Gregory L Desilva

Interests

Research

Soft Tissue Coverage, Elbow and Wrist Trauma, Bone Defects and Upper Extremity, Resident Education

Teaching

Soft Tissue Coverage, Elbow and Wrist Trauma, Bone Defects and Upper Extremity, Resident Education

Courses

No activities entered.

Scholarly Contributions

Journals/Publications

• Barton, D., & DeSilva, G. (2021). An Update on Simple Elbow Dislocations: A Protocol for Early Return to Sport in High School Wrestlers. Current sports medicine reports, 20(5), 266-270.
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  The principles and management of simple elbow dislocations have evolved over time. In the past, a conservative approach of immobilization and slow rehabilitation were used. More modern treatments emphasize an understanding of the soft tissues about the elbow joint and prescribe an aggressive approach to regaining motion. Elbow stiffness is a common effect of the injury. We outline our treatment principles in a series of high school wrestlers with simple elbow dislocation. The ultimate goal is to return to sport in a safe but early timeframe. We recommend a brief period of immobilization with close follow-up and no motion restrictions after immobilization is removed. This review and case series emphasize the importance of aggressive but safe return to sport in high school wrestlers with an elbow dislocation.
• Sherman, N. C., Sorenson, J. C., Khwaja, A. M., & DeSilva, G. L. (2021). The Geographic Movement Patterns and Career and Personal Interests of Orthopaedic Surgery Residents in the United States. Journal of the American Academy of Orthopaedic Surgeons. Global research & reviews, 5(9).
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  Orthopaedic surgery continues to be a highly desired residency specialty for graduating medical students in the United States. The geographic preferences and trajectories of orthopaedic surgery applicants are not well understood.
• Khwaja, A., Du, P. Z., & DeSilva, G. L. (2020). Website evaluation for shoulder and elbow fellowships in the United States: an evaluation of accessibility and content. JSES international, 4(3), 449-452.
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  When examining the access and content related to shoulder and elbow fellowship websites, only 64% of programs had individual websites in a query performed 5 years earlier. The purpose of this study was to re-evaluate content about individual programs listed on the American Shoulder and Elbow Surgeons (ASES) website and on individual program websites and compare the results to prior data.
• Roberts, H. J., & DeSilva, G. L. (2020). Can Sural Fasciocutaneous Flaps Be Effective in Patients Older Than 65?. Clinical orthopaedics and related research, 478(4), 734-738.
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  Many studies have evaluated the reverse sural fasciocutaneous flap for coverage of wounds on the distal lower extremity, and many of these have focused on younger, healthy patients. However, to our knowledge, there has been no dedicated study focusing on older patients. We believe there is a generalized concern about performing these procedures in older patients because of microvascular changes associated with aging.
• Roberts, H., & DeSilva, G. (2020). Reply to the Letter to the Editor: Can Sural Fasciocutaneous Flaps Be Effective in Patients Older Than 65?. Clinical orthopaedics and related research, 478(7), 1701.
• Morin, M., & DeSilva, G. (2019). Lunate Dislocation in a Division 1 Football Player. Current sports medicine reports, 16(5), 312-313.
• Wasterlain, A. S., Melamed, E., Bello, R., Karia, R., Capo, J. T., & , S. o. (2017). The Effect of Price on Surgeons' Choice of Implants: A Randomized Controlled Survey. The Journal of hand surgery, 42(8), 593-601.e6.
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  Surgical costs are under scrutiny and surgeons are being held increasingly responsible for cost containment. In some instances, implants are the largest component of total procedure cost, yet previous studies reveal that surgeons' knowledge of implant prices is poor. Our study aims to (1) understand drivers behind implant selection and (2) assess whether educating surgeons about implant costs affects implant selection.
• Becker, S. J., Bruinsma, W. E., Guitton, T. G., van der Horst, C. M., Strackee, S. D., Ring, D., & , S. o. (2016). Interobserver Agreement of the Eaton-Glickel Classification for Trapeziometacarpal and Scaphotrapezial Arthrosis. The Journal of hand surgery, 41(4), 532-540.e1.
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  To determine whether simplification of the Eaton-Glickel (E-G) classification of trapeziometacarpal (TMC) joint arthrosis (eliminating evaluation of the scaphotrapezial [ST] joint) and information about the patient's symptoms and examination influence interobserver reliability. We also tested the null hypotheses that no patient and/or surgeon factors affect radiographic rating of TMC joint arthrosis and that no surgeon factors affect the radiographic rating of ST joint arthrosis.
• Claessen, F. M., Stoop, N., Doornberg, J. N., Guitton, T. G., van den Bekerom, M. P., Ring, D., & , S. o. (2016). Interpretation of Post-operative Distal Humerus Radiographs After Internal Fixation: Prediction of Later Loss of Fixation. The Journal of hand surgery, 41(10), e337-e341.
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  Stable fixation of distal humerus fracture fragments is necessary for adequate healing and maintenance of reduction. The purpose of this study was to measure the reliability and accuracy of interpretation of postoperative radiographs to predict which implants will loosen or break after operative treatment of bicolumnar distal humerus fractures. We also addressed agreement among surgeons regarding which fracture fixation will loosen or break and the influence of years in independent practice, location of practice, and so forth.
