Medical Specialties Commons^™

Symptomatic Manifestations Of Hip Dysplasia In Young Adults: How Do Patients Present Before And After Surgery?, John M. Gaddis, Amanda Wheeler, Yossef Alsabawi, Erika Shults, Charles South, Joel E. Wells

Research Symposium

Background: Hip dysplasia is a common source of hip pain in young adults that can lead to early-onset osteoarthritis. The Bernese periacetabular osteotomy (PAO) and total hip arthroplasty (THA) have shown good results as surgical treatment options for this disorder, yet pain may persist after surgery. A previous study described the clinical features of pre-treated hip dysplasia in a traditional clinical cohort; however, to our knowledge, no previous studies have examined the symptomatic manifestations of hip dysplasia in young adults before and after various surgical treatments including the analysis of pain locations in numerous anatomical areas through a body pain …

Metallosis And An Adverse Reaction To Metal Debris Following Dislocation Of A Metal-On-Metal Hip Arthroplasty: A Case Report, John M. Gaddis, Amanda Wheeler, Bretton Laboret, Joel Wells

Research Symposium

Background: Primary total hip arthroplasties have a reported survivorship exceeding 95% at 10-year data. Metal-on-metal bearing surfaces were introduced to minimize wear rate for patients undergoing THA, however, long-term data has shown an unacceptably high failure rate requiring THA revision. The metal-on-metal implants can lead to failure with the generation of the metal ions, specifically cobalt and chromium. The rise in levels of these metal ions can result in adverse reaction to metal debris (ARMD) which can consist of macroscopic necrosis, corrosive osteolysis, sterile hip effusions, and pseudotumor. There are no specific clinical signs or symptoms indicating metallosis, rather, diagnosis …

Assessing The Accuracy And Readability Of Chatgpt 4.0’S Responses To Common Patient Questions Regarding Periacetabular Osteotomy (Pao), John M. Gaddis, Elias Arellano, Yossef Alsabawi, Pablo Castaneda, Joel Wells

Research Symposium

Aims: The study aimed to evaluate the accuracy, comprehensiveness, and readability of responses generated by ChatGPT 4.0 to 30 common patient questions about the Bernese Periacetabular Osteotomy (PAO).

Methods: Two fellowship-trained orthopaedic surgeons specializing in hip preservation selected thirty questions from a prior study identifying common PAO questions on social media. Each question was entered into ChatGPT 4.0, and the surgeons independently graded responses. Responses were evaluated using an established grading system: “excellent,” “satisfactory requiring minimal clarification,” “satisfactory requiring moderate clarification,” or “unsatisfactory.” Accuracy and comprehensiveness were assessed based on the concordance of response content with current literature. Readability was …

Staged Reconstruction And Salvage Of 5th Finger With Corticocancellous Distal Radius Autograft: A Case Report, Emmanuel Franco, Zayd Ayas, Frank Gerold

Research Symposium

Background: Finger reconstruction in the aftermath of severe trauma poses significant challenges in restorative surgery, particularly when addressing extensive soft tissue damage, comminuted fractures, and simultaneous neurovascular complications. This study presents a case of a patient with a complicated distal phalangeal fracture that pursued digit salvage.

Case Presentation: Patient is a 31-year-old woman who sustained a severe injury to her right 5th digit during an ATV rollover. The trauma resulted in an exposed and comminuted fracture of the proximal phalanx with associated loss of soft tissues, flexor tendon, radial nerve injury, and vascular compromise. She elected to pursue digit salvage …

Intraoperative Imaging In Orthopedic Settings: An Assessment Of Changes In Adherence To Imaging Guidelines, Emmanuel Franco, Tabitha Abraham, Zayd Ayas, Frank Gerold

Research Symposium

Background: High-quality intraoperative photography is vital for treatment planning, patient counseling, and surgical education. Inconsistencies in image quality are prevalent in orthopedic literature due to the absence of formalized criteria specific to orthopedic settings. In 2014, "Medical Photography: Principles for Orthopedics" introduced guidelines intending to standardize protocols for capturing clinical images. By comparing the quality of images taken both before and after these proposed guidelines, this project aims to evaluate whether this has influenced a trend toward standardization and consistency in intraoperative orthopedic photography.

