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Friday, July 29, 2011

Stress fractures, active component, U.S. Armed Forces, 2004-2010.

No abstract.  Lee D; Armed Forces Health Surveillance Center (AFHSC). MSMR. 2011 May;18(5):8-11. No abstract available. PMID: 21793616 PDF

Effects of different initial bundle tensioning strategies on the outcome of double-bundle ACL reconstruction: a cohort study.

The current clinical study does not recommend manual maximum of initial tension applied to the anteromedial or posterolateral bundles with graft tension imbalance at 30 degrees of flexion in double-bundle ACL reconstruction to achieve a better clinical outcome. Muneta T, Koga H, Ju YJ, Yagishita K, Sekiya I. Sports Med Arthrosc Rehabil Ther Technol. 2011 Jul 8;3(1):15. [Epub ahead of print] PMID: 21794179

Tendon phenotype should dictate tissue engineering modality in tendon repair: a review.

Advancements in the technical aspects of tendon repair have significantly improved the treatment of tendon injuries. Arthroscopic techniques, suture material, and improved rehabilitation have all been contributing factors. Biological augmentation and tissue engineering appear to have the potential to improve clinical outcomes as well. After review of the physiology of tendon repair, three critical components of tissue engineering can be discerned: the cellular component, the carrier vehicle (matrix or scaffold), and the bioactive component (growth factors, platelet rich plasma). These three components are discussed with regard to each of three tendon types: Intra-synovial (flexor tendon), extra-synovial (Achilles tendon), and extra-synovial tendon under compression (rotator cuff). Scaffolds, biologically enhanced scaffolds, growth factors, platelet rich plasma, gene therapy, mesenchymal stem cells, and local environment factors in combination or alone may contribute to tendon healing. In the future it may be beneficial to differentiate these modes of healing augmentation with regard to tendon subtype. Gott M, Ast M, Lane LB, Schwartz JA, Catanzano A, Razzano P, Grande DA. Discov Med. 2011 Jul;12(62):75-84. PMID: 21794211

Isolated scaphoid fracture with anterosuperior dislocation of the proximal fragment.

Isolated fracture of the scaphoid with an associated anterosuperior dislocation of the proximal fragment is an extremely rare injury. We present two cases where open reduction and internal fixation through a palmar and dorsal approach was performed. No instances of non-union, necrosis of the proximal fragment of the scaphoid or scapholunate dissociation were noted during a mean follow-up period of 18months. Clinical results (active motion, power grip, DASH) following such injury and intervention are presented. The aetiology of this rare injury is discussed. Durand S, Macquillan A, Delpit X. Chir Main. 2011 Jul 5. [Epub ahead of print] PMID: 21795095

Fractures during Childhood and Adolescence in Healthy Boys: Relation with Bone Mass, Microstructure, and Strength.

In a homogeneous cohort of healthy boys, fractures recorded until 15.2±05 yr of age were associated with lower femoral neck aBMD and with lower distal tibia trabecular vBMD and number, stiffness and failure load. These deficits in bone mineral mass, microstructure and strength could contribute to the occurrence of fractures during growth.  Chevalley T, Bonjour JP, van Rietbergen B, Ferrari S, Rizzoli R. J Clin Endocrinol Metab. 2011 Jul 27. [pub ahead of print] PMID: 21795454

Contrast-enhanced sonographic characterization of the vascularity of the repaired rotator cuff: utility of maximum intensity projection imaging.

The maximum intensity projection technique after contrast-enhanced sonography provides a topographic map of rotator cuff vascularity; the latter has been implicated as an important factor in promoting bone-tendon healing. Approximately 3 months after rotator cuff repair, the suture anchor and peribursal regions showed the most robust vascularity. Maximum intensity projection imaging further establishes that there is a global increase in vascular response at the repair site after exercise.  Adler RS, Johnson KM, Fealy S, Maderazo A, Gallo RA, Gamradt SC, Warren RF. J Ultrasound Med. 2011 Aug;30(8):1103-9. PMID: 21795486

Operative treatment of avascular necrosis of the femoral head after proximal femur fractures in adolescents.

