Faculty Bibliography

Conductive hydrogels have emerged as promising materials for soft tissue interfacing by combining tissue-like mechanical compliance with electrical conductivity, thereby enabling improved electrical communication with electroactive biological tissues. This work presents an electroconductive composite hydrogel fabricated via light-based vat-polymerization by integrating a choline-based bio-ionic liquid (IL) with gelatin methacryloyl (GelMA). The resulting hydrogels demonstrate tunable conductivity, structural integrity, and high print fidelity when fabricated using digital light processing (DLP) light-based 3D printing. Electrical conductivity was optimized at 20% v/v IL concentration, with the hydrogels demonstrating stable performance for over 28 days. A food-grade photoabsorber was integrated into the formulation to improve DLP resolution and was effectively removed after printing process. The hydrogels supported the human mesenchymal stem cells' viability and proliferation, confirming their cytocompatibility. They also promoted enhanced maturation of primary neurons, demonstrating a supportive microenvironment for neural cells. In vivo implantation of indocyanine green-loaded hydrogels exhibited sustained stability and robust retention of signal over a period of 4 weeks, with histological analysis indicating seamless integration with surrounding tissues. Impedance spectroscopy at both gut and spinal cord interfaces illustrated that GelMA/IL composites achieved the lowest impedance across a range of frequencies, outperforming both GelMA-only and tissue-only conditions. Collectively, these findings position light-based vat-polymerized electroconductive composites as a promising platform for the development of anatomically conformal materials tailored for soft tissue interfacing.

BACKGROUND:Chronic postamputation pain is frequently caused by symptomatic neuroma formation. Advanced nerve interface procedures, including targeted muscle reinnervation (TMR) and regenerative peripheral nerve interface (RPNI), were developed to enhance prosthetic control and have been shown to reduce phantom and residual limb pain. However, data regarding how surgical timing relates to postoperative complications and reoperations remain limited. This study evaluated postoperative outcomes after acute and delayed TMR/RPNI in upper-extremity amputees. METHODS:We retrospectively analyzed 48 upper-extremity amputations in 42 patients who underwent TMR and/or RPNI. Procedures were classified as acute (prophylactic) or delayed (symptomatic). Baseline and operative variables were analyzed using Mann-Whitney U and chi-square tests. Multivariable logistic regression was used to evaluate the association between surgical timing and postoperative complications after adjustment. RESULTS:Of 48 limbs, 25 (52.1%) underwent acute and 23 (47.9%) delayed procedures. Baseline characteristics differed in smoking history, amputation etiology, and number of nerves treated. Complication rates were 20.0% and 21.7%, respectively. Wound-related complications occurred predominantly after acute procedures, whereas recurrent neuroma reoperations occurred predominantly after delayed procedures. Unexpected reoperation rates at 1 year were 12.0% and 21.7%, respectively. Mean 1-year pain scores were lower after acute than delayed procedures (2.09 vs 3.70). CONCLUSIONS:Acute and delayed TMR/RPNI had similar complication and reoperation rates, with differing event patterns. Surgical timing was not significantly associated with complications after adjustment, though meaningful differences cannot be excluded due to heterogeneity and limited power. These findings support individualized timing and the need for larger prospective studies including patient-reported outcomes.

BACKGROUND:Carpal tunnel syndrome (CTS) and cubital tunnel syndrome (CuTS) are the most common upper extremity compressive neuropathies. Although often considered isolated conditions, they may occur concomitantly, and the clinical significance of dual compression remains poorly defined. This study evaluated whether concomitant CTS/CuTS represents a distinct clinical subgroup characterized by greater objective motor impairment compared with isolated entrapment syndromes. METHODS:Eighty-six adults evaluated between 2021 and 2025 were prospectively enrolled, including isolated CTS (n = 32), isolated CuTS (n = 26), and concomitant CTS/CuTS (n = 28). Standardized examinations assessed sensory findings and intrinsic motor strength using Medical Research Council grading. Multivariable logistic and ordinal regression analyses identified predictors of decreased intrinsic muscle strength. RESULTS: = .0471). CONCLUSIONS:Concomitant CTS/CuTS is associated with greater baseline intrinsic motor impairment despite similar sensory findings, suggesting that dual-site compression reflects greater motor involvement rather than the incidental coexistence of 2 isolated entrapment syndromes.

BACKGROUND/UNASSIGNED:Pneumatic tourniquets are routinely used in upper extremity surgery to create a bloodless operative field, often at a standard pressure of 250 mm Hg. However, high pressures may lead to complications, including tissue damage and increased pain. This study investigates whether tailoring tourniquet pressures to individual systolic blood pressure (SBP) can achieve comparable surgical field visualization while reducing inflation pressure. MATERIALS AND METHODS/UNASSIGNED:-tests. RESULTS/UNASSIGNED: = 0.27). Tourniquet adjustments were rare (2.13%, intervention only). CONCLUSION/UNASSIGNED:SBP-based tourniquet pressures effectively maintain surgical field visualization at lower pressures without compromising safety or increasing pain. These findings support wider adoption of this method and warrant further large-scale studies.

Transradial amputation of appropriate length preserves forearm rotation and facilitates prosthetic use; however, high rates of phantom limb pain and neuropathic medication use persist. This case describes a multidisciplinary approach to transradial amputation that integrates targeted muscle reinnervation, regenerative peripheral nerve interfaces, and bone and soft tissue management to optimize pain control and prosthetic success. A 29-year-old man with a severe ballistic injury and complex regional pain syndrome underwent transradial amputation with targeted muscle reinnervation and regenerative peripheral nerve interface. Limb length was preserved in accordance with prosthetic guidelines, and myodesis was performed to improve residual limb stability and myoelectric signal quality. This case highlights how nerve management and prosthetic-informed surgical planning optimizes functional outcomes and quality of life after traumatic transradial amputation.

