Medical Specialties Commons^™

Geographic And Age-Based Variations In Medicare Reimbursement Among Assh Members., Michael P. Gaspar, Patrick M. Kane, Grace B. Honik, Eon K. Shin, Sidney M. Jacoby, A. Lee Osterman

Department of Orthopaedic Surgery Faculty Papers

Background: The purpose of this study was to investigate how American Society for Surgery of the Hand (ASSH) members' Medicare reimbursement depends on their geographical location and number of years in practice. Methods: Demographic data for surgeons who were active members of the ASSH in 2012 were obtained using information publicly available through the US Centers for Medicare and Medicaid Services (CMS). "Hand-surgeons-per-capita" and average reimbursement per surgeon were calculated for each state. Regression analysis was performed to determine a relationship between (1) each state's average reimbursement versus the number of ASSH members in that state, (2) average reimbursement versus …

Chemical Modification Of Extracellular Matrix By Cold Atmospheric Plasma-Generated Reactive Species Affects Chondrogenesis And Bone Formation., Peter Eisenhauer, Natalie Chernets, You Song, Danil Dobrynin, Nancy Pleshko, Marla J Steinbeck, Theresa A. Freeman

Department of Orthopaedic Surgery Faculty Papers

The goal of this study was to investigate whether cold plasma generated by dielectric barrier discharge (DBD) modifies extracellular matrices (ECM) to influence chondrogenesis and endochondral ossification. Replacement of cartilage by bone during endochondral ossification is essential in fetal skeletal development, bone growth and fracture healing. Regulation of this process by the ECM occurs through matrix remodelling, involving a variety of cell attachment molecules and growth factors, which influence cell morphology and protein expression. The commercially available ECM, Matrigel, was treated with microsecond or nanosecond pulsed (μsp or nsp, respectively) DBD frequencies conditions at the equivalent frequencies (1 kHz) or …

The Financial And Professional Impact Of Anterior Cruciate Ligament Injuries In National Football League Athletes., Eric S. Secrist, Suneel B. Bhat, Christopher C. Dodson

Rothman Institute Papers

BACKGROUND: Anterior cruciate ligament (ACL) injuries can have negative consequences on the careers of National Football League (NFL) players, however no study has ever analyzed the financial impact of these injuries in this population.

PURPOSE: To quantify the impact of ACL injuries on salary and career length in NFL athletes.

STUDY DESIGN: Cohort study; Level of evidence, 3.

METHODS: Any player in the NFL suffering an ACL injury from 2010 to 2013 was identified using a comprehensive online search. A database of NFL player salaries was used to conduct a matched cohort analysis comparing ACL-injured players with the rest of …

Spinal Compression Fractures: No Additional Pain Relief With Use Of Back Braces, Kayla A. Berigan, Brandon Baker, Zakaria Ahmad, Aaron Simpson

Clinical Research in Practice: The Journal of Team Hippocrates

A critical appraisal and clinical application of Li M, Law SW, Cheng J, Kee HM, Wong MS. A comparison study on the efficacy of SpinoMed® and soft lumbar orthosis for osteoporotic vertebral fracture. J. Prosthet. Orthot. Int. 2015;39(4):270-276. doi: 10.1177/0309364614528204

Early Detection Of Idiopathic Scoliosis In Adolescents, M. Timothry Hresko, Vishwas Talwalkar, Richard Schwend

Orthopaedic Surgery and Sports Medicine Faculty Publications

The early detection of idiopathic scoliosis has been advocated since the 1950s and ’60s, concurrent with the development in the modern era of ambulatory spinal orthoses to treat scoliosis in adolescents. This led to the development of screening programs for specific populations, as evidenced by school screening programs in the United States and public health systems in Europe and Asia. Over time, the value of population screening in terms of optimal health care and economics has been debated in the popular press, by the U.S. Preventive Services Task Force, and by professional societies. Recent studies on the effectiveness of bracing …

Catastrophic Femoral Head-Stem Trunnion Dissociation Secondary To Corrosion., Laura Matsen Ko, Antonia F. Chen, Md, Mba, Gregory K Deirmengian, William J. Hozack Md, Peter F. Sharkey

Rothman Institute Papers

BACKGROUND: Modular femoral heads provide procedural enhancement by allowing accurate restoration of hip offset and limb-length equalization. However, corrosion may lead to adverse local tissue reactions. Severe trunnion corrosion can also lead to femoral head dissociation and catastrophic implant failure following primary total hip arthroplasty.

