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Nabil Ebraheim

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I was born in Cairo, Egypt

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Ümit Haluk Atasever

Erciyes University

Çiğdem GÖKSEL

Istanbul Technical University

Banaras Hindu University, Varanasi

eka wilda faida

STIKES YAYASAN RUMAH SAKIT Dr. SOETOMO

Lorena Ciallella

Universidad de Buenos Aires

Mario Abbruzzese

Universidad Austral

Ananda B Bhavanani

SRI BALAJI VIDYAPEETH University

Xavier Ferrer-Francesch

University Autonoma of Barcelona

Weill Cornell Medicine

Masood Naseripour

Iran University of Medical Sciences

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Papers by Nabil Ebraheim

Roy-Camille Technique for Traumatic Instability of the Lower Cervical Spine

The Internet Journal of Spine Surgery, 2005

This study is a retrospective review of the charts and radiographs of sixty-seven patients treate... more This study is a retrospective review of the charts and radiographs of sixty-seven patients treated with posterior lateral mass plating and iliac crest bone grafting in the cervical spine with the Roy-Camille technique. The goal of the study is to determine the safety and efficacy of the Roy-Camille technique for screw placement in the cervical spine. All patients went on to develop a solid fusion. Sixty-one patients out of 67 (91.0%) with incomplete cord injuries improved at least one Frankel grade. Complications consisted of 3/67 wound infections, 1/67 deep wound infection and 2/67 superficial wound infection; neither requiring hardware removal. One patient with osteoporosis developed a loose screw. There were no patients with neurologic compromise or vascular injury related to the Roy-Camille technique. This study supports the Roy-Camille technique as being a safe and effective method of acquiring posterior cervical fusion.

Posterior Lateral Mass Screw Fixation: Anatomic and Radiographic Considerations

During the last 10 years, posterior plating utilizing lateral mass screw fixation has become more... more During the last 10 years, posterior plating utilizing lateral mass screw fixation has become more popular for treating instability of the lower cervical spine. Injury to the spinal nerves associated with insertion of lateral mass screws is the main complication of this procedure. The purpose of this article is to briefly review the status of this procedure and to update the advances in anatomic and radiographic studies as to avoid or minimize spinal nerve injury.

Sex Specific Sacroiliac Joint Biomechanics During Standing Upright

Spine, Sep 15, 2018

Study Design. The comparison of sacroiliac joint (SIJ) angular motions, pelvis ligaments strain, ... more Study Design. The comparison of sacroiliac joint (SIJ) angular motions, pelvis ligaments strain, load sharing, and stress distribution across the joint for male and female spine-pelvis-femur models using finite element analysis. Objective. To quantify biomechanical parameters at SIJ for all motions for both male and female models. Summary of Background Data. SIJ has been recognized as a main source of pain in 13% to 30% of patients with low back pain. It is shown that the SIJ rotation and translation in different planes are not exceeding 28 to 38 and 2 mm, respectively. Due to limitation of in vivo and in vitro studies, it is difficult to quantify certain biomechanical parameters such as load-sharing and stress distribution across the joint. Finite element analysis is a useful tool which can be utilized to understand the biomechanics of the SIJ. Methods. The validated finite element models of a male and a female lumbar spine-pelvis-femur were developed from computer tomography (CT) scans. The models were used to simulate spine physiological motions. The range of motion, ligament strains, load sharing, and stress distribution across the left and right SIJs were compared between male and female models. Results. Motions data at SIJs demonstrated that female model experienced 86% higher mobility in flexion, 264% in extension, 143% in left bending, and 228% in right bending compared with the male model. The stresses and loads on SIJs were higher on the female model compared with the male model. Female model ligaments underwent larger strains compared with the male model ligaments. Conclusion. Female SIJ had higher mobility, stresses, loads, and pelvis ligament strains compared with the male SIJ which led to higher stress across the joint, especially on the sacrum under identical loading conditions. This could be a possible reason for higher incidence of SIJ pain and pelvic stress fracture in females.

