Publications by authors named "Jason W Stoneback"

15 Publications

  • Page 1 of 1

Mineral bone disease in autosomal dominant polycystic kidney disease.

Kidney Int 2021 04 11;99(4):977-985. Epub 2020 Sep 11.

Division of Renal Diseases and Hypertension, University of Colorado Denver Anschutz Medical Campus, Aurora, Colorado, USA. Electronic address:

Mice with disruption of Pkd1 in osteoblasts demonstrate reduced bone mineral density, trabecular bone volume and cortical thickness. To date, the bone phenotype in adult patients with autosomal dominant polycystic kidney disease (ADPKD) with stage I and II chronic kidney disease has not been investigated. To examine this, we characterized biochemical markers of mineral metabolism, examined bone turnover and biology, and estimated risk of fracture in patients with ADPKD. Markers of mineral metabolism were measured in 944 patients with ADPKD and other causes of kidney disease. Histomorphometry and immunohistochemistry were compared on bone biopsies from 20 patients with ADPKD with a mean eGFR of 97 ml/min/1.73m and 17 healthy individuals. Furthermore, adults with end stage kidney disease (ESKD) initiating hemodialysis between 2002-2013 and estimated the risk of bone fracture associated with ADPKD as compared to other etiologies of kidney disease were examined. Intact fibroblast growth factor 23 was higher and total alkaline phosphatase lower in patients with compared to patients without ADPKD with chronic kidney disease. Compared to healthy individuals, patients with ADPKD demonstrated significantly lower osteoid volume/bone volume (0.61 vs. 1.21%) and bone formation rate/bone surface (0.012 vs. 0.026 μm/μm/day). ESKD due to ADPKD was not associated with a higher risk of fracture as compared to ESKD due to diabetes (age adjusted incidence rate ratio: 0.53 (95% confidence interval 0.31, 0.74) or compared to other etiologies of kidney disease. Thus, individuals with ADPKD have lower alkaline phosphatase, higher circulating intact fibroblast growth factor 23 and decreased bone formation rate. However, ADPKD is not associated with higher rates of bone fracture in ESKD.
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http://dx.doi.org/10.1016/j.kint.2020.07.041DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7993988PMC
April 2021

Defining the volume of consultations for musculoskeletal infection encountered by pediatric orthopaedic services in the United States.

PLoS One 2020 4;15(6):e0234055. Epub 2020 Jun 4.

Nationwide Children’s Hospital, Columbus, OH, United States of America,

Objective: Adequate resources are required to rapidly diagnose and treat pediatric musculoskeletal infection (MSKI). The workload MSKI consults contribute to pediatric orthopaedic services is unknown as prior epidemiologic studies are variable and negative work-ups are not included in national discharge databases. The hypothesis was tested that MSKI consults constitute a substantial volume of total consultations for pediatric orthopaedic services across the United States.

Study Design: Eighteen institutions from the Children's ORthopaedic Trauma and Infection Consortium for Evidence-based Study (CORTICES) group retrospectively reviewed a minimum of 1 year of hospital data, reporting the total number of surgeons, total consultations, and MSKI-related consultations. Consultations were classified by the location of consultation (emergency department or inpatient). Culture positivity rate and pathogens were also reported.

Results: 87,449 total orthopaedic consultations and 7,814 MSKI-related consultations performed by 229 pediatric orthopaedic surgeons were reviewed. There was an average of 13 orthopaedic surgeons per site each performing an average of 154 consultations per year. On average, 9% of consultations were MSKI related and 37% of these consults yielded positive cultures. Finally, a weak inverse monotonic relationship was noted between percent culture positivity and percent of total orthopedic consults for MSKI.

