Orthopedics Commons^™

Role Of Lipid-Lowering Therapy In Peripheral Artery Disease, Agastya Deepak Belur, Aangi J. Shah, Salim S. Virani, Mounica Vorla, Dinesh K. Kalra

Office of the Provost

Atherosclerosis is a multifactorial, lipoprotein-driven condition that leads to plaque formation within the arterial tree, leading to subsequent arterial stenosis and thrombosis that accounts for a large burden of cardiovascular morbidity and mortality globally. Atherosclerosis of the lower extremities is called peripheral artery disease and is a major cause of loss in mobility, amputation, and critical limb ischemia. Peripheral artery disease is a common condition with a gamut of clinical manifestations that affects an estimated 10 million people in the United States of America and 200 million people worldwide. The role of apolipoprotein B-containing lipoproteins, such as LDL and remnant …

Recovery Time Following Operative Versus Nonoperative Humeral Shaft Fracture Treatment, Susan Wager, Trevor D. Wolterink, Jager Haan, Yash Hedge, Chrystina James, Stephanie J. Muh

Medical Student Research Symposium

INTRODUCTION: Humeral shaft fractures represent approximately 5% of fractures in the United States. Treatment modalities include nonoperative, and operative with open reduction internal fixation (ORIF) or intramedullary nail (IMN). There is no consensus on which option is best. The purpose of this study was to compare the length of time from fracture care to radiographic union between nonoperative, ORIF, and IMN treatments for humeral shaft fractures.

METHODS: This retrospective study analyzed trends in the management of midshaft humerus fracture between July of 2013 and December of 2020. Fracture characteristics and treatment outcomes were recorded from patients with humeral shaft fractures …

Time-To-Surgery And Short-Term Outcomes Of Trimalleolar Ankle Fracture During The Covid-19 Pandemic, Gabriel Burdick Bs, Rami Beydoun Bs, Alexander Pietroski Ms, Jonathan Warren Bs, Bushra Fathima Bs, Trevor Wolterink Bs, Michael Mcintosh Bs, Neethi Sriranga Bs, Stephanie Muh Md

Medical Student Research Symposium

PURPOSE: The purpose of this study was to evaluate the impact of the Coronavirus Disease 2019 (COVID-19) pandemic on time-to-surgery, complication rates, and functional outcomes of open reduction and internal fixation (ORIF) for trimalleolar ankle fracture.

METHODS: This retrospective cohort study compared patients who underwent ORIF for trimalleolar ankle fracture between April and July of 2020 of the COVID-19 pandemic (COVID group) to a pre-pandemic cohort treated in 2018 (2018 group). Demographic information, fracture characteristics, and surgical outcomes were collected from patients’ medical charts.

RESULTS: The COVID and 2018 groups consisted of 32 and 100 patients, respectively. The two groups …

Corticosteroid Injection Exhibits Symptomatic Improvement In Cts Patients With Negative Emgs, Brooke G. Garnica, Aaron R. Prater, Elizabeth A. Washnock-Schmid, Alaa Hazime, Dr. Charles S. Day

Medical Student Research Symposium

Introduction

While corticosteroid injections for carpal tunnel syndrome (CTS) are effective in patients with mild EMGs, no literature has examined the effectiveness of injections in patients with negative EMGs. We hypothesized that patients with negative EMGs will have minimal symptomatic and functional improvement.

Methods

The Boston Carpal Tunnel Questionnaire (BCTQ) was administered to patients clinically diagnosed with CTS and a negative or mild EMG prior to corticosteroid injection. The BCTQ comprises functional (FSS) and symptom status (SSS) questions. The patient was re-evaluated at 2-weeks, 1-, 3-, and 6-months post-injection. Data were analyzed via one-way ANOVA tests. A post-hoc Benjamini-Hochberg FDR …

The Cgas-Sting Pathway Affects Vertebral Bone But Does Not Promote Intervertebral Disc Cell Senescence Or Degeneration, Olivia K. Ottone, C. James Kim, John A. Collins, Makarand V. Risbud

Department of Orthopaedic Surgery Faculty Papers

The DNA-sensing cGAS-STING pathway promotes the senescence-associated secretory phenotype (SASP) and mediates type-I interferon inflammatory responses to foreign viral and bacterial DNA as well as self-DNA. Studies of the intervertebral disc in humans and mice demonstrate associations between aging, increased cell senescence, and disc degeneration. Herein we assessed the role of STING in SASP promotion in STING gain- (N153S) and loss-of-function mouse models. N153S mice evidenced elevated circulating levels of proinflammatory markers including IL-1β, IL-6, and TNF-α, showed elevated monocyte and macrophage abundance in the vertebral marrow, and exhibited a mild trabecular and cortical bone phenotype in caudal vertebrae. Interestingly, …

