Mark S Hsiao

University of Texas at El Paso, El Paso, Texas, United States

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Publications (10)25.05 Total impact

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    ABSTRACT: Little is known about the incidence and characteristics of primary, or external, shoulder impingement in an occupationally and physically active population. A longitudinal, prospective epidemiologic database was used to determine the incidence and risk factors for shoulder subacromial impingement in the United States (U.S.) military. Our hypothesis was that shoulder impingement is influenced by age, sex, race, military rank, and branch of service. The Defense Medical Epidemiology Database was queried for all shoulder impingement injuries using International Classification of Disease, Ninth Addition, Clinical Modification code 726.10 within a 10-year period from 1999 through 2008. An overall injury incidence was calculated, and a multivariate analysis performed among demographic groups. In an at-risk population of 13,768,534 person-years, we identified 106,940 cases of shoulder impingement resulting in an incidence of 7.77/1000 person-years in the U.S. military. The incidence of shoulder impingement increased with age and was highest in the group aged ≥40 years (incidence rate ratio [IRR], 4.90; 95% confidence interval [CI], 4.61-5.21), was 9.5% higher among men (IRR, 1.10, 95% CI, 1.06-1.13), and compared with service members in the Navy, those in the Air Force, Army, and Marine Corps were associated with higher rates of shoulder impingement (IRR, 1.46 [95% CI, 1.42-1.50], 1.42 [95% CI, 1.39-1.46], and 1.31 [95% CI, 1.26-1.36], respectively). The incidence of shoulder impingement among U.S. military personnel is 7.77/1000 person-years. An age of ≥40 years was a significant independent risk factor for injury. Copyright © 2015 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.
    No preview · Article · Apr 2015 · Journal of shoulder and elbow surgery / American Shoulder and Elbow Surgeons ... [et al.]
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    ABSTRACT: Purpose Shoulder pathology, particularly SLAP (superior labrum anterior-posterior) lesions, is prevalent in overhead athletes and physically active individuals. The aim of this study is to quantify the burden of SLAP lesions in the military and establish risk factors for diagnosis. Methods A retrospective analysis of all service members diagnosed with a SLAP lesion (International Classification of Disease, Ninth Revision code 840.70) in the Defense Medical Epidemiological Database between 2002 and 2009 was performed. Available epidemiological risk factors including age, sex, race, military rank, and branch of service were evaluated using multivariate Poisson regression analysis, and cumulative and subgroup incidence rates were calculated. Results During the study period, approximately 23,632 SLAP lesions were diagnosed among a population at risk of 11,082,738, resulting in an adjusted incidence rate of 2.13 per 1,000 person-years. The adjusted annual incidence rate for SLAP lesions increased from 0.31 cases per 1,000 person-years in 2002 to 1.88 cases per 1,000 person-years in 2009, with an average annual increase of 21.2 % (95 % CI 20.7 %, 22.0 %, p p p Conclusion This is the first study to establish the epidemiology of SLAP lesions within an active military cohort in the American population. Sex, age, race, military rank, and branch of military service were all independently associated with the incidence rate of SLAP lesions in this physically active population at high risk for shoulder injury. Level of evidence II.
    No preview · Article · Dec 2013 · Knee Surgery Sports Traumatology Arthroscopy

