Orthopedics Commons^™

Is Your Cyst Really A Ganglion Cyst? A Case Report Of Angioleiomyoma Mimicking A Plantar Fascia Cystic Lesion, Christopher Anjorin Ms Dpmc, Joseph Bender Dpm

School of Podiatric Medicine - Student Research

Ganglion cysts are among the most common benign soft tissue masses encountered in podiatric clinical practice, and their diagnosis is often presumed based on location, clinical observation, and transillumination. However, this case highlights a diagnostic idiosyncrasy: a lesion clinically presumed to be a ganglion cyst within the plantar fascia was ultimately identified as an angioleiomyoma following surgical excision and histopathological evaluation. This finding underscores the importance of maintaining a broad differential diagnosis when assessing cystic lesions, particularly those that transilluminate, as benign vascular tumors may closely mimic more common entities in both clinical presentation and imaging. More importantly, what if …

Higher Mortality And Distinct Complications After Anterior Cervical Discectomy And Fusion In Dialysis Patients, Despite Improvements Over Prior Decade: A National Inpatient Study, Mitchell K. Ng, Leonidas E. Mastrokostas, Paul G. Mastrokostas, William A. Green, Joshua Mathew, Gregorio Baek, Yasmine Eichbaum, Yulia Lee, Morgan Hitchner, Jonathan Dalton, Adam Fano, Alec Giakas, Rajendra Singh, Brendan Reitman, Afshin E. Razi, Daniel R. Fassett, Alan S. Hilibrand, Alex R. Vaccaro, Christopher K. Kepler, Gregory D. Schroeder, Andrew P. Alvarez

Rothman Institute Papers

Introduction: Dialysis patients undergoing anterior cervical discectomy and fusion (ACDF) face elevated perioperative risk due to complex comorbidities. This study aimed to (1) identify associations between dialysis status and perioperative complications after ACDF, (2) quantify differences in length of stay (LOS), hospitalization costs, and discharge disposition, and (3) provide a contemporary national benchmark for outcomes in this high-risk population. Materials and Methods: The 2016–2022 National Inpatient Sample was queried for adult elective ACDF cases. Dialysis dependence was identified through International Classification of Diseases-10 codes for end-stage renal disease with hemodialysis or peritoneal dialysis. Demographics, comorbidities, complications, LOS, costs, and discharge …

What Factors Do Patients Consider When Choosing A Hand Surgeon?, Monik Debkowska, Jeremy Ruskin, Brian Lynch, Samuel Caradonna, David Komatsu, Edward Wang, Samantha Muhlrad

Stony Brook Orthopaedic and Musculoskeletal Journal

Introduction: Many patients find themselves frustrated wasting time and money when searching for the right hand specialist, only to be referred to a different one. There has been little research evaluating patient decision making when choosing a hand surgeon. Specialists would benefit from learning how to optimize their practice to reach their appropriate patient population for maximum benefit and minimum resource waste, both for the patients and physicians. We therefore conducted a survey study to evaluate which factors patients consider important when choosing a hand surgeon, and if these factors differ based on patient demographics. Our hypothesis is that patients …

Intravenous Versus Oral Tranexamic Acid In Shoulder Arthroplasty, Tarishi Parmar, Akin Adio, Mohammad Daher, Adam Khan, John Horneff, Joseph A. Abboud

Rothman Institute Papers

PURPOSE: Tranexamic acid (TXA) is used in shoulder arthroplasty to reduce blood loss. While intravenous (IV) TXA is standard, oral TXA offers advantages in cost and administration. This study compares 90-day complications and postoperative laboratory values between IV and oral TXA in total shoulder arthroplasty (TSA).

