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Friday, August 19, 2011

One resident's experience designing and running a randomized control trial in orthopedic surgery.

All ACGME-accredited orthopedic residency programs require residents to participate in research during their training. The levels of evidence adopted for clinical research validate the randomized clinical trial (RCT) as the gold (Level 1) standard. While many residents aspire to conduct or be involved in an RCT during their orthopedic training, I would like to describe my experience as an orthopedic surgery resident designing and running an RCT. O'Donnell PW. J Surg Educ. 2011 May-Jun;68(3):250-3. Epub 2011 Jan 15. PMID: 21481812   PDF

Military Malpractice System Needs Overhaul

Reform of the existing administrative approach to malpractice offers the best hope to improve the military's response to medical injury compensation for veterans, health policy specialists suggested.
For more than 60 years, prevailing doctrine has maintained a "seemingly indefensible inequity between civilians and active-duty service members injured as a result of malpractice." However, eliminating the doctrine would simply "replace one injustice with another," according to an article in the August 18 issue of the New England Journal of Medicine. (PDF) via Medpage Today

Closed Reduction and Early Mobilization in Fractures of the Humeral Capitellum.

Seven consecutive patients with an isolated fracture of the humeral capitellum were treated by a single surgeon at a Level II care facility according to a simple treatment algorithm. Closed reduction was attempted in all cases using a standard technique. After reduction, the arm was splinted at 90° of flexion and mobilized at 14 days. All patients completed a clinical and radiographic follow-up consisting of a radiographic evaluation of reduction, elbow range of motion, Disabilities of the Arm, Shoulder and Hand Questionnaire, and a subjective rating of patient satisfaction. None of the patients required conversion to open reduction internal fixation or excision. Disabilities of the Arm, Shoulder and Hand Questionnaire scores ranged from 6 to 13 points (out of 100; mean, 9). The mean flexion/extension arc of motion obtained was 126° with minimal loss of rotation. Patient satisfaction was rated as excellent in five patients and good in two. All fractures appeared united at the most recent clinical and radiographic review. Closed reduction and early mobilization appears to be a safe and effective method of treating displaced fractures of the humeral capitellum with clinical results comparable to that of open reduction internal fixation. Puloski S, Kemp K, Sheps D, Hildebrand K, Donaghy J. J Orthop Trauma. 2011 Jul 28. [Epub ahead of print] PMID: 21804417  PDF

Towards an assessment of bone fracture healing using pulsed mode ultrasound.

Healing rate of fractured bone differs from one patient to another which may lead to incorrect consequent medical procedures. Thus, quantitative assessment of bone healing after fracture becomes important. In this paper, we present a mathematical model which describes the interaction of a pulsed mode ultrasound waves with a multilayered biological structure. The model is applied to estimate the bone callus thickness and degree of hardness. Different frequencies are utilized to obtain highest measurement sensitivity and accuracy of callus thickness and degree of hardness. It is found that a transducer operating at 1 MHz has the highest sensitivity to the different phases of callus hardening. On the other hand, a 3 MHz transducer yields the highest sensitivity to the thickness of the callus layer. Thus, using both frequencies might prove to be useful for full quantitative assessment of the bone healing process. Qaddoumi N, Al-Nashash H, Sediq AB, Al-Shamsi H, Al-Mehrizi M, Khalaf K. Technol Health Care. 2011 Jan 1;19(4):261-9. PMID: 21849736

Posterior Tibial Tendon Tear After 4-Cortex Syndesmotic Screw Fixation: A Case Report and Literature Review.

We describe a previously unreported problem of a patient who underwent errant 4-cortex syndesmotic screw fixation with resultant posterior tibial tendon tear necessitating removal of hardware and repair of a tendon tear. Kwon JY, Campbell JT, Myerson MS. J Orthop Trauma. 2011 Aug 12. [Epub ahead of print] PMID: 21849910

High-resolution magic angle spinning NMR spectroscopy of human osteoarthritic cartilage.

