Medical Specialties Commons^™

A Mssic Study Reveals Non- Modifiable Risk Factors Were Associated With Post-Operative Hematoma Following Acdf, Richard Easton, Matthew Lipphardt, Matthew Easton, Nicholas Papakonstantinou, Lonni Schultz, Hsueh-Han Yeh, Cecile Pestano

Posters

Introduction

Post-operative hematoma (POH) following anterior cervical discectomy (ACDF) is uncommon . Although rare, POH is recognized as a potentially catastrophic post-operative complication . There is limited information as to who is vulnerable . From a large database, the authors sought to identify common modifiable and non-modifiable risk factors for developing POH and its associated clinical outcomes.

Materials and Methods

The Michigan Spine Surgery Improvement Collaborative (MSSIC) is a statewide quality improvement initiative . ACDF cases in MSSIC registry from 2014-2018 were identified . Patients who developed POH (POH) were compared to those who did not (non-POH) . Chi-square and …

Anterior Cervical Discectomy And Fusion After Presentation To The Acute Care Setting: A Comparison Of Post-Operative Outcomes, Alex Miller, James Whaley, Daniel Park

Conference Presentation Abstracts

Introduction: For patients presenting with cervical radiculopathy or cervical myelopathy, surgical treatment is typically pursued after discussion in the outpatient setting. Yet, there exists a group of patients presenting to the acute care setting with intractable pain or progressive neurologic deficits who are indicated for operative treatment outside of outpatient evaluation. Given the differences in initial management and pre-operative optimization, it is unclear if surgical and post-operative outcomes differ between these populations. Materials and Methods: This was a retrospective cohort study from an academic medical center. Surgical case logs from the institution’s electronic medical record were used to identify patients …

Phenotype Characterization Of Genetic Murine Mouse Models Of Developmental Dysplasia Of The Hip (Ddh), Stephanie Mrowczynski, Kevin Baker, Michael Newton

Posters

Developmental dysplasia of the hip (DDH) is a congenital hip alteration that changes the “ball in socket” movement of the leg inside the pelvis. Genome-wide association studies have identified CX3CR1 polymorphisms associated with increased risk of Developmental Dysplasia of the Hip. Mouse models of CX3CR1 knock-out (KO) mice show unilateral, bony discrepancies between the femur head and acetabulum in comparison to wild-type (WT) mice, as well as gait impairment similar to that of humans with osteoarthritis (which develops in DDH patients later in life). The primary goal of this project is to assess joint congruity in a CX3CR1 KO model …

Imaging-Based Modules For Musculoskeletal Anatomy & Pathology In Preclinical Medical Education, Ameen Suhrawardy, Tarek Almsaddi, Sarah Fried, Sayf Al-Katib, Drew Moore, Malli Barremkala

Posters

Many medical students report a lack of adequate orthopedic and musculoskeletal (MSK) teaching in the preclinical medical curriculum. As gross anatomy is emphasized in pre-clinical education, students may feel a disconnect from clinical anatomy proficiency. This project assesses the efficacy of a preclinical image-based module to teach MSK anatomy and pathology concepts to preclinical medical students.

The Routine Use And Cost Analysis Of Acid-Fast Bacilli And Fungal Cultures In Foot And Ankle Surgery: A Retrospective Study, Margaret Bohr, Robert Dean, Zein El-Zein, Megan Audet, Paul Fortin, Zachary Vaupel

Posters

Infection is a significant complication seen in orthopaedic surgery. In such cases, samples are sent to be cultured for aerobes, anaerobes, acid-fast bacilli (AFB) and fungi. AFB and fungi are generally slow-growing, difficult to culture, and rarely the pathogen, whereas aerobic and anaerobic cultures are routinely positive and guide antibiotic treatment. The goal of this study is to evaluate the value of routinely ordering AFB and fungal cultures in the setting of foot and ankle surgery.

