Publications by authors named "Arvind von Keudell"
The myotendinous junction (MTJ) is a weak link in the musculoskeletal system. Here, we isolated the tips of single myofibres from healthy human hamstring muscles for confocal microscopy (n=6) and RNAscope in situ hybridisation (n=6) to gain insight into the profiles of cells and myonuclei in this region, in a fibre type manner. A marked presence of mononuclear cells was observed coating the myofibre tips (confirmed by serial block face scanning electron microscopy and cryosection immunofluorescence), with higher numbers for type I (median 29; range 16-63) than type II (16; 9-23) myofibres (p<0.
View Article and Find Full Text PDFBackground: Peripheral intravenous (PIV) infiltration and extravasation are common complications of intravenous fluid administration. Here, we aim to investigate risk factors associated with major adverse events following PIV infiltration, which may help risk stratify those who require early surgical consultation.
Methods: Retrospectively, patients were identified who had a documented PIV infiltration or extravasation event at 3 academic hospitals between 2015 and 2022.
Management of aseptic nonunions of bicondylar tibial plateau fractures.
Eur J Orthop Surg Traumatol
November 2024
Article Synopsis
Article Synopsis
- This literature review looks at how orthopaedic trauma affects patients' mental health, highlighting the importance of addressing both physical and psychological challenges.
- It emphasizes the need for better resources and education for healthcare providers to improve patient outcomes and rehabilitation.
- The findings point out gaps in current research and advocate for stronger collaboration among healthcare professionals, mental health experts, and support systems to enhance care for those with severe orthopaedic injuries.
Article Synopsis
- The study analyzed 572 patients diagnosed with non-traumatic extremity compartment syndrome (NTECS) from two trauma centers over 13 years, focusing on causes, patient demographics, diagnostic methods, treatment, and in-hospital mortality rates.
- Common causes of NTECS included hypercoagulable states, substance use, and shock, with shock-associated NTECS having the highest in-hospital mortality rate of 58%, and an overall average mortality of 20% across all cases.
- The findings indicate that approximately 13% of patients required surgical interventions such as skin grafts or amputations, highlighting the need for heightened clinical suspicion and further research to improve outcomes in NTECS
Introduction: Elder abuse is a prevalent, though often overlooked and underreported, cause of musculoskeletal injury in the elderly population. The purpose of this review is to provide an updated overview of the prevalence of elder abuse, its association with musculoskeletal injuries, and the available resources to aid orthopaedic surgeons in early detection and intervention.
Significance: Improved training on this topic is needed throughout the medical education of orthopaedic surgeons to effectively recognize and address elder abuse.
Intimate partner violence is an overlooked, underestimated, and under reported cause of musculoskeletal injury. This literature review aims to provide an updated overview of the prevalence of IPV, along with the identification and screening tools available to orthopaedic surgeons for early detection and intervention. Additionally, the review discusses the importance of training in medical education for orthopaedic surgeons to effectively recognize and address IPV.
View Article and Find Full Text PDFObjectives: To investigate the association between the Comprehensive Geriatric Assessment-based Frailty Index and adverse outcomes in older adult patients undergoing hip fracture surgery.
Design: Retrospective cohort study.
Setting: Academic Level 1 Trauma Center.
Bicondylar tibial plateau fractures are technically demanding fractures that have a high complication rate. We sought to review the recent literature with the aim to summarize the development of new classification systems that may enhance the surgeon's understanding of the fracture pattern and injury. We highlight the best methods for infection control and touch on new innovative solutions using 3D printer models and augmented mixed reality to provide potentially personalized solutions for each specific fracture configuration.
View Article and Find Full Text PDFArticle Synopsis
- A study conducted at 25 hospitals compared the effectiveness of two antiseptic solutions (iodine povacrylex and chlorhexidine gluconate) in preventing surgical-site infections during extremity fracture surgeries.
- Results showed that iodine povacrylex led to a lower rate of infections in patients with closed fractures (2.4% vs. 3.3%) but did not show a significant difference for open fractures (6.5% vs. 7.3%).
