Orthopedics Commons^™

Dysphagia Should Be Reported As A Separate Legacy Outcome Measure After Anterior Cervical Discectomy And Fusion, Philip Zakko, Rafid Kasir, Nai-Wei Chen, Daniel K. Park

Conference Presentation Abstracts

INTRODUCTION: Dysphagia is a common complication after anterior cervical discectomy and fusion (ACDF) but is not a routinely asked question in legacy patient-reported outcome measures. This study looks to see whether there are associations between dysphagia and legacy outcome measures. METHODS: We retrospectively reviewed 168 patients who underwent ACDF surgery from 2017 to 2019 at a single institution. Demographics, anthropometric data, Neck disability index (NDI), visual analog scale (VAS) pain scores, PROMIS-Health and -Mental scores, Charlson Comorbidities Index (CCI), and Eating Assessment Tool (EAT-10) were obtained for each patient preop and 1, 3, 6, and 12 months postop. Repeated measure …

Diagnosing Total Joint Arthroplasty-Associated Periprosthetic Joint Infections In Immunocompromised Patient Populations, Philip Zakko, Erin A. Baker, Christian M. Huber, Corinn Gehrke, Brett J. Friedman, Michael A. Flierl

Conference Presentation Abstracts

The 2018 ICM/MSIS classification system was used to assess PJI diagnosis in immunocompromised vs. non-immunocompromised patient populations to determine applicability of the scoring criteria.

Musculoskeletal Injuries And Conditions In The Orthopaedic Surgeon: A Survey, Katherine Swank, Jamie Furness, Erin A. Baker, Corinn Gehrke, Rachel S. Rohde

Conference Presentation Abstracts

Musculoskeletal conditions are common in orthopaedic surgeons and may lead to morbidity and missed work.

The Routine Use And Cost Analysis Of Acid-Fast Bacilli And Fungal Cultures In Foot And Ankle Surgery: A Retrospective Study, Zein S. El-Zein, Scott Diamond, Margaret C. Bohr, Erin A. Baker, Mackenzie M. Fleischer, Corinn Gehrke, Paul T. Fortin, Zachary Vaupel

Conference Presentation Abstracts

This study highlighted low rates of positive AFB/fungal cultures in our foot and ankle surgery department and demonstrated that routine use of such cultures poses substantial costs to the hospital.

Long-Term Clinical And Functional Outcomes Of Distally Based Sural Artery Flap: A Retrospective Case Series, Pervaiz Hashmi, Abeer Musaddiq, Muhammad Ali, Alizah Hashmi, Marij Zahid, Zohaib Nawaz

Section of Orthopaedic Surgery

Background: Reconstruction of soft tissue defects around the lower leg, foot and ankle is a challenge for orthopedic surgeons. These defects commonly occur as a result of trauma, infection and tumor excision. Sural artery neurovascular island flap is a relatively thin, pliable and insensate flap with minimum donor-site morbidity and acceptable aesthetic outcome.
Methods: A retrospective analysis of a case series was conducted, all operated by a single surgeon over a period of 25 years from July 1996 to February 2020. Data were collected through a structured proforma; the variables included were as follows: demographic data, mechanism of injury, defect …

Rehabilitation And Return-To-Play Criteria After Fresh Osteochondral Allograft Transplantation: A Systematic Review., Michael Stark, Somnath Rao, Brendan Gleason, Robert A. Jack, Bradford Tucker, Sommer Hammoud, Kevin B. Freedman

Rothman Institute Papers

Background: Fresh osteochondral allograft (OCA) is a treatment option that allows for the transfer of size-matched allograft cartilage and subchondral bone into articular defects of the knee. Although long-term studies show good functional improvement with OCA, there continues to be wide variability and a lack of consensus in terms of postoperative rehabilitation protocols and return to sport.

Purpose: To systematically review the literature and evaluate the reported rehabilitation protocols after OCA of the knee, including weightbearing and range of motion (ROM) restrictions as well as return-to-play criteria.

Study Design: Systematic review; Level of evidence, 4.

