American Orthopaedic Society for Sports Medicine's Annual Meeting in San Diego July 2011 Part II

Study identifies patients who should not undergo surgery for a snapping hip tendon.  Researchers at Hospital for Special Surgery have identified a group of patients who may have increased difficulty for surgical treatment of a snapping psoas, a condition that usually develops because a teenager or young adult has a pelvis that grows faster than their psoas tendon. The study will be presented at the annual meeting of the American Orthopaedic Society for Sports Medicine (AOSSM), held July 7-11 in San Diego. Eurekalert!

Arthroscopic treatment of common hip problem improves range of motion. Arthroscopic treatment of a common hip problem that leads to arthritis is successful in terms of restoring range of motion, according to results from a recent Hospital for Special Surgery study. The study will be presented at the annual meeting of the American Orthopaedic Society for Sports Medicine, held July 7-11 in San Diego. "This is the first study to show that in patients who are being treated for hip impingement with arthroscopy, not only do we restore their mechanical measurements, but by doing so, we have improved their functional range of motion across the joint," said Bryan T. Kelly, M.D., co-director of the Center for Hip Pain and Preservation at Hospital for Special Surgery in New York. Eurekalert!

Loss of motion after knee surgery may increase osteoarthritis risk, research suggests.  The study examined data from 780 patients who were at least five years after ACL reconstruction with a patellar tendon graft. In individual follow-ups, patients were evaluated and rated based on knee range of motion tests and radiographs. The percentage of patients with normal radiographs (no arthritic changes in the knee) was 71 percent in patients with normal range of motion compared to 55 percent of patients who showed deficits in motion. In patients who had similar meniscus removal, osteoarthritis was observed more in patients who had motion deficits. Eurekalert!

Arthroscopy and open surgery are equally efficacious in treating common hip problem in most patients.   Researchers at Hospital for Special Surgery have found that in comparison to open surgery, arthroscopic treatment of a common hip problem that leads to arthritis produces similar outcomes in terms of repairing structural problems in most patients. The study will be published in the July 2011 TK issue of the American Journal of Sports Medicine. Eurekalert!

Male smokers less likely to need joint replacement surgery of hip or knee

Surprising results from a new study revealed that men who smoke had less risk of undergoing total joint replacement surgery than those who never smoked. Researchers also reported that men who were overweight, or who engaged in vigorous physical activity were more likely to need arthroplasty. Details of this study are now available in Arthritis & Rheumatism via MedicalXpress.com

American Orthopaedic Society for Sports Medicine's Annual Meeting in San Diego July 2011

Previous cancer history increases chances of clotting disorders after knee surgery, study suggests 

 A history of cancer was a significant risk factor for developing blood clotting issues following knee arthroscopy, according to a study being presented at the American Orthopaedic Society for Sports Medicine's Annual Meeting in San Diego. Researchers from the Mayo Clinic in Rochester, Minnesota analyzed the records of more than 12,000 patients who had undergone the common knee procedure. EurekAlert! 

Graft size and patient age may be predictor of need for future ACL revisions A smaller sized hamstring graft in an anterior cruciate ligament (ACL) reconstruction patient less than 20 years old may increase revision rates, according to research presented at the American Orthopaedic Society for Sports Medicine's Annual Meeting in San Diego today. EurekAlert! 

New research points to a possible gender link in knee injuries  Gender may be associated with an increased risk of cartilage lesions in anterior cruciate ligament (ACL) injured knees, according to research being presented at the American Orthopaedic Society for Sports Medicine's Annual Meeting in San Diego. EurekAlert! 

ACLS Review App can help you master algorithms, prepare for ACLS Certification [App Review]

Advanced Cardiac Life Support (ACLS) is a critical aspect of medical care, yet can intimidate many physicians-in-training. Whether in code situations for surgical inpatients, new arrivals to the emergency department, or even fellow passengers at an airport, mastery of ACLS algorithms is vital for all healthcare professionals, and can mean the difference between life and death. iMedicalApps

WebLib Launches Free HealthMash iPhone and Android Apps

WebLib LLC (http://weblib.com), a company specializing in search technologies and natural language processing tools, has released new versions of its consumer health search engine HealthMash for users of iPhone and Android mobile phones. These free applications allow users to find relevant health information from a wide variety of trusted medical sources. The apps work as full-scale, portable versions of the HealthMash website. MedicalSmartphones.com

J Am Acad Orthop Surg. 2011 Jul;19(7)

Note: The Journal of the American Academy of Orthopaedic Surgeons is found in NKO via Acedemic OneFile

1. Surgical exposures of the radius and ulna. Catalano LW 3rd, Zlotolow DA, Hitchcock PB, Shah SN, Barron OA. J Am Acad Orthop Surg. 2011 Jul;19(7):430-8. PMID: 21724922

2. Advances in magnetic resonance imaging of articular cartilage. Jazrawi LM, Alaia MJ, Chang G, Fitzgerald EF, Recht MP. J Am Acad Orthop Surg. 2011 Jul;19(7):420-9. PMID: 21724921

3. Multiple myeloma: diagnosis and orthopaedic implications. Scharschmidt TJ, Lindsey JD, Becker PS, Conrad EU. J Am Acad Orthop Surg. 2011 Jul;19(7):410-9. PMID: 21724920

4. Management of distal clavicle fractures. Banerjee R, Waterman B, Padalecki J, Robertson W.

J Am Acad Orthop Surg. 2011 Jul;19(7):392-401.PMID: 21724918

5. Abductor tendon tears of the hip: evaluation and management. Lachiewicz PF.

J Am Acad Orthop Surg. 2011 Jul;19(7):385-91. PMID: 21724917

Femoral-shaft fractures and nonunions treated with intramedullary nails: The role of dynamisation.

Dynamisation of a previously interlocked intramedullary nail is believed to stimulate an osteogenic response due to increased load across the fracture site. The purpose of this study was to retrospectively investigate fracture patterns that could tolerate dynamisation without the risk of major complications.

Papakostidis C, Psyllakis I, Vardakas D, Grestas A, Giannoudis PV. Injury. 2011 Jul 2. [Epub ahead of print] PMID: 21726859

Physicians, Pharma, and “free” medical apps

The medical app industry is a big business, but the apps are no longer the product – the physicians, nurses, and other healthcare providers who use them are. In the first part of this series, we examined some of the financial forces driving the medical app industry. Our focus then was Epocrates, the veritable founder of the industry. As is clearly stated in their recent SEC statement, Epocrates primary revenue stream has become the pharmaceutical industry and as such a key goal has become to further grow their user base by enhancing their free offerings.

Now, one might be tempted to say that this is just one company or even that it is just limited to free apps. iMedicalApps

Get the Sermo mobile app for iPhone and iPad

Ever wish you could have a colleague’s opinion on a tough case, unusual rash, EKG, or Xray finding? Now you can on Sermo - the largest online physician-only network.

Created in 2006 by physicians, for physicians, Sermo is the largest online physician network and the only real-time medicine™ platform. Sermo membership is exclusive to US physicians. Sermo is always FREE, private and secure. MedicalSmartphones.com

Analysis of the Trauma Section of the Orthopaedic In-Training Examination

The OrthopaedicIn-TrainingExaminationis a comprehensive test produced annually by the American Academy of Orthopaedic Surgeons, and was first administered in 1963. At the time of the examination's conception, its objectives were to: (1) measure the knowledge of orthopedic residents and provide objective comparisons; (2) help determine acceptable minimal standards for trainees; and (3) help provide an objective assessment of orthopedic education. We retrospectively reviewed all Orthopaedic In-Training Examinations from 2004 to 2008, with particular focus on the questions listed in the musculoskeletal trauma domain on each year's program director report. The musculoskeletal trauma domain, including topics, recommended answers, and references, was reviewed to provide an educational resource for residents and residency programs when studying or designing educational curricula. The information in this analysis may help in development of a core musculoskeletal trauma knowledge base or facilitate determination of appropriate journal club and didactic lecture content. Taylor BC, Fowler TT. Orthopedics. 2011 Jul 7;34(7):e261-6. PMID: 21717986 HTML (full text)

Research in THA and TKA From the United States Has Declined Over the Past Decade Relative to Other Countries.

