Biomedical subjects

Eric J Strauss

Publications and source records attributed to Eric J Strauss.

9 recordsLinked to original sources

PubMed2007

Glove tears during arthroscopic shoulder surgery using solid-core suture.

PURPOSE: Surgeons have noticed an increased incidence of finger lacerations associated with arthroscopic knot tying with solid-core suture material. This study examines glove perforations and finger lacerations during arthroscopic shoulder surgery. METHODS: We collected 400 surgical gloves from 50 consecutive arthroscopic shoulder repair procedures using No. 2 solid-core sutures. Two surgeons using double gloves were involved in every case, with one being responsible for tying all knots. Powder-free latex gloves were worn in all cases. Knots consisted of a sliding stitch of the surgeon's preference followed by 3 half-hitches via a knot-pusher instrument. All gloves were inspected grossly and then tested for tears with an electroconductivity meter. RESULTS: The knot-tying surgeon had significantly more glove tears than the control (P < .01). Tears were localized to the radial side of the index finger of the glove at the distal interphalangeal joint in all cases. Of the tying surgeon's gloves, 68 (34%) were found to have tears. These included 17 inner gloves (17%) and 51 outer gloves (51%). If an inner glove was torn, the corresponding outer glove was torn in all cases. A mean of 3.96 knots were tied in each case. There was a significantly higher incidence of inner glove tears when more than 3 knots were tied (P < .03). There was no significant difference in glove tears between suture types. Finger lacerations did occur in the absence of glove tears. However, in the presence of an inner glove tear, there was a statistically significant association with a finger laceration at the corresponding level (P < .03). CONCLUSIONS: Intraoperative glove tears and subsequent finger lacerations occur with a high frequency when arthroscopic knots are tied with solid-core suture material. Risk can potentially be minimized by frequent glove changes or use of more durable, less penetrable gloves. CLINICAL RELEVANCE: This study addresses surgeon and patient safety during arthroscopic shoulder surgery.

Arthroscopy↗

PubMed2006

Arthroscopic-assisted core decompression of the humeral head.

Humeral head osteonecrosis is a progressive disease that requires prompt diagnosis and treatment. Core decompression is a viable treatment option for early-stage cases. Most surgeons perform core decompression by arthroscopically visualizing the necrotic area of bone and using a cannulated drill to take a core. Several attempts are frequently needed to reach the proper location. In the hip multiple passes are associated with complications. We describe the use of an anterior cruciate ligament (ACL) tibial drill guide to precisely localize the area of necrotic bone. Diagnostic arthroscopy is performed to assess the areas of osteonecrosis. Core decompression is performed by use of an ACL tibial guide, brought in through the anterior or posterior portal to precisely localize the necrotic area in preparation for drilling. Under image intensification, Steinmann pins are advanced into the area of osteonecrosis. Once positioned, several 4-mm cores are made. We treated 3 patients with this technique, and all had immediate pain relief. The use of the ACL guide allows precise localization of the area of humeral head involvement and avoids multiple drillings into unaffected areas. Initial indications are that arthroscopic-assisted core decompression with an ACL guide is an effective alternative to previously used methods.

Adult↗

PubMed2006

Operative treatment of acute Achilles tendon ruptures: an institutional review of clinical outcomes.

PURPOSE: To retrospectively review the clinical outcome and incidence of post-operative complications after open end-to-end repair of acute Achilles tendon ruptures. METHODS: Seventy consecutive patients (74 open Achilles tendon repairs) operated on between 1989 and 2002 were identified for inclusion in this investigation. The medical records were reviewed and patients were contacted for a follow up interview in order to survey their post-operative function. Outcome scores were calculated based on the Boyden outcome and AOFAS ankle-hindfoot scoring systems. Post-operative complications were documented during the chart review and follow up interview, including an additional nine patients (nine repairs), who were not included in the clinical evaluation portion of the study. RESULTS: Fifty-two patients (54 repairs) were successfully contacted and completed the follow up interview. Within this cohort there were 44 males and 8 females with a mean age of 41 years. Achilles tendon rupture in this population was attributable to participation in athletic activity in 87% of cases. At a mean post-operative follow up of 45 months, 96% of cases achieved an overall Boyden outcome score of good to excellent. The mean AOFAS ankle-hindfoot score was 96, with 74% of cases scoring greater than 90. Forty-two cases (78%) reported no pain and 40 cases (74%) reported no activity limitations. Fourteen post-operative complications were identified after 83 open Achilles tendon repairs, resulting in an institutional complication rate of 16.8%. The complications included four superficial wound infections, five deep wound infections requiring irrigation and debridement, one heel ulcer secondary to post-operative boot wear, three partial Achilles tendon re-ruptures, and one complete Achilles tendon re-rupture. CONCLUSION: Our results demonstrate that open end-to-end repair of acute Achilles tendon ruptures provides long-term functional outcomes with consistent good to excellent results. However, this high clinical success rate was associated with a relatively high incidence of post-operative complications. With careful attention to the surgical wound and patient adherence to post-operative rehabilitation protocols, operative repair of acute Achilles tendon ruptures is a reliable treatment for active patients.

