Browsing by Author "Klaber, Ianiv"

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    Compressive cryotherapy is superior to cryotherapy alone in reducing pain after hip arthroscopy
    (2019) Klaber, Ianiv; Greeff, Eugene; O'Donnell, John
    The early post-operative period after hip arthroscopy for femoroacetabular impingement is characterized by pain and swelling. Minimization of pain is of critical importance to the patient, but pain might also reduce patients' compliance to early physiotherapy, delay rehabilitation and hospital discharge. Avoiding early mobilization represents a risk factor for developing capsulolabral adhesions. Compressive cryotherapy (CC) has been shown to reduce pain after knee and hip replacement surgery. The aim of this study was to assess the effect of the inclusion of CC in the pain management and early discharge after hip arthroscopy. A prospective cohort of 20 patients who received CC and 20 retrospectively matched controls who received standard cryotherapy (SC) were compared. The CC was added to the standard post-operative analgesia and rehabilitation protocol. Using non-parametric tests, the percentage of patients discharged in post-operative day one, pain VAS scores and analgesia requirement were compared. The CC group reported significantly lower pain scores compared to SC; VAS 1 (03) and 2 (0-5) (P = 0.0028), respectively. A non-significant reduction in analgesic requirement 1.75 versus 2.8 doses per patient was found and 20/20 patients were discharged on post-operative day one versus 17/20 in the SC group (P = 0.23). Patients treated with CC after hip arthroscopy reported lower levels of pain during the early post-operative phase and were able to be discharged home sooner when compared with a matched control group receiving ice therapy alone. A trend towards lower opioid analgesia requirement was observed.
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    Decreased mortality in patients with fragility fracture of a fracture liaison service coordinated by Chile's first nurse practitioner
    (2024) Leyan, Sandra; Olate, Catalina Vidal; Klaber, Ianiv; Kelly-Weeder, Susan
    Background:Fragility fractures have significant sequelae, including pain, loss of mobility, and increased risk of mortality. Fracture liaison services (FLS) represent a coordinated, interdisciplinary approach to secondary prevention and reduce mortality.Purpose:To investigate the effectiveness and patient outcomes regarding readmission and mortality of a newly developed, nurse practitioner (NP) coordinated FLS in Chile.Methodology:Retrospective longitudinal analysis of 214 patients who agreed to participate in a FLS was conducted. Variables studied include patient age, gender, anatomical fracture site, dual x-ray absorptiometry scans, medication, readmission information, and mortality. Demographics and clinical data were collected and analyzed with bivariate and multivariate statistics. Kaplan-Meier curves and log-rank tests were performed to compare survival curves between those who did and did not participate in the FLS.Results:The study sample was predominantly female (85%) with a mean age of 76 (SD: 12; range 41-101) years. The most frequently noted fracture sites were hip (n = 167), wrist (n = 132), and spine (n = 72). At one-year follow-up, the FLS group had a significantly lower mortality (5%, 10 patients) than those who did not participate in the program (12% [N = 50], p = .005). The Kaplan-Meier analysis indicated that patients who participated in the FLS had significantly better survival rates than those who did not participate.Conclusions:Significantly improved survival rates were observed in FLS patients. Chile's first FLS demonstrated improved patient outcomes, specifically a reduced mortality in patients who were enrolled in the FLS.Implications:The NP role was fundamental in the screening, diagnosis, and treatment of patients with osteoporosis.
