Joseph D Zuckerman, M.D.

Degenerative arthritis of the knee secondary to ochronosis: A case report
Abimbola O.; Hall G.; Zuckerman J.D.
2011 ;69(4):331-334, Bulletin of the NYU Hospital for Joint Diseases
Alkaptonuria is a rare disease in which a deficiency in the homogentisate 1, 2-dioxygenase enzyme results in a buildup of homogentisic acid. Ochronosis, the deposition of excess homogentisic acid in connective tissue, causes brownish-black pigmentation and weakening of the tissue ultimately resulting in chronic inflammation, degeneration, and osteoarthritis. There is currently no definitive cure for alkaptonuric ochronosis, and management is usually symptomatic. However, total joint replacements in severe cases of ochronotic osteoarthritis have comparable outcomes to osteoarthritic patients without ochronosis. We report a case of a patient with ochronotic arthritis of the knee treated with total knee arthroplasty
— id: 148749, year: 2011, vol: 69, page: 331, stat: Journal Article,

Success in orthopaedic training: resident selection and predictors of quality performance
Egol, Kenneth A; Collins, Jason; Zuckerman, Joseph D
2011 Feb;19(2):72-80, Journal of the American Academy of Orthopaedic Surgeons
Multiple studies have attempted to determine which attributes are predictive of success during residency as well as the optimal method of selecting residents who possess these attributes. Factors that are consistently ranked as being important in the selection of candidates into orthopaedic residency programs include performance during orthopaedic rotation, United States Medical Licensing Examination (USMLE) Step 1 score, Alpha Omega Alpha Honor Medical Society membership, medical school class rank, interview performance, and letters of recommendation. No consensus exists regarding the best predictors of resident success, but trends do exist. High USMLE Step 1 scores have been shown to correlate with high Orthopaedic In-Training Examination scores and improved surgical skill ratings during residency, whereas higher numbers of medical school clinical honors grades have been correlated to higher overall resident performance, higher residency interpersonal skills grading, higher resident knowledge grading, and higher surgical skills evaluations. Successful resident performance can be measured by evaluating psychomotor abilities, cognitive skills, and affective domain
— id: 127228, year: 2011, vol: 19, page: 72, stat: Journal Article,

Managing episodes of care: strategies for orthopaedic surgeons in the era of reform
Enquist, Mary; Bosco Iii, Joseph A; Pazand, Lily; Habibi, Karim A; Donoghue, Richard J; Zuckerman, Joseph D
2011 May;93(10):e55-e55, Journal of bone & joint surgery (American volume)
— id: 132596, year: 2011, vol: 93, page: e55, stat: Journal Article,

Blood, bugs, and motion - what do we really know in regard to total joint arthroplasty?
Glassner, Philip J; Slover, James D; Bosco, Joseph A 3rd; Zuckerman, Joseph D
2011 ;69(1):73-80, Bulletin of the NYU Hospital for Joint Diseases
In total joint arthroplasty, it is often necessary to formulate decisions that are not clearly evidence-based. This review presents some current controversial topics in total joint arthroplasty, including preoperative autologous blood donation versus erythropoietin (EPO) usage, preoperative screening and treatment for methicillin resistant Staphylococcus aureus (MRSA), and the use of continuous passive motion (CPM) following total knee arthroplasty, providing an evidence-based guide for the treating orthopaedic surgeon. Our review shows that preoperative autologous blood donation is over utilized, with EPO being under utilized. Surgeons are encouraged to develop patient-specific strategies, which have been shown to decrease transfusion rates, reduce wasted autologous blood, and increase EPO use. Definitive conclusions regarding MRSA screening for orthopaedic patients cannot be drawn; but due to the significant cost and morbidity associated with a postoperative MRSA infection, we believe a screen and treat protocol should be considered for all patients being admitted to the hospital for elective or emergent surgery. Short-term (3 to 5 days) inpatient use of CPM is recommended at this time. It is low-cost, has minimal risk, and may be a factor in decreasing the length of stay, potentially leading to significant cost savings. However, no long-term benefits of CPM use have been established
— id: 128798, year: 2011, vol: 69, page: 73, stat: Journal Article,

Three- and Four-part Fractures Have Poorer Function Than One-part Proximal Humerus Fractures
Ong C; Bechtel C; Walsh M; Zuckerman JD; Egol KA
2011 Dec;469(12):3292-3299, Clinical orthopaedics & related research
BACKGROUND: Locking plates have become a commonly used fixation device in the operative treatment of three- and four-part proximal humerus fractures. Examining function in patients treated nonoperatively and operatively should help determine whether and when surgery is appropriate in these difficult-to-treat fractures. QUESTIONS/PURPOSES: We compared functional scores, ROM, and radiographs in patients with one-part proximal humerus fractures treated nonoperatively to those in patients with displaced three- and four-part proximal humerus fractures treated with open reduction and internal fixation using locking plates. PATIENTS AND METHODS: We retrospectively reviewed 142 patients with proximal humerus fractures treated with a standardized treatment algorithm over a 6-year period. Three- and four-part fractures were treated surgically while one-part fractures were treated nonoperatively. Functional scores, ROM, and radiographs were used to evaluate outcomes. American Shoulder and Elbow Surgeons and SF-36 scores were obtained at 12 months. Of the 142 patients, 101 (51 with three- or four-part fractures and 50 with one-part fractures) had a minimum followup of 12 months (average, 19 months; range, 12-64 months). RESULTS: The fractures united in all patients. At 1 year, the patients with one-part fractures had better SF-36 physical and mental scores and American Shoulder and Elbow Surgeons scores than the three- and four-part fractures. Both groups had similar shoulder ROM. Nine patients treated operatively had complications, four of which were related to screw penetration into the joint. CONCLUSIONS: Patients with three- and four-part fractures should be advised of the likelihood of persistent functional impairment and a relatively higher risk of complications when treated operatively with locked plates. LEVEL OF EVIDENCE: Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence
— id: 135033, year: 2011, vol: 469, page: 3292, stat: Journal Article,

Luxatio erecta: case series with review of diagnostic and management principles
Patel, Deepan N; Zuckerman, Joseph D; Egol, Kenneth A
2011 Nov;40(11):566-570, American journal of orthopedics (Belle Mead, NJ)
We reviewed 11 cases of luxatio erecta (inferior shoulder dislocation) managed acutely at our institutions to gain insight into the diagnostic and management principles of this condition. We then compared our findings with those in the current literature. Luxatio erecta requires careful clinical and radiographic evaluation and a high index of suspicion for associated injuries, as they occur frequently and can be significant given their tendency to be associated with higher energy trauma. Our results indicate that the majority of patients return to preinjury level of shoulder function, despite associated injuries. Closed reduction constituted definitive management in 100% of the cases in our series, and there was no recurrent instability at follow-up
— id: 150567, year: 2011, vol: 40, page: 566, stat: Journal Article,

Frozen shoulder: a consensus definition
Zuckerman, Joseph D; Rokito, Andrew
2011 Mar;20(2):322-325, Journal of shoulder & elbow surgery
INTRODUCTION: Frozen shoulder (FS) is a common diagnosis treated by orthopaedic surgeons and other physicians caring for musculoskeletal problems. However, there is no standard definition and classification for this common condition. MATERIALS AND METHODS: We asked 211 clinician members of the American Shoulder and Elbow Surgeons to review our proposed definition of FS and its classification into primary and secondary types. Secondary FS was further divided into intrinsic, extrinsic, and systemic types. The survey required responses to 5 specific questions via an analog scale (1, strongly disagree; 5, strongly agree). Agreement was defined as a 4 or 5 on the analog scale. RESULTS: We received 190 responses (90%). Eighty-two percent agreed with the proposed definition of FS. Eighty-five percent agreed that FS should be divided into primary and secondary types. Sixty-six percent agreed with subdivision of secondary FS into intrinsic, extrinsic, and systemic types. Eighty-four percent agreed that there was a clinical entity of primary or idiopathic FS. Eighty-five percent agreed that obtaining a consensus definition and classification of FS was a worthwhile endeavor. DISCUSSION: Significant benefits can be gained from the development of a standard definition and classification of FS, achieved through a consensus of shoulder specialists, that provides a strong foundation for potential acceptance by all musculoskeletal specialists who treat this condition
— id: 138147, year: 2011, vol: 20, page: 322, stat: Journal Article,

Management of humeral and glenoid bone loss--associated with glenohumeral instability
DiPaola, Matthew J; Jazrawi, Laith M; Rokito, Andrew S; Kwon, Young W; Patel, Lava; Pahk, Brian; Zuckerman, Joseph D
2010 ;68(4):245-250, Bulletin of the NYU Hospital for Joint Diseases
Anterior glenohumeral instability complicated by bone loss is a challenging problem and, when severe, may require surgical treatment with bone grafting. We review our institution's experience with humeral head and glenoid bone grafting for large Hill-Sachs lesions and glenoid defects. MATERIALS AND METHODS: Patients who underwent intra-articular bone reconstruction for Hill-Sachs and large glenoid defects for anterior instability at our institution during 2002-2008 were retrospectively reviewed. Those who had undergone concomitant humeral head replacement were excluded. Six patients were identified as having undergone allograft or autograft iliac crest bone graft reconstruction of the glenoid, with four available for full follow-up (average 39 months; range, 7 to 63). Five patients were identified as having undergone humeral head allograft reconstruction and four were available for full follow-up (average 28 months; range, 11 to 40). The remaining three patients were available for telephone follow-up. American Shoulder and Elbow Society (ASES) and University of California, Los Angles (UCLA) scores were recorded and radiographs obtained. RESULTS: Average postoperative ASES and UCLA scores for glenoid bone graft patients were 91 and 33, respectively. Average postoperative ASES and UCLA scores for humeral bone graft patients were 85.3 and 28.4, respectively. Glenoid bone graft shoulders, when compared to the opposite normal side, lost an average of 3 degrees of forward flexion, 10 degrees of external rotation, and two levels of internal rotation. Humeral head bone-grafted shoulders, lost an average of 23 degrees of forward flexion, 8 degrees of external rotation, and two levels of internal rotation. No episodes of recurrent subluxation or dislocations were reported. Radiographs showed no evidence of graft resorption or hardware prominence. CONCLUSIONS: Bone grafting procedures around the shoulder for the treatment of instability provided relief from recurrent instability and good functional results
— id: 133848, year: 2010, vol: 68, page: 245, stat: Journal Article,

The boards
Egol, Kenneth A; Jazrawi, Laith M; Zuckerman, Joseph D
Orthopedic residency & fellowship : a guide to success Thorofare NJ : Slack, 2010,
— id: 5484, year: 2010, vol: , page: ?, stat: Chapter,

Handbook of fractures
Egol, Kenneth A; Koval, Kenneth J; Zuckerman, Joseph D
Philadelphia PA : Lippincott Williams & Wilkins, 2010,
— id: 2204, year: 2010, vol: , page: , stat: ,

In memoriam: Alan M. Levine, MD
Fischgrund, Jeffrey S; Zuckerman, Joseph D
2010 Jan;18(1):1-2, Journal of the American Academy of Orthopaedic Surgeons
— id: 115364, year: 2010, vol: 18, page: 1, stat: Journal Article,

Athletic participation after hip and knee arthroplasty
Golant, Alexander; Christoforou, Dimitrios C; Slover, James D; Zuckerman, Joseph D
2010 ;68(2):76-83, Bulletin of the NYU Hospital for Joint Diseases
The issue of athletic participation after hip and knee arthroplasty has become more relevant in recent years, with an increase in the number of young and active patients receiving joint replacements. This article reviews patient-, surgery-, implant-, and sports-related factors, and discusses currently available guidelines that should be considered by the physician when counseling patients regarding a return to athletic activity after total joint arthroplasty. Current evidence regarding appropriate athletic participation after total hip arthroplasty, resurfacing hip arthroplasty, total knee arthroplasty, and unicondylar knee arthroplasty is reviewed
— id: 111377, year: 2010, vol: 68, page: 76, stat: Journal Article,

Assessment of arthroscopic training in U.S. orthopedic surgery residency programs--a resident self-assessment
Hall, Michael P; Kaplan, Kevin M; Gorczynski, Christopher T; Zuckerman, Joseph D; Rosen, Jeffrey E
2010 ;68(1):5-10, Bulletin of the NYU Hospital for Joint Diseases
BACKGROUND: There has been an increasing number of arthroscopic surgeries performed in general orthopedic surgery practice, as well as a rapid evolution of arthroscopic techniques. The objective of this investigation was to assess the adequacy of arthroscopic training in U.S. orthopedic residency programs from a resident and program director perspective. MATERIALS AND METHODS: The study was performed with a mail-in survey to orthopaedic surgery residents and program directors. Out of 151 programs contacted, we received responses from 24 program directors (15.9%) and 272 residents (11.1% of 2447 possible residents in years 2 through 5 in 2006). Program demographics and resident and program director assessments of arthroscopic surgical training was obtained from the questionnaire. Assessment of open surgical techniques was used as a control. The responses from fifth-year residents (83 of a possible 612 in 2006 (13.6%)) and program directors were used for detailed analysis. RESULTS: Only 32% (27/83) of fifth-year residents felt there was adequate time dedicated to arthroscopic training, compared to 66% (16/24) of program directors (p < 0.01). Thirty-four percent (28/83) of fifth-year residents felt as prepared in arthroscopy as open techniques, in contrast to 58% (14/24) of program directors, who felt fifth-year residents were appropriately prepared in arthroscopic techniques (p = 0.03). The amount of surgery that residents are allowed to perform correlated significantly (p < 0.01) with confidence levels. CONCLUSIONS: Fifth-year residents who were surveyed felt less prepared in arthroscopic training, compared to open surgical procedures. Program directors surveyed over estimated confidence levels in fifth-year residents performing arthroscopic procedures. To ensure that graduating residents are appropriately prepared for the current demands of a clinical setting, it may be necessary to reexamine residency requirements to ensure adequate practice in developing arthroscopic surgical skills
— id: 108928, year: 2010, vol: 68, page: 5, stat: Journal Article,

Orthopedic residency & fellowship : a guide to success
Jazrawi, Laith M; Egol, Kenneth A; Zuckerman, Joseph D
Thorofare NJ : Slack, 2010,
— id: 2208, year: 2010, vol: , page: , stat: ,

Analysis of reverse total shoulder joint forces and glenoid fixation
Kwon, Young W; Forman, Rachel E; Walker, Peter S; Zuckerman, Joseph D
2010 ;68(4):273-280, Bulletin of the NYU Hospital for Joint Diseases
Reverse total shoulder arthroplasty (rTSA) implants are intended to restore stability and function to shoulders with rotator cuff deficiency. The implant consists of a glenosphere projecting from a glenoid baseplate and articulating in a socket at the proximal end of a humeral component. Despite the demonstrated clinical efficacy, little information is available regarding the joint forces about this construct and the stability of the glenoid component against these forces. Our hypotheses were that the joint forces about the rTSA were comparable to that about a normal shoulder joint, and that the micromotion between the baseplate and the scapula against these loads would be sufficiently low to induce bone ingrowth. To investigate this, a custom testing rig was constructed to simulate active shoulder elevation in fresh-frozen shoulder specimens. The forces about the rTSA were calculated and found to include compressive and shear forces up to 0.7 and 0.4 BW, respectively. In contrast to a normal shoulder, where the joint forces peak at 90 degrees of abduction, forces about the rTSA were highest at about 60 degrees of abduction. These forces were then applied in cyclic loading conditions to the glenoid baseplate, and the micromotion of the implant relative to the bone was measured in the four quadrants of the component. For two different rTSA designs (DePuy Delta III(R) and Encore RSP(R)) and in the entire range of the fixation testing, the cyclical micromotions were always less than 62 microm. Thus, under loading conditions similar to physiological shoulder elevation, micromotion of the glenoid component was sufficiently low and within previously published limits to induce bone ingrowth
— id: 117344, year: 2010, vol: 68, page: 273, stat: Journal Article,

Recovery of shoulder strength and proprioception after open surgery for recurrent anterior instability: a comparison of two surgical techniques
Rokito, Andrew S; Birdzell, Maureen Gallagher; Cuomo, Frances; Di Paola, Matthew J; Zuckerman, Joseph D
2010 Jun;19(4):564-569, Journal of shoulder & elbow surgery
BACKGROUND: Previous studies have documented a decrease in proprioceptive capacity in the unstable shoulder. The degree to which surgical approach affects recovery of strength and proprioception is unknown. MATERIALS AND METHODS: The recovery of strength and proprioception after open surgery for recurrent anterior glenohumeral instability was compared for 2 surgical procedures. A prospective analysis of 55 consecutive patients with posttraumatic unilateral recurrent anterior glenohumeral instability was performed. Thirty patients (group 1) underwent an open inferior capsular shift with detachment of the subscapularis, and 25 (group 2) underwent an anterior capsulolabral reconstruction. RESULTS: Mean preoperative proprioception and strength values were significantly lower for the affected shoulders in both groups. At 6 months after surgery, there were no significant differences for mean strength and proprioception values between the unaffected and operative sides for group 2 patients. In group 1 patients, however, there were still significant deficits in mean position sense and strength values. Complete restoration of proprioception and strength, however, was evident by 12 months in group 1. CONCLUSION: This study demonstrates that there are significant deficits in both strength and proprioception in patients with posttraumatic, recurrent anterior glenohumeral instability. Although both are completely restored by 1 year after surgery, a subscapularis-splitting approach allows for complete recovery of strength and position sense as early as 6 months postoperatively. Detachment of the subscapularis delays recovery of strength and position sense for up to 12 months after surgery
— id: 113725, year: 2010, vol: 19, page: 564, stat: Journal Article,

Revision shoulder arthroplasty: an analysis of indications and outcomes
Sajadi, Kaveh R; Kwon, Young W; Zuckerman, Joseph D
2010 Mar;19(2):308-313, Journal of shoulder & elbow surgery
BACKGROUND: We reviewed all revision operations performed by a single surgeon on previous hemi- and total shoulder arthroplasties from November 1987 to March 2005. METHOD: Thirty-five patients' charts were reviewed to determine the causes of failures. In addition, their outcomes after the revision surgery were analyzed. RESULTS: Overall, results were satisfactory in 71% by Neer criteria at a mean follow-up of 27.6 months. Outcomes were related to reason for failure. When failure was because of glenoid erosion, loosening, or humeral loosening, the mean improvement in forward elevation (FE) (28.9 degrees ) and external rotation (ER) (16.1 degrees ) was significantly better (P=.024 FE; P=.000 ER) than when the failure was because of infection, soft-tissue problems, or pain of undetermined origin (FE=-5.6 degrees ; ER=-6.8 degrees ).Likewise, UCLA scores in the first group were significantly better than in the second group (P=.003). In the first group, 16/18 patients were satisfied, while in the second group only 4/17 were satisfied. CONCLUSION: Our data suggest that patients whose revisions are because of glenoid erosion or component loosening can expect to have better outcomes than those whose revisions are performed for infection, instability, or other soft-tissue problems
— id: 115367, year: 2010, vol: 19, page: 308, stat: Journal Article,

Sex and race characteristics in patients undergoing hip and knee arthroplasty in an urban setting
Slover, James D; Walsh, Michael G; Zuckerman, Joseph D
2010 Jun;25(4):576-580, Journal of arthroplasty
The purpose of this study was to examine the relationship between sex, race, and preoperative function in a large diverse patient population undergoing hip and knee arthroplasty. An observational study was conducted on 3542 consecutive primary unilateral total hip and knee arthroplasties. Harris Hip and Knee Society Scores were used to quantify preoperative function. The results demonstrate lower function, with average Harris Hip Scores that were 4.9 (P < .0001) and 8.77 (P < .001) and average Knee Society Scores that were 6.03 (P < .06) and 12.8 (P < .001) points lower in African American and Hispanic patients than white patients for the population, respectively. This study demonstrates that Hispanic and African American patients have worse preoperative hip and knee function before arthroplasty than white patients. Future efforts to elucidate the reasons for this decreased function as well as efforts to rectify any disparities should target these patient populations
— id: 109784, year: 2010, vol: 25, page: 576, stat: Journal Article,

Bilateral stress fractures of the pubic rami following THA--an unusual case of groin pain
Smith, Daniel; Zuckerman, Joseph D
2010 ;68(1):43-45, Bulletin of the NYU Hospital for Joint Diseases
Stress fractures of the pubic rami are rare occurrences and most frequently occur in association with total hip arthroplasty (THA). Reported historically with both cemented and noncemented THA components, postoperative stress fractures likely occur secondary to a rapid postoperative increase in patient activity following years of disability. Though stress fractures of the pubic rami should be considered in the differential diagnosis of groin pain following THA, they require a high degree of suspicion. Diagnosis may be achieved via bone scan after ruling out alternative causes of postoperative groin pain and after accounting for associated medical conditions. Treatment is minimally invasive, requiring a limited period of weightbearing and activity modifIcation, often with full resolution of groin pain and a return to postoperative activity levels
— id: 108932, year: 2010, vol: 68, page: 43, stat: Journal Article,

Accuracy of financial disclosures reported by physicians
Zuckerman, Joseph D
2010 Feb 4;362(5):470-470, New England journal of medicine
— id: 115363, year: 2010, vol: 362, page: 470, stat: Journal Article,

Program and institutional requirements
Zuckerman, Joseph D
Orthopedic residency & fellowship : a guide to success Thorofare NJ : Slack, 2010,
— id: 5480, year: 2010, vol: , page: ?, stat: Chapter,

What to do if you don't match
Zuckerman, Joseph D
Orthopedic residency & fellowship : a guide to success Thorofare NJ : Slack, 2010,
— id: 5477, year: 2010, vol: , page: ?, stat: Chapter,

Occupational shoulder disorders
Halpern M; Hurd J; Zuckerman J
The Shoulder Philadelphia, PA : Saunders/Elsevier, 2009,
— id: 5100, year: 2009, vol: , page: ?, stat: Chapter,

Prevalence, health care expenditures, and orthopedic surgery workforce for musculoskeletal conditions
Haralson, Robert H 3rd; Zuckerman, Joseph D
2009 Oct 14;302(14):1586-1587, JAMA
— id: 115366, year: 2009, vol: 302, page: 1586, stat: Journal Article,

An evaluation of the relationships between reverse shoulder design parameters and range of motion, impingement, and stability
Roche, Chris; Flurin, Pierre-Henri; Wright, Thomas; Crosby, Lynn A; Mauldin, Michael; Zuckerman, Joseph D
2009 Sep-Oct;18(5):734-741, Journal of shoulder & elbow surgery
SUMMARY: The purpose of this study was to evaluate the role of reverse shoulder design parameters on performance. A computer analysis was conducted on the Grammont reverse shoulder to quantify the effect of varying design parameters on functional measurements during humeral abduction/adduction. The Grammont reverse shoulder impinged inferiorly and superiorly on the glenoid at 30.75 degrees and 95 degrees of humeral abduction, with an average jump distance of 10 mm. Several linear relationships were identified. To demonstrate the application of these relationships, a novel prosthesis was designed. The proposed 38-, 42-, and 46-mm reverse shoulder designs impinged inferiorly and superiorly on the glenoid at 7.25 degrees /87.5 degrees , 1 degrees /87.5 degrees , and 0 degrees /89.25 degrees of humeral abduction with an average jump distance of 11.7, 13.5, and 14.1 mm, respectively. The results of this study demonstrate that subtle changes in design parameters can minimize inferior glenoid impingement and offer the potential for dramatic functional improvements in range of motion (39%) and jump distance (36%)
— id: 94143, year: 2009, vol: 18, page: 734, stat: Journal Article,

Perioperating nurses and technicians' perceptions of ergonomic risk factors in the surgical environment
Sheikhzadeh, Ali; Gore, Chaitrali; Zuckerman, Joseph D; Nordin, Margareta
2009 Sep;40(5):833-839, Applied ergonomics
The aim of this study was to identify the magnitude and characteristics of work-related musculoskeletal complaints among perioperative nurses and technicians (PNT) and determine the associated ergonomic risk factors in the operating room (OR) environment based on self-report and focus group discussion. The 50 PNTs who participated in the study completed a self-report survey for musculoskeletal symptoms, Job Description Questionnaire, and Psychometric Evaluation Questionnaire, and participated in focus groups to discuss potential OR ergonomic risk factors. The results of the study demonstrated a high prevalence of work-related musculoskeletal disorders (WMSD) among PNTs, with lower back pain the most prevalent (84%) complaint, followed by ankle/foot (74%) and shoulder (74%) pain. In addition, lower back pain (31%), followed by ankle/knee (24%) pain were found to be the main causes of absenteeism from work. Participants suggested simple ergonomic and engineering solutions can be adopted to improve the work environment of PNTs
— id: 93939, year: 2009, vol: 40, page: 833, stat: Journal Article,

Factors associated with successful performance in an orthopaedic surgery residency
Spitzer, Allison B; Gage, Mark J; Looze, Christopher A; Walsh, Michael; Zuckerman, Joseph D; Egol, Kenneth A
2009 Nov;91(11):2750-2755, Journal of bone & joint surgery (American volume)
— id: 105184, year: 2009, vol: 91, page: 2750, stat: Journal Article,

The glenoid in shoulder arthroplasty
Strauss, Eric J; Roche, Chris; Flurin, Pierre-Henri; Wright, Thomas; Zuckerman, Joseph D
2009 Sep-Oct;18(5):819-833, Journal of shoulder & elbow surgery
Total shoulder arthroplasty is a common treatment for glenohumeral arthritis. One of the most common failure modes of total shoulder arthroplasty is glenoid loosening, causing postoperative pain, limitation of function, and potentially, the need for revision surgery. The literature has devoted considerable attention to the design of the glenoid component; efforts to better understand the biomechanics of the reconstructed glenohumeral joint and identify factors that contribute to glenoid component loosening are ongoing. This article reviews the current state of knowledge about the glenoid in total shoulder arthroplasty, summarizing the anatomic parameters of the intact glenoid, variations in component design and fixation, the mechanisms of glenoid loosening, the outcomes of revision surgery in the treatment of glenoid component failure, and alternative treatments for younger patients
— id: 101889, year: 2009, vol: 18, page: 819, stat: Journal Article,

Deep vein thrombosis prophylaxis
Weber, Kristy L; Zuckerman, Joseph D; Watters, William C 3rd; Turkelson, Charles M
2009 Dec;136(6):1699-1700, Chest
— id: 115365, year: 2009, vol: 136, page: 1699, stat: Journal Article,

Operative experience in an orthopaedic surgery residency program: the effect of work-hour restrictions
Baskies, Michael A; Ruchelsman, David E; Capeci, Craig M; Zuckerman, Joseph D; Egol, Kenneth A
2008 Apr;90(4):924-927, Journal of bone & joint surgery (American volume)
BACKGROUND: The implementation of Section 405 of the New York State Public Health Code and the adoption of similar policies by the Accreditation Council for Graduate Medical Education in 2002 restricted resident work hours to eighty hours per week. The effect of these policies on operative volume in an orthopaedic surgery residency training program is a topic of concern. The purpose of this study was to evaluate the effect of the work-hour restrictions on the operative experiences of residents in a large university-based orthopaedic surgery residency training program in an urban setting. METHODS: We analyzed the operative logs of 109 consecutive orthopaedic surgery residents (postgraduate years 2 through 5) from 2000 through 2006, representing a consecutive interval of years before and after the adoption of the work-hour restrictions. RESULTS: Following the implementation of the new work-hour policies, there was no significant difference in the operative volume for postgraduate year-2, 3, or 4 residents. However, the average operative volume for a postgraduate year-5 resident increased from 274.8 to 348.4 cases (p = 0.001). In addition, on analysis of all residents as two cohorts (before 2002 and after 2002), the operative volume for residents increased by an average of 46.6 cases per year (p = 0.02). CONCLUSIONS: On the basis of the findings of this study, concerns over the potential adverse effects of the resident work-hour polices on operative volume for orthopaedic surgery residents appear to be unfounded
— id: 76797, year: 2008, vol: 90, page: 924, stat: Journal Article,

Early complications in proximal humerus fractures (OTA Types 11) treated with locked plates
Egol, Kenneth A; Ong, Crispin C; Walsh, Michael; Jazrawi, Laith M; Tejwani, Nirmal C; Zuckerman, Joseph D
2008 Mar;22(3):159-164, Journal of orthopaedic trauma
PURPOSE: To examine our incidence of early complications that occur using the Proximal Humeral Internal Locking System (PHILOS) and to determine the contributing factors. SETTING: Academic medical center. PATIENTS: Fifty-one consecutive patients treated with a proximal humerus locking plate. OUTCOME: Development of an intraoperative, acute postoperative, or delayed postoperative complication. METHODS: A retrospective analysis was undertaken of a consecutive series of proximal humerus fractures treated with a locking plate between February 2003 and January 2006 at our institution. Fifty-one fractures or fracture nonunions were identified in 18 male and 33 female patients with an average age of 61. All acute injuries were treated with a similar protocol of open reduction internal fixation with the PHILOS plate followed by early range of shoulder motion. Nonunions were treated in a similar manner with the addition of iliac crest bone graft placement. Patients were objectively assessed on their outcome by physical as well as radiological examination. All complications were recorded. Statistical analyses were performed to determine if patient age, fracture type, or number of screws placed in the humeral head contributed to complications. RESULTS: Fifty-one patients were available for minimum 6-month follow-up (mean, 16 months; range, 6 to 45 months). Radiographically, 92% of the cases united at 3 months after surgery, and 2 fractures had signs of osteonecrosis at latest follow-up. Sixteen complications were seen in 12 patients (24%). Eight shoulders in eight patients (16%) had screws that penetrated the humeral head. Two patients developed osteonecrosis at latest follow-up. One acute fracture and one nonunion failed to unite after index surgery. Significant heterotopic bone developed in 1 patient. Early implant failure occurred in 2 patients; one was revised to a longer plate, and one underwent resection arthroplasty. There was one acute postoperative infection. CONCLUSION: The major complication reported in this study was screw penetration, suggesting that exceptional vigilance must be taken in estimating the appropriate number and length of screws used to prevent articular penetration; although the device provides exceptional fixation stability, its indication must be scrutinized for each individual patient, taking the extent of trauma/fracture and age into consideration and carefully weighing it against other forms of treatment
— id: 76798, year: 2008, vol: 22, page: 159, stat: Journal Article,

Subacromial corticosteroid injections
Gruson, Konrad I; Ruchelsman, David E; Zuckerman, Joseph D
2008 Jan-Feb;17(1 Suppl):118S-130S, Journal of shoulder & elbow surgery
The use of subacromial injections to treat shoulder pain has remained one of the most common procedures for the practicing orthopedist, rheumatologist, and general practitioner. Despite this, many prospective studies have questioned the efficacy of corticosteroid injections compared with nonsteroidal anti-inflammatory drugs or injections of local anesthetics alone, or both, when used for the treatment of symptomatic rotator cuff disease. Accurate diagnosis of the etiology of a patient's shoulder pain and proper injection technique are important in achieving satisfactory clinical outcomes. Both extrinsic as well as intrinsic etiologies for rotator cuff disease should be considered and must be elucidated with appropriate physical examination techniques. Although subacromial injections appear straightforward, more recent cadaveric, radiographic, and clinical studies have demonstrated variable accuracy rates using the two common techniques. In addition, absolute sterile technique must be used because infections of the subacromial space after injections, although uncommon, have generally led to debilitating conditions. This article reviews the etiology and pathophysiology of rotator cuff disease and the indications and techniques for subacromial corticosteroid injections
— id: 75856, year: 2008, vol: 17, page: 118S, stat: Journal Article,

Surgical management of hip fractures: an evidence-based review of the literature. II: intertrochanteric fractures
Kaplan, Kevin; Miyamoto, Ryan; Levine, Brett R; Egol, Kenneth A; Zuckerman, Joseph D
2008 Nov;16(11):665-673, Journal of the American Academy of Orthopaedic Surgeons
Treatment of intertrochanteric hip fracture is based on patient medical condition, preexisting degenerative arthritis, bone quality, and the biomechanics of the fracture configuration. A critical review of the evidence-based literature demonstrates a preference for surgical fixation in patients who are medically stable. Stable fractures can be successfully treated with plate-and-screw implants and with intramedullary devices. Although unstable fractures may theoretically benefit from load-sharing intramedullary implants, this result has not been demonstrated in the current evidence-based literature
— id: 93741, year: 2008, vol: 16, page: 665, stat: Journal Article,

Fraturas manual para consulta rapida = [Handbook of fractures]
Koval, Kenneth; Zuckerman, Joseph D
Rio de Janeiro : Rio de Janeiro Di Livros, 2008,
— id: 2213, year: 2008, vol: , page: , stat: ,

Surgical management of hip fractures: an evidence-based review of the literature. I: femoral neck fractures
Miyamoto, Ryan G; Kaplan, Kevin M; Levine, Brett R; Egol, Kenneth A; Zuckerman, Joseph D
2008 Oct;16(10):596-607, Journal of the American Academy of Orthopaedic Surgeons
During the past 10 years, there has been a worldwide effort in all medical fields to base clinical health care decisions on available evidence as described by thorough reviews of the literature. Hip fractures pose a significant health care problem worldwide, with an annual incidence of approximately 1.7 million. Globally, the mean age of the population is increasing, and the number of hip fractures is expected to triple in the next 50 years. One-year mortality rates currently range from 14% to 36%, and care for these patients represents a major global economic burden. Surgical options for the management of femoral neck fractures are closely linked to individual patient factors and to the location and degree of fracture displacement. Nonsurgical management of intracapsular hip fractures is limited. Based on a critical, evidence-based review of the current literature, we have found minimal differences between implants used for internal fixation of displaced fractures. Cemented, unipolar hemiarthroplasty remains a good option with reasonable results. In the appropriate patient population, outcomes following total hip arthroplasty are favorable and appear to be superior to those of internal fixation
— id: 93742, year: 2008, vol: 16, page: 596, 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,

Chronic glenohumeral dislocation
Sahajpal, Deenesh T; Zuckerman, Joseph D
2008 Jul;16(7):385-398, Journal of the American Academy of Orthopaedic Surgeons
The evaluation and management of chronic glenohumeral dislocations can be challenging. By definition, chronic glenohumeral dislocations represent injuries that were not identified at the time of injury. Therefore, the primary goal is to avoid circumstances in which these injuries are not recognized. This includes undertaking a comprehensive clinical evaluation as well as appropriate imaging studies to understand the pathoanatomic changes-specifically, the humeral head impression fracture and any associated glenoid changes. The size of the impression fracture and duration of the dislocation are important factors in determining the appropriate treatment approach. Satisfactory outcomes can be achieved by using a variety of techniques, including open reduction combined with tendon transfers, allograft reconstruction, disimpaction and bone grafting and prosthetic replacement. Equally important, however, is recognizing patients in whom successful outcomes can be achieved with nonsurgical management
— id: 94144, year: 2008, vol: 16, page: 385, stat: Journal Article,

Core decompression for nontraumatic osteonecrosis of the humeral head: a technique article
Sahajpal, Deenesh T; Zuckerman, Joseph D
2008 ;66(2):118-119, Bulletin of the NYU Hospital for Joint Diseases
Core decompression may used in the management of early stage, precollapse nontraumatic osteonecrosis of the humeral head. We propose a technique without risk of complications associated with injury to the biceps tendon or the blood supply to the humeral head
— id: 93317, year: 2008, vol: 66, page: 118, stat: Journal Article,

