Medicine and Health Sciences Commons^™

Subclinical Presentation Of Cutibacterium Acnes Infection Following Revision Rotator Cuff Repair: A Case Report, Zachary Walker, David Shuster, David Sosnoski, Ali Hamade, Hussein Saad, Marc Milia

Posters

Cutibacterium acnes is a gram-positive anaerobic bacillus which is commonly found in the sebaceous glands of the skin generally in the axilla, chest and back regions 1,2.

Shoulder infections have been reported to occur at 3.4% following arthroscopic or open shoulder surgeries, where they are most commonly due to C. acnes3,4.

This case report demonstrates a unique case and management of a subclinical presentation of confirmed C. acnes infection.

Pseudoaneurysm Development After Short Cephalomedullary Femoral Nailing, Nicholas E. Runge, Daniel P. Mccall

Posters

Hip fractures are amongst the most treated conditions by orthopaedic surgeons1 and are routinely treated with cephalomedullary nails (CMN)s.

Pseudoaneurysm formation is a rare complication after femoral CMN. The primary cause of pseudoaneurysm formation in previous studies has been found to be related to overpenetration of the far cortex with a drill or screw.

Patients with neuromuscular diseases may have aberrant anatomy potentially leading to increased risk of pseudoaneurysm formation

This the first case report of a patient with post-polio syndrome who developed a symptomatic deep femoral artery pseudoaneurysm status post short CMN fixation for a basicervical femoral neck fracture …

Remove The Ring: A Quality Improvement Initiative For Upper Extremity Trauma, Brandon Wallace, Matthew Charlick, Josiah Valk, Aaron Seidman

Posters

Upper extremity trauma is a common injury and post traumatic edema is an expected sequela. Retained rings on the digits prohibit circumferential swelling and may lead to tourniquet syndrome if left in place leading to a devastating and avoidable consequence.

Expeditious ring removal in upper extremity trauma is prudent for patient safety.

Radiographs are typically obtained early in the triage and treatment of patients suffering from upper extremity trauma. This presented itself as as reliable efficient target to have rings removed prior to this treatment step.

An opportunity to make a systemic change to maximize patient safety and care was …

Sole Searching: The Mystery Of A Left Foot Mood Swing Unraveled, Kaitlin Sebranek, Randy Semma

Posters

About 0.2% of patients in the Diabetic population have Charcot Neuroarthropathy.

When the gold standard of offloading in a total contact cast fails for CN patients, surgical treatment can be considered to achieve a stable, plantigrade, and functional foot.

Due to the complexity of the condition, potential complications such as hardware breakage, nonunion, and infection can result over time.

Complications And Formation Of Sinus Tracts Due To Presence Of Lead From Foreign Bodies In Soft Tissue: A Case Report, Peter J. Godoy, Marshall G. Solomon

Posters

A cornerstone of lower extremity limb salvage is to avoid development of wound complications involved in soft tissue infections . Predicting probability of sinus tract development due to presence of lead in soft tissues from foreign bodies. In this particular case a bullet fragment from a previous gunshot wound was noted to be the catalyst disrupting multiple biologic processes and impairing the function of soft tissues to heal. Predicting a level of contamination in this particular case lead believed to cause oxidative stress and inflammation and prompt excisional removal can avoid sinus tract formations and complications. This study presents a …

The Curious Case Of Ainhum Dactolysis Spontanea, Jesse Miller, Michele Bertele-Semma, Randy Semma

Posters

46 yo African male, no major PMH.

Pt presents with severe pain in the right 5th toe.

Pt had used a corn remover at home treatment 2 years ago which they stated started the progression in the pain of the patient.

Pt states that the toe has progressively become more constricted and painful.

Pt states that they want their toe amputated to relieve the pain.

