Biomedical subjects

Robert H Brophy

Publications and source records attributed to Robert H Brophy.

11 recordsLinked to original sources

PubMed2007

Prevalence of musculoskeletal disorders at the NFL Combine--trends from 1987 to 2000.

PURPOSE: The National Football League holds an annual combine where individual teams evaluate college football players likely to be drafted. As part of the combine, the players are evaluated with a medical history, physical exam, and review of imaging studies, and then they are rated medically as to their ability to participate in the NFL. The purpose of this study was to review the prevalence of musculoskeletal disorders in this population and to test the hypothesis that fewer players were medically disqualified over calendar time from 1987 to 2000. METHODS: The available summary data for all players reviewed at the annual combine by the medical staff of one NFL team from 1987 to 2000 was analyzed, including each player's position, collegiate division, medical rating, and their diagnoses and surgical procedures. RESULTS: A total of 5047 complete records were available for analysis. The average number of diagnoses per player was 2.45, and the average number of procedures was 0.53. The most common diagnoses were ankle sprain, burner, hand/wrist soft-tissue injury, knee MCL injury, and AC-joint injury. The most common procedures were meniscectomy, knee arthroscopy, ACL reconstruction, shoulder stabilization, and ORIF ankle fracture. Overall, 5.63% of the players were rejected for medical reasons. The risk of failure dropped during the study period (P < 0.0002). Over time, fewer players with a history of ACL reconstruction received a failing grade (P = 0.0005). CONCLUSION: The percentage of athletes with a failing grade, particularly those with a history of ACL reconstruction, decreased over the study period. Knowing the trends in prevalence of injury and treatment for these athletes may help optimize their care and aid the development of injury-prevention and treatment strategies.

Adult↗

PubMed2007

Innovations in the management of displaced proximal humerus fractures.

The management of displaced proximal humerus fractures has evolved toward humeral head preservation, with treatment decisions based on careful assessment of vascular status, bone quality, fracture pattern, degree of displacement, and patient age and activity level. The AO/ASIF fracture classification is helpful in guiding treatment and in stratifying the risk for associated disruption of the humeral head blood supply. Nonsurgical treatment consists of sling immobilization. For patients requiring surgery, options include closed reduction and percutaneous fixation; transosseous suture fixation; open reduction and internal fixation, with either conventional or locking plate fixation; bone graft; and hemiarthroplasty. Proximal humerus fractures must be evaluated on an individual basis, with treatment tailored according to patient and fracture characteristics.

Algorithms↗

PubMed2006

Anterior cruciate ligament revision: double-bundle augmentation of primary vertical graft.

A variety of factors contribute to the failure of primary anterior cruciate ligament (ACL) reconstruction; most commonly, it is technical error related to tunnel placement. Recently, the increasing popularity of the all-endoscopic ACL reconstruction and concern about graft impingement may have led to more posterior placement of the tibial tunnel by surgeons. Working through a tibial tunnel placed too posterior makes it more difficult to recognize the correct starting position on the femur, and more likely to start the femoral tunnel in a central 12 o'clock position. The combination of subtle posterior placement of the tibial tunnel and central placement of the femoral tunnel results in a graft that is malpositioned in both the sagittal and coronal planes--a "vertical graft." We present a novel method of ACL revision surgery applicable to a specific subset of ACL revision patients with an intact "vertical graft" and instability that is rotational more than translational. In these patients, a double-bundle revision ACL augmentation technique can be used, leaving the original graft in place. A new tibial tunnel is placed anterior to the original and a new femoral tunnel lateral to the original. Reconstruction is performed with allograft and the combined ACL construct provides robust translational and rotational stability to the tibiofemoral joint.

Anterior Cruciate Ligament↗

PubMed2006

The two-step maneuver for closed reduction of inferior glenohumeral dislocation (luxatio erecta to anterior dislocation to reduction).

