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The Duke Orthopaedic Journal
Current Issue : Volume 6, Issue 1, July-June 2016
 
 
1.  Letter from the Editors
Letter from the Editors
Alexander J Lampley MD, Vasili Karas MD MS, Lindsay T Kleeman MD, Andrew P Matson MD
[Pages No:xv]
Full Text PDF | Abstract | FREE

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.

 
2.  Letter from the Faculty Advisor
Letter from the Faculty Advisor
Rhett K Hallows MD
[Pages No:xvi]
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ABSTRACT

It gives me great pleasure to present you the 6th issue of The Duke Orthopaedic Journal (DOJ). I have taken over as faculty advisor as Selene Parekh, has stepped down. Over the last 5 years, the editors along with Selene have invested their passion and hard work into this journal, and I am eager to help build upon their success.

 
3.  Letter from the Chairman—Asking Good Questions Research at Duke Orthopaedics
Letter from the Chairman—Asking Good Questions: Research at Duke Orthopaedics
Benjamin A Alman MD FRCSC
[Pages No:xvii-xviii]
Full Text PDF | Abstract | FREE

ABSTRACT

Generating and using new knowledge to improve musculoskeletal health is a critical function of any academic orthopaedic department, and a goal of Duke Orthopaedics. The first step in undertaking such a task is to identify the right questions to ask; yet we are not really taught how to ask good questions in formal orthopaedic training. All of us started out as good questioners.

 
4.  Special Interest Article
Program Director for the Ages
Robert D Fitch MD
[Pages No:xix-xx]
Full Text PDF | Abstract | FREE

ABSTRACT

At the 61st annual meeting of the Piedmont Orthopaedic Society Bill Hardaker was the guest of honor. His address to the membership was entitled “On the Shoulders of Giants.” Typical of Bill, he chose to acclaim four icons of Duke Orthopaedics rather than place the spotlight on himself. It was a moving speech and I remember thinking that his public speaking skills have always been underrated; and that one day he would be added to the list of those he praised. That day has come.

 
5.  Special Interest Article
Resident Awards
Alexander J Lampley MD
[Pages No:xxi]
Full Text PDF | Abstract | FREE

ABSTRACT

The chief resident class annually select a 3rd year resident who they feel best exemplifies the qualities embodied by Ogden. In June of 2015, Mitchell Klement was awarded this special honor. He began his higher education at Marquette University followed by Georgetown University School of Medicine where he established himself as an excellent student with a passion for orthopaedic surgery. At Duke, he is a leader among the residents, and his commitment to Duke Orthopaedics is exceptional.

 
6.  Special Interest Article
Faculty Teaching Award
Vasili Karas MD MS
[Pages No:xxii]
Full Text PDF | Abstract | FREE

ABSTRACT

Each year, the graduating chief resident class reflects on the faculty member who has demonstrated a commitment to teaching and a passion for training residents while at Duke. The Duke faculty as a whole is a devoted group of educators and all deserve the highest praise for their efforts in training the next generation of orthopaedic surgeons. This makes choosing one faculty member to be recognized extraordinarily difficult. The 2015 chief class chose Brian Brigman as the recipient of the teaching award.

 
7.  Special Interest Article
Duke Sports Sciences Institute
Evan M Guerrero MD, Beau J Kildow MD, Travis J Dekker MD, Claude T Moorman III MD
[Pages No:xxiii-xxiv]
Full Text PDF | Abstract | FREE

ABSTRACT

Today, a large construction site occupies the former establishment of the Finch-Yeager building on Frank Bassett Drive, home to Duke Sports Medicine since 1981. Its demolition is part of a 250 million Dollar renovation and construction of a new twelve-story, 91,000 square foot tower that is part of Wallace Wade Stadium. The 30-year-old Finch-Yeager building served as the foundation to world-class patient care in sports medicine. Due to the rapidly expanding clinical and research practice, Duke Sports Medicine had a vision to establish a larger facility to incorporate a multifaceted approach to patient care.

 
8.  Special Interest Article
Feagin Leadership Program Update
Michael Moorwood MD, Travis Dekker MD, Dean Taylor MD
[Pages No:xxv-xxvi]
Full Text PDF | Abstract | FREE

ABSTRACT

The John A Feagin Jr, Leadership Program was established in 2009 in honor of John A Feagin Jr, and the exceptional leadership that he displayed during his long, successful career. For 7 years, the program has cultivated leadership skills among Duke medical students, orthopaedic and nonorthopaedic residents, and fellows. Scholars accepted into this program do so with the full understanding that they are making a tremendous commitment of their time and energy. Acceptance into the program is highly sought after and applications are growing every year.

