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2021 - 2022SCHOLARS REVIEWTogether We are Making a Difference!FOLLOW OUR SOCIAL MEDIA #NTHDIMENSIONS

COPYRIGHT2022 Nth Dimensions Summer Internship Culminationof Scholarly Activityhttp://www.nthdimensions.orgCopyright © 2022 All rights reserved. No portion of this book may be reproduced in anyform without permission from the copyright owner or respectiveauthor for the individual body of work, except as permitted by U.S.copyright law. For permissions, contact Nth Dimensions forcommunication with each author.Print in the United States of AmericaEditor: Letitia Bradford, MD; Monique C. Chambers, MD, MSL; Willam A.J. Ross Jr., MD1st Edition

TABLE OF CONTENTSSCHOLARS REVIEW | 2021 - 202201N t h D i m e n s i o n s | O U R W H Y + S U C C E S S 02N t h D i m e n s i o n s | S C H O L A R S M A T C H R E S U L T S03N t h D i m e n s i o n s | P R O G R A M S04N t h D i m e n s i o n s | S C H O L A R S 05N t h D i m e n s i o n s | P A R T N E R S06N t h D i m e n s i o n s | O U T C O M E S07N t h D i m e n s i o n s | Y E A R I N R E V I E W

MONIQUE CHAMBERS, MD, MSLResearch CoordinatorLETITIA BRADFORD, MD, FAAOS, FACSExecutive DirectorSONYA SEYMOURDirector of Partnerships+ ProgramsNICHOLE HAMILTONSenior ProgramCoordinatorBIANCA ALLENDermatology ProgramCoordinatorBONNIE SIMPSON MASON, MD, FAAOSFounder and Senior AdvisorNTH DIMENSIONSLEADERSHIP TEAMWILLIAM A.J. ROSS, JR., MD, FAAOSDirector of Clinical Education

Dear Friends of Nth, Nth Scholars, Partners, and Alumni!The Nth Dimensions Team and I are pleased to welcome you to the Nth Dimensions’Scholars Review for 2021 - 2022. This is Nth Dimensions' 18th year of officially addressinghealth equity and eliminating healthcare disparities through our diversity and inclusionpipeline/pathway programs for women and minority students and residents across theUnited States....Nth Dimensions is proud to say that we are the most successful diversitypipeline/pathway program nationwide for medical students seeking to match in theleast diverse fields of medicine.With our 2022 match rate for all Nth Scholars and Affiliates pursuing careers in allspecialties of 91% and our overall match rate of 92% for the past five years,Nth Dimensions Scholars are EXCELLENCE PERSONIFIED as LEADERS, SCHOLARS, andPHYSICIANS in SERVICE for ALL communities.As such, we are proud to share our annual Nth Scholars Review with you because ithighlights our motto and core pillars:The opportunity toThe opportunity toThe opportunity toinfluence othersinfluence othersinfluence othersbehind you is whatbehind you is whatbehind you is whatcontinues to drivecontinues to drivecontinues to driveme...especiallyme...especiallyme...especiallywhen “they” saywhen “they” saywhen “they” sayyou cannot do it!you cannot do it!you cannot do it!EXECUTIVE DIRECTOR'SNOTE

SCHOLARSNth Dimensions prioritizes the developmentof a skill set which includes basic scienceand clinically based research for our NthScholars as current and future clinician-scientists. Our research programs haveenabled students to produce researchprojects, give presentations, and producepublications at a level of excellence thatsurpasses medical students at their level.Nth Dimensions’ primary objective is todevelop the next generation of leadersthrough our ongoing professionaldevelopment and mentoring programs. Weunderstand that executive skills must betaught and reinforced over time and NthDimensions has integrated leadershipdevelopment into our Phase I – 4 programs.Thus, it is our contention that with earlyexposure and skills, all students can excel asresearchers and innovators.LEADERS PHYSICIANSOur clinical curriculum is implemented in 4separate phases. This year, NthDimensions has returned to in-personPhase 1 Bioskills programs nationwide. InPhase 2, we had 44 Nth DimensionsSummer Interns (NDSI) this past summerin three specialties: Orthopaedic Surgery,Dermatology, and Radiology. We areslated to expand our programming toinclude Pathology in 2023. In our Phase 3programs, we were fortunate enough to beable to host approximately 100 medicalstudents (twice the amount of ourprevious years!!) at the annual meeting ofthe American Academy of OrthopaedicSurgery in conjunction with the J. RobertGladden Orthopaedic Society. In addition,an inaugural medical student symposiumwas held at the American Academy ofDermatology (AAD) annual conference inBoston. With support from the AAD, we hadapproximately 50 students join us forprogramming. In phase 4, we strive tocontinue reinforcing our students' supportnetwork through Health and Wellnessservices that include private counselingsessions, group wellness services, and theidentification of alternative learning styleswith recommendations for services for thestudents in need of assistance. Theseservices continue to be offered to ouralumni as they progress into Residencyand Fellowship. EXECUTIVE DIRECTOR'SNOTE

Together, we aremaking adifference!SERVICELetitia Bradford Lifting as we Climb,Executive DirectorNth Dimensions a 501c3 Non-ProfitOrganizationLetitia Bradford, MD, FAAOS, FACSCommunity service, mentoring, andaccountability for our fellow Nth Scholarshave always been at the core of ourprogramming. Each NDSI Scholarparticipates in a day of service in the localcommunity they are interning in for thesummer. We continue to developadditional partnerships because of ourscholars’ willingness to demonstrate theircommitment to the communities theyserve.Continuous thanks go to each and everyNth Dimensions volunteer preceptor andfaculty member, our Friends of Nth Donors,Partners, Alumni, Scholars, and our Boardof Directors.The success of Nth Dimensions is definitelya team effort, and I am personally thankfulto the entire Nth Dimensions team andstaff for their unwavering and dedicatedsupport of our students and our programsyear-round. Your belief in the mission andvision of what Nth Dimensions has alwaysbeen and continues to be what propels usto new heights.In closing, please enjoy perusing our 2021 -2022 Nth Dimensions Scholars Review. Iknow that you will be impressed with thelevel of excellence demonstrated by ourNth Scholars as Leaders, Scholars, andPhysicians in Service to Others. EXECUTIVE DIRECTOR'SNOTE

01THE REASON BEHIND WHAT WE DOS E C T I O NNTH DIMENSIONSOUR WHY + SUCCESSSUCCESS

(REFERENCES AVAILABLE UPON REQUEST) BACKGROUNDNTH DIMENSIONSOUR WHYearly exposure tospecialty fields; addressing educationalgaps; mentoring; the presence of andinteraction with facultyreflective of women andunderrepresentedminority groups; the development of aninstitutional culture ornetwork that issupportive of women andminority physicians. [1, 6]These include Healthcare disparities have become arecent focus of literature in the UnitedStates. The preparation of a physicianworkforce that mirrors the gender, racial,and ethnic makeup of the population is animportant step toward eliminating thesedisparities. [7]The current composition of the physicianworkforce in the United States has failed toreflect the changes seen in its population.One study states that the inability of theoverall health professionals to keep pacewith the US population is a greatercontributor to health disparities thanaccess to care. [5]Regarding specialty fields of medicine, thelack of physician workforce diversity for allspecialties is well documented in theliterature. [3, 10]Orthopaedic surgery, in particular, isamong the least diverse specialties forunderrepresented minorities(eg, with only 3% of US orthopaedicsurgeons of African-American descent)and is the least diverse for women, withfemales accounting for only 7% of allpracticing orthopaedic surgeons. [3]However, there is data to support theefficacy of certain strategies that increasephysician workforce diversity.

NTH DIMENSIONSSUCCESS1041:3AT LEAST 1 OF EVERY3 (35%) BLACK,PRACTICINGORTHOPAEDICSURGEONSPARTICIPATED IN NTHDIMENSIONS INVARIOUS ROLES.NTH DIMENSIONS HAS MATCHED 133STUDENTS INTO ORTHOPAEDIC SURGERYRESIDENCY PROGRAMS, WITH 104 BEINGUNDERREPRESENTED MINORITIES AND 36OF THOSE MINORITY WOMEN. THE AVERAGE NTHDIMENSIONSRESIDENCY MATCHRATE FOR THE LASTFIVE YEARS IS 92%.92%45xWOMEN WHOPARTICIPATED IN ALLTHE PROGRAMS' PHASESWERE 45 TIMES MORELIKELY TO APPLY TO ANORTHOPAEDIC SURGERYRESIDENCY THAN THEIRNON-PARTICIPANTCOUNTERPARTS. 36

NTH DIMENSIONSSUCCESSLifting as we climb."Nth Dimensions is proud to say that we are the most successful diversitypipeline program nationwide for medical students seeking to match in theleast diverse fields of medicine." – Dr. Bonnie Simpson Mason, Founder and Sr. Advisor4440The total number of Scholars acceptedinto the Nth Dimensions SummerInternship program in 2022.The number of medical schoolsrepresented in the 2022 NDSI cohort.26The number of women in the 2022 NDSIcohort.24The number of URM students in the 2022NDSI cohort.

NTH DIMENSIONSSUCCESSScholar Presentation HighlightsTYLER KELLY, 2021 NDSI SCHOLARUniversity of South CarolinaSchool of Medicine Greenville"As  a  third-year  medical  student,  I  embraced  theopportunity  to  deliver  a  podium  presentation  atthe  2021  AAOS  Annual  Meeting.  What  made  thisexperience  so  special  is  that  the  work  I  presentedwas  the  result  of  my  summer  research  project  asan  Nth  Dimensions  scholar, working  alongside  Dr.Melissa  Zimel  at  the  University  of  California  SanFrancisco.The  support  and  preparation  that  I  received  fromthe  Nth  leadership  team,  my  Nth  mentors  andpartners, including Dr. Melissa Zimel, Dr. RosannaWustrack, and Dr.  Coleen Sabatini, as  well as  myfellow Nth scholars, allowed me to step into thatopportunity  with  confidence  and  an  invaluablesense of belonging.  This milestone motivated meto  continue  striving  and  growing,  proactivelyseeking what is to come."TYLER NSEKPONG, 2021 NDSI SCHOLARUniversity of Texas Medical Branch
Nth  Dimensions  has  been  instrumental  in  myunderstanding  of  scholarly  activity.  During  my  NthDimensions  Summer  Internship  experience,  I  wasconnected  to  my  mentor  Dr.  Jaysson  Brooks.  Dr.Brooks  guided me  through  the process  of creatingmy  first  research  project  and  explained  how  topresent our information on different platforms. Duringmy internship, I also learned how to utilize databasesto  find  supporting  articles  and  further  tips  onacademic writing. Through this experience, I was ableto present nationally and even turn this project into apublication.  None  of  this  would  be  possible  withoutthe support and encouragement I received from myNth  Dimensions  family.  Nth  Dimensions  is  genuinelydedicated to empowering excellence."

NTH DIMENSIONSSUCCESS“NTH IS ELIMINATING HEALTH DISPARITIES BYDIVERSIFYINGTHE PHYSICIAN WORKFORCE”Through the generous support of ouracademic partners and industrysponsors, we are currently helpingand have helped over 400 womenand underrepresented minority NthScholars and Affiliates to achievetheir dream of becoming physiciansand surgeons in specialty fields.Thank youfor Lifting with us!

NTH DIMENSIONS MATCH RESULTS02S E C T I O NNTH DIMENSIONS SCHOLARS MATCHRESULTSMATCHRESULTS

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Nth DIMENSIONS2022 Match RateAs we celebrate almost twenty years as leaders,scholars, and physicians in service to allcommunities, Nth Dimensions proudly announcesthat 91% of our Nth Scholars and Affiliates havesuccessfully matched into residency positions in2022. NTH DIMENSIONS AFFILIATE MATCHES

FROM PREMED TO PRACTICE03S E C T I O NNTH DIMENSIONS PROGRAMSPHASES

NTH DIMENSIONSPHASE 1Every year, Nth Dimensions continues to offer earlyexposure, hands-on experiences, researchopportunities, and ongoing mentoring anddevelopment for thousands of high school,undergraduate, and medical students, as well asresidents and fellows. Over the past five years, NthDimensions has also created and maintainedsimilar longitudinal programs for radiology,dermatology, and physical therapy. interactions with multiple practicingdermatologists, orthopaedicsurgeons, and radiologists, usingactual medical equipmentprovided by industry partners. Paving the wayfor nextgenscholarsEARLY EXPOSUREEarly exposure to competitivemedical specialtiesis positivelyassociated withincreasedresidencyapplications to the specialty by women andunderrepresented in medicine. TheNth Dimensions multi-phasedprogram intentionally and specificallyexposes students to medicalspecialties early in their educationprocess. PROGRAMMINGThrough aninteractiveworkshop,participants meetand work with avariety of gender,race, and ethnicityconcordant role models while engaging in hands-onexperiences. More than 50% of allstudents encountered in Phase 1 ofprogramming have not previouslyseen or met a specialty physician orsurgeon of color, one who is awoman, or both. WORKSHOPSThese workshopsengage studentsat all educationallevels and arecharacterized bysmall group

Nth Dimensions preceptors, their colleagues,staff, and residents volunteer to host studentsin clinical environments throughout thesummer while the summer internssimultaneously complete research projects forpresentation at the end of the summer at theNational Medical Association annual meeting. Phase 2 programming consists of the Nth Dimensions Summer Internshipprogram, which uniquely matches competitively selected rising second-yearmedical students with practicing dermatologists, orthopaedic surgeons, andradiologists for an immersive 8-week clinical and research experience. NTH DIMENSIONSPHASE 2SummerInternship

NTH DIMENSIONSPHASE 3Formal programming during this phaseinvolves the Medical Student Symposium thatNth Dimensions conducts annually inconjunction with the Annual Meetings of theAmerican Academy of Dermatology and theAmerican Academy of Orthopaedic Surgeons.Scholars and affiliates participate in paneldiscussions, hands-on workshops, and didacticlectures during this multiday event. Participantsattend small group sessions to discusseducational and career plans and arecontinually exposed to an extensive, nationwidenetwork of non-stereotypical underrepresenteddermatologists and orthopaedic surgeons witha wide variety of lived experiences. Nth Dimensions Phase 3 programs recognizethe necessity of ongoing mentoring andprofessional development of its NthDimensions Scholars and students interestedin dermatology and orthopedics that may nothave completed the Nth Dimensions SummerInternship program. These students arereferred to as Nth Dimensions affiliates. Nth scholars and affiliates receive ongoingmentoring for personal statement reviews,sub-internship selections, in-person andvirtual interviewing skills training, andselective research year placement andsupport. Education +Encouragement

NTH DIMENSIONSPHASE 4 & 5Nth  Dimensions’  evolving  phase  4  and  5programs  are  focused  on  residenteducation, guidance, and support.Once  matched,  Nth  Dimensions’  alumnicontinue  to  receive  mentoring  andprofessional development support from NthDimensions through the Strategic MentoringProgram.The  Strategic  Mentoring  Program  preparesand assists  scholars as  they transition  intoresidency, as well as once they are at theirrespective  institutions.  The  programprovides  proactive  networking,communication, and feedback strategies tohelp  residents  excel  academically  andprofessionally  while  identifying  andneutralizing  institutional  or  programmaticbarriers to their success.StrategicMentorship &Enrichment

NTH SCHOLARS EXCEL WITH THE GUIDANCE AND1:1 MENTORSHIP FROM THEIR NTH DIMENSIONSPRECEPTORSSCHOLARS04S E C T I O NNTH DIMENSIONS SCHOLARS ABSTRACTS

DERMATOLOGY SUMMER INTERNSNTH DIMENSIONS ABSTRACTSABSTRACTS

PRECEPTORDr. Rebecca VasquezUniversity of Texas Southwestern Medical CenterTITLEINTRODUCTIONMelanoma incidence rates in the United States are lower among Hispanics (4.5per 100,000) compared to White non-Hispanics (21.6 per 100,000). However, early-stage diagnosis is less among Hispanics (74%) than White non-Hispanics (91%).The purpose of this study is to assess both melanoma presentation and outcomesin a large Hispanic cohort at a local safety-net hospital to improve detection andaddress gaps in health care in this community. Melanoma Presentation and Outcomes in Hispanic Patients at Parkland HealthHospital System: a Retrospective StudyVALERIE S. ENCARNACIÓN CORTÉSMETHODSWe conducted a retrospective chart review using data from a local safety-nethospital from 2010 to 2020. Patients diagnosed with melanoma and self-reportedas Hispanic were included. Demographic data was collected along with othertumor characteristics (including location, Breslow depth, presence of metastaticdisease, and disease-related mortality). Patients without a biopsy confirmingmelanoma were excluded. Descriptive statistics were used to analyze the data.RESULTSOf the 438 patients diagnosed with melanoma,154 patients identified as Hispanic.Of these, 26 were excluded due to lack of biopsy. The results for the remaining 128Hispanic patients reveal most patients were females (n=65) with a mean age of54 years at presentation. Melanoma had an average Breslow depth of 6mm attime of presentation and involved the hands/feet (37.5%). Thirty-two (25%)patients were diagnosed with metastatic disease and nearly 25% died fromdisease-related complications.University of Puerto Rico, Medical Sciences CampusNTH DIMENSIONSABSTRACTSCONCLUSIONSOur findings support prior studies showing delayed diagnosis in the Hispaniccommunity. Future studies including comparisons among different racial/ethnicgroups could help reveal the magnitude of this disparity at a local safety-nethospital in order to develop solutions to improve health care in this setting. AUTHORSValerie S. Encarnación Cortés, BS, Jacqueline Mckesey, MD, Rebecca Vasquez, MD AFFILIATIONSUniversity of Puerto Rico, Medical Sciences Campus, San Juan, PRUT Southwestern Medical Center, Dallas, TX1.2.

