Mark Vitale - Academia.edu (original) (raw)
Papers by Mark Vitale
Journal of wrist surgery, Jan 6, 2016
Background Studies have established an increased risk of radiocarpal joint posttraumatic arthriti... more Background Studies have established an increased risk of radiocarpal joint posttraumatic arthritis in patients with displaced intra-articular fractures of the distal radius, although this phenomenon has yet to be evaluated in the distal radioulnar joint (DRUJ). Purpose We hypothesized that patients with displaced intra-articular fractures of the sigmoid notch would have a higher prevalence of DRUJ arthritis and greater upper extremity dysfunction after operative treatment of distal radius fractures compared with fractures without sigmoid notch involvement. We also hypothesized that the degree of sigmoid notch incongruity would be correlated with the grade of DRUJ arthritis and the severity of upper extremity dysfunction. Patients and Methods A retrospective review was conducted on surgically treated patients with distal radius fractures with pre-and/or postoperative computed tomography (CT) scans. Patients were divided into groups based on presence or absence of fracture extension into the sigmoid notch. Within the sigmoid notch group, postoperative CT scans were used to measure sigmoid notch fracture step-off and diastasis (mm), as well as volar or dorsal DRUJ subluxation (%). Patients were administered Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaires and radiographs were obtained to grade DRUJ arthritis using the Kellgren-Lawrence (KL) radiographic criteria. Results Thirty-three patients were included (19 with sigmoid notch involvement and 14 without) with an average radiographic follow-up of 6.3 years (range: 3.5-10.1 years). DASH scores were available for all patients, and radiographic follow-up was available in 24 patients (73%). A trend toward higher grade of DRUJ arthritis and poorer average DASH was found in those with sigmoid notch involvement, but was not statistically different. In the sigmoid notch group there were poorer DASH scores in patients with coronal step-off > 1.0-mm (p < 0.05). There were no significant correlations between
The Journal of Hand Surgery, Sep 1, 2017
Experiment 2. We used elbow MRI data of a Japanese monkey to create CG of its bones and nerves. E... more Experiment 2. We used elbow MRI data of a Japanese monkey to create CG of its bones and nerves. Elbow arthroscopy was performed on the monkey using anteromedial and posterior portals with CG of the bones and nerves superimposed onto the elbow arthroscopy video images. The AR range of error was examined at a 1-cm scopeeobject distance. Results: We superimposed the CG onto the elbow arthroscopy video images for both the full-size 3D model and the monkey (Fig. 77-1). The arthroscopic view was initially quite different from the superimposed CG due to lens distortion. However, we corrected the CG position and shape to match the arthroscopic view using lens distortion parameters estimated from the calibration pattern (Fig. 77-2). Ultimately, the AR position and shape errors were limited to 2.3 mm at a 1-cm scopeeobject distance. Summary Points: The technological integration of AR into arthroscopy succeeded as a feasibility study and demonstrated acceptable accuracy. With further iteration and refinement, the capability of AR-enhanced arthroscopic visualization has the potential to be a transformative technology. This technique will contribute to reducing the possibility of serious complications associated with elbow arthroscopy.
The Journal of Hand Surgery, Feb 1, 2015
THE PATIENT A 37-year-old man injured his right wrist in a motor vehicle collision. In the emerge... more THE PATIENT A 37-year-old man injured his right wrist in a motor vehicle collision. In the emergency department he had severe wrist pain and median nerve paresthesia. Wrist radiographs identified a dorsal perilunate dislocation (PLD) with the carpus dislocated dorsally and the lunate tilted volar but still located in the lunate fossa. Post-reduction computed tomography scan confirmed no fractures.
Journal of Hand Surgery Global Online
The Journal of Hand Surgery, 2020
Purpose Skin tears are an unpleasant complication that may occur after collagenase Clostridium hi... more Purpose Skin tears are an unpleasant complication that may occur after collagenase Clostridium histolyticum (CCH) administration to treat Dupuytren contractures of the fingers. The purpose of this study was to determine risk factors for the development of this complication. Methods Over a 6-year period, patients with a measurable metacarpophalangeal or proximal interphalangeal joint Dupuytren contracture and a palpable cord treated with CCH were prospectively observed. Patients were assessed for the development of skin tears immediately on the day of manipulation as well 30 days or more after manipulation. Results A total of 117 patients (174 cords) met inclusion criteria. There was a 25.6% incidence of skin tears (30 of 117 patients; 33 skin tears). Multivariable regression analysis revealed that patients with a combined digital flexion contracture (total combined metacarpophalangeal, proximal interphalangeal, and distal interphalangeal joint contracture) of 75 and greater and those treated with 2 simultaneous doses of CCH in the same hand were more likely to sustain a tear. All skin tears healed with nonsurgical management at short-term follow-up. Conclusions Although a relatively minor complication, skin tears are not well-tolerated by all patients and may change the postinjection course of orthosis use, wound care, and manual activity. Based on these results, patients with digital contractures 75 or greater and those treated with 2 simultaneous doses of CCH in the same hand may be counseled that they have a higher likelihood of developing a skin tear during manipulation. Pretreatment education may reduce anxiety experienced by patients who otherwise unexpectedly develop a skin tear at the time of manipulation.
