Orthopedics Commons^™

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, …

Konsep Diagnosis Dan Penatalaksanaan Fraktur Osteoporosis Terkini, I Gusti Ngurah Wien Aryana, Febyan Febyan

Jurnal Penyakit Dalam Indonesia

Osteoporosis is a metabolic bone disease that is caused by a decreased amount of bone mass, and microarchitectural damage to bone tissue that affects the bone to break easily. Osteoporosis can be divided into primary and secondary etiologies. Vertebral, hip, distal radius, and proximal humerus are the most common predilection of fracture complication due to osteoporosis. The diagnosis of osteoporotic fractures is established based on the identification of risk factors, general clinical manifestations, specific manifestation from each fracture predilection, and advanced examinations, including radiology imaging and dual-energy x-ray absorptiometry. The purpose of osteoporotic fractures management in elderly is a stable …

Femoral Neck Fracture Management In The Young Patient: A Case Review, Luis Berrios, Kevin J. Orellana, Michael Lago, Frank Gerold

Research Colloquium

Introduction:The optimal management of femoral neck fractures in the young patient remains controversial. Although there are universally accepted principles, there remains some variability in the optimal timing of surgery and method of fixation. In general, surgery should be performed on an urgent or emergent basis when feasible to decrease peri-operative complications, length of stay, and most importantly the ultimate likelihood of avascular necrosis. However, it is important to note that the preference toward a specific method of fixation remains heterogeneous among orthopedic surgeons.(1)

The purpose of this study is to present our preferred technique for treatment of displaced femoral …

Rare Case Of Prosthetic Joint Infection Caused By Salmonella Enterica - A Case Report, Carlos Ramos, Shyama Appareddy, Peter J. Gonzalez

Research Colloquium

Introduction: Collectively, over 1 million total knee arthroplasties (TKA) and total hip arthroplasties (THA) are performed in the United States each year. In 2010 it was estimated that 1.58% of the United States general population has received a TKA. Prosthetic joint infections (PJI) are the most common indication for a TKA revision1 . In total, S. aureus is responsible for about 50% of all prosthetic joint infections, and about 15% are caused by gram negative pathogens2 .

Objective: This is a case report which describes the presentation and clinical course of a 59-yearold female with Salmonella enterica septic arthritis of …

Wrist Motion Is Distinct Between Touch Screen And Manual Or Digital Devices, Mandi J. Lopez, Catherine Takawira, Mary P. Fox, Pengju Wang, Evan Boatwright, Thomas Lucak, Chin Chi Liu, Bryce Fugarino

School of Medicine Faculty Publications

Background Restricted motion during touch screen device use may contribute to wrist overuse injuries. Wrist radioulnar deviation and extension while using touch screen devices and digital or manual counterparts in male and female medical professional dominant and non-dominant hands were quantified to test the hypothesis that mobile touch screen device use reduces wrist motion. Methods An active motion detection system was used to record wrist motion of 12 participants while: tablet swiping and turning book pages; raising a cell and traditional phone to the ear; texting and typing; and entering numbers on a cell phone and manual calculator. Medial and …

Prescribing Protocol For Postoperative Opioids In An Orthopedic Spine Practice, Kelly M. Manda

Doctor of Nursing Practice (DNP) Scholarly Project

Problem: The opioid epidemic is magnified by excessive post-surgery prescriptions. Over six months at an orthopedic spine practice, 50% of patients received two or more opioid refills beyond their first. This highlighted the absence of a clear prescribing policy and emphasized the need for a structured protocol and to promote patient safety.

Aim of the Project: The primary aim was to implement a prescribing protocol to lower opioid refills provided to post-surgical patients in this surgical practice. The desired result was to reduce the number of opioid refills provided to patients after surgery.

