Orthopedics Commons^™

Anatomical Relationships Of The Anterior Blood Vessels To The Lower Lumbar Intervertebral Discs: Analysis Based On Magnetic Resonance Imaging Of Patients In The Prone Position., Alexander R Vaccaro, Christopher K Kepler, Jeffrey A Rihn, Hidekazu Suzuki, John K Ratliff, James S Harrop, William B Morrison, Worawat Limthongkul, Todd J Albert

Rothman Institute Papers

BACKGROUND: Intra-abdominal vascular injuries are rare during posterior lumbar spinal surgery, but they can result in major morbidity or mortality when they do occur. We are aware of no prior studies that have used prone patient positioning during magnetic resonance imaging for the purpose of characterizing the retroperitoneal iliac vasculature with respect to the intervertebral disc. The purpose of this study was to define the vascular anatomy adjacent to the lower lumbar spine with use of supine and prone magnetic resonance imaging.

METHODS: A prospective observational study included thirty patients without spinal abnormality who underwent supine and prone magnetic resonance …

Volume 1 (2012), Unm Department Of Orthopaedic Surgery

UNM Orthopaedic Research Journal

No abstract provided.

Revision Total Knee Arthroplasty: Infection Should Be Ruled Out In All Cases, Mohammad R. Rasouli, Armin Aalami Harandi, Bahar Adeli, James J. Purtill, Javad Parvizi

Rothman Institute Papers

We hypothesized that some aseptic revision total knee arthroplasty failures are indeed caused by occult infection. This prospective study recruited 65 patients undergoing revision total knee arthroplasty. The mean follow-up period was 19 months. Collected synovial fluid was analyzed by Ibis T5000 biosensor (Abbott Molecular Inc, Ill; a multiplex polymerase chain reaction technology). Cases were considered as infected or aseptic based on the surgeon's judgment and Ibis findings. Based on Ibis biosensor, 17 aseptic cases were indeed infected that had been missed. Of these 17 cases, 2 developed infection after the index revision. A considerable number of so-called aseptic failures …

Periprosthetic Joint Infection: Are Patients With Multiple Prosthetic Joints At Risk?, S Mehdi Jafari, David S Casper, Camilo Restrepo, Benjamin Zmistowski, Javad Parvizi, Peter F Sharkey

Rothman Institute Papers

Patients who present with a periprosthetic joint infection in a single joint may have multiple prosthetic joints. The risk of these patients developing a subsequent infection in another prosthetic joint is unknown. Our purposes were (1) to identify the risk of developing a subsequent infection in another prosthetic joint and (2) to describe the time span and organism profile to the second prosthetic infection. We retrospectively identified 55 patients with periprosthetic joint infection who had another prosthetic joint in place at the time of presentation. Of the 55 patients, 11 (20%) developed a periprosthetic joint infection in a second joint. …

Does The Load-Sharing Classification Predict Ligamentous Injury, Neurological Injury, And The Need For Surgery In Patients With Thoracolumbar Burst Fractures?: Clinical Article., Kristen Radcliff, Christopher K Kepler, Todd A Rubin, Motasem Maaieh, Alan S Hilibrand, James Harrop, Jeffrey A Rihn, Todd J Albert, Alexander R Vaccaro

Department of Orthopaedic Surgery Faculty Papers

OBJECT: The load-sharing score (LSS) of vertebral body comminution is predictive of results after short-segment posterior instrumentation of thoracolumbar burst fractures. Some authors have posited that an LSS > 6 is predictive of neurological injury, ligamentous injury, and the need for surgical intervention. However, the authors of the present study hypothesized that the LSS does not predict ligamentous or neurological injury.

METHODS: The prospectively collected spinal cord injury database from a single institution was queried for thoracolumbar burst fractures. Study inclusion criteria were acute (< 24 hours) burst fractures between T-10 and L-2 with preoperative CT and MRI. Flexion-distraction injuries and pathological fractures were excluded. Four experienced spine surgeons determined the LSS and posterior ligamentous complex (PLC) integrity. Neurological status was assessed from a review of the medical records.

