Medicine and Health Sciences Commons^™

Full Issue: Volume 2, Issue 1 - April 2024

Bone Bulletin

i - Editors’ Note by Ari Clements & Amit Syal

ii - Foreword by Dr. Alan Hilibrand

7 - Exploring Approaches to Treatment of Musculoskeletal Injuries by Catherine Alvaro

9 - A Spotlight on the Various Subspecialties of Orthopedic Surgery by Ryan Garemani

14 - Exploring the Importance of Implant Selection in Total Hip Arthroplasty by John Czarnecki

16 - Revolutionizing Orthopaedics: Exploring the Therapeutic Potential of Stem Cells by Harrison Fellheimer

18 - Shoulder Arthroplasty in Patients with Inflammatory Arthritis: Preoperative and Perioperative Management of Disease Modifying Anti-Rheumatic Drug Therapy by Daniel Kwak

22 - The Role of Psychological …

Redefining Recovery: Multimodal Analgesics And Tranexamic Acid In Orthopedic Surgery, Elijah Hoffman

Bone Bulletin

Introduction As the demand for joint replacements continues to rise, optimizing patient outcomes and enhancing recovery have become paramount goals for orthopedic surgeons. Patients used to have minimal mobility following a Total Knee Arthroplasty (TKA) or Total Hip Arthroplasty (THA) due to pain or the effects of sedation from anesthesia. This would lead to longer hospital stays, more complications, and higher opioid use.¹ These surgeries also resulted in levels of blood loss that required transfusion therapy postoperatively.² In recent years, there has been a paradigm shift in postoperative care for total joint arthroplasty (TJA), marked by significant advancements …

A Review Of The Effects Of Early Sport Specialization On The Health Of Adolescent Baseball Players, Robert C. Juniewicz

Bone Bulletin

Introduction

Participation in sports during adolescence is beneficial for participants as it improves fitness, enhances psychosocial development, increases academic performance, and boosts self-esteem.¹ One of the most popular sports among adolescent athletes is baseball, with nearly 500,000 high school players in the United States in 2020.1 While participation in sports has been shown to have clear benefits and has been steadily increasing, recent decades have also seen a dramatic rise in the level of competition.² As a direct result, there has been an increase in the prevalence of early sports specialization (ESS) with an estimated 14-47% of adolescent …

The Ins And Outs Of Wide-Awake Hand Surgery, Molly Milano

Bone Bulletin

Introduction

As the name might imply, “wide awake local anesthesia no tourniquet” (WALANT) is a surgical method to perform hand surgery using only a local anesthetic without the use of a tourniquet or any sedation and general anesthetics. The WALANT technique takes advantage of the vasoconstrictive effects of epinephrine combined with the local anesthetic effects of lidocaine to create a surgical field that does not require a tourniquet or general anesthesia.¹ The main contributor is epinephrine, which decreases bleeding in the surgical field while also lengthening lidocaine’s absorption and effect.² When first introduced to the surgical world, the …

Examining The Role Of Augmented Reality In Total Hip Arthroplasty, Joseph Raphael

Bone Bulletin

Background

In 2023, it was reported that total hip arthroplasty (THA) was the main and effective surgical treatment for advanced hip osteoarthritis, osteonecrosis, and rheumatoid arthritis.¹ As the population ages, the number of annual THA procedures is projected to grow and reach 635,000 by the year 2030.² As such, further improving outcomes in THA will benefit this large population. On average age for individuals who sustain a hip fracture is 80 years old and the lifetime prevalence of hip fractures is 20% in women and 10% in men.³ Fracture reduction and internal fixation or arthroplasty are often …

The Role Of Psychological Readiness In Recovery From Acl Injury In Female Athletes, Samantha Meacock

Bone Bulletin

The Anterior Cruciate Ligament (ACL) injury is common in sports, with female athletes facing a disproportionately higher risk in comparison to male athletes.¹ This susceptibility is the result of a complex relationship between various factors including anatomical, biomechanical, hormonal, neuromuscular, and environmental influences.² In addition, the unique challenges that females face with respect to sports, violence, body image, and family planning create additional stressors that may further contribute to an increased risk for injury.^3,4 Following ACL Reconstruction (ACLR) surgery, these gender discrepancies carry over into recovery as female athletes exhibit decreased rates of return to sport (RTS) …

