Orthopedics Commons^™

Outcomes And National Trends For The Surgical Treatment Of Lumbar Spine Trauma., Doniel Drazin, Miriam Nuno, Faris Shweikeh, Alex R. Vaccaro, Eli Baron, Terrence T. Kim, J. Patrick Johnson

Department of Orthopaedic Surgery Faculty Papers

Introduction. Operative treatment of lumbar spine compression fractures includes fusion and/or cement augmentation. Our aim was to evaluate postoperative differences in patients treated surgically with fusion, vertebroplasty, or kyphoplasty. Methods. The Nationwide Inpatient Sample Database search for adult vertebral compression fracture patients treated 2004-2011 identified 102,316 surgical patients: 30.6% underwent spinal fusion, 17.1% underwent kyphoplasty, and 49.9% underwent vertebroplasty. Univariate analysis of patient and hospital characteristics, by treatment, was performed. Multivariable analysis was used to determine factors associated with mortality, nonroutine discharge, complications, and patient safety. Results. Average patient age: fusion (46.2), kyphoplasty (78.5), vertebroplasty (76.7) (p < .0001). Gender, race, household income, hospital-specific characteristics, and insurance differences were found (p ≤ .001). Leading comorbidities were hypertension, osteoporosis, and diabetes. Risks for higher mortality (OR 2.0: CI: 1.6-2.5), nonroutine discharge (OR 1.6, CI: 1.6-1.7), complications (OR 1.1, CI: 1.0-1.1), and safety related events (OR 1.1, CI: 1.0-1.1) rose consistently with increasing age, particularly among fusion patients. Preexisting comorbidities and longer in-hospital length of stay were associated with increased odds of nonroutine discharge, complications, and patient safety. Conclusions. Fusion patients had higher rates of poorer outcomes compared to vertebroplasty and kyphoplasty cohorts. Mortality, nonroutine discharge, complications, and adverse events increased consistently with older age.

Circadian Factors Bmal1 And Rorα Control Hif-1Α Transcriptional Activity In Nucleus Pulposus Cells: Implications In Maintenance Of Intervertebral Disc Health., Kaori Suyama, Elizabeth S Silagi, Hyowon Choi, Kou Sakabe, Joji Mochida, Irving M Shapiro, Makarand V Risbud

Department of Orthopaedic Surgery Faculty Papers

BMAL1 and RORα are major regulators of the circadian molecular oscillator. Since previous work in other cell types has shown cross talk between circadian rhythm genes and hypoxic signaling, we investigated the role of BMAL1 and RORα in controlling HIF-1-dependent transcriptional responses in NP cells that exist in the physiologically hypoxic intervertebral disc. HIF-1-dependent HRE reporter activity was further promoted by co-transfection with either BMAL1 or RORα. In addition, stable silencing of BMAL1 or inhibition of RORα activity resulted in decreased HRE activation. Inhibition of RORα also modulated HIF1α-TAD activity. Interestingly, immunoprecipitation studies showed no evidence of BMAL1, CLOCK or …

The Role Of Sonic Hedgehog Signaling In Osteoclastogenesis And Jaw Bone Destruction., Tsuyoshi Shimo, Kenichi Matsumoto, Kiyofumi Takabatake, Eriko Aoyama, Yuichiro Takebe, Soichiro Ibaragi, Tatsuo Okui, Naito Kurio, Hiroyuki Takada, Kyoichi Obata, Pai Pang, Masahiro Iwamoto, Hitoshi Nagatsuka, Akira Sasaki

Department of Orthopaedic Surgery Faculty Papers

Sonic hedgehog (SHH) and its signaling have been identified in several human cancers, and increased levels of its expression appear to correlate with disease progression and metastasis. However, the role of SHH in bone destruction associated with oral squamous cell carcinomas is still unclear. In this study we analyzed SHH expression and the role played by SHH signaling in gingival carcinoma-induced jawbone destruction. From an analysis of surgically resected lower gingival squamous cell carcinoma mandible samples, we found that SHH was highly expressed in tumor cells that had invaded the bone matrix. On the other hand, the hedgehog receptor Patched …

