Orthopedics Commons^™

Tja Patient Demographic Before And After Covid-19 Elective Surgery Restrictions, Morgan Mccoy, Natalie C. Touchet, Anna Cohen-Rosenblum, Andrew Chapple

Medical Research Day

Background: Total joint arthroplasty (TJA) includes total hip (THA) and total knee arthroplasty (TKA). In 2020, the COVID-19 pandemic caused cessation of non-emergent TJA operations between mid-March and April 2020. The purpose of this study is to analyze effects and potential disparities in access to care due to the COVID-19 restrictions. Methods: A database was used to examine demographics of patients undergoing TJA from May-December 2019 (Pre-COVID-19) and May-December 2020 (Post-COVID-19 restrictions). Categorical covariates were summarized by reporting counts and percentages and compared using Fisher exact tests. Continuous covariates were summarized by reporting means and standard deviations. Two-sample t-tests were …

Traumatic Anterior Shoulder Dislocation With Concomitant Pectoralis Rupture And Bankart Lesion, Alayna Vaughan, Tyler Luthringer, Joseph Abboud

Rothman Institute Faculty Papers

Traumatic anterior shoulder dislocation is frequently associated with injury to the static soft tissue stabilizers of the glenohumeral joint, with the most common injury being an anterior inferior labral avulsion (Bankart lesion) in 73% of patients after a first time dislocation1. Bony injury can also occur from a single episode of instability. Glenoid rim fractures occur in 5.4%-11% of patients. Greater tuberosity fractures occur in 12%-15% in primary anterior shoulder dislocations. Hill-Sachs lesions occur in 38%-90% of primary anterior shoulder dislocations. Less commonly there can be vascular and nerve injury. Additionally, in patients over the age of 40, rotator cuff …

Clinical Practice Guidelines: The Road Map To Better Care, Mary I. Fisher

Physical Therapy Faculty Publications

Systematic reviews and meta-analyses are important tools in translating research evidence into clinical practice as they critically evaluate and summarize the body of evidence on clinical topics. Clinicians can use these studies to quickly survey the current literature base to increase understanding of a clinical diagnosis they make, with the intent of using this information to improve their clinical practice. A well-written systematic review or meta-analysis, with critical evaluation of study quality, is then that Cliffs Note version of what to know and what to do. Therefore, with the proliferation of systematic reviews and meta-analyses, we should see a corresponding …

Venous Thromboembolism In Musculoskeletal Oncology Surgery, Ahna Donahue, Keenan Sobol, John A. Abraham

Rothman Institute Faculty Papers

Abstract

Venous thromboembolism (VTE), including both deep venous thrombosis (DVT) and pulmonary embolism (PE), is a major complication of musculoskeletal surgery in general, and the risk is heightened in musculoskeletal oncology surgery. Despite the well-known association between cancer and VTE, the mechanism promoting this pathology is not entirely well understood. It is estimated that nearly all cancer patients will experience from some form of VTE, whether or not clinically relevant, during the course of their disease. Nonetheless, numerous studies have analyzed the occurrence and prevention of VTE in patients with cardiovascular disease or suffering trauma, but very few have specifically …

Larger Perioperative Opioid Prescriptions Lead To Prolonged Opioid Use After Hand And Upper Extremity Surgery: A Multicenter Analysis, Clay B Townsend, Justin A Ly, Ryan Judy, Matthew Sherman, Nick Elmer, Christine Conroy, Hesham M Abdelfattah, Mark K Solarz, Katharine Woozley, Asif M Ilyas

Rothman Institute Faculty Papers

Introduction: The opioid epidemic remains an ongoing public health crisis. The purpose of this study was to investigate whether surgeons' prescribing patterns of the initial postoperative opioid prescription predispose patients to prolonged opioid use after upper extremity surgery.

