Orthopedics Commons^™

Letter From The Residency Director, Unm Department Of Orthopaedic Surgery

UNM Orthopaedic Research Journal

No abstract provided.

Periprosthetic Fractures Of The Femur After Total Hip Arthroplasty And Hemiarthroplasty: A Review, Reilly R. Kuehn

UNM Orthopaedic Research Journal

Periprosthetic fractures of the femur after total hip arthroplasty (THA) and hemiarthroplasty represent relatively uncommon but challenging complications. The incidence of these types of fractures has been rising, owing to an increasing number of hip arthroplasties performed, aging population, and prevalent use of uncemented stems, which may have unsuccessful long-term results compared with use of cemented stems. Method of treatment has been generally based on the Vancouver classification system that describes radiographic characteristics of fractures and stability of the femoral stems in respect to placement in the bone. In particular, the presence of loose stems has often indicated the need …

Treatment Of Injuries And Conditions Of The Distal Clavicle: A Review, Heather M. Menzer

UNM Orthopaedic Research Journal

Several trauma-related injuries and degenerative conditions affect the distal end of the clavicle. Fractures of the distal clavicle and separations of the acromioclavicular (AC) joint are common, resulting from direct impact onto the shoulder region. Osteolysis and osteoarthritis of degenerative processes of the AC joint are caused by repetitive activity and overuse of the shoulder. To help identify options for treating the distal end of the clavicle, this review highlighted notable anatomical locations and biomechanics; findings of physical examinations; classification systems of injuries; and standard operative and nonoperative methods used for treatment. Although distal clavicle fractures, AC joint separations, osteolysis, …

Splinting Method For Preventing Thermal Injuries In Patients With Malleolar Fractures Of The Ankle After Operative Treatment Performed Under Regional Anesthesia, Alex Telis, Katherine J. Gavin, Heather M. Menzer, E Brooke Baker, Richard A. Miller

UNM Orthopaedic Research Journal

After performing open reduction and internal fixation (ORIF) for treating malleolar fractures of the ankle, surgeons typically use plaster splints during postoperative recovery of patients. Use of regional anesthesia during ORIF has been noted as a risk factor for burns in patients using plaster splints, possibly owing to inability to feel pain after undergoing regional block. We describe a successful postoperative splinting technique used for preventing thermal injuries in this patient population. We reviewed medical records of patients between 2011 and 2013 at our institution with malleolar ankle fractures who had underwent ORIF under general anesthesia, peripheral nerve block, or …

Predicting Vancouver Types B1 And B2 Periprosthetic Fractures Of The Femur, David M. Bennett, Logan R. Koehler, David J. Margolis, Matthew J. Radelet, Zhenqiang Lu, Tony G. Pedri, Michael M. Decker, Michael D. Miller

UNM Orthopaedic Research Journal

Background: Periprosthetic fractures of the femur after primary total hip arthroplasty (THA) can be complex and difficult injuries to treat. Because of the increased prevalence of THA, an overall increase is anticipated in the incidence of this complication. Vancouver types B1 and B2 periprosthetic femur fractures (defined as fractures around or just below the stem, with well-fixed and loose femoral stems, respectively) are particularly challenging to accurately classify and thereby treat owing to the difficulty in interpreting stability of stems on initial radiographs. To determine whether the method of stem fixation (ie, cement or press fit) may be a predictor …

Psychosocial And Demographic Factors Influencing Pain Scores Of Patients With Knee Osteoarthritis, Lauren A. Eberly, Dustin L. Richter, George D. Comerci, Deana M. Mercer, Gary W. Mlady, Daniel C. Wascher, Robert C. Schenck Jr

UNM Orthopaedic Research Journal

Background: Noted levels of pain in patients with diagnosed osteoarthritis (OA) of the knee are commonly assessed by using a numeric scoring system. However, the results of pain levels in patients with knee OA may be influenced by factors other than the patient’s actual physical discomfort or disease severity, including demographic and psychosocial variables. We retrospectively examined 355 patients with knee OA who had reported associated pain levels using a 0- to 10-point rating scale.

