Robin Gehrmann - Academia.edu (original) (raw)
Papers by Robin Gehrmann
PubMed, Jun 1, 2015
Since 1887, approximately 50 cases of an intra-articular patellar dislocation have been reported ... more Since 1887, approximately 50 cases of an intra-articular patellar dislocation have been reported in the worldwide literature. The vast majority of patients required an open reduction of the patella or closed reduction under general anesthesia. This injury has never been reported in association with a coronal shear fracture of the femoral condyle. A 14-year-old boy presented to our institution with his left knee locked in flexion after a direct blow. Radiographs showed the patella rotated on its horizontal axis and lying in a transverse position within the knee joint, as well as a concomitant femoral condyle fracture. After a successful closed reduction of the patella, the patient underwent open reduction and rigid fixation of the femoral condyle fracture with countersunk interfragmentary screws. At 12 months, the patient was ambulating on the left leg and had painless motion of the knee. We present a rare injury pattern in a skeletally immature patient after a direct blow to the knee. By treating the injuries in a sequential manner and providing a stable fixation construct, the patient was able to achieve a satisfactory return to function even after sustaining a considerable injury to the knee.
Knee, Dec 1, 2015
Patellar sleeve fractures are easily missed injuries since plain radiographs may not show a bony ... more Patellar sleeve fractures are easily missed injuries since plain radiographs may not show a bony fragment at the time of injury. Failure to diagnose these injuries can result in patellar instability, extensor lag, and anterior knee pain. We report a novel treatment using a Taylor spatial frame as part of a staged reconstruction to regain length of the extensor mechanism and maintain knee motion prior to performing primary repair of the avulsed patellar sleeve fragment. In our case, an 11-year-old male presented to our institution six months after sustaining a patellar sleeve fracture. Radiographic examination with the knee in extension revealed a 23-mm gap between the inferior patellar pole fragment and the remaining patella. The patient was ultimately taken to the operating room twelve months after the initial injury for placement of a Taylor spatial frame to regain length of the extensor mechanism. The patient began immediate knee range-of-motion exercises, and performed daily soft tissue lengthening of two millimeters. After four weeks of treatment the patient underwent removal of the fixator and primary repair of the patella. At final follow up six years after patellar reconstruction, the patient had an active knee range-of-motion from five degrees of hyperextension to 140°of flexion. Where current literature reports suboptimal results even when treatment is delayed for two months, in our case the patient was able to obtain a high level of function after treatment with a two-stage reconstruction using a Taylor spatial frame.
PubMed, Nov 1, 2005
Ankle injuries are common in the general and athletic populations. These injuries constitute 21% ... more Ankle injuries are common in the general and athletic populations. These injuries constitute 21% of all sports-related injuries. The wide spectrum of sports-related ankle injuries includes ligamentous injuries, soft-tissue and osseous impingement, osteochondral lesions of the talus, tendon injuries, and fractures. Occult lesions (eg, fractures of the lateral process of the talus, fractures of the anterior process of the calcaneus, fractures of the base of the fifth metatarsal, os trigonum, stress fractures) may be missed on initial physical examination, and patients with such injuries often present to a sports clinic with persistent pain around the ankle. Because of increasing participation in sporting events, health care professionals involved in the care of athletes at all levels must have a thorough understanding of the anatomy, pathophysiology, and initial management of ankle injuries. In this review, we describe the pertinent anatomy, pathology, diagnosis, and treatment of sports-related injuries of the ankle.
The American Journal of Orthopedics, 2005
Ankle injuries are common in the general and athletic populations. These injuries constitute 21% ... more Ankle injuries are common in the general and athletic populations. These injuries constitute 21% of all sports-related injuries. The wide spectrum of sports-related ankle injuries includes ligamentous injuries, soft-tissue and osseous impingement, osteochondral lesions of the talus, tendon injuries, and fractures. Occult lesions (eg, fractures of the lateral process of the talus, fractures of the anterior process of the calcaneus, fractures of the base of the fifth metatarsal, os trigonum, stress fractures) may be missed on initial physical examination, and patients with such injuries often present to a sports clinic with persistent pain around the ankle. Because of increasing participation in sporting events, health care professionals involved in the care of athletes at all levels must have a thorough understanding of the anatomy, pathophysiology, and initial management of ankle injuries. In this review, we describe the pertinent anatomy, pathology, diagnosis, and treatment of spor...
