Extended healing validation of an artificial tendon to connect the quadriceps muscle to the Tibia: 180-day study

Whenever a tendon or its bone insertion is disrupted or removed, existing surgical techniques provide a temporary connection or scaffolding to promote healing, but the interface of living to non-living materials soon breaks down under the stress of these applications, if it must bear the load more than acutely. Patients are thus disabled whose prostheses, defect size, or mere anatomy limit the availability or outcomes of such treatments. Our group developed the OrthoCoupler™ device to join skeletal muscle to prosthetic or natural structures without this interface breakdown. Melvin AJ, Litsky AS, Mayerson JL, Stringer K, Juncosa-Melvin N.

J Orthop Res. 2011 Dec 16. [Epub ahead of print] PMID: 22179930 PDF

CourseSmart presents a great, comprehensive model for the digital future of medical education

Many university providers and educators around the world have embraced digital course materials in order to supplement existing course materials. Many now aim to go beyond merely distributing PDF notes or making lectures available online and use platforms like the iPad to teach medicine in new ways.

CourseSmart, a venture founded in 2007 and supported by many leading publishers, aims to provide eTextbooks and digital learning tools to students across America. CourseSmart is one of the largest provider of digital course materials and their catalog includes over 90% of the core textbooks in use today by North American Universities. iMedicalApps

Ultrasound Related Ortho Articles via PubMed

Ultrasound-guided intervention around the hip joint.

Ultrasound of the rotator cable: prevalence and morphology in asymptomatic shoulders.

Which Knee and Probe Position Determines the Final Diagnosis of Knee Inflammation by Ultrasound? Results from a European Multicenter Study.

Ultrasonographic diagnosis of articular chondrocalcinosis.

Springer "Online First" Ortho Related Articles

The chondrotoxicity of single-dose corticosteroids

Abstract

Purpose

Corticosteroids are commonly injected into the joint space. However, studies have not examined the chondrotoxicity of one-time injection doses. The purpose of this study is to evaluate the effect of dexamethasone sodium phosphate (Decadron^®), methylprednisolone acetate (Depo-Medrol^®), betamethasone sodium phosphate and betamethasone acetate (Celestone^® Soluspan^®), and triamcinolone acetonide (Kenalog^®) on human chondrocyte viability in vitro.

Methods

Single-injection doses of each of the corticosteroids were separately delivered to human chondrocytes for their respective average duration of action and compared to controls using a bioreactor containing a continuous infusion pump constructed to mimic joint fluid metabolism. A 14-day time-controlled trial was also performed. A live/dead reduced biohazard viability/cytotoxicity assay was used to quantify chondrocyte viability.

Results

Over their average duration of action, betamethasone sodium phosphate/acetate solution and triamcinolone acetonide caused significant decreases in chondrocyte viability compared to control media (19.8 ± 2.9% vs. 5.2 ± 2.1%, P = 0.0025 and 10.2 ± 1.3% vs. 4.8 ± 0.9%, P = 0.0049, respectively). In the 14-day trial, only betamethasone sodium phosphate/acetate solution caused a significant decrease in chondrocyte viability compared to control media (21.5% vs. 4.6%, P < 0.001).

Conclusions

A single-injection dose of betamethasone sodium phosphate and betamethasone acetate solution illustrated consistent and significant chondrotoxicity using a physiologically relevant in vitro model and should be used with caution. Given the observed chondrotoxicity of triamcinolone acetonide in a single trial, there may be some evidence that this medication is chondrotoxic. However, at 14 days, betamethasone sodium phosphate and betamethasone acetate was the only condition that caused significant cell death.

