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Saturday, September 17, 2011

A systematic survey of the quality of research reporting in general orthopaedic journals.

The poor reporting and use of statistical methods in orthopaedic papers has been widely discussed by both clinicians and statisticians. A detailed review of research published in general orthopaedic journals was undertaken to assess the quality of experimental design, statistical analysis and reporting. Parsons NR, Hiskens R, Price CL, Achten J, Costa ML. J Bone Joint Surg Br. 2011 Sep;93(9):1154-9. PMID: 21911523 PDF

Ballistic Fractures: Indirect Fracture to Bone

Two mechanisms of injury, the temporary cavity and the sonic wave, have been proposed to produce indirect fractures as a projectile passes nearby in tissue. The purpose of this study is to evaluate the temporal relationship of pressure waves using strain gauge technology and high-speed video to elucidate whether the sonic wave, the temporary cavity, or both are responsible for the formation of indirect fractures. Dougherty, Paul J. MD; Sherman, Don MS; Dau, Nathan MS; Bir, Cynthia PhD. Journal of Trauma-Injury Infection & Critical Care: POST AUTHOR CORRECTIONS, 15 September 2011 PDF

Review of techniques for monitoring the healing fracture of bones for implementation in an internally fixated pelvis.

Sacral fractures from high-impact trauma often cause instability in the pelvic ring structure. Treatment is by internal fixation which clamps the fractured edges together to promote healing. Healing could take up to 12 weeks whereby patients are bedridden to avoid hindrances to the fracture from movement or weight bearing activities. Immobility can lead to muscle degradation and longer periods of rehabilitation. The ability to determine the time at which the fracture is stable enough to allow partial weight-bearing is important to reduce hospitalisation time. This review looks into different techniques used for monitoring the fracture healing of bones which could lead to possible methods for in situ and non-invasive assessment of healing fracture in a fixated pelvis. Wong LC, Chiu WK, Russ M, Liew S. Med Eng Phys. 2011 Sep 13. [Epub ahead of print] PMID: 21920792

Impact of restriction of cefepime use on the antimicrobial susceptibility of Gram-negative bacilli related to healthcare-associated infections in an orthopedic hospital.

Restriction of cefepime use had a positive impact on K. pneumoniae and Enterobacter spp, given that after this restriction, their susceptibilities to ciprofloxacin improved. However, for A. baumanii, the impact was negative, given the worsening of susceptibility to imipenem. Oliveira PR, Paula AP, Dal-Paz K, Felix CS, Rossi F, Silva JS, Lima AL. Infect Drug Resist. 2011;4:149-54. Epub 2011 Aug 4. PMID: 21904460 PDF

Bioprocess forces and their impact on cell behavior: implications for bone regeneration therapy.

Bioprocess forces such as shear stress experienced during routine cell culture are considered to be harmful to cells. However, the impact of physical forces on cell behavior is an area of growing interest within the tissue engineering community, and it is widely acknowledged that mechanical stimulation including shear stress can enhance osteogenic differentiation. This paper considers the effects of bioprocess shear stress on cell responses such as survival and proliferation in several contexts, including suspension-adapted cells used for recombinant protein and monoclonal antibody manufacture, adherent cells for therapy in suspension, and adherent cells attached to their growth substrates. The enhanced osteogenic differentiation that fluid flow shear stress is widely found to induce is discussed, along with the tissue engineering of mineralized tissue using perfusion bioreactors. Recent evidence that bioprocess forces produced during capillary transfer or pipetting of cell suspensions can enhance osteogenic responses is also discussed.  Brindley D, Moorthy K, Lee JH, Mason C, Kim HW, Wall I. J Tissue Eng. 2011;2011:620247. Epub 2011 Aug 23. PMID:21904661  PDF

Locked antegrade intramedullary nailing of humeral shaft fractures

This paper reports the results of treating 35 humeral shaft fractures with antegrade nailing in patients between the ages of 25 and 92 (mean 64.5): 14 patients were aged between 25 and 59, and 21 between 66 and 92. The nail was set in place proximally with a spiral blade and distally with 1 or 2 screws. In the first 14 cases, uncannulated humeral nailing (UHN) was carried out, and in the next 21 cannulated humeral nailing (CHN). The latter technique uses a guide wire which, in cases of an error in the length of the nail, is useful in that it allows another nail to be set in place. Iacobellis C, Agrò T, Aldegheri R. Musculoskelet Surg. 2011 Sep 16. [Epub ahead of print] PMID: 21922194

Effects of using a surgical clamp to hold tension while tying knots with commonly used orthopedic sutures.

