Medical Specialties Commons^™

Chondroblastoma Of The Cuboid With An Associated Aneurysmal Bone Cyst: A Case Report, Yasir J Sepah, Masood Umer, Khurram Minhas, Kamran Hafeez

Department of Surgery Docs

Abstract

We report the case of a young adult who presented with a painful foot due to chondroblastoma associated with an aneurismal bonecyst.Chondroblastoma is a rare benign cartilaginous neoplasm that accounts for approximately 1% of all bone tumors and characteristically arises in the epiphysis of a long bone, particularly the humerus, tibia, and femur. Chondroblastoma can affect people of all ages. It is, however, most common in children and young adults between the ages of 10 and 20 years. Association of chondroblastoma with aneurysmal bone cyst is well documented however this association has only once been reported in the cuboid.Imaging …

Regional Variability In Use Of A Novel Assessment Of Thoracolumbar Spine Fractures: United States Versus International Surgeons, John Ratliff, Neel Anand, Alexander R. Vaccaro, Moe R. Lim, Joon Y. Lee, Paul Arnold, James S. Harrop, Raja Rampersaud, Christopher M. Bono, Ralf H. Gahr, Trauma Study Group Spine

Department of Orthopaedic Surgery Faculty Papers

Background: Considerable variability exists in clinical approaches to thoracolumbar fractures. Controversy in evaluation and nomenclature contribute to this confusion, with significant differences found between physicians, between different specialties, and in different geographic regions. A new classification system for thoracolumbar injuries, the Thoracolumbar Injury Severity Score (TLISS), was recently described by Vaccaro. No assessment of regional differences has been described. We report regional variability in use of the TLISS system between United States and non-US surgeons.

Methods: Twenty-eight spine surgeons (8 neurosurgeons and 20 orthopedic surgeons) reviewed 56 clinical thoracolumbar injury case histories, which included pertinent imaging studies. Cases were classified …

Does ‘Excessive’ Anticoagulation Predispose To Periprosthetic Infection?, Javad Parvizi, Elie Ghanem, Ashish Joshi, Peter F. Sharkey, William J. Hozack, Richard H. Rothman

Department of Orthopaedic Surgery Faculty Papers

Background
Although persistent drainage and hematoma formation are recognized risk factors for the development of periprosthetic infection, it is not known if excess anticoagulation is a predisposing factor.

Methods
We conducted a 2 to 1 case-control study with 78 cases who underwent revision for septic failure. The controls underwent the same index procedure but did not develop consequent infection. Patient comorbidities, medications, intraoperative, and postoperative factors were compared.

Results
Postoperative wound complications including development of hematoma and wound drainage were significant risk factors for periprosthetic infection. A mean international normalized ratio of greater than 1.5 was found to be more …

Diet, Nutrition, Obesity And Their Role In Arthritis, Peter F. Sharkey, David L. Paskin, Thomas D. Meade, Richard H. Rothman

Department of Orthopaedic Surgery Faculty Papers

Obesity and poor nutrition, individually and together, have created costly musculoskeletal disease epidemic in the United States. Processed food, with abundant "empty" calories, has contributed greatly to our dietary woes. Much of the food consumed today is packed with calories but refined to the point that essential nutrients are lacking. Even worse, processed food may have ingredients added that are detrimental to good health. Abundant research has documented a close relationship between obesity, poor diet and orthopaedic problems. Dietary supplements have been proven to provide both disease prevention and therapeutic benefits. Unfortunately, many weight loss programs and methods are ineffective …

Concave Pit-Containing Scaffold Surfaces Improve Stem Cell-Derived Osteoblast Performance And Lead To Significant Bone Tissue Formation., Antonio Graziano, Riccardo D'Aquino, Maria Gabriella Cusella-De Angelis, Gregorio Laino, Adriano Piattelli, Maurizio Pacifici, Alfredo De Rosa, Gianpaolo Papaccio

Department of Orthopaedic Surgery Faculty Papers

BACKGROUND: Scaffold surface features are thought to be important regulators of stem cell performance and endurance in tissue engineering applications, but details about these fundamental aspects of stem cell biology remain largely unclear.