The Effects Of Vitamin D Supplementation On Athletic Performance And Injury Prevention, Amani Adeeb Abushamma

Journal of Sports Medicine and Allied Health Sciences: Official Journal of the Ohio Athletic Trainers Association

Vitamin D supplementation has numerous effects on athletic performance and plays a significant role in preventing an athlete’s risk of getting injuries. Vitamin D has an impact on numerous physiological functions such as: bone health, muscle function, inflammatory response, and immune function. An athlete’s bone and muscle health are essential for maximum performance and career success. A bone fracture due to vitamin D deficiency can delay an athlete’s training and ultimately inhibit obtaining a collegiate scholarship and/or contract. A cross sectional study found that more than half of athletic trainers did not view 25-hydroxyvitamin D(25[OH]) testing and vitamin D supplementation …

Beach Chair Versus Lateral Decubitus Surgical Positioning For Arthroscopic Anterior Shoulder Stabilization: A Retrospective Comparison Of Clinical And Patient-Reported Outcomes, Ryan W Paul, Sydney Streicher, Alim Osman, Chuka Ukekwe, Usman Zareef, Kevin B Freedman, Brandon J Erickson, Sommer Hammoud, Meghan E Bishop

Rothman Institute Papers

Background: Surgical positioning can affect both perioperative and postoperative complication rates. It is unclear whether beach-chair versus lateral decubitus positioning affects outcomes in patients undergoing arthroscopic anterior shoulder stabilization surgery.

Purpose: The purpose of this study was to compare recurrent instability, complications, and patient-reported outcomes between patients who underwent arthroscopic anterior shoulder stabilization in the beach-chair versus the lateral decubitus positions. It was hypothesized that recurrent instability, complications, and patient-reported outcomes would not be affected by surgical positioning.

Study Design: Cohort study; Level of evidence, 3.

Methods: The authors reviewed the medical records of patients who underwent shoulder stabilization ( …

Adopting Clinical Practice Guidelines For Pharmacologic Management Of Acute Spinal Cord Injury From A Developed World Context To A Developing Global Region, Seyed Behnam Jazayeri, Seyed Farzad Maroufi, Zahra Ghodsi, Heshmatollah Ghawami, Ahmad Pourrashidi, Abbas Amirjamshidi, Mojtaba Mojtahedzadeh, Jalil Arabkheradmand, Farzin Farahbakhsh, Maryam Shabany, Morteza Faghih-Jouibari, Michael G Fehlings, Brian K Kwon, James Harrop, Vafa Rahimi-Movaghar

Department of Neurosurgery Faculty Papers

Background: Proper utilization of high-quality clinical practice guidelines (CPGs) eliminates the dependence of patients' outcomes on the ability and knowledge of "individual" health care providers and reduces unwarranted variation in care. The aim of this study was to adapt/adopt two CPGs for pharmacologic management of acute spinal cord injury (SCI) using guideline adaptation methods.

Methods: This study was conducted based on the ADAPTE process. Following establishment of an organizing committee and choosing the health topics, we appraised the quality of the CPGs using the Appraisal of Clinical Guidelines for Research & Evaluation II (AGREE II). Then, the authors extracted and …

Variations In Surgeon-Applied Loads During Passive Range Of Motion Following Total Knee Replacement With Relevance To Computational Modeling, Cj Bakle Ii

All Theses

Total knee replacement (TKR) is generally considered a successful treatment for musculoskeletal disorders of the knee. However, as many as 20% of patients report some dissatisfaction in their physical function after TKR. And approximately 50% of early revisions needed to address conditions related to component alignment and soft tissue tension to stabilize the knee. During TKR, surgeons manually perform passive range of motion (ROM) assessments to gain feedback perceived as tension in ligaments and other soft tissues. Such assessments are highly subjective and rely on the surgeon's perception of soft tissue tension rather than quantitative objective means. The variability in …

Outcomes And Return-To-Sport Rates For Elite Athletes With Femoral Retroversion Undergoing Hip Arthroscopy: A Propensity-Matched Analysis With Minimum 2-Year Follow-Up, Jade S Owens, Andrew E Jimenez, Michael S Lee, David R Maldonado, Ajay C Lall, Benjamin G Domb

Faculty, Staff and Student Publications

BACKGROUND: Return to sports (RTS) and patient-reported outcomes (PROs) for elite athletes with femoral version abnormalities undergoing hip arthroscopy have not been well established.

PURPOSES: To (1) report minimum 2-year PROs and RTS rates in elite athletes with femoral retroversion who underwent primary hip arthroscopy and (2) compare clinical results to those of a propensity-matched control group of elite athletes with normal femoral version who underwent primary hip arthroscopy.

