Low back pain in the uniformed service member: approach to surgical treatment based on a review of the literature.

The clinical entity of chronic low back pain is not well understood at present. Disparate spinal conditions can result in symptoms of low back pain, and various treatment options have been proposed in the literature including surgical intervention and prolonged nonoperative therapy. Low back pain, as well as lumbar degenerative disc disorders and spondylosis, is common among uniformed service members, and studies, along with treatment recommendations, regarding these entities in the civilian community are not necessarily translatable to military personnel. This literature review endeavors to review the evidence for interventions for low back pain and seeks to formulate a treatment algorithm that takes into account the unique requirements of military personnel. Ultimately, more research must be done, investigating the specific results of treatments for spinal conditions within the military community before definitive recommendations can be made.

PTSD Relief Comes With a Mantra (CME/CE)

Transcendental meditation has potential benefits for combat-related posttraumatic stress disorder (PTSD), a small case series of U.S. military veterans showed.  Five veterans of the Iraq and Afghanistan wars all had significant improvement on the Clinician-Administered PTSD Scale (CAPS) -- the gold standard for the assessment and diagnosis of PTSD -- after eight weeks of meditation (P=0.02), according to Joshua Rosenthal, MD, of Capital Clinical Research Associates in Rockville, Md., and colleagues.

Evidence-based practice in arthroscopic knee surgery

Knee arthroscopy is a minimally-invasive technique that allows intra-articular assessment and treatment of knee joint pathology. It has proven benefits of reduced patient morbidity, earlier recovery and mobilisation, and it is cost-effective. In this paper we review the anatomy of the knee joint, indications and contra-indications to knee arthroscopic use, and consider the main techniques of knee arthroscopy including types of anaesthetic, prophylactic antibiotics, theatre setup and arthroscopic portals, and post-operative care.

Blast-Related Brain Injuries Detected in U.S. Military

An advanced imaging technique has revealed that some U.S. military personnel with mild blast-related traumatic brain injuries have abnormalities in the brain that have not been seen with other types of imaging.
The abnormalities were found in the brain’s white matter, the wiring system that nerve cells in the brain use to communicate with each other.
The study is reported June 2 in The New England Journal of Medicine by scientists at Washington University School of Medicine in St. Louis and the Landstuhl Regional Medical Center in Landstuhl, Germany.

Patient Safety Climate Among Orthopaedic Surgery Residents

Patient safety has attained a higher profile since the Institute of Medicine's report, To Err Is Human: Building a Safer Health System, was distributed in 2000¹. This report suggested that many hospital errors were related to flaws within the health-care delivery system. Many organizations—aviation, nuclear power, the military, and some industries—have realized that safe systems are essential for creating a barrier between human errors and adverse events². Organizations with systems designed to minimize errors, prevent adverse events, and produce reliable outcomes despite intrinsic risks have been termed highly reliable organizations^2,3. Health-care institutions are now being challenged by both internal and external forces to become highly reliable organizations by applying systems-based approaches to address patient safety.

Fracture Prediction Methods May be Useful for Patients with Diabetes

Use of established fracture prediction methods in older patients with type 2 diabetes mellitus (DM) found that scores from these methods were associated with hip and nonspine fracture risk, and a certain score associated with higher risk of fracture compared to persons without DM, according to a study in the June 1 issue of JAMA. Because patients with type 2 DM often have higher levels of bone mineral density (BMD), it has been uncertain the applicability of fracture risk screening methods typically used for patients with lower levels of BMD.

Limb Salvage Team Helps Victims of Haitian Earthquake

A team of plastic and orthopedic surgeons achieved a high success rate in limb salvage—minimizing the need for amputations—among patients injured in last year's devastating earthquake in Haiti, reports a study in the June issue of Plastic and Reconstructive Surgery®, the official medical journal of the American Society of Plastic Surgeons (ASPS).

Surgical Radiology app provides high quality training and is a great value

Surgical Radiology is an app that aims to teach appropriate surgical radiology interpretation skills for surgeons and trainees. It emphasizes the clinical implications for imaging findings and prompts the user to identify the imaging abnormality and suggest treatments, where appropriate. It is a free app written for the iOS platform, developed by Drs. Dangleben and Lee at the Lehigh Valley Health Network, a Level I Trama Center in Pennsylvania with a general surgery residency.

External fixation and temporary stabilization of femoral and tibial trauma.

External fixation is an important option in the acute management of unstable femoral and tibial fractures and the temporary stabilization of periarticular injuries of the knee or ankle. The value of external fixation as the modality of choice in selective civilian and military applications is well documented. Primary indications include damage control for multitrauma management in patients with concomitant traumatized integument and/or excessive swelling and/or systemic instability and stabilization for transport in hostile or austere environments. The purpose of this article is to discuss the indications for temporary external fixation of lower extremity long bones and complicated distal femoral, proximal tibia, and tibial plafond fractures; to outline technical considerations in the application of temporary external fixation devices; and to summarize the experience in the use of prepackaged external fixators and their indications in combat.

Breaking the fracture cycle through effective and coordinated models of care

A prior fracture at least doubles a patient's future fracture risk – yet numerous studies from across the world have found that healthcare systems fail to respond to the first fracture to prevent future fractures. Professor Cyrus Cooper, chair of the Committee of Scientific Advisors of the International Osteoporosis Foundation (IOF) and director of the MRC Lifecourse Epidemiology Unit, University of Southampton in the UK stated, "Studies from the UK, USA and Australia have reported that 45% or more of today's hip fracture patients have a prior fracture history. Healthcare systems are evidently failing to respond to the first fracture – this is, tragically, a missed opportunity for intervention. Worldwide, millions of people go on to experience debilitating and life-threatening hip fractures, at great cost to the individual and to healthcare systems."

A versatile grid holder and grid for miniscrew placement.

The biggest challenge in mini-screw placement is the accuracy and ease of placement, thus avoiding their proximity to the adjacent root structures during insertion. We have designed a very simple and inexpensive grid holder and a grid which can be used on buccal and palatal surfaces of maxillary and mandibular arches, in anterior as well as posterior regions. The grid-holder is effortlessly piggy-backed facially on the existing archwire bracket unit without removing the archwire. The assembly can be easily disengaged when pilot drilling has been done. The grid holder is versatile and can accept most kinds of grids and eyelets available. It is fabricated out of materials routinely available in any orthodontic practice. The same assembly can be reused again after autoclaving on different patients.