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Saturday, October 8, 2011

PubMed and PubMed Central (PMC) — What is the Difference?

Most of you know what PubMed is, but for anyone confused about it or just plain interested in the relationship between PubMed and the similarly named PubMed Central (PMC), the quick and dirty difference is summed up here.  ReferencePoint

Long-term bisphosphonate usage and subtrochanteric insufficiency fractures: A cause for concern?

For over a decade, bisphosphonate administration has evolved and become the cornerstone of the prevention and treatment of fragility fractures. Millions of post-menopausal women have relied on, and continue to depend on, the long-acting, bone density-maintaining pharmaceutical drug to prevent low-energy fractures. In return, we have seen the number of fragility fractures decrease, along with associated costs and emotional benefits. However, with any drug, there are often concerns with side effects and complications, and this unique drug class is seeing one such complication in atypical subtrochanteric femoral fracture, counterproductive to that which it was designed to prevent. This has created concern over long-term bisphosphonate administration and its potential link to these atypical fractures. There is controversial evidence surrounding such a definitive link, and no protocol for managing these fractures. This review offers the latest information regarding this rare but increasingly controversial adverse effect and its potential connection to one of the most successful forms of treatment that is available for the management of fragility fractures. Yoon RS, Hwang JS, Beebe KS. J Bone Joint Surg Br. 2011 Oct;93(10):1289-95. PMID: 21969423

SAMMC now the largest military medical facility

Military troops and civic leaders Friday celebrated completion of a 760,000-square-foot addition that will make the San Antonio Military Medical Center the Defense Department's largest inpatient hospital.

As if on cue, morning showers relented long enough for a brief dedication at the SAMMC Consolidated Tower, or “CoTo,” one of the final components of Fort Sam Houston's five-year medical complex expansion.

Post-operative pain management. (Cochrane Systematic Review)

This month sees the landmark publication of an authoritative Cochrane overview of systematic reviews of oral analgesics for acute post-operative pain in adults.The lead author, Professor Andrew Moore describes this study in this month's podcasts Pain management is a routine feature of everyday medicine. To the uninitiated, post-operative analgesia is often considered a straightforward pain problem. After all, the extent and timing of tissue damage are predictable, the damage occurs normally in controlled circumstances in a clinical environment with access to analgesia, and in many societies there is choice of analgesic strategy. However, despite the ubiquity of pain and analgesic practice, post-operative pain management is commonly reported to be poor. In part, the limited success of routine post-operative pain management may be due to a lack of clarity on the evidence base for different pain management interventions and strategies. Eccleston C. Cochrane Database Syst Rev. 2011 Sep 5;10:ED000033. PMID: 21975793  (click here to listen to the podcast).

Pilon fractures: advances in surgical management.

Pilon fractures are challenging to manage because of the complexity of the injury pattern and the risk of significant complications. Variables such as fracture pattern, soft-tissue injury, and preexisting patient factors can lead to unpredictable outcomes. Avoiding complications associated with the soft-tissue envelope is paramount to optimizing outcomes. In persons with soft-tissue compromise, the use of temporary external fixation and staged management is helpful in reducing further injury and complications. Evidence in support of new surgical approaches and minimally invasive techniques is incomplete. Soft-tissue management, such as negative-pressure dressings, may be helpful in preventing complications. Crist BD, Khazzam M, Murtha YM, Della Rocca GJ. J Am Acad Orthop Surg. 2011 Oct;19(10):612-22. PMID: 21980026 PDF

Biologic and pharmacologic augmentation of rotator cuff repairs.

As rotator cuff repair techniques have improved, failure of the tendon to heal to the proximal humerus is less likely to occur from weak tendon-to-bone fixation. More likely causes of failure include biologic factors such as intrinsic tendon degeneration, fatty atrophy, fatty infiltration of muscle, and lack of vascularity of the tendons. High failure rates have led to the investigation of biologic augmentation to potentially enhance the healing response. Histologic studies have shown that restoration of the rotator cuff footprint during repair can help reestablish the enthesis. In animal models, growth factors and their delivery scaffolds as well as tissue engineering have shown promise in decreasing scar tissue while maintaining biomechanical strength. Platelet-rich plasma may be a safe adjuvant to rotator cuff repair, but it has not been shown to improve healing or function. Many of these strategies need to be further defined to permit understanding of, and to optimize, the biologic environment; in addition, techniques need to be refined for clinical use.  Edwards SL, Lynch TS, Saltzman MD, Terry MA, Nuber GW. J Am Acad Orthop Surg. 2011 Oct;19(10):583-9. PMID: 21980023 PDF

The impact of complementary and alternative treatment modalities on the care of orthopaedic patients.

