Publications by authors named "Siddhant Mehta"

13 Publications

  • Page 1 of 1

A rare cause of acute compartment syndrome after gluteal cyst rupture.

J Community Hosp Intern Med Perspect 2021 Mar 23;11(2):266-268. Epub 2021 Mar 23.

Department of Internal Medicine and Department of Family Medicine Hackensack Meridian Health Palisades Medical CenterNorth Bergen NJ USA.

Acute Compartment Syndrome (ACS) is a serious medical condition that often results in high morbidity. ACS more commonly presents after substantial trauma in the extremities where compartment pressures can be measured. Here, we present an unusual case of a healthy man who presented with ACS of the thigh secondary to rupture of the gluteal cyst which was formed after multiple unsupervised testosterone injections. Our goal is to encourage a broad differential diagnosis while keeping limb threatening conditions and emergencies on top in patients complaining of leg pain and also to educate the patient population on safety concerns of unsupervised intramuscular injections.
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http://dx.doi.org/10.1080/20009666.2021.1877401DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8043523PMC
March 2021

Prevalence and risk factors for development of subscapularis and biceps pathology in shoulders with degenerative rotator cuff disease: a prospective cohort evaluation.

J Shoulder Elbow Surg 2020 Mar;29(3):451-458

Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, MO, USA. Electronic address:

Background: The prevalence of subscapularis and long head of biceps (LHB) in relation to the presence and severity of posterosuperior (PS) rotator cuff disease is not known.

Methods: Subjects with asymptomatic rotator cuff tears were enrolled for this prospective longitudinal study (n = 354) and followed annually with shoulder ultrasonography and clinical evaluations to assess for the presence of subscapularis, LHB, and PS rotator cuff pathology and pain development.

Results: Subscapularis pathology developed in 14% of shoulders over a median follow-up of 5 years, with partial-thickness tearing occurring most commonly (83%). Age, sex, and hand dominance were not associated with subscapularis pathology. A greater proportion of concomitant full-thickness PS cuff tears were observed in shoulders that developed subscapularis tears (76% vs. 50%, P = .002). The PS cuff tear width (10 mm vs. 14 mm, P = .01) at the time of enrollment and both tear width (10 mm vs. 15 mm, P = .003) and length (12 mm vs. 15.5 mm, P = .02) at the time of diagnosis of subscapularis pathology were greater in subscapularis-torn shoulders. LHB pathology was prevalent in 34% of shoulders, with dislocation/subluxation occurring in 63% and higher prevalence in subscapularis-torn shoulders (71% vs. 12%, P < .01). Subscapularis-torn shoulders were more likely to develop pain (67% vs. 45%, P = .004), and concomitant PS cuff tear enlargement was associated with greater risk for pain development (76% vs. 36%, P = .01).

Conclusions: The development of subscapularis and LHB pathology is significantly related to the size of the PS cuff tear. Subscapularis involvement is associated with greater risk of pain development in degenerative rotator cuff disease.
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http://dx.doi.org/10.1016/j.jse.2019.11.012DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7178076PMC
March 2020

Management of the B2 Glenoid in Glenohumeral Osteoarthritis.

Orthop Clin North Am 2019 Oct 31;50(4):509-520. Epub 2019 Jul 31.

Shoulder and Elbow Surgery, Department of Orthopaedic Surgery, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8233, Saint Louis, MO 63110, USA. Electronic address:

The Walch B2 glenoid is characterized by a biconcave glenoid deformity, acquired glenoid retroversion, and posterior humeral head subluxation. Surgical reconstruction of the B2 glenoid remains a challenge. Surgical management options include arthroscopic debridement, hemiarthroplasty, anatomic total shoulder arthroplasty with eccentric reaming, bone grafting or augmented glenoid implants, and reverse total shoulder arthroplasty. Multiple factors dictate the optimal surgical management strategy.. This article describes each of these techniques and presents the current available literature in an effort to guide evidence-based decisions in the surgical management of the B2 glenoid deformity.
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http://dx.doi.org/10.1016/j.ocl.2019.05.006DOI Listing
October 2019

Rates of neurovascular injury, compartment syndrome, and early infection in operatively treated civilian ballistic forearm fractures.