Methods: PubMed, EMBASE, Cumulative Index …

Prevalence Trend And Disparities In Rheumatoid Arthritis Among Us Adults, 2005–2018, Yingke Xu, Qing Wu

School of Public Health Faculty Research

Rheumatoid arthritis (RA) trends among US adults and disparities in RA patients in recent years have not been well described. We aimed to examine the trend of RA prevalence and disparities among US adults. Data from the National Health and Nutrition Examination Survey (NHANES) of the years 2005–2018 were analyzed to examine the self-reported RA prevalence trend. Age-adjusted RA prevalence stratified by race/ethnicity and socioeconomic status (SES), as well as associated linear trends, were calculated for both genders. The multivariable adjustment was used to evaluate the association between race, SES, and RA. During 2005–2018, there was no significant linear trend …

Patient Resilience Has Moderate Correlation With Functional Outcomes, But Not Satisfaction, After Primary Unilateral Total Knee Arthroplasty., Amer Haffar, Sean Bryan, Marc Harwood, Jess H. Lonner

Rothman Institute Papers

Background: As many as 20% of patients who undergo total knee arthroplasty (TKA) are dissatisfied. Psychological factors have been shown to play a role in outcomes after TKA. The purpose of this study was to investigate the impact of patient resilience on functional outcomes and satisfaction after primary unilateral TKA.

Methods: Eighty-six patients who underwent primary unilateral TKA by a single surgeon were studied. Primary outcomes were the Brief Resilience Scale (BRS), mental health component of the Veterans Rand 12-Item Health Survey (VR-12 MCS), Knee Injury and Osteoarthritis Outcome Score for Joint Replacement, and New Knee Society Score. Correlations between …

Robotic Assistance In Unicompartmental Knee Arthroplasty Results In Superior Early Functional Recovery And Is More Likely To Meet Patient Expectations., Meredith P. Crizer, Amer Haffar, Andrew Battenberg, Mikayla Mcgrath, Ryan Sutton, Jess H Lonner

Rothman Institute Papers

Robotic technology has reduced the errors of implant alignment in unicompartmental knee arthroplasty (UKA), but its impact on functional recovery after UKA is poorly defined. The purpose of this study was to compare early functional recovery, pain levels, and satisfaction in UKA performed with either robotic assistance or conventional methods. A retrospective analysis was performed on 89 matched consecutive patients who underwent outpatient UKA by a single physician using either conventional instruments (n = 39) or robotic methods (n = 50), with otherwise identical perioperative protocols. Outcomes studied included Lower Extremity Functional Score (LEFS), new Knee Society Score …

Endoscopic Proximal Median Nerve Decompression: An Alternative Treatment For Pronator Syndrome, Scott A. Barnett, Sagar A. Shah, Rasheed I. Ahmad

School of Medicine Faculty Publications

Proximal forearm median nerve compressive neuropathy, termed as pronator syndrome, is difficult to diagnose and often overlooked. Its symptoms include vague proximal volar forearm pain that may be associated with paresthesia and numbness in the median nerve distribution. Weakness is typically not present. The treatment of pronator syndrome is largely nonsurgical, consisting of activity modification, anti-inflammatory medication, corticosteroid injections, stretching, and periods of splinting. Surgery is indicated when conservative therapy fails; however, there is no consensus on the treatment approach or technique. Most decompressions are performed using an open technique through a variety of incisions. Recently, endoscopic approaches have drawn …

Why We Can’T Wait, Mary I. Fisher

Physical Therapy Faculty Publications

No abstract provided.

Improving Patient Outcomes With Post-Op Education For Nurses Caring For Patients Undergoing Total Joint Replacement, Amanda Collier

Doctor of Nursing Practice Projects

Background: Surgical site infections (SSI) are the third most reported nosocomial infection causing an increased length of stay, increased healthcare cost, and a substantial increase in morbidity. A SSI is an infection developing within 30 days of surgery without using an implant and within one year of surgery utilizing any form of implant. Typically SSI occurs at the time of incision. However, poor postoperative wound care can lead to an SSI.

Purpose: This project aims to educate nursing staff on care of the total joint replacement (TJR) patient to reduce readmission rates for postoperative SSI.