Tendon repairs are often performed under some degree of tension, and in these instances the use of a clamp to temporarily secure a knot following the first throw can lessen gap formation while subsequent suture throws are made. The effect of clamping on the ultimate tensile load, stiffness, elongation, and mechanism of failure of suture loops has not been investigated for several commonly used orthopedic sutures, and it was the purpose of this study to investigate this issue. Bisson LJ, Sobel AD, Godfrey D. Knee Surg Sports Traumatol Arthrosc. 2011 Sep 16. [Epub ahead of print] PMID: 21922319

Sonography in carpal tunnel syndrome.

Our objective in this study was to assess the diagnostic utility of the median nerve cross-sectional area (CSA) at the wrist, the wrist-forearm ratio, and the wrist-forearm difference in patients with and without carpal tunnel syndrome (CTS). Hunderfund AN, Boon AJ, Mandrekar JN, Sorenson EJ. Muscle Nerve. 2011 Oct;44(4):485-91. PMID: 21922467

Degeneration of the Knee Joint in Skeletally Immature Patients With a Diagnosis of an Anterior Cruciate Ligament Tear: Is There Harm in Delay of Treatment?

In skeletally immature patients with an anterior cruciate ligament (ACL) tear and significant growth remaining, the risk of inducing a growth disturbance with early reconstruction must be balanced against the risk of further intra-articular damage by delaying treatment until closer to skeletal maturity.  Lawrence JT, Argawal N, Ganley TJ. Am J Sports Med. 2011 Sep 14. [Epub ahead of print] PMID: 21917611 PDF

Friday, September 16, 2011

Efficacy of a combined oral clindamycin-rifampicin regimen for therapy of staphylococcal osteoarticular infections

A majority of osteoarticular and implant-related infections are due to staphylococci and biofilm formation. Combined therapy including rifampicin is frequently recommended. Indeed, rifampicin penetrates biofilms and kills adherent staphylococci, but cannot be administered as monotherapy because of the rapid emergence of resistant mutants. While several antibiotic combinations including rifampicin have been implemented, evaluation of the clindamycin-rifampicin combination has been neglected, presumably because of the emergence of alternative combinations, such as quinolone-rifampicin, and the fear of potential antagonistic interactions.  Czekaj J, Dinh A, Moldovan A, Vaudaux P, Gras G, Hoffmeyer P, Lew D, Bernard L, Uçkay I. Scand J Infect Dis. 2011 Sep 15. [Epub ahead of print]PMID: 21916775 PDF

Orthopedic Surgeon and App developer, Interview with Matt Ockendon.

Here at iMedicalApps, we believe that medical mobile technology has the potential to improve modern healthcare. One such developer, who happens to be an orthopedic surgeon as well, Matt Ockendon, has released a number of apps which successfully demonstrate how medical mobile technology can be used within a healthcare environment.

In addition, some of his applications (such as IOS Fixator and Hallux Angles) have hinted at what could be possible for the future of medicine and mobile technology. We were able to catch up with him recently and interviewed him regarding his thoughts on mobile health and developing medical apps. iMedical Apps

Thursday, September 15, 2011

In Vivo Vascularity Alterations in Repaired Rotator Cuffs Determined by Contrast-Enhanced Ultrasound

Visualization of vascularization using contrast-enhanced ultrasound could help in deciding on an appropriate repair technique or on the form of postoperative rehabilitation after rotator cuff repair.   Tadanao Funakoshi, Norimasa Iwasaki, Tamotsu Kamishima, Mutsumi Nishida, Yoichi Ito, Kinya Nishida, Makoto Motomiya, Naoki Suenaga, and Akio Minami. Am J Sports Med September 14, 2011 ; published online before print September 14, 2011 PDF

Meta-Analysis of Pinning in Supracondylar Fracture of the Humerus in Children

 Lateral pinning is preferable to cross pinning for fixation of pediatric supracondylar humerus fractures as a result of decreased risk of ulnar nerve injury. Woratanarat, Patarawan MD, PhD; Angsanuntsukh, Chanika MD; Rattanasiri, Sasivimol PhD; Attia, John MD, PhD, FRCPC, FRACP; Woratanarat, Thira MD, MMedSc; Thakkinstian, Ammarin PhD. Journal of Orthopaedic Trauma: POST AUTHOR CORRECTIONS, 08 September 2011 PDF

Are Recent Graduates of Orthopaedic Training Programs Performing Less Fracture Care? American Board of Orthopedic Surgeons Part II: A Quality Improvement Initiative

