Brian Page - Academia.edu (original) (raw)
Papers by Brian Page
Annals of Physiotherapy & Occupational Therapy, 2020
Objectives: To determine whether a condensed screw construct or a dispersed screw construct is mo... more Objectives: To determine whether a condensed screw construct or a dispersed screw construct is more likely to sustain a subtrochanteric fracture after cannulated screw fixation for femoral neck fractures, and to report the characteristics of the screw constructs in our patient population that sustained a subtrochanteric fracture. Methods: We performed a biomechanical analysis of two screw constructs and a consecutive case series of patients treated with cannulated screw fixation for femoral neck fractures sustaining subtrochanteric fracture. The biomechanical study consisted of two groups of biocomposite femora: (1) Condensed screw group (CS) (n=7); (2) Dispersed screw group (DS) (n=7). Axial loading was applied to the biomechanical group until fracture, and a load deformation curve was used to quantify the mechanical behavior by measuring the load (kN) at failure, displacement (mm) at failure, and initial construct stiffness (kN/mm). The case series involved a retrospective chart review of patients treated with cannulated screw fixation who sustained a subtrochanteric fracture (n=7). Radiographs were analyzed for trends in failure during chart review. Results: There was a trend towards increased load to failure in the DS group compared with the CS group. We did not observe a statistical difference (p = 0.1023) in load to failure, but we did observe increased stiffness in the DS group (p = 0.0346). Post-hoc non-inferiority analysis demonstrated that the DS were not inferior to CS group. We found a 3.9% incidence of periimplant fracture in our patient population who underwent cannulated screw fixation. Conclusion: The results of this study suggest that maximally dispersing screw placement within the femoral neck, may have higher load to failure than more condense screws. The authors of this study advocate maximizing spacing of the screws within the femoral neck while letting the anatomy of the femoral neck dictate the position of the distal screw relative to the lesser trochanter.
JAAOS: Global Research and Reviews
Introduction: Bone defects may be managed with bone transport or acute shortening and lengthening... more Introduction: Bone defects may be managed with bone transport or acute shortening and lengthening using circular external fixation devices. We performed a multicenter retrospective cohort study to compare the outcomes between the Ilizarov frames and hexapod frames for the management of bone defects. Methods: Patients treated for bone defects using either Ilizarov or hexapod frames were included for analysis in two specialist institutions. Primary outcomes were time to consolidation, bone healing index (BHI), and external fixator index (EFI). Radiographic parameters included the medial proximal tibial angle, lateral distal tibial angle, posterior proximal tibial angle, and anterior distal tibial angle. Results: There were 137 hexapods and 90 Ilizarov frames in total. The mean time to follow-up was 3.7 years in the hexapod group and 4.0 years in the Ilizarov group. Hexapods had a significantly lower time to consolidation (253 days versus 449 days) (P < 0.0001) and BHI (59.1 days/cm...
Journal of Orthopaedic Trauma
Objectives: To determine whether there is an association between surgical approach and dislocatio... more Objectives: To determine whether there is an association between surgical approach and dislocation risk in patients with cognitive impairment compared with those without cognitive impairment treated with hemiarthroplasty for femoral neck fracture. Design: Retrospective study. Setting: Large, multicenter health system. Patients/Participants: One thousand four hundred eighty-one patients who underwent hemiarthroplasty for femoral neck fractures. 828 hips met inclusion criteria, 290 (35.0%) were cognitively impaired, and 538 (65.0%) were cognitively intact. Intervention: Hemiarthroplasty. Main Outcome Measure: Prosthetic hip dislocation. Results: The overall dislocation rate was 2.1% (17 of 828), 3.4% (10 of 290) in the cognitively impaired group, and 1.3% (7 of 538) in the cognitively intact group with a median time to dislocation of 20.5 days (range 2–326 days), 24.5 days (range 3–326 days), and 19.0 days (range 2–36 days), respectively. In the entire cohort, there were no dislocatio...
