Orthopedics Commons^™

Loss Of Function Mutation In Ank Causes Aberrant Mineralization And Acquisition Of Osteoblast-Like-Phenotype By The Cells Of The Intervertebral Disc, Takashi Ohnishi, Victoria Tran, Kimheak Sao, Pranay Ramteke, William Querido, Ruteja A. Barve, Koen Van De Wetering, Makarand V. Risbud

Department of Orthopaedic Surgery Faculty Papers

Pathological mineralization of intervertebral disc is debilitating and painful and linked to disc degeneration in a subset of human patients. An adenosine triphosphate efflux transporter, progressive ankylosis (ANK) is a regulator of extracellular inorganic pyrophosphate levels and plays an important role in tissue mineralization. However, the function of ANK in intervertebral disc has not been fully explored. Herein we analyzed the spinal phenotype of Ank mutant mice (ank/ank) with attenuated ANK function. Micro-computed tomography and histological analysis showed that loss of ANK function results in the aberrant annulus fibrosus mineralization and peripheral disc fusions with cranial to caudal progression in …

Utility Of Seated Lateral Radiographs In The Diagnosis And Classification Of Lumbar Degenerative Spondylolisthesis, Tariq Z. Issa, Yunsoo Lee, Emily Berthiaume, Mark J. Lambrechts, Caroline Zaworski, Qudratallah S. Qadiri, Henley Spracklen, Richard Padovano, Jackson Weber, John J. Mangan, Jose A, Canseco, Barrett I. Woods, I. David Kaye, Alan S. Hilibrand, Christopher K. Kepler, Alexander R. Vaccaro, Gregory D. Schroeder, Joseph K. Lee

Rothman Institute Faculty Papers

STUDY DESIGN: Retrospective cohort study.

PURPOSE: Our goal was to determine which radiographic images are most essential for degenerative spondylolisthesis (DS) classification and instability detection.

OVERVIEW OF LITERATURE: The heterogeneity in DS requires multiple imaging views to evaluate vertebral translation, disc space, slip angle, and instability. However, there are several restrictions on frequently used imaging perspectives such as flexion-extension and upright radiography.

METHODS: We assessed baseline neutral upright, standing flexion, seated lateral radiographs, and magnetic resonance imaging (MRI) for patients identified with spondylolisthesis from January 2021 to May 2022 by a single spine surgeon. DS was classified by Meyerding and …

Enough Is Enough: Salvage Procedures In Severe Periprosthetic Joint Infection, Yves Gramlich, Javad Parvizi

Rothman Institute Faculty Papers

Background

In severe cases of periprosthetic joint infection involving negative host-dependent factors, individual-based decisions between a curative therapy vs. salvage procedure are necessary. We aimed to review salvage procedures in severe periprosthetic joint infection cases, where a gold standard of a curative two-stage exchange can no longer be achieved. The options of knee arthrodesis, amputation, persistent fistula (stable drainage), or a debridement, antibiotics, and implant retention procedure in late-onset cases are discussed, including lifelong antibiotic suppression alone.

Methods

We focused on known salvage procedures for severe periprosthetic joint infection of the hip and knee, such as amputation, arthrodesis, antibiotic …

Republication Of "Uses Of Braces And Orthotics For Conservative Management Of Foot And Ankle Disorders"., Osama Elattar, Tyler Smith, Adam Ferguson, Daniel Farber, Keith Wapner

Orthopedic Surgery Resident Research

Nonsurgical management is almost always considered the first-line treatment for the vast majority of foot and ankle pathologies. Foot orthoses, shoe modifications, and therapeutic footwear are considered essential tools for successful conservative management of different foot and ankle disorders. Orthopedic foot and ankle surgeons should have a meticulous understanding of the lower extremity biomechanics as well as the pathoanatomy and the sequelae of diseases affecting the foot and/or ankle. This is essential to the understanding of the desired effects of the different inserts, orthotics, shoe modifications, or braces that may be prescribed for these conditions. In this article, we will …

Validation Of The Hierarchical Nature Of The Ao Spine Sacral Classification And The Development Of The Sacral Ao Spine Injury Score, Brian A. Karamian, Gregory D. Schroeder, Mark J. Lambrechts, Jose A. Canseco, Emiliano N. Vialle, Frank Kandziora, Lorin M. Benneker, Rajasekaran Shanmuganathan, F. Cumhur Öner, Klaus J. Schnake, Christopher K. Kepler, Alexander R. Vaccaro

Rothman Institute Faculty Papers

STUDY DESIGN: Global cross-sectional survey.

