Surgery Commons^™

Neuromotor Compromise As A Presenting Symptom In Advanced Lower Extremity Soft Tissue Sarcoma: A Case Series, Adam Maestas, Parsa Charkhchi, Farbod Malek

HCA Healthcare Journal of Medicine

Background

Soft tissue sarcomas (STS) are rare malignant tumors of mesenchymal origin, representing less than 1% of adult cancers. Approximately half arise in the extremities, most often presenting as a painless, enlarging mass. Symptoms are often misattributed to benign neuropathic or musculoskeletal causes, leading to delayed diagnosis and treatment. Neurological deficits such as foot drop or distal weakness are exceptionally uncommon presenting signs and generally indicate advanced local invasion or compression of major peripheral nerves. Recognizing acute neuromotor compromise as a potential manifestation of soft tissue malignancy is crucial for timely oncologic evaluation and limb-sparing management.

Case Presentation

This series …

The Biological Response Of Human Np Cells To Soluble Collagen Vi, Jonathan Dalton, Srikanth N. Divi, Yasmine Eichbaum, Panya Luksanapruksa, Mitchell K. Ng, Rachel Huang, Alan S. Hilibrand, Alex R. Vaccaro, Dessislava Z. Markova, Christopher K. Kepler

Department of Orthopaedic Surgery Faculty Papers

Extracellular matrix (ECM) dysregulation plays a significant role in the development of intervertebral disc disease (IVDD). The ECM around the chondrocytes in the nucleus pulposus (NP) is unique in that it contains ColVI. While linked to chondrocyte proliferation in cartilage, ColVI's specific role in IVD degeneration is less clear. Our aim was to determine the expression of ColVI in NP cells from degenerative IVDs, along with the effects of soluble ColVI on NP cells. Thus, we compared the expression levels of ColVI in human degenerated IVD samples, along with the effect of soluble ColVI on primary human NP cells. A …

Myelomalacia Severity On Preoperative Magnetic Resonance Imaging Does Not Predict Patient-Reported Outcomes After Anterior Cervical Discectomy And Fusion, Mitchell K. Ng, Joshua Mathew, Robert J. Oris, Yulia Lee, Jonathan Dalton, Gregorio Baek, Ashley Thommana, William A. Green, Yasmine Eichbaum, Morgan Hitchner, Brandon Martinazzi, Ali Farooqi, Alec Giakas, Paul Gunter, Vinay Bijoor, Andrew Vanchikorn, John J. Mangan, David I. Kaye, Mark F. Kurd, Thomas Cha, Jose A Canseco, Alan S. Hilibrand, Alexander R. Vaccaro, Christopher K. Kepler, Gregory D. Schroeder

Department of Orthopaedic Surgery Faculty Papers

STUDY DESIGN/SETTING: Retrospective cohort study.

BACKGROUND: Signal changes within the spinal cord on magnetic resonance imaging (MRI) or myelomalacia, are frequently seen in patients with cervical myelopathy. While often assumed to predict the outcomes, their prognostic value remains uncertain. Therefore, this study aimed to: (1) describe the clinical characteristics of patients with myelomalacia undergoing Anterior cervical discectomy and fusion (ACDF); (2) evaluate whether MRI findings correlate with patient-reported outcomes (PROMs); and (3) determine whether morphology predict recovery.

METHODS: A retrospective review at a single tertiary care center was performed (2014-2021). Patients were included if they underwent a primary elective ACDF …

Transforaminal Endoscopic Lumbar Decompression: Defining Its Scope And Limitations, Kai-Uwe Lewandrowski, Álvaro Dowling, Jun Ho Lee, Benedikt W Burkhardt, Óscar L. Alves, Avelino Parajón, Jorge Felippe Ramirez, Nicola Montemurro, Alex R. Vaccaro, Morgan P. Lorio

Department of Orthopaedic Surgery Faculty Papers

BACKGROUND: Transforaminal endoscopic lumbar decompression (TELD) has emerged as a minimally invasive alternative for managing lumbar stenosis and disc herniations. While the literature consistently reports favorable outcomes, real-world adoption remains variable, with discrepancies often linked to surgeon experience and case complexity.

OBJECTIVE: To evaluate surgeon perspectives on the clinical applicability of TELD across different pathologies and compare these findings with published evidence.