Design Methods: This …

Publisher Correction To: Development Of The Asia Pacific Consortium On Osteoporosis (Apco) Framework: Clinical Standards Of Care For The Screening, Diagnosis, And Management Of Osteoporosis In The Asia-Pacific Region, M Chandran, P J. Mitchell, T Amphansap, S K. Bhadada, M Chadha, D-C Chan, Y-S Chung, P Ebeling, N Gilchrist, Aysha Habib Khan

Department of Pathology and Laboratory Medicine

No abstract provided.

An Investigation Of A Novel Dural Repair Device For Intraoperative Incidental Durotomy Repair., Kartik Shenoy, Chester J. Donnally, Evan D. Sheha, Krishn Khanna, Srinivas K. Prasad

Rothman Institute Papers

Incidental durotomies, or dural tears, can be very difficult and time consuming to repair properly when they are encountered in confined spaces. A novel dural repair device was developed to address these situations. In this paper, the novel device was assessed against the use of traditional tools and techniques for dural repairs in two independent studies using an intricate clinical simulation model. The aim was to examine the results of the two assessments and link the outcomes to the clinical use of the novel device in the operating room. The novel device outperformed conventional techniques as measured by dural repair …

Microfracture For Cartilage Defects In Today’S Orthopaedics: Pearls And Pitfalls, Himanshu Yn, Sufyan Ibrahim

Manipal Journal of Medical Sciences

Microfracture technique has vacillating clinical outcomes, limited demographic applicability, high failure rate, and variable patient satisfaction. Although it does not deserve to be a gold standard technique, there has not been a technique that could overcome all possible disadvantages associated with the technique and at the same time give a favourable result/be suitable for widespread use/not have its own disadvantages. Microfracture, integrated with biomaterial/stem cell transfer has shown promise over the past decade but studies evaluating the long-term efficacy of the tests and standardization are lacking. Besides, cost and operative difficulties limit widespread use. Twenty-five years into the field, microfracture …

Solitary Plasmacytoma Of Manubrium Sterni - A Case Report, Shyamasunder N. Bhat, Sp Mohanty

Manipal Journal of Medical Sciences

Solitary plasmacytoma is a tumour consisting of neoplastic monoclonal plasma cells without systemic involvement. It constitutes about 5% of all plasma cell dyscrasias and is mainly detected in the spine, pelvis and ribs and rarely in the sternum.

Here we report a case of a 45-year-old man presenting with pain and swelling in the midline of the chest over manubrium sterni. Plain radiograph and CT scan revealed an expansile, osteolytic lesion in the manubrium sterni. There was no M Band in protein electrophoresis, and the iliac bone marrow aspirate did not show plasmacytoma. However, histopathology of the lesion was suggestive …

Functional Outcomes Of Unstable Ankle Fractures With And Without Syndesmotic Fixation In The Adolescent Population, Connor J. Paez, Benjamin M. Lurie, Vidyadhar V. Upasani, Andrew T. Pennock

School of Medicine Faculty Research

Purpose: The purpose of this study was to compare functional outcomes of adolescents with and without ankle syndesmotic injuries and identify predictors of functional outcome after operative ankle fractures. Methods: A retrospective review was conducted on operative adolescent ankle fractures treated between 2009 and 2019 with a minimum of one-year follow-up (mean 4.35 years). Patients who underwent syndesmotic fixation (SF) (n = 48) were compared with operative ankle fractures without syndesmotic injury (n = 63). Functional outcomes were assessed using standardized questionnaires, specifically the Foot and Ankle Ability Measure (FAAM) and Single Assessment Numerical Evaluation. Results: There were no differences …

The Chevron Capitate-Trapezoid Joint: A Case Report, Dean W. Smith

Western Journal of Orthopaedics

Anatomical variations to the human skeletal system are common and frequently reported in the literature. The structures around the hand and wrist are no exception, and these variations can affect ligaments, tendons, muscles, nerves, arteries, joints, and bone morphology. Musculoskeletal health care providers must be familiar with normal, individual variations when encountered during patient care and diagnostic imaging. In some instances, morphological variations have resulted in differences in kinematics, while others have been found in association with certain medical conditions. We discuss an unusual variation of the capitate-trapezoid joint. To the best of our knowledge, no prior studies have previously …