Methods: This multicenter retrospective study was done at three academic institutions. Patients who underwent carpal tunnel release, basal joint arthroplasty, and distal radius fracture open reduction and internal fixation over a 1.5-year period were included. Opioid prescription data were obtained from the Pennsylvania Prescription Drug Monitoring Program website.

Results: Postoperatively, 30.1% of the patients (191/634) filled ≥1 additional opioid prescription, and 14.0% …

Failure Factors For Carpal Tunnel Syndrome Surgical Treatment: When And How To Perform A Revision Carpal Tunnel Decompression Surgery, Carlos Henrique Fernandes, João Baptista Gomes Santos, Francisco Schwartz-Fernandes, A. Lee Ostermann, Flávio Faloppa

Department of Surgery Faculty Papers

Despite being a procedure widely used all over the world with high rates of symptom remission, surgical treatment of carpal tunnel syndrome may present unsatisfactory outcomes. Such outcomes may be manifested clinically by non-remission of symptoms, remission of symptoms with recurrence a time after surgery or appearance of different symptoms after surgery. Different factors are related to this unsuccessful surgical treatment of carpal tunnel syndrome. Prevention can be achieved through a thorough preoperative clinical evaluation of the patient. As such, the surgeon will be able to make differential or concomitant diagnoses, as well as determine factors related to patient dissatisfaction. …

Determination Of The Protective Capacity Of Hand Wraps In Combat Athletes Using Force Analysis, Eva M. Gusnowski

Electronic Thesis and Dissertation Repository

Upper extremity injuries are common in combat athletes, and are highest in the hand/wrist. Although protective hand gear is used, there is a paucity of research investigating its effectiveness. This study addressed this knowledge gap by measuring the level of force transmitted to the hand during striking using two types of hand wraps. This prospective cross over study included six combat athletes. A load cell was placed over the proximal phalanges/metacarpophalangeal joints and was used to measure sustained peak force during striking while covered with either standard linear or gel-reinforced hand wraps and boxing gloves. The gel reinforced wraps consistently …

Short-Term Pain Outcomes In Robotic Versus Manual Total Hip Arthroplasty, Brienne Paradis Oms3, Andrea M. Bodine Md

Advances in Clinical Medical Research and Healthcare Delivery

Background: Four-hundred-fifty-thousand patients annually undergo total hip arthroplasty (THA) in the United States. THA has been shown to alleviate pain, restore function, and improve quality of life. Manual implant postoperative complications have led to a need for more advanced technology. Robotic assisted THA has the potential for greater accuracy in component positioning compared to manual. Comparing robotic and manual THA, significant differences have been shown in hip-specific functional outcomes, component positioning, complications, and patient-centered outcomes. The effects of these techniques on differences from baseline pain have yet to be investigated.

Methods: A retrospective review of the Berkshire Medical Center electronic …

How Does Spinopelvic Alignment Influence Short-Term Clinical Outcomes After Lumbar Fusion In Patients With Single-Level Degenerative Spondylolisthesis?, Stephen Dimaria, Brian A. Karamian, Mark J. Lambrechts, Arun P. Kanhere, John J. Mangan, Winston W. Yen, Arlene Maheu, Mahir A. Qureshi, Jose A. Canseco, David L. Kaye, Barrett I. Woods, Mark F. Kurd

Rothman Institute Faculty Papers

Context: Studies on adult spinal deformity have shown spinopelvic malalignment results in worse outcomes. However, it is unclear if this relationship exists in patients with single‑level degenerative spondylolisthesis (DS) receiving short‑segment fusions.

Aims: To determine if spinopelvic alignment affects patient‑reported outcome measures (PROMs) after posterior lumbar decompression and fusion (PLDF) with or without a transforaminal lumbar interbody fusion in patients with L4‑5 DS.

Settings and Design: A retrospective cohort analysis was conducted on patients who underwent PLDF for L4‑5 DS at a single tertiary referral academic medical center.

