Ronald Lindsey

• The University of Texas Medical Branch at Galveston

Introduction: Patients with long bone fractures often present to the emergency department (ED) with severe pain and are typically treated with opioid and non-opioid analgesics. Historical data reveals racial disparities in analgesic administration, with White patients more likely to receive analgesics. With the diversifying US population, health eq...

Povidone-iodine is a common antiseptic demonstrating success in reducing infection rates in primary arthroplasty; however, recent data suggest that its use in revision arthroplasty may increase infection rates. This study evaluated the effect of povidone-iodine solution on antibiotic cement and investigated the connection between povidone-iodine an...

Knee osteoarthritis (OA) pain often challenges the physical activity necessary for managing life-threatening chronic diseases. Standard severe knee OA treatment of total knee arthroplasty (TKA) and physical therapy (PT) is effective at improving pain and function but whether such benefits translate to physical activity is unclear. We enrolled 22 pa...

Existing guidelines regarding indications for initial cervical spine magnetic resonance imaging (MRI) do not indicate when to perform repeat MRI in patients with previously documented degenerative disease. This study evaluates the efficacy of repeat MRI in patients with previously diagnosed degenerative cervical disease. Between 2013 and 2018, 153...

Background Odontoid process fractures are among the most common in elderly cervical spines. Their treatment often requires fixation, which may include use of implants anteriorly or posteriorly. Bone density can significantly affect the outcomes of these procedures. Currently, little is known about bone mineral density (BMD) distributions within cer...

Background The etiology of bone refractures after screw removal can be attributed to residual drill hole defects. This biomechanical study compared the torsional strength of bones containing various sized cortical drill defects in a tibia model. Methods Bicortical drill hole defects of 3 mm, 4 mm, and 5 mm diameters were tested in 26 composite tib...

Patient recruitment and retention are challenging for longitudinal studies. Stay-at-home restrictions for the Galveston and Houston regions in 2020 for COVID-19 and in 2021 for the Winter Storms shut down elective healthcare activities and created additional recruitment barriers during the implementation of a 12-month study examining the physical f...

Orthopaedic hardware explantation is a multifaceted topic with complex legal, ethical, and scientific aspects that require thorough exploration. Issues of device ownership, explant-induced disease propagation, and potential device resale pose legal risks to providers and health-care institutions. Ethically, implant removal highlights the potential...

Introduction: Chronic global pelvic instability can be due to many different etiologies with infection being an uncommon cause. We present a case of chronic global pelvis instability secondary to osteomyelitis involving both the anterior and posterior ring, a rare and challenging problem with no standard treatment. Case presentation: A 57-year-o...

Introduction: Surgical navigation technology has recently become more prevalent for total knee arthroplasty. Surgical navigation typically requires pin placement in the proximal tibia diaphysis to stabilize the bone-tracking hardware, and there have been several recent reports of fractures through these residual navigation pin holes. The objective...

Objective: To compare physical function, pain, impairments (stiffness, range of motion, and strength), and health-related quality of life (HRQOL) outcomes between patients with and without diabetes mellitus, before and after a total knee arthroplasty (TKA). Design: Prognosis systematic review. Literature search: We searched MEDLINE/PubMed, CIN...

Objectives: Acute compartment syndrome (CS) is a common complication of tibia shaft fractures (TSFs), and occurs when the pressure inside a myofascial compartment rises and impairs tissue perfusion. If treatment is delayed due to a missed diagnosis, amputation or permanent loss of function can result. This study aims to determine the incidence, cli...

Background: It is unclear whether the sacroiliac joint is vulnerable to adjacent segment disease. Clinical studies have suggested that many patients who have undergone lumbar arthrodesis will develop adjacent segment disease, which may contribute to sacroiliac joint degeneration. The purpose of the present study was to examine whether arthrodesis...

Cerclage fixation following intraoperative fracture of the proximal femur during total hip arthroplasty (THA) carries a risk of compromising the femoral blood supply. Thus, we sought to determine the minimum cerclage cable tension required to restore the stability of a cementless femoral stem. Cementless femoral prostheses were implanted in seven p...

BACKGROUND CONTEXT Patients referred to spine surgeons often present with previous advanced imaging and frequently expect repeat imaging of their disease. Numerous guidelines exist regarding indications for obtaining an initial cervical spine MRI, but it is unknown if and when to obtain a repeat MRI in patients with previously documented degenerati...

Aim: This study aimed at comparing the mechanical properties of conventional and locking dual plates in adjacent and orthogonal orientations for the surgical fixation of transverse femoral shaft fractures. It also assessed the failure mechanics after dual adjacent and orthogonal locking plate removal. Methods: Thirty-two composite femurs were tr...

