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Herrero C, Jejurikar N, Trionfo A, Karamitopoulos M. Talk It Out to Walk It Out A Guide for Residents and Medical Students on the Fundamentals of Gait. Bull Hosp Jt Dis (2013) 2024; 82:33-38. [PMID: 38431975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/05/2024]
Abstract
Although gait is one of the most globally ubiquitous concepts-traversing all geographic, cultural, and language barriers-it is often seen as an overwhelming and confusing concept. This review describes the phases and components of gait to help the clinician identify what is normal, evaluate what is not normal, and understand some common pathologic gait patterns seen in the different orthopedic subspecialties.
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Jejurikar N, Herrero C, Fabbri N. The Role of Distraction Osteogenesis in Limb Salvage for Tumors. Bull Hosp Jt Dis (2013) 2024; 82:39-42. [PMID: 38431976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/05/2024]
Abstract
Modern technology and advances in medicine have facilitated increasing rates of limb salvage in the treatment of sarcomas. Orthopedic oncologists have a wide array of reconstruction options for limb salvage, ranging from allografts to endoprosthesis reconstruction. Limb lengthening is another option available to an orthopedic oncologist faced with bony defects and limb length discrepancies following resection. This review provides a brief history of limb lengthening, the principles of distraction osteogenesis, and current applications in orthopedic oncology. Considering the complications and challenges associated with the lengthening process, appropriate patient selection and thorough patient counseling is key to optimizing outcomes.
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Herrero C, Jejurikar N, Kanakamedala A, Iban YC, Castañeda P. Correction to: Point of Care Ultrasound as Performed by the Clinician for the Enhancement of Physical Examination: A Technique Guide for Developmental Hip Dysplasia. Indian J Orthop 2022; 56:1842. [PMID: 36187577 PMCID: PMC9485408 DOI: 10.1007/s43465-022-00725-1] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
[This corrects the article DOI: 10.1007/s43465-021-00570-8.].
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Affiliation(s)
- Christina Herrero
- NYU Langone Health Department of Orthopaedic Surgery, 301 E 17th St, New York, NY 10010 USA
| | - Neha Jejurikar
- NYU Langone Health Department of Orthopaedic Surgery, 301 E 17th St, New York, NY 10010 USA
| | - Ajay Kanakamedala
- NYU Langone Health Department of Orthopaedic Surgery, 301 E 17th St, New York, NY 10010 USA
| | | | - Pablo Castañeda
- NYU Langone Health Department of Orthopaedic Surgery, 301 E 17th St, New York, NY 10010 USA
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Deemer AR, Jejurikar N, Konda S, Leucht P, Egol KA. Approach variation affects outcomes after operative repair of lateral tibial plateau fractures. Eur J Orthop Surg Traumatol 2022:10.1007/s00590-022-03343-7. [PMID: 35916931 DOI: 10.1007/s00590-022-03343-7] [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] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 07/22/2022] [Indexed: 06/15/2023]
Abstract
PURPOSE To determine if the type of approach used for treatment of lateral split-depression tibial plateau fractures affects clinical outcome and complications rate. METHODS This is a retrospective review of 169 patients who presented between 01/2005 and 12/2020 to a Level-I trauma center for operative management of an isolated lateral Schatzker II tibial plateau fractures (AO/OTA Type 41B3.1) treated through a single anterolateral approach: a 90-degree "L" (L), longitudinal vertical (V), or "lazy S" (S). Postoperative radiographic, clinical, and functional outcomes were assessed at 3, 6, 12 months, and beyond. RESULTS Average time to radiographic healing was longer in the S incision cohort (p < 0.05). Furthermore, patients within the S incision cohort developed more postoperative wound complications at follow-up when compared to those within the L and V incision cohorts (p < 0.05). Additionally, reoperation rates were greater in the S incision cohort (p < 0.05). Lastly, on physical examination of the knee, patients within the S incision cohort had significantly poorer knee range of motion (p < 0.05). CONCLUSIONS Our study demonstrates that skin incision type in the anterolateral approach to the proximal tibia has an association with outcomes following operative repair of tibial plateau fractures. The information from this study can be used to inform surgeons about the potential complications and long-term outcomes that patients may experience when undergoing operative repair of a tibial plateau fracture through a specific incision type. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Alexa R Deemer
- Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, NYU Langone Health, NYU Langone Medical Center, 301 E 17th Street, New York, NY, 10003, USA
| | - Neha Jejurikar
- Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, NYU Langone Health, NYU Langone Medical Center, 301 E 17th Street, New York, NY, 10003, USA
| | - Sanjit Konda
- Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, NYU Langone Health, NYU Langone Medical Center, 301 E 17th Street, New York, NY, 10003, USA
- Department of Orthopedic Surgery, Jamaica Hospital Medical Center, New York, NY, USA
| | - Philipp Leucht
- Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, NYU Langone Health, NYU Langone Medical Center, 301 E 17th Street, New York, NY, 10003, USA
| | - Kenneth A Egol
- Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, NYU Langone Health, NYU Langone Medical Center, 301 E 17th Street, New York, NY, 10003, USA.
