The Paul R. Lipscomb
Alumni Society
Presents
Orthopaedic
Graduate
Research
Symposium
Friday, June 21, 2013
with special guest speaker
Robert Anderson, M.D.
Sponsored by
University of California, Davis
Health System
Department of Orthopaedic Surgery
Welcome to the
2013 Paul R. Lipscomb
Alumni Society
Graduate
Research Symposium
This outstanding gathering is an
opportunity for our department to
highlight scientific and clinical research,
and to reconnect with clinical faculty and
alumni who have served our department
over the years. Our special guest this
year is Dr. Robert Anderson, Founding
Member of the Foot and Ankle Institute
at OrthoCarolina.
Most importantly, this is an occasion to
commemorate the graduation of twelve
exceptional men and women - five
residents and seven fellows - into the
ranks of orthopaedic surgery. While
always a bittersweet occasion, this day
validates the wonderful camaraderie
and continuity of our field.
Thank you for being part
of this memorable event.
Orthopaedic Surgery Chairs
Paul R. Lipscomb, M.D.
Professor Emeritus
Chair 1969-1979
Michael W. Chapman, M.D.
Professor Emeritus
Chair 1979-1999
George T. Rab, M.D.
Professor
Chair 1999-2006
Paul E. Di Cesare, M.D., FACS
Professor
Michael W. Chapman
Chair 2006-2011
Richard A. Marder, M.D.
Professor
Acting Chair 2011 - present
Visiting Professors
1982 - Robert B. Winter, M.D.
1983 - Anthony Catterall, M.D.
1984 - Eugene E. Bleck, M.D.
1985 - Paul P. Griffin, M.D.
1986 - M. Mark Hoffer, M.D.
1987 - Robert B. Salter, M.D.
1988 - Colin F. Moseley, M.D.
1989 - James R. Gage, M.D.
1990 - James F. Kellam, M.D.
1991 - David S. Braddford, M.D.
1992 - Adrian E. Flatt, M.D.
1993 - Augusto Sarmiento, M.D.
1994 - M. Mark Hoffer, M.D.
1995 - James R. Andrews, M.D.
1996 - James R. Urbaniak, M.D.
1997 - Stuart L. Weinstein, M.D.
1998 - Robert A. Mann, M.D.
1999 - Joseph M. Lane, M.D.
2000 - Andrew J. Weiland, M.D.
2001 - Joel M. Matta, M.D.
2002 - Terry R. Trammell, M.D.
2003 - Kaye E. Wilkins, M.D.
2004 - Richard Gelberman, M.D.
2005 - Robert H. Hensinger, M.D.
2006 - James Heckman, M.D.
2007 - Thomas A. Einhorn, M.D.
2008 - Joseph A. Buckwalter, M.D.
2009 - Peter J. Stern, M.D.
2010 - Joseph Borrelli, Jr., M.D.
2011 - Keith Bridwell, M.D.
2012 - Gary G. Poehling, M.D.
2013 - Robert Anderson, M.D.
Robert Anderson, M.D.
President of the American Orthopaedic
Foot and Ankle Society & Founding
Member of the Foot and Ankle Institute
at OrthoCarolina
Dr. Anderson is a founding orthopaedic
surgeon of the Foot and Ankle Institute
of OrthoCarolina in Charlotte, North
Carolina, practicing there since 1989.
His fellowship training was in foot and
ankle disorders, with a large experience
in sport related injuries. He serves as
a consultant to a number of NFL/NBA/
NHL/MLB teams and colleges. He is the
foot and ankle consultant to MLB Umpires
Division and has served as a team
orthopaedist to the Carolina Panthers
since 2000. He serves as the Chairman
of the Foot and Ankle Subcommittee
for the NFL. Additional appointments
include Chief of Foot and Ankle Service
at the Carolinas Medical Center, Codirector of the Fellowship Program at
OrthoCarolina, and Vice-chief of the
Department of Orthopaedic Surgery at
OrthoCarolina. He is a Past President of
the Medical Staff of Carolinas Medical
Center with 1700 physician members.
Dr. Anderson is also a past-president
of the American Orthopaedic Foot and
Ankle Society. Research appointments
include Editor-in-Chief of Techniques
in Foot and Ankle Surgery; associate
editor/reviewer for JBJS, JAAOS, AJSM
and numerous other peer-review
publications. He has authored numerous
other book chapters and manuscripts. He
was born in Milwaukee, Wisconsin and
attended the University of Mississippi.
He completed his medical degree at the
Medical College of Wisconsin (formerly
Marquette
School
of
Medicine),
completed his residency at Carolinas
Medical Center in Orthopedic Surgery
and a fellowship at the Medical College
of Wisconsin in foot and ankle surgery.
Faculty
University of California Davis
Health System
KYRIACOS A. ATHANASIOU, Ph.D., Ph.M.
Distinguished Professor, Orthopaedic Research and
Biomedical Engineering
ROBERT H. ALLEN, M.D.
Associate Professor, Hand and Upper Extremity
BLAINE A. CHRISTIANSEN, Ph.D.
Assistant Professor, Orthopaedic Research Laboratory
RAKESH DONTHINENI, M.D.
Associate Clinical Professor, Oncology
JONATHAN G. EASTMAN, M.D.
Assistant Professor, Trauma Service
TANIA A. FERGUSON, M.D., MAS
Associate Professor, Trauma Service
DAVID P. FYHRIE, Ph.D.
Professor, Orthopaedic Research Laboratory
MAURO M. GIORDANI, M.D.
Associate Professor, Chief of Adult Reconstructive Service
ERIC GIZA, M.D.
Associate Professor, Chief of Foot and Ankle Service
MUNISH C. GUPTA, M.D.
Professor, Chief of Adult and Pediatric Spine Service
DOMINIK R. HAUDENSCHILD, Ph.D.
Assistant Professor, Orthopaedic Research Laboratory
ERIC O. KLINEBERG, M.D.
Assistant Professor, Adult and Pediatric Spine Service
J. KENT LEACH, Ph.D.
Associate Professor, Orthopaedic Research Laboratory
and Biomedical Engineering
CASSANDRA A. LEE, M.D.
Assistant Professor, Sports Medicine
MARK A. LEE, M.D.
Associate Professor, Trauma Service
RICHARD A. MARDER, M.D.
Professor and Acting Chair, Chief of Sports Medicine
GAVIN C.T. PEREIRA, MBBS, FRCS
Assistant Professor, Adult Reconstructive Service
DEBRA J. POPEJOY, M.D.
