factor
- Department of Orthopedic Surgery, Tel Aviv Medical Center, 6 Weizmann St., Tel Aviv 6423906, Israel affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Franck Atlan
- Department of Orthopedic Surgery, Tel Aviv Medical Center, 6 Weizmann St., Tel Aviv 6423906, Israel affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tamir Pritsch
- Department of Orthopedic Surgery, Tel Aviv Medical Center, 6 Weizmann St., Tel Aviv 6423906, Israel affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Netta Rumack
- Surgical Innovation and 3D Printing Unit, Tel-Aviv Medical Center, 6 Weizmann St., Tel Aviv 6423906, Israel
| | - Eran Golden
- Surgical Innovation and 3D Printing Unit, Tel-Aviv Medical Center, 6 Weizmann St., Tel Aviv 6423906, Israel
| | - Solomon Dadia
- Department of Orthopedic Surgery, Tel Aviv Medical Center, 6 Weizmann St., Tel Aviv 6423906, Israel affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel - Surgical Innovation and 3D Printing Unit, Tel-Aviv Medical Center, 6 Weizmann St., Tel Aviv 6423906, Israel
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25
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Gurel R, Elbaz E, Ashkenazi I, Rotman D, Factor S, Chechik O, Warschawski Y, Albagli A. Trans tibial amputation with or without a tourniquet in patients with diabetic foot infection and peripheral vascular disease: Comparison of postoperative outcomes. J Orthop Surg (Hong Kong) 2022; 30:10225536221102694. [PMID: 35577526 DOI: 10.1177/10225536221102694] [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] [Indexed: 11/16/2022] Open
Abstract
Background: Transtibial amputation (TTA) due to complications of diabetic foot infection (DFI) or peripheral vascular disease (PVD) is a high-risk procedure in fragile patients. The risks of reoperation, blood loss requiring blood transfusion, and mortality are high. The use of a tourniquet in this procedure is controversial and scarcely reported. Objective: this study aimed to compare the outcomes of TTAs with or without a tourniquet in a single tertiary medical center. Methods: We retrospectively identified all patients who had undergone TTA in our institution (1/2019-1/2020) and included only those who underwent the procedure due to complications of DFI or PVD (n = 69). The retrieved data included demographics, comorbidities, ASA score, the use of a tourniquet, operation duration, pre- and postoperative hemoglobin levels, administration of blood transfusions, hospitalization length, surgical site infection and 60-days reoperation and mortality rates. Results: TTA with a tourniquet was superior to TTA without a tourniquet in reducing the average operation length by 11 min (p = 0.05), the median postoperative hospitalization by 6 days (p = 0.04), and the use of blood transfusions (odds ratio [OR] = 0.176, 95% confidence interval [CI]: 0.031-0.996). Conclusions: Our findings demonstrated advantages in operative time, hospitalization length, and blood transfusion requirement for TTA with a tourniquet compared to TTA without a tourniquet.
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Affiliation(s)
- Ron Gurel
- Department of Orthopedic Surgery, 26738Tel Aviv Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel
| | - Etay Elbaz
- Department of Orthopedic Surgery, 26738Tel Aviv Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel
| | - Itay Ashkenazi
- Department of Orthopedic Surgery, 26738Tel Aviv Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel
| | - Dani Rotman
- Department of Orthopedic Surgery, 26738Tel Aviv Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel
| | - Shai Factor
- Department of Orthopedic Surgery, 26738Tel Aviv Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel
| | - Ofir Chechik
- Department of Orthopedic Surgery, 26738Tel Aviv Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel
| | - Yaniv Warschawski
- Department of Orthopedic Surgery, 26738Tel Aviv Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel
| | - Assaf Albagli
- Department of Orthopedic Surgery, 26738Tel Aviv Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel
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26
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Atlan F, Pritsch T, Tordjman D, Khabyeh-Hasbani N, Halperin D, Factor S. Wrist arthroscopy for diagnosis and treatment of acute and chronic conditions. SICOT J 2022; 8:17. [PMID: 35593692 PMCID: PMC9121853 DOI: 10.1051/sicotj/2022015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 04/13/2022] [Indexed: 11/15/2022] Open
Abstract
Wrist arthroscopy is a constantly evolving procedure. Allowing direct visualization and dynamic testing of intra-articular structures led to a novel approach toward traumatic and degenerative lesions based on most of the classifications routinely used in wrist surgery. The development of specific instrumentation, combined with a novel understanding of the local anatomy, progressively allowed wrist surgeons to describe more ambitious and complex surgeries. Wrist arthroscopy has become an increasingly useful tool in hand and wrist surgeons' panoply and seems promised to have further development in the future. This paper discusses the surgical technique and the various pathologies that can be treated by arthroscopy of the wrist.
