Publications

Surgical technique: arthroscopic treatment of heterotopic ossification of the hip after prior hip arthroscopy

Ong, Crispin; Hall, Michael; YOUM, THOMAS

Clinical orthopaedics & related research2013 Apr;471(4):1277-1282

BACKGROUND: The incidence of heterotopic ossification (HO) after hip arthroscopy reportedly ranges from less than 1.0% to 6.3%. Although open debridement has been described and a few series mention arthroscopic debridement, the techniques for arthroscopic excision of HO have not been described in detail. We describe the arthroscopic treatment of this complication. DESCRIPTION OF TECHNIQUE: Revision arthroscopy was completed in the central and peripheral compartments using prior portals and fluoroscopy was used to identify the HO. Spinal needle localization was used to triangulate onto the HO. Cannulas were inserted over the spinal needle. Once the HO was clearly identified with the arthroscope, it was excised using a burr and confirmed on fluoroscopy. METHODS: We retrospectively reviewed 66 patients who underwent arthroscopic treatment of femoroacetabular impingement between July 2008 and June 2010. There were 36 females and 30 males with an average age of 38 years (range, 15-68 years). Eight of the 66 (12%) patients had HO develop. Using the grading of Brooker et al., six patients had Grade 1, one had Grade 2, and one had Grade 3 HO. Three patients with HO were symptomatic and underwent arthroscopic resection. We obtained modified Harris hip scores (HHS) and radiographs at followup. The minimum followup for the three patients with revision surgery was 2 years (mean, 2 years 2 months; range, 2 years-2 years 8 months). RESULTS: The three patients who underwent arthroscopic resection had HHS ranging from 85 to 96 at last followup. No patient had recurrence of HO. CONCLUSIONS: Our data suggest HO is not uncommon after hip arthroscopy for the treatment of femoroacetabular impingement but most patients have minor degrees and no symptoms. In symptomatic patients, arthroscopic excision appears to relieve pain and restore function.

Are femoral nerve blocks effective for early postoperative pain management after hip arthroscopy?

Ward, James P; Albert, David B; Altman, Robert; Goldstein, Rachel Y; Cuff, Germaine; YOUM, THOMAS

Arthroscopy 2012 Aug;28(8):1064-1069

PURPOSE: To evaluate the utility of femoral nerve blocks in postoperative pain control after hip arthroscopy. METHODS: Forty consecutive patients scheduled for hip arthroscopy were randomized into 2 groups for postoperative pain control. Half were to receive routine intravenous narcotics for pain scores of 7 or above in the postanesthesia care unit (PACU), and the other half were to receive a femoral nerve block in the PACU for the same pain scores. Data were compared with respect to patient sex, patient age, traction times, type of procedure, nausea, overall patient satisfaction with analgesia, and duration of time in the PACU. RESULTS: Thirty-six patients had initial pain scores of 7 of 10 or greater on a visual analog scale. Of these patients, 16 were randomized to receive postoperative morphine and 20 to receive a femoral nerve block. There were no significant differences between the 2 groups with respect to sex, age, traction times, or type of procedure performed. Patients who received morphine had a significantly longer time to discharge from the PACU (216 minutes) than the femoral nerve block group (177 minutes). The morphine group was also significantly more likely to report postoperative nausea (75%) than the femoral nerve block group (10%). Patients receiving femoral nerve blocks were significantly more likely to be satisfied with their postoperative pain control (90%) than those who had received morphine (25%). All of the patients receiving a femoral nerve block stated that they would undergo the block again if they needed another hip arthroscopy. CONCLUSIONS: On the basis of all criteria studied (quality of pain relief, length of stay in the PACU, side effects, and patient satisfaction), a femoral nerve block is an excellent alternative to routine narcotic pain medication in patients undergoing hip arthroscopy. LEVEL OF EVIDENCE: Level II, randomized controlled trial.

