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Tuesday, May 22, 2012

New article in Archives of Surgery addressing Ortho Resident work hours


Despite new limits on resident work hours almost half of the orthopedic residents at two of Harvard's hospitals said they were fatigued during work hours, and 27% said they were impaired by lack of sleep.

Moreover, the doctors-in-training said they average just a little over 5 hours' sleep daily during work weeks, Frank McCormick, MD, of Massachusetts General Hospital, and colleagues reported in the May 21 issue of Archives of Surgery. MedPage Today

Quick and easy SI joint adjustment to correct joint rotation.

A quick fix is possible for sacroiliac joint pain in many children andadolescents (MedicalXpress)

Investigators report that a simple bedside manual therapy to correct a painful misaligned sacroiliac joint was highly successful in a group of 45 patients 10 to 20 years of age. Thirty-six patients (80 percent) obtained significant pain relief, whereas nine patients (20 percent) experienced minimal to no relief. In 24 patients (53 percent) complete resolution of pain was experienced immediately upon treatment. Only two patients required a second treatment because of symptom recurrence. These findings are reported in a new article of the June 2012 issue of the Journal of Neurosurgery: Pediatrics, "Sacroiliac joint pain in the pediatric population" (PDF).

Note: 20 years ago, while a student in Physical Therapy,  I had my wife treat my rotated right SI joint with this technique.  I felt a big pop and my long aching right SI joint problem went away and has not returned.

Friday, May 4, 2012

Engineering to extend the life of hip replacements

Hip implant for long-term use
Researchers at the Fraunhofer Institute for Manufacturing Engineering and Automation IPA in Stuttgart, partnering in an international team on an EC-funded project entitled "ENDURE" (Enhanced Durability Resurfacing Endoprosthesis), have now developed a new kind of hip implant that, unlike the conventional counterpart implants on the market today, provide a metal-free solution and bone-like elasticity. This is the result of a metal-free, high-tech composite: The hip socket is made of carbon fibre-reinforced PEEK – a high-strength, wear resistant, biocompatible polymer composite. For the femoral head, ceramic was used. In addition to this, a hydroxylapatite coating at the interface to the bone helps ensure that the bone tissue will fuse thoroughly with the surface structure of the implant. "The cobalt-chromium implants in use to date are very rigid, and the load transfer to the bone is non-optimal leading to potential adverse bone adaptation. Thanks to the new combination of materials, the transmission of force through the PEEK hip socket to the pelvic bone is modeled on natural conditions. And there are no metal ions released," notes IPA engineer Jasmin Hipp. The researcher and her team were able to confirm the good wear resistance in initial tests of the new hip replacement using a robot that simulated various series of movements such as walking or climbing and descending stairs. Eurekalert!

Another new tool for information sharing

DocTrackr lets you control your documents — wherever they are
Nearly everyone talks about putting more of their documents in the cloud. But not everyone feels secure doing it. That’s the target audience for DocTrackr’s new service, which lets users retain control of Word,  Excel, PDF or other documents even when they’ve been emailed to others or put into cloud storage.
 GigaOm
Novel Bone Scaffold Draws Strength from Tiny Silk Fibers
Every few months or so, researchers announce a new breakthrough with silk. For instance, earlier this year in March, scientists from the US Air Force Research Laboratory reported that they had transformed the material into a bactericidal fabric. In February, researchers at University of Akron had developed a spider-silk inspired thread for wound-healing applications. MedGadget

Related:

Spinning Some Silken Science
Spiders and silkworms make silk by the yard. Why can’t we copy them? Silk is strong, light and flexible and is being examined for use in everything from medical sutures to advanced electronics. Silk researcher David Kaplan explains the challenges in bioengineering silk. (NPR)

