Orthopedics Commons^™

Understanding Decision Making As It Influences Treatment In Thoracolumbar Burst Fractures Without Neurological Deficit: Conceptual Framework And Methodology, Charlotte Dandurand, Cumhur F. Öner, Olesja Hazenbiller, Richard J. Bransford, Klaus Schnake, Alexander R. Vaccaro, Lorin M. Benneker, Emiliano Vialle, Gregory D. Schroeder, Shanmuganathan Rajasekaran, Mohammad El-Skarkawi, Rishi M. Kanna, Mohamed Aly, Martin Holas, Jose A. Canseco, Sander Muijs, Eugen Cezar Popescu, Jin Wee Tee, Gaston Camino-Willhuber, Andrei Fernandes Joaquim, Ory Keynan, Harvinder Singh Chhabra, Sebastian Bigdon, Ulrich Spiegel, Marcel F. Dvorak

Rothman Institute Papers

STUDY DESIGN: This paper presents a description of a conceptual framework and methodology that is applicable to the manuscripts that comprise this focus issue.

OBJECTIVES: Our goal is to present a conceptual framework which is relied upon to better understand the processes through which surgeons make therapeutic decisions around how to treat thoracolumbar burst fractures (TL) fractures.

METHODS: We will describe the methodology used in the AO Spine TL A3/4 Study prospective observational study and how the radiographs collected for this study were utilized to study the relationships between various variables that factor into surgeon decision making.

RESULTS: With 22 …

Interobserver Reliability In The Classification Of Thoracolumbar Fractures Using The Ao Spine Tl Injury Classification System Among 22 Clinical Experts In Spine Trauma Care, Jose A. Canseco, Taylor Paziuk, Gregory D. Schroeder, Marcel F. Dvorak, Cumhur F. Öner, Lorin M. Benneker, Emiliano Vialle, Shanmuganathan Rajasekaran, Mohammad El-Sharkawi, Richard J. Bransford, Rishi M. Kanna, Martin Holas, Sander Muijs, Eugen Cezar Popescu, Charlotte Dandurand, Jin W. Tee, Gaston Camino-Willhuber, Mohamed M. Aly, Andrei Fernandes Joaquim, Ory Keynan, Harvinder Singh Chhabra, Sebastian Bigdon, Ulrich J. Spiegl, Klaus Schnake, Alexander R. Vaccaro

Rothman Institute Papers

STUDY DESIGN: Reliability study utilizing 183 injury CT scans by 22 spine trauma experts with assessment of radiographic features, classification of injuries and treatment recommendations.

OBJECTIVES: To assess the reliability of the AOSpine TL Injury Classification System (TLICS) including the categories within the classification and the M1 modifier.

METHODS: Kappa and Intraclass correlation coefficients were produced. Associations of various imaging characteristics (comminution, PLC status) and treatment recommendations were analyzed through regression analysis. Multivariable logistic regression modeling was used for making predictive algorithms.

RESULTS: Reliability of the AO Spine TLICS at differentiating A3 and A4 injuries (N = 71) (K = …

The Ao Spine Thoracolumbar Injury Classification System And Treatment Algorithm In Decision Making For Thoracolumbar Burst Fractures Without Neurologic Deficit, Barry T.S. Kweh, Jin Wee Tee, Charlotte Dandurand, Alexander R. Vaccaro, Benneker M. Lorin, Klaus Schnake, Emiliano Vialle, Shanmuganathan Rajasekaran, Mohammad El-Skarkawi, Richard J. Bransford, Rishi M. Kanna, Mohamed M. Aly, Martin Holas, Jose A. Canseco, Sander Muijs, Eugen C. Popescu, Gaston Camino-Willhuber, Andrei F. Joaquim, Harvinder S. Chhabra, Sebastian Frederick Bigdon, Ulrich Spiegel, Marcel Dvorak, Cumhur F. Öner, Gregory Schroeder

Rothman Institute Papers

STUDY DESIGN: Prospective Observational Study.

