Orthopedics Commons^™

Rna Sequencing Reveals A Role Of Tonebp Transcription Factor In Regulation Of Pro-Inflammatory Genes In Response To Hyperosmolarity In Healthy Nucleus Pulposus Cells: A Homeostatic Response?, Zariel I. Johnson, Irving M. Shapiro, Makarand V. Risbud

Department of Orthopaedic Surgery Faculty Papers

Transcription factor tonicity-responsive enhancer-binding protein (TonEBP/NFAT5) is critical for osmo-adaptation and extracellular matrix homeostasis of nucleus pulposus (NP) cells in their hypertonic tissue niche. Recent studies implicate TonEBP signaling in inflammatory disease and rheumatoid arthritis pathogenesis. However, broader functions of TonEBP in the disc remain unknown. RNA sequencing was performed on NP cells with TonEBP knockdown under hypertonic conditions. 1140 TonEBP-dependent genes were identified and categorized using Ingenuity Pathway Analysis. Bioinformatic analysis showed enrichment of matrix homeostasis and cytokine/chemokine signaling pathways. C-C motif chemokine ligand 2 (CCL2), interleukin 6 (IL6), tumor necrosis factor (TNF), and nitric oxide synthase 2 (NOS2) …

Near-Complete Humerus Reconstruction In The Pediatric Patient With Vascularized Free Fibula Transfer., John Shuck, Benjamin C Wood, Christopher Zarella, Albert K Oh, Robert M Henshaw, Gary F Rogers

Surgery Faculty Publications

Vascularized free fibula transfer remains the gold standard for reconstruction of large segmental diaphyseal defects of the upper extremity. In the pediatric patient, before skeletal maturity, free fibula transfer with the fibular head provides an active physis for growth and an articular interface for glenohumeral joint reconstruction. Clinical and cadaveric studies have demonstrated that the vascular supply to the fibular head originates, in most cases, from the anterior tibial system. However, anatomical variation exists, and we report a case in which a vascularized fibula autograft including the physis was transferred on the peroneal artery in a 5-year-old patient with Ewing's …

The Development Of A Universally Accepted Sacral Fracture Classification: A Survey Of Aospine And Aotrauma Members., Gregory D. Schroeder, Mark Kurd, Christopher K. Kepler, James C. Krieg, Jefferson R. Wilson, Conor P. Kleweno, Reza Firoozabadi, Carlo Bellabarba, Frank Kandizoria, Klause J. Schnake, S. Rajesekaran, Marcel F. Dvorak, Jens R. Chapman, Luiz R. Vialle, F. C. Oner, Alex R. Vaccaro

Rothman Institute Papers

Study Design Survey study. Objective To determine the global perspective on controversial aspects of sacral fracture classifications. Methods While developing the AOSpine Sacral Injury Classification System, a survey was sent to all members of AOSpine and AOTrauma. The survey asked four yes-or-no questions to help determine the best way to handle controversial aspects of sacral fractures in future classifications. Chi-square tests were initially used to compare surgeons' answers to the four key questions of the survey, and then the data was modeled through multivariable logistic regression analysis. Results A total of 474 surgeons answered all questions in the survey. Overall …

Early Experience Of Dynamic Hip Screw With Spiral Blade And Locking Side Plate For The Stabilization Of Trochanteric Fractures., Akbar Jaleel Zubair, Rizwan Haroon Rashid, Marij Zahid, Masood Umer, Pervaiz Hashmi

Department of Surgery Docs

Abstract

OBJECTIVE:

To evaluate early experience with helical hip system in osteoporotic elderly patients with per-trochanteric fractures.

METHODS:

The retrospective study was conducted at Aga Khan University Hospital, Karachi, and comprised records of patients having low-velocity pertrochanteric fractures who were fixed with spiral blade Dynamic Helical Hip Systemfrom July to December 2014 and were followed up for a minimum of 3 months. Demographic variables and clinical outcomes were noted from the medical records whereas operative details were recorded from the operative note. Radiological variables and outcomes were assessed by viewing appropriate pre-operative, post-operative and follow-up radiographs.

