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Biomedical subjects

Rami Mosheiff

Publications and source records attributed to Rami Mosheiff.

At least 19 recordsLinked to original sources
PubMed2006

A short plate compression screw with diagonal bolts--a biomechanical evaluation performed experimentally and by numerical computation.

INTRODUCTION: Decreasing the length of the side plate of the dynamic hip screw would theoretically allow a smaller surgical incision, a shorter surgical time, decreased operative blood loss and minimal periosteal stripping. A new design of a very short plate dynamic hip screw based on two diagonal screws has been developed. Our study compares the new design and the four-hole side plate in respect to mechanical properties and bio-mechanical outcomes utilizing the Finite Element Analysis method. METHODS: Four pairs of fresh frozen cadaveric femora were extracted from male corpses aged 25-43 years (mean 34.8). One femur of each pair was fixated by means of the new system and the other by means of the conventional design. Mechanical loading was applied to all four pairs. The decline which occurred during the periodical loadings and the breakage loads of fixated bones were measured. Mechanical performance and probability of failure was assessed by conducting a mathematical analysis using the finite element method. FINDINGS: The average deflection under excessive cyclic loading was 33% higher in the bones fixated with the very short plate-dynamic hip screw device than in those fixated with the conventional dynamic hip screw. The average load failure during the collapse-loading test was 3120N for the very short plate-dynamic hip screw as compared to 4160N for the regular device. Mechanical testing did not provide decisive results regarding failure. The mathematical analysis performed indicated that the maximal stress in the very short plate-dynamic hip screw reached values 3-4-fold higher than in the regular dynamic hip screw. INTERPRETATION: Although the new design offers a minimally invasive approach to subtrochanteric femur fracture fixation, it was found to have insufficient biomechanical performance resulting in high probability of mechanical failure. The authors believe that the finite element method may have the potential to serve as an additional clinical tool for performing surgical preplanning and assist in decision making.

Adult↗
PubMed2006

Computerized navigation for the internal fixation of femoral neck fractures.

BACKGROUND: Accurate placement of cannulated screws is essential to ensure secure fixation of femoral neck fractures. We compared computerized navigation and conventional fluoroscopy with regard to the accuracy of screw placement for the fixation of femoral neck fractures. METHODS: We retrospectively compared two groups of twenty consecutive patients with a femoral neck fracture who underwent internal fixation with three cannulated screws. Computer-based navigation was used to guide screw placement in one group, and conventional fluoroscopy was used in the other group. Radiographic evaluation included the measurement of screw parallelism and spread, the calibrated distance from the lesser trochanter, and joint penetration. The follow-up period was two years. The rates of complications in both groups were evaluated. RESULTS: The navigation-assisted group had better screw parallelism and greater spread of the screws. There was a tendency for fewer reoperations and significantly fewer overall complications in the patients in whom computerized navigation was used (p < 0.018). CONCLUSIONS: Computerized navigation improves the accuracy of cannulated screw placement in the internal fixation of femoral neck fractures. It may provide better mechanical stability and improved fracture outcome.

Aged↗
PubMed2006

Blast and penetrating fragment injuries to the extremities.

Blast injury to the extremities is the most common form of injury in recent military campaigns and in civilian terror attacks. Most orthopaedic trauma is caused by the secondary effect of blast--penetrating fragment injury. Timely wound débridement and excision of contaminated or avascular tissue, along with prevention of sepsis, are crucial to managing extremity injury. Late reconstruction and functional results are very challenging for the surgical team to achieve.

Blast Injuries↗
PubMed2005

Guided bone regeneration in the treatment of segmental diaphyseal defects: a comparison between resorbable and non-resorbable membranes.

This study compares non-absorbable, ethyl cellulose (EC) membranes and absorbable, chitosan (CH) membranes in a rabbit model. Bone regeneration, evaluated by radiological and pathological parameters, was seen in both groups. In the EC group the process was faster but was followed by a sharp decrease, whereas in the CH group it was slower and continuous.