Applications Of Minirail External Fixator In Arthrodesis Foot Surgery For The High-Risk Patient Population: A Case Series, Reema Naman

Posters

Since the inception of external fixation, there have been many modifications to the utilization of the devices, including the size. The minirail external fixator has evolved since the usage for bracymetatarsia into more complex devices. In the podiatric patient population, there are many comorbidities encountered such as diabetes, idiopathic neuropathy, and smoking. In the diabetic neuropathic population the purpose of use of the minirail external fixator was to provide additional stability as a mini-superconstruct as per Sammarco principles. An additional benefit of the fixator is the option of removing the pins if there are any signs of infection. The purpose …

Two For One – Simultaneous Bilateral Shoulder Injuries In Gym Teacher: A Case Report, Zachary Walker, Josiah Valk, David Sosnoski, Kelley Brossy, Mohamed Saad

Posters

28M gym teacher history of T1DM, seizure d/o, and alcohol use disorder presents with bilateral shoulder pain after an inebriated fall, two nights prior. Not on antiepileptics at baseline. C/o bilateral shoulder pain and mid-thoracic spine pain.

Utilization Of Negative Pressure Wound Therapy And Split Thickness Skin Grafts In The Context Of Complex Skin Closure Via Secondary Intention: A Protocol Approach, Jihan Toma, Eric Li, Randy Semma, Michele Bertelle-Semma, Asif Khan

Posters

Patients with complex, chronic foot wounds or ulcerations are at risk for major amputations. In this quality improvement (QI) initiative, we present an implemented protocol for patients with foot ulcerations and attempt to heal them using a combination of wound vac therapy and split thickness skin grafting. These patients have a history of either diabetes and/or neuropathy that makes wound healing more difficult than an otherwise healthy individual.

Diabetic Limb Salvage: Chopart Amputation, Jesse Miller, Randy Semma

Posters

Diabetic limb salvage is the act of saving a limb, even with decreased function after infection.

It is the difficult choice of the surgeon/patient to decide to proceed with salvage versus amputation proximally.

Case Report Of Bullous Diabeticorum: A Self-Limiting Condition With Potentially Devastating Consequences, Taylor Allison, Randy Semma

Posters

Bullous diabeticorum (BD) is a skin manifestation of patients with diabetes mellitus with an incidence of about 0.16% per year (Larsen et al) although the condition is believed to be widely underdiagnosed. The blistering disease favors acral regions of the body including the feet. There are no accepted diagnostic tests, and histopathology results are often inconclusive which makes BD a clinical diagnosis of exclusion. It is often self-limiting and resolves in a few weeks without residual sequelae. However, it may present with a secondary bacterial infection which can put patients at risk for soft tissue infections and osteomyelitis requiring more …

Revisional Arthrodesis Of Tarsometatarsal (Lisfranc) Complex Injury Secondary To Non-Union, Lei Wilson, Randy Semma

Posters

The tarsometatarsal joint and its components provide structural support for the foot. Notably the Lisfranc ligament is a fundamental stabilizer for the midfoot. Injuries to this component are complex and can be debilitating. These injuries require surgical intervention when significant displacement resulting in instability is involved.

Following success of several previous repairs of Lisfranc fractures and dislocations, a treatment algorithm has been proposed. This case report demonstrates the success of the algorithm which has allowed the surgeon to perform reduction and repair in a reproducible, step-wise manner with minimal difficulty to ensure successional revisional arthrodesis of a non-union

Cohort Study Using A Survey To Evaluate The Effects Of Sleep On Hba1c Levels And Foot Pathology In Patients Seen In The Podiatry Clinic, Carmen Johnson, Eric Li, Jihan Toma, Marshall G. Solomon

Posters

We investigate the impacts of sleep issues on patients in the podiatry clinic by comparing HbA1c, sleep, and foot pathology. Diabetic foot pathology of peripheral arterial disease, peripheral neuropathy, lower extremity ulcerations, and a history of lower extremity amputation all increase the patient's risk of future amputation. Once a patient has an amputation of the lower extremity the five-year mortality rates are 40-70%. So, limb salvage not only improves the quality of life, but also increases the life expectancy for patients. Through a survey and chart review, we are investigating possible impacts of sleep issues on diabetic patients seen in …

Septic First Metatarsophalangeal Joint Arthrodesis With Alternative Mini-Rail Fixation, Brenna Barker, Morgan Gascoyne, Randy Semma

Posters

For non-infection cases, first metatarsal phalangeal joint arthrodesis is a definitive procedure for painful, arthritic joints.

