Bone tissue composition varies across anatomic sites in the proximal femur and the iliac crest.

Thus, the average cortical tissue mineral content and the widths of the distributions of cortical crystal size/perfection differ at the subtrochanteric femur relative to the greater trochanter and the iliac crest. In particular, the cortex of the iliac crest has lower mineral content relative to that of the subtrochanteric femur and may have limited utility as a surrogate for subtrochanteric bone. Donnelly E, Meredith DS, Nguyen JT, Boskey AL. J Orthop Res. 2011 Oct 27. doi: 10.1002/jor.21574. [Epub ahead of print] PMID: 22034199

Multi-touch table system for medical visualization: application to orthopedic surgery planning.

Medical imaging plays a central role in a vast range of healthcare practices. The usefulness of 3D visualizations has been demonstrated for many types of treatment planning. Nevertheless, full access to 3D renderings outside of the radiology department is still scarce even for many image-centric specialties. Our work stems from the hypothesis that this under-utilization is partly due to existing visualization systems not taking the prerequisites of this application domain fully into account. We have developed a medical visualization table intended to better fit the clinical reality. The overall design goals were two-fold: similarity to a real physical situation and a very low learning threshold. This paper describes the development of the visualization table with focus on key design decisions. The developed features include two novel interaction components for touch tables. A user study including five orthopedic surgeons demonstrates that the system is appropriate and useful for this application domain. Lundström C, Rydell T, Forsell C, Persson A, Ynnerman A. IEEE Trans Vis Comput Graph. 2011 Dec;17(12):1775-84. PMID: 22034294

Must Read: M.R.I.’s, Often Overused, Often Mislead, Doctors Warn

Dr. James Andrews, a widely known sports medicine orthopedist in Gulf Breeze, Fla., wanted to test his suspicion that M.R.I.’s, the scans given to almost every injured athlete or casual exerciser, might be a bit misleading. So he scanned the shoulders of 31 perfectly healthy professional baseball pitchers.

The pitchers were not injured and had no pain. But the M.R.I.’s found abnormal shoulder cartilage in 90 percent of them and abnormal rotator cuff tendons in 87 percent. “If you want an excuse to operate on a pitcher’s throwing shoulder, just get an M.R.I.,” Dr. Andrews says. Published: October 28, 2011 in The NYT

Journal of Surgical Education: in press, corrected proofs

Operating Room Fatigue: Is Your Twentieth Surgical Knot as Strong as Your First? PDF

Self-Regulated Learning Strategies Used in Surgical Clerkship and the Relationship with Clinical Achievement PDF

Learning Styles of First-Year Orthopedic Surgical Residents at 1 Accredited Institution PDF

Mastery Learning Simulation-Based Curriculum for Laparoscopic TEP Inguinal Hernia Repair PDF

Descriptive Operative Reports: Teaching, Learning, and Milestones to Safe Surgery PDF

Sleep, Supervision, Education, and Servi Views of Junior and Senior Residents PDF

The American Journal of Sports Medicine: PreView articles

Long-term Results of Surgical Decompression of Chronic Exertional Compartment Syndrome of the Forearm in Motocross Racers

The Incidence and Clinical Relevance of Graft Hypertrophy After Matrix-Based Autologous Chondrocyte Implantation

Relationship Between Proximal Femoral and Acetabular Alignment in Normal Hip Joints Using 3-Dimensional Computed Tomography

Man gets smartphone dock built into prosthetic arm

Source: The Telegraph

A British man has become the world's first ever patient to have a smartphone docking system built into his prosthetic arm. Trevor Prideaux, who was born without his left arm, used to have to balance the smartphone on his prosthetic arm or put it on a flat surface to use it.

But now Mr Prideaux, 50, can call and text his loved ones without moving the mobile, which is embedded into his fibreglass and laminate limb. The Telegraph

Extracorporeal shockwave-induced expression of lubricin in tendons and septa.