This study evaluates rater accuracy and variation for the purpose of using intraoperative ultrasound (US) imaging to detect dorsal screw protrusion during fixed-angle volar plating of distal radius fractures. Stabilizing volar plates and screws with varying lengths of dorsal protrusion were applied to 10 cadaver wrist pairs. After a brief training...

Evaluation of coagulation is vital in the care of the orthopaedic patients, particularly in the subspecialties of trauma, spine, arthroplasty, and revision surgery resulting from blood loss and coagulopathies. Although conventional tests (prothrombin time/international normalized ratio, activated partial thromboplastin time, platelet count, and fib...

Background: The predictors of erroneous publication reporting among orthopaedic surgery residency applicants have not been established. Methods: A retrospective analysis of the reported scholarly activity of candidates who applied to our orthopaedic surgery department for a first-year residency position in 2017 was conducted to determine the inc...

Background: The objective of this study was to determine the impact of the type and orientation of peripheral screw placement in an eccentrically positioned locking plate on the structural integrity of the plate-diaphyseal bone interface. We hypothesized that central placement of the screw at the end of the plate in this setting is more important...

Background: Tenosynovitis and tendon rupture caused by screw penetration of the dorsal cortex are common complications after fixed-angle volar plating of a distal radius fracture. Detecting screw prominence with plain radiography is difficult due to the topography of the distal radius dorsal cortex. Computed tomography (CT) offers more detailed ima...

Case: A 29-year-old man with mild hemophilia A and Ollier disease presented with bilateral atraumatic forearm pseudotumors. Both forearm pseudotumors were successfully treated surgically with staged radical extirpation and factor VIII replacement therapy. Conclusion: Pseudotumors typically occur in adolescents with severe, poorly controlled hemo...

Introduction: The impact of the interview date on matching in orthopaedic surgery residency is unknown. Materials and methods: A retrospective review of interviewed applicants for a first-year orthopaedic surgery residency was conducted to determine the likelihood of matching based on being interviewed early versus late at our program. The Unite...

Background : 25-hydroxyvitamin-D (25[OH]D) and Dual-energy x-ray absorptiometry (DEXA) are routinely evaluated in bone health clinics, but existing literature is conflicting with regard to whether these factors predict fragility fractures. We hypothesized that both serum 25(OH)D levels and bone density are lower in patients who have sustained fragi...

Introduction A paucity of work force planning literature exists for hand therapy services. Purpose This descriptive study aimed to map the geographical distribution of US Certified Hand Therapists (CHT) and describe characteristics of US populations living in respective CHT workplace areas. Methods A de-identified Zip Code list of all active CHTs...

Spinal epidural hematoma is a rare condition, characterized by an accumulation of blood in the epidural space with compression of the spinal cord, that can have devastating consequences if not recognized and treated promptly. Because the etiology is often unclear and the medical history is frequently innocuous, a high index of suspicion is required...

Complex tibia fractures are often provisionally stabilized with external fixation prior to definitive fracture fixation. Bicortical defects, such as those left after removal of a fixator pin, can decrease the torsional strength of long bone. Evaluating the effect of subsequent plate fixation in close proximity to a defect on the torsional strength...

Background Transverse patellar fractures require fixation that anatomically restores continuity of the knee extensor complex and resiliency to the loads of early postoperative knee mobilization. The objective of this study was to evaluate the biomechanical fixation strength of three patellar osteosynthesis techniques. Methods Transverse osteotomie...

Pyogenic flexor tenosynovitis is an orthopedic emergency most commonly caused by Staphylococcus aureus and streptococci and occasionally, when associated with water exposure, Mycobacterium marinum. Shewanella algae, a gram-negative bacillus found in warm saltwater environments, has infrequently been reported to cause serious soft tissue infections...

Purpose: The objective of this study was to assess the biomechanical properties of bicortical locking screws, unicortical locking screws, and unicortical far-cortex-abutting locking screw fixation in a cadaver model of comminuted midshaft clavicle fractures stabilized with a locking plate placed on the superior surface of the clavicle. Methods:...

Introduction: Intramedullary (IM) reaming of long bones without nail fixation has expanded to include bone graft harvesting and debridement for infection or tumor. This study evaluated the effects of IM reaming on the residual biomechanical properties of a composite femur model. Methods: Eighteen composite femurs were sequentially reamed to 13, 14,...

Introduction: Orthopaedic efforts to date aiming to reduce radiation doses in computed tomography (CT) have been made solely for scoliosis imaging. In the present study, we examined whether a significant reduction of CT radiation dose affects the accuracy and reliability of visualizing experimental bone defects in a porcine model. Methods: Six bico...

The goal of this study was to determine whether injury, level of surgeon training, and patient factors are associated with increased use of fluoroscopy during open reduction and internal fixation of ankle fractures. These relationships are not well defined. The study was a retrospective chart review of patients treated at an academic institution wi...

