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Saturday, September 24, 2011

Inflammatory Response Is Associated with Critical Colonization in Combat Wounds.

Modern combat- or blast-related injuries are characterized by devastatingly massive zones of injury that violate soft tissue, bone, and neurovascular structures. In our translational research program, we have determined that healing of traumatic combat wounds is dependent on the immune response. Although the majority of combat wounds are not critically colonized with bacteria, there exists a correlation between critical colonization and the concentration of inflammatory cytokines and chemokines measured in wound effluent or patient serum. Brown TS, Hawksworth JS, Sheppard FR, Tadaki DK, Elster E. Surg Infect (Larchmt). 2011 Sep 21. [Epub ahead of print] PMID: 21936666

See also:
Inflammatory biomarkers in combat wound healing JS Hawksworth, A Stojadinovic, FA Gage…  Annals of Surgery 2009 -
Cited by 15

The Classic: A Dissertation Upon Dislocations and Fractures of the Clavicle and Shoulder-Joint.

This Classic Article is a reprint of a section on scapula fractures in the original work by T. Callaway, Jr., A Dissertation Upon Dislocations and Fractures of the Clavicle and Shoulder-Joint. A biographical sketch of Thomas Callaway, Jr. The Classic Article is ©1849 and is reprinted from Callaway T. A Dissertation Upon Dislocations and Fractures of the Clavicle and Shoulder-Joint. London: Samuel Highly; 1849. Callaway T. Clin Orthop Relat Res. 2011 Sep 22. [Epub ahead of print] PMID: 21938533  [Free HTML to 1849 text from]  PDF

AJR Am J Roentgenol. 2011 Oct;197(4)

1. Focal Periphyseal Edema (FOPE) Zone on MRI of the Adolescent Knee: A Potentially Painful Manifestation of Physiologic Physeal Fusion? Zbojniewicz AM, Laor T. AJR Am J Roentgenol. 2011 Oct;197(4):998-1004. PMID: 21940591
2. MRI Versus Radiography of Acromioclavicular Joint Dislocation. Nemec U, Oberleitner G, Nemec SF, Gruber M, Weber M, Czerny C, Krestan CR. AJR Am J Roentgenol. 2011 Oct;197(4):968-973. PMID: 21940587
3. Bisphosphonate-Related Complete Atypical Subtrochanteric Femoral Fractures: Diagnostic Utility of Radiography. Rosenberg ZS, La Rocca Vieira R, Chan SS, Babb J, Akyol Y, Rybak LD, Moore S, Bencardino JT, Peck V, Tejwani NC, Egol KA. AJR Am J Roentgenol. 2011 Oct;197(4):954-960. PMID: 21940585
4. Fluoroscopically Guided Diagnostic and Therapeutic Injections Into Foot Articulations: Report of Short-Term Patient Responses and Comparison of Outcomes Between Various Injection Sites. Peterson CK, Buck F, Pfirrmann CW, Zanetti M, Hodler J. AJR Am J Roentgenol. 2011 Oct;197(4):949-953. PMID: 21940584
5. Long Head of Biceps Brachii Tendon Evaluation: Accuracy of Preoperative Ultrasound. Skendzel JG, Jacobson JA, Carpenter JE, Miller BS. AJR Am J Roentgenol. 2011 Oct;197(4):942-948. PMID: 21940583
6. Bone Marrow Edema Patterns in the Ankle and Hindfoot: Distinguishing MRI Features. Rios AM, Rosenberg ZS, Bencardino JT, Rodrigo SP, Theran SG. AJR Am J Roentgenol. 2011 Oct;197(4):W720-W729. PMID: 21940545
7. Ultrasound of the Shoulder: Asymptomatic Findings in Men. Girish G, Lobo LG, Jacobson JA, Morag Y, Miller B, Jamadar DA. AJR Am J Roentgenol. 2011 Oct;197(4):W713-W719. PMID: 21940544

Meniscal Regeneration: A Cause of Persisting Pain following Total Knee Arthroplasty.