Functional outcome following one-part proximal humeral fractures: a prospective study
Tejwani, Nirmal C; Liporace, Frank; Walsh, Michael; France, Monet A; Zuckerman, Joseph D; Egol, Kenneth A
2008 Mar-Apr;17(2):216-219, Journal of shoulder & elbow surgery
A prospective study was undertaken to determine if patients recover pre-injury level of shoulder function 1 year after 1 part proximal humeral fractures. Of the 67 patients enrolled, 43 were female and 24 male with an average age of 64.8 years (range, 25-90 years). All patients underwent a similar treatment protocol consisting of early therapy for range of shoulder motion and strengthening. Baseline demographics and functional assessment, including the American Shoulder and Elbow Surgeons (ASES) evaluation form and the SF-36, were obtained at the time of injury. Functional and demographic data were evaluated with a Student's t test. Fifty-four patients (80%) completed a 1-year follow-up. By 3 months, all patients attained radiographic and clinical evidence of union and no loss of reduction. At 1 year, the ASES score was similar to pre-injury status (93.7 vs 99.1; P = .12). The range of shoulder motion of the affected side was diminished compared to the unaffected extremity in internal rotation (P < .001) and external rotation (P < .001) but not forward flexion. Patients, who sustain minimally displaced proximal humeral fractures treated nonoperatively, largely returned to preoperative functional status at 1-year follow-up. Patients should be counseled and made aware of the decreased range of shoulder motion following this fracture
— id: 76767, year: 2008, vol: 17, page: 216, stat: Journal Article,

First Vice Presidential address: practice management
Zuckerman, Joseph D
2008 Jul;16(7):367-368, Journal of the American Academy of Orthopaedic Surgeons
— id: 94145, year: 2008, vol: 16, page: 367, stat: Journal Article,

Reconstructing Proximal Humeral Fractures Using the Bicipital Groove as a Landmark
Angibaud, Laurent; Zuckerman, Joseph D; Flurin, Pierre-Henri; Roche, Chris; Wright, Thomas
2007 May;458:168-174, Clinical orthopaedics & related research
Controversy persists in the literature regarding the use of the bicipital groove as an anatomic landmark to restore humeral head retroversion when treating complex proximal humeral fractures with arthroplasty. We quantified the three-dimensional geometry of the bicipital groove in 49 dried humeri relative to the intramedullary axis, quantified the reliability of using the bicipital groove as an anatomic landmark, and compared this reliability with that of the conventional technique that uses a fixed, average angle relative to the epicondylar axis to establish humeral head retroversion. The data show the anterior offset of the bicipital groove is nearly constant from proximal (7.3 mm +/- 2.8 mm) to distal (7.2 mm +/- 1.5 mm) relative to the intramedullary axis. Given the consistency, the distal bicipital groove (at the level of the surgical neck) is a reasonable landmark to establish humeral head retroversion after complex proximal humeral fractures having reliability (angular error of 7.9 degrees +/- 5.8 degrees ) as good as or better than the conventional fixed-angle technique
— id: 70977, year: 2007, vol: 458, page: 168, stat: Journal Article,

The rotator interval: anatomy, pathology, and strategies for treatment
Hunt, Stephen A; Kwon, Young W; Zuckerman, Joseph D
2007 Apr;15(4):218-227, Journal of the American Academy of Orthopaedic Surgeons
Over the past two decades, it has become accepted that the rotator interval is a distinct anatomic entity that plays an important role in affecting the proper function of the glenohumeral joint. The rotator interval is an anatomic region in the anterosuperior aspect of the glenohumeral joint that represents a complex interaction of the fibers of the coracohumeral ligament, the superior glenohumeral ligament, the glenohumeral joint capsule, and the supraspinatus and subscapularis tendons. As basic science and clinical studies continue to elucidate the precise role of the rotator interval, understanding of and therapeutic interventions for rotator interval pathology also continue to evolve. Lesions of the rotator interval may result in glenohumeral joint contractures, shoulder instability, or in lesions to the long head of the biceps tendon. Long-term clinical trials may clarify the results of current surgical interventions and further enhance understanding of the rotator interval.
— id: 72731, year: 2007, vol: 15, page: 218, stat: Journal Article,

Resident work-hour rules: a survey of residents' and program directors' opinions and attitudes
Immerman, Igor; Kubiak, Erik N; Zuckerman, Joseph D
2007 Dec;36(12):E172-E179, American journal of orthopedics (Belle Mead, NJ)
In July 2003, the Accreditation Council for Graduate Medical Education (ACGME) established nationwide guidelines for resident working environments and duty hours. Following these guidelines became a requirement for all accredited residency programs. Two years after implementation, we conducted a national survey to assess the opinions and attitudes of orthopedic residents and program directors toward the ACGME work-hour regulations and the effects of these regulations on resident education, resident quality of life, and patient care. Nine hundred seventy-six residents (30% response rate) and 85 program directors (56% response rate) completed the questionnaire. For resident education, junior residents were more likely than senior residents and program directors to perceive the work-hour regulations as having a positive effect on education. There was overall agreement among the 3 groups that resident quality of life had improved as a result of work-hour regulations. For patient care, junior residents viewed the new regulations positively for surgical training and patient care, whereas senior residents and program directors disagreed. This survey showed meaningful differences in the attitudes and opinions of junior residents, senior residents, and program directors toward the new ACGME work-hour regulations
— id: 76344, year: 2007, vol: 36, page: E172, stat: Journal Article,

Thromboprophylaxis after hip fracture: evaluation of 3 pharmacologic agents
Jeong, Gerard K; Gruson, Konrad I; Egol, Kenneth A; Aharonoff, Gina B; Karp, Adam H; Zuckerman, Joseph D; Koval, Kenneth J
2007 Mar;36(3):135-140, American journal of orthopedics (Belle Mead, NJ)
We compared the clinical efficacy and side-effect profiles of aspirin, dextran 40, and low-molecular-weight heparin (enoxaparin) in preventing thromboembolic phenomena after hip fracture surgery. All patients admitted with a diagnosis of hip fracture to our institution between July 1, 1987, and December 31, 1999, were evaluated. Study inclusion criteria were age 65 years or older, previously ambulatory, cognitively intact, home-dwelling, and having a nonpathologic intertrochanteric or femoral neck fracture. Each patient received mechanical thromboprophylaxis (above-knee elastic stockings) and 1 pharmacologic agent (aspirin, dextran 40, or enoxaparin); patients who received aspirin were also given a calf sequential compression device. Meeting the selection criteria and included in the study were 917 patients. Findings included low incidence of thromboembolic phenomena (deep vein thrombosis, 0.5%-1.7%; pulmonary embolism, 0%-2.0%; fatal pulmonary embolism, 0%-0.5%) and no difference among the 3 pharmacologic agents in thromboembolic prophylaxis efficacy. Use of enoxaparin was associated with a significant increase (3.8%) in wound hematoma compared with dextran 40 (1.6%) and aspirin (2.4%) (P<.01). The 3 agents were found not to differ with respect to mortality, thromboembolic phenomena, hemorrhagic complications, or wound complications.
— id: 72734, year: 2007, vol: 36, page: 135, stat: Journal Article,

Orthopedic surgery residents' study habits and performance on the orthopedic in-training examination
Miyamoto, Ryan G Jr; Klein, Gregg R; Walsh, Michael; Zuckerman, Joseph D
2007 Dec;36(12):E185-E188, American journal of orthopedics (Belle Mead, NJ)
The Orthopaedic In-Training Examination (OITE) is a tool used by residency directors to evaluate a resident's fund of orthopedic knowledge. In this study, we correlated resident study habits and preparation tools with performance on the OITE. Data analysis indicated statistically significant correlations between successful OITE performance and frequent review of current orthopedic journals (Journal of Bone and Joint Surgery-American Edition, r = .6, P < .001; Journal of the American Academy of Orthopaedic Surgeons, r = .36, P = .02), daily orthopedic reading (r = .34, P = .03), increased preparation time for OITE (r = .31, P = .04), and more hours committed to studying (r = .37, P = .01). In addition, residents who emphasized prior OITEs and self-assessment examinations when preparing had higher scores (r = .53, P < .001, and r = .64, P < .001, respectively). Our study results show that several factors, including structured study habits and use of specific study materials, contribute to residents' successful OITE performance. Adaptation of these findings by current orthopedic residents may have a positive impact on OITE performance
— id: 76345, year: 2007, vol: 36, page: E185, stat: Journal Article,

The effect of cartilage-derived morphogenetic protein 2 on initial healing of a rotator cuff defect in a rat model
Murray, Douglas H; Kubiak, Erik N; Jazrawi, Laith M; Araghi, Arash; Kummer, Frederick; Loebenberg, Mark I; Zuckerman, Joseph D
2007 Mar-Apr;16(2):251-254, Journal of shoulder & elbow surgery
This animal study evaluated the healing of supraspinatus tendon tears by use of a cartilage-derived morphogenetic protein 2 growth factor (CDMP-2) delivered to the repair. Forty-eight rats had bilateral, surgically created complete tears repaired by sutures with the growth factor introduced on one side. They were killed at 2, 3, 4, and 6 weeks, and the strength of the repairs was determined and histologic analysis performed. At 4 and 6 weeks, the CDMP-2-treated repairs were significantly stronger than the untreated repairs and histologic analysis showed more organized healing. The use of growth factors introduced at the time of rotator cuff repair might promote more rapid healing and subsequent, rapid patient rehabilitation
— id: 70978, year: 2007, vol: 16, page: 251, stat: Journal Article,

Traumatic subacromial dislocation of the acromioclavicular joint: a case report
Namkoong, Suk; Zuckerman, Joseph D; Rose, Donald J
2007 Jan-Feb;16(1):e8-10, Journal of shoulder & elbow surgery
— id: 70979, year: 2007, vol: 16, page: e8, stat: Journal Article,

Evaluation of the shoulder and elbow
Plausinis D; Zuckerman JD
Musculoskeletal disorders in the workplace : principles and practice Philadelphia PA : Mosby Elsevier, 2007,
— id: 5132, year: 2007, vol: , page: ?, stat: Chapter,

Shoulder Arthroplasty for Posttraumatic Arthritis
Sajadi KR; Zuckerman JD
2007 ;18(1):89-95, Seminars in arthroplasty
Posttraumatic arthritis is a degenerative arthritis of the glenohumeral joint that develops after previous fracture and is characterized by bony deformity and soft tissue changes. Articular incongruity in the absence of significant deformity is a good prognostic factor, as is the ability to correct all osseous and soft tissue abnormalities. The need for greater tuberosity osteotomy is a poor prognostic factor. Poor results may also be due to irreparable soft tissue deficits, tension on the tuberosities interfering with healing, limited healing potential in the presence of nonunion, poor patient compliance, and prosthetic design not being conducive to tuberosity reattachment. copyright 2007 Elsevier Inc. All rights reserved
— id: 71036, year: 2007, vol: 18, page: 89, stat: Journal Article,

Complications of intramedullary Hagie pin fixation for acute midshaft clavicle fractures
Strauss, Eric J; Egol, Kenneth A; France, Monet A; Koval, Kenneth J; Zuckerman, Joseph D
2007 May-Jun;16(3):280-284, Journal of shoulder & elbow surgery
The purpose of this report was to evaluate patient outcomes after treatment of acute midshaft clavicle fractures with an intramedullary Hagie pin, including clinical results and the incidence of postoperative complications. Between 1993 and 2003, 16 patients who underwent intramedullary Hagie pin fixation of a midshaft clavicle fracture were identified. The medical records of each patient were reviewed to ascertain the mechanism of injury, indication for surgical intervention, and treatment course. Clinical outcomes were evaluated with respect to time to fracture union, postoperative shoulder range of motion, and symptoms related to the fracture site and ipsilateral shoulder. The inpatient postoperative course and outpatient follow-up visits were assessed in an effort to document the incidence of postoperative complications. The most common mechanism of injury was participation in athletic activity. Operative indications included significant deformity, polytrauma, and neurovascular compromise. The mean time from injury to operative fracture stabilization was 15.8 days. No intraoperative complications occurred. All 16 patients (100%) were available for follow-up to fracture union, which occurred in all cases at a mean of 12.4 weeks. Of the 16 patients, 14 were available for further follow-up, and at a mean follow-up of 9 months, 85.7% had regained near-full to full range of shoulder motion and 93% had no symptoms related to the fracture site or ipsilateral shoulder. Postoperative complications occurred in 8 patients (50%), including 3 cases of skin breakdown related to hardware prominence, 2 cases of hardware breakage, 2 cases of decreased sensation in the region of the surgical incision, and 1 case of persistent pain over the operative site. When indicated, the use of intramedullary devices for the stabilization of clavicle fractures offers theoretic advantages over traditional plate and screw fixation. In this case series, intramedullary Hagie pin fixation resulted in fracture union in 100% of cases, with a high percentage of patients regaining full range of shoulder motion and resolution of symptoms. However, there was a 50% incidence of postoperative complications associated with this treatment method. We believe that the complication rate associated with the use of the Hagie pin should preclude the use of this particular implant.
— id: 73015, year: 2007, vol: 16, page: 280, stat: Journal Article,

Advanced reconstruction shoulder
Zuckerman, Joseph D
Rosemont IL : American Academy of Orthopaedic Surgeons, 2007,
— id: 2207, year: 2007, vol: , page: , stat: ,

Jian bu gu zhe = [Shoulder fractures]
Zuckerman, Joseph D; Koval, Kenneth J
Shenyang Shi : Liaoning ke xue ji shu chu ban she, 2007,
— id: 2209, year: 2007, vol: , page: , stat: ,

Fracturas del hombro : guia practica de manejo = [Shoulder fractures : the practical guide to management]
Zuckerman, Joseph D; Koval, Kenneth J; Zapata, Gustavo A
Caracas, Venezuela : AMOLCA, 2007,
— id: 2212, year: 2007, vol: , page: , stat: ,

Handbook of fractures
Koval, Kenneth J; Zuckerman, Joseph D
Philadelphia PA : Lippincott Williams & Wilkins, 2006,
— id: 2205, year: 2006, vol: , page: , stat: ,

Increasingly conflicted: an analysis of conflicts of interest reported at the annual meetings of the Orthopaedic Trauma Association
Kubiak, Erik N; Park, Samuel S; Egol, Kenneth; Zuckerman, Joseph D; Koval, Kenneth J
2006 ;63(3-4):83-87, Bulletin (Hospital for Joint Diseases)
PURPOSE: To identify trends in industry sponsorship of orthopaedic trauma research presented at the annual meetings of the Orthopaedic Trauma Association since the establishment of conflict of interest (COI) reporting policies in 1993. BACKGROUND: Industry plays a large role in funding orthopaedic basic science and clinical research. The purpose of this study was to analyze the role of industrial support in orthopaedic research as documented in the final programs of the annual meetings of the Orthopaedic Trauma Association (OTA), determine the incidence and nature of COI in the papers and posters accepted for OTA presentation, and report any changes in the frequency of reporting since disclosure policies were enacted in 1993. METHODS: This paper analyzes COI for all years since the adoption of the reporting policies 1993-2002. From 1993-1998, presenters of posters and papers presented at the Orthopaedic Trauma Association annual meetings were required to disclose COI greater than dollar 500, the type of monetary distribution was not recorded. From 1999-2002, presenters of posters and papers were required to acknowledge the type of COI: 1. research grant, 2. miscellaneous non-income support, 3. royalties, 4. stock, and 5. consultant fees. All COI categories were recorded for each year Linear regression was used to determine significance of trends in the pooled data. RESULTS: There was an increase in the percentage of papers accepted and presented at the OTA between 1993 and 2002 with COI. The number of papers reporting COI rose from 7.6% in 1993 to 12.6% in 2002 (p = 0.0129). There was no significant increase in posters with COI over that same time period. No changes were observed in the nature of industrial involvement since the change in reporting enacted in 1999. There were no observed trends in NIH or OTA grant distribution between 1993 and 2002. DISCUSSION AND CONCLUSION: Industry is playing an increasing role in the funding oforthopaedic research. The majority of industrial support is in the form of research grants. The increasing industrial support of scientific research in the public sector is to be applauded as long as it does not lead to the sequestering and suppression of information that may be disadvantageous to the industrial sponsor
— id: 69342, year: 2006, vol: 63, page: 83, stat: Journal Article,

Subluxations and dislocations about the glenohumeral joint
Kwon YW; Zuckerman JD
Rockwood and Green's fractures in adults Philadelphia : Lippincott Williams & Wilkins, 2006,
— id: 4604, year: 2006, vol: , page: 1285, stat: Chapter,

Subluxations and dislocations about the glenohumeral joint
Kwon, Young W; Zuckerman, Joseph D
Rockwood and Green's fractures in adults Philadelphia PA : Lippincott, Williams & Wilkins, 2006,
— id: 5486, year: 2006, vol: , page: ?, stat: Chapter,

A survey of decision-making processes in the treatment of common shoulder ailments among primary care physicians
Loebenberg, Mark I; Rosen, Jeffrey E; Ishak, Charbel; Jazrawi, Laith M; Zuckerman, Joseph D
2006 ;63(3-4):137-144, Bulletin (Hospital for Joint Diseases)
To encourage consistent care for patients with musculoskeletal complaints, the AAOS developed treatment algorithms to aid primary care physicians in the management of these patients. A survey was designed to assess whether a random group of primary care physicians treated their patients in a manner consistent with these algorithms. The AAOS algorithm for shoulder pain was used to develop a questionnaire for primary care physicians. An Internet company provided access to a national base of physicians who volunteered to complete the survey. Ten questions were presented on five shoulder conditions: rotator cuff disease, fractures, instability, arthritis, and frozen shoulder The 'correct' answer was based upon the AAOS algorithm. The survey was completed by 706 physicians who treated variable (one to greater than ten) numbers of shoulder patients per month. Forty-eight percent of the physicians treated acute trauma according to the algorithm, 87% treated arthritis, and 58% treated instability. Only 46% of physicians chose the correct answer for an acute rotator cuff tear and 29% for chronic rotator cuff symptoms. Forty-four percent followed the algorithm for frozen shoulder. Overall only 49% of the patients described were treated according to the AAOS algorithms. Based on the number of shoulder patients seen each month, in one month over 2000 patients could be tested by the surveyed physicians in a manner inconsistent with the treatment algorithms, suggesting the need for improved musculoskeletal education for primary care physicians
— id: 69068, year: 2006, vol: 63, page: 137, stat: Journal Article,

Anatomic validation of an "anatomic" shoulder system
Roche, C; Angibaud, L; Flurin, P H; Wright, T; Fulkerson, E; Zuckerman, Joseph
2006 ;63(3-4):93-97, Bulletin (Hospital for Joint Diseases)
An anatomic study was conducted on 49 dried cadaveric humeri and 24 dried cadaveric scapula to ascertain the variability of the following parameters: humeral neck angle, humeral head retroversion, humeral head medial offset, humeral head posterior offset, humeral head diameter glenoid height, glenoid width, and the glenoid height to width ratio. For verification purposes, the results of this study were found to be within 1.5% to 14.3% of other anatomic studies published in the literature. This observed variability was then compared to that provided by an 'anatomic' shoulder prosthesis (Equinoxe, Exactech, Inc.); viewed independently, this prosthesis can restore humeral neck angle in 94% of humeri, 'secondary' retroversion in 92% of humeri, medial offset in 100% of humeri, posterior offset in 100% of humeri, and humeral head diameter in 96% of humeri. Additionally, the glenoid prosthesis height to width ratio was found to be within 5% and 10% of 71% and 96% of cadaveric glenoids, respectively. The results of this analysis indicate that a dual-offset 'anatomic ' shoulder prosthesis has the capability to successfully restore glenohumeral anatomy in this representative population
— id: 70980, year: 2006, vol: 63, page: 93, stat: Journal Article,

Glenoid loosening in response to dynamic multi-axis eccentric loading: a comparison between keeled and pegged designs with an equivalent radial mismatch
Roche, C; Angibaud, L; Flurin, P H; Wright, T; Zuckerman, Joseph
2006 ;63(3-4):88-92, Bulletin (Hospital for Joint Diseases)
Glenoid loosening is a common failure mode observed in total shoulder arthroplasty. In an effort to isolate the affect of differing fixation techniques on loosening, an edge displacement test was conducted using two, pear-shaped, UHMWPE glenoid designs: one keel and one peg, each having a glenohumeral radial mismatch of 4.3 mm. The susceptibility of each design to loosening was established by quantifiably comparing the maximum glenoid edge displacement before and after 100,000 cycles of eccentric loading by the humeral head along both the superoinferior (SI) and anteroposterior (AP) glenoid axes. Regardless of the axes tested, the results of this study indicate that no discernable difference in edge displacement (distraction and compression) occurred before or after cyclic, eccentric loading for either the keeled or pegged glenoid designs. Additionally, each keel andpeg glenoid remained firmly fixed after testing, suggesting that either fixation technique provides sufficient resistance to edge displacement
— id: 70981, year: 2006, vol: 63, page: 88, stat: Journal Article,

Predictive value of preoperative arterial blood gas evaluation for geriatric patients with hip fractures
Susarla, Anand; Kubiak, Erik N; Egol, Kenneth A; Karp, Adam; Zuckerman, Joseplh D; Koval, Kenneth J
2006 Feb;35(2):74-78, American journal of orthopedics (Belle Mead, NJ)
The high incidence of preoperative silent pulmonary embolisms (PEs) among elderly patients with hip fractures has led some authors to recommend making acquisition of arterial blood gas (ABG) levels a routine part of the preoperative workup. In the study reported here, we retrospectively reviewed 254 patients in our hip-fracture database and determined that ABG levels have poor positive predictive value for PEs and add little to the positive predictive value or negative predictive value of careful clinical examination. Therefore, we do not recommend making acquisition of ABG levels a routine part of the preoperative evaluation
— id: 64786, year: 2006, vol: 35, page: 74, stat: Journal Article,

Concurrent bilateral femoral neck stress fractures and osteonecrosis of the hip. A case report
Zuckerman, Joseph D; Shin, Steven S; Polatsch, Daniel B; Schweitzer, Mark
2006 Apr;88(4):857-860, Journal of bone & joint surgery (American volume)
— id: 64474, year: 2006, vol: 88, page: 857, stat: Journal Article,

Recurrent anterior glenohumeral instability with onset after forty years of age: the role of the anterior mechanism
Araghi, Arash; Prasarn, Mark; St Clair, Selvon; Zuckerman, Joseph D
2005 ;62(3-4):99-101, Bulletin (Hospital for Joint Diseases)
Recurrent instability in patients over forty years of age is felt to occur primarily as a result of an associated rotator cuff tear. This is often referred to as the 'posterior mechanism.' We reviewed our patients over the age of forty who underwent an anterior shoulder repair to identify the incidence of capsulolabral detachments and the role of an 'anterior mechanism' in this patient population. A retrospective review of all patients from 1985 to 2000 was performed to identify patients who had surgery for recurrent instability that began after forty years of age. Of the 265 patients records reviewed, 11 patients were identified who fulfilled the inclusion criteria. Of the 11 patients identified, 9 patients underwent anterior capsulolabral reconstruction for recurrent instability; the remaining two patients underwent repair of large rotator cuff tears. All 9 patients had a capsulolabral detachment, 4 had a rotator interval defect, 2 had anterior and inferior capsular redundancy, 1 had a small rotator cuff tear and 1 had an anterior capsular avulsion from the humeral head. At minimum follow-up of 32 months none of the patients reported episodes of instability. The reported incidence of rotator cuff tears in patients over the age of forty following an initial traumatic anterior glenohumeral dislocation ranges from 35% to 100%. When recurrent instability occurs, it is postulated to occur via a 'posterior mechanism' (i.e., secondary to a significant full-thickness rotator cuff tear). However, all of our patients had an anterior capsulolabral detachment as the 'common lesion' associated with recurrent instability. Although small, this series emphasizes the role of the 'anterior mechanism' in patients who develop recurrent instability after the age of forty. A high rate of success was achieved by addressing the pathoanatomic changes identified
— id: 58721, year: 2005, vol: 62, page: 99, stat: Journal Article,

Revision anterior shoulder repair for recurrent anterior glenohumeral instability
Araghi, Arash; Prasarn, Mark; St Clair, Selvon; Zuckerman, Joseph D
2005 ;62(3-4):102-104, Bulletin (Hospital for Joint Diseases)
Although the operative management of recurrent anterior glenohumeral instability has received significant attention in literature, the outcome of revision anterior shoulder repair is much less frequently reported. We report the results of our experience with this challenging problem. Retrospective chart review identified 29 patients who underwent revision anterior shoulder repair. Prior procedures included eight Bankart repairs, seven capsular shifts, 10 combined Bankart and capsular shift procedures, three Putti-Platt procedures, two staple capsulorrhaphies, two Bristow procedures, seven arthroscopie procedures, and one Magnuson-Stack. The average age of the patients was 31.6 years (range: 18 to 52 years) and the dominant extremity was involved in 69%. Findings at the time of revision anterior shoulder repair included 22 patients with capsulolabral detachment, 24 with capsular redundancy, and 14 with rotator interval defects. Twenty-three of the 29 patients were available for at least a two-year follow-up. Twenty-one (91%) remain stable. One patient was non-compliant with the postoperative immobilization and re-dislocated within the first month. The second patient, who had a prior Bankart procedure followed by a capsular shift two years later, underwent a capsular shift for significant capsular laxity. He re-dislocated approximately 15 months postoperatively. Our success rate of 91% in this small series approaches the results of primary open repair for recurrent glenohumeral instability. To achieve a successful outcome, it is essential to address all pathology at the time of revision repair
— id: 58720, year: 2005, vol: 62, page: 102, stat: Journal Article,

Management of bone loss associated with recurrent anterior glenohumeral instability
Chen, Andrew L; Hunt, Stephen A; Hawkins, Richard J; Zuckerman, Joseph D
2005 Jun;33(6):912-925, American journal of sports medicine
The diagnosis and treatment of osseous deficiencies associated with anterior shoulder instability have been a challenge to physicians for centuries. Whereas historical goals centered on the stable reduction and prevention of recurrent dislocation, current standards of success are predicated on the restoration of motion and strength and the return to functional activities, including competitive athletics. Reestablishment of anterior shoulder stability thus requires the recognition of osseous defects of the humeral head and glenoid, as well as a thorough understanding of the available treatment options in the context of a disciplined treatment algorithm. Although many surgical procedures have been described for the management of osseous deficiencies in association with anterior shoulder instability, in the authors' experience, such procedures are seldom necessary. The purpose of this summary is to review treatment options as well as indications and techniques to address these bony deficiencies
— id: 70983, year: 2005, vol: 33, page: 912, stat: Journal Article,

The effect of degenerative arthritis and prosthetic arthroplasty on shoulder proprioception
Cuomo, Frances; Birdzell, Maureen Gallagher; Zuckerman, Joseph D
2005 Jul-Aug;14(4):345-348, Journal of shoulder & elbow surgery
The effect of glenohumeral arthritis and subsequent total shoulder arthroplasty (TSA) on shoulder proprioception has not been evaluated previously. A prospective analysis of 20 consecutive patients with unilateral advanced glenohumeral arthritis who underwent TSA was undertaken. Shoulder proprioception testing for passive position sense and detection of motion was performed 1 week before surgery and 6 months after TSA. The presence of glenohumeral arthritis had a significant effect on position sense for all 3 planes tested (flexion, abduction, and external rotation). There were significant differences (P < .05) compared with the uninvolved shoulder and with a group of 20 age- and gender-matched subjects without a history of shoulder problems. Six months after TSA, position sense was significantly improved (P < .05) and was not significantly different from that in the contralateral shoulder or the comparison group. Detection of motion was also significantly worse in the arthritic group compared with that in the uninvolved contralateral side (P < .05). Six months after TSA, the sensitivity to detection of motion improved (P < .01) and was not significantly different than that in the uninvolved contralateral shoulder. In addition, the postoperative values for the involved shoulder were not significantly different than those in the age- and gender-matched comparison group. This study demonstrates a significant decrease in proprioceptive function in patients with advanced glenohumeral arthritis. After TSA, there was a marked improvement in proprioception
— id: 70982, year: 2005, vol: 14, page: 345, stat: Journal Article,

Gender differences in patients with hip fracture: a greater risk of morbidity and mortality in men
Endo, Yoshimi; Aharonoff, Gina B; Zuckerman, Joseph D; Egol, Kenneth A; Koval, Kenneth J
2005 Jan;19(1):29-35, Journal of orthopaedic trauma
OBJECTIVE: To determine gender-specific differences in prefracture status and postoperative outcome in elderly hip fracture patients who were ambulatory, community-dwelling, and cognitively intact prior to fracture. DESIGN: Retrospective analysis of prospectively collected data. SETTING: Urban orthopedic referral hospital. PATIENTS: A total of 983 consecutive patients (206 males and 777 females) who sustained a nonpathologic hip fracture were followed for a minimum of 12 months. INTERVENTION: Operative treatment of a proximal femur fracture. MAIN OUTCOME MEASUREMENTS: Postoperative medical complications, place of discharge, 1-year mortality, and postoperative recovery of ambulation, basic activities of daily living, and instrumental activities of daily living. RESULTS: Men were more likely to be married or living with someone else, and they were more dependent in instrumental activities of daily living than women prior to hip fracture. Furthermore, men were sicker as evidenced by a higher American Society of Anesthesiologists rating of preoperative risk. Postoperatively, men were more likely to sustain a medical complication and had a higher mortality at 1 year compared to women. There were no statistically significant gender differences in patient age, fracture type, prefracture level of help, ambulation, or dependence in basic activities of daily living, place of discharge, and postoperative recovery of ambulation as well as basic and instrumental activities of daily living. CONCLUSIONS: Male gender was a risk factor for sustaining a postoperative complication as well as a higher mortality at 1 year post hip fracture
— id: 51390, year: 2005, vol: 19, page: 29, stat: Journal Article,

Temporal and geographic variation in hip fracture rates for people aged 65 or older, New York State, 1985-1996
Hiebert, Rudi; Aharonoff, Gina B; Capla, Edward L; Egol, Kenneth A; Zuckerman, Joseph D; Koval, Kenneth J
2005 May;34(5):252-255, American journal of orthopedics (Belle Mead, NJ)
We describe temporal and regional variation in hip fracture rates for people aged 65 or older in New York state (NYS) from 1985 to 1996. Our descriptive study was of all hip fracture cases admitted to NYS hospitals during that period. Case data were obtained from the Statewide Planning and Research Cooperative System (SPARCS) of the NYS Department of Health. US Census Bureau population estimates were obtained for each year from 1985 to 1996 to compute the annual hip fracture rate for each NYS county. These rates were adjusted for differences in age, gender, and race and were compared using logistic regression. Approximately 14,000 hip fractures occurred annually from 1985 to 1996. The annual rate (number of hip fractures per 1000 population) decreased from 6.4 in 1985 to 5.3 in 1996. White women aged 85 or older had the highest rate (26/1000); nonwhite men aged 65 to 69 had the lowest rate (<1/1000). Statewide annual rates decreased slightly over time, but this change was not reflected in all age, gender, and race subgroups. There was important, consistent variation in county rates after adjustment for age, gender, and race. Other researchers have identified geographic variation in national rates, but the postulated environmental and weather-related factors (eg, water fluoridation use; rainfall and sunshine amounts) have explained only a small proportion of this variation. Identification of risk factors that can better explain regional rate variation may lead to development of intervention strategies that could significantly reduce the risk for hip fracture among people 65 or older
— id: 56027, year: 2005, vol: 34, page: 252, stat: Journal Article,

Hip fracture outcomes in patients with Parkinson's disease
Idjadi, Jeremy A; Aharonoff, Gina B; Su, Hsiu; Richmond, Jeffrey; Egol, Kenneth A; Zuckerman, Joseph D; Koval, Kenneth J
2005 Jul;34(7):341-346, American journal of orthopedics (Belle Mead, NJ)
In a prospective, consecutive study conducted at a university teaching hospital, we evaluated the effects of Parkinson's disease (PD) on hip fracture outcomes. We followed 920 community-dwelling patients, aged 65 or older, who sustained a hip fracture that was operatively treated between July 1, 1987, and June 30, 1998. Presence or absence of PD had no bearing on type of surgery performed. Examined outcomes were postoperative complication rates; in-hospital mortality; length of hospital stay; discharge status (to home or to a skilled nursing facility); and mortality rate, place of residence, recovery of prefracture ambulatory ability, and return to prefracture activities of daily living (ADLs) 1 year after surgery Thirty-one patients (3.4%) had a history of PD before hip fracture. Patients with PD were more likely to be male, to live with another person, to have less ambulatory ability, and to be dependent in ADLs before hip fracture. Compared with patients without PD, they were hospitalized significantly longer and were more likely to be discharged to a skilled nursing facility. In addition, they declined more in level of independence in basic ADLs but not as much in instrumental ADLs at 1-year follow-up. Rates of postoperative complications, recovery of ambulatory ability within 1 year, and mortality within 1 year did not differ. These findings may guide orthopedic surgeons in counseling patients with PD and a hip fracture
— id: 58890, year: 2005, vol: 34, page: 341, stat: Journal Article,

Outcome after treatment of proximal humeral fractures with humeral head replacement
Kwon, Young W; Zuckerman, Joseph D
2005 ;54:363-369, Instructional course lectures (American Association of Orthopaedic Surgeons)
After its initial description by Neer and associates, humeral head replacement has been widely used to treat complex fractures of the proximal humerus. Many studies have confirmed that the treatment of proximal humeral fractures with humeral head replacement is associated with reliable pain relief as well as good patient satisfaction. A limited number of studies have also suggested that the prostheses have reasonable longevity, with the rate of prosthesis survival at 83% to 94% at 10 years. The functional outcome after the procedure, however, has not been as predictable. Using various outcomes scoring instruments, multiple studies have reported a wide range of results. Some authors have reported mostly disappointing outcomes, whereas others have reported generally satisfactory results. The most critical factor influencing the long-term outcome appears to be the position of the greater tuberosity. Other factors that are also associated with a good outcome include younger age, minimal delay between the traumatic event and the surgical procedure, and the absence of any neurologic deficit. For young patients with a complex proximal humeral fracture, humeral head replacement still remains a viable treatment option. However, whenever possible, most authors favor open reduction and internal fixation because of the issues affecting the longevity of the prosthesis. By understanding and minimizing the risk factors leading to a poor result, a reasonable functional outcome, reliable pain relief and a high rate of patient satisfaction can be expected after treatment of proximal humeral fractures with humeral head replacement
— id: 56083, year: 2005, vol: 54, page: 363, stat: Journal Article,

What's new in hip fractures? Current concepts
Liporace, Frank A; Egol, Kenneth A; Tejwani, Nirmal; Zuckerman, Joseph D; Koval, Kenneth J
2005 Feb;34(2):66-74, American journal of orthopedics (Belle Mead, NJ)
Hip fractures have been among the most studied injury patterns in adults. The number of hip fractures is increasing exponentially, and their treatment costs place great economic strain on society. Recently developed hip fracture treatments, emphasizing cost containment, deformity prevention, and evidence-based medicine, are attempts to optimize patient outcomes. In this article, we outline some of these developments with respect to femoral neck and intertrochanteric fractures
— id: 65602, year: 2005, vol: 34, page: 66, stat: Journal Article,

