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Saturday, December 31, 2011

Secrets of the Operating Room

Fragile egos, obese patients and talking organs: A surgeon's view of what happens under the scalpel. Wall Street Journal

Friday, December 30, 2011

New Ortho Related Kindle Books via Amazon

Best Evidence for Spine Surgery: 20 Cardinal Cases E-Book: 20 Cardinal Cases E-Book by Rahul Jandial and Steven R. Garfin (Feb 1, 2012)Kindle eBook

Presentation, Imaging and Treatment of Common Musculoskeletal Conditions E-Book: MRI-Arthroscopy Correlation by Timothy G. Sanders and Mark D. Miller (Dec 15, 2011)Kindle eBook

Shoulder Instability: A Comprehensive Approach E-Book: A Comprehensive Approach E-Book by Matthew T Provencher and Anthony A Romeo (Dec 15, 2011)Kindle eBook

Operative Techniques in Orthopaedic Surgery by Sam W. Wiesel (Dec 14, 2011)Kindle eBook

Orthopedic Imaging: A Practical Approach by Adam Greenspan (Dec 7, 2011)Kindle eBook

Master Techniques in Orthopaedic Surgery: Orthopaedic Oncology and Complex Reconstruction by Franklin H. Sim, Peter F.M. Choong and Kristy L. Weber (Dec 7, 2011)Kindle eBook

JSCM publishes revised International Standards for Neurological Classification of Spinal Cord Injury

The 2011 revision of the International Standards for the Neurological Classification of Spinal Cord Injury (ISNCSCI) was published in the November 2011 issue of the Journal of Spinal Cord Medicine. The accompanying reference article by Steven Kirshblum et al clarifies the modifications to this newest revision. Both are available for free download via (#6, Nov 2011). Eurekalert!

Thursday, December 29, 2011

Despite enthusiasm from healthcare providers, hospitals are slow to adopt tablet systems

Its no secret that healthcare providers are adopting tablets at a rapid pace – one survey found that over 25% of physicians own a tablet and that was nearly nine months ago.

This trend, both with tablets and smartphones, has generally been bottom-up; physicians, PA’s, NP’s, nurses, and other healthcare providers are buying consumer devices and bringing them into the clinical world.
However, as Eric Yablonka, CIO of University of Chicago Hospitals put it, “This is not ‘nice to have stuff’ anymore, this is life saving stuff now.” iMedicalApps

The Year in Review: BMP-2 Saga Prompts Change

As part of the Year in Review series, MedPage Today reporters are revisiting major news stories and following up with an analysis of the impact of the original report, as well as subsequent news generated by the initial publication. Here's what has happened with the bone morphogenetic protein-2 saga (BMP-2) since last May when we published an article about a critical review of the product.  MedPage Today

Coursemart Neuroanatomy iPad e-book has some good features, but lacks in important areas


  • $47.95 for 540 days (rental)


  • Large number of medical titles
  • Can be viewed on multiple devices
  • Offline and online reading
  • Annotation and search functions


  • Poor image and text quality
  • Cannot ‘turn off’ labels on figures
  • No jump links in the text to figures or other parts of the book
  • No integrated media (videos) into the text
  • Book is rented, not owned
  • Not much different from reading a PDF iMedicalApps

Open source licensing defuses copyright law's threat to medicine

Enforcing copyright law could potentially interfere with patient care, stifle innovation and discourage research, but using open source licensing instead can prevent the problem, according to a physician – who practices both at the University of California, San Francisco and the San Francisco VA Medical Center – and a legal scholar at the UC Hastings College of Law.

“For a long time, doctors have been able to ignore copyright, but that is changing in a dramatic way,” said John Newman, MD, PhD, of UCSF and SFVAMC.

“The exercise of copyright is creating a threat to basic medical care,” said Robin Feldman, JD, professor of law and Director of the Law and Bioscience Project at UC Hastings.

They discuss the issue in a “Perspective” in the Dec. 29 issue of the New England Journal of Medicine. MedicalXpress

Wednesday, December 28, 2011

Wartime spine injuries: understanding the improvised explosive device and biophysics of blast trauma.

The improvised explosive device (IED) has been the most significant threat by terrorists worldwide. Blast trauma has produced a wide pattern of combat spinal column injuries not commonly experienced in the civilian community. Unfortunately, explosion-related injuries have also become a widespread reality of civilian life throughout the world, and civilian medical providers who are involved in emergency trauma care must be prepared to manage casualties from terrorist attacks using high-energy explosive devices. Treatment decisions for complex spine injuries after blast trauma require special planning, taking into consideration many different factors and the complicated multiple organ system injuries not normally experienced at most civilian trauma centers. Therefore, an understanding about the effects of blast trauma by spine surgeons in the community has become imperative, as the battlefield has been brought closer to home in many countries through domestic terrorism and mass casualty situations, with the lines blurred between military and civilian trauma. We set out to provide the spine surgeon with a brief overview on the use of IEDs for terrorism and the current conflicts in Iraq and Afghanistan and also a perspective on the biophysics of blast trauma.
Kang DG, Lehman RA Jr, Carragee EJ. Spine J. 2011 Dec 22. [Epub ahead of print] PMID: 22197184

"How did this ever get published?"

