Medicine and Health Sciences Commons^™

Perioperative Nutritional Considerations In Orthopaedic Surgery: A Review Of The Literature, William Curtis, Timothy Choi, Aamir Ahmad, Christopher Shultz

Western Journal of Orthopaedics

Macronutrients and micronutrients play an essential role in the surgical process, beginning in preoperative preparation and extending well into postoperative recovery. It is important that orthopaedic surgeons and their patients understand the physiological impact of the surgical stress response and the ways in which adequate perioperative nutrition can help combat its negative effects. Throughout this article, the authors discuss the important roles of macronutrients, such as carbohydrates, protein, and fatty acids, and that of micronutrients, including zinc and vitamins C, D, A, and E, in the perioperative period. The authors aim to explain the physiological effects of surgery on nutrition …

Back Matter, Arianna Medina

Western Journal of Orthopaedics

No abstract provided.

Treatment Of An Unusual Infection Following Anterior Cruciate Ligament Reconstruction, Daniel Warren, David Michaeli, Benjamin Estrada, James Slauterbeck

Western Journal of Orthopaedics

The authors present an uncommon complication of pediatric anterior cruciate ligament (ACL) reconstruction involving a rare organism in the setting of multiple patient-specific factors that altered treatment. Management of postoperative mycobacterial infections requires thorough knowledge of the side effects of each medication used. Prolonged use of a fluoroquinolone in the setting of ACL reconstruction graft healing introduces the risk of injury to the graft, and tactful patient counseling must be employed to help diminish this risk. The potential for ototoxicity secondary to extended aminoglycoside use is especially worrisome and should be monitored. This plan required careful balancing of several important …

Let’S Focus On The Fibrosis: Targeting Ccn2 In Dupuytren’S Disease, Alex G. Lambi, Ryan Dahlberg, Tomas Holy, Joseph T. Tarr, Deana Mercer, Steven N. Popoff, Mary F. Barbe

Western Journal of Orthopaedics

Dupuytren’s disease is a progressive, benign fibroproliferative disorder of the hands that can lead to debilitating hand contractures. Once symptomatic, treatment involves either surgical intervention, specifically fasciectomy or percutaneous needle aponeurotomy, or enzymatic degradation with clostridial collagenase. Currently, collagenase is the only pharmacotherapy that has been approved for the treatment of Dupuytren’s contracture. There is a need for a pharmacotherapeutic that can be administered to limit disease progression and prevent recurrence after treatment. Targeting the underlying fibrotic pathophysiology is critical. The authors propose a novel target to be considered in Dupuytren’s disease – cell communication network factor 2/connective tissue growth …

Principles Of Arthroscopic - Assisted Open Reduction Internal Fixation In The Management Of Displaced Articular Fractures, Nathan Sherman, Matthew Miller, Michael D. Feldman

Western Journal of Orthopaedics

The primary objective of fracture fixation is to obtain anatomic reduction with stable fixation while minimizing damage to the surrounding structures. Displaced articular fractures represent a surgical challenge, but anatomic alignment with restoration of the articular surface is the gold standard of management. Using open techniques, intra-articular visualization can require large dissections and added soft-tissue insult. However, arthroscopic-assisted open reduction internal fixation (AAORIF) may represent a less invasive means of articular fracture management in appropriate patients with select fractures. The general principles of AAORIF are modified from basic arthroscopic principles, including positioning, portal placement, fluid management, visualization, soft-tissue management, and …

Pelvic Ring Injury Secondary To Traumatic Vaginal Delivery: A Case For Early Surgical Fixation, Tyler J. Chavez, Taylor P. Gurnea, Hernan Lebensohn, Johnathan P. Jensen, Samer Kakish

Western Journal of Orthopaedics

During the gestational period, the body undergoes a normal physiologic widening of the pubic symphysis in preparation for childbirth. Although exceedingly rare, despite increased laxity, the pelvic ring remains at risk of serious injury during delivery. The current body of literature on this topic includes only a few case reports without clear guidance on the acute management of non-physiologic pubic symphysis widening and pelvic ring injuries following childbirth. The authors present a case of a 31-year-old pregnant woman (G2P0101) who sustained an APC2 (OTA B2.3) pelvic ring injury during vaginal delivery requiring open reduction and internal fixation for failure to …

Front Matter, Arianna Medina

Western Journal of Orthopaedics

No abstract provided.