Injury 2018 Dec 6;49(12):2244-2247. Epub 2018 Oct 6.

University of Mississippi Medical Center, Department of Orthopedic Surgery and Rehabilitation, 2500 North State Street, Jackson, MS, 39216, United States. Electronic address:

Purpose: The purpose of this study is to evaluate the incidence of neurovascular injuries, compartment syndrome, early postoperative infection as well as the injury factors predictive of neurovascular injury following ballistic fractures of the radius and ulna.

Methods: A retrospective review was performed to identify all ballistic fractures of the radius and ulna in skeletally mature patients over a 5-year period at a single level-1 trauma center. Chart and radiographic review was performed to identify patient and injury demographics, associated neurologic or vascular injuries, and fracture characteristics. Fracture location was measured on computerized imaging software and fractures were grouped into bone(s) segments involved. Proximal, mid-diaphyseal, and distal locations were used for statistical analysis.

Results: Fifty-six extremities in fifty-five patients were identified (mean age 32 years; male to female ratio 9:1). Overall incidence of neurologic injury was 50%, arterial injury 32%, and compartment syndrome 7.1%. Presence of a proximal third forearm fracture was associated with an increased risk for neurologic injury (p < 0.01), with an odds ratio of 5.7 (95% confidence interval, 1.7-18.4). Furthermore, all high velocity/energy ballistic injuries had associated neurologic injuries (p = 0.02).

Conclusion: Ballistic forearm fractures result in high rates of neurovascular injury. Fractures caused by high velocity/energy firearms have extremely high rates of neurologic injury when compared with low velocity ballistic injuries. Ballistic fractures involving the proximal third of the radius or ulna are five times more likely to be associated with neurologic injury after a ballistic injury and should be assessed carefully on initial evaluation.
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http://dx.doi.org/10.1016/j.injury.2018.10.009DOI Listing
December 2018

Radiographic Evaluation of Intermetatarsal Angle Correction Following First MTP Joint Arthrodesis for Severe Hallux Valgus.

Foot Ankle Int 2016 Nov 11;37(11):1183-1186. Epub 2016 Jul 11.

Department of Orthopaedic Surgery, Worcester Medical Center, Worcester, MA, USA.

Background: Arthrodesis is a standard operative treatment for symptomatic arthritis of the first metatarsophalangeal (MTP) joint. Patients with degenerative joint disease (DJD), severe hallux valgus, and metatarsus primus varus may also require fusion of the first MTP joint. An important question in the latter group of patients is whether a proximal first metatarsal osteotomy is required, in addition to the first MTP joint fusion. Our hypothesis was that patients with severe hallux valgus and metatarsus primus varus, treated with first MTP joint arthrodesis alone, would have correction of the first-to-second intermetatarsal angle (1-2 IMA) and hallux valgus angle (HVA) to near population norms, without the addition of a proximal first metatarsal osteotomy.

Methods: Preoperative and postoperative radiographs of 19 feet, in 17 patients, with preoperative IMA greater than 15 were analyzed. Weight-bearing radiographs were divided into pre- and postoperative cohorts. Three independent reviewers measured these radiographs and mean 1-2 IMA and HVA were calculated. Mean follow-up was 10 months.

Results: The mean preoperative 1-2 IMA was 19.2 degrees (15.6-24.3). The mean preoperative HVA was 48.5 (36-56.6). The mean postoperative values for 1-2 IMA and HVA were 10.8 and 12.3 degrees, respectively. The mean change in IMA was 8.3 degrees and in the hallux valgus angle was 36.4 degrees. The differences between pre- and postoperative measurement for both angles were statistically significant (P < .001). Seven of 19 (37%) feet were corrected to an IMA of less than 9 degrees (normal), whereas in 15/19 feet the postoperative IMA was 12.3 degrees or less. The postoperative HVA was less than 15 degrees in 15/19 (79%) feet.

