Orthopedics Commons^™

Discontinuation And Switching Patterns Of Tumour Necrosis Factor Inhibitors (Tnfis) In Tnfi-Naive And Tnfi-Experienced Patients With Psoriatic Arthritis: An Observational Study From The Us-Based Corrona Registry., Philip Mease, Chitra Karki, Mei Liu, Youfu Li, Bernice Gershenson, Hua Feng, Peter Hur, Jeffrey D Greenberg

Articles, Abstracts, and Reports

Objective: To examine patterns of tumour necrosis factor inhibitor (TNFi) use in TNFi-naive and TNFi-experienced patients with psoriatic arthritis (PsA) in the USA.

Methods: All patients aged ≥18 years with PsA enrolled in the Corrona Psoriatic Arthritis/Spondyloarthritis Registry who initiated a TNFi (index therapy) between March 2013 and January 2017 and had ≥1 follow-up visit were included. Times to and rates of discontinuation/switch of the index TNFi were compared between TNFi-naive and TNFi-experienced cohorts. Patient demographics and disease characteristics at the time of TNFi initiation (baseline) were compared between cohorts and between patients who continued versus discontinued their index TNFi …

Is Botulinum Toxin Injection Effective In Reducing Pain In Patients Diagnosed With Plantar Fasciitis?, David A. Fry

PCOM Physician Assistant Studies Student Scholarship

OBJECTIVE: The objective of this selective EBM review is to determine whether or not botulinum toxin injection is effective in reducing pain in patients diagnosed with plantar fasciitis.

STUDY DESIGN: Review of three randomized controlled trials (RCTs) comparing the efficacy of botulinum toxin injections versus corticosteroid injections for improving pain and dysfunction in those diagnosed with plantar fasciitis.

DATA SOURCES: All articles were presented in English and were taken from peer reviewed sources using PubMed. All articles were published from 2012-2017.

OUTCOMES: Outcomes of investigation measured are pain score measured using the VASvisual analog scale and Foot Health Status Questionnaire. …

Oral Contraceptive Pills Are Not A Risk Factor For Deep Vein Thrombosis Or Pulmonary Embolism After Arthroscopic Shoulder Surgery, Austin V. Stone, Avinesh Agarwalla, Anirudh K. Gowd, Cale A. Jacobs, Jeffrey A Macalena, Bryson P. Lesniak, Nikhil N. Verma, Anthony A. Romeo, Brian Forsythe

Orthopaedic Surgery and Sports Medicine Faculty Publications

Background: Worldwide, more than 100 million women between the ages of 15 and 49 years take oral contraceptive pills (OCPs). OCP use increases the risk of venous thromboembolism (VTE) through its primary drug, ethinylestradiol, which slows liver metabolism, promotes tissue retention, and ultimately favors fibrinolysis inhibition and thrombosis.

Purpose: To evaluate the effects of OCP use on VTE after arthroscopic shoulder surgery.

Study Design: Cohort study; Level of evidence, 3.

Methods: A large national payer database (PearlDiver) was queried for patients undergoing arthroscopic shoulder surgery. The incidence of VTE was evaluated in female patients taking OCPs and those not taking …

Traumatic Neuroma Of The Median Nerve: A Case Report, Keir Johnson, Amber West, Brooke Baker

UNM Orthopaedic Research Journal

Peripheral nerve neuromas are growths that develop after nerve trauma, which can result in enlarged and painful nerve ends when severed. Treatment of neuromas that form within a continuous nerve is controversial; however, success has been reported after general neurolysis with decompression of the nerve after its isolation from the surrounding scar bed. We describe a 21-year-old man who presented with symptoms of pain and intermittent numbness in his left elbow. Findings of high-resolution magnetic resonance imaging and ultrasound confirmed the diagnosis of median nerve neuroma at the level of the forearm. He subsequently underwent neurolysis with protective nerve wrap, …

Fracture Of The Ulnar Sesamoid Bone In The Thumb Of A Collegiate Basketball Player: A Case Report, Andrew M. Hyden, Christopher A. Mcgrew, Deana Mercer

