Orthopedics Commons^™

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 …

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 …

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. …

The Loss Of Opa1 Accelerates Intervertebral Disc Degeneration And Osteoarthritis In Aged Mice, Vedavathi Madhu, Miriam Hernandaz-Meadows, Ashley Coleman, Kimheak Sao, Kameron Inguito, Owen Haslam, Paige Boneski, Hiromi Sesaki, Ruteja Barve, John Collins, Makarand Risbud

Department of Orthopaedic Surgery Faculty Papers

Recent studies have highlighted the importance of mitochondria in NP cells and articular chondrocyte health. Since the understanding of mechanisms governing mitochondrial dynamics in these tissues is lacking, we investigated the role of OPA1, a mitochondrial fusion protein, in their homeostasis. OPA1 knockdown in NP cells altered mitochondrial size and cristae shape and increased the oxygen consumption rate. OPA1 governed the morphology of multiple organelles, including peroxisomes, early endosomes and cis-Golgi and loss resulted in the dysregulation of autophagy. Metabolic profiling and

Proceedings Of The 2025 Nassi Annual Meeting, Patrick C. Hsieh, Chiung-Chyi Shen, Alan S. Hilibrand, D. Scott Kreine, David R. O’Brien Jr., Hani H. Mhaidli, Jau-Ching Wu, Wen-Cheng Huang

Department of Orthopaedic Surgery Faculty Papers

No abstract provided.

Detecting Early Changes In Cartilage Collagen And Proteoglycans Distribution Gradients In Mice Harboring The R992c Collagen Ii Mutant Using 2d Correlation Infrared Spectroscopy, Jolanta Fertala, Andrzej Steplewski, Andrzej Fertala

Department of Orthopaedic Surgery Faculty Papers

Collagen II is a vital structural component in developing bones and mature cartilage. Muta- tions in this protein cause spondyloepiphyseal dysplasia, a disease characterized primarily by altered skeletal growth and manifesting with a range of phenotypes, from lethal to mild. This study examined transgenic mice harboring the R992C (p.R1124C) substitution in colla- gen II. Previous research demonstrated significant growth abnormalities and disorganized growth plate structure in these mice, and histological signs of osteoarthritic changes in the knee joints of 9-month-old mice with the R992C mutation. Our study focuses on detecting early structural changes in the articular cartilage that occur before …

Epidemiological Trends Of Facial Fractures In The United States, Gabriel I. Onor, Ugochi T. Aguwa, Nicholas Barksdale, Isaiah X. Hughes, Molly Milano, Camila Cordero, Uche Nwagu, Oluwatomi Akingbola, Chibuzo J. Aguwa, Michael C. Okoronkwo

Department of Orthopaedic Surgery Faculty Papers

BACKGROUND: Sustaining facial fractures may pose significant challenges to patients' health and quality of life. In the United States (U.S.), facial fractures account for 20 % of all sports-related injuries in pediatrics and many of these injuries are associated with traumatic brain injury. The objective of this study was to identify overall and sports-related incidence rates of facial fractures presenting to U.S. hospital emergency departments from 2014 to 2023 and define demographic risk factors for these injuries.

METHODS: The National Electronic Injury Surveillance System was queried to identify facial fractures from 2014 to 2023 as well as associated demographic data. …

The Effect Of Celecoxib And Mumab911 On Strain Adaptive Bone Remodeling And Fracture Repair In Female Mice: Implications For Rapidly Progressive Osteoarthritis, Nicholas Ruggiero, Alexandra Ciuciu, Ashkan Sedigh, Ibtesam Rajpar, David Shelton, Patrice Belanger, Kathryn Gropp, John A. Collins, Theresa A. Freeman, Ryan E. Tomlinson

Department of Orthopaedic Surgery Faculty Papers

Debilitating pain is the primary clinical feature of osteoarthritis (OA) that drives the enormous healthcare costs. Osteoarthritis-related pain is often treated with non-steroidal anti-inflammatory drugs (NSAIDs), which effectively relieve pain and inflammation by inhibition of prostaglandin synthesis. Antibodies directed against nerve growth factor (NGF) were tested some time ago as an alternative potential analgesic for musculoskeletal pain, including osteoarthritis-related pain. Unfortunately, clinical development of these drugs was put on hold due to adverse outcomes - primarily rapidly progressive osteoarthritis. Both prostaglandin synthesis and NGF have been implicated as critical mediators of strain adaptive bone remodeling, which may play a role …