Journal of Wrist Surgery
Mycobacterium avium intracellulare (MAI) infections of the hand, wrist, and upper extremity are r... more Mycobacterium avium intracellulare (MAI) infections of the hand, wrist, and upper extremity are rare, but potentially devastating atypical mycobacterial infections that can affect tendon, bone, and other soft tissues of the musculoskeletal system. We present an immunocompromised patient presenting with acute swelling and pain in the dorsum of the hand and wrist that underwent a wrist extensor tenosynovectomy with intraoperative cultures revealing infection with MAI. The patient developed severe progression of the infection with osteomyelitis of the distal forearm and carpal bones, multiple subsequent extensor tendon ruptures, and dorsal skin necrosis. The infection was eradicated with a combination of surgical treatment and antibiotic therapy. The case is discussed in context of the prior scant literature of infectious tenosynovitis of the hand, wrist, and upper extremity caused by MAI. This case report and literature review outline recommendations for diagnosis and effective treatm...
Journal of Pediatric Orthopaedics B, 2006
The primary goal of surgical equalization of lower extremity limb length discrepancy is to enhanc... more The primary goal of surgical equalization of lower extremity limb length discrepancy is to enhance the quality of life of patients by improving their function, gait, appearance, and pain secondary to compensation for the limb length discrepancy. While many surgeons use a cutoff point of 2 cm as an indication for intervention, little attention has been given to the effect of limb length discrepancy on quality of life. Therefore, the purpose of this study was to determine the relationship between limb length discrepancy and health-related quality of life and to assess whether the commonly accepted 2 cm cutoff serves to predict patients with and without quality of life perturbations. The Child Health Questionnaire was used to collect information from the parents of 76 children diagnosed with limb length discrepancy, and these data were compared with data from scanograms. Differences in quality of life became more apparent with increasing limb length discrepancy, especially among psychosocial health domains. As expected, patients with a limb length discrepancy of 2 cm or below generally fared better than patients with larger discrepancies, but no discrete cutoff could be identified within this group.
Instructional course lectures, 2015
Proximal interphalangeal joint injuries are common and often can be treated nonsurgically. Some d... more Proximal interphalangeal joint injuries are common and often can be treated nonsurgically. Some dorsal fracture-dislocations, however, require special attention or surgical management to optimize outcomes. Treatment options for dorsal proximal interphalangeal fracture-dislocations include splinting, percutaneous pinning, fracture fixation, external fixation devices, volar plate arthroplasty, and hemihamate arthroplasty.
The American journal of sports medicine, 2010
ABSTRACT Background: Orthopaedic injuries negatively affect the academic lives of children.Hypoth... more ABSTRACT Background: Orthopaedic injuries negatively affect the academic lives of children.Hypothesis: The timing of anterior cruciate ligament (ACL) and medial patellofemoral ligament (MPFL) reconstructions affects academic performance in school-aged athletes.Study Design: Cohort study; Level of evidence, 2.Methods: Records of patients ≤18 years old who underwent ACL or MPFL reconstructions from 2001-2007 were reviewed retrospectively. Subjects had been administered a unique questionnaire to evaluate school life in the immediate postoperative period as well as International Knee Documentation Committee (IDKC), Lysholm, and Kujala knee-specific questionnaires. Patients were in 1 of 3 study cohorts: group A (surgery during school year), group B (surgery during school holiday), and group C (surgery during summer break).Results: There were 62 subjects (53 ACL and 12 MPFL reconstructions). A higher proportion of patients in group A required being driven to school (88.5%) than groups B (63.6%) or C (64.7%) (P < .05). A lower proportion of patients in group A returned to school immediately after surgery (3.8%) than groups B (36.4%) or C (88.2%) (P < .005). Among children who had never failed a test before surgery, a higher proportion of patients in group A failed a test (36.4%) after return to school than groups B (0%) or C (0%) (P < .05). Patients in group C had higher mean Likert scores (4.5) than groups A (3.8) or B (3.7) (P = .05) in response to the question “my grades suffered in my classes.” Delay in surgery was negatively correlated with IKDC, Lysholm, and Kujala questionnaire scores (P < .05).Conclusion: In school-aged athletes with ligamentous knee injuries receiving operative treatment, surgery on a school day causes more academic difficulties than surgery during a holiday or summer break. Academic benefits of delaying surgery during the school year must be weighed against potentially worse outcomes encountered with prolonged surgical delay.