Complex Lisfranc Injury In A Professional Bull Rider, Elizabeth Eichman, Stephan Sierra, Matthew Ferguson

Western Journal of Orthopaedics

American bull riding is one of the most dangerous sports in the world, with a high prevalence of injury. Due to the high-velocity trauma that is common in this sport, injuries occur frequently and are often classified as severe despite the use of protective equipment. While Lisfranc fracture-dislocations are somewhat common in elite athletes, open Lisfranc fractures are much less common. Consequently, there are little data concerning recovery and return to sport. This case demonstrates an uncommon presentation of open Lisfranc fracture dislocation and first metatarsophalangeal dislocation in a professional bull rider who was able to return to sport at …

Terrible Triad In A Pediatric Patient: A Case Report, Colin J. Carroll, Gonzalo Sumarriva, Russell Parks, Caroline Vasco, Ross Dunbar

Western Journal of Orthopaedics

A terrible triad elbow injury consists of an elbow dislocation with associated radial head and coronoid fractures. This type of injury is rare in the pediatric population. In this case, a 14-year-old adolescent male suffered a right-sided terrible triad elbow injury after falling onto his right elbow. He was taken to the operating room for open reduction and internal fixation. The patient is now three years postoperatively with full range of motion of his elbow with no pain and no incidents of dislocation.

Diversifying The Field: Reflflections Of Female Orthopaedic Residents, Kate M. Parker, Audrey C. Wassef

Western Journal of Orthopaedics

No abstract provided.

Reconstruction Of Charcot Foot Deformity Using Circular External Fixators And Fusion: A Case Report, M Bryant Transtrum, Allen Wang, Diego Sanchez, Joshua Tadlock, Ahmed Thabet, Amr Abdelgawad

Western Journal of Orthopaedics

Charcot neuroarthropathy is a complication of the joints in patients with peripheral neuropathy, characterized by massive hyperemia, bone resorption, and joint destruction. The complex deformities that can result may lead to subsequent ulcers, osteomyelitis, and eventually limb amputation. Concurrent soft-tissue pathologies, such as ulcers and infections, complicate operative management. Thus, deformity correction may be necessary for wound healing before final fixation. In this case report, the authors describe a 48-year-old man who presented with a severe Charcot deformity of the foot and accompanying non-healing diabetic foot ulcer overlying the talar head. The authors elected to proceed with staged reconstruction, starting …

The Orthopaedist’S Role In Preventing Workplace Violence, Nicholas W. Brady, Andrew Paterson

Western Journal of Orthopaedics

No abstract provided.

Imposter Syndrome, Or Not?, Allicia O. Imada

Western Journal of Orthopaedics

No abstract provided.

Differences In Ct Scan Measurements Of Femoral Neck Shaft Angle And Acetabular Version Among Sex, Age, And Ethnicity From A Large Cadaveric Database, Bryce N. Clinger, Scott Plaster, River S. Fine, Justin R. Marshall, Dustin L. Richter

Western Journal of Orthopaedics

Background: Management of proximal femur and acetabular pathologies, such as femoroacetabular impingement, hip osteoarthritis, or hip fractures, requires an understanding of the patient’s anatomy for accurate diagnosis and treatment. Variability in femoral neckshaft angle (FNA) and acetabular version (AV) has been shown, but little insight into differences between ages, ethnicities, and sexes has been evaluated. Methods: Two hundred and fifty cadaveric specimens from the New Mexico Decedent Image Database were evenly divided by sex and among five ethnic groups (Asian American, Black/African American, Hispanic, Native American, White). Using multiplanar reconstruction, thincut computed tomography scans were reviewed by three independent observers. …

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 …

Risk Factors For Reoperation Following Operative Fixation Of Distal Femur Fractures: A Report Of 73 Consecutive Cases, Aditya Desai, Victoria Oakes, John Pisquiy, Christopher Dodo, Ahmed A. Toreih, Wael Azzam, Amr Abdelgawad, Ahmed M. Thabet

Western Journal of Orthopaedics

Introduction: Various factors including patient demographics, fracture types, and fixation methods can affect the outcomes of distal femur fractures. This study aimed to analyze the risk factors for reoperation after operative fixation of these fractures. Methods: This was an institional review board (IRB) approved retrospective study of extra-articuilar, partial articular, and complete articular distal femur fractures treated with operative fixation at a Level I trauma center between 2008 and 2018. The study included a consecutive series of adult patients operatively treated for a distal femur fracture. The primary outcome was reoperation rate due to infection, non-union, or implant failure. Periprosthetic …

Foundations Of Intramedullary Femoral Shaft Fracture Fixation: Avoidance, Recognition, And Management Of Common Pitfalls, Christopher Kurnik, Jory Wasserburger, William Curtis, Tyler Chavez

Western Journal of Orthopaedics

Intramedullary nailing is an effective treatment of femoral shaft fractures. However, this procedure has several common complications and technical problems that can interfere with full recovery in some patients. The purpose of this review article is to expand on the literature with the authors’ own experiences to summarize the following common complications of femoral nailing: missed injuries, suboptimal surgical timing, malreduction, reaming errors, implant insertion errors, pain-management problems, and implant removal errors. Strategies are also identified to help avoid and manage these complications.

