Srinath Kamineni
University of Kentucky
Network
Latest external collaboration on country level. Dive into details by clicking on the dots.
Publication
Featured researches published by Srinath Kamineni.
Operative Orthopadie Und Traumatologie | 2005
Lars Peter Müller; Srinath Kamineni; Pol Maria Rommens; Bernhard F. Morrey
ZusammenfassungOperationszielErreichen einer stabilen und schmerzfreien Funktion durch primäre Implantation einer totalen Ellenbogenprothese bei komplexen intraartikulären distalen Humerusfrakturen älterer Patienten.IndikationenFraktur mit freien Fragmenten oder schlechter Knochenqualität, die eine stabile Osteosynthese nicht zulassen. Geschlossene, komplexe intraartikuläre distale Humerusfraktur (Typ C nach der AO-Klassifikation).Typ-A- und B-Fraktur des distalen Humerus bei Patienten mit vorbestehenden degenerativen Veränderungen, rheumatoiden Erkrankungen oder Voroperationen des Gelenks. Gute Mitarbeit des Patienten, geringer Funktionsanspruch, Patientenalter > 65 Jahre.KontraindikationenOffene Frakturen (Typ II oder III nach Gustilo-Anderson).Infizierte Wundverhältnisse, offene Weichteilverletzungen.Fehlende Mitarbeit des Patienten, hoher Funktionalitätsanspruch, Patientenalter > 65 Jahre.Paralyse des Bizepsmuskels.OperationstechnikRückenlagerung des Patienten. Dorsaler Zugang zum Ellenbogengelenk. Darstellen der medialen Anteile des Musculus triceps an der Insertion des dorsalen Humerus und der Gelenkkapsel, Abdrängen in Kontinuität mit dem ulnaren Periost und der Unterarmfaszie. Bei Entfernung des frakturierten distalen Anteils des Humerus kann der Ansatz des Musculus triceps belassen werden. Vorbereitung des Humerusschafts: Bei mehrfach frakturierten Kondylen ist eine Rekonstruktion nicht notwendig; intramedulläres Entfernen des Knochens von der medialen und lateralen suprakondylären Kante mit einer Fräse. Entfernen der Olekranonspitze. Knochenspananlagerung hinter der anterioren Lasche der humeralen Komponente. Einzementieren der humeralen und ulnaren Komponente. Nachresektion des Radiuskopfes bzw. Processus coronoideus bei Impingement der Gelenkfacetten. Transossäre Reinsertion des Musculus triceps am Olekranon.WeiterbehandlungSelbständige Bewegungsübungen. Vermeidung des Hebens von Gewichten > 5 kg, keine wiederholten Dauerbelastungen > 1 kg Gewicht und keine forcierten Bewegungen im Ellenbogengelenk, z. B. Schlagsportarten.Ergebnisse49 Totalendoprothesen wurden bei 48 Patienten (Durchschnittsalter 67 Jahre) aufgrund distaler Humerusfrakturen eingesetzt. 43 Frakturen konnten nach einem Zeitraum von 7 Jahren nachuntersucht werden. Nach der AO-Klassifikation wurden fünf Typ- A , fünf Typ-B und 33 Typ-C Frakturen behandelt. Der durchschnittliche Bewegungsumfang lag zwischen 24° und 131°. Der „Mayo Elbow Performance Score“ betrug durchschnittlich 93.Die Komplikationen aller 49 Patienten wurden anhand der Akten erfasst. 32-mal bestanden im Verlauf keine Komplikationen. Insgesamt mussten zehn Revisionseingriffe durchgeführt werden, fünfmal war im Verlauf eine Revisionsarthroplastie erforderlich.Retrospektiv kann die Totalendoprothese des Ellenbogens in der Versorgung distaler Humerustrümmerfrakturen unter strenger Berücksichtigung der genannten Indikationen empfohlen werden.AbstractObjectiveAchieving stability and pain-free function for osteoporotic intraarticular multifragmentary fractures of the distal humerus in elderly patients by primary total elbow replacement (TER).IndicationsNon-soft-tissue-attached fragments, poor-quality bone, where stable osteosynthesis is not attainable.Severely comminuted intraarticular closed type C fractures according to the AO classification with multiple small bone/cartilage fragments.In case of degenerative joint diseases and/or previous surgery in rheumatoid patients also type A and B fractures. High compliance, low demand, and old patient > 65 years.ContraindicationsType II or III Gustilo-Anderson open fractures (primary irrigation and debridement).Preexisting infection, open wounds.Younger, high-demand or noncompliant patient.Paralysis of the biceps muscle.Surgical TechniqueSupine positioning of patient. Triceps-sparing dorsal approach. Elevation of medial aspect of the triceps from posterior aspect of the humerus and capsula, reflecting the triceps in continuity with the ulnar periosteum and the forearm fascia. If removal of distal part of the humerus, the triceps insertion can be left intact. Preparation of humerus: no reconstruction of multifractured condyles; excavate bone from medial and lateral supracondylar ridges with burr. Preparation of ulna: remove tip of olecranon. Cemented humeral and ulnar components. Bone graft interposition behind anterior flange of humeral component. Resection of radial head and coronoid process, if impingement after trial reduction. Triceps reattachment transosseous through olecranon.Postoperative ManagementNo formal physical-therapy sessions. Avoid single-event weight lifting of > 5 kg and repetitive lifting of > 1 kg. Discourage playing racquets sports.Results49 acute distal humeral fractures in 48 patients (average age: 67 years) were treated with TER. 43 fractures were followed at an average of 7 years. According to the AO classification, five fractures were type A, five type B, and 33 type C. The average flexion arc at follow-up was 24–131°, the Mayo Elbow Performance Score averaged 93.Data of complications were obtained from records in all 49 patients. 32 of the 49 elbows had neither a complication nor any further surgery from the time of the index arthroplasty to the most recent follow-up evaluation. Ten additional operative procedures, including five revision arthroplasties, were required.The retrospective review supports recommendation for TER for the treatment of an acute distal humeral fracture, when strict inclusion criteria are observed.
