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Case Report Calcaneogenesis

Fri, 01 May 2009 05:00:00 GMT

The Journal of Bone and Joint Surgery , Vol. 91-B, No. 5, May 2009

Author: M. R. Brinker, D. P. Loncarich, E. G. Melissinos, D. P. O’Connor

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1-May-09 0:00 AM

Management of Falls After Total Knee Arthroplasty

Sat, 01 Mar 2008 06:00:00 GMT

Orthopedics, Vol 31, No.3, March 2008

Author: Richard J. Kearns,MD, Mark R. Brinker,MD and Daniel P. O'Connor, PhD

Click here to read the entire published article by Dr Brinker

This study evaluated 78 patients who fell after total knee arthroplasty. Eight patients (10.3%) had soft-tissue injuries that led to a poor clinical course (deep infection, unplanned return to the operating room, temporary or permanent resection arthroplasty, or knee arthrodesis).

Factors related to a poor clinical course included copious bleeding from the surgical wound immediately after falling, falling within 8 weeks of arthroplasty, and rupturing the parapatellar surgical wound and quadriceps repair. Patients who fall and have bleeding from their surgical wound should receive emergency surgical irrigation and debridement. A treatment protocol for patients who fall after total knee arthroplasty is presented.

1-Mar-08 0:00 AM

Ilizarov Distraction Before Revision Hip Arthroplasty After Resection Arthroplasty With Profound Limb Shortening

Tue, 01 Jan 2008 06:00:00 GMT

The Journal of Arthroplasty Vol. 00 No. 0 2008

Author: Mark R. Brinker, MD, Daniel P. O'Connor, PhD, Vasilios Mathews, MD

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1-Jan-08 0:00 AM

Outcomes of Tibial Nonunion in Older Adults Following Treatment Using the Ilizarov Method

Mon, 01 Oct 2007 05:00:00 GMT

J Orthop Trauma, Vol. 2, No. 9, October 2007

Author: M.R. Brinker, MD and Daniel P.O O'Conner, PhD

Click here to read the entire published article by Dr Brinker

Objectives: To describe the functional outcomes of treatment using the Ilizarov method for tibial nonunions in older patients (.60 years of age).

Design: Prospective case series. Setting: Tertiary referral center.

Patients: Twenty-three consecutive patients with an average age of 72 years (61 to 92) who had tibial nonunions for an average duration of 13 months (3 to 46). Fourteen patients had an associated deformity and eight patients had infection.

Intervention: Ilizarov deformity correction, compression, or bone transport.

Main Outcome Measurements: Brief Pain Inventory, American Academy of Orthopaedic Surgeons (AAOS) Lower Limb Core Scale, Short Form (SF)-12, quality-adjusted life years.

Results: Three patients did not complete treatment: two patients died of cardiovascular disease during the treatment period and one patient demanded early removal of the Ilizarov device against medical advice. All 20 patients who completed treatment achieved bony union. Two of the 20 patients died before final follow-up, one patient was unable to participate in follow-up, and one patient was lost. At an average follow-up of 38 months (18 to 61), all of the remaining 16 patients were bearing full weight. AAOS Lower Limb Core Scale scores improved from 39 to 78 points (P , 0.001), pain intensity decreased from 3.6 to 0.9 (P = 0.001), SF-12 Physical Component Summary scores improved from 26.5 points to 35.3 points (P = 0.030), and SF-12 Mental Component Summary scores improved from 41.6 points to 48.7 points (P = 0.011). The improvement in quality of life is equivalent to 5.3 quality-adjusted life years per patient, which was larger than the average improvement in quality of life following total hip arthroplasty reported in published series.

Conclusions: Treatment using the Ilizarov method restored function and had a profoundly positive effect on quality of life in these elderly patients with tibial nonunions.

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1-Oct-07 0:00 AM

Metabolic and Endocrine Abnormalities in Patients With Nonunions

Sat, 01 Sep 2007 05:00:00 GMT

J Orthop Trauma, Vol 21, No.8, Sept 2007

Author: Mark R. Brinker, MD, Daniel P. O'Connor, PhD, Yomna T. Monla, MD, and Thomas P. Earthman, MD

Click here to read the entire published article by Dr Brinker

Objectives: To determine whether patients with unexplained nonunions, patients with a history of multiple low-energy fractures with at least one progressing to a nonunion, and patients with a nonunion of a nondisplaced pubic rami or sacral ala fracture would have an underlying metabolic or endocrine abnormality that had not been previously diagnosed.

Design: Case series.

Setting: Tertiary referral center. Patients and Intervention: From a larger series of 683 consecutive patients with nonunion seen by us between January 1998 and December 2005, 37 patients were referred to 1 of 2 clinically practicing endocrinologists to undergo an evaluation for metabolic and endocrine abnormalities. The screening criteriawere: 1) an unexplained nonunion that occurred despite adequate reduction and stabilization (and debridement in initially infected cases) without obvious technical error and without any other obvious etiology; 2) a history of multiple low-energy fractures with at least one progressing to a nonunion; or 3) a nonunion of a nondisplaced pubic rami or sacral ala fracture.