Absorbable Implants↗
PubMed2005

Clinical review: the Israeli experience: conventional terrorism and critical care.

Over the past four years there have been 93 multiple-casualty terrorist attacks in Israel, 33 of them in Jerusalem. The Hadassah-Hebrew University Medical Center is the only Level I trauma center in Jerusalem and has therefore gained important experience in caring for critically injured patients. To do so we have developed a highly flexible operational system for managing the general intensive care unit (GICU). The focus of this review will be on the organizational steps needed to provide operational flexibility, emphasizing the importance of forward deployment of intensive care unit personnel to the trauma bay and emergency room and the existence of a chain of command to limit chaos. A retrospective review of the hospital's response to multiple-casualty terror incidents occurring between 1 October 2000 and 1 September 2004 was performed. Information was assembled from the medical center's trauma registry and from GICU patient admission and discharge records. Patients are described with regard to the severity and type of injury. The organizational work within intensive care is described. Finally, specific issues related to the diagnosis and management of lung, brain, orthopedic and abdominal injuries, caused by bomb blast events associated with shrapnel, are described. This review emphasizes the importance of a multidisciplinary team approach in caring for these patients.

Abdominal Injuries↗
PubMed2005

Percutaneous compression plating for intertrochanteric fractures. Surgical technique, tips for surgery, and results.

OBJECTIVE: Fixation of intertrochanteric fractures by a minimally invasive technique using the Percutaneous Compression Plate (PCCP) allowing anatomic reduction and immediate postoperative weight bearing. INDICATIONS: Intertrochanteric fractures. CONTRAINDICATIONS: Intertrochanteric fractures that cannot be reduced by closed manipulation, subtrochanteric and reverse oblique fractures (AO/OTA 31-A3). SURGICAL TECHNIQUE: Placement of patient on a fracture table with a posterior reduction device (PORD) supporting the fracture. Reduction of the fracture by closed manipulation. Percutaneous insertion of the plate through a lateral proximal incision. Adaptation of the plate to the lateral aspect of the proximal femoral shaft with a bone clamp inserted through a second, more distal incision. Insertion of telescoping compression neck screw through the plate into the neck and securing of plate to the femoral shaft with three additional screws. Finally, completion of fracture fixation with second neck screw. RESULTS: Of 130 patients with intertrochanteric fractures treated using the described technique at the Orthopedic Surgery Department Hadassah University Hospital, Jerusalem, Israel, between May 2000 and December 2001, 108 were available for this study. Patients' age averaged 81 years (+/- 8 years). Mean surgical time was 67 min and mean hospital stay 11.5 days. 40% of patients did not require a transfusion during hospitalization, while 8.3% needed more than three units of packed cells. Complications occurred in four patients: two implant failures that were successfully revised with a Compression Hip Screw, one nonunion treated with hip arthroplasty; the fourth patient had a shortening of 3 cm needing a heel lift. Three patients developed an infection, one requiring surgical debridement.

Aged↗
PubMed2005

Percutaneous compression plating versus compression hip screw fixation for the treatment of intertrochanteric hip fractures.

Percutaneous compression plate (PCCP) devices are used for the fixation of intertrochanteric hip fractures by a minimally invasive technique. One hundred and eight patients who underwent this procedure were retrospectively compared with 155 patients who underwent compression hip screw (CHS) fixation. The general characteristics of the two groups, including age, sex, side of injury and co-morbidities assessed by the ASA score were similar. The operative time was significantly shorter in the PCCP group (67 versus 87 min, p=0.00). Postoperative blood transfusions were not required in 40% of the patients in the PCCP group compared to 24% of the patients in the CHS group (p<0.01). The rate of systemic postoperative complications was lower in the PCCP group (p=0.02) both in univariate and multivariate analyses. A considerable reduction was observed in cardiovascular complications (OR=3.1, p<0.05). Length of hospitalisation, implant failure and mortality rates were not significantly different between the two study groups. We conclude that the PCCP device offers several advantages over CHS device and may improve the current treatment of intertrochanteric hip fractures while maintaining a similar success rate in fracture fixation.

