Orthopedics Commons^™

Achondroplasia Natural History Study (Clarity): 60-Year Experience In Orthopedic Surgery From Four Skeletal Dysplasia Centers, Nickolas J Nahm, W G Stuart Mackenzie, William G Mackenzie, Ethan Gough, S Shahrukh Hashmi, Jacqueline T Hecht, Janet M Legare, Mary Ellen Little, Peggy Modaff, Richard M Pauli, David F Rodriguez-Buritica, Maria Elena Serna, Cory J Smid, Julie Hoover-Fong, Michael B Bober

Faculty, Staff and Student Publications

BACKGROUND: The purpose of this study was to describe the frequency and risk factors for orthopedic surgery in patients with achondroplasia. CLARITY (The Achondroplasia Natural History Study) includes clinical data from achondroplasia patients receiving treatment at four skeletal dysplasia centers in the United States from 1957 to 2018. Data were entered and stored in a Research Electronic Data Capture (REDCap) database.

RESULTS: Information from one thousand three hundred and seventy-four patients with achondroplasia were included in this study. Four hundred and eight (29.7%) patients had at least one orthopedic surgery during their lifetime and 299 (21.8%) patients underwent multiple procedures. …

Achondroplasia Natural History Study (Clarity): 60-Year Experience In Orthopedic Surgery From Four Skeletal Dysplasia Centers, Nickolas J Nahm, W G Stuart Mackenzie, William G Mackenzie, Ethan Gough, S Shahrukh Hashmi, Jacqueline T Hecht, Janet M Legare, Mary Ellen Little, Peggy Modaff, Richard M Pauli, David F Rodriguez-Buritica, Maria Elena Serna, Cory J Smid, Julie Hoover-Fong, Michael B Bober

Faculty, Staff and Student Publications

BACKGROUND: The purpose of this study was to describe the frequency and risk factors for orthopedic surgery in patients with achondroplasia. CLARITY (The Achondroplasia Natural History Study) includes clinical data from achondroplasia patients receiving treatment at four skeletal dysplasia centers in the United States from 1957 to 2018. Data were entered and stored in a Research Electronic Data Capture (REDCap) database.

RESULTS: Information from one thousand three hundred and seventy-four patients with achondroplasia were included in this study. Four hundred and eight (29.7%) patients had at least one orthopedic surgery during their lifetime and 299 (21.8%) patients underwent multiple procedures. …

Osteoporosis In The Setting Of Shoulder Arthroplasty: A Narrative Review, Mohammad Daher, Mohamad Fares, Peter Boufadel, Akshay Khanna, Ziad Zalaquett, Joseph A. Abboud

Rothman Institute Papers

Patients who undergo shoulder surgery are frequently affected by osteoporosis and osteopenia, and the prevalence of this association is expected to increase due to the growing number of elderly individuals undergoing these procedures. It may be advisable to conduct a preoperative DXA scan for orthopedic surgical candidates at high risk, to detect those who could benefit from early intervention and avoid any related adverse events. Some of these complications include periprosthetic fractures, infection, subsequent fragility fractures, and have an all-cause revision arthroplasty at 2 years post-op. Some studies analyzed the beneficence of antiresorptive medications pre-operatively but the latter did not …

The Dome Technique For Managing Massive Anterosuperior Medial Acetabular Bone Loss In Revision Total Hip Arthroplasty: Short-Term Outcomes, Tyler J. Humphrey, Colin M. Baker, P. M. Courtney, Wayne G. Paprosky, Hany S. Bedair, Neil P. Sheth, Christopher M. Melnic

Rothman Institute Papers

PURPOSE: The dome technique is a technique used in performance of revision total hip arthroplasty (THA) involving intraoperative joining of two porous metal acetabular augments to fill a massive anterosuperior medial acetabular bone defect. While excellent outcomes were achieved using this surgical technique in a series of three cases, short-term results have not been reported. We hypothesized that excellent short-term clinical and patient reported outcomes could be achieved with use of the dome technique.