Standard fixation methods include screws, plates, staples, or a combination of the three.

For complex septic joint cases, an alternative method of fixation is needed to reduce the risk of infection retention.

The Diagnosis Of Polyarteritis Nodosa In The Setting Of Lower Extremity Lesions: A Case Report, Eric Li, Jihan Toma, George Gopoian

Posters

Polyarteritis nodosa (PAN) is a systemic necrotizing vasculitis affecting medium-sized arteries, involving multiple organs, with the most frequently affected tissues being skin and peripheral nerves (1). The distinct pearl neckless pattern led to the naming of this condition (2). Cutaneous polyarteritis nodosa (CPAN) is a variant of PAN confined to the skin, muscles and peripheral nerves in the absence of any systemic involvement (1). This rare form of systemic necrotizing vasculitis is limited to the medium-sized arteries of the skin and has a more favorable prognosis (1). PAN is also linked to Hepatitis B(2). The current diagnostic criteria for CPAN …

Repair Of Achilles Tendon Re-Rupture With Fhl Transfer: A Case Study, Taylor Allison, Joshua Kazdan

Posters

The Achilles tendon consists of the soleus muscle and two heads of the gastrocnemius muscle. Loss of its function can result in loss of plantarflexion strength, which can impact activities of daily living. In a study by Scheller et al, Achilles tendon ruptures were missed on initial evaluation on 25% of their patients. Other studies have reported a similar incidence of misdiagnoses. Patients may also delay treatment due to decreased pain after the initial injury. Ruptures diagnosed 4 weeks from injury are often considered chronic, and many of these patients benefit from surgical repair. A flexor hallucis longus (FHL) transfer …

Antibiotics Vs Surgical Resection In Foot And Ankle Osteomyelitis, Travis Rich, Marshall G. Solomon

Posters

Osteomyelitis, a serious bone infection, is particularly challenging in diabetic patients due to poor vascularization and impaired immune response.1 Timely and effective treatment is essential to prevent severe complications, including limb loss or even death.2 This study aims to evaluate the likelihood of surgical excision or amputation versus antibiotic treatment alone in diabetic patients with bone biopsyconfirmed acute osteomyelitis of the lower extremity.

Failed Medial Column Fusion Due To Subtalar Joint Instability, Travis Rich, Randy Semma, Michele Bertelle-Semma

Posters

CNA is a destructive complication affecting the bone and joint structure, most often in diabetics w/ longstanding peripheral neuropathy.

High incidence of major amputation associated with Charcot foot.

Kaposi Sarcoma Case Study, Mohamed Elshebiny, Marshall G. Solomon

Posters

No abstract provided.

Pyogenic Tenosynovitis Of Tibialis Anterior Tendon After Cat Bite, Daniel Blascak, David Sosnoski, Aaron Seidman

Posters

Pyogenic tenosynovitis is a bacterial infection of the synovial sheath that surrounds a tendon.

Commonly occurs within flexor tendons of the hand; theoretically can occur within any sheathed tendon.

Delayed diagnosis may lead to spread of infection to surrounding tissues and tendon rupture.

Tibialis anterior tendon is encased in a synovial sheath that runs from above the superior extensor retinaculum to the talonavicular joint.

Only five cases of pyogenic tenosynovitis of the tibialis anterior tendon have been reported in the literature.

None of the reported cases were due to animal bite injury.

