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Articles 1 - 30 of 125
Full-Text Articles in Orthopedics
Full Issue, Arianna Medina
21st Century Perspective On The Changing Pattern Of Nerve Injuries From Gunshot Wounds In The U.S., Thomas A. Decoster
21st Century Perspective On The Changing Pattern Of Nerve Injuries From Gunshot Wounds In The U.S., Thomas A. Decoster
Western Journal of Orthopaedics
Gunshot wounds (GSWs) with nerve injuries in the 21st century differ significantly from those reported in the 20th century. The vast majority are now low-velocity civilian injuries, in contrast to high-velocity military injuries previously reported. The rate of nerve injury in civilian GSWs is approximately 5%, compared with the 30% reported in military cohorts. However, the most common pattern of nerve injury in the current civilian population is neurotmesis and partial neurotmesis, in contrast to the majority axonotmesis of the military cohorts. In the 20th century, treatment generally consisted of watchful waiting for signs of spontaneous recovery over three months …
Peripheral Nerve Repair And Reconstruction: Current Techniques, Adjuncts, And Emerging Therapies, Niklaus Skipp, Lana Dokic, Christina Wassef, Jazzlyn Gonzalez, Ana Love, Heather Mercer, Deana Mercer
Peripheral Nerve Repair And Reconstruction: Current Techniques, Adjuncts, And Emerging Therapies, Niklaus Skipp, Lana Dokic, Christina Wassef, Jazzlyn Gonzalez, Ana Love, Heather Mercer, Deana Mercer
Western Journal of Orthopaedics
Peripheral nerve injuries require reconstruction when direct, tension-free repair is not possible. A range of reconstructive strategies are used to restore continuity and promote axonal regeneration, including graft-based reconstruction, nerve transfers, conduit-based repair, supercharged end-to-side augmentation, and emerging regenerative therapies. Autologous interfascicular nerve grafts and vascularized grafts remain established techniques, whereas processed nerve allografts provide a donor-sparing alternative. Nerve transfers are increasingly used for proximal injuries with long regeneration distances, and conduits are an option for gaps shorter than 5 mm. Nerve-wrapping techniques are used to reduce perineural scarring and preserve gliding in complex or revision cases. Emerging adjunctive therapies, …
The Effect Of Institutional Reputation On Clerkship Grades, Jerry Speight Grimes
The Effect Of Institutional Reputation On Clerkship Grades, Jerry Speight Grimes
Western Journal of Orthopaedics
Background: Clinical rotation scores have been reported to predict resident performance. However, the reporting of clerkship grades varies widely across institutions. The authors explored the correlation of an institution’s reputation and the percentage of students receiving honors. Methods: During the review of applicants for orthopaedic residency, the percentage of students receiving the highest grade in the surgery and internal medicine clerkships was recorded for each institution. The authors then compared published institutional rankings with the proportion of students awarded honors in these clerkships. Results: One hundred nineteen institutions were reviewed. There was poor correlation between the institutional rankings by U.S. …
Analysis Of Patient Factors That Predict Early Restoration Of Neutral Dorsiflexion After Achilles Tendon Rupture, W. Chad Elliott, Alvin Ouseph, Alexander Abraham, Jerry Speight Grimes
Analysis Of Patient Factors That Predict Early Restoration Of Neutral Dorsiflexion After Achilles Tendon Rupture, W. Chad Elliott, Alvin Ouseph, Alexander Abraham, Jerry Speight Grimes
Western Journal of Orthopaedics
Background: Achilles Tendon Rupture (ATR) is a common musculoskeletal injury with an increasing incidence in the United States. Early functional rehabilitation is a key component of improving patient outcomes, and restoration of range of motion is a common threshold for progression to strengthening. Neutral ankle dorsiflexion represents an important early milestone in ATR recovery. This study aimed to assess which patient factors were associated with achieving this early rehabilitation milestone. Methods: A retrospective review was performed on 70 patients who sustained ATR and were treated at an academic center. Demographics, baseline characteristics, and common ATR risk factors were collected. The …