Conclusion: This pre- and postoperative radiographic analysis of patients with severe bunion deformity demonstrated that HVA and 1-2 IMA were acceptably corrected without the addition of a proximal first metatarsal osteotomy.

Level Of Evidence: Level III, retrospective comparative series.
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http://dx.doi.org/10.1177/1071100716656442DOI Listing
November 2016

Radiographic correction of stage III posterior tibial tendon dysfunction with a modified triple arthrodesis.

Foot Ankle Int 2013 Oct 5;34(10):1355-63. Epub 2013 Jul 5.

Department of Orthopaedic Surgery & Rehabilitation, University of Mississippi Medical Center, Jackson, MS, USA.

Background: The literature supports fusion as the surgical treatment of choice for stage III posterior tibial tendon dysfunction (PTTD). The present study reports the radiographic correction following a modified triple arthrodesis (fusions of the subtalar, talonavicular, and first tarsometatarsal joints) in patients with stage III PTTD.

Methods: An institutional review board-approved retrospective study was performed to assess the radiographic outcome of a modified triple arthrodesis in 21 patients (22 feet). Pre- and postoperative weight-bearing radiographs were reviewed in a blinded fashion by clinicians of varying levels of training. The talo-first metatarsal, talocalcaneal, and talonavicular coverage angles were measured on anteroposterior views. On lateral views, the talo-first metatarsal (Meary's), talocalcaneal, calcaneal pitch, and talar declination angles and the medial cuneiform to floor distance were measured. Statistical analysis was performed to compare pre- and postoperative measurements, assess the degree of correction, and determine interobserver reliability of the radiographic measurements.

Results: All measurements improved significantly after treatment with a modified triple arthrodesis (P ≤ .001). The medial cuneiform to floor distance (0.910), talonavicular coverage angle (0.896), and lateral talo-first metatarsal angle (0.873) were the most reproducible between observers. Postoperatively, 100% of feet were corrected to normal medial cuneiform to floor distance and talonavicular coverage angle, and 90.9% were corrected to a normal lateral talo-first metatarsal angle.

Conclusion: The modified triple arthrodesis resulted in a reliable and reproducible correction of the deformity seen in rigid stage III PTTD.

Level Of Evidence: Level IV, case series.
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http://dx.doi.org/10.1177/1071100713489285DOI Listing
October 2013

Effect of extracellular adenosine triphosphate on activity of osteoblast like cells - biomed 2013.

Biomed Sci Instrum 2013 ;49:259-66

University of Mississippi Medical Center.

Platelet dense granules contain serotonin, adenosine triphosphate (ATP), and adenosine diphosphate (ADP). These molecules are present in platelet rich plasma (PRP), and may therefore have an impact on the efficacy of PRP therapy. Additionally, nucleotides are important extracellular signaling molecules in a variety of tissue types including bone. The purpose of this investigation was to evaluate the in vitro dose-dependent effects of extracellular adenosine triphosphate (ATP) exposure on activity of human osteoblast-like cells. MG-63 cells were exposed to phosphate buffered saline (control group) or ATP solution (20 µM, 100µM, 200 µM). Osteoblast viability was evaluated at 24, 48, and 72 hours using nonspecific and osteoblast-specific markers and cellular morphology. No significant differences in total protein, malonlydialdehyde (MDA), or glutathione were observed with ATP exposure at any timepoint. High dose ATP exposure resulted in a significantly higher production of nitric oxide compared to controls and other groups. With respect to alkaline phosphatase activity and osteopontin production, no significant differences were present with ATP exposure. Overall conclusion: Extracellular ATP exposure modulated osteoblast activity with no change in cell viability in vitro.
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February 2016

Effects of local insulin delivery on subperiosteal angiogenesis and mineralized tissue formation during fracture healing.