METHODS: An international cross-sectional survey was conducted among spine surgeons. Responses were analyzed using Rasch modeling to assess consensus levels, with agreement categorized as strong, moderate, weak, or disagreement. Differential Item Functioning (DIF) and correlation analyses were applied …

Real-World Clinical Outcomes Of Robotic-Assisted Total Knee Arthroplasty: A Propensity-Matched Comparative Study, Hassan Yassine, Amir Ghafarian, Jawad Saad, Abdel Kareem Hilo, Muaaz Wajahath, Khaled Saleh

Medical Student Research Symposium

Background:

Robotic-assisted total knee arthroplasty (RA-TKA) is increasingly utilized to improve component alignment and soft-tissue balance, yet its impact on clinically meaningful outcomes in large real-world populations remains uncertain. Although prior studies demonstrate improved radiographic accuracy, whether robotic assistance reduces postoperative complications, opioid utilization, or midterm mechanical failure has not been established at scale.

Methods:

We conducted a retrospective, propensity-matched cohort study using the TriNetX US Collaborative Network to identify adults undergoing primary TKA from 2018–2023. Robotic-assisted procedures were defined by CPT 27447 with concurrent robotic navigation codes. Propensity score matching (1:1) was performed to balance demographics and comorbidities, yielding …

Investigating Racial Differences In The Receipt Of Antenatal Interventions Prior To Periviable Delivery, Niurka Monteserin, Whitney Bender

Department of Orthopaedic Surgery Faculty Papers

BACKGROUND: The Society for Maternal Fetal Medicine (SMFM) provides guidance on the use of antenatal corticosteroids, antibiotics, and cesarean delivery in the periviable period. Although racial differences exist in postnatal active management of periviable neonates have been described, less is known about racial differences in antenatal interventions preceding delivery.

OBJECTIVE: To evaluate differences in the receipt of antenatal interventions before periviable delivery by birthing parent race.

METHODS:  We conducted a population-based cohort study using the National Center for Health Statistics database including periviable deliveries (20w0d-25w6d) from 2016-2021. Individuals delivering a non-anomalous live singleton gestation in a hospital were included. Births …

Isass Brave New Continuing Medical Education World: The Stifling Of Innovation In Spine Surgery Through Overrestriction Of Collaboration, Morgan P. Lorio, Kai-Uwe Lewandrowski, Óscar L. Alves, Avelino Parajón, Matthew Scott-Young, Hansen A. Yuan, Alex R. Vaccaro

Department of Orthopaedic Surgery Faculty Papers

BACKGROUND: in 2020, the accreditation Council for Continuing Medical education (aCCMe) released the Standards for Integrity and Independence in Accredited Continuing Medical Education, effective january 1, 2022, to ensure that accredited activities are accurate, balanced, evidence-based, and clearly separated from marketing and sales. although these aims are broadly supported, implementation may have unintended consequences in procedure-intensive specialties such as spine surgery, where surgeon–industry collaboration often drives device innovation, clinical trials, and dissemination of new techniques.

OBJECTIVE: To examine how current interpretations of ACCME eligibility and financial-relationship standards may affect continuing medical education in spine surgery and to propose practical adaptations …

Impact Of Obesity On Complication Rates After Treatment Of Slipped Capital Femoral Epiphysis: A Retrospective Cohort Database Study, Holden Archer, Scott B Rosenfeld, Pablo Castañeda, Jessica A Mcgraw-Heinrich, Simon P Kelley

Faculty, Staff and Students Publications

Background: While obesity is a well-established risk factor for slipped capital femoral epiphysis (SCFE), limited data exist regarding its impact on postoperative complication rates. This study aimed to evaluate the association between obesity and complications following SCFE treatment.

