Shai Luria
The Hebrew University of Jerusalem, Orthopedics, Faculty Member
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Date Presented 4/7/2016 The focus of the study was to evaluate the impact of trigger finger (TF) from a biopsychosocial perspective. Although TF is considered to be mild hand pathology, we found that it has a wide-ranging impact.... more
Date Presented 4/7/2016 The focus of the study was to evaluate the impact of trigger finger (TF) from a biopsychosocial perspective. Although TF is considered to be mild hand pathology, we found that it has a wide-ranging impact. Activity, participation, and quality of life should be addressed when treating people with TF. Primary Author and Speaker: Danit Langer Contributing Authors: Adina Maeir, Michael Michailevich, Yael Applebaum, Shai Luria
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PurposeThe surgical treatment of scaphoid fractures consists of reduction of the fracture followed by stable internal fixation using a headless compression screw. Proper positioning of the screw remains technically challenging and... more
PurposeThe surgical treatment of scaphoid fractures consists of reduction of the fracture followed by stable internal fixation using a headless compression screw. Proper positioning of the screw remains technically challenging and therefore computer assisted surgery may have an advantage.Navigation assisted surgery requires placement and registration of stable reference markers which is technically impossible in a small bone like the scaphoid. Custom made wrist-positioning devices with built-in reference markers have been developed for this purpose. The purpose of this study was to evaluate a different method of navigation assisted scaphoid fracture fixation. Temporary stabilisation with a pin of the scaphoid to the radius enables placement of the reference markers on the radius. Our hypothesis was that this method will achieve precise fracture fixation, superior to the standard free hand technique.MethodsIn 20 identical saw bone models with mobile scaphoids, the scaphoid was stabilised to the radius usin...
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Background: Osteoporotic tibial fractures may be a challenge both in diagnosis and treatment. The aim of treatment is obtaining joint congruity and normal alignment, joint stability, adequate soft tissue healing and functional range of... more
Background: Osteoporotic tibial fractures may be a challenge both in diagnosis and treatment. The aim of treatment is obtaining joint congruity and normal alignment, joint stability, adequate soft tissue healing and functional range of motion. The goal is prevention of degenerative osteoarthritis. In the majority of cases the treatment of tibial plateau fractures consists of open reduction and internal fixation. Objectives: The presentation of two aspects of the osteoporotic fracture – the insufficiency fracture and fixation of the fractures by a more appropriate method. Patients: We present our experience with 7 cases treated during the past 2 years. Two of these cases presented with no story of trauma, normal X-rays and were diagnosed clinically and on CT and bone scanning. The other 5 cases resulted of minor trauma and operative treatment was in order, using a modified fixation technique – a small fragment plate. Results: The patients suffering from fractures with normal X-rays suffered from insufficiency fractures and were treated conservatively. The patients suffering from depressed, split or comminuted fractures were treated by open reduction and internal fixation with a small fragment plate. Discussion and Conclusion: Insufficiency fractures often are misdiagnosed as exacerbation of chronic metabolic or inflammatory diseases and a fracture is not suspected until intense augmentation of radionuclide is seen on bone scan. Screening of patients presenting wit non-traumatic knee pain has shown a prevalence insufficiency fractures of the tibial plateau between 3 to 8% of the cases. These cases may be much more common than we commonly presume. The fractures in need of reduction and fixation of the plateau fracture involve raising the depressed articular fragment, the possible addition of bone graft augmentation and buttressing of the osteochondral fragment with a plate. These buttress plates may hold the cortical rim of the plateau but many times fail in maintaining the reduction of the intra-articular surface of the plateau. This again results in degenerative changes in the joint and pain. Internal fixation of these fractures with small fragment plates may be a solution to this problem, as demonstrated by the 5 presented cases treated operatively. The plates are smaller in size and are held by more screws, which are more proximal to the articular surface. This way they allow better control and maintenance of the anatomic reduction and in combination with an a-traumatic dissection and less stress shielding effect, result in a low rate of local complications.