Decreasing reimbursement, increasing surgical volumes, and prohibitive institutional review board polices potentially deter residents from entering the subspecialty of joint replacement, while also inhibiting research production by existing surgeons. Our hypothesis is that there has been a decline in total hip arthroplasty (THA) and total knee arthroplasty (TKA) research in the United States relative to other countries over the past decade. Meneghini RM, Russo GS, Lieberman JR. Orthopedics. 2011 Jul 7;34(7):e245-50. PMID: 21717983   HTML (full text)

Spine Journal Takes Aim at Infuse Research



Bone morphogenetic protein 2

The Spine Journal is devoting an entire issue to critical reviews of
published studies of Medtronic's bone morphogenetic protein-2 product known as Infuse, a unprecedented publishing event that was prompted in part by a Milwaukee Journal Sentinel/Medpage Today investigation. MedPageToday

Rivaroxaban Wins FDA Approval for DVT Prevention

The FDA has approved rivaroxaban (Xarelto), an oral, once-daily, factor Xa inhibitor, for prevention of deep vein thrombosis in patients undergoing knee or hip replacement surgery, according to an announcement by Janssen Pharmaceuticals. MedPageToday

Medtronic’s New CD Horizon Fenestrated Screw Spinal System

Medtronic launched the CD HORIZON Fenestrated Screw Spinal System, initially making it available in Europe.  The device features screws through which bone cement can be injected to establish an anchor for the screws within fragile, osteopenic bones. MedGadget

Earlier exit from hospital after hip operation

Discharged from the hospital within two days of a total hip replacement operation? It’s possible, thanks to the new 'Fast Track' protocol that underwent testing in the U.S., in response to both patient requests for shorter hospital stays and economic realities of providing medical care. According to Dr. Lawrence Gulotta and colleagues, from Hospital for Special Surgery in New York, a carefully screened group of patients undergoing total hip replacement can be discharged from the hospital two days after surgery, without any increase in complications or adverse effects compared with the more traditional protocol. Their work is published online in Springer's HSS Journal. Springer
Note: This journal is not indexed in PubMed

The Journal of Hand Surgery Volume 36, Issue 7, Pages A1-A32, 1131-1266 (July 2011)

Volume 36, Issue 7, Pages A1-A32, 1131-1266 (July 2011)

 

Articles in Press



New Article RSS Feed : http://rss.sciencedirect.com/publication/science/6881

Review: minimally invasive versus conventional dynamic hip screw fixation in elderly patients with intertrochanteric fractures: a systematic review and meta-analysis.

There was no significance difference between the 2 groups with regard to postoperative complications and implant position. The MIDHS technique may achieve perioperative benefits when compared with the CDHS technique. Tao Cheng, Guoyou Zhang, Xianlong Zhang. Surg Innov. 2011 Jun;18(2):99-105. PMID: 21712233

Surgical repair of the distal biceps brachii tendon: a comparative study of three surgical fixation techniques.

In summary, we achieved good clinical and functional results after surgical repair of the distal biceps tendon using Corkscrews, Mitek anchors, or transosseous sutures. The results conferred by Corkscrews were comparable to the other techniques, justifying their use. Citak M, Backhaus M, Seybold D, Suero EM, Schildhauer TA, Roetman B. Knee Surg Sports Traumatol Arthrosc. 2011 Jun 29. [Epub ahead of print] PMID: 21713413

Evidence-based treatment of open ankle fractures.

There is a lack of high quality literature concerning the (operative) treatment of patients with open ankle fractures. Remarkable is that most authors reported satisfactory results after performance of their treatment protocol. Based on the available literature, we formulated guidelines regarding: timing of operative treatment, wound irrigation, the role of internal fixation, wound coverage and closure, the use of antibiotics and additional therapies. Hulsker CC, Kleinveld S, Zonnenberg CB, Hogervorst M, van den Bekerom MP. Arch Orthop Trauma Surg. 2011 Jun 29. [Epub ahead of print] PMID: 21713539

Google+ for doctors, and why physicians should be careful

So, how should physicians handle Google+?

Similar to the way doctors should use Facebook.  I’ve recommended in the past that physicians maintain two profiles, a personal one to share only with close family and friends, and a professional page that is open to the public.  As far as I can tell, Google+ offers no such personal-professional differentiation.  So if you join, it’s imperative that your pictures and personal content be well-vetted before you post.  Since this is a Google product, there’s a greater chance that what’s found on Google+ will be indexed in the search engine.

Google Circles has the potential to be that application to isolate your professional identity (you can selectively share content with different groups), and physicians need to be vigilant in using that feature.  For now, be careful about what you put on your Google Profile.

J Foot Ankle Surg. 2011 Jul-Aug;50(4)

1. The hematoma block: a simple, effective technique for closed reduction of ankle fracture dislocations. Ross A, Catanzariti AR, Mendicino RW. J Foot Ankle Surg. 2011 Jul-Aug;50(4):507-9. PMID: 21708343 PDF

2. Misdiagnosis of OTA Type B (Weber B) Ankle Fractures Leading to Nonunion. Donken CC, van Laarhoven CJ, Edwards MJ, Verhofstad MH. J Foot Ankle Surg. 2011 Jul-Aug;50(4):430-3. PMID: 21708342 PDF

3. Displacement of the anterior process of the calcaneus after evans calcaneal osteotomy. Dunn SP, Meyer J. J Foot Ankle Surg. 2011 Jul-Aug;50(4):402-6. PMID: 21708341 PDF

4. Identifying Risk Factors in Subtalar Arthroereisis Explantation: A Propensity-matched Analysis. Cook EA, Cook JJ, Basile P. J Foot Ankle Surg. 2011 Jul-Aug;50(4):395-401. PMID:  21708340

5. Arthroplasty or arthrodesis. Malay DS. J Foot Ankle Surg. 2011 Jul-Aug;50(4):373. No abstract available. PMID:  21708339 PDF

J Foot Ankle Surg link to Articles in Press
RSS feed to Articles in Press: http://rss.sciencedirect.com/publication/science/13040

Surgical simulators and hip fractures: a role in residency training?

Orthopedic surgery residency training requires intellectual and motor skill development. In this study, we utilized a computer-based haptic simulator to examine a potential model for evaluation of resident proficiency and efficiency in the placement of a center guide wire during fixation of an intertrochanteric proximal femur fracture. We hypothesize the junior residents will utilize more fluoroscopy and require more time to complete the task. Froelich JM, Milbrandt JC, Novicoff WM, Saleh KJ, Allan DG. J Surg Educ. 2011 Jul-Aug;68(4):298-302. Epub 2011 Apr 16. PMID: 21708367 PDF

J Surg Educ. articles in press

Knee Surgery, Sports Traumatology, Arthroscopy - [Epub ahead of print]

1. Endoscopic versus open bursectomy of lateral malleolar bursitis. Choi JH, Lee KT, Lee YK, Kim DH, Kim JR, Chung WC, Cha SD. Knee Surg Sports Traumatol Arthrosc. 2011 Jun 28. [Epub ahead of print]PMID: 21710113

2. Isokinetic muscle strength and knee function associated with double femoral pin fixation and fixation with interference screw in anterior cruciate ligament reconstruction. Fernandes TL, Protta TR, Fregni F, Neto RB, Pedrinelli A, Camanho GL, Hernandez AJ. Knee Surg Sports Traumatol Arthrosc. 2011 Jun 28. [Epub ahead of print] PMID: 21710112

3. Anatomic double-bundle and over-the-top single-bundle with additional extra-articular tenodesis: an in vivo quantitative assessment of knee laxity in two different ACL reconstructions. Zaffagnini S, Signorelli C, Lopomo N, Bonanzinga T, Marcheggiani Muccioli GM, Bignozzi S, Visani A, Marcacci M. Knee Surg Sports Traumatol Arthrosc. 2011 Jun 28. [Epub ahead of print] PMID: 21710111

4. Bony and soft tissue landmarks of the ACL tibial insertion site: an anatomical study. Ferretti M, Doca D, Ingham SM, Cohen M, Fu FH. Knee Surg Sports Traumatol Arthrosc. 2011 Jun 28. [Epub ahead of print] PMID: 21710110

Surgical Technique: Revision ACL Reconstruction With a Rectangular Tunnel Technique.

