Orthopedics Commons^™

Sexually Dimorphic Effects Of Gpnmb Modulation On Vertebral Bone Mass Regulation And Intravertebral Disc Health, Hakem Altawil, Fayez Safadi

Williams Honors College, Honors Research Projects

Osteoporosis and vertebral degeneration are major contributors to musculoskeletal morbidity, yet the molecular mechanisms regulating vertebral bone and intervertebral disc (IVD) homeostasis remain incompletely understood. GPNMB (osteoactivin) has been identified as a regulator of bone remodeling, though its role in spine health is unclear. This study evaluated the effects of GPNMB deficiency on lumbar vertebral bone microarchitecture and IVD integrity in a sex-dependent context.

Six-month-old male and female wild-type (WT) and GPNMB knockout (KO) mice were analyzed using micro–computed tomography (µCT) of lumbar vertebrae (L4–L6) and histological assessment of the L5–L6 IVD. KO males exhibited increased bone volume fraction, bone …

Predictors Of Increased Length Of Stay And Cost In Readmissions For Spinal Surgical Site Infections, Matthew Giammanco, Alex Zhang, Phillip Alexeev, Ryan Snowden

SPARK Symposium Presentations

Abstract:

Background

Surgical site infection (SSI) following spinal surgery remains a costly and morbid complication, frequently necessitating hospital readmission and operative management. While prior studies have characterized the overall economic burden of spinal SSI, the specific drivers of cost during SSI-related readmissions are poorly defined. The primary research question of this study was to identify clinical, operative, and microbiologic factors associated with increased hospital cost, length of stay, and financial margins during readmission for operative management of spinal SSI.

Methods

We performed a retrospective cohort study of adult patients readmitted for surgical management of spinal SSI at a single tertiary …

Traction Table Positioning For Cephalomedullary Nailing Of Proximal Femur Fractures In Patients With Ipsilateral Below-Knee Amputation, Brogan Hill, Andres D. Toledo, Christopher Morford, Riley Hamel, Nate Tomilonus, Andrew Boltuch

West Florida Division GME Research Day 2026

No abstract provided.

Effects Of Glucagon-Like-Peptide-1 Receptor Agonists (Glp-1a) Medications In Patients Undergoing Total Hip Arthroplasty (Tha): A Systematic Review And Meta-Analysis, Tanner Haechten, Troy B. Puga, Vincent Dieu, Mckenna W. Box, Kyle O'Connor, John T. Riehl

North Texas GME Research Forum 2026

Background Glucagon-Like-Peptide-1 Receptor Agonists (GLP-1a) medications have rapidly grown in popularity, however, their effects on the outcomes of Total Hip Arthroplasty (THA) remain largely unclear. The objective of this systematic review and meta-analysis is to evaluate the outcomes of patients undergoing THA and using a GLP-1a medication. Methods A search was conducted across six databases. The search used a combination of keywords and Medical Subject Heading (MeSH) terms. Titles and abstracts were screened for eligibility for inclusion criteria. Full texts were screened and included if they met eligibility criteria. Demographics and results of the studies were extracted from included articles. …

Outcomes Of Total Knee Arthroplasty (Tka) In Patients On Glucagon-Like-Peptide-1 Receptor Agonists (Glp-1a): A Systematic Review And Meta-Analysis, Lachlan Anderson, Troy B. Puga, Erica Olfson, Kyle P. O'Connor, Mckenna W. Box, John T. Riehl

North Texas GME Research Forum 2026

Introduction Glucagon-Like-Peptide-1 Receptor Agonist (GLP-1a) medications are commonly prescribed to treat diabetes and obesity, however, their effects on the outcomes of Total Knee Arthroplasty (TKA) remain largely unclear. The objective of this systematic review and meta-analysis is to evaluate the outcomes of patients undergoing TKA while using a GLP-1a medication.

Methods A search was conducted across MEDLINE/Pubmed, Cochrane, Google Scholar, Web of Science, and Embase databases. The search used a combination of keywords and Medical Subject Heading (MeSH) terms. Titles and abstracts were screened for eligibility. Full texts were then screened and included if they met eligibility criteria. Demographics and …

Understanding Resiliency In Nrmp Match Applicants Pursuing Orthopaedic Surgery Residency, Sean Mcmillan, Shelby Ramsey, Brian Truong, Manuel Pontes, Charlie Yoo, Efstratios Papdelis, Elizabeth Ford, Robert Garner, William Diciurcio

MidAmerica Division GME Healthcare Symposium 2026

No abstract provided.