Assistant Professor, Pediatric Orthopaedics
GEORGE T. RAB, M.D.
Professor, Pediatric Orthopaedics
A. HARI REDDI, Ph.D.
Distinguished Professor, Lawrence J. Ellison Chair of
Molecular Biology, Acting Director of the Orthopaedic
Research Laboratories, Acting Vice Chair
ROLANDO F. ROBERTO, M.D.
Associate Professor, Adult and Pediatric Spine
Surgery
PETER B. SALAMON, M.D.
Clinical Professor, Pediatric Orthopaedics
ROBERT M. SZABO, M.D., MPH
Professor, Chief of Hand, Upper Extremity and
Microvascular Surgery
JAMES M. VAN DEN BOGAERDE, M.D.
Assistant Professor, Sports Medicine
PHILIP R. WOLINSKY, M.D.
Professor, Chief of Trauma Service
BRAD J. YOO, M.D.
Associate Professor, Trauma Service
Faculty
Shriners Hospital for Children
Northern California
ANDREA S. BAUER, M.D.
Assistant Professor, Pediatric Orthopaedics
JENNETTE L. BOAKES, M.D.
Clinical Professor, Pediatric Orthopaedics
JON R. DAVIDS, M.D.
Associate Professor, Pediatric Orthopaedics
MICHELLE A. JAMES, M.D.
Clinical Professor, Chief of Orthopaedics Pediatric
Service
JOEL A. LERMAN, M.D.
Associate Clinical Professor, Pediatric Orthopaedics
Program
Friday, June 21, 2013
Resident and Fellow Research Presentations
Medical Education Building, Lecture Hall 1222
7:15 AM
Continental Breakfast
7:45 AM
Welcome - Richard A. Marder,
M.D., Professor and Acting
Department Chair
7:55 AM
Introduction of Guest Speaker Eric Giza, M.D.
8:00 AM
Visiting Professor: Robert
Anderson, M.D., Founding
Member of the Foot and Ankle
Institute at OrthoCarolina
“Sports Foot and Ankle Injuries in
the NFL”
9:00 AM
Alumni Lectures (Young
Alumni) “What is it like out there
2-3 years after graduation?”
9:30 AM
BREAK
9:40 AM
Philbert Y. Huang, M.D., Ph.D.
“Injuries to the PCL Complex and
Medial Structures of the Knee:
Finite Element Analysis”
10:00 AM
Raj S. Kullar, M.D.
10:20 AM
Lance K. Mitsunaga, M.D.
“Can a Universal Protocol for
Prevention of Surgical Site
Infections Reduce Postoperative
Infection Rates to Zero in Spine
Surgery Patients?”
“The Properties of the
Subscapularis Following Repair
in Reverse Total Shoulder
Arthroplasty: a Cadaveric and
Biomechanical Analysis”
10:40 AM Daemeon A. Nicolaou, M.D.
“Comparison in Fatigue Strength
of Various Plaster Posterior Short
Leg Splint Configurations”
11:00 AM Derek F. Amanatullah, M.D.,
Ph.D.
“Calculating the Position of
the Joint Line of the Knee in
Relationship to Anatomic
Landmarks”
11:30 AM BREAK (PHOTOS)
12:00 PM Bryon D. Hobby, M.D.
“Analysis of Patient Outcomes
Following Anterior Approach Total
Hip Arthroplasty for Femoral Neck
Fracture”
12:10 PM David L. Rothberg, M.D.
“Posterior Facet Cartilage Injury
in Operatively Treated Intraarticular Calcaneus Fractures”
12:20 PM John David Burrow, D.O.
“Evaluation of Knee Kinematics
in the Sagittal and Coronal Planes
in Navigation Assisted Total Knee
Arthroplasty and Correlation with
Three-Month Postoperative Range
of Motion”
12:30 PM Igor Immerman, M.D.
“Real-time 2D and 3D MR
Imaging During Active Wrist
Motion”
12:40 PM Peter D. Rinaldi, D.O.
“Effect of Knee Flexion Angle
During Medial Patellofemoral
Ligament Graft Fixation on
Patellofemoral Contact Pressures”
12:50 PM Todd D. Cook, M.D.
“Incidence, Risk Factors, and
Outcomes of Proximal Junctional
Kyphosis in Adult Spinal
Deformity Surgery”
1:00 PM
Adjournment
Derek F.
Amanatullah, M.D., Ph.D.
Administrative Chief
Education
B.S. 1998: University of Southern
California, Biomedical Engineering
M.S. 2001: Albert Einstein College
of Medicine, Developmental and
Molecular Biology
M.D. 2007: Albert Einstein College of
Medicine
Ph.D. 2007: Albert Einstein College of
Medicine, Cellular Biology
Next Step
Adult Lower Extremity Reconstruction
Fellowship, Mayo Clinic, Rochester, MN
Career Objective
I am dedicated to becoming an
internationally recognized surgeonscientist. I am currently looking for an
academic surgical practice that will allow
me to focus on the surgical management
of the arthritic hip and knee as well
as pursue the development of new
diagnostic and regenerative techniques
for degenerative joint disease.
Spouse
Marirose C. Amanatullah
Personal Statement
I published 30 peer reviewed manuscripts
and 9 non-peer reviewed manuscripts.
Eleven additional manuscripts are
submitted for publication in peer
reviewed journals, and I am in the
process of drafting 11 manuscripts
based on my current work. I made 31
podium presentations and presented
21 posters at national and international
orthopaedic conferences over the last
three years. I received numerous awards
for my orthopaedic research, including
the Sanford and Darlene Anzel Award,
Lloyd W. Taylor Resident Award,
Vernon Thompson Award, and the
J. Harold LaBriola Resident Award.
Additionally, I was selected as an
International Cartilage Research Society
Traveling Clinical Scientist and attended
the American Academy of Orthopaedic
Surgeons Clinical Scientist Development
Program.
I served as the editor-in-chief of the
Einstein Journal of Biology and Medicine
for three years and have recently been
invited as a guest editor of Cartilage.
I am an active reviewer for numerous
journals, including the Journal of the
American Academy of Orthopaedic
Surgeons, Tissue Engineering, Tissue
Engineering and Regenerative Medicine,
and Cartilage as well as a resident
advisor to the American Journal of
Orthopaedics. I served as a voting
member of the Continuous Quality
Improvement Committee and chair of
the Resident Medical Staff Committee
at the University of California, Davis as
well as a resident liaison to the American
Academy of Orthopaedic Surgeons. I
am personally interested in intellectual
property and am currently involved in
the development of four patents.
