Orthopedics Commons^™

Unicameral Bone Cysts: Current Concepts, Shahryar Noordin, Salim Allana, Masood Umer, Mujahid Jamil, Kiran Hilal, Nasir Ud Din

Section of Orthopaedic Surgery

Unicameral bone cysts (UBC) or simple/solitary bone cysts are benign fluid filled cavities that enlarge over time, resulting in thinning of the bone. Usually these cysts are reported in the metaphyseal areas of long bones with open physes. 85% of UBCs occur almost exclusively in children and adolescents. UBCs are more aggressive in the first decade of life and correspondingly the recurrence rate for these patients is four times that for adolescents. The proximal humerus and femur account for almost 90% of these cases. UBCs are classified as active when they are within 1 cm of the physis and latent …

Secukinumab Improves Active Psoriatic Arthritis Symptoms And Inhibits Radiographic Progression: Primary Results From The Randomised, Double-Blind, Phase Iii Future 5 Study., Philip Mease, Désirée Van Der Heijde, Robert Landewé, Shephard Mpofu, Proton Rahman, Hasan Tahir, Atul Singhal, Elke Boettcher, Sandra Navarra, Karin Meiser, Aimee Readie, Luminita Pricop, Ken Abrams

Articles, Abstracts, and Reports

OBJECTIVES: To evaluate the effect of subcutaneous (s.c.) secukinumab, an interleukin-17A inhibitor, on clinical signs and symptoms and radiographic progression in patients with psoriatic arthritis (PsA).

METHODS: Adults (n=996) with active PsA were randomised 2:2:2:3 to s.c. secukinumab 300 mg or 150 mg with loading dose (LD), 150 mg without LD or placebo. All groups received secukinumab or placebo at baseline, weeks 1, 2 and 3 and then every 4 weeks from week 4. The primary endpoint was the proportion of patients achieving an American College of Rheumatology 20 (ACR20) response at week 16.

RESULTS: Significantly more patients achieved an …

Injuries In The Chinese Arena Football League: American Versus Chinese Players., Tianwu Chen, Austin Wetzler, Scott Singer, Michael Feldman, David Rubenstein, Gunnar Gillespie, Shiyi Chen, Merrick Wetzler

Rothman Institute Papers

Background: Arena football is an indoor version of American football played in indoor arenas on a smaller field with 8 players per team. Only 1 study has evaluated injury rates in arena football, and no study had compared 2 distinct cohorts of players.

Purpose/Hypothesis: The purpose of this study was to evaluate and compare injury rates in American versus Chinese athletes in the Chinese Arena Football League. Our hypothesis was that the rate of significant injuries (≥7 days of time lost from play) would be statistically significantly higher in Chinese athletes.

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

Methods: …

Secukinumab Versus Adalimumab For Psoriatic Arthritis: Comparative Effectiveness Up To 48 Weeks Using A Matching-Adjusted Indirect Comparison., Peter Nash, Iain B Mcinnes, Philip Mease, Howard Thom, Matthias Hunger, Andreas Karabis, Kunal Gandhi, Shephard Mpofu, Steffen M Jugl

Articles, Abstracts, and Reports

INTRODUCTION: Secukinumab and adalimumab are approved for adults with active psoriatic arthritis (PsA). In the absence of direct randomized controlled trial (RCT) data, matching-adjusted indirect comparison can estimate the comparative effectiveness in anti-tumor necrosis factor (TNF)-naïve populations.

METHODS: Individual patient data from the FUTURE 2 RCT (secukinumab vs. placebo; N = 299) were adjusted to match baseline characteristics of the ADEPT RCT (adalimumab vs. placebo; N = 313). Logistic regression determined adjustment weights for age, body weight, sex, race, methotrexate use, psoriasis affecting ≥ 3% of body surface area, Psoriasis Area and Severity Index score, Health Assessment Questionnaire Disability Index …

Percutaneous Heel Cord Release For Clubfoot: A Retrospective, Multicentre Cost Analysis, B. Hedrick, F. K. Gettys, S. Richards, Ryan D. Muchow, C. -H. Jo, M. D. Abbott

Orthopaedic Surgery and Sports Medicine Faculty Publications

Purpose The Ponseti method of treatment is the standard of care for idiopathic clubfoot. Following serial casting, percutaneous tendo-Achilles tenotomy (TAT) is performed to correct residual equinus. This procedure can be performed in either the outpatient clinic or the operating room. The purpose of this study was to evaluate the expense of this procedure by examining hospital charges in both settings.

