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Nhan DT, Gong DC, Khoo KJ, Whitson AJ, Matsen FA, Hsu JE. Culturing explants for Cutibacterium at revision shoulder arthroplasty: an analysis of explant and tissue samples at corresponding anatomic sites. J Shoulder Elbow Surg 2022; 31:2017-2022. [PMID: 35447317 DOI: 10.1016/j.jse.2022.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Revised: 02/22/2022] [Accepted: 03/06/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Culturing of deep tissues obtained at revision arthroplasty for Cutibacterium is a key component of diagnosing a periprosthetic infection. The value of culturing explanted components has not been well described. This study sought to answer the following questions: (1) How does the culture positivity of explant cultures compare with that of deep tissue cultures? (2) How often are explant cultures positive when tissue cultures are not, and vice versa? (3) How does the bacterial density in explant cultures compare with that in tissue cultures? METHODS A total of 106 anatomic arthroplasties revised over a 7-year period were included. Explant (humeral head, humeral stem, and glenoid) and tissue (collar membrane, humeral canal tissue, and periglenoid tissue) specimens were sent for semiquantitative Cutibacterium culture. We compared culture positivity and bacterial density when cultures of an explant and tissue adjacent to the implant were both available. RESULTS Explants had positive cultures at a higher rate than adjacent tissue specimens for most anatomic sites. Of the shoulders that had Cutibacterium growth, a higher proportion of explants were culture positive when tissue samples were negative (23%-43%) than vice versa (0%-21%). The Cutibacterium density was higher in explants than in tissues. Considering only the results of tissue samples, 16% of the shoulders met our threshold for infection treatment (≥2 positive cultures); however, with the inclusion of the results for explant cultures, additional 14% of cases-a total of 30%-met the criteria for infection treatment. CONCLUSIONS In this group of patients, culturing explants in addition to tissue cultures increased the sensitivity for detecting Cutibacterium in revision shoulder arthroplasty.
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Affiliation(s)
- Derek T Nhan
- Department of Orthopaedics and Sports Medicine, University of Washington Medical Center, Seattle, WA, USA
| | - Davin C Gong
- Department of Orthopaedics and Sports Medicine, University of Washington Medical Center, Seattle, WA, USA
| | - Kevin J Khoo
- Department of Orthopaedics and Sports Medicine, University of Washington Medical Center, Seattle, WA, USA
| | - Anastasia J Whitson
- Department of Orthopaedics and Sports Medicine, University of Washington Medical Center, Seattle, WA, USA
| | - Frederick A Matsen
- Department of Orthopaedics and Sports Medicine, University of Washington Medical Center, Seattle, WA, USA
| | - Jason E Hsu
- Department of Orthopaedics and Sports Medicine, University of Washington Medical Center, Seattle, WA, USA.
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Ikwuezunma IA, Suresh KV, Nhan DT, Bryant BR, Kotian RN, Lee RJ. Patient-reported outcomes after operative versus nonoperative treatment of pediatric lateral humeral condyle fractures. Medicine (Baltimore) 2021; 100:e27440. [PMID: 34731118 PMCID: PMC8519235 DOI: 10.1097/md.0000000000027440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 09/19/2021] [Indexed: 01/05/2023] Open
Abstract
Lateral humeral condyle fractures in children are treated with several approaches, yet it is unclear which has the best treatment outcomes. We hypothesized that functional outcomes would be equivalent between treatment types, reduction approaches, and fixation types. Our purpose was to assess patient-reported outcomes and complications by treatment type (operative versus nonoperative), reduction approach (open versus percutaneous), and fixation type (cannulated screws versus Kirschner wires).We retrospectively reviewed data from acute lateral humeral condyle fractures treated at our level-1 pediatric trauma center from 2008 to 2017. Patients were included if they were 8 years or older and had completed clinical follow-up. Fractures were categorized by fracture severity as mild (<2-mm displacement), moderate (isolated, 2- to 5-mm displacement), or severe (isolated, >5-mm displacement or >2-mm displacement with concomitant elbow dislocation or other elbow fracture). We extracted data on patient age, sex, treatment type, reduction approach, fixation type, patient-reported outcomes (shortened Disabilities of the Arm, Shoulder, and Hand and Patient Reported Outcome Measurement Information System upper extremity), treatment complications, and follow-up duration. Patients in the operative versus nonoperative group and across fracture severity subgroups did not differ significantly by age, sex, or follow-up duration. Bivariate analysis was performed to determine whether outcomes differed by intervention. Alpha = 0.05.No differences were observed in patient-reported outcomes between operative versus nonoperative groups for the mild and severe fracture subgroups. No differences were observed between approach (open versus percutaneous) or instrumentation (cannulated screw versus Kirschner wire fixation) for any outcome measure within the operative group. Patients whose fractures were stabilized with screws versus wires had significantly higher rates of return to the operating room (94% versus 8.3%, P < .001). The overall complication rate for our cohort was low, with no differences by treatment type or fracture severity.In our cohort, patient-reported outcomes were similar across fracture severity categories, irrespective of treatment or fixation type. Patients who underwent internal fixation with cannulated screws experienced significantly higher rates of return to the operating room compared with those treated with Kirschner wires but otherwise had similar complication rates and patient-reported outcomes.Level of Evidence: 3.