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The use of three-dimensional (3-D) technology in upper extremity surgery has the potential to revolutionize the way that hand and upper limb procedures are planned and performed. 3-D technology can assist in the diagnosis and treatment of... more
The use of three-dimensional (3-D) technology in upper extremity surgery has the potential to revolutionize the way that hand and upper limb procedures are planned and performed. 3-D technology can assist in the diagnosis and treatment of conditions, allowing virtual preoperative planning and surgical templating. 3-D printing can allow the production of patient-specific jigs, instruments and implants, allowing surgeons to plan and perform complex procedures with greater precision and accuracy. Previously, cost has been a barrier to the use of 3-D technology, which is now falling rapidly. This review article will discuss the current status of 3-D technology and printing, including its applications, ethics and challenges in hand and upper limb surgery. We have provided case examples to outline how clinicians can incorporate 3-D technology in their clinical practice for congenital deformities, management of acute fracture and malunion and arthroplasty.
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A 47-year-old healthy male was treated for his tennis elbow with a steroid injection elsewhere. In the affected forearm, he was surgical treated for a forearm fracture, thirty years previously. After the injection, he developed posterior... more
A 47-year-old healthy male was treated for his tennis elbow with a steroid injection elsewhere. In the affected forearm, he was surgical treated for a forearm fracture, thirty years previously. After the injection, he developed posterior interosseous nerve palsy. He was treated with neurolysis of the nerve from the radial tunnel and distal to the supinator, where it was found to be adherent to the healed fracture site. Most of the motor nerve function returned within two years. We believe this to be an example of a “double crush” phenomenon of the radial nerve. Injection of steroids to treat lateral epicondylitis is extremely common and previous injury or surgery to the extremity should be considered before its administration.
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Ulnocarpal abutment or the ulnocarpal impaction syndrome occurs when excessive loads exist between the distal ulna and ulnar carpus. This overloading occurs as a result of the distal ulnar articular surface being more distal than the... more
Ulnocarpal abutment or the ulnocarpal impaction syndrome occurs when excessive loads exist between the distal ulna and ulnar carpus. This overloading occurs as a result of the distal ulnar articular surface being more distal than the ulnar articular surface of the distal radius. This situation has been termed positive ulnar variance, and it can quickly lead to ulnar-sided wrist degenerative changes and functional losses. Patients often have vague, ulnar-sided complaints of chronic pain and swelling with an insidious onset that does not correlate with any specific traumatic event. Many procedures have been developed to alleviate this condition, but the gold standard for correcting positive ulnar variance is the ulnar shortening osteotomy. The goals of the shortening procedure are to relieve pain and prevent arthritis by reestablishing a neutral or slightly negative ulnar variance. We describe a new plate and compression system in which an oblique ulnar diaphyseal osteotomy is both completed and stabilized through the same jig-based system.
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Open revision has been the standard approach for treatment of recurrent carpal tunnel syndrome. The authors hypothesized that endoscopic revision would yield results comparable to those with open revision. Forty-one patients with... more
Open revision has been the standard approach for treatment of recurrent carpal tunnel syndrome. The authors hypothesized that endoscopic revision would yield results comparable to those with open revision. Forty-one patients with unilateral recurrence were analyzed prospectively before and after endoscopic revision for a period of 1 year. All had clinical signs or symptoms, a positive response to a steroid injection, and electrodiagnostic findings consistent with carpal tunnel syndrome after primary open release and had failed to improve after an average of 16 months. Follow-up evaluations were performed with validated outcome instruments and quantitative measurements of strength and sensation. Thirty-seven of the 41 patients reported improvement after the endoscopic revision. Significant improvement was seen at 3 and 12 months after the procedure in the Carpal Tunnel Syndrome Symptom Severity Score, the Carpal Tunnel Syndrome Functional Status Score, the University of Washington satisfaction score, pinch strength and sensation, and a decrease in scar sensitivity. An improvement in grip strength was measured after 12 months. The satisfaction score was found to be significantly correlated to the Symptom Severity Score and the Functional Status Score. Endoscopic release of recurrent carpal tunnel syndrome may be performed safely using standard technique with good results. The advantage of the procedure is the ability to approach the tunnel while avoiding the scarring related to the previous open approach. This technique is not adequate for cases after several open revisions, suspected nerve injury, or extension of the previous open approach proximal to the wrist crease.