The Effect Of Nonsteroidal Anti-Inflammatory Drugs On Union Rates Following Operative Repair Of Distal Radius Fractures, Michael Chang, Alexis Kasper, Juliet Chung, Justin Wright, Margaret Pennington, Asif M. Ilyas

Student Papers, Posters & Projects

Purpose

Methods

Methylprednisolone After Shoulder Arthroplasty Leads To Decreased Opioid Prescriptions Without An Increased Risk Of Infection: A Matched Cohort Analysis, Tej Joshi, Tuckerman Jones, Akhil Katakam, Daniella Ogilvie, Amanda Azer, Sefy Paulose, Balazs Galdi

Jefferson Hospital Staff Papers and Presentations

Background

Methods

Improving Deep Vein Thrombosis Rates In Spine Surgery Patients, Arbaz A. Momin, Md, James Harrop, Md

Health Equity and Quality Improvement (HEQI) Summit

Background

- DVT/PEs are sources of morbidity and mortality in hospitalized patients
- Spine surgery patients are immobile postop and tend to be obese
- For spine surgery patients DVT rates reported to range from 0.3% to 15.5%
- DVT propagation to PE can lead to significant mortality

• 30-day case fatality rate of PE is 3.9%

- Quality metric that hospitals are evaluated

• Patient safety indicator (PSI)

Integrating Artificial Intelligence In Orthopedic Care: Advancements In Bone Care And Future Directions, Rahul Kumar, Kyle Sporn, Joshua Ong, Ethan Waisberg, Phani Paladugu, Swapna Vaja, Tamer Hage, Tejas C. Sekhar, Amar S. Vadhera, Alex Ngo, Nasif Zaman, Alireza Tavakkoli, Mouayad Masalkhi

SKMC Student Presentations and Publications

Artificial intelligence (AI) is revolutionizing the field of orthopedic bioengineering by increasing diagnostic accuracy and surgical precision and improving patient outcomes. This review highlights using AI for orthopedics in preoperative planning, intraoperative robotics, smart implants, and bone regeneration. AI-powered imaging, automated 3D anatomical modeling, and robotic-assisted surgery have dramatically changed orthopedic practices. AI has improved surgical planning by enhancing complex image interpretation and providing augmented reality guidance to create highly accurate surgical strategies. Intraoperatively, robotic-assisted surgeries enhance accuracy and reduce human error while minimizing invasiveness. AI-powered smart implant sensors allow for in vivo monitoring, early complication detection, and individualized rehabilitation. …

Sirt6 Deficiency Promotes Senescence And Age-Associated Intervertebral Disc Degeneration In Mice, Pranay Ramteke, Bahiyah Watson, Mallory Toci, Victoria Tran, Shira N Johnston, Maria Tsingas, Ruteja Barve, Ramkrishna Mitra, Richard Loeser, John Collins, Makarand Risbud

Department of Orthopaedic Surgery Faculty Papers

Intervertebral disc degeneration is a major risk factor contributing to chronic low back and neck pain. While the etiological factors for disc degeneration vary, age is still one of the most important risk factors. Recent studies have shown the promising role of SIRT6 in mammalian aging and skeletal tissue health, however its role in the intervertebral disc health remains unexplored. We investigated the contribution of SIRT6 to disc health by studying the age-dependent spinal phenotype of mice with conditional deletion of Sirt6 in the disc (Acan^CreERT2; Sirt6^fl/fl). Histological studies showed a degenerative phenotype in knockout mice …

