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  1. Article ; Online: A novel surgical technique for distal radius fractures using the "mini distractor".

    Mallon, Zachary O / Schlauch, Adam M

    Trauma case reports

    2023  Volume 47, Page(s) 100926

    Abstract: Open reduction and internal fixation of distal radius fractures is one of the most common operations for orthopaedic surgeons. A vital step of the operation is restoring radial height, which can be challenging if the surgeon is operating alone. To ... ...

    Abstract Open reduction and internal fixation of distal radius fractures is one of the most common operations for orthopaedic surgeons. A vital step of the operation is restoring radial height, which can be challenging if the surgeon is operating alone. To address this, we present a novel surgical technique called the distal radius mini distractor. The technique utilizes a compression / distraction device in tandem with a volar locking plate to aid in the reduction of impacted distal radius fractures. The written technique guide is presented alongside intra-operative surgical pictures and fluoroscopy. The objective of this article is to introduce the mini distractor technique, which can be of particular use for the surgeon operating without assistance.
    Language English
    Publishing date 2023-09-02
    Publishing country Netherlands
    Document type Case Reports
    ZDB-ID 2835433-3
    ISSN 2352-6440 ; 2352-6440
    ISSN (online) 2352-6440
    ISSN 2352-6440
    DOI 10.1016/j.tcr.2023.100926
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  2. Article ; Online: Staged allograft fixation for complex open distal humerus fracture with ulnohumeral bone loss in a young adult: a technique guide.

    Schlauch, Adam Michael / Mallon, Zachary O

    JSES reviews, reports, and techniques

    2023  Volume 3, Issue 4, Page(s) 567–575

    Language English
    Publishing date 2023-06-01
    Publishing country Netherlands
    Document type Journal Article
    ISSN 2666-6391
    ISSN (online) 2666-6391
    DOI 10.1016/j.xrrt.2023.05.003
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  3. Article ; Online: Posttraumatic Cubitus Varus: Respect the Columns.

    Schlauch, Adam M / Manske, Mary Claire / Leshikar, Holly B / Davids, Jon R

    Journal of pediatric orthopedics

    2024  

    Abstract: Posttraumatic cubitus varus is a multiplanar deformity that results from an improperly reduced supracondylar humerus fracture. The prevention of posttraumatic cubitus varus hinges on the stable restoration of all 3 columns of the distal humerus while ... ...

    Abstract Posttraumatic cubitus varus is a multiplanar deformity that results from an improperly reduced supracondylar humerus fracture. The prevention of posttraumatic cubitus varus hinges on the stable restoration of all 3 columns of the distal humerus while avoiding malrotation. The collapse of any column leads to varying degrees of deformity in the coronal, sagittal, and/or axial plane. The purpose of this article is to explain the pattern of the deformity and use this to summarize preventative tactics for avoiding its described sequelae. We also summarize, illustrate, and present case examples for the various osteotomies used to correct the deformity, and speculate future directions.
    Language English
    Publishing date 2024-03-22
    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.0000000000002671
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  4. Article ; Online: Risk Factors for Revision of External Fixation of Unstable Ankle Injuries.

    Schlauch, Adam M / Shah, Ishan / Crawford, Benjamin / Piple, Amit / Krosin, Michael

    Journal of the American Academy of Orthopaedic Surgeons. Global research & reviews

    2024  Volume 8, Issue 4

    Abstract: Introduction: External fixation of unstable ankle injuries is commonly done by orthopaedic surgeons. An improper technique can negate the benefits of the procedure and necessitate revision. This study sought to determine the risk factors for revision of ...

