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Environmental Restoration Operations Consolidated Quarterly Report, January 2019, Sandia National Laboratories/Nm

Environmental Restoration

Environmental Restoration Operations Consolidated Quarterly Report, January 2019 for the Department of Energy Natural Nuclear Security Administration, Sandia National Laboratories that addressees all quarterly reporting (July to September 2018) required under the Hazardous and Solid Waste Amendments Module of the Resource Conservation and Recovery Act Permit and the Compliance Order on Consent for SNL/NM. EPA ID# NM5890110518

Ntess Dmrs 2019, Sandia National Laboratories/Nm

Municipal Separate Storm Sewer System (MS4) Permit

No abstract provided.

Ntess Annual Report 2019, Sandia National Laboratories/Nm

Municipal Separate Storm Sewer System (MS4) Permit

No abstract provided.

Swmpp Appendices 2019, Sandia National Laboratories/Nm

Municipal Separate Storm Sewer System (MS4) Permit

No abstract provided.

Ms4 Swmpp 2019, Sandia National Laboratories/Nm

Municipal Separate Storm Sewer System (MS4) Permit

No abstract provided.

Rigid Nail Fixation For Treatment Of Femur Fractures In Children Aged 6 To 12 Years: A Review, Brielle Payne Plost, David M. Bennett, Andrew W. Parsons, Matthew G. Wharton

UNM Orthopaedic Research Journal

Although femoral shaft fractures are common in children, treatment using rigid intramedullary nail fixation remains controversial owing to concerns of avascular necrosis (AVN) and disruption of growth of the proximal femur. We examined studies on AVN complications and proximal femur deformity after rigid nail fixation in children aged 6 to 12 years. Of the 13 studies included, nine had no incidents of AVN or clinically significant proximal femur deformity using a greater trochanter entry point. Four studies showed cases of AVN or proximal femoral deformity in patients treated with intramedullary nails through a starting point at or near the piriformis …

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 …

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 …

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 …

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 …

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 …

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.

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 …

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 …

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 …

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 …

Multimodal Analgesia In Orthopaedic Surgery And Presentation Of A Comprehensive Postoperative Pain Protocol: A Review, Christopher L. Shultz, Benjamin D. Packard, Kathryn C. Helmig, Christopher Kurnik, Benjamin S. Albertson, Nathan E. Huff, Gehron P. Treme

UNM Orthopaedic Research Journal

Rising opioid use in the United States has now been termed an epidemic. Opioid use is associated with considerable morbidity, mortality, and cost to the healthcare system. Orthopaedic surgeons play a key role in the opioid epidemic by prescribing postoperative narcotics. Although our understanding of the quantity of narcotics to prescribe postoperatively for analgesia is progressing, there is still a paucity of data focused on routine postoperative pain protocols. The purpose of this article is to review the current options for both opioid and non-opioid analgesia and put forth a multisubspecialty orthopaedic protocol of postoperative pain. On the basis of …

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 …

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 …

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 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 …

Alumni Map 2019, Unm Department Of Orthopaedic Surgery

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 …

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 …

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 …

Physical Therapy Faculty, Unm Department Of Orthopaedic Surgery

UNM Orthopaedic Research Journal

No abstract provided.

Advanced Practice Providers, Unm Department Of Orthopaedic Surgery

UNM Orthopaedic Research Journal

No abstract provided.

Fellows And Chiefs, Unm Department Of Orthopaedic Surgery

UNM Orthopaedic Research Journal

No abstract provided.