Methods: We queried a large national database for pediatric patients who underwent treatment for SCFE between June 2005 and June 2025. We divided this cohort into patients with obesity and patients without obesity. We matched the cohorts with a propensity scoring algorithm on a one-to-one basis, resulting in 1,175 patients in each group. We tracked outcomes including infection, pulmonary embolism (PE), chondrolysis, …

Acute Compartment Syndrome Following Lower Leg Vascular Injury: A Big-Data Approach To Estimating Incidence And Risk Factors, Harry Moroz, Edward J. Harvey, Yasser C. Bouklouch

Journal of Shock and Hemodynamics

Acute Compartment Syndrome (ACS) is a limb- and life-threatening complication of lower leg fractures. Rapid recognition and fasciotomy can prevent irreversible ischemic injury, but ACS is often under-recognized. Vascular injury may increase the risk of ACS by impairing perfusion and exacerbating swelling. This study aimed to determine the incidence, risk factors, and outcomes of ACS in patients with lower leg fractures, with particular emphasis on the impact of vascular injury. This retrospective cohort study used data from the 2017 American College of Surgeons Trauma Quality Programs database to perform a multicenter analysis of patients with lower leg fractures. Patients were …

Dasatinib And Quercetin Senolytic Treatment Delays Early Onset Intervertebral Disc Degeneration In Sm/J Mice, Emanuel J. Novais, Olivia K. Ottone, Sanjana Jagannath, Esther Jesutofunmi Akande, Makarand V. Risbud

Department of Orthopaedic Surgery Faculty Papers

Genetic background is a major determinant of disc degeneration, a leading cause of chronic back pain and disability. Herein, we demonstrate that premature disc cell senescence contributes to early-onset degeneration in SM/J mice and test two systemic senotherapeutic strategies to mitigate it: Navitoclax (Nav.) and a cocktail of Dasatinib and Quercetin (DQ). While Nav. treatment did not improve severe degeneration in SM/J mice or senescence status, DQ-treated mice showed lower grades of degeneration and a decreased abundance of senescence markers, including p19ARF, p21, and the senescence-associated secretory phenotype (SASP). DQ improved disc cell viability and phenotype retention and retarded fibrosis …

Variability In The Orthopaedic Residency Trainee Trauma Surgical Experience, Todd Phillips, Benjamin Fiedler, Joshua T Morrow, Zbigniew Gugala, Melvyn Harrington, Douglas R Dirschl

Faculty, Staff and Students Publications

Background: The aim of this study was to analyze fracture fixation case logs from residents training at a level 1 trauma center to assess variability across residents' surgical experiences within a single residency program. The authors hypothesize that notable variability exists between residents' surgical experiences in fracture care.

Methods: A retrospective case series was conducted at a single, urban residency program with a level 1 trauma center. Completed case logs were collected from program graduates from 2022 to 2024. All surgical cases involving fracture fixation at the level 1 trauma center were included for analysis. The anatomic region of the …

Utility Of Diagnostic Arthroscopy Before Medial Patellofemoral Ligament Reconstruction In Pediatric And Adolescent Patients Without Articular Findings On Magnetic Resonance Imaging, Holden Archer, Kaleb Patterson, Jonathan D Schwartzman, Scott D Mckay, Indranil Kushare

Faculty, Staff and Students Publications

BACKGROUND: Medial patellofemoral ligament (MPFL) reconstruction is frequently used to manage recurrent patellar instability. Diagnostic arthroscopy is commonly performed before MPFL reconstruction to identify, confirm, and address intra-articular pathology. However, when preoperative magnetic resonance imaging (MRI) does not demonstrate intra-articular lesions, it is unclear how often diagnostic arthroscopy in pediatric patients alters surgical management.

PURPOSE: To determine the utility of diagnostic arthroscopy in young patients undergoing MPFL reconstruction who had no intra-articular chondral or osteochondral pathology, meniscal tears, or loose bodies identified on preoperative MRI, and to characterize intra-articular pathology detected on arthroscopy but not identified on MRI.

STUDY DESIGN: …

Incidence Of Carpal Tunnel Syndrome After The Diagnosis Of Ulnar Neuropathy, Harrison S. Fellheimer, Eric Didomenico, Mahaa Ayub, Magnolia Livingston, William L. Justice, Gabriel I. Onor, Eric Tecce, Pedro K. Beredjiklian

Department of Orthopaedic Surgery Faculty Papers

PURPOSE: The purpose of this study is to determine whether patients diagnosed with ulnar nerve lesions (UNLs) have an increased risk of developing carpal tunnel syndrome (CTS).