 
9.  Special Interest Article
Piedmont Orthopaedic Society Annual Meeting Update (2015)
Mitchell R Klement MD
[Pages No:xxvii]
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ABSTRACT

The 63rd annual Piedmont Orthopaedic Society meeting returned to The Cloister at Sea Island, Georgia, for the 29th time after traveling abroad to Greece the year before. The cherished biennial location welcomed 81 members, 46 children, and a grand total attendance of 210. The meeting was also attended by five current Duke residents, including Andrew “Keola” Richardson, recipient of the John M Harrelson Chief Resident Teaching Award; Richard Rutherford and Kathleen Rickert, recipients of the Ralph Coonrad Pediatric Orthopaedic Traveling Fellowships; Jonathan Godin, inaugural recipient of the William T Hardaker, Jr Residents Fellowship; and Mitchell Klement, recipient of the William S Ogden Junior Resident Traveling Fellowship.

 
10.  Special Interest Article
Emily Berend Adult Reconstruction Symposium (2015)
Lindsay T Kleeman MD
[Pages No:xxviii-xxix]
Full Text PDF | Abstract | FREE

ABSTRACT

The 7th annual Emily Berend Adult Reconstruction Symposium (EBARS) had another successful year this past April at our own Duke University Medical Center. Created and hosted by former Duke Residents, Keith Berend, Michael Berend, and Michael Bolognesi, EBARS is held in loving memory of the brothers’ late mother, Emily Berend, to serve as an intensive and interactive forum to develop knowledge and skills for practicing evidence-based adult reconstruction. Now in its 7th year, it continues to be a favorite event of the educational year enjoyed by residents, fellows, and attending from near and far. The symposium spans the course of two days and features a variety of didactic and interactive sessions, including live cadaver demonstrations, review of the current literature, and debate over controversial topics.

 
11.  Special Interest Article
North Carolina Orthopaedic Association Annual Meeting
Andrew P Matson MD
[Pages No:xxx]
Full Text PDF | Abstract | FREE

ABSTRACT

Despite record-breaking levels of rainfall in South Carolina, the 2015 Annual Meeting of the North Carolina Orthopaedic Association (NCOA) ran smoothly at the Kiawah Island Golf Resort from October 9 to 11, 2015. With large segments of the highway closed due to flooding, conference attendees were redirected through Wilmington or Charlotte to reach the conference on Friday. Eventually, the sun did poke through following the academic agenda which allowed conference-goers to enjoy the beautiful scenery of Kiawah Island.

 
12.  Special Interest Article
American Academy of Orthopaedic Surgery (AAOS) and Orthopaedic Research Society (ORS) Annual Meetings Update
Lindsay T Kleeman MD
[Pages No:xxxi-xxxiv]
Full Text PDF | Abstract | FREE

ABSTRACT

This marked an exciting year for Duke Orthopaedics as our department gave a record number of presentations at both the American Academy of Orthopaedic Surgery (AAOS) and Orthopaedic Research Society (ORS) annual meetings in Orlando, FL. Several of the residents and faculty attended, joined by dozens of Piedmont members from across the country. Excellent talks and posters were presented by all, with special recognition given to Benjamin Alman’s paper on “Improving Bone Healing in Neurofibromatosis: A Study in Mice” and Louis DeFrates’ work on “The Effects of ACL Graft Placement on in vivo Knee Function and Cartilage Thickness Distribution,” for which he was awarded the Kappa Delta Young Investigator Award on March 3.

 
13.  Special Interest Article
Journey of an Orthopaedic Resident in India: 7th Annual Parekh Indo-US Foot and Ankle Course
Julie Neumann MD
[Pages No:xxxv-xxxvii]
Full Text PDF | Abstract | FREE

ABSTRACT

In this final year of residency, as I reflect on the last 4½ years here at Duke, several of my fondest memories are my experiences during the 7th Annual Parekh Indo-US Foot and Ankle Course in Ahmedabad, Gujarat, India, the birthplace of Mahatma Gandhi. I initially applied for selection as the Parekh Family Foundation Resident Scholar due to my growing interest in the orthopaedic subspecialty of foot and ankle. I had no idea what a life-changing experience this trip to India would become. No India travel book adequately prepares one for the unique culture and camaraderie of the Indian people that I grew to fully appreciate by the end of even this short, four-night visit.