- Ultimately, the study concluded that iodine povacrylex is a more effective skin antiseptic for closed extremity fractures, resulting in fewer infections compared to chlorhexidine, though both had similar outcomes for reoperations and adverse events.
Background: Bicondylar tibial plateau fractures are complex injuries that commonly require surgical repair. Long-term clinical outcome has been associated with discrepancies in leg alignment, instability and condylar width abnormalities. While intuitive, the degree of articular damage at time of injury has not been linked to outcomes in patients with bicondylar tibial plateau fractures.
View Article and Find Full Text PDFArticle Synopsis
- Shock waves are used to treat bone conditions, but studies show mixed results regarding their effectiveness for pain and healing, partly due to a lack of research on dosage impact.
- * The purpose of the study was to analyze how different doses of shockwave therapy correlate with clinical outcomes in various bone conditions using meta-regression of controlled trials.
- * After reviewing 3641 studies, eight were selected, showing that shockwave therapy post-surgery significantly reduced pain and improved function at different intervals, but there was no clear link between dosage and clinical improvement.
Outcomes of Reverse Total Shoulder Arthroplasty for Proximal Humerus Fracture Versus Rotator Cuff Arthropathy.
J Am Acad Orthop Surg Glob Res Rev
October 2023
Introduction: Reverse total shoulder arthroplasty (RSA) is used to treat a variety of shoulder-related pathologies. This study compared medium-term clinical outcomes of less than 10-year follow-up in patients treated with RSA for proximal humerus fracture (PHF) versus rotator cuff arthropathy (RCA).
Methods: This retrospective review was conducted at two tertiary care centers, in which self-reported clinical outcomes were assessed using four validated instruments, that is, American Shoulder and Elbow Society (ASES) score, Shoulder Pain and Disability Index (SPADI), visual analog scale (VAS), and shoulder subjective value (SSV).
Article Synopsis
- - The study focuses on non-operative management for low-impact pelvic fractures, analyzing data from nearly 124,000 adult patients between 2011 and 2018 to identify trends and demographic patterns.
- - The average patient was a 68.7-year-old female with a moderate level of health-related issues (CCI of 3.83), and most patients were treated at urban teaching hospitals, with a typical hospital stay of about 6.3 days.
- - The in-hospital mortality rate was 3.28%, with higher risks observed in male patients (5.1%) and those of Asian descent (3.8%), indicating specific demographic factors that could influence outcomes following non-operative treatment.
Article Synopsis
- - The study analyzes the cost-effectiveness of surgical vs. non-surgical treatment options for humeral shaft fractures using a decision tree model and various cost factors including surgical fees and lost wages.
- - Results showed that operative treatment had lower costs per meaningful improvement in DASH scores over 6-month and 1-year follow-ups, making it more cost-effective compared to nonoperative treatment, especially when wage loss was considered.
- - Nonoperative treatment could become more cost-effective only if its union rate significantly increased, suggesting that under typical conditions, surgery is the better financial choice for treating these fractures.
Article Synopsis
- - Natural language processing with large language models, a branch of AI, is increasingly applied in medicine and orthopaedic surgery to interpret text and generate relevant responses.
- - Although these models can produce high-quality scientific manuscripts, they can also create false or misleading information—known as "AI hallucinations"—which raises serious concerns about research integrity.
- - Current academic publishing practices are not equipped to detect the involvement of these AI models in research, highlighting the need for updated guidelines and enhanced editorial screening processes in orthopaedic literature.
Objectives: To determine the effect of anti-factor Xa assay dosing of low-molecular-weight heparin (LMWH) on rates of venous thromboembolism (VTE), deep vein thrombosis (DVT), pulmonary embolism (PE), bleeding, and mortality among orthopaedic trauma patients.
Data Sources: PubMed/MEDLINE, Embase, Ovid, Cochrane Central Register of Controlled Trials (CENTRAL), clinicaltrials.gov , and Scopus were systematically searched from inception of the database to 2021.
Article Synopsis
- - The study evaluates the quality of evidence in geriatric trauma research, focusing on how many studies include cognitively impaired patients and the methods used for diagnosing such impairments.