Research Interests: Medicine, Probability, Endoscopy, Prospective studies, Humans, and 15 moreFemale, Male, Electromyography, Carpal Tunnel Syndrome, Recurrence, Clinical Sciences, Middle Aged, Adult, Analysis of Variance, Median Nerve, Grip strength, Recovery of Function, Carpal tunnel release, minimally invasive surgical procedures, and Hand strength
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Research Interests: Orthopedic Surgery, Biomedical Engineering, Regeneration, Skeletal muscle biology, Medicine, and 15 moreModels, Female, Animals, Peptides, Behavioral Animal Models, Nerve Regeneration, Clinical Sciences, Sciatic Nerve Injury, T lymphocytes, Immune system, Rats, Rat, Peripheral Nerve, Sciatic Nerve, and Glatiramer acetate
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Seattle, Wash. Background: Open revision has been the standard approach for treatment of recurrent carpal tunnel syndrome. The authors hypothesized that endoscopic revision would yield results comparable to those with open revision.... more
Seattle, Wash. Background: Open revision has been the standard approach for treatment of recurrent carpal tunnel syndrome. The authors hypothesized that endoscopic revision would yield results comparable to those with open revision. Methods: Forty-one patients with unilateral recurrence were analyzed prospectively before and after endoscopic revision for a period of 1 year. All had clinical signs or symptoms, a positive response to a steroid injection, and electrodiagnostic findings consistent with carpal tunnel syndrome after primary open release and had failed to improve after an average of 16 months. Follow-up evaluations were performed with validated outcome instruments and quantitative measurements of strength and sensation. Results: Thirty-seven of the 41 patients reported improvement after the endoscopic revision. Significant improvement was seen at 3 and 12 months after the procedure in the Carpal Tunnel Syndrome Symptom Severity Score, the Carpal Tunnel Syndrome Functional ...
Research Interests: Surgery, Medicine, Sensation, Carpal Tunnel Syndrome, Median Nerve, and 2 moreWrist and Grip strength(Wrist and Grip strength)
(Wrist and Grip strength)
Objective Using three-dimensional (3D) computed tomography models of acute scaphoid fractures, we looked for differences between volumetric size of the fracture fragments, recognizable groups, or a shared common fracture area. Methods We... more
Objective Using three-dimensional (3D) computed tomography models of acute scaphoid fractures, we looked for differences between volumetric size of the fracture fragments, recognizable groups, or a shared common fracture area. Methods We studied 51 patients with an adequate computed tomography scan of an acute scaphoid fracture using 3D modeling. Fracture surfaces were identified and fragment volumetric size of the fracture fragments was measured. A principal component analysis was used to find groups. Density mapping was used to image probable common fracture areas in the scaphoid. Results Forty-nine of 51 fractures had a similar pattern. It was not possible to identify subgroups based on fracture pattern. The mean volumetric size of the fracture fragments of the proximal (1.45 cm3 ± 0.49 cm3 standard deviation [SD]) and distal fracture fragments (1.53 cm3 ± 0.48 cm3 SD) was similar. There was a single common fracture area in the middle third of the bone. In the distal third, there...
