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Retrospective Comparative Study
Julie A Neumann MD, Kathleen D Rickert MD, Kendall E Bradley MD, Brian D Lewis MD, Monet A France MD, Steven A Olson MD

Concomitant Hip Arthroscopy and Periacetabular Osteotomy: Is there a Difference in Perioperative Complications compared with Periacetabular Osteotomy Alone?

[Year:2017] [Month:July-June] [Volumn:7 ] [Number:1] [Pages:63] [Pages No:51-57][No of Hits : 1685]


ABSTRACT

Purpose: To evaluate the safety of hip arthroscopy combined with a periacetabular osteotomy (PAO) compared with PAO alone in treating concomitant intra-articular pathology in hip dysplasia.

Materials and methods: Forty-one patients (46 hips) with symptomatic hip dysplasia were retrospectively reviewed. Pre- and postoperative radiographic data and intraoperative data consisting of estimated blood loss, intraoperative and postoperative blood transfusions, operative time, and length of hospital stay were recorded. The complications occurring within the first 3 months after surgery including lateral femoral cutaneous and pudendal nerve neuropraxia, wound complications, and reoperations were recorded. Additionally, rates of deep venous thrombosis and other major adverse outcomes (myocardial infarction, pulmonary embolism, stroke, death) were examined.

Results: Twenty-one patients (24 hips) underwent PAO alone. Twenty patients (22 hips) underwent hip arthroscopy followed immediately by PAO. There were no significant differences in the 90-day complication rates between the two groups, comparing the rate of neuropraxia (p = 0.155) and wound complications (p = 0.6). Operative time for PAO alone was 179 minutes (standard deviation [SD] ± 37) compared with 251 minutes (SD ± 52) for combined hip arthroscopy and PAO (p < 0.001). No incidence of deep vein thrombosis or major adverse events was noted in either group. Preoperative lateral center edge angle (LCEA) and acetabular index (AI) were 14° and 20° respectively, in the PAO-alone group and 19° and 16° respectively, in the combined group. Postoperatively, LCEA was 29° in the PAOalone group and 30° in the combined group. Postoperative AI was 11° in the PAO-alone group and 5° in the combined group.

Conclusion: This study demonstrates that hip arthroscopy in combination with PAO to treat intra-articular pathology shows no difference in 90-day complication rates when compared with PAO alone.

Level of evidence: Level III, retrospective comparative study Keywords:

Neumann JA, Rickert KD, Bradley KE, Lewis BD, France MA, Olson SA. Concomitant Hip Arthroscopy and Periacetabular Osteotomy: Is there a Difference in Perioperative Complications compared with Periacetabular Osteotomy Alone? The Duke Orthop J 2017;7(1):51-57.

Source of support: Nil

Conflict of interest: None


 
Review Article
Daniel J Blizzard MD, Perez Agaba BS, Michael P Morwood MD, Jennifer L Jerele MD, Robert D Zura MD

Risks and Benefits of the Different Types of Gloves used in the Perioperative Setting

[Year:2017] [Month:July-June] [Volumn:7 ] [Number:1] [Pages:63] [Pages No:3-10][No of Hits : 1467]


ABSTRACT

The role of powder gloves in allergic reactions, infections, wound healing and granuloma formation has been known for many years. Despite a gradual shift away from powder gloves over the last several decades, many healthcare professionals and facilities continue to use powder gloves as the FDA has continued to refrain from issuing a comprehensive formal ban. However, recent advancements in glove technology and position statements by professional societies have continued the push for removal of powder gloves from all clinical and surgical settings and will hopefully entirely eradicate usage in the coming years.

Keywords: Glove, Infection, Operating room, Surgical glove.

Blizzard DJ, Agaba P, Morwood MP, Jerele JL, Zura RD. Risks and Benefits of the different Types of Gloves used in the Perioperative Setting. The Duke Orthop J 2017;7(1):3-10.

Source of support: Nil

Conflict of interest: None


 
Expert Diagnostic Study
Brian T Nickel MD, Marc J Richard MD, Ilvy Cotterell MD, Megan Crosmer MD, David S Ruch MD, Fraser J Leversedge MD

Ultrasound-guided Cubital Tunnel Injection: Description of Technique and Accuracy in a Cadaver Model

[Year:2017] [Month:July-June] [Volumn:7 ] [Number:1] [Pages:63] [Pages No:43-45][No of Hits : 742]


ABSTRACT

Introduction: Ulnar nerve (UN) and cubital tunnel morphology is influenced by elbow positioning, potentially compromising injection accuracy and placing the nerve at risk during cubital tunnel injection.

Materials and methods: Based on previous anatomical studies of the cubital tunnel, a proof of concept injection model was developed. Eighteen above-elbow cadaver specimens were positioned in 45° elbow flexion and in neutral forearm rotation. The ultrasound transducer was oriented in the transverse plane, in-line with the medial epicondyle and olecranon tip, facilitating visualization of the UN and cubital tunnel. A 25-gauge needle oriented parallel to the ulna was inserted percutaneously at the midpoint between olecranon and epicondyle. The needle was advanced under ultrasound guidance to replicate injection and was secured. Open dissection confirmed its location.

Results: 18/18 needle tips were within the cubital tunnel and no needles penetrated the UN.

Discussion: Ultrasound-guided cubital tunnel injection, with the elbow in 45° flexion and with neutral forearm rotation was a safe and reliable technique in this cadaveric model. Future clinical studies may evaluate the efficacy of both diagnostic and therapeutic cubital tunnel injection.

Keywords: Cubital tunnel, Injection, Sonography, Ulnar nerve, Ultrasound.

Nickel BT, Richard MJ, Cotterell I, Crosmer M, Ruch DS, Leversedge FJ. Ultrasound-guided Cubital Tunnel Injection: Description of Technique and Accuracy in a Cadaver Model. The Duke Orthop J 2017;7(1):43-45.

Source of support: The authors received a restricted research grant from Bioventus to support the costs of this study. No personal benefits or financial awards were received by any of the authors related to this study. The senior author has received consulting fees from Bioventus.

Conflict of interest: None


 
Case Report
Kwadwo A Owusu-Akyaw MD, Jonathan Godin MD, Stefano Pecchia MD, Alexander Oldweiler BS, Claude T Moorman MD

Adipose-derived Mesenchymal Stem Cells and Arthroscopic Surgery

[Year:2017] [Month:July-June] [Volumn:7 ] [Number:1] [Pages:63] [Pages No:34-38][No of Hits : 735]


ABSTRACT

Mesenchymal stem cells (MSCs) are multipotent cells with potential reparative properties for connective tissues, such as articular cartilage. The Lipogems adipose graft harvest system is a relatively novel technique for harvesting adiposederived MSCs and may be utilized in conjunction with various orthopaedic sports medicine procedures.

Keywords: Arthroscopy, Orthopaedic surgery, Stem cell.

Owusu-Akyaw KA, Godin J, Pecchia S, Oldweiler A, Moorman CT. Adipose-derived Mesenchymal Stem Cells and Arthroscopic Surgery. The Duke Orthop J 2017;7(1):34-38.

Source of support: Nil

Conflict of interest: None


 
Review Article
Rita Baumgartner MD, Saam Morshed MD, PhD, MPH

Assessment Measures for Evaluation of Outcomes in Transtibial Amputees resulting from Trauma: A Systematic Review

[Year:2017] [Month:July-June] [Volumn:7 ] [Number:1] [Pages:63] [Pages No:23-29][No of Hits : 730]


ABSTRACT

Introduction: Amputations secondary to high-energy open fractures and blast, ballistic, and crush injuries to the lower extremity are common challenges faced by military and civilian orthopaedic surgeons. A lack of consensus on domains to be measured and quality of prosthetic rendering pose methodological challenges to researchers and clinicians alike. We conducted a systematic review of the literature to summarize which domains of health, prosthetic fit, and prosthetic alignment are used to describe outcomes for lower extremity amputees secondary to trauma.

Materials and methods: A search of PubMed, Cochrane, and Embase was conducted including the keywords: Amputation, traumatic, transtibial, survey, and metric. Articles were selected based on whether the study assessed clinical outcomes following transtibial amputation following trauma. Experimental and observational comparative studies and case series were included. Study characteristics and results were extracted using standardized data forms. The number of unique measures recorded, the frequency of measure use, and the number outcome measures were validated and were compiled.

Results: Literature search ultimately resulted in 273 articles being included. A conceptual model was constructed to capture and organize the causal and temporal relationships between fit, alignment, and outcome. Of the 68 articles that used questionnaires to assess prosthetic fit, 37 used a questionnaire designed specifically for the study as opposed to a published or validated tool. Four validated tools were commonly used to capture patient satisfaction with a prosthesis: The OPUS, PEQ, TAPES, and the Socket Comfort Fit Score. Prosthetic alignment was assessed in 19 of 273 articles. One article validated the use of an alignment jig for quantification and prescription of prostheses. Totally, 8 of 19 articles assessing alignment used gait analysis and ground reaction forces to capture differences due to alterations in alignment.

Discussion: Choice of an appropriate outcome measure is critical in generating evidence to support treatment decisions for patients undergoing transtibial amputation after trauma. We found a large number of different tools being used across studies, making results difficult to compare. Prosthetic fit and comfort of the residual limb in the socket and the alignment of the socket and the shank of the prosthesis make up the foundation for the proposed conceptual model. In order to distinguish effects attributable to an intervention of interest vs the impact of the quality of the socket fitting, validation of a clinically objective scoring system to assess socket fit is necessary.

Conclusion: A large number of different tools are currently being used across studies to assess outcomes for transtibial amputees resulting from trauma, and there is a need for development and validation of a clinically objective scoring system to assess socket fit.

Keywords: Assessment tool, Transtibial amputation, Traumatic.

Baumgartner R, Morshed S. Assessment Measures for Evaluation of Outcomes in Transtibial Amputees resulting from Trauma: A Systematic Review. The Duke Orthop J 2017;7(1):23-29.

Source of support: Nil

Conflict of interest: None


 
Case Report
Rita E Baumgartner MD, Matthew D Jones MD, Sharon L Hame MD, David R McAllister MD

Preoperative Deep Vein Thrombosis following Acute Anterior Cruciate Ligament Tear: Report of Three Cases

[Year:2017] [Month:July-June] [Volumn:7 ] [Number:1] [Pages:63] [Pages No:30-33][No of Hits : 700]


ABSTRACT

Case report: We report 3 cases of preoperative deep vein thrombosis (DVT) following anterior cruciate ligament (ACL) injury in a 20-year-old female volleyball player (C1), a 22-year-old female snowboarder (C2), and a 36-year-old male recreational basketball player (C3). In all three cases, the patients presented with hypersensitivity in the injured knee and guarded significantly on physical examination. The patients were all placed on anticoagulation prior to operative intervention. C1 underwent repair 45 days after her injury and C2 delayed repair until completion of a 6 month course of warfarin. C3 did not undergo repair of the ACL; he developed significant stiffness and had diagnostic arthroscopy with lysis of adhesions and synovectomy 5 months following his injury.

Conclusion: Data is limited regarding the risk of DVT after nonmajor orthopaedic injury, such as ACL injury. Recognition and immediate treatment of the DVT is essential in minimizing the risk of additional complications. Duration of anticoagulation and delay in surgical intervention should be determined based on individual patient goals and risk factors.

Keywords: Anterior cruciate ligament, Deep venous thrombosis, Preoperative.

Baumgartner RE, Jones MD, Hame SL, McAllister DR. Preoperative Deep Vein Thrombosis following Acute Anterior Cruciate Ligament Tear: Report of Three Cases. The Duke Orthop J 2017;7(1):30-33. .

Source of support: Nil

Conflict of interest: None


 
Clinical Study
Jason M Jennings MD DPT, Ramon A Ruberte Thiele MD MS, Evgeny Krynetskiy MD, Samuel S Wellman MD, David E Attarian MD FACS, Michael P Bolognesi MD

Independent Analysis of the Dorr Classification of Proximal Femoral Morphology: A Reliability Study

[Year:2016] [Month:July-June] [Volumn:6 ] [Number:1] [Pages:68] [Pages No:12-16][No of Hits : 1536]


ABSTRACT

The purpose of this study was to assess the inter- and intraobserver reliability through visual perception of a previously described classification system of proximal femoral morphology. The interobserver reliability ranged from slight to moderate across testing. Experience appears to play a role as the intratester reliability did not differ with fellowship trained attending physicians, but differences were seen with junior- and senior-level residents. The diversity of the proximal femoral morphology likely represents a continuum rather than three distinct shapes. This may imply that for many proximal femoral canals, characterization of a single type may not be possible. Further research is warranted to determine the clinical significance of these findings.

Keywords: Bone quality, Proximal femoral morphology, Total hip arthroplasty.

How to cite this article:Jennings JM, Thiele RAR, Krynetskiy E, Wellman SS, Attarian DE, Bolognesi MP. Independent Analysis of the Dorr Classification of Proximal Femoral Morphology: A Reliability Study. The Duke Orthop J 2016;6(1):12-16.

Source of support: Nil

Conflict of interest: None


 
Technical Report
Travis J Dekker MD, Beau J Kildow MD, Evan M Guerrero MD, Claude T Moorman III MD

Technical Aspects of Addressing Multiligament Knee Instability

[Year:2016] [Month:July-June] [Volumn:6 ] [Number:1] [Pages:68] [Pages No:47-53][No of Hits : 1260]


ABSTRACT

Multiligament Knee Injuries (MLKI) are rare but devastating injuries that require both acute and chronic management. These injuries necessitate operative management with individual patient factors dictating management in an acute (<6weeks) versus chronic (>6 weeks) time frame. Anterior cruciate ligament, posterior cruciate ligament and posterolateral corner reconstruction remains the gold standard for operative management while most medial collateral ligament injuries can be managed non-operatively. Graft fixation sequence is essential in re-tensioning the soft tissues to allow for a functional and balanced knee post-operatively- the PCL is first fixed in flexion, followed by the ACL in extension, and then lastly, the PLC and MCL are addressed as needed. This review paper highlights technical considerations demonstrated in two case reports to include timing of surgery, graft selection and sequence of graft fixation.

Keywords: Graft fixation sequence, Graft selection, Multligament knee injury, Technical considerations.

How to cite this article:Dekker TJ, Kildow BJ, Guerrero EM, Moorman CT III. Technical Aspects of Addressing Multiligament Knee Instability. The Duke Orthop J 2016;6(1):47-53.

Source of support: Nil

Conflict of interest: None


 
Clinical Study
Lauren Porras MD, Blake R Boggess DO

Economic Analysis of Accuracy and Cost of Ultrasound-guided Intraarticular Hip Injections

[Year:2016] [Month:July-June] [Volumn:6 ] [Number:1] [Pages:68] [Pages No:35-40][No of Hits : 1075]


ABSTRACT

Background: Ultrasonography is an increasingly valuable tool for the diagnosis and treatment of musculoskeletal disorders. In the past, ultrasound has been used for diagnostic purposes, with increasing use of image guidance for joint injections.

Hypothesis: Ultrasound-guided intraarticular native nontraumatic hip injections are equally as accurate with less cost as other diagnostic imaging modalities including fluoroscopicguided injections.

Design: This analysis was based on a meta-analysis of the accuracy of the different imaging modalities. Initially a search was performed for intraarticular hip injections in PubMed, Embase, and ClinicalTrials.gov. Injection accuracy rates between groups were analyzed via proportional meta-analysis. For the economic analysis, compensation data were determined from estimated charges from Duke University Medical Center.

Results: Compared with gold standards of accurate injections (such as fluoroscopic and computed tomography-guided injections), ultrasound is 97% as accurate (confidence interval 93%, 99%). Based on 2014 reimbursement data, reimbursement for large-joint intraarticular injection averages $61.99 (37.38£, 47.18€) ($49.20-$76.31). Fluoroscopic global reimbursement averages $105.32 (63.51£, 80.13€) ($76.75-$134.72). Ultrasound guidance global reimbursement averages $75.99 (45.86£, 57.83€) ($57.95-$93.15).

Conclusion: Ultrasound-guided hip injections are an accurate technique for alleviating hip pain at less cost. In an era of increasing concern for health care expenditures, finding an accurate, effective, and cost-friendly alternative has the potential for widespread adaptation and practice.

Keywords: Accuracy, Cost analysis, Guided injections, Musculoskeletal ultrasound.

How to cite this article:Porras L, Boggess B. Economic Analysis of Accuracy and Cost of Ultrasound-guided Intraarticular Hip Injections. The Duke Orthop J 2016;6(1):35-40.

Source of support: The Duke University Internal Medicine Research Grant funded this study.

Conflict of interest: Dr Boggess maintains industry relationships with GE, SonoSite, Bioventus, and Arthrex although none provided funding. For the remaining authors none were declared.


