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Biomedical subjects

Michael Zlowodzki

Publications and source records attributed to Michael Zlowodzki.

At least 19 recordsLinked to original sources
PubMed2006

Evidence-based resources and search strategies for orthopaedic surgeons.

Identification of information on a specific topic of interest can be a difficult and time-consuming task. The key to successful and time-efficient article identification is to use easily accessible, complete, and most up-to-date information sources and to perform a focused search that minimises hits without missing relevant articles. Pre-appraised articles and databases allowing "pre-filtering" techniques for high level evidence are useful for a quick search for the best available evidence. For a more comprehensive review, a combination of MEDLINE, EMBASE and meeting abstract databases is usually more than sufficient. Full-text publications can be obtained from the Cochrane library and from OVID.

Congresses as Topic↗
PubMed2006

Treatment of scapula fractures: systematic review of 520 fractures in 22 case series.

BACKGROUND: Fractures of the scapula account for 3% to 5% of all fractures of the shoulder girdle and make up less than 1% of all broken bones. Scapula fractures typically occur after high-energy trauma, and approximately 90% of the patients have associated injuries. OBJECTIVE: (1) To determine the incidences of nonoperative and operative treatment of different scapula fracture types, (2) to systematically stratify the reported results of nonoperatively and operatively treated scapula fractures on the basis of different fracture types and to summarize functional results, and (3) to quantify infection and secondary surgical procedure rates after operative treatment.

Adult↗
PubMed2006

Operative treatment of acute distal femur fractures: systematic review of 2 comparative studies and 45 case series (1989 to 2005).

BACKGROUND: The incidence of distal femur fractures is approximately 37 per 100,000 person-years. Typically, distal femur fractures are caused by a high-energy injury mechanism in young men or a low-energy mechanism in elderly women. Managing these fractures can be a challenging task. Most surgeons agree that distal femur fractures need to be treated operatively to achieve optimal patient outcomes. The articular fracture component is usually treated with open reduction and internal lag screw fixation or external tension wire fixation (Illizarov). However, there is no consensus on the type of implant for the fixation of the metaphyseal-diaphyseal fracture component. OBJECTIVE: The aim of this study is to systematically summarize and compare the results of different fixation techniques (traditional compression plating, antegrade nailing, retrograde nailing, submuscular locked internal fixation, and external fixation) in the operative management of acute nonperiprosthetic distal femur fractures (AO/OTA type 33A and C) and the characteristics of the fractures for each treatment (articular/nonarticular and open/closed). Additionally an attempt was made to evaluate the impact of surgical experience on nonunion rate, fixation failure rate, deep infection rate, and secondary surgical procedure rate. In the context of this article compression plating relates to techniques/implants that require compression of the implant to the femoral shaft-it does not relate to interfragmentary compression.

Adult↗
PubMed2006

Treatment of distal tibia fractures without articular involvement: a systematic review of 1125 fractures.

BACKGROUND: The management of unstable distal tibia fractures remains challenging. The mechanism of injury and the prognosis of these fractures are different from pilon fractures, but their proximity to the ankle makes the surgical treatment more complicated than the treatment tibial midshaft fractures. A variety of treatment methods have been suggested for these injuries, including nonoperative treatment, external fixation, intramedullary nailing, and plate fixation. However, each of these treatment options is associated with certain challenges. Nonoperative treatment may be complicated by loss of reduction and subsequent malunion. Similarly, external fixation of distal tibia fractures may result in insufficient reduction, malunion, and pin tract infection. Intramedullary nailing can be considered the "gold standard" for the treatment of tibial midshaft fractures, but there are concerns about their use in distal tibia fractures. This is because of technical difficulties with distal nail fixation, the risk of nail propagation into the ankle joint, and the discrepancy between the diaphyseal and metaphyseal diameter of the intramedullary canal. Open reduction and internal plate fixation results in extensive soft tissue dissection and may be associated with wound complications and infections. The optimal treatment of unstable distal tibia without articular involvement remains controversial. OBJECTIVES: This study was designed to review the outcomes of different treatment methods for extra-articular distal tibia fractures. The English literature was systematically reviewed and the rates of malunion, nonunion, infection, fixation failure, and secondary surgical procedures were extracted.

