York Orthopaedic Hospital Research Articles

Dr. Newton Shaffer (1846-1928): Renowned Orthopedic Surgeon and Founder of the American Orthopaedic Association.

An unsung hero of American orthopedic surgery is the largely forgotten Dr. Newton Melman Shaffer (1846-1928). Upon graduating from medical school at New York University, Shaffer began his career training at the Hospital for the Ruptured and Crippled in 1867. Shaffer then went on to practice at St. Luke's Hospital and New York Orthopaedic Dispensary and Hospital where he became chief. Here, Shaffer made major contributions to the field in treating clubfoot and tuberculosis. He then declared orthopedics as a separate entity from general surgery at the 10th International Medical Congress. He helped start the American Orthopaedic Association to push for the recognition of American orthopedics to the international community. In 1900, Shaffer opened the first state-run hospital for underprivileged children requiring rehabilitation. During his career, Shaffer advocated for conservative orthopedic treatments, aided in the invention of medical devices, contributed largely to academic orthopedics, and successfully advocated for the inception of the field of orthopedic surgery.

The Role of Additional K-Wires on AO Type C Distal Radius Fracture Treatment with External Fixator in Young Population.

Objectives Several methods have been proposed to treat AO type C distal radius fracture. External fixator has gained popularity for its simple procedure and rapid recovery. Some surgeons suggested that additional K-wires may play a critical role in the outcome. The purpose of study is to evaluate the role of additional K wires in treating distal radial fracture with external fixator regarding its outcome. Material and Methods From January 2006 to January 2010, 40 patients with AO type C distal radius fracture were treated with external fixator, with (EF) or without additional K wires (EFK). Radiologic outcome parameters include radial inclination, volar tilt, radial length, and the presence of radiocarpal arthritis according to Knirk and Jupiter. Clinical outcomes include New York Orthopedic Hospital (NYOH) wrist scoring scale. Results Radiographic outcome showed significant difference in regard of articular congruency at the final follow-up with the EFK group showing the advantage in maintaining the articular incongruity. NYOH wrist scoring scale showed no significant difference between both groups at final follow-up. The amount of articular step-off was less in EFK group with significant statistical finding on the final follow up. Conclusion Both EF and EFK technique were able to provide satisfactory result in treating AO type C distal radius fractures. We observed that EFK is superior in reducing the number of radiocarpal arthritic changes compared to EF group due to its superiority in reducing articular step-off.

Clinical Outcomes of Volar Oblique Ligament Reconstruction in Thumb Basal Joint Arthritis

Introduction: Volar oblique ligament (VOL) is known as a primary trapeziometacarpal joint stabilizer. Because ligament laxity is one of most important cause of thumb basal joint arthritis, Eaton and Littler introduced their technique reconstructing VOL as a treatment of that; however, they recommended using this treatment only for Eaton-Littler stages I and II through their study result. We evaluated clinical outcomes of VOL reconstruction applied for patients with stage I, stage II, and even early stage III thumb basal joint arthritis. Material and Methods: We analyzed 21 patients who had undergone surgery for thumb basal joint arthritis in our hospital from May 2011 to October 2014 and had a minimum 12 month follow-up. All patients were women and the mean age at diagnosis was 58.5 years (range, 43-78 years). Six patients were Eaton stage I, 9 were II, and 6 were III. Functional outcome were evaluated using New York Orthopedic Hospital Wrist Scoring Scale, which assessed range of motion (ROM), grip power, radiologic findings, pain, and hand function. The stability of basal joint and progression of arthritis were also evaluated. Wilcoxon rank sum test was used for statistical analysis. The mean follow-up period was 21.6 months (12-56 months). Result: The overall functional results according to New York Orthopedic Hospital Wrist Scoring Scale were 1 excellent, 10 good, 7 fair, and 3 poor. We divided two groups (Eaton stage I, II vs III) and analyzed nonparametric test; however, it did not show a significant difference ( P = .856). Two of 6 patients with stage III osteoarthritis showed poor result. At last follow-up, average grip power was 83.3% of normal side. The stability of VOL-reconstructed basal joint were restored and maintained in 15 of 21 joints. The arthritis was progressed in 4 joints, 1 of 6 Eaton stage I, 1 of 9 Eaton stage II, and 2 of 6 Eaton stage III joints. Conclusion: Our results suggested that VOL reconstruction is a reliable method for management of Eaton stage I and II osteoarthritis and can be applied even in early Eaton stage III osteoarthritis before performing salvage procedures.

