Michael Doarn

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Acute TFCC Injury

Operative Techniques in Sports Medicine, Jun 1, 2016

Wrist injuries are common in athletic competition and tears of the triangular fibrocartilage comp... more Wrist injuries are common in athletic competition and tears of the triangular fibrocartilage complex (TFCC) are the main source of athletes presenting with acute onset ulnar-sided wrist pain. Treatment for TFCC injuries varies based on the acuity and location of the tear. Degenerative tears are often associated with ulnar positive variance and are best treated with debridement and joint leveling. The focus on athletes encompasses primarily acute injuries, which are often traumatic in nature from twisting such as a torque to the wrist or from a fall on an outstretched hand. Acute tears on the periphery of the TFCC have been shown to have adequate blood supply and potential to heal, and both open and arthroscopic repair techniques have been described. Arthroscopic procedures have shown improved outcomes to open. Athletes and their families should be made aware of the various surgical options available to them and treatment should be tailored to each individual situation.

Epidemiology of and Risk Factors for Table Saw Injuries of the Hands and Fingers

Journal of hand surgery global online, May 1, 2023

Infection and Nonunion After Fasciotomy for Compartment Syndrome Associated With Tibia Fractures: A Matched Cohort Comparison

Journal of Orthopaedic Trauma, Jul 1, 2016

Compare the rates of union and infection in patients treated with and without fasciotomy for acut... more Compare the rates of union and infection in patients treated with and without fasciotomy for acute compartment syndrome (ACS) in operatively managed tibia fractures. Retrospective review. Level 1 regional trauma center. Operated for tibial plateau fractures (Group 1) and tibial shaft fractures (Group 3) with ACS requiring fasciotomy were matched to patients without ACS (plateau: Group 2, shaft: Group 4) in a 1:3 ratio for age, gender, fracture pattern, and open/closed injury. Surgical treatment with plates/screws (plateau fractures) or intramedullary rod (shaft fractures). Patients with ACS were treated with a two-incision four-compartment fasciotomy. Time to union and incidence of deep infection, non-union, and delayed union. 184 patients were included - Group 1: 23 patients, Group 2: 69 patients, Group 3: 23 patients, and Group 4: 69 patients. Time to union averaged 26.8 weeks for Groups 1 and 3 and 21.5 weeks for Groups 2 and 4 (p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;0.05). Nonunion occurred in 20% for Groups 1 and 3 and in 5% for Groups 2 and 4 (p=0.003). Deep infection developed in 20% for Groups 1 and 3 and in 4% for Groups 2 and 4 (p=0.001). There was a significant increase in infection in Group 1 versus Group 2 and nonunion in Group 3 versus Group 4. There were significantly more smokers for those with fasciotomies (46%) than without (20%, p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001) though all statistical results remained similar after a binary regression analysis. Four-compartment fasciotomies in patients with tibial shaft or plateau fractures is associated with a significant increase in infection and non-union. Prognostic level III. See Instructions for Authors for a complete description of levels of evidence.

Retrograde Headless Intramedullary Screw Fixation for Displaced Fifth Metacarpal Neck and Shaft Fractures: Short Term Results

Hand, Mar 28, 2014

Background This study aimed to evaluate the early clinical outcomes of retrograde headless intram... more Background This study aimed to evaluate the early clinical outcomes of retrograde headless intramedullary screw fixation for displaced fifth metacarpal neck and shaft fractures. Methods We retrospectively reviewed nine patients treated with retrograde intramedullary screw fixation of fifth metacarpal neck and shaft fractures between 2011 and 2013. Patient demographics and outcomes including hand dominance, age, sex, type of injury, injury and postoperative radiographs, return to work, time to fracture union radiographically, complications, visual analog score, disabilities of the arm, shoulder, and hand scores, postoperative metacarpophalangeal joint range of motion, and grip strength were recorded. Results Nine fractures in nine patients with a mean age of 32 years (19-54) were included. There were seven metacarpal neck and two metacarpal shaft fractures. All patients sustained injury by direct impact of fist against an object. No case involved worker's compensation. Patients had a mean follow-up of 36 weeks (6-57 weeks) and at the time of latest follow-up had no pain. Mean radiographic healing was 49 days (28-85 days). Mean return to work was 6 weeks (4-10 weeks). Mean metacarpalphalangeal joint motion was 0°extension and 90°flexion. Mean disabilities of the arm, shoulder, and hand scores pre-and postoperatively improved from 43 to 0.7, respectively. The mean postoperative grip strength was measured of the injured hand (40 kg) and uninjured hand (41 kg). Conclusions Retrograde headless intramedullary screw fixation of fifth metacarpal neck and shaft fractures has overall favorable early outcomes and offers the benefit of stable fixation, early motion without cast immobilization, and the ability for early return to work. This technique is a viable surgical option for these fractures and may be considered in the appropriate patient population.