OBJECTIVE: To determine the alignment of the AO Spine Thoracolumbar Injury Classification system and treatment algorithm with contemporary surgical decision making.

METHODS: 183 cases of thoracolumbar burst fractures were reviewed by 22 AO Spine Knowledge Forum Trauma experts. These experienced clinicians classified the fracture morphology, integrity of the posterior ligamentous complex and degree of comminution. Management recommendations were collected.

RESULTS: There was a statistically significant stepwise increase in rates of operative management with escalating category of injury (P < .001). An excellent correlation existed between recommended expert management and the actual treatment of each injury category: A0/A1/A2 (OR 1.09, 95% CI 0.70-1.69, P = .71), A3/4 (OR 1.62, 95% CI 0.98-2.66, P = .58) and B1/B2/C (1.00, 95% …

Expert Opinion, Real-World Classification, And Decision-Making In Thoracolumbar Burst Fractures Without Neurologic Deficits?, Gaston Camino-Willhuber, Sebastian Bigdon, Charlotte Dandurand, Marcel F. Dvorak, Cumhur F. Öner, Klaus Schnake, Sander Muijs, Lorin M. Benneker, Emiliano Vialle, Jin W. Tee, Ory Keynan, Harvinder S. Chhabra, Andrei F. Joaquim, Eugen C. Popescu, Jose A Canseco, Martin Holas, Rishi M. Kanna, Mohamed M. Aly, Nader Fallah, Gregory D. Schroeder, Ulrich Spiegl, Mohammad El-Skarkawi, Richard J. Bransford, Shanmuganathan Rajasekaran, Alexander R. Vaccaro

Rothman Institute Papers

STUDY DESIGN: Retrospective analysis of prospectively collected data.

OBJECTIVES: To compare decision-making between an expert panel and real-world spine surgeons in thoracolumbar burst fractures (TLBFs) without neurological deficits and analyze which factors influence surgical decision-making.

METHODS: This study is a sub-analysis of a prospective observational study in TL fractures. Twenty two experts were asked to review 183 CT scans and recommend treatment for each fracture. The expert recommendation was based on radiographic review.

RESULTS: Overall agreement between the expert panel and real-world surgeons regarding surgery was 63.2%. In 36.8% of cases, the expert panel recommended surgery that was not performed …

Advancing Virtual At-Home Care For Community Health Center Patients Using Patient Self-Care Tools, Technology, And Education [Letter], Cheryl Modica, Joy H. Lewis, Curtis Bay

SOMA Faculty Publications

Abstract

Introduction

Health centers are community-based, patient directed primary care providers that offer accessible, high-quality primary care within medically underserved communities. Screening for cancer and managing complex chronic conditions such as diabetes, hypertension, obesity, and depression are vital services for the vulnerable populations seen by community health centers. Delivering care for complex chronic conditions and preventive services using virtual models that integrate self-care tools and technology is an important approach to increasing access for hard-to-reach patients served by health centers.

Objective

This study aimed to explore the use of a virtual care model, applied using a systems approach and patient-driven …

No Difference In Pullout Strength Between A Bio-Inductive Implant And A Semitendinosus Tendon Graft In A Biomechanical Study Of Medial Patellofemoral Ligament Repair Augmentation., Austin Wetzler, Sean Mcmillan, Erik Brewer, Aakash Patel, Samuel Handy, Merrick Wetzler

Orthopedic Surgery Resident Research

PURPOSE: To compare the pullout strength of a bio-inductive implant (BI) used to augment a medial patellofemoral ligament (MPFL) repair with the pullout strength of semitendinosus graft in a biomechanical cadaveric model.