Gluteal Compartment Syndrome Following Prolonged Immobilization In The Setting Of Polysubstance Use: A Two-Patient Case Series, Daulton Sauce, Mark Gamadia, Robert Garner, Molly Black

MidAmerica Division GME Healthcare Symposium 2026

No abstract provided.

Thoracolumbar Fractures: Historical Systems And Advancements With The Ao Spine Classification, Barry Ting Sheen Kweh, Alex R. Vaccaro, Gregory D. Schroeder, Jose A. Canseco, Maximilian Reinhold, Mohamed M. Aly, Sebastian Bigdon, Mohammad El-Skarkawi, Richard J. Bransford, Andrei Fernandes Joaquim, Harvinder Singh Chhabra, Emiliano Vialle, Rishi M. Kanna, Charlotte Dandurand, Cumhur Öner, Jin Wee Tee

Rothman Institute Papers

Study Design: Systematic Review. Objective: To describe the historical classifications of thoracolumbar injuries and their evolution into the AO Spine Thoracolumbar Injury Classification System. Methods: A systematic review of MEDLINE, EMBASE and Cochrane Databases was performed in keeping with Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Results: 445 articles were crystallized to 14 included studies. Simple categorization systems offered by Bohler or Watson-Jones merely identify fracture morphology. Holdsworth and Denis conveyed a sense of the stability of injuries by noting columns of stability, but still failed to take into consideration important factors such as neurological status or …

Accuracy Of The Nestlé Mini Nutritional Assessment® (Mna®) Screen In Identifying Prealbumin–Defined Malnutrition Amongst Spine Surgery Patients, Stylianos Mysirlidis, Luke Fischbach, Matthew Giammanco, Alex Zhang, Phillip Alexeev, Ryan Snowden

SPARK Symposium Presentations

Abstract:

Background:

Malnutrition is a significant risk factor for patients undergoing surgery, including those receiving spine surgery. These patients are at greater risk of adverse postoperative outcomes, impaired wound healing, and spinal fusion failure. Therefore, it is essential to identify at-risk, malnourished patients prior to intervention to mitigate any complications such as surgical site infections, unplanned readmissions, and reoperations. The primary focus of this study was to assess the accuracy of the Nestlé Mini Nutritional Assessment® (MNA®) on identifying true malnutrition amongst those patients undergoing spine surgery.

Methods:

We conducted a retrospective cohort study of 674 consecutive …

Current Concepts In Hip And Core Assessment To Reduce The Risk Of Acl Injury, Jeremy M. Burnham, Anthony T. Drazick, Ghislain Aminake, Darren L. Johnson, Mary Lloyd Ireland, Brian W. Noehren

Orthopaedic Surgery and Sports Medicine Faculty Publications

Background: Hip and trunk (“core”) muscle dysfunction has emerged as a modifiable contributor to lower-limb biomechanics linked with non-contact anterior cruciate ligament (ACL) injuries. Clinicians increasingly target core stability and control during injury-prevention screening and post-operative rehabilitation programs; however, the literature lacks a focused synthesis of core-directed strategies for ACL injury mitigation. The purpose of this current concepts review is to synthesize current evidence on hip- and core-focused assessment and rehabilitation strategies that may mitigate ACL injury risk.

Design: Current Concepts Review.

Methods: A narrative search of PubMed and Google Scholar (January 2000 – April 2025) identified biomechanical, prospective, interventional, …

Intraosseous (Io) Analgesia Medication Administration In Orthopaedic Surgery: A Brief Review, Jenna Chrabolowski, Troy B. Puga, Abanoub Attallahm, Mckenna W. Box, John T. Riehl

North Texas GME Research Forum 2026

Introduction

Intraosseous (IO) analgesia is a novel strategy for pain control in orthopaedic surgery. This brief review aims to provide an overview of IO analgesia in orthopaedic surgery.

