1
|
Lam A, Gordon AM, Thabet AM, Abdelgawad AA. Antegrade Flexible Nailing for Pediatric Metaphyseal-diaphyseal Junction Distal Radius Fracture, is it Safe? Tech Hand Up Extrem Surg 2023; 27:161-164. [PMID: 37009675 DOI: 10.1097/bth.0000000000000430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2023]
Abstract
Fractures involving the distal radius metaphyseal-diaphyseal junction (MDJ) present a unique challenge for pediatric orthopedic surgeons. These fractures are too proximal for percutaneous K -wire fixation and too distal for retrograde flexible nailing. The purpose of this study was to: (1) determine the safety of a described antegrade approach from the posterior interosseous nerve (PIN); (2) assess the efficacy of antegrade nailing in cases of distal MDJ fractures; and (3) describe a standardized lateral approach to the proximal radius. A cadaveric study was performed using 10 adult forearms. Anterograde flexinail was introduced at the proximal radius based on the described "safe zone". Distal MDJ fractures were created using osteotomes. We evaluated the distance between the entry point to the PIN in addition to the quality of the reduction for the fracture. The average distance between the entry point and piercing instrument to the PIN was 5.4 cm (range: 4.7 to 6.0 cm). When grouped based on sex, the average distance was significantly further for males (5.8 cm, range: 5.2 to 6.0 cm) versus females (4.9 cm, range: 4.7 to 5.2 cm), P =0.004. Fracture reduction was not maintained after the introduction of the antegrade flexible nail across the fracture site. For all specimens, >25% displacement was seen on the anterior-posterior imaging. Our modified lateral approach to the starting point in the proximal radius is safe as long as the entry point for antegrade flexible nailing stays proximal to the radial tuberosity during the lateral approach to the proximal radius while the elbow is flexed and the forearm pronated.
Collapse
Affiliation(s)
- Aaron Lam
- Department of Orthopedic Surgery and Rehabilitation, Maimonides Medical Center, Brooklyn, New York, NY
| | - Adam M Gordon
- Department of Orthopedic Surgery and Rehabilitation, Maimonides Medical Center, Brooklyn, New York, NY
| | - Ahmed M Thabet
- Department of Orthopedic Surgery, Texas Tech, El Paso, TX
| | - Amr A Abdelgawad
- Department of Orthopedic Surgery and Rehabilitation, Maimonides Medical Center, Brooklyn, New York, NY
| |
Collapse
|
2
|
Adlan S, Abd El-Rahman A, Mohamed SAB, Thabet AM, Hamada EM, Farouk BR, El Sherif FA. Systemic Analgesia versus Continuous Erector Spinae Plane Block (ESPB) Infusion During Paediatric Nephrectomy: A Randomized, Controlled Trial. Local Reg Anesth 2023; 16:59-69. [PMID: 37304230 PMCID: PMC10254591 DOI: 10.2147/lra.s401980] [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] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 06/01/2023] [Indexed: 06/13/2023] Open
Abstract
Purpose A subcostal flank incision is required for open radical nephrectomy, which is a surgical procedure used to remove tumors of the kidney that are malignant. The erector spinae plane block (ESPB) and continuous catheter use in children are receiving more and more support by paediatric regional anaesthesiologists. Our objective was to compare systemic analgesic to continuous ESPB for pain relief in paediatric patients undergoing open radical nephrectomy. Methods Sixty children with cancer ASA I or II and undergoing open radical nephrectomy between the ages of two and seven participated in this prospective, randomized, controlled, and open label study. The cases were divided into two equal groups (E and T groups); Group E received ipsilateral continuous ultrasound-guided ESPB at T9 (thoracic vertebrae), with a bolus of 0.4 mL/kg bupivacaine 0.25%. Immediately postoperatively, Group E (ESPB group) received continuous ESPB with a PCA (patient controlled analgesia) pump at a rate of 0.2 mL/kg/hour bupivacaine 0.125%. Group T (Tramadol group), Tramadol hydrochloride was administered intravenously at a dose of 2 mg/kg/8hour, which could be increased to 2 mg/kg/6hours. Then, we followed up on patients' total analgesic consumption for 48 hours following surgery, as well as the time it took for them to request rescue analgesic, their FLACC and sedation scores, and their hemodynamics and side effects immediately following surgery as well as at 2, 4, 6, 8, 12, 18, 24, 36, and 48 hours. Results A highly significant difference in total tramadol consumed in group T 11.97 ± 1.13 mg/kg while group E was 2.07± 1.54 mg/kg (p < 0.001). 100% patients in group T requested analgesia compared to 46.7% patients in group E (p < 0.001). From 2 to 48 hour, FLACC significantly decreased in E compared to T group (p≤ 0.006) at all-time points. Conclusion Ultrasound-guided continuous ESPB significantly provided better postoperative pain relief, reduced postoperative tramadol consumption and reduced pain scores compared with the use of tramadol alone, in paediatric cancer patients undergoing nephrectomy.
Collapse
Affiliation(s)
- Suzan Adlan
- National Cancer Institute, Cairo University, Cairo, Egypt
| | | | | | | | | | | | | |
Collapse
|
3
|
Thabet AM, Alzuheir IM, Laham NAA, Helal BYA, Fayyad AF, Jalboush NH, Gharaibeh MH. First report of mobile colistin resistance gene mcr-1 in avian pathogenic Escherichia coli isolated from turkeys in the Gaza Strip, Palestine. Vet World 2023; 16:1260-1265. [PMID: 37577205 PMCID: PMC10421552 DOI: 10.14202/vetworld.2023.1260-1265] [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] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 05/15/2023] [Indexed: 08/15/2023] Open
Abstract
Background and Aim Colistin is used to treat avian pathogenic Escherichia coli (APEC), a microorganism that affects turkey meat production in the Gaza Strip and worldwide. However, the recent emergence of plasmid-borne mobile colistin resistance (mcr) genes in pathogenic E. coli strains is a serious antimicrobial resistance (AMR) challenge for both human and animal health. In December 2018, colistin was banned as a veterinary antimicrobial in the Gaza Strip. This study aimed to detect and track the prevalence of colistin-resistant APEC isolated from turkey flocks in the Gaza Strip. Materials and Methods This study investigated 239 APEC isolates from turkey flocks in the Gaza Strip between October 2018 and December 2021 (at 6-month intervals). The colistin-resistant APEC strains were detected using the broth microdilution method. The mcr-1 gene was identified using a polymerase chain reaction. Results The overall colistin resistance among the isolated APECs was 32.2% during the study period. The average resistance in the first interval was 37.5%, which significantly decreased to 9.3% in the last interval. Among the 77 phenotypically resistant isolates, 32.4% were positive for mcr-1. The average abundance of mcr-1 in the first interval was 66.6%, which decreased to 25% in the last interval. Conclusion To the best of our knowledge, this is the first study reporting the presence of the mcr-1 gene among the APEC isolates from turkeys in the Gaza Strip. Banned veterinary use of colistin significantly decreased the percentage of resistant APEC isolates from turkeys in Gaza Strip. Further studies are needed to investigate other colistin resistance genes and track the emergence of AMR.
Collapse
Affiliation(s)
- Ahmed M. Thabet
- Thabet Center for Veterinary Services diagnostic laboratory, Gaza Strip, Palestine
- Department of Veterinary Medicine, Faculty of Agriculture and Veterinary Medicine, Al-Azhar University, Gaza Strip, Palestine
| | - Ibrahim M. Alzuheir
- Department of Veterinary Medicine, Faculty of Agriculture and Veterinary Medicine, An-Najah National University, P.O. Box 7 Nablus, Palestine
| | - Nahed A. Al Laham
- Department of Laboratory Medicine, Faculty of Applied Medical Sciences, Al-Azhar University, Gaza Strip, Palestine
| | - Belal Y. Abu Helal
- Department of Veterinary Medicine, Faculty of Agriculture and Veterinary Medicine, An-Najah National University, P.O. Box 7 Nablus, Palestine
| | - Adnan F. Fayyad
- Department of Veterinary Medicine, Faculty of Agriculture and Veterinary Medicine, An-Najah National University, P.O. Box 7 Nablus, Palestine
| | - Nasr H. Jalboush
- Department of Veterinary Medicine, Faculty of Agriculture and Veterinary Medicine, An-Najah National University, P.O. Box 7 Nablus, Palestine
| | - Mohammad H. Gharaibeh
- Department of Basic Veterinary Medical Science, Faculty of Veterinary Medicine, Jordan University of Science and Technology, P. O. Box 3030 Irbid, 22110, Jordan
| |
Collapse
|
4
|
Polmear MM, Nicholson TC, Blair JA, Thabet AM, Adler AH, Rajani R. Injuries Sustained With Falls From Height in Crossing the United States-Mexico Border at a Level I Trauma Center: A Prospective Cohort Study. J Am Acad Orthop Surg Glob Res Rev 2023; 7:01979360-202306000-00004. [PMID: 37285513 DOI: 10.5435/jaaosglobal-d-23-00005] [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] [Received: 01/07/2023] [Accepted: 04/04/2023] [Indexed: 06/09/2023]
Abstract
INTRODUCTION The US Department of Homeland Security has reported increases in encounters and apprehensions at the US Southwest border for the past several years. The purposes of this study were to assess the demographics, patterns of injuries, and surgical interventions, associated with falls from height along the US-Mexico border. METHODS A prospective cohort study was conducted at a Level I trauma center from January 2016 through December 2021 of all patients who fell from height crossing the US-Mexico border and presented with injuries requiring admission. RESULTS A total of 448 patients were admitted with a median age of 30 years (interquartile range [IQR] 16, range 6 to 65). Monthly frequency of admissions increased markedly with a median of 18.5 (IQR 5.3) in 2021. Patients presented with limited health data, and comorbidities were identified in 111 patients (24.7%). Median height fallen was 5.5 m (18 ft). Patients sustaining a fall from ≥ 5.5 m were markedly more likely to have an Injury Severity Score (ISS) of > 15. Median length of stay was 9 days (IQR 11). There were a total of 1,066 injuries with 723 extremity and pelvic; 236 spine; and 107 head or neck, face, thorax, or abdominal injuries. Median ISS was 9.0 (IQR 7, range 1 to 75, 33% > 15). Tibial plafond fracture and spine injury were markedly associated with longer lengths of stay and ISS > 15. All injuries resulted in 635 separate surgical events and 930 procedures. Clinical follow-up occurred in 55 patients (12.2%), with median duration of 28 days (range 6 days to 8 months). DISCUSSION Injuries associated with border crossings and falls from height were serious and increased in frequency. As the US policy on border security evolves, surgeons in these regions should be prepared to handle the associated injuries and sequelae. Prevention of these serious and debilitating injuries should be undertaken to decrease the burden of disease.
