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Saturday, September 3, 2011

Military Medicine: recent articles

Performance of Military Tasks After Clavicle Plating  Management of displaced midshaft clavicle fractures in the military, a largely shoulder-bearing population, is controversial. We aimed to report the military-relevant functional outcomes after plate fixation. Huh, Jeannie1; A. Posner, Matthew2; Bear, Russell R.2; Banerjee, Rahul3; Owens, Brett D.4; Hsu, Joseph R.5; Military Medicine, Volume 176, Number 8, August 2011 , pp. 950-955(6).

Diagnoses and Mechanisms of Musculoskeletal Injuries in an Infantry Brigade Combat Team Deployed to Afghanistan Evaluated by the Brigade Physical Therapist Musculoskeletal injuries are the most common cause for disability in deployed environments. Current research is limited to body region affected by the injury. Objective: To determine the prevalence of musculoskeletal diagnoses and mechanisms of injury (MOI) as well as associations to specific Military Occupational Specialties (MOS) in a deployed Brigade Combat Team (BCT). Roy, Tanja C. Military Medicine, Volume 176, Number 8, August 2011 , pp. 903-908(6).

Orthopedic Injuries Before Combat Deployment—Will the Soldiers Be Ready for Combat When Their Unit Is Called Upon? Orthopedic injuries can occur anytime; but, before a known deployment, they can affect mission planning for commanders. A longitudinal cohort study of 158 soldiers with an orthopedic injury approximately 3 months before, and after, initial deployment in support of Operation Iraqi Freedom from a U.S. Army Brigade Combat Team was performed. Frank, Amy J. Military Medicine, Volume 176, Number 9, September 2011 , pp. 1015-1018(4).

Treatment of Trans-Scaphoid Perilunate Dislocations Using a Volar Approach With Scaphoid Osteosynthesis and Temporary Kirschner Wire Fixation Trans-scaphoid perilunate fracture dislocations (TSPLD) are uncommon injuries and constitute about 3% of all carpal injuries. Up to 25% of these high energy trauma cases go undiagnosed. Presented are 43 (3 female, 40 male) consecutive patients treated for dorsal TSPLD, all were closed fractures. Malović, Mario1; Pavić, Roman2; Milošević, Milan; Military Medicine, Volume 176, Number 9, September 2011 , pp. 1077-1082(6)

Friday, September 2, 2011

Glucocorticoid treatment may prevent long-term damage to joints

Joint injury can result in irreversible damage of cartilage which, despite treatment and surgery, often eventually leads to osteoarthritis (OA) in later life. New research published in BioMed Central's open access journal Arthritis Research & Therapy ( PDF ) demonstrates that short term treatment of damaged cartilage with glucocorticoids can reduce long term degenerative changes and may provide hope for prevention of OA after injury.  MedicalXpress

Cartilage fragments from osteoarthritic knee promote chondrogenesis of mesenchymal stem cells without exogenous growth factor induction

Extracellular matrix (ECM) is thought to participate significantly in guiding the differentiation process of mesenchymal stem cells (MSCs). In this study, we hypothesized that cartilage fragments from osteoarthritic knee could promote chondrogenesis of MSCs. Nonworn parts of cartilage tissues were obtained during total knee arthroplasty (TKA) surgery. Cartilage fragments and MSCs were wrapped into fibrin glue; and the constructs were implanted subcutaneously into nude mice. Histological analysis showed neocartilage-like structure with positive Alcian blue staining in the cartilage fragment–fibrin–MSC constructs. However, constructs with only MSCs in fibrin showed condensed appearance like MSCs in the pellet culture. Gene expression of type II collagen in the constructs with 60 mg cartilage fragments were significantly elevated after 4 weeks of implantation. Conversely, the constructs without cartilage fragments failed to express type II collagen, which indicated MSCs did not differentiate into a chondrogenic lineage. In conclusion, we demonstrated the effect of cartilage fragments from osteoarthritic knee in promoting chondrogenic differentiation of MSCs. This may be a favorable strategy for MSC chondrogenesis without exogenous growth factor induction. Chen, C.-C., Liao, C.-H., Wang, Y.-H., Hsu, Y.-M., Huang, S.-H., Chang, C.-H. and Fang, H.-W. (2011), Cartilage fragments from osteoarthritic knee promote chondrogenesis of mesenchymal stem cells without exogenous growth factor induction. Journal of Orthopaedic Research.  PDF

