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Wednesday, October 19, 2011

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 M, Pavić R, Milosević M. Mil Med. 2011 Sep;176(9):1077-82. PMID: 21987969 PDF

Magnetic resonance imaging in glenohumeral instability.

The glenohumeral joint is the most commonly dislocated joint of the body and anterior instability is the most common type of shoulder instability. Magnetic resonance (MR) imaging, and more recently, MR arthrography, have become the essential investigation modalities of glenohumeral instability, especially for pre-procedure evaluation before arthroscopic surgery. Injuries associated with glenohumeral instability are variable, and can involve the bones, the labor-ligamentous components, or the rotator cuff. Anterior instability is associated with injuries of the anterior labrum and the anterior band of the inferior glenohumeral ligament, in the form of Bankart lesion and its variants; whereas posterior instability is associated with reverse Bankart and reverse Hill-Sachs lesion. Multidirectional instability often has no labral pathology on imaging but shows specific osseous changes such as increased chondrolabral retroversion. This article reviews the relevant anatomy in brief, the MR imaging technique and the arthrographic technique, and describes the MR findings in each type of instability as well as common imaging pitfalls  Jana M, Gamanagatti S. World J Radiol. 2011 Sep 28;3(9):224-32. PMID: 22007285  PDF

Tuesday, October 18, 2011

Limb salvage in open tibia fractures: are prehospital time and tourniquet significant?

Letter to Editor

Are spine injuries sustained in battle truly different?

Battle spine injury and NBSI are separate entities that may ultimately have disparate long-term prognoses. Nonbattle spine injury patients, although having similar MOIs compared with civilian spinal trauma, maintain a different patient demographic. Further research must be directed at accurately quantifying the long-term disabilities of all spine injuries sustained in a combat theater, whether they are the result of battle or not. Blair JA, Patzkowski JC, Schoenfeld AJ, Cross Rivera JD, Grenier ES, Lehman RA, Hsu JR; Skeletal Trauma Research Consortium (STReC). Spine J. 2011 Oct 13. [Epub ahead of print] PMID: 22000726

Trabecular microstructure of the human lunate in Kienbock's disease.

The trabecular microstructure of normal lunates and lunates with Kienböck's disease was investigated using micro-computed tomography (micro-CT). Five lunates with advanced Kienböck's disease were obtained during lunate excision and scaphocapitate fusion, and five control lunates were from embalmed cadavers. Microstructural morphometric parameters were measured using micro-CT images. Han KJ, Kim JY, Chung NS, Lee HR, Lee YS. J Hand Surg Eur Vol. 2011 Sep 30. [Epub ahead of print] PMID: 21965181 PDF

See also:
Kienböck's disease

Autologous osteochondral graft for traumatic defects of finger joints.

Finger joint defects in 16 adults were treated with an autologous osteochondral graft from the base of the second metacarpal, the radial styloid, the base of the third metacarpal or the trapezoid and these patients were followed up from between 12 and 62 months. There was no donor site morbidity. One patient had resorption of the graft and developed pain. The joint was subsequently fused. The mean range of movement was 55.8% of the opposite normal joint. At follow up, 15 patients had no discomfort or mild discomfort. Three had mild narrowing of the joint space and two had slight joint subluxation. Only two patients with concomitant severe injury to the same limb had difficulty performing daily activities. Ten were open injuries and these had poorer outcomes. A hemicondylar defect of a finger joint can be treated using an osteochondral graft obtained from the same hand. Wu WC, Fok MW, Fung KY, Tam KH. J Hand Surg Eur Vol. 2011 Oct 14. [Epub ahead of print] PMID: 22002507 PDF

MR imaging of the postoperative knee.