    Abstract Introduction: External fixation of unstable ankle injuries is commonly done by orthopaedic surgeons. An improper technique can negate the benefits of the procedure and necessitate revision. This study sought to determine the risk factors for revision of external fixation of unstable ankle injuries.
    Methods: Retrospective cohort at a level I academic trauma center of 120 consecutive patients underwent external fixation of an unstable ankle injury. Exclusion criteria included external fixation for reason other than fracture, inadequate intraoperative imaging, skeletal immaturity, and follow-up less than 30 days. Primary outcome measurement was revision of external fixation within 30 days.
    Results: Ninety-seven patients met inclusion criteria. Eighteen (18.6%) underwent revision within 30 days of whom 5 (28%, P < 0.001) had a poor reduction intraoperatively. No patients with a good reduction required revision. Revised patients had a significantly higher talar tilt (P < 0.001) and were more likely to lack a first metatarsal pin (P = 0.018). Multivariate analysis revealed talar tilt >0.5° (odds ratio, 22.62; 95% confidence interval, 6.52 to 50.63) as an independent risk factor for revision.
    Discussion: For external fixation of unstable ankle injuries, poor reduction quality is a risk factor for need for revision surgery. Orthopaedic surgeons should be critical of their final intraoperative assessment to prevent revision.
    MeSH term(s) Humans ; Retrospective Studies ; Fracture Fixation/methods ; External Fixators ; Ankle Injuries/diagnostic imaging ; Ankle Injuries/surgery ; Risk Factors
    Language English
    Publishing date 2024-03-26
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2898328-2
    ISSN 2474-7661 ; 1067-151X
    ISSN (online) 2474-7661
    ISSN 1067-151X
    DOI e23.00243
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  5. Article ; Online: The high-risk hip fracture patient and the palliative care consult : A retrospective study to investigate risks of complications and the utility of a palliative care consult in hip fracture patients undergoing surgical fixation.

    Schlauch, Adam M / Michelson, James D / Holleran, Amanda / Ames, Elizabeth

    Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA

    2022  Volume 34, Issue 3, Page(s) 507–513

    Abstract: We evaluated the utility of a palliative care consult (PCC) in high-risk hip fracture patients. The main result was that a PCC reflects certain risk factors for post-surgical complications and is associated with a delay to surgery in the high-risk ... ...

    Abstract We evaluated the utility of a palliative care consult (PCC) in high-risk hip fracture patients. The main result was that a PCC reflects certain risk factors for post-surgical complications and is associated with a delay to surgery in the high-risk patient population that it served.
    Purpose: The objective of this study was to identify risks of complications in surgically managed hip fractures and determine the utility of a PCC in this population, particularly regarding time to the operating room (OR).
    Methods: Retrospective cohort at a Level I academic trauma center.
    Results: Four hundred sixty-two patients were treated surgically for hip fracture. Decreased pre-injury ambulatory status (OR 2.18, 95% CI 1.13-4.20, p = .02), time to OR > 48 h (OR 4.76, 95% CI 1.43-15.87, p = .011), and obtaining a pre-operative PCC (OR 3.03, 95% CI 1.34-6.85, p = .008) were independent risk factors for post-surgical complications. Multivariate risk factors for obtaining a PCC included older age (OR 1.1, CI 1.0-1.1, p = .007), pre-injury ambulatory status (OR 2.2, CI 1.3-3.9, p = .005), renal failure (OR 3.1, CI 1.1-9.0, p = 0.032), and higher ASA category (OR 2.6, CI 1.2-5.5, p = .014). A delay of more than 48 h was associated with being male ( OR 4.6, CI 1.4-15.0, p = .013) or having obtained a PCC (OR 5.5, CI 1.4-22.7, p = .017).
    Conclusions: Obtaining a PCC can reflect risks of complications and mortality. It is a valuable resource for use in high-risk patients who are inherently at risk for delays to surgery and should be used judiciously.
    MeSH term(s) Humans ; Male ; Female ; Retrospective Studies ; Palliative Care ; Hip Fractures/epidemiology ; Risk Factors ; Postoperative Complications/etiology
    Language English
    Publishing date 2022-12-14
    Publishing country England
    Document type Journal Article
    ZDB-ID 1064892-6
    ISSN 1433-2965 ; 0937-941X
    ISSN (online) 1433-2965
    ISSN 0937-941X
    DOI 10.1007/s00198-022-06634-1
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  6. Article ; Online: The effect of body weight on interfragmentary fracture strain in plate fixation of distal femur fractures: A finite element analysis.

    Shah, Ishan D / Schlauch, Adam M / Phan, Lisa / Han, Jiho / Eng, Oluwatodimu Richard Raji M / Farrell, Brian

    Orthopaedics & traumatology, surgery & research : OTSR

    2024  , Page(s) 103868

    Abstract: Introduction: Distal femur fractures are difficult to successfully treat due to high rates of nonunion. Obesity is an independent prognostic risk factor for nonunion. Advances in finite element analyses (FEAs) have allowed researchers to better ... ...

