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Holzer E, Moisan P, Keshet D, Bernstein M. Surgical Treatment of Leg Length Discrepancy and Knee Flexion Contracture Associated with a Congenital Absence of Quadriceps. Case Rep Orthop Res 2021. [DOI: 10.1159/000521428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
We report the case of an 18-year-old male with congenital absence of quadriceps and hypoplasia of the patella who presented with a significant leg length discrepancy (LLD) and knee flexion contracture. Surgical management was aimed toward lengthening the limb, stabilizing the joint, and correcting the knee flexion contracture. Correction of a significant congenital LLD and knee flexion contracture poses challenges due to long-standing altered biomechanics. These are rare conditions for which no accepted surgical algorithms exist. It is essential to anticipate the biomechanical consequences of limb lengthening and flexion contracture correction that might arise and plan comprehensive interventions accordingly.
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Keltz E, Keshet D, Peled E, Zvi Y, Norman D, Keren Y. Interobserver and intraobserver agreement for Letournel acetabular fracture classification system using 3-dimensional printed solid models. World J Orthop 2021; 12:82-93. [PMID: 33614427 PMCID: PMC7866486 DOI: 10.5312/wjo.v12.i2.82] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 12/08/2020] [Accepted: 12/17/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Acetabular fractures pose diagnostic and surgical challenges. They are classified using the Judet-Letournel system, which is based solely on X-ray. However, computed tomography (CT) imaging is now more widely utilized in diagnosing these injuries. The emergence of 3-dimensional (3-D) printing technology in varying orthopedic fields has provided surgeons a solid model that improves their spatial understanding of complex fractures and ability to plan pre-operatively.
AIM To evaluate the reliability of the Judet-Letournel classification system of acetabular fractures, when using either CT imaging or 3-D printed models.
METHODS Seven patients with acetabular fractures underwent pelvic CT imaging, which was then used to create solid, 3-D printed models. Eighteen orthopaedic trauma surgeons responded to questionnaires regarding fracture classification and preferred surgical approach. The same questionnaire was completed using only CT imaging, and two weeks later, using only 3-D printed models. The inter- and intra-observer agreement rates were then analyzed.
RESULTS Inter-observer agreement rates based on CT imaging or 3-D printed models were moderate for fracture classification: κ = 0.44, κ = 0.55, respectively (P < 0.001) and fair for preferred surgical approach: κ = 0.34, κ = 0.29, respectively (P < 0.005). Intra-observer agreement rates for fracture classification and preferred surgical approach comparing CT imaging or 3-D printed models were moderate: κ = 0.48, κ = 0.41, respectively. No significant difference in intra-observer agreement was detected when comparing orthopedic pelvic specialists to general orthopedic traumatologists.
CONCLUSION The Judet-Letournel classification demonstrated only moderate rates of agreement. The use of 3-D printed models increased the inter-observer agreement rates with respect to fracture classification, but decreased it with respect to the preferred surgical approach. This study highlights the role of 3-D printed models in acetabular fractures by improving spatial understanding of these complex injuries, thus providing more reliable fracture diagnoses and alternative viewpoints for pre-operative planning.
