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Tinney A, Moaveni AK, Kimmel LA, Gabbe BJ. Predictors of clavicle fixation in multiply injured patients. J Orthop 2020; 21:35-39. [PMID: 32071531 DOI: 10.1016/j.jor.2020.02.001] [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: 01/04/2020] [Revised: 01/31/2020] [Accepted: 02/02/2020] [Indexed: 11/28/2022] Open
Abstract
Introduction Clavicle fractures account for approximately 10% of all fractures in multiply injured patients. Our study aims to determine factors associated with surgical fixation of the clavicle fracture in multiply injured patients. Methods Major adult trauma patients from 2005 to 2014 with a clavicle fracture were included. Multivariate analysis was undertaken to determine the variables associated with fixation. Results 1779 patients (median age of 47 and a median Injury Severity Score of 17) were included. 273 (15%) patients underwent clavicle fixation. Factors associated with surgical fixation of the clavicle included: year, younger age, ICU admission, or an associated humerus or scapula fracture.
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Affiliation(s)
- Adrian Tinney
- Department of Surgery, The Alfred Hospital, Melbourne, Australia
| | - Afshin Kamali Moaveni
- Department of Surgery, The Alfred Hospital, Melbourne, Australia.,Department of Orthopaedic Surgery, The Alfred Hospital, Melbourne, Australia
| | - Lara A Kimmel
- Department of Physiotherapy, Alfred Hospital, Melbourne, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Victoria, Australia
| | - Belinda J Gabbe
- Department of Epidemiology and Preventive Medicine, Monash University, Victoria, Australia.,Health Data Research UK, Swansea University Medical School, Swansea University, United Kingdom
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Livingstone A, Asaid R, Moaveni AK. Is routine distal clavicle resection necessary in rotator cuff repair surgery? A systematic review and meta-analysis. Shoulder Elbow 2019; 11:39-45. [PMID: 31019561 PMCID: PMC6463380 DOI: 10.1177/1758573217741124] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [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: 06/12/2017] [Accepted: 10/14/2017] [Indexed: 11/15/2022]
Abstract
BACKGROUND The objective of the present study was to perform a systematic review and meta-analysis of randomized controlled trials looking at the effect of distal clavicle resection in patients undergoing rotator cuff repair (RCR). METHODS A systematic literature search was undertaken to identify randomized controlled trials looking at RCR +/- distal clavicle resection. Primary clinical outcome measures included in the meta-analysis were American Shoulder Elbow Society (ASES) score, pain on visual analogue scale and range of motion in forward elevation. RESULTS The systematic review identified three studies with a total of 203 participants. Those who underwent distal clavicle resection in conjunction with RCR had worse pain and acromioclavicular joint tenderness at 3-month follow-up. This difference, however, was not observed at the 24-month follow-up. The mean difference (95% confidence interval) for the ASES score was 0.45 (-3.67 to 4.58) and pain on visual analogue scale was - 0.27 (-0.70 to 0.16). CONCLUSIONS Routine distal clavicle resection in the setting of rotator cuff repair does not result in improved outcomes for patients with no difference being observed at 24 months post surgery. The results of our systematic review and meta-analysis do not support routine distal clavicle resection when performing RCR.
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Affiliation(s)
| | - Rafik Asaid
- Alfred Hospital, Melbourne, VIC, Australia,Rafik Asaid, Alfred Hospital, 55 Commercial Road, Melbourne, VIC 3004, Austrailia.