Shoulder Arthroplasty In Patients With Inflammatory Arthritis: Preoperative And Perioperative Management Of Disease Modifying Anti-Rheumatic Drug Therapy, Daniel Kwak

Bone Bulletin

Introduction

Inflammatory arthritis is a debilitating systemic autoimmune and inflammatory disease that leads to joint damage, resulting in significant pain and disability. Rheumatoid arthritis (RA) is the most common inflammatory arthritis typically associated with advanced arthritic changes of the glenohumeral joint as well as with rotator cuff tears.²⁰ Since the introduction of disease modifying anti-rheumatic drug (DMARD) therapy, patients diagnosed with inflammatory rheumatic diseases have observed improvements in pain management and functional outcomes, alongside a reduction in the occurrence of upper limb arthroplasties.¹⁶ Nonetheless, total joint arthroplasty still remains common in the treatment of RA.^8,14

One recognized …

Revolutionizing Orthopaedics: Exploring The Therapeutic Potential Of Stem Cells, Harrison Fellheimer

Bone Bulletin

The development of stem cells holds the key to a revolutionary era in medicine, unlocking multisystem processes that will help restore normal function in the human body. Stem cells are undifferentiated cells that have the capability to give rise to cells of the same type, and from which new cells can arise through the process of differentiation. Several sources of stem cells can be broadly categorized into three main types: embryonic stem cells (ESC), adult stem cells, and induced pluripotent stem cells (iPSCs).¹

Exploring The Importance Of Implant Selection In Total Hip Arthroplasty, John Czarnecki

Bone Bulletin

Introduction

Total Hip Arthroplasty (THA) is a rapidly growing field within the United States. In 2023 alone, 1,050,821 arthroplasties were performed, making it the second-most performed arthroplasty of the year.1 With over a million of these procedures completed each year, there are several medical device companies that create their own implants to be used in these procedures. Each company can patent their own device and go through a thorough process involving the FDA to receive approval provided there is evidence from clinical trials that demonstrates their device improves patient outcomes.2 With the many implant options available, one question to consider …

A Spotlight On The Various Subspecialties Of Orthopedic Surgery, Ryan Garemani

Bone Bulletin

Introduction

Currently, 60% of orthopedic surgeons are specialists, 25% have specialty interests, and the remaining 15% are generalists.¹ Given the numbers, most orthopedists focus on a specific anatomical area or patient demographic, from delicate nerve work to the larger surgical field encountered in adult reconstruction. This article embarks on a journey through the diverse and impactful world of orthopedic subspecialties, shedding light on the breadth of practice offered.

According to Joseph A. Abboud, MD, a Rothman Orthopedics upper extremity surgeon, residents typically decide on a sub-specialty in their third or fourth year. For medical students, whether captivated by orthopedics …

Exploring Approaches To Treatment Of Musculoskeletal Injuries, Catherine Alvaro

Bone Bulletin

When approaching musculoskeletal injuries, there are many components of the patient assessment that contribute to different treatment options. Interviews with both an orthopedic surgeon and a sports medicine physician revealed similar yet different ways of diagnosing and treating orthopedic conditions.

Foreword, Alan S. Hilibrand

Bone Bulletin

As the Vice Chair of Academic Affairs and Faculty Development and as Director of Undergraduate Medical Education for the Department of Orthopaedic Surgery at the Sidney Kimmel Medical College, I am honored to once again have this opportunity to write a foreword for the second issue of the Bone Bulletin.

For many years, the DePalma Orthopaedic Society has provided medical students at SKMC with an excellent venue to learn about orthopaedic surgery, and its members continue to focus much time and energy on mentoring younger students interested in the field of orthopedic surgery. The DePalma leadership has worked hard …

Editors’ Note, Ari Clements, Amit Syal

Bone Bulletin

This year, we are very excited to announce the second issue of the Bone Bulletin, DePalma Orthopaedic Society’s student-run, non-peer reviewed journal for Sidney Kimmel Medical College (SKMC) students. The journal was initially started to provide another way to become involved with orthopaedics in medical school as well as providing a unique platform to report on diverse aspects of the field through editorial and opinion pieces.

