Medical Specialties Commons^™

Mesenchymal Stem Cell-Derived Extracellular Vesicles: Seeking Into Cell-Free Therapies For Bone-Affected Lysosomal Storage Disorders, Andrés Felipe Leal, Harry Pachajoa, Shunji Tomatsu

Department of Pediatrics Faculty Papers

Lysosomal storage disorders (LSDs) constitute a group of monogenic systemic diseases resulting from deficiencies in specific lysosomal enzymes that cause the intralysosomal accumulation of non- or partially degraded substrates, leading to lysosomal dysfunction. In some cases of LSDs, the bone is more severely affected, thus producing skeletal manifestations in patients. Current therapies, such as enzyme replacement therapy (ERT) and gene therapy (GT), show limited efficacy in correcting skeletal abnormalities. Increasing evidence suggests that microenvironmental disturbances also contribute significantly to disease pathogenesis. Therefore, therapeutic strategies targeting lysosomal dysfunction and microenvironmental dysregulation are needed. Mesenchymal stem-cell-derived extracellular vesicles (MSC-EVs) are emerging as …

Full Issue: Volume 3, Issue 1 - June 2025

Bone Bulletin

i - Editors’ Note

ii - Foreword by Dr. Alan Hilibrand

7 - Challenges and Concerns of Artificial Intelligence in Shoulder and Elbow by Claude J. Regis

10 - Exploring Robotic-Assisted Total Knee Arthroplasty by Sahil Shah

13 - The Future of Robot-Assisted Surgery in Foot and Ankle Procedures by Sam Duggan

16 - Revolutionizing Spine Surgery: The Potential Role of AI in Enhancing Surgical Workflow and Patient Outcomes by Samuel Ezeonu

21 - Management of Periprosthetic Humeral Fractures Following Shoulder Arthroplasty by Akshay Khanna

24 - Patient Specific Implants in Total Shoulder Arthroplasty by Alexander Zavitsanos

26 - Posterior …

Comparison Of Autograft, Allograft, And Conduits For Peripheral Upper Extremity Nerve Repair A Critical Review Of The Current State Of Bone Grafting In Orthopaedic Surgery, Samantha Meacock

Bone Bulletin

Introduction

Several mechanisms of injury can cause peripheral nerve injury (PNI) and subsequent impaired quality of life with loss of motor and/or sensory function. Trauma is a common cause of injury with the most commonly injured nerves being the radial (53%), ulnar (32%), and median nerves (15%).¹ The preferred treatment for PNI is reconnecting severed nerve ends anatomically with tension-free end-to-end direct nerve repair of healthy fascicles. However, if the nerve ends cannot be brought together without tension, gapping can occur, and a direct tension-less repair is not possible.⁵ In the case of a lengthy nerve gap, a …

A Critical Review Of The Current State Of Bone Grafting In Orthopaedic Surgery, Joseph Kelly

Bone Bulletin

Introduction

Millions of people around the world currently suffer from orthopaedic injuries and illness due to trauma, degenerative diseases, cancer, and infections that require bone grafting techniques to heal. Bone grafting allows a surgeon to replace missing, broken, or infected bone with a substitute that returns the structural integrity of the bone. Bone grafting can rebuild bones but can also help bones with existing defects to heal properly. There are multiple types of bone grafts, and each may be indicated in different scenarios to optimize healing, restore function, and prevent complications depending on the bone in question. The three broad …

Distal Radius Fractures: A Common Injury With Disproportionate Results, Brady Stillman

Bone Bulletin

Introduction

A distal radius fracture (DRF) is a common upper-extremity injury that occurs when the radius is fractured near the wrist, usually after falling on an outstretched or flexed hand. DRFs account for one-sixth of fracture-related emergency department visits.² In a 2009 study, a sample of 87 million Americans with upper-extremity fractures revealed the most common fracture sites were the distal radius and ulna.³ The distal radius was the most common fracture site in patients younger than 18 and older than 49, and the incidence is increasing in older adulthood.^{3, 4} A DRF can be classified as …

Innovative Pain Management Protocols In Orthopedics And Their Role In Reducing Postoperative Opioid Use, Jake Lamonaca