Journal of Bone and Joint Surgery, American Volume | 2002
Srinath Kamineni; N. G. Maritz; Bernard F. Morrey
Background: Heterotopic ossification about the elbow joint can lead to considerable functional disability, including the loss of forearm rotation. Many procedures have been described for the treatment of proximal radioulnar synostosis. Varying degrees of success have been achieved with regard to the improvement of the flexion arc, but less success has been reported in terms of the restoration of forearm rotation. The success of treatment is associated with the extent of heterotopic ossification, soft-tissue scarring, and anatomical distortion. A new and simple technique to address the unresectable proximal radioulnar synostosis is described. Methods: Seven patients were managed with a partial proximal radial resection distal to the synostosis and were followed for an average of eighty months (range, twenty-four to 144 months). Results: Forearm rotation improved from an average fixed pronation of 5° to an average arc of 98° (range, 40° to 175°). The average functional score improved from 57 points preoperatively to 81 points at the time of the final review. Complications included reankylosis at the site of the resection and ulnar-nerve sensory neurapraxia in one patient each. Conclusions: Resection of a 1-cm-thick section of the proximal part of the radial shaft provides a safe and reliable method of improving forearm rotation in patients with heterotopic ossification of the elbow. A single technical factor that seems to positively influence the result is the application of bone wax at the resection site. This simple procedure is ideally suited for patients who have a proximal radioulnar synostosis that (1) is too extensive to allow a safe and discrete resection, (2) involves the articular surface, and (3) is associated with an anatomical deformity.
Journal of Orthopaedic Surgery and Research | 2015
Srinath Kamineni; Timothy A. Butterfield; Anthony P. Sinai
BackgroundTendinopathy is a common clinical pathology, with mixed treatment results, especially when chronic. In this study, we examine the effects of an ultrasonic debridement modality in a rabbit tendinopathy model.We asked four questions: 1) Was it possible to create and visualize with ultrasound a tendinopathy lesion in a rabbit Achilles tendon? 2) Was it possible to guide a 19-gauge ultrasonic probe into the tendinopathy lesion? 3) Following ultrasonic treatment, was tendinopathy debris histologically present? and 4) Was the collagen profile qualitatively and quantitatively normalized following treatment?MethodsSkeletally mature female New Zealand white rabbits (n = 12) were injected with, ultrasonography localization, 0.150 ml of collagenase into the Achilles tendon. The collagenase-induced Achilles tendinopathy (3 weeks) was treated with percutaneous ultrasonic debridement. The tendons were harvested, at 3 weeks after treatment, and were subjected to histological assessment (modified Movin score) and biochemical analysis (collagen isoform content).ResultsHistopathological examination revealed that all tendons injected with collagenase showed areas of hypercellularity and focal areas of tendon disorganization and degeneration. The treated tendons had lower (improved) histopathological scores than injured tendons (P < 0.001). Western blot analysis showed that ultrasonic therapy restored, within statistical limits, collagen type I, III, and X expressions in a treated tendon, to qualitative and semi-quantitative levels of a normal tendon.ConclusionsWe were successfully able to create a collagenase-injected tendinopathy lesion in a rabbit Achilles tendon and visualize the lesion with an ultrasound probe. A 19-gauge ultrasonic probe was inserted into the tendinopathic lesion under direct ultrasound guidance, and minimal tendinopathic debris remained after treatment. The treated tendon demonstrated a normalized qualitative and semi-quantitative collagen profile and improved histological appearance in the short term. This technique demonstrates scientific merit with respect to the minimally invasive treatment of tendinopathy and warrants further studies.Clinical relevanceRecalcitrant tendinopathy has evaded consistent non-operative treatment since the tendinopathic debris remains in situ, to some extent, with non-operative approaches. This percutaneous emulsification/evacuation approach, under direct ultrasound visualization, has the potential to cure recalcitrant tendinopathies without open surgery, which would benefit the patient and result in significant healthcare cost reductions.
