Medical Specialties Commons^™

Predicting Running Ability After Lower Extremity Amputation: A Review, Rebecca Dutton

Western Journal of Orthopaedics

The ability to ambulate with a prosthesis after lower extremity limb loss is an important determinant of functional independence and quality of life. Some individuals may be capable of achieving higher levels of mobility (eg, running) that can further improve function, physical health, and mental health. Thus, a fundamental understanding of the variables that help predict ambulation ability after lower limb loss is important. Particular attention should be given to modifiable predictors, as interventions directed at these conditions can help facilitate optimal mobility and function. This article reviews various factors that influence the ability

Malreductions Following Intramedullary Nail Fixation Of Femur Shaft Fractures, Jory Wasserburger, Christopher Kurnik, Thomas A. Decoster

Western Journal of Orthopaedics

Femur shaft fractures are common injuries frequently treated with intramedullary fixation. Although satisfactory alignment is usually achieved, malreductions can happen in sagittal and coronal planes, as well as along the longitude axis. The causes of malposition with femoral nailing include fracture location, comminution, and suboptimal technique. We identify the most common patterns of malreduction of nailed femu

Cost Analyses Of Nonoperative Treatment Of Sports-Medicine Conditions Are Lacking, Casey Slattery, Jai Yao, Amy Cizik, Mia S. Hagen

Western Journal of Orthopaedics

The purpose of this study was to qualitatively review existing studies that examined cost data within sports medicine. A literature search was conducted for all economic studies related to sports-medicine conditions from 2000 to 2017 within the United States. Area of analysis, data source utilized, and the type of collected cost data was identified. There were 29 studies that met criteria, with the majority of studies (60%) focused on rotator cuff repair and anterior cruciate ligament reconstruction. Substantial variability in data source, practice setting, data metrics, and reported measures makes interpretation of existing reports challenging. Greater diversity in topics and …

Can The Contralateral Knee Effectively Estimate Pre-Injury Patellar Height? A Control Study, Benjamin Albertson, Andrew Ockuly, Ian Fletcher, Daniel Wascher

Western Journal of Orthopaedics

Introduction: Patellar height abnormalities have been associated with patellar instability, which is common among adolescents and young adults. Pre-injury patellar height is often unknown in patients with a patellar instability episode. The purpose of this study was to determine whether patellar height of one knee could effectively estimate patellar height of the contralateral knee in control patients between the ages of 13 and 25 years. Methods: A retrospective chart review was conducted to identify 40 patients who obtained bilateral knee radiographs with no prior surgical intervention or diagnosis of injury to the extensor mechanism. CatonDeschamps Index (CDI) was measured by …

The Vulcan Sign: A Radiographic And Clinical Indicator Of Plantar Plate And Collatoeral Ligament Injury, Katherine Gavin

Western Journal of Orthopaedics

Introduction: There is no consensus on terminology used to describe the radiographic and clinical findings commonly encountered in second metatarsophalangeal (MTP) instability. We propose the use of a consensus term, the Vulcan sign, to describe the deformity commonly seen in second MTP instability and verify its utility as an adjunct in the diagnosis and treatment of plantar plate and collateral ligament pathology. Methods: We retrospectively evaluated preoperative anteroposterior weight-bearing x-rays of 156 feet of patients who underwent operative intervention for second MTP instability and the presence of a Vulcan sign at the second webspace, defined as more than 50% medial …

The Importance Of The Screening Anteroposterior Pelvis Radiograph In Trauma Patients: A Level-1 Trauma Center's Experience With Traumatic Hip Dislocations, Ansab Khwaja, Brad Askam, Matt Morin, Aditya Manoharan

Western Journal of Orthopaedics

Background: Advanced Trauma Life Support guidelines strongly recommend obtaining anteroposterior (AP) pelvis radiographs when evaluating patients with traumatic injuries. Recently, there has been a trend at our institution to forego AP pelvis radiographs, and to obtain computed tomography (CT) scans as the initial imaging modality of the pelvis instead. Lifesaving interventions, such as the application of a pelvic binder, can be delayed due to the time it takes to complete a primary survey and a CT scan. This study aims to evaluate the effects of bypassing an AP pelvis radiograph on the management of acute traumatic dislocations of the hip. …