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Abstract
Childhood obesity is a growing epidemic in the United States, and is associated with an increased risk of lower-extremity physeal fractures, and fractures requiring operative intervention. However, no study has assessed the risk upper extremity physeal fractures among overweight children. Our purpose was to compare the following upper-extremity fracture characteristics in overweight and obese children with those of normal-weight/underweight children (herein, "normal weight"): mechanism of injury, anatomical location, fracture pattern, physeal involvement, and treatment types. We hypothesized that overweight and obese children would be higher risk for physeal and complete fractures with low-energy mechanisms and would therefore more frequently require operative intervention compared with normal-weight children.We performed a cross-sectional review of our database of 608 patients aged 2 to 16 years, and included patients who sustained isolated upper-extremity fractures at our level-1 pediatric tertiary care center from January 2014 to August 2017. Excluded were patients who sustained pathologic fractures and those without basic demographic or radiologic information. Using body mass index percentile for age and sex, we categorized patients as obese (≥95th percentile), overweight (85th to <95th percentile), normal weight (5th to <85th percentile), or underweight (<5th percentile). The obese and overweight groups were analyzed both separately and as a combined overweight/obese group. Demographic data included age, sex, height, and weight. Fractures were classified based on fracture location, fracture pattern (transverse, comminuted, buckle, greenstick, avulsion, or oblique), physeal involvement, and treatment type. Of the 608 patients, 58% were normal weight, 23% were overweight, and 19% were obese. There were no differences in the mean ages or sex distributions among the 3 groups.Among patients with low-energy mechanisms of injury, overweight/obese patients had significantly greater proportions of complete fractures compared with normal-weight children (complete: 65% vs 55%, P = .001; transverse: 43% vs 27%, P = .006). In addition, the overweight/obese group sustained significantly more upper-extremity physeal fractures (37%) than did the normal-weight group (23%) (P = .007).Compared with those in normal-weight children, upper-extremity fracture patterns differ in overweight and obese children, who have higher risk of physeal injuries and complete fractures caused by low-energy mechanisms.Level of Evidence: Level III, retrospective comparative study.