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The article reviews key considerations and our preferred methods in treating upper extremity palsies, gunshot wounds and scaphoid nonunion. For these three difficult conditions, I highlight the importance of a team approach when treating... more
The article reviews key considerations and our preferred methods in treating upper extremity palsies, gunshot wounds and scaphoid nonunion. For these three difficult conditions, I highlight the importance of a team approach when treating upper extremity neuromuscular disease, flexibility and creativity when treating gunshot wounds, and my personal protocol for dealing with scaphoid fracture nonunions. Level of evidence: V
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In the early 1960s, several members of the Israeli Orthopedic Society and the Israeli Plastic Surgery Society developed a special interest in hand surgery. Professor Isidor Kessler was the first to switch from general orthopaedics to hand... more
In the early 1960s, several members of the Israeli Orthopedic Society and the Israeli Plastic Surgery Society developed a special interest in hand surgery. Professor Isidor Kessler was the first to switch from general orthopaedics to hand surgery as his primary and then sole specialization. He was trained by Joseph Boyes and colleagues in California, where he was active mainly in the development of the Niebauer prostheses. He went on to become internationally renowned for his innovative studies on tendon repair and finger lengthening (Kessler, 1973). Upon his return to Israel, he started the first hand surgery service at the Kaplan Medical Center in Rehovot. In 1967, after the Six Day War, many upper limb injuries needed efficient and professional care. The War of Attrition (1968–1970) and the Yom Kippur War (1973) that followed left more than 10,000 injured, about a third of whom had upper limb injuries. To deal with the injured, the Ministry of Health founded five medical units dedicated to hand surgery. In 1975, the first international hand surgery conference was held in Tel Aviv with the participation of the American Association for Surgery of the Hand and other societies.
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INTRODUCTION This study describes the characteristics of hand trauma treated in community-based emergency centers (CBECs) in Israel. It was hypothesized that the rate of hand trauma, as well as patient and injury characteristics, would... more
INTRODUCTION This study describes the characteristics of hand trauma treated in community-based emergency centers (CBECs) in Israel. It was hypothesized that the rate of hand trauma, as well as patient and injury characteristics, would differ from a recent study of patients treated in hospital emergency departments (EDs) in Jerusalem. METHODS Data on all hand injury patients treated at any of the CBECs belonging to a large nationwide chain in 2017 were retrieved from the electronic medical records of the treatment centers, including demographic and clinical characteristics. RESULTS Over the course of 2017, 53,574 individuals were treated for forearm, wrist and hand injuries (35% of all trauma patients treated during this period). The majority of the patients were male (62%). Contusions and fractures were common (80%) with a minority of lacerations (10%). Crush injuries and amputations were rare. Dog bites accounted for 1.5% of the injuries under the age of 10. Females were treated more with painkillers and opioids, especially over the age of 65, with variability between centers. Although the rate of fractures was similar between teens and the elderly, the elderly were treated with immobilization less frequently, and were referred to EDs for further care. Hospital referral rates differed significantly between centers. DISCUSSION A higher rate of hand trauma was found in the CBECs in comparison to the hospital ED report (35% vs. 20% of all trauma patients, respectively). Patients treated at the CBECs, in comparison to the ED, were less often male, less often young adults, and differed in terms of type of injury. In the CBECs there were more contusions, as well as fewer lacerations and open wound injuries. In contrast, dog bites in children were found to be much more prevalent than previously reported. Hospital referral indications, the use of immobilization and pain management were found to vary according to age, gender and treatment center. Due to the high rate of hand trauma in CBECs, specific protocols are needed for these patients. The use of opioids should be specifically addressed, considering recent changes in treatment protocols. Thus, the prevalence and characteristics of hand trauma may be biased in studies based on hospital records.
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Purpose Knowing the morphology of any fracture, including scaphoid fractures, is important in order to determine the fracture stability and the appropriate fixation technique. Scaphoid fractures are classified according to their... more
Purpose Knowing the morphology of any fracture, including scaphoid fractures, is important in order to determine the fracture stability and the appropriate fixation technique. Scaphoid fractures are classified according to their radiographic appearance, and simple transverse waist fractures are considered the most common. There is no description in the literature of the 3-dimensional morphology of scaphoid fractures. Our hypothesis was that most scaphoid fractures are not perpendicular to its long axis, i.e. they are not simple transverse fractures. Methods A 3-dimensional analysis was performed of CT scans of acute scaphoid fractures, conducted at two medical centers during a period of 6 years. A total of 124 scans were analysed (Amira Dev 5.3, Visage Imaging Inc). Thirty of the fractures were displaced and virtually reduced. Anatomical landmarks were marked on the distal radius articular surface in order to orient the scaphoid in the wrist. Shape analysis of the scaphoids and a ca...
