Orthopedics Commons^™

Navigation-Assisted Percutaneous Fixation Of An Anterior Column And Posterior Hemitransverse Fracture In An Elderly Patient: A Case Report., Matthew Rohl, Taylor J Manes, Nate Rodriguez, Kevin Monahan, Joseph P Scheschuk

Surgery Articles

INTRODUCTION: Acetabular fractures in elderly patients are often the result of low-energy trauma and are complicated by osteopenia, comorbidities, and limited physiologic reserve. Minimally invasive approaches, such as percutaneous fixation have emerged as viable alternatives to open reduction in selected fracture patterns.

CASE REPORT: We report the case of a 76-year-old male with a history of coronary artery disease, hypertension, hyperlipidemia, and osteopenia who sustained a comminuted right anterior column and posterior hemitransverse acetabular fracture following a ground-level fall. His hospital course was complicated by rhabdomyolysis and elevated troponin levels, necessitating cardiac evaluation, which demonstrated normal left ventricular function and …

Acute Correction Of Acquired Genu Valgum Secondary To Post-Traumatic Growth Arrest At The Time Of Distal Femur Fracture., Josiah Wolf, Nicholas Pelz, Adam Mansour, Christopher Iobst, Allen Kadado

Surgery Articles

A 14-year-old male patient sustained a distal femur fracture after a ground-level fall. His history was notable for severe acquired genu valgum secondary to a childhood lawnmower accident, which had required multiple limb salvage procedures including a Syme amputation and soft-tissue skin grafting. Acute correction of the limb deformity was performed concurrently with fracture fixation using a retrograde intramedullary nail and poller blocking screws. Retrograde intramedullary nailing represents a viable treatment option for simultaneous acute correction of acquired genu valgum and stabilization of distal femur fractures.

Temporal Trends In The Epidemiology Of Hip Osteoarthritis In The Usa, 1990-2019: A Cross-Sectional Time-Series Study Using Gbd Data., Arsalaan Sayyed, Gabrielle Lucia Dykhouse, Taylor J Manes, Cameron Sabet, Minali Gautami Nemani, Ambrose Loc Ngo, Ayah A Ibrahim, Phillip C Mckegg, Jignesh N Patel

Ambulatory and Primary Care Articles

OBJECTIVES: To evaluate temporal trends in the epidemiology of hip osteoarthritis (OA) in the USA from 1990 to 2019, with stratification by sex and geographic region.

DESIGN: Cross-sectional time-series analysis using secondary data from the Global Burden of Disease (GBD) study.

SETTING: US population-based analysis, stratified by the four US Census Bureau regions: Northeast, Midwest, South and West.

PARTICIPANTS: De-identified, aggregate population-level data representing all adults in the USA from 1990 to 2019, drawn from the GBD database.

PRIMARY AND SECONDARY OUTCOME MEASURES: Age-standardised rates per 100 000 population for years lived with disability (YLDs), prevalence and incidence of hip …

Epidemiology Of Lower Extremity Amputations In The United States: An Analysis Of The Global Burden Of Disease Database From 1990 To 2019., Peter B Spencer, Cameron J Sabet, Gabrielle Dykhouse, Taylor J Manes, Phillip C Mckegg, Ambrose Loc T Ngo, Ayah Ibrahim, Jack Weick

Surgery Articles

BACKGROUND: Lower extremity amputations (LEAs) are medically, psychologically, and functionally devastating. The objective of our study was to evaluate region- and sex-specific differences of unilateral and bilateral LEAs across the United States (US) from 1990 to 2019.

METHODS: The Global Burden of Disease database was used to analyze years lived with disability (YLDs), prevalence, and incidence rates per 100,000 people for LEAs in the US from 1990 to 2019. Data were stratified into four US Census Bureau-defined regions: Northeast, Midwest, South, and West. Differences between regions and sexes were assessed, with statistical significance defined as p < 0.05.