METHODOLOGY AND FINDINGS: In the present study, smooth clinical-grade lactide-coglyolic acid 85:15 (PLGA) scaffolds were carved as membranes and treated with NMP (N-metil-pyrrolidone) to create controlled subtractive pits or microcavities. Scanning electron and confocal microscopy revealed that the NMP-treated membranes contained: (i) large microcavities of 80-120 microm in diameter and 40-100 microm in depth, which we termed primary; and (ii) smaller microcavities of 10-20 microm in diameter …

Acute Proximal Hamstring Rupture, Steven B. Cohen, James Bradley

Department of Orthopaedic Surgery Faculty Papers

Hamstring strain is common in athletes, and both diagnosis and surgical treatment of this injury are becoming more common. Nonsurgical treatment of complete ruptures has resulted in complications such as muscle weakness and sciatic neuralgia. Surgical treatment recently has been advocated to repair the complete rupture of the hamstring tendons from the ischial tuberosity. Surgical repair involves a transverse incision in the gluteal crease, protection of the sciatic nerve, mobilization of the ruptured tendons, and repair to the ischial tuberosity with the use of suture anchors. Reports in the literature of surgical treatment of proximal hamstring rupture are few, and …

Surgical Versus Nonsurgical Treatment For Lumbar Degenerative Spondylolisthesis., James N Weinstein, Jon D Lurie, Tor D Tosteson, Brett Hanscom, Anna N A Tosteson, Emily A Blood, Nancy J O Birkmeyer, Alan Hilibrand, Harry Herkowitz, Frank P Cammisa, Todd J Albert, Sanford E Emery, Lawrence G Lenke, William A Abdu, Michael Longley, Thomas J Errico, Serena S Hu

Rothman Institute Papers

BACKGROUND: Management of degenerative spondylolisthesis with spinal stenosis is controversial. Surgery is widely used, but its effectiveness in comparison with that of nonsurgical treatment has not been demonstrated in controlled trials.

METHODS: Surgical candidates from 13 centers in 11 U.S. states who had at least 12 weeks of symptoms and image-confirmed degenerative spondylolisthesis were offered enrollment in a randomized cohort or an observational cohort. Treatment was standard decompressive laminectomy (with or without fusion) or usual nonsurgical care. The primary outcome measures were the Medical Outcomes Study 36-Item Short-Form General Health Survey (SF-36) bodily pain and physical function scores (100-point scales, …

Pathophysiology, Diagnosis, And Treatment Of Spinal Meningoceles And Arachnoid Cysts, Ryan M. Dahlgren, Eli M. Baron, Alexander R. Vaccaro

Department of Orthopaedic Surgery Faculty Papers

Though the nomenclature regarding spinal arachnoid cysts and meningoceles is confusing and sometimes overlapping, spinal arachnoid cysts and meningoceles are distinct entities with different presentations and etiologies. Meningoceles are usually congenital lesions discovered at infancy with a high incidence of associated anomalies. Spinal arachnoid cysts are most often asymptomatic but can cause nerve root and/or cord compression. We review the presentation, pathophysiology, and management of these lesions.

Management Of Morel-Lavallee Lesion Of The Knee: Twenty-Seven Cases In The National Football League, Samir G. Tejwani, Steven B. Cohen, James P. Bradley

Department of Orthopaedic Surgery Faculty Papers

BACKGROUND: The Morel-Lavallee lesion is a closed degloving injury most commonly described in the region of the hip joint after blunt trauma. It also occurs in the knee as a result of shearing trauma during football and is a distinct lesion from prepatellar bursitis and quadriceps contusion.

PURPOSE: To review the authors' experience with Morel-Lavallee lesion of the knee in the elite contact athlete to construct a diagnostic and treatment algorithm.

STUDY DESIGN: Case series; Level of evidence, 4.

METHODS: Twenty-seven knees in 24 players were identified from 1 National Football League team's annual injury database as having sustained a …

Rotator Cuff Contusions Of The Shoulder In Professional Football Players: Epidemiology And Magnetic Resonance Imaging Findings, Steven B. Cohen, Jeffrey D. Towers, James P. Bradley

Department of Orthopaedic Surgery Faculty Papers

BACKGROUND: No published reports have studied the epidemiology and magnetic resonance imaging findings associated with rotator cuff contusions of the shoulder in professional football players.