• Janssen, S. J., Molleman, J., Guitton, T. G., Ring, D., & , S. O. (2016). Erratum to: What Middle Phalanx Base Fracture Characteristics are Most Reliable and Useful for Surgical Decision-making?. Clinical orthopaedics and related research, 474(4), 1080-1.
• Dezfuli, B., Edwards, C. J., & DeSilva, G. L. (2015). Distal Radius Fracture Hematoma Block with Combined Lidocaine and Bupivacaine can induce Seizures while within Therapeutic Window: A Case Report. Journal of orthopaedic case reports, 2(4), 10-3.
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  Hematoma blocks are effective pain management modalities for closed reduction of distal radius fractures. Complications of hematoma blocks are associated with systemic reaction to anesthetic used.
• Hageman, M. G., Jayakumar, P., King, J. D., Guitton, T. G., Doornberg, J. N., Ring, D., & , S. o. (2015). The factors influencing the decision making of operative treatment for proximal humeral fractures. Journal of shoulder and elbow surgery, 24(1), e21-6.
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  The factors influencing the decision making of operative treatment for fractures of the proximal humerus are debated. We hypothesized that there is no difference in treatment recommendations between surgeons shown radiographs alone and those shown radiographs and patient information. Secondarily, we addressed (1) factors associated with a recommendation for operative treatment, (2) factors associated with recommendation for arthroplasty, (3) concordance with the recommendations of the treating surgeons, and (4) factors affecting the inter-rater reliability of treatment recommendations.
• Heap, J. C., Dezfuli, B., Bennett, D. M., Chapman, E., & DeSilva, G. L. (2015). The internet as a source of information for De Quervain's tendinitis. Hand (New York, N.Y.), 10(1), 131-6.
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  Many individuals are turning to the Internet for information about various health conditions, and in our study we evaluated the quality and readability of information on the internet about De Quervain's tendinitis.
• Janssen, S. J., Teunis, T., Guitton, T. G., Ring, D., & , S. o. (2015). Do Surgeons Treat Their Patients Like They Would Treat Themselves?. Clinical orthopaedics and related research, 473(11), 3564-72.
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  There is substantial unexplained geographical and surgeon-to-surgeon variation in rates of surgery. One would expect surgeons to treat patients and themselves similarly based on best evidence and accounting for patient preferences.
• Jones, R., Hughes, T., Lawson, K., & DeSilva, G. (2015). Citation analysis of the 100 most common articles regarding distal radius fractures. Journal of clinical orthopaedics and trauma, 8(1), 73-75.
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  Bibliometric studies are increasingly being utilized as a tool for gauging the impact of different literature within a given field. The purpose of this study was to identify the most cited articles related to the management of distal radius fractures to better understand how the evidence of this topic has been shaped and changed over time.
• Melville, D. M., Taljanovic, M. S., Scalcione, L. R., Eble, J. M., Gimber, L. H., DeSilva, G. L., & Sheppard, J. E. (2015). Imaging and management of thumb carpometacarpal joint osteoarthritis. Skeletal radiology, 44(2), 165-77.
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  Primary osteoarthritis (OA) involving the thumb carpometacarpal (CMC) joint is a common and frequently debilitating disease. Clinical examination and radiographs are usually sufficient for diagnosis; however, familiarity with the cross-sectional anatomy is useful for diagnosis of this condition. The most widely used classification system for the radiographic staging of thumb carpometacarpal joint OA was first presented by Eaton and Littler, ranging from mild (stages I and II) to severe (stage IV) disease. If conservative treatment fails, surgical treatment is considered. A variety of surgical techniques have been developed and implemented for the management of this pervasive and disabling condition. The purpose of this article is to review the anatomy of the basal joints of the thumb, pathophysiology, preoperative imaging, and various surgical techniques that are utilized in the treatment of OA of the basal joints of the thumb with emphasis on normal postoperative radiographic findings and possible postoperative complications.
• Schannen, A. P., Truchan, L., Goshima, K., Bentley, R., & DeSilva, G. L. (2015). Sural Versus Perforator Flaps for Distal Medial Leg Wounds. Orthopedics, 38(12), e1059-64.
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  Soft tissue coverage of distal medial ankle wounds is a challenging problem in orthopedic surgery because of the limited local tissues and prominent instrumentation. Traditionally, these wounds required free tissue transfer to achieve suitable coverage and subsequent bony union. To better respect the reconstructive ladder and to avoid the inherent difficulty of free flap coverage, rotational flaps have been used to cover these wounds. Both sural fasciocutaneous flaps and rotational fasciocutaneous perforator (propeller) flaps have been described for distal medial soft tissue coverage. The authors performed a retrospective chart review of patients who underwent distal medial leg coverage with the use of either sural flaps or rotational fasciocutaneous perforator flaps. The authors identified 14 patients by Current Procedural Terminology code who met the study criteria. The average age and degree of medical comorbidities were comparable in the 2 groups. The authors reviewed their medical records to evaluate fracture healing, flap size, complications, and return to normal shoe wear. All 7 sural flaps healed without incident, with underlying fracture healing. Of the 7 perforator flaps, 6 healed without incident, with underlying fracture healing. One perforator-based flap was complicated by superficial tip necrosis and went on to heal with local wound care. All patients returned to normal shoe wear. Both sural artery rotational flaps and posterior tibial artery-based rotational flaps are viable options for coverage of the distal medial leg. Coverage can be achieved reliably without microsurgery, anticoagulation, or monitoring in the intensive care unit.
