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Friday, June 17, 2011

New Ortho related Systematic Reviews from Cochrane

Harding P, Rasekaba T, Smirneos L, Holland AE.
Cochrane Database Syst Rev. 2011 Jun 15;6:CD008130. PMID: 21678373 [PubMed - in process] Related citations

Meuffels DE, Reijman M, Scholten RJ, Verhaar JA.
Cochrane Database Syst Rev. 2011 Jun 15;6:CD007601.PMID: 21678367 [PubMed - in process]
Kurup H, Hossain M, Andrew JG.
Cochrane Database Syst Rev. 2011 Jun 15;6:CD005959. PMID: 21678350 [PubMed - in process]
van den Bekerom MP, van der Windt DA, Ter Riet G, van der Heijden GJ, Bouter LM.
Cochrane Database Syst Rev. 2011 Jun 15;6:CD001250. PMID: 21678332 [PubMed - in process]

Sensory nerve induced inflammation contributes to heterotopic ossification.

Heterotopic ossification (HO), or bone formation in soft tissues, is often the result of traumatic injury. Much evidence has linked the release of BMPs (Bone Morphogenetic Proteins) upon injury to this process. HO was once thought to be a rare occurrence, but recent statistics from the military suggest that as many as 60% of traumatic injuries, resulting from bomb blasts, have associated HO. In this study, we attempt to define the role of peripheral nerves in this process. J Cell Biochem. 2011 Jun 15. doi: 10.1002/jcb.23225. [Epub ahead of print]

Corrective osteotomy in forearm fracture malunion improves functional outcome in adults.

Malunions of forearm fractures in adults can present with limitation of forearm rotation, or as distal radioulnar joint instability with functional impairment. This contrasts with paediatric patients in whom malunions of similar severities are often better tolerated. We did a retrospective review of six adult patients after corrective forearm osteotomy for symptomatic malunited forearm shaft fractures. The corrective operations were done between 7 and 168 months after initial injury, using oblique or wedge osteotomies. Median follow-up was 22.5 months. The patients recovered well, with statistically significant improvement in forearm rotation and Disabilities of the Arm, Shoulder, and Hand (DASH) scores. No significant complications occurred.
J Hand Surg Eur Vol. 2011 Feb;36(2):102-6. PDF

Thursday, June 16, 2011

EMS ACLS Guide app can deliver critical information while in the field

Emergency care begins well before patients reach the doors of the Emergency Room. And numerous studies have shown that despite high-tech critical care units, the fate of our sickest patients often rests in the speed and intelligence of the paramedics and first responders who first arrive on scene. So its crucial that they be intimately familiar with the up to date critical care algorithms.

The EMS ACLS Guide by Informed Publishing offers these initial providers with an array of information, easily accessible on iOS and Android platforms.  The developers admittedly target their app at EMTs and first responders, but this app could also be a valuable tool for all healthcare providers. iMedicalApps

Features of hindfoot 3D kinetics in flat foot in ankle-joint maximal dorsiflexion and plantarflexion.

Tibiotalar-joint plantarflexion decreased and talocalcaneal and talonavicular-joint adduction increased in the maximal ankle-joint plantarflexion in stage II in comparison with normal cases. Tibiotalar-joint plantarflexion and adduction were decreased and of the talocalcaneal and talonavicular joints increased in stage III in comparison with stage II cases. J Orthop Sci. 2011 Jun 15. [Epub ahead of print]

In vivo three-dimensional motion analysis of the shoulder joint during internal and external rotation.

We clarified the existence of a specific scapulohumeral motion pattern, whereby the glenohumeral joint moves with internal rotation and the scapulothoracic joint moves with anterior tilt together with internal rotation motion of the shoulder joint. Int Orthop. 2011 Jun 15. [Epub ahead of print]

Systematic review and meta-analysis on the rate of postoperative venous thromboembolism in orthopaedic surgery in Asian patients without thromboprophylaxis.

Postoperative venous thromboembolism (VTE) is a common life-threatening complication after surgery. This review analysed the rate and mortality of VTE after orthopaedic surgery in Asia. Br J Surg. 2011 Jun 14. doi: 10.1002/bjs.7589. [Epub ahead of print]

Median nerve changes following steroid injection for carpal tunnel syndrome.

Introduction: Neuromuscular ultrasound is a painless, radiation-free, high-resolution imaging modality for assessment of the peripheral nervous system. The purpose of this study was to use neuromuscular ultrasound to assess the changes that occur in the median nerve after steroid injection for carpal tunnel syndrome (CTS). Methods: Ultrasound and nerve conduction studies were performed at baseline and 1 week, 1 month, and 6 months after steroid injection in 19 individuals (29 wrists) with CTS. Results: Significant changes were noted in median nerve cross-sectional area (P < 0.001), mobility (P = 0.001), and vascularity (P = 0.042) at the distal wrist crease after steroid injection, and the nerve cross-sectional area correlated with symptom score and electrodiagnostic parameters. Changes in the ultrasonographic parameters were seen within 1 week of injection. Conclusions: These findings suggest neuromuscular ultrasound is potentially helpful for the assessment of individuals undergoing treatment for CTS, as typical changes can be expected after successful treatment injection. Muscle Nerve 44: 25-29, 2011.

