Daniel B. Polatsch

Dependency after hip fracture in geriatric patients: a study of predictive factors.

Five hundred and sixteen community-dwelling, ambulatory, geriatric hip fracture patients who were independent prior to fracture were followed prospectively to determine which patients regained their prefracture independent living status at 3-, 6-, and 12-month follow-up. At 3-, 6-, and 12-month follow-up, 78, 77, and 76% of the patients, respectively, had regained their prefracture independent living status. Analysis was performed to determine which pre- and postinjury factors were predictive of a patient regaining prefracture independent living status at 3, 6, and 12 months after fracture. Patients who were younger than age 85, independent in activities of daily living prior to fracture, independent in ambulation at hospital discharge, and who had three or more medical comorbidities were more likely to regain their prefracture independent living status.

Capitellum fractures: a biomechanical evaluation of three fixation methods.

Objective To determine the relative stability of three fixation methods for displaced capitellum fractures. Design Twelve matched pairs of embalmed humeri were divided into two equal groups and simulated capitellum fractures created. The first group compared cancellous lag screws placed in an anteroposterior direction to screws placed in the posteroanterior direction. The second group compared the Acutrac compression screw, inserted anteroposteriorly, to the more stable construct from the first test group. Methods All specimens were cyclically tested with simulated physiologic loading. Both displacement of the capitellum over a range of cycles and the number of cycles to failure were recorded. Results Fixation with posteroanteriorly directed cancellous lag screws was significantly more stable than anteroposteriorly directed screws at 2000 cycles (p = 0.007); loads to failure were not statistically different. Fixation by the Acutrac screws was significantly more stable than posteroanterior cancellous screws at 2000 cycles (p = 0.03). The Acutrac fixation had a higher failure load; however, this was not statistically significant. Conclusion The headless screws tested in this biomechanical study provided more stable fixation of capitellum fractures in the cadaveric specimens than four-millimeter partially threaded cancellous lag screws and may do so in the clinical setting. When the cancellous lag screws were tested, insertion in the posteroanterior direction provided more stable fixation than the anteroposterior direction and has clinical benefit of not violating the articular surface. Ultimately, the decision of which method to use lies with the attending surgeon and the technique with which he or she feels most comfortable.

Split fractures of the lateral tibial plateau : Evaluation of three fixation methods

A laboratory study was performed to compare the stability and ultimate strength of three standard fixation techniques for split-type lateral tibial plateau fractures. The three methods of fixation were (a) three 6.5-mm cancellous lag screws with washers; (b) two 6.5-mm cancellous lag screws with washers and an additional antiglide 4.5-mm cortical screw with washer; and (c) six-hole L-shaped buttress plate. Twelve pairs of embalmed mildly osteopenic lower extremities were used. Simulated split-type lateral tibial plateau fractures were created, reduced, and then instrumented in a matched pair design. The instrumented specimens were axially loaded to determine resistance to displacement, cyclically loaded to 10,000 cycles to determine dynamic stability, and then loaded to failure. There were no statistically significant differences found between resistance to displacement or failure strength as a function of either fragment size or sample bone density. On the basis of biomechanical stability, there appears to be no difference between the three fixation techniques tested. The results of this study suggest that use of an antiglide screw or buttress plate does not offer an advantage over lag screw fixation alone for the treatment of split type lateral tibial plateau fractures.

Tape blisters following hip surgery. A prospective, randomized study of two types of tape.

BACKGROUND Tape blisters after hip surgery can be a source of postoperative morbidity and can increase patient discomfort. The purpose of this prospective study was to compare two different types of tape to determine whether the type of tape influences the rate of blister formation. METHODS Ninety-nine patients (100 hips) were enrolled in the study. Patients were randomized into one of two treatment groups: one treated with a nonstretchable silk tape and one treated with a perforated, stretchable cloth tape. After surgery, the assigned tape was applied over the postoperative dressing with care not to produce skin tension. At the first dressing change, the presence or absence of blisters was recorded as were the number, size, location, and type of any blisters. The presence or absence of tape blisters was recorded at the time of each subsequent dressing change. RESULTS A tape blister developed on twenty-five hips in twenty-five patients. The risk of a blister developing was 41% (twenty of forty-nine patients) when the nonstretchable silk tape was used and 10% (five of fifty patients) when the perforated cloth tape was used (relative risk = 4.08, 95% confidence interval = 1.53 to 10.87, p = 0.005). We found no association between formation of tape blisters and the age or gender of the patient, number of medical comorbidities, smoking history, results of nutritional assessment, or type of surgery. CONCLUSIONS The prevalence of tape blisters was significantly lower when perforated cloth tape was used than it was when nonstretchable silk tape was used.