RESULTS: From 1990 to …

Fractures In Parkinson's Disease: Pathophysiology, Prevention, And Orthopedic Outcomes., Ali Osman, Tala Maya, Rayyan Bhutta, Natasha Doshi, Maryam Khan, Sara Shah, Paslene Periceles, Janae Rasmussen

Surgery Articles

Fractures are an important comorbidity in Parkinson's disease (PD), which can result in disability, mortality, and high healthcare costs. Impaired mobility, postural instability, bradykinesia, muscle rigidity, and decreased bone mineral density (BMD) contribute to the increased risk of falls, which often result in hip and upper extremity fractures. Hip fractures in patients with PD are associated with an increased hospital length of stay and a decline in functional independence. Multimodal fall prevention in PD is well established, but prevention of fractures is often underutilized, despite evidence-based interventions. Information on fall-related fracture outcomes after exercise interventions is an area warranting further …

Lumbar Microdiscectomy: A Rare Case Of A Duplicate L5 Exiting Nerve Root., Sahil Garg, Sean M Muir, Arianna K Gill, Komi E Afetse, Sanjitpal S Gill

Surgery Articles

The microdiscectomy procedure has been regarded as the preferred method for the treatment of lumbar disc herniation (LDH). Intraoperatively, the procedure may be further complicated due to underlying anatomical variations in the lumbar spine or nerve root variations. Nerve root anomalies (NRAs), in particular, are relatively underdiscussed within the literature. Despite the rarity of these variations to the exiting nerve root, the increased surgical risk that an NRA may add warrants the need for increased awareness and associated complication mitigation. This case describes a rare instance of a symptomatic duplicate L5 nerve root discovered preoperatively and highlights the steps taken …

Reconstruction Of A Pelvic Nonunion Secondary To Metastatic Breast Cancer And Palliative Radiation., Ronald Peirish, Landon Reading, Cesar Cereijo

Surgery Articles

Pathologic pelvic nonunions are uncommon, although they remain a difficult problem and require meticulous surgical planning and execution for desired outcomes. In this paper, we discuss a patient who sustained a pathologic pelvic insufficiency fracture secondary to radiation therapy for metastatic breast cancer, who subsequently developed a symptomatic nonunion that required surgical intervention secondary to debilitating pain and inability to ambulate. We also discuss the classification of insufficiency fractures of the pelvis to guide treatment, in addition to complications associated with surgical intervention. A 51-year-old female with a 12-year history of metastatic breast cancer. She presented to an outside facility …

Elbow Interpositional Arthroplasty Using An Achilles Tendon Allograft: A Case Report., Matthew Glazier, Morgan Turnow, Hunter Pharis, Taylor Manes, Hayden Schuette, Stephen Wiseman

Surgery Articles

INTRODUCTION: The treatment of post-traumatic elbow arthritis poses a significant challenge for orthopedic surgeons, especially in young active patients. Total elbow arthroplasty is often the recommended treatment option in older patients; however, interpositional arthroplasty remains a viable option in high-demand patients.

CASE REPORT: We report a case of a 50-year-old male who presented after the development of post-traumatic arthritis of the elbow after multiple prior surgeries. He was treated with an interpositional arthroplasty using an Achilles tendon graft and allowed immediate range of motion as tolerated in a hinged elbow brace without the use of any form of distraction external …

Epidemiology Of Shoulder Dislocations In The United States From 1990 To 2019: A Temporal Study Using The Global Burden Of Disease Database., Gabrielle Dykhouse, Ambrose Loc T Ngo, Phillip C Mckegg, Peter B Spencer, Arsalaan Sayyed, Taylor J Manes, Morgan Turnow, Nathaniel Long

Surgery Articles

Introduction The shoulder joint is a common site for joint dislocation, with many individuals suffering from recurrent dislocations following treatment. The purpose of this study was to evaluate the epidemiology of shoulder dislocations in the United States from 1990 to 2019. Methods The Global Burden of Disease database was utilized to collect epidemiological data on shoulder dislocations in the United States (U.S.) from 1990 to 2019. These data included age-standardized rates of years lived with disability (YLDs), prevalence rates, and incidence rates per 100,000 people. Using the U.S. Census Bureau definitions, the data were stratified into four regions: the Northeast, …

Utility Of Revised Risk Analysis Index As A Predictor Of Mortality And Morbidity In Orthopaedic Trauma., Chirag Soni, Victor Koltenyuk, Nithin Gupta, Haad A Arif, Aruni Areti, Taylor Manes, Luke A Lopas, Jan P Szatkowski, Christian A Bowers, Benjamin C Taylor, Jack W Weick

Trauma and Acute Care Articles

OBJECTIVES: The aim of this study was to determine the applicability of the Revised Risk Analysis Index (RAI-Rev) in orthopaedic trauma and compare the predictive discrimination for the RAI-Rev and the 5-Item Modified Frailty Index (mFI-5) for 30-day postoperative outcomes.