Methods: To assess quality differences in orthopedic images before and after the 2014 guidelines, 60 intraoperative …

Impact Of Diabetes On Fall Related Lower Limb Fractures, Bryce M. Bellon, Daniel Salinas, Patrick De La Torre Shutz, Hunter Butler, Sean Corcoran, Kelsey Baker

Research Symposium

Background: Diabetes is a disorder that affects many Americans, characterized primarily by hyperglycemia due to either insulin resistance or lack of insulin secretion. This condition not only impacts blood sugar levels but also has significant effects on bone health. In diabetes, bone density is often decreased due to reduced osteoblast activity, which is responsible for bone formation, and increased osteoclast activity, which leads to bone resorption. This imbalance accelerates the breakdown of bone. Additionally, diabetics frequently suffer from lower extremity arterial disease (LEAD), which results in poor vascularization of the lower limbs. These factors contribute to an increased risk of …

Various Bone Disorders Affecting The Rio Grande Valley, Blake C. Martin, Justin Z. Heckman, Manoj Peiris

Research Symposium

Background: The underserved community that is the Rio Grande Valley (RGV), has a distinct demographic profile, with a high prevalence of chronic conditions such as diabetes and obesity, that warrants investigation of various health issues. The main objective of our study was to analyze the demographic disparities between osteoporosis, osteomalacia, rickets, Paget bone disease, and osteonecrosis in the RGV. We hypothesized that the frequency of osteoporosis would be the most common bone condition (of those analyzed) in the Rio Grande Valley and that the demographics between the various bone conditions would vary depending on age, sex, BMI, and ethnicity …

Joint Involvement In A Psoriasis Affected Population In A Medically Underrepresented Region, Blake C. Martin, Jared Hensley, Manoj Peiris

Research Symposium

Background: Psoriatic arthritis is an aggressive condition that may be characterized by compromised quality of life and significant morbidity. The prevalence of psoriatic arthritis in patients with psoriasis is around 1.7% at 5 years, 3.1% at 10 years, 5.1% at 20 years, and 20.5% at 30 years which shows an increase in joint involvement with increasing age, at least until the age of 30. The objective of this study was to explore joint involvement in psoriatic patients in this region and determine what are the demographic disparities in Psoriatic patients regarding joint involvement. We hypothesized that individuals with psoriasis between …

Gout Versus Pseudogout In The Medically Underserved Rio Grande Valley, Blake C. Martin, Fernando Cisneros, Kristina Vatcheva

Research Symposium

Background: Gout and pseudogout are inflammatory joint conditions, with gout being one of the most prevalent etiologies of chronic inflammatory arthritis in the United States. The patient population in the Rio Grande Valley (RGV) has a distinct demographic profile that warrants exploration of various health conditions. The primary objective of this study is to compare the frequencies of gout and pseudogout in the Rio Grande Valley to national frequencies and determine if there were demographic disparities between Gout and Pseudogout in this community. We hypothesized that the frequency gout and pseudogout would be higher in the RGV compared to the …

Demographic And Clinical Characterization Of Bone Metastases And Primary Malignant Bone Neoplasia In The Rio Grande Valley, Blake C. Martin, Neharika Penmetcha, Aun Bangash, Juan Lopez Alvarenga

Research Symposium

Background: The Rio Grande Valley (RGV) is a developing clinical research region characterized by its distinctive demographic profile that offers an opportunity to investigate diverse health issues. This pilot investigation seeks to identify the characteristics of patients diagnosed with bone metastasis and primary malignant bone neoplasia (PMBN) in the RGV. The main objective was to evaluate the demographic and clinical characteristics linked to bone metastases and PMBN in patients from the Rio Grande Valley. We hypothesized that older age and higher BMI individuals would have greater frequency of metastatic lesions compared to PMBN.