• Content Type Journal Article
• Category Knee
• Pages 1-6
• DOI 10.1007/s00167-011-1820-6
• Authors
  • Jason L. Dragoo, Department of Orthopaedic Surgery, Stanford University, 450 Broadway Street, Pavilion C, 4th Floor, Redwood City, CA 94063-6342, USA
  • Christina M. Danial, Department of Orthopaedic Surgery, Stanford University, 450 Broadway Street, Pavilion C, 4th Floor, Redwood City, CA 94063-6342, USA
  • Hillary J. Braun, Department of Orthopaedic Surgery, Stanford University, 450 Broadway Street, Pavilion C, 4th Floor, Redwood City, CA 94063-6342, USA
  • Michael A. Pouliot, Department of Orthopaedic Surgery, Stanford University, 450 Broadway Street, Pavilion C, 4th Floor, Redwood City, CA 94063-6342, USA
  • Hyeon Joo Kim, Department of Orthopaedic Surgery, Stanford University, 450 Broadway Street, Pavilion C, 4th Floor, Redwood City, CA 94063-6342, USA

• Journal Knee Surgery, Sports Traumatology, Arthroscopy
• Online ISSN 1433-7347
• Print ISSN 0942-2056

Treatment of patellar tendinopathy—a systematic review of randomized controlled trials

Length-change patterns of the collateral ligaments after total knee arthroplasty

The role of static and dynamic rotatory laxity testing in evaluating ACL injury

Inside the Pentagon’s Alt-Medicine Mecca, Where the Generals Meditate

Yoga is now a mainstay at Walter Reed
 and other military hospitals,and even
part of routine training for personnel.

The general is surprisingly good at meditation. It’s not just the impeccable posture — that might be expected of a man long used to standing at attention. It’s his hands, which rest idly on his knees, and his combat boots, which remain planted firmly on the floor. Over the next several minutes, Lt. Gen. Eric Schoomaker, the Surgeon General of the Army, will keep his eyes closed and his face perfectly relaxed.

The Pentagon is turning to alternative medicine to help alleviate the devastating symptoms of Post-traumatic stress disorder that afflict more than 250,000 military personnel; soothe the brain trauma that’s left thousands more with tremors, speech impediments and memory lapses; and assuage the chronic pain that lingers after grueling, repeat deployments.

The Samueli Institute might be the Pentagon’s best chance at making alt-medicine work. Or, at least, figuring out if it even stands a chance.

Thanks to leadership with years of experience in military circles, not to mention a billionaire benefactor with friends in prominent places, they’ve got no shortage of resources with which to do just that. More than half of the Institute’s $13.5 million in annual funding is provided by congressional funding (or “earmarks”), the Department of Defense and Veteran’s Affairs.

“Wherever you’ve come from, wherever you imagine you’re going, you’re actually only doing it right now, in this moment.” Our meditation guru for the day, Dr. Wayne Jonas, is not only a retired Army medical officer and former director of the holistic branch of the National Institute of Health. Wired

Recently Published Research on Integrative Medicine in the Military

Smart Bandage Promotes and Guides Vessel Formation

Researchers at University of Illinois Urbana–Champaign developed an amazing little bandage, which they call a “microvascular stamp”, that promotes angiogenesis while guiding exactly where the vessels should go.
It is imbued with living cells, positioned in a defined pattern, that release growth factors around a wound and cause vessels to grow where intended.  The study will be appearing in next month’s issue of Advanced Materials. MedGadget

Lubricant in Metal-On-Metal Hip Implants Found to Be Graphite, Not Proteins

A team of engineers and physicians have made a surprising discovery that offers a target for designing new materials for hip implants that are less susceptible to the joint’s normal wear and tear.

Researchers from Northwestern University, Evanston, IL, Rush University Medical Center, Chicago, and the University of Duisburg-Essen Germany found that graphitic carbon is a key element in a lubricatin layer that forms on metal-on-metal hip implants. The lubricant is more similar to the lubrication of a combustion engine than that of a natural joint.

The study will be published Dec. 23 by the journal Science.  NewsWise

Journal of Orthopaedic Trauma [epub ahead of print] - link here onsite

Letter to Editor

Amputation or Limb Salvage Is Still a Question

Secondary Amputations of Blast-Induced Limb Injuries: What's Happened in the First Hours?

