Outcomes of Cephalomedullary Nailing in The Treatment of Extracapsular Proximal Femur Fractures and Factors Affecting it

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Vol 6 | Issue 2 | July-Dec 2020 | page:2-6 | Vivek Sodhai, Meghraj Holambe, Chetan Pradhan, Atul Patil, Chetan Puram, Parag Sancheti, Ashok Shyam

Author: Vivek Sodhai [1], Meghraj Holambe [2], Chetan Pradhan [1], Atul Patil [2], Chetan Puram [2], Parag Sancheti [2], Ashok Shyam [2,3].

[1] Department of Trauma, Sancheti Institute Of Orthopaedics and Rehabilitation, Pune, India.
[2] Department of Orthopaedics, Sancheti Institute Of Orthopaedics and Rehabilitation, Pune, India.
[3] Department of Research, Indian Orthopaedic Research Group, Thane, India.

Address of Correspondence

Dr. Vivek Sodhai,
Lecturer, Department of Trauma, Sancheti Institute Of Orthopaedics and Rehabilitation, Pune, India.
E-mail: vivek.sodhai89@gmail.com

Abstract

Indroduction: Cephalomedullary nailing (CMN) has become popular in treatment of extracapsular proximal femur fractures due to its mechanical advantages. This study aims to analyse the functional outcomes of the same and factors affecting it.
Material and Methods: 140 prospective cases of extracapsular proximal femur fractures were treated with CMN between October 2016 and October 2017 with a minimum follow-up period of 12 months. Patients were clinically assessed with range of motion, weight bearing status, Harris hip score (HHS) and Short form (SF)-36 score. Radiologically, fracture reduction, change in neck shaft angle (NSA) and neck length ratio in comparison to unaffected hip.
Results: 140 patients, 52 had excellent while 88 had good HHS. Patient in age group 20-40 had an average HHS of 87.79, 40-60 age group had an average HHS of 87.41, while patients in age group > 60 years had an average HHS of 87.63. Patients achieved average full weight bearing at 9.94 ± 2.76 weeks (p-value 0.578). Change in the neck shaft angle (NSA) was statistically significant in the immediate post-operative and at 1-year radiographs (p-value <0.001). Comparison of neck length ratio between affected and unaffected hip showed no statistical difference. There was no significant difference in function, range of motion and HHS in males (88.51 ± 2.72) compared with females (87.61 ± 2.98) (p-value 0.082). There was no significant association between occurrence of limp with change in NSA and neck length ratio (all p values >0.05). 6 complications occurred (1 peri-implant fracture, 2 surgical site infections and 3 cases of helical blade migration).
Conclusion: CMN gives excellent functional outcomes in all AO types A1, A2, A3 irrespective of age and sex with early mobilisation, full weight bearing and better functional range of movement. Limp occurred independant of change in NSA and neck length ratio.
Keywords: Extracapsular proximal femur fractures; Cephalomedullary nailing; Unstable intertrochanteric fractures; Reverse oblique fractures..