Assessment Of Radiographic Features In Predicting Complete Quadriceps And Complete Patellar Tendon Ruptures In The Pre-Operative Setting, Mitchell Pfennig, Matthew Astolfi, Christopher Vasileff, Betina Hinckel

Posters

Acute patellar tendon or quadriceps tendon rupture is a severely debilitating injury resulting in complete loss of the knee extensor mechanism. Early diagnosis and prompt surgical repair are preferential in order to achieve good functional outcomes. In the setting of trauma and knee pain, plain film radiographs of the knee are obtained to rule out fractures. Patellar and quadriceps tendon rupture is primarily a clinical diagnosis but can benefit from additional imaging to differentiate between a partial and complete tear when there is uncertainty. Our goal is to assess the reliability and reproducibility of radiographic features in a population with …

Trends & Outcomes In Shoulder Arthroplasty: Comparing Anatomic, Reverse, & Hemiarthroplasty, James Gannon, Anthony Arveschoug, Leonardo M. Cavinatto

Posters

The field of shoulder replacement has evolved greatly since the inception of the reverse shoulder arthroplasty (RTSA) in 2004. With yearly gains of 32%, the RTSA now encompasses the largest portion of shoulder arthroplasty procedures. In contrast, the anatomic total shoulder arthroplasty (ATSA) and hemiarthroplasty (HA) have steadied or decreased. Surgical outcomes between these three procedures are mixed however. The purpose of this study was to characterize trends and outcomes between the RTSA, ATSA, and HA at a large-volume, single-institution center

Surveillance Of Dual-Mobility Hip Systems: Damage Mode And Clinical Data Analysis, Camilla Cascardo, Conner D. Ahlgren, Michael J. Maxwell, Tyler Vovos, Mark Karadsheh, Drew Moore

Posters

Hip instability following total hip arthroplasty (THA) is a prominent indication for revision surgery. Dual mobility (DM) implants are designed to increase stability, and trending use makes characterizing in vivo damage and clinical failure modes important. This study expounds upon micro- and macroscopic damage mode findings of Lombardo et al., including novel screw ring damage using an updated retrieval registry.

Osteoporosis Is Underdiagnosed And Undertreated In Patients With Fragility Femoral Neck And Vertebral Compression Fractures, Philip Zakko, Lauren Eberhardt, Madeline Declercq, Ahyoung Park, Megan Audet, Daniel Park

Conference Presentation Abstracts

Background/Introduction

Femoral neck (FNF) and vertebral compression fractures (VCF) are common fragility fractures (FF) in the elderly population. Defined as fractures from low-energy trauma, FF are diagnostic of osteoporosis and require treatment. The purpose of this study was to assess whether patients were appropriately diagnosed and treated for osteoporosis following fragility FNF and VCF.

Materials/Methods

A retrospective chart review was performed at a single-institution from 1/1/2017 to 12/31/2020 on consecutive patients who sustained fragility FNF treated with closed reduction percutaneous pinning, hemiarthroplasty, or total hip arthroplasty or VCF treated with kyphoplasty. Patients <50 years of age, who sustained a high-energy or a non-osteoporotic pathologic fracture, were treated non-operatively, or deceased within one-year post-op were excluded. Preoperative demographics, ASA, CCI, smoking, alcohol, and glucocorticoid use were obtained. Diagnosis and treatment of osteoporosis, including dual-energy X-ray absorptiometry (DEXA) scans, calcium, vitamin D, bisphosphonates, denosumab, and alternative treatments (teriparatide, calcitonin, raloxifene, estrogen) were assessed pre-op and within one-year post-op. Subsequent FF were recorded.

Results

Of 593 patients, 276 FNF and 94 …

Biportal Endoscopic Spine Surgery For Lumbar Laminectomy And Discectomy: Post-Operative Outcomes And Surgical Learning Curve, Matthew Lipphardt, Philip Zakko, Ali Jawad, Daniel Park, Maximillian Lee

Conference Presentation Abstracts

Background/Introduction

Biportal endoscopic spine surgery (BESS) is a minimally invasive spinal surgery which has gained increased traction for lumbar laminectomy and discectomy. To justify the transition from tubular or open surgery to BESS, BESS outcomes and surgical learning curve should be known. The primary goal of this study is to evaluate rates of complications with BESS as well as how these rates change with increased surgeon experience, especially in the US environment.