Materials and Methods:Patients were divided into groups based on preoperative cutoff …

Next-Generation Sequencing Supports Targeted Antibiotic Treatment For Culture Negative Orthopedic Infections, Ravina Kullar, Emanuele Chisari, James Snyder, Christopher Cooper, Javad Parvizi, Jason Sniffen

Rothman Institute Faculty Papers

The isolation of an infective pathogen can be challenging in some patients with active, clinically apparent infectious diseases. Despite efforts in the microbiology lab to improve the sensitivity of culture in orthopedic implant-associated infections, the clinically relevant information often falls short of expectations. The management of peri-prosthetic joint infections (PJI) provides an excellent example of the use and benefits of newer diagnostic technologies to supplement the often-inadequate yield of traditional culture methods as a substantial percentage of orthopedic infections are culture-negative. Next-generation sequencing (NGS) has the potential to improve upon this yield. Bringing molecular diagnostics into practice can provide critical …

Review: Management Of Midshaft Clavicle Fractures In Adolescents , Matthew B. Holloway

Longitudinal Scholar's Project

Clavicle fractures are common injuries that occur across all age ranges, but are largely seen in young, active males. The majority of these fractures (70-80%) occur in the midshaft of the clavicle. The purpose of this review was to compare non-operative treatment to operative treatment of midclavicular fractures and determine whether treatment for adolescent clavicle fractures more closely aligns with pediatric or adult management. Adolescent clavicle fractures are increasingly treated with open reduction and internal fixation, especially in the 15 to 19 age group. Nevertheless, there remains a lack of high-level studies comparing outcomes of operative and conservative treatment specifically …

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 …

Pediatric Supracondylar Humeral Fractures: Epidemiology And Mechanisms Of Injury During The Covid-19 Pandemic, Dan Cohen, Jeffrey Kay, Mohammed Shehab, Darren De Sa, Devin C. Peterson, Waleed Kishta

Western Journal of Orthopaedics

Background: The purpose of this study was to evaluate the impact of the COVID-19 pandemic activity restrictions on pediatric supracondylar humerus fracture epidemiology in terms of both mechanism of injury and fracture patterns.

Methods: This was a retrospective chart review of all patients presenting with types II-IV supracondylar humerus fractures between March 15^th and June 30^th 2020 at the McMaster University Medical Centre. Data were collected from our secure electronic medical records for information on patient demographic data, mechanism of injury, operative reports and imaging. 5 treating surgeons independently analyzed each patient’s radiographs and classified them according …

Screening And Assessment Of Cancer-Related Fatigue: An Executive Summary And Road Map For Clinical Implementation, Joy C. Cohn, Shana Harrington, Jeannette Lee, Daniel Malone, Mary I. Fisher

Physical Therapy Faculty Publications

Background: Cancer-related fatigue (CRF) prevalence is reported as high as 90%. Cancer-related fatigue is multidimensional and associated with lower health-related quality of life. Effective screening and assessment are dependent upon use of valid, reliable, and clinically feasible measures. This Executive Summary of the Screening and Assessment of Cancer-related Fatigue Clinical Practice Guideline provides recommendations for best measures to screen and assess for CRF based on the quality and level of evidence, psychometric strength of the tools, and clinical utility.

Methods: After a systematic review of the literature, studies evaluating CRF measurement tools were assessed for quality; data extraction included psychometrics …

Unsupervised Home Exercises Versus Formal Physical Therapy After Primary Total Hip Arthroplasty: A Systematic Review, Yash P. Chaudhry, Hunter Hayes, Zachary Wells, Efstratios Papadelis, Alfonso Arevalo, Timothy Horan, Harpal S Khanuja, Carl Deirmengian

Orthopedic Surgery Resident Research

Historically, postoperative exercise and physical therapy (PT) have been viewed as crucial to a successful outcome following primary total hip arthroplasty (THA). This systematic review and meta-analysis aimed to assess differences in both short- and long-term objective and self-reported measures between primary THA patients with formal supervised physical therapy versus unsupervised home exercises after discharge. A search was conducted of six electronic databases from inception to December 14, 2020, for randomized controlled trials (RCTs) comparing changes from baseline in lower extremity strength (LES), aerobic capacity, and self-reported physical function and quality of life (QoL) between supervised and unsupervised physical therapy/exercise …

