Effects Of Coronavirus (Covid-19) Pandemic On Orthopedic Residency Program In The Seventh Largest City Of The World: Recommendations From A Resource-Constrained Setting, Marij Zahid, Syed Arif Ali, Naveed Baloch, Shahryar Noordin

Section of Orthopaedic Surgery

The coronavirus (COVID-19) pandemic has hit the entire world hard. Since its inception from Wuhan China the whole world is affected now. Health care facilities and workers are overwhelmed and the situation is changing on daily basis. With the changes in the dynamics of the hospitals, residency and fellowships training programs have also suffered undoubtedly. Due to decreased elective cases and outpatient clinics surgical training gets compromised, however on the other side this physical distancing and isolation have proven to be effective measures in controlling the disease. In this article we share our experience of effect of COVID-19 pandemic on …

Femoral Diaphysis Fracture In A Collegiate Male Hockey Player: A Case Report, Matthew Bain, James Slauterbeck

Western Journal of Orthopaedics

Femoral diaphysis fractures represent a small subset of sports-related orthopaedic trauma, accounting for less than 1% of all sports fractures. We describe a 22-year-old male ice hockey player who slid and crashed into the boards during practice. Radiographs revealed fracture of the femoral diaphysis, necessitating surgical intervention to insert an intermedullary nail. Rehabilitation was a hybrid of an anterior cruciate ligament reconstruction and hip labrum repair protocols. There was emphasis on rotator cuff strengthening and lower-extremity rehabilitation owing to a pre-existing shoulder dislocation that occurred during the same season. He returned to skating at 16 weeks, and at 20 weeks …

Arthroscopic Management Of Focal Pigmented Villonodular Synovitis In The Scaphotrapeziotrapezoidal Joint, John E. Nolan, Brian W. Gross, Nathan T. Morrell

Western Journal of Orthopaedics

A 43-year-old man presented with persistent wrist pain and loss of range of motion after nonoperative therapy. Magnetic resonance imaging showed features consistent with pigmented villonodular synovitis (PVNS) of the scaphotrapeziotrapezoidal joint. He underwent arthroscopic excision and synovectomy. At 2 years postoperatively, he had no symptomatic recurrence. This case shows the importance of considering PVNS for chronic pain of small joints, and it highlights the viability for arthroscopic synovectomy as a treatment option.

Measurement Of Femoral Notch Type Show Low Inter-Rater Reliability, Evan D. Boyd, Michael S. Barnum, James R. Saluterbeck, Pamela M. Vacek

Western Journal of Orthopaedics

Background: Preventing first time anterior cruciate ligament (ACL) injury and the devastating sequela of post-traumatic osteoarthritis in the young athlete has attracted efforts to identify risk factors for development of ACL injury. Femoral notch type has been related to risk of ACL injury in previous studies. However, little data exists to support the reliability of assessing this qualitative measurement amongst independent investigators. Methods: Femoral notch type was measured from magnetic resonance imaging sections of 344 injured ACL and control knees by three investigators with different levels of professional experience. Inter-rater reliability was assessed using Cohen’s kappa statistic. Results: The simple …

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 …

Acute Opioid Withdrawal Mimicking Postoperative Joint Infection Following Anterior Cruciate Ligament (Acl) Reconstruction: A Case Report., Qingwu Kong, Martin Griffis, Brandon J Shallop, Amrit S Khalsa, Kyle Brougham, Paul A Marchetto

Department of Orthopaedic Surgery Faculty Papers

BACKGROUND A short course of opioid narcotics is often prescribed for postoperative anterior cruciate ligament (ACL) reconstruction pain management. Unfortunately, there is a well-documented incidence of opioid withdrawal syndrome (OWS) following short-term use of these medications. OWS can present with symptoms such as influenza-like illness. It is important to differentiate OWS from infectious illnesses, especially after surgery. CASE REPORT We present a case of OWS in a patient who underwent ACL reconstruction 7 days prior. The patient's OWS symptoms were similar to symptoms of a postoperative infection. The knee was aspirated, and the analysis of the aspirate was not concerning …

Seasonal Influence On Postoperative Hip Fracture Complications: Retrospective Cohort Of More Than 1000 Patients From A Tertiary-Care University Hospital, Obada Hasan, Mashal Amin, Fatima Mahmood, Amna Rabbani, Umar Rabbani, Shahryar Noordin

Department of Paediatrics and Child Health

Background: Hip fractures account for one of the most debilitating conditions affecting the general population amongst the developed and developing nations. Investigators aimed to study the influence of the ongoing season i.e. whether patients operated upon in summer or winter, on post-operative complications occurring within 30 days of surgical procedure for hip fractures at a tertiary care hospital and level 1 trauma center.
Materials and methods: Investigators conducted a non-funded, non-commercialized retrospective cohort of 1045 patients with hip fractures managed surgically. Primary exposure was surgical procedures undertaken during the summer months (April-September). Our primary outcome was determining post-operative complication rates …

