Medical Specialties Commons^™

The Rotator Cuff Tendon-To-Bone Interface: Maturation, Aging, And 3d Bioprinting For Regeneration, Xiping Jiang

Theses & Dissertations

Rotator cuff tendon injuries often occur at the tendon-to-bone interface (i.e., enthesis) area with a high prevalence for the elderly population. In addition, regeneration of the gradient structure of the enthesis is still a significant clinical challenge. Our studies aim to identify the histological, molecular, and biomechanical alterations of the rotator cuff enthesis with maturation and aging, and develop a novel therapeutic method using three-dimensional (3D) bioprinting technique to regenerate a functional enthesis. Striking variations of the entheses were observed both histologically and biomechanically during the maturation process. The histological features did not show many differences at the insertion site …

Dual-Mobility Implants And Constrained Liners In Revision Total Hip Arthroplasty, Emanuele Chisari, Blair Ashley, Ryan Sutton, Garrett Largoza, Marco Dispagna, Nitin Goyal, P. Maxwell Courtney, Javad Parvizi

Rothman Institute Papers

Background

Instability remains the most common complication after revision total hip arthroplasty (THA). The purpose of this study was to determine whether there was a difference in aseptic revision rates and survivorship between dual-mobility (DM) and constrained liners (CL) in revision THA.

Methods

We reviewed a consecutive series of 2432 revision THA patients from 2008 to 2019 at our institution and identified all patients who received either a CL or DM bearing. We compared demographics, comorbidities, indications, dislocations, and aseptic failure rates between the two groups. Bivariate and multivariate regression analyses were used to determine risk factors for failure, and …

Increased Use Of Opioids Perioperatively Leads To Unmanaged Postoperative Pain, Halida Sehic

Nursing | Senior Theses

Background: Total knee and total hip joint arthroplasty are two frequently preformed surgeries, with 5.2 million total knee arthroplasties performed the United States between the year 2000 and 2010 (Williams et al., 2015). Opioids are widely used to manage pain for patients undergoing total joint arthroplasty. However, use of opioids is associated with undesirable adverse effects, such as nausea and respiratory depression, (Johnson et al., 2011). In postoperative patients following total joint replacement, 75 % of the patients complain of inadequately controlled moderate to severe pain (De Luca et al., 2018). Increased use and overprescribing increase tolerance to opioids …

Gut Permeability And Osteoarthritis, Towards A Mechanistic Understanding Of The Pathogenesis: A Systematic Review, Giorgio Guido, Guido Ausenda, Veronica Iascone, Emanuele Chisari

Rothman Institute Papers

Osteoarthritis (OA) is the most common condition affecting human joints. Along with mechanical and genetic factors, low-grade inflammation is increasingly supported as a causal factor in the development of OA. Gut microbiota and intestinal permeability, via the disruption of tight junction competency, are proposed to explain a gut-joint axis through the interaction with the host immune system. Since previous studies and methods have underestimated the role of the gut-joint axis in OA and have only focussed on the characterisation of microbiota phenotypes, this systematic review aims to appraise the current evidence concerning the influence of gut permeability in the pathogenesis …

Pragmatic Randomized Trial Evaluating Pre-Operative Aqueous Antiseptic Skin Solution In Open Fractures (Aqueous-Prep): The Feasibility Of A Cluster Randomized Crossover Study, Sheila Sprague, Paige Guyatt, Sofia Bzovsky, Uyen Nguyen, Mohit Bhandari, Lehana Thabane, Brad Petrisor, Herman S. Johal, Jordan Leonard, Shannon Dodds, Franca Mossuto, Robert V. O’Toole, Andrea Howe, Haley K. Demyanovich, Megan Camara, Nathan N. O’Hara, Gerard P. Slobogean, Jeffrey Wells, Jean Claude D’Alleyrand, Anthony D. Harris, Daniel C. Mullins, Amber Wood, Gregory J. Della Rocca, Joan Hebden, Lucas Marchand, Lyndsay M. O’Hara, Robert Zura, Michael J. Gardner, Jenna Blasman, Jonah Davies, Stephen Liang

Orthopaedic Surgery Faculty Publications

Background: Approximately 1 in 10 patients with a surgically treated open fracture will develop a surgical site infection. The Aqueous-PREP trial will investigate the effect of 10% povidone-iodine versus 4% chlorhexidine in aqueous antiseptic solutions in reducing infections after open fracture surgery. The study protocol was published in April 2020.