Journal of Pediatric Orthopaedics, 2005
The ongoing controversy regarding the appropriate treatment of clubfoot has resulted in much vari... more The ongoing controversy regarding the appropriate treatment of clubfoot has resulted in much variability in practice patterns, making the assessment of long-term outcomes a difficult one. Recently, new patient-based measures of outcomes have allowed for improved methods of assessing health outcomes in children. The purpose of this study was to follow up on a cohort of adolescents who underwent surgical repair at the authors&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;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; institution. Traditional (radiographs) and patient-based measures were obtained from 24 patients. The Child Health Questionnaire showed that the quality of life of these patients was relatively high after surgery, and these scores were comparable to those of age-matched young athletes with healthy feet. The disease-specific instrument, which was also administered, showed similar results. The role of radiographic measures was limited, as they did not reflect patient-based outcomes after clubfoot surgery. Both generic and disease-specific measures should be used as primary endpoints in evaluating treatment results in this area.
Journal of Shoulder and Elbow Surgery, 2007
The setting was inpatient secondary care. The economic study was carried out in the USA. Dates to... more The setting was inpatient secondary care. The economic study was carried out in the USA. Dates to which data relate The dates over which patients were recruited into the study were not reported. The price year was not reported. Link between effectiveness and cost data The costing was undertaken prospectively on the same patient sample that provided the effectiveness data. Study sample No sample size would appear to have been determined in the planning phase of the study in order to assure a certain power. The authors enrolled eligible patients undergoing surgical repair by the principal investigator. They did not report how many patients were excluded from the study or how many eligible patients refused to participate. A total of 87 patients (54% male) were enrolled into the study. Study design The study was a within-group comparison that was undertaken in a single centre. The principal investigator of the study performed all surgical operations. The patients were followed up for 1 year. The authors did not report if there was any loss to follow-up.
Journal of Pediatric Orthopaedics B, 2006
The primary goal of surgical equalization of lower extremity limb length discrepancy is to enhanc... more The primary goal of surgical equalization of lower extremity limb length discrepancy is to enhance the quality of life of patients by improving their function, gait, appearance, and pain secondary to compensation for the limb length discrepancy. While many surgeons use a cutoff point of 2 cm as an indication for intervention, little attention has been given to the effect of limb length discrepancy on quality of life. Therefore, the purpose of this study was to determine the relationship between limb length discrepancy and health-related quality of life and to assess whether the commonly accepted 2 cm cutoff serves to predict patients with and without quality of life perturbations. The Child Health Questionnaire was used to collect information from the parents of 76 children diagnosed with limb length discrepancy, and these data were compared with data from scanograms. Differences in quality of life became more apparent with increasing limb length discrepancy, especially among psychosocial health domains. As expected, patients with a limb length discrepancy of 2 cm or below generally fared better than patients with larger discrepancies, but no discrete cutoff could be identified within this group.
Journal of Pediatric Orthopaedics, 2005
The ongoing controversy regarding the appropriate treatment of clubfoot has resulted in much vari... more The ongoing controversy regarding the appropriate treatment of clubfoot has resulted in much variability in practice patterns, making the assessment of long-term outcomes a difficult one. Recently, new patient-based measures of outcomes have allowed for improved methods of assessing health outcomes in children. The purpose of this study was to follow up on a cohort of adolescents who underwent surgical repair at the authors&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;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; institution. Traditional (radiographs) and patient-based measures were obtained from 24 patients. The Child Health Questionnaire showed that the quality of life of these patients was relatively high after surgery, and these scores were comparable to those of age-matched young athletes with healthy feet. The disease-specific instrument, which was also administered, showed similar results. The role of radiographic measures was limited, as they did not reflect patient-based outcomes after clubfoot surgery. Both generic and disease-specific measures should be used as primary endpoints in evaluating treatment results in this area.
Journal of Pediatric Orthopaedics, 2005
While volume/outcomes relationships have been shown for several areas of orthopaedics, previous s... more While volume/outcomes relationships have been shown for several areas of orthopaedics, previous studies have not examined this relationship in the area of scoliosis surgery. The Office of Statewide Planning and Development (OSHPD) California inpatient discharge database was used for a retrospective review of all patients 25 years of age or younger with a diagnosis of scoliosis and a spinal fusion procedure from 1995 to 1999 (n = 3,606). Univariate and multivariate analyses were conducted to determine the effect of various factors on in-hospital mortality, surgical complications, reoperations, and length of stay (LOS). Univariate analyses revealed significant effects of age, sex, illness severity, neuromuscular disease, surgical approach, Medicaid status, and annual hospital volume on outcomes (P &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;lt; 0.05). After controlling for these factors using multivariate regression, patients insured by Medicaid were found to have a significantly greater odds for complications (P = 0.017) and a significantly increased LOS (P &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;lt; 0.001) compared with patients with all other sources of payment. Additionally, multivariate regression revealed an inverse relationship between annual hospital volume and likelihood of reoperation, as patients treated at hospitals with annual volumes of 5.1 to 25.0, 25.1 to 50.0, and greater than 50.0 spinal fusions all had approximately half the odds of reoperation (P = 0.042, P = 0.004, and P = 0.028 respectively) as patients treated at hospitals with an annual volume of 5.0 or fewer spinal fusions per year. The current data suggest that being insured with Medicaid in the state of California is associated with poorer outcomes after scoliosis surgery. Additionally, this study documents a volume/outcomes relationship in scoliosis surgery.