Meals RA. J Hand Surg Am. 2012 Jan;37(1):1-2. No abstract available.  PMID: 22196289 PDF

The High Cost of Failing Artificial Hips

The most widespread medical implant failure in decades — involving thousands of all-metal artificial hips that need to be replaced prematurely — has entered the money phase.

Medical and legal experts estimate the hip failures may cost taxpayers, insurers, employers and others billions of dollars in coming years, contributing to the soaring cost of health care. The financial fallout is expected to be unusually large and complex because the episode involves a class of products, not a single device or just one company. NYTimes

Shoulderdoc App Fluidly Conveys A Heavy Dose of Shoulder Information

The Shoulderdoc app is the accompanying app to Shoulderdoc. This website is every shoulder surgeon’s guilty pleasure. It contains more information on shoulder surgery and treatments than one can find in one place on the web.

Shoulderdoc is the brainchild of Dr. Leonard Funk, a specialist shoulder surgeon in the UK. Dr. Funk has spent the last decade feeding his main website with a plethora of useful shoulder related content. I like the concept of having a “go to” shoulder site where I can quickly find all of the latest feeds of articles, patient education topics and latest trends. I’ve always found the site to be updated frequently, the content to be good and referenced well. I do have a few hang-ups about the site, though. iMedicalApps

NSF gives $1.2 million grant for diabetes app that uses smartphone camera to prevent limb amputations

Researchers at Worcester Polytechnic Institute (WPI) in Massachusetts recently received a $1.2 million grant from the National Science Foundation to develop a smartphone diabetes app.  This app will guide patients with diabetes as well as foot ulcers on how to manage their disease. iMedicalapps

Sepsis Guide is a well-designed and up-to-date app for critical care practitioners

Sepsis is the bread and butter of any critical care physician, hospitalist, and emergency room physician. In sepsis management, early diagnosis and aggressive intervention are critical. Guidelines like the Rivers protocol highlight the use of fluid rehydration, early antibiotics, and above all else recognition of sepsis at the earliest possible point. iMedicalApps

Tuesday, December 27, 2011

International Orthopaedics [Epub ahead of print]

1. Steps in the undertaking of a systematic review in orthopaedic surgery. Sambunjak D, Franić M. Int Orthop. 2011 Dec 24. [Epub ahead of print] PMID: 22198362
2. Infection and revision strategies in total disc arthroplasty. Gerometta A, Rodriguez Olaverri JC, Bittan F. Int Orthop. 2011 Dec 24. [Epub ahead of print] PMID: 22198361
3. The relevance of the anatomical basis of fracture for the subsequent treatment of the anterior humeral circumflex artery and the axillary nerve. Chen YF, Zhu NF, Zhang CQ, Wang L, Wei HF, Lu Y. Int Orthop. 2011 Dec 24. [Epub ahead of print] PMID: 22198360

Carpal tunnel syndrome diagnosed by general practitioners: an observational study.

In these 187 patients, EDX confirmed CTS clinical diagnosis in 180. In 40 (17%), the neurologists disagreed with the clinical diagnosis of CTS because signs and symptoms were not those of clinical CTS. We showed that general practitioners are very well capable of making a clinical diagnosis of CTS. Therefore, direct referral of patients by general practitioners for nerve conduction studies to have their diagnosis of CTS confirmed is a desirable and time-saving procedure. Claes F, Bernsen H, Meulstee J, Verhagen WI. Neurol Sci. 2011 Dec 24. [Epub ahead of print] PMID: 22198648

Position Change of the Neurovascular Structures around the Carpal Tunnel with Dynamic Wrist Motion.

It is appropriate to transect the ligament greater than 4 mm apart from the lateral margin of the hook of the hamate without placing the edge of the scalpel toward the ulnar side. We would also recommend not transecting the transverse carpal ligament in the ulnar flexed wrist position to protect the ulnar neurovascular structure. Kwon JY, Kim JY, Hong JT, Sung JH, Son BC, Lee SW. J Korean Neurosurg Soc. 2011 Oct;50(4):377-80. Epub 2011 Oct 31. PMID: 22200022

Monday, December 26, 2011

Indications for bullet removal: overview of the literature, and clinical practice guidelines for European trauma surgeons