RESULTS:

Of the 32 …

Contribution Of Tactile Dysfunction To Manual Motor Dysfunction In Type Ii Diabetes, Nereyda Ochoa, Gloria R Gogola, Stacey L Gorniak

Faculty, Staff and Student Publications

Introduction:

Changes in sensory and motor functions of the hand in Type II Diabetes (T2D) patients have been reported; there is speculation that these changes are driven by tactile dysfunction. The purpose of this study was to evaluate the effects of tactile feedback on manual function in T2D patients.

Methods:

T2D patients and healthy controls underwent median nerve blocks at the wrist and elbow. All participants underwent traditional timed motor evaluations, force dynamometry, laboratory-based kinetic evaluations, and sensory evaluation.

Results:

Tactile sensation in the T2D group at baseline was found to be equivalent to tactile function of the control group …

Lamina Spreader Technique Improves Debridement Of Loose Bone And Cement In Total Knee Arthroplasty, Sinan E. Ozgur, Ali Oliashirazi, Grant S. Buchanan, Franklin D. Shuler

Marshall Journal of Medicine

Abstract

Loose bone and cement can promote polyethylene wear that may lead to failure in total knee arthroplasty. The authors propose a technique to enhance the debridement of loose bodies by distracting the cemented components with a lamina spreader following standard debridement with pulsatile lavage. Cement and bone/soft tissue debris was recovered from 51 consecutive primary total knee arthroplasty patients. This technique facilitated the removal of hidden debris in 80% of patients (41/51). On average, 2.6 fragments measuring 158 mm³ were removed per patient. The authors advocate that distraction with a lamina spreader be used to reduce potential sources …

Technique To Improve Cement Penetration In Total Knee Arthroplasty, Richard Boe Jr, Ali Oliashirazi

Marshall Journal of Medicine

In total knee arthroplasty, infection has always been cited as being the number one cause of failure. However, more recent studies have shown aseptic loosening as the top reason for failure now. Proper cement technique is an important factor in reducing the occurrence of aseptic loosening. Clean and dried bone are important in achieving rigid cement fixation. Subchondral cysts may be hidden below the cut bone surface and may interfere with cement interdigitation. During a recent total knee arthroplasty case, a simple technique was developed for identifying and clearing out these cysts. By only using the suction tip, the gentle …

A Prospective Evaluation Of Opioid Utilization After Upper-Extremity Surgical Procedures: Identifying Consumption Patterns And Determining Prescribing Guidelines., Nayoung Kim, Jonas L. Matzon, Jack Abboudi, Christopher M. Jones, William Kirkpatrick, Charles Leinberry, Frederic Liss, Kevin F F. Lutsky, Mark L. Wang, Mitchell Maltenfort, Asif M Ilyas

Rothman Institute Papers

BACKGROUND: Although adequate management of postoperative pain with oral analgesics is an important aspect of surgical procedures, inadvertent overprescribing can lead to excess availability of opioids in the community for potential diversion. The purpose of our study was to prospectively evaluate opioid consumption following outpatient upper-extremity surgical procedures to determine opioid utilization patterns and to develop prescribing guidelines.

METHODS: All patients undergoing outpatient upper-extremity surgical procedures over a consecutive 6-month period had the following prospective data collected: patient demographic characteristics, surgical details, anesthesia type, and opioid prescription and consumption patterns. Analysis of variance and post hoc comparisons were performed using …

Self-Perceptions Of Disability And Impairment In An Indian Prosthetic Population Using Jaipur Foot Technology, Litany Esguerra

Independent Study Project (ISP) Collection

Twenty-nine first time and repeat prosthetic users were interviewed over a period of three weeks to determine how they perceived their own disability at Bhagwan Mahaveer Viklang Sahayata Samiti, or Jaipur Foot, located in Jaipur, India. The questions delineated different aspects of people’s disabilities and impairment, and asked a multitude of questions regarding social, economic, political, and other contexts, influenced by the conceptual framework of the International Classification of Functioning (ICF). The study analyzed all of the factors as specified by the questionnaire and found that many varying trends over all types of prosthetic users. The study also used the …

