64 results on '"Andrew J. Rosenbaum"'
Search Results
2. Diagnostic Performance and Advanced Imaging Reduction With Digital Tomosynthesis in Scaphoid Fracture Management
- Author
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Keegan Cole, David Quinn, Andrew J. Rosenbaum, Sarah Sternbach, and Eric Perloff
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medicine.medical_specialty ,medicine.medical_treatment ,Scaphoid fracture ,Wrist ,030218 nuclear medicine & medical imaging ,Fractures, Bone ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Humans ,Orthopedics and Sports Medicine ,Fractures, Closed ,Medical diagnosis ,Reduction (orthopedic surgery) ,Retrospective Studies ,Scaphoid Bone ,Modality (human–computer interaction) ,business.industry ,Hand Injuries ,Wrist Injuries ,medicine.disease ,Tomosynthesis ,medicine.anatomical_structure ,030220 oncology & carcinogenesis ,Surgery ,Radiology ,business - Abstract
Background Management of scaphoid fractures often requires advanced imaging to achieve accurate diagnoses and appropriate treatment. Digital tomosynthesis (DTS) is a cross-sectional imaging modality that may be used to substitute magnetic resonance imaging or computed tomographic scans. The purpose of this study is to: (1) determine the diagnostic accuracy of DTS in occult scaphoid fractures; and (2) report on the reduction of other advanced imaging when using DTS. Methods From May 2014 to October 2017, the charts of all patients who underwent scaphoid tomogram were retrospectively reviewed. The diagnostic accuracy of DTS for occult fracture was compared with 2-week follow-up plain films. To measure the reduction in utilization of advanced imaging, it was determined whether DTS eliminated the need for advanced imaging by providing adequate information regarding the clinical question. Results A total of 78 patients underwent scaphoid tomography in this time frame: 39 for occult fracture, 33 for fracture union, 5 for fracture morphology, and 1 for hardware positioning. For the detection of occult fracture, DTS had a sensitivity of 100%, specificity of 83%, positive predictive value of 64%, and negative predictive value of 100%. Advanced imaging was not used in 35 of the remaining 39 patients based on the results obtained by DTS. In patients who did receive advanced imaging, 83% of tomograms provided conclusive diagnostic information. Conclusions Digital tomosynthesis increases the diagnostic sensitivity of occult scaphoid fractures, reducing unnecessary immobilization and advanced imaging. Digital tomosynthesis provides clinical detail beyond plain film, which reduces the need to obtain advanced imaging when assessing union, fracture pattern, and hardware placement.
- Published
- 2021
3. Cannabinoid Use in Musculoskeletal Illness: a Review of the Current Evidence
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Curtis T. Adams, Joseph R Young, Kyle Richardson, Afshin A. Anoushiravani, Casey M O'Connor, and Andrew J. Rosenbaum
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030222 orthopedics ,medicine.medical_specialty ,Sports medicine ,business.industry ,medicine.medical_treatment ,Hot Topics ,030229 sport sciences ,Perioperative ,Endocannabinoid system ,Bone remodeling ,03 medical and health sciences ,0302 clinical medicine ,Marijuana use ,mental disorders ,medicine ,Orthopedics and Sports Medicine ,Cannabinoid ,Intensive care medicine ,business ,Cannabidiol ,medicine.drug - Abstract
PURPOSE OF REVIEW: The use of cannabinoids has increased since legalization of recreational and medical use in the USA. It is likely that many orthopaedic patients consume cannabinoid products during the traumatic or perioperative period. The purpose of this study was to investigate the pre-clinical data evaluating the mechanism of action of cannabidiol (CBD) and Δ(9)-Tetrahydrocannabinol (Δ(9)-THC) and to evaluate the current clinical data on the use of cannabinoids in musculoskeletal illness. RECENT FINDINGS: Recent pre-clinical studies have demonstrated that cannabinoid use and the endocannabinoid system (ECS) has an important role in bone healing and bone homeostasis. There is data that suggests that the use of cannabidiol (CBD) may increase bone healing, whereas the use of Δ(9)-Tetrahydrocannabinol (Δ(9)-THC), the major psychoactive ingredient in marijuana, likely inhibits bone metabolism and repair. The clinical implications and consumption of marijuana by orthopaedic patients have not been thoroughly evaluated. Studies have demonstrated concern for negative cardiovascular and psychiatric effects caused by marijuana use, but have not yet elucidated outcomes in the orthopaedic literature. SUMMARY: With the recent increase in advertising of CBD products and legalization of marijuana, it is likely that many orthopaedic patients are consuming cannabinoid products. The clinical implications and consumption of these products are unclear. We need more robust and well-designed clinical studies prior to making further recommendations to our patients on the consumption of these products.
- Published
- 2020
4. Diagnosis and Treatment of Peritalar Injuries in the Acute Trauma Setting: A Review of the Literature
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Joseph R Young, Andrew J. Rosenbaum, Muhammad Moral, Abdul Arain, Curtis T. Adams, Khusboo Desai, and Stefanos F. Haddad
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Orthopedic surgery ,Orthodontics ,030222 orthopedics ,business.industry ,Chronic pain ,Context (language use) ,Review Article ,030229 sport sciences ,musculoskeletal system ,medicine.disease ,Occult ,03 medical and health sciences ,0302 clinical medicine ,Deformity ,medicine ,Orthopedics and Sports Medicine ,Calcaneus ,Tibia ,medicine.symptom ,business ,Acute trauma ,RD701-811 ,Foot (unit) - Abstract
The bony and ligamentous structure of the foot is a complex kinematic interaction, designed to transmit force and motion in an energy-efficient and stable manner. Visible deformity of the foot or atypical patterns of swelling should raise significant concern for foot trauma. In some instances, disruption of either bony structure or supporting ligaments is identified years after injury due to chronic pain in the hindfoot or midfoot. This article will focus on injuries relating to the peritalar complex, the bony articulation between the tibia, talus, calcaneus, and navicular bones, supplemented with multiple ligamentous structures. Attention will be given to the five most common peritalar injuries to illustrate the nature of each and briefly describe methods for achieving the correct diagnosis in the context of acute trauma. This includes subtalar dislocations, chopart joint injuries, talar fractures, navicular fractures, and occult calcaneal fractures.
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- 2020
5. Isolated pediatric transolecranon fracture‐dislocation of the elbow managed nonoperatively: A case report and review of literature
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Hamza Murtaza, Andrew J. Rosenbaum, Abdul Arain, Matthew J. Anderson, and Stefanos F. Haddad
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medicine.medical_specialty ,medicine.medical_treatment ,Elbow ,lcsh:Medicine ,Case Report ,Case Reports ,030204 cardiovascular system & hematology ,03 medical and health sciences ,0302 clinical medicine ,Dislocation (syntax) ,medicine ,pediatric orthopedic ,Nonoperative management ,Reduction (orthopedic surgery) ,lcsh:R5-920 ,business.industry ,lcsh:R ,General Medicine ,pediatric elbow fracture‐dislocation ,Surgery ,medicine.anatomical_structure ,030220 oncology & carcinogenesis ,pediatric olecranon fracture‐dislocation ,Fracture (geology) ,transolecranon fracture‐dislocation ,business ,lcsh:Medicine (General) - Abstract
We report on the sixth case of an isolated pediatric transolecranon fracture‐dislocation, and the first case utilizing nonoperative management in a cast following closed reduction resulting in an excellent outcome. Our case provides support for nonoperative management of these rare injuries, especially when surgery is not practical or desirable.
- Published
- 2019
6. Indolent Propionibacterium acnes infection associated with orthopedic hardware in the ankle: A case report and literature review
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Connor W Sullivan, Kyle Angelicola-Richardson, Abdul Arain, Stefanos F. Haddad, and Andrew J. Rosenbaum
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medicine.medical_specialty ,lcsh:Medicine ,Case Report ,Case Reports ,030204 cardiovascular system & hematology ,03 medical and health sciences ,Propionibacterium acnes ,0302 clinical medicine ,medicine ,Good outcome ,lcsh:R5-920 ,biology ,business.industry ,lcsh:R ,Propionibacterium acnes in orthopedic hardware ,General Medicine ,biology.organism_classification ,Dermatology ,P. acnes foot and ankle infection ,Propionibacterium acnes infection of the foot ,medicine.anatomical_structure ,030220 oncology & carcinogenesis ,Orthopedic surgery ,Ankle ,lcsh:Medicine (General) ,business ,Foot (unit) - Abstract
Propionibacterium acnes (P. acnes) infections of the foot and ankle are very rare and require a unique approach to prevention, diagnosis, and treatment. Clinicians should consider P. acnes as a cause for all late and indolent orthopedic infections, as appropriate surgical and medical management can result in a good outcome.
