Orthopedics Commons^™

The Effectiveness Of Oral Non-Steroidal Anti-Inflammatories Versus Steroid Injections In Patients With Shoulder Pain, Darren Scott Pledger

Physician Assistant Scholarly Project Posters

- The fact that shoulder pain is the most common musculoskeletal complaint in primary care shows that clinicians must have an arsenal of quality interventions to treat this problem.

- The need for quality research and evidenced based guidelines are necessary to educate clinicians on their treatment options, the efficacy of those treatments, and their safety profiles.

Simultaneous Avulsion Fractures Of The Tibial Tuberosity Of Both Knees In A 14-Year-Old Boy: A Case Report, Margaret E. Pusateri, Selina R. Silva, Christopher A. Mcgrew

UNM Orthopaedic Research Journal

Fractures of the tibial tuberosity are uncommon injuries in adolescents, representing an estimated 0.4% to 2.7% of all pediatric fractures. Most of these injuries occur in young, active males commonly between the ages of 12 to 17 years. Sports, particularly those involving jumping or sudden starts and stops, are most often implicated. Injuries of the tibial tuberosity of both knees are especially rare, with little more than 30 cases reported in the past 60 years. We present a 14-year-old male football player with simultaneous avulsion fractures of the tibial tuberosity of both knees. We reviewed the anatomy, mechanisms of injury, …

Letter From The Residency Director, Unm Department Of Orthopaedic Surgery

UNM Orthopaedic Research Journal

No abstract provided.

Do Non-Steroidal Anti-Inflammatory Drugs Increase The Risk For Non- Or Mal-Union Following Acute Fracture? A Literature Review, Bryan Moritz

Theses and Graduate Projects

NSAID medications are among the most commonly used analgesic medications world wide, and it was estimated in 2010 (updated 2015 data is expected to be published next year) that about 29 million adults in the United States regularly used NSAID medications at least three times per week for more than three months. Fracture healing has been shown to be dependent on the inflammatory cascade. NSAID medication use appears to have a mechanistic in-vivo and in-vitro animal risk for the development of non- and mal-union following fracture. However, human data is lacking to support total avoidance of this analgesic option for …

Sprengel's Deformity, Muhammad Younus Khan Durrani, Amir Humza Sohail, Inamullah Khan, Pervaiz Hashmi

Section of Orthopaedic Surgery

Various shoulder bone deformities have been identified in the pediatric age group, with the most common being undescended scapula. Sprengel's deformity is dysplasia and malposition of the scapula, especially in the supraspinatus portion, mainly due to abnormal descent in the embryonic period. The clavicle is shorter and has a different contour. In some patients cervical spine deformities are also noted. This is a case of 3 years old girl presented to the clinic with difficulty in abducting right shoulder and sleeping with an internal rotation of the right arm. With physical examinations and radiological investigations sprengel's deformity was diagnosed. Sprengel's …

Role Of Extent Of Resection On Quality Of Life In Patients With Newly Diagnosed Gbm, Usama Khalid Choudry, Huzaifa Ismail Shaikh, Areeba Nisar, Saad Akhtar Khan, Muhammad Shahzad Shamim

Section of Orthopaedic Surgery

Glioblastomas known for their adverse outcomes are most reportedly managed by surgical resection. Studies on the impact of (Extent of Resection) EOR against Quality of Life (QOL) are very limited. We have collected data from recent studies in this review to extract a general consensus among the neurosurgeons regarding the EOR. Key parameters like functional independence, neurocognitive improvements and global health status have been explored in the context of QOL. The currently available data suggests that an increased EOR may help improve QOL in GBM patients. With the help of recent advancements it may be possible to attain a better …

Primary Total Hip Arthroplasty: Staying Out Of Trouble Intraoperatively, Shahryar Noordin, Riaz Hussain Lakdawala, Bassam A. Masri

Section of Orthopaedic Surgery

Total hip Arthroplasty is one of the most successful and commonly performed procedures in Orthopaedic Surgery. Meticulous preoperative planning allows to surgeon anticipate potential problems to reduce postoperative complications and optimize patient outcomes. Currently, the posterior approach is the most common approach utilized in the United States. In order to prevent errors in stem version, especially with cementless fixation, the entry point should be posterior, and the initial entry point should be aligned in the correct anteversion as this will determine the ultimate version of the stem. Preoperative evaluation should asses for true and apparent lengths. For successful osseointegration of …