Ultrasound Imaging/Therapy: new from PubMed

1. Propagation of two longitudinal waves in a cancellous bone with the closed pore boundary. Mizuno K, Nagatani Y, Yamashita K, Matsukawa M. J Acoust Soc Am. 2011 Aug;130(2):EL122. PMID: 21877770
2. Efficacy of therapeutic ultrasound in the treatment of spasticity: A randomized controlled study. Sahin N, Ugurlu H, Karahan AY. NeuroRehabilitation. 2011 Jan 1;29(1):61-6. PMID: 21876297
3. Dynamic imaging and function of partial supraspinatus tendon tears. Gerber C, Zubler V, Hodler J, Catanzaro S, Jost B, Fucentese SF. Arthroscopy. 2011 Sep;27(9):1180-6. PMID: 21875528
Ultrasound Q. 2011 Sep;27(3):199-200. No abstract available. PMID: 21873857

Journal of Orthopaedic Trauma - Published Ahead-of-Print

Thursday, September 1, 2011

Innovative spinal stapling leads to astonishing outcome for little girl

Six weeks ago Diab performed a rare surgical procedure on Grace called vertebral body stapling at UCSF Benioff Children’s Hospital, the only hospital West of the Mississippi to perform the surgery. While vertebral body stapling is a “newer” operative option, it was first developed in the 1950's. In its original iteration, the surgery failed because the staples were too weak to hold the vertebrae and migrated out of the bone and floated around the chest. MedicalXpress

Exercise boosts health by influencing stem cells to become bone, not fat, McMaster researchers find

McMaster researchers have found one more reason to exercise: working out triggers influential stem cells to become bone instead of fat, improving overall health by boosting the body's capacity to make blood.  The body's mesenchymal stem cells are most likely to become fat or bone, depending on which path they follow.

Using treadmill-conditioned mice, a team led by the Department of Kinesiology's Gianni Parise has shown that aerobic exercise triggers those cells to become bone more often than fat.  The exercising mice ran less than an hour, three times a week, enough time to have a significant impact on their blood production, says Parise, an associate professor.  In sedentary mice, the same stem cells were more likely to become fat, impairing blood production in the marrow cavities of bones.

The research appears in a new paper published by the Journal of the Federation of American Societies for Experimental Biology. Eurekalert!

The Borden Institute - publishes the Textbooks of Military Medicine

The Borden Institute, an agency of the US Army Medical Department Center & School, publishes the Textbooks of Military Medicine (free PDF versions). The volumes in the series, now numbering 20, constitute a comprehensive treatise on the art and science of military medicine, covering such diverse topics as military preventive medicine, military medical ethics, harsh environments, and care of combat injuries.

Borden also publishes specialty clinical titles and works on military medical history. Print version of textbook volumes are available for free in PDF.
Currently Available:

Care of the Combat Amputee (2009) Free PDF

Books in Production:

Musculoskeletal Injuries in Military Women
This monograph discusses the most common musculoskeletal injuries in military women. Prevention and management of these injuries are very important to sustain the fighting force and maintain military readiness. Information about the incidence, risk factors, prevention, diagnosis, evaluation, treatment, and rehabilitation of common musculoskeletal overuse and traumatic injuries sustained by women in the military is included. Sections topics  cover an overview of musculoskeletal injuries in military women; common lower extremity overuse injuries; common traumatic injuries; an overview of general injury prevention, treatment, and rehabilitation techniques; and specific injury prevention, treatment, and rehabilitation techniques in the military.

Emergency War Surgery, 4th Ed
As an update to the much-referenced 2004 version, information in this edition reflects lessons learned from American involvement in Iraq and Afghanistan, and represents state-of-the-art principles and practices of forward trauma surgery. This publication expertly addresses the appropriate medical management of blast wounds, burns, multiple penetrating injuries, as well as other battle and nonbattle injuries. Topics include triage, hemorrhage control, airway/breathing, shock and resuscitation, anesthesia, infections, critical care, damage control surgery, face and neck injuries, soft-tissue injuries, ocular injuries, head injuries, extremity fractures, thoracic injuries, amputations, abdominal injuries, pediatric care, and more.

Ligament Contribution to Patterns of Articular Fractures of the Distal Radius

Intra-articular fractures of the distal radius are common injuries, but the correlation between ligament attachments and fracture location is poorly understood. The purpose of this study was to assess the location of intra-articular fractures compared to the known ligament attachments of the distal radius. Daniel G. Mandziak MBBS, Adam C. Watts MBBS and Gregory I. Bain PhD, MBBS. The Journal of Hand Surgery (Article in Press), Available online 31 August 2011  PDF

Wednesday, August 31, 2011

Journal of Surgical Education (Articles in Press)

Monitoring Universal Protocol Compliance Through Real-Time Clandestine Observation by Medical Students Results in Performance Improvement  (PDF)

Octenidine in combination with polymethylmethacrylate: a new option for preventing infection?