Popliteus Interposition In Metaphyseal Tibial Fractures: The Radiographic Clues That Cannot Be Missed, Lucca Gontijo Giarola, Paulo De Tarso Cardoso Gomes, Robinson Esteves Dos Santos Pires, Guilherme Moreira Abreu E Silva, Marco Antônio Percope De Andrade, Túlio Vinícius De Oliveira Campos
Popliteus Interposition In Metaphyseal Tibial Fractures: The Radiographic Clues That Cannot Be Missed, Lucca Gontijo Giarola, Paulo De Tarso Cardoso Gomes, Robinson Esteves Dos Santos Pires, Guilherme Moreira Abreu E Silva, Marco Antônio Percope De Andrade, Túlio Vinícius De Oliveira Campos
Western Journal of Orthopaedics
High-energy proximal tibia fractures present significant challenges for orthopaedic surgeons, with well-recognized risks including malreduction and nonunion. Although double plating through two mini-open parallel incisions is an established technique for selected patients, nonuion can still occur. One potential contributing factor is entrapment of the popliteus muscle within the distal spike of the posteromedial plateau fragment. This report uses illustrative cases to demonstrate how to identify, address, and prevent this complication. Strategies for managing delayed cases that progress to nonunion are also discussed
Prosthetic Knee Joint Infection Caused By Gemella Morbillorum, Nataly Echevarria-Castro, Shaleen Duhra, Leonor Echevarria
Prosthetic Knee Joint Infection Caused By Gemella Morbillorum, Nataly Echevarria-Castro, Shaleen Duhra, Leonor Echevarria
Western Journal of Orthopaedics
Gemella morbillorum is a gram-positive coccus found in the gastrointestinal tract, and is an uncommon cause of human infections, including prosthetic joint infections (PJI). Reported risk factors include immunosuppression, recent gastrointestinal procedures, and poor dental hygiene. This report describes a case of knee PJI caused by G. morbillorum, likely due to hematogenous seeding following a colonoscopy three months earlier. The patient is a 70-year-old man with well-controlled diabetes mellitus who had undergone total knee arthroplasty three years prior. He presented with three weeks of left knee swelling. Synovial fluid culture revealed G. morbillorum. The patient was treated with debridement, antibiotics, …
Arthroscopic Management Of A Loose Body In The Pisotriquetral Joint: A Case Report, Giovanni Chioda, Tomas Holy, Nicholas Newcomb, Nathan Morrell
Arthroscopic Management Of A Loose Body In The Pisotriquetral Joint: A Case Report, Giovanni Chioda, Tomas Holy, Nicholas Newcomb, Nathan Morrell
Western Journal of Orthopaedics
The pisotriquetral joint is the smallest of the four joints comprising the wrist and is a source of ulnar-sided wrist pain. This condyloid joint connects the pisiform to the triquetrum and is supported by several surrounding ligaments. A variety of pathologies may affect the pisotriquetral joint, including the presence of loose bodies. Because of its small size and the inherent difficulty of visualization, the pisotriquetral joint is often overlooked as an independent joint. Techniques for arthroscopic visualization and loose-body removal have previously been described using the 6R and 4-5 portals. In the following case report, the authors describe successful visualization …
Back Matter, Arianna Medina
Distal Adding-On As A Complication Of Posterior Spinal Fusion In Adolescent Idiopathic Scoliosis: A Scoping Review Of Contemporary Evidence, Hussein Hashem, Hassan Abou Adma, Joseph Hayek, Ali Rezazadeh Shirazi, Karim Gaber, Waleed Kishta
Distal Adding-On As A Complication Of Posterior Spinal Fusion In Adolescent Idiopathic Scoliosis: A Scoping Review Of Contemporary Evidence, Hussein Hashem, Hassan Abou Adma, Joseph Hayek, Ali Rezazadeh Shirazi, Karim Gaber, Waleed Kishta
Western Journal of Orthopaedics