Wednesday, May 2, 2012

The American Journal of Surgery: articles in press

1.  Systematic review and meta-analysis of electrocautery versus scalpel for surgical skin incisions. Review Article. In Press, Corrected Proof, Available online 24 April 2012. Lisa N.F. Aird, Carl J. Brown. PDF (715 K)
2.  Educational feedback in the operating room: a gap between resident and faculty perceptions. Original Research Article. In Press, Corrected Proof, Available online 24 April 2012. Aaron R. Jensen, Andrew S. Wright, Sara Kim, Karen D. Horvath, Kristine E. Calhoun. PDF (2246 K)  
In Press, Corrected Proof, Available online 9 April 2012. H.L. Aanning, Andrew Van Osdol, Chantal Allamargot, Brandt E. Becker, Thomas C. Howard, Micah L. Likness, Courtney E. Merkwan, Dan D. Tarver. PDF (1396 K)  
4.  The age of transfused blood predicts hematocrit response among critically ill surgical patients. Original Research Article. In Press, Corrected Proof, Available online 31 March 2012. Fredric M. Pieracci, Ernest E. Moore, Teresa Chin, Nicole Townsend, Eduardo Gonzalez, Clay C. Burlew, Carlton C. Barnett Jr. PDF (537 K)
5.  The combat experience of military surgical assets in Iraq and Afghanistan: a historical review. Review Article. In Press, Corrected Proof, Available online 20 March 2012. Andrew J. Schoenfeld. PDF (1285 K)  
6.  Defining a new paradigm for surgical education. In Press, Corrected Proof, Available online 4 February 2012. John Maa. PDF (74 K)  
7.  Surgeons' leadership in the operating room: an observational study. Original Research Article. In Press, Corrected Proof, Available online 16 December 2011. Sarah Henrickson Parker, Steven Yule, Rhona Flin, Aileen McKinley. PDF (243 K)  
8.  The adoption of advanced surgical techniques: are surgical masterclasses enough? Original Research Article. In Press, Corrected Proof, Available online 6 August 2011. Trystan Lewis, Rajesh Aggarwal, Colin Sugden, Ara Darzi. PDF (413 K)  
9.  Performance skills for surgeons: lessons from sport. In Press, Corrected Proof, Available online 4 August 2011. Eugene J. Gibney. PDF (88 K)  
10.  Angioembolization for pelvic fractures. In Press, Corrected Proof, Available online 28 July 2011. Michael Sugrue. PDF (73 K)

Sleepiness may affect surgeons' ability to deal with the unexpected.

Sleep deprivation increases cognitive workload during simulated surgical tasks
Sleep-deprived surgeons can perform a previously learned task or learn a new task as well as surgeons who are rested, according to Penn State College of Medicine researchers. However, in sleep-deprived surgeons, the brain must work harder, which could lead to problems during unexpected events.

The researchers reached these conclusions using simulations to study the effects of sleepiness on surgeons.
"Particularly in surgery, simulation has become the introduction to many procedures for new residents," said Jonathan Tomasko, M.D., a research fellow involved in surgical resident training. "Coupled with an 80-hour work week restriction, simulation is becoming increasingly important to ensure an adequate level of skill prior to operation on a patient." Eureklert!
American Journal of Surgery
PDF

Returning to sports after THA.

Does Impact Sport Activity Influence Total Hip Arthroplasty Durability?

Return to sport is a key patient demand after hip arthroplasty and some patients are even involved in high-impact sports. Although polyethylene wear is related to the number of cycles and the importance of the load, it is unclear whether high-impact sport per se influences THA durability.
Clinical Orthopaedics and Related Research 
PDF

Tuesday, May 1, 2012

Shortage of Hand Surgeons

Wrist, hand and finger trauma are the most common injuries presenting to emergency departments nationwide, yet only 7 percent of Tennessee hospitals have a hand specialist on call 24/7 to treat these patients, according to a Vanderbilt study published online today in the Annals of Plastic Surgery.
Link to PDF
Eurekalert!

What do fecal transplants have to do with Ortho?

Using the same technology as discussed below, some forward thinking Resident could determine what microfloral exists in wounds that heal well vs. wounds that become infected.  A solution of microflora that promotes wound healing can then be applied to wounds to prevent infections.

Synthetic stool a prospective treatment for C. difficile
A synthetic mixture of intestinal bacteria could one day replace stool transplants as a treatment for Clostridium difficile (C. difficile). C . difficile is a toxin-producing bacteria that can overpopulate the colon when antibiotics eradicate other, naturally protective bacteria living there. Eurekalert!

Learning radiographic imaging

Tablet-based case conferences improve resident learning
Tablet-based conference mirroring is giving residents an up close and personal look at images and making radiology case conferences a more interactive learning experience, a new study shows. 2012 American Roentgen Ray Society Annual Meeting via Eurekalert!