Failed hip arthroscopy: causes and treatment options

Ward, James P; Rogers, Patrick; YOUM, THOMAS Orthopedics (Thorofare NJ)

Orthopedics (Thorofare NJ)2012 Jul;35(7):612-617

Indications for arthroscopic surgery of the hip have increased over the past several years, along with the number of procedures performed annually. In addition, the number of unsuccessful procedures and subsequent revision surgeries have also increased. Recent literature has defined several common causes for failed hip arthroscopy. Severe osteoarthritis and osteonecrosis are associated with poor outcomes. Findings during revision hip arthroscopy consistently demonstrate untreated femoroacetabular impingement, chondral defects, labral tears, and postoperative adhesions. The treating surgeon must be diligent in his or her indications for surgery, as well as in addressing all pathology at the initial surgery.

Femoral nerve blocks are effective for post-operative pain control after hip arthroscopy

YOUM, T; Ward, J; Albert, D; Altman, R; Rosenberg, A; Cuff, G; Goldstein, R Arthroscopy

Arthroscopy 2012 June 2012;28(6):e69-e69

SUMMARY By all criteria studied (quality of pain relief, length of stay in the PACU, side effects and patient satisfaction), a femoral nerve block is an excellent alternative to routine narcotic pain medication in patients undergoing hip arthroscopy. DATA Purpose: To evaluate the utility of femoral nerve blocks in post-operative pain control after hip arthroscopy. Methods: Forty consecutive patients scheduled for hip arthroscopy were randomized into two groups for postoperative pain control. Half were to receive routine intravenous narcotics for pain scores of seven or above in the PACU, the other half were to receive a femoral nerve block in the PACU for the same pain scores. Data was compared with respect to patient sex, age, nausea, overall satisfaction with analgesia, and duration of time in the PACU. Results: Thirty-six patients had initial pain scores of seven or greater. Sixteen were randomized to receive post-operative morphine, and twenty to receive a femoral nerve block. There were no significant differences between the two groups with respect to sex or age of the patients. Patients who received morphine had a significantly longer time to discharge from the PACU (216 mins) than the femoral nerve block group (177 mins). The morphine group was also significantly more likely to report post-operative nausea (75%) than the femoral nerve block group (10%). Patients receiving femoral nerve blocks were significantly more likely to be satisfied with their post-operative pain control (90%) than those who had received morphine (25%). All of the patients receiving femoral nerve block stated that they would have the block again if they needed another hip arthroscopy.

Management of focal cartilage defects in the knee: Is ACI the answer?

Strauss E.J.; Fonseca L.E.; Shah M.R.; Youm T.

2011;69(1):63-72, Bulletin of the NYU Hospital for Joint Diseases

Injuries to the articular cartilage of the knee are common. They alter the normal distribution of weightbearing forces and predispose patients to the development of degenerative joint disease. The management of focal chondral lesions continues to be problematic for the treating orthopaedic surgeon. Although many treatment options are currently available, none fulfill the criteria for an ideal repair solution: a hyaline repair tissue that completely fills the defect and integrates well with the surrounding normal cartilage. Autologous chondrocyte implantation (ACI) is a relatively new cell-based treatment method for full-thickness cartilage injuries that in recent years has increased in popularity, with early studies showing promising results. The current article reviews the nature of cartilage lesions in the knee and the treatment modalities utilized in their management, focusing on the role ACI plays in the surgical treatment of these complex injuries

– id: J0209891, year: 2011, vol: 69, page: 63, stat: Journal Article,

Femoroacetabular impingement–diagnosis and treatment

Kaplan, Kevin M; Shah, Mehul R; Youm, Thomas

2010;68(2):70-5, Bulletin of the NYU Hospital for Joint Diseases

Femoroacetabular impingement results from an abnormal contact between the femur and the pelvis. This abnormal contact leads to developmental changes in the femoral neck, labrum, and acetabulum. Secondary to the altered hip joint mechanics, chondral damage occurs and initiates the degenerative process, eventually leading to osteoarthritis. Numerous etiologies have been implicated in femoroacetabular impingement, and a variety of treatment algorithms have been established, with no definitive gold standard. However, the treatment of this disorder with joint preserving techniques offers a viable option between the extremes of nonoperative treatment and total joint arthroplasty