Bone Plates↗
PubMed2006

Biomechanical evaluation of the less invasive stabilization system and the 95-degree angled blade plate for the internal fixation of distal femur Fractures in human cadaveric bones with high bone mineral density.

BACKGROUND: The less invasive stabilization system (LISS) is an internal fixator that utilizes unicortical locked screws for fixation of distal femur fractures. A question is whether locked unicortical screw fixation is sufficient, when compared with a standard implant such as a blade plate. METHODS: Eight matched pairs of fresh-frozen cadaveric femora were instrumented with either the LISS or a 95-degree blade plate. A 4-cm supracondylar gap fracture model was created and all bone-implant constructs were tested to failure in axial loading. RESULTS: All constructs failed by plastic deformation of the implant. There was no significant difference between the LISS and the blade plate constructs with respect to load to failure. CONCLUSIONS: Despite unicortical fixation axial loading to failure of the LISS did not result in implant/screw pull-out neither proximally nor distally. However, there does not appear to be a biomechanical advantage of using the LISS as opposed to a blade plate in bones with high bone mineral density.

Biomechanical Phenomena↗
PubMed2006

Common pitfalls in the conduct of clinical research.

Recently, paradigm shift from expert opinion towards evidence-based medicine has occurred encouraging physicians to base their treatment decisions on the best available research evidence. In the hierarchy of evidence randomized clinical trials (level 1 evidence) are considered of the highest quality (least biased) while non-randomized studies represent lower levels (levels 2-4). Several pitfalls in the design and conduct of clinical research include: lack of randomization, lack of concealment, lack of blinding, and errors in hypothesis testing (type I and II errors). A basic understanding of these principles of research will empower both investigators and readers when applying the results of research to clinical practice.

Biomedical Research↗
PubMed2005

Perception of Garden's classification for femoral neck fractures: an international survey of 298 orthopaedic trauma surgeons.

The Garden classification is the most popular femoral neck fracture classification system. We surveyed orthopaedic surgeons about their preferences for femoral neck fracture classification systems and their belief about their ability to discriminate between the four different Garden fracture types. A questionnaire was developed to examine surgeons' training and experience and their preferences for classification of femoral neck fractures by consulting five orthopaedic surgeons in Canada and the United States, and the previous literature. The Garden classification was the preferred femoral neck fracture classification for 72% of all the surveyed surgeons (n=298). Only 39% of all the surveyed surgeons believed they were able to distinguish all four Garden fracture types. However, 96% of the surgeons felt they could differentiate between undisplaced (Garden I/II) and displaced (Garden III/IV) fractures. High variability in the surgeons' perceptions of the Garden classification system provides a rationale for discontinuing the use of this system in daily practice.

Adult↗
PubMed2005

The application of dermatotraction for primary skin closure.

Management of an open wound is a problem frequently encountered in the treatment of fractures. Skin grafting, rotational flaps, free flaps, and healing by secondary intention add a considerable amount of morbidity and cost to the patient. Therefore, it is ideal to obtain primary closure when possible. This communication describes a technique that uses spinal needles, using towel clips and the natural stretching ability of the skin to enable primary closure of wounds. The technique described uses dermatotraction to stretch the skin is a cost-effective way to achieve primary closure of large wounds with supplies that are readily available in every operating room.

Adult↗
PubMed2005

Intramedullary nailing following external fixation in femoral and tibial shaft fractures.

BACKGROUND: Intramedullary nailing is the standard of care for the definitive management of lower extremity long bone fractures. Occasionally, temporary external fixation is used in fractures with severe open wounds or vascular injury before definitive intramedullary nailing. Secondary intramedullary nailing following external fixation is somewhat controversial, especially with respect to the duration of external fixation that is allowable before the risk of infection following later nailing becomes too great. Several recent studies have provided further insight into this issue. OBJECTIVE: The primary objective is to evaluate infection and nonunion rates in patients treated with temporary external fixation and secondary intramedullary nailing for lower extremity long bone fractures. The secondary objective is to evaluate whether the duration of external fixation and the interval time (defined as the time from external fixator removal to intramedullary nailing) influence the risk of infection after intramedullary nailing.

