Medicine and Health Sciences Commons^™

Volume Vi (2017), Unm Department Of Orthopaedic Surgery

UNM Orthopaedic Research Journal

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Faculty, Unm Department Of Orthopaedic Surgery

UNM Orthopaedic Research Journal

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Front Matter, Unm Department Of Orthopaedic Surgery

UNM Orthopaedic Research Journal

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Mid-Level Providers, Unm Department Of Orthopaedic Surgery

UNM Orthopaedic Research Journal

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Physical Therapy Faculty, Unm Department Of Orthopaedic Surgery

UNM Orthopaedic Research Journal

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Fellows And Chiefs, Unm Department Of Orthopaedic Surgery

UNM Orthopaedic Research Journal

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Residents, Unm Department Of Orthopaedic Surgery

UNM Orthopaedic Research Journal

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Division Of Research, Unm Department Of Orthopaedic Surgery

UNM Orthopaedic Research Journal

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Letter From The Chair, Unm Department Of Orthopaedic Surgery

UNM Orthopaedic Research Journal

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Letter From The Co-Editors, Unm Department Of Orthopaedic Surgery

UNM Orthopaedic Research Journal

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Letter From The Chief Of The Division Of Physical Therapy, Unm Department Of Orthopaedic Surgery

UNM Orthopaedic Research Journal

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Letter From The Residency Director, Unm Department Of Orthopaedic Surgery

UNM Orthopaedic Research Journal

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Value-Based Bundled Repayment In Total Joint Arthroplasty, Michael M. Decker

UNM Orthopaedic Research Journal

The United States continues to spend an unprecedented amount of annual money on healthcare. However, the costs of providing care may not appropriately reflect the quality of care patients are receiving. This is particularly concerning when examining the projected increase in total joint arthroplasty (TJA) procedures over the next few decades, which are expected to increase to nearly 4 million procedures annually. The Center for Medicare and Medicaid Services (CMS) has responded by increasingly shifting reimbursements from the less efficient fee-forservice repayment model to value-based repayment. The Comprehensive Care for Joint Replacement (CJR) bundle payment model has recently been implemented …

Alumni Map, Unm Department Of Orthopaedic Surgery

UNM Orthopaedic Research Journal

No abstract provided.

Performance-Enhancing Drugs: A Review, G Keith Gill

UNM Orthopaedic Research Journal

Performance-enhancing drugs and substances have been an integral part of athletics and society. The immense popularity and financial compensation associated with success in sports often results in a desire to win at all costs, which stimulates a never-ending appetite for use of ergogenic aids. Athletes have experimented with these substances (ranging from over-the-counter supplements to anabolic-androgenic steroids and beyond) if a possibility of advantage exists, whether scientifically or theoretically supported. As the technology to create new designer drugs becomes more available, the ability to test for the presence of these substances lags slightly behind. The knowledge base of sports-medicine physicians …

Elbow Injuries In The Throwing Athlete: A Review, Drew K. Newhoff

UNM Orthopaedic Research Journal

Overhand-throwing motions can create supraphysiologic stresses on the elbow. Repeated stresses often result in overuse injuries affecting the elbow, which are commonly seen in throwing athletes. Noted problems include medial epicondylitis, valgus extension overload, olecranon stress fractures, ulnar neuritis, and damage to the ulnar collateral ligament. Symptoms of pain or numbness at presentation vary in location depending on the injury. Successful diagnosis is typically made using results of physical examinations of elbow, wrist, and arm extensions; results of tests for valgus instability; and findings radiographs can all help indicate the problem. However, pathological features of these injuries are not always …

Current Issues In Treatment Of Anterior Shoulder Instability: A Review, Ian Power

UNM Orthopaedic Research Journal

Anterior shoulder instability can be problematic in the young, active population, particularly in athletes and military personnel. The shoulder joint is the most frequently dislocated joint, and there is a high rate of dislocation recurrence in younger patients. The stability of the glenohumeral joint is conferred through the bony anatomy and the static and dynamic stabilizers. Recognizing pathological features, identifying glenoid bone loss, and detecting Bankart and Hill-Sachs lesions are key to formulating an appropriate treatment strategy and improving surgical outcomes. Furthermore, the concept of critical bone loss has been refined by looking at subcritical loss. Recent evidence has shown …

Antegrade Nailing Of Femur Shaft Fractures: A Review, Thomas A. Decoster, Shahram Bozorgnia, Samer Kakish

UNM Orthopaedic Research Journal

Rigid intramedullary (IM) nailing is an effective procedure for treating fractures of the femoral shaft. Despite the existence of alternative devices and techniques (eg, unreamed nails, flexible nails, plates, external fixation, and traction), the use of rigid reamed nails has shown excellent healing rates, return of function, alignment, and low complications. This type of nail has been used in an antegrade approach to the entry site of the fracture, resulting in successful treatment. We describe indications, contraindications, and surgical techniques of antegrade IM nailing associated with our personal experience and published results. We provide pearls and pitfalls to assist orthopaedic …

Radiographic And Clinical Evaluation Of Syndesmotic Screws In Treating Injuries Of The Distal Aspect Of The Tibiofibular Syndesmosis, James A. Dollahite, Paul J. Goodwyn, Katherine J. Gavin, Richard A. Miller

UNM Orthopaedic Research Journal

Background: Several factors can affect the success of surgical treatment of injuries to the distal aspect of the tibiofibular syndesmosis, including the bony articulation between the distal aspect of the fibula, tibia, and the supporting ligamentous structures; number and size of screws; number of cortices penetrated; and planned routine removal of screws.