Review of the Evidence: Evidence highlighted …

Pelvic Fractures - An Overview, Shashank Cheemalapati

Digital Journal of Clinical Medicine

Pelvic fractures are injuries commonly caused by high-energy trauma, such as motor vehicle accidents and falls from a height. Understanding the anatomy, mechanisms of injury, classification, diagnosis and the management of these fractures is crucial to improve patient outcomes. This short article aims to provide a comprehensive overview of the current state of knowledge regarding pelvic fractures.

Cold Atmospheric Pressure Plasma-Antibiotic Synergy In Pseudomonas Aeruginosa Biofilms Is Mediated Via Oxidative Stress Response, Jordanne-Amee Maybin, Thomas P. Thompson, Padrig B. Flynn, Timofey Skvortsov, Noreen J. Hickok, Theresa A. Freeman, Brendan F. Gilmore

Department of Orthopaedic Surgery Faculty Papers

Cold atmospheric-pressure plasma (CAP) has emerged as a potential alternative or adjuvant to conventional antibiotics for the treatment of bacterial infections, including those caused by antibiotic-resistant pathogens. The potential of sub-lethal CAP exposures to synergise conventional antimicrobials for the eradication of Pseudomonas aeruginosa biofilms is investigated in this study. The efficacy of antimicrobials following or in the absence of sub-lethal CAP pre-treatment in P. aeruginosa biofilms was assessed. CAP pre-treatment resulted in an increase in both planktonic and biofilm antimicrobial sensitivity for all three strains tested (PAO1, PA14, and PA10548), with both minimum inhibitory concentrations (MICs) and minimum biofilm eradication …

Assessing Inflammation In The Pathology Of Knee Osteoarthritis, Zachary J. Koudys

Electronic Thesis and Dissertation Repository

Osteoarthritis (OA) is a joint disease that causes pain, stiffness, and loss of function. Inflammation of the synovium plays a role in the pathology of OA. Macrophages are the dominant immune cells in synovial tissue. Activated macrophages over-express the translocator protein (TSPO). [¹⁸F]FEPPA is a 2^nd generation positron emission tomography (PET) tracer that can target TSPO with high specificity. Hybrid [¹⁸F]FEPPA PET/MRI may enable accurate quantification of macrophage activity in vivo. In this work, [¹⁸F]FEPPA tracer uptake in knee synovial tissue was measured ex vivo using autoradiography and was validated to correlate to …

Worse Postoperative Outcomes And Higher Reoperation In Smokers Compared To Nonsmokers For Arthroscopic Rotator Cuff Repair, Susan G. Wager, Spencer Brown, Michael Gaudiani, Joshua P. Castle, Eric Jiang, Vasilios Moutzouros, Eric Makhni, Stephanie J. Muh

Medical Student Research Symposium

Introduction: Smoking impairs healing potential and is a significant risk factor for complications following orthopaedic surgeries. The purpose of this study was to determine if a cohort of former or current smokers at time of surgery met the minimally clinical important difference (MCID) for Patient-Reported Outcomes Measurement Information System Upper Extremity (PROMIS-UE), Depression (PROMIS-D), and Pain Interference (PROMIS-PI) scores in comparison to nonsmokers.

Methods: A retrospective review of patients who underwent rotator cuff repair was performed. Patients who completed preoperative and 6-month postoperative PROMIS scores were included. The MCID was calculated using a distribution technique with a threshold of 0.5 …

The Top 50 Most Cited Articles On The Medial Patellofemoral Ligament (Mpfl): A Bibliometric Analysis, Varag Abed, Alex Duvall, Jonathan D. Rexroth, Alyssa Goodwin, Joseph Liu, Austin Stone

Medical Student Research Symposium

Objectives: To determine which original articles on the topic of the medial patellofemoral ligament (MPFL) have been cited the most in the literature utilizing a bibliometric approach. Secondarily, to determine temporal trends between article types.