Bone Bulletin

Background

The opioid epidemic has emerged as one of the most pressing public health challenges of our time, marked by significant increases in opioid-related dependence, abuse, and death in recent years. Excess prescription of opioids represents a major contributing factor to this crisis.¹ The origins and impact of the opioid epidemic in the United States are documented in Sam Quinones research narrative, Dreamland. He highlights how pharmaceutical companies leveraged misinterpreted research—particularly a 1980 letter published in The New England Journal of Medicine suggesting a low risk of addiction associated with opioids—to normalize their widespread prescription. This flawed evidence served …

Analyzing The Common Criteria And Decision-Making Process For Opting Between Same-Day And Overnight Surgeries For Improved Patient Management, Gaston Davis

Bone Bulletin

Introduction

Within the scope of sports medicine, the decision to opt for same-day or overnight surgeries is multifactorial and relies on many interplaying considerations. Common factors include patient health, surgical complexity, and post-operative care requirements. This article explores the criteria and decision-making process involved in choosing between these two surgical options for common sports-related injuries, such as shoulder, elbow, hand, hip, knee, and ankle injuries.

Posterior Shoulder Dislocations In The Setting Of Seizures, Alex Charlton

Bone Bulletin

The shoulder joint provides an exceptional range of motion that allows for flexion, extension, adduction, abduction, internal rotation, external rotation, and 360-degree circumduction; however, this mobility comes at the expense of decreased stability.¹ Shoulder dislocations account for 50% of all joint dislocations, with anterior dislocation being the most common and usually associated with trauma.² In comparison, about 2-5% of shoulder dislocations are posterior and are often associated with more unique etiologies.¹ One of the most interesting resulting from a tonic seizure in an individual with epilepsy.

Patient Specific Implants In Total Shoulder Arthroplasty, Alexander Zavitsanos

Bone Bulletin

Primary total joint arthroplasty (TJA) is one of the most commonly performed procedures in the United States, and is expected to be utilized more in the coming decades, with estimates of around 2 million TJAs performed annually by 2030.^1,2 While the first attempts at TJA occurred in the late 1800s, utilizing a variety of implant materials such as ivory and rubber, over the past 100+ years, the methods employed in TJA and the quality of implants used have progressed immensely with advances in material science and procedural methods^8-12. However, the implants currently used in all types of …

Management Of Periprosthetic Humeral Fractures Following Shoulder Arthroplasty, Akshay Khanna

Bone Bulletin

Introduction Since the introduction of reverse total shoulder arthroplasty (RTSA) in 2004, the total incidence of primary total shoulder arthroplasties in the United States has doubled to over 30 cases per 100,000 persons.^1,2 Despite overall complication rates decreasing with the advancement of novel techniques and implant designs, there are rising concerns regarding the frequency of certain complications including glenohumeral instability, rotator cuff tearing, and periprosthetic fracture.^3,4 Glenoid fractures are relatively rare, occurring at a rate of 1.4% in one national registry study.^19,20 The risk of periprosthetic humeral fracture, however, is of particular concern because of how devastating …

Revolutionizing Spine Surgery: The Potential Role Of Ai In Enhancing Surgical Workflow And Patient Outcomes, Samuel Ezeonu

Bone Bulletin

Introduction

With the growing incidence of degenerative spine pathology¹, surgeons have been tasked to treat more patients than ever. According to Mani et al., the number of single and multilevel fusion procedures are both projected to double over the next 25 years.² In light of this trend, several strategies have been proposed to reduce the resultant burden placed on hospitals and surgeons, while maintaining optimal standards of care. Namely, the use of artificial intelligence (AI) is a growing field that has greatly increased in the last decade. AI has the potential to relieve the cognitive workload placed …

The Future Of Robot-Assisted Surgery In Foot And Ankle Procedures, Sam Duggan

Bone Bulletin

Robot-assisted surgeries are becoming common in most fields of orthopaedics by providing increased accuracy and precision, reducing revision procedures.^1,2 Surgeons specializing in hip and knee, and more recently, spine, have seen tremendous increases in the use of robotics. Still, foot and ankle surgery has had little to no adoption of robotics due to the complex foot and ankle anatomy, in addition to small operating windows; however, usage in spine surgery may be a strong indicator of future use in foot and ankle surgery, as spine surgery similarly requires extreme precision in small operating spaces, with the added benefit of …