METHODS: We describe 5 cases, from our institution, in which the femoral head became dissociated from the femoral stem trunnion secondary to severe corrosion. Possible causes are evaluated.

RESULTS: Demographic commonalities among the 5 patients included a body mass index (BMI) of ≥30 kg/m(2) and male sex. All femoral heads were made of cobalt-chromium alloy …

The 2015 American-British-Canadian Traveling Fellows Report., Alpesh A. Patel, Robert H. Brophy, Rajiv Gandhi, Hue H. Luu, Kishore Mulpuri, Suken A Shah, Sanjeev Kakar

Department of Orthopaedic Surgery Faculty Papers

No abstract provided.

Omitting Histopathology In Wrist Ganglions. A Risky Proposition, Akbar Jaleel Zubairi, Santosh Kumar, Yasir Mohib, Rizwan Haroon Rashid, Shahryar Noordin

Department of Surgery Docs

ABSTRACT Objectives: To identify incidence and utility of histopathology in wrist ganglions. Methods: A retrospective study of 112 patients operated for wrist swellings between January 2009 and March 2014 at Aga Khan University Hospital, Karachi, Pakistan, was conducted. Medical records were reviewed for demographics, history, location and associated symptoms, provisional diagnosis and operative details. Histopathology reports were reviewed to confirm the final diagnosis. Results: One hundred and twelve patients were included in the study (34 males and 78 females) with a mean age of 28 ± 12 years. Ninety-five percent of ganglia were dorsally located and 85% were solitary in …

Intertrochanteric Hip Fractures In Octogenarian Patients: Do We Need To Rethink Fixation Strategy?, Shahryar Noordin, Shahbano 1, Tashfeen Ahmad, Idrees Shah

Department of Surgery Docs

Abstract

OBJECTIVE:

To compare outcomes in octogenarians with younger patients up to 1 year after undergoing dynamic hip screw fixation for intertrochanteric fractures to see the effectiveness of the implant.

METHODS:

The retrospective case-control study was conducted at The Aga Khan University and comprised records of patients who underwent dynamic hip screw surgery between January 1, 2010, and December 31, 2012. They were divided into two groups based on their age:. Group A <80 years; and Group B > 80 years. All patients had a one-year follow-up> Data including mortality, morbidity, radiological healing time, postoperative ambulatory status and Harris hip score were recorded.

RESULTS:

Of the …

A Comparison Of Cervical And Trunk Musculoskeletal Characteristics Between Female And Male Army Helicopter Pilots, Takashi Nagai, Karen A. Keenan, John P. Abt, Timothy C. Sell, Brian W. Smalley, Michael D. Wirt, Scott M. Lephart

International Journal of Aviation, Aeronautics, and Aerospace

Introduction: Neck pain (NP) and low back pain (LBP) are prevalent among military helicopter pilots. Although there have been few studies on sex differences in the NP/LBP prevalence in this population, females are shown to be at a greater risk of NP/LBP in civilian studies. This disparity may be due to musculoskeletal characteristics differences that predispose females for NP/LBP. The purpose of this study was to compare cervical and trunk musculoskeletal characteristics between male and female pilots. Methods: A total of 8 female pilots (Age: 27.6 ± 4.2yrs, HT: 166.1 ± 7.7cm, WT: 67.9 ± 10.6kg) were tested, and they …

A Comparison Of Imaging Modalities For The Diagnosis Of Osteomyelitis, Brandon J. Smith, Md, Grant S. Buchanan, Md, Franklin D. Shuler, Md, Phd

