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Papers by Eran Maman

Journal of Clinical Medicine

Bone marrow aspirate concentrate (BMAC) is an autologous cell composition that is obtained throug... more Bone marrow aspirate concentrate (BMAC) is an autologous cell composition that is obtained through a needle aspiration from the iliac crest. The purpose of this study was to evaluate the outcomes of patients treated with open reduction and internal fixation with BMAC supplementation for clavicle fracture nonunion. This was a retrospective case series of 21 consecutive patients with clavicle fracture nonunion that were treated with ORIF and BMAC supplementation between 2013 and 2020. Patients were evaluated for fracture union, time to union, complications related to surgical and donor site, and functional outcome using the Quick Disability of the Arm Shoulder and Hand (QDASH), subjective shoulder value (SSV), and pain. The mean age was 41.8 years. The mean follow-up was 36 months. Twenty (95.2%) patients demonstrated fracture union, with a mean time to union of 4.5 months. Good functional scores were achieved: SSV, 74.3; QDASH, 23.3; pain level, 3.1. There were no complications or pa...

The American journal of sports medicine, Jan 27, 2015

The effect of corticosteroids on tendons is poorly understood, and current data are insufficient ... more The effect of corticosteroids on tendons is poorly understood, and current data are insufficient and conflicting. To evaluate the effects of corticosteroid injections on intact and injured rotator cuffs (RCs) through biomechanical and radiographic analyses in a rat model. Controlled laboratory study. A total of 70 rats were assigned to 7 groups. Uninjured rats (no tear) received either a single saline injection, a single methylprednisolone acetate (MTA) injection, or triple MTA injections. Injured rats (unilateral supraspinatus injury) received either a single saline injection, triple saline injections, a single MTA injection, or triple MTA injections (injections were subacromial; repeat injections were administered weekly). Rats were sacrificed 1 week after final injection. Shoulders were harvested and grossly inspected, and the supraspinatus tendon was evaluated biomechanically. Bone density at the tendon insertion site on the greater tuberosity was assessed by micro-computed tomo...

Background: Injury to the axillary nerve has devastating results. Variations in the distance betw... more Background: Injury to the axillary nerve has devastating results. Variations in the distance between the acromial edge and axillary nerve range from 20-70 mm. The purpose of this study was to anatomically analyze the relations between the anterior trunk of the axillary nerve and the acromion in order to provide guidelines for minimizing intraoperative iatrogenic neural injury. Methods: The distances between the axillary nerve and the posterolateral, midlateral , and anterolateral edges of the acromion were measured in 60 cadaveric shoulders (30 fresh cadavers). The correlations between these measurements to the weight, height and sex of the cadavers were statistically analyzed. Results: The distances between the axillary nerve and all three acromial anatomic landmarks significantly correlated with the cadaver’s height (p<0.001) The axillary nerve was found as close as 30-35 mm distal to the acromion in cadavers shorter than 170 cm, (5.7”), whereas the minimal distance between the...

PURPOSE Analyze temporal MRI changes of non surgically treated rotator cuff tears (RCTs) with cor... more PURPOSE Analyze temporal MRI changes of non surgically treated rotator cuff tears (RCTs) with correlation to clinical exam. METHOD AND MATERIALS 59 shoulders (33 F: 26 M; mean age 59) with RCTs on initial MRI, managed nonoperatively (physiotherapy & rehabilitation) were prospectively studied. All patients had followup MRI >6 months after the initial study (mean 20 mos) and were assessed for pain, ROM and strength by a single orthopedic surgeon at baseline and followup time-points. All MRIs were assessed in blinded fashion for; RCT location, dimensions, and type (full/partial thickness RCTs [FTT/PTT]); ACJ OA; acromial shape/spurs; and muscular atrophy. Interval RCT size progression/diminution (defined as change in any dimension >2mm) was correlated to age, gender, other MRI findings and clinical findings. RESULTS Baseline MRI showed 29 FTTs, 26 PTTs and 4 combined FTT/PTTs. 58/59 RCTs involved supraspinatus, 10/59 involved multiple tendons. Followup MRI showed RCT progression ...

The American journal of sports medicine, 2014

Statins are lipid-lowering drugs with many beneficial pleiotropic effects. Cyclooxygenase (COX2) ... more Statins are lipid-lowering drugs with many beneficial pleiotropic effects. Cyclooxygenase (COX2) selective inhibitors that are commonly prescribed in orthopaedic patients may effect healing. Evidence indicates that statins stimulate COX2 activity. Atorvastatin (ATV) administration will enhance tendon healing by stimulating the acute inflammatory phase via increasing the production of prostaglandin E2 (PGE2). Controlled laboratory study. After experimental rotator cuff (RC) tearing and suturing, 48 Wistar rats were randomly allocated into 4 groups: (1) ATV (20 mg/kg), (2) celecoxib (CEL; COX2 inhibitor) (10 mg/kg), (3) ATV + CEL (20 mg/kg + 10 mg/kg), and (4) saline alone. Animals were sacrificed 3 weeks after RC tears and repair, and tendon integrity was tested biomechanically in tension. To further evaluate the underlying mechanism of action, human and rat primary tenocytes were obtained from the supraspinatus tendon. Cultures were treated with a therapeutic dosage of 5 commonly us...

