To address this deficiency, a senior medical student at our institution designed and moderated sm... more To address this deficiency, a senior medical student at our institution designed and moderated smallgroup interactive discussions with third-year medical students on acute fracture management during their family medicine clerkship. Methods: In these sessions, students learned how to diagnose and comprehensively work up a case of a suspected fracture, how to effectively communicate findings from physical exam and X-ray, and when to appropriately consult a surgeon for treatment. Results: This module was piloted with a total of 14 students in two separate small groups. One hundred percent of students regarded the module as very useful, and there was a 50% improvement in pre-versus posteducational assessment. Discussion: Our experience suggests that students can quickly improve clinical skills for fracture management in a focused smallgroup interactive session. In addition, these sessions can be effectively designed and implemented by senior medical students. This module may be used with either clinical or preclinical students, but we believe that this information would be best received by clinical students on family medicine, emergency medicine, or orthopedic rotations.
Case: A 33-year-old woman with Glanzmann thrombasthenia presented to us with a distal tibia nonun... more Case: A 33-year-old woman with Glanzmann thrombasthenia presented to us with a distal tibia nonunion. We attempted to treat her with a multiplanar ring external fixator, but the patient was unable to tolerate the correction, so we resorted to a tibiotalocalcaneal fusion. Hemostasis was difficult to achieve despite the use of antithrombinolytics, factor VII, and platelet transfusions. Conclusion: Bleeding can be difficult to control in patients with Glanzmann thrombasthenia. However, overaggressive preadministration of antithrombinolytics should be avoided because it may have adverse effects such as acrocyanosis. The presence of thrombasthenia does not seem to affect the success of arthrodesis.
Table 3. Selected review of results of AVM embolization in various clinical situations and region... more Table 3. Selected review of results of AVM embolization in various clinical situations and regions of the body.
Table 3. Selected review of results of AVM embolization in various clinical situations and region... more Table 3. Selected review of results of AVM embolization in various clinical situations and regions of the body.
Background Odontoid process fractures are among the most common in elderly cervical spines. Their... more Background Odontoid process fractures are among the most common in elderly cervical spines. Their treatment often requires fixation, which may include use of implants anteriorly or posteriorly. Bone density can significantly affect the outcomes of these procedures. Currently, little is known about bone mineral density (BMD) distributions within cervical spine in elderly. This study documented BMD distribution across various anatomical regions of elderly cervical vertebrae. Methods and findings Twenty-three human cadaveric C1-C5 spine segments (14 males and 9 female, 74±9.3 y.o.) were imaged via quantitative CT-scan. Using an established experimental protocol, the three-dimensional shapes of the vertebrae were reconstructed from CT images and partitioned in bone regions (4 regions for C1, 14 regions for C2 and 12 regions for C3-5). The BMD was calculated from the Hounsfield units via calibration phantom. For each vertebral level, effects of gender and anatomical bone region on BMD di...
Numerous wingless arthropods as well as diverse vertebrates are capable of mid-air righting. We s... more Numerous wingless arthropods as well as diverse vertebrates are capable of mid-air righting. We studied the biomechanics of the aerial righting reflex in first-instar nymphs of the stick insect Extatosoma tiaratum. After being released upside-down, insects reoriented dorsoventrally and stabilized body posture via active modulation of limb positions and associated aerodynamic torques. We identified specific reflexes for bilaterally asymmetric leg displacements which elicit body rotation and subsequently stabilize mid-air posture. Coordinated appendicular movements thus improve torsional manoeuvrability in the absence of wings, as may have characterized the initial origins of controlled aerial behaviour in arthropods. Design of small aerial or multimodal robotic vehicles may similarly benefit from use of such strategies for flight control.
Wounds : a compendium of clinical research and practice, 2020
OBJECTIVE This case report explores an effective treatment modality in a medically complicated pa... more OBJECTIVE This case report explores an effective treatment modality in a medically complicated patient, with considerable wound dehiscence refractory to treatment with negative pressure wound therapy (NPWT). CASE REPORT A 35-year-old woman with a past medical history of hypothyroidism, osteoporosis, and rheumatoid arthritis treated with tumor necrosis factor (TNF) alpha inhibitors and disease-modifying antirheumatic drugs presented to the clinic following right great toe arthrodesis, metatarsal neck osteotomies, extensor tendon lengthening, and capsulotomy of the second, third, fourth, and fifth toes 2 weeks prior, with wound dehiscence of the right great toe and subsequent exposure of surgical hardware, complicated by infection. At the 2-week postop, a urinary bladder matrix was placed on the wound following failed NPWT, which was in place for 10 days. At the 3-month follow-up, the wound was closed and without any drainage. Patient reported a significant reduction in pain (visual a...