Methods: Articles on the topic of the MPFL were identified by utilizing the Web of Science Database. The search yielded 1,596 results and the top 50 cited original articles were collected for further analysis. The following information was gathered for all included articles: title, first author's name, journal name, year of publication, impact factor of the journal in 2021, total number of citations of the …

Toll-Like Receptor 4 Signaling In Osteoblasts Is Required For Load-Induced Bone Formation In Mice, Ibtesam Rajpar, Gaurav Kumar, Paolo Fortina, Ryan E. Tomlinson

Department of Orthopaedic Surgery Faculty Papers

In mature bone, NGF is produced by osteoblasts following mechanical loading and signals through resident sensory nerves expressing its high affinity receptor, neurotrophic tyrosine kinase receptor type 1 (TrkA), to support bone formation. Here, we investigated whether osteoblastic expression of Toll-like receptor 4 (TLR4), a key receptor in the NF-κB signaling pathway, is required to initiate NGF-TrkA signaling required for load-induced bone formation. Although Tlr4 conditional knockout mice have normal skeletal mass and strength in adulthood, the loss of TLR4 signaling significantly reduced lamellar bone formation following loading. Inhibition of TLR4 signaling reduced Ngf expression in primary osteoblasts and RNA …

Development Of An Affordable, Manual Method Of Dna Extraction From Bones And Teeth ​, Varos Victer Manukyan, Lara Laughrey, Ryan V. Powers, Amar Paul, Davis Johnston, Dashon Eure, Todeh Toomians, John A. Kriak, Kyle B. Bills, David W. Sant

Annual Research Symposium

No abstract provided.

Comparative Study Between Short And Long Proximal Femoral Nailing In Management Of Intertrochanteric Fracture In Elderly Patients, Ibrahim Ahmed Mostafa, Lotfy Mohamed Aly Shwitter, Mohamed Gomaa Ahmed Ali Abd Elaty

Al-Azhar International Medical Journal

Background: Elderly people frequently suffer from intertrochanteric fractures; to address the challenges associated with treating unstable fractures, trochanteric-entry intramedullary nails have been developed. Both of short and long PFN apparatuses are being used to cure the trochanteric hip fractures. Compared to long devices, short PFN have recently been shown to cause less blood loss and speed up operations. Other research, however, has revealed that a lengthy PFN may be linked to fewer ipsilateral femur fractures in the future. Objective: To compare the surgical time, estimated blood loss, hospital stay and intra-operative complications and the effectiveness of short and long proximal …

Clinicopathological And Prognostic Significance Of Cxcr4 Expression In Osteosarcoma: A Meta-Analysis, I Gusti Ngurah Ananda Wira Kusuma, Grace Yulia Alphani Yapson, John Nolan, I Gede Eka Wiratnaya, I Gede Putu Supadmanaba

BioMedicine

Background: The C-X-C Motif Chemokine Receptor (CXCR4) is an oncogene that has been widely studied and associated with worse clinicopathological features and prognosis outcomes in many types of cancer. Besides that, significance of CXCR4 expression on clinicopathological features and prognostic factors in osteosarcoma (OS) requires further validation.

Aim: We conducted a meta-analysis to evaluate the association between positive CXCR4 expression with clinicopathological features and prognosis in OS.

Methods: Literature searches on Pubmed, Cochrane Library, and Web of Science were conducted systematically up to December 2021 to find relevant references. The effects of CXCR4 expression on clinicopathological characteristics and prognostic were …

Gut Permeability May Be Associated With Periprosthetic Joint Infection After Total Hip And Knee Arthroplasty, Emanuele Chisari, Jeongeun Cho, Marjan Wouthuyzen-Bakker, Javad Parvizi

Rothman Institute Faculty Papers

A growing number of recent investigations on the human genome, gut microbiome, and proteomics suggests that the loss of mucosal barrier function, particularly in the gastrointestinal tract, may substantially affect antigen trafficking, ultimately influencing the close bidirectional interaction between the gut microbiome and the immune system. This cross-talk is highly influential in shaping the host immune system function and ultimately affecting the outcome of interventions. We hypothesized that the loss of mucosal barrier in the gut may be associatedto acute and chronic periprosthetic joint infections (PJI). Zonulin, soluble CD14 (sCD14), and lipopolysaccharide (LPS) were tested in plasma as part of …

