Biomedical subjects

Anthony Adili

Publications and source records attributed to Anthony Adili.

9 recordsLinked to original sources

PubMed2006

Predictive risk factors for stiff knees in total knee arthroplasty.

Retrospective review of 1216 primary total knee arthroplasties (TKAs) to evaluate incidence and predictors of arthrofibrosis, defined as flexion less than 90 degrees 1 year post-TKA. Incidence of stiffness post-TKA was 3.7% (45/1216). A matched case-control study was then conducted to identify predictive factors for this outcome. Preoperative flexion and intraoperative flexion were predictive of ultimate postoperative flexion (P = .001 and P = .039, respectively). There was no correlation between postoperative stiffness and specific medical comorbidities, including diabetes. Preoperative and postoperative relative decreased patellar height and stiffness postoperative were significantly correlated (P = .001). Although stiffness post-TKA is multifactorial, careful attention to surgical exposure, restoring gap kinematics, minimizing surgical trauma to the patellar ligament/extensor mechanism, appropriate implant selection, and physiotherapy combined with a well-motivated patient may all serve to reduce the incidence of stiffness post-TKA.

Aged↗

PubMed2006

Incidence and timing of myocardial infarction after total joint arthroplasty.

Retrospective review of 3471 patients who underwent total joint arthroplasty (TJA) (1479 hips, 1992 knees) to determine the incidence and timing of inhospital myocardial infarction (MI) after TJA. Sixty-three patients (1.8%; 95% CI, 1.4%-2.4%) suffered a perioperative MI occurring at a mean of 3 days post surgery. In multivariate analysis, increased age, body mass index, bilateral TJA, diabetes, and American Society of Anesthesiologists rating 3 were associated with perioperative MI. Our data cautions against hospital discharge within 3 days of surgery.

Aged↗

PubMed2004

Robot-assisted orthopedic surgery.

The main advantages of robot-assisted orthopedic surgery over conventional orthopedic techniques are improved accuracy and precision in the preparation of bone surfaces, more reliable and reproducible outcomes, and greater spatial accuracy. Orthopedic surgery is ideally suited for the application of robotic systems. The ability to isolate and rigidly fix bones in known positions allows robotic devices to be securely fixed to the bone. As such, the bone is treated as a fixed object, simplifying the computer control of the robotic system. Commercially available robotic systems can be categorized as either passive or active devices, or can be categorized as positioning or milling/cutting devices. Computer assisted orthopedic surgery is a related area of technological development in orthopedics; however, robot-assisted orthopedic surgery can achieve levels of accuracy, precision, and safety not capable with computer assisted orthopedic surgery. Applications of robot-assisted orthopedic surgery currently under investigation include total hip and knee replacement, tunnel placement for reconstruction of knee ligaments, and trauma and spinal procedures. Several short-term studies demonstrate the feasibility of robotic applications in orthopedics, however, there are no published long-term data defining the efficacy of robot-assisted orthopedic surgery. Issues of cost, training, and safety must be addressed before robot-assisted orthopedic surgery becomes widely available. Robot-assisted orthopedic surgery is still very much in its infancy but it has the potential to transform the way orthopedic procedures are done in the future.

Humans↗

PubMed2003

Predictors of early and late instability following conservative treatment of extra-articular distal radius fractures.

INTRODUCTION: The purpose of this study was to identify radiological predictors of early and late instability following conservative treatment of extra-articular distal radius fractures. MATERIALS AND METHODS: An observational study design was employed using patient records and standardized radiological follow-up examinations as data sources. The database at a single institution was used to identify all patients with extra-articular distal radius fractures over the course of 1 year. A total of 71 patients with extra-articular distal radius fractures (50 dorsally displaced, 21 undisplaced) fulfilled the inclusion criteria. Patients were predominantly female (87%) with a pooled mean age of 64.9 years. All patients with displaced extra-articular distal radius fractures underwent closed reduction with subsequent cast immobilization. Undisplaced fractures were simply treated with cast immobilization. The primary outcomes were early (1 week) and late (6 weeks) instability of the fracture. Instability was defined as: (1) dorsal tilt >15 degrees, (2) volar tilt >20 degrees, (3) ulnar variance >4 mm, (4) radial inclination <10 degrees. RESULTS: Degree of radial shortening and volar tilt were predictive of early instability ( p<0.05), with dorsal comminution also approaching statistical significance ( p=0.06). Radial inclination, age, radial shortening, and volar tilt were predictive of late failure ( p<0.05). An unexpected result showed that one-third of undisplaced fractures went on to fail, most of which occurred in those patients over the age of 65 years. CONCLUSION: An awareness of independent predictors of instability in extra-articular distal radius fractures is helpful in anticipating the final alignment outcome.