PRECEPTORDr. Meena SinghKMC Hair CenterTITLEINTRODU CTIONIntroLichen Planus is a chronic, inflammatory, cutaneous, and mucosal disease.Dental amalgam sensitivity has been noted as a cause of contact dermatitis-induced cutaneous Lichen Planus Pigmentosus. Associations with cutaneousLichen Planus and Lichen Planopilaris (LPP) hair loss are commonly encountered.LPP is an inflammatory, cicatricial (scarring) form of hair loss characterized byerythematous, perifollicular papules and loss of follicular orifices upon physicalexamination, usually affecting the vertex and parietal scalp. Frontal FibrosingAlopecia (FFA) is a patterned, cicatricial form of hair loss considered to be aprevalent form of LPP. Clinically, FFA presents as a band-shaped recession of thefrontotemporal hairline together with bilateral loss of the eyebrows in addition tothe perifollicular erythematous papules characteristic of LPP. Central CentrifugalCicatricial Alopecia (CCCA) is the most common form of scarring hair lossdiagnosed most often in women of African descent. Clinically, it is characterizedby hair loss radiating outward from the vertex scalp. Androgenetic Alopecia(AGA) is a common form of non-scarring alopecia in men and women, due todihydrotestosterone attacking the hair follicles. In both individuals, it is a form ofthinning that occurs in a specific, characteristic pattern. The purpose of thisstudy is to determine if there is an association between inflammatory types ofhair loss (LPP, FFA, and CCCA) and dental amalgams compared to non-inflammatory hair loss (AGA). We hypothesize a positive correlation betweeninflammatory forms of hair loss and dental amalgam number and length of time.Exploring Correlations between Metal Dental Implant-Induced Sensitivities andInflammation and Inflammatory Hair Loss UGONNA NWANNUNUMETHODSA retrospective chart review was performed on new hair loss patients between2020-2022. We looked at 25-50 patients each of KMC Dermatology, presentingwith diagnoses of LPP, FFA, CCCA, or AGA were called to determine their dentalhistory. They were asked if they had any crowns/fillings, if any of their dental workcontained metal, and how long they have had this dental work. All responses wererecorded. Percentages of each answer were calculated to determine possiblecorrelations.Howard University College of MedicineNTH DIMENSIONSABSTRACTS

RESULTSOf the 50 patients with CCCA, 86% indicated having crowns/fillings, 36% indicatedhaving dental amalgams, 28% indicated having between 5-9 dental amalgamsfor more than 10 years, and 2% indicated 10 or more dental amalgams for morethan 10 years. Of the 25 patients called with confirmed LPP, 96% reported having crowns/fillings,64% reported having dental amalgams, 36% reported having between 5-9 dentalamalgams for more than 10 years, and 24% reported having 10 or more dentalamalgams for greater than 10 years. Of the 25 patients with FFA, 92% expressed having crowns/fillings, 48% expressedhaving dental amalgams, 32% expressed having 5-9 dental amalgams for longerthan 10 years, and 0% expressed having 10 or more amalgams greater than 10years. Of the 50 patients with AGA, 76% reported having crowns/fillings, 36% reportedhaving dental amalgams, 26% reported having 5-9 dental amalgams for longerthan 10 years, and 4% reported having 10 or more dental amalgams for longerthan 10 years. CONCLUSIONSThe highest incidence of crowns/fillings, dental amalgams, and multiple, long-term dental amalgams was observed in patients with LPP. Patients withinflammatory hair loss forms demonstrated a greater percentage of dentalamalgams than those with AGA. Similarities were observed in the prevalence ofdental crowns/fillings among LPP and FFA patients, but there was increasedvariation between the incidences and longevity of dental amalgams. The resultsof our study remain preliminary. Future outlook involves increasing the studycohort size and determining extrapolatory statistics for the correlation of dentalamalgams and inflammatory hair loss. We intend to take a closer look at dentalamalgam incidence, age of hair loss onset, and severity of diagnoses–makingsure to account for confounding factors such as genetic predisposition toinflammatory hair loss. AUTHORSUgonna Nwannunu, Mikayla Woodard, Meena Singh, MD, FAADAFFILIATIONSHoward University College of Medicine, Washington, D.C.Morehouse School of Medicine, Atlanta, GADepartment of Dermatology, Kansas Medical Center, Shawnee, KS1.2.3.NTH DIMENSIONSABSTRACTS

P R E C E P T O RDr. Chesahna KindredKindred Hair & Skin CenterT I T L EI N T R O D U C T I O NHidradenitis Suppurativa (HS) is a chronic, disabling, undertreated skin conditionthat disproportionately affects Black Americans. It is characterized byinflammatory nodules and sinus tracts (tunnels under the skin) often found in thefolds of the body such as the axilla and groin. Given the follicular occlusivepathogenesis of HS, laser hair removal (LHR) has demonstrated promising results.This study aims to evaluate the efficacy of a 1064nm Nd:YAG laser with 650 μspulse technology in improving participants’ clinical conditions, quality of life, andpain levels, especially in patients of African descent.Effectiveness of 1064nm Nd:YAG Laser with 650μs Pulse Technology forHidradenitis Suppurativa ManagementADRIANA RICHMONDM E T H O D SHS patients from a single dermatology practice with an ethnically diverse patientpopulation will be screened for symmetrical lesions in bilateral anatomic sitesand undergo a one month washout period, refraining from use of any HSmedication. Before treatment, participants will complete a quality of life surveyand pain level assessment. Biopsies will be collected from four participants. Overthe course of four months, lesions on one side of the body will undergo LHR everytwo weeks, while the contralateral side will go untreated, serving as the control.Two weeks after their eighth treatment, patients' clinical condition, quality of life,and pain levels will be reassessed to measure improvement, and new biopsiesfrom the same four participants will be collected. R E S U L T SThe study will include 20 individuals at least 18 years of age with mild tomoderate HS. Thus far, one individual has started therapy. Prior to treatment, thepatient reported a Visual Analogue Score of 10/10 and Dermatology Life QualityIndex score of 29/30, indicating their HS is severely affecting their mood, dailyactivities, leisure, work, and personal relationships. University of California, San Diego, School of MedicineC O N C L U S I O N SPrevious studies have found LHR to decrease patients’ symptoms, one studynoting a 32% improvement according to the Lesion Area and Severity Index score.Such findings not only guide clinical management, but also influence policy toapprove insurance coverage for patients who will benefit from its use.Furthermore, since higher melanin content can affect both LHR efficacy andincreases risks for hyperpigmentation and blistering, it is essential to includedarker skin tones in these studies. NTH DIMENSIONSABSTRACTS

A U T H O R SAdriana Richmond, Lourdes Valdez, Chesahna Kindred MD, MBA, FAADA F F I L I A T I O N S1. School of Medicine, University of California, San Diego, San Diego, CA2. School of Medicine, University of Nevada, Reno, Reno, NV3. Kindred Hair & Skin Center, Columbia, MDNTH DIMENSIONSABSTRACTS

PRECEPTORDr. Janiene LukeLoma Linda UniversityTITLEINTRODUCTIONBlack barbershops and hair salons are cornerstones of the Blackcommunity – they cultivate a sense of belonging, refuge, and mutualunderstanding. These spaces hold great potential to become venues for education,training, and may serve as potential screening sites to aid in overcominginstitutional and sociocultural barriers to care. Extensive research on theincorporation of these forms of outreach in Black barbershops and salons hasbeen established for fields like oncology (eg, prostate and lung cancer screenings),endocrinology (eg, diabetes screenings) and infectious disease (HIV/STIscreenings); however, there is a paucity of evidence in the literature that evaluatesthe presence or impact of comparable interventions in the field of dermatology.Given barbers and hairstylists are in frequent contact with the scalp, hair and skinof their patrons, it would be useful to equip them with an educational module torecognize common skin and hair conditions that may require a referral forevaluation and/or management by a dermatologist (eg, pseudofolliculitis barbae,acne keloidalis nuchae, acne vulgaris). The purpose of this learning module is toincrease awareness, aid in earlier diagnosis/management of dermatologicconditions, and ultimately help bridge the healthcare gap for patients of color in themedical system.Development of a Dermatologic Educational Module for use in Barbershops and HairSalons: Fostering Access to Dermatologic Care Within the Black CommunityJAMON THOMASHoward University College of MedicineMETHODSA literature review was conducted to better ascertain the role of barbershops andsalons in health education within the community. Additionally, these papersprovided a deeper understanding of the impact of health outreach in these spaces,providing examples of best practices and effective methods for implementation.Using this information, a cohesive learning module/brochure was created usingcomputer design software. The brochures will be printed for distribution in localbarbershops and hair salons. A video component will also accompany theinformation. NTH DIMENSIONSABSTRACTS

RESULTS/CONCLUSIONSThe first phase of this project was development of the brochure which willbe distributed to barbershops and hair salons in the Washington, DC area and inHyattsville, Maryland. Additionally, a follow up survey study will be conducted tomeasure the impact of this form of health education/outreach. This study servesto determine the perceptions of stylists/barbers after reviewing/completing theeducational module with respect to knowledge gained and likelihood to refer to adermatologist for hair/scalp or skin issues.AUTHORSJamon Thomas, Janiene Luke, MD AFFILIATIONSHoward University College of MedicineLoma Linda University Dermatology 1.2.NTH DIMENSIONSABSTRACTS

P R E C E P T O RDr. Chesahna KindredKindred Hair & Skin CenterT I T L EI N T R O D U C T I O NIHidradenitis Suppurativa (HS) is a chronic inflammatory skin condition with apredilection for African American and female patients. HS consists of recurrentabscesses and sinus tracts in intertriginous areas such as groin folds, and axillae.This condition has debilitating medical and psychosocial consequences. Whilethere are currently many single and multimodal treatments available formoderate to severe HS, treatment of severe cases remains difficult, leading topatient frustration and lack of follow-up. This study aims to explore the rationaleof HS patient-initiated loss to follow-up.Rationale of Patient-Initiated Loss to Follow Up in Hidradenitis SuppurativaPatients L O U R D E S V A L D E ZM E T H O D SWe identified 72 patients at a single center with dermatologist-diagnosed HSseen within the last 12 months (06/30/2021-06/30/2022). Of those 72 patients, 35were determined to be severe by previous treatment methods including laser hairremoval, Humira, Prednisone, marsupialization, and Secukinumab as typicalinjections were ineffective. Of those 35 patients, 11 were not seen within the last 6months and determined to be lost to follow-up. These individuals were polled toexplore the rationalization of discontinued treatment. The responses of theremaining patients are categorized and organized in a histogram (Figure 1). R E S U L T SOf the 11 patients with severe HS that were lost to follow up, 4 did not respondafter three attempts at contact. Of the remaining 7 patients, 3 (27. 27%) reporteddiscontinued care due to scheduling conflicts, 1 (9.09%) had improvement ofsymptoms, 1 (9.09%) lost medical coverage, 1 (9.09%) cost, and 1 (9.09%)discontinued care due to a competing comorbidity.University of Nevada, Reno, School of MedicineD I S C U S S I O NAlthough the Hurley staging system was developed to determine the extent of HSseverity, some dermatologists believe that it does not do so accurately.Therefore, treatment is used to determine severity and guide course of action asopposed to the Hurley staging system. This study determined that of the 7patients with severe HS that were reached, the largest contributor to patient-initiated loss to follow-up were scheduling conflicts with the remaining rationalesbeing equal contributors. Subsequently these 7 patients were further contacted toschedule a follow-up appointment to reestablish care. NTH DIMENSIONSABSTRACTS

A U T H O R SLourdes Valdez, Adriana Richmond, Chesahna Kindred, MD4, MBA, FAADA F F I L I A T I O N SUniversity of Nevada Reno School of MedicineUniversity of California, San Diego School of MedicineKindred Hair & Skin Center1.2.3.C O N C L U S I O NTools of population health can help physicians effectively address barriers tocare experienced among this patient population and to improve patientoutcomes. It’s possible that if these barriers are addressed at earlier points in thetimeline of care that severe complications, a decrease in patient quality of life,and an increased use of high-cost resources can be avoided. NTH DIMENSIONSABSTRACTS

P R E C E P T O RDr. Hope MitchellMitchell DermatologyT I T L EI N T R O D U C T I O NCentral Centrifugal Cicatricial Alopecia (CCCA) is a form of hair loss thattypically begins in the center of the scalp and grows outward over time. This formof alopecia can be discouraging as it is scarring when caught late. Artificialintelligence (AI) is an emerging form of tracking patient’s hair growth. AI can beutilized in hair loss to keep patients informed of their progress as hair growth is aslow process often invisible to the naked eye. This study evaluates the use ofartificial intelligence as an effective method of monitoring hair growth in CCCA.The Efficacy of Artificial Intelligence in Monitoring Central Centrifugal CicatricialAlopeciaK I M B E R L Y W I L L I A M SM E T H O D SMethodsIn this retrospective analysis, trichoscopy photos were obtained fromnine patients with CCCA. These photos were analyzed using artificial intelligenceand the investigator global assessment (IGA) scale to determine the percentchange in density of hair in the frontal and vertex regions of the patient’s scalps.A paired t-test (α : 0.05) was performed comparing AI to the IGA scale and a p-value was obtained. All data was collected on patients at a single privatepractice dermatology office. Inclusion criteria involved having a diagnosis ofCCCA and an initial and follow-up artificial intelligence check at least twomonths apart. R E S U L T SWith a p-value of 0.0655 there was no significant difference in calculated percentchange in hair density between artificial intelligence and the IGA scale. Thissuggests artificial intelligence can be used as a viable option for monitoring hairgrowth in patients with CCCA.University of Miami Leonard M. MillerSchool of MedicineC O N C L U S I O N SArtificial intelligence is a viable option for monitoring hair growth in patients withCCCA. Further research should be conducted to analyze AI’s efficacy inevaluating percent change in hair diameter and its efficacy on textured hair andgray hairs. Potential future directions of research include evaluating artificialintelligence’s ease of use.NTH DIMENSIONSABSTRACTS

A U T H O R SKimberly Williams, Adriana Richmond, Lourdes Valdez, Chesahna Kindred, MD,Hope Mitchell, MDA F F I L I A T I O N S1. School of Medicine, University of Miami, Miami, FL2. Mitchell Dermatology, Perrysburg, OH 3. Kindred Hair & Skin Center, Columbia, MDNTH DIMENSIONSABSTRACTS

P R E C E P T O RDr. Meena SinghKMC Hair CenterT I T L EI N T R O D U C T I O NIntroLichen Planus is a chronic, inflammatory, cutaneous, and mucosal disease.Dental amalgam sensitivity has been noted as a cause of contact dermatitis-induced cutaneous Lichen Planus Pigmentosus. Associations with cutaneousLichen Planus and Lichen Planopilaris (LPP) hair loss are commonly encountered.LPP is an inflammatory, cicatricial (scarring) form of hair loss characterized byerythematous, perifollicular papules and loss of follicular orifices upon physicalexamination, usually affecting the vertex and parietal scalp. Frontal FibrosingAlopecia (FFA) is a patterned, cicatricial form of hair loss considered to be aprevalent form of LPP. Clinically, FFA presents as a band-shaped recession of thefrontotemporal hairline together with bilateral loss of the eyebrows in addition tothe perifollicular erythematous papules characteristic of LPP. Central CentrifugalCicatricial Alopecia (CCCA) is the most common form of scarring hair lossdiagnosed most often in women of African descent. Clinically, it is characterizedby hair loss radiating outward from the vertex scalp. Androgenetic Alopecia(AGA) is a common form of non-scarring alopecia in men and women, due todihydrotestosterone attacking the hair follicles. In both individuals, it is a form ofthinning that occurs in a specific, characteristic pattern. The purpose of thisstudy is to determine if there is an association between inflammatory types ofhair loss (LPP, FFA, and CCCA) and dental amalgams compared to non-inflammatory hair loss (AGA). We hypothesize a positive correlation betweeninflammatory forms of hair loss and dental amalgam number and length of time.Exploring Correlations between Metal Dental Implant-Induced Sensitivities andInflammation and Inflammatory Hair Loss M I K A Y L A W O O D A R DM E T H O D SA retrospective chart review was performed on new hair loss patients between2020-2022. We looked at 25-50 patients each of KMC Dermatology, presentingwith diagnoses of LPP, FFA, CCCA, or AGA were called to determine their dentalhistory. They were asked if they had any crowns/fillings, if any of their dental workcontained metal, and how long they have had this dental work. All responses wererecorded. Percentages of each answer were calculated to determine possiblecorrelations.Morehouse School of MedicineNTH DIMENSIONSABSTRACTS

R E S U L T SOf the 50 patients with CCCA, 86% indicated having crowns/fillings, 36% indicatedhaving dental amalgams, 28% indicated having between 5-9 dental amalgamsfor more than 10 years, and 2% indicated 10 or more dental amalgams for morethan 10 years. Of the 25 patients called with confirmed LPP, 96% reported having crowns/fillings,64% reported having dental amalgams, 36% reported having between 5-9 dentalamalgams for more than 10 years, and 24% reported having 10 or more dentalamalgams for greater than 10 years. Of the 25 patients with FFA, 92% expressed having crowns/fillings, 48% expressedhaving dental amalgams, 32% expressed having 5-9 dental amalgams for longerthan 10 years, and 0% expressed having 10 or more amalgams greater than 10years. Of the 50 patients with AGA, 76% reported having crowns/fillings, 36% reportedhaving dental amalgams, 26% reported having 5-9 dental amalgams for longerthan 10 years, and 4% reported having 10 or more dental amalgams for longerthan 10 years. C O N C L U S I O N SThe highest incidence of crowns/fillings, dental amalgams, and multiple, long-term dental amalgams was observed in patients with LPP. Patients withinflammatory hair loss forms demonstrated a greater percentage of dentalamalgams than those with AGA. Similarities were observed in the prevalence ofdental crowns/fillings among LPP and FFA patients, but there was increasedvariation between the incidences and longevity of dental amalgams. The resultsof our study remain preliminary. Future outlook involves increasing the studycohort size and determining extrapolatory statistics for the correlation of dentalamalgams and inflammatory hair loss. We intend to take a closer look at dentalamalgam incidence, age of hair loss onset, and severity of diagnoses–makingsure to account for confounding factors such as genetic predisposition toinflammatory hair loss. A U T H O R SMikayla Woodard, Ugonna Nwannunu, Meena Singh, MD, FAADA F F I L I A T I O N SMorehouse School of Medicine, Atlanta, GAHoward University College of Medicine, Washington, D.C.Department of Dermatology, Kansas Medical Center, Shawnee, KS1.2.3.NTH DIMENSIONSABSTRACTS

P R E C E P T O RDr. Hope MitchellMitchell DermatologyT I T L EI N T R O D U C T I O NWhen treating skin of color, special consideration must be given because of thegreater tendency for injury and dyschromia from the very modalities used intreatment. The impact is not simply cosmetic. The patient’s psychological well-being and quality of life can be adversely affected. Chemical peels have been proven to be a safe and efficacious mode of treatmentin patients with skin of color. Blended acid chemical peels that include additionallightening agents are beneficial to use in the treatment of hyperpigmentation.Depending on the composition of the acids and additional lightening agents in ablended chemical peel, there is the potential to target melasma in three ways:tyrosinase inhibition, inhibition of the transfer of melanin, and an increased rateof desquamation. Thus, this study aims to determine the efficacy of using a seriesof blended chemical peels that include additional lightening agents in thetreatment of melasma in skin of color. Efficacy of Using Blended Acid Chemical Peels in the Treatment of Melasma J I A N A W Y C H EM E T H O D SA cohort study was executed using patients that have sought treatment formelasma. Participants were selected from the electronic health record of aprivate dermatology practice. A pre-treatment baseline was established byvisually documenting the patient’s starting point with photographs andcalculating the Melasma Area and Severity Index (MASI). After completion of theseries of chemical peels, the Melasma Area and Severity Index was recalculated,and new photos were collected. The pre-treatment MASI and photographs werecompared to the post-treatment MASI and photographs. A statistical analysiswas performed using the MASI collected pre-treatment and post-treatment.Statistical significance was determined with a p-value of <0.05.R E S U L T SAlthough there was an overall reduction in the mean post-treatment MASI, whichindicated improvement, the improvement wasn’t statistically significant (Mean atbaseline=13.85, Mean after treatment=12.575, p=0.0702). A t-score was calculatedvia paired t-test using the pre and post treatment MASI. Meharry Medical CollegeNTH DIMENSIONSABSTRACTS

C O N C L U S I O N SIn our cohort, although the results are not statistically significant, a largersample size with a greater power could potentially yield statistically significantresults. It is also noted that patients treated with a blended acid chemical peelcontaining acids and lightening agents that target three or more mechanismsthat regulate skin pigmentation yielded a greater reduction in the pre vs posttreatment MASI. Further studies are required to measure the significance of thecomposition of blended acid chemical peels in the treatment of melasma in skinof color. A U T H O R SJiana Wyche, MHS,1, Hope Mitchell, MD, FAAD2A F F I L I A T I O N S1. Meharry Medical College, Nashville, TN2. Mitchell Dermatology, Perrysburg, OHNTH DIMENSIONSABSTRACTS