METHODS: A retrospective cohort study was conducted using the TriNetX database, which contains data of >100 million patients. We identified 360,021 patients with UNLs and matched them 1:1 with controls. The incidence of CTS was assessed at 1, 2, 3, 4, and 5 years following the diagnosis of UNL. Statistical analyses were used to evaluate the development of CTS in the UNL cohort compared with controls.

RESULTS:  Patients with UNL demonstrated a significantly …

Influenza Infection Has Higher Risk Of Postoperative Complications Than Covid-19 In Shoulder Arthroplasty Patients, Jad J Lawand, Umar Ghilzai, Caleb Witsken, Dion Birhiray, Abdullah Ghali, Youssef M Khalafallah, Rohan G Reddy, Sameer R Khawaja, Adil Shahzad Ahmed

Faculty, Staff and Students Publications

INTRODUCTION: The COVID-19 pandemic has captured the attention of healthcare systems worldwide, and testing remains a mainstay of preoperative testing before all surgical procedures, including shoulder arthroplasty. Other viral illnesses, specifically influenza, while still having severe complications, are either overshadowed by testing for COVID-19 or not tested at all.

METHODS: A multi-institutional cohort study using the TriNetX network examined patients undergoing total or hemi shoulder arthroplasty from January 2020 to March 2024. Matched cohorts were created: one with influenza and one with COVID-19 infection, 14 days before surgery.

RESULTS: A total of 3233 and 18,209 patients were included in the …

Increasing Utilization Trends Of Robotic Assistance In Orthopaedic Surgery, Anish K. Ponna, Alec Giakas, Anthony A. Khoudary, Spencer N. Uggla, Sina Ramtin, Yousef A. Soliman, Asif M. Ilyas

Department of Orthopaedic Surgery Faculty Papers

INTRODUCTION: Robotic-assisted surgeries in orthopaedics have increased, particularly in hip and knee arthroplasty and spine surgeries. This study evaluates national utilization trends of robotic-assisted orthopaedic surgeries and demographic and geographic distribution of patients undergoing these surgeries.

METHODS: A retrospective cohort study was conducted on patients who underwent total hip arthroplasty, total and partial knee arthroplasty, or spine arthrodesis from 2017 to 2023 using the TriNetX database. Relevant International Classification of Diseases, 10th Revision, and Current Procedural Terminology codes identified patients who underwent a primary surgery with a corresponding robot-assisted code on the same day. Temporal trends in procedural volume were …

Concomitant Subacromial Decompression Remains Commonly Performed During Rotator Cuff Repair: A Trinetx Study, Madison Baldauf, Zachary Krumm, Savannah Ward, Katherine Worcester, Kevin Bonner Md

Knowledge and Creativity Expo

Introduction:

Arthroscopic rotator cuff repair (RCR) is among the most frequently performed shoulder procedures in the US and is often accompanied by concomitant subacromial decompression (SAD). In recent years some studies have called into question the benefit of SAD in this setting. The topic is controversial as many surgeons still feel SAD is indicated. This study aims to characterize the changes in proportion of SAD performed concomitantly with RCR over recent years using TriNetX.

Methods:

The TriNetX database was queried for all patients undergoing arthroscopic rotator cuff repair from 2013 to 2025. Cohorts were established using the Current Procedural Terminology …

Symptomatic Manifestations Of Hip Dysplasia In Young Adults: How Do Patients Present Before Or After Surgery? Results From A Social Media Cohort, John M. Gaddis, Amanda J. Wheeler, Erika Shults, Charles South, Stephen T. Duncan, Joel Wells

School of Medicine Publications

This study aimed to analyse the symptomatic differences of hip dysplasia before or after separate surgical interventions, including pain location and characteristics, severity, patient-reported outcomes, and a body pain diagram. A REDCap-based survey was distributed through social media from October 2023 to May 2024 and targeted individuals with current or past hip pain. The survey gathered data on demographics, comprehensive hip-specific history, and various patient-reported outcome measures. Of 509 completed surveys, 287 respondents reported a diagnosis of hip dysplasia and were divided into cohorts based on treatment history: no surgery (n = 65), post-periacetabular osteotomy (PAO) (n = 162), post-THA …

Association Between Bmi Z-Score And Postoperative Complications In Pediatric Neuromuscular Scoliosis Surgery, Alexander K Mihas, Dion Birhiray, Chun Wai Hung, Lorenzo R Deveza, Dallas Vanorny, Frank Gerow, Darrell Hanson, Benny Dahl

Faculty, Staff and Students Publications

Study Design

Single-center retrospective review.

