Osgood/Thesis Day

Wednesday April 26, 2000

Bigelow Amphitheater • Massachusetts General Hospital

Senior Resident Thesis Presentations

First Session
Moderated by Thomas S. Thornhill, MD

Technique and Functional Outcome of Surgical Repair of the Achilles Tendon

Lars Richardson, MD
Advisor: Michael Wilson, MD
Discussor: Louis Meeks, MD

Dr. Lars Richardson, retrospectively reviewed 30 patients treated from 1992-99 by his advisor, Dr. Michael Wilson, for Achilles tendon rupture. All patients underwent open repair through a posteromedial "J"-shaped incision with pull-out wire technique. After an average followup of four years, all patients had good to excellent results as measured by the American Orthopaedic Foot and Ankle Society ankle hindfoot and Leppilahti Achilles scores. Twenty-two patients were able to return to all pre-injury sports and activity. Interestingly, Dr. Richardson noted that five of the eight women in the study had subsequent shoe wear limitations.

In his discussion of this work, Dr. Louis Meeks gave a historical perspective of the treatment of Achilles tendon rupture, noting the transition from non-operative to operative treatment that took place in the mid-1980’s. He emphasized the merits of open repair with the pull-out wire technique, most notable of which is the marked decreased rate of re-rupture as compared to patients treated with cast immobilization. He also commended Dr. Richardson and Dr. Wilson for their study of 30 patients treated by a single surgeon adhering to a unified operative and postoperative rehabilitation protocol. Interestingly, when members of the audience were asked how they would have their Achilles tendon rupture treated, all but two indicated they would opt for open repair.

Complications of Halo Immobilization of the Cervical Spine in the Elderly

Lisa Taitsman, MD
Advisor: Francis Pedlow, MD
Discussor: Augustus White, MD

Dr. Lisa Taitsman performed a retrospective chart review of 75 patients older than 65 years who were treated with halo vests at the Massachusetts General Hospital or Brigham and Women’s Hospital from 1990-1999. Fifty-five percent of patients treated had at least one complication, and 16% required readmission for complications of halo immobilization. Dr. Taitsman reported a 29% incidence of pin site complication, a 23% incidence of pneumonia, and an 11% incidence of gastrostomy tube placement for feeding and/or aspiration risk. Interestingly, 17% of patients had respiratory compromise requiring intubation or intensive care unit monitoring, and all eight patient deaths were secondary to respiratory problems. Taitsman and her advisor, Dr. Francis Pedlow, urged careful patient selection, monitoring, and counseling when treating elderly patients with halo immobilization. 

Dr. Augustus White served as discussor for this thesis, emphasizing that the complication rate was likely underestimated in this patient population, given the retrospective design of the study. He encouraged that future analysis include not only hospital record review but also analysis of patient radiographs, medical co-morbidities, and careful clinical follow-up.

Significance of Scapholunate Interval in the Pediatric Population

Wael Kaawach, MD
Advisor: Peter Waters, MD
Discussor: Barry Simmons, MD

Noting a rising prevalence in wrist pain and carpal instability in children, perhaps due to increasing participation in youth sports, Dr. Wael Kaawach attempted to quantify normal reference values for the scapho-lunate interval in children. In conjunction with his advisor, Dr. Peter Waters, Dr. Kaawach analyzed 121 wrist x-rays in 37 male and 50 female patients with ages ranging from six to 15 years. He subsequently generated age- and gender-specific normative values for the scapholunate interval based on linear regression analysis with 95% confidence intervals used to define the normal ranges. Dr. Kaawach hopes that this information will aid in the screening and diagnostic work-up of children with chronic wrist pain. 

Dr. Barry Simmons served as the discussor of this presentation. He noted the surprising finding by prior investigators that there is asymmetric carpal maturation and ossification of one wrist compared to the other in children and urged further analysis of normative values of the scapholunate interval in rela-tion to the contralateral wrist