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Major JW, Ernst AJ, Kallevang JK, Kaeck A, Grijalva SD, Douglas TJ, Wilson AW, Garry CB. A radiologic determination of the different screw cutting patterns in cut and uncut orthopedic cortical screws using a novel imaging technique. Skeletal Radiol 2023; 52:2461-2467. [PMID: 37237173 DOI: 10.1007/s00256-023-04368-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 05/17/2023] [Accepted: 05/17/2023] [Indexed: 05/28/2023]
Abstract
OBJECTIVE We hypothesize that cut screws will deform in a manner that increases the core and outer diameters of the screw hole compared to uncut controls, and effects will be more pronounced in titanium screws. MATERIALS AND METHODS We used biomechanical polyurethane foam blocks to simulate cortical bone. We organized four groups of stainless steel and titanium cut and uncut screws. Blocks were fitted with a jig to ensure perpendicular screw insertion. We imaged the blocks using digital mammography and measured them using PACS software. Power analysis determined a power of 0.95 and an alpha error of 0.05. RESULTS Highly statistically significant differences in core diameter were found after cutting stainless steel and titanium screws. Cutting stainless steel screws increased core diameter by 0.30 mm (95% CI, 0.16 to 0.45; p < .001). Titanium screws' core diameter increased by 0.45 mm (95% CI, 0.30 to 0.61; p < .001). No significant differences were found in the outer diameters of stainless steel and titanium screws after cutting. CONCLUSION Titanium and stainless steel screw tracts demonstrated screw core diameter and screw thread pattern deformation after cutting. Titanium screws demonstrated more significant effects.
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Affiliation(s)
- Joshua W Major
- Department of Radiology, Naval Medical Center Portsmouth, Portsmouth, VA, 23708-2197, USA.
| | - Andrew J Ernst
- Department of Orthopaedic Surgery, Naval Medical Center Portsmouth, Portsmouth, VA, 23708-2197, USA
| | - Jonathan K Kallevang
- Department of Orthopaedic Surgery, Naval Medical Center Portsmouth, Portsmouth, VA, 23708-2197, USA
| | - Alexander Kaeck
- Department of Radiation Physics, Naval Medical Center Portsmouth, Portsmouth, VA, 23708-2197, USA
| | - Stephen D Grijalva
- Department of Orthopaedic Surgery, Naval Medical Center Portsmouth, Portsmouth, VA, 23708-2197, USA
| | - Thomas J Douglas
- Department of Orthopaedic Surgery, Naval Medical Center Portsmouth, Portsmouth, VA, 23708-2197, USA
| | - Andrew W Wilson
- Department of Orthopaedic Surgery, University of Tennessee College of Medicine Chattanooga, Chattanooga, TN, USA
| | - Conor B Garry
- Department of Orthopaedic Surgery, Naval Medical Center Portsmouth, Portsmouth, VA, 23708-2197, USA
- Department of Orthopaedic Surgery, University of Tennessee College of Medicine Chattanooga, Chattanooga, TN, USA
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Garry CB, Middlebrooks R, Moore JD, Souza JM, Sayles TE, Ricca RL. Experience in Providing Ambulatory Surgery From an Expeditionary Fast Transport Mobile and Rapidly Deployable Expeditionary Medical Unit During Continuing Promise 2018. Mil Med 2023; 188:usad001. [PMID: 36688361 DOI: 10.1093/milmed/usad001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 08/17/2022] [Accepted: 01/02/2023] [Indexed: 01/24/2023] Open
Abstract
INTRODUCTION This article describes the surgical component of the Continuing Promise 2018 (CP-18) medical training and military cooperation mission. We report on the surgical experience and lessons learned from performing peacetime ambulatory surgeries in a tent-based facility constructed on partner nation territory. METHODS This CP mission was unique in utilizing a land-based expeditionary surgical facility. Institutional Review Board approval was obtained to collect prospective deidentified patient data and aggregate information on all surgical cases performed. Specific aims of this study included describing surgical patient characteristics and evaluating conservatively selected cases performed in this environment. Body mass index (BMI) was used as a crude screening tool for perioperative risk to assist patient selection. Our secondary aim was to report lessons learned from preparation, logistics, and host nation exchanges. The team coordinated medical credentialing and documentation of all medical supplies with each host nation. Advance teams collaborated with local physicians in country to arrange training exchanges and identify surgical candidates. RESULTS The mission was conducted from February to April 2018. Only two of five planned partner nation visits were completed. The surgical facility supported 78 procedures over 14 surgical days, averaging over six cases performed per core surgical day. Patients were predominantly female, with a mean age of 25.4 and a mean BMI of 31.1. The average surgical time was 37.5 minutes, the average anesthesia time was 70 minutes, and the average recovery time was 47.6 minutes. No significant complications or adverse events were noted. CONCLUSIONS CP-18 was the first CP mission to perform elective ambulatory surgery on foreign soil using a tent-based facility in a noncombat, nondisaster environment instead of a hospital or amphibious ship. This mission demonstrated that such a facility may be employed to safely perform low-risk ambulatory surgeries on carefully selected patients. The Expeditionary Medical Unit, coupled with the fast transport vessel enabled rapid expeditionary surgical facility setup with significant military and disaster relief applications. Expansion of surgical indications should be performed carefully and deliberately to avoid complications and damage to international relationships.
