Orthopedics Commons^™

Performance Of The Promis After Operative Interventions For Shoulder Instability, Christina J. Hajewski, Natalie A. Glass, Robert W. Westermann, Matthew Bollier, Brian R. Wolf, Carolyn Hettrich

Orthopaedic Surgery and Sports Medicine Faculty Publications

Background: The Patient-Reported Outcomes Measurement Information System (PROMIS) was developed to capture patient-reported outcomes (PROs) in an efficient manner. Few studies have assessed this instrument postoperatively.

Purpose: To compare the PROMIS Physical Function computer adaptive test (PROMIS PF CAT) and Upper Extremity (PROMIS UE) item bank to other previously validated PRO instruments and to evaluate ceiling and floor effects and construct validity responsiveness in patients who underwent operative interventions for shoulder instability.

Study Design: Cohort study (diagnosis); Level of evidence, 2.

Methods: A total of 72 patients who underwent operative interventions for shoulder instability completed the American Shoulder and Elbow …

How Infant Positioning Impacts Hip Motion And The Associated Implications For Babies With Hip Dysplasia, Lauren Buchele

Biomedical Engineering Undergraduate Honors Theses

Developmental dysplasia of the hip (DDH) refers to a group of disorders, ranging from slight instability (Grades 1-3) to a severe dislocation (Grade 4) of the femoral head from the acetabulum [1]. In order to treat DDH in infants, a reduction procedure and the use of a lower body harness to secure the hip joint as the bones and ligaments re-form properly is typically prescribed. The Pavlik Harness is currently the “gold-standard” orthopedic device used to place hips in proper positioning. However, little research has been reported on the biomechanical affects during use of these device types.

Although the Pavlik …

Inadvertent Radial Head Inversion During Closed Reduction Of A Pediatric Radial Neck Fracture, Zachary J. Sirois, Sarah Kreul, Craig F. Shank

Orthopaedic Surgery Faculty Publications

Management of displaced pediatric radial neck fractures can be fraught with challenges. This unique case presents an 11-year-old female with a Salter-Harris type II radial neck fracture and how her radial head overturned 180° with the articular surface facing the radial shaft rather than the capitellum during closed manipulation under anesthesia. The malreduction subsequently required open reduction and highlights the importance of a careful stepwise approach to managing markedly displaced radial neck fractures. After closed reduction, meticulous assessment of intraoperative imaging when determining proper alignment is of the utmost importance as a result of the transverse nature of Salter-Harris type …

Routine Patellar Resurfacing During Total Knee Arthroplasty Is Not Cost-Effective In Patients Without Patellar Arthritis, Harold I. Salmons, Bs, Benjamin Zmistowski, Md, Yale A. Fillingham, Md, Derek Ward, Md, Robert P. Good, Md, Jess H. Lonner, Md

Department of Orthopaedic Surgery Posters

• During total knee arthroplasty (TKA), whether or not one should routinely resurface the patella is controversial.
• Leaving an unresurfaced patella following index TKA may lead to anterior knee pain (AKP), patellofemoral crepitus, and future secondary resurfacing operations.
• However, routinely resurfacing the patella (PR) may lead to patellar fracture, aseptic loosening, patellar instability, avascular necrosis, and patellar clunk.
• The purpose of the present study is to utilize the existing level one evidence to assess the cost-utility of routine patella resurfacing during primary TKA.
• Hypothesis: Selective resurfacing of the patella is more cost effective than routine patellar resurfacing during primary TKA.

Protocol For Serious Fall Injury Adjudication In The Strategies To Reduce Injuries And Develop Confidence In Elders (Stride) Study, David A. Ganz, Albert L. Siu, Jay Magaziner, Nancy K. Latham, Thomas G. Travison, Nancy P. Lorenze, Charles Lu, Rixin Wang, Erich J. Greene, Cynthia L. Stowe, Lea N. Harvin, Katy L.B. Araujo, Jerry H. Gurwitz, Yuri Agrawal, Rosaly Correa-De-Araujo, Peter Peduzzi, Thomas M. Gill, Shalender Bhasin, Thomas M. Gill, David B. Reuben, Siobhan Mcmahon, Nancy K. Latham, Shehzad Basaria, Brooke Brawley, Richard Eder, Amy Larson, Lori Goehring, Molly Lukas, Scott Margolis, Thomas W. Storer, Martha B. Carnie, Priscilla Gazarian