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Carter S, Liew S, Brown G, Moaveni AK. Barriers to Completion of Research Projects Among Orthopaedic Trainees. J Surg Educ 2018; 75:1630-1634. [PMID: 29699930 DOI: 10.1016/j.jsurg.2018.04.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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: 11/29/2017] [Revised: 02/18/2018] [Accepted: 04/03/2018] [Indexed: 06/08/2023]
Abstract
INTRODUCTION & AIM It is a requirement of the Australian Orthopaedic Association (AOA) training program that surgical education training (SET) trainees demonstrate competency in clinical or basic science research as part of their teaching curriculum. The aim of this study is to identify barriers in completing research by the Victorian and Tasmanian Region AOA SET trainees. METHODS We designed a short qualitative survey which was distributed to all Victorian and Tasmanian orthopaedic trainees through the AOA. The survey consisted of 18 questions most of which were based on a 5-point Likert scale with options to add comments based on individual experience. RESULTS Thirty-two (61%) orthopaedic trainees responded to the survey. Two did not give consent for their data to be used. Trainees were more likely to abandon their research projects if they had insufficient time to complete a project (p = 0.01), had fewer opportunities to take part in research (p = 0.011), were unable to complete a research project within their hospital rotation (p = 0.024), and did not have access to funding (p = 0.025). CONCLUSION A large amount of research is abandoned by trainees. The barriers to research completion are similar to those found in the literature, however, not all barriers identified in the literature were found to be barriers to the Victorian and Tasmanian Orthopaedic trainees. By identifying barriers to research completion within training programs, we hope to assist efficiency and help improve the likelihood of project completion as well as assist mentors in their guidance of trainees while conducting research.
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Affiliation(s)
- Sean Carter
- Department of Orthopaedics, The Alfred, Melbourne, Victoria, Australia.
| | - Susan Liew
- Department of Orthopaedics, The Alfred, Melbourne, Victoria, Australia
| | - Graeme Brown
- Department of Orthopaedics, University Hospital, Geelong, Victoria, Australia
| | - Afshin Kamali Moaveni
- Department of Orthopaedics, The Alfred, Melbourne, Victoria, Australia; Department of Surgery, Monash University, Melbourne, Victoria, Australia
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Salipas A, Kimmel LA, Edwards ER, Rakhra S, Moaveni AK. Natural history of medial clavicle fractures. Injury 2016; 47:2235-2239. [PMID: 27387790 DOI: 10.1016/j.injury.2016.06.011] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [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: 02/10/2016] [Revised: 05/29/2016] [Accepted: 06/04/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND Fractures of the medial third of the clavicle comprise less than 3% of all clavicle fractures. The natural history and optimal management of these rare injuries are unknown. The aim of our study is to describe the demographics, management and outcomes of patients with medial clavicle fractures treated at a Level 1 Trauma Centre. METHODS A retrospective review was conducted of patients presenting to our institution between January 2008 and March 2013 with a medial third clavicle fracture. Clinical and radiographic data were recorded including mechanism of injury, fracture pattern and displacement, associated injuries, management and complications. Functional outcomes were assessed using the Glasgow Outcome Scale Extended (GOS-E) scores from the Victorian Orthopaedic Trauma Outcomes Registry (VOTOR). Shoulder outcomes were assessed using two patient reported outcomes scores, the American Shoulder and Elbow Society Score (ASES) and the Subjective Shoulder Value (SSV). RESULTS Sixty eight medial clavicle fractures in 68 patients were evaluated. The majority of patients were male (n=53), with a median age of 53.5 years (interquartile range (IQR) 37.5-74.5 years). The most common mechanism of injury was motor vehicle accident (n=28). The in-hospital mortality rate was 4.4%. The fracture pattern was almost equally distributed between extra articular (n=35) and intra-articular (n=33). Fifty-five fractures (80.9%) had minimal or no displacement. Associated injuries were predominantly thoracic (n=31). All fractures were initially managed non-operatively, with a broad arm sling. Delayed operative fixation was performed for painful atrophic delayed union in two patients (2.9%). Both patients were under 65 years of age and had a severely displaced fracture of the medial clavicle. One intra-operative vascular complication was seen, with no adverse long-term outcome. Follow-up was obtained in 85.0% of the surviving cohort at an average of three years post injury (range 1-6 years). The mean ASES score was 80.3 (SD 24.8, range 10-100,), and the mean SSV score was 77.0 (SD 24.6, range 10-100). CONCLUSION Sixty eight patients with medial clavicle fractures were identified over a 5year period, with excellent functional results seen following conservative management.