Marshall Journal of Medicine

Osteomyelitis is an increasingly common pathology that often poses a diagnostic challenge to clinicians. Accurate and timely diagnosis is critical to preventing complications that can result in the loss of life or limb. In addition to history, physical exam, and laboratory studies, diagnostic imaging plays an essential role in the diagnostic process. This narrative review article discusses various imaging modalities employed to diagnose osteomyelitis: plain films, computed tomography (CT), magnetic resonance imaging (MRI), ultrasound, bone scintigraphy, and positron emission tomography (PET). Articles were obtained from Pubmed and screened for relevance to the topic of diagnostic imaging for osteomyelitis. The authors …

Vitamin K2 (Menaquinone) Supplementation And Its Benefits In Cardiovascular Disease, Osteoporosis, And Cancer, Grant S. Buchanan, Md, Thomas Melvin, Brandon Merritt, Charles Bishop, Md, Franklin D. Shuler, Md, Phd

Marshall Journal of Medicine

Vitamin K is known to play an essential role in the coagulation cascade; however, a growing body of research has found that a subtype of this vitamin, vitamin K₂ (menaquinone) may have a beneficial effect in osteoporosis, cardiovascular disease, and cancer. This purpose of this article is to provide a comprehensive review of recent literature regarding menaquinone and its role in human health. This review discusses the physiology of menaquinone, its clinical benefits in cardiovascular disease, osteoporosis, and cancer, and how it may interact with certain medications. The authors conclude that menaquinone supplementation has been shown to improve carboxylation …

What's New In Musculoskeletal Infection: Update On Biofilms., Arvind Nana, Sandra B Nelson, Alex Mclaren, Antonia F. Chen, Md, Mba

Rothman Institute Papers

No abstract provided.

Oncology Edge Task Force On Prostate Cancer Outcomes: A Systematic Review Of Outcome Measures For Functional Mobility, Claire Davies, Genevieve Colon, Hannah Geyer, Lucinda Pfalzer, Mary Insana Fisher

Physical Therapy Faculty Publications

Background: The medical treatment of prostate cancer results in multiple impairments in body structure and declines functional abilities, resulting in activity limitations and participation restrictions. Measurement of functional mobility is an essential outcome measure in survivorship care.

Purpose: The purpose of this systematic review is to make recommendations of the best measurement tools to assess functional mobility in men treated for prostate cancer based on psychometric properties and clinical utility.

Methods: Multiple electronic databases were searched from February to March 2014. Studies of tools used to assess functional mobility were included if they met the following criteria: reported psychometric properties, …

Reduction Of Friction By Recombinant Human Proteoglycan 4 In Il-1Α Stimulated Bovine Cartilage Explants, Katherine M. Larson, Ling Zhang, Khaled A. Elsaid, Tannin A. Schmidt, Braden C. Fleming, Gary J. Badger, Gregory D. Jay

Pharmacy Faculty Articles and Research

A boundary lubricant attaches and protects sliding bearing surfaces by preventing interlocking asperity-asperity contact. Proteoglycan-4 (PRG4) is a boundary lubricant found in the synovial fluid that provides chondroprotection to articular surfaces. Inflammation of the diarthrodial joint modulates local PRG4 concentration. Thus, we measured the effects of inflammation, with Interkeukin-1α (IL-1α) incubation, upon boundary lubrication and PRG4 expression in bovine cartilage explants. We further aimed to determine whether the addition of exogenous human recombinant PRG4 (rhPRG4) could mitigate the effects of inflammation on boundary lubrication and PRG4 expression in vitro.

Cartilage explants, following a 7-day incubation with IL-1α, were tested …

Response Shift And Functional Outcomes In Individuals With Chronic Ankle Instability, Cameron J. Powden

Health Services Research Dissertations

Ankle sprains are one of the most common injuries sustained by those who are physically active. One in three individuals will develop a condition known as chronic ankle instability (CAI) after suffering a single ankle sprain. These individuals suffer from recurrent bouts of ankle instability, residual symptoms, and a myriad of other mechanical and functional impairments as well as health-related quality of life (HRQL) deficits. Due to the abundance of health consequences associated with this condition it is imperative to establish evidence based interventions that are focused on restoring function and HRQL to pre-injury statuses.