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Affiliation(s)
- Franck Atlan
- Hand Surgery Unit, Department of Orthopaedic Surgery, Tel Aviv Medical Center, 6 Weitzman Street, Tel Aviv 6423906, Israel, affiliated with the Sackler Faculty of Medicine, Tel Aviv University Tel Aviv Israel
| | - Tamir Pritsch
- Hand Surgery Unit, Department of Orthopaedic Surgery, Tel Aviv Medical Center, 6 Weitzman Street, Tel Aviv 6423906, Israel, affiliated with the Sackler Faculty of Medicine, Tel Aviv University Tel Aviv Israel
| | - Daniel Tordjman
- Hand Surgery Unit, Department of Orthopaedic Surgery, Tel Aviv Medical Center, 6 Weitzman Street, Tel Aviv 6423906, Israel, affiliated with the Sackler Faculty of Medicine, Tel Aviv University Tel Aviv Israel
| | - Nathan Khabyeh-Hasbani
- Hand Surgery Unit, Department of Orthopaedic Surgery, Tel Aviv Medical Center, 6 Weitzman Street, Tel Aviv 6423906, Israel, affiliated with the Sackler Faculty of Medicine, Tel Aviv University Tel Aviv Israel
| | - Dania Halperin
- Hand Surgery Unit, Department of Orthopaedic Surgery, Tel Aviv Medical Center, 6 Weitzman Street, Tel Aviv 6423906, Israel, affiliated with the Sackler Faculty of Medicine, Tel Aviv University Tel Aviv Israel
| | - Shai Factor
- Hand Surgery Unit, Department of Orthopaedic Surgery, Tel Aviv Medical Center, 6 Weitzman Street, Tel Aviv 6423906, Israel, affiliated with the Sackler Faculty of Medicine, Tel Aviv University Tel Aviv Israel
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Maman E, Kazum E, Abboud JA, Zinger Y, Factor S, Chechik O, Dolkart O. Biodegradable balloon spacer for massive irreparable rotator cuff tears is associated with improved functional outcomes, low revisions, and complications rate at minimum one year follow-up. Int Orthop 2022; 46:573-579. [PMID: 35112145 DOI: 10.1007/s00264-021-05289-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 12/17/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE This study was designed to investigate the efficacy of the InSpace balloon spacer with a specific focus on clinical and patient-related parameters, functional scores InSpace durability, and satisfaction in patients with massive irreparable rotator cuff tears (IRCT) at minimum one year follow-up. METHODS Between 2010 and 2018, patients with symptomatic IRCTs were treated with InSpace balloon implantation. Demographic characteristics, concomitant procedures, and patient's reported outcomes (PROMs) were obtained as well as satisfaction rate and willingness to undergo the procedure again. Need for subsequent surgery and conversion to reverse total shoulder arthroplasty (RTSA) and time to conversion were also evaluated. RESULTS Seventy-eight patients (mean age of 70 years, range 46-86) who underwent an InSpace (OrthoSpace, Inc., Caesarea, Israel) balloon implantation were included. Mean follow-up was 56 months (median = 49.6, range 16-129 months). Sixteen out of our 29 pseudoparalytic patients (55.2%) exceed 90° of forward flexion post-surgery with mean improvement of 73° (20-150). Patients older than 65 years of age displayed a statistically significant improved ASES score (60.6 to 46.4, P < 0.05). Patients who underwent a subscapularis (SSC) repair demonstrated a superior ASES score (63.4 compared to 50.4, P = 0.06). CONCLUSIONS Based on the current study, spacer implantation is a low-risk, clinically effective treatment for the patients with IRCTs. Patient-specific parameters such as age, BMI, and gender should be considered during patient selection process. SSC tendon tears should be repaired if needed. Improvement in function and symptoms from this procedure may negate or delay the need for RTSA even for some of the pseudoparalytic patients.
