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Neal C Chen - One of the best experts on this subject based on the ideXlab platform.
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postoperative dorsal proximal interphalangeal joint Subluxation in volar base middle phalanx fractures
Journal of Hand and Microsurgery, 2020Co-Authors: Kamilcan Oflazoglu, Suzanne C Wilkens, Hinne A Rakhorst, Kyle R Eberlin, David Ring, Neal C ChenAbstract:Introduction This study was designed to assess factors associated with postoperative dorsal proximal interphalangeal (PIP) joint Subluxation after operative treatment of volar base middle phalanx fractures. Our second purpose was to study the association between postoperative dorsal Subluxation with postoperative arthritis. Materials and Methods We identified 44 surgically treated volar base PIP joint fractures with available pre- and postoperative radiographs between 2002 and 2015 at two academic medical systems with a median follow-up of 3.5 months. Demographic, injury, radiographic, and treatment data that might be associated with postoperative dorsal Subluxation were collected. Three hand surgeons independently assessed Subluxation and arthritis on radiographs. Bivariate analysis was performed to analyze our two study purposes. Results Six of 44 (14%) had postoperative dorsal Subluxation after initial surgery. Bivariate analysis showed no factors with statistically significant association with postoperative Subluxation, assessed independently by three hand surgeons on radiographs. Fifty per cent of the joints with postoperative arthritis had postoperative Subluxation compared with 21% of joints without postoperative Subluxation. No significant association was found between postoperative dorsal Subluxation with postoperative arthritis. Conclusion The association of persistent Subluxation and early arthrosis in dorsal PIP joint fracture dislocations needs further study. At this time, it is unclear in what ways persistent Subluxation or arthrosis affects the rate of reoperation. Level of Evidence This is a therapeutic level IV study.
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dorsal Subluxation of the proximal interphalangeal joint after volar base fracture of the middle phalanx
Hand, 2020Co-Authors: Kamilcan Oflazoglu, Hinne A Rakhorst, Catherine A De Planque, Thierry G Guitton, Neal C ChenAbstract:Background: Treatment decisions regarding volar base fractures of the middle phalanx depend on whether the proximal interphalangeal (PIP) joint is reduced. Our aim was to study the agreement among hand surgeons in determining whether the PIP joint fractures are subluxated and to study the factors associated with Subluxation of these fractures. Methods: In this retrospective chart review, 413 volar base fractures of the middle phalanx were included. Demographic and injury-related factors were gathered from medical records and radiographs. Using a Web-based survey, interobserver agreement was determined among 105 hand surgeons on the assessment of PIP joint Subluxation of a series of 26 cases. Using the cohort of 413 fractures, a threshold for percent articular involvement and relative fracture displacement that corresponds with Subluxation of the PIP joint was analyzed. Results: We found moderate to substantial agreement between hand surgeons on Subluxation (κ = 0.59, P < .0001) and an overall percent agreement of 85%. Percent articular involvement and relative fracture displacement were independently associated with Subluxation of the PIP joint (P < .001). Percent articular involvement of 35% had a specificity of 90% and a negative predicting value (NPV) of 92% for joint Subluxation. Relative fracture displacement of 35% had a specificity of 92% and an NPV of 94% for joint Subluxation. Conclusions: Surgeons generally agree on whether a PIP joint is subluxated. Percent articular involvement and relative fragment displacement are objective measurements that can help characterize joint stability and assist with decision-making.
