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Publications (188)
Purpose
This is the second phase in an investigation of the psychosocial impact of orthopedic surgery on adolescents. What are the core psychosocial factors that shape the experience of adolescent patients aged 11–18 who are undergoing orthopedic surgery?
Methods
Two 43-question surveys (preoperative and postoperative) were developed as modified v...
Introduction
Traditionally, stiff hypertrophic nonunions have been managed with open preparation of the nonunion site, which is then secured with internal fixation. Alternative surgical options are available including distraction osteogenesis with an external fixator. There is currently a limited amount of literature pertaining to the use of distra...
Circular external fixators often use fine transfixion wires as part of the construct. When a wire needs to be placed obliquely, standard methods of attaching the wire to the ring can cause tension in the surrounding soft tissues and the underlying bone. One method to avoid this issue is to use a long wire fixation bolt with conical washers above an...
Introduction
While traditionally a treatment for congenital deformities, limb-lengthening surgery has recently been utilized as a cosmetic solution for patients with less-than-desirable heights. Despite a growing rise in popularity, stature-lengthening surgery carries a host of social stigmas and ethical concerns. With the emergence of natural lang...
The motorized internal lengthening nail (MILN) has revolutionized the ability to perform distraction osteogenesis without the use of circular external fixation. Lengthening of the tibia bone can be accomplished with great success using an MILN. Contraindications for the MILN in the tibia have traditionally been a small intramedullary canal and open...
Iatrogenic deformities are those limb deformities that have occurred as a result of medical management. They can occur after fracture care or may result from growth plate disturbances. Angular deviations and soft tissue contractures can arise from limb-lengthening surgery and are also considered iatrogenic. Over time, surgeons are accepting less de...
Objectives
To analyze our patient’s complication profile and rate after removal of hardware (ROH) surgery, and survey our patients to ask their overall status and improvement in symptomatology post-operatively.
Design
Retrospective chart review and survey.
Setting
Academic, tertiary referral center.
Patients/participants
173 patients with 314 pi...
OBJECTIVES
To report a case series of extra-articular osteotomies for the management of intra-articular tibial plateau malunions and to assess the ability to correct deformity and improve knee range of motion (ROM).
METHODS
Design
Retrospective case series
Setting
Academic, tertiary, referral center.
Patient Selection Criteria
Adult patients wi...
Introduction
The use of osseointegrated limb replacement prostheses for amputees are rapidly growing in popularity due to the many benefits over conventional sockets. Many institutions worldwide are beginning to provide this surgical option to their patients and are advertising the service online. The aim of this study was to assess the quality and...
Purpose
With advances in orthopedic implants, the use of intramedullary lengthening devices has gained increasing popularity as an alternative technique compared to lengthening with external fixators, with alleged comparable or better outcomes. The aim of this study is to report our single-center technique and outcomes of combined ankle arthrodesis...
Background
The lateral opening wedge distal femoral osteotomy (DFO) is an effective treatment for genu valgum to improve mechanical alignment, decrease lateral compartment loads, and decrease the risk of knee osteoarthritis. Multiple studies have utilized outcome scores assessing functional changes related to pain and joint stability, with a focus...
Introduction
Tibial deformities are common, but substantial concern may be associated with corrective osteotomy regarding major complications reported in classic literature. Such studies chiefly focused on high tibial osteotomy, with relatively little investigation of other areas and types of deformity. The primary aim of this study was to identify...
Background
Extra-articular lower-leg deformities mandate unique considerations when planning total knee arthroplasty (TKA). Poor limb alignment may increase perioperative complications and cause early implant failure. This study reports on the safety and efficacy of staged, extra-articular deformity correction about the knee in the setting of osteo...
Introduction
The purpose of this study was to determine how the Limb Deformity–Modified Scoliosis Research Society (LD-SRS) and Patient-Reported Outcomes Measurement Information System (PROMIS) questionnaire scores differ between patients with femoral version abnormalities and healthy control subjects.