Distal adding-on (DAO) is a complication of spinal fusion characterized by postoperative deformity progression distal to the fusion construct. DAO after posterior spinal fusion for adolescent idiopathic scoliosis (AIS) is variably defined and inconsistently managed. This scoping review synthesizes evidence on DAO detection, management, and outcomes. A PRISMA-ScR–guided search identified relevant studies. Thirty-one studies (2,998 patients; median follow-up, 30 months) met inclusion criteria. Reported DAO incidence ranged from 3.5% to 62.5%, reflecting heterogeneity in definitions, patient factors, surgical constructs, and follow-up duration. Revision surgery was infrequent and typically delayed. When performed, it was most often prompted by progressive coronal decompensation …
Infection Rates In Gunshot-Related Hand Fractures Treated Nonoperatively, T. Kyle Summers, Ian Garrison, Matthew C. Watterson, Brandon Barnes, Charles Rodriguez-Feo
Infection Rates In Gunshot-Related Hand Fractures Treated Nonoperatively, T. Kyle Summers, Ian Garrison, Matthew C. Watterson, Brandon Barnes, Charles Rodriguez-Feo
Western Journal of Orthopaedics
Background: Firearm-associated injuries in the U.S. represent a major public health crisis, contributing substantially to major levels of morbidity, mortality, and economic stress. Recommendations for the management of gunshot-related hand fractures remain limited, particularly in low-velocity injuries, and current guidance often leaves treatment decisions to the discretion of the operating surgeon. Methods: A retrospective analysis was performed to identify phalangeal and metacarpal fractures at a Level I trauma center from 2017 to 2023, resulting in 579 patients. Only fractures resulting from firearm injuries were included, resulting in 56 patients. Infection rates were observed in patients treated nonoperatively and those treated …
Increased Mortality And Reduced Survival In Nonagenarians With Hip Fractures: Implications For Geriatric Care, Roman Austin, Julio Avila, Audrey Wassef, Kate Parker, Katherine Gavin
Increased Mortality And Reduced Survival In Nonagenarians With Hip Fractures: Implications For Geriatric Care, Roman Austin, Julio Avila, Audrey Wassef, Kate Parker, Katherine Gavin
Western Journal of Orthopaedics
Background: Hip fractures in nonagenarians (patients aged ≥ 90 years) are becoming increasingly common as the population ages, yet outcomes in this group remain poorly characterized. This study compared in-hospital mortality and survivorship at three months, six months, and one year after hip fracture surgery in nonagenarians with a younger elderly cohort aged 65 years to 89 years. Secondary outcomes included fracture characteristics, surgical management, and discharge disposition. Methods: A retrospective chart review was conducted on patients who underwent hip fracture surgery at a single Level I Trauma Center from August 2019 to December 2021. Patients were grouped into nonagenarians …
Insertion Of An Internal Joint Stabilizer Through A Posterolateral Approach For The Management Of Complex Elbow Instability, Miguel A. Pirela-Cruz, Nikalus Skipp, Ana Love, Deana Mercer, Jazzlyn Gonzalez
Insertion Of An Internal Joint Stabilizer Through A Posterolateral Approach For The Management Of Complex Elbow Instability, Miguel A. Pirela-Cruz, Nikalus Skipp, Ana Love, Deana Mercer, Jazzlyn Gonzalez
Western Journal of Orthopaedics
Background: Complex elbow fracture-dislocations represent a substantial surgical challenge. Achieving adequate stability while permitting early postoperative motion is essential to prevent stiffness. The internal joint stabilizer (IJS) has emerged as an alternative to hinged external fixation, providing internal dynamic stabilization with improved patient tolerance and reduced risk of soft-tissue complications. Although the IJS is commonly inserted through a lateral approach, injuries involving multiple anatomical structures may necessitate broader exposure. Purpose: To describe the surgical technique for IJS insertion through a posterolateral approach (PLA) for complex elbow injuries involving multiple anatomical structures. Methods: The PLA provides extensile exposure to the posterior, …