MATERIALS AND METHODS: A multicenter case series was conducted for evaluation of patients who underwent revision THA using the dome technique for management of Paprosky 3B …

The Effects Of Synovial Fluid And Inflammatory Cells On Orthopaedic Implant Alloys, Lisa Phan

Theses and Dissertations (ETD)

Introduction. Total knee arthroplasty (TKA) is a common surgical procedure used to treat end-stage osteoarthritis. The implants used in TKA typically consist of a Cobalt Chromium Molybdenum (CoCrMo) femoral component and a Titanium Aluminum Vanadium (TiAlV) alloy baseplate. These metal alloys are chosen for their mechanical properties, corrosion resistance, high affinity for bone, and biocompatibility. However, they can be susceptible to mechanical and electrochemical wear, leading to the release of metal ions. Osteoarthritis and inflammation can alter the composition of Synovial Fluid (SF), potentially causing implant corrosion and the release of metal ions into the surrounding tissue. These metal ions …

Intracept Technique At Adjacent Levels To Fusions With Pedicle Screws, David Stolzenberg, Paul Kitei, David Tran, Ryan Pfeifer

Rothman Institute Papers

No abstract provided.

Sex- And Ethnic-Specific Patterns In The Incidence Of Hip Fracture Among Older Us Asian And Non-Hispanic White Adults, Joan C Lo, Malini Chandra, David R Lee, Jeanne A Darbinian, Nancy P Gordon, David W Zeltser, Christopher D Grimsrud, Catherine Lee

Faculty, Staff and Student Publications

BACKGROUND: Asian and Pacific Islander (Asian/PI) adults have lower hip fracture incidence than non-Hispanic White (NHW) adults, but data regarding Asian/PI subgroups are limited. We compared hip fracture incidence among older US Asian/PI and NHW populations, including ethnic subgroup differences.

METHODS: Using observational data from a California healthcare system, we identified Asian/PI and NHW adults aged ≥50 years (2000-2019) and followed subjects to 2021 for hip fracture determined by principal/primary hospital diagnosis or by secondary hospital diagnosis with hip/femur procedure codes. Age-adjusted hip fracture incidence was calculated with 95% confidence intervals (CIs). Log-Poisson regression was used to determine fracture incidence …

Effect Of Age And Sex On Psychological Readiness And Patient-Reported Outcomes 6 Months After Primary Acl Reconstruction, Matthew D Milewski, Jessica L Traver, Ryan P Coene, Kathryn Williams, Dai Sugimoto, Dennis E Kramer, Mininder S Kocher, Lyle J Micheli, Yi-Meng Yen, Melissa A Christino

Faculty, Staff and Student Publications

BACKGROUND: Successful return to sport after anterior cruciate ligament (ACL) reconstruction (ACLR) can be affected by a patient's physical and psychological state throughout the rehabilitation process.

PURPOSE: To prospectively compare differences in patients at 6 months after primary ACLR with the ACL-Return to Sport after Injury (ACL-RSI), International Knee Documentation Committee (IKDC) or pediatric (Pedi)-IKDC, Hospital for Special Surgery Pediatric Functional Activity Brief Scale (Pedi-FABS), and Patient-Reported Outcomes Measurement Information System-Psychological Stress Experiences (PROMIS-PSE) scores.

STUDY DESIGN: Prospective cohort study; Level of evidence, 2.

METHODS: Patients enrolled were 8 to 35 years old who underwent primary ACLR and had their …

Assessing The Contributions Of Modifiable Risk Factors To Serious Falls And Fragility Fractures Among Older Persons Living With Hiv, Julie A Womack, Terrence E Murphy, Linda Leo-Summers, Jonathan Bates, Samah Jarad, Thomas M Gill, Evelyn Hsieh, Maria C Rodriguez-Barradas, Phyllis C Tien, Michael T Yin, Cynthia A Brandt, Amy C Justice

Faculty, Staff and Students Publications

BACKGROUND: Although 50 years represents middle age among uninfected individuals, studies have shown that persons living with HIV (PWH) begin to demonstrate elevated risk for serious falls and fragility fractures in the sixth decade; the proportions of these outcomes attributable to modifiable factors are unknown.

METHODS: We analyzed 21,041 older PWH on antiretroviral therapy (ART) from the Veterans Aging Cohort Study from 01/01/2010 through 09/30/2015. Serious falls were identified by Ecodes and a machine-learning algorithm applied to radiology reports. Fragility fractures (hip, vertebral, and upper arm) were identified using ICD9 codes. Predictors for both models included a serious fall within …

A Comparison Of Radiographic Alignment Between Bilateral And Unilateral Interbody Cages In Patients Undergoing Transforaminal Lumbar Interbody Fusion, Mark J. Lambrechts, Jeremy Heard, Nicholas D. D'Antonio, John Bodnar, Gregory Schroeder, Evan Bloom, Jose Canseco, Barrett Woods, Ian David Kaye, Mark Kurd, Jeffrey Rihn, Alan Hilibrand, Gregory D. Schroeder, Alex R. Vaccaro, Christopher Kepler

Rothman Institute Papers

Study Design

Purpose:

Overview of Literature

Methods:

Incidence, Risk Factors, And Outcomes Of Incidental Durotomy During Lumbar Spine Decompression With Or Without Fusion, Gregory Toci, Mark James Lambrechts, Tariq Issa, Brian A. Karamian, Nicholas Siegel, Nicholas D'Antonio, Jose Canseco, Mark Kurd, Barrett Woods, Ian D. Kaye, Alan Hilibrand, Christopher K. Kepler, Alexander Vaccaro, Gregory Schroeder

Rothman Institute Papers

STUDY DESIGN: Retrospective cohort study.