The effect of greater tuberosity placement on active range of motion after hemiarthroplasty for acute fractures of the proximal humerus
Loebenberg, Mark I; Jones, David A; Zuckerman, Joseph D
2005 ;62(3-4):90-93, Bulletin (Hospital for Joint Diseases)
Union of the greater tuberosity to the humeral shaft after hemiarthroplasty for acute fractures of the proximal humerus is a critical factor in the restoration of glenohumeral function. A retrospective review was undertaken to examine 23 consecutive patients who underwent hemiarthroplasty for the treatment of acute three- and four-part fractures of the proximal humerus. The study was conducted to examine the relationship between the position of the healed greater tuberosity and postoperative range of motion. The average age of the patients was 66.5 years. The average follow up was 3.8 years with a range of 24 to 108 months. Active range of motion was measured in forward elevation, external rotation, and internal rotation. Postoperative radiographs were examined to determine the position of the united greater tuberosity in relation to the top of the replaced humeral head. The tuberosity was fixed at an average of 15.4 mm below the top of the humeral head (range: 3 to 26 mm). A radiographic assessment of a control population of 50 normal proximal humeri demonstrated an average tuberosity position of 6.7 mm (range: 2 to 12 mm) below the superior aspect of the humeral head. Polynomial regression analysis demonstrated a polynomial relationship for active range of motion and tuberosity height. ANOVA testing demonstrated statistically significant differences in all ranges of motion. Active forward elevation for Group I (3 to 9 mm) was 88 degrees, Group 11 (10 to 16 mm) was 126 degrees, and Group III (17 to 26 mm) was 85 degrees (p = 0.04). Active external rotation for Group I was 19 degrees, Group II was 48 degrees, and Group III was 29 degrees (p = 0.01). Active internal rotation for Group I was to L2, Group II was to T10, and Group III was to L2 (p = 0.01). Although many factors affect the final ranges of motion in patients who undergo prosthetic replacement for acute proximal humeral fractures we believe that placement of the greater tuberosity 10 to 16 mm below the humeral head will assist in the maximum recovery of glenohumeral motion
— id: 58723, year: 2005, vol: 62, page: 90, stat: Journal Article,

Hospital for Joint Diseases, 1905-2005 : one hundred years of excellence
McDowell, Baynon; Green, William S; Zuckerman, Joseph D
New York : HJD, 2005,
— id: 2211, year: 2005, vol: , page: , stat: ,

The effects of weather and seasonality on hip fracture incidence in older adults
Mirchandani, Sunil; Aharonoff, Gina B; Hiebert, Rudi; Capla, Edward L; Zuckerman, Joseph D; Koval, Kenneth J
2005 Feb;28(2):149-155, Orthopedics (Thorofare NJ)
This study examined the effect of weather and seasonality on hipfracture incidence in older adults residing in New York City. A total off 66,346 patients aged > or = 65 years who sustained a fracture of the femoralneck or intertrochanteric region from 1985 to 1996 comprised the study population. Hip fractures were more likely to occur in the winter than in any of the other seasons (P<.001). Factors significantly correlated with hip fractureincluded minimum daily temperature (r=.167, P<.001), daily wind speed (r=.166, P<.001), maximum daily temperature (r=.155, P<.001), minutes of sunshine (r=.067, P<.01), and average relative humidity (r=.033, P=.03). A greater number of hip fractures occurred in colder months, withambient temperature rather than any adverse circumstances related to rainor snowfall associated most closely to injury. As most fractures occurredindoors, precipitation is less likely to play a part in hip fracture occurrence in this population
— id: 56344, year: 2005, vol: 28, page: 149, stat: Journal Article,

Ochronotic arthropathy: a report of 3 cases
Moghtaderi, Sam; Rokito, Andrew S; Zuckerman, Joseph D
2005 Mar;34(3):136-139, American journal of orthopedics (Belle Mead, NJ)
— id: 70984, year: 2005, vol: 34, page: 136, stat: Journal Article,

Complications of humeral head replacement for proximal humeral fractures
Plausinis D; Kwon YW; Zuckerman JD
2005 ;87(1):204-213, Journal of bone & joint surgery (American volume)
— id: 47909, year: 2005, vol: 87, page: 204, stat: Journal Article,

Complications of humeral head replacement for proximal humeral fractures
Plausinis, Derek; Kwon, Young W; Zuckerman, Joseph D
2005 ;54:371-380, Instructional course lectures (American Association of Orthopaedic Surgeons)
Humeral head replacement has been widely used for the treatment of complex proximal humeral fractures. The procedure is associated with a high rate of patient satisfaction as well as reliable relief of pain. The functional outcomes, however, have been variable. Reported complications include infection, neurologic injury, intraoperative fracture, instability, tuberosity malunion and nonunion, rotator cuff tear, heterotopic ossification, glenoid erosion, and stiffness. When technical factors such as tuberosity malunion or component malpositioning are considered as postoperative complications, the incidence of complications is relatively high. This high rate of complications, in turn, may be related to the wide range of reported functional outcomes
— id: 56082, year: 2005, vol: 54, page: 371, stat: Journal Article,

Posterior capsulorrhaphy for treatment of recurrent posterior glenohumeral instability
Shin, Robert D; Polatsch, Daniel B; Rokito, Andrew S; Zuckerman, Joseph D
2005 ;63(1-2):9-12, Bulletin (Hospital for Joint Diseases)
The surgical treatment of recurrent posterior shoulder instability via a posterior approach has had a variable degree of success reported in the literature with recurrence rates ranging between 8% and 45%. The purpose of this study was to review the results of posterior capsulorrhaphy in a consecutive series of patients with recurrent posterior instability. Seventeen consecutive patients underwent operative management for posterior glenohumeral instability. The dominant shoulder was involved in ten patients. All patients were male with an average age of 28.1 years (range: 16 to 54 years). Ten patients had sustained a specific injury which precipitated the instability. Six patients reported dislocations requiring formal closed reduction maneuvers; the remainder described episodes of recurrent subluxation with spontaneous reduction. All patients underwent a posterior capsulorrhaphy using an infraspinatus splitting approach. Eight shoulders required repair of a posterior capsulolabral detachment. In addition, one patient required augmentation with a posterior bone block for significant glenoid rim deficiency. Outcome was assessed by personal interview, clinical assessment, and standardized radiographs. At an average follow-up of 3.9 years (range: 1.8 to 10.8 years) patients estimated their overall shoulder function to be 81% of the contralateral unaffected shoulder. The subjective result was excellent for eight patients, good for five patients, fair in two patients, and poor in two patients. One of the poor outcomes was in a patient with glenohumeral degenerative changes at the index procedure which progressed and eventually required a total shoulder arthroplasty. The other poor result was in a patient found to have a full-thickness rotator cuff tear 10.6 years after the index procedure. Two patients (12%) had recurrence of their instability. Both of these patients sustained a significant re-injury which precipitated their symptoms. Five patients complained of occasional night pain at the time of their last follow-up examination. Only one patient (who was re-injured) had to change professions as a result of shoulder symptoms. Posterior capsulorrhaphy for treatment of isolated posterior glenohumeral instability yields satisfactory clinical results. Recurrent instability in this series was associated with a specific re-injury and did not appear to increase with longer follow-up
— id: 64472, year: 2005, vol: 63, page: 9, stat: Journal Article,

Arthroscopic versus mini-open rotator cuff repair: a comparison of clinical outcomes and patient satisfaction
Youm, Thomas; Murray, Doug H; Kubiak, Erik N; Rokito, Andrew S; Zuckerman, Joseph D
2005 Sep-Oct;14(5):455-459, Journal of shoulder & elbow surgery
This study compares the results of arthroscopic and arthroscopically assisted mini-open rotator cuff repair in a series of 84 patients who underwent repair of small, medium, or large tears between March 1997 and September 2001 with at least 2 years of follow-up. There were 42 arthroscopic repairs and 42 mini-open repairs. Of the patients, 81 (96.4%) had good or excellent UCLA (University of California, Los Angeles) scores (40 arthroscopic repairs [95.2%] and 41 mini-open repairs [97.6%]); there were 2 fair results and 1 poor outcome. The ASES (American Shoulder and Elbow Surgeons) scores averaged 91.1 for the arthroscopic group and 90.2 for the mini-open group (P > .05). Six patients required further surgery (three from the arthroscopic group and three from the mini-open group). Of 84 patients, 83 (98.8%) reported being satisfied with the procedure. At greater than 2 years of follow-up, arthroscopic and mini-open rotator cuff repairs produced similar results for small, medium, and large rotator cuff tears with equivalent patient satisfaction rates
— id: 62378, year: 2005, vol: 14, page: 455, stat: Journal Article,

Shoulder fractures : the practical guide to management
Zuckerman, Joseph D; Koval, Kenneth J
New York : Thieme, 2005,
— id: 1384, year: 2005, vol: , page: , stat: ,

The early effects of code 405 work rules on attitudes of orthopaedic residents and attending surgeons
Zuckerman, Joseph D; Kubiak, Eric N; Immerman, Igor; Dicesare, Paul
2005 Apr;87(4):903-908, Journal of bone & joint surgery (American volume)
BACKGROUND: The impact of strict enforcement of Section 405 of the New York State Public Health Code to restrict resident work to eighty hours per week and the adoption of a similar policy by the Accreditation Council on Graduate Medical Education in 2002 for orthopaedic residency training have not been evaluated. Adoption of these rules has created accreditation as well as staffing problems and has generated controversy in the surgical training community. The purposes of this study were (1) to evaluate the attitudes of orthopaedic residents and attending surgeons toward the Code 405 work-hour regulations and the effect of those regulations on the perceived quality of residency training, quality of life, and patient care and (2) to quantify the effect of the work-hour restrictions on the actual number of hours worked. METHODS: We administered a thirty-four-question Likert-style questionnaire to forty-eight orthopaedic surgery residents (postgraduate years [PGY]-2 through 5) and a similar twenty-nine-question Likert-style questionnaire to thirty-nine orthopaedic attending surgeons. All questionnaires were collected anonymously and analyzed. Additionally, resident work hours before and after strict enforcement of the Code 405 regulations were obtained from resident time sheets. RESULTS: The average weekly work hours decreased from 89.25 to 74.25 hours for PGY-2 residents and from 86.5 to 73.25 hours for PGY-3 residents, and they increased from 61.5 to 68.5 hours for PGY-4 residents. Residents at all levels felt that they had increased time available for reading. There was general agreement between attending and resident surgeons that their operating experience had been negatively impacted. Senior residents thought that their education had been negatively affected, while junior residents thought that their operating experience in general had been negatively affected. Senior residents and attending surgeons felt that continuity of care had been negatively impacted. All agreed that quality of life for the residents had improved and that residents were more rested. CONCLUSIONS: On the basis of the survey data, the implementation of the new work-hour restrictions was found to result in a decrease in the number of hours worked per week for PGY-2 and PGY-3 residents and in an increase in work hours for PGY-4 residents. This could explain the definite difference between the attitudes expressed by the senior residents and those of the junior residents. Senior residents felt that their education was negatively impacted by the work rules, while junior residents expressed a more neutral view. However, senior residents did not believe that their operative experience was as negatively impacted as did junior residents. Although junior and senior residents and attending surgeons agreed that resident quality of life had improved, we were not able to determine whether this offset the perceived negative impact on education, continuity of care, and operative experience
— id: 55910, year: 2005, vol: 87, page: 903, stat: Journal Article,

Fracture features : hip/supracondylar elbow/radial head
Zuckerman, Joseph D; Skaggs, David L; Steinman, Scott P
Glendale CA : Audio-Digest Foundation, 2005,
— id: 2210, year: 2005, vol: , page: , stat: ,

Outcomes after hip fracture
Aharonoff GB; Immerman I; Zuckerman JD
2004 ;19(3):229-234, Techniques in Orthopaedics
A successful outcome after hip fracture surgery depends on more than just the technical measures such as union, alignment, and range of motion. The central goal of treatment is to restore the patient to his or her prefracture state of function and independence. Comprehensive evaluation of outcomes after hip fracture has become an important component of treatment. Outcomes after the hip fracture include short- and long-term mortality, short- and long-term complications, length of hospital stay, place of discharge (home vs. nursing home), posttreatment ambulatory ability, and the return to prefracture level of function and independence in activities of daily living. A variety of factors have been found to contribute to these outcomes. These include, but are not limited to, age, gender, number and type of comorbidities, type of fracture, details of treatment, and prefracture functional status. Knowledge of the patient's risk factors for a poor functional result, as well as a thorough evaluation of the outcome after the fracture, are all intimately tied to a good result
— id: 46300, year: 2004, vol: 19, page: 229, stat: Journal Article,

Predictors of Discharge to a Skilled Nursing Facility following Hip Fracture Surgery in New York State
Aharonoff, Gina B; Barsky, Alla; Hiebert, Rudi; Zuckerman, Joseph D; Koval, Kenneth J
2004 Sep-Oct;50(5):298-302, Gerontology
Background: Hip fracture is always a very traumatic event, especially for an older person. Often, it is followed by a marked decrease in the level of functioning a patient is able to achieve after recovery. It is even more debilitating when a previously independent person must be discharged to an institution. Objective: This study examined factors and trends associated with discharge to a skilled nursing facility following hip fracture surgery. Methods: Data were analyzed for 89,723 hip fracture patients admitted in New York State from 1986 to 1996. Factors examined included age, gender, race, type of fracture, surgical technique, comorbidities, length of hospitalization and year of admission. Results: Thirty-five percent (32,130) of the patients were discharged to skilled nursing facilities. They tended to be 85+ years old, female, white, have 3+ comorbidities, a history of dementia, have sustained an intertrochanteric fracture, and have been admitted after 1990. In addition, there was a gradual increase in institutionalizations after 1990. Conclusion: In this study, factors were found that predicted discharge to skilled nursing facilities following hip fracture.
— id: 44527, year: 2004, vol: 50, page: 298, stat: Journal Article,

Periprosthetic sepsis
Della Valle, Craig J; Zuckerman, Joseph D; Di Cesare, Paul E
2004 Mar;(420):26-31, Clinical orthopaedics & related research
The diagnosis of septic implant failure can be difficult to make, yet is imperative for optimal patient outcomes in revision total hip arthroplasty. In most cases, a thorough history and physical examination combined with preoperative laboratory tests and an intraoperative frozen section are sufficient to differentiate septic from aseptic failure. If preoperative laboratory test values are elevated, preoperative aspiration of the hip can be used in selected patients to confirm or exclude the diagnosis of infection. Nuclear medicine studies comprise a second-line investigation to evaluate patients with a painful total hip arthroplasty in whom revision surgery otherwise is not indicated. Intraoperative tissue appearance in combination with intraoperative Gram stains are unreliable for detecting periprosthetic sepsis, and neither is adequate when considered alone for ruling out infection at the time of revision total hip arthroplasty. It is imperative that the surgeon doing revision total hip arthroplasty thoroughly understands the relative utility of preoperative and intraoperative tests used to diagnose periprosthetic sepsis
— id: 47553, year: 2004, vol: , page: 26, stat: Journal Article,

Effect of postoperative delirium on outcome after hip fracture
Edelstein, David M; Aharonoff, Gina B; Karp, Adam; Capla, Edward L; Zuckerman, Joseph D; Koval, Kenneth J
2004 May;(422):195-200, Clinical orthopaedics & related research
Nine-hundred twenty-one community-dwelling patients 65 years of age or older, who sustained an operatively treated hip fracture from July 1, 1987 to June 30, 1998 were followed up for the development of postoperative delirium. The outcomes examined in the current study were postoperative complication rates, in-hospital mortality, hospital length of stay, hospital discharge status, 1-year mortality rate, place of residence, recovery of ambulatory ability, and activities of daily living 1 year after surgery. Forty-seven (5.1%) patients were diagnosed with postoperative delirium. Patients who had delirium develop were more likely to be male, have a history of mild dementia, and have had surgery under general anesthesia. Patients who had postoperative delirium develop had a significantly longer length of hospitalization. They also had significantly higher rates of mortality at 1 year, were less likely to recover their prefracture level of ambulation, and were more likely to show a decline in level of independence in basic activities of daily living at the 1-year followup. There was no difference in the rate of postoperative complications, in-hospital mortality, discharge residence, and recovery of instrumental activities of daily living at 1 year
— id: 47552, year: 2004, vol: , page: 195, stat: Journal Article,

Occupational shoulder disorders
Halpern M; Arash A; Zuckerman J
The Shoulder Philadelphia : Saunders, 2004,
— id: 3199, year: 2004, vol: , page: ?, stat: Chapter,

Clinical pathway for hip fractures in the elderly: the Hospital for Joint Diseases experience
Koval, Kenneth J; Chen, Andrew L; Aharonoff, Gina B; Egol, Kenneth A; Zuckerman, Joseph D
2004 Aug;(425):72-81, Clinical orthopaedics & related research
Hip fractures are common injuries in the elderly and are associated with considerable morbidity and mortality. Although technical advances in the treatment of the elderly have resulted in improved fracture fixation and surgical outcomes, clinical pathways have been developed to further improve patient outcome while shortening hospital length of stay after hip fracture. We describe the clinical pathway used since 1990 at the Hospital for Joint Diseases. The outcomes of 747 patients treated before 1990 were compared with outcomes of 318 patients treated at our hospital after initiation of the clinical pathway. Use of the clinical pathway was associated with significant decreases in the acute care hospital length of stay, in-hospital mortality, and 1-year mortality
— id: 47551, year: 2004, vol: , page: 72, stat: Journal Article,

An articulating interval spacer in the treatment of an infected total shoulder arthroplasty
Loebenberg, Mark I; Zuckerman, Joseph D
2004 Jul-Aug;13(4):476-478, Journal of shoulder & elbow surgery
— id: 44528, year: 2004, vol: 13, page: 476, stat: Journal Article,

Modified Weaver-Dunn procedure for acromioclavicular joint dislocations
Rokito, Andrew S; Oh, Young Ho; Zuckerman, Joseph D
2004 Jan;27(1):21-28, Orthopedics (Thorofare NJ)
— id: 44531, year: 2004, vol: 27, page: 21, stat: Journal Article,

Accuracy of the axillary projection to determine fracture angulation of the proximal humerus
Simon, Jordan A; Puopolo, Steven M; Capla, Edward L; Egol, Kenneth A; Zuckerman, Joseph D; Koval, Kenneth J
2004 Feb;27(2):205-207, Orthopedics (Thorofare NJ)
The accuracy of measuring angulation of stable proximal humerus fractures using the axillary lateral projection was investigated. A closing wedge osteotomy with apex anterior angulation was performed on two cadaveric humeri to simulate a stable surgical neck fracture. One specimen was fixed at 30 degrees angulation and the other at 55 degrees. Axillary radiographs were taken with each specimen articulating with the glenoid of a cadaveric scapula. The humerus was held in neutral rotation. Abduction was set at 30 degrees, 60 degrees, and 90 degrees. In each position of abduction, an axillary lateral radiograph was taken in 30 degrees forward flexion, neutral, and 30 degrees extension to simulate various arm positions. A total of nine radiographs were taken for each specimen. The axillary view is not accurate for measurement of proximal humerus angulation at the arm positions commonly encountered in the trauma setting
— id: 44530, year: 2004, vol: 27, page: 205, stat: Journal Article,

The relation between discharge hemoglobin and outcome after hip fracture
Su, Hsiu; Aharonoff, Gina B; Zuckerman, Joseph D; Egol, Kenneth A; Koval, Kenneth J
2004 Nov;33(11):576-580, American journal of orthopedics (Belle Mead, NJ)
The purpose of this study was to determine the effect of the last hemoglobin level before patient discharge on outcome after hip fracture. We retrospectively reviewed data prospectively collected from July 1987 to December 1997 on 844 community-dwelling patients 65 or older who had sustained an operatively treated femoral neck or intertrochanteric fracture. Women with postoperative hemoglobin levels below 12.0 g/dL and men with levels below 13.0 g/dL were classified as having anemia. The main outcome measures were mortality, return to ambulatory ability, and return to activities of daily living at 3, 6, and 12 months. Hemoglobin data were available for 714 patients (85%). At time of last hemoglobin level measurement before discharge, 643 (90.1%) of the 714 patients were classified as having anemia. Patients who had sustained a femoral neck fracture that was treated with internal fixation were less likely to have anemia than were patients who had sustained a femoral neck fracture that was treated with hemiarthroplasty and patients who had sustained an intertrochanteric fracture (P < .001). Patients with anemia at the last discharge were not at increased risk for adverse outcomes at 3, 6, or 12 months compared with patients who did not have anemia
— id: 65604, year: 2004, vol: 33, page: 576, stat: Journal Article,

Atlas of orthopaedic surgery : a multimedia reference
Zuckerman, Joseph D; Koval, Kenneth J
Philadelphia PA : Lippincott Williams & Wilkins, 2004,
— id: 2206, year: 2004, vol: , page: , stat: ,

Conflict of interest in orthopaedic research
Zuckerman, Joseph D; Prasarn, Mark; Kubiak, Erik N; Koval, Kenneth J
2004 Feb;86-A(2):423-428, Journal of bone & joint surgery (American volume)
BACKGROUND: The expanding role of industrial support in biomedical research has resulted in both substantial interest and controversy in recent years. Our hypothesis was that, from 1985 to 2002, the role of industrial support in orthopaedic research increased, as documented by the research presented at the annual meetings of the American Academy of Orthopaedic Surgeons. METHODS: We analyzed the frequency and types of self-reported conflicts of interest for all presentations at the annual meetings of the American Academy of Orthopaedic Surgeons in 1985, 1988, 1992, 1997, 1999, and 2002. Conflicts of interest were recorded directly from the final program for each meeting analyzed. The analysis focused on the scientific presentations, Instructional Course Lectures, symposia, poster exhibits, and scientific exhibits. Information about specific types of support received by authors was first required in 1988. RESULTS: The incidence of conflicts of interest increased from 3% in 1985 to 39% in 2002 for scientific papers (p < 0.001); from 10% to 74%, respectively, for symposia (p < 0.001); from 22% to 60% for Instructional Course Lectures (p < 0.001); from 10% to 60% for scientific exhibits (p < 0.001); and from 9% in 1992 to 14% in 2002 for posters (p < 0.001). For presentations of all types, the incidence increased from 10% to 32% (p < 0.001). The types of conflict of interest also changed significantly from 1999 to 2002. In 1999, 73% of conflicts were documented as support directed to institutions and 27%, as support to individuals; in 2002, 57% were reported as support directed to institutions and 43%, as support to individuals (p < 0.01). CONCLUSIONS: The role of industrial support of orthopaedic research increased significantly between 1985 and 2002, as evidenced by the increase in the self-reported conflicts of interest for all types of presentations at the annual meetings of the American Academy of Orthopaedic Surgeons. In addition, the support directed to individuals, in contrast to that directed to institutions, increased significantly
— id: 42590, year: 2004, vol: 86-A, page: 423, stat: Journal Article,

Circumstances of falls causing hip fractures in the elderly. 1998
Aharonoff, Gina B; Dennis, Michael G; Elshinawy, Ashgan; Zuckerman, Joseph D; Koval, Kenneth J
2003 Sep;17(8 Suppl):S22-S26, Journal of orthopaedic trauma
— id: 44533, year: 2003, vol: 17, page: S22, stat: Journal Article,

Rheumatoid arthritis of the shoulder
Chen, Andrew L; Joseph, Thomas N; Zuckerman, Joseph D
2003 Jan-Feb;11(1):12-24, Journal of the American Academy of Orthopaedic Surgeons
Rheumatoid arthritis affecting the shoulder region is a progressive disorder that results in pain, loss of range of motion, and functional disability. The inflammatory response, which is of unknown etiology, results in synovitis, pannus formation, and articular destruction. Even when patient history and physical examination suggest rheumatoid involvement of the shoulder, laboratory assessment and radiographic evaluation often are necessary to establish the diagnosis. Nonsurgical management is the primary treatment, including pharmacologic and physical therapy regimens for patients with mild symptoms and functional disability. Surgical intervention is indicated in patients with significant pain and functional limitation when nonsurgical treatment fails to provide relief. The procedure selected depends on careful assessment of the degree of articular cartilage injury and compromise of the periarticular soft tissues
— id: 44548, year: 2003, vol: 11, page: 12, stat: Journal Article,

The role of the acromioclavicular joint in impingement syndrome
Chen, Andrew L; Rokito, Andrew S; Zuckerman, Joseph D
2003 Apr;22(2):343-357, Clinics in sports medicine
Although AC pathology usually represents a late manifestation of outlet impingement, it typically presents as a cause of pain that is resistant to nonoperative and operative measures designed to treat purely anterior acromial pathology. The bursitis that occurs with AC joint impingement may be indistinguishable from anterior acromial impingement on clinical presentation; however, physical examination, diagnostic injection, and radiographic evaluation are generally sufficient to establish the diagnosis of AC joint impingement. Nonoperative measures are indicated for the treatment of acute bursitis, although operative intervention may be necessary in cases of large, distally projecting osteophytes in the presence of AC joint degeneration. Acromioclavicular pathology, when present, should be addressed at the time of subacromial decompression, and may involve distal clavicular resection, beveling of the AC joint, or excision of marginal osteophytes. The results of surgery to address the AC contribution to impingement are generally favorable; future investigation may further clarify the role of coplaning and its potential contribution to continued postoperative AC pain and symptomatic instability
— id: 44546, year: 2003, vol: 22, page: 343, stat: Journal Article,

Rotator cuff repair in patients with type I diabetes mellitus
Chen, Andrew L; Shapiro, Joel A; Ahn, Anthony K; Zuckerman, Joseph D; Cuomo, Frances
2003 Sep-Oct;12(5):416-421, Journal of shoulder & elbow surgery
Insulin-dependent diabetes mellitus is associated with shoulder stiffness and a propensity toward postoperative wound complications and infection. We compared our results of open repair of full-thickness rotator cuff tears in 30 diabetic patients with those of a matched, nondiabetic population. No differences were observed in preoperative range of motion, although at a mean of 34 months, significant differences in shoulder active range of motion and passive range of motion were found postoperatively at 6 weeks, 6 months, and final follow-up (P <.05). On the basis of American Shoulder and Elbow Surgeons shoulder scoring, there were 27 (90%) and 28 (93%) good or excellent results in the diabetic and comparison groups, respectively. Complications occurred in 5 diabetic patients (17%), with 2 failures (7%) and 3 infections (10%), as compared with 1 failure (3%) and no infections in the comparison group. Repair of the diabetic rotator cuff may be performed with the expectation of improved motion and function, although less than nondiabetic counterparts. The surgeon should remain cognizant that a higher rate of complications, infection in particular, may occur after rotator cuff repair in the diabetic population
— id: 44538, year: 2003, vol: 12, page: 416, stat: Journal Article,

Interobserver reliability and intraobserver reproducibility in suprascapular notch typing
Dunkelgrun, Martin; Iesaka, Kazuho; Park, Samuel S; Kummer, Frederick J; Zuckerman, Joseph D
2003 ;61(3-4):118-122, Bulletin (Hospital for Joint Diseases)
The size and shape of the suprascapular notch may be a factor in suprascapular nerve entrapment. The suprascapular notches of 623 scapulae were digitally photographed and used to determine notch type and area. Three researchers used to different classification systems for suprascapular notch typing. These systems were compared for interobserver reliability and intraobserver reproducibility using the kappa test. The mean kappa value for the classification used by Rengachary and colleagues was 0.468 and for the classification used by Ticker and associates was 0.531 for the inferior border of the notch and 0.736 for the superior border of the notch. The classification system used by Ticker and associates was more reliable and reproducible and produced both a superior and an inferior classification, making it possibly more clinically relevant than the classification system used by Rengachary and colleagues
— id: 44529, year: 2003, vol: 61, page: 118, stat: Journal Article,

Total knee arthroplasty in a patient with quadriceps paralysis secondary to poliomyelitis: a case report
Evangelista, Gregory T; Zuckerman, Joseph D
2003 Dec;32(12):593-597, American journal of orthopedics (Belle Mead, NJ)
Degenerative joint disease is known to occur in patients with a history of polio. However, minimal or absent quadriceps function is generally considered to be a contraindication to total knee arthroplasty. We describe an elderly patient with quadriceps paralysis secondary to poliomyelitis who underwent a successful total knee replacement for severe osteoarthritis. The primary operative indication was disabling pain. At the 1-year follow-up the patient reported excellent pain relief, and there were no clinical or radiographic signs of deformity
— id: 44532, year: 2003, vol: 32, page: 593, stat: Journal Article,

Sixteen-year follow-up of the cemented spectron femoral stem for hip arthroplasty
Issack, Paul S; Botero, Herman G; Hiebert, Rudi N; Bong, Matthew R; Stuchin, Steven A; Zuckerman, Joseph D; Di Cesare, Paul E
2003 Oct;18(7):925-930, Journal of arthroplasty
Clinical and radiographic follow-up was performed on a consecutive series of 105 patients who underwent 120 total hip arthroplasties at the authors' institution from 1983 to 1988 with a straight, cobalt-chrome femoral stem implanted using a second-generation cementing technique. The mean age at the time of surgery was 68.5 years, and the mean follow-up was 16 years. At 16 years' follow-up, the prevalence of revision for aseptic loosening of the Spectron femoral component was only 4.2%; 5 stems were revised for aseptic loosening at a mean of 10.2 years after implantation. Sixteen-year survivorship of the component was 93.9% +/- 2.7% when revision for aseptic loosening was taken as the endpoint or 90.3% +/- 4.4% when either revision for aseptic loosening or radiographic evidence of loosening was taken as the endpoint
— id: 44537, year: 2003, vol: 18, page: 925, stat: Journal Article,

An AOA critical issue. Geriatric trauma: young ideas
Koval, Kenneth J; Meek, Robert; Schemitsch, Emil; Liporace, Frank; Strauss, Elton; Zuckerman, Joseph D
2003 Jul;85-A(7):1380-1388, Journal of bone & joint surgery (American volume)
— id: 44541, year: 2003, vol: 85-A, page: 1380, stat: Journal Article,

Two or three screws for fixation of femoral neck fractures?
Maurer, Stephen G; Wright, Kevin E; Kummer, Frederick J; Zuckerman, Joseph D; Koval, Kenneth J
2003 Sep;32(9):438-442, American journal of orthopedics (Belle Mead, NJ)
This study compares the stability of 3 cannulated cancellous lag screws with that of 2 cannulated cancellous lag screws for fixation of subcapital femoral neck fractures. Using 10 matched pairs of human cadaveric femurs, subcapital femoral neck osteotomies were created, reduced, and then randomized to 1 of the 2 fixation methods. The constructs were tested with anterior loading to 500 N, incremental axial loading from 100 N to 1000 N, and cyclic loading at 1000 N. The specimens stabilized using 3 screws showed greater resistance to anterior loading, less inferior femoral head displacement, and less superior gapping at the osteotomy site. Although 2 screws may be an acceptable fixation method for this fracture type, the addition of a third screw provides supplemental stability and appears justified
— id: 42881, year: 2003, vol: 32, page: 438, stat: Journal Article,

Mortality risk after hip fracture
Richmond, Jeffrey; Aharonoff, Gina B; Zuckerman, Joseph D; Koval, Kenneth J
2003 Jan;17(1):53-56, Journal of orthopaedic trauma
OBJECTIVE: To determine the mortality risk following hip fracture and identify factors predictive of increased mortality. DESIGN: Retrospective review of prospectively collected data. SETTING: Tertiary care orthopaedic hospital. BACKGROUND: Approximately 250,000 hip fractures occur annually in the United States. The greatest mortality risk following hip fracture has been demonstrated to be within the first 6 months of fracture, and some studies report that the risk approaches expected mortality after 6 months. However, more recent studies have demonstrated that an increased risk of mortality may persist for several years postfracture. The purpose of this study was to assess the excess mortality associated with hip fracture at up to 2 years postinjury. METHODS: All patients with a hip fracture who were admitted to our institution over a 10-year period were evaluated. Criteria for inclusion included: Caucasian, age 65 or older, previously ambulatory, and home dwelling. Patients were followed prospectively to determine the mortality risk associated with hip fracture over a 2-year follow-up period. Mortality was compared to a standardized population and standardized mortality ratios were calculated. RESULTS: Eight hundred thirty-six patients met the inclusion criteria and were included. The mortality risk was highest within the first 3 months following fracture, with standardized mortality ratios approaching that of the control population by two years. Patients age 65-84 had higher mortality risk when compared with patients age > or =85. American Society of Anesthesiologists classification was predictive of increased mortality risk in younger patients, with these patients having triple the mortality risk when compared to the reference population at 2-year follow-up. More elderly patients had minimal excess mortality associated with hip fracture at 1- and 2-year follow-up, regardless of ASA classification. CONCLUSION: The data demonstrate that hip fracture is not associated with significant excess mortality amongst patients older than age 85. Amongst younger patients, however, those with ASA classifications of 3 or 4 have significant excess mortality following hip fracture that persists up to 2 years after injury
— id: 44549, year: 2003, vol: 17, page: 53, stat: Journal Article,

Mortality risk after hip fracture. 2003
Richmond, Jeffrey; Aharonoff, Gina B; Zuckerman, Joseph D; Koval, Kenneth J
2003 Sep;17(8 Suppl):S2-S5, Journal of orthopaedic trauma
— id: 44535, year: 2003, vol: 17, page: S2, stat: Journal Article,

Outcome after hip fracture in individuals ninety years of age and older. 2001
Shah, Mehul R; Aharonoff, Gina B; Wolinsky, Philip; Zuckerman, Joseph D; Koval, Kenneth J
2003 Sep;17(8 Suppl):S6-11, Journal of orthopaedic trauma
— id: 44534, year: 2003, vol: 17, page: S6, stat: Journal Article,

In-hospital mortality after femoral neck fracture: do internal fixation and hemiarthroplasty differ?
Su, Hsiu; Aharonoff, Gina B; Hiebert, Rudi; Zuckerman, Joseph D; Koval, Kenneth J
2003 Mar;32(3):151-155, American journal of orthopedics (Belle Mead, NJ)
In this article, we examine rates of in-hospital mortality of elderly patients with femoral neck fracture treated with internal fixation or hemiarthroplasty. Data were analyzed for 51,003 patients (> or = 65 years old) admitted with femoral neck fractures to New York state hospitals between 1985 and 1996. The primary outcome examined was in-hospital mortality. Associations between type of surgical procedure and outcome were assessed using a multiple logistic regression model, adjusting for patient age, sex, race, number of comorbidities, and residence in a nursing facility before hip fracture. Approximately 30% of the study group had undergone open or closed reduction and internal fixation; the other 70% had undergone hemiarthroplasty. Forty-six percent of the internal fixation group and 56% of the hemiarthroplasty group were 85 years old or older (P < .001). Median hospital stays were 13 days for the internal fixation group and 15 days for the hemiarthroplasty group (P < 001). In-hospital mortality was 5.1% overall, 3.9% for the internal fixation group, and 5.6% for the hemiarthroplasty group (P < .001). The association between type of procedure and mortality held after adjusting for patient age, sex, and number of comorbidities (odds ratio, 1.42; 95% confidence interval, 1.29-1.56; P < .001). After controlling for potential confounding variables, we found that elderly patients who had undergone hemiarthroplasty after femoral neck fracture were more likely to die during hospitalization than those who had undergone internal fixation
— id: 39267, year: 2003, vol: 32, page: 151, stat: Journal Article,