METHODS: A retrospective cohort study using TriNetX identified adults undergoing primary TSA (2005-2025) receiving TXA on the day of surgery, stratified by route (IV vs. oral). One-to-one propensity score matching was performed. Ninety-day outcomes included transfusion, thromboembolic events, cardiac and renal complications, neurologic events, infection, wound dehiscence, readmissions, emergency department visits, opioid utilization, and …

Full Issue: Volume 4, Issue 1 - 2026

Bone Bulletin

i - Editors’ Note by Elijah Hoffman and Liam Gibbons

ii - Foreword by Dr. Alan Hilibrand

7 - Clinical Uncertainty in Digital Monitoring After Shoulder Arthroplasty by Abhi Pandey

10 - The Changing Value of Joint Arthroplasty Under the RVU System by Kiley Hamou

13 - SCALPEL TO ROBOT TO ALGORITHM: Robotics, Artificial Intelligence, and the Evolution of Spine Surgery by Mateja Stefanovic

18 - Suture-Free Nerve Repair in Upper-Extremity Surgery by Adam Gaughan

20 - The Impact of Wide-Awake Local Anesthesia No Tourniquet Surgery on Distal Radius Fracture Plating by Michael Carey

23 - Unicompartmental Versus Total Knee …

Biologic Adjuncts In Hand Surgery: Current Evidence, Limitations, And Clinical Implications, Joseph Kelly

Bone Bulletin

Introduction Biologic therapies such as platelet-rich plasma (PRP) and mesenchymal stem cell (MSC) based treatments, have gained substantial attention across orthopaedics as agents that may enhance tissue healing and modulate inflammation.^1,4 Their use has expanded in the management of degenerative joint disease, tendinopathies, and fracture nonunion across multiple subspecialties within the field.^1,3,6 Despite the developing research base, prior hand-focused reviews have noted that orthobiologics in hand surgery remains an underdeveloped area, leaving limited guidance available to inform clinical decision making.^1-2

Optimizing Total Knee Arthroplasty In Young Patients: Strategies For Enhancing Durability And Function, Bridger Bell

Bone Bulletin

Introduction

The subspecialty of orthopaedics focuses on the prevention, diagnosis, and treatment of diseases and injuries impacting the musculoskeletal system.1 Within orthopaedics, surgery for arthritis and related conditions make up half of those performed.² Of the surgical interventions for arthritis, total knee arthroplasty (TKA) is one of the most frequent, with over 700,000 performed per year in the United States and an expectation that nearly one million will be performed by 2030.3 Interestingly, since the 1980s, the prevalence of surgery in younger patients has continually increased.⁴ This has been accompanied by a declining average age of primary TKA …

Hazards For The Female Athlete: Disparities In Acl Injury Risk And The Evolving Research Base, Abby Skiena

Bone Bulletin

Introduction

Sex plays a significant role in sports medicine risk factors, but historically, there has been a lack of research involving female participants and investigating physiologic factors unique to female athletes.^1–4 Male athletes face a 2.26 times higher risk of hip and groin injuries, a 2.4 times higher risk of hamstring injuries, and a 1.8-2.8 times higher risk of acute fractures, especially in competitive situations.² Alternatively, female athletes experience a 2-8 times higher rate of anterior cruciate ligament (ACL) injuries, a 3.4 times higher risk of bone stress injuries, a 1.25 times higher rate of foot and ankle …

Outcomes In Robotic Knee Surgery, Tyler West

Bone Bulletin

Introduction

Total knee arthroplasty (TKA) is one of the most common orthopedic surgeries worldwide and is the mainstay for treating severe knee arthritis. In the United States, surgeons perform over 700,000 TKAs each year, and that number is expected to climb as osteoarthritis becomes more common in an aging population.^1,2 Roughly, two TKAs are completed for every one total hip arthroplasty (THA) and yet patient satisfaction after TKA has always lagged behind the THA.³ Hip replacements routinely see satisfaction rates above 90 percent.^2,3 For knees, however, satisfaction rates historically have fallen between 80 and 89 percent.^{4 …}

Conceptual Frameworks, Evolving Technology, And Common Misconceptions: How Orthopedic Hand Surgeons Choose Fracture Fixation Technique, Sudesh Jaisi

Bone Bulletin

Fracture fixation is often taught as a binary decision between operative and nonoperative management, which fails to reflect the complexity of real-world clinical decision-making. This article analyzes fracture fixation through a conceptual, fracture personality-based framework incorporating biomechanics, fracture characteristics, patient-specific factors, and evolving implant technology. Clinical decision-making is best understood as a spectrum of interventions, where multiple fixation strategies may be technically appropriate but differ in invasiveness, stability, complication risk, and functional recovery. Across representative fracture types, including distal radius and olecranon injuries, management is driven by fracture stability, anticipated behavior under physiologic load, and patient functional demands rather than …