The purpose of this study was to evaluate whether there has been a change in the amount of fracture care performed by recent graduates of orthopaedic residency programs over time. Koval, Kenneth J MD; Marsh, Larry MD; Anglen, Jeff MD; Weinstein, James DO, MS; Harrast, John J MS Journal of Orthopaedic Trauma: POST AUTHOR CORRECTIONS, 10 September 2011 PDF

The Reliability of Measurement of Tissue Pressure in Compartment Syndrome

Although there is general agreement as to the pathophysiology and treatment of compartment syndrome and the importance of intramuscular pressure measurements, there are many methods described to obtain these measurements. Variations in experimental measurements using current electronic monitoring, needle, and catheter devices of 18 to 22 mmHg are reported and are enough to cause errors in clinical decision-making that could result in significant clinical consequences. Current unacceptable reliability has been reported with the use of bevel-tipped needles and the clinical Whitesides technique. Because this is contrary to the authors' cumulative clinical and research experience with various methods when properly used (with the small required saline flush to assure a fluid continuum between tissue and the pressure monitor), this study was designed to clarify these problems. Although the two Whitesides techniques (original and clinical) are not in current use where digital methods are available, the clinical method is still used in the Third World. Hammerberg, E Mark MD; Whitesides, Thomas E Jr MD; Seiler, John G III MD Journal of Orthopaedic Trauma: POST AUTHOR CORRECTIONS, 10 September 2011 PDF

Identification of the Radial Nerve During the Posterior Approach to the Humerus: A Cadaveric Study

Our group has identified the point of intersection among three landmarks forming a point of intersection. This point is the confluence of the long and lateral heads of the triceps and the triceps aponeurosis. This serves as a visualized anatomic reference point during the posterior surgical exposure to the humerus and can be used to identify the radial nerve as it courses the posterior humerus.  Seigerman, Daniel A MD; Choung, Edward W DO, MS; Yoon, Richard S BS; Lu, Michael MD; Frank, Matthew A MD; Gaines, Robert J MD; Liporace, Frank A MD. Journal of Orthopaedic Trauma: POST AUTHOR CORRECTIONS, 10 September 2011 PDF

Trauma: My Life as an Emergency Surgeon (Navy)

TRAUMA is Dr. Cole's harrowing account of his life spent in the ER and on the battlegrounds, fighting to save lives. In addition to his gripping stories of treating victims of gunshot wounds, stabbings, attempted suicides, flesh-eating bacteria, car crashes, industrial accidents, murder, and war, the book also covers the years during Cole's residency training when he was faced with 120-hour work weeks, excessive sleep deprivation, and the pressures of having to manage people dying of traumatic injury, often with little support.
Unlike the authors of other medical memoirs, Cole trained to be a surgeon in the military and served as a physician member of a Marine Corps reconnaissance unit, United States Special Operations Command (USSOCOM), and on a Navy Reserve SEAL team.  From treating war casualties in Afghanistan and Iraq to his experiences as a civilian trauma surgeon treating alcoholics, drug addicts, criminals, and the mentally deranged, TRAUMA is an intense look at one man's commitment to his country and to those most desperately in need of aid.

About the Author

DR. JAMES COLE has served with USSOCOM and has been a Navy Officer, paratrooper, military diver, and surgeon. He left active duty in 2000 but after the events of September 11th, he rejoined the reserves and was deployed to both Afghanistan and Iraq. He practices Trauma Surgery, Critical Care, and Emergency General Surgery in Illinois.

UK DRAFFT - A Randomised Controlled Trial of Percutaneous Fixation with Kirschner Wires versus Volar Locking-Plate Fixation in the Treatment of Adult Patients with a Dorsally Displaced Fracture of the Distal Radius.

Fractures of the distal radius are extremely common injuries in adults. However, the optimal management remains controversial. In general, fractures of the distal radius are treated non-operatively if the bone fragments can be held in anatomical alignment by a plaster cast or orthotic. However, if this is not possible, then operative fixation is required. There are several operative options but the two most common in the UK, are Kirschner-wire fixation (K-wires) and volar plate fixation using fixed-angle screws (locking-plates). Costa ML, Achten J, Parsons NR, Rangan A, Edlin RP, Brown J, Lamb SE. BMC Musculoskelet Disord. 2011 Sep 13;12(1):201. [Epub ahead of print] PMID:  21914196  PDF

Patient-reported outcomes after silastic replacement of the trapezium for osteoarthritis.