Chronic Exertional Compartment Syndrome: A Review of Literature

Surgical case reports and images, Jan 5, 2022

Chronic exertional compartment syndrome (CECS) is a serious, yet underdiagnosed condition that ca... more Chronic exertional compartment syndrome (CECS) is a serious, yet underdiagnosed condition that can cause severe lower extremity pain in running athletes. CECS is a transient increase in compartment pressure leading to severe pain, paresthesia, and vascular compromise. Understanding the detailed anatomy is paramount to proper diagnosis and treatment. Diagnosis is made with measuring compartments pressures before and after exercise at certain time intervals. When properly diagnosed and treated, CECS can be appropriately managed and patients can return to their previous level of activity.

The location of the intervertebral lumbar disc on the posterior aspect of the spine

Surgical Neurology, Sep 1, 1997

BACKGROUND Epidural fibrosis or scar formation is considered one cause of failed lumbar discectom... more BACKGROUND Epidural fibrosis or scar formation is considered one cause of failed lumbar discectomy. Avoidance of unnecessary bony resection of the lamina may prevent or decrease postoperative scar formation. The knowledge of the precise location of the projection of the lumbar disc may also facilitate surgery and decrease patient morbidity. No studies exist regarding the projection of the lumbar disc on the posterior aspect of the lumbar spine.

Sex Specific Sacroiliac Joint Biomechanics During Standing Upright

Spine, Sep 15, 2018

Study Design. The comparison of sacroiliac joint (SIJ) angular motions, pelvis ligaments strain, ... more Study Design. The comparison of sacroiliac joint (SIJ) angular motions, pelvis ligaments strain, load sharing, and stress distribution across the joint for male and female spine-pelvis-femur models using finite element analysis. Objective. To quantify biomechanical parameters at SIJ for all motions for both male and female models. Summary of Background Data. SIJ has been recognized as a main source of pain in 13% to 30% of patients with low back pain. It is shown that the SIJ rotation and translation in different planes are not exceeding 28 to 38 and 2 mm, respectively. Due to limitation of in vivo and in vitro studies, it is difficult to quantify certain biomechanical parameters such as load-sharing and stress distribution across the joint. Finite element analysis is a useful tool which can be utilized to understand the biomechanics of the SIJ. Methods. The validated finite element models of a male and a female lumbar spine-pelvis-femur were developed from computer tomography (CT) scans. The models were used to simulate spine physiological motions. The range of motion, ligament strains, load sharing, and stress distribution across the left and right SIJs were compared between male and female models. Results. Motions data at SIJs demonstrated that female model experienced 86% higher mobility in flexion, 264% in extension, 143% in left bending, and 228% in right bending compared with the male model. The stresses and loads on SIJs were higher on the female model compared with the male model. Female model ligaments underwent larger strains compared with the male model ligaments. Conclusion. Female SIJ had higher mobility, stresses, loads, and pelvis ligament strains compared with the male SIJ which led to higher stress across the joint, especially on the sacrum under identical loading conditions. This could be a possible reason for higher incidence of SIJ pain and pelvic stress fracture in females.

Evaluation of Cervical Posterior Lateral Mass Screw Placement by Oblique Radiographs

Spine, Mar 1, 1996

Chronic Exertional Compartment Syndrome: A Review of Literature

Surgical case reports and images, Jan 5, 2022

Chronic exertional compartment syndrome (CECS) is a serious, yet underdiagnosed condition that ca... more Chronic exertional compartment syndrome (CECS) is a serious, yet underdiagnosed condition that can cause severe lower extremity pain in running athletes. CECS is a transient increase in compartment pressure leading to severe pain, paresthesia, and vascular compromise. Understanding the detailed anatomy is paramount to proper diagnosis and treatment. Diagnosis is made with measuring compartments pressures before and after exercise at certain time intervals. When properly diagnosed and treated, CECS can be appropriately managed and patients can return to their previous level of activity.

