The Experts below are selected from a list of 4626 Experts worldwide ranked by ideXlab platform
Emil H. Schemitsch - One of the best experts on this subject based on the ideXlab platform.
-
prognostic factors for predicting outcomes after Intramedullary Nailing of the tibia
Journal of Bone and Joint Surgery American Volume, 2012Co-Authors: Emil H. Schemitsch, Mohit Bhandari, Gordon H. Guyatt, David W Sanders, Marc F Swiontkowski, Paul Tornetta, Stephen D Walter, Rad Zdero, J C Goslings, David C TeagueAbstract:Several widely accepted systems classify long-bone injuries according to the nature and severity of damage to the bone1-3 and surrounding soft tissue2,3. Intramedullary Nailing is the most common repair method for tibial shaft fractures2-5. The choice between the use of reamed or unreamed Intramedullary Nailing, however, has been controversial4-18. Following tibial shaft fracture repair with use of nails, annual reoperation rates have been reported to be between 12% and 44%5. This substantial problem is due to nonunion, malunion, knee pain, osteomyelitis, infection, and/or broken implants2,3. The question of which characteristics are most predictive of risk of a negative outcome following tibial shaft fracture repair remains unresolved19-26. Investigators have assessed a number of potential prognostic factors, such as age, sex, fracture morphology, injury mechanism, severity of soft-tissue damage, surgical delay, diabetes, vasculopathy, alcohol use, smoking, corticosteroids, antibiotics, anticoagulants, anticonvulsants, and anti-inflammatory medications27-47. However, prior investigations were limited methodologically by small sample sizes, few participating health-care centers, lack of adjustment for confounders, and/or nonstandardized perioperative patient-care regimens. Accurate prediction of patients who are at an increased risk for poor outcomes following tibial Nailing may facilitate optimal patient care. We recently completed the Study to Prospectively Evaluate Reamed Intramedullary Nails in Patients with Tibial Fractures (SPRINT), a large, multicenter trial of reamed and unreamed Intramedullary Nailing in patients with tibial shaft fractures48. This trial suggested a benefit for reamed Intramedullary Nailing in patients with closed tibial shaft fractures, largely because of fewer dynamizations, and a potential advantage for unreamed Intramedullary Nailing in open tibial fractures48,49. Using the SPRINT data, we conducted an investigation of baseline and surgical factors previously documented to determine which were associated with increased risk of negative events within one year of tibial Intramedullary Nailing.
-
the effect of muscle contusion on cortical bone and muscle perfusion following reamed Intramedullary Nailing a novel canine tibia fracture model
Journal of Orthopaedic Surgery and Research, 2010Co-Authors: Henry Koo, Emil H. Schemitsch, Rad Zdero, Thomas Hupel, Alexei TovAbstract:Background Management of tibial fractures associated with soft tissue injury remains controversial. Previous studies have assessed perfusion of the fractured tibia and surrounding soft tissues in the setting of a normal soft tissue envelope. The purpose of this study was to determine the effects of muscle contusion on blood flow to the tibial cortex and muscle during reamed, Intramedullary Nailing of a tibial fracture.
-
compression plating versus Intramedullary Nailing of humeral shaft fractures a meta analysis
Acta Orthopaedica, 2006Co-Authors: Mohit Bhandari, P J Devereaux, Emil H. SchemitschAbstract:Background The choice of plates or Intramedullary nails for operatively treated humeral shaft fractures remains controversial, since randomized controlled trials have lacked sufficient power. A meta-analysis of existing trials would improve inferences regarding the treatment effect.Methods We reviewed randomized trials in Medline, Cochrane and SciSearch, along with other sources of published randomized trials from 1969–2000. Of 215 citations identified, only 3 studies were included.Results The 3 studies (involving 155 patients) were pooled, since they were homogeneous (p > 0.1). Plate fixation gave a lower relative risk of reoperation than Intramedullary Nailing (RR = 0.26, 95% CI 0.007–0.9, p = 0.03). This translated to a risk reduction of 74% for reoperation when plate fixation was employed. Thus, 1 reoperation could be prevented for every 10 patients treated with plates. Plate fixation also reduced the risk of shoulder problems in comparison to Intramedullary nails (RR = 0.10, 95% CI 0.03–0.4, p = 0.00...