JBJS Open Access
Background: An elevated brain natriuretic peptide (BNP) level has been shown to be associated wit... more Background: An elevated brain natriuretic peptide (BNP) level has been shown to be associated with mortality and cardiac events in cardiac surgery, but its utility in the prediction of morbidity and mortality in hip fracture surgery is unknown. The primary aim of this study was to determine if there is a difference in BNP level at the time of injury between patients who do and do not develop complications after hip fracture surgery. The secondary aim was to determine if there is a predictive relationship between complications associated with the initial BNP level and mortality. Methods: A retrospective chart review of 455 hip fractures in patients ≥60 years old that were operatively treated between February 2014 and July 2018 was performed. Patients were included if they had a BNP level within 48 hours after injury (BNPi). Specific perioperative (≤7 days), 30-day, 1-year, and 2-year postoperative complications were recorded. Wilcoxon rank-sum tests were used to determine if higher B...
Journal of Orthopaedic Trauma
Objectives: To assess the effects of Krackow suture technique on the vascularity of the patellar ... more Objectives: To assess the effects of Krackow suture technique on the vascularity of the patellar tendon. Methods: Six fresh-frozen matched pair cadaveric knee specimens were used. The superficial femoral arteries were cannulated in all knees. The experimental knee underwent an anterior approach, patellar tendon transection from the inferior pole of the patella, 4-strand Krackow stitch placement, patellar tendon repair via 3-bone tunnels, and standard skin closure. The control knee underwent the identical procedure without Krackow stitching. All specimens then underwent precontrast and postcontrast enhanced quantitative magnetic resonance imaging assessment (with gadolinium-based contrast agent). Region of interest analysis was performed to assess for variation in signal enhancement between the experimental and control limbs in various patellar tendon regions and subregions. Latex infusion and anatomical dissection were performed to further evaluate vessel integrity and assess extrin...
Journal of Orthopaedic Trauma, 2019
Objective: To document angles, from 2 difference starting points, or danger zones that should be ... more Objective: To document angles, from 2 difference starting points, or danger zones that should be avoided to minimize risk of injury or irritation to the saphenous neurovascular bundle (SNVB) during suture button (SB) fixation for distal tibiofibular syndesmosis injuries. Design: Retrospective imaging study. Setting: Academic Level 1 trauma center. Patients: Forty-eight randomly selected patients with healthy ankles and computed tomography scans for nonankle diagnoses. Main Outcome Measures: Computed tomography scans and 3D reconstructed images were used to define the angle between the SNVB and 2 different fibular starting points, using the direct lateral (DL) and the posterolateral (PL) starting points. Descriptive analyses were performed to identify angles that should be avoided during suture button fixation. Distances from the SNVB using preset angles of 0, 10, 20, and 30 degrees were analyzed. In addition, the width of the SNVB, the midsubstance angle of the SNVB, and the distanc...
Orthopedic Clinics of North America, 2013
Disclosures and Conflicts of Interest: The authors did not received payments or services, either ... more Disclosures and Conflicts of Interest: The authors did not received payments or services, either directly or indirectly (ie, via their institution) from a third party in support of any aspect of this work. The authors' institution has had a financial relationship with entities in the biomedical arena (Zimmer and Tornier) that could be perceived to influence, or have the potential to influence, what is written in this work. The authors have had no other relationships or have engaged in no other activities that could be perceived to influence, or have the potential to influence, what is written in this work.
Baylor University Medical Center Proceedings, 2019
Acromioclavicular (AC) joint separations are common in both sports and trauma injuries. Many surg... more Acromioclavicular (AC) joint separations are common in both sports and trauma injuries. Many surgical options exist for fixation of these injuries. Although the suture button has become popular, it has a moderately high complication rate. The most common complication is the loss of reduction, but another common complication is knot-related pain. This article outlines a method of suture button fixation that addresses both of these complications with a novel knotless construct using TightRopes.
