Orthopedics Commons^™

Strengthening Orthopaedic Care At National Level: Output Of A Structured Residency Programme At Aga Khan University, Fateh Ali Janjua, Shah Fahad, Tashfeen Ahmad, Masood Umer

Section of Orthopaedic Surgery

This descriptive review of the output of the orthopaedic residency programme of Aga Khan University, Karachi, comprised information regarding the number of graduated residents and their educational background which was retrieved from departmental records. Information about their work location, subspecialty, current working status, participation in medical camps and national disaster relief efforts were obtained from various sources, including fellow surgeons, and social media profiles. From 1989 to 2017, a total of 48 residents graduated from the programme, with only 2(4.2%) of them being females. Overall, 19(39.6%) residents hailed from areas outside Karachi; 28(58.3%) belonged to Karachi; 1(2%) came from Kenya; …

Excision Of A Rare Triquetral Body Fracture Nonunion, Michael J. Niemann, William C. Brooks, Priscilla Cavanaugh, Andrea B. Lese, John S. Taras

Faculty & Staff Scholarship

Aside from the more common dorsal avulsion fractures, isolated triquetral body fractures are a rare injury and often missed. When they are identified, conservative treatment via immobilization is often the standard of care for initial treatment. Rarely, triquetral body fractures can develop into symptomatic nonunions, causing considerable pain and disability. Multiple classification schemes have been described to categorize triquetrum fractures; however, distal triquetrum fractures fit into none of the established models. There is scarce literature describing treatment of triquetral body fracture nonunions. The few reports that exist often use a variation of open reduction internal fixation with or without grafting …

Postdischarge Opioid Use After Total Hip And Total Knee Arthroplasty, Keenan Atwood, Taylor Shackleford, Wesley Lemons, Jennifer L. Eicher, Brock A. Lindsey, Adam E. Klein

Faculty & Staff Scholarship

Background

Methods

Detecting Anterior Cruciate Ligament Tears And Posterolateral Corner Injuries On Magnetic Resonance Imaging, Paul Woloszyn, Vishal Desai, Md, Simukayi Mutasa, Md, Tiffany D’Souza, Dominick Battistini, Sasha Mitts, Bryan Sadler

Phase 1

Introduction: Anterior Cruciate Ligament (ACL) tears are an extremely common orthopedic injury, with an incidence ranging from 39-52 per 100,000. Knee Magnetic Resonance Imaging (MRI) scans are the gold standard for diagnosing ACL tears and their comorbidities, such as posterolateral corner injuries; the results of these scans determine the appropriate treatment needed for patients. There is evidence that machine learning can be used to automate the detection of pathology on MRI, and we hypothesize that we can train a neural network machine learning model to accurately interpret ACL injuries and posterolateral corner injuries.

Methods: We will be analyzing over 1000 …

Patient-Reported Outcomes Data In Patients With Psoriatic Arthritis From A Randomised Trial Of Etanercept And Methotrexate As Monotherapy Or In Combination., Vibeke Strand, Philip Mease, Ervant J Maksabedian Hernandez, Bradley S Stolshek, Lyrica X H Liu, David H Collier, Gregory Kricorian, Joseph F Merola

Articles, Abstracts, and Reports

OBJECTIVES: We examined patient-reported outcomes (PROs) in The Study of Etanercept And Methotrexate in Patients with Psoriatic Arthritis (PsA); a 48-week, phase 3, randomised controlled trial that compared outcomes with methotrexate (MTX) monotherapy, etanercept monotherapy, and MTX+ etanercept in patients with PsA.

METHODS: Efficacy endpoints included: mean changes from baseline and proportion of patients who reported improvements≥minimal clinically important difference (MCID) at week 24 in treatment groups for Health Assessment Questionnaire-Disability Index, Patient Global Assessment (PtGA), Patient Global Assessment of Joint Pain (PtGAJP) and Medical Outcomes Study Short Form-36 Questionnaire (SF-36) Physical Component Summary (PCS), and Mental Component Summary, and …

The Modern Use Of The Extended Humeral Head (Cuff Tear Arthropathy) Hemiarthroplasty., Tyler J Smith, Sarav S Shah, Justin W Peterson, Glen Ross

Orthopedic Surgery Resident Research

Today, the treatment of osteoarthritis in the rotator cuff-deficient population is largely dominated by reverse shoulder arthroplasty (RSA). Despite the popularity of and increased familiarity with this procedure, the complication rate of RSA remains significant. An extended humeral head hemiarthroplasty may provide a less invasive alternative for select patients with cuff tear arthropathy (CTA) and preserved glenohumeral active elevation. With the indications for reverse arthroplasty expanding to younger patients, there are concerns about the longevity of this implant, as well as the associated revision burden. In the setting of failed RSA, the bone stock available for glenosphere baseplate fixation can …

Anterior-Based Muscle Sparing Approach For Total Hip Arthroplasty, Callahan M. Sturgeon, George M. Babikian, Brian J. Mcgrory, Adam J. Rana

Costas T. Lambrew Research Retreat 2021

A high value, high quality and low cost surgery: a 7.5 year single-center, retrospective case series

Measuring Vastus Medialis Cross-Sectional Area With Panoramic Ultrasound Over Time, Kaitlin Minnehan, Elizabeth Scharnetzki, Kaitlyn Chin, Christina Holt, William Dexter

Costas T. Lambrew Research Retreat 2021

Panoramic ultrasound detected a statistically significant decrease in the VM CSA of participants after 70 days of bedrest without exercise.