Methods and design: The Aqueous-PREP trial is a pragmatic, multicenter, open-label, randomized multiple period cluster crossover trial. Each participating cluster is randomly assigned in a 1:1 ratio to provide 1 of the 2 study interventions on all eligible patients during a study period. The intervention periods are 2 months in …

Assessing Vertebral Body Rotation For Percutaneous Pedicle Screw Placement In Scoliosis Surgery, Patrik Suwak, Abhishek Kumar, Kirby Bonvillain, Matthew Darlow, Peter D'Amore, Claudia Leonardi, Leland C. Mccluskey

School of Medicine Faculty Publications

Study Design: Retrospective Review. Objective: The aim of this study was to evaluate the incidence and magnitude of pedicle asymmetry as well as spinous process deviation in the healthy lumbar spine. Summary of Background Data: Minimally invasive spine surgery relies on fluoroscopic imaging as bony landmarks used for instrumentation are not exposed. The precision of techniques used to determine vertebral body rotation intraoperatively may be confounded by anatomic variation or pathology. Here, we investigate the physiologic variation in different anatomic structures of the lumbar spine used for percutaneous pedicle screw placement. Methods: 100 normal lumbar CT scans, without evidence of …

Return-To-Play Rates And Clinical Outcomes Of Baseball Players After Concomitant Ulnar Collateral Ligament Reconstruction And Selective Ulnar Nerve Transposition., Somnath Rao, Taylor D'Amore, Donald P. Willier, Richard J. Gawel, Robert A Jack, Steven B. Cohen, Michael G. Ciccotti

Rothman Institute Papers

Background: Injury to the ulnar collateral ligament (UCL) leading to medial elbow instability and possible ulnar neuritis is common in overhead-throwing athletes. Treatment may require UCL reconstruction (UCLR) and concomitant ulnar nerve transposition (UNT) for those with preoperative ulnar neuritis.

Purpose: To evaluate the return-to-play (RTP) rates, clinical outcomes, and rates of persistent ulnar neuritis after concomitant UCLR and UNT in a cohort of baseball players with confirmed preoperative ulnar neuritis.

Study Design: Case series; Level of evidence, 4.

Methods: Eligible patients were those who underwent concomitant UCLR and UNT at a single institution between January 2008 and June 2018 …

Evaluation Of Bone Formation On Orthopedic Implant Surfaces Using An Ex-Vivo Bone Bioreactor System, Rupak Dua, Hugh Jones, Philip C Noble

Faculty, Staff and Student Publications

Recent advances in materials and manufacturing processes have allowed the fabrication of intricate implant surfaces to facilitate bony attachment. However, refinement and evaluation of these new design strategies are hindered by the cost and complications of animal studies, particularly during early iterations in the development process. To address this problem, we have previously constructed and validated an ex-vivo bone bioreactor culture system that can maintain the viability of bone samples for an extended period ex-vivo. In this study, we investigated the mineralization of a titanium wire mesh scaffold under both static and dynamic culturing using our ex vivo bioreactor system. …

Surgical Treatment Of Femoroacetabular Impingement: Minimum 10-Year Outcome And Risk Factors For Failure, Hamed Vahedi, Steven Yacovelli, Claudio Diaz, Javad Parvizi

Rothman Institute Papers

Background: Femoroacetabular impingement (FAI) is a well-known cause of hip pain and dysfunction in young adults. Surgical treatment has been widely popularized during the past decade. However, most reported results have been limited to short-term and intermediate-term follow-up. The long-term success rate and risk factors for failure are largely unknown. This study aimed to report the long-term (minimum, 10 years) clinical outcomes of surgical treatment of FAI and to describe the clinical and radiographic parameters associated with the failure of treatment involving femoroacetabular osteoplasty (FAO) and labral repair.

Methods: Using our prospective hip preservation database, 164 patients (178 hips) who …

The Fate Of Periprosthetic Joint Infection Following Megaprosthesis Reconstruction, Kamolsak Sukhonthamarn, Timothy L Tan, John Strony, Scot A. Brown, David Nazarian, Javad Parvizi

Rothman Institute Papers

Background: A megaprosthesis may be used for reconstruction in patients with massive bone loss or a periprosthetic fracture. Periprosthetic joint infection (PJI) may occur after a megaprosthesis reconstruction and may pose a major challenge. The outcomes of managing PJI in patients with a megaprosthesis is relatively unclear. The aim of this study was to investigate the clinical course and outcomes of PJI in patients with a megaprosthesis in place.