Exploring The Interaction Between Cranial Nerves V And Vii In Chronic Eyelid Myokymia: A Case Report, Karina Miramontes, Adam Walsh, Tomas Tafoya
Exploring The Interaction Between Cranial Nerves V And Vii In Chronic Eyelid Myokymia: A Case Report, Karina Miramontes, Adam Walsh, Tomas Tafoya
Western Journal of Orthopaedics
Eyelid myokymia involves involuntary contractions of the orbicularis oculi muscle and is commonly associated with stress, fatigue, and craniocervical factors. Emerging evidence suggests that altered trigeminocervical interactions and craniomandibular muscle tension may contribute to symptom persistence; however, the condition remains underrecognized in physical therapy. This report describes a 65-year-old woman with chronic benign eyelid myokymia and cervical pain who completed 12 physical therapy sessions that included suboccipital functional dry needling, temporomandibular soft-tissue mobilization (STM), and cervical stabilization exercises. A reduction in eyelid myokymia was first observed at the fifth visit, coinciding with the initiation of temporomandibular STM. These findings suggest …
Massive Upper Extremity Neurofibroma Treated With Limb-Sparing Debulking: A Case Report, Danielle Cummings, Tomas Holy, Nathan Morrell
Massive Upper Extremity Neurofibroma Treated With Limb-Sparing Debulking: A Case Report, Danielle Cummings, Tomas Holy, Nathan Morrell
Western Journal of Orthopaedics
Surgical management of neurofibromas in Neurofibromatosis type 1 (Von Recklinghausen’s disease), can be challenging because tumor size, location, hypervascularity, and tissue friability pose the risk for significant intraoperative and postoperative blood loss. Despite these risks, surgery is often necessary because of functional losses or cosmetic concerns. The authors present a 31-year-old woman with a massive neurofibroma on her right distal forearm, wrist, and hand, who ultimately underwent surgical resection because of functional impairment of her hand. She required postoperative hospitalization and blood transfusion for management of acute blood loss anemia. Because of concerns regarding blood loss and surgical morbidity, the …
Median Nerve Intraneural Hematoma As An Intraoperative Finding During Carpal Tunnel Release: A Case Report, Ana Silva, Gil Gonrtre, Nikalus Skipp, Ana Love, Deana Mercer
Median Nerve Intraneural Hematoma As An Intraoperative Finding During Carpal Tunnel Release: A Case Report, Ana Silva, Gil Gonrtre, Nikalus Skipp, Ana Love, Deana Mercer
Western Journal of Orthopaedics
Carpal tunnel syndrome (CTS) is the most common compressive neuropathy and typically progresses slowly. Intraoperatively, flexor tenosynovitis, nerve edema, or hourglass deformity may be observed. In rare cases, acute compression symptoms occur due to mass effect on the nerve. Intraneural hematoma of the median nerve is uncommon and has been reported primarily in acute CTS cases associated with trauma. This report describes an 87-year-old patient with a history of mild CTS who underwent carpal tunnel release due to worsening symptoms. After the initial incision, a thickened flexor retinaculum, an hourglass deformity of the median nerve, and an intraneural hematoma were …
Proximal Iliotibial Band Rupture In A 74-Year-Old High-Level, Female Athlete: A Case Report, Jeremiah M. Langsfeld, Joseph Esquibel, Dustin L. Richter
Proximal Iliotibial Band Rupture In A 74-Year-Old High-Level, Female Athlete: A Case Report, Jeremiah M. Langsfeld, Joseph Esquibel, Dustin L. Richter
Western Journal of Orthopaedics
A 74-year-old female endurance athlete presented with progressive pain over the left proximal and lateral hip distal to the iliac crest. Symptoms developed over three weeks, impairing weightbearing. Magnetic resonance imaging demonstrated a high-grade tear of the proximal iliotibial band at its iliac crest insertion. The patient was treated nonoperatively and returned to high-level, asymptomatic competition three months after symptom onset. This case offers a nonoperative approach to the rare presentation of a proximal iliotibial band rupture.