Symptomatic Combined Thumb Cmc Arthritis And Slac Wrist: Incidence & Treatment Options, Frank Lalezar, Lawrence C. Hurst

Stony Brook Orthopaedic and Musculoskeletal Journal

Thumb basal joint osteoarthritis and scapholunate advanced collapse are common degenerative wrist disorders. Surprisingly, literature describing the incidence and treatment of these two disorders in the same wrist is limited. This study sought to determine how often these disorders present concurrently, as well as report on outcomes from a new surgical technique devised to treat these cases.

Are Radiographs Over-Utilized In Pediatric Orthopaedic Emergency Room Care?, Brian Lynch, Stephen Bowen, David E. Komatsu, Wesley Carrion

Stony Brook Orthopaedic and Musculoskeletal Journal

Background: There is an estimated $760 to $935 billion in annual cost of waste in the United States healthcare system. $12.8 to $28.6 billion is attributed to wasteful studies/treatments. In an effort to examine current waste in our institution, we examined the use of radiographs in orthopedic patients evaluated in our pediatric emergency department (ED). The pediatric population is largely unable to make decisions for themselves and thus are susceptible to unneeded studies.

Hypothesis/Purpose: We propose that there is a significant amount of waste, in regard to: time, cost, and resources in the ED. Additionally, we believe that unnecessary studies …

Hip Fractures Before And During The Covid-19 Pandemic: Comparative Demographics And Outcomes, Alireza K. Nazemi, Samer M. Al-Humadi, Ryan Tantone, Thomas R. Hays, Stephen N. Bowen, David E. Komatsu, Nicholas Divaris

Stony Brook Orthopaedic and Musculoskeletal Journal

Background: During the height of the COVID-19 pandemic in NY, hip fractures requiring operative management continued to present to Stony Brook University Hospital. Given the novelty of SARS-CoV-2, there is recent interest in the pandemic and its relationship to orthopaedic operative outcomes.

Purpose: This retrospective cohort study compared outcomes for operative hip fractures in patients prior to and during the COVID-19 pandemic at a Level 1 academic center.

Methods: Data were collected from patients age18 years or older who underwent operative management for hip fractures performed from January 21, 2019 to July 1, 2019 (pre-pandemic) and from January 21, 2020 …

The Efficacy Of Platelet-Rich Plasma Administration For Rotator Cuff Tears, Angela Bekampis

Capstone Showcase

Despite advancing surgical techniques for rotator cuff tears (RCTs), the recovery from surgery is often painful and the rate of re-tear remains high. The use of platelet-rich plasma (PRP) is being studied as an adjunct therapy in order to increase the success of treatment. The goal of this study is to consolidate and compare the results of previous research to determine whether the use of PRP had significant benefit in the treatment of RCTs. Therefore the research question was: in adults (18+) diagnosed with a partial or full-thickness rotator cuff tears, does the use of PRP as an adjuvant treatment …

Acupuncture Therapy In The Treatment Of Osteoarthritis Of The Knee, Reece Bartell

Capstone Showcase

Abstract

Introduction: Osteoarthritis (OA) is a chronic condition that affects the joints of the body, most commonly the knees; it has the potential to cause debilitating pain, and stiffness and decrease quality of life. The current management involves lifestyle modifications of a healthy diet and exercise as well as analgesics like NSAIDs or acetaminophen to manage symptoms. Long-term use of these medications has been associated with many side effects affecting the GI and CV system. This review analyzes the use of acupuncture therapy (I) for symptom management (O) in patients aged 60-80 years old suffering from mild to moderate …

Is There A Role For Ct Pan-Scans In The Initial Work-Up Of Fragility Fracture Patients?, Eric Lepkowsky, Trevor Simcox, Hunter Rogoff, Shahidul Islam, Omid Barzideh

Stony Brook Orthopaedic and Musculoskeletal Journal

Background: CT pan-scans have become increasingly commonplace as part of the initial diagnostic work-up for patients sustaining traumatic injuries. They have proven effective in improving diagnostic accuracy in those with high energy mechanisms of injury. However, the utility of pan-scans in the geriatric population sustaining low energy traumatic injuries remains unproven. There is no study that assesses the usefulness of CT pan-scans in patients who sustain injuries related to osteoporosis, also known as fragility fractures.