Body rotations during aerial righting of nymphal Extatosoma tiaratum. The insect is represented b... more Body rotations during aerial righting of nymphal Extatosoma tiaratum. The insect is represented by a disc fixed at the insect's COM and parallel with the (x_b, y_b) plane.
Numerous wingless arthropods as well as diverse vertebrates are capable of mid-air righting. We s... more Numerous wingless arthropods as well as diverse vertebrates are capable of mid-air righting. We studied the biomechanics of the aerial righting reflex in first-instar nymphs of the stick insect Extatosoma tiaratum. After being released upside-down, insects reoriented dorsoventrally and stabilized body posture via active modulation of limb positions and associated aerodynamic torques. We identified specific reflexes for bilaterally asymmetric leg displacements which elicit body rotation and subsequently stabilize mid-air posture. Coordinated appendicular movements thus improve torsional manoeuvrability in the absence of wings, as may have characterized the initial origins of controlled aerial behaviour in arthropods. Design of small aerial or multimodal robotic vehicles may similarly benefit from use of such strategies for flight control.
Numerous wingless arthropods as well as diverse vertebrates are capable of mid-air righting. We s... more Numerous wingless arthropods as well as diverse vertebrates are capable of mid-air righting. We studied the biomechanics of the aerial righting reflex in first-instar nymphs of the stick insect Extatosoma tiaratum. After being released upside-down, insects reoriented dorsoventrally and stabilized body posture via active modulation of limb positions and associated aerodynamic torques. We identified specific reflexes for bilaterally asymmetric leg displacements which elicit body rotation and subsequently stabilize mid-air posture. Coordinated appendicular movements thus improve torsional manoeuvrability in the absence of wings, as may have characterized the initial origins of controlled aerial behaviour in arthropods. Design of small aerial or multimodal robotic vehicles may similarly benefit from use of such strategies for flight control.
Background. Intramedullary screw fixation of Jones fractures using partially threaded screws is a... more Background. Intramedullary screw fixation of Jones fractures using partially threaded screws is a common method of fixation for these injuries, but refracture continues to be a problem. Various other fixation strategies, such as headless compression screws, plantar plating, and tension-band wiring. have been developed to mitigate these issues. Biomechanical studies with regard to these other fixation strategies are limited. Herein, we investigate the compression strength and angular stiffness of Jones fractures fixed with Herbert-style headless compression screws. Methods. Jones fractures were created in 10 fresh-frozen pairs of cadaveric fifth metatarsals. A bone from each pair was instrumented with either a conventional, partially threaded screw 5.0 or 6.5 mm in diameter, or a headless compression screw 5.0 or 7.0 mm in diameter. Sizes were determined via sequential tapping until a snug fit was obtained. Each metatarsal was stressed via cantilever bending over 1000 cycles. We moni...
In this case report, we present a unique case of idiopathic peroneal tenosynovitis in an otherwis... more In this case report, we present a unique case of idiopathic peroneal tenosynovitis in an otherwise healthy patient, presenting with a three-month history of pain over the lateral aspect of the right foot. Imaging revealed that fluid distention and synovial thickening distend the common peroneal tendon sheath and peroneus longus and brevis tendon sheaths. The patient was managed operatively with excision of the peroneus longus tendon, a side-to-side tenodesis, and Bröstrom-Gould lateral ankle ligament repair. Histologic examination was suggestive of a chronic inflammatory process possibly due to underlying autoimmune etiology. At three-month follow-up, the patient reported complete resolution of pain and is resuming normal activities without difficulty.
