Terry Axelrod - Academia.edu (original) (raw)

Papers by Terry Axelrod

JBJS case connector, Jan 27, 2016

Case: A fifty-three-year-old man presented with an intrathoracic glenohumeral dislocation (ITGHD)... more Case: A fifty-three-year-old man presented with an intrathoracic glenohumeral dislocation (ITGHD) and associated hemothorax, rib fracture, massive rotator cuff tear, and axillary nerve palsy following an ice hockey injury. Treatment consisted of closed reduction and staged open rotator cuff repair. Despite a substantial injury, the patient recovered nearly normal use of the arm two years postoperatively. Conclusion: ITGHD is an extremely rare entity. This injury should be managed by a multidisciplinary team with anticipation of associated thoracic and vascular injuries. In cases with repairable pathology (e.g., an acute rotator cuff tear), good functional outcomes can be obtained.

The Journal of Hand Surgery, Jul 1, 1998

Two patients are reported who had tendon rupture and plate breakage following internal fixation w... more Two patients are reported who had tendon rupture and plate breakage following internal fixation with the newly designed AO/ASIF titanium distal radius plate system (pi plate). The incidence of complications with this system warrants further evaluation.

Springer eBooks, Aug 1, 2005

The Journal of Hand Surgery, 1989

Radiographic definition of the dorsal and palmar edges of the distal radius The dorsal and palmar... more Radiographic definition of the dorsal and palmar edges of the distal radius The dorsal and palmar edges of the distal radius, as well as the concavity of the articular surface were labeled with wire and radiographs taken from neutral to 30 degrees of added dorsal tilt. The dorsal edge was identified as the structure that protrudes distally in neutral. The palmar edge was found to overlap with the sclerotic subchondral bone of the radius in neutral. With increasing dorsal tilt the profile of the palmar edge appeared as it protruded distal to the sclerotic subchondral line of the radius. The profile of the palmar edge could be distinguished from that of the dorsal edge on the anteroposterior view. The wire, which was placed midway between the dorsal and palmar edges and the concavity of the articular surface corresponded to the prominent sclerotic subchondral bone line of the distal radius. This did not change in position with increasing dorsal tilt. This clarification of the radiologic anatomy is helpful in extending the use of the anteroposterior radiograph for the interpretation of fractures and malunions of the distal radius.

$Research paper thumbnail of Limited open reduction of the lunate facet in comminuted intra-articular fractures of the distal radius$

The Journal of Hand Surgery, 1988

Anomalous muscles and ulnar nerve compression at the wrist. Hand 1977;9;140-2. 19. Jeffery AK. Co... more Anomalous muscles and ulnar nerve compression at the wrist. Hand 1977;9;140-2. 19. Jeffery AK. Compression of the deep palmar branch of the ulnar nerve by an anomalous muscle. Case report and review.

Orthopedic Clinics of North America, Apr 1, 2007

Traumatic injuries of the distal radioulnar joint (DRUJ) give rise to wrist pathologies that requ... more Traumatic injuries of the distal radioulnar joint (DRUJ) give rise to wrist pathologies that require special consideration for management. There may be substantial ongoing disability arising from failure to recognize, treat, and rehabilitate individuals with injuries to the DRUJ. These may occur as isolated injuries without associated fractures, but occur more commonly with fractures of the radius. These challenging DRUJ injuries may be simple or complex (irreducible or severe instability). They also may be acute or become a chronic problem. An adequate knowledge of the stabilizers of the DRUJ is essential in understanding treatment options. Traumatic instability of the DRUJ, its anatomy, and its stabilizing factors are reviewed, followed by an algorithm to guide selection of treatment options in complex cases.

Background: The research team aimed to assess the relationship between performance in a competenc... more Background: The research team aimed to assess the relationship between performance in a competency-based curriculum (CBC) evaluation, and the Orthopaedic In-Training Examination (OITE) in the Postgraduate Year 1 (PGY1) cohort of 2016-2017.Methods: After development of the ‘Basic Trauma’ (BHT) and ‘Basic Arthroplasty’ (BA) CBC modules, assessment consisted of multiple-choice questions (MCQ), objective structured clinical evaluation (OSCE), structured oral panels, and the OITE were conducted annually. We collated MCQ and OSCE evaluations for BHT and BA, as well as the OITE result for the same cohort from PGY1 and the end of PGY2. We evaluated the OITE score difference for correlation with the scores attained for the two CBC modules.Results: Among all participants (n=9), there was a significant improvement in mean OITE scores from PGY1 to PGY2 (43.78% (±4.09) to 56.67% (±4.24); t-test p= 0.00). There was no significant correlation between OITE improvement, and scores attained in the BH...

