Medical Specialties Commons^™

Diagnosing Total Joint Arthroplasty-Associated Periprosthetic Joint Infections In Immunocompromised Patient Populations, Philip Zakko, Erin A. Baker, Christian M. Huber, Corinn Gehrke, Brett J. Friedman, Michael A. Flierl

Conference Presentation Abstracts

The 2018 ICM/MSIS classification system was used to assess PJI diagnosis in immunocompromised vs. non-immunocompromised patient populations to determine applicability of the scoring criteria.

Treatment And Outcomes Of Soft Tissue Sarcoma Of Groin, Hip And Thigh: A Retrospective Review From A Tertiary Care Hospital, Masood Umer, Javeria Saeed, Zaid Ahmed Shamsi, Muhammad Usman Tariq

Section of Orthopaedic Surgery

Objective: To study the frequency of the thigh, hip and groin soft tissue sarcomas and retrospectively analyse the management, treatment results, and outcomes of these uncommon malignant tumours, in a tertiary care hospital of the city of Karachi.
Methodology: Data of soft tissue tumours registered from 2017-2018 was retrieved during January 2019 to March 2019 from Aga Khan University Hospital, Karachi bone and soft tissue tumour registry. A retrospective review was performed and all soft tissue tumour cases treated with surgical intervention (with adjuvant /neoadjuvant therapy) or palliative intention were included.
Results: Total 119 cases of soft tissue tumours (STS) …

Prevention Of Falls In Hospital: Audit Report From A Tertiary Care Hospital Of Pakistan, Anum Sadruddin Pidani, Tashfeen Ahmad, Nasreen Panjwani, Shahryar Noordin

Department of Surgery Docs

Objective: The study aims to assess the fall incidents in past 5 years and fall assessment practices at the Aga Khan University Hospital, Karachi.
Methods: We performed a single-center retrospective audit at Aga Khan University Hospital from October 2019 to December 2019. A list of all patients admitted to Aga Khan University Hospital under the Musculoskeletal and Sports Medicine Service Line was obtained using the Hospital Information Management System (HIMS) from Jan 2017 to June 2018. Data including fall assessment scores was collected retrospectively from medical record files.
Results: A total of 1499 patients were admitted during this time period, …

Long-Term Clinical And Functional Outcomes Of Distally Based Sural Artery Flap: A Retrospective Case Series, Pervaiz Hashmi, Abeer Musaddiq, Muhammad Ali, Alizah Hashmi, Marij Zahid, Zohaib Nawaz

Section of Orthopaedic Surgery

Background: Reconstruction of soft tissue defects around the lower leg, foot and ankle is a challenge for orthopedic surgeons. These defects commonly occur as a result of trauma, infection and tumor excision. Sural artery neurovascular island flap is a relatively thin, pliable and insensate flap with minimum donor-site morbidity and acceptable aesthetic outcome.
Methods: A retrospective analysis of a case series was conducted, all operated by a single surgeon over a period of 25 years from July 1996 to February 2020. Data were collected through a structured proforma; the variables included were as follows: demographic data, mechanism of injury, defect …

Rehabilitation And Return-To-Play Criteria After Fresh Osteochondral Allograft Transplantation: A Systematic Review., Michael Stark, Somnath Rao, Brendan Gleason, Robert A. Jack, Bradford Tucker, Sommer Hammoud, Kevin B. Freedman

Rothman Institute Papers

Background: Fresh osteochondral allograft (OCA) is a treatment option that allows for the transfer of size-matched allograft cartilage and subchondral bone into articular defects of the knee. Although long-term studies show good functional improvement with OCA, there continues to be wide variability and a lack of consensus in terms of postoperative rehabilitation protocols and return to sport.

Purpose: To systematically review the literature and evaluate the reported rehabilitation protocols after OCA of the knee, including weightbearing and range of motion (ROM) restrictions as well as return-to-play criteria.

Study Design: Systematic review; Level of evidence, 4.

