Medical Specialties Commons^™

A Day In The Life Of An Orthopaedic Surgeon With Dr. Rachel Shakked, Anne Cohen

Bone Bulletin

From a young age, Dr. Shakked knew she wanted to be a doctor and started medical school with an interest in pursuing medical oncology. As a third year, she did her surgery rotation with low expectations but ended up loving it and discovering the field of orthopaedics. After completing her fellowship in 2016, she is now a foot and ankle specialist at the Rothman Institute where she experiences a mix of both private and academic practice. This conversation was born from her desire to show students what life is like beyond medical school and residency, and the importance of living …

First Job Considerations As An Orthopaedic Surgery Attending: Picking A Practice Setting, Purab Kothari

Bone Bulletin

A career in medicine is a journey with many forks in the road as medical students choose specialties, then subspecialties, and finally a practice setting. Particularly with the latter, becoming familiar with the various practice options early on can lead to an easier decision when the time to join the workforce arrives. Additionally, the ability to work in a setting that aligns with one’s career goals may ultimately lead to increased job satisfaction and reduced burnout risk. The following article aims to define various practice settings, including academic, private, community, “privademics” and locum tenens, and explore key considerations orthopaedic surgery …

New Trends In Orthopaedic Surgery Residency Applications: The Role Of Preference Signaling, J. Liam Gibbons

Bone Bulletin

Introduction

Orthopaedic surgery is known to be one of the most competitive specialties for medical students to pursue. It is important for applicants to have a strong portfolio of achievements, including research, presentations, and volunteering to increase chances of matching. USMLE scores and AOA membership tend to be higher among residency applicants that match into orthopaedic surgery. Moreover, the match rate for orthopaedics is lower at 74% compared to the overall match rate of 93.8%.¹ To increase chances of matching into an orthopaedic program, it is recommended to start preparing early and stay informed about trends and strategies in …

A Practical Guide To Etiquette In The Orthopaedic Or For The Rotating Medical Student, Tyler Radack

Bone Bulletin

The Operating Room, the operating theatre, the lair of the Orthopaedic surgeon, it goes by many names. It is a place most try to avoid, but this daunting windowless room is a classroom and training ground for many. And for the medical student interested in an orthopaedic surgery career, making an impression in the operating room is vital to matching into their desired orthopaedic residency.¹

Unfortunately, making an impression in the operating room is difficult, or more precisely, making a good impression in the operating room is difficult. Furthermore, every operating room dynamic can be different, and the personalities …

Injuries, Management, And Prevention In The Weekend Warrior, John Paulik

Bone Bulletin

Introduction

Sports medicine is known for heroically returning competitors back to the big game just in the nick of time for the winning play. This storybook ending is a reality of sports medicine. However, the majority of athletes will not end up on ESPN in the newest 30 for 30. This begs the question - who is an athlete? To some, it may be defined as someone who participates in an organized sport, culminating in regular competition and requiring systematic training.¹ This definition, however, excludes those who regularly exercise with the goal of improving their health or appearance.^{2 …}

Foreword, Alan S. Hilibrand

Bone Bulletin

As the Director of Undergraduate Medical Education for the Department of Orthopedic Surgery at the Sidney Kimmel Medical College, I am thrilled to have this opportunity to introduce the inaugural issue of the Bone Bulletin. Through the activities of the DePalma Orthopaedic Society, medical students at SKMC have had an excellent venue to learn about orthopaedic surgery, and our surgeons here at Rothman Orthopaedics have enthusiastically mentored younger students interested in the field of orthopedic surgery. The DePalma leadership has worked hard on many initiatives in recent years: providing forums for orthopaedic faculty to speak about their work, assembling lists …

Editor's Note, Payton Boere, Ari Clements

Bone Bulletin

We are thrilled to introduce the inaugural issue of the Bone Bulletin, DePalma Orthopaedic Society’s student-run, non-peer reviewed journal for Sidney Kimmel Medical College (SKMC) students. The journal’s aim is to provide yet another way to be involved with orthopaedics in medical school and to promote student interest in orthopaedics by reporting on diverse aspects of the field through editorial and opinion pieces. Under the close 1-on-1 mentorship of a physician from the Rothman Orthopaedic Institute, students have a hands-on opportunity to write about and directly engage with orthopaedic research and developments.

