Orthopedics Commons^™

Blood Transfusions Increase The Risk For Venous Thromboembolism Events Following Total Joint Arthroplasty, Noam Shohat, Leanne Ludwick, Graham S Goh, Matthew Sherman, Joseph Paladino, Javad Parvizi

Rothman Institute Papers

The association between blood transfusions and thromboembolic events (VTE) following total joint arthroplasty (TJA) remains debatable. Using contemporary institutional data, this study aimed to determine whether blood transfusions increase the risk of VTE following primary and revision TJA. This was a single institution, retrospective cohort study. The clinical records of all patients (n = 34,824) undergoing primary and revision TJA between 2009 and 2020 were reviewed. Demographic variables, co-morbidities, type of chemoprophylaxis and intraoperative factors such as use of tranexamic acid were collected. Clinical notes, hospital orders, and discharge summaries were reviewed to determine if a patient received a blood …

Spinal Cord Signal Change On Magnetic Resonance Imaging May Predict Worse Clinical In- And Outpatient Outcomes In Patients With Spinal Cord Injury: A Prospective Multicenter Study In 459 Patients., Thorsten Jentzsch, David W Cadotte, Jefferson R Wilson, Fan Jiang, Jetan H Badhiwala, Muhammad A Akbar, Brett Rocos, Robert G Grossman, Bizhan Aarabi, James Harrop, Michael G Fehlings

Department of Orthopaedic Surgery Faculty Papers

Prognostic factors for clinical outcome after spinal cord (SC) injury (SCI) are limited but important in patient management and education. There is a lack of evidence regarding magnetic resonance imaging (MRI) and clinical outcomes in SCI patients. Therefore, we aimed to investigate whether baseline MRI features predicted the clinical course of the disease. This study is an ancillary to the prospective North American Clinical Trials Network (NACTN) registry. Patients were enrolled from 2005-2017. MRI within 72 h of injury and a minimum follow-up of one year were available for 459 patients. Patients with American Spinal Injury Association impairment scale (AIS) …

Limb Salvage Therapy In Septic Diabetic Foot Ulcer In Patients Unwilling To Undergo Amputation, Luke Hong

Clinical Research in Practice: The Journal of Team Hippocrates

A clinical decision report appraising

Shojaiefard A, Khorgami Z, Larijani B. Septic diabetic foot is not necessarily an indication for amputation. J Foot Ankle Surg. 2008;47(5):419-423. https://doi.org/10.1053/j.jfas.2008.05.005

for a patient with a septic diabetic foot.

Diagnostic Accuracy Of Ultrasonography For Rotator Cuff Tears: A Systematic Review And Meta-Analysis, Ali S Farooqi, Alexander Lee, David Novikov, Ann Marie Kelly, Xinning Li, John D Kelly, Robert L Parisien

Department of Medicine Faculty Papers

Background: With recent improvements in transducer strength, image resolution, and operator training, ultrasound (US) provides an excellent alternative imaging modality for the diagnosis of rotator cuff tears.

Purpose: To evaluate the diagnostic accuracy of US for partial- and full-thickness rotator cuff tears and biceps tendon tears, compare diagnostic values with those of magnetic resonance imaging (MRI) using arthroscopy as the reference standard, assess longitudinal improvements in accuracy, and compare diagnostic values from operators with different training backgrounds.

Study Design: Systematic review; Level of evidence, 3.

Methods: The PubMed and Cochrane Library databases were systematically searched for full-text journal articles published …

Postoperative Outcomes Of Hip Fracture Surgery In Geriatric Patients On Clopidogrel Or Warfarin At The Time Of Surgery, Josh Locker, Elizabeth Lyden, Justin Siebler

Graduate Medical Education Research Journal

BACKGROUND: The purpose of our study is to evaluate if surgical intervention in the setting of an elevated INR or continued use of clopidogrel lead to elevated post-operative mortality and/or morbidity compared to INR reversal or surgical delay.

METHODS: We retrospectively reviewed 1,007 patients age > 55 undergoing hip fracture fixation at our institution over a 10 year span. We placed patients into four groups based upon their anticoagulation status at the time of surgery. Descriptive statistics were utilized to evaluate for differences in mortality rates, blood loss, time to surgery, and wound complications.

