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Biomedical subjects

Joseph D Zuckerman

Publications and source records attributed to Joseph D Zuckerman.

At least 19 recordsLinked to original sources
PubMed2007

Reconstructing proximal humeral fractures using the bicipital groove as a landmark.

Controversy persists in the literature regarding the use of the bicipital groove as an anatomic landmark to restore humeral head retroversion when treating complex proximal humeral fractures with arthroplasty. We quantified the three-dimensional geometry of the bicipital groove in 49 dried humeri relative to the intramedullary axis, quantified the reliability of using the bicipital groove as an anatomic landmark, and compared this reliability with that of the conventional technique that uses a fixed, average angle relative to the epicondylar axis to establish humeral head retroversion. The data show the anterior offset of the bicipital groove is nearly constant from proximal (7.3 mm +/- 2.8 mm) to distal (7.2 mm +/- 1.5 mm) relative to the intramedullary axis. Given the consistency, the distal bicipital groove (at the level of the surgical neck) is a reasonable landmark to establish humeral head retroversion after complex proximal humeral fractures having reliability (angular error of 7.9 degrees +/- 5.8 degrees) as good as or better than the conventional fixed-angle technique.

Humans↗
PubMed2006

The effect of cartilage-derived morphogenetic protein 2 on initial healing of a rotator cuff defect in a rat model.

This animal study evaluated the healing of supraspinatus tendon tears by use of a cartilage-derived morphogenetic protein 2 growth factor (CDMP-2) delivered to the repair. Forty-eight rats had bilateral, surgically created complete tears repaired by sutures with the growth factor introduced on one side. They were killed at 2, 3, 4, and 6 weeks, and the strength of the repairs was determined and histologic analysis performed. At 4 and 6 weeks, the CDMP-2-treated repairs were significantly stronger than the untreated repairs and histologic analysis showed more organized healing. The use of growth factors introduced at the time of rotator cuff repair might promote more rapid healing and subsequent, rapid patient rehabilitation.

Animals↗
PubMed2006

Increasingly conflicted: an analysis of conflicts of interest reported at the annual meetings of the Orthopaedic Trauma Association.

PURPOSE: To identify trends in industry sponsorship of orthopaedic trauma research presented at the annual meetings of the Orthopaedic Trauma Association since the establishment of conflict of interest (COI) reporting policies in 1993. BACKGROUND: Industry plays a large role in funding orthopaedic basic science and clinical research. The purpose of this study was to analyze the role of industrial support in orthopaedic research as documented in the final programs of the annual meetings of the Orthopaedic Trauma Association (OTA), determine the incidence and nature of COI in the papers and posters accepted for OTA presentation, and report any changes in the frequency of reporting since disclosure policies were enacted in 1993. METHODS: This paper analyzes COI for all years since the adoption of the reporting policies 1993-2002. From 1993-1998, presenters of posters and papers presented at the Orthopaedic Trauma Association annual meetings were required to disclose COI greater than dollar 500, the type of monetary distribution was not recorded. From 1999-2002, presenters of posters and papers were required to acknowledge the type of COI: 1. research grant, 2. miscellaneous non-income support, 3. royalties, 4. stock, and 5. consultant fees. All COI categories were recorded for each year Linear regression was used to determine significance of trends in the pooled data. RESULTS: There was an increase in the percentage of papers accepted and presented at the OTA between 1993 and 2002 with COI. The number of papers reporting COI rose from 7.6% in 1993 to 12.6% in 2002 (p = 0.0129). There was no significant increase in posters with COI over that same time period. No changes were observed in the nature of industrial involvement since the change in reporting enacted in 1999. There were no observed trends in NIH or OTA grant distribution between 1993 and 2002. DISCUSSION AND CONCLUSION: Industry is playing an increasing role in the funding oforthopaedic research. The majority of industrial support is in the form of research grants. The increasing industrial support of scientific research in the public sector is to be applauded as long as it does not lead to the sequestering and suppression of information that may be disadvantageous to the industrial sponsor.

