Medical Specialties Commons^™

Variations In Practice Patterns Among Neurosurgeons And Orthopaedic Surgeons In The Management Of Spinal Disorders, Manzar Hussain, Sadaf Nasir, Amber Moed, Ghulam Murtaza

Section of Neurosurgery

Study design: This is a case series.
Purpose: We wanted to identify variations in the practice patterns among neurosurgeons and orthopedic surgeons for the management of spinal disorders.
Overview of literature: Spinal disorders are common in the clinical practice of both neurosurgeons and orthopedic surgeons. It has been observed that despite the availability of various guidelines, there is lack of consensus among surgeons about the management of various disorders.
Methods: A questionnaire was distributed, either directly or via e-mail, to the both the neurosurgeons and orthopedic surgeons who worked at 5 tertiary care centers within a single region of Korea. …

Molecular Diagnostics In Periprosthetic Joint Infection., Javad Parvizi, Lesley Walinchus, Bahar Adeli

Department of Orthopaedic Surgery Faculty Papers

Periprosthetic joint infection (PJI) is a significant and costly challenge to the orthopedic community. The lack of a gold standard for diagnosis remains the biggest obstacle in the detection and subsequent treatment of PJI. Molecular markers in the serum and joint fluid aspirate hold immense promise to enhance the development of a firm diagnostic criterion. The primary goal is one marker with high sensitivity and specificity. Here, we review our current research efforts in the field of molecular markers: C-reactive protein, erythrocyte sedimentation rate, white blood cells, and leukocyte esterase. Each marker has been studied to determine its sensitivity, specificity, …

An Organ Culture System To Model Early Degenerative Changes Of The Intervertebral Disc., Ravi K Ponnappan, Dessislava Z Markova, Paul Jd Antonio, Hallie B Murray, Alexander R Vaccaro, Irving M Shapiro, D Greg Anderson, Todd J Albert, Makarand V Risbud

Department of Orthopaedic Surgery Faculty Papers

ABSTRACT: INTRODUCTION: Back pain, a significant source of morbidity in our society, is related to the degenerative changes of the intervertebral disc. At present, the treatment of disc disease consists of therapies that are aimed at symptomatic relief. This shortcoming stems in large part from our lack of understanding of the biochemical and molecular events that drive the disease process. The goal of this study is to develop a model of early disc degeneration using an organ culture. This approach is based on our previous studies that indicate that organ culture closely models molecular events that occur in vivo in …

Duration Of Symptoms Resulting From Lumbar Disc Herniation: Effect On Treatment Outcomes: Analysis Of The Spine Patient Outcomes Research Trial (Sport)., Jeffrey A Rihn, Alan Hilibrand, Kristen Radcliff, Mark Kurd, Jon Lurie, Emily Blood, Todd J Albert, James N Weinstein

Rothman Institute Faculty Papers

BACKGROUND: The purpose of the present study was to determine if the duration of symptoms affects outcomes following the treatment of intervertebral lumbar disc herniation.

METHODS: An as-treated analysis was performed on patients enrolled in the Spine Patient Outcomes Research Trial (SPORT) for the treatment of intervertebral lumbar disc herniation. Randomized and observational cohorts were combined. A comparison was made between patients who had had symptoms for six months or less (n = 927) and those who had had symptoms for more than six months (n = 265). Primary and secondary outcomes were measured at baseline and at regular follow-up …

Duration Of Symptoms Resulting From Lumbar Disc Herniation: Effect On Treatment Outcomes: Analysis Of The Spine Patient Outcomes Research Trial (Sport)., Jeffrey A Rihn, Alan S Hilibrand, Kristen Radcliff, Mark Kurd, Jon Lurie, Emily Blood, Todd J Albert, James N Weinstein

Department of Orthopaedic Surgery Faculty Papers

BACKGROUND: The purpose of the present study was to determine if the duration of symptoms affects outcomes following the treatment of intervertebral lumbar disc herniation.