Differential injury responses in oral mucosal and cutaneous wounds
Szpaderska, A M; Zuckerman, J D; DiPietro, L A
2003 Aug;82(8):621-626, Journal of dental research
Oral mucosa heals faster than does skin, yet few studies have compared the repair at oral mucosal and cutaneous sites. To determine whether the privileged healing of oral injuries involves a differential inflammatory phase, we compared the inflammatory cell infiltrate and cytokine production in wounds of equivalent size in oral mucosa and skin. Significantly lower levels of macrophage, neutrophil, and T-cell infiltration were observed in oral vs. dermal wounds. RT-PCR analysis of inflammatory cytokine production demonstrated that oral wounds contained significantly less IL-6 and KC than did skin wounds. Similarly, the level of the pro-fibrotic cytokine TGF-b1 was lower in mucosal than in skin wounds. No significant differences between skin and mucosal wounds were observed for the expression of the anti-inflammatory cytokine IL-10 and the TGF-beta1 modulators, fibromodulin and LTBP-1. These findings demonstrate that diminished inflammation is a key feature of the privileged repair of oral mucosa
— id: 44540, year: 2003, vol: 82, page: 621, stat: Journal Article,

The role of industry in Internet education
Wieting, Mark W; Mevis, Howard; Zuckerman, Joseph D
2003 Jul;(412):28-32, Clinical orthopaedics & related research
Each year hundreds of accredited continuing medical education conferences and meetings receive industry support through unrestricted educational grants. Many of these programs might not occur without this funding support. With the explosive growth of continuing medical education on the Internet, industry again is being asked to provide assistance through unrestricted educational grants and in some instances educational content. At the same time, industry is using the Internet to provide orthopaedic surgeons with education and information about their products and services. Education and information do not require continuing medical education accreditation to be valuable. Although some people in continuing medical education voice ethical concerns regarding the nature of industry's involvement in education, meeting the needs of orthopaedic surgeons remains the top priority. As demands on the orthopaedic surgeons' time continue to impact participation in educational meetings, industry will continue to play a critical role in helping educational organizations such as medical specialty societies develop new, innovative educational programs for presentation via the Internet
— id: 47554, year: 2003, vol: , page: 28, stat: Journal Article,

Lessons learned from the activation of a disaster plan: 9/11
Wolinsky, Philip R; Tejwani, Nirmal C; Testa, N Noel; Zuckerman, Joseph D
2003 Sep;85-A(9):1844-1846, Journal of bone & joint surgery (American volume)
— id: 44539, year: 2003, vol: 85-A, page: 1844, stat: Journal Article,

The effect of instability and subsequent anterior shoulder repair on proprioceptive ability
Zuckerman, Joseph D; Gallagher, Maureen A; Cuomo, Frances; Rokito, Andrew
2003 Mar-Apr;12(2):105-109, Journal of shoulder & elbow surgery
Proprioceptive ability was prospectively evaluated in patients with recurrent traumatic anterior instability who subsequently underwent anterior shoulder repair. Thirty consecutive patients were evaluated for passive position sense and detection of motion with the shoulder in flexion, abduction, and external rotation 1 week before surgery. They were then retested at 6 and 12 months postoperatively. A significant deficit in proprioception was found when the unstable side was compared with the uninvolved side before surgery. Six months after surgical repair, position sense showed an improvement of approximately 50% but was still found to be significantly different on the involved side; detection of motion was no longer significantly different from the uninvolved shoulder. One year after open anterior shoulder repair, both position sense and detection of motion were equivalent to those of the uninvolved shoulder
— id: 44547, year: 2003, vol: 12, page: 105, stat: Journal Article,

Fatigue failure of a shoulder hemiarthroplasty stem: a case report
Zuckerman, Joseph D; Shapiro, Joel A; Moghtaderi, Sam; Kummer, Frederick J
2003 Nov-Dec;12(6):635-636, Journal of shoulder & elbow surgery
— id: 44536, year: 2003, vol: 12, page: 635, stat: Journal Article,

An analysis of orthopaedic residency selection criteria
Bernstein, Adam D; Jazrawi, Laith M; Elbeshbeshy, Basil; Della Valle, Craig J; Zuckerman, Joseph D
2002 2003;61(1-2):49-57, Bulletin (Hospital for Joint Diseases)
The lack of literature on residency selection criteria used by orthopaedic program directors has left medical students in the position of relying on rumor and anecdotal information as to what program directors value most highly when sorting through large candidate pools. The purpose of this study was to compare the perspectives on resident selection criteria solicited from orthopaedic program directors and residency applicants. A power analysis was done to determine adequate sample size. A 26-item questionnaire was mailed to 98 residency applicants who interviewed at our program and 156 orthopaedic program directors. The program directors were also asked to elaborate on those factors that were most important in their selection process. A two-tailed Student's t-test was employed to compare the two groups. Significance was set at p < 0.05. Statistically significant differences between applicant and program director ratings were found in 12 of the 26 questionnaire items. Applicants (n = 91) ranked the following criteria as most important: a letter of recommendation from an orthopaedic surgeon (8.6 on a scale of 1 to 10, 10 being most important), USMLE I score (7.7), and rank in medical school (7.6). The most important criteria for the directors (n = 109) were: the applicant performed a rotation at the director's program (7.9), USMLE I score (7.8), and rank in medical school (7.8). This study provides the most comprehensive empirical data to date as to the factors which orthopaedic program directors consider most important during the residency selection process. To our knowledge, this is the first study in the orthopaedic literature that compares the program directors 'and residency applicants' views on resident selection criteria. Significant differences were found between applicant and program director views on resident selection criteria
— id: 44544, year: 2002, vol: 61, page: 49, stat: Journal Article,

Orthopaedic resident-selection criteria
Bernstein, Adam D; Jazrawi, Laith M; Elbeshbeshy, Basil; Della Valle, Craig J; Zuckerman, Joseph D
2002 Nov;84-A(11):2090-2096, Journal of bone & joint surgery (American volume)
— id: 32637, year: 2002, vol: 84-A, page: 2090, stat: Journal Article,

Fit of current glenoid component designs: an anatomic cadaver study
Checroun, Anthony J; Hawkins, Christopher; Kummer, Frederick J; Zuckerman, Joseph D
2002 Nov-Dec;11(6):614-617, Journal of shoulder & elbow surgery
The glenoids of 412 scapula specimens were templated with the use of 6 currently available glenoid systems to determine the goodness of fit for the various designs. When a fitting criterion of a mismatch of less than 2 mm between the template and the actual glenoid periphery for 8 radial locations was used, the various designs fit from 0% to 48% of the glenoids. Because glenoid component fixation longevity can depend on the degree of osseous support, these results indicate that glenoid component design and sizing can be improved
— id: 44551, year: 2002, vol: 11, page: 614, stat: Journal Article,

Thromboembolic prophylaxis for patients with a fracture of the proximal femur
Della Valle, Craig J; Mirzabeigi, Edwin; Zuckerman, Joseph D; Koval, Kenneth J
2002 Jan;31(1):16-24, American journal of orthopedics (Belle Mead, NJ)
Patients with a fracture of the proximal femur are at high risk for thromboembolic complications necessitating some form of preoperative and postoperative thromboembolic prophylaxis. Despite the knowledge that patients with a proximal femur fracture are at particularly high risk for both deep venous thrombosis and pulmonary embolism, there is no consensus on which strategy is most effective at preventing thromboembolic events in this patient population. The pathophysiology and associated risk factors for thromboembolic complications in this patient population are discussed. We present a review of studies that address the efficacy and safety of both mechanical and pharmacological methods of thromboembolic prophylaxis to assist the orthopedic surgeon in selecting among the different modalities available for thromboembolic prophylaxis
— id: 44555, year: 2002, vol: 31, page: 16, stat: Journal Article,

The relationship between admission hemoglobin level and outcome after hip fracture
Gruson, Konrad I; Aharonoff, Gina B; Egol, Kenneth A; Zuckerman, Joseph D; Koval, Kenneth J
2002 Jan;16(1):39-44, Journal of orthopaedic trauma
OBJECTIVE: To determine the effect of admission hemoglobin level on patient outcome after hip fracture. STUDY DESIGN: Prospective, consecutive. PATIENTS: From July 1991 to June 1997, 395 community-dwelling patients sixty-five years of age or older who had sustained an operatively treated femoral neck or intertrochanteric fracture were prospectively followed up. MAIN OUTCOME MEASUREMENTS: Postoperative complications, in-hospital mortality rate, hospital length of stay, hospital discharge status, place of residence at one year, and mortality and recovery of ambulatory ability and activities of daily living status at three, six, and twelve months. RESULTS: Women with admission hemoglobin levels below 12.0 grams per deciliter and men with admission hemoglobin levels below 13.0 grams per deciliter were classified as anemic. One hundred eighty patients (45.6 percent) were considered anemic on admission. Patients who were anemic were more likely to have an American Society of Anesthesiologists rating of III or IV and have sustained an intertrochanteric fracture. Hospital length of stay and mortality rate at six and twelve months were significantly higher for patients who were anemic on admission. There were no differences in the incidence of postoperative complications, hospital discharge status, place of residence at one year, in-hospital mortality rate, and three-month mortality rate between patients who were and were not anemic on admission. In addition, there were no differences in the recovery of ambulatory ability and of basic and instrumental activities of daily living status at three, six, and twelve months between the two patient groups. CONCLUSIONS: Patients at risk for poor outcomes after hip fracture can be identified by assessing hemoglobin levels at hospital admission
— id: 44556, year: 2002, vol: 16, page: 39, stat: Journal Article,

Reconstruction of chronic distal biceps tendon rupture with use of fascia lata combined with a ligament augmentation device: a report of 3 cases
Kaplan, F Thomas D; Rokito, Andrew S; Birdzell, Maureen G; Zuckerman, Joseph D
2002 Nov-Dec;11(6):633-636, Journal of shoulder & elbow surgery
— id: 44550, year: 2002, vol: 11, page: 633, stat: Journal Article,

Preoperative identification of a bone-cement allergy in a patient undergoing total knee arthroplasty
Kaplan, Kevin; Della Valle, Craig J; Haines, Kathleen; Zuckerman, Joseph D
2002 Sep;17(6):788-791, Journal of arthroplasty
Allergy to polymethyl methacrylate bone-cement or its components is unusual. Because of the potential for an inflammatory response in an allergic patient and the possibility of pain and loosening if a cemented implant is used, it is imperative to identify patients with this allergy to modify their treatment. We report the case of an otherwise healthy 60-year-old woman who needed a total knee arthroplasty and who had an allergy to methyl methacrylate bone-cement identified preoperatively. The appropriate evaluation for a patient who is suspected to have an allergy to bone-cement or its components is reviewed
— id: 44552, year: 2002, vol: 17, page: 788, stat: Journal Article,

Handbook of fractures
Koval, Kenneth J; Zuckerman, Joseph D
Philadelphia PA : Lippincott Williams & Wilkins, 2002,
— id: 900, year: 2002, vol: , page: , stat: ,

National Consensus Conference on Improving the Continuum of Care for Patients with Hip Fracture
Morris, Alan H; Zuckerman, Joseph D
2002 Apr;84-A(4):670-674, Journal of bone & joint surgery (American volume)
— id: 44554, year: 2002, vol: 84-A, page: 670, stat: Journal Article,

Unipolar versus bipolar hemiarthroplasty: functional outcome after femoral neck fracture at a minimum of thirty-six months of follow-up
Ong, Bernard C; Maurer, Stephen G; Aharonoff, Gina B; Zuckerman, Joseph D; Koval, Kenneth J
2002 May;16(5):317-322, Journal of orthopaedic trauma
OBJECTIVES: This investigation was undertaken to compare a series of elderly individuals who sustained a displaced femoral neck fracture treated with either a cemented bipolar prosthesis or a cemented modular unipolar prosthesis. DESIGN: A retrospective review of prospectively collected data. SETTING: Hospital-based tertiary care orthopaedic trauma practice. PATIENTS AND PARTICIPANTS: Two hundred eighty-one community dwelling elderly patients sixty-five years of age or older who sustained a displaced femoral neck fracture (Garden Types III-IV) and underwent primary prosthetic replacement. INTERVENTION: One hundred one patients received a cemented bipolar prosthesis and 180 received a cemented modular unipolar prosthesis. MAIN OUTCOME MEASUREMENTS: The study was designed to determine whether there were any significant differences in: (a) the rate of prosthetic dislocation, postoperative medical and wound complications, or need for revision surgery, and (b) the functional outcome, including the incidence of hip pain and recovery of preinjury levels of ambulatory status and activities of daily living, at a minimum of thirty-six months of follow-up. RESULTS: The two groups of patients did not differ in preinjury characteristics (age, sex, American Society of Anesthesiologist rating of operative risk, number of comorbidities, fracture type, activities of daily living, ambulatory status). There were no significant differences in the rates of postoperative medical or wound complications or dislocation. Ninety-two patients died during the period of study. Forty patients were lost to follow-up or refused to participate. Consequently, 149 patients were followed for a minimum of thirty-six months. Functional ability was compared between both groups with regard to recovery of ambulatory status and activities of daily living, as well as the incidence of hip pain at a minimum of thirty-six months of follow-up. No significant differences were found between the unipolar and bipolar groups. CONCLUSION: Based on the results of this study, there does not appear to be any advantage to the use of a bipolar endoprosthesis in the management of displaced femoral neck fractures in the elderly. Furthermore, the extra cost of bipolar endoprostheses does not seem to warrant its use
— id: 42882, year: 2002, vol: 16, page: 317, stat: Journal Article,

The shoulder in baseball pitching: biomechanics and related injuries-part 1
Park, Samuel S; Loebenberg, Mark L; Rokito, Andrew S; Zuckerman, Joseph D
2002 2003;61(1-2):68-79, Bulletin (Hospital for Joint Diseases)
The extreme range of motion at the shoulder, the high angular velocities and torques, and the repetitious nature of the pitching motion combine to make the shoulder vulnerable to injury during the baseball pitch. An understanding of the biomechanics that contribute to shoulder injuries during each phase of the pitching motion can facilitate the athlete's diagnosis, treatment, and rehabilitation. Common injuries that occur during the late cocking and acceleration phases of the pitch include anterior instability and impingement, bicipital tendinitis, and subacromial impingement. Nonoperative treatment consisting of an initial period of rest and NSAIDS, followed by physical therapy and a gradual return to activity, is usually successful. When this approach fails, surgical intervention, either arthroscopic or open, may be necessary. Physical therapy and rehabilitation are directed toward restoring the integrity and strength of the dynamic and static stabilizers of the shoulder joint, yet preserving the range of motion necessary for performance. Through rehabilitation, the dedicated athlete can often return to the pitching mound at his previous level of performance
— id: 44543, year: 2002, vol: 61, page: 68, stat: Journal Article,

The shoulder in baseball pitching: biomechanics and related injuries-part 2
Park, Samuel S; Loebenberg, Mark L; Rokito, Andrew S; Zuckerman, Joseph D
2002 2003;61(1-2):80-88, Bulletin (Hospital for Joint Diseases)
The extreme range of motion at the shoulder, the high angular velocities and torques, and the repetitious nature of the pitching motion combine to make the shoulder vulnerable to injury during the baseball pitch. An understanding of the biomechanics that contribute to shoulder injuries during each phase of the pitching motion can facilitate the athlete's diagnosis, treatment, and rehabilitation. The athlete's symptoms and signs, as well as radiographic imaging, are key elements in arriving at a diagnosis of shoulder injuries. Nonoperative treatment consisting of an initial period of rest and NSAIDS, followed by physical therapy and a gradual return to activity, is usually successful. When this approach fails, surgical intervention, either arthroscopic or open, may be necessary. Physical therapy and rehabilitation are directed toward restoring the integrity and strength of the dynamic and static stabilizers of the shoulder joint, yet preserving the range of motion necessary for performance. Through rehabilitation, the dedicated athlete can often return to the pitching mound at his previous level of performance
— id: 44542, year: 2002, vol: 61, page: 80, stat: Journal Article,

A comparison of nonoperative and operative treatment of type II distal clavicle fractures
Rokito, Andrew S; Zuckerman, Joseph D; Shaari, Jeffrey M; Eisenberg, David P; Cuomo, Frances; Gallagher, Maureen A
2002 2003;61(1-2):32-39, Bulletin (Hospital for Joint Diseases)
A retrospective study was performed to compare nonoperative and operative treatments of Type II distal clavicle fractures. From a total of 30 diagnosed patients, 16 were identified as receiving nonoperative treatment and 14 open reduction and coracoclavicular stabilization. The average follow-up was 53.5 months for the nonoperative group and 59.8 months for the operative group. All patients were evaluated postoperatively for pain, range of motion, function, and fracture healing as well as for isokinetic strength. Fractures treated surgically achieved union within six to ten weeks. Nonoperative treatment resulted in seven nonunions. There were no significant differences between the two groups in the mean UCLA, Constant, and ASES scores. Nonunion had no significant effect on functional outcome or strength. This study suggests that Type II distal clavicle fractures can be successfully managed nonoperatively. The high incidence of nonunion does not impede a clinical outcome comparable to that achieved by surgical treatment
— id: 44545, year: 2002, vol: 61, page: 32, stat: Journal Article,

Glenohumeral arthroplasty: indications and preoperative considerations
Shapiro, Joel; Zuckerman, Joseph D
2002 ;51(6):3-10, Instructional course lectures (American Association of Orthopaedic Surgeons)
The indications for glenohumeral arthroplasty are severe pain and restricted range of motion associated with radiographic evidence of advanced glenohumeral arthritis. Nonsurgical management consisting of rest, physical therapy, and antiinflammatory medication should be tried before considering surgical management. It is important that each patient be evaluated on the basis of the clinical disease and radiographic characteristics of the underlying diagnosis. Preoperative considerations should include a careful assessment of bone quality and quantity and associated deformity. Evaluation of the soft tissues, particularly the rotator cuff and deltoid muscles, is essential because the success of total shoulder arthroplasty depends greatly on the integrity of these structures. Associated upper and lower extremity degenerative arthritis should be evaluated and carefully considered, particularly with respect to the timing of surgical management. Careful consideration of these factors is invaluable in obtaining successful outcomes of total shoulder arthroplasty
— id: 44553, year: 2002, vol: 51, page: 3, stat: Journal Article,

Midterm clinical and radiographic results with the genesis I total knee prosthesis
Chen AL; Mujtaba M; Zuckerman JD; Jeong GK; Joseph TN; Wright K; Di Cesare PE
2001 Dec;16(8):1055-1062, Journal of arthroplasty
The midterm results of primary posterior cruciate ligament-retaining, minimally conforming, cemented modular total knee arthroplasties using the Genesis I prosthesis in 110 knees in 72 patients were reviewed. Patients were evaluated at a mean follow-up of 7.3 years by Knee Society pain and functional scores, radiographic and survivorship analysis, and Western Ontario and MacMaster Universities Osteoarthritis Index (WOMAC) health status questionnaire. Range of motion increased from an average of 96.3 degrees to 112.5 degrees. Knee Society pain and functional scores increased from preoperative averages of 55 and 44 to 92 and 88, respectively. There were 91 excellent, 16 good, 1 fair, and 2 poor results. WOMAC scores were increased significantly in each subcategory examined (pain, stiffness, and physical function). Kaplan-Meier survivorship was 97% at 10 years. An increase in loosening as a result of eccentric stress concentration secondary to the nonconforming design of this prosthesis, theoretically a matter of some clinical concern, was not shown in this investigation
— id: 44557, year: 2001, vol: 16, page: 1055, stat: Journal Article,

Efficacy of combined technetium-99m sulfur colloid/indium-111 leukocyte scans to detect infected total hip and knee arthroplasties
Joseph TN; Mujtaba M; Chen AL; Maurer SL; Zuckerman JD; Maldjian C; Di Cesare PE
2001 Sep;16(6):753-758, Journal of arthroplasty
The reliability of combined indium-111 leukocyte/technetium-99m sulfur colloid scans, with and without the addition of blood pooling and blood flow studies, in the diagnosis of infected total joint arthroplasty was investigated. Both scans were performed on 58 patients before reoperation of total hip or knee arthroplasty in the period 1996-1999. Results for imaging alone included 100% specificity, 46% sensitivity, 100% positive predictive value, 84% negative predictive value, and 88% accuracy. Inclusion of blood pooling and flow phase data improved results to 66% sensitivity, 89% negative predictive value, and 90% accuracy, with reductions in specificity (98%) and positive predictive value (91%). Routine use of these radionuclide scans is not supported by these data
— id: 26668, year: 2001, vol: 16, page: 753, stat: Journal Article,

Outcome after hip fracture in individuals ninety years of age and older
Shah MR; Aharonoff GB; Wolinsky P; Zuckerman JD; Koval KJ
2001 Jan;15(1):34-39, Journal of orthopaedic trauma
OBJECTIVE: To assess outcome after hip fracture in patients ninety years of age and older, as compared with a population of the same age and sex in the United States and younger patients with hip fractures. DESIGN: Prospective, consecutive. SETTING: University teaching hospital. METHODS: Eight hundred fifty community-dwelling elderly people who sustained an operatively treated hip fracture were prospectively followed up. MAIN OUTCOME MEASUREMENTS: The outcomes examined in this study were the patients' in-hospital mortality and postoperative complication rates, hospital length of stay, discharge status, mortality rate, place of residence, ambulatory ability, and independence in basic and instrumental activities of daily living twelve months after surgery. RESULTS AND CONCLUSIONS: The mean patient age was 79.7 years (range 65 to 105 years). Seventy-six (8.9 percent) patients were ninety years of age and older. Patients who were ninety years of age and older had significantly longer mean hospital lengths of stay than younger individuals (p = 0.01). People ninety years of age and older were more likely to die during the hospital stay (p = 0.001) and within one year of surgery (p = 0.001). Patients who were ninety years of age and older were more likely to have a decrease in their basic activities of daily living status (p = 0.03) and ambulation level (p = 0.01). Younger individuals had a higher standard mortality ratio (1.48) than did patients who were ninety years of age and older (1.24). Being ninety years of age and older was not predictive of having a postoperative complication, of being placed in a skilled nursing facility at discharge or at one-year follow-up, or recovering of prefracture independence in instrumental activities of daily living
— id: 26824, year: 2001, vol: 15, page: 34, stat: Journal Article,

Effect of depression on functional recovery following hip fracture
Aharanoff, G; Cusimano, K; Wolinsky, P; Zuckerman, J; Koval, K
2000 AUG ;48(8):S124-S124, Journal of the American Geriatrics Society
— id: 54476, year: 2000, vol: 48, page: S124, stat: Journal Article,

Superior labrum anterior-posterior lesions: diagnosis with MR arthrography of the shoulder
Bencardino JT; Beltran J; Rosenberg ZS; Rokito A; Schmahmann S; Mota J; Mellado JM; Zuckerman J; Cuomo F; Rose D
2000 Jan;214(1):267-271, Radiology
PURPOSE: To determine the accuracy of magnetic resonance (MR) arthrography in the diagnosis of superior labrum anterior-posterior (SLAP) lesions of the shoulder. MATERIALS AND METHODS: From January 1995 to June 1998, MR arthrography of the shoulder was performed in 159 patients with a history of chronic shoulder pain or instability. Fifty-two patients underwent arthroscopy or open surgery 12 days to 5 months after MR arthrography. Diagnostic criteria for SLAP lesion included marked fraying of the articular aspect of the labrum, biceps anchor avulsion, inferiorly displaced bucket handle fragment, and extension of the tear into the biceps tendon fibers. Surgical findings were correlated with those from MR arthrography. RESULTS: SLAP injuries were diagnosed at surgery in 19 of the 52 patients (37%). Six of the 19 lesions (32%) were classified as type I, nine (47%) as type II, one (5%) as type III, and three (16%) as type IV. MR arthrography had a sensitivity of 89% (17 of 19 patients), a specificity of 91% (30 of 33 patients), and an accuracy of 90% (47 of 52 patients). The MR arthrographic classification showed correlation with the arthroscopic or surgical classification in 13 of 17 patients (76%) in whom SLAP lesions were diagnosed at MR arthrography. CONCLUSION: MR arthrography is a useful and accurate technique in the diagnosis of SLAP lesions of the shoulder. MR arthrography provides pertinent preoperative information with regard to the exact location of tears and grade of involvement of the biceps tendon
— id: 27850, year: 2000, vol: 214, page: 267, stat: Journal Article,

Elbow joint biomechanics: basic science and clinical applications
Bernstein AD; Jazrawi LM; Rokito AS; Zuckerman JD
2000 Dec;23(12):1293-1301, Orthopedics (Thorofare NJ)
— id: 32643, year: 2000, vol: 23, page: 1293, stat: Journal Article,

Dislocations of the sternoclavicular joint
Dennis MG; Kummer FJ; Zuckerman JD
2000 ;59(3):153-157, Bulletin (Hospital for Joint Diseases)
The effects of the anterior and posterior sternoclavicular joint (SCJ) soft tissue structures on joint dislocation strength by sequential sectioning the ligaments and capsule of twenty-eight SCJs were evaluated. The medial clavicle of each specimen was initially loaded in the anterior and posterior directions to provide control values for joint laxity. The anterior or posterior ligaments and capsular structures of the SCJs were then selectively cut and the specimens retested for laxity and then loaded to failure simulating either anterior or posterior dislocation. Testing of intact specimens showed that the posterior ligaments were stiffer than other structures in that it was significantly more difficult to posteriorly displace the SCJ than in any other direction and that the capsule was the important anterior structure affecting joint laxity. Load-to-failure testing showed that it required 50% more force to create a failure by posterior dislocation than by anterior dislocation. The results of this study explain the clinical rarity of posterior sternoclavicular joint dislocations
— id: 44558, year: 2000, vol: 59, page: 153, stat: Journal Article,

The effects of diabetes on outcome after hip fracture
Dubey A; Aharonoff GB; Zuckerman JD; Koval KJ
2000 ;59(2):94-98, Bulletin (Hospital for Joint Diseases)
Recent studies have suggested that patients with a history of diabetes undergoing hip fracture stabilization have higher rates of morbidity and mortality as well as poorer functional results than control groups of non-diabetics. This study was performed to evaluate the effect of diabetes on patient outcome after hip fracture. Between July 1987 and December 1996, 849 community dwelling elderly who sustained an operatively treated hip fracture were prospectively followed to determine the effect of diabetes on patient outcome. The predictor variable was the presence or absence of diabetes mellitus. Ninety-three patients (11%) had a history of diabetes. Diabetic patients were more dependent in activities of daily living and ambulation prior to hip fracture. The presence of diabetes mellitus also increased the likelihood of a patient dying during hospitalization, but had no effect on recovery of ambulatory ability or activities of daily living. Although diabetic patients have increased in-hospital mortality when compared to non-diabetic patients, patients with diabetes are just as likely to recover pre-fracture functional status as non-diabetic patients
— id: 44560, year: 2000, vol: 59, page: 94, stat: Journal Article,

Selected orthopedic problems in the elderly
Goldstein J; Zuckerman JD
2000 Aug;26(3):593-616, Rheumatic diseases clinics of North America
The changes that occur in the body as part of the normal aging process and the degenerative changes that often accompany them predispose the elderly to various orthopedic problems. Age, general health, and functional level are all important factors in determining the optimum management of these patients. Treatments are aimed at restoring patient independence and activity to preinjury levels, while at the same time minimizing the risks of treatment complications
— id: 44559, year: 2000, vol: 26, page: 593, 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,

Hip arthroplasty with a collared straight cobalt-chrome femoral stem using second-generation cementing technique: a 10-year-average follow-up study
Kale AA; Della Valle CJ; Frankel VH; Stuchin SA; Zuckerman JD; Di Cesare PE
2000 Feb;15(2):187-193, Journal of arthroplasty
Clinical and radiographic results of 116 patients who had undergone 132 hip arthroplasties at our institution from 1983 to 1988 with a collared cemented straight cobalt-chrome femoral stem using second-generation cementing technique were reviewed. Twenty hips in 20 patients who were part of the original cohort were lost to follow-up. Mean age at the time of surgery was 68.2 years. Mean radiographic follow-up was 9.6 years with a minimum follow-up of 5 years. Ten-year survivorship of the component was 96.5% with revision considered as an endpoint and 94.2% with either revision or radiographic loosening considered the endpoint. Three implants (2.3%) were revised for aseptic loosening at a mean of 8.1 years after implantation. One implant (0.8%) was revised for septic loosening at 10.5 years after surgery. Of the implants not revised, 1 showed evidence of circumferential bone-cement radiolucencies, and 1 had radiolucencies at the implant-cement interface. Five of the surviving femoral components (5.0%) showed focal areas of cystic osteolysis, and proximal femoral bone resorption under the collar was seen in 32 patients (31.7%). There were no cases of cement fracture or stem subsidence. The biomechanical and material properties of this stem combined with second-generation cementing technique look promising for long-term survivorship
— id: 44564, year: 2000, vol: 15, page: 187, stat: Journal Article,

Hip fractures : a practical guide to management
Koval, Kenneth J.; Zuckerman, Joseph D. (Joseph David)
New York : Springer, c2000,
— id: 708, year: 2000, vol: , page: , stat: ,

Sternoclavicular joint injuries and disorders
Medvecky MJ; Zuckerman JD
2000 ;49(3):397-406, Instructional course lectures (American Association of Orthopaedic Surgeons)
— id: 44563, year: 2000, vol: 49, page: 397, stat: Journal Article,

The predictive value of indium-111 leukocyte scans in the diagnosis of infected total hip, knee, or resection arthroplasties
Scher DM; Pak K; Lonner JH; Finkel JE; Zuckerman JD; Di Cesare PE
2000 Apr;15(3):295-300, Journal of arthroplasty
To evaluate the usefulness of the indium-111 scan in detecting actually or potentially infected total hip, knee, and resection arthroplasties, 153 scans were performed on 143 patients who underwent reoperation for a loose or painful total joint arthroplasty or a resection arthroplasty between 1990 and 1996. Scans were interpreted as infected, not infected, or equivocal by an experienced nuclear medicine radiologist. Patients were considered to be infected if they met any 2 of the following criteria: i) positive intraoperative cultures, ii) final permanent histologic section indicating acute inflammation, and iii) intraoperative findings of gross purulence within the joint. Twenty-six patients (17%) met the infection criteria at the time of reoperation. Indium scans were found to have a 77% sensitivity, 86% specificity, 54% and 95% positive and negative predictive values, and 84% accuracy for the prediction of infection. Of 6 equivocal scans, none were infected. The results of this study suggest limited indications for the use of the indium-111 scan in the evaluation of painful hip, knee, or resection arthroplasties. A negative indium scan may be helpful in suggesting the absence of infection in cases in which the diagnosis is not otherwise evident
— id: 38889, year: 2000, vol: 15, page: 295, stat: Journal Article,

Effect of previous cerebrovascular accident on outcome after hip fracture
Youm T; Aharonoff G; Zuckerman JD; Koval KJ
2000 Jun-Jul;14(5):329-334, Journal of orthopaedic trauma
OBJECTIVE: To evaluate the effect of previous cerebrovascular accident on outcome after hip fracture. STUDY DESIGN: Prospective, consecutive. PATIENTS: From July 1987 to March 1997, 862 community-dwelling patients sixty-five years of age or older who had sustained an operatively treated femoral neck or intertrochanteric fracture were prospectively followed. INTERVENTION: All patients had operative fracture treatment. MAIN OUTCOME MEASUREMENTS: Postoperative complications, in-hospital mortality, hospital length of stay, hospital discharge status, one-year mortality and place of residence, and return to preinjury ambulatory level, basic and instrumental activities of daily living status. RESULTS: Sixty-three patients (7.3 percent) had a history of cerebrovascular accident; the fracture was on the hemiplegic side in forty-six (86.8 percent) of the fifty-three patients with hemiplegia. Patients who had a history of cerebrovascular accident were more likely to be male and have an American Society of Anesthesiologists (ASA) rating of III or IV. They were also more likely to have three or more comorbidities, be a home ambulator, and be dependent on basic and instrumental activities of daily living before hip fracture. Hospital length of stay was significantly higher for patients who had a history of cerebrovascular accident. There were no differences in the incidence of hospital mortality or one-year mortality between patients who did and did not have a history of cerebrovascular accident before hip fracture. In addition, at one-year follow-up, when controlling for prefracture level of function, there were no differences in the rate of functional recovery between the two groups of patients. CONCLUSIONS: The functional recovery of elderly hip fracture patients who had a prior cerebrovascular accident was similar to that of patients who had no history of a prior cerebrovascular accident
— id: 44562, year: 2000, vol: 14, page: 329, stat: Journal Article,

A functional recovery score for elderly hip fracture patients: I. Development
Zuckerman JD; Koval KJ; Aharonoff GB; Hiebert R; Skovron ML
2000 Jan;14(1):20-25, Journal of orthopaedic trauma
OBJECTIVE: To develop a Functional Recovery Score for ambulatory elderly hip fracture patients related to independent functioning to assess restoration of function to prefracture status. STUDY DESIGN/METHODS: The phases of this effort consisted of: (a) identification of five relevant components represented by sixteen specific functional capacities; (b) assessment of the importance independent community-dwelling elderly gave to the sixteen functional capacities; (c) pilot testing of a sixteen-item preliminary questionnaire in recovering elderly hip fracture patients; and (d) modification of the questionnaire to an eleven-item score. RESULTS: The resulting eleven-item Functional Recovery Score is comprised of three main components: basic activities of daily living (BADL) assessed by four items, instrumental activities of daily living (IADL) assessed by six items, and mobility assessed by one item. Basic activities of daily living comprise 44 percent of the score; instrumental activities of daily living comprise 23 percent, and mobility comprises 33 percent. Complete independence in basic and instrumental activities of daily living and mobility results in a score of 100 percent
— id: 44566, year: 2000, vol: 14, page: 20, stat: Journal Article,

A functional recovery score for elderly hip fracture patients: II. Validity and reliability
Zuckerman JD; Koval KJ; Aharonoff GB; Skovron ML
2000 Jan;14(1):26-30, Journal of orthopaedic trauma
OBJECTIVE: To assess predictive and discriminant validity and responsiveness of the Functional Recovery Score, a disease-specific health assessment tool. STUDY DESIGN: Prospective, consecutive. METHODS: Six hundred eighty-two elderly patients who sustained a hip fracture were prospectively followed and evaluated by using the Functional Recovery Score at three, six, and twelve months after surgery RESULTS: The Functional Recovery Score (FRS) was found to be responsive to change: scores after hip fracture were significantly lower at three months than prefracture, increased significantly from three to six months, and increased slightly between six and twelve months after fracture, consistent with expectation. The FRS had predictive validity: prefracture scores were predictive of death, skilled nursing facility transfer, and rehospitalization within one year of fracture. In addition, the FRS had discriminant validity. Mean scores for the following groups were significantly different from each other at three and six months: (a) patients who were alive, living in the community, and did not require rehospitalization; (b) those who were admitted to a skilled nursing facility; and (c) those who were rehospitalized. Comparison of the FRS with a sex- and age-matched non-hip-fracture population indicated that hip fracture resulted in a 20 percent loss of function within the first year. Reliability testing of telephone interviews of patients as a means of obtaining information indicated very high reliability. CONCLUSION: The Functional Recovery Score is a reliable method of assessing functional outcome for elderly hip fracture patients
— id: 44565, year: 2000, vol: 14, page: 26, stat: Journal Article,

