Medicine and Health Sciences Commons^™

Local Injections Of Β-Ngf Accelerates Endochondral Fracture Repair By Promoting Cartilage To Bone Conversion., Kevin O. Rivera, Fabrizio Russo, Ryan M. Boileau, Ryan E. Tomlinson, Theodore Miclau, Ralph S. Marcucio, Tejal A. Desai, Chelsea S. Bahney

Department of Orthopaedic Surgery Faculty Papers

There are currently no pharmacological approaches in fracture healing designed to therapeutically stimulate endochondral ossification. In this study, we test nerve growth factor (NGF) as an understudied therapeutic for fracture repair. We first characterized endogenous expression of Ngf and its receptor tropomyosin receptor kinase A (TrkA) during tibial fracture repair, finding that they peak during the cartilaginous phase. We then tested two injection regimens and found that local β-NGF injections during the endochondral/cartilaginous phase promoted osteogenic marker expression. Gene expression data from β-NGF stimulated cartilage callus explants show a promotion in markers associated with endochondral ossification such as Ihh, Alpl, …

Three Decades Of Research On Recombinant Collagens: Reinventing The Wheel Or Developing New Biomedical Products?, Andrzej Fertala

Department of Orthopaedic Surgery Faculty Papers

Collagens provide the building blocks for diverse tissues and organs. Furthermore, these proteins act as signaling molecules that control cell behavior during organ development, growth, and repair. Their long half-life, mechanical strength, ability to assemble into fibrils and networks, biocompatibility, and abundance from readily available discarded animal tissues make collagens an attractive material in biomedicine, drug and food industries, and cosmetic products. About three decades ago, pioneering experiments led to recombinant human collagens' expression, thereby initiating studies on the potential use of these proteins as substitutes for the animal-derived collagens. Since then, scientists have utilized various systems to produce native-like …

Bioactivating A Bone Substitute Accelerates Graft Incorporation In A Murine Model Of Vertical Ridge Augmentation, Jinlong Chen, Xue Yuan, Zhijun Li, Daniel J Bahat, Jill A Helms

Department of Orthopaedic Surgery Faculty Papers

OBJECTIVE: Compared to autologous bone grafts, allogeneic bone grafts integrate slowly, which can adversely affect clinical outcomes. Here, our goal was to understand the molecular mechanisms underlying graft incorporation, and then test clinically feasible methods to accelerate this process.

METHODS: Wild-type and transgenic Wnt "reporter" mice were used in a vertical ridge augmentation procedure. The surgery consisted of tunneling procedure to elevate the maxillary edentulous ridge periosteum, followed by the insertion of bone graft. Micro-computed tomographic imaging, and molecular/cellular analyses were used to follow the bone graft over time. Sclerostin null mice, and mice carrying an activated form of β-catenin …

Osseous Changes Following Reverse Total Shoulder Arthroplasty Combined With Latissimus Dorsi Transfer: A Case Series, Jason S Klein, Peter S Johnston, Benjamin W Sears, Manan S Patel, Armodios M Hatzidakis, Mark D. Lazarus

Department of Orthopaedic Surgery Faculty Papers

Background: This is the first report on the incidence of proximal humerus osseous changes and associated clinical consequences in reverse total shoulder arthroplasty combined with a latissimus dorsi tendon transfer (RTSA+LDT).

Methods: A multicenter, retrospective review identified all patients who had undergone a primary RTSA+LDT and had at least 3-month radiographic follow-up between 2012 and 2017. Data collection included demographics, oral steroid use, repair technique for LDT fixation, radiographic humeral osseous changes, complications, and need for revision surgery.

Results: Twenty-four patients were included with an average age of 70.7 ± 7.9 years and follow-up of 16.3 (3-50) months. Ten patients …

The Role Of Nerves In Skeletal Development, Adaptation, And Aging., Ryan E Tomlinson, Blaine A Christiansen, Adrienne A Giannone, Damian C Genetos

Department of Orthopaedic Surgery Faculty Papers

The skeleton is well-innervated, but only recently have the functions of this complex network in bone started to become known. Although our knowledge of skeletal sensory and sympathetic innervation is incomplete, including the specific locations and subtypes of nerves in bone, we are now able to reconcile early studies utilizing denervation models with recent work dissecting the molecular signaling between bone and nerve. In total, sensory innervation functions in bone much as it does elsewhere in the body-to sense and respond to stimuli, including mechanical loading. Similarly, sympathetic nerves regulate autonomic functions related to bone, including homeostatic remodeling and vascular …

