Ultrasound in Space Leads to Improved Ultrasound Down Here

This research led to the publication of the 2010 ICU Ultrasound Pocket Book and an atlas of “normal” ultrasound images and techniques for acquiring them that can be used by astronauts with minimal training.  Dulchavsky and colleagues tested these techniques and the diagnostic accuracy of them by using the custodial personnel in the Henry Ford Hospital. A video on the site shows some of the applications the team has already implemented through the World Interactive Network Focused on Critical UltraSound (WINFOCUS) to train individuals to use ultrasound techniques in under-served regions. MedGadget.com

Shoulder US: Anatomy, Technique, and Scanning Pitfalls.

The accuracy of shoulder ultrasonography (US) is largely dependent on the US examination technique. It is essential that the individual performing the US examination has an understanding of pertinent anatomy, such as bone surface anatomy and tendon orientation. It is also important to be familiar with imaging pitfalls related to US technique, such as anisotropy. In this article, shoulder US scanning technique, as well as related anatomy and scanning pitfalls, will be reviewed. The use of a protocol-driven shoulder US examination is important to ensure a comprehensive and efficient evaluation. An on-line video tutorial demonstrating a shoulder US also accompanies this article. Jacobson JA. Radiology. 2011 Jul;260(1):6-16. PMID: 21697306  PDF   Video

A New Technique for Removing Intramedullary Cement.

Treatment of infected long bone fractures or nonunions requires stability for bony union, yet retained implants can lead to persistent infection. Antibiotic cement intramedullary nails, in addition to external fixation, are commonly used to deliver intramedullary antibiotics in infected long bone fractures and provide temporary stability. However, the retrieval of these nails can result in debonding of antibiotic cement, which can require significant time and effort to remove. A variety of methods, including intramedullary hooks, reverse curettes, flexible osteotomes, and stacked guide rods, are commonly used to remove cement fragments. When these methods fail to allow access to the entire length of the canal, the Reamer Irrigator Aspirator system (Synthes, Paoli, PA) serves as an effective method for removing retained intramedullary cement. The surgical technique is described, and three cases illustrate the successful use of the Reamer Irrigator Aspirator system for removal of an antibiotic cement intramedullary nail. Lowe JA, Vosburg C, Murtha YM, Della Rocca GJ, Crist BD. J Orthop Trauma. 2011 Jun 21. [Epub ahead of print] PMID: 21697739 Link to Published Ahead of Print

Extra-articular Malunions of the Scapula: A Comparison of Functional Outcome Before and After Reconstruction.

Malunion after nonoperative treatment of a displaced scapula fracture may be associated with poor functional and cosmetic outcomes. Operative reconstruction can yield good surgical and functional results. Cole PA, Talbot M, Schroder LK, Anavian J. J Orthop Trauma. 2011 Jun 21. [Epub ahead of print] PMID:  21697740 Link to Published Ahead of Print

Screw Depth Sounding in Proximal Humerus Fractures to Avoid Iatrogenic Intra-articular Penetration.

Unstable and displaced proximal humerus fractures remain a treatment challenge. The use of locked plates has improved construct stability, but complication rates remain high. Biomechanical studies have emphasized the importance of anchoring screws in the subchondral bone of the humeral head to improve implant stability. However, the spherical shape of the proximal humerus and the limited tactile sensation of its soft cancellous bone make determining accurate screw length difficult, and reported rates of intraoperative screw penetration are high. Iatrogenic screw penetration, even if recognized and corrected before leaving the operating room, may lead to late failure. We present a simple technique of quickly and safely determining screw length using a blunt-tipped Kirschner wire and instruments found in basic orthopaedic sets. Bengard MJ, Gardner MJ. J Orthop Trauma. 2011 Jun 21. [Epub ahead of print] PMID:  21697741 Link to Published Ahead of Print

Use and efficacy of bone morphogenetic proteins in fracture healing.

Although the efficacy of BMPs as stimulators of bone repair has been demonstrated in model systems and clinical studies, the use of BMPs to enhance fracture healing in the clinical setting is still controversial. Issues such as when, where and how much of which BMP is the most effective and profitable to use still have to be elucidated. But optimisation of the BMP products used in combination with cheaper production methods will inevitably stimulate the clinical use of BMPs for bone fracture healing in the near future. Lissenberg-Thunnissen SN, de Gorter DJ, Sier CF, Schipper IB. Int Orthop. 2011 Jun 23. [Epub ahead of print] PMID:  21698428

Internal versus external fixation for unstable distal radius fractures: an up-to-date meta-analysis.