METHODS: An as-treated analysis was performed on patients enrolled in the Spine Patient Outcomes Research Trial (SPORT) for the treatment of intervertebral lumbar disc herniation. Randomized and observational cohorts were combined. A comparison was made between patients who had had symptoms for six months or less (n = 927) and those who had had symptoms for more than six months (n = 265). Primary and secondary outcomes were measured at baseline and at regular follow-up …

Burden Of Traumatic Spine Fractures In Tehran, Iran., Maziar Moradi-Lakeh, Mohammad R Rasouli, Alexander Vaccaro, Soheil Saadat, Mohammad R Zarei, Vafa Rahimi-Movaghar

Rothman Institute Faculty Papers

UNLABELLED: ABSTRACT:

BACKGROUND: The Disability-Adjusted Life Year (DALY) was designed by the World Health Organization (WHO) to measure, compare, and analyze the burden of various diseases. To the best of our knowledge, this is the first study on the assessment of burden of traumatic spinal fracture (TSF) in an Iranian community. We estimated burden of TSF includes both isolated (iTSF) and associated injuries related to traumatic spinal fractures (aTSF) in Tehran, the capital of Iran, for the year 2006-2007 using DALYs.

METHODS: Burden of TSF was estimated based on information provided by the national data on Iranian trauma, data from …

Challenges And Barriers To Improving Care Of The Musculoskeletal Patient Of The Future - A Debate Article And Global Perspective., Hangama C Fayaz, Jesse B Jupiter, Hans Christoph Pape, R Malcolm Smith, Peter V Giannoudis, Christopher G Moran, Christian Krettek, Karl J Prommersberger, Michael J Raschke, Javad Parvizi

Rothman Institute Faculty Papers

UNLABELLED: ABSTRACT:

BACKGROUND: With greater technological developments in the care of musculoskeletal patients, we are entering an era of rapid change in our understanding of the pathophysiology of traumatic injury; assessment and treatment of polytrauma and related disorders; and treatment outcomes. In developed countries, it is very likely that we will have algorithms for the approach to many musculoskeletal disorders as we strive for the best approach with which to evaluate treatment success. This debate article is founded on predictions of future health care needs that are solely based on the subjective inputs and opinions of the world's leading orthopedic …

Defining Bone Health And Fracture Risk In West Virginia: The World Health Organization Frax® Assessment Tool, Franklin D. Shuler Md, Jacob Conjeski Md

Orthopaedics

This article highlights the expanding burden of osteoporosis in West Virginia. WV ranks second nationally in the percentage of its population that is ≥ 65 years of age. Our older population increases the risk of osteoporosis and fracture; the most recent data indicates that 77% of our women age 50 and older have osteoporosis or low bone mass. The lifetime risk of osteoporotic related fracture is alarming and occurs in 50% of females and 25% of males age 50 and older. The risk of osteoporosis related hip fracture in women is equal to the combined risk of breast, uterine or …

Legal Aspects Of Aerobic Capacity: Objective Evidence Of The Ability To Work, Margaret E. Ciccolella, Tommy Boone, Todd E. Davenport

School of Pharmacy Faculty Articles

The article discusses the legality of aerobic capacity testing in disability cases particularly chronic fatigue syndrome (CFS). It says that aerobic capacity testing can be used to document functional impairments in patients with CFS after the failure of Functional Capacity Evaluation (FCE) in evaluating the ability to work of CFS patients who claim for insurance benefits. It presents case law reviews that illustrate the importance of expert testimony in disability related insurance benefit.

Hamstring Injuries In Professional Football Players: Magnetic Resonance Imaging Correlation With Return To Play., Steven B Cohen, Jeffrey D Towers, Adam Zoga, Jay J Irrgang, Junaid Makda, Peter F Deluca, James P Bradley

Rothman Institute Faculty Papers

BACKGROUND: Magnetic resonance imaging (MRI) allows for detailed evaluation of hamstring injuries; however, there is no classification that allows prediction of return to play.

