Medical Specialties Commons^™

Management Of Failed Uka To Tka: Conventional Versus Robotic-Assisted Conversion Technique., Andrew G Yun, Marilena Qutami, Mary Chang-Hwa Chen, Kory B Dylan Pasko

Articles, Abstracts, and Reports

BACKGROUND: Failure of unicompartmental knee arthroplasty (UKA) is a distressing and technically challenging complication. Conventional conversion techniques (CCT) with rods and jigs have produced varying results. A robotic-assisted conversion technique (RCT) is an unexplored, though possibly advantageous, alternative. We compare our reconstructive outcomes between conventional and robotic methods in the management of failed UKA.

METHODS: Thirty-four patients with a failed UKA were retrospectively reviewed. Patients underwent conversion total knee arthroplasty (TKA) with either a CCT or RCT. Seventeen patients were included in each group. All procedures were done by a single surgeon at a single institution, with a mean time …

Comparison Of Non-Nsaid Pain Management In The Treatment Of Patients With Symptomatic Knee Osteoarthritis, Nicholas Schmitz

Theses and Graduate Projects

Objective: To compare the efficacy of other modalities and interventions versus standard first-line therapy of nonsteroidal anti-inflammatory drugs for pain management in patients with symptomatic knee osteoarthritis

Methods: Perform literature reviews outlining patients suffering from Grade II or higher KOA using the Kellgren-Lawrence classification system and currently experiencing symptoms of pain, stiffness, and impaired physical functioning. Use data and results from various studies to compare improvement of symptoms from these modalities versus improvement of NSAIDs alone.

Results: Weight loss and physical activity should remain the mainstay of early osteoarthritis treatment to help slow disease progression and symptoms of KOA. Duloxetine …

Long-Term Safety And Tolerability Of Apremilast Versus Placebo In Psoriatic Arthritis: A Pooled Safety Analysis Of Three Phase Iii, Randomized, Controlled Trials., Philip Mease, Dafna D Gladman, Juan J Gomez-Reino, Stephen Hall, Arthur Kavanaugh, Eric Lespessailles, Georg Schett, Maria Paris, Nikolay Delev, Lichen Teng, Jürgen Wollenhaupt

Articles, Abstracts, and Reports

OBJECTIVE: Psoriatic arthritis (PsA) requires long-term treatment, yet safety concerns and monitoring requirements make maintenance a challenge. This analysis of pooled Psoriatic Arthritis Long-term Assessment of Clinical Efficacy (PALACE) 1, 2, and 3 data describes 3-year apremilast safety and tolerability in PsA.

METHODS: Patients with active PsA were randomized (1:1:1) to placebo, apremilast 30 mg twice daily, or apremilast 20 mg twice daily. Placebo patients were re-randomized to apremilast 30 mg twice daily or 20 mg twice daily at week 16 (early escape) or 24. Double-blind treatment continued to week 52; patients could continue apremilast during an open-label, long-term treatment …

Lessons Amidst A Pandemic, Mary I. Fisher

Physical Therapy Faculty Publications

No abstract provided.

Characterization Of Patients With Axial Spondyloarthritis By Enthesitis Presence: Data From The Corrona Psoriatic Arthritis/Spondyloarthritis Registry., Philip Mease, Mei Liu, Sabrina Rebello, Winnie Hua, Robert R Mclean, Esther Yi, Yujin Park, Alexis Ogdie

Articles, Abstracts, and Reports

OBJECTIVE: To compare the characteristics of patients with axial spondyloarthritis (axSpA) who had enthesitis versus those without enthesitis.

METHODS: This study included adult patients with axSpA enrolled in the Corrona Psoriatic Arthritis/Spondyloarthritis Registry (March 2013 to August 2018). Enthesitis was assessed at enrollment via the Spondyloarthritis Research Consortium of Canada Enthesitis Index. Characteristics were compared between patients with and without enthesitis using t tests or Wilcoxon rank-sum tests for continuous variables and χ

RESULTS: Of 477 patients with axSpA, 121 (25.4%) had enthesitis (mean, 3.9 sites) at enrollment. Higher proportions of patients with enthesitis were female and had nonradiographic axSpA …

Thrower's Exostosis Of The Shoulder: A Systematic Review With A Novel Classification, Michael T. Freehill, Sandeep Mannava, Laurence D. Higgins, Alexandre Lädermann, Austin V. Stone

Orthopaedic Surgery and Sports Medicine Faculty Publications

Background: A variety of thrower's exostoses are grouped under the term Bennett lesion, which makes understanding diagnosis and treatment difficult.

