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Dive into the research topics where Marcus F. Sciadini is active.

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Featured researches published by Marcus F. Sciadini.


Journal of Orthopaedic Trauma | 2012

Geriatric Trauma: Demographics, Injuries, and Mortality

Julie M. Keller; Marcus F. Sciadini; Elizabeth Sinclair; Robert V. OʼToole

Objectives: To identify injuries that elderly sustain during high-energy trauma and determine which are associated with mortality. Design: Retrospective review of prospectively collected database. Setting: Academic trauma center. Patients: Patients selected from database of all trauma admissions from January 2004 through June 2009. Study population consisted of patients directly admitted from scene of injury who sustained high-energy trauma with at least one orthopaedic injury and were 65 years or older (n = 597). Intervention: Review of demographics, trauma markers, injuries, and disposition statuses. Main Outcome Measurements: Statistical analysis using &khgr;2 test, Student t test, and logistic regression analysis. Results: The most common fractures were of the rib, distal radius, pelvic ring, facial bones, proximal humerus, clavicle, ankle, and sacrum. The injuries associated with the highest mortality rates were fractures of the cervical spine with neurological deficit (47%), at the C2 level (44%), and of the proximal femur (25%), pelvic ring (25%), clavicle (24%), and distal humerus (24%). The fractures significantly associated with mortality were fractures of the clavicle (P = 0.001), foot joints (P = 0.001), proximal humerus or shaft and head of the humerus (P = 0.002), sacroiliac joint (P = 0.004), and distal ulna (P = 0.002). Conclusions: Elderly patients present with significantly worse injuries, remain in the hospital longer, require greater use of resources after discharge, and die at 3 times the rate of the younger population. Although the high mortality rates associated with cervical spine, hip, and pelvic ring fractures were not unexpected, the injuries that were statistically associated with mortality were unexpected. Injuries such as clavicle fracture were statistically associated with mortality. As our population ages and becomes more active, the demographic may gain in clinical importance. Level of Evidence: Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.


Cancer | 1995

Telomerase activity and oncogenesis in giant cell tumor of bone

Herbert S. Schwartz; Saul F. Juliao; Marcus F. Sciadini; Lora K. Miller; Merlin G. Butler

Background. Benign giant cell tumor of bone (GCT) is a primary skeletal neoplasm with an unpredictable pattern of biologic aggressiveness and cytogenetic findings characterized by telomeric associations and telomeric reduction. The role of maintaining telomeric integrity is performed by telomerase. To determine if telomerase activity is present, cell extracts from fibroblasts and tumor cells from five patients with GCT were analyzed and compared with HeLa (a positive control cell line).


Journal of Orthopaedic Trauma | 2010

Young-burgess Classification of Pelvic Ring Fractures: Does It Predict Mortality, Transfusion Requirements, and Non-orthopaedic Injuries?

Theodore T. Manson; Robert V. O'Toole; Augusta Whitney; Brian Duggan; Marcus F. Sciadini; Jason W. Nascone

Objectives: The objectives of this study were to evaluate the ability of the Young-Burgess classification system to predict mortality, transfusion requirements, and nonorthopaedic injuries in patients with pelvic ring fractures and to determine whether mortality rates after pelvic fractures have changed over time. Design: Retrospective review. Setting: Level I trauma center. Patients: One thousand two hundred forty-eight patients with pelvic fractures during a 7-year period. Intervention: None. Main Outcome Measurements: Mortality at index admission, transfusion requirement during first 24 hours, and presence of nonorthopaedic injuries as a function of Young-Burgess pelvic classification type. Mortality compared with historic controls. Results: Despite a relatively large sample size, the ability of the Young-Burgess system to predict mortality only approached statistical significance (P = 0.07, Kruskal-Wallis). The Young-Burgess system differentiated transfusion requirements-lateral compression Type 3 (LC3) and anteroposterior compression Types 2 (APC2) and 3 (APC3) fractures had higher transfusion requirements than did lateral compression Type 1 (LC1), anteroposterior compression Type 1 (APC1), and vertical shear (VS) (P < 0.05)-but was not as useful at predicting head, chest, or abdomen injuries. Dividing fractures into stable and unstable types allowed the system to predict mortality rates, abdomen injury rates, and transfusion requirements. Overall mortality in the study group was 9.1%, unchanged from original Young-Burgess studies 15 years previously (P = 0.3). Conclusions: The Young-Burgess system is useful for predicting transfusion requirements. For the system to predict mortality or nonorthopaedic injuries, fractures must be divided into stable (APC1, LC1) and unstable (APC2, APC3, LC2, LC3, VS, combined mechanism of injury) types. LC1 injuries are very common and not always benign (overall mortality rate, 8.2%).