Unicompartmental Versus Total Knee Arthroplasty In Osteoarthritis: Indications, Outcomes, And Value-Based Care, Spencer Uggla

Bone Bulletin

Introduction

Knee osteoarthritis (OA) is a highly prevalent and disabling condition, affecting an estimated 654 million people worldwide in 2023. It is the most common diagnosis among patients over 45 years of age who present with activity-related knee pain.1 When nonoperative management fails, surgical intervention is frequently required to relieve pain and restore function. Traditionally, total knee arthroplasty (TKA) has been considered the gold standard surgical treatment for advanced OA, with approximately 700,000 procedures performed annually and projections exceeding 1 million by 2030.²

The Impact Of Wide-Awake Local Anesthesia No Tourniquet Surgery On Distal Radius Fracture Plating, Michael Carey

Bone Bulletin

Introduction

The surgical technique known as wideawake local anesthesia no tourniquet (WALANT) has been widely used in soft tissue hand procedures since 2005.1 A local surgical field block using lidocaine with epinephrine provides local anesthesia and hemostasis via alpha-1 adrenergic agonism without the need for general anesthesia with a tourniquet. In addition to reducing costs related to general anesthesia (GA), WALANT procedures are suitable for American Society of Anesthesiologists Physical Status Classification 4 (ASA 4) high-risk patients, specifically by eliminating anesthesia risks such as nausea, aspiration, pneumonia, and thromboembolism, all while maintaining or improving clinical outcomes compared with the current …

Suture-Free Nerve Repair In Upper-Extremity Surgery, Adam Gaughan

Bone Bulletin

Introduction

Peripheral nerves have a limited capacity to regenerate.¹ Treating peripheral nerve injuries and the ensuing recovery of sensory and/or motor function are challenging for surgeons due to a number of variables that impact nerve recovery; including, the mechanism of nerve transection, the level or distance of injury relative to the target organ, patient age and comorbidities, and the repair technique employed. Most factors are not modifiable, but repair techniques are modifiable and can have a meaningful impact on outcomes. Nerve repair opt ions inc lude di r e ct end- to- end r epai r (neurorrhaphy), conduit-assisted repair, …

Scalpel To Robot To Algorithm: Robotics, Artificial Intelligence, And The Evolution Of Spine Surgery, Mateja Stefanovic

Bone Bulletin

Introduction

The past five decades in spine surgery have seen innovations in pedicle screw fixation, image-guided navigation, and first-generation robotics; each change was confronted with skepticism for uprooting existing paradigms until pushback inevitably yielded progress. Artificial intelligence (AI) and machine learning (ML) feel different in kind. Beyond better instrumentation, they represent entirely new frameworks for processing clinical information at unprecedented scale and speed. A neural network trained on thousands of preoperative records can learn to detect interactions among imaging findings, laboratory indices, functional variables, and comorbidity burden that conventional statistical models are structurally unable to identify.¹˒² Simultaneously, robotic platforms outfitted …

The Changing Value Of Joint Arthroplasty Under The Rvu System, Kiley Hamou

Bone Bulletin

Background and Introduction of Total Knee Arthroplasty

Few procedures in modern medicine illustrate the value of surgical advancement more clearly than total hip and total knee arthroplasty. Over the past several decades, advances in surgical technique, pre-operative management, and postoperative rehabilitation have transformed joint replacement into one of the most successful procedures in medicine. Patient satisfaction rates routinely exceed 90% and millions of individuals regain mobility, independence and quality of life each year through these operations.¹ However, despite this clinical success and societal value, physician reimbursement for joint replacement surgery and many other successful orthopedic procedures has steadily declined. …

Clinical Uncertainty In Digital Monitoring After Shoulder Arthroplasty, Abhimaneu Pandey