We developed the rectangular tunnel ACL reconstruction (RT ACLR) using a 10-mm wide bone-patellar tendon-bone (BTB) graft through rectangular tunnels with a rectangular aperture to reduce tunnel size: the cross-sectional area of the tunnels of 50 mm(2) (5 × 10 mm) in RT ACLR is less than that of 79 mm(2) in a conventional 10-mm round tunnel technique presuming the technique would be more suitable in revision ACLR with previous improperly placed tunnels. Shino K, Mae T, Nakamura N. Clin Orthop Relat Res. 2011 Jun 28. [Epub ahead of print] PMID: 21710294

Revision of the Shoulder Normalization tests is required to include rhomboid major and teres major.

The four "Shoulder Normalization Tests" were found previously to be a parsimonious set of isometric tests that produce maximal voluntary isometric contractions (MVIC) in the supraspinatus, infraspinatus, subscapularis, trapezius, serratus anterior, deltoid, latissimus dorsi, and pectoralis major [Boettcher et al. (2008). J Orthop Res 26:1591-1597]. However, these tests have not been validated for rhomboid major and teres major.  Ginn KA, Halaki M, Cathers I. J Orthop Res. 2011 Jun 27. doi: 10.1002/jor.21488. [Epub ahead of print] PMID: 21710606 PDF

Stanmore’s Juvenile Extendible Femoral System Gets U.S. Green Light

UK-based Stanmore Implants received FDA approval for its Juvenile Tumour System (“JTS”) non-invasive extendible distal femoral replacement.  Indicated for use in pediatric ortho oncology surgeries, the implant can later be slowly extended using an external magnet system without having to perform another invasive procedure on the patient. MedGadget

Osteoarthritis incidence significantly higher among US military personnel

New research shows significantly higher osteoarthritis (OA) incidence rates in military populations than among comparable age groups in the general population. The magnitude of the difference in OA rates between military service members and the general population also increased with advancing age category. Black service members had higher OA rates than white military personnel or those in other race categories according to the study findings published in Arthritis & Rheumatism, a peer-reviewed journal of the American College of Rheumatology (ACR).  Eurekalert!

Related article:

Incidence of acute traumatic patellar dislocation among active-duty United States military service members.

Hsiao M, Owens BD, Burks R, Sturdivant RX, Cameron KL. Am J Sports Med. 2010 Oct;38(10):1997-2004. Epub 2010 Jul 8. PMID: 20616375 [PubMed - indexed for MEDLINE] Related citations PDF

Complications following autologous bone graft harvesting from the iliac crest and using the RIA: A systematic review.

Bone grafting is a commonly performed surgical procedure to augment bone regeneration in a variety of cases in orthopaedic and maxillofacial surgery. Autologous bone graft remains to be the 'gold standard' and the iliac crest to be the most common harvesting site. The intramedullary canal of long bones represents another potential site for large volume of autologous bone graft harvesting and is recently being used as an alternative donor site. However, harvesting of autologous bone graft is associated with morbidity and a number of complications. The aim of this systematic review was to collect and summarise the existing data on reported complications after harvesting autologous bone from the iliac crest (anterior and posterior) and the long bone intramedullary canal using the RIA device. Dimitriou R, Mataliotakis GI, Angoules AG, Kanakaris NK, Giannoudis PV. Injury. 2011 Jun 24. [Epub ahead of print] PMID: 21704997 PDF

Journal of Bone & Joint Surgery - British Volume 93B(7) pgs. 857-1000 July 2011

1. Neuritis ossificans of the tibial, common peroneal and lateral sural cutaneous nerves. Katz LD, Lindskog D, Eisen R. J Bone Joint Surg Br. 2011 Jul;93(7):992-4. PMID: 21705578  

2.

Long-term results of conservative treatment of Sanders type 4 fractures of the calcaneum: A SERIES OF 64 CASES. Gurkan V, Dursun M, Orhun H, Sari F, Bulbul M, Aydogan M. J Bone Joint Surg Br. 2011 Jul;93(7):975-9. PMID: 21705574

3. The biomechanical performance of locking plate fixation with intramedullary fibular strut graft augmentation in the treatment of unstable fractures of the proximal humerus. Bae JH, Oh JK, Chon CS, Oh CW, Hwang JH, Yoon YC. J Bone Joint Surg Br. 2011 Jul;93(7):937-41. PMID: 21705567 [PubMed - in process]

4. Percutaneous screw fixation without bone grafting for established scaphoid nonunion with substantial bone loss. Mahmoud M, Koptan W. J Bone Joint Surg Br. 2011 Jul;93(7):932-6. PMID: 21705566 [PubMed - in process]

5. A brief report on managing infected nonunion of a high tibial osteotomy in two stages: A CASE SERIES INVOLVING SEVEN KNEES. Karatosun V, Demir T, Unver B, Gunal I. J Bone Joint Surg Br. 2011 Jul;93(7):904-6. PMID: 21705561 [PubMed - in process]

6. High tibial osteotomy with a dynamic axial fixator: PRECISION IN ACHIEVING ALIGNMENT.

Bachhal V, Sankhala SS, Jindal N, Dhillon MS. J Bone Joint Surg Br. 2011 Jul;93(7):897-903. PMID: 21705560 [PubMed - in process]

The hidden costs of your favorite medical apps

Medical apps are becoming big business. Epocrates is now a publicly traded company worth nearly $500 million. Medscape is owned by WebMD, another publicly traded company worth nearly $3 billion. Despite the clearly powerful financial factors at play here, the most popular and comprehensive apps are free. Even for fee-based apps, the prices and volumes don’t explain the overall financial pictures of the companies behind them. Clearly the money is not coming from the physicians, medical students, and other healthcare professionals who are using these apps. iMedicalApps

The American Journal of Sports Medicine [Epub ahead of print]

1. Chronic Tears of the Reflected Head of the Rectus Femoris: Results of Operative Treatment. (PDF) Wittstein J, Klein S, Garrett WE. Am J Sports Med. 2011 Jun 24. [Epub ahead of print] PMID: 21705650

2. Are Meniscus and Cartilage Injuries Related to Time to Anterior Cruciate Ligament Reconstruction? (PDF)

Chhadia AM, Inacio MC, Maletis GB, Csintalan RP, Davis BR, Funahashi TT. Am J Sports Med. 2011 Jun 24. [Epub ahead of print] PMID: 21705649

3. Arthroscopic Management of Chronic Patellar Tendinopathy. (PDF)

Pascarella A, Alam M, Pascarella F, Latte C, Di Salvatore MG, Maffulli N.

Am J Sports Med. 2011 Jun 24. [Epub ahead of print] PMID: 21705648

Fracture status in men assessed by quantitative ultrasound measurements at the calcaneus.

Objectives- The aim of the study was to assess fracture status in men by quantitative ultrasound measurements at the calcaneus. The diagnostic accuracy of quantitative ultrasound measurements was evaluated at baseline and follow-up. Methods- We observed 165 men (baseline age ± SD, 59.84 ± 10.6 years) recruited from an outpatient osteoporosis clinic. The mean follow-up duration was approximately 101.3 ± 35 months. There was no difference in either age or body mass index at baseline between the patients with a fracture history (n = 30) and the others (n = 135). The following fractures were identified at baseline: ankle, 15; wrist, 10; rib, 9; foot, 5; and hip, 1. The speed of sound (meters per second), broadband ultrasound attenuation (decibels per megahertz), and stiffness index (percent) were measured with a quantitative ultrasound device. The date of fracture occurrence at follow-up was defined as the final point. Results- In the patients with a fracture history, the ultrasound variables were significantly lower than those in the rest of the group (P < .05). During the follow-up period, fractures occurred in 21 patients (wrist, 11; ankle, 5; rib, 3; hip, 1; and humerus, 1), and the ultrasound outcomes were nonsignificantly lower in the fractured men. The risk of fracture was estimated by the Cox regression analysis. A prior fracture was the only factor that significantly (4 times) increased the risk of a subsequent fracture (hazard ratio, 4.21; 95% confidence interval, 1.81-9.86; P < .001). Conclusions- Calcaneus ultrasound measurements can distinguish between patients with fractures and those without. In follow-up, ultrasound measurements did not indicate an increased fracture risk; a prior osteoporotic fracture was the major prognostic factor. Pluskiewicz W, Wilk R, Wielgórecki A, Golba KS, Drozdzowska B. J Ultrasound Med. 2011 Jul;30(7):877-82. PMID: 21705719

Primary internal fixation and soft-tissue reconstruction in the treatment for an open Lisfranc fracture-dislocation.