We suggest that the final results are significant and there is some evidence supporting the use of open reduction and internal fixation. Cui Z, Pan J, Yu B, Zhang K, Xiong X. Int Orthop. 2011 Jun 23. [Epub ahead of print] PMID:  21698429

Effect of body weight on the outcome of displaced intracapsular fracture neck of femur treated by internal fixation; a clinical study of 198 patients.

The aim of this study was to assess any possible correlation between body weight and fracture union following displaced intracapsular fractures of the neck of femur treated by a closed reduction and internal fixation. A total of 198 patients with such injuries treated by closed reduction and internal fixation, were recruited retrospectively. Patients were followed up until fracture endpoint (union or non-union) with a minimum follow up of 100 days. The mean body weight for the 118 patients without fracture healing complications was 64.6kg versus 61.8kg for the 80 patients with complications, a difference that was not statistically significant (p=0.17). Analysis of data related to sex and age also found no relationship between weight and fracture healing complications. Our results indicate there is no relationship between body weight and fracture healing complications following displaced intracapsular fractures treated by internal fixation.

Alazzawi S, Mayahi R, Parker MJ. Hip Int. 2011 Jun 6;21(3):340-343. doi: 10.5301/HIP.2011.8385.  [Epub ahead of print] PMID: 21698585

Think WarFighter Prevention: High serum 25-hydroxyvitamin D is associated with low incidence of stress fractures.

There was a monotonic inverse dose-response gradient between serum 25(OH)D and risk of stress fracture. There was double the risk of stress fractures of the tibia and fibula in women with serum 25(OH)D concentration < 20 ng/ml, compared to those with ≥ 40 ng/ml. A target for prevention of stress fractures would be a serum 25(OH)D concentration of > 40 ng/ml, achievable with 4000 IU/day vitamin D(3) supplementation. Burgi AA, Gorham ED, Garland CF, Mohr SB, Garland FC, Zeng K, Thompson K, Lappe JM. J Bone Miner Res. 2011 Jun 22. doi: 10.1002/jbmr.451. [Epub ahead of print] Naval Health Research Center, San Diego, California.

Surgical Site Infection: Prevention and Treatment of Surgical Site Infection.

Free Online Book via NCBI Bookshelf

National Collaborating Centre for Women's and Children's Health (UK).

London: RCOG Press; 2008 Oct.PMID: 21698848 [PubMed]

Arthroscopy: The Journal of Arthroscopic & Related Surgery July 2011 27(7)

Latest issue now available.

Articles in Press

Single-row repair versus double-row repair of full-thickness rotator cuff tears.

Despite the fact that double-row repair shows a significantly higher rate of tendon healing and greater external rotation than does single-row repair, there is no significant improvement in shoulder function, muscle strength, forward flexion, internal rotation, patient satisfaction, or return to work. Prasathaporn N, Kuptniratsaikul S, Kongrukgreatiyos K. Arthroscopy. 2011 Jul;27(7):978-85. PMID: 21693349

Electromechanical Delay of the Knee Flexor Muscles After Harvesting the Hamstrings for Anterior Cruciate Ligament Reconstruction.

Although the EMD of ST and BF was significantly increased due to fatigue, as expected, their synchronization pattern as identified by the difference in their EMDs remained the same. Thus, the reconstructed knee responded in a balanced manner and the hamstrings firing pattern remained the same, despite the intervention to the ST tendon. Ristanis S, Tsepis E, Giotis D, Zampeli F, Stergiou N, Georgoulis AD. Clin J Sport Med. 2011 Jun 18. [Epub ahead of print] PMID:  21694593

Medical students create free medical translation app, conquering language barriers to patient care

MediBabble uses touch-screen software that allows health care providers to play medical history questions and instructions out loud, so far in five languages. From questions as simple as “Can you tell me your name?” to more specific inquiries like, “Do you get recurring lung infections?” the app translates more than 2,500 exam questions into Russian, Spanish, Cantonese, Mandarin and Haitian Creole. MedicalXpress

The arrangement and the attachment areas of three ACL bundles

This study clarified the arrangement of three fiber bundles of ACL and detailed geographical locations of their attachment sites. The detailed anatomic description of the natural ACL attachment might suggest to surgeons where to make tunnels during anatomical double/triple bundle ACL reconstruction.  Otsubo H, Shino K, Suzuki D, Kamiya T, Suzuki T, Watanabe K, Fujimiya M, Iwahashi T, Yamashita T. Knee Surg Sports Traumatol Arthrosc. 2011 Jun 22. [Epub ahead of print] PMID: 21695467

New Issue of "Foot & Ankle International" Available Online

Foot & Ankle International July 2011 (Vol. 32 #7)

Spinal Manipulation Brings Only Minor Improvement in Chronic Back Pain, Systematic Review Finds

Spinal manipulative therapy (SMT) has significant but very small benefits for patients with chronic low back pain, according to a special review article in the June 1 issue of Spine.