By providing close 1-on-1 mentorship with a Rothman physician, the Bone Bulletin gives students a hands-on opportunity to engage with orthopaedic research and developments. Throughout this journal, you will find a variety of …

Adding Ofirmev: The Effectiveness Of Multimodal Treatment, Kimberly R. Bilal-Williams

MSN Capstone Projects

This project is on enhancing pain management in total knee arthroplasty (TKA) clients via the intravenous (IV) administration of acetaminophen (Ofirmev) by multimodal regimen. The patient, intervention, comparison, outcome, and time (PICOT) question shaping this initiative looks at frequency and intensity of patients’ pain scores as well as practical outcome measures such as healing and physical therapy during the recovery period ending with discharge. After a thorough literature synopsis, it is evident that multimodal pain management strategies including IV acetaminophen provide a better prospectus in comparison to the ones that solely employ opioids. Research repeatedly demonstrates the use of IV …

Positive Predictor Factors Of Hip Mosaicplasty And Cartilage Repair: A Meta-Analysis Is It Comparable To Predictor Factors Of Mosaicplasty In The Knee?, Caroline E. Quindlen, Gene Shaffer Md, James Raphael Md, S. Ali Ghasemi Md

Tower Health Research Day

No abstract provided.

Do Nsaids' Decrease Union Rates Following Joint Arthrodesis? A Meta-Analysis, Emerson Rowe, Julian Takagi-Stewart, Asif Ilyas, Sina Ramtin

Tower Health Research Day

No abstract provided.

Lower Extremity Trauma Is Associated With An Increased Rate Of New Mental Health Disorder Diagnosis And Suicide Attempt, Bela P. Delvadia, Julianna E. Holzer, Jacob S. Budin, Arjun Verma, Onyebuchi A. Imonugo, Olivia C. Lee, William F. Sherman

Tower Health Research Day

No abstract provided.

The Incidence And Impact Of Bisphosphonates On Multiple Myeloma, Bela P. Delvadia, Lacee Collins, Julianna E. Winter, Matthew W. Cole, Olivia C. Lee, William F. Sherman

Tower Health Research Day

No abstract provided.

Sixty-Two Percent Of Abstracts From The American Association Of Hand Surgery Annual Meeting 2017-2020 Are Later Published, Tyson Stoker, Benjamin Millar, Lilah Fones, Asif Ilyas

Tower Health Research Day

No abstract provided.

Adductor Canal Regional Anesthetic Placement In Pediatric Patients For Knee Arthroscopy: Defining The Optimal Location And Analysis Of Other Trends, Isaac Jin, Christine Song, Sujay Deshpande, Andrew Yang, Ethan Schollaert, Neha Divi, Aysha Hasan Md

Tower Health Research Day

No abstract provided.

Anterior Hip Pain In Adolescent Female Wrestler, Melanie Kennedy

Posters

No abstract provided.

A Perfect Storm?: The Association Of Vitamin D With Injury Incidence Among Acrobatics And Tumbling Athletes, Katherine M. Lee, Andrew R. Gallucci, Jeff S. Forsse, Leticia Cherpe De Souza, Laura R. Irvin, Emily J. Boyer, Kristin H. Fant, Jeffery Heileson, Leslee Funderburk

Internet Journal of Allied Health Sciences and Practice

Purpose: Acrobatics and Tumbling (A&T) is an emerging NCAA sport. Due to the novelty of the sport, limited research on injury incidence and correlates exists. Anecdotal evidence suggests that A&T presents with high injury rates. A relationship between vitamin D and bony injuries exists among athletes, but little is known about soft tissue injuries. Understanding the causes and incidence of injuries, including vitamin D, may assist athletic trainers. Methods: Forty-two A&T athletes (19.69 ± 1.199 years) completed 2 blood draws as part of routine medical care prior to and following fall training period. Results: Average vitamin D at T1 was …

Delayed Diagnosis Of Mycobacterium Bovis Bacillus Calmette-Guérin Periprosthetic Joint Infection Following Total Knee Arthroplasty, Christopher E. Pelt, Salika Shakir, Michael J. Cahill, Jakrapun Pupaibool, Barbara C. Cahill

SKMC Student Presentations and Publications

Periprosthetic joint infection (PJI) can present challenges in diagnosis and treatment, particularly in the setting of atypical causative organisms such as fungi and mycobacteria. Herein, we present a case and provide a review of the diagnosis and treatment of an unusual PJI caused by bacillus Calmette-Guérin, administered during the treatment of bladder cancer 3 years prior to total knee arthroplasty and subsequent PJI. Although the patient's history of bladder cancer was known, neither his Bacillus Calmette-Guérin treatment nor its potential for distant site spread that could lead to PJI were appreciated, leading to a prolonged diagnostic evaluation and treatment course.