Journal of Orthopaedic Trauma | 2008

Are locking screws advantageous with plate fixation of humeral shaft fractures? A biomechanical analysis of synthetic and cadaveric bone.

Robert V. OʼToole; Romney C. Andersen; Oleg Vesnovsky; Melvin Alexander; L. D. Timmie Topoleski; Jason W. Nascone; Marcus F. Sciadini; Clifford H. Turen; W. Andrew Eglseder

Objectives: To investigate whether locking screws offer any advantage over nonlocking screws for plate fixation of humeral shaft fractures for weight-bearing applications. Design: Mechanical evaluation of stiffness in torsion, bending, and axial loading and failure in axial loading in synthetic and cadaveric bone. Setting: Biomechanical laboratory in an academic medical center. Methods: We modeled a comminuted midshaft humeral fracture in both synthetic and cadaveric bone. Humeri were plated posteriorly. Two study groups each used identical 10-hole, 3.5-mm locking compression plates that can accept either locking or nonlocking screws. The first group used only nonlocking screws and the second only locking screws. Stiffness testing and failure testing were performed for both the synthetic bones (n = 6) and the cadaveric matched pairs (n = 12). Fatigue testing was set at 90,000 cycles of 440 N of axial loading. Main Outcome Measures: Torsion, bending, and axial stiffness and axial failure force after cyclic loading. Results: With synthetic bones, no significant difference was observed in any of the 4 tested stiffness modes between the plates with locking screws and those with nonlocking screws (anteroposterior, P = 0.51; mediolateral, P = 0.50; axial, P = 0.15; torsional, P = 0.08). With initial failure testing of the constructs in axial loading, both plates failed above anticipated physiologic loads of 440 N (mean failure load for both constructs >4200 N), but no advantage to locking screws was shown. The cadaveric portion of the study also showed no biomechanical advantage of locking screws over nonlocking screws for stiffness of the construct in the 4 tested modes (P > 0.40). Fatigue and failure testing showed that both constructs were able to withstand strenuous fatigue and to fail above anticipated loads (mean failure >3400 N). No difference in failure force was shown between the 2 groups (P = 0.67). Conclusions: Synthetic and cadaveric bone testing showed that locking screws offer no obvious biomechanical benefit in this application.


Journal of Orthopaedic Trauma | 1996

Evaluation of ground cortical autograft as a bone graft material in a new canine bilateral segmental long bone defect model.

Kenneth D. Johnson; Adrian August; Marcus F. Sciadini; Cathy Smith

The recent orthopaedic literature reflects a growing number of bone graft substitutes and osteogenic growth factors under investigation in a number of animal models. We attempted to establish a well-controlled, large animal model of a segmental defect in a weight-bearing long bone by developing a bilateral diaphyseal radial defect model in the canine. We also evaluated the effectiveness of ground cortical autograft as a graft material. Twenty-three adult mongrel dogs underwent bilateral radial osteotomies with creation of a 2.0-2.5-cm diaphyseal defect on each side. All dogs received cancellous autograft (CAN) on one side, nine received no graft material (DEF) on the opposite side, and 14 received morselized cortical autograft (CORT) on the opposite side. Radii were stabilized by external fixation. Animals were followed radiographically at 6-week intervals to evaluate the healing process. Thirteen dogs were sacrificed at short-term follow-up (8-12 weeks postsurgery) and 10 at long-term (16-24 weeks). Biomechanical torsion testing to failure and histological evaluation were performed on each defect. All CAN radii achieved union (100%) while only one of nine DEF radii (11%) and none of 14 (0%) of CORT radii achieved union. Statistically significant differences in biomechanical parameters between both test groups and their corresponding autograft control radii were found. Histology revealed fibrous nonunions in the DEF and CORT radii. These results demonstrate that the bilateral canine radial defect model represents a consistent and reproducible model for bone healing of segmental defects in weight-bearing long bones and that ground cortical autograft is an ineffective graft material.