• Bruinsma, W. E., Guitton, T., Ring, D., & , S. o. (2014). Radiographic loss of contact between radial head fracture fragments is moderately reliable. Clinical orthopaedics and related research, 472(7), 2113-9.
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  Loss of contact between radial head fracture fragments is strongly associated with other elbow or forearm injuries. If this finding has adequate interobserver reliability, it could help examiners identify and treat associated ligament injuries and fractures (eg, forearm interosseous ligament injury or elbow dislocation).
• Döring, A. C., Hageman, M. G., Mulder, F. J., Guitton, T. G., Ring, D., , S. o., & , S. o. (2014). Trigger finger: assessment of surgeon and patient preferences and priorities for decision making. The Journal of hand surgery, 39(11), 2208-13.e2.
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  To test the null hypothesis that there are no differences in the priorities and preferences of patients with idiopathic trigger finger (TF) and hand surgeons.
• Hageman, M. G., Kinaci, A., Ju, K., Guitton, T. G., Mudgal, C. S., Ring, D., & , S. o. (2014). Carpal tunnel syndrome: assessment of surgeon and patient preferences and priorities for decision-making. The Journal of hand surgery, 39(9), 1799-1804.e1.
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  This study tested the null hypothesis that there are no differences between the preferences of hand surgeons and those patients with carpal tunnel syndrome (CTS) facing decisions about management of CTS (ie, the preferred content of a decision aid).
• Mellema, J. J., Doornberg, J. N., Guitton, T. G., Ring, D., & , S. o. (2014). Biomechanical studies: science (f)or common sense?. Injury, 45(12), 2035-9.
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  It is our impression that many biomechanical studies invest substantial resources studying the obvious: that more and larger metal is stronger. The purpose of this study is to evaluate if a subset of biomechanical studies comparing fixation constructs just document common sense.
• Neuhaus, V., Bot, A. G., Guitton, T. G., Ring, D. C., , S. o., Abdel-Ghany, M. I., Abrams, J., Abzug, J. M., Adolfsson, L. E., Balfour, G. W., Bamberger, H. B., Barquet, A., Baskies, M., Batson, W. A., Baxamusa, T., Bayne, G. J., Begue, T., Behrman, M., Beingessner, D., , Biert, J., et al. (2014). Scapula fractures: interobserver reliability of classification and treatment. Journal of orthopaedic trauma, 28(3), 124-9.
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  There is substantial variation in the classification and management of scapula fractures. The first purpose of this study was to analyze the interobserver reliability of the OTA/AO classification and the New International Classification for Scapula Fractures. The second purpose was to assess the proportion of agreement among orthopaedic surgeons on operative or nonoperative treatment.
• Schannen, A. P., Goshima, K., Latt, L. D., & Desilva, G. L. (2014). Simultaneous soft tissue coverage of both medial and lateral ankle wounds: Sural and rotational flap coverage after revision fixation in an infected diabetic ankle fracture. Journal of orthopaedics, 11(1), 19-22.
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  To describe a case of simultaneous medial and lateral soft tissue coverage for exposed orthopaedic implants in the setting of revision fixation of a non-united ankle fracture. This was achieved using a sural flap as well as a propeller flap.
• Tosti, R., Ilyas, A. M., Mellema, J. J., Guitton, T. G., Ring, D., & , S. o. (2014). Interobserver variability in the treatment of little finger metacarpal neck fractures. The Journal of hand surgery, 39(9), 1722-7.
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  To address the null hypothesis that surgeons shown radiographs of little finger metacarpal neck fractures with measured fracture angulation would recommend surgery as often as surgeons shown unmarked radiographs.
• Agel, J., Evans, A. R., Marsh, J. L., Decoster, T. A., Lundy, D. W., Kellam, J. F., Jones, C. B., & Desilva, G. L. (2013). The OTA open fracture classification: a study of reliability and agreement. Journal of orthopaedic trauma, 27(7), 379-84; discussion 384-5.
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  To determine the reliability of the Orthopaedic Trauma Association (OTA) Open Fracture Classification.
• Gradl, G., Neuhaus, V., Fuchsberger, T., Guitton, T. G., Prommersberger, K. J., Ring, D., & , S. o. (2013). Radiographic diagnosis of scapholunate dissociation among intra-articular fractures of the distal radius: interobserver reliability. The Journal of hand surgery, 38(9), 1685-90.
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  To evaluate the reliability and accuracy of diagnosis of scapholunate dissociation (SLD) among AO type C (compression articular) fractures of the distal radius.
• Hageman, M. G., Becker, S. J., Bot, A. G., Guitton, T., Ring, D., & , S. o. (2013). Variation in recommendation for surgical treatment for compressive neuropathy. The Journal of hand surgery, 38(5), 856-62.