Methods: Data was gathered from the …

Demographic And Clinical Characteristics Of Patients With Benign Bone Tumors: Evidence Of Bimodal Age Distribution In A Hispanic Population, Blake C. Martin, Mohammad Khalil, Juan Lopez Alvarenga

Research Symposium

Background: As far as researchers know, there’s no way to prevent BBTs from forming. Although these tumors generally do not metastasize, they can still be dangerous as they may grow and compress healthy tissues and lead to poor outcomes. The principal objective was to evaluate the demographic and clinical characteristics linked to BBTs in individuals from the Rio Grande Valley. We hypothesized that older age, males, and higher BMI individuals would have greater frequency of BBTs.

Methods: This was a retrospective chart review and IRB approval was obtained prior to starting this study. We obtained medical charts for individuals who …

Characterizing Fracture Distribution By Sex, Age, And Body Region: Insights From A Regional Population Study, Blake C. Martin, Jared Hensley, Juan Lopez Alvarenga

Research Symposium

Background: This Rio Grande Valley (RGV) region of South Texas is a unique region that is impoverished and medically underserved. We conducted this study in order to further the knowledge of orthopedics in this unique, medically underserved community. We sought to determine if certain body regions, based on sex and age, were at increased risk for fracture in this population. We hypothesized that females would have increased fracture frequency at older ages while males would have increased fracture frequency at all other ages. We also hypothesized that femur and forearm fractures would be increased in females compared to males.

Methods …

Bone And Joint Infections: A Retrospective Chart Review Of The Medically Underserved Rio Grande Valley, Blake C. Martin, Chloe Harris, Manoj Peiris

Research Symposium

Background: The Rio Grande Valley (RGV) is a demographically unique region that is impoverished and medically underserved. Because of its unique patient population, this community may be at increased risk for bone and joint infections and the morbidity and mortality that follows. The goal of this study was to analyze individuals with osteomyelitis, septic arthritis, and periprosthetic joint infections and determine which infectious bone or joint conditions are most prevalent in the Rio Grande Valley and determine if there were any demographic disparities between the various types of bone and joint infections and healthy individuals. We hypothesized that age and …

Association Of Joint Disease With Demographic Factors In Clinical Populations Of The Rio Grande Valley, Blake C. Martin, Devian D. Baez, Juan C. Lopez-Alvarenga

Research Symposium

Background: The Rio Grande Valley (RGV) is a medically underserved, demographically unique population that warrants the exploration of various conditions, including joint conditions, such as osteoarthritis (OA), rheumatoid arthritis (RA), gout, ankylosing spondylitis (AS), psoriatic arthritis (PA), juvenile idiopathic arthritis (JIA), and septic arthritis (SA). We sought to determine the demographic disparities between the different types of common joint conditions in this community. We hypothesized that OA would follow national trends and be the most common joint condition in the Rio Grande Valley. We hypothesized that the demographics between the various joint conditions would vary depending on age, sex, BMI, …

Gut-Spine Connection: Unexplored Pathways To Improving Outcomes In Spinal Health And Disease, Anesu K. Murambadoro, Julia Saifetiarova, Priya Kale, Victor A. Bob-Yellowe, Paul Bonilla, Aun A. Bangash, Isabella Ortigoza, Anjana Ganesh, Mohammed S. Razzaque

Research Symposium

Introduction: Lumbar spinal fusion is among the most expensive procedures in the Medicare system, with costs exceeding $33 billion annually. Improving recovery outcomes for these procedures is critical, and emerging research suggests that microbiome-targeted therapies could play a key role. There is growing evidence linking spinal health with gut microbiota alterations, particularly through the gut-spine axis, which involves the gut-disc, gut-bone, and gut-immune interactions. This bidirectional relationship between gut microbiota and spinal health offers a novel approach for understanding recovery mechanisms. Additionally, magnesium deficiency, which is prevalent, may exacerbate both gut dysbiosis and poor bone health, contributing to chronic skeletal …

Evaluating Industry Relationships And Transparency: Insights From Orthopedic Surgeons In The Cms Open Payments Database, Anesu K. Murambadoro, Mario Keko, Edward Rodriguez, John J. Wixted