References

1. Parker MJ, Handoll HH. (2008) Gamma and other cephalocondylic intramedullary nails versus extramedullary implants for extracapsular hip fractures in adults. Cochrane Database Syst Rev Jul 16;(3):CD000093.
2. Gullberg B, Johnell O, Kanis JA. (1997) World-wide projections for hip fracture. Osteoporos Int. 7(5):407-13.
3. Kaufer H, Mathews LS, Sonstegard D, Arbor A. (1974) Stable Fixation of Intertrochanteric Fractures A BIOMECHANICAL EVALUATION. J Bone Joint Surg. 56(5):899-907.
4. Weise K, Schwab E. (2001) Stabilization in treatment of per- and subtrochanteric fractures of the femur. Chirug. 72(11):1277-82.
5. Merredy P, Kamath S, Ramakrishnan M, et al. (2009) The AO/ASIF proximal femoral nail antirotation (PFNA): a new design for the treatment of unstable proximal femoral fractures. Injury. Apr;40(4):428–32.
6. Sircar P, Godkar D, Mahgerefteh S, Chambers K, Niranjan S, Cucco R. (2007) Morbidity and mortality among patients with hip fractures surgically repaired within and after 48 hours. Am J Ther. Nov-Dec;14(6):508–13.
7. Garg B, Marimuthu K, Kumar V, Malhotra R, Kotwal PP. (2011) Outcome of short proximal femoral nail antirotation and dynamic hip screw for fixation of unstable trochanteric fractures. A randomised prospective comparative trial. Hip Int. Sep-Oct;21(5):531–6.
8. Shen L, Zhang Y, Shen Y, Cui Z. (2013) Antirotation proximal femoral nail versus dynamic hip screw for intertrochanteric fractures: a meta-analysis of randomized controlled studies. Orthop Traumatol Surg Res. Jun;99(4):377–383.
9. Zou J, Xu Y, Yang H. (2009) A comparison of proximal femoral nail antirotation and dynamic hip screw devices in trochanteric fractures. J Int Med Res. Jul-Aug;37(4):1057–1064.
10. Hwang JH, Garg AK, Oh JK, Oh CW, Lee SJ, Myung-Rae C et al. (2012) A biomechanical evaluation of proximal femoral nail antirotation with respect to helical blade position in femoral head: a cadaveric study. Indian J Orthop. Nov;46(6):627–32.
11. Vaquero J, Munoz J, Prat S, Ramirez C, Aguado HJ, Moreno E et al. (2012) Proximal Femoral Nail Antirotation versus Gamma3 nail for intramedullary nailing of unstable trochanteric fractures. A randomised comparative study. Injury. Dec;43 Suppl 2:S47–S54.
12. D’Arrigo C, Carcangiu A, Perugia D, Scapellato S, Alonzo R, Frontini S et al. (2012) Intertrochanteric fractures: comparison between two different locking nails. Int Orthop. Dec;36(12):2545–2551.
13. Simmermacher RK, Ljungqvist J, Bail H, Hockertz T, Vochteloo AJ, Ochs U et al. (2008) The new proximal femoral nail antirotation (PFNA) in daily practice: results of a multicentre clinical study. Injury Aug;39(8):932–9.
14. Gadegone WM, Salphale YS. (2007) Proximal femoral nail – an analysis of 100 cases of proximal femoral fractures with an average follow up of 1 year. Int Orthop. Jun;31(3):403-8.
15. Boldin C, Seibert FJ, Frankhauser F, Peicha G, Grechenig W, Szyszkowitz R. (2003) The proximal femoral nail (PFN) — a minimal invasive treatment of unstable proximal femoral fractures: a prospective study of 55 patients with a follow-up of 15 months. Acta Orthop Scand. Feb;74(1):53-8.
16. Krigbaum H, Takemoto S, Kim HT, Kuo AC. (2016) Costs and Complications of Short Versus Long Cephalomedullary Nailing of OTA 31-A2 Proximal Femur Fractures in U.S. Veterans. J Orthop Trauma. Mar;30(3):125-9.
17. Jacob J, Desai A, Trompeter A. (2017) Decision Making in the Management of Extracapsular Fractures of the Proximal Femur – is the Dynamic Hip Screw the Prevailing Gold Standard? Open Orthop J. Oct 31;11:1213-1217.
18. https://www2.aofoundation.org/wps/portal/surgerypopup?bone=Femur&segment=Proximal&showPage=indication&print=no&soloState=fbox&teaserTitle=&contentUrl=srg/popup/additional_material/31/31_Classification.jsp
19. Rosenblum SF, Zuckerman JD, Kummer FJ, Tam BS. (1992) A biomechanical evaluation of the gamma nail. J Bone Joint Surg Br. May;74(3):352-7.
20. Leung KS, So WS, Shen WY, Hui PW. (1992) Gamma nails and dynamic hip screws for peritrochanteric fractures: A randomised prospective study in elderly patients. J Bone Joint Surg Br. May;74(3):345-51.
21. Radford PJ, Needoff M, Webb JK. (1993) A prospective randomised comparison of the dynamic hip screw and the gamma locking nail. J Bone Joint Surg Br. Sep;75(5):789-93.
22. Puram C, Pradhan C, Patil A, Sodhai V, Sancheti P, Shyam A. (2017) Outcomes of dynamic hip screw augmented with trochanteric wiring for treatment of unstable type A2 intertrochanteric femur fractures. Injury. Aug;48 Suppl 2:S72-S77.
23. Kuzyk PR, Bhandari M, McKee MD, Russell TA, Schemitsch EH. (2009) Intramedullary versus extramedullary fixation for subtrochanteric femur Fractures. J Orthop Trauma Jul;23(6):465-70.
24. Xianshang Zeng, Ke Zhan, Lili Zhang, Dan Zeng, Weiguang Yu, Xinchao Zhang et al. (2017) Conversion to total hip arthroplasty after failed proximal femoral nail antirotations or dynamic hip screw fixations for stable intertrochanteric femur fractures: a retrospective study with a minimum follow-up of 3 years. BMC Musculoskelet Disord. 18:38.
25. Kothiyal P, Vij K, Gupta P, Rawat P, Sharma N. (2017) Functional evaluation of proximal femoral fractures managed with cephalomedullary nailing by oxford hip score – A prospective study. International Journal of Orthopaedics Sciences 3(3):980-985.
26. Christian Carulli, Federico Piacentini, Tommaso Paoli, Roberto Civinini, Massimo Innocenti. (2017) A comparison of two fixation methods for femoral trochanteric fractures: a new generation intramedullary system vs sliding hip screw. Clin Cases Miner Bone Metab. Jan-Apr;14(1):40-47.
27. Galanopoulos IP, Mavrogenis AF, Mageloikonomos PD, Vottis CT, Mitsiokapa E, Koulouvaris P et al. (2018) Similar function and complications for patients with short versus long hip nailing for unstable pertrochanteric fractures. SICOT J. 4:23.
28. Kleweno C, Morgan J, Redshaw J, Harris M, Rodriguez E, Zurakowski D et al. (2014) Short versus long cephalomedullary nails for the treatment of intertrochanteric hip fractures in patients older than 65 years. J Orthop Trauma. Jul;28(7):391-7.
29. Robinson CM, Houshian S, Khan LA. (2005) Trochanteric-entry long cephalomedullary nailing of subtrochanteric fractures caused by low-energy trauma. J Bone Joint Surg Am. Oct;87(10):2217-26.
30. Murena L, Moretti A, Meo F, Saggioro E, Barbati G, Ratti C et al. (2018) Predictors of cut-out after cephalomedullary nail fixation of pertrochanteric fractures: a retrospective study of 813 patients. Arch Orthop Trauma Surg. Mar;138(3):351–9.
31. Nherera L, Trueman P, Horner A, Watson T, Johnstone AJ. (2018) Comparison of a twin interlocking derotation and compression screw cephalomedullary nail (InterTAN) with a single screw derotation cephalomedullary nail (proximal femoral nail antirotation): a systematic review and meta-analysis for intertrochanteric fractures. J Orthop Surg Res. Dec;13:46.
32. Keong-Hwan Kim, Kye Young Han, Keun Woo Kim, Jun Hee Lee, Myung Ki Chung. (2018) Local Postoperative Complications after Surgery for Intertrochanteric Fractures Using Cephalomedullary Nails. Hip Pelvis. Sep;30(3):168-174.
33. WL Loo, SYJ Loh, HC Lee. (2011) Review of Proximal Nail Antirotation (PFNA) and PFNA-2 –Our Local Experience. Malaysian Orthopaedic Journal Vol 5 No 2.
34. Ma KL, Wang X, Luan FJ, Xu HT, Fang Y, Min J et al. (2014) Proximal femoral nails antirotation, Gamma nails, and dynamic hip screws for fixation of intertrochanteric fractures of femur: A meta-analysis. Orthop Traumatol Surg Res 100(8):859–66.

