Nader Paksima, D.O., MPH

Intrinsic contractures of the hand
Paksima, Nader; Besh, Basil R
2012 Feb;28(1):81-86, Hand clinics
Contractures of the intrinsic muscles of the fingers disrupt the delicate and complex balance of intrinsic and extrinsic muscles, which allows the hand to be so versatile and functional. The loss of muscle function primarily affects the interphalangeal joints but also may affect etacarpophalangeal joints. The resulting clinical picture is often termed, intrinsic contracture or intrinsic-plus hand. Disruption of the balance between intrinsic and extrinsic muscles has many causes and may be secondary to changes within the intrinsic musculature or the tendon unit. This article reviews diagnosis, etiology, and treatment algorithms in the management of intrinsic contractures of the fingers
— id: 141990, year: 2012, vol: 28, page: 81, stat: Journal Article,

An aggressive group a streptococcal cellulitis of the hand and forearm requiring surgical debridement
Bharucha, Neil J; Alaia, Michael J; Paksima, Nader; Christoforou, Dimitrios; Gupta, Salil
2011 Jan;34(1):57-57, Orthopedics (Thorofare NJ)
Group A streptococcus is responsible for a diverse range of soft tissue infections. Manifestations range from minor oropharyngeal and cellulitic skin infections to more severe conditions such as necrotizing fasciitis and septic shock. Troubling increases in the incidence and the severity of streptococcal infections have been reported over the past 25 years. Cases of streptococcal necrotizing fasciitis have received significant attention in the literature, with prompt surgical debridement being the mainstay of treatment. However, cases of rapidly progressing upper extremity streptococcal cellulitis leading to shock and a subsequent surgical intervention have not been well described.This article presents a case of an 85-year-old woman with a rapidly progressing, erythematous, painful, swollen hand associated with fever, hypotension, and mental status change. Due to a high clinical suspicion for necrotizing fasciitis, the patient was rapidly resuscitated and underwent immediate surgical irrigation and debridement. All intraoperative fascial pathology specimens were negative for necrotizing fasciitis, leading to a final diagnosis of Group A streptococcal cellulitis. Although surgical intervention is not commonly considered in patients with cellulitis, our patient benefited from irrigation and debridement with soft tissue decompression. In cases of necrotizing fasciitis as well as rapidly progressive cellulitis, prompt diagnosis and aggressive treatment may help patients avoid the catastrophic consequences of rapidly progressive group A streptococcal infections
— id: 120797, year: 2011, vol: 34, page: 57, stat: Journal Article,

Comparison of radiographic stress views for scapholunate dynamic instability in a cadaver model
Lee, Steve K; Desai, Healthy; Silver, Benjamin; Dhaliwal, Gurpreet; Paksima, Nader
2011 Jul;36(7):1149-1157, Journal of hand surgery (American volume)
PURPOSE: Many different stress views for the diagnosis of scapholunate (SL) instability have been described in the literature. The purpose of this study is to compare these stress views and determine which view has the greatest utility for demonstrating SL gap radiographically. METHODS: We performed a literature search for articles describing SL radiographic stress views. We created SL instability in 9 cadaveric wrists by ligamentous sectioning and imaged each specimen using all radiographic views found in the literature. These included the 'clenched pencil' view, clenched fist views in varying positions, and traction views. Scapholunate gaps were measured using digital calipers. RESULTS: We found 8 different SL radiographic stress views specifically described in the literature. In order to further characterize the best stress views, we studied additional parameters, including varied ulnar deviation and degree of obliquity. The clenched pencil view resulted in the most consistent views with the widest SL gaps. With clenched fist views, SL gap trended to a peak at 30 degrees of ulnar deviation. CONCLUSIONS: The clenched pencil view was the best stress view to demonstrate dynamic SL instability. It also allows for a contralateral comparison on 1 radiograph. We recommend this view when evaluating for SL pathology. CLINICAL RELEVANCE: This assessment of relative diagnostic utility might assist clinicians in the creation and use of protocols for the diagnosis of dynamic SL instability
— id: 134725, year: 2011, vol: 36, page: 1149, stat: Journal Article,

