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Saturday, July 2, 2011

Spine Journal Takes Aim at Infuse Research

Bone morphogenetic protein 2
The Spine Journal is devoting an entire issue to critical reviews of
published studies of Medtronic's bone morphogenetic protein-2 product known as Infuse, a unprecedented publishing event that was prompted in part by a Milwaukee Journal Sentinel/Medpage Today investigation. MedPageToday

Rivaroxaban Wins FDA Approval for DVT Prevention

The FDA has approved rivaroxaban (Xarelto), an oral, once-daily, factor Xa inhibitor, for prevention of deep vein thrombosis in patients undergoing knee or hip replacement surgery, according to an announcement by Janssen Pharmaceuticals. MedPageToday

Medtronic’s New CD Horizon Fenestrated Screw Spinal System

Medtronic launched the CD HORIZON Fenestrated Screw Spinal System, initially making it available in Europe.  The device features screws through which bone cement can be injected to establish an anchor for the screws within fragile, osteopenic bones. MedGadget

Earlier exit from hospital after hip operation

Discharged from the hospital within two days of a total hip replacement operation? It’s possible, thanks to the new 'Fast Track' protocol that underwent testing in the U.S., in response to both patient requests for shorter hospital stays and economic realities of providing medical care. According to Dr. Lawrence Gulotta and colleagues, from Hospital for Special Surgery in New York, a carefully screened group of patients undergoing total hip replacement can be discharged from the hospital two days after surgery, without any increase in complications or adverse effects compared with the more traditional protocol. Their work is published online in Springer's HSS Journal. Springer
Note: This journal is not indexed in PubMed

Thursday, June 30, 2011

The Journal of Hand Surgery Volume 36, Issue 7, Pages A1-A32, 1131-1266 (July 2011)

Articles in Press

New Article RSS Feed :

Review: minimally invasive versus conventional dynamic hip screw fixation in elderly patients with intertrochanteric fractures: a systematic review and meta-analysis.

There was no significance difference between the 2 groups with regard to postoperative complications and implant position. The MIDHS technique may achieve perioperative benefits when compared with the CDHS technique. Tao Cheng, Guoyou Zhang, Xianlong Zhang. Surg Innov. 2011 Jun;18(2):99-105. PMID: 21712233

Surgical repair of the distal biceps brachii tendon: a comparative study of three surgical fixation techniques.

In summary, we achieved good clinical and functional results after surgical repair of the distal biceps tendon using Corkscrews, Mitek anchors, or transosseous sutures. The results conferred by Corkscrews were comparable to the other techniques, justifying their use. Citak M, Backhaus M, Seybold D, Suero EM, Schildhauer TA, Roetman B. Knee Surg Sports Traumatol Arthrosc. 2011 Jun 29. [Epub ahead of print] PMID: 21713413

Evidence-based treatment of open ankle fractures.

There is a lack of high quality literature concerning the (operative) treatment of patients with open ankle fractures. Remarkable is that most authors reported satisfactory results after performance of their treatment protocol. Based on the available literature, we formulated guidelines regarding: timing of operative treatment, wound irrigation, the role of internal fixation, wound coverage and closure, the use of antibiotics and additional therapies. Hulsker CC, Kleinveld S, Zonnenberg CB, Hogervorst M, van den Bekerom MP. Arch Orthop Trauma Surg. 2011 Jun 29. [Epub ahead of print] PMID: 21713539

Google+ for doctors, and why physicians should be careful

So, how should physicians handle Google+?

Similar to the way doctors should use Facebook.  I’ve recommended in the past that physicians maintain two profiles, a personal one to share only with close family and friends, and a professional page that is open to the public.  As far as I can tell, Google+ offers no such personal-professional differentiation.  So if you join, it’s imperative that your pictures and personal content be well-vetted before you post.  Since this is a Google product, there’s a greater chance that what’s found on Google+ will be indexed in the search engine.

Google Circles has the potential to be that application to isolate your professional identity (you can selectively share content with different groups), and physicians need to be vigilant in using that feature.  For now, be careful about what you put on your Google Profile.

