Orthopedics Commons^™

High-Dose Oral Pyrophosphate Inhibits Connective Tissue Calcification In Abcc6 Null Mice But May Affect Bone Structure, Ibtesam Rajpar, Nicholas Yancy, Jacob Beiriger, Christina Shao, Syed Naqvi, Deana Mancuso, Fatemeh Niaziorimi, Ryan E Tomlinson, Koen Van De Wetering

Department of Orthopaedic Surgery Faculty Papers

Pseudoxanthoma elasticum (PXE) is a rare inherited disorder marked by abnormal calcium phosphate deposition in soft connective tissues, particularly the skin, arteries, and eyes. It is caused by inactivating mutations in the ABCC6 gene, which encodes a hepatic efflux transporter. Loss of ABCC6 function leads to reduced plasma levels of pyrophosphate (PPi), a key inhibitor of calcification, thereby promoting ectopic mineralization. Oral PPi therapy has emerged as a potential treatment, but its effectiveness is uncertain. Most ingested PPi is hydrolyzed in the gut to inorganic phosphate, which may worsen calcification. Moreover, its impact on mineralized tissues remains largely unexplored. Abcc6−/− …

Repair Techniques For Acute Rupture Of The Patellar Tendon: A Systematic Review, Gaston Davis, Harrison S. Fellheimer, Christian Mccormick, Kevin B. Freedman

Rothman Institute Papers

BACKGROUND: Multiple techniques exist to repair acute tears of the patellar tendon. Surgical repair is required to reestablish full function of the extensor mechanism of the knee, and optimal results typically occur when the tear is repaired acutely.

PURPOSE: To systematically review the literature to evaluate treatment outcomes and complication rates after acute surgical repair of patellar tendon ruptures using suture anchor repair, transosseous repair, and end-to-end repair.

STUDY DESIGN: Scoping review; Level of evidence, 4.

METHODS: A systematic review was performed to analyze outcomes after patellar tendon repair in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews …

Regional Anesthesia Utilizing Liposomal Bupivacaine, With Or Without Dexamethasone, Provides Excellent Pain Control And Minimizes Opioid Consumption Following Anterior Cruciate Ligament Reconstruction, William L. Johns, Armen Voskeridjian, Benjamin Miltenberg, Rahul Muchintala, Christopher C. Dodson, Steven B. Cohen, John Salvo, Matthew Sherman, Michael G. Ciccotti, Sommer Hammoud

Rothman Institute Papers

BACKGROUND: Perioperative nerve blocks are commonly used for regional analgesia with anterior cruciate ligament (ACL) reconstruction (ACLR). Liposomal bupivacaine (LB) is a long-acting anesthetic agent providing up to 72 hours of nerve blockade. It is theorized that the addition of dexamethasone to LB (LB+dex) may prolong the analgesic duration.

PURPOSE: To characterize pain control and opioid consumption with adductor canal block (ACB), interspace between the popliteal artery and capsule of the posterior knee (iPACK), and suprasartorial infiltration (SSI) regional anesthetic techniques utilizing LB after ACLR and to compare LB versus LB+dex.

STUDY DESIGN: Randomized controlled trial; Level of evidence, 1. …

Posterior Subperiosteal Abscess Of The Distal Femur In A Pediatric Patient: A Rare Surgical Presentation Of Acute Hematogenous Osteomyelitis, Michael Dearman, Corey Bindner

School of Medicine Student Publications and Presentations

Introduction: Pediatric osteomyelitis commonly arises from acute hematogenous spread and remains diagnostically challenging due to limited radiographic findings and difficulty obtaining MRI in young children. Subperiosteal abscess formation is an uncommon but serious complication, with posterior distal femoral involvement reported only once previously.