External Fixators↗
PubMed2005

Discrepancies between proceedings abstracts and posters at a scientific meeting.

The proceedings handbook of abstracts from scientific meetings aims to provide meeting attendees with an accurate summary of scientific presentations. Given that posters are prepared closer to the meeting than the abstracts for the proceedings book, we hypothesized that there is a high rate of inconsistency between abstracts in the proceedings handbook and the corresponding posters. We compared the poster abstracts printed in the proceedings handbook with the actual posters at the 71st annual meeting of the American Academy of Orthopaedic Surgeons in 2004. Our comparison included all 50 trauma posters and 52 adult reconstruction knee posters. This comparison revealed discrepancies in 76% of the presented posters. These changes were detected in all parts of the posters including titles (33%), authorship (49%), methods (8%), results (30%), and conclusions (2%). The sample size changed in 15% of the studies. Discrepancies between the trauma posters versus the adult reconstruction knee posters were similar. Our findings suggest that discrepancies between the poster abstracts in the proceedings handbook and actual poster presentations are common, but changes in conclusions are rare. Meeting attendees should not assume that the proceedings handbook provides an accurate reflection of poster presentations. Visiting the poster section is recommended.

Abstracting and Indexing↗
PubMed2005

CASE REPORTS: malignant fibrous histiocytoma of bone arising in chronic osteomyelitis.

This case report shows the importance of frozen section and/or permanent section pathology for diagnosis of tumorous conditions in patients with chronic osteomyelitis. According to published reports, a coincidence of malignant fibrous histiocytoma of bone and post-fracture osteomyelitis has occurred in only four patients. Our report details the treatment of 51-year-old man with a fracture 15 years previously and subsequent chronic osteomyelitis of the left distal femur. The original treatment was open reduction and casting. Fifteen years after the injury, the patient presented to the emergency room with increasing pain, erythema, swelling, and increased purulent discharge from the distal femur. Irrigation and debridement was done, but no frozen section or permanent pathology specimens were obtained. The left distal femur was radically resected for treatment of osteomyelitis. Histologic samples of the specimen revealed malignant fibrous histiocytoma of bone. A metastatic workup was negative. Subsequently, the left hip was disarticulated for wide resection of the tumor. One of two inguinal lymph nodes removed at that time was positive for malignant fibrous histiocytoma. The patient had additional chemotherapy. He was still alive 27 months after the operation.

Bone Neoplasms↗
PubMed2005

Treatment of acute midshaft clavicle fractures: systematic review of 2144 fractures: on behalf of the Evidence-Based Orthopaedic Trauma Working Group.

BACKGROUND: Fractures of the clavicle were reported to represent 2.6% of all fractures with an overall incidence of 64 per 100,000 per year (1987, Malmö, Sweden). Midshaft fractures account for approximately 69% to 81% of all clavicle fractures. Treatment options for acute midshaft clavicle fractures include nonoperative treatment (mostly sling or figure-of-eight bandage), open reduction and internal fixation with plates, and closed or open reduction and internal fixation with intramedullary pins, wires, or a nail. Most surgeons prefer nonoperative treatment of nondisplaced midshaft clavicle fractures. However, the optimal treatment option for isolated acute displaced midshaft clavicle fractures remains controversial. OBJECTIVES: This study was designed to systematically summarize and compare results of different treatment options (nonoperative, operative extramedullary fixation, and operative intramedullary fixation) in the management of midshaft clavicle fractures, specifically for displaced fractures.

Clavicle↗
PubMed2005

Functional outcome after treatment of lower-extremity nonunions.