Predicting Revision Following In Situ Ulnar Nerve Decompression For Patients With Idiopathic Cubital Tunnel Syndrome., Michael P. Gaspar, Patrick M. Kane, Dechporn Putthiwara, Sidney M. Jacoby, A. Lee Osterman

Department of Orthopaedic Surgery Faculty Papers

PURPOSE: To determine the incidence of revision and potential risk factors for needing revision surgery following in situ ulnar nerve decompression for patients with idiopathic cubital tunnel syndrome (CTS).

METHODS: We conducted a retrospective chart review of all patients treated at 1 specialty hand center with an open in situ ulnar nerve decompression for idiopathic CTS from January 2006 through December 2010. Revision incidence was determined by identifying patients who underwent additional surgeries for recurrent or persistent ulnar nerve symptoms. Bivariate analysis was performed to determine which variables had a significant influence on the need for revision surgery.

RESULTS: Revision …

Variables Prognostic For Delayed Union And Nonunion Following Ulnar Shortening Fixed With A Dedicated Osteotomy Plate., Michael P. Gaspar, Patrick M. Kane, Ralph C Zohn, Taylor Buckley, Sidney M. Jacoby, Eon K. Shin

Department of Orthopaedic Surgery Faculty Papers

PURPOSE: To examine potential risk factors for the development of delayed or nonunion following elective ulnar shortening osteotomy using a dedicated osteotomy plating system.

METHODS: We performed a retrospective review of all patients who underwent elective ulnar shortening using the TriMed single osteotomy dynamic compression plating system by 1 of 2 fellowship-trained hand surgeons over a 5-year period. Demographic data and medical, surgical, and social histories were reviewed. Time to bony union was determined radiographically by a blinded reviewer. Bivariate statistical analysis was performed to examine the effect of explanatory variables on the time to union and the incidence of …

Use Of High-Speed X Ray And Video To Analyze Distal Radius Fracture Pathomechanics., Christina Gutowski, Kurosh Darvish, Frederic E. Liss, Asif M. Ilyas, Christopher M. Jones

Department of Orthopaedic Surgery Faculty Papers

The purpose of this study is to investigate the failure sequence of the distal radius during a simulated fall onto an outstretched hand using cadaver forearms and high-speed X ray and video systems. This apparatus records the beginning and propagation of bony failure, ultimately resulting in distal radius or forearm fracture. The effects of 3 different wrist guard designs are investigated using this system. Serving as a proof-of-concept analysis, this study supports this imaging technique to be used in larger studies of orthopedic trauma and protective devices and specifically for distal radius fractures.

Pain Management Strategies In Hand Surgery., Constantinos Ketonis, Md, Phd, Asif M Ilyas, Frederic Liss

Department of Orthopaedic Surgery Faculty Papers

Modern anesthetic agents have allowed for the rapid expansion of ambulatory surgery, particularly in hand surgery. The choice between general anesthesia, peripheral regional blocks, regional intravenous anesthesia (Bier block), local block with sedation, and the recently popularized wide-awake hand surgery depends on several variables, including the type and duration of the procedure and patient characteristics, coexisting conditions, location, and expected length of the procedure. This article discusses the various perioperative and postoperative analgesic options to optimize the hand surgical patients' experience.

Role Of Phenol-Soluble Modulins In Formation Of Staphylococcus Aureus Biofilms In Synovial Fluid., Sana S Dastgheyb, Amer E Villaruz, Katherine Y Le, Vee Y Tan, Anthony C Duong, Som S Chatterjee, Gordon Y C Cheung, Hwang-Soo Joo, Noreen J Hickok, Michael Otto