 
Technical Report
Brian D Lewis MD, Steven A Olson MD

Technique for Combined Hip Arthroscopy and Periacetabular Osteotomy for the Patient with Hip Dysplasia and Intraarticular Pathology

[Year:2016] [Month:July-June] [Volumn:6 ] [Number:1] [Pages:68] [Pages No:41-46][No of Hits : 687]


ABSTRACT

The Bernese periacetabular osteotomy (PAO) is a powerful technique for correcting acetabular coverage in patients with developmental dysplasia of the hip. However, there is increasing recognition of additional intraarticular pathologies that may contribute to ongoing pain. For this reason, for the last 3 years, we have combined hip arthroscopy with PAO to treat intraarticular pathology along with improving acetabular coverage. Our technique is reviewed below.

Keywords: Arthroscopy, Dysplasia, Hip, Osteotomy.

How to cite this article:Lewis BD, Olson SA. Technique for Combined Hip Arthroscopy and Periacetabular Osteotomy for the Patient with Hip Dysplasia and Intraarticular Pathology. The Duke Orthop J 2016;6(1):41-46.

Source of support: Nil

Conflict of interest: None


 
Clinical Study
Marc J Richard MD, Alexander J Lampley MD, Priyesh D Patel MD, Riikka EK Nomides MD, Suhail K Mithani MD, Fraser J Leversedge MD, David S Ruch MD

The Importance of the Palmar Lunate Facet in the Treatment of Distal Radius Fractures

[Year:2016] [Month:July-June] [Volumn:6 ] [Number:1] [Pages:68] [Pages No:56-60][No of Hits : 631]


ABSTRACT

Background: While there have been multiple studies published that have stressed the importance of restoring various different radiographic parameters to improve functional outcome scores, there is no consensus on the parameter that correlates most with patients’ functional outcomes. We hypothesize that obtaining near anatomical reduction of the palmar lunate facet is critical to improving functional outcome scores. The purpose of this study is to determine the effects of reduction and stabilization of the palmar lunate facet on functional outcomes in patients with intra-articular distal radius fracture.

Materials and methods: We prospectively collected clinical examination data, radiographic measurements, and functional outcome scores on 157 patients who were treated operatively for multifragmentary intra-articular fractures of the distal radius (AO Type C3) between 1996 and 2006. Prospective data were acquired at 3, 6 months, and 1 year postsurgical intervention in clinical follow-up. Based on radiographic measurements, patients were designated into a nondisplaced palmar lunate facet group and a displaced palmar lunate facet group. Clinical and functional outcomes were then compared between the groups.

Results: Patients without displacement had a significantly higher value of wrist extension and forearm supination when compared with the patients with displacement. In addition, the Gartland and Werley score was significantly higher in patients with displacement of the palmar lunate facet.

Conclusion: This study demonstrates that patients with near anatomical reduction of the palmar lunate facet after surgical treatment of an intra-articular distal radius fracture had improved range of motion and better functional outcome scores compared with patients with residual displacement of the palmar lunate facet.

keywords: Distal radius fracture, Lunate facet, Outcomes.

How to cite this article:Richard MJ, Lampley AJ, Patel PD, Nomides REK, Mithani SK, Leversedge FJ, Ruch DS. The Importance of the Palmar Lunate Facet in the Treatment of Distal Radius Fractures. The Duke Orthop J 2016;6(1):56-60.

Source of support: Nil

Conflict of interest: None


 
Clinical Study
Daniel J Blizzard MD MHS, Christopher P Miller MD, Sonya T Blizzard MD MHS, Jonathan N Grauer MD

Incidence and Demographics of Cervical Spine Fractures over a 10 Year Period at a Level I Trauma Center

[Year:2016] [Month:July-June] [Volumn:6 ] [Number:1] [Pages:68] [Pages No:21-25][No of Hits : 629]


ABSTRACT

Background: In an effort to capture all cervical fractures in the trauma setting, many institutions have implemented protocols for urgent cervical computed tomographic (CT) imaging for any patient with traumatic neck pain. This has led to a high frequency of negative imaging studies.

Objectives: The objective is to characterize a consecutive series of cervical spine fractures diagnosed at a single Level I trauma center over a 10-year period. It is expected that a greater awareness of the associations between age, injury mechanism, and fracture type may facilitate the diagnosis and management of patients with cervical spine trauma.

Methods: In this study, every cervical CT scan ordered in the Emergency Department (ED) at our institution was reviewed and evaluated for fractures. The relevant demographic data and mechanism of injury for patients with fractures were recorded.

Results: Of 763,099 ED visits, 13,896 cervical CT scans were ordered (1.8% of visits) and 492 scans (3.5% of scans, 0.06% of visits) were found to have cervical fractures resulting from blunt trauma. There was a bimodal distribution of fractures with respect to age, with peaks at 20 to 24 and >85 years of age. These age ranges were also found to have higher incidence of fracture than would be predicted by population alone. Fractures in younger patients resulted from high-energy trauma and fractures in older patients resulted primarily from falls.

Conclusion: This elucidation of epidemiology and mechanism of cervical fractures can be used to improve the rapidity of diagnosis and management of these potentially devastating injuries.

Keywords: Cervical spine, Cervical spine fracture, Computed tomography, Level I Trauma, Trauma.

How to cite this article:Blizzard DJ, Miller CP, Blizzard ST, Grauer JN. Incidence and Demographics of Cervical Spine Fractures over a 10 Year Period at a Level I Trauma Center. The Duke Orthop J 2016;6(1):21-25.

Source of support: Nil.

Conflict of interest: None.


 
Clinical Study
Kamran S Hamid MD MPH, Benedict U Nwachukwu MD MBA, Eugene Hsu MD MBA, Sayon Dutta MD MBA, Sharon N Babcock MD, Brett W Baker MD, Andrew D Wohler BS, Ralph B D’Agostino Jr PhD, Jason E Lang MD

A Clinical Trial Evaluation of Pager versus Smart-device Efficacy in an Academic Hospital Setting

[Year:2016] [Month:July-June] [Volumn:6 ] [Number:1] [Pages:68] [Pages No:1-6][No of Hits : 591]


ABSTRACT

Introduction: Health care delivery is contingent on efficient communication among providers. We hypothesized that using smart-device two-way communication would result in faster provider responses when compared with alphanumeric paging among resident physicians in an academic medical center.

Methods: Resident physicians were given an Apple iPad Mini smart device with a Health Insurance Portability and Accountability Act-compliant smart-device two-way communication application. Patient care messages were randomized for transmission via smart-device two-way texting or standard one-way paging. Physician response time was recorded as the primary outcome measure.

Results: The study was halted after participation of the first 24 residents due to safety concerns. A technical glitch was identified in which the smart devices automatically powered off to conserve battery life. The first 72 smart devices to first 37 pager communication response times were similar (8 vs 6 minutes, p = 0.43). In analysis of responses within 5 minutes of c ommunication ( the t ime s mart d evices p owered o ff), smart-device responses occurred significantly faster (1 vs 2 minutes, p < 0.05) but the response frequency was less in the smart-device group (33 vs 62%, p < 0.05), and thus the study was ended early due to safety concerns.

Discussion: Based on our initial findings, smart devices have potential to improve communication but technical issues must be addressed prior to usage as the sole means of communication.

Keywords: Academic, Communication, Device, Hospital, iPad, Pager, Trial, Smart.

How to cite this article:Hamid KS, Nwachukwu BU, Hsu E, Dutta S, Babcock SN, Baker BW, Wohler AD, D’Agostino RB Jr, Lang JE. A Clinical Trial Evaluation of Pager vs S mart-device E fficacy i n a n Academic Hospital Setting. The Duke Orthop J 2016;6(1):1-6.

Source of support: This study was funded by an intramural IRSC grant at Wake Forest Baptist Medical Center.

Conflict of interest: None


 
Letter from the Editors
Alexander J Lampley MD, Vasili Karas MD MS, Lindsay T Kleeman MD, Andrew P Matson MD

Letter from the Editors

[Year:2016] [Month:July-June] [Volumn:6 ] [Number:1] [Pages:68] [Pages No:xv][No of Hits : 524]


ABSTRACT

Dear Colleagues,

This marks the 6th edition of The Duke Orthopaedic Journal (DOJ). Looking back, we applaud the past editorial boards and journal founders, Selene Parekh, Will Eward, and Stephanie Mayer, who have brought the journal from infancy into a part of Duke Orthopaedic tradition. With an increasing readership and a broader base of contributors, the DOJ has continued to mature over the past 5 years.


 
Clinical Study
Taylor R McClellan BS, Roberto D Calderon MD, Michael P Bolognesi MD, David E Attarian MD, Paul F Lachiewicz MD, Samuel S Wellman MD

Dislocation Rate at Short-term Follow-up after Revision Total Hip Arthroplasty with a Dual Mobility Component

[Year:2016] [Month:July-June] [Volumn:6 ] [Number:1] [Pages:68] [Pages No:17-20][No of Hits : 523]


ABSTRACT

Patients undergoing a revision total hip arthroplasty (THA) are at increased risk for dislocation. The literature suggests dualmobility components may decrease the frequency of dislocation. We conducted a retrospective study of one type of dual mobility acetabular component implanted in 82 revision THA cases that were considered at increased risk for dislocation. Of the 82 hips, 58 had a mean follow-up of 12 months (3-28 months). The indication for revision was instability in 18 hips (31%), adverse metal-on-metal reaction in 13 hips (22%), reimplantation for infection in 11 hips (19%), and aseptic loosening of the acetabular component in 9 hips (16%). In the course of follow-up, 6 hips developed a deep infection requiring reoperation. There were no early hip dislocations.

Keywords: Dislocation, Dual mobility, Instability, Revision, Total hip arthroplasty.

How to cite this article:McClellan TR, Calderon RD, Bolognesi MP, Attarian DE, Lachiewicz PF, Wellman SS. Dislocation Rate at Short-term Follow-up after Revision Total Hip Arthroplasty with a Dual Mobility Component. The Duke Orthop J 2016;6(1):17-20.

Source of support: Nil

Conflict of interest: None


 
Case Report
Brian L Dial MD, Michael P Morwood MD, Robert D Fitch MD

Pediatric Tillaux Ankle Fracture with Concomitant Adult-type Supination External Rotation Fracture Pattern: A Rare Injury

[Year:2016] [Month:July-June] [Volumn:6 ] [Number:1] [Pages:68] [Pages No:61-63][No of Hits : 511]


ABSTRACT

The juvenile Tillaux fracture is a transitional ankle fracture that occurs in the adolescent population. The juvenile Tillaux fracture is an avulsion injury of the distal tibia’s anterolateral epiphysis as the result of excessive external rotation. The purpose of this article is to present a pediatric ankle fracture that is best described as a supination-external rotation type IV ankle injury with an associated Tillaux fragment. This fracture pattern represents a unique variant to classically described pediatric ankle fractures.

keywords: Adolescent ankle fracture, Juvenile Tillaux fracture, Transitional ankle fracture.

How to cite this article:Dial BL, Morwood MP, Fitch RD. Pediatric Tillaux Ankle Fracture with Concomitant Adult-type Supination External Rotation Fracture Pattern: A Rare Injury. The Duke Orthop J 2016;6(1):61-63.

Source of support: Nil

Conflict of interest: None


 
Review Article
Michael A Gallizzi MD MS, Lindsay T Kleeman MD, Daniel J Blizzard MD MS, Melissa M Erickson MD

Current Trends in the Management of Lumbar Spine Injuries in Athletes

[Year:2015] [Month:July-June] [Volumn:5 ] [Number:1] [Pages:72] [Pages No:63-67][No of Hits : 4753]


ABSTRACT

Lumbar spine injuries are prevalent among athletes and are likely to increase with the rising popularity of extreme sports. It is important for physicians to understand the basic anatomy of the lumbar spine along with the injury patterns that can occur with axial loading, hyperflexion and flexion-distraction forces. The majority of low back injuries in athletes are due to muscle strains and rarely need further treatment. Athletes that are subjected to repetitive hyperextension forces are at risk for spondylolysis with or without spondylolisthesis which requires further imaging to determine need for surgical intervention. Lumbar disk herniations are usually from axial forces and can be result in surgical emergencies, if they cause compression on the spinal cord or conus. Lumbar spine fractures can vary from stress fractures of the endplates to burst fractures or fracturedislocations which require surgical intervention, if associated with neurologic deficit or instability. Similar to the management of cervical spine injuries, patients with a suspected lumbar injury should be evaluated systematically with full spine precautions and careful neurologic examination to determine need for transfer to higher care center.

Keywords: Athlete, Lumbar, Lumbar spine, Sports, Sports injury, Management.

Gallizzi MA, Kleeman LT, Blizzard DJ, Erickson MM. Current Trends in the Management of Lumbar Spine Injuries in Athletes. The Duke Orthop J 2015;5(1):63-67.

Source of support: Nil

Conflict of interest: None


 
Technical Report
Glenn Shi MD, Christopher E Gross MD, Jeannie Huh MD MSc, Selene G Parekh MD MBA

Pantalar Arthrodesis: Surgical Technique and Review of Literature

[Year:2015] [Month:July-June] [Volumn:5 ] [Number:1] [Pages:72] [Pages No:48-52][No of Hits : 3490]


ABSTRACT

Surgical options for treatment of tibiotalar, subtalar, and transverse tarsal joint arthritis are limited. Pantalar arthrodesis can produce a stable and braceable if not painless foot in the plantigrade position. This article presents a review of etiology, clinical evaluation, procedural technique and outcomes reported in literature.

Keywords: Pantalar, Arthrodesis, Fusion, Technique.

Shi G, Gross CE, Huh J, Parekh SG. Pantalar Arthrodesis: Surgical Technique and Review of Literature. The Duke Orthop J 2015;5(1):48-52.

Source of support: Nil

Conflict of interest: None


 
Review Article
Lindsay T Kleeman MD, Michael A Gallizzi MD MS, Daniel J Blizzard MD MS, Melissa M Erickson MD

Cervical Spine Injuries in Sports

[Year:2015] [Month:July-June] [Volumn:5 ] [Number:1] [Pages:72] [Pages No:58-62][No of Hits : 2909]


ABSTRACT

Injuries to the cervical spine in athletes are rare but potentially devastating outcomes resulting from involvement in sports activities. New rules and regulations implemented by national sports organizations have helped to decrease the rate of cervical spine and spinal cord injuries sustained by athletes. A basic understanding of cervical spine anatomy, physical examination and spine precautions is necessary for any physician evaluating athletes on the field to determine if transfer to higher level of care is needed. It is particularly important to know the systematic protocol for spine immobilization, neurologic exam and helmet removal in a patient with a suspected cervical spine injury. While cervical strain is the most common cervical spine injury, physicians should be familiar with the presentation for other injuries, such as Burner’s syndrome (Stinger), cervical disk herniation, transient quadriplegia and cervical spine fractures or dislocations. Special consideration is needed when evaluating patients with Down syndrome as they are at higher risk for atlantoaxial instability. Determination of when an athlete can return to play is patient-specific with early return to play allowed only in a completely asymptomatic patient.

Keywords: Athlete, Cervical, Cervical spine, Sports, Sports injury, Management.

Kleeman LT, Gallizzi MA, Blizzard DJ, Erickson MM. Cervical Spine Injuries in Sports. The Duke Orthop J 2015;5(1):58-62.

Source of support: Nil

Conflict of interest: None


 
Special Interest Article
Elizabeth W Hubbard MD, Mitchell R Klement MD

Tribute to Dr William T Hardaker Jr

[Year:2015] [Month:July-June] [Volumn:5 ] [Number:1] [Pages:72] [Pages No:xvii-xix][No of Hits : 2880]


ABSTRACT

Dr William T Hardaker Jr, MD, was born in December 24, 1941, in Charleston, South Carolina, to parents, William Hardaker Sr and Gale Angas Hardaker. He demonstrated tremendous leadership, dedication and commitment to his activities early on, rising to the rank of Eagle Scout. These qualities also allowed him to excel both academically and athletically where he went on to pursue BA in Political Science from the University of Pennsylvania. At Penn, he was both an active member of the Reserve Officers’ Training Corps (ROTC) and was a 4 years starter on the football team. He was elected as a team captain in his senior year and graduated in 1963.


 
Review Article
Tyler Vovos MS, Daniel J Blizzard MD MS, Grant Garrigues MD

Management of Terrible Triad Injuries of the Elbow

[Year:2015] [Month:July-June] [Volumn:5 ] [Number:1] [Pages:72] [Pages No:28-34][No of Hits : 1919]


ABSTRACT

The term ‘Terrible Triad’ was initially coined by Hotchkiss et al to describe fracture-dislocations of the elbow involving three specific injuries: a posterolateral dislocation, coronoid fracture and radial head fracture.1 Fracture-dislocations of this type are notoriously unstable secondary to loss of the anterior buttress support from the coronoid, valgus support from the radial head, and the posterolateral stabilization of the lateral ulnar collateral ligament (LUCL).2,3 Furthermore, these injury patterns are particularly difficult to treat and have resulted in poor functional outcomes including the need for multiple reoperations.4-6
Herein, the pathoanatomy, classification, diagnosis and management of these challenging injuries will be discussed.

Keywords: Terrible triad elbow, Collateral ligaments, Dislocations, Fractures, Elbow, Elbow joint, Radius, Radius fractures, Coronoid, Coronoid fractures.

