Injury to the distal triceps tendon is uncommon and can be difficult to diagnose, especially when... more Injury to the distal triceps tendon is uncommon and can be difficult to diagnose, especially when a partial rupture or tear occurs. In situations where an incomplete disruption to the musculotendinous unit occurs, a palpable defect or clear functional loss may not be present. Advanced imaging techniques, such as magnetic resonance imaging or ultrasound, can be used to confirm the diagnosis and define the extent of injury. The treatment of a complete rupture of the distal triceps tendon is repair or reconstruction, whereas the management of a patient with a partial triceps rupture is related to the pain, functional deficit, and expectations of the patient. This article presents 2 patients with chronic, near complete disruptions of the distal triceps tendon. In both patients, surgical reconstruction of the injured tendon was accomplished using ipsilateral palmaris longus autograft. This technique allows the treating surgeon to harvest the graft from the ipsilateral upper extremity. The palmaris autograft is then used to reconstruct the injured portion of the triceps tendon using a Pulvertaft weave technique through the intact triceps tendon and osseous tunnels within the proximal ulna. This technique allows for easy surgical setup and harvest of autograft tendon and provides a structurally sound technique for a tension-free reconstruction of the injured tendon. It also permits early postoperative elbow range of motion, with active elbow extension allowed at 6 weeks. The authors have used this technique successfully in the treatment of chronic partial tears of the distal triceps tendon.
The Journal of the American Academy of Orthopaedic Surgeons, Jan 30, 2016
The Morel-Lavallée lesion is a closed soft-tissue degloving injury commonly associated with high-... more The Morel-Lavallée lesion is a closed soft-tissue degloving injury commonly associated with high-energy trauma. The thigh, hip, and pelvic region are the most commonly affected locations. Timely identification and management of a Morel-Lavallée lesion is crucial because distracting injuries in the polytraumatized patient can result in a missed or delayed diagnosis. Bacterial colonization of these closed soft-tissue injuries has resulted in their association with high rates of perioperative infection. Recently, MRI has been used to characterize and classify these lesions. Definitive management is dictated by the size, location, and age of the injury and ranges from percutaneous drainage to open débridement and irrigation. Chronic lesions may lead to the development of pseudocysts and contour deformities of the extremity.
Fractures of the posteromedial process of the talus are frequently the result of high-energy trau... more Fractures of the posteromedial process of the talus are frequently the result of high-energy trauma to the lower extremity. The treatment of these uncommon injuries may be unfamiliar and challenging to many surgeons. Significant pain and disability can result if these injuries are not recognized or treated appropriately. Open reduction and internal fixation via a posteromedial approach with screws is a mainstay of operative treatment for simple fractures. In cases of fracture impaction and/or comminution, a medial uniplanar external fixator may be used to improve intraoperative fracture visualization and mini-fragment plates and screws can be used to secure areas of comminution. Level V, expert opinion.
The adult rat ventral prostate, which has been used extensively as a model for hormone-dependent ... more The adult rat ventral prostate, which has been used extensively as a model for hormone-dependent prostate cancer, is composed of hormone-dependent columnar secretory epithelial cells and a mixture of hormone-independent cuboidal epithelial cells, bas- al epithelial cells, and stromal cells. Androgen ablation causes the gland to regress due to the selective loss of the secretory luminal epithelial cells that undergo
American journal of orthopedics (Belle Mead, N.J.), 2015
Symptomatic hypertrophic nonunions of the inferior pubic ramus are amenable to percutaneous screw... more Symptomatic hypertrophic nonunions of the inferior pubic ramus are amenable to percutaneous screw fixation in patients with suitable osseous anatomy. Preoperative planning, knowledge of bony and surrounding soft-tissue anatomy, and understanding of intraoperative pelvic fluoroscopy are required for proper screw fixation in the medullary canal of the inferior pubic ramus. In this article, we report 2 cases of adults with symptomatic hypertrophic nonunions of the superior and inferior pubic ramus, treated successfully with percutaneous medullary screw fixation. Percutaneous screw fixation can be used to successfully treat symptomatic hypertrophic nonunion of the inferior ramus and avoid the potential morbidity of a more extensive open surgical procedure.
The adult rat ventral prostate, which has been used extensively as a model for hormone-dependent ... more The adult rat ventral prostate, which has been used extensively as a model for hormone-dependent prostate cancer, is composed of hormone-dependent columnar secretory epithelial cells and a mixture of hormone-independent cuboidal epithelial cells, basal epithelial cells, and stromal cells. Androgen ablation causes the gland to regress due to the selective loss of the secretory luminal epithelial cells that undergo apoptosis. Most, if not all, of the studies examining the induction of apoptosis and the mechanism of regression have used young adult males at around 3 months of age. Prostate cancer, however, is a disease of older males, and we have therefore investigated whether age-related changes in hormone sensitivity and apoptosis occur in the ventral prostate of aged animals (12 months old) compared to young animals (3 months old). We have observed distinct differences in the morphology of the prostate between young and old rats prior to castration and a significant slowing in the r...