Journal of Shoulder and Elbow Surgery | 2012
Abdo Bachoura; Andrew S. Deane; Srinath Kamineni
BACKGROUND This study investigated the morphologic safety and applicability of intramedullary fixation of midshaft clavicle fractures by analyzing the pertinent clavicle anatomy using 3-dimensional computer simulation. MATERIALS AND METHODS Computed tomography was used to scan 22 skeletonized clavicles. Computer software was used to simulate middle-segment fracture fixation by fitting a cylindrical corridor within the clavicle in the area that intramedullary devices normally cross during surgery. The cylindrical corridor crossed the fracture line on both sides, and the number of cortical diameters that were bypassed was recorded. We assumed that 1 to 2 cortical diameters had to be bypassed to achieve adequate fixation. The medial and lateral exit points of the cylindrical corridor were measured and described in relation to the sternoclavicular and acromioclavicular ends respectively. RESULTS Simulation revealed that 15 of 22 clavicles could be bypassed by 2 cortical diameters on either side of the midline fracture, 6 clavicles could be bypassed by 1 cortical diameter medial to the fracture line, and 1 clavicle could not be bypassed by any cortical diameters medial to the fracture line. The medial exit point of the cylindrical corridor was anterior in 20 of 22 cases and an average of 44.2 mm lateral to the sternoclavicular end. The lateral exit point of the cylindrical corridor was posterosuperior in 16 of 22 cases and an average of 26.5 mm medial to the acromioclavicular end. CONCLUSION In most clavicles, straight intramedullary fixation appears to be a morphologically safe and effective method of fixation.
International Scholarly Research Notices | 2012
Abdo Bachoura; Ruriko Yoshida; Christian Lattermann; Srinath Kamineni
A retrospective review of 21 patients that underwent bone screw removal from the elbow was studied in relation to the type of metal, duration of implantation, and the location of the screws about the elbow. Screw failure during extraction was the dependent variable. Five of 21 patients experienced hardware failure during extraction. Fourteen patients had titanium alloy implants. In four cases, titanium screws broke during extraction. Compared to stainless steel, titanium screw failure during removal was not statistically significant (P = 0.61). Screw removal 12 months after surgery was more likely to result in broken, retained screws in general (P = 0.046) and specifically for titanium alloy (P = 0.003). Bone screws removed from the distal humerus or proximal ulna had an equal chance of fracturing (P = 0.28). There appears to be a time-related association of titanium alloy bone screw failure during hardware removal cases from the elbow. This may be explained by titaniums properties and osseointegration.
World journal of orthopedics | 2015
David A Hamilton; Danielle Reilly; Felix Wipf; Srinath Kamineni
AIM To determine whether use of a precontoured olecranon plate provides adequate fixation to withstand supraphysiologic force in a comminuted olecranon fracture model. METHODS Five samples of fourth generation composite bones and five samples of fresh frozen human cadaveric left ulnae were utilized for this study. The cadaveric specimens underwent dual-energy X-ray absorptiometry (DEXA) scanning to quantify the bone quality. The composite and cadaveric bones were prepared by creating a comminuted olecranon fracture and fixed with a pre-contoured olecranon plate with locking screws. Construct stiffness and failure load were measured by subjecting specimens to cantilever bending moments until failure. Fracture site motion was measured with differential variable resistance transducer spanning the fracture. Statistical analysis was performed with two-tailed Mann-Whitney-U test with Monte Carlo Exact test. RESULTS There was a significant difference in fixation stiffness and strength between the composite bones and human cadaver bones. Failure modes differed in cadaveric and composite specimens. The load to failure for the composite bones (n = 5) and human cadaver bones (n = 5) specimens were 10.67 nm (range 9.40-11.91 nm) and 13.05 nm (range 12.59-15.38 nm) respectively. This difference was statistically significant (P ˂ 0.007, 97% power). Median stiffness for composite bones and human cadaver bones specimens were 5.69 nm/mm (range 4.69-6.80 nm/mm) and 7.55 nm/mm (range 6.31-7.72 nm/mm). There was a significant difference for stiffness (P ˂ 0.033, 79% power) between composite bones and cadaveric bones. No correlation was found between the DEXA results and stiffness. All cadaveric specimens withstood the physiologic load anticipated postoperatively. Catastrophic failure occurred in all composite specimens. All failures resulted from composite bone failure at the distal screw site and not hardware failure. There were no catastrophic fracture failures in the cadaveric specimens. Failure of 4/5 cadaveric specimens was defined when a fracture gap of 2 mm was observed, but 1/5 cadaveric specimens failed due to a failure of the triceps mechanism. All failures occurred at forces greater than that expected in postoperative period prior to healing. CONCLUSION The pre-contoured olecranon plate provides adequate fixation to withstand physiologic force in a composite bone and cadaveric comminuted olecranon fracture model.
