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  1. Article ; Online: Delayed elective total shoulder arthroplasty: causes and eventual outcomes.

    Tobin, Jacqueline G / Neel, Garrett B / Guareschi, Alexander S / Barfield, William R / Eichinger, Josef K / Friedman, Richard J

    International orthopaedics

    2024  

    Abstract: Purpose: The purpose of this study is to identify risk factors for delays in planned total shoulder arthroplasty (TSA) and determine the perioperative outcomes of TSAs that experienced a delay.: Methods: The American College of Surgeons National ... ...

    Abstract Purpose: The purpose of this study is to identify risk factors for delays in planned total shoulder arthroplasty (TSA) and determine the perioperative outcomes of TSAs that experienced a delay.
    Methods: The American College of Surgeons National Quality Improvement Program (NSQIP) database was queried from 2006 to 2019 for primary TSA. Delayed TSA was defined as surgery that occurred greater than one day after hospital admission. Patient demographics, comorbidities, and post-operative complications were collected and compared; the incidence of delayed TSA was analyzed.
    Results: The delayed patients were older, had a higher BMI, a higher rate of recent prior major surgery, and more comorbidities. Delayed patients had higher rates of postoperative complications, return to the OR, and 30-day readmission. Between 2006 and 2019, the rate of delayed TSA decreased.
    Conclusion: Surgeons should take care to ensure that patients with comorbidities undergo thorough preoperative clearance to prevent same-day cancellations and postoperative complications.
    Language English
    Publishing date 2024-05-15
    Publishing country Germany
    Document type Journal Article
    ZDB-ID 80384-4
    ISSN 1432-5195 ; 0341-2695
    ISSN (online) 1432-5195
    ISSN 0341-2695
    DOI 10.1007/s00264-024-06210-8
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: Re: Vertically Oriented Femoral Neck Fractures: A Biomechanical Comparison of 3 Fixation Constructs.

    Hartsock, Langdon A / Barfield, William R

    Journal of orthopaedic trauma

    2017  Volume 31, Issue 9, Page(s) e305

    Language English
    Publishing date 2017
    Publishing country United States
    Document type Journal Article ; Comment
    ZDB-ID 639099-7
    ISSN 1531-2291 ; 0890-5339
    ISSN (online) 1531-2291
    ISSN 0890-5339
    DOI 10.1097/BOT.0000000000000934
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  3. Article ; Online: Impact of age on shoulder range of motion and strength.

    Pike, J Mattison / Singh, Suvleen K / Barfield, William R / Schoch, Bradley / Friedman, Richard J / Eichinger, Josef K

    JSES international

    2022  Volume 6, Issue 6, Page(s) 1029–1033

    Abstract: Background: Total shoulder arthroplasty (TSA) is a surgical technique commonly used to treat patients with arthritis and rotator cuff deficiency. Its purpose is to reduce pain and improve shoulder function, namely range of motion (ROM) and strength. ... ...

    Abstract Background: Total shoulder arthroplasty (TSA) is a surgical technique commonly used to treat patients with arthritis and rotator cuff deficiency. Its purpose is to reduce pain and improve shoulder function, namely range of motion (ROM) and strength. While shoulder ROM and strength have been studied extensively in patients with various shoulder pathologies, there is a dearth of knowledge with regard to the asymptomatic population.
    Methods: A cross-sectional study was conducted in the outpatient orthopaedic clinic following institutional review board approval. Patients 18 years of age and older with at least one asymptomatic and healthy shoulder with no prior history of shoulder surgery, injury, or pain were enrolled in the study. Demographic information, ROM, and strength measurements were collected for 256 shoulders, evenly stratified into groups by age and sex. A goniometer was used to measure forward elevation, abduction, and external rotation, and a handheld dynamometer was utilized for measuring strength. Statistical evaluation was conducted using Pearson correlations, analysis of variance, and Bonferroni and Mann-Whitney post hoc tests, with
    Results: Abduction strength (
    Conclusion: Shoulder strength significantly decreased with age, with abduction strength and external rotation strength displaying the strongest negative correlations. Decreases in strength were most prominent in patients 66 years of age and above. Shoulder ROM was not as tightly correlated with age, although abduction, forward elevation, and internal rotation were found to generally decrease over time. Differences in external rotation were not clinically significant. These correlations provide useful controls for patients of various ages regarding their clinical outcomes when presenting with shoulder pathology. Variations in current literature allow this study to verify the impact of age on shoulder ROM and strength.
    Language English
    Publishing date 2022-09-14
    Publishing country United States
    Document type Journal Article
    ISSN 2666-6383
    ISSN (online) 2666-6383
    DOI 10.1016/j.jseint.2022.08.016
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  4. Article ; Online: Does glenohumeral offset affect clinical outcomes in a lateralized reverse total shoulder arthroplasty?

