Piotr Blachut - Academia.edu (original) (raw)

Papers by Piotr Blachut

Journal of orthopaedic trauma, 2017

The optimal treatment protocol for bicondylar plateau fractures remains controversial. Contrary t... more The optimal treatment protocol for bicondylar plateau fractures remains controversial. Contrary to popular practice which favors a staged protocol in many high-energy fracture patterns, we have used early single-stage open reduction and internal fixation (ORIF) to treat these injuries whenever possible. The purpose of this study was to determine the complication rate and the functional and radiographic outcomes of this strategy. Retrospective cohort study and prospective data collection. Level I trauma center. One hundred one patients with 102 OTA/AO type 41-C bicondylar tibial plateau fractures were treated with early definitive ORIF, defined as nonstaged surgery performed within 72 hours from injury. A subset of patients was part of a longitudinal study and reported functional outcomes at 1 year. Early definitive ORIF. Primary outcome: reoperation rate, defined as any surgery within 12 months after the index operation; secondary outcomes: quality and stability of radiographic frac...

Journal of orthopaedic trauma, Jan 17, 2017

To determine the trajectory of recovery following tibial shaft fracture treated with intramedulla... more To determine the trajectory of recovery following tibial shaft fracture treated with intramedullary nail over the first five years, and to evaluate the magnitude of the changes in functional outcome at various time intervals. Prospective cohort study. A level 1 trauma center. 132 patients with tibial shaft fracture (OTA 42-A,B,C) were enrolled into the Center's prospectively enrolled orthopaedic trauma database between January 2005 and February 2010. Functional outcome data was collected at baseline, 6 months, 1 year, and 5 years. Enrolled patients were treated acutely with intramedullary nailing of their tibia. Evaluation was performed using the Short Form-36 and Short Musculoskeletal Function Assessment. Mean SF-36 physical component scores improved between 6-12 months (p = 0.0008) and between 1-5 years (p = 0.0029). Similarly, mean SMFA physical function scores improved between 6-12 months (p = 0.0254) and between 1-5 years (p = 0.0106). In both scores, the rate or slope of t...

World journal of surgery, Jan 17, 2017

In low- and middle-income countries, the volume of traumatic injuries requiring orthopaedic inter... more In low- and middle-income countries, the volume of traumatic injuries requiring orthopaedic intervention routinely exceeds the capacity of available surgical resources. The objective of this study was to identify predictors of surgical care for lower extremity fracture patients at a high-demand, resource-limited public hospital in Uganda. Skeletally mature patients admitted with the intention of definitive surgical treatment of an isolated tibia or femur fractures to the national referral hospital in Uganda were recruited to participate in this study. Demographic, socioeconomic, and clinical data were collected through participant interviews at the time of injury and 6 months post-injury. Social capital (use of social networks to gain access to surgery), financial leveraging, and ethnicity were also included as variables in this analysis. A probit estimation model was used to identify independent and interactive predictors of surgical treatment. Of the 64 patients included in the fi...

Canadian Journal of Surgery Journal Canadien De Chirurgie, Jun 1, 2009

Canadian Journal of Surgery Journal Canadien De Chirurgie, Jun 1, 2006

Osteitis pubis is a rare and self-limited condition. Surgery may be necessary in 5%-10% of cases.... more Osteitis pubis is a rare and self-limited condition. Surgery may be necessary in 5%-10% of cases. The outcome after surgery for osteitis pubis is not known. To determine the success of surgical intervention for osteitis pubis, we used a computerized data registry to identify patients (10 women [mean age 40 yr]) who underwent surgery for osteitis pubis. A retrospective chart review was carried out. We also searched the literature for all cases of osteitis pubis managed surgically and identified 73 cases. The 10 patients in our series had had symptoms for a mean of 4 years preoperatively. Onset of pain was insidious in 4 patients, it followed childbirth in 4 and it followed trauma in 2. Depending on the surgeon's preference, either a wedge resection of the symphysis pubis was performed or a symphysiodesis. At the latest follow-up (average 26 mo), although all patients had some improvement, only 6 of 10 patients were satisfied with the outcome. From the literature review, we identified 3 categories of patients with osteitis pubis: elite athletes, patients with postoperative or infectious osteitis pubis and the remainder, which would include the patients in our series. Four types of surgical intervention are described: curettage, arthrodesis, wedge resection and wide resection. The elite athletes respond well to curettage. Patients with osteitis pubis following urologic or gynecologic procedures or have a proven infection require surgery in roughly 50% of cases. The third group has an unpredictable outcome.