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Affiliation(s)
- Andrew Salipas
- Department of Orthopaedic Surgery, Alfred Health, Melbourne, Victoria, Australia.
| | - Lara A Kimmel
- Department of Orthopaedic Surgery, Alfred Health, Melbourne, Victoria, Australia
| | - Elton R Edwards
- Department of Orthopaedic Surgery, Alfred Health, Melbourne, Victoria, Australia
| | - Sandeep Rakhra
- Department of Orthopaedic Surgery, Alfred Health, Melbourne, Victoria, Australia
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Papakonstantinou MK, Hart MJ, Farrugia R, Gosling C, Kamali Moaveni A, van Bavel D, Page RS, Richardson MD. Prevalence of non-union and delayed union in proximal humeral fractures. ANZ J Surg 2016; 87:55-59. [PMID: 27619072 DOI: 10.1111/ans.13756] [Citation(s) in RCA: 10] [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] [Subscribe] [Scholar Register] [Received: 08/01/2015] [Revised: 07/17/2016] [Accepted: 07/30/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND Little is known about the prevalence of proximal humeral non-union. There is disagreement on what constitutes union, delayed union and non-union. Our aim was to determine the prevalence of these complications in proximal humeral fractures (PHFs) admitted to trauma hospitals. METHODS The Victorian Orthopaedic Trauma Outcomes Registry identified 419 cases of PHFs, of which 306 were analysed. Three upper limb orthopaedic surgeons used X-rays to classify fractures according to the Neer classification and determine union. Twelve-item Short Form Health Survey scores were used to assess patient health and wellbeing. RESULTS Of 306 cases, 49.4% reached union. Median time to union was 100 days (confidence interval 90-121). Of these, 17.0% united by 60 days, 8.5% united by 89 days and 23.9% united after 90 days, demonstrating 'prolonged delayed union'. There were 25 non-unions with a prevalence of 8.2%, most occurring in two-part surgical neck fractures. CONCLUSION Our cohort of largely displaced PHFs admitted to trauma hospitals had a non-union prevalence of 8.2% and an overall delayed union prevalence of 32.4%. Consensus is required on definitions of non-union and delayed union timeframes.
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Affiliation(s)
| | - Melissa J Hart
- Victorian Orthopaedic Trauma Outcomes Registry, Melbourne, Victoria, Australia.,Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Richard Farrugia
- Department of Orthopaedics, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Cameron Gosling
- Department of Physiotherapy, Monash University, Melbourne, Victoria, Australia
| | | | - Dirk van Bavel
- Department of Orthopaedics, Dandenong Hospital, Dandenong, Victoria, Australia.,Department of Orthopaedics, The Epworth Hospital, Melbourne, Victoria, Australia
| | - Richard S Page
- Department of Orthopaedics, University Hospital, Geelong, Victoria, Australia.,School of Medicine, Deakin University, Geelong, Victoria, Australia
| | - Martin D Richardson
- Department of Orthopaedics, The Epworth Hospital, Melbourne, Victoria, Australia.,Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia
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Papakonstantinou MK, Hart MJ, Farrugia R, Gabbe BJ, Kamali Moaveni A, van Bavel D, Page RS, Richardson MD. Interobserver agreement of Neer and AO classifications for proximal humeral fractures. ANZ J Surg 2016; 86:280-4. [DOI: 10.1111/ans.13451] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2015] [Indexed: 11/30/2022]
Affiliation(s)
| | - Melissa J. Hart
- Victorian Orthopaedic Trauma Outcomes Registry (VOTOR); Melbourne Victoria Australia
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine; Monash University; Melbourne Victoria Australia
| | - Richard Farrugia
- Department of Orthopaedics; The Royal Melbourne Hospital; Melbourne Victoria Australia
| | - Belinda J. Gabbe
- Department of Epidemiology and Preventative Medicine; Monash University; Melbourne Victoria Australia
| | | | - Dirk van Bavel
- Department of Orthopaedics; St Vincent's Hospital; Melbourne Victoria Australia
- Department of Orthopaedics; The Epworth Hospital; Melbourne Victoria Australia
| | - Richard S. Page