Mohit Bhandari - One of the best experts on this subject based on the ideXlab platform.
-
prognostic factors for predicting outcomes after Intramedullary Nailing of the tibia
Journal of Bone and Joint Surgery American Volume, 2012Co-Authors: Emil H. Schemitsch, Mohit Bhandari, Gordon H. Guyatt, David W Sanders, Marc F Swiontkowski, Paul Tornetta, Stephen D Walter, Rad Zdero, J C Goslings, David C TeagueAbstract:Several widely accepted systems classify long-bone injuries according to the nature and severity of damage to the bone1-3 and surrounding soft tissue2,3. Intramedullary Nailing is the most common repair method for tibial shaft fractures2-5. The choice between the use of reamed or unreamed Intramedullary Nailing, however, has been controversial4-18. Following tibial shaft fracture repair with use of nails, annual reoperation rates have been reported to be between 12% and 44%5. This substantial problem is due to nonunion, malunion, knee pain, osteomyelitis, infection, and/or broken implants2,3. The question of which characteristics are most predictive of risk of a negative outcome following tibial shaft fracture repair remains unresolved19-26. Investigators have assessed a number of potential prognostic factors, such as age, sex, fracture morphology, injury mechanism, severity of soft-tissue damage, surgical delay, diabetes, vasculopathy, alcohol use, smoking, corticosteroids, antibiotics, anticoagulants, anticonvulsants, and anti-inflammatory medications27-47. However, prior investigations were limited methodologically by small sample sizes, few participating health-care centers, lack of adjustment for confounders, and/or nonstandardized perioperative patient-care regimens. Accurate prediction of patients who are at an increased risk for poor outcomes following tibial Nailing may facilitate optimal patient care. We recently completed the Study to Prospectively Evaluate Reamed Intramedullary Nails in Patients with Tibial Fractures (SPRINT), a large, multicenter trial of reamed and unreamed Intramedullary Nailing in patients with tibial shaft fractures48. This trial suggested a benefit for reamed Intramedullary Nailing in patients with closed tibial shaft fractures, largely because of fewer dynamizations, and a potential advantage for unreamed Intramedullary Nailing in open tibial fractures48,49. Using the SPRINT data, we conducted an investigation of baseline and surgical factors previously documented to determine which were associated with increased risk of negative events within one year of tibial Intramedullary Nailing.
-
compression plating versus Intramedullary Nailing of humeral shaft fractures a meta analysis
Acta Orthopaedica, 2006Co-Authors: Mohit Bhandari, P J Devereaux, Emil H. SchemitschAbstract:Background The choice of plates or Intramedullary nails for operatively treated humeral shaft fractures remains controversial, since randomized controlled trials have lacked sufficient power. A meta-analysis of existing trials would improve inferences regarding the treatment effect.Methods We reviewed randomized trials in Medline, Cochrane and SciSearch, along with other sources of published randomized trials from 1969–2000. Of 215 citations identified, only 3 studies were included.Results The 3 studies (involving 155 patients) were pooled, since they were homogeneous (p > 0.1). Plate fixation gave a lower relative risk of reoperation than Intramedullary Nailing (RR = 0.26, 95% CI 0.007–0.9, p = 0.03). This translated to a risk reduction of 74% for reoperation when plate fixation was employed. Thus, 1 reoperation could be prevented for every 10 patients treated with plates. Plate fixation also reduced the risk of shoulder problems in comparison to Intramedullary nails (RR = 0.10, 95% CI 0.03–0.4, p = 0.00...
-
Intramedullary Nailing following external fixation in femoral and tibial shaft fractures
Journal of Orthopaedic Trauma, 2005Co-Authors: Mohit Bhandari, Michael Zlowodzki, Paul F Tornetta, Andrew H Schmidt, David C TemplemanAbstract:Background:Intramedullary Nailing is the standard of care for the definitive management of lower extremity long bone fractures. Occasionally, temporary external fixation is used in fractures with severe open wounds or vascular injury before definitive Intramedullary Nailing. Secondary Intramedullary
J Glynne Andrew - One of the best experts on this subject based on the ideXlab platform.