How Reliable Is The Assessment Of Fusion Status Following Acdf Using Dynamic Flexion-Extension Radiographs?, Christopher T. Martin, Sangwook Tim Yoon, Ram Kiran Alluri, Edward C. Benzel, Chris M. Bono, Samuel K. Cho, Dean Chou, Xiaolong Chen, Jason P. Y. Cheung, Juan P. Cabrera, Stipe Ćorluka, Andreas K. Demetriades, Matthew F. Gary, Zoher Ghogawala, Waeel Hamouda, Inbo Han, Dimitri Hauri, Patrick C. Hsieh, Amit Jain, Jun S. Kim, Hai V. Le, Philip K. Louie, Zhuojing Luo, Hans-Jörg Meisel, Sathish Muthu, Dal-Sung Ryu, Charles A. Sansur, Andrew J. Schoenfeld, Laura Scaramuzzo, Gregory D. Schroeder, Shanmuganathan Rajasekaran, Veranis Sotiris, Gianluca Vadalà, Pieter-Paul A. Vergroesen, Jeffrey C. Wang, Yabin Wu, K. Daniel Riew

Rothman Institute Papers

Study DesignReliability study.ObjectivesThe radiographic diagnosis of non-union is not standardized. Prior authors have suggested using a cutoff of < 1 mm interspinous process motion (ISPM) on flexion-extension radiographs, but the ability of practicing surgeons to make these measurements reliably is not clear.Methods29 practicing spine surgeons measured ISPM on 19 levels of ACDF from 9 patients. Surgeons relied on these measurements to report on fusion status. Inter-observer correlation co-efficients (ICC), standard error (SEM) and the minimum detectable difference (MD) of these measurements were calculated. We screened for clerical errors by checking measurements more than one standard deviation from the group mean.ResultsThe ICC for ISPM was .76 (.64; .88) with a SEM of 1 mm and a MD of 2.76 mm. Agreement on fusion status was moderate, with an ICC of .6 (.44; .76). After screening for and removing clerical errors, the ICC improved to .82 (.71; .91), SEM improved to .83 mm, and MD improved to 2.29 mm. Six reviewers had an ICC >.9. The ICC from these high performing reviewers was .94 (.9; .97), SEM was .45 mm, and MD was 1.26 mm.ConclusionsThe MD of 2.29 mm in our study group was not precise enough to support a cutoff of < 1 mm ISPM as the sole measurement technique in screening for non-union after ACDF, and there was only moderate agreement amongst surgeons on fusion status based on dynamic radiographs. More stringent techniques are necessary to avoid mis-diagnosing non-union in clinical studies. Future studies should consider auditing measurements to identify clerical errors.

Evaluating Bone Fracture Healing In A Rabbit Model Using Doppler Imaging Modes, Shear Wave Elastography, X-Ray, And Dual-Energy X-Ray Absorptiometry, Priscilla Machado, Rachel Blackman, Ji-Bin Liu, Collleen Dempsey, Flemming Forsberg, Traci Fox

Department of Radiology Faculty Papers

OBJECTIVE: This study investigated methods of evaluating the bone fracture healing process using superb microvascular imaging (SMI; two modes color SMI [cSMI] and monochromeSMI [mSMI]), and shear wave elastography (SWE), relative to X-ray, dual-energy X-ray absorptiometry (DXA), and platelet endothelial cell adhesion molecule 1 (PECAM-1) also know as cluster of differentiation 31 (CD-31) staining in a rabbit model.

METHODS: This IACUC-approved study involved eight rabbits that underwent a bilateral fibula osteotomy and were followed for 7 or 21 days (Groups 1 and 2 with 4 rabbits in each). Ultrasound examinations using cSMI, mSMI, and SWE were performed on Days 0, …

Effect Of A Digital Health Exercise Program On The Intention For Spinal Surgery In Adult Spinal Deformity: Exploratory Cross-Sectional Survey, Marsalis Christian Brown, Christopher Quincy Lin, Christopher Jin, Matthew Rohde, Brett Rocos, Jonathan Belding, Barrett I. Woods, Stacey J. Ackerman

Rothman Institute Papers

BACKGROUND: Adult spinal deformity (ASD) is a prevalent condition estimated at 38%. Symptomatic ASD is associated with substantial health care costs. The role of nonoperative interventions in the management of ASD remains elusive. The National Scoliosis Clinic's (NSC) scoliosis realignment therapy (SRT) is a personalized digital health exercise program for the nonoperative management of ASD.

OBJECTIVE: This exploratory study had two objectives: (1) to evaluate the effect of the SRT program on users' intention of having spinal fusion; and (2) from a US payer perspective, to estimate the annual cost savings per 100,000 beneficiaries by averting spinal surgery.

METHODS: Individuals …