Medical Specialties Commons^™

Handheld Magnet Screening Of External Fixator Components: A Laboratory Assessment Of Gross Ferromagnetism Relevant To Mri Safety, Troy B. Puga, Mckenna W. Box, Lyn D. Ward, John T. Riehl

North Texas GME Research Forum 2026

Introduction Much controversy remains regarding the ability of patients with an external fixator in place to undergo Magnetic Resonance Imaging (MRI). The main concern for radiology departments is that the external fixator system components can lead to adverse events due to interactions of the external fixator and the magnet of the MRI. However, there is no clear evidence to support these claims or theories in the current literature. Yet, MRI’s are denied daily across the country for patients having an external fixator in place. Numerous patients with an external fixator would likely benefit from an MRI to prevent delayed care, …

Efficacy And Outcomes Of Oxidized Regenerated Cellulose (Orc) In Total Joint Arthroplasty (Tja): A Systematic Review And Meta-Analysis, Jenna Chrabolowski, Troy B. Puga, Abanoub Attalah, Kyle P. O'Connor, Mckenna W. Box, Ashley Stovall, Michael Muncy, John T. Riehl

North Texas GME Research Forum 2026

Introduction Intraoperative and postoperative blood loss is a major concern and challenge for surgeons in total joint arthroplasty (TJA). Patients with large blood loss can develop postoperative anemia and associated complications. Novel hemostatic agents, such as oxidized regenerated cellulose (ORC) have grown in popularity as intraoperative hemostatic adjuncts. The aim of this systematic review and meta-analysis is to evaluate the efficacy of ORC for intraoperative and postoperative blood loss.

Methods A search was conducted across MEDLINE/Pubmed, Cochrane, Google Scholar, Web of Science, and Embase databases. Titles and abstracts were screened for eligibility for inclusion criteria. Full texts were screened and …

Expert Consensus On Osteoporosis Risk Management In Patients With Sleep Disorders, Siqi Leng, Jinming Yang, Yuming Jin, Jie Shi, Ye Zhang, Junying Zhou, Lusi Tan, Taomei Li, Peiyan Ni, Kejia Hu, Yuan Shi, Jiamin Liao, Yun Li, Pei Xue, Christian Benedict, Alexandros N. Vgontzas, Michael Furian, Talant Sooronbaev, Naima Covassin, Virend K. Somers, Zhoulong Yu, Hongqiang Sun, Xiao Tan, Jihui Zhang, Yun Kwok Wing, Yue Leng, Larry D. Sanford, Michael V. Vitiello, Katie L. Stone, Rong Ren, Lin Lu, Xiangdong Tang

Department of Biomedical and Translational Sciences Faculty Publications

A rate-limiting step in the prevention and early intervention of osteoporosis is identifying its asymptomatic onset. Accumulating evidence shows that sleep disorders are associated with an increased risk of osteoporosis. Given their early detectable and modifiable nature, integrating sleep disorder management into osteoporosis prevention and care pathways offers a novel approach for enhancing skeletal health. This expert consensus represents a collaborative effort by specialists in sleep medicine and orthopedics from across the world, integrating epidemiological, mechanistic, and interventional evidence to provide general guidance for prevention and clinical practice, and to foster multidisciplinary collaboration in the management of sleep disorders and …

Revisiting The Faith Trial: A Secondary Analysis Yielding Novel Insights With The Win Ratio, Sofia Bzovsky, Nathan N. O'Hara, Gerard P. Slobogean, Sheila Sprague, Daniel E. Axelrod, Graeme Hoit, Kiara Pannozzo, Mohit Bhandari, Marc Swiontkowski, Emil Schemitsch, Rudolf W. Poolman, The Faith Investigators

Orthopaedic Surgery Faculty Publications

Background: Many orthopaedic trials use any unplanned reoperation as the primary outcome, but this overlooks how patients experience those outcomes. Using a high-quality hip fracture trial, we demonstrate how the relative importance of multiple patient-important outcomes can be effectively incorporated into data analysis, providing a more comprehensive understanding of treatment impact. Methods: This secondary analysis of the Fixation using Alternative Implants for the Treatment of Hip Fracture (FAITH) trial included 1,079 patients aged 50 years or older with a low-energy femoral neck fracture who were randomly assigned to treatment with a sliding hip screw or cancellous screws. The original trial …

Opioid Prescribing Patterns Following Isolated Trigger Finger Release: A Single-Institution Quality Improvement Study, Brandalynn Mathis, Robert Garner, Cameron Sprong, Mark Gamadia, Alan Cornett, Steven Smith

MidAmerica Division GME Healthcare Symposium 2026

No abstract provided.