Methods

A search was conducted across seven databases. Titles and abstracts were screened followed by full-text review for inclusion criteria. Demographics and results were extracted from included articles.

Results

Ten studies met inclusion criteria and involved patients undergoing knee surgery and spinal surgery. IO lidocaine was shown to be effective for postoperative and intraprocedural pain control during vertebroplasty and kyphoplasty. IO morphine and IO NSAIDs were shown to be effective in reducing …

Pigmented Villonodular Synovitis (Pvns) After A Distal Femur Non-Union: A Case Report, Troy Puga, Jenna Chrabolowski, Mckenna W. Box, Kisan Parikh

North Texas GME Research Forum 2026

Background Pigmented villonodular synovitis (PVNS) is a rare benign neoplastic process that involves extensive proliferation of the synovium of a joint. Development of PVNS has been potentially linked to traumatic etiologies, however, evidence for this remains limited. This case report aims to present a case of PVNS that developed after a traumatic etiology.

Case Presentation A 62 year old female presented with recurrent left knee effusion and non-union of the left distal femur roughly four years after an MVC and index open reduction and internal fixation with a lateral locking plate and screw construct. Left knee aspiration at initial visit …

Outcomes After Orif Of Closed Bimalleolar And Trimalleolar Ankle Fractures In Patients With Autoimmune Disease, Mckenna Box, Troy B. Puga, Lachlan Anderson, Alyssa Kozlowski, John T. Riehl

North Texas GME Research Forum 2026

Background: Autoimmune disease is associated with chronic systemic inflammation, immunosuppressive therapy, and increased medical comorbidity, which may influence postoperative outcomes following fracture fixation. Data evaluating outcomes after ankle fracture surgery in this population remain limited. We hypothesized that autoimmune disease would be associated with higher postoperative complication rates following open reduction and internal fixation (ORIF) of closed ankle fractures.

Methods: We performed a retrospective cohort study using a multi-hospital dataset (2017-2025) to identify adult patients undergoing ORIF for closed bimalleolar or trimalleolar ankle fractures. Patients with autoimmune disease were propensity score matched 1:2 to patients without autoimmune disease based on …

Association Of Glp-1 Receptor Agonist Use With Postoperative Outcomes After Rotator Cuff Repair In Patients With Diabetes: A Propensity Score–Matched Analysis, Mckenna W. Box, Troy B. Puga, Hans Drawbert, Aysu Erdemir, John T. Riehl

North Texas GME Research Forum 2026

Background Diabetes impairs tendon healing after rotator cuff repair (RCR), with early postoperative poor glycemic control linked to a higher failure risk in studies. GLP-1 receptor agonists (GLP-1RAs) are increasingly used for glycemic control. Preclinical studies indicate that GLP-1RA may benefit rotator cuff healing through anti-inflammatory mechanisms as well. However, real-world data on the effects of GLP-1RAs on RCR outcomes remain incompletely understood.

Methods We conducted a retrospective cohort study using an institutional dataset (01/01/2016 to 09/30/2024) of adults aged 18-74 years with type 2 diabetes who underwent RCR. GLP-1RA exposure was established by home medication lists. Patients with autoimmune …

Biologic Versus Non-Biologic Immunosuppressant Use And Outcomes After Orif Of Closed Ankle Fractures: A Propensity-Matched Analysis, Mckenna W. Box, Troy B. Puga, Lachlan Anderson, Alyssa Kozlowski, John T. Riehl

North Texas GME Research Forum 2026

Background: The effect of biologic immunosuppressant therapy on postoperative outcomes following ankle fracture open reduction and internal fixation (ORIF) remains unclear, and concerns regarding infection and impaired healing often influence perioperative decision-making. We hypothesized that biologic immunosuppressant use would be associated with higher rates of postoperative complications following ORIF of closed ankle fractures compared with non-biologic immunosuppressant therapy.

