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Article: Creation of a Custom-Length, Humeral Antibiotic Cement Spacer for Use in Treatment of Shoulder Periprosthetic Joint Infection.

Klosterman, Emma L / Cotter, Eric J / Squire, Matthew W / Grogan, Brian F

Arthroscopy techniques

2021 Volume 10, Issue 2, Page(s) e481–e486

Abstract: Periprosthetic joint infection of the shoulder is a challenging clinical situation to manage owing to the fastidious organisms often present and delayed clinical presentation. While several treatment options have been described, the mainstay of treatment ...

Abstract	Periprosthetic joint infection of the shoulder is a challenging clinical situation to manage owing to the fastidious organisms often present and delayed clinical presentation. While several treatment options have been described, the mainstay of treatment remains a staged revision with the use of a humeral antibiotic cement spacer. Such spacers are commercially available or can be made by hand. When an extended humeral osteotomy is required to remove a well-fixed long stem humeral component, it may be advantageous to place an antibiotic spacer with a stem length approximately as long as the hardware being removed. This technique demonstrates creation of a custom length, humeral antibiotic cement spacer for use in treatment of shoulder periprosthetic joint infection.
Language	English
Publishing date	2021-01-15
Publishing country	Netherlands
Document type	Journal Article
ISSN	2212-6287
ISSN	2212-6287
DOI	10.1016/j.eats.2020.10.027
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Patient compliance and satisfaction with topical benzoyl peroxide gel prior to shoulder surgery.

Polce, Evan M / Cotter, Eric J / Polania-Gonzalez, Ernesto / Grogan, Brian F

JSES international

2022 Volume 6, Issue 4, Page(s) 686–689

Abstract: Background: Cutibacterium acnes: Methods: All patients undergoing operative intervention, either open or arthroscopic, about the shoulder from August 7, 2020, through July 15, 2021, by a single surgeon were instructed to apply BPO to the shoulder ... ...

Abstract	Background: Cutibacterium acnes Methods: All patients undergoing operative intervention, either open or arthroscopic, about the shoulder from August 7, 2020, through July 15, 2021, by a single surgeon were instructed to apply BPO to the shoulder after showering, on dry skin, in the morning and evening, starting 48 hours before their surgical date. Patients were instructed to apply a half-dollar-sized quantity for each treatment. There were a total of 5 topical applications. On the day of surgery, patients were given a 6-question survey regarding side effects experienced, BPO treatments missed, ease of treatment, and a scenario question. Demographic information was collected, and a satisfaction survey was administered upon study completion. Results: A total of 183 patients out of a possible 284 eligible patients (64.4%) completed the survey. The median (interquartile range) age at surgery was 59.9 years. Sixty-four participants (35%) in the study cohort were female. One-hundred thirteen (61.7%) had an arthroscopic surgical approach, whereas 70 (38.3%) underwent open shoulder surgery. Most patients (N = 152, 83.5%) experienced no side effects from the topical 5% BPO gel treatments. Twenty-two (12.0%) patients missed 1 treatment, 10 (5.5%) missed 2 treatments, 1 (0.5%) missed 3 treatments, 3 (1.6%) missed 4 treatments, and 4 (2.2%) missed all 5 treatments. The majority of patients, 143 (78.1%), completed all 5 treatments. When prompted to choose between serial skin preparation treatments at home leading up to surgery or a single light-based decolonization procedure in the preoperative holding area on the day of surgery, 111 (60.7%) preferred to undergo antimicrobial treatment at home and arrive for surgery as otherwise scheduled. Conclusion: Serial preoperative applications of topical 5% BPO gel are well tolerated by the majority of patients. Over 20% of patients missed at least one application of BPO. Most patients prefer home-based antimicrobial treatments compared with arriving earlier on the day of surgery for a single light-based antimicrobial treatment.
Language	English
Publishing date	2022-03-07
Publishing country	United States
Document type	Journal Article
ISSN	2666-6383
ISSN (online)	2666-6383
DOI	10.1016/j.jseint.2022.02.009
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Article ; Online: Bone quality in total shoulder arthroplasty: a prospective study correlating computed tomography Hounsfield units with thumb test and fracture risk assessment tool score.