- - Out of 2711 publications reviewed, 723 articles were included, highlighting a prevalence of small, retrospective studies focused on mortality and complications rather than prospective research and quality of life outcomes.
- - A significant issue identified is the exclusion of cognitively impaired patients from studies, leading to selection bias and poor definition of cognitive impairment, emphasizing the need for better diagnostic methods and inclusive outcome measures in future research.
Article Synopsis
- The study investigates the effectiveness of reverse shoulder arthroplasty (RSA) for treating complex proximal humerus fractures in patients under 70 compared to those over 70, challenging the traditional age-based treatment norms.
- Researchers analyzed outcomes from 115 patients who underwent RSA between 2004 and 2016, focusing on complications, reoperation rates, and functional scores.
- Findings revealed no significant differences in outcomes between the two age groups, suggesting that younger patients can expect similar success rates from RSA as older patients do over a minimum follow-up of three years.
Article Synopsis
- - The study aimed to assess whether the involvement of the posterior wall (PW) in associated both-column acetabular fractures (ABCAFs) affects clinical outcomes, specifically the rate of conversion to total hip arthroplasty (THA).
- - Conducted at two major trauma centers, the research compared 18 patients with PW involvement to 26 without, focusing on THA conversion rates, post-operative pain, and complications after at least 12 months of follow-up.
- - Results showed no significant differences in conversion to THA, complication rates, or post-operative pain between the two groups, concluding that PW involvement does not lead to worse clinical outcomes in ABCAFs.
Use of a Six-Item Modified Frailty Index to Predict 30-day Adverse Events, Readmission, and Mortality in Older Patients Undergoing Surgical Fixation of Lower Extremity, Pelvic, and Acetabular Fractures.
J Am Acad Orthop Surg Glob Res Rev
January 2023
Article Synopsis
- A retrospective study evaluated a new six-item modified frailty index (MF-6) to predict short-term outcomes in patients over 65 undergoing surgery for lower extremity fractures.
- The study analyzed data from 9,463 patients, finding that those with an MF-6 score of 3 or higher faced significantly increased risks of discharge to a non-home destination, mortality, major complications, and readmission.
- The MF-6 outperformed an existing five-item frailty index (MF-5) in predicting these outcomes, suggesting its potential for improving patient risk stratification as healthcare moves toward value-based care.
Purpose: Complete articular tibial plateau fractures are typically high-energy injuries associated with significant soft tissue trauma. The primary aim of this study was to evaluate the incidence of wound complications and need for soft tissue coverage after open, complete articular tibial plateau fractures. The secondary aim was to study the effect of timing of fixation and timing of flap coverage on deep infection rates in these injuries.
View Article and Find Full Text PDFArticle Synopsis
- This study investigates how rural living and socioeconomic status affect outcomes after orthopedic trauma surgery, focusing on fractures.
- Researchers analyzed data from over 235,000 patients to determine if rural patients faced higher risks of mortality and complications compared to urban patients.
- The findings revealed that rural status increased the risk of mortality for hip fracture patients but not for other fracture types, and low income was linked to higher mortality in urban polytrauma patients only.
Characteristics and outcomes of patients who undergo fasciotomies for upper arm compartment syndrome.
Eur J Orthop Surg Traumatol
August 2023
Purpose: Describe the demographic, injury-related, treatment-related, and outcome-related characteristics of patients who undergo fasciotomies for acute upper arm compartment syndrome (ACS).
Methods: From January 1, 2006, to June 30, 2015, 438 patients with a diagnosis code of upper extremity (including hand, forearm, arm, and shoulder) compartment syndrome at two tertiary care centers were identified. Of those patients, 423 were excluded for a diagnosis other than upper arm ACS or incomplete documentation.
Unlabelled: Advanced posttraumatic osteoarthritis (PTOA) of the knee is a cause of substantial disability, particularly in younger individuals, and the treatment of choice is total knee arthroplasty (TKA). Racial and socioeconomic disparities exist in the use of TKA, but, to our knowledge, there have been no studies examining these disparities among patients with PTOA.
Methods: We performed chi-square and logistic regression analyses on data from the Nationwide Inpatient Sample (NIS).