Mani Kahn's research while affiliated with Montefiore Medical Center and other places

Category Trauma; Ankle Introduction/Purpose Ankle fractures are very common. Most unstable ankle fractures require surgical intervention in order to obtain better clinical outcomes. However, there is still conflicting evidence about the implications of time to surgery on post- operative wound complications. Purpose of study To investigate if early or delayed surgery results in difference in wound complications in patients who underwent surgical intervention for ankle fracture. Methods A retrospective review of 238 ankle fracture cases treated with open reduction and internal fixation (ORIF) from October 28, 2016, through May 12, 2022 was completed at our institution. Patients were divided into 4 groups based on the time to surgery. In group 1, surgery was within a week. In group 2, surgery was in 2nd week. In group 3, surgery was in 3rd week. In group 4, surgery was after 3 weeks. Wound complications including minor wound complication and wound infection were investigated. The other factors including BMI, smoking, diabetes, etc. were investigated as well to avoid confounding bias. Since most of patients accepted surgery either in first 4 days (early surgery group) or between 10 to 20 days (delayed surgery group) in this series of patients. We also analyzed those two time points. Data was analyzed using STATA. Results 238 patients with ankle fracture were analyzed. 36, 96, 71 and 35 patients were included in group 1, 2, 3 and 4 respectively. For BMI, smoking, and diabetes, no significant difference among 4 groups. The rate of minor wound complications in group 1, 2, 3 and 4 was 13.8%, 12.5%, 8.5% and 0%. The rate of wound infection in group 1, 2, 3 and 4 was 5.6%, 3.1%, 1.4% and 0%. For minor wound complication, there was significant decrease in group 4, as compared with group 1 and group 2 (p < 0.05). Interestingly, in term of early vs delayed surgery, both infection rate (13.3% vs 2.8%) and minor wound complication rate (33.3% vs 10.8%) significantly decreased in the delayed surgery group (p < 0.05). Conclusion Delayed ORIF of ankle fracture resulted in decreased both minor wound complication rate and infection rate.

Background: Brazilian jiu-jitsu (BJJ) is a martial art that focuses on ground combat, emphasizing skill over strength and submission over striking. The purpose of this study is to evaluate the nature of injuries affecting practitioners of BJJ in the settings of competition, training, and conditioning. Methods: An online survey was created to collect demographic and injury-specific information. This survey was distributed to the 234 schools in the United States registered with the International Brazilian Jiu-Jitsu Federation (IBJJF). The survey was also distributed to local BJJ schools and at local tournaments in the Greater New York City area. Data from a total of N=56 participants were recorded for this survey. Results: The majority of participants were male (n=44, 78.6%) and amateur competitors (n=29, 51.8%) with an average duration of BJJ training of 6.9 ± 5.9 years. The majority of participants (82.1%) train at least six hours per week and compete in an average of 4.6 ± 2.5 competitions per year. The most common injuries were to the finger/hand (78.6%) and knee (61.5%). The most commonly reported fracture was of the hand/fingers (n=6). Of the 156 total injuries reported, 133 (85.3%) occurred during practice or training rather than in competition and 76 (48.7%) required medical attention. Few injuries required surgical intervention. Conclusions: This study provides novel information regarding injury characteristics of BJJ practitioners with respect to the level of training and use of protective equipment that can guide expectations and management for this unique group of athletes. Amateur BJJ practitioners are the most commonly injured, and largely experience injuries of the upper extremities during training or conditioning rather than during competition.

Treating large bone defects resulting from trauma, tumors, or infection can be challenging, as current methods such as external fixation with bone transport, bone grafting, or amputation often come with high costs, high failure rates, high requirements for follow-up, and potential complications. In this case report, we present the successful treatment of a complicated, infected tibial shaft non-union by using a personalized three-dimensional (3D)-printed titanium mesh cage. This case adds to the existing body of literature by demonstrating successful integration of bone into a titanium implant and a demonstration of immediate postoperative weight bearing in the setting of suboptimal operative and psychosocial conditions. Futhermore, this report highlights the flexibility of 3D-printing technology and its ability to allow for continued limb salvage, even after a planned bone transport procedure has been interrupted. The use of 3D-printed implants customized to the patient's specific needs offers a promising new avenue for treating complex tibial pathologies, and the technology's versatility and ability to be tailored to individual patients makes it a promising tool for addressing a wide range of bone defects.

Category Other; Ankle Introduction/Purpose On March 1, 2020, the first case of novel coronavirus (COVID-19) in New York City (NYC) was confirmed. By March 16, the NYC mayor and New York State Governor issued executive orders to postpone elective surgeries. At our tertiary care academic medical care center in the Bronx, the densely populated community of 1.4 million saw many COVID-19 positive cases. In response, the hospital quickly accommodated these patients, while maintaining outpatient orthopedic care. Consequently, only emergent orthopedic cases were granted permission to rapidly proceed to surgery. Most foot and ankle cases were deemed amenable to non-surgical or delayed surgical care. The purpose of this study is to characterize a series of patients with foot and ankle pathology whose orthopedic care was altered due to the pandemic. Methods This is a retrospective chart review from February 2020-May 2020 encompassing the time that elective surgery was on hold and one month prior, to capture those patients were scheduled for surgery prior to the pandemic. Included were patients with foot and ankle pathology that required urgent orthopedic care, who were seen in the foot and ankle clinic, fracture clinic, and subsequently in the general orthopedic clinic that was instituted on an emergent bases. Excluded were patients who required intervention to address elective foot and ankle issues such as osteoarthritis, or ankle instability, and those were referred to an outside institution for further treatment. Throughout the pandemic, contact was made with patients either directly in clinic, via a telehealth portal or telephone. Descriptive statistics are taken. Results Of the 17 patients included in this series, 11 (65%) patients were managed non operatively. Of these, 4 chose nonoperative management due to shared decision making between the patient and surgeon. 2 patients could not have surgery due to complications related to COVID-19. As the zenith of the pandemic passed 2 patients remained fearful of infection and therefore chose non operative management. 3 patients that had been in contact with the orthopedic department refused further imaging. 6 patients were managed operatively. 2 patients had surgery during the peak of the pandemic, both of whom tested positive for COVID and who failed conservative management. 4 patients had delayed surgery. Of these four cases, 3 were malunion corrections that would have benefitted from more prompt surgery. Conclusion There was an overall decrease in foot & ankle cases. Non- emergent foot and ankle surgery was delayed to divert resources to patients who were stricken with the COVID-19 virus. While every attempt was made to provide the appropriate care for all, a personalized approach to foot and ankle health was developed to address health concerns, preferences, and logistics. As the course of this global pandemic is still uncertain, it is imperative to have a strategy in place to deal with urgent cases, should a second wave of cases once again affect our ability to provide routine care.