The document summarizes a study conducted at Baystate Medical Center on surgical rib fixation (SRF) in patients with flail chest or severe rib fractures. The study compared outcomes between patients aged 65 and older and those aged 64 and younger who underwent SRF. The results showed that the median number of ventilator days, injury severity score, intensive care unit length of stay, and hospital length of stay were similar between the two age groups, suggesting there should be no age restrictions for SRF. The goals are to improve outcomes for rib fracture patients and establish a national registry through further research.
Corrigendum to “Special surgical technique for knee arthroplasty”Apollo Hospitals
We typically operate more than 1200-1800 cases a year, out of which we have included 300 cases randomly for the study. All these selected cases were local residents and easy to follow-up.
Colorado shoulder surgeon, Dr. Peter Millett taught in Portland, Oregon on the Steelhead Surgical Advanced Shoulder Course. Here is a sneak peek of his presentation.
Corrigendum to “Special surgical technique for knee arthroplasty”Apollo Hospitals
We typically operate more than 1200-1800 cases a year, out of which we have included 300 cases randomly for the study. All these selected cases were local residents and easy to follow-up.
Colorado shoulder surgeon, Dr. Peter Millett taught in Portland, Oregon on the Steelhead Surgical Advanced Shoulder Course. Here is a sneak peek of his presentation.
Predictors of Patients’ Functional Outcome after Motor Nerve Transfers in Man...Professor M. A. Imam
To maximize outcome in nerve transfers:
1- The recipient nerve reinnervated close to the target muscle.
2- Direct repair without intervening grafts.
3- Similarly behaving neuromuscular units (agonistic donors and recipients)
Colorado shoulder specialist Dr. Peter Millett analyzes a case study of a 48 year-old active male with a supraspinatus tear with Grade 2 atrophy. The goal of arthroscopic rotator cuff repair is to restore the anatomy, biomechanics, shoulder function and promote healing. The advantages of arthroscopic repair is lower complication rates than RSTA and tendon transfer and overall improved functional outcomes.
Depending on the type of rotator cuff tear will help establish the reconstruction classification. In Dr. Millett's study from AAOS in 2014 there are four tear pattern recognitions: crescent, L/Reverse L, U-Shape and Massive Contracted. These pattern recognitions are required for modern arthroscopic rotator cuff repair to help facilitate anatomic restoration, optimize biomechanical properties and tendon biology, along with decrease failure rates.
For older patients, Dr. Millett conducted a study on the outcomes of rotator cuff repairs in older patients. The study found that the mean patient satisfaction was 9/10 improvement in pain affecting ADLs and ability to participate in sporting activities.
Dr. Mohannad Barakat has been working in the field of trauma, orthopaedic and spinal surgery for many years. His specialities include emergency medicine, ENT, genera surgery and cardiothoracic surgery.
Dr Neelam Venkatramana Reddy is one of the best orthopedic doctors in Hyderabad with extensive experience in the area of joint replacement for a span of fifteen years.
Visit: www.neelamramanareddy.com
Predictors of Patients’ Functional Outcome after Motor Nerve Transfers in Man...Professor M. A. Imam
To maximize outcome in nerve transfers:
1- The recipient nerve reinnervated close to the target muscle.
2- Direct repair without intervening grafts.
3- Similarly behaving neuromuscular units (agonistic donors and recipients)
Colorado shoulder specialist Dr. Peter Millett analyzes a case study of a 48 year-old active male with a supraspinatus tear with Grade 2 atrophy. The goal of arthroscopic rotator cuff repair is to restore the anatomy, biomechanics, shoulder function and promote healing. The advantages of arthroscopic repair is lower complication rates than RSTA and tendon transfer and overall improved functional outcomes.
Depending on the type of rotator cuff tear will help establish the reconstruction classification. In Dr. Millett's study from AAOS in 2014 there are four tear pattern recognitions: crescent, L/Reverse L, U-Shape and Massive Contracted. These pattern recognitions are required for modern arthroscopic rotator cuff repair to help facilitate anatomic restoration, optimize biomechanical properties and tendon biology, along with decrease failure rates.
For older patients, Dr. Millett conducted a study on the outcomes of rotator cuff repairs in older patients. The study found that the mean patient satisfaction was 9/10 improvement in pain affecting ADLs and ability to participate in sporting activities.