$Research paper thumbnail of Fracture fixation in the operative management of hip fractures (FAITH): an international, multicentre, randomised controlled trial$

The Lancet, 2017

Background High rates of re-operations after initial hip fracture fixation, the associated morbid... more Background High rates of re-operations after initial hip fracture fixation, the associated morbidity, mortality, and costs motivated the Fixation using Alternative Implants for the Treatment of Hip fractures (FAITH) randomised controlled trial. Methods We randomised 1,079 patients with a low-energy femoral neck fracture fracture requiring fracture fixation in 81 centres to a single large diameter screw with a side-plate (sliding hip screw) or the current standard, multiple small diameter cancellous screws (Clinical Trials Identification Number: NCT01908751). The primary outcome was hip re-operation within 24 months. Health-related quality of life (HRQL) was measured by the SF-12, EQ-5D, and WOMAC score. Findings Re-operations did not convincingly differ by type of surgical fixation: 107 of 542 patients (19•7%) in the sliding hip screw group and 117 of 537 patients (21•8%) in the cancellous screws group (hazard ratio, 0•83; 95% CI, 0•63 to 1•09; p=0•18). Avascular necrosis was more common in the sliding hip screw group than in the cancellous screws group (50 patients [9•2%] vs. 28 patients [5•2%]; hazard ratio, 1•78; 95% CI, 1•09 to 2•91; p=0•02). The three HRQL instruments were consistent in showing no important difference by treatment group at 24 months. A priori subgroups suggested lower reoperation rates with sliding hip screws in patients with displaced fractures (interaction p=0•04), base of femoral neck fractures (interaction p=0•04), and current Page 3 of 33 smokers (interaction p=0•02); current smoking appeared the dominant effect modifier in an analysis that included all three variables. Interpretation Among patients with a femoral neck fracture fracture there was no convincing difference in hip re-operations or HRQL among patients allocated to sliding hip screw compared to cancellous screws. Avascular necrosis was higher with sliding hip screws.

Orthopedics, 1989

Malunions of distal radius fractures are commonplace. Patients are decreasingly willing to accept... more Malunions of distal radius fractures are commonplace. Patients are decreasingly willing to accept the disability that may be associated with them. While the first line of treatment is initial good fracture care, corrective osteotomies offer later opportunity for pain relief and improved function.

Acute compartment syndrome is a surgical emergency and its diagnosis is more difficult in obtunde... more Acute compartment syndrome is a surgical emergency and its diagnosis is more difficult in obtunded or insensate patients. We present the case of a 34-year-old woman who sustained a Gustilo-Anderson grade III open midshaft femur fracture with an isolated femoral vein injury treated with direct repair. She developed lower leg compartment syndrome at 48 hours postoperatively, necessitating fasciotomies. She was subsequently found to have a DVT in her femoral vein at the level of the repair and was started on therapeutic anticoagulation. This case highlights the importance of recognition of isolated venous injuries in a trauma setting as a risk factor for developing compartment syndrome.

Purpose To examine measurement properties of four disability outcomes in patients with advanced o... more Purpose To examine measurement properties of four disability outcomes in patients with advanced osteoarthritis of the glenohumeral joint. Methods This was a prospective longitudinal study of patients with advanced osteoarthritis of the glenohumeral joint who underwent a Total Shoulder Arthroplasty (TSA) and were followed for 6 months. Four measures [Western Ontario Osteoarthritis Shoulder (WOOS) Index, the American Shoulder and Elbow Surgeons (ASES) assessment, Constant-Murley score (CMS), and Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH)] were completed 2-3 weeks before surgery and at 6 months after surgery. Results Seventy-seven patients (average age: 66, range 35 to 86, 60% women, 40% men) participated in the study. The Cronbach9s Coefficient Alpha of subjective measures was high at 0.91, 0.86, and 0.83 for WOOS, ASES, and QuickDASH respectively. All measures were able to discriminate between men and women9s levels of disability at p Conclusion All four disability...