Orthopaedic Surgery Faculty Publications

Background: This paper describes a protocol for determining the incidence of serious fall injuries for Strategies to Reduce Injuries and Develop Confidence in Elders (STRIDE), a large, multicenter pragmatic clinical trial with limited resources for event adjudication. We describe how administrative data (from participating health systems and Medicare claims) can be used to confirm participant-reported events, with more time- and resource-intensive full-text medical record data used only on an "as-needed" basis. Methods: STRIDE is a pragmatic cluster-randomized controlled trial involving 5451 participants age ≥ 70 and at increased risk for falls, served by 86 primary care practices in 10 US …

Comparison Of Administratively Collected (Icd-10) Vs. Prospectively Collected Adverse Event Data, Joseph G. O'Sullivan

OHSU-PSU School of Public Health Annual Conference

Background: Accurate adverse event reporting is vital for analyzing outcomes and implementing the proper systemic efforts to improve them. Complication reporting and tracking has implications in medical practice, billing, and ultimately patient safety.

Objectives: To determine accuracy of complications reported in administrative data compared to prospectively obtained data.

Methods: A total of 1,213 patients undergoing spine surgery were followed over a two-year period (January 2011 to December 2012) sampled at a single institution. All patients undergoing spine surgery were eligible for inclusion in the study. Prospective data collection of adverse events was accomplished using OrthoSAVES, a standardized …

A New Method For Assessing Smoking Behavior In Orthopaedic Patients, David Gallacher

OHSU-PSU School of Public Health Annual Conference

“A New Method for Assessing Smoking Behavior in Orthopaedic Patients”

Background:Tobacco use is associated with post-operative complications and self-reporting often introduces a bias that underestimates the true exposure. Traditional tobacco testing methods, including serum cotinine are associated with issues of specificity, as they do not differentiate active smokers from those on nicotine replacement therapies (NRTs). This study intends to evaluate the effectiveness of point-of-care carbon monoxide (CO) breathalyzer test to assess patient smoking status and to differentiate active smokers from those using NRTs.

Methods:Eligible patients will be >18 years old and indicated for joint or fracture surgery at …

Exploring Mobility Help-Seeking Behavior Among People With Physical Disabilities: A Case Study Of Jaipur Foot, Alex Podell

Independent Study Project (ISP) Collection

It is estimated that as many as 90 million people living in India experience some sort of disability (The World Bank, 2007). As India’s population keeps growing and aging, not only will the medical aspects, but also the societal impacts of disability need to be brought to the forefront of discussion, developmental strategy, and policy implementation. This study sought to analyze factors influencing the process of seeking help from formal and informal sources for people with physical disabilities. Data was collected from 10 people with physical disabilities receiving a variety of mobility aids from the NGO, Bhagwan Mahaveer Viklang Sahayata …

Sport Participation And Specialization Characteristics Among Pediatric Soccer Athletes, Tamara Valovich Mcleod, Michael Israel, Melissa A. Christino, Jane S. Chung, Scott D. Mckay, Pamela J. Lang, David R. Bell, Charles M. Chan, Allison Crepeau, Elizabeth Davis, Amanda L. Fletcher, Jessica Laniak, Kelsie Mccaffrey, Donna M. Pacicca, Mark Riederer, Katherine Rizzone, Jeremy K. Rush, Tracy Zaslow

Manuscripts, Articles, Book Chapters and Other Papers

© The Author(s) 2019.

Background: Soccer is an increasingly popular sport for children and adolescents in the United States. Little is known about participation patterns related to sport specialization.

Purpose: To investigate soccer participation levels and sport specialization characteristics among youth soccer athletes.

Study Design: Cross-sectional study. Methods: Adolescent athletes aged between 12 and 18 years completed an online survey addressing participant demographics, sports and soccer participation history, and level of specialization. Descriptive analyses characterized participation, while chi-square and Kruskal-Wallis tests assessed the influence of specialization, sex, and grade on survey variables.

Results: Overall, 83.7% of 746 respondents participated in …

Temporary Fracture Stabilization Device, Steven J. Lawrence

Orthopaedic Surgery and Sports Medicine Faculty Patents

A temporary fracture stabilization device includes a first intramedullary fixation rod, a second intramedullary fixation rod, a first extramedullary connector, a second extramedullary connector and a fastener. A field kit for temporary fracture stabilization is also disclosed.

