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Sunday, July 31, 2011

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

1.  Navigated opening wedge high tibial osteotomy improves intraoperative correction angle compared with conventional method. Akamatsu Y, Mitsugi N, Mochida Y, Taki N, Kobayashi H, Takeuchi R, Saito T. Knee Surg Sports Traumatol Arthrosc. 2011 Jul 29. [Epub ahead of print] PMID: 21800168
2.
Hardeman F, Londers J, Favril A, Witvrouw E, Bellemans J, Victor J. Knee Surg Sports Traumatol Arthrosc. 2011 Jul 29. [Epub ahead of print] PMID: 21800167
3. The painful knee after total knee arthroplasty. Becker R, Bonnin M, Hofmann S. Knee Surg Sports Traumatol Arthrosc. 2011 Jul 29. [Epub ahead of print] No abstract available. PMID: 21800166
4. Medium to long-term follow-up after ACL revision. Lind M, Lund B, Faunø P, Said S, Miller LL, Christiansen SE. Knee Surg Sports Traumatol Arthrosc. 2011 Jul 29. [Epub ahead of print] PMID: 21800165

Insufficiency femoral intertrochanteric fractures associated with greater trochanteric avulsion fractures.

Insufficiency fractures are often overlooked, particularly when associated with greater trochanteric avulsion fractures. Here, we report magnetic resonance imaging (MRI) findings of insufficiency femoral intertrochanteric fractures associated with greater trochanteric avulsion fractures treated by internal fixation.  Suzuki K, Kawachi S, Nanke H. Arch Orthop Trauma Surg. 2011 Jul 29. [Epub ahead of print] PMID: 21800198

Friday, July 29, 2011

Stress fractures, active component, U.S. Armed Forces, 2004-2010.

No abstract.  Lee D; Armed Forces Health Surveillance Center (AFHSC). MSMR. 2011 May;18(5):8-11. No abstract available. PMID: 21793616 PDF

Effects of different initial bundle tensioning strategies on the outcome of double-bundle ACL reconstruction: a cohort study.

The current clinical study does not recommend manual maximum of initial tension applied to the anteromedial or posterolateral bundles with graft tension imbalance at 30 degrees of flexion in double-bundle ACL reconstruction to achieve a better clinical outcome. Muneta T, Koga H, Ju YJ, Yagishita K, Sekiya I. Sports Med Arthrosc Rehabil Ther Technol. 2011 Jul 8;3(1):15. [Epub ahead of print] PMID: 21794179

Tendon phenotype should dictate tissue engineering modality in tendon repair: a review.

Advancements in the technical aspects of tendon repair have significantly improved the treatment of tendon injuries. Arthroscopic techniques, suture material, and improved rehabilitation have all been contributing factors. Biological augmentation and tissue engineering appear to have the potential to improve clinical outcomes as well. After review of the physiology of tendon repair, three critical components of tissue engineering can be discerned: the cellular component, the carrier vehicle (matrix or scaffold), and the bioactive component (growth factors, platelet rich plasma). These three components are discussed with regard to each of three tendon types: Intra-synovial (flexor tendon), extra-synovial (Achilles tendon), and extra-synovial tendon under compression (rotator cuff). Scaffolds, biologically enhanced scaffolds, growth factors, platelet rich plasma, gene therapy, mesenchymal stem cells, and local environment factors in combination or alone may contribute to tendon healing. In the future it may be beneficial to differentiate these modes of healing augmentation with regard to tendon subtype. Gott M, Ast M, Lane LB, Schwartz JA, Catanzano A, Razzano P, Grande DA. Discov Med. 2011 Jul;12(62):75-84. PMID: 21794211

Isolated scaphoid fracture with anterosuperior dislocation of the proximal fragment.

Isolated fracture of the scaphoid with an associated anterosuperior dislocation of the proximal fragment is an extremely rare injury. We present two cases where open reduction and internal fixation through a palmar and dorsal approach was performed. No instances of non-union, necrosis of the proximal fragment of the scaphoid or scapholunate dissociation were noted during a mean follow-up period of 18months. Clinical results (active motion, power grip, DASH) following such injury and intervention are presented. The aetiology of this rare injury is discussed. Durand S, Macquillan A, Delpit X. Chir Main. 2011 Jul 5. [Epub ahead of print] PMID: 21795095

Fractures during Childhood and Adolescence in Healthy Boys: Relation with Bone Mass, Microstructure, and Strength.