Methods
A retrospective database review ident...
A judicious, well-planned bone and soft tissue debridement remains one of the cornerstones of state-of-the-art treatment of fracture-related infection (FRI). Meticulous surgical excision of all non-viable tissue can, however, lead to the creation of large soft tissue defects. The management of these defects is complex and numerous factors need to b...
Introduction:
Bone defects may be managed with bone transport or acute shortening and lengthening using circular external fixation devices. We performed a multicenter retrospective cohort study to compare the outcomes between the Ilizarov frames and hexapod frames for the management of bone defects.
Methods:
Patients treated for bone defects usi...
Background:
When lengthening the tibia segment using motorized internal lengthening nails (MILN), undesired distal migration of the proximal fibula segment is prevented by tibiofibular stabilization, traditionally using a screw. A tightened cortical suspensory fixation rope (tether) is an alternative option, but its appropriateness has never been...
Multiple treatments exist for ankle osteoarthritis. Ankle arthrodesis is the gold standard in late-stage osteoarthritis, but sacrifices range of motion and risks nonunion. Total ankle arthroplasty is typically reserved for low-demand patients as the long-term outcomes are poor. Ankle distraction arthroplasty is a joint sparing procedure which utili...
Background
Axial malalignment of the bilateral femurs and tibias, previously known as “miserable” malalignment, now renamed tetratorsional malalignment (TTM), presents with hip and/or knee pain refractory to nonoperative treatment.
Purpose
We sought to investigate whether bilateral rotational osteotomy of the femur and tibia leads to improvement i...
Background:
Fixator-assisted nailing techniques that incorporate magnetic internal lengthening nails (MILNs) permit acute deformity correction and then gradual limb lengthening without needing postoperative external fixators.
Purposes:
We sought to investigate the safety and accuracy of a fixator-assisted, blocking screw technique using retrogra...
Background
Percutaneous femoral derotational osteotomies are performed in both adult and pediatric patients. There is little published on the outcomes after femoral derotational osteotomy in pediatric patients.
Methods
A retrospective cohort study of pediatric patients treated with percutaneous femoral derotational osteotomy by one of two surgeons...
Critical-sized bone defects in the tibia can arise as sequelae of trauma, infection, tumor, or the treatment of congenital limb deficiencies. Treatment of these defects often requires bone transport, which has traditionally been accomplished using circular external fixators. The development of a bone transport nail facilitated tibia reconstruction...
Aims
The Precice Stryde® internal magnetic lengthening nail allowed many patients a full weight-bearing experience during femur and tibia lengthening, but concerns over corrosion, pain and radiographic changes led to the implant's recall. Despite the recall, it is important to understand the rate of these occurrences and their influence on the over...
Background
Osseointegration (OI) limb has been performed for over 30 years and is an example of an advance in technology and surgical technique which has led to improvements in patient mobility and quality of life. An increasing number of patients seek information about osseointegration. The aim of this study was to categorise the most frequently a...
Background
Opening wedge high tibial osteotomy (OWHTO) is a safe surgical procedure to treat medial compartmental osteoarthritis caused by a varus deformity. Over-correction of this varus deformity can lead to lateral compartment over-loading. In our study, we planned our correction by using the mechanical axis deviation (MAD).
Purpose
The purpose...
Purpose:
To (1) develop a deep-learning (DL) algorithm capable of producing limb-length and knee-alignment measurements, and (2) determine the association between limb-length discrepancy (LLD), coronal-plane alignment, osteoarthritis (OA) severity, and patient-reported knee pain.
Methods:
A multicenter, prospective patient cohort from the Osteoa...
Background:
Calcium sulfate (CS) is used extensively as an antibiotic carrier in the treatment of chronic osteomyelitis, largely due to its biodegradable nature. The aim of this systematic review and meta-analysis is to analyze the comprehensive performance of CS in the literature when compared to other biomaterials or treatments for osteomyelitis...