Reliability And Validity Of The English Version Of The Aospine Prost (Patient Reported Outcome Spine Trauma), Said Sadiqi, Marcel F Dvorak, Alex R. Vaccaro, Gregory D. Schroeder, Marcel W Post, Lorin M Benneker, Frank Kandziora, S Rajasekaran, Klaus J Schnake, Emiliano N Vialle, F Cumhur Oner

Department of Orthopaedic Surgery Faculty Papers

STUDY DESIGN: Multicenter validation study.

OBJECTIVE: The aim of this study was to translate and adapt the AOSpine PROST (Patient Reported Outcome Spine Trauma) into English, and test its psychometric properties among North-American spine trauma patients.

SUMMARY OF BACKGROUND DATA: In the absence of an outcome instrument specifically designed and validated for traumatic spinal column injury patients, it is difficult to measure the effect size of various treatment options. The AOSpine Knowledge Forum Trauma initiated a project and developed the AOSpine PROST consisting of 19 items.

METHODS: Patients were recruited from two level-1 North-American trauma centers. For concurrent validity, next …

The Role Of Machine Learning In Spine Surgery: The Future Is Now, Michael Chang, Jose A Canseco, Kristen Nicholson, Neil Patel, Alex R. Vaccaro

Department of Orthopaedic Surgery Faculty Papers

The recent influx of machine learning centered investigations in the spine surgery literature has led to increased enthusiasm as to the prospect of using artificial intelligence to create clinical decision support tools, optimize postoperative outcomes, and improve technologies used in the operating room. However, the methodology underlying machine learning in spine research is often overlooked as the subject matter is quite novel and may be foreign to practicing spine surgeons. Improper application of machine learning is a significant bioethics challenge, given the potential consequences of over- or underestimating the results of such studies for clinical decision-making processes. Proper peer review …

Description And Reliability Of The Aospine Sacral Classification System, Alex R. Vaccaro, Gregory D. Schroeder, Srikanth N. Divi, Christopher K Kepler, Conor P Kleweno, James C. Krieg, Jefferson R Wilson, Jörg H Holstein, Mark Kurd, Reza Firoozabadi, Luiz R Vialle, F Cumhur Oner, Frank Kandziora, Jens R Chapman, Klaus J Schnake, Lorin M Benneker, Marcel F Dvorak, Shanmuganathan Rajasekaran, Emiliano N Vialle, Andrei F Joaquim, Mohammad Mostafa El-Sharkawi, Gaurav R Dhakal, Eugen C Popescu, Rishi M Kanna, S P J Muijs, Jin W Tee, Carlo Bellabarba

Department of Orthopaedic Surgery Faculty Papers

BACKGROUND: Several classification systems exist for sacral fractures; however, these systems are primarily descriptive, are not uniformly used, have not been validated, and have not been associated with a treatment algorithm or prognosis. The goal of the present study was to demonstrate the reliability of the AOSpine Sacral Classification System among a group of international spine and trauma surgeons.

METHODS: A total of 38 sacral fractures were reviewed independently by 18 surgeons selected from an expert panel of AOSpine and AOTrauma members. Each case was graded by each surgeon on 2 separate occasions, 4 weeks apart. Intrarater reproducibility and interrater …

A Surgeon's Handedness In Direct Anterior Approach-Hip Replacement., Xiangpeng Kong, Minzhi Yang, Alvin Ong, Renwen Guo, Jiying Chen, Yan Wang, Wei Chai

Department of Orthopaedic Surgery Faculty Papers

BACKGROUND: The impact of handedness on clinical outcomes was easily overlooked in hip replacement. This study aimed to find whether the component positioning and hip function were affected by the handedness in total hip arthroplasty (THA) through direct anterior approach (DAA).

METHODS: Total 102 patients who underwent bilateral DAA-THAs simultaneously between May 2016 and November 2018 in our institute were reviewed. All surgeries were operated by one right-handed surgeon. Their demographic, cup positioning, stem alignment, femoral stem fit, Harris hip score (HHS), intraoperative and postoperative complications were used to evaluate the role of handedness in DAA.

