Surgery Commons^™

Primary Total Hip Arthroplasty For A Displaced Femoral Neck Fracture In An Above-The-Knee Amputee: A Case Report., Nathaniel J Starcher, Jignesh Patel, Andrew R Golden, Cameron A Kirk

Surgery Articles

Introduction: Femoral neck fractures in patients with ipsilateral above-knee amputations are uncommon and present unique diagnostic, biomechanical, and surgical challenges. The absence of a distal limb limits fracture reduction, intraoperative manipulation, and implant positioning, making standard treatment techniques difficult to perform. Although several fixation and arthroplasty strategies have been described for lower-extremity amputees, reports detailing primary total hip arthroplasty (THA) for displaced femoral neck fractures in young above-knee amputees remain scarce. This case highlights a practical surgical technique utilizing a temporary Steinmann pin as a lever arm to facilitate femoral control during arthroplasty and contributes to the limited orthopedic literature …

Induced Membrane Reconstruction Of A 6-Cm Ulnar Defect With Concurrent Revision Bone Grafting Of Radial Nonunion Following Gustilo-Anderson Type Iiib Open Forearm Fracture: A Case Report., John N Manfredi, Abdullah B Chandasir, Mitchell Lomis, Brent Prenger, Humzah Ali, Kyra Urquhart-Foster, Caleb J Bischoff, Abrar Adil Ansari

Surgery Articles

The induced membrane technique (IMT) is a two-stage reconstructive procedure for critical-sized bone defects. We report a 31-year-old male who sustained a Gustilo-Anderson grade IIIB open fracture of the radius and ulna following a high-energy dirt bike injury, complicated by Serratia marcescens fracture-related infection and septic nonunion. Intraoperative debridement at Stage 1 revealed a 6-cm defect of the ulna, which was managed with an antibiotic-impregnated polymethylmethacrylate (PMMA) spacer. A concomitant radial nonunion, identified on postdebridement CT, was addressed at Stage 2 with concurrent revision open reduction and internal fixation (ORIF) and autogenous femoral bone grafting. Culture-directed oral antibiotic therapy was …

Early Hands-On Surgical Exposure: Outcomes Of A Student-Led Surgical Externship Program For Preclinical Students, Meryem C. Guler, Elizabeth Spitz, Jennifer E. Geller, Talar Tatarian, Renee Tholey

Department of Surgery Faculty Papers

Objective: Early surgical exposure may potentially influence medical students' decision to pursue a surgical career. At our urban, academic medical school, senior medical students developed a Surgical Externship Program (SEP) to provide first-years with hands-on OR experience. This program is a structured 1- to 2-week immersive experience in which first-year students scrubbed into operations, participated in rounds, and engaged with surgical teams under resident and attending supervision. This study evaluates the SEP's impact on surgical interest, OR confidence, and clinical exposure.

Setting: Academic tertiary care hospital.

Participants: First-year medical students.

Design: First-year students participated in a 1- or 2-week SEP …

Reversible Microvascular Ischemia With St-Segment Elevation: An Underrecognized Manifestation Of Antibody-Mediated Rejection In Cardiac Allograft Recipients, Jonathan Ahn, Justin Daneshrad, Liset Stoletniy, Dmitry Abramov

The VAD Journal

Electrocardiographic manifestations of cardiac allograft rejection are often subtle, and stress-induced ST-segment elevation associated with antibody-mediated rejection (AMR) is rarely reported. We describe a 34-year-old heart transplant recipient with progressive exertional angina, nonobstructive coronary disease on angiography, and exercise-induced ST-segment elevation in lead augmented vector right, high-lateral leads I, and augmented voltage left, along with diffuse ST-segment depressions, hypotension, and transient ventricular tachycardia. Concurrent emergence of complement-binding donor-specific antibodies with high mean fluorescence intensity raised concern for AMR, prompting treatment with corticosteroids, plasma exchange, and intravenous immunoglobulin despite the absence of biopsy confirmation. After therapy, symptoms, exercise-induced ischemic electrocardiographic abnormalities, …

Osteoblast-Derived Nerve Growth Factor Supports Skeletal Adaptation To Mechanical Load And The Osteoanabolic Effect Of Gambogic Amide In Mice, Ibtesam Rajpar, Eri Mclaughlin, Gabriella Fioravanti, Nicholas Ruggiero, Nohael Cherian, Liliana Minichiello, Ryan E. Tomlinson

Department of Orthopaedic Surgery Faculty Papers

In adult mice, new bone accrual following mechanical load is mediated by the neurotrophin nerve growth factor (NGF) that is expressed by osteoblasts on the bone surface. NGF can bind to its high affinity receptor, neurotrophic tyrosine kinase receptor type 1 (TrkA), on peripheral sensory nerves resident in bone and support new bone formation. However, the osteoanabolic therapeutic potential of NGF-TrkA signaling to repair bone is limited due to the long-lasting thermal and mechanical hyperalgesia induced by administration of NGF in mice and humans. Here, we investigated whether 1) mature osteoblasts are the primary source of NGF required for bone …