Hayden, Alexander / Cotter, Eric J / Hennick, Terah / Hetzel, Scott / Wollaeger, John / Anderson, Scott / Grogan, Brian F

JSES international

2023 Volume 7, Issue 4, Page(s) 628–635

Abstract: Background: To evaluate if Hounsfield units (HU) measured on preoperative computed tomography (CT) scans at the anatomic neck of the proximal humerus correlates with intraoperative findings of the "thumb test" in assessment of bone quality in shoulder ... ...

Abstract	Background: To evaluate if Hounsfield units (HU) measured on preoperative computed tomography (CT) scans at the anatomic neck of the proximal humerus correlates with intraoperative findings of the "thumb test" in assessment of bone quality in shoulder arthroplasty patients. Methods: Primary anatomic total shoulder and reverse total shoulder arthroplasty patients from 2019-2022 with an available preoperative CT scan of the operative shoulder were prospectively enrolled at a single center with 3 surgeons who perform shoulder arthroplasty. The "thumb test" was performed intraoperatively; a positive test signified "good bone." Demographic information, including prior dual x-ray absorptiometry scans, was extracted from the medical record. HU at the cut surface of the proximal humerus were calculated, as was cortical bone thickness on preoperative CT. Fracture risk assessment tool (FRAX) scores were calculated for 10-year risk of osteoporotic fracture. Results: A total of 149 patients were enrolled. Mean age was 67.6 ± 8.5 years with 69 (46.3%) being males. Patients with a negative thumb test were significantly older (72.3 ± 6.6 vs. 66.5 ± 8.6 years; Conclusions: Surgeons are poor at identifying suboptimal bone quality at the anatomic neck of the proximal humerus based on intraoperative thumb test when referencing against CT HU and FRAX scores. The objective measures of CT HU and FRAX scoring may be useful metrics to incorporate into surgeons' preoperative plans for humeral stem fixation using readily available imaging and demographic data.
Language	English
Publishing date	2023-04-12
Publishing country	United States
Document type	Journal Article
ISSN	2666-6383
ISSN (online)	2666-6383
DOI	10.1016/j.jseint.2023.03.012
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Article ; Online: Factors considered in ranking orthopedic shoulder and elbow fellowship applicants: a survey of program directors.

Erickson, Jonathan G / Johnson, Kristina P / Grogan, Brian F / Cannada, Lisa K / Whiting, Paul S

JSES reviews, reports, and techniques

2021 Volume 1, Issue 2, Page(s) 151–154

Abstract: Background: Orthopedic fellowship positions continue to be increasingly competitive, with most orthopedic residency graduates pursuing fellowship after completion of residency. Shoulder and elbow fellowship training represents an increasingly ... ...

Abstract	Background: Orthopedic fellowship positions continue to be increasingly competitive, with most orthopedic residency graduates pursuing fellowship after completion of residency. Shoulder and elbow fellowship training represents an increasingly competitive and relatively smaller cohort of applicants than other subspecialties; there are only 29 programs with a total of 40 offered positions. The purpose of this survey is to identify and rank factors considered most important by shoulder and elbow fellowship directors when identifying potential fellowship candidates. Methods: A web-based survey was emailed to all 29 orthopedic shoulder and elbow fellowship directors recognized by American Shoulder and Elbow Surgeons. Demographic information was collected regarding program size, total number of applicants interviewed, and total number of applicants subsequently ranked. The survey also included a list of twelve applicant characteristics which each program director was asked to rank in a sequential order (most important to least). The median score of each factor was calculated, and a weighted score was applied to the top five (of twelve) categories selected by each program. Five points were given to the top-ranked factor. Four points were given to factors ranked 2 Results: Twenty-two of 29 (76%) orthopedic shoulder and elbow fellowship programs responded to the survey. Fourteen of 22 (64%) programs interview 20 or fewer applicants each year. No programs ranked more than 25 applicants. Twelve of 22 (55%) of program directors rated the interview as the most important factor, whereas 6 of 22 (27%) selected letters of recommendation. Based on the weighted score calculation, interviews, letters of recommendation, and personal connections to the applicant/letter writers comprised the top three categories, respectively, and captured 193 of 330 (58%) of the total available points in the weighted score. Strength of shoulder/elbow experience in residency, ties to the geographical area, and comments made regarding technical competence scored among the lowest factors. Conclusion: Orthopedic shoulder and elbow fellowship directors consistently ranked interviews, letters of recommendation, and personal connection to applicant/letter writer higher than other factors when ranking applicants. This information provides both program directors as well as applicants with important information to consider when navigating the shoulder and elbow fellowship application process.
Language	English
Publishing date	2021-01-01
Publishing country	Netherlands
Document type	Journal Article
ISSN	2666-6391
ISSN (online)	2666-6391
DOI	10.1016/j.xrrt.2020.12.001
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Article ; Online: Osteoporosis Screening Is Often Indicated but Overlooked Prior to Rotator Cuff Repair.