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Classifications of scaphoid fractures associate the angle of the fracture with its stability. To examine this assumption, we measured acute scaphoid fracture angles and inclinations in relation to different scaphoid axes, using fracture... more
Classifications of scaphoid fractures associate the angle of the fracture with its stability. To examine this assumption, we measured acute scaphoid fracture angles and inclinations in relation to different scaphoid axes, using fracture displacement as an indicator of instability. We examined the effect of using different axes on the measurements of angles. CT scans of 133 scaphoid fractures were classified according to the location of the fractures. Using a three-dimensional computer model, we computed four scaphoid axes. For each fracture, we then measured the fracture angle and the direction of the fracture inclination in relation to each one of the axes. We found a correlation between displacement and the angles of proximal fractures using one of these axes (the surface principal component analysis axis). No such correlations were found for waist fractures, which were the majority of fractures. There were significant differences between the measurements made with different axes....
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Thalidomide was first used during the 50's-60's, especially for morning sickness in pregnant women. It was found to be a powerful teratogen only years later and was banned from use. At the same time it was found to have... more
Thalidomide was first used during the 50's-60's, especially for morning sickness in pregnant women. It was found to be a powerful teratogen only years later and was banned from use. At the same time it was found to have anti-inflammatory and anti-angiogenic properties and was approved as treatment for leprosy. As such, thalidomide might be used against pathological neovascularization, as seen in mustard gas exposure. From past experience we know that the eyes are the most vulnerable organ to mustard gas exposure. In some of the casualties there is a late sequella including pathological corneal neovascularization. So far there is no specific effective treatment against this neovascularization. The purpose of this review is to examine current research about the potential use of thalidomide as an anti-angiogenic agent, including potential role in treating mustard gas eye injury.
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BACKGROUND The trigger finger is a common condition of the hand that is treated by family physicians, orthopedic and hand surgeons. The patients suffer from pain, triggering of the finger and may develop a flexion contracture of the... more
BACKGROUND The trigger finger is a common condition of the hand that is treated by family physicians, orthopedic and hand surgeons. The patients suffer from pain, triggering of the finger and may develop a flexion contracture of the finger, causing significant functional limitations. AIM The objectives of this study were to evaluate factors involved in the diagnosis and treatment of this condition, as well as the differences in treatment between specialists. METHODS The different specialists were asked to rate the importance of symptoms, examination and imaging studies regarding the decision to refer a patient for surgery as well as suggest the treatment of a hypothetical patient complaining of typical symptoms. RESULTS In the 158 questionnaires collected, the complaint of limited finger range of motion and previous treatment were rated most important. Family physicians stated that age, occupation and rate of recent triggering were considered to be additional important factors (p=.0...
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Introduction Scaphoid fractures are commonly treated with a single headless screw. There are different recommendations regarding the optimal location of this screw. The purpose of this study was to compare the location of screws placed... more
Introduction Scaphoid fractures are commonly treated with a single headless screw. There are different recommendations regarding the optimal location of this screw. The purpose of this study was to compare the location of screws placed for the treatment of acute scaphoid fractures with theoretical and virtual screw locations. Materials and Methods 10 patients with acute scaphoid fractures treated surgically and with available pre- and postoperative CT scans were included. The scans were analysed using a 3D software model (Amira Dev 5.3, Mercury Computer Systems, Chelmsford, MA). On the preoperative CTs the displaced fractures were virtually reduced. Possible screw locations for fracture fixation were examined including one along the central third of the proximal fragment (central base screw), the scaphoid longitudinal axis calculated mathematically (PCA screw) and a screw placed perpendicular to the fracture plane (90 degree screw). The angle between the axes and fracture plains wer...