Lubricin, a lubricating glycoprotein that facilitates tendon gliding, is upregulated by mechanical as well as biochemical stimuli, prompting this study of its induction by extracorporeal shockwave therapy (ESWT). The objective of this study was to characterize and quantify the effect of ESWT on lubricin expression in tendons and septa in a rat model. Hindlimbs of six rats were treated with low-dose ESWT and those of another six with high-dose ESWT, using contralateral limbs as controls. After 4 days, resected samples were processed for immunolocalization of lubricin using a purified monoclonal antibody. ESWT was found to increase lubricin expression in both low-dose and high-dose ESWT-treated tendons and also in septa. Lubricin expression generally increased with increasing dose of ESWT. Increased lubricin expression may contribute to the beneficial effects of ESWT in providing pain and symptom relief in musculoskeletal disorders by decreasing erosive wear. Zhang D, Kearney CJ, Cheriyan T, Schmid TM, Spector M. Cell Tissue Res. 2011 Oct 19. [Epub ahead of print] PMID: 22009294 

Lubricin PubMed RSS Search

An Introduction to Inkling – the future of medical education

If you have been a regular reader of iMedicalApps.com, then you will have heard of Inkling, the interactive electronic textbook company.

If you haven’t, then allow me to introduce you to one aspect of the future of medical education. Inkling has enjoyed a meteoric rise since their humble beginnings in 2010, and we are a massive fan of their body of work. In the first of this series on Inkling, we are going to look at their company profile and the impact they are making in the medical education sector. iMedicalApps

Understanding The Orthopedic Surgeon Salary | Apparent Articles

The area of orthopedic surgery had grown in popularity and has increased the competition in this field. Even with the competition, the Bureau of Labor Statistics is predicting that this area of specialty will continue to grow. The range for orthopedic surgeon salary starts at three hundred and fifty thousand annually, and can go over five hundred thousand annually. The highest salaries are earned by doctors who work in a private practice. Apparent Articles

Epocrates app for iPhone gets major facelift, akin to Facebook app

Epocrates has done a tremendous facelift on their mobile app for the iPhone. Gone are the basic menu trees, and replacing them are moveable icons, similar to an older version of the Facebook app, before it’s recent reincarnation. iMedicalApps

Lower dose of corticosteroids just as effective as higher for shoulder pain

Although corticosteroid injections are one of the most common treatments for shoulder pain, there have been relatively few high-quality investigations of their efficacy and duration of action. In a study scheduled for publication in the December issue of the Archives of Physical Medicine and Rehabilitation, researchers report on the first comparative study of the two most commonly corticosteroid doses administered for shoulder pain. They found that lower doses were just as effective as higher doses in terms of reduction of pain, improved range of motion and duration of efficacy. Eurekalert!  PDF

PubMed Alternative? NLMplus is Featured by the NLM

NLMplus ( http://nlmplus.com) is an innovative semantic search and discovery application, developed by WebLib LLC, a small business in Maryland, in response to a challenge contest by the National Library of Medicine (NLM) to make use of NLM’s vast collection of biomedical data and services for the benefit of the Library’s diverse worldwide user communities. ScienceRoll

Six year outcome excision of the trapezium for trapeziometacarpal joint osteoarthritis: is it improved by ligament reconstruction and temporary Kirschner wire insertion?

This randomized prospective study compared the treatment of trapeziometacarpal joint osteoarthritis with a) trapeziectomy with no ligament reconstruction, no soft tissue interposition and no temporary Kirschner wire stabilization (Group T); b) trapeziectomy with flexor carpi radialis ligament reconstruction and interposition and temporary K-wire stabilization (Group T+LRTI). Salem H, Davis TR. J Hand Surg Eur Vol. 2011 Oct 24. [Epub ahead of print] PMID: 22025011

Hyponatremia and bone: an emerging relationship.