Physicians’ Knowledge And Beliefs Regarding Athletic Trainers, Joseph H. Vogler, Lindsey E. Eberman, Zachary K. Winkelmann, M. Seth Smith, James L. Turner, Kenneth E. Games

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

Purpose: The relationship between athletic trainers (ATs) and physicians is a legal obligation and collaboration to improve patient outcomes. The objective of this study was to examine the knowledge of physicians regarding the educational preparation, legal obligations, and scope of practice for ATs and how it relates to previous experiences with ATs. Additionally physicians’ perceptions of Interprofessional Collaboration (IPC) were studied. Methods: 169 physicians medical doctors (MD)=133/169, 78.7%, doctor of osteopathy (DO)=36/169, 21%) completed a 36-question web-based survey, which included a validated IPC scale. Results: Respondents with experience working with an AT scored significantly higher (P < 0.01) on the knowledge assessment, where physicians currently working with an AT scored higher (5.4/8) than those who previously worked with an AT (4.2/8) and those who had never worked with an AT (3.3/8). Additionally, physicians with previous exposure to an AT as an athlete had significantly higher knowledge scores than those without exposure (P < 0.01). Two areas of weakness in IPC from the physician’s perspective included sharing of important information (2.48/4) and importance of work as compared to others on the team (2.38/4). Conclusions: Physicians who have a current working relationship with an AT and those that had access to an AT as an athlete demonstrated significantly higher knowledge about an AT’s academic preparation, legal obligations, and scope of practice. Moreover, physicians currently working with an AT report positive interprofessional collaborations.

Infected Non-Union Of Tibia Treated With Ilizarov External Fixator: Our Experience, Shah Fahad, Aysha Habib, Muhammad Awais, Masood Umer, Haroon Rashid

Section of Orthopaedic Surgery

Introduction: Tibia is the most common long bone fractured due its vulnerable subcutaneous location and most often associated with acquired complications of delayed union or non-union due to infection. Amongst the various treatment options to treat them, the Ilizarov external fixator application is considered superior due to its multiple advantages. The objective of this study was to analyse the role of Ilizarov fixation in infected tibial non-union, as well as to assess bony union and associated functional outcomes.
Materials and Methods: A retrospective review was conducted for the duration between 1st January 2005 to 31st December 2016. Total of fifty-one …

Does Surgeon Experience Influence The Amount Of Radiation Exposure During Orthopedic Procedures?: A Systematic Review, Azeem Tariq Malik, Hamid Hussain Rai, Riaz Hussain Lakdawala

Section of Orthopaedic Surgery

With an increasing use of intraoperative fluoroscopy in operating rooms worldwide, the topic of radiation exposure has become a major concern among hospital staff, doctors and patients alike. Since fluoroscopy has become an integral part in orthopedic intraoperative management, we sought to identify whether surgeon grade or experience plays a role in the amount of radiation used and consequently exposed. We performed a systematic review examining the association between surgeon experience and radiation exposure using primary outcome measures (radiation dose and total screening time/fluoroscopy time). To be included in the review, the study population had to compare varying surgeon experience …

A Value Analysis Of Microsurgical Lower Extremity Reconstruction Vs. Acellular Urinary Bladder Matrix (Ubm) For Radiation Wounds Of The Lower Extremity, Christopher J. Micallef, Jamie N. Johnson, R. Michael Johnson

Orthopaedic Surgery Faculty Publications

In the USA, external beam radiation is offered to patients as an alternative to surgery for non-melanoma skin cancers. While this technique may be useful in highly specific patient populations, recalcitrant chronic radiation wounds can result. These complex wounds ultimately may require major reconstructive surgery to achieve closure. Porcine urinary bladder matrix (UBM) may be effective in the treatment of radiation wounds and eliminating the need for vascularized tissue transfers. A case report of an elderly male with bilateral radiation wounds of the lower extremity, one extremity treated with free flap reconstruction and the other with porcine urinary bladder matrix, …

Ultrasound-Triggered Antibiotic Release From Peek Clips To Prevent Spinal Fusion Infection: Initial Evaluations., Lauren J. Delaney, Daniel Macdonald, Jay Leung, Keith Fitzgerald, Alex M. Sevit, John R. Eisenbrey, Neil Patel, Flemming Forsberg, Christopher K. Kepler, Taolin Fang, Steven M. Kurtz, Noreen J. Hickok

Department of Orthopaedic Surgery Faculty Papers

Despite aggressive peri-operative antibiotic treatments, up to 10% of patients undergoing instrumented spinal surgery develop an infection. Like most implant-associated infections, spinal infections persist through colonization and biofilm formation on spinal instrumentation, which can include metal screws and rods for fixation and an intervertebral cage commonly comprised of polyether ether ketone (PEEK). We have designed a PEEK antibiotic reservoir that would clip to the metal fixation rod and that would achieve slow antibiotic release over several days, followed by a bolus release of antibiotics triggered by ultrasound (US) rupture of a reservoir membrane. We have found using human physiological fluid …