Patients treated for ANFH had good medium-term outcomes after THR for total necrosis and also after VITO for partial necrosis.  Bartoníček J, Vávra J, Bartoška R, Havránek P. Int Orthop. 2011 Jul 28. [Epub ahead of print] PMID: 21796335

Development and Validation of a Computational Model for Investigation of Wrist Biomechanics.

The computational model was able to accurately predict flexion, extension, radial deviation, and ulnar deviation motions in four states: normal (intact), RSL fusion, RSL fusion with the scaphoid distal pole excised, and RSL fusion with both the scaphoid distal pole and triquetrum excised. The model was also able to calculate other parameters of interest that are not easily obtainable experimentally, such as midcarpal forces. This model and modeling approach are anticipated to have value as a predictive clinical tool including effect of injuries or anatomical variations and initial outcome of surgical procedures for patient specific planning and custom implant design.  Majors BJ, Wayne JS. Ann Biomed Eng. 2011 Jul 28. [Epub ahead of print] PMID:  21796501]

Learning of musculoskeletal ligament stress testing in a gross anatomy laboratory.

Human anatomy in physical therapy programs is a basic science course serving as a foundation for subsequent clinical courses. Integration of anatomy with a clinical emphasis throughout a curriculum provides opportunities for reinforcement of previously learned material. Considering the human cadaver laboratory as a fixed cost to our program, we sought opportunities to add value to the resource via vertical integration into a clinical skills course taught later in the curriculum. Krause DA, Youdas JW, Hollman JH. Anat Sci Educ. 2011 Jul 27. doi: 10.1002/ase.248. [Epub ahead of print] PMID: 21796799

Heterotopic ossification in complex orthopaedic combat wounds: quantification and characterization of osteogenic precursor cell activity in traumatized muscle.

Heterotopic ossification frequently develops following high-energy blast injuries sustained in modern warfare. We hypothesized that differences in the population of progenitor cells present in a wound would correlate with the subsequent formation of heterotopic ossification.   Davis TA, O'Brien FP, Anam K, Grijalva S, Potter BK, Elster EA. J Bone Joint Surg Am. 2011 Jun 15;93(12):1122-31. PMID: 21776549

Thursday, July 28, 2011

Risk factors for fractured clavicle in the newborn.

We could not identify significant risk factors that could be dealt with in order to avoid a fractured clavicle being sustained during birth. Most fractured clavicles occur in normal newborns following normal labor and delivery.  Lurie S, Wand S, Golan A, Sadan O. J Obstet Gynaecol Res. 2011 Jul 25. doi: 10.1111/j.1447-0756.2011.01576.x. [Epub ahead of print] PMID: 21790882

A brachialis muscle rupture diagnosed by ultrasound; case report.

Trauma to the elbow caused by lifting heavy objects frequently involves rupture of the tendon of the biceps brachii muscle. Less frequently a rupture of the brachialis muscle occurs. To our knowledge, only five cases involving traumatic rupture of the brachialis muscle were described in the past 20 years. We will briefly report these cases. To demonstrate and evaluate muscle injuries, magnetic resonance imaging (MRI) is considered the most sensitive and specific method of choice. We report an isolated brachialis muscle rupture caused by resisted flexion and pronation of the lower arm. Physical examination combined with ultrasound evaluation confirmed the diagnosis of ruptured brachialis muscle. Treatment was non-operative with full restoration of function.  Schonberger TJ, Ernst MF. Int J Emerg Med. 2011 Jul 26;4(1):46. [Epub ahead of print] PMID: 21791098

Effectiveness of intra-articular hyaluronan (Synvisc, hylan G-F 20) for the treatment of first metatarsophalangeal joint osteoarthritis: a randomised placebo-controlled trial.