I am personally and professionally
indebted to so many. My mentors gave
me the tough feedback required to
hone my critical thinking and decision
making skills. My friends gave me the
encouragement required to overcome
numerous personal and intellectual
hurdles. My family gave me the
unconditional love required to become a
better person. My parents have endured
all 16 years of my training and are the
only people who understand the depths
of my personal and professional failures
and how this forms the foundation of
my current success. They have never
wavered. They are the bedrock of my
life. My wife shares my personal values
and professional dreams. She is the love
of my life. We are the perfect team poised
to build a prosperous and fulfilling life
together.
Calculating the Position of
the Joint Line of the Knee
in Relationship to Anatomic
Landmarks
Derek F. Amanatullah, M.D., Ph.D.,
Michael J. Alaia, M.D., Kenneth
Montini, M.D., Matthew J. Lopez, M.D.,
Paul E. Di Cesare, M.D., & Gavin C.
Pereira, MBBS
Restoration of the joint line of the knee
during primary and revision total knee
arthroplasty is one of many critical steps
that directly influence patient outcomes.
Fifty MRI scans of normal atraumatic
knees were analyzed to determine a
quantitative relationship between the
joint line of the knee and the bony
landmarks of the knee joint: femoral
epicondyles, metaphyseal flare of the
femur, tibial tubercle, and proximal tibiofemoral joint. The absolute distances of
these anatomic landmarks to the joint
line of the knee were highly variable
due to patient size and gender. In order
to negate the effect of size and gender,
the ratios of these distances of the joint
line of the knee were normalized to the
respective bony diameters. The distance
of the lateral epicondyle to the joint line
of the knee was about one-third the interepicondylar diameter. The distance of
the lateral flare of the femur to the joint
line of the knee was one-half the interflare diameter. The distance of the tibial
tubercle to the joint line of the knee was
one-half the diameter of the tibia in the
sagittal plane at the level of the tibial
tubercle. The distance of the proximal
tibio-femoral joint to the joint line of
the knee was one-third the diameter
of the tibia in the coronal plane at the
level of the proximal tibio-femoral joint.
The spatial relationship of the joint line
of the knee to the femur and tibia was
made by calculating ratios across the
joint line. The joint line of the knee was
halfway between the lateral epicondyle
and proximal tibio-fibular joint in the
coronal plane. This description supports
a simple three-step algorithm allowing
orthopaedic surgeons to calculate,
instead of estimate, the location of the
joint line of the knee.
Philbert Y.
Huang, M.D., Ph.D.
Administrative
Chief
Education
B.S.: Biomedical Engineering,
UC San Diego
M.D./Ph.D.: Biomedical Engineering,
UC Davis
Next Step
Sports Medicine Fellowship
Sports, Orthopedic, And Rehabilitation
(SOAR) Medicine Associates
Bay Area, CA
Career Objective
To provide the best patient care through
arthroscopy and general orthopaedics in
an academic and athletic team setting.
Spouse
Fiancee Wendy Lee, M.D.
Personal Statement
The field of medicine and orthopedic
surgery has been a long journey of
training and is indeed a humbling one.
I have been honored to work alongside
many brilliant mentors and co-residents
at UC Davis. It is truly a privilege to
operate, and I have finally come to
understand the sometimes difficult, yet
rewarding pathway that is residency. I
would like to thank my Dad Raymond,
sister Mona, and brother Jeffrey for their
unending support and hospitality as I
would visit home in Southern California
during my vacations. I would also like
to thank my beautiful fiancé Wendy, who
has shown me such love and selflessness
for which I would have not been able to
get this far and be this happy without
you. I dedicate this milestone in my
life to the memory of my mother Grace,
whose passion, work ethic, and caring
made this day possible.
Injuries to the PCL Complex and
Medial Structures of the Knee:
Finite Element Analysis
Philbert Huang, M.D., Ph.D., Jamie
Dunaway, B.S., Nesrin Sarigul-Klijn,
Ph.D., Cassandra Lee, M.D.
Introduction: The stability of the knee
with regards to posterior tibial translation
is afforded by the posterior cruciate
ligament (PCL) as well as several medial
sided structures. A combined injury of
the medial structures of the knee and
PCL is less common, and it is unclear
whether both or just one of the two
structures injured needs to be surgically
reconstructed to restore functional
stability. The current study involves the
construction of a finite element model
of the human knee joint in order to
determine the effects of posterior cruciate
ligament injury on joint kinematics and
contact forces.
Furthermore, this model aims to provide
clinicians with quantitative information
when faced with PCL reconstruction
decision-making. One objective for this
study will be to determine the least
amount of tibia and femur length to be
included in the model in order to yield
accurate results. Another objective will be
to determine the necessity of the patella,
fibula, meniscofemoral ligaments, and
anterolateral and posteromedial bundles
of the PCL, which are structures not
included in previous knee finite element
models.
Background:
Numerous
finite
element models of the knee have been
accomplished with assumptions and
simplifications for modeling ligaments,
bone, and cartilage. Each of these
biological tissues contains its own set of
non-linear, viscoelastic properties, which
are not only difficult to determine from
experimental data, but are also patientspecific. Therefore, accurately assessing a
patient’s knee joint characteristics after a
PCL injury without experimental data to
compare to requires both an anatomically
and physiologically correct model with
accurate viscoelastic material properties
of included biological tissues.
Loading conditions: When comparing
varying degrees of flexion/extension of
the knee joint, as well as subject position
(standing, sitting, or lying down), loading
and boundary tolerances on the superior
and inferior cross-sections of the femur
and tibia will likely not remain constant.
Furthermore, the concept of pre-stresses
in ligaments must be introduced. Nonlinear springs may be used in the modeling
program, as they can hold a pre-stress.
It may be assumed that the ligaments
are at equilibrium such that they are
only exhibiting an elastic response in a
resting position. This concept must be
addressed in finite element models of the
knee, as patients without much femoral
loading (e.g. lying down) must have
pre-stresses in ligaments to keep the
joint stable. Therefore, there must be a
resting length for all ligaments, in which
strained ligaments will develop strainrate dependent non-linear stress profiles.
Normally Excluded biological tissues:
Simplifying the knee joint to a model
that includes the four major ligaments
has been shown to yield reliable data in
assessing knee joint stresses. However,
when excluding certain ligaments, bone
and cartilage may yield stress values
and deformations to a point beyond
acceptable errors from experimental
data. Important tissues to consider
modeling in the knee in conjunction
with the aforementioned ligaments and
cartilage are: the quadriceps tendon, the
patella, the patellar ligament, the anterior
and posterior mensicofemoral ligaments,
and the fibula.