RESULTS: Comorbid conditions occurred at a higher …

The Ironman, Mary I. Fisher

Physical Therapy Faculty Publications

No abstract provided.

Association Between Pitch Break On The 4-Seam Fastball And Slider And Shoulder Injury In Major League Baseball Pitchers: A Case-Control Study, Brooks N. Platt, Anthony J. Zacharias, Caitlin Conley, Lindsay Hockensmith, Nicholas Stockwell, Aaron Sciascia, Austin V. Stone

Orthopaedic Surgery and Sports Medicine Faculty Publications

Background: Few specific risk factors are known for shoulder injury in professional pitchers. New pitch-tracking data allow for risk stratification based on advanced metrics.

Purpose/Hypothesis: The purpose of this study was to determine the association between shoulder injury, pitch frequency, and pitch metrics (velocity, total break, break angle, and spin rate) for the 4-seam fastball, curveball, and slider. We hypothesized that more frequent use of the 4-seam fastball would be associated with shoulder injury.

Study Design: Case-control study; Level of evidence, 3.

Methods: The Major League Baseball (MLB) database was queried for pitchers who had been placed on the injury …

Bassini Inguinal Hernia Repair: Obsolete Or Still A Viable Surgical Option? A Single Center Cohort Study, Wayne Tse, William Johns, James Maher, Jeannie Rivers, Thomas Miller

Department of Orthopaedic Surgery Faculty Papers

Background: Most inguinal hernias are presently repaired using some type of mesh technique. This mesh can be placed through an inguinal incision or positioned through a laparoscopic approach. Either way, results have been impressive including a low recurrence rate, minimal pain and a rapid return to work and normal activity compared to tissue based approaches. Notwithstanding these results, there is still a subset of patients who, for various reasons, are strongly opposed to having a mesh repair. This study summarizes our 13 year experience with such patients and why the Bassini hernia repair is a viable surgical option in these …

Prevalence Of Os Acromiale In An Indigenous East African Population: A Computerized Tomography Scan-Based Study, Mordicai Atinga, Njalalle Baraza, Sarah Wambui, Wachira Joseph Thiong’O, Angela Atinga

General Surgery, East Africa

Background: Failure of fusion to any of the acromion physes at maturity may lead to an os acromiale. A radiological review into the prevalence of os acromiale in an indigenous East African population was performed using computer tomography (CT) imaging. The study aimed to demonstrate a lower prevalence of os acromiale in an urban population compared with cadaveric studies.

Methods: This was a cross-sectional study with consecutive sampling. CT scans of both shoulders obtained for non-shoulder pathology were used for the analysis. CT scanning was performed at a tertiary referral hospital from January 2019 to July 2020.

Results …

Posterior And Middle Facets Of The Subtalar Joint: The Retrospective Search For An Early Sign Of Peritalar Subluxation And Progressive Flatfoot Deformity, Elijah C. Auch, Nacime Mansur, Shuyuan Li, Kevin Dibbern, John Femino, Daniel Baumfeld, Cesar De Cesar Netto, Thiago Alexandre Alves

Conference Presentation Abstracts

INTRODUCTION | Adult acquired flatfoot deformity (AAFD) is a complex three-dimensional (3D) pathology characterized by peritalar subluxation (PTS) of the hindfoot. The objective of this study was to compare the amount of subluxation between the middle and posterior facets in patients with AAFD. METHODS | In this IRB-approved retrospective comparative study, seventy-six AAFD patients (87 feet) who underwent weightbearing CT (WBCT) were included. Two blinded Fellowship-Trained Orthopedic Foot and Ankle Surgeons with >10 years of experience measured subtalar joint subluxation at the posterior and middle facets as well as the Foot and Ankle Offset (FAO). Intra- and interobserver agreement was …

Percutaneous Distal Metatarsal Mini-Invasive Osteotomy: Comparison Between Standard Vs. Modified Intraosseous Approach - A Cadaveric Study, Elijah C. Auch, Fernando S. Martins, Victoria Vivtcharenko, Eli Schmidt, Shuyuan Li, Alexandre L. Godoy-Santos, John Femino, Cesar De Cesar Netto