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

JBJS Case Connector, 2015

Case: A twenty-two-year-old male patient presented to our trauma center after a motor-vehicle acc... more Case: A twenty-two-year-old male patient presented to our trauma center after a motor-vehicle accident in which he sustained multiple injuries, including a volar dislocation of the hamate and ipsilateral scapholunate dissociation. Following closed reduction of the hamate dislocation, open reduction and stabilization of these carpal injuries was undertaken two days post-injury via a dorsal approach. Percutaneous Kirschner wires were used as well as two mini suture anchors to repair the scapholunate ligament. The patient was immobilized for six weeks and Kirschner wires were removed at twelve weeks postoperatively. Conclusion: To our knowledge, hamate dislocation with scapholunate dissociation and its surgical treatment have not previously been described. Successful surgical treatment for this injury pattern may be performed dorsally via direct reduction and repair of the scapholunate ligament with percutaneous pinning of the affected carpal bones.

Hand clinics, 2014

This article describes the basic bony, ligamentous, and neurologic anatomy of the structures abou... more This article describes the basic bony, ligamentous, and neurologic anatomy of the structures about the elbow. The surgical exposures of the elbow joint are described, providing details of the various posterior, lateral, and medial approaches to the articular segments. Clinical applications describing the potential benefits of each surgical exposure are provided as examples.

$Research paper thumbnail of Intra-articular fractures of the upper extremity: new concepts in surgical treatment$

Instructional course lectures, 2003

New techniques of internal fixation, postoperative rehabilitation, and emphasis on functional as ... more New techniques of internal fixation, postoperative rehabilitation, and emphasis on functional as well as radiographic outcome have refined the surgical treatment of complex fractures of the glenoid, humeral head, supracondylar and intracondylar humerus, olecranon, radial head, distal radius, and distal radioulnar joint over the past decade. Early stabilization and rehabilitation of these injuries leads to soft-tissue stabilization and facilitates the patient's ability to place the hand in three-dimensional space.

Journal of Orthopaedics and Trauma, 2013

Recent studies favor surgical management of displaced clavicle fractures. Displacement is measure... more Recent studies favor surgical management of displaced clavicle fractures. Displacement is measured using anterior-posterior (AP) X-rays. Since displacement can occur in all three dimensions, however, standard methods of evaluation can be difficult and inaccurate. This study was conducted to determine the X-ray angle that provides the most accurate assessment. Nine CT scans of acute displaced clavicle fractures were analyzed with AmiraDev imaging software. 3D measurements for degrees of shortening and fracture displacement of the fracture clavicle were taken. Using a segmentation and manipulation module, five digitally reconstructed radiographs (DRRs) mimicking AP X-rays were created for every CT, with each DDR differing slightly by projection angle. After comparison to the original CTs, all samples using an AP view with a 20°downward tilt yielded displacements closest to the 3D "gold standard" or true measurements. Therefore, it is suggested that using this projection would provide the most accurate indication of fracture displacement.

The Journal of Hand Surgery, 1990

Clinical and radiographic assessment of the results of 40 Swanson silicone ulnar head prosthesis ... more Clinical and radiographic assessment of the results of 40 Swanson silicone ulnar head prosthesis implants in three different patient groups is presented. Twenty-eight were done for treatment of rheumatoid arthritis, eight for tdnoradial impingement after the Darrach procedure, and four for ulnocarpat impingement resulting from malunited Colles' fractures. Patients were reviewed 12 to 48 months after operation (mean, 29 months). Seventy-eight percent of patients reported relief of pain and improved function. Radiologic examination showed that all patients exhibited resorption of the distal ulna (mean 4.4 mm) and that resorption was worst in the group with rheumatoid arthritis. Bone resorption about the implant predisposed the cap to both side-toside tilt and pistoning of the prosthesis on supination and pronation. There was a 10% revision rate because of silicone synovitis. Although clinical results remain satisfactory for patients with rheumatoid arthritis and ulnocarpal impingement, the radiologic results suggest that Swanson ulnar head replacement should be restricted to elderly patients with rheumatoid arthritis.

Clinical Orthopaedics and Related Research, 1985

Antigen presenting cells may have a direct bearing on the results of allotransplantation of bone.... more Antigen presenting cells may have a direct bearing on the results of allotransplantation of bone. There is no doubt that these cells are neither T nor B lymphocytes and that they do reside in the bone marrow. Evidence suggests that these bone marrow cells are of the granulocyte lineage and that they initiate immunologic reactions in vitro. The removal of bone marrow that contains these cells from bone allografts would decrease the immunologic response to the implantation of such transplants.