Research Symposium

Introduction: Industry payments to physicians may risk introducing bias into patient care. The Open Payments (OP) database, established by Physician Payments Sunshine Act, reports these payments to promote transparency. Orthopedic surgeons receive the highest industry payments especially in the category of royalties/licensing, prompting questions about conflicts of interest and whether the database accurately reflects the status across the specialty. We hypothesize that the OP database underrepresents the relationships that orthopedic surgeons have with industry. We seek to assess the validity of reported industry payments, particularly in the categories of royalties and licensing payments to determine how to improve transparency and …

Spine Surgery In South Texas: The Impact Of Rurality On Surgeon Demographics And Access To Care, Anesu K. Murambadoro, Kevin Garcia Valdez, Patrick De La Torre Schutz, Allison J. Mcadams, Anjali Rose Binoy, Kelsey Baker

Research Symposium

Introduction: Female representation in spine surgery remains low, with only 4% of orthopedic spine surgeons and 9% of neurosurgeons identifying as female. Studies have shown that factors such as societal perceptions, limited support for family planning, and a lack of mentorship deter women from pursuing surgical careers. We hypothesize that representation may be further impacted in US-Border regions. Specifically, over 90% of Texas' 32 border counties lack sufficient primary care services, including specialty care such as orthopedic surgery and neurosurgery, leading residents to seek care outside the region. Here, we sought to evaluate the demographics of spine surgeons (orthopedic and …

Space Flight Missions Over 6 Months Significantly Increase The Risk Of Shoulder Pathology And Rotator Cuff Tears, Benjamin Fiedler, Meghana Jami, Srikhar V Chilukuri, Abdullah Ghali, Todd Phillips, Adil Shahzad Ahmed

Faculty, Staff and Students Publications

Background: The purpose of this study was to determine risk of shoulder injury in astronauts returning from space flight and highlight the need for further exploration of risk factors and preventative strategies.

Methods: Using The Lifetime Surveillance of Astronaut Health epidemiology database at National Aeronautics and Space Administration, a retrospective cohort study was conducted to assess the effect of space flight mission duration on rate of shoulder injury among astronauts. Inclusion criteria were all astronauts who participated in space flight regardless of age or space flight mission time. Exclusion criteria were all injuries occurring greater than 5 years following return …

Which Systemic Responses Should We Evolve To Help Surgeons Navigate Their Regret Experiences?, Ryan X Lam, Ruhi Thapar, Eric J Silberfein, Lorenzo R Deveza

Faculty, Staff and Students Publications

Regret in surgical practice is typically construed as resulting from the commission or the omission of a specific action at a specific decision point, which leads to a deleterious outcome. This article suggests a need to expand this conception of surgical regret to better account for surgeons' regret experiences arising from factors beyond their control. The commentary accompanying the case investigates these external sources of regret, such as resource limitations or professional interpersonal dynamics that prevent a desired outcome from being realized. It also discusses the normative value of addressing surgeons' experiences of regret, especially as a catalyst to facilitate …

Evaluating Dysphagia Duration And Severity After Acdf In Patients With Underlying Dysphagia - A Prospective, Multicenter Study, Aditya Mazmudar, Taylor Paziuk, Khoa Tran, Tyler Henry, Samuel Oh, Caroline Purtill, Daniel Habbal, Goutham Yalla, Quinlin Harrill, Brandon Sherrod, Erica Bisson, Darrel Brodke, Christopher Kepler, Gregory Schroeder, Alex Vaccaro, Alan Hilibrand, Jeffrey Rihn

Department of Orthopaedic Surgery Faculty Papers

STUDY DESIGN: Prospective Cohort Study.

OBJECTIVES: The purpose of this study was to prospectively evaluate the impact of preoperative dysphagia on the postoperative incidence and severity of dysphagia in patients undergoing ACDF at multiple institutions.