This indicates that N-acetyl can serve as an important bio-marker of OA disease progression. A decrease in the alanine concentration in OA may be attributed to the degradation of the collagen framework with disease progression and eventual loss of the degradation products that are transported from cartilage into the synovial cavity.  Shet K, Siddiqui SM, Yoshihara H, Kurhanewicz J, Ries M, Li X. NMR Biomed. 2011 Aug 18. doi: 10.1002/nbm.1769. [Epub ahead of print] PMID: 21850648

New 'bionic' leg gives amputees a natural gait

A new lower-limb prosthetic developed at Vanderbilt University allows amputees to walk without the leg-dragging gait characteristic of conventional artificial legs.

The device uses the latest advances in computer, sensor, electric motor and battery technology to give it bionic capabilities: It is the first prosthetic with powered knee and ankle joints that operate in unison. It comes equipped with sensors that monitor its user's motion. It has microprocessors programmed to use this data to predict what the person is trying to do and operate the device in ways that facilitate these movements. Eurekalert!

Fujifilm releases radiology viewing app, allows physicians and radiologists to view medical images on the go

Fujifilm Synapase Mobility is now available in the U.S., and not just on the iPhone, but for the Android and iPad as well.  Fujifilm makes a variety of medical images devices, from ultrasound devices to computed radiology devices (x-rays).

If you use their backend server (Synapse PACS and Synapse RIS), you can now view your images on your mobile devices. Whats really interesting about their mobile suite is that it’s browser independent, scalable, and doesn’t just display static images.
Currently the system isn’t FDA approved, but with the amount of business Fujifilm already has in the medical ecosystem, one would think this would happen sooner than later.

It provides advanced viewing capabilities for physicians to view 3D images as well as to be able to zoom, window and level, and use MIP/MPR just as they would do at a clinical workstation. Synapse® Mobility is for non-diagnostic use only. iMedicalApps

Thursday, August 18, 2011

The microbiological basis for a revised antibiotic regimen in high-energy tibial fractures: Preventing deep infections by nosocomial organisms

Following high-energy open fracture, a single prophylactic antibiotic regimen directed against environmental wound contaminants does not provide cover for the organisms responsible for deepest SSI's and may have depopulated the niche, promoting nosocomial contamination prior to definitive closure. We advocate a dynamic prophylactic strategy, tailoring a second wave of prophylaxis against nosocomial organisms at the time of definitive wound closure, and at the same time avoiding the potential complications of prolonged antibiotic use. Glass GE, Barrett SP, Sanderson F, Pearse MF, Nanchahal J. J Plast Reconstr Aesthet Surg. 2011 Mar;64(3):375-80. Epub 2010 Jun 29. PMID: 20591757 PDF

Link to articles that have cited above article since publication

Injury: Articles in Press

Pretraining and posttraining assessment of residents' performance in the fourth accreditation council for graduate medical education competency: patient communication skills.

Patient communication skills need to be taught as part of residency training. With limited training, case-specific skills (herein, involving patients with cancer) are likely to improve more than general communication skills. Chandawarkar RY, Ruscher KA, Krajewski A, Garg M, Pfeiffer C, Singh R, Longo WE, Kozol RA, Lesnikoski B, Nadkarni P. Arch Surg. 2011 Aug;146(8):916-21. PMID: 21844435  PDF

Is Dynamic Gadolinium Enhancement Needed in MR Imaging for the Preoperative Assessment of Scaphoidal Viability in Patients with Scaphoid Nonunion? [Musculoskeletal Imaging]

Because the diagnostic performance of dynamic gadolinium-enhanced MR imaging in the evaluation of scaphoid viability was inferior to that of a standard MR imaging protocol, dynamic acquisition may not be needed in patients with nonunion of scaphoid fractures. Donati OF, Zanetti M, Nagy L, Bode B, Schweizer A, Pfirrmann CW. Radiology. 2011 Jun 28. [Epub ahead of print] PMID: 21712471  PDF

[Reality of provision of care in Germany in the fields of orthopedics and casualty surgery.]

