Browsing by Author "Schneider, Prism S"

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    Four-Dimensional Computed Tomography to Determine Normal Syndesmotic Motion and to Compare Motion after Rigid and Flexible Fixation of Syndesmotic Injuries
    (2020-11-27) Wong, Murray T; Schneider, Prism S; Edwards, W Brent; Wiens, Charmaine AS; Manske, Sarah L; LaMothe, Jeremy M
    Syndesmotic injuries occur in up to one-quarter of all ankle fractures. Despite mitigating efforts, malreduction of the syndesmosis is common after both rigid and flexible fixation methods, causing inferior patient function. Conventional assessments of syndesmotic reduction do not account for normal syndesmotic motion with ankle range-of-motion (ROM). The aims of this thesis were to use four-dimensional computed tomography (4DCT) to determine normal syndesmotic motion and to investigate the impact of rigid and flexible fixation on postoperative syndesmotic kinematics. Fifty-eight uninjured ankles were imaged to quantify normal syndesmotic kinematics. Thirteen patients after rigid or flexible fixation underwent bilateral ankle 4DCT to evaluate postoperative syndesmotic kinematics. Measures of syndesmotic width including anterior, middle, and posterior syndesmosis distances as well as tibiofibular clear space and tibiofibular overlap were automatically extracted from 4DCT data. Sagittal translation and fibular rotation were also recorded. Linear mixed effects models were used to determine the position of the syndesmosis at neutral dorsiflexion as well as syndesmotic motion, defined as the change in syndesmotic measurements with ankle ROM.In uninjured ankles, various measures of syndesmotic width decreased by 0.7-1.1 mm as ankles moved from dorsiflexion to plantarflexion (p < 0.001). The fibula externally rotated by 1.2° with plantarflexion (p < 0.001). There was no significant motion in the sagittal plane (p = 0.43). Rigid fixation increased syndesmotic width compared to uninjured ankles when measured by middle syndesmotic distance and tibiofibular clear space only (p = 0.039 and 0.032 respectively). Rigid fixation demonstrated reduced motion compared to uninjured ankles in middle and posterior syndesmotic distance, tibiofibular clear space, and tibiofibular overlap (p < 0.01). There were no differences in syndesmotic position or motion between flexible fixation and uninjured ankles.Ankle plantarflexion leads to decreased syndesmotic width and fibular external rotation in uninjured ankles, indicating ankle position must be accounted for when performing syndesmotic imaging and fixation. Flexible fixation better restores syndesmotic position and motion compared to rigid fixation. These findings may be used to decrease the rate of syndesmotic malreduction and, consequently, improve post-surgical outcomes.
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    PrEvention of posttraumatic contractuRes with Ketotifen 2 (PERK 2) – protocol for a multicenter randomized clinical trial
    (2020-02-24) Ademola, Ayoola; Hildebrand, Kevin A; Schneider, Prism S; Mohtadi, Nicholas G H; White, Neil J; Bosse, Michael J; Garven, Alexandra; Walker, Richard E A; Sajobi, Tolulope T
    Abstract Background Injuries and resulting stiffness around joints, especially the elbow, have huge psychological effects by reducing quality of life through interference with normal daily activities such as feeding, dressing, grooming, and reaching for objects. Over the last several years and through numerous research results, the myofibroblast-mast cell-neuropeptide axis of fibrosis had been implicated in post-traumatic joint contractures. Pre-clinical models and a pilot randomized clinical trial (RCT) demonstrated the feasibility and safety of using Ketotifen Fumarate (KF), a mast cell stabilizer to prevent elbow joint contractures. This study aims to evaluate the efficacy of KF in reducing joint contracture severity in adult participants with operately treated elbow fractures and/or dislocations. Methods/design A Phase III randomized, controlled, double-blinded multicentre trial with 3 parallel groups (KF 2 mg or 5 mg or lactose placebo twice daily orally for 6 weeks). The study population consist of adults who are at least 18 years old and within 7 days of injury. The types of injuries are distal humerus (AO/OTA type 13) and/or proximal ulna and/or proximal radius fractures (AO/OTA type 2 U1 and/or 2R1) and/or elbow dislocations (open fractures with or without nerve injury may be included). A stratified randomization scheme by hospital site will be used to assign eligible participants to the groups in a 1:1:1 ratio. The primary outcome is change in elbow flexion-extension range of motion (ROM) arc from baseline to 12 weeks post-randomization. The secondary outcomes are changes in ROM from baseline to 6, 24 & 52 weeks, PROMs at 2, 6, 12, 24 & 52 weeks and impact of KF on safety including serious adverse events and fracture healing. Descriptive analysis for all outcomes will be reported and ANCOVA be used to evaluate the efficacy KF over lactose placebo with respect to the improvement in ROM. Discussion The results of this study will provide evidence for the use of KF in reducing post-traumatic joint contractures and improving quality of life after joint injuries. Trial registration This study was prospectively registered (July 10, 2018) with ClinicalTrials.gov reference: NCT03582176.