Browsing by Author "Virkus, Walter"

Now showing 1 - 4 of 4
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    A Liberal Transfusion Strategy Leads to Higher Infection Rates, ORthopaedic Trauma and Anemia: Conservative vs. Liberal Transfusion Strategy (ORACL), a Prospective Randomized Study 30 Day Inpatient Complications
    (2022-09-17) Mullis, Leilani; Mullis, Brian; Virkus, Walter; Kempton, Laurence
    Purpose: There is ongoing debate what level of anemia should be used as a transfusion trigger for asymptomatic trauma patients no longer in a resuscitative phase immediately following trauma. A previous retrospective case-control study by one of the lead investigators showed there was a higher risk of complications with a more liberal strategy, and this appeared to be dose-dependent. Multiple previous studies have shown allogeneic blood transfusion is immunosuppressive and may increase infection rates in surgical patients. This study was completed to determine if a more conservative strategy was safe and might decrease the risk of infection. Methods: The ORACL pilot study randomized 100 patients ages 18-50 to a conservative transfusion strategy of 5.5 g/dL vs a liberal strategy of 7.0 g/dL in asymptomatic patients no longer being resuscitated who required inpatient admission for an associated musculoskeletal injury. Enrollment was performed at 3 level 1 trauma centers from 2014-2021. Ninety-nine patients completed 30 day follow up. Results: There was a significant association between a liberal transfusion strategy and higher rate of deep infection (defined as unplanned return to OR for debridement or admission for IV antibiotics) but superficial infection (defined as oral antibiotics alone needed without admission or debridement) did not reach statistical significance (Table 1). Multiple secondary outcomes or complications that might occur due to anemia or transfusion were not different between the two groups. Conclusion: This study shows a conservative transfusion strategy of 5.5 g/dL in an asymptomatic young Orthopaedic trauma patient leads to a lower deep infection rate without an increase in adverse outcomes.
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    Intramedullary Nailing of Periarticular Fractures
    (Wolters Kluwer, 2018-08) Virkus, Walter; Kempton, Laurence; Sorkin, Anthony; Gaski, Greg; Orthopaedic Surgery, School of Medicine
    Plate fixation has historically been the preferred surgical treatment method for periarticular fractures of the lower extremity. This trend has stemmed from difficulties with fracture reduction and concerns of inadequate fixation with intramedullary implants. However, the body of literature on management of periarticular fractures of the lower extremities has expanded in recent years, indicating that intramedullary nailing of distal femur, proximal tibia, and distal tibia fractures may be the preferred method of treatment in some cases. Intramedullary nailing reliably leads to excellent outcomes when performed for appropriate indications and when potential difficulties are recognized and addressed.
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    A modified Levine approach for exposure of the anterior column, anterior wall and sacroiliac joint: a surgical technique and a case series
    (Wolters Kluwer, 2021-03) Jang, Yohan; Virkus, Walter; McKinley, Todd; Orthopaedic Surgery, School of Medicine
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    Results of Low Distal Femur Periprosthetic Fractures
    (Wolters Kluwer, 2022-02-28) Virkus, Walter; Lieder, Charles; Jang, Yohan; Rea, Parker; Gaski, Greg; Orthopaedic Surgery, School of Medicine
    Objectives- To compare retrograde intramedullary nail (RIMN) and open reduction internal fixation (ORIF) in very distal periprosthetic distal femur fractures (PDFF) to determine if RIMN is an acceptable option for these fractures that are often considered too distal for IMN due to limited bone stock. Design- Retrospective comparative series Setting- Level One trauma center Patients- Patients treated with fracture fixation for a very distal PDFF, defined as the fracture extending to the anterior flange of the implant or distal. Fifty-six patients met inclusion criteria, with eight excluded for less than twelve months of follow-up. Intervention- Fracture fixation with RIMN or ORIF Main Outcome Measurements- The primary outcome was unplanned return to surgery. Secondary outcomes included fracture union, radiographic alignment, Visual Analog Score (VAS) and Patient-Reported Outcome Measurement Information System (PROMIS) Physical Function (PF) and Pain Interference (PI). Results- Mean follow up was 27 months. Twelve patients were treated with ORIF and 36 with RIMN. Twenty-one fractures were at the flange and 27 extended distal to the flange. There were no differences between fixation methods with respect to reoperation, deep infection, nonunion, malunion, VAS pain score, and PROMIS PI score. Mean PROMIS PF score was higher in the RIMN group compared to ORIF. There were five reoperations in the RIMN group (14%) and three in the ORIF group (25%). Conclusion- This is the largest series, to our knowledge, of a subset of very distal PDFFs. The results suggest that RIMN may be an acceptable treatment option for these very difficult fractures.