UNM Orthopaedic Research Journal

Sesamoid fractures of the hand are uncommon occurrences that can lead to prolonged pain and swelling if delayed in diagnosis. This is particularly problematic in competitive athletes. We describe an ulnar sesamoid fracture of the thumb due to a blunt traumatic injury in a Division I collegiate basketball player. The 22-year-old woman injured her left thumb when kicked during a game. The patient was treated nonoperatively with promising outcomes. Sesamoid fractures of the hand can be difficult to diagnose, and any delay can lengthen the amount of time before the athlete returns to play. Radiographic findings may help healthcare providers …

Open Lumbosacral Dislocation: A Case Report, Travis M. Hughes, Tony G. Pedri, Antony Kallur

UNM Orthopaedic Research Journal

Open injuries in the lumbar spine are rare. We describe a 20-year-old woman who presented with persistent weaknesses due to an associated lumbar plexus injury. She underwent surgical treatment of lumbosacral dislocation with prompt reduction with debridement and stabilization. At 7 months postoperatively, her symptoms showed signs of recovery. We believe the immediate reduction of the dislocation prevented permanent neurological injury, and stabilization helped healing and early mobilization. In keeping with the classical teaching of open fracture treatment, prioritizing early initiation of intravenous antibiotics and prompt debridement and stabilization may have helped decrease the long-term morbidity and overall sequelae of …

Accuracy And Reliability Of Examiners’ Observations Of Pre-Practice Warm-Up And Fifa 11+ Injury Prevention Program Exercises, James R. Slauterbeck, Pamela M. Vacek, Rebecca Choquette, Tessa Kettelkamp, Autumn Reilly, Brandon Lentine, Bruce D. Beynnon

UNM Orthopaedic Research Journal

Background: The Fédération Internationale de Football Association (FIFA) 11+ is an injury prevention program that decreases the incidence of lower extremity injuries. The purpose of the current study was to understand what specific exercises prevented injury from occurring. We thus developed and tested a form to identify these exercises. We hypothesize that trained examiners could accurately and reliably use this form to identify and record individual exercises performed during preparticipation warm-up.

Methods: A repeated-measures study design was used in this investigation. After observing five prepractice warm-up videos obtained from multiple high schools, 11 examiners observed and recorded performed exercises at …

Training Orthopaedic Residents To Formulate Evidence-Based Questions, Jonathan D. Eldredge

UNM Orthopaedic Research Journal

Background: Formulating questions that are both focused and answerable is an essential clinical skill for evidence-based practice (EBP). Possessing this skill can successfully launch research projects. Yet studies have depicted mixed results pertaining to the teaching of question formulation. This report describes introducing orthopaedic residents to question formulation and showcases an accompanying evaluation rubric originally developed for training second-year medical students.

Methods: In this prospective cohort study, a total of 23 orthopaedic residents at The University of New Mexico Health Sciences Center participated in a 1-hour training. The study included application exercises using an evaluation rubric for learners to assess …

Physical Therapy Faculty, Unm Department Of Orthopaedic Surgery

UNM Orthopaedic Research Journal

No abstract provided.

Letter From The Residency Director, Unm Department Of Orthopaedic Surgery

UNM Orthopaedic Research Journal

No abstract provided.

Unmorj Full Instructions For Authors, Unm Department Of Orthopaedic Surgery

UNM Orthopaedic Research Journal

No abstract provided.

Tofacitinib Or Adalimumab Versus Placebo: Patient-Reported Outcomes From Opal Broaden-A Phase Iii Study Of Active Psoriatic Arthritis In Patients With An Inadequate Response To Conventional Synthetic Disease-Modifying Antirheumatic Drugs., Vibeke Strand, Kurt De Vlam, Jose A Covarrubias-Cobos, Philip Mease, Dafna D Gladman, Daniela Graham, Cunshan Wang, Joseph C Cappelleri, Thijs Hendrikx, Ming-Ann Hsu

Articles, Abstracts, and Reports

Objectives: Tofacitinib is an oral Janus kinase inhibitor for treatment of psoriatic arthritis (PsA). We evaluated patient-reported outcomes (PROs) in patients with PsA refractory to ≥1 conventional synthetic disease-modifying antirheumatic drug (csDMARD-IR) and tumour necrosis factor inhibitor-naïve in a 12-month, phase III randomised controlled trial (OPAL Broaden [NCT01877668]).