Dr. Mohannad Barakat has been working in the field of trauma, orthopaedic and spinal surgery for many years. His specialities include emergency medicine, ENT, genera surgery and cardiothoracic surgery.
Dr Neelam Venkatramana Reddy is one of the best orthopedic doctors in Hyderabad with extensive experience in the area of joint replacement for a span of fifteen years.
Visit: www.neelamramanareddy.com
Comparison Results between Patients with Developmental Hip Dysplasia Treated ...CrimsonPublishersOPROJ
Comparison Results between Patients with Developmental Hip Dysplasia Treated with Either Salter or Pemberton Osteotomy by Dello Russo Bibiana* in Orthopedic Research Online Journal
‘Double X’ Cross Fixationin Paediatric Supracondylar Humerus Fractures: A 20-...clinicsoncology
Over the last 50 years, the developments emerged in the diagnosis and treatment of supracondylar humerus fractures (SHF) have significantly reduced the number of severe complications while certain complications with dreadful evolution, such as elbow stiffness or Volkmann’s syndrome, have completely vanished. During my residency, in 1982, on the suggestion of Prof. Pesamosca, I have performed a surgical intervention for a patient diagnosed with SHF
Background: Distal femur fractures make up 6 to 7% of all femur fractures. Various plating options for distal femur fracture are conventional buttress plates, fixed-angle devices, and locking plates. This study was planned to evaluate and explore locking compression plate fixation in distal end femur fractures which is expected to provide a stable fixation with minimum exposure, early mobilization, less complications and a better quality of life.
Methods: The study was conducted as prospective clinical study in 20 skeletally mature patients with x-ray evidence of distal femur fracture fulfilling inclusion and exclusion criteria, operated with distal femur LCP plating. Patients were assessed radiologically and classified according to distal femur fracture classification and outcome graded as excellent, good, fair and poor based on Lysholm Knee Score.
Results: Out of 15 excellent outcome cases, 3 cases were type A1 fracture, 1 case had type A3, 2 cases had type B1 and B2 each, 5 cases had type C2 and 2 cases had type C3 fracture. 1 case with good outcome was type C3. 1 case with fair outcome was type B2. While 3 cases with poor outcome were type A1, A2 and C3.
Conclusions: The DF-LCP is an ideal implant to use for fractures of the distal femur. However, accurate positioning and fixation are required to produce satisfactory results. We recommend use of this implant in Type A and C, osteoporotic and periprosthetic fractures.
Keywords: Distal femur, DF-LCP, Lysholm score, Periprosthetic fracture
ABSTRACT
Objective: To evaluate the role of age as a moderator of bone regeneration patterns and
symphysis remodeling after genioplasty.
Method: Fifty-four patients who underwent genioplasty at the end of their orthodontic treatment
were divided into three age groups: younger than 15 years at the time of surgery (group 1), 15 to
19 years (group 2), and 20 years or older (group 3). Twenty-three patients who did not accept
genioplasty and had a follow-up radiograph 2 years after the end of their orthodontic treatment
were used as a control group. Patients were evaluated at three time points: immediate preoperative
(T1), immediate postoperative (T2,) and 2 years postsurgery (T3).
Results: The mean genial advancement at surgery was similar for the three age groups, but the
extent of remodeling around the repositioned chin was greater in group 1, less in group 2, and still
less in group 3. Symphysis thickness increased significantly during the 2-year postsurgery interval
for the three groups, and this increase was significantly greater in group 1 than in group 3.
Remodeling above and behind the repositioned chin also was greater in the younger patients. This
was related to greater vertical growth of the dentoalveolar process in the younger patients. There
was no evidence of a deleterious effect on mandibular growth.
Conclusion: The outcomes of forward-upward genioplasty include increased symphysis
thickness, bone apposition above B point, and remodeling at the inferior border. When indications
for this type of genioplasty are recognized, early surgical correction (before age 15) produces a
better outcome in terms of bone remodeling. (Angle Orthod. 0000;00:000–000.)
