A NOVEL DESIGN OF A ROBOTIC GLOVE SYSTEM FOR PATIENTS WITH BRACHIAL PLEXUS INJURIES.

This paper presents the design of an exoskeleton glove system for people who suffer from the brachial plexus injuries in an effort to restore their lost grasping functionality. The robotic system consists of an embedded controller and a portable glove system. The glove system consists of Linear Series Elastic Actuators (SEA), Rotary SEA and optimized finger linkages to provide motion to each finger and a coupled motion of the hand and the wrist.

INTEGRATED AND CONFIGURABLE VOICE ACTIVATION AND SPEAKER VERIFICATION SYSTEM FOR A ROBOTIC EXOSKELETON GLOVE.

Efficient human-machine interface (HMI) for exoskeletons remains an active research topic, where sample methods have been proposed including using computer vision, EEG (electroencephalogram), and voice recognition. However, some of these methods lack sufficient accuracy, security, and portability. This paper proposes a HMI referred as integrated trigger-word configurable voice activation and speaker verification system (CVASV).

Longitudinal white-matter abnormalities in sports-related concussion: A diffusion MRI study.

Objective: To study longitudinal recovery trajectories of white matter after sports-related concussion (SRC) by performing diffusion tensor imaging (DTI) on collegiate athletes who sustained SRC.

Methods: Collegiate athletes (n = 219, 82 concussed athletes, 68 contact-sport controls, and 69 non-contact-sport controls) were included from the Concussion Assessment, Research and Education Consortium. The participants completed clinical assessments and DTI at 4 time points: 24 to 48 hours after injury, asymptomatic state, 7 days after return-to-play, and 6 months after injury.

Long-Term Outcomes of Spring-Assisted Surgery for Sagittal Craniosynostosis.

Background: Spring-assisted surgery is an accepted alternative to cranial vault remodeling for treatment of sagittal craniosynostosis. The long-term safety and efficacy profiles of spring-assisted surgery have not been established.

Methods: This study is a retrospective examination of all patients treated with spring-assisted surgery (n = 175) or cranial vault remodeling (n = 50) for sagittal craniosynostosis at the authors' institution from 2003 to 2017.

Modeled Wide-Awake, Local-Anesthetic, No-Tourniquet Surgical Procedures Do Not Impair Driving Fitness: An Experimental On-Road Noninferiority Study.

Background: The use of wide-awake, local-anesthetic, no-tourniquet (WALANT) surgical techniques is increasingly common, and patients commonly ask whether they may drive home following these procedures. The impact of a numb hand and bulky dressing on driving fitness is unknown, and there is no literature to guide surgeons when counseling these patients. Thus, the primary objective of the present study was to determine driving fitness following a modeled-WALANT procedure.

Postoperative Anemia Predicts Length of Stay for Geriatric Patients Undergoing Minimally Invasive Lumbar Spine Fusion Surgery.

Introduction: We hypothesize that postoperative anemia will predict length of stay (LOS) for geriatric patients undergoing minimally invasive (MIS) lumbar spine fusions.

Materials And Methods: Patients who underwent MIS lateral and transforaminal lumbar interbody fusion between January 2017 and March 2018 at an academic tertiary care referral center were selected. Eighty-one patients were included.

Opioids and Spinal Cord Stimulators: Pre- and Postoperative Opioid Use Patterns and Predictors of Prolonged Postoperative Opioid Use.

Objective: The aim of the study was to compare trends and differences in preoperative and prolonged postoperative opioid use following spinal cord stimulator (SCS) implantation and to determine factors associated with prolonged postoperative opioid use.

Methods: A database of private-payer insurance records was queried to identify patients who underwent a primary paddle lead SCS placement via a laminectomy (CPT-C3655) from 2008-2015. Our resulting cohort was stratified into those with prolonged postoperative opioid use, opioid use between 3- and 6-month postoperation, and those without.

Proper Disposal of Prescription Opioids in Southwest Virginia: Assessment of Patient, Physician, and Medical Student Beliefs and Practices.

Context: Southwestern Virginia demonstrates the highest regional mortality rate from prescription opioid overdoses. Nationally, 65% of patients misusing opioid medications received them from friends and family, underscoring the need for effective disposal of unused narcotics.