Case: A 33-year-old woman with Glanzmann thrombasthenia presented to us with a distal tibia nonun... more Case: A 33-year-old woman with Glanzmann thrombasthenia presented to us with a distal tibia nonunion. We attempted to treat her with a multiplanar ring external fixator, but the patient was unable to tolerate the correction, so we resorted to a tibiotalocalcaneal fusion. Hemostasis was difficult to achieve despite the use of antithrombinolytics, factor VII, and platelet transfusions. Conclusion: Bleeding can be difficult to control in patients with Glanzmann thrombasthenia. However, overaggressive preadministration of antithrombinolytics should be avoided because it may have adverse effects such as acrocyanosis. The presence of thrombasthenia does not seem to affect the success of arthrodesis.
Category: Ankle, Ankle Arthritis, Arthroscopy, Basic Sciences/Biologics, Bunion, Hindfoot, Lesser... more Category: Ankle, Ankle Arthritis, Arthroscopy, Basic Sciences/Biologics, Bunion, Hindfoot, Lesser Toes, Midfoot/Forefoot, Sports, Trauma Introduction/Purpose: Managing post-operative pain in patients has become a growing concern given the increasing focus on controlling opioid use. Over the counter (OTC) analgesics such as tylenol and ibuprofen have been shown to be useful adjuncts to post-operative pain regimens and may decrease opioid use. However utilization of these adjuncts may be limited by patient education especially if they are not formally prescribed by the physcian. In this work we aim to identify how often post-operative patients utilize OTC analgesics to supplement their pain control and what are the barriers to usage. Methods: All bony foot and ankle procedures performed by a single foot and ankle surgeon were reviewed between the dates of 7/1/2017 - 6/30/2018. Inclusion criteria were age over 18 and not incarcerated. Bony procedures included any osteotomy, fracture fi...
Category: Ankle, Hindfoot, Midfoot/Forefoot Introduction/Purpose: Opioid utilization after foot a... more Category: Ankle, Hindfoot, Midfoot/Forefoot Introduction/Purpose: Opioid utilization after foot and ankle surgery has received more attention recently with several papers publishing guidelines on the number of opioids to prescribe following surgery. To our knowledge the patient populations that have been studied in all of these papers are all private payer mixes, with a low amount of indigent patients. Social factors often have a large influence over surgical outcomes and therefore we aimed to see if this held true for post-operative opioid utilization as well. In this study we investigated differences in opioid utilization among patients with either Medicaid, Medicare or commercial insurance. Methods: All bony foot and ankle procedures performed by a single foot and ankle surgeon were reviewed between the dates of 7/1/2017 - 6/30/2018. Inclusion criteria were age over 18, did not have a history of chronic pain, and not incarcerated. Bony procedures included any osteotomy, fracture ...
Category: Midfoot/Forefoot Introduction/Purpose: Open reduction and internal fixation with transa... more Category: Midfoot/Forefoot Introduction/Purpose: Open reduction and internal fixation with transarticular screws to stabilize Lisfranc injuries may increase the risk of arthritis or affect outcomes. Extra-articular or bridge plating to stabilize these injuries avoids this articular damage. This study analyzes the functional outcomes and complications in patients who underwent this type of joint preserving fixation for Lisfranc injuries. Methods: A retrospective review of all patients treated for a Lisfranc injury at a level 1 trauma center from July 2008 to October 2015 was conducted. Patients over 18 years of age who were not incarcerated and did not have any concomitant procedures in the lower extremities were included. Patient electronic medical records were reviewed. Outcomes were analyzed with AOFAS scores. Results: There were 16 patients included in the study with an average follow up time of 57 months (15 - 102 months). Average AOFAS score was 79 (SD 16) and time to return to...
Numerous wingless arthropods as well as diverse vertebrates are capable of mid-air righting. We s... more Numerous wingless arthropods as well as diverse vertebrates are capable of mid-air righting. We studied the biomechanics of the aerial righting reflex in first-instar nymphs of the stick insectExtatosoma tiaratum. After being released upside-down, insects reoriented dorsoventrally and stabilized body posture via active modulation of limb positions and associated aerodynamic torques. We identified specific reflexes for bilaterally asymmetric leg displacements which elicit body rotation and subsequently stabilize mid-air posture. Coordinated appendicular movements thus improve torsional manoeuvrability in the absence of wings, as may have characterized the initial origins of controlled aerial behaviour in arthropods. Design of small aerial or multimodal robotic vehicles may similarly benefit from use of such strategies for flight control.