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- 2019
7. Noninsertional Tibialis Anterior Tendon Rupture Managed With Midsubstance SpeedBridge Repair
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Andrew J. Rosenbaum and Eric Perloff
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business.industry ,Medicine ,Orthopedics and Sports Medicine ,Surgery ,Anatomy ,business ,Tibialis anterior tendon - Published
- 2019
8. The etiology, evaluation, and management of plantar fibromatosis
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Ian D. Hutchinson, Sarah Sternbach, Joseph R Young, Andrew J. Rosenbaum, and Max Willinger
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medicine.medical_specialty ,plantar fascia ,business.industry ,medicine.medical_treatment ,Review ,Disease ,Evidence-based medicine ,medicine.disease ,Dermatology ,Radiation therapy ,medicine.anatomical_structure ,Quality of life ,Ledderhose disease ,Etiology ,Medicine ,Orthopedics and Sports Medicine ,Plantar fascia ,business ,plantar fibromatosis ,Tamoxifen ,Plantar fibromatosis ,medicine.drug - Abstract
Plantar fibromatosis (Ledderhose disease) is a rare, benign, hyperproliferative fibrous tissue disorder resulting in the formation of nodules along the plantar fascia. This condition can be locally aggressive, and often results in pain, functional disability, and decreased quality of life. Diagnosis is primarily clinical, but MRI and ultrasound are useful confirmatory adjuncts. Given the benign nature of this condition, treatment has historically involved symptomatic management. A multitude of conservative treatment strategies supported by varying levels of evidence have been described mostly in small-scale trials. These therapies include steroid injections, verapamil, radiation therapy, extracorporeal shock wave therapy, tamoxifen, and collagenase. When conservative measures fail, surgical removal of fibromas and adjacent plantar fascia is often done, although recurrence is common. This review aims to provide a broad overview of the clinical features of this disease as well as the current treatment strategies being employed in the management of this condition.
- Published
- 2018
9. Radiographic Outcomes in the Treatment of Type II Adult Acquired Flatfoot Deformity Following Lateral Column Lengthening with a Titanium Wedge versus Autograft or Allograft
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Afshin A. Anoushiravani, Casey M O'Connor, Andrew J. Rosenbaum, Matthew J. Anderson, and Kyle Richardson
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Orthodontics ,business.product_category ,business.industry ,Radiography ,Forefoot ,Flatfoot ,Flatfoot deformity ,Article ,Wedge (mechanical device) ,Lateral Column Lengthening ,lcsh:RD701-811 ,lcsh:Orthopedic surgery ,Autograft ,Medicine ,Stage iib ,In patient ,business ,A titanium - Abstract
Category: Midfoot/Forefoot Introduction/Purpose: Lateral column lengthening (LCL) is a surgical procedure used to manage forefoot abduction occurring in patients with stage IIB Adult Acquired Flat Foot Deformity (AAFD). This procedure utilizes an opening wedge osteotomy of the calcaneus which is then filled with autograft, allograft, or a titanium wedge. The primary aim of this study was to compare the radiographic outcomes of these different bone substitutes in the setting of stage IIB AAFD with the use of LCL. Methods: All patients who underwent LCL from October 2008 until October 2018 were retrospectively reviewed. Preoperative weight bearing radiographs, initial postoperative radiographs and 1-year weight bearing radiographs were reviewed. The following radiographic measurements were recorded: talonavicular uncoverage angle, incongruency angle, and calcaneal pitch. Results: A total of 44 patients were included in our study. The mean age of the cohort was 54 (range 18-74). The study cohort was divided into two groups. There were 17 (38.7%) patients that received a titanium wedge and 27 (61.5%) that received autograft or allograft. Patients that underwent LCL with the autograft/allograft group were significantly older (p=0.006). Patients who underwent LCL with a titanium wedge had a significantly higher preoperative talonavicular angle (p=0.013). There were no significant differences in post-operative talonavicular uncoverage angle, incongruency angle or calcaneal pitch at 6 months or 1 year. Conclusion: Adult acquired flat foot deformity is a difficult disorder to treat surgically. Lateral column lengthening is a common surgical procedure used to treat forefoot abduction that occurs. Our results show that at 6 months and 1 year no radiographic difference exists between autograft/allograft bone substitutes versus titanium wedge in LCL. Future research should evaluate the differences in patient reported outcomes between autograft/allograft versus titanium wedge bone substitutes. [Table: see text]
- Published
- 2020
10. Perioperative Management of Orthopaedic Patients with Hematologic Disorders: A Critical Analysis Review
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Casey M O'Connor, Joseph R Young, Andrew J. Rosenbaum, Cory M Czajka, and Lauren Vignaly
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medicine.medical_specialty ,Preoperative planning ,Perioperative management ,business.industry ,MEDLINE ,Disease ,Hemorrhagic Disorders ,Perioperative Care ,Hematologic disorders ,Orthopedic surgery ,Medicine ,Effective treatment ,Humans ,Orthopedics and Sports Medicine ,Surgery ,Orthopedic Procedures ,Hematologist ,business ,Intensive care medicine - Abstract
Perioperative management of orthopaedic patients with a hematologic disorder is a complex endeavor that requires a multidisciplinary team-based approach. A team composed of an experienced orthopaedic surgeon, an anesthesiologist, and a hematologist is necessary to achieve optimal outcomes. Patients with hemophilia and other complex hematologic disorders should be managed at, or in consultation with a hematologist at, a comprehensive hemophilia center. Bleeding disorders and inherited thrombophilia present unique challenges for the perioperative management of orthopaedic surgery. Comprehensive preoperative planning and familiarity with treatment guidelines can help to minimize these risks. Knowledge of the disease processes outlined in this article will provide orthopaedic surgeons with the requisite background knowledge that is needed to initiate safe and effective treatment strategies involving this high-risk patient population.
- Published
- 2020
11. Comprehensive Review of Rock Climbing Injuries
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Richard L. Uhl, Andrew J. Rosenbaum, and Keegan P. Cole
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medicine.medical_specialty ,Cumulative Trauma Disorders ,Poison control ,Suicide prevention ,Occupational safety and health ,03 medical and health sciences ,0302 clinical medicine ,Rockfall ,Injury prevention ,medicine ,Humans ,Orthopedics and Sports Medicine ,Musculoskeletal System ,030222 orthopedics ,geography ,geography.geographical_feature_category ,business.industry ,Human factors and ergonomics ,030229 sport sciences ,Mountaineering ,Falling (accident) ,Climbing ,Athletic Injuries ,Chronic Disease ,Physical therapy ,Surgery ,Accidental Falls ,medicine.symptom ,business ,human activities - Abstract
Increasing numbers of people are participating in the sport of rock climbing, and its growth is expected to continue with the sport's Olympic debut in 2020. Extreme loading of the upper extremities, contorted positioning of the lower extremities, rockfall, and falling from height create an elevated and diverse injury potential that is affected by experience level and quantity of participation. Injuries vary from acute traumatic injuries to chronic overuse injuries. Unique sport-specific injuries to the flexor tendon pulley system exist, but the remaining musculoskeletal system is not exempt from injury. Orthopaedic evaluation and surgery is frequently required. Understanding the sport of rock climbing and its injury patterns, treatments, and prevention is necessary to diagnose, manage, and counsel the rock-climbing athlete.
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- 2020
12. Hamstring Autograft Reconstruction of the Peroneus Brevis
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Andrew J. Rosenbaum and Scott J. Ellis
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030222 orthopedics ,03 medical and health sciences ,medicine.medical_specialty ,0302 clinical medicine ,business.industry ,medicine ,Orthopedics and Sports Medicine ,Surgery ,030229 sport sciences ,Peroneus brevis ,business ,Hamstring - Published
- 2018
13. Classifications in Brief: Garden Classification of Femoral Neck Fractures
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Mostafa M. Abousayed, Andrew J. Rosenbaum, Jillian M Kazley, and Samik Banerjee
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Orthodontics ,030222 orthopedics ,business.industry ,Other Features ,MEDLINE ,Reproducibility of Results ,General Medicine ,Femoral Neck Fractures ,Diagnosis, Differential ,03 medical and health sciences ,0302 clinical medicine ,Predictive Value of Tests ,Garden classification ,Terminology as Topic ,Predictive value of tests ,Humans ,Medicine ,Orthopedics and Sports Medicine ,Surgery ,030212 general & internal medicine ,business - Published
- 2018
14. Bilateral native knee septic arthritis due to Propionibacterium acnes; a case report and review of literature
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Muhammad Moral, Sean Thadani, Keegan Cole, Andrew J. Rosenbaum, and Abdul Arain
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medicine.medical_specialty ,Standard of care ,bilateral knee P. acnes infection ,medicine.drug_class ,medicine.medical_treatment ,Antibiotics ,lcsh:Medicine ,Case Report ,Case Reports ,030204 cardiovascular system & hematology ,03 medical and health sciences ,Propionibacterium acnes ,0302 clinical medicine ,medicine ,indolent native knee septic arthritis ,bilateral native knee septic arthritis ,lcsh:R5-920 ,Debridement ,biology ,business.industry ,lcsh:R ,General Medicine ,biology.organism_classification ,medicine.disease ,native knee septic P. acnes infection ,Surgery ,030220 oncology & carcinogenesis ,Septic arthritis ,lcsh:Medicine (General) ,business - Abstract
Propionibacterium acnes should be considered in any case of indolent septic arthritis. Cultures should be followed for 2 weeks as our cultures were negative for 7 days before growing P. acnes. Irrigation and debridement followed by antibiotics is the standard of care.
