Kenneth J Koval

..S. Medicare population stratified by hospital referral region and (2) whether the type of fracture treatment is affected by patient age, race, sex, comorbidity, or hospital referral region...

..The purpose of this study was to evaluate whether there has been a change in the amount of fracture care performed by recent graduates of orthopaedic residency programs over time...

..This study was performed to address the effect of alcohol on in-hospital mortality for drivers in MVAs admitted to a trauma center before and after controlling for injury severity, safety device use, and patient demographics...

..The purpose of this study was to use the United States Medicare database to determine the complication rate for ankle fractures in elderly patients treated operatively and to compare it to fractures treated nonoperatively...

..The purpose of this prospective study was to compare two different types of tape to determine whether the type of tape influences the rate of blister formation...

..09). Surgery type (arthroplasty vs open reduction and internal fixation [ORIF], P < .03) and surgery duration (P < .05) had more of an effect on postoperative blister formation than dressing type...

..The present study was designed to identify changes in practice patterns regarding operative fixation of distal radial fractures between 1999 and 2007 and to assess the results of those treatments over time...

..The purpose of this study was to evaluate the possible risk factors for hospital transfer in a population of patients unlikely to require transfer to a level-I center for medical reasons...

..This paper presents a clinical pathway for the treatment of hip fractures in the elderly with the above aims...

..1%; there was little effect for any of the studied factors on risk for in-hospital complication. Contrary to expectation, hospital setting and teaching status were generally not as relevant to in-hospital outcomes as other factors were...

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..The purpose of this study was to evaluate the results using this standardized protocol...

..To describe the epidemiology of perioperative anemia in patients with hip fracture and assess the relationship between the hemoglobin measurements and clinical outcomes...

..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...

..No specimen lost fixation during cycling. CONCLUSION: The L.I.S.S plating system provides stable fixation of complex bicondylar tibial plateau fractures allowing early range of knee motion with favorable clinical results...

..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...

..This study was performed to evaluate when patients recover sufficiently to drive an automobile after operative repair of various other lower extremity fractures...

..To examine unidentified heterogeneity in hip fracture patients that may predict variation in functional outcomes...

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..This study was performed to examine the relationship among pain, analgesics, and other factors on delirium in hip fracture patients...

..This study compares the biomechanical stability of two volar locked plate systems for fixation of unstable, extra-articular distal radius fractures...

..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...

..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...

..Length of stay was shortest in high volume centers. In-hospital outcomes associated with surgical fixation of the pelvis, acetabulum, or both were not uniformly associated with hospital volume...

..The results of this study suggest use of plates with unicortical screws for the described fracture is not recommended...

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..Models where the femoral head had a higher compressive strength than that of the femoral neck may simulate fracture patterns with significant medial cortex comminution that are prone to varus collapse...

..Evaluate whether supplementary fibular fixation helped maintain axial alignment in distal metaphyseal tibia-fibula fractures treated by locked intramedullary nailing...

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..To examine the relationship between early physical therapy (PT), later therapy, and mobility 2 and 6 months after hip fracture...

..The stiffest of the fixators varied by a factor of three in compression, five in bending, and three in torsion. Although the ideal stiffness of a wrist fixator is unknown, there is a large variation in the stiffness of existing devices...

..Our approach led to the restoration of elbow joint stability in all patients...

..28-0.39), the seatbelt- only group had a 51% mortality reduction (AOR, 0.49; 99% CI, 0.45-0.52), and the air-bag-only group had a 32% mortality reduction (AOR, 0.68, 99% CI, 0.57-0.80). Injury Severity Scores showed a similar pattern...

..Surgical experience in primary and revision THA has a significant effect on patient outcomes after hemiarthroplasty for femoral neck fracture...

..Although various methods exist for exploring the "July effect," it is critical to take into account inherent month-to-month variation in outcomes and to use nonteaching hospitals as a control group...

..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...

..CONCLUSION: A sliding hip screw with an attached lateral support plate provides stability and ability to resist medial displacement of the femoral shaft similar to that seen with the IMHS...

..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...

..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...

..CONCLUSIONS: Male gender was a risk factor for sustaining a postoperative complication as well as a higher mortality at 1 year post hip fracture...

..Conventional plates may continue to be the fixation method of choice for periarticular fractures which demand perfect anatomical reduction and to certain types of nonunions which require increased stability for union...

..CONCLUSIONS: Patients at risk for poor outcomes after hip fracture can be identified by assessing hemoglobin levels at hospital admission...

..05). The Acutrac screws tested in this biomechanical study provided more stable fixation of simulated capitellum fractures than Herbert screws. This appears to be related to the design of these screws...