Baseline Patient Characteristics Associated With Response To Biologic Therapy In Patients With Psoriatic Arthritis Enrolled In The Corrona Psoriatic Arthritis/Spondyloarthritis Registry., Philip Mease, Chitra Karki, Mei Liu, Arthur Kavanaugh, Christopher T Ritchlin, Doquyen Hoa Huynh, Jacqueline B Palmer, Jeffrey D Greenberg

Articles, Abstracts, and Reports

Objectives: To compare baseline characteristics between patients with psoriatic arthritis (PsA) who achieved and did not achieve minimal disease activity (MDA) with biologic therapy in the US-based Corrona Psoriatic Arthritis/Spondyloarthritis Registry.

Methods: Patients with PsA aged ≥18 years enrolled between March 2013 and March 2016 who were receiving biologics at enrolment (baseline), not in MDA and had ≥2 follow-up visits were included. Patients were classified as those who remained on their index biologic and achieved MDA at the second follow-up visit (MDA achievers (MDA-A)) and those who did not (MDA non-achievers (MDA-NA)). Demographics, clinical characteristics, patient-reported outcomes and medication history …

The Effects Of Emerging Technology On Healthcare And The Difficulties Of Integration, Skyler J. Pavlish-Carpenter

Honors Undergraduate Theses

Background: Disruptive technology describes technology that is significantly more advanced than previous iterations, such as: 3D printing, genetic manipulation, stem cell research, innovative surgical procedures, and computer-based charting software. These technologies often require extensive overhauls to implement into older systems and must overcome many difficult financial and societal complications before they can be widely used. In a field like healthcare that makes frequent advancements, these difficulties can mean that the technology will not be utilized to its full potential or implemented at all.

Objective: To determine the inhibiting factors that prevent disruptive technology from being implemented in conventional healthcare.

Methods: …

Novel Extra-Thoracic Vats Minimally Invasive Technique For Management Of Multiple Rib Fractures., Natalie N Merchant, Osita Onugha

Articles, Abstracts, and Reports

We report an elderly patient with chronic obstructive pulmonary disease (COPD), Alzheimer's disease and early dementia who presented with multiple displaced rib fractures of left ribs 4 through 9 with flail segments of ribs 4 through 8 and an associated traumatic pneumatocele from rib puncture of the left upper lobe. The decision to treat this patient operatively was based on the presence of flail chest, the patient's age, baseline co-morbidities and limited physiological reserve. Surgical rib fixation is traditionally performed with a thoracotomy incision and open exposure for extra-thoracic rib fixation, however, this patient underwent chest wall stabilization using an …

The Top 50 Most-Cited Articles On Total Ankle Arthroplasty: A Bibliometric Analysis, Azeem Tariq Malik, Shahryar Noordin

Section of Orthopaedic Surgery

Total Ankle Arthroplasty (TAA) is a relatively new and evolving field in Foot and Ankle surgery. We conducted a citation analysis to identify the characteristics of the top 50 most cited articles on total ankle arthroplasty. Using the Web of Science database and the search strategy total ankle arthroplasty OR total ankle replacement, we identified 2445 articles. After filtering for relevant articles, the top 50 cited articles on total ankle arthroplasty were retrieved for descriptive and statistical analysis. The publication years ranged from 1979 to 2013. USA was the most productive country in terms of research output, followed by …

4-Year Results From The Rapid-Psa Phase 3 Randomised Placebo-Controlled Trial Of Certolizumab Pegol In Psoriatic Arthritis., Désirée Van Der Heijde, Atul Deodhar, Oliver Fitzgerald, Roy Fleischmann, Dafna Gladman, Alice B Gottlieb, Bengt Hoepken, Lars Bauer, Oscar Irvin-Sellers, Majed Khraishi, Luke Peterson, Anthony Turkiewicz, Jürgen Wollenhaupt, Philip Mease

Articles, Abstracts, and Reports

Objective: To report the efficacy, patient-reported, radiographic and safety outcomes of 4 years' certolizumab pegol (CZP) treatment in patients with psoriatic arthritis (PsA).