    Wolf, G Jacob / Reid, Jared J / Rabinowitz, Justin R / Barcel, D Anthony / Barfield, William R / Eichinger, Josef K / Friedman, Richard J

    Journal of shoulder and elbow surgery

    2022  Volume 32, Issue 1, Page(s) 50–58

    Abstract: Background: Reverse total shoulder arthroplasty (rTSA) exhibits high rates of success and low complication rates. rTSA has undergone numerous design adaptations over recent years, and lateralization of implant components provides theoretical and ... ...

    Abstract Background: Reverse total shoulder arthroplasty (rTSA) exhibits high rates of success and low complication rates. rTSA has undergone numerous design adaptations over recent years, and lateralization of implant components provides theoretical and biomechanical benefits in stability and range of motion (ROM) as well as decreased rates of notching. However, the magnitude of implant lateralization and its effect on these outcomes is less well understood. The purpose of this study was to evaluate how increasing glenohumeral offset affects outcomes after rTSA, specifically in a lateralized humerus + medialized glenoid implant model.
    Methods: Primary rTSA using a lateralized humeral + medialized glenoid implant model performed at a single academic institution between 2012 and 2018 were retrospectively reviewed. Patient-reported outcome (PRO) parameters and clinical outcomes including ROM were evaluated both pre- and postoperatively. Pre- and postoperative radiographs were analyzed for measurement of glenohumeral offset, defined as the acromial-tuberosity offset (ATO) distance on the anteroposterior radiograph.
    Results: A total of 130 rTSAs were included in the analysis, with a mean follow-up of 35 mo. The mean postoperative absolute ATO was 16 mm, and the mean delta ATO (difference from pre- to postoperatively) was 4.6 mm further lateralized. Among all study patients, improvements in all ROM parameters and all PROs were observed from pre- to postoperative assessments. When assessing for the effects of lateralization on these outcomes, multivariate analysis failed to reveal a significant effect from the absolute postoperative ATO or the delta ATO on any outcome parameter.
    Conclusions: rTSA using a lateralized humeral + medialized glenoid implant model exhibits excellent clinical outcomes in ROM and PROs. However, the magnitude of lateralization as measured radiographically by the ATO did not significantly affect these outcomes; patients exhibited universally good outcomes irrespective of the degree of offset restoration.
    Language English
    Publishing date 2022-07-21
    Publishing country United States
    Document type Journal Article
    ZDB-ID 1170782-3
    ISSN 1532-6500 ; 1058-2746
    ISSN (online) 1532-6500
    ISSN 1058-2746
    DOI 10.1016/j.jse.2022.06.007
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  5. Article ; Online: Hemiepiphyseodesis for Juvenile and Adolescent Tibia Vara Utilizing Percutaneous Transphyseal Screws.

    Murphy, Robert F / Pacult, Mark A / Barfield, William R / Mooney, James F

    Journal of pediatric orthopedics

    2019  Volume 40, Issue 1, Page(s) 17–22

    Abstract: Background: In juvenile and adolescent tibia vara patients with sufficient growth remaining, implant-controlled hemiepiphyseodesis, or guided growth, can be used to correct deformity. Recent reports have described hardware failure of certain ... ...

