Aspetic Nonunion Of Long Bones In Children: A Report Of Twelve Cases, Rami Khalifa, Amr Abdelgawad, Ahmed M. Thabet

Western Journal of Orthopaedics

Background: There are very few reports in the literature that directly address nonunion in children. The current study aimed to present a series of long bones nonunion in children following fractures and corrective osteotomies. Methods: This was a retrospective study that included pediatric patients diagnosed with nonunion following long bone fractures or corrective osteotomies. Patients with nonunion following femoral neck or lateral humeral condyle fractures were excluded. The clinical and radiological records were retrospectively analyzed. Results: Eight patients developed nonunion after fractures, while four patients had nonunion after corrective osteotomies. The mean age at the time of surgical procedure for …

The Versatility Of Taylor Spatial Frame In Treating Comple Posttraumatic Deformities Of The Lower Extremity, Rami Khalifa, Amr Abdelgawad, Ahmed M. Thabet

Western Journal of Orthopaedics

Background: The Taylor Spatial Frame (TSF) is a multiplanar external fixator with a computerized web-based program to provide accurate fractures reduction and deformity correction. This study aimed to evaluate our results after the treatment of complex lower extremity injuries with the external fixators including TSF. Methods: This retrospective case series included eight patients with complex lower extremity injuries treated with TSF. The medical records and radiographs were reviewed. The ASAMI score was used as an outcome measure. Statistical analysis used Microsoft Excel descriptive statistics. No inferential statistical tests were done owing to the small sample size. Results: The mean age …

The University Of New Mexico Orthopaedics Research Journal 2020, Unm Department Of Orthopaedic Surgery

Western Journal of Orthopaedics

No abstract provided.

Front Matter, Unm Department Of Orthopaedic Surgery

Western Journal of Orthopaedics

No abstract provided.

Mesh Plate Fixation For Complex Patella Fractures: A Surgical Technique, Rami Khalifia, Eric Potter, Sherif Dabash, Richard S. Yoon

Western Journal of Orthopaedics

Different types of low-profile plates have been designed for fixation of complex patellar fractures. Plate fixation of patella fractures provides stable fixation and allows earlier mobilization. This report describes three cases of complex patellar fractures. The report includes a detailed description and tips of the surgical technique

Osteomalacia In A Young Adult Male Presenting As Chronic Wrist Pain: A Case Report, Daniel Gonzales-Luna, Dean W. Smith

Western Journal of Orthopaedics

Chronic wrist pain is a common problem encountered by orthopaedic surgeons, yet osteomalacia is rarely considered in the differential diagnosis in the United States. We present a case involving a 37-year-old man who experienced bilateral wrist pain and weakness for more than 2 years. Further investigation revealed a history of chronic leg pain, low serum 25-hydroxy vitamin D levels, and decreased bone density. He was diagnosed with osteomalacia and treated with vitamin D supplementation and increased sun exposure. At 6 months follow-up, the patient had resolution of his pain and normalized vitamin D levels. To our knowledge, the literature has …

Single-Event Multilevel Surgery Of The Upper Extremity: A Case Report, Elizabeth Mcleod, Lacey Floyd, Justin Bartley

Western Journal of Orthopaedics

Single-event multilevel surgery has been used successfully to treat pediatric patients with cerebral palsy for decades; however, it has not been widely used to treat adult patients. Tendinopathies of the arm often coexist, and performing single event surgery to correct one joint pathology may further exacerbate coexisting tendinopathies. Accordingly, performing single-event multilevel surgery in the appropriate patient allows for the correction of multiple conditions of the same limb in a single surgery. Single-event multilevel surgery offers many benefits, including cost savings, convenience for the patient, less potential complications owing to a single anesthetic and hospitalization event, and a shorter overall …

Systematic Review Of Cost-Effective Analyses In Sports Medicine From 2014 To 2020, Casey Slattery, Mia S. Hagen, Amy Cizik, Albert O. Gee

Western Journal of Orthopaedics

The quality of recent cost-effectiveness studies and whether there is sufficient evidence to achieve valuebased health care in sports medicine are unknown. The purpose of this study was to perform a systematic review of recent cost-effective analyses (CEA) in sports medicine to determine the quality of publications from the last 6 years. A literature search was conducted for CEA studies on diagnostic tests, treatment options, and surgical procedures for sports medicine-related conditions between 2014 and 2020 in the United States. Two reviewers scored each study using the Quality of Health Economic Studies (QHES) instrument to assess methodological quality. Eighteen CEA …