Characterization of acromial concavity. An in vitro computer analysis
Zuckerman JD; Kummer FJ; Panos SN
2000 ;59(2):69-72, Bulletin (Hospital for Joint Diseases)
Variations in the shape and orientation of the anterior acromion have been implicated as predisposing factors for the development of rotator cuff problems. We determined and analyzed by computer digitization the anterior and posterior acromial slopes for 141 cadaver shoulders (whose rotator cuff status had been previously assessed). No significant differences in either the anterior or posterior angle were found between the intact and rotator cuff tear groups. Frequency histograms of both angles demonstrated continuous, normal distributions. The individual acromions were consistently asymmetric in that the anterior slope was larger than the posterior slope. However, the anterior slope distribution did not reveal groupings indicative of the specific acromial types previously reported. These results suggest that acromial classification into flat, curved, and hooked types does not accurately describe the actual anatomical findings
— id: 44561, year: 2000, vol: 59, page: 69, stat: Journal Article,

Hemiarthroplasty for cuff tear arthropathy [In Process Citation]
Zuckerman JD; Scott AJ; Gallagher MA
2000 May-Jun;9(3):169-172, Journal of shoulder & elbow surgery
A retrospective review was conducted on 15 cases of shoulder hemiarthroplasty performed for cuff tear arthropathy. All cases had advanced glenohumeral arthritis with complete supraspinatus and infraspinatus rupture and substantial involvement of the teres minor and subscapularis. The mean patient age was 73 years; the mean follow-up was 28.2 months. Range of motion, functional ability, pain relief, and overall patient satisfaction were assessed preoperatively and postoperatively. The average active forward elevation increased from 69 degrees to 86 degrees, and the average active external rotation increased from 15 degrees to 29 degrees. Thirteen patients had an increase in their ability to perform activities of daily living, 1 patient was unchanged, and 1 patient had a decrease in ability to perform activities of daily living. Pain relief was significantly improved in all but 1 patient. Eleven patients (13 of 15 shoulders, 87%) expressed an overall satisfaction with their surgery. Patients were assessed preoperatively and postoperatively through use of the UCLA Rating Scale; the average increase was 11 to 22 points. In addition, isokinetic strength testing was performed preoperatively and postoperatively on 6 of the 15 involved shoulders. An increase in peak torque in forward elevation, abduction, and external rotation was noted postoperatively. The findings of this study indicate that favorable clinical results can be obtained after hemiarthroplasty of the shoulder with associated massive rotator cuff deficiency
— id: 11606, year: 2000, vol: 9, page: 169, stat: Journal Article,

Analysis of frozen sections of intraoperative specimens obtained at the time of reoperation after hip or knee resection arthroplasty for the treatment of infection
Della Valle CJ; Bogner E; Desai P; Lonner JH; Adler E; Zuckerman JD; Di Cesare PE
1999 May;81(5):684-689, Journal of bone & joint surgery (American volume)
BACKGROUND: Despite the effectiveness of a two-stage exchange protocol for the treatment of deep periprosthetic infection, infection can persist after resection arthroplasty and treatment with antibiotics, leading to a failed second-stage reconstruction. Intraoperative analysis of frozen sections has been shown to have a high sensitivity and specificity for the identification of infection at the time of revision arthroplasty; however, the usefulness of this test at the time of reoperation after resection arthroplasty and treatment with antibiotics is, to our knowledge, unknown. METHODS: The medical records of sixty-four consecutive patients who had had a resection arthroplasty of either the knee (thirty-three patients) or the hip (thirty-one patients) and had had intraoperative analysis of frozen sections of periprosthetic tissue obtained at the time of a second-stage operation were reviewed. The mean interval between the resection arthroplasty and the attempted reimplantation was nineteen weeks. The results of the intraoperative analysis of the frozen sections were compared with those of analysis of permanent histological sections of the same tissues and with those of intraoperative cultures of specimens obtained from within the joint. The findings of the analyses of the frozen sections and the permanent histological sections were considered to be consistent with acute inflammation and infection if a mean of ten polymorphonuclear leukocytes or more per high-power field (forty times magnification) were seen in the five most cellular areas. RESULTS: The intraoperative frozen sections of the specimens from two patients (one of whom was considered to have a persistent infection) met the criteria for acute inflammation. Four patients were considered to have a persistent infection on the basis of positive intraoperative cultures or permanent histological sections. Overall, intraoperative analysis of frozen sections at the time of reimplantation after resection arthroplasty had a sensitivity of 25 percent (detection of one of four persistent infections), a specificity of 98 percent, a positive predictive value of 50 percent (one of two), a negative predictive value of 95 percent, and an accuracy of 94 percent. CONCLUSIONS: A negative finding on intraoperative analysis of frozen sections has a high predictive value with regard to ruling out the presence of infection; however, the sensitivity of the test for the detection of persistent infection is poor
— id: 56443, year: 1999, vol: 81, page: 684, stat: Journal Article,

The role of intraoperative Gram stain in revision total joint arthroplasty
Della Valle CJ; Scher DM; Kim YH; Oxley CM; Desai P; Zuckerman JD; Di Cesare PE
1999 Jun;14(4):500-504, Journal of arthroplasty
The ability to identify intraoperatively patients with an infected prosthesis at the time of a revision procedure assists the surgeon in selecting appropriate management. The results of 413 intraoperative Gram stains were compared with the results of operative cultures, permanent histology, and the surgeon's intraoperative assessment to determine the ability of Gram stains to identify periprosthetic infection. Gram staining correctly identified the presence of infection in 10 of the 68 cases that met study criteria for infection (sensitivity of 14.7%). Four false-positive Gram stains were encountered. Intraoperative Gram stains do not have adequate sensitivity to be helpful in identifying periprosthetic infection and should not be performed on a routine basis. They may be helpful, however, in cases in which gross purulence is encountered to assist in the selection of initial antibiotic therapy. The use of intraoperative Gram staining alone is inadequate for ruling out infection at the time of revision total joint arthroplasty
— id: 6165, year: 1999, vol: 14, page: 500, stat: Journal Article,

Supratherapeutic levels of heparin anticoagulation result in increased complications
Della, Valle C J; Jazrawi, L M; Zuckerman, J D; Di, Cesare P E
1999 Jun 04-05;29(Suppl. 1):125-125, Haemostasis
— id: 15809, year: 1999, vol: 29, page: 125, stat: Journal Article,

Hip fracture epidemiology: a review
Dubey A; Koval KJ; Zuckerman JD
1999 Sep;28(9):497-506, American journal of orthopedics (Belle Mead, NJ)
The incidence of hip fracture worldwide varies significantly from region to region. Numerous factors such as age, sex, race, site of residence, medical comorbidities, osseous anatomy, nutrition, smoking, and climate can affect the risk of hip fracture. Although no consensus exists for the role of all of these variables in hip fracture incidence, analysis of theses factors may result in a better understanding of hip fracture etiology and development of preventive measures
— id: 11958, year: 1999, vol: 28, page: 497, stat: Journal Article,

Radial head fractures associated with elbow dislocations treated by immediate stabilization and early motion
Frankle MA; Koval KJ; Sanders RW; Zuckerman JD
1999 Jul-Aug;8(4):355-360, Journal of shoulder & elbow surgery
Twenty-one elbow dislocations with an associated radial head fracture were treated with immediate joint reduction, stabilization, and early range-of-motion exercises. In all cases initial treatment involved closed reduction of the ulnohumeral joint. For those cases involving minimally displaced and a few moderately displaced radial head fractures, treatment consisted of benign neglect (4 of 21). Of the more severely displaced fractures (17 of 21), 9 were treated with open-reduction internal fixation and 8 with immediate silicone head replacement. Despite radial head treatment, 6 of these cases remained unstable, prompting primary repair of collateral ligaments; 3 eventually required application of a hinged fixator as a salvage option. Results confirmed that initial radial head displacement predicts functional outcome. Our study demonstrates that fracture dislocations of the elbow demand a broad consideration of treatment options and that reconstruction of elbow stability requires either primary repair of collateral ligaments or the possible use of a hinged fixator device
— id: 44567, year: 1999, vol: 8, page: 355, stat: Journal Article,

Internal fixation of femoral neck fractures with posterior comminution: a biomechanical study
Kauffman JI; Simon JA; Kummer FJ; Pearlman CJ; Zuckerman JD; Koval KJ
1999 Mar-Apr;13(3):155-159, Journal of orthopaedic trauma
OBJECTIVES: This study was performed to determine whether four cancellous lag screws provide significantly improved rigidity and fixation strength compared with three screws for fixation of displaced femoral neck fractures with posterior comminution. DESIGN: Biomechanical cadaver study. INTERVENTION: Eight pairs of mildly osteopenic femurs were selected, and each pair was fixed with three or four cancellous lag screws (randomly assigned) after the creation of a simulated femoral neck fracture with posterior comminution. A separate comparison with an unmatched group of six similar femurs with a simulated femoral neck fracture without posterior comminution and instrumented with three screws was performed to investigate the effect of posterior comminution. MAIN OUTCOME MEASUREMENT: The specimens were non-destructively tested to determine fixation rigidity in axial and anterior loading. Cyclic axial loading was then performed for 10,000 cycles; the femurs were retested for rigidity and finally were axially loaded until failure. RESULTS: The femurs with a posterior defect stabilized with three screws had significantly less resistance to axial and anterior displacement and sustained significantly lower axial loads to failure than those stabilized with four screws. The specimens instrumented with three screws without a posterior defect exhibited greater resistance to displacement in anterior loading and sustained greater axial loads to failure than those with a posterior defect stabilized with three screws. CONCLUSION: This study suggests that there are benefits to using four screws for fixation of femoral neck fractures with posterior comminution
— id: 6087, year: 1999, vol: 13, page: 155, stat: Journal Article,

A standardized method for assessment of elbow function. Research Committee, American Shoulder and Elbow Surgeons
King GJ; Richards RR; Zuckerman JD; Blasier R; Dillman C; Friedman RJ; Gartsman GM; Iannotti JP; Murnahan JP; Mow VC; Woo SL
1999 Jul-Aug;8(4):351-354, Journal of shoulder & elbow surgery
The American Shoulder and Elbow Surgeons have adopted a standardized form for assessment of the elbow. This form was developed by the Research Committee of the American Shoulder and Elbow Surgeons and subsequently adopted by the membership. The patient self-evaluation section contains visual analog scales for pain and a series of questions relating to function of the extremity. The responses to the questions are scored on a 4-point ordinal scale. The physician assessment section has 4 parts: motion, stability, strength, and physical findings. It is hoped that adoption of this method of data collection will stimulate multicenter studies and improve communication between professionals who assess and treat patients with elbow disorders
— id: 44568, year: 1999, vol: 8, page: 351, stat: Journal Article,

Hip fracture in the elderly: the effect of anesthetic technique
Koval KJ; Aharonoff GB; Rosenberg AD; Schmigelski C; Bernstein RL; Zuckerman JD
1999 Jan;22(1):31-34, Orthopedics (Thorofare NJ)
Seven hundred forty-nine community-dwelling, previously ambulatory, elderly patients who sustained a femoral neck or intertrochanteric fracture underwent prospective follow-up to determine whether anesthetic technique (spinal or general) had an effect on inpatient morbidity and mortality, or 1-year mortality. One hundred seven patients were excluded from the study as the anesthetic technique was 'predetermined' based on a underlying medical condition. Of the remaining 642 patients, 362 (56.4%) received general and 280 (43.6%) received spinal anesthesia. Twenty (3.1%) patients died during hospitalization; 73 (11.4%) patients developed one or more postoperative medical complications. The 1-year mortality rate was 12.1%. There was no difference in inpatient morbidity and mortality, or 1-year mortality rates between patients receiving general or spinal anesthesia
— id: 6047, year: 1999, vol: 22, page: 31, stat: Journal Article,

The effects of nutritional status on outcome after hip fracture
Koval KJ; Maurer SG; Su ET; Aharonoff GB; Zuckerman JD
1999 Mar-Apr;13(3):164-169, Journal of orthopaedic trauma
OBJECTIVE: To determine the effect of nutrition on patient outcome after hip fracture. STUDY DESIGN: Retrospective review of prospectively collected data. METHODS: Four hundred ninety hip fracture patients had albumin and total lymphocyte count levels determined at the time of admission and constituted the study population. These variables were examined as predictors for outcomes, including: in-hospital mortality, postoperative complications, hospital length of stay, hospital discharge status, one-year mortality rate, ambulatory ability, and independence in basic and instrumental activities of daily living twelve months after surgery. RESULTS: Eighty-seven patients (18 percent) were found to be malnourished on hospital admission based on a preoperative albumin level of < 3.5 grams/deciliter, and 280 patients (57 percent) based on a total lymphocyte count of < 1,500 cells/milliliter. An albumin level of < 3.5 grams/deciliter was predictive for increased length of stay (p = 0.03) and for in-hospital mortality (p = 0.03). A total lymphocyte count < 1,500 cells/milliliter was predictive for one-year mortality (p < 0.01). Patients with abnormal albumin and total lymphocyte count were 2.9 times more likely to have a length of stay greater than two weeks (p = 0.03), 3.9 times more likely to die within one year after surgery (p = 0.02), and 4.6 times less likely to recover their prefracture level of independence in basic activities of daily living (p < 0.01). Neither parameter was predictive for patients developing a postoperative complication, hospital discharge status (home versus nursing home), recovery of prefracture ambulatory ability, or independence in instrumental activities of daily living at twelve-month follow-up. CONCLUSION: Patients at risk for poor outcomes after hip fracture can be identified using relatively inexpensive laboratory tests such as albumin and total lymphocyte count
— id: 6088, year: 1999, vol: 13, page: 164, stat: Journal Article,

Osteonecrosis of the humeral head
Loebenberg MI; Plate AM; Zuckerman JD
1999 ;48:349-357, Instructional course lectures (American Association of Orthopaedic Surgeons)
— id: 56414, year: 1999, vol: 48, page: 349, stat: Journal Article,

Long-term functional outcome of repair of large and massive chronic tears of the rotator cuff
Rokito AS; Cuomo F; Gallagher MA; Zuckerman JD
1999 Jul;81(7):991-997, Journal of bone & joint surgery (American volume)
BACKGROUND: There have been conflicting reports regarding the effect of the size of a tear of the rotator cuff on the ultimate functional outcome after repair of the rotator cuff. While some authors have reported that the size of the tear does not adversely affect the overall result of repair, others have reported that the outcome is less predictable after repair of a large tear than after repair of a small tear. The purpose of the present study was to examine the long-term functional outcome and the recovery of strength in thirty consecutive patients who had had repair of a large or massive tear of the rotator cuff. METHODS: Thirty consecutive patients who had operative repair of a large or massive chronic tear of the rotator cuff had a comprehensive isokinetic assessment of the strength of the shoulder preoperatively, twelve months postoperatively, and a mean of sixty-five months (range, forty-six to ninety-three months) postoperatively. The functional outcome was assessed with the University of California at Los Angeles shoulder score. RESULTS: All patients reported that they were satisfied with the result and had increased strength compared with preoperatively. There was a significant decrease in pain (p < 0.01) and significant improvements in function (p < 0.01) and the range of motion (p < 0.01). The mean University of California at Los Angeles shoulder score increased significantly from 12.3 points preoperatively to 31.0 points at the most recent follow-up examination (p < 0.01). The mean peak torque in flexion, abduction, and external rotation increased significantly to 80 percent (p < 0.01), 73 percent (p < 0.01), and 91 percent (p < 0.01), respectively, of that of the uninvolved shoulder by the time of the most recent follow-up examination. CONCLUSIONS: Repair of a large or massive tear of the rotator cuff can have a satisfactory long-term outcome. The results of the present study suggest that more than one year is needed for complete restoration of strength. The strength of the affected shoulders still did not equal that of the unaffected, contralateral shoulders by the time of the long-term follow-up
— id: 56462, year: 1999, vol: 81, page: 991, stat: Journal Article,

The real cost of avoiding blood transfusions during total hip replacement
Rosenberg, AD; Mirzabeigi, E; Koval, KJ; Della Valle, C; Wheeler, MC; Zuckerman, JD
1999 OCT ;39(10):26S-26S, Transfusion
— id: 53808, year: 1999, vol: 39, page: 26S, stat: Journal Article,

The most cost efficient method of avoiding allogeneic transfusions in patients undergoing total knee replacement (TKR)
Rosenberg, AD; Mirzabeigi, E; Koval, KJ; Rosenberg, GD; Wheeler, MC; Zuckerman, JD
1999 OCT ;39(10):26S-26S, Transfusion
— id: 53809, year: 1999, vol: 39, page: 26S, stat: Journal Article,

Do all hip fractures result from a fall?
Youm T; Koval KJ; Kummer FJ; Zuckerman JD
1999 Mar;28(3):190-194, American journal of orthopedics (Belle Mead, NJ)
Although most fractures of the proximal femur result from a fall and are related to direct loads to the hip, there is evidence that intrinsic factors, such as muscle contraction, can result in a hip fracture and subsequent fall. This paper reviews the current literature on the various mechanisms of femoral neck and intertrochanteric fractures
— id: 12026, year: 1999, vol: 28, page: 190, stat: Journal Article,

The economic impact of geriatric hip fractures
Youm T; Koval KJ; Zuckerman JD
1999 Jul;28(7):423-428, American journal of orthopedics (Belle Mead, NJ)
Hip fractures, a significant cause of morbidity and mortality in the elderly, are expected to exponentially increase in frequency over the next 50 years as a result of increased life expectancy and population growth. The economic impact of the cost of hip fractures may be enormous. The overall cost of hip fractures includes not only death and illness, but also the costs of medical and custodial care, functional limitations, reduced quality of life, loss of independence, and inability to work, as well as other factors that are difficult to assess--most notably, the indirect effect of the hip fracture on the spouse or family members responsible for care. This review will evaluate the cost of geriatric hip fractures in the hopes of defining the enormous socioeconomic burden of such fractures
— id: 44569, year: 1999, vol: 28, page: 423, stat: Journal Article,

Normal shoulder proprioception and the effect of lidocaine injection
Zuckerman JD; Gallagher MA; Lehman C; Kraushaar BS; Choueka J
1999 Jan-Feb;8(1):11-16, Journal of shoulder & elbow surgery
The purpose of this study was to investigate the effect of age, dominance, joint position, and lidocaine injection on proprioception of the normal shoulder. Position sense and the detection of passive shoulder motion were investigated in 40 young (20 to 30 years) and old (50 to 70 years) subjects. An additional 20 young subjects were tested before and after a glenohumeral (n = 10) or a subacromial (n = 10) lidocaine injection was performed. A significant decline occurred in proprioception between the young and old age groups. No difference was observed between dominant and nondominant sides. Position sense was consistently less accurate in the maximum range of motion tested when compared with the lesser ranges tested for flexion and abduction. No differences were identified in the ability to detect motion in flexion, abduction, and external rotation in the younger group, whereas in the older group a difference was observed in flexion. No learning effect was detected for any test trial. No significant changes occurred in proprioceptive ability after either glenohumeral or subacromial lidocaine injection was performed
— id: 56408, year: 1999, vol: 8, page: 11, stat: Journal Article,

Circumstances of falls causing hip fractures in the elderly
Aharonoff GB; Dennis MG; Elshinawy A; Zuckerman JD; Koval KJ
1998 Mar;(348):10-14, Clinical orthopaedics & related research
A prospective analysis was performed on 832 patients to determine the circumstances surrounding falls leading to hip fracture within a homogeneous, elderly urban population. Special emphasis was placed on the season of year, time of day, location of fall, and other circumstances in which the fracture occurred. All patients were community dwelling, cognitively intact, previously ambulatory elderly who sustained a femoral neck or intertrochanteric fracture. Most fractures occurred at home, particularly in patients who were older, less healthy, and poorer ambulators. More than 75% of fractures resulted from a fall while the patient was standing or walking. Most falls occurred during daylight hours with a peak seen in the afternoon. No seasonal variation in the incidence of hip fractures was observed
— id: 47449, year: 1998, vol: , page: 10, stat: Journal Article,

Open versus arthroscopic decompression for subacromial impingement. A comprehensive review of the literature from the last 25 years
Checroun AJ; Dennis MG; Zuckerman JD
1998 ;57(3):145-151, Bulletin (Hospital for Joint Diseases)
The operative management (open versus arthroscopic) of subacromial impingement was investigated through a search of the English-language literature from 1970 to 1996. Thirty-four clinical studies comprising 1,935 patients met the following selection criteria: a study published in a peer reviewed journal, a valid materials and methods section (describing age, gender, number of subjects, follow-up period, treatment modality, and impingement stage), and acromioplasty without rotator cuff repair. Six hundred and ninety-eight patients had an open decompression (OD) and 1,237 had an arthroscopic subacromial decompression (ASD) for Stage II and III impingement. When possible, only Stage II patients were reviewed. A few studies combined Stage II and III patients in their results; thus, the patients were placed into two groups (OD and ASD) composed of four categories: OD of Stage II impingement (494 patients), OD of Stage II and III impingement (204 patients), ASD of Stage II impingement (727 patients), and ASD of Stage II and III impingement (510 patients). The average duration of symptoms before surgery ranged from 6 months to 43 months in the OD group and 6 months to 61 months in the ASD group. The average age was 41.8 and 42.1 years, clinical follow-up 6 months to 62 months and 12 months to 41 months in the OD and ASD groups, respectively. The objective success rates were 83.3% versus 81.4% and the subjective success rates were 90.0% versus 89.3% for OD versus ASD, respectively. Return to work ranged from 43% to 100% in the OD group and 74% to 100% in the ASD group. Based on our review, the outcome from ASD is similar to OD. For persistent stage II primary impingement, we recommend starting with ASD and reserve OD for surgical failures. ASD allows earlier rehabilitation than OD because complete detachment of the deltoid is not performed, yet ASD is technically more demanding and has a long learning curve
— id: 57024, year: 1998, vol: 57, page: 145, stat: Journal Article,

Results of cemented metal-backed acetabular components: a 10-year-average follow-up study
Chen FS; Di Cesare PE; Kale AA; Lee JF; Frankel VH; Stuchin SA; Zuckerman JD
1998 Dec;13(8):867-873, Journal of arthroplasty
The clinical and radiographic results of 86 primary total hip arthroplasties performed in 74 patients from 1983 to 1987 with a cemented metal-backed acetabular component and a cemented collared straight femoral stem with a 32-mm head were reviewed at a mean follow-up of 10.1 years. Seven patients (9.2%) underwent acetabular component revision at a mean of 9.0 years after implantation; an additional 24 components (31.6%) demonstrated evidence of radiographic loosening, resulting in a total failure rate of 40.8%. Periacetabular radiolucencies were noted in Charnley zones at the following rates: 34.2% in zone I, 18.4% in zone II, and 27.6% in zone III. In addition, 18.4% and 38.2% of implants demonstrated evidence of migration and excessive polyethylene wear. Excessively vertical cup placement (>49 degrees inclination) at the time of initial arthroplasty was statistically correlated with polyethylene wear, implant migration, and fixation failure. A trend of increasing implant failure was also noted with decreasing polyethylene liner thickness. Periacetabular cement mantle thickness was not statistically correlated with subsequent component loosening or failure. Results of Kaplan-Meier survivorship analysis using revision as an endpoint showed 93.6% survivorship at 10 years and 88.4% at 12 years. The mean modified Harris hip scores were 46.9 preoperatively and 81.8 at final follow-up. The significant overall rates of radiographic loosening, migration, polyethylene wear, and implant revision confirm the suspected trend of increasing failure rates of cemented metal-backed acetabular components over time
— id: 6042, year: 1998, vol: 13, page: 867, stat: Journal Article,

The rheumatoid shoulder
Cuomo F; Greller MJ; Zuckerman JD
1998 Feb;24(1):67-82, Rheumatic diseases clinics of North America
Rheumatoid arthritis of the glenohumeral joint can produce significant pain and disability that interferes with the ability to perform even the basic activities of daily living. In this article the authors discuss the epidemiologic aspects of rheumatoid arthritis, the pathologic condition as it affects the shoulder complex (consisting of the glenohumeral, acromioclavicular, and sternoclavicular joints), the differential diagnosis, clinical and radiographic manifestations, and treatment approaches designed to maintain or regain function
— id: 7538, year: 1998, vol: 24, page: 67, stat: Journal Article,

The influence of acromioclavicular joint morphology on rotator cuff tears
Cuomo F; Kummer FJ; Zuckerman JD; Lyon T; Blair B; Olsen T
1998 Nov-Dec;7(6):555-559, Journal of shoulder & elbow surgery
A detailed anatomic study of 123 shoulders was performed to define the location of the acromioclavicular (AC) joint within the supraspinatus outlet and to determine the correlation of AC joint morphologic characteristics with the presence of full-thickness rotator cuff tears (RCTs). The presence, location, and extent of RCTs were first documented for each shoulder, and 2 anatomic landmarks consisting of the anterolateral acromial corner and the inferior midpoint of the AC joint were identified and their positions digitized in 3 dimensions to calculate outlet space and clearance and AC joint locations. High resolution x-ray films were then obtained to determine the extent of degenerative changes including the location and size of inferior osteophytes and joint space. These specimens were cleaned of all soft tissues, and additional measurements were made. All data were entered into a computerized database and analyzed with respect to age, sex, and the presence of RCT. Comparison of age-matched RCT versus non-RCT groups revealed no significant differences in the position of the AC joint within the supraspinatus outlet. When AC joint morphologic characteristics were compared with those of a nontear, age-matched group, no significant differences with regard to joint space narrowing were found, but significantly larger and greater number of osteophytes were identified on both sides of the joint in the RCT group. In conclusion, the position of the AC joint is fairly constant within the supraspinatus outlet and does not appear to predispose to RCTs. The morphology of the AC joint contribution of the tears seems to be acquired in nature rather than inherent in its location within the outlet
— id: 56399, year: 1998, vol: 7, page: 555, stat: Journal Article,

Hip fracture prevention: a review
Dubey A; Koval KJ; Zuckerman JD
1998 Jun;27(6):407-412, American journal of orthopedics (Belle Mead, NJ)
The incidence of hip fractures worldwide is expected to almost quadruple in the next 60 years. Increased cost-containment pressures will focus attention not only on improvements in hip fracture treatment but also on prevention. Three approaches that can prevent hip fractures--preventing falls, preventing and treating bone fragility, and using external hip protectors--are reviewed. Although it is impossible to prevent all hip fractures, these methods may significantly reduce the annual incidence of these fractures
— id: 12101, year: 1998, vol: 27, page: 407, stat: Journal Article,

Risk of hip fracture in individuals aged 65 and over in New York state: Little change between 1985 and 1996
Hiebert R; Aharonoff G; Koval K; Zuckerman J
1998 ;46(9):S54-S54, Journal of the American Geriatrics Society
— id: 8151, year: 1998, vol: 46, page: S54, stat: Journal Article,

The effect of intraarticular anesthesia and elastic bandage on elbow proprioception
Khabie V; Schwartz MC; Rokito AS; Gallagher MA; Cuomo F; Zuckerman JD
1998 Sep-Oct;7(5):501-504, Journal of shoulder & elbow surgery
Twenty uninjured male volunteers were studied to characterize normal elbow proprioception and to investigate the effect of applying an elastic bandage to the extremity and injection of an intraarticular anesthetic. A modified Biodex dynamometer was used to study position sense and detection of motion. In part 1 of the study position sense was tested by flexing the elbow to a predetermined angle, returning to the starting position, and then asking the subject to identify that angle. In part 2 detection of motion was tested by asking the subject to disengage the apparatus by pressing a stop button when movement was detected. The testing conditions in part 1 and part 2 were repeated after the elbow was wrapped with an elastic bandage and again after an intraarticular injection of 3 cc 1% lidocaine with the bandage removed. Ten additional subjects underwent testing of both elbows to examine the effect of arm dominance. Mean position sense was within 3.3 degrees+/-1.3 degrees of the actual angle in trials without an elastic bandage or an anesthetic. A significant improvement in position sense was observed (2.2 degrees+/-1.2 degrees) after an elastic bandage was applied (P < .004). No significant difference was seen in position sense after lidocaine was injected. The mean threshold for detection of motion in trials without an elastic bandage or an anesthetic was 4.21 degrees+/-1.56 degrees. No significant differences were seen in detection of motion observed with the elastic bandage or intraarticular anesthetic. No significant differences were seen between dominant and nondominant extremities for both position sense and detection of motion. The application of an elastic bandage improved position sense, suggesting that tactile cues from cutaneous or other extraarticular receptors may play a role in elbow proprioception. Intraarticular anesthesia, however, had little effect, suggesting that intracapsular receptors play a lesser role in elbow proprioception. The determination of proprioceptive qualities for the normal elbow can aid in the understanding of elbow function and provide a basis for defining its role in elbow dysfunction
— id: 57041, year: 1998, vol: 7, page: 501, stat: Journal Article,

Functional outcome after hip fracture. Effect of general versus regional anesthesia
Koval KJ; Aharonoff GB; Rosenberg AD; Bernstein RL; Zuckerman JD
1998 Mar;(348):37-41, Clinical orthopaedics & related research
The effect of anesthetic technique on ambulation and functional recovery after hip fracture was studied in a series of 631 community dwelling, elderly patients. Functional recovery at followup was determined by an 11-item functional rating scale. In univariate analysis, recovery of ambulatory ability and percent functional recovery were significantly higher at 6 months for patients who had general anesthesia. When controlling for potential confounding variables, however, no differences were observed in recovery of ambulatory ability or percent functional recovery between the two groups at 3, 6, or 12 months after hip fracture
— id: 47452, year: 1998, vol: , page: 37, stat: Journal Article,

Effect of acute inpatient rehabilitation on outcome after fracture of the femoral neck or intertrochanteric fracture
Koval KJ; Aharonoff GB; Su ET; Zuckerman JD
1998 Mar;80(3):357-364, Journal of bone & joint surgery (American volume)
A study was performed to assess the impact of intensive inpatient rehabilitation on the outcome after a fracture of the femoral neck or an intertrochanteric fracture. Before 1990, our hospital did not have an inpatient rehabilitation program. On January 1, 1990, a diagnosis-related-group-exempt (DRG-exempt) acute rehabilitation program was initiated. Patients were discharged to this program after evaluation by a staff physiatrist. Before 1990, twenty-seven (9.0 per cent) of 301 patients were discharged to an outside rehabilitation facility. After January 1990, the percentage of patients who were discharged to the DRG-exempt program increased yearly, from nineteen (17 per cent) of 113 patients in 1990 to forty-one (64 per cent) of sixty-four patients in 1993; this difference was significant (p < 0.01). Before 1990, the average duration of the stay in the hospital was 21.9 days. After January 1990, the average duration for the patients who did not enter the rehabilitation program was 20.0 days whereas the average duration for those who did was 31.4 days (16.1 days for acute care and 15.6 days for the rehabilitation program). There were no differences in the hospital discharge status or in the walking ability, place of residence, need for home assistance, or independence in basic and instrumental activities of daily living at the six and twelve-month follow-up examinations between patients who had been managed before initiation of the rehabilitation program and those managed after it or between patients who had been discharged to this program after its initiation and those who had not. These results raise serious questions regarding the global cost-effectiveness of these programs for patients who have had a fracture of the femoral neck or an intertrochanteric fracture
— id: 57180, year: 1998, vol: 80, page: 357, stat: Journal Article,

Postoperative weight-bearing after a fracture of the femoral neck or an intertrochanteric fracture
Koval KJ; Sala DA; Kummer FJ; Zuckerman JD
1998 Mar;80(3):352-356, Journal of bone & joint surgery (American volume)
Sixty patients who had had operative treatment of a fracture of the femoral neck or an intertrochanteric fracture were allowed to bear weight as tolerated on the injured limb. The average age was seventy-seven years. Computerized gait-testing was performed at one, two, three, six, and twelve weeks postoperatively to quantify weight-bearing. For the purpose of analysis, the patients were divided into three groups according to whether they had internal fixation of a stable fracture, internal fixation of an unstable fracture, or a primary hemiarthroplasty. Thirty-two patients completed the entire twelve-week study. The average amount of weight that these patients placed on the injured limb increased progressively with time. The average load supported by the injured limb was 51 per cent that of the uninjured limb at one week, and it gradually increased to 87 per cent at twelve weeks. During the first three weeks, the patients who had had internal fixation bore substantially less weight than those who had had a hemiarthroplasty. By six weeks, we could detect no significant differences, with the numbers available, among the groups with regard to weight-bearing or other measured gait parameters. We concluded that elderly patients who are allowed to bear weight as tolerated after operative treatment of a fracture of the femoral neck or an intertrochanteric fracture appear to voluntarily limit loading of the injured limb
— id: 57181, year: 1998, vol: 80, page: 352, stat: Journal Article,

Predictors of functional recovery after hip fracture in the elderly
Koval KJ; Skovron ML; Aharonoff GB; Zuckerman JD
1998 Mar;(348):22-28, Clinical orthopaedics & related research
Three hundred thirty-eight community dwelling, ambulatory, elderly patients who sustained a hip fracture were observed prospectively to determine which patient and fracture characteristics at hospital admission predicted functional recovery at 3, 6, and 12 months. Multiple logistic regression was performed to estimate the simultaneous contributions of the predictor variables to failure of functional recovery. Before sustaining a fracture, 16% of patients were dependent on basic activities of daily living and 46% were dependent on instrumental activities of daily living. By 1 year after fracture, 73% of the patients had recovered to their basic activities of daily living status before fracture whereas only 48% had recovered to their instrumental activities of daily living status before fracture. Patients who were age 85 years or older, who lived alone before sustaining a fracture, and who had one or more comorbidities were at increased risk of delay or failure in recovering basic activities of daily living. Only instrumental activities of daily living independence before fracture predicted failure to recover instrumental activities of daily living function by 3 and 6 months after fracture. At 1 year, patient age 85 years or older was the only predictor of failure to recover instrumental activities of daily living function that existed before fracture. Based on characteristics at admission, a group of patients at high risk for failure to recover basic activities of daily living function within 1 year of sustaining a hip fracture can be identified
— id: 47451, year: 1998, vol: , page: 22, stat: Journal Article,

Hip fractures are an increasingly important public health problem
Koval KJ; Zuckerman JD
1998 Mar;(348):2-2, Clinical orthopaedics & related research
— id: 47555, year: 1998, vol: , page: 2, stat: Journal Article,

Fractures in the elderly
Koval, Kenneth J.; Zuckerman, Joseph D. (Joseph David)
Philadelphia : Lippicott-Raven, c1998,
— id: 700, year: 1998, vol: , page: , stat: ,

Update on fractures of the hip
Koval, Kenneth J.; Zuckerman, Joseph D.; Frankel, Victor H
Philadelphia : Lippicott-Raven, c1998,
— id: 601, year: 1998, vol: , page: , stat: ,

The use of the bicipital groove for alignment of the humeral stem in shoulder arthroplasty
Kummer FJ; Perkins R; Zuckerman JD
1998 Mar-Apr;7(2):144-146, Journal of shoulder & elbow surgery
Four hundred twenty humeri were measured to determine humeral head retroversion and its relation to the location of the bicipital groove. Average head retroversion was found to be 28.3 degrees (+/- 13.2 degrees), and the angular orientation of the bicipital groove referenced to the transepicondylar axis was 55.5 degrees (+/- 13.8 degrees). The average difference between these angular orientations was 27.3 degrees (+/- 14.2 degrees). This result implies that the bicipital groove can be used as a landmark for prosthetic stem positioning in shoulder arthroplasty if the center of the lateral aspect of the stem is posteriorly offset approximately 30 degrees from the center of the groove. However, because of the appreciable variation in these averages, the use of the bicipital groove as a reference can result in a significant error of humeral stem alignment, which should be considered when determining the retroversion for a particular patient
— id: 44571, year: 1998, vol: 7, page: 144, stat: Journal Article,