Ewerbeck V. Orthopade. 2011 Aug 17. [Epub ahead of print] German. No abstract available. PMID: 21845478 PDF

Note: Article is in Gernman but is open access. However, the article can be saved as PDF then translated at home (this feature of Google Translate is blocked by the DoD) using this link:

Role Playing Boosts Surgical Residents' Bedside Manner

A quick course in communication skills may improve surgical residents' interactions with some patients, researchers said.

Although it didn't significantly improve general communication skills, a two-hour program involving lectures and role playing resulted in significantly better scores on a case-specific content checklist (P=0.005), Rajiv Chandawarkar, MD, of the University of Connecticut Health Center in Farmington, Conn., and colleagues reported in the August issue of the Archives of SurgeryMedPage Today

DVT Risk Low After General Surgery (CME/CE)

Deep vein thrombosis (DVT) occurs infrequently following general surgery, but when it does, it often involves a central venous catheter, a review of a large clinical series showed.
DVT occurred in fewer than 2% of 2,189 operations, and catheter-associated clotting caused 60% of the episodes. Medpage Today

Treatment for distal tibial fractures with intramedullary nails and blocking screws

Blocking screws helped to achieve better reduction and alignment with intramedullary nailing of distal tibial fractures by decreasing the effective diameter of the medullary canal. The use of blocking screws enabled to use the intramedullary nailing as an alternative while treating distal tibial fractures.  SpringerLink             

Disability system leaves troops in 'vast unknown'

The government determines the pay and benefits given to wounded, sick or injured troops for their military service. Under the old system, a medical board would determine their level of military compensation and the service member would be discharged. Then the veteran essentially would have to go through the process again with the Veterans Affairs Department to determine benefits. While they waited for their VA claim to be processed, many of the war wounded were going broke.

Under the new system, which started in 2007 and will be completely rolled out at military bases nationwide by the end of September, the service member essentially goes through both disability evaluation systems at the same time before leaving the military. AP

Wednesday, August 17, 2011

New compound may accelerate bone healing, prevent osteoporosis

Hiroki Yokota, professor of biomedical engineering at Indiana University-Purdue University Indianapolis (IUPUI) and adjunct professor of anatomy and cell biology at the IU School of Medicine, will investigate the effect of salubrinal -- a chemical compound originally developed to encourage insulin production in individuals with diabetes -- on human bone strength and growth. Early laboratory research supported by the Indiana Clinical and Translational Sciences Institute (CTSI) suggests weakened bones treated with salubrinal experience a statistically significant increase in strength, as well as accelerated healing in bones that have been fractured.

Archives of Orthopaedic and Tauma Surgery [Epub ahead of print]

15. The virtual isocentric aiming device: a new mechanical targeting concept. Mendel T, Hänni M, Gueorguiev B, Wohlrab D, Hofmann GO. Arch Orthop Trauma Surg. 2011 Aug 13. [Epub ahead of print] PMID: 21842286
16. Interdisciplinary inter-observer agreement and accuracy of MR imaging of the shoulder with arthroscopic correlation. Halma JJ, Eshuis R, Krebbers YM, Weits T, de Gast A. Arch Orthop Trauma Surg. 2011 Aug 13. [Epub ahead of print] PMID: 21842285 PDF
García VV, Duhrkop DC, Seijas R, Ares O, Cugat R. Arch Orthop Trauma Surg. 2011 Aug 13. [Epub ahead of print] PMID: 21842284
18. Transtendon arthroscopic repair of high grade partial-thickness articular surface tears of the rotator cuff with biceps tendon augmentation: technical note and preliminary results. Ji JH, Shafi M, Jeong JJ, Lee YS, McFarland EG, Kim TK, Chung JY. Arch Orthop Trauma Surg. 2011 Aug 13. [Epub ahead of print] PMID: 21842283

Ultrasound-Guided Injection Techniques for the Low Back and Hip Joint.