Achilles Tendon↗

PubMed2006

Hybrid femoral fixation of soft-tissue grafts in anterior cruciate ligament reconstruction using the EndoButton CL and bioabsorbable interference screws: a biomechanical study.

PURPOSE: The purpose of this study was to evaluate the effect of hybrid femoral fixation with bioabsorbable interference screws (BioRCI; Smith & Nephew Endoscopy, Andover, MA) and EndoButton CL (Smith & Nephew Endoscopy) fixation. METHODS: Biomechanical testing of 3 different fixation techniques was performed by use of porcine hind-limb distal femurs and mature bovine extremity common extensor tendons. Two independent testing sessions were examined. The first testing session (group A) compared femoral fixation via the EndoButton CL device (n = 6) with femoral fixation via the EndoButton CL device with the addition of a BioRCI screw (n = 6). The second testing session (group B) compared femoral fixation via BioRCI screws alone (n = 6) with femoral fixation via the EndoButton CL device with the addition of a BioRCI screw (n = 6). The femur-graft complex was cyclically loaded between 50 and 250 N at 1 Hz for 1,000 cycles. After cycling, the amount of graft slippage was determined by measuring the change in grip-to-grip distance. The complex was then loaded to failure at 1 mm/s, and the ultimate tensile strength, stiffness, and mode of failure were determined. RESULTS: In group A the addition of an interference screw to the EndoButton CL fixation increased the ultimate tensile strength (1,364.7 +/- 102.4 N for EndoButton CL alone v 1,449.3 +/- 94.4 N for combined technique, P = .035) and stiffness (195.5 +/- 12.1 N/mm for EndoButton CL alone v 307.3 +/- 54.9 N/mm for combined technique, P = .004) and decreased the amount of graft slippage (2.6 +/- 0.5 mm for EndoButton CL alone v 2.0 +/- 0.3 mm for combined technique, P = .017). In group B the addition of the EndoButton CL device to interference screw fixation significantly increased the ultimate tensile strength (643.5 +/- 148.4 N for BioRCI screws alone v 1,290.3 +/- 254.4 N for combined technique, P = .004) but had no effect on stiffness (315.7 +/- 38.9 N/mm for BioRCI screws alone v 341.5 +/- 64.0 N/mm for combined technique, P = .267) or graft slippage (2.7 +/- 1.0 mm for BioRCI screws alone v 2.0 +/- 0.6 mm for combined technique, P = .087). CONCLUSIONS: Our study shows that hybrid femoral fixation of double-looped gracilis-semitendinosus grafts via the EndoButton CL device and a bioabsorbable interference screw is stronger than interference or EndoButton CL fixation alone with respect to ultimate tensile strength, stiffness, and slippage. The addition of an interference screw to suspensory fixation via the EndoButton CL device increased the ultimate tensile strength from 1,360 N to 1,450 N, improved reconstruction stiffness from 200 N/mm to 300 N/mm, and decreased the amount of graft slippage resulting from cyclic loading from 2.6 mm to 2.0 mm. CLINICAL RELEVANCE: The hybrid fixation of the EndoButton CL device and an interference screw is a stronger and stiffer construct than either device alone and allows for aperture fixation, which may translate into better clinical results.

Absorbable Implants↗

PubMed2006

Blisters associated with lower-extremity fracture: results of a prospective treatment protocol.