Arthroscopic Suprapectoral Biceps Tenodesis: The Best Of Both Worlds, Tyler Pratte, Tyler Smith, Alfonso Arevalo, Joseph Wazen, David Rubenstein

Orthopedic Surgery Resident Research

Biceps tendinopathy and superior labrum anterior posterior lesions are a common source of shoulder pain and disability and can be effectively treated with biceps tenodesis. There are a variety of open and arthroscopic tenodesis techniques, but no one technique has demonstrated superiority. Arthroscopic techniques often disregard the extra-articular portions of the biceps tendon as a potential source of pain. Open techniques address this concern; however, they can be associated with wound complications, increased blood loss, nerve injury, and disruptions to surgical workflow. Here, we describe an all arthroscopic tenodesis technique at the suprapectoral zone of the tendon. This method addresses …

Open Repair Of Complete Proximal Hamstring Avulsions In Workers' Compensation Patients, Emma E Johnson, Joseph M Brutico, Lasya Rangavajjula, Yuwei Xia, Ryan W Paul, Peters Otlans, Justin W Arner, Sommer Hammoud, James P Bradley, Steven B Cohen

Rothman Institute Faculty Papers

Background: Several studies have reported excellent results after surgical repair of proximal hamstring avulsions. However, the effect on these patients of receiving workers' compensation has not yet been explored.

Hypothesis: Workers' compensation patients undergoing proximal hamstring repair of complete tears will have similar outcomes when compared with a matched control group of non-workers' compensation patients.

Study Design: Cohort study; Level of evidence, 3.

Methods: Workers' compensation patients who underwent complete proximal hamstring avulsion open repair between 2010 and 2019 were identified (WC group). A control group was matched by age (±3 years), sex, and body mass index (BMI; ±3). Demographics …

Periprosthetic Knee Infection After Benign Tumor Excision Complicated By Carbapenem Resistant Enterobacteriaceae: A Case Report, Jennifer Adams, Daniel Habenicht, Duncan C. Ramsey

MEDI 9331 Scholarly Activities Clinical Years

Introduction

Periprosthetic joint infection (PJI) is a major complication after total knee arthroscopy. Enterobacter is a rare cause of PJI.

Case presentation

We present a 65 year old Caucasian man who presented with acute right knee PJI with Carbapenem-resistant Enterobacteriaceae (CRE) two months after undergoing right knee intra-articular mass removal with endoprosthetic reconstruction. The periprosthetic joint infection (PJI) was treated with revision with 1-stage static spacer and IV meropenem.

Discussion

CRE is an uncommon cause of PJI, but when it does occur, it commonly infects patients who are immunosuppressed or have specific risk factors. For an immunocompetent patient with CRE …

Biomechanical Characterization Of Semi-Rigid Constructs And The Potential Effect On Proximal Junctional Kyphosis In The Thoracic Spine, Chloe Cadieux

Electronic Thesis and Dissertation Repository

Long spinal fusions are the mainstay of treatment in adult spinal deformity; however, proximal junctional kyphosis (PJK) is a common and potentially catastrophic complication that can occur following this procedure. It has been hypothesized that using semi-rigid constructs at the superior aspect of the instrumentation may decrease this complication. The objective of this thesis was to determine if there is a biomechanical advantage between various semi-rigid constructs utilized in long spinal fusions to help decrease the risk of PJK. Nine human cadaveric spines (T1 – T12) instrumented with the standard all-pedicle-screw construct (APS) were compared to various semi-rigid constructs including …

'Empty Toe' Phenomenon: A Unique Trauma Case, Sadaf Sheikh, Junaid Khan, Rizwan Haroon Rashid

Section of Orthopaedic Surgery

No abstract provided.