A 24-year-old military policeman underwent arthroscopic femoral neck osteoplasty and labral repai... more A 24-year-old military policeman underwent arthroscopic femoral neck osteoplasty and labral repair of his right hip following failed conservative management of femoroacetabular impingement. His postoperative course was complicated by recurring posterior instability of his right hip initially presenting as a posterior dislocation on postoperative day 19. Iatrogenic disruption of the hip's static stabilizers in the setting of underlying coxa valga is the likely culprit. Although anterior dislocation following hip arthroscopy has been described, posterior dislocation has not. Further, we identified a successful and less-invasive approach to the treatment of this complication, in the form of a spica cast. Prior cases pertaining to post-arthroscopy hip instability have only described operative interventions, such as capsular repair and plication, as effective revision procedures.
Background: Health literacy is the most important predictor of an individual's health status, wit... more Background: Health literacy is the most important predictor of an individual's health status, with more frequent hospitalizations, worse control of chronic conditions, and suboptimal treatment outcomes associated with limited literacy. Despite this, little is known about musculoskeletal health literacy. As such, this study utilized a musculoskeletal specific literacy sur vey (the LiMP questionnaire) to evaluate the level of comprehension in patients presenting to the emergency department with musculoskeletal complaints, with an emphasis on their understanding of anatomy, terminology, diagnosis and treatment of musculoskeletal conditions. The relationship between musculoskeletal specific and general health literacy was also assessed, in addition to the risk factors for limited musculoskeletal comprehension.
Background: Inadequate health literacy has been correlated with poorer health and worse outcomes ... more Background: Inadequate health literacy has been correlated with poorer health and worse outcomes in musculoskeletal health. It is therefore helpful to identify those with deficiencies to obtain better results. Through the use of a previously developed Literacy in Musculoskeletal Problems (LiMP) questionnaire, the prevalence of musculoskeletal literacy was compared between patients in an emergency department (ED) and an outpatient orthopaedic practice.
Approximately 33% of Americans have inadequate health literacy, which is associated with decrease... more Approximately 33% of Americans have inadequate health literacy, which is associated with decreased medical knowledge, increased hospitalization and use of emergency care, and worse control of diseases. In this study, the Literacy in Musculoskeletal Problems (LiMP) questionnaire was used to evaluate the prevalence of limited musculoskeletal literacy in patients presenting to the emergency department (ED) with foot and ankle-related complaints, as these individuals may be at increased risk for inferior outcomes. In this cross-sectional study, individuals ≥18 years of age presenting with foot and ankle-related complaints to the ED were invited to participate. Participants completed a demographic survey and the LiMP questionnaire, with scores ≥6 indicative of adequate musculoskeletal literacy. The prevalence of adequate health literacy and the influence of demographic parameters was assessed. P values <.05 were considered significant. The mean LiMP score was 5 ± 2.06. Limited musculo...
Mesenchymal stem cells (MSCs) are of great interest to both clinicians and researchers for their ... more Mesenchymal stem cells (MSCs) are of great interest to both clinicians and researchers for their great potential to enhance tissue engineering. Their ease of isolation, manipulability and potential for differentiation are specifically what have made them so attractive. These multipotent cells have been found to differentiate into cartilage, bone, fat, muscle, tendon, skin, hematopoietic-supporting stroma and neural tissue. Their diverse in vivo distribution includes bone marrow, adipose, periosteum, synovial membrane, skeletal muscle, dermis, pericytes, blood, trabecular bone, human umbilical cord, lung, dental pulp and periodontal ligament. Despite their frequent use in research, no standardized criteria exist for the identification of mesenchymal stem cells; The International Society for Cellular Therapy has sought to change this with a set of guidelines elucidating the major surface markers found on these cells. While many studies have shown MSCs to be just as effective as unipot...
Background. Ankle fractures in diabetics are challenging to treat, and only generalized clinical ... more Background. Ankle fractures in diabetics are challenging to treat, and only generalized clinical guidelines specific to their treatment exist. As such, the American Orthopaedic Foot and Ankle Society (AOFAS) membership was polled regarding the management of different types of ankle fractures in this patient population. Methods. We developed a multiple-choice survey with 3 clinical scenarios involving diabetic ankle fractures that was sent via e-mail to the 895 active members of the AOFAS. In addition to providing demographic information, respondents identified their preferred stabilization method, the need for supplemental fixation, and each patient's weight-bearing status. Results. Respondents' number of years in practice, number of ankle fractures treated monthly, and type of fellowship training did not correlate with management strategies. Enhanced fixation with syndesmotic screws was advocated in the setting of displaced fractures without syndesmotic injury, while castin...
