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James M Schuster - One of the best experts on this subject based on the ideXlab platform.
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thoracolumbar Transverse Process fractures are more frequently associated with nonspinal injury than clinically significant spine fracture
World Neurosurgery, 2021Co-Authors: John D Arena, Svetlana Kvint, Yohannes Ghenbot, Susanna Howard, Ashwin G Ramayya, Saurabh Sinha, Dmitriy Petrov, Isaac H Chen, James M SchusterAbstract:Objective We studied the risk of associated spinal and nonspinal injuries (NSIs) in the setting of observed thoracolumbar Transverse Process fracture (TPF) and examined the clinical management of TPF. Methods Patients treated at a Level I trauma center over a 5-year period were screened for thoracolumbar TPF. Prevalence of associated spinal fractures and NSIs as well as relationship to level of TPF was explored. Clinical management and follow-up outcomes were reviewed. Results A total of 252 patients with thoracolumbar TPFs were identified. NSIs were commonly observed (70.6%, n = 178); however, associated spinal fractures were more rarely seen (24.6%, n = 62, P Conclusions NSIs are nearly 3 times more common in patients with thoracolumbar TPFs than associated clinically relevant spinal fractures. Spine service consultation for TPF may be unnecessary unless fracture is associated with a clinically relevant spinal injury, which represents a minority of cases. However, detection of TPF should raise suspicion for high likelihood of associated NSIs.
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thoracolumbar Transverse Process fractures are more frequently associated with nonspinal injury than clinically significant spine fracture
World Neurosurgery, 2021Co-Authors: John D Arena, Svetlana Kvint, Yohannes Ghenbot, Susanna Howard, Ashwin G Ramayya, Saurabh Sinha, Dmitriy Petrov, Isaac H Chen, James M SchusterAbstract:OBJECTIVE We studied the risk of associated spinal and nonspinal injuries (NSIs) in the setting of observed thoracolumbar Transverse Process fracture (TPF) and examined the clinical management of TPF. METHODS Patients treated at a Level I trauma center over a 5-year period were screened for thoracolumbar TPF. Prevalence of associated spinal fractures and NSIs as well as relationship to level of TPF was explored. Clinical management and follow-up outcomes were reviewed. RESULTS A total of 252 patients with thoracolumbar TPFs were identified. NSIs were commonly observed (70.6%, n = 178); however, associated spinal fractures were more rarely seen (24.6%, n = 62, P < 0.0001). No patients had neurological deficits attributable to TPFs, and only 3 patients with isolated TPFs were treated with orthosis. Among patients with outpatient follow-up (70.6%, n = 178), none developed delayed-onset neurological deficits or spinal instability. Thoracic TPFs (odds ratio = 3.56, 95% confidence interval = 1.20-10.56) and L1 TPFs (odds ratio = 2.48, 95% confidence interval = 1.41-4.36) were predictive of associated thoracic NSIs. L5 TPF was associated with pelvic fractures (odds ratio = 6.30, 95% confidence interval = 3.26-12.17). There was no difference in rate of NSIs between isolated TPF (70.0%) and TPF with associated clinically relevant spinal fracture (72.6%, P = 0.70). CONCLUSIONS NSIs are nearly 3 times more common in patients with thoracolumbar TPFs than associated clinically relevant spinal fractures. Spine service consultation for TPF may be unnecessary unless fracture is associated with a clinically relevant spinal injury, which represents a minority of cases. However, detection of TPF should raise suspicion for high likelihood of associated NSIs.
Peter Wall - One of the best experts on this subject based on the ideXlab platform.
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is a fixed angle device superior to cancellous screw fixation in the stabilisation of maisonneuve ankle fractures
Orthopaedic Proceedings, 2012Co-Authors: Ian Starks, Andrew Frost, Peter WallAbstract:The management of pelvic fractures remains a challenging problem for orthopaedic surgeons. The prompt recognition of unstable fracture patterns is important in reducing mortality and morbidity. It is perceived wisdom that a fracture of the Transverse Process of L5 is a predictor of pelvic fracture instability. There is a paucity of evidence in the literature to support this belief. The aim of our study was to determine if a fracture of the Transverse Process of L5 was a predictor of pelvic fracture instability. The Hospital Trauma database was reviewed. Between 2006 and 2009, 65 pelvic fractures were identified. They were classified according to the Burgess and Young classification. There were 37 stable and 28 unstable fractures. 14 patients had an associated fracture of the Transverse Process of L5; 9 were associated with an unstable fracture pattern. The odds ratio was 3; the relative risk 1.7. A fracture of the Transverse Process of L5 is associated with an increased risk of pelvic fracture instability. Its presence should alert the attending physicians to the possibility of an unstable injury.
