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1.
J Surg Orthop Adv ; 28(3): 175-179, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31675293

RESUMO

The objective of this analysis was to compare the efficiency of scholarly activity withinmilitary orthopaedic training programs. The authors obtained the lists of abstracts accepted for presentation at the 2009 through 2014 Society of Military Orthopaedic Surgeons (SOMOS) annual meetings. Data were extracted for each individual presentation. Three primary groups were compared: a traditional program, a research program, and a hybrid program. The hybrid program produced the highest percentage of the presentations (28.6%). The traditional program contributed the most presentations (3.32) and publications (2.16) per resident and had the highest publication rate (87.7%) and the shortest time to publication (14.4 months). The research program published in the highest average impact journals (3.2). The addition of a research year does not improve the number of academic presentations or published papers but may improve the impact factor of the journals in which the projects are published. (Journal of Surgical Orthopaedic Advances 28(3):175-179, 2019).


Assuntos
Internato e Residência , Ortopedia , Publicações , Bolsas de Estudo , Humanos , Militares , Ortopedia/educação
2.
Am J Sports Med ; 47(8): 1909-1914, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31150277

RESUMO

BACKGROUND: Shoulder instability has been well described in young men; however, few studies have specifically evaluated the pathoanatomy and unique spectrum of injuries in women with shoulder instability. PURPOSE: To describe the pathoanatomy of operative shoulder instability in a collegiate female cohort. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: The authors performed a retrospective analysis of a consecutive series of female students at a National Collegiate Athletic Association Division I military service academy treated operatively for shoulder instability by a single surgeon between September 2008 and September 2014. Preoperative data collected included patient age, sport, mechanism of injury, number and frequency of dislocations, direction of instability, and co-occurring surgical abnormalities at the time of arthroscopy. Outcome variables included recurrent instability after surgery and need for revision. RESULTS: Thirty-six female student athletes with an average age of 20 years (range, 18-22 years) were included. The majority of instability events were traumatic in nature (69%), and 61% of the total events were subluxations. Rugby was the most common sport for experiencing instability (7 patients), followed by obstacle course training (6 patients). Thirty-two patients (89%) reported multiple instability events, averaging 4 per shoulder. The primary direction of instability was anterior in 26, combined anterior and posterior in 7, and 3 met criteria for multidirectional instability. At the time of surgery, 26 patients (72%) had a Bankart tear, 9 (25%) had a posterior labral tear, and 5 (14%) had superior labrum anterior to posterior tears. Nine patients (25%) were found to have humeral avulsion of the glenohumeral ligament (HAGL) lesions, 7 (19%) had partial-thickness articular-sided rotator cuff tears, and only 1 patient (3%) had evidence of true attritional glenoid bone loss. Hill-Sachs lesions were found in 16 patients (44%). Recurrent instability occurred in 9 patients (25%) following arthroscopic stabilization, and revision surgery was performed in 6 (17%). CONCLUSION: Shoulder instability in female athletes presents commonly as multiple subluxation events. While soft tissue Bankart lesions were found in numbers equal to those in previous studies include both sexes, bony Bankart lesions were less common in women. Finally, the presence of combined anterior and posterior labral tears and HAGLs in women was more common than previously reported.

3.
J Knee Surg ; 32(2): 134-137, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30609440

RESUMO

Osteoarthritis is a particularly burdensome and career-limiting condition for military service members. The daily demands of military service place the service members at a baseline increased risk of developing primary OA as well as increased risk of acute knee injuries that further predispose to developing posttraumatic OA. There are multiple treatment options available for primary and posttraumatic OA from osteotomy to arthroplasty.