The use of complementary and alternative medicine is widespread and popular with the lay public. Although prevalence of use varies among specific patient populations, complementary and alternative medicine, in particular herbal remedies, are widely marketed and used by orthopaedic patients. Herbal supplements can have a negative impact on the perioperative period and may interact with conventional medicines used to manage chronic conditions. Physician-patient communication often does not include the subject of alternative medicines, leading to underreporting of use. Orthopaedic surgeons should adopt methods to routinely elicit from their patients the use of complementary and alternative medicine and should monitor and counsel patients on potential side effects and drug-herb interactions. Preoperative instructions should include cessation of the use of herbal supplements.  Rispler DT, Sara J. J Am Acad Orthop Surg. 2011 Oct;19(10):634-43. PMID: 2198002 PDF

Friday, October 7, 2011

Will CT Ordering Practices Change if We Educate Residents About the Potential Effects of Radiation Exposure? Experience at a Large Academic Medical Center.

Most clinicians did not change their CT scan ordering after receiving education about radiation from a radiologist. Radiation education allowed clinicians to discuss CT benefits and risks with their patients and to choose appropriate CT protocols. Referring physician groups are interested in this topic, and radiologists should be encouraged to give radiation lectures to them. Horowitz JM, Yaghmai V, Miller FH, Russell EJ. Acad Radiol. 2011 Nov;18(11):1447-52. Epub 2011 Sep 1. PMID: 21889895

New Ultrasound Related Ortho Articles From PubMed

Utility of duplex ultrasound in detecting and grading de novo femoropopliteal lesions. PDF

Frequent discordance between clinical and musculoskeletal ultrasound examinations of foot disease in juvenile idiopathic arthritis.

Shoulder pain and an isolated teres minor nerve lesion. PDF

Thursday, October 6, 2011

Absence of Glutamine Supplementation Prevents Differentiation of Murine Calvarial Osteoblasts to a Mineralizing Phenotype.

Osteoblasts in vitro differentiate from a proliferating to a mineralizing phenotype upon transfer to a medium rich in beta-glycerophosphate and ascorbic acid. The nutritional requirements of the cells at different stages of this differentiation process are not known. In other cell types, nutritional supplementation during surgery can improve the outcome in terms of speed of patient recovery and prognosis. There is therefore the potential for supplementation at the site of fracture repair or bone grafting with critical osteoblast nutritional factors to potentially accelerate healing. Brown PM, Hutchison JD, Crockett JC. Calcif Tissue Int. 2011 Oct 5. [Epub ahead of print] PMID: 21972050

Journal of Surgical Education: in press, corrected proofs

Teaching Evidence Based Medicine to Surgery Residents-Is Journal Club the Best Format? A Systematic Review of the Literature PDF

Assessing Trainee Impact on Operative Time for Common General Surgical Procedures in ACS-NSQIP PDF

Implementation of an Objective Structured Clinical Exam (OSCE) into Orthopedic Surgery Residency Training PDF

The Effect of Problem-Based Learning With Cooperative-Learning Strategies in Surgery Clerkships PDF

More Fun With the Da Vinci Surgical Robot: Grape Peeling

It brings us great relief knowing that the same robot that can perform complicated surgical procedures in the morning can help prepare lunch for the hungry surgeon after the operation is over.

Here’s a video from the North Bristol NHS Trust in the UK showing the da Vinci surgical robot peeling a grape:

Wednesday, October 5, 2011

Autologous Chondrocyte Implantation for Treatment of Cartilage Defects of the Knee: What Predicts the Need for Reintervention?

Autologous chondrocyte implantation (ACI) is a well-established treatment option for isolated cartilage defects of the knee joint, providing satisfying outcome. However, cases of treatment failure with the need for surgical reintervention are reported; typical patient's individual and environmental risk factors have previously not been described. Jungmann PM, Salzmann GM, Schmal H, Pestka JM, Südkamp NP, Niemeyer P. Am J Sports Med. 2011 Oct 3. [Epub ahead of print] PMID: 21969180 PDF

Measurement of knee joint gaps without bone resection: “Physiologic” extension and flexion gaps in total knee arthroplasty are asymmetric and unequal and anterior and posterior cruciate ligament resections produce different gap changes