The importance of anatomical reduction for improved outcome has been recognised in the management of Lisfranc injuries. Operative fixation is indicated in case of dislocation or unstable ligamentous injury, because discongruity of the Lisfranc joint can lead to deleterious functional outcome. Screws are the recommended method of fixation of the medial en middle column, and K-wires are used for stabilisation of the unstable lateral column. Primary arthrodesis can provide advantages in pure ligamentous injury. In the management of complex open Lisfranc fractures, external fixation with K-wires can be used, but often results in a high percentage of arc deformities and functional limitations. In recent years, there is a progressive change from external to internal fixation in primary stabilisation of open fractures. This case report describes the treatment for a grade III open Lisfranc fracture-dislocation by use of primary internal fixation and soft-tissue reconstruction. Sanli I, Hermus J, Poeze M. Musculoskelet Surg. 2011 Jun 25. [Epub ahead of print] PMID: 21706153

Hip fracture management, before and beyond surgery and medication: a synthesis of the evidence.

Multidisciplinary medical management of patients with hip fractures is being improved within the hospital environment resulting in earlier discharge with decreased morbidity. There is evidence to show the benefits to patients with hip fractures from peripheral modalities within the hospital; however unless resident in a facility, multidisciplinary management is not clearly of benefit. O'Malley NT, Blauth M, Suhm N, Kates SL. Arch Orthop Trauma Surg. 2011 Jun 25. [Epub ahead of print] PMID: 21706188

Arthroscopic repair of type II superior labrum anterior posterior (SLAP) lesions in patients over the age of 45 years: a prospective study.

Superior labrum anterior posterior (SLAP) lesions are a well-defined cause of shoulder pain and disability and may occur in conjunction with rotator cuff tears. This study was designed to prospectively evaluate the minimum 2 year results of arthroscopic repair of type II SLAP lesions in patients over the age of 45 years with and without rotator cuff tears. Kanatli U, Ozturk BY, Bolukbasi S. Arch Orthop Trauma Surg. 2011 Jun 26. [Epub ahead of print] PMID: 21706304

Military static line parachuting injuries seen by the airborne battalion provider.

Military static line parachuting exposes jumpers to a variety of novel methods of injury. Providers assigned to Airborne units need to develop and maintain a high index of suspicion when dealing with jump-related injuries. Understanding the incident rate and the mechanism of injury can help a provider better identify injuries based on the history of the incidence and develop that index of suspicion. Injuries can happen at almost any point during the jump process and each step has both common and unique injuries associated with it. In addition to identifying, managing, and treating the injuries involved, providing information on estimated time until return to duty can be beneficial for the commander. In the end, a provider?s best tools for managing Airborne-related injuries are an understanding of Airborne operations, quality orthopedic skills, and a high index of suspicion. Healy ML. J Spec Oper Med. 2011 Spring;11(2):45-51.

Ultrasound in Space Leads to Improved Ultrasound Down Here

This research led to the publication of the 2010 ICU Ultrasound Pocket Book and an atlas of “normal” ultrasound images and techniques for acquiring them that can be used by astronauts with minimal training.  Dulchavsky and colleagues tested these techniques and the diagnostic accuracy of them by using the custodial personnel in the Henry Ford Hospital. A video on the site shows some of the applications the team has already implemented through the World Interactive Network Focused on Critical UltraSound (WINFOCUS) to train individuals to use ultrasound techniques in under-served regions. MedGadget.com

Shoulder US: Anatomy, Technique, and Scanning Pitfalls.

The accuracy of shoulder ultrasonography (US) is largely dependent on the US examination technique. It is essential that the individual performing the US examination has an understanding of pertinent anatomy, such as bone surface anatomy and tendon orientation. It is also important to be familiar with imaging pitfalls related to US technique, such as anisotropy. In this article, shoulder US scanning technique, as well as related anatomy and scanning pitfalls, will be reviewed. The use of a protocol-driven shoulder US examination is important to ensure a comprehensive and efficient evaluation. An on-line video tutorial demonstrating a shoulder US also accompanies this article. Jacobson JA. Radiology. 2011 Jul;260(1):6-16. PMID: 21697306  PDF   Video

A New Technique for Removing Intramedullary Cement.

Treatment of infected long bone fractures or nonunions requires stability for bony union, yet retained implants can lead to persistent infection. Antibiotic cement intramedullary nails, in addition to external fixation, are commonly used to deliver intramedullary antibiotics in infected long bone fractures and provide temporary stability. However, the retrieval of these nails can result in debonding of antibiotic cement, which can require significant time and effort to remove. A variety of methods, including intramedullary hooks, reverse curettes, flexible osteotomes, and stacked guide rods, are commonly used to remove cement fragments. When these methods fail to allow access to the entire length of the canal, the Reamer Irrigator Aspirator system (Synthes, Paoli, PA) serves as an effective method for removing retained intramedullary cement. The surgical technique is described, and three cases illustrate the successful use of the Reamer Irrigator Aspirator system for removal of an antibiotic cement intramedullary nail. Lowe JA, Vosburg C, Murtha YM, Della Rocca GJ, Crist BD. J Orthop Trauma. 2011 Jun 21. [Epub ahead of print] PMID: 21697739 Link to Published Ahead of Print

Extra-articular Malunions of the Scapula: A Comparison of Functional Outcome Before and After Reconstruction.

Malunion after nonoperative treatment of a displaced scapula fracture may be associated with poor functional and cosmetic outcomes. Operative reconstruction can yield good surgical and functional results. Cole PA, Talbot M, Schroder LK, Anavian J. J Orthop Trauma. 2011 Jun 21. [Epub ahead of print] PMID:  21697740 Link to Published Ahead of Print

Screw Depth Sounding in Proximal Humerus Fractures to Avoid Iatrogenic Intra-articular Penetration.

Unstable and displaced proximal humerus fractures remain a treatment challenge. The use of locked plates has improved construct stability, but complication rates remain high. Biomechanical studies have emphasized the importance of anchoring screws in the subchondral bone of the humeral head to improve implant stability. However, the spherical shape of the proximal humerus and the limited tactile sensation of its soft cancellous bone make determining accurate screw length difficult, and reported rates of intraoperative screw penetration are high. Iatrogenic screw penetration, even if recognized and corrected before leaving the operating room, may lead to late failure. We present a simple technique of quickly and safely determining screw length using a blunt-tipped Kirschner wire and instruments found in basic orthopaedic sets. Bengard MJ, Gardner MJ. J Orthop Trauma. 2011 Jun 21. [Epub ahead of print] PMID:  21697741 Link to Published Ahead of Print

Use and efficacy of bone morphogenetic proteins in fracture healing.

Although the efficacy of BMPs as stimulators of bone repair has been demonstrated in model systems and clinical studies, the use of BMPs to enhance fracture healing in the clinical setting is still controversial. Issues such as when, where and how much of which BMP is the most effective and profitable to use still have to be elucidated. But optimisation of the BMP products used in combination with cheaper production methods will inevitably stimulate the clinical use of BMPs for bone fracture healing in the near future. Lissenberg-Thunnissen SN, de Gorter DJ, Sier CF, Schipper IB. Int Orthop. 2011 Jun 23. [Epub ahead of print] PMID:  21698428

Internal versus external fixation for unstable distal radius fractures: an up-to-date meta-analysis.