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Affiliation(s)
- Eran Keltz
- Division of Orthopedic Surgery, Rambam Health Care Campus, Haifa 3525408, Israel
- Ruth Rappaport Faculty of Medicine, Technion Israel Institute of Technology, Haifa 3200003, Israel
| | - Doron Keshet
- Division of Orthopedic Surgery, Rambam Health Care Campus, Haifa 3525408, Israel
- Ruth Rappaport Faculty of Medicine, Technion Israel Institute of Technology, Haifa 3200003, Israel
| | - Eli Peled
- Division of Orthopedic Surgery, Rambam Health Care Campus, Haifa 3525408, Israel
- Ruth Rappaport Faculty of Medicine, Technion Israel Institute of Technology, Haifa 3200003, Israel
| | - Yoav Zvi
- Department of Orthopaedic Surgery, Montefiore Medical Center, New York, NY 10461, United States
| | - Doron Norman
- Division of Orthopedic Surgery, Rambam Health Care Campus, Haifa 3525408, Israel
- Ruth Rappaport Faculty of Medicine, Technion Israel Institute of Technology, Haifa 3200003, Israel
| | - Yaniv Keren
- Division of Orthopedic Surgery, Rambam Health Care Campus, Haifa 3525408, Israel
- Ruth Rappaport Faculty of Medicine, Technion Israel Institute of Technology, Haifa 3200003, Israel
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Keshet D, Bernstein M, Dahan-Oliel N, Ouellet J, Pauyo T, Rabau O, Saran N, Hamdy R. Management of common elective paediatric orthopaedic conditions during the COVID-19 pandemic: the Montreal experience. J Child Orthop 2020; 14:161-166. [PMID: 32582382 PMCID: PMC7302409 DOI: 10.1302/1863-2548.14.200107] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
PURPOSE To explore safe delays for the treatment of common paediatric orthopaedic conditions when faced with a life-threatening pandemic, COVID-19, and to propose a categorization system to address this question. METHODS Review of the literature related to acceptable delays for treatment of common orthopaedic conditions, experience of healthcare professionals from low resource communities and expertise of experienced surgeons. RESULTS Guidelines for the management of cancellations of elective surgeries during a period of resource reallocation are proposed. Elective cases must not be postponed indefinitely as adverse outcomes may result. Triage of waiting lists should include continuous monitoring of the patient and close communication with families despite social distancing and travel restrictions. Telehealth becomes a necessity. Common orthopaedic conditions are triaged into four groups according to urgency and safe and acceptable delay. Categories proposed are Emergent (life and limb threatening conditions), Urgent (within seven days), Semi-elective (postponed for three months) and Elective (postponed for three to 12 months). In total, 25 common orthopaedic conditions are reviewed and categorized. CONCLUSION Given the uncertainty within healthcare during a pandemic, it is necessary to determine acceptable delays for elective conditions. We report our experience in developing guidelines and propose categorizing elective cases into four categories, based on the length of delay. Telemedicine plays a key role in determining the gravity of each situation and hence the amount of delay. These guidelines will assist others dealing with elective cases in the midst of a crisis. This paper initiates a coordinated effort to develop a consensus statement on safe delays.Published without peer review.
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Affiliation(s)
- Doron Keshet
- Division of Paediatric Orthopaedics, Shriners Hospital for Children-Canada, Montreal, Quebec, Canada,Montreal Children’s Hospital, Montreal, Quebec, Canada,McGill University, Montreal, Quebec, Canada
| | - Mitchell Bernstein
- Division of Paediatric Orthopaedics, Shriners Hospital for Children-Canada, Montreal, Quebec, Canada,Montreal Children’s Hospital, Montreal, Quebec, Canada,McGill University, Montreal, Quebec, Canada
| | - Noemi Dahan-Oliel
- Division of Paediatric Orthopaedics, Shriners Hospital for Children-Canada, Montreal, Quebec, Canada,McGill University, Montreal, Quebec, Canada
| | - Jean Ouellet
- Division of Paediatric Orthopaedics, Shriners Hospital for Children-Canada, Montreal, Quebec, Canada,Montreal Children’s Hospital, Montreal, Quebec, Canada,McGill University, Montreal, Quebec, Canada
| | - Thierry Pauyo
- Division of Paediatric Orthopaedics, Shriners Hospital for Children-Canada, Montreal, Quebec, Canada,Montreal Children’s Hospital, Montreal, Quebec, Canada,McGill University, Montreal, Quebec, Canada
| | - Oded Rabau
- Division of Paediatric Orthopaedics, Shriners Hospital for Children-Canada, Montreal, Quebec, Canada,Montreal Children’s Hospital, Montreal, Quebec, Canada,McGill University, Montreal, Quebec, Canada
| | - Neil Saran
- Division of Paediatric Orthopaedics, Shriners Hospital for Children-Canada, Montreal, Quebec, Canada,Montreal Children’s Hospital, Montreal, Quebec, Canada,McGill University, Montreal, Quebec, Canada
| | - Reggie Hamdy