Journal of surgical orthopaedic advances | 2013
Abdo Bachoura; Koichi Sasaki; Srinath Kamineni
The purpose of this study is to qualitatively and quantitatively describe the morphology of the biceps insertion on the radial tuberosity. Twenty-four preserved human elbows were carefully dissected and the insertions of the biceps conserved. The radius and the shape of the biceps insertion on the radial tuberosity were computerized using a three-dimensional digitizer. The length, width, and surface area of the footprints were measured. The soft tissue status of the muscle insertions and shape of the footprints were qualitatively described. The mean length of the biceps footprint was 24.1 ± 2.4 mm, the mean width was 11.1 ± 2.6 mm, and the mean area of the footprint was 219.0 ± 60.2 mm(2). Avascular, degenerate tissue fibers, consistent with tissue fibrosis were observed in 46% of the specimens. These changes may demonstrate natural changes of the distal biceps tendon and may improve our understanding of biceps tendinopathy and its prevalence.
Journal of Musculoskeletal Research | 2012
Srinath Kamineni; Zubair Wani; Zong Ping Luo; Yoshida Ruriko; Kai Nan An
There is very little data addressing cartilage response to tensile forces, and no literature attempts to correlate compressive with tensile modalities. Our hypothesis was that the cyclic compression and tension modulate chondrocyte matrix proteoglycan synthetic response differently. Porcine chondrocytes cultured to confluence on a flexible membrane were subjected to cyclic compression (Group A: 13 KPa at 1 Hz) or tension (Group C: 10% strain at 1 Hz) for 16 or 32 h; while controls not subjected to any force were kept (Group B). The chondrocytes were then stained with alcian blue and stained areas quantified with confocal microscopy and image processing software. Two-factor ANOVA with post-hoc tests (Scheffe and Bonferroni) statistical analysis were used. Proteoglycan staining covered 46% (range 28%–61%) and 39% (range 26%–49%) of the surface area following 32 and 16 h of compression respectively, 23% (range 15%–49%) for control, and 19% (range 10%–29%) and 16% (range 9%–25%) following 16 and 32 h tension respectively. Proteoglycan content following all compressions was significantly greater than with cyclic tension or control (p < 0.0001). Our data demonstrate that chondrocytes cultured in vitro respond to compression distinctly different from tension and that it is highly sensitive to mechanical loading, with rapid adaptation to its mechanical environment. These results imply that cartilage grown in culture, with the intention of transplantation, may structurally benefit from an environment of cyclic loading at higher frequencies.
Arthroscopy techniques | 2012
Srinath Kamineni; David A Hamilton
Elbow arthroscopy has increased in popularity in the past 10 years for both diagnostic and therapeutic purposes. A major limiting factor faced by the elbow arthroscopist is the close proximity of the neurovasculature to the working field, with the risk of iatrogenic injury. Many arthroscopic procedures are less extensive than their open equivalents because of an inability to consistently and safely eliminate the risk of neural and vascular injury. Many open procedures in the posterior compartment of the elbow joint are not routinely performed arthroscopically. The primary reason for this restriction in arthroscopic practice is the locality of the posteromedially positioned ulnar nerve in the posterior compartment. Experience and practice with elbow arthroscopic techniques allows surgeons to expand the indications for arthroscopic treatment of an increasing number of elbow pathologies. A philosophy that is routine in open surgery when dealing with pathology that is adjacent to neurovasculature is to identify the neurovasculature and hence reduce the risk of injury. Our aim is to translate this philosophy to arthroscopy by helping define a safe technique for identifying the ulnar nerve in the posteromedial elbow gutter and allowing for a safer performance of procedures in the posteromedial region of the elbow.
Archive | 2018
Srinath Kamineni
Since its introduction as a treatment for the unreconstructable rotator cuff tear and cuff tear arthropathy, the reverse shoulder arthroplasty (RSA) has become a mainstay of treating these pathologies. With increasing success has followed increasing usage, expansion of indications, and the inevitable increase in complications and revision surgeries. A recent systematic literature review reported an overall complication rate of 20% and that 13% of RSA operations either needed surgical revision of the implants or reoperations. Failure of RSA can be due to a surgeon-related technical error, an implant design-related failure, or a general failure related to any arthroplasty. Indeed, many of these factors coexist when an operation fails. The vast majority of complications can be grouped into some major categories, such as instability, infections, component loosening, component disassembling, fractures, and scapular notching.