Medical Specialties Commons^™

Pediatric Body Mass Index (Bmi) And Distal Radius Fracture Incidence, Jessica Avila, Tyler Hough, Nikalus Skipp, Amber L. West, Deana Mercer

Western Journal of Orthopaedics

Background: The authors postulate that obesity in children increases the risk of distal radius fracture compared to children who are not obese. Because it is difficult to determine the population at risk, the authors observed the inverse of the rate of obesity in pediatric patients with distal radius fractures in an attempt to determine if there was a difference compared to national data on frequency of obesity in the pediatric population in general. If the rate of obesity was greater in distal radius fractures than the overall population, this would constitute evidence that obesity may increase the risk of distal …

Reverse Palmaris Longus Involving Guyon’S Canal Causing Ulnar Nerve Compression, David Peberdy, Sameer Gujral

Western Journal of Orthopaedics

The authors present a case of reverse palmaris longus muscle (RPLM) with consequential compression of the ulnar nerve within Guyon’s canal. They report clinical findings, investigations, including magnetic resonance imagining and functional assessments, and intraoperative findings. The authors found improved sensory and motor function following excision of RPLM. There are few previous case reports regarding RPLM and concomitant compression of the ulnar nerve within Guyon’s canal.

Rehabilitation Medicine In Rural New Mexico And Beyond, Rebecca A. Dutton

Western Journal of Orthopaedics

No abstract provided.

Outcomes Of Hemiepiphysiodesis For Juvenile Hallux Valgus: A Systematic Review, Karim Gaber, Faran Chaudhry, Ihtisham Ahmad, Emmanuel Olaonipekun, Waleed Kishta

Western Journal of Orthopaedics

Juvenile hallux valgus (JHV) is a common deformity of the forefoot that may result in significant pain and discomfort. To correct JHV, percutaneous, or minimally invasive surgeries have become more popular than open surgeries due to reductions in morbidity. One of these procedures is percutaneous hemiepiphysiodesis. The aim of this study was to evaluate the efficacy of percutaneous hemiepiphysiodesis for JHV by investigating the available literature on the procedure.

In this systematic review, the authors’ search strategy identified 91 studies, but only five met the inclusion criteria. The identified studies included 76 patients and 132 feet. There was an improvement …

Change In Posterior Tibial Slope And Patellar Height During Medial Opening Wedge High Tibial Osteotomy: A Retrospective Cohort Study, Jessica A. Nelson, Brandon M. Painter, Dustin L. Richter, Jennifer S. Weaver, Robert C. Schenck

Western Journal of Orthopaedics

Background: Medial opening wedge high tibial osteotomy (MOWHTO) may be indicated for patients who have varus alignment, medial knee pain, and medial knee compartment osteoarthritis. Another indication for MOWHTO is in patients with a history of recurrent anterior cruciate ligament (ACL) deficiency or failed ACL reconstruction (ACLR) with varus alignment. Some patients have MOWHTO combined with a primary or revision ACLR.

Methods: This is a retrospective case series that was approved by the Institutional Review Board at the authors’ institution. The purpose of this series is to report on average coronal plane alignment, posterior tibial slope (PTS), and patellar height …

Does Matching Humeral Version In Anatomic Shoulder Arthroplasty Affect Postoperative Range Of Motion? A Pilot Study, Shane Johns, William Curtis, Nicholas Newcomb, Ryan Dahlberg, Christopher Shultz

Western Journal of Orthopaedics

Background: While considerable focus has been given to address glenoid morphology and version in anatomic total shoulder arthroplasty (TSA), there has been little attention paid to the potential impacts of humeral version on postoperative outcomes. The purpose of this study is to assess the impact of matching native humeral version on postoperative range of motion (ROM) after anatomic TSA.

