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Ganta A, Solasz S, Fisher N, Leucht P, Konda S, Egol K. Pneumothorax After Superior Plating of Clavicle Fractures: Are the Concerns Warranted? J Am Acad Orthop Surg 2024:00124635-990000000-00907. [PMID: 38457528 DOI: 10.5435/jaaos-d-23-00634] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 01/25/2024] [Indexed: 03/10/2024] Open
Abstract
PURPOSE The primary goal of this study was to determine the anatomic relationship between the clavicle and the apical lung segment. The secondary goal was to determine the incidence of pneumothorax (PTX) in patients who underwent clavicle ORIF to analyze the utility of postoperative chest radiographs. METHODS Six hundred thirty-one patients with a midshaft clavicle fracture who underwent superior plating at a single institution were identified. Forty-two patients had a CT scan of the chest. Three points on the uninjured clavicle were defined: 2 cm from the medial end of the clavicle, the mid-point of the clavicle, and 2 cm from the lateral end of the clavicle. At each point, the distance from both the inferior cortex and the superior cortex of the clavicle to the apical lung segment was measured. All 631 patients who underwent Open Reduction and Internal Fixation had a postoperative chest radiograph to evaluate implant placement, restoration of clavicular length, and presence of PTX. RESULTS From the lateral end of the clavicle, the mean distance of the lung was 60.0 ± 14.9 mm (20.1 to 96.1 mm) from the inferior cortex of the clavicle. At the mid-point, the mean distance of the lung was 32.3 ± 7.2 mm (20.4 to 45.5 mm) from the inferior cortex of the clavicle. At the medial end, the mean distance of the lung was 18.0 ± 5.5 mm (8.1 to 28.9 mm) from the inferior cortex of the clavicle. A review of postoperative radiographs for all 631 patients revealed none (0%) with a postoperative iatrogenic PTX. CONCLUSION The risk of injury is minimal in all three zones. Postoperative chest radiographs after clavicle fracture repair to rule out PTX are unnecessary.
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Affiliation(s)
- Abhishek Ganta
- From the Department of Orthopedic Surgery, Division of Orthopedic Trauma Surgery, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY (Ganta, Solasz, Fisher, Leucht, Konda, and Egol), and Department of Orthopaedic Surgery, Jamaica Hospital Medical Center, Richmond Hill, NY (Konda, and Egol)
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Herbosa CG, Saleh H, Kadiyala ML, Solasz S, McLaurin TM, Leucht P, Egol KA, Tejwani NC. Early Weight-bearing Following Surgical Treatment of Ankle Fractures Without Trans-syndesmotic Fixation Is Safe and Improves Short-term Outcomes. J Orthop Trauma 2024; 38:e98-e104. [PMID: 38117568 DOI: 10.1097/bot.0000000000002741] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/12/2023] [Indexed: 12/22/2023]
Abstract
OBJECTIVES The objective of this study was to ascertain outcome differences after fixation of unstable rotational ankle fractures allowed to weight-bear 2 weeks postoperatively compared with 6 weeks. METHODS DESIGN Prospective case-control study. SETTING Academic medical center; Level 1 trauma center. PATIENT SELECTION CRITERIA Patients with unstable ankle fractures (OTA/AO:44A-C) undergoing open reduction internal fixation (ORIF) were enrolled. Patients requiring trans-syndesmotic fixation were excluded. Two surgeons allowed weight-bearing at 2 weeks postoperatively (early weight-bearing [EWB] cohort). Two other surgeons instructed standard non-weight-bearing until 6 weeks postoperatively (non-weight-bearing cohort). OUTCOME MEASURES AND COMPARISONS The main outcome measures included the Olerud-Molander questionnaire, the SF-36 questionnaire, and visual analog scale at 6 weeks, 3 months, 6 months, and 12 months postoperatively and complications, return to work, range of ankle motion, and reoperations at 12 months were compared between the 2 cohorts. RESULTS One hundred seven patients were included. The 2 cohorts did not differ in demographics or preinjury scores ( P > 0.05). Six weeks postoperatively, EWB patients had improved functional outcomes as measured