– id: J0190836, year: 2010, vol: 68, page: 70, stat: Journal Article,

Osteochondritis Dissecans of the Capitellum: Current Concepts

Ruchelsman, David E.; Hall, Michael P.; Youm, Thomas

2010 SEP;18(9):557-567, Journal of the American Academy of Orthopaedic Surgeons

Osteochondritis dissecans (OCD) of the capitellum is an uncommon disorder seen primarily in the adolescent overhead athlete. Unlike Fanner disease, a self-limiting condition of the immature capitellum, OCD is multifactorial and likely results from microtrauma in the setting of cartilage mismatch and vascular susceptibility. The natural history of OCD is poorly understood, and degenerative joint disease may develop over time. Multiple modalities aid in diagnosis, including radiography, MRI, and magnetic resonance arthrography. Lesion size, location, and grade determine management, which should attempt to address subchondral bone loss and articular cartilage damage. Early, stable lesions are managed with rest. Surgery should be considered for unstable lesions. Most investigators advocate arthroscopic debridement with marrow stimulation. Fragment fixation and bone grafting also have provided good short-term results, but concerns persist regarding the healing potential of advanced lesions. Osteochondral autograft transplantation appears to be promising and should be reserved for larger, higher grade lesions. Clinical outcomes and return to sport are variable. Longer-term follow-up studies are necessary to fully assess surgical management, and patients must be counseled appropriately

– id: J0192746, year: 2010, vol: 18, page: 557, stat: Journal Article,

The effect of the long head of the biceps on glenohumeral kinematics

Youm, Thomas; ElAttrache, Neal S; Tibone, James E; McGarry, Michelle H; Lee, Thay Q

2009 Jan-Feb;18(1):122-9, Journal of shoulder & elbow surgery

The long head of the biceps has been described as a stabilizing force in the setting of glenohumeral instability. However, data are lacking on the effect of loading the long head of the biceps on glenohumeral kinematics. Six cadaveric shoulders were tested for glenohumeral rotational range of motion and translation using a custom shoulder testing system and the Microscribe 3DLX (Immersion, San Jose, CA). The path of glenohumeral articulation (PGA) was measured by calculating the humeral head center with respect to the glenoid articular surface at maximal internal rotation, 30 degrees, 60 degrees, 90 degrees, and maximal external rotation. Significant decreases in glenohumeral rotational range of motion and translation were found with 22-N biceps loading vs the unloaded group. With respect to the PGA, the humeral rotation center was shifted posterior with biceps loading at maximal internal rotation, 30 degrees, and 60 degrees of external rotation. Loading the long head of the biceps significantly affects glenohumeral rotational range of motion, translations, and kinematics

– id: J0160208, year: 2009, vol: 18, page: 122, stat: Journal Article,

A broken scalpel blade tip: an unusual complication of knee arthroscopy

Gruson, Konrad I; Ilalov, Kirill; Youm, Thomas

2008;66(1):54-6, Bulletin of the NYU Hospital for Joint Diseases

The case of a patient is presented in whom a No. 11 scalpel blade was inadvertently broken and embedded within the lateral femoral condyle during initial arthroscopic portal creation. After a thorough diagnostic arthroscopy and synovectomy to expose the distal femoral articular surface was unsuccessful, luoroscopy was performed to localize the blade fragment in orthogonal planes. The blade tip was eventually retrieved from its position below the surface of the cartilage. The details of the loss and recovery of the blade fragment reinforce that exceptional care must be taken and attention given during the creation of portals, particularly when resistance is encountered. Additionally, all instruments, especially scalpel blades, should be exam- ined carefully when removed from the knee joint

– id: J0139234, year: 2008, vol: 66, page: 54, stat: Journal Article,

Simulated type II superior labral anterior posterior lesions do not alter the path of glenohumeral articulation: a cadaveric biomechanical study

Youm, Thomas; Tibone, James E; ElAttrache, Neal S; McGarry, Michelle H; Lee, Thay Q