Distal radial fractures in the elderly: operative compared with nonoperative treatment
Egol, K A; Walsh, M; Romo-Cardoso, S; Dorsky, Seth; Paksima, N
2010 Sep;92(9):1851-1857, Journal of bone & joint surgery (American volume)
BACKGROUND: There is much debate regarding the optimal treatment of displaced, unstable distal radial fractures in the elderly. The purpose of this retrospective review was to compare outcomes for elderly patients with a displaced distal radial fracture who were treated with or without surgical intervention. METHODS: This case-control study examined ninety patients over the age of sixty-five who were treated with or without surgery for a displaced distal radial fracture. All fractures were initially treated with closed reduction and splinting. Patients who failed an acceptable closed reduction were offered surgical intervention. Patients who did not undergo surgery were treated until healing with cast immobilization. Patients who underwent surgery were treated with either plate-and-screw fixation or external fixation. Baseline radiographs and functional scores were obtained prior to treatment. Follow-up was conducted at two, six, twelve, twenty-four, and fifty-two weeks. Clinical and radiographic follow-up was completed at each visit, while functional scores were obtained at the twelve, twenty-four, and fifty-two-week follow-up evaluations. Outcomes at fixed time points were compared between groups with standard statistical methods. RESULTS: Forty-six patients with a mean age of seventy-six years were treated nonoperatively, and forty-four patients with a mean age of seventy-three years were treated operatively. Other than age, there was no difference with respect to baseline demographics between the cohorts. At twenty-four weeks, patients who underwent surgery had better wrist extension (p = 0.04) than those who had not had surgery. At one year, this difference was not seen. No difference in functional status based on the Disabilities of the Arm, Shoulder and Hand scores and pain scores at any of the follow-up points was seen between the groups. Grip strength at one year was significantly better in the operative group. Radiographic outcome was superior for the patients in the operative group at each follow-up interval. There was no difference between the groups with regard to complications. CONCLUSIONS: Our findings suggest that minor limitations in the range of wrist motion and diminished grip strength, as seen with nonoperative care, do not seem to limit functional recovery at one year. LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions to Authors for a complete description of levels of evidence
— id: 111549, year: 2010, vol: 92, page: 1851, stat: Journal Article,

A biomechanical study of extensor tendon repair methods: introduction to the running-interlocking horizontal mattress extensor tendon repair technique
Lee, Steve K; Dubey, Ashok; Kim, Byung H; Zingman, Alissa; Landa, Josh; Paksima, Nader
2010 Jan;35(1):19-23, Journal of hand surgery (American volume)
PURPOSE: Extensor tendon injuries are common; however, relatively few studies have evaluated extensor tendon repair methods. The purpose of this study was to investigate the properties of the running-interlocking horizontal mattress repair method with regard to tendon shortening, stiffness, strength, and time needed to perform the repair, compared with the modified Bunnell method and the augmented Becker method. METHODS: Twenty-four extensor tendons from 8 fresh-frozen cadaveric hands were harvested from zone 6. The harvested tendons were randomly assigned into 1 of 3 repair groups: augmented Becker, modified Bunnell, and running-interlocking horizontal mattress repair methods. The running-interlocking horizontal mattress repair combines a running suture with an interlocking horizontal mattress suture. Each repaired tendon was measured for length before and after repair and tested for stiffness, ultimate load to failure, and time required to perform the repair. RESULTS: The running-interlocking horizontal mattress repair was significantly stiffer (8,506 N/m) than the augmented Becker (5,971 N/m) and the modified Bunnell (6,719 N/m) repairs. The running-interlocking horizontal mattress repair resulted in significantly less shortening (1.7 mm) than the augmented Becker (6.2 mm) and modified Bunnell (6.3 mm) repairs. The running-interlocking horizontal mattress repair took significantly less time to perform without a significant difference in the ultimate load to failure (running-interlocking horizontal mattress repair, 51 N; augmented Becker, 53 N; modified Bunnell, 48 N). CONCLUSIONS: The running-interlocking horizontal mattress repair is significantly stiffer and faster to perform than either the augmented Becker or the modified Bunnell repairs, and it results in less shortening than either of these methods. The running-interlocking horizontal mattress repair should be strong enough to withstand some early motion
— id: 106510, year: 2010, vol: 35, page: 19, stat: Journal Article,

Complications of distal radius fracture fixation
Patel, Vipul P; Paksima, Nader
2010 ;68(2):112-118, Bulletin of the NYU Hospital for Joint Diseases
— id: 111382, year: 2010, vol: 68, page: 112, stat: Journal Article,