Archives of orthopaedic and trauma surgery, 2014

Rotator cuff tear (RCT) is a common cause of pain and disability among adults. Platelet-rich plas... more Rotator cuff tear (RCT) is a common cause of pain and disability among adults. Platelet-rich plasma (PRP) is a fraction of whole blood containing concentrated growth factors and proteins important for tissue healing. This study aimed at investigating the effects of local autologous PRP injection on repaired rotator cuff (RC) tendon repair in rats. Following experimental RCT and suturing, 44 Wistar rats were randomly allocated into two groups: (1) RC repair only (controls); (2) RC repair + PRP administration-shoulders were treated with intra-articular PRP immediately after the repair. Animals were killed after 3 weeks and tendon, were tested biomechanically in tension (12 rats/group). The remaining tendons (10 rats/group) were stained using hematoxylin and eosin and Picro-sirius Red. Histological analysis evaluated the cellular aspects of the repair tissue. PRP administration following experimental RC tear and suture resulted in a significantly higher maximal load (p < 0.001) and ...

Clinical orthopaedics and related research, 2007

Tumors of the axilla are rare and pose a surgical challenge because they are usually large at pre... more Tumors of the axilla are rare and pose a surgical challenge because they are usually large at presentation and in close proximity to the major neurovascular bundle of the upper extremity. The use of detailed preoperative evaluation studies and extensile surgical exposure for these tumors enabled us to determine tumor resectability and proceed with a safe resection or perform an amputation when required. We retrospectively reviewed 27 patients who underwent resection of an axillary tumor from 1989 to 2004 and analyzed their presenting symptoms, results of preoperative studies, type of surgery, and functional outcome. Tumors were exposed using a utilitarian shoulder approach that revealed no tumor invasion of the neurovascular bundle in 19 patients and invasion in eight. The former group was treated with tumor resection and the latter with forequarter amputation. Neurologic deficit, limb edema, and angiographic observation of arterial narrowing were associated with amputation. Good fu...

Current Orthopaedic Practice, 2009

ABSTRACT Background: Transient osteoporosis of the hip (TOH) is a rare disease of unknown etiolog... more ABSTRACT Background: Transient osteoporosis of the hip (TOH) is a rare disease of unknown etiology, affecting middle-aged men, women in the third trimester of pregnancy, and rarely children, adolescents and nonpregnant women. Presenting symptoms are sudden hip pain and limp, initially with unremarkable radiographs and blood tests. Methods: Forty-eight patients (54 hips) with sudden hip pain were examined. All had radiographs, technetium bone scan and MRI. Increased uptake on bone scan and bone edema in the femoral head and neck on MRI were found in all patients. Five patients diagnosed with other disease processes were excluded from the study. The remaining (37 men, 6 nonpregnant women; 49 hips) were diagnosed with TOH. All had repeated clinical and MRI investigations until resolution of symptoms. Twenty-six patients had bone density measurements (DEXA) of both hips and spine. Mean follow-up was 43 months (range, 12–106 months). Results: Spontaneous resolution of symptoms occurred in all patients, and all were asymptomatic at final follow-up, although one patient had minor restriction of flexion. Despite the presence of crescent lines on initial MRI in 14 patients, none progressed to osteonecrosis, and crescent lines were not apparent on follow-up MRI. Excellent correlation was found between radiographic bone edema resolution and clinical improvement. DEXA measurements revealed nine men with abnormal bone density despite their relatively young ages. Conclusion: TOH is a benign disease, does not progress to osteonecrosis, and should be treated conservatively. Crescent lines may initially appear on MRI only to resolve spontaneously. Other diagnoses should be investigated if pain and bone edema persist.

Shoulder & Elbow, 2011

... Page 3. S The vanishing shoulder Ben-Galim et al. The process was thus diagnosed as an asepti... more ... Page 3. S The vanishing shoulder Ben-Galim et al. The process was thus diagnosed as an aseptic idiopathic chondrolysis. ... There is only one previous report of a case of rapidly progressive idiopathic chondrolysis simulating tuberculosis of the shoulder by Kahan et al. ...

Orthopaedic Nursing, 2013

Involuntary cast-saw burns are attributable to poorly padded casts, cast material, or improper te... more Involuntary cast-saw burns are attributable to poorly padded casts, cast material, or improper technique. Another factor potentially associated with the risk of injury is the distance between the inner perimeter of the cast and the patient&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s skin (safety distance). Eighty computed tomographic scans of the lower limb following cast application were analyzed. Safety distance was measured above, below, and at the level of the knee and ankle joints at 4 different aspects (posterior, anterior, medial, and lateral). The highest safety distance measured was at the anterior aspect, 5 cm beneath the ankle joint (8.13 ± 3.73 mm). The lowest distance measured was consistently at the posterior aspect at all levels, especially 5 cm below the ankle joint (2.02 ± 1.31 mm). The anterior aspect of the leg is the safest area to split a cast based on safety distance measurements. Patient and limb position may also affect the safety distance at various areas along the limb.