Authorship↗
PubMed2006

A survey of decision-making processes in the treatment of common shoulder ailments among primary care physicians.

To encourage consistent care for patients with musculoskeletal complaints, the AAOS developed treatment algorithms to aid primary care physicians in the management of these patients. A survey was designed to assess whether a random group of primary care physicians treated their patients in a manner consistent with these algorithms. The AAOS algorithm for shoulder pain was used to develop a questionnaire for primary care physicians. An Internet company provided access to a national base of physicians who volunteered to complete the survey. Ten questions were presented on five shoulder conditions: rotator cuff disease, fractures, instability, arthritis, and frozen shoulder The "correct" answer was based upon the AAOS algorithm. The survey was completed by 706 physicians who treated variable (one to greater than ten) numbers of shoulder patients per month. Forty-eight percent of the physicians treated acute trauma according to the algorithm, 87% treated arthritis, and 58% treated instability. Only 46% of physicians chose the correct answer for an acute rotator cuff tear and 29% for chronic rotator cuff symptoms. Forty-four percent followed the algorithm for frozen shoulder. Overall only 49% of the patients described were treated according to the AAOS algorithms. Based on the number of shoulder patients seen each month, in one month over 2000 patients could be tested by the surveyed physicians in a manner inconsistent with the treatment algorithms, suggesting the need for improved musculoskeletal education for primary care physicians.

Algorithms↗
PubMed2005

Gender differences in patients with hip fracture: a greater risk of morbidity and mortality in men.

OBJECTIVE: To determine gender-specific differences in prefracture status and postoperative outcome in elderly hip fracture patients who were ambulatory, community-dwelling, and cognitively intact prior to fracture. DESIGN: Retrospective analysis of prospectively collected data. SETTING: Urban orthopedic referral hospital. PATIENTS: A total of 983 consecutive patients (206 males and 777 females) who sustained a nonpathologic hip fracture were followed for a minimum of 12 months. INTERVENTION: Operative treatment of a proximal femur fracture. MAIN OUTCOME MEASUREMENTS: Postoperative medical complications, place of discharge, 1-year mortality, and postoperative recovery of ambulation, basic activities of daily living, and instrumental activities of daily living. RESULTS: Men were more likely to be married or living with someone else, and they were more dependent in instrumental activities of daily living than women prior to hip fracture. Furthermore, men were sicker as evidenced by a higher American Society of Anesthesiologists rating of preoperative risk. Postoperatively, men were more likely to sustain a medical complication and had a higher mortality at 1 year compared to women. There were no statistically significant gender differences in patient age, fracture type, prefracture level of help, ambulation, or dependence in basic activities of daily living, place of discharge, and postoperative recovery of ambulation as well as basic and instrumental activities of daily living. CONCLUSIONS: Male gender was a risk factor for sustaining a postoperative complication as well as a higher mortality at 1 year post hip fracture.

Activities of Daily Living↗
PubMed2005

Management of bone loss associated with recurrent anterior glenohumeral instability.

The diagnosis and treatment of osseous deficiencies associated with anterior shoulder instability have been a challenge to physicians for centuries. Whereas historical goals centered on the stable reduction and prevention of recurrent dislocation, current standards of success are predicated on the restoration of motion and strength and the return to functional activities, including competitive athletics. Reestablishment of anterior shoulder stability thus requires the recognition of osseous defects of the humeral head and glenoid, as well as a thorough understanding of the available treatment options in the context of a disciplined treatment algorithm. Although many surgical procedures have been described for the management of osseous deficiencies in association with anterior shoulder instability, in the authors' experience, such procedures are seldom necessary. The purpose of this summary is to review treatment options as well as indications and techniques to address these bony deficiencies.

Bone Density↗
PubMed2005

The early effects of code 405 work rules on attitudes of orthopaedic residents and attending surgeons.

