1
|
Dixit A, Cautela FS, Cooper CS, Beyer GA, Messina JC, Mait JE, Shah NV, Diebo BG, Paulino CB, Urban WP. ORIF versus arthroplasty for open proximal humerus fractures: Nationwide Inpatient Sample data between 1998 and 2013. J Orthop Traumatol 2018; 19:12. [PMID: 30132086 PMCID: PMC6103959 DOI: 10.1186/s10195-018-0503-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [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] [Received: 09/01/2017] [Accepted: 11/27/2017] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Limited data exists in analyzing open reduction and internal fixation (ORIF) and arthroplasty in the management of open proximal humerus fractures. We analyzed differences in hospital course between these procedures, patient demographics, complication rate, length of stay, hospital charges, and mortality rate. MATERIALS AND METHODS This is a retrospective review of the Nationwide Inpatient Sample database. ICD-9 codes identified patients hospitalized for open proximal humerus fractures from 1998 to 2013 who underwent ORIF or shoulder arthroplasty (hemi-, total, or reverse). Demographics and in-hospital complications were compared. Logistic regression controlling for age, gender, and Deyo index tested the impact of ORIF vs ARTH on any complications. RESULTS Seven hundred thirty patients were included (ORIF, n = 662 vs ARTH, n = 68). ORIF patients were younger (p < 0.001), more likely to be males (p < 0.001), and had a lower Deyo score (p = 0.012). Both groups had comparable complication rates (21.4% vs 18.0%, p = 0.535), lengths of stay (7.86 days vs 7.44 days, p = 0.833), hospital charges ($76,998 vs $64,133, p = 0.360), and mortality rates (0.2% vs 0%, p = 0.761). Type of surgery was not a predictor of any complications (OR = 0.67 [95% CI 0.33-1.35], p = 0.266), extended length of stay (OR = 1.01 [95% CI 0.58-1.78], p = 0.967), or high hospital charges (OR = 1.39 [95% CI 0.68-2.86], p = 0.366). CONCLUSION We revealed no differences in hospital course between ORIF and arthroplasty for management of open proximal humerus fractures. Although differences in demographics existed, no differences in complication rates, length of stay, hospital charges and mortality rates were noted. Future studies can evaluate the long-term outcomes of these procedures. LEVEL OF EVIDENCE Level III.
Collapse
Affiliation(s)
- Anant Dixit
- Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York, Downstate Medical Center, 450 Clarkson Avenue, Box 30, Brooklyn, NY, 11203, USA
| | - Frank S Cautela
- Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York, Downstate Medical Center, 450 Clarkson Avenue, Box 30, Brooklyn, NY, 11203, USA
| | - Colin S Cooper
- Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York, Downstate Medical Center, 450 Clarkson Avenue, Box 30, Brooklyn, NY, 11203, USA
| | - George A Beyer
- Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York, Downstate Medical Center, 450 Clarkson Avenue, Box 30, Brooklyn, NY, 11203, USA
| | - James C Messina
- Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York, Downstate Medical Center, 450 Clarkson Avenue, Box 30, Brooklyn, NY, 11203, USA
| | - Jeffrey E Mait
- Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York, Downstate Medical Center, 450 Clarkson Avenue, Box 30, Brooklyn, NY, 11203, USA
| | - Neil V Shah
- Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York, Downstate Medical Center, 450 Clarkson Avenue, Box 30, Brooklyn, NY, 11203, USA
| | - Bassel G Diebo
- Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York, Downstate Medical Center, 450 Clarkson Avenue, Box 30, Brooklyn, NY, 11203, USA.
| | - Carl B Paulino
- Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York, Downstate Medical Center, 450 Clarkson Avenue, Box 30, Brooklyn, NY, 11203, USA
| | - William P Urban
- Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York, Downstate Medical Center, 450 Clarkson Avenue, Box 30, Brooklyn, NY, 11203, USA
| |
Collapse
|
2
|
Mait JE, Hayes WT, Blum CL, Pivec R, Zaino CJ, Jauregui JJ, Saha S, Uribe JA, Urban WP. A Biomechanical Comparison of Different Tendon Repair Techniques. J Long Term Eff Med Implants 2017; 26:167-171. [PMID: 28094741 DOI: 10.1615/jlongtermeffmedimplants.2016016536] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Previous studies have examined multiple suture techniques for the repair of ruptured tendons. In this study, we investigated how the two- and four-stranded Krackow suture weave techniques compared with a novel Krackow/Bunnell suture technique. Our hypothesis was that the Krackow/Bunnell suture would have greater strength compared with the two- and four-stranded Krackow suture in terms of resistance to pullout from the muscle tendon. Thirty fresh bovine Achilles tendons were assigned randomly to three groups: (1) two-stranded Krackow, (2) fourstranded Krackow, and (3) the Krackow/Bunnell combination. After suture placement, all specimens were subjected to initial cyclic loading (0-200 N for 200 cycles) and then the tension to failure force defined as the pullout through the muscle tendon was evaluated. Significantly greater deformation before suture failure was seen in the Krackow/Bunnell group compared with the four-stranded Krackow construct (36.2 vs. 28.7 mm, p = 0.009), as well as greater energy required to rupture the suture (4635 vs. 3346 N/mm; p = 0.016). There was no significant difference with regard to the force to failure between the two groups (four-stranded Krackow vs. Krackow/Bunnell). The two-stranded Krackow was found to be inferior to both the four-stranded Krakow and the Krakow/Bunnell techniques with regard to load to failure. We have found that the Krackow/Bunnell suture technique is at least comparable to, if not superior to, the four-stranded Krackow technique with regard to deformation before suture failure and energy required to rupture the tendon. Therefore, the Krackow/Bunnell technique may be an optimal construct if the surgeon is concerned about suture pullout through the tendon; however, future studies evaluating this technique in the clinical setting are required before making any final conclusions for patient use.
