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  The Routine Use and Cost Analysis of Acid-Fast Bacilli and Fungal Cultures in Foot and Ankle Surgery: A Retrospective Study

  Margaret Bohr, Robert Dean, Zein El-Zein, Megan Audet, Paul Fortin, and Zachary Vaupel

  Publication Date: 5-2023

  Infection is a significant complication seen in orthopaedic surgery. In such cases, samples are sent to be cultured for aerobes, anaerobes, acid-fast bacilli (AFB) and fungi. AFB and fungi are generally slow-growing, difficult to culture, and rarely the pathogen, whereas aerobic and anaerobic cultures are routinely positive and guide antibiotic treatment. The goal of this study is to evaluate the value of routinely ordering AFB and fungal cultures in the setting of foot and ankle surgery.

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  Surveillance of Dual-Mobility Hip Systems: Damage Mode and Clinical Data Analysis

  Camilla Cascardo, Conner D. Ahlgren, Michael J. Maxwell, Tyler Vovos, Mark Karadsheh, and Drew Moore

  Publication Date: 5-2023

  Hip instability following total hip arthroplasty (THA) is a prominent indication for revision surgery. Dual mobility (DM) implants are designed to increase stability, and trending use makes characterizing in vivo damage and clinical failure modes important. This study expounds upon micro- and macroscopic damage mode findings of Lombardo et al., including novel screw ring damage using an updated retrieval registry.

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  A MSSIC Study Reveals Non- Modifiable Risk Factors Were Associated with Post-Operative Hematoma following ACDF

  Richard Easton, Matthew Lipphardt, Matthew Easton, Nicholas Papakonstantinou, Lonni Schultz, Hsueh-Han Yeh, and Cecile Pestano

  Publication Date: 11-29-2023

  Introduction

  Post-operative hematoma (POH) following anterior cervical discectomy (ACDF) is uncommon . Although rare, POH is recognized as a potentially catastrophic post-operative complication . There is limited information as to who is vulnerable . From a large database, the authors sought to identify common modifiable and non-modifiable risk factors for developing POH and its associated clinical outcomes.

  Materials and Methods

  The Michigan Spine Surgery Improvement Collaborative (MSSIC) is a statewide quality improvement initiative . ACDF cases in MSSIC registry from 2014-2018 were identified . Patients who developed POH (POH) were compared to those who did not (non-POH) . Chi-square and t-test analyses were done to compare the two groups in terms of demographics, surgical characteristics, patient reported outcomes (baseline and postoperative PROMIS-PF score), and other postoperative symptoms or complications . All analyses were performed by using SAS 9 .4

  Results

  Incidence of POH is low . Of the 9,958 cases, it only occurred in 114 cases (1 .1%) . POH was associated with male gender (1 .6% vs 0 .7%, p < .001), advanced age (age 59±11 vs 55±11, p < .001), baseline use of anticoagulation (2 .3% vs 1 .1%, p= .031), previous spine surgery (1 .6% vs 0 .9%, p= .005) and inpatient procedures (1 .3% vs 0 .7%, p= .024) . POH was also associated with which cervical levels were operated (p< .001), with the highest rates observed in surgeries involving C3-C6 (3 .6%) and C3-C5 (3 .8%) while the lowest in surgeries involving C5 to C7 (0 .5%) . Smoking, multi-level surgery, corpectomy and drain use were not associated with hematoma (p> .10 for all) . Reports of dysphagia (6 .9% vs 29 .8%, p < .001), prolonged hoarseness (2 .4% vs 9 .7%, p < .001) and weakness (5% vs 10 .5%, p= .007) were common in the POH group . No significant differences in PROMIS outcomes were observed between POH and the non-POH groups at baseline (p= .232) and post-operatively at 90 days, 1 year, and 2 years (p> .05)

  Conclusion

  POH is rare . Intrinsic or non-modifiable risk factors identified were gender, age, baseline use of anticoagulation, prior surgery and anatomical exposure . Dysphagia, prolonged hoarseness and weakness were common in the POH group . Discussion: Although intrinsic factors cannot be eliminated, surgical risk factors can be minimized . Our large database review revealed procedures involving C3-C5 and C3-C6 had the highest rate of hematoma compared to more caudal surgeries . Difficulties with exposure as well as vascular anatomy in the upper cervical spine, the cricothyroid arteries bilaterally (Figure 1), could explain this finding . Thorough visual inspection to ensure hemostasis is obtained prior to closure is critical . POH, if left unrecognized put patients at significant risk for this life-threatening postoperative complication . Effective screening targeted at high-risk patients may help in prevention and early detection

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  Trends & Outcomes in Shoulder Arthroplasty: Comparing Anatomic, Reverse, & Hemiarthroplasty