PURPOSE: To correlate time for return to play in professional football players with MRI findings after acute hamstring strains and to create an MRI scoring scale predictive of return to sports.

STUDY DESIGN: Descriptive epidemiologic study.

METHODS: Thirty-eight professional football players (43 cases) sustained acute hamstring strains with MRI evaluation. Records were retrospectively reviewed, and MRIs were evaluated by 2 musculoskeletal radiologists, graded with a traditional radiologic grade, and scored with a new MRI score. Results …

Effectiveness Of Neuromuscular Conditioning To Prevent Anterior Cruciate Ligament Injuries In Female Athletes: A Critical Synthesis Of Literature, Shiren G. Assaly, Todd E. Davenport, Katrin Mattern-Baxter

School of Pharmacy Faculty Articles

Background and Purpose: Anterior cruciate ligament (ACL) injuries are common among female athletes. The purpose of this literature review was to assess the effectiveness of neuromuscular conditioning to modify biomechanical risk factors for ACL injury.

METHOD: A structured literature search was conducted to identify primary research articles. Articles were graded according to their strength of evidence and a qualitative literature review was completed.

RESULTS: Seven primary research studies were available for analysis that documented the effects of neuromuscular conditioning (range of evidence grades: 1B to 3B). Lower limb kinematics, lower limb kinetics, and incidence of tears were the primary outcomes …

Isolated Cryptococcal Osteomyelitis In An Immunocompetent Patient, Irfan Qadir, Farheen Ali, Umair Zafar Malik, Masood Umer

Department of Surgery

bstract

Cryptococcosis is a rare infection in HIV-negative individuals. While the lungs and the central nervous system are most commonly infected, skeletal cryptococcosis is uncommon and isolated osteomyelitis due to Cryptococcus neoformans is quite rare. To our knowledge, only 47 cases of isolated cryptococcal osteomyelitis have been reported from 1974 to 2005. We report a case of isolatedcryptococcal osteomyelitis in an immunocompetent patient, who received 12 weeks of fluconazole with complete recovery.

Pressure Pain Threshold Testing Demonstrates Predictive Ability In People With Acute Whiplash., David Walton

David Walton

No abstract provided.

Classification And Treatment Of Proximal Humerus Fractures: Inter-Observer Reliability And Agreement Across Imaging Modalities And Experience., Abtin Foroohar, Rick Tosti, John M Richmond, John P Gaughan, Asif M Ilyas

Rothman Institute Faculty Papers

SUMMARY: Proximal humerus fractures (PHF) are common injuries, but previous studies have documented poor inter-observer reliability in fracture classification. This disparity has been attributed to multiple variables including poor imaging studies and inadequate surgeon experience. The purpose of this study is to evaluate whether inter-observer agreement can be improved with the application of multiple imaging modalities including X-ray, CT, and 3D CT reconstructions, stratified by physician experience, for both classification and treatment of PHFs.

METHODS: Inter-observer agreement was measured for classification and treatment of PHFs. A total of sixteen fractures were imaged by plain X-ray (scapular AP and lateral), CT …

Systematically Controlling For The Influence Of Age, Sex, Hertz And Time Post-Whole-Body Vibration Exposure On Four Measures Of Physical Performance In Community-Dwelling Older Adults: A Randomized Cross-Over Study, Harold L. Merriman, C. Jayne Brahler, Kurt Jackson

Physical Therapy Faculty Publications

Though popular, there is little agreement on what whole-body vibration (WBV) parameters will optimize performance. This study aimed to clarify the effects of age, sex, hertz, and time on four physical function indicators in community-dwelling older adults (N = 32). Participants were exposed to 2 minutes WBV per session at either 2 Hz or 26 Hz, and outcome measures were recorded at 2-, 20-, and 40-minute post-WBV. Timed get-up-and-go and chair sit-and-reach performances improved post-WBV for both sexes, were significantly different between 2 Hz and 26 Hz treatments (P ≤ 0.05), and showed statistically significant interactions between age and gender …

Ct Scanning Is Sufficient To Clear The Cervical Spine Of Elderly Falls Less Than 5 Feet., Douglas Lehman Md, Rovinder S. Sandhu Md, Leslie Baga Bsn, Farheen Hussain Ms, John J. Hong Md

Administration & Leadership

No abstract provided.

