Digital Commons Network^™

Infection Rates In Gunshot-Related Hand Fractures Treated Nonoperatively, T. Kyle Summers, Ian Garrison, Matthew C. Watterson, Brandon Barnes, Charles Rodriguez-Feo

Western Journal of Orthopaedics

Background: Firearm-associated injuries in the U.S. represent a major public health crisis, contributing substantially to major levels of morbidity, mortality, and economic stress. Recommendations for the management of gunshot-related hand fractures remain limited, particularly in low-velocity injuries, and current guidance often leaves treatment decisions to the discretion of the operating surgeon. Methods: A retrospective analysis was performed to identify phalangeal and metacarpal fractures at a Level I trauma center from 2017 to 2023, resulting in 579 patients. Only fractures resulting from firearm injuries were included, resulting in 56 patients. Infection rates were observed in patients treated nonoperatively and those treated …

Increased Mortality And Reduced Survival In Nonagenarians With Hip Fractures: Implications For Geriatric Care, Roman Austin, Julio Avila, Audrey Wassef, Kate Parker, Katherine Gavin

Western Journal of Orthopaedics

Background: Hip fractures in nonagenarians (patients aged ≥ 90 years) are becoming increasingly common as the population ages, yet outcomes in this group remain poorly characterized. This study compared in-hospital mortality and survivorship at three months, six months, and one year after hip fracture surgery in nonagenarians with a younger elderly cohort aged 65 years to 89 years. Secondary outcomes included fracture characteristics, surgical management, and discharge disposition. Methods: A retrospective chart review was conducted on patients who underwent hip fracture surgery at a single Level I Trauma Center from August 2019 to December 2021. Patients were grouped into nonagenarians …

Massive Upper Extremity Neurofibroma Treated With Limb-Sparing Debulking: A Case Report, Danielle Cummings, Tomas Holy, Nathan Morrell

Western Journal of Orthopaedics

Surgical management of neurofibromas in Neurofibromatosis type 1 (Von Recklinghausen’s disease), can be challenging because tumor size, location, hypervascularity, and tissue friability pose the risk for significant intraoperative and postoperative blood loss. Despite these risks, surgery is often necessary because of functional losses or cosmetic concerns. The authors present a 31-year-old woman with a massive neurofibroma on her right distal forearm, wrist, and hand, who ultimately underwent surgical resection because of functional impairment of her hand. She required postoperative hospitalization and blood transfusion for management of acute blood loss anemia. Because of concerns regarding blood loss and surgical morbidity, the …

Median Nerve Intraneural Hematoma As An Intraoperative Finding During Carpal Tunnel Release: A Case Report, Ana Silva, Gil Gonrtre, Nikalus Skipp, Ana Love, Deana Mercer

Western Journal of Orthopaedics

Carpal tunnel syndrome (CTS) is the most common compressive neuropathy and typically progresses slowly. Intraoperatively, flexor tenosynovitis, nerve edema, or hourglass deformity may be observed. In rare cases, acute compression symptoms occur due to mass effect on the nerve. Intraneural hematoma of the median nerve is uncommon and has been reported primarily in acute CTS cases associated with trauma. This report describes an 87-year-old patient with a history of mild CTS who underwent carpal tunnel release due to worsening symptoms. After the initial incision, a thickened flexor retinaculum, an hourglass deformity of the median nerve, and an intraneural hematoma were …

Proximal Iliotibial Band Rupture In A 74-Year-Old High-Level, Female Athlete: A Case Report, Jeremiah M. Langsfeld, Joseph Esquibel, Dustin L. Richter

Western Journal of Orthopaedics

A 74-year-old female endurance athlete presented with progressive pain over the left proximal and lateral hip distal to the iliac crest. Symptoms developed over three weeks, impairing weightbearing. Magnetic resonance imaging demonstrated a high-grade tear of the proximal iliotibial band at its iliac crest insertion. The patient was treated nonoperatively and returned to high-level, asymptomatic competition three months after symptom onset. This case offers a nonoperative approach to the rare presentation of a proximal iliotibial band rupture.