Many patients have persisting knee pain following total knee arthroplasty. We report the unusual case of a patient whose chronic lateral and medial knee pain were caused by entrapped regenerated meniscal tissue. This was diagnosed and successfully treated by arthroscopic debridement. Matar HE, Dala-Ali B, Atkinson HD. Case Report Med. 2011;2011:761726. Epub 2011 Sep 20. PMID: 21941562

Pain Management Interventions for Hip Fracture 2011 [Internet]. Free full-text from NLM.


To review and synthesize the evidence on pain management interventions in nonpathological hip fracture patients following low-energy trauma. Outcomes include pain management (short and long term), mortality, functional status, pain medication use, mental status, health-related quality of life, quality of sleep, ability to participate in rehabilitation, return to pre-fracture living arrangements, health services utilization, and adverse effects.


Comprehensive literature searches were conducted in 25 electronic databases from 1990 to present. Searches of the grey literature, trial registries, and reference lists of previous systematic reviews and included studies were conducted to identify additional studies.  PDF

Rockville (MD): Agency for Healthcare Research and Quality (US); May 2011.
Report No.: 11-EHC022-EF

Lab Notes: Building a Better Knee

The osteoporosis drug teriparatide (Forteo) may have another therapeutic use -- regenerating joint cartilage lost in osteoarthritis.

In a series of animal experiments, the drug both protected the cells that generate cartilage and regenerated new ones, according to Erik Sampson, PhD, and colleagues at the University of Rochester Medical Center in upstate New York.

In a mouse model of osteoarthritis, giving the drug for a month resulted in knee-joint cartilage that was 32% thicker than in control animals, the researchers said in Science Translational Medicine. MedPage Today

Friday, September 23, 2011

New [epub ahead of print] from Skeletal Radiology

Register now for "Discover the New JBJS Online" October 6, 2011, 12:00 - 12:45 PM EDT

Save the date! On Thursday, October 6th at 12:00 PM, EDT, JBJS and Silverchair will host a webinar for subscribing institutions to introduce the features and tools of the new JBJS Online and the SCM 6.0 platform. JBJS is the first of many STM journals to be hosted on Silverchair's new publishing platform, so don't miss this opportunity to learn about this new resource now.  Register here for Live Webcast via GoToMeeting.

Note: The DoD blocks GoToMeeting even though it is a Citrix product.  To view this webinar, Library Services has reserved the Library Conference Room 1200 to 1245 on Oct 6th, 2011.  The other option is to view the webinar from wireless locations around NMCP.

Report Examines Lower Body Blast Injuries

WASHINGTON, Sept. 21, 2011 – The Army Surgeon General’s Office released its report yesterday on dismounted complex blast injuries, which more than twice as many service members have suffered annually since the 2009 troop surge in Afghanistan.

Army Brig. Gen. (Dr.) Joseph Caravalho Jr., commander of the Army’s Northern Regional Medical Command, detailed the report’s findings to reporters here.

The injury pattern known as DCBI, Caravalho said, is typically caused by a mine or roadside-bomb explosion, affects troops on foot patrol, and involves traumatic amputation of one leg, at least a severe injury to the other leg, and wounds to any or all of the pelvis, abdomen and genitals
Army Surgeon General Lt. Gen. Eric Schoomaker charted a task force in 2011 to study the injury pattern, Caravalho said. The group, which Caravalho chaired, included experts from the Army, Marine Corps and Veterans Affairs Department, who examined the causes, prevention, protection, treatment and long-term care options for service members suffering these severe injuries, he added.

“These are life-defining injuries for these warriors and their families, but it is not desperate,” Caravalho said. “All of us in uniform understand it’s not just about saving lives; it’s about doing everything military medicine can do to help them lead full and productive lives.”

The report details the number of surviving service member amputees from January 2010 to March 2011. Of 194 amputations, 78 resulted from DCBI and 116 from other causes. By service, 53 Marines, 23 soldiers and two sailors suffered dismounted complex blast injuries resulting in amputation (PDF). DoD

Thursday, September 22, 2011

Bisphosphonates for periprosthetic bone loss after joint arthroplasty: a meta-analysis of 14 randomized controlled trials.