DESIGN: This is a retrospective cohort study.

SETTING: The American College of Surgeons National Surgical Quality Improvement database was used.

PATIENT SELECTION: All patients aged 18 or older who underwent surgical treatment for forearm, humerus, pelvis, acetabulum, femur, tibia, and hindfoot fractures from 2015 to 2020 were included.

OUTCOME: 30-day postoperative mortality, major complications, and wound complications consisting of surgical …

Epidemiology Of Hip Dislocations In The United States From 1990 To 2019: A Temporal Study Using The Global Burden Of Disease Database., Ambrose Loc T Ngo, Gabrielle Dykhouse, Taylor J Manes, Phillip C Mckegg, Cameron J Sabet, Brett Barthman, Robert Golden

Trauma and Acute Care Articles

Introduction Hip dislocations are devastating injuries that require urgent intervention to minimize the development of severe complications. This study aimed to evaluate the epidemiology of hip dislocations in the United States (U.S.) from 1990 to 2019. Methods This study is a descriptive retrospective epidemiological study. The Global Burden of Disease (GBD) database was used to collect epidemiological data on hip dislocation in the U.S. from 1990 to 2019. Data included years lived with disability (YLDs), prevalence, and incidence rates per 100,000 people. Data were regionally stratified into Northeast, Midwest, South, and West by the U.S. Census definition. Bartlett's test was …

Risk Analysis Index For Estimation Of 30-Day Postoperative Mortality In Hip Fractures., Nithin K Gupta, Hikmat R Chmait, Vikram Gill, Morgan Turnow, Taylor Manes, Benjamin C Taylor, Jack W Weick, Christian Bowers

Surgery Articles

IMPORTANCE: Hip fractures present a substantial public health challenge, with projections of more than 500 000 per year by 2040. As such, frailty indices such as the Revised Risk Analysis Index (RAI) and the Modified Five-Item Frailty Index (mFI-5) have been recently investigated as metrics for preoperative risk stratification for these patients.

OBJECTIVE: To understand the accuracy of frailty, as measured by the RAI and the mFI-5, for estimating 30-day mortality following surgically managed hip fractures.

DESIGN, SETTING, AND PARTICIPANTS: This retrospective cross-sectional analysis used the American College of Surgeons' National Surgical Quality Improvement database. Patients aged 65 years old …

Recent And Future Trends In Osteopathic Orthopedic Surgery Residency Match Rates Following The Transition To A Single Accreditation System., Morgan Turnow, Minali Nemani, Nithin Gupta, Hayden Hartman, Taylor Manes, Tyler Williamson, Arianna Gianakos

Medical Education Articles

CONTEXT: Medical education in the United States has undergone significant changes, specifically within the osteopathic community. In 2020, a merger occurred between the American Osteopathic Association (AOA) and the Accreditation Council for Graduate Medical Education (ACGME), forming a single accreditation system (SAS) for graduate medical education and residency placement, with the purpose to create consistency within graduate medical education and to provide equal opportunities for applicants pursuing all specialties in medicine. However, osteopathic medical students, especially students applying to competitive residencies including orthopedic surgery, have faced challenges, raising concerns about future implications within this field.