Methods: From a total of 219 patients who underwent megaprosthesis replacement for non-oncologic conditions, 38 (17.4%) developed subsequent PJI. A retrospective review of the medical record was performed to ascertain the …

Improving Motor Neuron-Like Cell Differentiation Of Henscs By The Combination Of Epothilone B Loaded Pcl Microspheres In Optimized 3d Collagen Hydrogel, Narges Mahmoodi, Jafar Ai, Zahra Hassannejad, Somayeh Ebrahimi-Barough, Elham Hasanzadeh, Houra Nekounam, Alex R. Vaccaro, Vafa Rahimi-Movaghar

Department of Orthopaedic Surgery Faculty Papers

Spinal cord regeneration is limited due to various obstacles and complex pathophysiological events after injury. Combination therapy is one approach that recently garnered attention for spinal cord injury (SCI) recovery. A composite of three-dimensional (3D) collagen hydrogel containing epothilone B (EpoB)-loaded polycaprolactone (PCL) microspheres (2.5 ng/mg, 10 ng/mg, and 40 ng/mg EpoB/PCL) were fabricated and optimized to improve motor neuron (MN) differentiation efficacy of human endometrial stem cells (hEnSCs). The microspheres were characterized using liquid chromatography-mass/mass spectrometry (LC-mas/mas) to assess the drug release and scanning electron microscope (SEM) for morphological assessment. hEnSCs were isolated, then characterized by flow cytometry, and …

Factors Associated With Surgeon Recommendation For Additional Cast Immobilization Of A Ct-Verified Nondisplaced Scaphoid Waist Fracture, Anne Eve J. Bulstra, Tom J. Crijns, Stein J. Janssen, Geert A. Buijze, David Ring, Ruurd L. Jaarsma, Gino M.M.J. Kerkhoffs, Miryam C. Obdeijn, Job N. Doornberg, A. Peters, A. B. Spoor, Abhay Shrivastava, Aakash Chauhan, Adam Shafritz, Asif M. Ilyas, Anne J.H. Vochteloo, Andrew John Powell, Alberto Pérez Castillo, Alexandre Leme Godoy-Santos, Amparo Gomez Gelvez, Andrea Bauer, Antonio Barquet, Anze Kristan, Ante Prkic, Axel Jubel, Boj Mirck, B. E. Kreis, H. Brent Bamberger, William Dias Belangero, Bernard F. Hearon, Bradley Palmer

Orthopaedic Surgery Faculty Publications

Introduction: Data from clinical trials suggest that CT-confirmed nondisplaced scaphoid waist fractures heal with less than the conventional 8-12 weeks of immobilization. Barriers to adopting shorter immobilization times in clinical practice may include a strong influence of fracture tenderness and radiographic appearance on decision-making. This study aimed to investigate (1) the degree to which surgeons use fracture tenderness and radiographic appearance of union, among other factors, to decide whether or not to recommend additional cast immobilization after 8 or 12 weeks of immobilization; (2) identify surgeon factors associated with the decision to continue cast immobilization after 8 or 12 weeks. …

Outcomes For Hand Burns Treated With Autologous Skin Cell Suspension In 20% Tbsa And Smaller Injuries, George Malcolm Taylor, Scott A. Barnett, Charles T. Tuggle, Jeff E. Carter, Herb A. Phelan

School of Medicine Faculty Publications

In order to address the confounder of TBSA on burn outcomes, we sought to analyze our experience with the use of autologous skin cell suspensions (ASCS) in a cohort of subjects with hand burns whose TBSA totaled 20% or less. We hypothesized that the use of ASCS in conjunction with 2:1 meshed autograft for the treatment of hand burn injuries would provide comparable outcomes to hand burns treated with sheet or minimally meshed autograft alone. A retrospective review was conducted for all deep partial and full-Thickness hand burns treated with split-Thickness autograft (STAG) at our urban verified burn center between …

Blood Transfusions Increase The Risk For Venous Thromboembolism Events Following Total Joint Arthroplasty, Noam Shohat, Leanne Ludwick, Graham S Goh, Matthew Sherman, Joseph Paladino, Javad Parvizi

Rothman Institute Papers

The association between blood transfusions and thromboembolic events (VTE) following total joint arthroplasty (TJA) remains debatable. Using contemporary institutional data, this study aimed to determine whether blood transfusions increase the risk of VTE following primary and revision TJA. This was a single institution, retrospective cohort study. The clinical records of all patients (n = 34,824) undergoing primary and revision TJA between 2009 and 2020 were reviewed. Demographic variables, co-morbidities, type of chemoprophylaxis and intraoperative factors such as use of tranexamic acid were collected. Clinical notes, hospital orders, and discharge summaries were reviewed to determine if a patient received a blood …