Recent Ortho/Trauma related articles from Pubmed

1. Exercise training to prevent anterior knee pain in military recruits. Divine J. Clin J Sport Med. 2012 May;22(3):288-9. PMID: 22544060
2. Physical therapy and surgery. Valle-Onate R, Ward MM, Kerr GS. Am J Med Sci. 2012 May;343(5):353-6. PMID: 22543536
3. The contribution of MRI to the diagnosis of traumatic tears of the anterior cruciate ligament. Guenoun D, Le Corroller T, Amous Z, Pauly V, Sbihi A, Champsaur P. Diagn Interv Imaging. 2012 Apr 26. [Epub ahead of print] PMID: 22542209
4. Judet osteoperiosteal decortication for treatment of non-union: The Cornwall experience. Guyver P, Wakeling C, Naik K, Norton M. Injury. 2012 Apr 27. [Epub ahead of print] PMID: 22542168
5. Deep infection after hip fracture surgery: Predictors of early mortality. Duckworth AD, Phillips SA, Stone O, Moran M, Breusch SJ, Biant LC. Injury. 2012 Apr 27. [Epub ahead of print] PMID: 22542166
6. Acromioclavicular joint reconstruction: a comparative biomechanical study of three techniques. Lädermann A, Gueorguiev B, Stimec B, Fasel J, Rothstock S, Hoffmeyer P. J Shoulder Elbow Surg. 2012 Apr 26. [Epub ahead of print] PMID: 22541912
7. Temporary joint-spanning external fixation before internal fixation of open intra-articular distal humeral fractures: a staged protocol. Kloen P, Helfet DL, Lorich DG, Paul O, Brouwer KM, Ring D. J Shoulder Elbow Surg. 2012 Apr 26. [Epub ahead of print]
PMID: 22541911
8.  Atraumatic, Symptomatic Ankle Plica Successfully Treated by Arthroscopic Debridement: A Case Report. Highcock AJ, Cohen D, Platt S. J Foot Ankle Surg. 2012 Apr 25. [Epub ahead of print] PMID: 22541910
9. Anatomic direct repair of chronic distal biceps brachii tendon rupture without interposition graft. Bosman HA, Fincher M, Saw N. J Shoulder Elbow Surg. 2012 Apr 25. [Epub ahead of print] PMID: 22541865
10. Reconstruction of the Posterior Oblique Ligament and the Posterior Cruciate Ligament in Knees With Posteromedial Instability. Weimann A, Schatka I, Herbort M, Achtnich A, Zantop T, Raschke M, Petersen W. Arthroscopy. 2012 Apr 26. [Epub ahead of print] PMID: 22541643
11. Pediatric variants of the transolecranon fracture dislocation: recognition and tension band fixation: report of 3 cases. Butler MA, Martus JE, Schoenecker JG. J Hand Surg Am. 2012 May;37(5):999-1002. PMID: 22541155
12. Anterior interosseous nerve palsy following the use of elbow crutches. Wu F, Ismaeel A, Siddiqi R. N Am J Med Sci. 2011 Jun;3(6):296-8. PMID: 22540102
13. Anatomic Characteristics and Radiographic References of the Anterolateral and Posteromedial Bundles of the Posterior Cruciate Ligament. Osti M, Tschann P, Künzel KH, Benedetto KP. Am J Sports Med. 2012 Apr 26. [Epub ahead of print] PMID: 22539538
14. MRI is Unnecessary for Diagnosing Acute Achilles Tendon Ruptures: Clinical Diagnostic Criteria. Garras DN, Raikin SM, Bhat SB, Taweel N, Karanjia H. Clin Orthop Relat Res. 2012 Apr 27. [Epub ahead of print] PMID: 22538958
15. Traumatic Epiphysiolysis of the Proximal Femur. Egkher A, Schlenz I, Seitz H.
Acta Chir Orthop Traumatol Cech. 2012;79(2):114-118. PMID: 22538100
16. Both Column Fractures of the Acetabulum: Epidemiology, Operative Management and Long-Term-Results. Gänsslen A, Frink M, Hildebrand F, Krettek C. Acta Chir Orthop Traumatol Cech. 2012;79(2):107-113. PMID: 22538099
17. Antegrade interlocking nailing for distal femoral fractures. Kulkarni SG, Varshneya A, Kulkarni GS, Kulkarni MG, Kulkarni VS, Kulkarni RM. J Orthop Surg (Hong Kong). 2012 Apr;20(1):48-54. PMID: 22535811 Free Article
18. Retrograde nailing and compression bolts in the treatment of type C distal femoral fractures. Garnavos C, Lygdas P, Lasanianos NG. Injury. 2012 Apr 23. [Epub ahead of print] PMID:  22534462
19. An evaluation of the quality of statistical design and analysis of published medical research: results from a systematic survey of general orthopaedic journals. Parsons NR, Price CL, Hiskens R, Achten J, Costa ML. BMC Med Res Methodol. 2012 Apr 25;12(1):60. [Epub ahead of print] PMID: 22533688 Free Article
20. Updates on Intra-Articular Hyaluronic Acid Therapy for Knee Osteoarthritis. Keith MP. Am J Orthop (Belle Mead NJ). 2012 Apr;41(4):E61-E63. PMID: 22530214
21. Occupational hazards facing orthopedic surgeons. Lester JD, Hsu S, Ahmad CS.
Am J Orthop (Belle Mead NJ). 2012 Mar;41(3):132-9. PMID: 22530210
22. Diagnosis of an isolated posterior malleolar fracture in a young female military cadet: a resident case report. Miller JM, Svoboda SJ, Gerber JP. Int J Sports Phys Ther. 2012 Apr;7(2):167-72. PMID: 22530191 Free PMC Article
23. Causes and predictors of early re-admission after surgery for a fracture of the hip. Khan MA, Hossain FS, Dashti Z, Muthukumar N. J Bone Joint Surg Br. 2012; May;94(5):690-7. PMID: 22529093 Free Article
24. The effects of plasma rich in growth factors (PRGF-Endoret) on healing of medial collateral ligament of the knee. Yoshioka T, Kanamori A, Washio T, Aoto K, Uemura K, Sakane M, Ochiai N. Knee Surg Sports Traumatol Arthrosc. 2012 Apr 13. [Epub ahead of print] PMID: 22527414

