- Orthopaedic Surgery
Board Certification: American Board of Orthopaedic Surgery, Hand Surgery (2002)
Board Certification: American Board of Orthopaedic Surgery, Orthopaedic Surgery (1999)
Fellowship: Los Angeles County - USC Medical Center (1996) CA
Residency: Yale New Haven Hospital (1995) CT
Internship: Yale School of Medicine General Surgery Program (1991) CT
Medical Education: University of Michigan School of Medicine (1990) MI
Percutaneous fixation of scaphoid fractures
JOURNAL OF THE AMERICAN ACADEMY OF ORTHOPAEDIC SURGEONS
2007; 15 (8): 474-485
Recent advances in techniques and implants have led to renewed interest in percutaneous screw fixation of acute scaphoid fractures. The closed (cast) treatment of acute scaphoid fractures generally has good outcome, with bony union resulting; however, closed treatment can result in delayed union, nonunion, malunion, cast- induced joint stiffness, and lost time from employment and avocations. Acute percutaneous fixation of scaphoid fracture has been proposed as a means to minimize some of the complications of closed (cast) treatment. Percutaneous treatment of both nondisplaced and displaced scaphoid fractures reportedly can achieve a nearly 100% union rate with minimal complications. Fixation of scaphoid fractures with headless compression screws can be done using both volar and dorsal approaches. The fracture reduction and alignment are assessed by fluoroscopy and arthroscopy. Appropriately performed acute percutaneous internal fixation is now a standard treatment option for a selected group of patients with acute scaphoid fracture.
View details for Web of Science ID 000248642000004
View details for PubMedID 17664367
Avoidance and treatment of complications of distal radius fractures
2005; 21 (3): 295-?
The treatment of distal radius fractures continues to be fraught with complications. The more widespread use of internal fixation and supple-mental bone grafting with external fixation has decreased the incidence of malunions from closed-cast treatment and percutaneous pinning, but increased the risk of the complications specific to surgical intervention. Careful diagnosis, surgical planning, surgical technique, and postoperative rehabilitation can help optimize outcome in these difficult fractures.
View details for DOI 10.1016/j.hcl.2005.04.004
View details for Web of Science ID 000231434200004
View details for PubMedID 16039441
Percutaneous internal fixation of scaphoid fractures via an arthroscopically assisted dorsal approach.
The Journal of bone and joint surgery. American volume
2002; 84-A Suppl 2: 21-36
Percutaneous internal fixation of scaphoid fractures allows for more predictable union and less morbidity than cast treatment or open internal fixation. A headless cannulated compression screw (standard Acutrak) is implanted by way of a dorsal percutaneous approach with the aid of fluoroscopy and arthroscopy to confirm screw position and fracture reduction. This technique is indicated in the correction of acute proximal pole fractures, acute waist fractures, and delayed unions that are not associated with avascular necrosis or collapse. The details of this technique are reviewed. In a consecutive series of twenty-seven fractures (seventeen waist fractures and ten proximal pole fractures) treated with arthroscopically assisted dorsal percutaneous fixation, computed tomographic scanning confirmed 100% union at an average of twelve weeks. Eighteen fractures were treated within one month after the injury, and nine were treated more than one month after the injury. In this series, the fractures that were treated early (less than one month after the injury) healed more quickly than those treated later.
View details for DOI 10.2106/00004623-200200002-00003
View details for PubMedID 12479336
Intra-articular distal radius fractures: arthroscopic assessment of radiographically assisted reduction.
The Journal of hand surgery
2001; 26 (6): 1036-41
The optimal means of assessing articular displacement during closed reduction of distal radius fractures is unknown. The purpose of this study was to evaluate the in vivo accuracy of fluoroscopy (C-arm) and plain radiographs (XR) in measuring articular step-off and gap and to determine if postreduction arthroscopy can identify malreduced intra-articular fractures that would benefit from reduction. Fifteen intra-articular distal radius fractures underwent closed manipulation and percutaneous pinning. Reduction was assessed sequentially by C-arm, XR, and wrist arthroscopy. The width of gapping between articular surface fragments was underestimated to a statistically significant degree by both C-arm and XR. The magnitude of articular step-off measured with arthroscopy was not statistically different than that measured radiographically. In 5 (33%) cases, the optimal reduction obtained using C-arm and XR was found to have an articular displacement of >1mm by adjunctive arthroscopy. Complete reduction and pinning was performed with satisfactory results. These results suggest that adjunctive arthroscopy may detect residual gapping of the articular surface that is not seen by C-arm or XR. Residual displacement noted by adjunctive arthroscopy may prompt another reduction effort and result in an improved articular alignment of intra-articular distal radius fractures.
View details for DOI 10.1053/jhsu.2001.28760
View details for PubMedID 11721247
Arthroscopy of the metacarpophalangeal joint.
1999; 15 (3): 501-27
The refinement of technology with improved lighting and smaller optics has made possible new techniques of MCP joint arthroscopy. It is the mastery of the unique anatomy of these different--not just smaller--joints, however, that permits the applications of these new skills. Arthroscopy of the MCP joint permits the diagnosis of pathology not well visualized by other means, and the treatment of these lesions with minimal soft tissue disruption. The authors' experience with arthroscopically aided reduction of fractures of the MCP joint has shown it to be as good as or better than open repair of these fractures. The authors have found the same to be true in treating ulnar collateral ligament injuries of the thumb. Although there is a learning curve with small joint arthroscopy, when the team and surgeon are familiar with the new routines and instruments, the time to accomplish the tasks quickly decreases and is often shorter than that for standard open procedures. The authors' experience suggests that the application of these techniques can allow treatment of MCP pathology with fewer complications than open approaches and may result in improved final function.
View details for PubMedID 10451827
Effects of calcitonin gene-related peptide on bone turnover in ovariectomized rats.
1997; 21 (3): 269-74
Calcitonin gene-related peptide (CGRP) is a neuropeptide abundantly concentrated in sensory nerve endings innervating bone metaphysis and periosteum, which indicates that it plays a local role in bone metabolism. CGRP-alpha and -beta share structural and functional homology with calcitonin (CT) and have been shown to inhibit bone resorption in vitro and to induce hypocalcemia in vivo. We recently reported that CGRP stimulates the production of the growth factor insulin-like growth factor-I and inhibits that of the cytokine tumor necrosis factor-alpha by osteoblasts, suggesting that CGRP may control bone cell activity. To investigate this possibility, we used ovariectomized (ovx) rats as a high bone turnover model and compared the effects of CGRP to those of CT. ovx young female rats were injected daily starting the day after surgery with either phosphate-buffered saline, CGRP-alpha (1.15 mg/kg per day), or CT (3 micrograms/kg per day) for 28 days. Ovariectomy induced an increase in bone turnover associated with a 60% loss in trabecular bone volume of the proximal tibia. CGRP inhibited bone resorption but not bone formation, and was nevertheless less efficient than CT in preventing bone loss, since CGRP-treated rats had a loss of 46% of cancellous bone, whereas CT-treated rats had a loss of 21%. This suggests that CGRP is either less potent than CT at inhibiting bone resorption or else very rapidly degraded. These data indicate that CGRP can control bone cells through a mechanism that is in part different from that of CT, and further suggest that CGRP may play a local role in bone metabolism.
View details for DOI 10.1016/s8756-3282(97)00142-7
View details for PubMedID 9276092
The use of blood cultures.
1993; 269 (24): 3109-10
View details for PubMedID 8505811