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- 2019
15. Does musculoskeletal health literacy differ between urban and rural orthopaedic patients?
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Andrew J. Rosenbaum, Christopher Johnson, Maxwell C. Alley, Denis R. Pauze, Ankoor Talwar, Julie Tirrell, August Leinhart, and Daniel Pauze
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030222 orthopedics ,medicine.medical_specialty ,business.industry ,media_common.quotation_subject ,General Medicine ,Literacy ,03 medical and health sciences ,0302 clinical medicine ,Family medicine ,Musculoskeletal health ,Medicine ,030212 general & internal medicine ,business ,media_common - Published
- 2017
16. Radiographic Analysis of National Football League Players' Fifth Metatarsal Morphology Relationship to Proximal Fifth Metatarsal Fracture Risk
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Samuel A. Taylor, Christopher Johnson, Bridget DeSandis, Conor I Murphy, Sydney C. Karnovsky, Andrew J. Rosenbaum, Mark C. Drakos, and Russell F. Warren
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Adult ,Male ,Radiography ,Football ,Metatarsal fracture ,League ,Jones fracture ,Metatarsus adductus ,03 medical and health sciences ,Fractures, Bone ,Young Adult ,0302 clinical medicine ,Medicine ,Humans ,Orthopedics and Sports Medicine ,Metatarsal Bones ,Retrospective Studies ,Orthodontics ,030222 orthopedics ,business.industry ,Foot ,030229 sport sciences ,medicine.disease ,Case-Control Studies ,Surgery ,Foot Injury ,business - Abstract
Background: Fractures of the proximal fifth metatarsal are one of the most common foot injuries in athletes. Repetitive stresses endured by the fifth metatarsal can lead to stress fracture, delayed union, and refracture, making optimal treatment challenging. A radiographic analysis of fifth metatarsal morphology and foot type in National Football League (NFL) players was performed to investigate morphologic risk factors for these injuries. Methods: This was a case-control study that looked at NFL players treated between 1992 and 2012, as well as participants at the NFL Combine. Ninety-six feet (51 athletes) were included. Fractures were present in 15 feet. Two reviewers assessed fifth metatarsal morphology and foot type on anteroposterior, lateral, and oblique radiographs. Differences in foot type and metatarsal morphology between athletes with and without fractures were determined. Results: On anteroposterior radiographs, significant differences in apex medullary canal width, 4-5 intermetatarsal angle, fifth metatarsal angle, and talar head uncovering were observed between fractured and non-fractured feet ( P = .001, .003, .004, .008, respectively). On lateral radiographs, significant differences in the fifth metatarsal length, distance to apex, apex height, fifth metatarsal angle, and talocalcaneal angle were observed between fractured and nonfractured feet ( P = .04, .01, .02, .01, .01, respectively). On oblique radiographs, a significant difference was observed in apex height between fractured and nonfractured feet ( P = .002). Conclusion: Individuals with long, narrow, and straight fifth metatarsals with an adducted forefoot were most at risk for fifth metatarsal fractures. With this insight, attempts at fracture prevention can be implemented via footwear modifications, orthoses, and off-loading braces that account for those aforementioned morphologic attributes that place athletes at risk. Level of Evidence: Level III, retrospective comparative study.
- Published
- 2018
17. Health Literacy and Recall of Postoperative Instructions in Patients Undergoing the Lapidus Procedure
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Mackenzie T. Jones, Amelia Hummel, Scott J. Ellis, Jonathan Day, Andrew Roney, Andrew J. Rosenbaum, and Jonathan H. Garfinkel
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030222 orthopedics ,medicine.medical_specialty ,Recall ,business.industry ,Lapidus ,recall ,Health literacy ,Patient Instructions ,Article ,patient education ,Active participation ,Comprehension ,lcsh:RD701-811 ,03 medical and health sciences ,0302 clinical medicine ,lcsh:Orthopedic surgery ,Physical therapy ,Medicine ,In patient ,030212 general & internal medicine ,comprehension ,business ,health literacy ,Patient education - Abstract
Background: Active participation in patients’ own care is essential for success after Lapidus procedure. Poor health literacy, comprehension, and retention of patient instructions may be correlated with patient participation. Currently, there is no objective measure of how well patients internalize and retain instructions before and after a Lapidus procedure. We performed this study to assess how much of the information given to patients preoperatively was able to be recalled at the first postoperative visit. Methods: All patients between ages 18 and 88 years undergoing a Lapidus procedure for hallux valgus by the senior author between June 2016 and July 2018 were considered eligible for inclusion. Patients were excluded if they had a history of previous bunion surgery or if the procedure was part of a flatfoot reconstruction. Patients were given written and verbal instructions at the preoperative visit. Demographic and comprehension surveys were administered at their first visit approximately 2 weeks postoperatively. A total of 50 patients, of which 42 (84%) were female and 43 (86%) had a bachelor’s degree or higher, were enrolled. Results: Mean overall score on the comprehension survey was 6.2/8 (±1.2), mean procedure subscore was 1.8/3 (±0.64), and mean postoperative protocol subscore was 4.4/5 (±0.8). The most frequently missed question asked patients to identify the joint fused in the procedure. Conclusion: Although comprehension and retention of instructions given preoperatively was quite high in our well-educated cohort, our findings highlight the importance of delivering clear instructions preoperatively and reinforcing these instructions often. Level of Evidence: Level II, prospective cohort study.
- Published
- 2020
18. Response to 'Letter Regarding: Radiographic Analysis of National Football League Players’ Fifth Metatarsal Morphology Relationship to Proximal Fifth Metatarsal Fracture Risk'
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Conor Murphy, Andrew J. Rosenbaum, Bridget DeSandis, Russell F. Warren, Sydney C. Karnovsky, Mark C. Drakos, Samuel A. Taylor, and Christopher Johnson
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Orthodontics ,business.industry ,Radiography ,Medicine ,Orthopedics and Sports Medicine ,Surgery ,Metatarsal fracture ,Football ,League ,Foot Injury ,Metatarsal bones ,business - Published
- 2020
19. Trends in Urgent Care Utilization Following Ankle Fracture Fixation
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Muhammad Moral, Christopher K. Johnson, Mostafa M. Abousayed, Andrew J. Rosenbaum, and Sarah Sternbach
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Adult ,Male ,medicine.medical_specialty ,Ankle Fractures ,Patient Readmission ,Care utilization ,03 medical and health sciences ,Fracture Fixation, Internal ,0302 clinical medicine ,Postoperative Complications ,Fracture fixation ,medicine ,Ambulatory Care ,Humans ,Orthopedics and Sports Medicine ,030212 general & internal medicine ,Aged ,Retrospective Studies ,030222 orthopedics ,business.industry ,Middle Aged ,Patient Acceptance of Health Care ,Ankle fracture surgery ,Open Fracture Reduction ,medicine.anatomical_structure ,Physical therapy ,Surgery ,Female ,Ankle ,business ,Medicaid - Abstract
Background: The Centers for Medicare and Medicaid services (CMS) have implemented initiatives to improve postdischarge care and reduce unnecessary readmissions. Readmissions within 30 days are frequent and represent an economic burden on both patients and the healthcare system. The aim of this study was to evaluate the frequency and causes for urgent care visits within 30 days of discharge after ankle open reduction and internal fixation (ORIF) and determine factors correlated with such visits. Methods: This was a retrospective analysis of prospectively collected data. All patients who underwent ankle ORIF at our institution between July 1, 2016, and June 30, 2017, were included. Patients were identified using Current Procedural Terminology (CPT) codes for ankle ORIF. Patients’ demographics including age, sex, race, body mass index, occupation, insurance payer, and comorbidities were documented. Results: Thirty-five patients (10.51%) had urgent care visits within 30 days of discharge. Patients presented at a mean of 11.8 days after the day of surgery. Sixteen patients (45.71%) had cast/splint-related issues, 7 (20%) presented with pain, and 7 (20%) with increased operative site drainage. Univariate analysis demonstrated a statistically significant association between postoperative urgent care visits and patients with diabetes ( P = .03) or underlying psychiatric disorders ( P = .03). Conclusion: In this population study of patients undergoing ankle fracture surgery, we found that the rate of urgent care visits within 30 days of discharge exceeded the rate of inpatient readmission. Additionally, patients with diabetes and psychiatric disorders were significantly more likely to present to an urgent care facility postoperatively, potentially accounting for increased expenditures of the healthcare system. Level of Evidence: Level III, comparative series.
- Published
- 2018
20. Advances in Wound Management
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Richard L. Uhl, Kristen M. Rezak, Samik Banerjee, and Andrew J. Rosenbaum
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medicine.medical_specialty ,medicine.medical_treatment ,Surgical Wound ,MEDLINE ,030207 dermatology & venereal diseases ,03 medical and health sciences ,Wound care ,0302 clinical medicine ,Multidisciplinary approach ,Negative-pressure wound therapy ,Health care ,medicine ,Humans ,Surgical Wound Infection ,Orthopedics and Sports Medicine ,Acellular Dermis ,Orthopedic Procedures ,Intensive care medicine ,SURGICAL DRESSINGS ,Biological Products ,Wound Healing ,integumentary system ,business.industry ,Wound Closure Techniques ,Tissue Expansion Devices ,Bandages ,Extracellular Matrix ,Wound management ,030220 oncology & carcinogenesis ,Surgery ,business - Abstract
Wound management is a notable healthcare and financial burden, accounting for >$10 billion in annual healthcare spending in the United States. A multidisciplinary approach involving orthopaedic and plastic surgeons, wound care nursing, and medical and support staff is often necessary to improve outcomes. Orthopaedic surgeons must be familiar with the fundamental principles and evidenced-based concepts for the management of acute and chronic wounds. Knowledge of surgical dressings, negative pressure wound therapy, tissue expanders, dermal apposition, biologics, and extracellular matrices can aide practitioners in optimizing wound care.