Inter- And Intra-Observer Differences In Proximal Fifth Metatarsal Fractures, Benjamin Packard, Kathryn Yeagar, Richard A. Miller, Katherine Gavin

Western Journal of Orthopaedics

Introduction: Proximal fifth metatarsal fractures are common. When using the Lawrence and Botte Classification for these injuries, they are classified as type 1, 2, and 3. Identifying the zone of injury is crucial to guide treatment. The authors hypothesize that interand intra-observer reliability of these fractures is low. Methods: Anteroposterior (AP), lateral, and oblique x-rays of 60 patients with isolated fifth metatarsal base fractures were reviewed. Five physicians evaluated the radiographs and classified the fractures as type 1,2, or 3. Each of the three radiographic views were examined separately. Results were then analyzed for inter- and intra-observer reliability. Results: Sixty …

Quantifying Coverage Of A Distal Radius Volar Plate Using A Novel Pronator Quadratus Rotational Muscle Flap Technique, Christina Salas, Leslie Neher, Joshua Romero, Camille Aubin-Lemay

Western Journal of Orthopaedics

Background: Flexor tenosynovitis and tendon rupture are rare, yet serious complications after treatment of a fractured distal radius with a volar plate. The highest incidents of rupture are associated with the plate on or distal to the watershed line of the radius. While studies have shown that reattachment of the pronator quadratus (PQ) following plating does not lead to improved measures in grip strength or range of motion, it may reduce the incidence of these complications. Reattachment of the PQ after a standard approach does not often capture the distal edge of the plate. We report results of a new …

Aspetic Nonunion Of Long Bones In Children: A Report Of Twelve Cases, Rami Khalifa, Amr Abdelgawad, Ahmed M. Thabet

Western Journal of Orthopaedics

Background: There are very few reports in the literature that directly address nonunion in children. The current study aimed to present a series of long bones nonunion in children following fractures and corrective osteotomies. Methods: This was a retrospective study that included pediatric patients diagnosed with nonunion following long bone fractures or corrective osteotomies. Patients with nonunion following femoral neck or lateral humeral condyle fractures were excluded. The clinical and radiological records were retrospectively analyzed. Results: Eight patients developed nonunion after fractures, while four patients had nonunion after corrective osteotomies. The mean age at the time of surgical procedure for …

The Versatility Of Taylor Spatial Frame In Treating Comple Posttraumatic Deformities Of The Lower Extremity, Rami Khalifa, Amr Abdelgawad, Ahmed M. Thabet

Western Journal of Orthopaedics

Background: The Taylor Spatial Frame (TSF) is a multiplanar external fixator with a computerized web-based program to provide accurate fractures reduction and deformity correction. This study aimed to evaluate our results after the treatment of complex lower extremity injuries with the external fixators including TSF. Methods: This retrospective case series included eight patients with complex lower extremity injuries treated with TSF. The medical records and radiographs were reviewed. The ASAMI score was used as an outcome measure. Statistical analysis used Microsoft Excel descriptive statistics. No inferential statistical tests were done owing to the small sample size. Results: The mean age …

The University Of New Mexico Orthopaedics Research Journal 2020, Unm Department Of Orthopaedic Surgery

Western Journal of Orthopaedics

No abstract provided.

Evolving Role For Pharmacotherapy In Nafld/Nash, Suzanna L. Attia, Samir Softic, Marialena Mouzaki

Pediatrics Faculty Publications

Nonalcoholic fatty liver disease (NAFLD) is a highly prevalent, dynamic disease that occurs across the age spectrum and can lead to cirrhosis and hepatocellular carcinoma. There are currently no US Food and Drug Administration (FDA) approved treatments for NAFLD; however, this is a field of active research. This review summarizes emerging pharmacotherapies for the treatment of adult and pediatric NAFLD. Investigated pharmacotherapies predominantly target bile acid signaling, insulin resistance, and lipid handling within the liver. Three drugs have gone on to phase III trials for which results are available. Of those, obeticholic acid is the single agent that demonstrates promise …

Front Matter, Unm Department Of Orthopaedic Surgery

Western Journal of Orthopaedics

No abstract provided.