The closure of the distal tibial physis occurs over an 18-month period between ages 12 and 15 yea... more The closure of the distal tibial physis occurs over an 18-month period between ages 12 and 15 years. During this time period, children are susceptible to several transitional fractures, so labeled because they are transitioning to skeletal maturity. In the setting of an external rotation force, triplane and Tillaux fractures can occur. These fractures, which present similarly to other Salter-Harris growth plate injuries, do not fit neatly into any 1 classification scheme and are not easily evaluated on plain radiographs. Computed tomography scans are required to optimally assess these fractures and to determine the need for closed vs open treatment. Regardless of which treatment modality is chosen, anatomic reduction is the goal. This article discusses the approach to these unique fractures.
American journal of orthopedics (Belle Mead, N.J.)
B acillus cereus is an aerobic, spore-forming, gram-positive rod. It has historically been associ... more B acillus cereus is an aerobic, spore-forming, gram-positive rod. It has historically been associated with "fried rice syndrome," a foodborne diarrheal and emetic illness resulting from eating fried rice dishes that have been sitting at room temperature for hours. Although this illness is a serious consequence of inoculation, an even more devastating sequela is the soft-tissue infection that the illness can cause. In the set-ting of penetrating trauma or postsurgical contamination, B cereus can mimic necrotizing fasciitis, with tissue destruction mandating urgent surgical debridement, systemic resuscita-tion, and antimicrobial therapy. In this article, we report the case of a 9-year-old boy who developed culture-positive B cereus fasciitis of the right lower extremity after being impaled on a tree branch. Institutional review board approval was obtained, and the patient and his family provided written informed con-sent for print and electronic publication of this case repo...
Jacques Lisfranc (1790-1847), a field surgeon in Napoleon's army, described an amputation involvi... more Jacques Lisfranc (1790-1847), a field surgeon in Napoleon's army, described an amputation involving the tarsometatarsal (TMT) joint due to a severe gangrene that developed when a soldier fell from a horse with his foot caught in a stirrup. 1-3 Although this is one type of TMT joint injury, it must be understood that the so-called Lisfranc injury does not delineate any one specific fracture or dislocation, but instead a spectrum of processes involving the TMT joint complex.
The biology of fracture healing is better understood than ever before, with advancements such as ... more The biology of fracture healing is better understood than ever before, with advancements such as the locking screw leading to more predictable and less eventful osseous healing. However, at times one's intrinsic biological response, and even concurrent surgical stabilization, is inadequate. In hopes of facilitating osseous union, bone grafts, bone substitutes and orthobiologics are being relied on more than ever before. The osteoinductive, osteoconductive and osteogenic properties of these substrates have been elucidated in the basic science literature and validated in clinical orthopaedic practice. Furthermore, an industry built around these items is more successful and in demand than ever before. This review provides a comprehensive overview of the basic science, clinical utility and economics of bone grafts, bone substitutes and orthobiologics.
795 The case: Enhance your diagnostic skills with this "test yourself" monthly column, ... more 795 The case: Enhance your diagnostic skills with this "test yourself" monthly column, which features a radiograph and challenges you to make a diagnosis. n radiologic case study Your diagnosis? For answer see page 853 Figure: Coronal (A) and sagittal (B) computed tomography scans of the right ankle. A 13-year-old boy presented to the emergency department with bilateral ankle pain and swelling following a 5-foot fall from a swing set.
American journal of orthopedics (Belle Mead, N.J.)
T he role of a mentor is first described in Homer's The Odyssey, when Odysseus entrusts Mento... more T he role of a mentor is first described in Homer's The Odyssey, when Odysseus entrusts Mentor with the care of his family. 1 During the 20 years in which Odysseus is gone, Mentor becomes a teacher to Odysseus' son Telemachus, providing wisdom and guidance. Historically, mentoring has been thought of as the interaction between a protégé and a more experienced in-dividual. While this remains true, an effective and mean-ingful mentorship is a considerably more intimate experi-ence—one between 2 individuals that involves an ongoing relationship of learning, dialogue, and challenge to facili-tate both career and personal development. Although both formal and informal approaches to mentoring have been described, the underlying principles of the mentor-mentee relationship remain the same. The corporate world has embraced mentorship pro-grams, with 76% of Fortune magazine's 100 best companies to work for in America offering mentoring programs, as compared with 56% of the rest. ...
