Orthopedics Commons^™

Front Matter, Unm Department Of Orthopaedic Surgery

UNM Orthopaedic Research Journal

No abstract provided.

Unm Department Of Orthopaedic Surgery Faculty, Unm Department Of Orthopaedic Surgery

UNM Orthopaedic Research Journal

No abstract provided.

The University Of New Mexico Orthopaedics Research Journal 2019, Unm Department Of Orthopaedic Surgery

UNM Orthopaedic Research Journal

No abstract provided.

Intraoperative Finding Of Vascular Malformation During Carpal Tunnel Release: A Case Report, Mark S. Anderson, Moheb S. Moneim

UNM Orthopaedic Research Journal

Carpal tunnel release is a common surgical procedure performed by hand surgeons. The procedure is typically straightforward; however, uncommon causes of median nerve compression encountered intraoperatively may add complexity. We describe a 67-year-old man with carpal tunnel syndrome and an intraoperative finding of a compressive vascular malformation during a mini-open carpal tunnel release. A space-occupying malformation of a persistent median artery was bisecting the nerve and thought to be responsible for the patient’s symptoms. The compression was relieved through extended carpal tunnel release without requiring removal of the vascular malformation. The patient’s symptoms improved postoperatively. Hand surgeons undertaking this procedure …

Chronic Volar Lunate Dislocation Resulting In Carpal Tunnel Syndrome: A Case Report, Travis D. Blood, Amanda J. Fantry, Nathan T. Morrell

UNM Orthopaedic Research Journal

Lunate dislocations are rare injuries caused by highenergy trauma disrupting the ligamentous restraints that connect the lunate to the carpus. We describe a case of missed volar lunate dislocation 10 years after the initial injury. The patient presented to our clinic with symptoms of carpal tunnel syndrome after falling on an outstretched arm. He had increasing paresthesias in his median nerve territory and underwent a proximal row carpectomy with release of the transverse carpal ligament. At 2 years postoperatively, successful outcomes were noted with an 80° arc of motion of the carpus and complete resolution of carpal tunnel symptoms. Although …

Traumatic Neuroma Of The Median Nerve: A Case Report, Keir Johnson, Amber West, Brooke Baker

UNM Orthopaedic Research Journal

Peripheral nerve neuromas are growths that develop after nerve trauma, which can result in enlarged and painful nerve ends when severed. Treatment of neuromas that form within a continuous nerve is controversial; however, success has been reported after general neurolysis with decompression of the nerve after its isolation from the surrounding scar bed. We describe a 21-year-old man who presented with symptoms of pain and intermittent numbness in his left elbow. Findings of high-resolution magnetic resonance imaging and ultrasound confirmed the diagnosis of median nerve neuroma at the level of the forearm. He subsequently underwent neurolysis with protective nerve wrap, …

Ipsilateral Femoral Neck And Shaft Fractures With A Floating Knee Injury: A Case Report, Matthew T. Philippi, Scott M. Sandilands, Paul J. Goodwyn, Samer Kakish

UNM Orthopaedic Research Journal

Isolated ipsilateral fractures of the femoral neck and shaft are rare injuries. Similarly, a floating knee (ie, ipsilateral fractures of the femur and tibia) is uncommon. We describe a 34-year-old man with ipsilateral fractures of the femoral neck and shaft with an ipsilateral floating knee after a motorcycle collision. He was treated with operative fixation, and was walking without assistive devices at his most recent follow-up appointment in February 2019. We believe this to be a unique combination of injuries not yet described in studies.

Intraoperative Finding Of Flexor Carpi Radialis Avulsion During Closed Distal Radius Fracture: A Case Report, Camille Aubin-Lemay, Deana Mercer

UNM Orthopaedic Research Journal

Distal radius fractures are a common reason for orthopaedic consultations in emergency departments and outpatient orthopaedic clinics. Ruptures of the extensor pollicis longus tendon have been regularly described in conjunction with distal radius fractures, whereas only five cases of flexor tendon injuries have been reported. We describe a patient with acute rupture of the flexor tendon identified during operative fixation of the distal radius fracture. The tendon avulsion was repaired at the same time as fracture fixation; unfortunately, the patient was lost to follow-up. This case highlights the importance of a careful physical examination in treating high-energy traumatic injuries and …

