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Bono Treated With Metal Plates, ‘Intensive Therapy’ After Bike Injury

Rolling Stone – November 19, 2014

Three days after U2 revealed that lead singer Bono injured his arm in a “cycling spill” requiring surgery, the grim details of the singer’s accident and prognosis have been disclosed to Rolling Stone.

While riding his bike through New York’s Central Park on Sunday, the singer attempted to avoid another rider and was involved in what doctors have called a “high energy bicycle accident.”

According to orthopedic trauma surgeon Dean Lorich, MD, “[Bono] was taken emergently to the operating room…where the elbow was washed out and debrided, a nerve trapped in the break was moved and the bone was repaired with three metal plates and 18 screws.” On Monday, Bono underwent a second surgery to repair a fractured left pinky finger.

While it’s still unclear how long the singer will be recuperating, Lorich tells Rolling Stone that Bono will “require intensive and progressive therapy,” but “a full recovery is expected.”

Read full story: Rolling Stone.

Ga$ Fuels E.R. Boom ‘Cycle’

NY Post – August 4, 2008

As gas prices continue to soar, another statistic is also swelling: the number of cyclists and scooter enthusiasts that end up in the E.R.

“I am going to be operating on three patients this week from motorcycle accidents,” said Dean Lorich, MD, associate director of orthopedic trauma surgery at Hospital for Special Surgery in New York. “It’s quadrupled in the last four weeks to two to three a week, compared to one big one a month during the summer.”

New riders, who are turning to two wheels over four to beat gas prices, are often inexperienced and as a result are pushing up the E.R. statistic, according to Lorich.

Read the full story at nypost.com.

Hospital for Special Surgery Orthopedic Trauma Team On the Ground in Haiti

New York, NY – January 18, 2010 

A team of anesthesiologists, nurses and orthopedic trauma surgeons from Hospital for Special Surgery headed for Haiti on Friday and have been performing surgery and tending to those impacted by the earthquake ever since.

Led by David L. Helfet, M.D., and Dean Lorich, MD, and including physicians from NewYork-Presbyterian Hospital, the team has been working round the clock at Hopital de la Communaute Haitienne in Port-au-Prince suburb of Petion-Ville and have already performed more than 50 surgical procedures. With air transport provided by global medical device company Synthes and surgical supplies donated by Synthes, Hospital for Special Surgery and NewYork-Presbyterian, the team is working under extremely rudimentary conditions with limited security.

The medical team currently in Haiti will be relieved tomorrow evening when a new team from Hospital for Special Surgery will take their place. “This is an important humanitarian effort that requires our team to perform hands-on medicine on people who have been suffering since the earthquake last week,” said Dr. Helfet. “We had to quickly adjust from the high tech Hospital for Special Surgery environment with the most state-of-the-art radiologic and surgical equipment, to a makeshift hospital where we are trying to save lives and limbs.”

According to Louis Shapiro, President and CEO of Hospital for Special Surgery, “It’s in times like these that we need to act with skill and compassion. We are extremely proud of our team and the contributions they are making to help the people of Haiti. We will continue to contribute to these efforts as best we can in the coming days and weeks.”

HSS Medical Team in Haiti

About Hospital for Special Surgery

Founded in 1863, Hospital for Special Surgery (HSS) is a world leader in orthopedics, rheumatology and rehabilitation. HSS is nationally ranked No. 2 in orthopedics, No. 3 in rheumatology and No. 24 in neurology by U.S.News & World Report (2009), and has received Magnet Recognition for Excellence in Nursing Service from the American Nurses Credentialing Center, and has one of the lowest infection rates in the country. In 2008 and 2007, HSS was a recipient of the HealthGrades Joint Replacement Excellence Award. A member of the NewYork-Presbyterian Healthcare System and an affiliate of Weill Cornell Medical College, HSS provides orthopedic and rheumatologic patient care at NewYork-Presbyterian Hospital at New York Weill Cornell Medical Center. All Hospital for Special Surgery medical staff are on the faculty of Weill Cornell Medical College. The hospital’s research division is internationally recognized as a leader in the investigation of musculoskeletal and autoimmune diseases. Hospital for Special Surgery is located in New York City and online at www.hss.edu.