Purpose of Review
To review the topic of osseointegration amputation reconstruction, which inserts a transcutaneous metal implant into the remaining intramedullary bone of a person with an amputation to facilitate a direct bone-anchored connection to an external prosthesis, eliminating the molded socket interface.
Recent Findings
Evidence continue...
Rotational deformity of the lower limbs often presents alongside other chief complaints and are easily missed without careful examination and imaging assessment. Particularly patients with patellofemoral subluxation or dislocation necessitate further evaluation. Advanced imaging with CT or MRI is helpful to understand the magnitude of deformity and...
Background: The study was done (1) to report on our recent experience with antibiotic-loaded
calcium sulfate-coated interlocking intramedullary nails (CS-IMN) for
infection prevention or infection eradication and (2) to compare the efficacy of
CS-IMN versus antibiotic-loaded polymethylmethacrylate-coated IMN (PMMA-IMN)
for infection eradication.
Me...
For patients with primary or recurrent malignancy leading to a transfemoral amputation, the prospect of normal ambulation with a socket prosthesis is unpredictable, particularly when the residual limb is short. Excessive energy expenditure, sweating, pinching, skin breakdown, and poor fit all lead to lack of prosthetic use and diminished quality of...
Ankle distraction arthroplasty (ADA) is a procedure based on the concept that mechanical unloading of an arthritic joint will initiate a healing response in the subchondral bone and articular cartilage. ADA utilizes the patient's own healing response, preserves joint motion, and is a great option for patients with osteoarthritis who are not ready f...
Introduction:
The purpose of this study was to determine how Limb Deformity Modified Scoliosis Research Society (LD-SRS) scores differ between patients with different types and degrees of limb deformity compared with control subjects.
Methods:
Patients who were >17 years and scheduled for reconstructive surgery for limb lengthening or angular de...
Hexapod frames have proven to be essential in
the management of complex acute fracture and
nonunion management. They allow the orthopaedic
reconstructive community to manage the
most complex of conditions including open fractures,
infected nonunions and soft-tissue deficiency
which may be managed now with
intentional deformity through manipulation...
The technique of circular external fixation has been widely applied to treat an array of orthopaedic pathologies, including acute fractures and fracture nonunions. The evolution of this technology has led to many exciting new applications and designs: the hexapod—a highly sophisticated frame with six adjustable struts attached to rings that relies...
IntroductionMagnetic internal lengthening nails (MILNs) have been used for femoral lengthening to avoid complications associated with external fixation. The titanium version of the MILN (PRECICE®) has been in use since 2011 but had limitations (50–75 lb) in post-operative weight bearing. A new stainless-steel version of the MILN (STRYDE®) allows 15...
Introduction:
Russell-Silver syndrome (RSS) is a unique cause of syndromic, and often severe, limb length discrepancy (LLD). RSS causes growth retardation both in utero and postnatally, with asymmetry in limb length more noticeable as growth progresses throughout childhood and adolescent. We aim to present the largest cohort in the literature on l...
Background:
Ankle distraction arthroplasty has emerged as an alternative treatment for ankle arthritis. There are few reports on the magnetic resonance imaging (MRI) findings after distraction arthroplasty. This study sought to determine whether there are positive changes on MRI after ankle distraction and improvements on X-ray. Additionally, pati...
Aim and objective:
Tibial lengthening can be performed by distraction osteogenesis via lengthening and then nailing (LATN) or by using a magnetic lengthening nail (MLN). MLN avoids the complications of external fixation while providing accurate and easily controlled lengthening. Concerns exist still regarding the high upfront cost of the magnetic...
Background:
High tibial osteotomy (HTO) is a well-known procedure for the correction of knee varus. The purpose of this study was to compare the radiological results and accuracy of deformity correction performed using two different techniques: acute opening wedge correction using a plate and gradual correction with a monolateral external fixator....
Purpose
Addressing the psychosocial needs of adolescents can improve surgical outcomes. The aim of this retrospective comparative study was to understand the core psychosocial factors that shaped the experiences of adolescents who underwent multiple limb lengthening/reconstruction surgeries (LLRS).