Quantitative Mri And 3d-Printing For Monitoring Periprosthetic Joint Infection, Greg Hong

Electronic Thesis and Dissertation Repository

Joint replacements are becoming increasingly commonplace with over 130,000 joint arthroplasties being performed annually in Canada. Although joint replacement surgery is highly successful, implants do occasionally fail and need to be replaced via costly and difficult revision surgery. Periprosthetic joint infection (PJI) has recently become the leading reason for revision of both hip and knee replacements, which is unfortunate because PJI is difficult to diagnose and treat effectively; diagnosis is made particularly difficult by the lack of established non-invasive (imaging) means of evaluating PJI. This thesis aims to demonstrate that magnetic resonance imaging (MRI) has potential for diagnosing and monitoring …

Fibroblast Growth Factor Receptor 1-Bound Extracellular Vesicle As Novel Therapy For Osteoarthritis, Bryan Gervais De Liyis, John Nolan, Made Agus Maharjana

BioMedicine

Osteoarthritis (OA) is a joint condition that causes significant impairment of the chondrocyte. The gradual degradation of the cartilage lining of one or more freely moving joints, as well as persistent inflammation, are the causes of osteoarthritis. Current medication focus on alleviating symptoms rather than curing the condition. The aim of this review is to evaluate the potential use of fibroblast growth factor receptor 1 extracellular vesicle as novel therapy for osteoarthritis. This review article was completed by searching for the keywords “Fibroblast Growth Factor Receptor 1”, “Extracellular Vesicle”, and “Osteoarthritis” in various journals in several search engines. Of the …

Injection Options For Non-Surgical Knee Pain Patients: A Quality Improvement Project, Alicia Emery

Epsilon Sigma at-Large Research Conference

Purpose: In an Orthopedic office in Northeast Tennessee clinical decision making about injection options for non-surgical candidates with knee osteoarthritis is unclear.

Aims: This quality improvement project will develop a clinical guideline so that providers know criteria for choosing optimal knee alternative treatments for non-surgical knee patients.

Outcome measures: An expert panel gave feedback and advice on the information presented for the injection types of Platelet Rich Plasma, Corticosteroids, Amniotic Allograft and Hyaluronic Acid. They edited the guideline then sent the edits back to be complied and edited using the Delphi method.

Process and Methods: The …

Comparison Of Automated Ribotyping, Spa Typing, And Mlst In 108 Clinical Isolates Of Staphylococcus Aureus From Orthopedic Infections, Stefano Ravaioli, Davide Campoccia, Werner Ruppitsch, Franz Allerberger, Alessandro Poggi, Emanuele Chisari, Lucio Montanaro, Carla Renata Arciola

Rothman Institute Faculty Papers

108 isolates of Staphylococcus aureus, belonging to six large ribogroups according to the automated Ribo-Printer® system, were studied with two highly used molecular methods for epidemiological studies, namely multi-locus sequence typing (MLST) and spa typing, followed by BURP and eBURST v3 analysis for clustering spa types and sequence (ST) types. The aim was to evaluate whether automated ribotyping could be considered a useful screening tool for identifying S. aureus genetic lineages with respect to spa typing and MLST. Clarifying the relationship of riboprinting with these typing methods and establishing whether ribogroups fit single clonal complexes were two main objectives. …

Long-Lasting Impairments In Quadriceps Mitochondrial Health, Muscle Size, And Phenotypic Composition Are Present After Non-Invasive Anterior Cruciate Ligament Injury, Steven M. Davi, Ahram Ahn, Mckenzie S. White, Timothy A. Butterfield, Kate Kosmac, Oh Sung Kwon, Lindsey K. Lepley

Center for Muscle Biology Faculty Publications

Introduction: Despite rigorous rehabilitation aimed at restoring muscle health, anterior cruciate ligament (ACL) injury is often hallmarked by significant long-term quadriceps muscle weakness. Derangements in mitochondrial function are a common feature of various atrophying conditions, yet it is unclear to what extent mitochondria are involved in the detrimental sequela of quadriceps dysfunction after ACL injury. Using a preclinical, non-invasive ACL injury rodent model, our objective was to explore the direct effect of an isolated ACL injury on mitochondrial function, muscle atrophy, and muscle phenotypic transitions.