The Effect Of Bony Parameters On The Pediatric Knee: Normal Versus Anterior Cruciate Ligament Injury Versus Tibial Spine Avulsion Fracture., Kenneth A. Shaw, Brian S. Dunoski, Neil J. Mardis, Donna M. Pacicca

Manuscripts, Articles, Book Chapters and Other Papers

Purpose  Anterior cruciate ligament (ACL) injuries can present as a ligamentous disruption or avulsion fracture of the tibial spine in pediatric patients. Differences in knee morphometric parameters have been investigated between pediatric cohorts with ACL disruptions and tibial spine avulsion fractures. However, no study to date has compared morphometric parameters in patients with tibial spine avulsion fracture against a control population. Methods  A retrospective review of pediatric patients undergoing knee magnetic resonance imaging (MRI) studies was performed, identifying 15 patients with tibial spine avulsion fracture between January 1, 2009, and January 1, 2013. Inclusionary criteria consisted of patients who sustained …

Evaluation And Management Of Sleep Disorders In The Hand Surgery Patient., Michael P. Gaspar, Patrick M. Kane, Sidney M. Jacoby, Patrick S. Gaspar, A. Lee Osterman

Department of Orthopaedic Surgery Faculty Papers

Despite posing a significant public health threat, sleep disorders remain poorly understood and often underdiagnosed and mismanaged. Although sleep disorders are seemingly unrelated, hand surgeons should be mindful of these because numerous conditions of the upper extremity have known associations with sleep disturbances that can adversely affect patient function and satisfaction. In addition, patients with sleep disorders are at significantly higher risk for severe, even life-threatening medical comorbidities, further amplifying the role of hand surgeons in the recognition of this condition.

Radiotherapy For Localised Ewing’S Sarcoma In Children, Masood Umer, Irfan Qadir, Ahmed Nadeem Abbasi, Zohra Lassi

Department of Surgery Docs

Umer M, Qadir I, Abbasi N, Das JK, Lassi ZS. Radiotherapy for localised Ewing's sarcoma in
children. Cochrane Database of Systematic Reviews 2014, Issue 5. Art. No.: CD011105.
DOI: 10.1002/14651858.CD011105. ... Radiotherapy for localised Ewing's sarcoma in children
(Protocol) Copyright © 2014 The Cochrane Collaboration. Published by John Wiley & Sons,
Ltd. ... Radiotherapy for localised Ewing's sarcoma in children (Protocol) Copyright © 2014 The
Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

Relationship Between Bone-Specific Physical Activity Scores And Measures For Body Composition And Bone Mineral Density In Healthy Young College Women., Sojung Kim, Wi-Young So, Jooyoung Kim, Dong Jun Sung

College of Science & Mathematics Departmental Research

OBJECTIVE: The purpose of this cross-sectional study was to investigate the relationship between bone-specific physical activity (BPAQ) scores, body composition, and bone mineral density (BMD) in healthy young college women.

METHODS: Seventy-three college women (21.7 ± 1.8 years; 162.1 ± 4.6 cm; 53.9 ± 5.8 kg) between the ages of 19 and 26 years were recruited from the universities in Seoul and Gyeonggi province, South Korea. We used dual energy X-ray absorptiometry to measure the lumbar spine (L2-L4) and proximal femur BMD (left side; total hip, femoral neck). The BPAQ scores (past, pBPAQ; current, cBPAQ; total, tBPAQ) were used to …

Spontaneous Hemarthrosis Of The Knee - Late Complication Of Flexible Femur Nailing: A Case Report., Indranil V Kushare, Matthew E. Oetgen, Suzanne J Walters

Orthopaedic Surgery Faculty Publications

We present a case report of acute spontaneous knee hemarthosis due to erosion of the nail through the knee joint capsule in a boy, seven months following retrograde flexible nailing for fractured femur. Careful positioning of the location of the insertion site of flexible nails and proper nail tip management are important to avoid this rare late complication.

Neurogenic Fever After Acute Traumatic Spinal Cord Injury: A Qualitative Systematic Review., Katherine E. Savage, Christina V. Oleson, Gregory D. Schroeder, Gursukhman S Sidhu, Alex R. Vaccaro

Rothman Institute Papers

STUDY DESIGN: Systematic review.