In summary, there are only a few clear indications for bullet removal. These include bullets found in joints, CSF, or the globe of the eye. Fragments leading to impingement on a nerve or a nerve root, and bullets lying within the lumen of a vessel, resulting in a risk of ischemia or embolization, should be removed. Rare indications are lead poisoning caused by a fragment, and removal that is required for a medico-legal examination. In all other cases the indication should be critically reviewed.  T. Dienstknecht, K. Horst, R. M. Sellei, A. Berner, M. Nerlich and T. C. Hardcastle. European Journal of Trauma and Emergency Surgery. Online First Dec 2011

Journal of Orthopaedic Trauma: epub ahead of print

Saturday, December 24, 2011

Extended healing validation of an artificial tendon to connect the quadriceps muscle to the Tibia: 180-day study

Whenever a tendon or its bone insertion is disrupted or removed, existing surgical techniques provide a temporary connection or scaffolding to promote healing, but the interface of living to non-living materials soon breaks down under the stress of these applications, if it must bear the load more than acutely. Patients are thus disabled whose prostheses, defect size, or mere anatomy limit the availability or outcomes of such treatments. Our group developed the OrthoCoupler™ device to join skeletal muscle to prosthetic or natural structures without this interface breakdown. Melvin AJ, Litsky AS, Mayerson JL, Stringer K, Juncosa-Melvin N.
J Orthop Res. 2011 Dec 16. [Epub ahead of print] PMID: 22179930 PDF

CourseSmart presents a great, comprehensive model for the digital future of medical education

Many university providers and educators around the world have embraced digital course materials in order to supplement existing course materials. Many now aim to go beyond merely distributing PDF notes or making lectures available online and use platforms like the iPad to teach medicine in new ways.

CourseSmart, a venture founded in 2007 and supported by many leading publishers, aims to provide eTextbooks and digital learning tools to students across America. CourseSmart is one of the largest provider of digital course materials and their catalog includes over 90% of the core textbooks in use today by North American Universities. iMedicalApps

Ultrasound Related Ortho Articles via PubMed

Springer "Online First" Ortho Related Articles

The chondrotoxicity of single-dose corticosteroids

Inside the Pentagon’s Alt-Medicine Mecca, Where the Generals Meditate

Yoga is now a mainstay at Walter Reed
 and other military hospitals,and even
part of routine training for personnel.
The general is surprisingly good at meditation. It’s not just the impeccable posture — that might be expected of a man long used to standing at attention. It’s his hands, which rest idly on his knees, and his combat boots, which remain planted firmly on the floor. Over the next several minutes, Lt. Gen. Eric Schoomaker, the Surgeon General of the Army, will keep his eyes closed and his face perfectly relaxed.

The Pentagon is turning to alternative medicine to help alleviate the devastating symptoms of Post-traumatic stress disorder that afflict more than 250,000 military personnel; soothe the brain trauma that’s left thousands more with tremors, speech impediments and memory lapses; and assuage the chronic pain that lingers after grueling, repeat deployments.

The Samueli Institute might be the Pentagon’s best chance at making alt-medicine work. Or, at least, figuring out if it even stands a chance.

Thanks to leadership with years of experience in military circles, not to mention a billionaire benefactor with friends in prominent places, they’ve got no shortage of resources with which to do just that. More than half of the Institute’s $13.5 million in annual funding is provided by congressional funding (or “earmarks”), the Department of Defense and Veteran’s Affairs.

“Wherever you’ve come from, wherever you imagine you’re going, you’re actually only doing it right now, in this moment.” Our meditation guru for the day, Dr. Wayne Jonas, is not only a retired Army medical officer and former director of the holistic branch of the National Institute of Health. Wired

Recently Published Research on Integrative Medicine in the Military

Smart Bandage Promotes and Guides Vessel Formation

Researchers at University of Illinois Urbana–Champaign developed an amazing little bandage, which they call a “microvascular stamp”, that promotes angiogenesis while guiding exactly where the vessels should go.
It is imbued with living cells, positioned in a defined pattern, that release growth factors around a wound and cause vessels to grow where intended.  The study will be appearing in next month’s issue of Advanced Materials. MedGadget

Friday, December 23, 2011

Lubricant in Metal-On-Metal Hip Implants Found to Be Graphite, Not Proteins

A team of engineers and physicians have made a surprising discovery that offers a target for designing new materials for hip implants that are less susceptible to the joint’s normal wear and tear.

Researchers from Northwestern University, Evanston, IL, Rush University Medical Center, Chicago, and the University of Duisburg-Essen Germany found that graphitic carbon is a key element in a lubricatin layer that forms on metal-on-metal hip implants. The lubricant is more similar to the lubrication of a combustion engine than that of a natural joint.

The study will be published Dec. 23 by the journal Science.  NewsWise

Thursday, December 22, 2011

Journal of Orthopaedic Trauma [epub ahead of print] - link here onsite

Letter to Editor

Amputation or Limb Salvage Is Still a Question

Secondary Amputations of Blast-Induced Limb Injuries: What's Happened in the First Hours?