Material properties: While properties
are patient specific due to physiological
responses and age, trabecular bone has
been cited to be largely apparent density
dependent. Previous studies have shown
that bones may be modeled as rigid
bodies in order to examine cartilage
and other viscoelastic tissue behaviors.
However, as this study aims to determine
alterations of stresses in bone due to PCL
removal, bone must be modeled as a nonrigid, density dependent transversely
isotropic material.
Methods: The software MIMICS will be
utilized to build a model of the knee joint
from CT and MRI of a sample patient.
The extent of femoral and tibial length
utilized in the model is to be determined.
Ligaments will be reconstructed using
MIMICS, at which there will be little to no
gap between bone and ligament contact.
A FE model will be built in Abaqus 6.10.
Eight node brick elements will be used
for all structures unless otherwise stated.
The mesh will be developed in Mimics. A
finite element model that appropriately
incorporates a“novel knee system” that
includes all functional structures can
help elucidate the role each structure
plays in the overall stability of the knee.
In this model, the ligaments, menisci,
and cartilage can be identified and
accurately represented. By modeling and
simulating an injury by removing one or
more ligaments at a time, the resultant
pathologic translations of the tibia with
respect to the femur by simulating
clinical exams can be determined. In
addition, contact forces in the joint and
the increase in stresses in the remaining
intact ligaments can be determined. The
information obtained from this study can
then be used towards clinical decisionmaking and patient care for those who
have sustained such an injury.
Raj S. Kullar, M.D.
Administrative
Chief
Education
B.S.: University of California, Davis
Biological Sciences
M.D.: University of California, Davis
Next Step
Fellowship – Sports Medicine, University
of Utah Sports Medicine
Career Objective
My career objectives are to provide
quality medical care to patients with a
smile on my face, and to always leave
work knowing that I am doing exactly
what I always wanted to do in life.
Spouse
Jasneet Kullar
Personal Statement
It brings me great pride and gratitude
to be able to say I have completed what
I feel is the best residency program in
California. What an amazing ride it
has really been. I feel so lucky to have
learned from such great mentors. Thank
you for your patience and willingness to
put up with me, even if it was painful at
times! Thank you to Margaret, the clinic,
operating room staff, and administrative
staff for making the last five years an
absolute blast.
On a more personal note, thanks to my
family for always being there for me. I
would be nowhere without the constant
support of my sisters, brother-in-laws,
and parents through undergrad, medical
school, and residency. I love you guys,
and I hope I am making you proud
today. I am also fortunate in that I am
clearing two of life’s hurdles in the same
year – getting married and completing
residency. I truly am excited to see what
life has in store. What I do know is that
whatever path my professional career
takes, I will do it with an amazing woman
by my side. I can’t wait to experience
that ride with you, Jasneet.
Good luck to all the juniors. See you
when I see you!
The Properties of the
Subscapularis Following Repair
in Reverse Total Shoulder
Arthroplasty: a Cadaveric and
Biomechanical Analysis
Kullar R, M.D., Anderson M, M.S.,
Van den Bogaerde JM, M.D.
A deltopectoral approach for reverse
total shoulder arthroplasty necessitates
release of the subscapularis for exposure
and implant placement. Recently, some
surgeons have begun repairing the
subscapularis with thoughts that it may
improve internal rotation or it may act as
a sling against anterior escape. We sought
to evaluate the functional integrity of
the subscapularis after reverse shoulder
replacement to cyclic and physiologic
loads, as well as the anatomic orientation
of the muscle after repair.
Twelve paired fresh frozen human
cadaveric shoulder girdle specimens
were dissected of all tissue except the
subscapularis. The scapula and humerus
were potted in polymethylmethacrylate
(PMMA, GC America) with the scapula
in neutral abduction and the humerus
in neutral rotation, and then mounted to
the Instrom.
Initial control measurements were
obtained to measure the intrinsic tension
of the native subscapularis, including a
passive test and active tension force with
a hooked force. A reverse shoulder was
then placed, the subscapularis repaired
through drill holes with #2 Fiberwire
sutures around the stem.
Similar
measurements were taken with the
reverse shoulder in place. Photographs
were taken before and after shoulder
replacement to document the location
of the subscapularis in relation to the
acromion and coracoid.
Data analysis showed a statistically
significant difference in pull ratio as
well as pull stiffness between control
and repair groups. There was also a
statistically significant difference in
passive slope between control and repair
groups, indicating a greater tension
within the subscapularis muscle. There
was no statistically significant difference
in passive maximal pull. There was
failure of the repair in 3 of 12 specimens.
In conclusion, the subscapularis is
significantly less functional after reverse
TSA, generating significantly less torque
and demonstrating higher tension
than control levels.
Three of twelve
repairs failed during testing. Thirdly,
the function of the subscapularis as
an internal rotator after reverse TSA
in physiologic conditions is certainly
limited.
Lance K.
Mitsunaga, M.D.
Administrative
Chief
Education
Undergraduate: Stanford University
M.D.: UC San Diego School of Medicine
Next Step
Orthopaedic Spine Surgery Fellowship at
Kaiser Permanente Northern California
Regional Spine Center in Oakland, CA.
Career Objective
I hope to do whatever I can as a spine
surgeon to affect the lives of my patients
and my community for the better.
Spouse
Mary Tran
Personal Statement
It is with the utmost pride with which I
call myself a graduate of the UC Davis
Department of Orthopaedic Surgery
Residency Program. When I think about
all those who came before me and made
this residency program into what it is
today, I realize how fortunate I am to
be a small part of this tradition. Five
years have abruptly come and gone, but
the lessons I have garnered here over
the years on what it truly means to be
a physician, a surgeon, and—perhaps,
most importantly—a good man, are
immeasurable. To the faculty, staff,
and all my teachers, thank you for your
patience and the knowledge you have
passed on. To my family, I hope I have
made you proud and made the most of
all your sacrifices. And, to Mary and
Cookie, I know the past few years have
not always been easy, but you have both
stayed faithfully by my side through
it all. I have no idea how I’ll ever earn
everything you have given to me, but I’ll
spend the rest of this life trying.
As we say in Hawaii: “A hui hou!” Until
we meet again…
Can a Universal Protocol for
Prevention of Surgical Site
Infections Reduce Postoperative
Infection Rates to Zero in Spine
Surgery Patients?