Successful Immediate Re-implantation of an Extruded Femoral Segment: a Case Report

HSS Journal, Dec 7, 2015

The location of the intervertebral lumbar disc on the posterior aspect of the spine

Surgical Neurology, Sep 1, 1997

BACKGROUND Epidural fibrosis or scar formation is considered one cause of failed lumbar discectom... more BACKGROUND Epidural fibrosis or scar formation is considered one cause of failed lumbar discectomy. Avoidance of unnecessary bony resection of the lamina may prevent or decrease postoperative scar formation. The knowledge of the precise location of the projection of the lumbar disc may also facilitate surgery and decrease patient morbidity. No studies exist regarding the projection of the lumbar disc on the posterior aspect of the lumbar spine.

Anatomic Considerations for the Placement of Distraction Pins in the Talus

Foot & Ankle International, Apr 1, 1994

Evaluation of Cervical Posterior Lateral Mass Screw Placement by Oblique Radiographs

Spine, Mar 1, 1996

Bilateral Below-Knee Amputation Surgery at the Scene: Case Report

Journal of Trauma-injury Infection and Critical Care, Oct 1, 2000

W hile military surgeons are prepared to provide care at or near the scene of battle, civilian tr... more W hile military surgeons are prepared to provide care at or near the scene of battle, civilian trauma surgeons are rarely, if ever, called on to perform such surgery. A review of the literature showed only one case report of two patients with extremity injury that required amputation at the scene. 1 In the first case, the left arm was caught in an auger. The distal humerus was transected to release the patient. In the second case, the patient was trapped for 5 hours by a grain silo that collapsed on him. The fourth and the fifth digits of the left hand were amputated to release the patient. The authors report a case that required bilateral belowknee amputation to release a trapped patient from his semitrailer. The present case was unique in that both feet were trapped for 7 hours and bilateral amputation, which is considered a major surgery, was performed safely at the scene. This report emphasizes that field surgery can be performed safely; however, teamwork is essential.

Successful Immediate Re-implantation of an Extruded Femoral Segment: a Case Report

HSS Journal, Dec 7, 2015

Comparison of intramedullary nail, plate, and external fixation in the treatment of distal tibia nonunions

International Orthopaedics, Feb 28, 2017

Purpose The purpose of this study was to examine time to union of extra-articular distal tibia no... more Purpose The purpose of this study was to examine time to union of extra-articular distal tibia nonunions based on fracture type and fixation methods: intramedullary nail (IMN), plate osteosynthesis (PO), and external fixation (EF). Methods This retrospective chart review included all patients who presented at a Level I trauma center with AO/OTA 43A & distal third 42A-C fracture nonunions between 2008 and 2014. Fixation methods were recorded and patient course was followed until nonunion had healed clinically. Results Thirty-three distal tibia nonunions were included, and 29 reached eventual union (88%). Five AO/OTA fracture types were present. Mean times to union from nonunion diagnosis between original fracture types were compared (p = 0.203). Comminuted fracture types had longer times to union from nonunion diagnosis compared to simple fracture types (78 vs. 46 weeks, p = 0.051) and more revision fixations (1.5 vs. 0.5, p = 0.037). Mean time to union from nonunion diagnosis was shorter when no revision fixation was done compared to revisions (15 vs. 42 weeks, p = 0.102). Times to union from nonunion diagnosis without revision fixation were: IMN (12 weeks), PO (27 weeks), and EF (13 weeks) (p = 0.202). Times to union from definitive revision fixation were: IMN (17 weeks), PO (21 weeks), and EF (66 weeks) (p = 0.009), with EF taking significantly longer than both other methods. 21 patients (64%) underwent revision fixation. Revision fail rates were: IMN (0/6, 0%), PO (2/8, 25%), and EF (15/21, 71%). Time to union was longer in revisions that changed fixation method compared to revisions that used the same method (51 vs. 18 weeks, p = 0.030). Deep infections were also associated with longer union times (81 vs. 47 weeks, p = 0.040). Conclusions In this nonunion population, comminuted fracture types needed more time and revisions to reach union. Time to union was only clinically shorter when revision fixation was not performed, but IMN and PO were both successful fixation options with significantly shorter times to union than EF. Mean time to union increased even more when revision of fixation method was performed vs. exchange revision, as did nonunions with deep infections.