Methods: We conducted a retrospective review of radiographs and clinic notes for all patients who underwent open reduction and internal fixation of injury to the tibiofibular syndesmosis, which was performed by a single surgeon (RAM), between January 2011 and December 2014. Only screws were used. The screws were …

Lateral Versus Dorsal Plating For Treating Metacarpal And Phalanx Fractures: A Retrospective Cohort Study, Joshua W. Hustedt, Collin C. Barber, Michael Bonnelli, Lloyd P. Champagne

UNM Orthopaedic Research Journal

Background: The purpose of this study was to investigate the differences between the dorsal and lateral plate position for metacarpal and phalanx fractures.

Methods: We conducted a retrospective review of prospectively collected patient data for 186 fractures treated by a single surgeon between 2009 and 2011. Rates of plate removal, total arc of postoperative motion (TAM), and patient and injury demographics were tested for association with plating position.

Results: Increasing age, larger plates, and dorsal plating were found in univariate analysis to be associated with decreased TAM and increased plate removal in phalanx but not in metacarpal fractures.

Conclusions: These …

Determining Frequency And Defining The Patient Profile Of Sacral Insufficiency Fractures, Blake Obrock, Jeremy Wearn, Matthew L. Dehart, Paxton Gehling, Amer M. Mirza

UNM Orthopaedic Research Journal

Background: Insufficiency fractures at the sacrum represent a considerable cause of low back pain and disability within the geriatric population. However, there has never been a large-scale study examining the epidemiologic trends associated with the disease, and thus this condition has been largely under recognized.

Methods: This study analyzed a Nationwide Inpatient Sample (NIS) database to trend frequency and burden of sacral insufficiency fractures (SIF). All inpatient stays from 1998 to 2010 noted on the NIS were included if the case maintained at least one or more diagnostic code. A total of 257,697 unique admissions (63% women, 37% men) met …

Hierarchical Modeling Versus Regression Analysis For Evaluating Results Of Orthopaedic Studies That Use The National Inpatient Sample, Joshua W. Hustedt, Kade Mcquivey, John C. Hustedt

UNM Orthopaedic Research Journal

Background: Owing to its hierarchical sampling structure, the National Inpatient Sample (NIS) often involves clusters of study data. We aimed to (1) understand the statistical methods of currently published orthopaedic studies using NIS and (2) examine the role of hierarchical modeling versus traditional regression analysis in a retrospective cohort of patients from NIS.

Methods: We conducted a systematic review to examine statistical methods of orthopaedic studies (published between 2005 and 2014) using NIS. Ultimately, 132 studies were identified. We noted percentages of studies that used hierarchical modeling versus traditional regression analysis. Using NIS, we identified a retrospective cohort of patients …

Radiographic Prevalence Of Osteoarthritis Of The Scaphotrapeziotrapezoid Joint In Patients With Carpometacarpal Osteoarthritis Of The Thumb: A Retrospective Case Series, Charlotte E. Orr, Robert Mercer, Deana M. Mercer, Drew K. Newhoff, Matthew D. Martin, Moheb S. Moneim

UNM Orthopaedic Research Journal

Background: In planning operative treatment of thumb carpometacarpal (CMC) joint osteoarthritis, surgeons should consider the presence of an arthritic scaphotrapeziotrapezoid (STT) joint. We aimed to determine the radiographic prevalence of concomitant (STT) osteoarthritis with thumb CMC osteoarthritis in patients who underwent surgical treatment at our institution. We hypothesized that the prevalence of concomitant arthritis at these 2 joints (STT and CMC) would be lower than previously reported.

Methods: Between September 2005 and July 2012, a total of 417 patients were identified from our institution using the Current Procedural Terminology code for thumb CMC joint arthroplasty (25447). After applying exclusion criteria …

External Fixation For Treating Tibial Shaft Fractures Using A Triangular Two-Planar Frame: A Computational And Biomechanical Study, Christina Salas, Daniel Hoopes, Mahmoud M. Reda Taha, Thomas A. Decoster

UNM Orthopaedic Research Journal

Background: Construct stability is a necessary characteristic of external fixators. Many commonly used fixators are constructed as symmetric one-plane frames. We postulate that asymmetric two-plane triangular constructs provide enhanced stability with simplicity and freedom in pin placement. We hypothesized that results of finite element analysis would determine optimal geometric configuration, and findings of mechanical testing would confirm the improved stability of two-plane triangular constructs.