How to Cite this article: Sodhai V, Holambe M, Pradhan C, Patil A, Puram C, Sancheti P, Shyam A | Outcomes of cephalomedullary nailing in the treatment of extracapsular proximal femur fractures and factors affecting it. | Trauma International | July-December 2020; 6(2): 02-06.

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From The Editor’s Desk!!

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Vol 6 | Issue 2 | July-Dec 2020 | page:1 | Ashok Shyam

Author: Ashok Shyam [2,3].

[1] Indian Orthopaedic Research Group, Thane, Maharashtra, India.
[2]  Sancheti Institute for Orthopaedics & Rehabilitation, Pune, Maharashtra, India.

Address of Correspondence

Dr. Ashok Shyam
Head of Academics, Sancheti Institute for Orthopaedics & Rehabilitation, Pune, Maharashtra, India.
Email: editor.trauma.international@gmail.com

We thank authors for their contribution in the July-December 2020 issue of Trauma International. This issue contains Cephalomedullary Nailing in The Treatment of Extracapsular Proximal Femur Fractures, Resource Utilization and Ethics of Urgent Orthopedic Spine Surgery During the COVID-19 Pandemic, Pulmonary Embolism as a Complication Following Anterior Cervical Discectomy and Fusion in a Patient with a History of COVID-19, Cervicothoracic Spine Osteoblastoma, Novel Adaptation of Suture Bridge Technique for Greater Tuberosity Redisplacement Post ORIF With PHILOS, Removal of Elastic Stable Intramedullary Nail. We appreciate efforts of the author s and hope for more contribution in the field of orthopaedic literature in the coming years.

How to Cite this article: Shyam A. From The Editor’s Desk. Trauma International. July-December 2020;6(2):1.

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Case of Cervicothoracic Spine Osteoblastoma in a 5 Year-old Boy

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Vol 6 | Issue 2 | July-December 2020 | page: 15-17 | Mohamed Hbibi, Sarra Benmiloud, Meriem Haloua, Meryem Boubbou, Moustapha Hida

Authors: Mohamed Hbibi [1], Sarra Benmiloud [2], Meriem Haloua [2], Meryem Boubbou [2], Moustapha Hida [1].

[1] Unit of Pediatric Hematology-Oncology, Department of Pediatrics, Mother- Child Hospital University Hospital Hassan II, Faculty of Medicine and Pharmacy, University of Sidi Mohamed Ben Abdellah, 30000 Fez, Morocco. [2] Department of Radiology, Mother-Child Hospital, University Hospital Hassan II, Faculty of Medicine and Pharmacy, University of Sidi Mohamed Ben Abdellah, 30000 Fez, Morocco.

Address of Correspondence

Dr. Mohamed Hbibi, Unit of Pediatric Hematology-Oncology, Department of Pediatrics, Mother- Child Hospital University Hospital Hassan II, Faculty of Medicine and Pharmacy, University of Sidi Mohamed Ben Abdellah, 30000 Fez, Morocco. E-mail: mohamed.hbibi@usmba.ac.ma

Abstract

Osteobalstoma is a benign primary bone tumor which represents 3% of all benign tumors and 1% of all bone tumors. It is localized commonly in the spine. We report the case of a 5 year-old boy with cervicothoracic spine osteoblastoma. The incidence of osteoblastoma is between de second and third decade; our case was seen in the first decade. The evaluation by computed tomography scan and magnetic resonance imaging show the lesion of posterior elements of D1 vertebrae with extension to 4 upper and underlying vertebrae. The decision of excision was taken a long time of discussion because for surgical team, the lesion was mimicking malignancy of the spine. The child had an uneventful postoperative recovery and the pain resolved after surgery. The objective of this article was to report a case of extensive osteoblastoma and to alert the clinician to avoid delay management due to differential diagnosis. Keywords: Osteoblatoma; Pediatric population; MRI; Surgical treatment.

References

1- Karthikeyan M, James H, Prakash S, Yin P, Aye Z, Naresh K; Unusual presentation of osteoblastoma as vertebra plana-a case report and review of literature. Spine J. 2017 Jan;17(1):e1-e5 2- Wesley H, George I J; Pediatric spinal tumors. Handb Clin Neurol. 2013; Vol. 112; p.959-65. 3- Myles S T, MacRae M E; Benign osteoblastoma of the spine in childhood. J Neurosurg. 1988 Jun;68(6):884-8. 4- Fred Ortmann; Osteoblastoma. https://emedicine.medscape.com. Updated: Oct 12, 2020 5- Amirjamshidi A, Abbassioun K; Osteoblastoma of the Third Cervical Vertebra in a 16-Year Old Boy: Case Report and Review of the Literature. Pediatr Neurosurg 2010;46:396–401 6- Joaquim AF, Ghizoni E, Valadares MGC, Appenzeller S, Aguiar SDS, Tedeschi H; Spinal tumors in children. Rev Assoc Med Bras. 2017 May;63(5):459-465 7- Jaffe HL: Benign osteoblastoma. Bull Hosp Joint Dis 1956;17:141–151. 8- Lichtenstein L: Benign osteoblastoma: a category of osteoid and bone-forming tumors other than classical osteoid osteoma, which may be mistaken for giant cell tumor or osteogenic sarcoma. Cancer 1956; 9: 1044–1052. 9- Pavan K A, Sreedhar V, Manas K P; A rare occurrence of osteoblastoma in a child. J Pediatr Neurosci 2010 Jul;5(2):153-6. 10- Cottalorda J , Bourelle S, Vanel O, Berger C, Stéphan J L; Spinal bone tumors in children. Arch Pediatr 2005 Jul;12(7):1131-8. 11- Ajit M, Nupur P, Nandeesh B N, Dhaval S; Cervical Spine Osteoblastoma with an Aneurysmal Bone Cyst in a 2-Year-Old Child: A Case Report. Pediatr Neurosurg .2019;54(1):46-50. 12- http://bonetumor.org/tumors-bone/osteoblastoma 13- Minhao Wu, Keke Xu, Yuanlong Xie, Feifei Yan, Zhouming Deng, Jun Lei, et al; Diagnostic and Management Options of Osteoblastoma in the Spine. Med Sci Monit.2019 Feb 20;25:1362-1372. 14- Galgano MA, Goulart CR, Iwenofu H, Chin LS, Lavelle W, Mendel E. Osteoblastomas of the spine: a comprehensive review. Neurosurg Focus. 2016 Aug;41(2):E4.