Vovos T, Blizzard DJ, Garrigues G. Management of Terrible Triad Injuries of the Elbow. The Duke Orthop J 2015;5(1): 28-34.

Source of support: Nil

Conflict of interest: None


 
Review Article
Jason M Jennings MD DPT, Douglas A Dennis MD

Wound Issues after Total Knee Arthroplasty

[Year:2015] [Month:July-June] [Volumn:5 ] [Number:1] [Pages:72] [Pages No:10-13][No of Hits : 1642]


ABSTRACT

Wound healing problems following total knee arthroplasty (TKA) are infrequent, but if present may lead to devastating results. Occurrence may be minimized by modifying patient risk factors, proper selection of skin incisions, and using operative techniques that protect soft tissues. When wound complications arise, prompt management is imperative to assure the best outcome after TKA.

Keywords: Total knee arthroplasty, Wound healing, Wound complications.

Jennings JM, Dennis DA. Wound Issues after Total Knee Arthroplasty. The Duke Orthop J 2015;5(1):10-13.

Source of support: Nil

Conflict of interest: None


 
Clinical Studies
SK Venkatesh Gupta MS, Pradeep Mandapalli MS

Comparative Study between Bridging External Fixation vs Volar Plating (Ellis-T Plate) for Comminuted Fracture of the Distal End Radius

[Year:2015] [Month:July-June] [Volumn:5 ] [Number:1] [Pages:72] [Pages No:20-24][No of Hits : 1530]


ABSTRACT

Background: The purpose of this study is to compare between the open reduction and internal fixation (ORIF) using a volar plate and external fixation with K-wire fixation for the treatment of unstable distal radius fractures.

Materials and methods: This investigation was designed to prospectively evaluate the outcomes of similar distal radius fracture patterns treated by ORIF with volar plating vs closed reduction and pinning with external fixation.

Results: Open reduction and internal fixation with volar locking plate group has overall decrease incidence of complications significantly less radial shortening and significantly greater postoperative wrist motion when compared to external fixation.

Conclusion: Use of volar locking plate resulted in a faster recovery of function compared with external fixation. Use of volar locking plate resulted in better anatomical function and grip strength. However, no functional advantage was demonstrated at or beyond 12 weeks or 1 year.

Keywords: Distal radius fracture, Volar plating, External fixation, K-wire, Comminuted.

Gupta SKV, Mandapalli P. Comparative Study between Bridging External Fixation vs Volar Plating (Ellis-T Plate) for Comminuted Fracture of the Distal End Radius. The Duke Orthop J 2015;5(1):20-24.

Source of support: Nil

Conflict of interest: None


 
Review Article
Samuel B Adams Jr MD, Christopher E Gross MD, David M Tainter MD, Mark E Easley MD, Selene G Parekh MD MBA

Surgical Management of Osteochondral Lesions of the Talus

[Year:2015] [Month:July-June] [Volumn:5 ] [Number:1] [Pages:72] [Pages No:35-47][No of Hits : 1340]


ABSTRACT

Osteochondral lesions of the talus (OLT) present a formidable treatment challenge to the orthopaedic surgeon. Historical cartilage repair strategies often result in the formation of fibrocartilage leading to suboptimal clinical results. With advances in regenerative medicine, modern surgical techniques are diverse and employ autograft, allograft and tissue-engineered constructs for cartilage repair. Fresh and particulated juvenile allograft transplantation have become popular options in the United States. Worldwide, both cellular and acellular tissue-engineered constructs are utilized. In all cases, there is still debate as to the optimal cell source and scaffold material and only shortterm clinical results are available. This article will review these current as well as experimental techniques for cartilage repair of osteochondral lesions of the talus.

Keywords: Talus, Osteochondral, Lesion, Osteochondritis dissecans, Microfracture, OLT, Allograft, OATS, PJCAT, ACI, MACI, AMIC, Metal resurfacing, Cartilage.

Adams Jr SB, Gross CE, Tainter DM, Easley ME, Parekh SG. Surgical Management of Osteochondral Lesions of the Talus. The Duke Orthop J 2015;5(1):35-47.

Source of support: Nil

Conflict of interest: None


 
Case Report
Ankit Arunbhai Desai MD Ortho DNB, BL Chandrakar MS, Rakesh Thakkar MS, Rahul Peswani JR

Lipoma in Thenar Region

[Year:2015] [Month:July-June] [Volumn:5 ] [Number:1] [Pages:72] [Pages No:68-69][No of Hits : 1289]


ABSTRACT

Lipomas can be found anywhere in the body, with the majority being located in the head and neck region, as well as the back and abdomen. Lipomas are one of the most common benign, mesenchymal neoplasms. They may progress in size overtime and they may or may not be painful. They may be superficial or deep. Deep soft-tissue lipomas of the hand are rare. Among them, thenar intramuscular lipomas are very rare. We are reporting case of thenar intramuscular lipoma.

Keywords: Lipoma, Thenar, Intramuscular lipoma.

Desai AA, Chandrakar BL, Thakkar R, Peswani R. Lipoma in Thenar Region. The Duke Orthop J 2015;5(1):68-69.

Source of support: Nil

Conflict of interest: None


 
Review Article
Vani Sabesan MD, Timothy R Jelsema MS, Daniel J Lombardo MD

Proper Postsurgical Pain Management in Orthopaedics: Reviewing the Efficacy of Wound Infiltration with Liposomal Bupivacaine (Exparel)

[Year:2015] [Month:July-June] [Volumn:5 ] [Number:1] [Pages:72] [Pages No:6-9][No of Hits : 994]


ABSTRACT

Adequate postoperative pain management after an orthopaedic procedure is critical for patient well-being, acceptable clinical outcomes and patient satisfaction. Current literature suggests over 80% of surgical patients’ state they have moderate to severe pain within 24 hours postoperatively. The standard in pain management for more than 40 years has been opioids, medications known for their many adverse effects and limited efficacy. Recently, a multimodal approach to pain control has been sought after for optimal postoperative pain management. This approach utilizes multiple methods of pain management, such as nerve blocks, wound infiltration with local anesthetics and oral analgesics, to concomitantly reduce postoperative pain. Liposomal bupivacaine, EXPAREL, has been shown to reduce pain for as long as 96 hours postoperatively in select studies. These studies have included both hard and soft-tissue procedures. The goal of this review is to examine the literature on EXPAREL and provide a comprehensive presentation for orthopaedic surgeons to apply to their practices.

Keywords: EXPAREL, Bupivacaine, Liposomal, Orthopaedics, Postoperative management, Pain.

Sabesan V, Jelsema TR, Lombardo DJ. Proper Postsurgical Pain Management in Orthopaedics: Reviewing the Efficacy of Wound Infiltration with Liposomal Bupivacaine (EXPAREL ). The Duke Orthop J 2015;5(1):6-9.

Source of support: Nil

Conflict of interest: None


 
Clinical Study
Benjamin Matthew Wooster MD, Samuel Evan Carstensen MD, James E Johnson PhD, Allston Julius Stubbs MD MBA

Model Orthopaedic Surgical Skills Curriculum for Fourth Year Medical Students

[Year:2015] [Month:July-June] [Volumn:5 ] [Number:1] [Pages:72] [Pages No:1-5][No of Hits : 935]


ABSTRACT

Musculoskeletal education in medical schools throughout the United States is inconsistent. Furthermore, formal surgical skill training in medical school is often lacking. Consequently, orthopaedic surgery residents in the United States are faced with a unique challenge as they transition from medical student to house officer in comparison to their peers pursuing more generalized specialties. In response, we designed and successfully implemented an innovative month long elective at Wake Forest University School of Medicine for fourth year medical students who were in the process of applying to orthopaedic surgery residency programs. This course provides medical students with an introduction to the basic skills and common surgical approaches that are commonly utilized early in orthopaedic surgery residency and beyond. While longitudinal data are needed, we believe this novel month long elective will allow the transition from medical student to house officer to be a smoother and more seamless process.

Keywords: Orthopaedic surgery, Curriculum development, Surgical skills.

Wooster BM, Carstensen SE, Johnson JE, Stubbs AJ. Model Orthopaedic Surgical Skills Curriculum for Fourth Year Medical Students. The Duke Orthop J 2015;5(1):1-5.

Source of support: Nil

Conflict of interest: Dr Allston Stubbs reports grants from Bauerfeind and Johnson and Johnson. He is a consultant for Smith and Nephew, Inc., and is a board or committee member with the International Society for Hip Arthroscopy, Journal of Arthroscopy, American Orthopaedic Society for Sports Medicine and Arthroscopy Association of North America.
All other authors report no declarations of interest.


 
Clinical Studies
Jonathan A Godin MD MBA, Jack G Skendzel MD, Jon K Sekiya MD

Cost Analysis of Failed Shoulder Stabilization

[Year:2015] [Month:July-June] [Volumn:5 ] [Number:1] [Pages:72] [Pages No:14-19][No of Hits : 884]


ABSTRACT

Background: Shoulder instability is a common problem, especially in the young, active population. Revision stabilization has a high rate of recurrent instability, low rates of return to play, and low clinical outcome scores. The challenge for surgeons is identifying the best surgery for each patient. To our knowledge, no studies have been published examining the cost of failed shoulder stabilization.

Hypothesis: The high cost of index and revision stabilization procedures in a cohort of patients with recurrent shoulder instability can be reduced through judicious preoperative planning and the use of more aggressive surgical techniques during the index operation.

Methods: We retrospectively reviewed the medical records and billing information of 18 consecutive patients treated at our institution for failed shoulder instability repairs during a 36-month period. Using the billing records for each case, a cost analysis was conducted from a societal perspective.

Results: The actual costs of index stabilization and revision stabilization procedures for our cohort of 18 patients amounted to $1,447,690. The costs of revision surgeries conducted for this cohort by a single surgeon at our institution amounted to $673,248. The hypothetical costs of primary arthroscopic stabilization and open stabilization for a cohort of 18 patients leading to permanent repair was $395,415 and $585,639 respectively. The incremental difference between actual costs and hypothetical costs of primary osteoarticular (OA) allograft stabilization for patients with bony defects is $278,394. For patients with significant bone defects, an open repair with failure rate of 44.9%, or an arthroscopic repair with failure rate of 62.8%, is cost neutral to a primary open repair with OA allograft. In addition, an open repair with failure rate of 13.0%, or an arthroscopic repair with failure rate of 41.3%, is cost neutral to a primary definitive repair.

Conclusion: Failed shoulder stabilization bears high costs to society, even without considering the psychological costs to patients. We must identify and refine diagnostic and prognostic factors to better determine the appropriate treatment modality for patients with primary shoulder instability.

Keywords: Cost, Analysis, Shoulder, Instability, Stabilization.

Godin JA, Skendzel JG, Sekiya JK. Cost Analysis of Failed Shoulder Stabilization. The Duke Orthop J 2015;5(1):14-19.

Source of support: Nil

Conflict of interest: None


 
Special Interest Article
James R Urbaniak MD

On the Shoulders of Giants: John P Adams MD

[Year:2015] [Month:July-June] [Volumn:5 ] [Number:1] [Pages:72] [Pages No:xx-xxi][No of Hits : 859]


ABSTRACT

Intellectually, John Adams has one of the best recalls I have ever encountered. He has gained a position of leadership in American Orthopaedics in both teaching and administration, and he is respected throughout the specialty. During the coming years, he is destined to reap many honors. So, Dr Lenox Baker wrote about John Adams in May 30, 1965, in a reference letter. Dr Baker, our Duke Orthopaedic Chairman for more than 30 years (1937-1967), prided himself in judging character, and his appraisal of Dr Adams was certainly not an overstatement.


 
Clinical Studies
David C Holst MD, Allston J Stubbs MD, Phillip R Mason MD, Adam Anx MD, Brad Perry MS, Elizabeth A Howse MD

Correlation of Atraumatic Pain with Acetabular Chondromalacia in Athletes

[Year:2015] [Month:July-June] [Volumn:5 ] [Number:1] [Pages:72] [Pages No:25-27][No of Hits : 793]


ABSTRACT

This study investigates the relationship of atraumatic, prearthritic hip pain to the severity of acetabular chondromalacia (CSI) documented at the time of hip arthroscopy in a group of athletes. Our hypothesis is that hip pain duration is positively correlated with acetabular cartilage damage. Forty-six consecutive patients with atraumatic, prearthritic hip pain underwent hip arthroscopy. The severity of chondral damage was compared to duration of symptoms, age, and Wiberg’s lateral center edge angle. For the cohort of male patients, the Pearson’s correlation coefficient was r = 0.43 for age (p = 0.049), r = 0.85 for pain duration (p < 0.001), and r = 0.13 for Wiberg angle (p = 0.573). These findings in the athletic, male cohort supports a positive correlation between duration of hip pain symptoms and degree of acetabular chondromalacia.

Keywords: Hip arthroscopy, Chondromalacia, Athlete, Atraumatic pain.

Holst DC, Stubbs AJ, Mason PR, Anx A, Perry B, Howse EA. Correlation of Atraumatic Pain with Acetabular Chondromalacia in Athletes. The Duke Orthop J 2015;5(1):25-27.

Source of support: Nil

Conflict of interest: None


 
Clinical Study
Michael A Gallizzi MD MS, Christine M Gagnon PhD, Daniel J Blizzard MD MS, Steven P Stanos DO

Failed Back Surgery Syndrome and Back Pain Patients: Medications They use and How They relate to Their Emotional and Physical Functioning

[Year:2015] [Month:July-June] [Volumn:5 ] [Number:1] [Pages:72] [Pages No:53-57][No of Hits : 740]


ABSTRACT

Study Design: Retrospective analysis.

Objective: To test the hypothesis that failed back surgery syndrome (FBSS) patients and nonsurgical back pain (NSBP) patients respond differently on psychological measures and differ in pain medication usage.

Summary of background data: The study was part of an interdisciplinary outpatient functional restoration program. There were 121 participants-42 with FBSS and 79 with NSBP-who participated in a multidisciplinary pain evaluation.

Methods: A chart review was performed and interventions were not applicable. The outcome measures for the study include: the beck depression inventory (BDI), pain disability index (PDI), state-trait anxiety inventory (STAI), multidimensional pain inventory pain severity (MPI-PS) subscale and medication quantification scale III (MQS-III).

Results: Pearson’s correlation analyses of all patients combined (28 FBSS and 39 NSBP) revealed significant relationships between MQS-III and BDI (r = 0.388, p < 0.01) and STAI (r = 0.323, p < 0.05). A significant correlation was found between MQS-III and STAI (r = 0.536, p < 0.05) among the NSBP patients. The MQS-III was significantly correlated with BDI (r = 0.536, p < 0.05) and MPI-PS t-scores (r = 0.356, p < 0.05) among the 40 NSBP patients. Independent t-tests of mean BDI, PDI, STAI, MPI-PS, and MQS-III scores revealed no significant group differences.

Conclusion: Results suggest that while there is differing correlation between FBSS and NSBP groups in pain medication use and psychometrics, the mean difference of quantity of pain medications used and scores on psychometric measurements in these groups are not different. While presurgical psychometrics and pain medication usage were not available for our FBSS patients, our results support that medication quantification with psychological prescreening before surgical intervention for back pain patients may help to limit the number of failed back surgeries. Thus, future research including preand postsurgical psychological functioning, physical functioning, and pain medication usage is suggested.

Keywords: Lower back pain, Failed back surgery syndrome, Analgesic drugs, Psychological measures.

Gallizzi MA, Gagnon CM, Blizzard DJ, Stanos SP. Failed Back Surgery Syndrome and Back Pain Patients: Medications They use and How They relate to Their Emotional and Physical Functioning. The Duke Orthop J 2015;5(1):53-57.

Source of support: Nil

Conflict of interest: None


 
Case Report
Mathew D Crawford MD, William C Eward DVM MD

What is the Diagnosis?

[Year:2015] [Month:July-June] [Volumn:5 ] [Number:1] [Pages:72] [Pages No:70-72][No of Hits : 720]


ABSTRACT

Melorheostosis is a rare, benign connective tissue disorder affecting both bone and soft tissues. Its insidious and variable presentation makes it a challenging clinical diagnosis. We describe the case of a patient presenting with monomelic involvement including significant contractures of the left upper extremity. This case illustrates the functional morbidity associated with melorheostosis as well as its characteristic (i.e. radiographs with flowing hyperostosis) and more rare (i.e. local gigantism) findings.

Keywords: Melorheostosis, Hyperostosis, Skeletal dysplasia.

Crawford MD, Eward WC. What is the Diagnosis? The Duke Orthop J 2015;5(1):70-72.