Mesh Plate Fixation For Complex Patella Fractures: A Surgical Technique, Rami Khalifia, Eric Potter, Sherif Dabash, Richard S. Yoon

Western Journal of Orthopaedics

Different types of low-profile plates have been designed for fixation of complex patellar fractures. Plate fixation of patella fractures provides stable fixation and allows earlier mobilization. This report describes three cases of complex patellar fractures. The report includes a detailed description and tips of the surgical technique

Osteomalacia In A Young Adult Male Presenting As Chronic Wrist Pain: A Case Report, Daniel Gonzales-Luna, Dean W. Smith

Western Journal of Orthopaedics

Chronic wrist pain is a common problem encountered by orthopaedic surgeons, yet osteomalacia is rarely considered in the differential diagnosis in the United States. We present a case involving a 37-year-old man who experienced bilateral wrist pain and weakness for more than 2 years. Further investigation revealed a history of chronic leg pain, low serum 25-hydroxy vitamin D levels, and decreased bone density. He was diagnosed with osteomalacia and treated with vitamin D supplementation and increased sun exposure. At 6 months follow-up, the patient had resolution of his pain and normalized vitamin D levels. To our knowledge, the literature has …

Single-Event Multilevel Surgery Of The Upper Extremity: A Case Report, Elizabeth Mcleod, Lacey Floyd, Justin Bartley

Western Journal of Orthopaedics

Single-event multilevel surgery has been used successfully to treat pediatric patients with cerebral palsy for decades; however, it has not been widely used to treat adult patients. Tendinopathies of the arm often coexist, and performing single event surgery to correct one joint pathology may further exacerbate coexisting tendinopathies. Accordingly, performing single-event multilevel surgery in the appropriate patient allows for the correction of multiple conditions of the same limb in a single surgery. Single-event multilevel surgery offers many benefits, including cost savings, convenience for the patient, less potential complications owing to a single anesthetic and hospitalization event, and a shorter overall …

Systematic Review Of Cost-Effective Analyses In Sports Medicine From 2014 To 2020, Casey Slattery, Mia S. Hagen, Amy Cizik, Albert O. Gee

Western Journal of Orthopaedics

The quality of recent cost-effectiveness studies and whether there is sufficient evidence to achieve valuebased health care in sports medicine are unknown. The purpose of this study was to perform a systematic review of recent cost-effective analyses (CEA) in sports medicine to determine the quality of publications from the last 6 years. A literature search was conducted for CEA studies on diagnostic tests, treatment options, and surgical procedures for sports medicine-related conditions between 2014 and 2020 in the United States. Two reviewers scored each study using the Quality of Health Economic Studies (QHES) instrument to assess methodological quality. Eighteen CEA …

Measurement Of Femoral Notch Type Show Low Inter-Rater Reliability, Evan D. Boyd, Michael S. Barnum, James R. Saluterbeck, Pamela M. Vacek

Western Journal of Orthopaedics

Background: Preventing first time anterior cruciate ligament (ACL) injury and the devastating sequela of post-traumatic osteoarthritis in the young athlete has attracted efforts to identify risk factors for development of ACL injury. Femoral notch type has been related to risk of ACL injury in previous studies. However, little data exists to support the reliability of assessing this qualitative measurement amongst independent investigators. Methods: Femoral notch type was measured from magnetic resonance imaging sections of 344 injured ACL and control knees by three investigators with different levels of professional experience. Inter-rater reliability was assessed using Cohen’s kappa statistic. Results: The simple …

Combined Open Calcaneocuboid, Naviculocuneiform And Subtalar Dislocation: A Case Report And Literature Review, Khai Phang Wong, Zhi Hao Tang, Gek Meng Tan