The Medoff sliding plate and a standard sliding hip screw for unstable intertrochanteric fractures: a mechanical comparison in cadaver femurs
Olsson O; Kummer FJ; Ceder L; Koval KJ; Larsson S; Zuckerman JD
1998 Jun;69(3):266-272, Acta orthopaedica Scandinavica
The Medoff sliding plate has a dual side capability along both the femoral shaft and neck to increase theoretically interfragmentary compression and load-sharing in hip fractures. We studied intertrochanteric fracture fixation in cadaveric bone to determine whether this device has a mechanical advantage over a standard sliding hip screw. 2-part and 4-part fractures were created in 12 cadaver femurs. The fractures were fixated and sequentially destabilized; bone and plate strains and fragment displacements were determined during testing, as a function of applied physiological loads before and after short-term cycling. The Medoff sliding plate imposed a higher mean medial cortex strain than the sliding hip screw in all fracture models and at all loading levels, and the difference was statistically significant in the 2-part and in the unstable 4-part fracture models. The loading of the medial cortex region after cycling was approximately 50% higher in the Medoff samples than in the sliding hip screw samples. There were no significant differences in plate strains, fracture displacements or load to failure between the 2 devices. These observations favor the dual sliding principle as regards providing fracture compression and load-sharing, which may explain low failure rates in clinical series of unstable intertrochanteric fractures, treated with the Medoff sliding plate
— id: 18479, year: 1998, vol: 69, page: 266, stat: Journal Article,

Open surgical treatment of anterior glenohumeral instability: an historical perspective and review of the literature. Part I
Rokito AS; Namkoong S; Zuckerman JD; Gallagher MA
1998 Nov;27(11):723-725, American journal of orthopedics (Belle Mead, NJ)
Anterior glenohumeral instability is an undesirable result of trauma to the shoulder. Several surgical treatments for this condition have been developed, beginning in the early years of the twentieth century. Although these procedures were usually popular at their inception, many of them have fallen out of favor as more information has been acquired concerning the long-term results and complications of their use. Often successful in preventing recurrent instability, these earlier procedures also often led to a loss of external rotation, and consequently, function. Newer procedures that aim to prevent recurrent instability while maintaining full range of motion and function have been devised. Part I of this paper presents a brief history of the treatment of glenohumeral instability and a review of the literature, including the Bankart and du Toit procedures. Part II, which will be published in the December 1998 issue, includes the Putti-Platt, Magnuson-Stack, Bristow, and newer procedures
— id: 12054, year: 1998, vol: 27, page: 723, stat: Journal Article,

Open surgical treatment of anterior glenohumeral instability: an historical perspective and review of the literature. Part II
Rokito AS; Namkoong S; Zuckerman JD; Gallagher MA
1998 Dec;27(12):784-790, American journal of orthopedics (Belle Mead, NJ)
Anterior glenohumeral instability is an undesirable result of trauma to the shoulder. Several surgical treatments for this condition have been developed, beginning in the early years of the twentieth century. Although many of these procedures were popular at their inception, many of them have fallen out of favor as more information has been acquired concerning the long-term results and complications of their use. While often successful in preventing recurrent instability, these earlier procedures also often led to a loss of external rotation, and consequently, function. Newer procedures have been devised that aim to prevent recurrent instability while maintaining full range of motion and function. Part I of this paper, published in the November issue, presented a brief history of the treatment of glenohumeral instability and a review of the literature, including the Bankart and du Toit procedures. Part II includes the Putti-Platt, the Magnuson-Stack, the Bristow, and capsular shift procedures
— id: 12049, year: 1998, vol: 27, page: 784, stat: Journal Article,

Examination of the lateral antebrachial cutaneous nerve: an anatomic study in human cadavers
Rosen JE; Rokito AS; Khabie V; Zuckerman JD
1998 Oct;27(10):690-692, American journal of orthopedics (Belle Mead, NJ)
Variations in the anatomic course of the cutaneous nerves about the lateral aspect of the elbow are important when surgical exposures and the establishment of arthroscopic portals are considered. The specific anatomic course taken by the lateral antebrachial cutaneous nerve and its relationship to the lateral epicondyle were determined by studying 33 upper extremities in 22 preserved adult cadavers. Considerable anatomic variation was found regarding the location of the lateral antebrachial cutaneous nerve as it crossed the elbow. The nerve pierced the brachial fascia an average of 3.2 cm proximal to the lateral epicondyle and was located an average of 4.5 cm medial to the lateral epicondyle as it crossed the interepicondylar line. In two instances, the nerve passed through the biceps muscle directly, prior to piercing the brachial fascia
— id: 24521, year: 1998, vol: 27, page: 690, stat: Journal Article,

Inpatient rehabilitation after total joint replacement
Zuckerman JD
1998 Mar 18;279(11):880-880, JAMA
— id: 44572, year: 1998, vol: 279, page: 880, stat: Journal Article,

Dedication to Victor H. Frankel
Zuckerman, JD
1998 MAR ;108(348):3-3, Clinical orthopaedics & related research
— id: 53531, year: 1998, vol: 108, page: 3, stat: Journal Article,

Hip fractures in the elderly: predictors of one year mortality
Aharonoff GB; Koval KJ; Skovron ML; Zuckerman JD
1997 Apr;11(3):162-165, Journal of orthopaedic trauma
OBJECTIVE: To determine the one year mortality following hip fracture in an ambulatory, community dwelling, cognitively intact elderly population and to examine the role of specific type, number, and severity of associated medical comorbidities. DESIGN: Prospective, consecutive. METHODS: Six hundred twelve elderly who sustained a non-pathologic hip fracture were followed. RESULTS: Twenty-four patients (4%) died during hospitalization; seventy-eight (12.7%) died within one year of fracture. The factors that were predictive of mortality, based on multivariate analysis, were patient age > 85 years, preinjury dependency in basic activities of daily living, a history of malignancy other than skin cancer, American Society of Anesthesiologists rating of operative risk 3 or 4, and the development of one or more in-hospital postoperative complications; all factors other than the development of an in-hospital complication were independent of treatment. CONCLUSION: These results indicate that efforts at reducing one year mortality after hip fracture should be directed at the prevention of postoperative complications
— id: 7099, year: 1997, vol: 11, page: 162, stat: Journal Article,

Functional recovery following hip fracture in the elderly
Egol KA; Koval KJ; Zuckerman JD
1997 Nov;11(8):594-599, Journal of orthopaedic trauma
— id: 44573, year: 1997, vol: 11, page: 594, stat: Journal Article,

Effects of age, testing speed, and arm dominance on isokinetic strength of the elbow
Gallagher MA; Cuomo F; Polonsky L; Berliner K; Zuckerman JD
1997 Jul-Aug;6(4):340-346, Journal of shoulder & elbow surgery
The strength of active flexion/extension and supination/pronation was measured isokinetically in 60 right-hand-dominant nonathletic men. They were equally divided into a younger group (20 to 30 years) and an older group (50 to 60 years) with moderate occupational and spare-time activity levels. Peak torque, work, power, and the angle of peak torque production were measured bilaterally at a slow (90 degrees/sec) and a fast (180 degrees/sec) speed of movement. Although highly significant differences were found between the young and older groups in flexion and extension, no age-related differences were found in supination and pronation. The dominant side had significantly higher levels of peak torque, work, and power in flexion; however, no significant differences were detected in peak torque for extension, supination, and pronation. Isokinetic peak torque and work were greater at the slower speed as opposed to power, which was significantly greater at the faster speed with the exception of pronation movement. With regard to the angle where peak torque was achieved, significant differences were detected between groups, which suggests that age appears to affect where in the range of motion peak torque is produced
— id: 56948, year: 1997, vol: 6, page: 340, stat: Journal Article,

Pubic rami fracture: a benign pelvic injury?
Koval KJ; Aharonoff GB; Schwartz MC; Alpert S; Cohen G; McShinawy A; Zuckerman JD
1997 Jan;11(1):7-9, Journal of orthopaedic trauma
OBJECTIVE: To present a consecutive series of older patients with pubic rami fractures and evaluate their long term functional outcome. STUDY DESIGN: Retrospective. METHODS: Sixty-three consecutive community-dwelling, ambulatory patients who sustained a public rami fracture and were treated at one hospital were reviewed. Fifty-two of sixty-three patients (83%) had radiographic evidence of pubic rami fracture at initial presentation; in the remaining eleven patients, the diagnosis of pubic rami fracture was made after additional imaging studies. Sixty patients (95%) required hospitalization for pain control and progressive mobilization. RESULTS: The hospital length of stay for the sixty admitted patients averaged fourteen days; patients who had three or more associated medical comorbidities or required use of a cane or walker for ambulation prior to fracture were more likely to have been hospitalized greater than two weeks. Thirty-eight patients were available for one year minimum follow-up; thirty-five of thirty-eight patients (92%) were living at home, 84% had no or mild complaints of hip/groin pain, 92% had returned to their prefracture ambulatory status, and 95% had returned to their performance function in activities of daily living. CONCLUSIONS: 1) Elderly patients with pubic rami fractures utilize substantial healthcare resources based upon length of stay and need for home care services; and 2) those patients who survive have a good prognosis with regard to long term pain relief and functional outcome
— id: 44577, year: 1997, vol: 11, page: 7, stat: Journal Article,

Functional outcome after minimally displaced fractures of the proximal part of the humerus
Koval KJ; Gallagher MA; Marsicano JG; Cuomo F; McShinawy A; Zuckerman JD
1997 Feb;79(2):203-207, Journal of bone & joint surgery (American volume)
One hundred and four patients who had a minimally displaced fracture of the proximal part of the humerus (a so-called one-part fracture) were managed with a standardized therapy regimen and followed for more than one year. The clinical outcome was assessed on the basis of pain, function, and the range of motion of the shoulder. The duration of follow-up averaged forty-one months (range, twelve to 117 months). All fractures united without additional displacement. Eighty patients (77 per cent) had a good or excellent result, fourteen (13 per cent) had a fair result, and ten (10 per cent) had a poor result. Ninety four patients (90 per cent) had either no or mild pain in the shoulder, eight (8 per cent) had moderate pain, and two (2 per cent) had severe pain. Functional recovery averaged 94 per cent; forty-eight patients (46 per cent) had 100 per cent functional recovery. At the time of the most recent follow-up, forward elevation of the injured shoulder averaged 89 per cent; external rotation, 87 per cent; and internal rotation, 88 per cent that of the uninjured shoulder. The percentage of good and excellent results was significantly greater (p < 0.01) and external rotation was significantly better (p < 0.01) at the time of the latest follow-up for the patients who had started supervised physical therapy less than fourteen days after the injury than for the patients who had started such therapy at fourteen days or later
— id: 44575, year: 1997, vol: 79, page: 203, stat: Journal Article,

Rehabilitation after hip fracture in the elderly. The Hospital for Joint Diseases Protocol
Koval KJ; Rosen J; Cahn RM; Zuckerman JD
1997 ;56(1):60-62, Bulletin (Hospital for Joint Diseases)
— id: 44576, year: 1997, vol: 56, page: 60, stat: Journal Article,

Does blood transfusion increase the risk of infection after hip fracture?
Koval KJ; Rosenberg AD; Zuckerman JD; Aharonoff GB; Skovron ML; Bernstein RL; Su E; Chakka M
1997 May;11(4):260-265, Journal of orthopaedic trauma
OBJECTIVE: To determine whether allogeneic red blood cell transfusion is a predictor for developing an in-hospital postoperative urinary tract, respiratory, or wound infection. STUDY DESIGN: Prospective, consecutive. METHODS: Six hundred eighty-seven community-dwelling, ambulatory, geriatric hip fracture patients were prospectively followed; all patients had operative fracture treatment and received perioperative antibiotics. RESULTS: Sixty-eight patients had a culture-positive infection before operative treatment. One hundred thirty-four of the remaining 619 patients (21.6%) developed a postoperative infection, primarily a urinary tract infection. The infection rate was 26.8% in transfused patients compared with 14.9% in nontransfused patients (p = 0.001). When stratifying by the type of infection, only the risk of urinary tract infection was statistically significant (p = 0.001). After controlling for the effect of patient age, sex, number of preinjury medical comorbidities, American Society of Anesthesiologists (ASA) rating of operative risk, fracture type, surgical delay, type of surgery, type of anesthesia, operative time, and blood loss, the relationship between allogeneic red blood cell transfusion and postoperative urinal tract infection remained statistically significant. CONCLUSIONS: Geriatric hip fracture patients who receive allogeneic red blood cell transfusions are at higher risk for developing a postoperative urinary tract infection than are those patients who are not transfused
— id: 7185, year: 1997, vol: 11, page: 260, stat: Journal Article,

Orthopaedic challenges in the aging population: trauma treatment and related clinical issues
Koval KJ; Zuckerman JD
1997 ;46:423-430, Instructional course lectures (American Association of Orthopaedic Surgeons)
— id: 56962, year: 1997, vol: 46, page: 423, stat: Journal Article,

A new technique for stabilization of complex intertrochanteric hip fractures
Kummer FJ; Koval KJ; Zuckerman JD
1997 ;56(2):102-103, Bulletin (Hospital for Joint Diseases)
— id: 56964, year: 1997, vol: 56, page: 102, stat: Journal Article,

Treatment of grade III acromioclavicular separations. Operative versus nonoperative management
Press J; Zuckerman JD; Gallagher M; Cuomo F
1997 ;56(2):77-83, Bulletin (Hospital for Joint Diseases)
Twenty-six patients with Grade III acromioclavicular joint separations were evaluated to determine the outcomes of nonoperative and operative management. Evaluation consisted of a detailed functional questionnaire, physical examination, and comprehensive isokinetic strength assessment. The patients were divided into two groups: operative (n = 16) and nonoperative (n = 10). Operative management consisted of coracoclavicular stabilization with heavy suture material and with nine of the sixteen patients treatment also consisted of coracoacromial ligament transfer and lateral clavicle resection. Nonoperative management consisted of short-term immobilization with early range of motion and rehabilitation. The two groups were similar in all characteristics except mean age: 30.7 years for the operative group and 49.6 years for the nonoperative group. Follow-up evaluation was performed an average of 32.9 months after either injury (nonoperative group) or surgery. Our results indicated that nonoperative management was superior to operative management with respect to time to return to work (0.8 months vs. 2.6 months), time to return to athletics (3.5 months vs. 6.4 months) and time of immobilization (2.7 weeks vs. 6.2 weeks). However, operative management was superior to nonoperative management in the following parameters: time to attain completely pain-free status, the patient's subjective impression of pain, range of motion, functional limitations, cosmesis, and long-term satisfaction. There were no significant differences between the two groups with respect to shoulder range of motion, manual muscle testing, or neurovascular findings. Isokinetic strength testing of the involved shoulder, expressed as a percentage of the uninvolved shoulder, showed no significant differences in peak torque, total work, or total power between the operative and nonoperative groups. However, comparison of the involved to the uninvolved extremity within each group did reveal a trend toward decreased peak torque, work, and power for abduction in the involved extremity regardless of the treatment used. These findings reached statistical significance only for power at the slower testing speed (60 degrees/sec). There was also a significant decrease in power in the involved extremity for external rotation at the faster speed (120 degrees/sec) in the nonoperative group. Finally, the absolute values for peak torque, work, and power were significantly greater for all motions tested in the operative group as compared to the nonoperative group. This may reflect the difference in age between the two groups. Based upon the patients studied, there are benefits to both nonoperative and operative methods of treatment of Grade III acromioclavicular separations. Recovery of strength did not differ between the two groups and therefore should be viewed as a less important factor in patient selection for operative versus nonoperative management. Careful patient selection should remain an important aspect of treatment for this controversial injury
— id: 56980, year: 1997, vol: 56, page: 77, stat: Journal Article,

Outcome assessment after fracture in the elderly
Skovron ML; Koval KJ; Aharonoff GB; Zuckerman JD
1997 ;46:439-443, Instructional course lectures (American Association of Orthopaedic Surgeons)
— id: 56994, year: 1997, vol: 46, page: 439, stat: Journal Article,

Salter-Harris type III fracture-dislocation of the proximal humerus
Wang P Jr; Koval KJ; Lehman W; Strongwater A; Grant A; Zuckerman JD
1997 Jul;6(3):219-222, Journal of pediatric orthopaedics. Pt. B
Salter-Harris type III fractures of the proximal humerus are rare injuries. We report a Salter-Harris type III anterior fracture-dislocation of the proximal humerus in a 10-year-old boy that was open reduced and internally stabilized. A bone scan performed during the initial hospitalization and at 2-year follow-up revealed devascularization and subsequent revascularization of the humeral head. At 2-year follow-up, the patient had full motion of the shoulder, no pain, and arm strength equal to that of the contralateral side. Four cases of Salter-Harris type III fractures of the proximal humerus have been previously reported; good early clinical outcomes were obtained in all. Despite devascularization of the epiphyseal fragment, excellent clinical outcomes may result
— id: 44574, year: 1997, vol: 6, page: 219, stat: Journal Article,

Proximal humeral replacement for complex fractures: indications and surgical technique
Zuckerman JD; Cuomo F; Koval KJ
1997 ;46:7-14, Instructional course lectures (American Association of Orthopaedic Surgeons)
— id: 57011, year: 1997, vol: 46, page: 7, stat: Journal Article,

Interobserver reliability of acromial morphology classification: an anatomic study
Zuckerman JD; Kummer FJ; Cuomo F; Greller M
1997 May-Jun;6(3):286-287, Journal of shoulder & elbow surgery
One hundred ten acromial anatomic specimens were classified by three shoulder surgeons with the classification system described by Bigliani et al. to determine the interobserver reliability. These results demonstrated a fair to poor level of interobserver reliability. Given this relatively low level of agreement, the diagnosis of impingement and rotator cuff tears should be based on clinical findings supplemented, when indicated, by rotatory cuff imaging with less diagnostic reliance placed on the assessment of acromial morphology
— id: 57012, year: 1997, vol: 6, page: 286, stat: Journal Article,

A method for open reduction and internal fixation of the unstable posterior sternoclavicular joint dislocation - Invited commentary
Zuckerman, J
1997 JUL ;11(5):381-381, Journal of orthopaedic trauma
— id: 53596, year: 1997, vol: 11, page: 381, stat: Journal Article,

Untitled - Reply
Zuckerman, JD; Skovron, ML; Koval, PHKJ; Aharonoff, G; Frankel, VH
1997 MAR ;79A(3):470-470, Journal of bone & joint surgery (American volume)
— id: 53211, year: 1997, vol: 79A, page: 470, stat: Journal Article,

Neuropathic Arthropathy: Review of Current Knowledge
Alpert SW; Koval KJ; Zuckerman JD
1996 Mar;4(2):100-108, Journal of the American Academy of Orthopaedic Surgeons
Neuropathic arthropathy is a chronic, progressive degenerative disorder affecting one or more peripheral or vertebral articulations, which develops as the result of a disturbance in the normal sensory (pain or proprioceptive) innervation of joints. Diabetes, syphilis, and syringomelia are the most commonly associated clinical entities. When neuropathic arthropathy is suspected, careful clinical evaluation should be performed to identify an underlying neurologic disorder. Patient education, joint protection, and early recognition of fractures are the most important general management principles. Surgery can be considered in cases of advanced joint destruction when there is significant disability
— id: 57578, year: 1996, vol: 4, page: 100, stat: Journal Article,

Efficacy of injections of corticosteroids for subacromial impingement syndrome
Blair B; Rokito AS; Cuomo F; Jarolem K; Zuckerman JD
1996 Nov;78(11):1685-1689, Journal of bone & joint surgery (American volume)
A prospective, randomized, controlled, double-blind clinical study was performed to determine the short-term efficacy of subacromial injection of corticosteroids for the treatment of subacromial impingement syndrome. Forty patients were randomized to receive either six milliliters of 1 per cent lidocaine without epinephrine (the control group) or two milliliters containing forty milligrams of triamcinolone acetonide per milliliter with four milliliters of 1 per cent lidocaine without epinephrine (the corticosteroid group). The patients were re-examined serially until completion of the study. Nineteen patients, whose mean age was fifty-six years (range, thirty-two to eighty years), were randomized to the corticosteroid group, and twenty-one patients, whose mean age was fifty-seven years (range, thirty-two to eighty-one years), were randomized to the control group. The mean duration of symptoms before the injection was eight months for both groups. Eighteen patients in the corticosteroid group and nineteen patients in the control group had moderate or severe pain before the injection. At the most recent follow-up evaluation, at a mean of thirty-three weeks for the corticosteroid group and twenty-eight weeks for the control group, three patients in the corticosteroid group had moderate or severe pain, compared with fifteen patients in the control group. The mean active range of forward elevation and external rotation improved by 24 and 11 degrees, respectively, for the corticosteroid group and by 10 and 5 degrees, respectively, for the control group. We concluded that subacromial injection of corticosteroids is an effective short-term therapy for the treatment of symptomatic subacromial impingement syndrome. The use of such injections can substantially decrease pain and increase the range of motion of the shoulder
— id: 44578, year: 1996, vol: 78, page: 1685, stat: Journal Article,

The effect of age, speed, and arm dominance on shoulder function in untrained men
Gallagher MA; Zuckerman JD; Cuomo F; Ortiz J
1996 Jan-Feb;5(1):25-31, Journal of shoulder & elbow surgery
Bilateral shoulder motor output measurements were obtained in 40 subjects with a Biodex dynamometer. The subjects included two groups, a younger group (20 to 30 years) and an older group (50 to 60 years). They were engaged in low to moderate levels of occupational and spare-time physical activity. Each subject performed three maximum effort shoulder movements in flexion/extension, abduction/adduction, and internal/external rotation at 60 degrees/sec and 120 degrees/sec. Side tested, axis, and speed were randomly selected. The findings indicate that a significant decline occurred in peak torque, work, and power for all axes of movement at both speeds when the older group was compared with the younger group. A decline in peak torque and work and a corresponding increase in power resulting from an increase in speed occurred in both age groups. The effect of age was the same at 60 degrees/sec and at 120 degrees/sec. Overall, no difference in dominant and nondominant motor function was seen in either the younger or older untrained men
— id: 44583, year: 1996, vol: 5, page: 25, stat: Journal Article,

Patients with femoral neck and intertrochanteric fractures. Are they the same?
Koval KJ; Aharonoff GB; Rokito AS; Lyon T; Zuckerman JD
1996 Sep;(330):166-172, Clinical orthopaedics & related research
A prospective analysis was performed involving 680 geriatric patients with hip fractures to determine whether the demographic profile of patients with femoral neck fractures was similar to that of patients with intertrochanteric fractures. All patients were community dwelling, cognitively intact, previously ambulatory elderly with femoral neck or intertrochanteric fracture. Three hundred fifty-eight patients (52.6%) sustained a femoral neck fracture; 322 (47.4%), an intertrochanteric fracture. Patients with an intertrochanteric fracture were significantly older, more likely to be limited to home ambulation, and were more dependent regarding basic and instrumental activities of daily living. After stratification by gender and adjustment for age, these differences remained significant in women only. There were no differences in age, prefracture ambulatory ability, or dependence in activities of daily living in men with either type of fracture
— id: 47556, year: 1996, vol: , page: 166, stat: Journal Article,

Surgical neck fractures of the proximal humerus: a laboratory evaluation of ten fixation techniques
Koval KJ; Blair B; Takei R; Kummer FJ; Zuckerman JD
1996 May;40(5):778-783, Journal of trauma
OBJECTIVE: A biomechanical cadaver study was performed to compare the stability and ultimate strength of ten standard fixation techniques used for the treatment of surgical neck fractures of the proximal humerus. DESIGN: One hundred twenty (60 fresh frozen, 60 embalmed) proximal humerus specimens were selected and divided into two groups: fresh frozen specimens represented a nonosteopenic group and embalmed specimens an osteopenic group. Simulated fractures were created at the level of the surgical neck, reduced, and randomly assigned to one of ten methods of fixation (six fresh frozen and six embalmed specimens per fixation group). These constructs were then mechanically tested with the humeri oriented to create primarily shear loading of the fixation. RESULTS AND CONCLUSIONS: The T-plate and screws provided significantly stronger fixation (p < 0.005) in the fresh frozen specimens than all other methods. The Ender nails/tension band construct was the second strongest fixation technique, providing significantly stronger fixation (p < 0.01) than all the remaining techniques. Four Schanz pins with one pin placed through the greater tuberosity followed by the T-plate and screws provided the strongest fixation in embalmed specimens. Tension band fixation in both humeral groups was shown to provide the least effective fixation
— id: 18483, year: 1996, vol: 40, page: 778, stat: Journal Article,

Split fractures of the lateral tibial plateau: evaluation of three fixation methods
Koval KJ; Polatsch D; Kummer FJ; Cheng D; Zuckerman JD
1996 ;10(5):304-308, Journal of orthopaedic trauma
A laboratory study was performed to compare the stability and ultimate strength of three standard fixation techniques for split-type lateral tibial plateau fractures. The three methods of fixation were (a) three 6.5-mm cancellous lag screws with washers; (b) two 6.5-mm cancellous lag screws with washers and an additional antiglide 4.5-mm cortical screw with washer; and (c) six-hole L-shaped buttress plate. Twelve pairs of embalmed mildly osteopenic lower extremities were used. Simulated split-type lateral tibial plateau fractures were created, reduced, and then instrumented in a matched pair design. The instrumented specimens were axially loaded to determine resistance to displacement, cyclically loaded to 10,000 cycles to determine dynamic stability, and then loaded to failure. There were no statistically significant differences found between resistance to displacement or failure strength as a function of either fragment size or sample bone density. On the basis of biomechanical stability, there appears to be no difference between the three fixation techniques tested. The results of this study suggest that use of an antiglide screw or buttress plate does not offer an advantage over lag screw fixation alone for the treatment of split type lateral tibial plateau fractures
— id: 18486, year: 1996, vol: 10, page: 304, stat: Journal Article,

Dependency after hip fracture in geriatric patients: a study of predictive factors
Koval KJ; Skovron ML; Polatsch D; Aharonoff GB; Zuckerman JD
1996 ;10(8):531-535, Journal of orthopaedic trauma
Five hundred and sixteen community-dwelling, ambulatory, geriatric hip fracture patients who were independent prior to fracture were followed prospectively to determine which patients regained their prefracture independent living status at 3-, 6-, and 12-month follow-up. At 3-, 6-, and 12-month follow-up, 78, 77, and 76% of the patients, respectively, had regained their prefracture independent living status. Analysis was performed to determine which pre- and postinjury factors were predictive of a patient regaining prefracture independent living status at 3, 6, and 12 months after fracture. Patients who were younger than age 85, independent in activities of daily living prior to fracture, independent in ambulation at hospital discharge, and who had three or more medical comorbidities were more likely to regain their prefracture independent living status
— id: 44585, year: 1996, vol: 10, page: 531, stat: Journal Article,

Coracoacromial ligament function: a phylomorphic analysis
Kummer FJ; Blank K; Zuckerman JD
1996 ;55(2):72-74, Bulletin (Hospital for Joint Diseases)
Various morphologic parameters of the coracoacromial region were quantified for five hominoid genera to examine the evolutionary development of the coracoacromial ligament (CAL) and its significance and relationship to shoulder function. No evolutionary correlation within the family Hominoidea was found for several calculated parameters obtained from osseous dimensions and CAL length. However, from an evolutionary analysis of the order Anthropoidea, it appears that the CAL is not solely a vestigial structure in humans but rather represents a stage in the development of the hominoid shoulder with the function of providing increased mechanical stability to the superior bony vault
— id: 44586, year: 1996, vol: 55, page: 72, stat: Journal Article,

Development of a telemeterized shoulder prosthesis
Kummer FJ; Lyon TR; Zuckerman JD
1996 Sep;(330):31-34, Clinical orthopaedics & related research
A telemeterized shoulder prosthesis was developed and tested, first in vitro and then in a cadaver implantation. The prototype prosthesis was instrumented with 3 strain gauges fixed within a hollow, tapered neck element whose output was used to determine the load vectors experimentally applied to the humeral head. Testing demonstrated accuracy of force measurement resolution to within 5% of actual applied forces. This design seems feasible for further investigations to develop a totally implantable telemeterized prosthesis
— id: 47557, year: 1996, vol: , page: 31, stat: Journal Article,

The reliability of analysis of intraoperative frozen sections for identifying active infection during revision hip or knee arthroplasty
Lonner JH; Desai P; Dicesare PE; Steiner G; Zuckerman JD
1996 Oct;78(10):1553-1558, Journal of bone & joint surgery (American volume)
A prospective study was performed to determine the reliability of analysis of intraoperative frozen sections for the identification of infection during 175 consecutive revision total joint arthroplasties (142 hip and thirty-three knee). The mean interval between the primary and the revision arthroplasty was 7.3 years (range, three months to twenty-three years). To reduce selections bias, tissue was obtained for frozen sections during all revisions in patients who did not have active drainage from the wound or a sinus tract. Of the 175 patients, twenty-three had at least five polymorphonuclear leukocytes per high-power field on analysis of the frozen sections and were considered to have an infection. Of these twenty-three, five had five to nine polymorphonuclear leukocytes per high-power field and eighteen had at least ten polymorphonuclear leukocytes per high-power field. The frozen sections for the remaining 152 patients were considered negative. On the basis of cultures of specimens obtained at the time of the revision operation, nineteen of the 175 patients were considered to have an infection. Of the 152 patients who had negative frozen sections, three were considered to have an infection on the basis of the results of the final cultures. Of the twenty-three patients who had positive frozen sections, sixteen were considered to have an infection on the basis of the results of the final cultures; all sixteen had frozen sections that had demonstrated at least ten polymorphonuclear leukocytes per high-power field. The sensitivity and specificity of the frozen sections were similar regardless of whether an index of five or ten polymorphonuclear leukocytes per high-power field was used. Analysis of the frozen sections had a sensitivity of 84 per cent for both indices, whereas the specificity was 96 per cent when the index was five polymorphonuclear leukocytes and 99 per cent when it was ten polymorphonuclear leukocytes. However, the positive predictive value of the frozen sections increased significantly (p < 0.05), from 70 to 89 per cent, when the index increased from five to ten polymorphonuclear leukocytes per high-power field. The negative predictive value of the frozen sections was 98 per cent for both indices. The current study suggests that it is valuable to obtain tissue for intraoperative frozen sections during revision hip and knee arthroplasty. At least ten polymorphonuclear leukocytes per high-power field was predictive of infection, while five to nine polymorphonuclear leukocytes per high-power field was not necessarily consistent with infection. Less than five polymorphonuclear leukocytes per high-power field reliably indicated the absence of infection
— id: 44579, year: 1996, vol: 78, page: 1553, stat: Journal Article,

Tibiotalar contact area and pressure distribution: the effect of mortise widening and syndesmosis fixation
Pereira DS; Koval KJ; Resnick RB; Sheskier SC; Kummer F; Zuckerman JD
1996 May;17(5):269-274, Foot & ankle international
An unconstrained cadaver ankle model was designed to reevaluate the effect of ankle mortise widening and syndesmotic fixation on the load-bearing characteristics of the tibiotalar joint. Tibiotalar contact area, centroid shift, and mean contact pressure were quantified using a pressure-sensitive film technique. Six fresh-frozen below-knee amputation specimens were axially loaded with 500 N in three positions: neutral, 10 degrees of dorsiflexion, and 20 degrees of plantarflexion. The tibiotalar contact area and centroid position for each specimen in its intact state were first determined and then compared with values obtained after syndesmotic fixation, mortise widening of 2 and 4 mm, and deep deltoid ligament transection. Syndesmotic fixation significantly decreased joint contact area but did not consistently affect centroid position. However, unlike earlier studies, which used more constrained ankle fracture models, mortise widening with or without deltoid rupture was not found to significantly affect contact area, centroid position, or joint contact pressure. When statically loaded, the talus moved to its position of maximal congruence in the mortise, rather than displacing laterally along with the lateral malleolus
— id: 18482, year: 1996, vol: 17, page: 269, stat: Journal Article,

Fixation stability of olecranon osteotomies
Petraco DM; Koval KJ; Kummer FJ; Zuckerman JD
1996 Dec;(333):181-185, Clinical orthopaedics & related research
Eighteen pairs of fresh frozen human upper extremities were selected and each randomized to 2 of 3 olecranon osteotomy and fixation technique groups: (1) transverse osteotomy with 0.062 Kirschner wire and tension band fixation; (2) chevron osteotomy with 6.5-mm cancellous lag screw and tension band fixation; and (3) oblique intraarticular osteotomy with 3.5-mm cortical lag screw and tension band fixation. The arms were mounted with the elbow at 90 degrees flexion and the wrist constrained; a dual linear displacement transducer across the osteotomy was used to determine angulation, translational displacement, and the total gap size. First the brachialis and then the triceps were incrementally loaded to 10 kg using a pulley and cable system to control force direction; the muscle load versus osteotomy displacement was recorded. Cycling with 10 kg was repeated 20 times with the brachialis and triceps alternately loaded and the osteotomy displacement remeasured. There were no statistically significant differences between the amounts of displacement for the 3 osteotomy and fixation techniques caused by either muscle action. The total displacement caused by the brachialis load for all techniques was appreciably greater than that of the triceps load. No significant increase in displacements occurred after 20 load cycles. These results suggest all 3 olecranon osteotomy and fixation techniques offer comparable stability, so the choice of technique should be left to the surgeon's preference
— id: 47457, year: 1996, vol: , page: 181, stat: Journal Article,

Medial dislocation of the long head of the biceps tendon. Magnetic resonance imaging evaluation
Rokito AS; Bilgen OF; Zuckerman JD; Cuomo F
1996 Apr;25(4):314, 318-23, American journal of orthopedics (Belle Mead, NJ)
Medial dislocation of the long head of the biceps branchii tendon is a rare occurrence and is often associated with degenerative or traumatic tears of the rotator cuff, specifically tears of the subscapularis tendon. Following a dislocation, the biceps tendon will assume either an intra- or extra-articular position depending on whether or not the subscapularis tendon detaches from its humoral insertion. Magnetic resonance imaging (MRI) has been found to provide valuable information concerning the location of the biceps tendon and the integrity of the rotator cuff. In this report, three patients with suspected dislocations of the biceps tendon are evaluated using MRI
— id: 44581, year: 1996, vol: 25, page: 314, 318, stat: Journal Article,

Partial rupture of the distal biceps tendon
Rokito AS; McLaughlin JA; Gallagher MA; Zuckerman JD
1996 Jan-Feb;5(1):73-75, Journal of shoulder & elbow surgery
— id: 44582, year: 1996, vol: 5, page: 73, stat: Journal Article,