    Abstract Introduction: Distal femur fractures are difficult to successfully treat due to high rates of nonunion. Obesity is an independent prognostic risk factor for nonunion. Advances in finite element analyses (FEAs) have allowed researchers to better understand the performance and behavior of constructs at the bone-implant interface under a variety of conditions. The purpose of this study is to determine the impact of body weight on fracture strain in a lateral locking plate construct for supracondylar femur fractures and whether additional construct rigidity is beneficial to optimize fracture strain in high body mass patients.
    Hypothesis: We hypothesized that increased loads would produce a higher interfragmentary strain (IFS), which could be decreased by shortening the working length of the construct.
    Materials and methods: A 3D finite element analysis was performed on two separate femur models with a comminuted supracondylar distal femur fracture fixed with a lateral distal femoral locking plate in bridging mode with Ansys software. Axial forces were varied to recreate the effect of load from normal and high body mass patients. Working length and screw density of the construct were varied for each condition. Measurements of interfragmentary strain and shear motion (SM) were compared.
    Results: Doubling the axial load from 70kg (control) to 140kg (high body mass) increased the interfragmentary strain by an average of 76% for the three working lengths (3.38%±1.67% to 4.37%±0.88% at the baseline working length (BWL), 1.42%±1.00% to 2.87%±2.02% at the intermediate working length (IWL) and 0.62%±0.22% to 1.22%±0.42% at the short working length (SWL)). On average, decreasing the working length in the 140kg load reduced the mean IFS to within 15% of the mean IFS of the 70kg load at the longer working length (2.87%±2.02% at IWL 140kg versus 3.38%±1.67% at BWL 70kg and 1.22%±0.45% SWL 140kg versus 1.42±1.00% IWL 70kg).
    Discussion: Increased axial load increases interfragmentary strain in an AO/OTA 33A distal femur fracture fixed with a lateral distal femoral locking plate. Decreasing the working length of the fixation construct in the high body mass model decreased interfragmentary strain. Higher loading conditions reflective of high body mass patients should be considered in studies investigating optimization of fracture strain.
    Level of proof: V; Finite Element Analysis (FEA).
    Language English
    Publishing date 2024-03-11
    Publishing country France
    Document type Journal Article
    ISSN 1877-0568
    ISSN (online) 1877-0568
    DOI 10.1016/j.otsr.2024.103868
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  7. Article: Missing the first post-operative visit is an independent risk factor for 90-day complication and re-admission following hip fracture surgery.

    Schlauch, Adam Michael / Shah, Ishan / Caicedo, Maria / Raji, Oluwatodimu Richard / Farrell, Brian

    Journal of orthopaedics

    2022  Volume 36, Page(s) 7–10

    Abstract: Introduction: Knowing the risk factors for poor outcomes following hip fracture surgery is necessary for appropriate patient care. The objective of this study was to determine if the first post-operative visit (POV) following hip fracture surgery is a ... ...

    Abstract Introduction: Knowing the risk factors for poor outcomes following hip fracture surgery is necessary for appropriate patient care. The objective of this study was to determine if the first post-operative visit (POV) following hip fracture surgery is a risk factor for increased mortality, complications, and re-admissions.
    Methods: This was a retrospective review of 285 patients who underwent operative fixation of a hip fracture at an academic acute care hospital. Outcome measurements were 90-day and one year mortality, 90-day complications, and 90-day re-admission rates in patients who missed or attended their first post-operative visit following hip fracture surgery.
    Results: 279 patients met inclusion criteria and had sufficient data for analysis, of which 213 (76.3%) made their first post-operative visit. 90-day and one-year mortality were significantly higher in the patients who missed their first POV (31.8% vs. 4.2%; 51.5% vs. 12.7%). Independent risk factors for 90-day complications were missing the first POV, coronary artery disease, and lower pre-injury status (ORs = 10.65, 2.80, 7.89, respectively). Independent risk factors for 90-day re-admission were missing the first POV, chronic obstructive pulmonary disease on home oxygen, and lower re-injury status (ORs = 8.04, 5.44, 5.47, respectively).
    Conclusion: Missing the first POV was the strongest independent risk factor for 90-day complications and 90-day readmission. Patients who miss their first POV have significantly higher 90-day and one year mortality rates.
    Language English
    Publishing date 2022-12-10
    Publishing country India
    Document type Journal Article
    ZDB-ID 2240839-3
    ISSN 0972-978X
    ISSN 0972-978X
    DOI 10.1016/j.jor.2022.12.004
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  8. Article ; Online: An Analysis of a Decade of Lumbar Interbody Cage Failures in the United States: A MAUDE Database Study.