Assuntos
Militares , Doenças Profissionais/cirurgia , Osteoartrite do Joelho/cirurgia , Reconstrução do Ligamento Cruzado Anterior/efeitos adversos , Artroplastia do Joelho , Doenças das Cartilagens/complicações , Doenças das Cartilagens/cirurgia , Humanos , Doenças Profissionais/complicações , Doenças Profissionais/etiologia , Osteoartrite do Joelho/complicações , Osteoartrite do Joelho/etiologia , Osteotomia , Retorno ao Trabalho
4.
Hand (N Y) ; 14(2): 197-202, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-29199471

RESUMO

BACKGROUND: The objective of this study was to examine the subjective and objective midterm functional clinical outcomes of surgically repaired triceps injuries in a moderate- to high-demand population. METHODS: The US Military Health System was queried to identify all surgically treated triceps tendon ruptures between 2008 and 2013. Primary endpoints included rates of rerupture, perioperative complications, or significant persistent elbow dysfunction; Disability of the Arm, Shoulder and Hand (DASH) score, Mayo Elbow score, and ability to do push-ups were also extracted. RESULTS: Thirty-seven patients underwent triceps tendon repair with a mean follow-up of 49.8 ± 17.3 months (range: 26.8-80.2). The most common mechanisms of injury were military duties (27%), sporting activity (24%), or fall-related (21.6%), with most injuries occurring during an eccentric movement (54%). While 45% experienced occasional elbow pain postoperatively, only 1 patient (2.7%) had a rerupture. Despite this, at 2 years, 31 patients (84%) were able to return to full military duty. While 6 patients were discharged from military service, only 1 underwent medical separation while 5 retired for reasons unrelated to their triceps tendon rupture. Patient-reported outcomes were available for 14 patients at final follow-up. The average DASH and Mayo Elbow scores were 4.7 (SD ± 4.7, range: 0-15.9) and 85.4 (SD ± 11.7, range: 60-100), respectively. The cohort could perform mean 54.2 (range: 9-90) push-ups. In additional, 12 of 14 (85.7%) were satisfied with their elbow function. CONCLUSIONS: The active duty cohort experienced excellent postoperative results with a high rate of return to military duty, despite nearly half of the patients recognizing some degree of activity-related, elbow pain.

5.
Am J Sports Med ; 46(7): 1606-1616, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29733680

RESUMO

BACKGROUND: Several studies have examined changes in patient-reported outcome measures (PROMs) after anterior cruciate ligament (ACL) injury, but no studies to date have prospectively evaluated changes from preinjury baseline through injury and follow-up among ACL-injured patients compared to the baseline and follow-up changes of uninjured patients. PURPOSE: To examine changes in PROMs over time from preinjury baseline to at least 2 years after ACL reconstruction and to compare these changes with those of an uninjured control group having similar physical activity requirements. STUDY DESIGN: Cohort study; Level of evidence, 2. METHODS: The authors conducted a prospective cohort study with a nested case-control analysis at a US service academy. All incoming first year students were recruited to participate in this study. Consenting participants completed a baseline questionnaire that included the KOOS (Knee injury and Osteoarthritis Outcome Score), WOMAC (Western Ontario and McMaster Universities Osteoarthritis Index), and MARS (Marx Activity Rating Scale). Participants who sustained a subsequent ACL injury completed assessments at the time of surgery and at 6, 12, and 24 months after surgery. Healthy participants were recruited to repeat the baseline assessments within 1 year of graduation. Inter- and intragroup differences at these time points were evaluated with dependent and independent t tests, respectively. We also compared these results with established minimum clinically important difference (MCID) values. RESULTS: Of 1268 first year students entering the academy, 1005 with no previous injuries consented to participate in this study (82% male, mean ± SD age 19 ± 1 years). Of those enrolled, 30 suffered an ACL injury and met the inclusion criteria for this study. Ninety uninjured control students who met the inclusion criteria completed follow-up assessments. There were statistically significant differences across all KOOS and WOMAC subscales between ACL-injured group and uninjured group at the time of the final follow-up assessment. Four KOOS subscales (Pain, Symptoms, Sports and Recreation Function, and Knee-Related Quality of Life) and the WOMAC Stiffness subscale demonstrated >8-point differences between groups, which exceeded the established MCID for these instruments. There were no significant differences between the ACL-injured group and uninjured groups noted for the MARS ( P = .635). At the time of final follow-up, the ACL-injured group also reported significant deficits on the WOMAC Stiffness subscale ( P = .032), the MARS ( P = .030), and all KOOS subscales, with the exception of Functional Activities of Daily Living, as compared with their preinjury baseline scores. These deficits exceeded the established MCID values for 3 KOOS subscales and the MARS. CONCLUSION: Patients with ACL injuries reported significant deficits on PROMs at least 2 years after surgical reconstruction in relation to preinjury baseline scores and an uninjured control group. Many of these deficits exceeded established MCID values.