Chronic Complex Volar Dislocation Of The Middle And Ring Finger Metacarpophalangeal Joint: A Case Report, Fernando Moreno, Jordan T. Carter, John J. Pisquiy, Michael M. Polmear

Western Journal of Orthopaedics

Metacarpophalangeal (MCP) joint dislocations are uncommon injuries. Most dislocations occur dorsally, with volar dislocations being rarer owing to the architecture of the joint. Because of the rarity of the condition, there is no accepted standard treatment for these injuries. The most commonly affected digit is the ring finger, followed by the middle finger and then the small finger. Management depends on the complexity of the injury, with complex dislocations requiring open reduction owing to interposed soft tissue and repair of damaged ligaments and tendons. We describe a 52-year-old man with chronic MCP dislocation who underwent unsuccessful open reduction and subsequently …

The Utility Of Continuous Passive Motion After Anterior Cruciate Ligament Reconstruction: A Systematic Review Of Comparative Studies, Taylor D'Amore, Somnath Rao, John Corvi, Robert Jack Ii, Fotios Tjoumakaris, Michael G. Ciccotti, Kevin Freedman

Department of Orthopaedic Surgery Faculty Papers

Background: The application of continuous passive motion (CPM) after anterior cruciate ligament reconstruction (ACLR) was popularized in the 1990s, but advancements in the understanding of ACLR rehabilitation have made the application of CPM controversial. Many sports medicine fellowship–trained surgeons report using CPM machines postoperatively. Purpose: To determine the efficacy of CPM use for recovery after ACLR with respect to knee range of motion (ROM), knee swelling, postoperative pain, and postoperative complications. Study Design: Systematic review; Level of evidence, 3. Methods: The PubMed (MEDLINE), EMBASE, Cochrane, Cumulative Index of Nursing, and Allied Health Literature databases were searched from inception to January …

Gunshot Wounds To The Foot And Ankle: Review Of Cases From A Level-1 Trauma Center, Allicia O. Imada, Jory Wasserburger, Aamir N. Ahmad, Katherine Gavin

Western Journal of Orthopaedics

Background: Gunshot injuries frequently involve the foot and ankle. The standard of care for treatment of gunshot injuries to the foot and ankle is not clear. To better understand these injuries, we completed a retrospective review of foot and ankle gunshot injuries at a level-1 trauma center seen as orthopaedic consults over a 2-year period. Methods: Orthopaedic consults for foot and ankle gunshot injuries from June 1st, 2018, through May 31st, 2020, were reviewed. Patient characteristics, zone of injury, mechanism of injury, associated injuries, treatment, follow-up, and outcomes were recorded. Results: Forty-eight foot and ankle gunshot injuries were identified, encompassing …

Distal Radial Shaft Malunion And Distal Radioulnar Joint Instability 8 Years After Postoperative Plate Failure: A Case Report, Allicia O. Imada, Casey D. Mcdonald, Deana Mercer

Western Journal of Orthopaedics

Radius shaft fractures often require operative treatment after skeletal maturity to restore functional range of motion. If the radial bow is not anatomically restored, pain and instability can occur from bony impingement and disruption of the distal radioulnar joint (DRUJ). We describe a 25-year-old woman with a radius shaft malunion and DRUJ instability. Eight years prior, at the age of 17, she underwent open reduction and internal fixation for a radial shaft fracture with subsequent reinjury at 10 weeks postoperatively. The reinjury was treated nonoperatively, and the patient went on to have painful range of motion and DRUJ instability. Radiographs …

Bisphosphonate Associated Atypical Femur Fracture And Contralateral Impending Atypical Femur Fracture In A Pediatric Patient With Osteogenesis Imperfecta: A Case Report, Benjamin Albertson, Taylor Polander, Selina Silva

Western Journal of Orthopaedics

Atypical femur fractures are rare, low-energy fractures that involve a specific constellation of radiographic findings. These fractures have been well described in adult osteoporotic patients on long-term bisphosphonates; however, little to no literature exists on atypical femur fractures in pediatric patients on long-term bisphosphonates. The use of bisphosphonates as treatment of osteogenesis imperfecta is common to reduce fracture rate and improve bone mineral density. We describe a 15-year-old adolescent boy with type I osteogenesis imperfecta on long-term bisphosphonate therapy. He presented with an atypical right femur fracture and an impending left femur fracture. To the authors’ knowledge, these findings represent …