Rosenbaum AJ, Czajka CM, Morse AS, Bagchi K. An atypical presentation of heterotopic ossification... more Rosenbaum AJ, Czajka CM, Morse AS, Bagchi K. An atypical presentation of heterotopic ossification following pelvic ring injury. Bull Hosp Jt Dis. Abstract Disruption of the pelvic ring is associated with great morbidity and mortality. The high-energy blunt trauma that often leads to these injuries is also responsible for the head, chest, spine, extremity, and genitourinary trauma seen concurrently. Ure-thral and bladder injuries have been reported in up to 25% of patients with pelvic fractures and can lead to a plethora of urogenital problems. Heterotopic ossification of the penis, presenting as erectile dysfunction, has never been described as a complication of pelvic ring injury. We present the first case of this type of heterotopic ossification, in a 46-year-old male who sustained an anteroposterior compression type II injury with no evidence of genitourinary tract damage. P elvic ring fractures are typically caused by high-energy blunt trauma. Their mortality rate is 15% to 25% ...
Soft tissue infections comprise a broad category of microbial infections, with cellulitis, absces... more Soft tissue infections comprise a broad category of microbial infections, with cellulitis, abscesses, necrotizing fasciitis and gas gangrene the most frequently encountered. A comprehensive history and physical examination is crucial and can help facilitate early diagnosis and management. Diag-nostic adjuncts including laboratory and imaging studies are available and can aid the clinician in the workup. Although cellulitis and abscesses are often treated with oral antibiotics or local drainage, respectively, necrotizing fasciitis and gas gangrene represent surgical emergencies with high morbidity and mortality. This article reviews the approach to diagnosis and management of soft tissue infections.
Bulletin of the Hospital for Joint Disease (2013), 2014
A 24-year-old military policeman underwent arthroscopic femoral neck osteoplasty and labral repai... more A 24-year-old military policeman underwent arthroscopic femoral neck osteoplasty and labral repair of his right hip following failed conservative management of femoroacetabular impingement. His postoperative course was complicated by recurring posterior instability of his right hip initially presenting as a posterior dislocation on postoperative day 19. Iatrogenic disruption of the hip's static stabilizers in the setting of underlying coxa valga is the likely culprit. Although anterior dislocation following hip arthroscopy has been described, posterior dislocation has not. Further, we identified a successful and less-invasive approach to the treatment of this complication, in the form of a spica cast. Prior cases pertaining to post-arthroscopy hip instability have only described operative interventions, such as capsular repair and plication, as effective revision procedures.
A 24-year-old military policeman underwent arthroscopic femoral neck osteoplasty and labral repai... more A 24-year-old military policeman underwent arthroscopic femoral neck osteoplasty and labral repair of his right hip following failed conservative management of femoroacetabular impingement. His postoperative course was complicated by recurring posterior instability of his right hip initially presenting as a posterior dislocation on postoperative day 19. Iatrogenic disruption of the hip's static stabilizers in the setting of underlying coxa valga is the likely culprit. Although anterior dislocation following hip arthroscopy has been described, posterior dislocation has not. Further, we identified a successful and less-invasive approach to the treatment of this complication, in the form of a spica cast. Prior cases pertaining to post-arthroscopy hip instability have only described operative interventions, such as capsular repair and plication, as effective revision procedures.
Background: Health literacy is the most important predictor of an individual's health status, wit... more Background: Health literacy is the most important predictor of an individual's health status, with more frequent hospitalizations, worse control of chronic conditions, and suboptimal treatment outcomes associated with limited literacy. Despite this, little is known about musculoskeletal health literacy. As such, this study utilized a musculoskeletal specific literacy sur vey (the LiMP questionnaire) to evaluate the level of comprehension in patients presenting to the emergency department with musculoskeletal complaints, with an emphasis on their understanding of anatomy, terminology, diagnosis and treatment of musculoskeletal conditions. The relationship between musculoskeletal specific and general health literacy was also assessed, in addition to the risk factors for limited musculoskeletal comprehension.
Background: Inadequate health literacy has been correlated with poorer health and worse outcomes ... more Background: Inadequate health literacy has been correlated with poorer health and worse outcomes in musculoskeletal health. It is therefore helpful to identify those with deficiencies to obtain better results. Through the use of a previously developed Literacy in Musculoskeletal Problems (LiMP) questionnaire, the prevalence of musculoskeletal literacy was compared between patients in an emergency department (ED) and an outpatient orthopaedic practice.