Wednesday, June 15, 2011

Cytokine expression in muscle following traumatic injury

Heterotopic ossification (HO) occurs at a high frequency in severe orthopaedic extremity injuries; however, the etiology of traumatic HO is virtually unknown. Osteogenic progenitor cells have previously been identified within traumatized muscle. Although the signaling mechanisms that lead to this dysregulated differentiation pathway have not been identified, it is assumed that inflammation and fibrosis, which contribute to an osteoinductive environment, are necessary for the development of HO. The hypothesis of this study was that cytokines related to chronic inflammation, fibrogenesis, and osteogenesis become up-regulated following severe muscle trauma where HO forms. J Orthop Res. 2011 Mar 30. doi: 10.1002/jor.21354. [Epub ahead of print] PDF

Nitrate patch prevents steroid-related bone necrosis

Avascular necrosis of the femoral head is a common complication with disabling effect for young patients after high-dose corticosteroid treatment. We could show that steroids have a vasoconstrictive effect on lateral epiphyseal arteries of the femoral head which could lead to ischemia and subsequent necrosis. In this study we investigated the preventive effect of a nitrate patch on steroid-related bone necrosis in a rabbit model. J Orthop Res. 2011 Apr 5. doi: 10.1002/jor.21420. [Epub ahead of print] PDF

Lubricin distribution in the torn human anterior cruciate ligament and meniscus

The objective of this study was to: (1) determine the distribution of lubricin in the human torn anterior cruciate ligament (ACL) and meniscus; (2) determine the distribution of lubricin in the human intact ACL and meniscus; (3) and identify potential cellular sources of lubricin in these tissues. Ten torn ACLs and six torn menisci were obtained from surgeries; for comparison, 11 intact ACLs and 13 intact menisci were obtained from total knee replacements. Samples were formalin fixed and processed for immunohistochemical staining with a monoclonal antibody for lubricin. In torn ACLs and menisci, lubricin was generally found as a discrete layer covering the torn surface. No surface lubricin staining was found on the transected edges produced during excision. Lubricin was also found on the native surfaces of intact ACLs and menisci. In all tissues, lubricin was found in the matrix and intracellularly. The surface layer of lubricin coating torn edges of ACLs and menisci may interfere with the integrative healing process needed for repair. J Orthop Res. 2011 Jun 6. doi: 10.1002/jor.21473. [Epub ahead of print]  PDF

Ceramic-on-Metal Hip Implant Wins FDA Nod

The first ceramic-on-metal implant for total hip replacement has been approved by the FDA, the agency announced. The Pinnacle CoMplete Acetabular Hip System is manufactured by DePuy Orthopaedics, a subsidiary of Johnson & Johnson, and based in Warsaw, Ind. The femoral head portion of the implant is made of ceramic and the acetabular (socket) component is a metal alloy.

With this approval, there are now five different combinations of materials from which hip implants can be made. Others already approved include ceramic-on-ceramic, ceramic-on-polyethylene, metal-on-polyethylene, and metal-on-metal. MedPageToday

New treatment for peripheral nerve defects: Reconstruction of a 2 cm, monkey median nerve gap by direct lengthening of both nerve stumps.

We have developed a new treatment for peripheral nerve defects: nerve-lengthening method, and confirmed the efficacy and safety of our method using cynomolgus monkeys. A 20-mm defect in the median nerve of monkey's forearms was repaired through the simultaneous lengthening of both nerve stumps with original nerve-lengthening device. To evaluate nerve regeneration after neurorrhaphy, electrophysiological, histological, and functional recovery were examined and compared to the standard autografting. Nerve conduction velocity, axon maturation, and the result of functional test were superior in the nerve-lengthening method than in the autografting. And there were no adverse events associated with our method. We concluded that this method is practical for clinical application. J Orthop Res. 2011 Jun 10. doi: 10.1002/jor.21476. [Epub ahead of print] PDF

The effect of hip position upon the location of the sciatic nerve: an MRI Study.

Allowance for the positional changes of the sciatic nerve is important when considering the safest position of the leg to perform hip operations, specifically the ischial osteotomy during a pelvic triple or periacetabular osteotomy. As for its proximity to the osteotomy site the sciatic nerve can be injured during these operations with the consequence of severe functional impairment. This is the first in-vivo study that demonstrates the effect of hip position upon the location of the sciatic nerve. J Pediatr Orthop. 2011 Mar;31(2):165-9.