by the Olerud-Molander and SF-36 questionnaires. Early weight-bearing patients also had better visual analog scale scores (standardized mean difference -0.98, 95% confidence interval [CI] -1.27 to -0.70, P < 0.05) and a greater proportion returning to full capacity work at 6 weeks (odds ratio = 3.42, 95% CI, 1.08-13.07, P < 0.05). One year postoperatively, EWB patients had improved pain measured by SF-36 (standardized mean difference 6.25, 95% CI, 5.59-6.92, P < 0.01) and visual analog scale scores (standardized mean difference -0.05, 95% CI, -0.32 to 0.23, P < 0.01). There were no differences in complications or reoperation at 12 months ( P > 0.05). CONCLUSIONS EWB patients had improved early function, final pain scores, and earlier return to work, without an increased complication rate compared with those kept non-weight-bearing for 6 weeks. LEVEL OF EVIDENCE Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Christopher G Herbosa
- Division of Orthopedic Trauma Surgery, Department of Orthopedic Surgery, NYU Langone Health, NYU Langone Orthopedic Hospital, New York, NY
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Solasz S, Ganta A, Robitsek RJ, Egol KA, Konda S. Thigh compartment syndrome: Outcomes in an urban level 1 trauma center. Injury 2024; 55:111331. [PMID: 38244251 DOI: 10.1016/j.injury.2024.111331] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 01/04/2024] [Accepted: 01/14/2024] [Indexed: 01/22/2024]
Abstract
INTRODUCTION Thigh compartment syndrome (TCS) is a rare surgical emergency associated with a high risk of morbidity with mortality rates as high as 47 %. There is sparse literature discussing the management as well as outcomes of these injuries. The purpose of this study is to review a consecutive series of patients presenting to a single urban Level 1 trauma center with TCS to identify injury characteristics, clinical presentation, and outcomes associated with this injury. METHODS A trauma database was queried for all patients with a diagnosis of TCS at a single level 1 urban trauma center between January 1, 2011 and December 31, 2021. Demographic and injury variables collected included age, sex, BMI, mechanism of injury, and creatine phosphokinase levels (CPK). Hospital quality measures including time from admission to surgery, length of both hospital and ICU stay, complications, and cost of care were collected. Descriptive statistics are reported as median [interquartile range] or N (percent). RESULTS There were 14 patients identified with a diagnosis of TCS. All were men with an average age 33.5 [23.5 - 38] years and an average BMI of 26 [22.9-28.1]. The most common cause of injury was blunt trauma (71.4 %), and the remaining 28.6 % were gunshot wound injuries. Within the cohort, 6 (42.9 %) patients sustained a femoral shaft fracture, and 4 (28.6 %) patients sustained a vascular injury. The median initial CPK of patients within this cohort was 3405 [1232-5339] and reached a peak of 5271 [3013-13,266]. The median time from admission to diagnosis was 6.8 [0-236.9] hours. The median time from admission to the operating room was 8.2 [0.6-236.9] hours, and the median number of operating room visits was 3 [2 - 6]. Five patients (35.7 %) wounds were closed with split thickness skin grafting. There were 12 (85.7 %) patients who required ICU care. The median ICU length of stay was 7.5 days [4-15]. The median hospital length of stay was 16.5 days [13.25-38.0]. The median total charges for a patient with thigh compartment syndrome was $129,159.00 [$24,768.00 - $587,152.00]. The median direct variable cost for these patients was $86,106.00 For comparison, the median direct variable cost for patients with femur fractures without TCS at this institution was $8,497.28 [$1,903.52-$21,893.13]. No patients required readmission within 60 days. There were no mortalities. CONCLUSION TCS is a rare and life-threatening injury associated with significant morbidity. Despite rapid diagnosis and fasciotomy, the majority of the patients have prolonged hospital courses, ICU lengths of stay, and significant costs of treatment. Providers can reference the outcomes reported in this study when caring for TCS patients.