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Affiliation(s)
- Eran Maman
- Division of Orthopaedic Surgery, Sackler Faculty of Medicine, Tel Aviv Sourasky Medical Center, Tel Aviv University, 6 Weizman Street, 6423906, Tel Aviv, Israel
| | - Efi Kazum
- Division of Orthopaedic Surgery, Sackler Faculty of Medicine, Tel Aviv Sourasky Medical Center, Tel Aviv University, 6 Weizman Street, 6423906, Tel Aviv, Israel
| | - Joseph A Abboud
- Department of Shoulder and Elbow Surgery, Rothman Orthopaedic Institute, Philadelphia, PA, USA
| | - Yarden Zinger
- Division of Orthopaedic Surgery, Sackler Faculty of Medicine, Tel Aviv Sourasky Medical Center, Tel Aviv University, 6 Weizman Street, 6423906, Tel Aviv, Israel
| | - Shai Factor
- Division of Orthopaedic Surgery, Sackler Faculty of Medicine, Tel Aviv Sourasky Medical Center, Tel Aviv University, 6 Weizman Street, 6423906, Tel Aviv, Israel
| | - Ofir Chechik
- Division of Orthopaedic Surgery, Sackler Faculty of Medicine, Tel Aviv Sourasky Medical Center, Tel Aviv University, 6 Weizman Street, 6423906, Tel Aviv, Israel
| | - Oleg Dolkart
- Division of Orthopaedic Surgery, Sackler Faculty of Medicine, Tel Aviv Sourasky Medical Center, Tel Aviv University, 6 Weizman Street, 6423906, Tel Aviv, Israel.
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Shichman I, Shaked O, Factor S, Weiss-Meilik A, Khoury A. Emergency department electric scooter injuries after the introduction of shared e-scooter services: A retrospective review of 3,331 cases. World J Emerg Med 2022; 13:5-10. [PMID: 35003408 DOI: 10.5847/wjem.j.1920-8642.2022.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 08/16/2021] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND To determine the frequency, characteristics, and use of resources related to electric scooter (e-scooter) injuries in the emergency department (ED) of a major metropolitan area hospital. METHODS We performed a retrospective review of all ED presentations related to e-scooter injuries at a level I trauma center between May 2017 and February 2020. We identified ED presentation data, injury-related data, patients' clinical course after evaluation, injury diagnosis, surgical procedures, and ED readmissions. RESULTS A total of 3,331 patients with e-scooter injuries presented to the ED over a 34-month period. There was a 6-fold increase in e-scooter-related injuries presenting to the ED, from an average of 26.9 injuries per month before the introduction of shared e-scooter services in August 2018 to an average of 152.6 injuries per month after its introduction. The average injury rate during weekdays was 3.27 per day, with the majority of injuries occurring in the afternoon. The most common mechanism of injury was rider fall (79.1%). There were a total of 2,637 orthopedic injuries, of which 599 (22.7%) were fractures. A total of 296 (8.9%) patients were hospitalized following the initial ED admission, and 462 surgeries were performed within 7 days of ED arrival. CONCLUSIONS The introduction of the shared e-scooter services is associated with a dramatic increase in e-scooter injuries presenting to the ED. E-scooter use carries considerably underestimated injury risks of high-energy trauma and misunderstood mechanisms of injuries. These injuries challenge the healthcare system, with a major impact on both EDs and surgical departments.
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Affiliation(s)
- Ittai Shichman
- Division of Orthopedics, Tel-Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine Tel-Aviv University, Tel Aviv 64239, Israel
| | - Or Shaked
- Division of Orthopedics, Tel-Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine Tel-Aviv University, Tel Aviv 64239, Israel
| | - Shai Factor
- Division of Orthopedics, Tel-Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine Tel-Aviv University, Tel Aviv 64239, Israel
| | - Ahuva Weiss-Meilik
- Head of I-Medata AI Center, Tel-Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine Tel-Aviv University, Tel Aviv 64239, Israel
| | - Amal Khoury
- Division of Orthopedics, Tel-Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine Tel-Aviv University, Tel Aviv 64239, Israel
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Amzallag N, Factor S, Shichman I, Ben-Tov T, Khoury A. Hip Fractures during the COVID-19 Pandemic: Demographics, Treatment Pathway, and Outcomes. Isr Med Assoc J 2021; 23:484-489. [PMID: 34392622] [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: 06/13/2023]
Abstract
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.
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Affiliation(s)
- Nissan Amzallag
- Department of Orthopedic Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine and Tel Aviv University, Tel Aviv, Israel
| | - Shai Factor
- Department of Orthopedic Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine and Tel Aviv University, Tel Aviv, Israel
| | - Ittai Shichman
- Department of Orthopedic Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine and Tel Aviv University, Tel Aviv, Israel
| | - Tomer Ben-Tov
- Department of Orthopedic Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine and Tel Aviv University, Tel Aviv, Israel
| | - Amal Khoury
- Department of Orthopedic Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine and Tel Aviv University, Tel Aviv, Israel
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Chechik O, Maman E, Kazum E, Grunstein A, Ben-Shabat D, Lin R, Efrima B, Factor S, Rotman D, Krespi R, Dolkart O, Rosenthal R. Self-reduction techniques taught via smartphone are effective for anterior shoulder dislocation: prospective randomized study. Knee Surg Sports Traumatol Arthrosc 2021; 29:2338-2341. [PMID: 33033846 DOI: 10.1007/s00167-020-06310-z] [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] [Accepted: 09/28/2020] [Indexed: 10/23/2022]
Abstract
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.