American Journal of Orthopedics, Mar 1, 2009

Journal of Bone Joint Surgery British Volume, Jul 1, 2011

Journal of orthopaedic trauma, 2015

Uganda, like many low-income countries, has a tremendous volume of orthopaedic trauma injuries. T... more Uganda, like many low-income countries, has a tremendous volume of orthopaedic trauma injuries. The Uganda Sustainable Trauma Orthopaedic Program (USTOP) is a partnership between the University of British Columbia and Makerere University that was initiated in 2007 to reduce the consequences of neglected orthopaedic trauma in Uganda. USTOP works with local collaborators to build orthopaedic trauma capacity through clinical training, skills workshops, system support, technology development, and research. USTOP has maintained a multidisciplinary approach to training, involving colleagues in anaesthesia, nursing, rehabilitation, and sterile reprocessing. Since the program's inception, the number of trained orthopaedic surgeons practicing in Uganda has more than doubled. Many of these newly trained surgeons provide clinical care in the previously underserved regional hospitals. The program has also worked with collaborators to develop several technologies aimed at reducing the cost o...

Journal of orthopaedic trauma, 2015

Many surgeons in low-resource settings do not have access to safe, affordable, or reliable surgic... more Many surgeons in low-resource settings do not have access to safe, affordable, or reliable surgical drilling tools. Surgeons often resort to nonsterile hardware drills because they are affordable, robust, and efficient, but they are impossible to sterilize using steam. A promising alternative is to use a Drill Cover system (a sterilizable fabric bag plus surgical chuck adapter) so that a nonsterile hardware drill can be used safely for surgical bone drilling. Our objective was to design a safe, effective, affordable Drill Cover system for scale in low-resource settings. We designed our device based on feedback from users at Mulago Hospital (Kampala, Uganda) and focused on 3 main aspects. First, the design included a sealed barrier between the surgical field and hardware drill that withstands pressurized fluid. Second, the selected hardware drill had a maximum speed of 1050 rpm to match common surgical drills and reduce risk of necrosis. Third, the fabric cover was optimized for ease...

The Journal of Bone and Joint Surgery

Between 1983 and 1989, forty-one open fractures of the tibial shaft were treated with débridement... more Between 1983 and 1989, forty-one open fractures of the tibial shaft were treated with débridement and provisional external fixation, followed by delayed soft-tissue closure and subsequent intramedullary nailing with reaming. The average duration of external fixation was seventeen days (range, six to fifty-two days). The average time between removal of the fixator and intramedullary nailing was nine days (range, zero to twenty-four days). Of thirty-nine patients who had adequate follow-up, two (5 per cent) subsequently had a deep infection. Both infections healed, with retention of the nail and without chronic osteomyelitis. There were two nonunions and one delayed union. Satisfactory alignment was achieved in thirty-seven patients (95 per cent). This sequential protocol for treatment, which involved a short period of external fixation and thus minimized colonization of the pin tracks, yielded excellent results and a low rate of infection.

Journal of Orthopaedic Trauma

We conducted a prospective, randomized study on 84 consecutive patients with 88 acute, traumatic ... more We conducted a prospective, randomized study on 84 consecutive patients with 88 acute, traumatic femoral shaft fractures using 32 Grosse-Kempf nails, 29 Russell-Taylor nails, and 27 Synthes nails. Although total operative times and proximal and distal locking times were similar for the three groups, the procedure was faster with the Grosse-Kempf nail. Three proximal fractures could not be locked with the Synthes nail. At first follow-up, we found no significant difference in terms of pain, limp, range of motion, or time to union; however, we removed fewer Synthes nails to resolve patient complaints of pain. Three delayed unions were attributed to fracture distraction. We conclude that all three nails are suitable for the treatment of almost all femoral shaft fractures. A careful analysis of intraoperative technique and instrumentation indicates that all three nails can be used safely and easily once experience is gained. Clinical outcome is similar regardless of the nail chosen.