Presentation And Application Of External Fixator Kickstand De-Rotational Bar Modification, Speros Gabriel, Grace Thiel, Cameron Sprong, Molly Black

MidAmerica Division GME Healthcare Symposium 2026

No abstract provided.

Distal Adding-On As A Complication Of Posterior Spinal Fusion In Adolescent Idiopathic Scoliosis: A Scoping Review Of Contemporary Evidence, Hussein Hashem, Hassan Abou Adma, Joseph Hayek, Ali Rezazadeh Shirazi, Karim Gaber, Waleed Kishta

Western Journal of Orthopaedics

Distal adding-on (DAO) is a complication of spinal fusion characterized by postoperative deformity progression distal to the fusion construct. DAO after posterior spinal fusion for adolescent idiopathic scoliosis (AIS) is variably defined and inconsistently managed. This scoping review synthesizes evidence on DAO detection, management, and outcomes. A PRISMA-ScR–guided search identified relevant studies. Thirty-one studies (2,998 patients; median follow-up, 30 months) met inclusion criteria. Reported DAO incidence ranged from 3.5% to 62.5%, reflecting heterogeneity in definitions, patient factors, surgical constructs, and follow-up duration. Revision surgery was infrequent and typically delayed. When performed, it was most often prompted by progressive coronal decompensation …

Infection Rates In Gunshot-Related Hand Fractures Treated Nonoperatively, T. Kyle Summers, Ian Garrison, Matthew C. Watterson, Brandon Barnes, Charles Rodriguez-Feo

Western Journal of Orthopaedics

Background: Firearm-associated injuries in the U.S. represent a major public health crisis, contributing substantially to major levels of morbidity, mortality, and economic stress. Recommendations for the management of gunshot-related hand fractures remain limited, particularly in low-velocity injuries, and current guidance often leaves treatment decisions to the discretion of the operating surgeon. Methods: A retrospective analysis was performed to identify phalangeal and metacarpal fractures at a Level I trauma center from 2017 to 2023, resulting in 579 patients. Only fractures resulting from firearm injuries were included, resulting in 56 patients. Infection rates were observed in patients treated nonoperatively and those treated …

Increased Mortality And Reduced Survival In Nonagenarians With Hip Fractures: Implications For Geriatric Care, Roman Austin, Julio Avila, Audrey Wassef, Kate Parker, Katherine Gavin

Western Journal of Orthopaedics

Background: Hip fractures in nonagenarians (patients aged ≥ 90 years) are becoming increasingly common as the population ages, yet outcomes in this group remain poorly characterized. This study compared in-hospital mortality and survivorship at three months, six months, and one year after hip fracture surgery in nonagenarians with a younger elderly cohort aged 65 years to 89 years. Secondary outcomes included fracture characteristics, surgical management, and discharge disposition. Methods: A retrospective chart review was conducted on patients who underwent hip fracture surgery at a single Level I Trauma Center from August 2019 to December 2021. Patients were grouped into nonagenarians …

Massive Upper Extremity Neurofibroma Treated With Limb-Sparing Debulking: A Case Report, Danielle Cummings, Tomas Holy, Nathan Morrell

Western Journal of Orthopaedics

Surgical management of neurofibromas in Neurofibromatosis type 1 (Von Recklinghausen’s disease), can be challenging because tumor size, location, hypervascularity, and tissue friability pose the risk for significant intraoperative and postoperative blood loss. Despite these risks, surgery is often necessary because of functional losses or cosmetic concerns. The authors present a 31-year-old woman with a massive neurofibroma on her right distal forearm, wrist, and hand, who ultimately underwent surgical resection because of functional impairment of her hand. She required postoperative hospitalization and blood transfusion for management of acute blood loss anemia. Because of concerns regarding blood loss and surgical morbidity, the …

Median Nerve Intraneural Hematoma As An Intraoperative Finding During Carpal Tunnel Release: A Case Report, Ana Silva, Gil Gonrtre, Nikalus Skipp, Ana Love, Deana Mercer

Western Journal of Orthopaedics

Carpal tunnel syndrome (CTS) is the most common compressive neuropathy and typically progresses slowly. Intraoperatively, flexor tenosynovitis, nerve edema, or hourglass deformity may be observed. In rare cases, acute compression symptoms occur due to mass effect on the nerve. Intraneural hematoma of the median nerve is uncommon and has been reported primarily in acute CTS cases associated with trauma. This report describes an 87-year-old patient with a history of mild CTS who underwent carpal tunnel release due to worsening symptoms. After the initial incision, a thickened flexor retinaculum, an hourglass deformity of the median nerve, and an intraneural hematoma were …

