Orthopedics Commons^™

Closed Treatment Of Displaced Radial Neck Fracture In An Adult, Nicholas Newcomb, Tomas Holy, Naomi Kelley, Nathan T. Morrell

Western Journal of Orthopaedics

Making up 1.5% to 4.0% of all fractures, radial head and neck fractures are typically treated based on the severity of angulation at the radial neck or if range of motion (ROM) is blocked. In this study, we present a case of a 43-year old woman with a Mason Type 2 radial neck fracture, successfully treated with closed reduction and one week of immobilization, resulting in near anatomic radial neck angulation without the need for operative intervention. The patient returned to work within two weeks and regained full ROM by six months, maintaining near anatomic reduction throughout. Keywords: Elbow Injury; …

Two-Stage Total Knee Arthroplasty (Tka) For A Rigid And Infected Knee: A Rare Case Report Of Aspergillosis, Túlio Vinícius De Oliveira Campos, David G. Kasuya Barbosa, Victor A. Kasuya Barbosa, Santiago Enrique Sarmiento Molina, Guilherme Moreira De Abreu Silva, Marco Antônio Percope De Andrade

Western Journal of Orthopaedics

Knee infection caused by Aspergillus is a rare condition that presents a diagnostic challenge for orthopaedic surgeons and musculoskeletal specialists. This case report aims to describe the treatment of a patient with active articular Aspergillus infection and knee arthrofibrosis through a two-stage total knee arthroplasty (TKA). A 37-year old woman presented with knee arthrofibrosis, which was complicated by an Aspergillus infection. The treatment involved a two-stage procedure: 1) bone cuts for TKA and systemic antibiotic therapy; and 2) TKA with the use of specific antibiotic-loaded cement. The patient has been followed for 30 months, showing no signs of failure.

Proximal Tibia Biplanar Anterior And Lateral Closing Wedge Osteotomy With Concomitant Revision Anterior Cruciate Ligament Reconstruction: A Case Report, Shane H. Johns, Lisandro Nardin, Jessica A. Nelson, Robert Schenck

Western Journal of Orthopaedics

This report documents a unique, successful strategy to manage a failed anterior cruciate ligament reconstruction (ACLR) in the setting of coronal and sagittal plane malalignment. The patient is a 38-year-old man with a history of a failed ACLR who presented with recurrent knee instability. Imaging revealed a posterior tibial slope (PTS) of 17° complicated by a varus malalignment of 10°. A single-stage anterior and lateral closing wedge tibial osteotomy (biplanar) with simultaneous revision anterior cruciate ligament reconstruction was performed. Final radiographic evaluation revealed that the tibial osteotomy healed with correction of coronal alignment to a physiologic 3° varus and a …

Recurrent Baker’S Cyst In A Pediatric Athlete: A Case Report, Gaurav Singh, Rebecca Peebles, Justin Bartley

Western Journal of Orthopaedics

Also known as popliteal cysts, Baker’s cysts are fluid-filled lesions found in the popliteal fossa, typically originating from the gastrocnemius-semimembranosus bursa. While these cysts are relatively common in adults, with a prevalence ranging from 5.0% to 41.0%, they are extremely rare in children, showing an incidence of just 2.4%. In most cases, Baker’s cysts result from intra-articular knee pathologies that lead to an increased production and sequestration of synovial fluid. The authors present the case of an athletic 16-year-old adolescent boy with a recurrent left-knee Baker’s cyst with magnetic resonance imaging showing no intra-articular pathology. Despite conservative treatment, including non-steroidal …

Treatment Of Congenital Cruciate Ligament Absence In A Teenager Knee-Ding Stability, Gaurav Singh, Anna Bergquist, Rebecca Peebles, Justin Bartley