Bone Bulletin

Introduction

Wearable sensor technology and smartphone based care platforms have been identified as promising technologies for postoperative care after joint arthroplasties.^1,2 In fact, in lower extremity arthroplasty, these technologies have already demonstrated their effectiveness in a multitude of randomized trials.^1,2 One recent multicenter RCT with 401 patients undergoing primary total knee arthroplasty (TKA) showed that self-directed rehabilitation using a smartwatch and mobile application (mymobility with Apple Watch, Zimmer Biomet) achieved comparable range of motion and patient-reported outcomes measures (PROMs) to standard post-operative rehab without increasing adverse events.¹ Related evidence also indicates that “episode of care” smartphone applications …

Foreword, Alan S. Hilibrand, Md, Mba

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 oversee the fourth 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 to receive support for their application to the specialty. The Bone Bulletin has provided a great opportunity for our orthopaedic surgery faculty members at Rothman Orthopaedics to mentor younger students interested in the field of orthopedic surgery. This is one of the many initiatives the …

Editors' Note, Elijah Hoffman, Liam Gibbons

Bone Bulletin

It is our pleasure to present the fourth edition of the Bone Bulletin, DePalma Orthopaedic Society’s student-run journal for Sidney Kimmel Medical College (SKMC) students. The journal provides a unique opportunity for medical students to be involved with scholarly work in orthopaedics, often representing their first experience with orthopedic scholarship and academic writing. Through the journal, students gain valuable experience in orthopedic research and scientific writing with close mentorship from the renowned physicians of Rothman Orthopaedics.

Each year, the journal has grown in scope and impact, addressing new topics in orthopaedics. We are thrilled to introduce our new contributors …

Clinical Outcomes After Ulnar Collateral Ligament Reconstruction With Palmaris Longus Versus Gracilis Autograft In Baseball Players: A Cohort Analysis, Michael C. Ciccotti, Brooks Martino, Frank Cautela, Nathaniel Tchangou, Daniel Kwak, Eric Didomenico, Harrison S. Fellheimer, Christopher C. Dodson, Steven B. Cohen, Michael G. Ciccotti

Rothman Institute Papers

BACKGROUND: Ulnar collateral ligament (UCL) reconstruction (UCLR) is a common procedure for overhead athletes, particularly baseball players sustaining partial or full UCL tears. Palmaris longus (PL) and gracilis (GR) autografts are the most frequently used graft sources, yet limited data compare clinical outcomes in baseball athletes.

PURPOSE: To compare patient-reported outcomes after UCLR with PL versus GR autografts in baseball players.

STUDY DESIGN: Cohort study; Level of evidence, 3.

METHODS: Patients who underwent isolated UCLR with either PL or GR autograft and a minimum of 2 years of follow-up were identified. All reconstructions were performed using the Modified Jobe or …

Tranexamic Acid In High-Risk Shoulder Arthroplasty Patients: Safety Across Thromboembolic, Cardiac, Renal, And Neurologic Risk Profiles, Tarishi Parmar, Akin Adio, Asim Handy, Mohammad Daher, Alec Kellish, Adam Khan, Joseph A. Abboud

Rothman Institute Papers

INTRODUCTION: Tranexamic acid (TXA) effectively reduces blood loss and transfusion requirements in shoulder arthroplasty. However, concerns regarding thromboembolic, neurologic, cardiac, and renal complications have limited its use in medically high-risk patients. This study evaluated temporal trends and the safety of TXA in high-risk patients undergoing total shoulder arthroplasty (TSA).

METHODS: A retrospective cohort study was conducted using TriNetX, identifying patients who underwent shoulder arthroplasty (2012-2025). Patients were stratified by preexisting high-risk conditions, including prior thromboembolism, renal failure, atrial fibrillation, seizure disorders, and visual disturbances. Within each subgroup, patients receiving TXA were propensity score-matched to those who did not. Perioperative TXA …

Transforaminal Endoscopic Lumbar Decompression: Defining Its Scope And Limitations, Kai-Uwe Lewandrowski, Álvaro Dowling, Jun Ho Lee, Benedikt W Burkhardt, Óscar L. Alves, Avelino Parajón, Jorge Felippe Ramirez, Nicola Montemurro, Alex R. Vaccaro, Morgan P. Lorio

Department of Orthopaedic Surgery Faculty Papers

BACKGROUND: Transforaminal endoscopic lumbar decompression (TELD) has emerged as a minimally invasive alternative for managing lumbar stenosis and disc herniations. While the literature consistently reports favorable outcomes, real-world adoption remains variable, with discrepancies often linked to surgeon experience and case complexity.