Novel Surgery May Help Young Trauma Patients Avoid Total Hip Replacements

New York City – January 29, 2010 

A novel surgery using transplanted bone and cartilage may help young patients avoid a hip replacement after a specific traumatic injury to the hip joint, according to a case study by orthopedic trauma specialists at Hospital for Special Surgery in New York. The study appears in the February issue of the Journal of Orthopaedic Trauma.

“This novel technique can help young patients to delay, or even possibly avoid altogether, the need for a total hip replacement,” said David L. Helfet, M.D., director of the Orthopedic Trauma Service at Hospital for Special Surgery. Hip replacements typically last 20 to 25 years, so a younger person who undergoes a hip replacement is likely to need multiple hip replacement surgeries/revisions in the span of his or her lifetime. Only one similar case report was found in the literature at the time of preparation of the present manuscript. This case was also a success, and doctors say the studies provide encouragement to clinicians that this type of surgery can be of benefit to other patients with similar injuries.

In certain high-energy accidents such as motor vehicle accidents or when a person falls off a ladder, fractures of the so-called femoral head can occur. The hip consists of a ball and socket joint and a femoral head fracture is an injury to the ball portion of the joint. In high-energy accidents, the femur can be forced to dislocate beyond the socket often causing a femoral head fracture, sometimes with an associated fracture to the hip socket. In the past, femoral head fractures with a bone and cartilage defect were treated primarily with a total hip replacement; which as stated is less than ideal in a young patient who would likely need multiple revision surgeries in their lifetime.

The case reported by researchers at Hospital for Special Surgery involved an injury to an 18-year-old man who was a belted driver involved in a motor vehicle collision, striking a pole. After being admitted and observed at the initial hospital, he was assessed as having a small fracture of the femoral head and was released on crutches. Twenty days following the injury, he presented at Hospital for Special Surgery. Computed tomography (CT) and magnetic resonance imaging (MRI) examinations were performed, which further delineated the large displaced section of the femoral head and a small associated fracture to the periphery of the hip socket (acetabulum).

Surgery was then performed, by orthopedic surgeons Dr. Helfet and Dr. Robert L. Buly, using a new technique that involves surgical dislocation of the femur in order to access and repair the fracture. Because one-third of the femoral head was missing due to the severe damage associated with the injury, doctors chose to transplant a special piece of frozen bone/cartilage. Hospitals, especially those with larger orthopedic surgery departments, have bone bank facilities that store bone and cartilage tissue based on surgical indications. Once thawed, the cartilage and bone were shaped to fit into the defect. The transplant was then anchored into place with two small headless screws. 

 “This is one of the first such case reports describing this procedure in the orthopaedic literature,” said Dr. Helfet. “The patient has had an early good functional recovery following such a severe injury to his hip joint.”

Post-operatively, the patient was on crutches, only 20 lbs weight bearing for two months, but he was told to avoid rigorous activities requiring further exertion. Subsequently, the patient was allowed to slowly progress to weight bearing as tolerated and work on obtaining full range of motion and strength of the hip. The patient returned for regular follow-up visits and x-rays of the hip revealed that the graft had properly incorporated. At 46 months following surgery, the patient is fully rehabilitated, was able to successfully complete his education, and has been able to return to the active life he enjoyed before the injury. Further studies with long-term results are needed, but the early results are promising.

“The surgery was a success. His is currently working as a mechanic for a country club. He was able to return to complete his education and perform a physically demanding job.” said Dr. Helfet. “The advantage of this surgery is the ability to delay or even avoid altogether a total hip replacement. Even more importantly, the longer a hip replacement can be delayed in a younger patient, the better, because there is less chance of one or multiple subsequent revision surgeries.”

Other authors involved in the case report are Markku T. Nousiainen, M.D,, from Sunnybrook Health Sciences Centre, University of Toronto; Milan K. Sen, M.D., from the University of Texas Medical Center at Houston; and Douglas N. Mintz, M.D., Dean Lorich, MD., Omesh Paul, M.D., and Robert L. Buly, M.D., from Hospital for Special Surgery.