RESULTS: The inclination of …

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 …

Prospective Study Of Military Special Operations Medical Personnel And Lower Extremity Fracture Immobilization In An Austere Environment, Kevin Martin, Trevor Mcbride, Alicia Unangst, Jaime Chisholm

Department of Orthopaedic Surgery Faculty Papers

Background: Austere fracture immobilization equipment and techniques are often overlooked, with few studies critically evaluating the process. The purpose of this study was to evaluate current austere splinting techniques and equipment used for lower extremity fractures while field testing a new 1-step spray-on foam splint.

Methods: This is a prospective analysis of austere splinting techniques. A cadaveric model with a distal third tibia-fibula fracture was used for testing. The specimens were placed in an austere environment and participants immobilized the injury with standard equipment (structural aluminum malleable [SAM] splint, 6-in. ACE wrap) while being critically evaluated. The specimens were also …

Sustaining The National Spinal Cord Injury Registry Of Iran (Nscir-Ir) In A Regional Center: Challenges And Solutions, Zahra Azadmanjir, Zahra Mohtasham-Amiri, Seyed-Mahdi Ziabari, Leila Kochakinejad, Hamid Haidari, Guilan University Of Medical Sciences, Hadis Sabour, Zahra Khazaeipour, Mahdi Sharif-Alhoseini, Zahra Ghodsi, Abbas Amirjamshidi, Farshad Akbarzadeh, Kazem Zendehdel, Amir Azarhomayouon, Khatereh Naghdi, Gerard Oreilly, Ellen Merete, Alexander Vaccaro, Edward C. Benzel, Seyed Behzad Jazayeri, Vafa Rahimi-Movaghar

Department of Orthopaedic Surgery Faculty Papers

Background: The National Traumatic Spinal Cord Injury Registry in Iran (NSCIR-IR), was implemented initially in three hospitals as a pilot phase from 11 Oct 2015 to 19 Jun 2016 and has been active in eight centers from 19 Jun 2016. Poursina Hospital, a trauma care referral center in Rasht, Guilan Province of Iran is one of the registry sites, and has been involved in registering eligible patients since 1 Jan 2016. This study aimed to identify the challenges and solutions for sustaining the NSCIR-IR in a regional center.

Methods: This was a mixed-methods study. For the quantitative analysis, a retrospective …

Correlation Of Early Outcomes And Intradiscal Interleukin-6 Expression In Lumbar Fusion Patients., John D Koerner, Dessislava Z Markova, Greg D Schroeder, Christopher L Antonacci, Joseph Mendelis, Alexander R Vaccaro, D Greg Anderson, Chris K Kepler

Department of Orthopaedic Surgery Faculty Papers

OBJECTIVE: To determine if there is correlation between intradiscal levels of interleukin-6 (IL-6) and early outcome measures in patients undergoing lumbar fusion for painful disc degeneration.

METHODS: Intervertebral disc tissue was separated into annulus fibrosus/nucleus pulposus and cultured separately in vitro in serum-free medium (Opti-MEM). Conditioned media was collected after 48 hours. The concentration of IL-6 was quantified using enzyme-linked immunosorbent assay. Pearson correlation coefficients quantified relationships between IL-6 levels and pre- and postoperative visual analogue scale (VAS) back pain and Oswestry Disability Index (ODI), as well as change in VAS/ODI.

RESULTS: Sixteen discs were harvested from 9 patients undergoing …

National Trends In Total Hip Arthroplasty For Traumatic Hip Fractures: An Analysis Of A Nationwide All-Payer Database., Anthony J Boniello, Alexander M Lieber, Kevin Denehy, Priscilla Cavanaugh, Yehuda E Kerbel, Andrew Star

Department of Orthopaedic Surgery Faculty Papers

BACKGROUND: Hemiarthroplasty (HA) has traditionally been the treatment of choice for elderly patients with displaced femoral neck fractures. Ideal treatment for younger, ambulatory patients is not as clear. Total hip arthroplasty (THA) has been increasingly utilized in this population however the factors associated with undergoing HA or THA have not been fully elucidated.

AIM: To examine what patient characteristics are associated with undergoing THA or HA. To determine if outcomes differ between the groups.

METHODS: We queried the Nationwide Inpatient Sample (NIS) for patients that underwent HA or THA for a femoral neck fracture between 2005 and 2014. The NIS …