OBJECTIVES: The main objective of …

Technique For Grafting Preexisting Bone Tunnels During The First Stage Of Revision Anterior Cruciate Ligament Reconstruction., Richard Ma, Samuel D Hawkins, Gregory D Caplinger, Joseph Temperato

Surgery Articles

The incidence of revision anterior cruciate ligament reconstruction is increasing. Anticipated convergence of malpositioned tunnels, significant graft tunnel widening, and bone loss are all indications for performing a 2-staged revision reconstruction. The goal of this Technical Note is to describe a simple bone-grafting technique for placing allograft bone matrix into femoral and tibial bone tunnels during the first stage of a 2-stage revision anterior cruciate ligament reconstruction.

Orthopedic Frailty Risk Stratification (Ofrs): A Systematic Review Of The Frailty Indices Predicting Adverse Outcomes In Orthopedics., Nithin K Gupta, Forrest Dunivin, Hikmat R Chmait, Chase Smitterberg, Azhaan Buttar, Moiz Fazal-Ur-Rehman, Taylor Manes, Morgan Turnow, Tyler K Williamson, Benjamin C Taylor, Jack W Weick, Christian Bowers

Surgery Articles

BACKGROUND: With a growing number of elderly patients requiring elective and non-elective procedures, frailty-based preoperative risk stratification is an emerging tool in orthopedic surgery to minimize adverse postoperative outcomes. This paper sought to understand the current literature regarding preoperative Orthopedic Frailty Risk Stratification (OFRS) and describe the disparate frailty indices and their capabilities for discrimination in predicting adverse postoperative outcomes.

METHODS: A literature search was conducted in Pubmed, Cochrane, and Scopus for articles published during or prior to February 2024 assessing frailty following surgery for orthopedic pathologies. Qualitative variables including study characteristics and application of frailty were collected and synthesized. …

Stealth Navigation With Ifuse-Torq Implant For Sacroiliac Joint Fusion Technique Guide., Jia Bao Lin, Bryan L Demyan, Logan M Bushnell, Morgan T Turnow, Benjamin C Taylor

Surgery Articles

INTRODUCTION: Dysfunction of the sacroiliac (SI) joint exists in nearly one-third of patients with lower back pain. There are nuances in diagnosing SI joint dysfunction with a combination of physical exam maneuvers and intra-articular injections. The management of patients with SI joint pain can include posterior pelvic fixation, which traditionally has been described using fluoroscopy to obtain safe placement of implants.

CASE REPORT: In this technique guide, we would like to introduce a novel technique of using Stealth navigation to facilitate SI fusion with the iFuse-TORQ implant.

CONCLUSION: SI dysfunction is a common cause of low back pain that can …

The Role Of Adjunctive Medial Plating In Distal Femur Fractures And Distal Femur Fractures Nonunions., Jerrod Steimle, Jaron L Lohmeyer, Benjamin Taylor, Daniel T Degenova

Trauma and Acute Care Articles

PURPOSE: There exists controversy in the treatment of acute distal femur fractures as well as distal femur fracture nonunions. The objective of this study is to determine the clinical benefit of adjunctive medial plate application in the setting of acute distal femur fractures and distal femur fracture nonunions.

METHODS: This is a retrospective comparative study at a Level 1 academic trauma center, including 104 patients treated for acute distal femur fractures and 23 patients treated for distal femur nonunions between 2015 and 2019. The study compared dual plate fixation to other methods of fixation.

RESULTS: In the acute fracture setting, …

Risk-Stratified Venous Thromboembolism Chemoprophylaxis After Total Joint Arthroplasty: Evaluation Of An Institutional Approach., Sara J Hyland, Maria J Fada, Michelle Secic, Robert A Fada, Marie M Lockhart, Richard H Parrish

OhioHealth Research Institute Articles

No abstract provided.

The Impact Of Fibular Fixation Method On Pilon Fracture Healing., Anthony Perugini, Scott Hyland, James Iandoli, Zachary Hill, John Peabody, Daniel Degenova, Mallory Faherty, Benjamin Taylor

OhioHealth Research Institute Articles

No abstract provided.

Is Fixation Of A Single End Of Flail Segment Rib Fractures Enough?, Anthony Perugini, James Iandoli, Nicholas Pelz, Daniel Degenova, Anthony Melaragno, Mallory Faherty, Benjamin C Taylor

OhioHealth Research Institute Articles

BACKGROUND: Segmental rib fractures in blunt thoracic trauma present with increased morbidity and mortality with an association of increased pulmonary insult and concomitant injuries. There is a paucity within the literature regarding the necessity of fixation of one or both segments of rib fractures in a flail chest. This study aimed to analyze surgical rib fixation and assess outcomes for non-fixed fractured rib ends in segmental rib fractures.