The Effect Of Critical Shoulder Angle On Functional Compensation In The Setting Of Cuff Tear Arthropathy., Jeffrey Lu, Manan Patel, Joseph A. Abboud, John G. Horneff

Rothman Institute Faculty Papers

Introduction: Critical shoulder angle (CSA) has been shown to influence rates of rotator cuff tears and glenohumeral arthritis with a larger CSA associated with rotator cuff tears and a smaller CSA associated with glenohumeral arthritis. There has been no study to determine whether such radiographic measurement influences the function of patients with demonstrated cuff tear arthropathy (CTA). The purpose of this study was to examine whether smaller CSAs were associated with greater range of motion (ROM) in patients diagnosed with CTA.

Materials and methods: Ninety-three patients with a diagnosis of CTA with adequate anteroposterior shoulder radiographs were included in the …

Do New Trainees Pose A Threat To Postoperative Complications After Hip Fracture Surgeries? Retrospective Cohort Of 1045 Patients Over A Decade At A University Hospital, Obada Hasan, Mashal Amin, Umar Rabbani, Amna Rabbani, Fatima Mahmood, Shahryar Noordin

Department of Paediatrics and Child Health

Introduction: Induction of new residents and surgical trainees in most institutes occurs once a year. Fresh residents with no experience, may pose a threat to the surgical procedure outcome and there can be a potential increase in patients' morbidity and mortality as a result of this turnover. Literature is inconclusive about this effect. Our aim was to study the "new residents' induction effect" on postoperative complications after hip fracture surgeries.
Methodology: This is non funded non commercialized study from a university hospital. Investigators studied a retrospective cohort of 1045 adult hip fracture patients who were operated at our tertiary care …

Effectiveness Of Home-Based Rehabilitation Program In Minimizing Disability And Secondary Falls After A Hip Fracture: Protocol For A Randomized Controlled Trial, Anum Sadruddin Pidani, Saniya Sabzwari, Khabir Ahmad, Ata Khan, Shahryar Noordin

Department of Surgery

Introduction: Hip fractures are a major health problem globally and are associated with increased morbidity, mortality, and substantial economic costs. Successful operative treatment of hip fracture patients is necessary for the optimization of post-op mobility and functional recovery of the patient. Rehabilitation after surgical stabilization of a hip fracture is crucial in order to restore pre-fracture function and to avoid long-term institutionalization. In particular ongoing exercise which targets balance can prevent up to 40% of falls. Therefore, we have designed a post-discharge home-based physical rehabilitation intervention program to minimize disability and falls in this high-risk elderly population.
Methods and analysis: …

Synergistic Effects Of Non Contact Induction Heating & Antibiotics On Staphylococcus Aureus Biofilm, Rajeshwar Singh Sidhu

Electronic Thesis and Dissertation Repository

Staphylococcus aureus is a major cause of prosthetic joint infection (PJI) in which it forms adherent biofilms, thick aggregates of extracellular polymeric substances (EPS) produced by the bacteria. Biofilm associated infections are difficult to treat as they have increased resistance to various antimicrobial agents, which means infected implants often require multiple procedures and prolonged antibiotic therapy. However, a new and emerging method of treatment of PJI is non-contact induction heating (NCIH) of metal implants. We sought to investigate the feasibility and effectiveness of NCIH along with synergistic effects of antibiotics (Vancomycin) in reducing bacterial load within surface associated biofilms in …

Low-Intensity Continuous Ultrasound For The Symptomatic Treatment Of Upper Shoulder And Neck Pain: A Randomized, Double-Blind Placebo-Controlled Clinical Trial, Stephanie Petterson, Kevin Plancher, Dominic Klyve, David Draper, Ralph Ortiz

All Faculty Scholarship for the College of the Sciences

Purpose: Low-intensity continuous ultrasound (LICUS) is an emerging high-dosimetry ultrasound-based therapy for accelerated tissue healing and the treatment of myofascial pain. In this study, LICUS treatment is clinically evaluated for chronic upper neck and shoulder pain in a randomized, multi-site, double-blind, placebo-controlled study. Patients and Methods: CONSORT guidelines were followed in conducting and reporting the clinical trial. Thirty-three participants with upper trapezius myofascial pain were randomized for treatment with active (n=25) or placebo (n=8) devices. Investigators and subjects were blinded to treatment groups. Participants self-reported pain daily, rating from 0– 10 on the numeric rating scale. If pain rating was …

An Investigation Of Stress-Related Factors And Injury Occurrence In Division Iii Ice Hockey Athletes 2020., Christian Kiesel