..The effects of transfusion on morbidity and mortality are controversial. The influence of transfusion on risk-adjusted mortality, readmissions, and functional mobility was examined...

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..Also, the volar locked plate was stiffer than the dorsal nonlocked plate for all loading configurations tested except when subjected to a dorsally applied eccentric load...

..This study investigated which variables influence patients' return to sports after operative fixation of an unstable ankle fracture...

..For firearm hospitalizations, 16- to 20-year-old black males have significantly higher risk compared with all other identified groups...

..The purpose of this study was to develop a triaging tool to predict pediatric in-hospital mortality from data available soon after emergency department (ED) presentation...

..The purpose of this study was to examine the cost-effectiveness of prophylactic fixation of the uninjured hip to prevent contralateral hip fracture...

..To determine the cost-effectiveness of open reduction internal fixation (ORIF) of displaced, midshaft clavicle fractures in adults...

..In this study, we evaluated predictors of short-term functional outcome following surgical stabilization of ankle fractures...

..033). Adding CT, although it may influence the decision to operate on Tillaux and triplane fractures, may not be as useful as previously thought...

..Posterior plating with this technique achieves greater stability compared to tension band wiring. Early clinical results indicate a low level of hardware related complications...

..There were no serious complications and no adverse reactions to the rhOP-I implant. Our study suggests that rhOP-1 may be a safe and effective adjuvant for the treatment of humeral diaphyseal nonunions...

..Therefore, we do not recommend making acquisition of ABG levels a routine part of the preoperative evaluation...

..Only half of all individuals in this study used any type of restraint device, which indicates the need for significant improvements in public health and safety seat belt utilization programs...

..Pin-track infection remains one of the most troublesome complications of external fixation, in some cases compromising otherwise successful fracture treatment...

..As most fractures occurredindoors, precipitation is less likely to play a part in hip fracture occurrence in this population...

..Both elastic stable intramedullary nails and external fixation can be utilized. We retrospectively reviewed our experience with these two techniques to determine if one is superior to the other...

..4%). Patient age, patient sex, number of medical comorbidities, smoking history, nutritional status, and type of surgery were not statistically significantly associated with risk for developing tape blisters...

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..Our results demonstrate the limitations of two scoring systems in predicting fracture stability and in making clinical decisions on the basis of their results...

..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...

..Phase 3 of our study presented the most accurate results in length determination of tibial nail length...

..LEVEL OF EVIDENCE: Level III, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence...

..When operative intervention is indicated, considerations include the characteristics of the fracture and the experience of the surgeon with the treatment modalities...

..Loading to failure demonstrated no significant differences between the two groups. CONCLUSION: This study demonstrated that 30 degrees of posterior sag does not result in a significant difference in construct strength or stability...

..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...

..09) in adjusted mean rates for THA (0.47%), HA (8.24%), ORIF (94.8%), or NM (2.11%). There were no significant disparities by race across hospital referral regions with regard to type of fracture treatment...

..LEVEL OF EVIDENCE: Prognostic study, Level IV (case series). See the Guideline for Authors for a complete description of levels of evidence...

..The purpose of this study was to determine when patients recover the ability to safely operate the brakes of an automobile following operative repair of an ankle fracture...

..This study was performed to evaluate whether early internal fixation or nonoperative treatment would be preferred for displaced, potentially unstable distal radial fractures that initially had an adequate reduction...

..Hip fracture is associated with significant mortality and disability. Patients who are discharged from the hospital with active clinical problems may have worse outcomes than those patients without active clinical problems...

..Ultimately, the decision of which method to use lies with the attending surgeon and the technique with which he or she feels most comfortable...

..Orthopaedic surgeons need to recognize features of child abuse. The purpose of this study was to identify common characteristics of child abuse and to delineate features of physical injury cases that would raise concern for child abuse...

..CONCLUSION: The two constructs showed equivalent rigidity and stability in all parameters assessed in elastic and cyclical tests. The TAN had a greater ultimate failure load...

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..05), and mean lag screw sliding difference was 4.5 mm (58%) (p < 0.05). CONCLUSION: The addition of an attachable lateral support plate to an SHS significantly decreased displacement of the femoral head after cyclic loading...

..To evaluate patient outcomes after treatment of lower-extremity fractures associated with blister formation and to assess complications after soft-tissue treatment using a prospective protocol...

..In this article, we outline some of these developments with respect to femoral neck and intertrochanteric fractures...

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..The 2 main methods of operative management are plate-and-screws and intramedullary fixation. Study results for both methods have been good. Indications for operative management, however, remain controversial...

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..The laudable goal of obtaining fracture healing and maintenance of a viable femoral head can be successfully achieved in a number of patients...