Purpose: To identify all types of reported thrower's and overhead athlete's exostoses and categorize them into a classification system to allow a morphology-based classification.

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

Methods: A systematic review of all articles pertaining to Bennett lesions and thrower's exostosis was performed. The classification and treatments were evaluated to describe the types, proposed causes, diagnosis, and treatment options.

Results: A total of 27 studies were included in the systematic review. The anatomic locations …

Effects Of Coronavirus (Covid-19) Pandemic On Orthopedic Residency Program In The Seventh Largest City Of The World: Recommendations From A Resource-Constrained Setting, Marij Zahid, Syed Arif Ali, Naveed Baloch, Shahryar Noordin

Section of Orthopaedic Surgery

The coronavirus (COVID-19) pandemic has hit the entire world hard. Since its inception from Wuhan China the whole world is affected now. Health care facilities and workers are overwhelmed and the situation is changing on daily basis. With the changes in the dynamics of the hospitals, residency and fellowships training programs have also suffered undoubtedly. Due to decreased elective cases and outpatient clinics surgical training gets compromised, however on the other side this physical distancing and isolation have proven to be effective measures in controlling the disease. In this article we share our experience of effect of COVID-19 pandemic on …

Covid-19: The New Mexico Experience And Background, Matthew Wharton, Marisa Su, Meghan Brett, Jon Femling

Western Journal of Orthopaedics

Introduction: The novel Coronavirus Disease 19 (COVID-19) identified in December 2019 and the associated pandemic has temporarily changed the way that we conduct medicine, allocate resources, and educate resident and fellows. The present investigation is a summary of The University of New Mexico clinical experience managing the sudden surge of critical patients, personal protective equipment management (PPE), and resident education. Methods: We evaluated and analyzed the data related to the COVID-19 pandemic patient load and management in New Mexico, the formation of teams to protect the providers from simultaneous exposure, the resident experience, the PPE management, and the change in …

Identification And Management Of Injuries Associated With Femoral Shaft Fracture, Brian N. Hodges, Thomas A. Decoster

Western Journal of Orthopaedics

Femoral shaft fractures are common injuries typically due to high-energy trauma. Injuries associated with femoral shaft fractures include ipsilateral femoral neck fractures, ipsilateral distal femur fractures, ipsilateral patella fractures, ipsilateral tibial shaft fractures, ipsilateral knee ligament injuries, acetabular and pelvis fractures, and small bone fractures. These injuries can go unnoticed, and it is important to recognize and treat these injuries accordingly.

Side-By-Side Comparison Of 4-Strand Versus 5-Strand Hamstring Graft Diameters In Patients Undergoing Anterior Cruciate Ligament Reconstruction, Dustin L. Richter, Michael Hopson, Tony Pedri, Gehron P. Treme

Western Journal of Orthopaedics

Background: Hamstring (HS) graft size is an independent risk factor in determining outcomes related to anterior cruciate ligament reconstruction (ACLR). Although anthropometric correlations with HS tendon size have been studied, a predictable association with resultant graft size has not been established. This study directly compares the difference in diameter between a 4-strand (4S) and 5-strand (5S) HS autograft in the same patient. Methods: A total of 31 consecutive patients undergoing ACLR with HS autograft were included in the study. The gracilis and semitendinosus tendons were harvested for each patient. The diameters and lengths of a standard 4S HS graft followed …

Alumni Map 2020, Unm Department Of Orthopaedic Surgery

Western Journal of Orthopaedics

No abstract provided.