Collapse
Affiliation(s)
- Michael M Polmear
- From theDepartment of Orthopaedic Surgery, Texas Tech University Health Sciences Center El Paso, El Paso, Texas (Dr. Polmear, Dr. Nicholson, Dr. Thabet, Dr. Adler, and Dr. Rajani); the Department of Orthopaedic Surgery, Medical College of Georgia at Augusta University, Augusta, GA (Dr. Blair)
| | | | | | | | | | | |
Collapse
|
5
|
Thabet AM, Alzuheir IM, Fayyad AF, Kheimar AM, Jalboush NH. Occurrence and phylogenetic analysis of fowl adenovirus E in broiler flocks from Gaza Strip Palestine. J Infect Dev Ctries 2023; 17:565-570. [PMID: 37159896 DOI: 10.3855/jidc.17434] [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: 09/23/2022] [Accepted: 02/22/2023] [Indexed: 05/11/2023] Open
Abstract
INTRODUCTION Inclusion-body hepatitis (IBH) and hydropericardium syndrome (HPS) are highly infectious diseases caused by fowl adenoviruses (FAdVs). IBH and HPS cause major economic losses in poultry production. IBH is caused by multiple FAdV serotypes such as FAdV-11, FAdV8a, and FAdV8b; while HPS is mainly caused by the FAdV-4 serotype. In 2018, we detected FAdVs in West Bank - Palestine for the first time. This study aims to monitor the emergence of new FAdVs in broiler farms in Gaza Strip-Palestine in 2022. METHODOLOGY The clinical signs, necropsy, and histopathological findings associated with IBH in the suspected birds were recorded. Polymerase chain reaction (PCR) was performed using primers matching the virus-encoded L1 loop of the hexon gene. The sequences of the L1 loop were analyzed and a phylogenetic tree was constructed and compared with the related FAdV field isolates and reference strains from different regions of the world available in GenBank. RESULTS The infected broiler displayed FAdVs-induced clinical symptoms and pathological lesions with mortality rates ranging from 20-46%. The L1 loop sequences from the infected flocks were submitted to GenBank with accession numbers ON638995, ON872150, and ON872151. The identified L1 loop gene has high nucleotide homology (96.7-97.9%) to the highly pathogenic FAdV E serotype 8b strain FAdV_isolate_04-53357-122_Canada_2007 (GenBank: EF685489) and 94.5-94.6% to FAdV_10_Belgium_2010 isolate 11-15941 (GenBank: AF339924.1). Furthermore, the phylogenetic analysis indicated that they belong to FAdV-E serotype 8b. CONCLUSIONS Our study reports the emergence of FAdV-E causing IBH disease in broiler chickens for the first time in Gaza in Palestine.
Collapse
Affiliation(s)
- Ahmed M Thabet
- Thabet Center for Veterinary Services (TCVS) - Diagnostic Laboratory, Gaza Strip, Palestine
| | - Ibrahim M Alzuheir
- Department of Veterinary Medicine, Faculty of Agriculture and Veterinary Medicine, An-Najah National University, Nablus, Palestine
| | - Adnan F Fayyad
- Department of Veterinary Medicine, Faculty of Agriculture and Veterinary Medicine, An-Najah National University, Nablus, Palestine
| | - Ahmed M Kheimar
- Department of Poultry Diseases, Faculty of Veterinary Medicine, Sohag University, 82424 Sohag, Egypt
| | - Nasr H Jalboush
- Department of Veterinary Medicine, Faculty of Agriculture and Veterinary Medicine, An-Najah National University, Nablus, Palestine
| |
Collapse
|
6
|
Saleh ES, De Carvalho AF, Hasan S, Abdelgawad A, Thabet AM, Moneim MS. Soft Tissue Benign Hand Masses in the First Web Space: A Retrospective Case Series. Cureus 2023; 15:e37847. [PMID: 37213983 PMCID: PMC10198707 DOI: 10.7759/cureus.37847] [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] [Subscribe] [Scholar Register] [Accepted: 04/17/2023] [Indexed: 05/23/2023] Open
Abstract
INTRODUCTION Hand masses are fairly common. While most of these masses are either ganglion cysts or benign tumors, masses in the first web space are not rare, and they may in fact represent a variety of lesions. These include both benign and malignant tumors, metastases, or congenital and anomalous structures, and may involve nerves, vascular structures, connective tissue, and joints. METHODS In this retrospective case series, data on 12 cases of first dorsal web space hand mass treated at our center over a period of five years were collected and analyzed. RESULTS Twelve consecutive patients presenting with a first dorsal web space hand mass over a period of five years were reviewed. This represented a group of nine females and three males, with a mean age of 53 years (range = 16-70 years). Seven patients had a mass on the right side and five on the left side. The surgical approach to resect the mass in all 12 patients was dorsal. The most common diagnosis was ganglion cyst (50%), followed by lipoma (25%) and aneurysm (16.6%). There was one case of eccrine spiradenoma. CONCLUSION First dorsal web space hand masses can encompass multiple different pathologies, and the first web space has an intricate anatomy. Both of these factors mandate a careful approach that includes meticulous preoperative planning with appropriate advanced imaging studies, which helps to make the surgical procedure more efficient and accurate.
Collapse
Affiliation(s)
- Ehab S Saleh
- Department of Orthopedic Surgery, Oakland University William Beaumont School of Medicine, Rochester, USA
| | | | - Sazid Hasan
- Department of Medicine, Oakland University William Beaumont School of Medicine, Rochester, USA
| | - Amr Abdelgawad
- Department of Orthopedic Surgery, Maimonides Medical Center, New York, USA
| | - Ahmed M Thabet
- Department of Orthopedic Surgery, Texas Tech University Health Sciences Center, El Paso, USA
| | - Moheb S Moneim
- Department of Orthopedic Surgery, University of New Mexico Health Sciences Center, Albuquerque, USA
| |
Collapse
|
7
|
Klahs KJ, Heh E, Yousaf M, Tadlock J, Thabet AM. Operative challenges of intramedullary nailing for subtrochanteric blastic pathological femur fracture: a case report. J Surg Case Rep 2023; 2023:rjac630. [PMID: 36685131 PMCID: PMC9844961 DOI: 10.1093/jscr/rjac630] [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] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 12/19/2022] [Indexed: 01/20/2023] Open
Abstract
Prostate adenocarcinoma metastasizes to bone and forms fragile blastic lesions, which can present as dense obstacles intraoperatively. There are limited reports on the challenges surgeons face when operating through these lesions. A 60-year-old male with a pathologic subtrochanteric femur fracture in the presence of blastic lesions was successfully treated with intramedullary (IM) fixation. Pathologic fractures from blastic bone lesions are expected to increase in prevalence as survivability improves for metastatic prostate cancer. Orthopedic surgeons, when performing IM fixation for these fractures, should be prepared to utilize accessory equipment and should adopt creative techniques for reduction and fixation.
Collapse
Affiliation(s)
- Kyle J Klahs
- Department of Orthopaedic Surgery, Texas Tech University Health Sciences Center, El Paso TX, USA
| | - Ethan Heh
- El Paso Paul Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso TX, USA
| | - Mohammad Yousaf
- El Paso Paul Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso TX, USA
| | - Joshua Tadlock
- Department of Orthopaedic Surgery, Texas Tech University Health Sciences Center, El Paso TX, USA
| | - Ahmed M Thabet
- Correspondence address. Department of Orthopaedic Surgery, El Paso Paul Foster School of Medicine, Texas Tech University Health Sciences Center, 4801 Alberta Ave El Paso, TX 79905, USA. Tel: (915) 215-5400; E-mail:
| |
Collapse
|
8
|
Klahs KJ, Polmear MM, Transtrum B, Rodriguez E, Abdelgawad A, Thabet AM. Correction of Cubitus Varus Using Computer-Assisted Hexapod Multiplanar External Fixators: A Report of 3 Cases. JBJS Case Connect 2023; 13:01709767-202303000-00009. [PMID: 36821393 DOI: 10.2106/jbjs.cc.22.00284] [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: 02/24/2023]
Abstract
CASE Three male patients, 8-, 13-, and 18-year-old, all developed posttraumatic cubitus varus elbow deformity after distal humerus supracondylar fractures. Each underwent a distal humerus osteotomy with application of a hexapod external fixator to gradually correct the deformity. CONCLUSION In patients with cubitus varus malunion, the stability of the hexapod external fixation, percutaneous nature of the osteotomy, and availability of running a residual computer-assisted program provides a consistent technique for deformity correction.
Collapse
Affiliation(s)
- Kyle J Klahs
- Texas Tech University Health Science Center, Paul Foster School of Medicine, El Paso, Texas.,William Beaumont Army Medical Center, Fort Bliss, El Paso, Texas
| | - Michael M Polmear
- Texas Tech University Health Science Center, Paul Foster School of Medicine, El Paso, Texas.,William Beaumont Army Medical Center, Fort Bliss, El Paso, Texas
| | | | | | | | - Ahmed M Thabet
- Texas Tech University Health Science Center, Paul Foster School of Medicine, El Paso, Texas
| |
Collapse
|
9
|
Thamer S, Kijak N, Toraih E, Thabet AM, Abdelgawad A. Tendon Transfers to Restore Shoulder Function for Obstetrical Brachial Plexus Palsy: A Systematic Review of the Literature. JBJS Rev 2023; 11:01874474-202301000-00005. [PMID: 36608169 DOI: 10.2106/jbjs.rvw.22.00165] [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: 01/07/2023]
Abstract
BACKGROUND Obstetrical brachial plexus palsy (OBPP) is a relatively common stretch injury of the brachial plexus sustained during delivery. Tendon transfers are commonly performed to improve shoulder function among patients with OBPP. Although several techniques for the surgical management of OBPP exist, it is unclear whether tendon transfers to the rotator cuff vs. posterior humerus yield different outcomes. METHODS A systematic search in PubMed, Web of Science, the Cumulative Index to Nursing and Allied Health Literature, the Cochrane Library, and Google Scholar up to January 1, 2021, was performed. Relevant publications were classified by surgical technique of tendon transfers to the rotator cuff or posterior humerus. The standard mean difference (SMD) and 95% confidence intervals were calculated to compare preoperative and postoperative aggregate Mallet scores as well as abduction and external rotation scores using the Mallet scale. A p value of <0.01 was considered significant. RESULTS Data from 26 studies and 951 patients (46.2% male patients) with a mean age of 68.9 ± 29.3 months were included. Eight hundred three patients underwent tendon transfer to the rotator cuff and 148 to the posterior humerus. The average postoperative follow-up period was 45.2 ± 21.7 months. The pooled cohort had an overall improvement in postoperative aggregate Mallet scores (SMD = 5.53, p < 0.001), abduction scores (SMD = 1.79, p < 0.001), and external rotation scores (SMD = 1.99, p < 0.001). Tendon transfer to the rotator cuff had a greater postoperative improvement in abduction (SMD = 1.90, p < 0.001) than transfer to the posterior humerus (SMD = 1.32, p < 0.001) while both techniques yielded similar improvements in external rotation (rotator cuff SMD = 2.01, p < 0.001, posterior humerus SMD = 1.98, p < 0.001). CONCLUSION This is the first systematic review comparing outcomes for tendon transfers to the rotator cuff vs. the posterior humerus for improving shoulder function in patients with OBPP. Overall, tendon transfers are an effective treatment for improving shoulder function. Transfer of the latissimus dorsi and teres major to the rotator cuff compared with transfer to the posterior humerus results in greater improvement in abduction while both techniques have similar results in improving external rotation. LEVEL OF EVIDENCE Level I Systematic review of Level I and Level II studies.
Collapse
Affiliation(s)
- Semran Thamer
- Dartmouth College Geisel School of Medicine, Hanover, New Hampshire
| | - Nicoletta Kijak
- State University of New York Downstate Medical Center, Brooklyn, New York
| | - Eman Toraih
- Division of General Endocrine and Oncologic Surgery, Department of Surgery, School of Medicine, Tulane University, New Orleans, Louisiana.,Medical Genetics Unit, Department of Histology and Cell Biology, Suez Canal University, Ismailia, Egypt
| | - Ahmed M Thabet
- Texas Tech University Health Sciences Center, El Paso, Texas
| | - Amr Abdelgawad
- Maimonides Medical Center, Department of Orthopaedics, Brooklyn, New York
| |
Collapse
|
10
|
Abdelgawad A, Elabd A, Pisquiy JJ, Thabet AM. Early internal fixation of open ankle malleolar fractures is not associated with increased complications: case control study. Acta Orthop Belg 2022; 88:825-833. [PMID: 36800669 DOI: 10.52628/88.4.9881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Abstract
The timing of definitive fixation of open ankle malleolar fractures is still controversial. This study intended to evaluate the outcome of patients who were managed by immediate definitive fixation in comparison to delayed definitive fixation following open ankle malleolar fractures. This was an IRB approved retrospective case control study of 32 patients who were treated with open reduction and internal fixation (ORIF) for open ankle malleolar fractures at our Level I trauma center 2011-2018. Patients were divided into 2 groups; immediate ORIF group (within 24 hours) and delayed ORIF group (first stage included debridement and external fixator or splinting followed by second stage of delayed ORIF). Outcomes assessed were postoperative complications (wound healing, infection, nonunion). Logistic regression models were used to access the unadjusted and adjusted associations between post- operative complications and selected co factors. The immediate definitive fixation group included 22 patients while the delayed staged fixation group included 10 patients. Gustilo type II and III open fractures were associated with higher complications rate (p-value = 0.012) in both groups. Comparing the 2 groups, There was no increase in complication in the immediate fixation group compared to the delayed group. Complications following open ankle malleolar fractures are usually associated with Gustilo type II and III open fractures. Immediate definitive fixation after adequate debridement was not found to increase complication rate compared to staged management.