Kienbock's Disease
Paksima, Nader; Canedo, Angelo
2009 Dec;34(10):1886-1889, Journal of hand surgery (American volume)
— id: 105675, year: 2009, vol: 34, page: 1886, stat: Journal Article,

The distal radioulnar joint
Tsai, Peter C; Paksima, Nader
2009 ;67(1):90-96, Bulletin of the NYU Hospital for Joint Diseases
The distal radioulnar joint (DRUJ) acts in concert with the proximal radioulnar joint to control forearm rotation. The DRUJ is stabilized by the triangular fibrocartilage complex (TFCC). This complex of fibrocartilage and ligaments support the joint through its arc of rotation, as well as provide a smooth surface for the ulnar side of the carpus. TFCC and DRUJ injuries are part of the common pattern of injuries we see with distal radius fractures. While much attention has been paid to the treatment of the distal radius fractures, many of the poor outcomes are due to untreated or unrecognized injuries to the DRUJ and its components
— id: 99291, year: 2009, vol: 67, page: 90, stat: Journal Article,

Management of flexor tendon injuries following surgical repair
Baskies, Michael A; Tuckman, David V; Paksima, Nader
2008 ;66(1):35-40, Bulletin of the NYU Hospital for Joint Diseases
— id: 96881, year: 2008, vol: 66, page: 35, stat: Journal Article,

Bridging external fixation and supplementary Kirschner-wire fixation versus volar locked plating for unstable fractures of the distal radius: a randomised, prospective trial
Egol, K; Walsh, M; Tejwani, N; McLaurin, T; Wynn, C; Paksima, N
2008 Sep;90(9):1214-1221, Journal of bone & joint surgery (British volume)
We performed a prospective, randomised trial to evaluate the outcome after surgery of displaced, unstable fractures of the distal radius. A total of 280 consecutive patients were enrolled in a prospective database and 88 identified who met the inclusion criteria for surgery. They were randomised to receive either bridging external fixation with supplementary Kirschner-wire fixation or volar-locked plating with screws. Both groups were similar in terms of age, gender, hand dominance, fracture pattern, socio-economic status and medical co-morbidities. Although the patients treated by volar plating had a statistically significant early improvement in the range of movement of the wrist, this advantage diminished with time and in absolute terms the difference in range of movement was clinically unimportant. Radiologically, there were no clinically significant differences in the reductions, although more patients with AO/OTA (Orthopaedic Trauma Association) type C fractures were allocated to the external fixation group. The function at one year was similar in the two groups. No clear advantage could be demonstrated with either treatment but fewer re-operations were required in the external fixation group
— id: 91339, year: 2008, vol: 90, page: 1214, stat: Journal Article,

Cold exposure injuries to the extremities
Golant, Alexander; Nord, Russell M; Paksima, Nader; Posner, Martin A
2008 Dec;16(12):704-715, Journal of the American Academy of Orthopaedic Surgeons
Cold exposure injuries comprise nonfreezing injuries that include chilblain (aka pernio) and trench, or immersion, foot, as well as freezing injuries that affect core body tissues resulting in hypothermia of peripheral tissues, causing frostnip or frostbite. Frostbite, the most serious peripheral injury, results in tissue necrosis from direct cellular damage and indirect damage secondary to vasospasm and arterial thromboses. The risk of frostbite is influenced by host factors, particularly alcohol use and smoking, and environmental factors, including ambient temperature, duration of exposure, altitude, and wind speed. Rewarming for frostbite should not begin until definitive medical care can be provided to avoid repeated freeze-thaw cycles, as these cause additional tissue necrosis. Rewarming should be rapid and for an affected limb should be performed by submersion in warm water at 104 degrees to 107.6 degrees F (40 degrees to 42 degrees C) for 15 to 30 minutes. Debridement of necrotic tissues is generally delayed until there is a clear demarcation from viable tissues, a process that usually takes from 1 to 3 months from the time of initial exposure. Immediate escharotomy and/or fasciotomy is necessary when circulation is compromised. In addition to the acute injury, frostbite is associated with late sequelae that include altered vasomotor function, neuropathies, joint articular cartilage changes, and, in children, growth defects caused by epiphyseal plate damage
— id: 96880, year: 2008, vol: 16, page: 704, stat: Journal Article,

