Medical Specialties Commons^™

Analysing Outcomes Through Orthopaedic Trauma Registry: A Prospective Cohort Study, Tashfeen Ahmad, Zehra Abdul Muhammad, Shahryar Noordin, Ammar Humayun

Section of Orthopaedic Surgery

Objective: To develop a registry for recording injury-specific data to identify gaps and improve care.
Methods: The prospective cohort study was conducted at Aga Khan University Hospital, Karachi, from June 2015 to July 2018 though enrollment of patients with limb trauma is continuing to date. Data on injuries and management related to Tibia shaft fractures was collected from medical records, and outcomes were assessed on follow-up visits. Internationally validated injury-specific scores were utilised for assessing functional, clinical and radiological outcomes. SPSS version 19 was used for data analysis.
Results: There were 763 patients with 825 limb injuries. Of the injuries, …

Comparison Of Visual Analog Pain Score Reported To Physician Vs Nurse In Nonoperatively Treated Foot And Ankle Patients, Trevor Mcbride, Bs, Maj Kevin D. Martin, Do, Cpt Jeffrey Wake, Do, Atc, Lt J. Preston Van Buren, Do, Cuyler Dewar, Bs

Phase 1

Background: Patient reported outcome measures (PROMs) are taking a more prominent role in Orthopedics as health care seeks to define treatment outcomes. The Visual Analogue Scale (VAS) is considered a reliable measure of acute pain. A previous study found that operative candidates’ VAS pain score was significantly higher when reported to the surgeon compared to the nurse. This study’s aim is to examine whether this phenomenon occurs in nonoperative patients. We hypothesize that patients’ VAS scores reported to the surgeon and a nurse will be the same

Methods: This study is a retrospective cohort of 201 consecutive nonoperative patients treated …

Treatment Outcomes In Gram Negative Periprosthetic Joint Infection, Irene Kalbian, Ba, Karan Goswami, Md, Carol Foltz, Phd, Nathan John, Bs, William Arnold, Md, Javad Parvizi, Md, Fcrs

Phase 1

Introduction: Outcomes associated with periprosthetic joint infection (PJI) involving Gram negative (GN) organisms are poorly understood. While prevailing beliefs indicate that GN PJI cases have poorer prognoses than Gram positive (GP) cases, the current literature is sparse and inconsistent.

Objective: The purpose of this study is to systematically compare the treatment outcomes for GN PJI versus GP PJI.

Methods: A retrospective review of 1189 PJI cases between 2007 and 2017 was performed using an institutional PJI database. Treatment failure defined by the Delphi criteria was compared between cases with only GN organisms (n=45) and only …

An Evaluation Of Ultrasound-Guided Regional Block Anesthesia In Outpatient Hand Surgery, Daniel Calem, Armen C. Voskeridjian, Md, Michael Rivlin, Md, Pedro Beredjiklian, Md, Mark L. Wang, Md, Phd

Phase 1

Introduction: The utilization of ultrasound-guided peripheral nerve blocks in orthopedic surgery has increased in popularity as the anesthesia of choice for the management of perioperative pain. Peripheral nerve blockade has been shown to increase overall surgical efficiency, improve patient satisfaction, reduce postoperative narcotic use, and decrease the duration of facility admissions, while increasing overall cost-effectiveness. To date, scant literature exists regarding the safety and efficacy of ultrasound-guided supraclavicular blocks used in common hand surgery procedures, and the rate of neurologic and vascular complications remains unknown.