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Affiliation(s)
| | | | - R. Jay Lee
- The Johns Hopkins University, Baltimore, MD
- Department of Orthopedic Surgery, University of Washington, Seattle, WA
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Nhan DT, Belkoff SM, Singh P, Sullivan BT, Klyce W, Lee RJ. Using the Remnant Anterior Cruciate Ligament to Improve Knee Stability: Biomechanical Analysis Using a Cadaveric Model. Orthop J Sports Med 2021; 9:2325967121996487. [PMID: 33889647 PMCID: PMC8033398 DOI: 10.1177/2325967121996487] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 12/14/2020] [Indexed: 11/17/2022] Open
Abstract
Background: Injured anterior cruciate ligament (ACL) tissue retains proprioceptive nerve
fibers, vascularity, and biomechanical properties. For these reasons,
remnant ACL tissue is often preserved during the treatment of ACL
injuries. Purpose: To assess through a cadaveric model whether reorienting and retensioning the
residual ACL via an osteotomy improves knee stability after partial ACL
tear, with substantial remnant tissue and intact femoral and tibial
attachments. Study Design: Controlled laboratory study. Methods: In 8 adult cadaveric knees, we measured anterior tibial translation and
rotational laxity at 30° and 90° of flexion with the ACL in its native state
and in 3 conditions: partial tear, retensioned, and ACL-deficient. The
partial-tear state consisted of a sectioned anteromedial ACL bundle. Results: In the native state, the translation was 10 ± 2.7 mm (mean ± SD) at 30° of
flexion and 8.4 ± 3.6 mm at 90° of flexion. Anterior translation of the
knees in the partial-tear state (14 ± 2.7 mm at 30° and 12 ± 2.7 mm at 90°)
was significantly greater than baseline (P < .001 for
both). Translation in the ACL-retensioned state (9.2 ± 1.7 mm at 30° and 7.2
± 2.1 mm at 90°) was significantly less than in the ACL-deficient state
(P < .001 for both), and translation was not
significantly different from that of the intact state. For ACL-deficient
knees, translation (20 ± 4.3 mm at 30° and 16 ± 4.4 mm at 90°) was
significantly greater than all other states (P < .001
for all). Although rotational testing demonstrated the least laxity at 30°
and 90° of flexion in the retensioned and intact states and the most laxity
in the ACL-deficient state, rotation was not significantly different among
any of the experimental states. Conclusion: In a cadaveric model of an incomplete ACL tear, a reorienting and
retensioning core osteotomy at the tibial insertion of the remnant ACL
improved anteroposterior translation of the knee without compromising its
rotational laxity. Clinical Relevance: The findings of this study support the concept of ACL tissue reorienting and
retensioning in the treatment of ACL laxity as an area for future
investigation.
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Affiliation(s)
- Derek T Nhan
- Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Stephen M Belkoff
- Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Prerna Singh
- Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Brian T Sullivan
- Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Walter Klyce
- Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - R Jay Lee
- Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Nhan DT, Woodhead BM, Gilotra MN, Matsen FA, Hsu JE. Efficacy of Home Prophylactic Benzoyl Peroxide and Chlorhexidine in Shoulder Surgery: A Systematic Review and Meta-Analysis. JBJS Rev 2020; 8:e2000023. [PMID: 32796196 DOI: 10.2106/jbjs.rvw.20.00023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Two predominant prophylactic home skin-disinfection regimens exist in shoulder surgery, benzoyl peroxide and chlorhexidine. Of these 2 regimens, benzoyl peroxide gel is more effective than chlorhexidine in reducing the rate of positive Cutibacterium cultures on the skin surface. At present, there are no studies that assess the impact of these home prophylactic measures on clinical infection rates.
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Affiliation(s)
- Derek T Nhan
- Department of Orthopaedic Surgery and Sports Medicine, University of Washington, Seattle, Washington
| | | | - Mohit N Gilotra
- Department of Orthopaedics, University of Maryland, Baltimore, Maryland
| | - Frederick A Matsen
- Department of Orthopaedic Surgery and Sports Medicine, University of Washington, Seattle, Washington
| | - Jason E Hsu
- Department of Orthopaedic Surgery and Sports Medicine, University of Washington, Seattle, Washington
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Klyce W, Nhan DT, Dunham AM, El Dafrawy MH, Shannon C, LaPorte DM. The Times, They Are A-Changing: Women Entering Academic Orthopedics Today Are Choosing Nonpediatric Fellowships at a Growing Rate. J Surg Educ 2020; 77:564-571. [PMID: 31932218 DOI: 10.1016/j.jsurg.2019.12.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 09/13/2019] [Accepted: 12/11/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE Pediatrics and hand surgery have historically been the orthopaedic subspecialties with the highest female representations. We sought to identify the gender distribution of orthopedic surgical faculty by subspecialty, geography, and educational background. We hypothesized that the proportion of women entering pediatric orthopaedics has decreased since 1980. DESIGN The Accreditation Council for Graduate Medical Education was used to generate a list of U.S. orthopedic residencies. Program websites were used to collect data regarding each faculty member's gender, residencies, fellowships, and graduation year. t tests were used to compare quantitative data and Fisher's exact tests to compare categorical data. Significance was defined as p < 0.05. SETTING Publicly available data from official websites of U.S. orthopedic residencies. PARTICIPANTS Of 153 residencies, 142 (93%) had accessible faculty lists. RESULTS Of 3596 orthopedic surgeons, 7.9% were women. Among fellowship-trained faculty, 22% of pediatric orthopedists were women compared with 7.6% of faculty in other orthopedic subspecialties (p < 0.00001). There was a significantly higher percentage of female faculty in the West (13%) than in any other U.S. census region (p < 0.001 vs. Midwest, vs. South, and vs. Northeast). A strong correlation with time was found in number of women completing fellowships other than hand or pediatrics from 1980 to 2014 (R2 = 0.95); a strong inverse correlation with time was found for pediatrics as a percentage of fellowships completed by women during the same period (R2 = 0.94). CONCLUSIONS Although pediatrics remains the most popular fellowship for female orthopedists, women who enter academic orthopedics are increasingly choosing nonpediatric subspecialties.