METHODS: This is a retrospective review of 125 patients who underwent open reduction internal fixation of flail segmental rib fractures at our urban Level 1 trauma center. Initial plain films and CT …

Current State Of Frailty In Revision Arthroplasty., Brendan Kelly, Nicholas Stratigakis, Arsalaan Sayyed, Tyler K Williamson, Cameron Atkison, Taylor Manes, Nithin Gupta, Morgan Turnow, Frank A Buttacavoli

Surgery Articles

No abstract provided.

Angle Accuracy Of Intramedullary Bone Resection Guides For Total Knee Arthroplasty., Matthew C Kane, Harold E Cates, Iou-Ren Chang

Surgery Articles

The importance of proper prosthetic placement has been confirmed in numerous studies. The objective of this study was to compare the planned resection angles to the verified intraoperative angles of femoral and tibial varus/valgus, tibial slope, and femoral flexion for each total knee performed using intramedullary (IM) cut guides for both distal femur and proximal tibia cuts. A total of 1,000 total knee arthroplasties (TKAs) were evaluated for this study. Intraoperative cut-check technology was used to show real-time validation of these resection angles. Assuming an acceptable range of within 2° of the planned cuts, results show the femoral varus/valgus angles …

Chronic Recurrent Shoulder Instability Treated With A Hemiarthroplasty, Glenojet Allograft Glenoid Reconstruction, And Anterior Capsular Reconstruction: A Case Report., Matthew Glazier, Morgan Turnow, Peter Spencer, Vishvam Metha, Hunter Pharis, Nathaniel Long, Stephen Wiseman

Surgery Articles

No abstract provided.

The Safety And Efficacy Of Posterior Lumbar Interbody Fusions In The Outpatient Setting., Hunter F Pharis, Daniel T Degenova, Braden J Passias, Taylor J Manes, Grace Parizek, Daryl Sybert

Surgery Articles

Introduction Outpatient surgical procedures have shown reduced costs, improved patient outcomes, and decreased postoperative complications. Interest in moving orthopedic and neurosurgical spine procedures to the outpatient setting has grown in recent years because of these factors. Studies investigating open posterior lumbar interbody fusions (PLIFs) in the outpatient setting are sparse. Methods The patients who underwent an open PLIF with pedicle screw and rod construct from 2014 to 2018 were retrospectively reviewed. Outpatient procedures were defined by patient discharge being on the same day of the procedure, without admittance to an inpatient ward. Pertinent demographic, clinical, radiographic, and surgical data were …

Sex-Differences In Psychological Readiness For Return-To-Sport Following Anterior Cruciate Ligament Reconstruction., Turk Robby, Nadim Hussein, Arakua Welbeck, Mallory Faherty, Carolyn Killelea, Lee Diehl, Jocelyn Wittstein, Jonathan Riboh, Alison Toth, Ned Amendola, Timothy C Sell

Surgery Articles

Females are at greatest risk for reinjury after return to sport (RTS) following anterior cruciate ligament (ACL) reconstruction (ACLR). The reasons for these sex differences, however, remain unclear. Psychological factors such as kinesiophobia have been identified as a potential predictor for reinjury following RTS. Studies investigating kinesiophobia have identified sex differences, yet whether this holds in the ACLR population remains unknown. The purpose of this study was to examine whether there are sex differences in kinesiophobia and other psychological factors, such as readiness to RTS and self-reported pain in the ACLR population. A total of 20 participants, eleven males (23.0 …

Far Posterior Approach For Rib Fracture Fixation: Surgical Technique And Tips., Taylor J Manes, Daniel T Degenova, Benjamin C Taylor, Jignesh N Patel