Collapse
|
11
|
D'Ambrosio M, Tang A, Menken L, Thabet AM, Liporace FA, Yoon RS. Adjunct neutralization plating in patella fracture fixation: a technical trick. OTA Int 2022; 5:e217. [PMID: 36569111 PMCID: PMC9782314 DOI: 10.1097/oi9.0000000000000217] [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] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 06/30/2022] [Indexed: 11/07/2022]
Abstract
Patella fracture outcomes are positive overall; however, in some cases, traditional fixation methods result in complications, including loss of fixation and irritable hardware requiring removal. We present a technique of plate fixation that we believe has the potential to improve stability and is less offensive in more comminuted fracture patterns. Improved stability should allow unfettered advancement of rehabilitation without concern for loss of fixation. Lower profile fixation offers a potential for diminishing the presence of irritating hardware requiring removal. We present our technique for using plate fixation to augment more complex patella fracture patterns.
Collapse
Affiliation(s)
- Matthew D'Ambrosio
- Division of Orthopaedic Trauma & Adult Reconstruction, Department of Orthopaedic Surgery, Saint Barnabas Medical Center—RWJBarnabas Health, Livingston, NJ
- Division of Orthopaedic Trauma & Adult Reconstruction, Department of Orthopaedic Surgery, Jersey City Medical Center—RWJBarnabas Health, Jersey City, NJ; and
| | - Alex Tang
- Division of Orthopaedic Trauma & Adult Reconstruction, Department of Orthopaedic Surgery, Saint Barnabas Medical Center—RWJBarnabas Health, Livingston, NJ
- Division of Orthopaedic Trauma & Adult Reconstruction, Department of Orthopaedic Surgery, Jersey City Medical Center—RWJBarnabas Health, Jersey City, NJ; and
| | - Luke Menken
- Division of Orthopaedic Trauma & Adult Reconstruction, Department of Orthopaedic Surgery, Saint Barnabas Medical Center—RWJBarnabas Health, Livingston, NJ
- Division of Orthopaedic Trauma & Adult Reconstruction, Department of Orthopaedic Surgery, Jersey City Medical Center—RWJBarnabas Health, Jersey City, NJ; and
| | - Ahmed M. Thabet
- Division of Orthopaedic Trauma, Department of Orthopaedic Surgery, Texas Tech University Health Sciences Center—El Paso, El Paso, TX
| | - Frank A. Liporace
- Division of Orthopaedic Trauma & Adult Reconstruction, Department of Orthopaedic Surgery, Saint Barnabas Medical Center—RWJBarnabas Health, Livingston, NJ
- Division of Orthopaedic Trauma & Adult Reconstruction, Department of Orthopaedic Surgery, Jersey City Medical Center—RWJBarnabas Health, Jersey City, NJ; and
| | - Richard S. Yoon
- Division of Orthopaedic Trauma & Adult Reconstruction, Department of Orthopaedic Surgery, Saint Barnabas Medical Center—RWJBarnabas Health, Livingston, NJ
- Division of Orthopaedic Trauma & Adult Reconstruction, Department of Orthopaedic Surgery, Jersey City Medical Center—RWJBarnabas Health, Jersey City, NJ; and
| |
Collapse
|
12
|
El Sherif FA, Youssef HA, Fares KM, Mohamed SAB, Ali AR, Thabet AM. Efficacy of Ketamine versus Magnesium Sulphate as Adjuvants to Levobupivacaine in Ultrasound Bilevel Erector Spinae Block in Breast Cancer Surgery (a Double-Blinded Randomized Controlled Study). Local Reg Anesth 2022; 15:87-96. [PMID: 36177362 PMCID: PMC9514291 DOI: 10.2147/lra.s379194] [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] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 09/14/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose Breast surgeons seek simple, safe, effective, and novel regional anesthesia techniques for postoperative analgesia. Erector spinae plane (ESP) block is a new ultrasound-guided technique. We aimed to explore the analgesic effect of adding ketamine and magnesium sulfate as adjuvants to levobupivacaine in ESP. Patients and Methods Sixty female patients (aged 18-60 years) with breast cancer, weighing 50-90 kg who were scheduled for modified radical mastectomy (MRM) were randomly allocated into three groups (20 patients each) to receive an ESP block with 20 mL 0.25% levobupivacaine with adjuvants according to the following groups: group C: levobupivacaine; group K: levobupivacaine + 2 mg/kg ketamine; and group M: levobupivacaine + 2 mg/kg magnesium sulfate. The block was administered preoperatively before anesthesia induction. Postoperatively, hemodynamics, visual analog scale scores, the first request for analgesia, total analgesic consumption, and side effects were observed for 48 hours. Results The total amount of Morphine rescue analgesia was significantly lower in groups M (7.00 ± 0.61 mg) and K (7.50 ± 0.58 mg) than in group C (14.40 ± 3.47 mg) during the first 48 h postoperatively. Nine (45%) patients in group M and 13 (65%) patients in K, compared with 20 (100%) patients in group C, requested analgesia. The time to first request of analgesia was significantly longer in groups M (30 h) and K (24 h) than in group C (7 h). No hemodynamic changes or serious side effects were observed. Conclusion Magnesium sulphate and ketamine seem to be both effective adjuvants to levobupivacaine in ESP blocks for postoperative analgesia in patients undergoing MRM, with slightly better analgesia provided by magnesium sulphate.
Collapse
Affiliation(s)
| | | | | | | | - Ali Rabiee Ali
- South Egypt Cancer Institute, Assiut University, Assiut, Egypt
| | | |
Collapse
|
13
|
Thabet AM, Adams A, Jeon S, Pisquiy J, Gelhert R, DeCoster TA, Abdelgawad A. Malpractice lawsuits in orthopedic trauma surgery: a meta-analysis of the literature. OTA Int 2022; 5:e199. [PMID: 36425091 PMCID: PMC9580045 DOI: 10.1097/oi9.0000000000000199] [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] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Accepted: 01/16/2022] [Indexed: 06/16/2023]
Abstract
Introduction The objectives for this study were to identify whether diagnostic or procedural errors more commonly resulted in lawsuit, as well as to elucidate how specific variables affected mean indemnity. Methods Systematic review of English-language articles in the PubMed and Google Scholar databases (through 2020) using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Meta-analysis was performed to estimate measures of proportions and differences in mean indemnity. Results The estimated probability of lawsuits related to orthopedic trauma in overall studies was 23.3%. There were no significant rate differences between main causes of claims (diagnostic vs procedural errors) and areas of injury (upper vs lower). There was no significant difference of mean indemnity between the probabilities of trauma-related claims, diagnostic error, and procedural error. Conclusion Non-trauma cases were more likely to result in lawsuit than trauma cases. Procedural errors accounted for most malpractice claims. The average indemnity increased according to the higher diagnostic errors, while the indemnity was lower with a relatively higher proportion of procedural errors. The most common cause of litigation varied between studies; however, among the most cited reasons were missed diagnosis/error in diagnosis, improper/substandard surgical performance, and, though not specifically studied in this analysis, errors of informed consent. Level of Evidence Economic and Decision Analyses Level VI.
Collapse
Affiliation(s)
- Ahmed M Thabet
- Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, TX
| | - Austin Adams
- Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, TX
| | - Soyoung Jeon
- Department of Economics, Applied Statistics and International Business, New Mexico State University, Las Cruces, NM
| | - John Pisquiy
- Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, TX
- West Virginia University, Department of Orthopedics, Morgantown, VA
| | - Rick Gelhert
- University of New Mexico, Department of Orthopaedic Surgery, Albuquerque, NM
| | - Thomas A DeCoster
- University of New Mexico, Department of Orthopaedic Surgery, Albuquerque, NM
| | | |
Collapse
|
14
|
Thabet AM, Craft M, Pisquiy J, Jeon S, Abdelgawad A, Azzam W. Tibial shaft fractures in the adolescents: treatment outcomes and the risk factors for complications. Injury 2022; 53:706-712. [PMID: 34862039 DOI: 10.1016/j.injury.2021.11.041] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 11/14/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Tibial shaft fractures are common injuries in the adolescent age group. The optimal method of treatment in this age group is still controversial. It relies on several factors including patient's age, fracture pattern, fracture location, and the condition of the soft tissue envelope. The purpose of this study was to report the clinical and radiographic outcomes of adolescent tibial shaft fractures treatment at a level-I trauma center. METHODS This retrospective study reviewed consecutive patients between 10 and 18 years of age who suffered from tibial shaft fractures between 2009 and 2018 at a level-I trauma center. Outcomes of interest were the successful fracture union (primary outcome) as evaluated by the Radiographic Union Scale in Tibial fractures (RUST) and the complications (secondary outcomes). RESULTS Fifty-two consecutive adolescent patients treated for tibial shaft fractures using elastic stable intramedullary nails (ESIN), interlocking nails, plates and screws, external fixators, and casts were included in the study. The mean follow-up period was 27.4 months. There was no statistically significant difference in the union rate and time to fracture union between the different treatment methods. Subject weight, fracture type, and method of treatment were significant predictors for the RUST scores at 12 weeks post-operative. Adolescents with heavier bodyweight correlated with lower RUST scores (p<0.001). Open fractures were associated with significantly longer time to union (p<0.001) and lower RUST scores (p<0.001) compared to closed fractures. The patients treated with interlocking nailing showed higher RUST scores than the casting treatment group (p = 0.01). There were no statistically significant differences in complication rates between the fixation methods. Union time was significantly longer with complications than without complications (p = 0.01). Open fractures had higher complication rates compared to closed fractures. In the multivariate logistic model, patients with open fracture were 5.5 times more likely to have complications (OR=5.46; p = 0.04). CONCLUSION Tibial shaft fractures in adolescents can be treated with several methods including ESIN, interlocking nail, plate and screws, external fixation, and casting. All are valid treatments for adolescent tibial shaft fractures and can achieve favorable outcomes. No single treatment method applies to all patients. Each method has advantages, disadvantages, and specific indications.