General agreement is that flexion and extension gaps should be equal and symmetrical in total knee arthroplasty (TKA) procedures. However, comparisons using a standard TKA approach to normal knee joints that have not undergone bone resection are currently unavailable. Since bony preparation can influence capsule and ligament tension, our purpose was to perform measurements without this influence. Andrej Maria Nowakowski, Martin Majewski1, Magdalena Müller-Gerbl, Victor Valderrabano. Journal of Orthopaedic Research; Article first published online: 5 OCT 2011 PDF

Deployed medics get new mobile, interactive guide to record medical information

As tablet devices become an increasingly accepted device for day-to-day computing needs, their appeal to enterprise continues to grow. Such is the case with the United States Army (admittedly not an organization I often think of as an “enterprise”), who recently updated their Commander’s Guide to MC4 app that can be accessed through military personnel’s iPhone, iPod Touch, iPad and various Android devices.

Medical Communications for Combat Casualty Care (MC4) is, in some ways, analogous to a hospital’s IT department – if that IT department had to manage care delivered everywhere from Tora Bora to Charleston. iMedicalApps

Radial nerve palsy associated with humeral shaft fracture. Is the energy of trauma a prognostic factor?

Radial nerve palsy associated with humeral shaft fractures is the most common nerve lesion complicating fractures of long bones. The purpose of the study was to review the outcome of surgical management in patients with low energy and high energy radial nerve palsy after humeral shaft fractures. Venouziou AI, Dailiana ZH, Varitimidis SE, Hantes ME, Gougoulias NE, Malizos KN. Injury. 2011 Nov;42(11):1289-93. Epub 2011 Feb 24. PMID:  21353219 PDF

Sonography of partial-thickness tears of the distal triceps brachii tendon.

The purpose of this study was to retrospectively characterize the sonographic appearance of partial-thickness distal triceps brachii tendon tears. Downey R, Jacobson JA, Fessell DP, Tran N, Morag Y, Kim SM.
J Ultrasound Med. 2011 Oct;30(10):1351-6. PMID: 21968485

FDA Okays Novel Gel to Curb Bleeding During Surgery

The FDA has approved a gel called LeGoo that temporarily stops blood flow during surgery. LeGoo is indicated for use in blood vessels below the neck and that are 4 mm or less in diameter.

The gel stops blood from filling a surgical area without causing damage to the vessel, which often happens when clamps or elastic loops are used, an FDA statement said.  MedPage Today

Tuesday, October 4, 2011

Proximal humerus fractures in the pediatric population: a systematic review

Proximal humerus fractures and epiphyseal separations in skeletally immature children and adolescents are traditionally treated non-operatively. Recently, authors have described the operative fixation of these injuries, particularly in older children and adolescents with displaced fractures. We performed a systematic review of the literature to identify operative indications for proximal humerus fractures in children and to compare the results by age, displacement, and treatment modality.  Sohrab Pahlavan, Keith D. Baldwin, Nirav K. Pandya, Surena Namdari and Harish Hosalkar. Journal of Children's Orthopaedics; Volume 5, Number 3, 187-194. PDF

Biomechanical evaluation of the expansive cannulated screw for fixation of femoral neck fractures.

Femoral neck fracture is one of the common clinical traumas, especially amongst elder patients. This study aims to test, compare and evaluate the bone-screw interface strengths, the fatigue strengths, and the stabilities of our newly designed expansive cannulated screw (ECS) and the common cannulated compression screw (CCS) in the fixation of femoral neck fracture, which is a summary of recent research. Zhang Y, Tian L, Yan Y, Sang H, Ma Z, Jie Q, Lei W, Wu Z. Injury. 2011 Nov;42(11):1372-6. Epub 2011 Aug 7. PMID: 21824615  PDF

Long Biceps Tendon: Normal Position, Shape, and Orientation in Its Groove in Neutral Position and External and Internal Rotation

Purpose: To characterize the position, shape, and orientation of the long biceps tendon (LBT) on transverse magnetic resonance (MR) images acquired in neutral position and in maximal external and internal rotation of the shoulder in asymptomatic volunteers. Florian M. Buck, MD, Tobias J. Dietrich, MD, Donald Resnick, MD, Bernhard Jost, MD and Christian W. A. Pfirrmann, MD, MBA. Radiology. Published online before print October 3, 2011 Full Text

Monday, October 3, 2011

IED Research Aimed at Reducing Soldiers' Amputations, Leg Injuries

A Mississippi State biomedical engineering researcher focused on decreasing amputations and other leg injuries to soldiers in IED-attacked vehicles will present her findings next week at a NATO conference in Canada.