Orthopedic implant infections represent a serious complication for both patient and surgeon. In order to minimize this risk, it has become standard practice in surgery and orthopedics to add antimicrobial substances to the polymethylmethacrylate (PMMA) bone cement. The aim of this study is to find new options for preventing infection by using alternative adjuvants in combination with PMMA. We hypothesized, that Octenidine, after being combined with PMMA, can be released in vitro and an antimicrobial efficacy of discharged Octenidine can be shown. Weckbach S, Möricke A, Braunwarth H, Goroncy-Bermes P, Bischoff M, Gebhard F. Arch Orthop Trauma Surg. 2011 Aug 30. [Epub ahead of print] PMID: 21877126

New chemical reagent turns mouse brain transparent - think animal models and muscle, connective tissues.

Researchers at RIKEN, Japan's flagship research organization, have developed a ground-breaking new aqueous reagent which literally turns biological tissue transparent. Experiments using fluorescence microscopy on samples treated with the reagent, published this week in Nature Neuroscience, have produced vivid 3D images of neurons and blood vessels deep inside the mouse brain. Highly effective and cheap to produce, the reagent offers an ideal means for analyzing the complex organs and networks that sustain living systems. RIKEN

HTA:101 and Comparative Effectiveness Research: a 2-Part Webinar Series (from NLM)

Educational Objectives:
  • Part I: (HTA 101: 2011 Update on Introduction to Health Technology Assessment): Gain an understanding of the origins and fundamental concepts of health technology assessment (HTA), the major organizations that produce or use HTA guidance, the primary data and integrative methods, how topics are determined, the sources of evidence, dissemination and evaluation of impact. This webinar is based on and complements HTA:101, an online primer.
  • Part II: (CER-HTA-PCOR: Converging on What Works for Patients): Learn about the evolving definitions used in comparative effectiveness research, the emerging focus on patient-centered outcomes research (PCOR), the types of methods used in conducting CER, the challenges of conducting CER, the controversies, and the relationships among CER, HTA, and PCOR.

Educating patients on knee surgery with a medical app - KneeDecide

OrcaMed has developed a series of anatomically precise mobile apps to aid the clinician who treats musculoskeletal conditions teach patients about relevant anatomy and pathology. We have previously reviewed their shoulder app (Shoulder Decide). Overall I think the KneeDecide app matches up equally as well and would work as a very useful aid in communicating basic knee anatomy and pathology to patients. iMedicalApps

Doctors' and nurses' hospital uniforms contain dangerous bacteria majority of the time, study shows

More than 60 percent of hospital nurses' and doctors' uniforms tested positive for potentially dangerous bacteria, according to a study published in the September issue of the American Journal of Infection Control (PDF), the official publication of APIC - the Association for Professionals in Infection Control and Epidemiology. MedicalXpress

Tuesday, August 30, 2011

Ghostwriting remains a fundamental problem in the medical literature

An editorial this week in PLoS Medicine (PDF) concludes that in the two years since extensive ghostwriting by pharmaceutical giant Wyeth to promote its hormone drug Prempro was exposed through litigation intervention by PLoS Medicine and The New York Times, medical ghostwriting remains a prevalent problem with few concrete solutions in sight. This week also sees the launch of the PLoS Ghostwriting Collection, which documents everything published across the PLoS journals on the topic.  MedicalXpress

Free calls home from Gmail for all U.S. service members

We understand that it’s not always easy or affordable for our troops serving overseas to call friends and family at home, so starting today we’re making it completely free for all uniformed military personnel with valid United States Military (.mil) email addresses to call the United States, right from Gmail.

Repair of Flexor Digitorum Profundus to Distal Phalanx: A Biomechanical Evaluation of Four Techniques.

Many techniques for repair of the flexor digitorum profundus to the distal phalanx show excessive gapping with variable clinical results. The purpose of this study was to test the biomechanical characteristics of an anchor-button (AB) technique, as compared to 3 other techniques.  Lee SK, Fajardo M, Kardashian G, Klein J, Tsai P, Christoforou D. J Hand Surg Am. 2011 Aug 26. [Epub ahead of print] PMID: 21873002

Results of Arthroscopic Decompression and Tuberoplasty for Irreparable Massive Rotator Cuff Tears.