PURPOSE: To determine a single professional football team's incidence, treatment, and magnetic resonance imaging appearance of players sustaining rotator cuff contusions of the shoulder.

STUDY DESIGN: Case series; Level of evidence, 4.

METHODS: From 1999 to 2005, a North American professional football team's injury records were retrospectively reviewed for athletes who had sustained a rotator cuff contusion of the shoulder during in-season participation. Those patients who had magnetic resonance imaging of the shoulder with a …

Three-Portal Technique For Anterior Cruciate Ligament Reconstruction: Use Of A Central Medial Portal, Steven B. Cohen, Freddie H. Fu

Department of Orthopaedic Surgery Faculty Papers

Standard endoscopic reconstruction of the anterior cruciate ligament (ACL) is performed with the use of 2 arthroscopic portals. The surgical error most commonly associated with ACL reconstruction is improper positioning of the tunnel. Errors in femoral tunnel position may be related to poor visualization of the lateral wall. When anatomic double-bundle ACL reconstruction is performed, proper visualization of the lateral wall is essential to ensure correct placement of both tunnels. We propose the use of a central portal, in addition to more standard anterolateral and anteromedial portals, to enhance visualization of the lateral wall. In addition, the arthroscope can be …

High Dietary Fat Intake Is Not Associated With High Levels Of Circulating Lipoproteins Or Total Cholesterol, C. Jayne Brahler, C. Wilson, Janine Baer

Physical Therapy Faculty Publications

The objective of this study was to determine the association between dietary intake of fats, waist to hip ratio (WHR), body mass index (BMI), and blood lipoproteins and total cholesterol (TC) using food frequency data in one group of apparently healthy, urban African American women and their daughters (n = 110). Subjects were fasted when blood was drawn, waist and hip circumferences and body weight and height were measured, and WHR and BMI were calculated.

Average daily total fat intakes were 91.46 g and 77.83 g for mothers and daughters, respectively, but average LDL levels of 104.4 g/L and 103.1 …

The Fate Of The Unexpected Positive Intraoperative Cultures After Revision Total Knee Arthroplasty, Robert L. Barrack, Ajay Aggarwal, R. Stephen J. Burnett, John C. Clohisy, Elie Ghanem, Peter Sharkey, Javad Parvizi

Department of Orthopaedic Surgery Faculty Papers

Of a consecutive series of 692 revision total knees at 3 centers, intraoperative cultures were unexpectedly found to be positive in 41 cases (5.9%). Of the 41, 29 (71%) cases had a single positive intraoperative culture and were determined to be a probable false positive based on absence of any other evidence of infection, of which 5 were treated with extended course of intravenous antibiotics after hospital discharge and the remaining 24 received no further treatment. None of these 24 patients manifested any sign of infection at follow-up, averaging 46 months (range, 24-74 months). Twelve patients were determined to have …

Understanding The Relationship Between The Emotional Competence Inventory - University Edition And The Myers-Briggs Type Indicator In The Admission Of College Students To An Orthopaedics-Based Honors Program, Carrie A. Yocum

Dissertations

Problem

The Orthopaedic Scholar Institute (OSI) Team realized its need for a more objective selection and admission process that, as much as possible, quantified the characteristics desired in OSI students rather than relying solely on referral perception, intuition, and an interview, but it did not have a clear method or approach to do so. Administering standardized inventories that highlighted these desired characteristics and aided in the selection and admission process seemed to be an objective approach to obtain more quantifiable data. The problem for my study was, therefore, whether the Myers- Briggs Type Indicator (MBTI) alone could measure a student’s …

A Hypothesis-Oriented Algorithm For Symptom-Based Diagnosis By Physical Therapists: Description And Case Series, Courtney D. Few, Todd E. Davenport, Hugh G. Watts

School of Pharmacy Faculty Articles

Study Design: Case series.

Subjects: Two patients referred to physical therapy with a diagnosis of lower back pain (LBP).

