Ortho News: 11/6/11

Saturday, November 12, 2011

The Journal of Trauma: epub ahead of print

Accidental and Intentional Perpetration of Serious Injury or Death: Correlates and Relationship to Trauma Exposure

The Floating Shoulder-Clinical and Radiological Results After Intramedullary Stabilization of the Clavicle in Cases With Minor Displacement of the Scapular Neck Fracture

AAOS News

New pediatric supracondylar humerus fractures CPG At their meeting on Sept. 24, 2011, the AAOS Board of Directors approved a new clinical practice guideline (CPG) on the treatment of pediatric supracondylar humerus fractures. This is the third CPG to focus on a primarily pediatric condition.

Supracondylar fractures of the humerus are widely considered to be the most common fracture of the elbow in children (Fig. 1). Approximately 3 percent of all fractures in children are supracondylar fractures. They often result from trauma to the elbow, most often due to a fall from a height or related to sports or leisure activities. AAOS

Hand Surgery: 2 new ultrasound articles

1. High definition ultrasound as diagnostic adjunct for incomplete carpal tunnel release. Tan TC, Yeo CJ, Smith EW. Hand Surg. 2011;16(3):289-94. PMID: 22072462

2. Ultrasonographic findings in cubital tunnel syndrome caused by a cubitus varus deformity. Shimizu H, Beppu M, Arai T, Kihara H, Izumiyama K. Hand Surg. 2011;16(3):233-8. PMID: 22072453

The American Journal of Sports Medicine: PreView articles

Femoral Tunnel Widening After Hamstring Anterior Cruciate Ligament Reconstruction With Bioabsorbable Transfix

Repair Integrity and Functional Outcome After Arthroscopic Rotator Cuff Repair: Double-Row Versus Suture-Bridge Technique

Minimum 10-Year Follow-up of Arthroscopic Intra-articular Bankart Repair Using Bioabsorbable Tacks

Retention of Movement Pattern Changes After a Lower Extremity Injury Prevention Program Is Affected by Program Durations

Clinical Outcome of Autologous Chondrocyte Implantation for Failed Microfracture Treatment of Full-Thickness Cartilage Defects of the Knee Joint

Meniscal Allograft Transplantation Without Bone Plugs: A 3-Year Minimum Follow-up Study

Knee Surgery, Sports Traumatology, Arthroscopy: Online 7 Nov 2011

Short-term outcome of the second generation characterized chondrocyte implantation for the treatment of cartilage lesions in the knee

The effect of tranexamic acid on blood loss and use of blood products in total knee arthroplasty: a meta-analysis

Patients with focal full-thickness cartilage lesions benefit less from ACL reconstruction at 2–5 years follow-up

Friday, November 11, 2011

Multiple associated injuries are common with spine fractures during war.

Spine fractures sustained in OEF and OIF have high rates of AIs. Musculoskeletal AIs are the most common, but visceral injuries adjacent to the spine fracture frequently occur. Multiple spine injuries are more prevalent after military trauma. Patzkowski JC, Blair JA, Schoenfeld AJ, Lehman RA, Hsu JR; Skeletal Trauma Research Consortium (STReC). Spine J. 2011 Nov 2. [Epub ahead of print] PMID: 22054909

Simplified Model to Predict Stress Fracture in Young Elite Combat Recruits.

The purpose of the study was to develop a simple prediction model for stress fractures (SF) in young male recruits in order to identify risk factors for SF. Data were collected from 57 young (18.5±0.5yrs) males prior to elite combat basic training (BT). Measurements included anthropometric variables, blood samples, fitness tests, bone quality (pQCT), psychological assessment, nutritional habits, and history of physical activity. A medical evaluation was done periodically. Moran DS, Finestone A, Arbel Y, Shabshin N, Laor A. J Strength Cond Res. 2011 Nov 4. [Epub ahead of print] PMID: 22067250

Surgical interventions for diaphyseal fractures of the radius and ulna in children.

There is a lack of evidence from randomised controlled trials to inform on when surgery is required and what type of surgery is best for treating children with fractures of the shafts of the radius, ulna or both bones. Abraham A, Kumar S, Chaudhry S, Ibrahim T. Cochrane Database Syst Rev. 2011 Nov 9;11:CD007907. PMID: 22071838

Surgical versus non-surgical interventions for treating patellar dislocation.