Objectives: (1) To understand patient, provider, and medical student beliefs and misconceptions regarding proper methods of opioid disposal; (2) to characterize discrepancies that exist between patient self-reported habits and medical student/provider perceptions of opioid usage, disposal, and diversion.

Demographic Trends in Paddle Lead Spinal Cord Stimulator Placement: Private Insurance and Medicare Beneficiaries.

Objective: Although spinal cord stimulators (SCS) continue to gain acceptance as a viable nonpharmacologic option for the treatment of chronic back pain, recent trends are not well established. The aim of this study was to evaluate recent overall demographic and regional trends in paddle lead SCS placement and to determine if differences in trends exist between private-payer and Medicare beneficiaries.

Methods: A retrospective review of Medicare and private-payer insurance records from 2007-2014 was performed to identify patients who underwent a primary paddle lead SCS placement via a laminectomy (CPT-63655).

Effect of Prescription Size on Opioid Use and Patient Satisfaction After Minor Hand Surgery: A Randomized Clinical Trial.

Objective: To determine the influence of initial prescription size on opioid consumption after minor hand surgeries. Secondary outcomes include efficacy of pain control, patient satisfaction, and refill requests.

Background: Retrospective studies have shown that opioid prescriptions for acute pain after surgical procedures are often excessive in size, which encourages misuse.

Use of Observation Status Versus Readmission in Elective Total Knee and Hip Arthroplasty Returns to Hospital: A Single-Institution Perspective.

Background: The Affordable Care Act's Readmission Reduction Program (RRP) and ongoing transparency efforts to promote consumer-driven competition place significant institutional focus on improving 30-day readmission rates. It remains unclear whether the reduction in readmission rates subsequent to the RRP occurred due to improved quality and/or partly due to increased use of observation status in conditions that may have been classified as readmissions prior to the RRP. We hypothesize that a significant percentage of our institution's 30-day readmissions after elective total knee and hip arthroplasty (TKA/THA) overestimate the needs, duration, and complexity of the hospital-based intervention and inaccurately reflect the quality of service provided.

Gait Analysis Reveals that Total Hip Arthroplasty Increases Power Production in the Hip During Level Walking and Stair Climbing.

Background: total hip arthroplasty (THA) is associated with decreased pain and improved function, including increased walking speed, but it does not always improve overall joint mechanics during activities of daily living such as level walking and stair climbing. The hip's ability to generate power to move and allow for smooth and efficient forward motion is critical to success after surgery. Although osteoarthritis (OA) of the hip limits the power of the affected joint, it is not known whether other joints in the affected limb or in the contralateral limb need to produce more power to compensate.

The role of prehabilitation with a telerehabilitation system prior to total knee arthroplasty.

Background: The purpose of the current study was to evaluate the usage of prehabilitation on a telehealth platform prior to total knee arthroplasty (TKA) and its impact on short-term outcomes. Specifically, the study examined whether patients participating in a prehabilitation program impacted length of stay (LOS) and discharge disposition.

Methods: A total of 476 consecutive patients who underwent TKA at three institutions were included.

Soft Tissue Reconstruction for Deep Defects over a Complicated Total Knee Arthroplasty: A Systematic Review.

Deep soft tissue defects after complicated primary or revision total knee arthroplasty (TKA) can be devastating to the patient and technically challenging. The purpose of this review was to (1) discuss different methods used to provide coverage for deep defects of the knee following TKA, as well as to (2) report on their success rates. A comprehensive literature search was performed.

An Innovative Method for Plantar Plate Repair: Technique Guide and Case Report.

Disruption of the plantar plate is a common cause of forefoot pain, metatarsalgia, and metatarsophalangeal joint malalignment. Although surgical repair of the plantar plate has improved, there has been no consensus on the clinical superiority of any single technique, or combination of techniques, described in the literature to date. In this publication, we report a case of plantar plate injury treated with an innovative new technique with 20-month follow-up.

Primary Acromioclavicular-Coracoclavicular Reconstruction Using 2 Allografts, TightRope, and Stabilization to the Acromion.