  James Gannon, Anthony Arveschoug, and Leonardo M. Cavinatto

  Publication Date: 5-2023

  The field of shoulder replacement has evolved greatly since the inception of the reverse shoulder arthroplasty (RTSA) in 2004. With yearly gains of 32%, the RTSA now encompasses the largest portion of shoulder arthroplasty procedures. In contrast, the anatomic total shoulder arthroplasty (ATSA) and hemiarthroplasty (HA) have steadied or decreased. Surgical outcomes between these three procedures are mixed however. The purpose of this study was to characterize trends and outcomes between the RTSA, ATSA, and HA at a large-volume, single-institution center

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  Out of Room – International Custom 3D Printed Implant for Rheumatologic Glenoid Deficiency: A Case Report

  Brian Golasa, Josiah Valk, Jared Lutsic, Justin Rebock, and Mohamed Saad

  Publication Date: 5-4-2023

  The advent of 3-Dimensional (3D) printing has provided orthopaedic surgeons the ability to design custom, patient-specific implants for a variety of different complex problems notably, severe bone loss.

  Rheumatoid arthritis (RA) is a debilitating, inflammatory, systemic disease affecting approximately 1.3 million adults in the United States (US).1 Orthopaedic manifestations are plentiful. Issues unique to the shoulder are: central glenoid wear, periarticular erosions and osteopenia, and subchondral cysts. Disease modifying antirheumatic drugs can be preventative but do not restore the erosive articular damage already done.

  Glenosphere fixation is critical for reverse total shoulder arthroplasty (rTSA) implant stability and longevity. Diminished bone quality and quantity are seen in RA-compromising fixation. Custom implants can allow for screw fixation into the coracoid when the glenoid vault is inadequate

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  Assessment of Radiographic Features in Predicting Complete Quadriceps and Complete Patellar Tendon Ruptures in the Pre-Operative Setting

  Mitchell Pfennig, Matthew Astolfi, Christopher Vasileff, and Betina Hinckel

  Publication Date: 5-2023

  Acute patellar tendon or quadriceps tendon rupture is a severely debilitating injury resulting in complete loss of the knee extensor mechanism. Early diagnosis and prompt surgical repair are preferential in order to achieve good functional outcomes. In the setting of trauma and knee pain, plain film radiographs of the knee are obtained to rule out fractures. Patellar and quadriceps tendon rupture is primarily a clinical diagnosis but can benefit from additional imaging to differentiate between a partial and complete tear when there is uncertainty. Our goal is to assess the reliability and reproducibility of radiographic features in a population with acute traumatic isolated quadriceps tendon or patellar tendon ruptures.

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  Pseudoaneurysm Development After Short Cephalomedullary Femoral Nailing

  Nicholas E. Runge and Daniel P. McCall

  Publication Date: 5-4-2023

  Hip fractures are amongst the most treated conditions by orthopaedic surgeons1 and are routinely treated with cephalomedullary nails (CMN)s.

  Pseudoaneurysm formation is a rare complication after femoral CMN. The primary cause of pseudoaneurysm formation in previous studies has been found to be related to overpenetration of the far cortex with a drill or screw.

  Patients with neuromuscular diseases may have aberrant anatomy potentially leading to increased risk of pseudoaneurysm formation.

  This the first case report of a patient with post-polio syndrome who developed a symptomatic deep femoral artery pseudoaneurysm status post short CMN fixation for a basicervical femoral neck fracture (FNF). Here we describe the work up and management of this uncommon complication.

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  Subacute Combined Degeneration of the Spinal Cord Induced by Nitrous Oxide Abuse: A Rare Patient Presentation to a Spine Surgery Clinic

  Jacob Shermetaro, Michael Bridges, Jonathan Avon, Nilesh Patel, and Brian Vosko

  Publication Date: 5-4-2023

  Introduction • Subacute combined degeneration (SCD) of the spinal cord is a disease involving the lateral and posterior columns of the spinal cord that can manifest in patients with vitamin B12 deficiency. • Nitrous oxide (N 2 O) induced SCD of the spinal cord is a result of N 2 O interfering with the metabolism of vitamin B12 and results in nervous system demyelination 1 • This is an infrequent complication of N 2 O anesthesia however cases are rising with recreational N 2 O use. • Given wide availability of N 2 O, clinicians must maintain a high index of suspicion when confronting patients with concerning clinical pictures.

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  Imaging-Based Modules for Musculoskeletal Anatomy & Pathology in Preclinical Medical Education

  Ameen Suhrawardy, Tarek Almsaddi, Sarah Fried, Sayf Al-katib, Drew Moore, and Malli Barremkala

  Publication Date: 5-2023

  Many medical students report a lack of adequate orthopedic and musculoskeletal (MSK) teaching in the preclinical medical curriculum. As gross anatomy is emphasized in pre-clinical education, students may feel a disconnect from clinical anatomy proficiency. This project assesses the efficacy of a preclinical image-based module to teach MSK anatomy and pathology concepts to preclinical medical students.