METHODS: After IRB approval, patients over 18 years of age who underwent an elective ACDF for degenerative conditions were prospectively enrolled at two academic centers from 2018 to 2021. Preoperative dysphagia was self-reported by patients through a pre-operative questionnaire on a binary basis. Patients completed dysphagia surveys (Bazaz, Dysphagia Short Questionnaire, 10-item Eating Assessment Tool) to assess dysphagia severity during their preoperative visit, and these …

Early Diet Liberalization After Anterior Lumbar Interbody Fusion Improves Postoperative Recovery, Tiffany Bridges, Matthew Meade, Parker L. Brush, Yunsoo Lee, Rajkishen Narayanan, Michael A. Mccurdy, Mark J. Lambrechts, Alex Charlton, Eleanor Jenkins, Robert Juniewicz, Henson Destine, I. David Kaye, Mark Kurd, Jose A. Canseco, Alan S. Hilibrand, Alex R. Vaccaro, Gregory D. Schroeder, Christopher K. Kepler

Department of Orthopaedic Surgery Faculty Papers

STUDY DESIGN: Retrospective Cohort Study.

OBJECTIVES: The objective of this study was to assess the impact of diet liberalization on short-term outcomes in patients undergoing anterior interbody lumbar fusion (ALIF).

METHODS: A retrospective review was performed for patients undergoing ALIF at our tertiary care center institution from 2010 to 2022. Electronic medical records were reviewed for demographics, surgical characteristics, and 90-day postoperative outcomes.

RESULTS: We included 515 patients in this study with 102 patients receiving a full diet on the same day as their operation. All other patients had a delay of at least 1 day (average 1.6 days) until …

An Update In Complication Rates Associated With Anterior Lumbar Surgery: A Systematic Review And Meta-Analysis, Tariq Z Issa, Teeto Ezeonu, Mason Sellig, Chester J Donnally, Rajkishen Narayanan, Brian A Karamian, Parthik D Patel, Srikanth N Divi, William A Robinson, Kartik Shenoy, Christopher K Kepler, Alexander R Vaccaro, Jose A Canseco

Department of Orthopaedic Surgery Faculty Papers

STUDY DESIGN: Systematic Review and meta-analysis.

OBJECTIVE: To conduct an updated systematic review and meta-analysis of complications associated with different anterior fusion techniques/approaches and adjuvant resources (i.e., computed tomography angiography (CTA), rhBMP-2, and access surgeons).

METHODS: A systematic review was conducted from 1/1/2014-4/1/2024 for studies evaluating the incidence of complications associated with anterior lumbar procedures. Comparisons of complications were made between surgical approach, use of CTA, rhBMP-2, and access surgeons. Meta-analyses were conducted using a generalized linear mixed model.

RESULTS: 54 studies were included in the final analysis with 8066 patients and an average follow-up of 31.2 months. The overall …

Can Oral Caffeine Decrease Postoperative Opioid Consumption Following Posterior Spinal Fusion In Adolescent Idiopathic Scoliosis? A Randomized Placebo-Controlled Trial., Anne E. Stuedemann, Richard M. Schwend, K Aaron Shaw, Nicolette Saddler, Michon Huston, Michael Benvenuti, Julia Leamon, Ashley K. Sherman, John Anderson

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: Current studies have examined the efficacy of opioid-sparing analgesics primarily in adult surgical populations, while fewer guide pediatric postoperative pain treatment. Caffeine exerts most of its biological effects by binding to adenosine receptors, which are important for modifying pain and inflammation. Caffeine's ability to modulate pain following posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS) has not been previously assessed.

METHODS: The hospital investigational drug study (IDS) pharmacy provided either a treatment dose or placebo dose of caffeine to be given to the patient and was also in charge of randomization for the study.