Background: The increasing role of physical therapists in primary care settings highlights the skills needed to determine the appropriateness of physical therapy for patients. A hypothesis-oriented algorithm for symptom-based diagnosis was developed for use by physical therapists. The goal of this process is to determine a diagnostic impression to guide decisions regarding patient disposition and physical therapist management. This case series demonstrates the process in two individuals with LBP referred to a community-based outpatient physical therapy clinic.

Diagnosis: Despite the fact …

Recurrent Burner Syndrome Due To Presumed Cervical Spine Osteoblastoma In A Collision Sport Athlete - A Case Report., Ilan Elias, Michael A Pahl, Adam C Zoga, Maurice L Goins, Alexander R Vaccaro

Department of Orthopaedic Surgery Faculty Papers

We present a case of a 35-year-old active rugby player presenting with a history of recurrent burner syndrome thought secondary to an osteoblastoma involving the posterior arch of the atlas. Radiographically, the lesion had features typical for a large osteoid osteoma or osteoblastoma, including osseous expansion, peripheral sclerosis and bony hypertrophy, internal lucency, and even suggestion of a central nidus. The patient subsequently underwent an en bloc resection of the posterior atlas via a standard posterior approach. The surgery revealed very good clinical results. In this report, we will discuss in detail, the presentation, treatment, and return to play recommendations …

The Sub-Axial Cervical Spine Injury Classification System (Slic): A Novel Approach To Recognize The Importance Of Morphology, Neurology And Integrity Of The Disco-Ligamentous Complex, Alexander R. Vaccaro, R. John Hulbert, Charles Fisher, Marcel Dvorak, Alpesh A. Patel, Ronald A. Lehman Jr., Paul Anderson, James Harrop, F. C. Oner, Paul Arnold, Michael Fehlings, Rune Hedlund, Ignacio Madrazo, Glenn Rechtine, Bizhan Aarabi, Mike Shainline, Spine Trauma Study Group

Department of Orthopaedic Surgery Faculty Papers

Abstract Background Context Despite technological advances in spine surgery, classification of sub-axial cervical spine injuries remains largely descriptive, lacking standardization and any relationship to prognosis or clinical decision making. Purpose The primary purpose of this paper is to define a classification system for sub-axial cervical spine trauma that conveys information about injury pattern and severity as well as treatment considerations and prognosis. The proposed system is designed to be both comprehensive and easy to use. The secondary objective is to evaluate the classification system in the basic principles of classification construction, namely reliability and validity. Study Design/Setting Derivation of the …

Treatment Of Spinal Tuberculosis: Role Of Surgical Intervention, Ather Enam, Ahmed Ali Shah

Section of Neurosurgery

The treatment of tuberculosis of the spine (Pott's disease) is essentially conservative and a vast majority of patients can be successfully managed on antituberculo us therapy (ATT) alone.1 Surgery is indicated in a few specific cases where deformity of spine, pain, or neurological compromise is becoming a serious issue. In cases where surgery is indicated the benefits are almost immediate and excellent. Tuberculosis (TB) is one of the leading causes of infectious disease-related deaths in under-developed countries and it has had a resurgence in developed countries as well. The most common site of bony dissemination of this disease is in …

Surgical Correction Of Severe Bilateral Thumb Pincer-Nail Deformity, Scott T. Van Duzer, John S. Taras

Department of Orthopaedic Surgery Faculty Papers

A 53 year old woman presented to the office with complaint of severe bilateral thumb nail pain and the deformity shown (Figure 1). She denied previous trauma to her thumb nails and had no history of previous bacterial or fungal infections of her nails. Based on the curvature of her nails, which increased from proximal to distal, a diagnosis of bilateral thumb pincer nail deformity was made.