METHODS: Six matched pairs of cadavers (12 knees) were used in the biomechanical testing comparing semitendinosus tendon (Semi-T) versus a BI. The Semi-T was harvested from 1 of the matched pairs. A standard double-bundle technique using 2 sockets in the upper two-thirds of the patella 15 mm apart was performed. After docking of the graft into the patella, the patella was dissected free of soft tissues and potted …

The Safety And Efficacy Of Posterior Lumbar Interbody Fusions In The Outpatient Setting., Hunter F Pharis, Daniel T Degenova, Braden J Passias, Taylor J Manes, Grace Parizek, Daryl Sybert

Surgery Articles

Introduction Outpatient surgical procedures have shown reduced costs, improved patient outcomes, and decreased postoperative complications. Interest in moving orthopedic and neurosurgical spine procedures to the outpatient setting has grown in recent years because of these factors. Studies investigating open posterior lumbar interbody fusions (PLIFs) in the outpatient setting are sparse. Methods The patients who underwent an open PLIF with pedicle screw and rod construct from 2014 to 2018 were retrospectively reviewed. Outpatient procedures were defined by patient discharge being on the same day of the procedure, without admittance to an inpatient ward. Pertinent demographic, clinical, radiographic, and surgical data were …

Biomechanical Comparison Of A Novel Circular Glenoid With Peripheral Ring Fixation To A Standard Anchor Pegged Glenoid In Total Shoulder Arthroplasty, Adam Khan, Andrew Jawa, J Michael Wiater, Derek J. Cuff, Anand M. Murthi, Matthew J. Smith, Luke Stanford Austin

Conference Presentation Abstracts

INTRODUCTION: Current standard total shoulder pegged glenoid component designs have a high rate of loosening, which accounts for the most common long term reason for surgical failure. Glenoid design, method of fixation, and implantation version all play a role in component stability. With current designs, 51% of standard glenoid components shift at 2 years. This study aimed to compare the biomechanical stability of a novel circular glenoid with peripheral ring fixation to a standard anchor pegged glenoid. Additionally, we compared the estimated bone removal for the glenoid design types. METHODS: Biomechanical testing [Figure 1] was performed to assess the glenoid …

Shoulder Arthroplasty Evolution: Comparing Reverse, Anatomic, And Hemiarthroplasty Trends And Outcomes In Key Demographics At A High-Volume Institution, James Fuchs Gannon, Mitchell Thomas Pfennig, Anthony Arveschoug, Betina Bremer Hinckel, J Michael Wiater, Leonardo M. Cavinatto

Conference Presentation Abstracts

The field of shoulder arthroplasty has changed markedly since the inception of the reverse total shoulder arthroplasty (RTSA) in 2004. With yearly gains of 32%, the RTSA now encompasses the largest portion of shoulder arthroplasty procedures. In contrast, the anatomic total shoulder arthroplasty (ATSA) and hemiarthroplasty (HA) have steadied or decreased in usage. Some have offered several explanations for these trends, such as expanding indications for the RTSA, in particular for pathologies traditionally treated with ATSA such as glenohumeral arthritis with an intact rotator cuff and no major bone loss/deformity. Others have cited superior postoperative outcomes of the RTSA over …

Patient Perception Of Different Autografts In Anterior Cruciate Ligament Reconstruction Using A Validated Online Survey Marketplace, Robert Dean, Tanner J. Hafen, Collin Braithwaite, Kevin Xavier Farley, Robert F. Laprade, Joseph Guettler, James Bicos

Conference Presentation Abstracts

INTRODUCTION: Anterior cruciate ligament (ACL) reconstruction is the gold standard treatment for ACL tears. ACL graft reconstruction is commonly performed with an autograft. Common autograft modalities include bone-patellar tendon-bone (BPTB), quadriceps tendon (QT), and hamstring tendon (HT) grafts. This study sought to evaluate the general population’s perception of the use of BPTB, QT, and HT autografts in ACL reconstruction. METHODS: A prospective cohort study was performed utilizing a 35-question survey. Participants were paid, and the survey was distributed via a clinically, validated, public, online marketplace in June 2023. After collecting baseline demographics, participants were queried on whether they held a …

Effect Of Vitamin E Enhanced Highly Cross-Linked Polyethylene On Wear Rate And Particle Debris In Anatomic Total Shoulder Arthroplasty: A Biomechanical Comparison To Ultrahigh-Molecular-Weight Polyethylene, Adam Khan, Andrew Jawa, Matthew J. Smith, J Michael Wiater, Derek J. Cuff, Anand M. Murthi, Luke Stanford Austin