Isolated trapezoid fractures: a case report with compilation of the literature
Gruson, Konrad I; Kaplan, Kevin M; Paksima, Nader
2008 ;66(1):57-60, Bulletin of the NYU Hospital for Joint Diseases
Isolated fractures of the trapezoid bone have been rarely reported in the literature, the mechanism of injury being an axial or bending load transmitted through the second metacarpal. We report a case of an isolated, nondisplaced trapezoid fracture that was sustained by direct trauma and subsequently treated successfully in a short-arm cast. Diagnostic and treatment strategies for isolated fractures of the trapezoid bone are reviewed as well as the results of operative and nonoperative treatment
— id: 79557, year: 2008, vol: 66, page: 57, stat: Journal Article,

Bilateral humerus and corner fractures in an 18-month-old infant: a case report and review of child abuse from the resident perspective
Kaplan, Kevin M; Gruson, Konrad I; Paksima, Nader
2008 ;66(2):124-128, Bulletin of the NYU Hospital for Joint Diseases
Child abuse continues to be a serious problem that is likely to be encountered in all medical specialties, with orthopaedic surgeons commonly evaluating children having sustained musculoskeletal injuries. In busy emergency departments and clinics, junior residents shoulder much of the responsibility in identifying cases of abuse. We report the case of an otherwise healthy 18-month-old child, who presented to the emergency room with bilateral humeral shaft and corner fractures. These injuries were originally presented to the orthopaedic resident as having occurred from an accidental fall from a crib. The appropriate evaluation for a patient suspected of sustaining an injury from child abuse is reviewed
— id: 93318, year: 2008, vol: 66, page: 124, stat: Journal Article,

Predictors of mortality after hip fracture: a 10-year prospective study
Paksima, Nader; Koval, Kenneth J; Aharanoff, Gina; Walsh, Michael; Kubiak, Erik N; Zuckerman, Joseph D; Egol, Kenneth A
2008 ;66(2):111-117, Bulletin of the NYU Hospital for Joint Diseases
The role of medical, social, and functional covariates on mortality after hip fracture was examined over a 16-year period. A total of 1109 patients with hip fractures were included in a prospective database. The inclusion criteria were patients who were age 65 years or older, ambulatory prior to fracture, cognitively intact, living in their own home at the time of the fracture, and had sustained a nonpathological femoral neck or intertrochanteric chip fracture. Data were analyzed using a Cox proportional hazards model. Mortality was compared with a standardized population, and standardized mortality ratios were calculated for 1, 2, 3, 5, and 10 years,respectively. The 1-, 2-, 5- and 10-year mortality rates were 11.9%, 18.5%, 41.2%, and 75.3%, respectively.The predictors of mortality were advanced age, male gender, high American Society of Anesthesiologists (ASA)classification, the presence of a major postoperative complication, a history of cancer, chronic obstructive pulmonary disorder, a history of congestive heart failure,ambulating with an assistive device, or being a household ambulator prior to hip fracture. The increased mortality risk was highest during the first year after hip fracture and returned to the risk of the standard population 3 years postoperatively. Males who are 65 to 84 years had the highest mortality risk
— id: 93316, year: 2008, vol: 66, page: 111, stat: Journal Article,

Treatment of an open infected type IIB distal clavicle fracture: case report and review of the literature
Strauss, Eric J; Kaplan, Kevin M; Paksima, Nader; Bosco, Joseph A 3rd
2008 ;66(2):129-133, Bulletin of the NYU Hospital for Joint Diseases
Clavicle fractures are common skeletal injuries that are typically managed nonoperatively, which results in a high rate of fracture union with few or no long-term sequelae. Type II distal clavicle fractures are an exception, with reported rates of nonunion ranging from 22% to 44%. This high rate of nonunion has led to controversy regarding the appropriate treatment of type II injuries. The following case report describes a type IIB distal clavicle fracture, in which nonoperative management was complicated by the breakdown of skin over the fracture site and the subsequent development of infection. This is a rare complication of conservative management. Thorough operative debridement, fracture stabilization via external fixation, and identification of the causative organism allowed for successful outcome in the management of this complex presentation
— id: 93319, year: 2008, vol: 66, page: 129, stat: Journal Article,