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Affiliation(s)
- Ofir Chechik
- 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
| | - Eran Maman
- 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
| | - Efi Kazum
- 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
| | - Alon Grunstein
- 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
| | - Dvir Ben-Shabat
- 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
| | - Ran Lin
- 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
| | - Ben Efrima
- 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
| | - Shai Factor
- 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
| | - Dani Rotman
- 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
| | - Rafael Krespi
- 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
| | - Oleg Dolkart
- 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.
| | - Ron Rosenthal
- 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
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Shichman I, Shaked O, Factor S, Elbaz E, Khoury A. Epidemiology of Fractures Sustained During Electric Scooter Accidents: A Retrospective Review of 563 Cases. J Bone Joint Surg Am 2021; 103:1125-1131. [PMID: 34109939 DOI: 10.2106/jbjs.20.01746] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [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: 02/01/2023]
Abstract
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.
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Affiliation(s)
- Ittai Shichman
- Division of Orthopedics, Tel-Aviv Sourasky Medical Center, Tel-Aviv, affiliated with the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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Factor S, Khoury A, Atzmon R, Vidra M, Amar E, Rath E. Combined endoscopic and mini-open repair of chronic complete proximal hamstring tendon avulsion: a novel approach and short-term outcomes. J Hip Preserv Surg 2021; 7:721-727. [PMID: 34377515 PMCID: PMC8349587 DOI: 10.1093/jhps/hnab006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 01/05/2021] [Accepted: 01/13/2021] [Indexed: 11/13/2022] Open
Abstract
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.
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Affiliation(s)
- Shai Factor
- 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
| | - Amal Khoury
- 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
| | - Ran Atzmon
- 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
| | - Matias Vidra
- 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
| | - Eyal Amar
- 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
| | - Ehud Rath
- 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
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Atlan F, Ashkenazi I, Shehadeh K, Ben-Shabat D, Shichman I, Eisenberg G, Rosenblatt Y, Tordjman D, Pritsch T, Factor S. Early postoperative dressing removal in hand surgery: Novel concepts for individualized surgical dressing management. Hand Surg Rehabil 2021; 40:389-393. [PMID: 33831625 DOI: 10.1016/j.hansur.2021.03.011] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 03/12/2021] [Accepted: 03/21/2021] [Indexed: 11/17/2022]
Abstract
Postoperative dressing protocols after clean surgery without implant vary widely. The purpose of this study was to elucidate whether early postoperative dressing removal is a valid option, as compared to untouched dressing or twice-weekly dressing change approach. A prospective randomized study was conducted on patients who underwent carpal tunnel release (CTR) or trigger finger release (TFR) between January and November 2020. Patients were randomly distributed into 3 groups: surgical dressing untouched until first follow up (SDU); surgical dressing changed twice a week in a health maintenance organization (HMO); and surgical dressing removed at first postoperative day (SDR). Data collected included patient characteristics, pre-and post-operative functional (QuickDASH) and autonomy (Instrumental Activities of Daily Living performance (IADL)) scores, Vancouver scar scale (VSS) and potential complications. Eighty-four patients were included: 28 (33.3%), 29 (34.5%) and 27 (32.1%) in the SDU, HMO and SDR groups, respectively. Deterioration in mean IADL score at 2-week follow-up was statistically significant in the HMO group (mean delta 3.35, p = 0.008). Quick DASH score improved significantly between preoperative and 2-week follow-up values only in the SDU group (mean delta 9.12, p = 0.012). Other parameters, including wound complications, did not differ significantly between groups. Early removal of postoperative dressing and immediate wound exposure was a safe option after CTR and TFR. An untouched bulky dressing correlated with early functional improvement. Finally, iterative dressing change in HMO showed no benefit and led to significant deterioration in early postoperative autonomy. IRB APPROVAL: 0548-18-TLV. LEVEL OF EVIDENCE: I.