Methods: Patients (N=422) received tofacitinib 5 mg or 10 mg twice daily, adalimumab 40 mg subcutaneously every 2 weeks or placebo advancing to tofacitinib 5 mg or 10 mg twice daily at month 3. Least squares mean changes from baseline and percentages of patients reporting improvements ≥minimum clinically important differences (MCID); and …

Measurement Properties Of The Minimal Disease Activity Criteria For Psoriatic Arthritis., Laura C Coates, Vibeke Strand, Hilary Wilson, Dennis Revicki, Brad Stolshek, Ahmed Samad, James B Chung, Dafna Gladman, Philip Mease

Articles, Abstracts, and Reports

Objective: To comprehensively assess evidence on the measurement properties of the minimal disease activity (MDA) criteria, a composite measure of the state of disease activity in psoriatic arthritis (PsA).

Methods: A targeted literature review was conducted to identify studies that informed the validity and/or ability of the MDA to detect change among patients known to have experienced a change in clinical status. The search was conducted using MEDLINE and Embase databases (published as of October 2017). Pertinent articles provided by investigators and identified from select conference proceedings were also evaluated.

Results: A total of 20 publications met the inclusion criteria. …

Are Plasma Rich Platelets More Effective In Decreasing Chronic Lower Back Pain As Compared To Epidural Injections In Young Adults?, Linda M. Leones

PCOM Physician Assistant Studies Student Scholarship

Objective: The objective of this selective EBM review is to determine whether or not PRP injections are more effective in decreasing chronic lower back pain as compared to epidural injections in young adults.

Study Design: Systematic review of three English language randomized controlled trials (RCTs), all published after 2012.

Data Sources: Two double-blind RCTs and one randomized open blinded end point (PROBE), which analyzed the effectiveness of PRP and epidural injections in young adults with chronic lower back pain. All studies were found using PubMed.

Outcome(s) Measured: Each of the articles analyzed the pain relief and function ability stated by …

Is Platelet-Rich Plasma (Prp) A More Effective Treatment In Reducing Pain Than Corticosteroid (Cs) Injections In Musculoskeletal Injuries?, Nicole Gazzola

PCOM Physician Assistant Studies Student Scholarship

OBJECTIVE: The objective of this selective EBM review is to determine whether or not, “Is Platelet-Rich Plasma (PRP) a more effective treatment in reducing pain than corticosteroid (CS) injections in musculoskeletal injuries?”

STUDY DESIGN: Review of three, double blind, randomized controlled trials (RCTs), published between 2013 and 2016, all in the English language were included. The articles compared platelet-rich plasma (PRP) and corticosteroid (CS) injections to a visually matched placebo of saline in regard to reduction of pain from baseline in varying different musculoskeletal injuries.

DATA SOURCES: Three RCTs were found using PubMed and Google Scholar. All articles were published …

Optimization Of Primary Cilia Detection In Musculoskeletal Tissue, Ragen Engel

Williams Honors College, Honors Research Projects

The objective of this research project was to optimize a laboratory technique for visualizing primary cilia in musculoskeletal tissue of young swine, specifically the growth plate of long bones. This was accomplished through varying fixation procedures, antigen retrieval methods, antibody concentrations, and incubation times. By varying these parameters, a reproducible procedure was developed to examine the primary cilia in multiple tissues including ligament, fascia, and growth plate. This experiment introduced variances in fixation methods, with methanol or formalin. Paraffin and frozen embedding techniques were also varied for comparison with regards to cilia visualization. Results from the acetylated alpha tubulin (aTUB) …

Post Surgical Outcomes Following Limited-Open Carpal Tunnel Release Or Endoscopic Carpal Tunnel Release, Keeley Shaye Smith

Online Theses and Dissertations

Carpal Tunnel Syndrome is a neurological condition that may contribute to decreased grip strength, sensory function, activities of daily living, and many other negative impacts on an individual’s life. The purpose of this study was to assess whether patients who received endoscopic carpal tunnel release had better patient reported outcomes than patients who received limited-open carpal tunnel release. This study prospectively assessed patient reported outcomes such as pain, Patient-Specific Functional Score, Quick Disabilities of the Arm Shoulder and Hand Score, two-point discrimination, and hand grip-strength. This study demonstrated that there were significant differences within all subjective data measures (p≤0.017) from …