Journal of the Mechanical Behavior of Biomedical Materials, 2013

Journal of Shoulder and Elbow Surgery, 2010

Background: Arthroscopic Bankart repair (ABR) is a standard treatment for recurrent anterior shou... more Background: Arthroscopic Bankart repair (ABR) is a standard treatment for recurrent anterior shoulder instability. Young age, hyperlaxity, loss of bone stock and multidirectional or voluntary type of instability are all associated with failure of this procedure. Rotator interval laxity is associated with shoulder instability, whereas rotator interval closure increases humeral head stability and reduces shoulder range of motion. Methods: The records of patients with recurrent anterior shoulder dislocations who underwent ABR with or without arthroscopic rotator interval closure (ARIC) in our department between 1999 and 2007 were reviewed. Rates of recurrent dislocation or symptomatic subluxation as well as functional outcome were evaluated using Walch-Dupley score. Results: Three (8.1%) of the 37 ABRþARIC patients (age 19-44 years, 32 males) had re-dislocated their shoulder at 42AE16 months following the procedure, all of which had systemic joint hyperlaxity. Six (13%) of the 46 ABR patients (age 19-39 years, 42 males) had re-dislocated their shoulder at 13AE14 months, three of which had systemic joint hyperlaxity and dislocated their shoulder within 1 year following the operation. Systemic joint hyperlaxity (28% of ABR and 41% of ABRþARIC patients) was significantly associated with recurrent dislocation and poor functional outcome. ABRþARIC patients had slightly more limited range of motion with similar good and excellent functional results (75%) at final follow up time.

The Journal of Bone and Joint Surgery (American), 2009

Rotator cuff tears are very common, but little is known about the outcome of nonoperative treatme... more Rotator cuff tears are very common, but little is known about the outcome of nonoperative treatment of symptomatic tears in terms of progression and the need for surgical intervention. Fifty-nine shoulders in fifty-four patients (thirty-three women and a mean age of 58.8 years) with rotator cuff tears on initial magnetic resonance imaging who had been managed nonoperatively were studied retrospectively. All had magnetic resonance imaging scans acquired six months or more after the initial study. The progression of the rotator cuff tears was associated with age, anatomical and associated parameters, follow-up time, and structural and other magnetic resonance imaging findings. Baseline magnetic resonance imaging scans demonstrated thirty-three full-thickness tears, twenty-six partial-thickness tears, and four combined full-thickness and partial-thickness tears. Fifty-eight of the fifty-nine tears involved the supraspinatus tendon, and ten involved multiple tendons. Progression in tear size occurred more often among the patients who were followed more than eighteen months (thirteen [48%] of twenty-seven shoulders) compared with those who were followed for less than eighteen months (six [19%] of thirty-two shoulders). Five tears (one partial-thickness tear) decreased in size. More than half (52%; seventeen) of the thirty-three full-thickness tears increased in size compared with 8% (two) of the twenty-six partial-thickness tears (p = 0.0005). Only 17% (six) of the thirty-five tears in patients who were sixty years old or less deteriorated compared with 54% (thirteen) of the twenty-four tears in patients who were more than sixty years old (p = 0.007). No shoulder in a patient with a partial-thickness tear demonstrated supraspinatus atrophy, whereas 24% of those with a full-thickness tear demonstrated atrophy (p = 0.007). The proportion with an increase in tear size was significantly larger for shoulders with fatty infiltration than for those without it (p = 0.0089). Factors that are associated with progression of a rotator cuff tear are an age of more than sixty years, a full-thickness tear, and fatty infiltration of the rotator cuff muscle(s). In the long-term follow-up of nonoperatively treated rotator cuff tears, magnetic resonance imaging can be used to monitor rotator cuff changes and guide patient management.

Injury, 2012

Fractures of the intertrochanteric region are very common among the elderly following even minor ... more Fractures of the intertrochanteric region are very common among the elderly following even minor trauma. In younger patients, these fractures are associated with high energy injuries and multitrauma. Intertrochanteric fractures are graded according to the AO/OTA classification as simple (31A1), multifragmentary (31A2) and intertrochanteric (AO 31A3). 1 The intertrochanteric AO31A3 fracture type is considered unstable and is further classified as reverse oblique (31A3.1), transverse (31A3.2) and multifragmentary (31A3.3). Early mobilisation, prevention of nonunion, malunion and thromboembolic complications are the main indications for surgical treatment of type 31A3 fractures. The surgical options for reverse oblique (RO) fractures include proximal femoral nails (PFNs), reconstruction nails and fixed angle devices such as the dynamic condylar 958 angled screw-plate (DCS). Several reports stated that the use of intramedullary devices confirmed some advantage over the dynamic hip screw-plate fixation, including a shorter operation time, less blood loss, a shorter hospital stay, lower rates of implant failure and delayed healing, thereby lessening the need for revision surgery. Although a 958 angled plate is usually selected for fixation of RO fractures, the PFN has shown several advantages. The PFN have biomechanical advantages, including a shorter lever arm, better stability and less potential for fracture collapse and limb shortening, 3 as well as the provision of an intramedullary buttress effect for preventing femoral shaft medialisation. The main disadvantages and many complications following surgical treatment with PFNs are due to intraoperatively occurring technical errors. The expandable PFN (EPFN) (Fixion; HMB Medical Technologies, Herzeliya, Israel) was developed to retain the mechanical characteristics of a large-diameter nail, to provide the good torsional stability between the femoral neck and shaft obtained by an expendable peg inserted in the femoral head (especially in cases of poor bone quality), and to avoid the need for interlocking screws. The purpose of this study was to compare the functional and radiographic results of the EPFN and the 958 DCS (Smith and Nephew, Memphis, USA) in the treatment of RO fractures. We hypothesised that EPFN provides equal or better mechanical support and results in better radiographic and functional outcome.