How to Cite this article: Hbibi M, Benmiloud S, Haloua M, Boubbou M, Hida M | Case of Cervicothoracic Spine Osteoblastoma in a 5 Year-old Boy | Trauma International | July-December 2020; 6(2): 15-17.

 

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Removal of Elastic Stable Intramedullary Nail

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Vol 6 | Issue 2 | July-December 2020 | page: 19-21 | Vivek M. Sodhai, Sandeep A. Patwardhan, Parag K. Sancheti, Ashok K. Shyam

Authors: Vivek M. Sodhai [1], Sandeep A. Patwardhan [1], Parag K. Sancheti [1], Ashok K. Shyam [1, 2]

[1] Department of Paediatric Orthopaedics, Sancheti Institute for Orthopaedics & Rehabilitation, Shivaji Nagar, Pune, Maharashtra, India.
[2] Department of Research, Indian Orthopaedic Research Group, Thane (W), Maharashtra. India.

Address of Correspondence
Dr. Vivek M. Sodhai,
Clinical fellow, Department of Paediatric Orthopaedics, Sancheti Institute for Orthopaedics & Rehabilitation, Shivaji Nagar, Pune, Maharashtra, India.
E-mail: vivek.sodhai89@gmail.com

Abstract

Introduction: Removal of the elastic stable intramedullary nail (ESIN) after the union is routinely performed in the pediatric population. However, ESIN removal can be lengthy and difficult due to the strong bonding between nail and bone.
Technique: We preferred keeping the nail tip tangentially flush (<5mm) to the bone to avoid skin irritation. In our technique, after incision and subcutaneous dissection, the nail tip is identified and exposed using a 6-mm osteotome, and a trough is created around it sufficient enough to pass the hollow mill over it. In cases with buried nail tip, a rectangular cortical window may be required. The nail tip is then gently bent at 90° using the hollow mill as the lever taking care not to cause an iatrogenic fracture. The nail tip is held at the bent from sideways with a plier and the nail is removed by rotatory backward motion or reverse impaction using a mallet in cases of strong bonding between nail and bone. Using this technique, ESIN removal was successful in all 28 cases using the previous incision. Of these cases, 10 were forearm (36%), 8 were tibia (28%), 7 were femur (25%) and 3 were humerus (11%). 6 cases (21%) were considered difficult due to increased thickness of the nails, deeper location of the nail tip, and increased bone growth around the tip of nails.
Conclusion: Our technique is simple, innovative, and can be easily reproduced by all Orthopaedic Surgeons. The use of this technique is recommended for all ESIN removals.
Keywords: Diaphyseal fractures; Elastic stable intramedullary nail; Hardware removal; Paediatric long bone.

References

1. Ligier JN, Metaizeau JP, Prevot J (1983) Closed flexible medullary nailing in pediatric traumatology. Chir Pediatr 24;383-385
2. Ligier JN, Metaizeau JP, Lascombes P, et al (1987) Treatment of diaphyseal fractures of both bones of the forearm in children using elastic stable pinning. Rev Chir Orthop Reparatrice L’ppar Moteur 73;(Suppl. 2):149- 151
3. Ligier JN, Metaizeau JP, Prevot J (1985) Elastic stable intramedullary pinning of long bone shaft fractures in children. Z Kinderchir organ Dtsch Schweiz Osterr Ges Kinderchir Surg Infancy Child 40;209-212
4. Fernandez FF, Langendorfer M, Wirth T, Eberhardt O (2010) Failures and complications in intramedullary nailing of children’s forearm fractures. J Child Orthop 4:159-167
5. Simanovsky N, Tair MA, Simanovsky N, Porat S (2006) Removal of Flexible Titanium Nails in Children. J Pediatr Orthop 26:188-192
6. Peterson HA (2005) Metallic Implant Removal in Children. J Pediatr Orthop 25:107-115
7. Slongo TF (2005) Complications and failure of the ESIN technique. Injury 36; S-A78-S-A85
8. Schmalzried TP, Grogan TJ, Neumeier PA, Dorey FJ (1991) Metal removal in a pediatric population: benign procedure or a necessary evil? J Pediatr Orthop 11:72-76
9. Lovell ME, Galasko CSB, Wright NB (1999) Removal of orthopedic implants in children: morbidity and postoperative radiologic changes. J Pediatr Orthop B 8:144-146
10. Simpson-white RW, Bryant R, Davies AG (2018) REMOVAL OF ELASTIC TITANIUM NAILS IN PAEDIATRIC PATIENTS: DIFFICULTY AND COMPLICATIONS. Orthopaedic Proceedings Vol. 95-B, No. SUPP_11
11. Resemyer B (1981) Bone-metal bonding after Kirschner wire studding. Arch Orthop Trauma Surg 98:153-155.
12. Gibon E, Béranger JS, Bachy M, Delpont M, Kabbaj R, Vialle R (2015) Influence of the bending of the tip of elastic stable intramedullary nails on removal and associated complications in pediatric both bone forearm fractures: A pilot study. Int J Surg 16;19-22.

How to Cite this article: Sodhai VM, Patwardhan SA, Sancheti PK, Shyam AK | Removal of Elastic Stable Intramedullary Nail | Trauma International | July-December 2020; 6(2): 19-21.

