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Friday, April 6, 2012

Research team finds compound that can spur cartilage growth

A research team from drug maker Novartis has discovered a compound that spurs cartilage growth in mice. As they describe in their paper published in the journal Science, the team has found that when a compound with molecules of kartogenin in it comes in contact with certain kinds of stem cells, chondrocytes develop, resulting in new cartilage growth, possibly paving the way perhaps, to a long sought treatment for osteoarthritis. MedicalXpress

Tumorpedia app for musculoskeletal tumors is well designed but light on content

Being an orthopaedic surgery resident with a particular interest in orthopaedic oncology, I was excited to try out the Tumorpedia family of apps.

I am always interested in expanding my sources of mobile references, and mobile study aids for orthopaedic in-training exams are sparse.

The Tumorpedia family of apps (Lite, Bone, Soft Tissue, Foot and Ankle, and Spanish) for iPhone/iPad claims to be “the most comprehensive source of musculoskeletal tumor information available for mobile devices.” iMedicalApps

A sprinkle of 'pixie dust' reduces post-surgical infection in spine

Scattering a gram of powdered antibiotic (vancomycin) directly into a spinal surgery wound appears to be a safe, cost-effective way to achieve low post-operative infection rates, according to a University of Rochester Medical Center study. MedicalXpress

Prolonged Versus Standard Duration Venous Thromboprophylaxis in Major Orthopedic Surgery: A Systematic Review.

Conclusion: Prolonged prophylaxis decreases the risk for venous thromboembolism, PE, and DVT while increasing the risk for minor bleeding in patients undergoing total hip replacement. Sobieraj DM, Lee S, Coleman CI, Tongbram V, Chen W, Colby J, Kluger J, Makanji S, Ashaye AO, White CM. Ann Intern Med. 2012 Mar 12. [Epub ahead of print] PMID: 22412039 Free Full Text

Treatment of displaced intraarticular calcaneal fractures with or without bone grafts: A systematic review of the literature.

CONCLUSIONS: The operative treatment of intraarticular calcaneal fractures with bone grafts could restore the Böhler's angle better and the patients could return to full weight bearing earlier. However, the functional and efficacy outcomes appear to be similar between the two treatment groups. There were more joint depression and comminuted fractures in the bone graft group, and the mean followup time was shorter. Large sample comparative studies are still needed. Yang Y, Zhao H, Zhou J, Yu G. Indian J Orthop. 2012 Mar;46(2):130-7. PMID: 22448049 Free PMC Article

Transposition of an arterial segment from a traumatically amputated lower limb to treat an upper limb vascular lesion on a multi injured patient as an alternative technique for trauma patients

Trauma is a public health problem that throughout the world. Extremity vascular injuries need special consideration for they threaten limbs and lives [16] and [6].

Blunt trauma has worse prognosis and higher amputation rates, when compared to penetrating vascular injuries, for civilian and military wounds [16], [3] and [1].

Repair can be achieved by lateral sutures, but more often the traumatized vessel requires excisions and end-to-end anastomosis. If a “tension free” anastomosis is not possible a graft interposition is indicated, using an autogenous vein if possible [16], [17], [9], [14] and [10] or a prosthesis, that have a greater risk of infection and inferior patency rates when compared to autogenous ones, which is an important consideration in young injured patients with long life expectancies [14].

The quest for autogenous conduits in the multi injured patient can be challenging and an amputated limb can provide an important source of autologous conduits [10] and [11].

In Iraq, reversed saphenous grafts from contralateral amputated lower limbs were used to reconstruct injured arteries and veins of the remaining lower extremity [10] and [11].

To the best of our knowledge, however, the transposition of an arterial segment from a traumatically amputated lower limb to treat an upper limb arterial injury has not been previously reported. This option may be associated with important benefits when compared to the saphenous alternative for trauma patients.

The aim of this article is to describe the utilization of an arterial segment removed from a traumatically amputated lower limb as an autologous graft to treat an axillary artery injury on a multi injured patient.