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

METHODS: Data were prospectively collected and retrospectively reviewed for elite (professional and collegiate) athletes with femoral version1, hip dysplasia, and previous ipsilateral hip …

Is Nonoperative Treatment Appropriate For All Patients With Type 1 Tibial Spine Fractures? A Multicenter Study Of The Tibial Spine Research Interest Group, Jilan L Shimberg, Tomasina M Leska, Aristides I Cruz, Henry B Ellis, Neeraj M Patel, Yi-Meng Yen, Tibial Spine Research Interest Group, Gregory A Schmale, R Justin Mistovich, Peter D Fabricant, Theodore J Ganley, Daniel W Green, Benjamin Johnson, Indranil Kushare, R Jay Lee, Scott D Mckay, Todd A Milbrandt, Jason Rhodes, Brant Sachleben, Jessica L Traver

Faculty, Staff and Student Publications

BACKGROUND: Type 1 tibial spine fractures are nondisplaced or ≤2 mm-displaced fractures of the tibial eminence and anterior cruciate ligament (ACL) insertion that are traditionally managed nonoperatively with immobilization.

HYPOTHESIS: Type 1 fractures do not carry a significant risk of associated injuries and therefore do not require advanced imaging or additional interventions aside from immobilization.

STUDY DESIGN: Case series; Level of evidence, 4.

METHODS: We reviewed 52 patients who were classified by their treating institution with type 1 tibial spine fractures. Patients aged ≤18 years with pretreatment plain radiographs and ≤ 1 year of follow-up were included. Pretreatment imaging was …

Resolution Of Deep Peroneal Nerve Palsy After Seroma Evacuation In A Primary Total Hip Arthroplasty: A Case Report., Brian W Skura, Craig Goubeaux, William C Burgette

Surgery Articles

INTRODUCTION: In this manuscript, we present a late presentation of deep peroneal nerve symptoms after total hip arthroplasty (THA) which subsequently completely resolved after seroma evacuation and sciatic nerve decompression. While hematoma formation causing deep peroneal nerve symptoms after THA has been reported in the literature, we are unaware of any reports of seroma formation causing similar symptoms.

CASE PRESENTATION: A 38-year-old female underwent an uncomplicated primary THA and developed paresthesia's over the lateral leg and foot drop on post-operative day 7. Ultrasound diagnosed a fluid collection compressing the sciatic nerve. The patient underwent seroma evacuation and sciatic nerve decompression. …

Fibroblast Growth Factor Receptor 1-Bound Extracellular Vesicle As Novel Therapy For Osteoarthritis, Bryan Gervais De Liyis, John Nolan, Made Agus Maharjana

BioMedicine

Osteoarthritis (OA) is a joint condition that causes significant impairment of the chondrocyte. The gradual degradation of the cartilage lining of one or more freely moving joints, as well as persistent inflammation, are the causes of osteoarthritis. Current medication focus on alleviating symptoms rather than curing the condition. The aim of this review is to evaluate the potential use of fibroblast growth factor receptor 1 extracellular vesicle as novel therapy for osteoarthritis. This review article was completed by searching for the keywords “Fibroblast Growth Factor Receptor 1”, “Extracellular Vesicle”, and “Osteoarthritis” in various journals in several search engines. Of the …

Spatial Transcriptomics Reveals Metabolic Changes Underly Age-Dependent Declines In Digit Regeneration, Robert J. Tower, Emily Busse, Josue Jaramillo, Michelle Lacey, Kevin Hoffseth, Anyonya R. Guntur, Jennifer Simkin, Mimi C. Sammarco

School of Medicine Faculty Publications

De novo limb regeneration after amputation is restricted in mammals to the distal digit tip. Central to this regenerative process is the blastema, a heterogeneous population of lineage-restricted, dedifferentiated cells that ultimately orchestrates regeneration of the amputated bone and surrounding soft tissue. To investigate skeletal regeneration, we made use of spatial transcriptomics to characterize the transcriptional profile specifically within the blastema. Using this technique, we generated a gene signature with high specificity for the blastema in both our spatial data, as well as other previously published single-cell RNA-sequencing transcriptomic studies. To elucidate potential mechanisms distinguishing regenerative from non-regenerative healing, we …

Is Blood Flow Restriction Training Superior For The Limitation Of Hamstring And Quadriceps Atrophy After Anterior Cruciate Ligament Reconstruction? A Review Of Randomized Controlled Trials, Joshua M. Spada, Ryan W. Paul, Bradford S. Tucker

Rowan-Virtua Research Day

Post operative recovery from Anterior Cruciate Ligament Reconstruction (ACLR) includes extensive rehabilitation of 6-9 months with return to sport/activity at 12 months