J Orthop Res 2013 May 13;31(5):783-91. Epub 2012 Dec 13.

Department of Orthopaedics, University of Medicine and Dentistry of New Jersey-New Jersey Medical School, 90 Bergen Street, Suite 7300, Newark, NJ 07103, USA.

Local insulin delivery has been shown to improve osseous healing in diabetic animals. The purpose of this study was to quantify the effects of local intramedullary delivery of saline or Ultralente insulin (UL) on various fracture healing parameters using an in vivo non-diabetic BB Wistar rat model. Quantitation of local insulin levels showed a rapid release of insulin from the fractured femora, demonstrating complete release at 2 days. RT-PCR analysis revealed that the expression of early osteogenic markers (Col1α2, osteopontin) was significantly enhanced with UL treatment when compared with saline controls (p < 0.05). Significant differences in VEGF + cells and vascularity were evident between the treatment and control groups at day 7 (p < 0.05). At day 21, histomorphometric analysis demonstrated a significant increase in percent mineralized tissue in the UL-treated animals compared with controls (p < 0.05), particularly within the subperiosteal region of the fracture callus. Mechanical testing at 4 weeks showed significantly greater mechanical strength for UL-treated animals (p < 0.05), but healing in control animals caught up at 6 weeks post-fracture. These results suggest that the primary osteogenic effect of UL during the early stages of fracture healing (1-3 weeks) is through an increase in osteogenic gene expression, subperiosteal angiogenesis, and mineralized tissue formation.
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http://dx.doi.org/10.1002/jor.22288DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6446235PMC
May 2013

Effect of platelet dense granule contents upon osteoblast viability.

Biomed Sci Instrum 2012 ;48:288-95

University of Mississippi Medical Center.

The incorporation of platelet-rich plasma (PRP) into scaffolds for application in musculoskeletal injuries has been a topic of recent interest in orthopaedic surgery. Platelets have dense granules containing ADP, ATP, serotonin, and calcium; and alpha granules containing PDGF, VEGF, IGF, TGF-ß, and EGF. Particular focus of previous studies has been on mitogenic effects of alpha granules, but the role of dense granules in PRP therapy currently remains undefined. The objective of the present study was to evaluate the effect of ATP, ADP, and serotonin upon osteoblast viability in vitro. Human osteoblast-like cells (MG-63 cells) were exposed to phosphate buffered saline (control group), ATP (20µM), ADP (10µM), and serotonin (11.75nM) for 24, 48, and 72 hours. Osteoblast viability was evaluated at each timepoint using biochemical assays. When compared to controls, osteoblasts treated with ATP and ADP resulted in a significant reduction in cell number, while serotonin caused an increase at 24 hours. Similar trends were noted at later timepoints. At 48 hours, a trend towards increase in glutathione was observed with ADP and ATP, but was not sustained at 72 hours. No significant differences in membrane damage were detected between groups. At 24 and 48 hours, ADP significantly increased nitric oxide production. Results of this study demonstrate that ATP, ADP, and serotonin induced significant structural adaptive responses to osteoblastic activities. The data revealed minimal functional alteration as evident by biomarker measurements. Overall conclusion: the results provided further insight regarding PRP therapy for traumatized bone.
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February 2016

The effects of local vanadium treatment on angiogenesis and chondrogenesis during fracture healing.

J Orthop Res 2012 Dec 31;30(12):1971-8. Epub 2012 May 31.

Department of Orthopaedics, University of Medicine and Dentistry of New Jersey, New Jersey Medical School, 90 Bergen Street, Suite 7300, Newark, New Jersey 07103, USA.