Conclusion: At large, academic pediatric tertiary care centers, pediatric orthopaedic services consult on an average of ~3,000 'rule-out' MSKI cases annually. These patients account for nearly 1 in 10 orthopaedic consultations, of which 1 in 3 are culture positive. Considering that 2 in 3 consultations were culture negative, estimating resources required for pediatric orthopaedic consult services to work up and treat children based on culture positive administrative discharge data underestimates clinical need. Finally, ascertainment bias must be considered when comparing differences in culture rates from different institution's pediatric orthopaedics services, given the variability in when orthopaedic physicians become involved in a MSKI workup.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0234055PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7272072PMC
August 2020

Plantar Flexion-Induced Entrapment of the Dorsalis Pedis Artery in a Teenaged Cross-Country Runner.

Ann Vasc Surg 2021 Jan 22;70:213-218. Epub 2020 Apr 22.

Department of Vascular Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO. Electronic address:

Background: Symptomatic peripheral artery disease of the lower extremity rarely affects young adults and, when present, typically has a nonatherosclerotic etiology. Anatomical variants have manifested as symptomatic foot ischemia in four cases in the literature. We describe the case of a 17-year-old girl presenting with foot pain upon plantar flexion due to dynamic dorsalis pedis (DP) artery entrapment by fibrous bands and the extensor hallucis brevis (EHB) tendon.

Methods: The patient was a 17-year-old girl who presented with right foot pain upon plantar flexion, which resolved upon returning to the neutral position. The potential site of compression was identified on MRI where the DP artery ran deep to the EHB tendon near the first and second tarsometatarsal joints. On diagnostic arteriogram, there was notching of the dorsalis pedis over the talus bone. The dorsalis pedis Doppler signal was obliterated upon plantar flexion. A longitudinal incision was made over the artery in the area of compression. The flexor retinaculum was incised. Abnormal fibrous bands were identified, which were lysed anterior to the artery. The EHB tendon was released and transferred distally to the extensor hallucis longus tendon.

Results: A completion angiogram showed a persistently patent dorsalis pedis artery with plantar flexion. She was discharged one day postoperatively without issues. On follow-up, the patient was ambulatory with complete resolution of her pain. Arterial duplex demonstrated normal velocities through the dorsalis pedis in all positions.

Conclusions: Symptomatic peripheral artery disease is a rare presentation in young adults and is usually due to nonatherosclerotic pathophysiology. We present a rare case of dorsalis pedis artery entrapment syndrome. Given the mechanical nature of obstruction, surgical correction was an effective treatment.
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http://dx.doi.org/10.1016/j.avsg.2020.03.045DOI Listing
January 2021

Successful Open Reduction and Internal Fixation of Proximal Humerus Fracture After Dysvascular Subcoracoid Humeral Head Dislocation: A Case Report.

JBJS Case Connect 2020 Jan-Mar;10(1):e0313

Division of Sports Medicine and Shoulder Surgery, Department of Orthopedics, University of Colorado, Aurora, Colorado.

Case: We present the case of a 36-year-old patient with a 4-part proximal humerus fracture with subcoracoid dislocation and devascularization of the humeral head after a fall onto his right shoulder.

Conclusion: The patient was successfully treated with open reduction and locking plate fixation to demonstrate that a successful postoperative functional outcome with humeral head survival can be achieved in these complex situations.
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http://dx.doi.org/10.2106/JBJS.CC.18.00313DOI Listing
January 2021

Fixing a Fragmented System: Impact of a Comprehensive Geriatric Hip Fracture Program on Long-Term Mortality.

Perm J 2019 1;23. Epub 2019 Nov 1.

Department of Orthopedic Surgery, University of Colorado School of Medicine, Aurora.

Context: Geriatric hip fractures are increasingly common and confer substantial morbidity and mortality. Fragmentation in geriatric hip fracture care remains a barrier to improved outcomes.

Objective: To evaluate the impact of a comprehensive geriatric hip fracture program on long-term mortality.

Design: We conducted a retrospective cohort study of patients aged 65 years and older admitted to our academic medical center between January 1, 2012, and March 31, 2016 with an acute fragility hip fracture. Mortality data were obtained for in-state residents from the state public health department.