In a homogeneous cohort of healthy boys, fractures recorded until 15.2±05 yr of age were associated with lower femoral neck aBMD and with lower distal tibia trabecular vBMD and number, stiffness and failure load. These deficits in bone mineral mass, microstructure and strength could contribute to the occurrence of fractures during growth.  Chevalley T, Bonjour JP, van Rietbergen B, Ferrari S, Rizzoli R. J Clin Endocrinol Metab. 2011 Jul 27. [pub ahead of print] PMID: 21795454

Contrast-enhanced sonographic characterization of the vascularity of the repaired rotator cuff: utility of maximum intensity projection imaging.

The maximum intensity projection technique after contrast-enhanced sonography provides a topographic map of rotator cuff vascularity; the latter has been implicated as an important factor in promoting bone-tendon healing. Approximately 3 months after rotator cuff repair, the suture anchor and peribursal regions showed the most robust vascularity. Maximum intensity projection imaging further establishes that there is a global increase in vascular response at the repair site after exercise.  Adler RS, Johnson KM, Fealy S, Maderazo A, Gallo RA, Gamradt SC, Warren RF. J Ultrasound Med. 2011 Aug;30(8):1103-9. PMID: 21795486

Operative treatment of avascular necrosis of the femoral head after proximal femur fractures in adolescents.

Patients treated for ANFH had good medium-term outcomes after THR for total necrosis and also after VITO for partial necrosis.  Bartoníček J, Vávra J, Bartoška R, Havránek P. Int Orthop. 2011 Jul 28. [Epub ahead of print] PMID: 21796335

Development and Validation of a Computational Model for Investigation of Wrist Biomechanics.

The computational model was able to accurately predict flexion, extension, radial deviation, and ulnar deviation motions in four states: normal (intact), RSL fusion, RSL fusion with the scaphoid distal pole excised, and RSL fusion with both the scaphoid distal pole and triquetrum excised. The model was also able to calculate other parameters of interest that are not easily obtainable experimentally, such as midcarpal forces. This model and modeling approach are anticipated to have value as a predictive clinical tool including effect of injuries or anatomical variations and initial outcome of surgical procedures for patient specific planning and custom implant design.  Majors BJ, Wayne JS. Ann Biomed Eng. 2011 Jul 28. [Epub ahead of print] PMID:  21796501]

Learning of musculoskeletal ligament stress testing in a gross anatomy laboratory.

Human anatomy in physical therapy programs is a basic science course serving as a foundation for subsequent clinical courses. Integration of anatomy with a clinical emphasis throughout a curriculum provides opportunities for reinforcement of previously learned material. Considering the human cadaver laboratory as a fixed cost to our program, we sought opportunities to add value to the resource via vertical integration into a clinical skills course taught later in the curriculum. Krause DA, Youdas JW, Hollman JH. Anat Sci Educ. 2011 Jul 27. doi: 10.1002/ase.248. [Epub ahead of print] PMID: 21796799

Heterotopic ossification in complex orthopaedic combat wounds: quantification and characterization of osteogenic precursor cell activity in traumatized muscle.

Heterotopic ossification frequently develops following high-energy blast injuries sustained in modern warfare. We hypothesized that differences in the population of progenitor cells present in a wound would correlate with the subsequent formation of heterotopic ossification.   Davis TA, O'Brien FP, Anam K, Grijalva S, Potter BK, Elster EA. J Bone Joint Surg Am. 2011 Jun 15;93(12):1122-31. PMID: 21776549
 

Thursday, July 28, 2011

Risk factors for fractured clavicle in the newborn.

We could not identify significant risk factors that could be dealt with in order to avoid a fractured clavicle being sustained during birth. Most fractured clavicles occur in normal newborns following normal labor and delivery.  Lurie S, Wand S, Golan A, Sadan O. J Obstet Gynaecol Res. 2011 Jul 25. doi: 10.1111/j.1447-0756.2011.01576.x. [Epub ahead of print] PMID: 21790882

A brachialis muscle rupture diagnosed by ultrasound; case report.