Sunday, April 29, 2012

From: Journal of Orthopaedic Research: Early view

Tibiofemoral cartilage contact biomechanics in patients after reconstruction of a ruptured anterior cruciate ligament.
We investigated the in vivo cartilage contact biomechanics of the tibiofemoral joint in patients after reconstruction of a ruptured anterior cruciate ligament (ACL). A dual fluoroscopic and MR imaging technique was used to investigate the cartilage contact biomechanics of the tibiofemoral joint during in vivo weight-bearing flexion of the knee in eight patients 6 months following clinically successful reconstruction of an acute isolated ACL rupture. Ali Hosseini, Samuel Van de Velde, Thomas J. Gill, Guoan Li*Article first published online: 23 APR 2012
PDF

From: The American Journal of Sports Medicine. Published online before print April 24, 2012

Survival Comparison of Allograft and Autograft Anterior Cruciate Ligament Reconstruction at the United States Military Academy
In this young active cohort, individuals having undergone an allograft ACL reconstruction were significantly more likely to experience clinical failure requiring revision reconstruction compared with those who underwent autologous graft reconstruction. The authors recommend the use of autograft in ACL reconstruction in young athletes. Mark Pallis, DO, Steven J. Svodoba, MD, Kenneth L. Cameron, PhD, MPH, ATC and Brett D. Owens, MD
PDF

From: Foot and Ankle Clinics of North America. Volume 17, Issue 2, June 2012, Pages 169–181

The RAM Classification: A Novel, Systematic Approach to the Adult-Acquired Flatfoot
The adult-acquired flatfoot (AAFF) is most commonly associated with dysfunction of the posterior tibial tendon (PTT) and presents clinically as a painful pes planus deformity.  From the time posterior tibial tendonitis was initially described in 1936 by Kulowski until 1983, little can be found throughout the literature pertaining to this topic aside from a few case series. In 1983, Johnson was the first to discuss the signs and symptoms that resulted from rupture of the PTT. He described a valgus deformity of the hindfoot and abduction deformity of the forefoot, which has since become the hallmark of this disorder. From this work, he established the “too many toes” sign and the inability to perform a single-leg heel rise as indicators of loss of PTT function.  Steven M. Raikin, MD, , Brian S. Winters, MD, Joseph N. Daniel, DO. Available online 27 April 2012.
PDF

From: The Journal of Hand Surgery. Volume 37, Issue 5, Pages A1-A32, 881-1120 (May 2012)

Continuing Medical EducationManagement of Scaphoid Nonunion
The primary risk factor for nonunion of the scaphoid is displacement/instability, but delayed or missed diagnosis, inadequate treatment, fracture location, and blood supply are also risk factors. Untreated nonunion leads to degenerative wrist arthritis—the so-called scaphoid nonunion advanced collapse wrist. However, the correlation of symptoms and disease is poor; the true “natural history” is debatable because we evaluate only symptomatic patients presenting for treatment. It is not clear that surgery can change the natural history, even if union is attained. The diagnosis of nonunion is made on radiographs, but computed tomography or magnetic resonance imaging scans can be useful to assess deformity and blood supply. Treatment options vary from percutaneous fixation to open reduction and internal fixation with vascularized or nonvascularized bone grafting to salvage procedures involving excision and/or arthrodesis of carpals.
Review Article Pages 1095-1100 Geert A. Buijze, Lidewij Ochtman, David Ring
PDF

Saturday, April 28, 2012

New protocol to avoid missing secondary shoulder injuries in the ER.

New standards for treating traumatic shoulder injuries to improve patient care
Traumatic shoulder injuries that result in a patient visit to the ER often contain a secondary injury that can cause pain and discomfort in that part of the body after the primary injury has healed. By focusing on the primary injury, radiologists sometimes miss the secondary injury, which can compromise treatment effectiveness. Trainees in the Brigham and Women's Hospital Radiology Residency Program developed new protocols aimed at drawing ER radiologists' attention to the potential presence of secondary should injuries. Better identification of these injuries could lead to improved patient outcomes. Eurekalert!