Methods: PubMed, EMBASE, Cumulative Index …

Prevalence Trend And Disparities In Rheumatoid Arthritis Among Us Adults, 2005–2018, Yingke Xu, Qing Wu

School of Public Health Faculty Research

Rheumatoid arthritis (RA) trends among US adults and disparities in RA patients in recent years have not been well described. We aimed to examine the trend of RA prevalence and disparities among US adults. Data from the National Health and Nutrition Examination Survey (NHANES) of the years 2005–2018 were analyzed to examine the self-reported RA prevalence trend. Age-adjusted RA prevalence stratified by race/ethnicity and socioeconomic status (SES), as well as associated linear trends, were calculated for both genders. The multivariable adjustment was used to evaluate the association between race, SES, and RA. During 2005–2018, there was no significant linear trend …

Patient Resilience Has Moderate Correlation With Functional Outcomes, But Not Satisfaction, After Primary Unilateral Total Knee Arthroplasty., Amer Haffar, Sean Bryan, Marc Harwood, Jess H. Lonner

Rothman Institute Papers

Background: As many as 20% of patients who undergo total knee arthroplasty (TKA) are dissatisfied. Psychological factors have been shown to play a role in outcomes after TKA. The purpose of this study was to investigate the impact of patient resilience on functional outcomes and satisfaction after primary unilateral TKA.

Methods: Eighty-six patients who underwent primary unilateral TKA by a single surgeon were studied. Primary outcomes were the Brief Resilience Scale (BRS), mental health component of the Veterans Rand 12-Item Health Survey (VR-12 MCS), Knee Injury and Osteoarthritis Outcome Score for Joint Replacement, and New Knee Society Score. Correlations between …

Robotic Assistance In Unicompartmental Knee Arthroplasty Results In Superior Early Functional Recovery And Is More Likely To Meet Patient Expectations., Meredith P. Crizer, Amer Haffar, Andrew Battenberg, Mikayla Mcgrath, Ryan Sutton, Jess H Lonner

Rothman Institute Papers

Robotic technology has reduced the errors of implant alignment in unicompartmental knee arthroplasty (UKA), but its impact on functional recovery after UKA is poorly defined. The purpose of this study was to compare early functional recovery, pain levels, and satisfaction in UKA performed with either robotic assistance or conventional methods. A retrospective analysis was performed on 89 matched consecutive patients who underwent outpatient UKA by a single physician using either conventional instruments (n = 39) or robotic methods (n = 50), with otherwise identical perioperative protocols. Outcomes studied included Lower Extremity Functional Score (LEFS), new Knee Society Score …

Why We Can’T Wait, Mary I. Fisher

Physical Therapy Faculty Publications

No abstract provided.

Improving Patient Outcomes With Post-Op Education For Nurses Caring For Patients Undergoing Total Joint Replacement, Amanda Collier

Doctor of Nursing Practice Projects

Background: Surgical site infections (SSI) are the third most reported nosocomial infection causing an increased length of stay, increased healthcare cost, and a substantial increase in morbidity. A SSI is an infection developing within 30 days of surgery without using an implant and within one year of surgery utilizing any form of implant. Typically SSI occurs at the time of incision. However, poor postoperative wound care can lead to an SSI.

Purpose: This project aims to educate nursing staff on care of the total joint replacement (TJR) patient to reduce readmission rates for postoperative SSI.

Design Methods: This …

Publisher Correction To: Development Of The Asia Pacific Consortium On Osteoporosis (Apco) Framework: Clinical Standards Of Care For The Screening, Diagnosis, And Management Of Osteoporosis In The Asia-Pacific Region, M Chandran, P J. Mitchell, T Amphansap, S K. Bhadada, M Chadha, D-C Chan, Y-S Chung, P Ebeling, N Gilchrist, Aysha Habib Khan

Department of Pathology and Laboratory Medicine

No abstract provided.

Endoscopic Proximal Median Nerve Decompression: An Alternative Treatment For Pronator Syndrome, Scott A. Barnett, Sagar A. Shah, Rasheed I. Ahmad

School of Medicine Faculty Publications

Proximal forearm median nerve compressive neuropathy, termed as pronator syndrome, is difficult to diagnose and often overlooked. Its symptoms include vague proximal volar forearm pain that may be associated with paresthesia and numbness in the median nerve distribution. Weakness is typically not present. The treatment of pronator syndrome is largely nonsurgical, consisting of activity modification, anti-inflammatory medication, corticosteroid injections, stretching, and periods of splinting. Surgery is indicated when conservative therapy fails; however, there is no consensus on the treatment approach or technique. Most decompressions are performed using an open technique through a variety of incisions. Recently, endoscopic approaches have drawn …