Lance Mitsunaga, M.D., Marko Tomov,
MSI, Deepak Nallur, B.S., Blythe
Durbin-Johnson, Ph.D., Rolando
Roberto, M.D.
Background: Surgical site infection (SSI)
rates are an important measure of quality
in spine surgery. SSIs in spine surgery
occur at a predictable rate, varying from
less than 1% to more than 10%, depending
on various factors. Postoperative SSIs
in spine surgery can lead to serious
consequences from a patient and socioeconomic standpoint.
Recently,
wound
irrigation
with
dilute betadine solution and the local
application of intra-wound antibiotic
powder prior to wound closure have
both been described to reduce rates of
postoperative spine SSIs.
Purpose: The aim of this study was
to evaluate the efficacy of a universal
protocol combining the use of dilute
betadine irrigation solution and intrawound vancomycin powder in the
prevention of SSIs after spinal surgery.
We hypothesized that implementing
this infection prevention protocol would
reduce SSI rates in spine surgery patients.
We also attempted to determine if there
are any patient or surgical characteristics
associated with SSIs.
Materials and Methods: Effective 1/1/12,
all spine surgery patients received the
study intervention:
Dilute Betadine
irrigation (0.3% weight/volume) and
one gram of vancomycin powder spread
throughout the wound.
All spinal surgery cases performed by
orthopaedic surgery staff physicians at
UCDMC from 2010-2012 were captured
by reviewing Health System databases
and data from NSQIP (National Surgical
Quality Improvement Program). Cases
requiring reoperation to treat SSIs were
identified using Current Procedural
Terminology (CPT) code data. Cases
requiring irrigation and debridement
with
either
subsequent
positive
intraoperative cultures or clinical
suspicion were considered SSI cases. A
chi-square analysis was performed to
compare SSI rates from 2010 and 2011
(prior to implementation of the universal
protocol) to those from 2012 (after the
protocol was initiated).
We also partnered with hospital NSQIP
personnel to obtain details of all spine
surgery infection cases (as well as noninfected control cases) from UCDMC
from the years 2010-2012, including
patient
demographics/co-morbidities
and procedural details. The effect of
patient and surgical characteristics
on the risk of SSI was first analyzed in
a univariate fashion for one patient/
surgical characteristic at a time. Patient/
surgical characteristics with p-values less
than 0.05 in this univariate analyses were
then included together in a multivariable
mixed effects logistic regression model.
Results: In 2010-2012, the total number
of spinal surgeries performed by
UCDMC orthopaedic surgeons was 599,
653, and 693, respectively. The SSI rate
for 2010-2011 (prior to implementing
our universal protocol) was 2.4%. This
was reduced to 1.7% in 2012, after the
protocol was initiated (p=.334).
In our univariate mixed effects logistic
regression analyses, smoking, alcohol
use,
anemia,
dyspnea,
coronary
artery
disease,
congestive
heart
failure,
malignancy,
coagulopathy,
and revision surgery were among the
factors individually associated with
significantly higher odds of SSI. Posthoc testing showed a significantly higher
odds of SSI among patients who had an
operation lasting more than 5 hours and
those who required a blood transfusion.
In our multivariable mixed effects
logistic regression analysis, alcohol use,
anemia, CAD, and revision surgery were
associated with significantly higher odds
of SSI.
Conclusions: Our study clarified SSI
rates in spinal surgery at UCDMC and
identified several patient and procedural
characteristics associated with SSIs. This
is the first step in performing a more
accurate preoperative risk assessment
for SSIs and to focus measures designed
to reduce SSIs. We found that two
specific SSI prevention measures in
spine surgery—topical irrigation with
dilute betadine solution and the simple
application of vancomycin powder—
have the potential to decrease SSI rates,
though we were not able to achieve
statistical significance.
Daemeon A.
Nicolaou, M.D.
Administrative
Chief
Education
B. S.: Neuroscience, UCLA 1994
M.D.: University of Michigan Medical
School, 2008
Next Step
Trauma Fellowship at
Univeristy in St. Louis, MO
St.
Louis
Career Objective
I would like to operate in a high energy
trauma facility specializing in pelvic and
acetabular trauma, as well as periarticular
fractures, malunions and nonunions. I
hope to serve at an institution where the
challenges lead to patient care advances
as I aspire to teach and continue to
learn from my colleagues, teammates,
friends as well as, the next generation of
Orthopaedic residents.
Spouse
I haven’t been lucky enough yet
Personal Statement
I would like to thank first and foremost
my family for all of their love and support
over these many years. They have always
been there supporting me through my
many adventures on this long journey.
I know that I would have never reached
this point in my life without them and
I’m sure I don’t say it enough, but I love
you all and am so thankful to have you.
Dr. Roberto, thank you for always having
our backs no matter the cost to yourself.
It has not gone unnoticed and is certainly
appreciated by all of us.
Miss MacNitt, you have been a life saver
on so many occasions. You really keep
this program and us residents on task
from behind the scenes. Thank you!!
Dr. Salamon, thank you for giving me the
bug to travel to other parts of the world
to share our knowledge of Orthopaedics
and learn from others. Go Blue!!
Dr. Manske, thank you for your zen-like
attitude and helping me develop from a
resident to a surgeon.
Dr. Marder, thank you for showing me
how to be a first class physician both
in and out of the operating room and
making sure I can do an ACL.:)
Dr. Hallare, thank you for allowing me
the chance to feel like a trauma surgeon.
I learned so much in that time and owe
you a debt of gratitude.
Finally, to my trauma mentors: Drs.
Wolinsky, Lee, Ferguson, Yoo and
Eastman. I would like to thank you for all
of your time and interest in my education
and training. I hope to build on the
fundamentals you have taught me. You
have inspired me with your dedication
to excellence, breadth of knowledge and
generous disposition to share with all
of us. You have set a high bar! I look
forward to seeing you all at future events
and conferences. You should certainly
expect to hear from me as I turn to you
for advice about complex cases. :)
Comparison in Fatigue Strength
of Various Plaster Posterior Short
Leg Splint Configurations
Daemeon Nicolaou, M.D., Matthew
Anderson, B.S., Brad Yoo, M.D.
This study looks at the strength of various
posterior short leg splint configurations
using 15 sheets of plaster of paris
splinting material: posterior slab, U-type
splint and rebar configuration. Testing
was done using the 5800R Instron
materials testing machine and cycled to
130N at 0.5 hertz for 10,000 cycles or until
failure. The data found no statistical
difference between the posterior slab and
rebar configurations of splint for cycles
to failure, 90.2 and 59.4 respectively,
whereas the U-type splint did not fail
within 10,000 cycles. From our data, the
standard U-type splint is the strongest
splint configuration and should be
utilized whenever a short leg plaster
splint is warranted in fracture care or
post-operatively.