RESULTS: Forty-four patients were included in the study. There were 4 patients for whom all observers …

Population-Based Survey Of Lumbar Surgery Beliefs In The United States, Amanda Elyse Mccauley, Zachery Clark Rasmussen

UNLV Theses, Dissertations, Professional Papers, and Capstones

Purpose/Hypothesis: Studies have shown that poor lumbar surgery outcomes may be influenced by a person’s preconceived perceptions of low back surgery (LBS). However, the perceptions of the general population about issues related to lumbar surgery are not known. Therefore, the purpose of this study was to investigate the general population’s perceptions regarding LBS.

Number of Subjects: This study included 262 participants (Average age: 46.1, SD=16.9; 125 Males, 137 Females) who completed the questionnaire from the general population in the Las Vegas area.

Materials/Methods: Questionnaire development involved expert panel feedback from three physical therapists, three spine surgeons, two surgeon assistants/nurses, two …

Subacromial Impingement Syndrome, Masood Umer, Irfan Qadir, Mohsin Azam

Department of Surgery Docs

Subacromial impingement syndrome (SAIS) represents a spectrum of pathology ranging from subacromial bursitis to rotator cuff tendinopathy and full-thickness rotator cuff tears. The relationship between subacromial impingement and rotator cuff disease in the etiology of rotator cuff injury is a matter of debate. However, the etiology is multi-factorial, and it has been attributed to both extrinsic and intrinsic mechanisms. Management includes physical therapy, injections, and, for some patients, surgery. No high-quality randomized controlled trials are available so far to provide possible evidence for differences in outcome of different treatment strategies. There remains a need for high-quality clinical research on the …

(Iv) Managing Bone Loss Of The Femur And Tibia In Revision Total Knee Arthroplasty, Glenn J. Kerr, M.D, Joseph A. Karam, M.D., Javad Parvizi, M.D., Frcs

Rothman Institute Papers

The number of primary and revision knee arthroplasty procedures performed yearly is steadily increasing. The management of bone loss at the time of revision surgery will play an integral role in the longevity and function of these knees into the future. There are a variety of options for addressing these defects varying from the use of polymethylmethacrylate bone cement, metal augments, sleeves, cones and large allograft replacements. This manuscript discusses the evaluation, classification and management of bone loss of the distal femur and proximal tibia.

Short Term Results Of Ligament Reconstruction And Tendon Interposition Resection Arthroplasty For Basal Joint Arthritis, Kashif Abbas, Pervaiz Hashmi, Hasnain Raza

Section of Orthopaedic Surgery

Carpometacarpal (CMC) joint of the thumb is the second most common site afflicted by osteoarthritis. Non surgical measures forms the first line of treatment with aim of preventing progression of disease, however, surgery becomes an option when symptoms are refractory to nonsurgical methods. Different procedures have been described in literature. Ligament reconstruction with tendon interposition (LRTI) is the most commonly performed procedure in North America for this problem. The Aim of study was to evaluate early results of ligament reconstruction and tendon interposition for CMC joint arthritis. This is a case series of ten patients operated in a tertiary care …

Preoperative Cardiac Evaluation In Proximal Femur Fractures And Its Effects On The Surgical Outcome, Kashif Abbas, Masood Umer, Raza A Zaidi

Department of Surgery Docs

OBJECTIVE:

The aim of the current study was to evaluate the impact of cardiac risk stratification and preoperative cardiac evaluation on final outcomes in patients with acute proximal femur fractures.

METHODS:

This retrospective review included one hundred and three patients who underwent a preoperative cardiac evaluation prior to proximal femur fracture operation between 2004 and 2007 at a tertiary care hospital. Patients were divided into two groups. Group A included 76 patients who were tested with ECG only and Group B included 27 patients with additional clearance. All of these files were reviewed according to a set pro forma. Statistical …

Does International Normalized Ratio Level Predict Pulmonary Embolism?, Patricia Hansen, Benjamin Zmistowski, Camilo Restrepo, Javad Parvizi, Richard H Rothman

Rothman Institute Papers

BACKGROUND: Preventing pulmonary embolism is a priority after major musculoskeletal surgery. The literature contains discrepant data regarding the influence of anticoagulation on the incidence of pulmonary embolism after joint arthroplasty. The American College of Chest Physicians guidelines recommend administration of oral anticoagulants (warfarin), aiming for an international normalized ratio (INR) level between 2 and 3. However, recent studies show aggressive anticoagulation (INR > 2) can lead to hematoma formation and increased risk of subsequent infection.