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Affiliation(s)
- Walter Klyce
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, Maryland
| | - Derek T Nhan
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, Maryland
| | - Alexandra M Dunham
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, Maryland
| | - Mostafa H El Dafrawy
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, Maryland
| | - Claire Shannon
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, Maryland
| | - Dawn M LaPorte
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, Maryland.
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Cleveland AW, Nhan DT, Akiyama M, Kleck CJ, Noshchenko A, Patel VV. Mini-open sacroiliac joint fusion with direct bone grafting and minimally invasive fixation using intraoperative navigation. J Spine Surg 2019; 5:31-37. [PMID: 31032436 DOI: 10.21037/jss.2019.01.04] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Background Describe a novel technique for sacroiliac arthrodesis using intraoperative navigation, direct bone grafting, and minimally invasive implants. Report on the outcomes of the first cohort of these patients. Methods Institutional review board (IRB) approved, single center, two surgeon, retrospective study. Results All patients were 18 years or older, primary sacroiliac fusions, and underwent novel technique described. Fifty patients underwent 57 surgeries. Twelve male/38 female patients. All received three sacroiliac implants. Average blood loss 42.8 mL. Average length of stay 1.9 nights. Average follow-up 13.96±13 months. Statistically significant improvements in Visual Analogue Scale (VAS) scores (<0.001) for all time periods 6 weeks, 3 months, 6 months, 12 months compared to preop. Other outcomes scores [Oswestry Disability Index (ODI), and Denver Sacroiliac Joint Questionnaire (DSIJQ)] also showed a general trend for clinical improvement at all postoperative time periods. Of 2/57 (3.5%) complications were identified. No patients required surgical revision within the study window. Conclusions Limited open sacroiliac arthrodesis using minimally invasive implants, intraoperative navigation, and direct open bone grafting is safe and demonstrates clinical benefit, similar to other techniques for minimally invasive sacroiliac arthrodesis. There is potential for improved long-term outcomes from increased union rates. Keywords Sacroiliac dysfunction; minimally invasive sacroiliac fusion; open sacroiliac fusion; navigation.