Journal of Orthopaedic Trauma | 2013

Proximal tibial intra-articular osteotomy for treatment of complex Schatzker type IV tibial plateau fractures with lateral joint line impaction: description of surgical technique and report of nine cases.

Marcus F. Sciadini; Stephen H. Sims

Summary: This study presents a retrospective review of 8 patients with 9 cases of an uncommon variant of medial tibial plateau fracture treated with a surgical approach not previously described in the literature. The fracture pattern is characterized by a displaced medial tibial plateau fracture with significant central and posterior impaction of the lateral tibial articular surface but an intact lateral cortex. A novel surgical approach with an intra-articular osteotomy of the lateral tibial plateau was used to facilitate visualization, reduction, and instrumentation of the lateral articular injury. Early clinical and radiographic results of this treatment approach were reviewed. We describe the fracture pattern, surgical technique, and early results and propose this technique as a reasonable alternative for treatment of a challenging clinical entity.


Journal of Trauma-injury Infection and Critical Care | 2010

Does Fracture Pattern Predict Death With Lateral Compression Type 1 Pelvic Fractures

Theodore T. Manson; Jason W. Nascone; Marcus F. Sciadini; Robert V. O'Toole

BACKGROUND Our goal was to analyze whether radiographic fracture pattern correlates with mortality of patients with lateral compression type 1 (LC1) fractures. METHODS We conducted a retrospective case-controlled study at a Level I trauma center. Radiographs and outcome data were obtained for 52 patients with LC1 fractures who died and 63 who lived. LC1 fractures were classified by Denis zone of sacral injury and presence of fracture displacement. Our main outcome measurement was mortality during index hospital admission. RESULTS No difference was observed in frequency of higher energy Denis zone II sacral fractures between patients with LC1 fractures who died (73.1%) and those who lived (69.8%, p = 0.86, χ²). No difference was observed in number of displaced fractures (50.0% vs. 34.9%, p = 0.15, χ²). Patients who died were more likely to have significant brain injury (69.2% vs. 14.2%, p < 0.0001, χ²), chest injury (73.1% vs. 49.2%, p < 0.05, χ²), or abdominal injury (30.8% vs. 9.5%, p < 0.05, χ²) than those who lived. CONCLUSION Sacral fracture pattern does not seem to be predictive of mortality for patients with LC1 pelvic fractures The presence of associated injuries seems to be the key driver of mortality.


Clinical Orthopaedics and Related Research | 2000

Growth factor modulation of distraction osteogenesis in a segmental defect model.

Marcus F. Sciadini; John M. Dawson; Daxes M. Banit; Saul F. Juliao; Kenneth D. Johnson; Wayne J. Lennington; Herbert S. Schwartz

A model was established in 39 dogs to investigate the growth factor modulation of regenerate bone in distraction osteogenesis. A segment of the diaphysis of the radius was resected unilaterally. An osteotomy was made proximal to the segmental defect to create a transport segment. A monolateral external fixator was applied. After a latency period, the segment was transported across the defect. One week after the transport assembly contacted the distal pin clamp, an ipsilateral osteotomy of the proximal ulna was performed. In 20 dogs, transforming growth factor-beta was injected into the regenerate bone halfway through the transport period. Four dogs were sacrificed before docking, when the regenerate bone was still immature. In specimens harvested halfway through the transport period, evidence was found of intramembranous ossification during distraction. In specimens harvested after the transport assembly contacted the distal pin clamp, evidence was found that the mature regenerate formed by endochondral ossification. Therefore, a combined mechanism of ossification is proposed for this segmental defect model that includes mechanical stimulus for bone differentiation. The one-time administration of transforming growth factor-beta retarded the formation of a stable, united regenerate. It is concluded that transforming growth factor-beta caused an effect opposite to that which was desired.