Methods We retrospectively reviewed charts of 382 idiopathic clubfoot patients with a mean age of 2.4 months (0.6 to 26.6) treated with the Ponseti method at three institutions. Patients were divided into three groups depending on the setting for …

Extreme Lateral Interbody Fusion Complicated By Fungal Osteomyelitis: Case Report And Quick Review Of The Literature., Ronen Blecher, Emre Yilmaz, Marc Moisi, Rod J Oskouian, Jens Chapman

Articles, Abstracts, and Reports

The authors describe a 67-year-old man with a prior history of alcohol abuse who presented with a complaint of worsening low back pain. Four months prior to his presentation, the patient had undergone extreme lateral interbody fusion (XLIF) of his lumbar 3-4 segment for the treatment of his chronic low back and legs pain. Imaging revealed a loosening of his interbody fusion implant on top of his prior lumbar spine instrumentation. In surgery, the removal of his loose implant was followed by decompression, the stabilization of the collapsed segment, and the implant of antibiotic-impregnated polymethyl-methacrylate (PMMA) spacer and beads. At …

Osteoporosis And Its Perspective In Pakistan: A Review Of Evidence And Issues For Addressing Fragility Fractures, Aysha Habib Khan, Lena Jafri, Sibtain Ahmed, Shahryar Noordin

Department of Pathology and Laboratory Medicine

Despite major advances in osteoporosis diagnosis and treatment, low rates of investigating and treating osteoporosis in patients with fragility fracture are reported in Pakistan. Cost of therapies, time and cost of resources for diagnosis, concerns about medications and lack of clarity regarding the onus of responsibility to undertake this care, are some of the barriers to osteoporosis identification and treatment. Data from our part of the world on osteoporosis as well as on fragility fractures is sparse. This review addresses the current screening and diagnostic strategies for osteoporosis and reviews the existing literature to highlight the issues prevalent in our …

Melatonin-Micronutrients Osteopenia Treatment Study (Mots): A Translational Study Assessing The Effects Of Melatonin, Strontium Citrate, Vitamin D3 And Vitamin K2 On Bone Density, Bone Turnover Markers And Health-Related Quality Of Life In Postmenopausal Osteopenic Women Following A One-Year Double-Blind Randomized Placebo-Controlled Trial And On Osteoblast-Osteoclast Co-Cultures, Sifat Maria

Electronic Theses and Dissertations

Objective: The purpose of this study was to assess if a novel combination of melatonin and three other natural bone-aiding micronutrients: strontium citrate, vitamins D₃ and K₂ (MSDK) could improve bone health by modulating the activity of osteoblasts and osteoclasts in favor of balanced bone remodeling and by improving the overall health-related quality of life in postmenopausal osteopenic women.

Methods: The Melatonin-micronutrients Osteopenia Treatment Study (MOTS) is a translational research study that used both clinical and in vitro approaches to assess the efficacy of MSDK on bone health in women and to identify potential mechanisms for its effects. …

Performance Of The Promis In Patients After Anterior Cruciate Ligament Reconstruction, Elizabeth J. Scott, Robert Westermann, Nathalie A. Glass, Carolyn Hettrich, Brian R. Wolf, Matthew J. Bollier

Orthopaedic Surgery and Sports Medicine Faculty Publications

Background: The Patient-Reported Outcomes Measurement Information System (PROMIS) is designed to advance patient-reported outcome (PRO) instruments by utilizing question banks for major health domains.

Purpose: To compare the responsiveness and construct validity of the PROMIS physical function computer adaptive test (PF CAT) with current PRO instruments for patients before and up to 2 years after anterior cruciate ligament (ACL) reconstruction.

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

Methods: Initially, 157 patients completed the PROMIS PF CAT, Short Form-36 Health Survey (SF-36 physical function [PF] and general health [GH]), Marx Activity Rating Scale (MARS), Knee injury and Osteoarthritis Outcome …

Corticosteroid Administration To Prevent Complications Of Anterior Cervical Spine Fusion: A Systematic Review., Shayan Abdollah Zadegan, Seyed Behnam Jazayeri, Aidin Abedi, Hirbod Nasiri Bonaki, Alexander R. Vaccaro, Vafa Rahimi-Movaghar

Rothman Institute Papers

Study Design: Systematic review.