Anatomic Considerations for the Placement of Distraction Pins in the Talus

Foot & Ankle International, Apr 1, 1994

Nonunion of Pelvic Fractures

Journal of Trauma-injury Infection and Critical Care, 1998

Nonunion of the pelvic bones is uncommon. It may be under-diagnosed because of the difficulty in ... more Nonunion of the pelvic bones is uncommon. It may be under-diagnosed because of the difficulty in visualization of the fracture and interpretation with conventional radiography. The authors report four cases of nonunion involving the pelvic bones. Nonunion of the posterior ilium was occult in two patients and was not apparent on routine radiographs. The two patients with nonunion of the anterior iliac crest had major displacement caused by muscle pull. Pain on weight-bearing and awkward gait were common symptoms. All patients required surgical management for symptomatic relief.

Bilateral Below-Knee Amputation Surgery at the Scene: Case Report

Journal of Trauma-injury Infection and Critical Care, Oct 1, 2000

W hile military surgeons are prepared to provide care at or near the scene of battle, civilian tr... more W hile military surgeons are prepared to provide care at or near the scene of battle, civilian trauma surgeons are rarely, if ever, called on to perform such surgery. A review of the literature showed only one case report of two patients with extremity injury that required amputation at the scene. 1 In the first case, the left arm was caught in an auger. The distal humerus was transected to release the patient. In the second case, the patient was trapped for 5 hours by a grain silo that collapsed on him. The fourth and the fifth digits of the left hand were amputated to release the patient. The authors report a case that required bilateral belowknee amputation to release a trapped patient from his semitrailer. The present case was unique in that both feet were trapped for 7 hours and bilateral amputation, which is considered a major surgery, was performed safely at the scene. This report emphasizes that field surgery can be performed safely; however, teamwork is essential.

Vulnerability of the Posterior Interosseous Nerve During Proximal Radius Exposures

Clinical Orthopaedics and Related Research, Jun 1, 1995

Comparison of intramedullary nail, plate, and external fixation in the treatment of distal tibia nonunions

International Orthopaedics, Feb 28, 2017

Purpose The purpose of this study was to examine time to union of extra-articular distal tibia no... more Purpose The purpose of this study was to examine time to union of extra-articular distal tibia nonunions based on fracture type and fixation methods: intramedullary nail (IMN), plate osteosynthesis (PO), and external fixation (EF). Methods This retrospective chart review included all patients who presented at a Level I trauma center with AO/OTA 43A & distal third 42A-C fracture nonunions between 2008 and 2014. Fixation methods were recorded and patient course was followed until nonunion had healed clinically. Results Thirty-three distal tibia nonunions were included, and 29 reached eventual union (88%). Five AO/OTA fracture types were present. Mean times to union from nonunion diagnosis between original fracture types were compared (p = 0.203). Comminuted fracture types had longer times to union from nonunion diagnosis compared to simple fracture types (78 vs. 46 weeks, p = 0.051) and more revision fixations (1.5 vs. 0.5, p = 0.037). Mean time to union from nonunion diagnosis was shorter when no revision fixation was done compared to revisions (15 vs. 42 weeks, p = 0.102). Times to union from nonunion diagnosis without revision fixation were: IMN (12 weeks), PO (27 weeks), and EF (13 weeks) (p = 0.202). Times to union from definitive revision fixation were: IMN (17 weeks), PO (21 weeks), and EF (66 weeks) (p = 0.009), with EF taking significantly longer than both other methods. 21 patients (64%) underwent revision fixation. Revision fail rates were: IMN (0/6, 0%), PO (2/8, 25%), and EF (15/21, 71%). Time to union was longer in revisions that changed fixation method compared to revisions that used the same method (51 vs. 18 weeks, p = 0.030). Deep infections were also associated with longer union times (81 vs. 47 weeks, p = 0.040). Conclusions In this nonunion population, comminuted fracture types needed more time and revisions to reach union. Time to union was only clinically shorter when revision fixation was not performed, but IMN and PO were both successful fixation options with significantly shorter times to union than EF. Mean time to union increased even more when revision of fixation method was performed vs. exchange revision, as did nonunions with deep infections.