Main Outcome Measures: Mortality within 1 year of index admission and overall survival based on available follow-up data.

Results: We identified 243 index admissions during the study period, including 135 before and 108 after program implementation in October 2014. The postintervention cohort trended toward a lower unadjusted 1-year mortality rate compared with the preintervention cohort (15.7% vs 24.4%, p = 0.111), as well as lower adjusted mortality at 1 year (relative risk = 0.73, 95% confidence interval = 0.46-1.16, p = 0.18), although the differences were not statistically significant. The postintervention cohort had significantly higher overall survival than did the preintervention cohort (hazard ratio for death = 0.43, 95% confidence interval = 0.25-0.74, p = 0.002).

Conclusion: Fixing fragmentation in geriatric hip fracture care such as through an orthogeriatric model is essential to improving overall survival for this patient population.
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http://dx.doi.org/10.7812/TPP/18.286DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6839739PMC
February 2020

Training Emergency Physicians in Ultrasound-guided Fascia Iliaca Compartment Blocks: Lessons in Change Management.

Cureus 2019 May 28;11(5):e4773. Epub 2019 May 28.

Emergency Medicine, Thomas Jefferson University, Philadelphia, USA.

Study objectives Older adults who sustain hip fractures are susceptible to high rates of morbidity and mortality. The systemic administration of opioids is associated with side effects disproportionately affecting the elderly. The ultrasound-guided fascia iliaca compartment block procedure (FICB) is associated with a reduced patient need for oral and parenteral opioids and with improved functional outcomes. We designed a multi-disciplinary quality improvement initiative to train emergency physicians (EPs) to perform the ultrasound-guided FICB procedure for geriatric hip fracture patients. We examined the lessons derived from the EPs' resistance to implementing a practice-changing behavior. Methods This study was a prospective observational cohort study. We included all emergency department (ED) patients > 65 years with X-ray confirmation of isolated hip fractures. We also enrolled the treating EPs. Patients were enrolled from March 2016 to January 2017 in an urban, academic ED with 100,000 annual visits. The ED ultrasound faculty trained ED faculty and residents in the FICB procedure. Seventeen of 50 attending EPs completed the training: classroom lecture and online narrated video instruction. The hands-on sessions consisted of three stations: scan a human model volunteer to review the sonoanatomy, practice the needle technique using a Blue Phantom Regional Anesthesia Ultrasound Training Block Model (Simulaids, Inc., NY, US), and practice the needle technique using a static simulator. We created a multi-disciplinary geriatric hip fracture order set for the electronic medical record. The attending EPs, caring for eligible patients, were asked to complete a Research Electronic Data Capture (REDCap) survey, and we analyzed the data using descriptive statistics. Results We enrolled 77 geriatric hip fracture patients. Two of the 77 patients received FICB. Thirty-two EPs participated as providers for these patients while 97% of these providers completed the post-intervention survey. Providers used the geriatric hip fracture order set in 10 of 77 encounters. Most EPs did not perform the block because they were not trained or did not feel comfortable performing it. Conclusion Despite the efficacy supported by the literature and training sessions offered, the EPs in this study did not adopt the FICB procedure. Future efforts could include developing a FICB on-call team, increasing the proportion of trained EPs through initial supervised hands-on practice, and partnering financial or education incentives with getting trained.
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http://dx.doi.org/10.7759/cureus.4773DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6663058PMC
May 2019

Pediatric and adolescent injury in rodeo.

Res Sports Med 2018 ;26(sup1):114-128

a Department of Orthopedic Surgery , University of Colorado School of Medicine , Aurora , USA.

