Papers by William Pannell
Injury, 2016
Antibiotic administration during the treatment of open fractures has been shown to reduce infecti... more Antibiotic administration during the treatment of open fractures has been shown to reduce infection rates and is considered a critical step in the management of these injuries. The purpose of this study was to determine if aminoglycoside administration during the treatment of open fractures leads to acute kidney injury. Patient records at a level I trauma centre were reviewed for adult patients who presented in 2014 with open fractures were screened for inclusion. Patients were excluded with fractures of the phalanges, metatarsals, and metacarpals, with isolated traumatic arthrotomies, or pre-existing renal dysfunction. Charts were reviewed for patient age, gender, race, past medical history, medication history, injury severity score, intravenous dye studies and fracture type. Patients were divided into those given cefazolin (Group A) and cefazolin with gentamicin (Group B). Laboratory values were used to determine which patients developed kidney dysfunction as measured using the RI...
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Journal of shoulder and elbow surgery / American Shoulder and Elbow Surgeons ... [et al.], Jan 18, 2016
The use of reverse total shoulder arthroplasty (RTSA) has significantly increased in recent years... more The use of reverse total shoulder arthroplasty (RTSA) has significantly increased in recent years. However, there is large variance in reported complication rates and sparse data on implant survival. This study used a statewide patient database to investigate complication rates and implant survival for RTSA. All patients undergoing RTSA or total shoulder arthroplasty (TSA) from 2011 to 2013 were identified within a statewide database. The complication and revision rates at 30 days, 90 days, 1 year, and 2 years postoperatively were determined. Potential risk factors for complications were analyzed with logistic regression, and Kaplan-Meier survival curves were used to compare implant failure. During the 3-year period, 10,844 procedures (6,658 TSA; 4,186 RTSA) were found within the database. The all-cause complication rate at 90 days and 2 years postoperatively was significantly higher for RTSA (P < .001). RTSA patients had a significantly increased risk of infection (P < .05) a...
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Journal of Shoulder and Elbow Surgery, 2015
Shoulder arthroplasty procedures are becoming increasingly prevalent in the United States due to ... more Shoulder arthroplasty procedures are becoming increasingly prevalent in the United States due to expanding indications and an aging population. Most patients are discharged home, but a subset of patients is discharged to a postacute care (PAC) facility. The purpose of this study was to identify the risk factors for discharge to a PAC facility after shoulder arthroplasty. The Nationwide Inpatient Sample discharge records from 2011 to 2012 were analyzed for patients who underwent a total shoulder arthroplasty (TSA) or reverse total shoulder arthroplasty (RTSA). Patient and hospital characteristics were identified. Univariate and multivariate analysis were used to determine the statistically significant risk factors for discharge to a PAC facility while controlling for covariates. In 2011 and 2012, 103,798 patients underwent shoulder arthroplasty procedures: 58,937 TSAs and 44,893 RTSAs were identified. RTSA patients were 1.3 times as likely to be discharged to a PAC facility as TSA patients (P = .001). Medicare patients were 2 times as likely to be discharged to a PAC facility than those with private insurance (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .001). In addition, women and patients presenting with a fracture, older age, or an increasing number of medical comorbidities were more likely to be discharged to a PAC facility (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .001). The risk factors identified in our study can be used to stratify patients at high risk for postoperative discharge to PAC, allowing for greater improvement in overall care and the facilitation of postoperative discharge planning.
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Journal of Wrist Surgery, 2015
Background The management of extra-articular distal radius fractures is highly variable, with no ... more Background The management of extra-articular distal radius fractures is highly variable, with no clear consensus regarding their optimal management. Purpose To assess comparatively the biomechanical stability of Kirschner wire (K-wire) fixation, volar plating, and intramedullary nailing for unstable, extra-articular distal radius fractures with both (1) constant and (2) cyclical axial compression, simulating forces experienced during early postoperative rehabilitation. Methods Twenty-six volar locking plate, intramedullary nail, and K-wire bone-implant constructs were biomechanically assessed using an unstable extra-articular distal radius bone model. Bone implant models were created for each type of construct. Three samples from each construct underwent compressive axial loading until fixation failure. The remaining samples from each construct underwent fatigue testing with a 50-N force for 2,000 cycles followed by repeat compressive axial loading until fixation failure. Results Axial loading revealed the volar plate was significantly stiffer than the intramedullary nail and K-wire constructs. Both the volar plate and intramedullary nail required greater than 300 N of force for fixation failure, while the K-wire construct failed at less than 150 N. Both the volar plate and intramedullary nail demonstrated less than 1 mm of displacement during cyclic loading, while the K-wire construct displaced greater than 3 mm. Postfatigue testing demonstrated the volar plate was stiffer than the intramedullary nail and K-wire constructs, and both the volar plate and intramedullary nail required greater than 300 N of force for fixation failure while the K-wire construct failed at less than 150 N. Conclusions Volar plating of unstable extra-articular distal radius fractures is biomechanically stiffer than K-wire and intramedullary fixation. Both the volar plate and intramedullary nail demonstrated the necessary stability and stiffness to maintain anatomic reduction during the postoperative rehabilitation period. Clinical Relevance Both the volar plate and intramedullary nail demonstrated the necessary biomechanical stability to maintain postoperative reduction in extra-articular distal radius fractures, warranting further clinical comparison.