 
14.  Special Interest Article
25 Years of Duke Foot and Ankle Surgery Fellowship Training
Kamran S Hamid MD MPH, James A Nunley MD
[Pages No:xxxviii-xl]
Full Text PDF | Abstract | FREE

ABSTRACT

INTRODUCTION

There is a growing demand for orthopedic surgeons trained in the management of foot and ankle conditions, yet recruitment is modest, and there remains wide variation in the process of fellowship education along with a dearth of training outcomes assessment. With a burgeoning population and incommensurate surgeon production, foot and ankle surgery is confronted by a potential relative workforce shortage unless we can improve recruitment and enhance educational efficiency.1

 
15.  Clinical Study
A Clinical Trial Evaluation of Pager versus Smart-device Efficacy in an Academic Hospital Setting
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
[Pages No:1-6]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10017-1061 | FREE

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

 
16.  Clinical Study
Management of Extremity Injuries by Residents: Can We improve Quality and Efficiency Through a Simple Checklist?
Kamran S Hamid MD, MPH, Benedict U Nwachukwu MD MBA, Bret A Nicks MD MHA, Sayon Dutta MD MPH, Eben Carrol MD
[Pages No:7-11]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10017-1062 | FREE

ABSTRACT

Introduction: Variation in practice among resident physicians is a barrier to providing consistent, high-quality care to patients with musculoskeletal injuries.

Materials and methods: A multidisciplinary group at an academic center developed a checklist for managing suspected extremity injuries in adults. Simulation testing was conducted in which 17 Emergency Medicine residents were randomized by year of training into cohorts of 8 “checklist” residents and 9 “no checklist” residents. Each resident performed 2 case simulations and was evaluated based on adherence to 12 predefined critical process measures.

Results: Usage of the checklist resulted in a decrease in delay of care events (8.3 vs 27.3%, p < 0.01) and decrease in potential medical errors (5.7 vs 22.2%, p < 0.01). All levels of training demonstrated improvements, and first-year residents using the checklist performed significantly better than thirdyear residents without the checklist, demonstrating decrease in delay of care events (8.3 vs 26.4%, p < 0.05) and decrease in potential medical errors (5.6 vs 18.1%, p < 0.05).

Conclusion: Implementation of a simple checklist can reduce delays in care and potential medical errors in the management of extremity injuries by resident physicians.

Keywords: Checklist, Cost, Education, Efficiency, Emergency medicine, Extremity, Fracture, Injury, Orthopaedics, Quality, Throughput, Value.

How to cite this article:Hamid KS, Nwachukwu BU, Nicks BA, Dutta S, Carroll EA. Management of Extremity Injuries by Residents: Can We improve Quality and Efficiency through a Simple Checklist? The Duke Orthop J 2016;6(1):7-11.

Source of support: Nil

Conflict of interest: None.

IRB statement: This simulation was undertaken as part of an institutional quality improvement project and was granted Institutional Review Board exemption.

 
17.  Clinical Study
Independent Analysis of the Dorr Classification of Proximal Femoral Morphology: A Reliability 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
[Pages No:12-16]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10017-1063 | FREE

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

 
18.  Clinical Study
Dislocation Rate at Short-term Follow-up after Revision Total Hip Arthroplasty with a Dual Mobility Component
Taylor R McClellan BS, Roberto D Calderon MD, Michael P Bolognesi MD, David E Attarian MD, Paul F Lachiewicz MD, Samuel S Wellman MD
[Pages No:17-20]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10017-1064 | FREE

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

 
19.  Clinical Study
Incidence and Demographics of Cervical Spine Fractures over a 10 Year Period at a Level I Trauma Center
Daniel J Blizzard MD MHS, Christopher P Miller MD, Sonya T Blizzard MD MHS, Jonathan N Grauer MD
[Pages No:21-25]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10017-1065 | FREE

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.

 
20.  Clinical Study
Ultrasonography Technique in the Evaluation of Massive Rotator Cuff Tears Repaired using a Porcine Acellular Dermal Matrix Xenograft through a Mini-open Approach
Julie A Neumann MD, Kathleen D Rickert MD, Alison P Toth MD, Blake R Boggess DO
[Pages No:26-34]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10017-1066 | FREE

ABSTRACT

Purpose: Massive rotator cuff tears (RCT) have been notoriously difficult to treat, but recently the novel use of interposition biologic scaffold grafts in repair of massive RCT has had promising results. However, there are no published guidelines regarding postoperative imaging evaluation of massive RCT repaired with xenograft. The purpose of this study was to (1) describe how to use ultrasound to evaluate a porcine acellular dermal matrix xenograft after repair of massive RCT and (2) evaluate healing of a xenograft using high-resolution ultrasound.