European Journal of Pain Supplements, 2011

Drugs & Aging, 2012

Background: Early surgical treatment is indicated to reduce mortality and morbidity associated wi... more Background: Early surgical treatment is indicated to reduce mortality and morbidity associated with immobilization due to hip fracture. The judiciousness of postponing surgery to allow withdrawal of clopidogrel and return of normal platelet function (5-10 days) in elderly patients being chronically treated with this antiplatelet medication is a matter of ongoing controversy. Objective: The purpose of this study was to compare the morbidity and mortality rates in elderly patients receiving long-term treatment with clopidogrel who were operated on with or without delay (due to withdrawal of clopidogrel) following a hip fracture. Methods: We compared relevant demographic and medical/surgical parameters in patients receiving long-term treatment with clopidogrel who sustained a hip fracture and underwent either early (n = 30, mean -SD age 81.6 -8.7 years, 17 males [57%]) or delayed (n = 30, mean -SD age 83.3 -7.1 years, 13 males [43%]) surgical intervention between May 2007 and February 2010. Results: Both groups were similar with regard to sex, age, co-morbidities and fracture type. The mortality rate was similar in both groups. Patients in the delayed treatment group had more complications associated with prolonged immobilization (pulmonary embolism, pulmonary oedema, decubitus ulcer). Time from admission to surgery and hospitalization stay were significantly longer in the delayed treatment group than in the early treatment group (mean -SD 7 days and 12 hours -2 days and 17 hours compared with 1 day and 16 hours -1 day [p < 0.0001] and 17 days and 17 hours -7 days and 5 hours versus 11 days and 2 hours -4 days and 19 hours [p = 0.0002], respectively). Conclusions: Early surgical intervention for hip fracture in patients receiving long-term treatment with clopidogrel appears to be safe in terms of bleeding complications. It has the potential to enable earlier mobilization and shorter hospitalization and may reduce mortality and complications associated with immobilization. Approval for publication Signed Date Number of amended pages returned ORIGINAL RESEARCH ARTICLE

Clinical Infectious Diseases, 2007

Background. Musculoskeletal manifestations (MMs) are considered to be rare in cat scratch disease... more Background. Musculoskeletal manifestations (MMs) are considered to be rare in cat scratch disease (CSD) and are not well characterized. We aimed to study MMs of CSD.

Arthroscopy: The Journal of Arthroscopic & Related Surgery, 2003

The arthroscope has served the orthopaedic surgeon as a diagnostic and operative tool since 1931.... more The arthroscope has served the orthopaedic surgeon as a diagnostic and operative tool since 1931. Several reports on its use in the treatment of extra-articular injuries have been published over the past few years. The surgical approach to the posterior ankle region is associated with some complications stemming from the poor blood supply to this region that can lead to wound complications and the formation of painful scars that later cause irritation when shoes are worn. We describe our experience in treating 3 hindfoot pathologic conditions, chronic Achilles tendonitis, os trigonum syndrome, and Haglund's deformity, by using an endoscope as an alternative to open surgical techniques. All the patients underwent a 2-portal endoscopic procedure, they suffered no complications, and they resumed their daily and sports activities after 2 to 3 months. Our results with the endoscopic treatment of hindfoot and Achilles tendon injuries indicate it to be a good alternative to the surgical approach, and to have the added advantage of reducing postoperative morbidity.

Arthroscopy: The Journal of Arthroscopic & Related Surgery, 2003

Arthroscopy: The Journal of Arthroscopic & Related Surgery, 2013

The purpose of this study was to assess the incidence of heterotopic ossification (HO) after hip ... more The purpose of this study was to assess the incidence of heterotopic ossification (HO) after hip arthroscopy. Between July 2010 and July 2011, 83 patients underwent hip arthroscopy for various etiologies. We prospectively reviewed 50 consecutive hip arthroscopy procedures (31 male and 19 female patients; mean age, 36.7 years) with a mean follow-up of 29.56 weeks (range, 9 to 62 weeks) to assess the incidence of HO and its effect on function and clinical outcome. Preoperative and postoperative evaluation included general assessment by visual analog scoring, modified Harris Hip Score, Hip Outcome Score, and preoperative and postoperative radiographs. Heterotopic bone formation was assessed on radiographs at a minimum of 9 weeks from surgery with the Brooker classification. Of the patients, 22 (44%) had radiographic evidence of postoperative HO (15 male patients): 13 (26%) had Brooker stage 1, 5 (10%) had Brooker stage 2, and 4 (8%) had Brooker stage 3. HO appeared as early as 9 weeks after surgery. No significant difference was found in demographic data, surgery-related data, or clinical and functional scores between patients with HO and patients without HO. No factor was found to significantly affect the incidence of HO after logistic regression. No distinct clinical manifestation was associated with the presence of HO. This study shows that the incidence of HO after hip arthroscopy may be underestimated. We could not find a contributing factor to the formation of HO. Although in most cases the presence of HO will have minimal or no clinical and functional significance, it should be sought at a minimum of 9 weeks postoperatively. Level IV, therapeutic case series.