Methods: All anatomic TSAs performed by a single surgeon between September 2021 and June 2023 were retrospectively reviewed. Patients undergoing TSA for fracture and/or revision TSA were excluded. This study group consisted of 20 patients whose native humeral version was measured …

Synovial Fluid Inflammatory Profiles Did Not Differ Between Isolated Anterior Cruciate Ligament And Multi-Ligament Knee Injuries, Cale A. Jacobs, Robert C. Schenck Jr., Leorrie A. Watson, Caitlin E.W. Conley, Darren L. Johnson, Austin V. Stone, Christian Lattermann, Dustin L. Richter

Western Journal of Orthopaedics

Background: Postoperative arthrofibrosis is more common following surgical treatment of multi-ligament knee injury (MLKI) than isolated anterior cruciate ligament (ACL) injury. It has been proposed that the increased prevalence of postoperative arthrofibrosis after MLKIs may be due to increased inflammation secondary to greater trauma to the joint. The purpose of this study was to compare synovial concentrations of pro-inflammatory and anti-inflammatory cytokines between patients with MLKI and ACL injuries.

Methods: Synovial fluid was aspirated from the operative knee at the time of surgery from 14 patients with MLKI and 10 patients with isolated ACL injury. Structures injured, the time between …

Full Issue, Arianna Medina

Western Journal of Orthopaedics

No abstract provided.

Long-Term Success In Managing Midfoot Lateral Column Arthritis: A Case Report, Damian Fountain, Cesar Cardenas, Nicholas Brady, Katherine Gavin, Richard Miller

Western Journal of Orthopaedics

The lateral column of the midfoot is crucial for midfoot mobility and foot stability. Although there are several nonoperative treatment options for arthritis that is isolated to the lateral column cuboid-metatarsal joints, there is a lack of consensus on the best operative intervention, given the rare nature of the disease. The patient in this case initially presented to clinic in 2007 with a significant history of lateral midfoot pain in the fourth and fifth metatarsal cuboid region. Despite nonoperative interventions, her symptoms progressed, and in January of 2009, she elected to undergo interpositional arthroplasty of left fourth and fifth metatarsal …

Isolated Rotational Dislocation Of The Talus: A Case Report, Tomas Holy, Nicholas Newcomb, Devin Maez, Christopher Paiz, Samer Kakish

Western Journal of Orthopaedics

A 46-year-old man sustained a closed pantalar dislocation in a high-speed motor vehicle ejection. The patient underwent closed reduction and splinting with subsequent open reduction and external fixation to ensure anatomic reduction of the tibiotalar, talonavicular, and subtalar joints, resulting in a pain free ankle with improving range of motion. In an effort to minimize the significantly morbid complications, such as avascular necrosis of the talus and rapid onset post-traumatic arthritis, treatment of closed pantalar dislocations should be performed in an emergent manner to minimize damage to the extensive articular surface and tenuous blood supply to the talus.

Chondroblastoma Of The Calcaneus Treated With Femoral Head Allograft Reconstruction For Subtalar Arthrodesis In A Skeletally Immature Patient: A Case Report, Benjamin B. Blanco, Ryan Dahlberg, David H. Chafey

Western Journal of Orthopaedics

Chondroblastomas are rare, benign, primary bone tumors most seen in men within their second decade of life in the epiphyseal/apophyseal region of long bones. Only a few cases of disease in the calcaneus have been reported previously, with treatment generally involving surgical curettage and local adjuvants. Recurrence rates can be as high as 38.0%, especially in a lesion near the physis or in skeletally immature patients. The authors present the case of a 14-year-old boy with active calcaneal chondroblastoma that was successfully treated with curettage, allograft reconstruction, and subtalar arthrodesis. The patient is now two years postoperative with no evidence …

Why You Should Use The New Ota Open Fracture Classification (Ofc3), Thomas A. Decoster, Meir Marmor

Western Journal of Orthopaedics

Open fracture classification has traditionally used a modified Gustilo Classification (GOFC). There are many recognized problems with the Gustilo classification. The Orthopaedic Trauma Association (OTA) produced an open fracture Classification (OTA OFC) in 2010 to overcome problems with GOFC. However, it has not been widely adapted, partially because there are too many categories. The OTA OFC has proven to be more effective in identifying particular parameters that affect outcome and treatment for open fractures than GOFC. Numerous authors have called for a reconciliation of the two classifications. The OTA Classification Committee has proposed a modification called the OTA OFC3, which …

