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Friday, August 12, 2011

Mobile Devices and Medical Liability: Some Important Considerations

As mobile devices become more and more integrated into clinical practice, our health system will have to not only figure out how this technology will change the face of medicine, but also how it will change the system of medical liability. Physicians and administrators alike shudder at the thought of malpractice, but considering the fact that 60% of physicians over the age of 55 have been sued at least once during their career, we have to carefully think about how all of our new tools fit into the liability picture. Michelle Mello, a Harvard health law professor, offered some insight at the World Congress Leadership Summit on mHealth. iMedicalApps

Kienböck Disease

Article in Press: Treatment of Kienböck Disease by Lunate Core Decompression  Mehrpour S, Kamrani S, Aghamirsalim M, Sorbi R, Kaya A. The Journal of Hand Surgery , Corrected Proof  PDF

1 - 3 From PubMed: 
1. Arthroscopic core decompression of the lunate in early stage Kienbock disease of the lunate. Bain GI, Smith ML, Watts AC. Tech Hand Up Extrem Surg. 2011 Mar;15(1):66-9. PMID:  21358528
2. Systematic review of the treatment of Kienböck's disease in its early and late stages. Innes L, Strauch RJ. J Hand Surg Am. 2010 May;35(5):713-7, 717.e1-4. Review. PMID: 20438990 PDF
3. Core decompression of the distal radius for the treatment of Kienböck's disease: a biomechanical study. Sherman GM, Spath C, Harley BJ, Weiner MM, Werner FW, Palmer AK. J Hand Surg Am. 2008 Nov;33(9):1478-81. PMID: 18984326 PDF

Surgical treatment of syndesmotic diastasis: emphasis on effect of syndesmotic screw on ankle function.

Fifty-two consecutive adult patients with syndesmotic diastasis (SD) were treated with closed anatomical reduction and stable fixation by a trans-syndesmotic cancellous screw. A short leg splint was prescribed for a six week postoperative period. Treatment outcomes of syndesmotic screw removal at various time points were studied and compared (group 1 at six weeks, group 2 at three months and group 3 at an average of nine months).  Hsu YT, Wu CC, Lee WC, Fan KF, Tseng IC, Lee PC. Int Orthop. 2011 Mar;35(3):359-64. Epub 2010 Nov 11. PMID: 21069524

Thursday, August 11, 2011

Associations between repeated deployments to OEF/OIF/OND, October 2001-December 2010, and post-deployment illnesses and injuries, active component, U.S. Armed Forces.

Since 2001, 1,347,731 U.S. military members have deployed to Afghanistan or Iraq; of these, approximately 40% deployed to Afghanistan or Iraq more than once. We assessed relationships between multiple deployments and diagnoses of diseases and injuries (as defined by 3-digit ICD-9-CM codes) among all male and female deployers within one year after returning from first through fifth deployments. For most illnesses and injuries, the proportions of deployers affected within one year post-deployment hardly varied in relation to the number of prior deployments. Back and joint disorders, sleep disorders, hypercholesterolemia, hypertension, chronic sinusitis, and allergic rhinitis were "excessive" among repeat compared to first-time deployers. Some conditions may be caused or exacerbated by repeat wartime deployments. On the other hand, repeat deployments may select for the most inherently resilient service members and/or incrementally increase the resilience of repeat deployers. Armed Forces Health Surveillance Center (AFHSC). MSMR. 2011 Jul;18(7):2-11. PMID: 21815709 PDF

Effectiveness of the Saline Load Test in Diagnosis of Traumatic Elbow Arthrotomies.

The purpose of this study was to investigate the amount of fluid required and the sensitivity of the saline load test to identify an intra-articular arthrotomy of the elbow. Feathers T, Stinner D, Kirk K, Kirby J, Hsu JR; Skeletal Trauma Research Consortium (STReC); Brooke Army Medical Center. J Trauma. 2011 Jul 15. [Epub ahead of print] PMID: 21768902 PDF

The Modern "Deck-Slap" Injury-Calcaneal Blast Fractures From Vehicle Explosions.

Calcaneal injuries following under-vehicle explosions are commonly associated with significant multiple injuries including severe lower limb injury. The frequency of associated spinal injuries mandates radiologic evaluation of the spine in all such patients. The severity of the hindfoot injury is reflected by the high infection rate and amputation rate. Only a small proportion of casualties were able to return to preinjury military duties.
 Ramasamy A, Hill AM, Phillip R, Gibb I, Bull AM, Clasper JC. J Trauma. 2011 Jul 29. [Epub ahead of print] PMID: 21808204 PDF

Impact of Stress on Resident Performance in Simulated Trauma Scenarios.