J Foot Ankle Surg. 2011 Jul-Aug;50(4)

1. The hematoma block: a simple, effective technique for closed reduction of ankle fracture dislocations. Ross A, Catanzariti AR, Mendicino RW. J Foot Ankle Surg. 2011 Jul-Aug;50(4):507-9. PMID: 21708343 PDF
2. Misdiagnosis of OTA Type B (Weber B) Ankle Fractures Leading to Nonunion. Donken CC, van Laarhoven CJ, Edwards MJ, Verhofstad MH. J Foot Ankle Surg. 2011 Jul-Aug;50(4):430-3. PMID: 21708342 PDF
3. Displacement of the anterior process of the calcaneus after evans calcaneal osteotomy. Dunn SP, Meyer J. J Foot Ankle Surg. 2011 Jul-Aug;50(4):402-6. PMID: 21708341 PDF
4. Identifying Risk Factors in Subtalar Arthroereisis Explantation: A Propensity-matched Analysis. Cook EA, Cook JJ, Basile P. J Foot Ankle Surg. 2011 Jul-Aug;50(4):395-401. PMID:  21708340
5. Arthroplasty or arthrodesis. Malay DS. J Foot Ankle Surg. 2011 Jul-Aug;50(4):373. No abstract available. PMID:  21708339 PDF

J Foot Ankle Surg link to Articles in Press
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Wednesday, June 29, 2011

Surgical simulators and hip fractures: a role in residency training?

Orthopedic surgery residency training requires intellectual and motor skill development. In this study, we utilized a computer-based haptic simulator to examine a potential model for evaluation of resident proficiency and efficiency in the placement of a center guide wire during fixation of an intertrochanteric proximal femur fracture. We hypothesize the junior residents will utilize more fluoroscopy and require more time to complete the task. Froelich JM, Milbrandt JC, Novicoff WM, Saleh KJ, Allan DG. J Surg Educ. 2011 Jul-Aug;68(4):298-302. Epub 2011 Apr 16. PMID: 21708367 PDF

J Surg Educ. articles in press

Knee Surgery, Sports Traumatology, Arthroscopy - [Epub ahead of print]

1. Endoscopic versus open bursectomy of lateral malleolar bursitis. Choi JH, Lee KT, Lee YK, Kim DH, Kim JR, Chung WC, Cha SD. Knee Surg Sports Traumatol Arthrosc. 2011 Jun 28. [Epub ahead of print]PMID: 21710113
2. Isokinetic muscle strength and knee function associated with double femoral pin fixation and fixation with interference screw in anterior cruciate ligament reconstruction. Fernandes TL, Protta TR, Fregni F, Neto RB, Pedrinelli A, Camanho GL, Hernandez AJ. Knee Surg Sports Traumatol Arthrosc. 2011 Jun 28. [Epub ahead of print] PMID: 21710112
3. Anatomic double-bundle and over-the-top single-bundle with additional extra-articular tenodesis: an in vivo quantitative assessment of knee laxity in two different ACL reconstructions. Zaffagnini S, Signorelli C, Lopomo N, Bonanzinga T, Marcheggiani Muccioli GM, Bignozzi S, Visani A, Marcacci M. Knee Surg Sports Traumatol Arthrosc. 2011 Jun 28. [Epub ahead of print] PMID: 21710111
4. Bony and soft tissue landmarks of the ACL tibial insertion site: an anatomical study. Ferretti M, Doca D, Ingham SM, Cohen M, Fu FH. Knee Surg Sports Traumatol Arthrosc. 2011 Jun 28. [Epub ahead of print] PMID: 21710110

Surgical Technique: Revision ACL Reconstruction With a Rectangular Tunnel Technique.

We developed the rectangular tunnel ACL reconstruction (RT ACLR) using a 10-mm wide bone-patellar tendon-bone (BTB) graft through rectangular tunnels with a rectangular aperture to reduce tunnel size: the cross-sectional area of the tunnels of 50 mm(2) (5 × 10 mm) in RT ACLR is less than that of 79 mm(2) in a conventional 10-mm round tunnel technique presuming the technique would be more suitable in revision ACLR with previous improperly placed tunnels. Shino K, Mae T, Nakamura N. Clin Orthop Relat Res. 2011 Jun 28. [Epub ahead of print] PMID: 21710294

Revision of the Shoulder Normalization tests is required to include rhomboid major and teres major.

The four "Shoulder Normalization Tests" were found previously to be a parsimonious set of isometric tests that produce maximal voluntary isometric contractions (MVIC) in the supraspinatus, infraspinatus, subscapularis, trapezius, serratus anterior, deltoid, latissimus dorsi, and pectoralis major [Boettcher et al. (2008). J Orthop Res 26:1591-1597]. However, these tests have not been validated for rhomboid major and teres major.  Ginn KA, Halaki M, Cathers I. J Orthop Res. 2011 Jun 27. doi: 10.1002/jor.21488. [Epub ahead of print] PMID: 21710606 PDF

Stanmore’s Juvenile Extendible Femoral System Gets U.S. Green Light

UK-based Stanmore Implants received FDA approval for its Juvenile Tumour System (“JTS”) non-invasive extendible distal femoral replacement.  Indicated for use in pediatric ortho oncology surgeries, the implant can later be slowly extended using an external magnet system without having to perform another invasive procedure on the patient. MedGadget

Osteoarthritis incidence significantly higher among US military personnel

New research shows significantly higher osteoarthritis (OA) incidence rates in military populations than among comparable age groups in the general population. The magnitude of the difference in OA rates between military service members and the general population also increased with advancing age category. Black service members had higher OA rates than white military personnel or those in other race categories according to the study findings published in Arthritis & Rheumatism, a peer-reviewed journal of the American College of Rheumatology (ACR).  Eurekalert!