Department of Orthopaedic Surgery Faculty Papers

Staphylococcus aureus is a leading cause of prosthetic joint infections, which, as we recently showed, proceed with the involvement of biofilm-like clusters that cause recalcitrance to antibiotic treatment. Here we analyzed why these clusters grow extraordinarily large, reaching macroscopically visible extensions (>1 mm). We found that while specific S. aureus surface proteins are a prerequisite for agglomeration in synovial fluid, low activity of the Agr regulatory system and subsequent low production of the phenol-soluble modulin (PSM) surfactant peptides cause agglomerates to grow to exceptional dimensions. Our results indicate that PSMs function by disrupting interactions of biofilm matrix molecules, such …

Understanding Nucleus Pulposus Cell Phenotype: A Prerequisite For Stem Cell Based Therapies To Treat Intervertebral Disc Degeneration., Hyowon Choi, Zariel I. Johnson, Makarand V. Risbud

Department of Orthopaedic Surgery Faculty Papers

Intervertebral disc (IVD) degeneration and associated low back pain (LBP) remains a major burden to our society without significant improvements in treatment strategies or patient's quality of life. While the recent cell-transplantation studies for treatment of degenerative disc disease have shown promising results, to better gauge the success and functional outcomes of these therapies, it is crucial to understand if transplanted cells give rise to healthy nucleus pulposus (NP) tissue. NP cell phenotype is unique and is defined by expression of a characteristic set of markers that reflect specialized physiology and function. This review summarizes phenotypic markers that mirror the …

Aquaporin 1 And 5 Expression Decreases During Human Intervertebral Disc Degeneration: Novel Hif-1-Mediated Regulation Of Aquaporins In Np Cells., Zariel I Johnson, Shilpa S Gogate, Rebecca Day, Abbie Binch, Dessislava Z Markova, Neil Chiverton, Ashley Cole, Matt Conner, Irving Shapiro, Christine L Le Maitre, Makarand V Risbud

Department of Orthopaedic Surgery Faculty Papers

Objectives of this study were to investigate whether AQP1 and AQP5 expression is altered during intervertebral disc degeneration and if hypoxia and HIF-1 regulate their expression in NP cells. AQP expression was measured in human tissues from different degenerative grades; regulation by hypoxia and HIF-1 was studied using promoter analysis and gain- and loss-of-function experiments. We show that both AQPs are expressed in the disc and that mRNA and protein levels decline with human disease severity. Bioinformatic analyses of AQP promoters showed multiple evolutionarily conserved HREs. Surprisingly, hypoxia failed to induce promoter activity or expression of either AQP. While genomic …

Management Of Complications Of Wrist Arthroplasty And Wrist Fusion., Michael P. Gaspar, Patrick M Kane, Eon K. Shin

Department of Orthopaedic Surgery Faculty Papers

The human wrist joint is unique from functional and anatomic standpoints. Numerous articulations exist within the wrist that allow for many options for partial wrist fusion and arthroplasty. In cases of pancarpal disease, fusion or arthroplasty of the entire wrist joint can be performed. Because of the high functional demand of the wrist, many of these surgical options can fail, leading to devastating complications. This article addresses the types of fusions and arthroplasties available for the wrist and discusses the potential complications associated with each. Methods to prevent these complications are presented and those to treat them once they have …

Posterior Surgical Approach Procedures For Cervical Myelopathy, Pedro H.I. Pohl, Marcel Jun Tamaoki, Luciano M. Rodrigues, Kristen Radcliff, Takashi Yurube, James D. Kang, João Carlos Belloti

Department of Orthopaedic Surgery Faculty Papers

This is the protocol for a review and there is no abstract. The objectives are as follows: The main objective of this review is to assess the effects of laminectomy and fusion versus laminoplasty for multilevel cervical stenosis with myelopathy, on treatment outcomes such as pain, quality of life, functional and neurological improvement, and complication rates. © 2015 The Cochrane Collaboration.