Objective: The purpose of this study was to examine the effectiveness and complication rate of …

Low Cost Reconstructive Options After Musculoskeletal Tumour Resection In Developing Countries: Affordable, Effective And Durable Alternatives, Arif Ali, Obada Hasan, Ahmed Habib, Masood Umer

Section of Orthopaedic Surgery

Over the last two, three decades, the overall survival rates for non-metastatic malignant tumours of the bone have dramatically improved. This has become possible due to the recent advances and multidisciplinary approach towards these diseases, specifically the advent of multi-agent chemotherapy and radiotherapy. Limb salvage has now become the norm in the treatment of musculoskeletal tumours without compromising on the overall survival and recurrence of the disease. In the era of metal, prosthetic reconstruction has become the standard procedure specifically in the large tumours which involve the joints as this method of reconstruction helps in joint mobility and early weight-bearing. …

Inflammatory Arthritis And Mycobacterium Tuberculosis Infection: A Diagnostic And Management Challenge For Knee Arthroplasty In Endemic Areas, Obada Hasan, Riaz Hussain Lakhdawala, Vickash Kumar, Syed Faisal Mahmood, Shahryar Noordin

Section of Orthopaedic Surgery

Tuberculosis continues to be one of the most challenging health problems more prevalent in developing countries. Pakistan ranks 5th in tuberculosis prevalence among the high-burden countries. Prosthetic joint infection of the knee by acid fast bacilli is a rare and distressing complication, occurring in nearly 1% of primary joint arthroplasties requiring prolonged medical treatment and multiple surgeries. A recent publication extensively reviewed English literature from 1952 to 2016, and repor ted only 64 prosthetic joint infec tion with tuberculosis, of which 27 cases involved the knee. Tuberculosis is a global health problem adding to the challenges that arthroplasty surgeons face …

Functional And Structural Studies Of Tolloid-Like 1 Mutants Associated With Atrial-Septal Defect 6., Lukasz Sieron, Marta Lesiak, Izabela Schisler, Zofia Drzazga, Andrzej Fertala, Aleksander L. Sieron

Department of Orthopaedic Surgery Faculty Papers

Inactive mammalian tolloid-like 1 (tll1) and mutations detected in tolloid-like 1 (TLL1) have been linked to the lack of the heart septa formation in mice and to a similar human inborn condition called atrial-septal defect 6 (ASD6; OMIM 613087, formerly ASD II). Previously, we reported four point mutations in TLL1 found in approximately 20% of ASD6 patients. Three mutations in the coding sequence were M182L, V238A, and I629V. In this work, we present the effects of these mutations on TLL1 function. Three recombinant cDNA constructs carrying the mutations and one wild-type construct were prepared and then expressed in HT-1080 cells. …

Intraoperative Finding Of Vascular Malformation During Carpal Tunnel Release: A Case Report, Mark S. Anderson, Moheb S. Moneim

UNM Orthopaedic Research Journal

Carpal tunnel release is a common surgical procedure performed by hand surgeons. The procedure is typically straightforward; however, uncommon causes of median nerve compression encountered intraoperatively may add complexity. We describe a 67-year-old man with carpal tunnel syndrome and an intraoperative finding of a compressive vascular malformation during a mini-open carpal tunnel release. A space-occupying malformation of a persistent median artery was bisecting the nerve and thought to be responsible for the patient’s symptoms. The compression was relieved through extended carpal tunnel release without requiring removal of the vascular malformation. The patient’s symptoms improved postoperatively. Hand surgeons undertaking this procedure …

Chronic Volar Lunate Dislocation Resulting In Carpal Tunnel Syndrome: A Case Report, Travis D. Blood, Amanda J. Fantry, Nathan T. Morrell

UNM Orthopaedic Research Journal

Lunate dislocations are rare injuries caused by highenergy trauma disrupting the ligamentous restraints that connect the lunate to the carpus. We describe a case of missed volar lunate dislocation 10 years after the initial injury. The patient presented to our clinic with symptoms of carpal tunnel syndrome after falling on an outstretched arm. He had increasing paresthesias in his median nerve territory and underwent a proximal row carpectomy with release of the transverse carpal ligament. At 2 years postoperatively, successful outcomes were noted with an 80° arc of motion of the carpus and complete resolution of carpal tunnel symptoms. Although …

Ipsilateral Femoral Neck And Shaft Fractures With A Floating Knee Injury: A Case Report, Matthew T. Philippi, Scott M. Sandilands, Paul J. Goodwyn, Samer Kakish

UNM Orthopaedic Research Journal

Isolated ipsilateral fractures of the femoral neck and shaft are rare injuries. Similarly, a floating knee (ie, ipsilateral fractures of the femur and tibia) is uncommon. We describe a 34-year-old man with ipsilateral fractures of the femoral neck and shaft with an ipsilateral floating knee after a motorcycle collision. He was treated with operative fixation, and was walking without assistive devices at his most recent follow-up appointment in February 2019. We believe this to be a unique combination of injuries not yet described in studies.