Foot & Ankle International
Stress fractures are debilitating injuries that occur in all types of patient populations, rangin... more Stress fractures are debilitating injuries that occur in all types of patient populations, ranging from military recruits and athletes to patients with chronic medical conditions, such as rheumatoid arthritis and metabolic bone disease. Because of the repetitive stress of endurance training, stress fractures are more frequent in the athletic population than the general public. The high forces associated with weightbearing help explain why they occur most frequently in the lower extremity of athletes involved in sports such as basketball, track and field, soccer, lacrosse, and ballet. In a review of 320 athletes with stress fractures, Matheson et al.22 found that most (49%) were in the tibia, followed by the tarsals (25.3%); the metatarsals were the least frequently involved (8.8%). A stress fracture is any fracture or microfracture that occurs as the result of repetitive loading to the bone rather than from a single traumatic event. A stress fracture can occur as the result of a marked increase in the load on a normal bone, such as may occur when a military recruit enters “bootcamp” and begins his or her new training regimen. Stress fractures also can occur from normal loading patterns in bone that is abnormally weak because of chronic diseases, such as rheumatoid arthritis or long-term corticoidsteroid use. The location of the stress fracture is dictated by the precipitating activity and the characteristic manner in which the force is absorbed in each person’s foot. The etiology of these injuries is complicated but can be divided into intrinsic and extrinsic factors, which can help explain the pathology and determine subsequent treatment options.14 Intrinsic factors include an excessively high arch, leg-length discrepancies, and excessive forefoot varus position,19 bone
American journal of orthopedics, 2005
Ankle injuries are common in the general and athletic populations. These injuries constitute 21% ... more Ankle injuries are common in the general and athletic populations. These injuries constitute 21% of all sports-related injuries. The wide spectrum of sports-related ankle injuries includes ligamentous injuries, soft-tissue and osseous impingement, osteochondral lesions of the talus, tendon injuries, and fractures. Occult lesions (eg, fractures of the lateral process of the talus, fractures of the anterior process of the calcaneus, fractures of the base of the fifth metatarsal, os trigonum, stress fractures) may be missed on initial physical examination, and patients with such injuries often present to a sports clinic with persistent pain around the ankle. Because of increasing participation in sporting events, health care professionals involved in the care of athletes at all levels must have a thorough understanding of the anatomy, pathophysiology, and initial management of ankle injuries. In this review, we describe the pertinent anatomy, pathology, diagnosis, and treatment of spor...
MOJ Orthopedics & Rheumatology
The purpose of this study was to evaluate two different repair techniques for the primary repair ... more The purpose of this study was to evaluate two different repair techniques for the primary repair of patellar tendon ruptures. Using a cadaveric model, we biomechanically compared a double Krackow stitch with, and without cerclage augmentation. The specimens were tested at loads comparable to those likely to be encountered during an early rehabilitation program (approximately 40 Newtons) and for maximal mechanical parameters. The force at failure of the augmented repairs was 329 ± 89 Newtons (N), while the non-augmented repairs failed at 278 ± 87 N. However, the force required to produce significant gapping at the repair site was not significantly different between both repair techniques. Additionally, there was no significant difference between the mean stiffness of the repairs in both groups within the loading range from 10-100N. However, as expected, at loads greater than 100 N the cerclage augmented repairs were significantly stiffer. Most notably, there was no gap formation in any of the constructs tested at forces (40 N) comparable to those seen during an early passive extension and active flexion program. These data suggest that it may be possible to achieve the benefits of an early rehabilitation program without augmentation of the repair, and thus avoid the potential complications arising from this additional material.
Since 1887, approximately 50 cases of an intra-articular patellar dislocation have been reported ... more Since 1887, approximately 50 cases of an intra-articular patellar dislocation have been reported in the worldwide literature. The vast majority of patients required an open reduction of the patella or closed reduction under general anesthesia. This injury has never been reported in association with a coronal shear fracture of the femoral condyle. A 14-year-old boy presented to our institution with his left knee locked in flexion after a direct blow. Radiographs showed the patella rotated on its horizontal axis and lying in a transverse position within the knee joint, as well as a concomitant femoral condyle fracture. After a successful closed reduction of the patella, the patient underwent open reduction and rigid fixation of the femoral condyle fracture with countersunk interfragmentary screws. At 12 months, the patient was ambulating on the left leg and had painless motion of the knee. We present a rare injury pattern in a skeletally immature patient after a direct blow to the kne...