Methods: RAPID-PsA (NCT01087788) was double-blind and placebo-controlled to Week 24, dose-blind to Week 48 and open-label (OL) to Week 216. Patients were randomised 1:1:1 to either placebo or CZP 200 mg every 2 weeks (Q2W) or 400 mg every 4 weeks (Q4W) (following 400 mg at Weeks 0/2/4). Patients randomised to CZP continued their assigned dose in the OL period. Patients randomised to placebo were re-randomised to CZP 200 mg Q2W or 400 mg Q4W (post-loading dose) …

Secukinumab In The Treatment Of Psoriatic Arthritis: Efficacy And Safety Results Through 3 Years From The Year 1 Extension Of The Randomised Phase Iii Future 1 Trial., Philip J Mease, Arthur Kavanaugh, Andreas Reimold, Hasan Tahir, Jürgen Rech, Stephen Hall, Piet Geusens, Pascale Pellet, Evie Maria Delicha, Shephard Mpofu, Luminita Pricop

Articles, Abstracts, and Reports

Objective: To assess the long-term (3 year) efficacy and safety of secukinumab in patients with active psoriatic arthritis (PsA) in the extension phase of the FUTURE 1 study (NCT01892436).

Methods: Following the 2-year core trial, eligible patients receiving subcutaneous secukinumab 150 or 75 mg entered a 3-year extension phase. Results are presented for key efficacy and safety endpoints at week 156.

Results: In total, 460 patients entered the extension study; 308 patients originally randomised to secukinumab were assessed for efficacy. Sustained improvements in all efficacy endpoints were achieved with secukinumab through week 156. Overall, 76.8%/54.9% (secukinumab 150 mg) and 65.2%/39.0% …

Therapeutic Benefit Of Apremilast On Enthesitis And Dactylitis In Patients With Psoriatic Arthritis: A Pooled Analysis Of The Palace 1-3 Studies., Dafna D Gladman, Arthur Kavanaugh, Juan J Gómez-Reino, Jürgen Wollenhaupt, Maurizio Cutolo, Georg Schett, Eric Lespessailles, Benoit Guerette, Nikolay Delev, Lichen Teng, Christopher J Edwards, Charles A Birbara, Philip J Mease

Articles, Abstracts, and Reports

Objective: The Psoriatic Arthritis Long-term Assessment of Clinical Efficacy (PALACE) clinical trial programme findings demonstrated that apremilast, an oral phosphodiesterase 4 inhibitor, is effective for treating psoriatic arthritis (PsA). Enthesitis and dactylitis are difficult-to-treat features of PsA leading to disability and affecting quality of life. PALACE 1, 2 and 3 data were pooled to assess the efficacy of apremilast on enthesitis and dactylitis outcomes in patients with these conditions at baseline.

Methods: Patients with enthesitis (n=945) or dactylitis (n=633) at baseline were analysed after receiving double-blind treatment with placebo, apremilast 30 mg two times per day or apremilast 20 mg …

Superior Capsular Reconstruction In The Active Population With A Massive Irreparable Rotator Cuff Tear, Emmanuel Hernandez

Physician Assistant Scholarly Project Posters

The prevalence of rotator cuff tears is a leading cause of upper extremity functional disability and affects people across the lifespan. The primary age groups that are diagnosed include young adults as well as the elderly population. Approximately one-fifth of rotator cuff tears (RCT) are diagnosed as “massive” and prove to be difficult for orthopedic surgeons to repair. If the massive RCT is also diagnosed as “irreparable”, surgical intervention is technically difficult and can be extremely challenging. Historically, treatment options have been limited for the young population to invasive surgical intervention or conservative measures such as physical therapy and pharmacologic …

Use Of Caudal Epidural Catheter In A Child With Cerebral Palsy With Prior Posterior Spine (T1-Sacrum) Fusion., Divya Dixit, Mary C. Theroux, Kirk W. Dabney, Freeman Miller

Department of Anesthesiology Faculty Papers

No abstract provided.

Letter From The Chief Of The Division Of Physical Therapy, Unm Department Of Orthopaedic Surgery

UNM Orthopaedic Research Journal

No abstract provided.

Below-Knee Amputations: A Review, Erika L. Garbrecht

UNM Orthopaedic Research Journal

At our institution, physicians from the orthopaedic department perform a considerable proportion of below-knee amputations. These amputations are performed to treat non-traumatic and traumatic injuries. However, the outcomes of amputation are not discussed as often in our educational experience as those of other procedures. The current review examines the current and relevant studies for indications and outcomes of patients with non-traumatic and traumatic conditions treated with below-knee amputations.

