Orthopedics Commons^™

Is Your Cyst Really A Ganglion Cyst? A Case Report Of Angioleiomyoma Mimicking A Plantar Fascia Cystic Lesion, Christopher Anjorin Ms Dpmc, Joseph Bender Dpm

School of Podiatric Medicine - Student Research

Ganglion cysts are among the most common benign soft tissue masses encountered in podiatric clinical practice, and their diagnosis is often presumed based on location, clinical observation, and transillumination. However, this case highlights a diagnostic idiosyncrasy: a lesion clinically presumed to be a ganglion cyst within the plantar fascia was ultimately identified as an angioleiomyoma following surgical excision and histopathological evaluation. This finding underscores the importance of maintaining a broad differential diagnosis when assessing cystic lesions, particularly those that transilluminate, as benign vascular tumors may closely mimic more common entities in both clinical presentation and imaging. More importantly, what if …

Iatrogenic Popliteus Tendon Injury During Total Knee Arthroplasty, Saswat Samant, Bibhudutta Sahoo, Saurav Narayan Nanda, Suman Mishra, Satya Ranjan Patra, Himanshu Mishra

Graduate Medical Education Research Journal

Background. The popliteus tendon (PT) plays a role in knee unlocking and posterolateral stability, yet the clinical impact of its iatrogenic injury during total knee replacement (TKR) remains poorly defined. This study aimed to evaluate the outcomes of patients with documented intraoperative PT injury during posterior-stabilised TKR.

Methods. A retrospective review was conducted on 111 varus knees undergoing posterior-stabilised TKR. Among these, seven cases (6.3%) of intraoperative PT injury were identified. The cohort had a mean age of 71 years and an average preoperative varus deformity of 14°. PT repair was performed in two of the seven injured cases.

Results. …

Multimodal Analgesia For Postoperative Pain Management In Total Shoulder Arthroplasty, Caroline Heramb

Lynchburg Journal of Medical Science

Total shoulder arthroplasty (TSA) is an increasingly common orthopedic procedure, yet postoperative pain management continues to rely heavily on opioid analgesics. Although multimodal analgesia (MMA) has become the standard of care in total hip and knee arthroplasty, consensus regarding the optimal multimodal approach for TSA remains limited. A comprehensive literature search was conducted using PubMed, CINAHL, the Cochrane Library, and Google Scholar. Following screening with inclusion and exclusion criteria, 42 articles were selected for review and synthesized. Current evidence supports MMA pathways incorporating regional anesthesia, non-opioid pharmacologic agents, perioperative corticosteroids, cryotherapy, and patient education to reduce postoperative opioid requirements without …

Hands Up! A Case Of Bilateral Luxatio Erecta, Madison Heck Do, Henry Kramarski Do, Adam Sigal Md

Transformative Medicine

Background:  An inferior shoulder dislocation, luxatio erecta, is a rare phenomenon that is seen in approximately 0.5% of shoulder dislocations; the incidence of bilateral luxatio erecta is even more uncommon. They can often be mistaken for anterior shoulder dislocations.

Case Description: This case report discusses the rare occurrence, identification and management of bilateral luxatio in a 48-year-old man after he dove 6 feet from a bridge and into a body of water.

Discussion: The pathognomonic presentation is a patient arriving with an arm hyper-abducted above the head with flexed elbows and pronated forearms. There are several concomitant injuries that can …

Osteoblast-Derived Nerve Growth Factor Supports Skeletal Adaptation To Mechanical Load And The Osteoanabolic Effect Of Gambogic Amide In Mice, Ibtesam Rajpar, Eri Mclaughlin, Gabriella Fioravanti, Nicholas Ruggiero, Nohael Cherian, Liliana Minichiello, Ryan E. Tomlinson

Department of Orthopaedic Surgery Faculty Papers

In adult mice, new bone accrual following mechanical load is mediated by the neurotrophin nerve growth factor (NGF) that is expressed by osteoblasts on the bone surface. NGF can bind to its high affinity receptor, neurotrophic tyrosine kinase receptor type 1 (TrkA), on peripheral sensory nerves resident in bone and support new bone formation. However, the osteoanabolic therapeutic potential of NGF-TrkA signaling to repair bone is limited due to the long-lasting thermal and mechanical hyperalgesia induced by administration of NGF in mice and humans. Here, we investigated whether 1) mature osteoblasts are the primary source of NGF required for bone …