Review Article

Incidence of Associated Injury in Posterior Shoulder Dislocation: Systematic Review of the Literature

External Fixation versus Internal Fixation for Unstable Distal Radius Fractures: A Systematic Review and Meta-Analysis of Comparative Clinical Trials

Original Article

Functional Outcomes After Operatively Treated Patella Fractures

Failure of Locked Design-Specific Plate Fixation of the Pubic Symphysis: A Report of Six Cases

Locked versus Standard Unlocked Plating of the Pubic Symphysis: A Cadaver Biomechanical Study

Comparison of the 95-Degree Angled Blade Plate and the Locking Condylar Plate for the Treatment of Distal Femoral Fractures

Medical App that replaces the reference cards in your white coat, Wards 101 i-pocketcards review

Though we are now able to cram a virtually unlimited amount of information into our pockets via our mobile devices, just a few short years ago, pocket books and pocket cards were the weapons of choice. There were few weapons more efficient than a well-designed set of pocket cards; they were a potent combination of critical information presented in a compact package available for extremely quick reference.

But times change, and white coat real estate is increasingly occupied by mobile technology. I admittedly do find pocket cards to be quicker in terms of looking up critical information at times, but as one begins carrying multiple pocket cards, this speed advantage is lost. There is only a finite space available, and mobile devices are increasingly being tapped to fulfill this role.

In a bid to stay on top of trends, Borm Bruckmeier has translated their Wards 101 Essentials Pocketcard Set, which covers common emergency, internal medicine, and ICU topics, to the iPhone and iPad via a universal iOS app. iMedicalapps

Review article: Plica syndrome of the knee

Review article: Plica syndrome of the knee. Plica syndrome is a pathological condition secondary to inflammation. Plicae around the knee are common and generally asymptomatic. They often are misdiagnosed. The morphology of knee plicae varies; mediopatellar plicae are the most common cause of the plicae syndrome. An intermittent dull pain is the most common symptom. Diagnosis is made by exclusion. Ultrasonography is useful; arthroscopy is the gold standard. Arthroscopic removal of the plica may be necessary when conservative treatment for up to 6 months fails. Al-Hadithy N, Gikas P, Mahapatra AM, Dowd G. J Orthop Surg (Hong Kong). 2011 Dec;19(3):354-8. PMID: 22184170 PDF

Real-time sonoelastography of the Achilles tendon: pattern description in healthy subjects and patients with surgically repaired complete ruptures

In sonoelastography, the recognition of normal tendon structure will be useful in assessing pathologies of the Achilles tendon. Additionally, in patients with excellent American Orthopedic Foot and Ankle Society (AOFAS) scores and surgically repaired complete ruptures, a hard and heterogeneous pattern of tendon structure may be a natural consequence of tendon healing. PDF

Naval technology could be a lifesaver

Battlefield corpsmen and medical professionals across the country gained a valuable tool last week, as the Food and Drug Administration approved the first hand-held device to detect life-threatening bleeding in the brain. The Infrascanner could be a particular boon to the Department of the Navy (DON), as heavy computed tomography (CT) machines are not normally carried aboard ships in the frigate or destroyer class, or in the field with the Marine Corps. MedicalXpress

Unprecedented international effort to improve safety of orthopedic devices

Responding to a need for better post-market surveillance of orthopedic devices, the U.S. Food and Drug Administration (FDA) established the International Consortium of Orthopaedic Registries (ICOR) in October 2010.

As outlined in a Dec. 21 special online supplement in the Journal of Bone and Joint Surgery, ICOR is in the process of developing a collaborative process for improving the safety of orthopedic devices using outcomes registries from the U.S. and other countries. The combined ICOR registries may include data on millions of orthopedic surgical procedures and all implantable devices on the market. Eurekalert!