QUESTIONS/PURPOSES: We asked whether an INR greater than 2 protects against pulmonary embolism.

PATIENTS AND METHODS: We identified 9112 patients with 10,122 admissions for joint arthroplasty …

Glenohumeral Tuberculous Arthritis Complicated With Beta Haemolytic Streptococcus: An Extraordinary Rare Association: A Case Report, Rizwan Haroon Rashid, Muhammad Usman Sarwar, Jaweed Akhter, Shahryar Noordin

Section of Orthopaedic Surgery

Introduction: Septic arthritis of the glenohumeral joint is a rare entity and its diagnosis is difficult with a superadded infection in the presence of underlying tuberculosis. We report the first case of group B beta haemolytic streptococcal glenohumeral arthritis with underlying tuberculosis.
Case Presentation: A 40 year old lady previously diagnosed to have poliomyelitis, rheumatoid arthritis, hepatitis C, and diabetes mellitus for the last 10 years, presented to the emergency room with diabetic ketoacidosis. Two weeks prior to presentation she developed fever along with pain and swelling in left shoulder with uncontrolled blood sugars. Local examination of the shoulder revealed …

What's New In Adult Reconstructive Knee Surgery., Carl A Deirmengian, Jess H Lonner

Rothman Institute Papers

The purpose of this review is to summarize studies on various topics in adult knee reconstruction that were published during the year 2010. The keywords “knee” and “arthroplasty” and “prospective” and “randomized” were used to perform a search of the National Library of Medicine's PubMed database; the search was limited to studies that were published in The Journal of Bone and Joint Surgery (American Volume) or The Journal of Arthroplasty in 2010. The resulting seventeen studies are included in this review of adult reconstruction of the knee and are included in the complete bibliography at the end of the manuscript. …

Controlled Biomineralization Of Electrospun Poly(Ε-Caprolactone) Fibers For Enhancing Their Mechanical Properties, Jingwei Xie, Shaoping Zhong, Bing Ma, Franklin D. Shuler, Chwee Teck Lim

MIIR Faculty Research

Electrospun polymeric fibers have been investigated as scaffolding materials for bone tissue engineering. However, their mechanical properties, and in particular stiffness and ultimate tensile strength, cannot match those of natural bones. The objective of the study was to develop novel composite nanofiber scaffolds by attaching minerals to polymeric fibers using an adhesive material-the mussel-inspired protein polydopamine-as a "superglue". Herein, we report for the first time the use of dopamine to regulate mineralization of electrospun poly(ε-caprolactone) (PCL) fibers to enhance their mechanical properties. We examined the mineralization of the PCL fibers by adjusting the concentration of HCO3 - and dopamine in …

Extraskeletal Effects Of Vitamin D: Potential Impact On Wv Disease Morbidity And Mortality, Franklin D. Shuler, Dana Lycans, Elias Salloum

Orthopaedics

Vitamin D is an essential nutrient and a secosteroid hormone that regulates many physiologic processes beyond calcium and bone homeostasis. These "extraskeletal" effects are impacted by the circulating levels of the storage form of vitamin D, 25-hydroxyvitamin D3. Levels of vitamin D can be detected after completing a simple 25(OH)D blood test. Vitamin D deficiency (< 30 ng/mL) is associated with a higher risk of many chronic diseases including, but not limited to, fourteen types of cancers, type 1 and 2 diabetes mellitus, obesity, cardiovascular disease, hypertension, stroke, and asthma. This article explores the association between vitamin D deficiency and the burden of chronic diseases in West Virginia.