The Journal of Bone and Joint Surgery

One hundred and fifty-two patients who had 154 closed fractures of the shaft of the tibia were pr... more One hundred and fifty-two patients who had 154 closed fractures of the shaft of the tibia were prospectively randomized to management with interlocking intramedullary nailing either with or without reaming. Thirteen patients who had been randomized to treatment without reaming were switched to the group that had reaming because of technical reasons; these patients were excluded from the analysis of the results. An additional five patients were lost to follow-up. Thus, seventy-two patients (seventy-three fractures) who had been managed with nailing with reaming and sixty-three patients (sixty-three fractures) who had been managed with nailing without reaming were available for follow-up at an average of twelve months (range, three to thirty-three months) postoperatively. The two groups were similar with regard to demographics and the configurations of the fractures. The average total duration of the procedures performed without reaming was eleven minutes shorter than that of the proc...

Canadian journal of surgery. Journal canadien de chirurgie

To compare the efficacy of the gamma nail (GN) to the dynamic hip screw (DHS) in the management o... more To compare the efficacy of the gamma nail (GN) to the dynamic hip screw (DHS) in the management of intertrochanteric hip fractures. Randomized, prospective clinical trial with a mean follow-up of 52 weeks (range from 11 to 82 weeks). A university teaching hospital. One hundred and one patients with 102 fractures: 49 fractures were treated with the DHS and 53 fractures were treated with the GN. Fracture fixation with the DHS or the GN. Comparison of duration of operation, blood loss, early and late complications, functional outcome and duration of hospital stay. There was no significant difference between the two groups with respect to intraoperative blood loss, days in hospital, time to union and eventual functional outcome. The length of the procedure and fluoroscopy time were longer for the GN group. Both the GN and the DHS can be used effectively for the treatment of intertrochanteric fractures. In this study the DHS was associated with a lower risk of local complications and sho...

The Journal of Bone and Joint Surgery

Ninety-one patients who had ninety-four open fractures of the tibial shaft were randomized into t... more Ninety-one patients who had ninety-four open fractures of the tibial shaft were randomized into two treatment groups. Fifty fractures (nine type-I, eighteen type-II, sixteen type-IIIA, and seven type-IIIB fractures, according to the classification of Gustilo et al.) were treated with nailing after reaming, and forty-four fractures (five type-I, sixteen type-II, nineteen type-IIIA, and four type-IIIB fractures) were treated with nailing without reaming. The average diameter of the nail was 11.5 millimeters (range, nine to fourteen millimeters) in the group treated with reaming and 9.2 millimeters (range, eight to ten millimeters) in the group treated without reaming. Follow-up information was adequate for forty-five patients (forty-seven fractures) who had been managed with reaming and forty patients (forty-one fractures) who had been managed without reaming. No clinically important differences were found between the two groups with regard to the technical aspects of the procedure or...

Operative Orthopädie und Traumatologie

Objective Reconstruction of large diaphyseal segmental defects in the tibia allowing for early fu... more Objective Reconstruction of large diaphyseal segmental defects in the tibia allowing for early functional rehabilitation.IndicationsSegmental diaphyseal defects of the tibia secondary to trauma, infection or tumor resection.ContraindicationsInsufficient proximal or distal tibial segments to permit stable fixation with a locked intramedullary nail.Absent fibula.Uncontrolled sepsis.Inadequate function of foot.Surgical TechniqueBony resection.Locked intramedullary nailing.Ipsilateral fibular transfer.Bone grafting/bone graft substitute.ResultsEight patients with segmental tibial defects were treated with intramedullary nailing of the tibia and ipsilateral fibular transfer. All patients were bearing full weight by 14 weeks following transfer of the fibula. There were six early complications in five patients and five late complications in four. They were attributed either to the index pathology or the surgical technique and all were manageable. Time to consolidation depended on the prima...

Revue de Chirurgie Orthopédique et Traumatologique, 2010

ABSTRACT The use of tension band wire technique for patella fractures fixation is a well-establis... more ABSTRACT The use of tension band wire technique for patella fractures fixation is a well-established technique. However, the standard technique, which involves using two Kirschner wires through the patella, can cause problems with prominent hardware, and difficulty capturing of the figure of eight wire. Here we describe a modified technique using four Kirschner wires, which allows each wire to be bent, and well-impacted in order to avoid these problems. The basic surgical technique, two case examples, and our case series are reviewed.

Orthopaedics & traumatology, surgery & research : OTSR, 2010

The use of tension band wire technique for patella fractures fixation is a well-established techn... more The use of tension band wire technique for patella fractures fixation is a well-established technique. However, the standard technique, which involves using two Kirschner wires through the patella, can cause problems with prominent hardware, and difficulty capturing the change to figure of eight wire. Here we describe a modified technique using four Kirschner wires, which allows each wire to be bent, and well-impacted in order to avoid these problems. The basic surgical technique, and our case series are reviewed.