PURPOSE: The primary objective of this study was to determine the incidence and risk factors for incidental durotomies during lumbar decompression surgeries. In addition, we aimed to determine the changes in patient-reported outcome measures (PROMs) based on incidental durotomy status.

OVERVIEW OF LITERATURE: There is limited literature investigating the affect of incidental durotomy on patient reported outcome measures. While the majority of research does not suggest differences in complications, readmission, or revision rates, many studies rely on public databases, and their sensitivity and specificity for identifying incidental durotomies is unknown.

METHODS: Patients undergoing lumbar decompression …

Maximizing Patient Benefit In Interfacility Transfer For The Management Of Pediatric Hand Trauma, Annie Glenney, Zainab Balogun, Meeti Mehta, Shirley Liu, Vivian Wang, Lucille Cheng, Darya Fadavi, Alexander Davit Iii

St. Chris Research Day

No abstract provided.

Treatment Of Angular Deformity And Limb Length Discrepancy With A Retrograde Femur Magnetic Intramedullary Nail: A Fixator-Assisted, Blocking Screw Technique, Erik J. Geiger, Adam D Geffner, S Robert Rozbruch, Austin T Fragomen

Rothman Institute Papers

Background: Fixator-assisted nailing techniques that incorporate magnetic internal lengthening nails (MILNs) permit acute deformity correction and then gradual limb lengthening without needing postoperative external fixators.

Purposes: We sought to investigate the safety and accuracy of a fixator-assisted, blocking screw technique using retrograde MILNs for the correction of LLD and limb malalignment.

Methods: Forty-one patients (13 patients with genu varum and 28 patients with genu valgum) with LLD treated with fixator-assisted, blocking screw retrograde MILN reconstruction were included. Preoperative LLD, mechanical axis deviation, and joint orientation angles were compared with values at the end of treatment, and bone healing indices were …

Full Issue: Volume 1, Issue 1 - May 2023

Bone Bulletin

Contents

i - Editors’ Note by Payton Boere and Ari Clements

ii - Foreword by Dr. Alan Hilibrand

7 - Injuries, Management, and Prevention in the Weekend Warrior by John Paulik

10 - A Practical Guide to Etiquette in the Orthopaedic OR for the Rotating Medical Student by Tyler Radack

13 - New Trends in Orthopaedic Surgery Residency Applications: The Role of Preference Signaling by J. Liam Gibbons

16 - First Job Considerations as an Orthopaedic Surgery Attending: Picking a Practice Setting by Purab Kothari

20 - A Day in the Life of an Orthopaedic Surgeon with Dr. Rachel Shakked …

Summary Of Early Sport Specialization In Baseball, Matthew Sabitsky

Bone Bulletin

Background/Scope of the Problem

Early sport specialization, defined as playing one sport for over eight months in a year without participation in any other sports, has gained significant popularity in recent years.^1,2 Increasing numbers of young baseball players are leaving their local leagues for travel programs where they may pay thousands to play for a team year-round.³ Youth baseball players are competing in more games than ever. During the busiest months, summer travel teams routinely schedule around 80 games over the course of just three months.⁴ Putting this in perspective, Division I college programs play about 60 …

Additional Strategies To Heal A Fracture: The Impact Of Lifestyle Modifications To Improve Bone Repair, Katie Duquette

Bone Bulletin

Suffering from a bone fracture can hinder a patient’s ability to work and greatly diminish their quality of life. Depending on fracture characteristics, treatment options consist of non-operative and operative management. Regardless of intervention needed, the process of bone healing is multi-factorial. Therefore, patients who are interested in maximizing their functional recovery can make changes within their control to optimize the healing process. Changes as simple as adding beets and probiotics could have a significant impact on returning function earlier and alleviating pain sooner.