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Affiliation(s)
- Sara Solasz
- NYU Langone Health, NYU Langone Orthopedic Hospital, Division of Orthopedic Trauma Surgery, Department of Orthopedic Surgery, 301 East 17th Street, New York, NY 10003, US
| | - Abhishek Ganta
- NYU Langone Health, NYU Langone Orthopedic Hospital, Division of Orthopedic Trauma Surgery, Department of Orthopedic Surgery, 301 East 17th Street, New York, NY 10003, US; Jamaica Hospital Medical Center, Department of Orthopaedic Surgery, 8900 Van Wyck Expressway, Richmond Hill, NY 11418, Canada
| | - R Jonathan Robitsek
- NYU Langone Health, NYU Langone Orthopedic Hospital, Division of Orthopedic Trauma Surgery, Department of Orthopedic Surgery, 301 East 17th Street, New York, NY 10003, US
| | - Kenneth A Egol
- NYU Langone Health, NYU Langone Orthopedic Hospital, Division of Orthopedic Trauma Surgery, Department of Orthopedic Surgery, 301 East 17th Street, New York, NY 10003, US; Jamaica Hospital Medical Center, Department of Orthopaedic Surgery, 8900 Van Wyck Expressway, Richmond Hill, NY 11418, Canada
| | - Sanjit Konda
- NYU Langone Health, NYU Langone Orthopedic Hospital, Division of Orthopedic Trauma Surgery, Department of Orthopedic Surgery, 301 East 17th Street, New York, NY 10003, US; Jamaica Hospital Medical Center, Department of Orthopaedic Surgery, 8900 Van Wyck Expressway, Richmond Hill, NY 11418, Canada.
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Deemer AR, Solasz S, Ganta A, Egol KA, Konda SR. External fixation about the elbow: Indications and long-term outcomes. J Clin Orthop Trauma 2024; 48:102335. [PMID: 38282805 PMCID: PMC10821167 DOI: 10.1016/j.jcot.2024.102335] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 12/20/2023] [Accepted: 01/04/2024] [Indexed: 01/30/2024] Open
Abstract
Background Operative management is often required for fractures of the elbow, with treatment goals aiming to restore stability, reduction, and early range of motion. The purpose of this study was to determine risk factors for necessitating the application of an external fixator, and to compare range of motion and functional outcomes between patients who required an elbow external fixator to those who did not. Hypothesis We hypothesize that patients who require an external fixator will have worse elbow range of motion and functional outcomes when compared to those who did not. Patients and methods This is a retrospective study of 391 patients who presented at a Level-I trauma center between March 2011 and January 2021 for operative management of a fracture/fracture-dislocation of the distal humerus (AO/OTA 13A-C) and/or proximal ulna and/or radius (AO/OTA 21A-C). A primary analysis was performed to determine risk factors for necessitating the application of an external fixator. A secondary analysis was performed comparing elbow range-of-motion and functional outcomes between cases and controls. Results 391 patients were identified; 26 required external fixation (cases) and 365 did not (controls). Significant risk factors for necessitating placement of an external fixator included large BMI (OR = 1.087, 95 % CI = 1.007-1.173, p = 0.033), elbow dislocation (OR = 7.549, 95 % CI = 2.387-23.870, p = 0.001), open wound status (OR = 9.584, 95 % CI = 2.794-32.878, p < 0.001), and additional non-contiguous orthopaedic injury (OR = 9.225, 95 % CI = 2.219-38.360, p = 0.002). Elbow ROM was poorer in the external fixator group with regards to extension (-15°), flexion (+19.4°), and pronation (+14.3°) (p < 0.05). In addition, those who did not need external fixation had better functional scores (+20.4 points MEPI) (p < 0.05). Discussion The use of external fixation about the elbow is associated with significantly worse initial injuries and results in poorer outcomes. These results can be used to inform the surgeon-patient discussion regarding treatment options and expected functional outcomes. Level of evidence III.