Roy-Camille Technique for Traumatic Instability of the Lower Cervical Spine

The Internet Journal of Spine Surgery, 2005

This study is a retrospective review of the charts and radiographs of sixty-seven patients treate... more This study is a retrospective review of the charts and radiographs of sixty-seven patients treated with posterior lateral mass plating and iliac crest bone grafting in the cervical spine with the Roy-Camille technique. The goal of the study is to determine the safety and efficacy of the Roy-Camille technique for screw placement in the cervical spine. All patients went on to develop a solid fusion. Sixty-one patients out of 67 (91.0%) with incomplete cord injuries improved at least one Frankel grade. Complications consisted of 3/67 wound infections, 1/67 deep wound infection and 2/67 superficial wound infection; neither requiring hardware removal. One patient with osteoporosis developed a loose screw. There were no patients with neurologic compromise or vascular injury related to the Roy-Camille technique. This study supports the Roy-Camille technique as being a safe and effective method of acquiring posterior cervical fusion.

Posterior Lateral Mass Screw Fixation: Anatomic and Radiographic Considerations

During the last 10 years, posterior plating utilizing lateral mass screw fixation has become more... more During the last 10 years, posterior plating utilizing lateral mass screw fixation has become more popular for treating instability of the lower cervical spine. Injury to the spinal nerves associated with insertion of lateral mass screws is the main complication of this procedure. The purpose of this article is to briefly review the status of this procedure and to update the advances in anatomic and radiographic studies as to avoid or minimize spinal nerve injury.

Sex Specific Sacroiliac Joint Biomechanics During Standing Upright

Spine, Sep 15, 2018

Study Design. The comparison of sacroiliac joint (SIJ) angular motions, pelvis ligaments strain, ... more Study Design. The comparison of sacroiliac joint (SIJ) angular motions, pelvis ligaments strain, load sharing, and stress distribution across the joint for male and female spine-pelvis-femur models using finite element analysis. Objective. To quantify biomechanical parameters at SIJ for all motions for both male and female models. Summary of Background Data. SIJ has been recognized as a main source of pain in 13% to 30% of patients with low back pain. It is shown that the SIJ rotation and translation in different planes are not exceeding 28 to 38 and 2 mm, respectively. Due to limitation of in vivo and in vitro studies, it is difficult to quantify certain biomechanical parameters such as load-sharing and stress distribution across the joint. Finite element analysis is a useful tool which can be utilized to understand the biomechanics of the SIJ. Methods. The validated finite element models of a male and a female lumbar spine-pelvis-femur were developed from computer tomography (CT) scans. The models were used to simulate spine physiological motions. The range of motion, ligament strains, load sharing, and stress distribution across the left and right SIJs were compared between male and female models. Results. Motions data at SIJs demonstrated that female model experienced 86% higher mobility in flexion, 264% in extension, 143% in left bending, and 228% in right bending compared with the male model. The stresses and loads on SIJs were higher on the female model compared with the male model. Female model ligaments underwent larger strains compared with the male model ligaments. Conclusion. Female SIJ had higher mobility, stresses, loads, and pelvis ligament strains compared with the male SIJ which led to higher stress across the joint, especially on the sacrum under identical loading conditions. This could be a possible reason for higher incidence of SIJ pain and pelvic stress fracture in females.

Chronic Exertional Compartment Syndrome: A Review of Literature

Surgical case reports and images, Jan 5, 2022

Chronic exertional compartment syndrome (CECS) is a serious, yet underdiagnosed condition that ca... more Chronic exertional compartment syndrome (CECS) is a serious, yet underdiagnosed condition that can cause severe lower extremity pain in running athletes. CECS is a transient increase in compartment pressure leading to severe pain, paresthesia, and vascular compromise. Understanding the detailed anatomy is paramount to proper diagnosis and treatment. Diagnosis is made with measuring compartments pressures before and after exercise at certain time intervals. When properly diagnosed and treated, CECS can be appropriately managed and patients can return to their previous level of activity.