Conference Presentation Abstracts

INTRODUCTION: Particle-induced osteolysis resulting from polyethylene wear remains a source of implant failure in anatomic total shoulder designs. Modern polyethylene components are irradiated in an oxygen-free environment to induce polyethylene cross-linking, but an unfortunate byproduct of this process is free radical production. Melting or heat annealing is one method of reducing free radicals but can compromise the component’s mechanical properties. The antioxidant, Vitamin E, has been introduced as an alternative adjuvant to neutralize free radicals. Specifically, in anatomic shoulder arthroplasty with a ceramic head component, the vitamin E-enhanced polyethylene showed improved wear compared to the conventional highly-cross linked polyethylene. This …

The Effect Of Marijuana On Postoperative Spine Patients' Emergency Room Visits, Readmission Rates, And Opioid Consumption, Vincent Buddle, James Feng, Maximillian Young-Kyu Lee, Ahyoung L. Park, Daniel K. Park

Conference Presentation Abstracts

INTRODUCTION: The social, political, and legal natural of marijuana has recently seen significant changes, particularly in favor of both medical and recreational use. Since being classified as a Schedule I substance in 1970 by the United States federal government, all but four states have legalized some form of its use. These changes have and will continue to lead to a significant number of orthopaedic patients using marijuana in the perioperative surgical setting. The objectives of this study are to 1) compare the 90-day rates of postoperative emergency department (ED) visits and 90-day readmission rates with patients whom tested positive for …

Patient Perception Of Allograft Versus Autograft In Anterior Cruciate Ligament Reconstruction Using A Valaidated Online Survey Marketplace, Tanner J. Hafen, Robert Dean, Collin Braithwaite, Joseph Guettler, Robert F. Laprade, James Bicos

Conference Presentation Abstracts

INTRODUCTION: Anterior cruciate ligament (ACL) reconstruction is the gold standard treatment for ACL tears. Reconstruction is accomplished through the use of an allograft or autograft. This study sought to evaluate the general population’s perception of the use of allografts and autografts in ACL reconstruction. METHODS: A prospective cohort study was performed utilizing a 35-question survey. Participants were paid, and the survey was distributed via a clinically validated, public, online marketplace in June 2023. After collecting baseline demographics, participants were queried on whether they held a preference for ACL reconstruction with an allograft or an autograft. All respondents then sequentially completed …

Significance Of Facet Fluid Index In Anterior Cervical Degenerative Spondylolisthesis, Yunsoo Lee, Jeremy Heard, Mark J Lambrechts, Nathaniel Kern, Bright Wiafe, Perry Goodman, John J. Mangan, Jose A. Canseco, Mark F. Kurd, Ian D. Kaye, Alan S. Hilibrand, Alex R. Vaccaro, Christopher K. Kepler, Gregory D. Schroeder, Jeffrey A. Rihn

Department of Orthopaedic Surgery Faculty Papers

STUDY DESIGN: Retrospective cohort study.

PURPOSE: To correlate cervical facet fluid characteristics to radiographic spondylolisthesis, determine if facet fluid is associated with instability in cervical degenerative spondylolisthesis, and examine whether vertebral levels with certain facet fluid characteristics and spondylolisthesis are more likely to be operated on.

OVERVIEW OF LITERATURE: The relationship between facet fluid and lumbar spondylolisthesis is well-documented; however, there is a paucity of literature investigating facet fluid in degenerative cervical spondylolisthesis.