There is insufficient high quality evidence to confirm any significant difference in outcome between surgical or non-surgical initial management of people following primary patellar dislocation, and none examining this comparison in people with recurrent patellar dislocation. Adequately powered randomised, multi-centre controlled trials, conducted and reported to contemporary standards are recommended. Hing CB, Smith TO, Donell S, Song F. Cochrane Database Syst Rev. 2011 Nov 9;11:CD008106. PMID: 22071844

Effect of partial meniscectomy at the medial posterior horn on tibiofemoral contact mechanics and meniscal hoop strains in human knees.

From a biomechanical point of view, our in vitro study suggests that the medial joint compartment is not in danger of accelerated cartilage degeneration up to a resection limit of 20% meniscal depth and 10 mm width. Contact mechanics are likely to be more sensitive to partial meniscectomy at higher flexion angles, which has to be further investigated. Seitz AM, Lubomierski A, Friemert B, Ignatius A, Dürselen L. J Orthop Res. 2011 Nov 9. [Epub ahead of print] PMID: 22072570

Lubricin is expressed in chondrocytes derived from osteoarthritic cartilage encapsulated in poly (ethylene glycol) diacrylate scaffold.

The results showed an increased expression of lubricin in explanted tissue and in monolayer cells from normal cartilage, and a decreased expression of lubricin in OA cartilage. The chondrocytes from OA cartilage after 5 weeks of culture in hydrogels (PEGDA) showed an increased expression of lubricin compared with the control cartilage. The present study demonstrated that OA chondrocytes encapsulated in PEGDA, grown in the scaffold and were able to restore lubricin biosynthesis. Thus our results suggest the possibility of applying autologous cell transplantation in conjunction with scaffold materials for repairing cartilage lesions in patients with OA to reduce at least the progression of the disease. Musumeci G, Loreto C, Carnazza ML, Coppolino F, Cardile V, Leonardi R. Eur J Histochem. 2011 Sep 21;55(3):e31. Epub 2011 Aug 27. PMID: 22073377

Thursday, November 10, 2011

Cone-beam computed tomography arthrography: an innovative modality for the evaluation of wrist ligament and cartilage injuries

Cone-beam computed tomography (CBCT) has become an important modality in dento-facial imaging but remains poorly used in the exploration of the musculoskeletal system. The purpose of this study was to prospectively evaluate the performance and radiation exposure of CBCT arthrography in the evaluation of ligament and cartilage injuries in cadaveric wrists, with gross pathology findings as the standard of reference. Reeta Ramdhian-Wihlm, Jean-Marie Le Minor, Matthieu Schmittbuh, Jeremy Jeantroux, Peter Mac Mahon, Francis Veillon, Jean-Claude Dosch, Jean-Louis Dietemann, Guillaume Bierry. Skeletal Radiology; Online Date Monday, November 07, 2011 PDF

Evaluation of ultrasound-guided diagnostic local anaesthetic hip joint injection for osteoarthritis.

The diagnosis of hip osteoarthritis is often complicated by co-existing pathology in the knee and spine, and mismatch between clinical and radiological signs. Temporary pain relief from a local anaesthetic injection into the hip joint has been reported to help localise symptoms, reducing the risk of unnecessary surgery being performed. We hypothesize that good surgical outcome is predicted by good analgesia following diagnostic injection, and that alternative pathology is present when there is no response to injection. Yoong P, Guirguis R, Darrah R, Wijeratna M, Porteous MJ. Skeletal Radiol. 2011 Nov 10. [Epub ahead of print] PMID: 22069031

Wednesday, November 9, 2011

Scientists identify proteins that direct bone demolition

Scientists at Washington University School of Medicine in St. Louis have identified four proteins that supervise bone demolition, directing the destructive work of cells known as osteoclasts. The finding will help efforts to prevent bone loss and weakening caused by osteoporosis, cancer and other conditions.