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Jejurikar N, Hacquebord J, Posner MA. Emanuel Kaplan, MD: Greatness in Hand Surgery. Bull Hosp Jt Dis (2013) 2021; 79:230-233. [PMID: 34842516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
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Herrero C, Jejurikar N, Kanakamedala A, Iban YC, Castañeda P. Point of Care Ultrasound as Performed by the Clinician for the Enhancement of Physical Examination: A Technique Guide for Developmental Hip Dysplasia. Indian J Orthop 2021; 55:1597-1600. [PMID: 35003546 PMCID: PMC8688612 DOI: 10.1007/s43465-021-00570-8] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 11/10/2021] [Indexed: 02/04/2023]
Abstract
Developmental dysplasia of the hip (DDH) is the most common anatomical pathology present in newborns. DDH is the most common orthopaedic disorder in newborns, with incidences cited from 4.4% to 51.8% depending on risk factors, populations and method of reporting. Traditionally, the standard physical exam for newborns includes the Barlow and Ortolani maneuvers. If either is positive by the pediatrician, the baby is then sent for evaluation by a pediatric orthopaedic surgeon. At this stage, either the pediatrician or pediatric orthopaedic surgeon obtains an ultrasound-the gold standard for DDH diagnosis. When early identification and treatment are not in place, it can lead to significant consequences on an individual's health and financial and public health implications for society at large. This is a detailed technique guide aimed to help physicians consistently perform thorough US evaluations of pediatric hips in order to successfully screen, diagnosis and manage treatment of DDH. SUPPLEMENTARY INFORMATION The online version contains supplementary material available at 10.1007/s43465-021-00570-8.
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Affiliation(s)
- Christina Herrero
- NYU Langone Health Department of Orthopaedic Surgery, 301 E 17th St, New York, NY 10010 USA
| | - Neha Jejurikar
- NYU Langone Health Department of Orthopaedic Surgery, 301 E 17th St, New York, NY 10010 USA
| | - Ajay Kanakamedala
- NYU Langone Health Department of Orthopaedic Surgery, 301 E 17th St, New York, NY 10010 USA
| | | | - Pablo Castañeda
- NYU Langone Health Department of Orthopaedic Surgery, 301 E 17th St, New York, NY 10010 USA
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Herrero CP, Jejurikar N, Carter CW. The psychology of the female athlete: how mental health and wellness mediate sports performance, injury and recovery. Ann Joint 2021. [DOI: 10.21037/aoj-20-53] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Jejurikar N, Moscona-Mishy L, Rubio M, Cavallaro R, Castañeda P. What is the Interobserver Reliability of an Ultrasound-enhanced Physical Examination of the Hip in Infants? A Prospective Study on the Ease of Acquiring Skills to Diagnose Hip Dysplasia. Clin Orthop Relat Res 2021; 479:1889-1896. [PMID: 34351316 PMCID: PMC8373553 DOI: 10.1097/corr.0000000000001863] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 05/26/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND Developmental dysplasia of the hip (DDH) is the most common disorder found in newborns. The consequences of DDH can be mitigated with early diagnosis and nonoperative treatment, but existing approaches do not address the current training deficit in making an early diagnosis. QUESTION/PURPOSE Can ultrasound be taught to and used reliably by different providers to identify DDH in neonates? METHODS This was a prospective observational study of a series of neonates referred for an evaluation of their hips. An experienced clinician trained three second examiners (a pediatric orthopaedic surgeon, an orthopaedic resident, and a pediatrician) in performing an ultrasound-enhanced physical examination. The 2-hour training process included video and clinical didactic sessions aimed to teach examiners to differentiate between stable and unstable hips in newborns using ultrasound. The experienced clinician was a pediatric orthopaedic surgeon who uses ultrasound regularly in clinical practice. Materials required for training include one ultrasound device. A total of 227 infants (454 hips) were examined by one of the three second examiners and the experienced clinician (gold standard) to assess reliability. Of the 454 hips reviewed, there were 18 dislocations, 24 unstable hips, and 63 dysplastic hips, and the remainder had normal findings. The cohort was composed of a series of patients younger than 6 months referred to a specialty pediatric orthopaedic practice. RESULTS Ultrasound-enhanced physical examination of the hip was easily taught, and the results were reliable among different levels of providers. The intraclass correlation coefficient between the gold-standard examiner and the other examiners for all hips was 0.915 (p = 0.001). When adjusting for only the binary outcome of normal versus abnormal hips, the intraclass correlation coefficient was 0.97 (p = 0.001). Thus, the agreement between learners and the experienced examiner was very high after learners completed the course. CONCLUSION After a 2-hour course, physicians were able to understand and reliably examine neonatal children using ultrasound to assess for DDH. The success of the didactic approach outlined in this study supports the need for ultrasound-enhanced examination training for the diagnosis of DDH in orthopaedic surgery and pediatric residency core curriculums. Training programs would best be supported through established residency programs. Expansion of training more residents in the use of ultrasound-enhanced physical examinations would require a study to determine its efficacy. This finding highlights the need for further research in implementing ultrasound-enhanced physical examinations on a broader scale. LEVEL OF EVIDENCE Level II, diagnostic study.