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factors associated with Subluxation in mallet fracture
Journal of Hand Surgery (European Volume), 2017Co-Authors: Kamilcan Oflazoglu, David Ring, Ali Moradi, Yvonne Braun, T Meijs, Neal C ChenAbstract:Radiographs and medical record of all adult patients with a mallet fracture in three hospitals between 2004 and 2014 were reviewed. International Classification of Diseases, Ninth Revision (ICD-9) codes and text search in radiographic reports were used to identify all acute patients with potential mallet fractures in our institutional database. Manually checking, 392 true mallet fractures were identified among them, 78 had Subluxation at the time of diagnosis and 19 had Subluxation at a later time point during treatment. Fragment size, fragment displacement, and interval between injury and treatment were associated with initial and late Subluxation. Subluxation was not observed when the fracture size was less than 39% of the total articular surface. For each 1% increase in total articular surface involvement in fractures with more than 39% involvement, the risk of Subluxation increased by 4% and for each 1% of displacement, the risk of Subluxation increased by 4%.Level of Evidence: IV
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risk of Subluxation or dislocation after operative treatment of terrible triad injuries
Journal of Orthopaedic Trauma, 2016Co-Authors: Dafang Zhang, David Ring, Matthew Tarabochia, Stein J Janssen, Neal C ChenAbstract:Objective The management of terrible triad injuries has evolved over the last 2 decades to include routine radial head fixation or replacement, reattachment of the lateral collateral ligament, with or without coronoid fixation. Our objective was to determine the likelihood of and factors associated with Subluxation or dislocation after operative treatment of terrible triad injuries among a large group of surgeons using current techniques. Design Retrospective cohort study. Setting Two level I trauma centers. Patients/participants A total of 107 patients with operatively treated terrible triad injuries from January 2000 to June 2015. Intervention Review of patient- and surgery-related factors during the first postoperative month. Main outcome measurement Radiographic Subluxation of the ulnohumeral joint. Results One hundred of the 107 patients (93%) treated with open fixation of terrible triad injuries had no radiographic Subluxation or redislocation. Two patients (2%) had slight transient radiographic Subluxation ("drop sign") that corrected with active exercises within weeks of surgery. Five patients (5%) had persistent radiographic Subluxation, 3 treated with a second surgery (3%). When treated within 2 weeks of injury, recurrent Subluxation or dislocation after operative fixation of terrible triad injuries was rare (1%), provided that the radial head was replaced and the lateral collateral ligament reattached. Conclusions Radiographic Subluxation is very uncommon with current operative management of terrible triad injuries of the elbow within 2 weeks. Patients treated more than 2 weeks after injury might benefit from ancillary fixation to limit Subluxation (ie, cross pinning, external fixation, or internal joint stabilizer). Level of evidence Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Kamilcan Oflazoglu - One of the best experts on this subject based on the ideXlab platform.
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postoperative dorsal proximal interphalangeal joint Subluxation in volar base middle phalanx fractures
Journal of Hand and Microsurgery, 2020Co-Authors: Kamilcan Oflazoglu, Suzanne C Wilkens, Hinne A Rakhorst, Kyle R Eberlin, David Ring, Neal C ChenAbstract:Introduction This study was designed to assess factors associated with postoperative dorsal proximal interphalangeal (PIP) joint Subluxation after operative treatment of volar base middle phalanx fractures. Our second purpose was to study the association between postoperative dorsal Subluxation with postoperative arthritis. Materials and Methods We identified 44 surgically treated volar base PIP joint fractures with available pre- and postoperative radiographs between 2002 and 2015 at two academic medical systems with a median follow-up of 3.5 months. Demographic, injury, radiographic, and treatment data that might be associated with postoperative dorsal Subluxation were collected. Three hand surgeons independently assessed Subluxation and arthritis on radiographs. Bivariate analysis was performed to analyze our two study purposes. Results Six of 44 (14%) had postoperative dorsal Subluxation after initial surgery. Bivariate analysis showed no factors with statistically significant association with postoperative Subluxation, assessed independently by three hand surgeons on radiographs. Fifty per cent of the joints with postoperative arthritis had postoperative Subluxation compared with 21% of joints without postoperative Subluxation. No significant association was found between postoperative dorsal Subluxation with postoperative arthritis. Conclusion The association of persistent Subluxation and early arthrosis in dorsal PIP joint fracture dislocations needs further study. At this time, it is unclear in what ways persistent Subluxation or arthrosis affects the rate of reoperation. Level of Evidence This is a therapeutic level IV study.
