Orthopedics Commons^™

Navigating The Fallout: How Pediatric Spine Surgeons Cope, Recover, And Persevere After Major Surgical Complications, Sandeep Yanamala, Richard M. Schwend, Hannah Geoffroy, Gary Sutkin

Research Days

Hypothesis: We hypothesized that surgeons who continue practicing after a major complication are more likely to have strong institutional and peer support, a growth mindset, and access to coping mechanisms that mitigate distress and legal pressures. Study Design:
Qualitative study using Constructivist Grounded Theory (CGT) based on semi-structured interviews with pediatric spine surgeons who have experienced major surgical complications.
Introduction:
Complications in pediatric spine surgery have significant emotional, ethical, and legal
consequences. However, little is known about the factors that differentiate surgeons who continue performing spine surgery from those who transition away.
Methods:
33 pediatric spine surgeons were interviewed (28 …

Sirt6 Deficiency Promotes Senescence And Age-Associated Intervertebral Disc Degeneration In Mice, Pranay Ramteke, Bahiyah Watson, Mallory Toci, Victoria Tran, Shira N Johnston, Maria Tsingas, Ruteja Barve, Ramkrishna Mitra, Richard Loeser, John Collins, Makarand Risbud

Department of Orthopaedic Surgery Faculty Papers

Intervertebral disc degeneration is a major risk factor contributing to chronic low back and neck pain. While the etiological factors for disc degeneration vary, age is still one of the most important risk factors. Recent studies have shown the promising role of SIRT6 in mammalian aging and skeletal tissue health, however its role in the intervertebral disc health remains unexplored. We investigated the contribution of SIRT6 to disc health by studying the age-dependent spinal phenotype of mice with conditional deletion of Sirt6 in the disc (Acan^CreERT2; Sirt6^fl/fl). Histological studies showed a degenerative phenotype in knockout mice …

Efficacy Of Platelet Rich Plasma On Thumb Basal Joint Osteoarthritis: A Narrative Review, Vrushank Shah, Alexander King

Rowan-Virtua Research Day

Platelet-rich plasma (PRP) has emerged as a potential treatment for carpometacarpal (CMC) joint osteoarthritis, with studies suggesting it may offer more durable symptom relief compared to corticosteroids. A comprehensive review of four studies, including two randomized controlled trials (RCTs), a retrospective study, and a pilot study, revealed that both PRP and corticosteroid injections led to short-term improvements in pain and function. However, PRP demonstrated significantly better long-term outcomes, with VAS scores decreasing from 75 to 20 in the PRP group at 12 months, compared to a modest reduction from 70 to 65 in the corticosteroid group. Additionally, PRP showed a …

The Relationship Between Running Cadence And Stress Fractures In Competitive Distance Runners, Jason A. Richwall

Rowan-Virtua Research Day

Running is one of the most popular sports and forms of exercise worldwide. Stress fractures are a common and potentially season-ending injury among competitive distance runners, with recurrence rates as high as 22%. Biomechanical factors, including running cadence, have been implicated in injury risk, but their precise role remains an area of active investigation. This literature review examines the relationship between cadence and stress fractures, drawing data from both observational and experimental studies. Observational studies suggest that low cadence and rearfoot striking are associated with increased risk of bone stress injuries. Experimental studies reinforce these findings, demonstrating that increased cadence …

The Effect Of Covid-19 On Total Joint Arthroplasty, Hailey Worstman, James E. Feng, Alex Miller, Drew Moore

Posters

• Arthritis is debilitating disease that is common throughout the U.S. For patients with refractory disease, total hip and knee arthroplasty, collectively known as total joint arthroplasty, are used for definitive management.1 •

Total joint arthroplasty, TJA, is one of the most common procedures in the U.S. and is typically inpatient in order to start physical therapy and promote joint mobility as soon as possible.

• Elective procedures, including total joint arthroplasties, were halted in March 2020 due to the pandemic.2,3

• When TJAs resumed they shifted towards outpatient procedures and at home physical therapy.4

• The impact of the …

Second-Site Periprosthetic Joint Infection After Subsequent Primary Hip Or Knee Arthroplasty, Daniel Nikolaidis, Devin Young, Andrew Steffensmeier, Robert Runner, Mark Karadsheh

Posters

Periprosthetic joint infections (PJI) can arise anytime in the lifetime of a patient. Therefore, patients who have multiple prosthetic joints are at risk for developing multiple PJIs. Polyarticular PJI can be classified as either synchronous or metachronous. Synchronous PJIs present simultaneously in two or more joints. Metachronous PJIs (MPJI) occur in two or more joints after a disease-free period. Incidence of MPJI varies in the literature from 8-20%.1