Comparison Of Helicopter And Ground Interfacility Transport On Time-To-Treatment Of Isolated Open Fractures, Jerry Speight Grimes, Duke Appiah

Western Journal of Orthopaedics

Background: Helicopter emergency medical services have become an integral part of trauma systems. When appropriately utilized, helicopter transport can improve the outcomes of trauma patients. The objective of this study was to determine if helicopter transport for interfacility transfers was effective in reducing time-to-treatment for isolated open fractures in the setting of a rural Level I trauma center. The authors hypothesized that helicopter transportation of isolated open fractures would not reduce time to definitive fixation.

Methods: All patients treated with isolated open fractures over a four-year period at a Level I trauma center were identified. In this study, the authors …

Radiographic Identification And Treatment Prioritization Of Pediatric Elbow Fractures, Hoang M. Nguyen, Bryce Clinger, Casey Slattery, Selina R. Silva, Patrick Bosch

Western Journal of Orthopaedics

Background: Constituting approximately 15.0% of fractures, pediatric elbow fractures often require surgical intervention. Accurate diagnosis in pediatric patients is challenging, demanding proficient radiographic expertise. Initial diagnosis falls to emergency medicine (EM) physicians and pediatricians, who may lack sufficient radiographic training. Previous research by Shrader found a 58.0% accuracy in non-academic EM physicians for pediatric elbow fractures. The purpose of the study is to build on Shrader’s work and assess orthopaedic surgery (OS), pediatric, EM, and residents’ ability to accurately interpret pediatric elbow radiographs.

Methods: OS, EM, and pediatric residents at a Level 1 trauma center in an academic institution examined …

Neuroarthropathy And Workers’ Compensation Denials In Healthcare, Jerry Speight Grimes

Western Journal of Orthopaedics

Background: Neuroarthropathy is a complication of peripheral neuropathy commonly associated with diabetes mellitus. The actual trigger for a neuroarthropathy episode is unknown. If the inciting event occurred at work, causality of neuroarthropathy is difficult to determine.

Methods: In this study, the authors retrospectively reviewed workers’ compensation claims to identify patients with diabetes mellitus, peripheral neuropathy, and neuroarthropathy. The correlation between their health status and claims status was reported. The number of workers’ compensation denials for services already performed were compared between the groups.

Results: Over a five-year period, 412 patients were evaluated in a tertiary foot and ankle clinic with …

Cross-Tasking In Surgery: An Efficient Method To Perform Multiple Tasks In Parallel, Jacob Sanchez, Robert C. Schenck Jr., Lillian J. Schenck, Urvij Modhia, Gehron Treme, Samer Kakish, Deana Mercer, Daniel C. Wascher, Dustin L. Richter

Western Journal of Orthopaedics

Multitasking is defined as the ability to perform more than one task or activity simultaneously, which can be inefficient, unsafe, and should be avoided when applied to surgery. Cross-tasking is a concept where processes can be safely performed in parallel. The authors present cross-tasking as a useful approach to surgical procedural task subsets, timing of parallel tasks, and combining parallel tasks when performing a specific orthopaedic operation. The authors use the examples of an anterior cruciate ligament reconstruction and complex spinal deformity correction to review the pearls and pitfalls of models that manage multiple simultaneous surgical and educational tasks. This …

Back Matter, Arianna Medina

Western Journal of Orthopaedics

No abstract provided.

Front Matter, Arianna Medina

Western Journal of Orthopaedics

No abstract provided.