Operative Vs Non-Operative Management Of Ventral Hernia: A Population Based Study Of Long-Term Benefits And Consequences, Sourav Podder, Julia A. Baran, Scott H. Koeneman, Francesco Palazzo, Nicole L. Dugan, Christopher Keating, Sami Tannouri

Department of Surgery Faculty Papers

Purpose: Ventral hernia (VH) management has progressed beyond simply physical repair of the defect. It now involves a strategy that purposefully restores abdominal core function and prevents future complications. This study investigates the association between ventral hernia repair (VHR) and functional disorders related to the abdominal core in addition to bowel obstruction, opioid misuse, and physical therapy utilization.

Methods: This retrospective cohort study used administrative codes from the TriNetX database. The outcomes of interest were spine and pelvic floor dysfunction, constipation, incontinence, genital prolapse, bowel obstruction, opioid misuse, and physical therapy utilization.

Results: A total of 587 384 patients were …

Interface Geometry Governs Probe Insertion Mechanics And Electrode Deviation In Layered Brain-Mimicking Phantoms For Deep Brain Stimulation, Siyu Chen, Chengyuan Wu, Ethan Anders, Rungun Nathan, Olivia M. Bailey, Qifu Wang, Curtis L. Johnson, Qianhong Wu

Department of Neurosurgery Faculty Papers

Parkinson's disease (PD) is a progressive neurological disorder often treated with Deep Brain Stimulation (DBS), a surgical procedure that involves implanting electrodes to improve motor function. Accurate electrode placement is critical for treatment efficacy but can be influenced by tissue deformation, insertion forces, and the mechanical properties of brain tissue. In this study, we investigated the role of layer interface angle as a controlled biomechanical factor affecting insertion forces and electrode deviation. A two-layer agar gel phantom was constructed to produce a prescribed stiffness transition between a lower-stiffness and a higher-stiffness gel layer, and its small-amplitude dynamic shear-stiffness contrast was …

Neuroimmune Phenotyping As The Next Frontier In Chronic Pain Medicine For Musculoskeletal Back Pain, Samer G. Salman, Rohan A. Phadke, Adithya Nair, Rahul Kumar, Arbaz Momin, Alireza Tavakkoli, James Rizkalla

Department of Neurosurgery Posters

Background: Chronic low back pain encompasses heterogeneous mechanical, neuropathic, nociplastic, and myofascial presentations that may reflect distinct neuroimmune mechanisms. We synthesized evidence linking these phenotypes to measurable biological features and clinically relevant treatment strategies.

Methods: We conducted a structured literature search of MEDLINE, Scopus, Web of Science, and the Cochrane Central Register of Controlled Trials for studies published from January 2005 through January 2025. Systematic reviews, randomized controlled trials, and mechanistic studies addressing neuroinflammation, glial activation, central sensitization, biomarkers, or imaging were organized according to four clinically relevant pain phenotypes and translational readiness.

Results: Neuroimmune findings differed across axial mechanical, …

My Love Story With Hifs In The Disc: A Journey To The Humboldt Research Award, Makarand V. Risbud

Department of Orthopaedic Surgery Faculty Papers

The intervertebral disc is a prime example of tissue adaptation to metabolic and mechanical extremes. As the largest avascular organ in the human body, the disc and the central nucleus pulposus (NP) endure constant compressive loading while sustaining a hypoxic, relatively acidic, and hyperosmotic microenvironment that would be inhospitable to most cell types. Over the past two decades, work from my laboratory has revealed extraordinary details of this type of adaptation, that hypoxia-inducible factors (HIFs), particularly HIF-1α, serve as master regulators of NP cell survival, metabolism, and matrix homeostasis. This review chronicles the scientific and personal journey that began with …

A Worldwide Cross-Sectional Survey Seeks The Current Global Practice Patterns On Perioperative Management In Elective Shoulder Replacement Surgery, Maciej Simon, Farhad Moola, Jennifer Coghlan, Osvandre Lech, Carlos Ramos, Njalalle Baraza, Hadrian Platzer, Simone Gantz, Andreas Seekamp, Babak Moradi

General Surgery, East Africa

Background Perioperative management in elective shoulder arthroplasty varies widely, with no universal consensus on best practices. This study aimed to characterize current global standards of perioperative care, including pre-operative, intraoperative, and post-operative management, among orthopedic surgeons performing elective shoulder replacement surgery, with the aim of contributing to a global standard of care.

Methods A comprehensive online questionnaire was designed and anonymously distributed to orthopedic societies on each continent. Participants were cross-sectionally surveyed with the goal of identifying current global pre-operative, intraoperative, and post-operative practices in patient care and discharge management.

