Duncan B Ackerman

Mayo Clinic - Rochester, Рочестер, Minnesota, United States

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Publications (8)13.35 Total impact

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    ABSTRACT: Retrospective review. To determine outcomes after anterior or posterior placement of vascularized-free fibular grafts in complex spinal reconstruction for tumor resection and osteomyelitis and to evaluate the results with respect to bony fusion, time to union, and complications. Biological reconstruction of segmental defects of the spinal column may be required when multiple vertebrae are resected for tumor or infection. Published series to date have not fully addressed surgical techniques or outcome and complications. A retrospective, Institutional Review Board-approved review was performed on the medical records and neuroimaging of all patients who underwent a vascularized-free fibular graft for a multisegmental spine reconstruction at a single institution over the last 10 years. Details regarding indications, the levels spanned, the graft length, and the time to union were evaluated. Seven patients (mean age, 43 y) underwent surgery using this technique, with an average follow-up of 38 months. Surgical indications included oncologic resection associated with radiation therapy (n=3) and surgical treatment of vertebral osteomyelitis (n=4). An average of 2.7 (median, 2) levels was fused with an average of 2.1 (median, 2) vertebral body excisions performed. Mean fibular length was 19.1 cm. Six of 7 patients achieved union at mean of 3.2 months. Complications specific to the fibular grafting procedure included 1 nonunion associated with pedicle thrombosis. Vascularized-free fibular grafts are effective in the treatment of complex spinal reconstruction after surgery for spinal tumors or osteomyelitis. The vascularized-free fibular graft adds structural support as well as living bone to the fusion site and is a reasonable alternative to nonvascularized grafts in locally compromised surgical beds.
    Journal of spinal disorders & techniques 05/2011; 24(3):170-6. DOI:10.1097/BSD.0b013e3181e666d0 · 1.89 Impact Factor
  • David B Jones · Duncan B Ackerman · Douglas M Sammer · Marco Rizzo
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    ABSTRACT: To review the rate of fusion, complications, and subjective outcome measures of proximal interphalangeal joint arthrodesis after failed implant arthroplasty. We conducted a retrospective review identifying patients from 1990 to 2009 who underwent proximal interphalangeal joint arthrodesis for implant arthroplasty failure. All types of implants were included. We reviewed clinical notes and radiographs identifying patient history, implant type, revisions before arthrodesis, method of arthrodesis, rate of union, time to union, and complications. We used the Michigan Hand Outcomes Questionnaire to assess patients' function and perceived clinical outcome. A total of 13 joints in 8 patients (6 female, 2 male) identified with an average clinical follow-up of 6.5 years (range, 1.0-12.3 y) were available for study. The average time from joint replacement to salvage for all implant types was 9.3 years (range, 1.6-32.2 y). Eight of the 13 fingers achieved union. The average time to union was 5.8 months (range, 1-11 mo). Eight of 13 fingers underwent removal of K-wires, tension band, or both. Excluding hardware-related problems, there were 4 additional complications in 4 patients. Salvage of failed proximal interphalangeal joint arthroplasty remains a challenging clinical problem. Although achieving solid fusion with arthrodesis is not completely reliable or without complication, patients' subjective and functional outcomes demonstrate fair to good results. Therapeutic IV.
    The Journal of hand surgery 02/2011; 36(2):259-64. DOI:10.1016/j.jhsa.2010.10.030 · 1.66 Impact Factor
  • M Rizzo · D B Ackerman · R L Rodrigues · R D Beckenbaugh
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    ABSTRACT: Salvage of failed total wrist arthroplasty by arthrodesis may be difficult because of bone loss and poor quality of bone and soft tissues. We examined the outcomes of wrist arthrodesis for failed total wrist arthroplasty in a retrospective study of 21 wrists in 17 patients. Clinical data, radiographs, patient-reported outcomes and DASH questionnaires were used. Thirteen women and four men had undergone total wrist arthroplasty at an average age of 55 years. The mode of failure was aseptic loosening in 13 wrists. The average time from the index arthroplasty to wrist arthrodesis was 7.6 years. Autograft and/or allograft bone graft was used in all of the wrists. Arthrodesis was achieved in 11 wrists and ten had a nonunion. Six arthrodeses underwent eight revisions for nonunion, with two achieving union. The mean DASH score was 29 in wrists that fused and 36 in those that did not fuse. Pain scores averaged 2.1 in the wrists that fused and 3.3 in the nonunion group. Most patients had clinical improvement.
    01/2011; 36(1):29-33. DOI:10.1177/1753193410376283