- Published
- 2018
21. Third Place
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Richard L. Uhl, Andrew J. Rosenbaum, Nancy Robak, Michael T. Mulligan, Denis R. Pauze, and Daniel Pauze
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medicine.medical_specialty ,business.industry ,media_common.quotation_subject ,General Medicine ,Emergency department ,medicine.disease ,Literacy ,Emergency medicine ,Orthopedic surgery ,Medicine ,Musculoskeletal health ,Medical emergency ,business ,media_common - Published
- 2015
22. Classifications in Brief: Lauge-Hansen Classification of Ankle Fractures
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John A. DiPreta, Mostafa M. Abousayed, Andrew J. Rosenbaum, and Jason P. Tartaglione
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medicine.medical_specialty ,Sports medicine ,business.industry ,Biomechanics ,Improved survival ,General Medicine ,Ankle Fractures ,In Brief ,Physical medicine and rehabilitation ,medicine.anatomical_structure ,External rotation ,Orthopedic surgery ,medicine ,Physical therapy ,Humans ,Orthopedics and Sports Medicine ,Surgery ,Ankle ,Lauge-Hansen classification ,business - Abstract
HistoryAnkle fractures are common musculoskeletal injuries thatoccur in a bimodal distribution, with peaks in younger menand older women [2], the former related to high-energytrauma and the latter to osteopenia and osteoporosis.Although ankle fractures currently account for 9% offractures, incidence and severity are increasing [1]. This isattributed to the increased life expectancy among olderindividuals and improved survival of patients with severefoot and ankle trauma [23, 26].The first ankle fracture classification, credited to Perci-val Pott, described three types of ankle fractures based onthe number of malleoli involved: unimalleolar, bimalleolar,and trimalleolar [21]. Despite its ease of use and repro-ducibility, the classification did not effectively guidemanagement, as it failed to differentiate stable from un-stable injuries.This was the impetus for the work of Niel Lauge-Hansen(1899–1976), a Danish physician who studied ankle frac-tures during the 1940s and 1950s, ultimately creating aclassification system based on a rotational mechanism ofinjury [11–15]. Lauge-Hansen’s classification, which waspublished in a 1950 issue of Archives of Surgery, has be-come one of the most widely used ankle fractureclassification systems [12]. Although still considered alandmark work regarding the biomechanics and deformingforces of ankle fractures, the quality, validity, and repro-ducibility of the Lauge-Hansen classification have beenchallenged [17, 19, 22, 25].PurposeAn ideal fracture classification would be reproducible,widely recognized, relevant for prognosis, and useful interms of clinical decision-making, documentation, andresearch.The primary normal motion of the ankle is dorsiflexionand plantar flexion, with osseous anatomy and ligamentouscomplexes that provide stability in all planes and axes ofrotation. When these structures are injured, there is sub-stantial risk of instability. Appropriate reconstructiontherefore is important, and a classification scheme thatidentifies injury patterns and guides treatment would bedesirable.Description of the Lauge-Hansen SystemNiel Lauge-Hansen used freshly amputated limbs to de-velop an ankle fracture classification based on foot positionat the time of the traumatic event (supination or pronation)and the direction of the deforming forces (abduction, ad-duction, or external rotation) [12].Cadaveric tibias were fixed with a vice and nails while arotational deforming force was applied by hand with the
- Published
- 2015
23. Dedicated Orthopaedic Operating Rooms
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Maria Vanushkina, Timothy T. Roberts, Jared T. Roberts, James Snyder, Andrew J. Rosenbaum, Kaushik Bagchi, Siddharth Khasnavis, Richard L. Uhl, and Dean N Papaliodis
- Subjects
Male ,Operating Rooms ,medicine.medical_specialty ,medicine.medical_treatment ,Femoral Neck Fractures ,law.invention ,Fracture Fixation, Internal ,law ,medicine ,Humans ,Internal fixation ,Orthopedics and Sports Medicine ,Myocardial infarction ,Stroke ,Aged ,Retrospective Studies ,business.industry ,Trauma center ,General Medicine ,Perioperative ,medicine.disease ,Arthroplasty ,Intensive care unit ,Surgery ,Case-Control Studies ,Female ,business - Abstract
OBJECTIVE Dedicated orthopaedic operating rooms (DOORs) are increasingly popular solutions to reducing after-hours procedures, physician fatigue, and elective schedule disruptions. Although the benefits to surgeons are well understood, there are comparatively few studies that explore the effects of DOORs on patient care. We compared treatments and outcomes for all consecutive patients with femoral neck fractures, 4 years before and 4 years after implementation of a DOOR-based schedule. DESIGN Retrospective case-control study. SETTING Level 1 academic trauma center. PATIENTS A total of 111 consecutive trauma patients undergoing surgical management of isolated OTA group 31-B femoral neck fractures. INTERVENTION Based on individual patient factors and fracture characteristics, patients were managed with either hemiarthroplasty or open reduction internal fixation (ORIF). MAIN OUTCOME MEASURES Surgical timing, intervention type, perioperative complications, and postoperative length of stay. RESULTS Retrospective analysis revealed a significant decrease in after-hour surgery (4 PM-7:30 AM) for all femoral neck fractures (66.7%-19.3%; P < 0.001). No significant differences were found between the rates of arthroplasty versus those of open reduction internal fixation. Patients undergoing surgical treatment for femoral neck fractures after DOOR suffered significantly fewer morbidities, including significantly decreased rates of postoperative intensive care unit admissions, stroke, infections, and myocardial infarction or congestive heart failure exacerbations. We also observed a significant decrease in postoperative mortality (5.6% pre-DOOR vs. 0% post-DOOR; P = 0.04). Patients undergoing hemiarthroplasty experienced a significant shorter hospitalization (14.5 days pre-DOOR vs. 9.9 days post-DOOR; P = 0.04). CONCLUSIONS In our experience, a weekday DOOR is closely associated with improvements in both patient safety and outcomes. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
- Published
- 2015
24. Vitamin D in Orthopaedics
- Author
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Andrew J. Rosenbaum, Elaine Y. Tran, and Richard L. Uhl
- Subjects
Male ,medicine.medical_specialty ,Bone density ,MEDLINE ,030209 endocrinology & metabolism ,vitamin D deficiency ,03 medical and health sciences ,0302 clinical medicine ,Bone Density ,medicine ,Vitamin D and neurology ,Prevalence ,Humans ,Orthopedics and Sports Medicine ,Orthopedic Procedures ,Vitamin D ,Aged ,030222 orthopedics ,biology ,business.industry ,Athletes ,Middle Aged ,medicine.disease ,biology.organism_classification ,Vitamin D Deficiency ,Surgery ,Treatment Outcome ,Elective Surgical Procedures ,Orthopedic surgery ,Female ,Bone Diseases ,business ,Elective Surgical Procedure - Published
- 2017
25. The Utilization of Internet Resources by Foot and Ankle Patients
- Author
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Anca Marinescu, Mackenzie T. Jones, Andrew J. Rosenbaum, and Scott J. Ellis
- Subjects
030222 orthopedics ,medicine.medical_specialty ,business.industry ,Internet resources ,media_common.quotation_subject ,education ,030229 sport sciences ,03 medical and health sciences ,lcsh:RD701-811 ,0302 clinical medicine ,medicine.anatomical_structure ,lcsh:Orthopedic surgery ,Physical therapy ,Medicine ,The Internet ,Quality (business) ,Ankle ,business ,Foot (unit) ,Patient education ,media_common - Abstract
Background: It is critical for patients seeking foot and ankle care to have access to quality online resources, as the treatment of their conditions may involve the use of a variety of diagnostic and therapeutic modalities with which they are unfamiliar. This study was performed to enhance our understanding of if and why patients use Internet-based educational materials, to identify trends in utilization, and to delineate the patient-perceived attributes of quality resources. Methods: Questionnaires were distributed to 150 adult foot and ankle patients. The questionnaire consisted of demographic and Internet utilization questions. Statistical analysis was performed to determine the frequency of responses for each question and the relationship between demographics and Internet usage. Results: Younger patients were more likely to use the Internet ( P= .006). However, there were no other significant differences in demographic attributes between patients who did (76%) and did not (24%) utilize the Internet ( P Conclusion: Although physician and medical society endorsement positively shape patients’ opinions of online education materials, patients often struggle in remembering the site they visited and if it was sponsored by a certain society. Despite this, patients are generally satisfied with online foot and ankle education resources. Future works must assess whether patient and physician perceptions of quality Internet resources are correlated. Level of Evidence: Level IV, case series.
- Published
- 2017
26. The Risk of Achilles Tendon Rupture in the Patients with Achilles Tendinopathy: Healthcare Database Analysis in the United States
- Author
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Ichiro Tonogai, Youichi Yasui, John G. Kennedy, Yoshiharu Shimozono, Hirotaka Kawano, and Andrew J. Rosenbaum
- Subjects
Adult ,Male ,Healthcare database ,medicine.medical_specialty ,Databases, Factual ,Article Subject ,Prior diagnosis ,lcsh:Medicine ,Achilles Tendon ,General Biochemistry, Genetics and Molecular Biology ,03 medical and health sciences ,0302 clinical medicine ,Older patients ,Risk Factors ,Tendon Injuries ,medicine ,Humans ,Orthopedic Procedures ,Aged ,Rupture ,030222 orthopedics ,Achilles tendon ,General Immunology and Microbiology ,business.industry ,lcsh:R ,030229 sport sciences ,General Medicine ,Middle Aged ,Patient record ,medicine.disease ,United States ,Surgery ,medicine.anatomical_structure ,Tendinopathy ,Orthopedic surgery ,Physical therapy ,Female ,Achilles tendon rupture ,medicine.symptom ,business ,Delivery of Health Care ,Research Article - Abstract
Introduction. Disorders of the Achilles tendon can be broadly classified into acute and chronic entities. Few studies have established chronic Achilles tendinopathy as a precursor to acute Achilles ruptures. In this study, we assessed the relationship between Achilles tendinopathy and rupture, clarifying the incidence of rupture in the setting of underlying tendinopathy.Methods. The United Healthcare Orthopedic Dataset from the PearlDiver Patient Record Database was used to identify patients with ICD-9 codes for Achilles rupture and/or Achilles tendinopathy. The number of patients with acute rupture, chronic tendinopathy, and rupture following a prior diagnosis of tendinopathy was assessed.Results.Four percent of patients with an underlying diagnosis of Achilles tendinopathy went on to sustain a rupture (7,232 patients). Older patients with tendinopathy were most vulnerable to subsequent rupture.Conclusions. The current study demonstrates that 4.0% of patients who were previously diagnosed with Achilles tendinopathy sustained an Achilles tendon rupture. Additionally, older patients with Achilles tendinopathy were most vulnerable. These findings are important as they can help clinicians more objectively council patients with Achilles tendinopathy.