Results Eighteen societies from 5 continents participated in the survey. …

Neuromotor Compromise As A Presenting Symptom In Advanced Lower Extremity Soft Tissue Sarcoma: A Case Series, Adam Maestas, Parsa Charkhchi, Farbod Malek

HCA Healthcare Journal of Medicine

Background

Soft tissue sarcomas (STS) are rare malignant tumors of mesenchymal origin, representing less than 1% of adult cancers. Approximately half arise in the extremities, most often presenting as a painless, enlarging mass. Symptoms are often misattributed to benign neuropathic or musculoskeletal causes, leading to delayed diagnosis and treatment. Neurological deficits such as foot drop or distal weakness are exceptionally uncommon presenting signs and generally indicate advanced local invasion or compression of major peripheral nerves. Recognizing acute neuromotor compromise as a potential manifestation of soft tissue malignancy is crucial for timely oncologic evaluation and limb-sparing management.

Case Presentation

This series …

Comparing The Expression Of Estrogen Receptors, Progesterone Receptors, And Human Epidermal Growth Factor Receptor 2 Between Initial Biopsy And Excision Specimens In Invasive Breast Carcinoma Cases. Is There A Need For Universal Repeat Testing? Experience From A Community Hospital, Astrid M. Sacasa, Gul Emek Wymer, Susana Ferra

HCA Healthcare Journal of Medicine

Background

The current national recommendation is that breast biomarkers estrogen receptors (ER), progesterone receptors (PR), and human epidermal growth factor receptor 2 (HER2) testing should be done on all primary invasive breast carcinomas and on recurrent or metastatic tumors. Repeat testing on a subsequent excision specimen is not indicated unless results appear discordant with the histopathologic findings. The objective of the current study was to evaluate the need for adopting universal reflex re-testing of breast biomarkers in excision specimens in our institution.

Methods

The study population included 70 sequential invasive breast cancer patients where the results of ER, PR, and …

Psychological Adaptation In Colorectal Cancer Survivors: Pilot Study Findings, Anuja L. Sarode, Emily M. Su, Amber Kerstetter-Fogle, Steve Paciorek, Erica L. Laipply

HCA Healthcare Journal of Medicine

Background

In this pilot study, we examined psychological impacts of colorectal cancer (CRC), focusing on cancer-related posttraumatic stress disorder (CR-PTSD) symptoms, posttraumatic growth (PTG), and their relationship with coping strategies in surgically treated CRC patients.

Methods

This prospective pre- and postoperative pilot study assessed CRC patients at 2 time points, pre- and postoperative. Psychological symptoms were evaluated using the PTSD Checklist for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (PCL-5) and the PTG Inventory Short Form (PTGI-SF). Coping strategies were assessed using the Brief Coping Orientation to Problems Experienced (COPE) instrument. Changes in CR-PTSD, PTG, and coping …

Coping Beyond Cancer: Exploring Fear Of Recurrence In Colorectal Cancer Survivors—A Pilot Investigation, Emily M. Su, Steve Paciorek, Erica L. Laipply, Anuja L. Sarode

HCA Healthcare Journal of Medicine

Background

Evidence is limited on the fear of cancer recurrence (FCR) among colorectal cancer (CRC) survivors in the US, especially regarding patterns and trends of post-recovery coping mechanisms. This pilot mixed-methods study quantified FCR, examined its associations with Brief COPE domains, and contextualized coping through qualitative analysis.

Methods

Twenty-three patients who successfully underwent CRC surgery were included in this pilot study. Fear of cancer recurrence was measured using the FCR Inventory (FCRI) Short Form, and coping strategies were assessed with the Brief Coping Orientation to Problems Experienced (COPE) survey. Descriptive statistics summarized participant characteristics, FCR, and COPE scores. Spearman correlation …

Retrieval Strategies For Embolized Left Atrial Appendage Closure Devices, Usama Sadiq, Muneeba Ali, Stacey Damito, Maxwell Ambrosino, Muhammad Sabri, Muhammad Ahmad Sadiq, Muhammad Hamza Sadiq, Richard Kovach, Sheena Rastogi, Muhammad Raza

Abington Jefferson Health Papers

BACKGROUND: Device embolization (DE) is a rare but potentially life-threatening complication of left atrial appendage occlusion (LAAO). As landmark trials broaden the eligible population for LAAO, operator preparedness for DE management becomes increasingly critical.