 

 

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Novel Adaptation of Suture Bridge Technique for Greater Tuberosity Redisplacement Post ORIF With PHILOS- A Technical Note

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Vol 6 | Issue 2 | July-December 2020 | page: 15-18 | Khayas Omer Kunheen, MC Tomichan, Rajeev PB, Adarsh Krishna K Bhat

Authors: Khayas Omer Kunheen [1], MC Tomichan [1], Rajeev PB [2], Adarsh Krishna K Bhat [1]

[1] Department of Orthopaedics, Government Medical College Kottayam, Kerala, India.
[2] Caritas hospital and Institute Of Health Sciences, Thellakom, Kottayam, Kerala, India.

Address of Correspondence
Dr. Khayas Omer Kunheen,
Chelat House, P.O Olavanna,Calicut 673019, Kerala, India.
E-mail: khayasomer@gmail.com

Abstract

Isolated Greater tuberosity (GT) fractures still pose a therapeutic challenge due to the wide variety of treatment options and lack of proper comparative studies on outcome. Plating still remains a valid option but has several unfavorable effects. One among them is redisplacement of tuberosity postoperatively especially in cases with comminution which may easily be missed in regular plain radiographs. Conventional techniques of fixation may remain insufficient in such scenarios. We hereby propose an adaptation of a described technique, in a 45-year-old male presenting with redisplacement of GT post plate fixation. Open double-row suture bridge construct was used to fix the displaced fragment maintaining the plate insitu and the patient had an excellent functional and radiological outcome on follow-up.
Keywords: Greater tuberosity fracture; Comminution; Double-row fixation; Suture anchor; Suture Bridge technique; PHILOS; Redisplacement.

References

1. Bahrs C, Lingenfelter E, Fischer F, Walters EM, Schnabel M. Mechanism of injury and morphology of the greater tuberosity fracture. J Shoulder Elbow Surg. 2006 Mar;15(2):140–7.
2. Kim E, Shin HK, Kim CH. Characteristics of an isolated greater tuberosity fracture of the humerus. J Orthop Sci. 2005 Sep;10(5):441–4.
3. Handschin AE, Cardell M, Contaldo C, Trentz O, Wanner GA. Functional results of angular-stable plate fixation in displaced proximal humeral fractures. Injury. 2008 Mar;39(3):306–13.
4. Mutch J, Laflamme GY, Hagemeister N, Cikes A, Rouleau DM. A new morphological classification for greater tuberosity fractures of the proximal humerus: validation and clinical Implications. Bone Jt J. 2014 May;96-B(5):646–51.
5. Park S-E, Jeong J-J, Panchal K, Lee J-Y, Min H-K, Ji J-H. Arthroscopic-assisted plate fixation for displaced large-sized comminuted greater tuberosity fractures of proximal humerus: a novel surgical technique. Knee Surg Sports Traumatol Arthrosc. 2016 Dec;24(12):3892–8.
6. Popp D, Strecker W. A simple and effective implant for displaced fractures of the greater tuberosity: the “Bamberg” plate. Arch Orthop Trauma Surg. 2011 Apr;131(4):509–12.
7. Szyszkowrtz R, Seggl W, Schleifer P, Cundy PJ. Proximal Humeral Fractures: Management Techniques and Expected Results. Clin Orthop. 1993 Jul;292:13–25.
8. Sproul RC, Iyengar JJ, Devcic Z, Feeley BT. A systematic review of locking plate fixation of proximal humerus fractures. Injury. 2011 Apr;42(4):408–13.
9. Bhatia DN, van Rooyen KS, du Toit DF, de Beer JF. Surgical treatment of comminuted, displaced fractures of the greater tuberosity of the proximal humerus: A new technique of double-row suture-anchor fixation and long-term results. Injury. 2006 Oct;37(10):946–52.
10. Flatow EL, Cuomo F, Maday MG, Miller SR, McIlveen SJ, Bigliani LU. Open reduction and internal fixation of two-part displaced fractures of the greater tuberosity of the proximal part of the humerus.: J Bone Jt Surg. 1991 Sep;73(8):1213–8.
11. Green A, Izzi J. Isolated fractures of the greater tuberosity of the proximal humerus. J Shoulder Elbow Surg. 2003 Nov;12(6):641–9.
12. Ji J-H, Jeong J-J, Kim Y-Y, Lee S-W, Kim D-Y, Park S-E. Clinical and radiologic outcomes of arthroscopic suture bridge repair for the greater tuberosity fractures of the proximal humerus. Arch Orthop Trauma Surg. 2017 Jan;137(1):9–17.
13. Lin C-L, Hong C-K, Jou I-M, Lin C-J, Su F-C, Su W-R. Suture anchor versus screw fixation for greater tuberosity fractures of the humerus-a biomechanical study. J Orthop Res. 2012 Mar;30(3):423–8.
14. Song HS, Williams GR. Arthroscopic Reduction and Fixation With Suture-Bridge Technique for Displaced or Comminuted Greater Tuberosity Fractures. Arthrosc J Arthrosc Relat Surg. 2008 Aug;24(8):956–60.
15. Platzer P, Kutscha-Lissberg F, Lehr S, Vecsei V, Gaebler C. The influence of displacement on shoulder function in patients with minimally displaced fractures of the greater tuberosity. Injury. 2005 Oct;36(10):1185–9.
16. Chun J-M, Groh GI, Rockwood CA. Two-part fractures of the proximal humerus. J Shoulder Elbow Surg. 1994 Sep;3(5):273–87.
17. Ji J-H, Shafi M, Song I-S, Kim Y-Y, McFarland EG, Moon C-Y. Arthroscopic Fixation Technique for Comminuted, Displaced Greater Tuberosity Fracture. Arthrosc J Arthrosc Relat Surg. 2010 May;26(5):600–9.
18. Naggar L. Surgical Management of Comminuted, Displaced Greater Tuberosity Fractures: A New Technique of Subacromial Spacer on Top of Double-Row Suture Anchor Fixation. Joints. 2018 Sep;06(03):211–4.
19. Sugaya H, Maeda K, Matsuki K, Moriishi J. Functional and Structural Outcome After Arthroscopic Full-Thickness Rotator Cuff Repair: Single-Row Versus Dual-Row Fixation. Arthrosc J Arthrosc Relat Surg. 2005 Nov;21(11):1307–16.
20. Tuoheti Y, Itoi E, Yamamoto N, Seki N, Abe H, Minagawa H, et al. Contact Area, Contact Pressure, and Pressure Patterns of the Tendon-Bone Interface after Rotator Cuff Repair. Am J Sports Med. 2005 Dec;33(12):1869–74.
21. Solberg BD, Moon CN, Franco DP, Paiement GD. Locked Plating of 3- and 4-Part Proximal Humerus Fractures in Older Patients: The Effect of Initial Fracture Pattern on Outcome. J Orthop Trauma. 2009;23(2):7.