Review Article

Incidence of Associated Injury in Posterior Shoulder Dislocation: Systematic Review of the Literature

External Fixation versus Internal Fixation for Unstable Distal Radius Fractures: A Systematic Review and Meta-Analysis of Comparative Clinical Trials

Original Article

Functional Outcomes After Operatively Treated Patella Fractures

Failure of Locked Design-Specific Plate Fixation of the Pubic Symphysis: A Report of Six Cases

Locked versus Standard Unlocked Plating of the Pubic Symphysis: A Cadaver Biomechanical Study

Comparison of the 95-Degree Angled Blade Plate and the Locking Condylar Plate for the Treatment of Distal Femoral Fractures

Medical App that replaces the reference cards in your white coat, Wards 101 i-pocketcards review

Though we are now able to cram a virtually unlimited amount of information into our pockets via our mobile devices, just a few short years ago, pocket books and pocket cards were the weapons of choice. There were few weapons more efficient than a well-designed set of pocket cards; they were a potent combination of critical information presented in a compact package available for extremely quick reference.

But times change, and white coat real estate is increasingly occupied by mobile technology. I admittedly do find pocket cards to be quicker in terms of looking up critical information at times, but as one begins carrying multiple pocket cards, this speed advantage is lost. There is only a finite space available, and mobile devices are increasingly being tapped to fulfill this role.

In a bid to stay on top of trends, Borm Bruckmeier has translated their Wards 101 Essentials Pocketcard Set, which covers common emergency, internal medicine, and ICU topics, to the iPhone and iPad via a universal iOS app. iMedicalapps

Wednesday, December 21, 2011

Review article: Plica syndrome of the knee

Review article: Plica syndrome of the knee. Plica syndrome is a pathological condition secondary to inflammation. Plicae around the knee are common and generally asymptomatic. They often are misdiagnosed. The morphology of knee plicae varies; mediopatellar plicae are the most common cause of the plicae syndrome. An intermittent dull pain is the most common symptom. Diagnosis is made by exclusion. Ultrasonography is useful; arthroscopy is the gold standard. Arthroscopic removal of the plica may be necessary when conservative treatment for up to 6 months fails. Al-Hadithy N, Gikas P, Mahapatra AM, Dowd G. J Orthop Surg (Hong Kong). 2011 Dec;19(3):354-8. PMID: 22184170 PDF

Real-time sonoelastography of the Achilles tendon: pattern description in healthy subjects and patients with surgically repaired complete ruptures

In sonoelastography, the recognition of normal tendon structure will be useful in assessing pathologies of the Achilles tendon. Additionally, in patients with excellent American Orthopedic Foot and Ankle Society (AOFAS) scores and surgically repaired complete ruptures, a hard and heterogeneous pattern of tendon structure may be a natural consequence of tendon healing. PDF

Naval technology could be a lifesaver

Battlefield corpsmen and medical professionals across the country gained a valuable tool last week, as the Food and Drug Administration approved the first hand-held device to detect life-threatening bleeding in the brain. The Infrascanner could be a particular boon to the Department of the Navy (DON), as heavy computed tomography (CT) machines are not normally carried aboard ships in the frigate or destroyer class, or in the field with the Marine Corps. MedicalXpress

Unprecedented international effort to improve safety of orthopedic devices

Responding to a need for better post-market surveillance of orthopedic devices, the U.S. Food and Drug Administration (FDA) established the International Consortium of Orthopaedic Registries (ICOR) in October 2010.

As outlined in a Dec. 21 special online supplement in the Journal of Bone and Joint Surgery, ICOR is in the process of developing a collaborative process for improving the safety of orthopedic devices using outcomes registries from the U.S. and other countries. The combined ICOR registries may include data on millions of orthopedic surgical procedures and all implantable devices on the market. Eurekalert!

The Journal of Bone & Joint Surgery
December 21, 2011 | Vol. 93. Issue Supplement 3

Knee Arthroplasty and Risk of Hip Fracture: A Population-Based, Case–Control Study

The majority of knee arthroplasties (KAs) are performed in patients with osteoarthritis (OA). Although bone mass may be increased in these patients, subjects with knee OA may have an increased risk of hip fracture, possibly due to an increased severity of falls. However, in patients with KAs, risk of hip fracture has not been studied extensively. Arief Lalmohamed, Frans Opdam, Nigel K. Arden, Daniel Prieto-Alhambra, Tjeerd van Staa, Hubertus G. M. Leufkens and Frank de Vries. Calcified Tissue International. Dec 2011.  PDF

The Journal of Hand Surgery: articles in press 21 Dec 2011

Community-Acquired Methicillin-Resistant Staphylococcus aureus Hand Infections in the Pediatric Population PDF