Western Journal of Orthopaedics

The congenital absence of the anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) is an extremely rare condition, with an estimated prevalence of 0.017 per 1,000 live births for ACL agenesis. The authors present the case of a 15-year-old adolescent girl with autosomal dominant multiple synostosis, who developed progressive bilateral knee pain and functional limitations. Bilateral knee x-rays revealed trochlear dysplasia and an absent tibial eminence, suggesting a congenital ligamentous abnormality. Magnetic resonance imaging confirmed the bilateral absence of both the ACL and PCL. Surgical reconstruction of both ligaments was performed, with the first procedure taking place in October …

Reverse Palmaris Longus Involving Guyon’S Canal Causing Ulnar Nerve Compression, David Peberdy, Sameer Gujral

Western Journal of Orthopaedics

The authors present a case of reverse palmaris longus muscle (RPLM) with consequential compression of the ulnar nerve within Guyon’s canal. They report clinical findings, investigations, including magnetic resonance imagining and functional assessments, and intraoperative findings. The authors found improved sensory and motor function following excision of RPLM. There are few previous case reports regarding RPLM and concomitant compression of the ulnar nerve within Guyon’s canal.

Rehabilitation Medicine In Rural New Mexico And Beyond, Rebecca A. Dutton

Western Journal of Orthopaedics

No abstract provided.

Outcomes Of Hemiepiphysiodesis For Juvenile Hallux Valgus: A Systematic Review, Karim Gaber, Faran Chaudhry, Ihtisham Ahmad, Emmanuel Olaonipekun, Waleed Kishta

Western Journal of Orthopaedics

Juvenile hallux valgus (JHV) is a common deformity of the forefoot that may result in significant pain and discomfort. To correct JHV, percutaneous, or minimally invasive surgeries have become more popular than open surgeries due to reductions in morbidity. One of these procedures is percutaneous hemiepiphysiodesis. The aim of this study was to evaluate the efficacy of percutaneous hemiepiphysiodesis for JHV by investigating the available literature on the procedure.

In this systematic review, the authors’ search strategy identified 91 studies, but only five met the inclusion criteria. The identified studies included 76 patients and 132 feet. There was an improvement …

Change In Posterior Tibial Slope And Patellar Height During Medial Opening Wedge High Tibial Osteotomy: A Retrospective Cohort Study, Jessica A. Nelson, Brandon M. Painter, Dustin L. Richter, Jennifer S. Weaver, Robert C. Schenck

Western Journal of Orthopaedics

Background: Medial opening wedge high tibial osteotomy (MOWHTO) may be indicated for patients who have varus alignment, medial knee pain, and medial knee compartment osteoarthritis. Another indication for MOWHTO is in patients with a history of recurrent anterior cruciate ligament (ACL) deficiency or failed ACL reconstruction (ACLR) with varus alignment. Some patients have MOWHTO combined with a primary or revision ACLR.

Methods: This is a retrospective case series that was approved by the Institutional Review Board at the authors’ institution. The purpose of this series is to report on average coronal plane alignment, posterior tibial slope (PTS), and patellar height …

Does Matching Humeral Version In Anatomic Shoulder Arthroplasty Affect Postoperative Range Of Motion? A Pilot Study, Shane Johns, William Curtis, Nicholas Newcomb, Ryan Dahlberg, Christopher Shultz

Western Journal of Orthopaedics

Background: While considerable focus has been given to address glenoid morphology and version in anatomic total shoulder arthroplasty (TSA), there has been little attention paid to the potential impacts of humeral version on postoperative outcomes. The purpose of this study is to assess the impact of matching native humeral version on postoperative range of motion (ROM) after anatomic TSA.