Measurement Of Femoral Notch Type Show Low Inter-Rater Reliability, Evan D. Boyd, Michael S. Barnum, James R. Saluterbeck, Pamela M. Vacek

Western Journal of Orthopaedics

Background: Preventing first time anterior cruciate ligament (ACL) injury and the devastating sequela of post-traumatic osteoarthritis in the young athlete has attracted efforts to identify risk factors for development of ACL injury. Femoral notch type has been related to risk of ACL injury in previous studies. However, little data exists to support the reliability of assessing this qualitative measurement amongst independent investigators. Methods: Femoral notch type was measured from magnetic resonance imaging sections of 344 injured ACL and control knees by three investigators with different levels of professional experience. Inter-rater reliability was assessed using Cohen’s kappa statistic. Results: The simple …

Combined Open Calcaneocuboid, Naviculocuneiform And Subtalar Dislocation: A Case Report And Literature Review, Khai Phang Wong, Zhi Hao Tang, Gek Meng Tan

BioMedicine

Open dislocations of the midfoot and subtalar joints are extremely rare injuries. Understanding the anatomy of these joints and the various injury patterns is imperative to obtain stable concentric reduction and provide good functional outcome. We present a report of a 26- year old male who was involved in a road traffic accident and sustained open dislocations of the calcaneocuboid, naviculocuneiform and subtalar joints. He initially underwent external fixation in view of the severe soft tissue injury. After improvement of the soft tissue condition, he underwent K-wiring of the calcaneocuboid joint, buttress plating of the talonaviculocuneiform joint, peroneal tendon reconstruction …

Acute Opioid Withdrawal Mimicking Postoperative Joint Infection Following Anterior Cruciate Ligament (Acl) Reconstruction: A Case Report., Qingwu Kong, Martin Griffis, Brandon J Shallop, Amrit S Khalsa, Kyle Brougham, Paul A Marchetto

Department of Orthopaedic Surgery Faculty Papers

BACKGROUND A short course of opioid narcotics is often prescribed for postoperative anterior cruciate ligament (ACL) reconstruction pain management. Unfortunately, there is a well-documented incidence of opioid withdrawal syndrome (OWS) following short-term use of these medications. OWS can present with symptoms such as influenza-like illness. It is important to differentiate OWS from infectious illnesses, especially after surgery. CASE REPORT We present a case of OWS in a patient who underwent ACL reconstruction 7 days prior. The patient's OWS symptoms were similar to symptoms of a postoperative infection. The knee was aspirated, and the analysis of the aspirate was not concerning …

Seasonal Influence On Postoperative Hip Fracture Complications: Retrospective Cohort Of More Than 1000 Patients From A Tertiary-Care University Hospital, Obada Hasan, Mashal Amin, Fatima Mahmood, Amna Rabbani, Umar Rabbani, Shahryar Noordin

Department of Paediatrics and Child Health

Background: Hip fractures account for one of the most debilitating conditions affecting the general population amongst the developed and developing nations. Investigators aimed to study the influence of the ongoing season i.e. whether patients operated upon in summer or winter, on post-operative complications occurring within 30 days of surgical procedure for hip fractures at a tertiary care hospital and level 1 trauma center.
Materials and methods: Investigators conducted a non-funded, non-commercialized retrospective cohort of 1045 patients with hip fractures managed surgically. Primary exposure was surgical procedures undertaken during the summer months (April-September). Our primary outcome was determining post-operative complication rates …

The Effect Of Critical Shoulder Angle On Functional Compensation In The Setting Of Cuff Tear Arthropathy., Jeffrey Lu, Manan Patel, Joseph A. Abboud, John G. Horneff

Rothman Institute Papers

Introduction: Critical shoulder angle (CSA) has been shown to influence rates of rotator cuff tears and glenohumeral arthritis with a larger CSA associated with rotator cuff tears and a smaller CSA associated with glenohumeral arthritis. There has been no study to determine whether such radiographic measurement influences the function of patients with demonstrated cuff tear arthropathy (CTA). The purpose of this study was to examine whether smaller CSAs were associated with greater range of motion (ROM) in patients diagnosed with CTA.