BACKGROUND: The impact of strict enforcement of Section 405 of the New York State Public Health Code to restrict resident work to eighty hours per week and the adoption of a similar policy by the Accreditation Council on Graduate Medical Education in 2002 for orthopaedic residency training have not been evaluated. Adoption of these rules has created accreditation as well as staffing problems and has generated controversy in the surgical training community. The purposes of this study were (1) to evaluate the attitudes of orthopaedic residents and attending surgeons toward the Code 405 work-hour regulations and the effect of those regulations on the perceived quality of residency training, quality of life, and patient care and (2) to quantify the effect of the work-hour restrictions on the actual number of hours worked. METHODS: We administered a thirty-four-question Likert-style questionnaire to forty-eight orthopaedic surgery residents (postgraduate years [PGY]-2 through 5) and a similar twenty-nine-question Likert-style questionnaire to thirty-nine orthopaedic attending surgeons. All questionnaires were collected anonymously and analyzed. Additionally, resident work hours before and after strict enforcement of the Code 405 regulations were obtained from resident time sheets. RESULTS: The average weekly work hours decreased from 89.25 to 74.25 hours for PGY-2 residents and from 86.5 to 73.25 hours for PGY-3 residents, and they increased from 61.5 to 68.5 hours for PGY-4 residents. Residents at all levels felt that they had increased time available for reading. There was general agreement between attending and resident surgeons that their operating experience had been negatively impacted. Senior residents thought that their education had been negatively affected, while junior residents thought that their operating experience in general had been negatively affected. Senior residents and attending surgeons felt that continuity of care had been negatively impacted. All agreed that quality of life for the residents had improved and that residents were more rested. CONCLUSIONS: On the basis of the survey data, the implementation of the new work-hour restrictions was found to result in a decrease in the number of hours worked per week for PGY-2 and PGY-3 residents and in an increase in work hours for PGY-4 residents. This could explain the definite difference between the attitudes expressed by the senior residents and those of the junior residents. Senior residents felt that their education was negatively impacted by the work rules, while junior residents expressed a more neutral view. However, senior residents did not believe that their operative experience was as negatively impacted as did junior residents. Although junior and senior residents and attending surgeons agreed that resident quality of life had improved, we were not able to determine whether this offset the perceived negative impact on education, continuity of care, and operative experience.

Attitude of Health Personnel↗
PubMed2005

The effects of weather and seasonality on hip fracture incidence in older adults.

This study examined the effect of weather and seasonality on hipfracture incidence in older adults residing in New York City. A total off 66,346 patients aged > or = 65 years who sustained a fracture of the femoralneck or intertrochanteric region from 1985 to 1996 comprised the study population. Hip fractures were more likely to occur in the winter than in any of the other seasons (P<.001). Factors significantly correlated with hip fractureincluded minimum daily temperature (r=.167, P<.001), daily wind speed (r=.166, P<.001), maximum daily temperature (r=.155, P<.001), minutes of sunshine (r=.067, P<.01), and average relative humidity (r=.033, P=.03). A greater number of hip fractures occurred in colder months, withambient temperature rather than any adverse circumstances related to rainor snowfall associated most closely to injury. As most fractures occurredindoors, precipitation is less likely to play a part in hip fracture occurrence in this population.

Aged↗
PubMed2005

What's new in hip fractures? Current concepts.

Hip fractures have been among the most studied injury patterns in adults. The number of hip fractures is increasing exponentially, and their treatment costs place great economic strain on society. Recently developed hip fracture treatments, emphasizing cost containment, deformity prevention, and evidence-based medicine, are attempts to optimize patient outcomes. In this article, we outline some of these developments with respect to femoral neck and intertrochanteric fractures.

Bone Screws↗
PubMed2005

Outcome after treatment of proximal humeral fractures with humeral head replacement.