High injury potential in rodeo is well recognized but the injury data for pediatric and adolescent rodeo athletes remain sparse. A systematic review of the literature published between 1990 and 2017 was conducted to assess the incidence and determinants of rodeo-related injuries in this population and to suggest injury prevention measures. Three of the 10 included studies reported event frequency and exposure data while the other seven pertained to particular injuries and/or rodeo events. Although each study documented cases of severe injuries, the limited epidemiological data indicated the majority of pediatric and adolescent athletes sustained minor injuries, such as sprains, strains, and contusions. Most injuries resulted from the impact of a fall or animal contact with the head being the most reported injury site. Owing to an unpredictable nature of this sport, injury prevention is challenging but there is evidence that helmets reduce the incidence and severity of head injuries.
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http://dx.doi.org/10.1080/15438627.2018.1439034DOI Listing
December 2018

Geriatric Hip Fracture Care: Fixing a Fragmented System.

Perm J 2017 ;21:16-104

Assistant Professor in the Department of Orthopedic Surgery at the University of Colorado Denver School of Medicine.

Context: Fragmentation in geriatric hip fracture care is a growing concern because of the aging population. Patients with hip fractures at our institution historically were admitted to multiple different services and units, leading to unnecessary variation in inpatient care. Such inconsistency contributed to delays in surgery, discharge, and functional recovery; hospital-acquired complications; failure to adhere to best practices in osteoporosis management; and poor coordination with outpatient practitioners.

Objective: To describe a stepwise approach to systems redesign for this patient population.

Design: We designed and implemented a comprehensive geriatric hip fracture program for patients aged 65 years and older at our academic Medical Center in October 2014. Key interventions included admission of all ward-status patients to the Orthopedics Service with hospitalist comanagement; geographic placement on the Orthopedics Unit; and standardized, evidence-based electronic order sets bundling geriatric best practices and a streamlined workflow for discharge planning.

Main Outcome Measures: Hospital length of stay.

Results: We identified 271 admissions among 267 patients between January 1, 2012, and March 31, 2016; of those, 154 were before and 117 were after program implementation. Mean hospital length of stay significantly improved from 6.4 to 5.5 days (p = 0.004). The 30-day all-cause readmission rate and discharge disposition remained stable. The percentage of patients receiving osteoporosis evaluation and treatment increased significantly. The rate of completed 30-day outpatient follow-up also improved.

Conclusion: Our comprehensive geriatric hip fracture program achieved and sustained gains in the quality and efficiency of care by improving fragmentation in the health care system.
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http://dx.doi.org/10.7812/TPP/16-104DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5424597PMC
March 2018

Is immediate weight bearing safe for periprosthetic distal femur fractures treated by locked plating? A feasibility study in 52 consecutive patients.

Patient Saf Surg 2016 7;10:26. Epub 2016 Dec 7.

Department of Orthopaedics, University of Colorado School of Medicine, Aurora, CO USA ; Department of Orthopaedics, Denver Health Medical Center, 777 Bannock St, Denver, CO 80204 USA.

Background: Periprosthetic distal femur fractures associated with total knee replacement are increasing in incidence. We hypothesized that a standardized management protocol would result in few implant failures and a low rate of postoperative complications.

Methods: Retrospective observational cohort study at an urban level 1 trauma center and academic level 2 trauma center. Consecutive patients with periprosthetic distal femur fractures and stable total knee arthroplasty were included between January 1, 2011 and December 31, 2014. Patients were managed by a standardized protocol of co-management by a hospitalist service, fracture fixation within 24 h of admission by less-invasive locked bridge plating, and immediate unrestricted postoperative weight bearing. The primary outcome measure was the rate of postoperative complications. Secondary outcome measures included time to surgery, intraoperative blood loss, duration of surgery, length of hospital stay, time to full weight bearing, and time to radiographic fracture healing.

Results: Fifty four fractures were treated in 52 patients. There were three implant failures, one deep infection, one nonunion and two patients with symptomatic malunion. One patient had knee pain due to patellar component instability associated with valgus alignment. There were ten thromboembolic complications despite consistent anticoagulation. Two patients died within 12 months of injury. Thirty-eight patients had returned to their pre-injury ambulation status at 1 year follow-up.