Aged↗
PubMed2005

Pelvic fractures in a level I trauma center: a test case for the efficacy of the evolving trauma system in Israel.

BACKGROUND: Pelvic fracture is a severe and life-threatening injury that requires treatment by a dedicated team. One of the goals of a nationwide trauma system is to provide appropriate medical care for such injuries. OBJECTIVES: To use pelvic fractures as a test case for the efficiency of the Israeli trauma system, as reflected in the experience of our medical center. METHODS: Data were obtained from the medical charts of all cases of pelvic fractures admitted to our medical center between 1987 and 1999. We obtained demographic data, information on the cause of injury, fracture classification, co-injuries and Injury Severity Score, treatment strategies, and mortality rate. RESULTS: Altogether, 808 patients with pelvic injuries were treated in our medical center. The most common cause of injury was motor vehicle accidents (51%). Pelvic fractures without acetabular involvement were diagnosed in 58% of patients and isolated acetabular fractures in 32%, while 10% sustained combined injuries to the pelvic ring and the acetabulum. The overall rate of operative stabilization was 34%. The majority of patients had associated injuries, mostly additional musculoskeletal injuries. Altogether, 13% were referred from Level II/III trauma centers. We observed an increase in the total number of local admissions, in the percentage of referred patients and in the percentage of operated patients during the study period. The observed mortality rate was 5%. CONCLUSIONS: Our results show a more than twofold increase in the percentage of referred patients following the designation of a Level I trauma center. These referrals are due not only to the designation as a Level I trauma center, but also to the presence of a dedicated team of pelvic fracture specialists, available 24 hours a day. In addition, a larger percentage of patients undergo surgery for internal fixation of pelvic fractures, in accordance with current worldwide trends.

Acetabulum↗
PubMed2004

First generation computerized fluoroscopic navigation in percutaneous pelvic surgery.

Percutaneous internal fixation of pelvic fractures has gained popularity allowing rapid mobilization with reduced surgical related morbidity; however, this method depends on conventional fluoroscopy, which exposes the patient and the surgeon to a significant amount of radiation. The use of computerized fluoroscopic navigation systems enables the simultaneous use of several radiographic projections. These preliminary fluoroscopic views are taken when the operating team stands at a distance from the radiation source. No further fluoroscopic radiation is used later during the surgical procedure. Computerized fluoroscopic navigation was used in the percutaneous insertion of 45 cannulated screws in 29 patients, including sacroiliac screws, pubic ramus screws, posterior column screws, and a supraacetabular transverse screw. Fluoroscopic verification of screw placement demonstrated a deviation <or=2 mm and <or=5 degrees. We believe the system saves fluoroscopic radiation time, yet improves the precision of the procedure. We believe that the use of this system is adequate for a selected patient population with pelvic fractures amenable to percutaneous screw fixation.

Acetabulum↗
PubMed2004

A multicasualty event: out-of-hospital and in-hospital organizational aspects.

UNLABELLED: In a wedding celebration of 700 participants, the third floor of the hall in which the celebration was taking place suddenly collapsed. While the walls remained intact, all three floors of the building collapsed, causing Israel's largest disaster. OBJECTIVES: To study the management of a multicasualty event (MCE), in the out-of-hospital and in-hospital phases, including rescue, emergency medical services (EMS) deployment and evacuation of casualties, emergency department (ED) deployment, recalling staff, medical care, imaging procedures, hospitalization, secondary referral, and interhospital transfer of patients. METHODS: Data on all the victims who arrived at the four EDs in Jerusalem were collected through medical files, telephone interviews, and hospital computerized information. RESULTS: The disaster resulted in 23 fatalities and 315 injured people; 43% were hospitalized. During the first hour, 42% were evacuated and after seven hours the scene was empty. Ninety-seven basic life support ambulances, 18 mobile intensive care units, 600 emergency medical technicians, 40 paramedics, and 15 physicians took part in the out-of-hospital stage. At the hospitals, about 1,300 staff members arrived immediately, either on demand or voluntarily, a number that seems too large for this disaster. Computed tomography (CT) demand was over its capability. CONCLUSIONS: During this MCE, the authors observed "rotating" bottleneck phenomena within out-of-hospital and in-hospital systems. For maximal efficiency, hospitals need to fully coordinate the influx and transfer of patients with out-of-hospital rescue services as well as with other hospitals. Each hospital has to immediately deploy its operational center, which will manage and monitor the hospital's resources and facilitate coordination with the relevant institutions.