Trauma to the elbow caused by lifting heavy objects frequently involves rupture of the tendon of the biceps brachii muscle. Less frequently a rupture of the brachialis muscle occurs. To our knowledge, only five cases involving traumatic rupture of the brachialis muscle were described in the past 20 years. We will briefly report these cases. To demonstrate and evaluate muscle injuries, magnetic resonance imaging (MRI) is considered the most sensitive and specific method of choice. We report an isolated brachialis muscle rupture caused by resisted flexion and pronation of the lower arm. Physical examination combined with ultrasound evaluation confirmed the diagnosis of ruptured brachialis muscle. Treatment was non-operative with full restoration of function.  Schonberger TJ, Ernst MF. Int J Emerg Med. 2011 Jul 26;4(1):46. [Epub ahead of print] PMID: 21791098

Effectiveness of intra-articular hyaluronan (Synvisc, hylan G-F 20) for the treatment of first metatarsophalangeal joint osteoarthritis: a randomised placebo-controlled trial.

An intra-articular injection of hylan G-F 20 is no more effective than a placebo in reducing symptoms in people with symptomatic first MTPJ OA  Munteanu SE, Zammit GV, Menz HB, Landorf KB, Handley CJ, Elzarka A, Deluca J. Ann Rheum Dis. 2011 Jul 25. [Epub ahead of print] PMID: 21791454

Comparison of Clinical Results of Anatomic Posterolateral Corner Reconstruction for Posterolateral Rotatory Instability of the Knee With or Without Popliteal Tendon Reconstruction.

 It is unknown whether popliteal tendon reconstruction is necessary in anatomic posterolateral corner reconstruction, although the tendon has function in the varus and rotatory stability of the knee joint. Hypothesis: Anatomic reconstructions of the posterolateral corner with the popliteal tendon reconstructed will present better clinical and radiographic results than cases with the popliteal tendon not reconstructed.  Yoon KH, Lee JH, Bae DK, Song SJ, Chung KY, Park YW. Am J Sports Med. 2011 Jul 26. [Epub ahead of print] PMID: 21791626 PDF

Retention treatment after periprosthetic total hip arthroplasty infection.

Retention treatment can be considered an initial treatment option in selected cases of primary THA, with a single organism, non-S. aureus infection with 50% chance of infection control and no disadvantages in terms of additional procedure, hospital stay, and treatment duration.  Choi HR, von Knoch F, Kandil AO, Zurakowski D, Moore S, Malchau H. Int Orthop. 2011 Jul 27. [Epub ahead of print] PMID: 21792609

Wednesday, July 27, 2011

A practical guide to research: design, execution, and publication

No abstract available. Karlsson J, Marx RG, Nakamura N, Bhandari M. Arthroscopy. 2011 Apr;27(4 Suppl):S1-S112. PMID: 21749939  PDF

Inflammatory phase of bone healing initiates the regenerative healing cascade.

Results from this study suggest that there are unfavorable immune cells and factors participating in the initial healing phase. In conclusion, identifying beneficial aspects may lead to promising therapeutical approaches that might benefit further by eliminating the unfavorable factors. Schmidt-Bleek K, Schell H, Schulz N, Hoff P, Perka C, Buttgereit F, Volk HD, Lienau J, Duda GN. Cell Tissue Res. 2011 Jul 26. [Epub ahead of print] PMID: 21789579

Sensate composite calcaneal flap in leg amputation: a full terminal weight-bearing surface-experience in eight adult patients.

Despite modern reconstruction techniques and replantation, the preservation of a severely traumatised limb, or even a limb affected by a congenital malformation, usually gives poorer functional results compared with amputation and prosthetisation. The aim of this study was to describe a hind foot (including the calcaneum and fat pad) sensate flap with a surface that allows full terminal weight bearing in transtibial amputations in adults.  Livani B, Castro G, Filho JR, Morgatho TR, Mongon ML, Belangero WD, Davitt M, Carvalho JA. Strategies Trauma Limb Reconstr. 2011 Jul 26. [Epub ahead of print] PMID: 21789589

Do Patients With Traumatic Recurrent Anterior Shoulder Instability Have Generalized Joint Laxity?