Managing Soft Tissue Sarcomas In A Developing Country: Are Prognostic Factors Similar To Those Of Developed World?, Irfan Qadir, Masood Umer, Hafiz Muhammad Umer, Nasir Uddin, Farrok Karson, Muhammad Sharoz Rabbani

Section of Orthopaedic Surgery

Background: Managing soft tissue sarcomas (STS) in a developing country with limited financial resources and a poor health referral system is a challenge. Presenting late, these extremity STS are prone to recurrence despite apparently complete resection. This study aimed to explore and compare the impact of clinico-pathological factors on recurrence and survival in Pakistan with the corresponding figures quoted from the developed world.
Methods: An institutional review was performed on all patients with primary STS of the extremities operated on between 1994 and 2008. The prognostic influence of clinical, pathologic, and treatment variables on local recurrence free survival (LRFS), metastasis …

Skeletal Manifestations Of Scurvy: A Case Report From Dubai, Shahryar Noordin, Naveed Baloch, Muhammad Sohail Salat, Abdul Rashid Memon, Tashfeen Ahmad

Section of Orthopaedic Surgery

Introduction: Nutritional deficiencies are rarely reported in developed countries. We report a child of Pakistani origin brought up in Dubai who developed skeletal manifestations of scurvy due to peculiar dietary habits.
Case Presentation: A 4.5 year old boy presented with pain and swelling of multiple joints for three months and inability to walk for two months. Dietary history was significant for exclusive meat intake for the preceding two years. On examination the child's height and weight were below the 5th percentile for his age. He was pale and tachycardic. There was significant swelling and tenderness over the wrist, knee and …

Upper Extremity Strength Characteristics In Female Recreational Tennis Players With And Without Lateral Epicondylalgia, Ann M. Lucado, Morey J. Kolber, M. Samuel Cheng, John L. Echternach Sr.

Rehabilitation Sciences Faculty Publications

STUDY DESIGN: Descriptive, cross-sectional.

OBJECTIVES: To compare static strength characteristics of the upper extremity musculature in female recreational tennis players with lateral epicondylalgia to those of nonsymptomatic tennis players and a control group of women who did not play tennis.

BACKGROUND: There is a paucity of research describing the relationship between lateral epicondylalgia and strength characteristics of the upper extremity musculature, despite the functional relationship between the shoulder, elbow, and wrist.

METHODS: Sixty-three women were recruited into 3 groups (n = 21 per group): symptomatic tennis players (SIP) with lateral epicondylalgia, nonsymptomatic tennis players, and controls. Data collection was performed …

Two-Week Joint Mobilization Intervention Improves Self-Reported Function, Range Of Motion, And Dynamic Balance In Those With Chronic Ankle Instability, Matthew C. Hoch, Richard D. Andreatta, David R. Mullineaux, Robert A. English, Jennifer M. Medina Mckeon, Carl G. Mattacola, Patrick O. Mckeon

Human Movement Studies & Special Education Faculty Publications

We examined the effect of a 2-week anterior-to-posterior ankle joint mobilization intervention on weight-bearing dorsiflexion range of motion (ROM), dynamic balance, and self-reported function in subjects with chronic ankle instability (CAI). In this prospective cohort study, subjects received six Maitland Grade III anterior-to-posterior joint mobilization treatments over 2 weeks. Weight-bearing dorsiflexion ROM, the anterior, posteromedial, and posterolateral reach directions of the Star Excursion Balance Test (SEBT), and self-reported function on the Foot and Ankle Ability Measure (FAAM) were assessed 1 week before the intervention (baseline), prior to the first treatment (pre-intervention), 24-48 h following the final treatment (post-intervention), and 1 …

The Use Of Preoperative Epoetin-Α In Revision Hip Arthroplasty., Lawrence A Delasotta, Ashwin Rangavajjula, Michael L Frank, Jamie Blair, Fabio Orozco, Alvin Ong

Rothman Institute Papers

PURPOSE: To evaluate the efficacy of preoperative epoetin-α on the revision hip arthroplasty patient. We hypothesized that epoetin-α will reduce blood transfusion. A pertinent review of the literature is provided.