Journal of Orthopaedic Trauma - published ahead of print

Use this link to get to articles

A New Fracture Model for "Terrible Triad" Injuries of the Elbow: Influence of Forearm Rotation on Injury Patterns

Patellar Tendon Healing With Platelet-Rich Plasma: A Prospective Randomized Controlled Trial

Hypothesis: Adding PRP to the patellar tendon harvest site would improve donor site healing and improve clinical outcome at 6 months after anterior cruciate ligament (ACL) reconstruction with a patellar tendon graft.

Patellar Tendon Healing With Platelet-Rich Plasma: A Prospective Randomized Controlled Trial. de Almeida AM, Demange MK, Sobrado MF, Rodrigues MB, Pedrinelli A, Hernandez AJ. Am J Sports Med. 2012 Apr 2. [Epub ahead of print] PMID: 22472272

Thursday, April 5, 2012

Tactical Use Skin Closure Device Stops Traumatic Bleeding in Combat Zones

Bleeding is the single largest cause of preventable trauma death, and when our armed forces are out in the combat zone, stopping a bleeding wound can be difficult. Dr. Dennis Filips, a retired trauma surgeon from the Canadian Navy and CEO of Edmonton, AB-based Innovative Trauma Care, saw a lot of bleeding while serving in Afghanistan, and wondered if there could be a way to reduce the mortality rate from traumatic hemorrhage other than using tourniquets and hemostatic wound agents, which take time to apply. MedGadget

App to help wounded soldiers created by Department of Defense

With the recent wars in Afghanistan and Iraq, the term “wounded warrior” has entered into common parlance as the numbers of men and women returning from combat with physical and mental trauma continues to grow.

To help improve access to support services, the  Department of Defense (DOD) has recently released a mobile app to help wounded soldiers and their families access information that can assist in their recovery and return to U.S. civilian life. iMedicalApps

New from Orthopedic Clinics of North America Volume 43, Issue 2 (April 2012)

TED: Jack Choi: On the virtual dissection table - Jack Choi (2012)

Onstage at TED2012, Jack Choi demonstrates a powerful tool for training medical students: a stretcher-sized multi-touch screen of the human body that lets you explore, dissect and understand the body's parts and systems. TED Talks

Monday, April 2, 2012

Two military surgical trauma treatment apps for the Kindle

An essential guide to important lessons in trauma surgery and critical care, First to Cut serves as a valuable companion to the famed Emergency War Surgery textbook. The introduction states: The first goal of this book is simple; to save lives. As all deployed combat surgeons know combat trauma is not your parent's civilian trauma. There is no equivalent to a patient with 100 fragmentation holes, above the knee amputation and a 10% burn in the civilian world. Being faced with these unique wounding patterns for the first time often results in mistakes that are not repeated due to experiencing it. We will document these experiences in a rapid format -in a conversational tone - so that combat surgeons can hopefully benefit from our mistakes and pearls of wisdom. To paraphrase Winston Churchill, these lessons can only be "forged in the fires of battle". Contents include: Fragmentation Wounds * Damage Control Resuscitation * Extremity and Vascular * Abdominal Injury * Urologic Injuries * Chest Injuries * Neck Injury * Brain and Spinal Injury * Burn Injury * Blast * Soft Tissue Injuries * Anesthesia * Triage * Military Unique * Intensive Care Unit * Post-Operative Complications * End of Life, Consent, Ethics * En Route Care * Field Expedient * Glossary of Terms.

An essential compilation of official Army military medical guidelines on over three dozen vital trauma care topics, this ebook serves as a valuable companion to the famed Emergency War Surgery textbook. Contents include:

Acoustic Trauma and Hearing Loss * Amputation * Blunt Abdominal Trauma * Burn Care * Canine Resuscitation * Management of Patients with Catastrophic, Non-Survivable Head Injury * Cervical and Thoracolumbar Spine Injury * Cervical Spine Evaluation * Clinical Management of Military Working Dogs * Compartment Syndrome and Fasciotomy * Damage Control Resuscitation * Emergent Resuscitative Thoracotomy * Fresh Whole Blood Transfusion * Frozen Blood * High Bilateral Amputation * Hypothermia Prevention * Infection Control * Inhalation Injury and Toxic Industrial Chemicals * Initial Care of Ocular and Adnexal Injuries * Intratheater Transfer and Transport * Management of Pain Anxiety and Delirium * Management of War Wounds * Management of Patients with Severe Head Injury * Neurosurgical Management * Nutrition * Pelvic Fracture Care * Post Splenectomy Vaccination * Prevention of Deep Venous Thrombosis * Trauma Airway Management * Unexploded Ordnance Management * Urologic Trauma Management * Use of Electronic Documentation * Use of MRI in Management of mTBI in the Deployed Setting * Use of Trauma Flow Sheets * Vascular Injury * Ventilator Associated Pneumonia