OBJECTIVE: The objective of this study was to validate the hierarchical nature of the AO Spine Sacral Classification System and develop an injury scoring system.

SUMMARY OF BACKGROUND DATA: Although substantial interobserver and intraobserver reliability of the AO Spine Sacral Classification System has been established, the hierarchical nature of the classification has yet to be validated.

METHODS: Respondents numerically graded each variable within the classification system for severity. Based on the results, a Sacral AO Spine Injury Score (AOSIS) was developed.

RESULTS: A total of 142 responses were received. The classification exhibited a hierarchical Injury …

Multiple Sterile Withdrawals From Iohexol Bottles Does Not Increase Contamination Risk, Caroline Purtill, Manraj Dhesi, Daniel Haber, Nicholas D'Antonio, Noreen J. Hickok, Jeremy I. Simon

Department of Orthopaedic Surgery Faculty Papers

BACKGROUND: There is a global shortage of iohexol contrast media, commonly used in epidural injections, as a result of lockdown and decreased production due to COVID-19. Iohexol bottles are designated for single use, which, depending on the vials available, often leads to wasting up to 95% of this limited resource. However, avoiding multiple withdrawals may be unnecessary if withdrawing multiple times using sterile technique does not increase the risk for contamination.

OBJECTIVES: The purpose of our study is to determine whether multiple withdrawals from iohexol injection bottles using a sterile technique poses a greater risk of introducing contaminants than a …

Impact Of Dual-Energy Computed Tomography (Dect) Postprocessing Protocols On Detection Of Monosodium Urate (Msu) Deposits In Foot Tendons Of Cadavers, Andrea Sabine Klauser, Sylvia Strobl, Christoph Schwabl, Christian Kremser, Werner Klotz, Violeta Vasilevska Nikodinovska, Hannes Stofferin, Yannick Scharll, Ethan Halpern

Department of Radiology Faculty Papers

Objective: To evaluate two different dual-energy computed tomography (DECT) post-processing protocols for the detection of MSU deposits in foot tendons of cadavers with verification by polarizing light microscopy as the gold standard. Material and Methods: A total of 40 embalmed cadavers (15 male; 25 female; median age, 82 years; mean, 80 years; range, 52–99; SD ± 10.9) underwent DECT to assess MSU deposits in foot tendons. Two postprocessing DECT protocols with different Hounsfield unit (HU) thresholds, 150/500 (=established) versus 120/500 (=modified). HU were applied to dual source acquisition with 80 kV for tube A and 140 kV for tube B. …

Postoperative Considerations Based On Graft Type After Anterior Cruciate Ligament Reconstruction A Narrative Review, Anne Leung, Bridget Desandis, Luke O'Brien, Sommer Hammoud, Ryan Zarzycki

Department of Orthopaedic Surgery Faculty Papers

Background and Objective: Graft selection for anterior cruciate ligament reconstruction (ACLR) affects rehabilitation throughout the course of postoperative care. Methods: A search of PubMed and EBSCO was performed and abstracts independently reviewed by two authors. This search was also supplemented with additional evidence relevant to each phase of ACLR rehabilitation.

Key Content and Findings: Direct implications of graft type on clinical decisions vary throughout treatment phases, transitioning from potential differences in acute postoperative pain management immediately after surgery to facilitating sufficient and appropriate lower extremity loading in subsequent weeks. Regardless of graft type, surgical limb weakness persists throughout the course …

Bibliometric Analysis Of Spinopelvic Alignment In Total Hip Arthroplasty, Samantha Harrer, Justin A. Magnuson, Gregory R. Toci, Andrew M. Star, Arjun Saxena

Rothman Institute Faculty Papers

INTRODUCTION: Postoperative dislocation of unclear etiology remains a concern after total hip arthroplasty (THA). Interest is growing in the importance of spinopelvic alignment on stability in THA. The purpose of this study was to analyze publication trends, areas of interest, and future research direction of spinopelvic alignment in THA.