Materials/Methods

A United States Fellowship trained orthopaedic surgeon's clinical practice database was interrogated for consecutive patients who underwent BESS at a single institution. Patients aged greater than 18 …

A Retrospective Evaluation Of External Rotation At 0 Degree And 90 Degrees Of Abduction After Atrhoscopic Latarjet Procedure, Michael E. Bodine, Shariff K. Bishai, Guy Ball, Cameron King, Lydia Wait, Grace Brannan

Conference Presentation Abstracts

BACKGROUND: Several papers have shown that shoulder stabilizing procedures, including the Latarjet procedure, lead to postoperative external rotation (ER) deficits. However, no study on arthroscopic Latarjet procedures has investigated the effect on ER when the arm is abducted at 0° and 90°. This study examined the relationship between the arthroscopic Latarjet procedure and the subsequent effect on external rotation at both 0° and 90° of abduction compared to the contralateral extremity. METHODS: Records of patients who underwent an arthroscopic Latarjet Procedure from December 2015 to April 2021 were retrospectively evaluated for this study. Requirements included both a three- and six-month …

Preoperative Mri Delays Surgery In Pediatric Patients With Infectious Atraumatic Extremity Pain, Ethan Englert, Collin Braithwaite, Aaron Lam, Mohamed Sarraj, Maria Aguirre-Flores, Abigail Kumagai, Amr Abdelgawad, Ahmed Thabet Hagag, Waleed Kishta, Ehab Saleh

Conference Presentation Abstracts

INTRODUCTION: Management of atraumatic extremity pain in a pediatric patient often poses a dilemma to the treating orthopedic surgeon. The benefits of timely intervention must often be weighed against the utility of preoperative MRI to better characterize the responsible infection or other pathology. To determine if outcomes were superior for patients who underwent preoperative vs. postoperative MRI, this multicenter study reviewed the hospital courses of pediatric patients who presented with atraumatic extremity pain, underwent irrigation and debridement, and received at least one preoperative or postoperative MRI during their admission. METHODS: This study is a multi-institution retrospective review from four pediatric …

Public Perception Of Robotic-Assisted Total Hip Replacement Surgery, James E. Feng, Marvee Espiritu, Phillip Vartanyan, Drew Moore, Robert Runner, Mark Karadsheh

Conference Presentation Abstracts

PURPOSE: Computer-assisted and robotic (CA/R) total hip arthroplasty (THA) has gained considerable attention due to its superior accuracy and precision. However, few studies have evaluated the public’s understanding and appraisal of this technology. Here, we evaluate the public’s initial perception of technology-assisted compared to traditional THA, and if interactive education may alter an individual’s preferences. MATERIALS & METHODS: A prospective cohort study was developed utilizing a 48-question, paid survey distributed via a clinically validated, public, online marketplace in April 2022. After collecting baseline demographics and knowledge regarding THA, participants were queried whether they would prefer a CA/R THA or traditional …

Patellofemoral Disorders, Betina Hinckel

Conference Presentation Abstracts

No abstract provided.

Analysis Of The Effects Of Intraoperative Neurophysiological Monitoring On Anterior Cervical Surgery: A Michigan Spine Surgery Improvement Collaborative (Mssic) Study, Conner D. Ahlgren, Philip Zakko, Andrew Zachary Blankenship, Daniel K. Park

Conference Presentation Abstracts

INTRODUCTION: The utility of intraoperative neurophysiological monitoring (IOM) for anterior cervical surgery remains controversial. Despite insufficient evidence demonstrating a clear benefit, IOM continues to be utilized and in some areas is considered standard of care. The aim of this study was to evaluate the effects of IOM on anterior cervical surgery outcomes by utilizing data from the Michigan Spine Surgery Improvement collaborative. METHODS: Anterior cervical surgeries from February 2014 to November 2019 were included for analysis. IOM (EMG, MMG, SSEPs, or MEP) was the primary variable examined. Primary outcome measures were: new weakness after surgery, new radicular symptoms, return to …

Pedicle Screw-Associated Violation Of The Adjacent Unfused Facet Joint: Clinical Outcomes And Fusion Rates, Nathan J. Sinz, David Hanwuk Kim, Raymond W. Hwang, Gyu-Ho Lee, Kevin Charles Baker, Rick C. Sasso, Daniel K. Park, Jeffrey S. Fischgrund, Ruijia Niu