METHODS: Patients diagnosed with cervical degenerative spondylolisthesis were identified from a hospital's medical records. Demographic and surgical characteristics were collected through a structured query language search and …

Predictive Algorithm For Surgery Recommendation In Thoracolumbar Burst Fractures Without Neurological Deficits, Charlotte Dandurand, Nader Fallah, Cumhur F. Öner, Richard J. Bransford, Klaus Schnake, Alex R. Vaccaro, Lorin M. Benneker, Emiliano Vialle, Gregory D. Schroeder, Shanmuganathan Rajasekaran, Mohammad El-Skarkawi, Rishi M. Kanna, Mohamed Aly, Martin Holas, Jose A. Canseco, Sander Muijs, Eugen Cezar Popescu, Jin Wee Tee, Gaston Camino-Willhuber, Andrei Fernandes Joaquim, Ory Keynan, Harvinder Singh Chhabra, Sebastian Bigdon, Ulrich Spiegel, Marcel F. Dvorak

Department of Orthopaedic Surgery Faculty Papers

STUDY DESIGN: Predictive algorithm via decision tree.

OBJECTIVES: Artificial intelligence (AI) remain an emerging field and have not previously been used to guide therapeutic decision making in thoracolumbar burst fractures. Building such models may reduce the variability in treatment recommendations. The goal of this study was to build a mathematical prediction rule based upon radiographic variables to guide treatment decisions.

METHODS: Twenty-two surgeons from the AO Knowledge Forum Trauma reviewed 183 cases from the Spine TL A3/A4 prospective study (classification, degree of certainty of posterior ligamentous complex (PLC) injury, use of M1 modifier, degree of comminution, treatment recommendation). Reviewers' regions …

Modified Himawari Technique For Comminuted Patella Fractures: A Case Report - An Economically Yet Rigidly Efficient Option, Leong Li Theng Dr, Eyrique Goh Boay Heong Dr

Manipal Journal of Nursing and Health Sciences

Comminuted patella fracture is a tricky and complicated case to manage and yet a common fracture. It’s often complicated with post operative pseudoarthrosis, malunion, poor rehabilitation and reduced knee range of motion. Tension band wiring, Cerclarge wiring and screw fixation are the common surgical modalities however it’s unable to hold peripherally scattered fragments in place rigidly. It is often associated with failure osteosynthesis, fracture displacement, resulting in post op osteoarthritis. Here we demonstrate a case of a modification of the original Himawari Technique as a much cost-effective method compared to the original, while being a superior treatment option with good …

Tetravalent Sars-Cov-2 S1 Subunit Protein Vaccination Elicits Robust Humoral And Cellular Immune Responses In Siv-Infected Rhesus Macaque Controllers, Rachel C Vanderkruik, Craig Ferguson, Lauren A Kobylski, Joseph J Locascio, Gabriella E Hamlett, Parker C Killenberg, Robert Lewis, Noah Jones, Ella T Rossa, Hannah Dineen, Rosalind Picard, Lee S Cohen

Faculty, Staff and Student Publications

BACKGROUND: Depression during pregnancy is increasingly recognized as a worldwide public health problem. If untreated, there can be detrimental outcomes for the mother and child. Anxiety is also often comorbid with depression. Although effective treatments exist, most women do not receive treatment. Technology is a mechanism to increase access to and engagement in mental health services.

OBJECTIVE: The Guardians is a mobile app, grounded in behavioral activation principles, which seeks to leverage mobile game mechanics and in-game rewards to encourage user engagement. This study seeks to assess app satisfaction and engagement and to explore changes in clinical symptoms of depression …

A New Perspective On Intervertebral Disc Calcification-From Bench To Bedside, Emanuel Novais, Rajkishen Narayanan, Jose Canseco, Koen Van De Wetering, Christopher Kepler, Alan Hilibrand, Alex Vaccaro, Makarand Risbud

Department of Orthopaedic Surgery Faculty Papers

Disc degeneration primarily contributes to chronic low back and neck pain. Consequently, there is an urgent need to understand the spectrum of disc degeneration phenotypes such as fibrosis, ectopic calcification, herniation, or mixed phenotypes. Amongst these phenotypes, disc calcification is the least studied. Ectopic calcification, by definition, is the pathological mineralization of soft tissues, widely studied in the context of conditions that afflict vasculature, skin, and cartilage. Clinically, disc calcification is associated with poor surgical outcomes and back pain refractory to conservative treatment. It is frequently seen as a consequence of disc aging and progressive degeneration but exhibits unique molecular …