Evaluating The Readability Of Online Patient Education Materials For Avascular Necrosis, Gabriella B. Smith, Grady H. Hofmann, Anna V. Gussner, Nicole S. Pham, Nneoma O. Duru, Kevin G. Shea

Journal of Patient-Centered Research and Reviews

Purpose: Avascular necrosis (AVN) is a progressive pathology affecting pediatric and adult patients. Given the risks of joint collapse and surgery, patients frequently research their condition online. The average reading level in the United States is approximately the eighth-grade level. The National Institutes of Health (NIH) recommend that patient materials be written at or below a sixth-grade level. This study aimed to assess the readability and quality of online AVN resources.

Methods: A Google search using the terms “avascular necrosis” and “osteonecrosis” was conducted, and firstpage results were aggregated. Flesch-Kincaid Grade Level, Gunning Fog Index, and Flesch Reading Ease tests …

Tarsal Tunnel Syndrome Due To Post-Traumatic Osseous Tunnel Formation: A Rare Case And Surgical Management, Dev Y. Patel, Eshan Doshi, Fiona Zimmerman, Jamal Revolus, Michael Kimball, Michael Franco

Cooper Rowan Medical Journal

Tarsal tunnel syndrome (TTS) is classically a compressive neuropathy of the posterior tibial nerve beneath the flexor retinaculum, presenting with plantar foot pain and paresthesias. Standard surgical management of TTS involves release of the flexor retinaculum to decompress the nerve. We report a rare and unusual case of TTS in which the posterior tibial nerve was encased within a post-traumatic osseous tunnel accompanied by dense fibrotic tissue, representing an atypical and previously undescribed etiology of nerve entrapment. In this case, surgical decompression required a modified approach involving meticulous dissection of the tibial nerve from its encasement by heterotopic ossification and …

Diversity Among Academic Orthopaedic Surgery Sports Medicine Faculty Across Us Residency Programs, Terence L. Thomas, Alexander Zavitsanos, Claude Regis, John Czarnicki, Harrison S. Fellheimer, Gabriel I. Onor, William Justice, Jalen Broome, Damon V. Briggs, Edward S. Chang, Meghan Bishop, Christopher C. Dodson

Rothman Institute Papers

BACKGROUND: Despite growing attention to workforce diversity in orthopaedic surgery, limited data exist describing the demographic composition of academic sports medicine faculty. This study examines the diversity of sports medicine fellowship-trained orthopaedic surgery faculty across US orthopaedic surgery residency training programs.

METHODS: A cross-sectional analysis of all ACGME-accredited orthopaedic surgery sports medicine faculty was conducted. Faculty data included sex, race, level of professorship, residency attended, year of residency graduation, and h-index. Underrepresented in Orthopaedics (URiO) was defined as non-White and non-Asian by race and all women. Descriptive statistics were performed.

RESULTS: A total of 812 sports medicine-fellowship trained faculty were …

My Love Story With Hifs In The Disc: A Journey To The Humboldt Research Award, Makarand V. Risbud

Department of Orthopaedic Surgery Faculty Papers

The intervertebral disc is a prime example of tissue adaptation to metabolic and mechanical extremes. As the largest avascular organ in the human body, the disc and the central nucleus pulposus (NP) endure constant compressive loading while sustaining a hypoxic, relatively acidic, and hyperosmotic microenvironment that would be inhospitable to most cell types. Over the past two decades, work from my laboratory has revealed extraordinary details of this type of adaptation, that hypoxia-inducible factors (HIFs), particularly HIF-1α, serve as master regulators of NP cell survival, metabolism, and matrix homeostasis. This review chronicles the scientific and personal journey that began with …

Sports Injuries You May Overlook, Sarah Gubara, Greg Canty

Pediatrics in Practice: A CME Podcast

Could this recurring pain or sudden limp mean something more than a sprain? Greg Canty, MD, Medical Director, Sports Medicine Center at Children's Mercy, walks through how to recognize concerning pediatric sports injuries that are often missed. This episode covers X‑ray‑negative knee injuries (patella dislocation, ACL tear, meniscus), pelvic avulsion and transitional ankle growth plate fractures, and overuse conditions such as gymnast wrist, spondylolysis, Little League elbow, and shoulder impingement. Dr. Canty outlines practical red flags—swelling, inability to weight‑bear, point tenderness, pain persisting beyond two weeks in single‑sport athletes, and declines in participation—and explains how assessing training load, sleep, nutrition, …