American journal of orthopedics (Belle Mead, N.J.), 2009

Canadian journal of surgery. Journal canadien de chirurgie, 2006

Osteitis pubis is a rare and self-limited condition. Surgery may be necessary in 5%-10% of cases.... more Osteitis pubis is a rare and self-limited condition. Surgery may be necessary in 5%-10% of cases. The outcome after surgery for osteitis pubis is not known. To determine the success of surgical intervention for osteitis pubis, we used a computerized data registry to identify patients (10 women [mean age 40 yr]) who underwent surgery for osteitis pubis. A retrospective chart review was carried out. We also searched the literature for all cases of osteitis pubis managed surgically and identified 73 cases. The 10 patients in our series had had symptoms for a mean of 4 years preoperatively. Onset of pain was insidious in 4 patients, it followed childbirth in 4 and it followed trauma in 2. Depending on the surgeon's preference, either a wedge resection of the symphysis pubis was performed or a symphysiodesis. At the latest follow-up (average 26 mo), although all patients had some improvement, only 6 of 10 patients were satisfied with the outcome. From the literature review, we identi...

The Journal of trauma, 1996

To review the results of surgical management of heterotopic ossification about the elbow in burne... more To review the results of surgical management of heterotopic ossification about the elbow in burned patients. Retrospective analysis with long-term patient follow-up. Eleven patients with 16 elbows requiring surgery were admitted between January 1, 1982 and December 31, 1993. A posterior approach to the elbow with release of the encased ulnar nerve +/- anterior transposition and transolecranon osteotomy to access extensive bone formation in the olecranon fossa was employed. Eight patients (11 elbows) were available for long-term follow-up conducted at mean 50 +/- 13 months after surgery. Long-term follow-up consisted of measurement of range of elbow motion, as well as clinical assessment of ulnar nerve function. For the 11 elbows examined postoperatively, the mean range of motion preoperatively in flexion-extension was 11 degrees +/- 5 degrees compared to 89 degrees +/- 12 degrees postoperatively (p < 0.001). Three patients with poor long-term results had ankylosis of the joint pr...

Journal of orthopaedic trauma, 2017

The optimal treatment protocol for bicondylar plateau fractures remains controversial. Contrary t... more The optimal treatment protocol for bicondylar plateau fractures remains controversial. Contrary to popular practice which favors a staged protocol in many high-energy fracture patterns, we have used early single-stage open reduction and internal fixation (ORIF) to treat these injuries whenever possible. The purpose of this study was to determine the complication rate and the functional and radiographic outcomes of this strategy. Retrospective cohort study and prospective data collection. Level I trauma center. One hundred one patients with 102 OTA/AO type 41-C bicondylar tibial plateau fractures were treated with early definitive ORIF, defined as nonstaged surgery performed within 72 hours from injury. A subset of patients was part of a longitudinal study and reported functional outcomes at 1 year. Early definitive ORIF. Primary outcome: reoperation rate, defined as any surgery within 12 months after the index operation; secondary outcomes: quality and stability of radiographic frac...

Journal of orthopaedic trauma, Jan 17, 2017

To determine the trajectory of recovery following tibial shaft fracture treated with intramedulla... more To determine the trajectory of recovery following tibial shaft fracture treated with intramedullary nail over the first five years, and to evaluate the magnitude of the changes in functional outcome at various time intervals. Prospective cohort study. A level 1 trauma center. 132 patients with tibial shaft fracture (OTA 42-A,B,C) were enrolled into the Center's prospectively enrolled orthopaedic trauma database between January 2005 and February 2010. Functional outcome data was collected at baseline, 6 months, 1 year, and 5 years. Enrolled patients were treated acutely with intramedullary nailing of their tibia. Evaluation was performed using the Short Form-36 and Short Musculoskeletal Function Assessment. Mean SF-36 physical component scores improved between 6-12 months (p = 0.0008) and between 1-5 years (p = 0.0029). Similarly, mean SMFA physical function scores improved between 6-12 months (p = 0.0254) and between 1-5 years (p = 0.0106). In both scores, the rate or slope of t...