Cotter, Eric J / Klosterman, Emma L / Winzenried, Alec E / Greiner, Justin J / Grogan, Brian F

Arthroscopy, sports medicine, and rehabilitation

2021 Volume 3, Issue 3, Page(s) e659–e665

Abstract: Purpose: To (1) report the percentage of patients undergoing rotator cuff repair (RCR) who were appropriately screened with dual-energy X-ray absorptiometry testing prior to surgery, if indicated, and (2) determine the percentage of patients properly ... ...

Abstract	Purpose: To (1) report the percentage of patients undergoing rotator cuff repair (RCR) who were appropriately screened with dual-energy X-ray absorptiometry testing prior to surgery, if indicated, and (2) determine the percentage of patients properly prescribed osteoporosis medications within 6 months of surgery. Methods: Consecutive patients aged 50 years or older who underwent elective RCR at a single tertiary-care center over a 1-year period were reviewed. Fracture risk was estimated using the Fracture Risk Assessment Tool (FRAX) with and without bone mineral density. The U.S. National Osteoporosis Foundation (NOF) criteria for screening and treatment were applied. Patients with acute fractures or revision surgery were excluded. Results: Of the 218 patients included, 129 were women (58.1%). The mean age was 61.5 ± 7.2 years. One hundred thirty-one RCRs (60.1%) occurred within 3 months of injury. A total of 69 patients (31.7%) met the NOF criteria for bone mineral density screening. Of these patients, 23 (33.3%) were appropriately screened with a dual-energy X-ray absorptiometry scan. Primary care providers initiated bone health assessment in 18 of the 23 appropriately screened patients, with orthopaedic providers initiating the workup in 3 patients (13.0%). Thirty-two patients (14.7%) met the NOF criteria for pharmacologic management of osteoporosis. Of these patients, 5 (15.6%) were treated. Patients meeting the medication criteria were older (69.1 ± 7.7 years vs 60.2 ± 6.3 years, Conclusions: Patients aged 50 years or older undergoing RCR are often not appropriately screened for osteoporosis. Even when appropriately screened, only 15.6% of patients meeting the indications for pharmacologic intervention for bone health optimization were prescribed appropriate medications. Although bone health optimization may or may not affect surgical timing, patient encounters related to rotator cuff tears can be used as an opportunity for providers to initiate osteoporosis screening and treatment protocols. Level of evidence: Level IV, therapeutic case series.
Language	English
Publishing date	2021-03-13
Publishing country	United States
Document type	Journal Article
ISSN	2666-061X
ISSN (online)	2666-061X
DOI	10.1016/j.asmr.2021.01.002
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Article ; Online: Wit, Wisdom, and Whitewater: A Journey With the 2021 AANA Traveling Fellows.

McDonald, Lucas S / Westermann, Robert W / Economopoulos, Kostas J / Grogan, Brian F / Graves, Benjamin R / Saithna, Adnan / Angelo, Richard L

Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association

2022 Volume 38, Issue 5, Page(s) 1749–1753

MeSH term(s)	Alanine/analogs & derivatives ; Humans ; Societies, Medical ; Travel
Chemical Substances	acetylalanine 4-nitroanilide (35978-75-7) ; Alanine (OF5P57N2ZX)
Language	English
Publishing date	2022-03-12
Publishing country	United States
Document type	Journal Article
ZDB-ID	632528-2
ISSN	1526-3231 ; 0749-8063
ISSN (online)	1526-3231
ISSN	0749-8063
DOI	10.1016/j.arthro.2022.03.002
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Article ; Online: Current State of Research Gap-Years in Orthopedic Surgery Residency Applicants: Program Directors' Perspectives.

