389 results match your criteria: "Paley Orthopedic & Spine Institute at St. Mary's Medical Center[Affiliation]"

Introduction: Many interventional strategies are commonly used to treat chronic low back pain (CLBP), though few are specifically intended to target the distinct underlying pathomechanisms causing low back pain. Restorative neurostimulation has been suggested as a specific treatment for mechanical CLBP resulting from multifidus dysfunction. In this randomized controlled trial, we report outcomes from a cohort of patients with CLBP associated with multifidus dysfunction treated with restorative neurostimulation compared to those randomized to a control group receiving optimal medical management (OMM) over 1 year.

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Background: The purpose of this study was to report the clinical and psychological outcomes of using a locking compression plate (LCP) as a sequential external fixator following the distraction phase in the treatment of tibial bone defects caused by fracture-related infection (FRI).

Methods: We retrospectively analyzed the clinical records and consecutive X-ray images of patients with tibial bone defects who were treated with an LCP as a sequential external fixator following the distraction phase, between June 2017 and December 2022. The ASAMI criteria were applied to assess the bone and functional outcomes, and postoperative complications were evaluated by using the Paley classification.

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Background: Swimming is one of the most common sporting activities in the United States, and often popular among shoulder arthroplasty patients. While return to sport has become a popular topic recently, the literature focused on swimming is limited. The purpose of this study is to report the rate of return to swim after primary shoulder arthroplasty and evaluate changes in performance after surgery.

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Correction of Ankle Malalignment in Severe Fibular Hemimelia.

J Pediatr Orthop

December 2024

Department of Spine Disorders and Pediatric Orthopedics, Poznan University of Medical Sciences, Poznan, Poland.

Background: Management of ankle joint deformity and instability are challenging issues in congenital fibular hemimelia (FH). This study aims to assess how much the SUPERankle procedure improves ankle alignment and provides durable ankle stability in patients with severe FH.

Methods: Seventeen children aged 53.

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Article Synopsis
  • The study aimed to analyze how changes in upper lumbar lordosis after spinal fusion affect the alignment of unfused lower lumbar segments in patients with Adolescent Idiopathic Scoliosis.
  • A retrospective review was conducted on 158 patients who underwent posterior spinal fusion, focusing on various spinal measurements and using MATLAB for 3D calculations.
  • Results indicated that increased upper lumbar lordosis influenced the lordotic shape of distal unfused segments, with varying impacts based on the specific levels of fusion, while overall sagittal alignment remained stable.
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  • The study examines the impact of implant density on outcomes in posterior spinal fusion surgery for adolescent idiopathic scoliosis (AIS), revealing limited differences between high-density and moderate-density screw constructs.
  • A total of 1865 patients were analyzed, showing similar age, sex distribution, and radiographic results, with slight advantages for high-density constructs in curve correction.
  • Overall, the findings suggest that moderate-density constructs can be effectively used in routine AIS surgeries, as both densities resulted in comparable patient-reported and radiographic outcomes after two years.
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Diagnosis and Management of Orthopaedic Conditions Associated With Hereditary Sensory Autonomic Neuropathies.

J Am Acad Orthop Surg

November 2024

From the Paley Orthopedic and Spine Institute, West Palm Beach, FL (Nugraha, Hariharan, Huser, and Feldman), and Department of Surgery, Florida Atlantic University School of Medicine (Hariharan and Feldman), Boca Raton, FL.

Hereditary sensory and autonomic neuropathies (HSANs) encompass a diverse group of inherited neuropathies characterized by notable sensory and autonomic involvement that affects musculoskeletal structures and systemic function. There are 8 recognized types of HSAN. The orthopaedic manifestations of HSAN are complex and diverse, including spinal deformity, Charcot arthropathy, osteomyelitis, fractures, osteonecrosis, osteoporosis, and skeletal deformities.