Pregnancy has a profound effect on the human body, particularly the musculoskeletal system. Hormonal changes cause ligamentous joint laxity, weight gain, and a shift in the center of gravity that leads to lumbar spine hyperlordosis and anterior tilting of the pelvis. In addition, vascular changes may lead to compromised metabolic supply in the low...

Background: The intraoperative decision to proceed with reimplantation total joint arthroplasty (rTJA) during the management of a periprosthetic infection can be challenging. Frozen section histopathology analysis can be employed to determine a wound's suitability for rTJA; however, its utility in predicting infection eradication remains controvers...

Introduction: Accurate femoral prosthesis press-fit is essential for successful cementless total hip arthroplasty (cTHA) and dependent upon proximal femur size and geometry. Study objectives were to determine the variability of proximal femur size and geometry in primary cTHA patients and correlate them with patient demographics and body mass index...

The sacroiliac joint is a diarthrodial articulation that transmits loads between the upper body and the lower extremities. In this capacity, this cartilage-lined joint—hyaline cartilage on the sacrum and fibrocartilage on the ilium—experiences multiplanar motion limited by an extremely sturdy multiligamentous complex. Biomechanical calculations by...

Introduction: Motorcycles have become an increasingly popular mode of transportation despite their association with a greater risk for injury compared with automobiles. Whereas the recent incidence of annual passenger vehicle fatalities in the United States of America (USA) has progressively declined, motorcycle fatalities have steadily increased i...

Most options for the surgical treatment of orthopaedic trauma involve the application of some type of implant or device in order to permanently or temporarily restore the anatomy or function of a joint or other skeletal anatomic structure. Symptomatic implants should be removed only after being ascertained as the source of symptoms, and although as...

In response to a decline in individual residents' performance and overall program performance on the Orthopaedic In-Training Examination (OITE), the authors' department initiated a daily literature reading program coupled with weekly tests on the assigned material. The goal of this study was to assess the effect of the reading program on individual...

Programs seek to expose trainees to research during residency. However, little is known in any formal sense regarding how to do this effectively, or whether these efforts result in more or better-quality research output. The objective of our study was to evaluate a dedicated resident research program in terms of the quantity and quality of resident...

Introduction: A new intramedullary nail (IMN) (Expert Nail) has recently been introduced with a design including an angular stable locking system (ASLS), which provides a fixed-angle interlocking construct. The study objective is to provide biomechanical assessment of IMN fixation of a distal tibia fracture using conventional versus ASLS interlocki...

Study design: Randomized laboratory cadaver study. Objective: The objective of this study was to determine the accuracy of anterior transpedicular screw placement in the cervical spine using conventional fluoroscopy versus computer-assisted navigation. Summary of background data: Traditionally, global cervical instability has required anterior...

Reliable classification of postoperative complications is important for quality improvement efforts. In 2014, The Knee Society proposed a grading system for complications after TKA, but to our knowledge, a relationship between complication grades and surgical outcomes has not yet been established. We attempted to determine (1) whether an associatio...

Purpose To provide comparative biomechanical evaluation of bicortical locking versus unicortical-abutting locking screw-plate fixation in a comminuted radius fracture model. Methods A validated synthetic substitute of the adult human radius with a 1.5-cm-long segmental mid-diaphyseal defect was used in the study to simulate a comminuted fracture....

In the view of efficiency and cost effectiveness the increasing incidence of gunshot wounds in Europe demands a modification of treatment protocols. The general basis are debridement of soft tissue injuries, antibiotics and fracture stabilization. The pathology of gunshot wounds and established treatment algorhythms, however have to be adjusted to...

Background: Clinical management guidelines usually advocate the surgical treatment of hip fractures within 20–48 hours of hospitalization, although many older patients present with significant medical conditions that require detection and possibly stabilization before surgery. The merits of an extensive preoperative medical workup versus a timely s...

Establish the nature and extent of femur sagittal bowing by determining outer and inner anterior cortex geometry and size using analytical three-dimensional computed tomography (3DCT) modeling and relate the resultant femoral curvature with the curvatures of available intramedullary nails. CT scans were rendered in 3D using modeling software to rec...

Despite the high prevalence of civilian gunshot injuries (GSIs) in the United States, no universally accepted classification currently exists. Recently, two of us (ZG, RWL) proposed a GSI classification based on energy transferred, vital structure damage, wound characteristics, fracture, and degree of contamination. This classification has not been...

To evaluate the ability of four magnetic resonance imaging (MRI) techniques to correct for metallic artifacts. These techniques consisted of 3 2D techniques and one 3D technique. In 2D imaging the techniques View Angle Tilting (VAT), Slice Encoding for Metal Artifact Correction (SEMAC) and a technique that employed a combination of the first two (S...

