All Publications

  • Outcomes of Humerus Nonunion Surgery in Patients with Initial Operative Fracture Fixation. Journal of orthopaedic trauma Harrison, N., Hysong, A., Posey, S., Yu, Z., Chen, A. T., Pallitto, P., Gardner, M., Dumpe, J., Mir, H., Babcock, S., Natoli, R. M., Adams, J. D., Zura, R. D., Miller, A., Seymour, R. B., Hsu, J. R., Obremskey, W., and the Evidence-Based Musculoskeletal Injury and Trauma Collective (EMIT) 2023


    OBJECTIVES: To describe outcomes following humerus aseptic nonunion surgery in patients whose initial fracture was treated operatively and to identify risk factors for nonunion surgery failure in the same population.METHODS.DESIGN: Retrospective Case series.SETTING: Eight academic level-one trauma centers.PATIENTS SELECTION CRITERIA: Patients with aseptic humerus nonunion (OTA/AO 11 and 12) after initial operative management between 1998 and 2019.OUTCOME MEASURES AND COMPARISONS: Success rate of nonunion surgery.RESULTS: 90 patients were included (56% female; median age 50 years; mean follow up 21.2 months). Of 90 aseptic humerus nonunions, 71 (78.9%) united following nonunion surgery. 30 patients (33.3%) experienced one or more post-operative complications including infection, failure of fixation, and readmission. Multivariate analysis found that not performing revision internal fixation during nonunion surgery (n=8; p=0.002) and post-operative de-novo infection (n=9; p=0.005) were associated with an increased risk of recalcitrant nonunion. Patient smoking status and the use of bone graft were not associated with differences in the nonunion repair success rate.CONCLUSIONS: This series of previously-operated aseptic humerus nonunions found that over one in five patients failed nonunion repair. De-novo post-operative infection and failure to perform revision internal fixation during nonunion surgery were associated with recalcitrant nonunion. Smoking and use of bone graft did not influence the success rate of nonunion surgery. These findings can be used to give patients a realistic expectation of results and complications following humerus nonunion surgery.

    View details for DOI 10.1097/BOT.0000000000002740

    View details for PubMedID 38158607

  • Outcome Measures of Medicare Patients With Diabetes Mellitus Undergoing Thoracolumbar Deformity Surgery. Clinical spine surgery Varshneya, K., Bhattacharjya, A., Sharma, J., Stienen, M. N., Medress, Z. A., Ratliff, J. K., Veeravagu, A. 2021


    STUDY DESIGN: This was a retrospective study.OBJECTIVE: The objective of this study was to identify the impact of diabetes on postoperative outcomes in Medicare patients undergoing adult spinal deformity (ASD) surgery.METHODS: We queried the MarketScan Medicare database to identify patients who underwent ASD surgery from 2007 to 2016. Patients were then stratified based on diabetes status at the time of the index operation. Patients not enrolled in the Medicare dataset and those with any prior history of trauma or tumor were excluded from this study.RESULTS: A total of 2564 patients met the inclusion criteria of this study, of which n=746 (29.1.%) were diabetic. Patients with diabetes had a higher rate of postoperative infection than nondiabetic patients (3.1% vs. 1.7%, P<0.05) within 90 days. Renal complications were also more elevated in the diabetic cohort (3.2% vs. 1.3%, P<0.05). Readmission rates were significantly higher in the diabetes cohort through of 60 days (15.2% vs. 11.8%, P<0.05) and 90 days (17.0% vs. 13.4%, P<0.05). When looking specifically at the outpatient payments, patients with diabetes did have a higher financial burden at 60 days ($8147 vs. $6956, P<0.05) and 90 days ($10,126 vs. $8376, P<0.05).CONCLUSIONS: In this study, diabetic patients who underwent ASD surgery had elevated rates of postoperative infection, outpatient costs, and rates of readmissions within 90 days. Further research should investigate the role of poor glycemic control on spine surgery outcomes.

    View details for DOI 10.1097/BSD.0000000000001229

    View details for PubMedID 34183547

  • Biomechanically superior treatments do not translate into improved outcomes in randomized controlled trials. European journal of orthopaedic surgery & traumatology : orthopedie traumatologie Xiong, G. X., Kang, J. R., Sharma, J., Finlay, A., Gardner, M. J., Bishop, J. A. 2021


    PURPOSE: Significant time and resources are devoted to conducting orthopaedic biomechanics research; however, it is not known how these studies relate to their subsequent clinical studies. The purpose of the present study was to determine whether biomechanically superior treatments were associated with improved clinical outcomes as determined by analogous randomized controlled trials (RCTs).METHODS: A systematic review was conducted to find RCTs that tested a research question based on a prior biomechanical study. PubMed and SCOPUS databases were queried for orthopaedic randomized controlled trials, and full text articles were reviewed to find RCTs which cited biomechanical studies with analogous comparison groups. A random-effects multi-level logistic regression model was conducted examining the association between RCT outcome and biomechanics outcome, adjusting for multiple outcomes nested within study.RESULTS: In total, 20,261 articles were reviewed yielding 21 RCTs citing a total of 43 analogous biomechanical studies. In 7 instances (16.2%), the RCT and a cited biomechanical study showed concordant results (i.e. the superior treatment in the RCT was also the superior construct in the biomechanical study). RCT outcome was not associated with biomechanical outcome (beta=-1.50, standard error=0.78, p=.05).CONCLUSION: This study assessed 21 orthopaedic RCTs with 43 corresponding biomechanical studies and found no association between superior biomechanical properties of a given orthopaedic treatment and improved clinical outcomes. Favourable biomechanical properties alone should not be the primary reason for selecting one treatment over another. Furthermore, RCTs based on biomechanical studies should be carefully designed to maximize the chance of providing clinically relevant insights.