Conference Presentation Abstracts

INTRODUCTION: Lumbar spine pedicle screws are the most commonly utilized implants for providing immediate spinal stability during fusion surgery. Ideal pedicle screw positioning includes avoiding violation of any adjacent unfused facet joints. Nevertheless, inadvertent screw malposition and screw-associated violation of adjacent facet joints (FJV) remains a potential complication of the procedure regardless of whether surgery is performed in open fashion or with minimally invasive techniques and despite the use of intraoperative imaging or surgical navigation. Given the proximity of the lumbar vertebral pedicle to the proximal facet joint, FJV occurs almost exclusively at the level of the proximal as opposed …

Shorter Length Of Stay And Increased Return To Work With Cervical Disc Arthroplasty Versus Anterior Cervical Discectomy And Fusion, Philip Zakko, Alex Miller, Daniel K. Park, Jad Khalil

Conference Presentation Abstracts

INTRODUCTION: Anterior cervical discectomy and fusion (ACDF) and cervical disc arthroplasty (CDA) are established surgical options for the treatment of cervical radiculopathy, myelopathy, and cervical degenerative disc disease. However, current literature does not demonstrate a clear benefit between ACDF or CDA. The primary objective of this study is to compare the outcomes of ACDF and CDA for patients enrolled in the Michigan Spine Surgery Improvement Collaborative (MSSIC) database. Secondary objectives include assessment of early complications, procedural/perioperative outcomes, and patient-reported outcome measures after both ACDF and CDA. METHODS: Patients undergoing 1 or 2 level ACDF or CDA surgery were included. A …

Assessing General Vs. Spinal Anesthesia As A Risk Factor For 90-Day Emergency Department Visits Status-Post Index Total Knee Arthroplasty: A Retrospective Case Control Study, Ian Penvose, Helen E. Huetteman, James Feng, Robert Runner, Drew Douglas Moore, Mark S. Karadsheh

Conference Presentation Abstracts

INTRODUCTION: As bundle payment care initiatives become ever prevalent in total knee arthroplasty (TKA), institutions have increasingly focused on cost-saving measures which maintain or improve upon the standard of care. One area of interest is identifying potential modifiable and non-modifiable risk factors. Here we evaluate the correlations of general versus spinal anesthesia in TKAs in perioperative outcomes. METHODS: All primary TKAs between 7/1/2013 to 12/31/2017 were obtained retrospectively from a prospective institutional database utilized for contribution to a state-wide joint arthroplasty database. Prospective data includes baseline demographics, select medical comorbidities, intraoperative variables and postoperative course/complications. Patients were separated into two …

Assessing Public Reported Perceptions Of Hand Surgery Provided In The Office Vs. An Ambulatory Surgery Center, Trevor Tooley, James Feng, Jannat Khan, Paul Scott Shapiro

Conference Presentation Abstracts

INTRODUCTION: There is a growing body of literature supporting the efficacy, safety, and benefits of wide awake office-based low risk hand surgery. Procedures such as a carpal tunnel release are now, under the right clinical circumstances, being performed in the office-setting as opposed to a traditional operating room. While there is growing evidence supporting technique, procedure room setup, and cost analyses of office-based surgery, there is little investigation into the public perceptions of having surgery done in the office. Here we sought to evaluate public perceptions of undergoing low risk hand surgery in the office setting. METHODS: A prospective survey …

Assessing Risk Factors For 90-Day Emergency Department Visits Status-Post Index Total Knee Arthroplasty: A Retrospective Case Control Study, Ian Penvose, Helen E. Huetteman, Phil Vartanyan, James Feng, Robert Runner, Drew Douglas Moore, Mark S. Karadsheh

Conference Presentation Abstracts

INTRODUCTION: With the increasing adoption of value-based healthcare initiatives in total knee arthroplasty (TKA), a greater emphasis has been placed on implementing cost-saving measures while maintaining or improving quality of care. One area of interest has been postoperative ED visits. Here we evaluate potential risk factors for 90-day ED visits. METHODS: This is a case control study from a large, tertiary, private, academic institution. All primary TKAs between 7/1/2013 to 12/31/2017 were obtained retrospectively from a prospective institutional database utilized for contribution to a state-wide joint arthroplasty database. All patient charts were subsequently verified and reviewed for all-cause 90-day ED …

Acute Post-Operative Pain Following Anterior Cruciate Ligament Reconstruction: A Comparison Of Patellar Tendon Vs Hamstring Autograft, Dustin J Randall, Denise Koueiter, Brandon Luczak, Kyle Anderson

Posters

INTRODUCTION
Choosing between a bone-patellar tendon-bone (BTB) or hamstring tendon (HS) graft for primary anterior cruciate ligament (ACL) reconstruction has long been a topic of debate and discrepancy in orthopaedic literature, with many factors contributing to the decision process. The purpose of this study is to analyze acute post-operative pain scores of patients who underwent ACL reconstruction and compare the results between BTB autograft and the HS autograft techniques.