After its initial description by Neer and associates, humeral head replacement has been widely used to treat complex fractures of the proximal humerus. Many studies have confirmed that the treatment of proximal humeral fractures with humeral head replacement is associated with reliable pain relief as well as good patient satisfaction. A limited number of studies have also suggested that the prostheses have reasonable longevity, with the rate of prosthesis survival at 83% to 94% at 10 years. The functional outcome after the procedure, however, has not been as predictable. Using various outcomes scoring instruments, multiple studies have reported a wide range of results. Some authors have reported mostly disappointing outcomes, whereas others have reported generally satisfactory results. The most critical factor influencing the long-term outcome appears to be the position of the greater tuberosity. Other factors that are also associated with a good outcome include younger age, minimal delay between the traumatic event and the surgical procedure, and the absence of any neurologic deficit. For young patients with a complex proximal humeral fracture, humeral head replacement still remains a viable treatment option. However, whenever possible, most authors favor open reduction and internal fixation because of the issues affecting the longevity of the prosthesis. By understanding and minimizing the risk factors leading to a poor result, a reasonable functional outcome, reliable pain relief and a high rate of patient satisfaction can be expected after treatment of proximal humeral fractures with humeral head replacement.

Adult↗
PubMed2005

Complications of humeral head replacement for proximal humeral fractures.

Humeral head replacement has been widely used for the treatment of complex proximal humeral fractures. The procedure is associated with a high rate of patient satisfaction as well as reliable relief of pain. The functional outcomes, however, have been variable. Reported complications include infection, neurologic injury, intraoperative fracture, instability, tuberosity malunion and nonunion, rotator cuff tear, heterotopic ossification, glenoid erosion, and stiffness. When technical factors such as tuberosity malunion or component malpositioning are considered as postoperative complications, the incidence of complications is relatively high. This high rate of complications, in turn, may be related to the wide range of reported functional outcomes.

Arthroplasty, Replacement↗
PubMed2005

Temporal and geographic variation in hip fracture rates for people aged 65 or older, New York State, 1985-1996.

We describe temporal and regional variation in hip fracture rates for people aged 65 or older in New York state (NYS) from 1985 to 1996. Our descriptive study was of all hip fracture cases admitted to NYS hospitals during that period. Case data were obtained from the Statewide Planning and Research Cooperative System (SPARCS) of the NYS Department of Health. US Census Bureau population estimates were obtained for each year from 1985 to 1996 to compute the annual hip fracture rate for each NYS county. These rates were adjusted for differences in age, gender, and race and were compared using logistic regression. Approximately 14,000 hip fractures occurred annually from 1985 to 1996. The annual rate (number of hip fractures per 1000 population) decreased from 6.4 in 1985 to 5.3 in 1996. White women aged 85 or older had the highest rate (26/1000); nonwhite men aged 65 to 69 had the lowest rate (<1/1000). Statewide annual rates decreased slightly over time, but this change was not reflected in all age, gender, and race subgroups. There was important, consistent variation in county rates after adjustment for age, gender, and race. Other researchers have identified geographic variation in national rates, but the postulated environmental and weather-related factors (eg, water fluoridation use; rainfall and sunshine amounts) have explained only a small proportion of this variation. Identification of risk factors that can better explain regional rate variation may lead to development of intervention strategies that could significantly reduce the risk for hip fracture among people 65 or older.

Age Factors↗
PubMed2005

The effect of greater tuberosity placement on active range of motion after hemiarthroplasty for acute fractures of the proximal humerus.