If physicians elevate their current recovery strategy advice, it may be possible to improve a patient’s …

Exploring The Use Of Robotics In Orthopaedic Surgery, Daniel Givner

Bone Bulletin

Over the last few decades, the use of robotics has dramatically increased across all surgical specialties. While initially only utilized in a few gynecological and urological procedures, robotics are now used in a wide range of surgical procedures ranging from general surgery, cardiovascular surgery, to otolaryngology and orthopaedic surgery. One study noted in the field of general surgery, roughly 15% of all surgeries are utilizing some form of robotics.1 Surgical robotics assist in a variety of ways ranging from guiding procedures by creating 3D images of the anatomic landscape, to allowing physicians to operate through telemanipulating in a separate room. …

Biologic Augmentation In Osteochondral Lesions Of The Talus, Yashas Reddy

Bone Bulletin

Introduction

Osteochondral lesions of the talus (OLT) are injuries involving damage to the cartilage and bone associated with the talar dome. They occur in up to 50% of ankle sprains and 73% of ankle fractures, varying in stability and severity.¹ Standard weightbearing ankle radiographs may allow for visualization of the lesions if substantial bone fragmentation is involved but CT and MRI are more sensitive for subchondral bone damage and purely cartilaginous lesions, respectively (Figure 1). The majority of patients with OLT are active individuals in their 20s and 30s, and often present after sustaining an acute inversion injury.^{2 …}

A Day In The Life Of An Orthopaedic Surgeon With Dr. Rachel Shakked, Anne Cohen

Bone Bulletin

From a young age, Dr. Shakked knew she wanted to be a doctor and started medical school with an interest in pursuing medical oncology. As a third year, she did her surgery rotation with low expectations but ended up loving it and discovering the field of orthopaedics. After completing her fellowship in 2016, she is now a foot and ankle specialist at the Rothman Institute where she experiences a mix of both private and academic practice. This conversation was born from her desire to show students what life is like beyond medical school and residency, and the importance of living …

First Job Considerations As An Orthopaedic Surgery Attending: Picking A Practice Setting, Purab Kothari

Bone Bulletin

A career in medicine is a journey with many forks in the road as medical students choose specialties, then subspecialties, and finally a practice setting. Particularly with the latter, becoming familiar with the various practice options early on can lead to an easier decision when the time to join the workforce arrives. Additionally, the ability to work in a setting that aligns with one’s career goals may ultimately lead to increased job satisfaction and reduced burnout risk. The following article aims to define various practice settings, including academic, private, community, “privademics” and locum tenens, and explore key considerations orthopaedic surgery …

New Trends In Orthopaedic Surgery Residency Applications: The Role Of Preference Signaling, J. Liam Gibbons

Bone Bulletin

Introduction

Orthopaedic surgery is known to be one of the most competitive specialties for medical students to pursue. It is important for applicants to have a strong portfolio of achievements, including research, presentations, and volunteering to increase chances of matching. USMLE scores and AOA membership tend to be higher among residency applicants that match into orthopaedic surgery. Moreover, the match rate for orthopaedics is lower at 74% compared to the overall match rate of 93.8%.¹ To increase chances of matching into an orthopaedic program, it is recommended to start preparing early and stay informed about trends and strategies in …

A Practical Guide To Etiquette In The Orthopaedic Or For The Rotating Medical Student, Tyler Radack

Bone Bulletin

The Operating Room, the operating theatre, the lair of the Orthopaedic surgeon, it goes by many names. It is a place most try to avoid, but this daunting windowless room is a classroom and training ground for many. And for the medical student interested in an orthopaedic surgery career, making an impression in the operating room is vital to matching into their desired orthopaedic residency.¹

Unfortunately, making an impression in the operating room is difficult, or more precisely, making a good impression in the operating room is difficult. Furthermore, every operating room dynamic can be different, and the personalities …

Injuries, Management, And Prevention In The Weekend Warrior, John Paulik

Bone Bulletin

Introduction

Sports medicine is known for heroically returning competitors back to the big game just in the nick of time for the winning play. This storybook ending is a reality of sports medicine. However, the majority of athletes will not end up on ESPN in the newest 30 for 30. This begs the question - who is an athlete? To some, it may be defined as someone who participates in an organized sport, culminating in regular competition and requiring systematic training.¹ This definition, however, excludes those who regularly exercise with the goal of improving their health or appearance.^{2 …}

Foreword, Alan S. Hilibrand

Bone Bulletin

As the Director of Undergraduate Medical Education for the Department of Orthopedic Surgery at the Sidney Kimmel Medical College, I am thrilled to have this opportunity to introduce the inaugural issue of the Bone Bulletin. Through the activities of the DePalma Orthopaedic Society, medical students at SKMC have had an excellent venue to learn about orthopaedic surgery, and our surgeons here at Rothman Orthopaedics have enthusiastically mentored younger students interested in the field of orthopedic surgery. The DePalma leadership has worked hard on many initiatives in recent years: providing forums for orthopaedic faculty to speak about their work, assembling lists …

