Medicine and Health Sciences Commons^™

Thrower's Exostosis Of The Shoulder: A Systematic Review With A Novel Classification, Michael T. Freehill, Sandeep Mannava, Laurence D. Higgins, Alexandre Lädermann, Austin V. Stone

Orthopaedic Surgery and Sports Medicine Faculty Publications

Background: A variety of thrower's exostoses are grouped under the term Bennett lesion, which makes understanding diagnosis and treatment difficult.

Purpose: To identify all types of reported thrower's and overhead athlete's exostoses and categorize them into a classification system to allow a morphology-based classification.

Study Design: Systematic review; Level of evidence, 4.

Methods: A systematic review of all articles pertaining to Bennett lesions and thrower's exostosis was performed. The classification and treatments were evaluated to describe the types, proposed causes, diagnosis, and treatment options.

Results: A total of 27 studies were included in the systematic review. The anatomic locations …

Operative Versus Conservative Treatment Of Clavicular And Scapular Fractures, Chase Davis

Theses and Graduate Projects

Background: Clavicle fractures and scapula fractures represent up to 4% and 1% of all fractures, respectively.^1-4,9-11 Historically, both fracture types have been treated conservatively with acceptable outcomes. The surgical correction of these fractures is currently being investigated as a viable alternative to conservative management.

Method: A systematic search of PubMed was performed to identify articles comparing open reduction and internal fixation (ORIF) with conservative treatment for both clavicular and scapular fractures. Specific outcomes of interest were shoulder function, pain, strength, range of motion, and risk of nonunion.

Results: ORIF of midshaft clavicular fractures results in increased shoulder function within …

Secukinumab Improves Active Psoriatic Arthritis Symptoms And Inhibits Radiographic Progression: Primary Results From The Randomised, Double-Blind, Phase Iii Future 5 Study., Philip Mease, Désirée Van Der Heijde, Robert Landewé, Shephard Mpofu, Proton Rahman, Hasan Tahir, Atul Singhal, Elke Boettcher, Sandra Navarra, Karin Meiser, Aimee Readie, Luminita Pricop, Ken Abrams

Philip Mease, MD

OBJECTIVES: To evaluate the effect of subcutaneous (s.c.) secukinumab, an interleukin-17A inhibitor, on clinical signs and symptoms and radiographic progression in patients with psoriatic arthritis (PsA).

METHODS: Adults (n=996) with active PsA were randomised 2:2:2:3 to s.c. secukinumab 300 mg or 150 mg with loading dose (LD), 150 mg without LD or placebo. All groups received secukinumab or placebo at baseline, weeks 1, 2 and 3 and then every 4 weeks from week 4. The primary endpoint was the proportion of patients achieving an American College of Rheumatology 20 (ACR20) response at week 16.

RESULTS: Significantly more patients achieved an …

Tofacitinib Or Adalimumab Versus Placebo: Patient-Reported Outcomes From Opal Broaden-A Phase Iii Study Of Active Psoriatic Arthritis In Patients With An Inadequate Response To Conventional Synthetic Disease-Modifying Antirheumatic Drugs., Vibeke Strand, Kurt De Vlam, Jose A Covarrubias-Cobos, Philip Mease, Dafna D Gladman, Daniela Graham, Cunshan Wang, Joseph C Cappelleri, Thijs Hendrikx, Ming-Ann Hsu

Articles, Abstracts, and Reports

Objectives: Tofacitinib is an oral Janus kinase inhibitor for treatment of psoriatic arthritis (PsA). We evaluated patient-reported outcomes (PROs) in patients with PsA refractory to ≥1 conventional synthetic disease-modifying antirheumatic drug (csDMARD-IR) and tumour necrosis factor inhibitor-naïve in a 12-month, phase III randomised controlled trial (OPAL Broaden [NCT01877668]).