Predictors of Pain During and the Day After Corticosteroid Injection for Idiopathic Trigger Finger PDF

Comparative Analysis of Intramedullary Nail Fixation Versus Casting for Treatment of Distal Radius Fractures PDF

Predicting the Outcome of Revision Carpal Tunnel Release PDF

Trigger Finger Treatment: A Comparison of 2 Splint Designs PDF

Open Reduction and Three-Dimensional Ulnar Osteotomy for Chronic Radial Head Dislocation Using a Computer-Generated Template: Case Report PDF

Ability of Near Infrared Spectroscopy to Measure Oxygenation in Isolated Upper Extremity Muscle Compartments PDF

Intrafocal Pin Plate Fixation of Distal Ulna Fractures Associated With Distal Radius Fractures PDF

Meta-Analysis of the Imaging Techniques for the Diagnosis of Complex Regional Pain Syndrome Type I PDF

Minimum 4-Year Follow-Up on Contralateral C7 Nerve Transfers for Brachial Plexus Injuries PDF

Aquatic therapy soon after total knee arthroplasty improves outcomes

Despite increased use of total hip arthroplasty (THA) and total knee arthroplasty (TKA), there is a notable lack of consensus about optimal postoperative treatment. Aquatic therapy has been shown to have a beneficial effect, and it is typically begun two weeks after surgery, after the wound has healed. According to a new study published in the Archives of Physical Medicine and Rehabilitation, beginning aquatic therapy just 6 days after TKA may lead to improved results, while delaying its onset an additional week may be more appropriate after a THA.   Eurekalert!

Tuesday, December 20, 2011

Journal of Surgical Education - Articles in Press

The Production of Audiovisual Teaching Tools in Minimally Invasive Surgery PDF

Do International Rotations Make Surgical Residents More Resource-Efficient? A Preliminary Study PDF

 Is There a Digital Generation Gap for E-Learning in Plastic Surgery? PDF

Limiting PGY 1 Residents to 16 Hours of Duty: Review and Report of a Workshop PDF

Perceived Benefits of a Transplant Surgery Experience to General Surgery Residency Training PDF

A Simulator Model for Sacroiliac Screw Placement PDF

Communication Tool Cuts Surgical Complications (CME/CE)

A program focusing on teamwork in the operating room appeared to lessen surgical complications at Veterans Affairs facilities, researchers found.

Hospitals that implemented the program had a significant drop in the annual surgical morbidity rate of 17% (P=0.01), compared with a nonsignificant decline for centers that hadn't yet started it, Yinong Young-Xu, ScD, of the National Center for Patient Safety in River Junction, Vt., and colleagues reported in the Archives of SurgeryMedPage Today

Monday, December 19, 2011

Recent Military Related Ortho Articles via PubMed

1. Proximal carpal row dislocation: a case report. Capo JT, Armbruster EJ, Hashem J. Hand (N Y). 2010 Dec;5(4):444-8. PMID: 22131931 Free PMC Article
2. Open lumbosacral spine fractures with thecal sac ligation after combat blast trauma. Kang DG, Cody JP, Lehman RA Jr. Spine J. 2011 Nov 29. [Epub ahead of print] PMID: 22133427
3. Bony avulsion of the supraspinatus origin from the scapular spine. Vochteloo AJ, Henket M, Vincken PW, Nagels J. J Orthop Traumatol. 2011 Dec 2. [Epub ahead of print] PMID: 22134393
4. Lumbar Spine Fractures Within a Complete American Cohort: Epidemiology and Risk Factors Among Military Service Members. Schoenfeld AJ, Romano D, Bader JO, Walker JJ. J Spinal Disord Tech. 2011 Nov 29. [Epub ahead of print] PMID: 22134730
Brisebois RJ, Tien HC. J Trauma. 2011 Nov;71(5 Suppl 1):S397-400. PMID: 22071994
6. Spinal injuries after improvised explosive device incidents: implications for Tactical Combat Casualty Care. Comstock S, Pannell D, Talbot M, Compton L, Withers N, Tien HC. J Trauma. 2011 Nov;71(5 Suppl 1):S413-7. PMID: 22071997
Indian J Orthop. 2011 Nov;45(6):573-5. PMID: 22144755 Free PMC Article
8. Percutaneous limited internal fixation combined with external fixation to treat open pelvic fractures concomitant with perineal lacerations. Chen L, Zhang G, Wu Y, Guo X, Yuan W. Orthopedics. 2011 Dec 6;34(12):e827-31. PMID: 22146197
9. Minimally Invasive Reduction Technique in Split Depression Type Tibial Pilon Fractures. Poyanli O, Esenkaya I, Ozkut AT, Akcal MA, Akan K, Unay K. J Foot Ankle Surg. 2011 Dec 8. [Epub ahead of print] PMID: 22154056
10. Case Report: Multifocal Subchondral Stress Fractures of the Femoral Heads and Tibial Condyles in a Young Military Recruit. Yoon PW, Yoo JJ, Yoon KS, Kim HJ. Clin Orthop Relat Res. 2011 Dec 13. [Epub ahead of print] PMID: 22161083

Top Anatomy Apps series starts with Anatomy Lectures: Topics In Focus

Here at iMedicalApps, we have decided to take a look at the anatomy apps currently available for the iPad to try and select a range that we consider the most useful for healthcare professionals. We have decided to focus on the iPad as we feel the large screen on this device is best suited to the task.