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Affiliation(s)
- F Atlan
- Tel Aviv Medical Center, Department of Orthopedic Surgery, Affiliated with the Sackler Faculty of Medicine and Tel Aviv University, Weizmann St. 6, 6423906 Tel Aviv-Yafo, Israel.
| | - I Ashkenazi
- Tel Aviv Medical Center, Department of Orthopedic Surgery, Affiliated with the Sackler Faculty of Medicine and Tel Aviv University, Weizmann St. 6, 6423906 Tel Aviv-Yafo, Israel
| | - K Shehadeh
- Tel Aviv Medical Center, Department of Orthopedic Surgery, Affiliated with the Sackler Faculty of Medicine and Tel Aviv University, Weizmann St. 6, 6423906 Tel Aviv-Yafo, Israel
| | - D Ben-Shabat
- Tel Aviv Medical Center, Department of Orthopedic Surgery, Affiliated with the Sackler Faculty of Medicine and Tel Aviv University, Weizmann St. 6, 6423906 Tel Aviv-Yafo, Israel
| | - I Shichman
- Tel Aviv Medical Center, Department of Orthopedic Surgery, Affiliated with the Sackler Faculty of Medicine and Tel Aviv University, Weizmann St. 6, 6423906 Tel Aviv-Yafo, Israel
| | - G Eisenberg
- Tel Aviv Medical Center, Department of Orthopedic Surgery, Affiliated with the Sackler Faculty of Medicine and Tel Aviv University, Weizmann St. 6, 6423906 Tel Aviv-Yafo, Israel
| | - Y Rosenblatt
- Tel Aviv Medical Center, Department of Orthopedic Surgery, Affiliated with the Sackler Faculty of Medicine and Tel Aviv University, Weizmann St. 6, 6423906 Tel Aviv-Yafo, Israel
| | - D Tordjman
- Tel Aviv Medical Center, Department of Orthopedic Surgery, Affiliated with the Sackler Faculty of Medicine and Tel Aviv University, Weizmann St. 6, 6423906 Tel Aviv-Yafo, Israel
| | - T Pritsch
- Tel Aviv Medical Center, Department of Orthopedic Surgery, Affiliated with the Sackler Faculty of Medicine and Tel Aviv University, Weizmann St. 6, 6423906 Tel Aviv-Yafo, Israel
| | - S Factor
- Tel Aviv Medical Center, Department of Orthopedic Surgery, Affiliated with the Sackler Faculty of Medicine and Tel Aviv University, Weizmann St. 6, 6423906 Tel Aviv-Yafo, Israel
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Factor S, Rotman D, Pritsch T, Allon R, Tordjman D, Atlan F, Rosenblatt Y. Radial head excision and Achilles allograft interposition arthroplasty for the treatment of chronic pediatric radiocapitellar pathologies: A report of four cases. Shoulder Elbow 2021; 13:213-222. [PMID: 33897853 PMCID: PMC8039757 DOI: 10.1177/1758573219897859] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 08/05/2019] [Revised: 10/29/2019] [Accepted: 10/09/2019] [Indexed: 11/15/2022]
Abstract
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.
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Affiliation(s)
- Shai Factor
- Division of Orthopedic Surgery, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Shai Factor, Orthopedic Division, Tel Aviv Medical Center, 6 Weitzman St., Tel Aviv 6423906, Israel.
| | - Dani Rotman
- Division of Orthopedic Surgery, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tamir Pritsch
- Division of Orthopedic Surgery, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Raviv Allon
- Rappaport Faculty of Medicine, The Technion—Israel Institute of Technology, Haifa, Israel
| | - Daniel Tordjman
- Division of Orthopedic Surgery, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Franck Atlan
- Division of Orthopedic Surgery, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yishai Rosenblatt
- Division of Orthopedic Surgery, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Warschawski Y, Rutenberg TF, Factor S, Tudor A, Sharfman Z, Morgan S, Lichtenstein A, Snir N. Dynamic locking plate vs. cannulated cancellous screw for displaced intracapsular hip fracture: A comparative study. J Orthop 2021; 24:15-18. [PMID: 33679022 DOI: 10.1016/j.jor.2021.02.008] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Accepted: 02/07/2021] [Indexed: 11/30/2022] Open
Abstract
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.
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Affiliation(s)
- Yaniv Warschawski
- Orthopedic Department, Tel Aviv Sourasky Medical Center, Ichilov Hospital, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tal Frenkel Rutenberg
- Orthopedic Department, Rabin Medical Center, Beilinson Hospital, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shai Factor
- Orthopedic Department, Tel Aviv Sourasky Medical Center, Ichilov Hospital, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Adirian Tudor
- Orthopedic Department, Tel Aviv Sourasky Medical Center, Ichilov Hospital, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | | | - Adi Lichtenstein
- Orthopedic Department, Tel Aviv Sourasky Medical Center, Ichilov Hospital, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nimrod Snir
- Orthopedic Department, Tel Aviv Sourasky Medical Center, Ichilov Hospital, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Amar E, Martin RL, Tudor A, Factor S, Atzmon R, Rath E. Midterm Outcomes and Satisfaction After Hip Arthroscopy Are Associated With Postoperative Rehabilitation Factors. Orthop J Sports Med 2021; 9:2325967120981888. [PMID: 33614802 PMCID: PMC7869163 DOI: 10.1177/2325967120981888] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 11/03/2020] [Indexed: 11/16/2022] Open
Abstract
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
(r = 0.22, P = .014; and
r = 0.24, P = .007, respectively) and
level of satisfaction (r = 0.24, P = .007;
and r = 0.21, P = .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;
P = .033). A significant correlation was identified
between the rating of the importance of their home program/self-practice and
postoperative HOS-ADL scores (r = 0.29; P
= .001) and their level of satisfaction (r = 0.23;
P = .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;
P = .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.
