|
|
 |
|
 |
James R. Kasser, MD
|
|
First Session
Moderator: James R. Kasser, MD
|
 |
 |
| Bojan B. Zoric, MD |
Thomas J. Gill, MD |
|
Transphyseal ACL Reconstruction in Skeletally Immature Patients
Bojan B. Zoric, MD
Discussor: Thomas J. Gill, MD
Advisor: Mininder Kocher, MD, MPH
Management of ACL injuries in skeletally immature patients is controversial.
Conventional adult reconstruction techniques risk potential iatrogenic
growth disturbance due to physeal damage. Dr. Zoric summarized
his study of “adult” type ACL reconstructions performed in adolescent patients
in whom a reconstruction that violated the physis has formerly been
considered too risky. He reported transphyseal ACL reconstruction using
autogenous quadrupled hamstring tendon grafts in 59 skeletally immature
pubescent adolescents that demonstrated no cases of angular deformity or
lower extremity length discrepancy. He concluded that by carefully minimizing
trauma to the physis, the ACL can be reconstructed without producing a
measurable longitudinal growth arrest or angular deformity.
Dr. Kasser asked how it could be possible that a well-fixed graft could
cross a growing physis without stretching over time. Dr. Zoric and his advisor
Dr. Kocher responded that they plan to follow up on some of their preliminary
data that shows that these grafts seem to grow or at least remodel
to a longer stable length over time.
|
 |
 |
| Andrew Jawa, MD |
Timothy Bhattacharyya, MD |
|
Wound Complications in Pilon, Ankle and Talus Fractures: A prospective study Evaluating Transcutaneous Oxygen Measurements
Andrew Jawa, MD
Discussor: Timothy Bhattacharyya, MD
Advisor: Mark Vrahas, MD
High rates of postoperative wound complications accompany open
reduction and internal fixation of pilon, talus and ankle fractures despite
delayed surgery and surgeon experience. There are few objective criteria that
define the optimal timing of surgery. Transcutaneous oxygen measurements
have been used to predict wound healing for amputation levels in vascular
disease and for diabetic ulcers, but is has not been used in the evaluation
of trauma. Dr. Jawa presented an original, prospective study in ankle and
related fractures, attempting to correlate local oxygen tension measured at the
planned operative site and subsequent skin healing.
His study is on-going, but to date preoperative transcutaneous oxygen
measurements did not predict surgical incision complications around the
ankle. The only predictor of complication in his series was a higher energy fracture
classification. Dr. Kellam explained that he had once conducted an almost
identical study with a similar, negative result, and that he’d never been able to
get it published. Only half-joking, he suggested there should be a “Journal of
Negative Results” in orthopaedics to share that type of information.
|
|
|
|