2008 Apr;36(4):767-74, American journal of sports medicine

BACKGROUND: Previous studies have demonstrated increased glenohumeral translations with simulated type II superior labral anterior posterior lesions, which may explain the sensation of instability in the overhead-throwing athlete. It is unknown whether this amount of increased translation alters glenohumeral kinematics. PURPOSE: To determine whether type II superior labral anterior posterior lesions significantly alter glenohumeral kinematics as defined by path of glenohumeral articulation in a simulated cadaveric model of the throwing shoulder. STUDY DESIGN: Controlled laboratory study. METHODS: Six cadaveric shoulders were tested for glenohumeral rotational range of motion and translation using a custom shoulder testing system and the Microscribe 3DLX. The path of glenohumeral articulation was measured by calculating the humeral head center with respect to the glenoid articular surface at maximal internal rotation, 30 degrees, 60 degrees, 90 degrees, and maximal external rotation. Data were recorded for vented intact shoulders, shoulders with arthroscopically created type II superior labral anterior posterior lesions, and shoulders with arthroscopically repaired superior labral anterior posterior lesions. RESULTS: A subtle but significant increase in external rotation (2.7 degrees) was seen after creating a type II lesion. Small increases in glenohumeral translation were found in the anterior (0.9 mm) and inferior (0.9 mm) directions with application of a 15-N force in the superior labral anterior posterior group. Increases in glenohumeral rotation and translation were restored to the intact state after repair of the lesion. No significant differences were found in the path of glenohumeral articulation for the superior labral anterior posterior condition compared with the intact shoulder. CONCLUSION: The small amounts of increased external rotation and translation found with arthroscopically created type II superior labral anterior posterior lesions do not significantly affect glenohumeral kinematics in this passive motion model as quantified by the path of glenohumeral articulation. CLINICAL RELEVANCE: Findings suggest that in the absence of pain or mechanical symptoms, type II superior labral anterior posterior lesions that do not significantly involve the superior and middle glenohumeral ligaments may not need surgical repair

– id: J0160209, year: 2008, vol: 36, page: 767, stat: Journal Article,

Posterolateral corner injuries of the knee

Frank, Joshua B; Youm, Thomas; Meislin, Robert J; Rokito, Andrew S

2007;65(2):106-14, Bulletin of the NYU Hospital for Joint Diseases

The posterolateral region of the knee is an anatomically complex area that plays an important role in the stabilization of the knee relative to specific force vectors at low angles of knee flexion. A renewed interest in this region and advanced biomechanical studies have brought additional understanding of both the anatomy and the function of posterolateral structures in knee stabilization and kinematics. Through sectioning and loading studies, the posterolateral corner has been shown to play a role in the prevention of varus angulation, external rotation, and posterior translation. The potential for long-term disability from these injuries may be related to increased articular pressure and chondral degeneration. The failure of the reconstruction of cruciate ligaments may be due to unrecognized or untreated posterolateral corner injuries. Various methods of repair and reconstruction have been described and new research is yielding superior results from reconstruction of this region

– id: J0129161, year: 2007, vol: 65, page: 106, stat: Journal Article,

Orthopedic management of decubitus ulcers around the proximal femur

Tryggestad, Kari-Elise; Youm, Thomas; Koval, Kenneth J

2006 Jul;35(7):316-21, American journal of orthopedics (Belle Mead, NJ)

Decubitus ulcers, commonly known as pressure ulcers or sores, represent localized areas of tissue necrosis. Despite increased awareness and use of preventive measures, these ulcers remain a major concern in the hospitalized and immobile patient population. When the hip joint becomes infected or the wound remains refractory to nonsurgical treatments, the orthopedic surgeon becomes involved in patient care. In this review, a brief overview of decubitus ulcers and their nonsurgical management is given, followed by a discussion of various flaps used in more extensive repairs. The major orthopedic procedures presented include proximal femoral resection (Girdlestone procedure), hip disarticulation, and hemipelvectomy. These surgeries retain an important position in managing complicated decubitus ulcers around the proximal femur

– id: J0120442, year: 2006, vol: 35, page: 316, stat: Journal Article,

Treatment of patients with spinoglenoid cysts associated with superior labral tears without cyst aspiration, debridement, or excision