Methods: A retrospective review was conducted of patients who sustained a fragility fracture at a Level 1 trauma center over a 15-month period. Patients underwent …

Effects Of Alcohol Use On Total Knee Arthroplasty Patient Osteoarthritis Severity, Preoperative Pain Scores, And Postoperative Range Of Motion: A Retrospective Study, Christopher Ruland, Samir Baig, Zach Warheit, David E. Komatsu, James Nicholson

Stony Brook Orthopaedic and Musculoskeletal Journal

Introduction: Despite the prevalence of significant alcohol use, the effect of alcohol consumption on patients undergoing total knee arthroplasty (TKA) is poorly understood. Other forms of substance abuse, such as narcotic dependence, decrease patient pain tolerance and increase self-reported pain scores, while excessive alcohol consumption has been associated with adverse outcomes following other elective surgical procedures. In the context of TKA, perception of pain is also likely linked to the ability to achieve functional postoperative range of motion (ROM), one of the most important predictive indicators of patient satisfaction. It is not well understood whether heavy alcohol users who are …

Biomechanical Comparison Of Krackow Open Repair And Percutaneous Achilles Repair System For Achilles Tendon Rupture: A Cadaveric And Finite Element Model Study, David R. Swanson, Alireza Nazemi, Bonnie Macaluso, Chaudhry R. Hassan, Megan Paulus, Yi-Xian Qin, David E. Komatsu

Stony Brook Orthopaedic and Musculoskeletal Journal

Achilles tendon ruptures are one of the most common tendon injuries. Numerous surgical procedures have been developed to repair these injuries, but there is no consensus as to which technique is superior. This combined cadaveric and finite element model study was performed to compare directly initial biomechanical integrity between two operative techniques and use these resulting data to validate a finite element model.

Multicenter Studies In Orthopaedic Trauma: Importance, Challenges, And Stony Brook’S Contributions, Amanda C. Pawlak, Nathan Olszewski, Maxwell Alley, Thomas Seaver, Diana Lee, Michael Doany, Paul Tornetta Iii, Stephen A. Kottmeier, Orthopaedic Trauma Research Consortium

Stony Brook Orthopaedic and Musculoskeletal Journal

Historically, research within the field of orthopaedic surgery has largely consisted of small cohort studies or case series, typically produced out of one single center.1 Multicenter studies, however, allow for larger sample sizes and analyses with greater power and improved generalizability.2 Though these collaborative studies present challenges, including time, cost, communication and authorship issues, the value of these types of studies cannot be overstated.2,3 The Orthopaedic Trauma Research Consortium (OTRC) is one of several multi-institution research groups dedicated to furthering the field of orthopaedic trauma research. This manuscript reviews four recent OTRC studies that Stony Brook provided significant contributions to: …

Development Of An Injectable Methylcellulose Hydrogel System For Nucleus Pulposus Repair And Regeneration, Nada A. Haq-Siddiqi

Dissertations and Theses

Low back pain is the most common cause of disability in the world and is often caused by degeneration or injury of the intervertebral disc (IVD). The IVD is a complex, fibrocartilaginous tissue that allows for the wide range of spinal mobility. Disc degeneration is a progressive condition believed to begin in the central, gelatinous nucleus pulposus (NP) region of the tissue, for which there are few preventative therapies. Current therapeutic strategies include pain management and exercise, or surgical intervention such as spinal fusion, none of which address the underlying cause of degeneration. With an increasingly aging population, the socioeconomic …

Patterns Of Lumbar Disc Degeneration: Magnetic Resonance Imaging Analysis In Symptomatic Subjects, Monchai Ruangchainikom, Michael D. Daubs, Akinobu Suzuki, Chengjie Xiong, Tetsuo Hayashi, Trevor P. Scott, Kevin Phan, Jeffrey C. Wang

School of Medicine Faculty Research

Study Design: Cross-sectional study. Purpose: To evaluate lumbar disc degeneration (LDD) on magnetic resonance imaging (MRI) in symptomatic subjects to accumulate baseline data on the pattern of degeneration. Overview of Literature: LDD plays an important role in the diagnosis and treatment of low-back pain in patients. Few studies have focused on the pattern of LDD to understand how the lumbar spine ages. Methods: This study included 1,095 patients (mean age, 44.29 years; range, 16–85 years) who underwent upright lumbar MRI. LDD was graded into five categories (I–V). Positive LDD was defined as grade III or greater. The prevalence and pattern …

Collagen Structure-Function Mapping Informs Applications For Regenerative Medicine., James D San Antonio, Olena Jacenko, Andrzej Fertala, Joseph P R O Orgel

Department of Orthopaedic Surgery Faculty Papers

Type I collagen, the predominant protein of vertebrates, assembles into fibrils that orchestrate the form and function of bone, tendon, skin, and other tissues. Collagen plays roles in hemostasis, wound healing, angiogenesis, and biomineralization, and its dysfunction contributes to fibrosis, atherosclerosis, cancer metastasis, and brittle bone disease. To elucidate the type I collagen structure-function relationship, we constructed a type I collagen fibril interactome, including its functional sites and disease-associated mutations. When projected onto an X-ray diffraction model of the native collagen microfibril, data revealed a matrix interaction domain that assumes structural roles including collagen assembly, crosslinking, proteoglycan (PG) binding, and …