The 2-step closed reduction maneuver was developed to aid in the rarely encountered inferior shoulder dislocation. The maneuver converts the humeral head from an inferior dislocation to an anterior dislocation and then reduces the humeral head into the glenoid. The operator places one hand on the shaft of the humerus and the other hand on the medial condyle. The hand on the shaft initiates an anteriorly directed force rotating the humeral head from an inferior to an anterior position. Once this is accomplished, the humerus is adducted against the body. The humerus is then external rotated reducing the humeral head into the glenoid. Two cases of inferior shoulder dislocation were closed reduced by using the described technique with minimal analgesia and without a change in the postreduction neurovascular status.

Humans↗

PubMed2006

Hybrid locked plating of osteoporotic fractures of the humerus.

BACKGROUND: Locked plating techniques recently have gained popularity and offer a different biomechanical approach for fracture fixation compared with traditional compression plating. In certain clinical situations, it may be preferable to employ a "hybrid" construct, in which an unlocked screw is used to assist with reduction and locked screws are subsequently used to protect the initial reduction. In the present study, we used an unstable osteoporotic fracture model of the humerus to determine (1) whether a hybrid construct behaved more like a locked construct or a conventional unlocked construct and (2) whether there was a difference between locked and unlocked constructs. METHODS: Thirty third-generation Sawbones humeri were divided into three groups of ten humeri each. A locking plate with combination holes was applied to each bone with use of either a locked construct, an unlocked construct, or a hybrid construct. To simulate purchase in osteoporotic bone, all screw-holes were drilled to 0.3 mm less than the diameter of the screw used. Each specimen was then osteotomized in the middle part of the shaft, and a 5-mm segment was removed. Oscillating cyclic torsion testing was performed to +/-10 N-m for 1000 cycles, torsional stiffness was determined at periodic cyclic intervals, and the groups were compared. RESULTS: The locked and hybrid constructs demonstrated similar behavior. The initial stiffness was similar in these two groups. At ten cycles, the locked and hybrid constructs retained 96.3% and 95.4% of their initial stiffness, respectively. During the remainder of cycling the stiffness of the locked and hybrid constructs decreased in a linear fashion (R(2) = 0.89 and 0.88, respectively), and at 1000 cycles the stiffness of the locked and hybrid constructs averaged 80.0% and 79.2% of the initial values, respectively (p = 1.0). In contrast, the unlocked constructs initially were significantly less stiff than both the locked and hybrid constructs (p < 0.001). At ten cycles the unlocked constructs retained 80.4% of their initial stiffness, and at 1000 cycles they retained only 22.3% of their initial stiffness. CONCLUSIONS: Hybrid constructs are mechanically similar to locked constructs, and both are significantly more stable than unlocked constructs under torsional cyclic loading. CLINICAL RELEVANCE: Combining screws in the hybrid configuration used in the present study did not compromise the mechanical performance of the construct. Hybrid constructs may decrease cost and may provide additional clinical value when treating fractures in osteoporotic bone.

Bone Plates↗

PubMed2005

An assessment of the methodological quality of research published in The American Journal of Sports Medicine.

BACKGROUND: Evidence-based medicine has become a popular topic in academic medicine during the past several decades and more recently in orthopaedics and sports medicine. HYPOTHESIS: Articles published in The American Journal of Sports Medicine have shown an improvement in methodological quality in 2001-2003, compared with 1991-1993. STUDY DESIGN: Systematic review. METHODS: All articles published in The American Journal of Sports Medicine during the periods 1991-1993 and 2001-2003 were reviewed and classified by type of study. The use of pertinent methodologies such as prospective data collection, randomization, blinding, and controlled studies was noted for each article. The frequency of each article type and the use of evidence-based techniques were compared across study periods. RESULTS: Case series and descriptive studies decreased during the study period, from 27.4% to 15.3% (P = .00003) and from 11.9% to 5.6% (P = .001), respectively, of articles published. Prospective cohort studies increased from 4.7% to 14.1% (P = .000005), and randomized, prospective clinical trials increased from 2.7% to 5.9% of articles (P = .04). More studies tested an explicit hypothesis (P = .0000002), used prospective data collection (P = .000003), and used blinding (P = .02), and more studies identified a funding source (P = .004). CONCLUSIONS: Overall, there was a shift toward more prospective and randomized research designs published in The American Journal of Sports Medicine during 2001-2003 compared to 1991-1993, demonstrating an improvement in the methodological quality of published research.