Materials and methods: A total of 37 consecutive patients underwent ultrasound evaluation of a repaired RCT at a mean of 33 months follow-up (23-48). Postoperative ultrasound findings were correlated to preoperative and postoperative functional (visual analog scale, Short-form 12, and Modified American shoulder and elbow score) and clinical outcomes (active range of motion and strength).

Results: Of the 37 patients, ultrasound showed that 33 (89.2%) of the cuff repairs were fully intact, 3 (8.1%) had partial thickness tears, and 1 (2.7%) had a full thickness tear. In this study, the integrity of the repair based on high-resolution ultrasound correlates with functional and clinical outcomes.

Conclusion: Ultrasound is an effective method to evaluate xenograft interposition grafts used in rotator cuff repair.

Keywords: Rotator cuff, Ultrasonography, Xenograft.

How to cite this article:Neumann JA, Rickert KD, Toth AP, Boggess BR. Ultrasonography Technique in the Evaluation of Massive Rotator Cuff Tears Repaired using a Porcine Acellular Dermal Matrix Xenograft through a Mini-open Approach. The Duke Orthop J 2016;6(1):26-34.

Source of support: Dr Blake Boggess received educational grants to teach ultrasound courses from GE, SonoSite, Bioventus, and Arthrex. Dr Alison Toth is a consultant and receives research support from Tornier. Drs Neumann and Rickert have no disclosures to report.

Conflict of interest: None

 
21.  Clinical Study
Economic Analysis of Accuracy and Cost of Ultrasound-guided Intraarticular Hip Injections
Lauren Porras MD, Blake R Boggess DO
[Pages No:35-40]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10017-1067 | FREE

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.

 
22.  Technical Report
Technique for Combined Hip Arthroscopy and Periacetabular Osteotomy for the Patient with Hip Dysplasia and Intraarticular Pathology
Brian D Lewis MD, Steven A Olson MD
[Pages No:41-46]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10017-1068 | FREE

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

 
23.  Technical Report
Technical Aspects of Addressing Multiligament Knee Instability
Travis J Dekker MD, Beau J Kildow MD, Evan M Guerrero MD, Claude T Moorman III MD
[Pages No:47-53]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10017-1069 | FREE

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

 
24.  Editorial
Physical Therapy Perspectives: A Resident’s Re-education
Matthew A Tao MD
[Pages No:54-55]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10017-1070 | FREE

ABSTRACT

While most of us are regular prescribers of physical therapy (PT), we are often guilty of underappreciating the intimate role this plays in postoperative success. The following is a personal account of lessons learned and value appreciated through the lens of an orthopaedic resident undergoing postoperative shoulder rehab. What transpired has fundamentally changed my understanding of what happens after patients leave the operating room and has inspired my future investment in the role of PT.

Keywords: Education, Physical therapy modalities, Postoperative care.

How to cite this article:Tao MA. Physical Therapy Perspectives: A Resident’s Reeducation. The Duke Orthop J 2016;6(1):54-55.

Source of support: Nil

Conflict of interest: None

 
25.  Clinical Study
The Importance of the Palmar Lunate Facet in the Treatment of Distal Radius Fractures
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
[Pages No:56-60]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10017-1071 | FREE

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

 
26.  Case Report
Pediatric Tillaux Ankle Fracture with Concomitant Adult-type Supination External Rotation Fracture Pattern: A Rare Injury
Brian L Dial MD, Michael P Morwood MD, Robert D Fitch MD
[Pages No:61-63]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10017-1072 | FREE

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

 
27.  Chief Resident Profile
Chief Autobiographies (2016)
Jonathan Godin, Drew Henderson, Julie Neumann, Kathleen Rickert, Richard Rutherford, Erika Templeton, Megan Crosmer, Matthew A Tao
[Pages No:64-68]
Full Text PDF | Abstract | FREE

ABSTRACT

I was born and raised in Flint, Michigan, as the oldest of five children. My parents instilled in us the values of compassion, hard work, teamwork, integrity, and loyalty. Later, I attended Johns Hopkins University where I solidified my interests in medicine and scientific research. My first exposure to the field of orthopaedics came while in college, and I was struck by the fact that a life as an orthopaedic surgeon would allow me to rebuild patients’ mobility and quality of life.

 
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