Background: Appropriate suture selection is necessary in providing mechanical stability to soft t... more Background: Appropriate suture selection is necessary in providing mechanical stability to soft tissue reconstructions. Caprolactone/glycolide (Panacryl™) became a popular suture, possessing excellent handling properties; however, clinical observations questioned the knot security of caprolactone/glycolide. Caprolactone/glycolide is still available on many commercial suture anchor systems. This study compared the security of the knots and ultimate tensile strength of braided caprolactone/glycolide suture to that of a commonly used suture material, braided polyester (Ethibond™). Materials: Suture knots of No. 2 braided polyester suture and No. 2 braided caprolactone/glycolide suture were submersed in a physiologic saline solution and stressed using a continuous (non-cyclic) load, simulating a single maximal loading event in a clinical setting. Continuous loading was done to achieve clinical suture knot failure (3-mm knot slippage), then continued until catastrophic suture failure (su...
The American Journal of Orthopedics, Dec 1, 2005
Ankle injuries are common in the general and athletic populations. These injuries constitute 21% ... more Ankle injuries are common in the general and athletic populations. These injuries constitute 21% of all sports-related injuries. The wide spectrum of sports-related ankle injuries includes ligamentous injuries, soft-tissue and osseous impingement, osteochondral lesions of the talus, tendon injuries, and fractures. Occult lesions (eg, fractures of the lateral process of the talus, fractures of the anterior process of the calcaneus, fractures of the base of the fifth metatarsal, os trigonum, stress fractures) may be missed on initial physical examination, and patients with such injuries often present to a sports clinic with persistent pain around the ankle. Because of increasing participation in sporting events, health care professionals involved in the care of athletes at all levels must have a thorough understanding of the anatomy, pathophysiology, and initial management of ankle injuries. In this review, we describe the pertinent anatomy, pathology, diagnosis, and treatment of sports-related injuries of the ankle.
Orthopaedic journal of sports medicine, 2015
Lack of insurance has been shown to lead to delays in seeking care as well as fewer preventive me... more Lack of insurance has been shown to lead to delays in seeking care as well as fewer preventive medicine visits and poorer overall health status. To investigate the effects of insurance status on the timing and treatment of patients with bucket-handle meniscus tears. Cohort study; Level of evidence, 3. Charts from 2004 to 2013 were retrospectively reviewed for patients diagnosed with bucket-handle meniscus tears. Patients were divided into 2 groups: insured or underinsured. The insured group included patients with commercial insurance or Medicare. The underinsured group included patients with Medicaid or Charity Care. Time intervals were categorized as <6 weeks or ≥6 weeks. A total of 52 patients were included in this study: 15 (29%) insured and 37 (71%) underinsured. Underinsured patients experienced delays in initial presentation to an orthopaedic surgeon (P = .004), time from magnetic resonance imaging to surgery (P = .01), and time from injury to surgery (P = .007). Repair rat...
American journal of orthopedics (Belle Mead, N.J.), 2015
Since 1887, approximately 50 cases of an intra-articular patellar dislocation have been reported ... more Since 1887, approximately 50 cases of an intra-articular patellar dislocation have been reported in the worldwide literature. The vast majority of patients required an open reduction of the patella or closed reduction under general anesthesia. This injury has never been reported in association with a coronal shear fracture of the femoral condyle. A 14-year-old boy presented to our institution with his left knee locked in flexion after a direct blow. Radiographs showed the patella rotated on its horizontal axis and lying in a transverse position within the knee joint, as well as a concomitant femoral condyle fracture. After a successful closed reduction of the patella, the patient underwent open reduction and rigid fixation of the femoral condyle fracture with countersunk interfragmentary screws. At 12 months, the patient was ambulating on the left leg and had painless motion of the knee. We present a rare injury pattern in a skeletally immature patient after a direct blow to the kne...
INTRODUCTION: The purpose of this retrospective case-control study is to report the long-term cli... more INTRODUCTION: The purpose of this retrospective case-control study is to report the long-term clinical, functional, and radiographic results of arthroscopic partial medial meniscectomy in an otherwise normal knee (i.e. with stable ligaments). An attempt was made to identify variables that can lead to poor outcome. METHODS: Between January 1985 and December 1988, a total of 256 arthroscopic partial medial meniscectomies were performed. Of the 256 knees, 72 knees (43 right and 29 left) met the following inclusion criteria: Patient’s age more than 40 years, no previous or subsequent knee injuries or surgeries, no mechanical malalignment of the knee, and a minimum follow-up of 15 years. There were 60 males and 12 females. The mean age of the patients at the time of operation was 47.5 years (range 40 to 72 years). All patients had a partial medial meniscectomy involving the posterior one-third segment of the meniscus and a stable peripheral rim was preserved in all cases. The anterior cr...