BioMedicine

Open dislocations of the midfoot and subtalar joints are extremely rare injuries. Understanding the anatomy of these joints and the various injury patterns is imperative to obtain stable concentric reduction and provide good functional outcome. We present a report of a 26- year old male who was involved in a road traffic accident and sustained open dislocations of the calcaneocuboid, naviculocuneiform and subtalar joints. He initially underwent external fixation in view of the severe soft tissue injury. After improvement of the soft tissue condition, he underwent K-wiring of the calcaneocuboid joint, buttress plating of the talonaviculocuneiform joint, peroneal tendon reconstruction …

Acute Kidney Injury Caused By Levetiracetam In A Patient With Status Epilepticus, Burak Erdinc, Snigdha Ghanta, Alexander Andreev, Karim O Elkholy, Sonu Sahni

Touro College of Osteopathic Medicine (New York) Publications and Research

Levetiracetam is a widely used, effective and usually well-tolerated anti-epileptic medicine. It is mostly excreted by kidneys and requires dose adjustment according to the glomerular filtration rate. Very few case reports have been published in the literature about levetiracetam causing acute kidney injury (AKI). We present a case of a 26-year-old male with a seizure disorder on levetiracetam, presented with status epilepticus requiring intubation for airway protection. He received 4 g of intravenous levetiracetam as a loading dose and continued with a maintenance dose of 750 mg intravenous every 12 hours. He had signs of AKI on day two and …

Effects Of A Postnatal Atrx Conditional Knockout In Neurons On Autism-Like Behaviours In Male And Female Mice., Nicole Martin-Kenny, Nathalie G Bérubé

Paediatrics Publications

BACKGROUND: Alpha-thalassemia/mental retardation, X-linked, or ATRX, is an autism susceptibility gene that encodes a chromatin remodeler. Mutations of ATRX result in the ATR-X intellectual disability syndrome and have been identified in autism spectrum disorder (ASD) patients. The mechanisms by which ATRX mutations lead to autism and autistic-like behaviours are not yet known. To address this question, we generated mice with postnatal Atrx inactivation in excitatory neurons of the forebrain and performed a battery of behavioural assays that assess autistic-like behaviours.

METHODS: Male and female mice with a postnatal conditional ablation of ATRX were generated using the Cre/lox system under the …

Congenital Pulmonary Airway Malformation (Cpam): An Interesting Ent Consultation., James Ding, Lauren E Melley, Alexander Manteghi

Otolaryngology (ENT) Resident Research

A 13-month-old boy was referred to the emergency department from the pediatrician’s office for increased shortness of breath. A 2-view chest X-ray was ordered revealing right hemithorax hyperlucency, minimal lung markings, and leftward mediastinal shift.

Differences In Angiographic Profile And Immediate Outcome Of Primary Percutaneous Coronary Intervention In Otherwise Risk-Free Young Male Smokers, Salik Ahmed, Sanam Khowaja, Saher Khowaja, Tariq Ashraf, Kanwal Aamir, Mahesh K. Batra, Musa Karim, Muhammad Anis M. Ahmedani, Syed Z. Jamal

Section of Internal Medicine

Introduction: Cigarette smoking is a well-established risk factor for the development and progression of coronary artery disease (CAD) and it is strongly related to cardiac morbidity and mortality. Therefore, this study aimed to compare the angiographic profile and immediate clinical outcomes in young male smokers and non-smokers without any other cardiac risk factors presented with ST-elevation myocardial infarction (STEMI).
Methods: This study includes young (≤40 years) male patients presented without cardiac risk factors other than smoking. Angiographic profile and immediate outcome of primary percutaneous coronary intervention (PCI) were collected from the hospital database.
Results: A total of 580 young male …

A Silent Fatal Presentation Of Pulmonary Embolism: Reflection And Discussion., Qian Zhang, Zain U. Abideen, Khine S. Shan, Thomas Yoon, Muhammad Farooq

Abington Jefferson Health Papers

Acute pulmonary embolism is a common medical condition that clinicians face in practice. It is important to have a prompt diagnosis with proper management as it is associated with high morbidity and mortality. However, a timely diagnosis is often difficult to obtain especially when the presenting symptoms are atypical, but the consequence could be fatal. We present an 80-year-old gentleman who presented with a near-syncope episode who subsequently was found to have acute extensive bilateral pulmonary embolisms after a code blue event.