This study quantified the effects of local intramedullary delivery of an organic vanadium salt, which may act as an insulin-mimetic on fracture healing. Using a BB Wistar rat femoral fracture model, local vanadyl acetylacetonate (VAC) was delivered to the fracture site and histomorphometry, mechanical testing, and immunohistochemistry were performed. Callus percent cartilage was 200% higher at day 7 (p < 0.05) and 88% higher at day 10 (p < 0.05) in the animals treated with 1.5 mg/kg of VAC. Callus percent mineralized tissue was 37% higher at day 14 (p < 0.05) and 31% higher at day 21 (p < 0.05) in the animals treated with 1.5 mg/kg of VAC. Maximum torque to failure was 104% and 154% higher at 4 weeks post-fracture (p < 0.05) for the healing femurs from the VAC-treated (1.5 and 3.0 mg/kg) animals. Animals treated with other VAC doses demonstrated increased mechanical parameters at 4 weeks (p < 0.05). Immunohistochemistry detected 62% more proliferating cells at days 7 (p < 0.05) and 94% more at day 10 (p < 0.05) in the animals treated with 1.5 mg/kg VAC. Results showed 100% more vascular endothelial growth factor-C (VEGF-C) positive cells and 80% more blood vessels at day 7 (p < 0.05) within the callus subperiosteal region of VAC-treated animals (1.5 mg/kg) compared to controls. The results suggest that local VAC treatment affects chondrogenesis and angiogenesis within the first 7-10 days post-fracture, which leads to enhanced mineralized tissue formation and accelerated fracture repair as early as 3-4 weeks post-fracture.
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http://dx.doi.org/10.1002/jor.22159DOI Listing
December 2012

Bone and wound healing in the diabetic patient.

Foot Ankle Clin 2010 Sep;15(3):411-37

Department of Orthopaedics, University of Medicine and Dentistry of New Jersey, Newark, 07103, USA.

Impaired soft tissue regeneration and delayed osseous healing are known complications associated with diabetes mellitus with regard to orthopedic surgery, making the management and treatment of diabetic patients undergoing foot and ankle surgery more complex and difficult. At the moment several options are available to address the known issues that complicate the clinical outcomes in these high-risk patients. Using a multifaceted approach, with close attention to intraoperative and perioperative considerations including modification of surgical technique to supplement fixation, local application of orthobiologics, tight glycemic control, administration of supplementary oxygen, and biophysical stimulation via low-intensity pulsed ultrasound and electrical bone stimulation, the impediments associated with diabetic healing can potentially be overcome, to yield improved clinical results for diabetic patients after acute or elective foot and ankle surgery.
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http://dx.doi.org/10.1016/j.fcl.2010.03.005DOI Listing
September 2010

Role of local insulin augmentation upon allograft incorporation in a rat femoral defect model.

J Orthop Res 2011 Jan;29(1):92-9

Department of Orthopaedics, University of Medicine and Dentistry of New Jersey-New Jersey Medical School, 185 South Orange Avenue, Newark, New Jersey 07103, USA.

Each year, over one million orthopedic operations are performed which a bony defect is presence, requiring the use of further augmentation in addition to bony fixation. Application of autogenous bone graft is the standard of care to promote healing of these defects, but several determents exist in using autogenous bone graft exist including limited supply and donor site morbidity. Prior work has demonstrated that local insulin application to fracture sites promote fracture healing, but no work has been performed to date in its effects upon defect healing/allograft incorporation. The goal of this study was to examine the potential role of local insulin application upon allograft incorporation. Microradiographic, histologic, and histomorphometric analysis outcome parameters showed that local insulin significantly accelerated new bone formation. Histological comparisons using predetermined scoring systems demonstrated significantly greater healing in femora treated with insulin compared to control femora (p < 0.001). Quantitatively more bone production was also observed, specifically in areas of endosteal (p = 0.010) and defect (p = 0.041) bone in femora treated with local insulin, compared to control femora, 6 weeks after implantation. This study demonstrates the potential of local insulin as an adjunct for the treatment of segmental defect and allograft incorporation.
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http://dx.doi.org/10.1002/jor.21205DOI Listing
January 2011