Early Management Of Adult Traumatic Spinal Cord Injury In Patients With Polytrauma: A Consensus And Clinical Recommendations Jointly Developed By The World Society Of Emergency Surgery (Wses) & The European Association Of Neurosurgical Societies (Eans), Edoardo Picetti, Andreas Demetriades, Fausto Catena, Bizhan Aarabi, Fikri Abu-Zidan, Oscar Alves, Luca Ansaloni, Rocco Armonda, Rafael Badenes, Miklosh Bala, Zsolt J Balogh, Andrea Barbanera, Alessandro Bertuccio, Walter Biffl, Pierre Bouzat, Andras Buki, Ana Maria Castano-Leon, Davide Cerasti, Giuseppe Citerio, Federico Coccolini, Raul Coimbra, Carlo Coniglio, Francesco Costa, Federico De Iure, Bart Depreitere, Enrico Fainardi, Michael Fehlings, Nikolay Gabrovsky, Daniel Agustin Godoy, Peter Gruen, Deepak Gupta, Gregory Hawryluk, Raimund Helbok, Iftakher Hossain, Peter Hutchinson, Corrado Iaccarino, Kenji Inaba, Marcel Ivanov, Stanislav Kaprovoy, Andrew Kirkpatrick, Sam Klein, Angelos Kolias, Nikolay Konovalov, Alfonso Lagares, Laura Lippa, Angelica Loza-Gomez, Teemu Luoto, Andrew Maas, Andrzej Maciejczak, Ronald Maier, Niklas Marklund, Matthew Martin, Ilaria Melloni, Sergio Mendoza-Lattes, Geert Meyfroidt, Marina Munari, Lena Napolitano, David Okonkwo, Yasuhiro Otomo, Marios Papadopoulos, Ondra Petr, Wilco Peul, Aichholz K Pudkrong, Zaffer Qasim, Frank Rasulo, Carla Reizinho, Florian Ringel, Sandro Rizoli, Elham Rostami, Andres Rubiano, Emanuele Russo, Aarti Sarwal, Jan Schwab, Franco Servadei, Deepak Sharma, Salman Sharif, Ehab Shiban, Lori Shutter, Philip Stahel, Fabio Taccone, Nicole Terpolilli, Claudius Thomé, Peter Toth, Parmenion Tsitsopoulos, Andrew Udy, Alex Vaccaro, Albert Varon, Monica Vavilala, Alexander Younsi, Monika Zackova, Tommaso Zoerle, Chiara Robba

Rothman Institute Papers

BACKGROUND: The early management of polytrauma patients with traumatic spinal cord injury (tSCI) is a major challenge. Sparse data is available to provide optimal care in this scenario and worldwide variability in clinical practice has been documented in recent studies.

METHODS: A multidisciplinary consensus panel of physicians selected for their established clinical and scientific expertise in the acute management of tSCI polytrauma patients with different specializations was established. The World Society of Emergency Surgery (WSES) and the European Association of Neurosurgical Societies (EANS) endorsed the consensus, and a modified Delphi approach was adopted.

RESULTS: A total of 17 statements were …

The Challenges Of Implementing And Documenting Ottawa Ankle Rules In The Pediatric Emergency Department: A Retrospective Study, Emmalee M. Kugler, Michael Gillman, Olivia Toner

Cooper Rowan Medical Journal

INTRODUCTION
Acute ankle sprains account for nearly 2% of visits to the pediatric emergency department (PED). The Ottawa Ankle Rules (OAR) were developed as a safe and effective clinical decision-making tool for detecting the need for radiographs in adults with acute ankle pain. OAR state radiographs are required with at least one of the following:

1. Inability to bear weight immediately following the injury and for four steps in the ED 2. Bony tenderness at the posterior edge of the lateral or medial malleolus

OBJECTIVE
Few prospective cohort studies have attempted to assess OAR pediatric populations. This study investigates the …