Methods: We conducted a retrospective cohort study using a multi-hospital administrative dataset (2017-2025) to identify adult patients undergoing ORIF for closed bimalleolar or trimalleolar ankle fractures who were prescribed immunosuppressive therapy. Patients were categorized based on biologic versus non-biologic immunosuppressant use. A …

Handheld Magnet Screening Of External Fixator Components: A Laboratory Assessment Of Gross Ferromagnetism Relevant To Mri Safety, Troy B. Puga, Mckenna W. Box, Lyn D. Ward, John T. Riehl

North Texas GME Research Forum 2026

Introduction Much controversy remains regarding the ability of patients with an external fixator in place to undergo Magnetic Resonance Imaging (MRI). The main concern for radiology departments is that the external fixator system components can lead to adverse events due to interactions of the external fixator and the magnet of the MRI. However, there is no clear evidence to support these claims or theories in the current literature. Yet, MRI’s are denied daily across the country for patients having an external fixator in place. Numerous patients with an external fixator would likely benefit from an MRI to prevent delayed care, …

Efficacy And Outcomes Of Oxidized Regenerated Cellulose (Orc) In Total Joint Arthroplasty (Tja): A Systematic Review And Meta-Analysis, Jenna Chrabolowski, Troy B. Puga, Abanoub Attalah, Kyle P. O'Connor, Mckenna W. Box, Ashley Stovall, Michael Muncy, John T. Riehl

North Texas GME Research Forum 2026

Introduction Intraoperative and postoperative blood loss is a major concern and challenge for surgeons in total joint arthroplasty (TJA). Patients with large blood loss can develop postoperative anemia and associated complications. Novel hemostatic agents, such as oxidized regenerated cellulose (ORC) have grown in popularity as intraoperative hemostatic adjuncts. The aim of this systematic review and meta-analysis is to evaluate the efficacy of ORC for intraoperative and postoperative blood loss.

Methods A search was conducted across MEDLINE/Pubmed, Cochrane, Google Scholar, Web of Science, and Embase databases. Titles and abstracts were screened for eligibility for inclusion criteria. Full texts were screened and …

3d-Printed Alginate Scaffolds Incorporated With Synergistic Strontium/Magnesium - Doped Bioglass Nanoparticles For Bone Regeneration: An In Vivo Evaluation In Rabbit Cranial Defects, Mehraneh Movahedi Aliabadi, Afsaneh Jahani, Seyed Majdoddin Vahidi Toorchi, Ali Moradi, Mohammad Hossein Ebrahimzadeh, Fatemeh Kalalinia, Farkhonde Sarhaddi, Lobat Tayebi, Nafiseh Jirofti

Electrical & Computer Engineering Faculty Publications

Nonunion fractures remain a major orthopedic challenge, highlighting the need for improved bone tissue engineering (BTE) strategies. This study hypothesized that incorporating Sr/Mg-doped 58S bioglass nanoparticles into 3D-printed alginate (Alg) scaffolds would improve their physicochemical, mechanical, and biological properties and enhance bone regeneration. Structural characterization showed that Sr/Mg-doping reduced bioglass size and produced interconnected porous scaffolds. Under wet conditions, Alg scaffold incorporating 2.5%Sr/Mg-doped 58S bioglass showed the highest Young’s modulus (0.4356 ± 0.0244 MPa), whereas under dry conditions, the Alg scaffold incorporating 5%Sr/Mg-doped 58S bioglass achieved the highest value (0.1945 ± 0.0519 MPa). In vitro studies demonstrated biocompatibility and enhanced …

Revisiting The Faith Trial: A Secondary Analysis Yielding Novel Insights With The Win Ratio, Sofia Bzovsky, Nathan N. O'Hara, Gerard P. Slobogean, Sheila Sprague, Daniel E. Axelrod, Graeme Hoit, Kiara Pannozzo, Mohit Bhandari, Marc Swiontkowski, Emil Schemitsch, Rudolf W. Poolman, The Faith Investigators

Orthopaedic Surgery Faculty Publications

Background: Many orthopaedic trials use any unplanned reoperation as the primary outcome, but this overlooks how patients experience those outcomes. Using a high-quality hip fracture trial, we demonstrate how the relative importance of multiple patient-important outcomes can be effectively incorporated into data analysis, providing a more comprehensive understanding of treatment impact. Methods: This secondary analysis of the Fixation using Alternative Implants for the Treatment of Hip Fracture (FAITH) trial included 1,079 patients aged 50 years or older with a low-energy femoral neck fracture who were randomly assigned to treatment with a sliding hip screw or cancellous screws. The original trial …

Opioid Prescribing Patterns Following Isolated Trigger Finger Release: A Single-Institution Quality Improvement Study, Brandalynn Mathis, Robert Garner, Cameron Sprong, Mark Gamadia, Alan Cornett, Steven Smith

MidAmerica Division GME Healthcare Symposium 2026

No abstract provided.