This is a privately authored news service and educational publication of Progressive Management. Our publications synthesize official government information with original material - they are not produced by the federal government. They are designed to provide a convenient user-friendly reference work to uniformly present authoritative knowledge that can be rapidly read, reviewed or searched. Vast archives of important data that might otherwise remain inaccessible are available for instant review no matter where you are.

The sympathetic innervation of the human foot

The sympathetic innervation of the hand was demonstrated using formaldehyde staining techniques in the 1990s and provides a basis for both medical (botulinum toxin type A) and surgical (sympathectomy) therapeutic approaches. This research investigates the sympathetic innervation of the human foot using tyrosine hydroxylase immunohistochemistry. Dellon AL, Höke A, Williams EH, Williams CG, Zhang Z, Rosson GD. Plast Reconstr Surg. 2012 Apr;129(4):905-9. PMID: 22456362

Sunday, April 1, 2012

Initial Achilles tendon repair strength-synthesized biomechanical data from 196 cadaver repairs.

CONCLUSIONS: Due to the small sample sizes, different study designs, and heterogeneity of strength measurement techniques, definite recommendations on surgical technique cannot be made but presented information might help in the decision making process for foot and ankle surgeons. Sadoghi P, Rosso C, Valderrabano V, Leithner A, Vavken P. Int Orthop. 2012 Mar 31. [Epub ahead of print] PMID: 22460821

Racial Differences in the Incidence of Acute Low Back Pain in US Military Service Members.

Conclusion. Race, gender, and age were all found to be significant risk factors for acute low back pain. The highest rates were identified in Blacks followed by Whites, Hispanics, and American Indian/Alaskan Native and the lowest rates in Asians/Pacific Islanders. Significant differences in the effect of gender and age were identified between the different racial groups. Knox JB, Orchowski JR, Owens B. Spine (Phila Pa 1976). 2012 Mar 27. [Epub ahead of print] PMID: 22460922

From the journal: Knee Surgery, Sports Traumatology, Arthroscopy

Scapular dyskinesis and SICK scapula syndrome following surgical treatment of type III acute acromioclavicular dislocations. Murena L, Canton G, Vulcano E, Cherubino P. Knee Surg Sports Traumatol Arthrosc. 2012 Mar 30. [Epub ahead of print] PMID: 22461014

Effect of graft tensioning on mechanical restoration in a rat model of anterior cruciate ligament reconstruction using free tendon graft. Fu SC, Cheng WH, Cheuk YC, Mok TY, Rolf CG, Yung SH, Chan KM. Knee Surg Sports Traumatol Arthrosc. 2012 Mar 30. [Epub ahead of print] PMID: 22461015

Close-looped graft suturing improves mechanical properties of interference screw fixation in ACL reconstruction. Prado M, Martín-Castilla B, Espejo-Reina A, Serrano-Fernández JM, Pérez-Blanca A, Ezquerro F. Knee Surg Sports Traumatol Arthrosc. 2012 Mar 30. [Epub ahead of print] PMID: 22461016

Clinical features and prognosis of discoid medial meniscus. Chen LX, Ao YF, Yu JK, Miao Y, Leung KK, Wang HJ, Lin L. Knee Surg Sports Traumatol Arthrosc. 2012 Mar 30. [Epub ahead of print] PMID: 22461017

Role of glucosamine in the treatment for osteoarthritis.