ORTHOPAEDIC SUMMER INTERNS NTH DIMENSIONS ABSTRACTSABSTRACTS

I N T R O D U C T I O NCompared to high-income countries (HICs) with few resource constraints, low-income countries (LICs) and lower-middle-income countries (LMICs) have ahigher prevalence of lower limb deformities with an incongruent level of researchand financial resources to meet their needs. Our current understanding of theprevalence of lower limb deformities from congenital, traumatic, infectious,oncologic, developmental and of nutritional etiology in LICs and LMICs is limited.Existing literature on lower limb deformities originates predominantly from HICsand focuses on a specific source of deformity as opposed to covering a broadrange of etiologies. We aim to review the evidence on the burden of lower limbdeformities in LICs and LMICs through a scoping review search of 3 databases. M E T H O D SA scoping review is currently underway. PubMed, Embase, and Web of Sciencewere all searched via search terms capturing the epidemiology of congenital,traumatic, infectious, oncologic, developmental, and nutritionally acquiredmusculoskeletal deformities in LICs and LMICs as approached through the lens ofsocioeconomic impact analyses. We categorize resource limited countries as LICsand LMICs. The countries are classified based on gross national income (GNI) percapita in U.S. dollars of the previous year, converted from local currencyaccording to the World Bank Atlas method. LICs are those with a GNI per capita of$1,085 or less in 2021; LMICs are those with a GNI per capita between $1,086 and$4,255. After duplicate search results were removed, we completed title/abstractscreening of 3,291 articles. 121 of these articles met inclusion criteria during thisfirst phase of review and progressed to full text screening. 53 studies wereincluded for data extraction. Extraction is currently underway. Reports will becategorized by country, etiology of lower limb deformity, diagnosis, treatmentrendered, and if provided, the methodology of describing the economic burden ofdisease discussed. Prevalence data from the literature will be used to extrapolateand estimate burden, categorized by the associated modality of the burden ofdisease discussed, whether on a systemic or individual economic level, functionallevel related to specific movement tests or outcomes, and/or psychological,social, or interpersonal level. P R E C E P T O RDr. Coleen SabatiniUCSF Benioff Children’s Hospital OaklandT I T L EBurden of Lower Limb Deformities in Resource Limited CountriesK E H I N D E A G O R OWright State University BoonshoftSchool of MedicineNTH DIMENSIONSABSTRACTS

R E S U L T SResults will include qualitative data reviewing existing studies of theepidemiology of lower limb deformities in LICs and LMICs. Results will also involvestatistics of how such deformities impact quality of life, assessed by the modalityof the burden discussed. We will also assess any provided discussions onmethodologies of economic burden. Preliminary data indicate a noteworthyincidence of lower limb deformities related to infectious etiology, traumaticamputation from work related injuries, road traffic accidents, and complicationsfrom seeking alternative treatment interventions associated with poverty andsignificant delays in receiving treatment. African countries are most represented.7/53 studies originate from Nigeria and India each. C O N C L U S I O N SFinal conclusions are forthcoming. Results thus far indicate a dearth of data, withwhat is present being very fragmented and generally reporting on only onesource of deformity in specific regions or hospitals within LICs and LMICs. Theinsight gathered in this study will help us to get a better sense of how the burdenof lower limb deformities in countries with limited resources further affect theeconomy, ability to receive adequate care and an improved quality of life. We willthen be able to make steps towards appropriately prioritizing how we canaddress these needs through resource allocation, policy recommendations andfuture research directions. A U T H O R SKehinde S. Agoro, Rachel L. Montoya MSc, Sanjeev Sabharwal, MD, MPH,, Coleen S.Sabatini, MD, MPHAFFILIATIONSWright State University Boonshoft School of Medicine, Dayton, OHWarren Alpert Medical School of Brown University, Providence, RI University of California San Francisco, Department of Orthopaedic Surgery,SanFrancisco, CAUCSF Benioff Children’s Hospital Oakland, Oakland, CA1.2.3.4.NTH DIMENSIONSABSTRACTS

I N T R O D U C T I O NThere is renewed interest in performing arthroscopic anterior cruciate ligament(ACL) repairs in appropriate patients who have Sherman Type 1 or II ACL tears.ACL repairs are, however, associated with a higher failure rate as compared toACL reconstruction. Our technique uses a hamstring autograft tissuereconstruction combined with ACL repair. We hypothesize that restoring thenative ACL femoral footprint and reconstructing the ACL with soft tissue willreduce failure and operation rates when compared with ACL repair alone. Thepurpose is toprovide between 2 and 10 year clinical follow-up of patients treated with acombination of ACL repair and reconstruction.M E T H O D SA retrospective case series study was conducted on patients with either ShermanI or II tears who underwent an ACL repair combined with reconstruction by thesenior author between October 2008 and August 2020. High-level athletes wereidentified as those that presently or subsequently went to play college sports forat least one year.R E S U L T SAfter reviewing the database, ten patients (mean age 18.4 ± 0.54 years, sixfemales, 4 males)with Sherman type I or II ACL tears underwent ACL repair withreconstruction during the specified time frame. There were no patients thatreturned with signs of infection or post operative complications. Importantly,there were no graft or repair ruptures. Per the senior author’s protocol, the returnto play (RTP) times were two months faster than his traditional ACLreconstruction (seven vs. nine months).C O N C L U S I O N SIn patients who have Sherman Type 1 or II ACL tears, hamstring autograft tissuereconstruction combined with ACL repair translates to earlier RTP and reducedfailure rates.A U T H O R SPeter T. Ajayi , Sloane Lipkin , Craig H. BennettA F F I L I A T I O N S1 Warren Alpert Medical School of Brown University2 LifeBridge Health Sports Medicine Institute3 Department of Orthopedics, Rubin Institute for Advanced OrthopaedicsP R E C E P T O RDr. Craig H. BennettLifeBridge Health Sports Medicine InstituteT I T L ECase Series of High Performing Athletes With Arthroscopic ACL Repair CombinedWith Single Bundle Hamstring Tendon Augmentation for Sherman Type I or II TearsP E T E R T . A J A Y IWarren Alpert Medical School of Brown UniversityNTH DIMENSIONSABSTRACTS

Instability in the hip is an encompassing term used to describe general looseningor weakness of the hip joint and is the second leading cause of total hiparthroplasty (THA) revision. Instability among primary THA ranges from 0.3% - 10%,but this rate increases up to 28%, following revision surgeries. Various strategiesexist to mitigate this risk. One such strategy includes the use of a constrainedbearing surface, which can be utilized in the absence of technical error or forabductor insufficiency. However, there is limited guidance on the management offailures of a constrained bearing THA. By review of literature, we seek to evaluatecontemporary methods to address recurrent instability following constrainedbearing THA.I N T R O D U C T I O NM E T H O D SWe present the case of a patient experiencing recurrent instability followingconstrained bearing THA. Indications for constrained bearing THA includedislocation following two revisions of hip dislocations. Further, we systematicallyreview literature between 2003 and 2021. Keywords used include “constrainedbearing THA”, “recurrent instability”, and “THA device instability”.R E S U L T SThe literature search strategy included 24 publications involving 56,838 patients.Reported strategies to address recurrent instability following THA include the useof constrained liners, the use of a femoral head greater than 36 millimeters, theadvancement of the greater trochanter, abductor muscle reconstruction, and theuse of dual mobility bearings. Common strategies for revision involve correctingunderlying etiology and upsizing the head and liner components. However, littleguidance is available for the management of failure of a constrained bearingTHA. Current literature supports the use of larger femoral head components toincrease jump distance and, in turn, decrease the probability of dislocation. Inaddition, several studies have noted the benefit of dual mobility cups inimproving stability and preserving motion, especially in more active individuals. P R E C E P T O RDr. Addisu Mesfin and Dr. Rishi BalkissoonUniversity of RochesterSchool of Medicine and DentistryT I T L ERecurrent Instability Following Constrained Bearing Total Hip Arthroplasty: A CaseReport and Review of Literature A M A N A N D E M I C H A E LRutgers Robert Wood Johnson Medical SchoolNTH DIMENSIONSABSTRACTS

C O N C L U S I O N SAlthough there are various strategies to prevent instability following THA, there isa current lack of research on techniques to improve stability following therevision of a constrained bearing THA. Further studies should be conducted todevelop guidance, including devices and techniques, to improve stabilityfollowing constrained bearing THA revisions. A U T H O R SAman Andemichael BA, Addisu Mesfin, MD, Rishi Balkissoon, MD, MPHA F F I L I A T I O N SRutgers Robert Wood Johnson Medical School, New Brunswick, NJDepartment of Orthopaedic Surgery and Rehabilitation; University of RochesterSchool of Medicine and Dentistry, Rochester, NY1.2.NTH DIMENSIONSABSTRACTS

P R E C E P T O RDr. Jon Barlow and Dr. Kelechi OkorohaMayo Clinic Rochester, MNT I T L ESpider Washer Technique for Revision Open Reduction Internal Fixation ofComminuted Olecranon FracturesI N T R O D U C T I O NMethods for reducing olecranon fractures vary given the injury severity anddisplacement. Popular techniques include tension band wiring (TBW) and platefixation (PF). There are few studies comparing outcomes for TBW to PF and evenfewer for intramedullary screw fixation. C L A R E N C E J U L I A N C L A R K I IM E T H O D SProximal fragments of olecranon were reduced posteriorly with a Kirschner wireand a clamp. Next, a 6.5mm cannulated compression headless screw and aspiked large washer were inserted into the medullary canal to reduce andcompress the fragments. A tension band wire was placed around the tricepsthrough a bone tunnel in the proximal ulna for additional support.R E S U L T SThe mean follow-up period was 12 months for both patients in the case series.Each underwent hardware removal 3 months after initial fixation due to infection.After revision, both patients achieved complete union, regained full range ofmotion (ROM), and were able to fully weight-bear at the 1-year follow-up. Adverseeffects were limited to persistent drainage without muscle soreness. Bothpatients were directed to follow up on a PRN basis after the 1-year follow-up.Wright State University,Boonshoft School of MedicineD I S C U S S I O NTBW and PF are associated with high removal rates and increased soft-tissueirritation. Reoperation rates range from 15% to 64% (PF), and 15% to 33% (TBW). Arecent study by Clifton et. al. stated that patients receiving intramedullary screwfixation experienced a 54% decrease in unplanned reoperation rates versus PF. NTH DIMENSIONSABSTRACTS

C O N C L U S I O N SSpider Washer fixation ensured that both patients avoided further surgery,regained full ROM and maintained stable fixation of the fracture fragments andtriceps.A U T H O R SClarence Julian Clark II , Jonathan Barlow, MDA F F I L I A T I O N SWright State University, Boonshoft School of Medicine, Dayton, OHMayo Clinic, Rochester, MN1.2.R E F E R E N C E SContreras, Erik & Lynch, Danny & Hatef, Sarah & Speeckaert, Amy & Goyal, Kanu.(2021). Risk factors for symptomatic hardware removal after plate fixation ofolecranon fractures: a retrospective chart review. Current Orthopaedic Practice.32. 474-478. 10.1097/BCO.0000000000001026.Meals C, Johnson C, Reitz L, et al. Intramedullary Screw Fixation of OlecranonFractures Reduces the Risk of Early Unplanned Reoperation: A RetrospectiveReview of 556 Patients. JOURNAL OF ORTHOPAEDIC TRAUMA. 2022;36(1):E24-E29.doi:10.1097/BOT.0000000000002145NTH DIMENSIONSABSTRACTS

P R E C E P T O RDr. Holly Tyler-Paris PilsonWake Forest School of MedicineAtrium Health Wake Forest BaptistT I T L EThe Effects of PKC Beta-II Inhibition on Oxidative Stress in MyoblastsI N T R O D U C T I O NProlonged tourniquet use during orthopaedic surgeries can lead to ischemia-reperfusion (I/R) injury to skeletal muscle and delay functional recovery. Excessmitochondrial reactive oxygen species (mROS) can trigger apoptosis, resulting inmuscle atrophy. Therefore, targeting mROS may be an effective therapeuticstrategy to prevent tourniquet-induced I/R injury in skeletal muscle. Proteinkinase C beta-II (PKCBII) is a key regulator of mROS production byphosphorylating p66Shc to trigger oxidative stress. Ruboxistaurin (RBX) is aselective PKCBII inhibitor that has been shown to block p66Shc activity to protectagainst I/R injury in the gastrointestinal tract, lung, and heart. However, thisprotection has not been established in skeletal muscle. We hypothesize thatRuboxistaurin (RBX) will decrease ROS levels using an in vitro model ofchemically-induced oxidative stress. T E A N D A C U N N I N G H A MM E T H O D SC2C12 myoblasts were incubated with a broad-spectrum PKC activator, phorbol12-myristate 13-acetate (PMA), for 1h or 3h at variable concentrations (100 nM – 1uM) to stimulate ROS production in 96-well plates. Myoblasts were pretreatedwith low dose (20 nM) and high dose (200 nM) RBX 30 min prior and at the onsetof PMA stimulation. Intracellular ROS levels and cell viability were detected with afluorescent probe and colorimetric assay using a microplate reader. All datawere evaluated using ANOVA and Tukey HSD post-hoc analysis. R E S U L T SPMA stimulation resulted in a four-fold change in ROS levels at all testedconcentrations compared to untreated controls (p<0.05). PMA concentrations(100 nM – 1uM) were not significant from each other. Cell viability of cellsstimulated with PMA (100 nM) with and without RBX (20 nM, 200 nM) treatmentwere similar to untreated controls. University of South CarolinaSchool of Medicine GreenvilleNTH DIMENSIONSABSTRACTS

C O N C L U S I O NThe data suggests that PMA-simulation of ROS is concentration independent.Therefore the lowest PMA concentration was used in all other experiments. RBXtreatments were found to be non-toxic to cells. The effects of RBX on ROS levelsfollowing PMA stimulation are pending. A U T H O R STeanda Cunningham, MS ; Tameka Dean, DO, MS ; Holly Pilson, MD ; Xue Ma, MD,PhD ; Maria De Los Santos,JDA F F I L I A T I O N SUniversity of South Carolina of Medicine Greenville, Greenville, SCWake Forest School of Medicine, Atrium Health Wake Forest Baptist, Winston-Salem, NCNoorda College of Osteopathic Medicine, Provo, UT1.2.3.NTH DIMENSIONSABSTRACTS

P R E C E P T O RDr. Holly Tyler-Paris PilsonWake Forest School of MedicineAtrium Health Wake Forest BaptistT I T L EInhibition of PKC Beta-II/p66Shc Pathway in Murine MyoblastsI N T R O D U C T I O NProlonged tourniquet use during orthopaedic surgeries can cause ischemia-reperfusion (I/R) injury, impairing muscle contractility and repair. I/R injurypromotes excess mitochondrial reactive oxygen species (mROS) production thatdisrupts the regenerative potential of myocytes. Protein kinase C beta-II (PKCβII)regulates mROS production by phosphorylating the redox p66Shc protein, whichtranslocates and accumulates in mitochondria to trigger apoptosis. PKCβIIinhibitors are known to block p66Shc activity in cardiac muscle to prevent tissuenecrosis from I/R injury but have not been well studied in skeletal muscle. Wehypothesize that Ruboxistaurin (RBX), a known PKCβII inhibitor peptide, will blockPKCβII translocation and p66shc activity to reduce ROS levels. M A R I A D E L O S S A N T O SM E T H O D SWe pretreated C2C12 myoblasts with RBX (200 nM), followed by 1h incubation withphorbol 12-myristate 13-acetate (PMA). We used dichlorodihydrofluoresceindiacetate (DCFDA) staining to detect ROS levels using immunofluorescencemicroscopy. Corrected total cell fluorescence (CTCF) was calculated usingImageJ software. We evaluated the effects of PMA and RBX on PKCβIItranslocation using comparative western blot analysis of cytosolic andmembrane fractions. Western blot band density was normalized to loadingcontrols. All data were evaluated using ANOVA and Tukey HSD post-hoc analysis. R E S U L T SMean CTCF units were normalized by total cells, resulting in comparable nucleiROI for analysis. ROS levels trend lower when exposed to PMA+RBX but did notreach significance due to small sample size.Noorda College of Osteopathic MedicineC O N C L U S I O N SIn future studies, we plan to evaluate the effects of PMA and RBX on PKCβIItranslocation using comparative western blot analysis of cytosolic andmembrane fractions. A U T H O R SMaria De Los Santos,JD; Tameka Dean, DO, MS; Holly Pilson, MD; Xue Ma, MD,PhD;Teanda Cunningham, MSA F F I L I A T I O N SNoorda College of Osteopathic Medicine, Provo, UTWake Forest School of Medicine, Atrium Health Wake Forest Baptist, Winston-Salem, NCUniversity of South Carolina of Medicine Greenville, Greenville, SC1.2.3.NTH DIMENSIONSABSTRACTS

P R E C E P T O RDr. David RichardsonCampbell Clinic OrthopedicsUniversity of Tennessee Health Sciences CenterT I T L ERecurrent Clubfoot Associated with Accessory Muscles – A Case Series andLiterature ReviewI N T R O D U C T I O NCongenital talipes equinovarus, or clubfoot, is one of the most commonmusculoskeletal disorders of unknown etiology. Patients are often successfullytreated via the Ponseti casting method. However, residual clubfoot deformity orclubfoot recurrence remains a problem for many patients. One cause of residualdeformity could be aberrant muscular anatomy in the posterior medial hindfoot.The aim of this work is to present four new cases to detail the current knowledgeabout the accessory musculature (the accessory soleus and flexor accessorismuscles) found during posteromedial soft tissue release. A secondary focus wasto present revised nomenclature for defining the name and anatomical locationof these aberrant structures.K A T H R Y N E A T O NM E T H O D SFour patients initially presented with what appeared to be idiopathic congenitalclubfoot. Ponseti protocols were utilized on all four including serial casting,percutaneous tendo-achilles tenotomy, and foot abduction orthosis brace wear.However, due to residual deformity or early recurrence, all four patients were notfully treated with the aforementioned methods. Each patient underwent moreextensive surgical treatment via posterior soft tissue releases. A literature reviewwas conducted regarding the abnormal muscular and tendinous anatomy foundin these four patients.R E S U L T SThere were four patients with recurrent clubfoot (3 males and 1 female). Alloriginally presented with a clubfoot at less than two years of age. Duringextensive surgical releases, patients were found to contain an abnormalaccessory slip of either the soleus or of the flexor hallucis longus muscle, whichwere identified structurally via anatomical origins and insertions; and weresubsequently removed. Thus, the clubfoot deformity was fully corrected. A literature review revealed various findings, such as background information onthe anatomical structure of the accessory soleus muscle in the setting ofrecurrent talipes equinovarus, as well as the most recent literature describing theflexor digitorum accessorius longus. Additionally, there were outcomes specifyingpotential embryologic causes of clubfoot, as well as other detailed findings thatwill be further discussed within the case series/literature review.University of Arkansas for Medical SciencesNTH DIMENSIONSABSTRACTS

D I S C U S S I O NThese cases represent four new examples of this aberrant anatomy to themedical literature. Our literature review reveals some confusing nomenclature forthe structures identified in our cases. The previously published term, flexordigitorum accessorius longus, is misleading as the structures found in our cases,and in the images and diagrams in the published literature seem to indicate astructure medial to the posteromedial neurovascular bundle. Therefore, wesuggest that these structures be redefined as either a flexor accessoris (assuggested by Dr. Perry Schoenecker) or an accessory soleus based on theposition of the muscle and its insertion point.A U T H O R SKathryn Eaton, PhD; Jonathan Rowland BS, CCRP; Karen Romer RN, BSN; Tonya Priggel; Derek M. Kelly, MDA F F I L I A T I O N SUniversity of Arkansas for Medical Sciences, Little Rock, AR1Campbell Clinic Orthopedics/University of Tennessee Health Sciences Center,Memphis, TN1.2.NTH DIMENSIONSABSTRACTS