Methods: All anatomic TSAs performed by a single surgeon between September 2021 and June 2023 were retrospectively reviewed. Patients undergoing TSA for fracture and/or revision TSA were excluded. This study group consisted of 20 patients whose native humeral version was measured …

Synovial Fluid Inflammatory Profiles Did Not Differ Between Isolated Anterior Cruciate Ligament And Multi-Ligament Knee Injuries, Cale A. Jacobs, Robert C. Schenck Jr., Leorrie A. Watson, Caitlin E.W. Conley, Darren L. Johnson, Austin V. Stone, Christian Lattermann, Dustin L. Richter

Western Journal of Orthopaedics

Background: Postoperative arthrofibrosis is more common following surgical treatment of multi-ligament knee injury (MLKI) than isolated anterior cruciate ligament (ACL) injury. It has been proposed that the increased prevalence of postoperative arthrofibrosis after MLKIs may be due to increased inflammation secondary to greater trauma to the joint. The purpose of this study was to compare synovial concentrations of pro-inflammatory and anti-inflammatory cytokines between patients with MLKI and ACL injuries.

Methods: Synovial fluid was aspirated from the operative knee at the time of surgery from 14 patients with MLKI and 10 patients with isolated ACL injury. Structures injured, the time between …

Cross-Tasking In Surgery: An Efficient Method To Perform Multiple Tasks In Parallel, Jacob Sanchez, Robert C. Schenck Jr., Lillian J. Schenck, Urvij Modhia, Gehron Treme, Samer Kakish, Deana Mercer, Daniel C. Wascher, Dustin L. Richter

Western Journal of Orthopaedics

Multitasking is defined as the ability to perform more than one task or activity simultaneously, which can be inefficient, unsafe, and should be avoided when applied to surgery. Cross-tasking is a concept where processes can be safely performed in parallel. The authors present cross-tasking as a useful approach to surgical procedural task subsets, timing of parallel tasks, and combining parallel tasks when performing a specific orthopaedic operation. The authors use the examples of an anterior cruciate ligament reconstruction and complex spinal deformity correction to review the pearls and pitfalls of models that manage multiple simultaneous surgical and educational tasks. This …

Full Issue, Arianna Medina

Western Journal of Orthopaedics

No abstract provided.

Pediatric Body Mass Index (Bmi) And Distal Radius Fracture Incidence, Jessica Avila, Tyler Hough, Nikalus Skipp, Amber L. West, Deana Mercer

Western Journal of Orthopaedics

Background: The authors postulate that obesity in children increases the risk of distal radius fracture compared to children who are not obese. Because it is difficult to determine the population at risk, the authors observed the inverse of the rate of obesity in pediatric patients with distal radius fractures in an attempt to determine if there was a difference compared to national data on frequency of obesity in the pediatric population in general. If the rate of obesity was greater in distal radius fractures than the overall population, this would constitute evidence that obesity may increase the risk of distal …

Long-Term Success In Managing Midfoot Lateral Column Arthritis: A Case Report, Damian Fountain, Cesar Cardenas, Nicholas Brady, Katherine Gavin, Richard Miller

Western Journal of Orthopaedics

The lateral column of the midfoot is crucial for midfoot mobility and foot stability. Although there are several nonoperative treatment options for arthritis that is isolated to the lateral column cuboid-metatarsal joints, there is a lack of consensus on the best operative intervention, given the rare nature of the disease. The patient in this case initially presented to clinic in 2007 with a significant history of lateral midfoot pain in the fourth and fifth metatarsal cuboid region. Despite nonoperative interventions, her symptoms progressed, and in January of 2009, she elected to undergo interpositional arthroplasty of left fourth and fifth metatarsal …

Chondroblastoma Of The Calcaneus Treated With Femoral Head Allograft Reconstruction For Subtalar Arthrodesis In A Skeletally Immature Patient: A Case Report, Benjamin B. Blanco, Ryan Dahlberg, David H. Chafey

Western Journal of Orthopaedics

Chondroblastomas are rare, benign, primary bone tumors most seen in men within their second decade of life in the epiphyseal/apophyseal region of long bones. Only a few cases of disease in the calcaneus have been reported previously, with treatment generally involving surgical curettage and local adjuvants. Recurrence rates can be as high as 38.0%, especially in a lesion near the physis or in skeletally immature patients. The authors present the case of a 14-year-old boy with active calcaneal chondroblastoma that was successfully treated with curettage, allograft reconstruction, and subtalar arthrodesis. The patient is now two years postoperative with no evidence …