Spinal Cord Signal Change On Magnetic Resonance Imaging May Predict Worse Clinical In- And Outpatient Outcomes In Patients With Spinal Cord Injury: A Prospective Multicenter Study In 459 Patients., Thorsten Jentzsch, David W Cadotte, Jefferson R Wilson, Fan Jiang, Jetan H Badhiwala, Muhammad A Akbar, Brett Rocos, Robert G Grossman, Bizhan Aarabi, James Harrop, Michael G Fehlings

Department of Orthopaedic Surgery Faculty Papers

Prognostic factors for clinical outcome after spinal cord (SC) injury (SCI) are limited but important in patient management and education. There is a lack of evidence regarding magnetic resonance imaging (MRI) and clinical outcomes in SCI patients. Therefore, we aimed to investigate whether baseline MRI features predicted the clinical course of the disease. This study is an ancillary to the prospective North American Clinical Trials Network (NACTN) registry. Patients were enrolled from 2005-2017. MRI within 72 h of injury and a minimum follow-up of one year were available for 459 patients. Patients with American Spinal Injury Association impairment scale (AIS) …

Limb Salvage Therapy In Septic Diabetic Foot Ulcer In Patients Unwilling To Undergo Amputation, Luke Hong

Clinical Research in Practice: The Journal of Team Hippocrates

A clinical decision report appraising

Shojaiefard A, Khorgami Z, Larijani B. Septic diabetic foot is not necessarily an indication for amputation. J Foot Ankle Surg. 2008;47(5):419-423. https://doi.org/10.1053/j.jfas.2008.05.005

for a patient with a septic diabetic foot.

Diagnostic Accuracy Of Ultrasonography For Rotator Cuff Tears: A Systematic Review And Meta-Analysis, Ali S Farooqi, Alexander Lee, David Novikov, Ann Marie Kelly, Xinning Li, John D Kelly, Robert L Parisien

Department of Medicine Faculty Papers

Background: With recent improvements in transducer strength, image resolution, and operator training, ultrasound (US) provides an excellent alternative imaging modality for the diagnosis of rotator cuff tears.

Purpose: To evaluate the diagnostic accuracy of US for partial- and full-thickness rotator cuff tears and biceps tendon tears, compare diagnostic values with those of magnetic resonance imaging (MRI) using arthroscopy as the reference standard, assess longitudinal improvements in accuracy, and compare diagnostic values from operators with different training backgrounds.

Study Design: Systematic review; Level of evidence, 3.

Methods: The PubMed and Cochrane Library databases were systematically searched for full-text journal articles published …

Postoperative Outcomes Of Hip Fracture Surgery In Geriatric Patients On Clopidogrel Or Warfarin At The Time Of Surgery, Josh Locker, Elizabeth Lyden, Justin Siebler

Graduate Medical Education Research Journal

BACKGROUND: The purpose of our study is to evaluate if surgical intervention in the setting of an elevated INR or continued use of clopidogrel lead to elevated post-operative mortality and/or morbidity compared to INR reversal or surgical delay.

METHODS: We retrospectively reviewed 1,007 patients age > 55 undergoing hip fracture fixation at our institution over a 10 year span. We placed patients into four groups based upon their anticoagulation status at the time of surgery. Descriptive statistics were utilized to evaluate for differences in mortality rates, blood loss, time to surgery, and wound complications.

RESULTS: Comorbid conditions occurred at a higher …

The Ironman, Mary I. Fisher

Physical Therapy Faculty Publications

No abstract provided.

Association Between Pitch Break On The 4-Seam Fastball And Slider And Shoulder Injury In Major League Baseball Pitchers: A Case-Control Study, Brooks N. Platt, Anthony J. Zacharias, Caitlin Conley, Lindsay Hockensmith, Nicholas Stockwell, Aaron Sciascia, Austin V. Stone

Orthopaedic Surgery and Sports Medicine Faculty Publications

Background: Few specific risk factors are known for shoulder injury in professional pitchers. New pitch-tracking data allow for risk stratification based on advanced metrics.

Purpose/Hypothesis: The purpose of this study was to determine the association between shoulder injury, pitch frequency, and pitch metrics (velocity, total break, break angle, and spin rate) for the 4-seam fastball, curveball, and slider. We hypothesized that more frequent use of the 4-seam fastball would be associated with shoulder injury.