A number of studies suggest a relationship between generalized joint laxity (GJL) and increased risk of some musculoskeletal injuries. However, there are conflicting data on the association between GJL and traumatic recurrent shoulder instability (RSI). Ranalletta M, Bongiovanni S, Suarez F, Ovenza JM, Maignon G. Clin Orthop Relat Res. 2011 Jul 26. [Epub ahead of print] PMID: 21789709

Tuesday, July 26, 2011

Clinical experience with a reverse-flow anterolateral thigh perforator flap for the reconstruction of soft-tissue defects of the knee and proximal lower leg.

Despite a variable vascular anatomy that can be challenging for the surgeon, reverse-flow anterolateral thigh perforator flap is a safe and reliable method for reconstruction of the defects around the knee and even the upper third of the leg. Demirseren ME, Efendioglu K, Demiralp CO, Kilicarslan K, Akkaya H. J Plast Reconstr Aesthet Surg. 2011 Jul 22. [Epub ahead of print] PMID: 21784720  PDF

Is the Anterior Tibial Artery Safe During Ankle Arthroscopy? Anatomic Analysis of the Anterior Tibial Artery at the Ankle Joint by Magnetic Resonance Imaging.

In 22 (6.2%) of the 358 cases, the ATA and its branches were located near the anterolateral ankle portal, which introduces the risk of vascular damage during arthroscopic surgery. Furthermore, the mean distance between the ATA and the joint capsule was only 2.3 ± 1.1 mm, and thus the ATA is very close to the anterior working space of the ankle joint. Careful preoperative evaluation and an intra-articular procedure may reduce the risk of vascular complications attributable to ankle arthroscopy. Son KH, Cho JH, Lee JW, Kwack KS, Han SH. Am J Sports Med. 2011 Jul 22. [Epub ahead of print] PMID: 21785000  PDF

Incidence of Patients with Lower Extremity Injuries Presenting to US Emergency Departments by Anatomic Region, Disease Category, and Age.

The incidence of patients with lower extremity injuries presenting to emergency departments in the United States with respect to specific anatomic regions and disease categories is unknown. Such information might be used for injury prevention, resource allocation, and training priorities. Lambers K, Ootes D, Ring D. Clin Orthop Relat Res. 2011 Jul 22. [Epub ahead of print] PMID: 21785896  PDF

Orthopedic resident anatomy review course: A collaboration between anatomists and orthopedic surgeons

A challenge for new residents and senior residents preparing for board examinations is refreshing their knowledge of basic science disciplines, such as human gross anatomy. The Department of Orthopaedics at the University of Utah School of Medicine has for many years held an annual Orthopedic Resident Anatomy Review Course during the summer months for all of its residents. The primary purpose of the course is to renew competencies in basic science disciplines so that incoming residents more quickly reach a level of functional proficiency and to afford senior residents a platform to teach their junior colleagues. Before 2005, this course was conducted with minimal participation from anyone outside of the Department of Orthopaedics. Many of the residents voiced concerns that the educational benefits were not proportionate to the time invested. To improve the teaching of orthopedic-related anatomy, an educational collaboration between the Departments of Neurobiology and Anatomy and Orthopaedics was established in 2004 and continues to the present time. The major objectives of refining the course pedagogy, developing a Course Manual and Dissection Guide, and evaluating the results by administering a course survey questionnaire are described in this article. Implementation of all facets of the revised course has resulted in better participation by orthopedic faculty and more favorable reviews by the participating residents. Based on current levels of interest and positive comments from course participants, the Anatomy and Orthopedic faculty course directors plan to continue to develop course materials and pedagogy.  Defriez CB, Morton DA, Horwitz DS, Eckel CM, Foreman KB, Albertine KH. Anat Sci Educ. 2011 Jul 22. [Epub ahead of print] PMID: 21786430

BBC Documentary: Blood and Guts: A History of Surgery (May need to view offsite)