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  It is our impression that there is substantial, unexplained variation in hand surgeon recommendations for treatment of peripheral mononeuropathy. We tested the null hypothesis that specific patient and provider factors do not influence recommendations for surgery.
• Hageman, M. G., Guitton, T. G., Ring, D., & , S. o. (2013). How surgeons make decisions when the evidence is inconclusive. The Journal of hand surgery, 38(6), 1202-8.
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  To address the factors that surgeons use to decide between 2 options for treatment when the evidence is inconclusive.
• Taljanovic, M. S., Karantanas, A., Griffith, J. F., DeSilva, G. L., Rieke, J. D., & Sheppard, J. E. (2012). Imaging and treatment of scaphoid fractures and their complications. Seminars in musculoskeletal radiology, 16(2), 159-73.
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  The scaphoid is the most commonly fractured carpal bone, with frequent complications that are predisposed by its anatomical location, anatomical configuration (shape and length), and vascular supply. The most common mechanism of injury is a fall onto an outstretched hand. Imaging plays a significant role in the initial evaluation and treatment of scaphoid fractures and their complications. Radiography should be the first imaging modality in the initial evaluation and follow-up of scaphoid fractures. Computed tomography with its superb spatial resolution enables better visualization and characterization of the fracture line, and the amount of displacement and angulation of the fracture fragments. Using the metal reduction artifact with computed tomography allows good follow-up of scaphoid fractures despite surgical hardware. Magnetic resonance imaging without contrast is the imaging modality of choice for depiction of radiographically occult scaphoid fracture, bone contusion, and associated soft tissue injury; contrast-enhanced imaging aids assessment of scaphoid fracture nonunion, osteonecrosis, fracture healing after bone grafting, and revitalization of the necrotic bone after bone grafting. Proper identification and classification of scaphoid fracture and its complications is necessary for appropriate treatment. This article describes the normal anatomy, mechanism of injury, and classification of stable and unstable fractures, together with the imaging and treatment algorithm of scaphoid fractures and their complications with an emphasis on magnetic resonance imaging.
• DeSilva, G. L., Fritzler, A., & DeSilva, S. P. (2007). Antibiotic-impregnated cement spacer for bone defects of the forearm and hand. Techniques in hand & upper extremity surgery, 11(2), 163-7.
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  Management of bone loss, particularly in the face of open or contaminated wounds, presents a reconstructive challenge. Polymethylmethacrylate impregnated with antibiotics has been used successfully in the treatment of infected total joint arthroplasty and open fractures. The cement delivers high-dose local concentrations of antibiotics while filling a space. This article presents our use of an antibiotic-impregnated cement spacer for bone loss in the forearm or hand in the face of open or infected wounds. The cement spacer fills a potential space, prevents the involution of the surrounding soft tissue, and delivers appropriate antibiotics. When the spacer is removed, the remaining sheath serves to hold and contain the cancellous bone graft.
• Grutter, P. W., Desilva, G. L., Meehan, R. E., & Desilva, S. P. (2004). The accuracy of distal posterior interosseous and anterior interosseous nerve injection. The Journal of hand surgery, 29(5), 865-70.
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  To standardize a technique of delivering a local anesthetic to the posterior interosseous nerve (PIN) and anterior interosseous nerve (AIN) by using the anatomic landmarks of the wrist and to evaluate the accuracy of the technique in a cadaver model.
• Jebson, P. J., DeSilva, G. L., Kuzon, W. M., Goulet, J. A., & Hak, D. J. (1998). The box frame fixator: a technique for simultaneous fracture and free-tissue transfer management. Plastic and reconstructive surgery, 102(1), 262-3.
• Goulet, J. A., Senunas, L. E., DeSilva, G. L., & Greenfield, M. L. (1997). Autogenous iliac crest bone graft. Complications and functional assessment. Clinical orthopaedics and related research, 76-81.
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  Functional outcomes and complications experienced by adult patients who underwent iliac crest bone grafting were evaluated to assess the effect of bone grafts on patient function. In addition to retrospective chart reviews, patients completed the Sickness Impact Profile and a detailed questionnaire on pain. One hundred ninety-two patients met study inclusion criteria. Major complications were recorded in four (2.4%) patients in whom infections developed requiring readmission. Thirty-seven (21.8%) patients had minor complications. One hundred nineteen of 170 patients were available for followup; of these 119 patients, 87 (73.1%) returned completed questionnaires. Thirty-three of 87 (37.9%) patients reported pain 6 months postoperatively. The incidence of pain decreased with time, with 16 of 87 (18.7%) patients continuing to report pain more than 2 years postoperatively. Proportionately more spine patients reported pain at all time points. The mean Sickness Impact Profile score for patients completing questionnaires was nine, suggesting most patients were functioning well 2 years postoperatively. The morbidity of iliac crest grafting remains substantial. Pain symptoms in this study sample seemed to last longer in more patients than earlier series have indicated. Minimizing muscle dissection around donor sites and the advent of bone graft substitutes may help alleviate these problems.