We suggest that the final results are significant and there is some evidence supporting the use of open reduction and internal fixation. Cui Z, Pan J, Yu B, Zhang K, Xiong X. Int Orthop. 2011 Jun 23. [Epub ahead of print] PMID:  21698429

Effect of body weight on the outcome of displaced intracapsular fracture neck of femur treated by internal fixation; a clinical study of 198 patients.

The aim of this study was to assess any possible correlation between body weight and fracture union following displaced intracapsular fractures of the neck of femur treated by a closed reduction and internal fixation. A total of 198 patients with such injuries treated by closed reduction and internal fixation, were recruited retrospectively. Patients were followed up until fracture endpoint (union or non-union) with a minimum follow up of 100 days. The mean body weight for the 118 patients without fracture healing complications was 64.6kg versus 61.8kg for the 80 patients with complications, a difference that was not statistically significant (p=0.17). Analysis of data related to sex and age also found no relationship between weight and fracture healing complications. Our results indicate there is no relationship between body weight and fracture healing complications following displaced intracapsular fractures treated by internal fixation.

Alazzawi S, Mayahi R, Parker MJ. Hip Int. 2011 Jun 6;21(3):340-343. doi: 10.5301/HIP.2011.8385.  [Epub ahead of print] PMID: 21698585

Think WarFighter Prevention: High serum 25-hydroxyvitamin D is associated with low incidence of stress fractures.

There was a monotonic inverse dose-response gradient between serum 25(OH)D and risk of stress fracture. There was double the risk of stress fractures of the tibia and fibula in women with serum 25(OH)D concentration < 20 ng/ml, compared to those with ≥ 40 ng/ml. A target for prevention of stress fractures would be a serum 25(OH)D concentration of > 40 ng/ml, achievable with 4000 IU/day vitamin D(3) supplementation. Burgi AA, Gorham ED, Garland CF, Mohr SB, Garland FC, Zeng K, Thompson K, Lappe JM. J Bone Miner Res. 2011 Jun 22. doi: 10.1002/jbmr.451. [Epub ahead of print] Naval Health Research Center, San Diego, California.

Surgical Site Infection: Prevention and Treatment of Surgical Site Infection.

Free Online Book via NCBI Bookshelf

National Collaborating Centre for Women's and Children's Health (UK).

London: RCOG Press; 2008 Oct.PMID: 21698848 [PubMed]

Arthroscopy: The Journal of Arthroscopic & Related Surgery July 2011 27(7)

Latest issue now available.

Articles in Press

Single-row repair versus double-row repair of full-thickness rotator cuff tears.

Despite the fact that double-row repair shows a significantly higher rate of tendon healing and greater external rotation than does single-row repair, there is no significant improvement in shoulder function, muscle strength, forward flexion, internal rotation, patient satisfaction, or return to work. Prasathaporn N, Kuptniratsaikul S, Kongrukgreatiyos K. Arthroscopy. 2011 Jul;27(7):978-85. PMID: 21693349

Electromechanical Delay of the Knee Flexor Muscles After Harvesting the Hamstrings for Anterior Cruciate Ligament Reconstruction.

Although the EMD of ST and BF was significantly increased due to fatigue, as expected, their synchronization pattern as identified by the difference in their EMDs remained the same. Thus, the reconstructed knee responded in a balanced manner and the hamstrings firing pattern remained the same, despite the intervention to the ST tendon. Ristanis S, Tsepis E, Giotis D, Zampeli F, Stergiou N, Georgoulis AD. Clin J Sport Med. 2011 Jun 18. [Epub ahead of print] PMID:  21694593

Medical students create free medical translation app, conquering language barriers to patient care

MediBabble uses touch-screen software that allows health care providers to play medical history questions and instructions out loud, so far in five languages. From questions as simple as “Can you tell me your name?” to more specific inquiries like, “Do you get recurring lung infections?” the app translates more than 2,500 exam questions into Russian, Spanish, Cantonese, Mandarin and Haitian Creole. MedicalXpress

The arrangement and the attachment areas of three ACL bundles

This study clarified the arrangement of three fiber bundles of ACL and detailed geographical locations of their attachment sites. The detailed anatomic description of the natural ACL attachment might suggest to surgeons where to make tunnels during anatomical double/triple bundle ACL reconstruction.  Otsubo H, Shino K, Suzuki D, Kamiya T, Suzuki T, Watanabe K, Fujimiya M, Iwahashi T, Yamashita T. Knee Surg Sports Traumatol Arthrosc. 2011 Jun 22. [Epub ahead of print] PMID: 21695467

New Issue of "Foot & Ankle International" Available Online

Foot & Ankle International July 2011 (Vol. 32 #7)

Spinal Manipulation Brings Only Minor Improvement in Chronic Back Pain, Systematic Review Finds

Spinal manipulative therapy (SMT) has significant but very small benefits for patients with chronic low back pain, according to a special review article in the June 1 issue of Spine.

Question:  How many Chiropractors does it take to screw in a light bulb?

A technique to remove a well-fixed titanium-coated RM acetabular cup in revision hip arthroplasty.

A major concern during revision hip arthroplasty is acetabular bone loss and bleeding during the extraction of well-fixed cementless acetabular cup, because no interface exists between the host bone and the cup. Forceful removal of such component using curved gouges and osteotomes often leads to extended bone loss and compromises reimplantation of a new socket. In the following case report, we removed a well-fixed polyethylene titanium-coated RM acetabular cup with 20 years of follow-up, by significant wear of the polyethylene layer. The isoelastic femoral stem was also removed by mechanical failure. We report a technique for removal of the cementless acetabular cup using powered acetabular reamers. The RM cup was sequentially reamed and when the polyethylene layer was thin enough, the remaining cup was removed easily by hand tools. The acetabular bone stock is preserved and the risks of bone fractures and bleeding are minimized. To our knowledge, these principles were applied only in cemented cups. We have used this technique in 10 cases with excellent results and no complications were noted. This is a simple, reproducible, non-costly, non-timing consuming, safe and successful technique to remove well-fixed titanium-coated RM acetabular cups. Judas FJ, Dias RF, Lucas FM. J Orthop Surg Res. 2011 Jun 20;6(1):31. [Epub ahead of print] PMID: 21689456

Peripartum pubic symphysis separation: a case report and review of the literature.

Although peripartum pubic symphysis diastasis is an uncommon complication of delivery, it can lead to considerable and sometimes long-term disability. Although the initial clinical examination and diagnostic workup for this complication are relatively straightforward, the best treatment for a peripartum pubic symphysis diastasis is less clear. Historically, nearly all women were treated conservatively with bed rest and pelvic binders. However, more recent case reports have described more invasive orthopedic procedures being used to help speedy recovery. In this study, we present a case of a 22-year-old primigravida who had a severe pubic symphysis separation after a vaginal delivery complicated by a shoulder dystocia. We also reviewed the literature on this topic over the past 20 years to gain a better understanding of the clinical factors surrounding peripartum pubic symphysis separation and the treatment option available to women with this complication. Target Audience: Obstetricians & Gynecologists Learning Objectives: After completing this CME activity, physicians should be better able to identify the clinical factors that associated with peripartum pubic symphysis separation; perform a diagnostic workup when a peripartum pubic symphysis separation is suspected; distinguish the conservative and invasive orthopedic interventions available for the treatment of peripartum pubic symphysis separation; and show that the degree of patient disability after peripartum pubic symphysis separation varies greatly and no clinical factors or diagnostic studies effectively predict the course of patient recovery. Nitsche JF, Howell T. Obstet Gynecol Surv. 2011 Mar;66(3):153-8. PMID: 21689485

Tendon fixation in arthroscopic latissimus dorsi transfer for irreparable posterosuperior cuff tears: An in vitro biomechanical comparison of interference screw and suture anchors.

The fixation of the tendon to the bone remains a challenging problem in the latissimus dorsi tendon transfer for irreparable cuff tears and can lead to unsatisfactory results. A new arthroscopic method of tendon to bone fixation using an interference screw has been developed and the purpose of this study was to compare its biomechanical properties to the ones of a standard fixation technique with anchors. Diop A, Maurel N, Chang VK, Kany J, Duranthon LD, Grimberg J. Clin Biomech (Bristol, Avon). 2011 Jun 18. [Epub ahead of print] PMID: 21689873

Traumatic Floating Clavicle: A Case Report.