OBJECTIVE: To evaluate surgeon perspectives on the clinical applicability of TELD across different pathologies and compare these findings with published evidence.

METHODS: An international cross-sectional survey was conducted among spine surgeons. Responses were analyzed using Rasch modeling to assess consensus levels, with agreement categorized as strong, moderate, weak, or disagreement. Differential Item Functioning (DIF) and correlation analyses were applied …

Myelomalacia Severity On Preoperative Magnetic Resonance Imaging Does Not Predict Patient-Reported Outcomes After Anterior Cervical Discectomy And Fusion, Mitchell K. Ng, Joshua Mathew, Robert J. Oris, Yulia Lee, Jonathan Dalton, Gregorio Baek, Ashley Thommana, William A. Green, Yasmine Eichbaum, Morgan Hitchner, Brandon Martinazzi, Ali Farooqi, Alec Giakas, Paul Gunter, Vinay Bijoor, Andrew Vanchikorn, John J. Mangan, David I. Kaye, Mark F. Kurd, Thomas Cha, Jose A Canseco, Alan S. Hilibrand, Alexander R. Vaccaro, Christopher K. Kepler, Gregory D. Schroeder

Department of Orthopaedic Surgery Faculty Papers

STUDY DESIGN/SETTING: Retrospective cohort study.

BACKGROUND: Signal changes within the spinal cord on magnetic resonance imaging (MRI) or myelomalacia, are frequently seen in patients with cervical myelopathy. While often assumed to predict the outcomes, their prognostic value remains uncertain. Therefore, this study aimed to: (1) describe the clinical characteristics of patients with myelomalacia undergoing Anterior cervical discectomy and fusion (ACDF); (2) evaluate whether MRI findings correlate with patient-reported outcomes (PROMs); and (3) determine whether morphology predict recovery.

METHODS: A retrospective review at a single tertiary care center was performed (2014-2021). Patients were included if they underwent a primary elective ACDF …

Does Staff Education Increase Sequential Compression Device Utilization: A Retrospective Study, Devin Q. John, Vincent Lee, Akshay V. Daji, Hans Lapica, Connor Donley, Matthew J. Mccrosson, Nino Coutelle, Carlos Fernandez, Diego Lima

HCA Healthcare Journal of Medicine

Background

Venous thromboembolism (VTE) is a significant perioperative safety concern among orthopedic patients, with an incidence of 0.4%-1.0% and a substantial risk of chronic complications. Sequential compression devices (SCDs) are recommended for VTE prophylaxis, yet compliance remains suboptimal due to staff misconceptions. This study evaluates the impact of a resident-led educational intervention on SCD utilization among nursing staff in orthopedic postoperative care.

Methods

This retrospective study was conducted at 2 hospitals (HCA Florida JFK Hospital and HCA Florida Palms West Hospital). Nursing staff participated in a single educational session addressing SCD benefits, application techniques, and operational protocols. Data on SCD …

Non-Tobacco Nicotine Dependence Is Associated With Increased Complications Following Clavicle Open Reduction Internal Fixation, Akin A. Adio, Rahul K. Goyal, Abby Skiena, Mohammad Daher, John G. Horneff, Hafiz F. Kassam, Brian W. Hill, Joseph A. Abboud

Rothman Institute Papers

BACKGROUND: Tobacco dependence is well established to impair bone healing and increase postoperative complications. However, the independent effects of nicotine, separate from combustion-related factors, remain unclear. This study aimed to evaluate the impact of non-tobacco nicotine dependence (NTND) following open reduction and internal fixation (ORIF) of clavicle fractures, including midshaft and lateral fracture subtypes.

