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JAAOS : Global Research & Reviews
Number of Followers: 0  

  This is an Open Access Journal Open Access journal
ISSN (Print) 2474-7661
Published by LWW Wolters Kluwer Homepage  [307 journals]
  • Allergic Contact Dermatitis to Mastisol Adhesive Used for Skin Closure in
           Orthopedic Surgery: A Case Report

    • Authors: Ezeh; Ugonna E.; Price, Harper N.; Belthur, Mohan V.
      Abstract: imageWe report on a rare case of allergic contact dermatitis (ACD) from Mastisol liquid adhesive. We are aware of a few reports in the medical literature, but none describes an allergic reaction during the third exposure to the offending agent. Our patient was a 20-year-old Caucasian man with a history of cerebral palsy spastic hemiplegia who underwent single-event multilevel soft-tissue surgery to optimize function of his left upper extremity. He developed a severe cutaneous allergic reaction after his third exposure to Mastisol. He was subsequently admitted to the inpatient service and managed without further complications by a multidisciplinary team comprising orthopedics, pediatrics, and dermatology. We discuss the etiology, clinical features, diagnosis, and treatment of this entity, and we also review relevant available literature on the subject. We aim at creating further awareness of allergic reactions because of exposure to available skin-prepping and wound-dressing agents.
      PubDate: Sat, 01 Sep 2018 00:00:00 GMT-
       
  • Clinical and CT Analysis of Lumbar Spine Arthrodesis: β-Tricalcium
           Phosphate Versus Demineralized Bone Matrix

    • Authors: Ricart; Pedro Hoffiz; Gandhi, Sapan D.; Geisinger, Jonathon; Baker, Kevin; Park, Daniel K.
      Abstract: imageBackground: Bone graft substitutes have been developed to circumvent donor site morbidity associated with iliac crest bone graft, but sparse literature compares the efficacy of various substitutes. Two commonly used bone graft substitutes used in lumbar fusion are β-tricalcium phosphate (BTP) and demineralized bone matrix (DBM).Methods: A retrospective review of patients who underwent instrumented posterolateral lumbar fusion was conducted by a single surgeon from January 2013 to December 2016. Patients were divided into two groups based on whether DBM or BTP as graft in conjunction with local autograft. Clinical outcomes scores were collected at a minimum of 1-year follow-up. Postoperative CT scans were evaluated to assess fusion.Results: Forty-one patients (DBM, 21 and BTP, 20) were reviewed. No significant differences were found in terms of age, sex, body mass index, smoking, diabetes, steroids, osteoporosis, American Society of Anesthesiologists classification, number of levels fused, estimated blood loss, length of stay, or surgical time between the DBM and BTP groups. A trend was found toward lower revision surgery (zero versus 15%), improved visual analog scale scores (postoperative change of 1.81 versus 3.25; P = 0.09), and higher rates of fusion (90% versus 70%; P = 0.09) in the DBM group compared with the BTP group.Conclusions: No significant difference was found in clinical outcomes at 1 year, with a trend toward a higher fusion rate and lower revision surgery with DBM.
      PubDate: Sat, 01 Sep 2018 00:00:00 GMT-
       
  • Management of an Unusual Periprosthetic Giant Cell Tumor of Bone of the
           Proximal Tibia

    • Authors: Chen; Eric A.; Caruana, Dennis L.; Khan, Fazel A.
      Abstract: imageGiant cell tumor of bone is a relatively rare type of bone tumor, accounting for approximately 4.9% to 9% of all primary osseous neoplasms.1 Management options include intralesional curettage, or more uncommonly, wide resection. This process is then followed by reconstruction with bone graft or bone cementation. We present a case of giant cell tumor of bone adjacent to the tibial component of a preexisting total knee arthroplasty, treated with extensive curettage, argon beam coagulation, polymethyl methacrylate cementation with strut reinforcement, and mesh reconstruction of the extensor mechanism. Twenty months after treatment, the patient was recurrence free with a stable prosthesis and had return to functional activity. We report this treatment modality as a potentially effective method of approaching this rare orthopaedic entity.
      PubDate: Sat, 01 Sep 2018 00:00:00 GMT-
       