This article will review the selected ultrasound-guided injection techniques that are performed in the low-back and hip-joint areas. Sonographic images and schematic illustrations of these ultrasound-guided injection techniques will be shown. Chen CP, Lew HL, Tsai WC, Hung YT, Hsu CC. Am J Phys Med Rehabil. 2011 Aug 12. [Epub ahead of print] PMID: 21844793

Diagnosing ulnar neuropathy at the elbow using magnetic resonance neurography.

Ulnar nerve size and signal intensity were greater in patients with ulnar neuropathy. MRN is a useful test in evaluating ulnar neuropathy at the elbow. Keen NN, Chin CT, Engstrom JW, Saloner D, Steinbach LS. Skeletal Radiol. 2011 Aug 16. [Epub ahead of print] PMID: 21845447

New Orthopedic Device Helps Wounded Warriors Run

FORT SAM HOUSTON, Texas -- A new energy-storing orthopedic device, along with an extensive rehabilitation program, is allowing wounded warriors who previously had difficulties walking or standing due to lower leg injuries to run again.

The Intrepid Dynamic Exoskeletal Orthosis, or IDEO, was designed by prosthetist Ryan Blanck at the Center for the Intrepid. It is a custom-fit device made from carbon and fiberglass that supports the foot and ankle and resembles an amputee’s running prosthetic.

The prevalence and effect of publication bias in orthopaedic meta-analyses.

Meta-analyses of randomized, controlled trials are considered the highest level-of-evidence, thus strongest source of information. However, questions concerning the validity of meta-analyses in orthopaedic surgery emerged recently. Among the most common sources for errors is publication bias. This describes the fact that studies with small or non-significant outcomes are less likely to be published, thus less likely to be identified and included in systematic reviews and meta-analyses. In this study we asked three questions: (1) Whether publication bias is assessed in orthopaedic meta-analyses, (2) What the actual prevalence of publication bias is, and (3) what effect publication bias has on the outcomes of orthopaedic meta-analyses.  Vavken P, Dorotka R. J Orthop Sci. 2011 Mar;16(2):238-44. Epub 2011 Mar 2. PMID: 21360256

Orthopedic surgery in the United States Army: a historical review.

The contribution of American military surgeons to the development of orthopedic surgery has not previously been explored. The experiences of American military surgeons in conflicts from the Civil War to Iraq and Afghanistan have advanced the orthopedic discipline, resulting in important developments within the field, as well as scientific discoveries that have benefited both the civilian and military communities. From advances in wound care, to spinal surgery, intramedullary nailing of long bone fractures, and external fixation, American military surgeons have been pioneers of orthopedic surgery. The goal of this review was to survey the American military orthopedic experience from the American Revolution to the wars in Iraq and Afghanistan.  Schoenfeld AJ. Mil Med. 2011 Jun;176(6):689-95. PMID: 21702390 PDF

Biomechanical Comparison of Arthroscopic Repairs for Acromioclavicular Joint Instability: Suture Button Systems Without Biological Augmentation.

Isolated reconstruction of the CC ligaments using single and double clavicular tunnel techniques results in a high load to failure for superior translation, which is equal to the native stability, and less translation in all 3 directions as well as higher superior stability when compared with the modified Weaver-Dunn procedure. A potential drawback is the risk of coracoid fracture, as the high load to failure of the device may exceed load to failure of cortical bone prior to device breakage. Clinical Relevance: Single clavicular tunnel arthroscopic reconstructions of the coracoacromial ligaments show good biomechanical results. Beitzel K, Obopilwe E, Chowaniec DM, Niver GE, Nowak MD, Hanypsiak BT, Guerra JJ, Arciero RA, Mazzocca AD. Am J Sports Med. 2011 Aug 12. [Epub ahead of print] PMID: 21841067 PDF

Tuesday, August 16, 2011

Clinical Orthopaedics and Related Research [Epub ahead of print]