Case Report: A 19-month-old male presented with fever and refusal to bear weight. Initial radiographs were unremarkable. Worsening symptoms prompted admission with rising inflammatory markers and blood cultures positive for gram positive cocci. MRI demonstrated distal femoral metaphyseal osteomyelitis with a posterior subperiosteal abscess. Through an anterior arthrotomy and metaphyseal drilling, osteomyelitis and joint involvement were addressed. …

Evaluation Of Micronized, Electrospun Fiber Matrix Effect On Outcomes Of Major Lower Extremity Amputations., Michael Dearman, Brittany Wagner, Alireza Behbudi, Luis Fernandez, Alan Cook, Rebecca Swindall, Brandi Pero, Alisha Thedford

School of Medicine Student Publications and Presentations

Background: Major lower extremity amputations are associated with substantial postoperative morbidity and mortality (Belmont). Restrata is a synthetic electrospun fiber matrix that is engineered to closely resemble human extracellular matrix to facilitate wound healing while avoiding the drawbacks of traditional biologic wound matrices (MacEwan, Fernandez). There have been no studies which have directly compared micronized electrospun fiber matrix (MEFM) to biologic xenograft matrices in patients undergoing major lower extremity amputation. The purpose of this study is to compare postoperative wound recovery in patients undergoing major lower extremity amputation, treated with MEFM (Restrata Minimatrix, Acera, St.Louis, Missouri ) versus a type …

Evaluation Of Micronized, Electrospun Fiber Matrix Effect On Outcomes Of Major Lower Extremity Amputations, Michael Dearman, Brittany Wagner, Luis Fernandez, Alireza Behbudi, Alan Cook, Rebecca Swindall, Brandi Pero, Alisha Thedford

School of Medicine Student Publications and Presentations

No abstract provided.

Sexually Dimorphic Effects Of Gpnmb Modulation On Vertebral Bone Mass Regulation And Intravertebral Disc Health, Hakem Altawil, Fayez Safadi

Williams Honors College, Honors Research Projects

Osteoporosis and vertebral degeneration are major contributors to musculoskeletal morbidity, yet the molecular mechanisms regulating vertebral bone and intervertebral disc (IVD) homeostasis remain incompletely understood. GPNMB (osteoactivin) has been identified as a regulator of bone remodeling, though its role in spine health is unclear. This study evaluated the effects of GPNMB deficiency on lumbar vertebral bone microarchitecture and IVD integrity in a sex-dependent context.

Six-month-old male and female wild-type (WT) and GPNMB knockout (KO) mice were analyzed using micro–computed tomography (µCT) of lumbar vertebrae (L4–L6) and histological assessment of the L5–L6 IVD. KO males exhibited increased bone volume fraction, bone …

Predictors Of Increased Length Of Stay And Cost In Readmissions For Spinal Surgical Site Infections, Matthew Giammanco, Alex Zhang, Phillip Alexeev, Ryan Snowden

SPARK Symposium Presentations

Abstract:

Background

Surgical site infection (SSI) following spinal surgery remains a costly and morbid complication, frequently necessitating hospital readmission and operative management. While prior studies have characterized the overall economic burden of spinal SSI, the specific drivers of cost during SSI-related readmissions are poorly defined. The primary research question of this study was to identify clinical, operative, and microbiologic factors associated with increased hospital cost, length of stay, and financial margins during readmission for operative management of spinal SSI.

Methods

We performed a retrospective cohort study of adult patients readmitted for surgical management of spinal SSI at a single tertiary …

Traction Table Positioning For Cephalomedullary Nailing Of Proximal Femur Fractures In Patients With Ipsilateral Below-Knee Amputation, Brogan Hill, Andres D. Toledo, Christopher Morford, Riley Hamel, Nate Tomilonus, Andrew Boltuch

West Florida Division GME Research Day 2026

No abstract provided.

Effects Of Glucagon-Like-Peptide-1 Receptor Agonists (Glp-1a) Medications In Patients Undergoing Total Hip Arthroplasty (Tha): A Systematic Review And Meta-Analysis, Tanner Haechten, Troy B. Puga, Vincent Dieu, Mckenna W. Box, Kyle O'Connor, John T. Riehl

North Texas GME Research Forum 2026

Background Glucagon-Like-Peptide-1 Receptor Agonists (GLP-1a) medications have rapidly grown in popularity, however, their effects on the outcomes of Total Hip Arthroplasty (THA) remain largely unclear. The objective of this systematic review and meta-analysis is to evaluate the outcomes of patients undergoing THA and using a GLP-1a medication. Methods A search was conducted across six databases. The search used a combination of keywords and Medical Subject Heading (MeSH) terms. Titles and abstracts were screened for eligibility for inclusion criteria. Full texts were screened and included if they met eligibility criteria. Demographics and results of the studies were extracted from included articles. …