The overall moderate evidence from the RCTs confirmed the significantly short-term and middle-term efficacy of BPs on periprosthetic bone loss after joint arthroplasty. To obtain a better efficacy, the second and the third generation of BPs may be the choice. Lin T, Yan SG, Cai XZ, Ying ZM. Osteoporos Int. 2011 Sep 20. [Epub ahead of print] PMID: 21932113

What causes MRI vertigo? Machine's magnetic field pushes fluid in the inner ear's balance organ

In a new study published in Current Biology online on Sept. 22, a team led by Johns Hopkins scientists suggests that MRI's strong magnet pushes on fluid that circulates in the inner ear's balance center, leading to a feeling of unexpected or unsteady movement. The finding could also call into question results of so-called functional MRI studies designed to detect what the brain and mind are doing under various circumstances. MedicalXpress

Radiation boost for artificial joints

A blast of gamma radiation could toughen up plastic prosthetic joints to make them strong enough to last for years, according to researchers in China writing in the current issue of the International Journal of Biomedical Engineering and TechnologyEurekalert!

Resident conferences that focus on mistakes result in higher quality of care

Residents who attend conferences that focus on missed or misinterpreted cases are 67% less likely to miss important findings when reading on-call musculoskeletal x-ray images, a new study shows. 
The study is published in the October, 2011 American Journal of Roentgenology(PDF). Eurekalert!

Foot and Ankle Clinics: Volume 16, Issue 3, Pages 375-536 (September 2011). Tendon Transfers in the Foot and Ankle

Principles of Balancing the Foot with Tendon Transfers PDF

The Basics and Science of Tendon Transfers PDF

Tendon Transfers for Equinovarus Deformity in Adults and Children PDF

The Bridle Procedure PDF

Tendon Transfers for the Adult Flexible Cavovarus Foot PDF

Tendon Transfers about the Hallux PDF

Forefoot Tendon Transfers PDF

Management of Paralytic Equinovalgus Deformity PDF

The Management of Spastic Equinovarus Deformity Following Stroke and Head Injury PDF

Subcutaneous fascial bands-a qualitative and morphometric analysis.

Although fascial bands within the subcutaneous (SQ) layer are commonly seen in ultrasound images, little is known about their functional role, much less their structural characteristics. This study's objective is to describe the morphological features of SQ fascial bands and to systematically evaluate the bands using image analyses tools and morphometric measures. Li W, Ahn AC. PLoS One. 2011;6(9):e23987. Epub 2011 Sep 8. PMID: 21931632 PDF

New Book in Library - Combat Radiology: diagnostic imaging of blast and ballistic injuries

Folio, Les R.
Location: HS Lib Call # WO 820 F65 2010

Where Generations Of Soldiers Healed And Moved On

Since it opened in 1909, the hospital named for Reed has had many famous patients.  One wood-paneled room is named for Gen. John J. Pershing, the American commander in World War I. The Pershing Suite is not your ordinary hospital room: The seats include leather armchairs, including one with a plush, high back. Pershing lived out his last years on the campus, close to his doctors.

"Several of the Army leaders who were young soldiers in World War I, who had worked for Pershing, came by here to see him before they went off to war in World War II," Pierce said. "Gen. George S. Patton came to this room to see Pershing, got down on his knees on this rug — and had Pershing bless him before he went off to war."

Several presidents also received medical treatment at Walter Reed. So as a historian, it's frustrating to Pierce that as the hospital closes, many Americans know it mainly for a scandal.  Listen to the Story via NPR

Bone regeneration: stem cell therapies and clinical studies in orthopaedics and traumatology.

Regenerative medicine seeks to repair or replace damaged tissues or organs, with the goal to fully restore structure and function without the formation of scar tissue. Cell based therapies are promising new therapeutic approaches in regenerative medicine. By using mesenchymal stem cells, good results have been reported for bone engineering in a number of clinical studies, most of them investigator initiated trials with limited scope with respect to controls and outcome. With the implementation of a new regulatory framework for advanced therapeutic medicinal products, the stage is set to improve both the characterization of the cells and combination products, and pave the way for improved controlled and well-designed clinical trials. Gómez-Barrena E, Rosset P, Müller I, Giordano R, Bunu C, Layrolle P, Konttinen YT, Luyten FP. J Cell Mol Med. 2011 Jun;15(6):1266-86. doi: 10.1111/j.1582-4934.2011.01265.x. Review. PMID: 21251219

Ultrasound-guided intervention around the hip joint.