Materials and methods: Ninety-three patients with a diagnosis of CTA with adequate anteroposterior shoulder radiographs were included in the …

Effectiveness Of Home-Based Rehabilitation Program In Minimizing Disability And Secondary Falls After A Hip Fracture: Protocol For A Randomized Controlled Trial, Anum Sadruddin Pidani, Saniya Sabzwari, Khabir Ahmad, Ata Khan, Shahryar Noordin

Department of Surgery Docs

Introduction: Hip fractures are a major health problem globally and are associated with increased morbidity, mortality, and substantial economic costs. Successful operative treatment of hip fracture patients is necessary for the optimization of post-op mobility and functional recovery of the patient. Rehabilitation after surgical stabilization of a hip fracture is crucial in order to restore pre-fracture function and to avoid long-term institutionalization. In particular ongoing exercise which targets balance can prevent up to 40% of falls. Therefore, we have designed a post-discharge home-based physical rehabilitation intervention program to minimize disability and falls in this high-risk elderly population.
Methods and analysis: …

Do New Trainees Pose A Threat To Postoperative Complications After Hip Fracture Surgeries? Retrospective Cohort Of 1045 Patients Over A Decade At A University Hospital, Obada Hasan, Mashal Amin, Umar Rabbani, Amna Rabbani, Fatima Mahmood, Shahryar Noordin

Department of Paediatrics and Child Health

Introduction: Induction of new residents and surgical trainees in most institutes occurs once a year. Fresh residents with no experience, may pose a threat to the surgical procedure outcome and there can be a potential increase in patients' morbidity and mortality as a result of this turnover. Literature is inconclusive about this effect. Our aim was to study the "new residents' induction effect" on postoperative complications after hip fracture surgeries.
Methodology: This is non funded non commercialized study from a university hospital. Investigators studied a retrospective cohort of 1045 adult hip fracture patients who were operated at our tertiary care …

Low-Intensity Continuous Ultrasound For The Symptomatic Treatment Of Upper Shoulder And Neck Pain: A Randomized, Double-Blind Placebo-Controlled Clinical Trial, Stephanie Petterson, Kevin Plancher, Dominic Klyve, David Draper, Ralph Ortiz

All Faculty Scholarship for the College of the Sciences

Purpose: Low-intensity continuous ultrasound (LICUS) is an emerging high-dosimetry ultrasound-based therapy for accelerated tissue healing and the treatment of myofascial pain. In this study, LICUS treatment is clinically evaluated for chronic upper neck and shoulder pain in a randomized, multi-site, double-blind, placebo-controlled study. Patients and Methods: CONSORT guidelines were followed in conducting and reporting the clinical trial. Thirty-three participants with upper trapezius myofascial pain were randomized for treatment with active (n=25) or placebo (n=8) devices. Investigators and subjects were blinded to treatment groups. Participants self-reported pain daily, rating from 0– 10 on the numeric rating scale. If pain rating was …

An Investigation Of Stress-Related Factors And Injury Occurrence In Division Iii Ice Hockey Athletes 2020., Christian Kiesel

Master's Theses

Many variables can factor into a student athlete sustaining an injury, but one of the most interesting is stress. The Stress and Injury Model is excellent in explaining how exactly history of stressors, personality, and coping mechanisms play a pivotal role in the stress response. If these three factors cause a negative stress response, then that will lead to an athlete becoming more likely to become injured. This study used 40 ice hockey players from a Division III NCAA institution. Each participant completed the Inventory of College Students’ Recent Life Experiences (ICSRLE) and Pittsburgh Sleep Quality Index (PSQI) every month …

Medial Femoral Condyle Vascularized Bone Graft For Treatment Of Midshaft Clavicle Recalcitrant Nonunion With Use Of The Transverse Cervical Artery As An Anastomosis., Christopher M Belyea, Jefferson L Lansford, Joseph B Golden, Emily H Shin, Rey D L Gumboc

Articles, Abstracts, and Reports

Vascularized medial femoral condyle bone grafts have been reported to be a reliable treatment for recalcitrant bony nonunions of the extremities. Although clavicle fracture nonunions are rare after treatment with open reduction internal fixation, symptomatic nonunions can be a challenge. The medial femoral condyle vascularized bone graft has been described as a treatment option for clavicle nonunions with the thoracoacromial trunk as the recipient anastomosis site. This case illustrates how the transverse cervical artery and accompanying veins can be used as an anastomosis when the thoracoacromial trunk is inaccessible because of previous surgical- and infection-related scaring. At the final follow-up, …

Secukinumab Provides Sustained Low Rates Of Radiographic Progression In Psoriatic Arthritis: 52-Week Results From A Phase 3 Study, Future 5., Désirée Van Der Heijde, Philip Mease, Robert B M Landewé, Proton Rahman, Hasan Tahir, Atul Singhal, Elke Boettcher, Sandra Navarra, Xuan Zhu, Gregory Ligozio, Aimee Readie, Shephard Mpofu, Luminita Pricop

Articles, Abstracts, and Reports

OBJECTIVE: To evaluate the effect of secukinumab on radiographic progression through 52 weeks in patients with PsA from the FUTURE 5 study.