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  Two for One – Simultaneous Bilateral Shoulder Injuries in Gym Teacher: A Case Report

  Zachary Walker, Josiah Valk, David Sosnosk, Kelley Brossy, and Mohamed Saad

  Publication Date: 5-4-2023

  This unique case stresses importance of a thorough physical exam and meticulous radiograph evaluation, especially in uncooperative patients. CT evaluation is recommended when radiographs are inconclusive but the physical exam is concerning. Fortunately, the injury was caught and managed during his admission. Bilateral shoulder injuries are uncommon but, when sustained, are most often related to electrocution or seizure activity. This patient benefited from multidisciplinary approach with Orthopedics (trauma & sports fellowship trained), Neurosurgery, Neurology, and Medicine to manage his shoulder and spine injuries, alcohol use disorder, and seizure activity

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  Remove the Ring: A Quality Improvement Initiative for Upper Extremity Trauma

  Brandon Wallace, Matthew Charlick, Josiah Valk, and Aaron Seidman

  Publication Date: 5-4-2023

  Upper extremity trauma is a common injury and post traumatic edema is an expected sequela. Retained rings on the digits prohibit circumferential swelling and may lead to tourniquet syndrome if left in place leading to a devastating and avoidable consequence. 1

  Expeditious ring removal in upper extremity trauma is prudent for patient safety. 2

  Radiographs are typically obtained early in the triage and treatment of patients suffering from upper extremity trauma. This presented itself as as reliable efficient target to have rings removed prior to this treatment step.

  An opportunity to make a systemic change to maximize patient safety and care was identified with efforts made to reduce time from presentation to ring removal.

  The authors proposed a hard-stop protocol. The aim was to foster interdisciplinary communication and to improve patient safety and outcomes by promoting early ring removal in the traumatic setting and thus limiting potential for this devastating complication.

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  ERAS vs Non-ERAS: A Hospital Performance Metrics Comparsion in Patients Undergoing Spinal Fusion

  Richard W. Easton, Gregory Smith, Matthew Lipphardt, Nai-Wei Chen, Pestano Cecile, Hermeli Mateo, Austin Ahlgren, Brady Vibert, Andrew Sagante, and Susan Vander Beek

  Publication Date: 5-2022

  Hospital metrics are measures used to evaluate surgical quality. The goal is to improve standards of care (SOC). Hospital performance is made publicly available and has reimbursement ramifications.

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  Patient Perception of Outpatient Ambulatory Clinics and COVID-19 Vaccines

  James E. Feng, Irene Z. Chen, Phillip Vartanyan, Marvee Espiritu, and Mark S. Karadsheh

  Publication Date: 4-28-2022

  Objectives

  - Elucidate different patient population perceptions with respect to outpatient clinics and telehealth during the Covid 19 pandemic

  - Evaluate what actions can be taken to improve patient perception of the outpatient clinic safety

  - Evaluate the public's perception of the Covid 19 vaccine 1 year after the pandemic

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  Parsonage-Turner Syndrome After COVID-19 Vaccination

  Kyle Flikkema and Kelley Brossy

  Publication Date: 5-2022

  Introduction • Parsonage-Turner syndrome (PTS), also referred to as brachial plexus neuritis or neuralgia amyotrophy, is an uncommon yet debilitating condition affecting the brachial plexus • PTS is characterized by the sudden onset of severe shoulder pain without antecedent trauma followed by muscle paralysis and sensory loss of the shoulder girdle and upper extremity • Although the etiology of this rare condition is largely unknown, it has been linked to numerous predisposing factors that may trigger an immune-mediated response including recent vaccine administration

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  Applying the Periprosthetic Joint Infection Consensus Definition to Ankle Implant-Associated and Infection-Suspected Procedures to Assess Diagnosis

  Jackson Harley, Erin Baker, Corinn K. Gehrke, David Ciufo, Zachary M. Vaupel, and Paul T. Fortin

  Publication Date: 5-2-2022

  INTRODUCTION
  Periprosthetic joint infection (PJI) affects 2-3% of all total joint replacement cases. In 10-30% of these cases, the organism is unidentifiable, which may impact treatment planning and outcomes. In this study, suspected periprosthetic infections of foot and ankle procedures treated by four foot and ankle-trained orthopedic surgeons were retrospectively reviewed to determine culture status and applicability of the 2018 International Consensus Meeting on Orthopedic Infections (ICM) classification system.