Alumni Map 2021, Unm Department Of Orthopaedic Surgery

Western Journal of Orthopaedics

No abstract provided.

Considerations In Surgical Timing For Femoral Shaft Fractures, Trevor Crean, William Curtis, Thomas A. Decoster

Western Journal of Orthopaedics

Femoral shaft fractures are a common orthopaedic injury. They are generally treated with intramedullary nailing. The optimal timing of operative treatment is variable and debated. Relatively simple femoral shaft fractures can be successfully treated in less than 24 hours in most health care systems. Femoral shaft fractures can be more complicated owing to various factors, such as multiple traumatic injuries, associated conditions, etc. These more complicated femoral shaft fractures benefit from stabilization within the first 6 hours to minimize complications. Stabilization of the long bones helps achieve an upright chest position and improves pulmonary, circulatory, and musculoskeletal function. Some patients …

Front Matter, Unm Department Of Orthopaedic Surgery

Western Journal of Orthopaedics

No abstract provided.

Seven Deadly Sins Of Volar Distal Radius Fracture Fixation, Allicia O. Imada, Jorge Orbay, Deana Mercer

Western Journal of Orthopaedics

Distal radius fractures are common injuries, accounting for 17.0% of all emergency department visits. Operative treatment is an option when indicated. Volar plating has become the most frequently used mode of fixation. Although fixed angle volar locking plates allow for reliable and stable fixation, complications have been reported. Complications include flexor and extensor tendon rupture, intra-articular screw penetration, malreduction, loss of reduction, carpal tunnel syndrome, implant failure, and complex regional pain syndrome. We propose seven principles to avoid these preventable outcomes and tips to succeed.

Effect Of Patient-Surgeon Orientation On Plunge Depth During Plate Fixation Of Clavicle Fractures, Aaron Mullane, Layla A. Haidar, Adam Kozemchak, Colton Wayne

Western Journal of Orthopaedics

Background: Operative management of clavicle fractures indicated for open reduction internal fixation poses significant risk to critical anatomic structures. The associated risks to the underlying neurovascular structures during clavicle fixation as a result of plunge depth for patients in the supine position in comparison to patients in the beach-chair position is currently unknown. The purpose of this study was to compare plunge depth measurements between the supine and beach-chair positions during plate fixation of clavicle fractures. Methods: The participant population at this single institution was comprised of residents, fellows, and fellowship-trained, attending orthopaedic surgeons. The participants drilled three bicortical holes …

A Novel Method In The Classification Of Proximal Fifth Metatarsal Fractures, Kathryn Yeager, Benjamin Packard, Richard A. Miller, Shravin Sridhar

Western Journal of Orthopaedics

Background: Proximal fifth metatarsal fractures are common. The authors previously performed a study examining the inter- and intraobserver reliability of the Lawrence and Botte Classification, which showed poor interobserver reliability of 16.67%. A novel approach was proposed for the classification of fifth metatarsal fractures using a mortise ankle radiographic view. Methods: The observers from the authors’ prior study reviewed non-weight bearing mortise views of 20 patients with isolated fifth metatarsal base fractures. These radiographs were identified from the 60 radiographs from the authors’ prior study. Five physicians evaluated the radiographs and classified the fractures as type 1, 2, or 3. …

Gunshot Wounds To The Foot And Ankle: Review Of Cases From A Level-1 Trauma Center, Allicia O. Imada, Jory Wasserburger, Aamir N. Ahmad, Katherine Gavin

Western Journal of Orthopaedics

Background: Gunshot injuries frequently involve the foot and ankle. The standard of care for treatment of gunshot injuries to the foot and ankle is not clear. To better understand these injuries, we completed a retrospective review of foot and ankle gunshot injuries at a level-1 trauma center seen as orthopaedic consults over a 2-year period. Methods: Orthopaedic consults for foot and ankle gunshot injuries from June 1st, 2018, through May 31st, 2020, were reviewed. Patient characteristics, zone of injury, mechanism of injury, associated injuries, treatment, follow-up, and outcomes were recorded. Results: Forty-eight foot and ankle gunshot injuries were identified, encompassing …

A Systematic Review To Examine Functional Recovery After Total Knee Arthroplasty And Successful Physical Therapy Protocols, Dominique M. Patterson, Colin F.K. Hansen, Yuri Yoshida