Approximately 33% of Americans have inadequate health literacy, which is associated with decrease... more Approximately 33% of Americans have inadequate health literacy, which is associated with decreased medical knowledge, increased hospitalization and use of emergency care, and worse control of diseases. In this study, the Literacy in Musculoskeletal Problems (LiMP) questionnaire was used to evaluate the prevalence of limited musculoskeletal literacy in patients presenting to the emergency department (ED) with foot and ankle-related complaints, as these individuals may be at increased risk for inferior outcomes. In this cross-sectional study, individuals ≥18 years of age presenting with foot and ankle-related complaints to the ED were invited to participate. Participants completed a demographic survey and the LiMP questionnaire, with scores ≥6 indicative of adequate musculoskeletal literacy. The prevalence of adequate health literacy and the influence of demographic parameters was assessed. P values <.05 were considered significant. The mean LiMP score was 5 ± 2.06. Limited musculo...
Mesenchymal stem cells (MSCs) are of great interest to both clinicians and researchers for their ... more Mesenchymal stem cells (MSCs) are of great interest to both clinicians and researchers for their great potential to enhance tissue engineering. Their ease of isolation, manipulability and potential for differentiation are specifically what have made them so attractive. These multipotent cells have been found to differentiate into cartilage, bone, fat, muscle, tendon, skin, hematopoietic-supporting stroma and neural tissue. Their diverse in vivo distribution includes bone marrow, adipose, periosteum, synovial membrane, skeletal muscle, dermis, pericytes, blood, trabecular bone, human umbilical cord, lung, dental pulp and periodontal ligament. Despite their frequent use in research, no standardized criteria exist for the identification of mesenchymal stem cells; The International Society for Cellular Therapy has sought to change this with a set of guidelines elucidating the major surface markers found on these cells. While many studies have shown MSCs to be just as effective as unipot...
Background. Ankle fractures in diabetics are challenging to treat, and only generalized clinical ... more Background. Ankle fractures in diabetics are challenging to treat, and only generalized clinical guidelines specific to their treatment exist. As such, the American Orthopaedic Foot and Ankle Society (AOFAS) membership was polled regarding the management of different types of ankle fractures in this patient population. Methods. We developed a multiple-choice survey with 3 clinical scenarios involving diabetic ankle fractures that was sent via e-mail to the 895 active members of the AOFAS. In addition to providing demographic information, respondents identified their preferred stabilization method, the need for supplemental fixation, and each patient's weight-bearing status. Results. Respondents' number of years in practice, number of ankle fractures treated monthly, and type of fellowship training did not correlate with management strategies. Enhanced fixation with syndesmotic screws was advocated in the setting of displaced fractures without syndesmotic injury, while castin...
The closure of the distal tibial physis occurs over an 18-month period between ages 12 and 15 yea... more The closure of the distal tibial physis occurs over an 18-month period between ages 12 and 15 years. During this time period, children are susceptible to several transitional fractures, so labeled because they are transitioning to skeletal maturity. In the setting of an external rotation force, triplane and Tillaux fractures can occur. These fractures, which present similarly to other Salter-Harris growth plate injuries, do not fit neatly into any 1 classification scheme and are not easily evaluated on plain radiographs. Computed tomography scans are required to optimally assess these fractures and to determine the need for closed vs open treatment. Regardless of which treatment modality is chosen, anatomic reduction is the goal. This article discusses the approach to these unique fractures.
American journal of orthopedics (Belle Mead, N.J.)
B acillus cereus is an aerobic, spore-forming, gram-positive rod. It has historically been associ... more B acillus cereus is an aerobic, spore-forming, gram-positive rod. It has historically been associated with "fried rice syndrome," a foodborne diarrheal and emetic illness resulting from eating fried rice dishes that have been sitting at room temperature for hours. Although this illness is a serious consequence of inoculation, an even more devastating sequela is the soft-tissue infection that the illness can cause. In the set-ting of penetrating trauma or postsurgical contamination, B cereus can mimic necrotizing fasciitis, with tissue destruction mandating urgent surgical debridement, systemic resuscita-tion, and antimicrobial therapy. In this article, we report the case of a 9-year-old boy who developed culture-positive B cereus fasciitis of the right lower extremity after being impaled on a tree branch. Institutional review board approval was obtained, and the patient and his family provided written informed con-sent for print and electronic publication of this case repo...
Jacques Lisfranc (1790-1847), a field surgeon in Napoleon's army, described an amputation involvi... more Jacques Lisfranc (1790-1847), a field surgeon in Napoleon's army, described an amputation involving the tarsometatarsal (TMT) joint due to a severe gangrene that developed when a soldier fell from a horse with his foot caught in a stirrup. 1-3 Although this is one type of TMT joint injury, it must be understood that the so-called Lisfranc injury does not delineate any one specific fracture or dislocation, but instead a spectrum of processes involving the TMT joint complex.