Defining Functional Shoulder Range Of Motion In Middle-Aged To Elderly Populations To Guide Shoulder Surgical Treatment, Tyler Sargent, Justin Smith, Christie Smith, John Krauss, Michelle Jankowski, J Michael Wiater

Posters

INTRODUCTION
Functional range of motion (ROM) is defined as the minimal required mobility of a joint to complete activities of daily living (ADL). Defining functional ROM will allow surgeons to decide which aging patients would benefit from surgical intervention aimed at improving shoulder functionality.

Applying The Periprosthetic Joint Infection Consensus Definition To Ankle Implant-Associated And Infection-Suspected Procedures To Assess Diagnosis, Jackson Harley, Erin Baker, Corinn K. Gehrke, David Ciufo, Zachary M. Vaupel, Paul T. Fortin

Posters

INTRODUCTION
Periprosthetic joint infection (PJI) affects 2-3% of all total joint replacement cases. In 10-30% of these cases, the organism is unidentifiable, which may impact treatment planning and outcomes. In this study, suspected periprosthetic infections of foot and ankle procedures treated by four foot and ankle-trained orthopedic surgeons were retrospectively reviewed to determine culture status and applicability of the 2018 International Consensus Meeting on Orthopedic Infections (ICM) classification system.

Evaluating Taper Junction Fretting And Corrosion In Reverse Total Shoulder Arthroplasty, Ian R. Penvose, Erin A. Baker, J. Michael Wiater, Corinn K. Gehrke, Jonathan O Wright, Omar N. Khatib, Brett P Wiater

Posters

INTRODUCTION
Taper junction fretting and corrosion (F&C) has been identified in total hip arthroplasty (THA) as an implant failure mode. Studies have reported taper F&C in in anatomic total shoulder arthroplasty (ATSA) implants, but limited literature has described comparable analyses in reverse shoulder arthroplasty (RTSA) implants. In this study, taper junction F&C in retrieved RTSA implants was assessed and analyzed.

Lumbar Motion Is Maintained With Paraspinous Tension Band For Degenerative Spondylolisthesis: Results From 24-Month Fda Study, Kee D. Kim, Rick Sasso, Serena Hu, Alan Villavicencio, S Tim Yoon, William Lavelle, Harvinder Sandhu, Hyun Bae, Jeffrey Fischgrund, Mick Perez-Cruet

Conference Presentation Abstracts

Introduction

Durable outcome for degenerative spondylolisthesis (DS) usually requires decompression and fusion. Fusion, however, places greater stress at adjacent levels with increased incidence of adjacent segment disease. A novel interspinous tension band is proposed for segmental stabilization after decompression for DS, as an alternative to fusion. An FDA IDE study (NCT03115983) compares decompression and stabilization with the tension band (treatment group) to decompression and transforaminal interbody instrumented fusion (control group) for symptomatic DS.

Methods

Prospectively enrolled IDE study subjects with 24 months postoperative radiographic follow-up were included in this analysis. X-rays obtained during the follow-up period for both the treatment …

Causes Of Early Hip Revision Vary By Age And Sex: Analysis Of Data From A Statewide Quality Registry, Jacob F. Markel, John A. Driscoll, Richard Hughes, Jamers Verner, Thomas Zheng, Brian Halstrom, David C. Markel