Arthroscopic Treatment Of Extensive Synovial Chondromatosis Of The Knee: A Case Report, Gaurav Singh, Bhavna Singh, Rebecca Peebles, Justin Bartley

Western Journal of Orthopaedics

Synovial chondromatosis (SC) is a rare, benign monoarticular disorder characterized by intra-articular cartilaginous loose bodies resulting from synovial metaplasia, most commonly affecting the knee. The authors present the case of a 44-year-old man with progressive, debilitating left knee pain, mechanical symptoms, and functional limitations unresponsive to conservative treatment. Radiographs were unremarkable, but magnetic resonance imaging (MRI) demonstrated multifocal noncalcified intra-articular bodies consistent with SC. The patient underwent arthroscopic debridement of the knee with limited synovectomy. Intraoperative findings included innumerable intra-articular cartilaginous loose bodies throughout the knee, synovial proliferation, and grade II chondromalacia. At three months postoperatively, the patient had regained …

Fibula Strut Allograft With Proximal Tibia Autograft For Treatment Of Humerus Nonunion: A Case Report And Review Of Oligotrophic Nonunion Management, Paul Wilson, Naomi Kelley, Samer Kakish

Western Journal of Orthopaedics

Due to their high incidence and frequent need for reoperation, nonunions of the humerus present a significant challenge in orthopaedics. Using fibular struts to treat nonunions have demonstrated excellent results. While fibular autografts provide both biologic and structural benefit, high donor site morbidity must be considered. Although their application in midshaft humeral nonunions remains limited, fibular allografts avoid donor site morbidity. Enhancing fibular strut allografts with biological components offers a promising strategy for treating fractures that have failed prior revisions. This case study presents a 36-year-old woman with an aseptic oligotrophic midshaft humeral nonunion who had an unsuccessful revision surgery. …

Popliteus Interposition In Metaphyseal Tibial Fractures: The Radiographic Clues That Cannot Be Missed, Lucca Gontijo Giarola, Paulo De Tarso Cardoso Gomes, Robinson Esteves Dos Santos Pires, Guilherme Moreira Abreu E Silva, Marco Antônio Percope De Andrade, Túlio Vinícius De Oliveira Campos

Western Journal of Orthopaedics

High-energy proximal tibia fractures present significant challenges for orthopaedic surgeons, with well-recognized risks including malreduction and nonunion. Although double plating through two mini-open parallel incisions is an established technique for selected patients, nonuion can still occur. One potential contributing factor is entrapment of the popliteus muscle within the distal spike of the posteromedial plateau fragment. This report uses illustrative cases to demonstrate how to identify, address, and prevent this complication. Strategies for managing delayed cases that progress to nonunion are also discussed

Front Matter, Arianna Medina

Western Journal of Orthopaedics

No abstract provided.

21st Century Perspective On The Changing Pattern Of Nerve Injuries From Gunshot Wounds In The U.S., Thomas A. Decoster

Western Journal of Orthopaedics

Gunshot wounds (GSWs) with nerve injuries in the 21st century differ significantly from those reported in the 20th century. The vast majority are now low-velocity civilian injuries, in contrast to high-velocity military injuries previously reported. The rate of nerve injury in civilian GSWs is approximately 5%, compared with the 30% reported in military cohorts. However, the most common pattern of nerve injury in the current civilian population is neurotmesis and partial neurotmesis, in contrast to the majority axonotmesis of the military cohorts. In the 20th century, treatment generally consisted of watchful waiting for signs of spontaneous recovery over three months …

Full Issue, Arianna Medina

Western Journal of Orthopaedics

No abstract provided.

Peripheral Nerve Repair And Reconstruction: Current Techniques, Adjuncts, And Emerging Therapies, Niklaus Skipp, Lana Dokic, Christina Wassef, Jazzlyn Gonzalez, Ana Love, Heather Mercer, Deana Mercer

Western Journal of Orthopaedics

Peripheral nerve injuries require reconstruction when direct, tension-free repair is not possible. A range of reconstructive strategies are used to restore continuity and promote axonal regeneration, including graft-based reconstruction, nerve transfers, conduit-based repair, supercharged end-to-side augmentation, and emerging regenerative therapies. Autologous interfascicular nerve grafts and vascularized grafts remain established techniques, whereas processed nerve allografts provide a donor-sparing alternative. Nerve transfers are increasingly used for proximal injuries with long regeneration distances, and conduits are an option for gaps shorter than 5 mm. Nerve-wrapping techniques are used to reduce perineural scarring and preserve gliding in complex or revision cases. Emerging adjunctive therapies, …

The Effect Of Institutional Reputation On Clerkship Grades, Jerry Speight Grimes

Western Journal of Orthopaedics

Background: Clinical rotation scores have been reported to predict resident performance. However, the reporting of clerkship grades varies widely across institutions. The authors explored the correlation of an institution’s reputation and the percentage of students receiving honors. Methods: During the review of applicants for orthopaedic residency, the percentage of students receiving the highest grade in the surgery and internal medicine clerkships was recorded for each institution. The authors then compared published institutional rankings with the proportion of students awarded honors in these clerkships. Results: One hundred nineteen institutions were reviewed. There was poor correlation between the institutional rankings by U.S. …