Methods: Patients (N=422) received tofacitinib 5 mg or 10 mg twice daily, adalimumab 40 mg subcutaneously every 2 weeks or placebo advancing to tofacitinib 5 mg or 10 mg twice daily at month 3. Least squares mean changes from baseline and percentages of patients reporting improvements ≥minimum clinically important differences (MCID); and …

Effect Of Tofacitinib On Patient-Reported Outcomes In Patients With Active Psoriatic Arthritis And An Inadequate Response To Tumour Necrosis Factor Inhibitors In The Phase Iii, Randomised Controlled Trial: Opal Beyond., Vibeke Strand, Kurt De Vlam, Jose A Covarrubias-Cobos, Philip Mease, Dafna D Gladman, Linda Chen, Elizabeth Kudlacz, Joseph Wu, Joseph C Cappelleri, Thijs Hendrikx, Ming-Ann Hsu

Articles, Abstracts, and Reports

Objectives: Tofacitinib is an oral Janus kinase inhibitor for treatment of psoriatic arthritis (PsA). Patient-reported outcomes (PROs) were evaluated in patients with PsA with inadequate responses to tumour necrosis factor inhibitors (TNFi-IR) in a 6-month, phase III randomised controlled trial (OPAL Beyond [NCT01882439]).

Methods: Patients (N=394) received tofacitinib 5 or 10 mg twice daily or placebo (advancing to tofacitinib 5 or 10 mg twice daily at month 3). Least squares mean changes from baseline and percentages of patients reporting improvements ≥minimum clinically important differences and scores ≥normative values were determined in Patient Global Assessment of disease activity (PtGA), Pain, Patient …

Comparison Of Osteoporosis Pharmacotherapy Fracture Rates: Analysis Of A Marketscan® Claims Database Cohort, Alan W. Reynolds, Guodong Liu, Paul T. Kocis, Jenna N. Skowronski, Douglas L. Leslie, Edward J. Fox

Student Papers, Posters & Projects

Background: Several different classes of medications have been shown to be efficacious at preventing fractures in patients with osteoporosis. No study has compared real world efficacy at preventing fractures between all currently approved medications.

Objectives: To directly compare the efficacy of all currently available osteoporosis medications by using a large population claims database.

Methods: The Truven Health Analytics MarketScan® database from 2008 - 2012 was used to identify all patients who started a new osteoporosis medication. Patients who experienced a fracture after at least 12 months of treatment were identified and risk factors for fracture for all patients were recorded. …

Secukinumab Improves Active Psoriatic Arthritis Symptoms And Inhibits Radiographic Progression: Primary Results From The Randomised, Double-Blind, Phase Iii Future 5 Study., Philip Mease, Désirée Van Der Heijde, Robert Landewé, Shephard Mpofu, Proton Rahman, Hasan Tahir, Atul Singhal, Elke Boettcher, Sandra Navarra, Karin Meiser, Aimee Readie, Luminita Pricop, Ken Abrams

Articles, Abstracts, and Reports

OBJECTIVES: To evaluate the effect of subcutaneous (s.c.) secukinumab, an interleukin-17A inhibitor, on clinical signs and symptoms and radiographic progression in patients with psoriatic arthritis (PsA).

METHODS: Adults (n=996) with active PsA were randomised 2:2:2:3 to s.c. secukinumab 300 mg or 150 mg with loading dose (LD), 150 mg without LD or placebo. All groups received secukinumab or placebo at baseline, weeks 1, 2 and 3 and then every 4 weeks from week 4. The primary endpoint was the proportion of patients achieving an American College of Rheumatology 20 (ACR20) response at week 16.

RESULTS: Significantly more patients achieved an …

Spinal Cord Trauma: An Overview Of Normal Structure And Function, Primary And Secondary Mechanisms Of Injury, And Emerging Treatment Modalities, Daniel Morin

Senior Honors Theses

The structures of the spinal cord and vertebral column are designed to provide flexibility, while still providing ample protection for the spinal cord deep within. While it does offer remarkable protection against most routine trauma, the spinal cord is still vulnerable to high-force etiologies of trauma and may become damaged as a result. These events are referred to as primary injury. Following the initial injury, the body’s own physiological responses cause a cascade of deleterious effects, known as secondary injury. Secondary injury is a major therapeutic target in mitigating the effects of spinal cord injury (SCI), and much research is …

2016 Sosort Guidelines: Orthopaedic And Rehabilitation Treatment Of Idiopathic Scoliosis During Growth., Stefano Negrini, Sabrina Donzelli, Angelo Gabriele Aulisa, Dariusz Czaprowski, Sanja Schreiber, Jean Claude De Mauroy, Helmut Diers, Theodoros B. Grivas, Patrick Knott, Tomasz Kotwicki, Andrea Lebel, Cindy Marti, Toru Maruyama, Joe O'Brien, Nigel Price, Eric Parent, Manuel Rigo, Michele Romano, Luke Stikeleather, James Wynne, Fabio Zaina