Berneese Periacetabular Osteotomy For Residual Hip Dysplasia In Adults - A Case Report And Review Of Literature, Izhar Kashif, Masood Umer, Haroon Rashid

Department of Surgery Docs

Abstract

Pelvic osteotomy for acetabular dysplasia has been introduced to improve acetabular coverage of the femoral head and reduce the risk of secondary osteoarthrosis. Several surgical methods for acetabular reorientation have been proposed for this purpose by reorientation of the acetabulum single, double, triple, spherical and periacetabular osteotomies. We report our first experience with periacetabulur berneese osteotomy described by Prof. R. Ganz and now the procedure of choice in appropriately selected patients. Fifteen years old boy who presented with complaints of fall and pain in the right gluteal region for 5 days duration that increased with walking. Examination revealed an …

The Impact Of Four Common Lumbar Spine Diagnoses Upon Overall Health Status, Michael A. Pahl, Brian Brislin, Scott Boden, Alan S. Hilibrand, Alexander Vaccaro, Brett Hanscom, Todd J. Albert

Department of Orthopaedic Surgery Faculty Papers

Background Context: The SF-36 health survey has been shown to be a valid instrument when used to measure the self-reported physical and mental health of patients. The impact of lumbar spinal disorders can be assessed as the difference between the SF-36 scale scores and age-and-gender specific population norms.

Purpose: To establish the impact upon the self-reported health status of patients with one of four common lumbar spinal diagnoses.

Study Design: A cross-sectional, observational assessment of the health status of spine patients.

Methods: Data from patients presenting to the participating centers of the National Spine Network with low back pain and/or …

Surgical Decision Making For Unstable Thoracolumbar Spine Injuries: Results Of A Consensus Panel Review By The Spine Trauma Study Group, Alexander R. Vaccaro, Moe R. Lim, R. John Hurlbert, Ronald A. Lehman, James Harrop, D. Charles Fisher, Marcel Dvorak, D. Greg Anderson, Steven C. Zeiller, Joon Y. Lee, Michael G. Fehlings, F. C. Oner, Spine Trauma Study Group

Department of Orthopaedic Surgery Faculty Papers

Objectives: The optimal surgical approach and treatment of unstable thoracolumbar spine injuries are poorly defined owing to a lack of widely accepted level I clinical literature. This lack of evidence based standards has led to varied practice patterns based on individual surgeon preferences. The purpose of this study was to survey the leaders in the field of spine trauma to define the major characteristics of thoracolumbar injuries that influence their surgical decision making. In the absence of good scientific data, expert consensus opinions may provide surgeons with a practical framework to guide therapy and to conduct future research.

Methods: A …

Prophylaxis Of Dvt With Enoxaparin In Patients Undergoing Total Knee Replacement, Abid Ullah Khan Niazi, Masood Umer, Mohammad Umar

Section of Orthopaedic Surgery

Objective: To evaluate the efficacy and safety of the low molecular weight heparin as prophylaxis against thromboembolism following total knee replacement surgery.
Methods: Post-operative bilateral lower extremity colour duplex scan was performed on 55 patients subjected to total knew arthroplasty. The scan was performed 7 days after surgery for detection of DVT. All patients were given Enoxaparin 40mg subcutaneous daily for 2 weeks as prophylaxis against DVT.
Results: Two patients were diagnosed as DVT by color duplex scanning and both were distal but only one was asymptomatic. Another patient developed pulmonary embolism and died subsequently. The major and minor wound …

Cutting Rate Effect On Temperature During Cortical Bone Sawing, Hamid Khalili Parsa, Ger Reilly, Brendan Mccormack

Conference Papers

When bone is cut the occurrence of thermal damage to the bone is of major concern to the surgeon. If the temperature exceeds 44°C for longer than 1 min, bone repair is impaired (Eriksson et al, 1984) and necrosis may occur. Repeated use of cutting blades may reduce the cutting efficiency (Wevers et al, 1987; Toksvig-Larsen et al, 1992). Wevers et al also found that there is a greater force required to cut cortical bone using a blunt saw compared to new one.