World journal of surgery, Jan 17, 2017

In low- and middle-income countries, the volume of traumatic injuries requiring orthopaedic inter... more In low- and middle-income countries, the volume of traumatic injuries requiring orthopaedic intervention routinely exceeds the capacity of available surgical resources. The objective of this study was to identify predictors of surgical care for lower extremity fracture patients at a high-demand, resource-limited public hospital in Uganda. Skeletally mature patients admitted with the intention of definitive surgical treatment of an isolated tibia or femur fractures to the national referral hospital in Uganda were recruited to participate in this study. Demographic, socioeconomic, and clinical data were collected through participant interviews at the time of injury and 6 months post-injury. Social capital (use of social networks to gain access to surgery), financial leveraging, and ethnicity were also included as variables in this analysis. A probit estimation model was used to identify independent and interactive predictors of surgical treatment. Of the 64 patients included in the fi...

Canadian Journal of Surgery Journal Canadien De Chirurgie, Jun 1, 2009

Canadian Journal of Surgery Journal Canadien De Chirurgie, Jun 1, 2006

Osteitis pubis is a rare and self-limited condition. Surgery may be necessary in 5%-10% of cases.... more Osteitis pubis is a rare and self-limited condition. Surgery may be necessary in 5%-10% of cases. The outcome after surgery for osteitis pubis is not known. To determine the success of surgical intervention for osteitis pubis, we used a computerized data registry to identify patients (10 women [mean age 40 yr]) who underwent surgery for osteitis pubis. A retrospective chart review was carried out. We also searched the literature for all cases of osteitis pubis managed surgically and identified 73 cases. The 10 patients in our series had had symptoms for a mean of 4 years preoperatively. Onset of pain was insidious in 4 patients, it followed childbirth in 4 and it followed trauma in 2. Depending on the surgeon&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s preference, either a wedge resection of the symphysis pubis was performed or a symphysiodesis. At the latest follow-up (average 26 mo), although all patients had some improvement, only 6 of 10 patients were satisfied with the outcome. From the literature review, we identified 3 categories of patients with osteitis pubis: elite athletes, patients with postoperative or infectious osteitis pubis and the remainder, which would include the patients in our series. Four types of surgical intervention are described: curettage, arthrodesis, wedge resection and wide resection. The elite athletes respond well to curettage. Patients with osteitis pubis following urologic or gynecologic procedures or have a proven infection require surgery in roughly 50% of cases. The third group has an unpredictable outcome.

American Journal of Orthopedics, Mar 1, 2009

Journal of Bone Joint Surgery British Volume, Jul 1, 2011

Journal of orthopaedic trauma, 2015

Uganda, like many low-income countries, has a tremendous volume of orthopaedic trauma injuries. T... more Uganda, like many low-income countries, has a tremendous volume of orthopaedic trauma injuries. The Uganda Sustainable Trauma Orthopaedic Program (USTOP) is a partnership between the University of British Columbia and Makerere University that was initiated in 2007 to reduce the consequences of neglected orthopaedic trauma in Uganda. USTOP works with local collaborators to build orthopaedic trauma capacity through clinical training, skills workshops, system support, technology development, and research. USTOP has maintained a multidisciplinary approach to training, involving colleagues in anaesthesia, nursing, rehabilitation, and sterile reprocessing. Since the program's inception, the number of trained orthopaedic surgeons practicing in Uganda has more than doubled. Many of these newly trained surgeons provide clinical care in the previously underserved regional hospitals. The program has also worked with collaborators to develop several technologies aimed at reducing the cost o...

Journal of orthopaedic trauma, 2015

Many surgeons in low-resource settings do not have access to safe, affordable, or reliable surgic... more Many surgeons in low-resource settings do not have access to safe, affordable, or reliable surgical drilling tools. Surgeons often resort to nonsterile hardware drills because they are affordable, robust, and efficient, but they are impossible to sterilize using steam. A promising alternative is to use a Drill Cover system (a sterilizable fabric bag plus surgical chuck adapter) so that a nonsterile hardware drill can be used safely for surgical bone drilling. Our objective was to design a safe, effective, affordable Drill Cover system for scale in low-resource settings. We designed our device based on feedback from users at Mulago Hospital (Kampala, Uganda) and focused on 3 main aspects. First, the design included a sealed barrier between the surgical field and hardware drill that withstands pressurized fluid. Second, the selected hardware drill had a maximum speed of 1050 rpm to match common surgical drills and reduce risk of necrosis. Third, the fabric cover was optimized for ease...