  • No preview · Article · Jun 2013 · Arthroscopy The Journal of Arthroscopic and Related Surgery
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    ABSTRACT: There are few reports on outcomes after hip arthroplasty in the military population despite increases among young, active patients. U.S. Army service members with coded hip arthroplasty between 2004 and 2010 were reviewed. Patient demographic variables were correlated with occupational outcomes. Of 183 patients, the occupational outcomes at a minimum 2 years postoperatively for service members undergoing primary hip arthroplasty were medically separated (n = 44, 24%), retired (n = 82, 45%), and returned to active duty (n = 57, 31%). Multivariate analysis identified that age less than 40 years [odds ratio (OR), 3.41; 95% confidence interval (CI), 1.14, 10.12] and enlisted rank (OR, 3.63; 95% CI, 1.29, 10.20) as major independent risk factors for medical separation. Univariate analysis revealed that officer rank had an increased likelihood of postoperative combat deployment than enlisted rank (OR, 3.39; 95% CI, 1.50, 7.94). Despite encouraging results in the civilian literature, this study documents modest retention rates on active duty at a minimum of 2 years after primary hip arthroplasty.
    No preview · Article · Mar 2013 · Journal of surgical orthopaedic advances
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    ABSTRACT: OBJECTIVES:: This investigation sought to describe orthopaedic wounds sustained by servicemembers deployed to Iraq or Afghanistan from 2005-2009. DESIGN:: Retrospective review of prospective data. SETTING:: Joint Theater Trauma Registry (JTTR) PATIENTS:: The 6,092 musculoskeletal casualties contained in the JTTR. INTERVENTION:: The JTTR was queried to identify all personnel sustaining musculoskeletal injuries in the period 2005-2009. Demographic information, injury mechanism, and nature of wounds were determined for all individuals. Deployment data for all servicemembers was obtained through the Defense Manpower Data Center and the incidence of orthopaedic injuries and wounding patterns was assessed. MAIN OUTCOME MEASUREMENTS:: Pairwise comparisons were made to identify statistically significant differences in incidence, and significant associations, between injury mechanism and injuries/wounding patterns. RESULTS:: The JTTR contained data on 6,092 musculoskeletal casualties with 17,177 wounds. Seventy-seven percent of all casualties sustained a musculoskeletal wound. The incidence of musculoskeletal combat casualties was 3.06 per 1,000 deployed personnel per year, with fractures occurring in 3.41 per 1,000, and soft-tissue wounds most commonly encountered (4.04 per 1,000). Amputations represented 6% of all combat wounds Most musculoskeletal wounds were caused by explosive blast (p<0.001), as were nearly all traumatic amputations. CONCLUSIONS:: This study represents the most complete description of the scope of orthopaedic war trauma. It also presents injury specific incidences that have not previously been described for musculoskeletal combat casualties. Musculoskeletal casualties may occurred in 3 of every 1,000 personnel deployed per year.
    No preview · Article · Nov 2012 · Journal of orthopaedic trauma
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    ABSTRACT: Although it is generally known that clavicle fractures represent a common injury of the shoulder girdle in the general population, the true incidence in the active duty military population is unknown. Given the implications for such injuries on the ability to perform occupation-specific tasks, determining the incidence in the U.S. military population is worthwhile. The purpose of this study was to determine the incidence of clavicle fractures in the U.S. military and to identify any demographic risk factors for injury. We performed a query of the Defense Medical Epidemiology Database with the code from the International Classification of Diseases, Ninth Revision, for clavicle fractures for the years 1999 through 2008. An overall injury incidence was calculated, in addition to multivariate analysis, to determine independent risk factors among the following demographic considerations: sex, race, branch of military service, rank, and age. During the study period, a total of 12,514 clavicle fractures were documented among an at-risk population of 13,770,767 person-years for an incidence rate (IR) of 0.91 per 1,000 person-years in the U.S. Military. Males, when compared with females, were more than twice as likely to sustain a clavicle fracture (IR ratios [IRR], 2.30; 95% confidence intervals [CI], 2.12-2.49). The peak incidence of clavicle fractures occurred in the age groups of <20 and 20 to 24. Compared to black service members, the white service members were associated with significantly higher rate of clavicle fractures (IRR, 2.45; 95% CI, 2.28-2.63). The service members serving in the Marine Corps were associated with a higher IR of clavicle fractures when compared to those in the Navy (IRR, 1.44; 95% CI, 1.35-1.53). Junior enlisted service members were 34% as likely to sustain a clavicle fracture when compared to senior officers (IRR, 1.46; 95% CI, 1.34-1.60 and IRR, 1.12; 95% CI, 0.99-1.28, respectively). The incidence of clavicle fractures among U.S. military personnel (0.908 per 1,000 person-years) is higher than previous epidemiological reports.
    No preview · Article · Aug 2012 · Military medicine
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    ABSTRACT: To examine the incidence of osteoarthritis and the influence of demographic and occupational factors associated with this condition among active duty US service members between 1999 and 2008. To determine the total number of incident cases of osteoarthritis, the Defense Medical Surveillance System (DMSS) was queried by sex, race, age, branch of military service, and rank using code 715 of the International Classification of Diseases, Ninth Revision, Clinical Modification. Multivariable Poisson regression analysis was used to estimate incidence rates, rate ratios, and 95% confidence intervals (95% CIs) for osteoarthritis per 1,000 person-years. A total of 108,266 incident cases of osteoarthritis were documented in the DMSS within a population that experienced 13,768,885 person-years at risk of disease during the study period. The overall unadjusted incidence rate among all active duty US service members during the study period was 7.86 cases per 1,000 person-years. Significant demographic and occupational risk factors for osteoarthritis included sex, age, race, branch of service, and rank (P<0.001). Women experienced an adjusted incidence rate for osteoarthritis that was nearly 20% higher than that for men (rate ratio 1.19 [95% CI 1.17-1.21]). Service members ages≥40 years experienced an adjusted incidence rate for osteoarthritis that was ∼19 times higher than that for those ages<20 years (rate ratio 18.61 [95% CI 17.57-19.57]). Black service members experienced significantly higher incidence rates of osteoarthritis than those in the white and "other" race categories. Rates of osteoarthritis were significantly higher in military populations than in comparable age groups in the general population.