Conclusion: A standardized approach of less-invasive locked plating fixation and immediate unrestricted weight bearing appears safe and feasible in the management of this vulnerable patient cohort.

Trial Registration Number: This is a retrospective observational study without a Trial registration number.
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http://dx.doi.org/10.1186/s13037-016-0114-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5142343PMC
December 2016

Clinical and Radiographic Outcomes After Submuscular Plating (SMP) of Pediatric Femoral Shaft Fractures.

J Pediatr Orthop 2018 Mar;38(3):138-143

Department of Pediatric Orthopaedic Surgery, Musculoskeletal Research Center.

Background: To evaluate lower extremity strength and alignment among children who underwent submuscular plating (SMP).

Methods: Subjects who underwent SMP for a length unstable femoral fracture returned for isokinetic strength testing ≥2 years after surgery. Extensor and flexor strength deficits (percent difference) between the operative and nonoperative limbs were evaluated. Radiographic measurements of mechanical alignment [anatomic lateral distal femoral angle (aLDFA)] and qualitative measurements (The Pediatric Outcomes Data Collection Instrument, PODCI) were obtained from all subjects. The upper 97.5% confidence interval approach to establishing clinical equivalency was utilized to compare differences in strength and alignment between the operative and nonoperative limbs. An extensor strength deficit of >19% and an aLDFA discrepancy of >5 degrees were considered to be clinically significant.

Results: The average age at surgery of the 10 subjects included in the study was 8.7 years. The hardware was placed an average of 27.9 mm from the distal femoral physis and was removed 6.4 months postsurgery. Among all subjects, the median PODCI scores were ≥97 according to all subscales. There was no significant difference in extension torque between the operative versus nonoperative limbs at 60 degrees/s (P=0.5400), 120 degrees/s (P=0.4214), or 180 degrees/s (P=0.8166). More importantly, extension strength deficits between the operative and nonoperative limbs were not clinically significant at 60 degrees/s [upper 97.5% confidence interval (CI), 10.9%], 120 degrees/s (upper 97.5% CI, 11.0%), or 180 degrees/s (upper 97.5% CI, 10.7%). The difference in aLDFA between the operative and nonoperative limb was less than the predefined clinically significant threshold of 5 degrees for all subjects.

Conclusions: SMP achieves satisfactory clinical and functional results. In this series, extensor strength deficits and/or lower extremity malalignment were not clinically meaningful. High patient satisfaction can be expected after implant removal.

Level Of Evidence: Level IV-case series.
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http://dx.doi.org/10.1097/BPO.0000000000000780DOI Listing
March 2018

Pediatric Knee Dislocations and Physeal Fractures About the Knee.

J Am Acad Orthop Surg 2015 Sep 13;23(9):571-80. Epub 2015 Aug 13.

Given the high incidence of vascular and neurologic injury associated with pediatric knee dislocations and displaced physeal injuries about the knee, a thorough understanding of the clinical and radiographic signs associated with these injuries, relevant anatomy, workup, reduction techniques, and surgical management is crucial. A higher incidence of these injuries in children is anticipated because of increased participation in high-energy activities that result in contact or collision during sports or recreation. Complications, such as vascular and nerve injuries and compartment syndrome, can be diagnosed early in the workup to prevent catastrophic outcomes. The clinical examination should include evaluation of the motor and sensory status of the limb, palpation of pulses, and measurement of ankle brachial indices. Radiographic examination should include plain radiography and supplemental advanced imaging, if indicated. Vascular imaging or expert consultation should be considered when the pulse or ankle brachial index is abnormal on clinical examination. Selection of nonsurgical or surgical treatment depends on the fracture pattern and stability.
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http://dx.doi.org/10.5435/JAAOS-D-14-00242DOI Listing
September 2015

Incidence of elbow dislocations in the United States population.