Journal of Clinical Medicine

Bone marrow aspirate concentrate (BMAC) is an autologous cell composition that is obtained throug... more Bone marrow aspirate concentrate (BMAC) is an autologous cell composition that is obtained through a needle aspiration from the iliac crest. The purpose of this study was to evaluate the outcomes of patients treated with open reduction and internal fixation with BMAC supplementation for clavicle fracture nonunion. This was a retrospective case series of 21 consecutive patients with clavicle fracture nonunion that were treated with ORIF and BMAC supplementation between 2013 and 2020. Patients were evaluated for fracture union, time to union, complications related to surgical and donor site, and functional outcome using the Quick Disability of the Arm Shoulder and Hand (QDASH), subjective shoulder value (SSV), and pain. The mean age was 41.8 years. The mean follow-up was 36 months. Twenty (95.2%) patients demonstrated fracture union, with a mean time to union of 4.5 months. Good functional scores were achieved: SSV, 74.3; QDASH, 23.3; pain level, 3.1. There were no complications or pa...

The American journal of sports medicine, Jan 27, 2015

The effect of corticosteroids on tendons is poorly understood, and current data are insufficient ... more The effect of corticosteroids on tendons is poorly understood, and current data are insufficient and conflicting. To evaluate the effects of corticosteroid injections on intact and injured rotator cuffs (RCs) through biomechanical and radiographic analyses in a rat model. Controlled laboratory study. A total of 70 rats were assigned to 7 groups. Uninjured rats (no tear) received either a single saline injection, a single methylprednisolone acetate (MTA) injection, or triple MTA injections. Injured rats (unilateral supraspinatus injury) received either a single saline injection, triple saline injections, a single MTA injection, or triple MTA injections (injections were subacromial; repeat injections were administered weekly). Rats were sacrificed 1 week after final injection. Shoulders were harvested and grossly inspected, and the supraspinatus tendon was evaluated biomechanically. Bone density at the tendon insertion site on the greater tuberosity was assessed by micro-computed tomo...

Background: Injury to the axillary nerve has devastating results. Variations in the distance betw... more Background: Injury to the axillary nerve has devastating results. Variations in the distance between the acromial edge and axillary nerve range from 20-70 mm. The purpose of this study was to anatomically analyze the relations between the anterior trunk of the axillary nerve and the acromion in order to provide guidelines for minimizing intraoperative iatrogenic neural injury. Methods: The distances between the axillary nerve and the posterolateral, midlateral , and anterolateral edges of the acromion were measured in 60 cadaveric shoulders (30 fresh cadavers). The correlations between these measurements to the weight, height and sex of the cadavers were statistically analyzed. Results: The distances between the axillary nerve and all three acromial anatomic landmarks significantly correlated with the cadaver’s height (p<0.001) The axillary nerve was found as close as 30-35 mm distal to the acromion in cadavers shorter than 170 cm, (5.7”), whereas the minimal distance between the...

PURPOSE Analyze temporal MRI changes of non surgically treated rotator cuff tears (RCTs) with cor... more PURPOSE Analyze temporal MRI changes of non surgically treated rotator cuff tears (RCTs) with correlation to clinical exam. METHOD AND MATERIALS 59 shoulders (33 F: 26 M; mean age 59) with RCTs on initial MRI, managed nonoperatively (physiotherapy & rehabilitation) were prospectively studied. All patients had followup MRI >6 months after the initial study (mean 20 mos) and were assessed for pain, ROM and strength by a single orthopedic surgeon at baseline and followup time-points. All MRIs were assessed in blinded fashion for; RCT location, dimensions, and type (full/partial thickness RCTs [FTT/PTT]); ACJ OA; acromial shape/spurs; and muscular atrophy. Interval RCT size progression/diminution (defined as change in any dimension >2mm) was correlated to age, gender, other MRI findings and clinical findings. RESULTS Baseline MRI showed 29 FTTs, 26 PTTs and 4 combined FTT/PTTs. 58/59 RCTs involved supraspinatus, 10/59 involved multiple tendons. Followup MRI showed RCT progression ...

The American journal of sports medicine, 2014

Statins are lipid-lowering drugs with many beneficial pleiotropic effects. Cyclooxygenase (COX2) ... more Statins are lipid-lowering drugs with many beneficial pleiotropic effects. Cyclooxygenase (COX2) selective inhibitors that are commonly prescribed in orthopaedic patients may effect healing. Evidence indicates that statins stimulate COX2 activity. Atorvastatin (ATV) administration will enhance tendon healing by stimulating the acute inflammatory phase via increasing the production of prostaglandin E2 (PGE2). Controlled laboratory study. After experimental rotator cuff (RC) tearing and suturing, 48 Wistar rats were randomly allocated into 4 groups: (1) ATV (20 mg/kg), (2) celecoxib (CEL; COX2 inhibitor) (10 mg/kg), (3) ATV + CEL (20 mg/kg + 10 mg/kg), and (4) saline alone. Animals were sacrificed 3 weeks after RC tears and repair, and tendon integrity was tested biomechanically in tension. To further evaluate the underlying mechanism of action, human and rat primary tenocytes were obtained from the supraspinatus tendon. Cultures were treated with a therapeutic dosage of 5 commonly us...