Source of support: Nil

Conflict of interest: None


 
Special Interest Article
Mitchell R Klement MD, Elizabeth W Hubbard MD

Feagin Leadership Forum Update

[Year:2015] [Month:July-June] [Volumn:5 ] [Number:1] [Pages:72] [Pages No:xxv-xxvi][No of Hits : 670]


ABSTRACT

The John A Feagin Jr, MD, Leadership Program was established in 2009 in honor of Dr John A Feagin Jr, MD. For 6 years, the program has strived to cultivate leadership skills among the Duke medical students, orthopaedic residents and fellows. Scholars accepted into this program do so with the full understanding that they (they are) making a tremendous commitment of their time and energy. The program involves a 10-month curriculum including topics, such as ‘Defining personal leadership and values’ and ‘Mentoring’. Scholars are also involved in a 10-month long group project as well as numerous seminars, workshops and mentorship programs. The goal of this program is to prepare the next generation of leaders and it continues to grow under the leadership of Program Chairman COL (Ret) Dean Taylor, ME; Program Executive LTC (Ret) Joe Doty, PhD; Advisory Board President COL (Ret) Walt Curl, MD and Vice President Kathy M Andolsek, MD MPH.


 
Letter from the Editors
Daniel J Blizzard MD MS, Mitchell R Klement MD, Elizabeth W Hubbard MD

Letter from the Editors

[Year:2015] [Month:July-June] [Volumn:5 ] [Number:1] [Pages:72] [Pages No:xiii][No of Hits : 601]


ABSTRACT

Dear Colleagues,
It is with great pleasure that we present the fifth edition of the Duke Orthopaedic Journal (DOJ). This has been a tremendous year for us and we are pleased to be able to publish a wide range of articles submitted from both our national and international associates. Many of our readers have inquired regarding if and when the journal would be indexed through PubMed. We have not yet gone forward with this change for a number of reasons. One major reason is that the journal’s founders and editors have taken pride in publishing what we feel is a unique record of the yearly changes and accomplishments of the Duke Orthopaedic Program and intend for the journal to be a source of new and interesting research.


 
Special Interest Article
Norah Foster MD

The 2015 Parekh Indo-US Foot and Ankle Surgery Annual Meeting Experience (Indian Adventures)

[Year:2015] [Month:July-June] [Volumn:5 ] [Number:1] [Pages:72] [Pages No:xxviii-xxx][No of Hits : 582]


ABSTRACT

The next time you think our duty hours are strict, know that we have it better than the airlines! What started as a very bumpy ride (literally) to India that was wrought with crew hours restrictions, flight delays, innocently walking out of an airport and almost not being let back in, and lost baggage, ended up in a unique experience that was both meaningful and inspirational.


 
Letter from the Chairman
Benjamin Alman MD FRCSC

Letter from the Chairman

[Year:2015] [Month:July-June] [Volumn:5 ] [Number:1] [Pages:72] [Pages No:xv-xvi][No of Hits : 581]


ABSTRACT

THE FUTURE OF DUKE ORTHOPAEDICS: DEVELOPING A CULTURE FOR SUCCESS

Academic orthopaedic departments have a special challenge to develop and maintain three core missions: To provide an exceptional level of patient-centered musculoskeletal care, to generate and use new knowledge to improve the care of people with musculoskeletal conditions, and to educate and train the next generation of musculoskeletal providers and the leaders of orthopaedic surgery tomorrow. Exceptional performance in any one core mission is a reason to celebrate. Our department reached an important milestone this year in demonstrating exceptional performance in its tripartite clinical, research and education mission. The department ranked 9th in the US News and World Report for clinical care, 6th in NIH funding for an orthopaedic department, and 5th in the inaugural Doximity/US News and World Report Residency rankings. This makes Duke orthopaedics the only department ranked 9th or better in all three of these indices. This is an important accomplishment, something that recognizes the incredible quality, dedication, and depth of the Duke faculty, trainees and staff.


 
Special Interest Article
Cameron Ledford MD

Piedmont Orthopaedic Meeting Update (2014)

[Year:2015] [Month:July-June] [Volumn:5 ] [Number:1] [Pages:72] [Pages No:xxvii][No of Hits : 558]


ABSTRACT

The 62nd Annual Orthopaedic Piedmont meeting marked a new milestone for our society by taking place in one of the world’s oldest and most influential cultures: Greece. This historical meeting (first one outside of the US except for Bermuda and St John’s, Virgin Islands) was attended by 85 members along with spouses, guests, and children totaling 210+. Current residents who attended the meeting included: William Mook, recipient of the John M Harrelson, Chief Resident Teaching Award, Cameron Ledford and John Lewis, recipients of the Ralph Coonrad Pediatric Orthopaedics Traveling Fellowships, and Matthew Tao, recipient of the William S Ogden, Junior Resident Award. The meeting provided education on current orthopaedic topics, Greek history and culture, and great fun for all ages.


 
Special Interest Article
Elizabeth W Hubbard MD

Emily Berend Adult Reconstruction Symposium (2014)

[Year:2015] [Month:July-June] [Volumn:5 ] [Number:1] [Pages:72] [Pages No:xxxi-xxxii][No of Hits : 539]


ABSTRACT

The Emily Berend Adult Reconstruction Symposia (EBARS) celebrated its 6th year at Duke University in April 25 and 26, 2014. Drs Michael (Duke Med ‘92; Ortho ‘98) and Keith (Duke Med ‘97; Ortho ‘02) Berend once again sponsored the educational symposia in honor of their late mother Emily. This 2-day educational event is designed to educate adult reconstruction surgeons as well as orthopaedic residents, fellows, allied health professionals and nurses about the most research changes in research and practice in adult reconstruction.


 
Letter from the Faculty Advisor
Selene G Parekh MD MBA

Letter from the Faculty Advisor

[Year:2015] [Month:July-June] [Volumn:5 ] [Number:1] [Pages:72] [Pages No:xiv][No of Hits : 502]


ABSTRACT

It gives me great pleasure to present the fifth issue of the Duke Orthopaedic Journal (DOJ). This year marks the 5 years anniversary of the journal. As we have grown, the journal continues to find its place in the tradition of Duke orthopaedics.


 
Case Report
Amit Agrawal

Spinal Cord Contusion and Quadriplegia in a Patient with Klippel-Feil Anomaly

[Year:2014] [Month:July-June] [Volumn:4 ] [Number:1] [Pages:32] [Pages No:1-2][No of Hits : 2841]


ABSTRACT

Keywords: Cervical cord contusion, Klippel-Feil anomaly, Minor trauma, Klippel-Feil syndrome.

How to cite this article: Agrawal A. Spinal Cord Contusion and Quadriplegia in a Patient with Klippel-Feil Anomaly. The Duke Orthop J 2014;4(1):1-2.

Source of support: Nil

Conflict of interest: None


 
Original Research
Pier Francesco Indelli MD PhD, Andrea Baldini MD, Luca Manfredini PT, Massimiliano Marcucci MD

Rotational Alignment Landmarks in Primary Total Knee Arthroplasty

[Year:2014] [Month:July-June] [Volumn:4 ] [Number:1] [Pages:32] [Pages No:8-12][No of Hits : 2323]


ABSTRACT

Purpose: We hypothesized that the anterior tibial surface curvature is a more reliable landmark for correct tibial component rotational positioning in TKA respect to the ‘Akagi’ line and the medial third of the tibial tubercle.

Methods: Three independent investigators reviewed 124 knee MRI scans, identifying independently the femoral transepicondylar axis (TEA), the femoral posterior condylar axis (PCA), a line connecting the middle of the posterior cruciate ligament and the medial edge of the patellar tendon attachment (Akagi’s line), the medial third of the tibial tubercle and the anterior tibial surface curvature. The most appropriate tibial baseplate tracing for the NexGen Total Knee System (Zimmer, Warsaw, USA) was superimposed matching the anterior tibial cortex with its anterior surface. At this point, the rotation of the tibial plate tracing was calculated in respect to the TEA, the medial third of the tibial tubercle line, the Akagi’s line and the PCA. Customized software was created and used for analysis of the MRI datasets.

Results: The investigators agreed on the localization of the Akagi’s line in 64% of the cases within 3° and in 85% of the cases within 5° (minimum -16°, maximum -7°): this landmark might lead to internal rotation of the tibial component. The observers agreed on the localization of the medial third of the tibial tubercle in 29% of the cases within 3° and, in 70% of the cases, within 5° (minimum -4°, maximum +4°): this landmark might lead to external rotation of the tibial component. The investigators agreed on the localization of the anterior tibial surface curvature in 89% of the cases within 3° and in 99% of the cases within 5° (minimum -1°, maximum +4°): component alignment along the anterior cortex guaranteed full matching ±3° to the epicondylar axis in 75% of the knees.

Conclusion: Alignment of the tibial component, when based on the anterior tibial surface, was more reliable and easier identifiable than either the Akagi’s line or the medial third of the tibial tubercle.

Level of evidence: Level 3 (Retrospective cohort study).

Keywords: TKA, Alignment, Bone landmarks, MRI.

How to cite this article: Indelli PF, Baldini A, Manfredini L, Marcucci M. Rotational Alignment Landmarks in Primary Total Knee Arthroplasty. The Duke Orthop J 2014;4(1):8-12.

Source of support: Nil

Conflict of interest: None


 
Special Interest Article
Jonathan A Godin

AAOS/ORS Annual Meeting Update

[Year:2014] [Month:July-June] [Volumn:4 ] [Number:1] [Pages:32] [Pages No:xxx-xxxiii][No of Hits : 2019]


ABSTRACT

The Duke Department of Orthopaedic Surgery had a proud showing at both the 2014 Orthopaedic Research Society (ORS) annual meeting held, March 15th to 18th, 2014 in New Orleans, Louisiana, as well as the American Academy of Orthopaedic Surgeons (AAOS) annual meeting held, March 11th to 15th, 2014 in New Orleans, Louisiana. Many members of the Duke Orthopaedic Surgery family were able to gather for the Piedmont Orthopedic Society Mid-Winter reception at the Sheraton New Orleans Hotel on Friday, March 14th. Listed below is a summary of the podium presentations, posters, demonstrations, and invited lectures from the current faculty and residents at these meetings.


 
Case Series
Richard J Nasca MD

Adhesive Capsulitis of the Shoulder in Patients with Diabetes

[Year:2014] [Month:July-June] [Volumn:4 ] [Number:1] [Pages:32] [Pages No:24-26][No of Hits : 1809]


ABSTRACT

Background: Adhesive capsulitis of the shoulder is common in patients with diabetes. The exact etiology is unknown. The aim of this study is to evaluate the results of subacromial bursal corticosteroid injections and a home program of Codman’s exercises in a cohort of diabetic patients with adhesive capsulitis.

Materials and methods: Twelve diabetic patients with adhesive capsulitis treated from November, 2011 to February, 2013 in an outpatient clinic were evaluated. The age range was 40 to 64 years with a mean age of 52. There were six males and six females. Six patients had involvement of the right shoulder, four had involvement of the left and two patients had bilateral shoulder involvement. The dominate upper extremity was affected in nine patients. There were 11 patients with type 2 diabetes and one with type 1 diabetes. All patients had an insidious onset of pain and stiffness in the affected shoulder. There was poorly localized tenderness about the shoulder with restricted abduction, forward flexion and internal rotation limited to the level of the buttocks or below. There were abnormal imaging studies in seven of the 12 patients. Five patients did not have imaging studies. Edema and thickening of rotator cuff tissue was the most frequent finding on magnetic resonance imaging (MRI). There was one small rotator cuff tear and one small labral tear. Patients were treated with a subacromial bursal space injection with 2 to 3 ml of 2% lidocaine and one milliliter of betamethasone sodium phosphate and sodium acetate (6 mg/ ml). Following the injection, passive stretching of the involved shoulder was done for a few minutes. The patients were instructed in Codman’s exercises and wall climbing.

Results: Good pain relief was experienced by 11 patients with only fair relief in one. The average range of motion posttreatment was greater than 110° forward flexion and greater than 140° abduction. Internal rotation was possible to the L3 level. Two patients had a recurrence of symptoms at 6 and 12 months, and both were treated with reinjection and subsequent symptomatic improvement. There were no complications, though some patients had a transient rise in their blood sugar following injection.

Conclusion: Subacromial bursal injections coupled with Codman’s exercises are effective in treating adhesive capsulitis of the shoulder in diabetic patients.

Keywords: Diabetic, Adhesive capsulitis, Subacromial injection.

Level of evidence: IV

How to cite this article: Nasca RJ. Adhesive Capsulitis of the Shoulder in Patients with Diabetes. The Duke Orthop J 2014;4(1):24-26.

Source of support: Nil

Conflict of interest: None


 
Case Series
Selene Parekh MD, Todd Bertrand MD, Robert Zura MD, Samuel Adams MD, Alan Yan MD

Novel Techniques in Treating Calcaneal Tuberosity Fractures

[Year:2014] [Month:July-June] [Volumn:4 ] [Number:1] [Pages:32] [Pages No:3-7][No of Hits : 1727]


ABSTRACT

Calcaneal tuberosity fractures comprise only 1 to 2% of all calcaneal fractures. Treatment of these injuries has traditionally included open reduction and internal fixation with various means including lag screws, suture anchors and K-wires. We report on a series of cases treated with excision of the tuberosity fragment with repair of the Achilles tendon supplemented by a flexor hallucis longus tendon transfer.

Keywords: Calcaneus, Tuberosity, Fracture, Achilles, Flexor hallucis longus.

How to cite this article: Parekh S, Bertrand T, Zura R, Adams S, Yan A. Novel Techniques in Treating Calcaneal Tuberosity Fractures. The Duke Orthop J 2014;4(1):3-7.

Source of support: Nil

Conflict of interest: None


 
Special Interest Article
Elizabeth W Hubbard MD, Lou Ogden

On the Shoulders of Giants: William S Ogden MD

[Year:2014] [Month:July-June] [Volumn:4 ] [Number:1] [Pages:32] [Pages No:xviii-xix][No of Hits : 1723]


ABSTRACT

While there have been several accomplished graduates from the Duke Orthopaedic Residency Program, few of them have made as strong and direct an impact on the residency program as Dr William Singleton Ogden.


 
Special Interest Article
Julie A Neumann MD, Kathryne J Stabile MD, Ann H Taylor BSN, Col (retired) Dean, C Taylor MD

John A Feagin Jr MD Leadership Program Update

[Year:2014] [Month:July-June] [Volumn:4 ] [Number:1] [Pages:32] [Pages No:xxv-xxvii][No of Hits : 1419]


ABSTRACT

This year marks the 5th year of the Duke Sports Medicine Feagin Leadership Program, created in honor of COL (Ret) John A Feagin Jr, MD, Duke University Emeritus Professor of Orthopaedic Surgery and graduate of United States Military Academy at West Point in 1955. This program continues to attract bright and highly motivated individuals from across the Duke Medical community interested in cultivating leadership skills. Throughout the academic year the Feagin Leadership faculty and scholars participate in seminars, workshops, conferences, and mentorship opportunities on various leadership principles and development initiatives. The goal of the program is to prepare the scholars to assume leadership positions in their respective medical professions and communities.


 
Original Research
Cameron K Ledford MD, Alexander R Vap MD, Michael P Bolognesi MD, Samuel S Wellman MD

Total Hip Arthroplasty in Very Young Bone Marrow Transplant Patients

[Year:2014] [Month:July-June] [Volumn:4 ] [Number:1] [Pages:32] [Pages No:19-23][No of Hits : 1253]


ABSTRACT

Concerns remain about total hip arthroplasty (THA) performed in very young patients, especially those with complex medical history such as allogeneic bone marrow transplantation (ABMT). This study retrospectively reviews the perioperative courses and functional outcomes of ABMT patients <21 years old undergoing primary uncemented THA. Nine THAs were performed in five ABMT patients at an average age of 19.7 years. The interval between ABMT and THA was 73.0 months with clinical follow-up of 25.8 months. Harris Hip Scores (HHS) increased dramatically from preoperatively 44.5 (31.1-53.4) to postoperatively 85.2 (72.0-96.0) and all patients subjectively reported a good (4 hips) to excellent (5 hips) overall outcome. There was one reoperation for periprosthetic fracture fixation but there were no infections or revisions performed. Despite the history of severe hematopoietic conditions requiring ABMT, these very young patients do appear to have improved pain and function following primary THA with short-term follow-up. These results are comparable to prior studies of adult ABMT patients undergoing THA and are encouraging given the complexity of the decision to perform hip arthroplasty in the medically complicated very young patient.

Keywords: Bone marrow transplant, Total hip arthroplasty, Osteonecrosis, Outcomes.

How to cite this article: Ledford CK, Vap AR, Bolognesi MP, Wellman SS. Total Hip Arthroplasty in Very Young Bone Marrow Transplant Patients. The Duke Orthop J 2014;4(1):19-23.

Source of support: Nil

Conflict of interest: None


 
Retrospective Review
Walter Harrill Wray MD, Jeffrey Greenberg MD, Josh C Vella MD

Safety and Efficacy of Arthroscopic Volar Carpal Ganglion Excision: An Anatomic and Clinical Study

[Year:2014] [Month:July-June] [Volumn:4 ] [Number:1] [Pages:32] [Pages No:27-32][No of Hits : 1233]


ABSTRACT

Purpose: Arthroscopic ganglionectomy is a viable alternative to open treatment and has widely been applied to treatment of dorsal ganglion pathology. The technique of arthroscopic volar carpal ganglion excision has recently been developed, and there is little peer-reviewed clinical evidence detailing its safety and efficacy. This study aims to present our experience with the development and implementation of this technique.