Methods
A novel 62-question survey was developed...
Benign bone tumors and tumor-like lesions are frequently diagnosed in children and adolescents. The immature skeleton is at risk for growth disturbances and deformity because of the effects of the lesions on normal bone architecture and the physis. The development, manifestation, and severity of the limb length inequality and deformity differs betw...
Introduction: Magnetic internal lengthening nails (MILNs) have been used for humeral lengthening to avoid complications
associated with external fixation. Purpose/Questions: We compared the 1-year Disabilities of the Arm, Shoulder and Hand
(DASH) score, adjacent joint range of motion (ROM), bone healing index (BHI), length achieved, distraction rat...
Background
The field of limb lengthening has undergone substantial advancement in recent years with respect to the subjective patient experience, the rate of surgical complications, and the time required to achieve regenerate consolidation. We aimed to assess the performance of motorized internal limb lengthening (MILL) devices when compared with a...
The challenging problem of long bone infection and limb length difference cannot be addressed using only an antibiotic-coated nonmagnetic static nail. The combined use of resorbable calcium sulfate and magnetic lengthening nails offers a possible solution to this dilemma, as well as for infected nonunions that require compression. We present a comb...
Background:
Patients presenting with end-stage ankle osteoarthritis (OA) in the setting of a concomitant extra-articular limb deformity pose a challenging problem that has not yet been described in the literature. We describe a case series of patients treated with external and internal fixation techniques followed by total ankle arthroplasty (TAA)...
Objectives:
(1) Evaluate intentional temporary limb deformation for closure of soft-tissue defects as a reconstruction strategy in open tibia fractures and (2) analyze the deformity parameters required for such reconstruction.
Design:
Multicenter retrospective cohort.
Setting:
Level I trauma center.
Patients/participants:
Nineteen patients 1...
Translational deformities are common complications of conservatively managed bone fractures and some surgically managed fractures with unstable patterns. Realigning the bones can be difficult when soft tissue, scars and calluses form. These deformities can be easily corrected with hexapodalic-based external fixators, but these fixators are not wide...
Emerging technologies have been implicated in the steady rise in healthcare expenditures. Although expensive, new technology has allowed for the treatment of very severe deformities within the field of limb lengthening and reconstruction. Beginning as early as the Ilizarov method of distraction osteogenesis, many of the treatments have resulted in...
Integrated methods of limb lengthening are superior to classic methods. We suggest the integration of plates and nails with circular frames to improve outcomes in patients undergoing limb lengthening procedures.
Background
Leg-length discrepancy (LLD) after primary THA is not uncommon. Little is known, however, about the role of hip-sparing procedures for equalization of LLD after THA.Questions/PurposesThe aim of this study is to report our experiences with these techniques in patients presenting at one institution over a 10-year period.Methods
We retrospe...
Introduction:
Integrated limb lengthening combines both internal and external fixation methods. It has been introduced to improve time to union, patient time in frame, risk of regenerate refracture, and patient function. We systematically review studies to assess whether integrated limb lengthening methods are superior to classic limb lengthening...
Background: To report on our experience with antibiotic cement coated interlocking intramedullary nails (ACC-IMNs) for limb salvage in septic complex lower extremity reconstruction with a minimum of 2-year follow up. Methods: We retrospectively reviewed the records of all consecutive patients who underwent a limb salvage procedure with ACC-IMNs. We...
Preoperative planning is important for accurate intraoperative execution in many surgical fields. Planning for distal femoral osteotomies (DFOs) and proximal tibial osteotomies (PTOs) consists of choosing the level of the osteotomy, measuring the angle of the osteotomy based on hip-knee-ankle alignment, and choosing a proper osteotomy wedge size. M...