Advances in orthopedic and arthroscopic surgical procedures of the knee such as, knee replacement, ligamentous reconstruction as well as articular cartilage and meniscus repair techniques have resulted in a significant increase in the number of patients undergoing knee arthroscopy or open surgery. As a consequence postoperative MR imaging examinations increase. Comprehensive knowledge of the normal postoperative MR imaging appearances and abnormal findings in the knee associated with failure or complications of common orthopedic and arthroscopic surgical procedures currently undertaken is crucial. This article reviews the various normal and pathological postoperative MR imaging findings following anterior and posterior cruciate ligament, medial collateral ligament and posterolateral corner reconstruction, meniscus and articular cartilage surgery as well as total knee arthroplasty with emphasis on those surgical procedures which general radiologists will likely be faced in their daily clinical routine. Gnannt R, Chhabra A, Theodoropoulos JS, Hodler J, Andreisek G. J Magn Reson Imaging. 2011 Nov;34 5):1007-21. PMID: 22002752

Virtual Issues from the Journal of Orthopaedic Research

Cutting Edge Issues in Hip and Knee Arthroplasty, October 2011

Advances in Distraction Osteogenesis, July 2011

Musculoskeletal Regenerative Medicine and Tissue Engineering, May 2011

Can We Improve Fracture Treatment?, April 2011

Computer-Assisted Orthopaedic Surgery, March 2011

Advances in Understanding of Joint Function, January 2011

See also:
Early Vew Articles

The Journal of Trauma: [Epub ahead of print]

1. Low Complication Rate Associated With Raising Mature Flap for Tibial Nonunion Reconstruction. Will RE, Fleming ME, Lafferty PM, Fletcher JW, Cole PA. J Trauma. 2011 Oct 13. [Epub ahead of print] PMID: 22002619 PDF
2. Scaphoid Fracture Epidemiology. Duckworth AD, Jenkins PJ, Aitken SA, Clement ND, Court-Brown CM, McQueen MM. J Trauma. 2011 Oct 13. [Epub ahead of print] PMID: 22002617 PDF
3. A Comparison of Absorbable Screws and Metallic Plates in Treating Calcaneal Fractures: A Prospective Randomized Trial. Zhang J, Ebraheim N, Lausé GE, Xiao B, Xu R. J Trauma. 2011 Oct 13. [Epub ahead of print] PMID: 22002615 PDF

Ossification process involving the human thoracic ligamentum flavum: role of transcription factors

Ossification of the ligamentum flavum (OLF) of the spine is associated with serious neurologic compromise, but the pathomechanism of this process remains unclear. The objective of this study was to investigate the pathomechanism of the ossification process, including the roles of various transcriptional factors in the ossification of human thoracic ligamentum flavum. Kenzo Uchida, Takafumi Yayama, Hong-Xin Cai, Hideaki Nakajima, Daisuke Sugita, Alexander Rodríguez Guerrero, Shigeru Kobayashi, Ai Yoshida, Ke-Bing Chen and Hisatoshi Baba. Arthritis Research & Therapy.2011-10-01. PDF

Computer-assisted patellar resection system: Development and insights

Incorrect resection of the patella during total knee arthroplasty (TKA) can lead to anterior knee pain (AKP), patellar maltracking, patellofemoral impingement, patellar fracture, component loosening, and reduced range of motion. Computer-assisted surgery (CAS) systems for the tibia and femur improve cut accuracy, but no CAS system is available for patellar resection. We developed a system that included an optoelectronic localizer, marker arrays on the patella and instruments, and navigation software. Chun Kit Fu1,Jeff Wai, Estee Lee, Carol Hutchison, Curtis Myden, Eldridge Batuyong, Carolyn Anglin. Journal of Orthopaedic Research. Article first published online: 17 OCT 2011 PDF

Monday, October 17, 2011

Google Body Browser Victim of Google Labs Shutdown, Lives on as Zygote Body

As announced by Google last July, it has shut down Labs, the playground where you could test unfinished prototypes built by Google engineers. One of the victims is Google Body Browser, the impressive Google Earth-like explorer for the human body, which was only launched last December.

However, no time for crying, as it will live on as Zygote Body, which will be a free application available online and as an Android app (Zygote is also the company which originally created the 3D models used in the body browser). The code for the 3D viewer behind Google Body will be open-sourced. Here is the announcement that was previously displayed on the Body Browser page:

As Google Labs winds down, we will be retiring Google Body. However, you will soon be able to find its functionality elsewhere. We are working on open-sourcing the code that powers Google Body so that anyone will be able to create and run a searchable 3D viewer. We are also working with our partner, Zygote Media Group, on an application called Zygote Body. This application will be free, available on the web and on Android, and will enable students, teachers, and others using Google Body to continue to have access to a human anatomy browser. MedGadget

Omega-3 fatty acids shown to prevent or slow progression of osteoarthritis

New research has shown for the first time that omega-3 in fish oil could "substantially and significantly" reduce the signs and symptoms of osteoarthritis.