Materials and methods: In the anatomic portion of the study, three cadaver arms were positioned for wrist arthroscopy and dissected to determine the distance between the volar capsule and adjacent vital structures. Ten axial wrist MRIs were reviewed to further define the distance between the volar capsule and adjacent vital structures.
In the clinical portion of the study, 15 patients (mean age 47 years) treated with arthroscopic volar carpal ganglion excision were evaluated. Final follow-up occurred at an average of 48 months (21-68 months). Fourteen patients completed a MHQ and 12 patients were able to return for clinical evaluation.

Results: The wrist dissection and the MRI both showed the radial artery, FPL and FCR to all be within 1 cm of the working area. The radial artery was adjacent to the capsule and at risk when the capsule was approached from the 6 R portal.
Clinically, there was a small but significant difference in the Michigan Hand Questionnaire scores between the operative and nonoperative wrists postoperatively (93.3 vs 98.5, p = 0.004). There was one recurrence (6.7%), not requiring further surgery, and 1 complication (6.7%), which did require a secondary procedure. Mean time to return to work was 11.2 days (1-91 days, N = 11). Mean time to return to maximum function was 5.6 weeks (N = 11). There was a significant difference in mean wrist extension of the operative vs nonoperative wrist (58.8 vs 66.3°, p = 0.01, N = 12). There was no significant difference in mean flexion of the operative vs nonoperative wrist (71.7 vs 71.3°, p = 0.7, N = 11) or grip strength between operative and nonoperative wrists (31.8 vs 34.9 kg, p = 0.06, N = 12).

Conclusion: This small anatomic and clinical series demonstrates that arthroscopic volar carpal ganglion excision is a safe and effective procedure with a low recurrence rate. We no longer use the 6R portal when excising volar carpal ganglions.

Level of evidence: IV therapeutic

Keywords: Arthroscopy, Carpal, Efficacy, Excision, Ganglion, Safety, Wrist.

How to cite this article: Wray WH, Greenberg J, Vella JC. Safety and Efficacy of Arthroscopic Volar Carpal Ganglion Excision: An Anatomic and Clinical Study. The Duke Orthop J 2014;4(1):27-32.

Source of support: Nil

Conflict of interest: None


 
Special Interest Article
R Andrew Henderson

Emily Berend Adult Reconstruction Symposium

[Year:2014] [Month:July-June] [Volumn:4 ] [Number:1] [Pages:32] [Pages No:xxxvi][No of Hits : 1052]


ABSTRACT

April 19th and 20th 2013 marked the fifth annual Emily Berend Adult Reconstruction symposium held at Duke University Medical center, co-hosted by brothers and former Duke Orthopaedic residents Keith R Berend, MD and Michael E Berend, MD. The yearly symposium is held in honor of their late mother who held tremendous regard for the Duke Orthopaedic Residency Program and the training it afforded her sons. An event skyrocketing in popularity since its inception, the course allows faculty from all over the country to engage in scholarly discussion about the latest trends and topics in hip and knee reconstruction, as well as cadaveric dissections/demonstrations and fellowship with one another.


 
Special Interest Article
Norah Foster

Annual Uganda Spine Surgery Volunteer Trip

[Year:2014] [Month:July-June] [Volumn:4 ] [Number:1] [Pages:32] [Pages No:xxxvii-xl][No of Hits : 1050]


ABSTRACT

Let it be: The Duke 2013 Uganda Medical Mission Experience

Sister Florence was the day floor nurse. She has been there many years and could accomplish anything with the barest of bones supplies. She and few other nurses managed all the spine ward patients which could be up to about thirty patients, many of which were quadriplegic or paraplegic and had significant needs. She was a hard worker to say the very least and she had the kindest soul. As we hurried in the first morning eager to get our shipped supplies unpacked, we came upon a minor delay as they were under lock and key and the individual with the key was not present. Used to the hustle and bustle of the US where we rarely have idle hands and continuously run the proverbial rat race in order to get things done, we were rather frustrated. Sister Florence merely said with a quiet calm, ‘Let it be’. And so we did.


 
Letter
Benjamin Alman MD

Letter from the Chairman

[Year:2014] [Month:July-June] [Volumn:4 ] [Number:1] [Pages:32] [Pages No:xv-xvii][No of Hits : 985]


ABSTRACT

Discovering opportunities: a 2020 vision for duke orthopaedics

Our Duke Orthopaedic family remains incredibly productive, despite the many challenges we face in our environment. This past year, we faced changes in the leadership of the Department as well as in many aspects of the larger Duke academic health enterprise; the adoption of a new electronic medical record and changes in healthcare funding, such as in North Carolina Medicaid. Despite these challenges, we came through the year stronger than ever. It is a testament to the industriousness, creativity, innovation, and loyalty of our faculty, staff and trainees that the department remains incredibly strong.


 
Special Interest Article
Alexander R Vap

Atlanta Rotation Experience

[Year:2014] [Month:July-June] [Volumn:4 ] [Number:1] [Pages:32] [Pages No:xlii][No of Hits : 952]


ABSTRACT

As a Duke resident, one’s fourth year is an exciting time. Now a senior resident, your role within the residency begins to transition to one of a leader and a teacher for junior residents. It is also a time when fellowship interviews, the important next step in one’s future career, take place. Most importantly, it is a time when all eight residents travel away from the Duke nest for a period of 6 months. For the fifth straight year, four residents have traveled south to spend that time with the staff of Children’s Orthopaedics of Atlanta at Atlanta’s Scottish Rite Pediatric Hospital.


 
Special Interest Article
John S Lewis

Indo-US Foot and Ankle Surgery Conference 2014

[Year:2014] [Month:July-June] [Volumn:4 ] [Number:1] [Pages:32] [Pages No:xxxiv-xxxv][No of Hits : 937]


ABSTRACT

The 5th Annual Indo-US Foot and Ankle Surgery Conference, founded and sponsored by the Parekh Family Foundation, was held from January 10th to 12th in Jaipur, India. Since its inception five years ago, the aim of the conference is to disseminate and share techniques in foot and ankle surgery with orthopaedic surgeons from the United States, India, South Asia, Europe, and beyond. An international faculty comprised of delegates from these regions run academic informational sessions, oversee instructional sawbones courses, and perform surgery while narrating via live video feed to the conference’s attendees.


 
Original Research
Todd E Bertrand MD, Michael P Bolognesi MD

Clinical Outcomes of First 100 Navigated Total Knee Arthroplasties at Duke University Medical Center

[Year:2014] [Month:July-June] [Volumn:4 ] [Number:1] [Pages:32] [Pages No:13-18][No of Hits : 917]


ABSTRACT

Background: Total knee arthroplasty (TKA) is one of the most clinically successful and cost-effective interventions in medicine. Implant malalignment can be a cause of early failure following total knee arthroplasty. Computer-assisted surgery has been employed to improve the precision of component alignment.

Questions/purpose: We asked: (1) What is the average coronal plane alignment of the first 100 patients undergoing computerassisted total knee arthroplasty at our institution? (2) How do our clinical and radiographic results compare to those values reported in the literature? (3) Was a ‘learning curve’ present as evidenced by improvements in coronal plane alignment over time?

Methods: We retrospectively reviewed our first 100 patients undergoing computer navigated total knee arthroplasty. We calculated postoperative knee range of motion (ROM), coronal alignment as well as preoperative and postoperative Knee Society Scores. Minimum follow-up was 4.3 years (0.2-8.25 years).

Results: Of the 100 patients, average postoperative limb alignment was 0.9° varus compared to the mechanical axis. Seventy-nine percent of patients had coronal plane alignment of ±3°. Knee Society Scores improved on average from 60 preoperatively (52-67) to 85 postoperatively (56-97).

Conclusion: Computer-assisted total knee arthroplasty is potentially a way to improve component alignment and overall patient satisfaction. In our cohort, average coronal alignment was similar to literature reported values for navigated and conventional total knee arthroplasty. The benefit of this technology remains unproven. Level of evidence: Level IV

Keywords: Total knee arthroplasty, Computer navigation, Outcomes.

How to cite this article: Bertrand TE, Bolognesi MP. Clinical Outcomes of First 100 Navigated Total Knee Arthroplasties at Duke University Medical Center. The Duke Orthop J 2014;4(1):13-18.

Source of support: Nil

Conflict of interest: None


 
Special Interest Article
Elizabeth Hubbard

Piedmont Orthopaedic Meeting Update

[Year:2014] [Month:July-June] [Volumn:4 ] [Number:1] [Pages:32] [Pages No:xxix][No of Hits : 901]


ABSTRACT

The 2013 Piedmont Meeting took place at the Cloister in Sea Island Georgia. There was an impressive attendance, which included current and former faculty as well as former residents. Current residents who attended the meeting included Dr Jordan Schaeffer, recipient of the John M Harrelson chief resident teaching award, Drs Philip Horne and Jason Jennings, recipients of the Ralph Coonrad pediatric orthopaedics traveling fellowships, and Dr Elizabeth Hubbard, recipient of the William S Ogden Jr junior resident award.


 
Special Interest Article
R Andrew Henderson

Duke Medical Pavilion Write-up

[Year:2014] [Month:July-June] [Volumn:4 ] [Number:1] [Pages:32] [Pages No:xxii-xxiii][No of Hits : 891]


ABSTRACT

For those who are not already aware, the physical plant of Duke Hospital has undergone a remarkable transformation over the past 5 years. Gone are the hospital-to-clinic monorail system and the old Bell Building. In their place, several state-of-the-art facility additions have opened in the space between the Duke South clinic building and the main hospital at Duke North. While the new Cancer Center and Medical School buildings are themselves tremendous additions to our medical landscape, perhaps the highlight of our infrastructure is the new Duke Medical Pavilion (DMP) which opened for business in July 2013.


 
Letter
Jonathan A Godin MD MBA, R Andrew Henderson MD MSc, Elizabeth W Hubbard MD

Letter from the Editors

[Year:2014] [Month:July-June] [Volumn:4 ] [Number:1] [Pages:32] [Pages No:xiii][No of Hits : 888]


ABSTRACT

Dear Colleagues,

This year marks the fourth installment of the Duke Orthopaedic Journal. This has been a year of reflection for the editorial board. As the journal matures, we must decide if the Journal should be a memoir of the past academic year supplemented by scientific articles or a PubMed-indexed journal, produced by the residents and faculty of Duke Orthopaedics. We hope that the Journal will soon be referenced on research databases, but we do not want to change the Journal’s identity as a unique publication updating readers on the year’s highlights and accomplishments within Duke Orthopaedics. In doing so, we continue to build upon the vision and dedication of the Journal’s founders: Dr Selene Parekh, Dr Will Eward and Dr Stephanie Mayer to expand the scope, visibility and credibility of the Journal within the scientific community.


 
Special Interest Article
Jonathan A Godin MD MBA

Resident Awards

[Year:2014] [Month:July-June] [Volumn:4 ] [Number:1] [Pages:32] [Pages No:xx][No of Hits : 798]


ABSTRACT

William Ogden Junior Resident Award

Each year, the chief residents select the third year resident who they feel best embodies the intangibles possessed by Dr Ogden. These characteristics, including passion, teamwork, work ethic, integrity and professionalism, make the Duke Orthopaedics residency special. In 2013, Dr Elizabeth Hubbard was chosen for this special honor. Dr Hubbard has a long history of excellence. Born and raised in Delaware, she attended Siena College in Upstate New York, where he was both an award-winning student and a standout volleyball player. After graduating from college, she went to nearby Albany Medical College, where she established herself as a diligent, hardworking student with a passion for Orthopaedics. While at Duke, Dr Hubbard has been a role model for all of us. She provides compassionate patient care, and she always goes the extra step. Outside of her clinical responsibilities, Liz was awarded a prestigious OREF research grant to study the role of computer-assisted training in sacroiliac screw placement. She cares deeply about the Duke Orthopaedics program and holds all of us to the highest standard of excellence and professionalism. There is no better role model for our junior residents than Dr Hubbard, who always puts the patient and her co-residents first. Dr Hubbard is planning a career in pediatric orthopaedics.


 
Special Interest Article
Elizabeth Hubbard

Asheville Rotation Update

[Year:2014] [Month:July-June] [Volumn:4 ] [Number:1] [Pages:32] [Pages No:xli][No of Hits : 740]


ABSTRACT

One of the highlights of our residency program is the 6 months rotation that 4th year residents spend working at the Asheville VA. This experience is one of the few rotations where residents play a major role in the clinical decision making for their patients, both in the operating room and in the clinics. With the guidance of Drs William Ogden, Frank Brown, John Lucey, Robert Francis, Richard Fellrath, Carey McKain and Glenn Rechtine, this is arguably one of the most educational and challenging times in residency because of the independence that is afforded to each resident surgeon. In the words of Dr Ogden, ‘More than anything else, (in Asheville) you are taught to be in-charge of the operating room and how to be in-charge of yourself.’


 
Special Interest Article
R Andrew Henderson

Faculty Teaching Award

[Year:2014] [Month:July-June] [Volumn:4 ] [Number:1] [Pages:32] [Pages No:xxi][No of Hits : 734]


ABSTRACT

Each year the outgoing chief residents select one attending surgeon who they feel has had the greatest impact on their collective residency training. In June of 2013, the departing chief class selected Dr Michael Bolognesi as the recipient of this departmental honor. It is the highest award given from the residents to our faculty, and given the sheer number of wonderful teachers scattered throughout the department of Orthopaedic Surgery here at Duke, it is both a highlyselective and a prestigious honor.


 
Letter
Selene G Parekh MD MBA

Letter from the Faculty Advisor

[Year:2014] [Month:July-June] [Volumn:4 ] [Number:1] [Pages:32] [Pages No:xiv][No of Hits : 715]


ABSTRACT

It gives me great pleasure to present the 2013-14 Duke Orthopaedic Journal (DOJ). This year marks the 4-year anniversary of the Journal. As we have grown, the Journal continues to find its place in the tradition of Duke Orthopaedics.


 
Special Interest Article
Jonathan A Godin

The Bassett Society Update

[Year:2014] [Month:July-June] [Volumn:4 ] [Number:1] [Pages:32] [Pages No:xxiv][No of Hits : 695]


ABSTRACT

The Bassett Society was founded in 1985 by Dr Frank H Bassett III, legendary orthopaedic surgeon at Duke University Medical Center. Dr Bassett served as the team physician for Duke Athletics from 1966 to 1993, but remained a prominent figure within the department even after retirement. He was known for his warmth and charisma, and inspired everyone he came into contact with students, athletes and doctors alike.


 
Special Interest Article
Jonathan A Godin

NCOA Update

[Year:2014] [Month:July-June] [Volumn:4 ] [Number:1] [Pages:32] [Pages No:xxviii][No of Hits : 671]


ABSTRACT

The 2013 North Carolina Orthopaedic Association Annual Meeting convened at The Greenbrier in White Sulphur Springs, WV for three days of education and fellowship. The scientific portion of the meeting featured several Duke residents, including Drs Tyler Watters, John Lewis, Elizabeth Hubbard, Norah Foster, Cameron Ledford, and Jonathan Godin. Drs Ledford and Lewis took home the first and second place resident research awards, respectively.


 
HISTORY OF MEDICINE
Cameron Ledford MD, Grant E Garrigues MD, Robert D Fitch MD

Ilizarov: The Man, The Myth, The Method: An Orthopaedic Inspiration

[Year:2013] [Month:July-June] [Volumn:3 ] [Number:1] [Pages:107] [Pages No:104-107][No of Hits : 12344]


ABSTRACT

There are many orthopaedic pioneers whose impact continues to live on today, teaching us valuable lessons, inspiring us to greatness, and touching the lives of generations of future patients. Professor Ilizarov, a nonsurgically trained general practitioner, represents such an important orthopaedic forefather for his instruction on how to grow bones and soft tissues that would otherwise face catastrophic deformity and dysfunction. A simple look at his life, his innovation, and astonishing legacy serves as an inspiration to all involved in the amazing field of orthopaedics.

Keywords: Gavril Ilizarov, Distraction osteogenesis, External fixation.

How to Cite: Ledford C, Garrigues GE, Fitch RD. Ilizarov: The Man, The Myth, The Method: An Orthopaedic Inspiration. The Duke Orthop J 2013;3(1):104-107.


 
ORIGINAL RESEARCH
William R Mook MD, James A Nunley MD

Allograft Reconstruction of Irreparable Peroneal Tendon Tears: A Preliminary Report

[Year:2013] [Month:July-June] [Volumn:3 ] [Number:1] [Pages:107] [Pages No:1-7][No of Hits : 8983]


ABSTRACT

Background: Peroneal tendon injuries represent a significant but underappreciated source of lateral ankle pain. Partial thickness tears of the peroneus brevis amenable to direct repair techniques are common. Irreparable tears are uncommon and require more complex surgical decision-making. Intercalary segment allograft reconstruction has been previously described as a treatment option; however, there are no reports of the outcomes of this technique in the literature. We present our results utilizing this technique.