Femoroacetabular Impingement: Saving The Joint, Ronald Huang, Javad Parvizi

Department of Orthopaedic Surgery Faculty Papers

Many factors have been linked to the development of osteoarthritis (OA) of the hip, but often, cases are still considered “idiopathic.” Femoroacetabular impingement (FAI) has been suggested as a possible etiologic factor for the otherwise “idiopathic” cases. It is theorized that the subtle morphologic abnormalities seen at the head-neck junction and acetabulum in FAI may lead to labral tears, chondral damage, and subsequent progression of OA. Prevalence of FAI has been suggested to be as high as 14% in the general population. It often presents in young active patients that subject their hip joint to repetitive micro trauma associated with …

The Use Of Motion Analysis Technology As An Alternative Means Of Assessing Spinal Deformity In Patients With Adolescent Idiopathic Scoliosis, Matthew J. Solomito

Master's Theses

Adolescent Idiopathic Scoliosis (AIS) is a three dimensional deformity of the spine that causes abnormal curvatures in the coronal and sagittal planes and abnormal vertebral rotations. The gold standard for diagnosing and tracking the progression of the deformity is through the use of repeated radiography and a patient can receive upwards of fifteen radiographic series over the course of treatment, which exposes this population to an increased risk of radiation-dependent complications.

This thesis presents the necessary calculations and the marker set required to make the motion capture technology a viable alternative to radiographs, in an effort to reduce the patient’s …

Use Of Tranexamic Acid Is A Cost Effective Method In Preventing Blood Loss During And After Total Knee Replacement, Yasir Jamal Sepah, Masood Umer, Tashfeen Ahmad, Faria Nasim, Muhammad Umer Chaudhry, Muhammad Umar

Section of Orthopaedic Surgery

Background & Purpose: Allogenic blood transfusion in elective orthopaedic surgery is best avoided owing to its associated risks. Total knee replacement often requires blood transfusion, more so when bilateral surgery is performed. Many strategies are currently being employed to reduce the amount of peri-operative allogenic transfusions. Anti-fibrinolytic compounds such as aminocaproic acid and tranexamic acid have been used systemically in perioperative settings with promising results. This study aimed to evaluate the effectiveness of tranexamic acid in reducing allogenic blood transfusion in total knee replacement surgery.
Methodology: This was a retrospective cohort study conducted on patients undergoing total knee replacement during …

Expansion And Preservation Of Multipotentiality Of Rabbit Bone-Marrow Derived Mesenchymal Stem Cells In Dextran-Based Microcarrier Spin Culture, Tunku Kamarul Zaman

Tunku Kamarul Zaman

The use of mesenchymal stem cells (MSCs) in tissue repair and regeneration despite their multipotentiality has been limited by their cell source quantity and decelerating proliferative yield efficiency. A study was thus undertaken to determine the feasibility of using microcarrier beads in spinner flask cultures for MSCs expansion and compared to that of conventional monolayer cultures and static microcarrier cultures. Isolation and characterization of bone marrow derived MSCs were conducted from six adult New Zealand white rabbits. Analysis of cell morphology on microcarriers and culture plates at different time points (D0, D3, D10, D14) during cell culture were performed using …

Potent Inhibition Of Heterotopic Ossification By Nuclear Retinoic Acid Receptor-Γ Agonists., Kengo Shimono, Wei-En Tung, Christine Macolino, Amber Hsu-Tsai Chi, Johanna H Didizian, Christina Mundy, Roshantha A Chandraratna, Yuji Mishina, Motomi Enomoto-Iwamoto, Maurizio Pacifici, Masahiro Iwamoto