Documentary series looking at the brutal, bloody and dangerous history of surgery. Michael Mosley recounts the history of surgery through its catastrophes and successes.
1. Into the Brain. Just over 100 years ago, cutting into the brain was a terrifying prospect for both patient and surgeon. They could expect the result to be the surgeon bloodied and defeated, and the patient dead. From freak accidents involving crowbars through the skull to notorious lobotomies with icepicks, this programme reveals how, through mishap and misadventure, brain surgery has become the life-saving discipline it is today.
2. Bleeding Hearts. With a family history of heart problems, presenter Michael Mosley takes a personal interest in these pioneers, who teetered on the scalpel-edge between saviour and executioner. Michael has a go at heart surgery, meets a man with no heartbeat and witnesses an operation where the patient is cooled until their brain stops and has all of their blood sucked out.
3. Spare Parts. These days, transplant surgery saves thousands of lives every year and almost everything, from heart to eyes, can be replaced. But in the beginning, transplants killed rather than cured, because surgeons didn’t understand that they were taking on one of the most efficient killing systems we know of – the human immune system.
4. Fixing Faces. Thought of as a modern phenomenon, it actually started over 400 years ago with a spate of botched nose jobs. Since then, surgeons have been entranced with the idea that not only could they fix the body, but could even fix our sense of self-esteem. Presenter Michael Mosley undergoes both 16th-century bondage and 21st-century botox in his journey of discovery.
5. Bloody Beginnings. Presenter Michael Mosley finds out how the early days of surgery were dark and barbaric, when the surgeon’s knife was more likely to kill you than save you, and invasive medicine generally meant being bloodlet by leeches to within an inch of your life.

Incidence of physician diagnosed osteoarthritis among active duty united states military service members.

The overall unadjusted incidence rate among all active duty US service members during the study period was 7.86 per 1,000 person-years. Significant demographic and occupational risk factors for OA included sex, age, race, service, and rank (p<0.001). Women experienced an adjusted incidence rate for OA that was nearly 20% higher than men (IRR=1.19, 95% CI=1.17, 1.21). Service members in the ≥40 age group experienced an adjusted incidence rate for OA that was approximately 19 times higher when compared to those in the <20 age category (IRR=18.61, 95% CI=17.57, 19.57). Black service members experienced significantly higher incidence rates of OA when compared to those in the white and other categories for race. Conclusion: Rates for OA were significantly higher in military populations when compared to comparable age groups in the general population.  Cameron KL, Hsiao MS, Owens BD, Burks R, Svoboda SJ. Arthritis Rheum. 2011 Jun 29.  [Epub ahead of print] PMID: 21717422

An Evaluation of Two Tourniquet Systems for the Control of Prehospital Lower Limb Hemorrhage.

Hemorrhage remains the main cause of preventable death on the modern battlefield. As Improvised Explosive Devices in Afghanistan become increasingly powerful, more proximal limb injuries occur. Significant concerns now exist about the ability of the windlass tourniquet to control distal hemorrhage after mid-thigh application. To evaluate the efficacy of the Combat Application Tourniquet (CAT) windlass tourniquet in comparison to the newer Emergency and Military Tourniquet (EMT) pneumatic tourniquet.  Taylor DM, Vater GM, Parker PJ. J Trauma. 2011 Jul 15. [Epub ahead of print] PMID: 21768905

Sunday, July 24, 2011

Proximal humerus fractures in the pediatric population: a systematic review.

The currently available literature supports a non-operative treatment approach, particularly in younger children with more growth remaining. Older patients (>13 years) with more widely displaced fractures may benefit from anatomic reduction with stabilization, though the data in the literature at this point is too weak to strongly recommend this approach. Further analysis with a more rigorous scientific method is necessary to evaluate the optimum treatment modality in this subgroup.   Pahlavan S, Baldwin KD, Pandya NK, Namdari S, Hosalkar H. J Child Orthop. 2011 Jun;5(3):187-94. Epub 2011 Mar 11. PMID: 21779308

Symptomatic heterotopic ossification: seven years after patella fracture.

We describe a case of heterotopic ossification (HO) of the lateral patella becoming symptomatic after 7 years following horizontal patella fracture. The patient presented peripatellar pain in full knee flexion and kneeling position. We resected the ossification, and the patient was immediately relieved from pain and was mobilised under full weight bearing with no limitation of knee flexion. The patient was able to return to his previous level of daily activities with no further episodes of pain. To our knowledge, this is the first case of heterotopic peripatellar ossification becoming symptomatic 7 years after a patellar fracture to be reported in the literature.  Daniilidis K, Vogt B, Raschke MJ. Musculoskelet Surg. 2011 Jul 21. [Epub ahead of print] PMID: 21779765

Reconstruction nailing for ipsilateral femoral neck and shaft fractures.