Prevalence Of Prolonged Sitting Among Orthoapedic Residents, Benjamin D. Packard, Richard A. Miller

Western Journal of Orthopaedics

Background: There is a plethora of data regarding the negative health consequences of sitting, including increased cardiometabolic risk factors and all-cause mortality. Correctable actions should be identified. Methods: A literature review was performed to examine articles that identified sitting prevalence and health consequences. A survey querying average hours per day spent sitting was distributed to orthopaedic residents at a single institution. Statistical analysis of the data was performed using a 2-tailed t test. Results: A total of 25 orthopaedic residents were surveyed, and 20 responses were received. The average time spent sitting was 5.38 hours per day. There was equal …

Pronator Quadratus Rotational Muscle Flap Technique For Coverage Of Hardware After Distal Radius Orif, Camille Aubin-Lemay, Henry Ran, Deana Mercer

Western Journal of Orthopaedics

Flexor tenosynovitis and tendon rupture are rare. Yet these occurrences can be serious complications after treatment of a fractured distal radius with a volar plate. The highest incidents of rupture are associated with the plate on or distal to the watershed line of the radius. Although studies have shown that reattachment of the pronator quadratus (PQ) following plating does not lead to improved measures in grip strength or range of motion, it is possible that doing so may reduce the incidence of flexor tendon irritation or rupture. Reattachment of the PQ after a standard approach does not often capture the …

Hallus Rigidus: A Technique For Reliable, Safe, And Reproducible Cheilectomy Excision, Jory Wasserburger, Amber Price, Matthew Wharton, Richard Miller

Western Journal of Orthopaedics

Hallux rigidus is a common cause of foot pain involving the hallux; however, the etiology is yet to be elucidated. There are many different treatments that have been described, including cheilectomy. Taking too much bone can cause joint instability and altered joint mechanics, whereas taking too little bone may not relieve pain. We present a reliable, safe, and reproducible technique for cheilectomy in the hallux rigidus.

Foreign Bodies In The Hand: A Case Report, Review Of Literature, And Guidance For Acute Management, Jessica Avila, Griffin Biedron, Jordan Carter, Gilberto A. Gonzalez

Western Journal of Orthopaedics

No abstract provided.

Isolated Proximal Fibula Fractures In Young Athletes Mimic Lateral Collateral Ligament Injury, Aaron M. Gray, Jason H. Nielson

Western Journal of Orthopaedics

Lateral knee injury is common among adolescent athletes in both contact and non-contact sports. Injuries in this population deserve special consideration regarding diagnosis and treatment due to the presence of open, closing, or recently closed physes. We describe two cases of isolated proximal fibula fractures with knee pain and laxity to varus stress in young athletes. Isolated proximal fibula fractures can mimic lateral collateral ligament injuries in the knee. Treatment for these injuries is conservative with bracing, protected weight bearing, and delayed or protected return to activity.

Femoral Diaphysis Fracture In A Collegiate Male Hockey Player: A Case Report, Matthew Bain, James Slauterbeck

Western Journal of Orthopaedics

Femoral diaphysis fractures represent a small subset of sports-related orthopaedic trauma, accounting for less than 1% of all sports fractures. We describe a 22-year-old male ice hockey player who slid and crashed into the boards during practice. Radiographs revealed fracture of the femoral diaphysis, necessitating surgical intervention to insert an intermedullary nail. Rehabilitation was a hybrid of an anterior cruciate ligament reconstruction and hip labrum repair protocols. There was emphasis on rotator cuff strengthening and lower-extremity rehabilitation owing to a pre-existing shoulder dislocation that occurred during the same season. He returned to skating at 16 weeks, and at 20 weeks …

A Case Of Osteosarcoma And Its Presentation In A Division I Collegiate Athlete, Alec Sundet, Allison Shepherd, James Slauterbeck

Western Journal of Orthopaedics

Primary bone and soft-tissue tumors may present by mimicking common sports injuries. Their diagnosis is contingent on maintaining a broad differential. We report a case of a 20-year-old male athlete who sustained a twisting injury to his planted right knee while playing college lacrosse. He was unable to bear weight or fully extend his knee. The team’s orthopaedic surgeon was concerned for a locked knee secondary to a possible flipped meniscal tear. Radiographs and magnetic resonance imaging were performed that led to the discovery of an expansile, sclerotic lesion arising from the posteromedial aspect of the distal femur. Biopsy of …

Treatment Of Both Column Acetabular Bone Loss In Multiple Myeloma Patient With Custom Triflange Acetabular Component: A Case Report, Scott Plaster, Kyle Stephen, David Chafey