1. Antimicrobial Gauze as a Dressing Reduces Pin Site Infection: A Randomized Controlled Trial. Lee CK, Chua YP, Saw A. Clin Orthop Relat Res. 2011 Aug 13. [Epub ahead of print] PMID: 21842299 PDF
Clin Orthop Relat Res. 2011 Aug 13. [Epub ahead of print] PMID: 21842298 PDF
3. Rectus Femoris Distal Tendon Resection Improves Knee Motion in Patients With Spastic Diplegia. Presedo A, Megrot F, Ilharreborde B, Mazda K, Penneçot GF. Clin Orthop Relat Res. 2011 Aug 13. [Epub ahead of print] PMID: 21842297 PDF

The levels of evidence in pediatric orthopaedic journals: where are we now?

In recent years, it has become common to publish a level of evidence grading for orthopaedic journal publications. Our primary research question is: is there an improvement in levels of evidence of articles published in pediatric orthopaedic journals over time? In addition, what is the current status of levels of evidence in pediatric orthopaedic journals? Cashin MS, Kelley SP, Douziech JR, Varghese RA, Hamilton QP, Mulpuri K. J Pediatr Orthop. 2011 Sep;31(6):721-5. PMID: 21841452

The Role of Preoperative Cardiac Investigation in Emergency Hip Surgery.

Given the well-recognized imperative to treat hip fractures as expeditiously as possible, there can arise uncertainty regarding the balance between preoperative medical optimization and delay of surgery. Echocardiography is often felt to considerably delay surgery with limited change to patient management.
 Heireamhoin SO, Ahmed M, Mulhall KJ. J Trauma. 2011 Aug 11. [Epub ahead of print] PMID: 21841513

Ultrasound in the selective screening of developmental dysplasia of the hip.

Developmental dysplasia of the hip (DDH) can result in chronic pain, gait abnormalities and degenerative arthritis. Infants with a family history, Breech delivery or unstable/"clicking" of the hip on examination are at higher risk. The goal is to detect cases early enough for normal hip development and function by the end of adolescence, but clinical examination alone is ineffective. Afaq AA, Stokes S, Fareed H, Zadeh HG, Watson M. Eur Rev Med Pharmacol Sci. 2011 Apr;15(4):394-8. PMID: 21608433

MR evaluation of femoral neck version and tibial torsion.

Abnormalities of femoral neck version have been associated with a number of hip abnormalities in children, including slipped capital femoral epiphysis, proximal femoral focal deficiency, coxa vara, a deep acetabulum and, rarely, developmental dysplasia of the hip. Orthopedic surgeons also are interested in quantifying the femoral neck anteversion or retroversion in children especially to plan derotational osteotomies. Historically, the angle of femoral version and tibial torsion has been measured with the use of radiography and later by CT. Both methods carry with them the risks associated with ionizing radiation. Techniques that utilize MR are used less often because of the associated lengthy imaging times. This article describes a technique using MRI to determine femoral neck version and tibial torsion with total scan times of approximately 10 min.
Koenig JK, Pring ME, Dwek JR. Pediatr Radiol. 2011 Aug 13. [Epub ahead of print] PMID:
21842328 PDF

A Doctor’s Review of the Android HTC Flyer as a Medical Tablet

The HTC Flyer promises to be the perfect medical tablet: it supports a fine-tip stylus and is small enough at 7 inches to comfortably carry around in a white coat. The recently reviewed BlackBerry PlayBook impressed with its size (also 7 inches), but ultimately suffered from its lack of third party apps. The HTC Flyer offers the potential of the growing Android marketplace and its many medical apps, so I was thrilled to purchase one for review. One of the two tablets earned a permanent spot in my white coat. Read on to find out which one and why. iMedicalApps

Journal of Rehabilitation Research and Development (from the Veterans Administration)

JRRD, the Journal of Rehabilitation Research and Development, has been a leading research journal for more than 45 years. Formerly the Bulletin of Prosthetics Research (BPR), JRRD debuted in 1983 to include cross-disciplinary findings in rehabilitation. JRRD, a scientifically indexed journal, publishes original research papers from U.S. and international researchers on all rehabilitation research disciplines.
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Monday, August 15, 2011