John David
Burrow, D.O.
Adult
Reconstruction
Fellow
Education
Undergraduate: University of Tennessee
at Martin, Martin, TN
M.D.: Virgina College of Osteopathic
Medicine, Blacksburg, VA
Residency: Orthopaedic Surgery,
UMDNJ, Stratford, NJ
Next Step
Associate in Adult Reconstruction,
Orthopedic Sports and Spine
Newport News, VA
Career Objective
To fullfill the increasing need for primary
arthroplasty and revision arthroplasty
in the upcomming years with a skilled
knowledge base and continue to seek
innovative and progressive ideas in
Adult Reconstruction.
Spouse
Darany Toy, D.O.
Personal Statement
I would like to thank the department of
Orthopaedics at UC Davis as a whole.
The knowledge obtained in review of
patients and lectureship over the last
year will serve as reinforcement for the
obstacles to come.
Additionally for the department of Adult
Reconstruction, I would like to express
my gratitude for the knowledge base
and variety of treatment options that
I was exposed to through the course of
the year. I feel that I have encountered
a wide range of complex patients and
pathology and I am confident that I will
make sound decisions for my patient’s
based on the knowledge acquired this
year.
I look forward to a career that will be in
high demand even in uncertain medical
climate. I will carry the knowledge base
acquired this year to better serve my
patients and hopefully expand upon this
as I evolve through my career.
Evaluation of Knee Kinematics
in the Sagittal and Coronal
Planes in Navigation Assisted
Total Knee Arthroplasty and
Correlation with Three-Month
Postoperative Range of Motion
John David Burrow, D.O.,
Gavin Pereira, M.D.,
MBBS, FRCS(Eng), FRCS(Orth)
Review: Total knee arthroplasty is one
of the most preformed Orthopaedic
surgeries in the United States with
projections to increase four fold over the
next 20 years. In general, postoperative
range of motion is dependent on a
number of factors including preoperative
range of motion. Still it is reported
that 10-20 % of patients do not achieve
complete satisfaction with total knee
arthroplasty. Recent studies suggest
that the postoperative stiffness may be a
result of altered kinematics affecting the
postoperative range of motion.
Methods: In this retrospective review
of 103 patients, 62 patients met the
requirements for inclusion utilizing
Stryker R navigation by a single surgeon
at a single institution, a comparison of
pre operative range of motion in flexion
and extension, as well as variation of
coronal plane from flexion to extension
with post operative and a correlation
between functional outcome at 3 months
in range of motion.
The data collected and saved at the
beginning of surgery after navigational
pins are set and the knee is registered,
is the basis of original kinematics of the
knee. At the time of finishing the surgery
and before removing the trackers, the
knee is taken through a final range of
motion and this data is collected as well.
The pre and post operative data was then
compared to the patient postoperative
range of motion at the three-month
evaluation.
Conclusions: The initial kinematics
compared to the balance of post
implantation kinematics can vary as
noted by data collection. It is thought
that a significant change in the kinematics
may result in less than optimal out comes
for patient satisfaction as noted by post
operative range of motion. Utilizing
Chi square analysis in a population
of 62 patients preformed at a single
institution by a single surgeon, a p value
of 0.00027493 concludes that a statistical
difference exists within the data set and
is further evaluated by odds ratio to
predict expected outcomes.
Todd D.
Cook, M.D.
Spine Fellow
Education
Undergraduate: University of Georgia,
Athens, GA
M.D.: George Washington University
School of Medicine, Washington, DC
Orthopedic Residency: JPS/Tarrant
County Hospital System,
Fort Worth, TX
Next Step
Private Practice Spartanburg, SC
Spouse
Alexis
Children
Kyle and Aiden
Personal Statement
I would like to thank everyone at the UC
Davis Department of Orthopaedics for
their commitment to the education and
guidance of the graduating fellows. This
year has been challenging but has been,
without question, the most fulfilling of
my Orthopedic training. I will always be
grateful for the Spine Faculty who have
shared their wealth of experience and
imparted the values necessary to provide
extraordinary spine care.
Incidence, Risk Factors, and
Outcomes of Proximal Junctional
Kyphosis in Adult Spinal
Deformity Surgery
Todd Cook, M.D., Munish Gupta, M.D.
Spinal fusion for adult spinal deformity
(ASD) is performed to correct sagittal
and coronal imbalance , achieve an
optimal correction and solid arthrodesis.
Proximal junctional kyphosis (PJK) is a
postoperative complication caused by
postoperative increased junctional stress
concentration. The reported incidence
of PJK after long fusion constructs for
ASD ranges from 25-39%. Previous
studies have cited older age, combined
anteroposterior fusion, low bone
mineral density, fusion to the sacrum,
inappropriate global spine alignment,
and greater sagittal vertical axis change
as risk factors for PJK.
Few studies have analyzed long term
follow up or clinical outcome data in
patients with PJK. The clinical outcome,
natural course of PJK, and the risk factors
of developing postoperative PJK have
not been fully defined. The purpose of
this study was to assess the prevalence,
natural course, and risk factors of PJK
after long instrumented spinal fusion for
ASD.
A retrospective review of a prospectively
collected
surgical
database
was
performed. All patients were treated with
long instrumented (> 5 levels) fusions
and had a minimum of 1-year follow-up.
All surgeries were performed at a single
institution by the senior author between
2003 and 2012. Inclusion criteria consisted
of age older than 21 years at the time of
surgery, ASD treated with instrumented
spinal fusion at a minimum 5 motion
segments, and complete radiographic
follow-up.
Complete
radiographic
review required adequate preoperative,
postoperative (6–12 wk), and most recent
follow-up anteroposterior and lateral 36in. long scoliosis radiographs. The effect
of age, sex, BMI, comorbidities, upper
instrumented vertebra (UIV) level, UIV
instrumentation type, surgery type,
global spine alignment (GSA), change
in sagittal vertical axis (SVA), incidence
of PJK, and clinical relevance of PJK was
investigated.
Bryon D.
Hobby, M.D.
Trauma Fellow
Education
Undergraduate: Concordia College,
Moorhead, MN
M.D.: University of Washington School
of Medicine, Seattle, WA
Residency: Orthopaedic Surgery,
University of New Mexico,
Albuquerque, NM
Next Step
Assitant Professor, Department of
Orthopaedics and Rehabilitation,
University of New Mexico,
Albuquerque, NM
Career Objective
I
look
forward
to
providing
comprehensive orthopaedic care to
trauma patients as well as educating
residents.