P R E C E P T O RDr. Rishi Balkissoon and Dr. Addisu MesfinUniversity of RochesterSchool of Medicine and DentistryT I T L EI N T R O D U C T I O NCalcium Pyrophosphate Dihydrate (CPPD) deposition in the cervical ligamentumflavum (CLF) is rare. As such, the natural history of cervical myelopathy as aresult of CPPD deposition within the CLF is not well understood. We describepresentation, imaging findings and treatment options of CPPD deposition, orpseudogout, in the cervical spine. Calcium Pyrophosphate Dihydrate of the Ligamentum Flavum – Review of theliterature and Case SeriesM A R K E H I O G H A EM E T H O D SUsing PubMed, we analyzed review and case studies reporting CPPD in the CLFpublished from 1978 to 2022. Keywords used were “pseudogout”, “Calciumpyrophosphate dihydrate deposit disease”, “cervical yellow ligament”, “cervicalligamentum flavum”, “cervical spine”. We excluded “crowned dense syndrome”and “ossification of ligament flavum”. Using a department database, we queriedfor patients treated for CPPD of the CLF. R E S U L T STwenty clinical studies on CPPD of the cervical spine with 69 patients (15- 92years, mean 72) were identified through PubMed. Two clinical patients wereidentified within the department’s database - a 60- and 70-year-old female.Based on our review, symptomatically, CPPD in the CLF most commonly presentsas neck pain, hand paresthesia and gait disturbances. In addition, the C5segment (54%) is the most affected segment and most likely location in whichCPPD crystals deposits due to advanced aging, trauma and repeated stretching.CPPD nodules show low signal intensity in T1 and T2 weighted images at theposterior lateral aspect of the spinal cord extending from the ligamentum flavum.Early surgical treatments such as a laminectomy with fusion produces betterlong-term outcome and return of neurological signs. Furthermore, a laminectomyshowed to be more effective up to five months after the start of symptomspresentation versus twenty-four months post.Medical College of WisconsinNTH DIMENSIONSABSTRACTS

C O N C L U S I O N SAlthough a rare condition, the prevalence of CPPD in the CLF indicates that itshould be considered as a differential diagnosis particularly as the age of thepopulation increases. CPPD’s progressively worsening nature makes an earlydiagnosis and treatment important in improving the patient’s overall quality oflife. A U T H O R SMark Ehioghae, MSc, Mark Lawlor, MD, Rishi Balkissoon, MD, MPH, Addisu Mesfin, MD A F F I L I A T I O N SMedical College of Wisconsin, Milwaukee, WI Department of Orthopaedic Surgery and Rehabilitation; University of RochesterSchool of Medicine and Dentistry, Rochester, NY1.2.NTH DIMENSIONSABSTRACTS

P R E C E P T O RDr. Melissa ZimelUniversity of California, San Francisco,School ofMedicine Department of Orthopaedic Surgery T I T L EB A C K G R O U N DLong term survival has improved for patients with lower extremity bone sarcomasTechnologic advances have allowed limb salvage surgery via endoprostheticreconstruction. Assessment of long-term survival and functional outcomes forspecific endoprosthetic devices are important for surgical decision-making.Previously reported short to intermediate-term survivorship data for compressiveosseointegration devices are promising. However, there are no studies examiningsurvivorship or patient-reported outcomes with 10-year follow up of implantationamong oncology patients. The purpose of this study is to evaluate patientstreated with a Compress® spindle (CPS) coupled with a distal femurendoprosthesis and rotating platform total knee replacement with a focus on (1)What is the survivorship of the CPS spindle? (2) What are the rates of infection,amputation, and revision? (3) What modes of failure are most prevalent? (4)What are patient-reported outcomes regarding function and self-perception ofhealth?Long-term Survivorship and functional outcomes following compressiveosseointegration endoprosthesis.I N O C H I G O N Z A L E Z C A L V OM E T H O D SA retrospective analysis evaluated the minimum 10-year survival and functionalresults of non-expandable implants used for oncologic reconstructions of aprimary sarcoma or locally aggressive bone tumor at the distal femur. Patientswith non-oncologic and revision indications were excluded from the cohort. Thecohort included 57 patients with non-expandable CPS devices implanted prior toJuly 2012 with a median follow-up of 123 months (range 3-285 months). Spindlesurvival analysis was determined using competing risk analysis. EQ5D-3L® andTESS surveys were used to assess health related quality of life. R E S U L T SThe cohort was composed of 19 females and 38 males with an average height,weight and BMI of 167.9cm, 81.6 kg and 27.2 respectively. The primary diagnosis ofthe study population was osteosarcoma (n=43, 75%). Spindle survivorship rate of91.23% at both 10 and 15 years.The revision-free survival rate was 77.2% at 10 yearsand 71.9% at 15 years . The two causes of spindle failure were absence ofosseointegration, n=3, occurring at a median of 19 months and periprostheticfractures, n=2. Twenty-one living patients with CPS devices in situ reported ahealth score of 0.7924 +/- 0.1543 (EQ5D-3L®), self-assessment score of 81.29 +/-11.31 and a self-perceived current state of function of 82.55 +/- 16.31(Female:82.40, Male: 82.69) (TESS)Georgetown University, School of MedicineNTH DIMENSIONSABSTRACTS

C O N C L U S I O N SOur study confirms that distal femoral CPS reconstruction has excellent spindlesurvival at 10 and 15 years, as well as good patient-reported functional outcomes.Additionally with the rise in popularity of Compress® spindle (CPS) and the typeof failures seen in these patients, we suggest a modification or addition to theHenderson Classifications of Failure to include failure of osseointegration. A U T H O R SInochi Gonzalez Calvo, BSd, Kara S. Tanaka, MFAb, Adrianna E. Carrasco, BAc, Musa B. Zaid, MDa, Richard J. O’Donnell, MDa, Rosanna L. Wustrack, MDaA F F I L I A T I O N SDepartment of Orthopaedic Surgery, University of California, San Francisco;San Francisco, CADepartment of Pathology, University of California, San Francisco; SanFrancisco, CAEastern Virginia Medical School; Norfolk, VASchool of Medicine, Georgetown University, Washington, DC1.2.3.4.NTH DIMENSIONSABSTRACTS

P R E C E P T O RDr. Julie SamoraNationwide Children’s Hospital,Department of Orthopedic Surgery,T I T L EI N T R O D U C T I O NIt has been well documented that insurance status contributes to healthdisparities and access to patient care. Assessment of treatment plans and costof medical care in specific populations and medical emergencies is necessary tounderstand better how outcomes differ and ultimately determine how health caredisparities can be minimized. This study will assess the role insurance statusplays in treatment outcomes in pediatric phalangeal neck fractures (PNF). Wehypothesize that although patients do not undergo different medical treatmentsbased on insurance type, there will be a difference in patient outcomes based oninsurance type.Outcomes of Phalangeal Neck Fractures in Children with Medicaid vs. PrivateInsuranceT A L A I J H A H A Y N E SM E T H O D SA retrospective chart review will be conducted on pediatric patients whosustained phalangeal neck fractures at a single institution between January 2015and January 2021. These patients were treated via closed reduction percutaneouspinning (CRPP) by fellowship-trained hand surgeons. Information is beinggathered on treatment plans, treatment adherence, long-term outcomes, andinsurance status. A voluntary outcomes questionnaire will be conducted, viaphone, following the chart review. Exclusion criteria include patients withinadequate records and those above eighteen. Patients with injury dates in 2022were excluded to allow for at least one year of follow-up. R E S U L T SInformation forthcoming pending completion.Morehouse School of MedicineC O N C L U S I O N SOur study is unique in that little is known about whether insurance status affectsoutcomes in phalangeal neck fractures. We aim to determine if there is acorrelation and to what extent it affects pediatric patients. We will utilize ourfindings to systematically improve the quality of patient care in hopes ofdiminishing any disparities or discrepancies we find.A U T H O R STalaijha Haynes, MS , Julie Balch Samora, MD, PhD, MPHA F F I L I A T I O N SMorehouse School of Medicine, Atlanta, GADepartment of Orthopedic Surgery, Nationwide Children’s Hospital, Columbus,OH1.2.NTH DIMENSIONSABSTRACTS

P R E C E P T O RDr. Rolando RobertoUniversity of California, Davis, School of MedicineT I T L EI N T R O D U C T I O NThe spine is the most common site of skeletal metastasis. Metastases to the spinecan cause spinal cord or nerve root compression, leading to neurologic deficitsand disability. Thus, patients with primary cancer require close clinical andradiographic surveillance to monitor for disease progression to spine metastasisPatients in socioeconomically deprived areas are more likely to have delayedpresentation and diagnosis for primary and/or metastatic cancer. In this study,our objective was to determine the sociodemographic characteristics of patientsundergoing surgery for metastatic spine disease at a single institution.Sociodemographic Characteristics of Patients Undergoing Surgery for MetastaticSpine DiseaseJ O S E P H H O L L A N DM E T H O D SThis was a retrospective case series at a tertiary referral center. Patients age ≥18years presenting to the emergency department with metastatic disease of thespine requiring surgical management were included. Basic demographicsincluded age, gender, race, ethnicity, and insurance payor. Sociodemographiccharacteristics were estimated using the Social Deprivation Index (SDI) and theArea Deprivation Index (ADI) for the state of California, which were obtainedthrough aggregated Zip Code Tabulation Area (ZCTA). SDI (scale of 1 to 100percentile) measures levels of disadvantage based on seven demographiccharacteristics, with higher SDI indicating higher deprivation. ADI (scale of 1 to 10decile) evaluates neighborhoods based on income, education, employment, andhousing quality, with higher ADI indicating higher level of disadvantage. R E S U L T SBetween 2015 to 2021, 64 patients underwent surgery for metastatic disease of thespine. Mean age was 61.0±12.5 years, with 60.9% males (n=39). In this cohort,89.1% were Non-Hispanic (n=57), and 71.9% were White (n=46). There were 62.5%insured patients through Medicare/Medicaid (n=40). Mean SDI was 61.5±28.0,while mean ADI was 7.7±2.2. In this cohort, 28.1% of patients (n=18) werediagnosed with primary cancer for the first time, while 39.1% (n=25) werediagnosed with metastatic cancer for the first time. During the indexhospitalization, 37.5% (n=24) received Palliative Care consult. The 3-month, 6-month, and all-time mortality rates were 26.7% (n=17), 39.5% (n=23), and 50%(n=32), respectively, with 10.9% of patients (n=7) expiring during their admission.University of Louisville School of MedicineNTH DIMENSIONSABSTRACTS

D I S C U S S I O NIn our study, we found 28.1% of patients were diagnosed with cancer for the firsttime during their admission for surgical management of metastatic spinedisease. The 3-month and 6-month mortality rates for patients undergoingsurgery for spinal metastasis were high at 26.7% and 39.5%, respectively. Themajority of patients came from disadvantaged sociodemographic backgrounds,as measured by the high Social Deprivation Index (SDI) percentile and AreaDeprivation Index (ADI) decile. More efforts are needed to improve access tocancer care especially for patients from deprived sociodemographicbackgrounds so that a new diagnosis of cancer is not made when patientspresent with symptomatic spine metastases requiring surgery.A U T H O R SDagoberto Piña, Venina Kalistratova, Zachary Boozé, Joseph Holland, Joseph Wick,MD, Wyatt Vander Voort, MD, Yashar Javidan, MD, Rolando Roberto, MD Eric Klineberg, MD, Shaina Lipa, MD, Hai Le, MDA F F I L I A T I O N SUofL School of Medicine, Louisville, KYUC Davis Health Department of Orthopedic Surgery, Sacramento, CAUC Davis School of Medicine, Sacramento, CA 1.2.3.NTH DIMENSIONSABSTRACTS

I N T R O D U C T I O NThere has been a significant amount of recent literature evaluating the hip-spinerelationship and its dynamic and static effects on hip instability. Conversely,there has been little written about the contribution of the surrounding hipabductor function to hip instability.M E T H O D SWe identified 5 magnetic resonance imaging postoperative (MRI) studies ofprimary total hip replacements following an instability episode. These werematched for demographics of age, sex, BMI, surgical approach, and time betweenMRI and index surgery in a 1:5 manner with a cohort of MRIs performed on THAswith no history of instability. The MRIs were reviewed in a blinded fashion by twofellowship-trained musculoskeletal radiologists. Four muscles (gluteus minimus,gluteus medius, gluteus maximus, and tensor fascia lata (TFL) were graded usingthe Goutallier Classification System from 0 (normal muscle) to 4 (76-100% fattyinfiltration) associated with degeneration of the muscle.R E S U L T SThere was a significantly higher score for fatty infiltration in the gluteus mediusof THAs that had a dislocation episode compared to the matched cohort with nohistory of hip dislocation (p 0.05). Of note, there was no difference in the scoresfor the gluteus minimus (1.7 versus 1.7), gluteus maximus (0.84 versus 0.85), andTFL (0.63 versus 0.71) suggesting that the cohorts were well matched and that thedegeneration was focal in the gluteus medius, rather than a more generalizedprocess in the peri-articular musculature.C O N C L U S I O N SIn this blinded MRI study we noted a higher degree of degeneration of the gluteusmedius in THAs with a history of dislocation. Though component position and thedynamic relationship between the hip and spine have a significant effect oninstability, this study introduces abductor function––specifically thedegeneration of the gluteus medius––as another contributing factor to THAinstability. This opens a potential pathway for therapeutic management targetinggluteus medius function associated with hip instability.A U T H O R SJustin Ikara, Aaron Weinblatt , Joseph Song, Agnes Cororaton, Kevin Math, William J. LongP R E C E P T O RDr. William J. LongHospital for Special SurgeryT I T L ETotal Hip Replacement Instability is Associated with a Higher Degree of GluteusMedius DegenerationJ U S T I N I K A R AMorehouse School of MedicineNTH DIMENSIONSABSTRACTS

P R E C E P T O RDr. Bryan LittleDetroit Medical Center T I T L ELength of Stay after Total Joint Arthroplasty Post COVID-19I N T R O D U C T I O NLength of stay (LOS) after total joint arthroplasty (TJA) of the hip and knee is animportant marker of the quality of surgical care. In the past several decades,there has been a gradual reduction in the length of stay following total jointarthroplasty. This decrease has been attributed to many factors, includingperioperative optimization of patient co-morbidities, patient education, and earlyrehabilitation. Earlier discharge offers benefits for both the patient and thehealthcare system by accelerating patient mobilization and autonomy andreducing costs. Recently, the SARS-CoV-2 pandemic has brought a newmotivating factor for reduced hospital duration with elective procedures. R I C H A R D I N G R A MM E T H O D SThis was a retrospective review of patients who underwent TJA from April 2020 toMarch 2021. Additionally, a comparative group of patients who underwent TJAfrom Jan 1, 2019, to Dec 31, 2019, were assessed. Data collection was performed bychart review. Our inclusion criteria included all adult patients (18-99 years old)who underwent primary, elective Total Hip Arthroplasty (THA), or Total Kneearthroplasty (TKA) during the specified periods. Exclusion criteria includedarthroplasty due to trauma, revision surgery due to any cause, and anyvulnerable groups, such as pregnant females or prisoners or if they are youngerthan 18 years old. R E S U L T SWe reviewed the charts of 283 patients. 135 of them underwent TKA and 148 ofthem underwent THA. The average age of the cohort was 63.7 years old. There wasa noticeable decrease in the length of stay of patients post-Covid whencompared to pre-Covid patients. This was true for patients who underwent bothTHA and TKA. The average LOS for patients undergoing THA between Jan 1, 2019,and Dec 31, 2019, was 2.7 days while the average for patients between April 1,2020, to March 31, 2021, was 1.7 days. There was a similar decrease seen inpatients who received TKAs. The average LOS for patients undergoing TKAbetween Jan 1, 2019, to Dec 31, 2019, was 3.3 while patients who received a TKAbetween April 1, 2020, and March 31, 2021, had an average LOS of 1.9 days. Meharry Medical CollegeNTH DIMENSIONSABSTRACTS

A U T H O R SRichard Ingram, Dominik Fleifel, MD, Abdul Zalikha, MD, Andreea Geamanu, PhD,Chaoyang Chen, MD, PhD, Hussein Darwiche, MD, Bryan Little, MDIn the patients observed the LOS after undergoing TJA has decreased since thespread of SARS-CoV-2 began. This could be due to increased motivation to freespace in the hospital and get patients to a place where they are less likely to beinfected. A possible area of future research is seeing how this decreased LOSaffects patient outcomes.C O N C L U S I O N SNTH DIMENSIONSABSTRACTS

P R E C E P T O RDr. Eileen CrawfordMichigan HealthT I T L EThe Change in Racial and Gender Diversity for Interviewed and MatchedOrthopaedic Surgery Residency Applicants Before and After Engagement with NthDimensionsI N T R O D U C T I O NResidency programs who recruit physicians from a variety of backgrounds havethe opportunity to improve health outcomes and provide a sense of security topatients who rarely experience care from someone who looks like them. Programssuch as Nth Dimensions connect underrepresented minority and female medicalstudents with orthopaedic surgeons early in their medical careers to increasetheir exposure to the field. While Nth Dimensions has been successful in helpingthese students match into orthopaedic surgery residency programs, the impactof this program on an individual residency program has not been described.R Y A N J O H N S O NM E T H O D SThis retrospective study examined applicant data for a single orthopaedicsurgery residency program at an ACGME-accredited institution in the midwesternUnited States. Racial and gender data were extracted for the past 6 years (2017-2022), including 3 years before and 3 years since the institution’s partnership withNth Dimensions. For each application year, the percentage ofeach race category and gender category as defined on the applicants’ ElectronicResidency Application Service (ERAS) applications was determined.R E S U L T SMeharry Medical College The percentage of white applicants showed a small decrease throughout thestudy, with 64% in 2017 and 58% in 2022, while the biggest increases in othergroups were seen in both the Asian (14% to 19%) and Black (4% to 9%) applicantgroups. The percentage of interviewed white applicants also started at 66% anddecreased to 54% by 2022,whereas the Asian (10% to 18%) and black (6% to 16%)interviewed groups slightly increased over time. The percentage of matchedwhite applicants to the program decreased from 63% in 2017 to 57% in 2022,compared to the Asian matched applicants moving from 13% in 2017 to 29% in2022 and the black matched applicants transitioning from 0% in 2017 to 14% in2022. The percentage of female applicants showed a small, steady increase overthe course of the study, with 18% female applicants in 2017 and 26% in 2022. Thepercentage of interviewed female applicants fluctuated but was similar from thebeginning of the study (37% in 2017) to the end (40% in 2022). Matched femaleapplicants changed from 0% in 2017 to 29% in 2022.NTH DIMENSIONSABSTRACTS

C O N C L U S I O N SOver the course of this study, the racial and gender diversity of interviewed andmatched applicants at a single midwestern orthopaedic surgery residencyprogram increased, with the largest change seen in matching more femaleapplicants. Since a partnership with Nth Dimensions was initiated during thistimeframe, it may have been a catalyst for this increased diversity, along withother factors such as changes in department leadership and implementationof virtual interviews. A U T H O R SRyan Johnson, MHS, Eileen Crawford, MDA F F I L I A T I O N SMeharry Medical College, Nashville, TNUniversity of Michigan, Department of Orthopedic Surgery, Ann Arbor, Michigan.Nth Dimensions, Chicago, IL1.2.3.NTH DIMENSIONSABSTRACTS