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Background. Trigger finger (TF) is a common hand pathology frequently encountered in hand clinics. Occupational therapists predominantly assess TF symptoms as opposed to using standardized hand functioning assessments. The purpose of this... more
Background. Trigger finger (TF) is a common hand pathology frequently encountered in hand clinics. Occupational therapists predominantly assess TF symptoms as opposed to using standardized hand functioning assessments. The purpose of this study was to assess the construct validity of dexterity and grip strength assessments for clients with TF. Method. Sixty-three participants with TF and 66 healthy controls were administered the Functional Dexterity Test (FDT), Purdue Pegboard Test (PPT), and Jamar® Hydraulic Hand Dynamometer (JD) and completed the Disabilities of Arm Shoulder and Hand questionnaire (DASH). TF symptoms were graded using the Quinnell classification. Results. Statistically significant differences were found between the groups in dexterity and grip strength. A statistically significant difference between the three TF grades was found on the PPT. All three test scores were moderately correlated with the DASH scores. Conclusion. This study provides innovative evidence fo...
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Research Interests: Magnetic Resonance Imaging, Aging, Treatment Outcome, Risk assessment, Medicine, and 14 moreHumans, Female, Follow-up studies, Aged, Middle Aged, Geriatric Assessment, Risk Assessment, X ray Computed Tomography, Knee Joint, Immobilization, Contrast Media, Analgesics, Combined Modality Therapy, and Medical and Health Sciences
BACKGROUND Explosion injuries to the upper extremity have specific clinical characteristics that differ from injuries due to other mechanisms. OBJECTIVES To evaluate the upper extremity injury pattern of attacks on civilian targets,... more
BACKGROUND Explosion injuries to the upper extremity have specific clinical characteristics that differ from injuries due to other mechanisms. OBJECTIVES To evaluate the upper extremity injury pattern of attacks on civilian targets, comparing bomb explosion injuries to gunshot injuries and their functional recovery using standard outcome measures. METHODS Of 157 patients admitted to the hospital between 2000 and 2004, 72 (46%) sustained explosion injuries and 85 (54%) gunshot injuries. The trauma registry files were reviewed and the patients completed the DASH Questionnaire (Disabilities of Arm, Shoulder and Hand) and SF-12 (Short Form-12) after a minimum period of 1 year. RESULTS Of the 157 patients, 72 (46%) had blast injuries and 85 (54%) had shooting injuries. The blast casualties had higher Injury Severity Scores (47% vs. 22% with a score of > 16, P = 0.02) and higher percent of patients treated in intensive care units (47% vs. 28%, P = 0.02). Although the Abbreviated Injury...
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CASE REPORT Quincke sign manifested on the wrist of a young healthy man. The patient had self-treated with topical antibiotics and steroids for a second-degree burn, but then developed contact dermatitis followed by cellulitis. He... more
CASE REPORT Quincke sign manifested on the wrist of a young healthy man. The patient had self-treated with topical antibiotics and steroids for a second-degree burn, but then developed contact dermatitis followed by cellulitis. He presented to the emergency department with a "blinking" effect of the skin lesion. CONCLUSION The "blinking" effect is the result of focal subcutaneous arterial dilatation in the zone of subcutaneous inflammation.
Research Interests: Medicine()
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PURPOSE In scaphoid fracture screw fixation, the screw is commonly placed along the long axis of the bone, without consideration of the fracture plane. This position is not perpendicular to transverse waist fractures or to the more common... more
PURPOSE In scaphoid fracture screw fixation, the screw is commonly placed along the long axis of the bone, without consideration of the fracture plane. This position is not perpendicular to transverse waist fractures or to the more common horizontal oblique fractures. Our aim was to examine the feasibility and describe possible approaches to, placing a screw perpendicular and in the center of the scaphoid waist fracture. METHODS Computed tomography of 12 cadaver wrists was performed in 3 positions to examine possible approaches in flexion, neutral, and extension of the wrist. The scans were evaluated using a 3-dimensional model that simulated horizontal oblique (60°) and transverse (90°) fractures. We examined all possible approaches for screw positioning and their deviation from the axis perpendicular to the fracture and in the center of its plane. RESULTS The preferred approaches for a perpendicular screw in a horizontal oblique fracture were found to be proximal-dorsal in flexion or transtrapezial in the extended or neutral positions (through the volar-radial trapezium). In transverse fractures, the possible approaches were proximal-dorsal or transtrapezial in the flexed or neutral positions and distal in the extended position (volar to volar-radial trapezium). In these approaches, the screw could be placed perpendicularly (deviating by < 10°) and in the center of the fracture in all specimens. CONCLUSIONS According to this model, it appears feasible to place a perpendicular screw in the center of a horizontal oblique waist fracture using a proximal-dorsal approach in flexion or a transtrapezial approach in neutral or extension positions of the wrist. Palpable landmarks may be used as additional guides to direct these approaches according to the clinical setting. CLINICAL RELEVANCE Perpendicular screw fixation of horizontal oblique or transverse scaphoid waist fractures is a possible option, if chosen for its biomechanical advantages.