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  • The Ilizarov method is a key technique for treating bone defects and nonunion, often enhanced by additional methods like the accordion maneuver, but there's limited research on its combined use for long bones in the lower limbs.
  • This study aims to systematically review the effectiveness of combining the Ilizarov method with the accordion technique specifically for treating deficiencies in long bones of the lower limbs, following PRISMA guidelines.
  • Analyzing data from eight studies involving 80 patients, the review assessed bone healing rates, functional outcomes, and complications, finding that 24% of patients had femoral defects.
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Objective: At present, due to the lack of early observation methods, the effect of the 'accordion' technique on the treatment of nonunion of the docking site varies greatly. In this study, color Doppler ultrasound was used to observe the docking site's local changes and investigate the relationship between local microenvironment changes and bone healing after the accordion technique.

Methods: 30 patients with tibial bone transport treated at the Department of Orthopedics, Second Hospital of Shanxi Medical University, from May 2018 to June 2022, were analyzed retrospectively.

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  • * A total of 2.1% of patients (n=138) experienced dislocations, primarily within the first 90 days post-surgery, with different treatment approaches for dislocation including closed reduction, open reduction, revision arthroplasty, or benign neglect.
  • * Among those treated with closed reduction, only 31% were successfully resolved without further intervention, while many either required revision surgery or experienced recurrent dislocations, highlighting the complexity of managing these postoperative complications.
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Purpose: Chronic osteomyelitis with large bone defects remains a challenging condition in orthopedic surgery. This study aimed to evaluate the clinical efficacy of hemicorticotomy bone transport assisted by 3D-printed customized guides in the treatment of chronic osteomyelitis with bone defects.

Methods: A retrospective analysis was conducted on 21 patients with chronic osteomyelitis treated with hemicorticotomy bone transport with 3D-printed guide assistance between January 2015 and January 2021.

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  • The American Society of Pain and Neuroscience (ASPN) recognizes a need for guidelines to help healthcare providers effectively use social media for best practices.
  • A panel of experts conducted research and analyzed literature to develop these best practices for healthcare professionals engaging online.
  • It's essential for providers to understand the impact of social media on patient perceptions and to navigate legal and ethical issues while maintaining a clear and educational online presence.
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Background: The accurate estimation of residual growth is crucial for the appropriate timing of growth-guiding surgery in patients with axial leg deviations. Skeletal age methods such as the Modified and the Abbreviated Modified Fels Knee System were developed on historical patient cohorts and the applicability to the modern pediatric population with axial leg deviation has not yet been evaluated.

Questions/purposes: Are both final adult height prediction methods (the Modified Fels Knee System (FKS) and the Abbreviated Modified Fels Knee System (aFKS)) accurate to determine SA and the final adult height on long leg radiographs in patients with axial leg deviations?Which multiplier table shows highest association between predicted and true final adult body height?Do FKS- and aFKS- skeletal age determination methods improve final adult body height prediction accuracy compared to the simple use of chronological age?

Methods: A single center, retrospective study of 31 patients who underwent temporary hemiepiphysiodesis due to axial leg deviations in the frontal plane between 2018 and 2020 was conducted.

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Aim: Congenital pseudarthrosis of the tibia (CPT) is a rare, dysplastic condition causing significant disability in the lower limbs. A treatment aims to achieve long-lasting union, prevent limb length discrepancies, and prevent soft tissue lesions. Traditional surgery often yields satisfactory results, but amputation may be proposed in failed cases.

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Background: Surgery for knee flexion contractures in patients with arthrogryposis multiplex congenital (AMC) have achieved extension to redirect the arc of motion and improve ambulation but has not demonstrated maintained increases in total range of motion (ROM). This study aimed to review the clinical outcomes of combined posterior knee release, proximal femoral shortening, and nerve decompression in patients with arthrogryposis.

Methods: A retrospective chart and radiographic review were performed on patients with AMC who underwent treatment for knee flexion deformities ≥30 degrees.