Spouse
Stephanie Hobby
Children
Maryn Hobby
Personal Statement
I would like to thank everyone at
University of California Davis Medical
Center’s Orthopaedic Department for
an excellent fellowship year. I would
especially like to thank the Trauma
Faculty for sharing their expertise and
guidance throughout the year. I look
forward to continuing relationships with
the faculty here and am excited to use
my experiences from my fellowship year
in my practice in New Mexico.
Igor
Immerman, M.D.
Hand Fellow
Education
Undergraduate: Johns Hopkins
University, Baltimore, M.D.
M.D.: Case Western Reserve University,
Cleveland, OH
Residency: NYU Hospital for Joint
Diseases, New York, NY
Next Step
A year of traveling together with my
wife in Israel and Russia. I plan on
spending time at academic Hand Surgery
departments in Jerusalem, Moscow, and
Saint Petersburg.
Career Objective
Academic practice focused on the Upper
Extremity and Hand Surgery
Spouse
Olesya Shayduk-Immerman
Personal Statement
I wish to thank the entire faculty of the
Department of Orthopaedic surgery for
the wonderfully educational experience
of the past year. I also want to thank all the
hardworking residents of the department
– it has been a pleasure learning with you,
and from you. Above all, I wish to thank
my mentor Dr Szabo, and the members
of the Hand Surgery faculty – Drs Allen,
James, and Bauer, for your teaching,
guidance, and mentorship. Your lessons
will remain with me throughout my
career, and I hope that you can continue
to be my mentors and advisors for years
to come.
Real-time 2D and 3D MR Imaging
During Active Wrist Motion
Igor Immerman, M.D., Robert D. Boutin,
M.D., Michael H. Buonocore, M.D., Ph.D.,
Zachary Ashwell, Robert M. Szabo, M.D.,
M.P.H., and Abhijit J. Chaudhari, Ph.D.
Hypothesis: Rapid magnetic resonance
imaging (Active-MRI) protocol can be
utilized to evaluate the wrist during realtime active motion, and the resulting
images enable measurement of metrics
typically evaluated in the setting of wrist
instability.
Methods: A 3T MR protocol utilizing
a balanced steady-state free precession
(bSSFP) pulse sequence (TrueFISP,
Siemens Healthcare, Inc.) was developed
for imaging the wrist at a single plane
during active movement, with 0.94mm x
0.94mm in-plane spatial resolution, 6mm
slice thickness, and temporal resolution
of 475ms per image (2D Active-MRI). To
measure motion parameters that occurred
out of the single plane, novel real-time 3T
MRI protocols were developed, utilizing
another bSSFP sequence (FIESTA, GE
Healthcare, Inc.) in 3D acquisition
mode. Volumetric data was obtained
during active motion, in different scans
providing the following isotropic spatial
and temporal resolutions: 1.2mm and
5.03s; 1.6mm and 2.95s, 2.0mm and 2.12s
(3D Active-MRI).
Fifteen wrists of asymptomatic volunteers
were scanned with 2D Active-MRI, and
four wrists of asymptomatic volunteers
were scanned with 3D Active-MRI
protocols. Specifics of evaluated motions
and measurements are shown in Figure 1.
All measurements were performed by
consensus of two experienced observers
(fellowship-trained
musculoskeletal
radiologist and an orthopedic hand
surgeon) in neutral and at the maximal
endpoints of the range of motion.
Results: The real-time 2D Active-MRI
imaging protocol allowed measurements
of parameters in the single plane of the
examined wrist motion (see Table 1).
3D volume rendering was able to show
out-of-plane movement and allowed
more precise measurements. Ulnar
variance was only measured in one wrist.
In pronation, neutral, and supination
UV was -1mm, -2mm, and -4mm,
respectively. The SL and CL angles were
measured in radial/ulnar deviation in
4 wrists. The mean SL angles in ulnar
deviation, neutral, and radial deviation
were 600, 720, and 680, respectively.
The mean CL angles in ulnar deviation,
neutral, and radial deviation were 00,
130(volar), and 20(dorsal), respectively.
Summary Points:
•
High resolution real-time 2D
single plane and 3D volumetric MR
images of the wrist can be successfully
acquired during active wrist motion with
negligible artifacts.
•
Active-MRI can be successfully
used to obtain objective information
relevant to wrist mechanics and
instability with no radiation exposure.
•
Active-MRI of the wrist is much
faster than routine “static” 2D and 3D MR
imaging, and may assist in a physiologic
and functional imaging evaluation.
Figure 1 – Images obtained and
parameters measured during active
wrist motion
ECU – extensor carpi ulnaris; DRUJ –
distal radioulnar joint; SL – scapholunate;
CL – capitolunate; RL - radiolunate
Table I: Quantitative metrics derived
from 2D motion-MRI images of the
wrist during the different maneuvers.
* One volunteer unable to complete the
pronation/supination motion protocol
** DRUJ Subluxation ratio, as described
by Park et al, JBJS(Am) 2008
*** The wrist harness limited the
ability for achieving the full range of
volarflexion in a subset of volunteers
therefore measurements for volarflexion
are not reported.
Thu-Ba LeBa, M.D.
Pediatric Fellow
Education
Undergraduate: Cornell University,
Ithaca, NY
Graduate: Columbia University,
New York, NY
M.D.: Tulane University,
New Orleans, LA
Residency: Orthopedic Surgery, UTMB,
Galveston, TX
Next Step
Pediatric Orthopaedic Surgeon
Department of Orthopaedic Surgery
Children’s Hospital of Central California
Madera, California
Spouse
Brandon Vo
Personal Statement
This past year has been a fantastic year of
learning and growth for me. I would like
to thank all my mentors at the Shrine and
at UC Davis for their continued teaching,
guidance, and encouragement. As I start
the next stage of my career, I aim to put
forth all that you have taught me about
being a compassionate doctor and a
skilled surgeon. I know our relationship
will continue to grow in the coming
years, as I will only be “down the road,”
and I look forward to it.
Scar Recurrence After Excision in
the Pediatric Population
Thu-Ba LeBa, M.D., Kevin Diaz, B.S.,
Samuel Adams, M.D., Jon Davids, M.D.
The purpose of this study is to determine
the recurrence of scars after excision at the
time of revision surgery in the pediatric
orthopaedic population. Children often
undergo hardware removal. Reasons for
removal may be for resumption of normal
growth or for lessening the difficulty of
removal later on due to bone overgrowth.