Collapse
Affiliation(s)
- Ahmed M Thabet
- Associate Professor, orthopaedic trauma, paediatric orthopaedic, limb lengthening, and deformity correction at Texas Tech University Health Sciences Center, El Paso, Texas, USA
| | - Madison Craft
- Department of Orthopaedic Surgery, College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Ok 73104, USA
| | - John Pisquiy
- Department of Orthopaedics, West Virginia University School of Medicine, West Virginia, USA
| | - Soyoung Jeon
- Assistant Professor, Department of Economics, Applied Statistics and International Business, New Mexico State University, Las Cruces, New Mexico, USA
| | - Amr Abdelgawad
- Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, New York, USA
| | - Wael Azzam
- Assistant Professor, Department of Orthopaedic Surgery, Faculty of Medicine, Tanta University, Tanta, Egypt.
| |
Collapse
|
15
|
El-Badawy O, Elsherbiny NM, Abdeltawab D, Magdy DM, Bakkar LM, Hassan SA, Hassan EA, Thabet AM, Ashmawy AM, Moustafa EF, Abbas WA, Ahmad AB, Rayan A, Saad K, Elhoufey A, Hussein HAM, Thabet AA, Zahran AM. COVID-19 Infection in Patients with Comorbidities: Clinical and Immunological Insight. Clin Appl Thromb Hemost 2022; 28:10760296221107889. [PMID: 35698744 PMCID: PMC9201308 DOI: 10.1177/10760296221107889] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
AIM Our study's objectives were to study the clinical and laboratory characteristics that may serve as biomarkers for predicting disease severity, IL-10 levels, and frequencies of different T cell subsets in comorbid COVID-19 patients. METHODS Sixty-two hospitalized COVID-19 patients with comorbidities were assessed clinically and radiologically. Blood samples were collected to assess the T lymphocyte subsets by flow cytometry and IL-10 levels by ELISA. RESULTS The most common comorbidities observed in COVID-19 patients were diabetes mellitus (DM), hypertension, and malignancies. Common symptoms and signs included fever, cough, dyspnea, fatigue, myalgia, and sore throat. CRP, ferritin, D dimer, LDH, urea, creatinine, and direct bilirubin were significantly increased in patients than controls. Lymphocyte count and CD4+ and CD8+ T-cells were significantly decreased in comorbid COVID-19 patients, and CD25 and CD45RA expression were increased. CD4+ and CD8+ regulatory T cells (Tregs) and IL-10 levels were significantly decreased in patients. CONCLUSIONS Many parameters were found to be predictive of severity in the comorbid patients in our study. Significant reductions in the levels and activation of CD4+ and CD8+ T-cells were found. In addition, CD4+ and CD8+ Tregs were significant decreased in patients, probably pointing to a prominent role of CD8+ Tregs in dampening CD4+ T-cell activation.
Collapse
Affiliation(s)
- Omnia El-Badawy
- Department of Medical Microbiology and Immunology, Faculty of
Medicine, Assiut University, Assiut, Egypt
| | - Nahla M. Elsherbiny
- Department of Medical Microbiology and Immunology, Faculty of
Medicine, Assiut University, Assiut, Egypt
| | - Doaa Abdeltawab
- Department of Gastroenterology and Tropical Medicine, Faculty of
Medicine, Assiut University, Assiut, Egypt
| | - Doaa M. Magdy
- Chest Diseases and Tuberculosis Department, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Lamees M. Bakkar
- Chest Diseases and Tuberculosis Department, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Shimaa A. Hassan
- Department of Anesthesia and ICU, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Elham A. Hassan
- Department of Gastroenterology and Tropical Medicine, Faculty of
Medicine, Assiut University, Assiut, Egypt
| | - Ahmed M. Thabet
- Department of Anesthesia and ICU, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Ahmed M. Ashmawy
- Department of Internal Medicine, Gastroenterology and Hepatology
Unit, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Ehab F. Moustafa
- Department of Gastroenterology and Tropical Medicine, Faculty of
Medicine, Assiut University, Assiut, Egypt
| | - Wael A. Abbas
- Department of Internal Medicine, Gastroenterology and Hepatology
Unit, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Ahmad Bahieldeen Ahmad
- Department of Internal Medicine, Critical Care Unit, Faculty of
Medicine, Assiut University, Assiut, Egypt
| | - Amal Rayan
- Department of Clinical Oncology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Khaled Saad
- Department of Pediatrics, Faculty of Medicine, Assiut University, Assiut, Egypt
- Khaled Saad, Professor of Pediatrics,
Assiut University Children's Hospital, Assiut, Egypt. Address: Assiut University
Children's Hospital, Assiut University Campus, 71111, Assiut, Egypt.
| | - Amira Elhoufey
- Department of Community Health Nursing, Faculty of Nursing, Assiut University, Assiut, Egypt
| | - Hosni A. M. Hussein
- Department of Microbiology, Faculty of Science, Al Azhar University, Assiut 71524, Egypt
| | - Ali A. Thabet
- Department of Zoology, Faculty of Science, Al Azhar University, Assiut 71524, Egypt
| | - Asmaa M. Zahran
- Department of Clinical Pathology, South Egypt Cancer Institute, Assiut University, Assiut, Egypt
| |
Collapse
|
16
|
Carter J, Abdelgawad A, Thabet AM. "Staged Reconstruction of Chronic Patella Alta with Ilizarov fixator and Achilles Tendon Allograft: A Case report". J Orthop Case Rep 2021; 11:54-58. [PMID: 35415106 PMCID: PMC8930335 DOI: 10.13107/jocr.2021.v11.i11.2514] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 10/19/2021] [Indexed: 11/15/2022] Open
Abstract
Introduction Chronic patella alta after chronic patellar tendon rupture or patella fracture non-union is a challenging condition to treat. Case Report In this report, we present the case of a 50-year-old male with inferior patellar pole fracture with non-union and chronic patella alta from a chain saw accident 12 years before presentation. An Ilizarov frame was used to reduce the patella to anatomic position before reconstructive surgery for knee extensor mechanism repair using an Achilles tendon allograft. Conclusion This case demonstrated the efficacy of the Ilizarov frame in the setting of chronic patella alta where primary repair would have been impossible due to significant scar tissue formation and quadriceps contracture.
Collapse
Affiliation(s)
- Jordan Carter
- Department of Orthopedics, University of Texas Health Science Center at San Antonio, Texas, USA
| | - Amr Abdelgawad
- Department of Orthopedic Surgery, Maimonides Medical Center, Brooklyn, New York, USA,
Address of Correspondence: Dr. Amr Abdelgawad, Department of Orthopedic Surgery, Maimonides Medical Center, 6010 Bay Parkway, Brooklyn, NY 11204. E-mail:
| | - Ahmed M Thabet
- Department of Orthopedic Surgery and Rehabilitation, Texas Tech University Health Sciences Center, El Paso, Texas, USA
| |
Collapse
|
17
|
Klahs KJ, Castagno C, Tadlock J, Garcia E, Abdelgawad A, Thabet AM. Novel Utilization of Anterior Intrapelvic (Stoppa) Approach for Periacetabular Ganz Osteotomy: A Report of 2 Cases. JBJS Case Connect 2021; 11:01709767-202112000-00015. [PMID: 34669617 DOI: 10.2106/jbjs.cc.21.00271] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE The Ganz periacetabular osteotomy (PAO) is widely used to correct developmental hip dysplasia in the adolescent and young adult population. The aim of this case study was to examine the novel utility and safety of Stoppa approach for the Ganz PAO in a 15-year-old girl and 25-year-old man. The Stoppa approach is traditionally used for acetabular fractures, and its use for a Ganz PAO is relatively novel. CONCLUSION The Stoppa approach allows surgeons to successfully perform the Ganz PAO while simultaneously providing direct visualization for all osteotomies and vital structures.
Collapse
Affiliation(s)
- Kyle J Klahs
- Texas Tech University Health Science Center, Paul Foster School of Medicine, El Paso, Texas.,William Beaumont Army Medical Center, Fort Bliss, El Paso, Texas
| | - Christopher Castagno
- Texas Tech University Health Science Center, Paul Foster School of Medicine, El Paso, Texas
| | - Joshua Tadlock
- Texas Tech University Health Science Center, Paul Foster School of Medicine, El Paso, Texas.,William Beaumont Army Medical Center, Fort Bliss, El Paso, Texas
| | - E'Stephan Garcia
- William Beaumont Army Medical Center, Fort Bliss, El Paso, Texas
| | | | - Ahmed M Thabet
- Texas Tech University Health Science Center, Paul Foster School of Medicine, El Paso, Texas
| |
Collapse
|
18
|
Pisquiy JJ, Toraih EA, Hussein MH, Khalifa R, Shoulah SA, Abdelgawad A, Thabet AM. Utility of 3-Dimensional Intraoperative Imaging in Pelvic and Acetabular Fractures: A Network Meta-Analysis. JBJS Rev 2021; 9:01874474-202106000-00013. [PMID: 34166271 DOI: 10.2106/jbjs.rvw.20.00129] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Successful surgical management of pelvic ring and acetabular fractures requires technical expertise to achieve an accurate reduction and stable fixation. The use of 3-dimensional (3D) intraoperative imaging (3DIOI) as an assessment tool has led to improved reduction and placement of implants. The purpose of this study was to assess the utility of using 3DIOI in the management of acetabular and pelvic fractures on the basis of outcomes reported in the literature. METHODS A literature search was performed using PubMed, the Cochrane Database of Systematic Reviews (CDSR), and Google Scholar using key terms. A network meta-analysis conducted using the frequentist approach allowed for statistical analysis of reported outcomes regarding screw position (in mm), fracture reduction (in mm), and complications. RESULTS A total of 9 studies were included in this analysis. When compared with conventional radiography, the mean radiation dose (in cGy·cm2) was significantly higher in 3DIOI (mean difference, 82.72; 95% confidence interval [CI], 21.83 to 143.61; p = 0.007). Use of 3DIOI yielded a 93% lower risk of developing medical complications (odds ratio [OR], 0.07; 95% CI, 0.02 to 0.35; p = 0.014). Use of 3DIOI yielded higher odds of achieving accurate screw placement (OR, 4.21; 95% CI, 1.44 to 12.32; p = 0.008) and perfect reduction (OR, 2.60; 95% CI, 1.19 to 5.68; p = 0.016). In ranking the imaging modalities, 12 of the 13 parameters analyzed were in favor of 3DIOI over conventional fluoroscopy and 2D navigation imaging. CONCLUSIONS Current literature supports the use of 3DIOI because of the decreased rates of misplaced implants, malreduced fractures, complications, and subsequent revision operations. The use of 3DIOI allows for improved visualization of pelvic anatomy when repairing pelvic and acetabular fractures, and helps surgeons to achieve favorable surgical outcomes. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Collapse
Affiliation(s)
- John J Pisquiy
- Department of Orthopaedic Surgery & Rehabilitation, Texas Tech University Health Sciences Center El Paso, El Paso, Texas.,Department of Orthopaedics, West Virginia University School of Medicine, Morgantown, West Virginia
| | - Eman A Toraih
- Department of Surgery, Tulane University, New Orleans, Louisiana
| | | | - Rami Khalifa
- Department of Orthopaedic Surgery & Rehabilitation, Texas Tech University Health Sciences Center El Paso, El Paso, Texas.,Department of Orthopaedics, Al Helal Hospital, Cairo, Egypt
| | - Saad A Shoulah
- Department of Orthopaedic Surgery, Benha University School of Medicine, Benha, Egypt
| | - Amr Abdelgawad
- Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, New York
| | - Ahmed M Thabet
- Department of Orthopaedic Surgery & Rehabilitation, Texas Tech University Health Sciences Center El Paso, El Paso, Texas
| |
Collapse
|
19
|
Thabet AM, Gerzina C, Sala F, Jeon S, Lovisetti G, Abdelgawad A, DeCoster TA, Azzam W. Outcomes and Complications With Treatment of Open Tibial Plafond Fractures With Circular External Fixator. Foot Ankle Int 2021; 42:723-733. [PMID: 33559484 DOI: 10.1177/1071100720979976] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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] [Indexed: 02/01/2023]
Abstract
BACKGROUND Open tibial plafond fractures (Orthopaedic Trauma Association and AO Foundation [OTA/AO] 43) are associated with severe complications, including deep infection (closed fractures, 20%; open fractures, 30%), amputation (3%-14%), and nonunion (up to 25%). Circular external fixators (CEFs) can minimize soft tissue injury. This study aimed to report the rate of union and occurrence of severe complications in patients with open tibial plafond fractures treated with CEFs. METHODS A retrospective review of case series was conducted at 3 level I trauma centers. The study included patients older than 18 years with open tibial plafond fractures treated with CEFs. The reported outcomes included union rate, deep infection, operative complications, and limb alignment. The radiographic measurements of anatomic alignment were obtained. Fifty-two patients were included in the study. RESULTS The primary union rate was 79%. No deep infection occurred in the majority (92%) of patients. No patient required amputation of the affected limb or free flap coverage. CONCLUSION Definitive fixation of open tibial plafond fractures with CEFs avoided severe soft tissue complications but resulted in variation in final radiographic alignment. LEVEL OF EVIDENCE Level IV, case series.