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    ABSTRACT: We are not aware of any data looking specifically at inpatient falls in an orthopedic ward. We reviewed all postoperative orthopedic patients who fell during 2003 and 2005 on a single postoperative orthopedic unit. Seventy patients (1%) fell, resulting in 2.5 falls per 1000 musculoskeletal inpatient days. Most (n = 45, 64%) were bathroom related, were unassisted (n = 54, 77%), and occurred during the evening or night shift (n = 46, 66%). Thirteen (19%) patients acquired an injury as a consequence. Female sex (odds ratio [OR] = 1.9), patient age greater than 65 years (OR = 1.7), prolonged admission (OR = 1.7), and admission for primary or revision knee arthroplasty (OR = 5.0) were all significant risk factors for a postoperative inpatient fall. This information has provided us with some insight to direct the development of a fall prevention program specific to postoperative orthopedic patients.
    The Journal of arthroplasty 11/2009; 25(1):10-4. DOI:10.1016/j.arth.2008.09.025 · 2.37 Impact Factor
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    ABSTRACT: This retrospective analysis examines the outcome of total joint arthroplasty for severe arthritis in patients with synovial chondromatosis. All 11 patients treated with total hip arthroplasty (n = 7) or total knee arthroplasty (n = 4) returned for follow-up at a mean of 10.8 years after surgery. Pain and functional scores improved significantly in all patients. Knee range of motion improved in all patients. Synovial chondromatosis recurred in 1 knee (25%) and 1 hip (14%). Total joint arthroplasty is a valuable treatment option for these patients with predictable improvement in pain and function. Knee range of motion is likely to improve but may be less than expected for primary total knee arthroplasty. Patients remain at risk for recurrence.
    The Journal of Arthroplasty 05/2008; 23(3):395-400. DOI:10.1016/j.arth.2007.06.014 · 2.37 Impact Factor
  • Duncan B Ackerman · Robert T Trousdale
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    ABSTRACT: Current methods of trochanteric sliding osteotomy typically preserve the lateral aspect of the greater trochanter, the vastus lateralis, the abductors, posterior capsule, and the external rotators. Our modification to this technique includes leaving an anterior vertical ridge of bone that resists the anterior-directed forces acting on the osteotomy. Furthermore, a chevron-shaped osteotomy provides some additional stabilization to the proximally directed pull of the abductors. We believe these modifications improve the intrinsic stability of the osteotomy, theoretically decreasing the rate of nonunion.
    The Journal of Arthroplasty 05/2008; 23(3):459-61. DOI:10.1016/j.arth.2007.10.006 · 2.37 Impact Factor
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    ABSTRACT: Synovial chondromatosis (SC) is a benign condition where the synovial lining of joints, bursae, or tendon sheaths undergoes metaplasia and ultimately forms cartilaginous loose bodies. Synovial chondromatosis of the foot and ankle is exceedingly rare, and outcomes following surgical excision are largely unknown. An Institutional Review Board-approved retrospective review of our institution's surgical database from 1970 to 2006 revealed 8 patients with SC of the foot and/or ankle confirmed by pathology. Eight patients (4 female and 4 male) presented with pain, locking, or stiffness. Average age at presentation was 37 (range, 19 to 60) years. Average followup was 9.5 (range, 1 to 31) years. Six patients had involvement of the ankle, and two, the midfoot. Four patients underwent ankle synovectomy with loose body removal, and were pain-free at last followup. One patient underwent excision and midfoot arthrodesis for severe midfoot destruction. Three patients ultimately underwent below knee amputation, one for multiple recurrences and two for malignant transformation to low-grade chondrosarcoma. To our knowledge, this is the largest reported series of patients with SC of the foot and ankle. In half the patients, synovectomy with excision of loose bodies resulted in pain free return to normal function, without recurrence, at last followup. However, recurrence occurred in 3 (37.5%) of 8 patients with subsequent malignant transformation to low-grade chondrosarcoma occurring in 2 patients.
    Foot & Ankle International 04/2008; 29(3):312-7. DOI:10.3113/FAI.2008.0312 · 1.63 Impact Factor
  • Corey A Wulf · Duncan B Ackerman · Marco Rizzo
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    ABSTRACT: Distal radius fractures are among the most common fractures encountered by orthopedic surgeons. Because of many fracture patterns and types, it has been difficult to develop a comprehensive classification. Treatment options vary depending on injury severity and stability of the fracture reduction. Closed reduction and immobilization can be used for stable fractures. Common surgeries include pinning with and without external fixation and open reduction and internal fixation. Technological advances such as locking and fixed angle plates have made the volar approach feasible. Dorsal plating with low profile plates and fragment-specific techniques can be successful in treating distal radius fractures. Following fracture reduction and stabilization, assessment of distal radioulnar joint stability is essential and must be stabilized when necessary.
    Hand Clinics 06/2007; 23(2):209-26, vi. DOI:10.1016/j.hcl.2007.03.003 · 1.07 Impact Factor