However, it is unclear how the previous
scars should be addressed. Assessment
of scar healing has been addressed in the
burn and plastics literature, but not in
orthopaedic surgery.
This was a prospective study of 37 patients
undergoing 58 hardware removals
from the tibia or femur. Patients were
examined preoperative, at 6 months and
at 12 months post surgery. Photographs
of the scars were taken at each visit. The
decision to revise the scar was made by
the surgeon at the time of the surgery. At
each clinical visit, a questionnaire with
a visual analog scale was completed to
assess the patient’s satisfactory of the
scar. Objective assessment of the scar was
performed by 2 orthopaedic surgeons
and a medical student using the Stony
Brook Scar Evaluation Scale.
The hypotheses of the study include: 1)
the Stony Brook Scar Evaluation Scale
can be used as a preoperative modality to
determine the necessity of scar revision;
2) Revised scars have a better appearance
at one year after surgery compared to the
preoperative appearance; and 3) Scars
that are deemed not necessary to revise
(having a midline incision) are no worse
at one year after surgery than before
surgery.
Peter D.
Rinaldi, D.O.
Sports Fellow
Education
Undergraduate: Eastern Washington
University, Cheney, WA
M.D.: Touro University College of
Osteopathic Medicine, Mare Island, CA
Residency: Orthopaedic Surgery,
Riverside County Regional Medical
Center, Moreno Valley, CA
Next Step
Currently interviewing for a private
practice position in Sacramento
Career Objective
I would like to build on my experience
through residency and fellowship for a
few years before seeking a teaching
position at an orthopaedic residency
program.
Spouse
Caroline Rinaldi
Personal Statement
I feel very blessed to have had the
opportunity to complete my Fellowship
here as part of the UC Davis Department
of Orthopaedic Surgery. It is impossible
to measure the influence of a mentor
on one’s development as a surgeon,
especially considering the thousands of
patients over the course of a career who
subsequently benefit from that influence.
I would like to thank the Sports Medicine
Faculty for your dedication, wisdom
and technical instruction as you served
as mentors to me this year. I believe
that the excellence of this department
is derived from its Faculty leadership
and that is manifested in the quality of
Residents selected to train at UCD. The
residents here are a great group and I
am grateful to them for enriching my
learning experience. I hope I was able to
contribute equally to your development
as you did to mine. Thank you also to
the Orthopaedic Department, Same Day
Surgery Center & J-Street clinic staff who
made my days here so enjoyable. If I can
deliver the same quality of care with
the personal touch that is the standard
here, my career will undoubtedly be
successful as measured by many healthy
and satisfied patients.
Effect of Knee Flexion Angle
During Medial Patellofemoral
Ligament Graft Fixation on
Patellofemoral Contact Pressures
Richard A. Marder, M.D.; Peter Rinaldi,
D.O.; Matthew Anderson, M.S.
Medial patellofemoral ligament reconstruction has been a popular topic in the
orthopaedic literature of late. There are
numerous techniques with several graft
options, fixation methods and points of
fixation described. A PubMed search for
“medial patellofemoral ligament reconstruction” returned 230 articles reflecting
an increase of 10 articles in one month’s
time. Recently, there have been a number
of articles highlighting the complications
encountered after MPFL reconstruction.
Published complication rates range from
15 to 20 percent overall, with complications requiring reoperation including
patellofemoral arthrosis, pain and decreased range of motion in addition to
recurrent patellar instability.
The purpose of this study is to determine
the optimal degree of knee flexion at
which to position the knee during MPFL
graft tightening and fixation to minimize
joint contact pressures during a flexionextension arc. In this biomechanical
study, we placed force transducers in
the subchondral bone of each cadaveric
specimen’s medial and lateral patellar
facets. The knees were cycled through a
range of motion, analyzing the resultant
patellar contact pressures after fixation
of the MPFL graft with the knee at zero,
15, 30 and 60 degrees of flexion, respectively. By minimizing contact pressure
felt at the articular surface, postoperative
pain, arthrosis, motion deficits and resultant need for additional surgery could be
reduced.
David L.
Rothberg, M.D.
Trauma Fellow
Education
Undergraduate: Oregon State University,
Corvallis, OR
M.D.: University of North Dakota, Grand
Forks, ND
Residency: University of Utah, Salt Lake
City, UT
Next Step
Assistant Professor, Department of
Orthopaedics, University of Utah, Salt
Lake City, UT
Career Objective
University Orthopaedic Trauma
Spouse
Suzanne O’Rourke Rothberg
Children
Evelyn Birdie Rothberg
Personal Statement
I would like to thank the UC Davis
Department of Orthopaedics for the
opportunity to train in the Trauma
Division. This has been an invaluable
year of learning that I will use for the rest
of my career and I am very grateful and
honored to have been here.
Posterior Facet Cartilage Injury
in Operatively Treated Intraarticular Calcaneus Fractures
David L. Rothberg, M.D., Bryon D.
Hobby, M.D., Brad J. Yoo, M.D.
Objective: To investigate the incidence
of posterior facet articular injury in joint
depression calcaneus fractures treated
with open reduction internal fixation.
The location, size, and depth of the
articular injury will also be examined.
Design: Prospective,
Cohort Study
Observational
Setting: Regional Trauma Center (Level
1)
Participants: A single surgeon series of
28 patients with 29 joint depression intraarticular calcaneus fractures.
Intervention: Intra-operative,
observational data collection.
Main Outcome Measures: Patient
demographic
and
injury
data,
radiographic fracture characterization,
and intraoperative observation of
articular injury size, depth, and location
will be recorded. Observations will be
correlated with the OTA and Sanders
classification systems.
Results: Age, sex, mechanism of injury,
and depth and location of cartilage
injury are not significantly different
between the 14 OTA/Sanders type 2
and 15 type 3 DIACF’s evaluated in this
study (p > 0.05). Posterior facet articular
cartilage delamination is found in 79%
of type 2 and 100% of type 3 fractures
(p = 0.10). Location of cartilage injury is
commonly (48%) along the distal, lateral
aspect of the posterior facet (p = 0.002).
The percentage area of cartilage injury
is significantly larger in type 3 fractures
(3.1%) then type 2 (1.3%) (p = 0.02).
Conclusions: DIACF’s have a consistent
location of posterior facet articular
cartilage delamination along the distal
lateral aspect of the osteo-articular
fragment. This lesion is larger in OTA/
Sanders classification type 3 fractures
compared to type 2 fractures.