    Abstract Background: In juvenile and adolescent tibia vara patients with sufficient growth remaining, implant-controlled hemiepiphyseodesis, or guided growth, can be used to correct deformity. Recent reports have described hardware failure of certain hemiepiphyseodesis implants in overweight patients with tibia vara. We describe our experience using transphyseal screws to correct deformity in this patient population.
    Methods: A retrospective chart and radiograph review was conducted on all juvenile and adolescent tibia vara patients who underwent lateral proximal tibial hemiepiphyseodesis using a single transphyseal screw. Charts were queried for preoperative and postoperative mechanical axis deviation, medial proximal tibial angle, lateral distal femoral angle, and postoperative complications or need for further surgery.
    Results: In total, 14 affected limbs in 9 patients (6 males) who underwent lateral proximal tibial transphyseal screw hemiepiphyseodesis were considered. Average chronologic age at implantation was 10.4 years and average body mass index was 31.7 kg/m. At average 23-month follow-up, the average mechanical axis deviation improved from 46 to 0 mm (P<0.001), and the average medial proximal tibial angle improved from 81 to 92 degrees (P<0.001). No limbs underwent further surgery to correct residual deformity. There were no complications or instances of implant failure associated with the transphyseal screws.
    Conclusions: Hemiepiphyseodesis using transphyseal screws is an effective technique to correct deformity in juvenile and adolescent tibia vara patients with sufficient growth remaining. This method can be used safely with few complications and with minimal risk of mechanical failure, even in overweight patients.
    Level of evidence: Level IV-therapeutic.
    MeSH term(s) Biomechanical Phenomena ; Body Mass Index ; Bone Diseases, Developmental/complications ; Bone Diseases, Developmental/diagnostic imaging ; Bone Diseases, Developmental/surgery ; Bone Screws ; Child ; Female ; Femur/surgery ; Follow-Up Studies ; Humans ; Male ; Orthopedic Procedures/instrumentation ; Orthopedic Procedures/methods ; Osteochondrosis/complications ; Osteochondrosis/congenital ; Osteochondrosis/diagnostic imaging ; Osteochondrosis/surgery ; Pediatric Obesity/complications ; Postoperative Complications/etiology ; Prosthesis Failure ; Radiography ; Retrospective Studies ; Tibia/surgery
    Language English
    Publishing date 2019-12-04
    Publishing country United States
    Document type Journal Article
    ZDB-ID 604642-3
    ISSN 1539-2570 ; 0271-6798
    ISSN (online) 1539-2570
    ISSN 0271-6798
    DOI 10.1097/BPO.0000000000001067
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  6. Article: The Rates of Nonunion and Malunion in Lower Extremity Fractures: Experience in South Carolina over 17 years.

    Daley, Dane N / Westbrook, Phillip A / Barfield, William R / Selassie, Anbesaw / Hartsock, Langdon A

    Journal of surgical orthopaedic advances

    2020  Volume 29, Issue 3, Page(s) 129–134

    Abstract: Our purpose was to determine the rates of lower extremity nonunion and malunion over 17 years in South Carolina. Our hypothesis was that malunions and nonunions decreased over time due to improved access to trauma centers and improved orthopaedic ... ...

    Abstract Our purpose was to determine the rates of lower extremity nonunion and malunion over 17 years in South Carolina. Our hypothesis was that malunions and nonunions decreased over time due to improved access to trauma centers and improved orthopaedic surgical training. The South Carolina Department of Budget and Control Hospital Discharge Database was queried between 1998-2014 and yielded a total of 4,994 malunions and 16,454 nonunions. Malunions increased from 1.2% (1998) to 1.8% (2010); nonunions increased from 4.0% (1999) to 5.8% (2011). Older age and gender were predictive of malunion and nonunion. This study identified females as having a higher odds ratio for malunion or nonunion; higher nonunion rates in worker's compensation or government payer status; and older age as incurring greater risks for sustaining fractures or developing a malunion or nonunion. There was increased prevalence of nonunion and malunion despite improved access to trauma centers and trained orthopaedic trauma surgeons. (Journal of Surgical Orthopaedic Advances 29(3):129-134, 2020).
    MeSH term(s) Aged ; Female ; Fractures, Malunited/epidemiology ; Fractures, Ununited/epidemiology ; Humans ; Lower Extremity ; South Carolina/epidemiology ; Tibial Fractures
    Language English
    Publishing date 2020-10-12
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2189157-6
    ISSN 2158-3811 ; 1548-825X ; 1059-1052
    ISSN (online) 2158-3811
    ISSN 1548-825X ; 1059-1052
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  7. Article ; Online: Heterotopic Ossification in Trauma.

    Barfield, William R / Holmes, Robert E / Hartsock, Langdon A

    The Orthopedic clinics of North America

    2017  Volume 48, Issue 1, Page(s) 35–46

    Abstract: Better understanding of the biology of heterotopic ossification (HO) formation will lead to treatment and prevention modalities that can be directed specifically at the cellular level. Early identification of HO precursor cells and target genes may ... ...