Journal of Orthopaedic Trauma | 2017

Survivorship after High-Energy Geriatric Trauma

Ida L. Gitajn; Renan C. Castillo; Stephen Breazeale; Carrie Schoonover; Peter Z. Berger; Yanjie Huang; Nathan N. OʼHara; Robert V. OʼToole; Marcus F. Sciadini

Objectives: To evaluate in-hospital, 1-year, and 5-year survivorship of geriatric patients after high-energy trauma, to compare survivorship of geriatric patients who sustained high-energy trauma with that of those who sustained low-energy trauma, and to identify predictors for mortality. Design: Retrospective. Setting: Urban Level I trauma center. Patients: Study group of 1849 patients with high-energy trauma and comparison group of 761 patients with low-energy trauma. Intervention: Each patient was observed from the time of index admission through the end of the study period or until death or readmission. Main Outcome Measurement: Long-term survivorship based on the Social Security Death Index. Results: Survivorship between patients with high-energy and low-energy injuries was statistically significant. Among patients who sustained high-energy injuries, in-hospital mortality was 8%, 1-year mortality was 15%, and 5-year mortality was 25%. Among patients who sustained low-energy injuries, in-hospital mortality was 3%, 1-year mortality was 23%, and 5-year mortality was 40%. Low-energy mechanism of injury was an independent predictor for 1-year and 5-year mortality, even when controlling for Charlson Comorbidity Index (CCI), Injury Severity Score (ISS), age, sex, body mass index (BMI), and admission Glasgow Coma Scale (GCS) score. Conclusions: Geriatric patients with high-energy injuries and those with low-energy injuries seem to represent different patient populations, and low-energy mechanism seems to be a marker for frailty. High-energy mechanism was associated with lower long-term mortality rates, even when controlling for CCI, ISS, age, sex, BMI and admission GCS score. Level of Evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.


Journal of Orthopaedic Trauma | 2013

Trans-syndesmotic fibular plating for fractures of the distal tibia and fibula with medial soft tissue injury: report of 6 cases and description of surgical technique.

Marcus F. Sciadini; Theodore T. Manson; Swapnil B. Shah

Summary: This report presents a retrospective review of several cases of distal fractures of the tibia and fibula with significant injury to the medial soft tissues treated either primarily or in staged fashion with fixed-angle trans-syndesmotic fixation. This fixation strategy was used in an effort to minimize further surgical trauma and implant load in the zone of soft tissue injury. Ten patients were identified between September 2002 and November 2010 who presented to a level I trauma center with fractures of the distal tibia and fibula associated with open medial wounds (9 patients) or extensive closed medial degloving injury (1 patient). They were all treated with trans-syndesmotic plating of the distal fibula. Two patients were lost to follow-up after initial treatment, and an additional 2 patients had follow-up durations of only 6.5 and 3 months, respectively. This left 6 patients with an average of 23.3 months of follow-up (range: 14–36 months). Radiographs and medical records were reviewed, and clinical and radiographic results were evaluated. All 6 patients had radiographic evidence of bony healing and had resumed weight bearing. Two patients required additional bone graft surgery to encourage healing, 1 of whom also required free-flap coverage as a component of the nonunion repair. One patient resumed weight bearing earlier than instructed and experienced mild but acceptable loss of reduction. No patients developed wound infections of either the medial traumatic or lateral surgical wounds, although, as noted above, 1 of the patients with a nonunion required medial free-flap coverage as a component of the nonunion repair because of incompetent medial soft tissues. Trans-syndesmotic fixation has previously been described as providing enhanced fixation of diabetic and osteoporotic ankle fractures but has not, to our knowledge, been described for the treatment of higher energy traumatic injuries. Specifically, the valgus distal tibial fracture, frequently associated with medial traction wounds, can present challenges to the treating surgeon in terms of obtaining adequate fixation although minimizing wound complications associated with the soft tissue injury. In a select subset of injuries, trans-syndesmotic fixation can provide a viable means of obtaining and maintaining either definitive fixation or enhancing the provisional fixation supplied by spanning external fixation.

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Herbert S. Schwartz

Vanderbilt University Medical Center

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