Radiographic Identification And Treatment Prioritization Of Pediatric Elbow Fractures, Hoang M. Nguyen, Bryce Clinger, Casey Slattery, Selina R. Silva, Patrick Bosch

Western Journal of Orthopaedics

Background: Constituting approximately 15.0% of fractures, pediatric elbow fractures often require surgical intervention. Accurate diagnosis in pediatric patients is challenging, demanding proficient radiographic expertise. Initial diagnosis falls to emergency medicine (EM) physicians and pediatricians, who may lack sufficient radiographic training. Previous research by Shrader found a 58.0% accuracy in non-academic EM physicians for pediatric elbow fractures. The purpose of the study is to build on Shrader’s work and assess orthopaedic surgery (OS), pediatric, EM, and residents’ ability to accurately interpret pediatric elbow radiographs.

Methods: OS, EM, and pediatric residents at a Level 1 trauma center in an academic institution examined …

Front Matter, Arianna Medina

Western Journal of Orthopaedics

No abstract provided.

Back Matter, Arianna Medina

Western Journal of Orthopaedics

No abstract provided.

Why You Should Use The New Ota Open Fracture Classification (Ofc3), Thomas A. Decoster, Meir Marmor

Western Journal of Orthopaedics

Open fracture classification has traditionally used a modified Gustilo Classification (GOFC). There are many recognized problems with the Gustilo classification. The Orthopaedic Trauma Association (OTA) produced an open fracture Classification (OTA OFC) in 2010 to overcome problems with GOFC. However, it has not been widely adapted, partially because there are too many categories. The OTA OFC has proven to be more effective in identifying particular parameters that affect outcome and treatment for open fractures than GOFC. Numerous authors have called for a reconciliation of the two classifications. The OTA Classification Committee has proposed a modification called the OTA OFC3, which …

Isolated Rotational Dislocation Of The Talus: A Case Report, Tomas Holy, Nicholas Newcomb, Devin Maez, Christopher Paiz, Samer Kakish

Western Journal of Orthopaedics

A 46-year-old man sustained a closed pantalar dislocation in a high-speed motor vehicle ejection. The patient underwent closed reduction and splinting with subsequent open reduction and external fixation to ensure anatomic reduction of the tibiotalar, talonavicular, and subtalar joints, resulting in a pain free ankle with improving range of motion. In an effort to minimize the significantly morbid complications, such as avascular necrosis of the talus and rapid onset post-traumatic arthritis, treatment of closed pantalar dislocations should be performed in an emergent manner to minimize damage to the extensive articular surface and tenuous blood supply to the talus.

Comparison Of Helicopter And Ground Interfacility Transport On Time-To-Treatment Of Isolated Open Fractures, Jerry Speight Grimes, Duke Appiah

Western Journal of Orthopaedics

Background: Helicopter emergency medical services have become an integral part of trauma systems. When appropriately utilized, helicopter transport can improve the outcomes of trauma patients. The objective of this study was to determine if helicopter transport for interfacility transfers was effective in reducing time-to-treatment for isolated open fractures in the setting of a rural Level I trauma center. The authors hypothesized that helicopter transportation of isolated open fractures would not reduce time to definitive fixation.

Methods: All patients treated with isolated open fractures over a four-year period at a Level I trauma center were identified. In this study, the authors …

Neuroarthropathy And Workers’ Compensation Denials In Healthcare, Jerry Speight Grimes

Western Journal of Orthopaedics

Background: Neuroarthropathy is a complication of peripheral neuropathy commonly associated with diabetes mellitus. The actual trigger for a neuroarthropathy episode is unknown. If the inciting event occurred at work, causality of neuroarthropathy is difficult to determine.