Exploring Robotic-Assisted Total Knee Arthroplasty, Sahil Shah

Bone Bulletin

Background and Introduction of Total Knee Arthroplasty

Within the field of orthopedics, joint replacements rank amongst the most common procedures. Among those, total knee arthroplasty (TKA) is the most commonly conducted joint replacement procedure at approximately 51.02% of arthroplasties between 2012 and 2022.¹ Annually, the American Academy of Orthopedic Surgeons estimates more than 700,000 TKAs are performed within the United States.² The procedure was introduced in 1968 to relieve severe joint pain and stiffness, as well as restore mobility in patients suffering from “end-stage degenerative knee osteoarthritis” or rheumatoid arthritis.³ TKAs revolutionized the treatment plan for patients …

Challenges And Concerns Of Artificial Intelligence In Shoulder And Elbow, Claude J. Regis

Bone Bulletin

Background

Artificial intelligence (AI) is rapidly transforming shoulder and elbow surgery, driving significant advancements across various domains. Currently, AI is enhancing diagnostic accuracy through imaging-based analysis, predictive modeling of clinical outcomes, implant identification, and automated image segmentation.^1,2 AI-driven personalized treatment plans are also anticipated to optimize patient care by tailoring interventions based on individual data analysis.³ Additionally, deep learning algorithms have been developed to automatically classify large sets of preoperative and postoperative radiographs in the setting of shoulder arthroplasty.⁴ These technologies, combined with AI, could revolutionize surgical training and intraoperative guidance, offering real-time data and enhanced visualization. …

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 happy to once again oversee the third annual issue of the Bone Bulletin. Through the activities of the DePalma Orthopaedic Society, medical students at SKMC have an excellent venue to learn about orthopaedic surgery, and through articles in this publication our surgeons 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 …

Editors' Note, Liam Gibbons, Amit Syal

Bone Bulletin

We are thrilled to introduce the third edition of the Bone Bulletin, DePalma Orthopaedic Society’s student-run, non-peer reviewed journal for Sidney Kimmel Medical College (SKMC) students. The journal aims to offer an additional avenue for medical students to engage with orthopaedics in medical school. Through the 1-on-1 mentorship with physicians from the Rothman Orthopaedic Institute, students gain hands-on experience writing about and directly engaging with current orthopaedic research and developments.

After each edition, it’s been exciting to see the journal continue to grow, with increasing numbers of students eager to get involved. This year, we are proud to announce …

Single-Level Anterior Cervical Discectomy And Fusion Is Associated With Higher Nonroutine Discharge Rates Compared To Cervical Disc Arthroplasty In Obese Patients, Paul G. Mastrokostas, Luke B. Schwartz, Eli Berglas, Aaron B. Lavi, Leonidas E. Mastrokostas, Jonathan Dalton, Christopher K. Kepler, Arya Varthi, Jad Bou Monsef, Afshin E. Razi, Mitchell K. Ng

Rothman Institute Papers

CONTEXT: Obesity is a recognized risk factor for adverse outcomes in cervical spine surgery. While cervical disc arthroplasty (CDA) has emerged as an alternative to anterior cervical discectomy and fusion (ACDF), comparative outcomes among obese patients remain underexplored.

AIMS: The aim of this study is to compare nonroutine discharge rates and other postoperative outcomes between obese patients undergoing single-level ACDF and CDA.

SETTINGS AND DESIGN: Retrospective cohort study using a national database.

SUBJECTS AND METHODS: The National Inpatient Sample was queried to identify obese patients who underwent single-level ACDF or CDA between 2016 and 2020. Inclusion and exclusion criteria were …

Commentary On Quality Improvement Case Series: Leukemic Arthritis Mimicking Septic Arthritis In A Pediatric Patient, Alexandre Arkader, Mihir M Thacker, Karim Masrouha

Department of Medicine Faculty Papers

No abstract provided.

