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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
  •  Summaries are written by medicine physicians
  •  Articles cover a wide range of subspecialties
  •  Share article summaries with colleagues
  •  Stay current with instant updates MedicalSmartphones

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?

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