Complex extremity wounds, if not addressed properly, are a leading cause of major limb amputation. Chronic wounds in salvaged extremities contribute to long-term morbidity in the extremity. Orthoplastic surgery treats limb-threatening conditions through the combined application of orthopaedic and plastic surgical principles, applied to clinical problems simultaneously. Key components include early stakeholder evaluation of the limb and patient and open collaborative communication between orthopaedic and plastic surgeons. Meticulous débridement at the time of presentation and careful selection of fixation informed by the overall reconstructive plan should be executed when the patient presents to the emergency department. Implementation of Orthoplastic protocols results in quicker time to skeletal stabilization and soft tissue coverage, reduced risk of infection, improved functional outcomes, and less cost for care. This review presents a protocol-driven guide for establishing an Orthoplastic program and optimizing limb salvage outcomes across diverse practice settings.

INTRODUCTION/BACKGROUND:Owing to the scaphoid's retrograde blood supply, fractures can compromise perfusion to the proximal pole, making it vulnerable to avascular necrosis (AVN) or irreversible bone death. Despite their differing prognoses, both conditions are evaluated using the same diagnostic methods. This review aims to determine the most reliable method of distinguishing between AVN and irreversible bone death, considering factors such as magnetic resonance imaging (MRI), computed tomography (CT), intraoperative findings, and histology. METHODS:A comprehensive literature search was conducted until November 2024. The diagnostic methods and criteria for AVN were collected, and the outcome was measured dichotomously as either resolution of AVN or irreversible bone death. Each AVN diagnostic method was categorized and the healing outcomes of all patients diagnosed with AVN in the study were compared. RESULTS:This systematic review included 27 studies and 423 patients. With regard to AVN healing, 195 out of 223 patients diagnosed with AVN via MRI eventually healed. Of those diagnosed with AVN via CT, nine out of 21 went on to heal, as did 308 out of 356 patients with no intraoperative punctate bleeding. Histologic evaluation had the lowest incidence of AVN resolution, with only six out of 19 patients healing. CONCLUSION/CONCLUSIONS:All diagnostic methods identified AVN resolution and irreversible bone death. However, all patients were solely diagnosed with AVN. There is no standardized method for diagnosing irreversible bone death because the existing literature conflates irreversible bone death with AVN, despite their distinct pathologies and prognoses. Consequently, our understanding of AVN and the point at which irreversible bone death occurs in the scaphoid is limited.

BACKGROUND:Avascular necrosis (AVN) of the proximal pole is a well-known complication of scaphoid fractures. Avascular necrosis is poorly understood, including the transition from ischemia to necrosis, optimal treatment, and why some AVN heals but others do not. The primary purpose of this study is to evaluate patient-related factors that are associated with healing outcomes in individuals with proximal pole AVN following scaphoid fractures. METHODS:This is a retrospective review of all patients diagnosed with scaphoid proximal pole AVN secondary to a fracture from 2018 to 2024 in a single center. Patient baseline characteristics and comorbidities at time of diagnosis were collected. If the patient underwent surgical management, procedural factors were collected. The primary outcome was AVN healing after 4 months of follow-up. RESULTS:= .886, respectively). CONCLUSIONS:Hyperlipidemia, elevated BMI, and advanced age are patient factors negatively associated with scaphoid proximal pole AVN healing-key information for accurately assessing patient prognosis. For surgical management, the choice of a vascularized bone, nonvascularized bone graft, or no graft does not significantly impact AVN healing.

BACKGROUND:This study examined whether the timing of total hip or knee arthroplasty (TJA) relative to elective hand surgery (HS) is associated with perioperative TJA outcomes, as both are among the most common orthopaedic procedures in the United States. METHODS:A retrospective cohort study was conducted of patients who underwent elective HS and TJA between 2011 and 2024. Patients were grouped by surgical order: HS first (HSF, n = 645) and TJA first (TJAF, n = 785). Differences between HSF and TJAF were assessed. Multivariable logistic regressions, Cox proportional hazards regressions, and linear regressions were used to adjust for patient demographics and comorbidities. The HSF patients were older (67.1 versus 64.3 years, P < 0.001), more prone to be discharged home (90.7 versus 83.8%, P < 0.001), and had a shorter length of stay (45.6 versus 60.4 hours, P < 0.001) compared to TJAF patients. RESULTS:Surgical order showed no association with 90-day emergency department visits and readmissions. Multivariable Cox regressions revealed that HSF was associated with a significantly higher hazard of aseptic revision (hazard risk (HR) = 2.65, P = 0.012). Functional TJA outcomes did not differ (P > 0.05) between groups. Although both groups improved in Patient-Reported Outcomes Measurements Information System (PROMIS) Pain Intensity and Pain Interference scores after TJA, HSF patients showed significantly less improvement in Pain Intensity at all timepoints (P < 0.05). Surgical order was not associated with improvement in Knee Injury and Osteoarthritis Outcome Score for Joint Replacement, Hip Injury and Osteoarthritis Outcome Score for Joint Replacement, or PROMIS Pain Interference scores. CONCLUSIONS:The timing of these elective surgeries is associated with TJA outcomes. While HSF is linked to a higher adjusted risk of aseptic revision, it is also independently associated with less adjusted improvement in PROMIS Pain Intensity. These findings suggest that although surgical order impacts specific recovery metrics, a patient's comorbidities may be the primary driver of complications.