Within the pages of this journal, you …

Observations On The Present And The Future Of Hip Surgery, Alberto Di Martino

Department of Orthopaedic Surgery Faculty Papers

No abstract provided.

Rare First Rib Pseudoarthrosis With Thoracic Outlet Syndrome In Pediatric Gymnast: A Case Report, Jessica M. Kraft, Ann L. Contrucci, Gary E. Freed

Research Day

Background: This case study evaluates the diagnosis and treatment of a 12 year old Caucasian male gymnast who had several diagnoses including an isolated first rib fracture, resultant pseudoarthrosis of the first rib, and the development of symptomatic thoracic outlet syndrome. We discuss the causes, prevalence, and suggestions for prompt diagnosis and treatment of these conditions in pediatric patients. Although all three conditions are rare in a child, this case highlights the importance of having a high clinical index of suspicion in recurrent pain in pre-pubertal athletes.

Case presentation: A 10 year old Caucasian male presented with a two to …

A Bone Of Contention: A Dynamic Ultrasound Assessment Of The Role Of The Radial Head In The Arthrokinematics Of The Proximal Radioulnar Joint, Kolson Lamb, Madison D. Hendricks, Courtney E. Grimes, Cameron A. Johnson, David Nguyen, Ruth Maher

Research Day

INTRODUCTION: The arthrokinematics of the proximal radioulnar joint (PRUJ) are believed to follow the convex-concave rule, meaning that when the convex radial head articulates with the concave radial notch on the ulna, rolling and gliding occur in opposite directions during forearm pronation and supination. Previous research using helical computerized tomography (CT) identified that the sequence of joint actions is in contrast with this rule, which would indicate a posterior glide of the radius on the ulna during pronation movement and the converse during supination.

OBJECTIVES: The aims of this study are to determine the arthrokinematics of the PRUJ while being …

Two Ais Cases, Two Surgeons, One Operating Room, One Day. The Results Of A Quality Improvement Initiative, Jonathan Warren, Robert C. Link, Sean Bonanni, John T. Anderson, Richard M. Schwend

Research Days

Background: To lessen surgical times for AIS patients undergoing posterior spinal instrumentation and fusion (PSIF), our department developed a quality improvement initiative where two AIS cases were completed in one day by a specialized team with two surgeons operating together in the same operating room (OR).

Objectives/Goal: We describe the results of this initiative and compare operative times and blood loss between cases to determine if operative time improves as experience with this structure increases.

Methods/Design: From 2017-2023, patients aged 10-18 years with AIS were prospectively scheduled to undergo primary PSIF on the dedicated “Two Spine Tuesday” at our institution. …

Preoperative Srs-22 Scores Predict Postoperative Achievement Of Distribution-Based Mcid In Ais Patients Treated With Posterior Spinal Instrumentation And Fusion, Jonathan Warren, Cyrus Etebari, Morgan Whitmire, Kenneth Furlough, Brant Ansley, John T. Anderson, Richard M. Schwend

Research Days

Background: There is a growing body of literature assessing the role of preoperative patientreported outcome measures in predicting postoperative achievement of the minimal clinically important difference (MCID). To the best of our knowledge, there are no studies assessing whether preoperative SRS-22 scores are predictive of postoperative achievement of MCID in patient with adolescent idiopathic scoliosis (AIS).

Objectives/Goal: Our purpose is to determine if preoperative SRS-22 scores in patients with AIS who undergo posterior spinal instrumentation and fusion can predict postoperative achievement of MCID.