The Knee, 2015
Patellar sleeve fractures are easily missed injuries since plain radiographs may not show a bony ... more Patellar sleeve fractures are easily missed injuries since plain radiographs may not show a bony fragment at the time of injury. Failure to diagnose these injuries can result in patellar instability, extensor lag, and anterior knee pain. We report a novel treatment using a Taylor spatial frame as part of a staged reconstruction to regain length of the extensor mechanism and maintain knee motion prior to performing primary repair of the avulsed patellar sleeve fragment. In our case, an 11-year-old male presented to our institution six months after sustaining a patellar sleeve fracture. Radiographic examination with the knee in extension revealed a 23-mm gap between the inferior patellar pole fragment and the remaining patella. The patient was ultimately taken to the operating room twelve months after the initial injury for placement of a Taylor spatial frame to regain length of the extensor mechanism. The patient began immediate knee range-of-motion exercises, and performed daily soft tissue lengthening of two millimeters. After four weeks of treatment the patient underwent removal of the fixator and primary repair of the patella. At final follow up six years after patellar reconstruction, the patient had an active knee range-of-motion from five degrees of hyperextension to 140° of flexion. Where current literature reports suboptimal results even when treatment is delayed for two months, in our case the patient was able to obtain a high level of function after treatment with a two-stage reconstruction using a Taylor spatial frame.
Medical Research Archives, 2015
The American journal of sports medicine
Der Chirurg; Zeitschrift für alle Gebiete der operativen Medizen, 1985
Pseudo-obstruction of the colon was observed in six patients. The cardinal feature is acute diste... more Pseudo-obstruction of the colon was observed in six patients. The cardinal feature is acute distension of the large bowel without distal obstruction. Apart from few idiopathic cases, the syndrome usually is associated with postoperative, posttraumatic or metabolic disorders of extraintestinal origin. Without treatment, increasing distension leads to cecal perforation with a high mortality. Treatment is conservative initially. If decompression by colonoscopy fails, cecostomy or right hemicolectomy are mandatory. The pathophysiologic mechanism of acute colonic pseudoobstruction is unknown. Whether Ogilvie's syndrome is a genuine clinical entity or a complication of associated diseases is still on question.
Clinical orthopaedics and related research, 2005
Feet are prone to bacterial contamination. We hypothesized that chlorhexidine scrub and isopropyl... more Feet are prone to bacterial contamination. We hypothesized that chlorhexidine scrub and isopropyl alcohol paint provide superior local flora reduction than povidone-iodine scrub and paint. Patients with intact, uninfected skin having clean elective foot and ankle surgery were prospectively enrolled and randomly assigned to skin preparation with povidone-iodine (Group 1) or chlorhexidine scrub and isopropyl alcohol paint (Group 2). Culture swabs (aerobic, anaerobic, acid fast, fungus, and routine antibiotic sensitivity) were taken from all web spaces, nail folds, toe surfaces, and proposed surgical incision sites. One-hundred twenty-seven patients were enrolled (mean age, 46 years; range, 16-85 years). Sixty-seven patients were assigned to Group 1; 60 patients were assigned to Group 2. In Group 1, 53 of 67 patients (79%) had positive cultures; in Group 2, 23 of 60 patients (38%) had positive cultures. These data indicate that chlorhexidine and alcohol provide better reduction in bact...
American journal of orthopedics (Belle Mead, N.J.), 2005
Ankle injuries are common in the general and athletic populations. These injuries constitute 21% ... more Ankle injuries are common in the general and athletic populations. These injuries constitute 21% of all sports-related injuries. The wide spectrum of sports-related ankle injuries includes ligamentous injuries, soft-tissue and osseous impingement, osteochondral lesions of the talus, tendon injuries, and fractures. Occult lesions (eg, fractures of the lateral process of the talus, fractures of the anterior process of the calcaneus, fractures of the base of the fifth metatarsal, os trigonum, stress fractures) may be missed on initial physical examination, and patients with such injuries often present to a sports clinic with persistent pain around the ankle. Because of increasing participation in sporting events, health care professionals involved in the care of athletes at all levels must have a thorough understanding of the anatomy, pathophysiology, and initial management of ankle injuries. In this review, we describe the pertinent anatomy, pathology, diagnosis, and treatment of spor...