Manuscripts, Articles, Book Chapters and Other Papers

Background: The International Scientific Society on Scoliosis Orthopaedic and Rehabilitation Treatment (SOSORT) produced its first guidelines in 2005 and renewed them in 2011. Recently published high-quality clinical trials on the effect of conservative treatment approaches (braces and exercises) for idiopathic scoliosis prompted us to update the last guidelines' version. The objective was to align the guidelines with the new scientific evidence to assure faster knowledge transfer into clinical practice of conservative treatment for idiopathic scoliosis (CTIS).

Methods: Physicians, researchers and allied health practitioners working in the area of CTIS were involved in the development of the 2016 guidelines. Multiple literature …

Current Issues In Treatment Of Anterior Shoulder Instability: A Review, Ian Power

UNM Orthopaedic Research Journal

Anterior shoulder instability can be problematic in the young, active population, particularly in athletes and military personnel. The shoulder joint is the most frequently dislocated joint, and there is a high rate of dislocation recurrence in younger patients. The stability of the glenohumeral joint is conferred through the bony anatomy and the static and dynamic stabilizers. Recognizing pathological features, identifying glenoid bone loss, and detecting Bankart and Hill-Sachs lesions are key to formulating an appropriate treatment strategy and improving surgical outcomes. Furthermore, the concept of critical bone loss has been refined by looking at subcritical loss. Recent evidence has shown …

Radiographic And Clinical Evaluation Of Syndesmotic Screws In Treating Injuries Of The Distal Aspect Of The Tibiofibular Syndesmosis, James A. Dollahite, Paul J. Goodwyn, Katherine J. Gavin, Richard A. Miller

UNM Orthopaedic Research Journal

Background: Several factors can affect the success of surgical treatment of injuries to the distal aspect of the tibiofibular syndesmosis, including the bony articulation between the distal aspect of the fibula, tibia, and the supporting ligamentous structures; number and size of screws; number of cortices penetrated; and planned routine removal of screws.

Methods: We conducted a retrospective review of radiographs and clinic notes for all patients who underwent open reduction and internal fixation of injury to the tibiofibular syndesmosis, which was performed by a single surgeon (RAM), between January 2011 and December 2014. Only screws were used. The screws were …

Lateral Versus Dorsal Plating For Treating Metacarpal And Phalanx Fractures: A Retrospective Cohort Study, Joshua W. Hustedt, Collin C. Barber, Michael Bonnelli, Lloyd P. Champagne

UNM Orthopaedic Research Journal

Background: The purpose of this study was to investigate the differences between the dorsal and lateral plate position for metacarpal and phalanx fractures.

Methods: We conducted a retrospective review of prospectively collected patient data for 186 fractures treated by a single surgeon between 2009 and 2011. Rates of plate removal, total arc of postoperative motion (TAM), and patient and injury demographics were tested for association with plating position.

Results: Increasing age, larger plates, and dorsal plating were found in univariate analysis to be associated with decreased TAM and increased plate removal in phalanx but not in metacarpal fractures.

Conclusions: These …

Radiographic Prevalence Of Osteoarthritis Of The Scaphotrapeziotrapezoid Joint In Patients With Carpometacarpal Osteoarthritis Of The Thumb: A Retrospective Case Series, Charlotte E. Orr, Robert Mercer, Deana M. Mercer, Drew K. Newhoff, Matthew D. Martin, Moheb S. Moneim

UNM Orthopaedic Research Journal

Background: In planning operative treatment of thumb carpometacarpal (CMC) joint osteoarthritis, surgeons should consider the presence of an arthritic scaphotrapeziotrapezoid (STT) joint. We aimed to determine the radiographic prevalence of concomitant (STT) osteoarthritis with thumb CMC osteoarthritis in patients who underwent surgical treatment at our institution. We hypothesized that the prevalence of concomitant arthritis at these 2 joints (STT and CMC) would be lower than previously reported.