Friday, April 27, 2012

New tools to help Ortho Residents share info:

Journal Club for iPhone
In medicine, evidence is the paradigm. It's important to understand the evidence-based trials which support our clinical practice. Of course, its difficult to be reading every single journal article in NEJM, Lancet, BMJ, JACC thoroughly. We sought to create an app that summarizes the most seminal articles into morsels that clinicians can digest quickly and focus primarily on what is important--which is taking care of patients.
 Journal Club App
Features:
  •  Summaries are written by medicine physicians
  •  Articles cover a wide range of subspecialties
  •  Share article summaries with colleagues
  •  Stay current with instant updates MedicalSmartphones

GoogleDrive
Google Drive and Chrome OS: Has the New ‘PC’ Arrived?
Google Drive’s impact on personal computing is bound to be big. Wired’s first test-drive of Drive sums up that many will like it, but “those who will prefer Google Drive are those who already prefer Google itself.” The bigger-impact question, coming as Act II of the launch, is: Will Google Drive integrated with Chrome OS usher in the next generation of cloud-based personal computing? Wired.com

High-impact sports increase quality of life but reduce durability of hip implants

Artificial hips find some sports wearing.
Involvement in high-impact activities such as football, skiing, tennis or martial arts, significantly increases the wear rate and reduces the 'lifespan' of hip implants in adults who have undergone total hip replacement surgery more than a decade earlier. The work by Matthieu Ollivier, from the Sainte-Marguerite Hospital in Marseille, France, and his team is published online in the Springer journal Clinical Orthopaedics and Related Research.

Building muscle: heavy wieghts low reps or light weight high reps?

Building muscle without heavy weights.
Weight training at a lower intensity but with more repetitions may be as effective for building muscle as lifting heavy weights says a new opinion piece in Applied Physiology, Nutrition, and Metabolism.

"The perspective provided in this review highlights that other resistance protocols, beyond the often discussed high-intensity training, can be effective in stimulating a muscle building response that may translate into bigger muscles after resistance training," says lead author Nicholas Burd. "These findings have important implications from a public health standpoint because skeletal muscle mass is a large contributor to daily energy expenditure and it assists in weight management. Additionally, skeletal muscle mass, because of its overall size, is the primary site of blood sugar disposal and thus will likely play a role in reducing the risk for development of type II diabetes."  Eurekalert!

A few genetic related posts:

Exercise gives genes a workout, but can coffee do the same?

Researchers discover genes for fracture susceptibility and osteoporosis risk.

Genes that promote cartilage healing protect against arthritis.

For Staff and Residents who engage in strenous exercise.

New mouthpiece found to reduce stress levels after strenuous exercise.
Mouthguards are used by almost everyone participating in sports. These devices, typically purchased over-the-counter and used on the upper teeth, are designed to protect against broken teeth and an injured tongue. Recently, researchers in South Carolina found that a customized device which rests on the lower jaw can decrease levels of serum cortisol following exercise. The reduction of this steroid hormone indicates less stress following strenuous activity and may provide a more rapid recovery after intense muscle exertion. MedicalXpress

Using the iPhone to diagnose nasal fractures

Study evaluates use of iPhone to help diagnose nasal fractures in the Emergency Department.
Nasal fractures are among the most common fractures presenting at the emergency department yet at times can be difficult to initially diagnose due to nasal edema and other factors. iMedicalApps

Wednesday, April 25, 2012

Introducing an iPad eBook version of the recently published "The Cowboy’s Companion: A Trail Guide for the Arthroscopic Shoulder Surgeon", written by Dr. Stephen Burkhart



Leading Surgeon in Arthroscopic Shoulder Surgery Publishes the First Surgical Animated eTextbook with Integrated Surgical Video The eBook and hardbound book cover a unified approach to shoulder surgery based on sound biomechanical and biological principles. Included are approximately 1,500 high resolution images and illustrations and seven hours of edited video and new surgical techniques, emphasizing new technology and techniques that have evolved over recent years. iMedicalApps

Comment on Military Orthopaedic Residency (Army)

Military Orthopedic Residency: The Good, the Challenging, and the Different (HTML)
Being part of a team means being part of something bigger than yourself—it is one of the most basic life-lessons. If your work is gratify­ing, you put forth a bit more effort than you would otherwise, and devel­op a sense of pride in both your team and your teammates. All of this applies to the military. We are a team and we share a common goal: providing the best possible care to our service members and their families. Our job as orthopedic residents within the military is to make sure we are well trained to succeed in this aim. Krueger CA, Stinner DJ. Am J Orthop (Belle Mead NJ) 2012 Mar;41(3):E51-E52. PMID: 22530205

LE Ortho injuries involving vascular repair

Combined orthopedic and vascular lower extremity injuries: sequence of care and outcomes
We conclude that temporary vascular shunting followed by orthopedic stabilization and then definitive vascular repair is the most reasonable sequence of care for minimizing rates of amputation and revascularization procedures in this cohort of patients. Desai P, Audige L, Suk M. Am J Orthop (Belle Mead NJ). 2012 Apr;41(4):182-6. PMID: 22530222

Tuesday, April 24, 2012

Study in journal Spine: acute back pain patients with poor prognosis

Patients with acute low back pain have poor prognosis.
Few patients with acute low back pain (LBP), with or without sciatica, declare sick leave; however, approximately half have one or more recurrences and a considerable proportion experience chronic pain six months or longer after the initial episode, according to a study published in the April 15 issue of Spine. MedicalXpress