Strength after surgical repair of the rotator cuff
Rokito AS; Zuckerman JD; Gallagher MA; Cuomo F
1996 Jan-Feb;5(1):12-17, Journal of shoulder & elbow surgery
Forty-two consecutive patients (20 men and 22 women, age range 39 to 78 years) with full-thickness rotator cuff tears underwent a comprehensive isokinetic strength assessment before and at 3-month intervals for 1 year after surgery. All patients underwent acromioplasty and rotator cuff repair and were treated with a standardized postoperative rehabilitation program. Isokinetic strength testing was performed in flexion/extension, abduction/adduction, and external/internal rotation at 60 degrees/sec. The unaffected contralateral shoulder was tested for comparison. Clinical outcomes were assessed with the University of California Los Angeles Shoulder Rating Scale (maximum = 35 points). The average University of California Los Angeles score was 31.2 by 1 year after operation. Patients with small and medium tears had an average rating of 33.5, whereas those with large and massive tears had an average score of 28.3. Strength increased gradually during the first postoperative year. The preoperative mean peak torque was 54%, 45%, and 64% of the uninvolved shoulder in flexion, abduction, and external rotation, respectively; after operation it increased to 78%, 80%, and 79% by 6 months and 84%, 90%, and 91% by 12 months. The greatest improvement in strength consistently occurred during the first 6 months after surgery. Patients also showed marked increases in both work and power. By 12 months after operation mean work had increased to 70% in flexion and abduction and 90% in external rotation of the uninvolved shoulder. Similarly, mean power had increased to 68%, 79%, and 90% of the uninvolved shoulder in flexion, abduction, and external rotation, respectively, by 12 months after operation. Recovery of strength correlated primarily with the size of the tear: for small and medium tears recovery of strength was almost complete during the first year, and for large and massive tears it was much slower and less consistent. By using isokinetic strength evaluation we found that recovery of strength after rotator cuff repair requires at least 1 year of rehabilitation
— id: 44584, year: 1996, vol: 5, page: 12, stat: Journal Article,

Hip fracture
Zuckerman JD
1996 Jun 6;334(23):1519-1525, New England journal of medicine
— id: 44580, year: 1996, vol: 334, page: 1519, stat: Journal Article,

Biomechanical comparison of the sliding hip screw and the dome plunger. Effects of material and fixation design
Choueka J; Koval KJ; Kummer FJ; Crawford G; Zuckerman JD
1995 Mar;77(2):277-283, Journal of bone & joint surgery (British volume)
We studied the biomechanical behaviour of three sliding fixation devices for trochanteric femoral fractures. These were a titanium alloy sideplate and lag screw, a titanium alloy sideplate and dome plunger with cement augmentation, and a stainless-steel sideplate and lag screw. We used 18 mildly osteoporotic cadaver femora, randomly assigned to one of the three fixation groups. Four displacement and two strain gauges were fixed to each specimen, and each femur was first tested intact (control), then as a two-part fracture and then as a four-part intertrochanteric fracture. A range of physiological loads was applied to determine load-bearing, load-sharing and head displacement. The four-part-fracture specimens were subsequently tested to failure to determine maximum fixation strengths and modes of failure. The dome-plunger group failed at a load 50% higher than that of the stainless-steel lag-screw group (p < 0.05) and at a load 20% higher than that of the titanium-alloy lag-screw group (NS). All 12 lag-screw specimens failed by cut-out through the femoral head or neck, but none of the dome-plunger group showed movement within the femoral head when tested to failure. Strain-gauge analysis showed that the dome plunger produced considerably less strain in the inferior neck and calcar region than either of the lag screws. Inferior displacement of the femoral head was greatest for the dome-plunger group, and was due to sliding of the plunger. The dome plunger with cement augmentation was able to support higher loads and did not fail by cut-out through the femoral head.(ABSTRACT TRUNCATED AT 250 WORDS)
— id: 57427, year: 1995, vol: 77, page: 277, stat: Journal Article,

Humeral head replacement for glenohumeral arthritis
Cofield RH; Frankle MA; Zuckerman JD
1995 Oct;6(4):214-221, Seminars in arthroplasty
From July 1977 through March of 1983, humeral head replacement was performed on 35 shoulders with osteoarthritis and 32 shoulders with rheumatoid arthritis and followed-up for an average of 9.3 years. Satisfactory pain relief was achieved in 44 (66%) and 52 of the shoulders (78%) were described by patients as being much better or better. Active elevation was improved from an average of 84 degrees to an average of 110 degrees with external rotation improving from 20 degrees to 44 degrees. Strength improvement also occurred. Only three complications developed, and these did not affect the final outcome. Because of moderate or severe pain, 12 shoulders (18%) required revision to total shoulder arthroplasty, and all patients were relieved of their pain. The result ratings were excellent in 10 shoulders, satisfactory in 23, and unsatisfactory in 34 (51%). With longer follow-up, a satisfactory level of pain relief may not continue for those patients with osteoarthritis and rheumatoid arthritis who have had humeral head replacement alone. Whereas this form of treatment should certainly be considered in those patients who have inadequate glenoid bone to support a glenoid implant and probably be considered in younger patients or patients who wish to remain more active, these latter patients must be fully appraised that the probability of continuing pain relief is less than has often been appreciated
— id: 44588, year: 1995, vol: 6, page: 214, stat: Journal Article,

The role of intraoperative frozen sections in revision total joint arthroplasty
Feldman DS; Lonner JH; Desai P; Zuckerman JD
1995 Dec;77(12):1807-1813, Journal of bone & joint surgery (American volume)
We performed a retrospective analysis of thirty-three consecutive total hip and knee (twenty-three hip and ten knee) revision arthroplasties during which intraoperative frozen sections were analyzed. Data for the study were collected by means of a review of the charts, radiographic analysis, and evaluation of both frozen and permanent histological sections. The frozen sections, of periprosthetic tissue at the bone-cement interface or the pseudocapsule, were considered positive for active infection if there were more than five polymorphonuclear leukocytes per high-power field in at least five distinct microscopic fields. All patients were available for follow-up, at an average of thirty-six months (range, seventeen to seventy-nine months) after the initial revision operation. The frozen sections from ten patients were positive for infection, and those from twenty-three patients were negative. Comparison of the results of the analyses of the frozen sections (both positive and negative) with those of the analyses of the permanent histological sections of similar tissue showed a correlation of 100 per cent (sensitivity, 1.00; specificity, 1.00; and accuracy, 1.00). Nine patients had positive intraoperative cultures, and all of them had positive frozen sections (sensitivity, 1.00). Of the twenty-four patients who had negative intraoperative cultures, twenty-three had negative frozen sections (specificity, 0.96). Of the nine patients who had positive intraoperative cultures, only two were found to have infection on intraoperative gram-staining. The surgeon's operative assessment regarding the presence of infection, compared with the final pathological diagnosis, demonstrated a sensitivity of 0.70, a specificity of 0.87, and an accuracy of 0.82. All ten patients who had positive frozen sections were managed with excision arthroplasty; six of them subsequently had reimplantation, and the excision was the definitive procedure in the remaining four. One patient who had had a delayed reimplantation had a secondary skin slough and eventually was managed with an arthrodesis of the knee. In the group that had negative frozen sections, eighteen patients had a primary exchange revision arthroplasty and five had a delayed reimplantation. At the time of follow-up, one patient who had had a delayed reimplantation had radiographic loosening of the femoral component and was asymptomatic. One patient who had had a primary exchange arthroplasty was managed with a second revision because of aseptic loosening. There was no clinical recurrence of infection in any patient. The data indicate that analysis of frozen sections of periprosthetic tissue is a reliable predictor of the presence of active infection during revision joint arthroplasty. We recommend its use to differentiate aseptic from septic loosening
— id: 44587, year: 1995, vol: 77, page: 1807, stat: Journal Article,

Functional outcome after humeral head replacement for acute three- and four-part proximal humeral fractures
Goldman RT; Koval KJ; Cuomo F; Gallagher MA; Zuckerman JD
1995 Mar-Apr;4(2):81-86, Journal of shoulder & elbow surgery
Twenty-six hemiarthroplasties were performed for acute three- and four-part proximal humerus fractures between March 1986 and December 1991. Postoperative pain, active range of motion, and function were evaluated in 22 patients at a mean follow-up period of 30 months (range 12 to 66 months) with the American Shoulder and Elbow Surgeons evaluation form. Seventy-three percent of patients reported only slight or no pain. Active forward elevation averaged 107 degrees, external rotation averaged 31 degrees, and the average internal rotation was to the second lumbar vertebra. Strength and stability were rarely problematic. Seventy-three percent of patients reported difficulty with at least three of 15 functional tasks tested. Lifting, carrying a weight, and using the hand at or above shoulder level were the most common limitations. This study indicates that hemiarthroplasty for acute three- and four-part fractures generally can be expected to result in painfree shoulders. However, recovery of function and range of motion are much less predictable
— id: 44589, year: 1995, vol: 4, page: 81, stat: Journal Article,

Ambulatory ability after hip fracture. A prospective study in geriatric patients
Koval KJ; Skovron ML; Aharonoff GB; Meadows SE; Zuckerman JD
1995 Jan;(310):150-159, Clinical orthopaedics & related research
Three hundred thirty-six community-dwelling, previously ambulatory, geriatric patients with hip fracture were observed prospectively to determine ambulatory ability at a minimum followup of 1 year. One hundred thirty-seven (41%) patients maintained their prefracture ambulatory ability at a minimum followup of 1 year; 134 (40%) patients remained ambulatory but became more dependent on assistive devices; 39 (12%) previous community ambulators became household ambulators, and 26 (8%) patients became nonfunctional ambulators. Analysis was performed to determine which pre- and postinjury factors were predictive of failure to recover ambulatory capacity 1 year after fracture. Potential predictor variables analyzed included age, gender, number of comorbid conditions, prefracture ambulatory ability, prefracture living situation, fracture type, American Society of Anesthesiologists rating of operative risk, type of surgery, and number of postoperative complications. Multiple logistic regression analysis identified significant contributions of age, prefracture ambulatory ability, American Society of Anesthesiologists rating of operative risk, and fracture type to ambulatory recovery
— id: 47558, year: 1995, vol: , page: 150, stat: Journal Article,

Fractures of the proximal part of the femur
Kyle RF; Cabanela ME; Russell TA; Swiontkowski MF; Winquist RA; Zuckerman JD; Schmidt AH; Koval KJ
1995 ;44(1):227-253, Instructional course lectures (American Association of Orthopaedic Surgeons)
The orthopaedic surgeon has a multitude of internal fixation devices and techniques available for use in the treatment of subtrochanteric fractures of the proximal femur. The successful use of second-generation locking nails is technically demanding. Close attention to positioning of the patient, reduction of the fracture, placement of the guide-wire, and insertion of the nail and of the proximal and distal locking screws is mandatory. The newer, high-strength hip-screws allow good fixation of a fracture that extends into the piriformis fossa. If medial comminution is present, this technique is best performed in conjunction with indirect reduction and bone-grafting. With proper technique, these devices allow the surgeon to manage predictably a complex subtrochanteric fracture that previously had to be treated with traction or extensive dissection and with (frequently inadequate) internal fixation
— id: 44591, year: 1995, vol: 44, page: 227, stat: Journal Article,

The incidence of full thickness rotator cuff tears in a large cadaveric population
Lehman C; Cuomo F; Kummer FJ; Zuckerman JD
1995 ;54(1):30-31, Bulletin (Hospital for Joint Diseases)
The incidence of full thickness rotator cuff tears was determined after careful dissection and inspection of 235 male and female cadavers ranging in age from 27-102 years with an average age of 64.7 years. A total of 456 shoulders were examined. Partial thickness tears were excluded from the study. Seventy-eight shoulders, 17% (53 female, 26 male) were found to have full thickness tears. The average age of those cadavers with tears was 77.8 years as compared to 64.7 years in the intact group. The incidence of full thickness tears was also found to increase with increasing age. In cadavers under 60 years of age the incidence of rotator cuff tears was 6% as opposed to 30% in those over 60 years of age
— id: 44590, year: 1995, vol: 54, page: 30, stat: Journal Article,

DOES BLOOD-TRANSFUSION INCREASE THE RISK OF INFECTION AFTER HIP FRACTURE SURGERY
ROSENBERG, AD; AHARONOFF, GB; KOVAL, K; ZUCKERMAN, JD; BERNSTEIN, RL
1995 SEP ;83(3A):A1000-A1000, Anesthesiology
— id: 86723, year: 1995, vol: 83, page: A1000, stat: Journal Article,

Effects of supine positioning and fracture post placement on the perineal countertraction force in awake volunteers
Toolan BC; Koval KJ; Kummer FJ; Goldsmith ME; Zuckerman JD
1995 Apr;9(2):164-170, Journal of orthopaedic trauma
An instrumented traction post was used to determine the magnitude and direction of the countertraction force applied to the perineum of 15 awake volunteers for a series of 12 positions used in fracture surgery and compared with their corresponding neutral position controls. The results demonstrated that adduction of the affected limb and abduction of the contralateral limb applied the greatest force to the perineum with ipsilateral and contralateral placement of the fracture post. These two maneuvers increased the perineal countertraction force 80% above their respective neutral readings. Abduction of the affected limb reduced the traction force by 50% with ipsilateral and contralateral placement of the fracture post. Flexion-abduction-external rotation of the contralateral leg reduced the forces applied to the perineum by 60% when the fracture post was placed contralateral to the affected limb. Contralateral placement of the post decreased the perineal countertraction force 46% below the value for ipsilateral post placement for this maneuver. Internal and external rotation of the affected limb had no effect on the perineal countertraction force for either placement of the post. There was a significant decrease in the perineal forces for the neutral positions after adduction of the affected limb and abduction of the contralateral limb with ipsilateral placement of the post, indicating that the volunteers shifted on the fracture table in response to pain. There was no significant difference in the direction of the countertraction force for the various positions.(ABSTRACT TRUNCATED AT 250 WORDS)
— id: 18488, year: 1995, vol: 9, page: 164, stat: Journal Article,

Modular unipolar versus bipolar prosthesis: a prospective evaluation of functional outcome after femoral neck fracture
Wathne RA; Koval KJ; Aharonoff GB; Zuckerman JD; Jones DA
1995 ;9(4):298-302, Journal of orthopaedic trauma
Between January 1, 1987, and December 31, 1992, 140 community-dwelling geriatric patients > or = 65 years of age with a displaced femoral neck fracture (Garden III-IV) underwent primary prosthetic replacement and were followed prospectively for a minimum of 1 year. Overall, 92 patients received a cemented bipolar prosthesis and 48 patients received a cemented modular unipolar prosthesis. There were no statistically significant differences between the two groups with respect to preinjury characteristics (age, sex, and number and severity of medical comorbidities) and functional ability. There were no statistically significant differences between the two groups with regard to the number of postoperative complications, length of stay, and 1 year mortality rate. An in-depth functional evaluation was obtained as follows: level of ambulation, independence in basic activities of daily living (feeding, bathing, dressing, toileting), and independence in instrumental activities of daily living (food shopping, food preparation, banking, laundry, housework, and use of public transportation). At 1 year follow-up, no statistically significant differences in functional ability were identified between the unipolar and bipolar groups. Furthermore, at a minimum of 1 year follow-up, there were no statistically significant differences between the two groups with regard to the need for revision surgery or the incidence hip pain. Based on the results of this study, there does not appear to be any advantage to the use of bipolar endoprosthesis for the treatment of femoral neck fractures in the elderly patient. The lower cost of modular unipolar prostheses compared with bipolar prostheses provides additional support for their use
— id: 44592, year: 1995, vol: 9, page: 298, stat: Journal Article,

Postoperative complications and mortality associated with operative delay in older patients who have a fracture of the hip
Zuckerman JD; Skovron ML; Koval KJ; Aharonoff G; Frankel VH
1995 Oct;77(10):1551-1556, Journal of bone & joint surgery (American volume)
We prospectively studied 367 patients who had a fracture of the hip, to determine the effect of an operative delay on postoperative complications and on the one-year mortality rate. All of the patients were at least sixty-five years old, cognitively intact, living at home, and able to walk before the fracture. An operative delay was defined as an interval of three calendar days or more between the time of admission to the hospital and the operation. The operation was performed within two calendar days after admission in 267 (73 per cent) of the patients. When the factors of the patient's age and sex and the number of pre-existing medical conditions were controlled, it was found that an operative delay beyond this period approximately doubled the risk of the patient dying before the end of the first postoperative year. When the patient's age and sex and the severity of pre-existing medical conditions were controlled, there was also an increase in mortality associated with an operative delay, although this was not significant. With the numbers studied, an operative delay beyond two calendar days did not have a significant effect on the prevalence of complications during hospitalization. We concluded that an operative delay of more than two calendar days after admission is an important predictor of mortality within one year for elderly patients who have a fracture of the hip and who are cognitively intact, able to walk, and living at home before the fracture. Optimally, such patients should have the operation within two calendar days after admission to the hospital
— id: 57013, year: 1995, vol: 77, page: 1551, stat: Journal Article,

Pain inhibition of shoulder strength in patients with impingement syndrome
Ben-Yishay A; Zuckerman JD; Gallagher M; Cuomo F
1994 Aug;17(8):685-688, Orthopedics (Thorofare NJ)
Fourteen patients with Stage II or III impingement syndrome (average age 58 years) were studied. Nine patients had full-thickness rotator cuff tears documented by arthrograms. Patients initially underwent a thorough shoulder examination followed by baseline isokinetic strength testing. Abduction/adduction testing was performed utilizing a Biodex dynamometer. Maximum concentric contractions were performed, and values for peak torque (PT), total work (W), and power (P) were obtained. All patients received a subacromial injection of 5 cc 1% lidocaine plus 5 cc 0.5% bupivacaine (Marcaine). After 5 minutes the testing sequence was repeated. Clinically, patients demonstrated marked improvement following injection. Eighty-six percent reported complete pain relief; the remaining two patients reported only mild discomfort at the extremes of motion. Improvement in functional activity of the affected shoulder was noted by all subjects. On manual muscle testing, 13 of 14 patients (93%) demonstrated increased abduction strength; 11 of 14 (79%) had improvement in external rotation. Mean increases in active forward elevation and external rotation were 36 degrees and 11 degrees, respectively (P < .01). Postinjection isokinetic changes in PT, W, and P for abduction/adduction were dramatic. For abduction, all patients showed significant increases in P (mean 82%), W (mean 90%), and PT (mean 48%) (all P < .05). No significant differences in range of motion testing or strength parameters were noted based on the presence or absence of a rotator cuff tear. For adduction, all patients showed significant increases in P (mean 208%), W (mean 183%), and PT (mean 41%) (all P < .05).(ABSTRACT TRUNCATED AT 250 WORDS)
— id: 44593, year: 1994, vol: 17, page: 685, stat: Journal Article,

Basicervical fractures of the proximal femur. A biomechanical study of 3 internal fixation techniques
Blair B; Koval KJ; Kummer F; Zuckerman JD
1994 Sep;(306):256-263, Clinical orthopaedics & related research
A biomechanical cadaver study was performed to compare the stability and ultimate strength of 3 standard fixation techniques used for treatment of basicervical hip fractures. Twenty one pairs of mildly osteoporotic femurs were selected, based on a computed tomography bone density reading of 40-50 Hounsfeld units and a Singh index of III. After initial mechanical characterization of intact femurs, basicervical femoral neck fractures were created, reduced, and then instrumented with random assignment to 1 of 3 methods of fixation: (1) 3 parallel 6.5-mm cannulated cancellous screws; (2) a 135 degrees sliding hip screw with a 4 hole side plate; and (3) a 135 degrees sliding hip screw with a 4 hole side plate and a 6.5-mm cannulated cancellous screw placed proximal and parallel to the sliding screw. Nine pairs were tested to failure in axial loading, 6 pairs in lateral bending, and 6 pairs in torsion. The group instrumented with the multiple cancellous screws had a significantly (p < 0.01) lower ultimate axial load to failure than either sliding hip screw group. However, the multiple screws demonstrated significantly (p < 0.01) less fracture displacement. There were no statistically significant differences in lateral bending or torsional testing behavior between the 3 fixation methods. Use of the sliding hip screw is recommended rather than use of multiple cancellous screws for treatment of basicervical femoral neck fractures. Although a superiorly located cancellous screw may provide rotational control during sliding hip screw insertion, it provides no incremental fixation after the sliding hip screw is placed
— id: 47458, year: 1994, vol: , page: 256, stat: Journal Article,

Fracture blisters
Giordano CP; Koval KJ; Zuckerman JD; Desai P
1994 Oct;(307):214-221, Clinical orthopaedics & related research
A clinical and histological study was performed on fracture blisters found in association with 13 surgically treated ankle fractures. The timing of surgery was dependent upon soft tissue swelling; the status of the blister did not affect this aspect of the decision making process. The average time from injury to surgery was 2.1 days (range, 1-3 days). At the time of surgery all blisters were intact. Skin biopsies were obtained from the edge of the incision in proximity to the blister, and from the bed of the blister when the incision was made through the blister. Clinically, 2 blister types were identified: (1) clear fluid filled, and (2) blood filled. Histologically, both blister types demonstrated a cleavage injury at the dermoepidermal junction. However, the dermis of the clear fluid filled blister retained occasional epithelial cells, while the dermis of blood filled blisters was completely devoid of epidermis. Minimal to no evidence of dermal injury was found in histologic sections from the blister beds or from the skin in close proximity to blisters. All incisions made through and around skin blisters went on to heal without evidence of infection or wound breakdown. Delayed wound healing occurred in 1 patient in whom an incision was placed through a blood filled blister. The blood filled blister appears to represent a slightly deeper injury than the clear fluid blister and had a higher risk of poor healing of surgical incisions
— id: 47559, year: 1994, vol: , page: 214, stat: Journal Article,

Functional recovery after fracture of the hip
Koval KJ; Zuckerman JD
1994 May;76(5):751-758, Journal of bone & joint surgery (American volume)
— id: 44595, year: 1994, vol: 76, page: 751, stat: Journal Article,

Hip Fractures: I. Overview and Evaluation and Treatment of Femoral-Neck Fractures
Koval KJ; Zuckerman JD
1994 May;2(3):141-149, Journal of the American Academy of Orthopaedic Surgeons
Hip fractures remain a major source of morbidity and mortality in the elderly, and their incidence is increasing as the population ages. Surgical management followed by early mobilization is the treatment of choice for most patients with hip fractures. However, all comorbid medical conditions, particularly cardiopulmonary and fluid- electrolyte imbalances, must be evaluated and stabilized prior to operative intervention. Nondisplaced femoral-neck fractures should be stabilized with multiple parallel lag screws or pins. The treatment of displaced femoral-neck fractures is based on the patient's age and activity level: young active patients should undergo open reduction and internal fixation; older, less active patients are usually treated with hemiarthroplasty, either uncemented or cemented. Regardless of treatment method, the goal is to return the patient to his or her prefracture level of function
— id: 57580, year: 1994, vol: 2, page: 141, stat: Journal Article,

Hip Fractures: II. Evaluation and Treatment of Intertrochanteric Fractures
Koval KJ; Zuckerman JD
1994 May;2(3):150-156, Journal of the American Academy of Orthopaedic Surgeons
Surgical stabilization followed by early mobilization is the treatment of choice for both nondisplaced and displaced intertrochanteric fractures. Fracture stability is dependent on the status of the posteromedial cortex. The sliding hip screw is the device mostly commonly used for fracture stabilization. The most important aspect of its insertion is secure placement within the femoral head. Although the sliding hip screw allows postoperative fracture impaction, it is essential to obtain an impacted reduction at the time of surgery. If there is a large posteromedial fragment, an attempt should be made to internally fix the fragment with a lag screw or cerclage wire. Although intramedullary hip screws have not been shown to be superior to the sliding hip screw, they may have selected indications
— id: 57579, year: 1994, vol: 2, page: 150, stat: Journal Article,

Vertical shear fractures of the medial malleolus: a biomechanical study of five internal fixation techniques
Toolan BC; Koval KJ; Kummer FJ; Sanders R; Zuckerman JD
1994 Sep;15(9):483-489, Foot & ankle international
Fifty embalmed human tibias were osteotomized to create a simulated vertical shear (supination-adduction) fracture of the medial malleolus and were stabilized using one of five internal fixation techniques. In offset axial testing, which simulated supination-adduction loading, the fixation strength of tibias stabilized with either cortical or cancellous lag screws placed perpendicular to the osteotomy was over five times greater than the strength of those treated with an antiglide plate and nearly two and a half times greater than those treated with cancellous lag screws placed oblique to the osteotomy. The tibias stabilized with cancellous lag screws placed perpendicular to the osteotomy exhibited twice the fixation strength of the tibias stabilized with an antiglide plate and distal lag screw. The tibias stabilized with an antiglide plate and distal lag screw and perpendicularly placed cortical or cancellous lag screws demonstrated three times greater resistance to displacement to the applied supination-adduction load than those stabilized with an antiglide plate alone. In offset transverse testing, to simulate loading in external rotation, the mean failure load of the tibias stabilized with cancellous lag screws placed perpendicular to the osteotomy was over two and a half times greater than those stabilized with an antiglide plate and distal lag screw. No significant differences were observed in the resistance to displacement for these tests. These results support the use of lag screws placed perpendicular to the fracture surface for stabilization of vertical shear fractures of the medial malleolus and indicate that the use of an antiglide plate, with or without a distal lag screw, does not offer any advantage over lag screw fixation
— id: 18489, year: 1994, vol: 15, page: 483, stat: Journal Article,

The effectiveness of a hospital-based strategy to reduce the cost of total joint implants
Zuckerman JD; Kummer FJ; Frankel VH
1994 Jun;76(6):807-811, Journal of bone & joint surgery (American volume)
Our hospital implemented an integrated cost-containment program designed to address the increasing disparity between the cost of orthopaedic implants used for total joint replacements and the amount of hospital reimbursement provided for these procedures. This program was divided into four phases: (1) the analysis of the specific usage of total hip and total knee implants at our institution, (2) the development of surgeons' awareness of the problem and the enlistment of their participation in the process of cost containment, (3) the initiation of a competitive bidding system to select standard prostheses that would be available for general use within the institution, and (4) the establishment of a prosthesis-utilization committee to monitor the process and to make decisions concerning the use of non-standard prostheses. Using this cost-containment program, our hospital greatly reduced the number of vendors and implant systems used; all implants were purchased on a consignment basis, which minimized the cost of implant inventory. The average cost reductions in the first year were 14 per cent for total hip implants and 24 per cent for total knee implants. Over-all implant costs were reduced by an estimated $706,477, or 23 per cent of the budget for implants for the previous year
— id: 44594, year: 1994, vol: 76, page: 807, stat: Journal Article,

Scapular osteochondroma presenting with exostosis bursata
Cuomo F; Blank K; Zuckerman JD; Present DA
1993 Winter;52(2):55-58, Bulletin (Hospital for Joint Diseases)
A 33-year-old male presented with acute onset of scapular winging following an injury to the shoulder girdle. A scapular osteochondroma was identified radiographically that was completely asymptomatic until the time of injury. Clinical presentation included the presence of a large exostosis bursata. Surgical resection of the osteochondroma resulted in resolution of all signs and symptoms
— id: 44601, year: 1993, vol: 52, page: 55, stat: Journal Article,

Magnetic resonance imaging of impingement and rotator cuff disorders. A surgical perspective
Cuomo F; Zuckerman JD
1993 Sep;1(1):65-76, Magnetic resonance imaging clinics of North America
In conclusion, the clinical picture of impingement syndrome is one of a continuum occurring as a result of compression of the bursa and rotator cuff within the subacromial space. In its early stages nonoperative management will often suffice, but in resistant cases and in cuff tears operative intervention is often indicated. The usefulness of MR imaging has greatly expanded for the orthopaedist diagnosing and treating the patient with impingement. After careful clinical evaluation and plain radiographs, MR imaging can significantly add to our knowledge as to the extent of the disease process. This added information can aid in tailoring an individualized treatment regimen and can be invaluable in the preoperative planning for patients with rotator cuff pathology
— id: 44597, year: 1993, vol: 1, page: 65, stat: Journal Article,

Clinical efficacy of aspirin and dextran for thromboprophylaxis in geriatric hip fracture patients
Feldman DS; Zuckerman JD; Walters I; Sakales SR
1993 ;7(1):1-5, Journal of orthopaedic trauma
The clinical efficacy of thromboprophylaxis with aspirin and dextran 40 was compared in a prospective review of 530 geriatric hip fracture patients treated surgically. All patients were also treated with early mobilization with weight bearing as tolerated and above-knee elastic stockings. In addition to clinical efficacy in preventing thromboembolic complications [deep vein thrombosis (DVT), pulmonary embolism (PE)], safety and cost-effectiveness were also assessed. The overall incidence of clinical thromboembolic disease was 2.8% (DVT = 0.4%, PE = 2.4%). The incidence of DVT (0.5%) and PE (2.6%) in the aspirin group was essentially the same as the incidence of DVT (0.3%) and PE (2.4%) in the dextran group. The inhospital mortality rate (aspirin 4.6%, dextran 3.8%), wound drainage (aspirin 1.5%, dextran 0.9%), deep wound infection (aspirin 0.5%, dextran 0.3%), gastrointestinal bleeding (aspirin 2.1%, dextran 1.5%), and congestive heart failure (aspirin 2.6%, dextran 1.8%) did not differ significantly between the two groups. The intraoperative transfusion rate was similar in both groups (aspirin .65 units, dextran .55 units). However, postoperatively, the transfusion rate was significantly higher in the dextran group (aspirin .26 units, dextran .41 units, p < .05). The treatment of thromboembolic complications was the same for each group and therefore represents similar treatment costs. However, the cost of prophylaxis with dextran was $309 per patient and with aspirin was $1.79 per patient. Our findings suggest that, based on clinical diagnostic criteria, aspirin and dextran are equally effective thromboembolic prophylactic agents in geriatric hip fracture patients. The safety, cost, and ease of administration of aspirin may make its use more desirable
— id: 44607, year: 1993, vol: 7, page: 1, stat: Journal Article,

A comparison of modified Knowles pins and cannulated cancellous screws for the treatment of nondisplaced or impacted femoral neck fractures
Jarolem KL; Koval KJ; Zuckerman JD; Aharonoff G
1993 Summer;53(3):11-14, Bulletin (Hospital for Joint Diseases)
A prospective study was performed comparing modified Knowles pins to cannulated cancellous screws for the treatment of nondisplaced and impacted femoral neck fractures. Forty-five impacted or nondisplaced fractures were identified: twenty-five were stabilized with modified Knowles pins and twenty with cannulated cancellous screws. Patient follow-up averaged twenty-four months (range 12 to 46 months) or until reoperation. Six patients (13%) required reoperation; these failures were evenly divided between the two groups. The remainder of patients (twenty-two patients (88%) in the Knowles pin group and seventeen patients (85%) in the cannulated screw group) were comparable with regard to functional outcome
— id: 44605, year: 1993, vol: 53, page: 11, stat: Journal Article,

Pudendal nerve palsy induced by fracture table
Lyon T; Koval KJ; Kummer F; Zuckerman JD
1993 May;22(5):521-525, Orthopaedic review
There are 23 cases in the literature of fracture table-induced pudendal nerve palsy. The majority of these patients had full sensory return; however, return of sexual function was unpredictable. The relevant anatomy, etiology, and incidence of this complication are discussed, and suggestions are made for its prevention
— id: 18490, year: 1993, vol: 22, page: 521, stat: Journal Article,

Posttraumatic tibial osteomyelitis: diagnosis, classification, and treatment
Meadows SE; Zuckerman JD; Koval KJ
1993 Winter;52(2):11-16, Bulletin (Hospital for Joint Diseases)
The problem of osteomyelitis has, to date, not been completely resolved. Recent research has provided additional insight into the pathogenesis of bone infection. Advances in pharmacology and in surgical techniques have enhanced our ability to treat such infections. Despite these advances, successful treatment of posttraumatic tibial osteomyelitis depends on adherence to several basic principles: complete debridement of necrotic and infected tissue, obtaining bony stability, the elimination of dead space, and the provision of durable soft tissue coverage. Armed with this new knowledge and surgical ability, treatment results have improved. We do not know, however, whether osteomyelitis can ever be 'cured,' since infections become manifest many years after injury or treatment
— id: 44604, year: 1993, vol: 52, page: 11, stat: Journal Article,

Technical pitfalls in the use of the sliding hip screw for fixation of intertrochanteric hip fractures
Rokito AS; Koval KJ; Zuckerman JD
1993 Apr;26(4):349-356, Contemporary orthopaedics
Two hundred fifty consecutive intertrochanteric fractures treated with a sliding hip screw (SHS) over a three year period were reviewed and specific types of technical pitfalls identified. Most pitfalls were technique dependent and potentially preventable with proper attention to the principles of fracture reduction and insertion of the device. Pitfalls encountered with the use of the SHS occurred as a result of either poor fracture reduction or implant insertion. Problems related to fracture reduction included poor radiographic visualization, posterior sag, varus angulation, and internal rotation of the femoral shaft in relation to the femoral neck. Potential pitfalls encountered during SHS insertion included superior guide wire placement, guide wire breakage or penetration into the hip joint or pelvis, loss of reduction during lag screw insertion, improper screw-barrel relationship, and improper plate application. Finally, the SHS may not be the implant of choice for all extracapsular hip fractures (i.e., the reverse obliquity fracture). This paper identifies the various pitfalls that may occur with the use of the SHS for the fixation of intertrochanteric hip fractures. Illustrative cases are provided and guidelines for avoiding these surgical pitfalls suggested
— id: 44599, year: 1993, vol: 26, page: 349, stat: Journal Article,

Symptomatic displacement of the lesser trochanter following trochanteric fracture fixation
Rokito AS; Simon M; Koval KJ; Zuckerman JD
1993 Winter;52(2):52-54, Bulletin (Hospital for Joint Diseases)
Unstable intertrochanteric hip fractures are characterized by comminution of the posteromedial cortex, resulting in a fragment of variable size containing the lesser trochanter. Controversy exists as to whether it is necessary to perform reduction and fixation of this fragment. This case lends further support to the practice of fixating the lesser trochanteric fragment in unstable intertrochanteric fractures
— id: 44602, year: 1993, vol: 52, page: 52, stat: Journal Article,

The Neer classification system for proximal humeral fractures. An assessment of interobserver reliability and intraobserver reproducibility
Sidor ML; Zuckerman JD; Lyon T; Koval K; Cuomo F; Schoenberg N
1993 Dec;75(12):1745-1750, Journal of bone & joint surgery (American volume)
The radiographs of fifty fractures of the proximal part of the humerus were used to assess the interobserver reliability and intraobserver reproducibility of the Neer classification system. A trauma series consisting of scapular anteroposterior, scapular lateral, and axillary radiographs was available for each fracture. The radiographs were reviewed by an orthopaedic shoulder specialist, an orthopaedic traumatologist, a skeletal radiologist, and two orthopaedic residents, in their fifth and second years of postgraduate training. The radiographs were reviewed on two different occasions, six months apart. Interobserver reliability was assessed by comparison of the fracture classifications determined by the five observers. Intraobserver reproducibility was evaluated by comparison of the classifications determined by each observer on the first and second viewings. Kappa (kappa) reliability coefficients were used. All five observers agreed on the final classification for 32 and 30 per cent of the fractures on the first and second viewings, respectively. Paired comparisons between the five observers showed a mean reliability coefficient of 0.48 (range, 0.43 to 0.58) for the first viewing and 0.52 (range, 0.37 to 0.62) for the second viewing. The attending physicians obtained a slightly higher kappa value than the orthopaedic residents (0.52 compared with 0.48). Reproducibility ranged from 0.83 (the shoulder specialist) to 0.50 (the skeletal radiologist), with a mean of 0.66. Simplification of the Neer classification system, from sixteen categories to six more general categories based on fracture type, did not significantly improve either interobserver reliability or intraobserver reproducibility
— id: 44596, year: 1993, vol: 75, page: 1745, stat: Journal Article,

Glenohumeral arthroplasty: a critical review of indications and preoperative considerations
Zuckerman JD; Cuomo F
1993 Winter;52(2):21-30, Bulletin (Hospital for Joint Diseases)
Total shoulder arthroplasty has become an effective treatment for advanced glenohumeral arthritis. The results depend, in part, on the underlying degenerative process. This article reviews the indications for glenohumeral arthroplasty, including important preoperative considerations. The different types of glenohumeral arthritides are discussed with respect to their clinical and radiographic manifestations, as well as their impact on preoperative planning
— id: 44603, year: 1993, vol: 52, page: 21, stat: Journal Article,