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is a fracture of the Transverse Process of l5 a predictor of pelvic fracture instability
Orthopaedic Proceedings, 2012Co-Authors: Ian Starks, Andrew Frost, Peter WallAbstract:The management of pelvic fractures remains a challenging problem for orthopaedic surgeons. The prompt recognition of unstable fracture patterns is important in reducing mortality and morbidity. It is perceived wisdom that a fracture of the Transverse Process of L5 is a predictor of pelvic fracture instability. There is a paucity of evidence in the literature to support this belief. The aim of our study was to determine if a fracture of the Transverse Process of L5 was a predictor of pelvic fracture instability. The Hospital Trauma database was reviewed. Between 2006 and 2009, 65 pelvic fractures were identified. They were classified according to the Burgess and Young classification. There were 37 stable and 28 unstable fractures. 14 patients had an associated fracture of the Transverse Process of L5; 9 were associated with an unstable fracture pattern. The odds ratio was 3; the relative risk 1.7. A fracture of the Transverse Process of L5 is associated with an increased risk of pelvic fracture instability. Its presence should alert the attending physicians to the possibility of an unstable injury.
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is a fracture of the Transverse Process of l5 a predictor of pelvic fracture instability
Journal of Bone and Joint Surgery-british Volume, 2011Co-Authors: Ian Starks, Andrew Frost, Peter WallAbstract:In the management of a pelvic fracture prompt recognition of an unstable fracture pattern is important in reducing mortality and morbidity. It is believed that a fracture of the Transverse Process of L5 is a predictor of pelvic fracture instability. However, there is little evidence in the literature to support this view. The aim of this study was to determine whether a fracture of the Transverse Process of L5 is a reliable predictor of pelvic fracture instability. We reviewed our hospital trauma database and identified 80 patients who sustained a pelvic fracture between 2006 and 2010. There were 32 women and 48 men with a mean age of 40 years (10 to 96). Most patients were injured in a road traffic accident or as a result of a fall from a height. A total of 41 patients (51%) had associated injuries. The pelvic fractures were categorised according to the Burgess and Young classification. There were 45 stable and 35 unstable fractures. An associated fracture of the Transverse Process of L5 was present in 17 patients; 14 (40%) of whom had an unstable fracture pattern. The odds ratio for an unstable fracture of the pelvis in the presence of a fracture of the Transverse Process of L5 was 9.3 and the relative risk was 2.5. A fracture of the Transverse Process of L5 in the presence of a pelvic fracture is associated with an increased risk of instability of the pelvic fracture. Its presence should alert the attending staff to this possibility.
John D Arena - One of the best experts on this subject based on the ideXlab platform.
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thoracolumbar Transverse Process fractures are more frequently associated with nonspinal injury than clinically significant spine fracture
World Neurosurgery, 2021Co-Authors: John D Arena, Svetlana Kvint, Yohannes Ghenbot, Susanna Howard, Ashwin G Ramayya, Saurabh Sinha, Dmitriy Petrov, Isaac H Chen, James M SchusterAbstract:Objective We studied the risk of associated spinal and nonspinal injuries (NSIs) in the setting of observed thoracolumbar Transverse Process fracture (TPF) and examined the clinical management of TPF. Methods Patients treated at a Level I trauma center over a 5-year period were screened for thoracolumbar TPF. Prevalence of associated spinal fractures and NSIs as well as relationship to level of TPF was explored. Clinical management and follow-up outcomes were reviewed. Results A total of 252 patients with thoracolumbar TPFs were identified. NSIs were commonly observed (70.6%, n = 178); however, associated spinal fractures were more rarely seen (24.6%, n = 62, P Conclusions NSIs are nearly 3 times more common in patients with thoracolumbar TPFs than associated clinically relevant spinal fractures. Spine service consultation for TPF may be unnecessary unless fracture is associated with a clinically relevant spinal injury, which represents a minority of cases. However, detection of TPF should raise suspicion for high likelihood of associated NSIs.