Annals of Physiotherapy & Occupational Therapy, 2020
Objectives: To determine whether a condensed screw construct or a dispersed screw construct is mo... more Objectives: To determine whether a condensed screw construct or a dispersed screw construct is more likely to sustain a subtrochanteric fracture after cannulated screw fixation for femoral neck fractures, and to report the characteristics of the screw constructs in our patient population that sustained a subtrochanteric fracture. Methods: We performed a biomechanical analysis of two screw constructs and a consecutive case series of patients treated with cannulated screw fixation for femoral neck fractures sustaining subtrochanteric fracture. The biomechanical study consisted of two groups of biocomposite femora: (1) Condensed screw group (CS) (n=7); (2) Dispersed screw group (DS) (n=7). Axial loading was applied to the biomechanical group until fracture, and a load deformation curve was used to quantify the mechanical behavior by measuring the load (kN) at failure, displacement (mm) at failure, and initial construct stiffness (kN/mm). The case series involved a retrospective chart review of patients treated with cannulated screw fixation who sustained a subtrochanteric fracture (n=7). Radiographs were analyzed for trends in failure during chart review. Results: There was a trend towards increased load to failure in the DS group compared with the CS group. We did not observe a statistical difference (p = 0.1023) in load to failure, but we did observe increased stiffness in the DS group (p = 0.0346). Post-hoc non-inferiority analysis demonstrated that the DS were not inferior to CS group. We found a 3.9% incidence of periimplant fracture in our patient population who underwent cannulated screw fixation. Conclusion: The results of this study suggest that maximally dispersing screw placement within the femoral neck, may have higher load to failure than more condense screws. The authors of this study advocate maximizing spacing of the screws within the femoral neck while letting the anatomy of the femoral neck dictate the position of the distal screw relative to the lesser trochanter.
JAAOS: Global Research and Reviews
Introduction: Bone defects may be managed with bone transport or acute shortening and lengthening... more Introduction: Bone defects may be managed with bone transport or acute shortening and lengthening using circular external fixation devices. We performed a multicenter retrospective cohort study to compare the outcomes between the Ilizarov frames and hexapod frames for the management of bone defects. Methods: Patients treated for bone defects using either Ilizarov or hexapod frames were included for analysis in two specialist institutions. Primary outcomes were time to consolidation, bone healing index (BHI), and external fixator index (EFI). Radiographic parameters included the medial proximal tibial angle, lateral distal tibial angle, posterior proximal tibial angle, and anterior distal tibial angle. Results: There were 137 hexapods and 90 Ilizarov frames in total. The mean time to follow-up was 3.7 years in the hexapod group and 4.0 years in the Ilizarov group. Hexapods had a significantly lower time to consolidation (253 days versus 449 days) (P < 0.0001) and BHI (59.1 days/cm...
Journal of Orthopaedic Trauma
Objectives: To determine whether there is an association between surgical approach and dislocatio... more Objectives: To determine whether there is an association between surgical approach and dislocation risk in patients with cognitive impairment compared with those without cognitive impairment treated with hemiarthroplasty for femoral neck fracture. Design: Retrospective study. Setting: Large, multicenter health system. Patients/Participants: One thousand four hundred eighty-one patients who underwent hemiarthroplasty for femoral neck fractures. 828 hips met inclusion criteria, 290 (35.0%) were cognitively impaired, and 538 (65.0%) were cognitively intact. Intervention: Hemiarthroplasty. Main Outcome Measure: Prosthetic hip dislocation. Results: The overall dislocation rate was 2.1% (17 of 828), 3.4% (10 of 290) in the cognitively impaired group, and 1.3% (7 of 538) in the cognitively intact group with a median time to dislocation of 20.5 days (range 2–326 days), 24.5 days (range 3–326 days), and 19.0 days (range 2–36 days), respectively. In the entire cohort, there were no dislocatio...