- Published
- 2017
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27. Radiologic Case Study
- Author
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Andrew J. Rosenbaum, Kaushik Bagchi, Michael T. Mulligan, Garrett R. Leonard, and Richard L. Uhl
- Subjects
medicine.medical_specialty ,Text mining ,business.industry ,Radiography ,MEDLINE ,medicine ,Radial head ,Orthopedics and Sports Medicine ,Surgery ,Posterior dislocation ,Radiology ,business - Published
- 2014
28. Cross-Sectional Assessment of Orthopedic Foot and Ankle Patient Knowledge
- Author
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David B. Levine, Andrew J. Rosenbaum, Scott J. Ellis, and Anca Marinescu
- Subjects
030222 orthopedics ,medicine.medical_specialty ,Medical knowledge ,business.industry ,Health literacy ,Perioperative ,Terminology ,03 medical and health sciences ,lcsh:RD701-811 ,0302 clinical medicine ,medicine.anatomical_structure ,Physical medicine and rehabilitation ,lcsh:Orthopedic surgery ,Orthopedic surgery ,Physical therapy ,Medicine ,030212 general & internal medicine ,Ankle ,business ,Foot (unit) ,Limited health literacy - Abstract
Background: Individuals with limited health literacy often struggle in effectively communicating with their physicians and may lack the skills needed to make informed health decisions. It is therefore important that providers have insight into patients’ baseline medical knowledge, as this can help physicians customize their approach to, and conversations with, each patient. As such, this study evaluated the foot and ankle–specific knowledge of patients seeking care for various foot and ankle ailments. Methods: An unvalidated survey developed by our study group was distributed to 206 patients, assessing their knowledge of foot and ankle anatomy, terminology, conditions, treatment, and perioperative issues. Performance was evaluated as a function of participants’ demographic factors. Results: Participants performed significantly worse on the conditions and treatment questions as compared to the anatomy, terminology, and perioperative considerations subsections. Significantly better performance correlated with education (≥college), visit type (preoperative evaluation), a current or previous health care occupation, and prior orthopedic surgeon evaluation. Conclusions: Patients’ knowledge of foot and ankle anatomy, terminology, conditions, treatment, and perioperative issues correlates with certain patient characteristics and demographics. With enhanced insight into the risk factors for limited knowledge, education campaigns can be designed to target those most in need.
- Published
- 2016
29. The Management of Ankle Fractures in Diabetics
- Author
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Samuel G. Dellenbaugh, John A. DiPreta, Richard L. Uhl, and Andrew J. Rosenbaum
- Subjects
medicine.medical_specialty ,Displaced fractures ,Fractures, Bone ,Stabilization methods ,Surveys and Questionnaires ,Diabetes Mellitus ,medicine ,Humans ,Orthopedics and Sports Medicine ,Practice Patterns, Physicians' ,Podiatry ,Societies, Medical ,business.industry ,Incidence ,Tarsal Bones ,Syndesmotic Injury ,United States ,Surgery ,Radiography ,Patient population ,medicine.anatomical_structure ,Orthopedic surgery ,Physical therapy ,Ankle ,business ,Foot (unit) - Abstract
Background. Ankle frac- tures in diabetics are challenging to treat, and only generalized clini- cal guidelines specific to their treat- ment exist. As such, the American Orthopaedic Foot and Ankle Society (AOFAS) membership was polled regarding the management of different types of ankle fractures in this patient population. Methods. We developed a multiple-choice survey with 3 clinical scenarios involving diabetic ankle frac- tures that was sent via e-mail to the 895 active members of the AOFAS. In addi- tion to providing demographic infor- mation, respondents identified their preferred stabilization method, the need for supplemental fixation, and each patient's weight-bearing status. Results. Respondents' number of years in prac- tice, number of ankle fractures treated monthly, and type of fellowship train- ing did not correlate with management strategies. Enhanced fixation with syn- desmotic screws was advocated in the setting of displaced fractures without syndesmotic injury, while casting was selected as the treatment for those that were nondisplaced. Prolonged periods of non-weight bearing were chosen by survey participants in all cases. Conclusion. We identified several treat- ment trends among AOFAS membership regarding ankle fractures in diabet- ics. However, it is pivotal that further investigation evaluate both optimal fix- ation strategies and the factors that influence surgeon decision mak- ing in the setting of dia- betic ankle fractures, as the orthopaedic surgeon is encountering such patients more than ever before.
- Published
- 2013
30. A Cross-Sectional Study of Musculoskeletal Health Literacy in Patients With Carpal Tunnel Syndrome
- Author
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Daniel S. Goldberg, Andrew Dunkman, Richard L. Uhl, Andrew J. Rosenbaum, and Michael T. Mulligan
- Subjects
Male ,medicine.medical_specialty ,Health Knowledge, Attitudes, Practice ,Cross-sectional study ,Limp ,media_common.quotation_subject ,Psychological intervention ,Health literacy ,Literacy ,03 medical and health sciences ,0302 clinical medicine ,Health care ,medicine ,Complaint ,Prevalence ,Humans ,Orthopedics and Sports Medicine ,030212 general & internal medicine ,Carpal tunnel syndrome ,media_common ,Surgery Articles ,030222 orthopedics ,business.industry ,Middle Aged ,medicine.disease ,Carpal Tunnel Syndrome ,Health Surveys ,Health Literacy ,Cross-Sectional Studies ,Physical therapy ,Surgery ,Female ,medicine.symptom ,business - Abstract
Background: Approximately 33% of Americans have inadequate health literacy, which is associated with infrequent use of preventative services, increased hospitalization and use of emergency care, and worse control of chronic diseases. In this study, the Literacy in Musculoskeletal Problems (LiMP) questionnaire was used to evaluate the prevalence of limited musculoskeletal literacy in patients undergoing carpal tunnel release (CTR), as these individuals may be at increased risk of inferior outcomes. Methods: This cross-sectional study included individuals older than or equal to 18 years of age who were scheduled for elective CTR. Participants completed a demographic survey and the LiMP questionnaire during their preoperative office visit. The prevalence of limited health literacy was determined, with chi-square analysis used to determine the influence of demographic parameters. Results: The mean LiMP score was 6 ± 1.40. Limited musculoskeletal literacy was seen in 34% of participants (22/65). Analysis identified race (Caucasian), gender (female), higher education levels (≥college), current or prior employment in a health care field, and a prior physician visit for a non–carpal tunnel musculoskeletal complaint as being associated with higher literacy rates. Conclusions: Approximately one-third of patients scheduled for elective CTR have limited musculoskeletal literacy and may lack the necessary skills required for making informed decisions regarding their care. This is concerning, as CTR is performed in the United States on roughly 500 000 individuals annually, at an estimated cost of 2 billion dollars. The identification of those most at risk is thus crucial, and will facilitate the development of education campaigns and interventions geared toward those who are most vulnerable.
- Published
- 2016
31. Can Fifth Metatarsal Morphology Predict Proximal Fifth Metatarsal Fracture Risk? A Radiographic Analysis of National Football League Players
- Author
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Andrew J. Rosenbaum, Russel Warren, Conor Murphy, Bridget DeSandis, Samuel A. Taylor, and Mark C. Drakos
- Subjects
Orthodontics ,medicine.medical_specialty ,biology ,business.industry ,Athletes ,Radiography ,Optimal treatment ,Metatarsal fracture ,Football ,League ,biology.organism_classification ,medicine.disease ,Jones fracture ,lcsh:RD701-811 ,lcsh:Orthopedic surgery ,Physical therapy ,medicine ,Foot Injury ,business - Abstract
Category: Sports. Introduction/Purpose: Fractures of the proximal fifth metatarsal are one of the most common foot injuries in athletes. Unfortunately, optimal treatment is often challenging, as the repetitive stresses endured by the fifth metatarsal can lead to delayed union and refracture following treatment. We therefore performed a radiographic analysis of fifth metatarsal morphology and foot type in NFL players, in search of morphologic risk factors for these injuries. Methods: NFL players treated by the senior authors between 1992 and 2012, as well as participants in the 2014 NFL Combine were evaluated. A total of 96 feet (51 athletes) were included. Fractures were present in 15 of the feet. Two reviewers assessed fifth metatarsal morphology and foot type on anteroposterior (AP), lateral and oblique radiographs, after receiving measurement training by the senior authors. Table 1 lists the specific parameters studied. Reviewers’ measurements were averaged, as were those from the radiographic series for each athlete. Differences in foot type and metatarsal morphology between athletes with and without fractures were determined via Student’s t-test analysis. Results: Athletes had an average height of 6’2” (range 5’8” to 6’8”) ft’in”, weight of 251 (range 184 to 336) lbs, and age of 22.4 (range 21.0 to 26.0) years. Reviewers’ inter-observer reliability was generally good to very good. On AP radiographs, statistically significant differences in apex medullary canal width, 4-5 intermetatarsal angle, 5th metatarsal angle, and talar head uncovering were observed between fractured and non-fractured feet (p=0.001, 0.003, 0.004, 0.008, respectively; Table 1). On lateral radiographs, statistically significant differences in the 5th metatarsal length, distance to apex, apex height, 5th metatarsal angle, and talocalcaneal angle were observed between fractured and non-fractured feet (p=0.04, 0.01, 0.02, 0.01, 0.01, respectively; Table 1). On oblique radiographs, a statistically significant difference was observed in apex height between fractured and non-fractured feet (p=0.002; Table 1). Conclusion: This investigation elucidates the relationship between fifth metatarsal morphology, foot type and proximal fifth metatarsal fractures. Specifically, individuals with long, straight and narrow fifth metatarsals, with an adducted forefoot are most at risk. Given athletes’ predisposition to refracture and nonunion following treatment of proximal fifth metatarsal fractures, which is at times career threatening, we believe that these findings are clinically relevant. With such insight, attempts at fracture prevention can be implemented via footwear modifications, orthoses, and off-loading braces that account for those aforementioned morphologic attributes that place athletes at-risk. Admittedly, future research must evaluate the utility of such interventions.