Known risk factors associated with MPJI include Rheumatoid Arthritis, sepsis or SIRS, infection with MRSA, ≥3 revision arthroplasties, longer length of stay in the hospital, and an index TKA PJI.2

Only a …

A Review Of Risk Factors For Postoperative Failure After Isolated Primary Medial Patellofemoral Ligament Reconstruction, Bilal Tarar, Ameen Suhrawardy, Clark Yin, Leonardo Cavinatto, Elizabeth Dennis, Jeffrey Fischgrund, Betina B. Hinckel

Posters

• Medial patellofemoral ligament reconstruction (MPFL-R) is a surgical treatment for patellar instability [1].

• Cases of post-operative recurrent dislocation and persistent instability may occur due to preexisting anatomic risk factors and technical errors in the procedure.

• Current rates of recurrent dislocation are reported to be up to 20% [2].

• Research Question: What anatomic and technical risk factors are associated with increased rates of recurrent dislocation after primary MPFL-R?

Metachronous Periprosthetic Joint Infection In Patients With Multiple Arthroplasties At Index Infection, Devin Young, Daniel Nikolaidis, Andrew Steffensmeier, Robert Runner, Mark Karadsheh

Posters

Periprosthetic joint infection (PJI) is a devastating complication of one of the most successful surgeries in medicine. About 1% to 2% of patients will develop PJI after primary total hip arthroplasty (THA) or primary total knee arthroplasty (TKA) [1]. The 5-year patient survival rate of THA PJI is estimated to be worse than that of common cancers, such as breast cancer [2]. The burden of this disease is likely to increase exponentially as the population ages and the number of patients undergoing total joint arthroplasties increases in the future [3].

Most devastating is what Murray et al deem as metachronous …

Gender And Racial Disparities In Pediatric Orthopaedic Surgery Fellows: A Decade-Long Analysis, Naomi Haque, Mazen Zamzam, Imran Bitar, Ehab Saleh

Posters

• The Association of American Medical Colleges (AAMC) has highlighted the increasing gender, racial, and ethnic diversity among medical student applicants, noting a significant rise in the number of underrepresented students.
• In the 2021-2022 academic year, there was an 18% increase in total applicants. The number of Black or African American applicants rose by 21%, with Black or African American students comprising 11.3% of matriculants in 2021, up from 9.5% the previous year. First-year students of Hispanic, Latino, or Spanish origin saw a 7.1% increase, making up 12.7% of matriculants. Additionally, women constituted 56.8% of applicants, 55.5% of matriculants, and 52.7% …

Recent And Future Trends In Osteopathic Orthopedic Surgery Residency Match Rates Following The Transition To A Single Accreditation System., Morgan Turnow, Minali Nemani, Nithin Gupta, Hayden Hartman, Taylor Manes, Tyler Williamson, Arianna Gianakos

Medical Education Articles

CONTEXT: Medical education in the United States has undergone significant changes, specifically within the osteopathic community. In 2020, a merger occurred between the American Osteopathic Association (AOA) and the Accreditation Council for Graduate Medical Education (ACGME), forming a single accreditation system (SAS) for graduate medical education and residency placement, with the purpose to create consistency within graduate medical education and to provide equal opportunities for applicants pursuing all specialties in medicine. However, osteopathic medical students, especially students applying to competitive residencies including orthopedic surgery, have faced challenges, raising concerns about future implications within this field.

OBJECTIVES: The main objective of …

The Use Of Intramedullary Screw For Fixation Of Distal Ulnar Fractures, Adam Lencer, John Pignataro, Justin Le, Joyce Daniel Suarez, Michael Rivlin

Rowan-Virtua Research Day

Background

Distal ulna fractures frequently accompany distal radius fractures but are often underappreciated in both clinical and research contexts. While conservative management is frequently employed, particularly following volar locking plate (VLP) fixation of the radius, certain indications, such as distal radioulnar joint (DRUJ) instability, comminution, or high-energy trauma, may necessitate surgical fixation. This study evaluates patient-reported outcomes among patients with distal radius fractures treated operatively, comparing those with and without concomitant distal ulna fractures, and further stratifying based on the method of ulna fixation.