Rehabilitation is initiated shortly following surgery to limit quadriceps and hamstring atrophy, maximizing long term tibiofemoral joint stability and functional outcomes

The best way to achieve improved muscle strength and prevent atrophy is progressive overload training, however, these activities cannot be performed post operatively without risk to the reconstructed knee

Blood Flow Restriction Training (BFR) involves impairing the blood supply for short periods through the application of an air-filled bladder or cuff to restrict the venous drainage of …

Latarjet Surgery Leads To Decreased Rates Of Subjective Instability Compared To Bankart Repair With Concomitant Remplissage, Joshua Spada, Ryan W. Paul, Manoj Reddy, Gabriel Onor, John Hayden Sonnier, Ari Clements, Meghan E. Bishop, Brandon J. Erickson

Rowan-Virtua Research Day

Background: Predictive factors for performing remplissage concomitantly with arthroscopic Bankart repair include the presence of humeral or glenoid defects >11% and/or revision surgery. International and societal consensus statements support these findings, as surgeons recommend the Latarjet procedure for patients with significant glenoid bone loss (>15-20%) while remplissage is recommended for patients with off-track or engaging Hill-Sachs lesions without significant glenoid bone loss. While several studies have compared outcomes between Latarjet surgery and remplissage, these studies have only evaluated patients with engaging Hill-Sachs lesions, not consecutive patient cohorts indicated for each surgery.

Purpose: To compare rates of recurrent instability, re-operation, …

Rate Of Intraoperative Proximal Femoral Fractures With Automated Broaching, Tyler Radack, Hope Skibicki, Julian Zangrilli, Ruchir Nanavati, Cole Kleinman, Michael Harrer

Rowan-Virtua Research Day

Intraoperative proximal femur fractures (PFF) occur in 3.7% of total hip arthroplasties (THA) using the standard mallet broaching technique and increase a patient’s risk of revision surgery from 3.4% to 10%. The Depuy KINCISE automatic broaching system is designed to attenuate the risk of these fractures by applying consistent co-linear force to the broach. The aim of this study is to determine if the KINCISE system decreases the rate of intraoperative PFF fracture during THA compared to the standard mallet technique.

Does Prehabilitation Prior To Ulnar Collateral Ligament Surgery Affect Return To Sport Rate Or Time In Baseball Players With Partial Ucl Tears?, Joshua Spada, Kourtney Snigar, Ryan W. Paul, Usman Zareef, Anya Hall, Brandon J. Erickson, Michael G. Ciccotti, Stephen J. Thomas

Rowan-Virtua Research Day

Those who suffer a partial thickness ulnar collateral ligament (UCL) tear often undergo a period of nonoperative management including physical therapy rehabilitation. This treatment is aimed at optimizing range of motion (ROM) and strengthening the supporting structures around the elbow to help offload the UCL.

Unfortunately, some of these patients fail nonoperative management and require surgical intervention. This creates a unique set of patients who essentially underwent “prehabilitation” prior to their UCL surgery. Prehabilitation is considered a period of structured physical therapy rehabilitation aimed at strengthening structures surrounding an injured tendon or ligament, to allow for dissipation of stress away …

Atypical Presentation Of Ankylosing Spondylitis, Chandni Patel, Milvin Shroff, Maleeha Memon, Shideh Doroudi, Christine Leroy

Rowan-Virtua Research Day

Radiographic axial spondyloarthritis axSpA ) or typical ankylosing spondyloarthritis (AS) is a classification of axial spondyloarthritis with the classic radiographic features of sacroiliitis. Axial spondyloarthritis is a disabling spondyloarthropathy of the spine that presents with chronic back pain usually before the age of 45. It may be associated with extraspinal features including dactylitis , synovitis, and enthesitis in addition to other nonarticular signs. Chronic back pain is one of the most common presenting symptoms for AS , but frequently there is a 5-7 year delay between the onset of symptoms and diagnosis of the disease . A standard AP plain …

The Use Of Computerized Tomography Scans In Elective Knee And Hip Arthroplasty-What Do They Tell Us And At What Risk?, Taylor D'Amore, Gregg R Klein, Jess H. Lonner

Rothman Institute Papers

The average background radiation exposure in the United States has nearly doubled over the previous quarter century, with almost all the increase derived from medical imaging. Nearly 2% of all cancers in the United States may be attributable to radiation from computerized tomography (CT) scans. Given the nondiagnostic nature of CT scans that are used in elective knee and hip arthroplasty today, special consideration should be given to the inherent risk of radiation exposure with routine use of this technology. Methods to decrease radiation exposure including modulating the settings of the CT machine and using alternative non-CT-based systems can decrease …