The overarching purpose of this …

Medicare Reimbursement For Total Joint Arthroplasty: The Driving Forces., Eric M. Padegimas, Kushagra Verma, Benjamin Zmistowski, Richard H. Rothman, James J. Purtill, Michael Howley

Department of Orthopaedic Surgery Faculty Papers

BACKGROUND: Total joint arthroplasty is a large and growing part of the U.S. Medicare budget, drawing attention to how much providers are paid for their services. The purpose of this study was to examine the variables that affect total joint arthroplasty reimbursement. Along with standard economic variables, we include unique health-care variables. Given the focus on value in the Affordable Care Act, the model examines the relationship of the quality of care to total joint arthroplasty reimbursement. We hoped to find that reimbursement patterns reward quality and reflect standard economic principles.

METHODS: Multivariable regression was performed to identify variables that …

Outcomes And National Trends For The Surgical Treatment Of Lumbar Spine Trauma., Doniel Drazin, Miriam Nuno, Faris Shweikeh, Alex R. Vaccaro, Eli Baron, Terrence T. Kim, J. Patrick Johnson

Department of Orthopaedic Surgery Faculty Papers

Introduction. Operative treatment of lumbar spine compression fractures includes fusion and/or cement augmentation. Our aim was to evaluate postoperative differences in patients treated surgically with fusion, vertebroplasty, or kyphoplasty. Methods. The Nationwide Inpatient Sample Database search for adult vertebral compression fracture patients treated 2004-2011 identified 102,316 surgical patients: 30.6% underwent spinal fusion, 17.1% underwent kyphoplasty, and 49.9% underwent vertebroplasty. Univariate analysis of patient and hospital characteristics, by treatment, was performed. Multivariable analysis was used to determine factors associated with mortality, nonroutine discharge, complications, and patient safety. Results. Average patient age: fusion (46.2), kyphoplasty (78.5), vertebroplasty (76.7) (p < .0001). Gender, race, household income, hospital-specific characteristics, and insurance differences were found (p ≤ .001). Leading comorbidities were hypertension, osteoporosis, and diabetes. Risks for higher mortality (OR 2.0: CI: 1.6-2.5), nonroutine discharge (OR 1.6, CI: 1.6-1.7), complications (OR 1.1, CI: 1.0-1.1), and safety related events (OR 1.1, CI: 1.0-1.1) rose consistently with increasing age, particularly among fusion patients. Preexisting comorbidities and longer in-hospital length of stay were associated with increased odds of nonroutine discharge, complications, and patient safety. Conclusions. Fusion patients had higher rates of poorer outcomes compared to vertebroplasty and kyphoplasty cohorts. Mortality, nonroutine discharge, complications, and adverse events increased consistently with older age.

Challenges And Pitfalls In Diagnosis Of Parosteal Osteosarcoma: A Clinicopathologic Study Of 23 Cases, Muhammad Usman Tariq, Nasir Uddin, Arsalan Ahmed, Shahid Pervez, Romana Idress, Saira Fatima, Masood Umer, Naila Kayani Naila Kayani

Department of Radiology

Objective: Parosteal Osteosarcoma (PO) is an uncommon variant of osteosarcoma. Diagnosing PO is important due to its malignant nature but the diversity of histologic features makes it challenging by adding a number of soft tissue, bony and cartilaginous lesions into the list of differential diagnosis. Our aim was to study the clinicopathologic and histological features of PO with emphasis on features helpful in its discrimination from other mimicking lesions. Methods: We reviewed 23 cases of PO diagnosed in our institution between January 2001 and August 2015. Results: Femur was the most commonly involved bone (68.2%) along with other long bones …

Volume V (2016), Unm Department Of Orthopaedic Surgery

UNM Orthopaedic Research Journal

No abstract provided.

Vitamin D Supplementation: Preventing Fractures, Courtney L. Carn, Michael S. Doherty

Physician Assistant Capstones, 2016 to 2019

Objective: To assess the ability of vitamin D supplementation in preventing musculoskeletal fractures. Methods: Systematic literature review using Google Scholar search terms “vitamin D supplementation” and “preventing hip fractures” from 2006-2015. Only RCTs, meta-analysis, and clinical guidelines were included. Results: Our search resulted in one meta-analysis and two randomized controlled trials. Conclusion: The summation of our investigation into vitamin D deficiency and the presence of musculoskeletal fractures has proven to be relatively inconclusive. The resulting data from our three studies did not provide any definitive proof that improved vitamin D levels correlates with better bone health.