Related article:
Hsiao M, Owens BD, Burks R, Sturdivant RX, Cameron KL. Am J Sports Med. 2010 Oct;38(10):1997-2004. Epub 2010 Jul 8. PMID: 20616375 [PubMed - indexed for MEDLINE] Related citations PDF

Tuesday, June 28, 2011

Complications following autologous bone graft harvesting from the iliac crest and using the RIA: A systematic review.

Bone grafting is a commonly performed surgical procedure to augment bone regeneration in a variety of cases in orthopaedic and maxillofacial surgery. Autologous bone graft remains to be the 'gold standard' and the iliac crest to be the most common harvesting site. The intramedullary canal of long bones represents another potential site for large volume of autologous bone graft harvesting and is recently being used as an alternative donor site. However, harvesting of autologous bone graft is associated with morbidity and a number of complications. The aim of this systematic review was to collect and summarise the existing data on reported complications after harvesting autologous bone from the iliac crest (anterior and posterior) and the long bone intramedullary canal using the RIA device. Dimitriou R, Mataliotakis GI, Angoules AG, Kanakaris NK, Giannoudis PV. Injury. 2011 Jun 24. [Epub ahead of print] PMID: 21704997 PDF

Journal of Bone & Joint Surgery - British Volume 93B(7) pgs. 857-1000 July 2011

1. Neuritis ossificans of the tibial, common peroneal and lateral sural cutaneous nerves. Katz LD, Lindskog D, Eisen R. J Bone Joint Surg Br. 2011 Jul;93(7):992-4. PMID: 21705578  
Long-term results of conservative treatment of Sanders type 4 fractures of the calcaneum: A SERIES OF 64 CASES. Gurkan V, Dursun M, Orhun H, Sari F, Bulbul M, Aydogan M. J Bone Joint Surg Br. 2011 Jul;93(7):975-9. PMID: 21705574
3. The biomechanical performance of locking plate fixation with intramedullary fibular strut graft augmentation in the treatment of unstable fractures of the proximal humerus. Bae JH, Oh JK, Chon CS, Oh CW, Hwang JH, Yoon YC. J Bone Joint Surg Br. 2011 Jul;93(7):937-41. PMID: 21705567 [PubMed - in process]
4. Percutaneous screw fixation without bone grafting for established scaphoid nonunion with substantial bone loss. Mahmoud M, Koptan W. J Bone Joint Surg Br. 2011 Jul;93(7):932-6. PMID: 21705566 [PubMed - in process]
5. A brief report on managing infected nonunion of a high tibial osteotomy in two stages: A CASE SERIES INVOLVING SEVEN KNEES. Karatosun V, Demir T, Unver B, Gunal I. J Bone Joint Surg Br. 2011 Jul;93(7):904-6. PMID: 21705561 [PubMed - in process]
Bachhal V, Sankhala SS, Jindal N, Dhillon MS. J Bone Joint Surg Br. 2011 Jul;93(7):897-903. PMID: 21705560 [PubMed - in process]

The hidden costs of your favorite medical apps

Medical apps are becoming big business. Epocrates is now a publicly traded company worth nearly $500 million. Medscape is owned by WebMD, another publicly traded company worth nearly $3 billion. Despite the clearly powerful financial factors at play here, the most popular and comprehensive apps are free. Even for fee-based apps, the prices and volumes don’t explain the overall financial pictures of the companies behind them. Clearly the money is not coming from the physicians, medical students, and other healthcare professionals who are using these apps. iMedicalApps

The American Journal of Sports Medicine [Epub ahead of print]

1. Chronic Tears of the Reflected Head of the Rectus Femoris: Results of Operative Treatment. (PDF) Wittstein J, Klein S, Garrett WE. Am J Sports Med. 2011 Jun 24. [Epub ahead of print] PMID: 21705650
Chhadia AM, Inacio MC, Maletis GB, Csintalan RP, Davis BR, Funahashi TT. Am J Sports Med. 2011 Jun 24. [Epub ahead of print] PMID: 21705649
Pascarella A, Alam M, Pascarella F, Latte C, Di Salvatore MG, Maffulli N.
Am J Sports Med. 2011 Jun 24. [Epub ahead of print] PMID: 21705648

Fracture status in men assessed by quantitative ultrasound measurements at the calcaneus.