    Abstract Better understanding of the biology of heterotopic ossification (HO) formation will lead to treatment and prevention modalities that can be directed specifically at the cellular level. Early identification of HO precursor cells and target genes may provide prognostic value that guides individualized prophylactic treatment. Better understanding of molecular signaling and proteomics variability will allow surgeons to individualize preemptive treatment to suppress inflammation and formation of HO. Careful surgical technique to avoid muscle damage is important. Damaged muscle should be debrided as a prophylactic measure. Hemostasis and avoidance of a postoperative hematoma may decrease the chance of formation of HO.
    MeSH term(s) Humans ; Ossification, Heterotopic/etiology ; Risk Factors ; Wounds and Injuries/complications
    Language English
    Publishing date 2017-01
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 417389-2
    ISSN 1558-1373 ; 0030-5898
    ISSN (online) 1558-1373
    ISSN 0030-5898
    DOI 10.1016/j.ocl.2016.08.009
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  8. Article ; Online: A Comparative Analysis of Revision Surgery Before or After 2 Years After Graduation From Growth-friendly Surgery for Early Onset Scoliosis.

    Prior, Anjali / Hardesty, Christina K / Emans, John B / Thompson, George H / Sponseller, Paul D / Smith, John T / Skaggs, David L / Vaughan, Majella / Barfield, William R / Murphy, Robert F

    Journal of pediatric orthopedics

    2023  Volume 43, Issue 8, Page(s) 481–485

    Abstract: Introduction: After discontinuation of growth-friendly (GF) surgery for early onset scoliosis, patients are termed graduates: they undergo a spinal fusion, are observed after final lengthening with GF implant maintenance, or are observed after GF ... ...

    Abstract Introduction: After discontinuation of growth-friendly (GF) surgery for early onset scoliosis, patients are termed graduates: they undergo a spinal fusion, are observed after final lengthening with GF implant maintenance, or are observed after GF implant removal. The purpose of this study was to compare the rates of and reasons for revision surgery in two cohorts of GF graduates: before or after 2 years of follow-up from graduation.
    Methods: A pediatric spine registry was queried for patients who underwent GF spine surgery with a minimum of 2 years of follow-ups after graduation by clinical and/or radiographic evidence. Scoliosis etiology, graduation strategy, number of, and reasons for revision surgery were queried.
    Results: There were 834 patients with a minimum of 2-year follow-up after graduation who were analyzed. There were 241 (29%) congenital, 271 (33%) neuromuscular, 168 (20%) syndromic, and 154 (18%) idiopathic. 803 (96%) had traditional growing rod/vertical expandable titanium rib as their GF construct and 31 (4%) had magnetically controlled growing rod. Five hundred ninety-six patients (71%) underwent spinal fusion at graduation, 208 (25%) had GF implants retained, and 30 (4%) had GF implants removed.In the entire cohort, there were 108/834 (13%) patients who underwent revision surgery. Of the revisions, 71/108 (66%) occurred as acute revisions (ARs) between 0 and 2 years from graduation (mean 0.6 y), and the most common AR indication was infection (26/71, 37%). The remaining 37/108 (34%) patients underwent delayed revision (DR) surgery >2 years (mean 3.8 y) from graduation, and the most common DR indication was implant issues (17/37, 46%).Graduation strategy affected revision rates. Of the 596 patients with spinal fusion as a graduation strategy, 98/596 (16%) underwent revision, compared with only 8/208 (4%) patients who had their GF implants retained, and 2/30 (7%) that had their GF implants removed ( P ≤ 0.001).A significantly higher percentage of the ARs had a spinal fusion as the graduation strategy (68/71, 96%) compared with 30/37 DRs, (81%, P = 0.015). In addition, the 71 patients who underwent AR undergo more revision surgeries (mean: 2, range: 1 to 7) than 37 patients who underwent DR (mean: 1, range: 1 to 2) ( P = 0.001).
    Conclusion: In this largest reported series of GF graduates to date, the overall risk of revision was 13%. Patients who undergo a revision at any time, as well as ARs in particular, are more likely to have a spinal fusion as their graduation strategy. Patients who underwent AR, on average, undergo more revision surgeries than patients who underwent DR.
    Level of evidence: Level III, comparative.
    MeSH term(s) Child ; Humans ; Scoliosis/diagnostic imaging ; Scoliosis/surgery ; Scoliosis/etiology ; Reoperation ; Retrospective Studies ; Spine/surgery ; Prostheses and Implants ; Spinal Fusion/adverse effects ; Treatment Outcome
    Language English
    Publishing date 2023-07-03
    Publishing country United States
    Document type Journal Article
    ZDB-ID 604642-3
    ISSN 1539-2570 ; 0271-6798
    ISSN (online) 1539-2570
    ISSN 0271-6798
    DOI 10.1097/BPO.0000000000002467
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  9. Article: Preoperative Smoking Cessation as a Durable Form of Long-Term Smoking Cessation.