Conference Presentation Abstracts

BACKGROUND | The objective of this cadaveric study was to identify and compare the structures at risk of damage in standard versus modified intraosseous distal mini-invasive metatarsal osteotomy (DMMO). Our hypothesis was that the modified DMMO technique may be a safer, less complex procedure that could decrease the risk of iatrogenic injuries. METHODS | 11 thawed fresh-frozen under the knee cadaveric specimens underwent DMMO of the forefoot. The modified technique proposed by this study enters the dorsal cortex (at 45 degrees) straight through to the plantar cortex followed by cutting the lateral cortices (panels D, E, F). The standard technique …

A New Pediatric Monteggia Fracture Type 4 Variant, Ehab S. Saleh

Articles

Introduction: Monteggia fracture-dislocations are rare and complex injuries that usually involve a fracture of the proximal ulna associated with a proximal radioulnar and radiocapitellar joint dislocations. These injuries comprise

Stability Of The Sacral Table Angle In Pediatric Patients With Spinal Pathology, David G. Wallington, Patrick D. Albright, Alexandria I. Chrumka, Rebecca D. Funk, Dale E. Rowe, Joseph K. Weistroffer, Karen M. Bovid

Conference Presentation Abstracts

INTRODUCTION | Pelvic incidence, lumbar lordosis, and pelvisacral angle are common radiographic measures used to evaluate sagittal alignment of the spine and pelvis to assist in clinical decision making. However, the natural history of the sacral table angle (STA) is not well characterized, and there remains uncertainty regarding STA progression over time. Previous studies have established that the STA is stable over time in adult patients, however this question has not been answered for younger patients who have not reached skeletal maturity. In this study, we aim to determine sacral table angle stability over time in a younger patient population. …

Current Evidence On Potential Of Adipose Derived Stem Cells To Enhance Bone Regeneration And Future Projection, Quang Le, Vedavathi Madhu, Joseph M Hart, Charles R Farber, Eli R Zunder, Abhijit S Dighe, Quanjun Cui

Department of Orthopaedic Surgery Faculty Papers

Injuries to the postnatal skeleton are naturally repaired through successive steps involving specific cell types in a process collectively termed “bone regeneration”. Although complex, bone regeneration occurs through a series of well-orchestrated stages wherein endogenous bone stem cells play a central role. In most situations, bone regeneration is successful; however, there are instances when it fails and creates non-healing injuries or fracture nonunion requiring surgical or therapeutic interventions. Transplantation of adult or mesenchymal stem cells (MSCs) defined by the International Society for Cell and Gene Therapy (ISCT) as CD105+-CD90+CD73+CD45-CD34-CD14orCD11b-CD79αorCD19-HLA-DR-is being investigated as an attractive therapy for bone regeneration throughout the …

Atypical Osteochondroma Of The Lumbar Spine Associated With Suprasellar Pineal Germinoma: A Case Report, Patrik Suwak, Scott A. Barnett, Bryant M. Song, Michael J. Heffernan

School of Medicine Faculty Publications

BACKGROUND Osteochondromas are the most common benign bone tumor, accounting for 36% of benign bone tumors. Often found within the appendicular skeleton, osteochondromas of the spine are rare, comprising 4% to 7% of primary benign spinal tumors. CASE SUMMARY We report a case of a solitary lumbar osteochondroma in an 18-year-old male with a history of a suprasellar pineal germinoma treated with combined chemotherapy and radiation. He underwent mass excision and partial laminectomy with the ultrasonic bone scalpel (Misonix, Farmingdale, NY, United States) at the L5 Level without the use of adjuvants. The patient returned to work and full activities …

Understanding Barriers And Facilitators To Implementation Of Psychosocial Care Within Orthopedic Trauma Centers: A Qualitative Study With Multidisciplinary Stakeholders From Geographically Diverse Settings, Ana-Maria Vranceanu, Jafar Bakhshaie, Mira Reichman, James Doorley, Ryan A. Mace, Cale A. Jacobs, Mitchel Harris, Kristin R. Archer, David Ring, A. Rani Elwy

Orthopaedic Surgery and Sports Medicine Faculty Publications

BACKGROUND: Psychosocial factors are pivotal in recovery after acute orthopedic traumatic injuries. Addressing psychosocial factors is an important opportunity for preventing persistent pain and disability. We aim to identify barriers and facilitators to the implementation of psychosocial care within outpatient orthopedic trauma settings using the Consolidated Framework for Implementation Research (CFIR) and Proctor's taxonomy of implementation outcomes, and to provide implementation strategies derived from qualitative data and supplemented by the Expert Recommendations for Implementing Change.