About Hospital for Special Surgery

Founded in 1863, Hospital for Special Surgery (HSS) is a world leader in orthopedics, rheumatology and rehabilitation. HSS is nationally ranked No. 2 in orthopedics, No. 3 in rheumatology and No. 24 in neurology by U.S.News & World Report (2009), and has received Magnet Recognition for Excellence in Nursing Service from the American Nurses Credentialing Center, and has one of the lowest infection rates in the country. In 2008 and 2007, HSS was a recipient of the HealthGrades Joint Replacement Excellence Award. A member of the NewYork-Presbyterian Healthcare System and an affiliate of Weill Cornell Medical College, HSS provides orthopedic and rheumatologic patient care at NewYork-Presbyterian Hospital at New York Weill Cornell Medical Center. All Hospital for Special Surgery medical staff are on the faculty of Weill Cornell Medical College. The hospital’s research division is internationally recognized as a leader in the investigation of musculoskeletal and autoimmune diseases. Hospital for Special Surgery is located in New York City and online at www.hss.edu.

Getting More Aggressive with Clavicle Fractures

Huffington Post – April 2, 2009

On Lance Armstrong’s way to becoming one of the greatest cyclists of all time, he has overcome many obstacles. This week he faces a new one: recovering from surgery for a broken clavicle. The clavicle, or collarbone, is the bone between one’s sternum and scapula (or shoulder blade). It plays an important role in the function of the shoulder girdle and serves to protect major blood vessels and nerves.

Clavicle fractures are very common injuries, accounting for about 5% of all fractures seen in emergency departments. They most frequently occur in the middle of the bone, and in adults, they usually result from forceful, direct impact to the bone.

Clavicle fractures are extremely painful. Patients may present with swelling, tenderness, bruising and/or deformity of the bone. In severe cases, the break can lead to compromise of the underlying neurovascular structures or even of the lung, which can cause problems breathing. Diagnosis is confirmed with xrays.

Although these fractures are very painful, the majority can successfully be treated with conservative measures, particularly non- and minimally-displaced fractures (meaning the pieces of bone haven’t moved too far apart from one another). Patients are placed in a sling and given pain medications. Often they can return to training for sports at about 6 weeks after the injury. If one goes back before the bone heals, there is clearly an increased risk of re-fracture.

Some of the indications for surgery include significant displacement of the bone ends such that they are tenting the skin, injury to the surrounding neurovascular structures, and fractures that come through the skin (or open fractures). Oftentimes, athletes are treated surgically to get them back to their sports more quickly. According to Dean Lorich, MD, an orthopedic surgeon at Hospital for Special Surgery, “Academically the reason to fix clavicle fractures is improved strength, endurance and cosmesis. The displaced clavicle can lead to significant shoulder asymmetry when healed (i.e., shortened shoulder) and large bump.” Lorich adds that “patients treated operatively are some of the most grateful patients I have, as their pain and disability disappear almost immediately.” Acutely, in most cases, he “prefers to use an intramedullary nail instead of a plate and screws, as it is done minimally invasively and almost never requires removal of the plate.”

Read the full story at huffingtonpost.com.

Drugs to Build Bones May Weaken Them

NYTimes.com – July 15, 2008

New questions have emerged about whether long-term use of bone-building drugs for osteoporosis may actually lead to weaker bones in a small number of people who use them.

The concern rises mainly from a series of case reports showing a rare type of leg fracture that shears straight across the upper thighbone after little or no trauma. Fractures in this sturdy part of the bone typically result from car accidents, or in the elderly and frail. But the case reports show the unusual fracture pattern in people who have used bone-building drugs called bisphosphonates for five years or more.

Some patients have reported that after weeks or months of unexplained aching, their thighbones simply snapped while they were walking or standing.

“Many of these women will tell you they thought the bone broke before they hit the ground,” said Dean Lorich, MD., associate director of orthopedic trauma surgery at Hospital for Special Surgery and NewYork-Presbyterian/Weill Cornell. Dr. Lorich and his colleagues published a study in The Journal of Orthopaedic Trauma last month reporting on 20 patients with the fracture. Nineteen had been using the bone drug Fosamax for an average of 6.9 years.

The doctors emphasize that the problem appears to be rare for a class of drug that clearly prevents fractures and has been life-saving for women with severe osteoporosis. Every year, American adults suffer 300,000 hip fractures.

Notably, studies suggest there is little extra benefit in taking the bone drugs more than five years. Dr. Lorich says that doctors should monitor the bone metabolism of long-term users and that some patients may want to consider taking time off the drugs. When fractures do occur, surgeons need to be alerted about long-term drug use, because the fracture may require more aggressive treatment and be slower to heal.

Read the full story at nytimes.com.