Western Journal of Orthopaedics

Massive acetabular bone loss with pelvic discontinuity remains a challenging obstacle with few arthroplasty solutions. We present a case of a 61-year-old man with multiple myeloma who suffered a pathologic acetabular fracture resulting in acetabular protrusio and eventually extensive acetabular bone loss. His prognosis was initially poor; however, he ultimately responded to his radiation and chemotherapy and was limited in his mobility by his extensive acetabular bone loss. Given his complex presentation, it was decided to go forward with total hip arthroplasty utilizing the Zimmer-Biomet custom triflange acetabular component. His outcome at 9 months is fair

Tibial Lengthening Using A Magnetic Lengthening Intramedullary Nail In An Hiv-Positive Patient: A Case Report And Review Of Literature, Rami Khalifa, Christopher Gerzina, Amr Abdelgawad, Ahmed M. Thabet

Western Journal of Orthopaedics

Limb lengthening can be affected by poor bone healing in patients with human immunodeficiency virus. This is a case report of a 56-year-old man with 6.1 cm leg length discrepancy and end-stage arthritis in the hip. The patient had total hip arthroplasty prior to his lengthening procedure. The patient was human immunodeficiency virus positive. This case report describes the experiences of using a motorized intramedullary magnetic lengthening nail in equalization of limb length discrepancy. Treatment for the patient included tibial lengthening with a motorized nail to correct the limb length discrepancy, with adequate bone healing in a patient with an …

Intra-Articular Osteoid Osteoma Of The Elbow: A Case Report, Catherine M. Westbom, John E. Nolan, Nathan T. Morrell

Western Journal of Orthopaedics

A 24-year-old woman, with 5 years of left elbow pain, was given a preliminary diagnosis of focal pigmented villonodular synovitis based on magnetic resonance imaging. She underwent arthroscopic debridement and was found to have an intra-articular bony mass. Histopathology was consistent with an intra-articular osteoid osteoma. The mass was removed arthroscopically with excellent symptomatic improvement. There was no recurrence of symptoms at 1 year follow-up.

Arthroscopic Management Of Focal Pigmented Villonodular Synovitis In The Scaphotrapeziotrapezoidal Joint, John E. Nolan, Brian W. Gross, Nathan T. Morrell

Western Journal of Orthopaedics

A 43-year-old man presented with persistent wrist pain and loss of range of motion after nonoperative therapy. Magnetic resonance imaging showed features consistent with pigmented villonodular synovitis (PVNS) of the scaphotrapeziotrapezoidal joint. He underwent arthroscopic excision and synovectomy. At 2 years postoperatively, he had no symptomatic recurrence. This case shows the importance of considering PVNS for chronic pain of small joints, and it highlights the viability for arthroscopic synovectomy as a treatment option.

Predicting Running Ability After Lower Extremity Amputation: A Review, Rebecca Dutton

Western Journal of Orthopaedics

The ability to ambulate with a prosthesis after lower extremity limb loss is an important determinant of functional independence and quality of life. Some individuals may be capable of achieving higher levels of mobility (eg, running) that can further improve function, physical health, and mental health. Thus, a fundamental understanding of the variables that help predict ambulation ability after lower limb loss is important. Particular attention should be given to modifiable predictors, as interventions directed at these conditions can help facilitate optimal mobility and function. This article reviews various factors that influence the ability

Malreductions Following Intramedullary Nail Fixation Of Femur Shaft Fractures, Jory Wasserburger, Christopher Kurnik, Thomas A. Decoster

Western Journal of Orthopaedics

Femur shaft fractures are common injuries frequently treated with intramedullary fixation. Although satisfactory alignment is usually achieved, malreductions can happen in sagittal and coronal planes, as well as along the longitude axis. The causes of malposition with femoral nailing include fracture location, comminution, and suboptimal technique. We identify the most common patterns of malreduction of nailed femu

Cost Analyses Of Nonoperative Treatment Of Sports-Medicine Conditions Are Lacking, Casey Slattery, Jai Yao, Amy Cizik, Mia S. Hagen