Master's Theses

Many variables can factor into a student athlete sustaining an injury, but one of the most interesting is stress. The Stress and Injury Model is excellent in explaining how exactly history of stressors, personality, and coping mechanisms play a pivotal role in the stress response. If these three factors cause a negative stress response, then that will lead to an athlete becoming more likely to become injured. This study used 40 ice hockey players from a Division III NCAA institution. Each participant completed the Inventory of College Students’ Recent Life Experiences (ICSRLE) and Pittsburgh Sleep Quality Index (PSQI) every month …

Secukinumab Provides Sustained Low Rates Of Radiographic Progression In Psoriatic Arthritis: 52-Week Results From A Phase 3 Study, Future 5., Désirée Van Der Heijde, Philip Mease, Robert B M Landewé, Proton Rahman, Hasan Tahir, Atul Singhal, Elke Boettcher, Sandra Navarra, Xuan Zhu, Gregory Ligozio, Aimee Readie, Shephard Mpofu, Luminita Pricop

Articles, Abstracts, and Reports

OBJECTIVE: To evaluate the effect of secukinumab on radiographic progression through 52 weeks in patients with PsA from the FUTURE 5 study.

METHODS: Patients with active PsA, stratified by prior anti-TNF use (naïve or inadequate response), were randomized to s.c. secukinumab 300 mg load (300 mg), 150 mg load (150 mg), 150 mg no load regimens or placebo at baseline, at weeks 1, 2 and 3 and every 4 weeks starting at week 4. Radiographic progression was assessed by change in van der Heijde-modified total Sharp score (vdH-mTSS; mean of two readers). Statistical analysis used a linear mixed-effects model (random …

An Analysis Of Patients Undergoing Hip And Knee Arthroplasties In An Accountable Care Organization, Harjot Uppal

Honors Theses

Background. Total hip arthroplasty (THA) and total knee arthroplasty (TKA) are commonly performed procedures, with over one million executed each year in the United States (U.S.) (Steiner et al., 2012). By 2030, THA and TKA are projected to become the most frequently performed elective surgical procedures in the U.S. (Cram et al., 2012; Kurtz et al., 2009). Many of the previous studies on THA and TKA procedures have focused on women, primarily because they are at increased risks of developing knee osteoarthritis and sustaining hip fractures (Cummings et al., 1990; Hedlund et al., 1987; Hinton et al., 1995; Myers et …

Medial Femoral Condyle Vascularized Bone Graft For Treatment Of Midshaft Clavicle Recalcitrant Nonunion With Use Of The Transverse Cervical Artery As An Anastomosis., Christopher M Belyea, Jefferson L Lansford, Joseph B Golden, Emily H Shin, Rey D L Gumboc

Articles, Abstracts, and Reports

Vascularized medial femoral condyle bone grafts have been reported to be a reliable treatment for recalcitrant bony nonunions of the extremities. Although clavicle fracture nonunions are rare after treatment with open reduction internal fixation, symptomatic nonunions can be a challenge. The medial femoral condyle vascularized bone graft has been described as a treatment option for clavicle nonunions with the thoracoacromial trunk as the recipient anastomosis site. This case illustrates how the transverse cervical artery and accompanying veins can be used as an anastomosis when the thoracoacromial trunk is inaccessible because of previous surgical- and infection-related scaring. At the final follow-up, …

Frailty And Post-Operative Outcomes In Adult Hip Fracture Patients, Melissa Yager

Dissertations

Abstract

Background/ Purpose: The majority of adult hip fracture patients never return to their pre-fracture functional level and have a poor quality of life (Kistler, Nicholas, Kates, & Friedman, 2015; Pioli et al., 2016; Sheehan et al., 2018). The prevalence of frailty in adult hip fracture patients is estimated at 51%. Frail patients with hip fractures are twice as likely to have a complication (Kistler et al., 2015). Extant studies have examined frailty and hip fractures independently, nonetheless, a gap in the literature exists with few investigations of the connection between frailty and post-operative outcomes after hip fracture. The purpose …

Right Arm Pain, Color Change And Swelling In A 17-Year-Old Male Baseball Pitcher, Alvin Chi

Research Days

No abstract provided.

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 …

The National Burden Of Orthopedic Injury: Cross-Sectional Estimates For Trauma System Planning And Optimization, Molly P. Jarman, Michael J. Weaver, Adil H. Haider, Ali Saleem, Mitchel B. Harris

Department of Surgery

Background: Management of orthopedic injuries is a critical component of comprehensive trauma care. As patterns of injury incidence and recovery change in the face of emerging injury prevention efforts and technologies and an aging US population, assessment of the burden of orthopedic injury is essential to optimize trauma system planning. We sought to estimate the incidence of orthopedic injury requiring emergency orthopedic surgery in the United States.
Methods: Using nationally representative samples from the Agency for Healthcare Research and Quality Healthcare Cost and Utilization Project, we estimated the incidence of orthopedic injury, polytrauma with orthopedic injury, and emergency operative orthopedic …