Study Design: Case-control study; Level of evidence, 3.

Methods: The Major League Baseball (MLB) database was queried for pitchers who had been placed on the injury …

Prevalence Of Os Acromiale In An Indigenous East African Population: A Computerized Tomography Scan-Based Study, Mordicai Atinga, Njalalle Baraza, Sarah Wambui, Wachira Joseph Thiong’O, Angela Atinga

General Surgery, East Africa

Background: Failure of fusion to any of the acromion physes at maturity may lead to an os acromiale. A radiological review into the prevalence of os acromiale in an indigenous East African population was performed using computer tomography (CT) imaging. The study aimed to demonstrate a lower prevalence of os acromiale in an urban population compared with cadaveric studies.

Methods: This was a cross-sectional study with consecutive sampling. CT scans of both shoulders obtained for non-shoulder pathology were used for the analysis. CT scanning was performed at a tertiary referral hospital from January 2019 to July 2020.

Results …

Posterior And Middle Facets Of The Subtalar Joint: The Retrospective Search For An Early Sign Of Peritalar Subluxation And Progressive Flatfoot Deformity, Elijah C. Auch, Nacime Mansur, Shuyuan Li, Kevin Dibbern, John Femino, Daniel Baumfeld, Cesar De Cesar Netto, Thiago Alexandre Alves

Conference Presentation Abstracts

INTRODUCTION | Adult acquired flatfoot deformity (AAFD) is a complex three-dimensional (3D) pathology characterized by peritalar subluxation (PTS) of the hindfoot. The objective of this study was to compare the amount of subluxation between the middle and posterior facets in patients with AAFD. METHODS | In this IRB-approved retrospective comparative study, seventy-six AAFD patients (87 feet) who underwent weightbearing CT (WBCT) were included. Two blinded Fellowship-Trained Orthopedic Foot and Ankle Surgeons with >10 years of experience measured subtalar joint subluxation at the posterior and middle facets as well as the Foot and Ankle Offset (FAO). Intra- and interobserver agreement was …

Percutaneous Distal Metatarsal Mini-Invasive Osteotomy: Comparison Between Standard Vs. Modified Intraosseous Approach - A Cadaveric Study, Elijah C. Auch, Fernando S. Martins, Victoria Vivtcharenko, Eli Schmidt, Shuyuan Li, Alexandre L. Godoy-Santos, John Femino, Cesar De Cesar Netto

Conference Presentation Abstracts

BACKGROUND | The objective of this cadaveric study was to identify and compare the structures at risk of damage in standard versus modified intraosseous distal mini-invasive metatarsal osteotomy (DMMO). Our hypothesis was that the modified DMMO technique may be a safer, less complex procedure that could decrease the risk of iatrogenic injuries. METHODS | 11 thawed fresh-frozen under the knee cadaveric specimens underwent DMMO of the forefoot. The modified technique proposed by this study enters the dorsal cortex (at 45 degrees) straight through to the plantar cortex followed by cutting the lateral cortices (panels D, E, F). The standard technique …

A New Pediatric Monteggia Fracture Type 4 Variant, Ehab S. Saleh

Articles

Introduction: Monteggia fracture-dislocations are rare and complex injuries that usually involve a fracture of the proximal ulna associated with a proximal radioulnar and radiocapitellar joint dislocations. These injuries comprise

Bassini Inguinal Hernia Repair: Obsolete Or Still A Viable Surgical Option? A Single Center Cohort Study, Wayne Tse, William Johns, James Maher, Jeannie Rivers, Thomas Miller

Department of Orthopaedic Surgery Faculty Papers

Background: Most inguinal hernias are presently repaired using some type of mesh technique. This mesh can be placed through an inguinal incision or positioned through a laparoscopic approach. Either way, results have been impressive including a low recurrence rate, minimal pain and a rapid return to work and normal activity compared to tissue based approaches. Notwithstanding these results, there is still a subset of patients who, for various reasons, are strongly opposed to having a mesh repair. This study summarizes our 13 year experience with such patients and why the Bassini hernia repair is a viable surgical option in these …

Stability Of The Sacral Table Angle In Pediatric Patients With Spinal Pathology, David G. Wallington, Patrick D. Albright, Alexandria I. Chrumka, Rebecca D. Funk, Dale E. Rowe, Joseph K. Weistroffer, Karen M. Bovid