Microfracture For Cartilage Defects In Today’S Orthopaedics: Pearls And Pitfalls, Himanshu Yn, Sufyan Ibrahim

Manipal Journal of Medical Sciences

Microfracture technique has vacillating clinical outcomes, limited demographic applicability, high failure rate, and variable patient satisfaction. Although it does not deserve to be a gold standard technique, there has not been a technique that could overcome all possible disadvantages associated with the technique and at the same time give a favourable result/be suitable for widespread use/not have its own disadvantages. Microfracture, integrated with biomaterial/stem cell transfer has shown promise over the past decade but studies evaluating the long-term efficacy of the tests and standardization are lacking. Besides, cost and operative difficulties limit widespread use. Twenty-five years into the field, microfracture …

Solitary Plasmacytoma Of Manubrium Sterni - A Case Report, Shyamasunder N. Bhat, Sp Mohanty

Manipal Journal of Medical Sciences

Solitary plasmacytoma is a tumour consisting of neoplastic monoclonal plasma cells without systemic involvement. It constitutes about 5% of all plasma cell dyscrasias and is mainly detected in the spine, pelvis and ribs and rarely in the sternum.

Here we report a case of a 45-year-old man presenting with pain and swelling in the midline of the chest over manubrium sterni. Plain radiograph and CT scan revealed an expansile, osteolytic lesion in the manubrium sterni. There was no M Band in protein electrophoresis, and the iliac bone marrow aspirate did not show plasmacytoma. However, histopathology of the lesion was suggestive …

An Investigation Of A Novel Dural Repair Device For Intraoperative Incidental Durotomy Repair., Kartik Shenoy, Chester J. Donnally, Evan D. Sheha, Krishn Khanna, Srinivas K. Prasad

Rothman Institute Papers

Incidental durotomies, or dural tears, can be very difficult and time consuming to repair properly when they are encountered in confined spaces. A novel dural repair device was developed to address these situations. In this paper, the novel device was assessed against the use of traditional tools and techniques for dural repairs in two independent studies using an intricate clinical simulation model. The aim was to examine the results of the two assessments and link the outcomes to the clinical use of the novel device in the operating room. The novel device outperformed conventional techniques as measured by dural repair …

Functional Outcomes Of Unstable Ankle Fractures With And Without Syndesmotic Fixation In The Adolescent Population, Connor J. Paez, Benjamin M. Lurie, Vidyadhar V. Upasani, Andrew T. Pennock

School of Medicine Faculty Research

Purpose: The purpose of this study was to compare functional outcomes of adolescents with and without ankle syndesmotic injuries and identify predictors of functional outcome after operative ankle fractures. Methods: A retrospective review was conducted on operative adolescent ankle fractures treated between 2009 and 2019 with a minimum of one-year follow-up (mean 4.35 years). Patients who underwent syndesmotic fixation (SF) (n = 48) were compared with operative ankle fractures without syndesmotic injury (n = 63). Functional outcomes were assessed using standardized questionnaires, specifically the Foot and Ankle Ability Measure (FAAM) and Single Assessment Numerical Evaluation. Results: There were no differences …

The Chevron Capitate-Trapezoid Joint: A Case Report, Dean W. Smith

Western Journal of Orthopaedics

Anatomical variations to the human skeletal system are common and frequently reported in the literature. The structures around the hand and wrist are no exception, and these variations can affect ligaments, tendons, muscles, nerves, arteries, joints, and bone morphology. Musculoskeletal health care providers must be familiar with normal, individual variations when encountered during patient care and diagnostic imaging. In some instances, morphological variations have resulted in differences in kinematics, while others have been found in association with certain medical conditions. We discuss an unusual variation of the capitate-trapezoid joint. To the best of our knowledge, no prior studies have previously …

Chronic Complex Volar Dislocation Of The Middle And Ring Finger Metacarpophalangeal Joint: A Case Report, Fernando Moreno, Jordan T. Carter, John J. Pisquiy, Michael M. Polmear

Western Journal of Orthopaedics

Metacarpophalangeal (MCP) joint dislocations are uncommon injuries. Most dislocations occur dorsally, with volar dislocations being rarer owing to the architecture of the joint. Because of the rarity of the condition, there is no accepted standard treatment for these injuries. The most commonly affected digit is the ring finger, followed by the middle finger and then the small finger. Management depends on the complexity of the injury, with complex dislocations requiring open reduction owing to interposed soft tissue and repair of damaged ligaments and tendons. We describe a 52-year-old man with chronic MCP dislocation who underwent unsuccessful open reduction and subsequently …

Front Matter, Unm Department Of Orthopaedic Surgery

Western Journal of Orthopaedics

No abstract provided.