Case-Control Studies↗

PubMed2005

Osteoarthritis following shoulder instability.

The association between shoulder instability and the development of glenohumeral osteoarthritis has not been well studied in the literature. It is clear that some degree of chondral damage is associated with instability, and there appears to be an increased risk of developing symptomatic osteoarthritis and ultimately requiring a shoulder arthroplasty in patients with a history of instability. More study is needed to define the relationship between the early onset of radiographically or arthroscopically diagnosed arthritic changes and clinically significant osteoarthritis. Surgical procedures to correct instability are known to put patients at risk for glenohumeral arthritis if they limit external rotation or if hardware migrates into the joint. Total shoulder replacement is an appropriate treatment for advanced, symptomatic osteoarthritis arising in shoulders with a history of instability. Outcomes are generally satisfactory, although not as good as in patients with primary osteoarthritis, and there is a higher risk of revision surgery.

Arthroplasty↗

PubMed2005

Planning brachial plexus surgery: treatment options and priorities.

Brachial plexus injuries are devastating and usually result from high-energy trauma in young patients. Clinicians treating brachial plexus injuries need to recognize the pattern of injury presenting in each patient. Most injuries can be described as either supraclavicular or infraclavicular. The specific injury is determined by means ofa precise workup, including careful physical examination, electrodiagnostic studies, and imaging studies; a thorough workup is essential for successful preoperative planning. Priorities need to be identified and matched with available resources in each patient. A growing number of good treatment alternatives are available. Finally,counseling patients toward realistic expectations isa critical component of preparation for surgery.

Brachial Plexus↗

PubMed2005

Measurement of shoulder activity level.

There are many measurement tools for assessing patients' shoulder symptoms (pain) and function (what patients can do), but they do not measure activity (how often a patient engages in activity). This is relevant because activity level can have an important impact on a patient's outcome. Our goal was to develop a short, easy to administer measure of shoulder activity which could be used to predict outcome of shoulder disorders. The activity scale was developed using established principles: item generation, item reduction, pretesting, and reliability and validity testing. The activity rating is a numerical sum of scores for five activities rated on a five-point frequency scale from never performed (0 points) to daily (4 points). Patients were scored on the following criteria: carrying an object 8 lb or heavier by hand, handling objects overhead, weight training with arms, swinging motion (ie, hitting tennis or golf ball), and lifting objects 25 lb or heavier. Two additional multiple choice questions provide a score assessing participation in contact and overhead sports. The activity scale showed excellent reliability and construct validity. It can be completed quickly and used in conjunction with patient-based measures of shoulder outcome to define patient populations for cohort studies, and to assess activity level as a prognostic factor in patients with shoulder disorders.

Activities of Daily Living↗

PubMed2005

The mechanical behavior of locking compression plates compared with dynamic compression plates in a cadaver radius model.