Journal of Pediatric Orthopaedics, 2005
While volume/outcomes relationships have been shown for several areas of orthopaedics, previous s... more While volume/outcomes relationships have been shown for several areas of orthopaedics, previous studies have not examined this relationship in the area of scoliosis surgery. The Office of Statewide Planning and Development (OSHPD) California inpatient discharge database was used for a retrospective review of all patients 25 years of age or younger with a diagnosis of scoliosis and a spinal fusion procedure from 1995 to 1999 (n = 3,606). Univariate and multivariate analyses were conducted to determine the effect of various factors on in-hospital mortality, surgical complications, reoperations, and length of stay (LOS). Univariate analyses revealed significant effects of age, sex, illness severity, neuromuscular disease, surgical approach, Medicaid status, and annual hospital volume on outcomes (P &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;lt; 0.05). After controlling for these factors using multivariate regression, patients insured by Medicaid were found to have a significantly greater odds for complications (P = 0.017) and a significantly increased LOS (P &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;lt; 0.001) compared with patients with all other sources of payment. Additionally, multivariate regression revealed an inverse relationship between annual hospital volume and likelihood of reoperation, as patients treated at hospitals with annual volumes of 5.1 to 25.0, 25.1 to 50.0, and greater than 50.0 spinal fusions all had approximately half the odds of reoperation (P = 0.042, P = 0.004, and P = 0.028 respectively) as patients treated at hospitals with an annual volume of 5.0 or fewer spinal fusions per year. The current data suggest that being insured with Medicaid in the state of California is associated with poorer outcomes after scoliosis surgery. Additionally, this study documents a volume/outcomes relationship in scoliosis surgery.
The American Journal of Sports Medicine, 2009
Background Orthopaedic injuries negatively affect the academic lives of children. Hypothesis The ... more Background Orthopaedic injuries negatively affect the academic lives of children. Hypothesis The timing of anterior cruciate ligament (ACL) and medial patellofemoral ligament (MPFL) reconstructions affects academic performance in school-aged athletes. Study Design Cohort study; Level of evidence, 2. Methods Records of patients ≤18 years old who underwent ACL or MPFL reconstructions from 2001-2007 were reviewed retrospectively. Subjects had been administered a unique questionnaire to evaluate school life in the immediate postoperative period as well as International Knee Documentation Committee (IDKC), Lysholm, and Kujala knee-specific questionnaires. Patients were in 1 of 3 study cohorts: group A (surgery during school year), group B (surgery during school holiday), and group C (surgery during summer break). Results There were 62 subjects (53 ACL and 12 MPFL reconstructions). A higher proportion of patients in group A required being driven to school (88.5%) than groups B (63.6%) or ...
Journal of Pediatric Orthopaedics, 2006
This study is a pilot effort towards the broader implementation of a national pediatric musculosk... more This study is a pilot effort towards the broader implementation of a national pediatric musculoskeletal trauma outcomes registry. The primary goal of this project is to explore the feasibility of a web-based data acquisition and management platform and to identify catalysts and obstacles to multi-center collaboration. A prospective cohort of children presenting to the Pediatric Emergency Departments with ankle, femur, supracondylar humerus, tibial spine, or open fractures at five clinical centers between October 2001 and March 2003 comprised the study population. Patients were enrolled via the treating orthopaedic resident, using a web-based data acquisition and management system. Orthopaedic attendees were sent an automated reminder to complete a follow-up form one week after treatment, and parents of enrolled children were sent child and parent health questionnaires by e-mail and mail in order to capture health-related quality of life and post-traumatic stress symptoms. A total of 299 patients were enrolled in the study with an average age of 7.3 years. Post-treatment follow-up questionnaires were completed by 39% of the attending orthopaedic surgeons, and by 43% of the enrolled patients or patient&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;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;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 parents. Children old enough to complete health questionnaires scored lower in 5 of 12 functional domains including Physical Function, Role/Social Emotional/Behavioral, Parental Impact-Emotional, Family Activities, and Family Cohesion. Within the subset of patients sustaining femur fractures whose parents completed health questionnaires, 9.5% reported significant post-traumatic stress symptoms. This study demonstrates the potential of a multi-center web-based registry to facilitate the collection of a rich array of pediatric trauma, treatment and patient-based outcomes data, although new regulatory issues regarding patient privacy pose challenges to such an approach.