Diagnosis Of Leprosy Using Sural Nerve Biopsy Findings: A Case Report, Bridgette M. Love, Deana Mercer, Amber West, Karen S. Santacruz, Elizabeth A. Mikola

UNM Orthopaedic Research Journal

Leprosy, also known as Hansen disease, is an uncommon chronic disease caused by the slowly growing acid-fast bacilli, Mycobacterium leprae. Leprosy has tropism for peripheral nerves and skin and can also be found in the upper respiratory tract, eyes, and nasal mucosa. When left untreated, there can be considerable nerve damage resulting in paralysis, blindness, and the crippling of hands and feet. Although infrequent in the United States, leprosy has been diagnosed in patients exposed to armadillos, an animal reservoir. We describe an 80-year-old man who presented with a 6-year history of chronic erythematous, macular rash, and progressive symmetric sensory …

Multiple Pterygium Syndrome With Severe Knee Flexion Contracture: A Case Report, Jory Wasserburger, Garrett Waller, Scott Plaster, David M. Bennett

UNM Orthopaedic Research Journal

Multiple pterygium syndrome, a subgroup of arthrogryposis multiplex congenita, is characterized by the webbing of different parts of the body. We describe a child who developed 140° flexion contractures of the popliteal fossa, which complicated mobility, skin care, and general hygiene. After seeking multiple opinions, the parents elected to proceed with through-knee amputation of both knees. At 6 month follow-up, the child had been fitted with bilateral prostheses and was able to ambulate with assistance. The findings of the current case suggest that in extreme cases of multiple pterygium syndrome, through-knee amputations may represent a predictable and functional treatment option …

Leukocytoclastic Vasculitis In A 66-Year-Old Woman After Fusion Of The Second Right Metatarsocuneiform Joint Using Titanium Plate And Screws: A Case Report, Sarah K. Brown, Christopher Kurnik, Emily M. Altman, Richard A. Miller

UNM Orthopaedic Research Journal

Metallic orthopaedic implants are known to instigate cutaneous reactions; however, the mechanism by which this occurs is not fully understood. Contact dermatitis after implantation of stainless steel fracture plates was first described in 1966, and similar reactions to various implants have been documented subsequently. Leukocytoclastic vasculitis (LCV) is an inflammatory condition of small dermal blood vessels resulting from neutrophil invasion, degranulation, and cell death caused by a type III hypersensitivity reaction. No studies have reported use of titanium orthopaedic implants resulting in LCV. We describe a 66-year-old woman who developed LCV after the fusion of her second right metatarsocuneiform joint …

Achilles Tendon Ruptures In Two Male Athletes In Ncaa Division I: Report Of Two Cases, Lisa Hardy, Michele Bliss, Garyn Worrall, James Slauterbeck

UNM Orthopaedic Research Journal

Major tendon ruptures are rare, with an Achilles tendon rupture (ATR) being the most frequent type. Reported cases most commonly involve male recreational athletes who have increased body mass indexes and are between ages 30 and 50 years. We describe two male athletes in Division I of the National Collegiate Athletic Association who underwent surgical repair for treating an ATR associated with running-related activities. In contrast to other cases, both patients had normal body mass indexes. These two cases identify high-level athletes who underwent operative Achilles tendon repair and returned to their sport at a similar level or high level …

Inclusion Body Myositis In A Middle-Aged Woman With Knee Pain And Weakness: A Case Report, Jacob Christensen, Christopher A. Mcgrew

UNM Orthopaedic Research Journal

Weakness and osteoarthritis are common concerns for orthopaedic and primary care physicians when caring for aging adults. We describe a 58-year-old woman with a history of Sjogren syndrome and knee osteoarthritis. She presented to our clinic for injection of viscosupplementation in her left knee, and review of her medical records revealed right hand weakness at 7 years after the onset of symptoms. Findings of muscle biopsy and multiple electromyograms revealed inclusion body myositis, primarily affecting the deep finger flexors and quadriceps muscles. On the basis of this diagnosis, physical therapy and supportive care were recommended. The results of the current …

An Uncommon Presentation Of Coxa Saltans: A Case Report, Christopher S. Bossart, Christopher A. Mcgrew, Rebecca A. Dutton