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Affiliation(s)
- Alexa R. Deemer
- NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY, USA
| | - Sara Solasz
- NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY, USA
| | - Abhishek Ganta
- NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY, USA
- Department of Orthopedic Surgery, Jamaica Hospital Medical Center, New York, NY, USA
| | - Kenneth A. Egol
- NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY, USA
- Department of Orthopedic Surgery, Jamaica Hospital Medical Center, New York, NY, USA
| | - Sanjit R. Konda
- NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY, USA
- Department of Orthopedic Surgery, Jamaica Hospital Medical Center, New York, NY, USA
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Solasz S, Konda SR, Schwarzkopf R, Slover J, Chang G, Egol KA. Total Hip Arthroplasty is the Most Effective Treatment for Atraumatic Subchondral Insufficiency Fractures of the Femoral Head. Bull Hosp Jt Dis (2013) 2023; 81:173-178. [PMID: 37639345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
BACKGROUND Subchondral insufficiency fracture of the femoral head (SIFH) is a relatively newly used diagnosisfollowing an insidious onset of hip pain in individuals without apparent antecedent trauma. The aim of this study was to investigate the outcomes of a consecutive series of patients with SIFH treated at one institution. METHODS A total of 93 patients aged 23 to 91 years who were treated for SIFH in the outpatient clinics at one academic, urban medical center between August 2012 and August 2019 were identified. The diagnosis was made by magnetic resonance imaging or radiograph of the hip and was confirmed by a radiologist specialized in orthopedic surgery. Patient demographics, injury history, duration of pain, treatment type, and persistence of pain were recorded. RESULTS Sixty-five (69.9%) patients with a mean age of 64.2 ± 9.4 years ultimately underwent total hip arthroplasty (THA). Twenty-eight (30.1%) patients chose no surgical intervention. Patients who underwent THA had less pain at their final follow-up appointment than patients who elected non-operative treatment (p < 0.001). At their final follow-up appointments, 92.9% of patients treated non-operatively reported pain, compared to only 13.8% of patients who underwent THA who had pain. Age, body mass index, and duration of pain prior to initial complaint did not affect presence of continued pain at final follow-up appointments, regardless of treatment type (p > 0.05). CONCLUSION In the majority of patients, SIFH is often not sufficiently managed with non-operative treatments. Pain reported among patients with confirmed or suspected SIFH is usually severe and interferes with patients' ability to perform their activities of daily life. Total hip arthroplasty seems to be the most reliable method of treatment for this condition. Physicians who treat patients with SIFH should counsel them as to the expectations of recovery and the potential for poorer outcome if treated without THA.
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Ihejirika-Lomedico R, Solasz S, Lorentz N, Egol KA, Leucht P. Effects of Intraoperative Local Pain Cocktail Injections on Early Function and Patient-Reported Outcomes: A Randomized Controlled Trial. J Orthop Trauma 2023; 37:433-439. [PMID: 37199438 DOI: 10.1097/bot.0000000000002628] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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] [Accepted: 04/24/2023] [Indexed: 05/19/2023]
Abstract
OBJECTIVE To determine whether a perioperative pain cocktail injection improves postoperative pain, ambulation distance, and long-term outcomes in patients with hip fracture. DESIGN Prospective, single-blinded, randomized controlled trial. SETTING Academic Medical Center. PATIENTS/PARTICIPANTS Patients with OTA/AO 31A1-3 and 31B1-3 fractures undergoing operative fixation, excluding arthroplasty. INTERVENTION Multimodal local injection of bupivacaine (Marcaine), morphine sulfate (Duramorph), ketorolac (Toradol) given at the fracture site at the time of hip fracture surgery (Hip Fracture Injection, HiFI). MAIN OUTCOME MEASUREMENTS Patient-reported pain, American Pain Society Patient Outcome Questionnaire (APS-POQ), narcotic usage, length of stay, postoperative ambulation, Short Musculoskeletal Function Assessment. RESULTS Seventy-five patients were in the treatment group and 109 in the control group. Patients in the HiFI group had a significant reduction in pain and narcotic usage compared with the control group on postoperative day (POD) 0 ( P < 0.01). Based on the APS-POQ, patients in the control group had a significantly harder time falling asleep, staying asleep, and experienced increased drowsiness on POD 1 ( P < 0.01). Patient ambulation distance was greater on POD 2 ( P < 0.01) and POD 3 ( P < 0.05) in the HiFI group. The control group experienced more major complications ( P < 0.05). At 6-week postop, patients in the treatment group reported significantly less pain, better ambulatory function, less insomnia, less depression, and better satisfaction than the control group as measured by the APS-POQ. The Short Musculoskeletal Function Assessment bothersome index was also significantly lower for patients in the HiFI group, P < 0.05. CONCLUSIONS Intraoperative HiFI not only improved early pain management and increased ambulation in patients undergoing hip fracture surgery while in the hospital, it was also associated with early improved health-related quality of life after discharge. LEVEL OF EVIDENCE Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