The Journal of Bone & Joint Surgery
December 21, 2011 | Vol. 93. Issue Supplement 3

Knee Arthroplasty and Risk of Hip Fracture: A Population-Based, Case–Control Study

The majority of knee arthroplasties (KAs) are performed in patients with osteoarthritis (OA). Although bone mass may be increased in these patients, subjects with knee OA may have an increased risk of hip fracture, possibly due to an increased severity of falls. However, in patients with KAs, risk of hip fracture has not been studied extensively. Arief Lalmohamed, Frans Opdam, Nigel K. Arden, Daniel Prieto-Alhambra, Tjeerd van Staa, Hubertus G. M. Leufkens and Frank de Vries. Calcified Tissue International. Dec 2011.  PDF

The Journal of Hand Surgery: articles in press 21 Dec 2011

Community-Acquired Methicillin-Resistant Staphylococcus aureus Hand Infections in the Pediatric Population PDF

Predictors of Pain During and the Day After Corticosteroid Injection for Idiopathic Trigger Finger PDF

Comparative Analysis of Intramedullary Nail Fixation Versus Casting for Treatment of Distal Radius Fractures PDF

Predicting the Outcome of Revision Carpal Tunnel Release PDF

Trigger Finger Treatment: A Comparison of 2 Splint Designs PDF

Open Reduction and Three-Dimensional Ulnar Osteotomy for Chronic Radial Head Dislocation Using a Computer-Generated Template: Case Report PDF

Ability of Near Infrared Spectroscopy to Measure Oxygenation in Isolated Upper Extremity Muscle Compartments PDF

Intrafocal Pin Plate Fixation of Distal Ulna Fractures Associated With Distal Radius Fractures PDF

Meta-Analysis of the Imaging Techniques for the Diagnosis of Complex Regional Pain Syndrome Type I PDF

Minimum 4-Year Follow-Up on Contralateral C7 Nerve Transfers for Brachial Plexus Injuries PDF

Aquatic therapy soon after total knee arthroplasty improves outcomes

Despite increased use of total hip arthroplasty (THA) and total knee arthroplasty (TKA), there is a notable lack of consensus about optimal postoperative treatment. Aquatic therapy has been shown to have a beneficial effect, and it is typically begun two weeks after surgery, after the wound has healed. According to a new study published in the Archives of Physical Medicine and Rehabilitation, beginning aquatic therapy just 6 days after TKA may lead to improved results, while delaying its onset an additional week may be more appropriate after a THA.   Eurekalert!

Journal of Surgical Education - Articles in Press

The Production of Audiovisual Teaching Tools in Minimally Invasive Surgery PDF

Do International Rotations Make Surgical Residents More Resource-Efficient? A Preliminary Study PDF

 Is There a Digital Generation Gap for E-Learning in Plastic Surgery? PDF

Limiting PGY 1 Residents to 16 Hours of Duty: Review and Report of a Workshop PDF

Perceived Benefits of a Transplant Surgery Experience to General Surgery Residency Training PDF

A Simulator Model for Sacroiliac Screw Placement PDF

Communication Tool Cuts Surgical Complications (CME/CE)

A program focusing on teamwork in the operating room appeared to lessen surgical complications at Veterans Affairs facilities, researchers found.

Hospitals that implemented the program had a significant drop in the annual surgical morbidity rate of 17% (P=0.01), compared with a nonsignificant decline for centers that hadn't yet started it, Yinong Young-Xu, ScD, of the National Center for Patient Safety in River Junction, Vt., and colleagues reported in the Archives of Surgery.  MedPage Today

Recent Military Related Ortho Articles via PubMed

1. Proximal carpal row dislocation: a case report. Capo JT, Armbruster EJ, Hashem J. Hand (N Y). 2010 Dec;5(4):444-8. PMID: 22131931 Free PMC Article

2. Open lumbosacral spine fractures with thecal sac ligation after combat blast trauma. Kang DG, Cody JP, Lehman RA Jr. Spine J. 2011 Nov 29. [Epub ahead of print] PMID: 22133427

3. Bony avulsion of the supraspinatus origin from the scapular spine. Vochteloo AJ, Henket M, Vincken PW, Nagels J. J Orthop Traumatol. 2011 Dec 2. [Epub ahead of print] PMID: 22134393