    View details for DOI 10.1007/s00590-021-03051-8

    View details for PubMedID 34176011

  • Anterior Cervical Discectomy and Fusion vs. Laminoplasty for Multilevel Cervical Spondylotic Myelopathy: A National Administrative Database Analysis. World neurosurgery Wadhwa, H., Sharma, J., Varshneya, K., Fatemi, P., Nathan, J., Medress, Z. A., Stienen, M. N., Ratliff, J. K., Veeravagu, A. 2021


    Anterior cervical discectomy and fusion (ACDF) is effective for treatment of single level cervical spondylotic myelopathy (CSM), but data surrounding multilevel CSM remains controversial. One alternative is laminoplasty, though evidence comparing these strategies remains sparce. In this paper, we retrospectively review readmission and reoperation rates among patients undergoing ACDF or laminoplasty for multilevel CSM from a national longitudinal administrative claims database.We queried the MarketScan Commercial Claims and Encounters database to identify patients who underwent ACDF or laminoplasty for multilevel CSM from 2007-2016. Patients were stratified by operation type. Patients younger than 18 years of age, with a history of tumor or trauma, or underwent an anterior-posterior approach were excluded from this study.A total of 5,445 patients were included, of which 1,521 underwent laminoplasty. A matched cohort who underwent ACDF was identified. The overall 90-day postoperative complication rate was higher in the laminoplasty cohort (OR 1.48 (95% CI 1.18 - 1.86); p < 0.0001). Mean length of stay and 90-day rates of readmission were higher in the laminoplasty cohort. Hospital and total costs of the index hospitalization were higher in the ACDF cohort, as were total payments up to 2 years after the index hospitalization.In this administrative claims database study, there was no difference in reoperation rate between ACDF and laminoplasty. ACDF had fewer complications and readmissions than laminoplasty but was associated with higher costs. Further, prospective research should investigate the factors driving the higher cost of ACDF in this population, and long-term clinical outcomes.

    View details for DOI 10.1016/j.wneu.2021.06.064

    View details for PubMedID 34153482

  • Changes in Pediatric Sports Injury Presentation During the COVID-19 Pandemic: A Multicenter Analysis. Orthopaedic journal of sports medicine Johnson, M. A., Halloran, K. n., Carpenter, C. n., Pascual-Leone, N. n., Parambath, A. n., Sharma, J. n., Seltzer, R. n., Ellis, H. B., Shea, K. G., Ganley, T. J. 2021; 9 (4): 23259671211010826


    The current coronavirus 2019 (COVID-19) pandemic has prompted a multitude of public health response measures including social distancing, school cancellations, and cessation of organized sports.To examine the impact of COVID-19 and corresponding public health measures on the characteristics of common pediatric musculoskeletal injuries associated with sports.Cohort study; Level of evidence, 3.This was a multicenter retrospective cohort study comparing patients with sports injuries presenting to 3 geographically diverse level I pediatric trauma hospitals and outpatient orthopaedic surgery clinics in the United States during the COVID-19 pandemic and a prepandemic period at the same institutions. Patients were included if they presented for care between February 15 and July 15 in 2020 (pandemic cohort) or between March 15 and April 15 in 2018 and 2019 (prepandemic cohort).Included were 1455 patients with an average age of 12.1 ± 4.5 years. When comparing patients presenting in 2018 and 2019 with those presenting in 2020, we observed a decrease in mean age during the pandemic (12.6 ± 4.0 vs 11.0 ± 5.2 years; P = .048). Additionally, a decrease in the proportion of injuries attributed to sports (48.8% vs 33.3%; P < .001) and those occurring at school (11.9% vs 4.0%; P = .001) was observed. The proportion of injuries attributable to clavicle fractures increased during the early stages of the pandemic (13.2% vs 34.7%; P < .001). There was no statistically significant delay to care in injuries presenting during the pandemic (41.5 ± 141.2 vs 19.23 ± 79.1 days; P = .175).Across 3 tertiary care institutions, patients were seen without significant delay during the pandemic. We observed a significant decline in pediatric musculoskeletal injuries associated with sports during the COVID-19 pandemic. This decrease has been accompanied by a shift in both injury type and mechanism.

    View details for DOI 10.1177/23259671211010826

    View details for PubMedID 33997072

    View details for PubMedCentralID PMC8107815