OBJECTIVE: The purpose of this cadaveric study was to compare the mechanical behavior of a locked compression plate, which uses threaded screw heads to create a fixed angle construct, with a dynamic compression plate construct in a cadaver radius model. DESIGN: Mechanical study with cyclic testing and high-speed optical motion analysis. SETTING: Biomechanics laboratory at an academic institution. PATIENTS/PARTICIPANTS: Eighteen pairs of fresh-frozen human cadaver radii were divided into 3 groups of 6 to be tested as a group in each of the following force applications: anteroposterior (AP) bending, mediolateral bending, or torsion. INTERVENTION: Each bone was osteotomized leaving a 5-mm fracture gap and then fixed with a plate. For each pair, 1 radius received a standard plate (limited-contact dynamic compression plates; LC-DCP), the contralateral radius was fixed with a locking compression plate (LCP), and specimens underwent cyclic loading. Normalized stiffness, average energy absorbed, and Newton-cycles to failure were calculated. In addition, a 3-dimensional, high-speed, infrared motion analysis system was used to evaluate motion at the fracture site. MAIN OUTCOME MEASUREMENTS: Construct stiffness, fracture site motion, cycles to failure, and energy absorption. Repeated measures ANOVA were used to detect differences between groups with time. RESULTS: In the torsion group, LCP specimens failed at 60% greater Newton-cycles than the LC-DCP (1473 vs. 918; P < 0.05). In the AP group, the LC-DCP absorbed significantly greater energy during 10,000 cycles compared with the LCP group (P < 0.05). The 2 constructs demonstrated different biomechanical behavior with time. As cycling progressed in the LC-DCP specimens under torsion testing, stiffness (measured at the actuator at the bone ends) did not change significantly; however, fracture motion (measured at the fracture surfaces) decreased significantly (P = 0.04). The LCP specimens did not display similar behavior. CONCLUSIONS: Our findings indicated that LCP constructs may demonstrate subtle mechanical superiority compared with the LC-DCP. The LCP specimens had less energy absorption in the AP group and survived longer in the torsion group. Discordance of motion between measurement regions was observed only in the LC-DCP torsion group, and may have been caused by plate-bone slippage or bone-screw subcatastrophic failure. However, many other compared parameters were found to be similar, and the clinical significance of the few differences found between constructs mandates further investigation.

Biomechanical Phenomena↗

PubMed2005

Interventions to improve osteoporosis treatment following hip fracture. A prospective, randomized trial.

BACKGROUND: Treatment of osteoporosis following a hip fracture has been notoriously poor. Many efforts have been made to improve treatment rates. The purpose of this study was to determine whether a perioperative inpatient intervention program, involving patient education and providing a list of questions for the primary care physician, increased the percentage of patients in whom osteoporosis was addressed following a hip fracture. METHODS: A prospective, randomized trial involving eighty patients who had been admitted to an academic medical center with a low-energy hip fracture was conducted. During their hospitalization, the study group patients were engaged in a fifteen-minute discussion regarding the association between osteoporosis and hip fractures, the efficacy of dual-energy x-ray absorptiometry scans in the diagnosis of osteoporosis and of bisphosphonates in its treatment, and the importance of medical follow-up for osteoporosis management. These patients were also provided with five questions regarding osteoporosis treatment to be given to their primary medical physician, and they were reminded about the questions during a follow-up telephone call six weeks later. The patients in the control group received a brochure describing methods for preventing falls. Both groups were contacted by telephone at six months after discharge to determine whether osteoporosis had been addressed. Positive indicators of intervention included assessment of bone mineral density with dual-energy x-ray absorptiometry and initiation of antiresorptive therapy. RESULTS: The average age in each group was eighty-two years, and 78% of the patients were female. Four patients in each group did not survive through the six-month follow-up period and were excluded from the trial. Fifteen (42%) of the thirty-six patients who had been randomized to the study group, compared with only seven (19%) of the thirty-six patients in the control group, had their osteoporosis addressed by their primary physician. This difference between the groups was significant (p = 0.036). CONCLUSIONS: Patients who were provided with information and questions for their primary care physician about osteoporosis were more likely to receive appropriate therapeutic intervention than were patients who had not received the information and questions. Orthopaedic surgeons have a unique opportunity to improve the rate of osteoporosis treatment in the perioperative period following a hip fracture by educating patients and directing them toward channels for long-term osteoporosis management.

Accidental Falls↗