A prospective, randomized, controlled trial of 2-octylcyanoacrylate versus suture repair for nail bed injuries
Strauss, Eric J; Weil, Wayne M; Jordan, Charles; Paksima, Nader
2008 Feb;33(2):250-253, Journal of hand surgery (American volume)
PURPOSE: To prospectively compare the efficacy of 2-octylcyanoacrylate (Dermabond; Ethicon Inc, Somerville, NJ) with standard suture repair in the management of nail bed lacerations. METHODS: Forty consecutive patients with acute nail bed lacerations were enrolled in this study. Eighteen patients were randomized to nail bed repair using Dermabond (2-octylcyanoacrylate), and 22 were randomized to standard repair using 6-0 chromic suture. At presentation, demographic information and laceration characteristics were recorded. The time required for nail bed laceration repair with each method was documented, and cosmetic and functional outcomes were assessed at 1, 3, and 6 months after injury. Comparisons between treatment groups were made using unpaired Student's t-tests. RESULTS: The Dermabond repair group was composed of 10 males and 8 females with a mean age of 32.3 years. The suture repair group was composed of 17 males and 5 females with a mean age of 29.5 years. The mean follow-up was 5.1 months (range 4-11 months) and 4.8 months (range 4-11 months) for the Dermabond group and suture group, respectively. There was no difference between the two treatment groups with respect to age, comorbidities, and length of follow-up (p>.05). The average time required for nail bed repair using Dermabond was 9.5 minutes, which was significantly less than that required for suture repair (27.8 minutes) (p<.0003). At each follow-up time point, there was no statistical difference in physician-judged cosmesis, patient-perceived cosmetic outcome, pain, or functional ability between the Dermabond and suture treatment cohorts (p>.05). CONCLUSIONS: Nail bed repair performed using Dermabond is significantly faster than suture repair, and it provides similar cosmetic and functional results. In the management of acute nail bed lacerations, Dermabond is an efficient and effective repair technique. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic I
— id: 78691, year: 2008, vol: 33, page: 250, stat: Journal Article,

Complete anaesthesia in the cutaneous distribution of the ulnar nerve following submuscular anterior transposition - a case report
Vigler, Mordechai; Farnejad, Farshad; Paksima, Nader
2008 ;66(4):327-328, Bulletin of the NYU Hospital for Joint Diseases
Complete anaesthesia in the cutaneous distribution of the ulnar nerve following submuscular anterior transposition of the ulnar nerve has not been previously reported. We postulate vascular insult as the etiology of this condition and suggest there may be clinical importance to preserving the ulnar nerve blood supply during submuscular anterior transposition
— id: 92773, year: 2008, vol: 66, page: 327, stat: Journal Article,

A new technique for reconstruction of the ulnar collateral ligament of the thumb
Baskies, Michael A; Tuckman, David; Paksima, Nader; Posner, Martin A
2007 Aug;35(8):1321-1325, American journal of sports medicine
BACKGROUND: Several previous studies have described reconstructive methods for the treatment of an injury to the ulnar collateral ligament of the thumb. However, there are few biomechanical studies to date to analyze the strength of the surgical reconstruction. PURPOSE: To evaluate 2 reconstruction techniques with use of a cadaveric model: (1) reconstruction with the use of a free tendon graft placed in a figure-of-8 fashion through drill holes in the metacarpal and proximal phalanx of the thumb, and (2) reconstruction with the use of the Bio-Tenodesis Screw System. STUDY DESIGN: Controlled laboratory study. METHODS: Eight matched pairs of cadaveric specimens underwent removal of the proper and accessory ulnar collateral ligaments. One of the 2 reconstruction methods was performed, and specimens were mounted on a materials-testing machine. The specimens were subjected to valgus stress to failure at 30 degrees of flexion. Failure was defined as valgus laxity of 30 degrees at the metacarpophalangeal joint. RESULTS: The peak load to failure was 23.5 +/- 11.4 N for the figure-of-8 reconstruction and 24.3 +/- 12.3 N for the reconstruction using the Bio-Tenodesis Screw System. Comparing the 2 groups, there was no statistically significant difference in peak loads to failure (P = .88). CONCLUSION: There was no statistically significant difference between the peak loads to failure of the 2 reconstructions. CLINICAL RELEVANCE: The Bio-Tenodesis Screw System may provide another viable option for surgical reconstruction of the ulnar collateral ligament of the thumb
— id: 74299, year: 2007, vol: 35, page: 1321, stat: Journal Article,