Obituary: Alexander Garcia MD (1919-2012)

Obituary: Alexander Garcia MD (1919-2012)

Comparison of efficacies of two fixation methods in treatment of complex intra-articular fracture of the distal radius

Objective To compare the efficacies and indications of locking compression plate (LCP) and external fixator plus Kirschner wires in treatment of complex intra-articular fracture of the dis-tal radius. Methods Ninety-eight patients with complex intra-articular fractures of the distal radius were treated with volar LCP or external fixator plus Kirschner wires, the efficacies of which were evaluated by comparing the grasping force and wrist function of the patients. Results All the patients were fol-lowed up for an average of 12.4 months, which showed fracture healing in all the patients. According to the wrist function assessment system of New York Orthopedic Hospital (1990), there was no statistical difference in the efficacy of LCP and external f'lxator plus Kirschner wires in treatment of types C1 or C2 fractures (P > 0.05), while the efficacy of external fixator plus Kirschner wires was significantly superior to that of LCP in treating type C3 fracture (P < 0.05). Conclusions For types C1 or C2 intra-articu-lar fractures of the distal radius, the efficacies of LCP and external fixator plus Kirschner wires are simi-lar, while the efficacy of external fixator plus Kirschner wires is superior to that of LCP in treating type C3 intra-articular fracture of the distal radius. Key words: Radius fractures; Fracture fixation, internal; External fixators; Locking compres-sion plate

Stand Up and Be Counted 2008*

It is an honor and pleasure for me to address you as the incoming 121st President of the American Orthopaedic Association (AOA). Today, I will speak to you about the AOA's commitment to leadership and how, through recent changes in its activities, it has embraced the challenge to “stand up and be counted.” But, first, I want to mention how my institution, the New York Orthopaedic Hospital, has been closely associated with the AOA and how I chose the title “Stand Up and Be Counted.” The New York Orthopaedic Hospital and Dispensary was founded in 1866, and there have been nine directors1. The Hospital sold its building in 1950 and became part of the Columbia Presbyterian Medical Center and now New York Presbyterian Hospital and Columbia University. Of the nine directors, three have been presidents of the AOA: Newton M. Shaffer, Harold M. Dick, and myself. Newton M. Shaffer, our second director, was one of the founders of the AOA. As nicely outlined in Dr. Urbaniak's A History of the American Orthopaedic Association, a preliminary meeting to discuss the formation of the AOA was held in Shaffer's New York apartment2. The AOA was formed in 1887 as the first orthopaedic association of its kind, and Newton Shaffer was the second president in 1888, following Virgil Gibney. The third director of the New York Orthopaedic Hospital, Russell A. Hibbs, one of the most famous orthopaedic surgeons in the history of our profession, was initially rejected. It appears that several influential AOA members did not like the manner in which he replaced Newton Shaffer as director of the New York Orthopaedic Hospital, and they blocked his admission. However, he was later unanimously accepted on the merit of his work concerning spinal fusion. Harold Dick was our eighth director …

Lumbosacral Fusion: The Mortised Transfacet Method by Use of the Vibrating Electric Saw for Circular Bone Blocks Earl D. McBride MD, Howard B. Shorbe MD CORR 1958;12:268-275

Reliably achieving spine fusion has been a problem since fusion was first described by Russell Hibbs of the New York Orthopaedic Hospital in 1911 [1]. Since that time, many dozens, if not hundreds of techniques have been proposed. PubMed lists over 1700 articles on the topic since 1935, many of which relate to techniques, and these 1700 articles undoubtedly reflect the tip of the iceberg. The reasons for performing a spine fusion have also varied and been greatly refined over the last century, and the success rates have varied depending, in addition to other factors, on both the reasons for the fusion and the technique. The article we highlight this month on lower lumbar spine fusion was published by Dr. Earl McBride and his colleague, Dr. Howard Shorbe, both of Oklahoma City [5]. Dr. McBride had been the founder and first President of the Association of Bone and Joint Surgeons (1947) [2, 3] which organized and has sponsored this journal since its inception in 1953. McBride and Shorbe noted, “a successful fusion depends on where and how the bone graft is implanted, not upon the amount of bone utilized” [5]. One of the more common reasons for surgery at the time was a ruptured disc, and they commented, “Removal of the offending disk protrusion alone is not likely to relieve the residual effects of progressive arthritic erosion and ligamentous weakness. How can such facts be ignored so completely?” [5] Their proposal was to fuse the facet joints, which often were arthritic in advance cases, using a dowel grafts cut by trephines on a vibrating saw and inserting those grafts into similar size cylindrical hole across the fact joints. They commented, “The nerve will not be damaged by the saw if it is directed properly and if correct depth adjustment has been made” [5]. Although mentioned in but a single sentence, this same point has been emphasized the past ten years or so with pedicle screws placed across the facet joints to achieve the same purpose: directing an implant in the proper direction requires great skill and knowledge. McBride and Shorbe [5] were not uniformly successful in achieving fusion: their rate of successful lumbar fusion was 91% at the L5-S1 level. When they operated on two levels, their rates of success were much lower: 65% at both levels. They noted, however, a successful fusion seen on a radiograph did not necessarily correlate with improvement of the patient: “…good and fair clinical healing was obtained in 97 percent of the total cases” [5]. They did not have the sophisticated instruments we do today in assessing success, and undoubtedly a contemporary assessment would lead to a lower clinical success rate. Nonetheless, their finding that successful bone fusion did not predict clinical outcome is consistent with a more recent report with the same finding in patients who had multiple back operations and other sorts of fusion [4]. Thus, their conclusion, “Satisfactory clinical results of facet graft fusions have always exceeded the number of cases showing solid bony union” [5] likely holds today.