UNM Orthopaedic Research Journal

Coxa saltans, or “snapping hip,” refers to various conditions that produce a palpable or audible snapping of the hip after movement. We present an uncommon case of coxa saltans in a patient with a snapping proximal hamstring tendon. Findings of dynamic ultrasound evaluation were used to confirm the source of snapping, characterized by a lateral subluxation of the conjoint tendon over the ischial tuberosity. Our patient was treated nonoperatively, and we observed mild improvement of her symptoms. Few cases of similar pathological findings have been described, with varying causes of tendon instability. The results of the current case may help …

Use Of Titanium Mesh Cage In Treating A Subtrochanteric Defect: A Case Report, Lucas D. Winter, James A. Dollahite, Rick Gehlert

UNM Orthopaedic Research Journal

Titanium mesh cages have been used during fixation of segmental defects in long bones; however, use in the subtrochanteric region of the proximal femur is a novel application. We describe a 38-year-old, 330-lb man with a highly comminuted fracture about the right femur after a gunshot wound. Immediate treatment involved use of a cement spacer. Findings of follow-up imaging showed about 26° external rotational deformity and 2-cm limb shortening. To correct the rotational abnormality and limb length discrepancy, a cylindrical titanium mesh cage and custom-made femur locking plate with a cancellous bone autograft were used. Subsequently, successful bridging was obtained …

Understanding And Improving Patient Satisfaction In Orthopaedic Surgical Procedures: A Review, Paul J. Johnson

UNM Orthopaedic Research Journal

Orthopaedic surgeons and their hospitals are being evaluated and reimbursed according to their ability to provide patient satisfaction. It behooves physicians to learn how patient satisfaction is evaluated, how patient satisfaction may be improved, and how improvements in patient satisfaction may positively influence patient outcomes both subjectively and objectively. The purpose of this review is to illuminate how evaluation works, how patient factors may affect or correlate with increased satisfaction, and how physicians can improve actions to enhance patient satisfaction. Notably, studies have found that improved care coordination, nursing follow-up, provider listening skills, providing realistic yet positive expectations, and sitting …

Fracture Of The Ulnar Sesamoid Bone In The Thumb Of A Collegiate Basketball Player: A Case Report, Andrew M. Hyden, Christopher A. Mcgrew, Deana Mercer

UNM Orthopaedic Research Journal

Sesamoid fractures of the hand are uncommon occurrences that can lead to prolonged pain and swelling if delayed in diagnosis. This is particularly problematic in competitive athletes. We describe an ulnar sesamoid fracture of the thumb due to a blunt traumatic injury in a Division I collegiate basketball player. The 22-year-old woman injured her left thumb when kicked during a game. The patient was treated nonoperatively with promising outcomes. Sesamoid fractures of the hand can be difficult to diagnose, and any delay can lengthen the amount of time before the athlete returns to play. Radiographic findings may help healthcare providers …

Open Lumbosacral Dislocation: A Case Report, Travis M. Hughes, Tony G. Pedri, Antony Kallur

UNM Orthopaedic Research Journal

Open injuries in the lumbar spine are rare. We describe a 20-year-old woman who presented with persistent weaknesses due to an associated lumbar plexus injury. She underwent surgical treatment of lumbosacral dislocation with prompt reduction with debridement and stabilization. At 7 months postoperatively, her symptoms showed signs of recovery. We believe the immediate reduction of the dislocation prevented permanent neurological injury, and stabilization helped healing and early mobilization. In keeping with the classical teaching of open fracture treatment, prioritizing early initiation of intravenous antibiotics and prompt debridement and stabilization may have helped decrease the long-term morbidity and overall sequelae of …

Complete Great Toe Sesamoid Excision: A Case Series, James A. Dollahite, Benjamin D. Packard, Richard A. Miller

UNM Orthopaedic Research Journal

Background: Hallux sesamoids notably contribute to the biomechanics of the great toe. Although frequently ignored or forgotten, injury to the hallux sesamoids can be debilitating. Conservative management remains the initial approach for symptomatic sesamoid disorders, but surgical excision is an option. We performed a retrospective case series to examine the preoperative characteristics and postsurgical outcomes of patients who underwent great toe sesamoidectomy.