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Carpal Joint Malalignment With Distal Radius Malunion and Factors in Correction After Distal Radius Osteotomy

Journal of hand surgery global online, Jul 1, 2023

This article generously published free of charge by the International Society for the Advancement of Spine Surgery. Unexplained Perioperative Vertebrobasilar Stroke in a Patient Undergoing Anterior Cervical Decompression and Disc

Background Vertebrobasilar stroke associated with the anterior approach to the cervical spine is ... more Background Vertebrobasilar stroke associated with the anterior approach to the cervical spine is rare and has not been reported in cervical disc arthroplasty surgery. We report the case of a 60-year-old patient who underwent cervical disc arthroplasty at C4-5, C5-6 and C6-7. Postoperatively, due to symptoms and signs of a cerebellar stroke, magnetic resonance imaging of the brain was obtained confirming this diagnosis. Despite thorough investigation no specific identifiable cause for the stroke has been identified. We hypothesis an unrecognised period of intraoperative hypotension may have caused a temporary reduction in vertebrobasilar blood flow. Methods A retrospective review of the patient’s case notes and a focused review of literature has been performed. Results Now two years postoperatively the patient has regained full power but has residual problems with balance. She has neuralgic pain down the right side of her body which following investigation is believed to result from ...

Carpal Joint Malalignment With Distal Radius Malunion and Factors in Correction After Distal Radius Osteotomy

Journal of Hand Surgery Global Online

Intramedullary Headless Screw Fixation for Phalanx Fractures: Technique and Review of Current Literature

Techniques in Hand & Upper Extremity Surgery

Premature Physeal Closure of an Extraphyseal Distal Radius Fracture Secondary to Smooth Kirschner Wire Fixation: A Case Report

Open Journal of Trauma, 2018

Premature closure of the distal radius physis is rare and is usually associated with a fracture p... more Premature closure of the distal radius physis is rare and is usually associated with a fracture pattern that involves the physis. We present a case of an extraphyseal distal radius fracture treated with closed reduction and percutaneous smooth Kirschner wire fi xation that went on to premature physeal closure at the site of wire fi xation. Surgeons should be aware that closures of the distal radius physis after metaphyseal fractures can occur with use of smooth Kirschner wires and that patients should be followed closely.

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Postero-Lateral Disc Prosthesis Combined With a Unilateral Facet Replacement Device Maintains Quantity and Quality of Motion at a Single Lumbar Level

International Journal of Spine Surgery, 2014

Background Mechanically replacing one or more pain generating articulations in the functional spi... more Background Mechanically replacing one or more pain generating articulations in the functional spinal unit (FSU) may be a motion preservation alternative to arthrodesis at the affected level. Baseline biomechanical data elucidating the quantity and quality of motion in such arthroplasty constructs is non-existent. Purpose The purpose of the study was to quantify the motion-preserving effect of a posterior total disc replacement (PDR) combined with a unilateral facet replacement (FR) system at a single lumbar level (L4-L5). We hypothesized that reinforcement of the FSU with unilateral FR to replace the resected, native facet joint following PDR implantation would restore quality and quantity of motion and additionally not change biomechanics at the adjacent levels. Study Design In-vitro study using human cadaveric lumbar spines. Methods Six (n=6) cadaveric lumbar spines (L1-S1) were evaluated using a pure-moment stability testing protocol (±7.5 Nm) in flexion-extension (F/E), lateral bending (LB) and axial rotation (AR). Each specimen was tested in: (1) intact; (2) unilateral FR; and (3) unilateral FR + PDR conditions. Index and adjacent level ROM (using hybrid protocol) were determined opto-electronically. Interpedicular travel (IPT) and instantaneous center of rotation (ICR) at the index level were radiographically determined for each condition. ROM, ICR, and IPT measurements were compared (repeated measures ANOVA) between the three conditions. Results Compared to the intact spine, no significant changes in F/E, LB or AR ROM were identified as a result of unilateral FR or unilateral FR + PDR. No significant changes in adjacent L3-L4 or L5-S1 ROM were identified in any loading mode. No significant differences in IPT were identified between the three test conditions in F/E, LB or AR at the L4-L5 level. The ICRs qualitatively were similar for the intact and unilateral FR conditions and appeared to follow placement (along the anterior-posterior (AP) direction) of the PDR in the disc space Conclusion Biomechanically, quantity and quality of motion are maintained with combined unilateral FR + PDR at a single lumbar spinal level.