The Impact Of Robotic Assistance For Lumbar Fusion Surgery On 90-Day Surgical Outcomes And 1-Year Revisions, Jeremy Heard, Yunsoo Lee, Nicholas D D'Antonio, Rajkishen Narayanan, Mark Lambrechts, John Bodnar, Caroline Purtill, Joshua Pezzulo, Dominic Farronato, Pat Fitzgerald, Jose Canseco, Ian Kaye, Alan Hilibrand, Alex Vaccaro, Christopher Kepler, Gregory Schroeder

Department of Orthopaedic Surgery Faculty Papers

Objectives: To evaluate the (1) 90-day surgical outcomes and (2) 1-year revision rate of robotic versus nonrobotic lumbar fusion surgery. Methods: Patients >18 years of age who underwent primary lumbar fusion surgery at our institution were identified and propensity-matched in a 1:1 fashion based on robotic assistance during surgery. Patient demographics, surgical characteristics, and surgical outcomes, including 90-day surgical complications and 1-year revisions, were collected. Multivariable regression analysis was performed. Significance was set to P < 0.05. Results: Four hundred and fifteen patients were identified as having robotic lumbar fusion and were matched to a control group. Bivariant analysis revealed no significant difference in total 90-day surgical complications (P = 0.193) or 1-year revisions (P = 0.178). The operative duration was longer in robotic surgery (287 + 123 vs. 205 + 88.3, P ≤ 0.001). Multivariable analysis revealed that robotic fusion was not a significant predictor of 90-day surgical complications (odds ratio [OR] = 0.76 [0.32-1.67], P = 0.499) or 1-year revisions (OR = 0.58 [0.28-1.18], P = 0.142). Other variables identified as the positive predictors of 1-year revisions included levels fused (OR = 1.26 [1.08-1.48], P = 0.004) and current smokers (OR = 3.51 [1.46-8.15], P = 0.004). Conclusion: Our study suggests that robotic-assisted and nonrobotic-assisted lumbar fusions are associated with a similar risk of 90-day surgical complications and 1-year revision rates; however, robotic surgery does increase time under anesthesia.

Evaluation Of Perioperative Care And Drivers Of Cost In Geriatric Thoracolumbar Trauma, Omar Tarawneh, Rajkishen Narayanan, Michael Mccurdy, Tariq Issa, Yunsoo Lee, Olivia Opara, Nicholas Pohl, Alexa Tomlak, Matthew Sherman, Jose Canseco, Alan Hilibrand, Alex Vaccaro, Gregory Schroeder, Christopher Kepler

Department of Orthopaedic Surgery Faculty Papers

INTRODUCTION: As the population of elderly patients continues to rise, the number of these individuals presenting with thoracolumbar trauma is expected to increase.

RESEARCH QUESTION: To investigate thoracolumbar fusion outcomes for patients with vertebral fractures as stratified by decade. Secondarily, we examined the variability of cost across age groups by identifying drivers of cost of care.

MATERIALS AND METHODS: We queried the United States Nationwide Inpatient Sample(NIS) for adult patients undergoing spinal fusion for thoracolumbar fractures between 2012 and 2017. Patients were stratified by decade 60-69(sexagenarians), 70-79(septuagenarians) and 80-89(octogenarians). Bivariable analysis followed by multivariable regression was performed to assess independent …

Increased Hif-2Α Activity In The Nucleus Pulposus Causes Intervertebral Disc Degeneration In The Aging Mouse Spine, Shira N Johnston, Maria Tsingas, Rahatul Ain, Ruteja A Barve, Makarand Risbud

Department of Orthopaedic Surgery Faculty Papers

Hypoxia-inducible factors (HIFs) are essential to the homeostasis of hypoxic tissues. Although HIF-2α, is expressed in nucleus pulposus (NP) cells, consequences of elevated HIF-2 activity on disc health remains unknown. We expressed HIF-2α with proline to alanine substitutions (P405A; P531A) in the Oxygen-dependent degradation domain (HIF-2αdPA) in the NP tissue using an inducible, nucleus pulposus-specific K19^CreERT allele to study HIF-2α function in the adult intervertebral disc. Expression of HIF-2α in NP impacted disc morphology, as evident from small but significantly higher scores of degeneration in NP of 24-month-old K19^CreERT; HIF-2α^dPA (K19-dPA) mice. Noteworthy, comparisons of grades …