Hyponatremia is the most common electrolyte disorder and is mainly known for its neurological complications. New studies suggest previously unrecognized complications of hyponatremia, including falls, osteoporosis and fractures. Because these novel associations are mainly derived from epidemiological studies, it remains unclear whether hyponatremia has a direct effect on bone or whether it is a surrogate marker of another etiology. Hoorn EJ, Liamis G, Zietse R, Zillikens MC. Nat Rev Endocrinol. 2011 Oct 25. [Epub ahead of print] PMID: 22024973

Fourth and fifth carpometacarpal fracture and dislocation of the hand: new classification and treatment

Cain’s classification of fourth and fifth carpometacarpal (CMC) fracture and dislocation does not include the intraarticular metacarpal (MC) base fracture that may influence the treatment outcome. We reviewed 37 cases of fourth and fifth CMC fracture and dislocation treated with operative method, and we have devised a new classification based on the articular surface of the hamate and the involvement of the MC base. Sang-Uk Lee, Il-Jung Park, Hyoung-Min Kim, Changhoon Jeong and Jin-Rok Oh. European Journal of Orthopaedic Surgery & Traumatology;  DOI: 10.1007/s00590-011-0887-6. Epub ahead of print.

Clinical Use of High-Resolution Ultrasonography for the Diagnosis of Type II Accessory Navicular Bone.

Medial foot pain is a common complaint in rehabilitation clinics. The differential diagnoses include many musculoskeletal disorders like tendonitis and inflammation of ossicles. Posterior tibialis tendonitis is a common cause of foot pain in adults. The accessory navicular (AN) bone is occasionally observed and considered as a secondary ossification center of the navicular bone. Occasionally, posterior tibialis tendonitis and AN bone may cause acute or chronic medial foot pain with varying degrees of dysfunction. Chuang YW, Tsai WS, Chen KH, Hsu HC. Am J Phys Med Rehabil. 2011 Oct 22. [Epub ahead of print] PMID: 22024638

Journal of Orthopaedic Trauma: epub ahead of print

Early Radial Head Excision for Displaced and Comminuted Radial Head Fractures: Considerations and Concerns at Long-Term Follow-Up

An Off-Loading Triceps Suture for Augmentation of Plate Fixation in Comminuted Osteoporotic Fractures of the Olecranon

Infection After Spanning External Fixation for High-Energy Tibial Plateau Fractures: Is Pin Site-Plate Overlap a Problem?

Pelvic Ring Injury Is Associated With Sexual Dysfunction in Women

Mechanical stress can help or hinder wound healing depending on time of application

A new study demonstrates that mechanical forces affect the growth and remodeling of blood vessels during tissue regeneration and wound healing. The forces diminish or enhance the vascularization process and tissue regeneration depending on when they are applied during the healing process.

The study found that applying mechanical forces to an injury site immediately after healing began disrupted vascular growth into the site and prevented bone healing. However, applying mechanical forces later in the healing process enhanced functional bone regeneration. The study's findings could influence treatment of tissue injuries and recommendations for rehabilitation.

The study was published last month in the journal Proceedings of the National Academy of Sciences. The research was supported by the National Institutes of Health, the Armed Forces Institute of Regenerative Medicine and the U.S. Department of Defense. Eurekalert!

Musculoskeletal neoplasms: biopsy and intervention.

Percutaneous core needle biopsy and fine-needle aspiration are safe and cost-effective methods and can be important steps in the workup of a bone or soft tissue lesion. These procedures should be performed in collaboration with the orthopedic oncologist who performs the definitive surgery. In the extremities, attention to compartmental anatomy is paramount. With frozen section evaluation at the time of biopsy, the chances of a nondiagnostic specimen necessitating rebiopsy are minimized. The principles underlying the percutaneous approach to various lesions are valuable and can be applied to minimally invasive percutaneous therapy for bone and soft tissue lesions. Huang AJ, Kattapuram SV. Radiol Clin North Am. 2011 Nov;49(6):1287-305. PMID: 2202429