METHODS: Patients with active PsA, stratified by prior anti-TNF use (naïve or inadequate response), were randomized to s.c. secukinumab 300 mg load (300 mg), 150 mg load (150 mg), 150 mg no load regimens or placebo at baseline, at weeks 1, 2 and 3 and every 4 weeks starting at week 4. Radiographic progression was assessed by change in van der Heijde-modified total Sharp score (vdH-mTSS; mean of two readers). Statistical analysis used a linear mixed-effects model (random …

Frailty And Post-Operative Outcomes In Adult Hip Fracture Patients, Melissa Yager

Dissertations

Abstract

Background/ Purpose: The majority of adult hip fracture patients never return to their pre-fracture functional level and have a poor quality of life (Kistler, Nicholas, Kates, & Friedman, 2015; Pioli et al., 2016; Sheehan et al., 2018). The prevalence of frailty in adult hip fracture patients is estimated at 51%. Frail patients with hip fractures are twice as likely to have a complication (Kistler et al., 2015). Extant studies have examined frailty and hip fractures independently, nonetheless, a gap in the literature exists with few investigations of the connection between frailty and post-operative outcomes after hip fracture. The purpose …

Right Arm Pain, Color Change And Swelling In A 17-Year-Old Male Baseball Pitcher, Alvin Chi

Research Days

No abstract provided.

Computer Based Learning Module: Neuraxial And Peripheral Nerve Blocks, Altan Halici

Doctor of Nursing Practice Projects

Neuraxial and peripheral nerve blocks (PNB) have been present for many years, but recently these pain management techniques are gaining popularity as an alternative to the use of opioids. Neuraxial and PNB reduce the opioid usage during and after the surgery and improve postoperative recovery in terms of pain relief, pain-related sleep disruption, and reduction of side effects, such as nausea and vomiting. Conversely, inadequate pain management after surgery may delay surgical recovery, decreased patient satisfaction, increased length of hospital stay, increased readmissions and healthcare costs (Patacsil, McAuliffe, Feyh, & Sigmon, 2016).

Perioperative nurses are instrumental during the post-operative period …

Novel Infection Status Post Electrocution Requiring A 4th Ray Amputation, William R. Judson, John D. Murphy, Phillip H. Sussman, John N. Harker

West Florida Division GME Research Day 2020

• Prevotella bivia is an anaerobic, non-pigmented, Gram-negative bacillus species that is known to inhabit the human female vaginal tract and oral flora. It is most commonly associated with endometritis and pelvic inflammatory disease.^{1, 2}
• Rarely, P. bivia has been found in the nail bed, chest wall, intervertebral discs, and hip and knee joints.¹ The bacteria has been linked to necrotizing fasciitis, osteomyelitis, or septic arthritis.^{3, 4}
• Only 3 other reports have described P. bivia infections in the upper extremity with one patient requiring amputation2, and one with deep soft tissue infection requiring multiple debridements and extensive tenosynovectomy. …

Fracture Blisters, Jessica Khabra, Jinal K. Patel, Gauthier L. Stepman, Kulveer Dabb, Kenny Hernandez, Debra Angelo, Johnathan Frunzi

West Florida Division GME Research Day 2020

Fracture blisters are tense vesicles or bullae that develop on edematous skin following some acute long bone fractures. Fracture blisters are infrequently seen, as the reported incidence is 2.9% to 6.6%.¹ This rare complication, may not regularly be encountered by Physicians in the hospital. Fracture blisters typically occur within 24-48 hours following high energy trauma injuries & may last up to several weeks. Ultimately, this condition can lead to prolonged hospital stay due to an increased risk of infection and delay in surgical intervention.² Early recognition of this dermatologic complication may be helpful in reducing hospital stays.