According to the University of Bristol study, funded by Arthritis Research UK and published in the journal Osteoarthritis and Cartilage, omega-3-rich diets fed to guinea pigs, which naturally develop osteoarthritis, reduced disease by 50 per cent compared to a standard diet. Eurekalert!

UGA study suggests key to avoiding ankle re-injury may be in the hips and knees

Nearly all active people suffer ankle sprains at some point in their lives, and a new University of Georgia study suggests that the different ways people move their hip and knee joints may influence the risk of re-injury.

In the past, sports medicine therapists prescribed strengthening and stretching exercises that targeted only ankle joints after a sprain. The study by UGA kinesiology researchers, published in the early online edition of the journal Clinical Biomechanics, suggests that movements at the knee and hip joints may play a role in ankle sprains as well. University of Georgia

New on Audio Digest. Must sign in first. User name and password on library intranet.

Volume 34, Issue 21
November 7, 2011
Acute anterior dislocation of the shoulder: has the standard changed? – Robert A. Arciero, MD
Maximizing results with arthroscopic 270º labral repair – Dr. Arciero
Revision of failed instability surgery – Dr. Arciero
Bone defects – Dr. Arciero

Volume 34, Issue 20
October 21, 2011
Beyond BMD: bone quality and bone strength – Mary L. Bouxsein, PhD
Bone imaging: what's on the horizon – Dr. Bouxsein

For knee and hip surgeries, robots show promise for a better fit

Orthopedic surgeons are doctors, but they are also artisans, sculpting bone so that it fits snugly with artificial hips and knees.

But even the best artists make mistakes, says Dr. William Bargar, an orthopedic surgeon at Sutter General Hospital in Sacramento, and the imperfections that are charming in handicrafts have no place in modern medicine. That's why he invented the bone-drilling Robodoc.

The robot, which excavates bones to make room for hip and knee replacements, is made by Curexo Technology Corp. in Fremont, Calif. It and another surgical tool, Robotic Arm Interactive Orthopedic (RIO) System made by Mako Surgical Corp. of Fort Lauderdale, Fla., are designed to minimize human error and turn surgical art into operating-room engineering.

Sunday, October 16, 2011

Older adults' experiences regarding discharge from hospital following orthopaedic intervention: A metasynthesis.

Older adults' experiences around hospital discharge, collected through qualitative research, provide health authorities with valuable information that could be used in care pathway planning. Health professionals involved in in-patient and community care should be aware that a perceived loss of independence, function and activity limitations, and the ability to cope with pain can influence mental outlook and consequently rehabilitation. Perry MA, Hudson HS, Meys S, Norrie O, Ralph T, Warner S. Disabil Rehabil. 2011 Oct 8. [Epub ahead of print] PMID: 21981113

Multiple stress fractures of the lower extremity in healthy young men

Stress fractures result from abnormal stresses imposed on normal bones by the continued and repeated actions of muscles or from normal stresses imposed on abnormal bones. The risk factors that can cause such stress fractures include excessive use, such as, in soldiers or athletes, nutritional deficiencies, and endocrine disorders. In addition, disease may arise from long-standing rheumatoid arthritis, osteoporosis, corticosteroid therapy, joint stiffness or contracture, or the correction of angular deformity. In these cases, stress fractures may occur in one area or multiple areas. However, no case of multiple stress fractures in a young man who was not a professional athlete and who had no stress fracture risk factor, such as, an endocrine disease, has been previously reported. Hyun-Ju Choi and Hong-Man Cho. Journal of Orthopaedics and Traumatology; First Published Online 14 October 2011. PDF

Improving Awareness of Best Practices to Reduce Surgical Site Infection: A Multistakeholder Approach