Methods/Design: SRS-22 forms were provided to all patients scheduled to undergo posterior spinal instrumentation and fusion. MCID …

Indications For Early Surgical Intervention In Adolescents With Salter-Harris Ii Distal Radius Fractures, Cyrus Etebari, Jonathan R. Warren, Olivia Pruss, Sricharan Yadali, Vincent Staggs, Micah K. Sinclair

Research Days

Introduction: Currently, there is little information regarding risk factors for failure of nonoperative treatment in Salter-Harris II distal radius fractures (SHII-DRF). Our purpose is to identify predictors of which patients will require acute surgery and which will develop late malunion based on degree of deformity and skeletal maturity.

Methods: This was a review of SHII-DRFs in patients 9 to 18 years of age, from 2017-2020. Demographics, initial displacement, displacement post-reduction, and displacement after cast removal were evaluated. Skeletal maturity was determined using Sander’s classification. These values were compared between patients who underwent casting alone, underwent acute surgery, or required late …

Common Misperceptions Of Child Abuse In Toddler Femur Fractures, Olivia Pruss, Jonathan Warren, Vincent Staggs, Grace Tideman, Collin Erickson, William L. Hennrikus, Richard M. Schwend

Research Days

Background: Current AAOS guidelines recommend that all children younger than thirty-six months with a femur fracture be evaluated for child abuse. However, the chance for abuse in walking-age children is highly unlikely at less than 20%.

Objectives/Goal: The purpose of this study is to identify how a patient’s age and femur fracture morphology impact the likelihood that providers assess a fracture as non-accidental and their decision to pursue further investigation of possible child abuse.

Methods/Design: This was a questionnaire study completed by clinicians from multiple specialties. There were 5 subgroup populations (6, 12, 18, 24, 35 months old) combined with …

Predicting Avascular Necrosis After Unstable Slipped Capital Femoral Epiphysis, Jonathan Warren, Alexander Metoxen, Michael Held, Brant Ansley, Berglund Lisa

Research Days

Background: There is no consensus in the literature on the risk of developing avascular necrosis (AVN) after unstable slipped capital femoral epiphysis (SCFE). In recent years, a number of studies have sought to better characterize risk factors for AVN in this population. However, to the best of our knowledge, there is no study that uses predictive modeling to assess the chance of developing AVN based on different patient-centric factors.

Objectives/Goal: Our goal is to assess whether or not previously-published risk factors for AVN in unstable SCFE such as duration of symptoms, reduction type, type of surgery, timing of surgery, and …

Two Adolescent Idiopathic Scoliosis (Ais) Cases, Two Surgeons, One Operating Room, One Day. Faster And Safer Than One Case In A Day., Jonathan Warren, Robert C. Link, Sean Bonanni, John T. Anderson, Richard M. Schwend

Research Days

Background: To lessen surgical times for AIS patients undergoing posterior spinal instrumentation and fusion (PSIF), our department developed a quality improvement initiative where two AIS cases were completed in one day by a specialized team with two surgeons operating together in the same operating room (OR).

Objectives/Goal: Our purpose is to describe the results of this initiative and compare operative times and outcomes to single cases completed by a single surgeon during the same period.

Methods/Design: From 2017-2023, patients aged 10-18 years with AIS were scheduled to undergo primary PSIF on the dedicated “Two Spine Tuesday” at our institution (Group …

Prevalence Of Hyperostosis Frontalis In Georgia Elderly Cadaver Population, Sara G. Meawad, Tristan C. Henris, Ansley Myrick, Savita Arya, Shiv Dhiman

Research Day

Introduction

Hyperostosis frontalis interna (HFI) is a condition that causes a benign thickening of the frontal bone. Many studies in the past have correlated sex with the incidence of HFI. Additionally, females, especially those postmenopausal, seem to be the predominant group affected. The primary objective of this study is to explore incidence of HFI and how it relates to the different sexes. The secondary objective is to further investigate the correlation of HFI with liver and gonadal pathologies.