Alumni Map 2021, Unm Department Of Orthopaedic Surgery

Western Journal of Orthopaedics

No abstract provided.

Considerations In Surgical Timing For Femoral Shaft Fractures, Trevor Crean, William Curtis, Thomas A. Decoster

Western Journal of Orthopaedics

Femoral shaft fractures are a common orthopaedic injury. They are generally treated with intramedullary nailing. The optimal timing of operative treatment is variable and debated. Relatively simple femoral shaft fractures can be successfully treated in less than 24 hours in most health care systems. Femoral shaft fractures can be more complicated owing to various factors, such as multiple traumatic injuries, associated conditions, etc. These more complicated femoral shaft fractures benefit from stabilization within the first 6 hours to minimize complications. Stabilization of the long bones helps achieve an upright chest position and improves pulmonary, circulatory, and musculoskeletal function. Some patients …

Seven Deadly Sins Of Volar Distal Radius Fracture Fixation, Allicia O. Imada, Jorge Orbay, Deana Mercer

Western Journal of Orthopaedics

Distal radius fractures are common injuries, accounting for 17.0% of all emergency department visits. Operative treatment is an option when indicated. Volar plating has become the most frequently used mode of fixation. Although fixed angle volar locking plates allow for reliable and stable fixation, complications have been reported. Complications include flexor and extensor tendon rupture, intra-articular screw penetration, malreduction, loss of reduction, carpal tunnel syndrome, implant failure, and complex regional pain syndrome. We propose seven principles to avoid these preventable outcomes and tips to succeed.

A Systematic Review To Examine Functional Recovery After Total Knee Arthroplasty And Successful Physical Therapy Protocols, Dominique M. Patterson, Colin F.K. Hansen, Yuri Yoshida

Western Journal of Orthopaedics

Background: Total knee arthroplasty (TKA) continues to be the most common elective procedure performed every year, with the goal to reduce pain and improve return to functional activities. Recent studies have investigated new surgical techniques and therapeutic interventions to determine which protocols result in reduced pain and accelerate return to function. Methods: We systematically reviewed 131 out of 301 studies between 1996 and 2019 to assess trends in patient functional performance and perceptive functional recovery after TKA from preoperative up to 2 years postoperative. We evaluated functional outcome measures recommended by the Osteoarthritis Research Society International. Results that considerably deviated …

Effect Of Patient-Surgeon Orientation On Plunge Depth During Plate Fixation Of Clavicle Fractures, Aaron Mullane, Layla A. Haidar, Adam Kozemchak, Colton Wayne

Western Journal of Orthopaedics

Background: Operative management of clavicle fractures indicated for open reduction internal fixation poses significant risk to critical anatomic structures. The associated risks to the underlying neurovascular structures during clavicle fixation as a result of plunge depth for patients in the supine position in comparison to patients in the beach-chair position is currently unknown. The purpose of this study was to compare plunge depth measurements between the supine and beach-chair positions during plate fixation of clavicle fractures. Methods: The participant population at this single institution was comprised of residents, fellows, and fellowship-trained, attending orthopaedic surgeons. The participants drilled three bicortical holes …

A Novel Method In The Classification Of Proximal Fifth Metatarsal Fractures, Kathryn Yeager, Benjamin Packard, Richard A. Miller, Shravin Sridhar

Western Journal of Orthopaedics

Background: Proximal fifth metatarsal fractures are common. The authors previously performed a study examining the inter- and intraobserver reliability of the Lawrence and Botte Classification, which showed poor interobserver reliability of 16.67%. A novel approach was proposed for the classification of fifth metatarsal fractures using a mortise ankle radiographic view. Methods: The observers from the authors’ prior study reviewed non-weight bearing mortise views of 20 patients with isolated fifth metatarsal base fractures. These radiographs were identified from the 60 radiographs from the authors’ prior study. Five physicians evaluated the radiographs and classified the fractures as type 1, 2, or 3. …