Collapse
Affiliation(s)
- Jeffrey E Mait
- Department of Orthopaedic Surgery and Rehabilitation Medicine, SUNY Downstate Medical Center, Brooklyn, NY
| | - Westley T Hayes
- Department of Orthopaedic Surgery and Rehabilitation Medicine, SUNY Downstate Medical Center/University Hospital Brooklyn, Brooklyn, NY
| | - Christopher L Blum
- Department of Orthopaedic Surgery and Rehabilitation Medicine, SUNY Downstate Medical Center, Brooklyn, NY
| | - Robert Pivec
- Department of Orthopaedic Surgery and Rehabilitation Medicine, SUNY Downstate Medical Center/University Hospital Brooklyn, Brooklyn, NY
| | - Christian J Zaino
- Department of Orthopaedic Surgery and Rehabilitation Medicine, SUNY Downstate Medical Center, Brooklyn, NY
| | - Julio J Jauregui
- Center for Joint Preservation and Replacement, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland; Department of Orthopaedic Surgery and Rehabilitation Medicine, SUNY Downstate Medical Center/University Hospital Brooklyn, Brooklyn, NY
| | - Subrata Saha
- Biomedical Engineering Program, School of Graduate Studies; Musculoskeletal Research, Dept. Orthopaedic Surgery and Rehabilitation Medicine; Dept. Neurosurgery; Department of Orthopaedic Surgery and Rehabilitation Medicine, SUNY Downstate Medical Center/University Hospital Brooklyn, Brooklyn, NY
| | - Jaime A Uribe
- Department of Orthopaedic Surgery and Rehabilitation Medicine, SUNY Downstate Medical Center/University Hospital Brooklyn, Brooklyn, NY
| | - William P Urban
- Department of Orthopaedic Surgery and Rehabilitation Medicine, SUNY Downstate Medical Center, Brooklyn, NY
| |
Collapse
|
3
|
Mait JE, Perino G, Unnanuntana A, Chang TL, Doty S, Schneider R, Lane JM. Multimodality treatment of a multifocal osteoblastoma-like tumor of the lower extremity. Skeletal Radiol 2012; 41:1153-61. [PMID: 22327394 DOI: 10.1007/s00256-011-1345-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2011] [Revised: 12/07/2011] [Accepted: 12/09/2011] [Indexed: 02/02/2023]
Abstract
Osteoblastoma-like tumor is a rare condition with limited information on its orthopedic management in the current medical literature. The tumor histologically resembles an osteoblastoma, although the radiographic features are similar to those observed in primary vascular lesions. The treatment in the previously reported cases involved aggressive procedures including amputation, en bloc resection, and chemotherapy because of the uncertainty regarding the biological behavior of the tumor. We present a case of this entity that was successfully treated by a combination therapy including intralesional curettage with adjuvant cryotherapy, in situ and intravenous administration of bisphosphonates and radioablation.
Collapse
Affiliation(s)
- Jeffrey E Mait
- Department of Orthopaedic Surgery and Rehabilitation Medicine, SUNY Downstate Medical Center, Brooklyn, NY 11203, USA.
| | | | | | | | | | | | | |
Collapse
|
4
|
Abstract
The pervasiveness of low bone mass (LBM) in beta-thalassemia (Thal) patients (pts) is escalating as the average life expectancy of these pts increases. Adolescence is a period of substantial bone accrual, which is crucial for future bone strength. Studies of LBM are prevalent among adults with Thal. However, limited information exists about bone accrual and LBM in adolescents with the disease. Thirty-one pts with beta-Thal (26 Thal major [TM], 5 Thal intermedia [TI]), aged 9-20 years (mean: 15.3 years), 14 males and 17 females, underwent measurement of spinal bone mineral density (BMD) by DEXA (Lunar, Prodigy). Height, weight, body mass index, and Tanner stage were assessed at the time of the BMD measurement. A total of 16.1% of the patients had normal bone mass (Z > or = -1), 22.6% had reduced bone mass (Z = -1 to -2), and 61.3% had low bone mass (Z < or = -2). BMD Z correlated with height and weight Z scores. Some 53.9% of subjects had normal gonadal function and 46.1% had induced puberty with gonadal steroids. BMD Z significantly worsened with age (P < .0001). However, there was no difference in the LBM prevalence between subjects with normal versus those with induced puberty: BMD Z was -2 or less in 71.4% of subjects with normal puberty versus 66.7% in those with induced puberty. Our results indicate a high prevalence of LBM among adolescents with Thal regardless of adequate transfusion and chelation regimens. Bone accrual was found to be suboptimal in adolescents with normal or induced puberty. Thus, calcium and vitamin D supplementation with antiresorptive therapies should be evaluated in the adolescent Thal pt with close monitoring of growth and sexual development.
Collapse
Affiliation(s)
- Maria G Vogiatzi
- Department of Pediatrics, New York-Presbyterian Hospital / Weill Medical College of Cornell University, New York, New York 10021, USA
| | | | | | | | | | | |
Collapse
|