OBJECTIVE: To determine the incidence, pathogenesis, and clinical outcomes related to neurogenic fevers following traumatic spinal cord injury (SCI).

METHODS: A systematic review of the literature was performed on thermodysregulation secondary to acute traumatic SCI in adult patients. A literature search was performed using PubMed (MEDLINE), Cochrane Central Register of Controlled Trials, and Scopus. Using strict inclusion and exclusion criteria, seven relevant articles were obtained.

RESULTS: The incidence of fever of all origins (both known and unknown) after SCI ranged from 22.5 to 71.7% with a mean incidence of 50.6% and a median incidence of 50.0%. …

Pain Management After Outpatient Anterior Cruciate Ligament Reconstruction: A Systematic Review Of Randomized Controlled Trials., Eric S. Secrist, Kevin B. Freedman, Michael G. Ciccotti, Donald W. Mazur, Sommer Hammoud

Rothman Institute Papers

BACKGROUND: Effective pain management after anterior cruciate ligament (ACL) reconstruction improves patient satisfaction and function.

PURPOSE: To collect and evaluate the available evidence from randomized controlled trials (RCTs) on pain control after ACL reconstruction.

STUDY DESIGN: Systematic review.

METHODS: A systematic literature review was performed using PubMed, Medline, Google Scholar, UpToDate, Cochrane Reviews, CINAHL, and Scopus following PRISMA guidelines (July 2014). Only RCTs comparing a method of postoperative pain control to another method or placebo were included.

RESULTS: A total of 77 RCTs met inclusion criteria: 14 on regional nerve blocks, 21 on intra-articular injections, 4 on intramuscular/intravenous injections, 12 …

Geographic And Age-Based Variations In Medicare Reimbursement Among Assh Members., Michael P. Gaspar, Patrick M. Kane, Grace B. Honik, Eon K. Shin, Sidney M. Jacoby, A. Lee Osterman

Department of Orthopaedic Surgery Faculty Papers

Background: The purpose of this study was to investigate how American Society for Surgery of the Hand (ASSH) members' Medicare reimbursement depends on their geographical location and number of years in practice. Methods: Demographic data for surgeons who were active members of the ASSH in 2012 were obtained using information publicly available through the US Centers for Medicare and Medicaid Services (CMS). "Hand-surgeons-per-capita" and average reimbursement per surgeon were calculated for each state. Regression analysis was performed to determine a relationship between (1) each state's average reimbursement versus the number of ASSH members in that state, (2) average reimbursement versus …

Chemical Modification Of Extracellular Matrix By Cold Atmospheric Plasma-Generated Reactive Species Affects Chondrogenesis And Bone Formation., Peter Eisenhauer, Natalie Chernets, You Song, Danil Dobrynin, Nancy Pleshko, Marla J Steinbeck, Theresa A. Freeman

Department of Orthopaedic Surgery Faculty Papers

The goal of this study was to investigate whether cold plasma generated by dielectric barrier discharge (DBD) modifies extracellular matrices (ECM) to influence chondrogenesis and endochondral ossification. Replacement of cartilage by bone during endochondral ossification is essential in fetal skeletal development, bone growth and fracture healing. Regulation of this process by the ECM occurs through matrix remodelling, involving a variety of cell attachment molecules and growth factors, which influence cell morphology and protein expression. The commercially available ECM, Matrigel, was treated with microsecond or nanosecond pulsed (μsp or nsp, respectively) DBD frequencies conditions at the equivalent frequencies (1 kHz) or …

The Financial And Professional Impact Of Anterior Cruciate Ligament Injuries In National Football League Athletes., Eric S. Secrist, Suneel B. Bhat, Christopher C. Dodson

Rothman Institute Papers

BACKGROUND: Anterior cruciate ligament (ACL) injuries can have negative consequences on the careers of National Football League (NFL) players, however no study has ever analyzed the financial impact of these injuries in this population.

PURPOSE: To quantify the impact of ACL injuries on salary and career length in NFL athletes.