J Bone Joint Surg Am 2012 Feb;94(3):240-5

Department of Orthopaedic Surgery, University of Colorado-Denver, 12631 East 17th Avenue, Room 4602, Aurora, CO 80045, USA.

Background: There is minimal published information regarding the epidemiology of simple elbow dislocations. The purpose of this study was to report the estimated incidence of elbow dislocations in the United States, with use of the National Electronic Injury Surveillance System (NEISS) database.

Methods: The NEISS database includes 102 hospitals representing a random sampling of all patients presenting to U.S. emergency departments. The database was queried for elbow dislocation events. NEISS data for 2002 through 2006 were used for raw data and weighted injury counts. Incidence rates with 95% confidence intervals (95% CI) were calculated by age group and sex, with use of U.S. census data.

Results: One thousand and sixty-six elbow dislocations were identified, representing a weighted estimate of 36,751 acute dislocations nationwide. A calculated incidence of 5.21 dislocations per 100,000 person-years (95% CI, 4.74 to 5.68) was noted. The highest incidence of elbow dislocations (43.5%) occurred in those who were ten to nineteen years old (6.87 per 100,000 person-years; 95% CI, 5.97 to 7.76). The incidence rate ratio for the comparison of dislocations in males with those in females was 1.02 (5.26 per 100,000 for males and 5.16 per 100,000 for females). In patients ten years or older, 474 injuries (44.5% of total dislocations) were sustained in sports. Males dislocated elbows in football, wrestling, and basketball. Females sustained elbow dislocations most frequently in gymnastics and skating activities.

Conclusions: The estimated incidence of elbow dislocations in the U.S. population is 5.21 per 100,000 person-years, with use of a national database. Adolescent males are at highest risk for dislocation. Nearly half of acute elbow dislocations occurred in sports, with males at highest risk with football, and females at risk with gymnastics and skating activities.
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http://dx.doi.org/10.2106/JBJS.J.01663DOI Listing
February 2012

Navigating the orthopaedic trauma fellowship match from a candidate's perspective.

J Orthop Trauma 2011 Dec;25 Suppl 3:S101-3

Carolinas MedicalCenter, Charlotte, NC 28232, USA.

The Orthopaedic Trauma Fellowship Match is now in its fourth year as the principal match service for prospective orthopaedic traumatology fellowship candidates. The match is facilitated by SF Match. There are now more than 50 participating programs in the United States and Canada, and the number of applicants has expanded in recent years. For many applicants, the match process can be very time consuming and expensive and there are a multitude of factors to consider. Here, we share our experiences in the trauma match and offer our best advice for success.
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http://dx.doi.org/10.1097/BOT.0b013e318237bb14DOI Listing
December 2011

Diagnosis and management of necrotizing fasciitis.

Orthopedics 2011 Mar;34(3):196

Denver Health, University of Colorado, Denver, Colorado, USA.S

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http://dx.doi.org/10.3928/01477447-20110124-20DOI Listing
March 2011

Femur shaft fracture fixation in head-injured patients: when is the right time?

J Orthop Trauma 2010 Feb;24(2):107-14

Department of Orthopaedic Surgery, Denver Health Medical Center, University of Colorado School of Medicine, Denver, CO 80204, USA.

The ideal timing and modality of femur shaft fracture fixation in head-injured patients remains a topic of debate. Several groups advocate the immediate definitive fixation of femur fractures ("early total care"), whereas others support the concept of "damage control orthopaedics" with temporary fracture fixation by means of external fixation and staged, planned conversion to internal fixation. The present review was designed to address this unresolved controversy by outlining the underlying immunopathophysiology of traumatic brain injury and providing clinical recommendations on the timing of femur shaft fracture fixation in patients with severe head injuries.
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http://dx.doi.org/10.1097/BOT.0b013e3181b6bdfcDOI Listing
February 2010
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