Methods: A total of 40 male and female, Long Evans rats (16-week-old) were exposed to …

Comparison Of Landing Biomechanics Between Different Competitive Levels Of Irish Dance, Jade Shields

West Chester University Master’s Theses

Abstract

Objectives: To determine differences in lower limb landing biomechanics and lower extremity function scale scores between champion levels, in young female Irish dancers.

Design: Cross-sectional.

Setting: McDade-Cara School of Irish Dance

Participants: 12 Open Champion (OC) level female Irish dancers (11.9 ± 3.37 years) and 9 Preliminary Champion (PC) Irish dancers (13.5 ± 3.37 years) performed the landing error scoring system test (LESS), and completed the lower extremity functional scale (LEFS) and a descriptive data questionnaire

Main outcome measures: LESS scoring sheet and LEFS PRO

Results: No significant differences found between OC and PC levels on …

Iatrogenic Electrocautery Damage And Cellular-Based Corrosion Of Total Joint Arthroplasty Biomaterials, Kirsten Carol Miller

Theses and Dissertations (ETD)

Introduction. The number of patients undergoing a Primary Total Knee Arthroplasty (PTKA) has been increasing steadily each year. Of those PTKA patients, 20% report long-term pain and/or some functional deficit. Cobalt-Chromium-Molybdenum (CoCrMo) alloy is one of the most used materials in Total Joint Arthroplasty (TJA) implants due the material’s high strength, high corrosion resistance, and biocompatibility. The release of metal ions and potential occurrence of metallosis in TJA has been shown to be detrimental to the longevity of the implant. The mechanisms leading to this increase in metal ion concentrations have been up for debate, with some believing it is …

The Effect Of Chronic Alcohol Consumption On Exercise-Induced Muscle Damage In Young Men, Emma Hamilton, Grant Hilliard

Honors Theses

PURPOSE: To investigate the effects of chronic alcohol consumption on exercise-induced muscle damage of the knee extensors in young men. METHODS: Twenty-one males (age 21.9 ± 1.1 yr; weight 183.4 ± 27.6 lbs; height 174.0 ± 13.1 cm) performed 100 maximal eccentric contractions at 30°/sec of the knee extensors using their non-dominant leg. The isometric and isokinetic muscle strengths (60°/sec and 180°/sec) were measured pre-exercise and immediately, 24 h, 48 h, 72 h, 96 h, and 120 h post-exercise. Muscle soreness and plasma creatine kinase (CK) activity were measured pre-exercise and 24 h, 48 h, 72 h, 96 h, and …

Hospital-Acquired Venous Thromboembolism Or Bleeding Following Total Joint Arthroplasty: A Systematic Review And Meta-Analysis For The Association Of The Gene Polymorphism., Michael Debeau

Medical Student Research Symposium

This review seeks to understand the current existing literature on genetic polymorphisms to VTE following orthopedic surgery. Using PRISMA guidelines, 234 studies were retrieved from PubMed and Cochrane. The eligibility assessment yielded 16 studies including a systematic review. A STREGA and STROBE quality assessment found these studies to have high methodological quality. A significant association was found between the PAI-1 4G/4G genotype and resistance to anticoagulation therapy (OR = 2.692; 95% CI = 1.302 - 4.702). Moreover, the MTHFR C677T and A1298C polymorphisms significantly increased the incidence of VTE in patients that are compound heterozygotes (OR = 2.89; 95% CI …