PubMed, Jun 1, 2015
Since 1887, approximately 50 cases of an intra-articular patellar dislocation have been reported ... more Since 1887, approximately 50 cases of an intra-articular patellar dislocation have been reported in the worldwide literature. The vast majority of patients required an open reduction of the patella or closed reduction under general anesthesia. This injury has never been reported in association with a coronal shear fracture of the femoral condyle. A 14-year-old boy presented to our institution with his left knee locked in flexion after a direct blow. Radiographs showed the patella rotated on its horizontal axis and lying in a transverse position within the knee joint, as well as a concomitant femoral condyle fracture. After a successful closed reduction of the patella, the patient underwent open reduction and rigid fixation of the femoral condyle fracture with countersunk interfragmentary screws. At 12 months, the patient was ambulating on the left leg and had painless motion of the knee. We present a rare injury pattern in a skeletally immature patient after a direct blow to the knee. By treating the injuries in a sequential manner and providing a stable fixation construct, the patient was able to achieve a satisfactory return to function even after sustaining a considerable injury to the knee.
Knee, Dec 1, 2015
Patellar sleeve fractures are easily missed injuries since plain radiographs may not show a bony ... more Patellar sleeve fractures are easily missed injuries since plain radiographs may not show a bony fragment at the time of injury. Failure to diagnose these injuries can result in patellar instability, extensor lag, and anterior knee pain. We report a novel treatment using a Taylor spatial frame as part of a staged reconstruction to regain length of the extensor mechanism and maintain knee motion prior to performing primary repair of the avulsed patellar sleeve fragment. In our case, an 11-year-old male presented to our institution six months after sustaining a patellar sleeve fracture. Radiographic examination with the knee in extension revealed a 23-mm gap between the inferior patellar pole fragment and the remaining patella. The patient was ultimately taken to the operating room twelve months after the initial injury for placement of a Taylor spatial frame to regain length of the extensor mechanism. The patient began immediate knee range-of-motion exercises, and performed daily soft tissue lengthening of two millimeters. After four weeks of treatment the patient underwent removal of the fixator and primary repair of the patella. At final follow up six years after patellar reconstruction, the patient had an active knee range-of-motion from five degrees of hyperextension to 140°of flexion. Where current literature reports suboptimal results even when treatment is delayed for two months, in our case the patient was able to obtain a high level of function after treatment with a two-stage reconstruction using a Taylor spatial frame.
PubMed, Nov 1, 2005
Ankle injuries are common in the general and athletic populations. These injuries constitute 21% ... more Ankle injuries are common in the general and athletic populations. These injuries constitute 21% of all sports-related injuries. The wide spectrum of sports-related ankle injuries includes ligamentous injuries, soft-tissue and osseous impingement, osteochondral lesions of the talus, tendon injuries, and fractures. Occult lesions (eg, fractures of the lateral process of the talus, fractures of the anterior process of the calcaneus, fractures of the base of the fifth metatarsal, os trigonum, stress fractures) may be missed on initial physical examination, and patients with such injuries often present to a sports clinic with persistent pain around the ankle. Because of increasing participation in sporting events, health care professionals involved in the care of athletes at all levels must have a thorough understanding of the anatomy, pathophysiology, and initial management of ankle injuries. In this review, we describe the pertinent anatomy, pathology, diagnosis, and treatment of sports-related injuries of the ankle.
The American Journal of Orthopedics, 2005
Ankle injuries are common in the general and athletic populations. These injuries constitute 21% ... more Ankle injuries are common in the general and athletic populations. These injuries constitute 21% of all sports-related injuries. The wide spectrum of sports-related ankle injuries includes ligamentous injuries, soft-tissue and osseous impingement, osteochondral lesions of the talus, tendon injuries, and fractures. Occult lesions (eg, fractures of the lateral process of the talus, fractures of the anterior process of the calcaneus, fractures of the base of the fifth metatarsal, os trigonum, stress fractures) may be missed on initial physical examination, and patients with such injuries often present to a sports clinic with persistent pain around the ankle. Because of increasing participation in sporting events, health care professionals involved in the care of athletes at all levels must have a thorough understanding of the anatomy, pathophysiology, and initial management of ankle injuries. In this review, we describe the pertinent anatomy, pathology, diagnosis, and treatment of spor...