Proximal Iliotibial Band Rupture In A 74-Year-Old High-Level, Female Athlete: A Case Report, Jeremiah M. Langsfeld, Joseph Esquibel, Dustin L. Richter

Western Journal of Orthopaedics

A 74-year-old female endurance athlete presented with progressive pain over the left proximal and lateral hip distal to the iliac crest. Symptoms developed over three weeks, impairing weightbearing. Magnetic resonance imaging demonstrated a high-grade tear of the proximal iliotibial band at its iliac crest insertion. The patient was treated nonoperatively and returned to high-level, asymptomatic competition three months after symptom onset. This case offers a nonoperative approach to the rare presentation of a proximal iliotibial band rupture.

Arthroscopic Treatment Of Extensive Synovial Chondromatosis Of The Knee: A Case Report, Gaurav Singh, Bhavna Singh, Rebecca Peebles, Justin Bartley

Western Journal of Orthopaedics

Synovial chondromatosis (SC) is a rare, benign monoarticular disorder characterized by intra-articular cartilaginous loose bodies resulting from synovial metaplasia, most commonly affecting the knee. The authors present the case of a 44-year-old man with progressive, debilitating left knee pain, mechanical symptoms, and functional limitations unresponsive to conservative treatment. Radiographs were unremarkable, but magnetic resonance imaging (MRI) demonstrated multifocal noncalcified intra-articular bodies consistent with SC. The patient underwent arthroscopic debridement of the knee with limited synovectomy. Intraoperative findings included innumerable intra-articular cartilaginous loose bodies throughout the knee, synovial proliferation, and grade II chondromalacia. At three months postoperatively, the patient had regained …

Fibula Strut Allograft With Proximal Tibia Autograft For Treatment Of Humerus Nonunion: A Case Report And Review Of Oligotrophic Nonunion Management, Paul Wilson, Naomi Kelley, Samer Kakish

Western Journal of Orthopaedics

Due to their high incidence and frequent need for reoperation, nonunions of the humerus present a significant challenge in orthopaedics. Using fibular struts to treat nonunions have demonstrated excellent results. While fibular autografts provide both biologic and structural benefit, high donor site morbidity must be considered. Although their application in midshaft humeral nonunions remains limited, fibular allografts avoid donor site morbidity. Enhancing fibular strut allografts with biological components offers a promising strategy for treating fractures that have failed prior revisions. This case study presents a 36-year-old woman with an aseptic oligotrophic midshaft humeral nonunion who had an unsuccessful revision surgery. …

Popliteus Interposition In Metaphyseal Tibial Fractures: The Radiographic Clues That Cannot Be Missed, Lucca Gontijo Giarola, Paulo De Tarso Cardoso Gomes, Robinson Esteves Dos Santos Pires, Guilherme Moreira Abreu E Silva, Marco Antônio Percope De Andrade, Túlio Vinícius De Oliveira Campos

Western Journal of Orthopaedics

High-energy proximal tibia fractures present significant challenges for orthopaedic surgeons, with well-recognized risks including malreduction and nonunion. Although double plating through two mini-open parallel incisions is an established technique for selected patients, nonuion can still occur. One potential contributing factor is entrapment of the popliteus muscle within the distal spike of the posteromedial plateau fragment. This report uses illustrative cases to demonstrate how to identify, address, and prevent this complication. Strategies for managing delayed cases that progress to nonunion are also discussed

Development And Evaluation Of A Modular 3-D Printed Adapter For Hands-Free Tissue Retraction, Fady E. Attia, Vijay A. Chhabra, Vaibhav Tadepalli,, Joseph Attia, Michael M. Hadeed

Stony Brook Orthopaedic and Musculoskeletal Journal

Fracture fixation procedures typically require precise retraction of soft tissues in order to provide adequate exposure of bone fragments for reduction and fixation. Such procedures require the use of multiple surgical assistants to maintain proper tissue retraction. This manual retraction using traditional instruments, such as Hohmann and Weitlaner retractors, can lead to inefficiencies and poor labor allocation within the operating room (OR). The purpose therefore is to develop and evaluate a three dimensional (3D)-printed Nylon PA12 adapter designed to dock Hohmann retractors onto Weitlaner retractors, enabling hands-free retraction during fracture fixation procedures and potentially improving labor allocation in the OR. …

Association Of Perioperative Steroid Use With Recovery Rate And Postoperative Infection Risk In Spinal Cord Injury, Nathan Zou, Athikur Rahman, Brian Lynch

Stony Brook Orthopaedic and Musculoskeletal Journal

Background: The purpose of this study is to compare recovery and infection outcomes between teenagers and adults who undergo surgery for traumatic spine injuries and the effect of steroid administration. Steroids are often used in traumatic spine injuries to help recovery, however there is a concern that steroid use could increase the risk of infection due to the suppression of the immune system. We examined the impact of postoperative steroid use on recovery rates and infection rates in both age groups.