Age Distribution↗

PubMed2003

Femoral head resurfacing for the treatment of osteonecrosis in the young patient.

We reviewed the clinical and radiographic results of 29 consecutive femoral head resurfacing procedures in 28 patients with avascular necrosis done from February 1997 until April 2000. There were 18 males and 10 females with an average age of 31.6 years (range, 12-48 years). The average Harris hip score significantly improved from 48.1 points preoperatively to 79.3 points at last followup. At final followup, 17 patients (18 hips [62%]) reported feeling much better or better than they did before hemiresurfacing. The overall survivorship was 75.9% at 3 years. Eight hips (27.6%) were converted to a total hip arthroplasty (THA) at an average 18 months (range, 8-43 months) after resurfacing. The results of this study suggest that femoral head resurfacing in a young patient with ON can greatly improve symptoms. The majority of patients were satisfied with the procedure but outcomes are unpredictable with only 62.5% of patients reporting satisfaction and good pain relief at last followup. We continue to offer this procedure in young patients with large necrotic lesions with the understanding that this procedure provides somewhat unpredictable pain relief; however, hemiresurfacing avoids the negatives associated with a bearing surface.

Adolescent↗

PubMed2002

Humeral shaft fractures as predictors of intra-abdominal injury in motor vehicle collision victims.

To assess the utility of humeral shaft fractures as predictors of organ injuries and skeletal injuries in multiply injured patients involved in motor vehicle collisions (MVCs). A prospectively collected database of multiply injured motor vehicle occupants with an Injury Severity Score (ISS) greater than 12 admitted to a level I regional trauma centre during a 102-month period (January 1992 to June 2000) was reviewed to assess skeletal and organ injuries associated with a humeral shaft fracture. The effect of occupant location within the vehicle, the point of collision, and the use of a seat belt restraint was also examined to identify trends in injury patterns. Data from 1070 motor vehicle occupants - 65 with concomitant humeral shaft fractures and 1005 without humeral shaft fractures - revealed that 63% of motor vehicle occupants who sustained humeral fractures were drivers, compared with 77% in the non-humeral fracture group. Those patients who sustained a humeral shaft fracture had a significantly greater number of liver injuries (p = 0.022), forearm/hand fractures (p < 0.001), tibial fractures (p < 0.01) and femoral fractures (p < 0.01) compared with controls. A lateral collision impact showed a trend towards increased splenic and hepatic injuries within the humeral shaft fracture group. The presence of a humeral shaft fracture in a multiply injured patient involved in a MVC is significantly associated with an increased incidence of both upper and lower extremity fractures and liver injury. Moreover, humeral shaft fractures may serve as a predictor of potential intra-abdominal pathology in multiply injured trauma patients involved in MVCs.

Abdominal Injuries↗

PubMed2002

The biomechanical effect of high-pressure irrigation on diaphyseal fracture healing in vivo.

OBJECTIVES: To evaluate the effect of both high-pressure pulsatile lavage and bulb syringe irrigation on the biomechanical parameters of fracture healing using an in vivo open noncontaminated diaphyseal femoral fracture model in rats. BACKGROUND: The utility of high-pressure pulsatile lavage irrigation on soft tissue debridement has been extrapolated to a similar perceived benefit in the debridement of bone. However, there have been several reports of a possible deleterious effect that high-pressure pulsatile lavage may have on bone architecture, intramedullary bacterial and contaminant seeding, and fracture healing. Although a previous in vivo histologic study suggests damage to bone architecture and impairment of early bone formation, it remains unclear whether these microscopic findings translate to a detectable decline in the biomechanical strength of the healing fracture. To our knowledge, there have been no reports of the in vivo effects high-pressure pulsatile lavage on fracture healing in open diaphyseal fractures. MATERIALS AND METHODS: Using sterile technique, standard open transverse mid-shaft femur fractures were created in thirty-six rats randomized into three groups: a control group underwent retrograde intramedullary pinning only; a bulb syringe irrigation group and a high-pressure pulsatile lavage group underwent identical procedures as the control group, except that the osteotomy site was irrigated with bulb syringe irrigation and high-pressure pulsatile lavage, respectively, before insertion of the intramedullary pin. Six rats from each group were killed at three weeks and six weeks, and the femora was mechanically tested in bending. RESULTS: Mechanical testing of the thirty-six femora revealed that the peak bending force (17.7 +/- 10.2 N) and stiffness (21.2 +/- 5.1 N/mm) of the healing fracture in the high-pressure irrigation group were significantly lower at three weeks when compared with the control (peak force, 28.1 +/- 5.9 N; stiffness, 31.4 +/- 5.8 N/mm) and the bulb syringe (peak force, 27.7 +/- 3.3 N; stiffness, 23.6 +/- 4.5 N/mm) irrigation groups (p < 0.05). The 37 percent lower peak bending force and 32 percent lower stiffness in the high-pressure pulsatile lavage group after three weeks of fracture healing were not present in the femora tested at six weeks. The high-pressure pulsatile lavage group did reveal a trend toward a lower peak bending force and stiffness after six weeks of fracture healing when compared with the control and bulb syringe irrigation groups, but the differences were not statistically significant at the 95 percent level. CONCLUSIONS: The use of high-pressure pulsatile lavage in open noncontaminated diaphyseal femur fractures in rats has a significant negative impact on the mechanical strength of the fracture callous during the early phases (three weeks) of fracture healing. However, it appears that the early deleterious effect of high-pressure pulsatile irrigation is not apparent in the late phases (six weeks) of fracture healing. Further study is required to evaluate the effect of high-pressure pulsatile lavage on fracture healing in the presence of wound contamination, fracture comminution, and soft tissue damage. CLINICAL SIGNIFICANCE: The findings of this study suggest that selective use of high-pressure irrigation in the management of open fractures appears warranted. In situations in which high-pressure lavage may be deleterious to bone healing, alternative strategies that optimize bacterial removal from soft tissues while preserving bone architecture will need to be investigated.