Assuntos
Lesões do Ligamento Cruzado Anterior/cirurgia , Medidas de Resultados Relatados pelo Paciente , Adolescente , Reconstrução do Ligamento Cruzado Anterior , Atletas , Estudos de Casos e Controles , Feminino , Humanos , Traumatismos do Joelho/cirurgia , Articulação do Joelho/cirurgia , Masculino , Militares , Osteoartrite/cirurgia , Estudos Prospectivos , Qualidade de Vida , Inquéritos e Questionários , Adulto Jovem
6.
Orthop J Sports Med ; 6(3): 2325967118758626, 2018 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-29552571

RESUMO

Background: There remains a debate over whether to retain the index anterior cruciate ligament (ACL) graft in the setting of septic arthritis. Purpose: To evaluate and compare clinical outcomes for the treatment of septic arthritis after ACL reconstruction (ACLR) in those with and without early graft retention. Study Design: Case series; Level of evidence, 4. Methods: The Military Health System was queried for all ACLR procedures performed between 2007 and 2013. Inclusion criteria required active military status, primary ACLR with secondary septic arthritis, and minimum 24-month surveillance. Demographic, clinical, and surgical variables were evaluated using descriptive statistics and regression analysis for factors influencing selected outcomes. Results: Of 9511 ACLR procedures, 31 (0.32%) were identified as having secondary septic arthritis requiring urgent arthroscopic irrigation and debridement and intravenous antibiotics (mean, 6.3 weeks). The majority (62%) were treated in the subacute (2 weeks to 2 months) setting. Index ACLR was performed with a hamstring autograft (n = 17, 55%), soft tissue allograft (n = 11, 35%), and patellar tendon autograft (n = 3, 10%). The graft was retained in 71% (n = 22) of patients, while 29% (n = 9) underwent early graft debridement. At a mean 26.9-month follow-up, 48% of patients (n = 15) had returned to the military. Graft removal was not predictive of return to active duty (P = .29). The presence of postoperative complications, including symptomatic postinfection arthritis (22.6%) and arthrofibrosis (9.7%), was the only variable predictive of inability to return to duty (odds ratio, 27.5 [95% CI, 3.24-233.47]; P = .002). Seven of 9 patients who underwent graft debridement underwent revision ACLR, and all 7 had stable knees at final follow-up compared with 68% (15/22) in the graft retention group. Conclusion: Arthroscopic debridement with early graft removal and staged revision ACLR remains a viable option for restoring knee stability (100%), although the rate of return to active duty was low in the graft resection group (33%). The risk of knee laxity did not differ based on early graft retention. Time to presentation with graft retention was not associated with a decreased rate of graft laxity.

