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"External Fixation for Distal Radius Fractures: Effect of Distraction on Outcome." FA Kaempffe, MD and Katherine M. Walker, BS.
Few studies have examined the potential adverse effects of excess distraction and prolonged duration of external fixation for the treatment of distal radius fractures. In this study, 19 patients with distal radius fractures treated with external fixation and supplemental Kirschner wire fixation between August 1991 and November 1997 were studied retrospectively. Patients were evaluated by questionnaire, chart review, radiographs, and clinical examination an average of 161 weeks after injury. Although no significant correlation was found between amount of distraction, as measured by carpal height index, and scores for pain, function, radiographs, motion, grip strength, and final result, a negative correlation was seen between duration of external fixation and scores for pain, motion, and total score, with motion scores being most affected. New York Orthopaedic Hospital grades of good or excellent were attained by 89% of patients. The data suggest that external fixation with supplemental pin fixation is a satisfactory method of treating severe fractures of the distal radius. Outcome likely is improved with shorter duration of external fixation. Clinical Orthopaedics and Related Research, Number 380, pp. 220-225; November, 2000.

"Anterior Fusion for Rotationally Unstable Cervical Spine Fractures." RM Lifeso, MD, MA Colucci, MD.
A retrospective analysis of 32 rotationally unstable cervical fractures treated with brace, halo vest, or posterior surgical constructions with fusion were compared with a second, prospective study of 18 similar fractures treated by early anterior discectomy, fusion and plating. Nonoperative treatment was found to be uniformly unsuccessful. Posterior stabilization and fusion led to unsuccessful results in 45% of patients. Anterior fusion resulted in solid union without residual deformity in all cases. Early anterior fusion is recommended I compression-extension Stage I cervical spine injuries. Spine, Volume 25, Number 16, pp: 2028-2034; August, 2000.

"The Search for Quality. Why An Orthopaedic Practice Became ISO-9002 Registered." FA Kaempffe, IV, MD, FA Kaempffe, III, BS.
Due to the rapidly changing climate of health care, our orthopaedic practice needed a way to simultaneously and continuously analyze and adjust its organizational mission and vision, patient satisfaction initiatives, external standards and accreditation statutes, financial and budgetary constraints, outcome management and data reporting, and information systems. We needed a system that would organize and monitor these initiatives without interrupting the patient care delivery process. We chose ISO-9000 as our model, and the entire practice management system, including the existing quality system, was redeveloped to conform to the model. Certification was awarded, and the system has resulted in improved patient satisfaction, reduced data entry error rates, and improved office efficiency resulting in continuing cost savings and increased practice revenues. Quality Progress, Volume 32, Number 11, pp. 110-117; November, 1999.

"Biplane Osteotomy and Epiphyseodesis of the Distal Radius for Correction of Wrist Deformity Due to Distal Ulnar Growth Arrest." FA Kaempffe, MD
Distal ulnar physeal fractures occur infrequently, and posttraumatic distal ulnar physeal arrest is rare. When distal ulnar growth arrest does occur, treatment options are dependent on patient age, deformity, and cosmetic deformity. This article describes the use of a biplane distal radial epiphyseodesis to correct the deformity associated with complete distal ulnar growth arrest in a 12 year old patient. Orthopedics, Volume 22, Number 1, pp. 84-86; January 1999.

"A Modified Surgical Procedure for Cubital Tunnel Syndrome: Partial Medial Epicondylectomy." FA Kaempffe, MD, John Farbach, BA.
Cubital tunnel release with partial medial epicondylectomy was performed in 32 patients with cubital tunnel syndrome unresponsive to conservative management. Twenty-seven patients were available for examination an average follow-up of 13 months. Ninety-three percent were subjectively improved, with results being excellent in 8, good in 10, fair in 8, and poor in one. Regression analysis showed a statistically significant correlation between outcome and slow ulnar nerve conduction velocity across the elbow, abnormal preoperative 2-point discrimination, abnormal preoperative terminal sensory latency of the ulnar nerve, and abnormal preoperative electromyographic studies. The results suggest that the procedure is an acceptable alternative for treatment of cubital tunnel syndrome. 1996 McCurdy-Stormont Presidents Award, Rochester Academy of Medicine. Journal of Hand Surgery, Volume 23A, Number 3, pp. 492-499; May, 1998.

"Central Perforation of the Articular Disc of the Triangular Fibrocartilage Complex in a 17-Year-Old Girl: Could It Be Congenital?" FA Kaempffe, MD.
A case of a central perforation of the horizontal portion of the triangular fibrocartilage complex in a 17-year-old girl is reported. The age of the patient, along with normal articular surfaces of the ulnar head and ulnar carpus and the lack of an ulnar positive wrist, made the existence of a degenerative tear unlikely. The possibility that the central perforation in this patient could be congenital suggests that this defect should be considered in the differential diagnosis of ulnar-sided wrist pain n the young patient. The American Journal of Orthopedics, Volume 26, Number 8, pp. 565-567; August, 1997.