Factors Related To Hypertension In Pediatric Patients Who Do Not Have Obstructive Sleep Apnea: A Retrospective Chart Study, Alyssa Exarchakis, Alexandra Cohen, Penghao Wang, Seema Rani, Diana Martinez

Department of Medicine Faculty Papers

Background/Objectives: The relationship between OSA and adult hypertension has been extensively studied; however, it remains understudied in pediatric patients without OSA. The aim of this study is to identify factors associated with pediatric hypertension without OSA, through an IRB-approved retrospective chart review of patients who underwent polysomnography at Nemours Children's Hospital, DE/NJ between January 2020 and July 2023. Methods: Eligibility criteria included children 8-17 years, completed PSG, and clinic visit blood pressure (BP). Anthropometrics, demographics, social determinants, and medical history were obtained from electronic medical records. Hypertension was defined as the average systolic and/or diastolic BP that is …

Brivaracetam Effectiveness And Patient-Reported Outcomes In Clinical Practice: Data From A 12-Month Prospective, Observational Study In The United States., Hina Dave, Michael R. Sperling, Hamada Hamid Altalib, Heidi Henninger, Roger J. Porter, Michael Gelfand, Prashant Dongre, Sami Elmoufti, Melinda S. Martin, Anne-Liv Schulz, Jacqueline A. French

Department of Neurology Faculty Papers

OBJECTIVE: Evaluate real-world effectiveness, patient-reported outcomes (PROs), and safety/tolerability of brivaracetam in patients (≥16 years) with focal-onset seizures currently receiving ≥ 1 antiseizure medication (ASM), and with historical or current use of levetiracetam, lamotrigine, oxcarbazepine, and/or carbamazepine.

METHODS: EP0088 was a 12-month, prospective, observational study of brivaracetam in a clinical practice setting in the US. Primary study outcome was brivaracetam retention at 12 months after brivaracetam initiation. Effect of brivaracetam on patients' perceptions of their health was assessed using Patient-Reported Outcomes Measurement Information System (PROMIS) short forms and Seizure-Related Disability Assessment Scale (SERDAS). Safety outcomes included incidence of treatment-emergent adverse …

Amino Acid Transporter Lat1 (Slc7a5) Promotes Metabolic Rewiring In Tnbc Progression Through The L-Trp/Qprt/Nad+ Pathway, Margot Y. Fedoroff, Lei Zhao, Shaomin Wang, Alok Bhushan, Haifeng Yang, Karen M. Bussard, Stephen C. Peiper, Jun He

Department of Pathology, Anatomy, and Cell Biology Faculty Papers

BACKGROUND: Cancer cells uptake excessive nutrients by expressing higher levels of glucose and/or amino acid transporters to meet their increased energy demands. L-type amino acid transporter 1 (LAT1), is regarded as a cancer-specific transporter for the uptake of large neutral amino acids such as L-tryptophan. However, the mechanism by which LAT1 rewires cellular metabolism to promote cancer progression and chemoresistance have not yet been investigated.

METHODS: The protein levels of LAT1, p-PKM2, and p-LDHA were determined in breast cancer tissue arrays by immunohistochemistry staining followed by survival analysis. The orthotopic breast cancer models in mice, syngeneic breast cancer models, and …

The Impact Of Operative Level On Patient-Reported Outcome Measures Following Single-Level Posterior Lumbar Decompression For Disc Herniation, Jonathan Dalton, Robert Oris, Omar Tarawneh, Gregory Toci, Rajkishen Narayanan, Dominic Finan, Hannah Bash, Marco Goldberg, John Mangan, Barrett Woods, Mark Kurd, Ian Kaye, Jose Canseco, Alan Hilibrand, Alex Vaccaro, Gregory Schroeder, Christopher Kepler

Department of Orthopaedic Surgery Faculty Papers

OBJECTIVE: To compare the impact of upper versus lower lumbar decompression on patient-reported outcome measures (PROMs).