Animals↗

PubMed2001

Valgus high tibial osteotomy. Comparison between an Ilizarov and a Coventry wedge technique for the treatment of medial compartment osteoarthritis of the knee.

A matched-pair comparative analysis was done comparing outcomes between a Coventry-type closing wedge valgus high tibial osteotomy (HTO) and an HTO using an Ilizarov apparatus. Thirty patients were treated with a mean follow-up interval of 28.1 months. Functional outcomes were evaluated using the Western Ontario and McMaster University (WOMAC) osteoarthritis index. Clinical and radiographic assessment of the index knee, complications, and over-all satisfaction of the patients were assessed. The procedures were performed between 1994 and 1997. The two groups were equal with respect to baseline demographics - age, sex, body mass index, smoking status. The patients undergoing an Ilizarov HTO had a significantly greater decrease in pain and increase in function at final follow-up assessment. Eleven of the 15 patients in the Ilizarov group were satisfied with the procedure compared to five in the closing wedge HTO group. The treatment of medial compartment osteoarthritis in genu varum of the knee with an Ilizarov apparatus produces outcomes that are comparable to the standard lateral closing wedge osteotomy.

Female↗

PubMedDate not supplied

Outcomes of intramedullary nail fixation through the olecranon apophysis in skeletally immature forearm fractures.

The objective of this study was to quantitatively investigate the long-term radiologic and functional outcomes of antegrade intramedullary (IM) nailing through the olecranon apophysis for ulnar fractures in skeletally immature patients. A retrospective review was conducted of skeletally immature patients with ulnar fractures that had antegrade IM nail fixation through the olecranon apophysis. Patients were excluded if they had a previous forearm fracture or a fracture of the contralateral forearm. Functional measures included the Activities Scale for Kids (ASK) questionnaire for patients younger than 15 years of age and the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire for patients older than 15 years of age. Forearm range-of-motion measurements were collected from the fractured forearm and the contralateral control forearm. Radiologic outcomes were evaluated for ulnar, olecranon, coronoid, and trochlear notch proportions. Nineteen patients were evaluated. The average age at operation was 10.8 years (range 1.6-15.9) and the mean follow-up time was 3.4 years (range 1.2-7.2). Nine patients completed the ASK questionnaire, with a mean score of 93.9 (range 68.9-100), and 10 patients completed the DASH questionnaire, with a mean score of 6.0 (range 0-35). The mean fractured forearm supination was 103.2 degrees compared with 109.2 degrees on the control forearm (P < 0.05). Furthermore, the mean fractured forearm trochlear notch width was 17.7 mm compared with 17.1 mm on the control forearm (P < 0.05). Similarly, the mean fractured forearm trochlear notch height was 16.5 mm compared with 17.0 mm on the control forearm (P < 0.05). This retrospective review suggests that antegrade IM nail fixation through the olecranon apophysis for ulnar fractures in skeletally immature patients is a safe procedure. There is no significant ulnar length disruption or functional limitations, despite the differences in trochlear notch measurements and supination between the fractured and control forearms. Overall, IM nail fixation through the olecranon apophysis for surgically indicated ulnar fractures has minimal outcome limitations, with no evidence of prospective growth disruption. A larger randomized prospective trial should be conducted to strengthen the evidence of this study.

Adolescent↗