Methods

A study is designed to explore the prevalence of hyperostosis frontalis interna among sexes in a sample of cadavers (n=38) at …

Outcomes Of Arthroscopic Vs. Open Biceps Tenodesis For Treatment Of Slap Lesion In Female Patients, Adeeb Hanna, Matthew Wallingford, William Johns, John Sonner, Emma Johnson, Sommer Hammoud, Brandon Erickson, Steven Cohen, Michael Ciccotti, Meghan Bishop

Rowan-Virtua Research Day

Background: Biceps tenodesis (BT) is one alternative treatment to repair of superior labrum anterior to posterior (SLAP) tears. It can be performed as an arthroscopy or open procedure. While there have been studies comparing the outcomes of SLAP repair procedures with BT for the treatment of SLAP tears, literature comparing arthroscopic and open BT for the treatment of SLAP tears is limited. Additionally, no previous study has specifically examined the outcomes of these procedures in female patients.

Hypothesis/Purpose: The purpose of this study was to compare outcomes following Arthroscopic BT and Open BT for SLAP tears in females. The authors …

Occurrence And Trends Of Musculoskeletal Pain Among Ski Instructors, Denis Causevic, Erol Kovacevic, Semir Masic, Seth Spicer, Ahmed Gawash

Rowan-Virtua Research Day

Musculoskeletal disorders (MSD) are incredibly common and are often related to work load. For any occupational or public health intervention, injury prevention is preferred to injury treatment. Occupational health and injury prevention research has the potential to help mitigate MSD in the workplace. The aim of this study was to determine how the work demands of ski instructors may affect the health of their musculoskeletal system.

Material and Methods

A cross-sectional study involved the participation of 87 ski instructors (age = 34.61 ±10.67) in Bosnia and Herzegovina (ATUS in Bosnia and Herzegovina). Observed variables were the prevalence of MSD measured …

The Effect Of Graft Selection On Patients’ Subjective Readiness To Return To Sport After Acl Reconstruction, Adeeb Hanna, William Johns, Emma Johnson, Bryson Kelmer, Gabriel Onor, Kevin Freedman, Christopher Dodson, Michael Ciccotti

Rowan-Virtua Research Day

Background: Patients who undergo ACL reconstruction with allografts may have an easier functional recovery compared to autograft patients. This is due to decreased donor site morbidity and less muscle atrophy compared to autograft patients. This “easier” recovery may be perceived by patients and may result in a subjective earlier readiness for return to sports.

Hypothesis/Purpose: To determine if there is a difference in perceived readiness to return to sport (RTS) in the first year postoperative period between individuals who undergo ACL reconstruction utilizing bone-patellar tendon-bone (BTB) autografts or allografts.

Study Design: Prospective Cohort Study, Level II Methods: This was a …

Arthroscopic Treatment Of Shoulder Stiffness With Rotator Cuff Repair Yields Similar Outcomes To Isolated Rotator Cuff Repair, Ruchir Nanavati, Parker L. Brush, Adrian Santana, Gregory R. Toci, Tariq Z. Issa, Daniel J. Fletcher, Joshua Hornstein

Rowan-Virtua Research Day

Purpose: To compare patient-reported and surgical outcome measures in patients with and without secondary shoulder stiffness (SSS) undergoing rotator cuff repair (RCR).

Methods: Patients undergoing rotator cuff repair from 2014 to 2020 with complete patient-reported outcome measures (PROMs) by the short-form 12 survey (SF-12) were retrospectively reviewed to identify if operative intervention for SSS was performed alongside the RCR. Those patients with operative intervention for SSS were propensity matched to a group without prior intervention for stiffness by age, sex, laterality, body mass index, diabetes mellitus status, and the presence of a thyroid disorder. The groups were compared by rotator …

Comparative Outcomes Of Autologous Chondrocyte Implantation And Osteochondral Allograft Transplantation With Patellar Realignment For Patellar Instability With Associated Cartilage Defects, Adeeb Hanna, Michael Campbell, John Matthews, Gabriel Onor, Emma Johnson, Bradford Tucker, Kevin Freedman

Rowan-Virtua Research Day

Abstract Background: Articular cartilage pathology can stem from a spectrum of etiologies including osteochondritis dissecans, avascular necrosis, degenerative joint disease, and injury resulting from recurrent instability of the patella.