Unfortunately, the development of anatomy apps for Android tablets is lagging behind Apple’s iOS and therefore not suitable for this current discussion. Furthermore, the majority of healthcare professionals who own a tablet, own an iPad.

The first app we are going to look at in this series is an atypical anatomy app. Instant Anatomy Lectures: Topics In Focus. Robert Whitaker is an eminent anatomist who has written a whole range of lectures covering all aspects of anatomy and runs a website dedicated to aiding learning in human anatomy. iMedicalApps

Knee pain common complaint in middle-aged and mature women

New research shows 63% of women age 50 and older reported persistent, incident, or intermittent knee pain during a 12-year study period. Predictors for persistent pain included higher body mass index (BMI), previous knee injury, and radiographic osteoarthritis (OA). Details of this longitudinal study are available in Arthritis & Rheumatism, a journal published by Wiley-Blackwell on behalf of the American College of Rheumatology (ACR). Eurekalert! 

Sunday, December 18, 2011

High clinical utility of computed tomography compared to radiography in elderly patients with occult hip fracture after low-energy trauma.

Computed tomography has a high clinical utility as it can detect nearly all clinically suspect but radiographically negative cervical hip fractures as well as most trochanteric fractures and avulsions. A negative CT is near-perfect in ruling out a hip fracture requiring surgery. Dunker D, Collin D, Göthlin JH, Geijer M. Emerg Radiol. 2011 Dec 16. [Epub ahead of print] PMID: 22173818

American Journal of Sports Medicine [Epub ahead of print]

1. Quantitative Analysis of Muscle and Tendon Retraction in Chronic Rotator Cuff Tears. Meyer DC, Farshad M, Amacker NA, Gerber C, Wieser K. Am J Sports Med. 2011 Dec 14. [Epub ahead of print] PMID: 22174340
2. A Retrospective Evaluation of Magnetic Resonance Imaging Effectiveness on Capitellar Osteochondritis Dissecans Among Overhead Athletes. Iwasaki N, Kamishima T, Kato H, Funakoshi T, Minami A. Am J Sports Med. 2011 Dec 14. [Epub ahead of print] PMID: 22174341
3. Influence of Cell Quality on Clinical Outcome After Autologous Chondrocyte Implantation. Niemeyer P, Pestka JM, Salzmann GM, Südkamp NP, Schmal H. Am J Sports Med. 2011 Dec 14. [Epub ahead of print] PMID: 22174342
4. The Biomechanical and Clinical Application of Using the Anterior Half of the Peroneus Longus Tendon as an Autograft Source. Zhao J, Huangfu X. Am J Sports Med. 2011 Dec 14. [Epub ahead of print] PMID: 22174343
5. The Role of Axial Compressive and Quadriceps Forces in Noncontact Anterior Cruciate Ligament Injury: A Cadaveric Study. Wall SJ, Rose DM, Sutter EG, Belkoff SM, Boden BP. Am J Sports Med. 2011 Dec 14. [Epub ahead of print] PMID: 22174344

Orthopaedic surgeons: as strong as an ox and almost twice as clever? Multicentre prospective comparative study.

Male orthopaedic surgeons have greater intelligence and grip strength than their male anaesthetic colleagues, who should find new ways to make fun of their orthopaedic friends. Subramanian P, Kantharuban S, Subramanian V, Willis-Owen SA, Willis-Owen CA. BMJ. 2011 Dec 15;343:d7506. PMID: 22174322 PDF

Long biceps tendon: normal position, shape, and orientation in its groove in neutral position and external and internal rotation.

Purpose: To characterize the position, shape, and orientation of the long biceps tendon (LBT) on transverse magnetic resonance (MR) images acquired in neutral position and in maximal external and internal rotation of the shoulder in asymptomatic volunteers. Buck FM, Dietrich TJ, Resnick D, Jost B, Pfirrmann CW. Radiology. 2011 Dec;261(3):872-81. Epub 2011 Oct 3. PMID: 21969668

Doctor on board? What is the optimal skill-mix in military pre-hospital care?