Collapse
Affiliation(s)
- Ahmed M Thabet
- Department of Orthopaedic Surgery and Rehabilitation, Texas Tech University Health Sciences Center, El Paso, Texas, USA
| | - Christopher Gerzina
- Department of Orthopaedics and Rehabilitation, Texas Tech University Health Sciences Center, Lubbock, Texas, USA
| | - Francesco Sala
- Department of Orthopedic Surgery and Traumatology, Niguarda Hospital, Milan, Italy
| | - Soyoung Jeon
- Department of Economics, Applied Statistics and International Business, New Mexico State University, Las Cruces, New Mexico, USA
| | - Giovanni Lovisetti
- Department of Orthopedic Surgery and Traumatology, Menaggio Hospital, Como, Italy
| | - Amr Abdelgawad
- Department of Orthopaedic Surgery, Maimonides Medical Center, Brookyln, New York, USA
| | - Thomas A DeCoster
- Department of Orthopaedics and Rehabilitation, University of New Mexico, Albuquerque, New Mexico, USA
| | - Wael Azzam
- Department of Orthopedic Surgery, Tanta University Hospital, Faculty of Medicine, Tanta University, Tanta, Egypt
| |
Collapse
|
20
|
Azzam W, Catagni MA, Ayoub MA, El-Sayed M, Thabet AM. Early correction of malunited supracondylar humerus fractures in young children. Injury 2020; 51:2574-2580. [PMID: 32843147 DOI: 10.1016/j.injury.2020.08.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 05/01/2020] [Revised: 08/11/2020] [Accepted: 08/16/2020] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Supracondylar fracture malunion usually results in cubitus varus deformity. The long-standing unsightly deformity causes psychological stress to the child and his/her parents in addition to biomechanical disturbances and functional disorders in the affected elbow. The optimal timing of corrective osteotomy is not well-established in the literature. The present study aimed to report the results of early correction of cubitus varus deformity using a simple technique and to focus on the timing of early correction after supracondylar fracture malunion. PATIENTS AND METHODS Thirty consecutive patients treated for recent cubitus varus deformity after malunited supracondylar fractures, in the period between January 2012 and August 2017, were retrospectively reviewed. All patients had early surgical correction of the deformity within one year after the initial injury. In patients who presented with maluniting supracondylar fracture, the fracture was splinted until union was achieved, then active exercises were encouraged until elbow ROM was regained. The deformity was then corrected with a lateral closing wedge (LCW) osteotomy and fixed with two lateral and one medial wire. RESULTS All the osteotomies united. All the deformities were corrected. The humerus-elbow-wrist (HEW) angle significantly improved compared to the pre-operative values (p<0.001). All patients achieved satisfactory results at the final evaluation. Twenty-six patients (86.7%) achieved excellent results while four patients (13.3%) achieved good results. CONCLUSION Early correction of cubitus varus deformity avoids the psychological stress of the long-standing unsightly deformity to the young child and his/her family. It also avoids the delayed biomechanical and functional disturbances to the affected elbow. The LCW osteotomy and the three-wires fixation technique are simple and effective to correct the deformity and maintain the correction.
Collapse
Affiliation(s)
- Wael Azzam
- Assistant Professor of Orthopaedic Surgery and Traumatology, Faculty of Medicine, Tanta University, Department of Orthopaedic Surgery and Traumatology, Tanta University Hospital, El-Geish Street, Tanta 31111, Egypt.
| | - Maurizio A Catagni
- Former Chief of the Ilizarov Unit and the Department of Orthopaedic Surgery and Traumatology, "Alessandro Manzoni" Hospital, Via dell'Eremo, 9/11, 23900 Lecco, Italy. Professor at the Milano University, Medical School. Director of the Ilizarov Unit at Mangioni Hospital - Lecco - Italy. Lecco - 42/H, Via C. Cattaneo, 23900.
| | - Mostafa A Ayoub
- Professor of Orthopaedic Surgery and Traumatology, Faculty of Medicine, Tanta University, Department of Orthopaedic Surgery and Traumatology, Tanta University Hospital, El-Geish Street, Tanta 31111, Egypt.
| | - Mohamed El-Sayed
- Professor and Head of Paediatric Orthopaedic Unit, Faculty of Medicine, Tanta University, Department of Orthopaedic Surgery and Traumatology, Tanta University Hospital, El-Geish Street, Tanta 31111, Egypt.
| | - Ahmed M Thabet
- Assistant Professor, orthopaedic trauma, paediatric orthopaedic, limb lengthening, and deformity correction at Texas Tech University Health Sciences Center, El Paso, 4801 Alberta Avenue, El Paso, TX 79905, USA; Assistant Professor of Orthopaedic Surgery and Traumatology, Faculty of Medicine, Benha University, Farida Nada Street, Benha 13512, Qalubia, Egypt.
| |
Collapse
|
21
|
Khalifa R, Craft MR, Wey AJ, Thabet AM, Abdelgawad A. Missed positional gluteal compartment syndrome in an obese patient after foot surgery: a case report. Patient Saf Surg 2020; 14:35. [PMID: 32973924 PMCID: PMC7493869 DOI: 10.1186/s13037-020-00260-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 09/08/2020] [Indexed: 11/13/2022] Open
Abstract
Background Gluteal compartment syndrome is an uncommon condition and can be difficult to diagnose. It has been diagnosed after trauma, vascular injury, infection, surgical positioning, and prolonged immobilization from drug or alcohol intoxication. The diagnosis is based on clinical findings and, in most cases, recognizing these symptoms and making a diagnosis early is critical to a complete recovery. Case presentation A 53-year-old male who underwent left foot surgery had severe pain to his contralateral hip and posterior gluteal compartment radiating to the right lower extremity immediately postoperative. He was positioned supine with a “bump” placed under his right hip to externally rotate his operative leg during the surgery. Due to the patient’s complex past medical history, a presumptive diagnosis of a herniated disc and/or compression of the sciatic nerve was made as a cause for the patient’s pain. This resulted in a misdiagnosis period of 36 h until the patient was diagnosed with unilateral gluteal compartment syndrome. Performing a fasciotomy was decided against due to the increased risk of complications. The patient was treated with administration of IV fluids and closely monitored. On post-op day 6, the patient was discharged. At three months post-op, the patient was walking without a limp and he had no changes in his peripheral neurologic examination compared to his preoperative baseline. Conclusion Gluteal compartment syndrome is a surgical emergency that must be considered postoperatively especially in obese patients with prolonged operation times who experience acute buttock pain. The use of positional bars or “bumps” in the gluteal area should be used with caution and raise awareness of this complication after orthopedic surgeries.
Collapse
Affiliation(s)
- Rami Khalifa
- Department of Orthopedic Surgery, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, TX 79905 USA
| | - Madison R Craft
- Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, TX 79905 USA
| | - Aaron J Wey
- Department of Orthopedic Surgery, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, TX 79905 USA
| | - Ahmed M Thabet
- Department of Orthopedic Surgery, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, TX 79905 USA
| | - Amr Abdelgawad
- Department of Orthopedic Surgery, Maimonides Medical Center, Maimonides Bone and Joint Center, 6010 Bay Parkway, Brooklyn, NY 11204 USA
| |
Collapse
|
22
|
Sala F, Domenicucci M, Thabet AM, Agus MA, Capitani D, Peretti GM. Combined circular external fixation and flexible intramedullary nailing for pediatric bilateral open tibia fractures in blast injury. J BIOL REG HOMEOS AG 2020; 34:231-236. Congress of the Italian Orthopaedic Research Society. [PMID: 33261283] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Management of blast injuries with open fractures and extensive soft tissue damage in pediatric patients is a challenging task even in experienced hands. This article reports the case of an 8-year-old boy with bilateral open tibia fractures and soft tissue loss due to the accidental explosion of a skyrocket. After the emergency procedures with lavage, debridement and temporary bone stabilization, we performed the definitive reconstruction surgery using a combined circular external fixation and flexible intramedullary nailing technique on both legs. This technique allowed easy access to the wounds for plastic surgery procedures and early bilateral weight bearing. All implants were removed within 6 months, the fractures healed with good axial alignment and the patient returned to his preinjury activities one year after the trauma. In this case, the combined use of circular external fixation and flexible intramedullary nailing ensured optimal fractures stabilization, minimizing the damage to the soft tissues and the obstruction for plastic surgeons. We believe that this technique should be considered in pediatric patients with open fractures of the lower limbs and extensive soft tissue injuries.
Collapse
Affiliation(s)
- F Sala
- Department of Orthopaedic Surgery and Traumatology, Niguarda Hospital, Milan, Italy
| | - M Domenicucci
- ASST degli Spedali Civili di Brescia, Brescia, Italy
| | - A M Thabet
- Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, TX, USA
| | - M A Agus
- Department of Orthopaedic Surgery and Traumatology, Niguarda Hospital, Milan, Italy
| | - D Capitani
- Department of Orthopaedic Surgery and Traumatology, Niguarda Hospital, Milan, Italy
| | - G M Peretti
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| |
Collapse
|
23
|
Abstract
Background: A radial incision with radial plate fixation for distal radius fracture has historically been avoided due to its risk to the superficial branch of the radial nerve (SBRN). With careful technique, it is possible to avoid injury to the SBRN, thereby minimizing the soft tissue injury associated with other approaches. We compare subjective and objective functional outcomes of radial plate fixation surgeries that we performed with those of dorsal and volar plate fixation in current literature. Methods: Patients at a single center who underwent radial plate fixation for an AO type A or AO type B distal radius fracture between December 2006 and December 2014 were enrolled in the study. Postoperative grip strength and 3-digit pinch strength were measured systematically in the injured and uninjured wrists. Patients also completed a Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) questionnaire to assess subjective outcomes. Results: Thirty-six patients met our inclusion criteria and had available medical records. Postoperative grip strength in the injured wrist was significantly lowered-68% compared with the uninjured wrist. After subgroup analysis of dominant and nondominant wrist injuries, there was no significant difference in grip strength between injured and uninjured wrists. There was no significant decrease in postoperative 3-digit pinch strength in the injured wrist-89% compared with the uninjured wrist. The mean QuickDASH score for our study participants was 20.9. Conclusions: Radial plate fixation is an effective approach for distal radius fractures. Objective and subjective outcomes are noninferior to those of a dorsal or volar approach.
Collapse
Affiliation(s)
- Sherif Dabash
- University of Texas Health Science
Center at Houston, USA,Sherif Dabash, Department of Orthopaedic
Surgery, University of Texas Health Science Center at Houston, 6431 Fannin
Street, Houston, TX 77030, USA.
| | - Eric Potter
- Texas Tech University Health Sciences
Center–El Paso, USA
| | | | - Juan Shunia
- Texas Tech University Health Sciences
Center–El Paso, USA
| | - Amr Abdelgawad
- Texas Tech University Health Sciences
Center–El Paso, USA
| | | | | |
Collapse
|
24
|
Dabash S, Elabd A, Potter E, Fernandez I, Gerzina C, Thabet AM, McGarvey W, Abdelgawad A. Adding deltoid ligament repair in ankle fracture treatment: Is it necessary? A systematic review. Foot Ankle Surg 2019; 25:714-720. [PMID: 30482440 DOI: 10.1016/j.fas.2018.11.001] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 08/18/2018] [Accepted: 11/02/2018] [Indexed: 02/04/2023]
Abstract
BACKGROUND Deltoid ligament injuries are typically caused by supination-external rotation or pronation injury. Numerous ligament reconstruction techniques have been proposed; however, clear indications for operative repair have not yet been well established in the literature. METHODS We reviewed primary research articles comparing ORIF treatment for ankle fracture with versus without deltoid ligament repair. RESULTS Five studies were identified with a total of 281 patients. 137 patients underwent ORIF with deltoid repair, while 144 patients underwent ORIF without deltoid ligament repair. Clinical, radiographic, and functional outcomes, as well as complications were considered. The average follow-up was 31 months (range, 5-120). CONCLUSIONS Current literature does not provide clear indication for repair of the deltoid ligament at the time of ankle fracture repair. There may be some advantages of adding deltoid ligament repair for patients with high fibular fractures or in patients with concomitant syndesmotic fixation. LEVEL OF CLINICAL EVIDENCE III.