Treatment And Return To Sport In Athletes With Scaphoid Fractures: A Narrative Review, Yolanda V. Gutierrez, Paul Bonilla, Emmanuel Franco, Ronald Shaju, Alyssa Sepulveda, Nicholas Bonazza, Robert Schenck, Aamir Ahmad

School of Medicine Publications

Scaphoid fractures are the most common fracture of the carpal bone and frequently occur in athletic populations due to acute trauma or repetitive wrist loading. Management of these injuries in athletes is challenging because of the need to balance reliable fracture healing with timely return to sport. This narrative review summarizes current literature regarding treatment strategies, healing outcomes, and return-to-sport timelines in athletes with scaphoid fractures. We conducted a literature search using PubMed, Scopus, and CINAHL between July 2025 and January 2026. A total of 862 records were identified, with 255 duplicates removed. Following title, abstract, and full-text screening, nine …

Postoperative Complications In Patients With Sickle Cell Disease After Total Shoulder Arthroplasty, Katie Zehner, Gwyneth C. Maloy, John Slevin, Wesley Day, Mitchell K. Ng, Xuan Luo, Jonathan N. Grauer, Arya G. Varthi

Rothman Institute Papers

BACKGROUND: Sickle cell disease (SCD) encompasses a spectrum of genetic hematologic disorders characterized by erythrocyte sickling. Patients may experience musculoskeletal manifestations, such as osteonecrosis, which may warrant consideration for total shoulder arthroplasty (TSA). While prior literature suggests patients with SCD more frequently suffer complications after orthopaedic procedures, this is not well characterized for TSA.

METHODS: Adult TSA patients (older than 18 years) were identified in the 2010 to 2023 PearlDiver M170 database. Patients with SCD were matched 1:4 to patients without SCD based on age, sex, and Elixhauser Comorbidity Index (ECI). Ninety-day postoperative complications, emergency department (ED) visits, and readmissions …

Timing Of Isotretinoin Exposure And Early Postoperative Complications After Anterior Cruciate Ligament Reconstruction, Areeb Ahmad, Ronald J. Shamus, Kassem Ghayyad, Daryl C. Osbahr, Adam J. Money, Michael G. Ciccotti, George J. Richard

Rothman Institute Papers

INTRODUCTION: Isotretinoin (ITN) is widely prescribed for severe acne in adolescents and young adults, a population where anterior cruciate ligament reconstruction (ACLR) is commonly performed. Long-standing concerns about impaired wound healing have prompted many surgeons to delay procedures, despite limited orthopaedic-specific evidence. This retrospective case series evaluates early postoperative clinical complications in patients with documented ITN exposure undergoing ACLR.

METHODS: We retrospectively reviewed primary ACLR cases from 2015 to 2025 at a multisite orthopaedic practice with documented ITN exposure within 12 months of surgery and at least 3 months of follow-up. ITN exposure was categorized as perioperative (≤10 days), recent …

The Rise And Fall Of Lateral Electrical Surface Stimulation (Less) Through The Lens Of Srs Archives., Ali Rezazadeh Shirazi, Jay I. Kumar, Katie Dold, George H. Thompson, Andrew G. King, Richard M. Schwend, John P. Lubicky, Jay Shapiro, Behrooz A. Akbarnia, History Committee Of The Scoliosis Research Society

Manuscripts, Articles, Book Chapters and Other Papers

PURPOSE: Lateral electrical surface stimulation (LESS), commercially known as the ScoliTron™, emerged in the late 1970s as a noninvasive alternative to bracing for adolescent idiopathic scoliosis. Early clinical reports generated considerable enthusiasm and adoption, but the technique was ultimately abandoned. This study examined the rise and fall of LESS through a combined analysis of the Scoliosis Research Society (SRS) archives and published literature, with the goal of understanding factors that influence the adoption, evaluation, and abandonment of innovation in scoliosis care.

METHODS: A structured historical review was conducted using archival materials from the Scoliosis Research Society (SRS), including meeting abstracts, …

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 …

Opioid Free Anesthesia In Arthroscopic Knee Surgery: A Feasible Approach To Patient Care, Carson Gifford, Denise Vidal, Dail Kim, Austin Goff, Paul Reynolds

HCA Healthcare Journal of Medicine

Background

The opioid epidemic has prompted exploration of opioid-free anesthesia (OFA) techniques, but the optimal approach is still debated. While some OFA protocols substitute opioids with other agents, these alternatives can introduce their own risks. The objective of this study was to investigate whether eliminating intraoperative opioids without analgesic substitution in arthroscopic knee procedures affects postoperative pain control and opioid requirements.