Intraoperative Finding Of Flexor Carpi Radialis Avulsion During Closed Distal Radius Fracture: A Case Report, Camille Aubin-Lemay, Deana Mercer

UNM Orthopaedic Research Journal

Distal radius fractures are a common reason for orthopaedic consultations in emergency departments and outpatient orthopaedic clinics. Ruptures of the extensor pollicis longus tendon have been regularly described in conjunction with distal radius fractures, whereas only five cases of flexor tendon injuries have been reported. We describe a patient with acute rupture of the flexor tendon identified during operative fixation of the distal radius fracture. The tendon avulsion was repaired at the same time as fracture fixation; unfortunately, the patient was lost to follow-up. This case highlights the importance of a careful physical examination in treating high-energy traumatic injuries and …

Diagnosis Of Leprosy Using Sural Nerve Biopsy Findings: A Case Report, Bridgette M. Love, Deana Mercer, Amber West, Karen S. Santacruz, Elizabeth A. Mikola

UNM Orthopaedic Research Journal

Leprosy, also known as Hansen disease, is an uncommon chronic disease caused by the slowly growing acid-fast bacilli, Mycobacterium leprae. Leprosy has tropism for peripheral nerves and skin and can also be found in the upper respiratory tract, eyes, and nasal mucosa. When left untreated, there can be considerable nerve damage resulting in paralysis, blindness, and the crippling of hands and feet. Although infrequent in the United States, leprosy has been diagnosed in patients exposed to armadillos, an animal reservoir. We describe an 80-year-old man who presented with a 6-year history of chronic erythematous, macular rash, and progressive symmetric sensory …

Multiple Pterygium Syndrome With Severe Knee Flexion Contracture: A Case Report, Jory Wasserburger, Garrett Waller, Scott Plaster, David M. Bennett

UNM Orthopaedic Research Journal

Multiple pterygium syndrome, a subgroup of arthrogryposis multiplex congenita, is characterized by the webbing of different parts of the body. We describe a child who developed 140° flexion contractures of the popliteal fossa, which complicated mobility, skin care, and general hygiene. After seeking multiple opinions, the parents elected to proceed with through-knee amputation of both knees. At 6 month follow-up, the child had been fitted with bilateral prostheses and was able to ambulate with assistance. The findings of the current case suggest that in extreme cases of multiple pterygium syndrome, through-knee amputations may represent a predictable and functional treatment option …

Leukocytoclastic Vasculitis In A 66-Year-Old Woman After Fusion Of The Second Right Metatarsocuneiform Joint Using Titanium Plate And Screws: A Case Report, Sarah K. Brown, Christopher Kurnik, Emily M. Altman, Richard A. Miller

UNM Orthopaedic Research Journal

Metallic orthopaedic implants are known to instigate cutaneous reactions; however, the mechanism by which this occurs is not fully understood. Contact dermatitis after implantation of stainless steel fracture plates was first described in 1966, and similar reactions to various implants have been documented subsequently. Leukocytoclastic vasculitis (LCV) is an inflammatory condition of small dermal blood vessels resulting from neutrophil invasion, degranulation, and cell death caused by a type III hypersensitivity reaction. No studies have reported use of titanium orthopaedic implants resulting in LCV. We describe a 66-year-old woman who developed LCV after the fusion of her second right metatarsocuneiform joint …