Arthroscopic Treatment Of Extensive Synovial Chondromatosis Of The Knee: A Case Report, Gaurav Singh, Bhavna Singh, Rebecca Peebles, Justin Bartley
Arthroscopic Treatment Of Extensive Synovial Chondromatosis Of The Knee: A Case Report, Gaurav Singh, Bhavna Singh, Rebecca Peebles, Justin Bartley
Western Journal of Orthopaedics
Synovial chondromatosis (SC) is a rare, benign monoarticular disorder characterized by intra-articular cartilaginous loose bodies resulting from synovial metaplasia, most commonly affecting the knee. The authors present the case of a 44-year-old man with progressive, debilitating left knee pain, mechanical symptoms, and functional limitations unresponsive to conservative treatment. Radiographs were unremarkable, but magnetic resonance imaging (MRI) demonstrated multifocal noncalcified intra-articular bodies consistent with SC. The patient underwent arthroscopic debridement of the knee with limited synovectomy. Intraoperative findings included innumerable intra-articular cartilaginous loose bodies throughout the knee, synovial proliferation, and grade II chondromalacia. At three months postoperatively, the patient had regained …
Fibula Strut Allograft With Proximal Tibia Autograft For Treatment Of Humerus Nonunion: A Case Report And Review Of Oligotrophic Nonunion Management, Paul Wilson, Naomi Kelley, Samer Kakish
Fibula Strut Allograft With Proximal Tibia Autograft For Treatment Of Humerus Nonunion: A Case Report And Review Of Oligotrophic Nonunion Management, Paul Wilson, Naomi Kelley, Samer Kakish
Western Journal of Orthopaedics
Due to their high incidence and frequent need for reoperation, nonunions of the humerus present a significant challenge in orthopaedics. Using fibular struts to treat nonunions have demonstrated excellent results. While fibular autografts provide both biologic and structural benefit, high donor site morbidity must be considered. Although their application in midshaft humeral nonunions remains limited, fibular allografts avoid donor site morbidity. Enhancing fibular strut allografts with biological components offers a promising strategy for treating fractures that have failed prior revisions. This case study presents a 36-year-old woman with an aseptic oligotrophic midshaft humeral nonunion who had an unsuccessful revision surgery. …
Decoding A Decade: Evolution In Distal Radius Fracture Techniques From Past To Present, Embracing The Efcr Method, Natasha G. Dark, Ahmed S. Raihane, Laurie G. Wells, Deana Mercer
Decoding A Decade: Evolution In Distal Radius Fracture Techniques From Past To Present, Embracing The Efcr Method, Natasha G. Dark, Ahmed S. Raihane, Laurie G. Wells, Deana Mercer
Western Journal of Orthopaedics
No abstract provided.
Front Matter, Arianna Medina
Front Matter, Arianna Medina
Full Issue, Arianna Medina
Back Matter, Arianna Medina
A Brief History Of Opioid-Use Disorder In The United States, Effect On Orthopaedics, And Current Management Options, William Curtis, Nicholas Newcomb, Eric S. Kruger, Christopher L. Shultz
A Brief History Of Opioid-Use Disorder In The United States, Effect On Orthopaedics, And Current Management Options, William Curtis, Nicholas Newcomb, Eric S. Kruger, Christopher L. Shultz
Western Journal of Orthopaedics
Declared a public health emergency in 2017 and leading to 11 million years of life lost worldwide, the American opioid crisis has impacted millions of people, with up to 7 million experiencing opioid use disorder. In orthopaedic surgery, opioid analgesia has been associated with various complications, including infections, deep vein thrombosis, prolonged hospital stays, and overall inferior outcomes after surgical procedures. Orthopaedic surgeons commonly rely on opioids to provide postoperative analgesia and may frequently encounter patients with opioid use disorder. It is therefore essential that orthopaedic surgeons understand opioid use disorder, its effect on orthopaedic outcomes, and management of opioid …
Scar Tissue Adhesions, Neuromuscular Guarding, And Functional Recovery: A Case Report Of Physical Therapy Post-Cholecystectomy, Raeisa Griñe, Adam Walsh
Scar Tissue Adhesions, Neuromuscular Guarding, And Functional Recovery: A Case Report Of Physical Therapy Post-Cholecystectomy, Raeisa Griñe, Adam Walsh
Western Journal of Orthopaedics
Scar tissue from abdominal surgeries, such as cholecystectomy, can lead to long-term issues such as restricted movement, painful spasms, and impaired function. Laparoscopic adhesiolysis is a common surgical treatment for pathological scar tissue impairments. Conservative care, such as physical therapy, is a commonly used approach for managing pathological scar tissue. In this case, manual therapy techniques and targeted exercises successfully reduced the intensity and frequency of abdominal spasms, improved core strength and endurance, and enhanced overall functional mobility. These improvements were reflected in enhanced scores on the Lower Extremity Functional Scale and the Vancouver Scar Scale in a 59-year-old woman …