- Published
- 2016
32. Response to 'Letter Regarding: The Internet for Patient Education: A Friend or Foe?'
- Author
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Scott J. Ellis and Andrew J. Rosenbaum
- Subjects
030222 orthopedics ,Medical education ,Internet ,business.industry ,030229 sport sciences ,Health Literacy ,03 medical and health sciences ,0302 clinical medicine ,Patient Education as Topic ,Medicine ,Humans ,Orthopedics and Sports Medicine ,Surgery ,The Internet ,business ,Patient education - Published
- 2016
33. Use of the arthroereisis screw with tendoscopic delivered platelet-rich plasma for early stage adult acquired flatfoot deformity
- Author
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D Moore, Hirotaka Kawano, John G. Kennedy, Masato Takao, Andrew J. Rosenbaum, Ichiro Tonogai, and Youichi Yasui
- Subjects
Adult ,Male ,medicine.medical_specialty ,Visual analogue scale ,medicine.medical_treatment ,Radiography ,Bone Screws ,Osteotomy ,03 medical and health sciences ,0302 clinical medicine ,Tendon transfer ,medicine ,Humans ,Orthopedics and Sports Medicine ,Aged ,Pain Measurement ,Retrospective Studies ,030222 orthopedics ,medicine.diagnostic_test ,business.industry ,Foot Deformities, Acquired ,Platelet-Rich Plasma ,Endoscopy ,030229 sport sciences ,Middle Aged ,Flatfoot ,Surgery ,medicine.anatomical_structure ,Treatment Outcome ,Orthopedic surgery ,Quality of Life ,Female ,Ankle ,business ,Posterior Tibial Tendon Dysfunction ,Follow-Up Studies - Abstract
Early stage adult acquired flatfoot deformity (AAFD) is traditionally treated with osteotomy and tendon transfer. Despite a high success rate, the long recovery time and associated morbidity are not sufficient. This study aims to evaluate the functional and radiological outcomes following the use of the arthroereisis screw with tendoscopic delivered PRP for early stage AAFD. Patients with stage IIa AAFD who underwent the use of the arthroereisis screw with tendoscopic delivered PRP with a minimum follow-up time of 24 months were retrospectively evaluated. Clinical outcomes for pain were evaluated with the Foot and Ankle Outcomes Score (FAOS) and Visual Analog Score (VAS). Radiographic deformity correction was assessed using weight-bearing imaging. Thirteen patients (13 feet) with mean follow-up of 29.5 months were included. The mean age was 37.3 years (range, 28–65 years). FAOS-reported symptoms, pain, daily activities, sports activities, and quality of life significantly improved from 52.1, 42.6, 57.6, 35.7, and 15.4 pre-operatively to 78.5, 68.2, 83.3, 65.0, and 49.6 post-operatively, respectively (p
- Published
- 2016
34. Social and Cultural Barriers: Understanding Musculoskeletal Health Literacy: AOA Critical Issues
- Author
-
Michael T. Mulligan, E. Anthony Rankin, Andrew J. Rosenbaum, and Richard L. Uhl
- Subjects
Patients ,media_common.quotation_subject ,Health literacy ,Literacy ,03 medical and health sciences ,0302 clinical medicine ,Nursing ,Surveys and Questionnaires ,Health care ,Musculoskeletal health ,Medicine ,Orthopedics and Sports Medicine ,030212 general & internal medicine ,Musculoskeletal Diseases ,Health policy ,Societies, Medical ,media_common ,Demography ,030222 orthopedics ,Physician-Patient Relations ,business.industry ,Communication ,General Medicine ,United States ,Health Literacy ,Comprehension ,Economics, Medical ,Orthopedics ,Cultural Deprivation ,Surgery ,Health education ,business ,Meaning (linguistics) - Abstract
The Institute of Medicine considers limited health literacy a “silent epidemic,” as approximately half of Americans lack the competencies necessary for making informed decisions regarding their health. Limited health literacy substantially impedes the effective dissemination and comprehension of relevant health information, and also complicates communication, compromises care, and leads to worse patient outcomes. Poor health, early death, and worse control of chronic conditions have also been associated with limited health literacy. Unfortunately, physicians often struggle to identify those with limited health literacy, which can have adverse effects on the physician-patient relationship. In this article, we discuss the meaning of health literacy, the risk factors for and consequences of limited health literacy, orthopaedic-specific implications and investigations, and the strategies orthopaedic surgeons can utilize to improve health literacy and communication.
- Published
- 2016
35. Nonunion of Humeral Shaft Fractures Following Flexible Nailing Fixation
- Author
-
Andrew J. Rosenbaum and Richard L. Uhl
- Subjects
Adult ,Male ,Humeral Fractures ,medicine.medical_specialty ,Nonunion ,Treatment outcome ,Bone Nails ,law.invention ,Intramedullary rod ,Fracture Fixation, Internal ,Fixation (surgical) ,law ,Elastic Modulus ,Fracture fixation ,Humans ,Medicine ,Orthopedics and Sports Medicine ,Fractures, Malunited ,integumentary system ,business.industry ,Middle Aged ,medicine.disease ,Surgery ,Radiography ,Treatment Outcome ,Plate osteosynthesis ,Humeral shaft ,Female ,business ,Operative fixation - Abstract
The treatment of humeral shaft fractures ranges from conservative modalities to operative fixation, including plate osteosynthesis and intramedullary fixation. Nonunion is a complication of conservative and operative interventions but is more often associated with elastic nailing. This article discusses elucidates the successful outcomes achieved with flexible nailing of humeral shaft fractures.
- Published
- 2012
36. Injuries Complicating Musical Practice and Performance: The Hand Surgeon's Approach to the Musician-Patient
- Author
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Andrew S. Morse, Andrew J. Rosenbaum, Richard L. Uhl, and Jacqueline Vanderzanden
- Subjects
education.field_of_study ,medicine.medical_specialty ,Cumulative Trauma Disorders ,business.industry ,Nerve Compression Syndromes ,Population ,Musical ,Diagnosis, Differential ,Occupational Diseases ,Thoracic Outlet Syndrome ,Dystonic Disorders ,Risk Factors ,Associated injury ,Physical therapy ,medicine ,Humans ,Orthopedics and Sports Medicine ,Surgery ,education ,business ,Music - Abstract
c s b i t a e In B ri ef H IGH-PERFORMANCE musculoskeletal injuries in the instrumental musician stem from repetitive motions, awkward postures, and long practice hours. Although their precise prevalence in this population is unclear, many have attempted to quantify this number and delineate the specific problems. Although the musculoskeletal conditions affecting usicians have been acknowledged since the early 700s, the prevailing mantra has been that of “no pain, o gain.” Performing arts medicine developed as ealth care providers began to understand the anatomic nd physiologic stresses endured while playing an intrument and their associated injury patterns. It is a ollaborative field of both nonsurgical and surgical speialists devoted to understanding and treating injures hat frequently complicate musical practice and perforance.