| | - Sara Solasz
- Department of Orthopedic Surgery, NYU Langone Health, New York, NY; and
| | - Nathan Lorentz
- Department of Orthopedic Surgery, NYU Langone Health, New York, NY; and
| | - Kenneth A Egol
- Department of Orthopedic Surgery, NYU Langone Health, New York, NY; and
| | - Philipp Leucht
- Department of Orthopedic Surgery, NYU Langone Health, New York, NY; and
- Department of Cell Biology, NYU Grossman School of Medicine, New York, NY
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Solasz S, Merrell L, Ganta A, Konda S, Egol KA. Factors Associated With the Development of a Confirmed Fracture-Related Infection. J Orthop Trauma 2023; 37:e361-e367. [PMID: 37587567 DOI: 10.1097/bot.0000000000002615] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/07/2023] [Indexed: 08/18/2023]
Abstract
OBJECTIVES To identify factors associated with the development of fracture-related infection (FRI) in patients who have undergone operative fixation of their fracture. DESIGN Retrospective study. SETTING Academic medical center. PATIENTS/PARTICIPANTS Patients with peripheral extremity long-bone fractures and shoulder and pelvic girdle fractures who underwent operative repair. This included patients who had undergone fixation inside and outside of our institution. INTERVENTION Chi-square, Fisher exact testing, analysis of variance (ANOVA), and t tests were used for analysis of data, as appropriate. Binomial logistic regression analysis was performed to determine risk factors of FRI. MAIN OUTCOME MEASUREMENTS Demographics, fracture location, injury mechanism, open wound status, and wound complication type. RESULTS One hundred ninety-three patients comprised the FRI cohort. Of those with confirmed signs of FRI, 36 (18.7%) had wound breakdown to bone or implant, 120 (62.1%) had a sinus track, and 170 patients (88.1%) had the confirmed presence of microorganisms in deep tissue samples obtained during operative intervention. Factors associated with development of an FRI were as follows: higher BMI; being of Black and Hispanic race; higher American Society of Anesthesiologists class; history of tobacco, alcohol, and drug use; and fractures of the lower extremity (foot, tibia, and femur/pelvis). The results of binary logistic regression demonstrated that treatment at an urban level I trauma center and drug use positively predicted the development of FRI. CONCLUSION Our results demonstrate that higher BMI; being of Black or Hispanic race; higher American Society of Anesthesiologists; history of tobacco, alcohol, and drug use; and fractures of the foot, tibia, and femur/pelvis are all factors associated with development of FRI. LEVEL OF EVIDENCE Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Sara Solasz
- NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY
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Konda SR, Solasz S, Ganta A, Egol KA. Monitored Anesthesia Care and Soft Tissue Infiltration with Local Anesthesia: An Anesthetic Option for High-Risk Patients with Hip Fractures. J Orthop Trauma 2023; 37:S3-S4. [PMID: 37443434 DOI: 10.1097/bot.0000000000002635] [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] [Accepted: 04/28/2023] [Indexed: 07/15/2023]
Abstract
SUMMARY This review demonstrates the technique for monitored anesthesia care and soft tissue infiltration with local anesthesia as the only form of anesthesia for short cephalomedullary nailing in medically complex patients. Monitored anesthesia care is defined as providing sedation and analgesia that is titrated to a level that preserves spontaneous breathing and airway reflexes. Soft tissue infiltration refers to soft tissue infiltration with local anesthesia directly into the surgical site and is performed by the surgeon before the start of the procedure.
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Affiliation(s)
- Sanjit R Konda
- Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, New York, NY; and
- Department of Orthopaedic Surgery, Jamaica Hospital Medical Center, Richmond Hill, NY
| | - Sara Solasz
- Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, New York, NY; and
| | - Abhishek Ganta
- Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, New York, NY; and
- Department of Orthopaedic Surgery, Jamaica Hospital Medical Center, Richmond Hill, NY
| | - Kenneth A Egol
- Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, New York, NY; and
- Department of Orthopaedic Surgery, Jamaica Hospital Medical Center, Richmond Hill, NY
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Solasz S, Ganta A, Egol KA, Konda SR. Acute Total Hip Replacement for Geriatric Acetabular Fracture: Anterior Intrapelvic Approach + Posterolateral Approach. J Orthop Trauma 2023; 37:S5-S6. [PMID: 37443435 DOI: 10.1097/bot.0000000000002633] [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] [Accepted: 04/27/2023] [Indexed: 07/15/2023]
Abstract
SUMMARY This review describes the indications and technique for acute total hip arthroplasty in an incomplete both-column acetabular fracture in a geriatric patient.