Development And Exploration Of A Z-Shaped Foot And Ankle Internal Fixation Plate, Rhaz Shaghaghi Paul, Ian Hames, Sean Rich

Williams Honors College, Honors Research Projects

This paper will detail the design process of developing a Z-shaped foot and ankle internal fixation plating system. Group 6: Plates for the Sole was made up of 5 team members, who worked together to accommodate their client’s request to complete a biomechanical analysis of a Z-Plate design and a construct a prototype. The Z-Plate’s purpose is to provide podiatrists with a new solution that can fit nicely on the small, irregular bones of the foot, while also remaining strong enough to withstand the forces and torques of the foot.

Marjolin's Tumor Complicating Chronic Periprosthetic Infection Of A Total Knee Arthroplasty, Timothy Horan, Matthew T. Wallace, Albert J. Aboulafia, Janet D. Conway

Orthopedic Surgery Resident Research

Marjolin's tumor is a term used to describe a malignancy developing in the setting of a chronic wound, infection, or other tissue subject to chronic inflammatory changes. These malignancies usually present after many years of chronicity, and can range from lower grade basal cell carcinomas to high-grade sarcomas. We present the case of a squamous cell carcinoma that developed within a chronic periprosthetic infection of a total knee arthroplasty of 7 years duration. The intra-articular location, association with an orthopaedic implant, and brief latency period are all unique features of this case.

A Traumatic Three-Level Brachial Plexus Palsy With Upper Trunk Avulsion, Andre Anderson, Michael Swartzon, Gautam Yagnik, John Uribe

All Publications

No abstract provided.

Long-Term Clinical Results Of Intra-Articular Injections For Osteoarthritis Of The Knee, Michael Swartzon, Andre Anderson, Luis Rodriguez

All Publications

No abstract provided.

Rotator Cuff Tear Progression In Professional Contact Athletes, Gautam Yagnik, William Davis, Michael Swartzon, John Uribe

All Publications

No abstract provided.

Drivers Of International Variation In Prevalence Of Disabling Low Back Pain: Findings From The Cultural And Psychosocial Influences On Disability Study, David Coggon, Georgia Ntani, Keith T. Palmer, Vanda E. Felli, Florencia Harari, Leonardo A. Quintana, Sarah A. Felknor, Marianela Rojas, Anna Cattrell, Muhammad Masood Kadir

Community Health Sciences

Background: Wide international variation in the prevalence of disabling low back pain (LBP) among working populations is not explained by known risk factors. It would be useful to know whether the drivers of this variation are specific to the spine or factors that predispose to musculoskeletal pain more generally.
Methods: Baseline information about musculoskeletal pain and risk factors was elicited from 11 710 participants aged 20-59 years, who were sampled from 45 occupational groups in 18 countries. Wider propensity to pain was characterized by the number of anatomical sites outside the low back that had been painful in …

Monitoring Postoperative Opioid Use Following Simple Arthroscopic Meniscectomy: A Performance-Improvement Strategy For Prescribing Recommendations And Community Safety., Vance Gardner, David Gazzaniga, Michael Shepard, Robert Grumet, Benjamin Rubin, Michael Dempewolf, Camille Bray, Carlos Prietto

Articles, Abstracts, and Reports

Background: Orthopaedic surgeons are confronted with a difficult dilemma: managing acute pain postoperatively and balancing the risk of prescription opioid use. To our knowledge, a prospective performance-improvement project providing opioid-prescription recommendations based on the actual amounts of usual and customary medication consumed following simple knee meniscectomy has not been described.

Methods: One hundred and two patients undergoing arthroscopic knee meniscectomy prospectively recorded postoperative pain medications in a pain journal. Arthroscopic procedures were performed at 2 centers by 9 fellowship-trained senior surgeons. Various usual and customary prescribing protocols were observed, and the amount of medication consumed was recorded. Prescription and over-the-counter …

Transgenic Mice Overexpressing Human Tnf-Α Experience Early Onset Spontaneous Intervertebral Disc Herniation In The Absence Of Overt Degeneration., Deborah J. Gorth, Irving M. Shapiro, Makarand V. Risbud