Fracture-dislocation of the elbow functional outcome following treatment with a standardized protocol
Egol, Kenneth A; Immerman, Igor; Paksima, Nader; Tejwani, Nirmal; Koval, Kenneth J
2007 ;65(4):263-270, Bulletin of the NYU Hospital for Joint Diseases
Fracture-dislocation of the elbow is a signiicant injury with mixed outcomes. The purpose of the study was to evaluate patient perceived outcome following surgical stabilization of these complex injuries. Twenty-nine available patients (76%) from 37 identiied with 'terrible triad' injury patterns, in- cluding ulnohumeral dislocation, radial head fracture, and coronoid fracture, were available for a minimum 1-year follow-up (mean, 27 months). All patients were evaluated by their treating physician. Radiographic outcome was evaluated at latest follow-up. Functional outcome was based upon DASH, Mayo elbow performance, and Broberg-Mor- rey scores. Complications were recorded. Results included that the average lexion-extension arc of elbow motion was 109 degrees +/- 27 degrees , and the average pronation-supination arc was 128 degrees +/- 44 degrees . Grip strength averaged 72% of the contralateral extremity. The Mayo score was a mean of 81 (range, 45 to 100), the Broberg-Morrey mean was 77 (range, 33 to 100) The mean DASH was 28 (range, 0 to 72). When compared to the age-based normal values, the mean patient's DASH score was 1.4 SD worse than an average person of the same age None of the injury characteristics, patient demographics or treatment modalities was signiicantly associated with a poor outcome at the 95% conidence interval. Conclusions are that the results with terrible triad injuries are often unsatisfactory, but surgical management with the use of a systematic approach may be beneicial. Our approach led to the restoration of elbow joint stability in all patients
— id: 76146, year: 2007, vol: 65, page: 263, stat: Journal Article,

The stiff elbow
Keschner, Mitchell T; Paksima, Nader
2007 ;65(1):24-28, Bulletin of the NYU Hospital for Joint Diseases
Etiologies of elbow contractures can be classified into intrinsic versus extrinsic causes. Posttraumatic elbow stiffness is the most common intrinsic cause and HO formation is the most common extrinsic cause of elbow contractures. Patients who sustain significant elbow trauma and have one or more risk factors for HO formation should be given prophylaxis against HO formation in the form of either indomethacin or radiation therapy. Early excision of HO has been shown to be safe and effective. Nonoperative measures are most effective if used within 6 months of contracture onset. These measures include physical therapy and an aggressive splinting program. If nonoperative measures are unsuccessful and the patient has functionally limiting elbow ROM, then surgical intervention should be considered. Careful preoperative assessment of the ulnar nerve is mandatory, as it may need to be transposed. Satisfactory results have been reported with arthroscopic elbow contracture releases. However, this procedure is technically challenging, with the potential for serious neurovascular complications. Satisfactory results have been published for open procedures as well. The direction of the greatest limitation of motion, the presence of ulnar nerve dysfunction, and the location of osteophytes all help to dictate which surgical approach should be selected.
— id: 73024, year: 2007, vol: 65, page: 24, stat: Journal Article,

Comparison of fixation methods for scaphoid nonunions: a biomechanical model
Panchal, Anand; Kubiak, Erik N; Keshner, Mitchell; Fulkerson, Eric; Paksima, Nader
2007 ;65(4):271-275, Bulletin of the NYU Hospital for Joint Diseases
The purpose of this study was to analyze the relative bio- mechanical stability of three types of internal ixation with cancellous bone graft in a cadaveric, scaphoid nonunion model. A scaphoid nonunion model was created by remov- ing a volar wedge of bone from the waist of the scaphoid in 18 fresh frozen human cadavers. Cancellous sawbone graft was inserted into the osteotomy site and three groups of six cadavers each were then internally ixed with a pair of parallel 0.045-inch K-wires, Mini-Acutrak screws, or Standard Acutrak screws, respectively for each group. The potted specimens were tested using an Instron(R) tensile testing machine by applying force to the distal pole of the scaphoid. The load and stiffness were calculated at 2 mm and 4 mm of displacement. Results showed that both the Mini-Acutrak screw and the Standard Acutrak screw were statistically stronger and stiffer at 2 mm displacement than the pair of parallel 0.045-inch K-wires. No statistically sig- niicant difference between the Standard and Mini-Acutrak screws was noted at 2 mm displacement. At higher loads (4 mm displacement), the Standard Acutrak became statisti- cally stronger and stiffer than the Mini-Acutrak screw. It was concluded that the Standard Acutrak screw followed by the Mini-Acutrak screw may be a better option than a pair of parallel 0.045-inch K-wires when treating scaphoid nonunions. The screws have increased strength of ixation and stiffness when compared to K-wires. Also, unlike the K wires, the Acutrak screws enhance fracture healing by achieving interfragmentary compression. Even in a cancel- lous bone graft model, interfragmentary compression was achieved and our concern that the bone graft would 'spit out' was allayed
— id: 96882, year: 2007, vol: 65, page: 271, stat: Journal Article,