The Journal of Bone and Joint Surgery

Between 1983 and 1989, forty-one open fractures of the tibial shaft were treated with débridement... more Between 1983 and 1989, forty-one open fractures of the tibial shaft were treated with débridement and provisional external fixation, followed by delayed soft-tissue closure and subsequent intramedullary nailing with reaming. The average duration of external fixation was seventeen days (range, six to fifty-two days). The average time between removal of the fixator and intramedullary nailing was nine days (range, zero to twenty-four days). Of thirty-nine patients who had adequate follow-up, two (5 per cent) subsequently had a deep infection. Both infections healed, with retention of the nail and without chronic osteomyelitis. There were two nonunions and one delayed union. Satisfactory alignment was achieved in thirty-seven patients (95 per cent). This sequential protocol for treatment, which involved a short period of external fixation and thus minimized colonization of the pin tracks, yielded excellent results and a low rate of infection.

Journal of Orthopaedic Trauma

We conducted a prospective, randomized study on 84 consecutive patients with 88 acute, traumatic ... more We conducted a prospective, randomized study on 84 consecutive patients with 88 acute, traumatic femoral shaft fractures using 32 Grosse-Kempf nails, 29 Russell-Taylor nails, and 27 Synthes nails. Although total operative times and proximal and distal locking times were similar for the three groups, the procedure was faster with the Grosse-Kempf nail. Three proximal fractures could not be locked with the Synthes nail. At first follow-up, we found no significant difference in terms of pain, limp, range of motion, or time to union; however, we removed fewer Synthes nails to resolve patient complaints of pain. Three delayed unions were attributed to fracture distraction. We conclude that all three nails are suitable for the treatment of almost all femoral shaft fractures. A careful analysis of intraoperative technique and instrumentation indicates that all three nails can be used safely and easily once experience is gained. Clinical outcome is similar regardless of the nail chosen.

The Journal of Bone and Joint Surgery

One hundred and fifty-two patients who had 154 closed fractures of the shaft of the tibia were pr... more One hundred and fifty-two patients who had 154 closed fractures of the shaft of the tibia were prospectively randomized to management with interlocking intramedullary nailing either with or without reaming. Thirteen patients who had been randomized to treatment without reaming were switched to the group that had reaming because of technical reasons; these patients were excluded from the analysis of the results. An additional five patients were lost to follow-up. Thus, seventy-two patients (seventy-three fractures) who had been managed with nailing with reaming and sixty-three patients (sixty-three fractures) who had been managed with nailing without reaming were available for follow-up at an average of twelve months (range, three to thirty-three months) postoperatively. The two groups were similar with regard to demographics and the configurations of the fractures. The average total duration of the procedures performed without reaming was eleven minutes shorter than that of the proc...

Canadian journal of surgery. Journal canadien de chirurgie

To compare the efficacy of the gamma nail (GN) to the dynamic hip screw (DHS) in the management o... more To compare the efficacy of the gamma nail (GN) to the dynamic hip screw (DHS) in the management of intertrochanteric hip fractures. Randomized, prospective clinical trial with a mean follow-up of 52 weeks (range from 11 to 82 weeks). A university teaching hospital. One hundred and one patients with 102 fractures: 49 fractures were treated with the DHS and 53 fractures were treated with the GN. Fracture fixation with the DHS or the GN. Comparison of duration of operation, blood loss, early and late complications, functional outcome and duration of hospital stay. There was no significant difference between the two groups with respect to intraoperative blood loss, days in hospital, time to union and eventual functional outcome. The length of the procedure and fluoroscopy time were longer for the GN group. Both the GN and the DHS can be used effectively for the treatment of intertrochanteric fractures. In this study the DHS was associated with a lower risk of local complications and sho...

The Journal of Bone and Joint Surgery

Ninety-one patients who had ninety-four open fractures of the tibial shaft were randomized into t... more Ninety-one patients who had ninety-four open fractures of the tibial shaft were randomized into two treatment groups. Fifty fractures (nine type-I, eighteen type-II, sixteen type-IIIA, and seven type-IIIB fractures, according to the classification of Gustilo et al.) were treated with nailing after reaming, and forty-four fractures (five type-I, sixteen type-II, nineteen type-IIIA, and four type-IIIB fractures) were treated with nailing without reaming. The average diameter of the nail was 11.5 millimeters (range, nine to fourteen millimeters) in the group treated with reaming and 9.2 millimeters (range, eight to ten millimeters) in the group treated without reaming. Follow-up information was adequate for forty-five patients (forty-seven fractures) who had been managed with reaming and forty patients (forty-one fractures) who had been managed without reaming. No clinically important differences were found between the two groups with regard to the technical aspects of the procedure or...