MATERIALS AND METHODS: Patients undergoing L1-L2, L2-L3, L4-L5, or L5-S1 single-level elective decompression with 1-year PROMs were identified. Included PROMs were the Oswestry Disability Index (ODI), visual analog scale (VAS) back and leg, and Short Form-12 physical (PCS) and mental (MCS) component scores. Minimal clinically important differences (MCID) were calculated. Multivariable regressions assessed the independent predictive ability of operative level controlling for demographic confounders.

RESULTS: Three hundred and forty-six patients were included (94 upper lumbar decompressions). Upper lumbar decompression patients were older (64.0 vs. …

A Comparison Of Different Posterior Arthrodesis Techniques Versus Anterior Dens Screw For Odontoid Fractures: A Systematic Review And Meta-Analysis, Pavlos Texakalidis, Stavros Matsoukas, Michael Cloney, Mykhaylo Krushelnytskyy, Kevin Swong, Najib El Tecle, Tyler Koski, Nader Dahdaleh

Department of Neurosurgery Faculty Papers

BACKGROUND AND OBJECTIVES: Odontoid fractures are often managed surgically. The most common approaches are anterior dens screw (ADS) and posterior arthrodesis (PA), with the latter being associated with significantly higher fusion rates. PA techniques can include wiring, C1-C2 transarticular (TA) screws, and C1 lateral mass (LM)-C2 pars/pedicle screws. Most comparative studies group multiple PA techniques together when comparing PA versus ADS. Our objective was to systematically review the literature and identify studies that separately provide fusion rates of each different posterior C1-C2 arthrodesis (PA) technique utilized compared to ADS.

METHODS: A systematic literature review was conducted according to the Preferred …

How Are We Defining Preoperative Anemia? A Comparison Of Various Anemia Thresholds Among Patients Undergoing Short-Construct Lumbar Spinal Fusion, Tariq Issa, Omar Tarawneh, Teeto Ezeonu, Mark Lambrechts, Mark Kurd, Ian Kaye, Jose Canseco, Alan Hilibrand, Alex Vaccaro, Christopher Kepler, Gregory Schroeder

Department of Orthopaedic Surgery Faculty Papers

BACKGROUND: Anemia is a risk factor for increased transfusions. However, various definitions of anemia have been described in scientific literature and a consensus on how to appropriately diagnose anemia or who to preoperatively optimize is lacking. We aimed to compare multiple anemia definitions and evaluate if any threshold best predicts transfusion requirements and surgical outcomes following spinal fusion.

METHODS: We conducted a retrospective cohort study of 1-2 level posterior spinal fusions. Preoperative hemoglobin was defined based on preoperative laboratories within 28 days of surgery. Anemia was diagnosed using the World Health Organization (WHO), the American Society of Hematology (ASH), and …

From Aortic Stenosis To Cardiomyopathy: The Hidden Impact Of Undiagnosed Acommissural Unicuspid Aortic Valve, Muhammad Sabri, Hamza Muhammadzai, Angad Bedi, Eddy Mizrahi, Matthew Collins

Abington Jefferson Health Papers

Unicuspid aortic valve (UAV) is a rare congenital anomaly, diagnosed in individuals aged 30 to 50. It is associated with aortic stenosis or aortic regurgitation, potentially leading to heart failure. We report a case of a 28-year-old male with an acommissural UAV, aortopathy, critical aortic stenosis, and heart failure with reduced ejection fraction, presenting with shortness of breath. This case is notable for late presentation of an acommissural UAV, which typically manifests in childhood.

Persistent Imbalance: Women’S Representation In North American Pediatric Cardiology Leadership Roles.Persistent Imbalance: Women’S Representation In North American Pediatric Cardiology Leadership Roles, Alaina K. Kipps, Audrey C. Marshall, Neha Bansal, Holly Bauser-Heaton, Nadine Choueiter, Devyani Chowdhury, Aarti Dalal, Molly Ehrlich, Lindsay R. Freud, Supriya S. Jain, Pei-Ni Jone, Kristin Laraja, Dalia Lopez-Colon, Sonal T. Owens, Christina Ronai, Ritu Sachdeva, Corey Stiver, Nicole Sutton, Terrie Vasilopoulos, Jennifer Co-Vu

Department of Pediatrics Faculty Papers

BACKGROUND: Despite recent gender parity of physicians entering pediatric cardiology, representation of women leaders lags their male colleagues.