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Affiliation(s)
- Eyal Amar
- Division of Orthopedic Surgery, Tel Aviv Medical Center Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - RobRoy L Martin
- Department of Physical Therapy, Rangos School of Health Sciences, Duquesne University, Pittsburgh, Pennsylvania, USA
| | - Adrian Tudor
- Division of Orthopedic Surgery, Tel Aviv Medical Center Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shai Factor
- Division of Orthopedic Surgery, Tel Aviv Medical Center Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ran Atzmon
- Department of Orthopaedic Surgery, Assuta Medical Center, Ashdod, Israel, Affiliated to Faculty of Health and Science, Ben Gurion University, Beer-Sheva, Israel
| | - Ehud Rath
- Division of Orthopedic Surgery, Tel Aviv Medical Center Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Shichman I, Factor S, Shaked O, Morgan S, Amzallag N, Gold A, Snir N, Warschawski Y. Effects of surgeon experience and patient characteristics on accuracy of digital pre-operative planning in total hip arthroplasty. Int Orthop 2020; 44:1951-1956. [PMID: 32699933 DOI: 10.1007/s00264-020-04733-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 07/14/2020] [Indexed: 01/28/2023]
Abstract
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.
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Affiliation(s)
- Ittai Shichman
- 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
| | - Shai Factor
- 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
| | - Or Shaked
- 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
| | - Samuel Morgan
- 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
| | - Nissan Amzallag
- 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
| | - Aviram Gold
- 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
| | - Nimrod Snir
- 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
| | - Yaniv Warschawski
- 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.
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Avnieli IB, Vidra M, Factor S, Atzmon R, Persitz J, Safran N, Rath E, Amar E. 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; 36:159-164. [PMID: 31864571 DOI: 10.1016/j.arthro.2019.08.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [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: 12/11/2018] [Revised: 07/28/2019] [Accepted: 08/03/2019] [Indexed: 02/02/2023]
Abstract
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.
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Affiliation(s)
| | - Matias Vidra
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Shai Factor
- Orthopedic Division, Souraski Medical Center, Tel-Aviv, Israel
| | - Ran Atzmon
- Department of Orthopedics, Assuta Medical Center, Ashdod, Israel
| | - Jonathan Persitz
- Department of Orthopedics, Assaf Harofeh Medical Center, Tzrifin, Israel
| | - Nathan Safran
- Johns Hopkins University, Baltimore, Maryland, U.S.A
| | - Ehud Rath
- Orthopedic Division, Souraski Medical Center, Tel-Aviv, Israel
| | - Eyal Amar
- Orthopedic Division, Souraski Medical Center, Tel-Aviv, Israel
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Rotman D, Factor S, Schermann H, Kadar A, Atlan F, Pritsch T, Rosenblatt Y. Manipulation under anesthesia for the postsurgical stiff elbow: a case series and review of literature. Eur J Orthop Surg Traumatol 2019; 29:1679-1685. [PMID: 31280368 DOI: 10.1007/s00590-019-02492-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Accepted: 07/02/2019] [Indexed: 12/29/2022]
Abstract
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.
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Affiliation(s)
- Dani Rotman
- Orthopaedic Division, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel. .,Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel.
| | - Shai Factor
- Orthopaedic Division, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Haggai Schermann
- Orthopaedic Division, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Assaf Kadar
- Orthopaedic Division, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Franck Atlan
- Orthopaedic Division, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Tamir Pritsch
- Orthopaedic Division, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Yishai Rosenblatt
- Orthopaedic Division, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
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40
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Steinberg EL, Warschawski Y, Elis J, Rotman D, Rachevsky G, Factor S, Salai M, Ben-Tov T. Financial impact and effect on the outcome of preoperative tests for at-risk older hip fracture patients. Geriatr Gerontol Int 2018; 18:937-942. [PMID: 29512305 DOI: 10.1111/ggi.13295] [Citation(s) in RCA: 2] [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] [Revised: 12/22/2017] [Accepted: 01/23/2018] [Indexed: 11/28/2022]
Abstract
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.