OBJECTIVES: To evaluate patient outcomes after treatment of lower-extremity fractures associated with blister formation and to assess complications after soft-tissue treatment using a prospective protocol. DESIGN: Retrospective evaluation of prospectively collected data. SETTING: Level I trauma center. PATIENTS/PARTICIPANTS: Between September 1999 and September 2003, 47 patients who had sustained a closed lower-extremity fracture with early development of fracture blisters in the zone of injury were followed. Blisters were characterized as either avoidable or unavoidable with respect to surgical incisions, and characteristics such as number, size, blood filled or clear filled, and the presence of an intact roof were documented. INTERVENTION: All blisters were unroofed, and antibiotic cream (silver sulfadiazine, Silvadene, King Pharmaceuticals Inc.) was applied twice daily until the blister bed had re-epithelialized. MAIN OUTCOME MEASUREMENTS: Fracture union and the development of wound or skin complications. Patient satisfaction with the cosmetic outcome of the treatment regimen was assessed through telephone survey at 23-month minimum follow-up. RESULTS: Twenty-eight patients presented with a single blister, and 19 had multiple blisters. Blister size averaged 9.7 cm. Twenty-two patients had blood-filled blisters, 20 had clear-filled blisters, and five had a combination of the two. Fracture patterns included 17 ankle fractures (OTA 44), 13 tibial plateau fractures (OTA 41), five tibial-shaft fractures (OTA 42), eight calcaneus fractures (OTA 45), and four pilon fractures (OTA 43). Mean delay in definitive surgical care was 7.7 days (range 0 to 20 days). The average delay of surgery for ankle fractures was 6 days (range 0 to 18 days), which was significantly less than the delay for calcaneus fractures (12 days, range 4 to 19 days, P < 0.02) and tibial plateau fractures (11 days, range 0 to 20 days, P < 0.02). Thirty-seven of the 45 patients (82.3%) available for follow-up at a mean of 27 weeks (range 14 to 35) had an uncomplicated postoperative course, and fracture union was achieved in 43 of 45 cases (95.6%). The soft-tissue complication rate associated with the standardized treatment regimen was 13.3% (6/45 cases), with three cases of minor soft-tissue breakdown, one superficial infection, and two major complications directly related to the presence of fracture blisters. Both major complications involved full-thickness skin breakdown occurring directly at the base of fracture blisters in patients with diabetes. The skin breakdown required further surgery in both cases. Including the two patients who developed nonunion, the overall complication rate for the treatment cohort was 17.7% (8/45 cases). At a mean follow-up of 51.9 months (range 23 to 73), three patients in the cohort had expired. Of the 42 patients available for evaluation, 28 patients (67%) were reachable for a telephone survey to assess satisfaction with the outcome of the fracture and soft-tissue management. Patients rated their satisfaction with the cosmetic appearance of their lower extremities after the standardized treatment regimen on a scale of 1 to 10 (with 10 representing very satisfied), with a mean of 9.07 (range 5 to 10). Six patients reported scarring at the sites of previous fracture blisters, all of which occurred after blistering of the blood-filled subtype. The presence of scarring significantly decreased patient satisfaction with cosmesis and overall treatment (P < 0.0001 and P < 0.01, respectively). CONCLUSIONS: Treatment of fracture blisters with a silver sulfadiazine (Silvadene) regimen proved to be successful in minimizing soft-tissue complications by promoting re-epithelialization in all nondiabetic patients. At long-term follow-up, patients were generally satisfied with the cosmetic outcome of the treatment regimen. Postoperative scarring, which was more common with blood-filled blisters, significantly impacted patient satisfaction. We urge caution when planning to make a surgical incision around an area of both full-thickness (blood-filled) and partial-thickness (clear-filled) fracture blisters in diabetic patients because the zone of injury might extend beyond the borders of the fracture blister.

Adult↗

PubMed2006

Outcomes analysis of revision total shoulder replacement.

BACKGROUND: The number of total shoulder arthroplasties has increased exponentially over the last ten years, creating a more prominent role for revision shoulder arthroplasty in the future. The main reasons for failure of shoulder arthroplasty can be classified as soft-tissue deficiencies, osseous deficiencies, component wear, or infection. We hypothesized that, despite appropriate surgical techniques, the outcome of revision total shoulder replacement can be predicted on the basis of the indication for the revision procedure. METHODS: We conducted a retrospective review of seventy-eight shoulders that had undergone revision shoulder arthroplasty. The shoulders were divided into two categories: (1) those with osseous or component-related problems and (2) those with soft-tissue deficiency. Category 1 consisted of four cohorts of shoulders: twenty-two treated with revision of the glenoid component, sixteen treated with conversion of a hemiarthroplasty to a total shoulder arthroplasty because of glenoid arthrosis, eight treated with revision of the humeral stem, and four treated for a periprosthetic fracture. Category 2 consisted of five cohorts of shoulders: ten treated with rotator cuff repair following total shoulder replacement, four with a failed tuberosity reconstruction, four with cuff tear arthropathy, five with instability, and five with infection. Patients were evaluated with the UCLA subjective outcome instrument, the L'Insalata shoulder questionnaire, and a subjective satisfaction scale (maximum score of 5 points). RESULTS: The average UCLA score was 21.4 points and the average L'Insalata score was 68.73 points for the seventy-eight shoulders that were analyzed. The average score on the subjective satisfaction questionnaire was 2.91 points. According to the UCLA scores, twenty-four revisions were considered to have had an excellent result; fifteen, a good result; twenty-four, a fair result; and fifteen, a poor result. The average scores for the category-1 shoulders were significantly better than those for the category-2 shoulders (p < 0.05). Of the different types of operations, revision or implantation of a glenoid component and open reduction and internal fixation of a periprosthetic fracture provided the best outcomes. Tuberosity reconstruction, hemiarthroplasty for treatment of cuff tear arthropathy, and revision due to infection had uniformly poor outcomes. CONCLUSIONS: In general, these results indicate that the outcome of revision shoulder arthroplasty can be predicted on the basis of the indication for the procedure. Component revisions, excluding humeral head revision for salvage, provide the best results, whereas soft-tissue reconstructions can be expected to yield poorer results overall. LEVEL OF EVIDENCE: Prognostic Level II. See Instructions to Authors for a complete description of levels of evidence.