Lakiesha N. Williams, an assistant professor of biological engineering at the university, will address NATO's Research and Technology Organization during a Monday-Wednesday [Oct. 3-5] defense meeting in Halifax, Canada. Organized by NATO'S Human Factors and Medicine Panel, the gathering will deal with "blast injury across the full landscape of military science." NewsWise

Breakthrough: A robot brain implanted in a rodent

With new cutting-edge technology aimed at providing amputees with robotic limbs, a Tel Aviv University researcher has successfully implanted a robotic cerebellum into the skull of a rodent with brain damage, restoring its capacity for movement.

In the future, this robo-cerebellum could lead to electronic implants that replace damaged tissues in the human brain. For the full story about TAU's cyborg cerebellum, see the ABCNews story  Eurekalert!

Peripheral Nerve Regeneration - same article with two different summaries.

Race to nerve regeneration: faster is better A team of researchers led by Clifford Woolf and Chi Ma, at Children's Hospital Boston and Harvard Medical School, Boston, has identified a way to accelerate the regeneration of injured peripheral nerves in mice such that muscle function is restored. In an accompanying commentary, Ahmet Höke, at Johns Hopkins School of Medicine, Baltimore, discusses the importance of this work to the clinical problem. MedicalXPress PDF

In reversing motor nerve damage, time is of the essence The study, published in the November issue of the (online October 3) has immediate implications for patients with motor nerve injuries, including carpal tunnel syndrome, cubital tunnel syndrome, nerve damage caused by surgery and brachial avulsion injuries: Time is of the essence in repairing nerve damage. MedicalXPress PDF

Patellofemoral Arthroplasty: 7-year Mean Follow-Up

Patellofemoral arthroplasty has had renewed interest with the purpose of this study to evaluate its outcomes. Between 2001 and 2006, 43 were performed in 37 patients who had a mean follow-up of 7 years (range, 4-8 years). Patient outcomes were determined using Knee Society objective and function scores, revision rates, and complication rates. The 5-year Kaplan-Meier survivorship was 95%. Knee Society objective scores improved from a mean of 64 points (range, 57-68 points) to 87 points (range, 50-100 points), and functional scores improved from a mean of 48 points (range, 45-50 points) to 82 points (range, 20-100 points). This study shows maintained successful clinical and radiographic results at mean 7-year follow-up for patellofemoral arthroplasty. Michael A. Mont, Aaron J. Johnson, Qais Naziri, Frank R. Kolisek, Wayne B. Leadbetter. The Journal of Arthroplasty, Available online 1 October 2011 PDF

The posterolateral fluoroscopy-guided injection technique into the posterior subtalar joint: description of the procedure and pilot study on patient outcomes

Fluoroscopy-guided puncture of the posterior subtalar joint using a posterolateral approach is possible. Clinically significant improvement is reported in 33% of patients after 1 month. Florian M. Buck, Christian W. A. Pfirrmann, Florian Brunner, Juerg Hodler, Cynthia Peterson. Skeletal Radiology. Online Date Tuesday, September 27, 2011. MetaPress

Mayo Clinic study: multiple surgeries and anesthesia exposure

Every year millions of babies and toddlers receive general anesthesia for procedures ranging from hernia repair to ear surgery. Now, researchers at Mayo Clinic in Rochester have found a link among children undergoing multiple surgeries requiring general anesthesia before age 2 and learning disabilities later in childhood.

The study, which will be published in the November 2011 issue of Pediatrics (published online Oct. 3), was conducted with existing data of 5,357 children from the Rochester Epidemiology Project and examined the medical and educational records of 1,050 children born between 1976 and 1982 in a single school district in Rochester. Eurekalert!

Sunday, October 2, 2011

Biopsy in Patients with Malignant Primary Bone and Soft-tissue Tumors

The Classic Article: The hazards of biopsy in patients with malignant primary bone and soft-tissue tumors. Mankin HJ, Lange TA, Spanier SS. J Bone Joint Surg Am. 1982 Oct;64(8):1121-7. No abstract available. PMID: 7130225 has been cited 343 times (Google Scholar) and counting. PDF

A PubMed search on this topic has been performed with the intent of allowing Orthopedic Surgeons to easily keep up with the new literature on this and related topics.  Search results will update automatically.  The search results are found in Ortho Topics  For best results, use Internet Explorer for viewing Ortho Topics results as display of the results with Firefox and with Chrome are not functional.

To view the complete list of PubMed results in Internet Explorer, click on the PubMed link in the upper left corner (see image to left).