- Published
- 2012
37. Multiplanar CT Analysis of Fifth Metatarsal Morphology: Implications for Operative Management of Zone II Fractures
- Author
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Mark C. Drakos, Conor Murphy, Andrew J. Rosenbaum, Quinn O’Malley, Bridget DeSandis, Gabrielle P. Konin, and Matthew M. Levitsky
- Subjects
Adult ,Male ,Percutaneous ,Medullary cavity ,Adolescent ,Radiography ,medicine.medical_treatment ,Bone Screws ,Jones fracture ,03 medical and health sciences ,Fracture Fixation, Internal ,Fractures, Bone ,Young Adult ,0302 clinical medicine ,Medicine ,Internal fixation ,Humans ,Orthopedics and Sports Medicine ,Foot Injuries ,Metatarsal Bones ,Aged ,Aged, 80 and over ,030222 orthopedics ,business.industry ,Ct analysis ,030229 sport sciences ,Anatomy ,Middle Aged ,medicine.disease ,Apex (geometry) ,Surgery ,Female ,Metatarsal bones ,business ,Tomography, X-Ray Computed - Abstract
Background:Percutaneous internal fixation is currently the method of choice treating proximal zone II fifth metatarsal fractures. Complications have been reported due to poor screw placement and inadequate screw sizing. The purpose of this study was to define the morphology of the fifth metatarsal to help guide surgeons in selecting the appropriate screw size preoperatively.Methods:Multiplanar analysis of fifth metatarsal morphology was completed using computed tomographic (CT) scans from 241 patients. Specific parameters were analyzed and defined in anteroposterior (AP), lateral, and oblique views including metatarsal length, distance from the base to apex of curvature, apex medullary canal width, apex height, and fifth metatarsal angle.Results:The average metatarsal length in the AP view was 71.4 ± 6.1 mm and in the lateral view 70.4 ± 6.0 mm, with 95% of patients having lengths between 59.3 and 83.5 mm and 58.4 and 82.4 mm, respectively. The average canal width at the apex of curvature was 4.1 ± 0.9 mm in the AP view and 5.3 ± 1.1 mm in the lateral view, with 95% of patients having widths between 2.2 and 5.9 mm and 3.2 and 7.5 mm, respectively. Average distance from apex to base was 42.6 ± 5.8 mm in the AP and 40.4 ± 6.4 mm in the lateral views. Every measurement taken in all 3 views had a significant correlation with height.Conclusions:When determining screw length, we believe lateral radiographs should be used since the distance from the base of the metatarsal to the apex was smaller in the lateral view. On average, the screw should be 40 mm or less to reduce risk of distraction. For screw diameter, the AP view should be used because canal shape is elliptical, and width was found to be significantly smaller in the AP view. Most canals can accommodate a 4.0- or 4.5-mm-diameter screw, and one should use the largest diameter screw possible. Larger individuals were likely to have more bowing in their metatarsal shaft, which may lead to a higher tendency to distract.Level of Evidence:Level III, comparative series.
- Published
- 2015
38. Subtle Injuries to the Lisfranc Joint
- Author
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Richard L. Uhl, Andrew J. Rosenbaum, Samuel G. Dellenbaugh, and John A. DiPreta
- Subjects
Adult ,Joint Instability ,Male ,musculoskeletal diseases ,Lisfranc injury ,Cuboid ,Adolescent ,business.industry ,Joint Dislocations ,Anatomy ,medicine.disease ,Tarsal Joints ,Tarsometatarsal joint complex ,Medial cuneiform ,Ligaments, Articular ,Humans ,Medicine ,Orthopedics and Sports Medicine ,Surgery ,Child ,Foot Injuries ,business ,Joint (geology) ,Lisfranc ligament ,Cuneiform - Abstract
The tarsometatarsal joint complex is an osseous and capsuloligamentous network that includes the 5 metatarsals, their articulations with the cuneiforms and cuboid, and the Lisfranc ligament, a strong interosseous attachment between the medial cuneiform and second metatarsal. A multitude of injury patterns exist involving the tarsometatarsal joint complex; a Lisfranc injury does not delineate a specific injury, but instead a spectrum of processes involving the tarsometatarsal joint complex.
- Published
- 2011
39. Online Patient Resources for Ankle Instability
- Author
-
Mostafa M. Abousayed, Navdeep Rai, Christopher K. Johnson, Andrew J. Rosenbaum, Jason P. Tartaglion, and Samuel Zonshayn
- Subjects
World Wide Web ,030222 orthopedics ,03 medical and health sciences ,Search engine ,0302 clinical medicine ,business.industry ,Medicine ,The Internet ,Objective analysis ,030212 general & internal medicine ,business ,Ankle instability - Abstract
Background: The Internet has drastically changed how patients access health-related information. There are several ways the public can access online health-related information such as search engines, blogs, support groups, and webinars. A recent study found that 45% of orthopedic patients searched for information online regarding their injury. Also, 78% believed they had better understanding of their condition after visiting these websites; furthermore, 41% felt the Internet supplied them with questions and concerns to discuss with their physicians. The aim of our study is to evaluate the accuracy, quality, and readability of online available information using the search terms “ankle sprain” and “ankle instability.” Methods: Three search engines (Google, Bing, and Yahoo) were used to search for the terms “ankle sprain” and “ankle instability.” The first 25 websites from each search were collected. Each website was assessed for quality, accuracy, and readability by 3 orthopedic residents blinded to the search term used. Websites were also evaluated for commercial bias and whether written by physicians or not. Results: Twenty sites were identified using Google, 14 using Bing, and 3 using Yahoo while the remaining 19 appeared in multiple search engines. Sixty-nine percent of the websites (39/56) were written by physicians whereas only 21% (12/56) were associated with commercial bias. The mean quality and accuracy of the websites written above a seventh-grade level was statistically significantly higher than those at or below a seventh-grade level ( P = .01). The mean accuracy of websites written by physicians was not statistically different from those not written by physicians ( P = .055). Conclusion: The current study highlights the poor quality and accuracy of online information related to ankle sprains, especially those with commercial bias. Furthermore, although websites written by or under supervision of physicians were found to be of superior quality, a majority of sites were found to have an unacceptably high reading level. Level of Evidence: Level IV, case series.
- Published
- 2018
40. Orthopaedic Primer of Nutritional Requirements for Patients with Musculoskeletal Problems
- Author
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Mahmoud Aldyab, Richard L. Uhl, Joe Messana, and Andrew J. Rosenbaum
- Subjects
0301 basic medicine ,medicine.medical_specialty ,030109 nutrition & dietetics ,Nutrition assessment ,Physical conditioning ,business.industry ,Nutritional Requirements ,MEDLINE ,030209 endocrinology & metabolism ,Perioperative ,Musculoskeletal problems ,03 medical and health sciences ,Nutrition Assessment ,0302 clinical medicine ,Physical therapy ,medicine ,Humans ,Wounds and Injuries ,Orthopedics and Sports Medicine ,Surgery ,Musculoskeletal Diseases ,Perioperative Period ,business ,Primer (cosmetics) ,Physical Conditioning, Human - Published
- 2018
41. The use of mesenchymal stem cells in tissue engineering
- Author
-
Joshua S. Dines, Andrew J. Rosenbaum, and Daniel A. Grande
- Subjects
Transplantation ,Embryology ,Pathology ,medicine.medical_specialty ,business.industry ,Mesenchymal stem cell ,Biomedical Engineering ,Clinical uses of mesenchymal stem cells ,Amniotic stem cells ,Review ,Regenerative medicine ,Cell therapy ,medicine.anatomical_structure ,Tissue engineering ,Medicine ,Bone marrow ,business ,Developmental Biology ,Stem cell transplantation for articular cartilage repair - Abstract
Mesenchymal stem cells (MSCs) are of great interest to both clinicians and researchers for their great potential to enhance tissue engineering. Their ease of isolation, manipulability and potential for differentiation are specifically what have made them so attractive. These multipotent cells have been found to differentiate into cartilage, bone, fat, muscle, tendon, skin, hematopoietic-supporting stroma and neural tissue. Their diverse in vivo distribution includes bone marrow, adipose, periosteum, synovial membrane, skeletal muscle, dermis, pericytes, blood, trabecular bone, human umbilical cord, lung, dental pulp and periodontal ligament. Despite their frequent use in research, no standardized criteria exist for the identification of mesenchymal stem cells; The International Society for Cellular Therapy has sought to change this with a set of guidelines elucidating the major surface markers found on these cells. While many studies have shown MSCs to be just as effective as unipotent cells for certain types of tissue regeneration, limitations do exist due to their immunosuppressive properties. This paper serves as a review pertaining to these issues, as well as others related to the use of MSCs in tissue engineering.