Cotter, Eric J / Polce, Evan M / Williams, Kathryn L / Spiker, Andrea M / Grogan, Brian F / Lang, Gerald J

The Iowa orthopaedic journal

2022 Volume 42, Issue 1, Page(s) 19–30

Abstract: Background: The purpose of this study was to determine how orthopedic residency program directors (PDs) evaluate residency applicants who participated in a research gap-year (RGY).: Methods: A 23 question electronically administered survey was ... ...

Abstract	Background: The purpose of this study was to determine how orthopedic residency program directors (PDs) evaluate residency applicants who participated in a research gap-year (RGY). Methods: A 23 question electronically administered survey was created and emailed to all Accreditation Council for Graduate Medical Education (ACGME) orthopedic residency PDs for the 2020-21 application cycle. PDs were emailed directly if active contact information was identifiable. If not, program coordinators were emailed. The survey contained questions regarding the background information of programs and aimed at identifying how PDs view and evaluate residency applicants who participated in a RGY. Descriptive statistics for each question were performed. Results: Eighty-four (41.8%) of 201 PDs responded. Most respondent programs (N=62, 73.8%) identified as an academic center. The most common geographic region was the Midwest, N=33 (39.3%). Few programs (N=3, 3.8%) utilize a publication "cut-off" when screening residency applicants. When asked how many peer-reviewed publications were necessary to deem a RGY as "productive," responses ranged from 0-15 publications (median interquartile range 4.5 [3-5]). Forty-one (53.3%) PDs stated they would council medical students to take a RGY with USMLE Step 1 scores being the #1 factor guiding that advice. More PDs disagree than agree (N=35, 43.6%; vs N=22, 28.2%) that applicants who complete a RGY are more competitive applicants, and 35 PDs (45.5%) agree research experiences will become more important in resident selection as USMLE Step 1 transitions to Pass/Fail. Conclusion: Program directors have varying views on residency applicants who did a RGY. While few programs use a publication cutoff, the median number of publications deemed as being a "productive" RGY was approximately 5. Many PDs agree that research experiences will become more important as USMLE Step becomes Pass/Fail. This information can be useful for students interested in pursuing a RGY and for residency programs when evaluating residency applicants.
MeSH term(s)	Education, Medical, Graduate ; Humans ; Internship and Residency ; Orthopedic Procedures/education ; Orthopedics/education ; Students, Medical
Language	English
Publishing date	2022-07-08
Publishing country	United States
Document type	Journal Article
ZDB-ID	1204065-4
ISSN	1555-1377 ; 1541-5457
ISSN (online)	1555-1377
ISSN	1541-5457
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Article ; Online: Antimicrobial effects of blue light therapy against cutibacterium acnes: optimal dosing and impact of serial treatments.

Cotter, Eric J / Cotter, Lisa M / Riley, Colleen N / Dixon, Jonah / VanDerwerker, Nicholas / Ufot, Aniekanabasi Ime / Godfrey, Jared / Gold, David / Hetzel, Scott J / Safdar, Nasia / Grogan, Brian F

JSES international

2023 Volume 8, Issue 2, Page(s) 328–334

Abstract: Background: Blue light therapy (BLT) is a Food and Drug Administration cleared modality used in dermatology as an effective treatment of acne. The primary purpose of this study is to determine if there are dose-dependent antimicrobial effects of BLT ... ...

Abstract	Background: Blue light therapy (BLT) is a Food and Drug Administration cleared modality used in dermatology as an effective treatment of acne. The primary purpose of this study is to determine if there are dose-dependent antimicrobial effects of BLT against Methods: A known strain of Results: All BLT treatment regimens resulted in significantly fewer CFUs than their aggregate control plate CFUs ( Conclusion: BLT is an effective antimicrobial agent against this single virulent strain of
Language	English
Publishing date	2023-12-18
Publishing country	United States
Document type	Journal Article
ISSN	2666-6383
ISSN (online)	2666-6383
DOI	10.1016/j.jseint.2023.11.020
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Article: Number of screws in the articular segment of distal humerus AO/OTA C-type fractures treated with open reduction internal fixation is associated with complication rate.