-
Dynamic compression plating versus locked Intramedullary Nailing for humeral shaft fractures in adults
Cochrane Database of Systematic Reviews, 2011Co-Authors: Harish Kurup, Munier Hossain, J Glynne AndrewAbstract:Background Surgical fixation of fractures of the shaft of the humerus generally involves plating or Nailing. It is unclear whether one method is more effective than the other. Objectives To compare compression plating and locked Intramedullary Nailing for primary surgical fixation (surgical fixation of an acute fracture or early fixation following failure of conservative treatment) of humeral shaft fractures in adults. Search methods We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (February 2011), The Cochrane Library 2011, Issue 1, MEDLINE and EMBASE (both to February 2011) and trial registries for ongoing trials. Selection criteria Randomised and quasi-randomised controlled trials comparing compression plates and locked Intramedullary nail fixation for humeral shaft fractures in adults. Data collection and analysis Two authors independently assessed trial methodology and extracted data. Disagreement was resolved by discussion, or third party adjudication. Treatment effects were assessed using risk ratios for dichotomous data and mean differences for continuous data, together with 95% confidence intervals. Where appropriate, data were pooled using a fixed-effect model. Main results Five small trials comparing dynamic compression plates with locked Intramedullary Nailing were included in this review. These involved a total of 260 participants undergoing surgery for either acute fractures or after early failure of conservative treatment. All five trials had methodological flaws, such as the lack of assessor blinding, that could have influenced their findings. There was no significant difference in fracture union between plating and Nailing (five trials, RR 1.05; 95% CI 0.97 to 1.13). There was a statistically significant increase in shoulder impingement following Nailing when compared with plating (five trials, RR 0.12; 95% CI 0.04 to 0.38). Intramedullary nails were removed significantly more frequently than plates (three trials, RR 0.17; 95% CI 0.04 to 0.76). There was no statistically significant difference between plating and Nailing in operating time, blood loss during surgery, iatrogenic radial nerve injury, return to pre-injury occupation by six months or American Shoulder and Elbow Surgeons (ASES) scores. Two further small trials are awaiting classification. Authors' conclusions The available evidence shows that Intramedullary Nailing is associated with an increased risk of shoulder impingement, with a related increase in restriction of shoulder movement and need for removal of metalwork. There was insufficient evidence to determine if there were any other important differences, including in functional outcome, between dynamic compression plating and locked Intramedullary Nailing for humeral shaft fractures.
Leisheng Jiang - One of the best experts on this subject based on the ideXlab platform.
-
plate fixation versus Intramedullary Nailing for displaced extra articular distal tibia fractures a system review
European Journal of Orthopaedic Surgery and Traumatology, 2015Co-Authors: Yuehua Yang, Leisheng JiangAbstract:Purpose The optimal surgical procedure for displaced extra-articular distal tibia fractures remains debated at present. The objective of this systematic review is to compare the complications and functional outcomes of this type of fracture after plate fixation and Intramedullary Nailing .
Markku Jarvinen - One of the best experts on this subject based on the ideXlab platform.