Presentation And Application Of External Fixator Kickstand De-Rotational Bar Modification, Speros Gabriel, Grace Thiel, Cameron Sprong, Molly Black

MidAmerica Division GME Healthcare Symposium 2026

No abstract provided.

Distal Adding-On As A Complication Of Posterior Spinal Fusion In Adolescent Idiopathic Scoliosis: A Scoping Review Of Contemporary Evidence, Hussein Hashem, Hassan Abou Adma, Joseph Hayek, Ali Rezazadeh Shirazi, Karim Gaber, Waleed Kishta

Western Journal of Orthopaedics

Distal adding-on (DAO) is a complication of spinal fusion characterized by postoperative deformity progression distal to the fusion construct. DAO after posterior spinal fusion for adolescent idiopathic scoliosis (AIS) is variably defined and inconsistently managed. This scoping review synthesizes evidence on DAO detection, management, and outcomes. A PRISMA-ScR–guided search identified relevant studies. Thirty-one studies (2,998 patients; median follow-up, 30 months) met inclusion criteria. Reported DAO incidence ranged from 3.5% to 62.5%, reflecting heterogeneity in definitions, patient factors, surgical constructs, and follow-up duration. Revision surgery was infrequent and typically delayed. When performed, it was most often prompted by progressive coronal decompensation …

Infection Rates In Gunshot-Related Hand Fractures Treated Nonoperatively, T. Kyle Summers, Ian Garrison, Matthew C. Watterson, Brandon Barnes, Charles Rodriguez-Feo

Western Journal of Orthopaedics

Background: Firearm-associated injuries in the U.S. represent a major public health crisis, contributing substantially to major levels of morbidity, mortality, and economic stress. Recommendations for the management of gunshot-related hand fractures remain limited, particularly in low-velocity injuries, and current guidance often leaves treatment decisions to the discretion of the operating surgeon. Methods: A retrospective analysis was performed to identify phalangeal and metacarpal fractures at a Level I trauma center from 2017 to 2023, resulting in 579 patients. Only fractures resulting from firearm injuries were included, resulting in 56 patients. Infection rates were observed in patients treated nonoperatively and those treated …

Increased Mortality And Reduced Survival In Nonagenarians With Hip Fractures: Implications For Geriatric Care, Roman Austin, Julio Avila, Audrey Wassef, Kate Parker, Katherine Gavin

Western Journal of Orthopaedics

Background: Hip fractures in nonagenarians (patients aged ≥ 90 years) are becoming increasingly common as the population ages, yet outcomes in this group remain poorly characterized. This study compared in-hospital mortality and survivorship at three months, six months, and one year after hip fracture surgery in nonagenarians with a younger elderly cohort aged 65 years to 89 years. Secondary outcomes included fracture characteristics, surgical management, and discharge disposition. Methods: A retrospective chart review was conducted on patients who underwent hip fracture surgery at a single Level I Trauma Center from August 2019 to December 2021. Patients were grouped into nonagenarians …

Massive Upper Extremity Neurofibroma Treated With Limb-Sparing Debulking: A Case Report, Danielle Cummings, Tomas Holy, Nathan Morrell

Western Journal of Orthopaedics

Surgical management of neurofibromas in Neurofibromatosis type 1 (Von Recklinghausen’s disease), can be challenging because tumor size, location, hypervascularity, and tissue friability pose the risk for significant intraoperative and postoperative blood loss. Despite these risks, surgery is often necessary because of functional losses or cosmetic concerns. The authors present a 31-year-old woman with a massive neurofibroma on her right distal forearm, wrist, and hand, who ultimately underwent surgical resection because of functional impairment of her hand. She required postoperative hospitalization and blood transfusion for management of acute blood loss anemia. Because of concerns regarding blood loss and surgical morbidity, the …