 In a military setting, pre-hospital times may be extended due to geographical or operational issues. Helicopter casevac enables patients to be transported expediently across all terrains. The skill-mix of the pre-hospital team can vary. Calderbank P, Woolley T, Mercer S, Schrager J, Kazel M, Bree S, Bowley DM. Emerg Med J. 2011 Oct;28(10):882-3. Epub 2010 Sep 15. PMID: 20844092

Military Medicine 2011 Nov;176(11) via PubMed

1. Effect of combined nicotine and shrapnel exposure on pain measures and gait after nerve injury. Rittenhouse B, Hill-Pryor CD, McConathy A, Parker P, Franco N, Toussaint E, Barker D, Prasad B, Pizarro JM. Mil Med. 2011 Nov;176(11):1335-40. PMID: 22165666
2. Incidence and risk factors for lumbar degenerative disc disease in the United States military 1999-2008. Schoenfeld AJ, Nelson JH, Burks R, Belmont PJ Jr. Mil Med. 2011 Nov;176(11):1320-4. PMID: 22165663
3. Cricothyroidotomy bottom-up training review: battlefield lessons learned. Bennett BL, Cailteux-Zevallos B, Kotora J. Mil Med. 2011 Nov;176(11):1311-9. PMID: 22165662
4. Cartesian positioning system for localization of blast and ballistic fragments: a phantom-based pilot study. Folio L, Fischer T, Shogan PJ, Frew M, Bunger R, Provenzale JM. Mil Med. 2011 Nov;176(11):1300-5. PMID: 22165660
5. Improving the emergency whole blood program. Cahill BP, Stinar TR. Mil Med. 2011 Nov;176(11):1287-91. PMID: 22165658

New Guideline on Transverse Myelitis Released (CME/CE)

Certain clinical, imaging, and laboratory findings can help determine the etiology and prognosis in patients presenting with transverse myelitis, according to a new guideline from the American Academy of Neurology. MedPage Today

American Academy of Neurology guidelines via National Guideline Clearinghouse - a comprehensive eLearning resource for orthopaedic surgeons.

 a comprehensive eLearning resource for orthopaedic surgeons.

  • Learn from hundreds of high-quality educational resources
  • Share your surgical case studies with over 4000 surgeons globally
  • Discuss techniques and exchange insights with medical colleagues
Registration is FREE and only takes a few moments. Click here to get started.

Friday, December 16, 2011

Orthopaedics: Structural support

In the 1960s, a remarkable substance called etidronate came into use as an effective treatment for bone problems. Etidronate is a bisphosphonate, a class of material known since the late 1800s to inhibit metal crystallization and corrosion, a feature that led to its wide usage in the oil and gas industry. More than 60 years later, researchers at Proctor & Gamble found that bisphosphonates are just as effective at preventing the destruction of bones in the human body as they are at stopping metal degradation. Proctor & Gamble began marketing etidronate as Didronel, and it soon became a standard treatment for muscle calcification, Paget's disease of bone, heterotropic ossification (in which bone is formed outside the skeleton), menopausal osteoporosis and, finally, bone degradation in multiple myelomaNature 480, S56–S57; (15 December 2011) PDF

Effects of in vivo mechanical loading on large bone defect regeneration.

Fracture healing is highly sensitive to mechanical conditions; however, the effects of mechanical loading on large bone defect regeneration have not been evaluated. In this study, we investigated the effects of functional loading on repair of critically sized segmental bone defects. Boerckel JD, Kolambkar YM, Stevens HY, Lin AS, Dupont KM, Guldberg RE. J Orthop Res. 2011 Dec 14. [Epub ahead of print] PMID: 22170172 PDF

The Journal of Hand Surgery, European Volume [Epub ahead of print]

1. Isolated, extra-articular neck and shaft fractures of the 4th and 5th metacarpals: a comparison of transverse and bouquet (intra-medullary) pinning in 67 patients. Sletten IN, Nordsletten L, Husby T, Odegaard RA, Hellund JC, Kvernmo HD. J Hand Surg Eur Vol. 2011 Dec 14. [Epub ahead of print] PMID: 22170245
2. Reconstruction of hypoplastic thumb using hemi-longitudinal metatarsal transfer. Chow CS, Ho PC, Tse WL, Hung LK. J Hand Surg Eur Vol. 2011 Dec 14. [Epub ahead of print] PMID: 22170244
3. Repair of a palmar soft tissue defect of the proximal interphalangeal joint with a transposition flap from the dorsum of the proximal phalanx. Zhang X, Shao X, Zhu M, Jiang R, Feng Y, Ren C. J Hand Surg Eur Vol. 2011 Dec 14. [Epub ahead of print] PMID: 22170242

Does team training save lives? A new science gives it a rigorous evaluation

Whether the task is flying a plane, fighting a battle, or caring for a patient, good teamwork is crucial to getting it done right. That's why team-building and training courses are big business in the U.S., and have been for decades. But lately something has changed: "There's a demand for evaluations—an emphasis on showing that team training makes a difference in safety, decision-making, communication, clinical outcomes—you name the ultimate criteria the industry has," says Eduardo Salas, an organizational psychologist at the University of Central Florida.