Asymptomatic pisiform-hamate coalition: a case report
Silverman, Adam T; Shin, Steven S; Paksima, Nader
2007 Jun;36(6):E88-E90, American journal of orthopedics (Belle Mead, NJ)
— id: 96883, year: 2007, vol: 36, page: E88, stat: Journal Article,

[In Process Citation]
Egol, Kenneth A; Hiebert, Rudi; Paksima, Nader; Koval, Kenneth J
2006 Nov;88(11):2535-2535, Journal of bone & joint surgery (American volume)
— id: 69349, year: 2006, vol: 88, page: 2535, stat: Journal Article,

Treatment of external fixation pins about the wrist: a prospective, randomized trial
Egol, Kenneth A; Paksima, Nader; Puopolo, Steven; Klugman, Jeffrey; Hiebert, Rudi; Koval, Kenneth J
2006 Feb;88(2):349-354, Journal of bone & joint surgery (American volume)
BACKGROUND: Pin-track infection remains one of the most troublesome complications of external fixation, in some cases compromising otherwise successful fracture treatment. METHODS: One hundred and eighteen patients (120 wrists) who had been managed with the placement of an external fixation device for the treatment of a displaced, unstable, distal radial fracture were randomized into one of three treatment groups: (1) weekly dry dressing changes without pin-site care; (2) daily pin-site care with a solution of one-half normal saline solution and one-half hydrogen peroxide; and (3) treatment with the placement of chlorhexidine-impregnated discs (Biopatch) around the pins, with weekly changes of the discs by the treating surgeon. The patients were followed at weekly intervals until the external fixator was removed. Radiographs were made biweekly. The patients were evaluated with regard to (1) erythema, (2) cellulitis, (3) drainage, (4) clinical or radiographic evidence of pin-loosening, (5) the need for antibiotics, and (6) the need for pin removal before fracture-healing due to infection. Differences in complication rates among the three groups, with adjustment for patient age, gender, and the performance of an associated open procedure, were evaluated. RESULTS: The average age of the patients was fifty-four years. Forty-seven wrists had an open procedure (either bone-grafting or open reduction and internal fixation) in addition to treatment with the external fixator. The fixators remained in place for an average of 5.9 weeks. Twenty-three patients (19%) had a complication related to the pin track, with twelve of these patients requiring oral antibiotics for the treatment of a pin-track infection. There were no significant differences among the three groups with regard to the prevalence of pin-site complications. The age of the patient was found to be significantly associated with an increased risk of postoperative pin-track complications (p = 0.04). CONCLUSIONS: We found a high rate of local wound complications around external fixation pin sites; however, most complications were minor and could be observed or treated with oral antibiotics. The prevalence of these complications was not decreased in association with the use of hydrogen peroxide wound care or chlorhexidine-impregnated dressings. On the basis of these results, we do not recommend additional wound care beyond the use of dry, sterile dressings for pin-track care after external fixation for the treatment of distal radial fractures
— id: 65594, year: 2006, vol: 88, page: 349, stat: Journal Article,

Total wrist arthroplasty
Lawler, Ericka A; Paksima, Nader
2006 ;64(3-4):98-105, Bulletin of the NYU Hospital for Joint Diseases
— id: 72403, year: 2006, vol: 64, page: 98, stat: Journal Article,