Collapse
Affiliation(s)
- Sherif Dabash
- Department of Orthopaedic Surgery, The University of Texas Health Science Center at Houston, 6431 Fannin Street, Houston, TX, 77030, United States.
| | - Ahmed Elabd
- Department of Orthopaedic Surgery & Rehabilitation, Texas Tech University Health Sciences Center - El Paso, 4801 Alberta Avenue, El Paso, TX, 79905 United States
| | - Eric Potter
- Department of Medical Education, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center - El Paso, Medical Education Building 2200, 5001 El Paso Drive, El Paso, TX, 79905, United States
| | - Isaac Fernandez
- Department of Orthopaedic Surgery & Rehabilitation, Texas Tech University Health Sciences Center - El Paso, 4801 Alberta Avenue, El Paso, TX, 79905 United States
| | - Chris Gerzina
- Department of Medical Education, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center - El Paso, Medical Education Building 2200, 5001 El Paso Drive, El Paso, TX, 79905, United States
| | - Ahmed M Thabet
- Department of Orthopaedic Surgery & Rehabilitation, Texas Tech University Health Sciences Center - El Paso, 4801 Alberta Avenue, El Paso, TX, 79905 United States
| | - William McGarvey
- Department of Orthopaedic Surgery, The University of Texas Health Science Center at Houston, 6431 Fannin Street, Houston, TX, 77030, United States
| | - Amr Abdelgawad
- Department of Orthopaedic Surgery & Rehabilitation, Texas Tech University Health Sciences Center - El Paso, 4801 Alberta Avenue, El Paso, TX, 79905 United States
| |
Collapse
|
25
|
Dabash S, Eisenstein ED, Potter E, Kusnezov N, Thabet AM, Abdelgawad AA. Unstable Ankle Fracture Fixation Using Locked Fibular Intramedullary Nail in High-Risk Patients. J Foot Ankle Surg 2019; 58:357-362. [PMID: 30612876 DOI: 10.1053/j.jfas.2018.08.033] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [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: 10/23/2017] [Indexed: 02/03/2023]
Abstract
Open reduction internal fixation is the gold standard for unstable ankle fracture fixation; however, complications in patients with multiple medical comorbidities are common. Intramedullary nail fixation of the fibula can help to mitigate these difficulties. A retrospective chart review was performed on all patients who underwent fixation for unstable ankle fracture between January 2015 and March 2016 at our level I trauma center. Comorbidities in the patient sample included were one or several of diabetes, renal disease, hypertension, advanced age with osteoporosis, hemorrhagic blisters, and alcoholism. The primary outcomes studied were wound complications, infections, and hardware failure or failure of fixation. Eighteen patients with a mean age of 61 years underwent fibular intramedullary nail fixation, all of whom were considered at high risk for postoperative complications. Patients presented with Weber B or C fracture patterns. All patients had syndesmotic fixation through the nail by one or two 3.5-mm tricortical screws. A medial malleolus was added if needed for stability. The average follow-up time was 291.1 (range 9 to 14 months) days. The prescribed range of time to weightbearing was 2 to 6 weeks. All patients maintained reduction of the fracture and had no wound complications. No syndesmotic screws broke postoperatively, although most patients to failed comply with the postoperative non-weightbearing restrictions. Intramedullary nailing of the fibula with syndesmotic intranail fixation is minimally invasive, quick, and provides adequate fixation strength. It offers a viable treatment option for patients at high risk for complications or who are suspected to have difficulty with follow-up or compliance.
Collapse
Affiliation(s)
- Sherif Dabash
- Foot and Ankle Clinical Fellow, Department of Orthopaedic Surgery, University of Texas Health Science Center at Houston, Houston, TX
| | | | - Eric Potter
- Medical Student, Texas Tech University Health Science Center/Paul L. Foster School of Medicine, El Paso, TX
| | - Nicholas Kusnezov
- Orthopaedic Surgery Resident, William Beaumont Army Medical Center, El Paso, TX
| | - Ahmed M Thabet
- Associate Professor of Orthopaedic Surgery, Texas Tech University Health Science Center/Paul L. Foster School of Medicine, El Paso, TX
| | - Amr A Abdelgawad
- Chairman of Orthopedic Department, Texas Tech University Health Science Center/Paul L. Foster School of Medicine, El Paso, TX.
| |
Collapse
|
26
|
Bove F, Sala F, Capitani P, Thabet AM, Scita V, Spagnolo R. Treatment of fractures of the tibial plateau (Schatzker VI) with external fixators versus plate osteosynthesis. Injury 2018; 49 Suppl 3:S12-S18. [PMID: 30415663 DOI: 10.1016/j.injury.2018.09.059] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [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: 06/23/2018] [Revised: 09/29/2018] [Accepted: 09/30/2018] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The purpose of this study was to determine the effectiveness of circular external fixation (CEF) as a definitive treatment option for patients with complex tibial plateau fractures (Schatzker VI) compared with the outcomes of a fixed angle locking plates' group. METHODS Level III evidence. Retrospective, comparative study in a Level I Trauma Center. Fourteen patients treated with CEF (Group A) were compared to fourteen patients treated with minimal invasive angle locking plates (Group B). The mean time from fractures to surgery was 19 days for Group A with a mean ISS of 24 and 7 days for Group B with a mean ISS of 14. The main outcome measures were clinical and radiographic. RESULTS Complete union was obtained in Group A at an average of 22 weeks and at 17 weeks in Group B. Two patients developed non-union, one in each group. Normal alignment was observed in both groups, no statistical differences were observed in Paley's anatomical posterior proximal tibial angle (aPPTA) and mechanical medial proximal tibial angle (mMPTA) between two groups. Results based on the Association for the Study and Application of the Method of Ilizarov criteria for Group A: 71% excellent and 29% good as far as bone outcomes are concerned and as 57% excellent, 37% good, and 7% fair for functional outcomes. CONCLUSIONS Definitive fixation with circular external fixator is effective in complex Schatzker VI tibial plateau fractures. Advantages include maintaining the frame till union, reduced risk of infection, early mobilization, restoration of the normal lower extremity alignment, versatility, and improved union rate in patients with multiple traumatic injuries, infection, and soft tissue injuries.
Collapse
Affiliation(s)
- Federico Bove
- Department of Orthopedic Surgery and Traumatology, Niguarda Hospital, Milan, Italy.
| | - Francesco Sala
- Department of Orthopedic Surgery and Traumatology, Niguarda Hospital, Milan, Italy.
| | - Paolo Capitani
- Department of Orthopedic Surgery and Traumatology, Niguarda Hospital, Milan, Italy.
| | - Ahmed M Thabet
- Department of Orthopaedic Surgery & Rehabilitation, Texas Tech University Health Sciences Center El Paso, Paul L. Foster School of Medicine, El Paso, Texas, USA.
| | - Valentina Scita
- Department of Orthopedic Surgery and Traumatology, Niguarda Hospital, Milan, Italy.
| | - Rosario Spagnolo
- Department of Orthopedic Surgery and Traumatology, San Giovanni Bianco Hospital, Bergamo, Italy.
| |
Collapse
|
27
|
Dabash S, Gerzina C, Prabhakar G, Thabet AM, Jeon S, Heinrich SD. Screw fixation for supracondylar humerus fractures in children: a report of seventeen cases. Eur J Orthop Surg Traumatol 2018; 29:575-581. [PMID: 30334099 DOI: 10.1007/s00590-018-2316-6] [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] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Accepted: 09/16/2018] [Indexed: 11/30/2022]
Abstract
PURPOSE Supracondylar fractures in the pediatric population are common. For years, K-wires have been the preferred method of surgical fixation. However, fixation with K-wires alone may lead to multiple complications. This study reports the results of surgical care of supracondylar humerus fractures using screw fixation with K-wires or screw fixation alone. METHODS This study retrospectively reviewed all patients with supracondylar humerus fractures treated with screw fixation between 2007 and 2013. Patients treated only with smooth wires, or having a displaced medial epicondyle, or presenting with lateral condyle fractures were excluded from the study. Flynn's criteria were used to determine the outcome. RESULTS Seventeen patients who met inclusion criteria formed the study group. All patients were followed until union, resolution of complications, and return to preinjury activity level. Satisfactory outcome was reported in 70.6% of patients with less than 15° loss of either flexion or extension. Mean time to union was 6.5 weeks (range 3.3-12.1 weeks). Screw fixation alone had a shorter mean time to union (5.5 weeks) than compared screw fixation with K-wires group (6.9 weeks). Full range of motion following surgical invention was associated with Flynn's criteria (p value = 0.044). CONCLUSION Screw fixation for pediatric supracondylar fractures is a viable option to achieve healing and early motion in highly unstable fractures as well as fractures which require (1) increased stability, (2) maintenance of stability during wound checks in the immediate postoperative period and after discontinuation of the cast, or (3) if further exploration like associated vascular injury is warranted.
Collapse
Affiliation(s)
- Sherif Dabash
- Orthopaedics Department, University of Texas Health Science Center at Houston, Houston, USA.
| | - Chris Gerzina
- Orthopaedics Department, Texas Tech University Health Sciences Center, El Paso, TX, USA
| | - Gautham Prabhakar
- Orthopaedics Department, Texas Tech University Health Sciences Center, El Paso, TX, USA
| | - Ahmed M Thabet
- Orthopaedics Department, Texas Tech University Health Sciences Center, El Paso, TX, USA
| | - Soyoung Jeon
- Statistical Consulting Laboratory, Department of Mathematical Sciences, University of Texas at El Paso (UTEP), El Paso, USA
| | | |
Collapse
|
28
|
Eisenstein ED, Misenhimer JJ, Kotb A, Thabet AM, Abdelgawad AA. Management of displaced midshaft clavicle fractures in adolescent patients using intramedullary flexible nails: A case series. J Clin Orthop Trauma 2018; 9:S97-S102. [PMID: 29628708 PMCID: PMC5883898 DOI: 10.1016/j.jcot.2017.06.019] [Citation(s) in RCA: 3] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 05/19/2017] [Accepted: 06/29/2017] [Indexed: 01/31/2023] Open
Abstract
INTRODUCTION Clavicle fractures are common injuries in adolescent patients. In this study we present our technique and results for treating non-comminuted displaced midshaft clavicle fractures using flexible intra medullary nails. METHODS A retrospective review of prospectively collected data using the electronic medical record was performed. Adolescent patients presenting to a level one pediatric trauma center with acute displaced non comminuted clavicular shaft fractures who were treated with intra medullary flexible nails were included in this study. RESULTS Seven adolescent patients with non-comminuted displaced mid shaft clavicle fractures were treated with flexible nails over a period of five and half years with an average follow up time of 10 months. The average age was 14.6 years (range 14-16), and a 2 mm nail was used in all cases. Closed reduction was obtained in five cases with only two cases needing open reduction to pass the nail. One patient had skin breakdown over the nail entry and had the nail removed in clinic two months after surgery, all other patients healed with no complication. Sports and full shoulder activity were allowed when radiographic healing was seen at an average 8 weeks. Implant removal was performed four of the seven patients. CONCLUSION Flexible intramedullary nailing is an effective minimally invasive method for the treatment of displaced midshaft clavicle fractures in the adolescent population. The surgeon should be aware that a 2 mm nail is likely the optimal diameter, and the nail is difficult to pass beyond the lateral 2-3 cm of the distal segment due to canal narrowing, but passage further than this is not necessary to achieve stability and union. Following these pearls will allow the surgeon to successfully perform the procedure.