Early Open Reduction And Internal Fixation Of Acute Low-Energy Tibial Plateau Fractures Does Not Increase The Rate Of Perioperative Complications, Jorge D. Guerra, Madison Craft, Diana P. Guerra, Ahmed M. Thabet

Western Journal of Orthopaedics

Introduction: The treatment algorithm for tibial plateau fractures continues to evolve as surgeon experience increases. Initial surgical procedures have been fine-tuned over time. Methods: This is a retrospective chart review of 132 patients with low-energy tibial plateau fractures (Schatzker I–IV) treated at a level-1 academic trauma center between January 2008 and February 2018. This study analyzes patient outcomes managed with primary operative intervention within 48 hours of admission. The average age was 45 years (range, 19 to 84 years). There were 92 men and 40 women. Statistical analysis focused on comparisons between historical complication rates and the findings of this …

Risk Factors For The Development Of A Symptomatic Contralateral Discoid Lateral Meniscus, Jason Nielson, Sean Davis, Aaron Gray, Brock Wentz

Western Journal of Orthopaedics

Background: Discoid menisci (DM) are oval or disc shaped menisci, differing from the normal crescent shaped meniscus. This difference in shape may be one factor as to why DM are more prone to injury when compared to normal menisci. The purpose of this study was to evaluate potential risk factors that may lead to the development of symptoms, requiring arthroscopic saucerization in adolescents with a history of symptomatic DM in the contralateral extremity. Methods: We retrospectively reviewed 126 patients with an arthroscopic diagnosis of DM to evaluate for the presence of a symptomatic contralateral DM variant. Mildly symptomatic DM status …

Hamstring Strength Recovery In Relation To Landing Patterns Following Anterior Cruciate Ligament Reconstruction: A Case Comparison Report, Kelsey A. Edwards, Rebecca A. Dutton, Yuri Yoshida, Dustin L. Richter

Western Journal of Orthopaedics

Introduction: Deficits in quadriceps strength following anterior cruciate ligament reconstruction (ACLR) are common and can be associated with biomechanical asymmetries during landing tasks. The relationship between quadriceps strength and knee function during ACLR recovery is well established. However, less is known regarding the role of hamstring strength in functional recovery after ACLR. We examined movement patterns during a drop-landing task in three patients following ACLR with different levels of quadriceps and hamstring strength. Methods: Three participants were assessed for quadriceps and hamstrings strength, functional performance, and lower-extremity biomechanics captured by a 3D motion analysis 6 months after ACLR. Results: Participant …

A Novel High Tibial Biplanar Osteotomy Technique For Simultaneous Coronal And Sagittal Correction: A Case Example, Ryan C. Price, Kathryn C. Helmig, Dustin L. Richter, Robert C. Schenck Jr

Western Journal of Orthopaedics

Medial opening wedge high tibial osteotomy (HTO) can provide symptom relief, improved ligamentous stability, and lower failure rates in patients with symptomatic medial knee osteoarthritis, ligament instability, and varus alignment after ligament reconstruction. It has been reported that correcting coronal plane abnormalities with a medial opening wedge HTO has resulted in altered posterior tibial slope angle (PTSA). We describe a 38-year-old woman with a history of severe polytrauma who presented with an anterior cruciate ligament tear in the setting of increased PTSA and a posterolateral corner injury with varus deformity of the knee. A medial biplanar HTO was performed using …

Cartilage Restoration Of The Patella Using Prochondrix® Osteochondral Allograft: A Case Report, Evan D. Boyd, Michael S. Barnum, James R. Slauterbeck

Western Journal of Orthopaedics

Articular cartilage injuries are challenging to treat because of the limited healing potential of articular cartilage. Various cartilage restoration procedures have been developed to restore the protective role of articular cartilage and to delay or prevent additional damage to the articular surface. ProChondrix® Cartilage Restoration Matrix is a cryopreserved hyaline cartilage allograft with viable chondrocytes and growth factors necessary to promote its incorporation and viability. We describe a 19-year-old man with a well-contained, full-thickness cartilage defect on his patella. He subsequently underwent cartilage restoration with a ProChondrix® osteochondral allograft. At 1-year postoperatively, the patient had both clinical and radiographic evidence …