Perceptions Of Stakeholders About The Role Of Health System In Suicide Prevention In Ghizer, Gilgit-Baltistan, Pakistan, Anila Anjum, Tazeen S. Ali, Nousheen Pradhan, Murad M. Khan Dr., Rozina Karmaliani Professor

Community Health Sciences

Background: Suicide is a serious global public health problem, with more than 800,000 people dying by suicide worldwide every year. 79% of suicides happen in Low and Middle-Income Countries (LMICs), where lack of national suicide prevention programs coupled with inadequate MH facilities for early identification and treatment of mental disorders add to seriousness of the problems. Although there is paucity of research, studies suggest that the rate of suicide in district Ghizer, Gilgit-Baltistan (GB), in northern Pakistan may be higher compared to rest of the country.
Methods: This study aimed to explore the perceptions of stakeholders about the role of …

Achieving Accurate Estimates Of Fetal Gestational Age And Personalised Predictions Of Fetal Growth Based On Data From An International Prospective Cohort Study: A Population-Based Machine Learning Study, Russell Fung, Jose Villar, Ali Dashti, Leila Cheikh Ismail, Eleonora Staines-Uria, Eric O. Ohuma, Maria Carvalho, Shama Munim, Zulfiqar Ahmed Bhutta, International Fetal And Newborn Growth Consortium For The 21st Century (Intergrowth-21st)

Department of Obstetrics & Gynaecology

Background: Preterm birth is a major global health challenge, the leading cause of death in children under 5 years of age, and a key measure of a population's general health and nutritional status. Current clinical methods of estimating fetal gestational age are often inaccurate. For example, between 20 and 30 weeks of gestation, the width of the 95% prediction interval around the actual gestational age is estimated to be 18-36 days, even when the best ultrasound estimates are used. The aims of this study are to improve estimates of fetal gestational age and provide personalised predictions of future growth.
Methods: …

Emergency Department Admissions During Covid-19: Implications From The 2002-2004 Sars Epidemic, Muhammad Musaab Munir, Russell S. Martins, Asad Mian

Medical College Documents

No abstract provided.

Vitamin A And Fish Oils For Preventing The Progression Of Retinitis Pigmentosa., Stephen G. Schwartz, Xue Wang, Pamela Chavis, Ajay E. Kuriyan, Samuel A. Abariga

Wills Eye Hospital Papers

BACKGROUND: Retinitis pigmentosa (RP) comprises a group of hereditary eye diseases characterized by progressive degeneration of retinal photoreceptors. It results in severe visual loss that may lead to blindness. Symptoms may become manifest during childhood or adulthood which include poor night vision (nyctalopia) and constriction of peripheral vision (visual field loss). Visual field loss is progressive and affects central vision later in the disease course. The worldwide prevalence of RP is approximately 1 in 4000, with 100,000 individuals affected in the USA. At this time, there is no proven therapy for RP.

OBJECTIVES: The objective of this review was to …

Editorial Management Of Cardiac Patients During The Covid-19 Pandemic, Günter Breithardt, Hani K. Najm, Marko Turina, Ahmed A. Arifi

Journal of the Saudi Heart Association

No abstract provided.

Health Care Delivery For Heart Failure Patients During The Covid-19 Pandemic; A Consensus Of The Saudi Heart Failure Working Group (Saudi-Hf), Abeer Bakhsh, Maryam Alqaseer, Fakhr Alayoubi, Rima S. Bader, Kamal Alghalayini, Abdelfatah Elasfar, Waleed Alhabeeb

Journal of the Saudi Heart Association

The Coronavirus disease 2019 (COVID-19) pandemic led to global and national rapid health system changes to treat the affected patients and prevent the spread of the virus. The social distancing, redirecting resources, and nationwide lockdown led to the cancellation of non-urgent hospital visits and interruption of continuity of care for patients with chronic cardiac conditions such as heart failure (HF). This consensus document addresses the domains of health care delivery that are affected by the pandemic. It explains the current situation of health care delivery to heart failure patients and further recommendation on how to overcome this. Thus, maintaining quality …