Publications by Year: 2026

STUDY DESIGN: Systematic review and meta-analysis.

OBJECTIVE: To determine whether venous thromboembolism (VTE) prophylaxis is necessary after spine trauma and to assess the efficacy and safety profiles of anticoagulation agents.

SUMMARY OF BACKGROUND DATA: Venous stasis, endothelial disruption, hypercoagulability, and orthopedic injury in spine trauma predispose 12%-64% of patients to deep vein thrombosis (DVT). Recent guidelines provide insufficient evidence to support or oppose routine VTE prophylaxis in this population.

METHODS: A systematic search was conducted in Medline, EMBASE, Web of Science Core Collection, and Cochrane Central Register of Controlled Trials from inception to March 2023. Controlled vocabulary, key terms, and synonyms related to spinal trauma and anticoagulation were used. Studies comparing different classes of anticoagulants or anticoagulation versus no anticoagulation were included. Four reviewers independently performed abstract screening, full-text review, and data extraction, resolving conflicts by consensus. The primary outcomes were deep vein thrombosis (DVT), pulmonary embolism (PE), major bleeding, and mortality.

RESULTS: Our search yielded 2948 articles, with 103 advancing to full-text review and 16 meeting inclusion criteria. Bias assessment using MINORS for 10 retrospective studies resulted in an average score of 16.8 ± 1.6, whereas 6 prospective studies had NOS scores >6, indicating high-quality evidence. Anticoagulation was significantly associated with lower odds of DVT (OR: 0.40; P =0.0013), with low heterogeneity (I² = 2%). Low-molecular-weight heparin (LMWH) was associated with significantly lower odds of DVT (OR: 0.78; P =0.0050) and PE (OR: 0.66; P =0.0013) compared with unfractionated heparin (UH). No significant difference in major bleeding was found (OR: 0.52; P =0.1397). LMWH was linked to reduced mortality (OR: 0.43; P <0.0001).

CONCLUSION: Chemical anticoagulants reduce DVT risk in spine trauma patients. LMWH provides superior protection against DVT, pulmonary embolism, and mortality compared with UH, with no significant increase in major bleeding.

Study DesignSystematic review and meta-analysis.ObjectiveTo evaluate the timing of anticoagulation in acute spinal trauma, specifically assessing the efficacy and safety of early (<48 hours) vs delayed administration for chemical venous thromboembolism prophylaxis.MethodsA systematic search of Medline, EMBASE, Web of Science, and Cochrane was conducted through February 2023 for studies comparing early vs delayed anticoagulation in acute spinal trauma patients. Studies reporting deep vein thrombosis (DVT), pulmonary embolism (PE), major bleeding, and mortality were included. Three reviewers independently screened and extracted data. Risk of bias was assessed using MINORS and the Newcastle-Ottawa Scale. The protocol was registered on PROSPERO (CRD42023397717).ResultsFive studies, comprising a total of 13,110 patients, compared anticoagulant administration within 48 hours of trauma vs after 48 hours, reporting DVT and PE as outcomes. Early administration was associated with significantly lower odds of DVT (OR: 0.20 [95% CI: 0.17-0.25], P = .0001, I2 = 34%) and PE (OR: 0.46 [95% CI: 0.34-0.62], P = .0001, I2 = 0%). Four studies evaluated major bleeding as an outcome and found slightly lower odds with early initiation, though the association was not statistically significant (OR: 0.85 [95% CI: 0.66-1.09], P = .1992). Similarly, 4 studies assessed mortality, with results that were also nonsignificant.ConclusionsThe current evidence indicates that early initiation of chemical anticoagulation within 48 hours of injury in spine trauma patients is associated with favorable outcomes in preventing thromboembolic complications, without significantly increasing the risk of bleeding or mortality.