Journal of Pediatric Orthopaedics, 2005
Journal of wrist surgery, Jan 6, 2016
Background Studies have established an increased risk of radiocarpal joint posttraumatic arthriti... more Background Studies have established an increased risk of radiocarpal joint posttraumatic arthritis in patients with displaced intra-articular fractures of the distal radius, although this phenomenon has yet to be evaluated in the distal radioulnar joint (DRUJ). Purpose We hypothesized that patients with displaced intra-articular fractures of the sigmoid notch would have a higher prevalence of DRUJ arthritis and greater upper extremity dysfunction after operative treatment of distal radius fractures compared with fractures without sigmoid notch involvement. We also hypothesized that the degree of sigmoid notch incongruity would be correlated with the grade of DRUJ arthritis and the severity of upper extremity dysfunction. Patients and Methods A retrospective review was conducted on surgically treated patients with distal radius fractures with pre-and/or postoperative computed tomography (CT) scans. Patients were divided into groups based on presence or absence of fracture extension into the sigmoid notch. Within the sigmoid notch group, postoperative CT scans were used to measure sigmoid notch fracture step-off and diastasis (mm), as well as volar or dorsal DRUJ subluxation (%). Patients were administered Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaires and radiographs were obtained to grade DRUJ arthritis using the Kellgren-Lawrence (KL) radiographic criteria. Results Thirty-three patients were included (19 with sigmoid notch involvement and 14 without) with an average radiographic follow-up of 6.3 years (range: 3.5-10.1 years). DASH scores were available for all patients, and radiographic follow-up was available in 24 patients (73%). A trend toward higher grade of DRUJ arthritis and poorer average DASH was found in those with sigmoid notch involvement, but was not statistically different. In the sigmoid notch group there were poorer DASH scores in patients with coronal step-off > 1.0-mm (p < 0.05). There were no significant correlations between
The Journal of Hand Surgery, Sep 1, 2017
Experiment 2. We used elbow MRI data of a Japanese monkey to create CG of its bones and nerves. E... more Experiment 2. We used elbow MRI data of a Japanese monkey to create CG of its bones and nerves. Elbow arthroscopy was performed on the monkey using anteromedial and posterior portals with CG of the bones and nerves superimposed onto the elbow arthroscopy video images. The AR range of error was examined at a 1-cm scopeeobject distance. Results: We superimposed the CG onto the elbow arthroscopy video images for both the full-size 3D model and the monkey (Fig. 77-1). The arthroscopic view was initially quite different from the superimposed CG due to lens distortion. However, we corrected the CG position and shape to match the arthroscopic view using lens distortion parameters estimated from the calibration pattern (Fig. 77-2). Ultimately, the AR position and shape errors were limited to 2.3 mm at a 1-cm scopeeobject distance. Summary Points: The technological integration of AR into arthroscopy succeeded as a feasibility study and demonstrated acceptable accuracy. With further iteration and refinement, the capability of AR-enhanced arthroscopic visualization has the potential to be a transformative technology. This technique will contribute to reducing the possibility of serious complications associated with elbow arthroscopy.
The Journal of Hand Surgery, Feb 1, 2015
THE PATIENT A 37-year-old man injured his right wrist in a motor vehicle collision. In the emerge... more THE PATIENT A 37-year-old man injured his right wrist in a motor vehicle collision. In the emergency department he had severe wrist pain and median nerve paresthesia. Wrist radiographs identified a dorsal perilunate dislocation (PLD) with the carpus dislocated dorsally and the lunate tilted volar but still located in the lunate fossa. Post-reduction computed tomography scan confirmed no fractures.
Journal of Hand Surgery Global Online
The Journal of Hand Surgery, 2020
Purpose Skin tears are an unpleasant complication that may occur after collagenase Clostridium hi... more Purpose Skin tears are an unpleasant complication that may occur after collagenase Clostridium histolyticum (CCH) administration to treat Dupuytren contractures of the fingers. The purpose of this study was to determine risk factors for the development of this complication. Methods Over a 6-year period, patients with a measurable metacarpophalangeal or proximal interphalangeal joint Dupuytren contracture and a palpable cord treated with CCH were prospectively observed. Patients were assessed for the development of skin tears immediately on the day of manipulation as well 30 days or more after manipulation. Results A total of 117 patients (174 cords) met inclusion criteria. There was a 25.6% incidence of skin tears (30 of 117 patients; 33 skin tears). Multivariable regression analysis revealed that patients with a combined digital flexion contracture (total combined metacarpophalangeal, proximal interphalangeal, and distal interphalangeal joint contracture) of 75 and greater and those treated with 2 simultaneous doses of CCH in the same hand were more likely to sustain a tear. All skin tears healed with nonsurgical management at short-term follow-up. Conclusions Although a relatively minor complication, skin tears are not well-tolerated by all patients and may change the postinjection course of orthosis use, wound care, and manual activity. Based on these results, patients with digital contractures 75 or greater and those treated with 2 simultaneous doses of CCH in the same hand may be counseled that they have a higher likelihood of developing a skin tear during manipulation. Pretreatment education may reduce anxiety experienced by patients who otherwise unexpectedly develop a skin tear at the time of manipulation.