CASE SUMMARY: We present 4 cases of LAAO DE managed with distinct retrieval strategies: 1) open surgical retrieval with concurrent AtriClip ligation for an endothelialized left atrial device; 2) sequential transseptal then retrograde arterial snaring for intraprocedural migration to the abdominal aorta; 3) transseptal retrieval using a dedicated ONO system with cerebral embolic protection for partial left atrial dislodgment; and 4) retrograde large-bore arterial retrieval for …

Allograft Tendon Pretensioning Technique Guide., Joseph R Brown, Robert W Mendicino

Surgery Articles

In foot and ankle surgery, allograft tendons are frequently used in both primary and revision cases to enhance stability and function. However, postoperative complications, such as creep, can compromise the intended correction and stability over time. This paper presents a practical guide on pretensioning techniques prior to implantation, aiming to reduce creep and improve long-term outcomes. Using two common allograft specimens, we demonstrate pretensioning methods with specific focus on tendon stitching, techniques for securing the allograft to the graft board, optimal tensioning and time parameters. We recommend pretensioning at 80 N for approximately 30 min to effectively decrease creep and …

An Investigation Of Pelvic Kinematics And Implications For Total Hip Arthroplasty, Kathryn Holland Colone

Electronic Theses and Dissertations

Total hip arthroplasty (THA) is one of the most commonly performed orthopaedic procedures, with approximately 500,000 surgeries performed annually in the United States alone. Although THA is widely regarded as highly successful, postoperative complications persist, highlighting the multifactorial nature of THA outcomes. Previous studies have demonstrated the importance of implant positioning and soft tissue mechanics, yet challenges remain in optimizing surgical decisions on a patient-specific basis. Recent advances in surgical planning tools have shifted the focus of preoperative planning toward optimizing patient-specific outcomes, highlighting the need to better understand how patient anatomy, surgical technique, and joint mechanics interact to influence …

Mechanism Of Injury And Fracture Status Influence Outcomes After Central Cord Injury, Karlo M. Pedro, Mohammed Ali Alvi, Kathleen Zang, Christopher Lozano, Jetan H. Badhiwala, Jefferson R. Wilson, James Harrop, James D. Guest, Bizhan Aarabi, Christopher I. Shaffrey, Michael G. Fehlings

Department of Neurosurgery Faculty Papers

Central cord syndrome (CCS) is the most common form of incomplete cervical spinal cord injury (SCI), yet its optimal management remains controversial. We examined whether stratifying CCS by injury stability improves treatment assessment. CCS was defined as an American Spinal Injury Association Impairment Scale (AIS) C/D cervical SCI with a ≥5-point lower-upper extremity motor score difference and classified as CCS-stable (CCS-S) or -unstable (CCS-U) based on the absence or presence of fracture/dislocation. Functional recovery at 1 year was assessed using the functional independence measure (FIM) motor score. Among 291 patients, 131 (45%) had CCS-S. These patients were older and more …

Improved Foraminal Expansion And Pain Scores Following Placement Of Novel Expandable Interlaminar Stabilization Device For Lumbar Spinal Stenosis, Robert P. Norton, Ian Koch, Kendra Primavera, Roy Y. Miloh, Alex R. Vaccaro, Mitchell K. Ng

Department of Orthopaedic Surgery Faculty Papers

STUDY DESIGN: Retrospective cohort study.

OBJECTIVE: To evaluate radiographic durability and clinical outcomes following placement of a novel expandable interlaminar stabilization device for single-level lumbar spinal stenosis. Specifically, we aimed to: 1) quantify immediate postoperative posterior column distraction; 2) determine whether foraminal expansion is improved postoperatively without radiographic subsidence; and (3) assess potential improvements in patient-reported pain/clinical outcomes.

METHODS: A retrospective review was performed of adult patients undergoing single-level decompression supplemented by an interlaminar device for symptomatic lumbar spinal stenosis by a single surgeon from 2024 to 2025. Radiographic parameters included anterior, middle, and posterior disc height, foraminal height, and …

Comparing The Use Of Reverse Total Shoulder Arthroplasty For Glenohumeral Osteoarthritis, Irreparable Rotator Cuff Tears, And Rotator Cuff Tears With Arthritis: A 2-Year Clinical Outcome Analysis Using The Enovis Altivate Reverse., Matthew R Rohl, Christopher Miller, Taylor J Manes, Tyler Hasbrook, Molly Moor, Scott P Stephens, Brian L Badman

Surgery Articles

Background: The purpose of this study was to compare outcomes of patients undergoing reverse total shoulder arthroplasty (rTSA) for rotator cuff tears with arthritis, irreparable rotator cuff tears without arthritis, and primary glenohumeral osteoarthritis.

Methods: A retrospective review of prospectively collected data was performed of patients undergoing primary rTSA using the AltiVate Reverse (Enovis; Austin, TX) by a single surgeon from 2021 to 2023. Patients were categorized as irreparable rotator cuff tear without arthritis, rotator cuff tear with arthritis, or primary glenohumeral osteoarthritis. Outcomes included American Shoulder and Elbow Surgeons (ASES) score, Simple Shoulder Test (SST), visual analog scale (VAS) …