Clinical anatomy of the coccyx: A systematic review.

Note: Special Clinical Anatomy Issue on Cadaver Use in Trauma Research Click for Access

Abstract: The coccyx has been relatively neglected in anatomical research which is surprising given the population prevalence of coccydynia and our inadequate understanding of its etiology. This systematic review analyzes available information on the clinical anatomy of the coccyx. A literature search using five electronic databases and standard anatomy reference texts was conducted yielding 61 primary and 7 secondary English-language sources. This was supplemented by a manual search of selected historical foreign language articles. The coccygeal vertebrae, associated joints, ligaments and muscles, coccygeal movements, nerves, and blood supply were analyzed in detail. Although the musculoskeletal aspects of the coccyx are reasonably well described, the precise anatomy of the coccygeal plexus and its distribution, the function of the coccygeal body, and the anatomy of the sacrococcygeal zygapophyseal joints are poorly documented. Further research into the anatomy of the coccyx may clarify the etiopathogenesis of coccydynia which remains uncertain in one-third of affected patients.Woon JT, Stringer MD. Clin Anat. 2011 Jul 7. [Epub ahead of print] PMID: 21739475

American Orthopaedic Society for Sports Medicine's Annual Meeting in San Diego July 2011 Part II

Study identifies patients who should not undergo surgery for a snapping hip tendon.  Researchers at Hospital for Special Surgery have identified a group of patients who may have increased difficulty for surgical treatment of a snapping psoas, a condition that usually develops because a teenager or young adult has a pelvis that grows faster than their psoas tendon. The study will be presented at the annual meeting of the American Orthopaedic Society for Sports Medicine (AOSSM), held July 7-11 in San Diego. Eurekalert!

Arthroscopic treatment of common hip problem improves range of motion. Arthroscopic treatment of a common hip problem that leads to arthritis is successful in terms of restoring range of motion, according to results from a recent Hospital for Special Surgery study. The study will be presented at the annual meeting of the American Orthopaedic Society for Sports Medicine, held July 7-11 in San Diego. "This is the first study to show that in patients who are being treated for hip impingement with arthroscopy, not only do we restore their mechanical measurements, but by doing so, we have improved their functional range of motion across the joint," said Bryan T. Kelly, M.D., co-director of the Center for Hip Pain and Preservation at Hospital for Special Surgery in New York. Eurekalert!

Loss of motion after knee surgery may increase osteoarthritis risk, research suggests.  The study examined data from 780 patients who were at least five years after ACL reconstruction with a patellar tendon graft. In individual follow-ups, patients were evaluated and rated based on knee range of motion tests and radiographs. The percentage of patients with normal radiographs (no arthritic changes in the knee) was 71 percent in patients with normal range of motion compared to 55 percent of patients who showed deficits in motion. In patients who had similar meniscus removal, osteoarthritis was observed more in patients who had motion deficits. Eurekalert!

Arthroscopy and open surgery are equally efficacious in treating common hip problem in most patients.   Researchers at Hospital for Special Surgery have found that in comparison to open surgery, arthroscopic treatment of a common hip problem that leads to arthritis produces similar outcomes in terms of repairing structural problems in most patients. The study will be published in the July 2011 TK issue of the American Journal of Sports Medicine. Eurekalert!

Male smokers less likely to need joint replacement surgery of hip or knee

Surprising results from a new study revealed that men who smoke had less risk of undergoing total joint replacement surgery than those who never smoked. Researchers also reported that men who were overweight, or who engaged in vigorous physical activity were more likely to need arthroplasty. Details of this study are now available in Arthritis & Rheumatism via MedicalXpress.com

American Orthopaedic Society for Sports Medicine's Annual Meeting in San Diego July 2011

Previous cancer history increases chances of clotting disorders after knee surgery, study suggests 

 A history of cancer was a significant risk factor for developing blood clotting issues following knee arthroscopy, according to a study being presented at the American Orthopaedic Society for Sports Medicine's Annual Meeting in San Diego. Researchers from the Mayo Clinic in Rochester, Minnesota analyzed the records of more than 12,000 patients who had undergone the common knee procedure. EurekAlert! 

Graft size and patient age may be predictor of need for future ACL revisions A smaller sized hamstring graft in an anterior cruciate ligament (ACL) reconstruction patient less than 20 years old may increase revision rates, according to research presented at the American Orthopaedic Society for Sports Medicine's Annual Meeting in San Diego today. EurekAlert! 

New research points to a possible gender link in knee injuries  Gender may be associated with an increased risk of cartilage lesions in anterior cruciate ligament (ACL) injured knees, according to research being presented at the American Orthopaedic Society for Sports Medicine's Annual Meeting in San Diego. EurekAlert! 