Methods

This retrospective review included 477 patients treated operatively for distal radius fractures by a single …

Incidence, Risk Factors, And Clinical Outcomes Of Heterotropic Ossification Following Reverse Shoulder Arthroplasty, Adam Friedman, Clarence Clark Ii, Jaylyn Thompson

Rowan-Virtua Research Day

Introduction: Heterotropic ossification (HO) is the pathologic formation of bone in soft tissue, often following trauma or surgery. HO is a common radiographic finding after reverse shoulder arthroplasty (RSA), yet its incidence, risk factors, and clinical significance remains under-explored. Despite the relatively high incidence, the etiology, risk factors, and functional outcomes are not understood.

Methods: This is a literature review to understand the incidence, risk factors, and clinical outcomes of HO following RSA. Pubmed, Embase, and Web of Science were the databases used to review nine peer-reviewed sources. No restrictions were placed on publication date due to the sparsity of …

Does Sports-Specialization Increase The Risk Of Injury In Youth Athletes?, Kinjal Shah

Rowan-Virtua Research Day

Sports specialization, defined as intensive, year-round training in a single sport for more than eight months per year, has become increasingly prevalent among youth athletes. While it is often pursued with the goal of elite performance, early specialization may increase the risk of both physical injuries and psychological strain. This risk is especially pronounced in individual sports such as swimming and tennis, where early and focused training is frequently encouraged. This study explores the association between early sports specialization and injury risk in young athletes, with the goal of identifying contributing factors and informing prevention strategies. Evidence suggests that while …

A Twist Of Fate: A Case Of Spiral Humerus Fracture After Arm Wrestling, Alec Mirchandani, James Espinosa, Alan Lucerna

Rowan-Virtua Research Day

Fractures of the humerus are relatively uncommon, with spiral fractures typically resulting from rotational forces. This case report describes a 25-year-old male who sustained a right-sided spiral humerus fracture during an arm-wrestling match. The diagnosis was confirmed through radiographic imaging, and the fracture was successfully managed with closed reduction and posterior long arm splinting. This case highlights the importance of recognizing less common mechanisms of injury, like arm wrestling, in the context of humeral fractures. It also emphasizes the effective non-operative treatment of such fractures in young, healthy individuals.

Periprosthetic Femur Fractures After Total Hip Arthroplasty: Risk Factors And Management Strategies, Clarence Julian Clark Ii, Adam Friedman, Jaylyn Thompson

Rowan-Virtua Research Day

Background: Periprosthetic femur fractures (PFFs) are increasingly recognized as a significant complication following total hip arthroplasty (THA), particularly as the number of procedures rises. While THA is one of the most successful orthopedic surgeries, PFFs can compromise outcomes and demand complex management.

Objective: To review current literature and identify patient- and implant-related risk factors for PFFs, as well as to summarize effective management strategies guided by classification systems.

Methods: A structured literature review was conducted using PubMed, focusing on articles published in the past 10 years. Eight peer-reviewed studies were selected based on relevance to femoral fractures post-THA. Data on …

The Gut Microbiome And Knee Osteoarthritis: A Review Of Emerging Pathophysiologic Links, Krisha S. Patel, Maduka Gunasinghe, Umer Shah, Kushkumar K. Patel, Zarif Ladak

Rowan-Virtua Research Day

Background

Knee osteoarthritis (OA), a multifactorial degenerative joint disease with growing prevalence in aging and obese populations, leads to disabling pain. Traditionally viewed as mechanically driven, increasing research implicates systemic inflammation and metabolic and neuroimmune modulation. The gut microbiome—an ecosystem of commensal organisms regulating host immune, metabolic, and inflammatory regulation—has emerged as a potential contributor to OA pathogenesis and symptom severity. This review aims to synthesize literature evaluating associations between gut microbiota composition and knee OA, focusing on inflammatory pathways, pain modulation, and emerging therapies.

Methods

A literature search was conducted using PubMed, Embase, Scopus, and Web of Science. Inclusion …

Efficacy Of Platelet-Rich Plasma In The Management And Treatment Of Achilles Tendon Ruptures: A Literature Review, Justin Le, Savana Coraggio, Emir Shahin, Valentin Nicholas Kotlyar, Joshua Sassaman, Christopher Cherfane, Gilbert Siu

Rowan-Virtua Research Day

Background

In the world of regenerative medicine, platelet-rich plasma (PRP) has gained much attention as a potential enhancer of musculoskeletal healing. However, despite promising results in many applications, the use of PRP in Achilles tendon ruptures (ATR) remains a topic of debate. While some studies suggest potential benefits in terms of pain reduction and early-phase healing, others report no significant difference in clinical or functional outcomes compared to standard treatment. This inconsistency underscores the need for further investigation into PRP’s role in tendon repair, particularly in high-stress, load-bearing structures such as the Achilles tendon.