An intra-articular injection of hylan G-F 20 is no more effective than a placebo in reducing symptoms in people with symptomatic first MTPJ OA  Munteanu SE, Zammit GV, Menz HB, Landorf KB, Handley CJ, Elzarka A, Deluca J. Ann Rheum Dis. 2011 Jul 25. [Epub ahead of print] PMID: 21791454

Comparison of Clinical Results of Anatomic Posterolateral Corner Reconstruction for Posterolateral Rotatory Instability of the Knee With or Without Popliteal Tendon Reconstruction.

 It is unknown whether popliteal tendon reconstruction is necessary in anatomic posterolateral corner reconstruction, although the tendon has function in the varus and rotatory stability of the knee joint. Hypothesis: Anatomic reconstructions of the posterolateral corner with the popliteal tendon reconstructed will present better clinical and radiographic results than cases with the popliteal tendon not reconstructed.  Yoon KH, Lee JH, Bae DK, Song SJ, Chung KY, Park YW. Am J Sports Med. 2011 Jul 26. [Epub ahead of print] PMID: 21791626 PDF

Retention treatment after periprosthetic total hip arthroplasty infection.

Retention treatment can be considered an initial treatment option in selected cases of primary THA, with a single organism, non-S. aureus infection with 50% chance of infection control and no disadvantages in terms of additional procedure, hospital stay, and treatment duration.  Choi HR, von Knoch F, Kandil AO, Zurakowski D, Moore S, Malchau H. Int Orthop. 2011 Jul 27. [Epub ahead of print] PMID: 21792609

Wednesday, July 27, 2011

A practical guide to research: design, execution, and publication

No abstract available. Karlsson J, Marx RG, Nakamura N, Bhandari M. Arthroscopy. 2011 Apr;27(4 Suppl):S1-S112. PMID: 21749939  PDF

Inflammatory phase of bone healing initiates the regenerative healing cascade.

Results from this study suggest that there are unfavorable immune cells and factors participating in the initial healing phase. In conclusion, identifying beneficial aspects may lead to promising therapeutical approaches that might benefit further by eliminating the unfavorable factors. Schmidt-Bleek K, Schell H, Schulz N, Hoff P, Perka C, Buttgereit F, Volk HD, Lienau J, Duda GN. Cell Tissue Res. 2011 Jul 26. [Epub ahead of print] PMID: 21789579

Sensate composite calcaneal flap in leg amputation: a full terminal weight-bearing surface-experience in eight adult patients.

Despite modern reconstruction techniques and replantation, the preservation of a severely traumatised limb, or even a limb affected by a congenital malformation, usually gives poorer functional results compared with amputation and prosthetisation. The aim of this study was to describe a hind foot (including the calcaneum and fat pad) sensate flap with a surface that allows full terminal weight bearing in transtibial amputations in adults.  Livani B, Castro G, Filho JR, Morgatho TR, Mongon ML, Belangero WD, Davitt M, Carvalho JA. Strategies Trauma Limb Reconstr. 2011 Jul 26. [Epub ahead of print] PMID: 21789589

Do Patients With Traumatic Recurrent Anterior Shoulder Instability Have Generalized Joint Laxity?

A number of studies suggest a relationship between generalized joint laxity (GJL) and increased risk of some musculoskeletal injuries. However, there are conflicting data on the association between GJL and traumatic recurrent shoulder instability (RSI). Ranalletta M, Bongiovanni S, Suarez F, Ovenza JM, Maignon G. Clin Orthop Relat Res. 2011 Jul 26. [Epub ahead of print] PMID: 21789709

Tuesday, July 26, 2011

Clinical experience with a reverse-flow anterolateral thigh perforator flap for the reconstruction of soft-tissue defects of the knee and proximal lower leg.

Despite a variable vascular anatomy that can be challenging for the surgeon, reverse-flow anterolateral thigh perforator flap is a safe and reliable method for reconstruction of the defects around the knee and even the upper third of the leg. Demirseren ME, Efendioglu K, Demiralp CO, Kilicarslan K, Akkaya H. J Plast Reconstr Aesthet Surg. 2011 Jul 22. [Epub ahead of print] PMID: 21784720  PDF

Is the Anterior Tibial Artery Safe During Ankle Arthroscopy? Anatomic Analysis of the Anterior Tibial Artery at the Ankle Joint by Magnetic Resonance Imaging.