Archives of orthopaedic and trauma surgery, 2014

Rotator cuff tear (RCT) is a common cause of pain and disability among adults. Platelet-rich plas... more Rotator cuff tear (RCT) is a common cause of pain and disability among adults. Platelet-rich plasma (PRP) is a fraction of whole blood containing concentrated growth factors and proteins important for tissue healing. This study aimed at investigating the effects of local autologous PRP injection on repaired rotator cuff (RC) tendon repair in rats. Following experimental RCT and suturing, 44 Wistar rats were randomly allocated into two groups: (1) RC repair only (controls); (2) RC repair + PRP administration-shoulders were treated with intra-articular PRP immediately after the repair. Animals were killed after 3 weeks and tendon, were tested biomechanically in tension (12 rats/group). The remaining tendons (10 rats/group) were stained using hematoxylin and eosin and Picro-sirius Red. Histological analysis evaluated the cellular aspects of the repair tissue. PRP administration following experimental RC tear and suture resulted in a significantly higher maximal load (p < 0.001) and ...

Clinical orthopaedics and related research, 2007

Tumors of the axilla are rare and pose a surgical challenge because they are usually large at pre... more Tumors of the axilla are rare and pose a surgical challenge because they are usually large at presentation and in close proximity to the major neurovascular bundle of the upper extremity. The use of detailed preoperative evaluation studies and extensile surgical exposure for these tumors enabled us to determine tumor resectability and proceed with a safe resection or perform an amputation when required. We retrospectively reviewed 27 patients who underwent resection of an axillary tumor from 1989 to 2004 and analyzed their presenting symptoms, results of preoperative studies, type of surgery, and functional outcome. Tumors were exposed using a utilitarian shoulder approach that revealed no tumor invasion of the neurovascular bundle in 19 patients and invasion in eight. The former group was treated with tumor resection and the latter with forequarter amputation. Neurologic deficit, limb edema, and angiographic observation of arterial narrowing were associated with amputation. Good fu...

Current Orthopaedic Practice, 2009

ABSTRACT Background: Transient osteoporosis of the hip (TOH) is a rare disease of unknown etiolog... more ABSTRACT Background: Transient osteoporosis of the hip (TOH) is a rare disease of unknown etiology, affecting middle-aged men, women in the third trimester of pregnancy, and rarely children, adolescents and nonpregnant women. Presenting symptoms are sudden hip pain and limp, initially with unremarkable radiographs and blood tests. Methods: Forty-eight patients (54 hips) with sudden hip pain were examined. All had radiographs, technetium bone scan and MRI. Increased uptake on bone scan and bone edema in the femoral head and neck on MRI were found in all patients. Five patients diagnosed with other disease processes were excluded from the study. The remaining (37 men, 6 nonpregnant women; 49 hips) were diagnosed with TOH. All had repeated clinical and MRI investigations until resolution of symptoms. Twenty-six patients had bone density measurements (DEXA) of both hips and spine. Mean follow-up was 43 months (range, 12–106 months). Results: Spontaneous resolution of symptoms occurred in all patients, and all were asymptomatic at final follow-up, although one patient had minor restriction of flexion. Despite the presence of crescent lines on initial MRI in 14 patients, none progressed to osteonecrosis, and crescent lines were not apparent on follow-up MRI. Excellent correlation was found between radiographic bone edema resolution and clinical improvement. DEXA measurements revealed nine men with abnormal bone density despite their relatively young ages. Conclusion: TOH is a benign disease, does not progress to osteonecrosis, and should be treated conservatively. Crescent lines may initially appear on MRI only to resolve spontaneously. Other diagnoses should be investigated if pain and bone edema persist.

Shoulder & Elbow, 2011

... Page 3. S The vanishing shoulder Ben-Galim et al. The process was thus diagnosed as an asepti... more ... Page 3. S The vanishing shoulder Ben-Galim et al. The process was thus diagnosed as an aseptic idiopathic chondrolysis. ... There is only one previous report of a case of rapidly progressive idiopathic chondrolysis simulating tuberculosis of the shoulder by Kahan et al. ...

Orthopaedic Nursing, 2013

Involuntary cast-saw burns are attributable to poorly padded casts, cast material, or improper te... more Involuntary cast-saw burns are attributable to poorly padded casts, cast material, or improper technique. Another factor potentially associated with the risk of injury is the distance between the inner perimeter of the cast and the patient&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s skin (safety distance). Eighty computed tomographic scans of the lower limb following cast application were analyzed. Safety distance was measured above, below, and at the level of the knee and ankle joints at 4 different aspects (posterior, anterior, medial, and lateral). The highest safety distance measured was at the anterior aspect, 5 cm beneath the ankle joint (8.13 ± 3.73 mm). The lowest distance measured was consistently at the posterior aspect at all levels, especially 5 cm below the ankle joint (2.02 ± 1.31 mm). The anterior aspect of the leg is the safest area to split a cast based on safety distance measurements. Patient and limb position may also affect the safety distance at various areas along the limb.