New Diagnosis Of X-Linked Agammaglobulinemia Presenting As Multi-Focal Acute Pseudomonal Osteomyelitis And Septic Arthritis In A 16-Month Old Boy: A Case Report, Walter Dehority

Western Journal of Orthopaedics

A previously healthy 16-month-old boy presented with 5 days of fever, a limp favoring his right side, and swelling and erythema of the dorsal left foot and left great toe. Contrasted magnetic resonance imaging revealed septic arthritis of the left knee, the interphalangeal joint of the left great toe, and the left subtalar and ankle joints. He had osteomyelitis of the left talus and intraosseous abscess formation in the left calcaneus. Cultures of the blood, left knee synovial fluid, and abscess fluid all showed growth of Pseudomonas aeruginosa. He was subsequently diagnosed with X-linked agammaglobulinemia with a novel mutation in …

Reconstruction Of A Chronic Quadriceps Tendon Rupture After Multiple Failed Repair Attempts: Technique And Case Report, Lauren Edge, Elizabeth Mcleod, Om Pathak, Justin Bartley

Western Journal of Orthopaedics

Rupture of the quadriceps tendon is a relatively uncommon injury that requires prompt surgical intervention to restore the function of the extension apparatus of the knee. Early, definitive surgical intervention generally produces excellent results. In the case of delayed surgery or re-rupture, the tendon is often retracted and scarred, thus complicating subsequent repairs and resulting in poor outcomes. We describe a middle-aged man who presented 4 years after his initial quadriceps rupture, following two repair attempts that failed. Upon presentation, he was unable to perform any active extension at the knee, and he ambulated with the use of a hinged …

Bilateral Peroneal Tendon Subluxation Associated With Complex Hindfoot Fractures: A Case Report, Benjamin C. Howse, Benjamin D. Packard, Rick J. Gehlert

Western Journal of Orthopaedics

A 41-year-old man presented to the emergency department after crashing his dirt bike and sustaining bilateral subtalar fracture dislocations. The left talus underwent open reduction internal fixation. At his first postoperative visit, the patient was found to have bilateral peroneal tendon subluxation (PTS). This case report discusses the cause of PTS and the challenges associated with accurate identification and diagnosis of this injury. We review the diagnostic and therapeutic challenges associated with injury, the negative impact on clinical outcomes, and the association between PTS and hindfoot trauma.

Front Matter, Unm Department Of Orthopaedic Surgery

Western Journal of Orthopaedics

No abstract provided.

Alumni Map 2021, Unm Department Of Orthopaedic Surgery

Western Journal of Orthopaedics

No abstract provided.

Considerations In Surgical Timing For Femoral Shaft Fractures, Trevor Crean, William Curtis, Thomas A. Decoster

Western Journal of Orthopaedics

Femoral shaft fractures are a common orthopaedic injury. They are generally treated with intramedullary nailing. The optimal timing of operative treatment is variable and debated. Relatively simple femoral shaft fractures can be successfully treated in less than 24 hours in most health care systems. Femoral shaft fractures can be more complicated owing to various factors, such as multiple traumatic injuries, associated conditions, etc. These more complicated femoral shaft fractures benefit from stabilization within the first 6 hours to minimize complications. Stabilization of the long bones helps achieve an upright chest position and improves pulmonary, circulatory, and musculoskeletal function. Some patients …

Seven Deadly Sins Of Volar Distal Radius Fracture Fixation, Allicia O. Imada, Jorge Orbay, Deana Mercer

Western Journal of Orthopaedics

Distal radius fractures are common injuries, accounting for 17.0% of all emergency department visits. Operative treatment is an option when indicated. Volar plating has become the most frequently used mode of fixation. Although fixed angle volar locking plates allow for reliable and stable fixation, complications have been reported. Complications include flexor and extensor tendon rupture, intra-articular screw penetration, malreduction, loss of reduction, carpal tunnel syndrome, implant failure, and complex regional pain syndrome. We propose seven principles to avoid these preventable outcomes and tips to succeed.