Youm, Thomas; Matthews, Peter V; El Attrache, Neal S

2006 May;22(5):548-52, Arthroscopy

PURPOSE: To describe a case series of 10 consecutive patients with spinoglenoid cysts and associated superior labral tears treated by labral repair performed by the same surgeon without formal cyst aspiration, debridement, or excision. METHODS: Ten patients with spinoglenoid cysts and associated superior labral tears demonstrated on preoperative magnetic resonance imaging (MRI) were retrospectively reviewed. Evidence of weakness on examination was further evaluated through nerve conduction studies. All 10 patients underwent surgical repair of the labral tear performed by the same surgeon without formal cyst aspiration, debridement, or excision. Postoperatively, detailed shoulder and neurologic examinations were performed, and follow-up nerve conduction studies and MRIs were obtained. RESULTS: Ten patients were evaluated clinically at a mean of 10.2 months after surgical repair (range, 6 to 27 months). In all, 8 males and 2 females of average age 47.7 years (range, 35 to 56 years) were studied. Preoperative examination revealed that 6 patients had external rotation weakness. Nerve conduction studies performed in these 6 patients confirmed suprascapular neuropathy in 4 of them. Labral repair without formal cyst excision resulted in successful outcomes for all 10 patients after spinoglenoid cysts associated with superior labral tears had been diagnosed. All 4 patients with suprascapular neuropathy recovered strength and demonstrated normal nerve conduction studies postoperatively. In 8 of 10 patients, MRIs performed postoperatively demonstrated complete resolution of the cyst, along with labral healing. All patients were able to return to work with no restrictions on activities, and all were satisfied with their outcomes. CONCLUSIONS: This study demonstrated successful clinical, electromyographic, and MRI outcomes for patients with spinoglenoid cysts and superior labral tears, who were treated by labral repair without formal cyst excision. Treatment given for intra-articular disease is the key component of surgical management. LEVEL OF EVIDENCE: Level IV, case series study

– id: J0115348, year: 2006, vol: 22, page: 548, 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):455-9, 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: J0111746, year: 2005, vol: 14, page: 455, stat: Journal Article,

Os acromiale: evaluation and treatment

Youm, Thomas; Hommen, Jan Pieter; Ong, Bernard C; Chen, Andrew L; Shin, Catherine

2005 Jun;34(6):277-83, American journal of orthopedics (Belle Mead, NJ)

Os acromiale is a developmental aberration in which the distal acromion fails to fuse. This aberration is often discovered incidentally but may present with a clinical picture similar to that of subacromial impingement syndrome. Treatment for symptomatic os acromiale is initially nonoperative-activity modification, physical therapy, corticosteroid injection, use of nonsteroidal anti-inflammatory medication. Nonoperative management of clinically significant, radiographically confirmed os acromiale should be pursued for at least 6 months before consideration of surgical intervention. Subacromial decompression is often necessary to address symptoms of impingement. Excision of the os fragment may provide definitive treatment for smaller fragments (<3 cm). Removal of larger fragments remains controversial and should be approached with caution. Surgical fixation of larger fragments with or without supplemental autograft in conjunction with a structured postoperative program of physical therapy can reliably provide relief for symptomatic os acromiale

– id: J0106960, year: 2005, vol: 34, page: 277, stat: Journal Article,

Postoperative management after total hip and knee arthroplasty

Youm, Thomas; Maurer, Steven G; Stuchin, Steven A

2005 Apr;20(3):322-4, Journal of arthroplasty

Despite major advances in the field of total joint arthroplasty, a standardized postoperative management protocol currently does not exist following total hip arthroplasty (THA) and total knee arthroplasty (TKA). A survey was mailed to the active members of the American Association of Hip and Knee Surgeons to investigate issues such as postoperative rehabilitation and activity restriction. The information derived from this survey provides the total joint surgeon with a compilation and consensus of responses that can serve as the foundation for a standardized postoperative protocol for THA and TKA surgery

– id: J0103338, year: 2005, vol: 20, page: 322, stat: Journal Article,

Bilateral cobalt alloy femoral component fracture: a case report

Pavone, Vito; Youm, Thomas; Baldini, Todd; Rimnac, Clare; Wright, Timothy; Sculco, Thomas

2004 Apr;33(4):185-9, American journal of orthopedics (Belle Mead, NJ)

Even though at present femoral component fracture is a rare complication of total hip replacement, conditions still exist that predispose the prosthesis to failure. Component failure should be considered when a patient presents with pain in a previously asymptomatic hip, particularly in complex dysplastic hips requiring small stems, trochanteric osteotomy, and compromised cement technique