Outcomes Of Total Knee Arthroplasty (Tka) In Patients On Glucagon-Like-Peptide-1 Receptor Agonists (Glp-1a): A Systematic Review And Meta-Analysis, Lachlan Anderson, Troy B. Puga, Erica Olfson, Kyle P. O'Connor, Mckenna W. Box, John T. Riehl

North Texas GME Research Forum 2026

Introduction Glucagon-Like-Peptide-1 Receptor Agonist (GLP-1a) medications are commonly prescribed to treat diabetes and obesity, however, their effects on the outcomes of Total Knee Arthroplasty (TKA) remain largely unclear. The objective of this systematic review and meta-analysis is to evaluate the outcomes of patients undergoing TKA while using a GLP-1a medication.

Methods A search was conducted across MEDLINE/Pubmed, Cochrane, Google Scholar, Web of Science, and Embase databases. The search used a combination of keywords and Medical Subject Heading (MeSH) terms. Titles and abstracts were screened for eligibility. Full texts were then screened and included if they met eligibility criteria. Demographics and …

Understanding Resiliency In Nrmp Match Applicants Pursuing Orthopaedic Surgery Residency, Sean Mcmillan, Shelby Ramsey, Brian Truong, Manuel Pontes, Charlie Yoo, Efstratios Papdelis, Elizabeth Ford, Robert Garner, William Diciurcio

MidAmerica Division GME Healthcare Symposium 2026

No abstract provided.

Gluteal Compartment Syndrome Following Prolonged Immobilization In The Setting Of Polysubstance Use: A Two-Patient Case Series, Daulton Sauce, Mark Gamadia, Robert Garner, Molly Black

MidAmerica Division GME Healthcare Symposium 2026

No abstract provided.

Thoracolumbar Fractures: Historical Systems And Advancements With The Ao Spine Classification, Barry Ting Sheen Kweh, Alex R. Vaccaro, Gregory D. Schroeder, Jose A. Canseco, Maximilian Reinhold, Mohamed M. Aly, Sebastian Bigdon, Mohammad El-Skarkawi, Richard J. Bransford, Andrei Fernandes Joaquim, Harvinder Singh Chhabra, Emiliano Vialle, Rishi M. Kanna, Charlotte Dandurand, Cumhur Öner, Jin Wee Tee

Rothman Institute Papers

Study Design: Systematic Review. Objective: To describe the historical classifications of thoracolumbar injuries and their evolution into the AO Spine Thoracolumbar Injury Classification System. Methods: A systematic review of MEDLINE, EMBASE and Cochrane Databases was performed in keeping with Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Results: 445 articles were crystallized to 14 included studies. Simple categorization systems offered by Bohler or Watson-Jones merely identify fracture morphology. Holdsworth and Denis conveyed a sense of the stability of injuries by noting columns of stability, but still failed to take into consideration important factors such as neurological status or …

Accuracy Of The Nestlé Mini Nutritional Assessment® (Mna®) Screen In Identifying Prealbumin–Defined Malnutrition Amongst Spine Surgery Patients, Stylianos Mysirlidis, Luke Fischbach, Matthew Giammanco, Alex Zhang, Phillip Alexeev, Ryan Snowden

SPARK Symposium Presentations

Abstract:

Background:

Malnutrition is a significant risk factor for patients undergoing surgery, including those receiving spine surgery. These patients are at greater risk of adverse postoperative outcomes, impaired wound healing, and spinal fusion failure. Therefore, it is essential to identify at-risk, malnourished patients prior to intervention to mitigate any complications such as surgical site infections, unplanned readmissions, and reoperations. The primary focus of this study was to assess the accuracy of the Nestlé Mini Nutritional Assessment® (MNA®) on identifying true malnutrition amongst those patients undergoing spine surgery.

Methods:

We conducted a retrospective cohort study of 674 consecutive …

Intraosseous (Io) Analgesia Medication Administration In Orthopaedic Surgery: A Brief Review, Jenna Chrabolowski, Troy B. Puga, Abanoub Attallahm, Mckenna W. Box, John T. Riehl

North Texas GME Research Forum 2026

Introduction

Intraosseous (IO) analgesia is a novel strategy for pain control in orthopaedic surgery. This brief review aims to provide an overview of IO analgesia in orthopaedic surgery.