Question:  How many Chiropractors does it take to screw in a light bulb?

A technique to remove a well-fixed titanium-coated RM acetabular cup in revision hip arthroplasty.

A major concern during revision hip arthroplasty is acetabular bone loss and bleeding during the extraction of well-fixed cementless acetabular cup, because no interface exists between the host bone and the cup. Forceful removal of such component using curved gouges and osteotomes often leads to extended bone loss and compromises reimplantation of a new socket. In the following case report, we removed a well-fixed polyethylene titanium-coated RM acetabular cup with 20 years of follow-up, by significant wear of the polyethylene layer. The isoelastic femoral stem was also removed by mechanical failure. We report a technique for removal of the cementless acetabular cup using powered acetabular reamers. The RM cup was sequentially reamed and when the polyethylene layer was thin enough, the remaining cup was removed easily by hand tools. The acetabular bone stock is preserved and the risks of bone fractures and bleeding are minimized. To our knowledge, these principles were applied only in cemented cups. We have used this technique in 10 cases with excellent results and no complications were noted. This is a simple, reproducible, non-costly, non-timing consuming, safe and successful technique to remove well-fixed titanium-coated RM acetabular cups. Judas FJ, Dias RF, Lucas FM. J Orthop Surg Res. 2011 Jun 20;6(1):31. [Epub ahead of print] PMID: 21689456

Peripartum pubic symphysis separation: a case report and review of the literature.

Although peripartum pubic symphysis diastasis is an uncommon complication of delivery, it can lead to considerable and sometimes long-term disability. Although the initial clinical examination and diagnostic workup for this complication are relatively straightforward, the best treatment for a peripartum pubic symphysis diastasis is less clear. Historically, nearly all women were treated conservatively with bed rest and pelvic binders. However, more recent case reports have described more invasive orthopedic procedures being used to help speedy recovery. In this study, we present a case of a 22-year-old primigravida who had a severe pubic symphysis separation after a vaginal delivery complicated by a shoulder dystocia. We also reviewed the literature on this topic over the past 20 years to gain a better understanding of the clinical factors surrounding peripartum pubic symphysis separation and the treatment option available to women with this complication. Target Audience: Obstetricians & Gynecologists Learning Objectives: After completing this CME activity, physicians should be better able to identify the clinical factors that associated with peripartum pubic symphysis separation; perform a diagnostic workup when a peripartum pubic symphysis separation is suspected; distinguish the conservative and invasive orthopedic interventions available for the treatment of peripartum pubic symphysis separation; and show that the degree of patient disability after peripartum pubic symphysis separation varies greatly and no clinical factors or diagnostic studies effectively predict the course of patient recovery. Nitsche JF, Howell T. Obstet Gynecol Surv. 2011 Mar;66(3):153-8. PMID: 21689485

Tendon fixation in arthroscopic latissimus dorsi transfer for irreparable posterosuperior cuff tears: An in vitro biomechanical comparison of interference screw and suture anchors.

The fixation of the tendon to the bone remains a challenging problem in the latissimus dorsi tendon transfer for irreparable cuff tears and can lead to unsatisfactory results. A new arthroscopic method of tendon to bone fixation using an interference screw has been developed and the purpose of this study was to compare its biomechanical properties to the ones of a standard fixation technique with anchors. Diop A, Maurel N, Chang VK, Kany J, Duranthon LD, Grimberg J. Clin Biomech (Bristol, Avon). 2011 Jun 18. [Epub ahead of print] PMID: 21689873

Traumatic Floating Clavicle: A Case Report.

Most published reports of a floating clavicle consist of a dislocation of both ends of the clavicle and are associated with a high-energy injury. We report a 71 year old patient with a fracture of the medial end of the clavicle with anterior sternoclavicular dislocation and a nondisplaced fracture of the lateral end of the same clavicle distal to the insertion of coracoclavicular ligaments due to a low velocity fall. Serra JT, Tomas J, Batalla L, Pedemonte J, Pacha D, Molero V, Carrera L. J Orthop Trauma. 2011 Jun 17. [Epub ahead of print] PMID: 21691221 Link to Publish Ahead of Print

Fracture blisters.