Most published reports of a floating clavicle consist of a dislocation of both ends of the clavicle and are associated with a high-energy injury. We report a 71 year old patient with a fracture of the medial end of the clavicle with anterior sternoclavicular dislocation and a nondisplaced fracture of the lateral end of the same clavicle distal to the insertion of coracoclavicular ligaments due to a low velocity fall. Serra JT, Tomas J, Batalla L, Pedemonte J, Pacha D, Molero V, Carrera L. J Orthop Trauma. 2011 Jun 17. [Epub ahead of print] PMID: 21691221 Link to Publish Ahead of Print

Fracture blisters.

Fracture blisters are a relatively uncommon complication of fractures in locations of the body, such as the ankle, wrist elbow and foot, where skin adheres tightly to bone with little subcutaneous fat cushioning. The blister that results resembles that of a second degree burn.These blisters significantly alter treatment, making it difficult to splint or cast and often overlying ideal surgical incision sites. Review of the literature reveals no consensus on management; however, most authors agree on early treatment prior to blister formation or delay until blister resolution before attempting surgical correction or stabilization. Uebbing CM, Walsh M, Miller JB, Abraham M, Arnold C. West J Emerg Med. 2011 Feb;12(1):131-3. PMID: 21691490 PDF

The effect of open Bristow-Latarjet procedure for anterior shoulder instability: a 10-year study.

Operative procedures are the usual treatment for patients with anterior traumatic shoulder instabilities. Soft tissue procedures, Bankart repair, cannot be performed in some patients. They need Bristow-Latarjet one. We decided to determine midterm results of this procedure in almost all types of anterior shoulder instability, even shoulders with Bankart lesion in non-athletic cases. Thirty patients after Bristow-Latarjet procedure from 1997 to 2007 were followed 2-8 years. Clinical outcomes, consisted of muscle strength, range of motion (mean 8.66 degrees decreased in external rotation with arm in neutral position and 18.33 with arm in 90 degrees of abduction), recurrent instability (no relapse), and Rowe score (mean 77.66) showed good to excellent results. We had no screw-related or neurovascular complications. Thirty percent of cases had signs of mild arthropathy. Although Bankart procedure is the preferred method in patients with isolated Bankart lesion, but we can perform Bristow-Latarjet for all types of anterior traumatic shoulder instability in non-athletics cases with acceptable results. Emami MJ, Solooki S, Meshksari Z, Vosoughi AR. Musculoskelet Surg. 2011 Jun 21. [Epub ahead of print] PMID: 21691734

Human dermal matrix scaffold augmentation for large and massive rotator cuff repairs: preliminary clinical and MRI results at 1-year follow-up.

The high incidence of recurrent tendon tears after repair of massive cuff lesions is prompting the research of materials aimed at mechanically or biologically reinforcing the tendon. Among the materials studied upto now, the extracellular matrix (ECM) scaffolds of human origin have proved to be the safest and most efficient, but the current laws about grafts and transplants preclude their use in Europe. In order to overcome this condition in 2006, we started a project regarding the production of an ECM scaffold of human origin which could be implanted in Europe too. In 2009, the clinical study began with the implantation of dermal matrix scaffolds in 7 middle-aged patients affected with large/massive cuff lesions and tendon degeneration. Out of 5 cases, followed for at least 1 year in which the scaffold was employed as an augmentation device, there were 3 patients with complete healing, 1 partial re-tear, and 1 total recurrence. The absence of adverse inflammatory or septic complications allows to continue this line of research with a prospective controlled study in order to define the real advantages and correct indications offered by scaffold application. Rotini R, Marinelli A, Guerra E, Bettelli G, Castagna A, Fini M, Bondioli E, Busacca M. Musculoskelet Surg. 2011 Jun 21. [Epub ahead of print] PMID: 21691735

Treatment of Jones Fracture Nonunion with Isolated Intramedullary Screw Fixation.

Although the treatment of acute Jones fractures is well described in published studies, the Jones fracture nonunion is more controversial with regard to treatment. Although nonoperative treatment is an option, surgery is the usual course. We conducted a retrospective case series of 7 patients (1 man and 6 women; age range, 39 to 54 years), who were initially treated nonoperatively for acute Jones fractures. They went on to develop nonunions and were treated with intramedullary screw fixation. All patients had healed radiographically by 11 weeks postoperatively. One screw (14.29%) required removal because of irritation. None of the patients to date have experienced a new fracture. Our results indicate that intramedullary screw fixation alone without bone grafting is a viable option for Jones fracture nonunions. Thomas JL, Davis BC.

J Foot Ankle Surg. 2011 Jun 16. [Epub ahead of print] PMID: 21684181  PDF

Testing procedures for SLAP lesions of the shoulder involving contraction and torsion of biceps long head and glenohumeral glides.

Testing procedures for SLAP lesions of the shoulder can combine resisted elbow flexion, forearm pronation and supination, and glenohumeral glides. These procedures reproduce symptoms by increasing biceps long head active tension or passive torsion, and by placing the shoulder in an unstable position. We compared activation of biceps long head and pain intensity, between supinated and pronated forearm positions, between different glides, and between individuals with and without shoulder impairment. A case control study.  Misra S, Watson L, Taylor NF, Green RA, Hairodin Z. J Sci Med Sport. 2011 Jun 16. [Epub ahead of print] PMID:  21684203

Validity of outcome measures used to assess one and six month outcomes in orthopaedic trauma patients.

To evaluate the validity of the 12-item Short Form Health Survey (SF-12), Sickness Impact Profile (SIP) and the Short Musculoskeletal Functional Assessment Questionnaire (SMFA) for use in an orthopaedic trauma population. Gosling CM, Gabbe BJ, Williamson OD, Sutherland AM, Cameron PA. Injury. 2011 Jun 17. [Epub ahead of print] PMID: 21684543

Arthroscopic-Assisted Reduction and Percutaneous Cannulated Screw Fixation for Ideberg Type III Glenoid Fractures: A Minimum 2-year Follow-up of 18 Cases.

Traditionally, open reduction and internal fixation is an acceptable choice for treating displaced glenoid articular fracture. Considering some major complications associated with open surgery, however, surgeons have explored a less invasive way to achieve fixation. Purpose: This investigation was undertaken to evaluate the clinical results of arthroscopic-assisted reduction and percutaneous cannulated screw fixation for the treatment of Ideberg type III glenoid fractures. Yang HB, Wang D, He XJ. Am J Sports Med. 2011 Jun 17. [Epub ahead of print] PMID: 21685317

Which is the Preferred Revision Technique for Loosened Iliac Screw?: A Novel Technique of Boring Cement Injection From the Outer Cortical Shell.

Wadding corticocancellous bone and increasing screw length failed to provide sufficient anchoring strength for a loosened iliac screw; however, both traditional and boring PMMA-augmented techniques could effectively increase the fixation strength. On the basis of the viewpoint of minimal invasion, the boring PMMA augmentation may serve as a suitable salvage technique for iliac screw loosening. Yu BS, Yang ZK, Li ZM, Zeng LW, Wang LB, Lu WW. J Spinal Disord Tech. 2011 Jun 16. [Epub ahead of print] PMID: 21685804

Fiber components of the shoulder superior labrum.

The superior labrum is not homogenous. The posterior portion mainly consists of the robust fiber component of the long head of the biceps tendon. The anterosuperior portion includes fibers of the sheet-like structure which contains numerous elastic fibers. Tensile stress from the rotator interval might be conveyed to the anterosuperior labrum. Arai R, Kobayashi M, Toda Y, Nakamura S, Miura T, Nakamura T. Surg Radiol Anat. 2011 Jun 19. [Epub ahead of print] PMID:  21688137

A pre-operative approach of range of motion simulation and verification for femoroacetabular impingement.