Operative Orthopädie und Traumatologie

Objective Reconstruction of large diaphyseal segmental defects in the tibia allowing for early fu... more Objective Reconstruction of large diaphyseal segmental defects in the tibia allowing for early functional rehabilitation.IndicationsSegmental diaphyseal defects of the tibia secondary to trauma, infection or tumor resection.ContraindicationsInsufficient proximal or distal tibial segments to permit stable fixation with a locked intramedullary nail.Absent fibula.Uncontrolled sepsis.Inadequate function of foot.Surgical TechniqueBony resection.Locked intramedullary nailing.Ipsilateral fibular transfer.Bone grafting/bone graft substitute.ResultsEight patients with segmental tibial defects were treated with intramedullary nailing of the tibia and ipsilateral fibular transfer. All patients were bearing full weight by 14 weeks following transfer of the fibula. There were six early complications in five patients and five late complications in four. They were attributed either to the index pathology or the surgical technique and all were manageable. Time to consolidation depended on the prima...

Revue de Chirurgie Orthopédique et Traumatologique, 2010

ABSTRACT The use of tension band wire technique for patella fractures fixation is a well-establis... more ABSTRACT The use of tension band wire technique for patella fractures fixation is a well-established technique. However, the standard technique, which involves using two Kirschner wires through the patella, can cause problems with prominent hardware, and difficulty capturing of the figure of eight wire. Here we describe a modified technique using four Kirschner wires, which allows each wire to be bent, and well-impacted in order to avoid these problems. The basic surgical technique, two case examples, and our case series are reviewed.

Orthopaedics & traumatology, surgery & research : OTSR, 2010

The use of tension band wire technique for patella fractures fixation is a well-established techn... more The use of tension band wire technique for patella fractures fixation is a well-established technique. However, the standard technique, which involves using two Kirschner wires through the patella, can cause problems with prominent hardware, and difficulty capturing the change to figure of eight wire. Here we describe a modified technique using four Kirschner wires, which allows each wire to be bent, and well-impacted in order to avoid these problems. The basic surgical technique, and our case series are reviewed.

American journal of orthopedics (Belle Mead, N.J.), 2009

Canadian journal of surgery. Journal canadien de chirurgie, 2006

Osteitis pubis is a rare and self-limited condition. Surgery may be necessary in 5%-10% of cases.... more Osteitis pubis is a rare and self-limited condition. Surgery may be necessary in 5%-10% of cases. The outcome after surgery for osteitis pubis is not known. To determine the success of surgical intervention for osteitis pubis, we used a computerized data registry to identify patients (10 women [mean age 40 yr]) who underwent surgery for osteitis pubis. A retrospective chart review was carried out. We also searched the literature for all cases of osteitis pubis managed surgically and identified 73 cases. The 10 patients in our series had had symptoms for a mean of 4 years preoperatively. Onset of pain was insidious in 4 patients, it followed childbirth in 4 and it followed trauma in 2. Depending on the surgeon's preference, either a wedge resection of the symphysis pubis was performed or a symphysiodesis. At the latest follow-up (average 26 mo), although all patients had some improvement, only 6 of 10 patients were satisfied with the outcome. From the literature review, we identi...

The Journal of trauma, 1996

To review the results of surgical management of heterotopic ossification about the elbow in burne... more To review the results of surgical management of heterotopic ossification about the elbow in burned patients. Retrospective analysis with long-term patient follow-up. Eleven patients with 16 elbows requiring surgery were admitted between January 1, 1982 and December 31, 1993. A posterior approach to the elbow with release of the encased ulnar nerve +/- anterior transposition and transolecranon osteotomy to access extensive bone formation in the olecranon fossa was employed. Eight patients (11 elbows) were available for long-term follow-up conducted at mean 50 +/- 13 months after surgery. Long-term follow-up consisted of measurement of range of elbow motion, as well as clinical assessment of ulnar nerve function. For the 11 elbows examined postoperatively, the mean range of motion preoperatively in flexion-extension was 11 degrees +/- 5 degrees compared to 89 degrees +/- 12 degrees postoperatively (p < 0.001). Three patients with poor long-term results had ankylosis of the joint pr...