Hypothesis/Purpose: The purpose of this study was to identify differences in clinical and functional outcomes in patients treated with either ACI or OCA transplantation for chondral defects with concomitant MPFL reconstruction and tibia tubercle osteotomy.

Study Design: Retrospective Cohort Study

Methods: A retrospective review identified patients who underwent autologous chondrocyte implantation (ACI) or osteochondral allograft (OCA) transplantation with concomitant medial patellofemoral ligament (MPFL) reconstruction and tibia tubercle osteotomy (TTO). Outcome measures …

Comparison Of Patient Outcomes In Female Patients Undergoing Slap Repair Or Biceps Tenodesis For The Treatment Of Slap Lesions, Adeeb Hanna, Matthew Wallingford, William Johns, John Sonner, Emma Johnson, Sommer Hammoud, Brandon Erickson, Steven Cohen, Michael G. Ciccotti, Meghan Bishop, Meghan Bishop

Rowan-Virtua Research Day

Background: There is no consensus on whether SLAP repair (SR) or biceps tenodesis (BT) yields superior long-term outcomes in managing superior labrum anterior to posterior (SLAP) tears. No previous study has examined outcomes of these procedures in female patients.

Hypothesis/Purpose: The purpose of this study was to compare outcomes following SR and BT for SLAP tears in females. The authors hypothesized there would be no difference in outcomes between patients who underwent SR or BT.

Study Design: Retrospective Cohort (level III)

Methods: Female patients who underwent SR or BT for treatment of SLAP tears between 1/1/2014 and 9/1/2019 were retrospectively …

Determining Accuracy Of Chondral Lesion Sizing Methods Prior To Surgery, Adeeb Hanna, Henson Destine, Emma Johnson, Michael Campbell, Austin Looney, Dominic Farronato, Joshua Pezzulo, Bradford S. Tucker, Kevin Freedman

Rowan-Virtua Research Day

Background: Osteochondral lesions of the knee may require cartilage restoration such as osteochondral allograft (OCA) transplantation or autologous chondrocyte implantation (ACI). Although MRI and arthroscopy can offer valuable information regarding lesion characteristics prior to these procedures, no study has compared the use of each in estimating the sizes of grafts used at the time of surgical correction.

Hypothesis/Purpose: To compare osteochondral defect size measurements and characteristics across MRI, arthroscopy, and at the time of implantation with OCA or ACI. Study Design: Retrospective Cohort Study (Level III)

Methods: Patients who underwent ACI and OCA transplantation at a single institution between 2015 …

Case Report: Use Of Bedside Handheld Ultrasound To Diagnose Finger Dislocation, Frank Wheeler, Philip Carhart, James Espinosa, Alan Lucerna, Henry Schuitema

Rowan-Virtua Research Day

Here we present the case of a 37-year-old male with a finger injury in which finger dislocation was suspected clinically. A bedside pocket ultrasound was performed using a water submersion technique, which identified a posterior dislocated right 2nd digit at the PIP joint. This finding was confirmed with an x-ray. This case report demonstrates that ultrasonography can be utilized to correctly identify finger dislocation. Although larger studies need to be performed to validate the accuracy of this imaging technique, the implications may improve care of the patient. It would also be particularly beneficial for this technique to be applied to …

Impact Of Draft Order On Stress Sonography Of The Ulnar Collateral Ligament Of The Elbow In Professional Baseball Pitchers: An 18-Year Study, Adeeb Hanna, John Sonnier, Brian Fliegel, Matthew Sherman, Michael Ciccotti, Robert Jack, Steven Cohen

Rowan-Virtua Research Day

Background: The MLB draft is a common route for players to enter professional baseball in the United States. Individuals taken in earlier rounds are typically higher-performing players. When looking at pitchers specifically, higher performance at the amateur level may be associated with increased frequency of adaptive change in the throwing elbow.

Purpose/Hypothesis: To determine if players taken in earlier rounds of the MLB draft have a greater frequency or extent of pathological change in the elbow, as measured by dynamic stress ultrasound.