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PURPOSE The recommended technique for the fixation of a scaphoid waist fracture involves a headless compression screw placed in the proximal fragment center. This is usually accomplished by placing a longitudinal axis screw as visualized... more
PURPOSE The recommended technique for the fixation of a scaphoid waist fracture involves a headless compression screw placed in the proximal fragment center. This is usually accomplished by placing a longitudinal axis screw as visualized by fluoroscopy. The screw length has been shown to have a biomechanical advantage. An alternative to these options, which has been debated in the literature, is a screw placed perpendicular to the fracture plane and in its center. The perpendicular screw may have a biomechanical advantage despite the fact that it may be shorter. This study examined the differences in location and length in actual patients between a screw in the center of the proximal fragment with a longitudinal axis screw, and the actual fixating screw. These were then compared to a perpendicular axis screw. METHODS Pre- and post-operative CT scans of 10 patients with scaphoid waist fractures were evaluated using a 3D computer model. Comparisons were made between the length, location and angle of actual and virtual screw alternatives; namely, a screw along the central third of the proximal fragment (central screw axis) where the scaphoid longitudinal axis was calculated mathematically (longitudinal screw axis) and a screw placed at 90° to the fracture plane and in its center (perpendicular screw axis). RESULTS The longitudinal axis screw was found to be significantly longer than the other axes (28.3mm). There was a significant difference between the perpendicular axis screw and the location and angle of the other screw axis, but it was only shorter than the longitudinal screw (23.6mm versus 25.5mm for the actual screw; ns.). CONCLUSIONS A computed longitudinal axis screw is longer than a central or actual screw placed longitudinally by visual inspection by the surgeon. Although it needs to be placed using computer assisted (CAS) techniques, it may have the biomechanical advantages of a longer screw in a similar trajectory. The perpendicular screw was found to be significantly different in position and angle but not shorter than the actually placed screw. It has biomechanical advantages and does not require visualization with CAS methods, making it the more attractive alternative.
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: Computer modeling of the wrist has followed other fields in the search for descriptive methods to understand the biomechanics of injury. Using patient-specific 3D computer models, we may better understand the biomechanics of wrist... more
: Computer modeling of the wrist has followed other fields in the search for descriptive methods to understand the biomechanics of injury. Using patient-specific 3D computer models, we may better understand the biomechanics of wrist fractures in order to plan better care. We may better estimate fracture morphology and stability and evaluate surgical indications, design more adequate or effective surgical approaches and develop novel methods of therapy. The purpose of this review is to question the actual advances made in the understanding of the wrist fractures using computer models.
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Since the 1960's, CS has become the main riot control agent in use by police and army forces throughout the world. The first post-exposure symptom is a burning sensation in the eyes, nose and throat. At a later stage, lacrimation,... more
Since the 1960's, CS has become the main riot control agent in use by police and army forces throughout the world. The first post-exposure symptom is a burning sensation in the eyes, nose and throat. At a later stage, lacrimation, rhinorrhea, conjunctivitis, sore throat and salivation appear. These symptoms are followed by chest pain and dry cough, and if the substance is swallowed, it may cause nausea and vomiting. This article reviews the physical properties of CS, the main dispersing techniques, the clinical signs and symptoms of exposure, including information on mutagenicity, carcinogenesis, pregnancy safety, and will introduce guidelines for treatment after exposure.