In 22 (6.2%) of the 358 cases, the ATA and its branches were located near the anterolateral ankle portal, which introduces the risk of vascular damage during arthroscopic surgery. Furthermore, the mean distance between the ATA and the joint capsule was only 2.3 ± 1.1 mm, and thus the ATA is very close to the anterior working space of the ankle joint. Careful preoperative evaluation and an intra-articular procedure may reduce the risk of vascular complications attributable to ankle arthroscopy. Son KH, Cho JH, Lee JW, Kwack KS, Han SH. Am J Sports Med. 2011 Jul 22. [Epub ahead of print] PMID: 21785000  PDF

Incidence of Patients with Lower Extremity Injuries Presenting to US Emergency Departments by Anatomic Region, Disease Category, and Age.

The incidence of patients with lower extremity injuries presenting to emergency departments in the United States with respect to specific anatomic regions and disease categories is unknown. Such information might be used for injury prevention, resource allocation, and training priorities. Lambers K, Ootes D, Ring D. Clin Orthop Relat Res. 2011 Jul 22. [Epub ahead of print] PMID: 21785896  PDF

Orthopedic resident anatomy review course: A collaboration between anatomists and orthopedic surgeons

A challenge for new residents and senior residents preparing for board examinations is refreshing their knowledge of basic science disciplines, such as human gross anatomy. The Department of Orthopaedics at the University of Utah School of Medicine has for many years held an annual Orthopedic Resident Anatomy Review Course during the summer months for all of its residents. The primary purpose of the course is to renew competencies in basic science disciplines so that incoming residents more quickly reach a level of functional proficiency and to afford senior residents a platform to teach their junior colleagues. Before 2005, this course was conducted with minimal participation from anyone outside of the Department of Orthopaedics. Many of the residents voiced concerns that the educational benefits were not proportionate to the time invested. To improve the teaching of orthopedic-related anatomy, an educational collaboration between the Departments of Neurobiology and Anatomy and Orthopaedics was established in 2004 and continues to the present time. The major objectives of refining the course pedagogy, developing a Course Manual and Dissection Guide, and evaluating the results by administering a course survey questionnaire are described in this article. Implementation of all facets of the revised course has resulted in better participation by orthopedic faculty and more favorable reviews by the participating residents. Based on current levels of interest and positive comments from course participants, the Anatomy and Orthopedic faculty course directors plan to continue to develop course materials and pedagogy.  Defriez CB, Morton DA, Horwitz DS, Eckel CM, Foreman KB, Albertine KH. Anat Sci Educ. 2011 Jul 22. [Epub ahead of print] PMID: 21786430

BBC Documentary: Blood and Guts: A History of Surgery (May need to view offsite)

Documentary series looking at the brutal, bloody and dangerous history of surgery. Michael Mosley recounts the history of surgery through its catastrophes and successes.
1. Into the Brain. Just over 100 years ago, cutting into the brain was a terrifying prospect for both patient and surgeon. They could expect the result to be the surgeon bloodied and defeated, and the patient dead. From freak accidents involving crowbars through the skull to notorious lobotomies with icepicks, this programme reveals how, through mishap and misadventure, brain surgery has become the life-saving discipline it is today.
2. Bleeding Hearts. With a family history of heart problems, presenter Michael Mosley takes a personal interest in these pioneers, who teetered on the scalpel-edge between saviour and executioner. Michael has a go at heart surgery, meets a man with no heartbeat and witnesses an operation where the patient is cooled until their brain stops and has all of their blood sucked out.
3. Spare Parts. These days, transplant surgery saves thousands of lives every year and almost everything, from heart to eyes, can be replaced. But in the beginning, transplants killed rather than cured, because surgeons didn’t understand that they were taking on one of the most efficient killing systems we know of – the human immune system.
4. Fixing Faces. Thought of as a modern phenomenon, it actually started over 400 years ago with a spate of botched nose jobs. Since then, surgeons have been entranced with the idea that not only could they fix the body, but could even fix our sense of self-esteem. Presenter Michael Mosley undergoes both 16th-century bondage and 21st-century botox in his journey of discovery.
5. Bloody Beginnings. Presenter Michael Mosley finds out how the early days of surgery were dark and barbaric, when the surgeon’s knife was more likely to kill you than save you, and invasive medicine generally meant being bloodlet by leeches to within an inch of your life.