P R E C E P T O RDr. Keith Aziz and Dr. Courtney ShermanMayo Clinic Jacksonville, FLT I T L EI N T R O D U C T I O NDog ownership has many health benefits, with improvements in both physical andmental health noted among pet owners. Increased physical activity andreduction in feelings of social isolation are likely responsible for some of thesebenefits. Recently, dog and pet ownership has markedly increased – with anincrease from 67% to 70% of households reporting pet ownership observed duringthe first year of the COVID pandemic; however, research on the incidence andepidemiology of dog-related musculoskeletal injuries is quite limited, orfrequently focuses on injuries caused by dog bites. Since some of the healthbenefits are related to increased physical activity from walking dogs, it isimportant to understand the risks associated with devices often used whilewalking dogs – such as leashes, harnesses, and collars. The purpose of this studywas to investigate and characterize upper extremity musculoskeletal injuriesrelated to dog leashes, harnesses, and collars.Upper Extremity Injuries Related to Dog Leashes, Harnesses, and CollarsT A Y L O R J O N E SM E T H O D SWe performed a retrospective review of all the patients presenting with acralupper extremity injuries relating to dog leashes or collars at a tertiary carereferral center from 2005-2022. Patients were identified through a combination ofchart review, current procedural terminology (CPT) codes, and InternationalClassification of Disease (ICD) codes. Demographic data including age, gender,body mass index (BMI), and past medical history were collected. Dog size, injurymechanism, injury patterns, and treatment were all recorded and assessed. R E S U L T S30 cases were included. 3 patients were male, 27 were female. Mean patient agewas 58 years (range, 21 to 80) and mean BMI was 25.1 (range, 19.0 to 38.3). Therewere 21 fractures (70.0%) and 9 soft-tissue injuries (30.0%). Treatment includedsurgery (N=14, 46.7%), immobilization (N=11, 36.7%), immediate motion (N=3,10.0%), corticosteroid injection (N=1, 3.3%), and pain management (N=1, 3.3%). Themost frequent injury sites were the wrist (N=14, 46.7%) and the hand (N=13, 43.3%).Injuries occurred from falling (N=14, 46.7%) or were related to the leash beingwrapped around the arm, writs, or finger (N=10, 30%). Among the 22 patients witha fracture, 15 (68.1%) had a history of osteopenia or osteoporosis. Additionally, 14patients were injured by what they described as a large dog. Meharry Medical CollegeNTH DIMENSIONSABSTRACTS

C O N C L U S I O N SDogs may cause musculoskeletal injuries by both direct and indirectmechanisms. Fractures were more likely than soft tissue injuries, and the handand wrist were the most common injury locations. In this series, women weresignificantly more likely to be injured than men. These injuries frequently requiredsurgical intervention, and an overwhelming number of these patients had a priordiagnosis of osteoporosis or osteopenia. The injury most often was the result ofthe leash, collar, or harness being wrapped around the hand or wrist improperly –causing a rotational moment around the upper extremity. While this study issmall and limited to one geographic area of the country, it does highlightcharacteristics of patients who are at risk for injury from a dog leash, collar orharness and emphasizes the importance of proper training and use of thisequipment. It also highlights the importance of counseling patients withmetabolic bone pathology about the risks of walking dogs and proper leash use.Going forward, patients with known osteoporosis and osteopenia should becounseled about the risks of upper extremity injury. A U T H O R SJones T, Chen Y, Shapiro SA, Aziz KT, Murray PMNTH DIMENSIONSABSTRACTS

P R E C E P T O RDr. Wakenda TylerColumbia UniversityT I T L EI N T R O D U C T I O NHemi or total hip arthroplasty is indicated for acute or impending pathologicalfemoral neck fractures, for which long stems have historically been indicated.However, more recent studies have shown that the use of long stems does notsignificantly prevent future metastases and has a higher risk of complication,especially when used with cement. The purpose of this study is to determine theprevalence of long stem vs short stem use and the use of cement among MSTSsurgeons for the treatment of impending pathological proximal femoral fracturesin light of recent change in literature recommendations.Long versus short stem arthroplasty and cement use for pathologic fractures ofthe femoral neck: a survey of treatment patternsT I M E R I J O R D A NM E T H O D SThis three-part survey was sent to MSTS-affiliated orthopedic oncologic surgeonsacross the US through the MSTS research committee. The three promptspresented cases of impending pathological fracture due to metastatic diseasewith clear indication for treatment with endoprosthesis. Each of the casespresented a different comorbidity status that affect the overall health of thepatient, including smoking history, ambulatory status, and age. Each prompt wasfollowed by the same two questions, one providing choices of stem length andcement use, the other a choice between arthroplasty and hemiarthroplasty. R E S U L T SResults are pending survey responses, as the study is ongoing. Based on therecent change in literature suggesting that standard and short stem cementedarthroplasty should be used over long stem cemented arthroplasty due to thedecreased complication risk and similar metastatic outcomes, we predict thatmore surgeons will choose cemented standard length and cementedintermediate length than long stem and uncemented arthroplasty.Eastern Virginia Medical SchoolC O N C L U S I O N SThis study helps to understand what surgical interventions are currently used,how orthopedic oncologists are influenced by the changes in treatmentrecommendations provided by studies from MD Anderson and others, and how thetreatment of patients with impending pathological fractures are being treatedacross the country. This study also provides a building block for future studiesinvolving pathologic treatment fractures, including current outcome trends of thedifferent surgical treatments and comorbidities affecting patient outcomes. NTH DIMENSIONSABSTRACTSA U T H O R STimeri Jordan, Eastern Virginia Medical School, Norfolk, VaWakenda Tyler, MD, Columbia University Department of Orthopedics, New York, NY

P R E C E P T O RDr. Rob GrayNorthShore University Health SystemT I T L EI N T R O D U C T I O NDistal radius fractures are the most common fractures encountered byorthopedic surgeons and is the second most common fracture experienced bypatients 65 and older (Levin LS, 2017). The American Academy of OrthopedicSurgeons (AAOS) has established clinical guidelines for orthopedic surgeons andother healthcare professionals to provide evidenced-based recommendations formanagement of distal radius fractures. Therefore, the purpose of this paper is toevaluate the quality of the top ten YouTube videos regarding distal radiusfractures in comparison to the clinical recommendations established by theAAOS. Evaluation of Wrist Fracture Patient Education Videos on Social Media S T E F A N K I N GM E T H O D SWe searched the top ten most-viewed videos on YouTube regarding distal radiusfractures to evaluate the quality of information for comparison. The criteria usedto measure the quality of the videos were based on the seven clinicalrecommendations proposed by the AAOS: 1) Arthroscopic Assistance; 2) HomeExercise Programming; 3) Indications for fixation of non-geriatric patients (agesunder 65); 4) Indications for fixation of geriatric patients (ages 65 and older); 5)Serial Radiography; 6) Fixation Technique; and 7) Opioid Use. R E S U L T SThe quality of each video was quantified by a percent score of the number ofcriteria matched by the seven evidenced based clinical recommendationsproposed by the AAOS. The fifth most watched video was found to have thegreatest percent of information overlap with the clinical recommendationsproposed by the AAOS. The remaining nine videos were found to have only one ortwo of the clinical guidelines mentioned. Morehouse School of MedicineC O N C L U S I O N SPatients should be cautious in solely relying on social media platforms (i.e.,YouTube) to receive accurate information as many commonly viewed videos arenot made by healthcare professionals. As a result, we propose that orthopaedicorganizations and practitioners should establish standardized descriptions aboutthe management of distal radius fractures that are specifically directed atpatients. A U T H O R SStefan King, Morehouse School of Medicine; Robert Gray, MD, NorthShoreUniversity HealthSystem, Skokie, ILNTH DIMENSIONSABSTRACTS

I N T R O D U C T I O NMinimally invasive bunionectomy is the standard of care for bunion correctiondue to its small incisions and faster healing. However, the minimally invasivenature of the procedure decreases visualization which can result in damage tothe vascular structures leading to avascular necrosis to the first metatarsal head.Chevron and transverse osteotomies are common minimally invasive techniquesused. Neither of these techniques has been compared against one another. Theaim of this study is to evaluate if variation exists between the two techniques inpotential arterial damage. M E T H O D STen first metatarsal osteotomies were performed on ten frozen cadaveric footspecimens. The osteotomies were completed using a minimally invasiveapproach, five using a chevron technique, and five using a transverse technique.The average osteotomy cut was 23.9 mm dorsally from the center of themetatarsal head outside of the intracapsular zone. The cadaveric specimenswere dissected, preserving the vascular plexus to the first metatarsal head. Thefirst dorsal metatarsal artery, first plantar metatarsal artery, and the superficialbranch of the medial plantar artery were observed for damage on a gross scale. R E S U L T SUpon dissection and observation, no vessel damage was appreciated on a grossscale in any of the ten cadaveric specimens using either osteotomy technique. C O N C L U S I O N SBased on the results of this study, there is no variation in arterial damagebetween the chevron versus transverse osteotomy for the minimally invasivebunionectomy. Neither the chevron nor transverse osteotomy techniques causedvessel damage that could be seen on a gross scale. Previous studies discuss asafe zone when performing this procedure. All osteotomies in this study wereperformed within the safe zone. Either transverse or chevron technique can beused without increased risk of avascular necrosis if surgeons remain in thedescribed safe zone. This study is limited by the small sample size. Futureresearch with a larger sample size would help to increase the strength of thesefindings.P R E C E P T O RDr. Gary StewartResurgens OrthopaedicsT I T L ETitlePreservation of 1st Metatarsal Head Blood Supply with Minimally InvasiveChevron vs Transverse OsteotomyA L E X I S L E M O N EWake Forest School of Medicine of Wake ForestBaptist Medical CenterNTH DIMENSIONSABSTRACTS

A U T H O R SDerrick Wendler MD, Gary Stewart MD, Erroll Bailey MD, Alexis LeMone BAA F F I L I A T I O N SWellStar Research Institute, Atlanta, GAResurgens Orthopaedics, McDonough and Fayetteville, GAWake Forest School of Medicine, Winston Salem, NCNTH DIMENSIONSABSTRACTS

I N T R O D U C T I O NLower limb deformities include a range of congenital or acquired conditions, suchas angular or rotational deformities, and associated leg length discrepancies.These conditions can lead to pain, discomfort, gait disturbances, functionallimitations, as well as challenges with mental health and social well-being. Thesephysical, psychological, behavioral and social challenges impact the health-related quality of life of a child (HRQOL). However, there is currently no acceptedpatient reported outcome measure (PROM) that can quantify and compare theeffects of these conditions on children’s HRQOL. LIMB-Q Kids is a new PROM,applicable to a multitude of limb deformities in 8–18-year-old patients. Thepurpose of this study was to translate and culturally adapt LIMB-Q Kids intoSpanish and test its comprehension and comprehensiveness in Spanish speakingchildren with lower limb differences.M E T H O D SThe field-test version of the LIMB-Q Kids consists of 11 scales (159 items)measuring appearance, physical function, symptoms (hip, knee, ankle, foot, andleg), school function, social function, and psychological function. Translation andcultural adaptation (TCA) guidelines by the International Society forPharmacoeconomics and Outcomes Research were followed. Two independentforward translations were conducted by translators who had Spanish as theirnative language and were fluent in English as well, and a reconciled Spanishversion was obtained. This version will be back-translated from Spanish to Englishby an independent bilingual translator and compared with the original Englishversion of LIMB-Q Kids. Cognitive debriefing interviews with 10 patients will assessunderstanding/interpretation of the LIMB-Q Kids in Spanish.R E S U L T SAfter forward translation, 6 out of 159 items were difficult to translate. Afterforward and backward translations, it is expected that 1-5 out of the 159 items willshow discrepancies between the original and back-translated versions. Any itemswith discrepancies will undergo further review to ensure the intent of the originalquestions is maintained in the Spanish version. Cognitive debriefing interviewswill be conducted with 10 patients with lower limb deformities (range 8 to 18). It isexpected that some participants report difficulty understanding 5-10 out of 159items, and 5-10 items to be altered in the final version of LIMB-Q Kids in Spanish.P R E C E P T O RDr. Judson KarlenPhoenix Children's HospitalT I T L ETranslation and Cultural Adaptation of LIMB-Q Kids in Spanish: A New PatientReported Outcome Measure for Children with Lower Limb DeformitiesL A U R A M A R R E R O - S A N T A N AUniversity of Puerto Rico School of MedicineNTH DIMENSIONSABSTRACTS

C O N C L U S I O N SOnce the Spanish version of LIMB-Q Kids is obtained and validated with the targetpopulation, it should be ready for an international field-test. Data from the fieldtest from the Spanish version along with field test data from 11 countries (22sites) will be used to reduce items and perform psychometric testing of LIMB-QKids. The TCA process will provide versions of LIMB-Q Kids in different languages.TCA is a crucial step towards ensuring that items in the new PROM areconceptually equivalent and culturally appropriate to be used in each country. A U T H O R SLaura Marrero-Santana, MS; Melissa Esparza, MDA F F I L I A T I O N SUniversity of Puerto Rico, Medical Sciences Campus, San Juan, PR; PhoenixChildren’s Hospital, Phoenix, AZNTH DIMENSIONSABSTRACTS

I N T R O D U C T I O NThe CT-based robotic-assisted system MAKO has demonstrated positiveoutcomes for patients undergoing total knee arthroplasty (TKA) includingdecreased postoperative pain and better implant positioning compared toconventional TKA. Obesity plays a significant role as a driver of patient outcomesduring TKA including increased operative time, surgical complications, andwound infections. While previous studies have examined implant positioning andpostoperative benefits of MAKO compared to conventional techniques, thesestudies fail to consider these differences in a cohort of strictly obese patients.Therefore, the primary aim of this retrospective cohort study was to evaluatedifferences in preoperative and postoperative radiographic measurements inpatients with a BMI > 35 to determine the effectiveness of correction by MAKOcompared to conventional TKA. Secondary outcomes included surgical time andestimated blood loss (EBL).M E T H O D SA single-center retrospective analysis of consecutive cases performed by asingle surgeon from January 2016 - January 2022 was enacted. A total of 120patient records were extracted with 60 patients in each cohort. Inclusion criteriaincluded patients with a minimum BMI > 35. Patients were stratified based ontreatment with MAKO compared to traditional TKA. Exclusion criteria included lackof radiographs preoperatively, postoperatively, or incomplete surgical andmedical records. Preoperative and postoperative measurements were obtainedfor flexion, extension, and femoral varus versus valgus alignment. Intraoperativemeasurements included the following: femoral flexion versus extension, femoralvarus versus valgus, femoral external rotation versus internal rotation, tibialvarus versus valgus, tibial slope, and overall mechanical alignment. Radiographicmeasurements included preoperative and postoperative hip-knee-ankle angle(HKA), mechanical alignment, and deviation. Student’s T-test was used forpreliminary analysis with Stata (Version 15.1, StataCorp, Durham, NC, USA).P R E C E P T O RDr. Jay LiebermanUniversity of Southern CaliforniaT I T L EThe Use of Advanced Navigation Tools in Obese Total Knee ArthroplastyB R I A N M C C R A EWarren Alpert Medicine Schoolof Brown UniversityNTH DIMENSIONSABSTRACTS

C O N C L U S I O N SOperative time was increased in the MAKO group compared to the traditional TKAgroup, but there was no significant difference in alignment or estimated bloodloss between the two groups. While these results confer that MAKO does notprovide perioperative advantages for the surgeon, postoperative outcomes andother comorbidities were not assessed. In addition, inter-case variability hasbeen standardized by the robotic systems which may not have entirely beencaptured. The remaining results of this study are still pending.A U T H O R SBrian K. McCrae Jr., BS; Ryan DiGiovanni, MD; Mary Richardson, BS; Nathanael D.Heckmann, MD; Daniel A. Oakes, MDA F F I L I A T I O N SThe Warren Alpert Medical School of Brown University, Providence, RIKeck School of Medicine of USC, Los Angeles, CAR E S U L T SPreliminary data collection showed that preoperative HKA averaged 5.58°± 8.54°in the MAKO group and 7.60°±7.88° in the traditional group, but these differenceswere not significant (p=0.185). Postoperative HKA averaged 1.3°±2.1° in the MAKOgroup and 1.61°±4.22° in the traditional group (p=0.613). Operative time wasincreased in the MAKO group with an average of 180.8 minutes compared to anaverage of 166.2 minutes in the traditional group (p<0.001). Blood loss was similarin both groups (MAKO 69.9 mL and traditional 61.7 ml, p=0.139). The remainder ofthis analysis is ongoing including additional data collection. These results arestill pending.NTH DIMENSIONSABSTRACTS

I N T R O D U C T I O NPatellar fracture and complications after utilizing BPTB autograft for ACLreconstruction are rare with an incidence ranging from 0.12 to 2.3% of cases.1–4Comminuted patella fractures can cause a reduced degree of extension of theknee, which makes appropriate treatment challenging. In this report, a case ispresented of a 20-year-old man who had a closed, comminuted patella fracture17 days after an anterior cruciate ligament revision reconstruction utilizing abone-patellar tendon-bone autograft. M E T H O D SThis is a retrospective case report of a 20-year-old male who sustained acomminuted patella fracture 3 months after BPTB autograft harvest for ACLreconstruction. A literature review was performed to determine the clinicalbackground of the case. Data collection included articles and studies sourcedthrough Google Scholar, PubMed, and using terms related to comminuted patellarfracture. For the studies to be selected the following must be met: (1)comminuted patellar fracture (2) BPTB harvest site after ACL reconstruction(PCP), or (3) outcome of patients with similar comminuted fractures at BPTBharvest sites. R E S U L T STo the authors’ knowledge, this is the first case report describing uniquechallenges with closed comminuted patellar fracture and usage of TricorticalIliac Crest Allograft. In addition, our case demonstrates the novel use of frozentricortical iliac crest with a Synthes large VA patellar 2.7mm locking plate toaddress the comminuted patellar fracture in the setting of ACL reconstructionwith a BPTB graft. 12 weeks after surgery: Range of motion was 10-15 degrees shortof full active extension and flexion to 110+ degrees.P R E C E P T O RDr. Jon Barlow and Dr. Kelechi OkorohaMayo Clinic Rochester, MNT I T L EIliac Crest Allograft for Bone-Patellar Tendon-Bone Donor Site Fracture: A CaseReportJ U A N M E D I N A - E C H E V E R R I AChicago Medical School at Rosalind FranklinUniversity of Medicine & ScienceC O N C L U S I O N SBased on follow up exams and radiological images, Open reduction and internalfixation with use of a frozen tricortical iliac crest allograft can serve as analternative technique to restore the extensor mechanism of the knee incomminuted patellar fractures following anterior cruciate ligamentreconstruction.NTH DIMENSIONSABSTRACTS

A U T H O R SJuan Medina-Echeverria, M.S, Aliya G. Feroe, M.D., MPH, Krystin A. Hidden, MDA F F I L I A T I O N SChicago Medical School, Rosalind Franklin University of Medicine and Science (RFU),Chicago, ILMayo Clinic, Rochester, MNMayo Clinic Hospital, Saint Mary’s Campus, Rochester, MN1.2.3.NTH DIMENSIONSABSTRACTS