Methods: In this study, the authors retrospectively reviewed workers’ compensation claims to identify patients with diabetes mellitus, peripheral neuropathy, and neuroarthropathy. The correlation between their health status and claims status was reported. The number of workers’ compensation denials for services already performed were compared between the groups.

Results: Over a five-year period, 412 patients were evaluated in a tertiary foot and ankle clinic with …

Front Matter, Arianna Medina

Western Journal of Orthopaedics

No abstract provided.

Back Matter, Arianna Medina

Western Journal of Orthopaedics

No abstract provided.

Principles Of Arthroscopic - Assisted Open Reduction Internal Fixation In The Management Of Displaced Articular Fractures, Nathan Sherman, Matthew Miller, Michael D. Feldman

Western Journal of Orthopaedics

The primary objective of fracture fixation is to obtain anatomic reduction with stable fixation while minimizing damage to the surrounding structures. Displaced articular fractures represent a surgical challenge, but anatomic alignment with restoration of the articular surface is the gold standard of management. Using open techniques, intra-articular visualization can require large dissections and added soft-tissue insult. However, arthroscopic-assisted open reduction internal fixation (AAORIF) may represent a less invasive means of articular fracture management in appropriate patients with select fractures. The general principles of AAORIF are modified from basic arthroscopic principles, including positioning, portal placement, fluid management, visualization, soft-tissue management, and …

Let’S Focus On The Fibrosis: Targeting Ccn2 In Dupuytren’S Disease, Alex G. Lambi, Ryan Dahlberg, Tomas Holy, Joseph T. Tarr, Deana Mercer, Steven N. Popoff, Mary F. Barbe

Western Journal of Orthopaedics

Dupuytren’s disease is a progressive, benign fibroproliferative disorder of the hands that can lead to debilitating hand contractures. Once symptomatic, treatment involves either surgical intervention, specifically fasciectomy or percutaneous needle aponeurotomy, or enzymatic degradation with clostridial collagenase. Currently, collagenase is the only pharmacotherapy that has been approved for the treatment of Dupuytren’s contracture. There is a need for a pharmacotherapeutic that can be administered to limit disease progression and prevent recurrence after treatment. Targeting the underlying fibrotic pathophysiology is critical. The authors propose a novel target to be considered in Dupuytren’s disease – cell communication network factor 2/connective tissue growth …

Complex Lisfranc Injury In A Professional Bull Rider, Elizabeth Eichman, Stephan Sierra, Matthew Ferguson

Western Journal of Orthopaedics

American bull riding is one of the most dangerous sports in the world, with a high prevalence of injury. Due to the high-velocity trauma that is common in this sport, injuries occur frequently and are often classified as severe despite the use of protective equipment. While Lisfranc fracture-dislocations are somewhat common in elite athletes, open Lisfranc fractures are much less common. Consequently, there are little data concerning recovery and return to sport. This case demonstrates an uncommon presentation of open Lisfranc fracture dislocation and first metatarsophalangeal dislocation in a professional bull rider who was able to return to sport at …

Terrible Triad In A Pediatric Patient: A Case Report, Colin J. Carroll, Gonzalo Sumarriva, Russell Parks, Caroline Vasco, Ross Dunbar

Western Journal of Orthopaedics

A terrible triad elbow injury consists of an elbow dislocation with associated radial head and coronoid fractures. This type of injury is rare in the pediatric population. In this case, a 14-year-old adolescent male suffered a right-sided terrible triad elbow injury after falling onto his right elbow. He was taken to the operating room for open reduction and internal fixation. The patient is now three years postoperatively with full range of motion of his elbow with no pain and no incidents of dislocation.

Diversifying The Field: Reflflections Of Female Orthopaedic Residents, Kate M. Parker, Audrey C. Wassef

Western Journal of Orthopaedics

No abstract provided.