Western Journal of Orthopaedics

Background: Total knee arthroplasty (TKA) continues to be the most common elective procedure performed every year, with the goal to reduce pain and improve return to functional activities. Recent studies have investigated new surgical techniques and therapeutic interventions to determine which protocols result in reduced pain and accelerate return to function. Methods: We systematically reviewed 131 out of 301 studies between 1996 and 2019 to assess trends in patient functional performance and perceptive functional recovery after TKA from preoperative up to 2 years postoperative. We evaluated functional outcome measures recommended by the Osteoarthritis Research Society International. Results that considerably deviated …

Early Open Reduction And Internal Fixation Of Acute Low-Energy Tibial Plateau Fractures Does Not Increase The Rate Of Perioperative Complications, Jorge D. Guerra, Madison Craft, Diana P. Guerra, Ahmed M. Thabet

Western Journal of Orthopaedics

Introduction: The treatment algorithm for tibial plateau fractures continues to evolve as surgeon experience increases. Initial surgical procedures have been fine-tuned over time. Methods: This is a retrospective chart review of 132 patients with low-energy tibial plateau fractures (Schatzker I–IV) treated at a level-1 academic trauma center between January 2008 and February 2018. This study analyzes patient outcomes managed with primary operative intervention within 48 hours of admission. The average age was 45 years (range, 19 to 84 years). There were 92 men and 40 women. Statistical analysis focused on comparisons between historical complication rates and the findings of this …

Hamstring Strength Recovery In Relation To Landing Patterns Following Anterior Cruciate Ligament Reconstruction: A Case Comparison Report, Kelsey A. Edwards, Rebecca A. Dutton, Yuri Yoshida, Dustin L. Richter

Western Journal of Orthopaedics

Introduction: Deficits in quadriceps strength following anterior cruciate ligament reconstruction (ACLR) are common and can be associated with biomechanical asymmetries during landing tasks. The relationship between quadriceps strength and knee function during ACLR recovery is well established. However, less is known regarding the role of hamstring strength in functional recovery after ACLR. We examined movement patterns during a drop-landing task in three patients following ACLR with different levels of quadriceps and hamstring strength. Methods: Three participants were assessed for quadriceps and hamstrings strength, functional performance, and lower-extremity biomechanics captured by a 3D motion analysis 6 months after ACLR. Results: Participant …

Distal Radial Shaft Malunion And Distal Radioulnar Joint Instability 8 Years After Postoperative Plate Failure: A Case Report, Allicia O. Imada, Casey D. Mcdonald, Deana Mercer

Western Journal of Orthopaedics

Radius shaft fractures often require operative treatment after skeletal maturity to restore functional range of motion. If the radial bow is not anatomically restored, pain and instability can occur from bony impingement and disruption of the distal radioulnar joint (DRUJ). We describe a 25-year-old woman with a radius shaft malunion and DRUJ instability. Eight years prior, at the age of 17, she underwent open reduction and internal fixation for a radial shaft fracture with subsequent reinjury at 10 weeks postoperatively. The reinjury was treated nonoperatively, and the patient went on to have painful range of motion and DRUJ instability. Radiographs …

A Novel High Tibial Biplanar Osteotomy Technique For Simultaneous Coronal And Sagittal Correction: A Case Example, Ryan C. Price, Kathryn C. Helmig, Dustin L. Richter, Robert C. Schenck Jr

Western Journal of Orthopaedics

Medial opening wedge high tibial osteotomy (HTO) can provide symptom relief, improved ligamentous stability, and lower failure rates in patients with symptomatic medial knee osteoarthritis, ligament instability, and varus alignment after ligament reconstruction. It has been reported that correcting coronal plane abnormalities with a medial opening wedge HTO has resulted in altered posterior tibial slope angle (PTSA). We describe a 38-year-old woman with a history of severe polytrauma who presented with an anterior cruciate ligament tear in the setting of increased PTSA and a posterolateral corner injury with varus deformity of the knee. A medial biplanar HTO was performed using …

The Chevron Capitate-Trapezoid Joint: A Case Report, Dean W. Smith

Western Journal of Orthopaedics

Anatomical variations to the human skeletal system are common and frequently reported in the literature. The structures around the hand and wrist are no exception, and these variations can affect ligaments, tendons, muscles, nerves, arteries, joints, and bone morphology. Musculoskeletal health care providers must be familiar with normal, individual variations when encountered during patient care and diagnostic imaging. In some instances, morphological variations have resulted in differences in kinematics, while others have been found in association with certain medical conditions. We discuss an unusual variation of the capitate-trapezoid joint. To the best of our knowledge, no prior studies have previously …