Cd21 Stains Dendritic Networks In Tertiary Lymphoid Structure Of Transplant Renal Biopsies To Avoid Misdiagnosis Of Borderline Changes, Brandon D. Metcalf, Wei Li, Hassan Kanaan, Ping L. Zhang

Posters

Tertiary Lymphoid Structures (TLS) have been described as germinal center-like lymphoid structures composed dendritic network, mixed lymphocytes and high endothelial venules in internal organs following primary lymphoid organs (thymus and spleen) and secondary lymphoid structures (lymph nodes and native lymphoid structures along GI tract).

The TLS is mainly located at peri-glomeruli, peri-vascular areas or renal pelvis following inflammatory insults. A recent study indicates that TLS can been seen up to 19 % of protocol transplant renal biopsies (TRB) (JASN, 2022;33:186-200).

We hypothesize that CD21 staining can identify dendritic cells of TLS so that borderline changes are not over-diagnosed.

Stepping Into Relief: Conquering Rheumatoid Arthritic Foot Pain With Podiatric Management, Natalie Diaz, Marshall Solomon, Inocencio Cuesta

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Rheumatoid arthritis (RA) is a chronic multifactorial autoimmune disease that causes progressive joint destruction along with causing cutaneous manifestations such as nodules. RA negatively impacts life by producing pain, impairing quality of life and biomechanical function of the lower extremities.

Laryngeal Tuberculosis Mimicking Laryngeal Candidiasis, Claire Walters, Maranda Saigh, Eytan Keidar

Posters

Tuberculosis (TB) from the bacterium Mycobacterium tuberculosis and candidiasis from the fungus Candida albicans are both opportunistic pathogens with the ability to instigate infections within the larynx with similar clinical features, yet vastly different diagnostic parameters and treatment regimens.

Here, we highlight a case of an Indian woman on immune-modulating drugs who presented with severe laryngeal symptoms initially presumed to be laryngeal candidiasis but was later discovered to be laryngeal tuberculosis.

Clinical Characteristics And Outcomes In Patients With Coronary Artery Aneurysms (Caa) Presenting With Acute Coronary Syndrome (Acs) Or Cardiomyopathy, Advaitha Misra, Mathangi Keshavan, Ersida Zerdelija, Zain Abidi, Alexandra Corrado, James Benke, Hassan Dalloul, Anton Salwan

Posters

Coronary artery aneurysms and ectasia are rare conditions with an incidence estimated at < 1% [1]. It is defined as either a focal or diffuse dilation of a coronary segment of at least one and a half times the adjacent normal segment [2,3].The most common etiology is atherosclerosis, although a variety of other culprits are implicated in its pathogenesis, such as vasculitidies and connective tissue disorders [3,4,5]. Its management is largely driven by the etiology of the coronary artery segment dilation and the presentation of disease at the time of diagnosis. Management strategies employ a judicious combination of medical therapy, percutaneous and surgical interventions. The presence of coronary artery aneurysm or ectasia has been associated with poor long-term outcomes [6,7,8]. Complications from coronary artery aneurysm influence management, largely guided by clinician judgment and limited published data. Given the paucity of evidence in the management of these conditions, we present a case series of three patients with coronary artery aneurysm or ectasia with varying presentations and their corresponding management. We aim to contribute to the growing body of evidence for the management of this elusive cardiac condition.

Case Report: Diagnosing & Treating Triple Negative Breast Cancer During Pregnancy, Sydney Mefford, Chloe Page

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Pregnancy associated breast cancer (PABC) is rare and can be seen in every 1 in 3000 pregnant patients. It is associated with a high morbidity rate, especially in cases of Triple Negative Breast Cancer (TNBC).

Prevalence has increased as society grows to have pregnancies at later ages. Risk is elevated for 1 year after delivery of baby.