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The Spine Journal, 2011
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The Spine Journal, 2013
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The Spine Journal, 2013
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Foot & Ankle International, 2013
Although tibiotalar fusion has historically been considered the gold standard treatment for end-s... more Although tibiotalar fusion has historically been considered the gold standard treatment for end-stage arthritis of the ankle, the performance of total ankle replacement appears to be gaining favor as improved outcomes have been observed with new implant designs and surgical techniques. The purpose of this study was to compare trends and demographics in the performance of ankle fusion and total ankle replacement in the United States. The Current Procedural Terminology (CPT) codes of patients undergoing ankle fusion and total ankle replacement were searched using the PearlDiver Patient Record Database, a national database of orthopaedic patients. The CPT codes for open ankle arthrodesis (27870), arthroscopic ankle arthrodesis (29899), and total ankle replacement (27700, 27702) were searched for the years 2004 to 2009 to identify relative changes in the performance of ankle fusion and replacement over time. The performance of ankle fusion was unchanged during the 6-year study period. In contrast, an increase in total ankle replacement was observed, from 0.63 cases per 10 000 patients searched in 2004 to 0.99 cases per 10 000 patients in 2009 (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .05). Both ankle fusion and total ankle replacement were performed most commonly in patients aged 60 to 69 years (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .05). Although an even gender distribution was observed in patients undergoing total ankle replacement, open and arthroscopic fusion were more commonly performed in males (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .05). With regard to regional distribution, open and arthroscopic fusion were most commonly performed in the western region of the United States, whereas total ankle replacement was performed most frequently in the Midwest (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .001). In the population studied, the performance of total ankle replacement increased 57% from 2004 to 2009 and was performed equally in male and female patients when compared to ankle fusion, which was more often performed in males and was unchanged with time. Level IV, cross-sectional study.
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Advanced Robotics, 2010
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Journal of Shoulder and Elbow Surgery, 2016
Little is known about the perioperative complication rates of the surgical management of midshaft... more Little is known about the perioperative complication rates of the surgical management of midshaft clavicle nonunions. The purpose of the current study was to report on the perioperative complication rates after surgical management of nonunions and to compare them with complication rates of acute fractures using a population cohort. The American College of Surgeons National Surgical Quality Improvement Program database was queried to identify patients who had undergone open reduction-internal fixation of midshaft clavicle fractures between 2007 and 2013. Patients were stratified by operative indication: acute fracture or nonunion. Patient characteristics and 30-day complication rates were compared between the 2 groups using univariate and multivariate analyses. A total of 1215 patients were included in our analysis. Of these, 1006 (82.8%) were acute midshaft clavicle fractures and 209 (17.2%) were midshaft nonunions. Patients undergoing surgical fixation for nonunion had a higher rate of total complications compared with the acute fracture group (5.26% vs. 2.28%; P = .034). On multivariate analysis, patients with a nonunion were at a &amp;amp;amp;amp;amp;amp;amp;amp;gt;2-fold increased risk of any postsurgical complication (odds ratio, 2.29 [95% confidence interval, 1.05-5.00]; P = .037) and &amp;amp;amp;amp;amp;amp;amp;amp;gt;3-fold increased risk of a wound complication (odds ratio, 3.22 [95% confidence interval, 1.02-10.20]; P = .046) compared with acute fractures. On the basis of these findings, patients undergoing surgical fixation for a midshaft clavicle nonunion are at an increased risk of short-term complications compared with acute fractures. This study provides additional information to consider in making management decisions for these common injuries.
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