Papers by Charles Goldfarb
Journal of Orthopaedic Trauma, 2010
Journal of Orthopaedic Trauma, 2002
Quantitatively evaluate plain radiographs, relative to computed tomography (CT) scans, for assess... more Quantitatively evaluate plain radiographs, relative to computed tomography (CT) scans, for assessment of articular fragment displacement (step and gap) in displaced acetabular fractures and in canine osteotomized acetabular specimens. Retrospective evaluation of a consecutive series of CT scans and plain radiographs of patients with displaced acetabular fractures and canine acetabulae osteotomized to represent acetabular fractures with displacement. Level I trauma center. Computed tomography scans and plain radiographic images of 62 consecutive patients with displaced acetabular fractures were reviewed; 20 patients met the inclusion criteria regarding location, fracture pattern, availability of plain radiographs and CT scans, and the position of the femoral head at the time of radiographic assessment. The hemipelvi of five adult mongrels underwent osteotomy of the acetabulum and similar radiographic evaluation. Three independent reviewers measured step and gap deformity on plain radiographs and CT scans utilizing a standardized measurement technique. Sensitivity and specificity of plain radiographs for detecting step and gap displacement (2 mm and 4 mm) relative to CT scans were determined. Intraclass correlation coefficient and intraobserver reliability was also calculated. For the canine specimens, sensitivities of each imaging method were determined relative to actual fragment displacement measurements. In the clinical images, when compared to CT, plain radiographs showed poor sensitivity at detecting step deformity (sensitivity = 25%). When analyzed by fracture type, plain radiographs were particularly poor at detecting step deformities in fractures involving a single column of the acetabulum (sensitivity = 0%). Excellent intraobserver and intraclass reliability existed among the three reviewers. Computed tomography scans were considerably more accurate in measuring step and gap displacement relative to actual measurements than plain radiographs in the canine specimens. 1) Plain radiographs showed poor sensitivity for the detection of step and gap deformities in patients with acetabular fractures and in osteotomized canine specimens, relative to CT scans; 2) differences between CT and plain radiographs in both specimen types were greatest with the most clinically relevant deformity-i.e., step; and 3) CT scans are essential and should continue to be used in conjunction with plain radiographs in the preoperative evaluation of displaced acetabular fractures and perhaps should be considered in the postoperative assessment of fracture reduction.
The Journal of hand surgery, 2015
To determine the impact of uninterrupted use of warfarin on hand and wrist surgery. This single-c... more To determine the impact of uninterrupted use of warfarin on hand and wrist surgery. This single-center, prospective cohort trial enrolled adult patients undergoing hand and wrist surgery. Between May 2009 and August 2014, 47 surgical patients receiving uninterrupted warfarin (50 procedures) were enrolled and matched as a group by age and procedure type to 48 surgical patients (50 procedures) who were not prescribed warfarin. Complications, defined as bleeding, infection, or wound dehiscence requiring reoperation, were recorded for each group. Surgical outcome measures were composed of objective findings affected by surgical site bleeding (ie, ecchymosis extent, hematoma presence, 2-point discrimination) and standardized patient-rated assessments (Quick-Disabilities of the Arm, Shoulder, and Hand, and visual analog scales: pain and swelling). We collected data preoperatively and at 2 and 4 weeks postoperatively. Statistical analyses contrasted complications and outcomes data between ...
The Journal of Bone and Joint Surgery
Although metacarpophalangeal joint arthroplasty is occasionally performed for joints affected by ... more Although metacarpophalangeal joint arthroplasty is occasionally performed for joints affected by osteoarthritis, it is most often done in patients with rheumatoid arthritis. The metacarpophalangeal joint is critical for proper finger function but is the most common site of involvement in the rheumatoid hand. A thorough understanding of the anatomy, pathophysiology, and mechanics of the metacarpophalangeal joint is a prerequisite for the evaluation and treatment of patients requiring metacarpophalangeal arthroplasty. Silicone rubber implants are the most frequently used device for treatment of revised metacarpophalangeal arthroplasty. Follow-up studies show that this surgery improves function and deformity and achieves nearly uniform patient satisfaction.