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Affiliation(s)
- Conor B Garry
- Department of Orthopaedic Surgery, Naval Medical Readiness and Training Center Portsmouth, Portsmouth, VA 23708, USA
| | - Reginald Middlebrooks
- Department of Anesthesia, Naval Medical Readiness and Training Center Portsmouth, Portsmouth, VA 23708, USA
| | - John D Moore
- Department of Anesthesia, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Jason M Souza
- Department of Plastic and Reconstructive Surgery, Walter Reed National Military Medical Center, Bethesda, MD 20814, USA
| | - Timothy E Sayles
- Department of Obstetrics and Gynecology, Naval Medical Readiness and Training Center Portsmouth, Portsmouth, VA 23708, USA
| | - Robert L Ricca
- Department of Surgery, Naval Medical Readiness and Training Center Portsmouth, Portsmouth, VA 23708, USA
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Garry CB, Ernst A, Sanderson G, Wilson AW. Synovial chondromatosis of the flexor hallucis longus tendon sheath. BMJ Case Rep 2022; 15:e252067. [PMID: 36270739 PMCID: PMC9594586 DOI: 10.1136/bcr-2022-252067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023] Open
Abstract
This case report discusses a rare case of secondary tenosynovial chondromatosis of the flexor hallucis longus (FHL). Synovial chrondomatosis is a rare, benign proliferative cartilaginous lesion arising from the synovial tissue or bursal lining of or near joints. When it is extra-articular, it is considered tenosynovial chondromatosis. The diagnosis is often delayed given the rarity of presentation and non-specific symptoms. The case was highly unusual in that hindfoot pain was caused by several centimetre-sized osteochondral bodies within the FHL tendon sheath. Anterior cheilectomy was performed. The patient returned to full activity following surgery without recurrence of the disease. The condition can be successfully treated operatively.
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Affiliation(s)
- Conor B Garry
- Department of Orthopaedic Surgery, University of Tennessee Health Science Center College of Medicine Chattanooga, Chattanooga, Tennessee, USA
- Department of Orthopaedic Surgery, Naval Medical Center Portsmouth, Portsmouth, Virginia, USA
| | - Andrew Ernst
- Department of Orthopaedic Surgery, Naval Medical Center Portsmouth, Portsmouth, Virginia, USA
| | - Galen Sanderson
- Department of Orthopaedic Surgery, Naval Medical Center Portsmouth, Portsmouth, Virginia, USA
| | - Andrew W Wilson
- Department of Orthopaedic Surgery, University of Tennessee Health Science Center College of Medicine Chattanooga, Chattanooga, Tennessee, USA
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Garry CB, Adsit MH, Land V, Sanderson G, Sheppard SG, Balazs GC. Bony Edema and Clinical Examination Findings Predict the Need for Distal Clavicle Excision at the Time of Shoulder Arthroscopy. HSS J 2022; 18:63-69. [PMID: 35087334 PMCID: PMC8753536 DOI: 10.1177/15563316211008457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Accepted: 01/15/2021] [Indexed: 02/03/2023]
Abstract
Background: Deciding to perform a distal clavicle excision for acromioclavicular joint arthritis, especially in conjunction with other arthroscopic shoulder procedures, is challenging for surgeons. Studies have reported mixed results on the value of magnetic resonance imaging (MRI) in decision making. Purpose: We sought to correlate MRI findings with clinical symptoms and the surgeon's decision to perform a distal clavicle excision. Methods: We compared MRI, clinical examination, and MRI findings of 200 patients who underwent distal clavicle excision for symptomatic acromioclavicular joint arthritis with 200 patients who underwent arthroscopic shoulder procedures for other reasons. Univariate statistics were used to determine correlations between physical examination findings, MRI findings, and the decision to perform distal clavicle excision. A binary logistic regression model was used to determine independent predictors of need for distal clavicle excision. Results: There was no difference in mean age, sex, and race between groups. Advanced acromioclavicular joint osteoarthritis was strongly correlated with positive physical examination findings. Bony edema correlated strongly with tenderness at the acromioclavicular joint but not pain with cross-body adduction testing. There was no association between higher MRI grade of osteoarthritis and the need for distal clavicle excision. Regression analysis identified both physical examination findings and bony edema on MRI as independent predictors of the need for distal clavicle excision. Conclusion: In the setting of positive clinical examination findings and bony edema of the distal clavicle, surgeons should feel reassured that distal clavicle excision is likely indicated.