Study reveals need for better screening, prevention of venous thromboembolism as numbers of outpatient surgeries grow

Outpatient surgery patients also at risk for blood clots.
A University of Michigan Health System study examined who's having outpatient surgery in the U.S. today, and showed 1 in 84 highest-risk patients suffers a dangerous blood clot after surgery. Hospitalized patients are often warned of the possibility of venous thromboembolism, which include blood clots that can form in the veins and travel to the lungs. However these warnings have not necessarily been extended to the outpatient surgery population, says U-M surgeon and lead study author Christopher J. Pannucci, M.D.

Reference: "Identifying patients at high risk for venous thromboembolism requiring treatment after outpatient surgery," Annals of Surgery, April 24, 2012. Eurekalert!

Fiber for bone health

New research underscores the health benefits of fibers, including bone health.
For years, fiber intake among the global population has been extremely low, setting the stage for potentially serious, long-term public health implications.(1) New research commissioned by Tate & Lyle and presented at the 2012 Experimental Biology conference in San Diego adds to the body of emerging research on fibers, including additional support for the role of soluble corn fiber in bone health.

"Years of research point to the health benefits of fiber for cardiovascular health, blood glucose control, digestion and gut health, yet average intake is approximately half the recommended amount," said Joanne Slavin, PhD, RD, of the University of Minnesota and a member of the 2010 Dietary Guidelines Advisory Committee. "With more than 90 percent of adults and children falling short of meeting their daily fiber recommendations, the 2010 Dietary Guidelines for Americans classified fiber as a nutrient of concern, since it's one of the critical nutrients most lacking in people's diets." Eurekalert!

New technique for pediatric limb lengthening

Rice University student engineers automate limb lengthening for kids.
Another day, another four turns of the screw. That's just a part of life for people, primarily children, undergoing the long and difficult process of distraction osteogenesis, a method to correct bone deformities that leave one limb shorter than the other.

A team of Rice University undergraduates has invented a device they hope will make the process safer and easier.

In collaboration with Shriners Hospital for Children in Houston, the students came up with "LinDi," a self-adjusting, automated linear distractor. It eliminates manual manipulation of the screw with a motorized process that makes the gradual growth of new bone a more natural process. And for the first time in such a device, they have built in a force-feedback loop that protects fragile tissues and nerves from being overstressed. Eureklaert!

Physician Executive Journal (PEJ)

Physician Executive Journal (PEJ) for iOS and Android.
The Physician Executive Journal (PEJ) is an award-winning publication covering the world of medical management and physician leadership. Published by the American College of Physician Executives. The journal is powered by Texterity.

Now, read the PEJ on your iOS or Android mobile device.

Learn more about the iOS app here and the Android app here

Two-photon polymerization-generated and micromolding-replicated 3D scaffolds for peripheral neural tissue engineering applications.

New technique may help severely damaged nerves regrow and restore function. Engineers at the University of Sheffield have developed a method of assisting nerves damaged by traumatic accidents to repair naturally, which could improve the chances of restoring sensation and movement in injured limbs. MedicalXpress

Sunday, April 22, 2012

Journal of Surgical Education: articles in press

1. Residents Can Successfully Teach Basic Surgical Skills in the Simulation Center. Original Research Article, In Press, Corrected Proof, Available online 16 April 2012; Luise I.M. Pernar, Douglas S. Smink, Gloria Hicks, Sarah E. Peyre. PDF (203 K)  
2. Measuring the Surgical Academic Output of an Institution: The “Institutional” H-Index. Original Research Article, In Press, Corrected Proof, Available online 5 April 2012; Kiran K. Turaga, T. Clark Gamblin. PDF (602 K)
3.  Quality Improvement Requirement. In Press, Corrected Proof, Available online 20 March 2012; John A. Weigelt; PDF (66 K)  
4. Master Surgeons' Operative Teaching Philosophies: A Qualitative Analysis of Parallels to Learning Theory. Original Research Article, In Press, Corrected Proof, Available online 20 March 2012; Luise I.M. Pernar, Stanley W. Ashley, Douglas S. Smink, Michael J. Zinner, Sarah E. Peyre. PDF (283 K)  
5. Cutting Errors in Surgery: Experience Limits Underestimation Bias in a Simulated Surgical Environment. Original Research Article, In Press, Corrected Proof, Available online 3 March 2012. Neha Malhotra, Jamie M. Poolton, Mark R. Wilson, Rich S.W. Masters. PDF (329 K)  
6. Objective Assessment of Surgical Training in Flexor Tendon Repair: The Utility of a Low-Cost Porcine Model as Demonstrated by a Single-Subject Research Design. Original Research Article, In Press, Corrected Proof, Available online 3 March 2012; Elisabeth Zetlitz, Scott Cameron Wearing, Alexander Nicol, Andrew Mackay Hart. PDF (462 K)  

AAOS Now - top stories

Autograft or Allograft for ACL Reconstruction?