Arthroscopic tuberoplasty with concomitant acromioplasty, as well as treatment of the biceps tendon when indicated, would be an option for diminishing pain and improving active forward elevation for irreparable massive rotator cuff tears. In particular, satisfactory results during the minimum follow-up period of 24 months can be achieved in the cases with good preservation of the preoperative and postoperative acromiohumeral interval and continuity in the inferior scapulohumeral line, regardless of preoperative mobility.  Lee BG, Cho NS, Rhee YG. Arthroscopy. 2011 Aug 26. [Epub ahead of print] PMID: 21873021

Observer variation for radiography, computed tomography, and magnetic resonance imaging of occult hip fractures.

There were almost perfect observer agreements for CT and MRI in diagnosing non-displaced, occult hip fractures. Observer agreements for radiography were moderate to substantial, and observer experience influenced agreement only at radiography Collin D, Dunker D, Göthlin JH, Geijer M. Acta Radiol. 2011 Aug 26. [Epub ahead of print] PMID: 21873504

The surgical treatment of knee stiffness following anterior cruciate ligament reconstruction.

In conclusion, arthroscopic arthrolysis, in conjunction with MUA, is an effective treatment for knee stiffness post-ACL reconstruction but ideally should be carried out within eight months.  Robertson GA, Coleman SG, Keating JF. Scott Med J. 2011 Aug;56(3):156-60. PMID: 21873721

Convergent Radioulnar Translocation With Radial Head Fracture in a Child: A Case Report and Review of the Literature.

Convergent type radioulnar translocation is an extremely rare form of injury occurring in a growing child. We report a case of convergent radioulnar translocation along with a radial head fracture in a young child. Open reduction of the elbow and internal fixation of the radial head fragment helped in achieving concentric reduction and good functional outcome at 2 years of follow-up. This case has been shown to highlight the diagnostic and management issues of this rare condition, which may be easily missed initially.  Agashe MV, Samant A, Aroojis AJ. J Orthop Trauma. 2011 Aug 20. [Epub ahead of print] PMID: 21873890

Greenbrier announces plans for medical institute. (Ortho Related)

Before choosing West Virginia and the Greenbrier for this facility, orthopedic surgeon Dr.  James Andrews, orthopedic practice consultant Michael Immel and healthcare developer Jack Diamond considered sites in London, England, Riyadh, Saudi Arabia, Brasilia, Brazil and Seoul, South Korea.

Dr. Andrews says the cornerstone of the project is the sports medicine component which will include a comprehensive diagnostic and clinical orthopedic sports medicine complex with state of the art operating rooms and teaching suites. West Virginia Public Broadcasting

Defense cuts will require more focus on critical enablers.

A fourth example of an area requiring sustained investment is military medicine, in general, and tele-medicine, in particular. As the size of the force shrinks, the value to the nation of each individual soldier, sailor, marine and airman's life and well-being increases. The survival rates for soldiers in combat is already above 90 percent. The marriage of near-instantaneous long-distance communications with advanced sensing and imaging is creating the potential for medical intervention and support at long range. Tele-medicine can improve critical care both in forward areas and in the transport of wounded personnel to advanced medical facilities. Military & Aerospace Electronics

Surgical management of pilon fractures with large segmental bone defects using fibular strut allografts: a report of two cases.

We present two patients with open pilon fractures with large bone defects treated successfully with fibular strut allografts. The patients were initially treated by massive irrigation, wound debridement, and temporary external fixation. After complete wound healing, the bone defects were managed. Because autologous iliac crest or fibular bone grafts were impossible to be harvested due to multiple fractures, the bone defects were reconstructed with fibular strut allografts. Fixation was performed with a periarticular distal tibia locking plate. At 2 months postoperatively, the patients ambulated with partial weight-bearing; at 6 months, they had full range of motion of the ankle joint and full weight-bearing.  Kim WY, Ji JH, Park SE, Kim YY, Jeong JJ, Kang HT. Eur J Orthop Surg Traumatol. 2011 Aug;21(6):439-444. Epub 2011 Mar 25. PMID: 21874131

Occult hip and pelvic fractures and accompanying muscle injuries around the hip.

Occult hip and pelvic fractures were almost equally seen among 113 cases with suspected hip fracture but were negative on plain radiography. Different patterns of associated muscle injuries in cases of occult hip fracture and pelvic fracture suggest that the mechanism of hip fracture and pelvic fracture is possibly different.  Ohishi T, Ito T, Suzuki D, Banno T, Honda Y. Arch Orthop Trauma Surg. 2011 Aug 28. [Epub ahead of print] PMID: 21874573

Clinical outcome after Chevron-Akin double osteotomy versus isolated Chevron procedure: a prospective matched group analysis.