Bilateral Posterior Fracture-Dislocation Of The Proximal Humerus After First-Time Seizure, John D. Murphy, Phillip Braunlich, Mohit Bansal

West Florida Division GME Research Day 2020

Fractures of the proximal humerus are commonly associated with osteoporosis and comprise 5.7% of all adult fractures [1]. Posterior dislocations of the shoulder comprise 2-5% of all shoulder dislocations, and when bilateral are even more infrequent, occurring less than 5%. [2,3]. Posterior dislocations are often associated with motor vehicle accidents, seizures, or electrical shock [4]. Fracture-dislocations of the proximal humerus occur in only 1% of all shoulder dislocations, thus making posterior fracture-dislocations off the proximal humerus exceedingly rare [5]. In this case report, we present a previously undescribed case presentation and treatment for bilateral posterior fracture-dislocations of the proximal humerus …

The National Burden Of Orthopedic Injury: Cross-Sectional Estimates For Trauma System Planning And Optimization, Molly P. Jarman, Michael J. Weaver, Adil H. Haider, Ali Saleem, Mitchel B. Harris

Department of Surgery Docs

Background: Management of orthopedic injuries is a critical component of comprehensive trauma care. As patterns of injury incidence and recovery change in the face of emerging injury prevention efforts and technologies and an aging US population, assessment of the burden of orthopedic injury is essential to optimize trauma system planning. We sought to estimate the incidence of orthopedic injury requiring emergency orthopedic surgery in the United States.
Methods: Using nationally representative samples from the Agency for Healthcare Research and Quality Healthcare Cost and Utilization Project, we estimated the incidence of orthopedic injury, polytrauma with orthopedic injury, and emergency operative orthopedic …

Prospective Study Of Military Special Operations Medical Personnel And Lower Extremity Fracture Immobilization In An Austere Environment, Kevin Martin, Trevor Mcbride, Alicia Unangst, Jaime Chisholm

Department of Orthopaedic Surgery Faculty Papers

Background: Austere fracture immobilization equipment and techniques are often overlooked, with few studies critically evaluating the process. The purpose of this study was to evaluate current austere splinting techniques and equipment used for lower extremity fractures while field testing a new 1-step spray-on foam splint.

Methods: This is a prospective analysis of austere splinting techniques. A cadaveric model with a distal third tibia-fibula fracture was used for testing. The specimens were placed in an austere environment and participants immobilized the injury with standard equipment (structural aluminum malleable [SAM] splint, 6-in. ACE wrap) while being critically evaluated. The specimens were also …

Designing An Antibiotic Eluting Trauma Screw To Reduce Short Term Infection In Bone Fractures, Dominic Lincoln

Honors Theses

Orthopedic infection in the United States is one of the most common and severe health risks faced by trauma patients. The most prevalent infection is orthopedic and trauma device-related infection (ORDI) and often occurs in long bones at the fracture site. The purpose of this paper is to explore this infection, its causes, and solutions currently on the market while providing novel solutions to the problem. The designs proposed will be evaluated for their effectiveness and value, while attempting to keep costs low for all stakeholders. The feasibility of patenting these ideas will also be considered, as will the testing …

What Outcomes Matter To Patients After Joint Or Spine Surgery?, Robin R. Whitebird, Leif I. Solberg, Christine K. Norton, Jeanette Y. Ziegenfuss, Stephen E. Asche, Elizabeth S. Grossman

Journal of Patient-Centered Research and Reviews

Purpose: Patient-reported outcome measures (PROMs) are increasingly used in clinical care, but there have been few studies of what patients identify as the most important outcomes.

Methods: Semi-structured interviews were conducted with 65 patients undergoing hip or knee replacement, spinal discectomy/laminotomy, or a spinal fusion. Interviews focused on outcomes patients identified as important, perceived usefulness of standardized PROMs measures, and contextual situations important to their care. Data were analyzed using a directed content analysis approach.

Results: Patients identified desired outcomes that were unique and important to them. Their preferred outcomes focused in the areas of freedom from pain, getting back …

Orthopedic Injuries In Athletes, Cameron Adams

Showcase of Undergraduate Research and Creative Endeavors (SOURCE)

When thinking of athletes and orthopedic injuries, we often associate these injuries with more physical sports such as football, basketball, or even soccer. What we don’t realize is that an injury of any degree can occur in any sport, regardless of the level of physicality. An orthopedic injury is any injury to the bones, muscles, or joints of the musculoskeletal system. These injuries include, but are not limited to, ACL tears, meniscus tears, broken bones, muscle tears, sprains, dislocations, or fractures, obtained during a sport. Most injuries of this nature are hard to ignore, but depending on the area and …