New England Journal of Medicine
Journal of Orthopaedic Trauma
This investigation was designed to compare computerized tomography (CT) and plain radiography for... more This investigation was designed to compare computerized tomography (CT) and plain radiography for detection of articular step and gap deformity after healing of operatively treated acetabular fractures. Retrospective review of CT and plain radiographic images of 15 patients treated operatively for a displaced acetabular fracture. Level I trauma center. Ability of CT scans and plain radiographs to detect residual articular steps and gaps after healing of acetabular fractures managed by open reduction and internal fixation. Using standardized evaluation techniques, more patients were found to have residual articular incongruities on CT scans (8 with step and 7 with gap) than on plain radiographs (1 with step and 6 with gap). In addition, a step deformity on CT scan correlated with a gap deformity, and as the size of the step deformity increased, so too did the size of the gap deformity. Based on our data, computerized tomography is more likely than plain radiographs to allow detection of residual articular incongruities in healed acetabular fractures. The authors believe that CT scans improve the evaluation of articular reduction and that this information can be used to further evaluate surgical technique and provide insight as to the impact of residual articular incongruity on the development of hip arthrosis.
The American journal of orthopedics
The Journal of Hand Surgery, 2015
To investigate the distinguishing morphological characteristics of children with radial longitudi... more To investigate the distinguishing morphological characteristics of children with radial longitudinal deficiency (RLD) in Holt-Oram syndrome (HOS). One hundred fourteen involved extremities in 62 patients with a diagnosis of HOS were identified at 3 institutions. Medical records and radiographs were evaluated. Radial longitudinal deficiency and thumb hypoplasia were classified according to the modified Bayne and Klug classification and Blauth classifications, respectively, when possible. Other unusual or distinguishing characteristics were catalogued. There was bilateral involvement in 84% of patients. The forearm was involved in 81% of the extremities and a shortened distal radius (Bayne and Klug type I RLD) was the most commonly identified forearm anomaly (40%). Radioulnar synostosis was present in 15% of the extremities, all in the proximal forearms with reduced radial heads. Thumb aplasia (Blauth type V hypoplastic thumb) was the most common type of classifiable thumb abnormality and occurred in 35% of involved thumbs. Twenty-seven percent of abnormal thumbs affected were not classifiable according to the Blauth classification, and 19% of involved thumbs (hypoplastic or absent) had first-web syndactyly. The upper extremity in HOS differs from the typical presentation of RLD. The forearm is more often involved and may demonstrate radioulnar synostosis. The thumb is frequently unclassifiable by the Blauth classification and has first-web syndactyly. The presence of radioulnar synostosis and syndactyly of the radial 2 digits in RLD should prompt the hand surgeon to obtain a cardiac evaluation and consider genetic testing for HOS. Diagnostic III.
The Journal of Hand Surgery, 2015
During the 5th week of human development, the distal end of the upper limb bud begins to flatten ... more During the 5th week of human development, the distal end of the upper limb bud begins to flatten and expand forming the autopod or handplate. Over the next few days the handplate will transform into a predictable series of segmented digits. The molecular mechanisms underlying digit formation are not fully understood, however, recent investigations in animal models and clinical genetics provide some interesting insights into the process.
The American journal of sports medicine, Jan 29, 2015
Lateral epicondylitis is a common cause of elbow pain that is treated with a variety of nonoperat... more Lateral epicondylitis is a common cause of elbow pain that is treated with a variety of nonoperative measures and often improves with time. Minimal research is available on patients in whom these nonoperative treatments fail. To identify baseline patient and disease factors associated with the failure of nonoperative treatment of lateral epicondylitis, defined as surgery after a period of nonoperative treatment. Case control study; Level of evidence, 3. A total of 580 patients treated for lateral epicondylitis at a tertiary center between 2007 and 2012 were analyzed. Disease-specific and patient demographic characteristics were compared between patient groups (nonoperative vs surgical treatment). A multivariable logistic regression model was created based on preliminary univariate testing to determine which characteristics were associated with failure of nonoperative treatment. Of the 580 patients, 92 (16%) underwent surgical treatment at a mean of 6 months (range, 0-31 months) from...