Analysis Of Patient Factors That Predict Early Restoration Of Neutral Dorsiflexion After Achilles Tendon Rupture, W. Chad Elliott, Alvin Ouseph, Alexander Abraham, Jerry Speight Grimes

Western Journal of Orthopaedics

Background: Achilles Tendon Rupture (ATR) is a common musculoskeletal injury with an increasing incidence in the United States. Early functional rehabilitation is a key component of improving patient outcomes, and restoration of range of motion is a common threshold for progression to strengthening. Neutral ankle dorsiflexion represents an important early milestone in ATR recovery. This study aimed to assess which patient factors were associated with achieving this early rehabilitation milestone. Methods: A retrospective review was performed on 70 patients who sustained ATR and were treated at an academic center. Demographics, baseline characteristics, and common ATR risk factors were collected. The …

Insertion Of An Internal Joint Stabilizer Through A Posterolateral Approach For The Management Of Complex Elbow Instability, Miguel A. Pirela-Cruz, Nikalus Skipp, Ana Love, Deana Mercer, Jazzlyn Gonzalez

Western Journal of Orthopaedics

Background: Complex elbow fracture-dislocations represent a substantial surgical challenge. Achieving adequate stability while permitting early postoperative motion is essential to prevent stiffness. The internal joint stabilizer (IJS) has emerged as an alternative to hinged external fixation, providing internal dynamic stabilization with improved patient tolerance and reduced risk of soft-tissue complications. Although the IJS is commonly inserted through a lateral approach, injuries involving multiple anatomical structures may necessitate broader exposure. Purpose: To describe the surgical technique for IJS insertion through a posterolateral approach (PLA) for complex elbow injuries involving multiple anatomical structures. Methods: The PLA provides extensile exposure to the posterior, …

Exploring The Interaction Between Cranial Nerves V And Vii In Chronic Eyelid Myokymia: A Case Report, Karina Miramontes, Adam Walsh, Tomas Tafoya

Western Journal of Orthopaedics

Eyelid myokymia involves involuntary contractions of the orbicularis oculi muscle and is commonly associated with stress, fatigue, and craniocervical factors. Emerging evidence suggests that altered trigeminocervical interactions and craniomandibular muscle tension may contribute to symptom persistence; however, the condition remains underrecognized in physical therapy. This report describes a 65-year-old woman with chronic benign eyelid myokymia and cervical pain who completed 12 physical therapy sessions that included suboccipital functional dry needling, temporomandibular soft-tissue mobilization (STM), and cervical stabilization exercises. A reduction in eyelid myokymia was first observed at the fifth visit, coinciding with the initiation of temporomandibular STM. These findings suggest …

Prosthetic Knee Joint Infection Caused By Gemella Morbillorum, Nataly Echevarria-Castro, Shaleen Duhra, Leonor Echevarria

Western Journal of Orthopaedics

Gemella morbillorum is a gram-positive coccus found in the gastrointestinal tract, and is an uncommon cause of human infections, including prosthetic joint infections (PJI). Reported risk factors include immunosuppression, recent gastrointestinal procedures, and poor dental hygiene. This report describes a case of knee PJI caused by G. morbillorum, likely due to hematogenous seeding following a colonoscopy three months earlier. The patient is a 70-year-old man with well-controlled diabetes mellitus who had undergone total knee arthroplasty three years prior. He presented with three weeks of left knee swelling. Synovial fluid culture revealed G. morbillorum. The patient was treated with debridement, antibiotics, …

Arthroscopic Management Of A Loose Body In The Pisotriquetral Joint: A Case Report, Giovanni Chioda, Tomas Holy, Nicholas Newcomb, Nathan Morrell

Western Journal of Orthopaedics

The pisotriquetral joint is the smallest of the four joints comprising the wrist and is a source of ulnar-sided wrist pain. This condyloid joint connects the pisiform to the triquetrum and is supported by several surrounding ligaments. A variety of pathologies may affect the pisotriquetral joint, including the presence of loose bodies. Because of its small size and the inherent difficulty of visualization, the pisotriquetral joint is often overlooked as an independent joint. Techniques for arthroscopic visualization and loose-body removal have previously been described using the 6R and 4-5 portals. In the following case report, the authors describe successful visualization …