Construct Length Analysis Of Type B And C Cervical And Thoracolumbar Fractures, Jeremy C. Heard, Mark J. Lambrechts, Yunsoo Lee, Teeto Ezeonu, Delano R. Trenchfield, Nicholas D. D'Antonio, Azra N. Dees, Bright M. Wiafe, John J. Mangan, Jose A. Canseco, Barrett I. Woods, Ian David Kaye, Alan S. Hilibrand, Alex R. Vaccaro, Christopher K. Kepler, Gregory D. Schroeder

Rothman Institute Papers

Objectives:

The purpose of this study is to identify if construct length affects the rate of surgical complications and instrumentation revision following surgical fixation of subaxial and thoracolumbar Type B and C fractures. This study evaluates the effect of ankylosing spondylitis/diffuse idiopathic skeletal hyperostosis (AS/DISH) within this population on outcomes.

Methods:

Retrospective review of 91 cervical and 89 thoracolumbar Type B and C fractures. Groups were divided by construct length for analysis: short-segment (constructs spanning two or less segments adjacent to the fracture) and long-segment (constructs spanning more than two segments adjacent to the vertebral fracture).

Results:

For cervical fractures, …

Optimal Duration Of Physical Therapy Following Total Knee Arthroplasty, Gregory Benes, Zachary Adams, Michael Dubic, Justin David, Claudia Leonardi, Amy Bronstone, Vinod Dasa

School of Medicine Faculty Publications

Aims & Objectives: The purpose of this study was to identify patient characteristics associated with engagement and completion of physical therapy (PT) following total knee arthroplasty (TKA) and examine the relationship between number of PT sessions attended and outcomes during the first 12 weeks after surgery. Methods: Patients underwent unilateral primary TKA by a single surgeon and were advised to complete 17 PT sessions over 6 weeks at a hospital-affiliated facility. Analyses examined predictors of PT engagement (attendance of ≥ 2 sessions) and completion (attendance of 17 ± 1 sessions) within 6 weeks and associations between number of PT sessions …

Opioid Use After In Situ Fixation Of Slipped Capital Femoral Epiphysis, Stephanie Coupal, Colleen Moreland, Jonathan R. Warren, Mckenna C. Noe, Lisa Berglund, Caleb Grote

Research Days

Preliminary results of a prospective single-institution study evaluating opioid use following in situ screw fixation of Slipped Capital Femoral Epiphysis (SCFE) in pediatric patients.

Postoperative Opioid Usage And Disposal Strategies After Arthroscopic Procedures In A Young Cohort: A Prospective Observational Study, William Johns, Emma Johnson, Joseph Brutico, Matthew Sherman, Kevin Freedman, William Emper, John Salvo, Sommer Hammoud

Rothman Institute Papers

BACKGROUND: Although several studies have noted that patients are routinely overprescribed opioids, few have reported usage after arthroscopic surgery.

PURPOSE: To determine opioid consumption and allocation for unused opioids after common arthroscopic surgeries.

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

METHODS: Patients between the ages of 15 and 40 years who were scheduled to undergo anterior cruciate ligament reconstruction (ACLR), labral repair of the hip or shoulder, meniscectomy, or meniscal repair were prospectively enrolled. Patients were prescribed either 5 mg hydrocodone-325 mg acetaminophen or 5 mg oxycodone-325 mg acetaminophen based on surgeon preference. Patients completed a daily opioid usage …

Outcomes Of Toddler’S Fractures After Implementation Of Comprehensive Care Management Protocol With Controlled Ankle (Cam) Boots, Sheena J. Amin Md, Janet K. O'Rear Bsn, Julia Leamon Msn, Olivia R. Pruss Bs, Mckenna C. Noe Bs, Micah K. Sinclair Md, Caleb W. Grote Md, Phd

Research Days

A study comparing skin breakdown complications in patients being treated for toddler's fractures at a single academic medical center before and after implementation of a new management and immobilization protocol involving the use of CAM boots.