Conversion From Knee Arthrodesis Back To Arthroplasty: A Particular Challenge In Combination With Fungal Periprosthetic Joint Infection., Sven Frieler, Emre Yilmaz, Ryan Goodmanson, Yannik Hanusrichter, Thomas A Schildhauer, Hinnerk Baecker

Articles, Abstracts, and Reports

A 58-year-old female treated at an outside facility with knee arthrodesis due to persistent periprosthetic joint infection fulfilled all prerequisites for a conversion back to arthroplasty, as part of a 2-stage revision. Owing to the detection of Candida parapsilosis, the treatment concept was converted to a three-stage procedure. A scheduled spacer exchange with additional amphotericin B-loaded polymethylmethacrylate was conducted as an intermediate revision before reimplantation. Conversion in the setting of fungal periprosthetic joint infection presents a challenge, and successful treatment hinges on the use of proper antifungal and antimicrobial protocols, advanced surgical techniques, and a multidisciplinary team approach. At …

Mycobacterium Fortuitum And Mycobacterium Abscessus Infections In The Foot And Ankle In Two Immunocompetent Patients, Khai Phang Wong, Zhi Hao Tang, Gek Meng Tan

BioMedicine

Nontuberculous mycobacteria (NTM) infections of the musculoskeletal system are commonly missed due to its rarity and the absence of systemic symptoms. A high clinical index of suspicion is required to recognize such infections as they may occur in immunocompetent hosts. We present two cases of foot and ankle NTM infections involving Mycobacterium fortuitum and Mycobacterium abscessus in two such patients. The first case involves an 83-year old lady who presented with a two-month history of multiple foot abscesses initially treated at a rural hospital. She underwent drainage and debridement of her foot, with eventual cultures growing Pseudomonas aeruginosa and Mycobacterium …

A Clinically Representative Rat Model Of Hip Hemiarthroplasty, Adam Dm Paish

Electronic Thesis and Dissertation Repository

Joint replacement is an increasingly common surgery with over 130,000 procedures performed annually in Canada. Although joint replacement surgery is highly successful, implants do not last a lifetime, and often have to be replaced via costly revision surgeries. Before innovations aimed at extending the life of implants are applied to the clinic, testing must be performed in animal models. Clinically representative small-animal models of joint replacement would be ideal in the initial stages of research and development, due to ease of handling and low costs, but few such models have been established in the literature. Thus, we describe the development …

Combined Open Calcaneocuboid, Naviculocuneiform And Subtalar Dislocation: A Case Report And Literature Review, Khai Phang Wong, Zhi Hao Tang, Gek Meng Tan

BioMedicine

Open dislocations of the midfoot and subtalar joints are extremely rare injuries. Understanding the anatomy of these joints and the various injury patterns is imperative to obtain stable concentric reduction and provide good functional outcome. We present a report of a 26- year old male who was involved in a road traffic accident and sustained open dislocations of the calcaneocuboid, naviculocuneiform and subtalar joints. He initially underwent external fixation in view of the severe soft tissue injury. After improvement of the soft tissue condition, he underwent K-wiring of the calcaneocuboid joint, buttress plating of the talonaviculocuneiform joint, peroneal tendon reconstruction …

Computer Based Learning Module: Neuraxial And Peripheral Nerve Blocks, Altan Halici

Doctor of Nursing Practice Projects

Neuraxial and peripheral nerve blocks (PNB) have been present for many years, but recently these pain management techniques are gaining popularity as an alternative to the use of opioids. Neuraxial and PNB reduce the opioid usage during and after the surgery and improve postoperative recovery in terms of pain relief, pain-related sleep disruption, and reduction of side effects, such as nausea and vomiting. Conversely, inadequate pain management after surgery may delay surgical recovery, decreased patient satisfaction, increased length of hospital stay, increased readmissions and healthcare costs (Patacsil, McAuliffe, Feyh, & Sigmon, 2016).

Perioperative nurses are instrumental during the post-operative period …