In trainees, some aspects of performance and immediate recall appear to be impaired in complex clinical scenarios in which they exhibit elevated subjective and physiologic stress responses. The findings of this study highlight a potential threat to patient safety and demand further investigation. Future studies should strive to further elucidate the effects of stress on specific components of performance and investigate ways to reduce its negative impact.  Harvey A, Bandiera G, Nathens AB, Leblanc VR. J Trauma. 2011 Jul 29. [Epub ahead of print] PMID: 21808212  PDF

Died of wounds on the battlefield: causation and implications for improving combat casualty care.

Understanding the epidemiology of death after battlefield injury is vital to combat casualty care performance improvement. The current analysis was undertaken to develop a comprehensive perspective of deaths that occurred after casualties reached a medical treatment facility.  Eastridge BJ, Hardin M, Cantrell J, Oetjen-Gerdes L, Zubko T, Mallak C, Wade CE, Simmons J, Mace J, Mabry R, Bolenbaucher R, Blackbourne LH. J Trauma. 2011 Jul;71(1 Suppl):S4-8. PMID: 21795876

The Role of Platelet-rich Plasma in Rotator Cuff Repair.

Injections of platelet-rich plasma (PRP) have led to reduced pain and improved recovery in other degenerate pathologies areas together with the restoration of function. This study reviews the current literature on PRP and in particular discusses its relevance in the treatment of rotator cuff tears. Mei-Dan O, Carmont MR. Sports Med Arthrosc. 2011 Sep;19(3):244-50. PMID: 21822108

Treatment of femur fractures in school-aged children using elastic stable intramedullary nailing: a systematic review.

Femur fractures are common long-bone injuries in school-aged children (6-12 years). Among the various acceptable treatment options, elastic stable intramedullary nailing (ESIN) has gained popularity over recent years although the level of evidence for ESIN is low. This study was a systematic review of the literature to examine the outcomes and complications of ESIN in school-aged children and to critically evaluate the quality of the available literature.  Baldwin K, Hsu JE, Wenger DR, Hosalkar HS. J Pediatr Orthop B. 2011 Sep;20(5):303-8. PMID: 21829144

Meniscal Repair Versus Partial Meniscectomy: A Systematic Review Comparing Reoperation Rates and Clinical Outcomes

Whereas meniscal repairs have a higher reoperation rate than partial meniscectomies, they are associated with better long-term outcomes. E. Scott Paxton, Michael V. Stock, Robert H. Brophy, Arthroscopy: The Journal of Arthroscopic and Related Surgery - 08 August 2011 (10.1016/j.arthro.2011.03.088)

Platelet-Rich Plasma Intra-Articular Injection Versus Hyaluronic Acid Viscosupplementation as Treatments for Cartilage Pathology: From Early Degeneration to Osteoarthritis

Autologous PRP injections showed more and longer efficacy than HA injections in reducing pain and symptoms and recovering articular function. Better results were achieved in younger and more active patients with a low degree of cartilage degeneration, whereas a worse outcome was obtained in more degenerated joints and in older patients, in whom results similar to those of viscosupplementation have been observed.
Elizaveta Kon, Bert Mandelbaum, Roberto Buda, Giuseppe Filardo, Marco Delcogliano, Antonio Timoncini, Pier Maria Fornasari, Sandro Giannini, Maurilio Marcacci, Arthroscopy: The Journal of Arthroscopic and Related Surgery - 11 August 2011 (10.1016/j.arthro.2011.05.011) PDF

Long-term results of the surgical treatment of type III acromioclavicular dislocations: AN UPDATE OF A PREVIOUS REPORT.