Journal of Shoulder and Elbow Surgery, 2015
The Journal of Hand Surgery, 2015
To evaluate the outcomes and complications in a series of children with clinodactyly treated with... more To evaluate the outcomes and complications in a series of children with clinodactyly treated with opening wedge osteotomy of the abnormal phalanx. We performed a retrospective review of all children with clinodactyly treated at our institution with opening wedge osteotomy of the abnormal middle phalanx between 2003 and 2013. Patients with concomitant pathology or prior surgery in the affected finger were excluded. Preoperative and postoperative clinical angle, radiographic angle, digital range of motion, and pain were compared and complications were recorded. We included 13 digits in 9 patients. All had greater than 20° of preoperative clinical angulation (mean, 36°). Mean age at time of surgery was 11 years; mean duration of follow-up was 25 months (range, 12-43 mo). All digits had significant improvement (mean, 32°) in clinical and radiographic angles after surgery. This improvement was maintained at final follow-up in 12 digits. Six patients had pain preoperatively and no patient had pain postoperatively. One digit had a recurrent deformity at final follow-up and 3 digits developed stiffness at the distal interphalangeal joint. Opening wedge osteotomy is an effective treatment for angulation in children with clinodactyly. We counsel families regarding the risk of distal interphalangeal joint stiffness. Therapeutic IV.
Journal of pediatric orthopedics
Hand (New York, N.Y.), 2012
Several studies support the use of CT for diagnosing coronal fractures of the distal radius but t... more Several studies support the use of CT for diagnosing coronal fractures of the distal radius but the inter-observer reliability of these observations is less well studied. We tested the null hypothesis that radiographs alone and the combination of radiographs and two-dimensional computed tomography scans (2DCT) have the same inter-observer variation for the diagnosis of coronal articular fracture lines in the distal radius. Using a web-based survey, 63 surgeons were randomized to evaluate 16 fractures of the distal radius on radiographs alone or radiographs and 2DCT for the presence or absence of a coronal fracture line of the lunate facet and, if present, the stability of the fracture. The kappa multirater measure was calculated to estimate agreement between observers. The inter-observer variation in diagnosis of a coronal fracture line was fair with both radiographs and 2DCT, as was the diagnosis of instability of the volar lunate facet fracture when present. Two-dimensional comput...
Instructional course lectures, 2007
Traumatic wrist instability encompasses a wide spectrum of injuries from the subtle partial ligam... more Traumatic wrist instability encompasses a wide spectrum of injuries from the subtle partial ligament tear to the dramatic perilunate dislocation. A timely diagnosis is based on the patient's history and physical examination together with radiographic and advanced imaging studies. Early intervention has been associated with improved patient outcomes.
The Journal of bone and joint surgery. American volume, 2007
The complex anatomy of the hand means that injuries result in substantial loss of function. The d... more The complex anatomy of the hand means that injuries result in substantial loss of function. The damage must be repaired to regain the lost function. Fractures need to heal in anatomic position, and the soft tissues must be supple so that the fingers can move through a useful range of motion. Evaluation and management of malunion, nonunion, bone loss, and stiff fingers are important factors in posttraumatic reconstruction of the hand.
Journal of orthopaedic trauma, 2004
Journal of orthopaedic trauma, 2002
To evaluate objectively the effectiveness of current surgical management of displaced acetabular ... more To evaluate objectively the effectiveness of current surgical management of displaced acetabular fractures. To provide insight into how these evaluation methods can be used to identify areas in which improvements in surgery and rehabilitation can be pursued to improve patient outcomes. Consecutive case series. University medical center. Fifteen patients were studied, each with an isolated, displaced acetabular fracture treated with a Kocher-Langenbeck approach. Primary outcome measures included hip muscle strength, including work (Joules/minute) and maximum torque (30 degrees/second) for abductors/adductors and flexors/extensors. Gait analysis of patients and able-bodied cohorts, including stride length, speed, and cadence, were also assessed. Motion analysis during gait was also studied for each body segment, including the trunk, pelvis, hip, knee, and ankle, in the sagittal, frontal, and axial planes. Motion data for the affected side was compared with motion data for the unaffect...
American journal of orthopedics (Belle Mead, N.J.), 2010
We conducted this study to evaluate the hypothesis that the need for a higher level of care is th... more We conducted this study to evaluate the hypothesis that the need for a higher level of care is the most important reason for the transfer of patients with hand trauma to a level I trauma center. We prospectively assessed 53 patients transferred to our level I trauma center for evaluation of an acute hand injury. Specialty of referring physician, case complexity as assessed with visual analog scale, and patient insurance status were obtained before transfer and were reassessed after arrival. Only 9 patients were examined by a surgeon before transfer. On the basis of injury severity, we judged that 40 of the 53 patients required the immediate care of a hand surgeon but that only 13 required the resources of a level I trauma center. Most of the patients were transferred without prior evaluation by a hand surgeon, despite there being an on-staff surgeon at many of the hospitals.
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Papers by Charles Goldfarb