  • Dual Motor Drill Continuously Measures Drilling Energy to Calculate Bone
           Density and Screw Pull-out Force in Real Time

    • Authors: Gilmer; Brian B.; Lang, Sarah D.
      Abstract: imageIntroduction: Low bone density complicates the surgical management of fractures. Screw stripping in osteoporotic bone leads to decreased fixation strength and weakening of the fixation construct. If low density could be detected during drilling, augmentation may be performed to prevent screw stripping. Furthermore, continuous monitoring of the drill bit depth and bone density can allow detection of the far cortex where density suddenly increases, providing immediate and accurate screw length measurement and reducing the risk of overpenetration or plunge in osteoporotic bone. Therefore, a dual motor drill was created to calculate bone density and pull-out force in real time. The purpose of this study was to determine whether real-time monitoring of drill bit torque and depth could be used to estimate bone density and pull-out force. We hypothesized that the calculated drilling energy could be used to determine density and would correlate with pull-out force.Methods: Drilling and screw insertion were performed using a validated composite unicortical bone model. Screws of 5-, 10-, and 20-mm length were placed into blocks of known densities (10, 20, 30, and 40 pounds per cubic foot). During creation of holes by the dual motor drill, drilling energy was recorded and used to calculate density. Calculated bone density was then compared with the known density of the block. The drill bit was exchanged for a screwdriver, and screw insertion energy was recorded in a similar fashion during screw placement. Screws were then subjected to maximal axial pull-out force testing with a material testing device. Recorded drilling energy and screw insertion energy were then correlated with the measured pull-out force.Results: Calculated bone density correlated very strongly with the known control density, confirming the accuracy of density calculations in real time. Drilling energy and screw insertion energy correlated very strongly with the measured pull-out force by destructive testing confirming ultimate pull-out force could be quantified during drilling or placement of a screw.Discussion: Our results confirmed that a dual motor drill can accurately and immediately allow determination of bone density and screw pull-out force before placing a screw. This knowledge could allow a surgeon to perform augmentation or alter surgical technique to prevent screw stripping and loss of fixation as well as detect the far cortex and prevent overpenetration in osteoporotic bone.
      PubDate: Sat, 01 Sep 2018 00:00:00 GMT-
       
  • Postoperative Pain After Surgical Treatment of Ankle Fractures: A
           Prospective Study

    • Authors: Chou; Loretta B.; Niu, Emily L.; Williams, Ariel A.; Duester, Rosanna; Anderson, Sophia E.; Harris, Alex H.S.; Hunt, Kenneth J.
      Abstract: imageBackground: Postoperative pain after fixation of ankle fractures has a substantial effect on surgical outcome and patient satisfaction. Patients requiring large amounts of narcotics are at higher risk of long-term use of pain medications. Few prospective studies investigate patient pain experience in the management of ankle fractures.Methods: We prospectively evaluated the pain experience in 63 patients undergoing open reduction and internal fixation of ankle. The Short-Form McGill Pain Questionnaire was administered preoperatively and postoperatively (PP) at 3 days (3dPP) and 6 weeks (6wPP). Anticipated postoperative pain (APP) was recorded.Results: No significant differences were found between PP, APP, and 3dPP; however, 6wPP was markedly lower. Significant correlations were found between PP and APP and between preoperative and postoperative Short-Form McGill Pain Questionnaire scores. PP and APP were independent predictors of 3dPP; however, only APP was predictive of 6wPP. Sex, age, and inpatient versus outpatient status were not notable factors. No statistically significant differences were found in pain scores between fracture types.Conclusions: Both preoperative pain severity and anticipated postoperative pain are predictive of postoperative pain levels. Orthopaedic surgeons should place a greater focus on the postoperative management of patient pain and expectations after surgical procedures.
      PubDate: Sat, 01 Sep 2018 00:00:00 GMT-
       
 
 
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