Union of the greater tuberosity to the humeral shaft after hemiarthroplasty for acute fractures of the proximal humerus is a critical factor in the restoration of glenohumeral function. A retrospective review was undertaken to examine 23 consecutive patients who underwent hemiarthroplasty for the treatment of acute three- and four-part fractures of the proximal humerus. The study was conducted to examine the relationship between the position of the healed greater tuberosity and postoperative range of motion. The average age of the patients was 66.5 years. The average follow up was 3.8 years with a range of 24 to 108 months. Active range of motion was measured in forward elevation, external rotation, and internal rotation. Postoperative radiographs were examined to determine the position of the united greater tuberosity in relation to the top of the replaced humeral head. The tuberosity was fixed at an average of 15.4 mm below the top of the humeral head (range: 3 to 26 mm). A radiographic assessment of a control population of 50 normal proximal humeri demonstrated an average tuberosity position of 6.7 mm (range: 2 to 12 mm) below the superior aspect of the humeral head. Polynomial regression analysis demonstrated a polynomial relationship for active range of motion and tuberosity height. ANOVA testing demonstrated statistically significant differences in all ranges of motion. Active forward elevation for Group I (3 to 9 mm) was 88 degrees, Group 11 (10 to 16 mm) was 126 degrees, and Group III (17 to 26 mm) was 85 degrees (p = 0.04). Active external rotation for Group I was 19 degrees, Group II was 48 degrees, and Group III was 29 degrees (p = 0.01). Active internal rotation for Group I was to L2, Group II was to T10, and Group III was to L2 (p = 0.01). Although many factors affect the final ranges of motion in patients who undergo prosthetic replacement for acute proximal humeral fractures we believe that placement of the greater tuberosity 10 to 16 mm below the humeral head will assist in the maximum recovery of glenohumeral motion.

Adult↗
PubMed2005

Recurrent anterior glenohumeral instability with onset after forty years of age: the role of the anterior mechanism.

Recurrent instability in patients over forty years of age is felt to occur primarily as a result of an associated rotator cuff tear. This is often referred to as the "posterior mechanism." We reviewed our patients over the age of forty who underwent an anterior shoulder repair to identify the incidence of capsulolabral detachments and the role of an "anterior mechanism" in this patient population. A retrospective review of all patients from 1985 to 2000 was performed to identify patients who had surgery for recurrent instability that began after forty years of age. Of the 265 patients records reviewed, 11 patients were identified who fulfilled the inclusion criteria. Of the 11 patients identified, 9 patients underwent anterior capsulolabral reconstruction for recurrent instability; the remaining two patients underwent repair of large rotator cuff tears. All 9 patients had a capsulolabral detachment, 4 had a rotator interval defect, 2 had anterior and inferior capsular redundancy, 1 had a small rotator cuff tear and 1 had an anterior capsular avulsion from the humeral head. At minimum follow-up of 32 months none of the patients reported episodes of instability. The reported incidence of rotator cuff tears in patients over the age of forty following an initial traumatic anterior glenohumeral dislocation ranges from 35% to 100%. When recurrent instability occurs, it is postulated to occur via a "posterior mechanism" (i.e., secondary to a significant full-thickness rotator cuff tear). However, all of our patients had an anterior capsulolabral detachment as the "common lesion" associated with recurrent instability. Although small, this series emphasizes the role of the "anterior mechanism" in patients who develop recurrent instability after the age of forty. A high rate of success was achieved by addressing the pathoanatomic changes identified.

Adult↗
PubMed2005

Revision anterior shoulder repair for recurrent anterior glenohumeral instability.

Although the operative management of recurrent anterior glenohumeral instability has received significant attention in literature, the outcome of revision anterior shoulder repair is much less frequently reported. We report the results of our experience with this challenging problem. Retrospective chart review identified 29 patients who underwent revision anterior shoulder repair. Prior procedures included eight Bankart repairs, seven capsular shifts, 10 combined Bankart and capsular shift procedures, three Putti-Platt procedures, two staple capsulorrhaphies, two Bristow procedures, seven arthroscopie procedures, and one Magnuson-Stack. The average age of the patients was 31.6 years (range: 18 to 52 years) and the dominant extremity was involved in 69%. Findings at the time of revision anterior shoulder repair included 22 patients with capsulolabral detachment, 24 with capsular redundancy, and 14 with rotator interval defects. Twenty-three of the 29 patients were available for at least a two-year follow-up. Twenty-one (91%) remain stable. One patient was non-compliant with the postoperative immobilization and re-dislocated within the first month. The second patient, who had a prior Bankart procedure followed by a capsular shift two years later, underwent a capsular shift for significant capsular laxity. He re-dislocated approximately 15 months postoperatively. Our success rate of 91% in this small series approaches the results of primary open repair for recurrent glenohumeral instability. To achieve a successful outcome, it is essential to address all pathology at the time of revision repair.

Adult↗