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The Journal of hand surgery 2014 Dec
Authors:
Jiang JJ, Phillips CS, Levitz SP, Benson LS
Abstract
A national surgical database was used to determine risk factors for complications in patients undergoing open reduction internal fixation (ORIF) for distal radius fractures.
The American College of Surgeons National Surgical Quality Improvement Program database for the 2006-2012 years was queried to identify all patients who underwent an ORIF of a distal radius fracture based on Current Procedural Terminology codes 25607, 25608, or 25609. The database is a statistically representative sample of prospectively collected perioperative surgical data from hospitals primarily in the United States. Demographics, comorbidities, preoperative laboratory values, and 30-day complications were compared between the patient groups with and without a postoperative complication. Multivariate analysis was performed to identify patient characteristics and comorbidities that were independently associated with early postoperative complications.
This retrospective analysis identified 3,003 patients who underwent an ORIF of the distal radius over 7 years. The number of patients with a complication within 30 days after surgery was 62 (2%), totaling 90 complications. Incidence of return to the operative room for the entire study population was 1.1%. Multivariate analysis, adjusting for confounding variables, showed that patients with a complication were more likely to have hypertension, congestive heart failure, preoperative chemotherapy or radiotherapy, longer operating time, and manifest preoperative impairment in independent living.
Approximately 2% of patients sustained a complication within 30 days following ORIF of a distal radius fracture. Recognition of the risk factors may help avoid complications in the identified high-risk patients.
Prognostic II.
PMID:
25447002
[PubMed - as supplied by publisher]
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American journal of orthopedics (Belle Mead, N.J.) 2013 Jun
Authors:
Hsu PA, Hsu AR, Sutter EG, Levitz SP, Rose DM, Segalman KA, Lee SK
Abstract
We sought to determine the effect anterior versus posterior in situ decompression with 360° external neurolysis on ulnar nerve subluxation. Ten cadaveric specimens were used, with anterior release performed on 5 specimens and posterior release the other 5 specimens. Each specimen was released for 4 cm centered over the cubital tunnel followed by 12 cm, 20 cm, and 20 cm with 360° external neurolysis. After release, the elbow was brought through a range of motion from 0° to 140° of flexion. Compared with posterior release, anterior release demonstrated significantly more total subluxation of the ulnar nerve for all release types from 80° to 120° of flexion (P<.05). At 140° of flexion, the 4-cm release, the 12-cm release, and the 20-cm release with 360° external neurolysis also demonstrated significantly more total subluxation with anterior release (P<.05). Ulnar nerve subluxation was significantly lower with posterior release, compared with anterior release for limited and complete in situ decompression.
PMID:
23805419
[PubMed - as supplied by publisher]
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Clinical orthopaedics and related research 2007 Nov
Authors:
Specht LM, Levitz S, Iorio R, Healy WL, Tilzey JF
Abstract
Accurate preoperative templating can facilitate precise, efficient, and reproducible total knee arthroplasty. We determined whether acetate templating accurately predicted knee implants used and compared the accuracy of digital templating. Preoperative planning was performed on 50 consecutive preoperative radiographs during 2005. After digital images were obtained, appropriately magnified analog films were printed. Four arthroplasty surgeons and one resident performed acetate templating and one arthroplasty surgeon trained in the technique performed digital templating. Acetate and digital templating accurately predicted the size of the implanted component to within one size, 91% versus 93%, respectively. The digital technique was more accurate than acetate for tibial component size. Acetate and digital templating did not differ in predicting femoral component size. Our data suggest digital templating is at least as accurate as traditional acetate templating for predicting knee implant sizing.
Level II, diagnostic study. See the Guidelines for Authors for a complete description of levels of evidence.
PMID:
18062050
[PubMed - as supplied by publisher]
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The Journal of hand surgery 2005 Jul
Authors:
Ring D, Patterson JD, Levitz S, Wang C, Jupiter JB
Abstract
The influence of angular deformity of the scaphoid on wrist function and arthrosis is debated and the reliability of the described quantitative measurements of deformity has been questioned. We hypothesized that the inherent imprecision with which computed tomography scanning planes are selected introduces another source of variability in measurements of scaphoid deformity, further diminishing their reliability.
Sagittal plane images of 15 computed tomograms of normal scaphoids were evaluated in 3 different reconstruction planes. Four observers measured the lateral intrascaphoid angle, the dorsal cortical angle, and the height-to-length ratio of the 45 images in random order and then measured them again in a distinct random order 2 weeks later. The variability of each observer's measurements (intraobserver reliability) was evaluated with Pearson correlation coefficients. The agreement of the measurements made by the 4 observers (interobserver reliability) and the agreement of the measurements of the same bone in different reconstruction planes (interplane reliability) were evaluated using interclass correlation coefficients.
The intraobserver reliability was poor for 27 of 36 comparisons. The interobserver reliability of the dorsal cortical angle and the intrascaphoid angle was poor for all reconstruction planes. The interobserver reliability of the height-to-length ratio was good for 2 planes and poor for the third plane. The interplane reliability was poor for 7 of 12 comparisons, with no single measurement technique remaining consistent for all observers across reconstruction planes.
Quantitative measurements of scaphoid deformity have very limited reliability for individual observers, between different observers, and depending on the plane in which the image of the scaphoid is produced. Even the most reliable measure of deformity (height-to-length ratio) was not consistent between reconstruction planes. Unless more reliable scanning and measurement techniques are developed ideas about the effect of scaphoid deformity on wrist function will remain to a large degree speculative.
PMID:
16039360
[PubMed - as supplied by publisher]
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The Journal of hand surgery 2005 May
Authors:
Levitz S, Ring D
Abstract
The benefit of placing the screw tip in the center of the proximal pole of the scaphoid is supported by clinical and biomechanical data. In this investigation we attempted to quantify guidelines for optimal screw insertion into the scaphoid through a volar percutaneous approach using measurements from computed tomography images.
The parameters of safe insertion of a 3.0-mm cannulated-headed screw (Synthes, Paoli, PA) using a volar (retrograde) insertion technique were measured using quantitative computer analysis of computed tomography images of 15 unfractured scaphoids. In the coronal plane the average screw length for the most radial, most ulnar, and intermediate paths for safe screw insertion and the radial clearance of the trapezium were measured. In the sagittal planes defined by these screw paths the length of the screw, the length and depth of the concavity on the volar surface of the scaphoid, and the distance between a line corresponding to the center of the screw path and the volar surface of the trapezium were measured.
Significant differences (1-way analysis of variance) were measured for the average screw lengths for different screw insertion paths in both the coronal and sagittal planes (with the shortest screw lengths observed for the most ulnar starting points) and for the volar clearance of the trapezium, which was greater for a radial screw path. The intermediate screw path-a measure of optimal screw insertion-passed radial to the radial edge of the trapezium in 10 of 15 patients (67%) with an average clearance of 3.9 mm (range, 1.1-7.9 mm) in those patients. The depth of the concavity on the volar surface of the scaphoid averaged 1.6, 2.0, and 2.5 mm in the 3 sagittal planes.
Screw fixation of the scaphoid through a volar approach is hindered by the trapezium, risks cutout through the concavity in the volar surface of the scaphoid, and is most likely to violate the dorsoulnar aspect of the radiocarpal articular surface of the scaphoid if the screw is too long. A relatively radial starting point facilitates placement of the screw tip in the center of the proximal pole and helps avoid the trapezium but drilling or partial excision of the trapezium often may be necessary for optimal screw placement.
PMID:
15925165
[PubMed - as supplied by publisher]