Objectives: Anterior cervical approach is associated with complications such as dysphagia and airway compromise. In this study, we aimed to systematically review the literature on the efficacy and safety of corticosteroid administration as a preventive measure of such complications in anterior cervical spine surgery with fusion.

Methods: Following a systematic literature search of MEDLINE, Embase, and Cochrane databases in July 2016, all comparative human studies that evaluated the effect of steroids for prevention of complications in anterior cervical spine surgery with fusion were included, irrespective of number of levels and language. Risk of bias was assessed …

Multimodal Pain Management Protocol Versus Patient Controlled Narcotic Analgesia For Postoperative Pain Control After Shoulder Arthroplasty, Thema Nicholson, Mitchell Maltenfort, Charles Getz, Mark Lazarus, Gerald R. Williams, Surena Namdari

Rothman Institute Papers

Background: Our institution's traditional pain management strategy after shoulder arthroplasty has involved the utilization of postoperative patient-controlled narcotic analgesia. More recently, we have implemented a protocol (TLC) that utilizes a multimodal approach. The purpose of this study was to determine whether this change has improved pain control and decreased narcotic utilization. Methods: Patients undergoing primary total shoulder or reverse arthroplasty were retrospectively studied. All patients underwent interscalene brachial plexus blockade. "Traditional" patients were provided a patient-controlled analgesic pump postoperatively. TLC patients were given preoperative and postoperative multimodal, non-narcotic analgesic medications and breakthrough narcotics. Morphine equivalent units (MEU) consumed and Visual …

Spinal Cord Trauma: An Overview Of Normal Structure And Function, Primary And Secondary Mechanisms Of Injury, And Emerging Treatment Modalities, Daniel Morin

Senior Honors Theses

The structures of the spinal cord and vertebral column are designed to provide flexibility, while still providing ample protection for the spinal cord deep within. While it does offer remarkable protection against most routine trauma, the spinal cord is still vulnerable to high-force etiologies of trauma and may become damaged as a result. These events are referred to as primary injury. Following the initial injury, the body’s own physiological responses cause a cascade of deleterious effects, known as secondary injury. Secondary injury is a major therapeutic target in mitigating the effects of spinal cord injury (SCI), and much research is …

A Review Of Mesenchymal Stem Cell Injections For Osteoarthritis, Ammar Qureshi, Jill Goodwin, Franklin D. Shuler, Timothy Wilson-Byrne, John J. Jasko, Charles Giangarra

Marshall Journal of Medicine

Mesenchymal stem cell (MSC) injections for osteoarthritis is reviewed.

Methods- PubMed search identifying articles in English from 2003-2018 that used intra- articular injection (IA), cartilage repair, cartilage regeneration, chondral injury, adipose stem cells, bone marrow stem cells, mesenchymal stem cells, or autologous stem cells.

Results – 388 patients receiving IA MSC injections are discussed with data obtained from 10 case reports or case series, 4 randomized clinical trials (RCT), 1 cohort study, and 3 case controlled therapeutic studies.

Conclusions – MSC injections may be an effective adjunct in the management of osteoarthritis and a variety of cartilage related pathologies.

Pyomyositis Mistaken For Septic Hip Arthritis In Children: The Role Of Mri In Diagnosis And Management, Franklin D. Shuler, Grant S. Buchanan, Cody Stover, Brock Johnson, Milad Modarresi, John J. Jasko

Marshall Journal of Medicine

Septic arthritis is an orthopaedic emergency which requires timely management to prevent joint destruction and poor outcome. Differentiating septic arthritis from transient synovitis in pediatric patients is aided by the use of Kocher criteria which have excellent sensitivity but lack specificity. In addition to these two disorders, primary pyomyositis is bacterial infection of skeletal muscle that most commonly affects children. Patients present with pain, swelling, fever, and elevated inflammatory markers which mimics septic arthritis. If left untreated, pyomyositis can lead to abscess formation and sepsis.