Objective

This review aims to evaluate …

Effectiveness Of Mind-Body Therapy Techniques In The Management Of Chronic Pain, Esha Sharma, Kalyna Leshchuk, Maria Cox, Kaitlyn Koo, Emily Sarett, Sarah Chen

Rowan-Virtua Research Day

In this review, we aim to determine whether mind-body therapies—defined here as mindfulness meditation, cognitive behavioral therapy (CBT), and mindfulness-based stress reduction (MBSR)—can effectively improve pain management in adults with chronic lower back pain, particularly when compared to standard opioid treatments alone or used in conjunction with them. Our hypothesis posits that mind-body therapies serve as valuable supplements to current opioid-based treatment plans, potentially improving not only pain outcomes but also overall quality of life and psychological well-being.

By synthesizing findings from randomized controlled trials (RCTs) and meta-analyses, this review builds on existing literature by narrowing the treatment scope and …

How Reliable Is The Assessment Of Fusion Status Following Acdf Using Dynamic Flexion-Extension Radiographs?, Christopher T. Martin, Sangwook Tim Yoon, Ram Kiran Alluri, Edward C. Benzel, Chris M. Bono, Samuel K. Cho, Dean Chou, Xiaolong Chen, Jason P. Y. Cheung, Juan P. Cabrera, Stipe Ćorluka, Andreas K. Demetriades, Matthew F. Gary, Zoher Ghogawala, Waeel Hamouda, Inbo Han, Dimitri Hauri, Patrick C. Hsieh, Amit Jain, Jun S. Kim, Hai V. Le, Philip K. Louie, Zhuojing Luo, Hans-Jörg Meisel, Sathish Muthu, Dal-Sung Ryu, Charles A. Sansur, Andrew J. Schoenfeld, Laura Scaramuzzo, Gregory D. Schroeder, Shanmuganathan Rajasekaran, Veranis Sotiris, Gianluca Vadalà, Pieter-Paul A. Vergroesen, Jeffrey C. Wang, Yabin Wu, K. Daniel Riew

Rothman Institute Papers

Study DesignReliability study.ObjectivesThe radiographic diagnosis of non-union is not standardized. Prior authors have suggested using a cutoff of < 1 mm interspinous process motion (ISPM) on flexion-extension radiographs, but the ability of practicing surgeons to make these measurements reliably is not clear.Methods29 practicing spine surgeons measured ISPM on 19 levels of ACDF from 9 patients. Surgeons relied on these measurements to report on fusion status. Inter-observer correlation co-efficients (ICC), standard error (SEM) and the minimum detectable difference (MD) of these measurements were calculated. We screened for clerical errors by checking measurements more than one standard deviation from the group mean.ResultsThe ICC for ISPM was .76 (.64; .88) with a SEM of 1 mm and a MD of 2.76 mm. Agreement on fusion status was moderate, with an ICC of .6 (.44; .76). After screening for and removing clerical errors, the ICC improved to .82 (.71; .91), SEM improved to .83 mm, and MD improved to 2.29 mm. Six reviewers had an ICC >.9. The ICC from these high performing reviewers was .94 (.9; .97), SEM was .45 mm, and MD was 1.26 mm.ConclusionsThe MD of 2.29 mm in our study group was not precise enough to support a cutoff of < 1 mm ISPM as the sole measurement technique in screening for non-union after ACDF, and there was only moderate agreement amongst surgeons on fusion status based on dynamic radiographs. More stringent techniques are necessary to avoid mis-diagnosing non-union in clinical studies. Future studies should consider auditing measurements to identify clerical errors.

Musculoskeletal Changes In Pregnancy: Implications For Long-Term Bone & Joint Health, Jaylyn Thompson, Clarence Julian Clark Ii, Nayarith Lopez, Aziza Ndaw

Rowan-Virtua Research Day

Pregnancy and lactation represent significant physiological challenges to maternal skeletal health, with substantial implications for both short and long-term musculoskeletal integrity. Research emphasizes that lactation induces notable skeletal adaptations, with up to 10% bone mineral density loss occurring in trabecular-rich regions such as the spine and hip (1,5). While most women experience substantial recovery post-weaning, the research indicates that recovery patterns vary significantly, with some women experiencing incomplete restoration of bone mass, potentially compromising long-term skeletal strength (3).

The underlying mechanisms driving these changes are primarily hormonal, with elevated parathyroid hormone-related protein (PTHrP) and decreased estrogen levels during lactation facilitating …