Department of Orthopaedic Surgery Faculty Papers

There is a well-established link between cytokine expression and the progression of intervertebral disc degeneration. Among these cytokines, interleukin-1β (IL-1β) and tumor necrosis factor-α (TNF-α) are the most commonly studied. To investigate whether systemic hTNF-α overexpression affects intervertebral disc health, we studied the spine phenotype of Tg197 mice, a widely used hTNF-α transgenic line. These mice were studied at 12-16 weeks of age using comprehensive histochemical and immunohistological analysis of the spinal motion segment. Micro-CT analysis was performed to quantify vertebral trabecular bone architecture. The Tg197 mice evidenced spontaneous annular tears and herniation with increased vascularity in subchondral bone and …

A Us Hospital Budget Impact Analysis Of A Skin Closure System Compared With Standard Of Care In Hip And Knee Arthroplasty., Kay Sadik, Jana Flener, Jeanine Gargiulo, Zachary D. Post, Steven Wurzelbacher, Andrew Hogan, Sarah Hollmann, Nicole Ferko

Department of Orthopaedic Surgery Faculty Papers

Background: Medicare's mandatory bundle for hip and knee arthroplasty necessitates provider accountability for quality and cost of care to 90 days, and wound closure may be a key area of consideration. The DERMABOND

Methods: A 90-day economic model was developed assuming 500 annual hip/knee arthroplasties for a typical US hospital setting. In current practice, wound closure methods for the final skin layer were set to 50% sutures and 50% staples. In future practice, this distribution shifted to 20% sutures, 20% staples, and 60% Skin Closure System. Health care resources included materials (eg, staplers, steri-strips, and traditional/barbed sutures), standard or premium …

Towards An In Vitro Model Of Testing Osteoblast Cellular Function In Contact With Various Surfaces, Raheleh Miralami

Theses & Dissertations

Past studies have shown that the success of total joint replacements depends on the biocompatibility of orthopaedic materials, which can be improved by modifying the implant surface. However, the exact roles of these modifications and their effective mechanisms are poorly understood. The objective of this study was to develop and evaluate a model system to investigate the impact of nano-structured surfaces, produced by the ion beam-assisted deposition (IBAD) technique, on biomarkers of osteointegration using an in vitro model. The IBAD technique was employed to deposit zirconium oxide (ZrO₂), Titanium oxide (TiO₂), and Titanium (Ti) nano-films on …

Isolated Gonococcal Extensor Tenosynovitis, Cory Lebowitz, Jonas Matzon

Department of Orthopaedic Surgery Faculty Papers

Neisseria gonorrhoeae is a mucosal infection that has the propensity to disseminate, causing symptoms that commonly include arthralgias, skin lesions, fevers, chills, dysuria, genital discharge, septic arthritis, and/or tenosynovitis. Typically, gonococcal tenosynovitis affects the flexor sheath and is associated with arthralgias, skin lesions, or both. To the best of our knowledge, there has not been a documented case of isolated gonococcal extensor tenosynovitis. We report the case of a 16-year-old boy with isolated left upper-extremity gonococcal extensor tenosynovitis who was successfully treated with surgical debridement and antibiotic therapy.

The Ratio Of Observed To Expected: How Much Of It Is Unexpected?, Jens R Chapman, Karsten Wiechert, Jeffrey C Wang

Articles, Abstracts, and Reports

No abstract provided.

Trends And Costs Of External Electrical Bone Stimulators And Grafting Materials In Anterior Lumbar Interbody Fusion., Anthony D'Oro, Zorica Buser, Darrel Scott Brodke, Jong-Beom Park, Sangwook Tim Yoon, Jim Aimen Youssef, Hans-Joerg Meisel, Kristen Radcliff, Patrick Hsieh, Jeffrey Chun Wang

Rothman Institute Papers

STUDY DESIGN: Retrospective review.

PURPOSE: To identify the trends in stimulator use, pair those trends with various grafting materials, and determine the influence of stimulators on the risk of revision surgery.

OVERVIEW OF LITERATURE: A large number of studies has reported beneficial effects of electromagnetic energy in healing long bone fractures. However, there are few clinical studies regarding the use of electrical stimulators in spinal fusion.

METHODS: We used insurance billing codes to identify patients with lumbar disc degeneration who underwent anterior lumbar interbody fusion (ALIF). Comparisons between patients who did and did not receive electrical stimulators following surgery were …