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Affiliation(s)
- Neha Jejurikar
- New York University Langone Orthopedic Hospital, New York, NY, USA
| | | | | | - Romina Cavallaro
- Hospital Interzonal General Dr. José Penna, Bahía Blanca, Buenos Aires, Argentina
| | - Pablo Castañeda
- New York University Langone Orthopedic Hospital, New York, NY, USA
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Anil U, Jejurikar N, Kenny L, Strauss EJ. Changes in Synovial Fluid Biomarker Concentration Before and After ACL Reconstruction. Bull Hosp Jt Dis (2013) 2019; 77:189-193. [PMID: 31487484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND Synovial fluid biomarkers can highlight the molecular milieu associated with knee pathology and have been shown to be significantly different in patients with anterior cruciate ligament (ACL) injuries compared to uninjured controls. The purpose of the current study was to establish how synovial fluid biomarker concentrations change in patients undergoing ACL reconstruction between the immediate preoperative period to the acute postoperative period. METHODS Patients were prospectively enrolled at the time of surgery from September 2016 to March 2017. Patients who had an operative knee synovial fluid sample obtained at the time of ACL reconstruction and provided a synovial fluid sample at their first postoperative appointment were included. The concentrations of 10 biomarkers were determined using a multiplex magnetic bead immunoassay. Biomarker concentrations before and after surgery were compared using a paired sample t-test. RESULTS Eight patients with mean age of 33.4 years who underwent isolated ACL reconstruction using a bonepatellar tendon-bone autograft were included. The mean time between surgery and postoperative office visit was 10.4 days. There was a statistically significant increase in the concentrations of interleukin-6 (IL-6, p = 0.014), monocyte chemoattractant protein-1 (MCP-1, p = 0.024), human matrix metalloproteinase 3 (MMP-3, p = 0.00002), macrophage inflammatory protein-1 beta (MIP-1β, p = 0.006), human interleukin-1 receptor antagonist (IL-1Ra, p = 0.017), and vascular endothelial growth factor (VEGF, p = 0.023) between the time of surgery and the first postoperative visit and a decrease in the concentration of tissue inhibitor of metalloproteinase-2 (p = 0.050). CONCLUSION The molecular profile of the synovial fluid changes in the early postoperative period following arthroscopic ACL reconstruction. The concentration of proinflammatory markers (such as IL-6, MCP-1, MMP-3, and MIP-1β) and growth factors including VEGF increases. The concentration of the anti-inflammatory marker tissue inhibitor of metalloproteinase-2 (TIMP-2) appears to decrease postoperatively.
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Pickell M, Jejurikar N, Anil U, Salata M, Davidson PA, Jazrawi LM, Strauss EJ. Management of Meniscal Pathology: From Partial Meniscectomy to Transplantation. Instr Course Lect 2018; 67:489-500. [PMID: 31411434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Meniscal tears are common injuries that may result in functionally limiting pain, swelling, and mechanical symptoms. The management of meniscal pathology has evolved as surgeons' understanding of the important role the menisci play in normal knee kinematics increases. Recent emphasis on partial meniscectomy, expanding indications for meniscal repair, and the increased use of meniscal allograft transplantation have helped improve the outcomes of patients with a meniscal tear who undergo treatment. Orthopaedic surgeons should understand meniscal function, pathology, and treatment approaches.
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Affiliation(s)
- Michael Pickell
- Sports Medicine Fellow, Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, New York
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Dai AZ, Zacchilli M, Jejurikar N, Pham H, Jazrawi L. Open 4-Compartment Fasciotomy for Chronic Exertional Compartment Syndrome of the Leg. Arthrosc Tech 2017; 6:e2191-e2201. [PMID: 29349018 PMCID: PMC5766428 DOI: 10.1016/j.eats.2017.08.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2017] [Accepted: 08/07/2017] [Indexed: 02/03/2023] Open
Abstract
Chronic exertional compartment syndrome (CECS) is a significant source of lower extremity pain and morbidity in the athletic population. Although endoscopic techniques have been introduced, open fasciotomy remains the mainstay of surgical treatment because of the paucity of evidence in support of an endoscopic approach. The literature on surgical management of CECS is mixed, and overall success rates are modest at best. Optimizing surgical technique, including prevention of neurovascular injury and wound complications, can make a significant impact on the clinical outcome. Here we present our surgical technique, including pearls and pitfalls, for open 4-compartment fasciotomy for treatment of chronic exertional compartment syndrome.
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Affiliation(s)
- Amos Z. Dai
- Address correspondence to Amos Z. Dai, B.S., NYU Hospital for Joint Diseases, 301 E 17th Street, Suite 1500, New York, NY 10003, U.S.A.NYU Hospital for Joint Diseases301 E 17th Street, Suite 1500New YorkNY10003U.S.A.
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