Conference Presentation Abstracts

INTRODUCTION: While THA is extremely successful, early failures do occur. The purpose of this study was to determine the cause of revision in specific patient demographic groups at three timepoints to improve quality. The data should guide treatment regimens and implant choice. METHODS: Data for cases performed between 2012 and 2018 from a statewide, quality improvement arthroplasty registry was used. The database included 79,205 THA cases and 1,433 revisions with identified etiology (1,584 total). All revisions performed at < 5 years from the primary THA were reviewed. Six groups: men/women, <65, 65-75, and >75 years, were compared at revision timepoints <6 mo, <1 year, and <5 years. RESULTS: There were obvious and significant differences between subgroups based on demographics and timepoints (p<.0001). The most common etiologies within 1 year (961 revisions) were: fracture (324, 33.7%), dislocation (235, 24.5%) and infection (164, 17.0%). 756 (78%) of the 1-year revisions occurred within 6 months, the vast majority within 6 weeks. At this early timepoint, the most common revision cause was fracture for all groups and ages (316, 42%) ranging from 27.6% in young men to 60% in older women. Joint instability became the leading cause for revision after 6 months in younger women whereas for younger men infection became the primary issue. The most striking finding was the incidence of fracture as the leading cause of revision at all time points for both men and women >75 years. CONCLUSION: This quality project demonstrated clinically significant differences in the reason for THA …

Augmented Immunomodulation Of Endogenous Marrow-Derived Stem Cells In The Setting Of Acl Rupture, Mackenzie Fleischer, Michael Newton, Samantha Hartner, John A. Driscoll, Anthony Arveschoug, Chritopher C. Vasileff, Kevin Baker

Conference Presentation Abstracts

PURPOSE: Augmentation of MSC immunomodulation is an unexplored, potentially useful therapeutic to combat PTOA following ACLR. Lower kynurenine-to-tryptophan ratios observed in synovial fluid of ACL rupture (ACLR) rats suggests decreased activity of tryptophan metabolizing enzyme, Ido, known to be secreted by MSCs to promote T-reg expansion and Th17 suppression. This study aims to characterize the immunomodulatory capacity of pharmacologically mobilized MSCs in conjunction with exogenously delivered Ido. METHODS: Rats (N = 48) underwent ACLR to evaluate the effects of mobilized MCSs on Ido1 and inflammatory cytokine expression profiles in the synovial fluid. Additionally, rats (N = 160) underwent ACLR to …

A New Pediatric Monteggia Fracture Type 4 Variant, Ehab S. Saleh

Articles

Introduction: Monteggia fracture-dislocations are rare and complex injuries that usually involve a fracture of the proximal ulna associated with a proximal radioulnar and radiocapitellar joint dislocations. These injuries comprise

Posterior And Middle Facets Of The Subtalar Joint: The Retrospective Search For An Early Sign Of Peritalar Subluxation And Progressive Flatfoot Deformity, Elijah C. Auch, Nacime Mansur, Shuyuan Li, Kevin Dibbern, John Femino, Daniel Baumfeld, Cesar De Cesar Netto, Thiago Alexandre Alves

Conference Presentation Abstracts

INTRODUCTION | Adult acquired flatfoot deformity (AAFD) is a complex three-dimensional (3D) pathology characterized by peritalar subluxation (PTS) of the hindfoot. The objective of this study was to compare the amount of subluxation between the middle and posterior facets in patients with AAFD. METHODS | In this IRB-approved retrospective comparative study, seventy-six AAFD patients (87 feet) who underwent weightbearing CT (WBCT) were included. Two blinded Fellowship-Trained Orthopedic Foot and Ankle Surgeons with >10 years of experience measured subtalar joint subluxation at the posterior and middle facets as well as the Foot and Ankle Offset (FAO). Intra- and interobserver agreement was …

Percutaneous Distal Metatarsal Mini-Invasive Osteotomy: Comparison Between Standard Vs. Modified Intraosseous Approach - A Cadaveric Study, Elijah C. Auch, Fernando S. Martins, Victoria Vivtcharenko, Eli Schmidt, Shuyuan Li, Alexandre L. Godoy-Santos, John Femino, Cesar De Cesar Netto

Conference Presentation Abstracts

BACKGROUND | The objective of this cadaveric study was to identify and compare the structures at risk of damage in standard versus modified intraosseous distal mini-invasive metatarsal osteotomy (DMMO). Our hypothesis was that the modified DMMO technique may be a safer, less complex procedure that could decrease the risk of iatrogenic injuries. METHODS | 11 thawed fresh-frozen under the knee cadaveric specimens underwent DMMO of the forefoot. The modified technique proposed by this study enters the dorsal cortex (at 45 degrees) straight through to the plantar cortex followed by cutting the lateral cortices (panels D, E, F). The standard technique …