Acromioclavicular (AC) joint injuries are a common cause of shoulder pain, particularly among young athletes participating in contact sports. Injuries to the AC joint most commonly occur from direct impact at the acromion and are classified as types I to VI. Although most AC joint injuries can be treated nonoperatively, types IV to VI are best treated with surgery, with type III being controversial and most surgeons recommending an initial trial of nonoperative treatment.

Orthopedic surgeons' views on the osteoporosis care gap and potential solutions: survey results.

Introduction: Osteoporosis is often not recognized until one or more fractures occur, yet post-fracture screening remains uncommon. Orthopedic surgeons are well situated to address this care gap. Both a protocol-based approach and fracture liaison services (FLS) have been proposed.

Cementless 3D Printed Highly Porous Titanium-Coated Baseplate Total Knee Arthroplasty: Survivorship and Outcomes at 2-Year Minimum Follow-Up.

Newer generation cementless total knee arthroplasty (TKA) implants continue to develop with demonstrated clinical success in multiple recent reports. The purpose of this study was to investigate (1) survivorship, (2) complications, and (3) clinical outcomes of a newer generation cementless and highly porous titanium-coated base plate manufactured using three-dimensional (3D) printing technology. We reviewed a single-surgeon, longitudinally maintained database of patients who underwent primary TKA using cementless, highly porous titanium-coated base plate implants from July 1, 2013 to December 31, 2016.

An increased Bax/Bcl-2 ratio in circulating inflammatory cells predicts primary response to infliximab in inflammatory bowel disease patients.

Background: Predicting the response of inflammatory bowel disease (IBD) patients to infliximab (IFX) is an unmet clinical need. The expression and density of transmembrane tumor necrosis factor-α in circulating leukocytes maybe directly related to response by promoting apoptosis.

Aim: We tested the hypothesis that direct apoptosis assessment by real-time polymerase chain reaction evaluation of pro-apoptotic (Bax) and anti-apoptotic (Bcl-2) proteins in peripheral blood mononuclear cells (PBMCs) might be associated with response to IFX.

Incidence, Positional Distribution, Severity, and Time Missed in Medial Collateral Ligament Injuries of the Knee in NCAA Division I Football Athletes.

Introduction: We studied injury to the medial collateral ligament (MCL) in National Collegiate Athletic Association (NCAA) Division I football players, their incidence, magnitude of injury, distribution by position, and missed time, which has not previously been described in a consecutive series.

Methods: The knee injuries sustained in 163 consecutive NCAA Division I collegiate football players at our institution were evaluated over a span of 6 years.

Results: The incidence of MCL injuries with any knee injury was 29% (47 of 163).

Operative Time, Length of Stay, Short-Term Readmission, and Complications after Hinged Primary Total Knee Arthroplasty: A Propensity Score Matched Analysis.

Despite the wide utilization of total knee arthroplasty (TKA), it can be technically challenging to perform in patients who have concomitant bone loss, ligamentous laxity, or high-grade deformity, whether in a revision situation or due to a primary pathology. Therefore, hinged knee prostheses have been developed to provide more stable fixation in these situations. The purpose of this study was to compare the short-term peri- and postoperative outcomes of patients undergoing primary TKA with and without hinged prosthesis.

Is ICD-9 Coding of Morbid Obesity Reliable in Patients Undergoing Total Knee Arthroplasty?

Morbid obesity is considered to have a stronger association with complications after total knee arthroplasty (TKA). Although the impact of obesity coding errors has been previously reported, the extent of coding inaccuracies with respect to morbid obesity is unclear. Therefore, the purpose of this study was to assess (1) the utility of coding in identifying morbid obesity and (2) the effects of morbid obesity on 90-day complications after TKA when morbid obesity was defined by both body mass index (BMI) and International Classification of Diseases 9th edition (ICD-9) coding.

Rates of osteoporosis screening and treatment following vertebral fracture.

Background Context: Osteoporosis remains an underrecognized and undertreated disease entity in the orthopaedic setting, accounting for substantial long-term morbidity and mortality. Osteoporosis is often not diagnosed or treated until multiple fractures have occurred. Vertebral compression fractures are the most common sentinel fracture, providing an opportunity to intervene with antiresorptive therapy before more debilitating fractures occur.