Military Medicine Works on Managing Pain

Military medicine is seeking additional ways to help patients manage their pain instead of just prescribing powerful drugs, the chief of staff of the Army’s pain management task force said here today. Col. Kevin Galloway told the Defense Writers Group that the military had to start looking at pain comprehensively. DoD

Todd Kuiken (Physiatrist/Engineer): A prosthetic arm that "feels"

Physiatrist and engineer Todd Kuiken is building a prosthetic arm that connects with the human nervous system -- improving motion, control and even feeling. Onstage, patient Amanda Kitts helps demonstrate this next-gen robotic arm. TED Talks

Increasing surgeon productivity: the effect of the addition of musculoskeletal physicians to an orthopedic surgery department.

The orthopedic surgery department at Mayo Clinic, Jacksonville, Florida, sought to improve the productivity of individual surgeons while maintaining quality of patient care as well as patient and physician satisfaction by expanding the department to include dedicated nonoperative musculoskeletal physicians who would evaluate patients and refer those requiring surgical care to surgeons within the department. With the addition of two such physicians, the yield of surgical patients by orthopedic surgeons increased by 20%, and the direct margin of the department increased by 19%. Moreover, referring physicians and patients were very satisfied with the care provided by the musculoskeletal physicians. Vizzini MR, O'Connor MI. J Med Pract Manage. 2011 Jul-Aug;27(1):29-35. PMID: 21936428

Color and Power Doppler US for Diagnosing Carpal Tunnel Syndrome and Determining Its Severity: A Quantitative Image Processing Method.

Color Doppler US can be used to accurately diagnose CTS. By processing the recorded power Doppler images and determining the number of pixels in the intraneural vascular area, the severity of CTS can be assessed. Ghasemi-Esfe AR, Khalilzadeh O, Vaziri-Bozorg SM, Jajroudi M, Shakiba M, Mazloumi M, Rahmani M.

Radiology. 2011 Nov;261(2):499-506. Epub 2011 Sep 7. PMID: 21900619

Diagnostic ultrasound for traumatic radial neuropathy.

The radial nerve is the most commonly injured nerve in cases of long-bone fracture.1 Traditionally, radial neuropathy following trauma is evaluated through a combination of history, examination, electrodiagnostic studies, and, in some cases, surgical exploration.2 Recent studies suggest that high-resolution ultrasound may be valuable in the pre-operative assessment of traumatic neuropathies.3-5 However, the benefit of dynamic ultrasound imaging (with movement of the arm in several positions) for traumatic radial nerve injury has not been described. We present a case in which dynamic high-resolution ultrasonography assisted in the diagnosis and treatment decision-making in an individual with a traumatic radial neuropathy. Cartwright MS, Yoon JS, Lee KH, Deal N, Walker FO. Am J Phys Med Rehabil. 2011 Apr;90(4):342-3. PMID: 20531154 PDF

The Effect of Operative Timing on Functional Outcome After Isolated Spinal Trauma

To evaluate the effect of operative timing on functional outcome in patients suffering spinal trauma, we conducted a retrospective analysis of the National Trauma Data Bank. By treating time to operation as a categorical variable and limiting our analysis to isolated spinal trauma, we hypothesized that time to operation would not be a predictor of functional outcome. Sacks, Greg D. MD, MPH; Panchmatia, Jaykar R. MA, MPH, MB BChir, MRCS (Eng); Marino, Miguel PhD; Hill, Caterina MSc; Rogers, Selwyn O. Jr. MD, MPH. Journal of Trauma-Injury Infection & Critical Care: POST AUTHOR CORRECTIONS, 24 October 2011

Correlation between radiological assessment of acute ankle fractures and syndesmotic injury on MRI

Owing to the shortcomings of clinical examination and radiographs, injury to the syndesmotic ligaments is often misdiagnosed. When there is no indication requiring that the fractured ankle be operated on, the syndesmosis is not tested intra-operatively, and rupture of this ligamentous complex may be missed. Subsequently the patient is not treated properly leading to chronic complaints such as instability, pain, and swelling. We evaluated three fracture classification methods and radiographic measurements with respect to syndesmotic injury. J. J. Hermans, N. Wentink, A. Beumer, W. C. J. Hop, M. P. Heijboer, A. F. C. M. Moonen, A. Z. Ginai. Skeletal Radiology; Online Date Wednesday, October 19, 2011.