Recurrent Dislocation of the Shoulder Joint

Recurrent Dislocation of the Shoulder Joint

THE CLASSIC: Dislocation and Instability Complicating Low Friction Arthroplasty of the Hip Joint

In 1945, New York Orthopaedic Hospital merged with the Presbyterian Hospital Trauma Service, and five years later joined the Columbia Presbyterian Medical Center in upper Manhattan. Dr. Frank E. Stinchfield, who became the chairman in July 1956, was one of the most celebrated orthopaedic surgeons in the United States. Dr. Stinchfield's remarkable energy, dedication and foresight led the hospital to the forefront of orthopaedic medicine, and it was regarded as a center of excellence in the nation. With his keen interest in orthopaedics, he was also a strong leader and administrator. Dr. Stinchfield contributed to maintaining the highest standards at the New York Orthopaedic Hospital, and to teaching the young men and women who wished to become orthopaedic surgeons. During a short visit to England in 1968, Dr. Stinchfield invited Dr. Nas Eftekhar to join the New York Orthopaedic Hospital Staff. In April 1969, Dr. Eftekhar performed the first Charnley total hip replacement and, two years later, the first total knee replacement at the New York Orthopaedic Hospital. The Hip and Implant Unit was formally established. A prospective documentation for hip and knee implant surgery in addition to a fellowship program was initiated.

Radiology of Shoulder Prostheses

This article is chiefly limited to the routine radiographic evaluation of shoulder arthroplasties and guidelines to their interpretation. Other imaging modalities for the evaluation of joint replacements are discussed elsewhere in this issue. The basic types of shoulder reconstructions and some of the shoulder replacement designs in previous and current use at The New York Orthopedic Hospital at Columbia Presbyterian Medical Center are illustrated, along with the indications and contraindications of the various types of reconstructions. Their complications and pertinent anatomy are included.

Bosworth Fracture-Dislocation and Resultant Compartment Syndrome

To The Editor: I read with disquiet “Bosworth Fracture-Dislocation and Resultant Compartment Syndrome. A Case Report” (2003;85:2211-4), by Beekman and Watson. They describe the case of a soccer player who sustained a fracture-dislocation that was reduced with difficulty and treated with a short leg cast. They also reported substantial soft-tissue swelling and observed that surgery was inevitably going to be required. I would ask why the patient was discharged home to elevate the leg? Surely there is a very strong case to be made for admitting the patient so that the leg could be treated with high elevation and ice packs … Corresponding author: Ryan Beekman, MD Department of Orthopaedic Surgery Wayne State University 4707 St. Antoine Boulevard Suite 1-South Detroit, MI 48201 rabeekman{at}hotmail.com

William Russell MacAusland Jr., MD 1922-2004

Bill MacAusland was born December 9, 1922, into a rich orthopaedic heritage, as both his father, William R. Sr., and his uncle, Andrew R., were practicing orthopaedic surgeons in the Boston area. Bill was educated at Milton Academy, Harvard College, and Harvard Medical School, graduating with a medical degree in 1947. He and Frances Prescott Baker were married and spent the next two years of his surgical training in Rochester, New York. Their first child was born in 1948, and in 1949 Bill began his training in orthopaedics at the New York Orthopaedic Hospital. His residency partner was John Gartland; they wrote three papers together and became lifelong friends. They were later to serve consecutive terms as Presidents of the American Academy of Orthopaedic Surgeons (AAOS). Bill spent two years as a captain in the United States Air Force at Maxwell Air Force Base in Alabama before returning to Boston to begin the practice of medicine with his father and uncle. His early years in practice were made memorable by the addition of five more children to his expanding family. His boundless energy enabled him to work in several hospitals in Boston and its environs. He loved to “be on service” and work with the residents. One resident commented that Bill “wore his shoes backwards” to get out of the operating room faster and onto his next task! A number of his residents joined him in practice, and all benefited greatly, both personally and professionally, from the association. The large, airy office at 412 Beacon Street easily accommodated two physicians at once, and Bill was readily available to consult on difficult problems and always gave helpful advice. His concern for patients was strong—if one of his patients was hospitalized with a particularly difficult problem, he would often visit that patient …

Inferior capsular shift for involuntary inferior and multidirectional instability of the shoulder: a preliminary report. 1980.