“We currently treat these disorders with drugs that inhibit osteoclasts,” says lead author Carl DeSelm, an MD/PhD student. “The ideal drug would slow down osteoclasts when they get out of control but still allow some breakdown so that renewed bone can be built in its place.” The findings appear in Developmental Cell. MedicalXpress

ORBIT 3D X-ray Scanner Eliminates the C-Arm From the Operating Room

Researchers at the Fraunhofer Institute are working on the ORBIT, a 3D X-ray scanner that overcomes many of the disadvantages of traditional C-arms. When using a C-arm, procedures need to be paused to make room and move the device in, which will circle around the patient capturing the 3D image. The ORBIT is an open system in which the X-ray source follows a circular path above the operating table. medGadget

Journal of Surgical Education: in press, corrected proofs

Video Review Using a Reliable Evaluation Metric Improves Team Function in High-Fidelity Simulated Trauma Resuscitation

The Surgical Skills Laboratory Residency Interview: An Enjoyable Alternative

Surgeon-Performed Ultrasound—A Call for Consensus and Standardization

Using the Hidden Curriculum to Teach Professionalism During the Surgery Clerkship

Invited Commentary for “Trauma Leadership: Does Perception Drive Reality?”

Surgical techniques and therapeutic results of anatomical reconstruction of coracoclavicular ligaments for acromioclavicular joint dislocations

Generally, the surgical treatment for traumatic acromioclavicular joint dislocation is recommended for type 5 according to Rockwood’s classification. We believe that anatomical restoration of coracoclavicular ligament could best restore the function of the acromioclavicular joint. We attempted to correctly reconstruct the anatomy of the coracoclavicular ligament (trapezoid and conoid ligaments) in which the ipsilateral palmaris longus tendon and Endobutton were used as the reconstructing ligament and fixation material, respectively. Katsumi Takase, Tsuyoshi Kumakura, Ryohei Kono and Kotaro Shinmura. European Journal of Orthopaedic Surgery & Traumatology. Online Nov. 2011.

ACR: Steroids Tied to Bone Death (CME/CE)

Even short courses of glucocorticoids in conditions such as lupus, rheumatoid arthritis, and many other diseases can be associated with the development of osteonecrosis, a researcher cautioned here.

For instance, exposure to these drugs for less than 30 days was associated with an odds ratio of 3.8 (95% CI 2.1 to 6.8) for osteonecrosis compared with no exposure, Steven C. Vlad, MD, of Boston University School of Medicine, reported at the annual meeting of the American College of Rheumatology. MedPage Today

Tuesday, November 8, 2011

Atraumatic Osteonecrosis of the Distal Radius and Ulna: Case Series and Review

Atraumatic multifocal osteonecrosis is defined as the occurrence of this entity in 3 or more anatomic locations, and is rare. We identified 6 patients with osteonecrotic lesions in the distal ulna, radius, or both. The purposes of this study were to describe the clinical manifestations of atraumatic multifocal osteonecrosis affecting these bones, to identify risk factors for developing the disease in these locations, and to evaluate the success of treatment by percutaneous drilling. D. Alex Stroh, Dawn M. LaPorte, David A. Marker, Aaron J. Johnson, Michael A. Mont. The Journal of Hand Surgery. Available online 5 November 2011.

AHRQ: Big Jump in Knee Replacement Surgery

Knee replacement surgery among middle-aged men and women increased 2.5-fold from 1997 to 2009, new figures from the Agency for Healthcare Research and Quality (AHRQ) show.

The rate of hospitalizations for knee arthroplasty for women ages 45 to 64 increased 157%, from 16 per 10,000 people in 1997 to 42 for every 10,000 people in the U.S. in 2009.

For men, the rate jumped 144%, from 11 stays to 28 stays per 10,000 people over the same time period, according to a report released last week by AHRQ on statistics in hospital-based care. MedPage Today

Osteoarthritis results from inflammatory processes, not just wear and tear, Stanford study suggests

In a study to be published online Nov. 6 in Nature Medicine, investigators at the Stanford University School of Medicine have shown that the development of osteoarthritis is in great part driven by low-grade inflammatory processes. This is at odds with the prevailing view attributing the condition to a lifetime of wear and tear on long-suffering joints. Eurekalert!