Background
Treatment for post-traumatic osteoarthritis (PTOA) of the ankle remains challenging. Distraction arthroplasty (DA) is an alternative for patients who are averse to or poor candidates for arthrodesis or joint replacement. The purpose of this study was to examine the role of microfracture (MFX) and concentrated bone marrow aspirate (CBMA)...
In an effort to fight the opioid epidemic, an NSAID pain protocol was created for osteotomy patients. The study asked if NSAIDs negatively affect bone healing or reduce the need for opioids.
Methods:
This was a retrospective review of 155 limbs that underwent osteotomy of a long bone with fixation. Patients received an NSAID-free protocol or an N...
The outcomes of motorized intramedullary lengthening nails are overwhelmingly good with acceptable complication rates and high surgeon satisfaction. While patients report overwhelming approval to surgeons, universal orthopedic outcomes scores fail to capture the true benefits of these procedures. Many studies have been cited in table format in this...
Post-traumatic osteoarthritis (PTOA) is a complex and painful problem in the foot and ankle. Ninety percent of osteoarthritis cases in the foot and ankle can be classified as post-traumatic. PTOA can affect any of the 33 joints in the foot and the ankle. Distraction arthroplasty is a method for treatment of early arthritic joints without fusing or...
External fixators have reinvented the art of deformity correction by incorporating the 4D technology of gradual correction over time into the operative strategy. Computer navigation through the use of hexapod technology has further advanced the surgeon’s ability to realign malunited fractures and nonunions safely and reproducibly. Frame stability i...
Once unpredictable, internal lengthening nails have evolved into sophisticated magnetically actuated implants that can distract or compress long bones with optimal force and high precision. These devices have fundamentally changed the field of limb lengthening and complex limb reconstruction making the entire patient experience simpler and less pai...
Introduction:
Isolated subtalar osteoarthritis (OA) is a debilitating condition usually occurring after trauma and particularly in the setting of an intraarticular calcaneal fracture. Currently, subtalar (talo-calcaneal joint) fusion surgery is the treatment of choice in managing subtalar OA after failure of conservative treatment. Unfortunately,...
Introduction: To confirm the success of our limb salvage treatment protocol and determine what factors are predictive of success versus failure in limb salvage techniques for patients with chronic osteomyelitis of the tibia and ankle. Methods: Retrospective case series analyzing factors and outcomes in patients who underwent limb salvage techniques...
Introduction
The magnetic intramedullary (IM) compression nail is capable of providing sustained compression for the treatment of nonunions of long bones. This ability was previously only possible with the use of external fixation. We asked the following questions: How effective is the IM compression nail at achieving union? How do we know when ade...
Extra-articular deformities of the femur and tibia in conjunction with advanced knee osteoarthritis pose unique challenges for the arthroplasty surgeon. Careful preoperative planning is needed to evaluate both the intra- and extra-articular deformities and to determine the best route to total knee arthroplasty. An intra-articular compensatory corre...
Fracture-related infection (FRI) remains a challenging complication that imposes a heavy burden on orthopaedic trauma patients. The surgical management eradicates the local infectious focus and if necessary facilitates bone healing. Treatment success is associated with debridement of all dead and poorly vascularized tissue. However, debridement is...
Introduction: Forearm deformity affects patients with Multiple Hereditary Exostosis (MHE), Ollier's disease, and other various congenital deformities as well as those with physeal growth arrest secondary to trauma. Acute correction of such deformities is complicated by risk of neurovascular compromise and as such, techniques that allow for gradual...
Introduction:
Historically, blocking screws have been used to assist in acute reduction of fractures during intramedullary (IM) nailing. The reverse-rule-of-thumbs (RROT) for blocking screws was introduced to facilitate internal lengthening nail use in deformity correction and limb lengthening. Our study investigated the ability of blocking screws...
Aim:
The treatment algorithm for end-stage ankle arthritis is imperfect. Young or active patients are challenging to treat as fusion and replacement carry predictable consequences. Ankle distraction arthroplasty is a less commonly utilized surgical procedure for the treatment of osteoarthritis of the ankle. The purpose of this study was to report...