– id: J0111747, year: 2004, vol: 33, page: 185, stat: Journal Article,

Discoid lateral meniscus: evaluation and treatment

Youm, Thomas; Chen, Andrew L

2004 May;33(5):234-8, American journal of orthopedics (Belle Mead, NJ)

Although the etiology of the discoid lateral meniscus (DLM) has been the subject of debate, the entity is now believed to result from abnormal development secondary to a deficiency in normal attachments. In children younger than 10 years, snapping knee syndrome is pathognomonic for an unstable DLM. In adolescents, clinical presentation varies and often includes symptoms typically found with meniscal tears. The asymptomatic DLM does not require surgery. Treatment for the symptomatic stable DLM is directed toward arthroscopic saucerization with preservation of enough meniscus to maintain some biomechanical function. Recent reports of meniscal repair for the unstable Wrisberg meniscus have been encouraging. Optimal treatment for DLM requires a high index of suspicion in the appropriate clinical setting and up-to-date knowledge of available therapeutic modalities

– id: J0071150, year: 2004, vol: 33, page: 234, stat: Journal Article,

Imaging of the elbow in the overhead throwing athlete

Chen, Andrew L; Youm, Thomas; Ong, Bernard C; Rafii, Mahvash; Rokito, Andrew S

2003 May-Jun;31(3):466-73, American journal of sports medicine

Elbow injuries in athletes who perform overhead throwing motions often present diagnostic challenges because of the undue stresses and often chronic, repetitive patterns of injury. Accurate and efficient assessment of the injured elbow is essential to maximize functional recovery and expedite return to play. Radiographic evaluation should be tailored to the specific injury suspected and requires a thorough understanding of normal anatomic relationships as well as familiarity with common injuries affecting these athletes

– id: J0111748, year: 2003, vol: 31, page: 466, 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):329-34, 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: J0069268, year: 2000, vol: 14, page: 329, stat: Journal Article,

Complications of tissue expansion in a public hospital

Youm T; Margiotta M; Kasabian A; Karp N

1999 Apr;42(4):396-401; discussion 401-2, Annals of plastic surgery

Avoidance of complications in tissue expansion requires careful outpatient observation and consistent follow-up-two factors that are difficult to manage in a city hospital-based population. To determine the complication rate of tissue expanders in a given population, the authors reviewed retrospectively 34 tissue expanders placed in 30 patients at a New York City public hospital over a 7-year period from 1989 to 1996. The mean age of the patients at the time of insertion was 25 years (range, 11 months-65 years). The most common conditions for treatment were nevi (N = 11), burn scars (N = 8), breast reconstructions (N = 8), and spina bifida (N = 4). Complications occurred in 22 of 34 expanders (65%). Complications included deep infection (N = 11), exposure (N = 7), breakdown of the surgical wound (N = 4), cellulitis (N = 3), drainage (N = 1), and deflation (N = 1). Major complications resulted in premature removal in 13 of 34 expanders (38%). Minor complications leading to successful completion of the expansion process occurred with 9 of 34 expanders (27%). No complications were recorded in the remaining 12 of 34 expanders (35%). Although tissue expansion is a potentially safe and effective method of reconstruction, this review should alert the surgeon to the distinct challenges that may be encountered in the public hospital

– id: J0103965, year: 1999, vol: 42, page: 396, stat: Journal Article,

Do all hip fractures result from a fall?

Youm T; Koval KJ; Kummer FJ; Zuckerman JD

1999 Mar;28(3):190-4, 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: J0009420, 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):423-8, 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: J0069278, year: 1999, vol: 28, page: 423, stat: Journal Article,

The safety of reinfusing unwashed wound drainage in the PACU [Abstract]

Rosenberg, AD; Youm, T; Koval, K; Orbeta, R; Soberano, T; Van Hoek, E

1998 FEB;86(2S):U119-U119, Anesthesia & analgesia

– id: J0094766, year: 1998, vol: 86, page: U119, stat: Journal Article,