Nonthermal Atmospheric Pressure Plasma Enhances Mouse Limb Bud Survival, Growth, And Elongation., Natalie Chernets, Jun Zhang, Marla J Steinbeck, Deepa S Kurpad, Eiki Koyama, Gary Friedman, Theresa A. Freeman

Department of Orthopaedic Surgery Faculty Papers

The enhanced differentiation of mesenchymal cells into chondrocytes or osteoblasts is of paramount importance in tissue engineering and regenerative therapies. A newly emerging body of evidence demonstrates that appendage regeneration is dependent on reactive oxygen species (ROS) production and signaling. Thus, we hypothesized that mesenchymal cell stimulation by nonthermal (NT)-plasma, which produces and induces ROS, would (1) promote skeletal cell differentiation and (2) limb autopod development. Stimulation with a single treatment of NT-plasma enhanced survival, growth, and elongation of mouse limb autopods in an in vitro organ culture system. Noticeable changes included enhanced development of digit length and definition of …

Loss Of Hif-1Α In The Notochord Results In Cell Death And Complete Disappearance Of The Nucleus Pulposus., Christophe Merceron, Laura Mangiavini, Alexander Robling, Tremika Leshan Wilson, Amato J Giaccia, Irving Shapiro, Ernestina Schipani, Makarand V Risbud

Department of Orthopaedic Surgery Faculty Papers

The intervertebral disc (IVD) is one of the largest avascular organs in vertebrates. The nucleus pulposus (NP), a highly hydrated and proteoglycan-enriched tissue, forms the inner portion of the IVD. The NP is surrounded by a multi-lamellar fibrocartilaginous structure, the annulus fibrosus (AF). This structure is covered superior and inferior side by cartilaginous endplates (CEP). The NP is a unique tissue within the IVD as it results from the differentiation of notochordal cells, whereas, AF and CEP derive from the sclerotome. The hypoxia inducible factor-1α (HIF-1α) is expressed in NP cells but its function in NP development and homeostasis is …

The Relative Efficacy Of Antifibrinolytics In Adolescent Idiopathic Scoliosis: A Prospective Randomized Trial., Kushagra Verma, Md, Thomas Errico, Chris Diefenbach, Christian Hoelscher, Austin Peters, Joseph Dryer, Tessa Huncke, Kirstin Boenigk, Baron S Lonner

Department of Orthopaedic Surgery Faculty Papers

BACKGROUND: Antifibrinolytics can reduce intraoperative blood loss. The primary aim of this study was to determine the efficacy of intraoperative tranexamic acid, epsilon-aminocaproic acid, and placebo at reducing perioperative blood loss and the transfusion rate in patients with adolescent idiopathic scoliosis undergoing posterior spinal arthrodesis.

METHODS: This is a prospective, randomized, double-blind comparison of tranexamic acid, epsilon-aminocaproic acid, and placebo used intraoperatively in patients with adolescent idiopathic scoliosis. One hundred and twenty-five patients with adolescent idiopathic scoliosis were randomly assigned to the tranexamic acid, epsilon-aminocaproic acid, or control groups. Parameters recorded included estimated blood loss, hematocrit, blood product usage, drain …

Addressing Hindfoot Arthritis With Concomitant Tibial Malunion Or Nonunion With Retrograde Tibiotalocalcaneal Nailing: A Novel Treatment Approach., Justin M Kane, Steven Raikin

Department of Orthopaedic Surgery Faculty Papers

BACKGROUND: Tibial malunions and nonunions are associated with degenerative changes about the ankle. A comprehensive literature review revealed no articles discussing treatment options for patients with tibial shaft malunion and ipsilateral ankle arthritis. The aim of our study was to evaluate a series of patients in whom tibial osteotomy and retrograde tibiotalocalcaneal nailing were used to treat both tibial deformity and ankle osteoarthritis.

METHODS: Twenty-five patients underwent retrograde tibiotalocalcaneal nailing with concomitant realignment tibial osteotomy with takedown of the nonunion or malunion in a single procedure. All surgical procedures were performed by a single surgeon at a single institution. Baseline …

The Hand In Art: Hand Of Hope, John S. Taras, Md

Department of Orthopaedic Surgery Faculty Papers

The “Hand of Hope” (Fig. 1) statue was commissioned for display in the street-level lobby of my practice, The Philadelphia Hand Center, by its founders, James M. Hunter, MD, and Lawrence H. Schneider, MD. The work became a hallmark of the practice’s former Walnut Street location as well as a recognizable feature of its neighborhood.