Methods

We conducted a retrospective analysis of 205 patients who underwent arthroscopic knee procedures between August and November 2023. Patients were divided into 2 groups: those who received intraoperative fentanyl (25-200 mcg, n = 144) and those who received …

Identifying Pyle's Metaphyseal Dysplasia – An Incidental Finding Of Skeletal Pathology On A Dental Checkup, Shruthi Parthasarathy, Amudhan Azhagan, Arthisri Anandhi Sekar, Poongodi V, Ram Shankar

Chulalongkorn Medical Journal

Introduction:

Pyle's disease, also known as familial metaphyseal dysplasia, is a rare autosomal recessive genetic disorder that primarily affects the skeletal system, particularly in children and adolescents. Characterized by distinctive radiographic features such as Erlenmeyer flask deformity and metaphyseal widening, Pyle's disease often goes underdiagnosed due to its mild clinical manifestations.

Case report:

This case report details a 15-year-old female patient presenting with retained milk teeth and unerupted permanent teeth, alongside notable skeletal abnormalities including genu valgum and kyphosis. Clinical and radiographic evaluations revealed significant dental anomalies, including multiple impacted permanent teeth and mild dysmorphic facial features. Although genetic testing …

Current Procedural Terminology Codes Combined With Hip And Femur Diagnosis-Related Groups Provide A More Accurate Assessment Of Costs., Robert A. Hymes, Daniel L. Rodkey, Max A. Schulman, Christopher Kuenze, Jeff E. Schulman, Jalen N. Broome, Sydney L. Payne, Greg E. Gaski

Jefferson Hospital Staff Papers and Presentations

Introduction: Diagnosis-Related Groups (DRGs) have become the basis of the Center of Medicare & Medicaid Services (CMS) hospital reimbursement system. Wide variability of patient factors and procedures bundled into a single DRG may contribute to significant cost variation and limited usefulness when analyzing economic performance. This investigation sought to analyze variation in hip and femur fracture inpatient costs as assessed by DRG and Current Procedural Terminology (CPT) codes.

Materials and methods: Patients age ≥ 18 treated with operatively managed fractures of the hip and femur at a Level 1 trauma center from 2019 to 2021 were retrospectively reviewed. Patients categorized …

An Investigation Of Pelvic Kinematics And Implications For Total Hip Arthroplasty, Kathryn Holland Colone

Electronic Theses and Dissertations

Total hip arthroplasty (THA) is one of the most commonly performed orthopaedic procedures, with approximately 500,000 surgeries performed annually in the United States alone. Although THA is widely regarded as highly successful, postoperative complications persist, highlighting the multifactorial nature of THA outcomes. Previous studies have demonstrated the importance of implant positioning and soft tissue mechanics, yet challenges remain in optimizing surgical decisions on a patient-specific basis. Recent advances in surgical planning tools have shifted the focus of preoperative planning toward optimizing patient-specific outcomes, highlighting the need to better understand how patient anatomy, surgical technique, and joint mechanics interact to influence …

Improved Foraminal Expansion And Pain Scores Following Placement Of Novel Expandable Interlaminar Stabilization Device For Lumbar Spinal Stenosis, Robert P. Norton, Ian Koch, Kendra Primavera, Roy Y. Miloh, Alex R. Vaccaro, Mitchell K. Ng

Department of Orthopaedic Surgery Faculty Papers

STUDY DESIGN: Retrospective cohort study.

OBJECTIVE: To evaluate radiographic durability and clinical outcomes following placement of a novel expandable interlaminar stabilization device for single-level lumbar spinal stenosis. Specifically, we aimed to: 1) quantify immediate postoperative posterior column distraction; 2) determine whether foraminal expansion is improved postoperatively without radiographic subsidence; and (3) assess potential improvements in patient-reported pain/clinical outcomes.

METHODS: A retrospective review was performed of adult patients undergoing single-level decompression supplemented by an interlaminar device for symptomatic lumbar spinal stenosis by a single surgeon from 2024 to 2025. Radiographic parameters included anterior, middle, and posterior disc height, foraminal height, and …