Femoroacetabular impingement (FAI) is increasingly recognized as a potential cause of hip osteoarthritis. A system capable of pre-operatively simulating hip range of motion (ROM) by given surface models from either healthy or FAI diseased bone is desirable. Chang TC, Kang H, Arata L, Zhao W. Int J Med Robot. 2011 Jun 18. doi: 10.1002/rcs.401. [Epub ahead of print] PMID: 21688380

New Ortho Books Soon to be Released

The Poly-Traumatized Patient with Fractures: A Multi-Disciplinary Approach by Hans-Christoph Pape, Roy Sanders and Joseph Borrelli Jr. (Jul 29, 2011)

Oxford Textbook of Trauma and Orthopaedics by Christopher Bulstrode, James Wilson-MacDonald, Jeremy Fairbank and Tim Briggs (Jul 1, 2011)

Perioperative Care of the Orthopedic Patient: The Hospital for Special Surgery Manual by Charles N. Cornell, Ronald MacKenzie and Stavros G. Memtsoudis (Jul 1, 2011)

Shoulder Arthroscopy by James Tibone, Felix H. III Savoie and Benjamin Shaffer (Jul 1, 2011)

Armed Conflict Injuries to the Extremities: A Treatment Manual by Alexander Lerner and Michael Soudry (Jun 29, 2011)

New device could revolutionize major knee surgery

Researchers from the University of Aberdeen’s School of Engineering in partnership with Mr Martyn Snow, a leading specialist in joints and cartilage at the Royal Orthopaedic Hospital, have developed a new fixation mechanism which could improve the success rate in cruciate knee ligament surgery. medicalxpress.com

Pocket Body iPad Anatomy app helps improve anatomical understanding

Pocket Body [Musculoskeletal] demonstrates the full range of capabilities of the iPad. This medical app has recently undergone a major update. It now includes information on nerves, arteries and veins as well as an improved lateral view. imedicalapps.com

New Ortho related Systematic Reviews from Cochrane

 1.

Early mobilisation for elbow fractures in adults.

Harding P, Rasekaba T, Smirneos L, Holland AE.

Cochrane Database Syst Rev. 2011 Jun 15;6:CD008130. PMID: 21678373 [PubMed - in process] Related citations

2.

Computer assisted surgery for knee ligament reconstruction.

Meuffels DE, Reijman M, Scholten RJ, Verhaar JA.

Cochrane Database Syst Rev. 2011 Jun 15;6:CD007601.PMID: 21678367 [PubMed - in process]

Related citations

3.

Dynamic compression plating versus locked intramedullary nailing for humeral shaft fractures in adults.

Kurup H, Hossain M, Andrew JG.

Cochrane Database Syst Rev. 2011 Jun 15;6:CD005959. PMID: 21678350 [PubMed - in process]

Related citations

4.

Therapeutic ultrasound for acute ankle sprains.

van den Bekerom MP, van der Windt DA, Ter Riet G, van der Heijden GJ, Bouter LM.

Cochrane Database Syst Rev. 2011 Jun 15;6:CD001250. PMID: 21678332 [PubMed - in process]

Related citations

Sensory nerve induced inflammation contributes to heterotopic ossification.

Heterotopic ossification (HO), or bone formation in soft tissues, is often the result of traumatic injury. Much evidence has linked the release of BMPs (Bone Morphogenetic Proteins) upon injury to this process. HO was once thought to be a rare occurrence, but recent statistics from the military suggest that as many as 60% of traumatic injuries, resulting from bomb blasts, have associated HO. In this study, we attempt to define the role of peripheral nerves in this process. J Cell Biochem. 2011 Jun 15. doi: 10.1002/jcb.23225. [Epub ahead of print]

Corrective osteotomy in forearm fracture malunion improves functional outcome in adults.

Malunions of forearm fractures in adults can present with limitation of forearm rotation, or as distal radioulnar joint instability with functional impairment. This contrasts with paediatric patients in whom malunions of similar severities are often better tolerated. We did a retrospective review of six adult patients after corrective forearm osteotomy for symptomatic malunited forearm shaft fractures. The corrective operations were done between 7 and 168 months after initial injury, using oblique or wedge osteotomies. Median follow-up was 22.5 months. The patients recovered well, with statistically significant improvement in forearm rotation and Disabilities of the Arm, Shoulder, and Hand (DASH) scores. No significant complications occurred.

J Hand Surg Eur Vol. 2011 Feb;36(2):102-6. PDF

EMS ACLS Guide app can deliver critical information while in the field

Emergency care begins well before patients reach the doors of the Emergency Room. And numerous studies have shown that despite high-tech critical care units, the fate of our sickest patients often rests in the speed and intelligence of the paramedics and first responders who first arrive on scene. So its crucial that they be intimately familiar with the up to date critical care algorithms.

The EMS ACLS Guide by Informed Publishing offers these initial providers with an array of information, easily accessible on iOS and Android platforms.  The developers admittedly target their app at EMTs and first responders, but this app could also be a valuable tool for all healthcare providers. iMedicalApps

Features of hindfoot 3D kinetics in flat foot in ankle-joint maximal dorsiflexion and plantarflexion.

Tibiotalar-joint plantarflexion decreased and talocalcaneal and talonavicular-joint adduction increased in the maximal ankle-joint plantarflexion in stage II in comparison with normal cases. Tibiotalar-joint plantarflexion and adduction were decreased and of the talocalcaneal and talonavicular joints increased in stage III in comparison with stage II cases. J Orthop Sci. 2011 Jun 15. [Epub ahead of print]

In vivo three-dimensional motion analysis of the shoulder joint during internal and external rotation.

We clarified the existence of a specific scapulohumeral motion pattern, whereby the glenohumeral joint moves with internal rotation and the scapulothoracic joint moves with anterior tilt together with internal rotation motion of the shoulder joint. Int Orthop. 2011 Jun 15. [Epub ahead of print]

Systematic review and meta-analysis on the rate of postoperative venous thromboembolism in orthopaedic surgery in Asian patients without thromboprophylaxis.

Postoperative venous thromboembolism (VTE) is a common life-threatening complication after surgery. This review analysed the rate and mortality of VTE after orthopaedic surgery in Asia. Br J Surg. 2011 Jun 14. doi: 10.1002/bjs.7589. [Epub ahead of print]

Median nerve changes following steroid injection for carpal tunnel syndrome.

Introduction: Neuromuscular ultrasound is a painless, radiation-free, high-resolution imaging modality for assessment of the peripheral nervous system. The purpose of this study was to use neuromuscular ultrasound to assess the changes that occur in the median nerve after steroid injection for carpal tunnel syndrome (CTS). Methods: Ultrasound and nerve conduction studies were performed at baseline and 1 week, 1 month, and 6 months after steroid injection in 19 individuals (29 wrists) with CTS. Results: Significant changes were noted in median nerve cross-sectional area (P < 0.001), mobility (P = 0.001), and vascularity (P = 0.042) at the distal wrist crease after steroid injection, and the nerve cross-sectional area correlated with symptom score and electrodiagnostic parameters. Changes in the ultrasonographic parameters were seen within 1 week of injection. Conclusions: These findings suggest neuromuscular ultrasound is potentially helpful for the assessment of individuals undergoing treatment for CTS, as typical changes can be expected after successful treatment injection. Muscle Nerve 44: 25-29, 2011.