Study Design: Retrospective Cohort Study Methods: Dynamic stress ultrasounds (SUS) were performed over an 18-year period on the …

Adaptive Changes Of The Ulnar Collateral Ligament Of Professional Baseball From Different Climates Over Multiple Seasons: An 18-Year Study, Adeeb Hanna, Brian Fliegel, John Sonnier, Matthew Sherman, Michael Ciccotti, Robert Jack, Steven Cohen

Rowan-Virtua Research Day

Background: The ulnar collateral ligament (UCL) is put under high levels of stress through the overhead throwing motion typical of professional baseball pitchers. In response to repetitive stress the UCL undergoes adaptive changes including thickening of the ligament and increased joint laxity under valgus stress. Studies examining the adaptive changes in the elbows of professional pitchers over multiple seasons are limited. Investigations such as this one offer insight into the changes in the UCL of professional pitchers over multiple years of professional play as well as the risk for injuries that may be associated with these changes.

Purpose/Hypothesis: The purpose …

Inpatient Opioid Use Varies By Construct Length Among Laminoplasty Versus Laminectomy And Fusion Patients, Harry M. Lightsey, Peter J. Georgakas, Matthew H. Lindsey, Caleb M. Yeung, Joseph H. Schwab, Harold A. Fogel, Stuart H. Hershman, Daniel G. Tobert, Kevin M. Hwang

Rothman Institute Papers

BACKGROUND: Laminoplasty (LP) and laminectomy and fusion (LF) are utilized to achieve decompression in patients with symptomatic degenerative cervical myelopathy (DCM). Comparative analyses aimed at determining outcomes and clarifying indications between these procedures represent an area of active research. Accordingly, we sought to compare inpatient opioid use between LP and LF patients and to determine if opioid use correlated with length of stay.

METHODS: Sociodemographic information, surgical and hospitalization data, and medication administration records were abstracted for patients >18 years of age who underwent LP or LF for DCM in the Mass General Brigham (MGB) health system between 2017 and …

Rerupture Outcome Of Conservative Versus Open Repair Versus Minimally Invasive Repair Of Acute Achilles Tendon Ruptures: A Systematic Review And Meta-Analysis, Haidong Deng, Xin Cheng, Yi Yang, Fang Fang, Jialing He, Yixin Tian, Tiangui Li, Yangchun Xiao, Yuning Feng, Peng Wang, Weelic Chong, Yang Hai, Yu Zhang

Department of Medicine Faculty Papers

OBJECTIVE: To compare the rerupture rate after conservative treatment, open repair, and minimally invasive surgery management of acute Achilles tendon ruptures.

DESIGN: Systematic review and network meta-analysis.

DATA SOURCES: We searched Medline, Embase, and the Cochrane Central Register of Controlled Trials from inception to August 2022.

METHODS: Randomised controlled trials involving different treatments for Achilles tendon rupture were included. The primary outcome was rerupture. Bayesian network meta-analysis with random effects was used to assess pooled relative risks (RRs) and 95% confidence intervals. We evaluated the heterogeneity and publication bias.

RESULTS: Thirteen trials with 1465 patients were included. In direct comparison, …

Assessment Of Radiographic Features In Predicting Complete Quadriceps And Complete Patellar Tendon Ruptures In The Pre-Operative Setting, Mitchell Pfennig, Matthew Astolfi, Christopher Vasileff, Betina Hinckel

Posters

Acute patellar tendon or quadriceps tendon rupture is a severely debilitating injury resulting in complete loss of the knee extensor mechanism. Early diagnosis and prompt surgical repair are preferential in order to achieve good functional outcomes. In the setting of trauma and knee pain, plain film radiographs of the knee are obtained to rule out fractures. Patellar and quadriceps tendon rupture is primarily a clinical diagnosis but can benefit from additional imaging to differentiate between a partial and complete tear when there is uncertainty. Our goal is to assess the reliability and reproducibility of radiographic features in a population with …