PRECEPTORDr. Erick SantosRio Health Medical CenterTITLECombatting  Lower  Extremity  Pain Using  Movement is Life  Multimedia  Interventionsand Home Exercise Programs Following COVID-19 QuarantineINTRODUCTIONOsteoarthritis  (OA)  and  lower  extremity  pain  are  leading  causes  of  disabilityworldwide.1 Movement Is Life describes joint pain as a multifactorial cycle of pain,leading  to  limited  mobility,  inactivity,  obesity,  and  more  pressure  on  joints,therefore causing more joint pain.2-4 MIL strives to combat the cycle of joint painby utilizing early  interventions  such  as  holistic multimedia  educational  materials.Studies  previous  to  the  COVID-19  pandemic  have  shown  that  when  given  acombination  of  MEM  and  home  exercise  program  interventions,  there  wasincreased  knowledge  and  meaningful  improvement  in  patient  well-being.3However,  the  COVID-19  pandemic  has  had  a  negative  effect  on  patients’  physicaland  emotional  health  and  these  same interventions  did  not  have  a correlation  toimprovements during this time period.10 There is, a growing realization that thetimescale  associated  with  this  crisis  may  permanently  change  the  veryfoundations  of  society's  ‘normal'  day-to-day  life.7  We  hypothesized  that  the  endof  the  pandemic  would  lead  to  an  increase  in  reported  physical health  as  well  asemotional health, however  to our surprise our data indicates that many peoplefeel physically and  emotionally the same  or worse since the quarantine ended.These  findings suggest that the  COVID-19 quarantine  will have lingering  effectson  the  patient's physical  and  mental  health, and  physicians  should be  aware  ofthese changes as they navigate treatment options in the future.
MYLES MOOREMETHODSPatients were recruited with lower extremity pain including  hip pain,  knee pain,and  ankle  pain  at  Rio  Health  Medical  Center.  Exclusion  criteria  included  age  lessthan  18  years  and  history  of  prior  lower-extremity  surgery  within  the  past  yearwith exception of diagnostic knee arthroscopy. Patients were given consent formsand  a  baseline  survey  (in  English  and  Spanish  upon  request)  that  included  basicdemographic  information  along with a series  of  questions.  The  specific questionsasked  patients  to  rate  their  overall  health,  pain  level,  emotional  wellbeing,  socialactivity,  eating  habits,  and  desire  to  improve  their  health  with  variables  on  ascale  from 1-10  (1 being  poor,  10  being  good).  Patients  were  also  asked  to  includetheir  weekly  physical activity, whether  they  had undergone  or  are  currently  doingphysical therapy, and whether they would be willing to do  an at-home exerciseprogram.  Participants  were  given  links  to  the  MIL  brochure,  a  link  to  the  MILhomepage,  and  at-home  exercises  specific  to  their  injury  provided  by  SportsMedicine Patient Advisor.Howard University College of MedicineNTH DIMENSIONSABSTRACTS

RESULTSThere were reported mean improvements in all categories except emotional well-being within a two-week span, however the improvements were not statisticallysignificant. We predict that the 4-week data will provide more statisticallysignificant data to suggest MEM and HEP can improved health outcomes.Additionally, our preliminary data that asked about patient physical andemotional well-being since quarantine ended showed an average score of 5.0526and 5.3157 respectively. This data indicates that many people feel physically andemotionally the same or worse although there were small-scale improvements inpain reporting at the 2-week follow-up. These findings suggest that the COVID-19quarantine will have lingering effects on the patient's physical and mental health,and physicians should be aware of these changes as they navigate treatmentoptions in the future.AUTHORSMyles Moore, Guillermo Ramirez, Kevin J Orellana, Paul Treviño OPA-C, Erick MSantos MD PhDAFFILIATIONSHoward University College of Medicine, University of Texas Rio Grande ValleySchool of Medicine, Rio Health Medical CenterParticipants then had 4 follow-up surveys each week to compare with their initialresponses. These follow-up surveys had three additional questions to inquireabout the effects that remained after the mandatory COVID-19 quarantineincluding physical health since mandatory quarantine restrictions were lifted,emotional health since mandatory quarantine restrictions were lifted, andemployment status. The means of the survey responses to were compared at analpha value of 0.05 to corresponding responses from the 2020 cohort in Orellanaet al, which was done at the same clinic with identical methods.METHODS (CON'T)NTH DIMENSIONSABSTRACTS

INTRODUCTIONFemur fractures can occur by various high energy and low energy mechanisms.Several factors may impact length of stay, includingpolytrauma, severity offracture pattern, or complications. The purpose of this study is to assess thepredictive factors associated with longer for length of hospital stay (LOS)following femur fracture.METHODSThis is a retrospective study of femur fractures treated at a level 1 trauma centerfrom January 2007 to December 2017. Several factors were collected includingage, gender, fracture mechanism and pattern, soft tissue injury, time tosurgeryand days to discharge were analyzed using secondary data analysis on 292patients who sustained a femur fracture that was stabilizedusing retrogradeintramedullary nailing.RESULTSIpsilateral lower extremity injury and soft tissue injury contributed significantly toLOS (p = <0.001) extending the mean days to discharge from 10.33 days to 18.30days with injury. Sacral, tibial and fibular, and foot and ankle injuries showed thelargest increase in mean days to discharge with an average 26.67, 22.36 and 22.12LOS respectively. Lower extremity ipsilateral injury and associated soft tissueinjury contributed significantly for the under 30 age group (p = 0.040), 30 to 64group (p= <0.001), and the 65 and above group (p =<0.001). Presence of an openfracture contributed significantly to associated soft tissue injury for the under 30age group (p = <0.001). Changes to mean LOS due to age, gender, fracturemechanism or classification were insignificant.CONCLUSIONSThe presence of soft tissue injuries or ipsilateral polytrauma is a significantlyassociated with increased length of hospital stay. However, factors such as ageof the patient, mechanism of injury, fracture severity or gender were notesignificantly predictive of length of stay.AUTHORSJakara Morgan, Heidi Israel, Ph.D, John T. Watson, M.D.AFFILIATIONSUniversity of South Carolina School of Medicine Greenville, Saint Louis UniversitySchool of MedicinePRECEPTORDr. Howard PlaceSaint Louis University School of MedicineTITLEEvaluating Strongest Predictors of Length of Hospital Stay Post-Femur Fracture: ARetrospective StudyJAKARA MORGANUniversity of South CarolinaSchool of Medicine, GreenvilleNTH DIMENSIONSABSTRACTS

INTRODUCTIONIIn previous studies, biopsy during Carpal Tunnel Release (CTR) has provenhelpful for early diagnosis of amyloidosis. However, a biopsy is an invasiveprocedure that is not without inherent risk. Further, the indications for biopsy-driven diagnosis have not been well established. This study aims to compare twoscreening criteria for CTR biopsies to determine their predictive screening valuedetecting amyloidosis. METHODSA retrospective study was performed on patients from a single orthopedicpractice setting who underwent CTR from April 2021 to July 2022. The entire cohortunderwent tenosynovial biopsy and processing with congo red stain to detect thepresence or absence of amyloidosis. Positive samples were further tested bymass spectrometry and immunostaining. A definitive diagnosis of amyloidosiswas confirmed either by pathology or cardiac consultation. Two separate criteriawere then applied to the cohort to determine their respective effectiveness inpredictive patients with or without biopsy confirmed amyloidosis. Group I criteriaincluded patients who met 2 criteria: (1) presence of bilateral carpal tunnelsyndrome (CTS) and (2) men ≥60 yrs of age or Black/African Americans.1 Group IIcriteria included patients who met any 2 of these 3 criteria: (1) men ≥ 50 years orwomen ≥ 60 years; (2) bilateral CTS or prior CTR; (3) presence of spinal stenosis,biceps tendon rupture, atrial fibrillation or flutter, pacemaker, congestive heartfailure, and/or family history of amyloidosis.2 The predictive value of eachcriteria was then calculated for direct comparison.RESULTSA total of 13 patients (54% female; avg age 73 +/- 9.8) were identified. Amongstthe entire cohort, two female patients had confirmed tested positive foramyloidosis following congo red stain which was also supported with pathology.Based on Group I criteria, 0 patients would have met requirements to undergo abiopsy. With the use of Group I criteria, the following values were obtained:positive predictive value (PPV) of 0, negative predictive value (NPV) of 0.33,sensitivity of 0 and specificity of 0.36. Group II criteria had a PPV of 0.15, NPV of 0,sensitivity of 1 and specificity of 0.PRECEPTORDr. Peter LopezFlorida Orthopaedic InstituteTITLEPredictive Value of Diagnostic Criteria applied to Amyloidosis Detection followingCarpal Tunnel ReleaseDANISA OYOLA-SOTOUniversidad Central del Caribe School of MedicineNTH DIMENSIONSABSTRACTS

CONCLUSIONSGroup II criteria had higher sensitivity than Group I criteria, thus Group II criteria ismore likely to identify patients with a greater propensity for biopsy-confirmedamyloidosis. Therefore, utilizing a more inclusive criteria such as Group II criteriacould aid in the detection of amyloidosis in patients undergoing CTR. However, due tothe small sample size, neither Group I or Group II criteria can be consideredstatistically significant. Future research should aim to establish more inclusivecriteria to identify patients that would benefit from an invasive biopsy. Theimportance of establishing such guidelines is because biopsy during CTR is costeffective and could increase early diagnosis and intervention of amyloidosis.2 Earlydiagnosis could be the key to decreasing the incidence of mortality in patients withamyloidosis.AUTHORSDanisa Oyola-Soto; Peter Lopez, MDAFFILIATIONSUniversidad Central del Caribe School of Medicine, PR; Florida Orthopedic Institute,FL; NTH DIMENSIONSABSTRACTS

PRECEPTORDr. Marcus CoeDartmouth Hitchcock Health TITLEINTRODUCTIONNotable geographic disparities in trauma outcomes exist between rural andurban residents, with a disproportionately large number of deaths occurring inrural emergency departments compared to urban counterparts.1, 2 Access totrauma care can be limited in rural areas, with time to hospital and time to first-physician contact averaging higher than urban counterparts.3 This inaccessibilitycould explain the worse outcomes associated with rural orthopedic trauma care.4To better characterize the geographic disparities in trauma care, this studyanalyzed whether patients residing in rural zip code regions experience worsepost-fracture outcomes than urban counterparts. Secondly, this study evaluatedthe relationship between validated measures of social deprivation and ruralversus urban rates of complications following orthopedic trauma care to assess ifboth access to care and social determinants of health impact patient outcomes.Geographic Disparities in Orthopedic Trauma Care Outcomes in Rural SettingsSAHITI PATIBANDLA METHODSThis retrospective study utilized a de-identified insurance claims data set andfracture Current Procedural Terminology (CPT) codes to identify a cohort oforthopedic trauma patients that received trauma care for all upper and lowerextremity fractures, excluding digits, between 2014 and 2020. Three-digit zipcodes were utilized as geographic identifiers to categorize each patient as arural or urban resident. Rural regions were typically areas of low populationdensity with less access to resources, while urban areas typically had higherpopulation density and resource accessibility, as classified by the US CensusBureau Criteria. International Classification of Diseases (ICD10) and CPT codeswere utilized to identify post-treatment complications, including length ofinpatient stay, opioid utilization, discharge disposition, reoperation, andreadmission at 30-day, 90-day, and one-year post-operative time intervals.Finally, the validated Social Deprivation Index measure was utilized to classify thesocial deprivation level of each geographic area based on zip code.University of Texas SouthwesternMedical School at DallasNTH DIMENSIONSABSTRACTS

AUTHORSSahiti Patibandla, Robert Gomez, Marcus P. Coe, MD, Paul M. Werth, PhD, LeahGitajn, MDAFFILIATIONSUniversity of Texas Southwestern Medical School, Dallas, TX.Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.1.2.RESULTS/CONCLUSIONSData analysis via multivariate, multiple logistic regression model is pending. Wehypothesize that rural residents would experience a higher rate of complicationsafter upper or lower extremity fracture injuries. Secondly, we hypothesize thatrural zip codes are associated with greater measures of deprivation and that thisinaccessibility to resources would be a mediator of worse health outcomes. Priorresearch supports the direction of our hypotheses. Studies have demonstratedmajor racial and gender disparities in trauma outcomes based on geographicregion.4 Furthermore, higher mortality rates have been found in low-income vs.high-income countries, as well as areas with access to Level 1 trauma centers vs.areas without such access.NTH DIMENSIONSABSTRACTS

PRECEPTORDr. William T. LongComputer Surgery InstituteTITLEINTRODUCTIONHip dislocation following total hip replacement remains a leading cause of failurerequiring hip revision surgery. Proper Acetabular cup placement using computernavigation (CN) combined with Anatomic Head Size are two methods that areused to decrease the incidence of dislocation. Anatomic head size is defined byfemoral head size 6 mm smaller than the outer diameter of the cup. Acombination of these methods has been shown to be an effective technique interms of reducing the incidence of dislocation and subsequent revision. To ourknowledge, this is the first study to assess the impact of combining both methodsto prevent the occurence of early and late hip dislocation.Evaluation of Wrist Fracture Patient Education Videos on Social Media WILLIAM ROSS IIIMETHODSThis is a retrospective study of 591 Primary Total hip replacements performedbetween January 2006 and December 2017 by a single physician. The surgery isperformed through a minimal incision posterior approach. Computer Navigationis used. The patients were divided into two groups based on the risk ofdislocation(high-risk vs. low-risk). Risk was stratified in three different categories;skeletal, soft tissue, or central nervous conditions. 168 of the 591(28%) patientswere considered high risk based on the given criteria. The rate of dislocation andsubsequent revision was calculated for the high and low risk groups and werecompared to one another. RESULTSThere were 9 dislocations following 591 hip replacements, including 6 in the high-risk group and 3 in the control group. (3.5% vs 0.7% ) with the overall dislocationrate being 1.5%. Two patients required revision surgery as a result of dislocation.The outcome of computer navigated total hip arthroplasty (CN-THA) combinedwith use of an anatomic prosthetic head size is reviewed. Morehouse School of MedicineCONCLUSIONSBased on data, the lower general rate of THR dislocation is around 2.84%. Thisstudy’s dislocation rate is almost half that of the lowest general rate of THRdislocation at 1.5% with the dislocation rate of the control group equaling .7%.There were 6 dislocations out of the 168 patients in the high risk group resulting ina dislocation rate of 3.5% which is in line with the “true” dislocation rate of 3.5%calculated by recent studies. Out of the 6 dislocations within the high-risk cohort,3 of them were due to traumatic injuries that would have resulted in dislocationof both replacement and anatomical hips. NTH DIMENSIONSABSTRACTS

Discounting those dislocations that were due to factors not associated with thesurgical approach used in the study, the dislocation rate due to failure of theprocedure in the high-risk cohort was 1.7%, half that of the “true” dislocation rateof the general population. When drawing a comparison between the general ratesof dislocation versus that of the study’s calculated rates using the dislocationrate due to failure and the calculated dislocation rate for the control group, onecan note that in both instances, the study’s rates are markedly less than that ofthe general rates. This realization leads to but one conclusion: Computer assistedcup placement combined with anatomic head size results in a lower rate ofdislocation and revision within the high and low risk patients. Based on the datawithin this study, the combination of Computer Navigation and the implantationof Anatomic Head Size femoral heads should be investigated as an improvementupon the field of total hip arthroplasties. The evidence suggests this method atleast halves the rates of dislocations in the general and the high-risk populationand needs to be treated as a burgeoning replacement for the current methodsand procedures. AUTHORSWilliam Long MD, Computer Surgery Institute, Los Angeles California, William RossIII MS, Morehouse School of Medicine, Roi Medina, MD,CONCLUSIONS (CON'T)NTH DIMENSIONSABSTRACTS

INTRODUCTIONOsteoporosis is a disease defined by low bone mass, leading to an increasedfracture risk. Studies have shown that one’s peak bone mineral density is reachedin their 20s, followed by a gradual decline beginning at age 40 and continuing forthe rest of their life. Recent studies have found multiple loci associated withmeasures of bone quality, including WNT16. The purpose of this project is to studywhether the single nucleotide polymorphism (SNP) rs10242100 is associated withmusculoskeletal phenotypes in young adults. METHODSThe Functional Single Nucleotide Polymorphism Associated with Human MuscleSize and Strength (FAMuSS) cohort consisted of young adults (ages 18-40)enrolled in a program to strengthen their non-dominant arm. The AssessingInherited Markers of Metabolic Syndrome in the Young (AIMMY) cohort consistedof young adults (ages 18-35) recruited to determine genetic variants associatedwith metabolic syndrome. Genotyping: Genotyping was performed using AppliedBiosystems QuantStudio 7 Flex Real-Time PCR System. Statistical Analysis: Hardy-Weinberg equilibrium (HWE) was tested in race-specific cohorts and analysis ofcovariance (ANCOVA) was used to examine genetic models of association amongSNP genotypes and musculoskeletal phenotypes in sex-stratified cohorts. RESULTSThe genotype distribution for rs10242100 of WNT16 was in HWE in the FAMuSScohort (p=0.34) and Howard University (HU) AIMMY cohort (p=0.11), but not in theUniversity of Calgary (UC) AIMMY cohort (p=0.040). Therefore, results for the UCcohort were not included in this analysis. Significant associations were found inthe additive model for FAMuSS. There were no significant associations in AIMMY.FAMuSS: In the additive model, WNT16 rs10242100 variants were associated withpercent change in isometric strength of the dominant arm (p=0.012) and baselinewhole arm volume for both the dominant (0.013) and non-dominant arms (0.009)in females and percent change in 1-repetition-maximum strength of thedominant arm (p=0.047 ) as well as baseline bone (plus marrow) volume of thedominant arm (p=0.049) and non-dominant arm (p=0.026) in males. PRECEPTORDr. Laura TosiChildren's National HospitalTITLEInfluence of Genetic Variation Within the WNT16 gene on MusculoskeletalPhenotypes in Young Adults LEAH SHEPHARDIndiana University School of MedicineNTH DIMENSIONSABSTRACTS

C O N C L U S I O N SPrevious studies have shown that rs10242100 is associated with bone mineraldensity. We found that this SNP was associated with changes in isometricstrength and baseline whole arm volume in females, and 1-repetition maximumstrength and baseline bone (plus bone marrow) volume in males. This workexpands on previous studies by demonstrating associations among WNT16rs10242100 and a larger collection of musculoskeletal phenotypes. As dimorphismis seen among different phenotypes, it also highlights the critical role of sex.Further studies should be performed among groups of other ethnic populations toassess the effects of those variables on expression of WNT16 variants andmusculoskeletal phenotypes. These findings expand our understanding of the role of WNT16 rs10242100 inmusculoskeletal phenotypes. With the rise of genetic testing, identifying andunderstanding the influence of WNT16 polymorphisms aims to positively impactthose at risk of osteoporotic fractures by allowing for more timely measures ofinjury prevention, leading to a reduced risk of fracture. A U T H O R SLeah Shephard, Stephanie Vu, Heather Gordish-Dressman, Laura L. Tosi, MD, FAAOSA F F I L I A T I O N SIndiana University School of Medicine, Indianapolis, IN The School of Medicine and Health Sciences, George Washington University,Washington, D.C. Children’s National Research and Innovation Center, Washington, D.C.1.2.3.NTH DIMENSIONSABSTRACTS