STUDY DESIGN: Cohort study; Level of evidence, 3.

METHODS: Any player in the NFL suffering an ACL injury from 2010 to 2013 was identified using a comprehensive online search. A database of NFL player salaries was used to conduct a matched cohort analysis comparing ACL-injured players with the rest of …

Spinal Compression Fractures: No Additional Pain Relief With Use Of Back Braces, Kayla A. Berigan, Brandon Baker, Zakaria Ahmad, Aaron Simpson

Clinical Research in Practice: The Journal of Team Hippocrates

A critical appraisal and clinical application of Li M, Law SW, Cheng J, Kee HM, Wong MS. A comparison study on the efficacy of SpinoMed® and soft lumbar orthosis for osteoporotic vertebral fracture. J. Prosthet. Orthot. Int. 2015;39(4):270-276. doi: 10.1177/0309364614528204

Early Detection Of Idiopathic Scoliosis In Adolescents, M. Timothry Hresko, Vishwas Talwalkar, Richard Schwend

Orthopaedic Surgery and Sports Medicine Faculty Publications

The early detection of idiopathic scoliosis has been advocated since the 1950s and ’60s, concurrent with the development in the modern era of ambulatory spinal orthoses to treat scoliosis in adolescents. This led to the development of screening programs for specific populations, as evidenced by school screening programs in the United States and public health systems in Europe and Asia. Over time, the value of population screening in terms of optimal health care and economics has been debated in the popular press, by the U.S. Preventive Services Task Force, and by professional societies. Recent studies on the effectiveness of bracing …

Catastrophic Femoral Head-Stem Trunnion Dissociation Secondary To Corrosion., Laura Matsen Ko, Antonia F. Chen, Md, Mba, Gregory K Deirmengian, William J. Hozack Md, Peter F. Sharkey

Rothman Institute Papers

BACKGROUND: Modular femoral heads provide procedural enhancement by allowing accurate restoration of hip offset and limb-length equalization. However, corrosion may lead to adverse local tissue reactions. Severe trunnion corrosion can also lead to femoral head dissociation and catastrophic implant failure following primary total hip arthroplasty.

METHODS: We describe 5 cases, from our institution, in which the femoral head became dissociated from the femoral stem trunnion secondary to severe corrosion. Possible causes are evaluated.

RESULTS: Demographic commonalities among the 5 patients included a body mass index (BMI) of ≥30 kg/m(2) and male sex. All femoral heads were made of cobalt-chromium alloy …

The 2015 American-British-Canadian Traveling Fellows Report., Alpesh A. Patel, Robert H. Brophy, Rajiv Gandhi, Hue H. Luu, Kishore Mulpuri, Suken A Shah, Sanjeev Kakar

Department of Orthopaedic Surgery Faculty Papers

No abstract provided.

Omitting Histopathology In Wrist Ganglions. A Risky Proposition, Akbar Jaleel Zubairi, Santosh Kumar, Yasir Mohib, Rizwan Haroon Rashid, Shahryar Noordin

Department of Surgery Docs

ABSTRACT Objectives: To identify incidence and utility of histopathology in wrist ganglions. Methods: A retrospective study of 112 patients operated for wrist swellings between January 2009 and March 2014 at Aga Khan University Hospital, Karachi, Pakistan, was conducted. Medical records were reviewed for demographics, history, location and associated symptoms, provisional diagnosis and operative details. Histopathology reports were reviewed to confirm the final diagnosis. Results: One hundred and twelve patients were included in the study (34 males and 78 females) with a mean age of 28 ± 12 years. Ninety-five percent of ganglia were dorsally located and 85% were solitary in …

Intertrochanteric Hip Fractures In Octogenarian Patients: Do We Need To Rethink Fixation Strategy?, Shahryar Noordin, Shahbano 1, Tashfeen Ahmad, Idrees Shah

Department of Surgery Docs

Abstract

OBJECTIVE:

To compare outcomes in octogenarians with younger patients up to 1 year after undergoing dynamic hip screw fixation for intertrochanteric fractures to see the effectiveness of the implant.