These findings indicate that Chevron-Akin double osteotomy is a save and practicable procedure for the treatment of mild-to-moderate hallux valgus. Superiority of combined Chevron-Akin procedure over an isolated Chevron osteotomy might be limited to distinct clinical settings, but should not be generally assumed.  Lechler P, Feldmann C, Köck FX, Schaumburger J, Grifka J, Handel M. Arch Orthop Trauma Surg. 2011 Aug 28. [Epub ahead of print] PMID: 21874575

Ischiofemoral impingement: evaluation with new MRI parameters and assessment of their reliability.

Clinicians and radiologists should be aware of IFI in patients with hip or groin pain, and MRI should be obtained for the presence of the QFM edema/fatty replacement, narrowing of the IFS-QFS, and other features that may help in the clinical diagnosis of IFI for the proper diagnosis and treatment of the disease.  Tosun O, Algin O, Yalcin N, Cay N, Ocakoglu G, Karaoglanoglu M. Skeletal Radiol. 2011 Aug 29. [Epub ahead of print] PMID: 21874607

Comparison of the diagnostic utility of Electromyography, Ultrasonography, Computed Tomography, Magnetic Resonance Imaging in idiopathic Carpal Tunnel Syndrome determined by clinical findings.

EMG or US could be used as the first-step test in most cases. If they are both available, EMG should be the first choice. They may be performed together when diagnosis is challenging. CT may especially be preferred for bone-related pathological conditions, while MRI may be preferred for soft tissue-related pathological conditions. Even though imaging studies have been proven to be powerful diagnostic tools for CTS, no conclusive information currently exists to support replacing EMG with imaging studies. Deniz FE, Oksüz E, Sarkaya B, Kurt S, Erkorkmaz U, Ulusoy H, Arslan S. Neurosurgery. 2011 Aug 23. [Epub ahead of print] PMID: 21869718

Drug-Coated Balloon Saves Ischemic Limbs (CME/CE, with audio)

Revascularization using a paclitaxel-eluting balloon dramatically improved outcomes in patients with critical lower-limb ischemia -- a condition with notoriously high rates of restenosis -- a single-center European study found.

In the first trial of angioplasty with drug-eluting balloons for lengthy occluded or stenosed infrapopliteal arteries, the restenosis rate at three months was 27.4%, Andrej Schmidt, MD, of Park Hospital Leipzig in Germany, and colleagues reported in the Sept. 6 Journal of the American College of Cardiology. Medpage Today

Surgical emergency management made easy with Emergencies in Clinical Surgery medical app

There is a rapidly growing market for the conversion of reference handbooks into applications. MedHand Mobile Libraries has exclusive rights to the Oxford University Press Handbooks. These are a common sight out on the wards and in libraries. Based on the Oxford Handbook of the same name, Emergencies in Clinical Surgery is one of the latest to receive the MedHand treatment. iMedicalApps

Sunday, August 28, 2011

Posterior remodeling of medial clavicle causing superior vena cava impingement

Injuries involving the sternoclavicular region resulting in posterior displacement of the medial clavicle are rare, and those that occur prior to fusion of the medial epiphyseal growth plate are more often a result of physis fracture, rather than sternoclavicular joint dislocation. Medial clavicular physis fractures initially are treated by closed reduction with the expectation of normal osseous repair and remodeling. We report a case of a previously fractured medial clavicle physis that abnormally remodeled, was reinjured, and resulted in posterior displacement with superior vena cava impingement and brachioplexopathy. Our case report describes the patient's initial injury and repair, the reinjury and discovery of abnormal remodeling, and the outcome of surgical intervention. We also include a review of recent literature on sternoclavicular joint injuries and treatment options. To our knowledge, this is the first reported case of an abnormally remodeled medial clavicle resulting in superior vena cava compression. Carbone P, Rose M, O'Daniel JA, Doukas WC, O'Toole RV, Anderson RC. Am J Orthop (Belle Mead NJ). 2011 Jun;40(6):297-300. PMID: 21869940 Free PDF with registration

Stanford researchers invent sutureless method for joining blood vessels

Reconnecting severed blood vessels is mostly done the same way today — with sutures — as it was 100 years ago, when the French surgeon Alexis Carrel won a Nobel Prize for advancing the technique. Now, a team of researchers at the Stanford University School of Medicine has developed a sutureless method that appears to be a faster, safer and easier alternative.

In animal studies, a team led by Stanford microsurgeon Geoffrey Gurtner, MD, used a poloxamer gel and bioadhesive rather than a needle and thread to join together blood vessels, a procedure called vascular anastomosis. Results of the research will be published online Aug. 28 in Nature Medicine. Lead authors of the study were Stanford postdoctoral scholar Edward Chang, MD, and surgery resident Michael Galvez, MD. Eurekalert!