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dorsal Subluxation of the proximal interphalangeal joint after volar base fracture of the middle phalanx
Hand, 2020Co-Authors: Kamilcan Oflazoglu, Hinne A Rakhorst, Catherine A De Planque, Thierry G Guitton, Neal C ChenAbstract:Background: Treatment decisions regarding volar base fractures of the middle phalanx depend on whether the proximal interphalangeal (PIP) joint is reduced. Our aim was to study the agreement among hand surgeons in determining whether the PIP joint fractures are subluxated and to study the factors associated with Subluxation of these fractures. Methods: In this retrospective chart review, 413 volar base fractures of the middle phalanx were included. Demographic and injury-related factors were gathered from medical records and radiographs. Using a Web-based survey, interobserver agreement was determined among 105 hand surgeons on the assessment of PIP joint Subluxation of a series of 26 cases. Using the cohort of 413 fractures, a threshold for percent articular involvement and relative fracture displacement that corresponds with Subluxation of the PIP joint was analyzed. Results: We found moderate to substantial agreement between hand surgeons on Subluxation (κ = 0.59, P < .0001) and an overall percent agreement of 85%. Percent articular involvement and relative fracture displacement were independently associated with Subluxation of the PIP joint (P < .001). Percent articular involvement of 35% had a specificity of 90% and a negative predicting value (NPV) of 92% for joint Subluxation. Relative fracture displacement of 35% had a specificity of 92% and an NPV of 94% for joint Subluxation. Conclusions: Surgeons generally agree on whether a PIP joint is subluxated. Percent articular involvement and relative fragment displacement are objective measurements that can help characterize joint stability and assist with decision-making.
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factors associated with Subluxation in mallet fracture
Journal of Hand Surgery (European Volume), 2017Co-Authors: Kamilcan Oflazoglu, David Ring, Ali Moradi, Yvonne Braun, T Meijs, Neal C ChenAbstract:Radiographs and medical record of all adult patients with a mallet fracture in three hospitals between 2004 and 2014 were reviewed. International Classification of Diseases, Ninth Revision (ICD-9) codes and text search in radiographic reports were used to identify all acute patients with potential mallet fractures in our institutional database. Manually checking, 392 true mallet fractures were identified among them, 78 had Subluxation at the time of diagnosis and 19 had Subluxation at a later time point during treatment. Fragment size, fragment displacement, and interval between injury and treatment were associated with initial and late Subluxation. Subluxation was not observed when the fracture size was less than 39% of the total articular surface. For each 1% increase in total articular surface involvement in fractures with more than 39% involvement, the risk of Subluxation increased by 4% and for each 1% of displacement, the risk of Subluxation increased by 4%.Level of Evidence: IV
Haruhiko Akiyama - One of the best experts on this subject based on the ideXlab platform.
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coronal tibiofemoral Subluxation is correlated to correction angle in medial opening wedge high tibial osteotomy
Knee Surgery Sports Traumatology Arthroscopy, 2018Co-Authors: Hiroyasu Ogawa, Kazu Matsumoto, Haruhiko AkiyamaAbstract:Purpose This study aimed to analyse the change in coronal tibiofemoral (CTF) Subluxation after high tibial osteotomy and to determine demographic variables associated with CTF Subluxation. The change in CTF Subluxation was hypothesised to be associated with the magnitude of correction of lower limb alignment and medial proximal tibial angle (MPTA).
Tomoyuki Saito - One of the best experts on this subject based on the ideXlab platform.