This retrospective study evaluated 69 Swanson trapezium replacements performed between 1990 and 2009 for trapeziometacarpal osteoarthritis in 58 patients. Pain and function were assessed using the Michigan Hand Questionnaire and the Disability of the Arm, Shoulder and Hand questionnaire.  Burke NG, Walsh J, Moran CJ, Cousins G, Moloney D, Kelly EP. J Hand Surg Eur Vol. 2011 Sep 13. [Epub ahead of print] PMID: 21914695

Primary Exploration of Radial Nerve is Not Required for Radial Nerve Palsy while Treating Humerus Shaft Fractures with Unreamed Humerus Nails (UHN).

Due to the high rates of spontaneous remissions of radial nerve palsy after treatment with UHN in humerus shaft fractures, primar exploration of the radial nerve does not appear to be necessary. Grass G, Kabir K, Ohse J, Rangger C, Besch L, Mathiak G. Open Orthop J. 2011;5:319-23. Epub 2011 Aug 26. PMID: 21915231 PDF

Injectability and mechanical properties of magnesium phosphate cements.

Up to now magnesium phosphate cements are mainly being utilized in wastewater treatment due to their adsorptive properties. Recently they also have been shown to have a high potential as degradable biocements for application as replacement materials for bone defects. In comparison to degradable calcium phosphate cements they have the advantage of setting at neutral pH, which is favorable in biological environment. Moseke C, Saratsis V, Gbureck U. J Mater Sci Mater Med. 2011 Sep 14. [Epub ahead of print] PMID: 21915697

Repair of rat calvarial bone defects by controlled release of rhBMP-2 from an injectable bone regeneration composite.

The objective of the present study was to enhance the regeneration ability of an injectable bone regeneration composite (IBRC) by the controlled release of recombinant human bone morphogenetic protein-2 (rhBMP-2)...In vitro and in vivo studies suggested that the present system is a potential bone critical defect repair material for clinical applications.  Tan R, She Z, Wang M, Yu X, Jin H, Feng Q. J Tissue Eng Regen Med. 2011 Sep 13. doi: 10.1002/term.463. [Epub ahead of print] PMID: 21916016

Wednesday, September 14, 2011

Three New Combat-related Orthopedic Books

Ties That Bind Sports Medicine and Military Medicine: Wartime Docs Showcase the Connections (The Physician and Sportsmedicine) - [Kindle Edition]  2011

Combat Orthopedic Surgery: Lessons Learned in Iraq and Afghanistan  2011

Armed Conflict Injuries to the Extremities: A Treatment Manual 2011

Meta-Analysis of Pinning in Supracondylar Fracture of the Humerus in Children. (Systematic Review)

Lateral pinning is preferable to cross pinning for fixation of pediatric supracondylar humerus fractures as a result of decreased risk of ulnar nerve injury. Woratanarat P, Angsanuntsukh C, Rattanasiri S, Attia J, Woratanarat T, Thakkinstian A. J Orthop Trauma. 2011 Sep 8. [Epub ahead of print] PMID: 21909033 PDF

Role of angiogenesis after muscle derived stem cell transplantation in injured medial collateral ligament

We performed this study to investigate the therapeutic role of vascular endothelial growth factor (VEGF) in medial collateral ligament (MCL) healing.....The findings of the present study suggest that angiogenesis plays a critical role in the healing process of injured MCL. Makoto Nishimori1, Tomoyuki Matsumoto1, Shusuke Ota1, Sebastian Kopf1, Yutaka Mifune1, Christopher Harner, Mitsuo Ochi, Freddie H. Fu, Johnny Huard1. Journal of Orthopaedic ResearchEarly View, Article first published online: 12 SEP. PDF

Tuesday, September 13, 2011

Pituitary hormone TSH found to directly influence bone growth

Researchers at Mount Sinai School of Medicine have found that thyroid-stimulating hormone (TSH), a hormone produced in the anterior pituitary gland that regulates endocrine function in the thyroid gland, can promote bone growth independent of its usual thyroid functions. The research suggests that TSH, or drugs that mimic its affect on bone, may be key to possible future treatments for osteoporosis and other conditions involving bone loss, such as cancer. The findings were published online this week in the National Academy of Sciences journal PNAS. Eurekalert!

Ultrasound imaging for the rheumatologist XXXIV. Sonographic assessment of the painful foot.

The foot is increasingly the focus of attention for rheumatologists when assessing patients presenting to a clinic and may represent underlying intra-articular inflammatory pathology or involvement of the surrounding soft tissues. This study describes the correlation between clinical and ultrasound (US) findings in patients presenting with a variety of rheumatic disorders linked with foot pain. Poor correlation was found between conventional clinical examination and US in cases with joint inflammation, tendonitis and, more particularly, those cases with enthesopathy. Meenagh G, Sakellariou G, Iagnocco A, Delle Sedie A, Riente L, Filippucci E, Grassi W, Bombardieri S, Valesini G, Montecucco CM. Clin Exp Rheumatol. 2011 Jul-Aug;29(4):601-3. Epub 2011 Aug 29. PMID: 21906427

Incidence of Pulmonary Embolus in Combat Casualties With Extremity Amputations and Fractures.