Results Of A Feasibility Randomized Controlled Trial (Rct) Of The Toolkit For Optimal Recovery (Tor): A Live Video Program To Prevent Chronic Pain In At-Risk Adults With Orthopedic Injuries, Ana-Maria Vranceanu, Cale A. Jacobs, Ann Lin, Jonathan Greenberg, Christopher J. Funes, Mitchel B. Harris, Marilyn M. Heng, Eric A. Macklin, David Ring

Orthopaedic Surgery and Sports Medicine Faculty Publications

Background: Orthopedic injuries are the leading cause of hospital admissions in the USA, and many of these patients transition into chronic pain. Currently, there are no evidence-based interventions targeting prevention of chronic pain in patients with orthopedic injuries. We iteratively developed a four-session intervention “The Toolkit for Optimal Recovery” (TOR) which we plan to subsequently test for efficacy in a phase III hybrid efficacy-effectiveness multi-site clinical trial. In order to prevent methodological weaknesses in the subsequent trial, we conducted a feasibility pilot to evaluate the TOR delivered via secure live video versus usual care (UC) in patients with orthopedic injuries …

A Novel Handheld Robotic-Assisted System For Unicompartmental Knee Arthroplasty: Surgical Technique And Early Survivorship., Andrew K. Battenberg, Nathan A. Netravali, Jess H. Lonner

Department of Orthopaedic Surgery Faculty Papers

Technology, including robotics, has been developed for use in unicompartmental knee arthroplasty (UKA) to improve accuracy and precision of bone preparation, implant positioning, and soft tissue balance. The NAVIO™ System (Smith and Nephew, Pittsburgh, PA, United States) is a handheld robotic system that assists surgeons in planning implant positioning based on an individual patient's anatomy and then preparing the bone surface to accurately achieve the plan. The surgical technique is presented herein. In addition, initial results are presented for 128 patients (mean age 64.7 years; 57.8% male) undergoing UKA with NAVIO. After a mean of follow-up period of 2.3 years, …

Opioid Consumption After Orthopedic Surgery: Prospective Randomized Trial On The Effects Of Preoperative Counseling, Sage Vincent, Taylor Paskey, Elizabeth Critchlow, Erica Mann, Talia Chapman, Md, Kristin Sandrowski, Md, Asif Ilyas, Md

Phase 1

Introduction: Recently, there have been increases in morbidity and mortality associated with opioid medications. Physician overprescribing, particularly within orthopedics, contributes to large quantities of leftover opioids, leading to an increased risk of non-medical opioid use and abuse.

Objective: To understand the role of preoperative patient counseling on postoperative opioid consumption, a prospective randomized study was done, with the idea that patients receiving counseling would take fewer opioids than their control counterparts.

Methods: Patients undergoing elective outpatient orthopedic surgery at Jefferson affiliate hospitals were enrolled over a 3-month period. Patients were randomized to a control group or to receive preoperative counseling …

Motor-Vehicle Crash Patient Injury Patterns From A Level One Trauma Center In A Metropolitan City: A Cross-Sectional Study, Obada Hasan, Sadaf Sheikh, Asad Abbas, Nida Zahid, Naveed Baloch

Section of Orthopaedic Surgery

Introduction: Motorcycles are an inexpensive and popular mode of transportation in Karachi, Pakistan, despite the increasing number of motor vehicle injuries. Although motorcycle-related injuries have been studied previously, to our knowledge, there are no published reports on the orthopedic injuries associated with motorcycles crashes.
Methods: We conducted a cross-sectional study of medical records of patients with motorcycle-related injuries in 2015, at the Aga Khan University in Karachi, Pakistan. We reviewed the patient demographic and medical data, helmet use, the Glasgow coma score, the spectrum of injuries, length of stay, specific injury diagnosis, and final disposition of patients. Data were analyzed …

Analysing Outcomes Through Orthopaedic Trauma Registry: A Prospective Cohort Study, Tashfeen Ahmad, Zehra Abdul Muhammad, Shahryar Noordin, Ammar Humayun

Section of Orthopaedic Surgery

Objective: To develop a registry for recording injury-specific data to identify gaps and improve care.
Methods: The prospective cohort study was conducted at Aga Khan University Hospital, Karachi, from June 2015 to July 2018 though enrollment of patients with limb trauma is continuing to date. Data on injuries and management related to Tibia shaft fractures was collected from medical records, and outcomes were assessed on follow-up visits. Internationally validated injury-specific scores were utilised for assessing functional, clinical and radiological outcomes. SPSS version 19 was used for data analysis.
Results: There were 763 patients with 825 limb injuries. Of the injuries, …