Anterior Cruciate Ligament Hybrid Remnant Preservation Reconstruction Demonstrates Similar Outcomes As Traditional Reconstruction After 6 Months: A Randomized Control Trial, Joshua P. Castle, Eleftherios L. Halkias, Brittaney Pratt, Ashley Frei, Matthew A. Gasparro, Vasilios Moutzouros

Medical Student Research Symposium

Background

The anterior cruciate ligament (ACL) is often debrided during reconstruction (ACLR) to improve visualization. However, remnant ACL tissue contains nerve fibers and including remnant tissue in ACLR could provide benefit. Therefore, a technique was developed that preserves the tibial remnant and incorporates it into ACLR: Hybrid Remnant Preservation Reconstruction (HRPR) ACLR. This study compares HRPR-ACLR to traditional reconstruction by comparing patient reported outcomes and complications.

Methods

Patients presenting to one surgeon's clinic with an ACL injury are screened. Exclusion criteria are patient age<14 years, multi-ligament injury, chronic tears, and revision ACLR. Patients are consented and randomized to HRPR or traditional ACLR. Demographics, patient-reported outcomes, range of motion (ROM) and complications were collected.

Results

Thirty-three patients were included, 20 HRPR and 13 controls. No demographic differences were noted. PROMIS-PF, …

Tendon Rupture And Tendonitis In Low-Profile Dorsal Versus Volar Plating For Distal Radius Fractures: A Systematic Review And Meta-Analysis, Matthew Myhand, Shreya Balusu, Alex Lindahl Bs, Hardy Evans Md, Charles Day Dr., Eric Jiang Dr.

Medical Student Research Symposium

Tendon Rupture and Tendonitis in Low-Profile Dorsal versus Volar Plating for Distal Radius Fractures: A Systematic Review and Meta-Analysis

Background: Dorsal plating of distal radius fractures has historically been associated with high rates of hardware removal, tendonitis, and tendon rupture. Newer generation low-profile dorsal plates are thinner (<1.6mm thick) with improved characteristics. We examine whether low-profile dorsal plates still have higher rates of tendon complications than volar locking plates.

Methods: We searched Ovid MEDLINE, Web of Science, and EMBASE for published literature describing tendon complications in association with plating of distal radius fractures. Inclusion criteria encompasses any primary study of low-profile dorsal plates that included data on tendon complications. Studies that included both low-profile dorsal and volar plating arms were included …

Midterm Outcomes Of Suture Anchor Fixation For Displaced Olecranon Fractures, Michael Gutman, Jacob Kirsch, Jonathan Koa, Mohamad Fares, Joseph Abboud

Department of Orthopaedic Surgery Faculty Papers

BACKGROUND: Displaced olecranon fractures constitute a challenging problem for elbow surgeons. The purpose of this study is to evaluate the role of suture anchor fixation for treating patients with displaced olecranon fractures.

METHODS: A retrospective review was performed for all consecutive patients with displaced olecranon fractures treated with suture anchor fixation with at least 2 years of clinical follow-up. Surgical repair was performed acutely in all cases with nonmetallic suture anchors in a double-row configuration utilizing suture augmentation via the triceps tendon. Osseous union and perioperative complications were uniformly assessed.

RESULTS: Suture anchor fixation was performed on 17 patients with …

Anatomic Factors Associated With Degeneration And Fraying Of The Coracoacromial Ligament, Ryan Lopez, Jaspal Singh, Mohammad Ghoraishian, Thema Nicholson, Stephen Gates, Surena Namdari

Rothman Institute Faculty Papers

BACKGROUND: The coracoacromial ligament (CAL) is frequently observed to be damaged during arthroscopy and it is unclear how demographic, anatomic, and radiographic factors are related to CAL degeneration in full-thickness rotator cuff tears.

METHODS: A prospective study was conducted of patients at a single institution undergoing shoulder arthroscopy for first-time, full-thickness rotator cuff tears. We evaluated preoperative anteroposterior radiographs to obtain critical shoulder angle, glenoid inclination, acromial index, acromiohumeral distance, lateral acromial angle, and acromial morphology. We documented CAL quality, rotator cuff tear size and pattern during arthroscopy. Multiple logistic regression was used to identify predictive factors for encountering severe …