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thoracolumbar Transverse Process fractures are more frequently associated with nonspinal injury than clinically significant spine fracture
World Neurosurgery, 2021Co-Authors: John D Arena, Svetlana Kvint, Yohannes Ghenbot, Susanna Howard, Ashwin G Ramayya, Saurabh Sinha, Dmitriy Petrov, Isaac H Chen, James M SchusterAbstract:OBJECTIVE We studied the risk of associated spinal and nonspinal injuries (NSIs) in the setting of observed thoracolumbar Transverse Process fracture (TPF) and examined the clinical management of TPF. METHODS Patients treated at a Level I trauma center over a 5-year period were screened for thoracolumbar TPF. Prevalence of associated spinal fractures and NSIs as well as relationship to level of TPF was explored. Clinical management and follow-up outcomes were reviewed. RESULTS A total of 252 patients with thoracolumbar TPFs were identified. NSIs were commonly observed (70.6%, n = 178); however, associated spinal fractures were more rarely seen (24.6%, n = 62, P < 0.0001). No patients had neurological deficits attributable to TPFs, and only 3 patients with isolated TPFs were treated with orthosis. Among patients with outpatient follow-up (70.6%, n = 178), none developed delayed-onset neurological deficits or spinal instability. Thoracic TPFs (odds ratio = 3.56, 95% confidence interval = 1.20-10.56) and L1 TPFs (odds ratio = 2.48, 95% confidence interval = 1.41-4.36) were predictive of associated thoracic NSIs. L5 TPF was associated with pelvic fractures (odds ratio = 6.30, 95% confidence interval = 3.26-12.17). There was no difference in rate of NSIs between isolated TPF (70.0%) and TPF with associated clinically relevant spinal fracture (72.6%, P = 0.70). CONCLUSIONS NSIs are nearly 3 times more common in patients with thoracolumbar TPFs than associated clinically relevant spinal fractures. Spine service consultation for TPF may be unnecessary unless fracture is associated with a clinically relevant spinal injury, which represents a minority of cases. However, detection of TPF should raise suspicion for high likelihood of associated NSIs.
Ding Jun Hao - One of the best experts on this subject based on the ideXlab platform.
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the prospective self controlled study of unilateral Transverse Process pedicle and bilateral puncture techniques in percutaneous kyphoplasty
Osteoporosis International, 2016Co-Authors: Liang Yan, Hao Guo, Tun Liu, Ding Jun HaoAbstract:Many previous studies have reported excellent clinical results with percutaneous kyphoplasty (PKP). In contrast, numerous complications and problems have also been reported, such as puncture difficulty, cement leakage, and adjacent vertebral fracture. This study is to evaluate the application and clinical outcomes of unilateral Transverse Process-pedicle and bilateral PKP in the treatment of osteoporotic vertebral compression fractures (OVCF). A total of 56 cases with two levels thoracolumbar OVCF were randomly assigned for treatment with unilateral Transverse Process-pedicle and bilateral PKP. The patients were followed up postoperatively and were assessed mainly with regard to clinical and radiologic outcomes. Clinical outcomes were evaluated with mainly the use of a visual analogue scale (VAS) for pain. Radiologic outcomes were assessed mainly on the basis of radiation dose and bone cement distribution. The operation was completed successfully in 56 cases. In the unilateral level, the operation time, the volume of the injected cement, and radiation dose were significantly less than bilateral level. All patients had significantly improvement on VAS score after the procedures, compared with their preoperative period. In the bilateral level, 7 patients had obvious pain in the puncture sites at 1 month postoperatively caused by facet joint violation. With local block treatment, the pain disappeared in all patients at the last follow-up. Both bilateral and unilateral PKP are relatively safe and effective treatments for patients with painful OVCF. But unilateral PKP received less radiation dose and operation time, offered a higher degree of deformity correction, and resulted in less complication than bilateral.
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a comparison between unilateral Transverse Process pedicle and bilateral puncture techniques in percutaneous kyphoplasty
Spine, 2014Co-Authors: Liang Yan, Renqi Jiang, Tuanjiang Liu, Ding Jun HaoAbstract:A prospective comparative study. To assess the clinical and radiological outcomes for the treatment of osteoporotic vertebral compression fractures using unilateral Transverse Process-pedicle and bilateral percutaneous kyphoplasty (PKP). PKP is a widely used vertebral augmentation procedure for treating painful vertebral compression fractures. A percutaneous bilateral approach is typically used to access the vertebral body. Many previous studies have reported excellent clinical results with PKP. In contrast, numerous complications and problems have also been reported, such as puncture difficulty, cement leakage, and adjacent vertebral fracture. This prospective study included 316 patients with single-level lumbar osteoporotic vertebral compression fracture, 224 females and 92 males with a mean age of 71.5 years. Randomized patients underwent PKP using 2 different puncture techniques. The patients were followed up postoperatively and were assessed mainly with regard to clinical and radiological outcomes. Clinical outcomes were evaluated mainly using the visual analogue scale for pain and 36-Item Short Form Health Survey (SF-36) questionnaire for health status. Radiological outcomes were assessed mainly on the basis of radiation dose, bone cement distribution, vertebral body height, and kyphotic angle. Patients were followed up from 12 to 28 months, with an average of 16.8 months. One hundred fifty-eight patients were treated with unilateral method and 151 patients were treated with bilateral method. In the unilateral group, the volume of the injected cement and radiation dose were significantly less than that in the bilateral group. All patients in both groups had significantly less pain after the procedures, compared with their preoperative period pain. No statistically significant differences were observed when visual analogue scale and 36-Item Short Form Health Survey were compared between the groups. Both unilateral and bilateral groups showed insignificant decrease in the kyphotic angle during the follow-ups. The kyphotic angle in the unilateral group improved more significantly than in the bilateral group. In the bilateral group, 16 patients had obvious pain in the puncture sites at 1 month postoperatively caused by facet joint violation. With local block treatment, the pain disappeared in all patients at the last follow-up. Both bilateral and unilateral PKP are relatively safe and provide effective treatment for patients with painful osteoporotic vertebral compression fracture. However, unilateral PKP received less radiation dose and operation time, it also offered a higher degree of deformity correction and resulted in less complication than bilateral PKP. Level of Evidence: 3
Ian Starks - One of the best experts on this subject based on the ideXlab platform.