Results: In all, 31 of the 37 patients (83.8%, 95% CI: 71.3% to 93.8%) who met our screening criteria had one or more new diagnoses of metabolic or endocrine abnormalities. The most common newly diagnosed abnormality was vitamin D deficiency (25 of 37 patients; 68%). Other newly diagnosed abnormalities included calcium imbalances, central hypogonadism, thyroid disorders, and parathyroid hormone disorders. All newly diagnosed abnormalities were treated medically. Eight patients who underwent no operative intervention following the diagnosis and treatment of a new metabolic or endocrine abnormality achieved bony union in an average of 7.6 months (range, 3 to 12 months) following their first visit to the endocrinologist.

Conclusions: Although our study does not prove a causal link between metabolic and endocrine abnormalities and either the development or healing of nonunions, 84% of the patients who met our screening criteria were found to have metabolic or endocrine abnormalities, and eight of our patients achieved bony union following medical treatment alone. All patients with nonunion who meet our screening criteria should be referred to an endocrinologist for evaluation because they are likely to have undiagnosed metabolic or endocrine abnormalities that may be interfering with bone healing.

KeyWords: fractures, ununited, bone, hormone, calcium, vitamin D, hypogonadism

1-Sep-07 0:00 AM

Ilizarov Treatment of Infected Nonunions of the Distal Humerus After Failure of Internal Fixation: An Outcomes Study

Thu, 01 Mar 2007 06:00:00 GMT

J Orthop Trauma ,Vol. 21, Number 3, March 2007

Author: Mark R. Brinker,MD, Daniel P. O'Connor,PhD, C. Craig Crouch,MD, Thomas L. Mehlhoff,MD, and James B. Bennett,MD

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1-Mar-07 0:00 AM

Payer Type Has Little Effect on Operative Rate and Surgeons’ Work Intensity

Sun, 01 Oct 2006 05:00:00 GMT

Clinical Orthopaedics and Related Research, No. 451, pp.257-262 Oct 2006

Author: Mark R. Brinker,MD, Daniel P. O'Connor,PhD, Peggy Pierce,FACMPE and James Weston Spears,BCE

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1-Oct-06 0:00 AM

Nonunions of the Femoral Shaft and Distal Femur

Fri, 11 Aug 2006 05:00:00 GMT

Rozbruch, Vol. 11

Author: Mark R. Brinker,MD and Daniel P. O'Connor

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11-Aug-06 0:00 AM

CT Scan Helps Delineate Cervical Osteoid Osteoma and Atypical Nidus

Sat, 17 Sep 2005 22:00:00 GMT

The Journal of Bone and Joint Surgery

Robert L. Barrack, MD, Mark R. Brinker, BA, Stephen W. Burke, MD; and John M. Roberts, MD

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17-Sep-05 5:00 PM

Bilateral Femoral Neck Fractures After Pelvic Irradiation

Fri, 17 Sep 2004 22:00:00 GMT

The American Journal of Orthopedics

Howard R. Epps, MD, Mark R. Brinker, MD, and Daniel P. O'Connor, PhD

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17-Sep-04 5:00 PM

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noemail@drbrinker.com — Tue, 16 Dec 2008 15:46:18 GMT

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Our Location

Thu, 27 May 2010 17:54:31 GMT

Texas Orthopedic Hospital

7401 South Main Street
Houston, TX 77030
713- 799-2300

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Bone Transport

Thu, 27 May 2010 17:54:04 GMT

Bone transport is a technique that allows the Orthopedic Surgeon to regenerate bony tissue within the patient’s extremity. This regeneration is typically used to fill a gap of missing bone due to trauma or infection. The method is particularly useful in cases of: Infected Nonunions Segmental Defects (large areas of missing bone) Chronic Bone Infections In order to perform a bone transport, the Ilizarov fixator is applied to the extremity and the bone is broken between rings using a variety of specialized techniques The controlled breaking of the bone is known as an “osteotomy” or “corticotomy”. After waiting about a week, bone transport begins at a rate of ¾ to 1 millimeter per day. Slow transport of one or more bone segments is accomplished by progressively moving a segment or segments of bone from one position to another (by distracting the ring connectors). Bone forms in the distraction site by a process known as distraction...

Limb Lengthening

Thu, 27 May 2010 17:53:53 GMT

The Ilizarov method can be used to lengthen a foreshortened bone. In order to accomplish this, the Ilizarov fixator is applied to the extremity and the bone is broken between rings using a variety of specialized techniques.

The controlled breaking of the bone is known as an “osteotomy” or “corticotomy”.

After waiting about a week, lengthening begins at a rate of ¾ to 1 millimeter per day. Slow gradual lengthening is accomplished by moving the rings progressively apart (by distracting the ring connectors). Bone forms in the distraction site by a process known as distraction osteogenesis.