    Piple, Amit S / Ungurean, Victor / Raji, Oluwatodimu R / Rowland, Andrea / Schlauch, Adam / Kondrashov, Dimitriy G / Hsu, Ken / Zucherman, James

    Spine

    2023  Volume 48, Issue 23, Page(s) 1652–1657

    Abstract: Study design: A retrospective case series.: Objective: This study aims to assess the rates of lumbar interbody cage failures based on their material and manufacturer.: Summary of background data: Perioperative lumbar interbody cage malfunctions ... ...

    Abstract Study design: A retrospective case series.
    Objective: This study aims to assess the rates of lumbar interbody cage failures based on their material and manufacturer.
    Summary of background data: Perioperative lumbar interbody cage malfunctions are underreported events in the spine literature and may result in complications. Although the Food and Drug Administration ensures the safety of these devices under physiological conditions after implantation, these devices may experience nonphysiological conditions during implantation, which may be overlooked.
    Materials and methods: The MAUDE database was examined for reports of lumbar cage device malfunctions from 2012 to 2021. Each report was categorized based on failure type and implant design. A market analysis was performed by dividing the total number of failures per year for each manufacturer by their approximate yearly revenue from spinal implants in the United States. Outlier analysis was performed to generate a threshold value above which failure rates were defined as greater than the normal index.
    Results: Overall, 1875 lumbar cage malfunctions were identified. Of these, 1230 (65.6%) were cage breakages, 257 (13.7%) were instrument malfunctions, 177 (9.4%) were cage migrations, 143 (7.6%) were assembly failures, 70 (4.5%) were screw-related failures, and 21 (1.1%) were cage collapses. Of the breakages, 923 (74.9%) occurred during insertion or impaction and 97 entries detailed a medical complication or a retained foreign body. Of the migrations, 155 (88.6%) were identified postoperatively, of which 73 (47.1%) detailed complications and 52 (33.5%) required a revision procedure. Market analysis demonstrated that Medtronic, Zimmer Biomet, Stryker, Seaspine, and K2M exceeded the calculated threshold.
    Conclusions: Lumbar cages with polyether ether ketone core material failed more frequently by breakage, whereas titanium surface cages failed more frequently by migration. Failure rates varied depending on the manufacturer. Most cage breakages identified in the present study occurred intraoperatively during implantation. These findings call for a more detailed Food and Drug Administration evaluation of these intraoperative malfunctions before commercial approval.
    Level of evidence: Level 4.
    MeSH term(s) Humans ; United States ; Retrospective Studies ; Radiography ; Bone Screws ; Polyethylene Glycols ; Spine ; Spinal Fusion/methods ; Lumbar Vertebrae/surgery
    Chemical Substances Polyethylene Glycols (3WJQ0SDW1A)
    Language English
    Publishing date 2023-01-23
    Publishing country United States
    Document type Journal Article
    ZDB-ID 752024-4
    ISSN 1528-1159 ; 0362-2436
    ISSN (online) 1528-1159
    ISSN 0362-2436
    DOI 10.1097/BRS.0000000000004583
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    Zs.A 1305: Show issues Location:
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  9. Article ; Online: Direct Anterior Versus Posterior Approach for Total Hip Arthroplasty Performed for Displaced Femoral Neck Fractures.

    Shah, Ishan D / Piple, Amit S / Schlauch, Adam M / Crawford, Benjamin D / Tamer, Pierre / Prentice, Heather A / Grimsrud, Christopher D

    Journal of orthopaedic trauma

    2023  Volume 37, Issue 11, Page(s) 539–546

    Abstract: Objectives: To compare perioperative, 90-day, and 1-year postoperative complications and outcomes between the direct anterior approach (DAA) and the posterior approach for total hip arthroplasty in geriatric patients with displaced femoral neck ... ...