 According to the Imatani and UCLA scores, there was no difference between the operated shoulder and the opposite shoulder (p > 0.05). Given the same situation, 35 (92.1%) patients would opt for the same surgical treatment again. Operative treatment of type III acromioclavicular joint injuries produces satisfactory long-term results.  Lizaur A, Sanz-Reig J, Gonzalez-Parreño S. J Bone Joint Surg Br. 2011 Aug;93(8):1088-92. PMID: 21768634

Wednesday, August 10, 2011

Clinical Orthopaedics and Related Research: [Epub ahead of print]

1. Risk Factors for Peroneal Nerve Injury and Recovery in Knee Dislocation. Peskun CJ, Chahal J, Steinfeld ZY, Whelan DB. Clin Orthop Relat Res. 2011 Aug 6. [Epub ahead of print] PMID: 21822573 PDF
2. Lateral Unicompartmental Knee Arthroplasty Through a Lateral Parapatellar Approach Has High Early Survivorship. Berend KR, Kolczun MC 2nd, George JW Jr, Lombardi AV Jr. Clin Orthop Relat Res. 2011 Aug 6. [Epub ahead of print] PMID: 21822570 PDF
3. A More Reliable Method to Assess Acetabular Component Position. Tiberi JV, Pulos N, Kertzner M, Schmlazried TP. Clin Orthop Relat Res. 2011 Aug 6. [Epub ahead of print] PMID: 21822569 PDF
4. Can Stress Radiography of the Knee Help Characterize Posterolateral Corner Injury? Gwathmey FW Jr, Tompkins MA, Gaskin CM, Miller MD. Clin Orthop Relat Res. 2011 Aug 6. [Epub ahead of print] PMID: 21822568 PDF
5. Can Surgeons Predict What Makes a Good TKA?: Intraoperative Surgeon Impression of TKA Quality Does Not Correlate With Knee Society Scores. Lee GC, Lotke PA. Clin Orthop Relat Res. 2011 Aug 6. [Epub ahead of print] PMID: 21822567 PDF

Position of shoulder arthroplasty and clinical outcome in proximal humerus fractures.

Four-part proximal humeral fractures are frequently treated with shoulder replacement. Outcome of this procedure has not been standardized, and there are controversy data on range of motion (ROM) and active function of the shoulder. The aim of this study is to compare shoulder prosthesis position (SPP) in terms of version of humeral head and height of stem with clinical subjective and objective outcome. Padua R, Padua L, Galluzzo M, Ceccarelli E, Alviti F, Castagna A. Musculoskelet Surg. 2011 Jul;95 Suppl :55-8. PMID: 21479866

Skeletal Radiology: Osteochondral Lesions

1. Limitations of radiographs in evaluating non-displaced osteochondral lesions of the talus. Dheer S, Khan M, Zoga AC, Morrison WB. Skeletal Radiol. 2011 Aug 9. [Epub ahead of print]  PMID: 21826614
2. High-resolution MR imaging of talar osteochondral lesions with new classification. Griffith JF, Lau DT, Yeung DK, Wong MW. Skeletal Radiol. 2011 Aug 9. [Epub ahead of print] PMID: 21826613

Tuesday, August 9, 2011

Lawson scientist presents joint pain treatment 2.0

When patients have OA in the knee, the fluid in their joint breaks down, causing pain and preventing natural shock absorption. To treat this condition, gel-like substances called "viscosupplements" are injected into the knee. This acts as a supplement for the fluid loss and provides temporary pain relief. In the COR1.0 study, Dr. Petrella and his colleagues compared Synvisc-One, the leading market viscosupplement for OA in the knee, to Hydros-TA Joint Therapy. Hydros-TA is a unique dual-action treatment combining steroids within a viscosupplement. It is believed to provide faster acting, longer lasting pain relief than either treatment alone. Eurekalert!

Curry spice could offer treatment hope for tendinitis

A derivative of a common culinary spice found in Indian curries could offer a new treatment hope for sufferers of the painful condition tendinitis, an international team of researchers has shown.  In a paper due to be published in the Journal of Biological Chemistry, the researchers at The University of Nottingham and Ludwig Maximilians University in Munich have shown that curcumin, which also gives the spice turmeric its trademark bright yellow colouring, can be used to suppress biological mechanisms that spark inflammation in tendon diseases. Eurekalert!

The Dedicated Orthopedic Trauma Operating Room

The development and implementation of a dedicated orthopedic trauma operating room (OTOR) that is used for the treatment of orthopedic trauma patients has changed and improved the practice of orthopedic trauma surgery. Advantages noted with OTOR implementation include improvements in morbidity and complication rates, enhancements in the professional and personal lifestyles of the on-call surgeon, and increased physician recruitment and retention in orthopedic traumatology. However, the inappropriate use of the OTOR, which can waste valuable resources and delay the treatment of emergent cases, must be monitored and avoided.