After a sojourn of several years residing next to Thomas Eakins’ portrait of the operative theatre in “The Gross Clinic,” at Thomas Jefferson University, the sculpture has returned to grace our office’s lobby in the historic Benjamin Franklin Hotel.

Stress Sonography Of The Ulnar Collateral Ligament Of The Elbow In Professional Baseball Pitchers: A 10-Year Study., Michael G Ciccotti, Alfred Atanda, Levon N. Nazarian, Christopher C Dodson, Laurens Holmes, Steven B. Cohen

Department of Orthopaedic Surgery Faculty Papers

BACKGROUND: An injury to the ulnar collateral ligament (UCL) of the elbow is potentially career threatening for elite baseball pitchers. Stress ultrasound (US) of the elbow allows for evaluation of both the UCL and the ulnohumeral joint space at rest and with stress.

HYPOTHESIS: Stress US can identify morphological and functional UCL changes and may predict the risk of a UCL injury in elite pitchers.

STUDY DESIGN: Cross-sectional study; Level of evidence, 3.

METHODS: A total of 368 asymptomatic professional baseball pitchers underwent preseason stress US of their dominant and nondominant elbows over a 10-year period (2002-2012). Stress US examinations …

Boning Up On Autophagy: The Role Of Autophagy In Skeletal Biology., Irving Shapiro, Robert Layfield, Martin Lotz, Carmine Settembre, Caroline Whitehouse

Department of Orthopaedic Surgery Faculty Papers

From an evolutionary perspective, the major function of bone is to provide stable sites for muscle attachment and affording protection of vital organs, especially the heart and lungs (ribs) and spinal cord (vertebrae and intervertebral discs). However, bone has a considerable number of other functions: serving as a store for mineral ions, providing a site for blood cell synthesis and participating in a complex system-wide endocrine system. Not surprisingly, bone and cartilage cell homeostasis is tightly controlled, as is the maintenance of tissue structure and mass. While a great deal of new information is accruing concerning skeletal cell homeostasis, one …

Periprosthetic Knee Infection: Ten Strategies That Work., Javad Parvizi, Md, Priscilla Ku Cavanaugh, Claudio Diaz-Ledezma

Department of Orthopaedic Surgery Faculty Papers

Periprosthetic joint infection (PJI) is one of the most serious complications following total knee arthroplasty (TKA). The demand for TKA is rapidly increasing, resulting in a subsequent increase in infections involving knee prosthesis. Despite the existence of common management practices, the best approach for several aspects in the management of periprosthetic knee infection remains controversial. This review examines the current understanding in the management of the following aspects of PJI: preoperative risk stratification, preoperative antibiotics, preoperative skin preparation, outpatient diagnosis, assessing for infection in revision cases, improving culture utility, irrigation and debridement, one and two-stage revision, and patient prognostic information. …

Allograft Reconstruction For Digital Nerve Loss., John S Taras, Nirav Amin, Nimit Patel, Lucy A Mccabe

Department of Orthopaedic Surgery Faculty Papers

PURPOSE: To investigate the outcomes of digital nerve repairs using processed nerve allograft for defects measuring 30 mm or less.

METHODS: Seventeen patients with 21 digital nerve lacerations in the hand underwent reconstruction with processed nerve allograft. Outcome data for 14 patients with 18 digital nerve lacerations were available for analysis. Postoperative outcome data were recorded at a minimum of 12 months and an average of 15 months. The average nerve gap measured 11 mm (range, 5-30 mm). Outcome measures included postoperative sensory examination as assessed by Semmes-Weinstein monofilaments and static and moving 2-point discrimination. Pain was graded using a …

Common Peroneal Nerve Palsy Following Total Knee Arthroplasty: Prognostic Factors And Course Of Recovery., Jai Hyung Park, Md, Camilo Restrepo, Md, Robert Norton, Md, Steven Mandel, Md, Peter F. Sharkey, Md, Javad Parvizi, Md