Methods: Between September 2005 and July 2012, a total of 417 patients were identified from our institution using the Current Procedural Terminology code for thumb CMC joint arthroplasty (25447). After applying exclusion criteria …

Transhumeral Amputation For Treating Necrotizing Fasciitis Infection Of The Upper Extremity: Report Of Two Cases, Drew K. Newhoff, Amber L. Price, Christina Salas, Deana M. Mercer

UNM Orthopaedic Research Journal

Necrotizing fasciitis, an infection of the skin and subcutaneous tissue, can spread rapidly. Studies have emphasized the importance of prompt surgical intervention with aggressive debridement of diseased tissue; however, mortality rates are high despite immediate treatment. We describe two men, aged 44 years (case 1) and 74 years (case 2), presenting with necrotizing fasciitis who underwent aggressive surgical intervention, multiple debridements, and eventual transhumeral amputation of the upper extremity. In each case, the patients were discharged from the hospital to their homes on amoxicillin-clavulanate at postoperative days 15 (case 1) and 32 (case 2). Findings of laboratory studies had normalized. …

Rare Tumors Adjacent To The Achilles Tendon: Report Of Two Cases, Jay J. Wojcik, Aditi S. Majumdar, Kathleen M. Madden, Richard A. Miller

UNM Orthopaedic Research Journal

Benign masses are not uncommon near the Achilles tendon of the ankle. However, the occurrence of angiomyomas or glomus tumors in the region has rarely been reported. We describe two patients, a 44-year-old woman and 44-yearold man, who presented with a tender mass posterior to the Achilles tendon. Excision led to successful removal of the lesion in both cases. Results of histological examinations revealed an angiomyoma and glomus tumor in the woman and man, respectively. Although rare, the presence of these tumors should be considered in the differential diagnosis of masses near the Achilles tendon.

How To Manage Knee Arthritis: Best Practices For Treatment Prior To Orthopaedic Referral, Ali Oliashirazi Md, Alex Caughran Md, Zain Quazi Md, Grant Buchanan Md, Akash Sharma, Franklin D. Shuler Md, Phd

Franklin D. Shuler

Osteoarthritis (OA) of the knee is a debilitating disease in which degeneration of the joint space cartilage can lead to life-altering pain and stiffness. The prevalence of OA has a strong correlation with age, with evidence of radiographic knee OA found in 37.4% of persons older than 60 years of age. According to the Agency for Healthcare Research and Quality’s (AHRQ) 2013 report, osteoarthritis was ranked the second most expensive condition for Medicare and private insurers, with over 90% of the hospitalizations for OA involving a knee or hip replacement. It is projected that by 2030 the number of primary …

How To Manage Knee Arthritis: Best Practices For Treatment Prior To Orthopaedic Referral, Ali Oliashirazi Md, Alex Caughran Md, Zain Quazi Md, Grant Buchanan Md, Akash Sharma, Franklin D. Shuler Md, Phd

Ali Oliashirazi

Osteoarthritis (OA) of the knee is a debilitating disease in which degeneration of the joint space cartilage can lead to life-altering pain and stiffness. The prevalence of OA has a strong correlation with age, with evidence of radiographic knee OA found in 37.4% of persons older than 60 years of age. According to the Agency for Healthcare Research and Quality’s (AHRQ) 2013 report, osteoarthritis was ranked the second most expensive condition for Medicare and private insurers, with over 90% of the hospitalizations for OA involving a knee or hip replacement. It is projected that by 2030 the number of primary …

Ruptures Of The Quadriceps And Patellar Tendons Of The Extensor Mechanism: A Review, Judd R. Fitzgerald

UNM Orthopaedic Research Journal

Damage to the quadriceps and patellar tendons of the extensor mechanism can be devastating and often life-changing injuries that require prompt diagnosis and treatment. A sound understanding of anatomy, biomechanics, and degenerative changes of both tendons and the extensor mechanism of the knee can help guide surgical repair and postoperative rehabilitation of patients. Immediate primary repair has often resulted in improved postoperative results compared with delayed reconstruction, and the avoidance of gap formation by use of careful techniques and augmentation has been critical for successful treatment. Additionally, patients with extensor mechanism injuries frequently have medical comorbidities or notable tendon degeneration; …

Causes, Evaluation, And Treatment Of Instability Of The Patellofemoral Joint Of The Knee: A Review, Michael J. Hopson