Materials and methods: A retrospective chart review was conducted to identify all patients who underwent intercalary allograft reconstruction of the peroneus brevis. Mechanism of injury, concomitant operative procedures, pertinent radiographic findings, pre- and postoperative physical examination, intercalary graft length, medical history, visual analog scores (VAS) for pain, short form-12 (SF-12) physical health survey, lower extremity functional scores (LEFS), and complications were reviewed.

Results: Eight patients with eight peroneus brevis tendon ruptures requiring reconstruction were indentified. Mean follow-up was 15 months (range, 10-31). The average length of the intercalary segment reconstructed was 12 cm ± 3.9 (range, 8-20). The average postoperative VAS decreased to 1.0 ± 1.6 from 4.0 ± 2.2 (p = 0.01). No patient had a higher postoperative pain score than preoperative pain score. Average postoperative eversion strength improved from 3.5 ± 1.2 to 4.81 ± 0.37 (p = 0.03). The average SF-12 survey improved from 41.1 ± 12.3 to 50.2 ± 9.31 (p = 0.06). The average LEFS improved from 53.3 ± 17.0 to 95.25 ± 10.0 (p = 0.02). Four patients experienced sensory numbness in the sural nerve distribution, and two of these were transient. There were no postoperative wound healing complications, infections, tendon reruptures or reoperations. No allograft associated complications were encountered. All patients returned to their preoperative activity levels.

Conclusion: Allograft reconstruction of the peroneus brevis can improve strength, decrease pain, and yield satisfactory patientreported outcomes. Importantly, this can be successfully performed without incurring the deleterious effects associated with tendon transfer procedures. Our results suggest that allograft reconstruction may be a safe and reasonable alternative in the treatment of irreparable peroneal tendon ruptures.

Level of evidence: Therapeutic level IV.

Keywords: Peroneal tendon, Tendon rupture, Allograft, Tendon reconstruction.

How to Cite: Mook WR, Nunley JA. Allograft Reconstruction of Irreparable Peroneal Tendon Tears: A Preliminary Report. The Duke Orthop J 2013;3(1):1-7.


 
SYSTEMATIC REVIEW
Stephanie W Mayer MD, Patrick W Joyner MD, Louis C Almekinders MD, Selene G Parekh MD MBA

Stress Fractures about the Foot and Ankle in Athletes

[Year:2013] [Month:July-June] [Volumn:3 ] [Number:1] [Pages:107] [Pages No:8-19][No of Hits : 8928]


ABSTRACT

Stress fractures of the foot and ankle are a common problem encountered by athletes of all levels and ages. This review summarizes the history and physical exam findings, radiographic imaging, diagnosis and treatment of stress fractures of the foot and ankle in those participating in athletic activities.
These injuries can be divided into low- and high-risk based upon their propensity to heal without complication. A wide variety of nonoperative strategies are employed based on the duration of symptoms, type of fracture, and patient factors such as activity type, desire to return to sport and compliance. Operative management has proven superior in several high risk types of stress fractures. Evidence on pharmacotherapy and physiologic therapy such as bone stimulators is evolving.
A high index of suspicion for stress fractures is appropriate in many high-risk groups of athletes with lower extremity pain. Proper and timely workup and treatment is successful in returning these athletes to sport in many cases. Education of athletes as well as their families, training and coaching staff is important. Attention to training regimens, technique, equipment and proper nutrition is paramount in the prevention of these injuries.

Keywords:Stress fracture, Athlete, Foot, Ankle.

How to Cite: Mayer SW, Joyner PW, Almekinders LC, Parekh SG. Stress Fractures about the Foot and Ankle in Athletes. The Duke Orthop J 2013;3(1):8-19.


 
ORIGINAL RESEARCH
Marc J Richard MD, Leonid I Katolik MD, Douglas P Hanel MD, Daniel A Wartinbee MD, David Ruch MD

Distraction Plating for the Treatment of Highly Comminuted Distal Radius Fractures in Elderly Patients

[Year:2013] [Month:July-June] [Volumn:3 ] [Number:1] [Pages:107] [Pages No:93-98][No of Hits : 5524]


ABSTRACT

Purpose: To evaluate the use of internal distraction plating for the management of comminuted, intra-articular distal radius fractures in patients over 60 years of age at two level one trauma centers. Our hypothesis was that distraction plating of comminuted distal radius fractures in the elderly would result in acceptable outcomes regarding range of motion, disabilities of the arm, shoulder and hand (DASH) score, and radiographic parameters and would thereby provide the upper extremity surgeon with another option for the treatment of these fractures.

Materials and methods: A retrospective review was performed on 33 patients over 60 years of age with comminuted distal radius fractures treated by internal distraction plating at two level 1 trauma centers. Patients were treated with internal distraction plating across the radiocarpal joint. At the time of final follow-up, radiographs were evaluated for ulnar variance, radial inclination, and palmar tilt. Range of motion, complications and DASH scores were also obtained.

Results: Thirty-three patients with a mean age of 70 years were treated with distraction plating for comminuted distal radius fractures. At final follow-up, all fractures had healed and radiographs demonstrated mean palmar tilt of 5° and mean positive ulnar variance of 0.6 mm. Mean radial inclination was 20°. Mean values for wrist flexion and extension were 46° and 50° respectively. Mean pronation and supination were 79° and 77° respectively. At the final follow-up, the mean DASH score was 32.

Conclusion: In the elderly, distraction plating is an effective method of treatment for comminuted, osteoporotic distal radius fractures.

Level of evidence: Therapeutic, Level IV (Retrospective case series).

Keywords: Distal radius fracture, ORIF, Bride plate, Spanning fixation.

How to Cite: Richard MJ, Katolik LI, Hanel DP, Wartinbee DA, Ruch D. Distraction Plating for the Treatment of Highly Comminuted Distal Radius Fractures in Elderly Patients. The Duke Orthop J 2013;3(1):93-98.


 
ORIGINAL RESEARCH
Constantine A Demetracopoulos MD, James K DeOrio MD, James A Nunley II MD

Posterior Tibial Tendon Excision and Postoperative Pain in Adult Flatfoot Reconstruction: A Preliminary Report

[Year:2013] [Month:July-June] [Volumn:3 ] [Number:1] [Pages:107] [Pages No:20-24][No of Hits : 4177]


ABSTRACT

Background: Posterior tibial tendon insufficiency plays a large role in the pathogenesis of adult acquired flatfoot deformity (AAFD) in select patients. Transfer of the flexor digitorum longus is indicated to compensate for the loss of posterior tibial tendon function; however the role of resection of the degenerated posterior tibial tendon remains unclear. The aim of this study was to determine the effect of posterior tibial tendon resection on pain relief following surgical treatment of stage II AAFD.

Methods: All patients who underwent surgical treatment for stage II AAFD and posterior tibial tendon insufficiency were retrospectively reviewed. Patients were divided into two groups based on whether the degenerated posterior tibial tendon was resected or left in situ. Twenty-seven patients with a mean follow-up of 13.3 months were included in the study. A visual analog scale (VAS) score for pain was recorded for each patient pre-operatively and at final follow-up. Concomitant surgical procedures and the incidence of postoperative medial arch pain were also reported. Preoperative deformity and postoperative deformity correction were assessed by measuring the anteroposterior talar-first metatarsal angle, the talonavicular (TN) coverage angle, the lateral talar-first metatarsal angle, and the calcaneal pitch onstandard weight bearing radiographs.

Results: Eleven patients underwent FDL transfer and resection of the posterior tibial tendon (PTT resection group), and 16 patients underwent FDL transfer without resection of the posterior tibial tendon (PTT in situ group). A greater percentage of patients in the PTT resection group underwent lateral column lengthening (100 vs 18.8%, p < 0.001), and a greater percentage of patients in the PTT in situ group had a medial displacement calcaneal osteotomy performed (93.8 vs 18.2%, p < 0.001). There was no difference in preoperative VAS pain scores between groups, and all patients demonstrated excellent pain relief postoperatively. No patient in either group reported medial arch pain postoperatively. Radiographic assessment revealed similar deformity preoperatively in both groups, and patients in the PTT resection group demonstrated a greater correction of the TN coverage angle (9.8 ± 4.6 vs 6.0 ± 4.1 degrees, p = 0.041).

Conclusion: Resection of the PTT did not significantly affect postoperative VAS scores at final follow-up. It did however, correlate with a slightly greater correction of the TN coverage angle. There were no instances of pain along the medial ankle or medial arch of the foot in either group postoperatively. Future prospective studies are needed to determine whether resection of the PTT is necessary at the time of surgery for stage II AAFD.

Keywords: Adult acquired flatfoot deformity, Posterior tibial tendon insufficiency, Talonavicular coverage, Postoperative pain, Tendinopathy.

How to Cite: Demetracopoulos CA, DeOrio JK, Nunley JA II. Posterior Tibial Tendon Excision and Postoperative Pain in Adult Flatfoot Reconstruction: A Preliminary Report. The Duke Orthop J 2013;3(1):20-24.


 
ORIGINAL RESEARCH
Nicholas A Viens MD, E Grant Sutter MS, Daniel S Mangiapani MD, Samuel B Adams MD, Robert D Zura MD

Unstable Ankle Fractures in Older Patients: A Consecutive Series with Modern Internal Fixation Techniques

[Year:2013] [Month:July-June] [Volumn:3 ] [Number:1] [Pages:107] [Pages No:25-31][No of Hits : 2843]


ABSTRACT

Background: Ankle fractures are among the most common injuries sustained by older patients. Management of these fractures remains both controversial and challenging. Clinical outcomes from a series of older patients treated surgically for unstable ankle fractures were reviewed to determine the effects of patient, injury and fixation factors on postoperative outcomes.

Materials and methods: A retrospective series of 58 consecutive patients age 60 years and older with 63 unstable ankle fractures treated surgically by a single surgeon over a 5- year period was reviewed. Forty-seven females (81.0%) and 11 males (19.0%) with a mean age of 72.6 (range, 60 to 88.4) years made up the sample.

Results: The most common injuries were OTA type 44-B2 (66.7%) or Lauge-Hansen supination-external rotation type-4 (76.2%) fractures. Forty-seven (74.6%) fractures were due to a low energy mechanism. Nineteen (30.6%) injuries were fracturedislocations and seven (11.1%) fractures were open. Augmented techniques were used in 31 (49.2%) cases overall. Ten (17.2%) patients experienced postoperative complications. Males, patients with fracture dislocations, high energy fractures, and open fractures experienced significantly worse outcomes (p < 0.05). Age, fracture type and the use of augmented technique were not predictive of clinical outcomes.

Conclusion: Overall in this series, older patients treated surgically for ankle fractures experienced good clinical outcomes. Further investigations are required in order to find patient and injury factors that can assist preoperative planning and predict outcomes.

Keywords:Ankle fracture, Elderly, Osteopenia, Augmented fixation, Locked plating.

How to Cite: Viens NA, Sutter EG, Mangiapani DS, Adams SB, Zura RD. Unstable Ankle Fractures in Older Patients: A Consecutive Series with Modern Internal Fixation Techniques. The Duke Orthop J 2013;3(1):25-31.


 
ORIGINAL RESEARCH
Walter H Wray III MD, J Mack Aldridge III MD, James A Nunley II MD, David S Ruch MD, Fraser J Leversedge MD

Restoration of Shoulder Abduction after Radial to Axillary Nerve Transfer following Trauma or Shoulder Arthroplasty

[Year:2013] [Month:July-June] [Volumn:3 ] [Number:1] [Pages:107] [Pages No:99-103][No of Hits : 2623]


ABSTRACT

Purpose: A loss of active shoulder abduction due to axillary nerve dysfunction may be caused by brachial plexus or isolated axillary nerve injury and is often associated with a severe functional deficit. The purpose of this study was to evaluate retrospectively the restoration of deltoid strength and shoulder abduction after transfer of a branch of the radial nerve to the axillary nerve for patients who had sustained an axillary nerve injury.

Materials and methods: We retrospectively reviewed all patients who underwent transfer of a branch of the radial nerve to the anterior branch of the axillary nerve at our institution, either alone or in combination with other nerve transfers, between 2004 and 2011. We identified, by chart review, 12 patients with an average follow-up of 16.7 months (6-36 months) who met inclusion criteria.

Results: Active shoulder abduction significantly improved from an average of 9.6° (0-60°) to 84.5° (0-160°) (p < 0.005). Average initial deltoid strength significantly improved from 0.3 (0-2) on the M scale to an average postoperative deltoid strength of 2.8 (0-5) (p < 0.005). Five of 12 (41.7%) achieved at least M4 strength and eight of 12 (66.7%) achieved at least M3 strength. No statistically significant difference was seen when subgroup analysis was performed for isolated nerve transfer vs multiple nerve transfer, mechanism of injury with MVC vs shoulder arthroplasty, age, branch of radial nerve transferred, or time from injury to surgery. No significant change in triceps strength was observed with an average of 4.9 (4-5) strength preoperatively and 4.8 (4-5) postoperatively (p = 0.34). There were three patients who achieved no significant gain in shoulder abduction or deltoid strength for unknown reasons.

Conclusion: Transfer of a branch of the radial nerve to the anterior branch of the axillary nerve is successful in improving deltoid strength and shoulder abduction in most patients. Our series, the largest North American series to our knowledge, has not shown outcomes as favorable as other series. Larger multicenter trials are needed.

Type of study/Level of evidence: This is a retrospective case series representing a level IV study.

Keywords: Brachial plexus, Axillary nerve, Radial nerve, Shoulder abduction, Neurotization.

Funding: No outside funding was received and the authors have no conflicts of interest to disclose.

How to Cite: Wray WH III, Aldridge JM III, Nunley JA II, Ruch DS, Leversedge FJ. Restoration of Shoulder Abduction after Radial to Axillary Nerve Transfer following Trauma or Shoulder Arthroplasty. The Duke Orthop J 2013;3(1):99-103.


 
CASE REPORT
Patrick N Siparsky MD, Matthew G Kanaan DO, William E Garrett Jr MD PhD

Bilateral Proximal Tibial Stress Fractures at the Epiphyseal Scar

[Year:2013] [Month:July-June] [Volumn:3 ] [Number:1] [Pages:107] [Pages No:71-73][No of Hits : 2496]


ABSTRACT

Tibial stress fractures are a common cause of pain in athletes including runners and are the most common stress fracture in athletes. The underlying pathoanatomy is microscopic cracks in the bone that never fully heal as a result of continued strain on the bone coupled with insufficient rest. The typical presentation is pain that initially begins with the onset of athletic activity, but eventually becomes persistent pain throughout the day with any loading of the bone. We present a case report of a 36-year-old male with bilateral proximal medial tibia stress fractures along the epiphyseal scar.

Keywords:Stress fracture, Stress reaction, Tibial stress fracture.

How to Cite: Siparsky PN, Kanaan MG, Garrett WE Jr. Bilateral Proximal Tibial Stress Fractures at the Epiphyseal Scar. The Duke Orthop J 2013;3(1):71-73.


 
RETROSPECTIVE COHORT STUDY
Patrick W Joyner MD, William J Mallon MD, Donald T Kirkendall PhD, William E Garrett Jr MD PhD

Relative Age Effect: Beyond the Youth Phenomenon

[Year:2013] [Month:July-June] [Volumn:3 ] [Number:1] [Pages:107] [Pages No:74-79][No of Hits : 2088]


ABSTRACT

The relative age effect (RAE) refers to the oversampling of youth born in the first quarter of the birth year when auditioning for selected age-restricted sports. This advantage conferred to the older athlete is the result of the older athlete being more physically and emotionally mature and, therefore, assumed to be a more advanced player. Chosen players will be exposed to better coaching, competition, teammates, and facilities in their respective sport. This RAE was first described in 1988 for ice hockey, and has since been described in numerous other sports, with a vast majority of the literature demonstrating an RAE in small cohorts, as well as in team sports and sports that incorporate a ball (i.e. soccer, basketball, hockey, etc). We extended the exploration of an RAE beyond specific sports by examining the birth quarter of over 44,000 Olympic athletes birth dates, born between 1964 and 1996. Our hypothesis is that not only did an RAE exist in Olympic athletes, but that it existed across selected categories of athletes (by gender), such as team vs individual sports, winter vs summer athletes, and sports using a ball vs those not using a ball. The fractions of births in the first vs the fourth quarter of the year were significantly different (p < 0.001) from each other for the summer and winter Olympians, ball and nonball sports, and team as well as individual sports. This significant difference was not gender specific. We found the general existence of an RAE in Olympic athletes regardless of global classification.

Keywords:Relative age effect, Olympic, Athletes.

How to Cite: Joyner PW, Mallon WJ, Kirkendall DT, Garrett WE Jr . Relative Age Effect: Beyond the Youth Phenomenon. The Duke Orthop J 2013;3(1):74-79.