P R E C E P T O RDr. Erika GanttOrthoCarolinaT I T L ESex Differences Do Not Affect Outcome Following Chronic Periprosthetic JointInfection Exchange TreatmentI N T R O D U C T I O NPeriprosthetic joint infection (PJI) is a rare but devastating complication aftertotal joint arthroplasty. Although the rate of total joint arthroplasty (TJA) isgreater in women than men, several studies have shown males to be at greaterrisk for PJI following primary TJA. However, the literature lacks studies examiningthe relationship between sex and outcomes following single and 2-stageexchange for PJI. The purpose of this study is to examine whether female patientshave a higher disease-free survival at 1-year follow-up compared to malepatients and how the profiles of infecting organisms and comorbidity burdensdiffer between sexes in order to provide insight for treatment strategies for PJIpatients in the future. M E G A N T E R S T E E GM E T H O D SA retrospective cohort registry study was done which reviewed patients whopresented to the OrthoCarolina Hip & Knee Center following a diagnosis of PJI andwere indicated for a 1 or 2-stage exchange for treatment between January 2010-January 2021. Eligible patients were at least 18 years of age, had confirmed PJIfollowing TJA, had a known infecting organism or confirmed culture negativeinfection, and underwent first stage resection as part of a planned one or two-stage exchange. Comorbidity and infection details including microbiology,serology, and pathology were collected for each patient. Incidence of primaryand aseptic revision arthroplasty cases were included between sexes. Successwas defined as disease-free survivorship at 1 year following reimplantation. R E S U L T S14,782 patients (6,973 male & 7,809 female) underwent a primary TJA during thestudy time frame. 6,652 patients (3,036 male & 3,616 female) underwent arevision TJA during the study time frame. 2,209 patients (1,155 male & 1,054female) underwent a revision TJA for PJI during the study time frame. 476patients met final eligibility criteria for inclusion. 250 male patients and 226female patients were analyzed. 200 males (80.0%) and 180 females (79.6%) werefound to be disease-free at 1 year follow up. There was no statistically significantdifference between male and female patients’ success at 1 year (p= .>0.99).Analysis of age (p=0.365) and BMI (p=0.623) also did not result in anystatistically significant differences with the sample size available.Saint Louis University School of Medicine NTH DIMENSIONSABSTRACTS

C O N C L U S I O N SHistorically, male patients are more likely to experience PJI as a complicationdespite, on average, more female patients undergoing a TJA procedure. Our studyfound that more male patients were diagnosed with a PJI necessitating aresection procedure. There was no significant difference in failure rate betweensexes at 1 year clinical follow up. A U T H O R SMegan Tersteeg, MS, Rory Metcalf, MD, Taylor Rowe, BA, Susan Odum, PhD, JesseOtero, MDA F F I L I A T I O N SSaint Louis University School of Medicine, Class of 2025, Saint Louis, MOOrthoCarolina Research Institute, Charlotte, NCAtrium Health Musckuloskeletal Institute , Charlotte, NCOrthoCarolina, Charlotte, NC1.2.3.4.NTH DIMENSIONSABSTRACTS

I N T R O D U C T I O NAnatomic total shoulder arthroplasty (ATSA) has proven to be a successfultreatment for glenohumeral osteoarthritis (GHOA). Nonetheless, it is uncertain ifthere is a correlation between pre-operative rotator cuff muscle atrophy on postclinical outcomes in patients who get an ATSA. The purpose of this study is toevaluate if there is a correlation between pre-operative rotator cuff musclevolume and clinical outcomes following ATSA for GHOA. M E T H O D SIn this study, 198 shoulders underwent ATSA for GHOA with a minimum of 2 yearsfollow up identified by a maintained prospective registry. Each rotator cuffmuscle was assessed and measured on a standardized preoperative magneticresonance image (MRI), using OsiriX image analysis, to generate an area of totalmuscle volume. The pre and postoperative patient reported clinical outcomes arethe American Shoulder and Elbow standardized shoulder assessment (ASES),Single Assessment Numerical Evaluation (SANE), range of motion (ROM), and painlevel. The above outcomes were assessed for correlations with preoperativerotator cuff muscle volume. R E S U L T SA total of 198 patients with a mean age of 62.0 ± 7.3 years (range: 42-78),underwent ATSA for GHOA with a minimum follow up of 2 years. MRIs wereevaluated for a quantitative measurement of muscle atrophy. A univariateanalysis did not show any significant findings when evaluating for supraspinatus,teres minor, and infraspinatus muscle volume in relation to clinical outcomes.There was a negative correlation in subscapularis muscle volume and its impacton postoperative internal rotation (R= -.142, P = 0.046). Furthermore, the size ratioof the posterior cuff to subscapularis muscle volume demonstrated a significantnegative correlation for change in SANE scores (R= -.141, P= 0.047), externalrotation (R= -0.149, P= 0.036), and internal rotation (R= -0.190, P=0.007).Nonetheless, there were no correlations between size ratio and other clinicaloutcomes. P R E C E P T O RDr. Andrew JawaNew England BaptistT I T L EImpact of Rotator Cuff Muscle Atrophy on Clinical Outcomes after Total ShoulderArthroplasty for Glenohumeral OsteoarthritisJ A L E N T H O M A SMeharry Medical CollegeNTH DIMENSIONSABSTRACTS

A U T H O R SJalen Thomas M.S, B.A, Dan Swanson B.S, Evan Glass B.S, Jacob Kirsch M.D,Andrew Jawa M.DA F F I L I A T I O N SMeharry Medical College, Nashville, TNDepartment of Orthopaedic Surgery, New England Baptist Hospital, Boston, MABoston Sports and Shoulder Center, Waltham, MA1.2.3.C O N C L U S I O N SPreoperative rotator cuff muscle volume does not have an obvious correlation onclinical outcomes. However, there is a negative association with the ratio of theposterior cuff to subscapularis, consistent with prior studies that have assessedvolume in patients undergoing reverse total shoulder arthroplasty. NTH DIMENSIONSABSTRACTS

PRECEPTORDr. Larry Martin and Dr. Paulvalery RouletteNovant Health Orthopaedics andSports Medicine InstituteTITLEIliac Fascia Blocks in Elderly with Hip Fractures: A Critical EvaluationINTRODUCTIONPatients over 65 years of age who sustain a hip fracture have a high risk formorbidity and mortality. An iliac fascia iliac block (FIB) is used in elderly hipfracture patients to minimize the use of opioids that are associated withincreased postoperative complications in the geriatric population. The purpose ofour study was to determine the effectiveness of the FIB in geriatric hip fracturepatients. NOAH THOMASMETHODSThis retrospective study of patients 65 years and older who were admitted toOrthopaedic Hospital from May 2020-May 2021 comprised our study population.Our hospital implemented the use of preoperative FIB in hip fracture patients withthe administration in the preoperative holding area by the anesthesiologist attheir discretion. During data collection, the following was studied and compared:anesthesia type, number of hours until surgery, fracture pattern, fracture fixation,physical therapy parameters including getting out of bed (OOB) postop, highestpain scores postop, initial postoperative visit pain score, narcotic medication use,length of stay (LOS) and discharge disposition. Statistics were calculated with asignificance value of (p<.05). RESULTSA total of 189 patients were included in the study.There were 109 hip fracturepatients in the control group who did not receive the FIB and 80 patients whoreceived the FIB. The average age for the control group was 80 (62-100) and83(62-102) for the FIB (p< .003) For the FIB group, 53% (51) had spinal anesthesiawhile 47% (38) had general anesthesia (GA). In the non-FIB group, 47% (51) hadSA, while 53% (58) received GA (p<0.05). For the FIB group, most patients tooknarcotics by mouth (PO) 70 % (46) compared to 19 patients taking both IV and PO(30%). In the Non-FIB group, 62 patients took only PO (58 %) compared to the 45(42%) taking IV and PO (p<.002). On the day of surgery, 38% (30) of patients in theFIB group were out of bed in comparison to Non-FIB 45% (49) (p<.481). On POD 160% (48) of patients in the FIB were recorded taking steps in comparison to 76%(83) of Non-FIB (p<.501). Meharry Medical CollegeNTH DIMENSIONSABSTRACTS

CONCLUSIONSPostoperatively, the FIB group reported their highest pain score an average painscore at an average of 32 hours compared to the Non-FIB group at 16 hours aftersurgery (p<.006). Postoperatively, the FIB group reported a highest pain scoreaverage of 7.4, compared to Non-FIB group of 2.29 (p<.027). The dischargedisposition was significantly improved in the non-FIB with 44% (48) of the groupdischarging home and 37% (40) discharged to a skilled nursing facility (SNF), incomparison to 24% (19) of FIB patients discharging home and 44% (61) SNF(p<.001).Administration of the FIB significantly increased the amount of time betweensurgery and maximum pain threshold. Additionally, pain scores were greater inthe FIB group once the block wore off. However, a concern with the FIB use ispossible delays in physical therapy participation due to the duration of the block.In our study, objective PT parameters were more robust on same day andpostoperative day 1 for the group who did not receive the FIB. AFFILIATIONSNoah Thomas, M.H.S, M.S., Meharry Medical College, Nth Dimensions, Lisa K.Cannada, MD, Novant Health Orthopedics Charlotte, North CarolinaRESULTS (CON'T)NTH DIMENSIONSABSTRACTS

INTRODUCTIONOsteoarthritis (OA) is a disease for which there is currently no definitive cure.Developing a way to produce chondrocytes with regenerative capacity provides apromising avenue as a cure for cartilage-related diseases. Multipotent progenitorcells (iMPCs) created from induced pluripotent stem cells (iPSCs) are a promisingcell source for cartilage regeneration. These cells do not sacrifice the healthyarticular cartilage and have shown a lower risk of hypertrophy. In most studies,bone morphogenetic proteins (BMPs) were shown to significantly enhancetransforming growth factor β (TGF β)-induced iMPC chondrogenesis. In contrast,TGFβ alone is sufficient to induce robust chondrogenesis of human primarymesenchymal stromal cells (MSCs). Currently, the mechanism underlying thisdifference between iMPCs and MSCs has not been fully understood. In this study,we tested different growth factors alone or in combination in stimulatingchondrogenesis in iMPCs and MSCs, with a special focus on chondrocytehypertrophy. METHODSChondrogenic pellet culture was conducted by first resuspending 0.3 x 106 MSCsor iMPCs in 200ul basic chondrogenic medium. The concentrations of growthfactors were 100 ng/mL bone morphogenetic protein (BMP)-6 and 10 ng/mLtransforming growth factor-beta. Cell total RNA was extracted and the extractedtotal RNA was prepared for RT-qPCR. Slides were stained using safranin-O withfast green counter-staining. RESULTSWe compared iMPCs-derived separated into four different experimental groups.The experimental groups for this included iMPC cultures grown in basicchondrogenic medium only (CM group), CM supplemented with TGFβ3 (T group)or BMP6 (B group), and TGFβ3+BMP6 (TB group). We examined the relativeexpression of both chondrocyte-associated and hypertrophy/osteogenesis-related genes under different chondrogenic conditions. The COL2 gene encodesfor collagen type II which is the main type of collagen found in cartilage. TheqPCR results showed that under the optimized scheme (TGFβ3+BMP6), the relativeexpression of chondrogenesis-related gene markers was the greatest across thefour groups. For all chondrocyte-associated markers measured, the expression inthe TB group was significant for each compared to the BMP6-only group. PRECEPTORDr. MaCalus HoganUniversity of Pittsburgh School of MedicineTITLEChondrogenic potential in human mesenchymal stromal cells versus iPSC-derived multipotent cellsLAUREN TURNERIndiana University School of MedicineNTH DIMENSIONSABSTRACTS

CONCLUSIONSMultipotent progenitor cells (iMPCs) created from induced pluripotent stem cells(iPSCs) is a promising cell source for cartilage regeneration. Here, we concludedan optimal induction method to generate hyaline cartilage-like tissue from iPSC-derived multipotent progenitor cells (iMPCs). Through comprehensive in vitro andin vivo studies, we demonstrate that iMPCs represent a better cell source thanprimary mesenchymal stem cells (MSCs) in regenerating hyaline cartilage. AUTHORSLauren Turner, Kanyakorn Riewruja MD, MaCalus Hogan MD, Hang Lin, PhD AFFILIATIONSIndiana University School of MedicineDepartment of Orthopedic Surgery, University of Pittsburgh School of MedicineMcGowan Institute for Regenerative Medicine, University of Pittsburgh School ofMedicine1.2.3.In the conventional induction scheme (TGF β3 as the single chondro-inducinggrowth factor), the relative gene expression was greater in comparison to the CMfor two of the three chondrocyte-associated markers. There was no difference inthe levels of chondrocyte-associated gene expression between the BMP6-inducedgroup and the CM group. (Fig. 1).Surprisingly, there were no significant differences between any of the groups incomparing the expression of the four hypertrophy and osteogenesis-relatedgenes (Figs. 2a & 2b).RESULTS (CON'T)NTH DIMENSIONSABSTRACTS

INTRODUCTIONRegional anesthesia has been increasingly used within orthopaedic surgery. Ithas been found to decrease opioid use and consumption and has beenassociated with decreased blood loss and clot formation in some lower extremitysurgeries – specifically hip and knee arthroplasty surgery. General anesthesia isnot without risks including malignant hyperthermia, laryngeal edema, vocal cordtrauma, and delirium. This has led to increased utilization of regional anesthesiain foot and ankle surgery. However, there is a paucity of research that comparesthe postoperative outcomes in patients treated with regional compared togeneral anesthesia in these surgeries. We hypothesize the use of regionalanesthesia in foot and ankle surgery leads to fewer short-term postoperativecomplications compared to general anesthesia. METHODSThe American College of Surgeons-National Surgical Quality ImprovementProgram (ACS-NSQIP) database was queried from 2006-2018 to identify patientsundergoing foot and ankle surgery. Current Procedural Terminology (CPT) codesfor all foot and ankle surgery were utilized to determine which participants toinclude in the analysis. The cohort was divided into patients who receivedregional anesthesia versus those who received general anesthesia, andcomparisons were made on demographic characteristics, and comorbidities,using chi-squared and t-test analyses. Multivariate logistic regressions wereperformed to identify whether lack of regional anesthesia was an independentrisk factor for infection, minor postoperative complications, and majorpostoperative complications. Major postoperative complications included anycomplication that had a long-term effect on someone’s life or led to reoperation,while minor postoperative complication included any event that needed medicalintervention but did not impact a person’s health long-term. The odds ratio and95% confidence intervals were used with significance p < .05 when looking atresults.PRECEPTORDr. Keith Aziz and Dr. Courtney ShermanMayo Clinic Jacksonville, FLTITLEFoot and Ankle Surgery Postoperative Complications with Regional versus GeneralAnesthesiaMARGARET VACCHIANODrexel University College of MedicineNTH DIMENSIONSABSTRACTS

C O N C L U S I O N SRegional anesthesia independently reduced the risk of minor postoperativecomplications up to 30-days following foot and ankle surgery in this study.Patients undergoing foot and ankle surgery may benefit from augmenting theiranesthetic plan with regional anesthesia. A U T H O R SMargaret Vacchiano, Keith Aziz, MD, Edward Haupt, MD A F F I L I A T I O N SDrexel University College of Medicine, West Reading, PAMayo Clinic, Jacksonville, FL1.2.Patients who received regional anesthesia were older and had morecomorbidities than those without regional anesthesia used which may be areason for the findings for major complications.R E S U L T SUsing the ACS-NSQIP database and CPT codes, there were 12,764 participants forregional anesthesia and 73,481 participants who had general anesthesia. Utilizinglogistic regression, this study found that the absence of regional anesthesia wasindependently associated with an increased risk for minor complications in footand ankle surgery (Odds Ratio (OR) 1.34, 95% Confidence Interval (CI) [1.25-1.44],p=0.00). The absence of regional anesthesia was not associated with increasedrisk of major complications in foot and ankle surgery (OR 1.04, CI [0.96-1.12],p=0.32). NTH DIMENSIONSABSTRACTS

I N T R O D U C T I O NIn the medical literature, increasing attention has been paid to health inequityand health care disparities. Clinical research is the portal through which thesources of these disparities can be understood. Concerns have been raised aboutthe appropriateness of inclusion of race and ethnicity as independent variablesin research on outcomes of medical treatments and interventions, or asimportant factors in treatment algorithms drafted by professional societies.However, understanding the interplay between race and ethnicity and the socialforces that may impact a patient’s outcome following surgical intervention iscritical to best serve a diverse patient population in an equitable fashion. Oncethe importance of inclusion of race and ethnicity has been understood, carefulattention must be paid to the way race and ethnicity are documented andanalyzed. As these topics have not received sufficient attention in the orthopedicliterature in general, and in the shoulder and elbow surgery literature inparticular, this investigation seeks to analyze the current approach to race andethnicity in the most cited published investigations of rotator cuff repair and toprovide guidance to investigators in shoulder and elbow clinical research movingforward.M E T H O D SA comprehensive database review of published investigations of rotator cuffrepair was performed. The Scopus database was utilized to search for articlesthat included the keyword “rotator cuff repair” with a date range of the last 10years (2013-2022). Inclusion criteria included the 20 most cited papers evaluatingclinical outcomes following rotator cuff repair. Investigations that were notclinical outcomes studies, including meta-analyses, systematic reviews, andbasic science studies, were excluded. Two investigators reviewed all articles andrecorded various metrics including study design, number of subjects, duration offollow-up, independent variables, dependent variables, and conclusions. Whetherrace and/or ethnicity were included in the study design in any way was alsorecorded. For those studies in which race and ethnicity were included, a detailedanalysis of the paper’s treatment of race using the JAMA Updated Guidance onReporting of Race and Ethnicity in Medical and Science Journals was performedand recorded.P R E C E P T O RDr. Paul Sethi and Dr. Marc KowalskyOrthopaedic & Neurosurgery SpecialistsT I T L ETreatment of race and ethnicity in shoulder and elbow research: An analysis ofthe most cited papers on rotator cuff repair.B Y R O N W A R DMorehouse School of MedicineNTH DIMENSIONSABSTRACTS

R E S U L T SA literature review from the “rotator cuff repair” search resulted in 4,554 articles.After the primary criteria of date range were applied, the number of articles wasreduced to 3,184. The literature review aimed to analyze the abstracts of the top20 most cited outcome studies on “rotator cuff repair.” The abstracts of the first20 studies out of the 3,184 studies were analyzed to determine if the study was anoutcome study. After 6 rounds of excluding and including studies based on studytype, we finally reached 20 outcome papers on “rotator cuff repair.” The abstractsof the 20 included studies were analyzed to examine if race was mentioned. Ifrace was mentioned, the researchers used the JAMA Updated Guidance onReporting of Race and Ethnicity in Medical and Science Journals to see if racewas mentioned properly. The studies were then analyzed to determine whetherrace was an independent or dependent variable.D I S C U S S I O NRace and ethnicity are two social constructs that lack scientific, biological, orclinical meaning. Despite this fact, race and ethnicity has been used incorrectlyin scientific and clinical literature fromthe beginning. Flanagin et. al state thatwhen race and ethnicity are reported in medical and scientific literature, theterminologies must be accurately stated and reflect fairness, equity, andconsistency (Flanagin et al., 2021). When describing race and ethnicity inscientific research, they should be described as an independent variable. Whenrace is described as a dependent variable, race is often described in isolationfrom other sociodemographic factors and other social determinants of health,including but not limited to racism disparities and inequalities. Failing to describerace correctly, leads to research lacking discussion of the implications of thefindings on the populations hampered by systematic inequalities. The mostcommonly-cited publications on rotator cuff repair do not adequately accountfor race and ethnicity. The authors believe that race and ethnicity should beincluded in outcomes research of shoulder and elbow surgery to consider socialdeterminants of clinical outcomes. Race and ethnicity should not be included inan analysis of biological determinants of outcomes and should not be included intreatment algorithms. When race and ethnicity are included in shoulder andelbow research, best practices should be followed including self-identificationand inclusion of adequate categories.A U T H O R SByron A. Ward BS Morehouse School of Medicine, Marc S. Kowalsky MD Orthopedic& Neurosurgery Specialists, Greenwich, CTNTH DIMENSIONSABSTRACTS