Objective

To investigate the association between BMI Z-scores and postoperative complications in pediatric patients with neuromuscular scoliosis undergoing spinal instrumentation.

Methods

Pediatric patients who underwent spinal instrumentation for neuromuscular scoliosis from July 2012 to June 2016 with a minimum 2-year follow-up were included. BMI and BMI Z-scores were calculated, and patients were stratified into CDC-defined BMI-for-age percentiles: underweight (< 5th percentile), normal (5th to < 85th percentile), overweight (85th to < 95th percentile), and obese (≥95th percentile). Logistic regression assessed associations of BMI, BMI Z-score, and BMI groups with postoperative complications.

Results

In total, 147 patients were included. Average follow-up was 3.2 ± 1.4 years. The most common diagnosis was cerebral palsy (39.5%). Complications occurred in 65 (44.2%) patients: 32 (21.8%) had a surgical site infection (SSI), …

Examining The Relationship Between Academic Excellence And Clinical Productivity In Orthopedic Surgery, Mohamad Y. Fares, Xiaoran Zhang, Harry H. Liu, Ana Paula Beck Da Silva Etges, Krishna Chopra, Brian Zhou, Ira Sivaram, Chrishaun Alexander, Peter Boufadel, Porter Jones, Derek A. Haas, Adam Z. Khan, Eric Wagner, Joseph A. Abboud

Rothman Institute Papers

Background/Objectives: The relationship between clinical volume and academic performance in orthopedic surgery remains understudied. The purpose of this study is to explore the characteristics of high-achieving academic orthopedic surgeons in an attempt to extrapolate patterns and trends that govern the relationship between clinical performance and academia in orthopedic surgery. Methods: The 2023 National Plan and Provider Enumeration System and Medicare claims data (2021–2022) databases were used to include all active orthopedic surgeons of different subspecialties. A publication score, based on publication volume, journal impact, and authorship position, was calculated for each included surgeon, and surgeons who scored in the top …

Elixhauser Comorbidity Index To Predict Perioperative Bleeding And Adverse Spine Surgery Outcomes, Mitchell K. Ng, Michael A. Mont, Mosadoluwa Afolabi, Prathiksha N V, Amitha Kumar, Stephen S. Johnston

Rothman Institute Papers

Introduction: As spine surgery volume continues to grow, ensuring patient safety and minimizing complications are increasingly critical. Disruptive bleeding—defined as hemorrhagic events requiring clinical intervention—is a significant perioperative challenge. This study aimed to: (1) quantify disruptive bleeding incidence; (2) evaluate associations between patient demographics, Elixhauser Comorbidity Index (ECI), and bleeding risk; and (3) assess the impact of disruptive bleeding on mortality, ventilator use, length of inpatient stay, 90-day readmissions, and inpatient costs. Methods: A nationwide healthcare database was used to identify patients who underwent spine surgery in 2019. Patients were subdivided by the Elixhauser Comorbidity Index (ECI) from 0 to …

P-15 Peptide Enhanced Bone Graft In Transforaminal Lumbar Interbody Fusion: A Randomized, Controlled, Investigational Device Exemption Study Demonstrating Improved Composite Clinical Success, James Harrop, John E. O'Toole, Michael P. Steinmetz, Rick C. Sasso, Christopher D. Chaput, K. Brandon Strenge, Greg Maislin, Jeffrey P. Mullin, Thomas B. Freeman, Anthony Guanciale, Howard Lantner, Michael E. Janssen, David G. Schwartz, John M. Small, Wellington K. Hsu, Paul M. Arnold

Department of Orthopaedic Surgery Faculty Papers

STUDY DESIGN: Prospective, multicenter, single-blind, randomized, controlled pivotal study.

OBJECTIVE: To evaluate whether P-15L (PearlMatrix P-15 Peptide Enhanced Bone Graft) is noninferior in effectiveness to local autograft when applied in single-level instrumented transforaminal lumbar interbody fusion (TLIF).