Ultrasound-Guided Sclerosing Treatment in Patients With Patellar Tendinopathy (Jumper's Knee): 44-Month Follow-up

A randomized controlled study has shown good clinical results after treatment with sclerosing injections into the area with neovessels in patients with patellar tendinopathy, but no study has investigated medium- or long-term outcomes. Hoksrud A, Bahr R. Am J Sports Med August 12, 2011 Published online before print. PDF

NYU Langone experts find MRI techniques can detect early osteoarthritis

Researchers from NYU Langone Medical Center's Departments of Orthopaedic Surgery and Radiology found that advanced MRI techniques can be used to detect subtle changes in joint cartilage microstructure – and provide physicians a diagnostic tool for finding key markers of early osteoarthritis (OA). By using these techniques during patient exams to identify OA earlier, clinicians can shift the management of the disease from eventual joint reconstruction to long-term preservation. The study was published in the July issue of the Journal of the American Academy of Orthopaedic Surgeons. Eurekalert!  PDF

History, clinical findings, magnetic resonance imaging, and arthroscopic correlation in meniscal lesions.

The aim of this prospective study was to compare the accuracy of clinical examination and magnetic resonance imaging (MRI) versus arthroscopic findings and to determine the value of an experienced examiner in clinical decision making. Ercin E, Kaya I, Sungur I, Demirbas E, Ugras AA, Cetinus EM. Knee Surg Sports Traumatol Arthrosc. 2011 Aug 11. [Epub ahead of print] PMID: 21833511

65 Outstanding Shoulder Surgeons and Specialists

The following shoulder surgeons and specialists were selected for this list based on the awards they have received from major organizations in the field, leadership in those organizations, work on professional publications and positions of service held at hospitals and practices. The surgeons are listed in alphabetical order by last name. All physicians placed on this list have undergone substantial review from our editorial staff. Physicians do not pay and cannot pay to be selected as an outstanding leader. This list is not an endorsement of any individual's or organization's clinical abilities. Becker's Orthopedic, spine & Pain Management Review

'Windmill of War' about pain, moving forward

"(It) is called ‘Windmill of War,' because no matter what's going on with the outside world these men are like a windmill, they just keep turning and moving and going to wherever they're needed," Gehrig said of her patient and all war veterans.

Thanks to medical advancements in the field and orthopedic surgeons like Gehrig, orthopedic patients across the country are able to move forward in their lives as normally as possible.

"The role an orthopedic surgeon plays in all this is the fact that we put their limbs together and they can then function after they heal," Gehrig said.

The American Academy of Orthopaedic Surgeons strives to showcase stories like Gehrig's patient's through the "Wounded in Action" art exhibit. Shown across the country, the exhibit has pieces from orthopedic surgeons and veterans who know what it is like to undergo such a life-changing experience.

Though Gehrig says that "Windmill of War" is a personal expression of how she feels toward her patients, it also is a call for all to take another look at those who have put their lives on the line for Americans.

"You can't really appreciate it until you hear some of the stories and see some of the residue of war and miracles happen with some of these injuries," Gehrig said. Bismarck Tribune

To see the entire "Wounded in Action" exhibit, visit

Sailors can wear ‘toe shoes’ despite military medical warnings

The Navy has reversed its policy banning minimalist 'toes shoes', Military Times reported. According to a fleetwide message released Aug. 5, sailors can wear the popular glove-like shoes, even during physical readiness tests, the newspaper reported.

However, the Navy Bureau of Medicine and Surgery has expressed concerns about the bare-bones Vibram Fivefingers shoes and warned against their use, according to Military Times.

While the Army banned soldiers from wearing the shoes during training earlier this summer, according to The Washington Post, the military school system endorsed them in March.
Read more on the toe shoe debate from Military Times.