Journal of Wrist Surgery
Mycobacterium avium intracellulare (MAI) infections of the hand, wrist, and upper extremity are r... more Mycobacterium avium intracellulare (MAI) infections of the hand, wrist, and upper extremity are rare, but potentially devastating atypical mycobacterial infections that can affect tendon, bone, and other soft tissues of the musculoskeletal system. We present an immunocompromised patient presenting with acute swelling and pain in the dorsum of the hand and wrist that underwent a wrist extensor tenosynovectomy with intraoperative cultures revealing infection with MAI. The patient developed severe progression of the infection with osteomyelitis of the distal forearm and carpal bones, multiple subsequent extensor tendon ruptures, and dorsal skin necrosis. The infection was eradicated with a combination of surgical treatment and antibiotic therapy. The case is discussed in context of the prior scant literature of infectious tenosynovitis of the hand, wrist, and upper extremity caused by MAI. This case report and literature review outline recommendations for diagnosis and effective treatm...
Journal of Pediatric Orthopaedics B, 2006
The primary goal of surgical equalization of lower extremity limb length discrepancy is to enhanc... more The primary goal of surgical equalization of lower extremity limb length discrepancy is to enhance the quality of life of patients by improving their function, gait, appearance, and pain secondary to compensation for the limb length discrepancy. While many surgeons use a cutoff point of 2 cm as an indication for intervention, little attention has been given to the effect of limb length discrepancy on quality of life. Therefore, the purpose of this study was to determine the relationship between limb length discrepancy and health-related quality of life and to assess whether the commonly accepted 2 cm cutoff serves to predict patients with and without quality of life perturbations. The Child Health Questionnaire was used to collect information from the parents of 76 children diagnosed with limb length discrepancy, and these data were compared with data from scanograms. Differences in quality of life became more apparent with increasing limb length discrepancy, especially among psychosocial health domains. As expected, patients with a limb length discrepancy of 2 cm or below generally fared better than patients with larger discrepancies, but no discrete cutoff could be identified within this group.
Instructional course lectures, 2015
Proximal interphalangeal joint injuries are common and often can be treated nonsurgically. Some d... more Proximal interphalangeal joint injuries are common and often can be treated nonsurgically. Some dorsal fracture-dislocations, however, require special attention or surgical management to optimize outcomes. Treatment options for dorsal proximal interphalangeal fracture-dislocations include splinting, percutaneous pinning, fracture fixation, external fixation devices, volar plate arthroplasty, and hemihamate arthroplasty.
The American journal of sports medicine, 2010
ABSTRACT Background: Orthopaedic injuries negatively affect the academic lives of children.Hypoth... more ABSTRACT Background: Orthopaedic injuries negatively affect the academic lives of children.Hypothesis: The timing of anterior cruciate ligament (ACL) and medial patellofemoral ligament (MPFL) reconstructions affects academic performance in school-aged athletes.Study Design: Cohort study; Level of evidence, 2.Methods: Records of patients ≤18 years old who underwent ACL or MPFL reconstructions from 2001-2007 were reviewed retrospectively. Subjects had been administered a unique questionnaire to evaluate school life in the immediate postoperative period as well as International Knee Documentation Committee (IDKC), Lysholm, and Kujala knee-specific questionnaires. Patients were in 1 of 3 study cohorts: group A (surgery during school year), group B (surgery during school holiday), and group C (surgery during summer break).Results: There were 62 subjects (53 ACL and 12 MPFL reconstructions). A higher proportion of patients in group A required being driven to school (88.5%) than groups B (63.6%) or C (64.7%) (P < .05). A lower proportion of patients in group A returned to school immediately after surgery (3.8%) than groups B (36.4%) or C (88.2%) (P < .005). Among children who had never failed a test before surgery, a higher proportion of patients in group A failed a test (36.4%) after return to school than groups B (0%) or C (0%) (P < .05). Patients in group C had higher mean Likert scores (4.5) than groups A (3.8) or B (3.7) (P = .05) in response to the question “my grades suffered in my classes.” Delay in surgery was negatively correlated with IKDC, Lysholm, and Kujala questionnaire scores (P < .05).Conclusion: In school-aged athletes with ligamentous knee injuries receiving operative treatment, surgery on a school day causes more academic difficulties than surgery during a holiday or summer break. Academic benefits of delaying surgery during the school year must be weighed against potentially worse outcomes encountered with prolonged surgical delay.