The objective of this retrospective study was to determine the incidence of pulmonary embolism (PE) in casualties of wartime extremity wounds and specifically in casualties with a trauma-associated amputation. 
Gillern SM, Sheppard FR, Evans KN, Graybill JC, Gage FA, Forsberg JA, Dunne JR, Tadaki DK, Elster EA. J Trauma. 2011 Sep;71(3):607-613. PMID: 21908998  PDF

Monday, September 12, 2011

Journal of Surgical Education: in press, corrected proofs

Women in Academic Surgery: The Pipeline Is Busted. This investigation examined the trends for gender-based advancement in academic surgery by performing a comparative analysis of the rate of change in the percentage of medical students, surgery residents, and full professors of surgery who are women. PDF

Educational Factors Outweigh the Importance of Lifestyle Factors for Residency Program Applicants: An International Comparative Study. Although studies have been conducted to identify factors that attract students to a career in surgery, the relative importance of factors that attract students to a particular training program remains unknown. Comparative data between countries may provide insights and ultimately provide guidance to program directors as they seek to attract the best applicants to their program. PDF

Determining Personal Talents and Behavioral Styles of Applicants to Surgical Training: A New Look at an Old Problem, Part I. The selection of residents for any program and their evaluation for success is an inexact science. Errors can prove costly, disruptive, and potentially damaging to training programs, and personal and professional setbacks can occur for resident applicants. A method was sought to determine the intangible characteristics of applicants to a general surgery residency program, particularly an assessment of behavior and motivation. The hypothesis was that such information could contribute to a more objective analysis of how well an applicant might fit into a program and its culture, and therefore improve the residents' chance for success and reduce the attrition rate for the program. PDF

European Journal of Orthopaedic Surgery & Traumatology: articles available before print publication

Instabilities of the ankle

How we do it: posteromedial supine approach to the medial tibial plateau surgical and anatomic approach

Simultaneous bilateral femoral neck stress fractures in a young military cadet: a rare case report

Treatment for a femoral shaft bone defect using heterotopic bone formation as autograft

Radiolunate coalition: a case report and literature review

Comparative study between locking plates versus proximal humeral nail for the treatment of 2-part proximal humeral fractures

New method could help prevent osteoarthritis

One of the problems with osteoarthritis has been diagnosing and monitoring the disease before symptoms become evident. It has therefore been difficult to change or delay the course of the disease. A few years ago, researchers from Lund University and Harvard Medical School developed a method to measure the degree of osteoarthritis using an MRI scanner, even at a very early stage. The method is called dGEMRIC (delayed gadolinium-enhanced MRI of cartilage).

The new method is described in Carl Siversson's thesis Three-dimensional T1 quantification techniques for assessment of cartilage quality using dGEMRIC:  Eurekalert!

Reverse total shoulder arthroplasty.

Reverse total shoulder arthroplasty was initially approved for use in rotator cuff arthropathy and well as chronic pseudoparalysis without arthritis in patients who were not appropriate for tendon transfer reconstructions. Traditional surgical options for these patients were limited and functional results were sub-optimal and at times catastrophic. The use of reverse shoulder arthroplasty has been found to effectively restore these patients function and relieve symptoms associated with their disease. Lenarz CJ, Gobezie R.
J Vis Exp. 2011 Jul 5;(53). pii: 2281. PMID: 21753747 Video

Sunday, September 11, 2011

Core Essence Orthopaedics Unveiled New Flexor Tendon Repair System at ASSH 2011

Core Essence Orthopaedics, Inc., a medical device company focused on orthopaedic soft tissue and skeletal repair of the extremities, has introduced their novel, surgeon-designed PONTiS™ Knotless Endotendonous Repair System at the 66th Annual Meeting of the American Society for Surgery of the Hand (ASSH).

As a pioneer of surgical innovation to the upper and lower extremity markets, Core Essence Orthopaedics developed PONTiS to enhance flexor tendon repair procedures. The high volume flexor tendon repair market has been long underserved and lacking surgical enhancements. In addressing this need, the PONTiS’ knotless system was designed as a minimally invasive approach that is a simple solution providing increased repair strength, decreased friction and allows for early and active motion protocol.