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Affiliation(s)
| | - Derek T Nhan
- Department of Orthopedics, University of Colorado, Aurora, CO, USA
| | - Michelle Akiyama
- Department of Orthopedics, University of Colorado, Aurora, CO, USA
| | | | | | - Vikas V Patel
- Department of Orthopedics, University of Colorado, Aurora, CO, USA
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Abstract
Background Bladder exstrophy is a congenital condition that affects the genitourinary and musculoskeletal systems, and less commonly affects the intestinal system, with cloacal exstrophy. This condition results from abnormal migration of the mesenchyme, between the endoderm and ectoderm, leading to anterior rupture of the cloacal membrane. Numerous osseous morphologic changes are observed in bladder exstrophy. Rotational anomalies include external rotation of the posterior part of the pelvis and iliac wings, on average 12°, and acetabular retroversion1-3. Although various osteotomy types have been described for initial bladder exstrophy closure, the anterior approach has demonstrated positive outcomes in improving daytime continence, gait, and correction of the diastasis4. Thus, the anterior iliac osteotomy provides an effective method to help close the pelvic ring and decrease stress on the anterior abdominal wall during exstrophy closure. In addition, this technique promotes continence by reconfiguring, and thereby restoring, the fibrous symphyseal bar and pelvic floor musculature5. Description The steps of the procedure include (1) preoperative planning, (2) patient positioning, (3) incision, (4) identification of the lateral femoral cutaneous nerve, (5) subperiosteal dissection of the iliac wing, (6) guide pin placement and anterior osteotomy, (7) posterior hinge osteotomy (for cloacal exstrophy and for patients ≥2 years old), (8) external fixator pin placement, (9) anterior internal fixation of the pubic symphysis (for cloacal exstrophy and for patients ≥2 years old), and (10) resumption of the urologic procedure followed by wound closure and application of external fixator. Alternatives Numerous previous techniques for osteotomies in bladder exstrophy have been developed, starting with Shultz in 1958, who recognized the importance of bringing the pubic bones together for gait correction in exstrophy repair6. O'Phelan was the first, to our knowledge, to document outcomes of this bilateral posterior osteotomy technique to reduce tension from the externally rotated iliac bones and widened pubic symphysis in a 2-stage bladder exstrophy closure7. Other approaches have included an oblique iliac wing osteotomy and pubic ramotomy, described by Frey and Cohen in 19898. However, the latter approach inadequately restores the pelvic osseous relations except in female newborns who would have a small diastasis after manual rotation of the pelvis. Rationale This procedure has several advantages over the prior conventional posterior approach. These include better approximation and improved mobility of the pubic rami at the time of closure, prevention of vertical migration of the hemipelvis, direct visual placement of an external fixator and adjustment postoperatively, and no requirement for turning the patient during the operation. In addition, this procedure allows for adjunctive posterior osteotomy from the anterior approach to provide adequate closure in those with cloacal exstrophy, prior failed closure, or extreme diastasis of >6 cm9.
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Abstract
BACKGROUND The Pediatric Orthopaedic Society of North America (POSNA) funds grants to improve pediatric musculoskeletal care and maximize new knowledge through publications, presentations, and further funding. We assessed the productivity of POSNA grants by number and rate of grant-specific publications, citations, and extramural funding; determined whether project type or completion status was associated with extramural funding; and compared the success of POSNA-funded versus all other podium presentations by publication rate and POSNA awards. METHODS We reviewed final reports for all 85 POSNA grants from 2003 to 2014. To determine grant productivity, we assessed the publication, presentation, and extramural funding rates, and the percentage of grants that achieved at least 1 scholarly output (publication or presentation). Citation counts were determined within 3 years after publication. RESULTS Overall, each grant achieved ~1.53 publications and 15.4 citations. Thirty-three percent secured extramural funding. However, 25% of grants could not be tracked to a scholarly product. Projects that reached completion and were of the basic science type (compared with clinical) were more likely to receive extramural funding. Compared with all other podiums, a greater proportion of POSNA-funded presentations led to a publication (64% vs. 48%, respectively; P=0.02) and were more likely to receive a POSNA award. Approximately 52% of funded projects were not presented at POSNA meetings. CONCLUSIONS Although most POSNA-funded projects led to scholarly output, 25% of them produced no publications or podium presentations. POSNA-funded projects were more likely to lead to a publication and to have a higher chance of winning a POSNA award compared with all other projects. The POSNA grant process is effective at identifying impactful research, but continued process improvement, such as a prospectively maintained database of grant recipient productivity and improved tracking of grant submission histories, are both in development as the first steps to improve accountability of grant recipients in translating their projects to scholarly products.