The location of the intervertebral lumbar disc on the posterior aspect of the spine

Surgical Neurology, Sep 1, 1997

BACKGROUND Epidural fibrosis or scar formation is considered one cause of failed lumbar discectom... more BACKGROUND Epidural fibrosis or scar formation is considered one cause of failed lumbar discectomy. Avoidance of unnecessary bony resection of the lamina may prevent or decrease postoperative scar formation. The knowledge of the precise location of the projection of the lumbar disc may also facilitate surgery and decrease patient morbidity. No studies exist regarding the projection of the lumbar disc on the posterior aspect of the lumbar spine.

Sex Specific Sacroiliac Joint Biomechanics During Standing Upright

Spine, Sep 15, 2018

Study Design. The comparison of sacroiliac joint (SIJ) angular motions, pelvis ligaments strain, ... more Study Design. The comparison of sacroiliac joint (SIJ) angular motions, pelvis ligaments strain, load sharing, and stress distribution across the joint for male and female spine-pelvis-femur models using finite element analysis. Objective. To quantify biomechanical parameters at SIJ for all motions for both male and female models. Summary of Background Data. SIJ has been recognized as a main source of pain in 13% to 30% of patients with low back pain. It is shown that the SIJ rotation and translation in different planes are not exceeding 28 to 38 and 2 mm, respectively. Due to limitation of in vivo and in vitro studies, it is difficult to quantify certain biomechanical parameters such as load-sharing and stress distribution across the joint. Finite element analysis is a useful tool which can be utilized to understand the biomechanics of the SIJ. Methods. The validated finite element models of a male and a female lumbar spine-pelvis-femur were developed from computer tomography (CT) scans. The models were used to simulate spine physiological motions. The range of motion, ligament strains, load sharing, and stress distribution across the left and right SIJs were compared between male and female models. Results. Motions data at SIJs demonstrated that female model experienced 86% higher mobility in flexion, 264% in extension, 143% in left bending, and 228% in right bending compared with the male model. The stresses and loads on SIJs were higher on the female model compared with the male model. Female model ligaments underwent larger strains compared with the male model ligaments. Conclusion. Female SIJ had higher mobility, stresses, loads, and pelvis ligament strains compared with the male SIJ which led to higher stress across the joint, especially on the sacrum under identical loading conditions. This could be a possible reason for higher incidence of SIJ pain and pelvic stress fracture in females.

Evaluation of Cervical Posterior Lateral Mass Screw Placement by Oblique Radiographs

Spine, Mar 1, 1996

Chronic Exertional Compartment Syndrome: A Review of Literature

Surgical case reports and images, Jan 5, 2022

Chronic exertional compartment syndrome (CECS) is a serious, yet underdiagnosed condition that ca... more Chronic exertional compartment syndrome (CECS) is a serious, yet underdiagnosed condition that can cause severe lower extremity pain in running athletes. CECS is a transient increase in compartment pressure leading to severe pain, paresthesia, and vascular compromise. Understanding the detailed anatomy is paramount to proper diagnosis and treatment. Diagnosis is made with measuring compartments pressures before and after exercise at certain time intervals. When properly diagnosed and treated, CECS can be appropriately managed and patients can return to their previous level of activity.

Successful Immediate Re-implantation of an Extruded Femoral Segment: a Case Report

HSS Journal, Dec 7, 2015

The location of the intervertebral lumbar disc on the posterior aspect of the spine

Surgical Neurology, Sep 1, 1997

BACKGROUND Epidural fibrosis or scar formation is considered one cause of failed lumbar discectom... more BACKGROUND Epidural fibrosis or scar formation is considered one cause of failed lumbar discectomy. Avoidance of unnecessary bony resection of the lamina may prevent or decrease postoperative scar formation. The knowledge of the precise location of the projection of the lumbar disc may also facilitate surgery and decrease patient morbidity. No studies exist regarding the projection of the lumbar disc on the posterior aspect of the lumbar spine.

