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Orlando, FL, United States

Adigweme O.O.,Orlando Regional Medical Center
The journal of knee surgery | Year: 2013

Periprosthetic patellar fractures represent a spectrum of injuries to a patient with a total knee arthroplasty. They range in severity from an inconsequential injury, which does not compromise function, to a severely debilitating injury that may require advanced reconstructive measures. This article will outline the epidemiology and risk factors associated with periprosthetic patellar fractures. Treatment options as they relate to injury mechanism, fracture severity, patellar component stability, and remaining bone stock will also be discussed. Finally, a review of the current literature regarding the results of treatment will be presented. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA. Source

Crum-Cianflone N.F.,Naval Medical Center San Diego | Wallace M.R.,Orlando Regional Medical Center
AIDS Patient Care and STDs | Year: 2014

Vaccines are critical components for protecting HIV-infected adults from an increasing number of preventable diseases. However, missed opportunities for vaccination among HIV-infected persons persist, likely due to concerns regarding the safety and efficacy of vaccines, as well as the changing nature of vaccine guidelines. In addition, the optimal timing of vaccination among HIV-infected adults in regards to HIV stage and receipt of antiretroviral therapy remain important questions. This article provides a review of the current recommendations regarding vaccines among HIV-infected adults and a comprehensive summary of the evidence-based literature of the benefits and risks of vaccines among this vulnerable population. © Copyright 2014, Mary Ann Liebert, Inc. 2014. Source

Alexander G.E.,University of South Florida | Bernasek T.L.,Florida Orthopaedic Institute | Crank R.L.,Foundation for Orthopaedic Research and Education | Haidukewych G.J.,Orlando Regional Medical Center
Journal of Arthroplasty | Year: 2013

Revision arthroplasty of large tibial defects remains a challenge. Thirty revision knee arthroplasties using a porous titanium tibial sleeve for Anderson Orthopaedic Research Institute (AORI) Type 2B and Type 3 defects with minimum 2. year follow up were retrospectively reviewed. The average Knee Society Score increased from 55 pre-operatively to 92 post-operatively. Six patients had a repeat operation though none were sleeve related. All radiographs at final follow-up showed well fixed components with osseous in-growth. Seven patients had end-of-stem pain, four of which resolved. Our short-term results show that porous titanium sleeves are a promising option when managing large areas of metaphyseal bone loss by filling defects and providing stable construct with biologic fixation. © 2013 Elsevier Inc.. Source

OBJECTIVE: To evaluate the effectiveness of a new basic science curriculum at a university-affiliated general surgery residency program. DESIGN: A retrospective evaluation of general surgery residents' American Board of Surgery (ABS) In-Training Examination (ABSITE) scores before and after the implementation of a new basic science curriculum. SETTING: Not-for-profit tertiary referral center with a university-affiliated Accreditation Council for Graduate Medical Education (ACGME) accredited community general surgery residency program. PARTICIPANTS: Postgraduate year (PGY) 1 through 5 general surgical residents. RESULTS: The total questions answered correctly (percent correct) in the main 3 categories improved after implementation of the new curriculum for PGY 1 (total test: 70 +/- 7 vs 60 +/- 9, p < 0.05; clinical science: 71 +/- 10 vs 59 +/- 9, p < 0.05; and basic science: 69 +/- 7 vs 60 +/- 10, p = 0.0003) and for PGY 2 residents (total test: 74 +/- 5 vs 66 +/- 7, p < 0.05; clinical science: 74 +/- 7 vs 66 +/- 8, p = 0.003; and basic science: 74 +/- 5 vs 66 +/- 8, p < 0.05). With the exception of the percentage of clinical questions answered correctly for the PGY 4 level, there was no statistically significant worsening of scores in any other subcategories for any other PGY levels (3 through 5) after implementation of the new program. Before the institution of the new curriculum, 24% (26/110) of residents scored below the 35th percentile, and after the institution of the new curriculum, this number decreased to 12% (12/98), p = 0.006. The first-time passage rate on the ABS Qualifying Examination was unchanged in the period before and after the implementation of the new curriculum (89% vs 86%; p = 0.08). When comparing the bimonthly quizzes with the ABSITE, the correlation coefficient was 0.34. CONCLUSION: After the implementation of a new basic science curriculum organized and directed by the faculty, there were statistically significant improvements of PGY 1 and 2 residents' ABSITE scores. Copyright (c) 2010 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved. Source

Bazylewicz D.B.,NYU Langone Medical Center | Egol K.A.,NYU Langone Medical Center | Koval K.J.,Orlando Regional Medical Center
Journal of Orthopaedic Trauma | Year: 2013

OBJECTIVES:: A unique complication of using full-length intramedullary nails for pertrochanteric and subtrochanteric femur fractures is nail penetration of the anterior cortex at the distal end of the femur because of a mismatch of the anatomic femoral bow with that of currently available cephalomedullary nails (CMNs). This study was performed to determine the rate of distal femoral cortical penetration after stabilization of the proximal femur in a consecutive series of patients using a long CMN with a curvature of 180 cm and to examine the final location of the nails within the femoral canal. DESIGN:: Retrospective chart review. SETTING:: Level 1 trauma center with tertiary care. PATIENTS/PARTICIPANTS:: Between June 2005 and September 2008, 271 consecutive proximal femoral fractures or impending fractures were stabilized using a specially designed CMN [pertrochanteric nail (PTN) system; Biomet, Warsaw, IN]. Fifty-seven fractures were excluded because of inadequate lateral radiographs, leaving 214 nails in 212 patients available for analysis. INTERVENTION:: The proximal femur fractures or impending fractures were stabilized with a full-length CMN with a shaft diameter of 11 mm and a radius of curvature of 180 cm. MAIN OUTCOME MEASUREMENTS:: Nail position was determined from the lateral radiograph, which included the minimal distance from the nail to the anterior cortex of the distal femur and the relative position of the nail within the medullary canal, at a level within 2 cm proximal to the superior pole of the patella. Based on the nail position within the distal femoral canal, the following were calculated: (1) the overall rate of distal femoral anterior cortical penetration, (2) the distribution of nail distances to the anterior cortex, and (3) the proportion of nails lying in each quarter of the space available for the nail. RESULTS:: Four surgeries (1.9%) were performed for pathologic fracture and 22 (10.3%) for impending pathologic fracture. The remaining 188 CMNs were used to stabilize OTA Type 31A1 fractures (52 nails, 24.3%), Type 31A2 fractures (62 nails, 29%), Type 31A3 fractures (15 nails, 6.5%), and Type 32 fractures (59 nails, 27.6%). Of the 214 cases available for radiographic analysis, there was 1 case (0.47%) of distal femoral anterior cortical penetration. Of the remaining 213 CMNs, 40% of nails ended up far anterior, 48% anterior, 10% posterior, and 2% far posterior. Sixteen percent (1/6) were within 3 mm of the anterior cortex and half were within 7 mm. The average distance from nail to the anterior cortex was 8.5 mm. CONCLUSION:: Use of a CMN with a radius of curvature of 180 cm to stabilize the proximal femur resulted in a very low rate of distal femoral anterior cortical penetration. However, most of the intramedullary nails ended up in the anterior half of the space available for the nail with 16% within 3 mm of the anterior cortex. These results highlight the importance of being aware of the complication of anterior cortical impingement and perforation during CMN insertion. LEVEL OF EVIDENCE:: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence. Copyright © 2012 by Lippincott Williams & Wilkins. Source

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