Achilles Tendon Ruptures In Two Male Athletes In Ncaa Division I: Report Of Two Cases, Lisa Hardy, Michele Bliss, Garyn Worrall, James Slauterbeck

UNM Orthopaedic Research Journal

Major tendon ruptures are rare, with an Achilles tendon rupture (ATR) being the most frequent type. Reported cases most commonly involve male recreational athletes who have increased body mass indexes and are between ages 30 and 50 years. We describe two male athletes in Division I of the National Collegiate Athletic Association who underwent surgical repair for treating an ATR associated with running-related activities. In contrast to other cases, both patients had normal body mass indexes. These two cases identify high-level athletes who underwent operative Achilles tendon repair and returned to their sport at a similar level or high level …

Inclusion Body Myositis In A Middle-Aged Woman With Knee Pain And Weakness: A Case Report, Jacob Christensen, Christopher A. Mcgrew

UNM Orthopaedic Research Journal

Weakness and osteoarthritis are common concerns for orthopaedic and primary care physicians when caring for aging adults. We describe a 58-year-old woman with a history of Sjogren syndrome and knee osteoarthritis. She presented to our clinic for injection of viscosupplementation in her left knee, and review of her medical records revealed right hand weakness at 7 years after the onset of symptoms. Findings of muscle biopsy and multiple electromyograms revealed inclusion body myositis, primarily affecting the deep finger flexors and quadriceps muscles. On the basis of this diagnosis, physical therapy and supportive care were recommended. The results of the current …

An Uncommon Presentation Of Coxa Saltans: A Case Report, Christopher S. Bossart, Christopher A. Mcgrew, Rebecca A. Dutton

UNM Orthopaedic Research Journal

Coxa saltans, or “snapping hip,” refers to various conditions that produce a palpable or audible snapping of the hip after movement. We present an uncommon case of coxa saltans in a patient with a snapping proximal hamstring tendon. Findings of dynamic ultrasound evaluation were used to confirm the source of snapping, characterized by a lateral subluxation of the conjoint tendon over the ischial tuberosity. Our patient was treated nonoperatively, and we observed mild improvement of her symptoms. Few cases of similar pathological findings have been described, with varying causes of tendon instability. The results of the current case may help …

Use Of Titanium Mesh Cage In Treating A Subtrochanteric Defect: A Case Report, Lucas D. Winter, James A. Dollahite, Rick Gehlert

UNM Orthopaedic Research Journal

Titanium mesh cages have been used during fixation of segmental defects in long bones; however, use in the subtrochanteric region of the proximal femur is a novel application. We describe a 38-year-old, 330-lb man with a highly comminuted fracture about the right femur after a gunshot wound. Immediate treatment involved use of a cement spacer. Findings of follow-up imaging showed about 26° external rotational deformity and 2-cm limb shortening. To correct the rotational abnormality and limb length discrepancy, a cylindrical titanium mesh cage and custom-made femur locking plate with a cancellous bone autograft were used. Subsequently, successful bridging was obtained …

Understanding And Improving Patient Satisfaction In Orthopaedic Surgical Procedures: A Review, Paul J. Johnson

UNM Orthopaedic Research Journal

Orthopaedic surgeons and their hospitals are being evaluated and reimbursed according to their ability to provide patient satisfaction. It behooves physicians to learn how patient satisfaction is evaluated, how patient satisfaction may be improved, and how improvements in patient satisfaction may positively influence patient outcomes both subjectively and objectively. The purpose of this review is to illuminate how evaluation works, how patient factors may affect or correlate with increased satisfaction, and how physicians can improve actions to enhance patient satisfaction. Notably, studies have found that improved care coordination, nursing follow-up, provider listening skills, providing realistic yet positive expectations, and sitting …

Complete Great Toe Sesamoid Excision: A Case Series, James A. Dollahite, Benjamin D. Packard, Richard A. Miller

UNM Orthopaedic Research Journal

Background: Hallux sesamoids notably contribute to the biomechanics of the great toe. Although frequently ignored or forgotten, injury to the hallux sesamoids can be debilitating. Conservative management remains the initial approach for symptomatic sesamoid disorders, but surgical excision is an option. We performed a retrospective case series to examine the preoperative characteristics and postsurgical outcomes of patients who underwent great toe sesamoidectomy.