The current study suggests that reconstruction nailing produces satisfactory clinical and functional results in the mid-term. The complications involved only the femoral shaft fracture and were successfully treated with a single operative procedure.  Tsarouhas A, Hantes ME, Karachalios T, Bargiotas K, Malizos KN. Strategies Trauma Limb Reconstr. 2011 Jul 21. [Epub ahead of print] PMID: 21779894

Friday, July 22, 2011

Why do I like Google+ even in Medicine?

This is a real professional networking site, while Facebook is just a playground for friends. ScienceRoll

Bone Feed allows the busy orthopedist to quickly browse abstracts, but can be improved

Being able to scan and read journal articles is integral to clinical practice and teaching. However, with so much information and new research available, sorting through the publications can be a daunting task. Even Orthopedics, considered to be a specialized field, has over 50 American publications and journals.

Dr. Jeffrey Wint, an orthopedic hand specialist in cooperation with Hand Fed developers created Bone Feed as a way for orthopedic surgeons at all levels of training to have access to abstracts from popular orthopedic journals using an iPhone. It is a good concept, but does the app perform?

Thursday, July 21, 2011

Knee Surg Sports Traumatol Arthrosc. 2011 Jul 20. [Epub ahead of print]

Yang JH, Yoon JR, Oh CH, Kim TS. Knee Surg Sports Traumatol Arthrosc. 2011 Jul 20. [Epub ahead of print] PMID: 21773833
Huri G, Atay OA, Ergen B, Atesok K, Johnson DL, Doral MN. Knee Surg Sports Traumatol Arthrosc. 2011 Jul 20. [Epub ahead of print] PMID: 21773832
Ellera Gomes JL, da Silva RC, Silla LM, Abreu MR, Pellanda R. Knee Surg Sports Traumatol Arthrosc. 2011 Jul 20. [Epub ahead of print] PMID:  21773831
Blonna D, Castoldi F, Delicio D, Bruzzone M, Dettoni F, Bonasia DE, Rossi R. Knee Surg Sports Traumatol Arthrosc. 2011 Jul 20. [Epub ahead of print] PMID: 21773830
Knee Surg Sports Traumatol Arthrosc. 2011 Jul 20. [Epub ahead of print] PMID:  21773829
6. Anterior cruciate ligament tears: conservative or surgical treatment? A critical review of the literature. Delincé P, Ghafil D. Knee Surg Sports Traumatol Arthrosc. 2011 Jul 20. [Epub ahead of print] PMID:  21773828
Van Dyck P, De Smet E, Veryser J, Lambrecht V, Gielen JL, Vanhoenacker FM, Dossche L, Parizel PM. Knee Surg Sports Traumatol Arthrosc. 2011 Jul 20. [Epub ahead of print] PMID:  21773827
8. Cryopreservation increases apoptosis in human menisci. Villalba R, Peña J, Navarro P, Luque E, Jimena I, Romero A, Gómez Villagrán JL. Knee Surg Sports Traumatol Arthrosc. 2011 Jul 20. [Epub ahead of print] PMID:  21773826

The Effect of Long-term Alendronate Treatment on Cortical Thickness of the Proximal Femur.

Long-term alendronate treatment did not appear to cause thickened femoral cortices within the detection limits of our method. This finding contrasts with the notion that long-term alendronate treatment leads to generalized cortical thickening. Unnanuntana A, Ashfaq K, Ton QV, Kleimeyer JP, Lane JM. Clin Orthop Relat Res. 2011 Jul 20. [Epub ahead of print] PMID: 21773861

Trying to save troops' lives with flying hospital

The critical care flights are part of a big evolution in getting wounded troops back to the U.S., which took about three weeks on average during the Vietnam War. That process can now take as little as three days, depending on the patient's needs.  The Associated Press rode along on one of these special flights when Castagna and two other patients were flown from Germany home to the U.S. AP

Coagulate is a useful reference when dealing with the anticoagulated patient in the OR

“Is it safe for me to perform a regional or neuraxial procedure on this patient taking anticoagulants?”
This is a question we are often faced with in the operating room when dealing with patients taking anticoagulants. Answering this question has become increasingly difficult as both the number of anticoagulant drugs and the indications for these drugs have increased recently. iMedicalApps