"Scholastic Soccer Injuries. A Prospective Study in Wayne County." FA Kaempffe, MD, B Heveron, BSN, S Schwabe MBA, JG Atkinson PhD.
Seven boys’ and six girls’ high school varsity soccer teams were prospectively studied for a single season. There were 24 injuries sustained by 15 male players, resulting in 119 total days of lost time, or 5 days per injury. There were 28 injuries among 120 female players, resulting in 141 total days of lost time, or 5 days per injury. The individual injury rates based upon exposure was 0.34/1000 hours of participation for males and 0.60/1000 hours for females; the team rate was 7.9 and 12.3 per 1000 hours, for males and females, respectively. Most injuries were to the lower extremities, with ankle sprains most common. Collision with another player was the most common cause of injury. Significantly more injuries occurred on wet grass, and defensive positions received more than their proportionate share of injuries. Both of these relationships were highly statistically significant (p<0.001). 1996 "Academy of Medicine Award," Rochester Academy of Medicine. Unpublished, though accepted for publication Contemporary Orthopaedics, 1996. Original manuscript only.

"Ultrasound Diagnosis of Triceps Tendon Rupture." FA Kaempffe, MD, Robert M. Lerner, MD.
Rupture of the triceps tendon is a rare injury, and clues to diagnosis on physical examination can be masked by pain and swelling. Two cases of triceps tendon rupture are reported in which ultrasonography was used to assist in the diagnosis. Clinical Orthopaedics and Related Research, Volume 332, pp. 138-142; November, 1996.

"External Fixation for Distal Radius Fractures: Adverse Effects of Excess Distraction." FA Kaempffe, MD.
External fixation is accepted treatment for some distal radius fractures. Ligamentotaxis is the basis for the technique, and failure to recognize its limitations can lead to excess distraction. This paper discusses potential complications of excess distraction as sell as its effect on outcome. Supplemental fixation techniques and multiplanar ligamentotaxis are advocated to improve outcome when external fixation is used. The American Journal of Orthopaedics, Volume 25, Number 3, pp. 205-209; March, 1996.

"Neoplasm as a Case of Shoulder Pain." FA Kaempffe, MD.
For most patients with shoulder pain, complaints are related to impingement syndrome, degenerative or inflammatory joint disease, instability or trauma. Neoplasm is a rare cause of shoulder pain, but should be considered, especially then patient presentation is unusual. This review includes a series of cases in which tumor was found to be the cause of pain. Journal of Family Practice, Volume 40, Number 5, pp. 480-485; May, 1995.

"The Effect of Knee Arthroscopy on Driving Reaction Times." FA Kaempffe, MD
Simple braking reaction times were determined using an automatic brake reaction time tester (Model 3548, AAA, Heathrow, Fla.). Both lower extremities of 17 control subjects without history of knee injury or surgery were tested. Each control was tested for 6 consecutive weeks. There were 3 males and 14 females with an average age of 34 years. Braking reaction times of 37 consecutive patients having unilateral knee arthroscopy were measured for an average of 5 weeks after surgery. Surgery on either knee was found to result in slower braking reaction times in both extremities. One week after surgery, braking times for both extremities were 0.9-0.14 second slower than controls, and at 6 weeks after surgery, reaction times still had not reached the 50^th percentile ranking as defined by the Traffic Safety and Engineering Department of AAA. (Press Release) Orthopaedics Today, Volume 15, Number 8, p. 11; August, 1995. Original manuscript only.

"Hand Therapy after Open Carpal Tunnel Release. Is It Necessary?" FA Kaempffe, MD
Thirty-eight consecutive patients undergoing open carpal tunnel release were prospectively studied to evaluate the need for postoperative hand therapy. One patient was lost to follow-up, leaving a study group of 37 patients undergoing 45 procedures. At the first postoperative evaluation two weeks after the procedure, the patients were included in a hand therapy program if there was any loss of digital motion. Based on this criteria, 10 patients (11 wrists) required therapy; 20 patients (36 wrists) did not. There was no significant difference in the rate of recovery of motion and grip strength when the therapy and nontherapy groups were compared. The data suggest the majority of patients following open carpal tunnel release do not need postoperative therapy. (Abstract) Orthopaedic Transactions, Volume 18, Number 4, p. 1206; 1995. Original manuscript only.

"Tears of the Rotator Cuff." B Heveron, BSN, FA Kaempffe, MD.
Pain and loss of motion, the results of rotator cuff tears, can be disabling. Initially, treatment is conservative, but surgical repair may be indicated after failed nonoperative management. Rotator cuff anatomy is reviewed in this article, as well as clinical and radiographic assessment of the patient with presumed rotator cuff pathology. Nonoperative and surgical treatment strategies are outlined. The rate of motion and functional recovery after repair is presented on the basis of a prospective study. Although most patients are able to perform work and daily activities three months after surgery, motion recovery can continue for at least a year. Orthopaedic Nursing, Volume 14, Number 6, pp: 38-41; November/December, 1995.

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