Western Journal of Orthopaedics

The purpose of this study was to qualitatively review existing studies that examined cost data within sports medicine. A literature search was conducted for all economic studies related to sports-medicine conditions from 2000 to 2017 within the United States. Area of analysis, data source utilized, and the type of collected cost data was identified. There were 29 studies that met criteria, with the majority of studies (60%) focused on rotator cuff repair and anterior cruciate ligament reconstruction. Substantial variability in data source, practice setting, data metrics, and reported measures makes interpretation of existing reports challenging. Greater diversity in topics and …

Can The Contralateral Knee Effectively Estimate Pre-Injury Patellar Height? A Control Study, Benjamin Albertson, Andrew Ockuly, Ian Fletcher, Daniel Wascher

Western Journal of Orthopaedics

Introduction: Patellar height abnormalities have been associated with patellar instability, which is common among adolescents and young adults. Pre-injury patellar height is often unknown in patients with a patellar instability episode. The purpose of this study was to determine whether patellar height of one knee could effectively estimate patellar height of the contralateral knee in control patients between the ages of 13 and 25 years. Methods: A retrospective chart review was conducted to identify 40 patients who obtained bilateral knee radiographs with no prior surgical intervention or diagnosis of injury to the extensor mechanism. CatonDeschamps Index (CDI) was measured by …

The Vulcan Sign: A Radiographic And Clinical Indicator Of Plantar Plate And Collatoeral Ligament Injury, Katherine Gavin

Western Journal of Orthopaedics

Introduction: There is no consensus on terminology used to describe the radiographic and clinical findings commonly encountered in second metatarsophalangeal (MTP) instability. We propose the use of a consensus term, the Vulcan sign, to describe the deformity commonly seen in second MTP instability and verify its utility as an adjunct in the diagnosis and treatment of plantar plate and collateral ligament pathology. Methods: We retrospectively evaluated preoperative anteroposterior weight-bearing x-rays of 156 feet of patients who underwent operative intervention for second MTP instability and the presence of a Vulcan sign at the second webspace, defined as more than 50% medial …

The Importance Of The Screening Anteroposterior Pelvis Radiograph In Trauma Patients: A Level-1 Trauma Center's Experience With Traumatic Hip Dislocations, Ansab Khwaja, Brad Askam, Matt Morin, Aditya Manoharan

Western Journal of Orthopaedics

Background: Advanced Trauma Life Support guidelines strongly recommend obtaining anteroposterior (AP) pelvis radiographs when evaluating patients with traumatic injuries. Recently, there has been a trend at our institution to forego AP pelvis radiographs, and to obtain computed tomography (CT) scans as the initial imaging modality of the pelvis instead. Lifesaving interventions, such as the application of a pelvic binder, can be delayed due to the time it takes to complete a primary survey and a CT scan. This study aims to evaluate the effects of bypassing an AP pelvis radiograph on the management of acute traumatic dislocations of the hip. …

Inter- And Intra-Observer Differences In Proximal Fifth Metatarsal Fractures, Benjamin Packard, Kathryn Yeagar, Richard A. Miller, Katherine Gavin

Western Journal of Orthopaedics

Introduction: Proximal fifth metatarsal fractures are common. When using the Lawrence and Botte Classification for these injuries, they are classified as type 1, 2, and 3. Identifying the zone of injury is crucial to guide treatment. The authors hypothesize that interand intra-observer reliability of these fractures is low. Methods: Anteroposterior (AP), lateral, and oblique x-rays of 60 patients with isolated fifth metatarsal base fractures were reviewed. Five physicians evaluated the radiographs and classified the fractures as type 1,2, or 3. Each of the three radiographic views were examined separately. Results were then analyzed for inter- and intra-observer reliability. Results: Sixty …

Quantifying Coverage Of A Distal Radius Volar Plate Using A Novel Pronator Quadratus Rotational Muscle Flap Technique, Christina Salas, Leslie Neher, Joshua Romero, Camille Aubin-Lemay

Western Journal of Orthopaedics

Background: Flexor tenosynovitis and tendon rupture are rare, yet serious complications after treatment of a fractured distal radius with a volar plate. The highest incidents of rupture are associated with the plate on or distal to the watershed line of the radius. While studies have shown that reattachment of the pronator quadratus (PQ) following plating does not lead to improved measures in grip strength or range of motion, it may reduce the incidence of these complications. Reattachment of the PQ after a standard approach does not often capture the distal edge of the plate. We report results of a new …