Midterm Results Of An Anatomical Radial Head Arthroplasty For Treating Fractures And Degenerative Joint Diseases Of The Radial Head, Gabriel Pertierra, Lauren L. Vernon, Francisco Rubio

UNM Orthopaedic Research Journal

Background: Radial head arthroplasty (RHA) is typically performed to restore elbow stability or function in patients with fractures or degenerative joint diseases. The procedure requires a specific operating technique to avoid complications such as overstuffing, capitellar erosion, stiffness, instability, micro motion, and loosening. It is difficult to restore native radial head function reliably.

Methods: We reviewed the medical records of 45 patients who underwent radial head arthroplasty using the ALIGN radial head implant (ALIGN Radial Head System, Skeletal Dynamics, Miami, FL) at our institution. A total of 15 patients met inclusion criteria and were contacted to complete a QuickDASH questionnaire, …

Clinical And Radiographic Comparison Between Patients With Achilles Midsubstance Ruptures And Achilles Sleeve Avulsions, Christopher L. Shultz, Matthew G. Wharton, Katherine J. Gavin, Richard A. Miller

UNM Orthopaedic Research Journal

No abstract provided.

Simulated Method To Perform The Coleman Block Test In Educating Orthopaedic Residents Outside Of The Clinic, Taylor J. Polander, Erika L. Garbrecht, Amber L. Price, Paul J. Johnson, Richard A. Miller

UNM Orthopaedic Research Journal

No abstract provided.

Chronic Tenosynovitis Caused By Mycobacterium Avium-Intracellulare Of The Flexor Tendons In A 65-Year-Old Man: A Case Report, Kourosh M. Kolahi, Moheb S. Moneim

UNM Orthopaedic Research Journal

We report a rare case of Mycobacterium aviumintracellulare flexor tenosynovitis in the hand of a 65-year-old man. The patient reported no history of penetrating trauma but was an avid gardener and presented nearly 2 years after the onset of symptoms. Our case highlights the difficulty in diagnosing mycobacterial infections owing to their lack of classic clinical and laboratory findings. Our patient underwent successful surgical debridement followed by oral antibiotic therapy, initiated 4 weeks after the culture was positive for a slow-growing organism.

Brachial Artery Vasculitis And Associated Stenosis Presenting As Elbow Pain In A 16-Year-Old Soccer Player: A Case Report, Eric R. Reynolds, Andrew D. Ashbaugh, James P. Toldi, Deana M. Mercer, Mark Langsfeld, Christopher A. Mcgrew

UNM Orthopaedic Research Journal

Chronic vascular occlusion in the upper extremity can result from repetitive trauma, atherosclerosis, proximal embolic events, hypercoagulable states, and systemic diseases such as collagen vascular disease and vasculitis. Considerable functional impairment can result from these maladies; however, sometimes the condition develops slowly with minimal effect on the patient. We describe a 16-year-old soccer player with slow-progressing elbow pain and loss of range in motion caused by brachial artery vasculitis and resultant brachial arterial stenosis. Although vascular insults and lesions rarely cause chronic vascular occlusion, physicians should consider this possibility in patients with localized pain or atrophy, especially if the condition …

An Inpatient Rehabilitation Interprofessional Care Pathway For Traumatic Hip Fracture: A Pilot Quality Improvement Project, Sarah Plante

DNP Scholarly Projects

Background: Each year over 300,000 older adults are hospitalized for hip fracture. The impact of the cost of hip fracture on the US health care system is estimated to be as high as $9 billion, with the typical cost of a hip fracture episode around $30,000. Formalized pathways have been developed and successfully utilized for many patient presentations, including hip fracture, in the acute setting. Although this research is important to the comprehensive care of the elderly hip fracture patient, very little research exists that outlines evidence-based best-practice for patients in the post-acute recovery period.