Evolving Care During a Decade at War

Flexible IM Nailing for Pediatric Tibial Fractures: Pearls and Pitfalls

Strongly enhanced levels of sclerostin during human fracture healing

Sclerostin (SOST), an antagonist of Wnt signaling, is an important negative regulator of bone formation. However, no data on the role of SOST in the human fracture healing have been published so far. This study addressed this issue. Seventy-five patients with long bone fractures were included into the study and divided in two groups. The first group contained 69 patients with normal fracture healing. Six patients with impaired fracture healing formed the second group. Thirty-four volunteers donated blood samples as control. Serum samples were collected over a period of 1 year following a standardized time schedule. In addition, SOST levels were measured in fracture hematoma and serum of 16 patients with bone fractures. Fracture hematoma contained significantly higher SOST concentrations compared to patient's serum. SOST levels in fracture hematoma and in patient's serum were both significantly higher than in the serum of controls. Highly elevated SOST serum concentrations were found in patients with physiological fracture healing. SOST levels were decreased in patients with impaired fracture healing. However, this difference was not statistically significant. This is the first study to provide evidence of strongly enhanced SOST levels in patients with bone fracture. The results indicate local and systemic involvement of SOST in humans during fracture healing.  Sarahrudi, K., Thomas, A., Albrecht, C. and Aharinejad, S. J. Orthop. Res. Article first published online: 16 APR 2012. PDF

Ultrasound-guided Fascia Iliaca Compartment Block for Hip Fractures in the Emergency Department.

Hip fracture (HFx) is a painful injury that is commonly seen in the emergency department (ED). Patients who experience pain from HFx are often treated with intravenous opiates, which may cause deleterious side effects, particularly in elderly patients. An alternative to systemic opioid analgesia involves peripheral nerve blockade. This approach may be ideally suited for the ED environment, where one injection could control pain for many hours. Haines L, Dickman E, Ayvazyan S, Pearl M, Wu S, Rosenblum D, Likourezos A.
J Emerg Med. 2012 Apr 9. [Epub ahead of print] PMID: 22494596 PDF

Patellar Stress Fracture After Transosseous Extensor Mechanism Repair: Report of 3 Cases

Stress fractures of the patella are reportedly rare. They can be seen in association with knee arthroplasty, anterior cruciate ligament (ACL) surgery, and rarely after impact sports. The fracture pattern is usually transverse. Longitudinal stress fractures do not typically disrupt the extensor mechanism and have not, to our knowledge, ever been identified as a postoperative complication of extensor mechanism repair. James M. Gregory, Seth L. Sherman, Richard Mather, Bernard R. Bach Jr. AJSM PreView, published on April 16, 2012 PDF

Anatomic Femoral Tunnel Drilling in Anterior Cruciate Ligament Reconstruction: Use of an Accessory Medial Portal Versus Traditional Transtibial Drilling

During anatomic anterior cruciate ligament (ACL) reconstruction, we have found that the femoral footprint can best be visualized from the anteromedial portal. Independent femoral tunnel drilling can then be performed through an accessory medial portal, medial and inferior to the standard anteromedial portal. Marc Tompkins, Matthew D. Milewski, Stephen F. Brockmeier, Cree M. Gaskin, Joseph M. Hart, Mark D. Miller. Am J Sports Med

Foot and Ankle Clinics: articles in press

1. Update on Stage IV Acquired Adult Flatfoot Disorder:: When the Deltoid Ligament Becomes Dysfunctional. Review Article. In Press, Corrected Proof, Available online 9 April 2012; Jeremy T. Smith, Eric M. Bluman. PDF (1020 K)  
2. Calcaneal Osteotomy in the Treatment of Adult Acquired Flatfoot Deformity. Review Article, In Press, Corrected Proof, Available online 9 April 2012; Abhijit R. Guha, Anthony M. Perera. PDF (1071 K)  
In Press, Corrected Proof, Available online 5 April 2012; Michael S. Aronow. PDF (1946 K)
4. Management of the Recurrent Deformity in a Flexible Foot Following Failure of Tendon Transfer: Is Arthrodesis Necessary? Review Article, In Press, Corrected Proof, Available online 5 April 2012; Safet O. Hatic II, Terrence M. Philbin. PDF (774 K)  
5. Tarsal Coalitions in the Adult Population: Does Treatment Differ from the Adolescent? Review Article, In Press, Corrected Proof, Available online 5 April 2012; Steven W.. Thorpe, Dane K. Wukich. PDF (888 K)  