New Audio-Digest Orthopaedics

Now available online!  Contact Library for User Name and Password

ETHICS
Audio-Digest Orthopaedics
Volume 34, Issue 15
August 7, 2011
Death and dying – Steven Z. Pantilat, MD
"Do not resuscitate" in the perioperative period – Carl W. Peters, MD

PEDIATRIC FOOT PROBLEMS
Audio-Digest Orthopaedics
Volume 34, Issue 14
July 21, 2011
Painful flatfoot in adolescents – Vincent Mosca, MD,
Adults with a history of club foot – Richard Miller, MD
Tarsal coalition: it’s not just about size – Dr. Mosca

FOOT AND ANKLE ORTHOPAEDICS
Audio-Digest Orthopaedics
Volume 34, Issue 13
July 7, 2011
Maximizing nonoperative treatment – Jeffrey L. Nacht, MD
Optimizing the patient for surgery – Alastair S.E. Younger, MD
Nonoperative management of the ankle – Kevin J. Wing, MD
Osteochondritis dissecans lesions of the talus – Gregory C. Berlet, MD

Wednesday, July 20, 2011

When injured muscles mistakenly grow bones

For hundreds of thousands of people, injuring a muscle through an accident like falling off a bike or having surgery can result in a strange and serious complication. Their muscles start growing bones. New research shows a neuropeptide called Substance P appears to trigger the formation of the extraskeletal bone. Eliminating Substance P prevents the bone growth, offering a new drug target to prevent and treat the bone growth. Journal of Cellular Biochemistry via Eurekalert!

Tuesday, July 19, 2011

Patient participation in surgical site marking: can this be an additional tool to help avoid wrong-site surgery?

Wrong-site surgery is defined as an operation conducted at the wrong site, on the wrong person, or resulting in the wrong procedure. Since 1993, more than 2200 wrong-site surgeries have been reported by the National Practitioner Data Base. A 2005 survey reported, 5.6% of replying academy fellows encountered a wrong-site surgery incident. Multiple interventions have been since suggested for prevention of these occurrences by the American Academy of Orthopaedic Surgeons and Joint Commission on Accreditation of Healthcare Organizations. Bergal LM, Schwarzkopf R, Walsh M, Tejwani NC. J Patient Saf. 2010 Dec;6(4):221-5. PMID: 21500609

Painful legacy of teen sports

Vigorous sports activities, like basketball, during childhood and adolescence can cause abnormal development of the femur in young athletes, resulting in a deformed hip with reduced rotation and pain during movement. This may explain why athletes are more likely to develop osteoarthritis than more sedentary individuals, according to Dr. Klaus Siebenrock, from the University of Bern in Switzerland, and colleagues, whose work is published online in Springer's journal Clinical Orthopaedics and Related Research. Eurekalert!

Monday, July 18, 2011

Army Develops Home-Made Leg Prostheses

The DIY spirit is so strong these days that even the U.S. Army is now building home made leg prostheses and planning on teaching Afghans how to make more from readily available parts. A team of soldiers developed a custom prototype for an eight year old boy who lost both legs, with the idea that locals should be able to make their own prostheses so that people injured by mines and bombs can get on their feet quickly, without having to wait for a distant charity to help.  medGadget.com

CPT® E/M Quick Reference App

CPT® E/M Quick Reference—now available for the Apple iPhone®, iPad® and iPod Touch®. Fast. Easy. Reliable. This on-the-go reference guide helps you easily determine the appropriate CPT Evaluation and Management (E/M) billing codes. Featuring both decision-tree logic and quick search options, this critical app allows you to digitally track the codes you select and then email them anywhere.  MedicalSmartphones.com

A meta-analysis of the Gamma nail and dynamic hip screw in treating peritrochanteric fractures

The review found there was a higher rate of postoperative femoral shaft fracture with Gamma nail compared with dynamic hip screw fixation in treating peritrochanteric fractures, but no differences for other outcomes; further research is needed. The authors' conclusions reflect the data presented, but should be interpreted considering the substantial methodological flaws in included trials and potential review process bias.
PubMedID
Original Paper URL

Saturday, July 16, 2011

Surgical Technique: A Minimally Invasive Approach to Scapula Neck and Body Fractures.