- Published
- 2008
42. Musculoskeletal Health Literacy in Patients With Foot and Ankle Injuries: A Cross-Sectional Survey of Comprehension
- Author
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Jason P. Tartaglione, Richard L. Uhl, Max Alley, Mostafa M. Abousayed, John A. DiPreta, Andrew J. Rosenbaum, and Michael T. Mulligan
- Subjects
Adult ,Male ,medicine.medical_specialty ,Cross-sectional study ,Limp ,media_common.quotation_subject ,Poison control ,Health literacy ,Literacy ,Occupational safety and health ,03 medical and health sciences ,0302 clinical medicine ,Surveys and Questionnaires ,Injury prevention ,medicine ,Humans ,Orthopedics and Sports Medicine ,030212 general & internal medicine ,Ankle Injuries ,Podiatry ,Foot Injuries ,media_common ,030222 orthopedics ,business.industry ,Emergency department ,Health Literacy ,Cross-Sectional Studies ,Physical therapy ,Surgery ,Female ,medicine.symptom ,business ,Comprehension ,Emergency Service, Hospital - Abstract
Purpose. Approximately 33% of Americans have inadequate health literacy, which is associated with decreased medical knowledge, increased hospitalization and use of emergency care, and worse control of diseases. In this study, the Literacy in Musculoskeletal Problems (LiMP) questionnaire was used to evaluate the prevalence of limited musculoskeletal literacy in patients presenting to the emergency department (ED) with foot and ankle–related complaints, as these individuals may be at increased risk for inferior outcomes. Methods. In this cross-sectional study, individuals ≥18 years of age presenting with foot and ankle–related complaints to the ED were invited to participate. Participants completed a demographic survey and the LiMP questionnaire, with scores ≥6 indicative of adequate musculoskeletal literacy. The prevalence of adequate health literacy and the influence of demographic parameters was assessed. P values .05). However, Caucasians and those with higher levels of education (equal to or more than college) were significantly more likely to possess adequate literacy ( P = .008, P = .04, respectively). Conclusions. Approximately one third of patients presenting to the ED with foot and ankle–related complaints have limited musculoskeletal literacy and may lack the necessary skills required for making informed decisions regarding their care. This is concerning and has tremendous socioeconomic implications, as more than 23 000 people per day require medical care for ankle sprains in the United States, with average treatment costs for this injury in the ED setting estimated at $1498. Identification of those most at risk is thus crucial and will facilitate the development of interventions geared toward those most vulnerable. Levels of Evidence: Prognostic, Level IV study
- Published
- 2015
43. Evaluating the Quality, Accuracy, and Readability of Online Resources Pertaining to Hallux Valgus
- Author
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Shazaan F. Hushmendy, Mostafa M. Abousayed, Jason P. Tartaglione, Andrew J. Rosenbaum, and John A. DiPreta
- Subjects
medicine.medical_specialty ,media_common.quotation_subject ,Scoring criteria ,Access to Information ,03 medical and health sciences ,0302 clinical medicine ,Patient Education as Topic ,Online search ,medicine ,Humans ,Orthopedics and Sports Medicine ,Statistical analysis ,Medical physics ,Quality (business) ,Podiatry ,Hallux Valgus ,media_common ,030222 orthopedics ,Internet ,biology ,business.industry ,Information Dissemination ,030229 sport sciences ,biology.organism_classification ,Readability ,Surgery ,Health Literacy ,Search Engine ,Access to information ,Valgus ,Search terms ,business - Abstract
Background. The Internet is one of the most widely utilized resources for health-related information. Evaluation of the medical literature suggests that the quality and accuracy of these resources are poor and written at inappropriately high reading levels. The purpose of our study was to evaluate the quality, accuracy, and readability of online resources pertaining to hallux valgus. Methods. Two search terms (“hallux valgus” and “bunion”) were entered into Google, Yahoo, and Bing. With the use of scoring criteria specific to hallux valgus, the quality and accuracy of online information related to hallux valgus was evaluated by 3 reviewers. The Flesch–Kincaid score was used to determine readability. Statistical analysis was performed with t tests and significance was determined by P values Levels of Evidence: Level IV
- Published
- 2015
44. Acute Fractures of the Tarsal Navicular
- Author
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Andrew J. Rosenbaum, Richard L. Uhl, Jason P. Tartaglione, Nilay Patel, and John A. DiPreta
- Subjects
medicine.medical_specialty ,Stress fractures ,business.industry ,Automobile safety ,medicine.disease ,Polytrauma ,Surgery ,body regions ,Avulsion ,Tarsal Bone ,medicine.anatomical_structure ,medicine ,Physical therapy ,Abdomen ,Orthopedics and Sports Medicine ,In patient ,Foot Injury ,business - Abstract
Tarsal bone injuries are most often incurred during motor-vehicle collisions and other high-energy trauma1. Although uncommon, they are being seen with increasing frequency. This trend is attributed to enhancements in automobile safety that have improved the protection of the abdomen, head, and neck but have left the feet unprotected in the pedal box area2,3. Despite the adverse impact of foot injuries on overall outcome and long-term function in patients with polytrauma, the diagnosis sometimes is not made or is made on a delayed basis as treating physicians focus on more obvious or life-threatening injuries1,4,5. The navicular is the most frequently injured tarsal bone3. In the acute setting, avulsion, tuberosity and body fractures, and comminuted fracture-dislocations can occur. Stress fractures of the navicular represent more chronic, low-energy injuries. They often present with an insidious onset of midfoot pain after an increase in the duration or intensity of exercise or other activity. It is important for orthopaedic surgeons to consider this injury when patients present with vague symptoms in the midfoot …
- Published
- 2015
45. Nerve Entrapments in Musicians
- Author
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Richard L. Uhl, Garrett R. Leonard, Andrew J. Rosenbaum, and Michael T. Mulligan
- Subjects
medicine.medical_specialty ,Modalities ,medicine.diagnostic_test ,business.industry ,Radial nerve entrapment ,Physical examination ,medicine.disease ,Surgery ,Cubital tunnel syndrome ,Entrapment ,medicine ,Physical therapy ,Entrapment Neuropathy ,Carpal tunnel syndrome ,business ,Thoracic outlet syndrome - Abstract
The instrumental musician is vulnerable to high-performance musculoskeletal injuries. Nerve entrapment syndromes are some of the most common and are attributed to the repetitive motions, awkward postures, and long practice hours of the instrumental musician. Although carpal tunnel syndrome and cubital tunnel syndrome are the most common, radial nerve entrapment, digital nerve entrapment, and thoracic outlet syndrome are not uncommon. The clinician must also remember that multiple sites of compression can exist concurrently. History and physical examination are usually enough to make a proper diagnosis, particularly when the musician-patient is evaluated with instrument in hand. When a diagnosis remains unclear, electrodiagnostic and imaging studies can be employed to aide in the workup. Conservative modalities are the mainstay of treatment. Operative intervention is reserved for the most severe refractory cases of entrapment neuropathy.
- Published
- 2015
46. Bilateral distal tibial transitional ankle fractures
- Author
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Mostafa M. Abousayed, John A. DiPreta, Cory M Czajka, Andrew J. Rosenbaum, Richard L. Uhl, and Richard Alfred
- Subjects
Male ,medicine.medical_specialty ,Adolescent ,business.industry ,Arthritis ,Emergency department ,Swing ,Ankle Fractures ,humanities ,Tibial Fractures ,Fracture Fixation, Internal ,Physical medicine and rehabilitation ,medicine.anatomical_structure ,medicine ,Humans ,Orthopedics and Sports Medicine ,Surgery ,Accidental Falls ,Ankle ,Ankle pain ,business ,Tomography, X-Ray Computed - Abstract
A 13-year-old boy presented to the emergency department with bilateral ankle pain and swelling following a 5-foot fall from a swing set.
- Published
- 2014
47. The Evaluation and Treatment of Polyostotic Lesions
- Author
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Timothy T. Roberts, Matthew R. DiCaprio, Andrew J. Rosenbaum, and Garrett R. Leonard
- Subjects
medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,Physical examination ,Disease ,Surgery ,Lesion ,Medicine ,Orthopedics and Sports Medicine ,Radiology ,Differential diagnosis ,medicine.symptom ,business - Abstract
The approach to skeletal lesions has been well described1-3. Nevertheless, these lesions remain intimidating to both clinicians and patients. This is particularly true in the setting of polyostotic lesions, which can represent a metastatic process. Although it is imperative to consider this diagnosis, especially in adults, multicentric skeletal lesions can be the manifestation of a plethora of processes, ranging from non-neoplastic and benign conditions to more devastating malignant lesions and metastatic disease (Table I). In order to ensure accurate diagnosis and treatment, orthopaedic surgeons must be familiar with these conditions and the necessary workup. This article presents the approach to polyostotic disease while also reviewing some of the more common conditions presenting as multicentric skeletal lesions. View this table: TABLE I Non-Neoplastic, Benign, and Malignant Conditions That Can Present As Polyostotic Disease* There are many ways in which patients with polyostotic lesions present to orthopaedic surgeons. Some patients already will have had imaging studies performed, whereas others are being seen for the first time. Regardless, a thorough history and physical examination must be performed as it is only with the combination of a history, physical examination, and imaging that a differential diagnosis can be appropriately formulated. Once a lesion is identified, a bone scan is useful for …
- Published
- 2014
48. Self-Reflection: Using Journal Entries to Enhance Teaching and Orthopedic Resident Communication
- Author
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Richard L. Uhl and Andrew J. Rosenbaum
- Subjects
medicine.medical_specialty ,Medical education ,020205 medical informatics ,Journal entry ,business.industry ,02 engineering and technology ,03 medical and health sciences ,0302 clinical medicine ,Self-reflection ,Orthopedic surgery ,0202 electrical engineering, electronic engineering, information engineering ,medicine ,Orthopedics and Sports Medicine ,Surgery ,030212 general & internal medicine ,business - Published
- 2016
49. The Internet for Patient Education
- Author
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Andrew J. Rosenbaum and Scott J. Ellis
- Subjects
Quality Control ,Internet ,030222 orthopedics ,Medical education ,Consumer Health Information ,business.industry ,MEDLINE ,Health literacy ,Health Literacy ,03 medical and health sciences ,0302 clinical medicine ,Humans ,Medicine ,Orthopedics and Sports Medicine ,Surgery ,The Internet ,030212 general & internal medicine ,business ,Patient education - Published
- 2016
50. Adult-Acquired Flatfoot Deformity
- Author
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Andrew J. Rosenbaum, Rachel J. Shakked, Maxwell C. Alley, and Mostafa M. Abousayed
- Subjects
Adult ,medicine.medical_specialty ,Radiography ,First line ,Physical examination ,Conservative Treatment ,03 medical and health sciences ,0302 clinical medicine ,Humans ,Medicine ,Orthopedic Procedures ,Orthopedics and Sports Medicine ,Posterior tibial tendon ,030222 orthopedics ,medicine.diagnostic_test ,Foot ,Foot Deformities, Acquired ,business.industry ,Disease Management ,030229 sport sciences ,musculoskeletal system ,Flatfoot ,Flatfoot deformity ,Surgery ,medicine.anatomical_structure ,Etiology ,Ankle ,business - Abstract
>> Adult-acquired flatfoot deformity is a complex process attributed mainly to posterior tibial tendon insufficiency.>> Thorough physical examination and radiographs of the foot and ankle are usually adequate to achieve diagnosis.>> Nonoperative management is the first line of treatment and has a re
- Published
- 2017
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