Diagnosis of bursal-side partial-thickness rotator cuff tears.

To study the clinical features and diagnosis of bursal-side partial-thickness rotator cuff tears. Methods:  From August 1999 to June 2006, 38 patients with bursal-side partial-thickness rotator cuff tear were evaluated. Twenty-eight men and ten women of average age 45.7 years (range, 18-69 years) with 11 left and 27 right shoulders were studied. According to the Ellman classification, 6 cases were classified as grade I, 7 as II and 25 as III. Physical and X-ray examination, including anteroposterior and supraspinatus outlet views, were performed on both shoulders of all patients. Ultrasonography and MR examination were performed in 27 and 35 patients, respectively. Xiao J, Cui GQ, Wang JQ. Orthop Surg. 2010 Nov;2(4):260-5. PMID: 22009960

Groin pain beyond the hip: how anatomy predisposes to injury as visualized by musculoskeletal ultrasound and MRI.

The purpose of this article is to show ultrasound and MRI examples of the normal anatomic structures and their resulting modifications from trauma and disease. CONCLUSION: Although groin pain from hip pathology is well recognized, lower anterior abdominal wall and anterior pelvis structures can be interrelated sources of pain. Brandon CJ, Jacobson JA, Fessell D, Dong Q, Morag Y, Girish G, Jamadar D. AJR Am J Roentgenol. 2011 Nov;197(5):1190-7. PMID: 22021514

Surgical Treatment within Six Months of Lumbar Disc Herniation Symptoms Associated with Improved Outcomes

A new study in the Journal of Bone and Joint Surgery (JBJS) found that patients with herniated lumbar disc symptoms were significantly worse if the patients had symptoms for more than six months prior to treatment, compared to those who had symptoms for six months or less. Symptoms included pain, function, general health, work status and patient satisfaction. AAOS

BMP-2 Researchers Minimized Cancer Finding

In 2009, when researchers were preparing to publish findings from a pivotal trial of a novel spinal fusion product, they discovered that the number of cancer cases among patients treated with bone morphogenetic protein-2 (BMP-2) had crossed the threshold for statistical significance -- but they chose to omit this information from the manuscript.

Medtronic, the company that paid for the study, was also aware that cancer had gone from a non-significant adverse event affecting eight patients, to a small, but significant side effect seen in nine patients. But it, too, said nothing.

That silence constitutes an ethical breach, according to independent researchers, but it is only the latest controversy revealed during an ongoing investigation by the Journal Sentinel/MedPage Today into the relationship between a group of prominent spine surgeons who have been paid millions by Medtronic. MedPage Today

Tensile properties, collagen content, and crosslinks in connective tissues of the immature knee joint.

The major connective tissues of the knee joint act in concert during locomotion to provide joint stability, smooth articulation, shock absorption, and distribution of mechanical stresses. These functions are largely conferred by the intrinsic material properties of the tissues, which are in turn determined by biochemical composition. A thorough understanding of the structure-function relationships of the connective tissues of the knee joint is needed to provide design parameters for efforts in tissue engineering. Eleswarapu SV, Responte DJ, Athanasiou KA. PLoS One. 2011;6(10):e26178. Epub 2011 Oct 13. PMID: 22022553 PDF

Skin-like sensor flexible enough for prosthetic limbs

Researchers at Stanford are developing new sensors so flexible and pressure-sensitive that they could be used to make touch-sensitive prosthetic limbs, pressure-sensitive badges, and more. CNET

University of Delaware to lead DoD orthopaedic rehabilitation consortium

The Department of Defense (DoD) Congressionally Directed Medical Research Programs (CDMRP) Peer Reviewed Orthopaedic Research Program (PRORP) has awarded a $19.7 million grant to the University of Delaware to create and manage a consortium that will improve the quality of life for warfighters who suffer significant limb injuries in combat.