Concurrent bilateral femoral neck stress fractures and osteonecrosis of the hip. A case report.

Although bilateral osteonecrosis of the femoral head and bilateral stress fracture of the femoral neck are well-documented conditions, the occurrence of both conditions in the same patient has not been reported, to our knowledge. We present the case of a patient with both entities who was managed with internal fixation of both hips, which provided stabilization of the stress fractures as well as treatment of the osteonecrosis with core decompression. Two years after treatment, the stress fractures had healed and there was no evidence of progression of the osteonecrosis. The patient granted permission for the publication of data concerning the case. Aforty-six-year-old woman presented to us with a six-month history of bilateral groin pain. The right hip was more painful than the left. There was no history of trauma. The medical history included interstitial nephritis, diagnosed on the basis of a renal biopsy performed five years earlier, and osteopenia, diagnosed on the basis of a bone mineral densitometry value that was -1.25 standard deviations below the mean for age and sex-matched controls. The nephritis was treated with a three-month course of prednisone at the time of the initial diagnosis. The serum creatinine level remained elevated at 2.0 to 3.2 mg/dL (176.8 to 282.9 μmol/L), but that level had remained stable since the diagnosis of interstitial nephritis five years earlier. The patient had not received medical treatment for the osteopenia although it was recommended to her at the time that the densitometry was performed. The patient had a history of drug and alcohol abuse more than twenty years previously, but she stated that she had not used drugs or alcohol since that time. There was no history of amenorrhea or an eating disorder. The patient stated that she was an “avid” runner, running >5 mi (>8 km) every morning, prior to …

Arthrodesis of the Metacarpophalangeal and Interphalangeal Joints of the Hand: Current Concepts.

Metacarpophalangeal arthrodesis and interphalangeal arthrodesis are excellent tools in the surgeon’s armamentarium to restore function of the disabled hand. Typical indications for these procedures are pain, deformity, and/or stiffness. Arthrodesis is generally considered a salvage procedure to be used when other reconstructive procedures, such as arthroplasty, are not possible or would be associated with a high rate of complication or failure. To determine the most functional position for arthrodesis in each patient, the surgeon should preoperatively evaluate the compromised joint in the context of the disease process, determine the initial cause of the joint pathology, and assess the condition of the surrounding joints. Current methods of achieving fusion of metacarpophalangeal and interphalangeal joints include options for incisions, bone preparation techniques, and surgical implants; each has advantages and associated risks.

Surgical Treatment of Scapholunate Dissociation in the Professional Basketball Player: Commentary

.c om The social and economic impact of disabling injury to the elite athlete cannot be ignored. In our sports-oriented society, professional sports has become a highly successful worldwide industry that depends on constant high-quality performance of both the team and individual participants. For the celebrated professional basketball player, scapholunate dissociation (SLD) constitutes a career-threatening injury that is publicly chronicled on a daily basis until treatment is complete. For the surgeon, the notoriety of an initial report of a successful surgery is, at most, a transient achievement, whereas an unrestrictive return to competition is the true measure of quality care. The unique, often distracting circumstances associated with treatment of this group must be recognized as potential pitfalls apt to prejudice outcome. Establishing a genuine credible rapport with the athlete andmaintaining open communication with all involved parties are essential aspects of management that avoid conflicting advice, disruption in continuity of care, compromised recovery, and a premature return to competition. Management of scapholunate interosseous ligament (SLIL) disruption is replete with numerous potential problems that in most cases can be avoided by recognition of the high-energy mechanism and spectrum of scapholunate (SL) injury, the key diagnostic features, and the efficacy of early surgical repair. SLIL is the primary component of

The Double Thenar Flap: A Technique to Reconstruct 2 Fingertip Amputations Simultaneously

Fingertip injuries are a common problem. There may be pulp loss and exposed bone. Various techniques have been described to reconstruct function as well as aesthetics; yet it is still unclear which treatment options should be chosen for each specific injury. Evidence-based treatment strategies are limited because there are no prospective randomized clinical trials evaluating one method with another. Fingertip injuries are usually variable in their presentation, and therefore treatment decisions are often dictated by the knowledge and expertise of the treating physician combined with the patients unique injury. With exposed bone and major distal soft tissue loss, many reconstructive techniques have been well-described including local advancement flaps, thenar flaps, and cross-finger flaps. There is scarce literature discussing surgical options when multiple fingers are involved. This report details a novel technique used to reconstruct 2 simultaneously injured fingers using the double thenar flap.