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coronal Subluxation of the proximal tibia relative to the distal femur after opening wedge high tibial osteotomy
Knee, 2017Co-Authors: Yasushi Akamatsu, Satoshi Ohno, Hideo Kobayashi, Yoshihiro Kusayama, Ken Kumagai, Tomoyuki SaitoAbstract:Abstract Background The coronal Subluxation of the proximal tibia relative to the distal femur is a common radiological finding in patients with knee osteoarthritis. The purpose was to evaluate whether the coronal Subluxation was corrected after opening wedge high tibial osteotomy (OWHTO), and whether this Subluxation was one cause of inconsistency between the actual and predicted alignments (correction loss). Methods Fifty-one patients (55 knees) were treated with OWHTO. The change of location between the intersection points of the femoral and tibial axes on the tibial plateau (Subluxation-C), the change of location between the lines through the most lateral points of the lateral femoral and tibial condyles (Subluxation-L), and joint space angle (JSA) were compared in standing knee radiographs before and one year after OWHTO. The Subluxation-C and Subluxation-L were converted to a percentage of the tibial plateau width. Results The mean Subluxation-C of 6.5% before OWHTO significantly increased to a mean Subluxation-C of 7.3% one year after OWHTO. The mean Subluxation-L of 6.3% and JSA of 4.5° before OWHTO significantly decreased to a Subluxation-L of 1.8% and JSA of 3.3° one year after OWHTO. The change in Subluxation-L correlated with the change in femorotibial angle and correction loss ( r =0.634, P r =0.463, P Conclusion The proximal tibia shifted medially relative to the distal femur after OWHTO. This medial shift correlated with the correction loss. The coronal Subluxation might be one cause of correction loss.
Bradley T Edwards - One of the best experts on this subject based on the ideXlab platform.
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static posterior Subluxation of the humeral head an unrecognized entity responsible for glenohumeral osteoarthritis in the young adult
Journal of Shoulder and Elbow Surgery, 2002Co-Authors: Gilles Walch, Claudio Ascani, Aziz Boulahia, Laurent Novejosserand, Bradley T EdwardsAbstract:Abstract Thirteen men with a mean age of 40 years had glenohumeral arthritis and symptoms of stiffness, pain, and locking of the joint at presentation. Provocative test results for anterior or posterior instability were negative. Computed tomography detected posterior humeral head Subluxation relative to the glenoid and posterior cartilage wear. All patients demonstrated this posterior Subluxation in the absence of posterior glenoid erosion. The mean glenoid retroversion was increased (14.5°). Increased glenoid retroversion was observed in the contralateral shoulder in 4 cases, and marked static posterior Subluxation was noted in the contralateral shoulder in 3 cases. Various surgical procedures were performed in 5 patients to correct this arthrogenic posterior Subluxation. Patients who underwent surgery were reviewed at a mean follow-up of 46 months with physical examination and computed tomography. The patients with the longer follow-up showed a progression of arthritis, and all cases showed persistent or recurrent posterior humeral Subluxation. Glenohumeral arthritis with static posterior Subluxation of the humeral head in the young adult could be the first stage of primary glenohumeral arthritis, predating signs of posterior glenoid erosion. Our attempts to correct this static posterior Subluxation failed. (J Shoulder Elbow Surg 2002;11:309-14)
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static posterior Subluxation of the humeral head an unrecognized entity responsible for glenohumeral osteoarthritis in the young adult
Journal of Shoulder and Elbow Surgery, 2002Co-Authors: Gilles Walch, Claudio Ascani, Aziz Boulahia, Laurent Novejosserand, Bradley T EdwardsAbstract:Thirteen men with a mean age of 40 years had glenohumeral arthritis and symptoms of stiffness, pain, and locking of the joint at presentation. Provocative test results for anterior or posterior instability were negative. Computed tomography detected posterior humeral head Subluxation relative to the glenoid and posterior cartilage wear. All patients demonstrated this posterior Subluxation in the absence of posterior glenoid erosion. The mean glenoid retroversion was increased (14.5 degrees ). Increased glenoid retroversion was observed in the contralateral shoulder in 4 cases, and marked static posterior Subluxation was noted in the contralateral shoulder in 3 cases. Various surgical procedures were performed in 5 patients to correct this arthrogenic posterior Subluxation. Patients who underwent surgery were reviewed at a mean follow-up of 46 months with physical examination and computed tomography. The patients with the longer follow-up showed a progression of arthritis, and all cases showed persistent or recurrent posterior humeral Subluxation. Glenohumeral arthritis with static posterior Subluxation of the humeral head in the young adult could be the first stage of primary glenohumeral arthritis, predating signs of posterior glenoid erosion. Our attempts to correct this static posterior Subluxation failed.