Fracture blisters are a relatively uncommon complication of fractures in locations of the body, such as the ankle, wrist elbow and foot, where skin adheres tightly to bone with little subcutaneous fat cushioning. The blister that results resembles that of a second degree burn.These blisters significantly alter treatment, making it difficult to splint or cast and often overlying ideal surgical incision sites. Review of the literature reveals no consensus on management; however, most authors agree on early treatment prior to blister formation or delay until blister resolution before attempting surgical correction or stabilization. Uebbing CM, Walsh M, Miller JB, Abraham M, Arnold C. West J Emerg Med. 2011 Feb;12(1):131-3. PMID: 21691490 PDF

The effect of open Bristow-Latarjet procedure for anterior shoulder instability: a 10-year study.

Operative procedures are the usual treatment for patients with anterior traumatic shoulder instabilities. Soft tissue procedures, Bankart repair, cannot be performed in some patients. They need Bristow-Latarjet one. We decided to determine midterm results of this procedure in almost all types of anterior shoulder instability, even shoulders with Bankart lesion in non-athletic cases. Thirty patients after Bristow-Latarjet procedure from 1997 to 2007 were followed 2-8 years. Clinical outcomes, consisted of muscle strength, range of motion (mean 8.66 degrees decreased in external rotation with arm in neutral position and 18.33 with arm in 90 degrees of abduction), recurrent instability (no relapse), and Rowe score (mean 77.66) showed good to excellent results. We had no screw-related or neurovascular complications. Thirty percent of cases had signs of mild arthropathy. Although Bankart procedure is the preferred method in patients with isolated Bankart lesion, but we can perform Bristow-Latarjet for all types of anterior traumatic shoulder instability in non-athletics cases with acceptable results. Emami MJ, Solooki S, Meshksari Z, Vosoughi AR. Musculoskelet Surg. 2011 Jun 21. [Epub ahead of print] PMID: 21691734

Human dermal matrix scaffold augmentation for large and massive rotator cuff repairs: preliminary clinical and MRI results at 1-year follow-up.

The high incidence of recurrent tendon tears after repair of massive cuff lesions is prompting the research of materials aimed at mechanically or biologically reinforcing the tendon. Among the materials studied upto now, the extracellular matrix (ECM) scaffolds of human origin have proved to be the safest and most efficient, but the current laws about grafts and transplants preclude their use in Europe. In order to overcome this condition in 2006, we started a project regarding the production of an ECM scaffold of human origin which could be implanted in Europe too. In 2009, the clinical study began with the implantation of dermal matrix scaffolds in 7 middle-aged patients affected with large/massive cuff lesions and tendon degeneration. Out of 5 cases, followed for at least 1 year in which the scaffold was employed as an augmentation device, there were 3 patients with complete healing, 1 partial re-tear, and 1 total recurrence. The absence of adverse inflammatory or septic complications allows to continue this line of research with a prospective controlled study in order to define the real advantages and correct indications offered by scaffold application. Rotini R, Marinelli A, Guerra E, Bettelli G, Castagna A, Fini M, Bondioli E, Busacca M. Musculoskelet Surg. 2011 Jun 21. [Epub ahead of print] PMID: 21691735

Treatment of Jones Fracture Nonunion with Isolated Intramedullary Screw Fixation.

Although the treatment of acute Jones fractures is well described in published studies, the Jones fracture nonunion is more controversial with regard to treatment. Although nonoperative treatment is an option, surgery is the usual course. We conducted a retrospective case series of 7 patients (1 man and 6 women; age range, 39 to 54 years), who were initially treated nonoperatively for acute Jones fractures. They went on to develop nonunions and were treated with intramedullary screw fixation. All patients had healed radiographically by 11 weeks postoperatively. One screw (14.29%) required removal because of irritation. None of the patients to date have experienced a new fracture. Our results indicate that intramedullary screw fixation alone without bone grafting is a viable option for Jones fracture nonunions. Thomas JL, Davis BC.

J Foot Ankle Surg. 2011 Jun 16. [Epub ahead of print] PMID: 21684181  PDF

Testing procedures for SLAP lesions of the shoulder involving contraction and torsion of biceps long head and glenohumeral glides.

Testing procedures for SLAP lesions of the shoulder can combine resisted elbow flexion, forearm pronation and supination, and glenohumeral glides. These procedures reproduce symptoms by increasing biceps long head active tension or passive torsion, and by placing the shoulder in an unstable position. We compared activation of biceps long head and pain intensity, between supinated and pronated forearm positions, between different glides, and between individuals with and without shoulder impairment. A case control study.  Misra S, Watson L, Taylor NF, Green RA, Hairodin Z. J Sci Med Sport. 2011 Jun 16. [Epub ahead of print] PMID:  21684203

Validity of outcome measures used to assess one and six month outcomes in orthopaedic trauma patients.