BACKGROUND: The results for nonunion surgery usually have been judged in terms of bony union, time to union, infection rate, range of motion for the adjacent joints, and muscle strength. The goal of this study was to assess the improvement of patient-oriented physical and mental functional outcomes. METHODS: The functional status of 23 patients with nonunion of the lower extremity was assessed using the Short-Form Health Survey (SF-36) questionnaire. The SF-36 subscores were compared with preoperative values and with the average values for the U.S. population. RESULTS: Of the 23 patients, 21 healed. The functional status for nonunions of the lower extremity was greatly improved 1 year after operative intervention in this study. Nevertheless, the results show that it did not reach the level of the average U.S. population. CONCLUSION: The results of this study can be used to guide patients' expectations regarding the functional outcome of treatment for a nonunion of the lower extremity.

Femoral Fractures↗
PubMed2005

The value of washers in cannulated screw fixation of femoral neck fractures.

BACKGROUND: Given the limited evidence to support the technical aspects of screw placement for treatment of femoral neck fractures, we conducted an observational study to evaluate demographic and radiographic variables associated with fixation failure. METHODS: Eligible patients with femoral neck fractures were treated with multiple cannulated screws across three academic centers during a 6-year period. The following variables were evaluated for their predictive value for fixation failure: age, gender, fracture type, presence of comminution, total number of screws, the absence of a washer, the screw configuration, reduction quality, the distance of the most inferior screw to the inferior neck, and screw alignment. Variables were evaluated separately and in a multivariable regression model. RESULTS: Eighty patients were included in the study. The overall failure rate was 30%. We identified four variables associated with fixation failure. These included the lack of washers (odds ratio [OR], 11.2; p = 0.03), imperfect quality of reduction (OR, 9.7; p < 0.01), age greater than 75 years (OR, 5.1; p = 0.04), and displaced versus undisplaced fracture type (OR, 3.8; p < 0.01). These four variables accounted for 43% of the variability in fixation failure (R(2) = 0.43). All other variables including the distance of the most inferior screw to the inferior/medial neck were found to be not significant. CONCLUSION: This study confirms previous findings in the literature that increased age, a displaced fracture type, and poor reduction increase the risk of fixation failure. Contradictory to current belief, there was no significant association between the distance of the inferior screw to the inferior/medial femoral neck cortex and fixation failure. A novel finding of the present study is that the use of washers significantly decreases the risk of fixation failure.

Adult↗
PubMed2004

Biomechanical evaluation of the less invasive stabilization system, angled blade plate, and retrograde intramedullary nail for the internal fixation of distal femur fractures.

OBJECTIVE: To evaluate the stability of the retrograde intramedullary nail (IMN), angled blade plate (ABP), and a locked internal fixator (Less Invasive Stabilization System [LISS], Synthes, Paoli, PA) for internal fixation of distal femur fractures. DESIGN: Destructive biomechanical testing of matched pairs of fresh-frozen human cadaveric bone-implant constructs. SETTING: Biomechanical laboratory. METHODS: A fracture model was created to simulate an AO/OTA33-A3 fracture. Forty-eight matched pairs of specimens were used. Six groups of 8 pairs each were tested to failure: LISS versus ABP and LISS versus IMN (axial, torsional, and cyclical axial). MAIN OUTCOME MEASUREMENT: Load to failure, mode of failure, energy to failure, displacement at the load to failure, and stiffness. RESULTS: Fixation strength (load/moment to failure) of the LISS constructs was 34% greater in axial loading (P = 0.01) and 32% less in torsional loading (P = 0.05) compared with ABP constructs and 13% greater in axial loading (P = 0.35) and 45% less in torsional loading (P < 0.01) compared with IMN constructs. Loss of distal fixation in axial loading occurred in 1 of 16 cases with the LISS, in 3 of 8 cases with the ABP, and in 8 of 8 cases with the IMN. Cyclical axial loading demonstrated significantly less plastic deformation for the LISS construct compared with ABP constructs (P < 0.01) and similar plastic deformation compared with IMN constructs (P = 0.98). CONCLUSIONS: All 3 fixation devices (LISS, ABP, and IMN) offer sufficient torsional stability and sufficient proximal fixation that withstands axial loading without failing. The LISS provides improved distal fixation, especially in osteoporotic bone, at the expense of more displacement at the fracture site.