Adolescent↗
PubMed2004

The use of computerized navigation in the treatment of gunshot and shrapnel injury.

OBJECTIVE: Trauma surgeons encounter numerous penetrating injuries nowadays. In some cases, missiles causing infection, pain and discomfort, or those retained within joints, bursae and other strategic sites, must be removed. This paper describes an innovative high-tech modality for use in the immediate removal of shrapnel and bullets from strategic anatomical sites. METHODS: Surgical computerized navigation based on real-time acquisition of fluoroscopic data was employed. Several fluoroscopic images of the required anatomical site were obtained. The accurate spatial location of the foreign object could be seen on the images displayed on the computer screen. No further fluoroscopic radiation was necessary. During surgery, the infra-red camera tracked the position of a surgical probe on the patient's anatomy and continuously updated its three-dimensional position simultaneously on all displayed images until the missile's location was reached. RESULTS: The use of percutaneous fluoroscopic navigation to remove retained metal objects, including bullets and shrapnel, has proved itself in 12 cases as an accurate measure involving reduced exposure to radiation. In contrast to CT- or MRI-based navigation, computerized fluoroscopic navigation does not require long preliminary preparation. Thus, it is highly efficient in the treatment of acute trauma victims. CONCLUSIONS: The use of this accurate technique in complex and dangerous situations where the foreign body is located in proximity to blood vessels, nerves and narrow 'safe-zones', is promising. This innovative technique reduces surgical time and radiation exposure. In our experience, it has rendered percutaneous missile removal much safer, even in hazardous situations.

Adult↗
PubMed2004

Using computerized fluoroscopic navigation to remove pelvic screws.

Orthopedic surgeons have recently recognized the benefits of using percutaneous fixation to treat pelvic-ring disruption. Surgical removal of pelvic internal fixation is performed in an anatomically "crowded" area, with no direct vision, and harbors its own risks. Computerized fluoroscopic navigation, which makes implant location easier and reduces radiation exposure, operative time, and soft-tissue damage, can make this procedure short and relatively safe.

Bone Screws↗
PubMed2003

Quantification of guided regeneration of weight-bearing bones.

An accurate histological evaluation system was established to improve and quantify the compatibility of membranes to provide bone regeneration in a large mid-diaphyseal bone defect, complementing radiographic evaluation. New bone formation obtained in critical segmental defects covered with tubular ethyl cellulose membranes was examined. Computerized radiography showed gradual new bone formation, which slows after 6 weeks. In a parallel histomorphological assessment, a characteristic process of new bone formation occurs inside the confined space and surrounding tissues. Histological findings are summarized according to the new scoring system, which clarifies the mechanism and provides complementary quantification of guided bone regeneration.

Animals↗
PubMed2002

Maneuvering the retrograde medullary screw in pubic ramus fractures.

This report describes an improved percutaneous insertion technique of a retrograde medullary screw in pubic ramus fractures. This improved technique enables the use of a relatively thick retrograde medullary screw in difficult anatomical variations such as narrow or curved pubic ramus. Maneuvering of the retrograde medullary screw gives control of the proximal fragment and can assist in fracture reduction.

Bone Screws↗