Sunday, August 14, 2011

Interventions for treating chronic ankle instability.

Neuromuscular training alone appears effective in the short term but whether this advantage would persist on longer-term follow-up is not known. While there is insufficient evidence to support any one surgical intervention over another surgical intervention for chronic ankle instability, it is likely that there are limitations to the use of dynamic tenodesis. After surgical reconstruction, early functional rehabilitation appears to be superior to six weeks immobilisation in restoring early function.  de Vries JS, Krips R, Sierevelt IN, Blankevoort L, van Dijk CN. Cochrane Database Syst Rev. 2011 Aug 10;(8):CD004124. PMID: 21833947

Clinical and Ultrasonographic Results of Ultrasonographically Guided Percutaneous Radiofrequency Lesioning in the Treatment of Recalcitrant Lateral Epicondylitis.

The authors present a newly developed minimally invasive procedure, ultrasonographically guided percutaneous radiofrequency thermal lesioning (RTL), and its clinical efficacy in treating recalcitrant lateral epicondylitis. Lin CL, Lee JS, Su WR, Kuo LC, Tai TW, Jou IM. Am J Sports Med. 2011 Aug 11. [Epub ahead of print] PMID: 21836121

Recent PubMed Entries for the European Journal of Trauma and Emergency Surgery (2007 to present). Not currently indexed for MEDLINE.

Open Access Articles Link

1. Outcomes following operative and non-operative management of humeral midshaft fractures: a prospective, observational cohort study of 47 patients. van Middendorp JJ, Kazacsay F, Lichtenhahn P, Renner N, Babst R, Melcher G. Eur J Trauma Emerg Surg. 2011 Jun;37(3):287-296. Epub 2011 Apr 1. PMID: 21837261
2. Bilateral proximal tibia fracture. Andriessen MJ, Mattens EC, Sleeboom C, Heij HA. Eur J Orthop Surg Traumatol. 2011 Apr;21(3):199-201. Epub 2010 Aug 29. PMID: 21837233
3. Results of 131 consecutive operated patients with a displaced proximal humerus fracture: an analysis with more than two years follow-up. Faraj D, Kooistra BW, Vd Stappen WA, Werre AJ. Eur J Orthop Surg Traumatol. 2011 Jan;21(1):7-12. Epub 2010 Jun 15. PMID: 21837232

Impact of AOA Status and Perceived Lifestyle on Career Choices of Medical School Graduates.

Based upon student ratings of such factors as predictable work hours and personal time, medical specialties have been identified as lifestyle friendly, intermediate, or unfriendly. Lifestyle friendly programs may be more desirable, more competitive, and for students elected to the Alpha Omega Alpha (AOA) Honor Medical Society, more attainable.  Grayson MS, Newton DA, Patrick PA, Smith L. J Gen Intern Med. 2011 Aug 12. [Epub ahead of print]PMID: 21837375

European Journal of Orthopaedic Surgery & Traumatology (1991 to present). Not currently indexed in MedLine

Open Access Articles Link

Most Recent:

1.  Technical Note. Technical details of using sural flap in pes equinovarus surgery: a preliminary report on the technique  Daghan Isik, M. Fethi Ceylan, Savas Guner, M. Ata Gokalp and Bekir Atik
Online First™, 10 August 2011 Show Summary 

4. Up-to date Review and Case Report. Distal fracture clavicle and acromioclavicular dislocation: a case report and review the literature Antonio Zarza Pérez, J. L. González Montane and A. D. Delgado Martínez Online First™, 4 August 2011  Show Summary 

5. Original Article. Pedicle screw diameter selection for safe insertion in the thoracic spine
Online First™, 4 August 2011 Show Summary 

6. Original Article. Tranexamic acid reduces blood loss in simultaneous bilateral total knee arthroplasty: a randomized control trial A. Raviraj, Ashish Anand, Murali Chakravarthy, S. Kumarswamy and Ajith Prabhu, et al. Online First™, 2 August 2011 Show Summary