 
SYSTEMATIC REVIEW
John S Lewis Jr MD, Daniel S Mangiapani MD, Bridgette D Furman BS, Virginia B Kraus MD PhD, Farshid Guilak PhD, Steven A Olson MD FACS

Post-traumatic Arthritis: An Update

[Year:2013] [Month:July-June] [Volumn:3 ] [Number:1] [Pages:107] [Pages No:32-35][No of Hits : 1938]


ABSTRACT

Post-traumatic arthritis (PTA) is a frequent cause of disability following trauma of weight-bearing joints and is associated with significant physical impairment and loss of function. The development of PTA often occurs after an articular fracture. Currently, the only treatment option available to orthopaedic surgeons in the management of an acute articular fracture is anatomic fracture reduction. The complex pathway involved in the development and progression of PTA after articular injury, however, remains unknown and largely unstudied. Proinflammatory cytokines, such as interleukin-1 (IL-1) and tumor necrosis factor-α (TNF-α) are upregulated in injured and degenerative joints and may play an important role in the pathogenesis of PTA. The central goal of ongoing research is to understand the sequence of biologic events-distinct from mechanical disruption of the joint surface-that cause progressive joint degeneration and ultimately the development of PTA. Promising new interventions on the molecular level have been shown to slow or halt the progression of these adverse events in animal models.

Keywords:Post-traumatic, Arthritis, Interleukin-1, Tumor necrosis factor-alpha.

How to Cite: Lewis JS Jr, Mangiapani DS, Furman BD, Kraus VB, Guilak F, Olson SA. Post-traumatic Arthritis: An Update. The Duke Orthop J 2013;3(1):32-35.


 
Special Interest
Jonathan A Godin MD MBA

Duke Orthopaedics Opens Page Road Clinic

[Year:2013] [Month:July-June] [Volumn:3 ] [Number:1] [Pages:107] [Pages No:xxvii][No of Hits : 1645]


ABSTRACT

Duke Orthopaedics has identified new opportunities to serve patients in the Triangle region while expanding its geographic reach. In July 2011, the Duke Medical Plaza at Page Road opened its doors. Located just off of I-40 and 54, close to Raleigh/ Durham International Airport, the plaza is strategically located in the middle of population growth in the Triangle area, thereby increasing access to Duke Orthopaedic care for many patients in the area.


 
ORIGINAL RESEARCH
Jared Kroger BS, Pierre Beaufond BS, Serkan Inceoglu PhD, Victoria Maskiewicz PhD, Wayne Cheng MD, Justin Eugene Brier-Jones BS

Setting Time Comparison of Four Antimicrobial Laden Calcium Sulfate Plasters

[Year:2013] [Month:July-June] [Volumn:3 ] [Number:1] [Pages:107] [Pages No:36-40][No of Hits : 1629]


ABSTRACT

Background: The surgeon may implant calcium sulfate pellets (aka gypsum) as a resorbable antimicrobial vehicle at the surgical site in severe cases of osteomyelitis. Gypsum setting times with or without antibiotic additives are found scattered throughout the literature, but often factors known to alter setting time are either not disclosed or not held constant between experiments. To our knowledge, no prior study compares the setting time of calcium sulfate plaster mixed with the four commonly used antibiotics under constant conditions as presented here.

Purpose: To compare the setting times of calcium sulfate hemihydrate mixtures containing vancomycin, cefazolin, tobramycin, or amphotericin B.

Materials and methods: Groups consisted of samples comprised of 6.3 gm calcium sulfate hemihydrate (CSH) mixed with approximately 1/4th a vial of lyophilized antimicrobial (vancomycin, cefazolin, tobramycin or amphotericin B) with CSH powder to normal saline ratio of 1.7 gm/ml and mixed for 30 seconds at controlled speed and humidity. Each sample initial setting time (Ti) and final setting time (Tf) were established by Gillmore needles method according to ASTM standard C266- 08 apparatus specifications.

Results: Kruskal-Wallis one-way analysis of variance by ranks revealed that antibiotic type affected the initial and final setting times of gypsum (p < 0.05). Post hoc analysis using Dunn's multiple comparisons indicated that there was no difference between control Ti (7.2 ± 1.1 min) and that of vancomycin or cefazolin group (9.8 ± 1.7 or 14.2 ± 1.3 min, respectively, p > 0.05), but the Ti of the tobramycin and amphotericin B groups (31.8 ± 5.7 and 140.4 ± 18.0 min) differed from the control Ti (p < 0.05). Likewise, there was no difference of control Tf (p > 0.05, 12.2 ± 1.1 min) when compared to vancomycin or cefazolin groups (22.2 ± 6.9 or 25.7 ± 4.1 min), but that the Tf of tobramycin and amphotericin B groups (76.3 ± 5.9 and 200.0 ± 21.1 min) each differed from the control group (p < 0.05).

Conclusion: This experiment is aimed to help surgeons plan when they should begin preparing their calcium sulfate antibiotic beads during surgery. As a general guideline, allow 15 minutes to set when adding a 1 gm vial of vancomycin or cefazolin, 30 minutes for adding a 1.2 gm vial tobramycin, and 2.5 hours for adding a 50 mg vial of amphotericin B.

Keywords:Calcium sulfate plaster, Antibiotic cement, Setting time.

How to Cite: Kroger J, Beaufond P, Inceoglu S, Maskiewicz V, Cheng W, Brier-Jones JE. Setting Time Comparison of Four Antimicrobial Laden Calcium Sulfate Plasters. The Duke Orthop J 2013;3(1):36-40.


 
Special Interest
Stephanie W Mayer MD, Braden K Mayer MD, Todd E Bertrand MD, MBA, Mark G Hamming MD, C Thomas Haytmanek MD, Jordan F Schaeffer MD, Donald E Fowler III MD, Karl M Schweitzer Jr MD

Tribute to Dr James Nunley

[Year:2013] [Month:July-June] [Volumn:3 ] [Number:1] [Pages:107] [Pages No:xxv][No of Hits : 1544]


ABSTRACT

As we, the Duke Orthopaedic Residency Class of 2013, round the corner into the last few months of our training, many emotions arise. We cannot believe we have been here this long, and we cannot believe it went by so fast. We reflect back on why we decided on Duke in the first place and hope that we have made those who chose us 5 years ago proud. We have had many meetings as a class this year regarding how we wanted to lead, what our policies would be, what we would try to teach and engrain into the minds and hearts of our fellow residents. At each of these meetings and in countless e-mail exchanges, the overriding theme was that we all wanted those who come after us to have as much pride in the program as those who came before us. Our program has been built on the shoulders of exceptional leaders, each of whom has sacrificed for the good of our department as well as contributed much to education and the advancement of the field during their careers.


 
ORIGINAL RESEARCH
Robert A Magnussen MD, Evrard Gancel MD, Elvire Servien MD PhD, Matthias Jacobi MD, Guillaume Demey MD, Philippe Neyret MD, Sebastien Lustig MD PhD

Simultaneous Unicompartmental Knee Arthroplasty and Lateral Patellar Facetectomy for Bicompartmental Degenerative Disease

[Year:2013] [Month:July-June] [Volumn:3 ] [Number:1] [Pages:107] [Pages No:61-66][No of Hits : 1509]


ABSTRACT

Introduction:Unicompartmental knee arthroplasty (UKA) is a treatment option in patients with unicompartmental degenerative disease. Compared to total knee arthroplasty (TKA), the advantages of UKA include accelerated recovery and cruciate ligament retention. These advantages, along with emerging evidence that mild patellofemoral joint osteoarthritis does not compromise results of UKA have encouraged expansion of the indications for UKA. Symptomatic lateral patellofemoral joint degenerative disease is a common cause of UKA revision. Partial lateral patellar facetectomy can provide relief from symptoms of lateral patellofemoral degenerative disease. We hypothesize that simultaneous UKA and lateral patellar facetectomy provides durable pain relief and functional improvement in a patient population with degenerative disease of one tibiofemoral compartment and the lateral patellofemoral joint.

Materials and methods:Between 2004 and 2008, 11 lateral UKA's were performed in association with partial lateral patellar facetectomy in 11 female patients (mean age: 66.7 years) with degenerative changes in one tibiofemoral compartment and the lateral patellofemoral joint. Patients were followed clinically and radiographically for a mean of 5 years.

Results: No patient underwent revision surgery in the followup period. The mean international Knee Society (IKS) knee score improved from 64.9 ± 11.2 points preoperatively to 87.5 ± 12.6 points at final follow-up (p = 0.01). The mean IKS functional score improved from 65.9 ± 23.5 points preoperatively to 83.2 ± 23.3 points at final follow-up (p = 0.012). The mean Kujala score was 84.3 ± 13.5 points postoperatively. Progression of patellofemoral OA was observed in one patient.

Conclusion: Simultaneous UKA and partial lateral patellar facetectomy is a viable treatment option for symptomatic degenerative disease involving one tibiofemoral compartment and the lateral patellofemoral joint. This treatment approach may be a useful alternative to TKA or bicompartmental arthroplasty in a carefully selected patient population.

Level of evidence: Case series-Level IV.

Keywords: Bicompartmental osteoarthritis, Unicompartmental knee arthroplasty, Lateral patellar facetectomy.

How to Cite:Magnussen RA, Gancel E, Servien E, Jacobi M, Demey G, Neyret P, Lustig S. Simultaneous Unicompartmental Knee Arthroplasty and Lateral Patellar Facetectomy for Bicompartmental Degenerative Disease. The Duke Orthop J 2013;3(1):61-66.


 
ORIGINAL RESEARCH
Steven J Svoboda MD, Dean C Taylor MD, Robert A Magnussen MD

The Anatomic Variability of the ‘Rotator Interval Capsule’: A Comparison of Arthroscopic and Open Investigations

[Year:2013] [Month:July-June] [Volumn:3 ] [Number:1] [Pages:107] [Pages No:54-60][No of Hits : 1499]


ABSTRACT

Introduction: Variably present rotator interval capsular openings (RICOs) complicate anterior shoulder capsular anatomy. Open and arthroscopic approaches may lead to differences in the appearance and size of RICOs. The purposes of this study are to: (1) Confirm that RICOs viewed from inside and outside the joint are the same structures, and (2) compare the size of RICOs when approached in an open manner vs arthroscopically.

Materials and methods:Twelve fresh cadaveric shoulders were randomized to two different approaches in order to identify and mark RICOs. In the first group, the superior glenohumeral ligament (SGHL) and middle glenohumeral ligament (MGHL) were marked arthroscopically. Sutures were placed in these structures in an open fashion. Repeat arthroscopy was then performed to determine whether the sutures penetrated the marked SGHL and MGHL. In the second group, these steps were reversed and arthroscopically placed sutures were evaluated in an open manner. Dimensions of the RICOs were measured both arthroscopically and open in each shoulder.

Results: All specimens had a RICO visualized both arthroscopically and open. Five of 12 specimens had an additional second RICO. RICO size measurements were similar for the arthroscopic and open techniques. Sutures placed via both the arthroscopic and open technique were noted to penetrate the marked structures in all cases. In addition, sutures placed through the SGHL while viewing arthroscopically always captured the coracohumeral ligament (CHL). Sutures placed through the SGHL with an open technique never engaged the CHL.

Conclusion: The capsular openings in the rotator interval were confirmed to be the same structures when observed arthroscopically and through an open approach.

Keywords: Rotator interval, Shoulder instability, Foramen of Weitbrecht, Foramen of Rouviere.

How to Cite:Svoboda SJ, Taylor DC, Magnussen RA. The Anatomic Variability of the 'Rotator Interval Capsule': A Comparison of Arthroscopic and Open Investigations. The Duke Orthop J 2013;3(1):54-60.


 
Special Interest
Steven A Olson MD

Proceedings from the Research Colloquium on Post-traumatic Arthritis

[Year:2013] [Month:July-June] [Volumn:3 ] [Number:1] [Pages:107] [Pages No:xliv][No of Hits : 1432]


ABSTRACT

The colloquium was attended by more than 40 participants from across Duke University Hospital, including Members of the Departments of Medicine, Orthopaedic Surgery, Physical Therapy and Radiology. This unique opportunity allowed investigators working in the area of arthritis after joint injury to share their own work, and learn of the ideas and efforts of others interested this growing area of clinical interest.


 
ORIGINAL RESEARCH
Kyle P Kokko MD PhD, Qian K Kang MD, Xuejun Wen MD PhD, Yueheui H An MD, William R Barfield PhD, Langdon A Hartsock MD

Novel Rabbit Model for the Evaluation of Open Tibia Fractures: Effect of Delayed Surgery on Infection Rate

[Year:2013] [Month:July-June] [Volumn:3 ] [Number:1] [Pages:107] [Pages No:48-53][No of Hits : 1419]


ABSTRACT

Introduction: The objective of this investigation was to evaluate the effects of delayed surgery on infection rates of open tibia fractures in a rabbit model. Our hypothesis was that delaying irrigation and debridement (I&D) would increase the risk of bony and soft tissue infection when antibiotics were withheld.

Materials and methods: A drill hole was created in the rabbit tibia and inoculated with Staphylococcus aureus. Animals underwent I&D at controlled delayed times of 6 hours (n = 11), 12 hours (n = 9) and 24 hours (n = 10). A stainless steel pin was inserted to mimic definitive fracture fixation with a metal prosthesis. No antibiotics were administered. Animals were sacrificed at 4 weeks and evaluated for infection.

Results: The percent of soft tissue infections with I&D delays of 6, 12 and 24 hours were 18, 22 and 40%, respectively [p = 0.59; odds ratio (OR) = 3]. The percentage of animals with osteomyelitis with I&D delays of 6, 12 and 24 hours were 9, 22 and 50%, respectively (p = 0.12; OR = 10).

Discussion: In the current model, delaying I&D from 6 to 24 hours may increase the rate of postoperative osteomyelitis and further investigation is warranted.

Keywords: Infection, Open tibia fracture, Irrigation and debridement, Delayed surgery, Natural history.

How to Cite:Kokko KP, Kang QK, Wen X, An YH, Barfield WR, Hartsock LA. Novel Rabbit Model for the Evaluation of Open Tibia Fractures: Effect of Delayed Surgery on Infection Rate. The Duke Orthop J 2013;3(1):48-53.


 
ORIGINAL RESEARCH
Anil K Gupta MD MBA, Alison P Toth MD

Management of Massive Rotator Cuff Tears in Active Patients with Minimal Glenohumeral Arthritis: A Prospective Observational Study with Clinical and Radiographic Analyses of Reconstruction using Dermal Tissue Matrix Xenograft

[Year:2013] [Month:July-June] [Volumn:3 ] [Number:1] [Pages:107] [Pages No:80-87][No of Hits : 1408]


ABSTRACT

Objectives: To evaluate the clinical and radiographic outcomes of patients undergoing interposition reconstruction of massive, otherwise irreparable rotator cuff tears through a mini-open approach with the use of a porcine dermal tissue matrix.

Materials and methods: We performed a prospective observational study of 26 patients (27 shoulders) who underwent reconstruction of massive rotator cuff tears using dermal tissue matrix xenograft. Pain level (scale 0-10, 10 = severe pain), active range of motion, and supraspinatus and external rotation strength were assessed. Additional outcome measures included modified American shoulder and elbow score (MASES) and short form-12 (SF-12) score. Clinical and radiographic analyses were performed at an average 32 months follow-up period (minimum 2-year follow-up). Ultrasound imaging (static and dynamic) of the operative shoulder was performed at final followup to assess the integrity of the reconstruction.

Results: Mean patient age was 60. Mean pain level decreased from 5.1 to 0.4 (p = 0.002). Mean active forward flexion, abduction, and external rotation motion improved from 138.8 to 167.3 (p = 0.024), 117.9 to 149.3 (p = 0.001) and 57.7 to 64.7° (p = 0.31), respectively. Supraspinatus and external rotation strength improved from 7.2 to 9.4 (p = 0.001) and 7.4 to 9.5 (p = 0.001), respectively. Mean MASES improved from 62.7 to 91.8 (p = 0.0007) and mean SF-12 scores improved from 48.4 to 56.6 (p = 0.044). Twenty-one patients (twenty-two shoulders) returned for a dynamic and static ultrasound of the operative shoulder at a minimum 2-year follow-up. Sixteen (73%) demonstrated a fully intact tendon/graft reconstruction. Five (22%) patients had partially intact reconstructions, and one (5%) had a complete tear at the graft-bone interface due to suture anchor pullout as a result of a fall. There were no cases of infection or tissue rejection.

Conclusion: We present a reproducible surgical technique for the management of massive irreparable rotator cuff tears. In our series, patients demonstrated a significant improvement in both subjective and objective clinical outcomes. Radiographic analysis demonstrated that the majority of patients had a fully intact reconstruction at a minimum 2-year follow-up.

Keywords: Massive rotator cuff tear, Xenograft, Augmentation, Repair.

How to Cite: Gupta AK, Toth AP. Management of Massive Rotator Cuff Tears in Active Patients with Minimal Glenohumeral Arthritis: A Prospective Observational Study with Clinical and Radiographic Analyses of Reconstruction using Dermal Tissue Matrix Xenograft. The Duke Orthop J 2013;3(1):80-87.