Due to potential for nearly identical presentations of septic arthritis and pyomyositis, differentiation of these …

Total Hip Arthroplasty: Copd And Its Effect On Postoperative Complications, Camille Boustani, Shane A. Sobrio, Alex Gu, Chapman Wei, Andrew Holmes

GW Research Days 2016 - 2020

Introduction

The demand for Total Hip Arthroplasty (THA) has rapidly risen and continues to due to high success rates of this procedure and the growing aging population. Particularly in Chronic Obstructive Pulmonary Disease (COPD), studies have indicated an increased risk of various postoperative complications across several surgery types. Despite the prevalence of COPD, very little has been investigated regarding postsurgical complications in patients with COPD following a THA. The aim of the current study is to utilize the NSQIP database and determine differences in short-term postoperative complications after undergoing THA, comparing patients with and without COPD.

Methods

In total, 74,814 …

Lumbar Decompression Surgery: Does Chronic Steroid Use Increase The Risk Of Postoperative Infectious Complications? – A Study Of The National Surgical Quality Improvement Program (Nsqip) Database, Shane Sobrio, Mikel Thista, Raj Rao, Alex Gu, Chapman Wei, Warren Yu

GW Research Days 2016 - 2020

Intro: It has long been established that corticosteroids have a negative impact on the human immune system’s ability to function at an optimal level. Many past studies have shown that patient’s will have higher rates of infection if they are taking chronic steroids. What has yet to be established is just how much of an increased risk patients on chronic steroids have for infection after undergoing lumbar decompression surgeries, of which there are thousands per year. We hypothesize that patients on chronic steroids will have higher rates of surgical site infections and higher rates of other infections (UTI, pneumonia, etc.) …

The Association Of Polymorphism Rs3736228 Within The Lrp5 Gene With Bone Mineral Density In A Cohort Of Caucasian Young Adults, Mohamed J. H. Al-Amoodi, Whitney Jones, Danny Lee, Steven Mckenzie, Helen C. Miller, Zach Zeller, Seth Stubblefield, Susan Knoblach, Heather Gordish-Dressman, Dustin Hittel, Laura L. Tosi

GW Research Days 2016 - 2020

INTRODUCTION: Osteoporosis is a significant burden for our aging population. Developing a better understanding of the genetic underpinnings of poor bone quality may assist in the future development of prevention strategies. Correa-Rodriguez et al. have identified a group of single nucleotide polymorphisms (SNPs) that were associated with bone mineral density (BMD) in a population of Spanish Caucasians. In particular, they found that SNP rs3736228 in the low-density lipoprotein receptor related protein 5 (LRP5) gene had an influence on BMD. While the role of LRP5 in the Wnt canonical pathway has been fairly well characterized, its association with phenotypic BMD and …

Risk For Post-Spinal Surgery Complications Associated With Pre-Operative Blood Transfusions, Ryan Lee, William Probasco, Alex Gu, Raj Rao

GW Research Days 2016 - 2020

Introduction: The frequency of spinal surgeries has increased dramatically in the United States over the past decade and, as with all surgeries, spinal procedures carry inherent risks for complications after the operation. Recently, it has been recognized that procedures in which intra-operative/post-operative blood transfusions are administered carry a higher risk of postoperative morbidity and increased length of hospital stay (Seisean et al.). Despite this, there is little literature, currently, analyzing post-operative complications associated with blood transfusions taking place 72 hours prior to spinal operations. The aim of this study was to investigate the prevalence of pre-operative blood transfusions in …

Oncology Section Edge Task Force On Cancer: Measures Of Cancer-Related Fatigue—A Systematic Review, Mary Insana Fisher, Claire Davies, Hannah Lacy, Deborah Doherty

Physical Therapy Faculty Publications

Background: Cancer-related fatigue (CRF) is one of the most common side effects of cancer and cancer treatment. Being able to accurately screen for and assess CRF will improve access to and prescriptions for interventions. Valid and reliable measures to screen for and assess CRF need to be identified.

Purpose: To identify and recommend reliable, valid, and clinically useful tools to screen for and assess CRF among those treated for cancer.

Methods: A systematic review of the literature was conducted to assess the published psychometric properties and clinical feasibility of each method identified. Task force members independently reviewed each measure using …

What Are Biofilms?, Noreen J. Hickok

Department of Orthopaedic Surgery Faculty Papers

No abstract provided.