OBJECTIVES: We sought to better understand the variation in women in leadership roles in pediatric cardiology.

METHODS: The gender of physicians in 16 prespecified leadership positions was collected by survey between July 2022 and January 2023 from pediatric cardiology programs with >5 cardiologists in North America. We analyzed the association of women leaders with center size (based on surgical volume), geographic region, presence of categorical fellowship program, and gender of division chief and department chair.

RESULTS: Across 99 centers, a median of …

Inflammatory Bowel Disease: Patient Journey And Cancer Pathology, Katie Contino, Ms

Student Papers, Posters & Projects

Inflammatory Bowel Disease is a relapsing-remitting autoimmune disease that affects the gastrointestinal tract. It consists of Crohn’s disease, which can affect the entire gastrointestinal system, and ulcerative colitis, which is limited to the colon. Inflammatory Bowel Disease has various different levels of severity that have different treatment and medication options once the diagnosis is confirmed with an endoscopic procedure. The treatment options range from daily medication to invasive surgical procedures. Specific diets are also used as a preventative measure to remain in remission. The intestinal damage inflicted to the epithelium increases the risk of developing colon cancer, specifically those with …

Systemic Exogenous Progestins With Or Without Estrogens Are Associated With Decreased Rates Of Venous Procedures For Varicose Veins, Paarth Jain, Adam M. Ostrovsky, Paul J Dimuzio, Luis H. Eraso, Michael Nooromid, Dawn Salvatore, Babak Abai

Department of Surgery Faculty Papers

OBJECTIVES: Risk factors for varicose veins (VVs) such as female sex, pregnancy, and obesity are high estrogen states, yet the role of systemic progestins with or without estrogens (SPEs) in VV management is not well characterized. This study investigates how SPE use affects rates of venous procedures for patients with VV.

METHODS: The TriNetX database was queried for subjects with International Classification of Diseases, 10th edition, diagnoses of asymptomatic VV, chronic venous insufficiency, and complicated VV (inflammation or ulceration). Patients were divided into a control cohort with no subsequent SPE use, a progestin-only cohort, and a combined estrogen-progestin (CEP) cohort. …

Individualized Functional And Structural Language Lateralities In Temporal Lobe Epilepsy And Their Impact On Memory, Ankeeta Ankeeta, Qirui Zhang, Sam Sharifzadeh Javidi, Shilpi Modi, Michael R. Sperling, Joseph I. Tracy

Department of Neurology Faculty Papers

The basis and impact of functional asymmetries in the brain, particularly language lateralization, are not fully understood, and the relationship between functional and structural asymmetries remains largely untested. This study investigated the degree to which asymmetries in hemispheric language laterality are concordant with asymmetries in gray matter (GM) structure and whether the hemispheric organization of memory is influenced by functional language asymmetries. Structural and functional MR data was acquired from 261 individuals, including those with unilateral temporal lobe epilepsy (LTLE = 96, RTLE = 69) and matched with healthy participants (HPs = 96). Functional language laterality indices (LIs) were calculated …

Multiple Subcortical And Subcortico-Cortico Dynamic Network Reconfigurations Characterize Focal-To-Bilateral Tonic-Clonic Seizures, Shilpi Modi, A. Ankeeta, Walter Hinds, Michael R. Sperling, Xiaosong He, Joseph I. Tracy

Department of Neurology Faculty Papers

Temporal lobe epilepsy (TLE) is the most common focal epilepsy, with focal to bilateral tonic-clonic seizures (FBTCS+) a more severe form of the disorder. Evidence has underscored the critical role of the thalamus, mesial temporal region, basal ganglia and cerebellum, along with the cortex, in the propagation, termination, and modulation of seizure activity. We examined time variant patterns of interaction within and between 7 cortical and 4 subcortical systems in 55 healthy controls and 56 patients with TLE (n = 40 with FBTCS+ and 15 without), isolating those patterns most distinctive of FBTCS+ utilizing tools from dynamic network neuroscience on …