View a Limb Lengthening Case Study

Distraction

Thu, 27 May 2010 17:53:31 GMT

Certain types of nonunions respond well to distraction.

Slow gradual distraction of bone segments is generally applied at the rate of ½ to ¾ millimeter per day by moving the rings progressively apart (by distracting the ring connectors)

Although it may seem counter intuitive, the mechanical force transmitted during the process of distraction (pulling the bone segments apart) results in improved local vascularity and rapid healing in certain types of nonunions.

View a Distraction Method Case Study

Compression

Thu, 27 May 2010 17:53:17 GMT

Compression is a useful treatment method for certain types of slow healing fractures (delayed unions) and fracture nonunions.

Slow gradual compression of bone segments is generally applied at the rate of ¼ to ½ millimeter per day by moving the rings closer together (by tightening the ring connectors).

The compressive force generated leads to rapid healing in certain types of cases.

View a Compression Method Case Study

Ilizarov Surgery

Thu, 27 May 2010 17:53:08 GMT

Dr. Brinker has performed more than 1,000 Ilizarov surgeries. The Ilizarov method utilizes a circular external fixator to stabilize bony segments. The system is comprised of a series of external rings which are attached to one another via various types of ring connectors. Tensioned wires and half pins are transfixed to bone and are also attached to the external rings, thereby stabilizing the entire bone. Because of the circumferential nature of the device, the Ilizarov external fixator provides superior mechanical strength and stability, resisting shear and rotational forces. In fact the method not only allows for early weight-bearing in lower extremity applications, but weight bearing actually promotes healing and is therefore encouraged throughout treatment. The Ilizarov technique offers many advantages over other treatments, including: Minimal Soft Tissue Dissection Required Bone Regeneration Potential Tremendous Versatility Ability to Stabilize Small Bone...

Foot

Thu, 27 May 2010 17:52:46 GMT

The foot is comprised of 26 bones, 33 joints, and more than 100 muscles, tendons and ligaments. High energy trauma to the lower extremity can result in devastating bone and soft tissue injuries of the foot. Because of the potentially disastrous consequences of severe foot injuries and their long-term consequences, it is of paramount importance to choose a surgeon with vast experience in foot reconstruction. With proper treatment, even the most severe foot injuries can be treated and the patient’s quality of life can be significantly improved. Foot Problems Treated by Dr. Brinker* Problem Types Number of Surgical Cases Fracture Nonunions 25 View Case Studies Infected Nonunions 2 ...

Ankle

Thu, 27 May 2010 17:52:37 GMT

Three bones form the ankle joint: - the bottom portion of the tibia (known as the tibial plafond) - the bottom portion of the fibula known as the lateral malleolus - the top portion of the talus bone. Many fractures involving the ankle require operative treatment. When the bones around the ankle fail to heal (a nonunion) or heal in a deformed position, surgical intervention is almost always required to restore lower extremity function. Ankle Problems Treated by Dr. Brinker* Problem Types Number of Surgical Cases Fracture Nonunions 117 View Case Studies Infected Nonunions 28 View Case Studies Deformities 47 View Case Studies ...

Tibia

Thu, 27 May 2010 17:52:26 GMT

The tibia and fibula provide the structural support of the lower portion of the leg with the tibia being the major weight bearing bone. The top of the tibia has two concave surfaces and makes up the lower portion of the knee joint. This portion of the tibia is known as the tibial plateau. The tibia is a somewhat tubular structure that runs from the tibial plateau above to the distal tibia (tibial plafond) below. The plafond makes up the upper portion of the ankle joint. Many fractures of the tibia require operative stabilization. Fractures of the tibial shaft are most commonly stabilized with a metal rod placed in the central medullary canal, although several other methods are used depending on specific injury and patient characteristics. Fractures of the top (a tibial plateau fracture) and bottom (a tibial pilon fracture) portions of the tibia are most commonly stabilized with either plate and screw fixation or external fixation, again depending on specific injury and patient...

Knee

Thu, 27 May 2010 17:52:15 GMT

The knee is a hinge joint located in the middle of the lower extremity. Four bones form the knee joint and include: the bottom portion of the femur (known as the femoral condyles); the top portion of the tibia and fibula (the bones of the lower leg); and the patella (knee cap). Many fractures around the knee require operative treatment. When the bones around the knee fail to heal (a nonunion) or heal in a deformed position, surgical intervention is almost always required to restore lower extremity function. Knee Problems Treated by Dr. Brinker* Problem Types Number of Surgical Cases Fracture Nonunions 39 Infected Nonunions 8 Deformities 66 ...

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noemail@drbrinker.com — Tue, 16 Dec 2008 15:46:17 GMT

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Expiration Date: 16-Mar-09 9:46 AM

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2008-12-16T15:46:17Z

Instructor: Instructor

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