Foot & Ankle International
Stress fractures are debilitating injuries that occur in all types of patient populations, rangin... more Stress fractures are debilitating injuries that occur in all types of patient populations, ranging from military recruits and athletes to patients with chronic medical conditions, such as rheumatoid arthritis and metabolic bone disease. Because of the repetitive stress of endurance training, stress fractures are more frequent in the athletic population than the general public. The high forces associated with weightbearing help explain why they occur most frequently in the lower extremity of athletes involved in sports such as basketball, track and field, soccer, lacrosse, and ballet. In a review of 320 athletes with stress fractures, Matheson et al.22 found that most (49%) were in the tibia, followed by the tarsals (25.3%); the metatarsals were the least frequently involved (8.8%). A stress fracture is any fracture or microfracture that occurs as the result of repetitive loading to the bone rather than from a single traumatic event. A stress fracture can occur as the result of a marked increase in the load on a normal bone, such as may occur when a military recruit enters “bootcamp” and begins his or her new training regimen. Stress fractures also can occur from normal loading patterns in bone that is abnormally weak because of chronic diseases, such as rheumatoid arthritis or long-term corticoidsteroid use. The location of the stress fracture is dictated by the precipitating activity and the characteristic manner in which the force is absorbed in each person’s foot. The etiology of these injuries is complicated but can be divided into intrinsic and extrinsic factors, which can help explain the pathology and determine subsequent treatment options.14 Intrinsic factors include an excessively high arch, leg-length discrepancies, and excessive forefoot varus position,19 bone
American journal of orthopedics, 2005
Ankle injuries are common in the general and athletic populations. These injuries constitute 21% ... more Ankle injuries are common in the general and athletic populations. These injuries constitute 21% of all sports-related injuries. The wide spectrum of sports-related ankle injuries includes ligamentous injuries, soft-tissue and osseous impingement, osteochondral lesions of the talus, tendon injuries, and fractures. Occult lesions (eg, fractures of the lateral process of the talus, fractures of the anterior process of the calcaneus, fractures of the base of the fifth metatarsal, os trigonum, stress fractures) may be missed on initial physical examination, and patients with such injuries often present to a sports clinic with persistent pain around the ankle. Because of increasing participation in sporting events, health care professionals involved in the care of athletes at all levels must have a thorough understanding of the anatomy, pathophysiology, and initial management of ankle injuries. In this review, we describe the pertinent anatomy, pathology, diagnosis, and treatment of spor...
MOJ Orthopedics & Rheumatology
The purpose of this study was to evaluate two different repair techniques for the primary repair ... more The purpose of this study was to evaluate two different repair techniques for the primary repair of patellar tendon ruptures. Using a cadaveric model, we biomechanically compared a double Krackow stitch with, and without cerclage augmentation. The specimens were tested at loads comparable to those likely to be encountered during an early rehabilitation program (approximately 40 Newtons) and for maximal mechanical parameters. The force at failure of the augmented repairs was 329 ± 89 Newtons (N), while the non-augmented repairs failed at 278 ± 87 N. However, the force required to produce significant gapping at the repair site was not significantly different between both repair techniques. Additionally, there was no significant difference between the mean stiffness of the repairs in both groups within the loading range from 10-100N. However, as expected, at loads greater than 100 N the cerclage augmented repairs were significantly stiffer. Most notably, there was no gap formation in any of the constructs tested at forces (40 N) comparable to those seen during an early passive extension and active flexion program. These data suggest that it may be possible to achieve the benefits of an early rehabilitation program without augmentation of the repair, and thus avoid the potential complications arising from this additional material.
Since 1887, approximately 50 cases of an intra-articular patellar dislocation have been reported ... more Since 1887, approximately 50 cases of an intra-articular patellar dislocation have been reported in the worldwide literature. The vast majority of patients required an open reduction of the patella or closed reduction under general anesthesia. This injury has never been reported in association with a coronal shear fracture of the femoral condyle. A 14-year-old boy presented to our institution with his left knee locked in flexion after a direct blow. Radiographs showed the patella rotated on its horizontal axis and lying in a transverse position within the knee joint, as well as a concomitant femoral condyle fracture. After a successful closed reduction of the patella, the patient underwent open reduction and rigid fixation of the femoral condyle fracture with countersunk interfragmentary screws. At 12 months, the patient was ambulating on the left leg and had painless motion of the knee. We present a rare injury pattern in a skeletally immature patient after a direct blow to the kne...