The approach of choice for open reduction internal fixation of displaced fractures involving the scapula neck or body is from posterior. We describe a new approach that minimizes the surgical insult to the soft tissues but preserves the ability to restore alignment and stability to the fracture.
Gauger EM, Cole PA. Clin Orthop Relat Res. 2011 Jul 15. [Epub ahead of print] PMID: 21761253

Augmented Reality for surgeons comes via mobile medical technology – Hallux Angles app

“Hallux Angles is a radiographic measurement aid to assist in the pre-op radiographic planning process. It is intended to supplement – not replace – conventional techniques. The target audience includes all those practicing forefoot surgery” iMedicalApps

Thursday, July 14, 2011

Study Identifies Patients at Increased Risk of Morbidity and Mortality after Bilateral Knee Replacement Surgery

Study Identifies Patients at Increased Risk of Morbidity and Mortality after Bilateral Knee Replacement Surgery - A new study by researchers at Hospital for Special Surgery has identified patients who are at a higher risk of morbidity and mortality when undergoing knee replacement surgery in both legs at the same time. Newswise

Monday, July 11, 2011

Spanish surgeons claim first double leg transplant

Spanish surgeons Monday performed the world's first double-leg transplant on a man whose legs were amputated above the knee after an accident, officials said. PhysOrg.com

Sunday, July 10, 2011

Journal of Orthopaedic Trauma [Epub ahead of print]

1. Managing Bone Defects. Nauth A, McKee MD, Einhorn TA, Watson JT, Li R, Schemitsch EH.
J Orthop Trauma. 2011 Jul 6. [Epub ahead of print] PMID: 21738065
2. Preclinical Animal Models in Trauma Research. Harvey EJ, Giannoudis PV, Martineau PA, Lansdowne JL, Dimitriou R, Moriarty TF, Richards RG. J Orthop Trauma. 2011 Jul 6. [Epub ahead of print] PMID: 21738062

Archives of Orthopaedic and Trauma Surgery [Epub ahead of print]

1. Relationship between human femorotibial joint configuration and the morphometry of the anterior cruciate ligament. Dargel J, Schmidt-Wiethoff R, Feiser J, Koebke J, Schlüter-Brust K, Eysel P, Michael JW. Arch Orthop Trauma Surg. 2011 Jul 8. [Epub ahead of print] PMID: 21739115
2. Hip abductor muscle strength after total hip arthroplasty with short stems. Kamada S, Naito M, Nakamura Y, Kiyama T. Arch Orthop Trauma Surg. 2011 Jul 8. [Epub ahead of print] PMID: 21739114

Saturday, July 9, 2011

Clinical anatomy of the coccyx: A systematic review.

Note: Special Clinical Anatomy Issue on Cadaver Use in Trauma Research Click for Access

Abstract: The coccyx has been relatively neglected in anatomical research which is surprising given the population prevalence of coccydynia and our inadequate understanding of its etiology. This systematic review analyzes available information on the clinical anatomy of the coccyx. A literature search using five electronic databases and standard anatomy reference texts was conducted yielding 61 primary and 7 secondary English-language sources. This was supplemented by a manual search of selected historical foreign language articles. The coccygeal vertebrae, associated joints, ligaments and muscles, coccygeal movements, nerves, and blood supply were analyzed in detail. Although the musculoskeletal aspects of the coccyx are reasonably well described, the precise anatomy of the coccygeal plexus and its distribution, the function of the coccygeal body, and the anatomy of the sacrococcygeal zygapophyseal joints are poorly documented. Further research into the anatomy of the coccyx may clarify the etiopathogenesis of coccydynia which remains uncertain in one-third of affected patients.Woon JT, Stringer MD. Clin Anat. 2011 Jul 7. [Epub ahead of print] PMID: 21739475

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!

Friday, July 8, 2011

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

Thursday, July 7, 2011

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

 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

Wednesday, July 6, 2011

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
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

Sunday, July 3, 2011

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)

Saturday, July 2, 2011

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

Thursday, June 30, 2011

The Journal of Hand Surgery 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

Wednesday, June 29, 2011

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:
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

Tuesday, June 28, 2011

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]
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
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
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.