Methods: Data obtained from the medical records of patients were Kellgren-Lawrence (KL) grade, demographic characteristics, body mass index (BMI), concomitant disorders, drug use, alcohol use, …

Estimation Of Simulated Blood Loss By Orthopaedic Residents Before And After Brief Training, Jeffrey T. Jobe, Erika L. Garbrecht, Heather M. Menzer, Richard A. Miller

UNM Orthopaedic Research Journal

Background: Accurate estimation of blood loss (EBL) may be helpful for patient safety during certain operative procedures; however, medical students and residents are rarely instructed in EBL. In a series of two tests, we attempted to reveal any significant improvement in accuracy of EBL after a brief training session.

Methods: Fourteen orthopaedic residents were recruited. Participants estimated the amounts of simulated blood before and after a training session that involved a visual of 110 cm3 of the spilled fluid. Three volumes of 50, 237, and 531 cm3 of simulated blood were spilled on a lap sponge, blanket, and trash bag, …

Design Of A Robotic Apparatus For Simulated Motion Of The Human Hand, Kenneth J. Smith, Sean R. Coss, Deana M. Mercer, Christina Salas, David I. Grow

UNM Orthopaedic Research Journal

Background: The hand is complex, in that any small disturbance to the flexor tendons, extensor tendons, and intrinsic muscles can result in dysfunction of the entire structure. We designed a robotic device to consistently load a native thumb carpometacarpal (CMC) joint in assessing the effects of ligamentous damage on stability of the thumb CMC joint.

Methods: The device consisted of a mechanical plate in which to fixate a cadaveric hand, a tendon-suture routing system, a bracket to couple multiple suture lines to a cable to maintain equal force among sutures and tendons, and the finger-thumb force measurement devices. To apply …

Investigating Potential Role Of Surgeons In Sternal Wire Failure By Biomechanical Tests, Christina Salas, Rachel N. Tufaro, C Etta Tabe, Kwasi Addae-Mensah, W Daniel Tanberg, Christopher Buksa, Jessica A. Avila, Jorge A. Wernly

UNM Orthopaedic Research Journal

Background: Stainless steel wires are commonly used to close the sternum after cardiac-related operative procedures. However, complications have been reported associated with fracture of wires and subsequent migration into the chest cavity. The objective of this study was to biomechanically evaluate the role of surgeons in contributing to wire failure. We hypothesized that surgeons may impose damage to the sternal wire, which may be exacerbated by postoperative wire degradation and patient movement.

Methods: A biomimetic sternal model and custom test fixture simulated a median sternotomy. The sternum was closed by a fellowship-trained cardiothoracic surgeon using figure-of-eight and simple closure techniques. …

Postoperative Complications In Patients With Trapeziometacarpal Joint Osteoarthritis Treated With Carpometacarpal Arthroplasty: Report Of Two Cases, Jessica A. Avila, Taylor H. Parnall, Ericka L. Charley, Lauren N. Mercer, Elizabeth A. Mikola, Deana M. Mercer

UNM Orthopaedic Research Journal

Osteoarthritis of the carpometacarpal (CMC) joint, specifically, of the thumb trapeziometacarpal (TMC) joint, is a common condition in older women. Complications associated with surgical treatment range from transient tendinitis to wrist instability. We present two patients in whom complications developed after undergoing CMC arthroplasty. In one patient, rupture of the flexor carpi radialis (FCR) was noted postoperatively after using a combination of ligament reconstruction and tendon interposition with complete trapeziectomy. The second patient presented with a flexor pollicis longus (FPL) tendon that was tethered with sutures, in which surgical release of the entrapped FPL tendon led to successful treatment. In …

Simultaneous Presence Of A Transligamentous Recurrent Motor Branch Of The Median Nerve And Palmaris Profundus Tendon In A Patient With Carpal Tunnel Syndrome: A Case Report, Dustin L. Larson, Moheb S. Moneim