Study describes first proof of principle for treating rare bone disease

FOP, fibrodysplasia ossificans progressiva, is a rare genetic disorder of progressive extra bone formation for which there is presently no cure. It is caused by a mutation in the gene for ACVR1/ALK2, a bone morphogenetic protein (BMP) receptor that occurs in all classically affected individuals. Individuals who have FOP harbor one normal copy and one damaged copy of the ACVR1/ALK2 gene in each cell. The mutation increases the amount of BMP in cells to greater than normal levels, which initiates the transformation of muscles and cartilage into a disabling second skeleton of bone. MedicalXpress

Journal of Orthopaedic Research: 2 new articles

Human platelet-rich plasma stimulates migration and chondrogenic differentiation of human subchondral progenitor cells Article first published online: 4 NOV 2011

Long-term oral administration of glucosamine or chondroitin sulfate reduces destruction of cartilage and up-regulation of MMP-3 mRNA in a model of spontaneous osteoarthritis in Hartley guinea pigs Article first published online: 4 NOV 2011

Displaced fracture of the waist of the scaphoid. [Instructional review: Upper limb]

A displaced fracture of the scaphoid is one in which the fragments have moved from their anatomical position or there is movement between them when stressed by physiological loads. Displacement is seen in about 20% of fractures of the waist of the scaphoid, as shown by translation, a gap, angulation or rotation. A CT scan in the true longitudinal axis of the scaphoid demonstrates the shape of the bone and displacement of the fracture more accurately than do plain radiographs. Displaced fractures can be treated in a plaster cast, accepting the risk of malunion and nonunion. Surgically the displacement can be reduced, checked radiologically, arthroscopically or visually, and stabilised with headless screws or wires. However, rates of union and deformity are unknown. Mild malunion is well tolerated, but the long-term outcome of a displaced fracture that healed in malalignment has not been established. This paper summarises aspects of the assessment, treatment and outcome of displaced fractures of the waist of the scaphoid. Dias JJ, Singh HP. J Bone Joint Surg Br. 2011 Nov;93(11):1433-9. PMID: 22058291

A Salute to Military Medicine, Our Brave Warriors

Our technology moves as fast as the fighting to come up with new ways to save lives on the battlefield; amid the horror and heartbreak, there have been medical advances. To all of our benefit, breakthroughs born of war and its injuries make their way to our emergency rooms, hospitals, athletic fields and doctors' offices -- and this, of course, does not take into account the great medical talent, the many doctors, nurses and other care-givers trained in our armed forces. Huffington Post

Sunday, November 6, 2011

Recent PubMed results for combat or high-energy trauma

1. Intrasubstance ruptures of the biceps brachii: diagnosis and management. Wilson DJ, Parada SA, Slevin JM, Arrington ED. Orthopedics. 2011 Nov;34(11):890-6. PMID: 22050257

2. Unusual case of isolated lunate fracture without ligamentous injury. Hsu AR, Hsu PA. Orthopedics. 2011 Nov 9;34(11):e785-9. PMID: 22049967

3. Open glenohumeral dislocation: skeletonization of the proximal humerus without associated fracture.

Maroney SS, Devinney DS. Orthopedics. 2011 Nov 9;34(11):e776-80. PMID: 22049963

4. Limb salvage of severely injured extremities after military wounds. Brown KV, Henman P, Stapley S, Clasper JC. J R Army Med Corps. 2011 Sep;157(3 Suppl 1):S315-23. PMID: 22049814

5. Damage control orthopaedics in the context of battlefield injuries: The use of temporary external fixation on combat trauma soldiers. Mathieu L, Bazile F, Barthélémy R, Duhamel P, Rigal S. Orthop Traumatol Surg Res. 2011 Oct 29. [Epub ahead of print] PMID: 22041574

6. Management of Dominant Upper Extremity Injuries: A Survey of Practice Patterns. Yancosek KE.

J Hand Ther. 2011 Oct 28. [Epub ahead of print] PMID: 22037284

7. Radiographic follow-up of 84 operatively treated scapula neck and body fractures. Cole PA, Gauger EM, Herrera DA, Anavian J, Tarkin IS. Injury. 2011 Oct 27. [Epub ahead of print] PMID: 22036452

8. Infection After Spanning External Fixation for High-Energy Tibial Plateau Fractures: Is Pin Site-Plate Overlap a Problem? Laible C, Earl-Royal E, Davidovitch R, Walsh M, Egol KA. J Orthop Trauma. 2011 Oct 18. [Epub ahead of print] PMID: 22011631

Successful Knee Extensor Mechanism Reconstruction in a Warfare-Related Open Lower Extremity Injury Complicated by Mucormycosis Infection: A Case Report.