Restoration Of Glenohumeral Motion In Erb's Palsy By Tendon Transfers, Syed Kamran Ahmed, Pervaiz Mehmood Hashmi

Section of Orthopaedic Surgery

Background: Children with erb's palsy have significant functional disability, mainly related to the shoulder. The objective of this study was to analyze the functional outcome of tendon transfers performed for restoration of shoulder motion in patients with Erb's palsy.
Methods: This descriptive case series was conducted at Aga Khan University Hospital from May 1999 to December 2003. Ten patients who had functional deficit of shoulder elevation were operated by a single surgeon. The surgical procedure; modified Sever L'Episcopo procedure was uniform in all cases. The data was collected through patient interviewing and medical records maintained through Health Information Management System …

Fixation Of Bilateral Pelvic Osteotomies With External Fixator In Exstrophy Bladder Complex, Salman Riaz, Shahbaz Sarwar, Masood Umer

Department of Surgery Docs

Abstract

OBJECTIVE:

To present the early results of pelvic osteotomies performed for repair of exstrophy bladder.

METHODS:

Five cases of exstrophy bladder were treated with closure following bilateral iliac osteotomies. Three patients underwent closure of pubic symphysis diastasis by use of external fixator, one by screws and cerclage wires, and one by use of K-wires and suture. The patients were followed up by the pediatric urologist and orthopedic surgeon.

RESULTS:

All patients achieved a closure of diastasis and a tension free repair after the index surgery. The average follow-up was 3.6 years with range of 4 months to 6 years. …

Posterior Longitudinal Ligament Status In Cervical Spine Bilateral Facet Dislocations, John A. Carrino, Geoffrey L. Manton, William B. Morrison, Alex R. Vaccaro, Mark E. Schweitzer, Adam E. Flanders

Department of Orthopaedic Surgery Faculty Papers

Objective: It is generally accepted that cervical spine bilateral facet dislocation results in complete disruption of the posterior longitudinal ligament. The goal of this study was to evaluate the integrity of numerous spine-stabilizing structures by MRI, and to determine if any associations between injury patterns exist with respect to the posterior longitudinal ligament status.

Design: Retrospective case series.

Patients: A retrospective review was performed of 30 cervical spine injury subjects with bilateral facet dislocation. Assessment of 1.5T MRI images was carried out for: intervertebral disc disruption, facet fracture, and ligamentous disruption. Statistical analyses were performed to evaluate for associations between …

An Experimental Technique For Measurement Of Heat Generated During Bone Sawing, Hamid Khalili Parsa, Ger Reilly, Brendan Mccormack

Conference Papers

Orthopaedic bone cutting processes such as osteotomy and hip arthroplasty involve the cutting of one with the aid of various manual and powered cutting instruments including manual and powered bone saws. The extent of surgically induced bone necrosis at the point of the cutting tool and the bone is mainly due to the frictional heat generated by bone cutting. Bone necrosis has an impact on bone regeneration, and the rate of healing of the bone post operation. The threshold temperature for impaired regeneration of bone is in the range of 44°C to 47°C. Overheating also affects the sharpness life of …

Suicidal Bus Bombing Of French Nationals In Pakistan: Physical Injuries And Management Of Survivors, Hasnain Zafar, Rifat Rehmani, Tabish Chawla, Masood Umer, Mohsin-E-Azam

Department of Surgery Docs

Abstract

BACKGROUND:

Suicidal bombing is particularly devastating and an increasingly common form of terrorist violence. In this paper, we present an epidemiologic description of the physical injuries of patients who survived the suicidal bombing attack in the context of the limited medical resources of a developing nation.

METHODS:

The management of individual patients was reviewed from a preprinted trauma form. Information on the nature of injuries, operative management and hospital course was recorded and data analyzed using the Trauma Registry.

RESULTS:

Twelve survivors out of 36 bomb blast victims brought to the Aga Khan University Hospital were transferred from primary …

Sequential Labelling And Acoustic Emission Analysis Of Damage Occurring In Cortical Bone During Indentation Cutting, Ger Reilly, Ashkan Safari, David Taylor, Brendan Mccormack

Conference Papers

When a surgeon uses a wedge shaped blade or an osteotome to cut cortical bone during an operative procedure the bone will fail by a process of microcracking and primary crack propagation. It has previously been observed that crack propagation is dependent on the direction of cutting relative to the main axis of the bone. It has also been observed that microcracks occurring during fracture release acoustic signals that facilitate real-time monitoring of a cutting process. In these novel studies, we labelled damage accumulation during cutting of cortical bone using sequential chelating dyes and we correlated recorded AE signals during …