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Affiliation(s)
- Derek T Nhan
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD
| | | | - A Noelle Larson
- Department of Orthopaedic Surgery, Mayo Clinic, Rochester, MN
| | - Paul D Sponseller
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD
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Tang X, Lu Y, Pang M, Nhan DT, Klyce W, Fritz J, Lee RJ. An Abbreviated Scale for the Assessment of Skeletal Bone Age Using Radiographs of the Knee. Orthopedics 2018; 41:e676-e680. [PMID: 30052264 DOI: 10.3928/01477447-20180724-03] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Accepted: 04/23/2018] [Indexed: 02/03/2023]
Abstract
Hand and wrist radiographs are the most common means for estimating skeletal bone age. There is no widely used scale for estimating skeletal bone age using knee radiographs. Do skeletal bone age estimates from knee-maturity scales correlate sufficiently with both chronologic age and estimates from a hand-wrist scale to potentially substitute for estimates from the latter? The authors reviewed the records of 503 patients 6 to 19 years old who had hand and knee radiographs obtained within 30 days of each other. They analyzed radiographs using the O'Connor knee scale (based on 10 maturation markers) and a new, abbreviated version of the O'Connor scale (based on 7 markers). The authors also analyzed radiographs of the hands of boys 12.5 to 16 years old and girls 10 to 16 years old using the shorthand method. Multivariate linear regression was used for analysis. Inter- and intrarater reliabilities were assessed. Skeletal bone age derived from the O'Connor and abbreviated knee scales correlated with chronologic age (adjusted R2=0.88 and 0.90, respectively). Compared with estimates from the hand-wrist scale, estimates were lower by a mean of 0.91 years for boys and 0.38 years for girls when using the O'Connor scale and 0.96 years for boys and 0.52 years for girls when using the abbreviated scale. Inter- and intrarater reliabilities were very good (κ=0.82 and 0.90, respectively) and were substantial at each bony landmark measured. Knee radiographs can be used to estimate skeletal bone age using an abbreviated knee scale. [Orthopedics. 2018; 41(5):e676-e680.].
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Abstract
Background Racquet sports have increased in popularity over the past decade. Although research is available regarding the epidemiological characteristics of tennis injuries, little is known about the frequency and characteristics of injuries in other racquet sports. Hypothesis Given the increase in all racquet sport participation in the United States (US), it is hypothesized that injuries have accordingly become more frequent. Study Design Descriptive epidemiology study. Methods Using the National Electronic Injury Surveillance System database, we reviewed the numbers of badminton and squash/racquetball injuries presenting to a representative sample of US emergency departments (EDs). We used weighted estimates to extrapolate the data to the US population. Incidence estimates were compared with national participation data and stratified. Results A total of 4330 injuries were reported, representing an estimated 173,000 injuries presenting to US EDs from 1997 through 2016. Despite the increase in the number of players from 2006 through 2016, the annual injury rate for squash/racquetball declined significantly, including the rates for each body region assessed. No similar trend was found for badminton injuries. Within our extrapolated ED cohort, the lower extremities were the most common body region injured (37%). Strains/sprains were the most common injury type in the trunk (73%), lower extremities (65%), and upper extremities (32%), whereas lacerations were most common in the head/neck (49%). In badminton, the youngest players (age range, 5-18 years) sustained twice as many fractures (relative risk [RR], 1.96; 95% CI, 1.14-3.38) and almost 3 times as many lacerations as patients in any other age group. Similarly, the youngest squash/racquetball players were at highest risk for lacerations (RR, 1.45; 95% CI, 1.22-1.73) and head and neck injuries (RR, 1.52; 95% CI, 1.26-1.83). Conclusion Although declines in rates of squash/racquetball injuries were observed, the increasing popularity of badminton, squash, and racquetball necessitates further preventive measures to improve player safety, with an emphasis on the youngest players.
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Affiliation(s)
- Derek T Nhan
- Division of Pediatric Orthopaedic Surgery, Johns Hopkins Children's Center, Baltimore, Maryland, USA
| | - Walter Klyce
- Division of Pediatric Orthopaedic Surgery, Johns Hopkins Children's Center, Baltimore, Maryland, USA
| | - R Jay Lee
- Division of Pediatric Orthopaedic Surgery, Johns Hopkins Children's Center, Baltimore, Maryland, USA
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Nhan DT, Garcia MR, Lee RJ. Bilateral Bicondylar Osteochondritis Dissecans in a Child with Spastic Diplegia and Crouch Gait: A Case Report. JBJS Case Connect 2018; 8:e41. [PMID: 29952775 DOI: 10.2106/jbjs.cc.17.00271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE The cause of osteochondritis dissecans is unknown. Various hypotheses suggest mechanical, ischemic, and hereditary causes. We describe a 13-year-old girl with spastic diplegia, a form of cerebral palsy, who had an associated crouch gait and presented with bilateral osteochondral defects of the medial and lateral femoral condyles. CONCLUSION This case highlights the potential role of repetitive microtrauma, likely due to the poor biomechanical forces in a crouch gait, and provides support for a mechanical cause of osteochondritis dissecans.