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Affiliation(s)
- Sara Solasz
- Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, New York, NY; and
| | - Abhishek Ganta
- Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, New York, NY; and
- Department of Orthopaedic Surgery, Jamaica Hospital Medical Center, Richmond Hill, NY
| | - Kenneth A Egol
- Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, New York, NY; and
- Department of Orthopaedic Surgery, Jamaica Hospital Medical Center, Richmond Hill, NY
| | - Sanjit R Konda
- Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, New York, NY; and
- Department of Orthopaedic Surgery, Jamaica Hospital Medical Center, Richmond Hill, NY
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Solasz S, Ganta A, Konda SR. Posteromedial Surgical Approach for Fixation of Haraguchi Type 2B Posterior Malleolar Fracture. J Orthop Trauma 2023; 37:S9-S10. [PMID: 37443437 DOI: 10.1097/bot.0000000000002634] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/27/2023] [Indexed: 07/15/2023]
Abstract
SUMMARY A case of a 26-year-old man with a displaced medial malleolus fracture with extension into the posteromedial aspect of the posterior malleolus is presented. A CT scan of the ankle is obtained demonstrating a Haraguchi type 2B posterior malleolus fracture with a posteromedial and posterolateral fragment. The posteromedial fragment extends into the posterior colliculus of the medial malleolus and has a subchondral impaction fracture. There is also a 1 × 1 cm piece of the articular surface of the posterior malleolus that has flipped 90 degrees and lodged itself between the posterolateral fracture fragment. This video overview and case presentation demonstrates a posteromedial approach with fixation strategy for the posterior malleolus.
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Affiliation(s)
- Sara Solasz
- Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, New York, NY; and
| | - Abhishek Ganta
- Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, New York, NY; and
- Department of Orthopaedic Surgery, Jamaica Hospital Medical Center, Richmond Hill, NY
| | - Sanjit R Konda
- Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, New York, NY; and
- Department of Orthopaedic Surgery, Jamaica Hospital Medical Center, Richmond Hill, NY
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Shields CN, Solasz S, Gonzalez LJ, Tong Y, Konda SR, Egol KA. Outpatient lower extremity fracture surgery: should we be concerned? Eur J Orthop Surg Traumatol 2021; 32:719-723. [PMID: 34101006 DOI: 10.1007/s00590-021-03029-6] [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] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Accepted: 04/09/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE With rising healthcare costs and insurance push against non-emergent hospital admission, lower extremity fracture treatment is shifting toward outpatient procedures over inpatient hospitalizations. This study compares outcomes for fractures treated as inpatient versus outpatient. METHODS We conducted a retrospective review of lower extremity fracture patients. We collected demographics, injury information, hospital course, and complication data. Length of stay was categorized as "inpatient" and "outpatient" based a 24-h hospital stay cutoff. Data analysis included differences between cohorts with regards to readmissions and complications. RESULTS We identified 229 patients who met inclusion criteria. Inpatient versus outpatient status was predictive of in-hospital complications; however, inpatient versus outpatient status did not predict 1-year readmission. CONCLUSION Outpatient surgery is safe and effective. As the population increases and ages, low-risk surgeries should be considered for outpatient rather than inpatient stays to lower costs, save resources, and reduce complications.
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Affiliation(s)
- Charlotte N Shields
- Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, NYU Langone Medical Center, 301 E 17th Street, New York, NY, 10003, USA
| | - Sara Solasz
- Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, NYU Langone Medical Center, 301 E 17th Street, New York, NY, 10003, USA
| | - Leah J Gonzalez
- Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, NYU Langone Medical Center, 301 E 17th Street, New York, NY, 10003, USA
| | - Yixuan Tong
- Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, NYU Langone Medical Center, 301 E 17th Street, New York, NY, 10003, USA
| | | | - Kenneth A Egol
- Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, NYU Langone Medical Center, 301 E 17th Street, New York, NY, 10003, USA. .,Jamaica Hospital Medical Center, Queens, NY, USA.
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