- Division of Paediatric Orthopaedics, Shriners Hospital for Children-Canada, Montreal, Quebec, Canada,Montreal Children’s Hospital, Montreal, Quebec, Canada,McGill University, Montreal, Quebec, Canada,Correspondence should be sent to Reggie Hamdy, Shriners Hospital for Children-Canada, 1003 Decarie Boulevard, Montreal, Quebec, H4A 0A9, Canada. E-mail:
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Toukan Y, Gur M, Keshet D, Bentur L. Negative Pressure Pulmonary Edema in a Child Following Laryngospasm Triggered by a Laryngeal Mask. Isr Med Assoc J 2019; 21:56-57. [PMID: 30685909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Yazeed Toukan
- Department of Pediatric Surgery, Rambam Health Care Campus, Haifa, Israel
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Michal Gur
- Department of Pediatric Surgery, Rambam Health Care Campus, Haifa, Israel
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Doron Keshet
- Department of Orthopedic Surgery, Rambam Health Care Campus, Haifa, Israel
| | - Lea Bentur
- Department of Pediatric Surgery, Rambam Health Care Campus, Haifa, Israel
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
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Keren Y, Sailofsky S, Keshet D, Barak M. The effect of 'Out of hours surgery Service' in Israel on hip fracture fixation outcomes: a retrospective analysis. Isr J Health Policy Res 2017; 6:27. [PMID: 28709440 PMCID: PMC5512834 DOI: 10.1186/s13584-017-0150-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [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: 09/14/2016] [Accepted: 04/03/2017] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND 'Out of Hours Surgery Service' (OHSS) was implemented in Israel, amongst other reasons, in order to reduce the time interval between hospital admission and surgery and consequently improve outcomes. The OHSS is currently operated in the public hospitals in Israel. In this study we compared the data of patients before and after OHSS implementation to determine its efficacy in improving patient care. METHODS This is a retrospective observational study of 792 adult patients who underwent hip fracture surgery between 2002 and 2007 in a single hospital. The study population included two groups: patients that were operated before the implementation of the OHSS (2002-2004) and after the implementation of the OHSS (2005-2007). Data regarding all patients was collected using the institution's computer program. The following variables were analyzed: patients' demographics, time interval from hospitalization to surgery, causes for delaying surgery, post-operative length of hospitalization and mortality. RESULTS Patients in the post-OHSS group had more illnesses and higher ASA classification than those in the pre-OHSS group. The post-OHSS group had a significantly decreased length of stay in the hospital before and after the surgery. After adjusting for ASA score and age, the post-OHSS group was found to have decreased post-operative hospitalization and lower post-operative mortality. Surgery was delayed in pre-OHSS period mainly due to operating rooms unavailability. CONCLUSION Implementation of OHSS facilitated operating room availability, thus early operation and reduced post-operative mortality. In accordance with other studies, patient's outcome is greatly influenced by the time from admission to hip fracture surgery.
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Affiliation(s)
- Yaniv Keren
- The Department of Orthopedic Surgery, Rambam Health Care Campus and the Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Sybil Sailofsky
- The Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Doron Keshet
- The Department of Orthopedic Surgery, Rambam Health Care Campus, Haifa, Israel
| | - Michal Barak
- The Department of Anesthesiology, Rambam Health Care Campus and the Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, POB 9602, Haifa, 31096, Israel.
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Abstract
The Taylor spatial frame (TSF) is a hexapod external fixator that can correct six-axis deformities. The mathematical base of all hexapod systems is projective geometry, which describes complex repositioning of an object in space. The Taylor brothers developed one of the first six-axis correction systems, which is known today as TSF. Over the years, this system has become the most used six-axis deformity correction device. In this review, we describe the history behind TSF development, and describe the principles and clinical utility for application of the TSF in different settings, such as acute trauma, malunions, and various deformities of the lower and upper limb.
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Affiliation(s)
- Doron Keshet
- Pediatric Orthopedics Unit, Rambam Health Care Center, Haifa, Israel,
| | - Mark Eidelman
- Pediatric Orthopedics Unit, Rambam Health Care Center, Haifa, Israel,
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