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Affiliation(s)
- Ely L Steinberg
- Orthopedic Division, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Yaniv Warschawski
- Orthopedic Division, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Jacob Elis
- Orthopedic Division, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Dani Rotman
- Orthopedic Division, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Gil Rachevsky
- Orthopedic Division, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Shai Factor
- Orthopedic Division, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Moshe Salai
- Orthopedic Division, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Tomer Ben-Tov
- Orthopedic Division, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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41
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Lee JM, Factor S, Lin Z, Vitebskiy I, Ellis FM, Kottos T. Reconfigurable directional lasing modes in cavities with generalized PT symmetry. Phys Rev Lett 2014; 112:253902. [PMID: 25014817 DOI: 10.1103/physrevlett.112.253902] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Indexed: 06/03/2023]
Abstract
We introduce a new family of generalized PT-symmetric cavities that involve gyrotropic elements and support reconfigurable unidirectional lasing modes. We derive conditions for which these modes exist and investigate a simple electronic circuit that experimentally demonstrates their feasibility in the radio-frequency domain.
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Affiliation(s)
- J M Lee
- Department of Physics, Wesleyan University, Middletown, Connecticut 06459, USA
| | - S Factor
- Department of Physics, Wesleyan University, Middletown, Connecticut 06459, USA
| | - Z Lin
- Department of Physics, Wesleyan University, Middletown, Connecticut 06459, USA and School of Engineering and Applied Sciences, Harvard University, Cambridge, Massachusetts 02138, USA
| | - I Vitebskiy
- Air Force Research Laboratory, Sensors Directorate, Wright Patterson AFB, Ohio 45433, USA
| | - F M Ellis
- Department of Physics, Wesleyan University, Middletown, Connecticut 06459, USA
| | - T Kottos
- Department of Physics, Wesleyan University, Middletown, Connecticut 06459, USA
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42
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Bernardini GL, Factor S, Lava N, Molho E, Ritaccio AL. Kevin Delgado Barron, MD (1929-2013). Neurology 2014. [DOI: 10.1212/wnl.0000000000000227] [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: 11/15/2022] Open
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43
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Reich SG, Factor S. William J. Weiner, MD (1945-2012). Neurology 2013. [DOI: 10.1212/01.wnl.0000435289.11480.25] [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: 11/15/2022] Open
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44
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Bender N, Factor S, Bodyfelt JD, Ramezani H, Christodoulides DN, Ellis FM, Kottos T. Observation of asymmetric transport in structures with active nonlinearities. Phys Rev Lett 2013; 110:234101. [PMID: 25167495 DOI: 10.1103/physrevlett.110.234101] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2012] [Indexed: 05/14/2023]
Abstract
A mechanism for asymmetric transport which is based on parity-time-symmetric nonlinearities is presented. We show that in contrast to the case of conservative nonlinearities, an increase of the complementary conductance strength leads to a simultaneous increase of asymmetry and transmittance intensity. We experimentally demonstrate the phenomenon using a pair of coupled Van der Pol oscillators as a reference system, each with complementary anharmonic gain and loss conductances, connected to transmission lines. An equivalent optical setup is also proposed.
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Affiliation(s)
- N Bender
- Department of Physics, Wesleyan University, Middletown, Connecticut 06459, USA
| | - S Factor
- Department of Physics, Wesleyan University, Middletown, Connecticut 06459, USA
| | - J D Bodyfelt
- Department of Physics, Wesleyan University, Middletown, Connecticut 06459, USA and Electroscience Laboratory, Ohio State University, Columbus, Ohio 43212, USA
| | - H Ramezani
- Department of Physics, Wesleyan University, Middletown, Connecticut 06459, USA
| | - D N Christodoulides
- College of Optics & Photonics-CREOL, University of Central Florida, Orlando, Florida 32816, USA
| | - F M Ellis
- Department of Physics, Wesleyan University, Middletown, Connecticut 06459, USA
| | - T Kottos
- Department of Physics, Wesleyan University, Middletown, Connecticut 06459, USA
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45
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Alcalay R, Rosado L, Mejia-Santana H, Orbe-Reilly M, Caccappolo E, Tang M, Ruiz D, Ross B, Verbitsky M, Kisselev S, Louis E, Comella C, Colcher A, Jennings D, Nance M, Bressman S, Scott W, Tanner C, Andrews H, Waters C, Fahn S, Cote L, Frucht S, Ford B, Rezak M, Novak K, Friedman J, Pfeiffer R, Marsh L, Hiner B, Siderowf A, Payami H, Molho E, Nutt J, Factor S, Ottman R, Clark L, Marder K. Clinical and Genetic Characteristics of Participants with Juvenile PD: The CORE-PD Study (IN10-2.001). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.in10-2.001] [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: 11/15/2022] Open