Anatomic Considerations for the Placement of Distraction Pins in the Talus

Foot & Ankle International, Apr 1, 1994

Evaluation of Cervical Posterior Lateral Mass Screw Placement by Oblique Radiographs

Spine, Mar 1, 1996

Bilateral Below-Knee Amputation Surgery at the Scene: Case Report

Journal of Trauma-injury Infection and Critical Care, Oct 1, 2000

W hile military surgeons are prepared to provide care at or near the scene of battle, civilian tr... more W hile military surgeons are prepared to provide care at or near the scene of battle, civilian trauma surgeons are rarely, if ever, called on to perform such surgery. A review of the literature showed only one case report of two patients with extremity injury that required amputation at the scene. 1 In the first case, the left arm was caught in an auger. The distal humerus was transected to release the patient. In the second case, the patient was trapped for 5 hours by a grain silo that collapsed on him. The fourth and the fifth digits of the left hand were amputated to release the patient. The authors report a case that required bilateral belowknee amputation to release a trapped patient from his semitrailer. The present case was unique in that both feet were trapped for 7 hours and bilateral amputation, which is considered a major surgery, was performed safely at the scene. This report emphasizes that field surgery can be performed safely; however, teamwork is essential.

Successful Immediate Re-implantation of an Extruded Femoral Segment: a Case Report

HSS Journal, Dec 7, 2015

Comparison of intramedullary nail, plate, and external fixation in the treatment of distal tibia nonunions

International Orthopaedics, Feb 28, 2017

Purpose The purpose of this study was to examine time to union of extra-articular distal tibia no... more Purpose The purpose of this study was to examine time to union of extra-articular distal tibia nonunions based on fracture type and fixation methods: intramedullary nail (IMN), plate osteosynthesis (PO), and external fixation (EF). Methods This retrospective chart review included all patients who presented at a Level I trauma center with AO/OTA 43A & distal third 42A-C fracture nonunions between 2008 and 2014. Fixation methods were recorded and patient course was followed until nonunion had healed clinically. Results Thirty-three distal tibia nonunions were included, and 29 reached eventual union (88%). Five AO/OTA fracture types were present. Mean times to union from nonunion diagnosis between original fracture types were compared (p = 0.203). Comminuted fracture types had longer times to union from nonunion diagnosis compared to simple fracture types (78 vs. 46 weeks, p = 0.051) and more revision fixations (1.5 vs. 0.5, p = 0.037). Mean time to union from nonunion diagnosis was shorter when no revision fixation was done compared to revisions (15 vs. 42 weeks, p = 0.102). Times to union from nonunion diagnosis without revision fixation were: IMN (12 weeks), PO (27 weeks), and EF (13 weeks) (p = 0.202). Times to union from definitive revision fixation were: IMN (17 weeks), PO (21 weeks), and EF (66 weeks) (p = 0.009), with EF taking significantly longer than both other methods. 21 patients (64%) underwent revision fixation. Revision fail rates were: IMN (0/6, 0%), PO (2/8, 25%), and EF (15/21, 71%). Time to union was longer in revisions that changed fixation method compared to revisions that used the same method (51 vs. 18 weeks, p = 0.030). Deep infections were also associated with longer union times (81 vs. 47 weeks, p = 0.040). Conclusions In this nonunion population, comminuted fracture types needed more time and revisions to reach union. Time to union was only clinically shorter when revision fixation was not performed, but IMN and PO were both successful fixation options with significantly shorter times to union than EF. Mean time to union increased even more when revision of fixation method was performed vs. exchange revision, as did nonunions with deep infections.