METHODS: Articles on the topic of spinopelvic alignment in THA published between 1990 and 2022 were obtained through Web of Science Core Collection of Clarivate Analytics (WSCCA). Results were screened by title, abstract, and full text. The inclusion criterion was English-language peer-reviewed journal publications on the clinical topic of spinopelvic alignment …

Diagnosis Of Periprosthetic Joint Infection: The Utility Of Biomarkers In 2023, Mehmet Kursat Yilmaz, Ahmad Abbaszadeh, Saad Tarabichi, Ibrahim Azboy, Javad Parvizi

Rothman Institute Faculty Papers

Periprosthetic joint infection (PJI) is a rare yet devastating complication following total joint arthroplasty (TJA). Early and accurate diagnosis of PJI is paramount in order to maximize the chances of successful treatment. However, we are yet to identify a single “gold standard” test for the diagnosis of PJI. As a result, the diagnosis of PJI is often challenging. Currently, the 2018 ICM definition of PJI is the only validated diagnostic criteria available. This article will review the importance of serum and synovial biomarkers in the diagnosis of PJI. In addition, it will provide a brief overview of the emerging modalities …

Reasons For Transfer And Subsequent Outcomes Among Patients Undergoing Elective Spine Surgery At An Orthopedic Specialty Hospital, Tristan B. Fried, Yunsoo Lee, Jeremy C. Heard, Nicholas S. Siegel, Tariq Z. Issa, Mark J. Lambrechts, Caroline Zaworski, Jasmine Wang, Taylor D'Amore, Amit Syal, Charles Lawall, John J. Mangan, Jose A. Canseco, Barrett I. Woods, Alan S. Hilibrand, Alex R. Vaccaro, Christopher K. Kepler, Gregory D. Schroeder

Rothman Institute Faculty Papers

Objective:

To evaluate the reasons for transfer as well as the 90-day outcomes of patients who were transferred from a high-volume orthopedic specialty hospital (OSH) following elective spine surgery.

Materials and Methods:

All patients admitted to a single OSH for elective spine surgery from 2014 to 2021 were retrospectively identified. Ninety-day complications, readmissions, revisions, and mortality events were collected and a 3:1 propensity match was conducted.

Results:

Thirty-five (1.5%) of 2351 spine patients were transferred, most commonly for arrhythmia (n = 7; 20%). Thirty-three transferred patients were matched to 99 who were not transferred, and groups had similar rates …

Perioperative Nutritional Considerations In Orthopaedic Surgery: A Review Of The Literature, William Curtis, Timothy Choi, Aamir Ahmad, Christopher Shultz

Western Journal of Orthopaedics

Macronutrients and micronutrients play an essential role in the surgical process, beginning in preoperative preparation and extending well into postoperative recovery. It is important that orthopaedic surgeons and their patients understand the physiological impact of the surgical stress response and the ways in which adequate perioperative nutrition can help combat its negative effects. Throughout this article, the authors discuss the important roles of macronutrients, such as carbohydrates, protein, and fatty acids, and that of micronutrients, including zinc and vitamins C, D, A, and E, in the perioperative period. The authors aim to explain the physiological effects of surgery on nutrition …

Back Matter, Arianna Medina

Western Journal of Orthopaedics

No abstract provided.

Treatment Of An Unusual Infection Following Anterior Cruciate Ligament Reconstruction, Daniel Warren, David Michaeli, Benjamin Estrada, James Slauterbeck

Western Journal of Orthopaedics

The authors present an uncommon complication of pediatric anterior cruciate ligament (ACL) reconstruction involving a rare organism in the setting of multiple patient-specific factors that altered treatment. Management of postoperative mycobacterial infections requires thorough knowledge of the side effects of each medication used. Prolonged use of a fluoroquinolone in the setting of ACL reconstruction graft healing introduces the risk of injury to the graft, and tactful patient counseling must be employed to help diminish this risk. The potential for ototoxicity secondary to extended aminoglycoside use is especially worrisome and should be monitored. This plan required careful balancing of several important …