Tuesday, June 14, 2011

Shoulder Decide beautifully demonstrates and teaches basic shoulder anatomy and pathology to patients

Shoulder Decide, available as separate iPhone and iPad apps, sets out to ameliorate this situation by educating patients about common shoulder problems. If I were to describe the app with one word, it would be “beautiful.” And that design factor, in addition to well-selected content, make this app a great asset to improve patient-physician communication. iMedicalApps

Surgical Technique: Medial Collateral Ligament Reconstruction Using Achilles Allograft for Combined Knee Ligament Injury.

This technique uses allograft that provides bone-to-bone healing on the femur, requires small incisions, and creates isometric reconstruction. When performed with a cruciate reconstruction, knee stability can be restored at 2 to 5 years followup. In patients with MCL with primary ACL reconstruction, return to preinjury activity level in recreational athletes can be achieved. Clin Orthop Relat Res. 2011 Jun 10. [Epub ahead of print]

Electromagnetic field stimulation for treating delayed union or non-union of long bone fractures in adults.

Authors' conclusions: Though the available evidence suggests that electromagnetic field stimulation may offer some benefit in the treatment of delayed union and non-union of long bone fractures, it is inconclusive and insufficient to inform current practice. More definitive conclusions on treatment effect await further well-conducted randomised controlled trials. Cochrane Database Syst Rev. 2011 Apr 13;4:CD008471. Review.

100 most cited articles in orthopaedic surgery.

Science Citation Index Expanded was searched for citations to articles published in any of the 49 journals in the subject category "ORTHOPEDICS." Each of the 49 journals was searched separately using the "cited reference search" to determine the 100 most often cited articles. Each article was reviewed for basic information including year of publication, country of origin, source journal of the article, article type, and level of evidence. We categorized the journal article by field of research where possible. Clin Orthop Relat Res. 2011 May;469(5):1487-97. Epub 2010 Oct 5. PDF

Monday, June 13, 2011

US Army to begin testing 85 smartphone apps

The U.S. Army will begin testing iPhones, Android smartphones, and tablets for use in war starting next week, reports The Wall Street Journal. Last December we reported on the military’s plans to test EMR applications on Apple and Android devices for use in the field, but this week’s announcement includes a handful of other specific applications. mobilehealthnews

At Ramstein, America's military aeromedical mission heats up

RAMSTEIN AIR BASE, Germany--It's warming up in the Middle East, and as the mercury rises, so does the intensity of fighting in Iraq and Afghanistan. And that means the number of seriously injured American soldiers passing through here is also rising every day. cnet

Blast-Induced Lower Extremity Fractures With Arterial Injury: Prevalence and Risk Factors for Amputation After Initial Limb-Preserving Treatment.

The purpose of this study is to determine the rate of late (secondary) amputation and to identify risk factors for amputation in injuries that were initially treated with limb preservation on the battlefield.

Operative complications of combat-related transtibial amputations: a comparison of the modified burgess and modified ertl tibiofibular synostosis techniques.

The complications of bone-bridging amputations remain ill defined. The purpose of this study was to compare the early and intermediate-term complications leading to reoperation between the modified Burgess and modified Ertl tibiofibular synostosis in combat-related transtibial amputations.

Biomechanical analysis of lateral humeral condyle fracture pinning.

The purpose of this study was to determine the optimum pin configuration and the number of pins needed to stabilize the Milch type II lateral humeral condyle fractures in a pediatric bone model.

Unstated factors in orthopaedic decision-making: a qualitative study.

Total joint replacement (TJR) of the hip or knee for osteoarthritis is among the most common elective surgical procedures. There is some inequity in provision of TJR. How decisions are made about who will have surgery may contribute to disparities in provision. The model of shared decision-making between patients and clinicians is advocated as an ideal by national bodies and guidelines. However, we do not know what happens within orthopaedic practice and whether this reflects the shared model. Our study examined how decisions are made about TJR in orthopaedic consultations.

Stem cells in orthopaedics and fracture healing.

Stem cell application is a burgeoning field of medicine that is likely to influence the future of orthopaedic surgery. Stem cells are associated with great promise and great controversy. For the orthopaedic surgeon, stem cells may change the way that orthopaedic surgery is practiced and the overall approach of the treatment of musculoskeletal disease. Stem cells may change the field of orthopaedics from a field dominated by surgical replacements and reconstructions to a field of regeneration and prevention. This review will introduce the basic concepts of stem cells pertinent to the orthopaedic surgeon and proceed with a more in depth discussion of current developments in the study of stem cells in fracture healing.

Sunday, June 12, 2011

Borderline femur fracture patients: early total care or damage control orthopaedics?

A recent randomized controlled trial (RCT) favours damage control orthopaedics (DCO) over early total care (ETC) in the management of high-energy femoral shaft fracture (FSF) patients with borderline physiology. The purpose of this study was to compare the borderline physiology FSF demographics, management and outcomes of a Level-1 trauma centre, John Hunter Hospital (JHH) with those of the RCT.