Department of Orthopaedic Surgery Faculty Papers

Common peroneal nerve palsy (CPNP) is a serious complication following total knee arthroplasty (TKA). There is little information regarding the clinical course and prognostic factors for recovery. Between January 2000 and December 2008, 44 patients (0.53%) developed CPNP following TKA and were matched to 100 control patients based on year of surgery, type of surgery and surgeon. Regression analysis was performed to identify prognostic factors for recovery. A significant difference was seen in CPNP patients who were on average younger (62.1 years) and had higher BMI (34.5 kg/m(2)) than those who did not have nerve palsy (67.5 years and 31.8 …

Aseptically Processed And Chemically Sterilized Btb Allografts For Anterior Cruciate Ligament Reconstruction: A Prospective Randomized Study., Peter A Indelicato, Michael G Ciccotti, Joel Boyd, Laurence D Higgins, Benjamin S Shaffer, C Thomas Vangsness

Department of Orthopaedic Surgery Faculty Papers

PURPOSE: To compare the clinical outcomes of bone-patellar tendon-bone (BTB) allografts processed via a novel sterilization system with the traditional aseptically processed BTB allografts for anterior cruciate ligament (ACL) reconstruction.

METHODS: A total of 67 patients undergoing ACL reconstruction at 6 independent investigation sites were randomized into one of two intervention groups, BioCleanse-sterilized or aseptic BTB allografts. Inclusion criteria included an acute, isolated, unilateral ACL tear, and exclusion criteria included prior ACL injury, multi-ligament reconstruction, and signs of degenerative joint disease. Post-op examiners and patients were blinded to graft type. Patients were evaluated at 6, 12, and 24 months. Clinical …

Developmental Dysplasia Of The Hip: Linkage Mapping And Whole Exome Sequencing Identify A Shared Variant In Cx3cr1 In All Affected Members Of A Large Multi-Generation Family., George J Feldman, Javad Parvizi, Mark Levenstien, Kathryn Scott, Jill A Erickson, Paolo Fortina, Marcella Devoto, Christopher L Peters

Department of Orthopaedic Surgery Faculty Papers

Developmental Dysplasia of the Hip (DDH) is a debilitating condition characterized by incomplete formation of the acetabulum leading to dislocation of the femur, suboptimal joint function, and accelerated wear of the articular cartilage resulting in arthritis. DDH affects 1 in 1000 newborns in the United States with well defined "pockets" of high prevalence in Japan, Italy and other Mediterranean countries. Although reasonably accurate for detecting gross forms of hip dysplasia, existing techniques fail to find milder forms of dysplasia. Undetected hip dysplasia is the leading cause of osteoarthritis of the hip in young individuals causing over 40% of cases in …

Acetabular Components In Total Hip Arthroplasty: Is There Evidence That Cementless Fixation Is Better?, Nader Toossi, Bahar Adeli, Andrew J Timperley, Fares S Haddad, Mitchell Maltenfort, Javad Parvizi

Department of Orthopaedic Surgery Faculty Papers

BACKGROUND: The use of cementless acetabular components in total hip arthroplasty has gained popularity over the past decade. Most total hip arthroplasties being performed in North America currently use cementless acetabular components. The objective of this systematic review and meta-analysis was to compare the survivorship and revision rate of cemented and cementless acetabular components utilized in total hip arthroplasty.