Cytokine expression in muscle following traumatic injury

Heterotopic ossification (HO) occurs at a high frequency in severe orthopaedic extremity injuries; however, the etiology of traumatic HO is virtually unknown. Osteogenic progenitor cells have previously been identified within traumatized muscle. Although the signaling mechanisms that lead to this dysregulated differentiation pathway have not been identified, it is assumed that inflammation and fibrosis, which contribute to an osteoinductive environment, are necessary for the development of HO. The hypothesis of this study was that cytokines related to chronic inflammation, fibrogenesis, and osteogenesis become up-regulated following severe muscle trauma where HO forms. J Orthop Res. 2011 Mar 30. doi: 10.1002/jor.21354. [Epub ahead of print] PDF

Nitrate patch prevents steroid-related bone necrosis

Avascular necrosis of the femoral head is a common complication with disabling effect for young patients after high-dose corticosteroid treatment. We could show that steroids have a vasoconstrictive effect on lateral epiphyseal arteries of the femoral head which could lead to ischemia and subsequent necrosis. In this study we investigated the preventive effect of a nitrate patch on steroid-related bone necrosis in a rabbit model. J Orthop Res. 2011 Apr 5. doi: 10.1002/jor.21420. [Epub ahead of print] PDF

Lubricin distribution in the torn human anterior cruciate ligament and meniscus

The objective of this study was to: (1) determine the distribution of lubricin in the human torn anterior cruciate ligament (ACL) and meniscus; (2) determine the distribution of lubricin in the human intact ACL and meniscus; (3) and identify potential cellular sources of lubricin in these tissues. Ten torn ACLs and six torn menisci were obtained from surgeries; for comparison, 11 intact ACLs and 13 intact menisci were obtained from total knee replacements. Samples were formalin fixed and processed for immunohistochemical staining with a monoclonal antibody for lubricin. In torn ACLs and menisci, lubricin was generally found as a discrete layer covering the torn surface. No surface lubricin staining was found on the transected edges produced during excision. Lubricin was also found on the native surfaces of intact ACLs and menisci. In all tissues, lubricin was found in the matrix and intracellularly. The surface layer of lubricin coating torn edges of ACLs and menisci may interfere with the integrative healing process needed for repair. J Orthop Res. 2011 Jun 6. doi: 10.1002/jor.21473. [Epub ahead of print]  PDF

Ceramic-on-Metal Hip Implant Wins FDA Nod

The first ceramic-on-metal implant for total hip replacement has been approved by the FDA, the agency announced. The Pinnacle CoMplete Acetabular Hip System is manufactured by DePuy Orthopaedics, a subsidiary of Johnson & Johnson, and based in Warsaw, Ind. The femoral head portion of the implant is made of ceramic and the acetabular (socket) component is a metal alloy.

With this approval, there are now five different combinations of materials from which hip implants can be made. Others already approved include ceramic-on-ceramic, ceramic-on-polyethylene, metal-on-polyethylene, and metal-on-metal. MedPageToday

New treatment for peripheral nerve defects: Reconstruction of a 2 cm, monkey median nerve gap by direct lengthening of both nerve stumps.

We have developed a new treatment for peripheral nerve defects: nerve-lengthening method, and confirmed the efficacy and safety of our method using cynomolgus monkeys. A 20-mm defect in the median nerve of monkey's forearms was repaired through the simultaneous lengthening of both nerve stumps with original nerve-lengthening device. To evaluate nerve regeneration after neurorrhaphy, electrophysiological, histological, and functional recovery were examined and compared to the standard autografting. Nerve conduction velocity, axon maturation, and the result of functional test were superior in the nerve-lengthening method than in the autografting. And there were no adverse events associated with our method. We concluded that this method is practical for clinical application. J Orthop Res. 2011 Jun 10. doi: 10.1002/jor.21476. [Epub ahead of print] PDF

The effect of hip position upon the location of the sciatic nerve: an MRI Study.

Allowance for the positional changes of the sciatic nerve is important when considering the safest position of the leg to perform hip operations, specifically the ischial osteotomy during a pelvic triple or periacetabular osteotomy. As for its proximity to the osteotomy site the sciatic nerve can be injured during these operations with the consequence of severe functional impairment. This is the first in-vivo study that demonstrates the effect of hip position upon the location of the sciatic nerve. J Pediatr Orthop. 2011 Mar;31(2):165-9.

Shoulder Decide beautifully demonstrates and teaches basic shoulder anatomy and pathology to patients

Shoulder Decide, available as separate iPhone and iPad apps, sets out to ameliorate this situation by educating patients about common shoulder problems. If I were to describe the app with one word, it would be “beautiful.” And that design factor, in addition to well-selected content, make this app a great asset to improve patient-physician communication. iMedicalApps

Surgical Technique: Medial Collateral Ligament Reconstruction Using Achilles Allograft for Combined Knee Ligament Injury.

This technique uses allograft that provides bone-to-bone healing on the femur, requires small incisions, and creates isometric reconstruction. When performed with a cruciate reconstruction, knee stability can be restored at 2 to 5 years followup. In patients with MCL with primary ACL reconstruction, return to preinjury activity level in recreational athletes can be achieved. Clin Orthop Relat Res. 2011 Jun 10. [Epub ahead of print]

Electromagnetic field stimulation for treating delayed union or non-union of long bone fractures in adults.

Authors' conclusions: Though the available evidence suggests that electromagnetic field stimulation may offer some benefit in the treatment of delayed union and non-union of long bone fractures, it is inconclusive and insufficient to inform current practice. More definitive conclusions on treatment effect await further well-conducted randomised controlled trials. Cochrane Database Syst Rev. 2011 Apr 13;4:CD008471. Review.

100 most cited articles in orthopaedic surgery.

Science Citation Index Expanded was searched for citations to articles published in any of the 49 journals in the subject category "ORTHOPEDICS." Each of the 49 journals was searched separately using the "cited reference search" to determine the 100 most often cited articles. Each article was reviewed for basic information including year of publication, country of origin, source journal of the article, article type, and level of evidence. We categorized the journal article by field of research where possible. Clin Orthop Relat Res. 2011 May;469(5):1487-97. Epub 2010 Oct 5. PDF

US Army to begin testing 85 smartphone apps

The U.S. Army will begin testing iPhones, Android smartphones, and tablets for use in war starting next week, reports The Wall Street Journal. Last December we reported on the military’s plans to test EMR applications on Apple and Android devices for use in the field, but this week’s announcement includes a handful of other specific applications. mobilehealthnews

At Ramstein, America's military aeromedical mission heats up

RAMSTEIN AIR BASE, Germany--It's warming up in the Middle East, and as the mercury rises, so does the intensity of fighting in Iraq and Afghanistan. And that means the number of seriously injured American soldiers passing through here is also rising every day. cnet

Blast-Induced Lower Extremity Fractures With Arterial Injury: Prevalence and Risk Factors for Amputation After Initial Limb-Preserving Treatment.

The purpose of this study is to determine the rate of late (secondary) amputation and to identify risk factors for amputation in injuries that were initially treated with limb preservation on the battlefield.

Operative complications of combat-related transtibial amputations: a comparison of the modified burgess and modified ertl tibiofibular synostosis techniques.

The complications of bone-bridging amputations remain ill defined. The purpose of this study was to compare the early and intermediate-term complications leading to reoperation between the modified Burgess and modified Ertl tibiofibular synostosis in combat-related transtibial amputations.

Biomechanical analysis of lateral humeral condyle fracture pinning.

The purpose of this study was to determine the optimum pin configuration and the number of pins needed to stabilize the Milch type II lateral humeral condyle fractures in a pediatric bone model.

Unstated factors in orthopaedic decision-making: a qualitative study.

Total joint replacement (TJR) of the hip or knee for osteoarthritis is among the most common elective surgical procedures. There is some inequity in provision of TJR. How decisions are made about who will have surgery may contribute to disparities in provision. The model of shared decision-making between patients and clinicians is advocated as an ideal by national bodies and guidelines. However, we do not know what happens within orthopaedic practice and whether this reflects the shared model. Our study examined how decisions are made about TJR in orthopaedic consultations.

Stem cells in orthopaedics and fracture healing.

Stem cell application is a burgeoning field of medicine that is likely to influence the future of orthopaedic surgery. Stem cells are associated with great promise and great controversy. For the orthopaedic surgeon, stem cells may change the way that orthopaedic surgery is practiced and the overall approach of the treatment of musculoskeletal disease. Stem cells may change the field of orthopaedics from a field dominated by surgical replacements and reconstructions to a field of regeneration and prevention. This review will introduce the basic concepts of stem cells pertinent to the orthopaedic surgeon and proceed with a more in depth discussion of current developments in the study of stem cells in fracture healing.

Borderline femur fracture patients: early total care or damage control orthopaedics?

A recent randomized controlled trial (RCT) favours damage control orthopaedics (DCO) over early total care (ETC) in the management of high-energy femoral shaft fracture (FSF) patients with borderline physiology. The purpose of this study was to compare the borderline physiology FSF demographics, management and outcomes of a Level-1 trauma centre, John Hunter Hospital (JHH) with those of the RCT.