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Mount Carmel, OH, United States

Boyles A.D.,Doctors Hospital | Taylor B.C.,Grant Medical Center | Ferrel J.R.,Mount Carmel Medical Center
Injury Extra | Year: 2013

Multiple rib fractures are common in blunt thoracic trauma, and while indicative of the severity of injury, are rarely implicated as the solitary cause of death. Significant chest wall injury and the presence of flail chest is associated with substantial dysfunction and morbidity, including the need for respiratory support, pneumonia or septicemia, and prolonged hospitalization and pain medication requirements [12]. Posterior rib fractures are commonly associated with flail segments, but are often minimally displaced due to surrounding soft tissue attachments and support. However, if associated with intrathoracic displacement, the risks of significant morbidity and even mortality increase exponentially, and surgical intervention is indicated to minimize this risk. © 2013 Elsevier Ltd. Source


Fowler T.T.,Mount Carmel Medical Center | Taylor B.C.,Grant Medical Center | Bellino M.J.,Stanford University | Althausen P.L.,Reno Orthopaedic Clinic
Journal of the American Academy of Orthopaedic Surgeons | Year: 2014

Despite significant advances in critical care management, flail chest remains a clinically significant finding, with a mortality rate of up to 33%. Nonsurgical management is associated with prolonged ventilator support, pneumonia, respiratory difficulties, and lengthy stays in the intensive care unit, as well as chronic pain from nonunion and malunion of the bony thorax. Treatment with aggressive pulmonary toilet, ventilator support, and different modalities of pain control remains the benchmark of care. However, several recent randomized controlled studies of surgical intervention of flail chest have demonstrated an improvement in the number of ventilator days, intensive care unit and hospital stays, incidence of pneumonia, and respiratory function and hospital costs, as well as faster return to work. The success of these surgical constructs compared with those of historical attempts at open fixation is largely the result of modern plating technology and improvement in surgical approaches. Clinical evidence continues to grow regarding proper indications and techniques for surgical stabilization of flail chest. © 2014 the American Academy of Orthopaedic Surgeons. Source


Fowler T.T.,Mount Carmel Medical Center
American journal of orthopedics (Belle Mead, N.J.) | Year: 2013

Dislocation of the scapula is a rare disorder. The nomenclature in the literature can be confusing as a result of nonspecific terms such as locked scapula and dislocated scapula when referring to both intra- and extra-thoracic dislocations. After a thorough review of the literature we further define and classify scapular dislocations to better understand prognosis and patient education. We report a case of a low-energy intrathoracic dislocation of the scapula due to anomalous anatomy. Similar to another reported case in the literature, we have been able to document recurrence of intrathoracic scapular dislocation only in association with persistent chest wall defects following rib resection. Source


Formaini N.,Grant Medical Center | Taylor B.C.,Grant Medical Center | Backes J.,Mount Carmel Medical Center | Bramwell T.J.,Grant Medical Center
Orthopedics | Year: 2013

Plate fixation of displaced clavicle fractures has proven to be reliable and reproducible, leading to high union rates and a low rate of associated complications. However, the decision of whether to place the plate superiorly or anteroinferiorly on the clavicle has remained controversial. The authors performed a retrospective review on a consecutive series of patients who underwent plate fixation for a displaced midshaft clavicle fracture at a Level I urban trauma center. A review of surgical records identified 138 patients with a displaced midshaft clavicle fracture requiring operative stabilization. A total of 105 patients who met the inclusion criteria were included in the analysis. Both superior and anteroinferior techniques resulted in a similar time to radiographic union (12.6±4.8 vs 11.3±5.2 weeks, respectively) and identical union rates (95%). At final follow-up, patient-reported implant prominence was nearly double in patients with a retained superior plate (54% vs 29%, respectively; P=.04). No significant difference existed in mean visual analog scale score at a mean of 2.77 years postoperatively, although a significant difference existed in the Oxford Shoulder Score questionnaire, with a mean score of 41.4 in the superior group and 44.4 in the anteroinferior group (P=.008). Implant removal occurred more frequently after superior plating but was not significant. Both superior and anteroinferior clavicle plating are safe treatment methods for displaced clavicle fractures. Superior plating leads to an increased rate of patient-reported implant prominence and may prompt more requests for implant removal. Source


Taylor B.C.,Grant Medical Center | French B.G.,Grant Medical Center | Ty Fowler T.,Mount Carmel Medical Center | Russell J.,Grant Medical Center | Poka A.,Grant Medical Center
Journal of the American Academy of Orthopaedic Surgeons | Year: 2012

Multiple surgeries are often required to manage segmental bone loss because of the complex mechanics and biology involved in reconstruction. These procedures can lead to prolonged recovery times, poor patient outcomes, and even delayed amputation. A twostage technique uses induced biologic membranes with delayed placement of bone graft to manage this clinical challenge. In the first stage, a polymethyl methacrylate spacer is placed in the defect to produce a bioactive membrane, which appears to mature biochemically and physically 4 to 8 weeks after spacer placement. In the second, cancellous autograft is placed within this membrane and, via elution of several growth factors, the membrane appears to prevent graft resorption and promote revascularization and consolidation of new bone. Excellent clinical results have been reported, with successful reconstruction of segmental bone defects >20 cm. Source

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