Anatomic Considerations for the Placement of Distraction Pins in the Talus

Foot & Ankle International, Apr 1, 1994

Nonunion of Pelvic Fractures

Journal of Trauma-injury Infection and Critical Care, 1998

Nonunion of the pelvic bones is uncommon. It may be under-diagnosed because of the difficulty in ... more Nonunion of the pelvic bones is uncommon. It may be under-diagnosed because of the difficulty in visualization of the fracture and interpretation with conventional radiography. The authors report four cases of nonunion involving the pelvic bones. Nonunion of the posterior ilium was occult in two patients and was not apparent on routine radiographs. The two patients with nonunion of the anterior iliac crest had major displacement caused by muscle pull. Pain on weight-bearing and awkward gait were common symptoms. All patients required surgical management for symptomatic relief.

Bilateral Below-Knee Amputation Surgery at the Scene: Case Report

Journal of Trauma-injury Infection and Critical Care, Oct 1, 2000

W hile military surgeons are prepared to provide care at or near the scene of battle, civilian tr... more W hile military surgeons are prepared to provide care at or near the scene of battle, civilian trauma surgeons are rarely, if ever, called on to perform such surgery. A review of the literature showed only one case report of two patients with extremity injury that required amputation at the scene. 1 In the first case, the left arm was caught in an auger. The distal humerus was transected to release the patient. In the second case, the patient was trapped for 5 hours by a grain silo that collapsed on him. The fourth and the fifth digits of the left hand were amputated to release the patient. The authors report a case that required bilateral belowknee amputation to release a trapped patient from his semitrailer. The present case was unique in that both feet were trapped for 7 hours and bilateral amputation, which is considered a major surgery, was performed safely at the scene. This report emphasizes that field surgery can be performed safely; however, teamwork is essential.

Vulnerability of the Posterior Interosseous Nerve During Proximal Radius Exposures

Clinical Orthopaedics and Related Research, Jun 1, 1995

Comparison of intramedullary nail, plate, and external fixation in the treatment of distal tibia nonunions

International Orthopaedics, Feb 28, 2017

Purpose The purpose of this study was to examine time to union of extra-articular distal tibia no... more Purpose The purpose of this study was to examine time to union of extra-articular distal tibia nonunions based on fracture type and fixation methods: intramedullary nail (IMN), plate osteosynthesis (PO), and external fixation (EF). Methods This retrospective chart review included all patients who presented at a Level I trauma center with AO/OTA 43A & distal third 42A-C fracture nonunions between 2008 and 2014. Fixation methods were recorded and patient course was followed until nonunion had healed clinically. Results Thirty-three distal tibia nonunions were included, and 29 reached eventual union (88%). Five AO/OTA fracture types were present. Mean times to union from nonunion diagnosis between original fracture types were compared (p = 0.203). Comminuted fracture types had longer times to union from nonunion diagnosis compared to simple fracture types (78 vs. 46 weeks, p = 0.051) and more revision fixations (1.5 vs. 0.5, p = 0.037). Mean time to union from nonunion diagnosis was shorter when no revision fixation was done compared to revisions (15 vs. 42 weeks, p = 0.102). Times to union from nonunion diagnosis without revision fixation were: IMN (12 weeks), PO (27 weeks), and EF (13 weeks) (p = 0.202). Times to union from definitive revision fixation were: IMN (17 weeks), PO (21 weeks), and EF (66 weeks) (p = 0.009), with EF taking significantly longer than both other methods. 21 patients (64%) underwent revision fixation. Revision fail rates were: IMN (0/6, 0%), PO (2/8, 25%), and EF (15/21, 71%). Time to union was longer in revisions that changed fixation method compared to revisions that used the same method (51 vs. 18 weeks, p = 0.030). Deep infections were also associated with longer union times (81 vs. 47 weeks, p = 0.040). Conclusions In this nonunion population, comminuted fracture types needed more time and revisions to reach union. Time to union was only clinically shorter when revision fixation was not performed, but IMN and PO were both successful fixation options with significantly shorter times to union than EF. Mean time to union increased even more when revision of fixation method was performed vs. exchange revision, as did nonunions with deep infections.