UNM Orthopaedic Research Journal

Instability of the patellofemoral (PF) joint of the knee is typically caused by chronic atraumatic injuries and inciting traumatic events. Anatomically, bony and softtissue structures surrounding the PF joint and extensor mechanism contribute to overall stability of the area, which results in efficient kinematic function at the PF articulation. Furthermore, physiological, genetic, anatomical, and demographical factors may affect the development and progression of PF joint instability. Treatment techniques have varied owing to individual factors that may have influence on pathological features of the injury. Nonoperative treatment has predominantly focused on strengthening of the quadriceps and vastus medialis by coordinated, closed …

Periprosthetic Fractures Of The Femur After Total Hip Arthroplasty And Hemiarthroplasty: A Review, Reilly R. Kuehn

UNM Orthopaedic Research Journal

Periprosthetic fractures of the femur after total hip arthroplasty (THA) and hemiarthroplasty represent relatively uncommon but challenging complications. The incidence of these types of fractures has been rising, owing to an increasing number of hip arthroplasties performed, aging population, and prevalent use of uncemented stems, which may have unsuccessful long-term results compared with use of cemented stems. Method of treatment has been generally based on the Vancouver classification system that describes radiographic characteristics of fractures and stability of the femoral stems in respect to placement in the bone. In particular, the presence of loose stems has often indicated the need …

Treatment Of Injuries And Conditions Of The Distal Clavicle: A Review, Heather M. Menzer

UNM Orthopaedic Research Journal

Several trauma-related injuries and degenerative conditions affect the distal end of the clavicle. Fractures of the distal clavicle and separations of the acromioclavicular (AC) joint are common, resulting from direct impact onto the shoulder region. Osteolysis and osteoarthritis of degenerative processes of the AC joint are caused by repetitive activity and overuse of the shoulder. To help identify options for treating the distal end of the clavicle, this review highlighted notable anatomical locations and biomechanics; findings of physical examinations; classification systems of injuries; and standard operative and nonoperative methods used for treatment. Although distal clavicle fractures, AC joint separations, osteolysis, …

Idiopathic Thrombocytopenic Purpura In A 21-Year-Old Collegiate Football Player: A Case Report, James A. Leinhart, Shane P. Cass, Matthew A. Tennison, Ronica A. Martinez, Christopher A. Mcgrew

UNM Orthopaedic Research Journal

Muscle cramps are commonly observed in collegiate athlete-patients; however, the condition may be a symptom of severe disorders. In particular, idiopathic thrombocytopenic purpura (ITP) may be a possible diagnosis and involves a decreased number of platelets in the bloodstream. We describe a 21-year-old collegiate player of American football with initially presented with cramping of the neck, abdomen, and forearms. Although findings of physical examination were normal, results of laboratory tests indicated ITP, and the patient was hospitalized for 3 days until the platelet count increased. Because the levels continued to decrease at 6-month followup, splenectomy and use of rituximab agents …

Spare-Parts Technique For Concurrent Treatment Of Ectrodactyly Of The Feet And Syndactyly Of The Hands In A 2-Year-Old Boy: A Case Report, Brielle K. Payne, Mary E. Logue, Selina R. Silva, Deana M. Mercer

UNM Orthopaedic Research Journal

Syndactyly is the most frequently occurring congenital malformation of the limbs. Although common, few studies have reported treating syndactyly using Z-plasty with and without full-thickness grafting. We present a 2-year-old boy who presented to our clinic with ectrodactyly of the feet and simple complete syndactyly of two fingers on each hand. After ectrodactyly reconstruction, we used the excess foot skin to cover finger defects. The patient recovered well postoperatively, with matching skin and no trouble with hair growth. Use of a spare-parts technique can help avoid complications associated with harvesting grafts from other donor sites. The results reinforce the importance …

How To Manage Knee Arthritis: Best Practices For Treatment Prior To Orthopaedic Referral, Ali Oliashirazi Md, Alex Caughran Md, Zain Quazi Md, Grant Buchanan Md, Akash Sharma, Franklin D. Shuler Md, Phd