Median Nerve Intraneural Hematoma As An Intraoperative Finding During Carpal Tunnel Release: A Case Report, Ana Silva, Gil Gonrtre, Nikalus Skipp, Ana Love, Deana Mercer

Western Journal of Orthopaedics

Carpal tunnel syndrome (CTS) is the most common compressive neuropathy and typically progresses slowly. Intraoperatively, flexor tenosynovitis, nerve edema, or hourglass deformity may be observed. In rare cases, acute compression symptoms occur due to mass effect on the nerve. Intraneural hematoma of the median nerve is uncommon and has been reported primarily in acute CTS cases associated with trauma. This report describes an 87-year-old patient with a history of mild CTS who underwent carpal tunnel release due to worsening symptoms. After the initial incision, a thickened flexor retinaculum, an hourglass deformity of the median nerve, and an intraneural hematoma were …

Proximal Iliotibial Band Rupture In A 74-Year-Old High-Level, Female Athlete: A Case Report, Jeremiah M. Langsfeld, Joseph Esquibel, Dustin L. Richter

Western Journal of Orthopaedics

A 74-year-old female endurance athlete presented with progressive pain over the left proximal and lateral hip distal to the iliac crest. Symptoms developed over three weeks, impairing weightbearing. Magnetic resonance imaging demonstrated a high-grade tear of the proximal iliotibial band at its iliac crest insertion. The patient was treated nonoperatively and returned to high-level, asymptomatic competition three months after symptom onset. This case offers a nonoperative approach to the rare presentation of a proximal iliotibial band rupture.

Arthroscopic Treatment Of Extensive Synovial Chondromatosis Of The Knee: A Case Report, Gaurav Singh, Bhavna Singh, Rebecca Peebles, Justin Bartley

Western Journal of Orthopaedics

Synovial chondromatosis (SC) is a rare, benign monoarticular disorder characterized by intra-articular cartilaginous loose bodies resulting from synovial metaplasia, most commonly affecting the knee. The authors present the case of a 44-year-old man with progressive, debilitating left knee pain, mechanical symptoms, and functional limitations unresponsive to conservative treatment. Radiographs were unremarkable, but magnetic resonance imaging (MRI) demonstrated multifocal noncalcified intra-articular bodies consistent with SC. The patient underwent arthroscopic debridement of the knee with limited synovectomy. Intraoperative findings included innumerable intra-articular cartilaginous loose bodies throughout the knee, synovial proliferation, and grade II chondromalacia. At three months postoperatively, the patient had regained …

Fibula Strut Allograft With Proximal Tibia Autograft For Treatment Of Humerus Nonunion: A Case Report And Review Of Oligotrophic Nonunion Management, Paul Wilson, Naomi Kelley, Samer Kakish

Western Journal of Orthopaedics

Due to their high incidence and frequent need for reoperation, nonunions of the humerus present a significant challenge in orthopaedics. Using fibular struts to treat nonunions have demonstrated excellent results. While fibular autografts provide both biologic and structural benefit, high donor site morbidity must be considered. Although their application in midshaft humeral nonunions remains limited, fibular allografts avoid donor site morbidity. Enhancing fibular strut allografts with biological components offers a promising strategy for treating fractures that have failed prior revisions. This case study presents a 36-year-old woman with an aseptic oligotrophic midshaft humeral nonunion who had an unsuccessful revision surgery. …

Popliteus Interposition In Metaphyseal Tibial Fractures: The Radiographic Clues That Cannot Be Missed, Lucca Gontijo Giarola, Paulo De Tarso Cardoso Gomes, Robinson Esteves Dos Santos Pires, Guilherme Moreira Abreu E Silva, Marco Antônio Percope De Andrade, Túlio Vinícius De Oliveira Campos

Western Journal of Orthopaedics

High-energy proximal tibia fractures present significant challenges for orthopaedic surgeons, with well-recognized risks including malreduction and nonunion. Although double plating through two mini-open parallel incisions is an established technique for selected patients, nonuion can still occur. One potential contributing factor is entrapment of the popliteus muscle within the distal spike of the posteromedial plateau fragment. This report uses illustrative cases to demonstrate how to identify, address, and prevent this complication. Strategies for managing delayed cases that progress to nonunion are also discussed