-
anterior knee pain after Intramedullary Nailing of fractures of the tibial shaft an eight year follow up of a prospective randomized study comparing two different nail insertion techniques
Journal of Trauma-injury Infection and Critical Care, 2008Co-Authors: Olli Vaisto, Jarmo Toivanen, Pekka Kannus, Markku JarvinenAbstract:Background:Anterior knee pain is the most common complication after Intramedullary Nailing of the tibia. Dissection of the patellar tendon and its sheath during transtendinous Nailing is thought to be a contributing cause of chronic anterior knee pain. The purpose of this long-term follow-up of a pr
-
anterior knee pain after Intramedullary Nailing of a tibial shaft fracture an ultrasound study of the patellar tendons of 36 patients
Journal of Orthopaedic Trauma, 2005Co-Authors: Olli Vaisto, Jarmo Toivanen, Timo Paakkala, Timo Jarvela, Pekka Kannus, Markku JarvinenAbstract:Objectives Chronic anterior knee pain is a common complication following Intramedullary Nailing of a tibial shaft fracture. The etiology of pain is often not known. This study sonographically examined the patellar tendons of patients with a nailed tibial shaft fracture. Design Prospective study. Setting University hospital. Patients Fifty consecutive patients with a nailed tibial shaft fracture were initially included in the study. Thirty-six of them could be measured at an average of 2.5 +/- 0.5 years after nail insertion (1.0 +/- 0.3 years after nail extraction). Intervention Reamed Intramedullary Nailing with 2 interlocking bolts at both ends of the nail (Grosse-Kempf-nail, Howmedica). Main outcome measurements The ultrasound investigation of the patellar tendons of the 36 patients. Results Twelve (33%) patients were painless and 24 (67%) patients had anterior knee pain at follow-up. With the reference to the mean difference in the thickness of the distal part of the patellar tendon in the operated limb versus nonoperated limb, the result was 1.4 +/- 1.1 mm in the chronic pain group and 2.6 +/- 2.5 mm in the painless group (P = 0.135, [95% confidence interval for the group difference = -0.4-2.8]). The corresponding values for the proximal part of the patellar tendon was 1.4 +/- 1.3 mm in the chronic pain group and 2.3 +/- 2.3 mm in the painless group (P = 0.251, [95% confidence interval for the group difference = -0.7-2.4]). There were no statistically significantly differences between study groups in the blood circulation of the patellar tendon or at the entry point, calcification of the patellar tendon, granulation tissue at the entry point, or occurrence of low echo areas in the patellar tendon. Conclusion After Intramedullary Nailing of a tibial shaft fracture, patients with or without anterior knee pain show similar changes in the ultrasound investigation of their patellar tendons. Based on those findings, it does not appear to make any difference as to the approach used (paratendinous or transtendinous) for Intramedullary Nailing of the tibia.
-
anterior knee pain after Intramedullary Nailing of fractures of the tibial shaft a prospective randomized study comparing two different nail insertion techniques
Journal of Bone and Joint Surgery American Volume, 2002Co-Authors: Jarmo Toivanen, Olli Vaisto, Pekka Kannus, Kyosti Latvala, S E Honkonen, Markku JarvinenAbstract:Background: Anterior knee pain is the most common complication after Intramedullary Nailing of the tibia. Dissection of the patellar tendon and its sheath during Nailing is thought to be a contributing cause of chronic anterior knee pain. The purpose of this prospective, randomized study was to assess whether the prevalence or the intensity of anterior knee pain following Intramedullary Nailing of a tibial shaft fracture is reduced by the use of a paratendinous incision for the nail entry portal. Methods: Fifty patients with a tibial shaft fracture requiring Intramedullary Nailing were randomized equally to treatment with paratendinous or transtendinous Nailing. Twenty-one patients from both study groups were followed for an average of three years after Nailing. After fracture union, all but two patients had elective nail removal through the same surgical approach as was used for the Nailing. At the follow-up evaluation, the patients used visual analog scales to report their level of anterior knee pain and the impairment caused by that pain. The scales described by Lysholm and Gillquist and by Tegner et al., the Iowa knee scoring system, and simple functional tests were used to quantitate the functional results. Isokinetic thigh-muscle strength was also measured. Results: Fourteen (67%) of the twenty-one patients treated with transtendinous Nailing reported anterior knee pain at the final evaluation. Of these fourteen patients, thirteen were mildly to severely impaired by the pain. Fifteen (71%) of the twenty-one patients treated with paratendinous Nailing reported anterior knee pain, and ten of the fifteen were impaired by the pain. The Lysholm, Tegner, and Iowa knee scoring systems; muscle-strength measurements; and functional tests showed no significant differences between the two groups. Conclusion: Compared with a transpatellar tendon approach, a paratendinous approach for nail insertion does not reduce the prevalence of chronic anterior knee pain or functional impairment by a clinically relevant amount after Intramedullary Nailing of a tibial shaft fracture.