METHODS: Forty-six patients were retrospectively reviewed. Sixteen patients received epoetin-α. Patients were case matched by age, preoperative hemoglobin, surgery, gender, and BMI. The clinical triggers for blood transfusion during or after the procedure were determined based on peri- and postoperative hemoglobin levels, ASA score, and/or clinical symptoms consistent with anemia. Blood salvage was not used.

RESULTS: Blood transfusion and length of stay were decreased in the epoetin-α group. Hemoglobin in …

Early Versus Delayed Decompression For Traumatic Cervical Spinal Cord Injury: Results Of The Surgical Timing In Acute Spinal Cord Injury Study (Stascis)., Michael G Fehlings, Alex R. Vaccaro, Jefferson R Wilson, Anoushka Singh, David W Cadotte, James Harrop, Bizhan Aarabi, Christopher Shaffrey, Marcel Dvorak, Charles Fisher, Paul Arnold, Eric M Massicotte, Stephen Lewis, Raja Rampersaud

Department of Orthopaedic Surgery Faculty Papers

BACKGROUND: There is convincing preclinical evidence that early decompression in the setting of spinal cord injury (SCI) improves neurologic outcomes. However, the effect of early surgical decompression in patients with acute SCI remains uncertain. Our objective was to evaluate the relative effectiveness of early (injury) versus late (≥ 24 hours after injury) decompressive surgery after traumatic cervical SCI.

METHODS: We performed a multicenter, international, prospective cohort study (Surgical Timing In Acute Spinal Cord Injury Study: STASCIS) in adults aged 16-80 with cervical SCI. Enrolment occurred between 2002 and 2009 at 6 North American centers. The primary outcome was ordinal change …

Minimal Invasive Decompression For Lumbar Spinal Stenosis., Victor Popov, David G Anderson

Department of Orthopaedic Surgery Faculty Papers

Lumbar spinal stenosis is a common condition in elderly patients and may lead to progressive back and leg pain, muscular weakness, sensory disturbance, and/or problems with ambulation. Multiple studies suggest that surgical decompression is an effective therapy for patients with symptomatic lumbar stenosis. Although traditional lumbar decompression is a time-honored procedure, minimally invasive procedures are now available which can achieve the goals of decompression with less bleeding, smaller incisions, and quicker patient recovery. This paper will review the technique of performing ipsilateral and bilateral decompressions using a tubular retractor system and microscope.

Minimal Invasive Decompression For Lumbar Spinal Stenosis., Victor Popov, David G Anderson

Department of Orthopaedic Surgery Faculty Papers

Lumbar spinal stenosis is a common condition in elderly patients and may lead to progressive back and leg pain, muscular weakness, sensory disturbance, and/or problems with ambulation. Multiple studies suggest that surgical decompression is an effective therapy for patients with symptomatic lumbar stenosis. Although traditional lumbar decompression is a time-honored procedure, minimally invasive procedures are now available which can achieve the goals of decompression with less bleeding, smaller incisions, and quicker patient recovery. This paper will review the technique of performing ipsilateral and bilateral decompressions using a tubular retractor system and microscope.

Late Removal Of Titanium Hardware From The Elbow Is Problematic, Abdo Bachoura, Ruriko Yoshida, Christian Lattermann, Srinath Kamineni

Orthopaedic Surgery and Sports Medicine Faculty Publications

A retrospective review of 21 patients that underwent bone screw removal from the elbow was studied in relation to the type of metal, duration of implantation, and the location of the screws about the elbow. Screw failure during extraction was the dependent variable. Five of 21 patients experienced hardware failure during extraction. Fourteen patients had titanium alloy implants. In four cases, titanium screws broke during extraction. Compared to stainless steel, titanium screw failure during removal was not statistically significant (P = 0.61). Screw removal 12 months after surgery was more likely to result in broken, retained screws in general …

Medication And Supplement Use For Managing Joint Symptoms Among Patients With Knee And Hip Osteoarthritis: A Cross-Sectional Study, Jeffrey B. Driban, Sara A. Boehret, Easwaran Balasubramanian, Nicole M. Cattano, Joseph Glutting, Michael R. Sitler

Sports Medicine Faculty Publications

No abstract provided.