Methods: We reviewed medical records of patients who underwent great toe sesamoidectomy performed by a single surgeon (RAM) during a 10-year period (26 patients, 28 procedures). Data collected included smoking status, prior first ray surgical treatment, highlevel athlete …

Periprosthetic Joint Infections: A Review, Jay J. Wojcik

UNM Orthopaedic Research Journal

No abstract provided.

Biomechanical Strength And Bulk Comparisons Between The Open-Book Technique And The Pulvertaft Method For Peroneal Tendon Transfer: A Pilot Study, Matthew Blue, Christian Douthit, Adam N. Wooldridge, Austin Williams, Micah Lierly-Chick, Kerry Gilbert, Jerry Grimes

UNM Orthopaedic Research Journal

Background: The Pulvertaft method has classically been used for the transfer of various tendon injuries owing to its biomechanical strength; however, this method has been shown to be bulky. We describe the open-book technique, which can offer comparable structural integrity with a decreased bulk. The purpose of this study was to determine whether the openbook technique is biomechanically equivalent to the Pulvertaft method for treating peroneal tendon injuries.

Methods: We evaluated five pairs of human cadaveric ankles. Within each pair, one specimen was randomly assigned to either the Pulvertaft or the open-book group. Using sharp dissection, the tendons were severed …

Comparison Of Joint Compression And Pull- Out Strength Of 6.5-Mm Self-Drilling Screws With Headed And Headless In Subtalar Arthrodesis: A Pilot Study, Christian Douthit, Matthew Blue, Adam N. Wooldridge, Micah Lierly-Chick, Kerry Gilbert, Jerry Grimes

UNM Orthopaedic Research Journal

Background: In patients with degenerative osteoarthritis of the subtalar joint, surgical treatment can include subtalar arthrodesis. Notably, mechanical factors such as compression and pull-out strength contribute to successful union, which can be achieved through use of headed or headless cannulate screws. The purpose of this study was to compare the resultant joint compressive force and pull-out strength between use of a headless 6.5-mm self-drilling cannulated compression screw and a more traditional headed 6.5- mm self-drilling cannulated compression screw.

Methods: This study used the calcaneus and talus from six paired fresh frozen specimens. The soft tissues were stripped and the joint …

The Future Of Infection Surveillance At Ambulatory Surgical Centers, Jenna Godfrey, Jory Wasserburger, Scott Plaster, Susan Kellie, Julia Manweiler, Robert C. Schenck Jr

UNM Orthopaedic Research Journal

Background: The Centers for Medicare and Medicaid (CMS) has begun mandating infection surveillance at surgical sites, which started in hospitals and is now in ambulatory surgical centers (ASCs). We found a 0.1% increase in infection rate between 2005 and 2007, which prompted us to examine the issue further. The purpose of the current study was to summarize the results of an investigation after an outbreak of infection at our ASC, specifically attempting to identify a common pathogen, vector, or unknown lapses in infection prevention. Additionally, we relate our experience to current trends in infection prevention at ASCs by examining the …

Comparison Of Intraoperative Fluoroscopy To Postoperative Weight-Bearing Radiographs Obtained 4 To 6 Weeks After Bunion Repair With A Chevron Osteotomy, Amber L. Price, Travis M. Hughes, Christopher Kurnik, Christina G. Kurnik, Katherine J. Gavin, Richard A. Miller

UNM Orthopaedic Research Journal

Background: During operative treatment of bunions, an attempt is made to correct the hallux valgus angle (HVA) and the intermetatarsal angle (IMA). In this study, the HVA and the IMA were measured using intraoperative C-arm fluoroscopic images obtained during surgical treatment of a bunion with chevron osteotomy. These angles were again measured using weight-bearing radiographs obtained 4 to 6 weeks postoperatively.

Methods: At our institution, we reviewed medical records of patients who underwent a bunion repair with chevron osteotomy between January 2013 and October 2017. A total of 26 feet from 24 patients were included. Three authors (ALP, TMH, and …

Patient Compliance With Follow-Up After Open Reduction And Internal Fixation For Treating Malleolar Ankle Fractures: A Retrospective Review, Matthew G. Wharton, Christopher L. Shultz, Benjamin D. Packard, Jory Wasserburger, Katherine J. Gavin, Richard A. Miller

UNM Orthopaedic Research Journal

Background: Compliance with follow-up after orthopaedic procedures is variable and does not always occur as recommended. Various factors such as medical, financial, cultural, and logistical reasons may contribute to this lack of compliance. The purpose of this study was to determine follow-up compliance of patients who had undergone open reduction and internal fixation (ORIF) for treating closed malleolar ankle fractures.