To review the outcomes of 65 patients younger than 55 years who underwent uncemented total hip ar... more To review the outcomes of 65 patients younger than 55 years who underwent uncemented total hip arthroplasty (THA) using third-generation ceramic-on-ceramic prostheses. Medical records of 30 men and 35 women (80 hips) aged 18 to 55 (mean, 39) years who underwent uncemented THA using third-generation ceramic-onceramic prostheses by a single surgeon were reviewed. 61 THAs used the Reflection cup with the Synergy stem (n=49), Spectron stem (n=7), or Anthology stem (n=5), and 19 THAs used the Trident cup with the Secur-Fit stem. Outcomes were assessed based on the UCLA Activity Score and Harris Hip Score, as well as radiolucency around the implants, malposition, and subsidence on radiographs. Patients were asked about their satisfaction with current activity level (yes/no), activity limitation (no limitation, musculoskeletal limitation, psychological impediments and lack of motivation, and pain or disability of the operative hip), and change in occupational activity level (same or simila...
The Journal of the American Academy of Orthopaedic Surgeons, 2015
Patients who sustain orthopaedic trauma are at risk for developing deep venous thrombosis and sym... more Patients who sustain orthopaedic trauma are at risk for developing deep venous thrombosis and symptomatic pulmonary emboli. The prevention of venous thromboembolism has moved to the forefront of patient safety initiatives, resulting in the formation of various guidelines to assist the practitioner. Recommendations for venous thromboembolism prophylaxis in the orthopaedic trauma patient exist, but there is insufficient evidence in the literature to make strong recommendations regarding type and duration of prophylaxis. The associated morbidity of chemical anticoagulants used in the orthopaedic trauma patient must also be taken into consideration, specifically the increased risk of bleeding. Mechanical prophylaxis is used in place of, or in addition to, these medications in certain situations. New, potentially superior anticoagulants have been developed but are still understudied. Larger studies are needed to further define the type and duration of deep venous thrombosis prophylaxis i...
Injury to the distal triceps tendon is uncommon and can be difficult to diagnose, especially when... more Injury to the distal triceps tendon is uncommon and can be difficult to diagnose, especially when a partial rupture or tear occurs. In situations where an incomplete disruption to the musculotendinous unit occurs, a palpable defect or clear functional loss may not be present. Advanced imaging techniques, such as magnetic resonance imaging or ultrasound, can be used to confirm the diagnosis and define the extent of injury. The treatment of a complete rupture of the distal triceps tendon is repair or reconstruction, whereas the management of a patient with a partial triceps rupture is related to the pain, functional deficit, and expectations of the patient. This article presents 2 patients with chronic, near complete disruptions of the distal triceps tendon. In both patients, surgical reconstruction of the injured tendon was accomplished using ipsilateral palmaris longus autograft. This technique allows the treating surgeon to harvest the graft from the ipsilateral upper extremity. The palmaris autograft is then used to reconstruct the injured portion of the triceps tendon using a Pulvertaft weave technique through the intact triceps tendon and osseous tunnels within the proximal ulna. This technique allows for easy surgical setup and harvest of autograft tendon and provides a structurally sound technique for a tension-free reconstruction of the injured tendon. It also permits early postoperative elbow range of motion, with active elbow extension allowed at 6 weeks. The authors have used this technique successfully in the treatment of chronic partial tears of the distal triceps tendon.
The Journal of the American Academy of Orthopaedic Surgeons, Jan 30, 2016
The Morel-Lavallée lesion is a closed soft-tissue degloving injury commonly associated with high-... more The Morel-Lavallée lesion is a closed soft-tissue degloving injury commonly associated with high-energy trauma. The thigh, hip, and pelvic region are the most commonly affected locations. Timely identification and management of a Morel-Lavallée lesion is crucial because distracting injuries in the polytraumatized patient can result in a missed or delayed diagnosis. Bacterial colonization of these closed soft-tissue injuries has resulted in their association with high rates of perioperative infection. Recently, MRI has been used to characterize and classify these lesions. Definitive management is dictated by the size, location, and age of the injury and ranges from percutaneous drainage to open débridement and irrigation. Chronic lesions may lead to the development of pseudocysts and contour deformities of the extremity.