Surgical site infection (SSI) is recognized as a focus area by the Centers for Medicare and Medicaid Services, the Joint Commission, the Institute for Healthcare Improvement, and the Institute of Medicine. An estimated 47% to 84% of SSIs present after discharge from the hospital or ambulatory care facility and, as a result, go undetected by standard SSI surveillance programs. Evidence-based processes and practices that are known to reduce the incidence of SSIs tend to be underused in routine practice. This article describes a multistakeholder process used to develop an educational initiative to raise awareness of best practices to reduce SSIs. The goal was to create a patient-centric educational initiative that involved an active partnership among all stakeholders-medical professional organizations, hospitals/health systems, health insurers, employers and other purchasers, and consumers/patients-to provide the climate necessary to create and sustain a culture of safety. Skoufalos A, Clarke JL, Napp M, Abrams KJ, Berman B, Armellino D, Schilling ME, Pracilio V. Am J Med Qual. 2011 Sep 29. [Epub ahead of print] PMID: 21960647 PDF

Optimization of intramedullary nailing by numerical simulation of fracture healing

Due to the annular gap between intramedullary (IM) nails and the endosteal surface, high interfragmentary movement can occur under loading. This could prolong the healing time, particularly for thin IM nails that are often used for unreamed IM nailing. The aims of our study were to determine the influence of the nail diameter on the healing time of human tibial shaft fractures and to investigate whether the healing time could be shortened by increasing the stiffness of the implant material. Therefore, a corroborated numerical model for simulating the fracture healing process in humans was used to simulate the healing process of human tibial fractures treated with IM nails. Tim Wehner1, Lutz Claes, Anita Ignatius, Ulrich Simon. Journal of Orthopaedic Research. Article first published online: 14 OCT 2011 PDF

Antibiotics Manual iPad app is a detailed reference resource for Providers

Antibiotics find their way into nearly every area of medicine. Accordingly, there is no shortage of resources that healthcare providers consult when it comes to understanding and prescribing antibiotics.

Add to this large body of tools a new app for the iPad called Antibiotics Manual by Spearhead Global Inc. This app is a collection of 188 flashcards, with each card detailing a particular antimicrobial. It is sold for $24.99 with a 50% educational discount available. The content comes from two infectious disease physicians from Temple University School of Medicine. iMedicalapps

Skeletal Radiology: 3 new articles

Down the Road in Ortho Research: the Automated Biology Explorer (ABE)

An interdisciplinary team of scientists at Vanderbilt University, Cornell University and CFD Research Corporation, Inc., has taken a major step toward this goal by demonstrating that a computer can analyze raw experimental data from a biological system and derive the basic mathematical equations that describe the way the system operates. According to the researchers, it is one of the most complex scientific modeling problems that a computer has solved completely from scratch.

The paper that describes this accomplishment is published in the October issue of the journal Physical Biology and is currently available online. The work was a collaboration between John P. Wikswo, the Gordon A. Cain University Professor at Vanderbilt, Michael Schmidt and Hod Lipson at the Creative Machines Lab at Cornell University and Jerry Jenkins and Ravishankar Vallabhajosyula at CFDRC in Huntsville, Ala.

The “brains” of the system, which Wikswo has christened the Automated Biology Explorer (ABE), is a unique piece of software called Eureqa developed at Cornell and released in 2009. Schmidt and Lipson originally created Eureqa to design robots without going through the normal trial and error stage that is both slow and expensive. After it succeeded, they realized it could also be applied to solving science problems.
One of Eureqa’s initial achievements was identifying the basic laws of motion by analyzing the motion of a double pendulum. What took Sir Isaac Newton years to discover, Eureqa did in a few hours when running on a personal computer. Vanderbilt University

Knee injuries on the rise in child and adolescent athletes

Sports-related knee injuries in children and adolescents seem to be increasing at an alarming rate. Researchers at the Children's Hospital of Philadelphia noted a more than 400 percent increase in these injuries at their institution over the last decade, according to new research presented on Sunday, Oct. 16, at the American Academy of Pediatrics (AAP) National Conference and Exhibition in Boston.

In "Knee Injuries In Children and Adolescents: Has There Been An Increase In ACL and Meniscus Tears In Recent Years?" researchers reviewed billing records of patients under age 18 treated for tibial spine fractures, ACL and meniscal tears, at a large academic children's hospital from 1999 through 2011. Over that time period, ACL tears increased by 11.35 injuries per year and meniscus tears increased by 13.95 injuries per year. However, tibial spine fractures, which are though to be caused by a similar mechanism as ACL tears, only jumped by 1.07 injuries per year. Eurekalert!