 
Special Interest
William R Mook MD

Emily Berend Adult Reconstructive Symposium Update

[Year:2013] [Month:July-June] [Volumn:3 ] [Number:1] [Pages:107] [Pages No:xliii][No of Hits : 1378]


ABSTRACT

This past year marked the fourth annual Emily Berend Adult Reconstructive symposium held at Duke University Medical Center hosted by brothers Keith R Berend, MD, and Michael E Berend, MD. The symposium is held in honor of their late mother who had great respect for the Duke Orthopaedic Residency Program and truly appreciated the training that both of her boys received. The symposium covered the latest topics pertaining to reconstruction of the hip and knee, and provided a forum for scholarly discussion, cadaveric demonstrations and fellowship.


 
ORIGINAL RESEARCH
Jocelyn Wittstein MD, Charles Spritzer MD, William E Garrett MD PhD

MRI Determination of Knee Effusion Volume: A Cadaveric Study

[Year:2013] [Month:July-June] [Volumn:3 ] [Number:1] [Pages:107] [Pages No:67-70][No of Hits : 1373]


ABSTRACT

Background: There is currently limited literature on quantitative determination of knee effusion volume using magnetic resonance imaging (MRI).

Purpose: To describe a method of knee effusion volume determination using MRI generated models and to demonstrate accuracy of this technique.

Materials and methods: Using axial T2-weighted turbo spin echo and sagittal SPACE sequences, MRIs of three cadaver knees with multiple saline loads were obtained. Effusions models were created and effusion volumes were estimated using the Rhinoceros software. Estimated and known effusion volumes were compared using a bivariate correlation analysis.

Results: The SPACE sequence and T2WTSE estimates were highly correlated with the known volumes (R = 0.996 and 0.993 respectively, p < 0.001).

Conclusion: MRI-generated models of knee effusions provide accurate estimates of knee effusion volumes.

Clinical relevance: MRI determination of knee effusion volume may provide a useful clinical outcomes tool.

Keywords: Effusion, Magnetic resonance imaging, Knee.

How to Cite: Wittstein J, Spritzer C, Garrett WE. MRI Determination of Knee Effusion Volume: A Cadaveric Study. The Duke Orthop J 2013;3(1):67-70.


 
Special Interest
Robert D Fitch MD, Ralph Coonrad MD

On the Shoulders of Giants: Eugene E Bleck MD

[Year:2013] [Month:July-June] [Volumn:3 ] [Number:1] [Pages:107] [Pages No:xxix][No of Hits : 1319]


ABSTRACT

Gene Bleck was a well-known pediatric orthopaedist of my age. In 1983, my first year in practice, he was president of POSNA, I had studied his classic textbook Orthopaedic Management of Cerebral Palsy; and Duke's Chairman, J Leonard Goldner frequently and fondly spoke of him!


 
Special Interest
William R Mook MD

Update from the John A Feagin Jr MD Leadership Program

[Year:2013] [Month:July-June] [Volumn:3 ] [Number:1] [Pages:107] [Pages No:xxxiv][No of Hits : 1239]


ABSTRACT

The Duke Sports Medicine Feagin Medical Scholars Program and Endowment, created in honor of Dr John A Feagin Jr, Duke University Emeritus Professor of Orthopaedic Surgery, has had another exciting and productive year. Now in its fourth year, the program continues to attract highly motivated medical students and residents from across the Duke Medicine community interested in honing their skills in preparation for assuming leadership positions in their respective medical professions and communities. The foundation of the leadership program's curriculum remains constant, emulating and cultivating the qualities that characterize the program's namesake: Professionalism, dedication, passion, enthusiasm and ingenuity. This year's curriculum evolved in exciting ways to meet the demands brought about by the changes to the domestic and international health care landscape.


 
ORIGINAL RESEARCH
Bret C Peterson MD, Daniel S Mangiapani MD, Ryan Kellogg MD, Fraser J Leversedge MD

Hand and Microvascular Replantation Call Availability Study: A National Real-time Survey of Level 1 and 2 Trauma Centers

[Year:2013] [Month:July-June] [Volumn:3 ] [Number:1] [Pages:107] [Pages No:88-92][No of Hits : 1122]


ABSTRACT

Purpose: The inconsistency of subspecialty emergency call services is a growing concern as declining reimbursements, increased legal risk, and challenging social and professional issues present a deterrent to call panel participation. This study assessed call availability of hand and microvascular replantation surgery at all level I and II trauma centers in the US.

Materials and methods: Between May and December 2010, all level I (n = 137) and level II (n = 153) trauma centers across the US were contacted by telephone. Phone contact was unannounced; responders were invited to participate in our IRBapproved anonymous survey regarding hand and microvascular replantation emergency coverage specific to their hospital.

Results: Level 1 centers: 117 of 137 (85%) participated, of which 64 (54.7%) had immediate access for hand surgery and microvascular replantation services. Six hospitals provided services 15 to 31 days per month and 3 hospitals supported 1 to 15 days per month. Ten hospitals indicated an inconsistent coverage which was difficult to estimate and 34 hospitals reported no coverage.
Level 2 centers: 132 of 153 (86.3%) participated, of which 38 (29%) had immediate access for hand surgery and microvascular replantation services. Seven hospitals provided services 15 to 31 days per month and 3 hospitals for 1 to 15 days per month. 84 hospitals reported no specific coverage protocol.

Conclusion: Consistent on-call availability for emergency hand and microvascular replantation services remains a challenge across the US:

  • 54.7% of level I trauma centers had immediate access to emergency hand and microvascular replantation services although many hospitals had intermittent coverage;
  • 29% of level II trauma centers had immediate access to emergency hand and microvascular replantation services although many hospitals had intermittent coverage. Over 50% had no specific coverage protocol;
  • Many hospitals indicated the presence of subspecialty hand surgery coverage, however microvascular replantation resources were not available consistently;
  • While not confirmed, the current study findings suggest that a more clearly defined and coordinated system of hand surgery and microvascular replantation emergency call coverage will likely improve the efficiency of a limited resource and, ultimately, improve patient care.

Keywords: Microvascular replantation, Orthopaedic surgery call, Trauma centers, Hand surgery.

How to Cite: Peterson BC, Mangiapani DS, Kellogg R, Leversedge FJ. Hand and Microvascular Replantation Call Availability Study: A National Real-time Survey of Level 1 and 2 Trauma Centers. The Duke Orthop J 2013;3(1):88-92.


 
Special Interest
William R Mook MD

ORS/AAOS Annual Meetings

[Year:2013] [Month:July-June] [Volumn:3 ] [Number:1] [Pages:107] [Pages No:xxxviii][No of Hits : 1002]


ABSTRACT

The Duke Department of Orthopaedic Surgery had a proud showing at both the 2013 Orthopaedic Research Society (ORS) annual meeting held from January 26th to 29th, 2013, in San Antonio, Texas, as well as the American Academy of Orthopaedic Surgeons (AAOS) annual meeting held from March 19th to 23rd, 2013, in Chicago, Illinois. Many members of the Duke Orthopaedic Surgery family were able to gather for the Piedmont Orthopaedic Society Mid-Winter reception held on March 22nd, 2013, at the Sheraton in downtown Chicago. Listed below is a summary of the podium presentations, posters, demonstrations, and invited lectures from the current faculty and residents at these meetings.


 
ORIGINAL RESEARCH
Brian A Mata MD, Robby Bowles PhD, Timothy K Mwangi BS, Lori A Setton PhD

Impaired Function and in vivo Imaging of NF-?B Activation in a Mouse Model of Knee Joint Inflammation

[Year:2013] [Month:July-June] [Volumn:3 ] [Number:1] [Pages:107] [Pages No:41-47][No of Hits : 899]


ABSTRACT

Objective: Osteoarthritis (OA) is a consequence of not only mechanical events such as joint instability, but also biological events that result in the upregulation of proinflammatory and catabolic mediators. The intra-articular injection of monoiodoacetate (MIA) has been widely used to induce OA. NF-κB activity has been linked to increased expression of proinflammatory cytokines (IL-1β, TNF-α, IL-6, etc), metalloproteinases (MMPs), chemokines and inducible enzymes, which all contribute to cartilage degradation and subsequent OA. The goal of this study was to use in vivo imaging (IVIS) of NF-κB activation to track longitudinal changes due to inflammation in a rodent model of OA.

Design: Twenty-four (24) NF-κB-luc reporter transgenic mice [BALB/C-Tg (NF-κB-RE-luc)-Xen, age 7-8 weeks] were given intra-articular knee injections with either MIA (n = 12) or normal saline (n = 12) to serve as a control. IVIS and ex vivo imaging of NF-κB and tactile allodynia measurements were performed, and correlations were recorded preoperatively and on days 1, 3, 7, 14, 21 and 28. Animals were euthanized on days 3 and 28 for ex vivo imaging, and tissues were stored for future immunohistochemical evaluation.

Results: NF-κB activity was significantly elevated in the MIA group on days 1 and 3 (p < 0.05) when compared to preoperative levels and was significantly elevated compared to the normal saline group on day 3 (p < 0.05). There was a significant increase in tactile allodynia in the MIA group compared to preoperative levels, as well as compared to the normal saline group at all time points (p < 0.05). in vivo NF-κB luminescence correlated with tactile allodynia (p < 0.0001) and with ex vivo imaging (p < 0.0001).

Conclusion: This study validates the use of IVIS imaging of NF-κB activity in a MIA rodent model of arthritis and provides evidence for the use of NF-κB luminescence imaging as an imaging biomarker of pain sensitivities. This can be utilized in the future to further elucidate NF-κB's role in inflammation and OA. In addition, it can help evaluate potential therapeutic agents that target NF-κB.

Keywords:Osteoarthritis, Inflammation, in vivo imaging.

How to Cite: Mata BA, Bowles R, Mwangi TK, Setton LA. Impaired Function and in vivo Imaging of NF-κB Activation in a Mouse Model of Knee Joint Inflammation. The Duke Orthop J 2013;3(1):41-47.


 
Special Interest
Donny Fowler MD

The Bassett Society Update

[Year:2013] [Month:July-June] [Volumn:3 ] [Number:1] [Pages:107] [Pages No:xxxiii][No of Hits : 754]


ABSTRACT

The Bassett Society was founded in 1985 by Dr Frank H Bassett III, legendary orthopaedic surgeon at Duke University Medical Center. Dr Bassett served as the team physician for Duke Athletics from 1966 to 1993, but remained a prominent figure within the department even after retirement. He was known for his warmth and charisma, and inspired everyone he came into contact with-students, athletes and doctors alike.


 
Special Interest
Jonathan C Riboh MD

The Atlanta Experience

[Year:2013] [Month:July-June] [Volumn:3 ] [Number:1] [Pages:107] [Pages No:lviii][No of Hits : 738]


ABSTRACT

Each year, half of the fourth year residents spend 6 months away from Duke furthering their experience in pediatric orthopaedics. For the fourth straight year, these residents have been working under the guidance of the attending staff at Children's Healthcare of Atlanta's Scottish Rite campus.


 
Special Interest
Karl M Schweitzer Jr MD

Indo-US Foot and Ankle Surgery Conference 2013

[Year:2013] [Month:July-June] [Volumn:3 ] [Number:1] [Pages:107] [Pages No:xli][No of Hits : 726]


ABSTRACT

The 4th annual Indo-US Foot and Ankle Surgery Conference, founded and sponsored by The Parekh Family Foundation was held from January 18th to 20th, 2013 in Kolkata, India. Since its inception, the aim of the conference was to disseminate and share techniques in foot and ankle surgery with surgeons from India, South Asia, the United States and beyond. Faculty from these respective countries run educational sessions and workshops, along with leading live surgeries.


 
Special Interest
Jonathan C Riboh MD

Resident Awards

[Year:2013] [Month:July-June] [Volumn:3 ] [Number:1] [Pages:107] [Pages No:xxxi][No of Hits : 721]


ABSTRACT

Best Junior Resident Award

Every year, the graduating chief residents elect the third year resident that they feel best embodies the intangibles that make the Duke Orthopaedics residency special. In June of 2012, Dr T Matt Chapman was chosen for this special honor. Dr Chapman has a long history of excellence. His higher education started at Davidson College, where he was a stellar student. He then travelled down the road to Wake Forest School of Medicine, where he established himself as a diligent, hard working student with a passion for Orthopaedics. This is also where he met his wife, Jenny. They were married after his final year of medical school in Kiawah Island, SC.


 
Editorial
Jonathan C Riboh MD, William R Mook MD, Jonathan A Godin MD MBA

Letter from the Editors

[Year:2013] [Month:July-June] [Volumn:3 ] [Number:1] [Pages:107] [Pages No:xxi][No of Hits : 662]


ABSTRACT

Dear Colleagues,

This year marks the third issue of the Duke Orthopaedic Journal. This has been a year of transition. No longer in its infancy, the Journal has taken on an important role in the Duke Orthopaedic tradition. The result has been a phenomenal interest among residents, faculty, and alumni in contributing to the Journal. We have expanded every section of the Journal, for which we have relied on a growing group of dedicated reviewers. We have created a rigorous peer-review process, and a Journal of the Duke family can be proud of.


 
Faculty Advisor
Selene G Parekh MD MBA

2013 Faculty Advisor's Corner

[Year:2013] [Month:July-June] [Volumn:3 ] [Number:1] [Pages:107] [Pages No:xxii][No of Hits : 647]


ABSTRACT

2012 to 2013 has once again been a busy year for Duke Orthopaedics. One of the biggest and most exciting announcements was the appointment of Dr Benjamin Alman as the Chairman of the Department. Dr Alman has been internationally recognized as a clinician, researcher and teacher. We look forward to his arrival and the opportunities it will bring.


 
Chairman's Corner
Benjamin Alman MD

From the Chairman’s Corner

[Year:2013] [Month:July-June] [Volumn:3 ] [Number:1] [Pages:107] [Pages No:xxiii][No of Hits : 642]


ABSTRACT

Alfred Shands Jr's Vision in 2013: Inventing the Future of Orthopaedics at Duke

We live in an era of fast paced changes in health care, affecting all clinical specialties, but these changes will have much more of an impact in resource intense clinical areas, such as orthopaedics. These changes are a special challenge for academic departments, which need to not only provide excellent care and be financially responsible but also have a mandate to educate the next generation of clinicians and undertake research that will improve the health of the population they serve.


 
Special Interest
Donna Roman

Annual Uganda Spine Surgery Volunteer Trip

[Year:2013] [Month:July-June] [Volumn:3 ] [Number:1] [Pages:107] [Pages No:xlii][No of Hits : 571]


ABSTRACT

In 2008, Dr William Richardson, MD, Associate Chief Medical Officer and Professor of Surgery at Duke University Hospital was asked to join a medical trip into eastern Africa with Neurosurgical colleague Michael Haglund, MD, PhD to assist with operative spine needs. This began a lasting relationship between Duke and Mulago Orthopaedics. Richardson returned in 2009 with donated orthopaedic supplies, equipment and a small volunteer team and with local Ugandan Orthopaedics headed by Dr Mallon Nyatti opened a dedicated operating area in back of the spine patient ward. This allowed spine surgeons the opportunity to do surgery without having to await the long queue of patients in the main operating area of the hospital which could result in as much as a 2- to 6-month delays for spine patients regardless of urgency.


 
Special Interest
Dan Wartinbee MD

Faculty Teaching Award

[Year:2013] [Month:July-June] [Volumn:3 ] [Number:1] [Pages:107] [Pages No:xxxii][No of Hits : 550]


ABSTRACT

This past year Marc Richard was honored with the Bassett teaching award. Each year the Bassett teaching award is given to the attending whom the chief class feels has had the greatest impact on resident training. Considering the sheer number of gifted surgeons that exist in the orthopaedic department at Duke, should signify just how special of an honor this award really is for Dr Richard to receive.


 
Special Interest
Matt Chapman MD

NCOA Update

[Year:2013] [Month:July-June] [Volumn:3 ] [Number:1] [Pages:107] [Pages No:xxxvii][No of Hits : 528]


ABSTRACT

The 2012 North Carolina Orthopaedic Association Annual Meeting convened in beautiful Pinehurst, NC for 3 days of education, fellowship and 'gimme' putts. The scientific portion of the meeting featured several Duke residents, Drs Tom Hershmiller, John Lewis, Matt Chapman, Adam Caputo, Tommy Haytmanek, Will Mook and Cameron Ledford as well as chairman Dr James Nunley. The highlight of the weekend, however, was the tribute to Dr William S Ogden. The moving presentation of the Honored Surgeon Award by Dr Edward Lilly took attendees through the life and practice of an orthopaedic surgeon dedicated to his family, his patients, and the physicians who had the privilege to spend time learning our trade from him.


 
Special Interest
Jason Jennings MD DPT

Asheville Rotation Update

[Year:2013] [Month:July-June] [Volumn:3 ] [Number:1] [Pages:107] [Pages No:lvii][No of Hits : 507]


ABSTRACT

Residents receive a diploma after completing their 6 months rotation in Asheville that reads 'Having graciously and dutifully endured excessive amounts of fatherly advice, ancient wisdom and guidance…..a distinguished graduate of the Asheville VA Over the Hill Gang School of Orthopaedic Surgery.' The Asheville VA has been the 'farm team' for our residents since 1969. We leave this rotation gaining experience in adult general orthopaedics with special emphasis on the following five surgeries: TKA, THA, rotator cuff repair, knee arthroscopy and carpal tunnel releases.

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