4. Lumbar Spine Fractures Within a Complete American Cohort: Epidemiology and Risk Factors Among Military Service Members. Schoenfeld AJ, Romano D, Bader JO, Walker JJ. J Spinal Disord Tech. 2011 Nov 29. [Epub ahead of print] PMID: 22134730

5. Surgical experience at the Canadian-led Role 3 Multinational Medical Unit in Kandahar, Afghanistan.

Brisebois RJ, Tien HC. J Trauma. 2011 Nov;71(5 Suppl 1):S397-400. PMID: 22071994

6. Spinal injuries after improvised explosive device incidents: implications for Tactical Combat Casualty Care. Comstock S, Pannell D, Talbot M, Compton L, Withers N, Tien HC. J Trauma. 2011 Nov;71(5 Suppl 1):S413-7. PMID: 22071997

7. Myositis ossificans around shoulder following military training programme. Kir MC, Ozdemir MT.

Indian J Orthop. 2011 Nov;45(6):573-5. PMID: 22144755 Free PMC Article

8. Percutaneous limited internal fixation combined with external fixation to treat open pelvic fractures concomitant with perineal lacerations. Chen L, Zhang G, Wu Y, Guo X, Yuan W. Orthopedics. 2011 Dec 6;34(12):e827-31. PMID: 22146197

9. Minimally Invasive Reduction Technique in Split Depression Type Tibial Pilon Fractures. Poyanli O, Esenkaya I, Ozkut AT, Akcal MA, Akan K, Unay K. J Foot Ankle Surg. 2011 Dec 8. [Epub ahead of print] PMID: 22154056

10. Case Report: Multifocal Subchondral Stress Fractures of the Femoral Heads and Tibial Condyles in a Young Military Recruit. Yoon PW, Yoo JJ, Yoon KS, Kim HJ. Clin Orthop Relat Res. 2011 Dec 13. [Epub ahead of print] PMID: 22161083

Top Anatomy Apps series starts with Anatomy Lectures: Topics In Focus

Here at iMedicalApps, we have decided to take a look at the anatomy apps currently available for the iPad to try and select a range that we consider the most useful for healthcare professionals. We have decided to focus on the iPad as we feel the large screen on this device is best suited to the task.

Unfortunately, the development of anatomy apps for Android tablets is lagging behind Apple’s iOS and therefore not suitable for this current discussion. Furthermore, the majority of healthcare professionals who own a tablet, own an iPad.

The first app we are going to look at in this series is an atypical anatomy app. Instant Anatomy Lectures: Topics In Focus. Robert Whitaker is an eminent anatomist who has written a whole range of lectures covering all aspects of anatomy and runs a website dedicated to aiding learning in human anatomy. iMedicalApps

Knee pain common complaint in middle-aged and mature women

New research shows 63% of women age 50 and older reported persistent, incident, or intermittent knee pain during a 12-year study period. Predictors for persistent pain included higher body mass index (BMI), previous knee injury, and radiographic osteoarthritis (OA). Details of this longitudinal study are available in Arthritis & Rheumatism, a journal published by Wiley-Blackwell on behalf of the American College of Rheumatology (ACR). Eurekalert! 

High clinical utility of computed tomography compared to radiography in elderly patients with occult hip fracture after low-energy trauma.

Computed tomography has a high clinical utility as it can detect nearly all clinically suspect but radiographically negative cervical hip fractures as well as most trochanteric fractures and avulsions. A negative CT is near-perfect in ruling out a hip fracture requiring surgery. Dunker D, Collin D, Göthlin JH, Geijer M. Emerg Radiol. 2011 Dec 16. [Epub ahead of print] PMID: 22173818

American Journal of Sports Medicine [Epub ahead of print]

1. Quantitative Analysis of Muscle and Tendon Retraction in Chronic Rotator Cuff Tears. Meyer DC, Farshad M, Amacker NA, Gerber C, Wieser K. Am J Sports Med. 2011 Dec 14. [Epub ahead of print] PMID: 22174340