Department of Orthopaedic Surgery Faculty Papers

Heterotopic ossification consists of ectopic bone formation within soft tissues after surgery or trauma. It can have debilitating consequences, but there is no definitive cure. Here we show that heterotopic ossification was essentially prevented in mice receiving a nuclear retinoic acid receptor-γ (RAR-γ) agonist. Side effects were minimal, and there was no significant rebound effect. To uncover the mechanisms of these responses, we treated mouse mesenchymal stem cells with an RAR-γ agonist and transplanted them into nude mice. Whereas control cells formed ectopic bone masses, cells that had been pretreated with the RAR-γ agonist did not, suggesting that they had …

A Preliminary Study Comparing The Use Of Allogenic Chondrogenic Pre-Differentiated And Undifferentiated Mesenchymal Stem Cells For The Repair Of Full Thickness Articular Cartilage Defects In Rabbits, Tunku Kamarul Zaman

Tunku Kamarul Zaman

Chondrogenic differentiated mesenchymal stem cells (CMSCs) have been shown to produce superior chondrogenic expression markers in vitro. However, the use of these cells in vivo has not been fully explored. In this study, in vivo assessment of cartilage repair potential between allogenic-derived chondrogenic pre-differentiated mesenchymal stem cells and undifferentiated MSCs (MSCs) were compared. Bilateral full thickness cartilage defects were created on the medial femoral condyles of 12 rabbits (n = 12). Rabbits were divided into two groups. In one group, the defects in the right knees were repaired using alginate encapsulated MSCs while in the second group, CMSCs were used. …

Platelet-Rich Plasma (Prp) Enhances Bone Healing In Non-United Critical-Sized Defects: A Preliminary Study Involving Rabbit Models, Tunku Kamarul Zaman

Tunku Kamarul Zaman

Introduction: The use of bone grafts in treating non- or delayed unions as the result of large bone loss is well established. However, despite good outcomes, the time to achieve complete union is still considerably long. To overcome this problem, the use of platelet-rich plasma (PRP) has been advocated albeit with varying success. To determine the true effectiveness of PRP in treating non-/delayed unions, a study was conducted using (n = 12) rabbit models. Methods and materials: Critical-sized defects measuring 2 cm created in the midshaft of the right rabbit tibias were stabilised using 2.7-mm small fragment plates. A spacer …

Short-Term And Long-Term Effects Of Orthopedic Biodegradable Implants, Ami R. Amini, James S. Wallace, Syam P. Nukavarapu

Articles - Patient Care

Presently, orthopedic and oral/maxillofacial implants represent a combined $2.8 billion market, a figure expected to experience significant and continued growth. Although traditional permanent implants have been proved clinically efficacious, they are also associated with several drawbacks, including secondary revision and removal surgeries. Non-permanent, biodegradable implants offer a promising alternative for patients, as they provide temporary support and degrade at a rate matching tissue formation, and thus, eliminate the need for secondary surgeries. These implants have been in clinical use for nearly 25 years, competing directly with, or maybe even exceeding, the performance of permanent implants. The initial implantation of biodegradable …

A Preliminary Study Of The Effects Of Glucosamine Sulphate And Chondroitin Sulphate On Surgically Treated And Untreated Focal Cartilage Damage, Tunku Kamarul Zaman

Tunku Kamarul Zaman

The effects of Glucosamine Sulphate (GS) and Chondroitin Sulphate (CS) on the healing of damaged and repaired articular cartilage were investigated. This study was conducted using 18 New Zealand white rabbits as experimental models. Focal cartilage defects, surgically created in the medial femoral condyle, were either treated by means of autologous chondrocyte implantation (ACI) or left untreated as controls. Rabbits were then divided into groups which received either GS+/-CS or no pharmacotherapy. Three rabbits from each group were sacrificed at 12 and 24 weeks post-surgery. Knees dissected from rabbits were then evaluated using gross quantification of repair tissue, glycosaminoglycan (GAG) …