Improving Rural Bone Health And Minimizing Fracture Risk In West Virginia: Validation Of The World Health Organization Frax® Assessment Tool As A Phone Survey For Osteoporosis Detection, Franklin D. Shuler Md, Phd, Kelly Scott Md, Mph, Timothy Wilson-Byrne Md, Miranda R. Morgan, Linda Morgan

Orthopaedics

West Virginia ranks second nationally in population ≥ 65 years old placing our state at greater risk for osteoporosis and fracture. The gold standard for detecting osteoporosis is dual X-ray absorptiometry (DXA), yet over half of West Virginia’s counties do not have this machine. Due to access barriers, a validated phone-administered fracture prediction tool would be beneficial for osteoporosis screening. The World Health Organization’s FRAX® fracture prediction tool was administered as a phone survey to 45 patients; these results were compared to DXA bone mineral density determination. Results confirmed that the FRAX® phone survey is as reliable as DXA in …

Synovial Neuronal Changes In Knee Joint Osteoarthritis, Haq Nawaz, Masood Umer, Shahryar Noordin, Bo Christer Bertilson, Jian Li, Aisha Siddiqah Ahmed, Mahmood Ahmed

Department of Surgery Docs

Abstract Purpose: The purpose is to study whether pain and inflammation in knee joint osteoarthritis (OA) are associated with local synovial neuronal changes. Methods: Synovial biopsies were harvested from the medial and lateral knee compartments from OA patients undergoing total joint replacement surgery. All patients had predominant pain at the medial joint compartment. Pain and knee joint function were evaluated by knee society score (KSS). Synovial inflammation was analyzed by histopathological analysis and expression of growth associated protein-43 (GAP-43), sensory (SP, CGRP) and autonomic (NPY, VIP, TH) neuropeptides was studied by single and double immunohistochemistry techniques. Results: We observed reduced …

Preoperative Assessment Clinic Reduces Total Joint Arthroplasty Case Cancellations, Angelica Adriano

Doctor of Nursing Practice Final Manuscripts

The purpose of this evidence-based project was to reduce the rate of elective total joint arthroplasty case cancellations by implementing a nurse practitioner-led Preoperative Assessment Clinic (POAC), in the orthopedic department of a major southern California Veterans Affairs (VA) hospital. Retrospective data collected in a 12-month time period showed a surgical cancellation rate of 22%. Reasons for delays or cancellations included: medical instability, abnormal labs and/or studies, patients requiring referral to specialists, dental clearance, patient-initiated cancellations, and active infections. The POAC reduced the rate of case cancellations at 1 year to 17% and at 2 years to 9%. Lost revenue …

Circadian Factors Bmal1 And Rorα Control Hif-1Α Transcriptional Activity In Nucleus Pulposus Cells: Implications In Maintenance Of Intervertebral Disc Health., Kaori Suyama, Elizabeth S Silagi, Hyowon Choi, Kou Sakabe, Joji Mochida, Irving M Shapiro, Makarand V Risbud

Department of Orthopaedic Surgery Faculty Papers

BMAL1 and RORα are major regulators of the circadian molecular oscillator. Since previous work in other cell types has shown cross talk between circadian rhythm genes and hypoxic signaling, we investigated the role of BMAL1 and RORα in controlling HIF-1-dependent transcriptional responses in NP cells that exist in the physiologically hypoxic intervertebral disc. HIF-1-dependent HRE reporter activity was further promoted by co-transfection with either BMAL1 or RORα. In addition, stable silencing of BMAL1 or inhibition of RORα activity resulted in decreased HRE activation. Inhibition of RORα also modulated HIF1α-TAD activity. Interestingly, immunoprecipitation studies showed no evidence of BMAL1, CLOCK or …