Orthopaedics

Osteoarthritis (OA) of the knee is a debilitating disease in which degeneration of the joint space cartilage can lead to life-altering pain and stiffness. The prevalence of OA has a strong correlation with age, with evidence of radiographic knee OA found in 37.4% of persons older than 60 years of age. According to the Agency for Healthcare Research and Quality’s (AHRQ) 2013 report, osteoarthritis was ranked the second most expensive condition for Medicare and private insurers, with over 90% of the hospitalizations for OA involving a knee or hip replacement. It is projected that by 2030 the number of primary …

Severely Deformed Extraarticular Fractures Of The Scapula: A Review, Sean B. Kuehn

UNM Orthopaedic Research Journal

Nonoperative treatment of severely deformed fractures of the scapula was historically common. However, the findings of newer research have challenged the notion that conservatively managing these fractures results in the most successful outcomes. In an attempt to possibly reveal important indicators for surgical treatment, I reviewed studies on scapula fractures involving scapular anatomy; associated injuries; technological advances that have helped with fracture evaluation; and treatment outcomes between nonsurgical and surgical methods. Although a universally accepted classification scheme of scapula fractures does not exist, use of 3D reconstruction with computed tomography can help define the level and category of fracture deformity. …

Learning The Laprade Technique For Reconstruction Of The Posterolateral Corner Of The Knee, Dustin L. Richter

UNM Orthopaedic Research Journal

No abstract provided.

Treatment Of Full Circumferential Segmental Bone Loss Of The Tibia Resulting From Acute Traumatic Injuries And Complications: A Review, Gregory C. Strohmeyer

UNM Orthopaedic Research Journal

Full circumferential segmental bone loss of the tibia presents a challenge to orthopaedic surgeons. These open fractures often involve extensive soft-tissue damage, which can contribute to poor long-term outcomes even if the tibia is successfully reconstructed. Although amputation was historically used to treat full circumferential segmental bone loss of the tibia because of the severity of the injury, the development of new reconstruction procedures has provided the option of limb salvage techniques. I reviewed studies on treatment of traumatic tibia bone loss, focusing particularly on full circumferential bone loss of greater than 3 cm. Treatment options included amputation, allograft replacement, …

Open Reduction And Internal Fixation For Treatment Of Proximal Humerus Fractures: A Review, Heather K. Woodin

UNM Orthopaedic Research Journal

Fractures of the proximal humerus are common in older patients, and the incidence of these fractures in the United States is expected to notably increase with the aging population. Nonoperative procedures have been preferred in elderly patients with stable fracture patterns to avoid complications associated with osteoporotic bone. However, more complex and unstable fracture patterns often necessitate operative techniques to allow for more anatomical healing. Although proximal humerus fractures have been thoroughly examined, systemized, and studied, no clear method to choosing an appropriate surgical treatment or candidate has been accepted. I reviewed the role of the following factors on successful …

Survey Of Current Articles Published On Total Ankle Arthroplasty And Ankle Fusion, Tony G. Pedri, Richard A. Miller

UNM Orthopaedic Research Journal

In the United States, ankle fusion is more commonly performed than total ankle arthroplasty (TAA) for treatment of degenerative joint disease of the ankle. However, recent advances in implant design and technique have led to a renewed interest in research on TAA. To shed light on current research trends and limited data rather than examine the merits between both methods, we performed a PubMed search of studies on TAA and ankle fusion between January 1, 2009, and January 1, 2015, published in both the American edition of the Journal of Bone and Joint Surgery (JBJS) and Foot & Ankle International …

Third Extensor Compartment Disruption And The Biomechanics Of Thumb Extension, Christina Salas, Drew K. Newhoff, Zainab Cheema, Allison A. Richards, Deana M. Mercer, Amanda K. Medoro, Ahmed M. Afifi, Moheb S. Moneim, John M. Veitch

UNM Orthopaedic Research Journal

Background: Procedures involving release of the third dorsal wrist compartment have been thought to transpose the extensor pollicis longus (EPL) tendon from its anatomical position. Few studies, however, have reported on the effects this might have on function and mechanics of the thumb. We analyzed the impacts of intact extensor retinaculum, release of the third dorsal compartment, and removal of Lister’s tubercle on thumb extension.

Methods: A total of 15 fresh-frozen cadaveric upper extremities (eight male, seven female; mean age, 52 years; range, 38-59 years) were used. For each specimen, three phases of testing were analyzed: the extensor retinaculum was …