How to Cite this article: Kunheen KO, MC Tomichan , Rajeev PB, Bhat AKK | Novel Adaptation of Suture Bridge Technique for Greater Tuberosity Redisplacement Post ORIF With PHILOSA Technical Note | Trauma International | July-December 2020; 6(2): 15-18.

 

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Pulmonary Embolism as a Complication Following Anterior Cervical Discectomy and Fusion in a Patient with a History of COVID-19: A Case Report and Literature Review

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Vol 6 | Issue 2 | July-December 2020 | page: 11-14 | Petros Koutsogiannis, Jordan Fakhoury, Kanwarpaul Grewal, Gus Katsigiorgis

Authors: Petros Koutsogiannis [1], Jordan Fakhoury [1], Kanwarpaul Grewal [1], Gus Katsigiorgis [1]

[1] Department of Orthopaedic Surgery, Long Island Jewish Hospital- Valley Stream, Northwell Health, New York.

Address of Correspondence
Dr. Petros Koutsogiannis,
Long Island Jewish Hospital- Valley Stream, Northwell Health, New York.
E-mail: pkoutsogiann@gmail.com

Abstract

This is a case report of an otherwise healthy 45-year-old male patient with a history of COVID-19, who later underwent an Anterior Cervical Spine Decompression and Fusion of level three to four for progressing neurological symptoms. The patient was readmitted eleven days postoperatively for shortness of breath and found to have a Pulmonary Embolism. The patient was at low risk for postoperative VTE, with no known current significant risk factors. He had a history of COVID-19, along with lab values and imaging that have been shown in other case series to help support the link between covid-19 and hypercoagulable state. We hope to support this hypothesis, and bring light to future larger scale studies, in order to better understand this disease and effectively create a preoperative assessment to identify such patients at risk, along with post-operative protocols for these patients having procedures in the future. To our knowledge, this is the first reported case of confirmed postoperative DVT/PE in an otherwise low-risk patient, who had a history of COVID-19 with full recovery. The rarity of this complication, along with options for how to risk-stratify these patients should be formally addressed, especially in those who require urgent spine surgery. These options are discussed, reviewed, and remarks as to where further attention and research is needed is addressed.

Keywords: Anterior Cervical Discectomy and Fusion; COVID-19; Pulmonary Embolism.

References

1. Smith GW, Robinson RA. The treatment of certain cervical-spine disorders by anterior removal of the intervertebral disc and interbody fusion. J Bone Joint Surg Am. 1958;40-A(3):607-624.
2. Garvey TA, Transfeldt EE, Malcolm JR, Kos P. Outcome of anterior cervical discectomy and fusion as perceived by patients treated for dominant axial-mechanical cervical spine pain. Spine (Phila Pa 1976). 2002;27(17):1887-1895. doi:10.1097/00007632-200209010-00015
3. Riew KD, Ecker E, Dettori JR. Anterior cervical discectomy and fusion for the management of axial neck pain in the absence of radiculopathy or myelopathy. Evid Based Spine Care J. 2010;1(3):45-50. doi:10.1055/s-0030-1267067
4. Yee TJ, Swong K, Park P. Complications of anterior cervical spine surgery: a systematic review of the literature. J Spine Surg. 2020;6(1):302-322. doi:10.21037/jss.2020.01.14
5. Sebastian AS, Currier BL, Clarke MJ, Larson D, Huddleston PM 3rd, Nassr A. Thromboembolic Disease after Cervical Spine Surgery: A Review of 5,405 Surgical Procedures and Matched Cohort Analysis. Global Spine J. 2016;6(5):465-471. doi:10.1055/s-0035-1569056
6. Oglesby, Matthew, BA*; Fineberg, Steven J., MD*; Patel, Alpesh A., MD†; Pelton, Miguel A., BS‡; Singh, Kern, MD§ The Incidence and Mortality of Thromboembolic Events in Cervical Spine Surgery, Spine: April 20, 2013 – Volume 38 – Issue 9 – p E521-E527 doi: 10.1097/BRS.0b013e3182897839
7. Zhou F, Yu T, Du R, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020;395(10229):1054-1062.
8. Zhao W, Zhong Z, Xie X, Yu Q, Liu J. Relation Between Chest CT Findings and Clinical Conditions of Coronavirus Disease (COVID-19) Pneumonia: A Multicenter Study. AJR Am J Roentgenol. 2020;214(5):1072-1077. doi:10.2214/AJR.20.22976
9. Lippi G, Favaloro EJ. D-dimer is Associated with Severity of Coronavirus Disease 2019: A Pooled Analysis. Thromb Haemost. 2020;120(5):876-878. doi:10.1055/s-0040-1709650
10. Han H, Yang L, Liu R, et al. Prominent changes in blood coagulation of patients with SARS-CoV-2 infection. Clin Chem Lab Med. 2020;58(7):1116-1120. doi:10.1515/cclm-2020-0188
11. World Health Organization. WHO Director-General’s opening remarks at the media briefing on COVID-19 – 11 March 2020. Available online at https://www.who.int/dg/speeches/detail/whodirector-general-s-opening-remarks-at-the-media-briefing-on-covid-19—11-march-2020, Accessed date: 23 October 2020.
12. Coronavirus Disease 2019 (COVID-19). Centers for Disease Control and Prevention. https://www.cdc.gov/coronavirus/2019-ncov/cases-updates/cases-in-us.html, Accessed date: 23 October 2020.
13. Tang N, Bai H, Chen X, et al. Anticoagulant treatment is associated with decreased mortality in severe coronavirus disease 2019 patients with coagulopathy. J Thromb Haemost Mar 27 2020. https://doi.org/10.1111/jth.14817
14. Parvizi, Javad MD, FRCS1,a; Ceylan, Hasan H. MD2; Kucukdurmaz, Fatih MD2; Merli, Geno MD3; Tuncay, Ibrahim MD2; Beverland, David MD4 Venous Thromboembolism Following Hip and Knee Arthroplasty, The Journal of Bone and Joint Surgery: June 7, 2017 – Volume 99 – Issue 11 – p 961-972 doi: 10.2106/JBJS.16.01253
15. Yin G, Ni B. Acute postoperative cervical spinal epidural hematoma. Acta Orthop Traumatol Turc. 2014;48(4):437-442. doi:10.3944/AOTT.2014.13.0133
16. Cox JB, Weaver KJ, Neal DW, Jacob RP, Hoh DJ. Decreased incidence of venous thromboembolism after spine surgery with early multimodal prophylaxis: Clinical article. J Neurosurg Spine. 2014;21(4):677-684. doi:10.3171/2014.6.SPINE13447
17. Zhang Y, Xiao M, Zhang S, et al. Coagulopathy and Antiphospholipid Antibodies in Patients with Covid-19. N Engl J Med. 2020;382(17):e38. doi:10.1056/NEJMc2007575
18. Bilaloglu S, Aphinyanaphongs Y, Jones S, Iturrate E, Hochman J, Berger JS. Thrombosis in Hospitalized Patients With COVID-19 in a New York City Health System. JAMA. 2020;324(8):799–801. doi:10.1001/jama.2020.13372
19. Griffin DO, Jensen A, Khan M, et al. Pulmonary Embolism and Increased Levels of D-Dimer in Patients with Coronavirus Disease. Emerging Infectious Diseases. 2020;26(8):1941-1943. doi:10.3201/eid2608.201477.