Fractures of the posteromedial process of the talus are frequently the result of high-energy trau... more Fractures of the posteromedial process of the talus are frequently the result of high-energy trauma to the lower extremity. The treatment of these uncommon injuries may be unfamiliar and challenging to many surgeons. Significant pain and disability can result if these injuries are not recognized or treated appropriately. Open reduction and internal fixation via a posteromedial approach with screws is a mainstay of operative treatment for simple fractures. In cases of fracture impaction and/or comminution, a medial uniplanar external fixator may be used to improve intraoperative fracture visualization and mini-fragment plates and screws can be used to secure areas of comminution. Level V, expert opinion.
The adult rat ventral prostate, which has been used extensively as a model for hormone-dependent ... more The adult rat ventral prostate, which has been used extensively as a model for hormone-dependent prostate cancer, is composed of hormone-dependent columnar secretory epithelial cells and a mixture of hormone-independent cuboidal epithelial cells, bas- al epithelial cells, and stromal cells. Androgen ablation causes the gland to regress due to the selective loss of the secretory luminal epithelial cells that undergo
American journal of orthopedics (Belle Mead, N.J.), 2015
Symptomatic hypertrophic nonunions of the inferior pubic ramus are amenable to percutaneous screw... more Symptomatic hypertrophic nonunions of the inferior pubic ramus are amenable to percutaneous screw fixation in patients with suitable osseous anatomy. Preoperative planning, knowledge of bony and surrounding soft-tissue anatomy, and understanding of intraoperative pelvic fluoroscopy are required for proper screw fixation in the medullary canal of the inferior pubic ramus. In this article, we report 2 cases of adults with symptomatic hypertrophic nonunions of the superior and inferior pubic ramus, treated successfully with percutaneous medullary screw fixation. Percutaneous screw fixation can be used to successfully treat symptomatic hypertrophic nonunion of the inferior ramus and avoid the potential morbidity of a more extensive open surgical procedure.
The adult rat ventral prostate, which has been used extensively as a model for hormone-dependent ... more The adult rat ventral prostate, which has been used extensively as a model for hormone-dependent prostate cancer, is composed of hormone-dependent columnar secretory epithelial cells and a mixture of hormone-independent cuboidal epithelial cells, basal epithelial cells, and stromal cells. Androgen ablation causes the gland to regress due to the selective loss of the secretory luminal epithelial cells that undergo apoptosis. Most, if not all, of the studies examining the induction of apoptosis and the mechanism of regression have used young adult males at around 3 months of age. Prostate cancer, however, is a disease of older males, and we have therefore investigated whether age-related changes in hormone sensitivity and apoptosis occur in the ventral prostate of aged animals (12 months old) compared to young animals (3 months old). We have observed distinct differences in the morphology of the prostate between young and old rats prior to castration and a significant slowing in the r...
To review the outcomes of 65 patients younger than 55 years who underwent uncemented total hip ar... more To review the outcomes of 65 patients younger than 55 years who underwent uncemented total hip arthroplasty (THA) using third-generation ceramic-on-ceramic prostheses. Medical records of 30 men and 35 women (80 hips) aged 18 to 55 (mean, 39) years who underwent uncemented THA using third-generation ceramic-onceramic prostheses by a single surgeon were reviewed. 61 THAs used the Reflection cup with the Synergy stem (n=49), Spectron stem (n=7), or Anthology stem (n=5), and 19 THAs used the Trident cup with the Secur-Fit stem. Outcomes were assessed based on the UCLA Activity Score and Harris Hip Score, as well as radiolucency around the implants, malposition, and subsidence on radiographs. Patients were asked about their satisfaction with current activity level (yes/no), activity limitation (no limitation, musculoskeletal limitation, psychological impediments and lack of motivation, and pain or disability of the operative hip), and change in occupational activity level (same or simila...
The Journal of the American Academy of Orthopaedic Surgeons, 2015
Patients who sustain orthopaedic trauma are at risk for developing deep venous thrombosis and sym... more Patients who sustain orthopaedic trauma are at risk for developing deep venous thrombosis and symptomatic pulmonary emboli. The prevention of venous thromboembolism has moved to the forefront of patient safety initiatives, resulting in the formation of various guidelines to assist the practitioner. Recommendations for venous thromboembolism prophylaxis in the orthopaedic trauma patient exist, but there is insufficient evidence in the literature to make strong recommendations regarding type and duration of prophylaxis. The associated morbidity of chemical anticoagulants used in the orthopaedic trauma patient must also be taken into consideration, specifically the increased risk of bleeding. Mechanical prophylaxis is used in place of, or in addition to, these medications in certain situations. New, potentially superior anticoagulants have been developed but are still understudied. Larger studies are needed to further define the type and duration of deep venous thrombosis prophylaxis i...
Uploads
Papers