Journal of the Mechanical Behavior of Biomedical Materials, 2013

Journal of Shoulder and Elbow Surgery, 2010

Background: Arthroscopic Bankart repair (ABR) is a standard treatment for recurrent anterior shou... more Background: Arthroscopic Bankart repair (ABR) is a standard treatment for recurrent anterior shoulder instability. Young age, hyperlaxity, loss of bone stock and multidirectional or voluntary type of instability are all associated with failure of this procedure. Rotator interval laxity is associated with shoulder instability, whereas rotator interval closure increases humeral head stability and reduces shoulder range of motion. Methods: The records of patients with recurrent anterior shoulder dislocations who underwent ABR with or without arthroscopic rotator interval closure (ARIC) in our department between 1999 and 2007 were reviewed. Rates of recurrent dislocation or symptomatic subluxation as well as functional outcome were evaluated using Walch-Dupley score. Results: Three (8.1%) of the 37 ABRþARIC patients (age 19-44 years, 32 males) had re-dislocated their shoulder at 42AE16 months following the procedure, all of which had systemic joint hyperlaxity. Six (13%) of the 46 ABR patients (age 19-39 years, 42 males) had re-dislocated their shoulder at 13AE14 months, three of which had systemic joint hyperlaxity and dislocated their shoulder within 1 year following the operation. Systemic joint hyperlaxity (28% of ABR and 41% of ABRþARIC patients) was significantly associated with recurrent dislocation and poor functional outcome. ABRþARIC patients had slightly more limited range of motion with similar good and excellent functional results (75%) at final follow up time.

The Journal of Bone and Joint Surgery (American), 2009

Rotator cuff tears are very common, but little is known about the outcome of nonoperative treatme... more Rotator cuff tears are very common, but little is known about the outcome of nonoperative treatment of symptomatic tears in terms of progression and the need for surgical intervention. Fifty-nine shoulders in fifty-four patients (thirty-three women and a mean age of 58.8 years) with rotator cuff tears on initial magnetic resonance imaging who had been managed nonoperatively were studied retrospectively. All had magnetic resonance imaging scans acquired six months or more after the initial study. The progression of the rotator cuff tears was associated with age, anatomical and associated parameters, follow-up time, and structural and other magnetic resonance imaging findings. Baseline magnetic resonance imaging scans demonstrated thirty-three full-thickness tears, twenty-six partial-thickness tears, and four combined full-thickness and partial-thickness tears. Fifty-eight of the fifty-nine tears involved the supraspinatus tendon, and ten involved multiple tendons. Progression in tear size occurred more often among the patients who were followed more than eighteen months (thirteen [48%] of twenty-seven shoulders) compared with those who were followed for less than eighteen months (six [19%] of thirty-two shoulders). Five tears (one partial-thickness tear) decreased in size. More than half (52%; seventeen) of the thirty-three full-thickness tears increased in size compared with 8% (two) of the twenty-six partial-thickness tears (p = 0.0005). Only 17% (six) of the thirty-five tears in patients who were sixty years old or less deteriorated compared with 54% (thirteen) of the twenty-four tears in patients who were more than sixty years old (p = 0.007). No shoulder in a patient with a partial-thickness tear demonstrated supraspinatus atrophy, whereas 24% of those with a full-thickness tear demonstrated atrophy (p = 0.007). The proportion with an increase in tear size was significantly larger for shoulders with fatty infiltration than for those without it (p = 0.0089). Factors that are associated with progression of a rotator cuff tear are an age of more than sixty years, a full-thickness tear, and fatty infiltration of the rotator cuff muscle(s). In the long-term follow-up of nonoperatively treated rotator cuff tears, magnetic resonance imaging can be used to monitor rotator cuff changes and guide patient management.

Injury, 2012

Fractures of the intertrochanteric region are very common among the elderly following even minor ... more Fractures of the intertrochanteric region are very common among the elderly following even minor trauma. In younger patients, these fractures are associated with high energy injuries and multitrauma. Intertrochanteric fractures are graded according to the AO/OTA classification as simple (31A1), multifragmentary (31A2) and intertrochanteric (AO 31A3). 1 The intertrochanteric AO31A3 fracture type is considered unstable and is further classified as reverse oblique (31A3.1), transverse (31A3.2) and multifragmentary (31A3.3). Early mobilisation, prevention of nonunion, malunion and thromboembolic complications are the main indications for surgical treatment of type 31A3 fractures. The surgical options for reverse oblique (RO) fractures include proximal femoral nails (PFNs), reconstruction nails and fixed angle devices such as the dynamic condylar 958 angled screw-plate (DCS). Several reports stated that the use of intramedullary devices confirmed some advantage over the dynamic hip screw-plate fixation, including a shorter operation time, less blood loss, a shorter hospital stay, lower rates of implant failure and delayed healing, thereby lessening the need for revision surgery. Although a 958 angled plate is usually selected for fixation of RO fractures, the PFN has shown several advantages. The PFN have biomechanical advantages, including a shorter lever arm, better stability and less potential for fracture collapse and limb shortening, 3 as well as the provision of an intramedullary buttress effect for preventing femoral shaft medialisation. The main disadvantages and many complications following surgical treatment with PFNs are due to intraoperatively occurring technical errors. The expandable PFN (EPFN) (Fixion; HMB Medical Technologies, Herzeliya, Israel) was developed to retain the mechanical characteristics of a large-diameter nail, to provide the good torsional stability between the femoral neck and shaft obtained by an expendable peg inserted in the femoral head (especially in cases of poor bone quality), and to avoid the need for interlocking screws. The purpose of this study was to compare the functional and radiographic results of the EPFN and the 958 DCS (Smith and Nephew, Memphis, USA) in the treatment of RO fractures. We hypothesised that EPFN provides equal or better mechanical support and results in better radiographic and functional outcome.