Study DesignTranslational rodent study.ObjectivesTo investigate (1) chemokine-mediated mesenchymal stem cell mobilization and homing to the intervertebral disc and (2) using this technique to mitigate intervertebral disc degeneration in a rat model.Methods(1) Recruitment of mesenchymal stem cells (MSCs) to intervertebral discs (IVD) was investigated using intradiscal chemokines. Hydrogel containing SDF-1, RANTES, MCP-1, or empty control was injected intradiscally, followed by near-infrared (NIR) imaging to observe MSC localization. (2) A rat IVD degeneration model was induced by annular puncture. Intradiscal RANTES injection and/or systemic AMD3100 injection was performed. Longitudinal imaging and histological analyses including Rutges Score (histologic degeneration) assessed IVD degeneration mitigation post-treatment up to 12-weeks. Statistical analyses included ANOVA and mixed-effects models to evaluate recruitment, retention, and regenerative potential of MSCs.Results(1) 24 rats were included in the investigation of MSC recruitment. In vivo NIR signal on 1-day post-intervention was highest with RANTES (P < .05). Ex vivo NIR signal at 14-days post-intervention was highest with RANTES (P < .05). (2) 36 IVD degeneration model rats underwent intradiscal RANTES and/or AMD3100 injection. AMD3100-treated groups showed larger nucleus pulposus (NP) volumes and reduced histologic damage, with lower Total Rutges scores (P = .004). RANTES treatment alone reduced Total Rutges scores (P = .009) and protected against IVD height loss at 6 weeks.ConclusionsIntradiscal delivery of RANTES/CCL5 promotes a sustained and targeted recruitment of MSCs to the IVD. In a rat model of IVD degeneration, administration of systemic AMD3100 and intradiscal RANTES mitigates IVD degeneration.

PURPOSE: Hand surgery fellowships include trainees from orthopedic, plastic, and general surgery. These pathways present an opportunity to examine variations in graduate medical education structures, such as program size, sponsoring department, and leadership composition. Limited research exists on the characteristics of these programs. The purpose of this study is to assess the structural and leadership characteristics of the Accreditation Council of Graduate Medical Education-accredited hand surgery fellowships in the United States. We hypothesized that characteristics (ie, faculty-to-fellow ratios and case volume) vary by specialty sponsorship. Leadership, although shaped by merit-based criteria, faces challenges in achieving broader demographic diversity.

METHODS: A cross-sectional analysis of 95 US hand surgery fellowship programs was conducted in 2025. Program characteristics were compared by region and specialty sponsorship.

RESULTS: Most programs were orthopedic-sponsored (n = 74, 77.9%), followed by plastic surgery (n = 19, 20.0%) and general surgery (n = 2, 2.11%). Programs averaged 2.22 fellows (SD = 1.35), with a faculty-to-fellow ratio of 3.98 (SD = 2.01) and an annual case volume of 846 per fellow (SD = 332). Orthopedic-sponsored programs had more fellows on average, a lower faculty-to-fellow ratio, and were less open to general surgery applicants compared to plastic surgery-sponsored programs. No notable regional differences were found in these characteristics. Program directors were predominantly men (n = 81, 85.3%) and orthopedic-trained (n = 70, 73.7%).

CONCLUSIONS: Hand surgery fellowships show consistent structural features, with notable differences between orthopedic- and plastic surgery-sponsored programs in enrollment, faculty-to-fellow ratios, and openness to general surgery applicants. Women leadership underrepresentation warrants further evaluation.

TYPE OF STUDY/LEVEL OF EVIDENCE: Cross-sectional descriptive study, level IV.

OBJECTIVES: The interest in bacteriophage therapy has significantly increased due to the rising prevalence of antibiotic-resistant bacterial infections. However, the pharmacology of bacteriophage therapy has not been systematically reviewed. This scoping review aims to summarize the current state of bacteriophage pharmacokinetics and pharmacodynamics research to identify knowledge gaps and guide future research.

METHODS: Following PRISMA-ScR guidelines, we conducted a scoping review through December 18th, 2023 of MEDLINE (Ovid), PubMed, Embase (Elsevier), Web of Science Core Collection (Clarivate), and Cochrane Central. We included studies that presented original data on the pharmacokinetics and pharmacodynamics of bacteriophage therapy for in vivo infection treatment.

RESULTS: In total, 34 in vivo studies were identified varying in multiple dimensions, including model organisms, target bacteria, delivery vehicles, modes of administration, and phage type. The scoping review maps the current research landscape of in vivo bacteriophage pharmacology.

CONCLUSIONS: Bacteriophage therapy shows notable promise as a potential alternative or therapeutic adjunct to antibiotics in clinical disease settings. Several studies of phage pharmacokinetics and pharmacodynamics have been conducted; however, these studies differ in multiple dimensions, complicating attempts to develop general principles for standardized phage administration. Further, significant gaps remain in understanding the numerous intrinsic phage and host factors that might affect the pharmacokinetics and pharmacodynamics of phage therapy in vivo.