Surgery Articles

BACKGROUND: The present video article describes the far posterior or paraspinal approach to posterior rib fractures. This approach is utilized to optimize visualization intraoperatively in cases of far-posterior rib fractures. This technique is also muscle-sparing, and muscle-sparing posterolateral, axillary, and anterior approaches have been shown to return up to 95% of periscapular strength by 6 months postoperatively

DESCRIPTION: Like most fractures, the skin incision depends on the fracture position. The vertical incision is made either just medial to a line equidistant between the palpable spinous processes and medial scapular border or directly centered over the fracture line in this region. …

Mild Biceps Tendonitis May Be Managed Nonoperatively During Shoulder Arthroscopy., Jonathan J Light, Wihan Du Plessis, Matthew H Adsit, Alexander T Eckstrom, Amanda B Firoved, Justin W Griffin, Kevin F Bonner

Surgery Articles

PURPOSE: The purposes of this study were to determine whether patients with mild biceps tendonitis required revision surgery after the biceps tendon was not surgically treated, while addressing concomitant pathology, and to evaluate whether preoperative groove pain affected patient-reported outcomes.

METHODS: Patients who underwent shoulder arthroscopy between 2015 and 2018 by a single surgeon for rotator cuff pathology, debridement, and distal clavicular excision (DCE), with or without subacromial decompression (SAD), and where the biceps tendon was not surgically addressed were retrospectively identified. Inclusion criteria were mild LS (< 50% hyperemic appearing biceps tendon arthroscopically), and a minimum 2-year follow-up. The primary outcome measure was the incidence of revision surgery. Secondary outcomes included American Shoulder and Elbow Surgeons (ASES) score, simple shoulder test (SST), pain level, and satisfaction scores. Two sample

RESULTS: Sixty-four of 69 eligible subjects (93%) were evaluated at a minimum …

Primary Retrograde Tibiotalocalcaneal Nailing In An Elderly Osteoporotic Patient With Ankle Fracture: A Case Report., Nolan P Schmitz, Daniel R Gaines, Jignesh N Patel

Surgery Articles

INTRODUCTION: Ankle fractures are a common orthopedic injury traditionally treated with open reduction and internal fixation or conservative management. One complication introduced with open reduction and internal fixation is the requirement for non or partial weight bearing in the post-operative period. This requirement poses a unique challenge for patients who may not comply with these weight-bearing restrictions. This case is the first known article that specifically illustrates the validity and effectiveness of retrograde tibiotalocalcaneal (TTC) nailing for patients who are unlikely to follow weight-bearing restrictions.

CASE REPORT: An 83-year-old Caucasian female with idiopathic mild mental retardation and Alzheimer's presented with …

Differences Between Patients With Diabetes Mellitus And Those Without In Cases Of Necrotizing Fasciitis., Daniel T Degenova, Scott S Hyland, Tucker Peabody, Nolan P Schmitz, Devon Myers, Robert Patterson, Jignesh Patel

Surgery Articles

Purposes This study aims to evaluate further differences between patients with diabetes and those without who have been diagnosed with necrotizing fasciitis (NF) to assist clinicians in improving morbidity and mortality. Methods All patients diagnosed with NF of an extremity were retrospectively reviewed and divided into two groups based on a diagnosis of diabetes. Patient charts were reviewed to obtain multiple variables, which were compared between groups. Results From 2015 to 2021, 115 patients underwent surgical intervention due to concern for NF of an extremity with 92 patients included for data computation. Patients with diabetes had an average Laboratory Risk …

Peri-Implant Proximal Humerus Fracture Stabilized With Stacked Plating: A Case Report., Daniel T Degenova, Matthew T Glazier, John B Schrock, Brian W Skura, Taylor N Hockman, Benjamin C Taylor

Surgery Articles

INTRODUCTION: A peri-implant proximal humerus fracture is a rare complication after open reduction and internal fixation (ORIF) and poses a surgical dilemma.

CASE REPORT: A 56-year-old male sustained a peri-implant proximal humerus fracture after undergoing ORIF. We present a stacked plating method for fixation of this injury. This construct allows for decreased operative time, less soft-tissue dissection, and the ability to leave previous intact hardware in place.

CONCLUSION: We describe the rare case of a peri-implant proximal humerus treated with stacked plating.