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    Diagnostic utility of open biopsy in patients with two culture-negative aspirations in the diagnostic work-up of periprosthetic joint infection
    (2023) Klaber, Ianiv; Scholz, Fabian; Citak, Mustafa; Zahar, Akos; Gehrke, Thorsten; Haasper, Carl; Hawi, Nael; Lausmann, Christian
    Introduction Different approaches have been proposed for bacterial identification in patients with a suspected periprosthetic joint infection (PJI). If a one-stage procedure is considered, a higher rate of preoperative bacterial identification can be achieved if biopsy is included in the diagnostic work-up. The performance of open biopsy (OB) in the context of PJI has not been clearly determined yet. The purpose of this study was to determine the value of an OB added to two consecutive culture-negative joint aspirations during PJI workup. Materials and methods We retrospectively analyzed the OB data from a single institution. Patients under PJI work-up of the hip or knee with two culture-negative periprosthetic aspirations who underwent OB were included. Sensitivity and specificity were calculated using the musculoskeletal infection society (MSIS) criteria as gold standard. Patients undergoing urgent irrigation and debridement and patients with history of surgery to the affected joint in the prior 6 weeks were excluded. Results 126 patients were included in this study. 62 (49.2%) patients had prior revisions, 48 of them due to PJI. The sensitivity and specificity of OB was 69.4% and 89.1%, respectively. The OB procedure led to the identification of the causative germ in 50 out of 126 (40%) cases so they could undergo one-stage (septic) exchange. Conclusion The OB is a valuable resource if preoperative synovial fluid cultures are negative, a high suspicion of infection persists and a one-stage procedure is preferred. It intends bacteria identification and allows surgeons to evaluate prosthetic complications for further surgical procedures.
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    High prevalence of deep vein thrombosis in elderly hip fracture patients with delayed hospital admission
    (2020) Bengoa, Francisco; Vicencio, Gerardo; Schweitzer, Daniel; Lira, Maria Jesus; Zamora, Tomas; Klaber, Ianiv
    Purpose Deep vein thrombosis (DVT) is a common complication in hip fracture patients, associated with significant morbidity and mortality. Research has focused on postoperative DVT, with scant reports on preoperative prevalence. The aim of this study was to describe the prevalence of preoperative DVT in patients accessing medical care >= 48 h after a hip fracture. Methods We included elderly patients admitted >= 48 h after sustaining a hip fracture, between September 2015 and October 2017. Patients with a previous episode of DVT, undergoing anticoagulation therapy, with pathologic fractures or undergoing cancer treatment were excluded. Of 273 patients, 59 were admitted at least 48 h after the fracture. DVT screening by Doppler ultrasound of both lower extremities was carried upon hospital admission. We recorded age, sex, Charlson comorbidity index and ASA score, fracture type, time since injury, time from admission to surgery and total length of hospital stay. Results We studied 41 patients, 79 (+/- 10.34) years old. The delay from injury to admission was 120 h (48-696 h). Seven patients (17.1%) had a DVT upon admission. There were no significant differences between patients with and without DVT, regarding time from admission to surgery or the total length of the hospital stay. Conclusions The prevalence of DVT in patients admitted >= 48 h after a hip fracture was 17.1%. The diagnosis and management of DVT did not increase time to surgery or hospital stay. Our results suggest routine screening for DVT in patients consulting emergency services >= 48 h after injury.