Collapse
Affiliation(s)
- Emmanuel D. Eisenstein
- Department of Orthopaedic Surgery, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, TX 79905, United States
| | - Jennifer J. Misenhimer
- Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, TX 79905, United States
| | - Ahmed Kotb
- Ain Shams University, Abbassia Square, Cairo, Egypt
| | - Ahmed M. Thabet
- Department of Orthopaedic Surgery, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, TX 79905, United States
| | - Amr A. Abdelgawad
- Department of Orthopaedic Surgery, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, TX 79905, United States,Corresponding author.
| |
Collapse
|
29
|
Dabash S, Prabhakar G, Potter E, Thabet AM, Abdelgawad A, Heinrich S. Management of growth arrest: Current practice and future directions. J Clin Orthop Trauma 2018; 9:S58-S66. [PMID: 29628701 PMCID: PMC5883917 DOI: 10.1016/j.jcot.2018.01.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [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: 11/11/2017] [Revised: 12/26/2017] [Accepted: 01/04/2018] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION Premature growth arrest can pose a challenge to the orthopedic surgeon. Various options for treating physeal arrest exist. METHODS Systematic searches were conducted on PubMed/Medline, ScienceDirect, OVID, and Cochrane Library. Secondary searching was performed, where certain articles from reference lists of the selected studies were reviewed that were not found in the primary search. RESULTS This review article discusses the different methods of management for premature growth arrest. CONCLUSIONS The use of mesenchymal stem cells provides a promising alternative treatment modality.
Collapse
Affiliation(s)
- Sherif Dabash
- Department of Orthopaedic Surgery, University of Texas Health Science Center at Houston, United States,Corresponding author.
| | - Gautham Prabhakar
- Department of Orthopaedic Surgery & Rehabilitation/Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, TX, United States
| | - Eric Potter
- Department of Orthopaedic Surgery & Rehabilitation/Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, TX, United States
| | - Ahmed M. Thabet
- Department of Orthopaedic Surgery & Rehabilitation/Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, TX, United States
| | - Amr Abdelgawad
- Department of Orthopaedic Surgery & Rehabilitation/Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, TX, United States
| | - Stephen Heinrich
- Department of Orthopaedics, Tulane University, New Orleans, LA, United States
| |
Collapse
|
30
|
Thabet AM, Simson JE, Gerzina C, Dabash S, Adler A, Abdelgawad AA. The impact of acute compartment syndrome on the outcome of tibia plateau fracture. Eur J Orthop Surg Traumatol 2017; 28:85-93. [PMID: 28785833 DOI: 10.1007/s00590-017-2017-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [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: 05/03/2017] [Accepted: 07/15/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND Acute compartment syndrome (ACS) is often associated with tibial plateau fractures and is a limb-threatening injury. Staged management through fasciotomy with delayed definitive fixation can prevent muscle necrosis and increase limb salvage rates. This procedure opens a large area for potential contamination and infection in the lower extremity. Recent studies have shown an increased risk of infection following fasciotomy and staged management for tibial plateau fractures. This study reports the rate of infection, delayed union, and nonunion in patients with this injury pattern. METHODS This study was a retrospective chart review, which received institutional review board approval. It surveyed patient radiographs, clinical notes, and operating room reports from a level I trauma center between 2010 through 2016. RESULTS The results demonstrated that 23 out of 221 consecutive patients with ACS of the lower extremity presented with tibial plateau fracture over a 65-month period. Of these 23 patients, four were lost to follow-up or died. Nineteen patient charts were surveyed, 63% were male (12/19) and 37% were female (7/19). One patient developed deep infection (5.3%). Three patients experienced delayed union (15.8%), and their fractures eventually achieved union without intervention. The mean time to union was 14 weeks. Schatzker type V/VI fractures were the most prevalent type of fractures seen among patients. CONCLUSION The infection rate found is lower than in other recently published studies. The incidence of delayed union or nonunion of the fracture was also lower than in other publications in the literature. Early decompression through double- or single-incision fasciotomy does not increase the risk of infection or nonunion of the fracture. The delayed union rates found in this study are lower than those in previous studies. LEVEL OF EVIDENCE Level IV prognostic.
Collapse
Affiliation(s)
- Ahmed M Thabet
- Department of Orthopaedic Surgery and Rehabilitation, Texas Tech University Health Sciences Center, 4801 Alberta Ave, El Paso, TX, 79905, USA
| | - Joshua E Simson
- Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, TX, USA
| | - Chris Gerzina
- Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, TX, USA
| | - Sherif Dabash
- Department of Orthopaedic Surgery and Rehabilitation, Texas Tech University Health Sciences Center, 4801 Alberta Ave, El Paso, TX, 79905, USA
| | - Adam Adler
- Department of Orthopaedic Surgery and Rehabilitation, Texas Tech University Health Sciences Center, 4801 Alberta Ave, El Paso, TX, 79905, USA
| | - Amr A Abdelgawad
- Department of Orthopaedic Surgery and Rehabilitation, Texas Tech University Health Sciences Center, 4801 Alberta Ave, El Paso, TX, 79905, USA.
| |
Collapse
|
31
|
Kusnezov N, Prabhakar G, Dallo M, Thabet AM, Abdelgawad AA. Bone grafting via reamer-irrigator-aspirator for nonunion of open Gustilo-Anderson type III tibial fractures treated with multiplanar external fixator. SICOT J 2017; 3:30. [PMID: 28387196 PMCID: PMC5384319 DOI: 10.1051/sicotj/2017002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [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: 09/30/2016] [Accepted: 12/27/2016] [Indexed: 11/30/2022] Open
Abstract
Introduction: The purpose of this investigation was to evaluate the outcomes following reamer-irrigator-aspirator (RIA) autogenous bone grafting (ABG) of high-grade open tibia fracture nonunions stabilized via multiplanar external fixation. Methods: We retrospectively reviewed all patients with Gustilo-Anderson type III open tibia fractures treated with multiplanar external fixation and who underwent RIA ABG for nonunion at our institutional Level 1 Trauma Center between 2008 and 2015. All patients between 15 and 65 years of age with a minimum of six-month follow-up were included. The primary outcomes of interest were achievement of union, time to union, and incidence of revision surgery. Complications and all-cause reoperation were recorded as secondary endpoints. Results: Fifteen patients met the inclusion criteria with a mean age of 41.1 ± 14.0 years. RIA ABG was harvested from the femur in all cases, with a mean volume of 34 ± 15 mL. At an average follow-up of 13.3 ± 6.8 months, all patients achieved union, including two who required repeat RIA ABG. One patient experienced a femoral shaft fracture four months following RIA that required intramedullary fixation. The average time to union was 6.0 ± 6.3 months. Twelve patients (80%) went on to union within six months and 13 (86.7%) within one year. Five patients experienced a total of six post-operative complications including three deep infections, one refracture through the nonunion site, and one gradual varus deformity. Two patients in this series required a subsequent RIA autografting procedure secondary to persistent nonunion despite initial RIA. Conclusion: We found that RIA ABG offered a reliable solution to nonunion of Gustilo-Anderson type III open tibial fractures treated with multiplanar external fixation, circumventing the need to change the method of fixation.
Collapse
Affiliation(s)
- Nicholas Kusnezov
- Department of Orthopaedic Surgery and Rehabilitation, Texas Tech University Health Sciences Center, El Paso, TX 79905, USA
| | - Gautham Prabhakar
- Department of Orthopaedic Surgery and Rehabilitation, Texas Tech University Health Sciences Center, El Paso, TX 79905, USA
| | - Matthew Dallo
- Department of Orthopaedic Surgery and Rehabilitation, Texas Tech University Health Sciences Center, El Paso, TX 79905, USA
| | - Ahmed M Thabet
- Department of Orthopaedic Surgery and Rehabilitation, Texas Tech University Health Sciences Center, El Paso, TX 79905, USA
| | - Amr A Abdelgawad
- Department of Orthopaedic Surgery and Rehabilitation, Texas Tech University Health Sciences Center, El Paso, TX 79905, USA
| |
Collapse
|
32
|
Kusnezov NA, Eisenstein ED, Diab N, Thabet AM, Abdelgawad A. Medial Malleolar Fractures and Associated Deltoid Ligament Disruptions: Current Management Controversies. Orthopedics 2017; 40:e216-e222. [PMID: 27992638 DOI: 10.3928/01477447-20161213-02] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Accepted: 05/24/2016] [Indexed: 02/03/2023]
Abstract
Operative fixation of medial malleolar fractures, whether isolated or in the setting of bi- or trimalleolar fractures, remains controversial. Increasingly, anatomic reduction and internal fixation is used to treat medial malleolar fractures to avoid long-term sequelae of symptomatic nonunion and posttraumatic osteoarthritis. However, outcomes have not been significantly different between operative and nonoperative cohorts. Repair of associated deltoid ligament disruption is not common because of reportedly poor outcomes. This review provides an overview of the literature on medial malleolar fracture fixation and current treatment options. [Orthopedics. 2017; 40(2):e216-e222.].
Collapse
|
33
|
Ghate S, Thabet AM, Gosey GM, Southern EP, Bégué RE, King AG. Primary Osteomyelitis of the Clavicle in Children. Orthopedics 2016; 39:e760-3. [PMID: 27280623 DOI: 10.3928/01477447-20160526-10] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Accepted: 07/22/2015] [Indexed: 02/03/2023]
Abstract
Osteomyelitis of the clavicle is a rare entity with a broad differential diagnosis and high potential for complications if not diagnosed promptly and treated appropriately. The threshold for surgical intervention should be low to prevent osteonecrosis and bony resorption. In addition, although rare, life-threatening complications have been reported. This report describes primary osteomyelitis of the clavicle that was diagnosed in a 22-month-old girl on her third clinical evaluation after 4 days of symptoms. She presented to a children's tertiary care emergency department with fever and acute pain and swelling of her right shoulder and arm. The diagnosis was confirmed through clinical, laboratory, and imaging studies including ultrasound; these revealed subperiosteal abscess formation, which may have developed in part as the result of a delayed diagnosis from the 2 prior emergency department visits. The patient was treated initially with intravenous antibiotics and underwent therapeutic as well as diagnostic needle-guided tissue aspiration under ultrasound guidance. This ruled out malignancy but was not curative, and the subperiosteal abscess recurred within 24 hours, prompting formal operative irrigation and debridement. The patient was seen for 12-month follow-up and has had no complications or evidence of recurrence. This case emphasizes the need for a high index of suspicion to prevent diagnostic delays as well as the importance of a low threshold for surgical debridement to minimize the potential for complications that could prolong the treatment course. [Orthopedics. 2016; 39(4):e760-e763.].
Collapse
|
34
|
Lamm BM, Gourdine-Shaw MC, Thabet AM, Jindal G, Herzenberg JE, Burghardt RD. Distraction osteogenesis for complex foot deformities: Gigli saw midfoot osteotomy with external fixation. J Foot Ankle Surg 2014; 53:567-76. [PMID: 24891089 DOI: 10.1053/j.jfas.2014.04.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [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: 11/01/2013] [Indexed: 02/03/2023]
Abstract
Open midfoot wedge osteotomy correction can cause neurovascular compromise, requires extensive exposure, sacrifices normal joints, and shortens the foot. We used a minimally invasive technique to treat complex foot deformities by combining percutaneous Gigli saw midfoot osteotomy, circular external fixation, and acute, gradual, or gradual with acute manipulation correction. The medical records of 23 patients (26 feet) with complex foot deformities (congenital, 18 feet; neuromuscular, 4 feet; post-traumatic, 3 feet; malunion, 1 foot) who had undergone treatment within an 18-year period (1990 through 2007) were retrospectively reviewed. We also performed the procedure on 10 cadaveric limbs to determine whether anatomic structures were at risk. Correction was achieved in all feet. The mean duration of external fixation treatment was 4.2 (range 3 to 7) months. The mean follow-up duration was 4.7 (range 2 to 18) years. A significant difference was observed in the pre- and postoperative, lateral view, talar-first metatarsal angle (p = .001). Minor complications (4 feet) consisted of bony exostoses. Major complications included recurrent deformity in 3 feet and sural nerve entrapment in 1 foot. Two patients had mild and one moderate foot pain. Three patients had impaired gait function; the remaining patients had functional gait. The mean interval until wearing regular shoes after external fixation removal was 2.3 (range 1 to 4) months. All but 1 of the patients were satisfied with the final results. We observed no cadaveric neurovascular injury. Our results have shown that percutaneous Gigli saw midfoot osteotomy can be performed without neurovascular injury and is capable of successfully correcting complex foot deformities.