A patient often initially presents to an orthopedic surgeon with the magnetic resonance image (MRI) ordered by his or her primary care physician in hand. Often, a significant period of time elapses after injury before the patient is assessed by the orthopedic surgeon; therefore, the initial MRI may be considered outdated because of a new injury or...

The long-term functional implications for patients with iatrogenic femoral malrotation following femoral intramedullary nail fixation remain unclear. This study examined the extent and direction of rotational alignment of the femur treated with intramedullary nail fixation and its long-term functional effects on patients' standing, walking, and sub...

Using an interactive, 3D, kinematic simulation of the human skeleton, the motion of the sacro-iliac (SI) joint is modeled based upon descriptions available in the literature. The major ligaments are added to the simulation data structure using deformable cubic B-spline curve paths. Ligament strains were generated and studied in response to the moti...

Although recently, the crime rate has steadily declined in the USA, most violent incidents continue to involve firearms. Nonfatal firearm-related crime had plummeted since 1993, before increasing in 2005 (Fig. 35.1). Moreover, the prevalent gun availability among civilians raised the incidence of assault (57%), self-inflicted (20%), and unintention...

Clearing the cervical spine is among the highest priorities in the early assessment of trauma patients in emergency centers. Annually, more than ten million patients present to trauma centers in the USA, and in all of these patients, the possibility of cervical spine injury must be considered [34, 43, 60]. However, the actual incidence of cervical...

The goal of cervical spine clearance is to establish that injuries are not present. Patients are classified into four groups: asymptomatic, temporarily nonassessable secondary to distracting injuries or intoxication, symptomatic, and obtunded. Level I evidence supports that the asymptomatic patient can be cleared on clinical grounds and does not re...

Background: Intraoperative access to radiographic images is essential for the accurate diagnosis, operative planning and surgical treatment of many musculoskeletal conditions. Traditionally, hardcopy radiographs have been readily available for this purpose. Recently, however, hardcopy radiographs have become less accessible because many hospitals h...

The outcome of peritrochanteric fracture fixation is dependent on lag screw placement in the femoral head. The dynamic hip screw technique permits initial, independent lag screw placement, while the cephalomedullary nail dictates its positioning. The objective of this study was to compare the accuracy of lag screw placement for both implant types....

Magnetic resonance imaging (MRI) is frequently used in the assessment of patients with shoulder pain. Occasionally, physicians will obtain a repeat MRI of a shoulder that has not had surgical intervention. The purpose of this study was to determine whether repeat shoulder MRI is diagnostically efficacious. All shoulder MRIs (1252 studies) performed...

Intramedullary nailing has become a standard treatment for adult tibial shaft fractures. Retained intramedullary nails have been associated with stress shielding, although their long-term effect on decreasing tibial bone mineral density is currently unclear. The purpose of this study was to determine if retained tibial intramedullary nails decrease...

This study determines the occurrence of significant, arthroscopically correctable intraarticular pathology at the time of valgus-producing high tibial osteotomy for symptomatic medial compartment arthrosis with varus malalignment. Thirty consecutive patients (32 knees) scheduled for the procedure underwent concomitant knee arthroscopy. In the later...

Adenovirus BMP2 gene therapy has potential of a robust endogenous BMP2 production, while circumventing many of the problems currently associated with recombinant BMP2. The study objective was to determine and compare the ability of adenovirus BMP2 ex vivo gene therapy in combination with three types of collagen carriers to release BMP2 in vitro and...

The treatment of large segmental diaphyseal bone deficiencies presents a formidable challenge. The standard treatment modalities such as cancellous bone grafting, cortical allografts, vascularized bone transfer, or distraction osteogenesis exhibit extremely high complication rates, and can culminate in limb amputation or major functional deficits....

The factors contributing to heterotopic ossification, the formation of bone in abnormal soft-tissue locations, are beginning to emerge, but little is known about microenvironmental conditions promoting this often devastating disease. Using a murine model in which endochondral bone formation is triggered in muscle by bone morphogenetic protein 2 (BM...

The department chair has a broad sphere of influence in which to promote diversity. The most immediate sphere of influence is on the department physicians(faculty, residents, and fellows) as well as administrators and support staff. The chair also can potentially influence this same group of individuals throughout the medical school as well as thro...

In this pilot study, the preliminary effectiveness of a composite graft consisting of demineralized bone matrix (DBM) putty (Grafton DBM) and aspirated bone marrow was evaluated for treating long bone fractures. Patients were ssigned randomly to treatment with the DBM putty composite (n = 10) or iliac crest autograft (n = 8), and had a minimum of 1...

We report a case series of three patients who sustained open Gustilo-Anderson Type IIIB tibia fractures associated with extensive segmental bone and soft tissue loss. The patients initially were treated with serial wound irrigations, débridements, and external fixation. After the soft tissue envelope was reconstructed successfully, each large segme...