The purpose of this article is to review some of the most common reasons for ultrasound intervention around the hip joint, and describe the techniques involved. CONCLUSION: Ultrasound alleviates the need for exposure to radiation and is already the modality of choice for aspiration of the hip joint, an intervention that may be helpful in guiding antimicrobial therapy and help avoid the need for surgical intervention. Ultrasound can also be used to access the hip for diagnostic or therapeutic injection. Rowbotham EL, Grainger AJ. AJR Am J Roentgenol. 2011 Jul;197(1):W122-7. Review. PMID: 21700972

Physicians can now access hospital medical records on Blackberry Playbook with Citrix Receiver app

Security is paramount in the healthcare industry and many clinicians access hospital EMR’s through Citrix servers.  With this new app for the Blackberry Playbook, physicians should be able to access their hospital’s electronic medical record in a mobile fashion. iMedicalApps

MAKOplasty Total Hip Arthroplasty Now Available for Total Hip Replacements

MAKO Surgical Corp. announced the availability of the RIO Robotic Arm Interactive Orthopedic System for use with total hip replacements – called MAKOplasty Total Hip Arthroplasty. The system is designed to assist surgeons in more precisely aligning and positioning implants during surgery, potentially reducing complications over conventional hip replacements. medGadget

Wednesday, September 21, 2011

Common stimulant may speed recovery from general anesthesia

Administration of the commonly used stimulant drug methylphenidate (Ritalin) was able to speed recovery from general anesthesia in an animal study conducted at Massachusetts General Hospital (MGH). The report, appearing in the October issue of Anesthesiology, is the first demonstration in mammals of what could be a safe and effective way to induce arousal from general anesthesia. While there are drugs to counteract many of the agents used by anesthesiologists – such as pain killers and muscle relaxants – until now there has been no way to actively reverse the unconsciousness induced by general anesthesia. MedicalXpress

Operative Treatment of Acetabular Fractures in an Older Population Through a Limited Ilioinguinal Approach

The limited ilioinguinal approach to certain fracture patterns commonly seen in the elderly was associated with a decreased blood loss and surgical time. Moreover, there was no negative impact on outcomes in our cohort. The benefits of decreased blood loss and shorter operative time have a potential positive impact on management of these injuries. Jeffcoat, Devon M MD; Carroll, Eben A MD; Huber, Florian G MD; Goldman, Ariel T MD; Miller, Anna N MD; Lorich, Dean G MD; Helfet, David L MD Published Ahead-of-Print. Journal of Orthopaedic Trauma: POST AUTHOR CORRECTIONS, 15 September 2011 PDF

Arthroplasty options in femoral-neck fracture: answers from the national registries.

Our review of data from national registries supports the continued use of bipolar hemiarthroplasty in femoral-neck fracture in the elderly and identifies age, method of fixation and surgical approach as important prognostic variables in determining implant survival. Kannan A, Kancherla R, McMahon S, Hawdon G, Soral A, Malhotra R. Int Orthop. 2011 Sep 20. [Epub ahead of print] PMID: 21931966

Tuesday, September 20, 2011

ONR officials meet with Navy Surgeon General to coordinate medical research

Influential leaders from the medical and research communities held high-level discussions on biomedical science and technology (S&T) initiatives at the Office of Naval Research (ONR), Sept. 16.

"ONR's relationship with naval medicine is very important, most visibly with the Marine Corps component because of the physical demands required on the battlefield," said Chief of Naval Research Rear Adm. Nevin Carr. "This meeting of the minds allowed us to engage on a wide range of topics. We had an opportunity to align our thoughts on delivering cutting-edge medical solutions to warfighters." Eurekalert!