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    Inter- and intra-observer agreement using the new AOSpine sacral fracture classification, with a comparison between spine and pelvic trauma surgeons
    (2022) Meissner-Haecker, Arturo; Diaz-Ledezma, Claudio; Klaber, Ianiv; Zamora, Tomas; Valencia, Manuel; Camino-Willhuber, Gaston; Astur, Nelson; Yurac, Ratko; Valacco, Marcelo; Urrutia, Julio
    Background: Sacral fractures treatment frequently involves both spine and pelvic trauma surgeons; therefore, a consistent communication among surgical specialists is required. We independently assessed the new AOSpine sacral fracture classification's agreement from the perspective of spine and pelvic trauma surgeons. Methods: Complete computerized tomography (CT) scans of 80 patients with sacral fractures were selected and classified using the new AOSpine sacral classification system by six spine surgeons and three pelvic trauma surgeons. After four weeks, the 80 cases were presented and reassessed by the same raters in a new random sequence. The Kappa coefficient ( K) was used to measure the inter-and intra-observer agreement. Results: The inter-observer agreement considering the fracture severity types (A, B, or C) was substantial for spine surgeons ( K= 0.68 [0.63 - 0.72]) and pelvic trauma surgeons ( K= 0.74 (0.64 - 0.84). Regarding the subtypes, both groups achieved moderate agreement with K= 0.52 (0.49 - 0.54) for spine surgeons and K= 0.51 (0.45 - 0.57) for pelvic trauma surgeons. The intra-observer agreement considering the fracture types was substantial for spine surgeons ( K= 0.74 [0.63 - 0.75]) and almost perfect for pelvic trauma surgeons ( K= 0.84 [0.74 - 0.93]). Concerning the subtypes, both groups achieved substantial agreement with, K= 0.61 (0.56 - 0.67) for spine surgeons and K= 0.68 (0.62 - 0.74) for pelvic trauma surgeons. Conclusion: This classification allows an adequate communication for spine surgeons and pelvic trauma surgeons at the fracture severity type, but the agreement is only moderate at the subtype level. Future prospective studies are required to evaluate whether this classification allows for treatment recommendations and establishing prognosis in patients with sacral fractures. @ 2021 Elsevier Ltd. All rights reserved.
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    Radiographic Assessment of Bone Quality Using 4 Radiographic Indexes: Canal Diaphysis Ratio Is Superior
    (2024) Faundez, Jorge; Carmona, Maximiliano; Klaber, Ianiv; Zamora, Tomas; Botello, Eduardo; Schweitzer, Daniel
    Background: Osteoporosis increases the risk of periprosthetic fracture and loosening in hip arthroplasty. Many methods have been proposed to assess bone quality in X-rays, including both qualitative such as the Dorr classification and quantitative such as the Calcar-Canal Ratio (CCR) and Cortical -Thickness index/Canal-Bone ratio (CTI/CBR). The Canal-Diaphysis ratio (CDR) has been described as a predictor for hip fragility fractures; however, its relationship with bone mineral density (BMD) has not been described. The purpose of this study was to evaluate the correlation of the Dorr classification, CCR, CTI/CBR, and CDR with BMD of the proximal femur in patients without hip fracture. Methods: Forty-seven patients over 45 years of age who had less than 6 months between radiographs and dual -energy X-ray absorptiometry were evaluated. Measurements of CCR, CBR, CDR, and Dorr classification were performed in all radiographs by 2 independent observers. Results: The CDR had a high correlation (r = 0.74, P=<0.01) with BMD, whereas the CTI/CBR had a moderate correlation (r = 0.49, P=<0.01), and the CCR had no correlation with BMD (r = 0.06, P = .96). When evaluating the receiver operating characteristic curve, CDR showed the best performance (area under curve [AUC] = 0.75) followed by CBR (AUC = 0.73) and CCR (AUC = 0.61). The optimal cutoff value for the CDR was 0.49, with 100% sensitivity and 58% specificity. The inter- and intra-observer variability was good for all methods. No differences were found between Dorr classification of patients who had or did not have osteoporosis. Conclusion: Of all the analyzed methods, the CDR was found to have the best correlation with BMD. This study proposes the use of CDR as a tool for assessing bone quality when deciding the implant fixation method in hip arthroplasty. (c) 2023 Elsevier Inc. All rights reserved.
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    Ten-Year Results Following One-Stage Septic Hip Exchange in the Management of Periprosthetic Joint Infection
    (2019) Zahar, Akos; Klaber, Ianiv; Gerken, Anne-Marie; Gehrke, Thorsten; Gebauer, Matthias; Lausmann, Christian; Citak, Mustafa
    Background: Although 2-stage revision is still considered the gold standard for surgical management of periprosthetic joint infection (PJI), 1-stage revision has been reported to be as effective. Long-term reports for 1-stage revision in hip PJIs are lacking.