Objectives- The aim of the study was to assess fracture status in men by quantitative ultrasound measurements at the calcaneus. The diagnostic accuracy of quantitative ultrasound measurements was evaluated at baseline and follow-up. Methods- We observed 165 men (baseline age ± SD, 59.84 ± 10.6 years) recruited from an outpatient osteoporosis clinic. The mean follow-up duration was approximately 101.3 ± 35 months. There was no difference in either age or body mass index at baseline between the patients with a fracture history (n = 30) and the others (n = 135). The following fractures were identified at baseline: ankle, 15; wrist, 10; rib, 9; foot, 5; and hip, 1. The speed of sound (meters per second), broadband ultrasound attenuation (decibels per megahertz), and stiffness index (percent) were measured with a quantitative ultrasound device. The date of fracture occurrence at follow-up was defined as the final point. Results- In the patients with a fracture history, the ultrasound variables were significantly lower than those in the rest of the group (P < .05). During the follow-up period, fractures occurred in 21 patients (wrist, 11; ankle, 5; rib, 3; hip, 1; and humerus, 1), and the ultrasound outcomes were nonsignificantly lower in the fractured men. The risk of fracture was estimated by the Cox regression analysis. A prior fracture was the only factor that significantly (4 times) increased the risk of a subsequent fracture (hazard ratio, 4.21; 95% confidence interval, 1.81-9.86; P < .001). Conclusions- Calcaneus ultrasound measurements can distinguish between patients with fractures and those without. In follow-up, ultrasound measurements did not indicate an increased fracture risk; a prior osteoporotic fracture was the major prognostic factor. Pluskiewicz W, Wilk R, Wielg√≥recki A, Golba KS, Drozdzowska B. J Ultrasound Med. 2011 Jul;30(7):877-82. PMID: 21705719

Primary internal fixation and soft-tissue reconstruction in the treatment for an open Lisfranc fracture-dislocation.

The importance of anatomical reduction for improved outcome has been recognised in the management of Lisfranc injuries. Operative fixation is indicated in case of dislocation or unstable ligamentous injury, because discongruity of the Lisfranc joint can lead to deleterious functional outcome. Screws are the recommended method of fixation of the medial en middle column, and K-wires are used for stabilisation of the unstable lateral column. Primary arthrodesis can provide advantages in pure ligamentous injury. In the management of complex open Lisfranc fractures, external fixation with K-wires can be used, but often results in a high percentage of arc deformities and functional limitations. In recent years, there is a progressive change from external to internal fixation in primary stabilisation of open fractures. This case report describes the treatment for a grade III open Lisfranc fracture-dislocation by use of primary internal fixation and soft-tissue reconstruction. Sanli I, Hermus J, Poeze M. Musculoskelet Surg. 2011 Jun 25. [Epub ahead of print] PMID: 21706153

Hip fracture management, before and beyond surgery and medication: a synthesis of the evidence.

Multidisciplinary medical management of patients with hip fractures is being improved within the hospital environment resulting in earlier discharge with decreased morbidity. There is evidence to show the benefits to patients with hip fractures from peripheral modalities within the hospital; however unless resident in a facility, multidisciplinary management is not clearly of benefit. O'Malley NT, Blauth M, Suhm N, Kates SL. Arch Orthop Trauma Surg. 2011 Jun 25. [Epub ahead of print] PMID: 21706188

Arthroscopic repair of type II superior labrum anterior posterior (SLAP) lesions in patients over the age of 45 years: a prospective study.

Superior labrum anterior posterior (SLAP) lesions are a well-defined cause of shoulder pain and disability and may occur in conjunction with rotator cuff tears. This study was designed to prospectively evaluate the minimum 2 year results of arthroscopic repair of type II SLAP lesions in patients over the age of 45 years with and without rotator cuff tears. Kanatli U, Ozturk BY, Bolukbasi S. Arch Orthop Trauma Surg. 2011 Jun 26. [Epub ahead of print] PMID: 21706304

Military static line parachuting injuries seen by the airborne battalion provider.

Military static line parachuting exposes jumpers to a variety of novel methods of injury. Providers assigned to Airborne units need to develop and maintain a high index of suspicion when dealing with jump-related injuries. Understanding the incident rate and the mechanism of injury can help a provider better identify injuries based on the history of the incidence and develop that index of suspicion. Injuries can happen at almost any point during the jump process and each step has both common and unique injuries associated with it. In addition to identifying, managing, and treating the injuries involved, providing information on estimated time until return to duty can be beneficial for the commander. In the end, a provider?s best tools for managing Airborne-related injuries are an understanding of Airborne operations, quality orthopedic skills, and a high index of suspicion. Healy ML. J Spec Oper Med. 2011 Spring;11(2):45-51.