Grogan, Brian F / Danford, Nicholas C / Lopez, Cesar D / Maier, Stephen P / Kongmalai, Pinkawas / Kovacevic, David / Levine, William N / Jobin, Charles M

SICOT-J

2021 Volume 7, Page(s) 25

Abstract: Introduction: Surgical treatment of distal humerus fractures can lead to numerous complications. Data suggest that the number of screws in the distal (articular) segment may be associated with complication rate. The purpose of this study is to evaluate ... ...

Abstract	Introduction: Surgical treatment of distal humerus fractures can lead to numerous complications. Data suggest that the number of screws in the distal (articular) segment may be associated with complication rate. The purpose of this study is to evaluate the association between a number of screws in the distal segment and complication rate for surgical treatment of distal humerus fractures. We hypothesize that the number of screws in the articular segment of distal humerus AO/OTA C-type fractures treated with open reduction internal fixation (ORIF) will be inversely proportional to the complication rate. Methods: We performed a single-center retrospective cohort study of 27 patients who underwent ORIF of distal humerus fractures C-type with at least six months of radiographic and clinical follow-up. Clinical outcomes including a range of motion, pain, revision surgery for stiffness and/or heterotopic ossification (HO), nonunion, and persistent ulnar nerve symptoms requiring revision neurolysis were recorded. Results: In C-type fractures, the use of three or fewer articular screws was significantly associated with nonunion or loss of fixation (RR 17, p = 0.006). Nineteen of 36 (53%) patients experienced at least one complication. The surgical approach, plate configuration, age, and ulnar nerve treatment (none, in situ release, transposition) were not associated with the need for revision surgery. Men had a higher risk of requiring surgical contracture release due to improving post-operative stiffness (RR 12, p = 0.02). Conclusion: In this retrospective study, the use of three or fewer screws to fix articular fragments in AO type C fractures was a significant risk for nonunion or loss of fixation. Plate configuration and surgical approach did not correlate with outcomes. Men had higher rates of complications and required more frequent revision surgery compared to women.
Language	English
Publishing date	2021-04-01
Publishing country	France
Document type	Journal Article
ISSN	2426-8887
ISSN	2426-8887
DOI	10.1051/sicotj/2021006
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Article ; Online: Incidence of Research Gap Years in Orthopaedic Residency Applicants: The New Standard?

Cotter, Eric J / Polce, Evan M / Lee, Eric / Williams, Kathryn L / Spiker, Andrea M / Grogan, Brian F / Lang, Gerald J

Journal of the American Academy of Orthopaedic Surgeons. Global research & reviews

2021 Volume 5, Issue 11

Abstract: Introduction: The purpose of this study was to (1) determine the incidence of a research gap year (RGY) in orthopaedic residency applicants at a single institution over a seven-year span; (2) compare applicant characteristics between applicants who did ... ...

Abstract	Introduction: The purpose of this study was to (1) determine the incidence of a research gap year (RGY) in orthopaedic residency applicants at a single institution over a seven-year span; (2) compare applicant characteristics between applicants who did a RGY with those who did not, and (3) report variables associated with match success for RGY applicants. Methods: Applicants who reported taking a year out from medical school to pursue research on their Electronic Residency Application Service to a single institution from 2014 to 2015 through 2020 to 2021 were reviewed. Results: A strong positive correlation was noted between the percentage of applicants who participated in a RGY and time (Pearson correlation: r = 0.945 [95% confidence interval (CI), 0.666-0.992], P = 0.001). Over the study period, 11% of applicants had done a RGY, most commonly after their third year of medical school (82.7%). Most RGY applicants matched orthopaedics (72.8%) and 19.4% matched at the same institution they did their RGY. Conclusion: The percentage of RGY applicants to the study institution nearly doubled between 2014 to 2015 and 2020 to 2021. RGY applicants had a higher match rate than nationally published match rates. Further study is needed on a national level.
MeSH term(s)	Incidence ; Internship and Residency ; Orthopedics/education
Language	English
Publishing date	2021-11-15
Publishing country	United States
Document type	Journal Article
ZDB-ID	2898328-2
ISSN	2474-7661 ; 1067-151X
ISSN (online)	2474-7661
ISSN	1067-151X
DOI	10.5435/JAAOSGlobal-D-21-00247
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