UNM Orthopaedic Research Journal

Carpal tunnel syndrome (CTS) is the most frequently encountered entrapment of the peripheral nerves in the upper extremity. Abnormal anatomical variations involving the recurrent motor branch of the median nerve and presence of a palmaris profundus tendon have been reported. We present a 53-year-old man in whom open carpal tunnel release led to complete resolution of numbness, tingling, and pain in the right hand by 1 month postoperatively. Intraoperatively, the simultaneous presence of a transligamentous recurrent motor branch of the median nerve and palmaris profundus tendon in the carpal tunnel was found and excised. Surgeons should be aware of the …

Simultaneous Dislocation Of Both Interphalangeal Joints In The Same Digit Of A 56-Year-Old Woman With Workers’ Compensation: A Case Report, Danika Z. Boomer, Kristin M. Loker, Deana M. Mercer

UNM Orthopaedic Research Journal

Dislocation of the interphalangeal (IP) joints of the fingers, particularly on the ulnar side of the hand, is common; however, simultaneous dislocation of both IP joints of the same finger is uncommon, and no studies have reported this injury in patients with workers’ compensation claims. We describe a 56-year-old woman with simultaneous dislocation of distal and proximal IP joints, who was successfully treated using a dorsal blocking splint followed by several months of undergoing occupational therapy. She had sustained the injury from a fall on the ground at work and was promptly treated with open reduction at an outside facility. …

Postoperative Deep Vein Thrombosis And Pulmonary Embolism After Ankle Fusion In A Patient With Hemophilia A: A Case Report, Christopher P. Bankhead, Michael J. Hopson, Richard A. Miller

UNM Orthopaedic Research Journal

Deep vein thrombosis (DVT) and subsequent pulmonary embolism (PE) are uncommon postoperative complications of operative procedures for treating injuries of the foot and ankle. Because the disorder of hemophilia A prevents blood clotting and increases bleeding, patients with this condition have been even less likely to develop DVT and PE. We present a 36-year-old man with hemophilia A in whom operative ankle fusion for treating hemophilic arthropathy of the left ankle led to DVT and PE. After decreasing dosage of antihemophilic medication and administering enoxaparin, the symptoms improved and the patient was discharged from the hospital on postoperative day 5. …

Idiopathic Thrombocytopenic Purpura In A 21-Year-Old Collegiate Football Player: A Case Report, James A. Leinhart, Shane P. Cass, Matthew A. Tennison, Ronica A. Martinez, Christopher A. Mcgrew

UNM Orthopaedic Research Journal

Muscle cramps are commonly observed in collegiate athlete-patients; however, the condition may be a symptom of severe disorders. In particular, idiopathic thrombocytopenic purpura (ITP) may be a possible diagnosis and involves a decreased number of platelets in the bloodstream. We describe a 21-year-old collegiate player of American football with initially presented with cramping of the neck, abdomen, and forearms. Although findings of physical examination were normal, results of laboratory tests indicated ITP, and the patient was hospitalized for 3 days until the platelet count increased. Because the levels continued to decrease at 6-month followup, splenectomy and use of rituximab agents …

Metasynchronous Rupture Of Both Achilles Tendons In A Patient Undergoing Statin Therapy: A Case Report, Paul J. Johnson, Richard A. Miller

UNM Orthopaedic Research Journal

In treating cholesterol-related cardiovascular diseases, statins are commonly used as preventative medication and are associated with few side effects. However, recent studies have described a connection between statins and development of tendinopathy. Similar research has noted bilateral rupture of the Achilles tendon, a rare injury, in patients undergoing statin therapy. We describe a 74-yearold man undergoing statin (ie, simvastatin) therapy who presented with pain and swelling in the right ankle after exertional-type activity. Magnetic resonance imaging confirmed a rupture of the Achilles tendon, with rupture of the left Achilles tendon identified 5 weeks later without any obvious trauma-related event. Nonoperative …