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Affiliation(s)
- Derek T Nhan
- Department of Orthopaedic Surgery, The Johns Hopkins Hospital, Baltimore, Maryland
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Abstract
Axial spondyloarthritis (axSpA), a subtype of spondyloarthritis, is a debilitating inflammatory condition involving the spinal and sacroiliac joints, contributing to a significant diminution in quality of life. Historically, characterization of patient outcomes in axSpA has been a challenge due to the lack of data from longitudinal epidemiologic studies and the nonspecific nature of inflammatory laboratory markers to monitor disease activity. In this review, measures developed to address these clinical domains are discussed and compared, of which 3 are commonly used in diagnosis and therapeutic planning. Provider data regarding utilization of these measures are also included to clarify current clinical practice trends.
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Affiliation(s)
- Derek T Nhan
- Veterans Affairs Medical Center (VAMC), Denver, CO, USA; University of Colorado School of Medicine, Aurora, CO, USA
| | - Liron Caplan
- Veterans Affairs Medical Center (VAMC), Denver, CO, USA; University of Colorado School of Medicine, Aurora, CO, USA.
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Abstract
Particles and solutes are excluded from the vicinity of hydrophilic surfaces, leaving large microsphere-free regions known as exclusion zones (EZs). Prior work had indicated that EZs could extend to distances of up to several hundred micrometers from the nucleating surface. These observations were made on large, extended surfaces, leaving open the question whether EZ size might depend on the characteristic dimension of the excluding surface. We placed one or few ion-exchange-resin beads whose diameters varied from 15 μm to 300 μm in cuvettes. The beads were suffused with aqueous microsphere suspensions for observing the surfaces' exclusionary behavior. Results showed a direct relation between bead size and EZ size over the full range of bead diameter, implying a similar relation for smaller particles or molecules, perhaps extending beyond the resolution of the light microscope.
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Affiliation(s)
- D T Nhan
- Department of Bioengineering, University of Washington, Seattle, WA 98195, USA
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Nhan DT, Cam DTV, Wille M, Defoirdt T, Bossier P, Sorgeloos P. Quorum quenching bacteria protect Macrobrachium rosenbergii larvae from Vibrio harveyi infection. J Appl Microbiol 2011; 109:1007-16. [PMID: 20408919 DOI: 10.1111/j.1365-2672.2010.04728.x] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIMS In this study, we investigated the effect of N-acyl homoserine lactone-degrading bacterial enrichment cultures (ECs) on larviculture of the giant freshwater prawn Macrobrachium rosenbergii. METHODS AND RESULTS The larval performance in terms of larval growth, larval survival, larval quality, duration of the larval rearing process and microflora levels in the rearing water as well as inside the prawn gut was investigated. The application of the EC bacteria was performed in two ways: by adding them directly into the larval rearing water and via enriched Artemia nauplii used for larval feeding. The results of the study demonstrated that both ECs that were tested had a similar positive effect on larval survival and larval quality, whereas they did not affect larval growth or the duration of the larval rearing process. CONCLUSIONS Under normal hatchery conditions, the optimal EC densities were found to be 10(6) CFU ml(-1) for adding into the rearing water and 5 × 10(8) CFU ml(-1) for enrichment of Artemia nauplii used for feeding of the larvae. In the hatchery, the ECs can be grown on waste streams of Artemia hatching. SIGNIFICANCE AND IMPACT OF THE STUDY Application of this kind of ECs could lead to a more sustainable aquaculture production, by replacing the use of antibiotics to control diseases.
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Affiliation(s)
- D T Nhan
- Laboratory of Aquaculture & Artemia Reference Center, Ghent University, Ghent, Belgium
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