METHODS: A retrospective cohort study was performed using a large national database. Patients undergoing ORIF of clavicle fractures were identified using procedural and diagnostic codes. Patients with non-tobacco nicotine dependence (e.g., vaping, patches, or gum) were identified and propensity score matched to (1) patients without nicotine …

Loss Of Mct1 Mediated Lactate Uptake Causes Delayed Endplate Maturation And Intervertebral Disc Degeneration, Maria Tsingas, Konstantinos Tsingas, Mei Smyers, Wujuan Zhang, Aaron R. Goldman, Eulisa Lawrence, John A. Collins, Makarand V. Risbud

Department of Orthopaedic Surgery Faculty Papers

During skeletal growth, it is thought that the lactate secreted by the glycolytic nucleus pulposus (NP) cells exits the intervertebral disc into circulation via endplates. Our current studies challenge this long-held notion. Mice with early postnatal, endplate, and annulus fibrosus-specific deletion of lactate importer, MCT1, exhibited disc degeneration characterized by NP cell loss and pronounced endplate structural changes. Using metabolic and transcriptomic approaches, we demonstrate that MCT1 loss inhibits endplate chondrocyte differentiation and that lactate serves both as a crucial TCA metabolite and promotes protein and histone lactylation and gene expression. These findings suggest that during skeletal growth, NP-derived lactate …

A Decade Of Leadership And Impact: Celebrating 10 Years Of The Ors Spine Section, Makarand V. Risbud

College of Life Sciences Faculty Papers

No abstract provided.

Silent Bones, Visible Changes: Increasing Osteoporosis Screening At Swedish Fmr, Alissa Kummer, Devin Beecher, Tara Ahmadi, Amanda Maxwell

All Podium Presentations

No abstract provided.

Mri-Based Deep Learning Radiomics Model For Automated Classification Of Disc Degeneration In The Lumbar Spine, Shiv Patil, Om Gandhi, Mert Karabacak, Matthew Carr, Konstantinos Margetis

Student Papers, Posters & Projects

Disc degeneration in the lumbar spine is a major cause of low back pain (LBP). The accurate grading of disc degeneration on magnetic resonance imaging (MRI) is critical for clinical management and patient selection for spine surgery. This study aims to develop and evaluate machine learning (ML) models that combine features from deep learning (DL) and radiomics for the automated prediction of Pfirrmann grade (PG), a measure of disc degeneration, using multi-parametric lumbar spine MRI. Sagittal T1, T2, and T2 SPACE MRIs of 218 patients with LBP were acquired from the SPIDER dataset. For each intervertebral disc and available sequence, …

Joint Disease And Demographic Factors In Clinical Populations Of Medically Underserved Communities, Blake C. Martin, Juan Lopez-Alvarenga, Michael Sander

School of Medicine Publications

Background: The Rio Grande Valley is a medically underserved, demographically unique population that warrants the exploration of various conditions.

Objectives: We sought to analyze the demographic disparities between the different types of common joint conditions in this community. We hypothesized that osteoarthritis would be the most common joint condition and that the demographics between the various joint conditions would vary depending on age, sex, BMI, and ethnicity.

Methods: This was a retrospective cohort, from January 1, 2018, to September 4, 2024. Patients’ charts were obtained using the ICD-10 diagnosis codes M15-M19 for osteoarthritis, M05-M06 for rheumatoid arthritis, M10 or M1A …

Comparative Effectiveness Of Liposomal Bupivacaine And Regional Nerve Blocks For Analgesia After Total Knee Arthroplasty, Ahmed Makled, Amir Ghafarian, Jawad Saad, Muhammed Zahriyeh, Muaaz Wajahath, Khaled Saleh

Medical Student Research Symposium

Title: Comparative Effectiveness of Liposomal Bupivacaine and Regional Nerve Blocks for Analgesia After Total Knee Arthroplasty

Introduction: Liposomal bupivacaine (Exparel) has been adopted in total knee arthroplasty (TKA) as a long-acting local anesthetic. However, its comparative effectiveness against standard regional anesthesia techniques, such as femoral or adductor canal block, remains insufficiently defined. This study evaluates postoperative analgesic utilization following TKA among patients receiving Exparel, regional blocks, or no regional intervention, using matched cohorts from a large national dataset.

Methods: Patients who underwent primary TKA between January 1, 2005 and January 1, 2025 were retrospectively identified from a multi-institutional electronic medical …