Collapse
Affiliation(s)
- Bradley M Lamm
- Head of Foot and Ankle Surgery and Director, Foot and Ankle Deformity Correction Fellowship, International Center for Limb Lengthening, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, MD.
| | - Monique C Gourdine-Shaw
- Chief of Podiatry, Department of Orthopaedics, Walter Reed National Military Medical Center, Bethesda, MD
| | - Ahmed M Thabet
- Lecturer of Orthopedics, Orthopedics Department, Benha University, Benha, Egypt
| | - Gaurav Jindal
- Unit Head, Department of Orthopaedics, Pushpanjali Crosslay Hospital, Ghaziabad, Uttar Pradesh, India
| | - John E Herzenberg
- Director, International Center for Limb Lengthening, Rubin Institute for Advanced Orthopedics and Director, Pediatric Orthopedics, Sinai Hospital of Baltimore, Baltimore, MD; and Clinical Professor, Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD
| | | |
Collapse
|
35
|
Thabet AM, Kowtharapu DN, Miller F, Dabney KW, Shah SA, Rogers K, Holmes L. Wrist fusion in patients with severe quadriplegic cerebral palsy. Musculoskelet Surg 2012; 96:199-204. [PMID: 22893448 DOI: 10.1007/s12306-012-0217-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2011] [Accepted: 07/25/2012] [Indexed: 06/01/2023]
Abstract
We report clinical and radiographic outcomes of wrist fusion achieved with pin or plate fixation in 14 patients with severe quadriplegic cerebral palsy (CP) (19 wrists). Average patient age at the time of surgery was 16.8 ± 1.7 years (14-20 years). Mean follow-up time for the 14 patients was 5.9 ± 3.1 years (range, 1-11 years). Indication for surgery was severe wrist deformity that interfered with hygienic care. Few complications occurred, and outcomes were satisfactory. Statistically significant mean difference was shown between the pre- and postoperative radiographic angles (37°, P = 0.001, and 24°, P = 0.04, for lateral and anteroposterior views, respectively). Caregivers reported that appearance was the most perceived rationale for surgery (63 %). Improved hygienic care was the primary perceived benefit. The majority (88 %) were satisfied with the results. We recommend wrist fusion to improve hygienic care, positioning, and appearance of the wrist, hand, and fingers in patients with severe quadriplegic CP.
Collapse
Affiliation(s)
- Ahmed M Thabet
- Department of Orthopedics, Alfred I. duPont Hospital for Children, Nemours Children's Clinic, 1600 Rockland Road, Wilmington, DE 19803, USA.
| | | | | | | | | | | | | |
Collapse
|
36
|
Thabet AM, Catagni MA, Guerreschi F. Total hip replacement fifteen years after pelvic support osteotomy (PSO): a case report and review of the literature. Musculoskelet Surg 2012; 96:141-7. [PMID: 22237840 DOI: 10.1007/s12306-011-0178-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2011] [Accepted: 12/26/2011] [Indexed: 10/14/2022]
Abstract
Treatment of chronic hip instability in children and young adults is challenging. Proximal femoral osteotomy had been suggested to provide pelvic stability and improved abductor function. Total hip replacement after pelvic support osteotomy can be challenging due to altered anatomy due to angulation of the proximal femur in both frontal and sagittal planes. This is a 29-year-old woman who had total hip replacement after pelvic support osteotomy. The patient had pelvic support at the age of 14 years. Pelvic support osteotomy delayed the need for total hip replacement for 15 years. Preoperative planning for total hip replacement with model was used for proper understanding of the anatomy of the proximal femur. Revision of femoral component was necessary due to penetration of the proximal femur. In conclusion, total hip replacement after pelvic support osteotomy is a technically demanding procedure, and careful attention to surgical details is necessary for successful outcome.
Collapse
Affiliation(s)
- Ahmed M Thabet
- Orthopedics Department, Benha Medical School, Benha, Egypt.
| | | | | |
Collapse
|
37
|
Latalski M, Elbatrawy YA, Thabet AM, Gregosiewicz A, Raganowicz T, Fatyga M. Enhancing bone healing during distraction osteogenesis with platelet-rich plasma. Injury 2011; 42:821-4. [PMID: 21513935 DOI: 10.1016/j.injury.2011.03.010] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2010] [Revised: 02/18/2011] [Accepted: 03/07/2011] [Indexed: 02/02/2023]
Abstract
UNLABELLED Gradual limb lengthening with external fixators using distraction osteogenesis principles is the gold standard for treatment of limb-length discrepancy. However, long treatment time is a major disadvantage of the current lengthening procedures. Efforts to decrease the treatment include biological and biomechanical factors. Injection of platelet-rich plasma (PRP) is a biological method to enhance bone healing during distraction osteogenesis. We hypothesised that PRP can enhance bone healing during limb lengthening. We report our experience with the use of PRP during distraction osteogenesis. This retrospective study included 19 patients divided into the standard group of 10 patients who did not receive PRP and the PRP group of nine patients who received PRP at the end of the distraction phase. The study variables included external fixator time, external fixation index, and complications during treatment. The PRP group had statistically significantly shorter treatment time (p=0.0412). Injection of PRP into regenerate bone might be an effective method to shorten treatment time during limb lengthening and lead to better functional outcomes and improved patient satisfaction. LEVEL OF EVIDENCE Level IV, therapeutic study.
Collapse
Affiliation(s)
- Michał Latalski
- Children Orthopedic Department Medical University, Lublin, Poland
| | | | | | | | | | | |
Collapse
|
38
|
Thabet AM, Al Ghamdi H, Abdulla T, Elhelou MW, Vostanis P. Attention deficit-hyperactivity symptoms among Palestinian children. East Mediterr Health J 2010; 16:505-510. [PMID: 20799549] [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: 05/29/2023]
Abstract
We aimed to establish the prevalence and distribution of attention deficit-hyperactivity disorder (ADHD) symptoms and other associated comorbid mental health problems in Palestinian schoolchildren. Thus 349 children aged 6-15 years were randomly selected from 23 schools in Gaza and the West Bank and were rated by their parents and teachers using both the ADHD DSM-IV Checklist and the Strengths and the Difficulties Questionnaire, which also measures conduct and emotional problems. There was a significant agreement between parents and teachers, with 4.3% of the children rated above the established cut-off scores on both the parent and teacher DSM-IV Checklist. Male gender, family size and living in an area of socioeconomic deprivation were independently associated with ADHD symptoms.
Collapse
Affiliation(s)
- A M Thabet
- Department of Community Mental Health, Al Quds University, Gaza
| | | | | | | | | |
Collapse
|
39
|
Lovisetti G, Sala F, Thabet AM, Catagni MA, Singh S. Osteocutaneous thermal necrosis of the leg salvaged by TSF/Ilizarov reconstruction. Report of 7 patients. Int Orthop 2010; 35:121-6. [PMID: 20177894 DOI: 10.1007/s00264-010-0952-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2009] [Revised: 12/30/2009] [Accepted: 01/05/2010] [Indexed: 11/28/2022]
Abstract
Injudicious reaming of the tibial shaft can lead to extreme local hyperthermia, which in turn can result in the rare but catastrophic complication of segmental bone and soft tissue necrosis (osteocutaneous thermal necrosis). This is a retrospective study showing osteocutaneous thermal necrosis occurring after tibial intramedullary reaming salvaged by Ilizarov reconstruction in seven patients from the collective experience of four limb reconstruction centres. All patients were males, with an average age of 51.8 years (range, 30-70 years), who had undergone intramedullary reaming during the treatment of closed tibial fractures. In all patients, circumferential bone and variable contiguous soft tissue necrosis developed a few days after reaming. Bone and soft tissue reconstruction was subsequently performed using a circular external fixator (Ilizarov apparatus or Taylor spatial frame) a mean of four months after injury in six patients; in one case, reconstruction was undertaken four years after the original injury. Two complications (secondary tissue breakdown at a bone transport site; premature consolidation) necessitated cessation of bone transport at one of two bone transport levels in two patients. All patients eventually healed with a good functional result after an average of 11.5 months in the fixator (range, 10-13 months).
Collapse
Affiliation(s)
- Giovanni Lovisetti
- Department of Orthopedic Surgery and Traumatology, Menaggio Hospital, Como, Italy
| | | | | | | | | |
Collapse
|
40
|
Wee J, Rahman T, Seliktar R, Akins R, Levine D, Richardson D, Dodge GR, Thabet AM, Holmes L, Mackenzie WG. Force feedback in limb lengthening. Annu Int Conf IEEE Eng Med Biol Soc 2010; 2010:5109-5112. [PMID: 21095804 DOI: 10.1109/iembs.2010.5626190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
A new variable-rate distraction system using a motorized distractor driven by feedback from the distraction force was designed. The distractor was mounted on a unilateral fixator and attached to the tibiae of 6 sheep that underwent distraction osteogenesis. The sheep were divided equally into 3 groups. In group 1, the forces were recorded but were not used to drive the lengthening rate. In group 2, force feedback was used and the desired distraction force level was set to 300 N and the initial rate was 1 mm/day. Group 3 also underwent force feedback with the desired force limit at 300 N, but the rate change was initiated earlier, at 200 N. The distraction force was recorded at 15 second intervals throughout the distraction phase and stored onboard the distractor.
Collapse
Affiliation(s)
- Jinyong Wee
- School of Biomedical Engineering Science and Health Systems, Drexel University, Philadelphia PA, USA.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
41
|
Kowtharapu DN, Thabet AM, Holmes L, Kruse R. Osteochondral flap avulsion fracture in a child with forearm compartment syndrome. Orthopedics 2008; 31:805. [PMID: 19292414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Traumatic elbow dislocations account for approximately 3% to 6% of childhood upper extremity injuries, and 41% of these dislocations are concomitant injuries around the elbow. Most of these injuries are associated with a fall on an outstretched hand. Compartment syndrome is one recognized complication after elbow dislocation and distal humeral and radial neck fracture. Compartment syndrome in the forearm is a devastating complication in children with forearm, elbow, and supracondylar fractures. Compartment syndrome occurs as the result of hypoxic damage caused by interruption of the circulation to the muscles. Any evidence of compartment syndrome requires compartment pressure measurements and possibly fasciotomy. Fasciotomy is recommended in the presence of clinical signs of compartment syndrome, such as undue pain (out of proportion to severity of injury), pallor, paresthesia, absent or deficient pulse, and paralysis of the limb. Osteochondral flap avulsion fracture is a rare clinical presentation in pediatric elbow injuries. To our knowledge only 8 cases have been reported in the literature. Our case is different from others in terms of delayed presentation, and is associated with olecranon fracture and forearm compartment syndrome. This case reemphasizes the anatomy of the semilunar notch of the proximal ulna and the importance of careful clinical and radiological examination in the treatment of childhood elbow injuries.
Collapse
Affiliation(s)
- Durga Nagaraju Kowtharapu
- Orthopedic Surgery, Alfred I. Dupont Hospital for Children, 1600 Rockland Rd, Wilmington, DE 19803, USA
| | | | | | | |
Collapse
|
42
|
Kruse RW, Thabet AM, Kowtharapu DN, Rahman T, Henley J. Functional Impact of a Long Arm Cast on Daily Activities and Sports in Children and Adolescents. Med Sci Sports Exerc 2008. [DOI: 10.1249/01.mss.0000321616.72790.54] [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: 11/21/2022]
|