RESULTS: There were 24 …

Ultrasound-Triggered Release Of Vancomycin From A Novel Spinal Device: Antibiotic Release And Efficacy In Vivo, Lauren J. Delaney, Priscilla Machado, Ji-Bin Liu, Rachel Evans, Asia Winslow, Neil Zhao, Christopher K. Kepler, Rajkishen Narayanan, Teeto Ezeonu, Viren Soni, Gagan Kaushal, Rachel Hilliard, Thomas P. Schaer, Noreen J. Hickok, Flemming Forsberg

Department of Orthopaedic Surgery Faculty Papers

Post-surgical spinal infection occurs in up to 20 % of patients, despite aggressive peri-operative antibiotic treatments. To improve prophylaxis, we have designed and evaluated an ultrasound-activated prophylactic antibiotic release system to combat post-surgical bacterial survival. Polylactic acid (PLA) clips (1 cm³) were 3D-printed with an interior reservoir (0.8 cm³) for carrying drug payload, specifically vancomycin (VAN). Under IACUC approval, clips were surgically implanted into the spines of sheep (n = 9) and swine (n = 2) by removing the spinous process at several levels of the lumbar spine. In the sheep, clips were insonated and the …

A Narrative Review Of Barriers To Utilization Of Surgical Risk Assessment Calculators, Jacob Lahti, Kaiya A. Noe, Abigail Veenstra, Sarah Gallitto, Victoria I. De Leon, Thomas C. Varkey, Nimit Agarwal

Annual Research Symposium

Over the last several decades, it has become the desire of surgical and medical teams to decrease risk levels involved for patients undergoing surgery. However, despite the advent of risk assessment calculators to help physicians obtain more accurate and objective judgements for postoperative complications, these tools are underutilized in standard clinical practices in comparison to other methods of risk assessment. This is likely due at least in part to certain barriers that decrease their functionality and ease of use. This review discusses the major barriers to the utilization of current risk calculators so as to allow for a better understanding …

Role Of Psychiatric Factors Hindering Physical Rehabilitation After Acl Reconstructive Surgery, Malak Rafik, Davian Caraballo, James Fini Jr., Nathan Barnhurst

Annual Research Symposium

No abstract provided.

A Systematic Review Of Recent Developments In Platelet-Rich Plasma Therapy In Hip Osteoarthritis: Variability In Protocols And Clinical Outcomes (2019–2024), Emily Awdish, Marlena Muszynska, Konrad Lautenschlager, Ali Hamade

Annual Research Symposium

No abstract provided.

Surgical Repair Of An Atypical Midsubstance Distal Biceps Tendon Partial Tear: A Case Report, Michael M. Valenzuela, Genoveffa R. Morway, Christopher M. Jones

Department of Orthopaedic Surgery Faculty Papers

No abstract provided.

Subtalar Dislocation With Isolated Talonavicular Dislocation – A Unique Case, Yaser J. Rahim, Naveen J. Pattisapu, Maxwell C. Alley

The Lahey Journal

Subtalar joint dislocations are infrequent injuries of the foot involving interruption of the articulations in the subtalar joint complex. These injuries involve dislocation of the talocalcaneal and talonavicular joints simultaneously with or without associated fractures. Subtalar joint dislocations are classified as medial or lateral, with medial dislocations occurring more commonly. Medial subtalar dislocations are generally not associated with other injuries whereas lateral subtalar dislocations are more frequently accompanied by fractures of talus, calcaneus or navicular. Prompt recognition of this dislocation and other injuries prevent negative sequelae associated with delayed treatment, and patients typically have a good outcome and return to …

Early Surgical Decompression For The Treatment Of Hourglass-Like Constriction Of The Posterior Interosseus Nerve, Nathan Redlich, Matan Ozery, Adam Haydel, Charles Cush, Rasheed Ahmad

School of Medicine Faculty Publications

Posterior interosseous nerve (PIN) syndrome refers to a rare compressive neuropathy of the PIN resulting in motor dysfunction of the forearm extensor compartment. Often, surgical exploration will reveal extrinsic structures that mechanically compress the nerve. Less frequently, PIN syndrome has been reported with a visible hourglass-like constriction and no identifiable causative adjacent structures. In our report, we describe an adolescent patient with PIN syndrome and associated hourglass-like constriction of the PIN. For diagnosis, we used physical examination, preoperative imaging, nerve studies, and intraoperative findings. To monitor recovery, we performed serial neurological examinations and documented patient-reported functional outcomes. The patient underwent …