Conference Presentation Abstracts

INTRODUCTION | Pelvic incidence, lumbar lordosis, and pelvisacral angle are common radiographic measures used to evaluate sagittal alignment of the spine and pelvis to assist in clinical decision making. However, the natural history of the sacral table angle (STA) is not well characterized, and there remains uncertainty regarding STA progression over time. Previous studies have established that the STA is stable over time in adult patients, however this question has not been answered for younger patients who have not reached skeletal maturity. In this study, we aim to determine sacral table angle stability over time in a younger patient population. …

Current Evidence On Potential Of Adipose Derived Stem Cells To Enhance Bone Regeneration And Future Projection, Quang Le, Vedavathi Madhu, Joseph M Hart, Charles R Farber, Eli R Zunder, Abhijit S Dighe, Quanjun Cui

Department of Orthopaedic Surgery Faculty Papers

Injuries to the postnatal skeleton are naturally repaired through successive steps involving specific cell types in a process collectively termed “bone regeneration”. Although complex, bone regeneration occurs through a series of well-orchestrated stages wherein endogenous bone stem cells play a central role. In most situations, bone regeneration is successful; however, there are instances when it fails and creates non-healing injuries or fracture nonunion requiring surgical or therapeutic interventions. Transplantation of adult or mesenchymal stem cells (MSCs) defined by the International Society for Cell and Gene Therapy (ISCT) as CD105+-CD90+CD73+CD45-CD34-CD14orCD11b-CD79αorCD19-HLA-DR-is being investigated as an attractive therapy for bone regeneration throughout the …

Atypical Osteochondroma Of The Lumbar Spine Associated With Suprasellar Pineal Germinoma: A Case Report, Patrik Suwak, Scott A. Barnett, Bryant M. Song, Michael J. Heffernan

School of Medicine Faculty Publications

BACKGROUND Osteochondromas are the most common benign bone tumor, accounting for 36% of benign bone tumors. Often found within the appendicular skeleton, osteochondromas of the spine are rare, comprising 4% to 7% of primary benign spinal tumors. CASE SUMMARY We report a case of a solitary lumbar osteochondroma in an 18-year-old male with a history of a suprasellar pineal germinoma treated with combined chemotherapy and radiation. He underwent mass excision and partial laminectomy with the ultrasonic bone scalpel (Misonix, Farmingdale, NY, United States) at the L5 Level without the use of adjuvants. The patient returned to work and full activities …

Understanding Barriers And Facilitators To Implementation Of Psychosocial Care Within Orthopedic Trauma Centers: A Qualitative Study With Multidisciplinary Stakeholders From Geographically Diverse Settings, Ana-Maria Vranceanu, Jafar Bakhshaie, Mira Reichman, James Doorley, Ryan A. Mace, Cale A. Jacobs, Mitchel Harris, Kristin R. Archer, David Ring, A. Rani Elwy

Orthopaedic Surgery and Sports Medicine Faculty Publications

BACKGROUND: Psychosocial factors are pivotal in recovery after acute orthopedic traumatic injuries. Addressing psychosocial factors is an important opportunity for preventing persistent pain and disability. We aim to identify barriers and facilitators to the implementation of psychosocial care within outpatient orthopedic trauma settings using the Consolidated Framework for Implementation Research (CFIR) and Proctor's taxonomy of implementation outcomes, and to provide implementation strategies derived from qualitative data and supplemented by the Expert Recommendations for Implementing Change.

METHODS: We conducted live video qualitative focus groups, exit interviews and individual interviews with stakeholders within 3 geographically diverse level 1 trauma settings (N …

Variations In Management Of A3 And A4 Cervical Spine Fractures As Designated By The Ao Spine Subaxial Injury Classification System, Barry Ting Sheen Kweh, Jin Wee Tee, Sander Muijs, F Cumhur Oner, Klaus John Schnake, Lorin Michael Benneker, Emiliano Neves Vialle, Frank Kanziora, Shanmuganathan Rajasekaran, Gregory D. Schroeder, Alex R. Vaccaro, Ao Spine Subaxial Injury Classification System Validation Group

Rothman Institute Papers

Objective: Optimal management of A3 and A4 cervical spine fractures, as defined by the AO Spine Subaxial Injury Classification System, remains controversial. The objectives of this study were to determine whether significant management variations exist with respect to 1) fracture location across the upper, middle, and lower subaxial cervical spine and 2) geographic region, experience, or specialty.

Methods: A survey was internationally distributed to 272 AO Spine members across six geographic regions (North America, South America, Europe, Africa, Asia, and the Middle East). Participants' management of A3 and A4 subaxial cervical fractures across cervical regions was assessed in four clinical …