Telemedicine to a moving ambulance improves outcome after trauma in simulated patients.

TM to a moving ambulance improved the care of simulated trauma patients. Furthermore, procedurally naïve EMTs were able to perform needle thoracostomy and pericardiocentesis with TM guidance. Charash WE, Caputo MP, Clark H, Callas PW, Rogers FB, Crookes BA, Alborg MS, Ricci MA. J Trauma. 2011 Jul;71(1):49-55. PMID: 21818014  PDF

Wayne State researcher discovers antibiotic useful for localized treatment of bone wear

Total joint replacement surgeries can help relieve joint pain common in people with conditions like osteoarthritis. But sometimes, the debris from prosthetic joints leads to aseptic loosening, or disintegration of surrounding bones. In 2009, a Wayne State University researcher determined that the anti-inflammatory antibiotic erythromycin can prevent and treat such disintegration. There was one caveat, however: there are side effects associated with long-term usage of erythromycin. Eurekalert!

The Plate-Joystick Technique to Reduce Proximal Humeral Fractures and Nonunions With a Varus Deformity Through the Extended Deltoid-Splitting Approach.

Fractures and nonunions in which there is a varus deformity of the humeral head producing posterinferior subluxation of the articular surface are increasingly recognized as an important subgroup of proximal humeral fractures. Operative open reduction and internal fixation of these injuries is often recommended when the varus deformity is severe. We describe a simple technique to assist in the open reduction and locking plate stabilization of this challenging and complex fracture subtype using tools and implants that are readily available in most modern orthopaedic trauma operating rooms. Robinson CM, Inman D, Phillips SA. J Orthop Trauma. 2011 Jul 28. [Epub ahead of print] PMID:  21804419  PDF

Arthroscopic Treatment of Rotator Cuff Disease (article in press)

The goal of this article is to summarize the current concepts on rotator cuff disease with an emphasis on arthroscopic treatment. Most rotator cuff tears are the result of an ongoing attritional process. Once present, a tear is likely to gradually increase in size. Partial thickness and subscapularis tears can both be successfully treated arthroscopically if conservative management fails. Partial tears involving greater than 50% of tendon thickness should be repaired. Articular sided partial tears involving less than 50% of the rotator cuff can reliably be treated with debridement. A more aggressive approach should be considered for low-grade tears (<50%) if they occur on the bursal side. Biomechanical and anatomic studies have shown clear superiority with dual-row fixation compared with single-row techniques. However, current studies have yet to show clear clinical advantage with dual-row over single-row repairs. Biceps tenotomy or tenodesis can reliably provide symptomatic improvement in patients with irreparable massive tears. True pseudoparalysis of the shoulder is a contraindication to this procedure alone and other alternatives should be considered. Jarrett CD, Schmidt CC. J Hand Surg Am. 2011 Aug 6. [Epub ahead of print] PMID: 21821368  PDF

See also:
Arthroscopic treatment of rotator cuff disease GM Gartsman - Journal of Shoulder and Elbow Surgery, 1995 - Elsevier Rotator cuff disease represents a spectrum of tendon lesions including inflammation of an intrinsically normal tendon, tendon fibrosis, partial-thickness tears, complete tears, and cuff tear arthropathy. An in-depth analysis of the entire subject is beyond the scope of this ...
Cited by 59 (drill up) - Related articles - All 3 versions - Import into EndNote

Visible Body is a complete, fully interactive 3D rendering of the human body and may one day replace traditional anatomy texts

Visible Body  3D Human Anatomy Atlas for iPad 2 is a huge breath of fresh air. While we at iMedicalApps have been reviewing anatomy apps that constantly improved on previous ones, Visible Body simply blew me away. After using Visible Body for mere minutes, it felt as if someone had read my previous review and made it a goal to silence my past quibbles. Not only does it take full advantage of the iPad’s touchscreen interface, it does so in such a gorgeous manner that there are not enough superlatives in my vocabulary to adequately describe it. But since a picture is worth a thousand words (especially when it comes to anatomy), I will include plenty of pictures to rectify my speechlessness and for you to judge for yourself. iMedicalApps

Have you tried the Google Translate App with your patients?