Notable Findings Of A Preparticipation Examination In An 18-Year-Old Volleyball Player: A Case Report, Stuart J. Lisle, Christopher A. Mcgrew

UNM Orthopaedic Research Journal

The preparticipation examination (PPE) is commonly performed to screen for potentially detrimental health conditions in competitive athletes to help decrease rates of morbidity and mortality associated with participation in sports. However, the significant clinical impact of PPE in the United States has yet to be determined. We describe an 18-year-old female athlete who presented with dizziness and a right-sided limp at 8 days after initial injury. Findings of PPE examination indicated that she had unknowingly sustained a concussion during a volleyball match and continued to play, which resulted in injury to the right foot. Despite abnormal findings of magnetic resonance …

Spare-Parts Technique For Concurrent Treatment Of Ectrodactyly Of The Feet And Syndactyly Of The Hands In A 2-Year-Old Boy: A Case Report, Brielle K. Payne, Mary E. Logue, Selina R. Silva, Deana M. Mercer

UNM Orthopaedic Research Journal

Syndactyly is the most frequently occurring congenital malformation of the limbs. Although common, few studies have reported treating syndactyly using Z-plasty with and without full-thickness grafting. We present a 2-year-old boy who presented to our clinic with ectrodactyly of the feet and simple complete syndactyly of two fingers on each hand. After ectrodactyly reconstruction, we used the excess foot skin to cover finger defects. The patient recovered well postoperatively, with matching skin and no trouble with hair growth. Use of a spare-parts technique can help avoid complications associated with harvesting grafts from other donor sites. The results reinforce the importance …

Becoming A Hand Surgeon, Moheb S. Moneim

UNM Orthopaedic Research Journal

No abstract provided.

Five Lessons Learned During Residency And Fellowship Interviews, Drew K. Newhoff

UNM Orthopaedic Research Journal

No abstract provided.

The Groundwork And Legacy Of Our First Chair, George E. Omer Jr, Md, 1970–1990, Thomas A. Decoster

UNM Orthopaedic Research Journal

No abstract provided.

My Chair Story: Listening With Leadership, 2006–Present, Robert C. Schenck Jr

UNM Orthopaedic Research Journal

No abstract provided.

A Technique Of Improved Medial Meniscus Visualization By Anterior Cruciate Ligament Graft Placement In Chronic Anterior Cruciate Deficient Knees, Christopher J. Vertullo, Lahann Wijenayake, Jane E. Grayson

Faculty Publications

It is customary to perform medial meniscus repair before anterior cruciate ligament (ACL) graft placement when undertaken as a combined procedure. However, in chronic ACL-deficient knees, intraoperative anterior tibiofemoral translation can cause the medial meniscus repair to be more technically challenging. Intraoperative anterior tibiofemoral translation can both reduce the visualization of the medial meniscus and make its reduction unstable. An operative sequence alteration of ACL graft placement and tensioning before medial meniscal repair improves medial meniscus visualization in chronically ACL-deficient knees by using the ACL graft’s ability to prevent anterior tibiofemoral translation. The technique sequence is as follows: (a) the …

Division Of Research, Unm Department Of Orthopaedic Surgery

UNM Orthopaedic Research Journal

No abstract provided.

Comparison Of Blood Loss Between Short-Stem And Conventional Femoral Implants In Total Hip Arthroplasty, Sean Kuehn, Drew K. Newhoff, Dukens Labaze, Aditi S. Majumdar, Rick J. Gehlert

UNM Orthopaedic Research Journal

Background: Although the postoperative results of total hip arthroplasty (THA) are generally successful, the standard technique and implant design have many proposed modifications. The purpose of the current study was to determine if using short-stem femoral implants minimized the intraoperative blood loss during THA when compared with conventional THA.