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[Clinical study of Cross-Union surgery for treatment of pseudarthrosis of tibia with neurofibromatosis type 1 in children].

Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi

October 2024

Department of Pediatric Orthopedics, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, 201102, P. R. China.

Article Synopsis
  • The study aimed to assess the effectiveness of Cross-Union surgery in treating tibial pseudarthrosis in children with neurofibromatosis type 1 (NF1).
  • Eight patients, aged between 1.8 and 13.3 years, had their clinical data analyzed for outcomes such as bone healing and any recurrence of fractures after surgery.
  • Results indicated an overall healing rate of 87.5% with no new fractures during follow-up, though some patients did experience minor leg length discrepancies and persistent ankle valgus.
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Background: Arthrogryposis multiplex congenita (AMC) encompasses congenital conditions with joint contractures in 2 or more joints. Patients with AMC may have scoliosis and neural axis malformations. The study aimed to determine the prevalence of tethered spinal cord (TSC), characterized by a low-lying conus medullaris, and secondarily, present preliminary findings following surgical untethering in children with AMC.

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Article Synopsis
  • * The workshop aimed to address the lack of understanding among physicians about the pathophysiology, radiology, and orthopedic options for managing long bone deformities in children with achondroplasia.
  • * The event featured presentations from a multinational survey, lectures, a debate, and interactive discussions, attracting 150 participants from 71 cities across 31 countries.
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Consent in Limb Lengthening Surgery: Predicting the True Incidence of Material Risk.

Strategies Trauma Limb Reconstr

August 2024

The Catterall Unit, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex, HA7 4LP, United Kingdom.

Aim: The consent process involves supported decision-making between the surgeon and the patient. Both potential benefits and material risks of the procedure require explanation, with adequate time for reflection. The complexity of limb reconstruction surgery includes the potential for multiple types of complications.

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  • The study aimed to evaluate how effective the iliac myocutaneous flap, which is supplied by the deep circumflex iliac artery, is for repairing complex wounds in the lower limbs that have cavities.
  • Seven patients (4 males, 3 females) aged 24-58 were analyzed, all with severe lower limb injuries due to various accidents; injury classifications indicated a range of bone and soft tissue damage.
  • Results showed that all flaps except one (which experienced partial necrosis) survived, with a successful healing rate and average bone healing time of 7.3 months, indicating the procedure's effectiveness for complex lower limb defects.
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  • Achondroplasia is a common skeletal disorder characterized by disproportionate short stature, and vosoritide is a new treatment that aims to enhance growth in affected children, while limb surgery remains a typical method to improve height and functionality.* -
  • An expert panel of 17 clinicians evaluated 120 statements regarding the combination of vosoritide and limb surgery, achieving high agreement on key principles such as setting goals for height and using a multidisciplinary approach for treatment.* -
  • Although many statements received unanimous support, there was some disagreement on the timing and effects of combining these treatments, indicating a need for more data to guide best practices.*
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Objective: Severe limb amputation trauma often results in bone and soft tissue defects after debridement. Traditional replantation aims to save the limb by shortening the ischemic period and using autologous transplantation for repair, but it can lead to surgical trauma, donor site damage, and prolonged operation time. Due to contusion, pollution, and complex injury, there is no unified standard for replantation and fixation.

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Introduction: Foot and ankle pathology can often require complex surgical reconstruction. Until recently, circular external fixators such as the Ilizarov frame have proven to be useful, yet they fall short when progressive, precise corrections are required. Computer-assisted hexapod external fixators seek to address many of the shortfalls of traditional circular fixators.

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: Severe spinal deformity manifests as a pronounced deviation from the normal curvature of the spine in the frontal, sagittal, and horizontal planes, where the coronal plane curvature exceeds 90 degrees and may coincide with hyperkyphotic deformity. The most severe deformities exhibit rigidity, with flexibility below 30%. If left untreated or improperly treated, these deformities can result in serious complications associated with progression of the curvature.

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