he Google Translate app for Android translates speech in real time. It works best if you don't have a heavy accent. Google Translate is a free mobile app (developed by Google) and you can instantly translate text between more than 50 languages. It includes:
Voice input
Soon, we won't need interpreters because we'll be using our technology, right? Maybe. MedicalSmartphones

Monday, August 8, 2011

New Ortho Books (via Amazon)

Knee Arthroscopy by Brian McKeon, James V. Bono and John C. Richmond (Aug 29, 2011)

New Advances in Wrist and Small Joint Arthroscopy, An Issue of Hand Clinics (The Clinics: Orthopedics) by David J. Slutsky (Aug 28, 2011)

The Poly-Traumatized Patient with Fractures: A Multi-Disciplinary Approach by Hans-Christoph Pape, Roy Sanders and Joseph Borrelli Jr. (Aug 28, 2011)

Tribology in Total Hip Arthroplasty by Karl Knahr (Aug 28, 2011)

Fundamentals of Revision Hip Arthroplasty: Diagnosis, Evaluation, and Treatment by David J. Jacofsky MD and Anthony K. Hedley MD (Aug 15, 2011)

Oxford Textbook of Trauma and Orthopaedics by Christopher Bulstrode, James Wilson-MacDonald,
Jeremy Fairbank and Tim Briggs (Aug 11, 2011)

Manual of INTERNAL FIXATION: Techniques Recommended by the AO-ASIF Group by Maurice E. Müller, Robert Schneider, Hans Willenegger and Martin Allgöwer (Jul 29, 2011)

FOOT AND ANKLE ARTHROSCOPY, An Issue of Clinics in Podiatric Medicine and Surgery (The Clinics: Orthopedics) by Lawrence G. Rubin DPM (Jul 28, 2011)

Concepts and Cases in Nonunion Treatment by Rene Marti and Peter Kloen (Jul 27, 2011)

Armed Conflict Injuries to the Extremities: A Treatment Manual by Alexander Lerner and Michael Soudry (Jul 18, 2011)

Sunday, August 7, 2011

Multidrug-resistant chronic osteomyelitis complicating war injury in iraqi civilians.

War-related orthopedic injury is frequently complicated by environmental contamination and delays in management, placing victims at increased risk for long-term infectious complications. We describe, among Iraqi civilians with war-related chronic osteomyelitis, the bacteriology of infection at the time of admission.  Murphy RA, Ronat JB, Fakhri RM, Herard P, Blackwell N, Abgrall S, Anderson DJ.
J Trauma. 2011 Jul;71(1):252-4. PMID: 21818032

Above- or below-elbow casts for distal third forearm fractures in children? A meta-analysis of the literature.

Fractures of the distal third forearm are common fractures in childhood. Most of these fractures can be treated non-operatively by means of closed reduction and immobilization. The purpose of this meta-analysis is to investigate whether above- or below-elbow cast should be considered the first-choice for conservative treatment.  Hendrickx RP, Campo MM, van Lieshout AP, Struijs PA, van den Bekerom MP. Arch Orthop Trauma Surg. 2011 Aug 5. [Epub ahead of print] PMID: 21818587

Hallux valgus angle as a predictor of recurrence following proximal metatarsal osteotomy.

Our radiographic results indicated that a preoperative hallux valgus angle >40° can be a risk factor for hallux valgus recurrence. Decreased risk factors for recurrence included hallux valgus angle ≤15° and an intermetatarsal angle <10° at the early follow-up. These risk factors may be helpful for modifying surgical procedures, improving surgical outcome, and predicting hallux valgus recurrence.  Okuda R, Kinoshita M, Yasuda T, Jotoku T, Shima H, Takamura M. J Orthop Sci. 2011 Aug 5. [Epub ahead of print] PMID: 21818604

Reconstructive osteotomy of fibular malunion: review of the literature.

The treatment of ankle fractures has a primary goal of restoring the full function of the injured extremity. Malunion of the fibula is the most common and most difficult ankle malunion to reconstruct. The most frequent malunions of the fibula are shortening and malrotation resulting in widening of the ankle mortise and talar instability, which may lead to posttraumatic osteoarthritis. The objective of this article is to review the literature concerning the results of osteotomies for correcting fibular malunions and to formulate recommendations for clinical practice. van Wensen RJ, van den Bekerom MP, Marti RK, van Heerwaarden RJ. Strategies Trauma Limb Reconstr. 2011 Aug;6(2):51-7. Epub 2011 Apr 6. PMID: 21818702 PDF