Methods: The medical records of patients who underwent THA using short-stem and conventional femoral implants between 2009 and 2013 were reviewed. Patients with previous surgical procedures for treating the acetabulum or proximal femur and patients without reported hematocrit levels were excluded; subsequently, a total of 53 patients for each group (short-stem …

Residents, Unm Department Of Orthopaedic Surgery

UNM Orthopaedic Research Journal

No abstract provided.

Strategies For The Management Of Postoperative Anemia In Elective Orthopedic Surgery, Taylor D. Steuber, Meredith L. Howard, Sarah A. Nisly

Scholarship and Professional Work – COPHS

Objective: To assess the use of oral iron, intravenous (IV) iron, and erythropoiesis-stimulating agents (ESAs) for the prevention and management of perioperative anemia in elective orthopedic surgery patients, and to provide a clinical algorithm for use. Data Sources: A PubMed and MEDLINE search was conducted from 1964 through March 2016 using the following search terms alone or in combination: orthopedic, surgery, elective, anemia, blood transfusion, iron, erythropoiesisstimulating agents, and erythropoietin. Study Selection and Data Extraction: All English-language prospective and retrospective human studies and meta-analyses evaluating oral iron, IV iron, or ESA alone or in combination in elective orthopedic surgery …

How To Manage Knee Arthritis: Best Practices For Treatment Prior To Orthopaedic Referral, Ali Oliashirazi Md, Alex Caughran Md, Zain Quazi Md, Grant Buchanan Md, Akash Sharma, Franklin D. Shuler Md, Phd

Orthopaedics

Osteoarthritis (OA) of the knee is a debilitating disease in which degeneration of the joint space cartilage can lead to life-altering pain and stiffness. The prevalence of OA has a strong correlation with age, with evidence of radiographic knee OA found in 37.4% of persons older than 60 years of age. According to the Agency for Healthcare Research and Quality’s (AHRQ) 2013 report, osteoarthritis was ranked the second most expensive condition for Medicare and private insurers, with over 90% of the hospitalizations for OA involving a knee or hip replacement. It is projected that by 2030 the number of primary …

Recurrence Of Ganglion Cysts Following Re-Excision, Lindsay S. Mcalpine, Msiii, Juana Medina, Md, Nayoung Kim, Bs, Michael Rivlin, Md

CwiC Posters

Previous studies have examined the recurrence of ganglion cysts after surgical excision at a rate of 4 to 40%. However, recurrence after revision surgical excision is unknown. The purpose of this study was to define the incidence of recurrent ganglion cysts in patients who underwent a 2nd excisional procedure.

Artificial Disc Replacement As An Alternative To Lumbar Spinal Function In The Treatment Of Chronic Low Back Pain, Jennifer Polniak

Physician Assistant Scholarly Project Posters

Chronic low back pain leads to activity limitations for the patient and widespread burdens on health care systems. Lumbar fusion has been the “gold standard” surgery for severe chronic low back pain non-responsive to conservative treatment, however it has been associated with continued limitations in spinal mobility. This study was executed in order to compare an alternative surgical intervention, artificial disc replacement, with lumbar spinal fusion in the treatment of chronic low back pain in terms of long term spinal function. Literature searches of trials, guidelines and systematic reviews within the past 5 years were completed exploring surgical procedures, associated …

Causes, Evaluation, And Treatment Of Instability Of The Patellofemoral Joint Of The Knee: A Review, Michael J. Hopson

UNM Orthopaedic Research Journal

Instability of the patellofemoral (PF) joint of the knee is typically caused by chronic atraumatic injuries and inciting traumatic events. Anatomically, bony and softtissue structures surrounding the PF joint and extensor mechanism contribute to overall stability of the area, which results in efficient kinematic function at the PF articulation. Furthermore, physiological, genetic, anatomical, and demographical factors may affect the development and progression of PF joint instability. Treatment techniques have varied owing to individual factors that may have influence on pathological features of the injury. Nonoperative treatment has predominantly focused on strengthening of the quadriceps and vastus medialis by coordinated, closed …