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Affiliation(s)
- Conor B. Garry
- Bone & Joint Sports Medicine Institute, Naval Medical Center Portsmouth, Portsmouth, VA, USA
| | | | - Vaughn Land
- Eastern Virginia Medical School, Norfolk, VA, USA
| | - Galen Sanderson
- Bone & Joint Sports Medicine Institute, Naval Medical Center Portsmouth, Portsmouth, VA, USA
| | - Sean G. Sheppard
- Department of Orthopedic Surgery, Naval Medical Center San Diego, San Diego, CA, USA
| | - George C. Balazs
- Bone & Joint Sports Medicine Institute, Naval Medical Center Portsmouth, Portsmouth, VA, USA,George C. Balazs, MD, Bone & Joint Sports Medicine Institute, Naval Medical Center Portsmouth, 620 John Paul Jones Cir, Portsmouth, VA 23708, USA.
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Jaskiewicz JL, Garry CB, Ernst AJ, Cole JH, Allen ML, Fox CC, Gendron RT, Gentry SL, Hughey SB, Stedje-Larsen ET. Impact of a Multidisciplinary Long-Term Opioid Therapy Safety Program at a Military Tertiary Academic Medical Center. Mil Med 2021; 187:22-27. [PMID: 34179995 DOI: 10.1093/milmed/usab255] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 05/04/2021] [Accepted: 06/16/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE In light of the ongoing opioid crisis, Naval Medical Center Portsmouth (NMCP) created the Long-Term Opioid Therapy Safety (LOTS) program to reduce risks and improve long-term opioid therapy outcomes. Our primary outcome was change in compliance with the recommended safety metrics. DESIGN This is a retrospective cohort study performed at NMCP, a large military academic medical center providing comprehensive medical care to DoD beneficiaries. The NMCP LOTS program provides both patient and provider narcotic education as well as medical record auditing. The NMCP LOTS program promotes adherence to published CDC, the DVA, and DoD guidelines. METHODS Anonymized data were compiled each fiscal quarter and were analyzed retrospectively. Adult patients prescribed opioids for at least 90 days without a gap of 30 days between prescriptions were included in this study. The investigators recorded and reported provider compliance with LOTS metrics over the same period. RESULTS Compliance with the recommended safety metrics improved. We noted a decrease in the number of long-term opioid patients, concurrent benzodiazepine prescriptions, and patients prescribed greater than 90 morphine equivalents per day during the observation period. The number of naloxone prescriptions for LOTS patients also increased, reflecting improved guideline adherence. CONCLUSION Systematic education and feedback to providers are effective in creating a system and culture of opioid reduction, safe opioid prescribing, and system accountability. This article presents a comprehensive approach to modifying prescribing patterns of long-term opioids in a large healthcare system.
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Affiliation(s)
| | - Conor B Garry
- Naval Medical Center Portsmouth, Portsmouth, VA 23708, USA
| | - Andrew J Ernst
- Naval Medical Center Portsmouth, Portsmouth, VA 23708, USA
| | - Jacob H Cole
- Naval Medical Center Portsmouth, Portsmouth, VA 23708, USA.,Naval Biotechnology Group, Naval Medical Center Portsmouth, Portsmouth, VA 23708, USA
| | | | | | | | - Shari L Gentry
- Naval Medical Center Portsmouth, Portsmouth, VA 23708, USA
| | - Scott B Hughey
- Naval Medical Center Portsmouth, Portsmouth, VA 23708, USA.,Naval Biotechnology Group, Naval Medical Center Portsmouth, Portsmouth, VA 23708, USA
| | - Eric T Stedje-Larsen
- Naval Medical Center Portsmouth, Portsmouth, VA 23708, USA.,Naval Biotechnology Group, Naval Medical Center Portsmouth, Portsmouth, VA 23708, USA
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