Basal joint arthritis: diagnosis and treatment
Polatsch, Daniel B; Paksima, Nader
2006 ;64(3-4):178-184, Bulletin of the NYU Hospital for Joint Diseases
— id: 72408, year: 2006, vol: 64, page: 178, stat: Journal Article,

Post-traumatic thumb reconstruction
Elbeshbeshy B; Paksima N
2001 2002;60(3-4):130-133, Bulletin (Hospital for Joint Diseases)
Many options exist for the management of post-traumatic thumb reconstruction. While the single most important factor for determining the most appropriate procedure is the level of the amputation, many other factors must be considered including patient considerations regarding function and cosmesis as well as the nature of the injury and the expertise of the surgeon. Patients must be included in the decision-making process and their needs and expectations must be clearly defined and addressed. The patient who is most concerned with cosmesis rather than function is more likely to be satisfied with a prosthesis than with even the most cutting-edge surgical procedure
— id: 36172, year: 2001, vol: 60, page: 130, stat: Journal Article,

Peripheral nerve injuries and repair in the upper extremity
Rosenfield J; Paksima N
2001 2002;60(3-4):155-161, Bulletin (Hospital for Joint Diseases)
Peripheral nerve injuries are commonly seen as a result of domestic, industrial, or military trauma. Sharp objects usually cause these nerve injuries. When assessing these injuries, it is important to evaluate each nerves' motor and sensory function. One must be cognizant of associated injuries such as fractures, vascular damage, and musculotendinous lacerations. The time since the injury, level of injury, and age of the patient are important prognosticators impacting the return of function. Intraoperatively, one must assess the vascularity of the soft tissue bed and the nerve itself, the nerve gap, conduction, and the topography of the fascicles to insure proper orientation. Application of the principles of nerve repair (magnification, minimal tension, meticulous soft tissue handling, experienced surgeon and staff) can enhance the chances for a successful result. Additionally, to maximize functional recovery following peripheral nerve repair, a carefully planned program of postoperative occupational therapy and rehabilitation must be instituted
— id: 36171, year: 2001, vol: 60, page: 155, stat: Journal Article,

Complications of treatment of complete acromioclavicular joint dislocations
Guttmann D; Paksima NE; Zuckerman JD
2000 ;49(4):407-413, Instructional course lectures (American Association of Orthopaedic Surgeons)
— id: 22627, year: 2000, vol: 49, page: 407, stat: Journal Article,

Management of recurrent, complex instability of the elbow with a hinged external fixator
McKee MD; Bowden SH; King GJ; Patterson SD; Jupiter JB; Bamberger HB; Paksima N
1998 Nov;80(6):1031-1036, Journal of bone & joint surgery (British volume)
We have treated 16 patients with recurrent complex elbow instability using a hinged external fixator. All patients had instability, dislocation or subluxation of the ulnohumeral joint. The injuries were open in eight patients and were associated with 20 other fractures and five peripheral nerve injuries. Two patients had received initial treatment from us; 14 had previously had a mean of 2.1 unsuccessful surgical procedures (1 to 6). The fixator was applied at a mean of 4.8 weeks (0 to 9) after the injury and remained on the elbow for a mean of 8.5 weeks (6 to 11). After treatment we found the mean range of flexion-extension to be 105 degrees (65 to 140). At a final follow-up of 23 months (14 to 40), the mean Morrey score was 84 (49 to 96): this translated into one poor, three fair, ten good and two excellent results. Complications included one fractured humeral pin, one temporary palsy of the radial nerve, one recurrent instability, one wound infection, one severe pin-track infection and one patient with reflex sympathetic dystrophy. Although technically demanding, the use of the fixator is an important advance in the management of recurrent complex elbow instability after failure of conventional treatment
— id: 22628, year: 1998, vol: 80, page: 1031, stat: Journal Article,

A new technique for arthroscopic resection of a bucket handle tear
Paksima N; Ceccarelli B; Vitols A
1998 Jul-Aug;14(5):537-539, Arthroscopy
The authors present a previously undescribed technique for excision of a bucket handle tear. The technique uses a Caspari suture punch to pass a suture through the meniscus and use the suture as a tool to maneuver the meniscus so that its posterior horn attachment can be cut. The technique is noteworthy in that it eliminates the need for establishing an additional portal
— id: 22629, year: 1998, vol: 14, page: 537, stat: Journal Article,