Aged↗
PubMed2004

Treatment of distal femur fractures using the less invasive stabilization system: surgical experience and early clinical results in 103 fractures.

OBJECTIVE: To summarize the complications and early clinical results of 123 distal femur fractures treated with the Less Invasive Stabilization System (LISS; Synthes, Paoli, PA). DESIGN: Retrospective analysis of prospectively enrolled patients. SETTING: Two academic level I trauma centers. SUBJECTS AND PARTICIPANTS: One hundred nineteen consecutive patients with 123 distal femur fractures (OTA type 33 and distal type 32 fractures) treated by 3 surgeons. One hundred three fractures (68 closed fractures and 35 open fractures) in 99 patients were followed up at least until union (mean follow-up = 14 months, range: 3-50 months). INTERVENTION: Surgical reduction and fixation of distal femur fractures. MAIN OUTCOME MEASUREMENTS: Perioperative complications, radiographic union, infection rate, loss of fixation, alignment, and range of motion. RESULTS: Ninety-six (93%) of 103 fractures healed without bone grafting. All fractures eventually healed with secondary procedures, including bone grafting (1 of 68 closed fractures and 6 of 35 open fractures). There were 5 losses of proximal fixation, 2 nonunions, and 3 acute infections. No cases of varus collapse or screw loosening in the distal femoral fragment were observed. Malreductions of the femoral fracture were seen in 6 fractures (6%). The mean range of knee motion was 1 degrees to 109 degrees . CONCLUSIONS: Treatment of distal femur fractures with the LISS is associated with high union rates without autogenous bone grafting (93%), a low incidence of infection (3%), and maintenance of distal femoral fixation (100%). No loss of fixation in the distal femoral condyles was observed despite the treatment of 30 patients older than 65 years. The LISS is an acceptable surgical option for treatment of distal femoral fractures.

Adult↗
PubMed2004

Treatment of proximal tibia fractures using the less invasive stabilization system: surgical experience and early clinical results in 77 fractures.

OBJECTIVE: To summarize the surgical experience and clinical results of the first 89 fractures of the proximal tibia treated with the Less Invasive Stabilization System (LISS; Synthes, Paoli, PA). DESIGN: Retrospective analysis of prospectively enrolled patients into a database. SETTING: Academic level I trauma center. SUBJECTS/PARTICIPANTS: Eighty-seven consecutive patients with 89 proximal tibia fractures (AO/OTA type 41 and proximal type 42 fractures) treated by 2 surgeons. Seventy-five patients with 77 fractures were followed until union. The mean follow-up was 14 months (range: 3-35 months). There were 55 closed fractures and 22 open fractures. INTERVENTION: Surgical reduction and fixation of fractures, followed by rehabilitation. MAIN OUTCOME MEASUREMENTS: Perioperative and postoperative complications, postoperative alignment, loss of fixation, time to full weight bearing, radiographic union, and range of motion. RESULTS: Seventy of 77 fractures healed without major complications (91%). There were 2 early losses of proximal fixation, 2 nonunions, 2 deep delayed infections, and 1 deep peroneal nerve palsy. Other complications included a superficial wound infection and 3 seromas. Postoperative malalignment occurred in 7 patients with 6 degrees to 10 degrees of angular deformity (6 flexion/extension and 1 varus/valgus malalignments), and an eighth patient had a 15 degrees flexion deformity. In 4 patients, the hardware was removed at an average of 13 months because of irritation (5%). The mean time for allowance of full weight bearing was 12.6 weeks (range: 6-21 weeks), and the mean range of final knee motion was 1 degrees to 122 degrees . CONCLUSIONS: The LISS provides stable fixation (97%), a high rate of union (97%), and a low (4%) rate of infection for proximal tibial fractures. The technique requires the successful use of new and unfamiliar surgical principles to effect an accurate reduction and acceptable rate of malalignment.

Adolescent↗