To address this deficiency, a senior medical student at our institution designed and moderated sm... more To address this deficiency, a senior medical student at our institution designed and moderated smallgroup interactive discussions with third-year medical students on acute fracture management during their family medicine clerkship. Methods: In these sessions, students learned how to diagnose and comprehensively work up a case of a suspected fracture, how to effectively communicate findings from physical exam and X-ray, and when to appropriately consult a surgeon for treatment. Results: This module was piloted with a total of 14 students in two separate small groups. One hundred percent of students regarded the module as very useful, and there was a 50% improvement in pre-versus posteducational assessment. Discussion: Our experience suggests that students can quickly improve clinical skills for fracture management in a focused smallgroup interactive session. In addition, these sessions can be effectively designed and implemented by senior medical students. This module may be used with either clinical or preclinical students, but we believe that this information would be best received by clinical students on family medicine, emergency medicine, or orthopedic rotations.
Case: A 33-year-old woman with Glanzmann thrombasthenia presented to us with a distal tibia nonun... more Case: A 33-year-old woman with Glanzmann thrombasthenia presented to us with a distal tibia nonunion. We attempted to treat her with a multiplanar ring external fixator, but the patient was unable to tolerate the correction, so we resorted to a tibiotalocalcaneal fusion. Hemostasis was difficult to achieve despite the use of antithrombinolytics, factor VII, and platelet transfusions. Conclusion: Bleeding can be difficult to control in patients with Glanzmann thrombasthenia. However, overaggressive preadministration of antithrombinolytics should be avoided because it may have adverse effects such as acrocyanosis. The presence of thrombasthenia does not seem to affect the success of arthrodesis.
Table 3. Selected review of results of AVM embolization in various clinical situations and region... more Table 3. Selected review of results of AVM embolization in various clinical situations and regions of the body.
Table 3. Selected review of results of AVM embolization in various clinical situations and region... more Table 3. Selected review of results of AVM embolization in various clinical situations and regions of the body.
Background Odontoid process fractures are among the most common in elderly cervical spines. Their... more Background Odontoid process fractures are among the most common in elderly cervical spines. Their treatment often requires fixation, which may include use of implants anteriorly or posteriorly. Bone density can significantly affect the outcomes of these procedures. Currently, little is known about bone mineral density (BMD) distributions within cervical spine in elderly. This study documented BMD distribution across various anatomical regions of elderly cervical vertebrae. Methods and findings Twenty-three human cadaveric C1-C5 spine segments (14 males and 9 female, 74±9.3 y.o.) were imaged via quantitative CT-scan. Using an established experimental protocol, the three-dimensional shapes of the vertebrae were reconstructed from CT images and partitioned in bone regions (4 regions for C1, 14 regions for C2 and 12 regions for C3-5). The BMD was calculated from the Hounsfield units via calibration phantom. For each vertebral level, effects of gender and anatomical bone region on BMD di...
Numerous wingless arthropods as well as diverse vertebrates are capable of mid-air righting. We s... more Numerous wingless arthropods as well as diverse vertebrates are capable of mid-air righting. We studied the biomechanics of the aerial righting reflex in first-instar nymphs of the stick insect Extatosoma tiaratum. After being released upside-down, insects reoriented dorsoventrally and stabilized body posture via active modulation of limb positions and associated aerodynamic torques. We identified specific reflexes for bilaterally asymmetric leg displacements which elicit body rotation and subsequently stabilize mid-air posture. Coordinated appendicular movements thus improve torsional manoeuvrability in the absence of wings, as may have characterized the initial origins of controlled aerial behaviour in arthropods. Design of small aerial or multimodal robotic vehicles may similarly benefit from use of such strategies for flight control.
Wounds : a compendium of clinical research and practice, 2020
OBJECTIVE This case report explores an effective treatment modality in a medically complicated pa... more OBJECTIVE This case report explores an effective treatment modality in a medically complicated patient, with considerable wound dehiscence refractory to treatment with negative pressure wound therapy (NPWT). CASE REPORT A 35-year-old woman with a past medical history of hypothyroidism, osteoporosis, and rheumatoid arthritis treated with tumor necrosis factor (TNF) alpha inhibitors and disease-modifying antirheumatic drugs presented to the clinic following right great toe arthrodesis, metatarsal neck osteotomies, extensor tendon lengthening, and capsulotomy of the second, third, fourth, and fifth toes 2 weeks prior, with wound dehiscence of the right great toe and subsequent exposure of surgical hardware, complicated by infection. At the 2-week postop, a urinary bladder matrix was placed on the wound following failed NPWT, which was in place for 10 days. At the 3-month follow-up, the wound was closed and without any drainage. Patient reported a significant reduction in pain (visual a...