Enhancing independence in the older hip fracture patient
Zuckerman JD; Fabian DR; Aharanoff G; Koval KJ; Frankel VH
1993 May;48(5):76-8, 81, Geriatrics
No doubt all experienced clinicians have observed cases in which a hip fracture dramatically diminished the independence and quality of life of an elderly person. This difficult problem requires a concentrated, multidisciplinary effort. More than 800 patients have now been treated using our interdisciplinary approach. A recent review of the data shows that results in this larger group compare favorably with those in the followup group described in this article. We believe that our approach shows promise as a model for the future. Further, comparisons with current practices may lead in some situations to significant improvements in hip fracture rehabilitation. Primary care physicians play a key role in this process of review and modification and in contributing to the overall restorative effort
— id: 44598, year: 1993, vol: 48, page: 76, stat: Journal Article,

Fractures of the scapula
Zuckerman JD; Koval KJ; Cuomo F
1993 ;42(4):271-281, Instructional course lectures (American Association of Orthopaedic Surgeons)
— id: 44600, year: 1993, vol: 42, page: 271, stat: Journal Article,

Suprascapular nerve palsy in a young athlete
Zuckerman JD; Polonsky L; Edelson G
1993 Summer;53(2):11-12, Bulletin (Hospital for Joint Diseases)
Palsy of the suprascapular nerve may be easily overlooked in the differential diagnosis of the painful shoulder. Although the diagnosis is well documented in the literature, opinion is still divided regarding its etiology and treatment. This case report offers an example of successful nonoperative management of a suprascapular nerve palsy which followed an acute episode of muscular stress in a young male athlete
— id: 44606, year: 1993, vol: 53, page: 11, stat: Journal Article,

Posttraumatic tibial osteomyelitis: a comparison of three treatment approaches
Koval KJ; Meadows SE; Rosen H; Silver L; Zuckerman JD
1992 Apr;15(4):455-460, Orthopedics (Thorofare NJ)
The treatment of 25 tibias in 25 patients with posttraumatic chronic osteomyelitis was reviewed. The approaches to soft tissue management fell into three groups: 1) muscle flap coverage; 2) primary closure with suction irrigation; and 3) open cancellous bone grafting. Treatment success was judged by the presence or absence of drainage and the local signs or symptoms of infection, and by the status of the tibial nonunion. Overall, 19 of 25 tibias (76%) had successful treatment. We found flap coverage to have a higher success rate (80%) than either primary closure with suction irrigation (45.5%) or open cancellous bone grafting (40%). These results further attest to the refractory nature of chronic osteomyelitis
— id: 44609, year: 1992, vol: 15, page: 455, stat: Journal Article,

Type III acromioclavicular joint separation associated with late brachial-plexus neurapraxia
Meislin RJ; Zuckerman JD; Nainzadeh N
1992 ;6(3):370-372, Journal of orthopaedic trauma
We report the case of a 28-year-old woman who developed signs and symptoms of brachial-plexus neurapraxia eight years after a type III acromioclavicular (AC) joint separation. Stabilization of the AC joint resulted in resolution of the symptoms
— id: 32686, year: 1992, vol: 6, page: 370, stat: Journal Article,

A biomechanical evaluation of the Gamma nail
Rosenblum SF; Zuckerman JD; Kummer FJ; Tam BS
1992 May;74(3):352-357, Journal of bone & joint surgery (British volume)
We examined the effect of the Gamma nail on strain distribution in the proximal femur, using ten cadaver femora instrumented with six unidirectional strain gauges along the medial and lateral cortices. The femora were loaded to 1800 N and strains were determined with or without distal interlocking screws before and after experimentally created two-part and four-part fractures. Motion of the sliding screw and the nail was also determined. Strain patterns and screw motion were compared with previously obtained values for a sliding hip screw device (SHS). The Gamma nail was shown to transmit decreasing load to the calcar with decreasing fracture stability, such that virtually no strain on the bone was seen in four-part fractures with the posteromedial fragment removed; increasing compression was noted, however, at the proximal lateral cortex. Conversely, the SHS showed increased calcar compression with decreasing fracture stability. The insertion of distal interlocking screws did not change the pattern of proximal femoral strain. The Gamma nail imparts non-physiological strains to the proximal femur, probably because of its inherent stiffness. These strains may alter bone remodelling and interfere with healing. Distal interlocking screws may not be necessary for stable intertrochanteric fractures
— id: 44608, year: 1992, vol: 74, page: 352, stat: Journal Article,

Hip fractures in geriatric patients. Results of an interdisciplinary hospital care program
Zuckerman JD; Sakales SR; Fabian DR; Frankel VH
1992 Jan;(274):213-225, Clinical orthopaedics & related research
The care of geriatric patients who sustain hip fractures is difficult because of associated medical comorbidities, the risk of medical and surgical complications, and the functional limitations that are often present before the fracture. The authors developed and used a comprehensive, interdisciplinary care program that has so far treated 431 geriatric hip fracture patients. The results of the program group were compared to a matched nonprogram group of patients (n = 60) cared for before the initiation of the program (and before the initiation of diagnosis-related groups). The program patients had fewer postoperative complications, significantly fewer (p less than .05) intensive care unit transfers (10.2% versus 20%), significantly improved (p less than .001) ambulatory ability at discharge (56.3% independent with assistive devices versus 18.2%), and proportionately fewer discharges to nursing homes (8.1% versus 19.3%). These results support the use of an interdisciplinary approach as a means of improving the inhospital care of geriatric hip fracture patients
— id: 47560, year: 1992, vol: , page: 213, stat: Journal Article,

Case report 662. Bilateral avascular necrosis of femur, with supervening suppurative arthritis of right hip
Nuovo MA; Sissons HA; Zuckerman JD
1991 ;20(3):217-221, Skeletal radiology
We present a case of suppurative arthritis occurring in a patient with bilateral osteonecrosis of the femoral head. Predisposing factors were chronic alcoholism (osteonecrosis) and septicemia due to intravenous drug abuse (suppurative arthritis). Although the association of suppurative arthritis and osteonecrosis is rarely reported in the literature, the prevalence of osteonecrosis and of various factors predisposing to the development of suppurative arthritis should remind us of the possibility that a patient with osteonecrosis who develops sudden worsening of joint pain or fever may have developed suppurative arthritis of the affected joint, particularly when there is evidence of bone destruction
— id: 44612, year: 1991, vol: 20, page: 217, stat: Journal Article,

Fatigue failure of the sliding screw in hip fracture fixation: a report of three cases
Spivak JM; Zuckerman JD; Kummer FJ; Frankel VH
1991 ;5(3):325-331, Journal of orthopaedic trauma
Hardware failure of the sliding screw system used in hip fracture fixation is rare. The fatigue failure of the sliding screw is always related clinically to nonunion or refracture along the path of the screw. In both situations, cyclic loading of the implant exceeds its endurance limit, and failure can ensue. Three cases of failure of the sliding screw are presented: a nonunion of a basicervical fracture, a nonunion secondary to stress fracture at the plate-barrel junction, and a refracture through the femoral neck after healing of an intertrochanteric fracture. A biomechanical analysis of the stresses on the sliding screw focuses on design features such as the internal threaded region used for the compression screw or the barrel length that creates increased stresses in the screw, thus lowering the number of cycles to failure. Based on this analysis, recommendations are made concerning implant design and surgical technique
— id: 44614, year: 1991, vol: 5, page: 325, stat: Journal Article,

The effect of arm position and capsular release on rotator cuff repair. A biomechanical study
Zuckerman JD; Leblanc JM; Choueka J; Kummer F
1991 May;73(3):402-405, Journal of bone & joint surgery (British volume)
A cadaver study was performed to determine the effect of arm position and capsular release on rotator cuff repair. Artificial defects were made in the rotator cuff to include only the supraspinatus (small) or both supraspinatus and infraspinatus (large). The defects were repaired in a standard manner with the shoulder abducted 30 degrees at the glenohumeral joint. Strain gauges were placed on the lateral cortex of the greater tuberosity and measurements were recorded in 36 different combinations of abduction, flexion/extension, and medial/lateral rotation. Readings were obtained before and after capsular release. With small tears, tension in the repair increased significantly with movement from 30 degrees to 15 degrees of abduction (p < 0.01) but was minimally affected by changes in flexion or rotation. Capsular release significantly reduced the force (p < 0.01) at 0 degree and 15 degrees abduction. For large tears, abduction of 30 degrees or more with lateral rotation and extension consistently produced the lowest values. Capsular release resulted in 30% less force at 0 degree abduction (p < 0.05)
— id: 44610, year: 1991, vol: 73, page: 402, stat: Journal Article,

The painful shoulder: Part I. Extrinsic disorders
Zuckerman JD; Mirabello SC; Newman D; Gallagher M; Cuomo F
1991 Jan;43(1):119-128, American family physician
Shoulder disorders are most commonly manifested by pain and limited function. Careful history and examination help the physician localize the problem to the shoulder joint, the surrounding tissues or adjacent sites that can cause referred pain to the shoulder. Common extrinsic causes of shoulder pain include postural problems and cervical spine disorders
— id: 44613, year: 1991, vol: 43, page: 119, stat: Journal Article,

The painful shoulder: Part II. Intrinsic disorders and impingement syndrome
Zuckerman JD; Mirabello SC; Newman D; Gallagher M; Cuomo F
1991 Feb;43(2):497-512, American family physician
Intrinsic disorders that can cause shoulder pain include arthritis, gout, pseudogout and osteonecrosis. In its mildest form, impingement syndrome may cause only minimal discomfort. At its worst, impingement syndrome may lead to rotator cuff tear. Bicipital tendinitis and rupture of the biceps tendon may also be associated with impingement. Early rehabilitative intervention is important. Physical therapy is directed toward restoring range of motion and muscle strength
— id: 44611, year: 1991, vol: 43, page: 497, stat: Journal Article,

In vivo stability of ferric hydroxide macroaggregates (FHMA). Is it a suitable carrier for radionuclides used in synovectomy?
Chinol M; Vallabhajosula S; Zuckerman JD; Goldsmith SJ
1990 ;17(5):479-486, International journal of radiation applications & instrumentation. Pt. B. Nuclear medicine & biology
Ferric hydroxide macroaggregates (FHMA) have been widely used as a carrier for several radionuclides used in radiation synovectomy. Different rates of extra-articular leakage of radioactivity have been observed with 90Y and 165Dy. In order to understand the mechanism(s) involved in the extra-articular leakage of radioactivity, the in vivo stability of FHMA carrier was studied. Following an injection of [59Fe]Fe-FHMA into the knees of normal rabbits, the cumulative leakage of [59Fe]Fe-FHMA was 2.9% at 5 days and 12.3% at 14 days. More than 60% of this activity was in the blood. But when FHMA was double labeled with 59Fe and 166Ho, the 59Fe leakage significantly increased to 18.5% at 5 days and 27% by 14 days. The instability of FHMA is accelerated when it is complexed with 166Ho and may be due to the 'mass effect' of 166Ho or due to radiolysis induced by high energy beta particles from 166Ho. These results suggest that FHMA is a suitable carrier only for the short lived radionuclides used in synovectomy
— id: 44618, year: 1990, vol: 17, page: 479, stat: Journal Article,

[Positive results of a care program for patients with hip fractures in New York]
Frankel VH; Zuckerman JD; Sakales SR; Fabian DR; Zetterberg C
1990 Feb 28;87(9):632-634, Lakartidningen
— id: 44617, year: 1990, vol: 87, page: 632, stat: Journal Article,

Polyethylene bearing component failure and dislocation in the triaxial elbow. A report of two cases
Matarese W; Stuchin SA; Kummer FJ; Zuckerman JD
1990 Dec;5(4):365-367, Journal of arthroplasty
Two cases of polyethylene bearing failure in the Triaxial elbow are presented. Although these were low-demand patients with the prostheses properly aligned, the severity of the wear suggests inadequate prosthesis design
— id: 44615, year: 1990, vol: 5, page: 365, stat: Journal Article,

A biomechanical analysis of the sliding hip screw: the question of plate angle
Meislin RJ; Zuckerman JD; Kummer FJ; Frankel VH
1990 ;4(2):130-136, Journal of orthopaedic trauma
There is general agreement that the implant of choice for intertrochanteric fractures is the sliding hip screw (SHS). However, considerable differences of opinion exist as to which plate angle--varying from 130 to 150 degrees--is preferred. Thus far there has been no cadaver-based biomechanical analysis of this problem. To examine these questions, we determined the effect of plate angle on plate strain and proximal medial femoral strain distribution in cadaver femurs fixed with 130, 135, 140, 145, and 150 degrees SHS after experimentally produced stable and unstable intertrochanteric fractures. Twenty-four fresh adult cadaver femurs were assigned randomly to either the 130, 135, 140, 145, or 150 degrees SHS group. Each femur was radiographed and bone mineral density was determined by dual-photon absorptiometry. Multiple-strain gauges were affixed to the femur, with specific focus on the proximal femur and plate. Femurs were loaded at 25 degrees adduction in increments of 70 N from 0 to 1,800 N in a servohydraulic testing machine. Femurs were tested in a progressive manner: (a) intact femur; (b) intact femur with SHS inserted; (c) a stable two-part intertrochanteric fracture reduced with SHS; (d) a four-part fracture with the posteromedial fragment (PMF) reduced anatomically by a lag screw; (e) the same fracture with the PMF rotated 180 degrees and held in place by a lag screw to approximate a 'near-anatomic' reduction; and (f) the same fracture with the PMF discarded. Screw sliding measurements were determined at regular intervals throughout each test.(ABSTRACT TRUNCATED AT 250 WORDS)
— id: 32689, year: 1990, vol: 4, page: 130, stat: Journal Article,

Revision of a loose glenoid component facilitated by a modular humeral component. A technical note
Shaffer BS; Giordano CP; Zuckerman JD
1990 ;5 Suppl(2):S79-S81, Journal of arthroplasty
Revision of a glenoid component can be difficult in the presence of a humeral component. Removal of the humeral component is generally required, which adds significantly to the difficulty of the procedure and increases the risk of complications. This report describes revision of a loose glenoid component that was greatly facilitated by the presence of a modular humeral component
— id: 44619, year: 1990, vol: 5 Suppl, page: S79, stat: Journal Article,

[Physical activity has a certain positive effect on the skeleton]
Zetterberg, C; Annerstedt, M; Nordin, M; Skovron, M L; Zuckerman, J
1990 Oct 17;87(42):3393-3395, Lakartidningen
— id: 78503, year: 1990, vol: 87, page: 3393, stat: Journal Article,

Injections for joint and soft tissue disorders: when and how to use them
Zuckerman JD; Meislin RJ; Rothberg M
1990 Apr;45(4):45-52, 55, Geriatrics
Joint and soft tissue injections may be the only way to differentiate various arthritic disorders, accurately identify a septic joint, and apply focused treatment. Certain considerations can make these injections safer and more effective. This article reviews the principles of diagnostic and therapeutic use of joint and soft tissue injections and makes specific recommendations for common injection sites. Also described are appropriate aseptic techniques for aspirating and injecting joints, bursae, and soft tissue, as well as the judicious use of corticosteroid injections in this age group
— id: 32688, year: 1990, vol: 45, page: 45, stat: Journal Article,

The challenge of geriatric hip fractures
Zuckerman JD; Sakales SR; Fabian DR; Frankel VH
1990 May-Jun;66(3):255-265, Bulletin of the New York Academy of Medicine
— id: 44616, year: 1990, vol: 66, page: 255, stat: Journal Article,

Comprehensive care of orthopaedic injuries in the elderly
Zuckerman, Joseph D. (Joseph David)
Baltimore : Urban & Schwarzenberg, c1990,
— id: 689, year: 1990, vol: , page: , stat: ,

Management of an infected total knee arthroplasty
Meislin R; Zuckerman JD
1989 Spring;49(1):21-36, Bulletin of the Hospital for Joint Diseases Orthopaedic Institute
Infection following total knee arthroplasty can be one of the most challenging problems in orthopaedic surgery. This article discusses the pertinent clinical factors to be considered and the treatment options in the management of patients with infection following total knee replacement
— id: 44621, year: 1989, vol: 49, page: 21, stat: Journal Article,

Bilateral posterior hip dislocations with femoral head fractures
Meislin RJ; Zuckerman JD
1989 ;3(4):358-361, Journal of orthopaedic trauma
An unusual case of bilateral posterior fracture-dislocation of the hip (Pipkin Type IV) occurred in a 63-year-old man with Paget's disease of the pelvis. Other injuries included a displaced humeral shaft fracture and patellar ligament disruption. Bilateral cemented total hip arthroplasty was performed to avoid the need for prolonged immobilization. Postoperative low-dose irradiation was used because of the risk of heterotopic ossification
— id: 32691, year: 1989, vol: 3, page: 358, stat: Journal Article,

Treatment of antigen-induced arthritis in rabbits with dysprosium-165-ferric hydroxide macroaggregates
Zuckerman JD; Sledge CB; Shortkroff S; Venkatesan P
1989 ;7(1):50-60, Journal of orthopaedic research
Dysprosium-165-ferric hydroxide macroaggregates (165Dy-FHMA) was used as an agent of radiation synovectomy in an antigen-induced arthritis model in New Zealand white rabbits. Animals were killed up to 6 months after treatment. 165Dy-FHMA was found to have a potent but temporary antiinflammatory effect on synovium for up to 3 months after treatment. Treated knees also showed significant preservation of articular cartilage architecture and proteoglycan content compared with untreated controls, but only during the first 3 months after treatment. In animals killed 3 and 6 months after treatment there were only minimal differences between the treated and untreated knees, indicating that the antiinflammatory effects on synovial tissue and articular cartilage preservation were not sustained
— id: 44620, year: 1989, vol: 7, page: 50, stat: Journal Article,

Geriatric knee disorders, Part II: Differential diagnosis and treatment
Chang WS; Zuckerman JD
1988 Mar;43(3):39-42, 44, 46 passim, Geriatrics
Part II of this two-part article reviews differential diagnosis of common geriatric knee disorders. Differentiating extra-articular from intra-articular causes of knee pain is stressed, since treatments and prognoses can be quite different. Referred pain from the ipsilateral hip and spine should also be kept in mind. The diagnostic approach to knee pain can be categorized anatomically and according to etiology: Is the pain coming from the bone (patella, femur, tibia, fibula), or the soft tissue (ligament, tendon, capsule, synovium, meniscus, muscle)? Is it degenerative, inflammatory, metabolic, traumatic, infectious, or neoplastic? These issues are included in the discussion
— id: 44623, year: 1988, vol: 43, page: 39, stat: Journal Article,

Geriatric knee disorders, Part I: Evaluative techniques
Chang WS; Zuckerman JD; Pitman MI
1988 Feb;43(2):73-7, 80, 83, Geriatrics
It is important to remember that knee disorders seen in the elderly are distinctly different from those seen in the younger individual. In the elderly, the problems are generally the result of chronic processes and, occasionally, an acute process on top of a chronic disorder. A careful history and physical examination should enable the physician in most cases to make the correct diagnosis. However, at times, specific laboratory studies may be ordered to confirm the diagnosis. In part I of this two-part review of geriatric knee disorders, the authors will focus on the anatomy, history, and physical examination of the knee joint. Common knee disorders specific to the elderly will be discussed in part II
— id: 44624, year: 1988, vol: 43, page: 73, stat: Journal Article,

Clostridial septic arthritis: case report and review of the literature
Fauser DJ; Zuckerman JD
1988 Feb;31(2):295-298, Arthritis & rheumatism
We describe a patient who had septic arthritis caused by Clostridium perfringens. Clostridial organisms are very uncommon causes of septic arthritis. Only 13 cases have been reported previously. The diagnosis should be suspected in patients with a history of penetrating joint trauma and in immunocompromised patients. Successful treatment has usually consisted of surgical synovectomy in combination with high-dose intravenous penicillin therapy. Multiple aspirations of affected joints as a definitive treatment should be used with caution and only in patients who are not candidates for surgery
— id: 38843, year: 1988, vol: 31, page: 295, stat: Journal Article,

Hip pain in the elderly: evaluation and diagnosis
Schon L; Zuckerman JD
1988 Jan;43(1):48-62, Geriatrics
Hip pain in the elderly can result in severe disability with compromise of independence. The causes of hip pain include many intrinsic and extrinsic disorders. Evaluation of the geriatric patient with pain in the vicinity of the hip requires a complete history and physical, radiographic evaluation and appropriate laboratory studies in order for proper management to be instituted
— id: 44625, year: 1988, vol: 43, page: 48, stat: Journal Article,

Repeat radiation synovectomy with dysprosium 165-ferric hydroxide macroaggregates in rheumatoid knees unresponsive to initial injection
Vella M; Zuckerman JD; Shortkroff S; Venkatesan P; Sledge CB
1988 Jun;31(6):789-792, Arthritis & rheumatism
Because of failure to fully respond to an initial intraarticular injection of dysprosium 165-ferric hydroxide macroaggregates, 17 patients with seropositive rheumatoid arthritis underwent repeat radiation synovectomy using this agent. Of the 13 patients who were evaluated 1 year later, 54% (7 knees) had good results, 31% (4 knees) had fair results, and 15% (2 knees) had poor results. The initial lack of significant benefit from radiation synovectomy did not appear to preclude a favorable response to a second injection
— id: 44622, year: 1988, vol: 31, page: 789, stat: Journal Article,

Benign solitary schwannoma of the foot. A case report and review of the literature
Zuckerman JD; Powers B; Miller JW; Lippert F
1988 Mar;(228):278-280, Clinical orthopaedics & related research
Benign solitary schwannomas of the foot are a rare occurrence; only four cases have been previously reported. A schwannoma associated with the medial plantar nerve present for more than 40 years before the onset of symptoms was diagnosed in a 73-year-old man. Excision of the mass, with preservation of the involved nerve, was possible and successfully relieved symptoms
— id: 47561, year: 1988, vol: , page: 278, stat: Journal Article,

Biomechanical evaluation of anatomic reduction versus medial displacement osteotomy in unstable intertrochanteric fractures
Chang WS; Zuckerman JD; Kummer FJ; Frankel VH
1987 Dec;(225):141-146, Clinical orthopaedics & related research
The biomechanical characteristics of anatomic reduction versus medial displacement osteotomy were compared for four-part intertrochanteric fractures experimentally produced in cadaver femurs. Eighteen pairs of femurs were assigned randomly to either the anatomic (A) or the medial displacement (MD) group and instrumented with multiple strain gauges. The femurs in the MD group were tested while intact and following four-part fracture with fixation. The femurs in the A group were first tested intact, followed by a stable two-part fracture with fixation, and then by a four-part fracture with fixation and perfect reduction of the posteromedial fragment (PMF) with a lag screw, partial reduction of the PMF, and with the PMF omitted. All fractures were fixed with a 135 degrees, four-hole, sliding hip screw. The strain distribution in the MD group changed significantly after fracture. The plate tensile strain increased by 360% while the compressive calcar strain decreased 85%. The plate tensile strain in the A group also increased significantly after four-part fracture when the PMF was perfectly reduced (160%), partially reduced (290%), or discarded (275%); the calcar compressive strains for these subgroups decreased approximately 50%. This laboratory study indicates that anatomic reduction of four-part intertrochanteric fractures with the sliding hip screw, regardless of the presence or position of the PMF, provides significantly higher compression across the calcar region and significantly lower tensile strain on the plate than fractures reduced by medial displacement osteotomy. The more physiologic strain distribution and the increased medial load transmission support the use of anatomic reduction for the treatment of unstable intertrochanteric fractures
— id: 47562, year: 1987, vol: , page: 141, stat: Journal Article,

Synovectomy of the rheumatoid knee using intra-articular injection of dysprosium-165-ferric hydroxide macroaggregates
Sledge CB; Zuckerman JD; Shortkroff S; Zalutsky MR; Venkatesan P; Snyder MA; Barrett WP
1987 Sep;69(7):970-975, Journal of bone & joint surgery (American volume)
One hundred and eleven patients who had seropositive rheumatoid arthritis and persistent synovitis of the knee were treated with intra-articular injection of 270 millicuries of dysprosium-165 bound to ferric hydroxide macroaggregates. A two-year follow-up was available for fifty-nine of the treated knees. Thirty-nine had a good result; nine, a fair result; and eleven, a poor result. Of the twenty-five knees that had Stage-I radiographic changes, nineteen had a good result. Of the thirty-four knees that had Stage-II radiographic changes, twenty showed a good result. Systemic spread of the radioactivity from the injected joint was minimum. The mean whole-body dose was calculated to be 0.3 rad and that to the liver twenty-four hours after injection, 3.2 rads. The results indicated that dysprosium-165-ferric hydroxide macroaggregate is an effective agent for performing radiation synovectomy, particularly in knees that have Stage-I radiographic changes. Because of the minimum rate of systemic spread of the dysprosium-165, it offers a definite advantage over agents that previously have been used
— id: 44626, year: 1987, vol: 69, page: 970, stat: Journal Article,

Geriatric shoulder pain: common causes and their management
Zuckerman JD; Shapiro I
1987 Sep;42(9):43-8, 51, Geriatrics
Shoulder pain in the geriatric patient is a common presentation encountered by primary care physicians. Proper evaluation requires an understanding of the pertinent anatomy, a thorough physical examination, and a knowledge of common shoulder disorders that occur in this population. This article provides information needed to evaluate the geriatric patient with shoulder pain. Common causes of shoulder pain--both intrinsic and extrinsic--and their management will be reviewed
— id: 44627, year: 1987, vol: 42, page: 43, stat: Journal Article,

Treatment of rheumatoid arthritis using radiopharmaceuticals
Zuckerman JD; Sledge CB; Shortkroff S; Venkatesan P
1987 ;14(3):211-218, International journal of radiation applications & instrumentation. Pt. B. Nuclear medicine & biology
One hundred and twenty one knees in 97 patients with seropositive rheumatoid arthritis and persistent knee synovitis were treated with the intra-articular injection of 270 mCi (30 GBq) of dysprosium-165 (165Dy) bound to ferric hydroxide macroaggregates. Of 81 knees evaluated at one year, 61% had good results, 23% had fair results and 16% had poor results. Of 44 knees evaluated at two years, 64% had good results, 16% had fair results and 20% had poor results. Knees with Stage I radiographic changes showed 72 and 81% good results at one and two years, respectively. Knees and Stage II radiographic changes showed 53 and 48% good results at one and two years, respectively. Leakage of radioactivity from the injected joint was minimal. Mean leakage to the venous blood was 0.15% of the injected dose. Mean leakage to the liver 24 h after injection was 0.64% of the injected dose. Mean leakage to the draining inguinal lymph nodes was 0.17% of the injected dose. These results indicate that 165Dy-ferric hydroxide macroaggregate is an effective agent for radiation synovectomy, particularly in knees with Stage I radiographic changes. The minimal leakage rates observed offer a definite advantage over previously used agents
— id: 44628, year: 1987, vol: 14, page: 211, stat: Journal Article,

Treatment of unstable femoral shaft fractures with closed interlocking intramedullary nailing
Zuckerman JD; Veith RG; Johnson KD; Bach AW; Hansen ST; Solvik S
1987 ;1(3):209-218, Journal of orthopaedic trauma
From 1979 to 1982, 64 femoral shaft fractures in 62 patients were treated by closed interlocking nailing at Harborview Medical Center, Seattle, WA, U.S.A., and Parkland Memorial Hospital, Dallas, TX, U.S.A. Twenty-nine patients sustained multiple system injuries and 29 of the involved extremities (45%) had at least one additional injury. There were 17 (26%) open fractures. Static mode nailing was used to treat 52 fractures; dynamic mode nailing was performed for 12 fractures. Patient follow-up averaged 17 months (range 7-41 months). The average time to union was 13.5 weeks. Normal femoral length within 1 cm was achieved in 97% of cases. Knee range of motion averaged 127 degrees. Complications (9%) included two delayed unions, one nonunion, two cases of shortening or lengthening of more than 1 cm, and one case of malunion with angulation or more than 10 degrees. The delayed unions and nonunions healed after one additional procedure. This study shows that closed interlocking nailing is a safe, effective technique that provides stable fixation in most unstable femoral shaft fractures. This technique represents a major advance in the treatment of difficult femoral shaft fractures that would be poorly suited for standard closed nailing
— id: 44629, year: 1987, vol: 1, page: 209, stat: Journal Article,

Treatment of rheumatoid synovitis of the knee with intraarticular injection of dysprosium 165-ferric hydroxide macroaggregates
Sledge CB; Zuckerman JD; Zalutsky MR; Atcher RW; Shortkroff S; Lionberger DR; Rose HA; Hurson BJ; Lankenner PA Jr; Anderson RJ; et al.
1986 Feb;29(2):153-159, Arthritis & rheumatism
One hundred eight knees of 93 patients with seropositive rheumatoid arthritis and persistent synovitis of the knee were treated with an intraarticular injection of 270 mCi of dysprosium 165 bound to ferric hydroxide macroaggregate. Leakage of radioactivity from the injected joint was minimal. Mean leakage to the venous blood 3 hours after injection was 0.11% of the injected dose; this corresponds to a mean whole body dose of 0.2 rads. Mean leakage to the liver 24 hours after injection was 0.64% of the injected dose; this corresponds to a mean liver dose of 3.2 rads. In 7 additional patients examined, there was negligible or near negligible activity found in the draining inguinal lymph nodes. One-year followup was possible for 74 knees (63 patients). Sixty-one percent of the knees had good results, 23% had fair results, and 16% had poor results. There was a direct correlation between the radiographic stage and response to treatment. In knees with stage I radiographic changes, 72% showed good results; 93% showed improvement. In knees with stage II changes, 59% showed good results; 81% showed improvement. These preliminary results indicate that dysprosium 165-ferric hydroxide macroaggregate is an effective agent for radiation synovectomy. The low leakage rates observed offer a definite advantage over agents previously used
— id: 44630, year: 1986, vol: 29, page: 153, stat: Journal Article,

Total joint replacement: latest developments for the geriatric patient
Zuckerman JD; Sledge CB
1985 Mar;40(3):71-3, 77, Geriatrics
Total joint replacement has significantly improved the treatment of patients with severe, disabling arthritis. Following replacement of the hip, knee, shoulder, or elbow, the vast majority of patients can expect excellent pain relief and functional improvement. The components of a successful total joint replacement include proper patient selection, optimal preoperative and postoperative management of associated medical problems, meticulous surgical technique, a comprehensive rehabilitation program, and proper prophylaxis against infection
— id: 44631, year: 1985, vol: 40, page: 71, stat: Journal Article,

Bunion surgery in adolescents: results of surgical treatment
Scranton PE Jr; Zuckerman JD
1984 Jan;4(1):39-43, Journal of pediatric orthopedics
The results of bunion surgery on 50 feet in 31 adolescents are reviewed. Average follow-up was 3 years 2 months. The failure rate was 36%. Fifty-one percent of the children had hypermobile flatfeet, and 32% had a long first ray. The recurrence rate in these groups was 56 and 50%, respectively. There were 20 reoperations for either recurrence (12) or hardware removal (eight). Elective bunion surgery in adolescents should only be performed in the face of progressive, painful deformity where both the patient and the patient's parents fully understand the goals and risks of surgery
— id: 44634, year: 1984, vol: 4, page: 39, stat: Journal Article,

Axillary artery injury as a complication of proximal humeral fractures. Two case reports and a review of the literature
Zuckerman JD; Flugstad DL; Teitz CC; King HA
1984 Oct;(189):234-237, Clinical orthopaedics & related research
Proximal humeral fractures are commonly seen in orthopedic practice. The vast majority of these fractures are nondisplaced. Infrequently, displaced proximal humeral fractures have associated neurovascular injuries. Injury to the brachial plexus is uncommon; axillary artery injury is rare. This is a report of two displaced proximal humeral fractures in elderly, intoxicated patients following low-energy trauma. Both fractures resulted in axillary artery injury requiring vascular reconstruction. Only nine similar cases were found in a review of the literature. Displaced proximal humeral fractures should be carefully evaluated for vascular injury, and arteriography should be used when necessary. If vascular reconstruction is indicated, the fracture must be internally fixed to prevent redisplacement and potential compromise of the vascular repair. Serial postoperative Doppler examinations are necessary to detect thrombus formation. With prompt diagnosis and treatment, prolonged limb ischemia and its sequelae can be prevented
— id: 47563, year: 1984, vol: , page: 234, stat: Journal Article,

Complications about the glenohumeral joint related to the use of screws and staples
Zuckerman JD; Matsen FA 3rd
1984 Feb;66(2):175-180, Journal of bone & joint surgery (American volume)
Screws and staples are used frequently in the surgical treatment of glenohumeral joint problems. We analyzed a series of thirty-seven patients with complications related to the use of these implants. Twenty-one patients had problems related to the use of screws for affixing a transferred coracoid process to the glenoid. Sixteen patients had problems related to the use of staples: ten had undergone capsulorrhaphy, four had had advancement of the subscapularis, and two had had repair of a rotator cuff tear. The complaints at examination were shoulder pain (thirty-six patients), decreased glenohumeral motion (nineteen patients), crepitus with glenohumeral motion (sixteen patients), and radiating paresthesias (four patients). The time between placement of the implant and the onset of symptoms ranged from four weeks to ten years. The screws or staples had been incorrectly placed in ten patients, had migrated or loosened in twenty-four, and had fractured in three. Thirty-four patients required a second surgical procedure specifically for removal of the implant. At operation fourteen patients (41 per cent) were noted to have sustained a significant injury to the articular surface of the glenoid or humerus. The results in this group of patients indicated that screws and staples can produce complications that require reoperation and are capable of causing a permanent loss of joint function. Adequate surgical exposure and careful placement of the implant appear to be essential when these devices are used about the glenohumeral joint
— id: 44633, year: 1984, vol: 66, page: 175, stat: Journal Article,

Acetabular augmentation for progressive hip subluxation in cerebral palsy
Zuckerman JD; Staheli LT; McLaughlin JF
1984 Aug;4(4):436-442, Journal of pediatric orthopedics
Between 1969 and 1981, 20 acetabular augmentations were performed on 17 cerebral palsied patients with progressive hip instability. Average follow-up was 41.5 months, with a range from 24 to 147 months. Evaluation of results was based on assessment of hip stability, center edge (CE) angle, range of motion, and postoperative complications. Eighteen hips were rated good, one fair, and one poor. Stability was achieved in 19 hips. The CE angle was increased from a preoperative mean of -17 degrees to a follow-up mean of 50 degrees. There was no significant difference between preoperative and follow-up hip range of motion. The only complication encountered was a supracondylar femur fracture sustained after spica cast immobilization. Acetabular augmentation can be used effectively in the treatment of progressive hip instability in patients with cerebral palsy
— id: 44632, year: 1984, vol: 4, page: 436, stat: Journal Article,

Anterior glenohumeral instability
Matsen FA 3rd; Zuckerman JD
1983 Jul;2(2):319-338, Clinics in sports medicine
Anterior glenohumeral instability is an important cause of shoulder disability in athletes. Recurrent glenohumeral instability can seriously impair the athlete's performance. Since the surgical repair of recurrent instability may result in a loss of flexibility, particularly in the thrower and gymnast, the physician must optimize both joint stability and joint flexibility
— id: 44570, year: 1983, vol: 2, page: 319, stat: Journal Article,