Methods

A search was conducted across seven databases. Titles and abstracts were screened followed by full-text review for inclusion criteria. Demographics and results were extracted from included articles.

Results

Ten studies met inclusion criteria and involved patients undergoing knee surgery and spinal surgery. IO lidocaine was shown to be effective for postoperative and intraprocedural pain control during vertebroplasty and kyphoplasty. IO morphine and IO NSAIDs were shown to be effective in reducing …

Pigmented Villonodular Synovitis (Pvns) After A Distal Femur Non-Union: A Case Report, Troy Puga, Jenna Chrabolowski, Mckenna W. Box, Kisan Parikh

North Texas GME Research Forum 2026

Background Pigmented villonodular synovitis (PVNS) is a rare benign neoplastic process that involves extensive proliferation of the synovium of a joint. Development of PVNS has been potentially linked to traumatic etiologies, however, evidence for this remains limited. This case report aims to present a case of PVNS that developed after a traumatic etiology.

Case Presentation A 62 year old female presented with recurrent left knee effusion and non-union of the left distal femur roughly four years after an MVC and index open reduction and internal fixation with a lateral locking plate and screw construct. Left knee aspiration at initial visit …

Outcomes After Orif Of Closed Bimalleolar And Trimalleolar Ankle Fractures In Patients With Autoimmune Disease, Mckenna Box, Troy B. Puga, Lachlan Anderson, Alyssa Kozlowski, John T. Riehl

North Texas GME Research Forum 2026

Background: Autoimmune disease is associated with chronic systemic inflammation, immunosuppressive therapy, and increased medical comorbidity, which may influence postoperative outcomes following fracture fixation. Data evaluating outcomes after ankle fracture surgery in this population remain limited. We hypothesized that autoimmune disease would be associated with higher postoperative complication rates following open reduction and internal fixation (ORIF) of closed ankle fractures.

Methods: We performed a retrospective cohort study using a multi-hospital dataset (2017-2025) to identify adult patients undergoing ORIF for closed bimalleolar or trimalleolar ankle fractures. Patients with autoimmune disease were propensity score matched 1:2 to patients without autoimmune disease based on …

Association Of Glp-1 Receptor Agonist Use With Postoperative Outcomes After Rotator Cuff Repair In Patients With Diabetes: A Propensity Score–Matched Analysis, Mckenna W. Box, Troy B. Puga, Hans Drawbert, Aysu Erdemir, John T. Riehl

North Texas GME Research Forum 2026

Background Diabetes impairs tendon healing after rotator cuff repair (RCR), with early postoperative poor glycemic control linked to a higher failure risk in studies. GLP-1 receptor agonists (GLP-1RAs) are increasingly used for glycemic control. Preclinical studies indicate that GLP-1RA may benefit rotator cuff healing through anti-inflammatory mechanisms as well. However, real-world data on the effects of GLP-1RAs on RCR outcomes remain incompletely understood.

Methods We conducted a retrospective cohort study using an institutional dataset (01/01/2016 to 09/30/2024) of adults aged 18-74 years with type 2 diabetes who underwent RCR. GLP-1RA exposure was established by home medication lists. Patients with autoimmune …

Biologic Versus Non-Biologic Immunosuppressant Use And Outcomes After Orif Of Closed Ankle Fractures: A Propensity-Matched Analysis, Mckenna W. Box, Troy B. Puga, Lachlan Anderson, Alyssa Kozlowski, John T. Riehl

North Texas GME Research Forum 2026

Background: The effect of biologic immunosuppressant therapy on postoperative outcomes following ankle fracture open reduction and internal fixation (ORIF) remains unclear, and concerns regarding infection and impaired healing often influence perioperative decision-making. We hypothesized that biologic immunosuppressant use would be associated with higher rates of postoperative complications following ORIF of closed ankle fractures compared with non-biologic immunosuppressant therapy.

Methods: We conducted a retrospective cohort study using a multi-hospital administrative dataset (2017-2025) to identify adult patients undergoing ORIF for closed bimalleolar or trimalleolar ankle fractures who were prescribed immunosuppressive therapy. Patients were categorized based on biologic versus non-biologic immunosuppressant use. A …