The biology of fracture healing is better understood than ever before, with advancements such as ... more The biology of fracture healing is better understood than ever before, with advancements such as the locking screw leading to more predictable and less eventful osseous healing. However, at times one's intrinsic biological response, and even concurrent surgical stabilization, is inadequate. In hopes of facilitating osseous union, bone grafts, bone substitutes and orthobiologics are being relied on more than ever before. The osteoinductive, osteoconductive and osteogenic properties of these substrates have been elucidated in the basic science literature and validated in clinical orthopaedic practice. Furthermore, an industry built around these items is more successful and in demand than ever before. This review provides a comprehensive overview of the basic science, clinical utility and economics of bone grafts, bone substitutes and orthobiologics.
795 The case: Enhance your diagnostic skills with this "test yourself" monthly column, ... more 795 The case: Enhance your diagnostic skills with this "test yourself" monthly column, which features a radiograph and challenges you to make a diagnosis. n radiologic case study Your diagnosis? For answer see page 853 Figure: Coronal (A) and sagittal (B) computed tomography scans of the right ankle. A 13-year-old boy presented to the emergency department with bilateral ankle pain and swelling following a 5-foot fall from a swing set.
American journal of orthopedics (Belle Mead, N.J.)
T he role of a mentor is first described in Homer's The Odyssey, when Odysseus entrusts Mento... more T he role of a mentor is first described in Homer's The Odyssey, when Odysseus entrusts Mentor with the care of his family. 1 During the 20 years in which Odysseus is gone, Mentor becomes a teacher to Odysseus' son Telemachus, providing wisdom and guidance. Historically, mentoring has been thought of as the interaction between a protégé and a more experienced in-dividual. While this remains true, an effective and mean-ingful mentorship is a considerably more intimate experi-ence—one between 2 individuals that involves an ongoing relationship of learning, dialogue, and challenge to facili-tate both career and personal development. Although both formal and informal approaches to mentoring have been described, the underlying principles of the mentor-mentee relationship remain the same. The corporate world has embraced mentorship pro-grams, with 76% of Fortune magazine's 100 best companies to work for in America offering mentoring programs, as compared with 56% of the rest. ...
Rosenbaum AJ, Czajka CM, Morse AS, Bagchi K. An atypical presentation of heterotopic ossification... more Rosenbaum AJ, Czajka CM, Morse AS, Bagchi K. An atypical presentation of heterotopic ossification following pelvic ring injury. Bull Hosp Jt Dis. Abstract Disruption of the pelvic ring is associated with great morbidity and mortality. The high-energy blunt trauma that often leads to these injuries is also responsible for the head, chest, spine, extremity, and genitourinary trauma seen concurrently. Ure-thral and bladder injuries have been reported in up to 25% of patients with pelvic fractures and can lead to a plethora of urogenital problems. Heterotopic ossification of the penis, presenting as erectile dysfunction, has never been described as a complication of pelvic ring injury. We present the first case of this type of heterotopic ossification, in a 46-year-old male who sustained an anteroposterior compression type II injury with no evidence of genitourinary tract damage. P elvic ring fractures are typically caused by high-energy blunt trauma. Their mortality rate is 15% to 25% ...
Soft tissue infections comprise a broad category of microbial infections, with cellulitis, absces... more Soft tissue infections comprise a broad category of microbial infections, with cellulitis, abscesses, necrotizing fasciitis and gas gangrene the most frequently encountered. A comprehensive history and physical examination is crucial and can help facilitate early diagnosis and management. Diag-nostic adjuncts including laboratory and imaging studies are available and can aid the clinician in the workup. Although cellulitis and abscesses are often treated with oral antibiotics or local drainage, respectively, necrotizing fasciitis and gas gangrene represent surgical emergencies with high morbidity and mortality. This article reviews the approach to diagnosis and management of soft tissue infections.
Bulletin of the Hospital for Joint Disease (2013), 2014
A 24-year-old military policeman underwent arthroscopic femoral neck osteoplasty and labral repai... more A 24-year-old military policeman underwent arthroscopic femoral neck osteoplasty and labral repair of his right hip following failed conservative management of femoroacetabular impingement. His postoperative course was complicated by recurring posterior instability of his right hip initially presenting as a posterior dislocation on postoperative day 19. Iatrogenic disruption of the hip's static stabilizers in the setting of underlying coxa valga is the likely culprit. Although anterior dislocation following hip arthroscopy has been described, posterior dislocation has not. Further, we identified a successful and less-invasive approach to the treatment of this complication, in the form of a spica cast. Prior cases pertaining to post-arthroscopy hip instability have only described operative interventions, such as capsular repair and plication, as effective revision procedures.
Uploads
Papers by Andrew Rosenbaum