    Abstract Objectives: To compare perioperative, 90-day, and 1-year postoperative complications and outcomes between the direct anterior approach (DAA) and the posterior approach for total hip arthroplasty in geriatric patients with displaced femoral neck fractures (FNFs).
    Design: Retrospective cohort study.
    Setting: Multicenter Health care Consortium.
    Patients: Seven-hundred and nine patients 60 years or older with acute displaced FNFs between 2009 and 2021.
    Intervention: Total hip arthroplasty using either DAA or posterior approach.
    Main outcome measurements: Rates of postoperative complications including dislocations, reoperations, and mortality at 90 days and 1 year postoperatively. Secondary outcome measures included ambulation capacity at discharge, ambulation distance with inpatient physical therapy, discharge disposition, and narcotic prescription quantities (morphine milligram equivalents).
    Results: Through a multivariable regression analysis, DAA was associated with significantly shorter operative time ( B = -6.89 minutes; 95% confidence interval [CI] -12.84 to -0.93; P = 0.024), lower likelihood of blood transfusion during the index hospital stay (adjusted odds ratios = 0.54; 95% CI 0.27 to 0.96; P = 0.045), and decreased average narcotic prescription amounts at 90 days (B = -230.45 morphine milligram equivalents; 95% CI -440.24 to -78.66; P = 0.035) postoperatively. There were no significant differences in medical complications, dislocations, reoperations, and mortality at 90 days and 1 year postoperatively.
    Conclusion: When comparing the DAA versus posterior approach for total hip arthroplasty performed for displaced FNF, DAA was associated with shorter operative time, lower likelihood of blood transfusion, and lower 90-day postoperative narcotic prescription amounts.
    Level of evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
    Language English
    Publishing date 2023-06-22
    Publishing country United States
    Document type Journal Article
    ZDB-ID 639099-7
    ISSN 1531-2291 ; 0890-5339
    ISSN (online) 1531-2291
    ISSN 0890-5339
    DOI 10.1097/BOT.0000000000002650
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  10. Article ; Online: Conditional survival after surgery for metastatic tumors of the spine: does prognosis change over time?

    Zaborovskii, Nikita / Schlauch, Adam / Shapton, John / Denisov, Anton / Ptashnikov, Dmitrii / Mikaylov, Dmitrii / Masevnin, Sergei / Smekalenkov, Oleg / Murakhovsky, Vladislav / Kondrashov, Dimitriy

    European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society

    2023  Volume 32, Issue 3, Page(s) 1010–1020

    Abstract: Purpose: Conditional survival (CS) provides a dynamic prediction of patient survival by incorporating the time an individual has already survived given their disease specific characteristics. The objective of the current study was to estimate CS among ... ...

    Abstract Purpose: Conditional survival (CS) provides a dynamic prediction of patient survival by incorporating the time an individual has already survived given their disease specific characteristics. The objective of the current study was to estimate CS among patients after surgery for spinal cord compression or spinal instability, as well as stratify CS according to relevant patient- and disease-related characteristics.
    Methods: The clinical outcomes of 361 patients undergoing surgical management of metastatic spinal tumors were retrospectively analyzed. Stratification of this cohort according to disease and surgery-specific characteristics allowed for univariate and multivariate statistical analyses of our study population. Observed overall and conditional survival estimates were calculated by the Kaplan-Meier method.
    Results: 12-month conditional survival in patients undergoing surgical management of metastatic spine tumors increased from 57% at baseline to 70% at 24 months following spine surgery. Overall survival (OS) was influenced by CCI grade, Katagiri tumor type, presence of lung metastasis, type of spine surgery, presence of postoperative systemic therapy and ambulatory status at follow-up. Analyses of OS and CS by prognostic strata were similar with exception of stratification by surgery type. Differences in survival between strata tend to converge over time. Unfavorable factors for OS appear to be less relevant after a period of 24 months following spine surgery.
    Conclusion: Patients after surgery for metastatic tumors of the spine can expect a positive trend in conditional survival as survivorship increases. Even patients with a more severe disease can be encouraged with gains in conditional survival over time.
    Level of evidence: Level IV (retrospective cohort study).
    MeSH term(s) Humans ; Retrospective Studies ; Prognosis ; Spine/surgery ; Lung Neoplasms ; Spinal Cord Compression/etiology ; Spinal Cord Compression/surgery
    Language English
    Publishing date 2023-01-28
    Publishing country Germany
    Document type Journal Article
    ZDB-ID 1115375-1
    ISSN 1432-0932 ; 0940-6719
    ISSN (online) 1432-0932
    ISSN 0940-6719
    DOI 10.1007/s00586-023-07548-0
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