The Journal of Hand Surgery: articles in press

1. Trapezoid Fractures: Report of 11 Cases. Original Research Article. In Press, Corrected Proof, Available online 21 April 2012; Nakul Kain, Carlos Heras-Palou. PDF (534 K)
2. Applicability of Large Databases in Outcomes Research. In Press, Corrected Proof, Available online 21 April 2012; Sunitha Malay, Melissa J. Shauver, Kevin C. Chung. PDF (354 K)
3. Predictors of Diagnosis of Ulnar Neuropathy After Surgically Treated Distal Humerus Fractures. Original Research Article. In Press, Corrected Proof, Available online 21 April 2012; Jimme K. Wiggers, Kim M. Brouwer, Gijs T.T. Helmerhorst, David Ring. PDF (223 K)
4. Hand Made: An Anatomical Study of the Human Spirit. In Press, Corrected Proof, Available online 14 April 2012; Kristy L. Hamilton. PDF (454 K)
5. Mobile Software Applications for Hand Surgeons. In Press, Corrected Proof, Available online 14 April 2012; Orrin I. Franko. PDF (168 K)
6. Hepatitis C and the Hand Surgeon: What You Should Know. In Press, Corrected Proof, Available online 14 April 2012; Nick Pappas, Donald H. Lee. PDF (419 K)
7. Electrothermal Collagen Shrinkage. In Press, Corrected Proof, Available online 14 April 2012; Pedro K. Beredjiklian, Michael Rivlin. PDF (159 K)
8. Hand Made: Recreating an Ancient Chinese Instrument, the Guqin. In Press, Corrected Proof, Available online 14 April 2012; Montri Daniel Wongworawat. PDF (640 K)
9. Glomus Tumor of Digital Nerve: Case Report. In Press, Corrected Proof, Available online 14 April 2012; Andrew Mitchell, Robert J. Spinner, Ana Ribeiro, Manuela Mafra, Maria M. Mouzinho, Bernd W. Scheithauer. PDF (1618 K)
10. Posterior Elbow Release and Humeral Osteotomy for Patients With Arthrogryposis. Review Article. In Press, Corrected Proof, Available online 5 April 2012 Dan A. Zlotolow, Scott H. Kozin. PDF (2541 K)
11. Biomechanical Measurements of Forearm Pronosupination With Common Methods of Immobilization. Original Research Article. In Press, Corrected Proof, Available online 5 April 2012; Aron M. Trocchia, John C. Elfar, Warren C. Hammert. PDF (519 K)

Recent Ortho related articles by Navy researchers

1. Short-Term Physical and Mental Health Outcomes for Combat Amputee and Nonamputee Extremity Injury Patients. Melcer T, Walker GJ, Sechriest VF 2nd, Galarneau M, Konoske P, Pyo J. J Orthop Trauma. 2012 Apr 9. [Epub ahead of print]
PMID: 22495531
J Trauma Acute Care Surg. 2012 Mar;72(3):733-6. PMID: 22491562
3. Perioperative administration of gabapentin for shoulder arthroscopy: a prospective, randomized, double-blind, placebo-controlled study. Spence D, Goff J, Mohan E, Bowen K, Osborne L, Maye J. AANA J. 2011 Aug;79(4 Suppl):S43-50. PMID: 22403966
4. Assessment of the effects of acute and repeated exposure to blast overpressure in rodents: toward a greater understanding of blast and the potential ramifications for injury in humans exposed to blast. Ahlers ST, Vasserman-Stokes E, Shaughness MC, Hall AA, Shear DA, Chavko M, McCarron RM, Stone JR. Front Neurol. 2012;3:32. Epub 2012 Mar 5. PMID: 22403572 Free PMC Article

Friday, April 20, 2012

Prevention of Venous Thromboembolism After Hip or Knee Arthroplasty Findings From a 2008 Survey of US Orthopedic Surgeons

A survey was mailed to a representative sample of US orthopedic surgeons to assess protocols for the prevention of venous thromboembolism after lower extremity total joint arthroplasty. Practices were examined by type of operation, annual surgical volume, and opinions of consensus guidelines issued by the American Academy of Orthopaedic Surgeons and the American College of Chest Physicians. Although there was near-unanimous agreement that routine thromboprophylaxis should be the standard practice for patients who undergo hip or knee arthroplasty, surgeons were divided as to the exact management approach. Frederick A. Anderson Jr., Wei Huang, Richard J. Friedman,, Louis M. Kwong, Jay R. Lieberman, Vincent D. Pellegrini, The Orthopaedic Surgeon's Survey Steering Committee. The Journal of Arthroplasty; Volume 27, Issue 5, May 2012, Pages 659–666.e5 PDF

Video Review of the New England Journal of Medicine iPad App

So how does the iPad app stack up? Does it merely take the online version of the NEJM and put PDF files on your iPad? Or, does it utilize the dynamic user interface of the iPad and allow for a transformational reading experience?

We have a video review of the app here: (register for free to view the video). iMedicalApps