Recurring Ankle Injuries In Dancers, Alexis Jawny

Honors Theses

The purpose of this research, obtained from various Journals of Dance Medicine and Science, is to identify the cause of recurring ankle injuries in the dance community. Ankle injuries are the most common type of injury making up 50% of injuries in dancers. The main cause of recurring ankle injuries is improper diagnosing and then leading to the wrong treatment plan. The research focusses on how to prevent these improper diagnoses and what the dancer and specialty care professional (orthopedics, physical therapists, and rehabilitative medicine) can do to decrease the number of ankle injuries occurring and reoccurring in the dance …

Segmental Excision Versus Intralesional Curettage With Adjuvant Therapy For Giant Cell Tumour Of Bone, Omar Yacob, Masood Umer, Marrium Gul, Irfan Qadir

Department of Radiology

Abstract

PURPOSE:

To review the functional outcome and local recurrence rate of 29 patients who underwent segmental excision or intralesionalcurettage with adjuvant therapy for giant cell tumour (GCT) of bone.

METHODS:

Records of 17 men and 12 women (mean age, 30.17 years) who underwent segmental excision (n=18) or intralesional curettage followed by adjuvant therapy (n=11) for GCT of the femur (n=13), tibia (n=8), radius (n=6), or ulna (n=2) were reviewed. Nine of the patients had recurrent GCT of bone and had undergone segmental excision (n=6) or intralesional curettage (n=3) elsewhere. Functional outcome was evaluated using the Musculoskeletal Tumour Society (MSTS) …

The Role Of Sonic Hedgehog Signaling In Osteoclastogenesis And Jaw Bone Destruction., Tsuyoshi Shimo, Kenichi Matsumoto, Kiyofumi Takabatake, Eriko Aoyama, Yuichiro Takebe, Soichiro Ibaragi, Tatsuo Okui, Naito Kurio, Hiroyuki Takada, Kyoichi Obata, Pai Pang, Masahiro Iwamoto, Hitoshi Nagatsuka, Akira Sasaki

Department of Orthopaedic Surgery Faculty Papers

Sonic hedgehog (SHH) and its signaling have been identified in several human cancers, and increased levels of its expression appear to correlate with disease progression and metastasis. However, the role of SHH in bone destruction associated with oral squamous cell carcinomas is still unclear. In this study we analyzed SHH expression and the role played by SHH signaling in gingival carcinoma-induced jawbone destruction. From an analysis of surgically resected lower gingival squamous cell carcinoma mandible samples, we found that SHH was highly expressed in tumor cells that had invaded the bone matrix. On the other hand, the hedgehog receptor Patched …

Anterior Cruciate Ligament Injuries In National Football League Athletes From 2010 To 2013: A Descriptive Epidemiology Study., Christopher C Dodson, Eric S Secrist, Suneel B Bhat, Daniel P Woods, Peter F Deluca

Rothman Institute Papers

BACKGROUND: There is a high incidence of anterior cruciate ligament (ACL) injuries among National Football League (NFL) athletes; however, the incidence of reinjury in this population is unknown.

PURPOSE: This retrospective epidemiological study analyzed all publicly disclosed ACL tears occurring in NFL players between 2010 and 2013 to characterize injury trends and determine the incidence of reinjury.

STUDY DESIGN: Descriptive epidemiological study.

METHODS: A comprehensive online search identified any NFL player who had suffered an ACL injury from 2010 to 2013. Position, playing surface, activity, and date were recorded. Each player was researched for any history of previous ACL injury. …

Intra-Articular Distal Radius Fractures: Postoperative Roentgenographic And Functional Outcomes, Muhammad Shahid Khan, Shahryar Noordin, Pervaiz Hashmi

Department of Surgery Docs

Abstract

OBJECTIVE:

To assess the outcome of volarlocking compression plate fixation for intra-articular distal radius fractures with respect to function of hand and roentgenographic parameters.

METHODS:

The retrospective study was conducted at the Aga Khan University Hospital, Karachi, and comprised patients who underwent locking compression plate fixation for intra-articular distal radius fractures between June 2009 and July 2012. Case notes, radiographic assessment and functional outcomes were noted. Functional outcome was determined with the help of telephone-based quick-dash score questionnaire administered atleast 6 months post-surgery. Radiological assessment of radial inclination, radial height and volar tilt was measured on immediate postoperative radiographs …