SUMMARY OF BACKGROUND DATA: P-15L, an FDA-designated Breakthrough Drug-Device, is a composite drug-device combination bone graft containing P-15, a 15-amino acid polypeptide, which enhances cell binding, proliferation, and differentiation, resulting in bone formation.

MATERIALS AND METHODS: Skeletally mature patients, aged 22 to 80 years, with degenerative disc disease (DDD) were randomized 1:1 to P-15L (investigational) or to the local autograft (control) during single-level …

Reliability Of Existing Measures And Classification Systems For Trochlear Dysplasia, Sean R. Waldron, Nihar S. Shah, Matthew W. Veerkamp, Brendan A. Williams, John A. Schlechter, Lauren H. Redler, Matthew D. Ellington, Shital N. Parikh

Department of Orthopaedic Surgery Faculty Papers

BACKGROUND: Patellofemoral instability (PFI) is common in adolescent patients and can lead to a reduction in quality of life and function, as well as long-term arthritis. Treatment of PFI involves assessing and, at times, surgically correcting underlying anatomic abnormalities. Trochlear dysplasia is the most common anatomic risk factor present in PFI.

PURPOSE: To determine the interrater reliability of existing measures and classification systems for the assessment of trochlear dysplasia.

STUDY DESIGN: Cohort study (diagnosis); Level of evidence, 3.

METHODS: As part of the PRISM (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) patellar instability Research Interest Group (RIG) project, a …

Management Of Displaced Supracondylar Fractures Of The Humerus Using Lateral Versus Crossed Kirschner Wires: A Prospective Randomized Controlled Clinical Trial, Ashlee Dobbe, Emily K. Schaeffer, Njalalle Baraza, Firoz Miyanji, Christine Alvarez, Anthony P. Cooper, Chris W. Reilly, Kishore Mulpuri

General Surgery, East Africa

Aims: We sought to evaluate whether loss of reduction in lateral Kirschner (K)-wiring is noninferior to crossed K-wiring in closed reduction and percutaneous pinning of Type III supracondylar humerus fractures.

Methods: A prospective, randomized, non-inferiority trial was conducted. Emergency department patients aged three to seven years with Type III supracondylar humerus fractures were invited to participate with informed consent. Block randomization allocated patients into one of two pin configuration groups (lateral or crossed). Surgical technique and postoperative management were standardized between groups. All patients were treated with above-elbow casts, but no strict standardized protocol was applied. The primary outcome was …

Preoperative Malnutrition Is Associated With Increased Postoperative Complications Following Lumbar Fusion: A Propensity-Matched Analysis, Ali Mehaidli, Muaaz Wajahath, Jad Lawand, Omar Abdalla, Lorenzo Deveza, Noah Hodson, Ryan J Berger, Kevin Taliaferro

Faculty, Staff and Students Publications

Background: Lumbar fusion (LF) is a common surgical intervention for degenerative spinal conditions but carries significant short- and long-term risks. Preoperative malnutrition, characterized by low serum albumin or leukocyte counts, impairs wound healing and increases susceptibility to infection, yet its influence on LF outcomes remains underexplored. This study evaluates the association between preoperative malnutrition and long-term postoperative outcomes following LF.

Methods: Adult patients undergoing LF between 2003 and 2023 were identified in the TriNetX US Collaborative Network. Malnutrition was defined as serum albumin < 3.5 g/dL or leukocyte count < 1,500/mm3 within 1 year preoperatively. A 1:1 propensity score match was performed for demographics, comorbidities, surgical approach, and body mass index (BMI), yielding two cohorts (n=20,693 each). Ninety-day and 5‑year postoperative outcomes were compared using hazard ratios (HRs) with 95% confidence intervals (CIs).