Journal of Pediatric Orthopaedics, 2005
The ongoing controversy regarding the appropriate treatment of clubfoot has resulted in much vari... more The ongoing controversy regarding the appropriate treatment of clubfoot has resulted in much variability in practice patterns, making the assessment of long-term outcomes a difficult one. Recently, new patient-based measures of outcomes have allowed for improved methods of assessing health outcomes in children. The purpose of this study was to follow up on a cohort of adolescents who underwent surgical repair at the authors&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;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; institution. Traditional (radiographs) and patient-based measures were obtained from 24 patients. The Child Health Questionnaire showed that the quality of life of these patients was relatively high after surgery, and these scores were comparable to those of age-matched young athletes with healthy feet. The disease-specific instrument, which was also administered, showed similar results. The role of radiographic measures was limited, as they did not reflect patient-based outcomes after clubfoot surgery. Both generic and disease-specific measures should be used as primary endpoints in evaluating treatment results in this area.
Journal of Shoulder and Elbow Surgery, 2007
The setting was inpatient secondary care. The economic study was carried out in the USA. Dates to... more The setting was inpatient secondary care. The economic study was carried out in the USA. Dates to which data relate The dates over which patients were recruited into the study were not reported. The price year was not reported. Link between effectiveness and cost data The costing was undertaken prospectively on the same patient sample that provided the effectiveness data. Study sample No sample size would appear to have been determined in the planning phase of the study in order to assure a certain power. The authors enrolled eligible patients undergoing surgical repair by the principal investigator. They did not report how many patients were excluded from the study or how many eligible patients refused to participate. A total of 87 patients (54% male) were enrolled into the study. Study design The study was a within-group comparison that was undertaken in a single centre. The principal investigator of the study performed all surgical operations. The patients were followed up for 1 year. The authors did not report if there was any loss to follow-up.
Journal of Pediatric Orthopaedics B, 2006
The primary goal of surgical equalization of lower extremity limb length discrepancy is to enhanc... more The primary goal of surgical equalization of lower extremity limb length discrepancy is to enhance the quality of life of patients by improving their function, gait, appearance, and pain secondary to compensation for the limb length discrepancy. While many surgeons use a cutoff point of 2 cm as an indication for intervention, little attention has been given to the effect of limb length discrepancy on quality of life. Therefore, the purpose of this study was to determine the relationship between limb length discrepancy and health-related quality of life and to assess whether the commonly accepted 2 cm cutoff serves to predict patients with and without quality of life perturbations. The Child Health Questionnaire was used to collect information from the parents of 76 children diagnosed with limb length discrepancy, and these data were compared with data from scanograms. Differences in quality of life became more apparent with increasing limb length discrepancy, especially among psychosocial health domains. As expected, patients with a limb length discrepancy of 2 cm or below generally fared better than patients with larger discrepancies, but no discrete cutoff could be identified within this group.
Journal of Pediatric Orthopaedics, 2005
The ongoing controversy regarding the appropriate treatment of clubfoot has resulted in much vari... more The ongoing controversy regarding the appropriate treatment of clubfoot has resulted in much variability in practice patterns, making the assessment of long-term outcomes a difficult one. Recently, new patient-based measures of outcomes have allowed for improved methods of assessing health outcomes in children. The purpose of this study was to follow up on a cohort of adolescents who underwent surgical repair at the authors&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;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; institution. Traditional (radiographs) and patient-based measures were obtained from 24 patients. The Child Health Questionnaire showed that the quality of life of these patients was relatively high after surgery, and these scores were comparable to those of age-matched young athletes with healthy feet. The disease-specific instrument, which was also administered, showed similar results. The role of radiographic measures was limited, as they did not reflect patient-based outcomes after clubfoot surgery. Both generic and disease-specific measures should be used as primary endpoints in evaluating treatment results in this area.
Journal of Pediatric Orthopaedics, 2005
While volume/outcomes relationships have been shown for several areas of orthopaedics, previous s... more While volume/outcomes relationships have been shown for several areas of orthopaedics, previous studies have not examined this relationship in the area of scoliosis surgery. The Office of Statewide Planning and Development (OSHPD) California inpatient discharge database was used for a retrospective review of all patients 25 years of age or younger with a diagnosis of scoliosis and a spinal fusion procedure from 1995 to 1999 (n = 3,606). Univariate and multivariate analyses were conducted to determine the effect of various factors on in-hospital mortality, surgical complications, reoperations, and length of stay (LOS). Univariate analyses revealed significant effects of age, sex, illness severity, neuromuscular disease, surgical approach, Medicaid status, and annual hospital volume on outcomes (P &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;lt; 0.05). After controlling for these factors using multivariate regression, patients insured by Medicaid were found to have a significantly greater odds for complications (P = 0.017) and a significantly increased LOS (P &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;lt; 0.001) compared with patients with all other sources of payment. Additionally, multivariate regression revealed an inverse relationship between annual hospital volume and likelihood of reoperation, as patients treated at hospitals with annual volumes of 5.1 to 25.0, 25.1 to 50.0, and greater than 50.0 spinal fusions all had approximately half the odds of reoperation (P = 0.042, P = 0.004, and P = 0.028 respectively) as patients treated at hospitals with an annual volume of 5.0 or fewer spinal fusions per year. The current data suggest that being insured with Medicaid in the state of California is associated with poorer outcomes after scoliosis surgery. Additionally, this study documents a volume/outcomes relationship in scoliosis surgery.
