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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.
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


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

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 

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

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

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

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.

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