Methods: We reviewed medical records of patients who underwent great toe sesamoidectomy performed by a single surgeon (RAM) during a 10-year period (26 patients, 28 procedures). Data collected included smoking status, prior first ray surgical treatment, highlevel athlete …

Periprosthetic Joint Infections: A Review, Jay J. Wojcik

UNM Orthopaedic Research Journal

No abstract provided.

Biomechanical Strength And Bulk Comparisons Between The Open-Book Technique And The Pulvertaft Method For Peroneal Tendon Transfer: A Pilot Study, Matthew Blue, Christian Douthit, Adam N. Wooldridge, Austin Williams, Micah Lierly-Chick, Kerry Gilbert, Jerry Grimes

UNM Orthopaedic Research Journal

Background: The Pulvertaft method has classically been used for the transfer of various tendon injuries owing to its biomechanical strength; however, this method has been shown to be bulky. We describe the open-book technique, which can offer comparable structural integrity with a decreased bulk. The purpose of this study was to determine whether the openbook technique is biomechanically equivalent to the Pulvertaft method for treating peroneal tendon injuries.

Methods: We evaluated five pairs of human cadaveric ankles. Within each pair, one specimen was randomly assigned to either the Pulvertaft or the open-book group. Using sharp dissection, the tendons were severed …

Comparison Of Joint Compression And Pull- Out Strength Of 6.5-Mm Self-Drilling Screws With Headed And Headless In Subtalar Arthrodesis: A Pilot Study, Christian Douthit, Matthew Blue, Adam N. Wooldridge, Micah Lierly-Chick, Kerry Gilbert, Jerry Grimes

UNM Orthopaedic Research Journal

Background: In patients with degenerative osteoarthritis of the subtalar joint, surgical treatment can include subtalar arthrodesis. Notably, mechanical factors such as compression and pull-out strength contribute to successful union, which can be achieved through use of headed or headless cannulate screws. The purpose of this study was to compare the resultant joint compressive force and pull-out strength between use of a headless 6.5-mm self-drilling cannulated compression screw and a more traditional headed 6.5- mm self-drilling cannulated compression screw.

Methods: This study used the calcaneus and talus from six paired fresh frozen specimens. The soft tissues were stripped and the joint …

The Future Of Infection Surveillance At Ambulatory Surgical Centers, Jenna Godfrey, Jory Wasserburger, Scott Plaster, Susan Kellie, Julia Manweiler, Robert C. Schenck Jr

UNM Orthopaedic Research Journal

Background: The Centers for Medicare and Medicaid (CMS) has begun mandating infection surveillance at surgical sites, which started in hospitals and is now in ambulatory surgical centers (ASCs). We found a 0.1% increase in infection rate between 2005 and 2007, which prompted us to examine the issue further. The purpose of the current study was to summarize the results of an investigation after an outbreak of infection at our ASC, specifically attempting to identify a common pathogen, vector, or unknown lapses in infection prevention. Additionally, we relate our experience to current trends in infection prevention at ASCs by examining the …

Comparison Of Intraoperative Fluoroscopy To Postoperative Weight-Bearing Radiographs Obtained 4 To 6 Weeks After Bunion Repair With A Chevron Osteotomy, Amber L. Price, Travis M. Hughes, Christopher Kurnik, Christina G. Kurnik, Katherine J. Gavin, Richard A. Miller

UNM Orthopaedic Research Journal

Background: During operative treatment of bunions, an attempt is made to correct the hallux valgus angle (HVA) and the intermetatarsal angle (IMA). In this study, the HVA and the IMA were measured using intraoperative C-arm fluoroscopic images obtained during surgical treatment of a bunion with chevron osteotomy. These angles were again measured using weight-bearing radiographs obtained 4 to 6 weeks postoperatively.