Editor's Note, Payton Boere, Ari Clements

Bone Bulletin

We are thrilled to introduce the inaugural issue of the Bone Bulletin, DePalma Orthopaedic Society’s student-run, non-peer reviewed journal for Sidney Kimmel Medical College (SKMC) students. The journal’s aim is to provide yet another way to be involved with orthopaedics in medical school and to promote student interest in orthopaedics by reporting on diverse aspects of the field through editorial and opinion pieces. Under the close 1-on-1 mentorship of a physician from the Rothman Orthopaedic Institute, students have a hands-on opportunity to write about and directly engage with orthopaedic research and developments.

Within the pages of this journal, you …

Observations On The Present And The Future Of Hip Surgery, Alberto Di Martino

Department of Orthopaedic Surgery Faculty Papers

No abstract provided.

Rare First Rib Pseudoarthrosis With Thoracic Outlet Syndrome In Pediatric Gymnast: A Case Report, Jessica M. Kraft, Ann L. Contrucci, Gary E. Freed

Research Day

Background: This case study evaluates the diagnosis and treatment of a 12 year old Caucasian male gymnast who had several diagnoses including an isolated first rib fracture, resultant pseudoarthrosis of the first rib, and the development of symptomatic thoracic outlet syndrome. We discuss the causes, prevalence, and suggestions for prompt diagnosis and treatment of these conditions in pediatric patients. Although all three conditions are rare in a child, this case highlights the importance of having a high clinical index of suspicion in recurrent pain in pre-pubertal athletes.

Case presentation: A 10 year old Caucasian male presented with a two to …

A Bone Of Contention: A Dynamic Ultrasound Assessment Of The Role Of The Radial Head In The Arthrokinematics Of The Proximal Radioulnar Joint, Kolson Lamb, Madison D. Hendricks, Courtney E. Grimes, Cameron A. Johnson, David Nguyen, Ruth Maher

Research Day

INTRODUCTION: The arthrokinematics of the proximal radioulnar joint (PRUJ) are believed to follow the convex-concave rule, meaning that when the convex radial head articulates with the concave radial notch on the ulna, rolling and gliding occur in opposite directions during forearm pronation and supination. Previous research using helical computerized tomography (CT) identified that the sequence of joint actions is in contrast with this rule, which would indicate a posterior glide of the radius on the ulna during pronation movement and the converse during supination.

OBJECTIVES: The aims of this study are to determine the arthrokinematics of the PRUJ while being …

Two Ais Cases, Two Surgeons, One Operating Room, One Day. The Results Of A Quality Improvement Initiative, Jonathan Warren, Robert C. Link, Sean Bonanni, John T. Anderson, Richard M. Schwend

Research Days

Background: To lessen surgical times for AIS patients undergoing posterior spinal instrumentation and fusion (PSIF), our department developed a quality improvement initiative where two AIS cases were completed in one day by a specialized team with two surgeons operating together in the same operating room (OR).

Objectives/Goal: We describe the results of this initiative and compare operative times and blood loss between cases to determine if operative time improves as experience with this structure increases.

Methods/Design: From 2017-2023, patients aged 10-18 years with AIS were prospectively scheduled to undergo primary PSIF on the dedicated “Two Spine Tuesday” at our institution. …

Preoperative Srs-22 Scores Predict Postoperative Achievement Of Distribution-Based Mcid In Ais Patients Treated With Posterior Spinal Instrumentation And Fusion, Jonathan Warren, Cyrus Etebari, Morgan Whitmire, Kenneth Furlough, Brant Ansley, John T. Anderson, Richard M. Schwend

Research Days

Background: There is a growing body of literature assessing the role of preoperative patientreported outcome measures in predicting postoperative achievement of the minimal clinically important difference (MCID). To the best of our knowledge, there are no studies assessing whether preoperative SRS-22 scores are predictive of postoperative achievement of MCID in patient with adolescent idiopathic scoliosis (AIS).

Objectives/Goal: Our purpose is to determine if preoperative SRS-22 scores in patients with AIS who undergo posterior spinal instrumentation and fusion can predict postoperative achievement of MCID.

Methods/Design: SRS-22 forms were provided to all patients scheduled to undergo posterior spinal instrumentation and fusion. MCID …