METHODS:

The retrospective case-control study was conducted at The Aga Khan University and comprised records of patients who underwent dynamic hip screw surgery between January 1, 2010, and December 31, 2012. They were divided into two groups based on their age:. Group A <80 years; and Group B > 80 years. All patients had a one-year follow-up> Data including mortality, morbidity, radiological healing time, postoperative ambulatory status and Harris hip score were recorded.

RESULTS:

Of the …

A Comparison Of Cervical And Trunk Musculoskeletal Characteristics Between Female And Male Army Helicopter Pilots, Takashi Nagai, Karen A. Keenan, John P. Abt, Timothy C. Sell, Brian W. Smalley, Michael D. Wirt, Scott M. Lephart

International Journal of Aviation, Aeronautics, and Aerospace

Introduction: Neck pain (NP) and low back pain (LBP) are prevalent among military helicopter pilots. Although there have been few studies on sex differences in the NP/LBP prevalence in this population, females are shown to be at a greater risk of NP/LBP in civilian studies. This disparity may be due to musculoskeletal characteristics differences that predispose females for NP/LBP. The purpose of this study was to compare cervical and trunk musculoskeletal characteristics between male and female pilots. Methods: A total of 8 female pilots (Age: 27.6 ± 4.2yrs, HT: 166.1 ± 7.7cm, WT: 67.9 ± 10.6kg) were tested, and they …

A Comparison Of Imaging Modalities For The Diagnosis Of Osteomyelitis, Brandon J. Smith, Md, Grant S. Buchanan, Md, Franklin D. Shuler, Md, Phd

Marshall Journal of Medicine

Osteomyelitis is an increasingly common pathology that often poses a diagnostic challenge to clinicians. Accurate and timely diagnosis is critical to preventing complications that can result in the loss of life or limb. In addition to history, physical exam, and laboratory studies, diagnostic imaging plays an essential role in the diagnostic process. This narrative review article discusses various imaging modalities employed to diagnose osteomyelitis: plain films, computed tomography (CT), magnetic resonance imaging (MRI), ultrasound, bone scintigraphy, and positron emission tomography (PET). Articles were obtained from Pubmed and screened for relevance to the topic of diagnostic imaging for osteomyelitis. The authors …

Vitamin K2 (Menaquinone) Supplementation And Its Benefits In Cardiovascular Disease, Osteoporosis, And Cancer, Grant S. Buchanan, Md, Thomas Melvin, Brandon Merritt, Charles Bishop, Md, Franklin D. Shuler, Md, Phd

Marshall Journal of Medicine

Vitamin K is known to play an essential role in the coagulation cascade; however, a growing body of research has found that a subtype of this vitamin, vitamin K₂ (menaquinone) may have a beneficial effect in osteoporosis, cardiovascular disease, and cancer. This purpose of this article is to provide a comprehensive review of recent literature regarding menaquinone and its role in human health. This review discusses the physiology of menaquinone, its clinical benefits in cardiovascular disease, osteoporosis, and cancer, and how it may interact with certain medications. The authors conclude that menaquinone supplementation has been shown to improve carboxylation …

What's New In Musculoskeletal Infection: Update On Biofilms., Arvind Nana, Sandra B Nelson, Alex Mclaren, Antonia F. Chen, Md, Mba

Rothman Institute Papers

No abstract provided.

Oncology Edge Task Force On Prostate Cancer Outcomes: A Systematic Review Of Outcome Measures For Functional Mobility, Claire Davies, Genevieve Colon, Hannah Geyer, Lucinda Pfalzer, Mary Insana Fisher

Physical Therapy Faculty Publications

Background: The medical treatment of prostate cancer results in multiple impairments in body structure and declines functional abilities, resulting in activity limitations and participation restrictions. Measurement of functional mobility is an essential outcome measure in survivorship care.

Purpose: The purpose of this systematic review is to make recommendations of the best measurement tools to assess functional mobility in men treated for prostate cancer based on psychometric properties and clinical utility.

Methods: Multiple electronic databases were searched from February to March 2014. Studies of tools used to assess functional mobility were included if they met the following criteria: reported psychometric properties, …