Over the last 20 years, several studies have investigated the ability of glucosamine sulfate to improve the symptoms (pain and function) and to delay the structural progression of osteoarthritis. There is now a large, convergent body of evidence that glucosamine sulfate, given at a daily oral dose of 1,500 mg, is able to significantly reduce the symptoms of osteoarthritis in the lower limbs. This dose of glucosamine sulfate has also been shown, in two independent studies, to prevent the joint space narrowing observed at the femorotibial compartment in patients with mild-to-moderate knee osteoarthritis. This effect also translated into a 50 % reduction in the incidence of osteoarthritis-related surgery of the lower limbs during a 5-year period following the withdrawal of the treatment. Some discrepancies have been described between the results of studies performed with a patent-protected formulation of glucosamine sulfate distributed as a drug and those having used glucosamine preparations purchased from global suppliers, packaged, and sold over-the-counter as nutritional supplements. Reginster JY, Neuprez A, Lecart MP, Sarlet N, Bruyere O. Rheumatol Int. 2012 Mar 30. [Epub ahead of print] PMID: 22461188

Another journal of interest: Clinical Cases in Mineral and Bone Metabolism

The management of sacral stress fractures: current concepts. Longhino V, Bonora C, Sansone V. Clin Cases Miner Bone Metab. 2011 Sep;8(3):19-23. PMID: 22461824

Painful hip arthroplasty: definition. Ferrata P, Carta S, Fortina M, Scipio D, Riva A, Di Giacinto S.
Clin Cases Miner Bone Metab. 2011 May;8(2):19-22. PMID: 22461810

Painful knee arthroplasty: definition and overview. Carulli C, Villano M, Bucciarelli G, Martini C, Innocenti M. Clin Cases Miner Bone Metab. 2011 May;8(2):23-5. PMID: 22461811

Painful knee prosthesis: surgical approach. Villano M, Carulli C, Puccini S, Soderi S, Innocenti M.
Clin Cases Miner Bone Metab. 2011 May;8(2):26-8. PMID: 22461812

Chicago Tribune: Surgical intern: Lessons learned A better scenario?

The orthopedic resident told me to put a "thumb spica cast" on the guy's hand and have him follow up in the clinic. As a brand new surgical intern, I had no idea what a thumb spica cast was; let alone how to make one. So I went to Google Images to see what it looked like, clicked on YouTube to figure out how to make a cast and then headed down to the emergency room and pretended I knew what the heck I was doing. The ER attending physician said I had excellent technique and that it looked as if I had been doing it for years. Chicago Tribune

Eplasty - open access journal worth a look


Combining the external fixation and microsurgical osteoseptocutaneous flap transplantation methods for limb salvage. Mateev M, Huang C, Imanaliev A, Ono S, Hyakusoku H, Ogawa R. Eplasty. 2012;12:e16. Epub 2012 Mar 22. PMID: 22461950

Use of Bioabsorbable Pins in Surgical Fixation of Comminuted Periarticular Fractures.

CONCLUSIONS:  In highly comminuted periarticular fractures, bioabsorbable pins are an intriguing alternative to traditional fixation methods. They afford similar effectiveness in maintaining stability without evidence of pin migration or other concerns of buried metallic implants. Bassuener SR, Mullis BH, Harrison RK, Sanders R. Clin J Sport Med. 2012 Mar 28. [Epub ahead of print] PMID: 22460347

Current advances in training orthopaedic patients to comply with partial weight-bearing instructions

Partial weight-bearing instructions are commonly given to orthopaedic patients and are an important part of post-injury and/or post-operative care. However, the ability of patients to comply with these instructions is poorly defined. Training methods for instructing these patients vary widely among institutions. Traditional methods of training include verbal instruction and use of a bathroom scale. Recent technological advances have created biofeedback devices capable of offering feedback to partial weight-bearing patients. Biofeedback devices have shown great promise in training patients to better comply with partial weight-bearing instructions. This review examines the background and significance of partial weight bearing and offers insights into current advances in training methods for partial weight-bearing patients. Hustedt JW, Blizzard DJ, Baumgaertner MR, Leslie MP, Grauer JN. Yale J Biol Med. 2012 Mar;85(1):119-25. Epub 2012 Mar 29. PMID: 22461750