7.
Mil Med ; 182(11): e1992-e1996, 2017 11.
Artigo em Inglês | MEDLINE | ID: mdl-29087870

RESUMO

INTRODUCTION: The Society of Military Orthopaedic Surgeons (SOMOS) is a robust academic organization with more than 1,000 members and has held annual academic scientific meetings since 1958. Currently, there is a paucity of data regarding the volume and quality of orthopaedic surgery presentations accepted for peer-reviewed publication. The purpose of this study was to answer the following questions: (1) What is the publication acceptance rate for abstract presented at SOMOS meetings? (2) What is the distribution by orthopaedic subspecialty for SOMOS presentations accepted for publication? (3) What is the overall quality of these publications? MATERIALS AND METHODS: Abstracts of podium presentations at SOMOS were reviewed from 2009 to 2013. Author institutional information was obtained. Abstracts were then queried in PubMed to obtain publication status, time to publication, and impact factor of the journal in which the manuscript was successfully published. RESULTS: From 2009 to 2013, 592 abstracts were presented at the SOMOS conference. Overall, 59% of abstracts went on to publication at a mean of 18.1 months. Published manuscripts appeared in 59 journals with a mean impact factor of 2.6. The subspecialties of spine (67%) and basic science (66%) achieved the highest abstract publication rate while sports had the highest mean impact factor (3.3). CONCLUSIONS: The annual SOMOS meeting is a productive academic event, producing quality presentations resulting in a high manuscript publication rate in every orthopaedic surgery subspecialty. This is the first series to demonstrate overall productivity of a general orthopaedic surgery scientific meeting as well as the subspecialty-specific impact factors of published investigations.


Assuntos
Fator de Impacto de Revistas , Militares/estatística & dados numéricos , Ortopedia/tendências , Publicações/estatística & dados numéricos , Humanos , Ortopedia/educação , Revisão por Pares/tendências
8.
Arthroscopy ; 32(11): 2251-2258, 2016 11.
Artigo em Inglês | MEDLINE | ID: mdl-27567322

RESUMO

PURPOSE: To examine the outcomes of arthroscopic treatment of the hip in a young, active military population. Specifically, the ability to return to duty was the prime indicator of success. In addition, an objective evaluation of various demographic and surgery-related variables was performed to identify predictors for success or failure of treatment in this military population. METHODS: A retrospective chart review was undertaken to ascertain the results of hip arthroscopy at a single academic military medical center. A total of 206 patients underwent 223 hip arthroscopies during a 13-year period (2000-2013). Of these, 159 patients met the inclusion criteria, which included active duty military service and at least 12-month follow-up. Veterans Affairs Beneficiaries, active duty dependents, and those with less than 12 months of follow-up were excluded. Surgeries were performed by 1 of 5 fellowship-trained orthopaedic surgeons. Data were collected from the Armed Forces Health Longitudinal Technology Application, Electronic profiling system, and Physical Evaluation Board. RESULTS: A total of 159 patients were available for the study, 102 males and 57 females. The average age of the patients overall was 30.9 ± 8.3 years (range, 18-52 years). Junior enlisted, which is considered entry level, made up 64.2% of the subjects. The most common diagnosis was femoroacetabular impingement, and the most common procedure performed was acetabuloplasty. Twenty-two percent of patients underwent evaluation by the medical retention board after hip arthroscopy and were separated from military service. Seventy-eight percent of soldiers were maintained on active duty after hip arthroscopy. The overall complication rate was 15.7%, with a major complication rate of 1.25% defined as femoral neck fracture, abdominal compartment syndrome, osteonecrosis, deep vein thrombosis and/or pulmonary embolus, and septic arthritis. Univariate analysis of risk factors showed the presence of a complication to be a significant predictor for failure to return to active duty (odds ratio [OR] 4.04, P = .0035) as was senior noncommissioned officer rank (OR 0.20, P = .0347). Multivariate analysis showed only the presence of a complication to be a significant predictor for failure to return to active duty (OR 3.71, P = .0083). CONCLUSIONS: Hip arthroscopy in a military population is effective in treating multiple causes and retaining soldiers on active duty status. Complications of any kind from surgery or postoperatively are significant predictors of medical separation and may warrant earlier initiation of a medical evaluation board. LEVEL OF EVIDENCE: Level IV, therapeutic case series.