Partnering To Change Culture: Advancing Rigor And Transparency In Neurosciences Through Pie Chart, Melissa L. Rethlefsen, Danielle Maurici-Pollock, Leah Everitt, Will White, Ingrid Hendrix, Alexa Copeland, Sam Mckenzie, C W. Shuttleworth

PIE CHART

PIE CHART (Policies, Infrastructure, and Education to CHAmpion Rigor and Transparency) is a new program seeking to develop, test, and iterate sustainable models for improving the culture of rigor and transparency within the University of New Mexico Health Sciences Center. This program is a unique partnership between the Health Sciences Library & Informatics Center and the Department of Neurosciences. This partnership enables departmental interventions, but also aims to benefit the broader community at the University of New Mexico. Using the Center for Open Science's Strategy for Culture Change framework, PIE CHART aims to incentivize rigorous and transparent neuroscience research through …

Pie Chart Overview And Tenure And Promotion, Melissa L. Rethlefsen

PIE CHART

This presentation gives an overview of PIE CHART and additional material relating to open science in tenure and promotion. Materials included in this project were supported by the National Institute Of Neurological Disorders And Stroke of the National Institutes of Health under Award Number RC2NS138557. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Front Matter, Natural Resources Journal Nrj

Natural Resources Journal

No abstract provided.

Cobalt's Climate Paradox: Global Ambitions For A Greener Future Rely On Blood-Stained Hands, Ashleigh Wootton

Natural Resources Journal

The global effort to mitigate climate change increasingly relies on widespread electrification, with lithium-ion batteries at its core and the key minerals required for their production concentrated in countries uniquely vulnerable to exploitation. Lithium-ion battery production relies heavily on cobalt, a critical mineral primarily sourced from the Democratic Republic of the Congo (DRC), which supplies approximately 70 percent of the world’s cobalt. As demand for cobalt is projected to rise sharply, the DRC has become indispensable to the global clean energy transition. Cobalt extraction in the DRC is closely linked to severe human rights abuses, including forced labor, child labor, …

Decoding A Decade: Evolution In Distal Radius Fracture Techniques From Past To Present, Embracing The Efcr Method, Natasha G. Dark, Ahmed S. Raihane, Laurie G. Wells, Deana Mercer

Western Journal of Orthopaedics

No abstract provided.

A Historical Analysis Of The Squatter Settlements (Sukumbasi) In Nepal And The Role Of Smart Settlements, Keshav Bhattarai, Ambika P. Adhikari

Himalayan Research Papers Archive

In Nepal, landless populations can broadly be categorized into two groups: urban squatters and rural landless families. Each group can further be distinguished by its level of political connection and access to power.

Among urban squatters, politically connected groups often occupy open public spaces in cities with some degree of protection or tolerance from political parties. In contrast, less powerful urban squatters usually settle on public land because they cannot afford formal housing. These settlements are commonly located in unsafe or marginal areas, such as riverbanks, flood-prone zones, and unused public spaces. Despite these risks, many remain in urban areas …

Adult Healthy Habits, Belinda E. Vicuna, Mahtab Soleimani, Yvonnie Baik, Elena Martinez, Theresa H. Cruz

Reports & Documents

No abstract provided.

Healthy Places Healthy People Toolkit: A Resource For The Navajo Nation, Sally Davis, Elijah Maas

Healthy Places, Healthy People Toolkit

The University of New Mexico’s Prevention Research Center (UNM PRC) developed an evidence-based model to increase physical activity in rural communities in NM. Starting in the small, rural town of Cuba, NM, the model was expanded to other rural communities. Given the success of the model, the PRC was invited to partner with 10 Navajo Chapters (communities) in the Eastern Agency of the Navajo Nation, with funding from the Centers for Disease Control and Prevention (CDC). Together, they engaged in a project called Healthy Places— Healthy People.

Solving Data Mining Challenges In Neutrosophic Environments Using Bio-Inspired Optimization Techniques, Samia Mandour, Abduallah Gamal, Mohamed Belal

Neutrosophic Sets and Systems

No abstract provided.

Effective Dominating Energy In Neutrosophic Over Graphs, E. Lincy, V. Maheswari

Neutrosophic Sets and Systems

No abstract provided.

Pythagorean Neutrosophic Fuzzy Em-Swara-Topsis Approach For Green Supply Selection, Sudip Kumar Gorey, Sreejata Sen Sarma, Avijit De

Neutrosophic Sets and Systems

No abstract provided.

Reliability Estimation Using Interval-Valued Neutrosophic Number For Multi-Criteria Decision Making Problems, Supriya Supriya, Suneel Kumar

Neutrosophic Sets and Systems

No abstract provided.