Subcutaneous zygomycosis infection associated with a lower extremity open fracture is a potentially life- and limb-threatening condition. This rare and poorly characterized infection complicating war wounds is unique, complex, and poses a significant reconstructive challenge. The objective of this article is to report the reconstruction of a complex Gustilo IIIC warfare-related distal femur fracture with partial extensor mechanism loss complicated by a subcutaneous zygomycosis infection using a novel combination of local and systemic antifungals with negative pressure wound therapy. Negative pressure wound therapy with silver-impregnated sponges and antibiotic/antifungal beads was used to provide temporary wound coverage, improve revascularization, and deliver local antifungal therapy. The distal open femur fracture was fixed using a lateral approach and the medial distal thigh wound and extensor mechanism were reconstructed using an extended gastrocnemius flap with skin graft. The limb was successfully salvaged and the patient is now ambulatory. Kumar AR, Hunt P, Ritter EM, Howard R. J Orthop Trauma. 2011 Oct 28. [Epub ahead of print] PMID: 22048185

Combined olecranon osteotomy with triceps reflecting approach for complex humerus fractures

Combined humeral shaft and distal intra-articular fracture patterns present a unique surgical challenge. Various surgical approaches have been described for both the humeral shaft and the distal humerus individually but few exposures allow combined intra-articular and humeral shaft exposure simultaneously. The combined olecranon osteotomy and posterior triceps-splitting approach as originally described by Ebraheim et al has recently been reviewed by Archdeacon. We report a combined anconeus sparing olecranon osteotomy with proximal triceps reflection or Gerwin approach for simultaneous access to both the distal and diaphyseal humerus. Jason C. Tanka, Stephen Loweb, Eric T. Miller. Injury Extra; In Press, Corrected Proof.

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.

Results of the femur fractures treated with the new selfdynamisable internal fixator (SIF)

As axial dynamisation is a recognised method, many authors using interlocking femoral nail perform an additional small operation two months after the primary operation in order to remove one screw so as to provide axial dynamisation. According to the literature, dynamisation happens in about 15–25% of cases, but it cannot be predicted which patient or fracture will need dynamisation. The aim of this study is to present a new selfdynamisable implant and a minimally invasive method for the internal fixation of different femoral fractures. Milorad Mitkovic, S. Milenkovic, I. Micic, D. Mladenovic and Milan Mitkovic European Journal of Trauma and Emergency Surgery; Nov 2011, Online First

Physiological assessment of the polytrauma patient: initial and secondary surgeries

The timing of fracture fixation in polytrauma patients has been debated for a long time. The decision between DCO (damage control orthopaedics) and ETC (early total care) is a difficult dilemma. Overzealous ETC in haemodynamically compromised patients with significant chest and head injuries can be detrimental. It has been shown, however, that early fracture fixation has a trend towards better outcome in patients with less severe injuries. Delaying all orthopaedic surgery in critically injured patients can be a safe alternative, but has several disadvantages like longer ICU stay and septic complications. The literature shows equivocal evidence for both settings. This article will summarize the historical background and controversies regarding patient assessment and decision making during the treatment of polytrauma patients. It will also give guidance for choosing DCO versus ETC in the clinical setting. N. Enninghorst, R. Peralta, O. Yoshino, R. Pfeifer, H. C. Pape, B. M. Hardy, D. C. Dewar and Z. J. Balogh. European Journal of Trauma and Emergency Surgery; Nov 2011, Online First

Mission Complete for Navy Medicine at EMF-Kuwait | Navy Medicine

This week I had the honor of presiding at the final Navy Change of Command and Transfer of Authority ceremony at Expeditionary Medical Facility-Kuwait (EMF-K) during which Navy Capt. Dick Turner, NC, was relieved by Army Col. Joe Robinson, MC, USA, commander of the Army’s 325th Combat Support Hospital (CSH). On this momentous occasion Nov 3., the Navy’s seven and a half year long commitment to provide health service support in Kuwait came to an end.

Navy Medicine assumed this mission April 1, 2004 from the Army’s 801st CSH in a Transfer of Authority ceremony at Camp Doha. Shortly thereafter Capt. Marty Snyder and his team from Naval Medical Center Portsmouth constructed the original 44-bed tent hospital near EMF-K’s current location on Camp Arifjan. Navy Medicine

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