Seminars in Musculoskeletal Radiology 15(4) September 2011

1. Postoperative imaging of the ankle and foot. Bergin D, Kearns S, Cullen E. Semin Musculoskelet Radiol. 2011 Sep;15(4):408-24. Epub 2011 Sep 16. PMID: 21928162

2. Imaging of the postoperative knee. Sanders TG. Semin Musculoskelet Radiol. 2011 Sep;15(4):383-407. Epub 2011 Sep 16. PMID: 21928161

3. Imaging of the postoperative hip. Carty FL, Cashman JP, Parvizi J, Zoga AC, Morrison WB.
Semin Musculoskelet Radiol. 2011 Sep;15(4):357-71. Epub 2011 Sep 16. PMID: 21928159

4. Postoperative imaging of the elbow, wrist, and hand. Macmahon PJ, Murphy DT, Zoga AC, Kavanagh EC. Semin Musculoskelet Radiol. 2011 Sep;15(4):340-56. Epub 2011 Sep 16. PMID:  21928158

5. Imaging of the postoperative shoulder. Jacobson JA, Miller B, Bedi A, Morag Y. Semin Musculoskelet Radiol. 2011 Sep;15(4):320-39. Epub 2011 Sep 16. PMID: 21928157

6. Managing postoperative artifacts on computed tomography and magnetic resonance imaging. Buckwalter KA, Lin C, Ford JM. Semin Musculoskelet Radiol. 2011 Sep;15(4):309-19. Epub 2011 Sep 16. PMID: 21928156

A New Reduction Technique for Completely Displaced Forearm and Wrist Fractures in Children: A Biomechanical Assessment and 4-year Clinical Evaluation.

Most pediatric distal radius fractures are treated with closed methods, however, in recent years an increasing number of fractures are treated with operative management. Multiple reduction techniques are described in the orthopaedic literature but no recent advances have been made in the closed management of these injuries. We describe the efficacy of new, single-provider manual reduction technique that improves reduction efficacy and we separately show its biomechanical superiority to other common techniques. Eichinger JK, Agochukwu U, Franklin J, Arrington ED, Bluman EM. J Pediatr Orthop. 2011 Oct-Nov;31(7):e73-9. PMID:  21926867 PDF

Emergence of chondrogenic progenitor stem cells in transplantation biology- prospects and drawbacks.

Avascular tissues such as a cartilage contains a unique type of cell called as the chondrocyte. We, however have not understood the origin of the chondrocyte population and how this population is maintained in the normal tissue. In spite of being considered to be a simple tissue, scientist had always faced difficulties to engineer this tissue. This is because different structural regions of the articular cartilage were never understood. In addition to this, the limited self-repair potential of cartilage tissue and lack of effective therapeutic options for the treatment of damaged cartilage has remained an unsolved problem. Mathur D, Pereira WC, Anand A. J Cell Biochem. 2011 Sep 16. doi: 10.1002/jcb.23367. [Epub ahead of print] PMID: 21928321

Quality Indicators in Pediatric Orthopaedic Surgery: A Systematic Review.

The ability to measure health system quality has become a priority for governments, the private sector, and the public. Quality indicators (QIs) refer to clear, measurable items related to outcomes. The use of QIs can initiate local quality improvement and track changes in quality over time as interventions are implemented. Kennedy A, Bakir C, Brauer CA. Clin Orthop Relat Res. 2011 Sep 13. [Epub ahead of print]PMID: 21912995

Using bone marrow to protect the brain

The ability to produce neuroprotectors, proteins that protect the human brain against neurodegenerative disorders such as Parkinson's and ALS, is the holy grail of brain research. A technology developed at Tel Aviv University does just that, and it's now out of the lab and in hospitals to begin clinical trials with patients suffering from amyotrophic lateral sclerosis (ALS), also known as Lou Gehrig's disease.

Developed by Prof. Daniel Offen and Prof. Eldad Melamed of TAU's Sackler Faculty of Medicine and Felsenstein Medical Research Center, the technology is now a patent-pending process that takes stem cells from a patient's own bone marrow and causes them to differentiate into astrocyte-like cells, which are responsible for the well-being of the brain's neurons. The cells release neurotrophic factors, or neuroprotectants, which have been shown to play a key role in reducing the progress of ALS, a debilitating disease characterized by the progressive degeneration of motor neurons, resulting in paralysis of a patient's limbs and organ function.