Body rotations during aerial righting of nymphal Extatosoma tiaratum. The insect is represented b... more Body rotations during aerial righting of nymphal Extatosoma tiaratum. The insect is represented by a disc fixed at the insect's COM and parallel with the (x_b, y_b) plane.
Numerous wingless arthropods as well as diverse vertebrates are capable of mid-air righting. We s... more Numerous wingless arthropods as well as diverse vertebrates are capable of mid-air righting. We studied the biomechanics of the aerial righting reflex in first-instar nymphs of the stick insect Extatosoma tiaratum. After being released upside-down, insects reoriented dorsoventrally and stabilized body posture via active modulation of limb positions and associated aerodynamic torques. We identified specific reflexes for bilaterally asymmetric leg displacements which elicit body rotation and subsequently stabilize mid-air posture. Coordinated appendicular movements thus improve torsional manoeuvrability in the absence of wings, as may have characterized the initial origins of controlled aerial behaviour in arthropods. Design of small aerial or multimodal robotic vehicles may similarly benefit from use of such strategies for flight control.
Numerous wingless arthropods as well as diverse vertebrates are capable of mid-air righting. We s... more Numerous wingless arthropods as well as diverse vertebrates are capable of mid-air righting. We studied the biomechanics of the aerial righting reflex in first-instar nymphs of the stick insect Extatosoma tiaratum. After being released upside-down, insects reoriented dorsoventrally and stabilized body posture via active modulation of limb positions and associated aerodynamic torques. We identified specific reflexes for bilaterally asymmetric leg displacements which elicit body rotation and subsequently stabilize mid-air posture. Coordinated appendicular movements thus improve torsional manoeuvrability in the absence of wings, as may have characterized the initial origins of controlled aerial behaviour in arthropods. Design of small aerial or multimodal robotic vehicles may similarly benefit from use of such strategies for flight control.
Background. Intramedullary screw fixation of Jones fractures using partially threaded screws is a... more Background. Intramedullary screw fixation of Jones fractures using partially threaded screws is a common method of fixation for these injuries, but refracture continues to be a problem. Various other fixation strategies, such as headless compression screws, plantar plating, and tension-band wiring. have been developed to mitigate these issues. Biomechanical studies with regard to these other fixation strategies are limited. Herein, we investigate the compression strength and angular stiffness of Jones fractures fixed with Herbert-style headless compression screws. Methods. Jones fractures were created in 10 fresh-frozen pairs of cadaveric fifth metatarsals. A bone from each pair was instrumented with either a conventional, partially threaded screw 5.0 or 6.5 mm in diameter, or a headless compression screw 5.0 or 7.0 mm in diameter. Sizes were determined via sequential tapping until a snug fit was obtained. Each metatarsal was stressed via cantilever bending over 1000 cycles. We moni...
In this case report, we present a unique case of idiopathic peroneal tenosynovitis in an otherwis... more In this case report, we present a unique case of idiopathic peroneal tenosynovitis in an otherwise healthy patient, presenting with a three-month history of pain over the lateral aspect of the right foot. Imaging revealed that fluid distention and synovial thickening distend the common peroneal tendon sheath and peroneus longus and brevis tendon sheaths. The patient was managed operatively with excision of the peroneus longus tendon, a side-to-side tenodesis, and Bröstrom-Gould lateral ankle ligament repair. Histologic examination was suggestive of a chronic inflammatory process possibly due to underlying autoimmune etiology. At three-month follow-up, the patient reported complete resolution of pain and is resuming normal activities without difficulty.