To evaluate the validity of the 12-item Short Form Health Survey (SF-12), Sickness Impact Profile (SIP) and the Short Musculoskeletal Functional Assessment Questionnaire (SMFA) for use in an orthopaedic trauma population. Gosling CM, Gabbe BJ, Williamson OD, Sutherland AM, Cameron PA. Injury. 2011 Jun 17. [Epub ahead of print] PMID: 21684543

Arthroscopic-Assisted Reduction and Percutaneous Cannulated Screw Fixation for Ideberg Type III Glenoid Fractures: A Minimum 2-year Follow-up of 18 Cases.

Traditionally, open reduction and internal fixation is an acceptable choice for treating displaced glenoid articular fracture. Considering some major complications associated with open surgery, however, surgeons have explored a less invasive way to achieve fixation. Purpose: This investigation was undertaken to evaluate the clinical results of arthroscopic-assisted reduction and percutaneous cannulated screw fixation for the treatment of Ideberg type III glenoid fractures. Yang HB, Wang D, He XJ. Am J Sports Med. 2011 Jun 17. [Epub ahead of print] PMID: 21685317

Which is the Preferred Revision Technique for Loosened Iliac Screw?: A Novel Technique of Boring Cement Injection From the Outer Cortical Shell.

Wadding corticocancellous bone and increasing screw length failed to provide sufficient anchoring strength for a loosened iliac screw; however, both traditional and boring PMMA-augmented techniques could effectively increase the fixation strength. On the basis of the viewpoint of minimal invasion, the boring PMMA augmentation may serve as a suitable salvage technique for iliac screw loosening. Yu BS, Yang ZK, Li ZM, Zeng LW, Wang LB, Lu WW. J Spinal Disord Tech. 2011 Jun 16. [Epub ahead of print] PMID: 21685804

Fiber components of the shoulder superior labrum.

The superior labrum is not homogenous. The posterior portion mainly consists of the robust fiber component of the long head of the biceps tendon. The anterosuperior portion includes fibers of the sheet-like structure which contains numerous elastic fibers. Tensile stress from the rotator interval might be conveyed to the anterosuperior labrum. Arai R, Kobayashi M, Toda Y, Nakamura S, Miura T, Nakamura T. Surg Radiol Anat. 2011 Jun 19. [Epub ahead of print] PMID:  21688137

A pre-operative approach of range of motion simulation and verification for femoroacetabular impingement.

Femoroacetabular impingement (FAI) is increasingly recognized as a potential cause of hip osteoarthritis. A system capable of pre-operatively simulating hip range of motion (ROM) by given surface models from either healthy or FAI diseased bone is desirable. Chang TC, Kang H, Arata L, Zhao W. Int J Med Robot. 2011 Jun 18. doi: 10.1002/rcs.401. [Epub ahead of print] PMID: 21688380

New Ortho Books Soon to be Released

The Poly-Traumatized Patient with Fractures: A Multi-Disciplinary Approach by Hans-Christoph Pape, Roy Sanders and Joseph Borrelli Jr. (Jul 29, 2011)

Oxford Textbook of Trauma and Orthopaedics by Christopher Bulstrode, James Wilson-MacDonald, Jeremy Fairbank and Tim Briggs (Jul 1, 2011)

Perioperative Care of the Orthopedic Patient: The Hospital for Special Surgery Manual by Charles N. Cornell, Ronald MacKenzie and Stavros G. Memtsoudis (Jul 1, 2011)

Shoulder Arthroscopy by James Tibone, Felix H. III Savoie and Benjamin Shaffer (Jul 1, 2011)

Armed Conflict Injuries to the Extremities: A Treatment Manual by Alexander Lerner and Michael Soudry (Jun 29, 2011)

New device could revolutionize major knee surgery

Researchers from the University of Aberdeen’s School of Engineering in partnership with Mr Martyn Snow, a leading specialist in joints and cartilage at the Royal Orthopaedic Hospital, have developed a new fixation mechanism which could improve the success rate in cruciate knee ligament surgery. medicalxpress.com

Pocket Body iPad Anatomy app helps improve anatomical understanding

Pocket Body [Musculoskeletal] demonstrates the full range of capabilities of the iPad. This medical app has recently undergone a major update. It now includes information on nerves, arteries and veins as well as an improved lateral view. imedicalapps.com