Browsing by Author "Payne, Joshua"
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Item Mechanism of Supination External Rotation Short Oblique Ankle Fractures Revisited: A Cadaveric Study(2016-03-23) Wood, Addison; Fisher, Cara; Nana, Arvind; Payne, Joshua; Le, DavidPURPOSE: The Lauge-Hansen classification system for ankle fractures has been the most commonly used system because it explained mechanism of injury of several common fracture patterns. However, there are limitations to the original Lauge-Hansen experiments and we have chosen to focus our central objective of this study on the biomechanical mechanisms behind stage 1 & 2 supination-external rotation (SER) ankle fractures in a cadaveric model. METHODS: 5 Fresh frozen cadaveric specimens were mounted into a custom made ankle rig with the tibia held rigid using half pins while allowing free movement of the fibula. The foot was secured to a wheel with a torque sensor attached to record examiner external rotational stress application. An electromagnetic tracking system was used to track the motion of the specimen with 6 degrees of freedom at each segment. A control arm was used to hold the foot in dorsiflexion while all other rotations were held in neutral. An ultrasound probe was used to monitor tibiofibular space as the examiner applied a controlled 100N maximal external rotational torque. Specimens were first tested with all ligaments intact prior to incremental resection of the anterior inferior tibiofibular ligament (AITFL) with repeat stress examination after each change. RESULTS: All specimens withstood the normal state testing of up to 100N of external rotational force without any injury. However, 4 out of 5 specimens received short oblique fracture patterns to the distal fibula after partial (75%) or full AITFL resection. Comparison of pre and post radiographs, visual observation via dissection, and live ultrasound video confirmed these results. 3D kinematics were recorded and analyzed as well to determine bone movement and fracture timing and compared to ultrasound video of the tibiofibular space. CONCLUSION: Prior studies have used unmeasured forces, non-physiological ligament strain rates, and poor alignment techniques. We sought to exclude the ligament strain rate and other design issues from our study by performing incremental resection of the AITFL as a synthetic mechanism for stage 1 SER ankle injuries and focusing on the reproducibility of the stage 2 fibula fracture in an SER injury. Our study demonstrated: 1. A 100N external rotational force did not result in an AITFL injury 2. Partial sectioning of the AITFL alongside a 100N external rotational force led to a reproducible oblique distal fibula fracture in a cadaveric ankle model.Item Reduction Technique in a Rockwood Grade VI Acromioclavicular Separation(2017-03-14) Payne, Joshua; Webb, Brian; Schaefer, TravisHypothesis and Purpose: Rockwood Grade VI acromioclavicular separations (AC) are extremely rare injuries and pose a challenge because the surgeon must reduce the clavicle to its appropriate anatomical position from the subcoracoid or subacromial space. After searching the literature, there is scant information of the appropriate reduction technique. This report aims to describe the reduction technique as well as the appropriate ligament reconstruction technique. Materials and Methods: A 35 year old female was involved in a rollover motor vehicle crash with ejection. The patient presented to the ED with multiple facial lacerations, closed nasal fracture, a closed displaced left scapula fracture, a closed right ulna fracture, and a Rockwood Grade VI AC separation. She presented with severe left shoulder pain as well as numbness over the medial aspect of her forearm. We present our case of distal clavicle excision, reduction, and reconstruction of the coracoclavicular ligaments. Results: The reduction was performed by placing a lobster claw clamp around the clavicular shaft to control the clavicle. A cobb elevator was used in a lever-like fashion to free the clavicle from the inferior coracoid. Soft tissue adhesion from the pectoralis minor and the anterior deltoid insertion were free with bovie electrocautery. A curette was used to sweep the pectoralis minor and the conjoined tendon off the clavicle as well as to cup the posterior inferior edge of the clavicle. Anterior and superior force was exerted on the clavicle until the clavicle was reduced into anatomic position. The distal clavicle was excised and the coracoclavicular ligament was reconstructed with a semitendinosis allograft. The patient's pain was improved post-operatively compared to pre-operatively and her pre-operative numbness was immediately resolved post-operatively. Conclusions: Rockwood grade VI AC separation is a rare injury without a clear reduction technique. We present a reduction and fixation technique that was successful in improving our patients pain and her pre-operative numbness.Item Treatment of Concurrent Ipsilateral Femoral Neck and Shaft Fractures(2017-03-14) Schaefer, Travis; Ming, Bryan; Caton, Tyler; Payne, JoshuaHypothesis: Ipsilateral femoral neck and shaft fractures occur in 6-9% of femur fractures (1), however; there is no current consensus for treatment in the Orthopaedic literature. The treatment of ipsilateral femoral neck and shaft fractures pose a technically difficult problem with nearly 60 different treatment methods (2), but no agreement exists regarding the ideal treatment method. Material and Methods: We propose our treatment algorithm for treating these fractures, as well as our cohort of six patients treated with the aforementioned algorithm. For stable intertrochanteric fractures and femoral neck fractures, we recommend a dynamic sliding hip screw and a retrograde femoral nail. For unstable intertrochanteric fractures, we recommend treatment with a single implant (cephalomedullary nail). We treated six patients with combination hip and femoral shaft fractures at a level 1 trauma hospital from April 2016 through February of 2017. Patients ranged from 19-42 years of age. Results: All fractures remain anatomically reduced, and have either gone on to union or are progressing to union in the expected time frame. One complication, a stiff knee below the fractures, has been reported for which the patient is still undergoing treatment. Conclusions: Our research is ongoing, but to this point, we conclude that this is a reliable method for treating these very challenging fractures.