Methods: A retrospective cohort study was conducted using the TriNetX Research Network, which includes data from over 100 healthcare …

Benign Painful Soft Tissue Tumors Of The Digits: A Contemporary Review, Nethmi Withanage, Athikur Rahman, Lawrence Hurst, Samantha Muhlrad

Stony Brook Orthopaedic and Musculoskeletal Journal

Purpose: Benign painful tumors of the digit are commonly encountered in hand surgery yet frequently pose diagnostic challenges due to overlapping clinical presentations. This review synthesizes current evidence on eight benign soft tissue tumors and cystic lesions that commonly cause digital pain: glomus tumor, giant cell tumor of the tendon sheath (GCTTS), digital mucous cyst, digital ganglion cyst, epidermoid inclusion cyst, pyogenic granuloma, nerve sheath tumors, and angioleiomyoma.

Methods: A comprehensive review of PubMed/MEDLINE was performed, supplemented by hand surgery textbooks and online educational resources. Case series, retrospective cohort studies, and review articles were included.

Results: Each tumor exhibits a …

A Narrative Review Of Bertolotti's Syndrome: Etiology, Classification, Diagnosis, And Treatment, Matyas Abel Tsegaye, Andrea Muffly

Rehabilitation Sciences Faculty Publications

Bertolotti's syndrome is a congenital condition characterized by chronic low back pain stemming from a lumbosacral transitional vertebra (LSTV). Because the condition is frequently overlooked, patients often face years of delayed diagnosis before the true source of their pain is identified. Furthermore, current information regarding the biological origins and clinical management of the condition remain scattered. To address this knowledge gap, this narrative review aims to provide a comprehensive overview of Bertolotti’s syndrome by consolidating these disparate sources and suggesting new connections. We synthesize the latest understanding of this condition, ranging from its genetic origins to modern clinical management. We …

Ultrasound-Based Assessment Of Talar Cartilage In Individuals With Chronic Ankle Instability: A Systematic Review, Amin Mohammadi, Saeed Eshghi, Iman Mohammadi, Patrick Wilson, Ryan Mccann

Rehabilitation Sciences Faculty Publications

Purpose

To systematically synthesize ultrasound (US) evidence on talar cartilage morphology and load-induced deformation in individuals with chronic ankle instability (CAI), and to map methodological approaches (acquisition, outcome definitions, loading paradigms, and normalization) to inform protocol standardization.

Methods

PubMed, Web of Science, and EBSCO were searched (March 31, 2025). Eligible studies reported quantitative US-derived talar cartilage morphology (e.g., thickness, cross-sectional area [CSA]) and/or deformation following standardized loading in CAI and comparison groups. Due to heterogeneity in imaging protocols, loading tasks, and outcome definitions, findings were synthesized narratively and organized by outcome domain.

Results

Across available cohorts, load-induced deformation was the …

Front Matter, Arianna Medina

Western Journal of Orthopaedics

No abstract provided.

Back Matter, Arianna Medina

Western Journal of Orthopaedics

No abstract provided.

21st Century Perspective On The Changing Pattern Of Nerve Injuries From Gunshot Wounds In The U.S., Thomas A. Decoster

Western Journal of Orthopaedics

Gunshot wounds (GSWs) with nerve injuries in the 21st century differ significantly from those reported in the 20th century. The vast majority are now low-velocity civilian injuries, in contrast to high-velocity military injuries previously reported. The rate of nerve injury in civilian GSWs is approximately 5%, compared with the 30% reported in military cohorts. However, the most common pattern of nerve injury in the current civilian population is neurotmesis and partial neurotmesis, in contrast to the majority axonotmesis of the military cohorts. In the 20th century, treatment generally consisted of watchful waiting for signs of spontaneous recovery over three months …

Full Issue, Arianna Medina

Western Journal of Orthopaedics

No abstract provided.