Methods: Medical records of patients who underwent ORIF for treating closed malleolar ankle fractures by the senior author (RAM) were reviewed to evaluate compliance with postoperative follow-up (n = 267). Inclusion criteria were patients with isolated, acute, closed fractures (n …

Accuracy And Reliability Of Examiners’ Observations Of Pre-Practice Warm-Up And Fifa 11+ Injury Prevention Program Exercises, James R. Slauterbeck, Pamela M. Vacek, Rebecca Choquette, Tessa Kettelkamp, Autumn Reilly, Brandon Lentine, Bruce D. Beynnon

UNM Orthopaedic Research Journal

Background: The Fédération Internationale de Football Association (FIFA) 11+ is an injury prevention program that decreases the incidence of lower extremity injuries. The purpose of the current study was to understand what specific exercises prevented injury from occurring. We thus developed and tested a form to identify these exercises. We hypothesize that trained examiners could accurately and reliably use this form to identify and record individual exercises performed during preparticipation warm-up.

Methods: A repeated-measures study design was used in this investigation. After observing five prepractice warm-up videos obtained from multiple high schools, 11 examiners observed and recorded performed exercises at …

Comparison Of Narcotic Prescribing Habits Between Trainee And Attending Orthopaedic Surgeons, Christopher L. Shultz, Ryan C. Price, Brett S. Mulawka, Dustin L. Richter, Gehron P. Treme

UNM Orthopaedic Research Journal

Background: Orthopaedic surgeons are among the highest prescribing physicians of narcotics to opioidnaïve patients. Despite the current opioid epidemic, few studies have specifically quantified the appropriate amount of opioids necessary for postoperative pain control. We hypothesized a significant variability in the quantity of postoperative opioids prescribed among trainee (ie, residents and fellows) and attending surgeons at a single institution.

Methods: Postoperative narcotic prescribing habits were assessed using an anonymous survey. Ultimately, 28 trainee physicians and 17 attending physicians responded to the survey (86.5%). The survey recorded the amount of 5-mg oxycodone tablets that were commonly prescribed to manage pain after …

Design For Transtibial Modifiable Socket For Immediate Postoperative Prosthesis, Matthew N. Rush, Evan Hagin, Jane Nguyen, Victoria Lujan, Rebecca A. Dutton, Christina Salas

UNM Orthopaedic Research Journal

Amputations are long-standing surgical procedures that have been performed for centuries; however, very little attention and urgency have been given to immediate restoration of movement and return to a normal lifestyle. In many cases, the time between amputation and prosthetic fitting can pause recovery and development of new routines. To increase recovery, immediate postoperative prostheses (IPOPs) have been developed yet these are under-utilized because of concerns for wound healing and complications with vascular diseases. Subsequently, we designed a transtibial IPOP that utilizes an ergonomic modifiable socket that allows for examination, wound care, and in situ edema control. Additionally, the IPOP …

Reflections On Sports Medicine Fellowship Applications, Christopher L. Shultz

UNM Orthopaedic Research Journal

No abstract provided.

Technique Of Proximal Pole Scaphoid Fracture Fixation Using A Retrograde Pin Placement But Antegrade Screw Placement: A Case Example, Sirikrishna K. Khalsa, Camille Aubin-Lemay, Deana Mercer

UNM Orthopaedic Research Journal

The scaphoid is the most commonly fractured bone of the carpal row. Because of its precarious blood supply, scaphoid fractures are predisposed to avascular necrosis (AVN) and nonunion. This is especially true with fractures of the proximal pole. To decrease the risk of nonunion and AVN, surgical treatment of proximal pole scaphoid fractures is recommended, which facilitates fracture consolidation and long-term wrist function. We describe a 16-year-old adolescent boy who presented with a fracture of the proximal pole of the scaphoid, initially managed nonoperatively. Subsequent imaging findings revealed nonunion of the scaphoid bone. For treatment, a percutaneous fixation was chosen …