Fishtail Deformity Complication Of Distal Humeral Fractures In Children, Jorge E. Licano, Ryan Price, Devin A. Maez, Selina A. Silva
Fishtail Deformity Complication Of Distal Humeral Fractures In Children, Jorge E. Licano, Ryan Price, Devin A. Maez, Selina A. Silva
Western Journal of Orthopaedics
Background: Pelvic ring injuries are complex surgical challenges requiring significant radiation exposure for safe placement of sacroiliac (SI) screw fixation. Traditionally, SI fixation has been performed with conventional C-arm fluoroscopy to guide screw placement. 3D navigated imaging is a technique that uses fluoroscopic scans and a navigation tracker to guide screws in space. The purpose of this study is to characterize a single institution’s experience with navigated SI fixation and the resulting radiation exposure to patient and staff. Methods: Records of 60 patients who underwent SI fixation using either conventional fluoroscopy (43) or 3D navigation (17) were reviewed. Exposure data …
Introducing The University Of New Mexico 12-Level Functional Scale: A Novel Approach For Assessing Functional Recovery In Orthopaedic Trauma Patients, Devin A. Maez, Rick J. Gehlert, Thomas A. Decoster
Introducing The University Of New Mexico 12-Level Functional Scale: A Novel Approach For Assessing Functional Recovery In Orthopaedic Trauma Patients, Devin A. Maez, Rick J. Gehlert, Thomas A. Decoster
Western Journal of Orthopaedics
The University of California at Los Angeles (UCLA) Activity Scale and other common activity scales are primarily used for patients undergoing joint reconstructive surgery. However, no such scale exists for musculoskeletal trauma patients. The authors propose The University of New Mexico (UNM) 12-Level Functional Activity Scale to address this gap in assessing functional activity and managing postoperative care for orthopaedic trauma patients. A comprehensive review of existing scales led to the development of the UNM Scale, emphasizing simplicity, objectivity, and potential benefits in patient education and interdisciplinary collaboration. The UNM Scale provides a structured approach to assess and monitor functional …
Fluoroscopy-Guided Versus 3d Navigated Percutaneous Sacroiliac Screw Fixation: A Comparison Of Radiation Exposure And Surgical Duration, Tyler J. Chavez, Jeremiah M. Langsfeld, Solomon Oloyede, Gordon H. Lee, Urvij Modhia
Fluoroscopy-Guided Versus 3d Navigated Percutaneous Sacroiliac Screw Fixation: A Comparison Of Radiation Exposure And Surgical Duration, Tyler J. Chavez, Jeremiah M. Langsfeld, Solomon Oloyede, Gordon H. Lee, Urvij Modhia
Western Journal of Orthopaedics
Background: Pelvic ring injuries are complex surgical challenges requiring significant radiation exposure for safe placement of sacroiliac (SI) screw fixation. Traditionally, SI fixation has been performed with conventional C-arm fluoroscopy to guide screw placement. 3D navigated imaging is a technique that uses fluoroscopic scans and a navigation tracker to guide screws in space. The purpose of this study is to characterize a single institution’s experience with navigated SI fixation and the resulting radiation exposure to patient and staff. Methods: Records of 60 patients who underwent SI fixation using either conventional fluoroscopy (43) or 3D navigation (17) were reviewed. Exposure data …
Rare Case Of Fungal Osteomyelitis Affecting An Intramedullary Lag Screw, Matthew C. Watterson, Robert T. Rella, Timothy K. Summers, David Michaeli, Jess Mullens
Rare Case Of Fungal Osteomyelitis Affecting An Intramedullary Lag Screw, Matthew C. Watterson, Robert T. Rella, Timothy K. Summers, David Michaeli, Jess Mullens
Western Journal of Orthopaedics
Osteomyelitis is an infection of the bone that is most commonly of bacterial origin. Cases of fungal osteomyelitis are rare, and treatment often requires a prolonged course of antimicrobials. The authors report a case of a 72-year old man with fungal osteomyelitis affecting an intracortical lag screw, which was discovered during fixation of the left femoral shaft following an injury that occurred 68 years after placement of the affected lag screw. Chronic osteomyelitis can be indolent and subclinical, with the patient experiencing no signs or symptoms of the disease despite having bone infection for decades. This condition may become clinically …