Peripheral Nerve Repair And Reconstruction: Current Techniques, Adjuncts, And Emerging Therapies, Niklaus Skipp, Lana Dokic, Christina Wassef, Jazzlyn Gonzalez, Ana Love, Heather Mercer, Deana Mercer

Western Journal of Orthopaedics

Peripheral nerve injuries require reconstruction when direct, tension-free repair is not possible. A range of reconstructive strategies are used to restore continuity and promote axonal regeneration, including graft-based reconstruction, nerve transfers, conduit-based repair, supercharged end-to-side augmentation, and emerging regenerative therapies. Autologous interfascicular nerve grafts and vascularized grafts remain established techniques, whereas processed nerve allografts provide a donor-sparing alternative. Nerve transfers are increasingly used for proximal injuries with long regeneration distances, and conduits are an option for gaps shorter than 5 mm. Nerve-wrapping techniques are used to reduce perineural scarring and preserve gliding in complex or revision cases. Emerging adjunctive therapies, …

The Effect Of Institutional Reputation On Clerkship Grades, Jerry Speight Grimes

Western Journal of Orthopaedics

Background: Clinical rotation scores have been reported to predict resident performance. However, the reporting of clerkship grades varies widely across institutions. The authors explored the correlation of an institution’s reputation and the percentage of students receiving honors. Methods: During the review of applicants for orthopaedic residency, the percentage of students receiving the highest grade in the surgery and internal medicine clerkships was recorded for each institution. The authors then compared published institutional rankings with the proportion of students awarded honors in these clerkships. Results: One hundred nineteen institutions were reviewed. There was poor correlation between the institutional rankings by U.S. …

Analysis Of Patient Factors That Predict Early Restoration Of Neutral Dorsiflexion After Achilles Tendon Rupture, W. Chad Elliott, Alvin Ouseph, Alexander Abraham, Jerry Speight Grimes

Western Journal of Orthopaedics

Background: Achilles Tendon Rupture (ATR) is a common musculoskeletal injury with an increasing incidence in the United States. Early functional rehabilitation is a key component of improving patient outcomes, and restoration of range of motion is a common threshold for progression to strengthening. Neutral ankle dorsiflexion represents an important early milestone in ATR recovery. This study aimed to assess which patient factors were associated with achieving this early rehabilitation milestone. Methods: A retrospective review was performed on 70 patients who sustained ATR and were treated at an academic center. Demographics, baseline characteristics, and common ATR risk factors were collected. The …

Insertion Of An Internal Joint Stabilizer Through A Posterolateral Approach For The Management Of Complex Elbow Instability, Miguel A. Pirela-Cruz, Nikalus Skipp, Ana Love, Deana Mercer, Jazzlyn Gonzalez

Western Journal of Orthopaedics

Background: Complex elbow fracture-dislocations represent a substantial surgical challenge. Achieving adequate stability while permitting early postoperative motion is essential to prevent stiffness. The internal joint stabilizer (IJS) has emerged as an alternative to hinged external fixation, providing internal dynamic stabilization with improved patient tolerance and reduced risk of soft-tissue complications. Although the IJS is commonly inserted through a lateral approach, injuries involving multiple anatomical structures may necessitate broader exposure. Purpose: To describe the surgical technique for IJS insertion through a posterolateral approach (PLA) for complex elbow injuries involving multiple anatomical structures. Methods: The PLA provides extensile exposure to the posterior, …

Exploring The Interaction Between Cranial Nerves V And Vii In Chronic Eyelid Myokymia: A Case Report, Karina Miramontes, Adam Walsh, Tomas Tafoya

Western Journal of Orthopaedics

Eyelid myokymia involves involuntary contractions of the orbicularis oculi muscle and is commonly associated with stress, fatigue, and craniocervical factors. Emerging evidence suggests that altered trigeminocervical interactions and craniomandibular muscle tension may contribute to symptom persistence; however, the condition remains underrecognized in physical therapy. This report describes a 65-year-old woman with chronic benign eyelid myokymia and cervical pain who completed 12 physical therapy sessions that included suboccipital functional dry needling, temporomandibular soft-tissue mobilization (STM), and cervical stabilization exercises. A reduction in eyelid myokymia was first observed at the fifth visit, coinciding with the initiation of temporomandibular STM. These findings suggest …

Prosthetic Knee Joint Infection Caused By Gemella Morbillorum, Nataly Echevarria-Castro, Shaleen Duhra, Leonor Echevarria

Western Journal of Orthopaedics

Gemella morbillorum is a gram-positive coccus found in the gastrointestinal tract, and is an uncommon cause of human infections, including prosthetic joint infections (PJI). Reported risk factors include immunosuppression, recent gastrointestinal procedures, and poor dental hygiene. This report describes a case of knee PJI caused by G. morbillorum, likely due to hematogenous seeding following a colonoscopy three months earlier. The patient is a 70-year-old man with well-controlled diabetes mellitus who had undergone total knee arthroplasty three years prior. He presented with three weeks of left knee swelling. Synovial fluid culture revealed G. morbillorum. The patient was treated with debridement, antibiotics, …