Background: Appropriate suture selection is necessary in providing mechanical stability to soft t... more Background: Appropriate suture selection is necessary in providing mechanical stability to soft tissue reconstructions. Caprolactone/glycolide (Panacryl™) became a popular suture, possessing excellent handling properties; however, clinical observations questioned the knot security of caprolactone/glycolide. Caprolactone/glycolide is still available on many commercial suture anchor systems. This study compared the security of the knots and ultimate tensile strength of braided caprolactone/glycolide suture to that of a commonly used suture material, braided polyester (Ethibond™). Materials: Suture knots of No. 2 braided polyester suture and No. 2 braided caprolactone/glycolide suture were submersed in a physiologic saline solution and stressed using a continuous (non-cyclic) load, simulating a single maximal loading event in a clinical setting. Continuous loading was done to achieve clinical suture knot failure (3-mm knot slippage), then continued until catastrophic suture failure (su...
The American Journal of Orthopedics, Dec 1, 2005
Ankle injuries are common in the general and athletic populations. These injuries constitute 21% ... more Ankle injuries are common in the general and athletic populations. These injuries constitute 21% of all sports-related injuries. The wide spectrum of sports-related ankle injuries includes ligamentous injuries, soft-tissue and osseous impingement, osteochondral lesions of the talus, tendon injuries, and fractures. Occult lesions (eg, fractures of the lateral process of the talus, fractures of the anterior process of the calcaneus, fractures of the base of the fifth metatarsal, os trigonum, stress fractures) may be missed on initial physical examination, and patients with such injuries often present to a sports clinic with persistent pain around the ankle. Because of increasing participation in sporting events, health care professionals involved in the care of athletes at all levels must have a thorough understanding of the anatomy, pathophysiology, and initial management of ankle injuries. In this review, we describe the pertinent anatomy, pathology, diagnosis, and treatment of sports-related injuries of the ankle.
Orthopaedic journal of sports medicine, 2015
Lack of insurance has been shown to lead to delays in seeking care as well as fewer preventive me... more Lack of insurance has been shown to lead to delays in seeking care as well as fewer preventive medicine visits and poorer overall health status. To investigate the effects of insurance status on the timing and treatment of patients with bucket-handle meniscus tears. Cohort study; Level of evidence, 3. Charts from 2004 to 2013 were retrospectively reviewed for patients diagnosed with bucket-handle meniscus tears. Patients were divided into 2 groups: insured or underinsured. The insured group included patients with commercial insurance or Medicare. The underinsured group included patients with Medicaid or Charity Care. Time intervals were categorized as <6 weeks or ≥6 weeks. A total of 52 patients were included in this study: 15 (29%) insured and 37 (71%) underinsured. Underinsured patients experienced delays in initial presentation to an orthopaedic surgeon (P = .004), time from magnetic resonance imaging to surgery (P = .01), and time from injury to surgery (P = .007). Repair rat...
American journal of orthopedics (Belle Mead, N.J.), 2015
Since 1887, approximately 50 cases of an intra-articular patellar dislocation have been reported ... more Since 1887, approximately 50 cases of an intra-articular patellar dislocation have been reported in the worldwide literature. The vast majority of patients required an open reduction of the patella or closed reduction under general anesthesia. This injury has never been reported in association with a coronal shear fracture of the femoral condyle. A 14-year-old boy presented to our institution with his left knee locked in flexion after a direct blow. Radiographs showed the patella rotated on its horizontal axis and lying in a transverse position within the knee joint, as well as a concomitant femoral condyle fracture. After a successful closed reduction of the patella, the patient underwent open reduction and rigid fixation of the femoral condyle fracture with countersunk interfragmentary screws. At 12 months, the patient was ambulating on the left leg and had painless motion of the knee. We present a rare injury pattern in a skeletally immature patient after a direct blow to the kne...
INTRODUCTION: The purpose of this retrospective case-control study is to report the long-term cli... more INTRODUCTION: The purpose of this retrospective case-control study is to report the long-term clinical, functional, and radiographic results of arthroscopic partial medial meniscectomy in an otherwise normal knee (i.e. with stable ligaments). An attempt was made to identify variables that can lead to poor outcome. METHODS: Between January 1985 and December 1988, a total of 256 arthroscopic partial medial meniscectomies were performed. Of the 256 knees, 72 knees (43 right and 29 left) met the following inclusion criteria: Patient’s age more than 40 years, no previous or subsequent knee injuries or surgeries, no mechanical malalignment of the knee, and a minimum follow-up of 15 years. There were 60 males and 12 females. The mean age of the patients at the time of operation was 47.5 years (range 40 to 72 years). All patients had a partial medial meniscectomy involving the posterior one-third segment of the meniscus and a stable peripheral rim was preserved in all cases. The anterior cr...