Case: A 33-year-old woman with Glanzmann thrombasthenia presented to us with a distal tibia nonun... more Case: A 33-year-old woman with Glanzmann thrombasthenia presented to us with a distal tibia nonunion. We attempted to treat her with a multiplanar ring external fixator, but the patient was unable to tolerate the correction, so we resorted to a tibiotalocalcaneal fusion. Hemostasis was difficult to achieve despite the use of antithrombinolytics, factor VII, and platelet transfusions. Conclusion: Bleeding can be difficult to control in patients with Glanzmann thrombasthenia. However, overaggressive preadministration of antithrombinolytics should be avoided because it may have adverse effects such as acrocyanosis. The presence of thrombasthenia does not seem to affect the success of arthrodesis.
Category: Ankle, Ankle Arthritis, Arthroscopy, Basic Sciences/Biologics, Bunion, Hindfoot, Lesser... more Category: Ankle, Ankle Arthritis, Arthroscopy, Basic Sciences/Biologics, Bunion, Hindfoot, Lesser Toes, Midfoot/Forefoot, Sports, Trauma Introduction/Purpose: Managing post-operative pain in patients has become a growing concern given the increasing focus on controlling opioid use. Over the counter (OTC) analgesics such as tylenol and ibuprofen have been shown to be useful adjuncts to post-operative pain regimens and may decrease opioid use. However utilization of these adjuncts may be limited by patient education especially if they are not formally prescribed by the physcian. In this work we aim to identify how often post-operative patients utilize OTC analgesics to supplement their pain control and what are the barriers to usage. Methods: All bony foot and ankle procedures performed by a single foot and ankle surgeon were reviewed between the dates of 7/1/2017 - 6/30/2018. Inclusion criteria were age over 18 and not incarcerated. Bony procedures included any osteotomy, fracture fi...
Category: Ankle, Hindfoot, Midfoot/Forefoot Introduction/Purpose: Opioid utilization after foot a... more Category: Ankle, Hindfoot, Midfoot/Forefoot Introduction/Purpose: Opioid utilization after foot and ankle surgery has received more attention recently with several papers publishing guidelines on the number of opioids to prescribe following surgery. To our knowledge the patient populations that have been studied in all of these papers are all private payer mixes, with a low amount of indigent patients. Social factors often have a large influence over surgical outcomes and therefore we aimed to see if this held true for post-operative opioid utilization as well. In this study we investigated differences in opioid utilization among patients with either Medicaid, Medicare or commercial insurance. Methods: All bony foot and ankle procedures performed by a single foot and ankle surgeon were reviewed between the dates of 7/1/2017 - 6/30/2018. Inclusion criteria were age over 18, did not have a history of chronic pain, and not incarcerated. Bony procedures included any osteotomy, fracture ...
Category: Midfoot/Forefoot Introduction/Purpose: Open reduction and internal fixation with transa... more Category: Midfoot/Forefoot Introduction/Purpose: Open reduction and internal fixation with transarticular screws to stabilize Lisfranc injuries may increase the risk of arthritis or affect outcomes. Extra-articular or bridge plating to stabilize these injuries avoids this articular damage. This study analyzes the functional outcomes and complications in patients who underwent this type of joint preserving fixation for Lisfranc injuries. Methods: A retrospective review of all patients treated for a Lisfranc injury at a level 1 trauma center from July 2008 to October 2015 was conducted. Patients over 18 years of age who were not incarcerated and did not have any concomitant procedures in the lower extremities were included. Patient electronic medical records were reviewed. Outcomes were analyzed with AOFAS scores. Results: There were 16 patients included in the study with an average follow up time of 57 months (15 - 102 months). Average AOFAS score was 79 (SD 16) and time to return to...
Numerous wingless arthropods as well as diverse vertebrates are capable of mid-air righting. We s... more Numerous wingless arthropods as well as diverse vertebrates are capable of mid-air righting. We studied the biomechanics of the aerial righting reflex in first-instar nymphs of the stick insectExtatosoma tiaratum. After being released upside-down, insects reoriented dorsoventrally and stabilized body posture via active modulation of limb positions and associated aerodynamic torques. We identified specific reflexes for bilaterally asymmetric leg displacements which elicit body rotation and subsequently stabilize mid-air posture. Coordinated appendicular movements thus improve torsional manoeuvrability in the absence of wings, as may have characterized the initial origins of controlled aerial behaviour in arthropods. Design of small aerial or multimodal robotic vehicles may similarly benefit from use of such strategies for flight control.
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Papers by Kenrick Lam