From the Department of Orthopaedic Surgery, Columbia University and The New York Orthopaedic Hospital, Columbia-Presbyterian Medical Center, New York, NY

Coronary Disease of the Hip

Coronary Disease of the Hip

External fixation for distal radius fractures: effect of distraction on outcome.

Few studies have examined the potential adverse effects of excess distraction and prolonged duration of external fixation for the treatment of distal radius fractures. In this study, 19 patients with distal radius fractures treated with external fixation and supplemental Kirschner wire fixation between August 1991 and November 1997 were studied retrospectively. Patients were evaluated by questionnaire, chart review, radiographs, and clinical examination an average of 161 weeks after injury. Although no significant correlation was found between amount of distraction, as measured by carpal height index, and scores for pain, function, radiographs, motion, grip, strength, and final result, a negative correlation was found of all categories with increasing carpal height index. A significant negative correlation was seen between duration of external fixation and scores for pain, motion, and total score, with motion scores being most affected. New York Orthopaedic Hospital grades of good or excellent were attained by 89% of the patients. The data suggest that external fixation with supplemental pin fixation is a satisfactory method of treating severe fractures of the distal radius. Outcome likely is improved with shorter duration of external fixation.

Anatomical reduction of intra-articular fractures of the distal radius

We treated 31 intra-articular fractures of the distal radius by arthroscopically-assisted reduction and percutaneous fixation with Kirschner (K-) wires. Tears of the triangular fibrocartilage (58%), scapholunate (85%) and lunotriquetral (61%) instability and osteochondral lesions (19%) were also treated. A total of 26 patients was independently reviewed at an average of 19 months. The mean pain score was 1.3/10, the range of movement 79% and the grip strength 90% of the contralateral wrist. Using the New York Orthopaedic Hospital score, 88% were graded excellent to good. On follow-up radiographs, 65% had no step and 31% had a step of ≤1 mm. Pain was significantly related to the size of the step. There was a significant difference in the incidence of persistent scapholunate diastasis and the Leibovic and Geissler grade (p &lt; 0.01): I (0%), II (0%), III (42%) and IV (100%). We recommend anatomical reduction and acceptance of a step of &lt; 1 mm since the size of the step is related to the incidence of pain.

Severe fractures of the distal radius: Effect of amount and duration of external fixator distraction on outcome

Although severe intra-articular fractures of the distal radius are often treated with external fixation/distraction, little attention has been devoted to the amount and duration of fixator distraction required to maximize outcome. To determine these effects, we conducted a retrospective study of 26 patients whose primary treatment was external fixation/distraction. Patients were evaluated by chart review, questionnaire, x-ray films, and physical examination an average of 104 weeks after injury. The carpal height index was used to quantify distraction. Scores for pain, function, wrist motion, and grip strength and the total score were adversely affected in proportion to the increase in carpal height index by distraction. Outcome was adversely affected as the duration of distraction increased. Motion scores were affected most. Overall, patients recovered at least 75% of motion and grip strength, and 85% attained New York Orthopedic Hospital grades of good or excellent. These are the first data to show that there are potential adverse effects from increasing amounts of distraction and prolonged use of the external fixator.

Bioengineering Activities at the New York Orthopaedic Hospital Research Laboratory

The studies described above are representative of the Laboratory's long-standing dedication to the philosophy of multi-disciplinary research. Results from these studies will continue to provide new insights as to the function of diarthrodial joints, articular cartilage and other hydrated soft tissues. It appears reasonable to expect that in the years ahead we will have a better understanding of the mechanisms behind histomorphogenesis, growth, functional adaptation, regeneration, ageing and degeneration of connective tissues and osteoarthritis resulting from these investigations being conducted at the New York Orthopaedic Hospital Research Laboratory.

Isolated Fracture of the Humeral Capitellum

Twenty-nine patients with fractures of the capitellum of the humerus were treated at the New York Orthopaedic Hospital during 15-year period; 17 were available for follow-up assessment. A classification based upon the specific nature of the fracture and the degree of trochlear involvement is a suggested guide to treatment and prognosis. Long-term follow-up studies compare resection, replacement with fixation, and closed reduction. Choice of treatment should be selective and individualized depending on age, character of the bone, and type of fracture.

Experience with Legg-Calv??-Perthes Disease (LCPD) 1968???1974 at the New York Orthopaedic Hospital

Of 19 patients (24 hips) with LCPD treated between 1968 and 1974, 18 hips were treated by nonoperative methods (the abduction weight-bearing program as described by Petrie), and six hips were treated by Salter innominate osteotomy. Using Catterall's classification of the roentgenographic changes, 14 cases were rated good; 4 were fair and 6 were poor. The age at the time of diagnosis was the most reliable diagnostic parameter.