The Knee, 2015
Patellar sleeve fractures are easily missed injuries since plain radiographs may not show a bony ... more Patellar sleeve fractures are easily missed injuries since plain radiographs may not show a bony fragment at the time of injury. Failure to diagnose these injuries can result in patellar instability, extensor lag, and anterior knee pain. We report a novel treatment using a Taylor spatial frame as part of a staged reconstruction to regain length of the extensor mechanism and maintain knee motion prior to performing primary repair of the avulsed patellar sleeve fragment. In our case, an 11-year-old male presented to our institution six months after sustaining a patellar sleeve fracture. Radiographic examination with the knee in extension revealed a 23-mm gap between the inferior patellar pole fragment and the remaining patella. The patient was ultimately taken to the operating room twelve months after the initial injury for placement of a Taylor spatial frame to regain length of the extensor mechanism. The patient began immediate knee range-of-motion exercises, and performed daily soft tissue lengthening of two millimeters. After four weeks of treatment the patient underwent removal of the fixator and primary repair of the patella. At final follow up six years after patellar reconstruction, the patient had an active knee range-of-motion from five degrees of hyperextension to 140° of flexion. Where current literature reports suboptimal results even when treatment is delayed for two months, in our case the patient was able to obtain a high level of function after treatment with a two-stage reconstruction using a Taylor spatial frame.
Medical Research Archives, 2015
The American journal of sports medicine
Der Chirurg; Zeitschrift für alle Gebiete der operativen Medizen, 1985
Pseudo-obstruction of the colon was observed in six patients. The cardinal feature is acute diste... more Pseudo-obstruction of the colon was observed in six patients. The cardinal feature is acute distension of the large bowel without distal obstruction. Apart from few idiopathic cases, the syndrome usually is associated with postoperative, posttraumatic or metabolic disorders of extraintestinal origin. Without treatment, increasing distension leads to cecal perforation with a high mortality. Treatment is conservative initially. If decompression by colonoscopy fails, cecostomy or right hemicolectomy are mandatory. The pathophysiologic mechanism of acute colonic pseudoobstruction is unknown. Whether Ogilvie's syndrome is a genuine clinical entity or a complication of associated diseases is still on question.
Clinical orthopaedics and related research, 2005
Feet are prone to bacterial contamination. We hypothesized that chlorhexidine scrub and isopropyl... more Feet are prone to bacterial contamination. We hypothesized that chlorhexidine scrub and isopropyl alcohol paint provide superior local flora reduction than povidone-iodine scrub and paint. Patients with intact, uninfected skin having clean elective foot and ankle surgery were prospectively enrolled and randomly assigned to skin preparation with povidone-iodine (Group 1) or chlorhexidine scrub and isopropyl alcohol paint (Group 2). Culture swabs (aerobic, anaerobic, acid fast, fungus, and routine antibiotic sensitivity) were taken from all web spaces, nail folds, toe surfaces, and proposed surgical incision sites. One-hundred twenty-seven patients were enrolled (mean age, 46 years; range, 16-85 years). Sixty-seven patients were assigned to Group 1; 60 patients were assigned to Group 2. In Group 1, 53 of 67 patients (79%) had positive cultures; in Group 2, 23 of 60 patients (38%) had positive cultures. These data indicate that chlorhexidine and alcohol provide better reduction in bact...
American journal of orthopedics (Belle Mead, N.J.), 2005
Ankle injuries are common in the general and athletic populations. These injuries constitute 21% ... more Ankle injuries are common in the general and athletic populations. These injuries constitute 21% of all sports-related injuries. The wide spectrum of sports-related ankle injuries includes ligamentous injuries, soft-tissue and osseous impingement, osteochondral lesions of the talus, tendon injuries, and fractures. Occult lesions (eg, fractures of the lateral process of the talus, fractures of the anterior process of the calcaneus, fractures of the base of the fifth metatarsal, os trigonum, stress fractures) may be missed on initial physical examination, and patients with such injuries often present to a sports clinic with persistent pain around the ankle. Because of increasing participation in sporting events, health care professionals involved in the care of athletes at all levels must have a thorough understanding of the anatomy, pathophysiology, and initial management of ankle injuries. In this review, we describe the pertinent anatomy, pathology, diagnosis, and treatment of spor...