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Thomas Thornhill, MD
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Third Session
Moderator: Thomas Thornhill, MD
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| Robert V. O'Toole, MD |
Mitchel Harris, MD |
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Use of the LISS for Periarticular Fractures of the Knee
Robert V. O’Toole, MD
Advisor: Mark Vrahas, MD
Discussor: Mitchel Harris, MD
A prospectively enrolled cohort of 152 patients whose femur and
tibia fractures were treated with the Less Invasive Stabilization System was
evaluated. These results were pooled with existing U.S. literature and compared
to historical data for other methods of treatment. They found a lower rate of
overall complications (15.1% for LISS v. 24.8% for others). Tibia fractures had a
lower infection rate (7% LISS v. 13.7%).
Dr. Harris noted that this series represents the largest reported
series with the LISS. He noted that the population was skewed toward older
patients, which reflects the trauma population as a whole at MGH and BWH. He
noted that a 70% follow up rate was somewhat poor but might be improved with a
LISS Registry. He wondered why LISS failed to show a lower infection rate in femur
fractures. Dr. Nunley suggested that the study might be stronger if it compared
LISS results to Partners trauma's own non-LISS results rather than to pooled
results.
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| Joseph J. Czarnecki, MD |
Art Boland, MD |
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Functional Outcome of Juvenile Osteochondritis Dessicans of the Knee Treated with Internal Fixation.
Joseph J. Czarnecki, MD
Advisor: Mininder Kocher, MD
Discussor: Art Boland, MD
This study compared rate of union and functional outcome in 24
patients (average age 14.7 yrs) treated with different methods of internal fixation
for OCD lesions. The total union rate was 84.6%. Outcomes were evaluated with
Lysholm and IKDC scores, which noted 73.1% good/excellent results. Results were
worse with use of absorbable pins rather than a Herbert screw to achieve
fixation.
Dr. Boland asked how the surgeons had decided which lesions to
fix with which technique. He also expressed surprise that the anatomic location
of the lesion had less influence on the outcome than might be expected. Dr.
Vrahas and Dr. Kocher also questioned how outcome might be measured in lesions
treated conservatively.
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| L. Pearce McCarty, MD |
Mark Vrahas, MD |
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Initial Experience with the Long AO/ASIF Trochanteric Fixation Nail in Unstable Intertrochanteric and Subtrochanteric Fractures
L. Pearce McCarty, MD
Advisor: Malcolm Smith, MD
Discussor: Mark Vrahas, MD
Fifty unstable intertrochanteric or subtrochanteric femur fractures
were treated with the trochanteric femoral nail (TFN), and the results evaluated
clinically for 36 and radiographically for 38 at an average of 9 months. Thirty
seven of 38 were found to heal radiographically, with one delayed union. There
were no cutouts or rod failures.
Dr. Vrahas noted that this patient cohort was comprised of older,
"sicker" patients than usually studied, with difficult fractures and osteoporosis.
He noted that the follow up rate was impressive, but suggested it should have
contrasted findings with similar patients and injuries treated in other ways. He
also wondered whether limbs treated with the TFN shortened less. He pointed out
that the cost of the TFN was approximately twice the cost of some alternatives,
but that it might be justified for the 28% of fractures that are unstable (as
defined in this study). Dr. Nunley praised this paper for teaching him something
he would put into practice immediately—recognizing and treating differently the
reverse-oblique intertrochanteric fracture.
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