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Protective antiself response to nervous system injury has been reported to be mediated by a T-cell subpopulation that can recognize self-antigens. Immune cells have been shown to play a role in the regulation of motor neuron survival... more
Protective antiself response to nervous system injury has been reported to be mediated by a T-cell subpopulation that can recognize self-antigens. Immune cells have been shown to play a role in the regulation of motor neuron survival after a peripheral nerve injury. The objective of the present study was to evaluate the effects of immune system augmentation with use of the antigen glatiramer acetate, which is known to affect T-cell immunity, on peripheral nerve regeneration. Wild-type and nude-type (T-cell-deficient) rats underwent crush injury of the sciatic nerve. Three and six weeks after the injury, the sciatic nerve was examined, both functionally (on the basis of footprint analysis and the tibialis anterior muscle response and weight) and histologically (on the basis of axon count). Significantly greater muscle responses were measured after three weeks in the group of wild-type rats that were treated with glatiramer acetate (control limb:injured limb ratio, 0.05 for the glatiramer acetate group [n = 9], compared with 0.51 for the saline solution group [n = 8]; p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05). Higher axon counts were also found in this group (control limb:injured limb ratio, -0.07 for the glatiramer acetate group [n = 10], compared with 0.29 for the saline solution group [n = 8]; p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05). The nude-type rats showed no response to the intervention after three weeks but showed a delayed response after six weeks. A second dose of glatiramer acetate, delivered forty-eight hours after the injury, did not result in an improved response as compared with the control groups. We found that a single treatment with glatiramer acetate resulted in accelerated functional and histological recovery after sciatic nerve crush injury. The role of T-cell immunity in the mechanism of glatiramer acetate was suggested by the partial and late response found in the T-cell-deficient rats.
Research Interests: Orthopedic Surgery, Biomedical Engineering, Regeneration, Skeletal muscle biology, Treatment, and 14 moreModels, Female, Animals, Peptides, Behavioral Animal Models, Nerve Regeneration, Clinical Sciences, T lymphocytes, Immune system, Rats, Rat, Peripheral Nerve, Sciatic Nerve, and Glatiramer acetate
Large posttraumatic pseudocysts are infamous for their tendency to recur despite repeated aspiration. The standard practice has been repeated extensive surgical debridement. To avoid the need for such treatment, talc was used to sclerose... more
Large posttraumatic pseudocysts are infamous for their tendency to recur despite repeated aspiration. The standard practice has been repeated extensive surgical debridement. To avoid the need for such treatment, talc was used to sclerose the lesion in 4 patients treated between 2000 and 2003. The patients were between the ages of 20 and 73 and had thigh and buttock pseudocysts that persisted for an average of 3 months. Talc was administered under fluoroscopic guidance and suction drainage (wall suction followed by a bulb vacuum drainage system) was applied for an average of 12 days. The patients were followed for an average period of 27 months after talc sclerodhesis. All persistent pseudocysts showed an immediate cessation of fluid accumulation in the treated space without reccurence. One case which was complicated by infection, had to be treated twice with talc to cease the accumulation. In this case, the infection recurred, although fluid accumulation did not recur. Talc sclerodhesis proved to be a simple and rapid method of treatment in posttraumatic cases classically treated by repeated and aggressive surgical methods.
Research Interests: Surgery, Treatment, Treatment Outcome, Case Report, Complication, and 15 moreHumans, Derivation, Age, Female, Male, Orthopedics, Clinical Sciences, Aged, Middle Aged, Adult, Suction, Sclerotherapy, Aspiration, TALC, and Orthopaedic Trauma(Humans, Derivation, Age, Female, Male, Orthopedics, Clinical Sciences, Aged, Middle Aged, Adult, Suction, Sclerotherapy, Aspiration, TALC, and Orthopaedic Trauma)
(Humans, Derivation, Age, Female, Male, Orthopedics, Clinical Sciences, Aged, Middle Aged, Adult, Suction, Sclerotherapy, Aspiration, TALC, and Orthopaedic Trauma)