METHODS: A primary literature search in PubMed identified 3488 articles, of which 3407 did not meet the inclusion criteria and were excluded. Only English-language articles on either the survivorship or revision rate of primary total hip arthroplasty at a minimum of …

Skeletal Cell Differentiation Is Enhanced By Atmospheric Dielectric Barrier Discharge Plasma Treatment., Marla J Steinbeck, Natalie Chernets, Jun Zhang, Deepa S Kurpad, Gregory Fridman, Alexander Fridman, Theresa A. Freeman

Department of Orthopaedic Surgery Faculty Papers

Enhancing chondrogenic and osteogenic differentiation is of paramount importance in providing effective regenerative therapies and improving the rate of fracture healing. This study investigated the potential of non-thermal atmospheric dielectric barrier discharge plasma (NT-plasma) to enhance chondrocyte and osteoblast proliferation and differentiation. Although the exact mechanism by which NT-plasma interacts with cells is undefined, it is known that during treatment the atmosphere is ionized generating extracellular reactive oxygen and nitrogen species (ROS and RNS) and an electric field. Appropriate NT-plasma conditions were determined using lactate-dehydrogenase release, flow cytometric live/dead assay, flow cytometric cell cycle analysis, and Western blots to evaluate …

Risk Factors For Wound Complications After Ankle Fracture Surgery., Adam G Miller, Andrew Margules, Steven M Raikin

Department of Orthopaedic Surgery Faculty Papers

BACKGROUND: The overall rate of complications after ankle fracture fixation varies between 5% and 40% depending on the population investigated, and wound complications have been reported to occur in 1.4% to 18.8% of patients. Large studies have focused on complications in terms of readmission, but few studies have examined risk factors for wound-related issues in the outpatient setting in a large number of patients. A review was performed to identify risk factors for wound complications tracked in the hospital and outpatient setting.

METHODS: Four hundred and seventy-eight patients underwent open reduction and internal fixation of an ankle fracture between 2003 …

Ulnar Tunnel Syndrome., Abdo Bachoura, Sidney M Jacoby

Department of Orthopaedic Surgery Faculty Papers

Ulnar tunnel syndrome could be broadly defined as a compressive neuropathy of the ulnar nerve at the level of the wrist. The ulnar tunnel, or Guyon's canal, has a complex and variable anatomy. Various factors may precipitate the onset of ulnar tunnel syndrome. Patient presentation depends on the anatomic zone of ulnar nerve compression: zone I compression, motor and sensory signs and symptoms; zone II compression, isolated motor deficits; and zone III compression; purely sensory deficits. Conservative treatment such as activity modification may be helpful, but often, surgical exploration of the ulnar tunnel with subsequent ulnar nerve decompression is indicated.

Low Rate Of Infection Control In Enterococcal Periprosthetic Joint Infections., Mohammad R Rasouli, Mohan S Tripathi, Robert Kenyon, Nathan Wetters, Craig J Della Valle, Javad Parvizi

Department of Orthopaedic Surgery Faculty Papers

BACKGROUND: Enterococcal periprosthetic joint infections (PJIs) are rare after joint arthroplasty. These cases are usually reported in series of PJIs caused by other pathogens. Because few studies have focused only on enterococcal PJIs, management and control of infection of these cases have not yet been well defined.

QUESTIONS/PURPOSES: We asked (1) what is the proportion of enterococcal PJI in our institutes; and (2) what is the rate of infection control in these cases?

METHODS: We respectively identified 22 and 14 joints with monomicrobial and polymicrobial PJI, respectively, caused by enterococcus. The diagnosis of PJI was made based on the presence …

The Impact Of Epidural Steroid Injections On The Outcomes Of Patients Treated For Lumbar Disc Herniation: A Subgroup Analysis Of The Sport Trial., Kristen Radcliff, Alan Hilibrand, Jon D Lurie, Tor D Tosteson, Lawrence Delasotta, Jeffrey Rihn, Wenyan Zhao, Alexander Vaccaro, Todd J Albert, James N Weinstein

Department of Orthopaedic Surgery Faculty Papers

BACKGROUND: The Spine Patient Outcomes Research Trial (SPORT) is a prospective, multicenter study of operative versus nonoperative treatment of lumbar intervertebral disc herniation. It has been suggested that epidural steroid injections may help improve patient outcomes and lower the rate of crossover to surgical treatment.

METHODS: One hundred and fifty-four patients included in the intervertebral disc herniation arm of the SPORT who had received an epidural steroid injection during the first three months of the study and no injection prior to the study (the ESI group) were compared with 453 patients who had not received an injection during the first …