The Bridging Advanced Developments for Exceptional Rehabilitation (BADER) Consortium will conduct clinical trial research at several hospitals, both military and civilian, across the country. Congressionally Directed Medical Research Programs (CDMRP)

My list of 25 free essential Android apps

I just wiped out my smartphone and I was going through the process of installing apps all over again. I decided that I would share my list of 25 free apps that I'm running on my smartphone.

I'm not including apps that are built-in like Maps, Facebook, Gmail, etc. I'm only listing apps that you have to download and install through the Android market. Medical SmartPhones

Early effect of hyaluronic acid intra-articular injections on serum and urine biomarkers in patients with knee osteoarthritis: An open-label observational prospective study

The aim of the study was to investigate the effect of hyaluronic acid (HA) intra articular injections (IA) on osteoarthritis (OA) biomarkers in patients with knee OA. Prospective open label study. Fifty-one patients with unilateral symptomatic K-OA received IA injections of 2mL of HA on days (D) 1, 7, 14 and were followed 3 months. Conrozier, T., Balblanc, J.-C., Richette, P., Mulleman, D., Maillet, B., Henrotin, Y., Rannou, F., Piroth, C., Hilliquin, P., Mathieu, P., Walliser-Lohse, A., Rousselot, I., Plattner, V., Maillefert, J.-F., Vignon, E., Chevalier, X. Journal of Orthopaedic Research; Article first published online: 24 OCT 2011 PDF

Infection After Spanning External Fixation for High-Energy Tibial Plateau Fractures: Is Pin Site-Plate Overlap a Problem?

The purpose of this study was to determine whether overlap between temporary external fixator pins and definitive plate fixation correlates with infection in high-energy tibial plateau fractures. Laible, Catherine MD; Earl-Royal, Emily BA; Davidovitch, Roy MD; Walsh, Mike PhD; Egol, Kenneth A MD. Journal of Orthopaedic Trauma: POST AUTHOR CORRECTIONS, 18 October 2011. PDF

The American Journal of Sports Medicine PreView Articles

Predictors of Radiographic Knee Osteoarthritis After Anterior Cruciate Ligament Reconstruction PDF

Effects of Platelet-Rich Fibrin Matrix on Repair Integrity of At-Risk Rotator Cuff Tears PDF

New Suture Method for Radial Tears of the Meniscus: Biomechanical Analysis of Cross-Suture and Double Horizontal Suture Techniques Using Cyclic Load Testing PDF

Traumatic Patellar Dislocation: Nonoperative Treatment Compared With MPFL Reconstruction Using Patellar Tendon PDF

Volar Plating for Unstable Proximal Interphalangeal Joint Dorsal Fracture-Dislocations

Fixation of unstable PIP joint DFDs via a volar approach is technically feasible with mini plates and screws. This treatment allows early active range of motion and provides good objective and subjective outcomes; however, noteworthy complications occurred in 39% of patients. Andre E.J. Cheah, David M.K. Tan, Alphonsus K.S. Chong, Winston Y.C. Chew. The Journal of Hand Surgery. In Press, Corrected Proof available online 22 October 2011 PDF

Host serum is not indispensable in collagen performance in viable meniscal transplantation at 4-week incubation

Viable meniscal transplantation has been criticized as an expensive and logistically demanding technique. The purpose was to compare the standard culture medium with another culture medium that is more widely available and easier to work with and to assess the collagen net ultrastructure architecture and the capacity of the preserved cells to produce proteins. Pablo Eduardo Gelber, Raúl Torres, Natalia Garcia-Giralt, Juan Erquicia, Ferran Abat and Juan Carlos Monllau. Knee Surgery, Sports Traumatology, Arthroscopy. DOI: 10.1007/s00167-011-1722-7