The answer to that demand is the subject of a new article in Current Directions in Psychological Science, a publication of the Association for Psychological Science. Eurekalert!

Supination stress of the great toe for assessing intraoperative correction of hallux valgus.

Supination stress of the great toe was an effective maneuver for assessing intraoperative correction of hallux valgus and metatarsus primus varus, and reduction of the sesamoids. Okuda R, Yasuda T, Jotoku T, Shima H. J Orthop Sci. 2011 Dec 15. [Epub ahead of print] PMID: 22170521

A case series featuring extremely short below-knee stumps.

Lower limb amputations should be evaluated carefully, especially with regard to the possibility of preserving the knee joint to enable a more physiological gait and lower energy consumption. Below-knee amputations were performed immediately below the tibial tuberosity with maintenance of the insertion of the patellar tendon, resulting in very short, but functional stumps. This case study examined whether very short below-knee stumps allow a more functional gait, as compared to more proximal amputations. Carvalho JA, Mongon MD, Belangero WD, Livani B. Prosthet Orthot Int. 2011 Dec 14. [Epub ahead of print] PMID: 22170876

Finding the Best PDF Management App for Healthcare Professionals

Finding the Best PDF Management App for Healthcare Professionals [Part 1]. A key function of any mobile device is file management. For healthcare professionals, management of our electronic library of PDFs – journal articles, interesting talks, and so on – can be particularly painful. This is especially true for our oncology and cardiology colleagues, for whom a new trial is released seemingly every day. Every day, physicians, nurses, PA’s, and other healthcare professionals read and use PDFs on mobile devices for functions ranging from a quick literature review to inform clinical decisions to annotating notes during a lecture.

Finding the Best PDF Management App for Healthcare Professionals [Part 2]. n the first part of this two part series, we looked at iBooks, Dropbox, iAnnotate, and Goodreader. Now in Part 2, we’ll look at Papers, Sente, and PDF Expert – and name our pick for best PDF management app for healthcare professionals. iMedicalApps

Team designs a bandage that spurs, guides blood vessel growth

Researchers have developed a bandage that stimulates and directs blood vessel growth on the surface of a wound. The bandage, called a "microvascular stamp," contains living cells that deliver growth factors to damaged tissues in a defined pattern. After a week, the pattern of the stamp "is written in blood vessels," the researchers report. A paper describing the new approach will appear as the January 2012 cover article of the journal Advanced Materials.

"Any kind of tissue you want to rebuild, including bone, muscle or skin, is highly vascularized," said University of Illinois chemical and biomolecular engineering professor Hyunjoon Kong, a co-principal investigator on the study with electrical and computer engineering professor Rashid Bashir. "But one of the big challenges in recreating vascular networks is how we can control the growth and spacing of new blood vessels." Eurekalert!

Thursday, December 15, 2011

University of Maryland finds restricting post-surgery blood transfusion is safe for some hip patients

More than half of the older, anemic patients in a New England Journal of Medicine study did not need blood transfusions as they recovered from hip surgery, according to new research co-authored by University of Maryland School of Medicine scientists. The findings could immediately change the way such patients are treated.

Doctors have long assumed that transfusions strengthen patients weakened by anemia, improving their chances at recovery from surgery after hip fracture. But the North American study of more than 2,000 patients found no significant difference in rate of recovery between patients who received transfusions at a moderate level of anemia and those who did not receive transfusions until their anemia was more advanced. Eurekalert!

Wednesday, December 14, 2011

New on Audio Digest

Volume 34, Issue 24
December 21, 2011
Low–energy distal radius fractures in osteoporotic bone: does the strategy change? – Leon S. Benson, MD
High–energy pediatric hip fractures: how to recognize and treat – Andrea S. Kramer, MD
Open reduction and internal fixation for displaced femoral neck fractures – David Stephen, MD
Calcaneal fractures: tips and pearls – John G. Anderson, MD

Volume 34, Issue 23
December 7, 2011
What's new in ACL reconstruction? – Nick Mohtadi, MD
Current concepts in treating focal cartilage defects – Dr. Mohtadi

Review of Vue Motion Medical Image Viewer, the first HTML5 based and FDA approved radiology viewer

As we recently reported, Carestream has received FDA clearance for its Vue Motion HTML5 based medical image viewer. This is a major step forward in ensuring cross-platform availability, theoretically making it accessible from any device that has a web browser.

Although other vendors have released apps for the iPad and other tablets to access their PACS systems, Vue Motion is the first web-based viewer that we know of that can be accessed from tablets without installing additional software. iMedicalapps