Endoscopic spine surgery (ESS) represents a development in minimally invasive procedures, offering the potential benefits of reduced tissue disruption, shorter recovery times, and enhanced precision. This review traces the historical development of ESS, explores its core techniques-including transforaminal, interlaminar, and biportal approaches-and evaluates its role in treating conditions like herniated disks and spinal stenosis. By comparing clinical outcomes of ESS with standard open surgery, this article highlights the importance of patient selection, surgeon expertise, and evidence-based practice. Challenges, such as the steep learning curve, limitations in visualization, and risk of complications, are discussed, along with strategies for integrating ESS into modern spine care. The review concludes by identifying research gaps and opportunities for technological advancements, aiming to guide surgeons in adopting ESS and improving patient outcomes.

PURPOSE: The purpose of this study was to evaluate the current geographic distribution of hand surgeons across the United States and characterize differences in patient access to medical care.

METHODS: We used the American Academy of Orthopaedic Surgeons, the American Association for Hand Surgery, and the American Society for Surgery of the Hand databases and Doximity to locate orthopedic, plastic, and general surgery-trained hand surgeons in the United States as of December 2024. Details about practice location and corresponding socioeconomic information from US counties were gathered. Counties were divided into those with hand surgeons and those without. Geographic and socioeconomic details were compared.

RESULTS: A total of 2,733 hand surgeons were identified. These surgeons primarily practiced in metropolitan and affluent areas. California, New York, Florida, and Pennsylvania had the most hand surgeons. The District of Columbia, Rhode Island, Connecticut, New Hampshire, and Vermont had the highest ratios of surgeons per person. Geographically, the West had the lowest number of hand surgeons, in contrast to the South, which maintained the most. Only 18.3% of US counties had at least one hand surgeon, and 32.9% of these counties had only one. Counties with hand surgeons had higher median incomes, lower poverty rates, and higher unemployment rates than counties without surgeons.

CONCLUSIONS: There is marked variation in the geographic distribution of hand surgeons. Western and economically disadvantaged regions appear to face significant shortages. To address these shortages, strategies such as growing medical education to increase interest in hand surgery, enhancing mentorship opportunities, and incentivizing practice in underserved areas are needed. Telemedicine and rural training programs could also play an important role in increasing access to care in remote locations.

LEVEL OF EVIDENCE: Cross-sectional study, III.

Peripheral nerve injuries lead to diminished function and pain via nociplastic phenomena. We propose a new strategy called directed functional reinnervation, in which nerves are reassigned to new peripheral targets with the intention of altering circuit function. Here, we redirect the saphenous sensory nerve into a skeletal muscle graft to curb nociplasticity and provide benign sensations or useful inputs for prosthetic applications. Electrophysiological functional characterization demonstrated robust afferent responses to mechanical stimulation of the muscle. Immunofluorescence staining indicated widespread innervation of various synapses within the muscle graft. With immediate graft placement, the injured nerve's dorsal root ganglia revealed comparable levels of nociceptive markers to uninjured nerves, suggesting a molecular basis for the prevention of pain sensitization. These findings contribute to the mechanism by which skeletal muscle grafts alleviate neuropathic pain and can be used as a sensory transmitter in conjunction with neural interfaces.

Supracondylar humerus fractures (SCHFs) are common injuries among children and typically occur after a fall on an outstretched hand. SCHFs may present with neurovascular injury specifically to the brachial artery and/or median nerve (or its deep motor branch), ulnar nerve, and/or radial nerve. Thorough examination of a patient's neurovascular status is imperative to appropriately guide treatment and determine whether a referral is needed. Minimally displaced SCHFs may be treated nonsurgically, whereas displaced injuries often require surgery. Displaced SCHFs may be treated nonsurgically with traction and splinting, but providers should expect a high rate of complications and notable disability. Of equal importance to consider is the status of the soft tissues. In resource-limited settings, such as rural or district hospitals, surgery for more severe SCHFs may not be feasible because of lack of fluoroscopy, implants, or staff adequately trained in musculoskeletal trauma. In these situations, referral to a hospital with increased resources and surgical capabilities is recommended when possible. We present an approach to the triage and treatment of SCHFs in various resource-constrained environments, broadly applicable to low- and middle-income countries.