- Department of Orthopaedics; University Hospital; Geelong Victoria Australia
- School of Medicine; Deakin University; Geelong Victoria Australia
| | - Martin D. Richardson
- Department of Orthopaedics; The Epworth Hospital; Melbourne Victoria Australia
- Department of Surgery; The University of Melbourne; Melbourne Victoria Australia
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Abstract
INTRODUCTION Trampoline-related injuries in adults are uncommon. Participation in trampolining is increasing following its admission as a sport in the Olympics and the opening of local recreational trampoline centres. The aim of this study was to assess the number and outcomes of adult trampoline-related orthopaedic injuries presenting to four trauma hospitals in Victoria. METHODS A cohort study was performed for the period 2007-2013. Adult patients registered by the Victorian Orthopaedic Trauma Outcomes Registry (VOTOR) who had sustained a trampolining related injury were included in this study. Descriptive analyses were used to describe the patient population, the injuries sustained and their in-hospital and 6-month outcomes. RESULTS There was an increase in trampolining injuries from 2007 (n=3) to 2012 (n=14) and 2013 (n=18). Overall, fifty patients with a median age of 25 (range 16-66) were identified. Thirty-five patients (70%) had lower limb injuries, 20 patients (40%) had spinal injuries and one patient had an upper limb injury. Thirty-nine patients (78%) required surgery. Fractures of the tibia (n=13), ankle fractures (n=12) and cervical spine injuries (n=7) were the most common injuries; all of which required surgery. Complications included death, spinal cord injuries, compartment syndrome and open fractures. At 6 months post injury, more than half (52%) of the patients had not achieved a good recovery, 32% had some form of persistent disability, 14% did not get back to work and overall physical health for the cohort was well below population norms for the SF-12. CONCLUSION Adult trampoline-related injuries have increased in the last few years in this cohort identified through VOTOR. Lower limb and spinal injuries are most prevalent. Public awareness and education are important to reduce the risk for people participating in this activity.
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Affiliation(s)
- Varun Arora
- Department of Orthopaedic Surgery, The Alfred Hospital, Melbourne, Australia
| | - Lara A Kimmel
- Department of Physiotherapy, Alfred Hospital, Melbourne, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Victoria, Australia
| | - Kathy Yu
- Gymnastics Australia, Australia; The Melbourne Sports Medicine Centre, Australia
| | - Belinda J Gabbe
- Department of Epidemiology and Preventive Medicine, Monash University, Victoria, Australia
| | - Susan M Liew
- Department of Orthopaedic Surgery, The Alfred Hospital, Melbourne, Australia; Department of Surgery, Monash University, Melbourne, Australia
| | - Afshin Kamali Moaveni
- Department of Orthopaedic Surgery, The Alfred Hospital, Melbourne, Australia; Department of Surgery, Monash University, Melbourne, Australia.
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Dyer DR, Troupis JM, Kamali Moaveni A. Wide field of view CT and acromioclavicular joint instability: A technical innovation. J Med Imaging Radiat Oncol 2015; 59:326-30. [DOI: 10.1111/1754-9485.12283] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2014] [Accepted: 12/23/2014] [Indexed: 11/28/2022]
Affiliation(s)
- David R Dyer
- Department of Orthopaedic Surgery; Dandenong Hospital; Melbourne Victoria Australia
| | - John M Troupis
- Department of Diagnostic Imaging; Monash Medical Centre; Melbourne Victoria Australia
| | - Afshin Kamali Moaveni
- Department of Orthopaedic Surgery; The Alfred Hospital; Melbourne Victoria Australia
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Kamali Moaveni A. Re: Are Australian and New Zealand trauma service resources reflective of the Australasian Trauma Verification Model Resource Criteria? ANZ J Surg 2014; 84:996. [PMID: 25444430 DOI: 10.1111/ans.12883] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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