Purpose: The primary aim of …

Using Foot Pressure Analysis To Predict Reoccurrence Of Deformity For Children With Unilateral Clubfoot, Juanita Jean Wallace

Theses and Dissertations--Kinesiology and Health Promotion

Reoccurrence of deformity can affect upwards of 64% of children with clubfoot. The ability to use foot function as a measure of reoccurrence has not been previously assessed. The purpose of this investigation was to utilize foot pressure analysis to predict the probability of reoccurrence in children with unilateral clubfoot. Retrospective foot pressure data revealed predictive algorithms detecting the probability of experiencing any type of reoccurrence (overall reoccurrence) and for experiencing a tibialis anterior tendon transfer (TATT). The equation for overall reoccurrence reported sensitivity and specificity of 0.82 and 0.81 and the equation for TATT reported values of 0.81 and …

The Role Of Psychosocial Factors On Pre And Postoperative Pain In Patients With Femoral Acetabular Impingement, Kate N. Jochimsen

Theses and Dissertations--Rehabilitation Sciences

Femoral acetabular impingement (FAI) is a bony hip condition that often results in tears to the acetabular labrum. Patients with FAI experience pain, decreased function, and quality of life. FAI and its’ sequela are treated definitively with hip arthroscopy. Hip arthroscopy is being performed with increasing frequency, and while most patients respond favorably, a subset of 10-20% of patients have suboptimal outcomes.

Previous research suggests that mental status may be a primary driver in the way patients with FAI respond to and feel pain. Measures of mental status include the presence of mood disorders and psychosocial patient reported outcomes (PROs). …

Effect Of Hemiepiphysiodesis On The Growth Plate: The Histopathological Changes And Mechanism Exploration Of Recurrence In Mini Pig Model., Jing Ding, Jin He, Zhi-Qiang Zhang, Zhen-Kai Wu, Fang-Chun Jin

Manuscripts, Articles, Book Chapters and Other Papers

Purpose: Hemiepiphysiodesis has been widely used to correct angular deformity of long bone in immature patients. However, there is a limited knowledge about the biomechanical effect of this technique on the histopathological changes of the growth plate and the mechanism of recurrence of malformation after implant removal. We aimed to evaluate the biomechanical effect of hemiepiphysiodesis on the histopathological changes of the growth plate and the mechanism of recurrence of malformation after implant removal in Bama miniature pigs, and to explore the role of asymmetric stress during this procedure.

Methods: Eight 3-month-old male Bama miniature pigs sustained surgeries on the …

Role Of Percutaneous Cholecystostomy Tube Placement In The Management Of Acute Calculus Cholecystitis In High Risk Patients, K. M. Inam Pal, Arif Ali, Hassaan Bari

Section of Orthopaedic Surgery

Objective: To evaluate the utility of percutaneous cholecystostomy tube in patients with acute calculus cholecystitis, who are considered unfit for immediate surgery.
Study Design: Observational study.
Place and Duration of Study: The Aga Khan University Hospital, Karachi, Pakistan, from January 2010 to December 2014.
Methodology: All adult patients who underwent percutaneous cholecystostomy tube placement for acute calculous cholecystitis were included. These patients were divided into two groups for further analysis. Group-I consisted those who had interval cholecystectomy after tube placement and Group-II were those who had no further treatment. Recurrence of symptoms, infections and operation related complications were noted.
Results …

Osteoid Osteoma: Contemporary Management, Shahryar Noordin, Salim Allana, Kiran Hilal, Riaz Hussain Lukhadwala, Anum Sadruddin Pidani, Nasir Ud Din

Section of Orthopaedic Surgery

Osteoid osteoma is a benign bone-forming tumor with hallmark of tumor cells directly forming mature bone. Osteoid osteoma accounts for around 5% of all bone tumors and 11% of benign bone tumors with a male predilection. It occurs predominantly in long bones of the appendicular skeleton. According to Musculoskeletal Tumor Society staging system for benign tumors, osteoid osteoma is a stage-2 lesion. It is classified based on location as cortical, cancellous, or subperiosteal. Nocturnal pain is the most common symptom that usually responds to salicyclates and non-steroidal anti-inflammatory medications. CT is the modality of choice not only for diagnosis but …

Superior Capsular Reconstruction In The Active Population With A Massive Irreparable Rotator Cuff Tear, Hernandez Emmanuel

Physician Assistant Scholarly Project Papers

The prevalence of rotator cuff tears is a leading cause of upper extremity functional disability and affects people across the lifespan. The primary age groups that are diagnosed include young adults as well as the elderly population. Early diagnosis and identification of rotator cuff injuries are paramount for the appropriate treatment to be facilitated. Approximately one-fifth of rotator cuff tears (RCT) are diagnosed as “massive” and prove to be difficult for orthopedic surgeons to repair. If the massive RCT is also diagnosed as “irreparable”, surgical intervention is technically difficult and is a challenging procedure. Historically, treatment options have been limited …