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  Evaluating Taper Junction Fretting and Corrosion in Reverse Total Shoulder Arthroplasty

  Ian R. Penvose, Erin A. Baker, J. Michael Wiater, Corinn K. Gehrke, Jonathan O Wright, Omar N. Khatib, and Brett P Wiater

  Publication Date: 5-2-2022

  INTRODUCTION
  Taper junction fretting and corrosion (F&C) has been identified in total hip arthroplasty (THA) as an implant failure mode. Studies have reported taper F&C in in anatomic total shoulder arthroplasty (ATSA) implants, but limited literature has described comparable analyses in reverse shoulder arthroplasty (RTSA) implants. In this study, taper junction F&C in retrieved RTSA implants was assessed and analyzed.

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  Acute Post-Operative Pain Following Anterior Cruciate Ligament Reconstruction: A comparison of Patellar Tendon vs Hamstring Autograft

  Dustin J Randall, Denise Koueiter, Brandon Luczak, and Kyle Anderson

  Publication Date: 5-2-2022

  INTRODUCTION
  Choosing between a bone-patellar tendon-bone (BTB) or hamstring tendon (HS) graft for primary anterior cruciate ligament (ACL) reconstruction has long been a topic of debate and discrepancy in orthopaedic literature, with many factors contributing to the decision process. The purpose of this study is to analyze acute post-operative pain scores of patients who underwent ACL reconstruction and compare the results between BTB autograft and the HS autograft techniques.

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  Defining Functional Shoulder Range of Motion in Middle-Aged to Elderly Populations to Guide Shoulder Surgical Treatment

  Tyler Sargent, Justin Smith, Christie Smith, John Krauss, Michelle Jankowski, and J Michael Wiater

  Publication Date: 5-2-2022

  INTRODUCTION
  Functional range of motion (ROM) is defined as the minimal required mobility of a joint to complete activities of daily living (ADL). Defining functional ROM will allow surgeons to decide which aging patients would benefit from surgical intervention aimed at improving shoulder functionality.

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  Asymmetric bilateral hip dislocations with an associated unstable pelvic ring injury: A Case Report

  Jacob Shermetaro, Jourdan Gard, and Kelley Brossy

  Publication Date: 5-2022

  Introduction • Asymmetric bilateral hip dislocations are rare injuries with one hip dislocating posteriorly while the contralateral hip dislocates anteriorly • .01%-0.02% of all joint dislocations1 • Even fewer of these injuries have been reported with an associated unstable pelvic ring injury • We report a case of asymmetric bilateral hip dislocations with an associated unstable pelvic ring injury and femoral head fracture

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  What is the Incidence of QT Prolongation and Life-Threatening Arrhythmia Following IV Methadone Administration in Patients Undergoing Lumbar Fusion?

  Gregory Smith, Richard W. Easton, Kuldeep Shah, Daniel Silvasi, Matthew Lipphardt, Julie George, Shengchuan Dai, Brian Williamson, Brady Vibert, Bradley Ahlgren, and Nicholas Papakonstantinou

  Publication Date: 5-2022

  Postoperative analgesia is a significant challenge following major spine surgery. Utilizing a combination of opioid and non-opioid medications, optimizing their analgesic benefits while decreasing unwanted side effects, has been an effective multi-modal strategy in an Enhanced Recovery After Surgery (ERAS) protocol.

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  Evaluating Trunnion-Taper Fretting and Corrosion Damage in Anatomic Total Shoulder and Shoulder Hemiarthroplasty Prostheses: A Retrieval Study

  Trevor Tooley, Michael Maxwell, Ian R. Penvose, Denise Koueiter, and J. Michael Wiater

  Publication Date: 4-28-2022

  Objectives:

  - To identify wear patterns in the male and female components of hemi and total shoulder arthroplasty implants

  - To assess the impact of different metal compositions between implant components

  - To determine what component combination has the lowest trunnion tribo-corrosion

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  An Irreducible Posterior Shoulder Fracture-Dislocation: A Case Report

  Josiah Valk, Jacob Shermetaro, David Sosnoski, and Kelley Brossy

  Publication Date: 5-2022

  Introduction • The shoulder is the most frequently dislocated joint in the body, but most commonly dislocated anteriorly • Posterior fracture-dislocations of the shoulder are exceedingly rare orthopedic injuries that only account for 2-5% of traumatic shoulder dislocations • These injuries have a reported annual prevalence of 0.6/100,0001 • Most commonly they are a result of high energy trauma, electrocution, or seizures caused by forced flexion, adduction and internal rotation of the shoulder • Timely diagnosis is critical for appropriate early treatment in order to help prevent complications such as avascular necrosis • Thorough physical and radiographic examination are needed to confirm diagnosis which may be missed or delayed in up to 79% of cases.