Stevenson A.N.,Doctors Hospital |
Myer III C.M.,Medical Center |
Shuler M.D.,Dinsmore and Shohl Attorneys |
Singer P.S.,Dinsmore and Shohl Attorneys
Laryngoscope | Year: 2012
Objectives/Hypothesis: To review malpractice cases involving complications following tonsillectomy. Study Design: Retrospective analysis at a tertiary medical center of jury verdict reports within the LexisNexis (Dayton, OH) database submitted after tonsillectomy malpractice cases. Methods: The LexisNexis MEGA Jury Verdicts and Settlements database was reviewed from 1984 through 2010 for complications resulting from tonsillectomy. Data including year of case, surgical complication, injury, case result, and judgment awarded were collected and analyzed. Results: One hundred seventy-eight reports met inclusion criteria and were reviewed. Postoperative bleeding was the most common complication (33.7%), followed by anoxic events (16.9%), and impaired function (15.7%). Patient death occurred in 40.4% of reports and was most frequently associated with postoperative bleeding (54.2%), followed by anoxic events (18.1%), and postoperative medication issues (16.7%). Monetary awards were available in 24.7% of reports. Anoxic event was noted to have the highest median award at $3,051,296, followed by postoperative medication at $950,000. Conclusions: Tonsillectomy carries a large amount of risk from a malpractice standpoint. Postoperative bleeding is the complication most commonly associated with malpractice claims, but may not carry the greatest overall risk from a patient care or monetary standpoint. Hypoxic and anoxic events, although less common, appear to carry more morbidity for the patient and are associated with greater settlements and judgments in malpractice claims. Tonsillectomy continues to carry a significant mortality risk, albeit infrequent, and a high level of vigilance should be employed to help reduce these risks. © 2011 The American Laryngological, Rhinological, and Otological Society, Inc.
Selinsky C.R.,Doctors Hospital |
Kuhn J.K.,University of Cincinnati
JAMA Otolaryngology - Head and Neck Surgery | Year: 2014
IMPORTANCE: An isolated congenital anomaly of the ossicular chain is a rare finding in an ear that, otherwise, appears clinically normal. The most common congenital ossicular anomaly is fixation of the stapes footplate. The least common congenital ossicular anomaly is isolated incus fixation, with only a few reported in the literature. OBSERVATIONS: We describe a woman in her 50s with a long history of left-sided hearing loss and unremarkable neurotologic findings aside from a tuning-fork examination result suggestive of left-sided conductive hearing loss. Intraoperatively, she was found to have isolated fixation of the incus to the fallopian canal. The incus-fallopian canal fixation was separated, and an autologous bone graft was placed between the lenticular process and stapes capitulum to create elevation and prevent refixation. One month postoperatively, an audiogram revealed a nearly complete air-bone gap closure. CONCLUSIONS AND RELEVANCE: Patients who present with conductive hearing loss, normal physical examination findings, and an apparent normal radiograph are generally assumed to have otosclerosis. This case illustrates an unanticipated unique anomaly that was surgically corrected by releasing the bony fixation of the incus to the fallopian canal and placing an autologous bone graft at the incostapedial joint. Copyright 2014 American Medical Association. All rights reserved.
Hyer C.F.,Orthopedic Foot and Ankle Center |
Cheney N.,Doctors Hospital
Journal of Foot and Ankle Surgery | Year: 2013
During the past 15 years, tibiotalocalcaneal nail arthrodesis has become an established procedure for the treatment of specific disorders of the hindfoot and ankle. However, controversy exists regarding the proper starting point for obtaining and maintaining the correct hindfoot position to allow successful fusion. One of the challenges with this procedure is aligning the tibial canal with the central talus and calcaneus for placement of the intramedullary nail. We performed a cadaver study to evaluate the radiographic and anatomic position of the tibial canal and the central talus as it relates to placement of a retrograde tibiotalocalcaneal nail. In our subjects, guide wires directed in an antegrade fashion down the tibial canal were more likely to enter lateral to the midline of the talus and miss the calcaneal body medially. These data have revealed a mismatch among the central axis of the tibia, talus, and calcaneus. Surgeons must pay careful attention to wire placement across these 3 bone segments during retrograde tibiotalocalcaneal nailing. © 2013 American College of Foot and Ankle Surgeons.
Franz R.W.,Vascular and Vein Center |
Willette P.A.,Mid Ohio Emergency Services LLC |
Wood M.J.,Doctors Hospital |
Wright M.L.,Orthopaedic Research and Reporting Ltd. |
Hartman J.F.,Orthopaedic Research and Reporting Ltd.
Journal of the American College of Surgeons | Year: 2012
Background: Despite progress in diagnosing and managing blunt cerebrovascular injury (BCVI), controversy remains regarding the appropriate population to screen. A systematic review of published literature was conducted to summarize the overall incidence of BCVI and the various screening criteria used to detect BCVI. A meta-analysis was performed to evaluate which screening criteria may be associated with BCVI. Goals were to confirm inclusion of certain criteria in current screening protocols and possibly eliminate criteria not associated with BCVI. Study Design: Studies published between January 1995 and April 2011 using digital subtraction angiography or CT angiography as a diagnostic modality and reporting overall BCVI incidence or prevalence of BCVI for specific screening criteria were examined. Screening criteria were analyzed using a random effects model to determine if an association with BCVI was present. Results: The incidence range of BCVI was between 0.18% and 2.70% among approximately 122,176 blunt trauma admissions. The meta-analysis encompassed 418 BCVI and 22,568 non-BCVI patients. Of the 9 screening criteria analyzed, cervical spine (odds ratio [OR] 5.45; 95% CI 2.24 to 13.27; p < 0.0001) and thoracic (OR 1.98; 95% CI 1.35 to 2.92; p = 0.001) injuries demonstrated a significant association with BCVI. Conclusions: Patients with cervical spine and thoracic injuries had significantly greater likelihoods of BCVI compared with patients without these injuries. All patients with either injury should be screened for BCVI. Multivariate logistic regression analysis is needed to elucidate the possible impact of the combined presence of screening criteria, but it was not possible in our study due to limitations in data presentation. Standardized reporting of BCVI data is not established and is recommended to permit future collaboration. © 2012 American College of Surgeons.
Brannon J.K.,Doctors Hospital
Orthopedics | Year: 2011
Osteonecrosis of the shoulder is a devastating disease, particularly in the young patient. Published data is replete with vascularized and nonvascularized bone grafting procedures for joint preservation of the hip; however, these same techniques have not been applied to the shoulder. When treating osteonecrosis of the shoulder, endoscopically-guided thorough debridement of the necrotic bone may promote good outcomes by ensuring that the bone graft, vascularized or nonvascularized, is stabilized against a viable host bed. In addition, this new technique facilitates access to the subchondral plate from the osseous side, thereby fully debriding the intraosseous fracture and allowing elevation of the articular surface if needed. When collapse is present, stage 3 disease secondary articular-sided changes may be present and should be addressed during concomitant arthroscopy. This article presents a case of endoscopically-guided thorough debridement of the humeral head combined with nonvascularized bone grafting of the residual cavity and stabilization, and concomitant arthroscopy for a 30-year-old woman with steroid-associated osteonecrosis.