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is a fixed angle device superior to cancellous screw fixation in the stabilisation of maisonneuve ankle fractures
Orthopaedic Proceedings, 2012Co-Authors: Ian Starks, Andrew Frost, Peter WallAbstract:The management of pelvic fractures remains a challenging problem for orthopaedic surgeons. The prompt recognition of unstable fracture patterns is important in reducing mortality and morbidity. It is perceived wisdom that a fracture of the Transverse Process of L5 is a predictor of pelvic fracture instability. There is a paucity of evidence in the literature to support this belief. The aim of our study was to determine if a fracture of the Transverse Process of L5 was a predictor of pelvic fracture instability. The Hospital Trauma database was reviewed. Between 2006 and 2009, 65 pelvic fractures were identified. They were classified according to the Burgess and Young classification. There were 37 stable and 28 unstable fractures. 14 patients had an associated fracture of the Transverse Process of L5; 9 were associated with an unstable fracture pattern. The odds ratio was 3; the relative risk 1.7. A fracture of the Transverse Process of L5 is associated with an increased risk of pelvic fracture instability. Its presence should alert the attending physicians to the possibility of an unstable injury.
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is a fracture of the Transverse Process of l5 a predictor of pelvic fracture instability
Orthopaedic Proceedings, 2012Co-Authors: Ian Starks, Andrew Frost, Peter WallAbstract:The management of pelvic fractures remains a challenging problem for orthopaedic surgeons. The prompt recognition of unstable fracture patterns is important in reducing mortality and morbidity. It is perceived wisdom that a fracture of the Transverse Process of L5 is a predictor of pelvic fracture instability. There is a paucity of evidence in the literature to support this belief. The aim of our study was to determine if a fracture of the Transverse Process of L5 was a predictor of pelvic fracture instability. The Hospital Trauma database was reviewed. Between 2006 and 2009, 65 pelvic fractures were identified. They were classified according to the Burgess and Young classification. There were 37 stable and 28 unstable fractures. 14 patients had an associated fracture of the Transverse Process of L5; 9 were associated with an unstable fracture pattern. The odds ratio was 3; the relative risk 1.7. A fracture of the Transverse Process of L5 is associated with an increased risk of pelvic fracture instability. Its presence should alert the attending physicians to the possibility of an unstable injury.
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is a fracture of the Transverse Process of l5 a predictor of pelvic fracture instability
Journal of Bone and Joint Surgery-british Volume, 2011Co-Authors: Ian Starks, Andrew Frost, Peter WallAbstract:In the management of a pelvic fracture prompt recognition of an unstable fracture pattern is important in reducing mortality and morbidity. It is believed that a fracture of the Transverse Process of L5 is a predictor of pelvic fracture instability. However, there is little evidence in the literature to support this view. The aim of this study was to determine whether a fracture of the Transverse Process of L5 is a reliable predictor of pelvic fracture instability. We reviewed our hospital trauma database and identified 80 patients who sustained a pelvic fracture between 2006 and 2010. There were 32 women and 48 men with a mean age of 40 years (10 to 96). Most patients were injured in a road traffic accident or as a result of a fall from a height. A total of 41 patients (51%) had associated injuries. The pelvic fractures were categorised according to the Burgess and Young classification. There were 45 stable and 35 unstable fractures. An associated fracture of the Transverse Process of L5 was present in 17 patients; 14 (40%) of whom had an unstable fracture pattern. The odds ratio for an unstable fracture of the pelvis in the presence of a fracture of the Transverse Process of L5 was 9.3 and the relative risk was 2.5. A fracture of the Transverse Process of L5 in the presence of a pelvic fracture is associated with an increased risk of instability of the pelvic fracture. Its presence should alert the attending staff to this possibility.