How to Cite this article: Koutsogiannis P, Fakhoury J, Grewal K, Katsigiorgis G | Pulmonary Embolism as a Complication Following Anterior Cervical Discectomy and Fusion in a Patient with a History of COVID-19: A Case Report and Literature Review | Trauma International | July-December 2020; 6(2): 11-14.

 

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Resource Utilization and Ethics of Urgent Orthopedic Spine Surgery During the COVID-19 Pandemic: A Case Report

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Vol 6 | Issue 2 | July-December 2020 | page: 7-10 | Matthew J. Partan, Peter B. White, Randy M. Cohn, Gus Katsigiorgis, Kanwarpaul Grewal

Authors: Matthew J. Partan [1, 2], Peter B. White [1, 2], Randy M. Cohn [1, 3, 4], Gus Katsigiorgis [1, 4], Kanwarpaul Grewal [1, 2, 4]

[1] Department of Orthopaedic Surgery, Northwell Health Plainview Hospital, Plainview, NY, USA.
[2] Department of Orthopaedic Surgery, Huntington, Northwell Health Huntington Hospital, NY, USA.
[3] Donald and Barbara Zucker School of Medicine at Hofstra, Hempstead, NY, USA. [4] Department of Orthopaedic Surgery, Long Island Jewish Valley Stream Hospital, Valley Stream, NY, USA.

Address of Correspondence

Dr. Matthew J. Partan,
Department of Orthopaedic Surgery, Plainview Hospital, 888 Old Country Road, Plainview, NY, USA.
Email: mpartan@northwell.edu

Abstract

Introduction: Severe acute respiratory syndrome coronavirus-2 (SARs-CoV-2), also known as a coronavirus disease-19 (COVID-19), is a novel respiratory disease that has quickly surmounted to pandemic proportions. The purpose of this case report is to discuss the decision-making process, and resource utilization for spine cases that necessitate urgent surgical intervention in light of the COVID-19 pandemic.
Case Presentation: A twenty-five-year-old Hispanic male presented to an emergency department in Long Island, New York on March 30th, 2020 with incomplete cauda equina with altered bladder function. An MRI revealed a moderately large central disc extrusion of L4/5 with deformation at the ventral thecal sac which resulted in severe spinal stenosis. Given displacement of immediately available resources, the patient required a transfer to an affiliate hospital with readily available operating room staff.
Conclusion: From the time of initial presentation to the emergency room the patient was successfully transferred and brought to the operating room suite within eight hours. The patient underwent an L4/5 decompression and microdiscectomy for a large extruded disk herniation at L4/5 level without complications. With our healthcare system in the epicenter of the COVID-19 pandemic, we are in a unique environment exposed to the harsh characteristics of the surge. In parallel with similarly challenged organizations, our system quickly adapted and adopted various guidelines and committees to organize resource allocation. As demonstrated in this case, the displacement of immediately available resources, such as anesthesia staff, placed strain on the routine workings of surgical coordination. In normal times the decision-making in this case may seem straightforward; however, this case demonstrates the strains that the COVID-19 pandemic placed on our healthcare system especially with regards to surgical acuity, COVID-19 exposure risk and resource allocation.
Keywords: Cauda equine; Spine; Medical ethics; COVID-19.  