Methods: At our institution, we reviewed medical records of patients who underwent a bunion repair with chevron osteotomy between January 2013 and October 2017. A total of 26 feet from 24 patients were included. Three authors (ALP, TMH, and …

Patient Compliance With Follow-Up After Open Reduction And Internal Fixation For Treating Malleolar Ankle Fractures: A Retrospective Review, Matthew G. Wharton, Christopher L. Shultz, Benjamin D. Packard, Jory Wasserburger, Katherine J. Gavin, Richard A. Miller

UNM Orthopaedic Research Journal

Background: Compliance with follow-up after orthopaedic procedures is variable and does not always occur as recommended. Various factors such as medical, financial, cultural, and logistical reasons may contribute to this lack of compliance. The purpose of this study was to determine follow-up compliance of patients who had undergone open reduction and internal fixation (ORIF) for treating closed malleolar ankle fractures.

Methods: Medical records of patients who underwent ORIF for treating closed malleolar ankle fractures by the senior author (RAM) were reviewed to evaluate compliance with postoperative follow-up (n = 267). Inclusion criteria were patients with isolated, acute, closed fractures (n …

Comparison Of Narcotic Prescribing Habits Between Trainee And Attending Orthopaedic Surgeons, Christopher L. Shultz, Ryan C. Price, Brett S. Mulawka, Dustin L. Richter, Gehron P. Treme

UNM Orthopaedic Research Journal

Background: Orthopaedic surgeons are among the highest prescribing physicians of narcotics to opioidnaïve patients. Despite the current opioid epidemic, few studies have specifically quantified the appropriate amount of opioids necessary for postoperative pain control. We hypothesized a significant variability in the quantity of postoperative opioids prescribed among trainee (ie, residents and fellows) and attending surgeons at a single institution.

Methods: Postoperative narcotic prescribing habits were assessed using an anonymous survey. Ultimately, 28 trainee physicians and 17 attending physicians responded to the survey (86.5%). The survey recorded the amount of 5-mg oxycodone tablets that were commonly prescribed to manage pain after …

Design For Transtibial Modifiable Socket For Immediate Postoperative Prosthesis, Matthew N. Rush, Evan Hagin, Jane Nguyen, Victoria Lujan, Rebecca A. Dutton, Christina Salas

UNM Orthopaedic Research Journal

Amputations are long-standing surgical procedures that have been performed for centuries; however, very little attention and urgency have been given to immediate restoration of movement and return to a normal lifestyle. In many cases, the time between amputation and prosthetic fitting can pause recovery and development of new routines. To increase recovery, immediate postoperative prostheses (IPOPs) have been developed yet these are under-utilized because of concerns for wound healing and complications with vascular diseases. Subsequently, we designed a transtibial IPOP that utilizes an ergonomic modifiable socket that allows for examination, wound care, and in situ edema control. Additionally, the IPOP …

Reflections On Sports Medicine Fellowship Applications, Christopher L. Shultz

UNM Orthopaedic Research Journal

No abstract provided.

Technique Of Proximal Pole Scaphoid Fracture Fixation Using A Retrograde Pin Placement But Antegrade Screw Placement: A Case Example, Sirikrishna K. Khalsa, Camille Aubin-Lemay, Deana Mercer

UNM Orthopaedic Research Journal

The scaphoid is the most commonly fractured bone of the carpal row. Because of its precarious blood supply, scaphoid fractures are predisposed to avascular necrosis (AVN) and nonunion. This is especially true with fractures of the proximal pole. To decrease the risk of nonunion and AVN, surgical treatment of proximal pole scaphoid fractures is recommended, which facilitates fracture consolidation and long-term wrist function. We describe a 16-year-old adolescent boy who presented with a fracture of the proximal pole of the scaphoid, initially managed nonoperatively. Subsequent imaging findings revealed nonunion of the scaphoid bone. For treatment, a percutaneous fixation was chosen …