Adult↗

PubMed2006

Nonsurgical complications after total hip and knee arthroplasty.

Postoperative medical complications after total hip arthroplasty (THA) and total knee arthroplasty (TKA) may occur in patients of any age. However, percentage of adverse events increases with increasing patient age and can cause significant morbidity and even mortality. It is important that the orthopedist identify risk factors and symptoms and be knowledgeable in the treatment of nonsurgical postoperative complications. Nonsurgical complications after THA and TKA include pulmonary embolism, fat embolism syndrome, pneumonia, myocardial infarction, postoperative delirium, cerebrovascular accident, urinary retention, urinary tract infections, and deep vein thrombosis.

Arthroplasty, Replacement, Hip↗

PubMed2005

Biochemical and biomechanical properties of lesion and adjacent articular cartilage after chondral defect repair in an equine model.

BACKGROUND: Chondral defects may lead to degradative changes in the surrounding cartilage, predisposing patients to developing osteoarthritis. PURPOSE: To quantify changes in the biomechanical and biochemical properties of the articular cartilage adjacent to chondral defects after experimental defect repair. STUDY DESIGN: Controlled laboratory study. METHODS: Specimens were harvested from tissue within (lesion), immediately adjacent to, and at a distance from (remote area) a full-thickness cartilage defect 8 months after cartilage repair with genetically modified chondrocytes expressing insulin-like growth factor-I or unmodified, control chondrocytes. Biomechanical properties, including instantaneous Young's and equilibrium aggregate moduli, were determined by confined compression testing. Biochemical properties, such as water and proteoglycan content, were also measured. RESULTS: The instantaneous Young's modulus, equilibrium modulus, and proteoglycan content increased, whereas water content decreased with increasing distance from the repaired lesion. The instantaneous Young's and equilibrium moduli of the adjacent articular cartilage were 80% and 50% that of remote area samples, respectively, whereas water content increased 0.9% and proteoglycan content was decreased by 35%. No significant changes in biomechanical and biochemical properties were found either in the lesion tissue or in adjacent cartilage with genetic modification of the chondrocytes. CONCLUSION: Articular cartilage adjacent to repaired chondral defects showed significant remodeling 8 months after chondral defect repair, regardless of whether genetically modified or unmodified cells were implanted. CLINICAL RELEVANCE: Changes in the biochemical and biomechanical properties of articular cartilage adjacent to repaired chondral defects may represent remodeling as part of an adaptive process or degeneration secondary to an altered distribution of joint forces. Quantification of these changes could provide important parameters for assessing progress after operative chondral defect repair.

Animals↗

PubMed2005

Arthroscopic thermal capsulorrhaphy as treatment for the unstable paralytic shoulder.

Patients who present with global capsular laxity and glenohumeral instability frequently can be treated successfully with shoulder girdle musculature strengthening exercises and activity modification. When such injury is caused by a paralytic shoulder, a rehabilitation program may not be a viable treatment option. Presented in this article are 3 patients with global capsular laxity and glenohumeral instability as a result of shoulder paralysis. We also describe an arthroscopic technique of thermal capsulorrhaphy. In our experience, arthroscopic thermal capsulorrhaphy used to treat global capsular laxity and glenohumeral instability resulting from a paralytic shoulder has decreased symptoms of shoulder instability and has significantly reduced shoulder pain.

Accidental Falls↗