METHODS: We conducted live video qualitative focus groups, exit interviews and individual interviews with stakeholders within 3 geographically diverse level 1 trauma settings (N …

Variations In Management Of A3 And A4 Cervical Spine Fractures As Designated By The Ao Spine Subaxial Injury Classification System, Barry Ting Sheen Kweh, Jin Wee Tee, Sander Muijs, F Cumhur Oner, Klaus John Schnake, Lorin Michael Benneker, Emiliano Neves Vialle, Frank Kanziora, Shanmuganathan Rajasekaran, Gregory D. Schroeder, Alex R. Vaccaro, Ao Spine Subaxial Injury Classification System Validation Group

Rothman Institute Papers

Objective: Optimal management of A3 and A4 cervical spine fractures, as defined by the AO Spine Subaxial Injury Classification System, remains controversial. The objectives of this study were to determine whether significant management variations exist with respect to 1) fracture location across the upper, middle, and lower subaxial cervical spine and 2) geographic region, experience, or specialty.

Methods: A survey was internationally distributed to 272 AO Spine members across six geographic regions (North America, South America, Europe, Africa, Asia, and the Middle East). Participants' management of A3 and A4 subaxial cervical fractures across cervical regions was assessed in four clinical …

Mechanisms Of Reducing Joint Stiffness By Blocking Collagen Fibrillogenesis In A Rabbit Model Of Posttraumatic Arthrofibrosis, Andrzej Steplewski, Jolanta Fertala, Ryan Tomlinson, Mark L. Wang, Allison Donahue, William V Arnold, Michael Rivlin, Pedro K Beredjiklian, Joseph A Abboud, Surena Namdari, Andrzej Fertala

Department of Orthopaedic Surgery Faculty Papers

Posttraumatic fibrotic scarring is a significant medical problem that alters the proper functioning of injured tissues. Current methods to reduce posttraumatic fibrosis rely on antiinflammatory and anti-proliferative agents with broad intracellular targets. As a result, their use is not fully effective and may cause unwanted side effects. Our group previously demonstrated that extracellular collagen fibrillogenesis is a valid and specific target to reduce collagen- rich scar buildup. Our previous studies showed that a rationally designed antibody that binds the C-terminal telopeptide of the α2(I) chain involved in the aggregation of collagen molecules limits fibril assembly in vitro and reduces scar …

Long-Term Treatment With Senolytic Drugs Dasatinib And Quercetin Ameliorates Age-Dependent Intervertebral Disc Degeneration In Mice, Emanuel J Novais, Victoria Tran, Shira N Johnston, Kayla R Darris, Alex J Roupas, Garrett A Sessions, Irving Shapiro, Brian O Diekman, Makarand V Risbud

Department of Orthopaedic Surgery Faculty Papers

Intervertebral disc degeneration is highly prevalent within the elderly population and is a leading cause of chronic back pain and disability. Due to the link between disc degeneration and senescence, we explored the ability of the Dasatinib and Quercetin drug combination (D + Q) to prevent an age-dependent progression of disc degeneration in mice. We treated C57BL/6 mice beginning at 6, 14, and 18 months of age, and analyzed them at 23 months of age. Interestingly, 6- and 14-month D + Q cohorts show lower incidences of degeneration, and the treatment results in a significant decrease in senescence markers p16INK4a, …

Hip Replacement For Femur Neck Fracture In The Elderly, Effects Of Delayed Surgical Intervention On Morbidity And Mortality, A Retrospective Comparative Study, Ahmed Habib, Shah Fahad, Muhammad Atif, Javeria Saeed, Pervaiz Hashmi, Mujahid Jamil Khattak

Section of Orthopaedic Surgery

Hip fracture is one of the most common injuries in the elderly population. Delay in operating on patients with hip fracture is associated with greater mortality and morbidity. A retrospective review of medical charts of patients who underwent primary total hip replacement (THR) for neck of femur fractures at our tertiary care level 1 trauma was carried out. Data was collected from the patients' charts and analysed for 30-day mortality and morbidity. A total of 96 patients were included in the study. Out of the 36 patients in the delayed THR group, mortality within 30 days was observed in 4 …