References

1. Richardson S, Hirsch JS, Narasimhan M, et al. Presenting Characteristics, Comorbidities, and Outcomes Among 5700 Patients Hospitalized With COVID-19 in the New York City Area. JAMA. Published online April 22, 2020. doi:10.1001/jama.2020.6775.
2. Centers for Disease Control and Prevention. Coronavirus disease 2019 (COVID-19): cases in US. Accessed April 22nd, 2020. https://www.cdc.gov/coronavirus/2019-ncov/cases-updates/cases-in-us.html.
3. Wu Z, McGoogan JM. Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: summary of a report of 72 314 cases from the Chinese Center for Disease Control and Prevention. JAMA. Published online February 24, 2020.
4. Emmanuel EJ, Persad G, Upshur R, et al. Fair Allocation of Scare Medical Resources in the time of COVID-19. Published March 23,2020; DOI: 10.1056/NEJMsb2005114.
5. Cuomo, A., 2020. Executive Order: Continuing Temporary Suspension And Modification Of Laws Relating To The Disaster Emergency. [online] <https://www.governor.ny.gov/sites/governor.ny.gov/files/atoms/files/EO_202.10.pdf> [Accessed 18 April 2020].
6. Murphy, P., 2020. Executive Order 109. [online] <https://nj.gov/infobank/eo/056murphy/pdf/EO-109.pdf> [Accessed 18 April 2020]. (2020), Global guidance for surgical care during the COVID‐19 pandemic. Br J Surg. doi:10.1002/bjs.11646
7. ACS Statement on the Importance of Maintaining the Emergency Care System udring the COVID-19 Pandemic, http://facs.org/covid-19/clinical-guidance/statement-maintain; 2020 [accessed 20 April 2020].
8. Center for Medicare and Medicaid Services: Opening up America again. Accessed April 23rd, 2020. https://www.cms.gov/files/document/covid-flexibility-reopen-essential-non-covid-services.pdf
9. Center for Medicare and Medicaid Services, 2020. Non-Emergent, Elective Medical Services, And Treatment Recommendations. [online] Available at: <https://www.cms.gov/files/document/cms-non-emergent-elective-medical-recommendations.pdf> [Accessed 18 April 2020].
10. Pandemic influenza plan: 2017 update. Washington, DC: Department of Health and Human Services, 2017 (https://www.cdc.gov/flu/pandemic-resources/pdf/pan-flu-report-2017v2.pdf opens in new tab). Accessed April 20th, 2020.
11. Emanuel, Ezekiel J., et al. Fair Allocation of Scarce Medical Resources in the Time of COVID-19. NEJM: 2020; www.nejm.org/doi/full/10.1056/NEJMsb005114.
12. Dinning, T A. R., and H. R. Schaeffer. Discogenic Compression Of The Cauda Equina: A Surgical Emergency. ANZ Journal of Surgery; 1993(63): 927-924., doi: 10.111/j.1445-2197.1993.tb01721.x.
13. Chau AMT, Xu LL, Pelzer NR, Gragnaniello C. Timing of surgical intervention in cauda equina syndrome: a systematic critical review. World Neurosurg 2014;81:640–50.
14. N. V. Todd & R. A. Dickson (2016) Standards of care in cauda equina syndrome, British Journal of Neurosurgery, 30:5, 518-522.5
15. Srikandarajah N, Boissaud-Cooke MA, Clark S, Wilby MJ. Does early surgical decompression in cauda equina syndrome improve bladder outcome? Spine (Phila Pa 1976) 2015;40:580–3. doi:10.1097/BRS.000000 0000000813
16.Shapiro S. Medical realities of cauda equina syndrome secondary to lumbar disc herniation. Spine 2000;25:348–52.
17.Todd NV. Cauda equina syndrome: the timing of surgery probably does influence outcome. Br J Neurosurgery 2005;301–6.
18. Jerwood D, Todd NV. Re-analysis of the timing of cauda equina surgery. Br J Neurosurg 2006;20:178–9.
19. Todd NV. Causes and outcomes of cauda equina syndrome in medicolegal practice: a single neurosurgical experience of 40 consecutive cases. Br J Neurosurg 2011;25:503–8.
20. Gleave JRW, Macfarlane R. Cauda equina syndrome: what is the relationship between timing of surgery and outcome? Br J Neurosurg 2002; 16:325–8.
21. Gleave JRW, Macfarlane R. Prognosis for recovery of bladder function following lumbar central disc prolapse. Br J Neurosurg 1990;4:205–10
22. McLain RF, Agrawal BM, Silverstein MP. Acute cauda equina syndrome caused by a disk herniation-is emergent surgery the correct option? Surgical decompression remains the standard of care. Spine (Phila Pa 1976) 2015;40:639–41. doi:10.1097/BRS.0000000000000848.
23. Zhu, J., Ji, P., Pang, J., Zhong, Z., Li, H., He, C., Zhang, J. and Zhao, C., 2020. Clinical characteristics of 3,062 COVID-19 patients: a meta-analysis. Journal of Medical Virology,.
24. Bai Y, Yao L, Wei T. Presumed asymptomatic carrier transmission of COVID 19. JAMA. Epub ahead of press
25. Lie SA, Wong SW, Wong LT, Wong TGL, Chong SY. Practical considerations for performing regional anesthesia: lessons learned from the COVID-19 pandemic. Can J Anaesth. 202 Mar 24.
26. Lei S, Jang F, Su W, et al. Clinical characteristics and outcomes of patients undergoing surgeries during the incubation period of COVID-19 infection. EClinical Medicine. [Epub ahead of press]
27. The origin, transmission and clinical therapies on coronavirus disease 2019 (COVID-19) outbreak – an update on the status. Mil Med Res. 2020 Mar;7(1):11..

How to Cite this article: Partan MJ, White PB, Cohn RM, Katsigiorgis G, Grewal K | Resource Utilization and Ethics of Urgent Orthopedic Spine Surgery During the COVID-19 Pandemic: A Case Report | Trauma International | July-December 2020; 6(2): —.

 

 

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