Assuntos
Artroscopia , Articulação do Quadril/cirurgia , Militares , Complicações Pós-Operatórias , Retorno ao Trabalho , Acetabuloplastia , Adolescente , Adulto , Artroscopia/efeitos adversos , Desbridamento , Feminino , Impacto Femoroacetabular/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Tenotomia , Estados Unidos , Adulto Jovem
9.
Arch Orthop Trauma Surg ; 134(5): 597-604, 2014 May.
Artigo em Inglês | MEDLINE | ID: mdl-24570142

RESUMO

STUDY DESIGN: Retrospective review of prospectively collected data. OBJECTIVE: To describe the impact of patient demographics, injury-specific factors, and medical co-morbidities on outcomes after hip fracture using the National Sample Program (NSP) of the National Trauma Data Bank (NTDB). METHODS: The 2008 NSP-NTDB was queried to identify patients sustaining hip fractures. Patient demographics, co-morbidities, injury-specific factors, and outcomes (including mortality and complications) were recorded and a national estimate model was developed. Unadjusted differences for risk factors were evaluated using t test/Wald Chi square analyses. Weighted logistic regression and sensitivity analyses were performed to control for all factors in the model. RESULTS: The weighted sample contained 44,419 incidents of hip fracture. The average age was 72.7. Sixty-two percent of the population was female and 80 % was white. The mortality rate was 4.5 % and 12.5 % sustained at least one complication. Seventeen percent of patients who sustained at least one complication died. Dialysis, presenting in shock, cardiac disease, male sex, and ISS were significant predictors of mortality, while dialysis, obesity, cardiac disease, diabetes, and a procedure delay of ≥2 days influenced complications. The major potential modifiable risk factor appears to be time to procedure, which had a significant impact on complications. CONCLUSIONS: This is the first study to postulate predictors of morbidity and mortality following hip fracture in a US national model. While many co-morbidities appear to be influential in predicting outcome, some of the more significant factors include the presence of shock, dialysis, obesity, and time to surgery. LEVEL OF EVIDENCE: Prognostic study, Level II.


Assuntos
Fraturas do Quadril/mortalidade , Fraturas do Quadril/cirurgia , Mortalidade Hospitalar , Idoso , Idoso de 80 Anos ou mais , Comorbidade , Bases de Dados Factuais , Feminino , Fraturas do Colo Femoral/complicações , Fraturas do Colo Femoral/epidemiologia , Fraturas do Colo Femoral/mortalidade , Fraturas do Colo Femoral/cirurgia , Fraturas do Quadril/complicações , Fraturas do Quadril/epidemiologia , Humanos , Hipertensão/epidemiologia , Escala de Gravidade do Ferimento , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Obesidade/epidemiologia , Complicações Pós-Operatórias/mortalidade , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Estados Unidos/epidemiologia
10.
Orthopedics ; 36(8): e986-9, 2013 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-23937763

RESUMO

To date, several strategies have been developed to provide local antibiotic therapy in the treatment of osteomyelitis, such as antibiotic-loaded bone cement, antibiotic-impregnated collagen sponges, polymethylmethacrylate beads, antibiotic-loaded bone graft, antibiotic-loaded synthetic bone substitutes, and antibiotic-coated implants. The optimum carrier for local antibiotic therapy has not been identified. Tibial osteomyelitis using methicillin-sensitive Staphylococcus aureus was created in a rat model. Rats were assigned to 3 treatment groups: group A, systemic antibiotics only; group B, systemic antibiotics plus surgical debridement; and group C, systemic antibiotics, surgical debridement, and application of cefazolin. Infection was assessed using gross tissue analysis, radiographs, quantitative bacteriology, and histopathology. One-half of the rat tibias were randomly chosen for histological evaluation and the other half were used for microbiological analysis. Radiographs were reviewed and graded by 4 blinded board-certified radiologists. Histology slides were reviewed and graded by a blinded board-certified pathologist. Gross tissue analysis of treatment groups B and C demonstrated a statistically significant improvement in soft tissue infection clearance compared with group A (P<.05). No difference was found between treatment groups B and C. No significant difference existed in gross tissue, radiographic, microbiologic, or histopathologic analyses among the 3 groups for osteomyelitis. The results of this study demonstrated that the local application of free antibiotic powder is as effective as local debridement alone in treating soft tissue infection associated with tibial osteomyelitis in a rat model.