Seeing Double An Atypical Presentation Of Rcvs, Lauren Kassab, Alexander Ismail, Jonathan Doty

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Reversible cerebral vasoconstriction syndrome (RCVS) is a syndrome characterized by reversible, multifocal narrowing of the cerebral arteries and a thunderclap headache (reaching a peak intensity within one minute). A less severe headache, or lack thereof, is rare (1). Additional neurologic symptoms are typically dependent on the sequelae of focal intracranial stenosis, including ischemia, PRES, and IPH. Common precipitants are cannabis, SSRIs, alcohol, cocaine, and eclampsia. Depending on the inciting cause, presentations can also widely vary over a course of months - years. Diagnosis can be pervasive, as noninvasive vascular imaging has an 80% sensitivity (2). Definitive diagnosis is made with …

Jamestown Canyon Virus Meningoencephalitis: A Case Report, Amy Ishbia, Hannah Guide, Matthew Sierra, Jonathan Doty

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Jamestown Canyon virus is a rare mosquito-borne orthobunyavirus that typically is asymptomatic or causes mild symptoms. However, it can rarely cause severe neuroinvasive disease [2,5]. The primary hosts include white-tailed deer, although moose, elk, and bison can also be hosts [2].

Typically, cases are seen between April and September, with a bimodal distribution peaking in spring and late summer [2].

Number of cases in the U.S. in 2024: 16 total cases, 11 neuroinvasive [1]. Number of cases in the U.S. between 2011-2023: 308, with 10 deaths, 206 neuroinvasive. One case was reported from Alpena, MI, where our patient resided [1].

The Role Of Adverse Childhood Events On The Progression Of Chronic Kidney Disease In Children: A Ckid Study, Ana Cortez, Matthew Matheson, John Cowden, Bradley Warady, Darcy K. Weidemann

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There is a paucity of research on the relationship between adverse childhood events (ACEs) and chronic kidney disease. The effect of ACEs on the long-term health outcomes of cardiovascular disease, cancer, and chronic lung disease first emerged in a paper published in 1998. The National Institutes of Health sponsored the ACE Study, which Kaiser Permanente carried out in California. The study used a 17-question survey addressing seven exposures: psychological, physical, contact-sexual abuse, substance abuse, mental illness, mother being treated violently, and criminal behavior in the household. The results revealed a strong relationship between childhood exposure to ACEs and health outcomes. …

Thyroid Dysfunction In Patients Receiving Immune Checkpoint Inhibitors, Emily Metzinger, Jennifer Boyd, Julia Broussard, Christopher Klockau

Posters

Objectives: The use of immune checkpoint inhibitors (ICIs) in cancer treatment is increasing. Literature about endocrinopathies associated with ICIs in children is limited. This study investigates ICIs and thyroid dysfunction in pediatric patients at one institution.

Methods: Retrospective chart review of patients ages 1 to 19 was completed who received any of the following ICIs between January 2000 and November 2023: PD-1 inhibitors (nivolumab or pembrolizumab), PD-L1 inhibitors (durvalumab or atezolizumab), and CTLA-4 inhibitors (ipilimumab or tremelimumab). Patients were excluded if thyroid function tests (TFTs) were not available to review or if patients passed away within 30 days of ICI …

The Use Of A Short And User-Friendly Questionnaire As A Screening Tool To Identify Potential Gaps In Nutrition Knowledge Of Adolescent Athletes, Roben Ohev Shalom, David Lick, Virginia E. Uhley

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Nutrition knowledge in adolescent athletes is rarely formally assessed by physicians. Current popular nutrition questionnaires include the CDC’s Youth Risk Behavior Survey (YRBSS) and the Nutrition for Sport Knowledge Questionnaire (NSKQ). These questionnaires are long and are not optimal to assess nutrition knowledge in adolescent athletes at their preparticipation examinations. A systematic review conducted by Tam et al, showed that questionnaires would benefit from interactive and attractive features including images. A novel nutrition questionnaire was adapted from the NSKQ that was user friendly, short in length, electronic and included images. We hypothesized that through collecting physicians feedback on the questionnaire …