European Journal of Pain Supplements, 2011

Drugs & Aging, 2012

Background: Early surgical treatment is indicated to reduce mortality and morbidity associated wi... more Background: Early surgical treatment is indicated to reduce mortality and morbidity associated with immobilization due to hip fracture. The judiciousness of postponing surgery to allow withdrawal of clopidogrel and return of normal platelet function (5-10 days) in elderly patients being chronically treated with this antiplatelet medication is a matter of ongoing controversy. Objective: The purpose of this study was to compare the morbidity and mortality rates in elderly patients receiving long-term treatment with clopidogrel who were operated on with or without delay (due to withdrawal of clopidogrel) following a hip fracture. Methods: We compared relevant demographic and medical/surgical parameters in patients receiving long-term treatment with clopidogrel who sustained a hip fracture and underwent either early (n = 30, mean -SD age 81.6 -8.7 years, 17 males [57%]) or delayed (n = 30, mean -SD age 83.3 -7.1 years, 13 males [43%]) surgical intervention between May 2007 and February 2010. Results: Both groups were similar with regard to sex, age, co-morbidities and fracture type. The mortality rate was similar in both groups. Patients in the delayed treatment group had more complications associated with prolonged immobilization (pulmonary embolism, pulmonary oedema, decubitus ulcer). Time from admission to surgery and hospitalization stay were significantly longer in the delayed treatment group than in the early treatment group (mean -SD 7 days and 12 hours -2 days and 17 hours compared with 1 day and 16 hours -1 day [p < 0.0001] and 17 days and 17 hours -7 days and 5 hours versus 11 days and 2 hours -4 days and 19 hours [p = 0.0002], respectively). Conclusions: Early surgical intervention for hip fracture in patients receiving long-term treatment with clopidogrel appears to be safe in terms of bleeding complications. It has the potential to enable earlier mobilization and shorter hospitalization and may reduce mortality and complications associated with immobilization. Approval for publication Signed Date Number of amended pages returned ORIGINAL RESEARCH ARTICLE

Clinical Infectious Diseases, 2007

Background. Musculoskeletal manifestations (MMs) are considered to be rare in cat scratch disease... more Background. Musculoskeletal manifestations (MMs) are considered to be rare in cat scratch disease (CSD) and are not well characterized. We aimed to study MMs of CSD.

Arthroscopy: The Journal of Arthroscopic & Related Surgery, 2003

The arthroscope has served the orthopaedic surgeon as a diagnostic and operative tool since 1931.... more The arthroscope has served the orthopaedic surgeon as a diagnostic and operative tool since 1931. Several reports on its use in the treatment of extra-articular injuries have been published over the past few years. The surgical approach to the posterior ankle region is associated with some complications stemming from the poor blood supply to this region that can lead to wound complications and the formation of painful scars that later cause irritation when shoes are worn. We describe our experience in treating 3 hindfoot pathologic conditions, chronic Achilles tendonitis, os trigonum syndrome, and Haglund's deformity, by using an endoscope as an alternative to open surgical techniques. All the patients underwent a 2-portal endoscopic procedure, they suffered no complications, and they resumed their daily and sports activities after 2 to 3 months. Our results with the endoscopic treatment of hindfoot and Achilles tendon injuries indicate it to be a good alternative to the surgical approach, and to have the added advantage of reducing postoperative morbidity.

Arthroscopy: The Journal of Arthroscopic & Related Surgery, 2003

Arthroscopy: The Journal of Arthroscopic & Related Surgery, 2013

The purpose of this study was to assess the incidence of heterotopic ossification (HO) after hip ... more The purpose of this study was to assess the incidence of heterotopic ossification (HO) after hip arthroscopy. Between July 2010 and July 2011, 83 patients underwent hip arthroscopy for various etiologies. We prospectively reviewed 50 consecutive hip arthroscopy procedures (31 male and 19 female patients; mean age, 36.7 years) with a mean follow-up of 29.56 weeks (range, 9 to 62 weeks) to assess the incidence of HO and its effect on function and clinical outcome. Preoperative and postoperative evaluation included general assessment by visual analog scoring, modified Harris Hip Score, Hip Outcome Score, and preoperative and postoperative radiographs. Heterotopic bone formation was assessed on radiographs at a minimum of 9 weeks from surgery with the Brooker classification. Of the patients, 22 (44%) had radiographic evidence of postoperative HO (15 male patients): 13 (26%) had Brooker stage 1, 5 (10%) had Brooker stage 2, and 4 (8%) had Brooker stage 3. HO appeared as early as 9 weeks after surgery. No significant difference was found in demographic data, surgery-related data, or clinical and functional scores between patients with HO and patients without HO. No factor was found to significantly affect the incidence of HO after logistic regression. No distinct clinical manifestation was associated with the presence of HO. This study shows that the incidence of HO after hip arthroscopy may be underestimated. We could not find a contributing factor to the formation of HO. Although in most cases the presence of HO will have minimal or no clinical and functional significance, it should be sought at a minimum of 9 weeks postoperatively. Level IV, therapeutic case series.