Methods: Retrospectively, the file records of the patients who underwent sleeve gastrectomy were examined. Demographic features, Body Mass Index (BMI), the mouth opening, Mallampati score, thyromental distance, sternomental distance, neck circumference measurements and videolaryngoscopic examination results were recorded Results: In a total of 140 consecutive patients (58 male, 82 female) were included in the study. The mean age of the study participants was 35.40 ± 9.78 and the mean BMI of the patients was 44.33 ± 7.52 kg/m2
. The mean mouth opening of the patients was 4.82 ± 0.54 cm
and the mean neck circumference was 43.52 ± 4.66 cm. The mean thyromental distance was 8.02 ± 1.00 cm and the mean sternomental distance was16.58 ± 1.53 cm. Difficult intubation was determined in 8 (5.7%) patients. In logistic regression analysis, age (p : 0.446), gender (p : 0.371), BMI (p : 0.947), snoring (p : 0.567), sleep apnea (p : 0.218), mouth opening (p : 0.687), thyromental distance (p :0.557), sternomental (p : 0.596) and neck circumference (p : 0.838) were not the independent predictors of difficult intubation. However, Mallampati score (p : 0.001) and preoperative direct laryngoscopy findings (p : 0.037) performed in outpatient clinic were the significant
predictors of difficult intubation. Interestingly, all patients with grade 4 laryngoscopy findings had difficult intubation.
Study of current pattern of Cervical Spondylotic Myelopathy and to evaluate t...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Medcrave Group - Open Locked Nailing Using an Expandable NailMedCrave
A retrospective study was performed using the hospital records. The mechanism of injury, the time between injury and surgery, blood transfusion requirements, blood loss, surgical times, time taken to weight bear (for the femoral/
tibial fractures), time for commencement of upper limb use (for humeral fractures), complication rates and the average follow up times were documented. Fifty-seven long bone fractures in 57 patients were included in this study. Complete results including preoperative X-Rays were available for 27 patients. In 30 cases, the actual X-Rays were not located but documentation by the treating surgeons was available.
Presentation for Total Hip ArthroplastyRickNuttall95
Presentation on whether precautions, assistive devices and femoral head sizes play a role in reducing dislocation rates after a total hip arthroplasty.
2. Flail Chest and how it is treated
Background information on rib
fractures
Surgical Rib Fixation (SRF) and how it
is utilized at Baystate
Study methods and
results/conclusions
Future of SRF?
3. • A flail chest occurs when a segment of the
thoracic cage is separated from the rest of the
chest wall.
• Result of a crushing chest injury
• Paradoxical respiration
http://medical-dictionary.thefreedictionary.com/flail+segment
This image shows the
paradoxical movements
of the flail segments
4. Major source of morbidity in the U.S.
Significant advances in pain control, no
improvement in the outcomes
Various reports beginning in the 1950s and
sporadic attempts through the mid 80’s
The safety and efficiency of SRF remains
uncertain (especially in age ≥ 65 population)
5. 11,807 Deaths from Thoracic Trauma
Mortality was 22% for the elderly versus 10%
for the young
The most common complication of rib
fractures is pneumonia
Up to 60% patients do not return to full time
employment
6. Surgical Rib Fixation is a surgery that allows
surgeons to apply artificial support to fractured
ribs
There are different methods of support that can
be used during SRF; these include Rib Loc,
Synthes Rib Matrix, and Intramedullary Nail
Here at Baystate, the Synthes Rib Matrix is
utilized
7. Ribs are realigned and
osteosynthes plates are
bent/cut to fit specific ribs.
The ribs are held together by
the osteosynthes plate, which
is screwed into the ribs.
Important for restoration of
the integrity of the chest wall:
• Plate apposition
• tissue mobilization
• shape formation
8. Baystate Medical Center has created a
multidisciplinary team approach to the care of rib
fracture patients.
This includes specific pain regimens,
multimodality target respiratory therapy, and
surgical intervention
The study conducted here at Baystate focused
on the concept of age restrictions within the
SRF patient population
9. Patients with flail chest or severe rib fractures who
were admitted to a Level 1 Trauma Center for SRF
between July 2010 and June 2014 were evaluated
Patients age ≥ 65 and age ≤ 64 were evaluated and
compared in the outcome variables:
1. Injury Severity Score
2. Total number of Fractures
3. Hospital Length of Stay
4. ICU LOS
5. Ventilator Days
6. Fractures Repaired
10. Utilized REDCap Database, which is a
secure, web-based application for building
and managing online databases
Research Electronic Data Capture
Also provides automated export
procedures for easy statistical analysis
11. The median number of
ventilator days, ISS, ICU
LOS, and Hospital LOS were
similar in both groups,
signaling that there should
not be age restrictions on
surgical rib fixations.