Presentations

• Taljanovic, M., Taljanovic, M., Desilva, G. L., Desilva, G. L., Chadaz, T., Chadaz, T., Sheppard, J. E., Sheppard, J. E., Becker, G. W., Becker, G. W., Turker, T., Turker, T., Krupinski, E., Krupinski, E., Gimber, L. H., & Gimber, L. H. (2018, March). Diffusion Tensor Imaging of the median nerve with ultrasound correlation in patients with carpal tunnel syndrome before and after flexor retinacular release. Society of Skeletal Radiology Annual Meeting. Austin, Texas: SSR.

Poster Presentations

• Taljanovic, M., Taljanovic, M., Desilva, G. L., Desilva, G. L., Chadaz, T., Chadaz, T., Sheppard, J. E., Sheppard, J. E., Becker, G. W., Becker, G. W., Turker, T., Turker, T., Krupinski, E. A., Krupinski, E. A., Gimber, L. H., Gimber, L. H., Taljanovic, M., Desilva, G. L., Chadaz, T., , Sheppard, J. E., et al. (2018, March). Diffusion Tensor Imaging of the Median Nerve with Ultrasound Correlation in Patients with Carpal Tunnel Syndrome Before and After Flexor Retinacular Release. 41st Annual Meeting of the Society of Skeletal Radiology (SSR). Austin, TX.
• Gimber, L. H., Gimber, L. H., Krupinski, E. A., Krupinski, E. A., Turker, T., Turker, T., Becker, G. W., Becker, G. W., Sheppard, J. E., Sheppard, J. E., Chadaz, T., Chadaz, T., Desilva, G. L., Desilva, G. L., Taljanovic, M., & Taljanovic, M. (2017, November). Diffusion Tensor Imaging of the Median Nerve with Ultrasound Correlation in Patients with Carpal Tunnel Syndrome Before and After Flexor Retinacular Release. Radiological Society of North America (RSNA). Chicago.