Conservative Management Of Medial Femoral Condyle Osteochondritis Dissecans In The Pediatric Knee, Kennedy J. Morey, Brian Harvey, Kennison Adams, El Domingo-Johnson, Angie Vanderpool, Natalie Stork, Donna Pacicca, Brian Lee, Kevin Latz

Research Days

This study investigates the effectiveness of various non-operative treatments for osteochondritis dissecans (OCD) lesions in the medial femoral condyle (MFC) of the knee, a condition commonly affecting pediatric populations. Our project aims to evaluate outcomes such as symptom resolution, return to activity, and the potential for avoiding surgical intervention among patients undergoing different methods of conservative management. Through a retrospective analysis of patients, the study identifies trends in the effectiveness of different conservative treatment methods.

Health Disparities In Slipped Capital Femoral Epiphysis (Scfe) Presentation, Rithika Ginjupalli, George Thomas, Rohit Siddabattula, Richard M. Schwend, Caleb Grote

Research Days

This study identifies various health disparities in SCFE presentations using neighborhood-level determinants COI and ICE in addition to sociodemographic determinants such as race and gender.

Improving Awareness And Utilization Of Safety Net Resources After Extremity Firearm Injury, Colleen M. Moreland, Caleb W. Grote, Richard M. Schwend, Julia G. Harris

Research Days

The orthopaedic surgery department can improve follow-on care for pediatric survivors of extremity firearm injuries by creating and implementing a checklist of defined safety net resources.

Electrical Stimulation Of The Medial Pin After Insertion Is Safe And Effective In Preventing Iatrogenic Ulnar Nerve Neuropraxias In Type Iii Supracondylar Fractures. A Case Series Of 128 Consecutive Patients., Lucas Georger B.A., Mckenna Noe B.S., Richard M. Schwend M.D.

Research Days

This case series explores the safety and efficacy of using a disposable nerve stimulator for intraoperative stimulation of both medial and lateral pins in Gartland type III supracondylar humerus fractures, revealing no instances of ulnar nerve stimulation response or postoperative iatrogenic ulnar nerve injury, thereby highlighting the potential for this cost-effective approach to ensure stable medial column pin fixation without ulnar nerve complications.

Safety And Efficacy Of Intraoperative Vectored Traction With Gardner-Wells (Gw) Tongs For Pediatric Spine Deformity Surgery - A Series Of 1000 Cases, Lucas Georger B.A., Krish Sardesai B.A., Andrew Dumas B.S., Mckenna Noe B.S., Richard M. Schwend M.D.

Research Days

Conducting an ongoing exploration, this study delves into the safety and efficacy of Gardner-Wells Tongs in pediatric spinal deformity surgery, involving a series of 418 cases, revealing a 5.5% complication rate primarily associated with facial swelling and abrasions, emphasizing the need for further investigation to validate the safety and effectiveness of this intervention.

Peripheral Nerve Stimulation Of The Shoulder: A Technical Primer, Sailesh Arulkumar, Elisa E. Neuchat, Eric Ly, Austin Ingwei Ly, Kiana Fahimipour, Mehul J. Desai

School of Medicine Faculty Publications

Scapulalgia or shoulder pain accounts for 16% of all musculoskeletal complaints in the healthy adult population and becomes more common as we age. When this pain exceeds 3 months in duration, it is deemed to be chronic, and typically treated in an escalating manner. Spanning a continuum of conservative and non-conservative measures, chronic shoulder pain treatments range from rest and physical therapy to surgery. Since each patient presents with a unique spectrum of symptoms a customized treatment plan is often required. Over the lifetime of many of these patients, a variety of treatment options are required. One of these treatment …

Subclinical Presentation Of Cutibacterium Acnes Infection Following Revision Rotator Cuff Repair: A Case Report, Zachary Walker, David Shuster, David Sosnoski, Ali Hamade, Hussein Saad, Marc Milia

Posters

Cutibacterium acnes is a gram-positive anaerobic bacillus which is commonly found in the sebaceous glands of the skin generally in the axilla, chest and back regions 1,2.

Shoulder infections have been reported to occur at 3.4% following arthroscopic or open shoulder surgeries, where they are most commonly due to C. acnes3,4.

This case report demonstrates a unique case and management of a subclinical presentation of confirmed C. acnes infection.