Journal of Pediatric Orthopaedics, 2005
While volume/outcomes relationships have been shown for several areas of orthopaedics, previous s... more While volume/outcomes relationships have been shown for several areas of orthopaedics, previous studies have not examined this relationship in the area of scoliosis surgery. The Office of Statewide Planning and Development (OSHPD) California inpatient discharge database was used for a retrospective review of all patients 25 years of age or younger with a diagnosis of scoliosis and a spinal fusion procedure from 1995 to 1999 (n = 3,606). Univariate and multivariate analyses were conducted to determine the effect of various factors on in-hospital mortality, surgical complications, reoperations, and length of stay (LOS). Univariate analyses revealed significant effects of age, sex, illness severity, neuromuscular disease, surgical approach, Medicaid status, and annual hospital volume on outcomes (P &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;lt; 0.05). After controlling for these factors using multivariate regression, patients insured by Medicaid were found to have a significantly greater odds for complications (P = 0.017) and a significantly increased LOS (P &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;lt; 0.001) compared with patients with all other sources of payment. Additionally, multivariate regression revealed an inverse relationship between annual hospital volume and likelihood of reoperation, as patients treated at hospitals with annual volumes of 5.1 to 25.0, 25.1 to 50.0, and greater than 50.0 spinal fusions all had approximately half the odds of reoperation (P = 0.042, P = 0.004, and P = 0.028 respectively) as patients treated at hospitals with an annual volume of 5.0 or fewer spinal fusions per year. The current data suggest that being insured with Medicaid in the state of California is associated with poorer outcomes after scoliosis surgery. Additionally, this study documents a volume/outcomes relationship in scoliosis surgery.
The American Journal of Sports Medicine, 2009
Background Orthopaedic injuries negatively affect the academic lives of children. Hypothesis The ... more Background Orthopaedic injuries negatively affect the academic lives of children. Hypothesis The timing of anterior cruciate ligament (ACL) and medial patellofemoral ligament (MPFL) reconstructions affects academic performance in school-aged athletes. Study Design Cohort study; Level of evidence, 2. Methods Records of patients ≤18 years old who underwent ACL or MPFL reconstructions from 2001-2007 were reviewed retrospectively. Subjects had been administered a unique questionnaire to evaluate school life in the immediate postoperative period as well as International Knee Documentation Committee (IDKC), Lysholm, and Kujala knee-specific questionnaires. Patients were in 1 of 3 study cohorts: group A (surgery during school year), group B (surgery during school holiday), and group C (surgery during summer break). Results There were 62 subjects (53 ACL and 12 MPFL reconstructions). A higher proportion of patients in group A required being driven to school (88.5%) than groups B (63.6%) or ...
Journal of Pediatric Orthopaedics, 2006
This study is a pilot effort towards the broader implementation of a national pediatric musculosk... more This study is a pilot effort towards the broader implementation of a national pediatric musculoskeletal trauma outcomes registry. The primary goal of this project is to explore the feasibility of a web-based data acquisition and management platform and to identify catalysts and obstacles to multi-center collaboration. A prospective cohort of children presenting to the Pediatric Emergency Departments with ankle, femur, supracondylar humerus, tibial spine, or open fractures at five clinical centers between October 2001 and March 2003 comprised the study population. Patients were enrolled via the treating orthopaedic resident, using a web-based data acquisition and management system. Orthopaedic attendees were sent an automated reminder to complete a follow-up form one week after treatment, and parents of enrolled children were sent child and parent health questionnaires by e-mail and mail in order to capture health-related quality of life and post-traumatic stress symptoms. A total of 299 patients were enrolled in the study with an average age of 7.3 years. Post-treatment follow-up questionnaires were completed by 39% of the attending orthopaedic surgeons, and by 43% of the enrolled patients or patient&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;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;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 parents. Children old enough to complete health questionnaires scored lower in 5 of 12 functional domains including Physical Function, Role/Social Emotional/Behavioral, Parental Impact-Emotional, Family Activities, and Family Cohesion. Within the subset of patients sustaining femur fractures whose parents completed health questionnaires, 9.5% reported significant post-traumatic stress symptoms. This study demonstrates the potential of a multi-center web-based registry to facilitate the collection of a rich array of pediatric trauma, treatment and patient-based outcomes data, although new regulatory issues regarding patient privacy pose challenges to such an approach.
Journal of Pediatric Orthopaedics, 2005