Assuntos
Infecções Bacterianas/diagnóstico , Infecções Bacterianas/tratamento farmacológico , Cefazolina/administração & dosagem , Osteomielite/diagnóstico , Osteomielite/tratamento farmacológico , Infecções Estafilocócicas/diagnóstico , Infecções Estafilocócicas/tratamento farmacológico , Animais , Antibacterianos/administração & dosagem , Pós/administração & dosagem , Ratos , Ratos Sprague-Dawley , Resultado do Tratamento
11.
J Surg Orthop Adv ; 20(4): 225-9, 2011.
Artigo em Inglês | MEDLINE | ID: mdl-22381414

RESUMO

Systemic supplemental oxygen therapy (SOT) and hyperbaric oxygen therapy (HBOT) have been shown to positively impact wound healing. The purpose of this study was to evaluate the effects of SOT and HBOT on tendon healing in a rat tendon model. The right patellar tendon of 90 male Sprague-Dawley rats was completely sectioned. Animals were randomized to receive HBOT, SOT, or room air therapy. Animals were sacrificed at 3- and 6-weeks postoperatively. The ultimate tensile strength in axial extension was compared between groups. Statistical significance was calculated using the Student's t-test. The SOT group exhibited the highest tensile strength at both time-points, although HBOT was the only treatment that exhibited a statistically significant increase in tensile strength between time-periods (p = 0.006). There was no statistical difference in ultimate tensile strength when the three groups were compared at the 3- or 6-week time-points. Results presented here cannot support the premise that intermittent HBOT or SOT significantly increases the healing of tendon repairs.


Assuntos
Oxigenação Hiperbárica , Oxigênio/uso terapêutico , Traumatismos dos Tendões/terapia , Cicatrização , Animais , Masculino , Ratos , Ratos Sprague-Dawley , Tendões/fisiologia , Resistência à Tração
13.
Am J Sports Med ; 38(1): 63-7, 2010 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-19737987

RESUMO

BACKGROUND: Two previous studies have examined the association between an increased posterior tibial slope and anterior cruciate ligament (ACL) injuries as measured on plain radiographs. The study results were contradictory, with 1 reporting a statistical difference and the other showing no association. PURPOSE: To determine if there is a difference in posterior tibial slope angle between patients with a history of noncontact ACL injury and a control group with no history of ACL injury. A secondary objective was to examine differences in tibial slope angle between male and female subjects within each group. STUDY DESIGN: Case-control study; Level of evidence, 3. METHODS: We identified all noncontact ACL injuries that were treated operatively at the United States Military Academy, West Point, New York, from 2004 to 2007. We digitally measured the posterior tibial slope from plain film radiographs of 140 noncontact ACL injuries, stratified them by sex, and compared them with a control cohort of 179 patients and radiographs. RESULTS: Subjects in the noncontact ACL group had significantly greater slope angles (9.39 degrees +/- 2.58 degrees) than did control subjects (8.50 degrees +/- 2.67 degrees) (P = .003). The trend toward greater tibial slope angles in the noncontact ACL group was also observed when each sex was examined independently; however, the difference was only statistically significant for the female subjects between the injury and control groups (9.8 degrees +/- 2.6 degrees vs 8.20 degrees +/- 2.4 degrees) (P = .002). CONCLUSION: Despite the identification of an increased posterior tibial slope as a possible risk factor for women, more research that combines the multifactorial nature of an ACL injury must be performed.


Assuntos
Lesões do Ligamento Cruzado Anterior , Traumatismos em Atletas/etiologia , Traumatismos do Joelho/etiologia , Tíbia/anatomia & histologia , Adulto , Análise de Variância , Ligamento Cruzado Anterior/diagnóstico por imagem , Traumatismos em Atletas/diagnóstico por imagem , Traumatismos em Atletas/epidemiologia , Estudos de Casos e Controles , Intervalos de Confiança , Feminino , Humanos , Traumatismos do Joelho/diagnóstico por imagem , Traumatismos do Joelho/epidemiologia , Masculino , New York/epidemiologia , Radiografia , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Estatística como Assunto , Tíbia/diagnóstico por imagem , Adulto Jovem
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