12. This project is intended
to improve the care and
outcomes of patients
with rib fractures.
Presentation at EAST
(Eastern Association for
Aurgical Trauma) at end
of January 2015
Creation of a national
registry
http://www.swedish.org/about/blog/august-2012/rib-fractures-
essentials-of-management-treatment
13. Thank you to Andrew Doben, M.D., who is the
primary researcher of this project
Thank you to Jeffry Nahmias, M.D., who made
this internship opportunity possible
Thank you to Jane Sicard and the Summer
Scholars for giving me the opportunity to present
my research here today
14. 1. Flail chest. (n.d.). Medterms. Retrieved July 21, 2014, from
http://www.medterms.com/script/main/art.asp?articlekey=3473
2. flail segment. (n.d.). TheFreeDictionary.com. Retrieved July 16, 2014, from http://medical-
dictionary.thefreedictionary.com/flail+segment(flail segment image/definition)
3. M.D., A. D. (Director) (2014, July 21). Surgical Management of Traumatic Rib Fractures.
Lecture conducted from , Springfield, MA.
4. Operative management of rib fractures in the setting of flail chest: a systematic review and
meta-analysis. (0001, January 18). Operative management of rib fractures in the setting of flail chest: a
systematic review and meta-analysis. Retrieved July 16, 2014
5. REDCap. (n.d.). REDCap. Retrieved August 4, 2014, from
https://collaborate.tuftsctsi.org/redcap/
6. SRF Abstract by Dr. Andrew Doben, M.D.
7. Swedish Medical Center Seattle and Issaquah. (n.d.). Swedish. Retrieved July 16, 2014, from
http://www.swedish.org/about/blog/august-2012/rib-fractures-essentials-of-management-
treatment
8. Tintinalli's Emergency Medicine: A Comprehensive Study Guide, 7e. (n.d.). AccessMedicine.
Retrieved July 16, 2014, from
http://accessmedicine.mhmedical.com/content.aspx?bookid=348§ionid=40381746&jumpsect
ionID=40408000&Resultclick=2
9. TRAUMA.ORG: Thoracic Trauma. (n.d.). TRAUMA.ORG: Thoracic Trauma. Retrieved July 16,
2014, from http://www.trauma.org/archive/thoracic/CHESTflail.html(flail chest definition)
Editor's Notes
Talk about flail chest and the effects it has on pulmonary function… how would flail chest be treated if SRF was unavailable?
Give background info on the severity of rib fractures and the complications that can follow… also talk about how they are treated and the risks of poor treatment
What exactly is SRF and how does baystate manage rib fracture cases?
How did we conduct this study/what was the protocol for our research?
What are the future plans for SRF?
Flail Chest is defined as a loss of stability of the chest wall due to three or
more ribs that are broken in two or more places as a result of a crushing
chest injury. (THIS IS AN ANTIQUATED DEFINITION)…The loose chest segment moves in a direction in the reverse of
normal; that is, the segment moves inward during inhalation and outward
during exhalation (also known as paradoxical respiration).
The frequency of flail chest is 150/100K injuries
Rib fractures remain a major source of morbidity and although there have been advances in pain control, the outcomes have not improved
The safety and efficiency of SRF remains uncertain because few studies have been conducted, especially in the age>65 population
Chest deformity and permanent respiratory struggles
60% never return to work
Different types of SRF procedures
A quick slide showing a summarized view of the SRF process using Synthes Rib Matrix
The Baystate team has created a multidisciplinary team approach in the care of fractured ribs
There are specific pain regimens and surgical interventions
All patients whom underwent SRF were reviewed in our study
This group of patients was then sub-divided into age <65 and age >65 presentation groups
Data was analyzed, revealing similarities between the two group
Wording? Who did we choose and why?
REDCap was the database software that was utilized for this study
Outcome variables
It was observed that the two study groups, ages > 65 and ages <64 were nearly identical in all variable outcomes. The median number of ventilator days, ISS, ICU LOS, and Hospital LOS were similar in both groups, signaling that there should not be age restrictions on surgical rib fixations.
Our results are consistent with others like it. We hope to present this data at a national conference where we will encourage other institutions to begin to share their data and outcomes of surgical rib fixation to create a national registry that perhaps will help determine the overall benefit to patients.