Is The Use Of Apixaban Or Enoxaparin, More Effective In The Prophylaxis Of Venous Thromboembolism Post-Orthopedic Surgery?, Jolene Bohensky

PCOM Physician Assistant Studies Student Scholarship

OBJECTIVE: The objective of this selective EBM review is to determine whether or not the use of Apixaban or Enoxaparin is more effective in the prophylaxis of venous thromboembolism post-orthopedic surgery.

STUDY DESIGN: Review of three English language randomized, double-blind, placebo-controlled clinical trials from 2009-2010.

DATA SOURCES: Randomized, double-blind placebo controlled, clinical trials comparing the effectiveness of Apixaban and Enoxaparin in the prophylaxis of Venous Thromboembolism (VTE) post-orthopedic surgery were found using PubMed, the Cochrane Database of Randomized Controlled Trials, and the Cochrane Databases of Systematic Reviews.

OUTCOMES MEASURED: Development of venous thromboembolism (VTE) post-orthopedic surgery including Total …

Passive Stretching And Its Effect On Spasticity And Range Of Motion In Children With Cerebral Palsy: A Systematic Review, Mallory Groppe, Katrin Baxter, Todd E. Davenport

School of Pharmacy Faculty Articles

Study Design: Only research studies published in peer-reviewed journals in the last two decades and published in the English language were included. Studies centered on surgical or pharmacological interventions were not included. To examine the strengths and weaknesses of these studies, the Physiotherapy Evidence Database (PEDro) scale and Sackett’s levels of evidence were used. Objectives: The aim of this paper is to analyze literature published in the past two decades, which explores the effects of stretching when used to reduce spasticity and increase range of motion in children with spastic cerebral palsy (CP), as well as to address the effects …

Stress Reactions Of Division-I Track Athletes, Laura Elizabeth Skarda

Dissertations and Theses

Problem: Track and field athletes, along with cross-country athletes have multiple and back to back seasons, creating overuse injuries. Stress fractures or stress reactions to the bone are the overuse injuries focused on in this study and literature review. There is a lack of information in the literature regarding stress reactions. Purpose: The goal of the study is to understand more information about stress reactions to bone and possibly increase the knowledge of health care professionals. Methods: Three case studies were examined through pre-existing medical chart notes and athletic trainer's notes regarding the stress reactions. A literature review was also …

Development Of An Ankle Function Model, Kelli R. Snyder

Dissertations and Theses @ UNI

Lateral ankle sprains (LAS) represent the most common orthopedic injury treated by athletic trainers, yet there is no consensus regarding the measurement of the effectiveness of care (e.g. outcomes). Further compounding this problem is the repetitive nature of LAS, often referred to as "functional" or "chronic" ankle instability (FAI, CAI, respectively). Although a common entity in practice and research, FAI is inconsistently defined and assessed. Essentially, athletic trainers are neglecting to address one of the most important issues identified in their profession (outcomes) for the most common injury for which they provide care (LAS). Therefore, the purpose of this research …

Variations In Practice Patterns Among Neurosurgeons And Orthopaedic Surgeons In The Management Of Spinal Disorders, Manzar Hussain, Sadaf Nasir, Amber Moed, Ghulam Murtaza

Section of Neurosurgery

Study design: This is a case series.
Purpose: We wanted to identify variations in the practice patterns among neurosurgeons and orthopedic surgeons for the management of spinal disorders.
Overview of literature: Spinal disorders are common in the clinical practice of both neurosurgeons and orthopedic surgeons. It has been observed that despite the availability of various guidelines, there is lack of consensus among surgeons about the management of various disorders.
Methods: A questionnaire was distributed, either directly or via e-mail, to the both the neurosurgeons and orthopedic surgeons who worked at 5 tertiary care centers within a single region of Korea. …