The research has appeared in the Journal of Stem Cells Reviews and Reports and a number of other publications. Eurekalert!

Surgical Intern Survival Guide app gives the new residents a simple, but limited starting point

As I have been told by many interns and residents, the jump from being a medical student to being an intern is something that cannot be explained, only experienced. As much as I try to understand and demystify, it remains both a daunting and exciting prospect.

The Surgical Intern Survival Guide by Drs. Dangleben and Garza attempts to ease the learning curve by answering common concerns and questions for green surgical interns in an easy to use guide. The app is available for iPhone and iPod Touch, and as the title suggests, would be best utilized by surgical interns. iMedicalApps

Reliability and necessity of computerized tomography in distal tibial physeal injuries.

Addition of CT in complex distal tibial physeal fractures did not increase interobserver reliability to classify the fracture or the treatment decision. Surgeons reported that the CT was most useful to plan screw placement and changed their treatment decision in about a fifth of the cases. Thawrani D, Kuester V, Gabos PG, Kruse RW, Littleton AG, Rogers KJ, Holmes L, Thacker MM. J Pediatr Orthop. 2011 Oct-Nov;31(7):745-50. PMID: 21926871

Monday, September 19, 2011

New Audio-Digest Orthopaedics

Now available online!  Contact Library for User Name and Password

Volume 34, Issue 19
October 7, 2011
Managing bone loss: anchors, remplissage, and Latarjet – Stephen S. Burkhart, MD
SLAP II lesions: biceps tenodesis is better – Pascal Boileau, MD
SLAP II lesions: discernment, decisions, and results – Stephen C. Weber. MD
Biceps pathology and treatment options – Evan L. Flatow, MD
Massive rotator cuff tears: arthroscopic repair and releases – Robert H. Bell , MD

Volume 34, Issue 18
September 21, 2011
Essentials for rotator cuff repair – Robert E. Hunter, MD
Single–row repair: why tissue tension is important – Mark H. Getelman, MD
Double–row repair is better – Stephen S. Burkhart, MD
Evidence–based patient selection for rotator cuff repair – Robert A. Pedowitz, MD, PhD
Massive rotator cuff tears – Evan L. Flatow, MD

Volume 34, Issue 17
September 7, 2011
Ankle fractures in neuropathic and diabetic patients – Peter G. Trafton, MD
Managing peritalar fractures and dislocations – Joseph Borrelli Jr, MD
The polytrauma patient: when and how to transfer – Timothy J. Bray, MD
Treatment of low–energy tibial plateau fractures: open vs percutaneous techniques – Dr. Borrelli
Complex tibial plateau fractures: staged protocols – Dr. Bray
Clavicular fractures: how to determine whether surgery is indicated – Michael D. McKee, MD

Volume 34, Issue 16
August 21, 2011
Lateral column lengthening and midfoot fusion – Alastair S.E. Younger, MD
Managing valgus angle pes planus – Timothy Daniels, MD
Ankle options: fusion and replacement – Dr. Daniels
Arthroscopic ankle fusion – Kevin J. Wing, MD

Causes of Gulf War Illness are complex and vary by deployment area -- Baylor University study

Gulf War Illness (GWI)—the chronic health condition that affects about one in four military veterans of the 1991 Gulf War—appears to be the result of several factors, which differed in importance depending upon the locations where veterans served during the war, according to a Baylor University study.

Published online today in the journal Environmental Health Perspectives, the study investigated links between GWI and veterans' locations during the war. GWI was most prevalent in veterans who served in forward areas of Iraq and Kuwait, where it was most strongly associated with use of a medication given to 1991 Gulf War troops to protect them from effects of nerve agents. For personnel who remained in support locations, GWI was significantly associated only with pesticide use during the war. Eurekalert!

Sunday, September 18, 2011

Spinal Fusion Patients Immobilized by Pain

An ongoing Milwaukee Journal Sentinel/MedPage Today investigation into a bone morphogenetic protein-2 device marketed as Infuse has uncovered a number of concerns about the safety of the product. In this special report, Infuse patients tell their stories. MedPage Today