I N T R O D U C T I O NThe number of total knee arthroplasties (TKA) and total hip arthroplasties (THA)are expected to continue to rise with the aging population. A known complicationis periprosthetic (PFF) and interprosthetic femur fractures (IFF) due to the poorbone quality and advanced age of these patients. In stable implants, thesefractures are often treated with open reduction and internal fixation (ORIF),Intramedullary Nail (IMN) , a combination of IMN/ORIF and distal femoralreplacement (DFR) but there are limited outcome studies in the literature onthese procedures, particularly on IFF. Our aim is to investigate techniquevariations which may lead to the lowest complication rates in patients with thesefractures.M E T H O D SA retrospective review was done examining the surgical stabilization andoutcome of PFF and IFF at the Charlotte Orthopedic Hospital by NovantOrthopedic surgeons from 2018-2022. Demographic data and surgery details wereobtained. Periprosthetic fractures treated with arthroplasty revision wereexcluded. Outcomes including complications, additional procedures andmortality rates were calculated.R E S U L T SThere were 30 PFF and 5 IFF in 34 patients. The average age was 76 y/o (range50-93). Twenty-nine patients were White, 3 Black, and 1 Hispanic. There were 19distal femur PFF and 11 Vancouver C PFF[LC1] [LC2] . The average OR time was 104minutes (range 39-210). 28[LC3] /34 fractures were treated with plate fixation viaORIF, 4 with intramedullary nails (IMN) and 2 underwent distal femur replacement(DFR). Out of the 34 patients, 4 patients underwent repeat operation (1-7procedures). Three had deep infections and a nonunion, and 1 had evacuation ofhematoma[LC4] . Three underwent revision ORIF. There was a 12% mortality rate(4/34) at the latest follow up.P R E C E P T O RDr. Larry Martin and Dr. Paulvalery RouletteNovant Health Orthopaedicsand Sports Medicine InstituteT I T L EPeriprosthetic and Interprosthetic Femur Fractures: Can We Do Better?J A L E N W A R R E NOhio University Heritage Collegeof Osteopathic MedicineNTH DIMENSIONSABSTRACTS

A U T H O R SJalen L. Warren, BS, Lisa K. Cannada, MDA F F I L I A T I O N SOhio University Heritage College Of Osteopathic Medicine, Dublin, OH Novant Health, Charlotte, NC1.2.C O N C L U S I O N SOverall, we found 15% (4/27) of plate fixations require additional surgery due to acomplication. Finding the best combination of stiffness to permit healing andrecommendations on working length might be useful in future work. Our mortalityrate was 12%. This is lower than the hip fracture mortality rate and is usefulinformation for patients with these fractures when deciding their plan fortreatment. When the surgical stabilization was completed by trauma surgeons,patients had both a decreased rate of repeat operation (7% vs. 38%) and adecreased average operation time ( 102 vs. 111 min) compared to when a totaljoint surgeon completed the procedure. This warrants evaluation with largerstudies, including additional details related to the techniques of plate fixationwhich lead to decreased complication rates. Further investigation on fixationdetails and surgeon specialty training may highlight what treatment methodprovides patients the best outcomes.NTH DIMENSIONSABSTRACTS

I N T R O D U C T I O NMetastatic disease to bone is associated with a poor overall prognosis. Due toadvancements in medical and surgical treatment, cancer patients are livinglonger resulting in greater potential for metastatic disease. Femoral prophylacticstabilization in patients at risk for pathological fracture, based on higher Mirels’score, has been found to correlate with increased overall survival. However, noprior study has assessed the correlation between Mirels’ scores and post-operative survival, for all extremities, regardless of whether surgery wasperformed for impending or traumatic fracture. In this study, we identifiedpatients with osseous metastatic disease that had been surgically treated todetermine if the Mirels’ scores were predictive of the patients’ post-operativesurvival. M E T H O D STwo hundred-seventeen patients with osseous disease were identified from theMD Anderson database. Patient demographics, cancer type, total number ofosseous lesions, Mirels’ scores, surgical procedures based on CPT codes, andmortality date were recorded. Pearson correlation coefficients were obtained tocompare Mirels’ score and overall survival. A linear regression was performed todetermine the variance accounted for by the predictor (i.e., Mirels’ score).R E S U L T SOf the 217 patients identified, 96 were male and 121 were female, with a mean ageof 60.2 years (+/- 14.2) at time of surgery. Mean post-operative survival was 486days (+/- 518). One hundred sixty patients had metastatic disease. Of these, 43were breast and 42 were renal cell carcinoma. There were also 34 patients withmultiple myeloma, 16 with primary bone sarcoma, 5 with lymphoma, and 2 withleukemia. The most common procedures performed were intramedullary (IM)nailing (94, 43%), arthroplasty (59, 27%), and resection (34, 27%). Forty-six lesionswere located in the right upper extremity (RUE) with a mean Mirels’ score of 8.91(+/- 1.170), 39 in the left upper extremity (LUE) with a mean score of 8.28 (+/-1.589), 88 in the right lower extremity (RLE) with a mean score of 10.33 (+/-1.552),and 77 in the lower left extremity (LLE) with a mean score of 9.83 (+/- 1.838). ThePearson correlation coefficients comparing Mirels’ scores and post-operativesurvival for RUE, LUE, RLE, LLE were -0.159, -0.113, 0.028, and -0.185 respectively. P R E C E P T O RDr. Valerae LewisUniversity of Texas MD Anderson Cancer CenterT I T L EMirels’ Criteria Poorly Correlates with Post-Operative Survival in OrthopaedicOncology PatientsJ A R O N W I L S O NArizona College of Osteopathic MedicineMidwestern UniversityNTH DIMENSIONSABSTRACTS

C O N C L U S I O N SThe data reveals that Mirels’ scores have a poor association with post-operativesurvival, with RUE, LUE, and LLE correlation coefficients only slightly negative andRLE being slightly positive. This signifies that a higher Mirels’ score may not be anindicator of decreased post-operative survivorship.A U T H O R SJaron Wilson, MS2, Shalin S. Patel, MD, Theresa Nalty, PhD,PT, Valerae O. Lewis, MDA F F I L I A T I O N S1 Arizona College of Osteopathic Medicine - Midwestern University, Glendale, AZ 2 University of Texas MD Anderson Cancer Center, Houston, TXNTH DIMENSIONSABSTRACTS

RADIOLOGY SUMMER INTERNABSTRACTSNTH DIMENSIONS ABSTRACTS

P R E C E P T O RDr. Kevin McGillUniversity of California, San Francisco, School ofMedicine Department of RadiologyT I T L EIncidence of Incidental Intrapelvic Findings on Pelvis MR I N T R O D U C T I O NThe American College of Radiology (ACR) recognizes the identification ofincidental findings on imaging as a matter of significant importance, to theextent it has created the Incidental Findings Committee which published a seriesof consensus white papers on the topic. Incidental findings are occasionallyidentified on magnetic resonance imaging of the pelvis performed formusculoskeletal reasons; for example, suspected pelvic, hip, or sacroiliac jointpathology may also demonstrate unexpected benign or malignant intrapelvicpathology. Accurate identification of incidental findings is essential todetermining the appropriate next step in management and eliminatingunnecessary follow-up imaging. The goal of this study is to describe thefrequency and type of incidental findings and follow-up recommendations inmusculoskeletal pelvic MRI studies performed at a tertiary/quaternary carecenter. R O B E R T B R O W NM E T H O D SWe retrospectively reviewed 589 consecutive pelvic MRI studies performedbetween January 01, 2016 and December 31, 2018. Only MRIs that were standardprotocoled pelvic musculoskeletal images of adults at UCSF and read bymusculoskeletal radiologists were included. Standard UCSF pelvic MRI protocol:from superior to the iliac crest down to the lesser trochanter. Only initial pelvicMRI studies were used if the patient had multiple MRIs done. Findings wereclassified based on the organ system.R E S U L T SOf the 429 studies which met the inclusion criteria, 196 (45%) included incidentalfindings. The average age was 52 with a minimum age of 18 and a maximum ageof 99. The studies consist of 366 female patients and 232 male patients. Fiftypercent of the findings were related to the reproductive system, usually female(34%). Although most of the findings were benign, 42 MRI studies includedrecommendations for either clinical or imaging follow-up. 36 studies includedintrapelvic findings which necessitated either immediate direct communicationwith the referring provider or an electronic alert through the dictation system torecommend either clinical and/or imaging follow-up. Morehouse School of MedicineNTH DIMENSIONSABSTRACTS

C O N C L U S I O N SIncidental intrapelvic findings are common in musculoskeletal pelvic MRI studies.In this study, the prevalence of these findings is often closely related to the sexand age of the patient. Women and people of older age tended to have a higherfrequency of incidental findings. While most often benign, there were a notablenumber of findings that were concerning for early disease requiring follow-upand/or timely notification of the referring provider. These included findings suchas adnexal masses, prostate enlargement, endometriosis, etc. This study helpsmusculoskeletal radiologists identify the probability of an intrapelvic findingbeing benign or clinically significant. The results can be used to describe how toreport findings to warn providers of potentially devastating medical conditions.There is also peace of mind for the patient where certain findings are benign anddo not need to be reported.A U T H O R SRobert Brown , Kevin McGill, MD, MPH , Antonio Westphalen MD, PhD Gabby Joseph, PhDA F F I L I A T I O N SMorehouse School of Medicine, Atlanta, GAUniversity of California San Francisco, San Francisco California 1.2.NTH DIMENSIONSABSTRACTS

05TOGETHER, WE ARE MAKING A DIFFERENCE.S E C T I O NNTH DIMENSIONS PARTNERS | SPONSORS |DONORSPARTNERS

Dr. Keith Aziz**Mayo Clinic Jacksonville | Orthopaedic SurgeryDr. Rishi Balkissoon**University of Rochester School of Medicine and Dentistry | Orthopaedic SurgeryDr. Jon BarlowMayo Clinic Rochester | Orthopaedic SurgeryDr. Christopher BayneUniversity of California, Davis, School of Medicine | Orthopaedic SurgeryDr. Craig BennettLifeBridge Health Sports Medicine Institute | Orthopaedic SurgeryDr. Marcus CoeDartmouth Hitchcock Health | Orthopaedic SurgeryDr. Eileen CrawfordMichigan Health | Orthopaedic SurgeryDr. Erika GanttOrthoCarolina | Orthopaedic SurgeryDr. Robert GrayNorthShore University Health System | Orthopaedic SurgeryDr. MaCalus HoganUniversity of Pittsburgh School of Medicine | Orthopaedic SurgeryDr. Andrew JawaNew England Baptist Health | Orthopaedic SurgeryDr. Judson KarlenPhoenix Children's Hospital | Orthopaedic SurgeryDr. Chesahna KindredKindred Hair & Skin Center | DermatologyDr. Marc KowalskyOrthopaedic & Neurosurgery Specialists | Orthopaedic SurgeryDr. Cassandra LeeUniversity of California, Davis, School of Medicine | Orthopaedic Surgery ** Nth Dimensions Alumni NTH DIMENSIONS 2022 PRECEPTORS

Dr. Valerae LewisUniversity of Texas MD Anderson Cancer Center | Orthopaedic SurgeryDr. Jay LiebermanUniversity of Southern California | Orthopaedic SurgeryDr. Bryan LittleDetroit Medical Center | Orthopaedic SurgeryDr. William J. LongHospital for Special Surgery | Orthopaedic SurgeryDr. William T. LongComputer Surgery Institute | Orthopaedic SurgeryDr. Peter LopezFlorida Orthopaedic Institute | Orthopaedic SurgeryDr. Janiene LukeLoma Linda University | DermatologyDr. Larry MartinNovant Health Orthopedics and Sports Medicine Institute | Orthopaedic SurgeryDr. Kevin McGillUniversity of California, San Francisco, School of Medicine | RadiologyDr. Addisu MesfinUniversity of Rochester School of Medicine and Dentistry | Orthopaedic SurgeryDr. Hope MitchellMitchell Dermatology | DermatologyDr. Kelechi Okoroha**Mayo Clinic Rochester | Orthopaedic SurgeryDr. Holly Tyler-Paris PilsonWake Forest Baptist Health | Orthopaedic SurgeryDr. Howard PlaceSaint Louis University School of Medicine | Orthopaedic SurgeryDr. David RichardsonCampbell Clinic | Orthopaedic Surgery ** Nth Dimensions Alumni NTH DIMENSIONS 2022 PRECEPTORS

Dr. Rolando RobertoUniversity of California, Davis, School of Medicine | Orthopaedic SurgeryDr. Paulvalery RouletteNovant Health Orthopedics and Sports Medicine Institute | Orthopaedic SurgeryDr. Coleen SabatiniUniversity of California, San Francisco, Benioff Hospital | Orthopaedic SurgeryDr. Julie SamoraNationwide Children's Hospital | Orthopaedic SurgeryDr. Erick SantosSouth Central Texas Bone and Joint Center | Orthopaedic SurgeryDr. Paul SethiOrthopaedic & Neurosurgery Specialists | Orthopaedic SurgeryDr. Courtney ShermanMayo Clinic Jacksonville | Orthopaedic SurgeryDr. Meena SinghKMC Hair Center | DermatologyDr. Gary StewartResurgens Orthopaedics | Orthopaedic SurgeryDr. Laura TosiChildren's National Hospital | Orthopaedic SurgeryDr. Wakenda TylerColumbia University | Orthopaedic SurgeryDr. Rebecca VasquezUniversity of Texas Southwestern | DermatologyDr. Melissa ZimelUniversity of California, San Francisco, School of Medicine | Orthopaedic Surgery

** Nth Dimensions AlumniNTH DIMENSIONS2022 PRECEPTORS

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Rochester, MN Jacksonville, FLNTH DIMENSIONS ACADEMIC & MEDICALCENTER PARTNERS

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06NTH DIMENSIONS IS THE MOST SUCCESSFULPIPELINE PROGRAM IN THE UNITED STATESS E C T I O NNTH DIMENSIONS OUTCOMESOUTCOMES

07LIFTING AS WE CLIMBYEARREVIEWS E C T I O NINNTH DIMENSIONS YEAR IN REVIEW

Nt h Gi v es B ack , ND S I 2 0 22NTH DIMENSIONS GIVES BACKA-YEAR-IN-REVIEWThe Nth Dimensions Summer Internshipprogram is intentionally designed to be atransformative experience. Nth Scholars may begin the summer withfeelings of uncertainty and doubt. However,over eight weeks, they are presented withunique opportunities to learn and try newthings, which allow them to evolve asleaders and physician-scientists. With the support of their Nth Dimensionspreceptors, Nth Scholars can contribute inmeaningful ways to several researchprojects and initiatives. They workcollaboratively and contribute to thecommunity and culture while learning andsharing their perspectives and ideas. Throughout the Nth Dimensions SummerInternship program, Nth Scholars areencouraged to embrace the opportunitiesto make an impact, big or small. They areempowered to look for ways to innovateand continually improve. Importantly, NthScholars are reminded not to focus solelyon the outcome and enjoy the journey.By Sonya Seymour, Director of Partnerships and ProgramsThe nature of the NDSI program requiresNth Scholars to be intelligent, creative, andadaptable to changing situations. The2022 NDSI cohort demonstrated theseabilities in every interaction, researchpresentation, and summer experience. Itwas a pleasure to see them each strive toreach new heights!

T H E M O S TA M A Z I N GE X P E R I E N C E"I f I cou l d continu e with m y interns h i pfo r e v e r , I w o u l d. I g u e ss t hat goes to say;th a t I a m s u re and more co n f i d e nt thanev e r t h a t I want to go int o o r t h o paedicsu r g e r y . I a m s o gra t e f u l for t h i sop p o r t u n ity and the mentor s h i p t h a t i tco m e s w i t h . I ha v e g r o wn s o m u c h a n d a mfo r e v e r grateful, " s a y s N DSI 2022 Sc h o l a rKe n n y A g oro."Happy that Nth has chosen me for thiscohort. Looking forward to building on thetradition and helping the next wave ofstudents who decide to join the programnext year. What this program has done forme in terms of my confidence cannot bemeasured," says NDSI 2022 Scholar PeterAjayi."I am extremely grateful for the opportunityto be part of such an amazing organization.My Nth Dimensions Summer Internshipexperience was one for the books. I can’tbelieve how much I’ve learned in 8 weeks. Iknow my cohort is going to do amazingthings, and I’m excited to see what thefuture has in store for us," says NDSI 2022Scholar Jiana Wyche.NTH DIMENSIONSA-YEAR-IN-REVIEW

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NTH DIMENSIONSA-YEAR-IN-REVIEW

NTH DIMENSIONSLIFTING AS WE CLIMBMartin Luther King once said, “Life’s most persistent and urgent question is, ‘What are youdoing for others?’” Over the past 20 years, Nth Dimensions has been “doing for others” byrelentlessly pursuing its core mission to “eliminate healthcare disparities in allcommunities by diversifying the physician workforce."From its start as the vision of a single Orthopaedic Surgeon, the growth, development, andimpact of Nth Dimensions has been nothing short of miraculous. As of 2021, at least 1 ofevery 3 Black orthopaedic surgeons had participated in some capacity in Nth Dimensionsprogramming. From 2009 through 2019, 20% of all black men who finished orthopaedicresidency programs had been Nth Dimensions Scholars or Affiliates. During that sameperiod, 30% of all black women who finished orthopaedic surgery residency programshad been Nth Scholars or Affiliates.In 2019 alone, Black women who had been Nth Dimensions Scholars or Affiliates made upmore than 50% of ALL black female orthopaedic surgery residents in the United States. In 2022, the growth and impact of Nth Dimensions continued. One hundred medicalstudents, the largest number in the almost twenty-year history of Nth Dimensions werebrought to the American Academy of Orthopaedic Surgeons (AAOS) annual conferencein Chicago for intense mentoring, education, and networking designed to facilitate theirstated goal of becoming Orthopaedic Surgeons. In addition, an inaugural medicalstudent symposium was held at the American Academy of Dermatology (AAD) annualconference in Boston, the first ever of its kind since the AAD was founded in 1938.There is no question that Nth Dimensions has been a pioneer and leader in identifyingand preparing underrepresented medical students to take their rightful place incompetitive specialties they were historically barred from. The critical concepts of love(sometimes “tough” love), lifelong mentorship, connection, accountability,encouragement, and support are inextricably woven into the fabric of Nth Dimensionsand are the source of its tremendous success. Despite ongoing challenges, Nth Dimensions looks forward to another 20 years andbeyond of changing the face of medicine to reflect the patients, we serve and, by sodoing, ensuring that all barriers to equitable healthcare are eliminated.By William A. Ross, JR., MD, FAAOS , Director of Clinical Education

FOLLOW OUR SOCIAL MEDIA#NTHDIMENSIONS2022OPM Education d/b/a Nth Dimensions is a 501(c)(3) Non-profit OrganizationN t h D i m e n s i o n s22 N Morgan St, Suite 113Chicago, IL 60607T H A N K Y O U F O R L I F T I N G W I T H U S !A B O U T N T HP R O G R A M SH O W T O G I V EE V E N T S