Results: Malnourished patients experienced significantly higher 90‑day rates of transfusion (8.4% vs. 4.5%; HR 1.87, 95% CI: …

High-Dose Oral Pyrophosphate Inhibits Connective Tissue Calcification In Abcc6 Null Mice But May Affect Bone Structure, Ibtesam Rajpar, Nicholas Yancy, Jacob Beiriger, Christina Shao, Syed Naqvi, Deana Mancuso, Fatemeh Niaziorimi, Ryan E Tomlinson, Koen Van De Wetering

Department of Orthopaedic Surgery Faculty Papers

Pseudoxanthoma elasticum (PXE) is a rare inherited disorder marked by abnormal calcium phosphate deposition in soft connective tissues, particularly the skin, arteries, and eyes. It is caused by inactivating mutations in the ABCC6 gene, which encodes a hepatic efflux transporter. Loss of ABCC6 function leads to reduced plasma levels of pyrophosphate (PPi), a key inhibitor of calcification, thereby promoting ectopic mineralization. Oral PPi therapy has emerged as a potential treatment, but its effectiveness is uncertain. Most ingested PPi is hydrolyzed in the gut to inorganic phosphate, which may worsen calcification. Moreover, its impact on mineralized tissues remains largely unexplored. Abcc6−/− …

Regional Anesthesia Utilizing Liposomal Bupivacaine, With Or Without Dexamethasone, Provides Excellent Pain Control And Minimizes Opioid Consumption Following Anterior Cruciate Ligament Reconstruction, William L. Johns, Armen Voskeridjian, Benjamin Miltenberg, Rahul Muchintala, Christopher C. Dodson, Steven B. Cohen, John Salvo, Matthew Sherman, Michael G. Ciccotti, Sommer Hammoud

Rothman Institute Papers

BACKGROUND: Perioperative nerve blocks are commonly used for regional analgesia with anterior cruciate ligament (ACL) reconstruction (ACLR). Liposomal bupivacaine (LB) is a long-acting anesthetic agent providing up to 72 hours of nerve blockade. It is theorized that the addition of dexamethasone to LB (LB+dex) may prolong the analgesic duration.

PURPOSE: To characterize pain control and opioid consumption with adductor canal block (ACB), interspace between the popliteal artery and capsule of the posterior knee (iPACK), and suprasartorial infiltration (SSI) regional anesthetic techniques utilizing LB after ACLR and to compare LB versus LB+dex.

STUDY DESIGN: Randomized controlled trial; Level of evidence, 1. …

Posterior Subperiosteal Abscess Of The Distal Femur In A Pediatric Patient: A Rare Surgical Presentation Of Acute Hematogenous Osteomyelitis, Michael Dearman, Corey Bindner

School of Medicine Student Publications and Presentations

Introduction: Pediatric osteomyelitis commonly arises from acute hematogenous spread and remains diagnostically challenging due to limited radiographic findings and difficulty obtaining MRI in young children. Subperiosteal abscess formation is an uncommon but serious complication, with posterior distal femoral involvement reported only once previously.

Case Report: A 19-month-old male presented with fever and refusal to bear weight. Initial radiographs were unremarkable. Worsening symptoms prompted admission with rising inflammatory markers and blood cultures positive for gram positive cocci. MRI demonstrated distal femoral metaphyseal osteomyelitis with a posterior subperiosteal abscess. Through an anterior arthrotomy and metaphyseal drilling, osteomyelitis and joint involvement were addressed. …

Evaluation Of Micronized, Electrospun Fiber Matrix Effect On Outcomes Of Major Lower Extremity Amputations., Michael Dearman, Brittany Wagner, Alireza Behbudi, Luis Fernandez, Alan Cook, Rebecca Swindall, Brandi Pero, Alisha Thedford

School of Medicine Student Publications and Presentations

Background: Major lower extremity amputations are associated with substantial postoperative morbidity and mortality (Belmont). Restrata is a synthetic electrospun fiber matrix that is engineered to closely resemble human extracellular matrix to facilitate wound healing while avoiding the drawbacks of traditional biologic wound matrices (MacEwan, Fernandez). There have been no studies which have directly compared micronized electrospun fiber matrix (MEFM) to biologic xenograft matrices in patients undergoing major lower extremity amputation. The purpose of this study is to compare postoperative wound recovery in patients undergoing major lower extremity amputation, treated with MEFM (Restrata Minimatrix, Acera, St.Louis, Missouri ) versus a type …

Evaluation Of Micronized, Electrospun Fiber Matrix Effect On Outcomes Of Major Lower Extremity Amputations, Michael Dearman, Brittany Wagner, Luis Fernandez, Alireza Behbudi, Alan Cook, Rebecca Swindall, Brandi Pero, Alisha Thedford

School of Medicine Student Publications and Presentations

No abstract provided.

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 …