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Epidemiology of and Risk Factors for Table Saw Injuries of the Hands and Fingers

Journal of Hand Surgery Global Online

Exercise-induced bilateral upper-arm anterior and posterior compartment syndrome with rhabdomyolysis

Journal of Shoulder and Elbow Surgery

Altered differentiation in acute myeloid leukemias; Role of ERG and FUS-ERG fusion protein

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Altered Differentiation in Acute Myeloid Leukemias; Role of ERG and FUS-ERG Fusion Protein

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Acute TFCC injury

Operative Techniques in Sports Medicine, 2016

Infection and Non-union Following Fasciotomy for Compartment Syndrome Associated with Tibia Fractures: A Matched Cohort Comparison

by Michael Doarn and Rebecca Griffing

Journal of orthopaedic trauma, Jan 5, 2016

Retrograde Headless Intramedullary Screw Fixation for Displaced Fifth Metacarpal Neck and Shaft Fractures: Short Term Results

HAND, 2014

This study aimed to evaluate the early clinical outcomes of retrograde headless intramedullary sc... more This study aimed to evaluate the early clinical outcomes of retrograde headless intramedullary screw fixation for displaced fifth metacarpal neck and shaft fractures. We retrospectively reviewed nine patients treated with retrograde intramedullary screw fixation of fifth metacarpal neck and shaft fractures between 2011 and 2013. Patient demographics and outcomes including hand dominance, age, sex, type of injury, injury and postoperative radiographs, return to work, time to fracture union radiographically, complications, visual analog score, disabilities of the arm, shoulder, and hand scores, postoperative metacarpophalangeal joint range of motion, and grip strength were recorded. Nine fractures in nine patients with a mean age of 32 years (19-54) were included. There were seven metacarpal neck and two metacarpal shaft fractures. All patients sustained injury by direct impact of fist against an object. No case involved worker&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s compensation. Patients had a mean follow-up of 36 weeks (6-57 weeks) and at the time of latest follow-up had no pain. Mean radiographic healing was 49 days (28-85 days). Mean return to work was 6 weeks (4-10 weeks). Mean metacarpalphalangeal joint motion was 0° extension and 90° flexion. Mean disabilities of the arm, shoulder, and hand scores pre- and postoperatively improved from 43 to 0.7, respectively. The mean postoperative grip strength was measured of the injured hand (40 kg) and un-injured hand (41 kg). Retrograde headless intramedullary screw fixation of fifth metacarpal neck and shaft fractures has overall favorable early outcomes and offers the benefit of stable fixation, early motion without cast immobilization, and the ability for early return to work. This technique is a viable surgical option for these fractures and may be considered in the appropriate patient population.

Postero-Lateral Disc Prosthesis Combined With a Unilateral Facet Replacement Device Maintains Quantity and Quality of Motion at a Single Lumbar Level

by Roger Gaskins, Aniruddh Nayak, and Michael Doarn

International Journal of Spine Surgery, 2014

Mechanically replacing one or more pain generating articulations in the functional spinal unit (F... more Mechanically replacing one or more pain generating articulations in the functional spinal unit (FSU) may be a motion preservation alternative to arthrodesis at the affected level. Baseline biomechanical data elucidating the quantity and quality of motion in such arthroplasty constructs is non-existent.

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