2. A Retrospective Evaluation of Magnetic Resonance Imaging Effectiveness on Capitellar Osteochondritis Dissecans Among Overhead Athletes. Iwasaki N, Kamishima T, Kato H, Funakoshi T, Minami A. Am J Sports Med. 2011 Dec 14. [Epub ahead of print] PMID: 22174341

3. Influence of Cell Quality on Clinical Outcome After Autologous Chondrocyte Implantation. Niemeyer P, Pestka JM, Salzmann GM, Südkamp NP, Schmal H. Am J Sports Med. 2011 Dec 14. [Epub ahead of print] PMID: 22174342

4. The Biomechanical and Clinical Application of Using the Anterior Half of the Peroneus Longus Tendon as an Autograft Source. Zhao J, Huangfu X. Am J Sports Med. 2011 Dec 14. [Epub ahead of print] PMID: 22174343

5. The Role of Axial Compressive and Quadriceps Forces in Noncontact Anterior Cruciate Ligament Injury: A Cadaveric Study. Wall SJ, Rose DM, Sutter EG, Belkoff SM, Boden BP. Am J Sports Med. 2011 Dec 14. [Epub ahead of print] PMID: 22174344

Orthopaedic surgeons: as strong as an ox and almost twice as clever? Multicentre prospective comparative study.

Male orthopaedic surgeons have greater intelligence and grip strength than their male anaesthetic colleagues, who should find new ways to make fun of their orthopaedic friends. Subramanian P, Kantharuban S, Subramanian V, Willis-Owen SA, Willis-Owen CA. BMJ. 2011 Dec 15;343:d7506. PMID: 22174322 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. Buck FM, Dietrich TJ, Resnick D, Jost B, Pfirrmann CW. Radiology. 2011 Dec;261(3):872-81. Epub 2011 Oct 3. PMID: 21969668

Doctor on board? What is the optimal skill-mix in military pre-hospital care?

 In a military setting, pre-hospital times may be extended due to geographical or operational issues. Helicopter casevac enables patients to be transported expediently across all terrains. The skill-mix of the pre-hospital team can vary. Calderbank P, Woolley T, Mercer S, Schrager J, Kazel M, Bree S, Bowley DM. Emerg Med J. 2011 Oct;28(10):882-3. Epub 2010 Sep 15. PMID: 20844092

Military Medicine 2011 Nov;176(11) via PubMed

1. Effect of combined nicotine and shrapnel exposure on pain measures and gait after nerve injury. Rittenhouse B, Hill-Pryor CD, McConathy A, Parker P, Franco N, Toussaint E, Barker D, Prasad B, Pizarro JM. Mil Med. 2011 Nov;176(11):1335-40. PMID: 22165666

2. Incidence and risk factors for lumbar degenerative disc disease in the United States military 1999-2008. Schoenfeld AJ, Nelson JH, Burks R, Belmont PJ Jr. Mil Med. 2011 Nov;176(11):1320-4. PMID: 22165663

3. Cricothyroidotomy bottom-up training review: battlefield lessons learned. Bennett BL, Cailteux-Zevallos B, Kotora J. Mil Med. 2011 Nov;176(11):1311-9. PMID: 22165662

4. Cartesian positioning system for localization of blast and ballistic fragments: a phantom-based pilot study. Folio L, Fischer T, Shogan PJ, Frew M, Bunger R, Provenzale JM. Mil Med. 2011 Nov;176(11):1300-5. PMID: 22165660

5. Improving the emergency whole blood program. Cahill BP, Stinar TR. Mil Med. 2011 Nov;176(11):1287-91. PMID: 22165658

New Guideline on Transverse Myelitis Released (CME/CE)

Certain clinical, imaging, and laboratory findings can help determine the etiology and prognosis in patients presenting with transverse myelitis, according to a new guideline from the American Academy of Neurology. MedPage Today

American Academy of Neurology guidelines via National Guideline Clearinghouse

Do-Surgery.com - a comprehensive eLearning resource for orthopaedic surgeons.

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