    Balmer, Jacob C / Anderson, Ashley B / Barfield, William R / Pellegrini, Vincent D / Demos, Harry A

    Journal of surgical orthopaedic advances

    2020  Volume 29, Issue 2, Page(s) 103–105

    Abstract: Smokers who undergo total joint arthroplasty (TJA) face increased rates of medical and surgical complications that can be reduced by preoperative smoking cessation. We investigated the long-term durability of preoperative smoking cessation among TJA ... ...

    Abstract Smokers who undergo total joint arthroplasty (TJA) face increased rates of medical and surgical complications that can be reduced by preoperative smoking cessation. We investigated the long-term durability of preoperative smoking cessation among TJA patients. Twenty-seven TJA patients who were identified as having an active history of smoking at the preoperative appointment before TJA consented to telephone survey about their perioperative and current smoking status. Average time from operation to survey was 3.7 years. Of the 27 patients, 21 (77.8%) were identified as having quit smoking prior to surgery. Of these 21 patients, 10 (47.6%) self-reported continued abstinence from smoking at the time of survey. Our cessation rate was significantly lower than reported long-term smoking cessation rates with standard therapies (p < 0.001). Our results suggest that preoperative counseling and a requirement for smoking-cessation prior to elective TJA may have long-term durability that exceeds that of popular reported methods. (Journal of Surgical Orthopaedic Advances 29(2):103-105, 2020).
    MeSH term(s) Arthroplasty ; Counseling ; Humans ; Preoperative Care ; Smoking ; Smoking Cessation
    Language English
    Publishing date 2020-06-25
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2189157-6
    ISSN 2158-3811 ; 1548-825X ; 1059-1052
    ISSN (online) 2158-3811
    ISSN 1548-825X ; 1059-1052
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  10. Article ; Online: A Single Sugar-Tong Splint Can Maintain Pediatric Forearm Fractures.

    Murphy, Robert F / Sleasman, Brian / Osborn, Davis / Barfield, William R / Dow, Matthew A / Mooney, James F

    Orthopedics

    2020  Volume 44, Issue 2, Page(s) e178–e182

    Abstract: Displaced pediatric forearm fractures often are treated with closed reduction and immobilization. Recent literature demonstrates no difference in maintaining alignment or needing repeat intervention in patients immobilized with either a single sugar-tong ...

    Abstract Displaced pediatric forearm fractures often are treated with closed reduction and immobilization. Recent literature demonstrates no difference in maintaining alignment or needing repeat intervention in patients immobilized with either a single sugar-tong splint or a long-arm cast, but most series include patients with distal fractures. This study included patients 3 to 15 years old who underwent closed reduction and immobilization for displaced midshaft or proximal forearm fractures. Radiographs from the time of injury, after reduction, and at 4-week follow-up were reviewed for coronal and sagittal plane angular alignment. Secondary interventions also were recorded. A total of 121 patients (70 long-arm cast, 51 simple sugar-tong splint) met inclusion criteria. Groups were matched in terms of age (
    MeSH term(s) Adolescent ; Child ; Child, Preschool ; Female ; Forearm Injuries/diagnostic imaging ; Forearm Injuries/surgery ; Humans ; Male ; Orthopedic Procedures/instrumentation ; Radiography ; Splints
    Language English
    Publishing date 2020-11-25
    Publishing country United States
    Document type Journal Article
    ZDB-ID 424447-3
    ISSN 1938-2367 ; 0147-7447
    ISSN (online) 1938-2367
    ISSN 0147-7447
    DOI 10.3928/01477447-20201119-06
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