Methods: Finite element modeling was used to analyze configurations for 16 triangular designs compared to a single-rod (SR) uniplanar frame. Variables included pin axial angulation (0°, 22.5°, 45°, and 90°), connectivity of the rod-to-pin couplers, and …

Suturing Workshop For Third-Year Medical Students: A Modern Educational Approach, Mary E. Logue, Ryan D. Lurtsema, Yuridia Leyva, Tyler J. Hough, Kelly M. Harrington, Deana M. Mercer

UNM Orthopaedic Research Journal

Background: This study sought to determine if developing suturing workshops based on modern educational theory would lead to a significant increase in third-year medical students’ confidence and preparedness as compared to before the workshop.

Methods: A group of pre-clinical, third-year medical students (n = 20) were voluntarily recruited. The workshop consisted of an interactive didactic session, a hands-on suturing session, and a question-answer session with surgeons. The nine-point Likert scale surveys were given pre-and post-workshop to 17 participants. Total scores of “confidence” and “preparedness” were analyzed using the Student t-test. Results of Q-Q plot and normality tests were used to …

Evaluation Of Content And Accessibility Of Orthopaedic Trauma Fellowship Websites, Travis M. Hughes, Bobby Dezfuli, Kimberly J. Franke, Jordan L. Smith, John T. Ruth

UNM Orthopaedic Research Journal

Background: Residents frequently use the internet to find material on fellowship programs. The Orthopaedic Trauma Association (OTA) website serves as a central hub for information on an orthopaedic trauma fellowship (OTF). This study aims to evaluate the accessibility, content, and perceived importance of OTF websites.

Methods: We reviewed the 49 OTFs accredited by the OTA fellowship database as of January 2014. We searched for corresponding OTF websites by using the provided OTA hyperlinks and conducting a separate Google search of program location and institution. Links to websites of general orthopaedic programs were not counted. Content of OTF websites was analyzed …

Understanding Radiocarpal Rotation Through In Vivo Pronation And Supination Of The Hand: A Single Case Study, Jorge L. Orbay, Joshua M. Romero, Neal Wostbrock, Deana M. Mercer

UNM Orthopaedic Research Journal

Background: Studies have not clearly defined the motion of the distal radius in relation to the carpus in vivo. We hypothesized that 1) with the hand fixed by grasping a handle to prevent hand and wrist motion, the resulting load in torsion generated by extrinsic muscle in vivo would create motion at the radiocarpal joint; and 2) the motion measured will be between the distal radius and the proximal row of the carpus.

Methods: The data was acquired from the senior author external to our institution; in the current study, we quantify the resulting radiocarpal motion. A K-wire was placed …

Automated Device To Enable Passive Pronation And Supination Activities Of The Hand For Experimental Testing With Cadaveric Specimens: A Collaboration Between The University Of New Mexico And New Mexico Institute Of Mining And Technology, Jodie Gomez, Jakub Mroczkowski, Lauren Long, Christopher A. Buksa, Deana M. Mercer, Christina Salas, David I. Grow

UNM Orthopaedic Research Journal

In cadaveric research, reproducing physiological conditions under which the specimens would be loaded in vivo is essential to achieve clinical applicability. This is a collaborative study bringing together engineers from The University of New Mexico and New Mexico Institute of Mining and Technology. We describe development of an automated device to enable passive pronation and supination of the hand (rotation achieved through direct manipulation) for use in cadaveric experimental testing of the hand, wrist, forearm, or elbow. We present a brief motivation for development of this device, design details, an overview of one possible application, and ways to use this …

3d Bioprinter + Electrospinner For Bone-Ligament Tissue Engineering, Sherif H. Aboubakr, Steven Nery, Lauren Long, Christopher A. Buksa, Chanju Fritch, Christina Salas

UNM Orthopaedic Research Journal

Modern 3D bioprinters have been shown to allow for precise control of structural geometry to build patientspecific scaffolds for tissue regeneration—primarily nonload- bearing tissue. However, 3D bioprinting is limited by cell viability, polymer cross-linking characteristics, and poor tensile properties. In comparison, electrospinning has been used to form fibrous structures with accelerated cellular maturation properties, improved growth and migration of cells, and increased tensile properties. Conversely, the mostly uncontrolled deposition of electrospun fibers can limit pore size and cell infiltration. In our Orthopaedic Biomechanics & Biomaterials Laboratory, a custom 3D Bioprinter + Electrospinner hybrid system (E-Spin Printer) was designed to merge …

Pilot Study Investigating The Use Of 3d Printing In Designing Upper-Extremity Prosthetics For Children: A Progress Report, Lauren Long, Christina Salas, Deana M. Mercer, Selina R. Silva, Jared Knigge

UNM Orthopaedic Research Journal

The availability and cost-effectiveness of functional prototypes and designs has increased considerably over the last decade because of 3D printing. The growing field of biomedical engineering is expanding on 3D-printing technology to make low-cost, upper-extremity prosthetics. This pilot study reports on the potential use of 3D printing for low-cost, upper-extremity prosthetics, specifically prosthetic hands for children. We start by characterizing existing open-source, 3D-printed upper-extremity prosthetics to determine their mechanical strength, statically and dynamically. Based on outcomes from these early tests, we optimize the existing designs to develop a new prosthetic. The prosthetic design, fabricated in The University of New Mexico …