Knee Range Of Motion: Reliability And Agreement Of 3 Measurement Methods, Paul G. Peters, Michael A. Herbenick, Philip A. Anloague, Ronald J. Markert, L. Joseph Rubino

Physical Therapy Faculty Publications

We conducted a study to compare 3 methods of measuring knee range of motion: visual estimation by physicians, hand goniometry by physical therapists, and radiographic goniometry. We hypothesized that reliability would be high within and across all techniques. We found intrarater and interrater reliability to be satisfactory for visual estimation, hand goniometry, and radiographic goniometry. Interrater reliability across methods did not agree satisfactorily. Between-methods differences in estimating knee range of motion may result from variations in technique among physicians and physical therapists.

A Comparison Of Two Pelvic Floor Muscle Training Programs In Females With Stress Urinary Incontinence: A Pilot Study, Betsy Donahoe-Fillmore, Wendy Chorny, C. Jayne Brahler, Ashley Ingley, Jennifer Kennedy, Valerie Osterfeld

Physical Therapy Faculty Publications

Background: Stress urinary incontinence (SUI) is a condition affecting millions of Americans. Few studies have assessed the benefits of different exercises involved in pelvic floor muscle training (PFMT). Purposte: The purpose of this study was to compare the effects of a traditional PFMT program to an assisted pelvic floor muscle training (APFMT) program that included contraction of hip musculature.

Investigating The Associations Between Core Strength, Postural Control And Fine Motor Performance In Children, Rachel Burnett, Nicole Cornett, Gina Rekart, Betsy Donahoe-Fillmore, C. Jayne Brahler, Susan Aebker, Megan Kreill

Physical Therapy Faculty Publications

Study design: Quantitative design including statistical analysis.

Objectives: The objective of this study was to determine if there is an association between core strength, postural control, fine motor precision and integration, specifically in typical children in the first and third grades, ages 6-10. The secondary purpose of this study was to determine if there was an association between BMI and fine and gross motor ability in this same population.

Background: The relationship between core strength, postural control and fine motor skills in children is not well understood. The assumption that trunk stability and control are necessary for the maturation of …

Osteochondral Grafting Of Knee Joint Using Mosaicplasty, Muhammad Abdul Wajid, Muhammad Idrees Shah, Mohsin E. Azam, Tashfeen Ahmad

Section of Orthopaedic Surgery

Focal cartilage defects of articular surface-traumatic and degenerative are difficult to treat, thus a variety of surgical techniques have been developed and reported for treatment of such defects. Procedures such as Priddies perforations, microfracture, abrasion chondroplasty have shown long-term results which are often less than adequate. One of the reasons is that all these techniques lead to the formation of fibrocartilage which has inferior mechanical properties as compared to the native hyaline cartilage. Mosaicplasty is a procedure which aims at replacing the lost articular cartilage with hyaline cartilage including underlying bone support, thus providing adequate stability to the cartilage and …

Arthroscopic Repair Of Meniscal Tears With Inside-Out Technique, Hasnain Raza, Kashif Abbas, Masood Umer

Section of Orthopaedic Surgery

Objective: To review the clinical results of arthroscopic meniscal repair and to identify factors that may affect the outcome.
Methods: A total of 15 arthroscopic meniscal repairs with inside-out in 14 patients over a 7-year period were evaluated retrospectively. The mean age was 41.2 +/- 11.5 years with a range of 26-64 years. Eleven patients underwent repair for medial meniscal tear, two patients for lateral meniscus and one patient for both in the same knee. All patients were functionally evaluated by Lysholm functional knee scores over an average follow-up of 1 year and 5 months (range: 0.5-7 years).
Results: The …