Let’S Focus On The Fibrosis: Targeting Ccn2 In Dupuytren’S Disease, Alex G. Lambi, Ryan Dahlberg, Tomas Holy, Joseph T. Tarr, Deana Mercer, Steven N. Popoff, Mary F. Barbe

Western Journal of Orthopaedics

Dupuytren’s disease is a progressive, benign fibroproliferative disorder of the hands that can lead to debilitating hand contractures. Once symptomatic, treatment involves either surgical intervention, specifically fasciectomy or percutaneous needle aponeurotomy, or enzymatic degradation with clostridial collagenase. Currently, collagenase is the only pharmacotherapy that has been approved for the treatment of Dupuytren’s contracture. There is a need for a pharmacotherapeutic that can be administered to limit disease progression and prevent recurrence after treatment. Targeting the underlying fibrotic pathophysiology is critical. The authors propose a novel target to be considered in Dupuytren’s disease – cell communication network factor 2/connective tissue growth …

Principles Of Arthroscopic - Assisted Open Reduction Internal Fixation In The Management Of Displaced Articular Fractures, Nathan Sherman, Matthew Miller, Michael D. Feldman

Western Journal of Orthopaedics

The primary objective of fracture fixation is to obtain anatomic reduction with stable fixation while minimizing damage to the surrounding structures. Displaced articular fractures represent a surgical challenge, but anatomic alignment with restoration of the articular surface is the gold standard of management. Using open techniques, intra-articular visualization can require large dissections and added soft-tissue insult. However, arthroscopic-assisted open reduction internal fixation (AAORIF) may represent a less invasive means of articular fracture management in appropriate patients with select fractures. The general principles of AAORIF are modified from basic arthroscopic principles, including positioning, portal placement, fluid management, visualization, soft-tissue management, and …

Pelvic Ring Injury Secondary To Traumatic Vaginal Delivery: A Case For Early Surgical Fixation, Tyler J. Chavez, Taylor P. Gurnea, Hernan Lebensohn, Johnathan P. Jensen, Samer Kakish

Western Journal of Orthopaedics

During the gestational period, the body undergoes a normal physiologic widening of the pubic symphysis in preparation for childbirth. Although exceedingly rare, despite increased laxity, the pelvic ring remains at risk of serious injury during delivery. The current body of literature on this topic includes only a few case reports without clear guidance on the acute management of non-physiologic pubic symphysis widening and pelvic ring injuries following childbirth. The authors present a case of a 31-year-old pregnant woman (G2P0101) who sustained an APC2 (OTA B2.3) pelvic ring injury during vaginal delivery requiring open reduction and internal fixation for failure to …

Front Matter, Arianna Medina

Western Journal of Orthopaedics

No abstract provided.

Complex Lisfranc Injury In A Professional Bull Rider, Elizabeth Eichman, Stephan Sierra, Matthew Ferguson

Western Journal of Orthopaedics

American bull riding is one of the most dangerous sports in the world, with a high prevalence of injury. Due to the high-velocity trauma that is common in this sport, injuries occur frequently and are often classified as severe despite the use of protective equipment. While Lisfranc fracture-dislocations are somewhat common in elite athletes, open Lisfranc fractures are much less common. Consequently, there are little data concerning recovery and return to sport. This case demonstrates an uncommon presentation of open Lisfranc fracture dislocation and first metatarsophalangeal dislocation in a professional bull rider who was able to return to sport at …

Terrible Triad In A Pediatric Patient: A Case Report, Colin J. Carroll, Gonzalo Sumarriva, Russell Parks, Caroline Vasco, Ross Dunbar

Western Journal of Orthopaedics

A terrible triad elbow injury consists of an elbow dislocation with associated radial head and coronoid fractures. This type of injury is rare in the pediatric population. In this case, a 14-year-old adolescent male suffered a right-sided terrible triad elbow injury after falling onto his right elbow. He was taken to the operating room for open reduction and internal fixation. The patient is now three years postoperatively with full range of motion of his elbow with no pain and no incidents of dislocation.