JBJS Open Access
Background: An elevated brain natriuretic peptide (BNP) level has been shown to be associated wit... more Background: An elevated brain natriuretic peptide (BNP) level has been shown to be associated with mortality and cardiac events in cardiac surgery, but its utility in the prediction of morbidity and mortality in hip fracture surgery is unknown. The primary aim of this study was to determine if there is a difference in BNP level at the time of injury between patients who do and do not develop complications after hip fracture surgery. The secondary aim was to determine if there is a predictive relationship between complications associated with the initial BNP level and mortality. Methods: A retrospective chart review of 455 hip fractures in patients ≥60 years old that were operatively treated between February 2014 and July 2018 was performed. Patients were included if they had a BNP level within 48 hours after injury (BNPi). Specific perioperative (≤7 days), 30-day, 1-year, and 2-year postoperative complications were recorded. Wilcoxon rank-sum tests were used to determine if higher B...
Journal of Orthopaedic Trauma
Objectives: To assess the effects of Krackow suture technique on the vascularity of the patellar ... more Objectives: To assess the effects of Krackow suture technique on the vascularity of the patellar tendon. Methods: Six fresh-frozen matched pair cadaveric knee specimens were used. The superficial femoral arteries were cannulated in all knees. The experimental knee underwent an anterior approach, patellar tendon transection from the inferior pole of the patella, 4-strand Krackow stitch placement, patellar tendon repair via 3-bone tunnels, and standard skin closure. The control knee underwent the identical procedure without Krackow stitching. All specimens then underwent precontrast and postcontrast enhanced quantitative magnetic resonance imaging assessment (with gadolinium-based contrast agent). Region of interest analysis was performed to assess for variation in signal enhancement between the experimental and control limbs in various patellar tendon regions and subregions. Latex infusion and anatomical dissection were performed to further evaluate vessel integrity and assess extrin...
Journal of Orthopaedic Trauma, 2019
Objective: To document angles, from 2 difference starting points, or danger zones that should be ... more Objective: To document angles, from 2 difference starting points, or danger zones that should be avoided to minimize risk of injury or irritation to the saphenous neurovascular bundle (SNVB) during suture button (SB) fixation for distal tibiofibular syndesmosis injuries. Design: Retrospective imaging study. Setting: Academic Level 1 trauma center. Patients: Forty-eight randomly selected patients with healthy ankles and computed tomography scans for nonankle diagnoses. Main Outcome Measures: Computed tomography scans and 3D reconstructed images were used to define the angle between the SNVB and 2 different fibular starting points, using the direct lateral (DL) and the posterolateral (PL) starting points. Descriptive analyses were performed to identify angles that should be avoided during suture button fixation. Distances from the SNVB using preset angles of 0, 10, 20, and 30 degrees were analyzed. In addition, the width of the SNVB, the midsubstance angle of the SNVB, and the distanc...
Orthopedic Clinics of North America, 2013
Disclosures and Conflicts of Interest: The authors did not received payments or services, either ... more Disclosures and Conflicts of Interest: The authors did not received payments or services, either directly or indirectly (ie, via their institution) from a third party in support of any aspect of this work. The authors' institution has had a financial relationship with entities in the biomedical arena (Zimmer and Tornier) that could be perceived to influence, or have the potential to influence, what is written in this work. The authors have had no other relationships or have engaged in no other activities that could be perceived to influence, or have the potential to influence, what is written in this work.
Baylor University Medical Center Proceedings, 2019
Acromioclavicular (AC) joint separations are common in both sports and trauma injuries. Many surg... more Acromioclavicular (AC) joint separations are common in both sports and trauma injuries. Many surgical options exist for fixation of these injuries. Although the suture button has become popular, it has a moderately high complication rate. The most common complication is the loss of reduction, but another common complication is knot-related pain. This article outlines a method of suture button fixation that addresses both of these complications with a novel knotless construct using TightRopes.