Incidence of physician diagnosed osteoarthritis among active duty united states military service members.

The overall unadjusted incidence rate among all active duty US service members during the study period was 7.86 per 1,000 person-years. Significant demographic and occupational risk factors for OA included sex, age, race, service, and rank (p<0.001). Women experienced an adjusted incidence rate for OA that was nearly 20% higher than men (IRR=1.19, 95% CI=1.17, 1.21). Service members in the ≥40 age group experienced an adjusted incidence rate for OA that was approximately 19 times higher when compared to those in the <20 age category (IRR=18.61, 95% CI=17.57, 19.57). Black service members experienced significantly higher incidence rates of OA when compared to those in the white and other categories for race. Conclusion: Rates for OA were significantly higher in military populations when compared to comparable age groups in the general population.  Cameron KL, Hsiao MS, Owens BD, Burks R, Svoboda SJ. Arthritis Rheum. 2011 Jun 29.  [Epub ahead of print] PMID: 21717422

An Evaluation of Two Tourniquet Systems for the Control of Prehospital Lower Limb Hemorrhage.

Hemorrhage remains the main cause of preventable death on the modern battlefield. As Improvised Explosive Devices in Afghanistan become increasingly powerful, more proximal limb injuries occur. Significant concerns now exist about the ability of the windlass tourniquet to control distal hemorrhage after mid-thigh application. To evaluate the efficacy of the Combat Application Tourniquet (CAT) windlass tourniquet in comparison to the newer Emergency and Military Tourniquet (EMT) pneumatic tourniquet.  Taylor DM, Vater GM, Parker PJ. J Trauma. 2011 Jul 15. [Epub ahead of print] PMID: 21768905

Sunday, July 24, 2011

Proximal humerus fractures in the pediatric population: a systematic review.

The currently available literature supports a non-operative treatment approach, particularly in younger children with more growth remaining. Older patients (>13 years) with more widely displaced fractures may benefit from anatomic reduction with stabilization, though the data in the literature at this point is too weak to strongly recommend this approach. Further analysis with a more rigorous scientific method is necessary to evaluate the optimum treatment modality in this subgroup.   Pahlavan S, Baldwin KD, Pandya NK, Namdari S, Hosalkar H. J Child Orthop. 2011 Jun;5(3):187-94. Epub 2011 Mar 11. PMID: 21779308

Symptomatic heterotopic ossification: seven years after patella fracture.

We describe a case of heterotopic ossification (HO) of the lateral patella becoming symptomatic after 7 years following horizontal patella fracture. The patient presented peripatellar pain in full knee flexion and kneeling position. We resected the ossification, and the patient was immediately relieved from pain and was mobilised under full weight bearing with no limitation of knee flexion. The patient was able to return to his previous level of daily activities with no further episodes of pain. To our knowledge, this is the first case of heterotopic peripatellar ossification becoming symptomatic 7 years after a patellar fracture to be reported in the literature.  Daniilidis K, Vogt B, Raschke MJ. Musculoskelet Surg. 2011 Jul 21. [Epub ahead of print] PMID: 21779765

Reconstruction nailing for ipsilateral femoral neck and shaft fractures.

The current study suggests that reconstruction nailing produces satisfactory clinical and functional results in the mid-term. The complications involved only the femoral shaft fracture and were successfully treated with a single operative procedure.  Tsarouhas A, Hantes ME, Karachalios T, Bargiotas K, Malizos KN. Strategies Trauma Limb Reconstr. 2011 Jul 21. [Epub ahead of print] PMID: 21779894