ACLS Review App can help you master algorithms, prepare for ACLS Certification [App Review]

Advanced Cardiac Life Support (ACLS) is a critical aspect of medical care, yet can intimidate many physicians-in-training. Whether in code situations for surgical inpatients, new arrivals to the emergency department, or even fellow passengers at an airport, mastery of ACLS algorithms is vital for all healthcare professionals, and can mean the difference between life and death. iMedicalApps

WebLib Launches Free HealthMash iPhone and Android Apps

WebLib LLC (http://weblib.com), a company specializing in search technologies and natural language processing tools, has released new versions of its consumer health search engine HealthMash for users of iPhone and Android mobile phones. These free applications allow users to find relevant health information from a wide variety of trusted medical sources. The apps work as full-scale, portable versions of the HealthMash website. MedicalSmartphones.com

J Am Acad Orthop Surg. 2011 Jul;19(7)

Note: The Journal of the American Academy of Orthopaedic Surgeons is found in NKO via Acedemic OneFile

1. Surgical exposures of the radius and ulna. Catalano LW 3rd, Zlotolow DA, Hitchcock PB, Shah SN, Barron OA. J Am Acad Orthop Surg. 2011 Jul;19(7):430-8. PMID: 21724922

2. Advances in magnetic resonance imaging of articular cartilage. Jazrawi LM, Alaia MJ, Chang G, Fitzgerald EF, Recht MP. J Am Acad Orthop Surg. 2011 Jul;19(7):420-9. PMID: 21724921

3. Multiple myeloma: diagnosis and orthopaedic implications. Scharschmidt TJ, Lindsey JD, Becker PS, Conrad EU. J Am Acad Orthop Surg. 2011 Jul;19(7):410-9. PMID: 21724920

4. Management of distal clavicle fractures. Banerjee R, Waterman B, Padalecki J, Robertson W.

J Am Acad Orthop Surg. 2011 Jul;19(7):392-401.PMID: 21724918

5. Abductor tendon tears of the hip: evaluation and management. Lachiewicz PF.

J Am Acad Orthop Surg. 2011 Jul;19(7):385-91. PMID: 21724917

Femoral-shaft fractures and nonunions treated with intramedullary nails: The role of dynamisation.

Dynamisation of a previously interlocked intramedullary nail is believed to stimulate an osteogenic response due to increased load across the fracture site. The purpose of this study was to retrospectively investigate fracture patterns that could tolerate dynamisation without the risk of major complications.

Papakostidis C, Psyllakis I, Vardakas D, Grestas A, Giannoudis PV. Injury. 2011 Jul 2. [Epub ahead of print] PMID: 21726859

Physicians, Pharma, and “free” medical apps

The medical app industry is a big business, but the apps are no longer the product – the physicians, nurses, and other healthcare providers who use them are. In the first part of this series, we examined some of the financial forces driving the medical app industry. Our focus then was Epocrates, the veritable founder of the industry. As is clearly stated in their recent SEC statement, Epocrates primary revenue stream has become the pharmaceutical industry and as such a key goal has become to further grow their user base by enhancing their free offerings.

Now, one might be tempted to say that this is just one company or even that it is just limited to free apps. iMedicalApps

Get the Sermo mobile app for iPhone and iPad

Ever wish you could have a colleague’s opinion on a tough case, unusual rash, EKG, or Xray finding? Now you can on Sermo - the largest online physician-only network.

Created in 2006 by physicians, for physicians, Sermo is the largest online physician network and the only real-time medicine™ platform. Sermo membership is exclusive to US physicians. Sermo is always FREE, private and secure. MedicalSmartphones.com

Analysis of the Trauma Section of the Orthopaedic In-Training Examination

The OrthopaedicIn-TrainingExaminationis a comprehensive test produced annually by the American Academy of Orthopaedic Surgeons, and was first administered in 1963. At the time of the examination's conception, its objectives were to: (1) measure the knowledge of orthopedic residents and provide objective comparisons; (2) help determine acceptable minimal standards for trainees; and (3) help provide an objective assessment of orthopedic education. We retrospectively reviewed all Orthopaedic In-Training Examinations from 2004 to 2008, with particular focus on the questions listed in the musculoskeletal trauma domain on each year's program director report. The musculoskeletal trauma domain, including topics, recommended answers, and references, was reviewed to provide an educational resource for residents and residency programs when studying or designing educational curricula. The information in this analysis may help in development of a core musculoskeletal trauma knowledge base or facilitate determination of appropriate journal club and didactic lecture content. Taylor BC, Fowler TT. Orthopedics. 2011 Jul 7;34(7):e261-6. PMID: 21717986 HTML (full text)

Research in THA and TKA From the United States Has Declined Over the Past Decade Relative to Other Countries.

Decreasing reimbursement, increasing surgical volumes, and prohibitive institutional review board polices potentially deter residents from entering the subspecialty of joint replacement, while also inhibiting research production by existing surgeons. Our hypothesis is that there has been a decline in total hip arthroplasty (THA) and total knee arthroplasty (TKA) research in the United States relative to other countries over the past decade. Meneghini RM, Russo GS, Lieberman JR. Orthopedics. 2011 Jul 7;34(7):e245-50. PMID: 21717983   HTML (full text)