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46
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Alcalay R, Rosado L, Mejia-Santana H, Orbe-Reilly M, Caccappolo E, Tang M, Ruiz D, Ross B, Verbitsky M, Kisselev S, Louis E, Comella C, Colcher A, Jennings D, Nance M, Bressman S, Scott W, Tanner C, Andrews H, Waters C, Fahn S, Cote L, Frucht S, Ford B, Rezak M, Novak K, Friedman J, Pfeiffer R, Marsh L, Hiner B, Siderowf A, Payami H, Molho E, Nutt J, Factor S, Ottman R, Clark L, Marder K. Clinical and Genetic Characteristics of Participants with Juvenile PD: The CORE-PD Study (S42.002). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.s42.002] [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: 11/15/2022] Open
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47
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Zutshi D, Cloud L, Factor S. Reversibility of Tardive Syndromes (P04.031). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.p04.031] [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: 11/15/2022] Open
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48
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Marder K, Tang MX, Alcalay R, Rosado L, Mejia-Santana H, Caccappolo E, Ruiz D, Orbe-Reilly M, Ross B, Louis E, Comella C, Colcher A, Siderowf A, Jennings D, Nance M, Rezak M, Novak K, Friedman J, Pfeiffer R, Marsh L, Hiner B, Payami H, Molho E, Factor S, Bressman S, Scott W, Tanner C, Mickel S, Andrews H, Waters C, Cote L, Frucht S, Ford B, Verbitsky M, Kisselev S, Ottman R, Clark L. Estimating the Cumulative Risk of PD in Carriers of Parkin Mutations: The CORE-PD Study (PD4.007). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.pd4.007] [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: 11/15/2022] Open
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49
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Alcalay RN, Caccappolo E, Mejia-Santana H, Tang MX, Rosado L, Orbe Reilly M, Ruiz D, Ross B, Verbitsky M, Kisselev S, Louis E, Comella C, Colcher A, Jennings D, Nance M, Bressman S, Scott WK, Tanner C, Mickel S, Andrews H, Waters C, Fahn S, Cote L, Frucht S, Ford B, Rezak M, Novak K, Friedman JH, Pfeiffer R, Marsh L, Hiner B, Siderowf A, Payami H, Molho E, Factor S, Ottman R, Clark LN, Marder K. Cognitive performance of GBA mutation carriers with early-onset PD: the CORE-PD study. Neurology 2012; 78:1434-40. [PMID: 22442429 DOI: 10.1212/wnl.0b013e318253d54b] [Citation(s) in RCA: 191] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To assess the cognitive phenotype of glucocerebrosidase (GBA) mutation carriers with early-onset Parkinson disease (PD). METHODS We administered a neuropsychological battery and the University of Pennsylvania Smell Identification Test (UPSIT) to participants in the CORE-PD study who were tested for mutations in PARKIN, LRRK2, and GBA. Participants included 33 GBA mutation carriers and 60 noncarriers of any genetic mutation. Primary analyses were performed on 26 GBA heterozygous mutation carriers without additional mutations and 39 age- and PD duration-matched noncarriers. Five cognitive domains, psychomotor speed, attention, memory, visuospatial function, and executive function, were created from transformed z scores of individual neuropsychological tests. Clinical diagnoses (normal, mild cognitive impairment [MCI], dementia) were assigned blind to genotype based on neuropsychological performance and functional impairment as assessed by the Clinical Dementia Rating (CDR) score. The association between GBA mutation status and neuropsychological performance, CDR, and clinical diagnoses was assessed. RESULTS Demographics, UPSIT, and Unified Parkinson's Disease Rating Scale-III performance did not differ between GBA carriers and noncarriers. GBA mutation carriers performed more poorly than noncarriers on the Mini-Mental State Examination (p = 0.035), and on the memory (p = 0.017) and visuospatial (p = 0.028) domains. The most prominent differences were observed in nonverbal memory performance (p < 0.001). Carriers were more likely to receive scores of 0.5 or higher on the CDR (p < 0.001), and a clinical diagnosis of either MCI or dementia (p = 0.004). CONCLUSION GBA mutation status may be an independent risk factor for cognitive impairment in patients with PD.
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Affiliation(s)
- R N Alcalay
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, USA.
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Cloud L, Helmers S, Jones R, Factor S, Testa C. Poster 3: Frequency of Epileptic Seizures in a Population of Juvenile Huntington's Disease Patients. Neurotherapeutics 2010. [DOI: 10.1016/j.nurt.2009.09.004] [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: 10/20/2022] Open
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