    Full-text · Article · Oct 2011 · Arthritis & Rheumatology
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    ABSTRACT: Pyoderma gangrenosum is a rare autoinflammatory syndrome manifested by skin lesions eventually creating ulcers. Surgical management can lead to scarring and contracture at the site of the lesion due to the pathergy phenomenon. A 43-year-old woman presented with a 5-year history of severe equinovarus deformity due to chronic pyoderma gangrenosum on her posteromedial ankle. She underwent a staged fusion. A gradual "closed" correction was performed in a Taylor spatial frame for 8 weeks in order to obviate the need for a surgical release in the area of the ulcer. She was ambulatory and full weight-bearing within 4 weeks of her frame removal. She maintained her correction with an accommodative foot orthosis until she had an uneventful tibiotalar calcaneal fusion with an intramedullary device. This case represents the success of using a Taylor spatial frame for staged fusion involving soft-tissue correction of severe, rigid equinovarus deformity due to pyoderma gangrenosum.
    Full-text · Article · Aug 2011 · Strategies in Trauma and Limb Reconstruction
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    ABSTRACT: Cohort study. The objective of this study was to characterize the incidence of spinal cord injury (SCI) within the population of the United States military from 2000-2009. This investigation also sought to define potential risk factors for the development of SCI. The population of the United States military from 2000-2009. The Defense Medical Epidemiology Database was queried for the years 2000-2009 using the International Classification of Diseases, Ninth Revision, Clinical Modification codes for SCI (806.0, 806.1, 806.2, 806.3, 806.4, 806.5, 806.8, 806.9, 952.0, 952.1, 952.2, 952.8, 952.9). The raw incidence of SCI was calculated and unadjusted incidence rates were generated for the risk factors of age, sex, race, military rank and branch of service. Adjusted incidence rate ratios were subsequently determined via multivariate Poisson regression analysis that controlled for other factors in the model and identified significant independent risk factors for SCI. Between 2000 and 2009, there were 5928 cases of SCI among a population at-risk of 13,813,333. The raw incidence of SCI within the population was 429 per million person-years. Male sex, white race, enlisted personnel and service in the Army, Navy or Marine Corps were found to be significant independent risk factors for SCI. The age groups 20-24, 25-29 and >40 were also found to be at significantly greater risk of developing the condition. This study is one of the few investigations to characterize the incidence, epidemiology and risk factors for SCI within the United States. Results presented here may represent the best-available evidence for risk factors of SCI in a large and diverse American cohort.
    No preview · Article · Mar 2011 · Spinal Cord
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    ABSTRACT: Although some studies have reported an increased incidence of patellar dislocations within active populations, few studies have reported incidence rates and examined risk factors for this injury. To examine the incidence of patellar dislocation injuries and the influence of demographic and occupational risk factors associated with injury among active-duty United States (US) service members between 1998 and 2007. Cohort study; Level of evidence, 3. Using the Defense Medical Surveillance System, a search was performed for International Classification of Disease, 9th Revision (ICD-9) code 836.3 among all US service members on active duty during the study period. Multivariable Poisson regression analysis was used to estimate the rate of patellar dislocation per 1000 person-years at risk to injury. Incidence rates (IRs) and incidence rate ratios (IRRs) for patellar dislocation along with 95% confidence intervals (CIs) were estimated by gender, age, race, branch of military service, and rank while controlling for the other variables in the model. There were a total of 9299 individuals with documented patellar dislocation injuries among a population at risk of 13 443 448 person-years. The IR was 0.69 per 1000 person-years at risk. Women were 61% more likely (IRR, 1.61; 95% CI, 1.53-1.69) to sustain a patellar dislocation injury than men. Rates were highest in the youngest age group and decreased with increasing age. Service members aged <20 years were 84% more likely (IRR, 1.84; 95% CI, 1.61-2.10) to sustain a patellar dislocation injury as service members aged ≥40 years. Differences were also noted by race, service, and rank. The incidence of patellar dislocation injuries among US service members was an order of magnitude greater than that previously reported in civilian population studies. Gender, age, race, rank, and branch of military service are important risk factors related to the incidence of patellar dislocation injuries in this population.
    No preview · Article · Oct 2010 · The American Journal of Sports Medicine

Publication Stats

67 Citations
25.05 Total Impact Points


  • 2012-2015
    • University of Texas at El Paso
      El Paso, Texas, United States
  • 2013
    • William Beaumont Army Medical Center
      El Paso, Texas, United States
  • 2011
    • Creighton University
      Omaha, Nebraska, United States
  • 2010-2011
    • Keller Army Community Hospital
      ვესტ-პოინტი, New York, United States